VA Ignores 30 Critical GAO Recommendations As Veterans Wait for Care

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, 2026, is not a one-time audit. It is the latest installment in an annual accountability exercise that GAO has conducted since 2015, sending letters to agency heads to flag recommendations that remain unimplemented and that carry the highest risk to agency performance. Veterans face delayed care, a broken electronic health records system that has cost billions and still isn't working as promised, and an acquisition apparatus that GAO has flagged as high-risk for years.

A Backlog That Keeps Growing

As of May 7, 2026, 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.

The math tells a cautionary story. 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.

To be fair to the agency, 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 that broader record offers limited comfort when 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 in this area: 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. For veterans navigating a system that serves millions of patients across hundreds of facilities, the gap between GAO's recommendations and VA's implementation is not abstract.

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 VA independently update both its total life cycle cost estimate and its integrated master schedule for the EHR modernization effort. The purpose is straightforward: the VA needs an honest, internally verified accounting of what this project will ultimately cost and how long it will take, so that Congress and agency leadership can make informed decisions about one of the largest IT investments in the federal government.

The EHR modernization program has been plagued by delays, cost overruns, and performance failures at initial deployment sites. GAO's veterans affairs audit findings in this area are part of a broader pattern of concern that has drawn scrutiny from both parties on Capitol Hill. The program is listed on GAO's High Risk List under "Improving IT Acquisitions and Management," and the recommendation to independently verify cost and schedule data remains open.

The intended benefit of the new system, interoperability with the Department of Defense and community care partners, is itself a significant policy goal. Service members transitioning from military to civilian care depend on seamless records transfer. That goal remains unrealized at scale.

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 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.

The second recommendation is particularly telling. 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, including IT and medical supplies, as areas where better measurement is needed. This area, too, sits on GAO's High Risk List, under "VA Acquisition Management."

Who Is Responsible Now

The letter is addressed to Douglas Collins, the Secretary of Veterans Affairs, a Republican former congressman from Georgia appointed by President Trump. Collins inherited an agency with deep institutional challenges, and the GAO report lands on his desk as a formal accounting of what remains undone.

GAO's report also flags a cross-cutting concern: the VA and the Department of Defense need to do a better job coordinating the transition of certain service members to civilian life, an issue GAO has catalogued under its broader work on government fragmentation and duplication.

The report notes, without elaboration, that congressional committees receive copies of the letter, and that Congress retains tools, including hearings, appropriations levers, and oversight authority, to press agencies to act on unimplemented recommendations. GAO's language here is deliberate. The watchdog agency is signaling to lawmakers that the accountability infrastructure exists; the question is whether they use it.

The Broader Pattern

This report is one piece of a larger GAO veterans affairs accountability effort. The prior year's priority recommendations letter, GAO-25-108071, identified 29 priority items. The year before that, a similar letter. The annual cadence is intentional: GAO uses repetition as a form of institutional pressure, returning each year to document what has and has not changed.

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.

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