VA is preparing to publicly release a report containing recommendations to invest in the most significant redesign of the VA health care system since the World War II era. The recommendations aim to realign and modernize VA health care facilities to improve Veteran health care access and outcomes.

The Asset and Infrastructure Review (AIR) report, to be released March 14, 2022, includes recommended investments that, if implemented, will see VA conduct a nationwide effort to build a VA health care network with the right facilities, in the right places, that provide the right care for Veterans in every part of the country.

The AIR report is part of VA’s commitment to keeping Veterans at the center of VA decision-making. It maximizes department resources to continually improve Veteran health care access and outcomes.

What’s in the report?

The recommended investments in the report include constructing new and modernizing existing VA health care facilities, as well as expanding VA partnerships with organizations that supplement VA’s own care delivery, such as the Department of Defense, Indian Health Service, academic institutions and community providers. The report also includes recommendations to close or relocate aged and underused VA health care facilities within some markets in a manner that will maintain the level of care VA currently offers and improve Veteran access in that market. Taken as a whole, the recommendations seek to maximize VA’s opportunities to provide Veterans a modern care experience; it also puts VA on a path to remain the primary, world-class provider and coordinator of Veterans health care for generations to come.

In the near-term, the AIR Report will have no significant impact on Veterans, VA employees and the VA facilities where Veterans receive care.

Who produced the report, and why?

To develop the report, VA conducted years of research and analysis, including interviews and collaboration with VA facility staff and leadership, as well as soliciting feedback from Veterans. Across its multiple volumes, the report presents an assessment of VA’s current infrastructure along with recommendations to keep VA on the leading edge of U.S. health care. It will ensure Veterans have convenient access to VA facilities in the areas where they live now and will live in the future. VA produced the report as required by the MISSION Act of 2018, which called for the nationwide study and accompanying recommendations for future investments.

As part of the AIR process, VA will publicly publish the report and submit it to the bipartisan, presidentially appointed and congressionally approved AIR Commission, which will review the recommendations.

During the AIR Commission’s review, the Commission will hold public hearings, visit VA facilities, meet with employees and VA partners – and, most important, listen to Veterans – to help them assess the recommendations. At the conclusion of that work, the AIR Commission will forward the recommendations, with any changes it deems necessary, to the President. The President will then determine whether or not to submit those recommendations to Congress. If the President does submit them, Congress can then accept those recommendations as a whole by inaction or reject those recommendations as a whole by passing a joint resolution of disapproval. If the recommendations are approved, VA must begin implementing them within three years. The timeline to complete implementation will vary within each market as VA works through a process to prioritize and fund projects.


VA is committed to maintaining transparency throughout this process and will provide timely updates on AIR-related news and events as this work continues through 2022 and beyond. More information, including the full AIR Report, will be available on on March 14.

By VAntage Point Contributor

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Published on Mar. 2, 2022

Estimated reading time is 3 min.

Views to date: 3,234


  1. STEVEN F GORDON MD March 13, 2022 at 11:52 pm

    I’m a vet. I’m a doctor. I’m working for the VA temporarily.

    You want more doctors? Revamp the VetPro torture cycle. It seriously takes about 120 hours out of your life. Don’t want to do away with VetPro? Train vets to take info from a CV and put it into VetPro. (Listen up! VetPro has online instructions that are false, and require printed instructions contradicting them. Putting in a reference? Nothing on the screen says, please wait and don’t sign off, this will take between 5 and 10 minutes during which you probably think the line has gone dead. There’s more. Please contact me.)

    You want to get more good out of your docs? You need to do something with CPRS. I don’t think anybody at the top realizes that half (literally half) the provider’s time is wasted with a really horrible computer system that could, in fact, be fixed. (They fixed, didn’t they?)

    Oh, wait they’re replacing it with Cerner. Not Epic. Because a certain business-friendly Prez decided to bypass the competitive bidding process. 9 out of 10 docs who have used both Cerner and Epic prefer Epic. It is more time-efficient and repairable; Cerner was cobbled together from inconsistent pieces in the 70s. Cerner has glitches that cannot be repaired. You talk to them; they’ll tell you about the time they tried to do a minor revision and shut the whole system down nationwide for 18 hours. Cerner will soon NOT be supported; the parent company is abandoning it.

