Accepting Community Care for major surgery is akin to letting the enemy’s doctor operate on you. It can leave you permanently disabled with no one willing to take responsibility.
When you get care inside the VA system, it comes with a guarantee — if something goes wrong, the VA owns it. Under 38 U.S.C. § 1151 and the Federal Tort Claims Act (FTCA), veterans can be compensated when VA doctors commit malpractice or when the VA fails to act. The VA has to fix mistakes, because the government is responsible for its own employees.
When you are referred out to Community Care, the rules change dramatically:
- Doctors are contractors, not VA employees. The government argues it is not responsible for their mistakes.
- If something goes wrong, you fall into a legal gray zone. State courts dismiss the doctor under “sovereign immunity,” while federal courts deny VA responsibility under the “independent contractor” defense.
- The VA does not police contractors. Even if a provider abandons you, refuses to investigate surgical failures, or ignores your VA records, the VA disclaims responsibility for oversight.
- You risk being left with no remedy at all. That means no compensation for injuries, no second surgery when the first fails, and years of pain and decline while agencies point fingers at each other.
The Hard Truth
Over the past decade, VA spending on Community Care has surged—from under $10 billion in the mid-2010s to tens of billions of dollars today. As of FY 2025, the VA projects $40.9 billion in obligations for non-VA medical (community care) services.
But surveys and GAO reports show much of that money goes unused because veterans don’t trust it. Many veterans already sense the problem: Community Care looks like “choice,” but in reality it’s a bureaucratic trap that leaves you with less accountability and worse continuity of care.
Practical Advice for Veterans
- Stay inside the VA when you can. Care may be slow or imperfect, but at least the VA has to own the outcome.
- If you must use Community Care, document everything. Save every message, scan, and record, because you’ll need them if you have to fight later.
- Expect denial and defense. Community Care doctors and hospitals operate under malpractice insurance models. Their instinct is to protect themselves first, not to admit errors or provide continuity.
- Prepare for litigation. If you end up harmed, expect to spend years fighting both the VA and the provider.
Bottom Line
The VA may push Community Care as a convenience, but it is the most dangerous form of care for veterans.
Veterans should never accept VA Community Care for surgery unless there is absolutely no other choice. Inside the VA system, accountability is guaranteed — if something goes wrong, the VA must own it and fix it. But with Community Care, you may be left with no remedy at all.
Accepting Community Care for major surgery is akin to letting the enemy’s doctor operate on you. The risk is not just medical — it’s legal, and it can leave you permanently disabled with no one willing to take responsibility.