Trump Cites the V.A. as a Central Achievement. But Troubles Simmer.

WASHINGTON — As he campaigns for a second term, President Trump brags about few things more consistently than his record on veterans affairs. Among his signature lines: “No one has done more for veterans than me.”

But nearly four years into his promises to fix systemic problems at the Department of Veterans Affairs, charges of sexism, ineptitude and other flaws remain.

Mr. Trump’s signature plan to expand veteran access to health care outside the department’s own health care centers has been hobbled by the coronavirus pandemic.

His secretary of veterans affairs, Robert L. Wilkie, has been ensnared in an investigation into whether he used his authority to discredit a female veteran who said she was assaulted at a veterans health center in Washington, D.C. Complaints of harassment at veteran’s centers by female veterans remains high.

Black workers recently accused leaders of the Kansas City V.A. of fostering a culture of racism. And as calls from Black veterans and active-duty members of the armed forces to remove the names of Confederate officers from military bases have grown louder, Mr. Wilkie’s own history of insensitive remarks have resurfaced, including those describing the president of the confederacy, Jefferson Davis, as a victim of Northern aggression. He also gave a vigorous defense of Nazi headstones at veterans cemeteries before bowing to pressure to remove them.

While some of Mr. Trump’s promises to ferret out corruption at the department have come to pass, other forms have taken root, including at a new office formed to protect whistle-blowers, which the inspector general determined often found ways to retaliate against them.

Beyond issues of administration at the Department of Veterans Affairs, questions remain about the care offered to those who served.

The suicide rate among veterans — one of Mr. Wilkie’s stated priorities — has not been reduced. The Trump administration’s cutbacks at the post office have hit some veterans, who say they are unable to get their prescriptions by mail.

And while care for veterans with coronavirus appeared to go well — deaths at the hospitals were lower than at many health systems — the department was plagued by a lack of protective equipment for its workers.

And an expensive plan to convert the system’s medical records electronically has hit one delay after another.

That long and expanding litany of problems at the Department of Veterans Affairs has left analysts and some veterans questioning why Mr. Trump has tried to make his record there a centerpiece of his quest for a second term.

“The challenges at the V.A. are multifaceted,” Terri Tanielian, a senior analyst at the RAND Corporation who specializes in military and veteran health issues, said. “Recognizing that addressing these issues takes sustained leadership commitment, not sound bites, is essential if we are going to deliver on the promises to veterans at the V.A.”

Mr. Trump is fond of saying that he delivered the Veterans Choice Program, which enables some veterans to get care outside of the agency’s health centers, and that “no president’s ever been able to do it, and we got it done.”

This is untrue; President Barack Obama signed that law, the product of a bill negotiated between Senators Bernie Sanders, independent of Vermont, and John McCain, Republican of Arizona, in 2014. What Mr. Trump signed in 2018 — a measure called was the Mission Act — greatly loosened the standards allowing veterans to seek primary care, urgent care and mental health services outside the department’s system.

The urgent care component is viewed largely as a success. But for primary and specialist care, the legislation has so far not transformed the system. It was somewhat hobbled out of the gate by a shortage of doctors in the network the department chose for the program. The company told lawmakers last year that it would probably need millions of dollars more to meet the coverage goals.

Then, the coronavirus hit, and in March, the department told Congress it would place a “temporary strategic pause in the Mission Act access standards for 90 days, or until the soonest possible time that routine care may safely resume.” Community care referrals fell about 70 percent and millions of veterans canceled appointments over the ensuing months.

“The V.A. has been conducting Mission Act referrals in many areas where it is safe to do so throughout this national emergency,” said Christina Noel, a spokeswoman for the department. “Some sites are doing more referrals amid the pandemic than they were prior to the pandemic.”

“During this public health crisis, our job is to make sure veterans are cared for properly and ensure they are not contracting Covid-19,” she added. “That’s why V.A. is taking into account whether referrals for community care are clinically appropriate during the Covid-19 outbreak.”

The pandemic allowed the department to move forcefully ahead with telemedicine, which could ease the need for a more extensive community care network for basic medical needs. The department had a 1,200-percent increase in video visits from the first week of March to the end of July.

Given the variable conditions across the country and the system’s highly decentralized structure, tracking the outside care veterans are receiving is difficult. But lawmakers and veterans groups note that wait times for care are increasing, which the Mission Act was meant to ease.

“I trusted V.A.’s decision in March to restrict non-urgent care, in the community and in V.A., and I trust that V.A. has and will move to remove those restrictions safely and in full compliance with the law moving forward,” said Representative Phil Roe of Tennessee, the senior Republican on the House Veterans Affairs Committee.

Mr. Trump also promised to root out fraud in the department. He vowed to use executive powers to remove and discipline the federal employees and managers who have violated the public’s trust.

But his move to protect and promote whistle-blowers had the opposite impact, according to a report by the inspector general, who found that, instead, the department targeted whistle blowers who reported on officials who were friendly with high-level employees in the department.

Recently, a former nursing assistant at a Department of Veterans Affairs hospital in West Virginia pleaded guilty to second-degree murder in the deaths of seven patients, and an emergency room doctor working on contract at a center in Washington, D.C., was heard saying that she did “not care” if a veteran who came seeking help killed himself, which he later did. In both cases, no senior managers were held accountable.

“The notion that policies and protocols can unfailingly stop those intent on committing crimes strains credulity,” Ms. Noel said.

In September, a senior House policy adviser on female veterans issues said she was sexually assaulted at the Department of Veterans Affairs hospital in Washington.

After receiving a complaint that Mr. Wilkie had tried to dig up dirt on the woman, a reserve Navy intelligence officer, the department’s inspector general began an investigation that is expected to conclude soon.

Around the same time, the deputy secretary of veterans affairs was abruptly and mysteriously fired, and three former and current employees from the department said it was partly because of his unwillingness to participate in the effort to smear the woman’s reputation. The case was one of thousands of complaints that female veterans make every year about harassment at veterans’ centers.

The recent slowdown over the Postal Service has also caused problems for veterans, who get roughly 80 percent of their prescriptions through the mail. For weeks, reports of a slowdown in the orders have mounted.

Last week, several health care workers complained about the problem. A doctor at a veterans affairs community care center in the Denver area said that roughly 15 percent of his patients reported that their drugs were going to the wrong place or not arriving at all. A colleague in New Orleans told him the center there had set up an outdoor tent outside the facility to help veterans scrambling for important medications like insulin.

The doctor, who requested anonymity because he feared retaliation from department officials, said the lagging prescriptions were making efforts to help those seeking care even harder.