    Care in the Community? I’m in the business of saying yes, but every single time I do it’s going to take 15 minutes to try to put it through CPRS. If you don’t believe me, you come down do the Pierre, SD CBOC and I’ll show you. That’s a challenge.

  2. STEVEN F GORDON MD March 13, 2022 at 11:36 pm


    I’m a family practice doctor working temporarily with the VA and I am absolutely horrified at what Agent Orange is doing to vets, yes, this late in the game. When I hear Agent Orange and neurologic, I think of Parkinson’s. Has anyone tried Sinemet (=carbidope/levodopa)? Parkinson’s is one of the 12 diseases caused by Agent Orange that the VA acknowledges with the word “presumption.” I have a lot to say about how the VA could get more and better care for the vets with existing resources, spending not one cent more. Or even using existing resources more effectively with money left over for, example home health aides.

  3. Karl Smith March 11, 2022 at 4:09 pm

    Full Dental care would be a nice addition, including for those non-service connected injuries. Everyone knows as we age dental care becomes more crucial. There are also numerous studies about proper dental care preventing infection, cardiac issues, longevity, and a host of other disease prevention. Please consider. Good dental is a KEY to good health.

  4. JG Juers March 10, 2022 at 8:55 pm

    I don’t particularly love being called a “market.”

  5. Leon Hinkle March 4, 2022 at 5:01 pm


  6. James August Anderson March 3, 2022 at 7:45 pm

    as always, it’s important to hold your Congressperson’s feet to the fire and keep scrutinizing their voting record on VA issues. the VA is always hostage to Congress and the forces of privatization due to budgetary issues. scanning the above comments seem to indicate a desire for expansion, as well as continuing improvement of VA services, but the $ always comes from Congress, which is always loath to going there-it’s a PITA, but those are the rules of the game…

  7. TIm Vet March 3, 2022 at 5:21 pm

    I have a hard time with this due to the recent proposed changes in the disability rating program. This may be just more of our hard earned rights being stripped away “again” just to save a penny or two.

    • Ricardo Puente March 4, 2022 at 3:01 pm

      My question is why have the VA handle veteran healthcare and not the USPHS? this would allow VA handle the non-life threatening items for veterans.

  8. Deborah M. Simmons March 3, 2022 at 5:14 pm

    My spouse is a disabled Army veteran who requires 24/7 care as he is completely dependent for ADLs and everything. The VA finally after much effort and paperwork (forms) gave us 28 hours/week of health aide help. 2/14/22, it was decreased to 16 hours/week. We were told the decision came from the “top”. Who made the decision in Washington? Due to Agent Orange exposure in Vietnam he has a neurological disorder. He was completely healthy and strong until 2014, when the symptoms started. Now he is in a wheelchair. He is deteriorating, not improving. We need help. Our requests are falling on deaf ears here in Orlando. No one cares. No one. He has lost his life and mine, too.

  9. Jeffrey Hill March 3, 2022 at 4:02 pm

    I do not trust the VA, I do not belive they work in my best intrests.

  10. Dr. Carl E. Thornblad March 3, 2022 at 2:41 pm

    The new proposed Mission Statement sounds great, but it is not being implemented. VA should include ALL VETERANS, SPOUSES, AND CAREGIVERS IN ALL PROGRAMS, especially the healthcare programs. There should be NO DISCRIMINATION such as only serving those with “military connected health problems” or only at Medical Centers in the US. There is a medical center in Manila, Philippines that currently discriminates those whom it will serve…there are more than 30,000 US VETERANS currently in the Philippines who deserve a “FULL SERVICE” VA MEDICAL CENTER, but are being refused service. All VA medical centers should serve all veterans…if we built it, we should use it to the fullest extent. The VA MISSION STATEMENT should apply to ALL VETERANS and to ALL VA FACILITIES !

