20

DEPARTMENT OF
VETERANS AFFAIRS
Brooks D. Tucker

MISSION STATEMENTThe Department of Veterans Affairs (VA) is the primary provider of health care,benefits, and memorial affairs for America’s veterans and their families. The VA
has the noble responsibility to render exceptional and timely support and services
with respect, compassion, and competence. The veteran is at the forefront of every
VA process and interaction. The VA must continually strive to be recognized as a“best in class,” “Veteran-centric”1 system with an organizational ethos inspiredby and accountable to the needs and problems of veterans, not subservient to theparochial preferences of a bureaucracy.
OVERVIEWAt the end of the Obama Administration, the VA was held in low esteem bothby the veterans it served and by the employees who served these former warriors.
Eroding morale caused by the downstream effects of a health care access crisis
in 2014 led to the resignation of Secretary Eric Shinseki and extensive oversight
investigations by Congress from 2015–2016.
By 2020, however, the VA had become one of the most respected U.S. agencies.
This significant progress was due in part to the leadership of Secretary Robert Wilkie(2018–2021) and his team of political appointees and career senior executives, manyof them veterans, who led the effort to ensure that the VA became “Veteran-centric”
in its governance decisions and fostered a more positive work environment.
This mindset translated into a department that was better attuned to employees’
and veterans’ needs and experiences in the daily operations of health care, benefits,— 641 —

Mandate for Leadership: The Conservative Promiseand memorial affairs. During that period, the VA received the largest number ofwatershed congressional authorizations to reform its health care and benefits thatit had received since the post–Vietnam War years along with historic increases inannual appropriations, which have tripled since the last full year of the George W.
Bush Administration.
The current VA leadership team of Biden appointees has adopted some of theirpredecessors’ governance processes. However, they have not sustained the previous
Administration’s commitment to a genuine “Veteran-centric” philosophy, most notably with respect to the delivery of health care, and harbor a bias toward expanding theunionized federal employee workforce that has not always been aligned with a focus
on “Veteran-centric” care. There also is growing concern in Congress and the veterancommunity that the VA is poorly managing and in some cases disregarding provisionsof the VA MISSION [Maintaining Internal Systems and Strengthening Integrated Outside Networks] Act of 20182 that codify broad access for veterans to non-VA health careproviders. Efforts to expand disability benefits to large populations without adequate
planning have caused an erosion of veterans’ trust in the VA enterprise.
Additionally, the current VA leadership is focusing very publicly on “social
equity and inclusion” within departmental policy discussions toward ends thatwill affect only a small minority of the veterans who use the VA. For the first time,
the VA is allowing access to abortion services, a medical procedure unrelated tomilitary service that the VA lacks the legal authority and clinical proficiency toperform. In addition to continuing the grotesque culture of violence against thechild in the womb, these sociopolitical initiatives and ideological indoctrinations
distract from the department’s core missions.
DEPARTMENTAL HISTORY

Following the Civil War, state veterans homes were established to provide medical and hospital treatment for all injuries and diseases. When the United Statesentered World War I in 1917, “Congress established a new system of Veteransbenefits, including programs for disability compensation, insurance for service
personnel and Veterans, and vocational rehabilitation for the disabled”3 that wasoverseen by three different federal programs: the Veterans Bureau, the Departmentof the Interior’s Bureau of Pensions, and the National Home for Disabled Volunteer
Soldiers. In 1921, Congress combined those programs into the Veterans Bureau.
Following World War II, a national VA hospital system, much of which remains
operational today, was established to care for millions of returning veterans.
Following the Vietnam War, the VA’s federally owned and operated hospital
network expanded again to meet the needs of the volunteer and draftee population.
In the past two decades, the VA has purposely transitioned to leasing medical properties rather than building expensive new facilities that can take years to complete
and often experience budget overruns. As the nature of health care has evolved— 642 —

