"So the situation wasn't getting better; it just added another forum that made it harder to get things done," said Sherman Gillums, an associate executive director with Paralyzed Veterans of America. "We attribute a lot of the early trouble—not the current backlog, but early trouble—to this, because it created an institutional laziness or institutional inefficiency and made that a part of the culture at the VA. People just accepted claims sitting around a long time because they had to do all of this other stuff.
"So if there is a snowball in all of this, I would say that's the little tiny thing that would eventually become the avalanche," he said.
President George W. Bush
The Bush administration sent troops to Iraq and Afghanistan, but when those troops came home injured, the Defense Department failed to adequately communicate it to the agency tasked with helping them.
Early on, the department was publicly counting only about a third of the casualties stemming from the War on Terror. That was because the Department was only counting servicemen and women immediately targeted in the department's wounded-in-action statistics. That accounting method left out those who were not targeted but were wounded nonetheless, such as troops injured when they were riding two trucks back from one that was hit by a roadside bomb, or those hurt in training or transportation.
The underreporting made it more difficult for the VA to prepare for the coming influx of requests for help. The poor sharing of information—including medical records—between the two agencies has long been a bone of contention, and it remains a challenge (albeit one that is improving) to this day.
"It's not surprising, really, that the VA ended up being poorly prepared for what happened, given the way that they were planning," said Harvard Kennedy School's Bilmes. "There was absolutely a lack of planning, a lack of capacity for planning .... They didn't know what hit them. They were completely overwhelmed."
Additionally, the VA's claims-processing time skyrocketed early in the Bush years. In 2002, it took the VA an average of 224 days to complete claims, as compared with 166 days in 1999.
While the agency was hampered by plenty of external factors, it is hardly an innocent victim. Agency leadership allowed its problems to fester and its infrastructure to crumble.
For example, the VA did not have a digital way to process claims nationwide until 2013, instead relying on an inefficient paper filing system. By comparison, the IRS rolled out its electronic filing system across the country—albeit with some problems—in 1990.
It's just one area where the agency was too slow to react to changes in the world around it.
Even by the mid-2000s, several years after 9/11, the VA was using out-of-date claims projections it had based on injury estimates that used assumptions from older wars. Due to medical advances, many service members who would have died from their injuries in past wars are now being saved. That means fewer deaths, but it also means more wounded veterans, a development the agency failed to anticipate and was slow to adapt to.
And agency leaders at times failed to request the funding needed to do their duty.
In 2005, under VA Secretary Jim Nicholson, after originally denying its fiscal predicament, it came out that the VA faced a $3 billion shortfall in funding for veterans health care. The situation required emergency supplemental funding from Congress.
"There was a leadership attitude that was not aggressive in pushing back against whatever administration … or even quietly going to Congress and saying we need more people," said Gerald Manar, national veterans service deputy director at the Veterans of Foreign Wars and a former 30-year VA employee.
Kennedy to Nixon to George H.W. Bush—and every president in between
In many ways, the Obama administration is paying for the negligence of past administrations, dating all the way back to President John F. Kennedy, who authorized the decade-long use of Agent Orange in Vietnam.
But it wasn't just Kennedy. Under President Johnson, Agent Orange was the dominant chemical used during the war. President Nixon halted its use, but a long line of presidents either refused to acknowledge the damage done or failed to address it.
President Carter's VA created the Agent Orange registry, where veterans who were worried about potential side effects could be examined. But four years later, a GAO report found that 55 percent of respondents felt that the VA's Agent Orange examinations either weren't thorough or they received little or no information on what long-term health impacts exposure could cause.
And President Reagan's legacy includes a damning congressional report from 1990 that found: "The Reagan administration had adopted a legal strategy of refusing liability in military and civilian cases of contamination involving toxic chemicals and nuclear radiation .... The Federal Government has suppressed or minimized findings of ill health effects among Vietnam veterans that could be linked to Agent Orange exposure."
Progress has been slow. Vietnam veterans won a major victory under President George H.W. Bush when Congress passed legislation allowing the VA secretary to make certain diseases, including Hodgkin's disease and non-Hodgkin's lymphoma, "presumptive" to Agent Orange exposure. This means that the VA automatically assumes the diseases are related to the defoliant that the veterans encountered during their military service, making it easier for them to collect disability payments.
The government's long-standing failure to address the damage done to veterans by Agent Orange mirrors the larger failure of the VA. It spans generations and party affiliations, and every effort to fix it comes with unintended consequences.
"This goes across party lines," said Ronald Abrams, the joint executive director with the National Veterans Legal Services Program, and a former VA official who has worked on veterans claims cases for 40 years. "Democrats and Republicans have allowed this festering sore to continue."