  11. Edward A.Blumberg March 3, 2022 at 12:49 pm

    The VA should ask the veterans how to fix the system. We’re the ones having to deal with everything that’s broken! Starting with Community Care system. These people can’t run a water faucet! Much less a system like this! They have absolutely no clue! I’ve been bounced around having my PRIVATE INSURANCE BILLED when I visit my audiologist who is a specialist in cochlear implants. (Which the VA does not have! ) They either wind up billing me or my insurance because Community Care failed to give them an authorization number. This has been on going for over 7 years. Now I have my Congressman involved. They need to rename the department COMMUNITY I DONT CARE!

  12. John March 3, 2022 at 12:45 pm

    The VA is trash and should be abolished just let us see who we want, I haven’t been able to see my primary for 2 years cause they keep using covid as an excuse to cancel my appointments but then when at the VA half the staff don’t wear the mask anyway so now that you have to do some work your going to use covid to get out of it where is the accountability ???????????

    • Alex March 3, 2022 at 1:06 pm

      Same here.

  13. Ricardo Lugo Ramos March 3, 2022 at 11:49 am

    This asset and infrastructure review report (AIR); could become a wonderful tool of modernizing are total VA hospital force care facilities; for present and future generations of veterans to come. We can not forget the glorified vision of President Abraham Lincoln; in the promise to maintain a high quality life and health for all the veterans warriors that serve with; distinguish American patriot’s spirit. So God help us / The Home of the Brave / In God we Trust. God Bless America.

  14. Andrew Yawger March 3, 2022 at 10:03 am

    I would like to have the ability to easily use VA Healthcare benefits with any private practice or facility. It is too time consuming to travel to VA facilities and I would think, too costly to have to maintain those facilities when there are non-VA equivalents where we need them.

  15. Monica Thomas March 3, 2022 at 10:02 am

    Full Dental care would be a nice addition, including for those non-service connected injuries. Everyone knows as we age dental care becomes more crucial. There are also numerous studies about proper dental care preventing infection, cardiac issues, longevity, and a host of other disease prevention. Please consider.

  16. John Pezzano March 3, 2022 at 9:35 am

    I wonder how many ordinary vets really had MEANINGFUL involvement in the decisions that are being made.

    Personally, I think the VA has to do much more in allowing vets to use local community facilities so that simple things like lab tests can be done without having to drive the long distances and wait long times for those things. I can go to the local hospital outpatient facility, get my labs done and be home in 30 minutes. With the VA, it is 2 hours travel time, crowded parking, crowded facilities and long waits. The result is 1/2 day down the drain just to get labs done. And ifI need fasting labs, it is worse as that travel time is during rush hour.

    The VA also needs to have a way for vets to file complaints. The local patient’s advocate office no longer does anything to help. The Inspector General does not accept complaints from vets about the VA. There needs to be an active office of responsibility that will investigate medical complaints, process complaints, and other issues brought up by vet patients and have the authority and willingness to do something to resolve it.

    Dental care should be available to more vets because this is one type of care not covered by most health insurance policies or even Medicare.

    There are community pharmacies and facilities that are on the VA list to provide service that don’t know they are on the list and can’t handle providing service when shown a VA card because it doesn’t look like an insurance card.

    The VA has never acted as a true country-wide organization so walking into an out-of-area facility is like starting from ground zero. Vets when away from their local area should be able to get appointments, same day care for urgent problems and even medications and supplies just as if they were in their local facility. Similarly, they should be able to do the same at any community facility. If a community doctor anywhere prescribes medication and sends the prescription to a VA pharmacy when the VA is not paying for the doctor’s service service, the VA pharmacy should be able to immediately dispense that medication (if in their formulary) without a VA doctor having to approve it.

    • Tired Vet March 17, 2022 at 6:48 pm

      You can’t get anyone to help you once you have a provider after you, the whole system moves to destroy you. There is no accountability and now they are going to start hiding all GS14 and below identities who have a hand in your care. You don’t even have the right to know who is making decisions about your care. I have had a social worker refusing ENT, GI, PMR and other services without any explanation just because he isn’t a GS14.

