Frequently Asked Questions

In this nationally representative sample, 20.5% of veterans reported that the Veterans Health Administration was their main source of health care (95% CI, 18.9%–22.3%). The estimate came from 4,069 community-dwelling US veterans surveyed in 2019–2020.

The authors noted that this was higher than the 16.9% reported in a 2011 national study.

Veterans who were more likely to use the VA as their main source of care were younger, black/African American, unmarried or unpartnered, had annual household income of $60,000 or less, and had combat exposure. In the multivariable model, these demographic and military characteristics remained independently associated with primary VA use.

Primary VA users also had greater cumulative trauma burden, a history of major depressive disorder or PTSD, a higher number of medical conditions, and lower self-reported cognitive functioning.

The strongest contributor in the relative importance analysis was annual household income of $60,000 or less, which accounted for 23% of the relative variance explained. Other major contributors were lower self-reported cognitive functioning (14%), younger age (11%), unmarried/unpartnered status (10%), lifetime history of major depressive disorder (9%), chronic pain (9%), lifetime history of PTSD (7%), and a sleep disorder diagnosis (6%).

The overall regression model explained a modest amount of variance in primary VA use (Nagelkerke R2 = 0.23).

Yes. Compared with veterans who did not use the VA as their main source of care, primary VA users were more likely to screen positive for lifetime and current alcohol use disorder, drug use disorder, major depressive disorder, PTSD, and generalized anxiety disorder.

They also had higher suicide risk indicators, including past-year suicidal ideation, lifetime nonsuicidal self-injury, suicide attempts, and future suicidal intent. In the multivariable analysis, a history of major depressive disorder and PTSD remained independently associated with primary VA use.

In the post hoc analysis of individual provider-diagnosed conditions, chronic pain, sleep disorders, and respiratory disorders were independently associated with primary VA health care use.

• Chronic pain: OR = 1.45 (95% CI, 1.18–1.78)
• Sleep disorders: OR = 1.38 (95% CI, 1.13–1.70)
• Respiratory disorders: OR = 1.31 (95% CI, 1.01–1.71)

All other individual medical conditions were nonsignificant in that analysis (Ps>.23).

Yes. Veterans who used the VA as their main source of health care reported greater perceived stigma and more barriers to mental health care than non-primary VA users.

They were more likely to worry that peers would treat them differently, see them as weak, or think less of them if they sought mental health care. They also more often endorsed logistical barriers such as transportation and scheduling problems, worries that mental health treatment does not work, and distrust of mental health professionals.

The study defined a primary VA user based on a single self-report item asking whether the VA was the veteran’s main source of health care. Participants were categorized as either primary VHA users or not primary VHA users from that response.

This measure did not distinguish between veterans who used the VA as a secondary source of care and those who did not use it at all.

This study analyzed data from the National Health and Resilience in Veterans Study, a nationally representative web-based survey of 4,069 community-dwelling US veterans conducted in 2019–2020. Weighted group comparisons were followed by multivariable logistic regression, a post hoc analysis of individual medical conditions, and a relative importance analysis.

Because the study was observational and based on self-report survey data, it identifies characteristics associated with primary VA use but does not establish that those factors caused veterans to rely on the VA as their main source of care.

The main limitations were that the data were collected in 2019–2020, relied on self-report, and measured primary VA use with a single question. The timing means the findings do not capture developments after the start of the COVID-19 pandemic, including the rapid expansion of telehealth services.

The authors also noted that participants who reported barriers to mental health care were not asked whether those barriers applied specifically to VA-based care or non-VA care. In addition, the single-item utilization measure did not separate secondary VA users from veterans who did not use VA care at all.