On October 29, a disabled Navy veteran and blogger named Theresa Aldrich, who keeps other former service members informed about developments at the Department of Veterans Affairs (VA), tuned in to what seemed to be a routine session of the Senate Veterans’ Affairs Committee (SVAC). The hearing had an innocuous title, “Putting Veterans First,” and SVAC members invited a panel of witnesses to discuss the question “Is the Current VA Disability System Keeping Its Promise?”
Instead, Aldrich discovered, it was a Republican response to a four-part series in The Washington Post, which accused veterans of bilking the taxpayer out of billions of dollars. Little of the ensuing discussion focused on any needed improvements in the VA disability system, as opposed to just echoing the sensational claims of the Post—that there is an epidemic of veterans defrauding the disability system. All of this, she warned her readers, would “set the stage to cut benefits for 6.9 million veterans.”
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The Republican committee members’ star witness was Daniel Gade, a retired Army lieutenant colonel whose leg was amputated after combat injuries suffered in Iraq. The former Department of Veterans Services commissioner from Virginia (and failed Republican Senate candidate in the state) co-authored a 2021 book called Wounding Warriors: How Bad Policy Is Making Veterans Sicker and Poorer with former Wall Street Journal reporter Daniel Huang. In it, they argued that the “flood” of new disability claims we have seen over the past two decades is not due to two decades of forever wars. Instead, they assert, the system encourages “veterans to be sick and then we wonder why we have so many sick veterans.” VA disability ratings, Gade and Huang insist, have been “misapplied to mental health disorders like PTSD, which have been repeatedly demonstrated to improve with effective therapies.”
As Gade testified, “For too long, you’ve been told that the best way to care for veterans is to shovel billions of taxpayer dollars into their pockets; this approach has resulted in a veteran class that is sicker, more marginally employed, and more suicidal than ever.” He insisted that “by paying veterans to be sick, we create more sick veterans, separated from meaningful lives of purpose—and we deepen our suicide crisis.”
Worse still, he said, “the compensation system traps veterans in a disability identity, teaching them to chase a 100% rating as proof of honor or source of validation. 9 of the top 10 conditions for newly rated veterans are easily exaggerated or totally unverifiable.” The VA also compensates for—and the health care system treats—conditions that have no relationship to their military service but are a normal result of the aging process. Why should veterans who have hypertension or obesity get taxpayer-funded care and money because they’ve gotten “old and fat”?
“CALL YOUR SENATORS,” Aldrich urged veterans. “They’re questioning whether compensation should exist for anything short of total incapacity. And they’re using a decorated, disabled veteran to sell it.”
Opening Salvo
Aldrich is correct: This is a second front in the conservative war on the Department of Veterans Affairs, the second-largest federal agency. As the Prospect has reported in detail, over the past decade, Republicans in Congress have been fighting—and too often winning—on their first front, namely the campaign to privatize the VA-run Veterans Health Administration (VHA).
Until now, however, the veterans disability system—operated by the Veterans Benefits Administration (VBA)—has been a sacred cow for politicians of all stripes on Capitol Hill. If anything has united Republicans and Democrats, it has been that combat veterans and other former service members who sustained injuries or illnesses while serving in uniform deserve compensation. Alas, no longer.
Nearly seven million American veterans currently receive VA payments for service-related physical or mental health conditions that left them partially or totally impaired; among them are 1.3 million men and women who served in Iraq and Afghanistan. In FY2025, their total compensation and pensions was $195 billion.
For decades now, the Republican Party has schemed to destroy “welfare” programs, to free up budget headroom for tax cuts for the rich, most recently taking an axe to Medicaid in the “Big Beautiful Bill.” Now, with Donald Trump in the White House, Russell Vought running the Office of Management and Budget (OMB), and Doug Collins as VA secretary—with a boost from The Washington Post—they are coming for veterans’ disability benefits.
