The answer is more complicated than whether the Food and Drug Administration has approved it.

Inside the Department of Veterans Affairs, a treatment can pass one scientific hurdle and still face others before it becomes routine care.

VA says the process can involve research, clinical guidelines, medication reviews, patient-safety systems, ethics reviews and practical questions about whether the health system has the staff, space and equipment to deliver it.

“VA moves new treatments into practice through a step-by-step process,” Dr. Ilse Wiechers, a VA mental health official, told Military Times. “Only after a treatment is shown to be safe and effective does VA roll it out more broadly.”

It starts with evidence, but evidence is only the beginning.

A new treatment may start with research, move through increasingly larger clinical trials and, for drugs and certain medical devices, undergo FDA review. VA must then consider how the evidence applies to the veterans it serves and how a treatment fits into the health system.

The 2023 VA/DoD Clinical Practice Guideline for PTSD uses the GRADE methodology to evaluate the quality and strength of evidence and weigh the benefits and harms of treatment options. The guideline also considers patient perspectives and feasibility when developing recommendations.

The 2023 PTSD guideline applied GRADE more rigorously than the 2017 version, according to the guideline. That resulted in some recommendations being downgraded as the evidence was reevaluated.

Recommendations can change as research develops, and veteran-specific evidence can matter, too.

Wiechers said evidence involving veterans can be an important consideration when VA evaluates whether a treatment should become available, even when research in other populations is promising.

For PTSD, however, the 2023 VA/DoD guideline says a lack of data on veterans or service members alone did not alter its recommendations. That helps explain why FDA approval and VA availability are not necessarily the same thing.

How a treatment moves into VA care

Repetitive transcranial magnetic stimulation, or rTMS, offers a concrete example of how the VA adopts a new treatment.

The FDA approved rTMS for depression in 2008. According to VA, the department then conducted a large study involving veterans, tested the treatment in a pilot program at 35 VA sites and expanded access after the pilot.

VA says more than 60 of its facilities now offer rTMS, with some operating specialized clinics that combine it with other advanced depression treatments. Dr. Wiechers added that the success of the program’s original 35 clinics, as listed on the VA’s website, resulted in the program expanding to over 60 facilities.

The sequence illustrates the difference between FDA approval and VA implementation. VA says it studied rTMS in its own patient population, tested its delivery across multiple facilities, and then expanded access.

There is no single office that makes the decision.

Dr. Wiechers described a team-based process in which draft policies are shared with offices responsible for delivering or overseeing a treatment. That allows potential risks, downsides and ethical concerns to be identified before policies are finalized.

Among the offices involved, Dr. Wiechers identified the Office of Mental Health and its programs, including the National Center for PTSD; the Office of Suicide Prevention; Pharmacy Services; the National Center for Ethics in Health Care; Nursing Services; and Care Management & Social Work Services.

The considerations extend beyond whether a treatment works.

Wiechers said VA also considers whether it has enough trained clinicians, specialized equipment and space to deliver a treatment, as well as whether adding it could take resources away from other care.

For medications, another layer comes into play.

VA’s National Formulary establishes the department’s national preferred list of medications. Some medications also have Criteria for Use documents that establish evidence-based conditions or restrictions for prescribing.

VA says medication reviews can be prompted by new FDA approvals or research that could affect evidence-based prescribing, clinical practice or health outcomes for veterans.

The formulary process includes VA physicians, Pharmacy Benefits Management officials and Veterans Integrated Service Network pharmacist executives. Formulary documents are reviewed, and feedback is solicited from health care teams.

An FDA-approved medication, therefore, can be available in civilian medicine while having different prescribing conditions inside VA.

That distinction can be particularly important for treatments that carry significant risks or require specialized monitoring.

Emerging treatments test the boundaries

Emerging mental health treatments illustrate the difference between scientific promise and routine clinical care.

The VA/DoD PTSD guideline, for example, recommends against benzodiazepines for PTSD, citing a lack of evidence of benefit and known harms, such as drug dependence and addiction.

