Cris Neely, a 49-year-old medically retired U.S. Army communications specialist from Kentucky, has spent the last 25 years navigating the challenges of the VA healthcare system. A former member of the First Cavalry Division, Mr. Neely had dreams of joining Delta Force, but his path was cut short by injuries sustained during training.

“I tried out for Special Forces twice in my early 20s,” he tells The New York Sun. “But I got injured both times.”

Serving with the 75th Ranger Regiment, Mr. Neely suffered a heat stroke that, combined with concussions and a hereditary predisposition, triggered mental health challenges, including bipolar disorder, anxiety, and paranoia. These issues led him to seek care at the VA, where he has experienced both triumphs and frustrations.

For Mr. Neely, the system’s shortcomings have been glaring, particularly in mental health services.

“The biggest issue is the shortage of qualified therapists,” he says. “Veterans are having to wait months between appointments, and some are even taking their own lives after being turned away.”

He recounts a particularly troubling experience when a student resident dismissed his concerns, accusing him of seeking medication for personal use. There have been bright spots too, like a recent evaluation by a neuropsychiatrist who helped him better understand his struggles. Despite improvements, Mr. Neely is one of many who see the need for systemic change.

The Department of Veterans Affairs, long rooted in noble intentions, has become synonymous with controversy and mismanagement, from excessive spending and failures at healthcare  to never-ending complaints about the backlog for care. Despite repeated promises of reform from past administrations, real change has remained out of reach.

President-elect Trump has nominated a Navy veteran, Doug Collins, who is also an Air Force Reserve chaplain and a former congressman of Georgia, to lead the embattled department. Can the Trump administration finally get it right? Why has meaningful change been so difficult to come by?

“New people come in, and they very much want to change the culture, but they face a lot of resistance from the Senior Executive Service members, or they get (caught in) the institutional tasks,” the strategic director of Concerned Veterans for America, John Byrnes, tells the Sun.

“With over 375,000 employees, most of whom are unionized within the Veterans Health Administration, reform efforts are frequently stalled by the sheer scale of the system and entrenched administrative habits,” Mr. Byrnes adds.

Ballooning Budgets, Job Cuts, and Bonuses for Big Wigs

The Department of Veterans Affairs has proposed a $369.3 billion budget for fiscal year 2025, with nearly $150 billion allocated for health care — $86 billion for facilities and $41 billion for private network care. This marks a 50.5 percent funding increase since 2021. 

Despite the budget boost, the Department of Veteran’s Affairs announced plans earlier this year to eliminate 10,000 frontline jobs, including psychologists and social workers, citing a budget shortfall. These cuts come as veterans face long wait times and high suicide rates.

Meanwhile, the Department is facing a backlash for improperly awarding $11 million in bonuses to senior executives last year. Although the payments have since been rescinded, critics highlight a bigger problem with the bonus model overall. 

“Unfortunately, the incentives there have become completely perverse. The bonuses are being used for things like false reporting or defending the number of employees you have,” Mr. Byrnes says. The intent was to foster administrative excellence, but instead, it has created a focus on administrative tasks and incentivized meeting arbitrary or non-contingent expectations.”

Problems With Accessing Private Care

A recent Government Accountability Office report published in June highlighted persistent challenges within the Department of Veterans Affairs in providing timely care, particularly for mental health services. The report found that many veterans referred to private sector care, often termed community care, due to long waits or travel distances at Veterans Affairs facilities faced additional delays, frequently waiting more than two weeks to schedule an appointment. In response, the Department of Veterans Affairs acknowledged the issue and stated its commitment to improving the efficiency of appointment scheduling.

The press secretary of Veteran’s Affairs, Terrence Hayes, told the Sun that in response, the Department is “taking immediate actions to address the identified concerns.” These steps include creating comprehensive documentation for Community Care contract oversight, with clear standard operating procedures and defined roles for all participants; reviewing the oversight and reporting responsibilities outlined in the Quality Assurance Surveillance Plans and updating them if necessary; and implementing a formal process for recording lessons learned from Community Care contracts, using best practices to improve oversight and inform future contracts.

