VA Form FL-10-55: Download & Prosthetic Repair Guide – VA Form FL-10-55, officially titled Authorization to Repair Prosthetic Appliance, is a VA form letter used by the Department of Veterans Affairs (VA) to authorize repairs to prosthetic appliances that exceed the standard limits on a veteran’s Prosthetic Service Card (PSC). It serves as official approval for vendors to perform more extensive repairs and ensures the VA will cover the additional costs when the invoice is submitted.
This form is part of the VA’s Prosthetic and Sensory Aids Service (PSAS) program, which helps eligible veterans maintain and repair essential prosthetic devices, orthotics, and related equipment.
Download VA Form FL-10-55 PDF
You can download the official VA Form FL-10-55 directly here:
Download VA Form FL-10-55 (FL1055NC.pdf)
Purpose of VA Form FL-10-55
The primary purpose of FL-10-55 is to provide authorization when repair costs for a prosthetic appliance exceed the pre-approved limit on a veteran’s Prosthetic Service Card (VA Form 10-2501). Vendors use this form to proceed with necessary repairs and attach it to their invoice for VA reimbursement.
Key details included on the form typically are:
- Veteran’s name and claim number
- Description of the appliance to be repaired
- Authorized total cost of repairs (excluding mailing)
- Instructions for submitting the original form with the invoice to the VA for payment
It ensures repairs are pre-approved, preventing unexpected denials and streamlining the billing process for both veterans and providers.
Who Needs VA Form FL-10-55?
This form is relevant for:
- Veterans with service-connected or non-service-connected conditions who use prosthetic appliances, artificial limbs, braces, wheelchairs, or other durable medical equipment issued or authorized by the VA.
- Commercial repair vendors or VA-authorized providers performing repairs that exceed PSC limits.
- VA Prosthetics staff authorizing additional repair funding.
Eligibility for prosthetic repairs generally follows VA health care enrollment and medical necessity determinations. Veterans enrolled in VA health care can access these services through their local VA medical center’s Prosthetic and Sensory Aids Service.
How to Use VA Form FL-10-55 for Prosthetic Repairs?
- Obtain a Prosthetic Service Card (PSC) — Veterans typically receive a VA Form 10-2501 card listing covered appliances and repair limits.
- Assess Repair Needs — If repairs exceed the card’s limit, the vendor or veteran contacts the local VA Prosthetics office.
- Request Authorization — VA issues FL-10-55 to approve the higher cost.
- Complete Repairs — The vendor performs the work and attaches the original FL-10-55 to the invoice.
- Submit for Payment — The vendor forwards the invoice and form to the designated VA office. Veterans should verify receipt and proper processing.
Veterans should contact their local VA medical center’s Prosthetics department for guidance. Find locations using the VA Facility Locator.
Related VA Prosthetic Forms and Services
- VA Form 10-2421: Prosthetics Authorization and Invoice for new items or services.
- VA Form 10-2501: Prosthetic Service Card for routine repairs within limits.
- VA Form 10-8678: Application for annual clothing allowance related to prosthetic use.
The VA’s PSAS provides a wide range of support, including custom prosthetics, repairs, sensory aids, and home modifications. For the latest policies, refer to official VA resources on prosthetic and rehabilitative items.
Frequently Asked Questions About VA Form FL-10-55
Q: Is FL-10-55 the same as a purchase order?
A: No. It is a specific authorization letter for exceeding repair cost limits on existing prosthetic service cards.
Q: Can any vendor use this form?
A: Typically, VA-authorized vendors or those contacted through the VA process. Prior authorization is usually required.
Q: What if repairs are needed urgently?
A: Contact your local VA Prosthetics office immediately. Emergency provisions may apply in certain cases.
Q: Where do I submit the completed form and invoice?
A: Follow the instructions on the FL-10-55, which directs submission to the specific VA office listed.
Get Help with VA Prosthetic Services
For personalized assistance with VA Form FL-10-55 or prosthetic repairs, reach out to the Prosthetic and Sensory Aids Service at your nearest VA medical center. Additional information is available on the official VA Prosthetics website and through veterans service organizations like DAV.