It also recommends against cannabis and cannabis-derived products for PTSD, citing a lack of well-designed randomized controlled trials and potentially serious side effects.

Veterans are questioning why their legal cannabis license can’t be considered by the VA.

“I have a medical cannabis license, and I have to pay for my medication out of pocket, but almost any other medication is covered by the VA,” explained George Canfield, a retired Army veteran.

“Why can’t VA offer some kind of subsidy to offset the cost of this naturally derived treatment? I don’t expect a VA-run dispensary, but I would like it to be more affordable since it’s what helps me more than any other medication I’ve tried,” he said. “And I’ve tried them all!”

Ketamine presents a different example. The VA/DoD guideline retained a weak recommendation against ketamine for PTSD, citing limitations in the evidence and a lack of demonstrated effectiveness for the condition.

Psychedelic-assisted therapies remain an area of active research, meaning promising findings do not by themselves establish a treatment as routine VA care.

VA has recently expanded its research into psychedelic therapies and is recruiting veteran participants for clinical trials in select regions.

For veterans, those distinctions can affect whether a treatment encountered outside VA is available or subject to different conditions within the federal health system.

What happens after a treatment works?

The process continues after a treatment enters clinical practice.

VA says it monitors treatments through individual reports of adverse events or other problems, ongoing quality monitoring and formal research.

If a patient experiences a bad reaction or other adverse outcome, local staff can report and investigate it. Dedicated safety programs can identify patterns that may warrant broader review or changes in guidance.

VA also evaluates how treatments perform in actual clinical practice, particularly when a new treatment is introduced or when policies governing its use change.

Once a treatment becomes standard care, researchers generally cannot create the same untreated comparison group used in many clinical trials.

Dr. Wiechers said the most rigorous safety and effectiveness checks tend to occur early, while a treatment is still being rolled out.

The process does not end there. VA and the Department of Defense periodically revisit clinical practice guidelines as evidence changes. The current 2023 VA/DoD PTSD guideline contains 34 evidence-based recommendations and is intended to assist, rather than replace, clinical judgment. The guideline is a tool for clinicians and does not define required care.

What veterans see at the end of the process

For a veteran sitting across from a VA clinician, much of this process is invisible.

The veteran sees a treatment that is available, restricted, unavailable or offered only through a clinical trial.

Behind that decision may be years of research, clinical practice guidelines, formulary reviews, safety monitoring and assessments of whether VA can deliver the treatment.

Dr. Wiechers said there are several reasons why a treatment may not be available to veterans.

“VA only offers treatments that have solid research behind them showing they help,” she said. When a treatment is not available, she said, it may be because “the evidence isn’t strong enough yet, or it hasn’t been proven to work well specifically for Veterans.”

There is no single moment when someone decides a treatment “works.”

Instead, VA describes a sequence of decisions involving evidence, safety, effectiveness for veterans, clinical guidance, feasibility and resources. Once a treatment reaches the clinic, monitoring and research continue.

The system is designed to answer a question bigger than whether a treatment works:

Is there enough evidence that it works for veterans, can VA deliver it safely and effectively, and should it become part of routine care?

Roughly 80% of mental health appointments made in the Veterans Affairs’ Community Care Program are scheduled within the department’s 30-day wait-time standard, but VA schedulers still struggle to meet the seven-day requirement for making these appointments, the VA Office of Inspector General has found.

The VA’s watchdog evaluated mental health referrals for community care at 133 VA medical systems and found that just five met the seven-day metric for scheduling the appointments.

But the inspectors also found that despite those delays, 80% of the referrals received appointments within 30 days.

Of those that didn’t meet the requirement, the average wait time for an appointment was 56 days.

In the report released Monday, OIG inspectors said the scheduling issues contributed to the delays in care, with staff often relying on telephone calls and postal mail to communicate with veterans.

Other roadblocks to timely referrals included providers not being available for the types of appointments veterans wanted and issues reaching providers, according to the report.