Preparing the Attack
Two years after publication of Gade and Huang’s Wounding Warriors, Russell Vought, then president of the conservative think tank Center for Renewing America (CRA), contributed to a report that advocated reducing or eliminating benefits to veterans with higher incomes, or who have VA disability ratings lower than 30 percent. CRA also proposed eliminating compensation for veterans whose conditions are not directly related to military service, which, as we will see, would also eliminate VA care for those conditions.
The Heritage Foundation’s Project 2025 guidebook for dismantling the administrative state (which Vought helped to shape) also calls for “significant cost savings from revising disability rating awards for future claimants.” The disability system, it contends, too often compensates conditions that “are tenuously related or wholly unrelated to military service.” Project 2025 also targeted the “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 Toxins,” for elimination.
The word “presumptive” refers to VA policy that does not require that veterans who suffer from some conditions that may arise after discharge have to personally prove the connection between their military service and that particular illness. Instead, thanks in part to pressure from veterans, Congress has financed research that studies the health effects of various toxic exposures, from Agent Orange in Vietnam, to deployment-related PTSD, to burn pit exposures during the war on terror. If the science documents a relationship between a particular exposure and a series of health problems (say Agent Orange and prostate cancer), then the VA is authorized to change its regulations to grant compensation and provide care.
As Gulf War veteran and former VA official Paul Sullivan explains, “Without these presumptions, each and every veteran who has developed prostate cancer, for example, would be forced to prove that they received a specific dose of Agent Orange, at a specific place, at a specific time during military service and this would have to be confirmed by military records and a medical opinion specific to that veteran.”
These hard-won “presumptions” are critical to veterans whose illnesses or conditions may not show up for years, even decades, after they leave the military. Jeff Roy is a 77-year-old Marine veteran who served in Vietnam between 1968 and 1969, where he was repeatedly exposed to Agent Orange. More than five decades later, he was diagnosed with prostate cancer. “How,” Roy asks, “after 50 years, could I even prove that I was in places, much less at a specific time when I received a specific dose of Agent Orange?”
As we shall see below, even with presumptive conditions there can be disputes with the VA about processing claims, which is why there are not only VBA claims processors but a VA Board of Veterans’ Appeals, and even a U.S. Court of Veterans Appeals, which operate outside the VA.
The Post Critique
In October, Washington Post reporters published the four articles, accompanied by two YouTube videos, to which Aldrich referred in her post. The first article, entitled “How Some Veterans Exploit $193 Billion VA Program, Due to Lax Controls,” was introduced by a lurid graphic in which disembodied hands try to grab a stack of government checks. The writers then claim that veterans are “swamping” the system with frivolous claims for problems like migraines, tinnitus, as well as those that are impossible to verify, like chronic pain and PTSD.
The VA system, they argue, is failing to “keep up with medical advances and changes in the workplace.” The current VA disability system “was designed 80 years ago to provide a safety net for unemployable veterans wounded or injured during World II. Today, the vast majority of disabled veterans under age 65 still work and collect paychecks from full-time jobs, records show.”
They contrast the VA system with disability programs like state workers’ compensation or the federal Social Security disability system that “help only people who certify that they are incapacitated or severely impaired in their ability to work.”
In their second story, the reporters present accounts of veterans who have committed rampant fraud—pretending they are blind when they can see, or that they are paralyzed when they are videoed doing backflips. “Veterans,” the reporters contend, can easily defraud the government presenting complaints like “depression, back pain, erectile dysfunction and migraine headaches [which] are difficult to confirm with objective medical tests.” Indeed, the reporters assert, the VA doesn’t adequately shepherd taxpayer dollars by rooting out fraud and abuse but is laxly managed and functions as “an honor system” in which VA “claims examiners usually take vets at their word.”