2025 Presidential Transition Projectwith a growth in same-day surgical procedures and outpatient care, so has the VA,
and in 2018 Congress added access to private-sector urgent care outlets as one of
the VA’s health care benefits.
Today, the VA operates 172 inpatient VA Medical Centers (VAMCs), which are
an average of 60 years old, and 1,113 Community Based Outpatient Clinics (CBOCs),
which are newer facilities designed to meet the needs of veterans closer to home.
The VA also manages a Community Care Network (CCN) through contracts with
Optum and TriWest, third-party health care administrators responsible for building and maintaining a robust population of community providers to meet the needsof veterans referred for care outside of the VA system. Currently, approximately
6.4 million veterans out of 18 million nationally (and out of the 9.1 million who areenrolled) use the VA for health care; the remainder use employer-sponsored plans,
Tricare, Medicare, and Medicaid.
The disability benefits system evolved significantly in the years between theCold War era and the global war on terrorism, a period when the VA enrolled large
numbers of veterans from World War II, Korea, and Vietnam who were seeking
disability benefits and health care. Disability compensation is the largest VA benefit,
but there also are dozens of others, the next largest of which are the GI Bill andthe Home Loan Guaranty. These benefits are administered through 56 Regional
Benefits Offices (RBOs) and hundreds of satellite sites around the country.
The Agent Orange Act of 19914 significantly expanded the scope of disability benefits for those who had deployed to Vietnam, and the cost of those benefits began toincrease dramatically as the Vietnam generation of veterans aged and began to experience adverse health conditions, some of which were presumed to have been caused
by defoliant chemicals used in Southeast Asia. In 2016 and 2017, a burdensome
backlog of appeals of denied disability claims from multiple wartime generations—abacklog numbering in the hundreds of thousands—led to a joint effort by the VA, Veteran Service Organizations (VSOs), and Congress to pass legislation that streamlined
appeal processes. Implemented in 2017, this historic “good governance” success hashelped the VA to reduce the number of these appeals dramatically.
The Sergeant First Class Heath Robinson Honoring Our Promise to Address
Comprehensive Toxics (PACT) Act of 20225 addressed adverse health outcomespresumed to be the result of veterans’ exposure to airborne toxins during the global
war on terrorism and further expanded disability benefits to the most recent generation of veterans. These ambitious authorities, like the 1991 authorities, havethe potential to overwhelm the VA’s ability to process new disability claims andadjudicate appeals. Currently, the VA is seeking to hire large numbers of personnel
to process these claims while exploring the use of an automated process to accelerate claims reviews and decisions. The ever-present lag in the hiring and trainingof new employees could result in major problems with the timely adjudication of
benefits well into the next Administration in 2025.

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Mandate for Leadership: The Conservative Promise

In sum, the VA for the foreseeable future will experience significant fiscal,
human capital, and infrastructure crosswinds and risks. Budgets are at historic
highs, and with a workforce now above 400,000, the VA is contending with alack of new veteran enrollees to offset the declining population of older veterans.
Recruitment of medical and benefits personnel has become more challenging.
Veterans are migrating from the northern states to the southern and westernstates for retirement and employment. Meanwhile, VA information technology (IT) is struggling to keep pace with the evolution of patient care and record
keeping. Consequently, VA leaders in the next Administration must be wise andcourageous political strategists, experienced managers to run day-to-day operations more effectively, innovators to address the changing veteran landscape,and agile “fixers” to mitigate and repair systemic problems created or ignoredby the present leadership team.
VETERANS HEALTH ADMINISTRATION (VHA)
Needed ReformsllRescind all departmental clinical policy directives that are contrary toprinciples of conservative governance starting with abortion services
and gender reassignment surgery. Neither aligns with service-connectedconditions that would warrant VA’s providing this type of clinical care, andboth follow the Left’s pernicious trend of abusing the role of government tofurther its own agenda.
Focus on the effects of shifting veteran demographics. At least during thenext decade, the VA will experience a significant generational shift in its
overall patient population. Of the approximately 18 million veterans alive
today, roughly 9.1 million are enrolled for VA health care, and 6.4 million ofthese enrollees use VA health care consistently. These 6.4 million veterans
are split almost evenly between those who are over age 65 and those
who are under age 65, but the share of VA’s health care dollars is spent
predominantly in the over-65 cohort. That share increases significantly as
veterans live longer and use the VHA system at a higher rate.