Delays in mental health consults are a problem because veterans who need the care may pose a risk to themselves and others without treatment, said Larry Reinkemeyer, assistant inspector general for audits and evaluation.

“Process improvements are needed to enable VA to meet its scheduling and appointment timeliness standards for mental health consults. Veterans who receive community care services for mental health consults represent a vulnerable group,” Reinkemeyer wrote in the report.

For the analysis, the OIG reviewed community care consults for mental health services from Oct. 1, 2024, through Sept. 30, 2025. More than 825,000 veterans received mental health treatment during that period, either directly from the VA — with more than 1 million consults to VA facilities — or 198,000 referrals for community care.

The analysts found that when an appointment did not meet the 30-day metric, scheduling delays consumed much of that window.

Community care is the VA’s program for veterans to receive medical services in the private sector with the cost covered by the VA.

By law, the VA must refer veterans to community care if the wait time for a primary or mental health care appointment at a VA facility is more than 20 days or the drive time is longer than 30 minutes.

Also by law, appointments must occur within 30 days to ensure patients have access to care.

The VA is in the process of reorganizing the management and structure of its medical arm, the Veterans Health Administration, to include reducing the number of regional offices and streamlining the leadership framework.

The reforms also will create a “Community Care Hub” designed to improve services to veterans by improving access to care, tracking payments and standardizing the referral/consult process.

The VA OIG made recommendations to improve the scheduling process, including: adjusting contracts for the companies that manage community care to ensure they can deliver timely care; evaluate its referral system to ensure that it follows best practices; improve its system for identifying available providers to ensure they can provide the care veterans want; and determine whether community care contractors can meet demand for in-person and tele health appointments.

In their response, VA officials said they have addressed several of the recommendations already and expect its new Community Care Network contracts to improve performance.

VA officials also said they were engaging with providers, its contractors and others to identify gaps and address them. They also noted that they are reviewing best practices for reaching patients and working with facilities to ensure that their schedulers are able to communicate with veterans and providers.

“The [Veterans Health Administration] greatly values the OIG’s assistance in ensuring that all stakeholders are unified in supporting VHA’s vision of providing all Veterans with access to the highest quality care,” wrote John Bartrum, the department’s former Under Secretary for Health.

The VA wants to remind veterans that same-day emergency mental health services are available at VA medical facilities as well as private emergency rooms at not cost to veterans — even if they aren’t enrolled in VA healthcare.

The number of veterans who have received care under the Emergent Suicide Crisis Benefit, provided under the Compact Act, has grew from 10,023 in fiscal 2023 to 15,218 in fiscal 2025, VA Press Secretary Quinn Slaven told Military Times on Wednesday.

It also helped 9,434 veterans in the first half of fiscal 2026.

“In FY25, VA covered a record-high $109,934,325 in acute suicide crisis care,” Slaven said. “VA employs several efforts to educate Veterans and non-VA emergency department staff about the availability of [Emergent Suicide Crisis Benefit]. Importantly, once crisis stabilization care has been provided, VA will work with all relevant parties to ensure eligible Veterans don’t get stuck with a bill.”

The 4.2% jobless rate for all veterans was up a tick from the 4.1% recorded in June, while the rate for post-9/11 veterans dropped from 4.8% in June to 4.7% in July. The unemployment rate for women veterans, meanwhile, went up from 3.6% in June to 3.8% in July.

The BLS report also included revised figures on the number of jobs added in June and May, which showed major downward trends. The initial May numbers showed that 129,000 jobs had been added, but that number was revised downward to 63,000. June’s initial job growth number was 57,000, but that number was revised to 20,000.

In addition, the BLS report stated, “Among the unemployed, the number of people on temporary layoff increased by 153,000 to 921,000 in July,” and the “number of permanent job losers changed little at 1.7 million.”

Friday’s BLS report came out the day after President Donald Trump declared at a Las Vegas rally that the U.S. economy was “the greatest in the history of the world,” although archived BLS reports show that the U.S. economy has added a total of 542,000 jobs over the 19 months of Trump’s second term, while nearly 2.7 million jobs were added in the last 19 months of the Biden administration.

