A blue mobile medical unit arrives outside shelters and transitional housing facilities in Tulsa, Oklahoma, where homeless veterans reside. Inside, a small group of VA healthcare professionals set up an exam room with blood pressure cuffs, stethoscopes, and other basic medical equipment. They then start treating patients who might otherwise fall through every loophole in the system. It provides a glimpse of what the Department of Veterans Affairs is truly designed to do once the politics settle down. It’s unglamorous work, far from the press conferences and performance metrics.

In the US, the VA is the biggest integrated healthcare system. In fiscal year 2025 alone, there were 170 medical centers, over 1,700 facilities, and 82 million appointments. The PACT Act, which President Biden signed in 2022, made millions of veterans newly eligible for care following service-related exposure to burn pits and other toxic substances. As a result, the operation’s scope is truly astounding and the population it serves is expanding rather than contracting. That law was bipartisan and widely supported. It has had a more complex downstream impact on the VA’s capacity.

Wait times at VA facilities are getting better, according to VA Secretary Doug Collins, who has been making this claim frequently and with considerable confidence. He informed lawmakers in February that “we’ve actually seen over the past year our wait times stabilize or go down.” He wrote in March that VA is “slashing wait times” and that it’s “a new day at VA.” He has referred to it in recent weeks as a “great transformation.” A more complex picture is provided by the internal data, which was acquired through a Freedom of Information Act request and examined by Government Executive.

In the first four months of fiscal year 2026, over ten major specialties were examined across 134 of the VA’s 170 medical centers. Approximately 42 percent of specialty-facility combinations saw patients wait longer for appointments than they had during the same period the year before. Just 37% reported improvements. Just 7% of neurology facilities were able to provide veterans with an appointment within 28 days, as required by the VA. Neurology wait times at the VA medical center in Omaha increased from an average of 27 days to 127 days. From 87 to 130 days in Dallas. These figures don’t represent an organization that has successfully made a turnaround.

Promise vs. Reality: What’s Actually Happening at the Department of Veterans Affairs Right Now

The percentage of facilities that met VA’s own standards decreased annually in the areas of physical therapy, oncology, and drug use disorder treatment. Wait times for oncology appointments worsened in half of the facilities. At a sizable portion of facilities, neurology and PTSD treatment—possibly the two specialties most urgently needed by veterans returning from recent conflicts—showed declining performance. Senator Jerry Moran, a Republican from Kansas who chairs the Senate Veterans Affairs Committee, stated unequivocally that “there is still more work to be done,” pointing out that no veteran dealing with mental health issues, addiction, or cancer should have to wait months for care they have earned.

Although VA officials contest the framing, the staffing picture is part of the explanation. Collins worked to drastically cut the department’s workforce, first proposing a goal of 80,000 jobs before deciding on 30,000 for fiscal year 2025. The VA’s healthcare division has lost a net 18,626 workers since Trump took office, including about 1,100 doctors, almost 3,000 nurses, and 800 medical support assistants who manage the logistically crucial task of making appointments. After analyzing the data, Dr. Steven Braverman, who was the chief operating officer of VHA and had previously worked in Army medicine for almost thirty years, came to the conclusion that “efficiency or productivity improvements won’t be fixed by the gap between demand and capacity.” To meet the rising demand, that calls for hiring more people or building more clinical facilities.”

President Trump signed an executive order this month directing federal agencies to establish pathways for investigational psychedelic therapies, which is addressing a different aspect of the VA’s problem in Austin. Veterans like Natasha Bajic, an Army veteran who spent 17 years in VA therapy programs for PTSD before traveling to Peru for an Ayahuasca treatment that she described as more transformative than everything that came before it combined, expressed cautious hope and sincere enthusiasm for the move. “Three nights in the jungle changed my life completely,” she replied. In the context of a federal healthcare system that handled 82 million appointments last year, there is something both encouraging and subtly damning about that sentence.

The tension that permeates everything is difficult to ignore. The VA has grown, seen more veterans, opened new facilities, and enrolled 100,000 new patients in 2026 more quickly than in prior years. Those are actual figures. However, staffing levels have decreased, wait times in critical specialties are worsening in many locations, and the discrepancy between official messaging and measured results is so obvious that even Republican senators are publicly pointing it out. The 2014 wait-time scandal, in which VA employees were discovered to be fabricating data, continues to serve as a warning standard. The agency has always operated in an environment where political performance and operational reality can diverge significantly. No one is implying that anything dramatic is currently taking place. However, VA’s institutional history should make everyone wary of repeating the pattern of claiming progress while the underlying data is still sorting itself out.