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While veterans' benefits have been provided by the federal government since the American Revolutionary War, a veteran-specific federal agency was not established until 1930, as the Veterans' Administration. In 1982, its mission was expanded to include caring for civilians and people who were not veterans in case of a national emergency. In 1989, the Veterans' Administration became a cabinet-level Department of Veterans Affairs. The president appoints the secretary of veterans affairs, who is also a cabinet member, to lead the agency.
As of June 2020, the VA employed 412,892 people at hundreds of Veterans Affairs medical facilities, clinics, benefits offices, and cemeteries. In fiscal year 2016 net program costs for the department were $273 billion, which includes the VBA Actuarial Cost of $106.5 billion for compensation benefits.
Veterans' Bureau
The United States' entrance into World War I in 1917 caused a massive increase in veterans, overwhelming the federal system. When the Republican nominee for president, Warren G. Harding, accepted his party's nomination to the 1920 presidential election, he issued a promise to the more than four million Americans who served in the war: It is not only a duty, it is a privilege to see that the sacrifices made shall be requited, and that those still suffering from casualties and disabilities shall be abundantly aided and restored to the highest capabilities of citizenship and enjoyment.At the time of the election, dissatisfaction with the benefits programs for World War I veterans ran rampant throughout the country. To receive benefits, veterans had to navigate through three different federal agencies: the Bureau of War Risk Insurance (BWRI) for insurance and compensation, the U.S. Public Health Service (PHS) for medical and hospital care, and the Federal Board for Vocational Education for rehabilitation, education, and job training. Veterans from previous conflicts continued to rely on the Bureau of Pensions and National Homes for Disabled Volunteer Service for their compensation and medical care respectively.
After winning the election, President Harding appointed a committee in April 1921 to identify a solution. On August 8, 1921, Harding signed Public Law 67-47, popularly known as the Sweet Act, which established the Veterans' Bureau, which absorbed the War Risk Bureau and the Rehabilitation Division of the Federal Board for Vocational Education. In 1922, it gained a large number of veterans' hospital facilities from the Public Health Service, most of which had been recently established on former U.S. Army bases.
One of the landmark measures included in the new law was removing the burden of proof for two disabilities that veterans claimed – tuberculosis and neuropsychiatric disorders. While the legislation only applied to those two categories, it was groundbreaking in establishing presumptive conditions for future claims.
Charles Forbes led the fledgling agency through its initial two years, before resigning in 1923. His replacement, former brigadier general Frank T. Hines took on director of the Veterans' Bureau. By the 1920s, the various benefits were administered by three different federal agencies: the Veterans' Bureau, the Bureau of Pensions, and the National Home for Disabled Volunteer Soldiers.
The United States final federal consolidation of veteran government entities came on July 21, 1930, when President Herbert Hoover signed Executive Order 5398, merging all three agencies into the Veterans' Administration.
World War II
In 1940, with war already raging in Europe and Asia, VA began preparing for potential American involvement in the conflict. Hines informed Congress that the agency was coordinating with the War Department to assist in the event of a national emergency with both hospital bed space and highly trained medical staff.
Following the Japanese attack on Pearl Harbor and America's entry into World War II, the U.S. Army's need for physicians and other healthcare professionals was acute. As the surgeon general of the Army, Maj. Gen. Norman T. Kirk, bluntly reported, "It was difficult during the past year to secure the additional Medical Corps officers needed to meet the requirements of the increasing Army since there are not sufficient physicians available to meet both military and civilian medical needs."
The military's demand for healthcare professionals drained staff from the civilian medical community and VA alike. Between 1942 and mid-1944, 16 percent of VA employees were furloughed for military service. A December 1943 agreement between Secretary of War Henry L. Stimson and the VA's administrator paved the way for a collaborative use of limited medical personnel. Their solution included inducting select VA doctors and dentists into the Army but allowing them to remain at VA facilities. While detailed to VA, Army personnel wore a distinctive shoulder sleeve insignia designed by the Heraldic Section of the Army's Office of the Quartermaster General. One of the most notable to wear this patch was Gen. Omar N. Bradley.
