Veterans' advocates — including lawmakers and the newly appointed leaders of the Veterans Affairs Department — are pushing sweeping reforms in benefits and management practices to modernize the system.
Sen. Daniel Akaka, D-Hawai'i, chairman of the Veterans' Affairs Committee, is shepherding legislation that would enhance education benefits, increase access to medical care and raise income ceilings that cut off access to services.
"This legislation expands insurance programs and secures cost-of-living increases for certain benefits, some of which have not been updated for decades," Akaka said.
All this comes as the VA is facing new challenges dealing with wounded veterans from two ongoing wars — many in need of extensive medical care.
Almost 40 percent of the veterans who have served in Iraq and Afghanistan have sought help through the VA health system, with 300,000 reporting mental health conditions. Suicides among veterans who saw combat in Iraq and Afghanistan have spiked.
The VA budget is still in its earliest stages, but rough estimates of the cost of some of these reforms reach the tens of billions of dollars.
Many veterans applaud the reforms but contend that the VA has a long way to go to regain its credibility.
And many say the Obama administration hasn't helped much lately.
Last month, the administration rescinded a proposal to charge insurers for the treatment of service-connected disabilities or illnesses after it raised hackles among vets.
Meanwhile, according to Senate testimony from top VA officials, waiting periods on benefit claims are sometimes six months or longer.
Reports by the Government Accountability Office in recent years have concluded that the VA has concealed funding problems and failed to implement key recommendations to improve treatment for veterans suffering from post-traumatic stress disorder.
"Both veterans and the VA staff have long been done a disservice by a top-down bureaucracy that has failed to be honest with Congress and (is) resistant to change," said Sen. Patty Murray, D-Wash.
The VA's new secretary, former Army Gen. Eric Shinseki, has promised to modernize the agency and streamline the delivery of benefits. He has said his top priorities include implementing the new Veterans' Assistance Act, which expands educational benefits for military veterans who have served since Sept. 11, 2001.
He has also promised to try to expand benefits to many middle-income veterans who were excluded under the Bush administration because they made more than about $30,000 annually.
But perhaps one of the most daunting challenges the VA faces is providing care to veterans who don't live near VA facilities. This includes a large number of National Guard members and reservists who have served in Iraq and Afghanistan.
These service members face challenges different from their active-duty counterparts, who typically return to military bases and all the support they provide.
Thomas Loftus, a Vietnam-era veteran now living in rural Virginia, said VA care, especially for those with complex brain injuries, is hours away.
"A three- to four-hour trip can be overwhelming for veterans with traumatic brain injury," he said. "At a minimum, there should be community-based personnel who can assess veterans for post-traumatic stress disorder and traumatic brain injury. Even for our veterans needing routine care for conditions like diabetes and high blood pressure, or group therapy for mental health conditions, they must travel one to two hours."
He suggested that the VA certify healthcare providers to work in community health centers, eliminating at least some of the travel for veterans.
One idea before Congress includes expanding benefits to cover emergency care for veterans outside the VA system.
Tammy Duckworth, a helicopter pilot severely wounded in Iraq and now up for a top position in the VA, told lawmakers Wed- nesday that if the VA "cannot be in every hometown across America, we will find partners who are."