In response, veterans advocates like the Veterans of Foreign Wars (VFW), Paralyzed Veterans of America (PVA), and Disabled American Veterans (DAV) challenged these claims. Individual veterans have inundated the Post with irate comments. But Theresa Aldrich’s media criticism was the best: “Take 25 years of claims data, find the worst outliers, ignore 6.9 million legitimate beneficiaries, and boom—you’ve got your fraud narrative.”
The Wrong Problems
There are two immediate issues with the Post report. First, while no one disputes some cases of fraud, even Trump’s own VA inspector general, Cheryl Mason, testified in the hearing that there is no mass fraud by veterans. Barely containing her fury at the Post articles, Mason said, “Only 3.7% of our active fraud investigations” involve veteran suspects. In fact, she said, the largest percentage of fraud investigations in VA programs and operations is perpetrated against the VA and veterans. Reports from the Office of Inspector General document far more fraud and abuse committed by private-sector providers, who overbill the government for billions for care provided through the Veterans Community Care Program, as well as by private companies that charge veterans thousands to help them file VA claims (known as “claims sharks”). The attack on the VA disability system largely ignores these realities. (To be fair, the Post did a story on the claims sharks, but it made veterans appear to be their accomplices rather than their victims.)
More fundamentally, proponents of broad changes that would dismantle much of the system don’t seem to understand why the VA differs—intentionally—from the model of state workers’ comp programs, that VA disability ratings are connected to health care access, or even the complex nature of veterans’ military-related health conditions.
Let us start with the workers’ comp comparison. According to Steve Birnbaum, an attorney who represents injured workers—some of whom have been employed by contractors who work for the Department of Defense—state workers’ comp systems define disability very narrowly. “Workmen’s compensation claims are determined strictly on the basis of the impairment of a worker’s ability to compete in the open labor market. Pain, suffering, and emotional distress are not part of the workers’ compensation system,” Birnbaum said. To get any consideration of those impacts of illness or injury, a worker would have to sue in civil court.
In most states, benefit levels are too low. Employers fight workers’ claims. Rehabilitation services are fragmented and managed by private insurers. Workers only get treatment for the specific work-related illness or injury they filed a claim over. Meanwhile, if unable to return to their old workplace, they often lose whatever job-based health insurance they had and end up in financial distress because workers’ comp only covers medical bills for their job-related health problems.
The same is true of Social Security Disability Insurance, Birnbaum told the Prospect—benefits are meager, the qualification process is extremely burdensome, and the result is up-or-down. “To qualify for Social Security Disability, the question is binary, black-and-white, can you work or can’t you,” he said.
The VBA process can be much more realistic. VA’s disability “percentage ratings represent as far as can practicably be determined the average impairment in earnings” caused by any type of disease or injury encountered during service, or incidental to it, a former VBA official told the Prospect.
In practice, he explained, the VA may also consider the impact of “symptoms on quality of life.” As Ryan Gallucci, executive director of the Washington office of the Veterans of Foreign Wars, explained in the Senate hearing, VA disability payment “compensates for loss of earning capacity, for the daily toll of living with injuries and illness that never go away. A paycheck does not erase a traumatic brain injury. A job does not make a missing leg grow back.”
Furthermore, the former official explained, the system also recognizes that veterans might only be able to work under limited circumstances. Jim O’Brien, (a pseudonym because the veteran asked to remain anonymous), for instance, served in the Army during the Gulf War. There, he was exposed to burn pit fumes, smoke from burning oil rigs, and sarin gas. That left him with skin conditions, respiratory problems, and chronic neuropathy of his hands and feet, which leaves him unable to walk or stand without intense discomfort. Jim sought VA care and was turned away at first, but got it after filing a disability claim. He received treatment and was rated at 100 percent for these disabilities.
Thanks to VA education benefits, he was able to find good white-collar work and has been steadily employed since he left the service—which would not have happened without VBA benefits. Still, he said, if he could trade those payments for ending his chronic conditions, he would do so instantly.