VHA enrollments of new users are increasingly at risk of being exceeded by
the deaths of current enrollees, primarily because significant numbers of
the Vietnam generation are reaching their life expectancy. The generationaltransition from Vietnam-era veterans to post-9/11 veterans will takeseveral years to complete. The ongoing demographic transition is a catalyst
for needed assessments of how the VA can improve the delivery of care
to a numerically declining and differently dispersed national population— 644 —

2025 Presidential Transition Projectof veterans—a population that is more active, reaching middle age orretirement age, and migrating for lifestyle and career reasons.
At the center of the VHA’s evolution during this generational transition
is an ongoing tension, some of it politically contrived, between Direct
Care for Veterans provided from inside the VHA system and Community
Care for Veterans who are referred to private providers participating inthe VHA’s two Community Care Networks (CCNs). In recent years, thebudget for Community Care has grown as demand from veterans has
risen sharply, sometimes outpacing the budgets for Community Care atindividual VAMCs.
The Trump Administration made Community Care part of its “Veterancentric” approach to ensure that veterans would be able to participate more
fully in their health care decisions and have options if or when the VHA was
unable to meet their needs. The Biden Administration has watered downthat effort, has sought various procedural ways to slow the rate of referrals
to private doctors, and at some facilities is reportedly manipulating theCommunity Care access standards required by the VA MISSION Act of 2018.
If the makeup of Congress is favorable in 2025, the next Administration
should rapidly and explicitly codify VA MISSION Act access standards
in legislation to prevent the VA from avoiding or watering down therequirements in the future.
First and foremost, a veterans bill of rights is needed so that veterans and
VA staff know exactly what benefits veterans are entitled to receive, with aclear process for the adjudication of disputes, and so that staff ensure thatall veterans are informed of their eligibility for Community Care. Currently,
veterans are not routinely and consistently told that they are eligible forCommunity Care unless they request information or are given a referral.
l

To strengthen Community Care, the next Administration should create new
Secretarial directives to implement the VA MISSION Act properly. Sections
for consideration and areas for reform include the following:
1.

Sections 101 and 103 (Community Care eligibility for access standards
and the best medical interest of the veteran).

2. Section 104 (Community Care access standards and standards for
quality of care).

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Mandate for Leadership: The Conservative Promise

3. Section 121 (developing and administering an education program thatteaches veterans about their health care options available from the
Department of Veterans Affairs).
4.

Section 152 (returning the Office for Innovation of Care and Payment to
the Office of Enterprise Integration with a joint governance process set
up with the VHA).

5. Section 161 (overhauling Family Caregiver Program expansion, which
has gone poorly, so that it focuses on consistency of eligibility andawareness that the most severely wounded or injured may require theprogram indefinitely).
llRequire the VHA to report publicly on all aspects of its operation, including
quality, safety, patient experience, timeliness, and cost-effectiveness, using
standards similar to those in the Medicare Accountable Care Organization
program so that the government may monitor and achieve continuous
improvement in the VA system more effectively.
Encourage VA Medical Centers to seek out relevant academic and privatesector input in their communities to improve the overall patient experience.

Budgetll

Conduct an independent audit of the VA similar to the 2018 Department of
Defense (DOD) audit to identify IT, management, financial, contracting, andother deficiencies.

