A veteran-led demand for enforcement, correction, and independent review at the Department of Veterans Affairs.

Document your experience: https://form.jotform.com/262174755362057

WHO WROTE THIS

I'm a veteran. I served in the Army from 2017 to 2022 and I'm rated 90 percent combined. That's the only authority I have. I don't work for VA. No veterans service organization put me up to this. I'm not a lawyer, I'm not funded by anyone, and I don't know a single person inside the system who could move any of this. Nobody asked me to write it. I wrote it because I spent years learning that nothing in my own care happened unless I asked for it by name. Eventually I got curious enough to go read what VA has actually committed to in writing, and it turned out most of what I'd been living through was already prohibited by VA's own rules.

I used AI to write this. I'd rather tell you myself than have someone point it out later, so here's exactly what that means. I found the documents. VA directives and handbooks, 38 CFR Part 4, the VA/DoD clinical practice guidelines, the Disability Benefits Questionnaires, the public laws. Dozens of them, thousands of pages. Then I worked through them with an AI assistant over many hours. It reads faster than I do and it doesn't get tired, and it caught contradictions sitting inside VA's own documents that I would have read straight past. It also told me I was wrong more than once, and those corrections are in this petition. What it couldn't give me is the experience. Every failure described here is one I lived or one I found sitting in VA's own policy. Every citation below I checked and linked by hand.

I'm a full-time student in constant pain, with service-connected conditions that make sustained work hard. I couldn't have produced this alone and I'm not going to pretend otherwise. If using a tool to read faster than my body allows discredits the argument for you, better you know that now than after you've signed. But don't take the writing on faith. Take the citations. Every one of them is linked below. Open them and check me.

WHY THIS PETITION IS DIFFERENT

Most petitions about VA ask VA to care more. This one doesn't. It asks VA to do the things it has already written down and signed.

Every demand below cites a VA directive, a VA handbook, a federal regulation, or a VA clinical practice guideline. Not one of them asks VA to invent a new standard of care. Most of them ask VA to meet the standard it published itself — in some cases decades ago.

That is a deliberate choice. "Fix the VA" has no shape. "VHA Directive 1230 says the clinically indicated date cannot be changed for capacity reasons — publish how often it was changed anyway" has a shape, an owner, and an answer.

WHAT SIGNING THIS ACTUALLY DOES

I'm going to be straight with you, because you've been told otherwise before.

A signature on a petition is not legally binding on any federal agency. No agency is required to read this. The White House petition site that used to guarantee a response shut down years ago.

What a signature is worth is this: it is one name on a list of people who can be pointed at a rulemaking comment window, a quarterly VA town hall, a congressional office, or a committee hearing on the day it matters. Ten thousand signatures is legally worthless and organizationally decisive. Every change to VA that veterans actually won — the Choice Act after Phoenix, the Clay Hunt Act — was won by a specific ask backed by documented cases and people willing to attach their names.

If you sign, the most useful next thing you can do is document what happened to you. The intake form takes about ten minutes, is anonymous by default, and is structured so every answer maps to a published VA standard. A pattern of forty documented accounts at one facility is what opens an inspection. A petition alone is not.

PART ONE — WHAT VA CAN DO TODAY

No new law. No rulemaking. These are VA's existing rules, unenforced.

   DEMAND 1. Publish test-result notification compliance, by facility.

VHA Directive 1088(1) requires that test results requiring action reach the patient within 7 calendar days, and results requiring no action within 14. The directive further requires every facility to "demonstrate how communication of results to patients is being monitored to document compliance."

Publish those facility-level monitoring results. This is a date subtracted from a date. There is nothing to interpret.

   DEMAND 2. Publish how often the clinically indicated date was changed.

VHA Directive 1230 defines the Patient Indicated Date as the date the provider and veteran agree care is clinically needed, and states without qualification: "The PID cannot be changed due to capacity or access reasons."

Every change to that date is a logged event in VA's scheduling system. Publish the count and distribution of post-entry PID modifications by facility. If the number is small, VA should want to say so.