In response to Friday’s report, White House aides put out not-to-worry statements noting job growth in construction and manufacturing.

White House spokesman Kush Desai said in a released statement that the “Trump industrial resurgence is on schedule.”

“Manufacturing (which added 5,000 jobs in July) and factory construction jobs grew again in July even as government payrolls continued to significantly shrink,” Desai said. “Unemployment claims are at record lows.”

On Fox Business News, White House National Economic Council Director Kevin Hassett said that the end of the FIFA World Cup was a factor in the number of jobs lost. He described it as a “sort of rebound from all the employment we got from the World Cup, because the World Cup was ending.”

Hassett’s comments contrasted with the analysis of other economists who have focused on the eventual long-term impact of artificial intelligence and the uncertainty over whether the chokehold on oil tankers passing through the Strait of Hormuz can be lifted.

“It’s a bleak (BLS) report,” Heather Long, chief economist for the Navy Federal Credit Union, said in a phone interview with Military Times. The report shows that “a lot of people are leaving the labor force,” and “there’s no doubt that the job market has flatlined in President Trump’s second term.”

“It’s just not a dynamic jobs market,” she added. “Tariffs and the war in Iran have caused companies to cut back” on hiring. To sidestep hiring slowdowns due to the impact of AI, “young people are looking again at trade schools.”

The BLS report also highlighted one of the great counter-intuitives of American economics: people losing their jobs can be good news for the stock markets, Long said.

By midday Friday, the Dow Industrial Average was up 50 points, possibly indicating that investors were betting on the gloomy jobs report making it unlikely that the Federal Reserve would raise interest rates in September.

The trial, known as the Psilocybin Intervention for Veterans Overcoming Treatment-Resistant Depression,” or PIVOT, study aims to include at least 240 veterans, all of whom have difficult-to-treat major depressive disorder and some who also have PTSD.

The study will take place at five VA medical centers through June 2031 and will assess patients’ levels of depression before and after treatment, side effects and overall response among participants.

“Far too many veterans are living with mental health conditions that don’t respond to available treatments,” VA Secretary Doug Collins said in a statement. “Under President [Donald] Trump, VA is pursuing all avenues to evaluate new treatments and offer meaningful relief for those who have worn the uniform. This clinical trial reflects another step toward this goal.”

Last month, researchers with Ohio State University’s Center for Psychedelic Drug Research and Education published the findings of a small, 12-person study on the safety of using psilocybin to treat severe PTSD in veterans.

After receiving eight hours of psychotherapy and two doses of synthetic psilocybin and integrative therapy, nine participants, or 75%, no longer met the clinical criteria for having PTSD.

According to the research, published July 30 in Communications Medicine, participants showed no serious adverse effects, including suicidal ideation or behavior. Non-serious side effects included headache, anxiety and dizziness.

“For a population with severe treatment-resistant PTSD, these results are striking,” said Stacey Armstrong, associate director and senior researcher at the center.

The PIVOT study will involve veterans with major depressive disorder who have not responded to current treatments, including those with or without a diagnosis of PTSD. In the double-blind, randomized trial, veterans will receive one dose of psilocybin or a placebo, along with therapeutic support. They will receive a second dose one month later, also with support, and will be evaluated two to four weeks following each session.

They also will receive follow-up six months after their participation.

VA officials said for the study, they will use pharmaceutical-grade drugs and treat veterans in a “safe, controlled, clinical setting.”

The five VA facilities that are slated to host the research include: the Birmingham VA Health Care System and Tuscaloosa VA Medical Center, Alabama; the VA Portland Health Care System, Oregon; Cpl. Michael Crescenz VA Medical Center, Philadelphia; and VA Puget Sound Health Care System, Seattle.

Trump signed an executive order in April directing the Food and Drug Administration to accelerate the review of some psychedelic therapies to treat mental health conditions. The order also required the FDA, the Department of Health and Human Services and the VA to collaborate on psychedelic research.