These reported delays in care, however, are part of a broader, long-standing problem within the Department. Despite substantial budget increases starting in 2007 and the hiring of thousands of employees, the backlog of benefit claims continues to grow. One major factor is that the Department is overwhelmed by a surge in disability claims — from combat injuries to psychological disorders — totaling 400,000 from Iraq and Afghanistan veterans since 2003, alongside aging veterans from earlier wars. Federal audits show ongoing delays in mental health care, diagnostic testing, and specialist consultations, leaving many veterans without timely treatment.

All this comes a decade after a scandal over wait times at Department of Veterans Affairs medical centers. The 2014 controversy, which implicated the Phoenix Department of Veterans Affairs and 77 other facilities in manipulating wait lists, prompted the passage of the Choice Act under President Obama, allowing veterans far from Veterans Affairs facilities to access private or “community” care. This access was further expanded by the 2018 Mission Act under Trump’s presidency, which reduced wait time and distance thresholds for private care eligibility. 

Mr. Byrnes explained that the veteran population has shifted from predominantly urban origins during conscription eras like World War II, Korea, and Vietnam to more rural roots with today’s all-volunteer force. This change presents challenges, as many rural veterans face long travel times — often more than an hour — to reach Veterans Affairs healthcare facilities, while local non-Veterans Affairs options remain underused due to restrictive policies. 

“Additionally, many veterans feel uncomfortable with the Veterans Affairs system, finding it overly institutionalized or unwelcoming, with security measures like metal detectors and hefty security checks,” he said. 

Even though veterans can technically receive care outside the Veterans Health Administration, the Department maintains responsibility for coordinating appointments and making referrals under the Community Care program. Bureaucrats, Mr. Byrnes continued, thus have the power to keep veterans in the Department’s system by canceling outside appointments or overriding provider recommendations.

One veteran who now works with the Department of Veterans Affairs in a contracting capacity tells the Sun that the waitlist scandal a decade ago ushered in changes that have enabled more veterans toward being able to use private healthcare, bringing about policies such as the Mission Act and Choice Act. While a step in the right direction, these are fraught with their own problems. 

“These programs aren’t always well-coordinated, and the legal and regulatory framework has been a mess,” the insider said. The Department of Veterans Affairs  “makes it incredibly difficult for providers to participate. Most health insurance systems are relatively straightforward. A provider submits your insurance info, confirms coverage, and moves forward. But with Veterans Affairs, providers have to enroll in specific programs, deal with excessive paperwork, and navigate complicated processes to get paid.” He says “it’s chaotic and discourages providers” from working with the VA.

Mr. Hayes contended that the Department is “currently providing more care and more benefits to more Veterans than ever before in the history of the department” and pointed to several record-breaking improvements, including issuing $187 billion in benefits to 6.7 million Veterans and survivors this year processing 2,517,519 disability benefit claims — a 27 percent increase over 2023’s record. 

The VA  “ensures that Veterans can access world-class care whenever and wherever they need it, whether that’s in the community or in the direct (Veterans Affairs) care system,” Mr. Hayes says. “In fact, (Veterans Affairs) has delivered record numbers of community care appointments to Veterans during each of the past 7 years.”

Mr. Hayes’ statement insisted that the Department itself has “driven down wait times for primary care and mental health care” and claims they “are the only health care system in America that publishes its wait times — so our Veterans can make informed decisions about their care.”

The Diversity Factor 

Critics lament that during the Biden-Harris administration, the Department of Veterans Affairs expanded its diversity, equity, and inclusion agenda, even as the backlog of veteran claims grew. 

Another veteran and longtime employee of the Department of Veteran Affairs pointed to the growing emphasis on hiring on the grounds of diversity over suitability or even veteran status not only “overrides performance” but can lead to claims falling by the wayside. As of recent data, around 28 percent of the Department of Veterans Affairs workforce are veterans.

