Not so very long ago, in 2018, the Department of Veterans Affairs was celebrating a record-high financial bonanza of $230 billion in federal funding. Today, even as the population of veterans is diminishing, VA budgetary resources have increased by $100 billion, to more than $338 billion. In the intervening years, the VA, which continues to cope with severe staff shortages, hasn’t reformed its perpetually backlogged benefits-claim process, hasn’t solved or even noticeably diminished the veteran-suicide crisis, hasn’t solved the problem of veteran homelessness, hasn’t managed successfully to field its new and exorbitantly expensive electronic-health-records system, and hasn’t helped many veterans to land new jobs — but it has punished veterans for the VA’s own accounting errors. Every year, we’re spending ever more billions on fewer and fewer military veterans, without even knowing what that money is accomplishing.

Fiscally, this trend is unsustainable. Socially, we can hardly call this “taking care” of veterans. Morally, it’s a dismissal of veterans, not a form of thanking them for their service. But above all, it’s political posturing — and completely on par for the historical course of veterans’ policy.

In 2021, the Left-leaning Center for American Progress noted that one of the VA’s most crucial issues was the need to harness its galloping budget. Even before American Rescue Plan allocations, the 2021 VA budget stood at a “whopping $243 billion,” which represented a 500% increase since 9/11, “an increase higher than that of any other federal agency” and greater than “the combined budgets of the Department of State, the US Agency for International Development, the Department of Justice, and the entire intelligence community.” Meanwhile, according to Jonathan Vespa of the U.S. Census Bureau, the veteran population declined by a third between 2000 and 2018, from 26.4 million to 18 million; according to VA statistics, the average decrease at the state level from 2000 to 2020 was 25%. And while today’s population of U.S. veterans totals around 17 million, not all those who served in the U.S. armed forces qualify for VA health care or the suite of disability, education, training, and home- and other loan programs. Yet the VA budget is hardly the only public money spent on veterans: The Institute for Veterans and Military Families (IVMF) at Syracuse University has calculated that the 50 states collectively spend more than $3.3 billion on veterans. Other federal agencies also fund veterans’ programs from their individual budgets.

Most people assume that the entire point of the VA is to provide health care to those who served, but by law and by statute, this is not the case. Of the 17 million former active-duty members of the armed forces (to say nothing of those who served exclusively in the Reserves or National Guard), about 9 million are “enrolled” in the VA’s healthcare system, which spans 1,255 healthcare facilities (most of which are east of the Mississippi River, reflecting 20th-century population patterns rather than those of 21st-century veterans). But according to the VA’s own documentation, in fiscal year 2020, the most recent year for which data are available, only around 6.4 million veterans were treated by the VA (in 2000, the number was half that).

In truth, the costs of providing health care to an aging veteran population that is on average older and sicker than the civilian population are undeniably large, and they are increasing along with healthcare costs in general. The expanding number of veterans using community care paid for by the VA, thanks to the Mission Act (which took effect in 2019), has also required increased budget lines for the VA. And the VA has had additional financial burdens placed on it thanks to the Forever GI Bill (2017), the Blue Water Navy Act (2019), and court cases related to them, with yet more costs to come from the massively expensive PACT Act, which addresses the needs of veterans exposed to toxic substances while serving (2022). But veterans’ advocates and VA cheerleaders also need to be honest in their portrayal of and rhetoric about the numbers of veterans that the VA can and does serve — whether in its health system or otherwise — as a proportion of the entire veteran population. Not only do best accounting practices require such honesty, but it is a moral necessity stitched into the fabric of democratic trust between citizens and the government.

Admittedly, this task is harder than it seems: There has not been a full accounting of veterans since the 2000 census. The VA itself is operating off a statistical model developed by the National Center for Veterans Analysis and Statistics, the latest version being the Veterans Populations Projection Model 2020 (VetPop 2020). Importantly, VetPop only projects the population of living U.S. veterans; it doesn’t have an actual number. Its numbers are frequently at odds with other data sources, such as the Census Bureau’s American Community Survey — sometimes by as much as 70% at the regional level. The differences matter, because it is VetPop that, as the agency’s overview explains, “is used for strategic, policy planning, and budgeting within the VA and by external organizations such as other federal agencies, Congress, state governments and other organizations.” Furthermore, even using the very same model, states, counties, and the federal government are frequently arriving at different numbers of veterans, as I discovered a few years ago in the course of researching an American Enterprise Institute report, “Mapping Veterans: Not Who You Think, Not Where You Think.”