As a result of the order, HHS and the VA signed an agreement last month to increase coordination on research, including increasing clinical trial participation, training therapists, nurses and doctors to administer psychedelic medications if they are approved and collecting data and evidence to support patients, physicians and federal regulators.

According to the VA, its staff is involved in 20 current clinical trials focused on psychedelic treatments for mental health conditions, including MDMA and LSD.

Studies sponsored by the Multidisciplinary Association of Psychedelic Studies have shown that 87% of veteran participants in a study on the use of MDMA — the chemical compound known recreationally as Ecstasy or Molly — had significant improvement in PTSD symptoms four months after receiving treatments, and 71% no longer met the diagnostic criteria for PTSD at the end of the studies.

The advancement of MDMA as a treatment met a setback in 2024, however, when the Food and Drug Administration rejected an application to approve it as a PTSD treatment, requesting more research on its safety and efficacy.

VA officials said in a release on the PIVOT study Wednesday that they strongly discourage self-medication, and veterans should not “replace other mental health treatment options with psychedelics or any other unprescribed substances.”

“Proven, evidence-based treatments are currently available at VA facilities to treat Veterans with mental health conditions,” they wrote.

The fall lasted only seconds, but the consequences would span a lifetime.

Under the cover of darkness in Balad, Iraq, Army Sgt. Will Fisher was moving into position for an overnight mission. He fell roughly 40 feet and landed on his feet while wearing about 100 pounds of gear. The force of the fall crushed the talus bone in his right ankle and broke his back. He was medically evacuated to Landstuhl Regional Medical Center in Germany.

That fall eventually cost him his leg and his career — the latter more than a decade earlier than he had hoped, and five critical years short of his qualifying for a full military pension.

“I wasn’t planning to leave the Army,” he said. “The injuries made that decision for me, and that was it. The retirement I’d spent almost 15 years working towards was gone.”

Service members qualify for full pensions after two decades of service, but only 17% reach the necessary 20-year mark of eligibility, a 2011 Defense Department report found. An estimated 54,000 veterans sustain career-ending combat injuries before reaching that threshold.

Consequently, medically retired veterans lose part of their retirement pay because they also receive disability compensation from the Department of Veterans Affairs. Last fall, those reductions averaged roughly $1,650 a month, or nearly $20,000 a year, according to the Congressional Budget Office.

The Major Richard Star Act would change that. The bill — named after an Army major who was medically retired after being injured in combat — has backing from nearly 80 senators, more than 330 House members, and Defense Secretary Pete Hegseth.

“It is unacceptable that tens of thousands of combat-injured veterans are denied the full military benefits they earned,” said Sen. Richard Blumenthal (D-Conn.), one of the bill’s lead sponsors, who characterized the offset as “one of the deepest injustices in our present veterans’ disability system.”

Some lawmakers support the bill’s premise, but worry about the cost: $78 billion over a decade, according to the CBO.

Sen. Mike Crapo, an Idaho Republican, is one of them. In a statement provided to The War Horse, a spokesperson for Crapo said, “We owe combat-injured veterans nothing less than our full support when they return from their military service.”

But his office also said Crapo is concerned about the bill’s overall price tag and “remains willing to work with his colleagues to address cost-related concerns.”

The cost previously prompted Sen. Ron Johnson, R-Wisc., to block the legislation, arguing the long-term financial impact required greater scrutiny.

The cost question Congress hasn’t resolved

When it was introduced in 2023, the Major Richard Star Act applied only to those who were medically retired due to combat injuries and was estimated to cost about $10 billion to $13 billion over 10 years. Eligibility was later extended to an additional 255,000 medically retired veterans regardless of how they became injured, inflating costs nearly sevenfold over the same period.

In an effort to help it finally pass, lawmakers in June included the Major Richard Star Act as part of the Take Care of America’s Veterans Act (TCAVA), a legislative package with more than 60 veteran-related measures. The version in that bill would again limit the benefits to only those 54,000 injured in combat, according to advocates and legislative language reviewed by The War Horse.

