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Army Specialist Saul Bosquez leaps over a hurdle using an artificial leg during rehabilitation at the Military Advanced Tr...

How the massive, pioneering and embattled VA health system was born

On this day in 1921, President Warren G. Harding cut short his summer vacation at Mount Prospect, New Hampshire, and returned to Washington to sign Public Law 67-47, an act that marked the most ambitious domestic program of his presidency.

The flourish of his fountain pen created a Veterans Bureau meant to take care of and treat disabled war veterans. Formally established on Aug. 9, 1921, all dedicated health and human services for U.S. armed services veterans were sequestered from the general population. We know this agency today as the massive U.S. Veterans Administration, which since 1989 has been a full-fledged federal department with its head serving as a member of the president’s Cabinet.

In the early 1920s, the U.S. was still reeling from the devastating effects of World War I and a terrible influenza pandemic. Even though the American involvement in World War I was minimal when compared to its European allies and enemies, the numbers were not insignificant. More than 4.7 million American men served in the “regular” U.S. armed forces, national guard units and draft units. These soldiers originated from every state, walk of life, race, creed and color.

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Yet the return to civilian life was far from easy and, for many, traumatic. African-American airmen and soldiers whose chests were adorned with medals of valor were forced, once again, to endure the dehumanizing effects of segregation. Other soldiers returned home to find that the “slackers” who never went to war were doing just fine, while they scrambled to find new jobs or claim the old ones they had worked before enlisting. And, of course, American life returned to normal and few family members or neighbors cared much about the sacrifices made in Flanders fields.

Anger and disappointment proliferated among those who served. The health care and other benefits these ex-servicemen had been promised by law in 1917 were difficult to find. Where was a soldier to go with lingering complaints of ringing in his ears from being bombarded by exploding shells? What was one to do to keep a flare-up of tuberculosis or mustard gas exposure at bay? Dentistry, still in its relative infancy when compared to the present, was hard to find for any American but especially for impoverished vets plagued by rotting teeth and dangerous abscesses. For those who lost limbs, there were few experts in prosthetics or physical medicine and rehabilitation. And then there were problems such as alcoholism, drug addiction and bouts of the agonizing fear, rage, night sweats and trembling we now know as post-traumatic stress disorder, which went untreated and ignored, to name but a few of the war-centric disabilities these men endured.

Wounded soldiers lie in an American field hospital in Auteuil, Paris, France around 1915 during World War I. Image courtesy of the Library of Congress/Handout via Reuters

Wounded soldiers lie in an American field hospital in Paris around 1915 during World War I. Image courtesy of the Library of Congress/Handout via Reuters

The medical profession was utterly unequipped to handle this tall order of problems. General practitioners were used to treating civilian disorders. Psychiatry was often reserved for the very rich and not yet terribly effective. The state-run mental hospitals and asylums dotting the land were largely holding pens for the poor deemed to be insane and a danger to others. Local hospitals focused on maternity care, pediatric health, acute medical problems and relatively simple surgical procedures. There simply did not exist the specialty health care professionals, hospitals and clinic services that disabled veterans so desperately needed.

American veterans were eventually successful at getting their congressmen’s and senators’ attention to acknowledge the sacrifices they made. A coalition of elected representatives from both political parties worked to establish a single, unified government agency called the Veterans Bureau. The 1921 law that resulted worked on the false congressional assumption that conjoining several different cogs of government under one roof would be an easy cure-all for the veterans’ problems. But getting the U.S. Public Health Service, the Federal Board for Vocational Education, the Bureau of Pensions of the Interior Department, the National Home for Disabled Volunteer Soldiers and a now-forgotten branch of the Treasury Department called the Bureau of War Risk Insurance was no easy task.

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The day after signing the veterans bill into law, President Harding appointed Col. Charles R. Forbes, the director of the Bureau of War Risk Insurance, to run the new Veterans Bureau. Easily confirmed by the U.S. Senate, Forbes and his staff struggled from the start to coordinate and decentralize services across the vast landscape of the United States.

While Veterans Bureau expenditures represented a fifth of federal expenditures, most of it flowed through the bureau as insurance and other monetary benefits. Forbes succeeded in both the basic reorganization of these disparate federal functions and established the VA’s national hospital system but at great cost to himself. (For what happened to Forbes, readers may wish to consult a new book on his work, entitled “A Time of Scandal: Charles R. Forbes, Warren G. Harding, and the Making of the Veterans Bureau” by Rosemary Stevens. Spoiler alert: In 1926, after being convicted of conspiracy to defraud the federal government by rigging government contracts, he was — wrongly, according to Stevens — sent to Leavenworth Penitentiary for 20 months).

Doctors and nurses working at U.S. Veterans Hospitals pioneered modern treatments for gunshot injuries, burns and trench foot — the all-too-common consequence of standing for days with poorly shod feet in muddy, wet trenches. They also advanced the treatment and prevention of infectious diseases such as typhoid and influenza and contributed to pulmonary medicine by treating the short- and long-term effects of exposure to mustard gas, a highly toxic weapon used in World War I. During and after World War II, as well as the Korean and Vietnam wars, there was an expansion of hospitals, health care facilities and clinical innovations in rehabilitation medicine — particularly in the operative and postoperative management of amputations. In the years since, advances have been made in the recognition and treatment of post-traumatic stress disorder and some of the most serious battle injuries experienced during the wars in Iraq and Afghanistan.

At present, the VA constitutes America’s largest integrated health care system with more than 1,700 care facilities serving more than 8.76 million veterans annually. Over the past 96 years, the Veterans Administration has experienced a roller-coaster ride of accomplishment, public opinion, resource allocation and criticism. After major battles and conflicts, the VA has often has been lauded by veterans and their families for its services and expertise. In between those periods, however, there have been many who questioned the benefit of such large federal expenditures for veterans and concerns over real problems in how well (or badly) the VA runs its hospitals and clinics.

Perhaps the most significant questions the American people need to ask and answer about this beleaguered American institution on its 96th anniversary include: Are civilian medical concerns, hospitals and health care systems so variable that designated federal veterans’ facilities are necessary? Does the United States have a duty and moral obligation to provide the best possible medical and hospital care for military veterans when they need it? And most importantly, how do we as a nation honor the men and women who have defended us and kept us from harm’s way?

Pedestrians walk past the U.S. Department of Veterans Affairs headquarters in Washington, D.C. Photo by Andrew Harrer/Bloomberg via Getty Images

Pedestrians walk past the U.S. Department of Veterans Affairs headquarters in Washington, D.C. Photo by Andrew Harrer/Bloomberg via Getty Images