Assess the misalignment of VHA facilities and rising infrastructure costs. The
VHA operates 172 inpatient medical facilities nationally that are an average of
60 years old. Some of these facilities are underutilized and inadequately staffed.
Facilities in certain urban and rural areas are seeing significant declines in theveteran population and strong competition for fresh medical staff.
In 2018, Congress authorized an Asset Infrastructure Review (AIR) of
national VHA medical markets to provide insight into where the VA
health care budget should be responsibly allocated to serve veterans mosteffectively. However, the Senate Veterans Affairs Committee lacked thepolitical will to act on the White House’s nominations of commission
members, and this ultimately led to termination of the AIR process.
The next Administration should seek out agile, creative, and politically
acceptable operational solutions to this aging infrastructure status quo,

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2025 Presidential Transition Project

reimagine the health care footprint in some locales, and spur a realignmentof capacity through budgetary allocations. Specifically:
1.

Embrace the expansion of Community Based Outpatient Clinics (CBOCs) as
an avenue to maintain a VA footprint in challenging medical markets without
investing further in obsolete and unaffordable VA health care campuses.

2. Explore the potential to pilot facility-sharing partnerships between the
VA and strained local health care systems to reduce costs by leveraging
limited talent and resources.
Personnellll

Extend the term of the Under Secretary for Health (USH) to five years.
Additionally, authority should be given to reappoint this individual for asecond five-year term both to allow for continuity and to protect the USH
from political transition.
Establish a Senior Executive Service (SES) position of VHA Care System
Chief Information Officer (CIO), selected by and reporting to the chief of the
VHA Care System with a dotted line to the VA CIO.
Identify a workflow process to bring wait times in compliance with VAMISSION Act–required time frames wherever possible.
1.

Assess the daily clinical appointment load for physicians and clinicalstaff in medical facilities where wait times for care are well outside of
the time frames required by the VA MISSION Act.

2. Require VHA facilities to increase the number of patients seen each day
to equal the number seen by DOD medical facilities: approximately 19
patients per provider per day. Currently, VA facilities may be seeing as
few as six patients per provider per day.
3. Consider a pilot program to extend weekday appointment hours andoffer Saturday appointment options to veterans if a facility continues todemonstrate that it has excess capacity and is experiencing delays in thedelivery of care for veterans.
4. Identify clinical services that are consistently in high demand but
require cost-prohibitive compensation to recruit and retain talent, andexamine exceptions for higher competitive pay.

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Mandate for Leadership: The Conservative Promise

5. Assess the medical facilities where Community Care is readily
available but referrals for Community Care are below the averages inother similar markets, referrals expiring are above the average, and/or canceled appointments are above the average. Identify reasonsand factors and consider possible ways to improve timeliness andresponsiveness for veterans.
6. Further explore how to leverage telehealth to reduce personnel costs
across the enterprise and serve veterans. Continue to pursue expansionof broadband services to remote and rural areas.
7.

Assess recruitment and retention in highly competitive medical markets
to identify common limiting factors for attracting high-demand,
specialized occupations.

8. Consider aggressively recruiting retired physicians who desire toserve veterans.
9.

Consider expanding VA tuition assistance in exchange for reciprocal
service in rural or understaffed VAMCs.

10. Examine the surpluses or deficits in mental health professionals
throughout the enterprise, recognizing that the department needs a
blend of social workers, therapists, psychologists, and psychiatrists witha focus on attracting high-quality talent.
lConduct a high-priority assessment of Electronic Health Record (EHR)
transition delays and functionality problems. VA innovation in healthcare for the next 20 years and beyond will rest squarely on the timely
implementation of the new VHA EHR in coordination with the DOD’s
parallel pacing effort. The VA’s EHR rollout has been blocked by technicaldelays at local facilities where personnel have raised safety concerns andinfrastructure has not been modernized to accept the new system.