Candace Wheeler, senior director of government and legislative affairs at the Tragedy Assistance Program for Survivors, said advocates ultimately focused on combat-injured retirees because broader proposals would “balloon the cost” and be harder to move through Congress. But after TCAVA failed to get a floor vote in July, its chances of passing this fiscal year are dwindling, leaving some confused about the status of the standalone bill.

According to congressional staff in Sen. Blumenthal’s office, lawmakers intended the amended Major Richard Star Act to extend eligibility to just 1,124 additional combat-wounded veterans, but the bill’s legislative language was interpreted by the DoD Office of the Actuary as applying to roughly 255,000 medically retired veterans, an estimate the Congressional Budget Office used in scoring the bill, accounting for the additional $68 billion.

However, Disabled American Veterans opposes the larger bill because of its funding mechanism, which would reduce future disability claims for some conditions, including tinnitus and sleep apnea. The group said the proposal asks one group of veterans to finance benefits for another and could set a precedent for future reductions in benefits.

“We would be 100% supportive without the poison pill,” said Todd Hunter, DAV’s deputy national communications director.

Currently, there are two similar bills before Congress: The original targeting combat-injured veterans only, and the expanded version that would apply to a broader group of medically retired veterans.

A career cut short five years before retirement

As lawmakers debate the cost, combat-injured veterans say they earned both their military retirement pay and disability benefits.

After serving eight years as a Marine and spending a few years as a civilian, Fisher joined the Army. He deployed repeatedly throughout Iraq, Afghanistan, Kosovo, Panama, and elsewhere. Then, on Oct. 19, 2009, while serving as an infantryman with Task Force 16, 155th Brigade Combat Team, in Balad, Iraq, rotor wash from a nearby U.S. helicopter knocked him from a ladder during overwatch operations, ending his career.

For four years, Fisher lived with chronic pain, heavy medications, and repeated efforts to save his right leg. Eventually, he chose to have it amputated below the knee.

“The pain was unbearable,” he said. “The surgeries didn’t work, and I was exhausted from daily medications that I didn’t want to be taking, and after all that, my right ankle was dead.”

Two days after surgery, Fisher was back on his feet. Nine weeks later, he was fitted with a prosthesis and walking.

“I have more legs than I have shoes,” said Fisher, who now owns 11 prosthetic legs.

Within months, he was running. Eight months after surgery, he returned to service as a volunteer firefighter. Later, he became Fort Hood’s first amputee civilian police officer, a job that allowed him to work alongside soldiers and train others for duties he once performed himself.

But because he served in that role as a civilian employee after medical retirement, the work did not count toward the 20 years of military service required for a full military pension.

The retirement they wanted but never received

Fisher wanted so badly to stay in the military that when the war with Iran began earlier this year, he called the recruiter’s office to ask whether the Army was taking retirees. He wanted to serve as a military police officer again, this time on active duty.

When Fisher left the Army in 2014, he had earned a military retirement worth $2,166 a month. He has never received it. The Army assigned him a 40% disability rating during his discharge process, which made him eligible for about $2,700 a month in disability compensation.

Under a federal policy known as the VA Waiver, Fisher’s disability compensation reduces his military retirement pay dollar for dollar. Since his disability pay exceeds the value of his retirement benefit, his retirement check is wiped out. But if both benefits were paid, Fisher’s monthly military-related income would be nearly $4,900.

“My retirement pay was earned through my years of service,” Fisher said. “My VA disability compensation is because I lost my leg serving my country. Those are two completely different things, and I don’t think one should cancel out the other.”

Fisher also earns a salary from his full-time job as a logistics manager for an appliance company. But he said the offset still affects his long-term financial stability. With the extra money, he would have more flexibility.

“I’d pay off debt, save some money, and I could enjoy my family a lot more,” he said.

Naomi Mathis understands the strain.