  17. Randy Tegland March 3, 2022 at 9:21 am

    Why is the VA system routing calls veterans try to make with their primary care physicians to the Minneapolis hospital? The menu to access information is difficult for many senior Veterans. The local VA centers shouldn’t be scheduled by an outside system. I want to talk to my primary care office directly it was so much easier before the call was routed to the Minneapolis hospital. It seems like the system to access care was changed to make getting care harder and many veterans might give up trying to access the health care system.

  18. Mike March 3, 2022 at 9:13 am

    My wife is on Champ Va and gets the best care through her private provider. She never has to pay anything. Why can’t we get the same deal. I thought the new choice program would accomplish that but it’s not easy getting in the program.

  19. Francis J. Constantine March 3, 2022 at 9:01 am

    The Erie, PA VAMC is a real blessing for vets in its service area. The facilities are clean and well kept, the physicians and other staff members are very caring and accessible, and the whole operation is a model of what VA healthcare should be. Please do not make any changes that would have a negative impact on the VAMC in Erie! Thank you.

  20. Ian Kornbeck March 3, 2022 at 8:56 am

    I’m sure this modernization or upgrade doesn’t apply to the Vermont Department of Veterans Affairs because they are allowed to pick and choose what systems fit best for them after all, a Veteran can’t even file a travel voucher on the website for reimbursement because the Whiteriver Junction VA doesn’t want to use that platform but, you can use it to check and verify appointments. The Whiteriver Junction VA Can’t even keep adequate staff to facilitate timely reimbursements to veteran’s who have file vouchers. What does that tell you about “Customer Service” or support for the Veterans.

  21. C. Antonio Alvarez-Moreno March 3, 2022 at 8:51 am

    I have read the above article and believe that the improvements referred to there are primarily directed towards improvement of facilities, not the actual health care that is provided. I understand that there is a need to periodically review the adequacy of facilities themselves, and the best location for these. However, the policies which are in place to provide healthcare to veterans needs to be reviewed as well. The following comments are directed towards one of the policies that I have encountered since first coming into the VA system in 1998.

    I am a veteran with a 100% service connected disability rating who resides in Washington, DC since 2009. As such, I am assigned to receive my healthcare at the VAMC-District of Columbia. Prior to that I lived in New Jersey and was assigned to the Ft. Dix, NJ veterans outpatient clinic for my healthcare, with referrals to the VAMC-Philadelphia for issues which could not be handled at the outpatient clinic.

    When I still lived in NJ I was able to go to the outpatient clinic in Ft. Dix and be seen without an appointment, and be seen by ny primary care physician, if it was a medical condition that needed immediate attention. There would of course be a waiting period because persons who already had an appointment would be seen first. I believe there was also a specific time by which I had to arrive in order to be seen. But it’s been a long time and I’m not sure about that or what that cutoff time was. Appointments were for routine matters.

    Later when I first arrived in Washington, DC and started using that facility there was also the ability to come in without an appointment and be seen by my primary care physician for emergent matters, as long as I arrived prior to 1:00 pm. Often I would have to wait all day but I would be squeezed into the schedule. Starting in 2016 with a change in my primary care physician, the prior one having left for another VA medical facility, that policy changed. I could no longer come in for emergent matters. For instance, a few years ago I caught poison ivy. Later I had a pain and a rash in my side. I was told that I would not be seen and would have to make an appointment with the receptionist in the clinic, and then go to the emergency room. In the case of the poison ivy I received medication in the ER. In the case of the pain and rash it turned out, after more than one ER visit, that I had shingles. I was given medication for that.

    On March 10, 2019 I was struck from behind by a car while I was on my motorcycle in NJ where I had gone to visit family. I was injured and taken by ambulance to the local hospital where I was given emergency first aid and some x-rays taken. I was discharged with specific instructions to go see my primary care physician upon return to the District of Columbia. The following day I appeared at the clinic, the Yellow Clinic, of my primary care physician at the VAMC-DC. I was turned away, being told by the nurse that works with my primary care physician that he refused to see me and that I would have to make an appointment with the receptionist, and then go to the ER.

