I dealt with the Nashville, Tn VA for my Dad. He got fairly good care no complaints there. His disability claim also went through pretty fast for an increase. I'd give them a B+.
My late husband got royally screwed by the Reno, VA for his claim for increase. He appealed for eight years before he got his 100%. He died just 2 months later. The evidence was there all along, but we knew nothing about the process and the rep was worthless. This was in the early 90's they deserved a F. Hospital care also sucked.
My friend Dave finally got a 70% rating last month from Reno, he filed the original claim in 2000. It is a very low ball rate too. The process seems to be a little bit better now than a couple of years ago.
The hospital and primary care is adequate if you have someone looking out for you. I feel sorry for anyone that does not have an advocate. Most of the doc's don't speak english very well, at least for all of us old folk that can't hear.
His last ICU hospital stay he had an allergic reaction to morphine,(hives, itching like mad all over his body) and if I had not called attention to this and made a fuss they would have continued the morphine. They ignored him.They tried to just blow it off because he has mild itching on his back all the time, but he was digging everywhere with this. You had to be blind not to see the difference. They finally discontinued the morphine ,gave him benadryl and the symptoms went away immediately.
Give a B for primary care, and a D for hospital.