During the invasion of Iraq in 2003, the former Air Force staff sergeant’s convoy came under attack amid what she described as “total chaos.” Mathis witnessed the aftermath of multiple combat incidents, including the death of a fellow service member. After returning home, she was diagnosed with post-traumatic stress disorder.

The condition led to a 100% disability rating from the VA. She was medically retired after serving 7.5 years, far short of her goal of serving at least 20 years and eventually becoming a chief master sergeant.

Like Fisher, Mathis said the loss was not simply financial. It was the loss of a career she intended to finish.

“My career was cut short,” she said. “I was not given the opportunity to serve out those 20 or 30 years. But I would have.”

Mathis qualifies for a special combat-injury compensation fund that partially supplements the offset. Even with that assistance, the shortfall still stings: nearly $800 a month less than if she received her full retirement and disability pay.

With three young children at home, Mathis said financial pressure forced her back into the workforce before she had fully recovered.

“I couldn’t pay rent or feed my kids. I needed a job immediately,” she said. “I wasn’t able to heal.”

Mathis now serves as DAV’s deputy national legislative director. She said she remains grateful for the life she built after military service, but still believes the country’s promise to injured service members should not end when their careers are cut short.

“I signed my name on the dotted line, and I wasn’t just under the impression — I was told — that the military would be there for me when I put up my boots,” Mathis said. “Well, they put my boots up for me.”

Sen. Ruben Gallego, D-Ariz., has proposed barring the VA from collecting voluntary or involuntary separation pay from veterans who are approved to receive disability compensation.

The bill also would allow veterans who later qualify for military retirement pay to remit the net amount they received instead of the gross amount so they don’t end up paying more than they actually received after taxes.

Gallego, a former Marine and Iraq War veteran, and Rep. Gus Bilirakis, R-Fla, introduced a similar bill in the House when Gallego served in that chamber, but the legislation never made it out of committee.

The senator said the legislation is needed because the money is paid out for separate reasons: disability payments are akin to workman’s compensation and separation pay reflects “time served” — an incentive tool used by the Defense Department to manage force strength and design.

“It is ridiculous to claw back money from a veteran who has put life and limb on the line, just because later in life they qualify for disability benefits,” Gallego said in a statement to Military Times.

From 2013 to 2023, the VA recouped $2.44 billion in separation pay and bonuses from 112,834 veterans under a law that the department cites as prohibiting it from paying disability compensation to those who received the pay unless the money is paid back.

The VA has been required to recover the money since the 1940s, and the Defense Department is required to inform transitioning service members of the potential for recoupment. Sometimes, however, veterans are surprised when letters announcing the recoupment arrive, sometimes decades after they left military service.

In one case, an Air Force officer received $30,000 in separation pay in 1990 and received a letter in 2024 telling him his entire disability compensation check would be withheld until the money was recouped.

The situation placed the veteran at risk for losing his living quarters and vehicle, he told Military.com at the time.

“I fail to comprehend how or why they intend to cut me off for several months without even negotiating a lesser but [survivable] monthly contribution. I also fail to understand why it took 34 years for VA to come up with this [scheme]. Why now?” retired Air Force Maj. Raymond Thomas, 75, told the publication.

By law, veterans’ monthly disability compensation can be withheld if they received readjustment pay, non-disability severance pay, disability severance pay, special separation benefits or involuntary or voluntary separation pay.

According to the VA, the recoupment effort hit a peak in 2018 with 17,066 veterans paying more than $396 million.

The Restore Veterans Compensation Act would also change the recoupment rate for retired military veterans who are required to make payments to 25% of their paychecks rather than the current 40% — an alteration that would lessen the financial impact of the recoupment.

When Gallego and Bilirakis introduced their bill in 2022, it drew the support of Disabled American Veterans who said the practice of withholding VA disability compensation because a service member received a separation benefit “must end.”

Sen. James Risch, R-Id. introduced a separate bill Wednesday that would limit the amount that veterans paid each month to the VA for recoupment.