   DEMAND 3. Give every veteran written notice when they become eligible for community care.

VHA Directive 1230 makes schedulers responsible for "reviewing community care eligibility and offering Veterans the choice to schedule an appointment in the community, if eligible."

Make that offer in writing and put it in the record whenever access standards are exceeded. The most common failure is not denial. It is silence.

   DEMAND 4. Name the underperforming service lines, or admit the criterion is dead.

One of the six MISSION Act community care eligibility criteria applies when a VA service line "is not providing care that complies with VA's quality standards." VHA Notice 2025-04 states that VHA "cannot utilize this eligibility criterion unless and until such Federal Register Notices announce underperforming VA medical service lines."

Disclose how many service lines have ever been so designated. An eligibility criterion that requires the agency to volunteer an admission against itself is not a protection.

   DEMAND 5. Report evidence-based PTSD treatment delivery, by facility.

The VA/DoD Clinical Practice Guideline for PTSD (2023) gives a Strong For recommendation to Cognitive Processing Therapy, EMDR, and Prolonged Exposure. That same guideline lists supportive counseling among interventions with insufficient evidence to recommend for or against.

Publish, by facility, the percentage of veterans with a PTSD diagnosis who received a documented course of CPT, EMDR, or PE. Veterans are being given the intervention VA declined to endorse while three endorsed options exist.

   DEMAND 6. Enforce the rules that already exist on musculoskeletal evaluation.

38 CFR 4.40 states: "Weakness is as important as limitation of motion, and a part which becomes painful on use must be regarded as seriously disabled." Section 4.59 states the intention "to recognize actually painful, unstable, or malaligned joints... as entitled to at least the minimum compensable rating for the joint."

Treat examinations that record degrees of motion and nothing else as inadequate under 38 CFR 4.2, which already obligates the rating board to return them.

   DEMAND 7. Enforce record review and pain rationale on C&P exams.

38 CFR 4.1 requires "accurate and fully descriptive medical examinations." Section 4.2 makes it "incumbent upon the rating board to return the report as inadequate" where detail is insufficient. The Disability Benefits Questionnaire itself requires review of "all procurable information," and requires an examiner who records no pain to state a rationale where the veteran's history documents pain.

Identify and count the exams missing these elements, and redo them at VA expense.

   DEMAND 8. Put the recommendation back in the treatment plan.

VHA Handbook 1004.01 requires that informed consent documentation include "a brief description of the recommended treatment or procedure," with alternatives discussed against it.

Recognize that handing a veteran a menu of options with no clinical recommendation is an incomplete consent process. This is not a request to reduce patient choice. Choosing between options is meaningful only when a clinician has said what they would do and why.

PART TWO — WHAT VA CAN CHANGE BY REGULATION

VA wrote these rules. VA can rewrite them. No act of Congress required.

   DEMAND 9. Rate tinnitus by the severity VA already measures.

38 CFR 4.87, Diagnostic Code 6260 assigns a flat 10 percent to recurrent tinnitus, and specifies "only a single evaluation... whether the sound is perceived in one ear, both ears, or in the head." Those criteria were last amended in 2003.

Meanwhile, the VA/DoD Clinical Practice Guideline for Tinnitus (2024) defines "bothersome tinnitus" as tinnitus affecting "sleep, concentration, or mood," distinguishes constant from intermittent from occasional by explicit thresholds, and directs clinicians to validated graded instruments — the Tinnitus Functional Index, the Tinnitus Handicap Inventory, the Tinnitus Primary Function Questionnaire.

VA has built the tools to measure tinnitus severity and instructs its clinicians to use them, then rates every case identically. Adopt a graded evaluation reflecting functional impairment. This is a request for internal consistency, and VA produced both halves of the evidence.

   DEMAND 10. Give the musculoskeletal rating tables somewhere to put the findings.