VETERANS BENEFITS ADMINISTRATION (VBA)
Needed Reforms

The most evident and ongoing concern is the complexity of benefits, which
can lead to confusion for the veteran and, if not mitigated early in the veteran’sinteractions, long-term distrust of and animosity toward the VA. Wholesale benefits reform is unnecessary and politically a “third rail,” but effective managerial— 648 —

2025 Presidential Transition Projectapproaches and technology tools that currently exist in the private sector could
be employed to improve existing VBA activities.
This problem is most pronounced in the disability claims process, which needs
more and better management attention focused on streamlining the procedures
involved in processing claims and administering benefits. The VA must improvetimeliness of claim adjudication and benefits delivery: Veterans want the VBA
to provide timely responses to requests for benefits support, render empathetic
customer service and understandable explanations of those benefits, and deliver
those benefits without frustrating delays (weeks, not months).
l

l

l

l

l

Identify performance targets for benefits, report publicly on actual
performance each quarter, and use these metrics to drive consistentimprovement.
Develop a new pilot “Express 30” commitment for a veteran’s first fully
developed disability compensation claim and organize the VBA to complete
the first claim in 30 days.
Hire more private companies to perform disability medical examinations.
Delays in completing the examinations could be eliminated with more
external capacity.
Increase automation. Hiring additional staff to process claims is costly,is inflexible, and has yielded mixed results. Attempting to change laws
and regulations simply to adjudicate claims would be a herculean effort
given their complexity. The best way to provide benefits faster and moreaccurately is by using technology to perform most of the work. Technology
currently exists in the private sector, but the VBA lacks the expertise
to use it. This would be more of an organizational challenge than atechnology hurdle.
Reduce improper payment and fraud. About $500 million is improperly
paid out each year. Better tools, training, and management could reduce thissubstantially, but rule changes at the departmental level would be needed.

BudgetThe VA’s Schedule for Rating Disabilities (VASRD) has assigned disability
ratings to a growing number of health conditions over time; some are tenuously
related or wholly unrelated to military service. The further growth in presumptive
service-connected medical conditions pursued by Congress and Veteran Service
Organizations, begun with Agent Orange and most recently for Burn Pits/Airborne— 649 —

Mandate for Leadership: The Conservative Promise

Toxins, has led to historic increases in mandatory VBA spending in recent years.
The VA has a time-phased plan to reassess the VASRD and its ratings for compensation, but this internal process can be slow and laborious, requires Office ofManagement and Budget (OMB) approvals, and can become politically charged
both in Congress and with VSOs.
lll

The next Administration should explore how VASRD reviews could beaccelerated with clearance from OMB to target significant cost savings fromrevising disability rating awards for future claimants while preserving themfully or partially for existing claimants.
The VBA’s Information Technology top-line budget should be reexamined
and reassessed in light of the need for expanded automation acrossthe enterprise.
Traditionally, VHA captures the large majority of VA IT funding. The VBA
needs to make the case for a larger IT budget with clear requirements to
support that request.

Personnel
l

l

l

l

Pursue reforms of the Human Capital Management process and operations
within the VBA to build a more blended workforce with more contractors toprocess claims. This would free federal employees to perform other duties
and be involved solely with the final decision to award benefits.

Improve the VBA acquisition workforce. The VBA needs more world-classcontractor support. Currently, few of the top companies have contracts with
the VBA, and the VBA needs to conduct more outreach to the private sector
through senior leader engagement and industry conferences.
To identify more effective and efficient ways to complete claims, establish aknowledge exchange program with top-tier private-sector companies thatdo similar work. The VBA is fundamentally a financial services organization.
A significant amount of its work has a private-sector analogue that could beleveraged to improve service to veterans.
For most of its existence, the VBA has been a risk-averse, insular, paper-basedorganization, implementing technology only over the past decade. This
insularity has led to a predominantly “build it ourselves” approach, partly
because VBA staff has limited experience or insight into current privatesector tools and methods and partly because the VBA struggles to compete— 650 —