    I received an appointment in April and then went to the ER. They sent me for some x-rays, as I recall, and gave me some pain medication as well. Later in April I came for my appointment with my primary care physician who made a referral to the Rehabilitation Services department for the injury of my right hand, which had been injured in the collision. Since then I have also undergone two surgeries of my cervical and lumbar spine for injuries from that collision, where I was struck from behind by a car and flew through the air landing hard on the road surface. I landed on my head as well as impacted other parts of my body. You would think that this would have been considered a serious matter necessitating my being seen by my primary care physician. Not so at the VAMC-DC.

    Is this the policy at all VA Medical Centers, or is this just here in the District of Columbia? I understand that I didn’t have an appointment, but like the shingles, these are things that just happen without warning. I didn’t purposely catch shingles and poison ivy or get struck by a vehicle just to go to the VA Medical Center to bother the staff there.

    I would appreciate your forwarding this comment to the appropriate department in the VA that is involved with the improvement of VA healthcare provision of services. I think these need improvement as well as the physical facilities. Thank you.

  22. A Caregiver March 3, 2022 at 8:23 am

    Speed up travel reimbursement manual reviews!
    It’s over a 6 month wait to get reimbursed. Ridiculous!

    • Edward A.Blumberg March 3, 2022 at 3:24 pm

      I totally agree with you! My VA hospitals Beneficiary/Travel Department is a joke. I too am waiting over 6 months for my payment. They should go back to the old method of cash payment on the spot. Much easier and simpler. Gues you need to find people who can count!

  23. Claude Hoyle March 3, 2022 at 6:18 am

    Remember a lot of older veterans
    Don’t know how to use computers
    Don’t make things harder on us when you modernize

  24. Terry Casey March 3, 2022 at 12:40 am

    That’s great and I hope the VA would include and keep up and offer to us veterans medical techniques that the public sector has been using for years such as laser eye surgery,,,more research on tennitis instead of offering only hearing aids. I have 2 bad knees ,,,meniscus problem with one,,,,popping out of socket on the other….lower back and cervical horrible problems. I need either surgery or a lot of epidermis or pain implants….Nothing has been done at all. I hurt so bad I have to lie down in the most embarrassing places like the aisles in k-mart,,leows,,let’s,,, Walmart outside on concrete or asphalt… for years I’ve had to do this…I see myself in a wheelchair in the not to distant future,,,instead of walking on my own 2 feet….and I haven’t even mentioned to my pcp yet about my extremely painful and broken botched left wrist surgery years ago… when they say you only get a 30 minute pcp visit that’s exactly what it means…you Have to leave for at least 3 more mths while you continue to suffer in pain….I’m getting very,,,very tired. My name is Terry Michael Casey

  25. james cordell bandy March 2, 2022 at 10:43 pm


  26. DAVID RENEAU March 2, 2022 at 10:37 pm

    The VA in East Tennessee has been pretty good to me. However, the community care part is terrible. I’ve been waiting for months now to get a referral from community care division to see an ENT specialist. Meanwhile, I am living with sinus and ear problems daily. Why not let the veteran go to their own doctor if the VA cannot provide the services in house and let that doctor bill the VA? It takes forever just to be seen by a VA doctor also. There needs to be some streamlining of the process.

    • Kerry March 3, 2022 at 8:51 am

      David, you can go to urgent care or ED in any city. After your visit, report it to the VA as an emergency. They, by law, have to cover you.

  27. David Berlier March 2, 2022 at 10:00 pm

    I bet no one said anything about someone to answer the phoned. It gets old everything you call in to talk to someone, you have to master bath some stupid machines ego. Then damn don’t make a mistake. If I called to talk to a machine I would have called Caterpillar. Atheist I could talk to something with some power.