Finally, unlike other workers’ comp systems, the VA is also compensating people who have traditionally been thought to be owed a sacred debt of gratitude. According to one former high-level VBA official, who requested anonymity, “as a government and society the VA is delivering on a moral and social agreement. We are working to honor the obligation that we will take care of you when you come home, if you defend this country. That’s not charity. That’s an earned benefit.”
As historian Jennifer Mittelstadt has explained, after the elimination of the draft and the establishment of an all-volunteer military, the U.S. developed a facsimile of a European-style welfare state, for a small sliver of the U.S. population. With a number of exceptions, access to free health care, education, and some financial compensation has proved essential to enticing recruits to join this all-volunteer force. Republicans and the Post would “Americanize” this program—reverting to stingy, extremely limited benefits that are very burdensome to access.
Narrowing the Scope of VA Care
In pursuing this agenda, one of the most disturbing ideas that benefit critics have floated is requiring the VA to only treat clearly identifiable service-related conditions. This was, in fact, standard operating procedure before 1994 when physician Kenneth W. Kizer, who had just been appointed VA undersecretary for health, began to make major changes in the system. Kizer realized that the idea of so limiting veterans’ health care made no sense.
“The human body does not respect bureaucratic rules established to make payment of benefits checks easier,” Kizer elaborates. “The human body is an integrated system. As clinicians, we know that if you are caring for a veteran who lost his leg from a blast explosion, and he later develops diabetes, you must treat that diabetes if you want to continue effectively treating his amputated limb. If his diabetes is not well controlled, he may develop a sore on his stump that will not heal. Then he won’t be able to wear his prosthesis and may even die from a systemic infection.” As multiple studies have shown, this model of integrated care has proved highly effective and should serve as an example for the rest of the system.
Kizer, with the assent of President Clinton and Congress, changed the system so that veterans were given care for both service- and non-service-related conditions. To reverse this long- established practice, Kizer argues, would turn back the clock on decades of treatment advances and gravely harm veterans’ health.
Veteran Care Relies on Disability
In fact, if anything, VA care is not generous enough. Most Americans think that all veterans receive free VA health care after leaving the service. This is not the case. With some exceptions, veterans must file and prove that they have a service-connected disability, which comes with a disability rating, to access VA health care. Proponents of cutting disability benefits typically ignore this fact. Based on these ratings, veterans are assigned to one of eight priority groups.
This system also dates back to the Kizer years, notably 1996, when Congress, at the behest of the VA, introduced major eligibility reform. “In order to make the provision of care more logical, Sen. Alan Simpson (R-WY), then chair of the Senate Veterans’ Affairs Committee, insisted that we have a mechanism to control costs by controlling the number of veterans who were eligible for care,” Kizer recounts. The compromise solution was the eight-tier priority system. Today, with some notable exceptions (if a veteran deployed to a war zone, that veteran can receive up to ten years of free care), that system is still in place.
According to this decades-old system, once the VA has approved a claim, then VA ratings start at zero and go up to 100 percent. Generally, a rating of zero does not provide compensation, but it does grant access to free health care. If Russell Vought has his way and eliminates disability ratings of 30 percent or less, millions of veterans could lose their health care.
The percentage rating system (known as “VA Math”) is quite complicated. For instance, ten disabilities rated at 10 percent do not usually add up to 100 percent, nor do two 50 percent ratings. Anything from 50 to 80 percent is possible. Nor are disability ratings given for life; they can change depending on conditions. Many veterans are discovering that their benefits are reduced if they undergo treatment. When Jeff Roy was operated on for his prostate cancer, he was sent a letter notifying him that his 100 percent rating had dropped to 20 percent—in spite of the fact that he was told he has active cancer, which has a nasty habit of returning even after remission. One VA primary care doctor confirmed this story to the Prospect. “I have a 76-year-old patient who has prostate cancer and who is afraid to get radiation treatment because he might lose his benefits.” The patient, who lives in a city where most housing is unaffordable to poorer or even middle-class veterans, fears that he will risk losing his housing.