No wonder even RAND, which operates federally funded research-and-development centers, has castigated the VA for having an extraordinarily complex, decidedly not transparent budget process. In a 2015 report, RAND expressed concerns that the VA “develops its budget from older data” and that “there can be problems with the assumptions used in this process.”

But there is another, frequently overlooked reason for the agency’s skyrocketing healthcare costs: There has been a substantial rise in the number of veterans, both with and without service-connected disabilities, who either have suddenly qualified for VA disability compensation or have had their disability rating increased, allowing them to qualify for VA health benefits for the first time or for additional, higher levels of benefits. For example, in 2001, VA Secretary Anthony Principi expanded the definition of “disability” for veterans who had served in the Vietnam War, making any diabetes diagnosis presumptively connected to service (that is, the federal government would be required to assume that the diabetes was caused by the military service and so be financially responsible). The number of service-disabled veterans claiming diabetes quickly surged; in 2004, according to an American Economic Association analysis of government data, it was the most common condition reported among Vietnam-era benefit recipients.

It should be noted that the disability-rating system itself is one of the oddities of the VA. Put the simplest way, the VA rates disability in increments of 10 percentage points to designate the severity of a particular health problem and its impact on the veteran’s ability to work and perform daily activities; each problem is rated separately, and the separate ratings are added up. This system creates its own incentive for veterans to reach a rating of 100%.

Diabetes was not the only condition to be classified as presumptively service-connected. Over the past 20 years, the VA has been steadily expanding its disability policies to categorize chronic fatigue and several other medical conditions as presumptively connected, whether for veterans of Vietnam or those of more recent wars. Now, with the passage of the PACT Act, not only will a large group of veterans who were exposed to toxic substances while serving be eligible for increased disability compensation and expanded healthcare services, but a large group of veterans without service-connected disabilities are suddenly eligible to use VA health care. (In March, President Biden expanded eligibility yet again, eliminating the act’s original eight-year phased-in approach.) This, as the nonpartisan Congressional Budget Office has noted, is going to be very expensive, amounting to at least $102 billion, over a decade, in healthcare costs alone.

Nonetheless, the expanding coverage and costs of its health care are not, in fact, the main driver of the VA’s ballooning budget. That would be the Veterans Benefit Administration, specifically the VA Disability Compensation (VADC) program, which alone now has a $137.7 billion price tag. VADC, part of what the Peter G. Peterson Foundation labels “VA income security programs,” has exploded in spending as the number of veterans applying to receive payments has leapt from 2.3 million in 2000 to 3.5 million in 2013 to over 5.4 million in 2022, and as those inflation-adjusted disability payments have leapt from an average of $11,900 to $20,686 per recipient. From 1950 to 2000, only around 9% of veterans ever received service-connected disability benefits. It’s now north of 25%. Notably, however, that number reaches an astounding 41% among post-9/11 veterans, who also record higher disability ratings (and therefore can be awarded more money) than all of the other veteran cohorts, and despite a smaller proportion (only 10%) of the all-volunteer force being in officially combat-related roles. What, then, has fueled this growth?

The superficial, easy answer is the aging of the veteran population: More veterans have become eligible beneficiaries as they’ve gotten older. Related to that answer is the expansion of medical conditions that the VA allows veterans to cite in disability claims (as with Vietnam-era veterans and diabetes). Today, missing a limb is far from being the main form of service-connected disability; rather, the two most common conditions for which disability payments are made are tinnitus and diminished hearing.

A second surface answer is the two decades of fighting in Afghanistan and Iraq. Advances in battlefield medicine and rapid evacuations to treatment centers have meant that more soldiers, sailors, airmen, and Marines are surviving wounds that would have killed them in previous wars. There’s also a heightened awareness of traumatic brain injury — the signature injury of the Global War on Terror — and widespread acceptance of the need for mental-health screenings related to post-traumatic stress (PTS). Higher awareness and societal acceptance of these conditions and treatments lead to more diagnoses.