Risch’s Veterans Earned Benefits Access Act would allow the VA to collect the separation pay but limit it to no more than 25% of their monthly disability compensation checks. Currently, the VA can withhold the entire amount of checks until the veteran pays back the government.

“My [bill] ensures that veterans can receive the disability benefits they need while repaying their separation pay,” Risch said in a release.

In a review of 9.9 million veterans in the VA medical system from 2000 to 2024, researchers from the Harvard T.H. Chan School of Public Health, the Department of Veterans Affairs and elsewhere found that 14,419 patients had received an ALS diagnosis.

In the group with ALS, 46% were Army veterans – nearly the same percentage of soldiers in the entire patient cohort.

Using the rate of ALS diagnoses among Army veterans as the baseline and adjusting for sex, race, and ethnicity, researchers found that Air Force veterans had a 29% higher rate, former Coast Guard members had a 26% higher rate and Navy veterans had a 15% higher rate. Marines had the lowest rate, at 22% below that of Army veterans.

Overall, officers had a 64% higher rate than enlisted personnel, while women officers had a 72% higher rate. Differences among branches were more apparent in men ages 61 and younger and less evident among men older than 75.

“Our study looked at the rates of ALS among people in different branches of the U.S. military and found ALS rates varied considerably by branch and rank, with larger differences among younger veterans,” said study author Marc Weisskopf at the Harvard T.H. Chan School of Public Health in a release.

ALS is a rare disease diagnosed in roughly 5,000 Americans each year, according to the Centers for Disease Control and Prevention. A fatal illness most famously associated with baseball legend Lou Gehrig and British astrophysicist Stephen Hawking, it is a progressive disease that affects the motor neurons, causing them to lose connectivity and die off.

There are two types of ALS: sporadic, meaning occurring without a known cause in the general population, and familial, likely the result of an inherited genetic mutation, according to the ALS Association.

While military personnel are diagnosed with ALS at nearly twice the rate of civilians, the cause has not been scientifically proven. The VA presumes the condition to be service-connected given the heightened occurrence in the veteran population.

Researchers have theorized that exposure to hazardous environments and substances, including burn pits, jet fuel, exhaust, heavy metals, dioxins and other toxic materials, may contribute, but no direct connection has been proven.

“Our findings suggest that officers and those serving in the Air Force, Navy or Coast Guard may have been exposed to military environments that increase risk of ALS,” said Weisskopf. “Future research should aim to identify these exposures.”

In the civilian population, some occupations such as airline pilots, truck drivers, metal workers and those who work with pesticides and other toxic substances are associated with increased ALS risk, according to a 2022 Columbia University study.

The authors noted that the likelihood of developing ALS is low, even in the U.S. military. Of the 9.9 million veteran records reviewed, less than 0.2% of patients were diagnosed with ALS, according to the study.

“It is … important to note that ALS is rare and the overall risk remains small, so even statistically significant increases associated with branch and rank represent only modest increases in risk among military personnel,” Weisskopf said.

VA staff evacuated an unknown number of patients to local hospitals and are caring for 27 patients at area shelters, according to the facility’s Facebook page. The medical center, which lies less than a third of a mile from the fire perimeter as of Monday, will remain closed, “with future operations to be determined.”

More than 60,000 people have been evacuated from the area as a result of three fires collectively known as the Spokane Complex Fire. More than 8,000 acres had burned as of Monday, with 0% containment, according to the Washington State Department of Natural Resources.

Mann-Grandstaff is closest to the Old Trails Fire, which began Saturday and was fueled by high winds.

“We are grateful for the support received. Spokane VA extends our sincere condolences to all victims, including local VA staff members who, like so many, have lost so much,” VA officials wrote on the hospital’s Facebook page.

According to the post, Spokane-area VA outpatient clinics and business operation centers are also closed. The hospital provides administration and services for local VA clinics, including records, pharmacy management and specialty care.

Mann-Grandstaff is a 46-bed facility with more than 1,400 full-time positions, including its clinics.

This is a developing story. It will be updated as more information becomes available.