  28. Stephen Rosenthal March 2, 2022 at 9:56 pm

    As a service connected disabled veteran, I would prefer that the entire V.A. Health system be eliminated and replaced with fully paid, no-copay medical insurance of the veteran’s choice. After several years of V.A. physicians telling me at my annual physical that the skin eruption on my leg was non-specific dermatitis; nothing to worry about, a private physician insisted on performing a biopsy. The following day I was told that I had squamous cell carcinoma for which I had surgery one week later.

  29. Michael Kleinschmidt March 2, 2022 at 9:32 pm

    65 days out before community care in Salt Lake City Utah can even consider my application. They say they are short handed do you think anyone out there wants a job? Beef up programs now before you upset the system which sounds like it will be years.

  30. Tom McClain March 2, 2022 at 8:56 pm

    Hope the report included input from external resources. Far more desirable than all of the “research” conducted internally.

  31. Jay A. Clark March 2, 2022 at 8:34 pm

    PLEASE consider for your report the need to strengthen and enhance all VA services, especially medical, BEFORE enrolling massive amounts of veterans. I have been nicely served by VA Medical since 1998. Yet, following the deserving enrollment of a massive number of Veterans whose enrollments were backlogged, medical services were, and still are severely stressed. Care has become brief and impersonal, medical clinics are overburdened, and service is often tantamount to the proverbial ‘Sick Call’ triage. Attempts to have the private sector ‘take up the slack’, was slow, inadequate, complicated and disorganized

  32. Thomas O'Connor March 2, 2022 at 8:17 pm

    Your telephone system in San Antonio is so dysfunctional that it is impossible to make contact with a PCM or other facility personnel. I have just about given up trying to use the Audie Murphy site and have started using private medical facilities. It is a disgrace to the military personnel living and stationed here, and it is a disgrace to the entire VA.

  33. Mark Uhart March 2, 2022 at 8:12 pm

    This usually means a reduction in services to Veterans. The last time there was a “realignment” many rural facilities were closed.
    The VA disability coding system is archaic and in bad need of an overhaul. There are many service-connected diseases and diagnosis that could be coded using IDC-11 but are not.

  34. Roger garcia March 2, 2022 at 8:02 pm

    To further maximize input from veterans who are the direct recipients of health care, establish new local va veterans group organizations that report quarterly recommendations directly to regional or va headquarters for consideration on improving overall health care for veterans. Yes, this is in addition to existing national veteran organizations that also provide veteran improvements to health care

  35. MKC Bobby Lester March 2, 2022 at 7:59 pm

    How about better health care for overseas veteran, like champva like dependents have. They have full coverage, we only can be treated for service connected disability.

    • Arthur W LUKE, Jr. March 3, 2022 at 9:17 am

      I have been a VA patient since 70’s on Long Island No.Shore Facilities. Because of funding, doctors and slow to implement state of art technology, practices, and support staff and current day resolutions and technology, I have had to rely on outside VA for support. The current state of Facilities access to Facilities for pools, gyms, library as well as veterans need for local needs such as housing are behind for access and need. The thought of employment and help at a VA is such, that I abandoned my interest because of a communication with my Dr., during hiring process, that should not taken place, by our rights of separation and medical status. I still have to rely on outside VA for access to technology care and procedure & medicines for certain care.

  36. Louis DeSantis March 2, 2022 at 7:21 pm

    Dental care for all elderly vets

  37. Donna Brown March 2, 2022 at 6:49 pm

    Change is always unsettling. As a veteran, I really appreciate the care I receive from the VAMC that services my area. However, I will try to be open-minded and see where the proposed recommendations for redesign and modernization of VA Health Care leads.

  38. Ann Ingram March 2, 2022 at 6:10 pm

    Thank you,

    Ann Ingram

  39. ANN INGRAM March 2, 2022 at 6:03 pm





  40. Fred Ruble March 2, 2022 at 5:19 pm

    Hopefully the VA realignment will work out better for the Vets than the realignment the AF, Army and Navy are living (existing) through!

Comments are closed.

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