But there are other, harder answers, and they are very unpopular among veterans’ lobbying groups (the Veterans Service Organizations) and at the VA. These answers have to do with the outdatedness of the VA’s disability system, a 100-year-old program on autopilot whose assumptions are all based on industrial-age employment and health models (for instance, that disability equals loss of limb and therefore permanent earnings loss because the person can no longer participate in the workforce). They are also related to the fact that, however well intentioned, the VA’s disability policies create perverse incentives for veterans to become sicker, not healthier. And they have to do, as well, with a change of mentality among the youngest generation of veterans, who appear to view disability compensation as a right they are owed by the mere fact of having served during wartime and are subsequently using that compensation as an alternative pension system. (Typically, to qualify for a military pension, one must have served for at least 20 years; the youngest veterans have, of course, not served so long.)

But the most unpopular answers of all have to do with symptom misrepresentation or malingering, especially among applicants for service-connected disability pensions for PTS, and with instances of deliberate fraud — whether perpetrated by civilians, employees at the VA, or veterans themselves — on the federal veterans’-support system.

A handful of large-scale economic studies by economists at various institutes and universities, including Stanford, have uncovered some correlated dynamics in the surge in veteran disability-compensation beneficiaries, especially for those veterans given the highest disability ratings (70% or more), over the past two decades. As Mark Duggan and Audrey Guo wrote in 2021 in the Hill, their research, with Courtney Coile, showed that the VA’s continual expansion of the list of medical conditions considered “presumptive” is directly linked to the tripling, since 2000, of the number of veterans receiving service-connected disability benefits. These researchers also found that the expansion seems to have had the negative “unintended consequence of substantially reducing employment among veterans.”

Outside of purely fiscal considerations, this is an inherently troubling finding, as decades of corresponding research proves that participation in the workforce is the main determinant of veterans’ successful transition to civilian life. “Success through work,” as political economist Nicholas Eberstadt wrote in the Wall Street Journal in 2022, “no matter one’s station, is a key to self-esteem, independence and belonging”; arguably, veterans need these three things even more distinctly than do civilians. But to date, seemingly no one has connected the importance of work with the well-being of veterans: Whereas in the 1990s American veterans were more likely than nonveterans to be in the labor force, by 2013 only three-quarters of male veterans aged 18 to 64 were in the workforce, compared with four-fifths of nonveterans of the same ages. As noted in the Economist in 2015, that drop coincided with the timing of the increased participation in and larger payouts from the VADC program, especially among Vietnam veterans. By 2013–14, the rapidly increasing rates of veteran suicides gaining national attention were largely driven by the rates of suicide for veterans aged 50 and over. It was often said in the 2010s that “20 vets die a day by suicide”; of those suicides, 65% were among the age cohort of Vietnam-era vets, then the largest population of U.S. veterans. The transition out of the workforce appears to be especially deadly for veterans. And yet of the billions that have been spent over the last decade by the VA on suicide-prevention programs, the focus has been on anything but those older vets.

The same trends — more medical conditions recognized by VADC, increased participation in VADC, a substantial increase in the average inflation-adjusted VADC benefit, and decreased participation in the workforce — are now playing out among Gulf War and post-9/11 veterans. (Note that VADC recipients are not prohibited from working or collecting other disability benefits, such as Social Security Disability Insurance.) It’s noticeable enough to have driven post-9/11 veteran Daniel Gade, who is an amputee, and former Wall Street Journal reporter Dan Xin Huang to write Wounding Warriors: How Bad Policy Is Making Veterans Sicker and Poorer (2021). The authors not only uncovered that disability compensation is too often separating veterans from work and community but also that the now overbroad labeling of disabilities is “causing veterans to adopt a disability-focused identity, which marks them as flawed and broken in their own eyes and the eyes of society.”

In combing through hard data and interviews with veterans, VA clinicians, and administrators, Gade and Huang discovered that, to use the words of one of the VA’s own psychologists, many veterans see disability payments as a “formal, belated recognition by the United States government of the individual’s sacrifices.” Why this is so is complex and no doubt partly influenced by the dynamics of an arguably too-small military tasked with carrying out a 20-year war. But another factor, as Brandon Archuleta lays out in his book Twenty Years of Service (2020), might be the Defense Department’s policy requiring two decades of service to qualify for military pensions. Only 17% of enlisted service members and 49% of officers currently stay in service long enough to qualify for a pension, Archuleta notes; but 12 years and eight deployments in the Special Forces do a lot more to a body than, say, 20 years performing in one of the armed forces’ musical bands. Veterans who see inequities in that situation might view disability compensation as a remedy.