The close of World War II resulted in not only a vast increase in the veteran population but also a large number of new benefits enacted by Congress for veterans of the war. In addition, during the late 1940s, the VA had to contend with aging World War I veterans. During that time, "the clientele of the VA increased almost fivefold with an addition of nearly 16,000,000 World War II veterans and approximately 4,000,000 World War I veterans." Prior to World War II, in response to scandals at the Veterans Bureau, programs that cared for veterans were centralized in Washington, D.C. This centralization caused delays and bottlenecks as the agency tried to serve World War II veterans. As a result, the VA went through a decentralization process, giving more authority to the field offices.
The Servicemen's Readjustment Act, commonly known as the GI Bill, was signed into law on June 22, 1944, by President Franklin D. Roosevelt. "The United States government began serious consolidated services to veterans in 1930. The GI Bill of Rights, which was passed in 1944, had more effect on the American way of life than any other legislation—with the possible exception of the Homestead Act."
Unlike previous legislation, the GI Bill stipulated that all benefits were to be managed by the VA. Further educational assistance acts were passed for the benefit of veterans of the Korean War.
Promotion to Department of Veterans Affairs
The Department of Veterans Affairs Act of 1988 (Pub. L. 100–527) changed the former Veterans' Administration, an independent government agency established in 1930 into a Cabinet-level Department of Veterans Affairs. It was signed into law by President Ronald Reagan on October 25, 1988, but came into effect under the term of his successor, George H. W. Bush, on March 15, 1989.
The reform period of 1995 to 2000 saw the Veterans Health Administration (VHA) dramatically improve care access, quality, and efficiency. This was achieved by leveraging its national integrated electronic health information system (VistA) and in so doing, implementing universal primary care, which increased patients treated by 24%, had a 48% increase in ambulatory care visits, and decreased staffing by 12%. By 2000, the VHA had 10,000 fewer employees than in 1995 and a 104% increase in patients treated since 1995, and had managed to maintain the same cost per patient-day, while all other facilities' costs had risen by over 30% to 40% during the same period.
Authored by Senator Jim Webb, the Post-9/11 Veterans Educational Assistance Act of 2008 doubled the GI Bill's college benefits and provided a 13-week extension to federal unemployment benefits. The new GI Bill more than doubled the value of the benefit from $40,000 to about $90,000. In-state public universities are essentially covered to provide full scholarships for veterans under the new education package. For those veterans who served at least three years, a monthly housing stipend was also added to the law. Congress and President Barack Obama extended the new GI Bill in August 2009 at a cost of roughly $70 billion over the next decade. The Department of Defense (DoD) allows individuals who, on or after August 1, 2009, have served at least six years in the Armed Forces and who agree to serve at least another four years in the U.S. Armed Forces to transfer unused entitlement to their surviving spouse. Service members reaching 10-year anniversaries could choose to transfer the benefit to any dependents, such as their spouse or children.
In May 2014, critics of the VA system reported problems with scheduling timely access to medical care. In May 2014, a retired doctor said that veterans died because of delays in getting care at the Phoenix, Arizona, Veterans Health Administration facilities. An investigation of delays in treatment in the Veterans Health Administration system conducted by the Veterans Affairs Inspector General of 3,409 veteran patients found that there were 28 instances of clinically significant delays in care associated with access or scheduling. Of these 28 patients, six were deceased. The same OIG report stated that the Office of Investigations had opened investigations at 93 sites of care in response to allegations of wait time manipulations, and found that wait time manipulations were prevalent throughout the VHA. On May 30, 2014, Secretary of Veterans Affairs Eric Shinseki resigned from office due to the fallout from the scandal, saying he could not explain the lack of integrity among some leaders in VA healthcare facilities. "That breach of integrity is irresponsible, it is indefensible, and unacceptable to me. I said when this situation began weeks to months ago that I thought the problem was limited and isolated because I believed that. I no longer believe it. It is systemic.