2025 Presidential Transition Projectwith the VHA for IT funding. Senior executive leadership needs moreinnovators and trail blazers—qualities that have sometimes been lacking
in the VBA’s senior ranks. Recruiting a more relevantly knowledgeable andtechnologically savvy team, along with robust political control of the VA, could
bring about better solutions to the VBA’s workflow challenges.
HUMAN RESOURCES AND ADMINISTRATION (HRA)
Needed ReformslllRescind all delegations of authority promulgated by the VA under the prior
Administration.
Transfer all career SES out of PA/PAS-designated positions on the first day
and ensure political control of the VA.
Take a close and analytically critical look at where hybrid and remote work
is a net positive as a functional necessity and where in-person collaborationand presence will help to instill a strong work ethic and a more cohesive
environment for productivity from the Office of the Secretary across theheadquarters enterprise.

The COVID-19 pandemic spurred a significant shift to hybrid and telework
options for large segments of the staff in the Washington headquarters, in its satellites, and at some VBA Regional Offices. The “remote work” expectation has
been amplified and formalized within the Biden Administration team at VA tothe extent that the current Secretary, Deputy Secretary, and their staffs are not “inoffice” as a matter of a routine presence while VA staff in Washington, D.C., have
limited in-person meetings, relying more frequently on video conference calls. The
short-term and long-term effects of this policy on the department are unknown,
but generally, the policy may be undermining the cohesiveness and competencies
of some staff functions and diluting general organizational accountability andresponsiveness.
BudgetlExpedite the acquisition of a new Human Resources Information
Technology (HRIT) system. The current system is not user-friendly; has
minimal fusion, middle-ware capacity; and is not conducive to data driven
personnel decisions. Personnel data needs to be organized and managed
to its full potential. The HRIT system, associated databases, and other“shadow” personnel systems have no shortage of data; the problem comeswith effective management of the data.

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Mandate for Leadership: The Conservative PromisellBroaden pay and benefits in critical VA skill sets (beyond medical careoccupations) to be more competitive with private-sector industry. IT,
acquisition, cyber, and economists are some examples of skill sets thatare difficult for the VA to recruit, largely because of the limitations offederal pay scales.
Continue to maximize the use of new VA hiring and pay authorities provided
by Congress in the RAISE Act6 and PACT Act7 as well as existing authorities instudent loan forgiveness and the Public Service Loan Forgiveness program.

Personnel
l

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Foster a culture that is mission (veteran) driven, alert, engaged, andhabitually responsive to the veteran, and structure an environment that
promotes a flexible and agile workplace.

Increase employee satisfaction/experience to improve recruitment andretention of VA personnel. Go beyond the traditional focus on the extrinsic(monetary pay and bonuses) and seek creative ways to instill teamwork,
loyalty, and pride.
Train leaders and managers to promote an energized and productive
workplace culture and reward those who do it well. Ensure that seniorleaders (SES) set the proper example.
Focus more attention on hiring veterans and military spouses. The
percentage of veterans employed at VA has been declining.
Support the White House Office of Presidential Personnel (PPO) in
identifying a fully vetted roster of candidates to assume all key positions at
VA well ahead of formal nominations. The VA is the second-largest federal
agency, yet it is authorized a woefully small number of PA/PAS positions
when compared to other agencies of lesser size. Congress and the Office of
Personnel Management should be engaged on ways to provide authorities
for a higher number of non-career PA positions. The White House PPO canbe inclined to discount the VA’s importance, but given the political attention
that VA can generate for Congress and the media, PPO should understandthe importance of finding talented political appointees to serve at VA.
Increase the number and utilization of Limited Term Appointment Senior
Executive Service positions for up to three years to work on special projects
to ensure talent refreshment, talent acquisition, and flexibility.

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2025 Presidential Transition ProjectlManage the relationship with organized labor effectively and proactively.
1.

Ensure that any agenda that includes labor/civil service reform in the VA
has a clear direction from the Secretarial level, support from the GeneralCounsel, alignment with the Assistant Secretary for Human Resourcesand Administration, and a unified and strong political will to carry it out.
Without those elements, labor reforms are very difficult to accomplish.

