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Even by the mid-2000s, several years after 9/11, the VA was using out-of-date claims projections it had based on injury estimates that used assumptions from older wars.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.