Why It Matters

The Department of Veterans Affairs is sitting on 30 unresolved priority recommendations from the Government Accountability Office, a growing pile of unfinished business that touches the most basic promises the federal government makes to those who served in uniform: timely health care, functioning technology, and competent management of billions of dollars in contracts.

The GAO report published May 22 is the latest installment in an annual accountability exercise that GAO has conducted since 2015. It sends letters to agency heads to flag recommendations that remain unimplemented and that carry the highest risk to agency performance. Veterans still face delayed care in a broken electronic health records system that has cost billions and still isn't working as promised.

A Backlog That Keeps Growing

As of May 7, the VA has 217 total open GAO recommendations. Of those, 30 are classified as priority recommendations, meaning GAO has determined they warrant the most urgent attention from agency leadership. A year ago, in May 2025, GAO identified 29 priority recommendations for the VA. In the intervening 12 months, the department implemented just two of them. GAO then added three new priority recommendations, bringing the total to 30.

Still, the VA's overall implementation rate of 88 percent exceeds the government-wide average of 77 percent, according to GAO's Performance and Accountability Report for Fiscal Year 2025. But the unresolved items are concentrated in areas GAO has placed on its High Risk List, a designation reserved for programs and operations most vulnerable to waste, fraud, abuse, and mismanagement.

Three Critical Areas

Health Care Access

GAO has been tracking the VA's struggles to oversee its health care system since at least 2010. The core recommendation is that the VA should take steps to fully meet leading practices for managing risk across its health care system so it can better respond to threats that could compromise the quality and timeliness of veterans' care.

This issue appears on GAO's High Risk List under the designation "Managing Risks and Improving VA Health Care." That it has remained there across multiple administrations, Democratic and Republican alike, underscores how deeply structural the problem is. It affects veterans navigating a system that serves millions of patients across hundreds of facilities.

The Electronic Health Records Debacle

Perhaps no single item in the VA's portfolio of open recommendations carries a higher price tag, literally and politically, than the department's effort to replace its legacy electronic health record system, known as VistA, with a modernized commercial platform from Oracle Cerner.

GAO has recommended that the VA independently update both its total life cycle cost estimate and its integrated master schedule for the EHR modernization effort. This program has been plagued by delays, cost overruns, and performance failures at initial deployment sites.

VA Open Recommendations on Acquisition Management

The third major area covers how the VA buys things. The department spends billions annually on goods and services, from medical supplies to information technology. GAO has recommended that the VA address challenges that undermine its framework for overseeing major acquisition programs, and separately, that it establish specific goals for cost avoidance and budget savings, and then actually track progress toward those goals. Without defined targets and tracking mechanisms, the VA cannot demonstrate whether its procurement practices are saving taxpayer money or not. GAO flagged common spending categories on its High Risk List, including IT and medical supplies, as areas where better measurement is needed.

Who Is Responsible

Douglas Collins, the Secretary of Veterans Affairs, a Republican former congressman from Georgia appointed by President Trump, inherited an agency with deep institutional challenges. The GAO report is a formal accounting of what remains undone.

The Broader Pattern

This report is one piece of a larger GAO accountability effort on veteran affairs. The prior year's priority recommendations letter, GAO-25-108071, identified 29 priority items, and there was a similar letter the year before that. For veterans, the cumulative effect of slow implementation is measured in appointment wait times, records that don't follow them from one provider to another, and contracts that may not deliver the value taxpayers are paying for. The 30 open priority recommendations now on the VA's ledger represent years of findings that the agency has acknowledged, but not yet resolved.

Access the Legis1 platform for comprehensive political news, data, and insights.

Spot something wrong? Report an issue with this article