Director's Message November 5, 2021

            This year’s theme – From today’s discovery to tomorrow’s reality: prosthetics advances rehabilitation a step further – features the exceptional customer service provided by PSAS staff in the procurement and provision of equipment and services to support Veteran’s highest level of function and independence.

              VA is the largest and most comprehensive provider of prosthetic devices and sensory aids. More than half of all Veterans treated within VHA received prosthetic devices, items, or services last year. In FY2021, VA provided more than 21 million prosthetics and sensory aid devices to Veterans to help enhance their well-being and improve their quality of life.
             The main components of the prosthetics department are Home Improvement Structural Alterations (HISA), Adaptive Automotive Equipment (AAE), Home Oxygen, and the Clothing Allowance (CA) program. VA covers everything from a shower renovation so a Veteran can have a walk-in shower, to adaptive controls in a Vehicle, and it’s the job of Prosthetics to process the paperwork and get the equipment to those in need. Yes, they even cover medical bills for service dogs.
              The Prosthetics Department at VAPIHCS serves Veterans across all the Pacific Islands through teamwork. Each member of the team plays an important role, because prosthetics works in concert with a lot of other services to provide sensory aids and other necessary medical equipment. Supply chain management handles all the ordering. The two clinical prosthetists share a lab with the staff at Tripler Army Medical Center (TAMC). On outer islands, Care in the Community (CITC) providers also play a big role. The chief of prosthetics must coordinate the whole team, and handle everything from paying for the glasses that optometry prescribes to ordering mobility aids like wheelchairs and canes.
              Raymond Madrid is our chief of prosthetics, he came to VAPIHCS during a difficult time when there was a large backlog of claims. He’s worked very hard to get through that backlog and get back to serving Veterans as their claims come in. Born and raised on Oahu, Mr. Madrid attended Moanalua High School and ran track when he was younger, so the area is very familiar to him. However, it wasn’t a straight line from Moanalua High School to where he sits now. Mr. Madrid joined the Air Force and proudly served his country for 15 years. When he got out, he took a job as secretary to the director of the VA in Miami. It was in Miami that he got into prosthetics and received the training that he needed to run a department. Finally, he was lucky enough to see a job at the VA in Pacific Islands open up, and he immediately applied.
              “I never thought I’d be able to come back,” he says. “I just got lucky.”
             It wasn’t all smooth sailing. When he arrived, there are a backlog of 6,000 cases waiting to be addressed. However, Mr. Madrid had already been in similar circumstances in Miami, and so he was able to rectify the problem within a year. When a Veteran files a claim, it is now addressed right away and handled as quickly as the system allows. This is a very meaningful accomplishment to Mr. Madrid, who feels passionately about helping Veterans.
             “It feels good to take care of your fellow comrades when they need something,” said  Madrid.
             The most important thing to remember with the prosthetics department is that they cannot help someone who is self-referred. Some VA services can allow Veterans to self-refer. An example would be radiology; a woman who finds a lump in her breast can self-refer for a mammogram. Audiology is also a service where a Veteran can self-refer. Unfortunately, prosthetics is not. Veterans must speak with their primary care provider first, and then get a consult put into the system. Mr. Madrid emphasizes this because he wants to help everyone who contacts him, but he must follow VA policy.
              The Prosthetics Department covers a wide variety of services. They also help a wide variety of people across the Pacific Islands. This includes things like flying clinical prosthetists to American Samoa, but it also includes working with Care in the Community partners on islands like Maui to help ensure that every Veteran that needs help can get it. Currently, there are no plans to expand the range of in-house services available through the Prosthetics department. Everyone is getting the help they need as they need it, and things are running smoothly as they are.
              However, things are never perfect. Mr. Madrid notes that some folks are angry with a recent change the VA policy on purchasing glasses. The VA only covers what is medically necessary. If a person wants something that isn’t medically necessary, they have always paid out of pocket. In the past, a Veteran could pay for any upgrades that they wanted when getting glasses through the VA. Now, a pair of glasses provided by the VA cannot be upgraded.
              Some vendors that Veterans chose to get glasses through took advantage of them, pushing huge amounts of upgrades that would cause a free pair of glasses to suddenly cost as much as $500 out-of-pocket. To save any Veteran from being taken advantage of in this way, VA no longer allows upgrades. It sounds unfortunate, but it will undoubtedly protect a lot of Veterans from predatory salespeople.
              As always, policies change and evolve as situations change and evolve. However, the Prosthetics department feels ready to adapt to whatever is in store for them. They are a solid team who clearly enjoy working together and who all have Veterans needs at heart. For more information you can call the Prosthetics department at 808-433-0835.
             On behalf of our entire VA Pacific Islands Health Care System Ohana, I’d like to thank all our PSAS staff for your commitment to helping Veterans achieve their goals, regain their independence, and ultimately improve their quality of life.

One Team, One Ohana!

Adam M. Robinson, Jr., MD, MBA, CPE
Director, VA Pacific Islands Health Care System
VADM, MC, USN, (RET)
36th Surgeon General, USN

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