“A big part of the issue is that veterans are often misunderstood in their claims. For example, I recently had a case where (a non-veteran employee) asked me about a military record. The person claimed hearing loss and tinnitus, which is common in the military. However, their job was office work. The (employee) who asked me was making fun of the idea that someone working in an office could have hearing problems,” the source tells the Sun. “But this person worked for an artillery unit, and when they went to the field, they had to be near loud cannons, which caused hearing damage. The system often doesn’t understand these nuances, which can lead to incorrect outcomes.”

The employee also told the Sun that the unions make it nearly impossible to fire an employee for poor performance or even issue a reprimand for constant lateness, which could be considered harassment. More than 79 percent of the Department’s workforce are unionized.

Scratching the Surface 

These issues are merely the tip of the iceberg when it comes to what the new administration will have to scrutinize and adjust. Another prominent cause for concern is that care is not delivered equally. 

In the summer of 1999, Daniel Richards, then a United States Marine stationed at Okinawa, Japan was in the back of a truck driving to Camp Kadena, an American Air Force base, when the vehicle careened from the road and he was ejected at full-force — marking the start of years of horrific injuries from a broken back, traumatic brain injury, vision loss, difficulty swallowing, kidney stones and debilitating headaches leading a medical discharge, made worse by a nightmare experience with his then hometown Veteran Affairs in Tennessee.

“They (the Veteran’s Administration) didn’t take me seriously, probably because I was a young guy trying to smile and I didn’t ‘look’ injured. It felt like they didn’t take my concerns seriously unless I had visible symptoms,” Mr. Richards, now 47, tells the Sun. “And the doctors were just numb from the workload.”

Frustrated and fed up with the system, Mr. Richards relocated to Hawaii in 2012 and says his Veterans Affairs care there could not be better, with staff and medical personnel taking the time to listen to his concerns and get to the root of the problem. Mr. Richards’s experience, however, speaks to what many veterans deem the arbitrary nature of the Department without a routine standard of care across all branches and locations.

“All VA’s should have this level of empathy and proactive care,” he noted. “Some offices feel like they’re just trying to get rid of you and dismiss you unless the issue is glaringly obvious.”

There is also the issue of fraud related to false disability claims, which comes with significant consequences, both financially and in terms of accessibility to vital resources for those in genuine need. A 2021 report by the Office of Inspector General disclosed that improper payments by the Department — partially due to fraudulent claims — totaled more than $11.3 billion annually, a trend which appears to have continued through 2023, according to the Government Accountability Office.

A slew of controversial, possibly illegal, for-profit companies have emerged in recent years, vowing to help veterans boost disability ratings. Critics say that the misuse of funds strains the system, inflating costs and creating backlogs that delay essential care for veterans facing severe disabilities. 

Staffing challenges further exacerbate the Department’s struggles. The agency is reported to face difficulty recruiting and retaining doctors and nurses due to uncompetitive pay and unpredictable schedules caused by clinician shortages. Budget constraints often lead to high turnover, with laborers drawn to better-paid, less demanding jobs in the private sector.

These staffing shortages and outdated facilities that are poorly located relative to the veteran population contribute to long waiting times for care. The influx of veterans requiring complex medical and psychological treatment, particularly after 9/11, has only deepened these challenges, straining an already overburdened system.

“We face significant challenges, particularly with mental health and the alarming rate of veteran suicides. Many cite 22 a day, but it’s closer to 17, which is still far higher than the national average,” Mr. Byrnes says. “Legislative action is crucial to solidify access standards for community care into statutory law, reducing the (Department of Veterans Affairs) ability to sidestep reforms. Ultimately, the focus should remain on providing veterans with the care they need, where and when they need it, without unnecessary barriers.”

Others are less optimistic that actual change is foreseeable without a never-before-seen willingness to fight.  

“If the organization truly wants change, they need to get rid of a significant portion of mid- and senior-level management. But the bureaucracy and union pressure make it seem nearly impossible,” the longtime Department employee adds. “It’s going to take someone with authority to say, ‘This is what we’re doing, and I don’t care what obstacles get in the way. If people won’t follow it, we’ll terminate them.’ The question is, how much resistance do they want? Do they really want change, or do they just want to say that they’re changing?”