At the same time, as shown by medical research, the cash incentives of disability compensation affect the way some veterans present their symptoms to VA evaluators. The VA seems to prioritize the disability-compensation ratings rather than actually treating the underlying condition: Only 0.1% of veterans receiving disability benefits for mental disorders report an improvement in their condition and have their benefits accordingly reduced over time. The others tend to reapply repeatedly for an increase in their disability rating until they reach 100% — and even then, the VA is not tying the benefits to a requirement for actual treatment, as Gade and Huang discovered, even though it is now well documented that PTS is a treatable condition. In addition, what we popularly and casually term “PTSD” is more often than not “transition stress” and distinct from clinical PTSD (the D for “disorder”), as Columbia University researchers Meaghan Mobbs and George Bonanno argued in a 2017 paper.

None of this is to discount the real suffering induced by post-traumatic stress or to deny that some veterans should receive disability compensation. PTS is real, and the definable subpopulation of veterans who have it need access to treatment. But it is also true that some significant number of veterans and civilians are exploiting the VA’s policy priorities and weak accountability measures. Even a week on the email list of the VA Office of Inspector General gives one shocking insight into the thousands of fraudulent schemes perpetrated by a variety of culprits — veterans, family members, VA employees, and civilians — all after VA monies. These schemes can amount to millions of dollars awarded per individual.

Such distasteful, unwelcome facts matter. Persistent fraud as a result of VA policy failures draws resources and attention away from those most in need of treatment for PTS and debilitating depression. The rewarding or encouraging of fraudulence is causing great cynicism and mistrust among generational cohorts of the veteran community, and among veterans toward the VA. Among those who have served, the ongoing discussion about who is “really a vet,” and how that status should be tied to benefits and public recognition, is frequently contentious, even if it is largely playing out under the radar of our national consciousness. It has its own effect not only on the willingness of upcoming generations to serve in the military but also on our present state of civic distrust.

“You don’t go to a veterans’ assembly and say, ‘We’re not going to help the veterans,’ ” said Democratic Vermont senator Patrick Leahy during the 2018 VA budget skirmishes. Congress has understood “help” as “money,” reflexively voting to increase federal funding for VA programs without first analyzing those programs and the system and behaviors they have created. Successive presidents have endorsed that approach. But good intentions don’t make good policy, and more money doesn’t make bad policy better. Powerful vested interests are isolated and insulated from mainstream policy-making, largely because of the deference civilians give to veterans and the symbolic role that the VA plays in fulfilling the nation’s gratitude toward those who have sacrificed to defend it. Veterans’ policy now resists any attempts to question its assumptions, let alone reform it. And this has a cost in veterans’ well-being.

In 1977, with lawmakers fearing political repercussions for supporting reform, Congress trashed the reforms proposed in a 1973 congressionally mandated study of the VA by the National Academy of Sciences. The study’s lead author, Saul Farber, publicly threw his hands up in the air. “In this political arena,” he said, “it seems our arms are too short to box with God.” But as the VA has consistently shown in the decades since, in both its public and its private scandals, it does not play God to veterans very successfully: According to the 2023 National Veteran Suicide Prevention Report, “in 2021, 6,392 Veterans died by suicide, 114 more than in 2020. Suicide remains the 13th leading cause of death for Veterans overall.” When the VA released its 2022 report, what was most notable was its absolute silence about its most striking graphic: Since 2001, the level of veteran suicides has always fluctuated within a range of 800, meaning that in 20 years there has essentially been no change. And despite the ever-increasing funding meant to reduce veteran homelessness, that also has recently risen.

Real improvement at the Department of Veterans Affairs will require policy-makers courageous enough and rebellious enough not to legislate by feelings alone and not to spend more money by reflex. The federal government should undertake a serious re-evaluation of what are and are not beneficial outcomes for our veterans and the whole of the country of which they are part.