Disability ratings also impact what kind of services veterans receive and how quickly they get them. Veterans who have lower disability ratings may be charged for care for their non-service- related conditions or be in a lower priority group for access to services. Veterans who have a 100 percent disability rating may receive services—like dental or nursing home care or access to vocational rehabilitation training—unavailable to people with lower ratings.
Similarly, while the VA is more generous than, say, Florida’s workers’ comp system, it’s not Norwegian either. The idea that a VBA claims adjustor simply rubber-stamps a claimant’s story is simply ludicrous, says Vietnam veteran Michael Blecker, former executive director of the San Francisco–based organization Swords to Plowshares. Blecker has spent decades representing veterans as they go through the arduous process of applying for benefits.
First, a veteran must fill out myriad forms (which if done incorrectly can in and of itself result in a denial) that provide information that demonstrates they are eligible for the benefit. This involves proving that the veteran has the right discharge status from the military (usually honorable), and has deployed in a war zone, or a place where they were subject to a toxic exposure or experience. All of this must then be confirmed by records from the Department of Defense.
The VA doesn’t take it on faith that a veteran has a presumptive condition; they have to prove they were in the service and in a place where the toxic exposures occurred. As Paul Sullivan told the Prospect, “You can’t just walk into the VBA and say, ‘Oh, I was poisoned by water in Camp Lejeune,’ you have to prove that you were in Camp Lejeune within the right dates for the required amount of time.” This, in turn, involves providing extensive medical records and/or having what is called a “C&P” (compensation and pension) exam, in which doctors, usually private contractors with the VA, try to verify that the veteran has the medical condition.
In many cases, claims are in fact denied, which can then result in an even more complex process of appealing the VA’s decision to various entities like VA reviewers, or the Board of Veterans’ Appeals. Often, veterans do not appeal and will not get benefits or care. Or they may have to wait years to find out their claim was granted.
The entire process can be so convoluted and cumbersome that veterans are always advised to get help from accredited veterans service or legal representatives. Without it, says Blecker, the game is too often stacked against the veteran. “For most veterans,” he says, “it’s like trying to face a fastball pitcher without a bat. There is no honor system where you have the benefit of the doubt, none at all. In fact, the VA isn’t even required to return a decision in a timely fashion and veterans can be left for years, even decades, without a decision.”
Theresa Aldrich couldn’t agree more. She told the Prospect that she started her website and continues to help veterans deal with the system not because it responds to and grants claims so rapidly but because its claims processing is so cumbersome. “Daniel Gade says that getting VA disability makes my life meaningless and has trapped me in idleness,” she told the Prospect. That’s not true, she says: “It gave me the stability to build platforms that have helped thousands of veterans win their claims and understand their benefits.”
Ripe for Reform
There is no disagreement that the VA disability system should be more rational, efficient, and produce speedier results. But, just like in debates about reforming state workers’ comp programs, the interests of injured workers and their former employers are not always aligned.
Ken Kizer has one big reform idea that would be popular with the half of all veterans not currently eligible for VA care, and likely the rest, too. “If we eliminated the connection between compensation and care and gave everyone who has served in the military access to health care upon discharge, that would do a lot to simplify the system,” he argues. “It would discourage veterans from trying to accumulate multiple ratings in order to get the care they were promised when they enlisted. It would lead to less tension between veterans and the VA.” Scrapping the enormous eligibility bureaucracy would also save a lot of money.
Gade actually favors this idea, though he wants to otherwise slash veterans’ benefits. He, Vought, and the other Republican “entitlement reformers” are likely to view any actual expansion in VA generosity with horror. Not only would it possibly cost money, it would be one step closer to universal health care coverage, free higher education modeled on the GI bill, or even student loan forgiveness by the federal government. When Gade ran for Senate in Virginia five years ago, he told state voters that would be “an immoral transfer of risk.” He lost.