The general rating policy at 38 CFR 4.40, 4.45, and 4.59 commands a functional, whole-picture evaluation. The rating tables at 4.71a are keyed almost entirely to degrees of motion and ankylosis. A veteran with imaging-confirmed degenerative disease, nerve involvement, instability, and full range of motion has serious pathology and no row on the table.

Open rulemaking to add evaluation criteria that receive objective imaging findings, neurological involvement, joint instability, and functional loss on repeated use and during flare-ups.

   DEMAND 11. Align disability pain assessment with VA's own pain science.

The VA/DoD Opioid CPG (2022) adopts the position that "pain and nociception are different phenomena" and that "verbal description is only one of several behaviors to express pain." The VA/DoD Osteoarthritis CPG (2026) states that up to 40 percent of patients with OA-related pain have a centralized pain process predominating, that "these estimates may be higher in U.S. Veterans and Service Members, especially those who are younger," and that clinicians should use validated tools such as the Central Sensitization Inventory. It further notes that such pain is characteristically "disproportionate to imaging findings."

Incorporate functional and mechanism-based pain assessment into disability evaluation rather than resting on a self-reported number. VA's clinical arm has already made this argument. Its evaluation process has not caught up.

   DEMAND 12. Written resolution of every complaint, with a route to disagree.

VHA Directive 1003.04 builds a rigorous internal complaint workflow — same-day documentation, same-day routing, two-business-day assignment, three contact attempts at varied times. It does not require VA to give the veteran a written decision, and it provides no appeal. The only letter guaranteed in the entire process is the one sent when VA could not reach you.

A Medicare-participating hospital does not have that option. Match it: a written resolution stating who reviewed the complaint, what steps were taken, what was found, and the date of completion — plus a stated route for a veteran who disagrees.

PART THREE — WHAT CONGRESS MUST DO

   DEMAND 13. Independent external review of clinical decisions.

This is the demand I consider most important, and the one most veterans have never heard framed this way.

If you have private insurance or a marketplace plan and your care is denied, you get an internal appeal — and then, if that fails, a binding external review by independent physicians with no relationship to your plan. Medicare beneficiaries have a comparable path running to an administrative law judge.

If you are a veteran and VA denies you a referral, an imaging study, a surgical consult, or a specific therapy, you have no equivalent. Clinical appeals stay inside VA. Patient advocacy complaints have no appeal. Privacy complaints explicitly have no appeal.

And VA already knows how to build this. A veteran disputing a rating gets a Supplemental Claim lane, a Higher-Level Review lane, a Board appeal before a Veterans Law Judge across three dockets, and then the U.S. Court of Appeals for Veterans Claims. A veteran disputing care gets a phone call from the person who said no.

Create an independent external clinical review mechanism for adverse clinical determinations — reviewers outside the deciding facility's chain of command, and a determination VA is required to implement. Every other insured American already has this.

Congress has already written this kind of protection into title 38 once. Section 14017 of the 21st Century Cures Act (P.L. 114-255) created 38 USC 5501A, which bars the Secretary from making an adverse determination about a beneficiary's mental capacity unless that veteran first receives notice of the proposed determination and the supporting evidence, an opportunity to request a hearing, an opportunity to present evidence including a medical opinion, and the right to be represented and to bring a medical professional to testify.

Four requirements. One paragraph. Effective on enactment. Do again what you already did in Section 14017 — for a different class of decision, and one that determines whether a veteran gets care rather than who manages their check.

   DEMAND 14. Factual disclosure to veterans harmed by VA care.

38 USC 5705 makes VA quality-assurance records confidential and privileged. That protection exists for a real reason — clinicians report candidly only when the report cannot become a deposition exhibit — and I am not asking to dismantle it.

I'm asking for something narrower. VA's own Patient Rights document promises: "You will be informed about how to request compensation and other remedies for any serious injuries." That promise does nothing if the veteran is never told an injury occurred.

Give a veteran harmed by VA care a factual disclosure of what happened — the findings, not the deliberative analysis. The patient safety field has drawn that line for decades.

   DEMAND 15. A separation health screening that finds what the veteran doesn't know to report.