2. Ensure that each senior leader in the process gets buy-in from reformminded career employees willing to accept and support change. Those
mid-level and senior-level managers exist, but they will need to be
identified early and shown trust and confidence.
3. Ensure that the White House communicates the labor reform agenda
swiftly. Trump Administration executive orders on civil service reform(official time, government-furnished office space) were issued too late,and departments and agencies were not prepared to execute them.
4. Anticipate the inevitable opportunities for legal challenges fromorganized labor, and be prepared for them to happen and be dragged
out—which makes early, decisive timing all the more important.
5. Ensure that the White House is prepared to support a concerted
and deliberate effort on implementation to avoid perceptions of adisconnected strategy and disaggregated effort.
6. Remain mindful of which labor contracts end, when they end, and what
the agency’s goals for renegotiation are. If not done effectively, contract
end dates will be missed or lack notification. It is therefore essential tohave a clear strategy with respect to what leadership wants from a newcontract: Do not make the perfect the enemy of the good in contract
negotiations.
lWork with Congress to sunset the Office of Accountability andWhistleblower Protection (OAWP). OAWP was well intentioned whenformed, but it is redundant with the activities of supervisors as well as
equal employment opportunity, Office of the Inspector General, Office ofSpecial Counsel, and other policies, programs, and procedures for holding
employees accountable. This redundancy results in lengthy investigations,gaps in coverage, and an overall ineffective method of employee andsupervisor accountability.

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Mandate for Leadership: The Conservative PromiselConsider decoupling HRA and the Office of Security and Preparedness(OSP). When Congress directed that the OAWP be established, it did notinclude authorities for a new Assistant Secretary position; consequently, theOSP was combined with HRA to free a PAS position. The functions of HRA
and OSP are dissimilar and thus create an organization that is difficult tostaff with the talent needed to execute both missions effectively.

AUTHOR’S NOTE: The preparation of this chapter was a collective enterprise of individuals involved in

the 2025 Presidential Transition Project. All contributors to this chapter are listed at the front of this volume,
but Darin Selnick, Paul R. Lawrence, and Christopher Anderson deserve special mention. The author alone
assumes responsibility for the content of this chapter, and no views expressed herein should be attributed to any
other individual.

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2025 Presidential Transition Project
ENDNOTES

1.
2.
3.
4.
5.

6.

7.

U.S. Department of Veterans Affairs, Veterans Health Division, VHA Directive 1003, “VHA Veteran Patient
Experience,” April 14, 2020, pp. 1 and B-1.
S. 2372, VA Mission Act of 2018, Public Law No. 115-182, 115th Congress, June 6, 2018, https://www.congress.
gov/115/plaws/publ182/PLAW-115publ182.pdf (accessed January 30, 2023).
U.S. Department of Veterans Affairs, VA History Office, “VA History,” last updated May 27, 2021, https://www.
va.gov/HISTORY/VA_History/Overview.asp (accessed January 28, 2023).
38 U.S. Code § 1116, https://www.law.cornell.edu/uscode/text/38/1116 (accessed January 28, 2023).
S. 3373, Sergeant First Class Heath Robinson Honoring Our Promise to Address Comprehensive Toxics Act of2022 (Honoring Our PACT Act of 2022), Public Law No. 117-168, 117th Congress, August 10, 2022, https://www.
congress.gov/117/plaws/publ168/PLAW-117publ168.pdf (accessed January 28, 2023).
H.R. 2471, Consolidated Appropriations Act, 2022, Public Law No. 117-103, 117th Congress, March 15, 2022,
Division S, Title I, https://www.congress.gov/117/plaws/publ103/PLAW-117publ103.pdf (accessed March 18,2023). Known variously as the Department of Veterans Affairs Nurse and Physician Assistant Retention andIncome Security Enhancement Act and the VA Nurse and Physician Assistant RAISE Act.
See note 5, supra.

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