Paradigm shift for VA amputation care.

As the Department of Defense (DOD) identified a need to modify the type and delivery of services to the combat-injured with major traumatic limb loss, so too has the Department of Veterans Affairs (VA). While the majority of veterans with amputations receiving care in VA medical facilities have sustained their amputations because of medical conditions such as diabetes and peripheral vascular disease, a significant number of individuals also sustain amputations because of trauma on the battlefield. Each major military operation has resulted in a new cohort of veterans with combatincurred traumatic amputation: almost 21,000 in the Union Army during the Civil War, more than 4,000 during World War I, about 15,000 during World War II, over 1,000 in the Korean war, an estimated 6,000 during the Vietnam war, and 15 during the Persian Gulf war [1]. To date, Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) conflicts have resulted in nearly 1,000 amputations. The VA has always been committed to the principles of rehabilitation, and one of the major goals driving care is to “restore the capability of veterans with disabilities to the greatest extent possible and improve their quality of life and that of their families.” To this end, the VA has invested significant resources into creating a new paradigm of care to meet the needs of the newly combat-injured veterans from OIF/OEF while also improving care to all veterans with amputations due to medical causes.