Veterans are expected to tell VA what is wrong with them. Most don't know. Conditions surface years later, by which point the fight is about whether they are service-connected.

A Separation Health Assessment already exists. Expand it in scope and quality, with findings automatically documented for both clinical and claims purposes. The argument here is not compassion, it is arithmetic: late detection costs VA more than early detection, every time.

WHAT THIS PETITION DOES NOT CLAIM

I'm not going to inflate this to make it hit harder.

I don't have verified statistics on how often these failures occur. I have VA's written standards, which are documented, and veterans' accounts, which are consistent but not yet counted. That is exactly why the intake form exists — and why the numbers, when I have them, will be published with their methodology attached.

I'm not claiming VA gets everything wrong. VA's written test-result standard is stronger than what most civilian practices commit to in writing. Its clinical practice guidelines are more methodologically rigorous than most health systems publish. Its patient advocacy workflow is tighter on paper than many civilian grievance offices. Several demands in this petition are built out of VA's own good documents being used against VA's own practice.

I can't help you with your claim. If you need help with an individual claim or appointment, an accredited Veterans Service Officer can represent you at no cost — they are listed at va.gov/ogc/apps/accreditation. This petition cannot do that, and won't pretend to.

WHAT I'M ASKING YOU TO DO

Sign. Your name next to mine is what makes the list mean something.

Document. Ten minutes on the intake form, anonymous by default: https://form.jotform.com/262174755362057

Show up. Under CARA (P.L. 114-198, Section 921), every VA medical facility must hold a public town hall on improving care at least once every 90 days, and every CBOC at least annually, with congressional offices notified at least 10 business days in advance. That is a guaranteed, scheduled, public venue at your own facility, and almost nobody uses it. Ask your facility when the next one is.

Write your own member of Congress, especially if they sit on the House or Senate Committee on Veterans' Affairs. A constituent letter citing a specific directive is worth more than a thousand generic signatures.

If you are in crisis, call the Veterans Crisis Line at 988 and press 1.

CITATIONS

VHA Directive 1088(1), Communicating Test Results to Providers and Patients (July 11, 2023; amended September 20, 2024)

VHA Directive 1230, Outpatient Scheduling Processes and Procedures (June 1, 2022)

VHA Directive 1003.04, VHA Patient Advocacy (November 9, 2023)

VHA Directive 1605.01, Privacy and Release of Information (July 24, 2023)

VHA Handbook 1004.01, Informed Consent for Clinical Treatments and Procedures

VHA Notice 2025-04, Community Nursing Home Program (August 8, 2025) — MISSION Act eligibility criteria

38 CFR Part 4, Sections 4.1, 4.2, 4.10, 4.40, 4.45, 4.59, 4.70, 4.71a, 4.87 (current as of August 4, 2026)

38 USC 5705 — confidentiality of medical quality assurance records

38 USC 5501A — beneficiaries' rights in mental competence determinations, as added by 21st Century Cures Act, P.L. 114-255, Section 14017 (Dec. 13, 2016)

42 USC 300jj-52 — information blocking, as added by 21st Century Cures Act, P.L. 114-255, Section 4004

38 CFR 17.4000 et seq. — Veterans Community Care Program

VA/DoD Clinical Practice Guideline for the Management of PTSD and Acute Stress Disorder (June 2023)

VA/DoD Clinical Practice Guideline for Tinnitus (June 2024)

VA/DoD Clinical Practice Guideline for the Use of Opioids in the Management of Chronic Pain (May 2022)

VA/DoD Clinical Practice Guideline for the Non-Surgical Management of Hip and Knee Osteoarthritis (May 2026)

VA Patient Rights and Responsibilities​

Comprehensive Addiction and Recovery Act, P.L. 114-198, Section 921 — community meeting requirement

Comparisons to civilian healthcare standards — CMS Conditions of Participation grievance requirements, ACA external review, and information-blocking rules — are stated here in substance and are being pinned to exact current citations before any formal submission. We would rather say that than overstate it.