The evolution of surgical assistants (surgeon’s assistant) is well documented during the last few decades. http://en.wikipedia.org/wiki/Surgeon's_assistant.  The ability to perform as a surgical assistant surgically is determined by education, training and experience.  The same rigor that a surgeon goes thru to be competent in their field.  The only nationally recognized surgical assistant certifying body that requires its practitioners to be clinically active by documenting surgical cases during their two year certifying cycles is the American Board Surgical Assistants; this ensures that the practitioner is clinically active.  As the surgical assistant profession has evolved in the US many allied health professionals have dedicated their careers to the profession of surgical assistant and the standards for the profession have also been elevated.  If VA decides not to include ABSA certification they are signaling to the industry the fragmentation of the surgical assistant profession and the self-interest of individuals over the public safety of the patients we serve as surgical assistants.