The Veterans Affairs Department doesn't have enough money to properly care for a surging number of patients, critics say.

Veterans complain of long waits for appointments. Some higher-income veterans who weren't disabled while in the military are turned away. And documents the Observer obtained about the Asheville and Salisbury veterans hospitals paint a picture of thin staffs struggling to properly treat patients.

It's difficult to determine the needs at the hospitals, the primary veterans medical centers in the Charlotte area. The VA would not provide budget requests or detailed information on how the hospitals spend the tax dollars they received. VA officials were not made available for interviews after repeated attempts.

To be sure, the VA's health care budget has increased -- by about 80 percent since President Bush took office.

But his request of $34.2 billion for VA health care next year is $2.6 billion less than veterans groups say the VA needs. Such differences have been typical in recent years. Critics say the White House has been too concerned with masking the true cost of war.

Proof, they say, came when the VA had to revise its numbers and seek more money than planned for 2005 and 2006.  Here are three reasons the VA's budget has been strained.

1. More veterans

The number of VA patients started to skyrocket in the late 1990s, growing by several hundred thousand a year.T  he increase started when lawmakers made more veterans eligible for health care. Further fueling the growth, word spread that the VA had improved -- enough that Business Week and others called it the best care in the U.S.

• The VA treated about 2.5 million patients in 1996, according to veterans groups. Next year, that number is expected to near 6 million (Note: While there was an 80 percent increase in funding for VA, there was a 140 percent increase in VA's patient load.  VA nearly always fails to mention the increase in veteran patients when describing their budget increases.)

• Even if the number of patients peaks in 2010, as the VA expects, demand will rise as veterans age.

Despite "extraordinary" increases to the budget, said Anthony Principi, the VA secretary during Bush's first term, "it hasn't been able to keep pace." 164,000 veterans older than 85 were alive in 1990.  980,000 veterans that old were alive in 2005.

2. Planning failures

The VA's plans for Iraq were too rosy. Some estimates relied on old data. And when projections proved faulty, the VA was slow to admit it.

The VA expected few Army National Guard and Reserve units would be needed, said Stephen Meskin, a former VA actuary. By 2005, those troops comprised more than 40 percent of U.S. forces in Iraq.

As VA leaders planned their 2005 budget, they used 2002 data that predated the war. Their estimate of how many troops would become patients was far too low.

A rallying point for critics: In 2005, Sen. Patty Murray, D-Wash., pushed for more money. VA leaders knew of a shortfall, congressional investigators later learned, but the proposal failed after VA Secretary James Nicholson (above right) said the agency didn't need more money and would instead rely on good management.

He later asked for and received additional funding. VA leaders told congressional investigators last year of changes to make future budgets more accurate.

3. Spending decisions

Some say the problem is not too little money, but how VA leaders spend it.

• The agency awarded $3.8 million in bonuses in 2006, including payments to some responsible for budget errors. Some who received money also sat on boards recommending bonuses.

A congressional hearing will likely be held next month.

• As tens of thousands returned from war with post-traumatic stress disorder, the VA didn't use a third of the $300 million it pledged for mental health treatment in 2005 and 2006, investigators found.

The VA also couldn't show how it spent another $112 million.

More money won't solve the problem as much as better management will, said Jeff Phillips, Republican spokesman for the House Committee on Veterans' Affairs and a former White House liaison for Nicholson's predecessor.  As proof, he said, the VA's data shows better caseload management has helped slash a wait list of patients.  "They are getting money," Phillips said. "The question is what are they doing with it?"

WHAT THEY SAY WENT WRONG: What's next?

1. "We were hiring employees, but the finances that come down from Congress through the VA was just nowhere close to what you needed."

DONALD DOERING, Chief nurse at the Salisbury veterans hospital from February 2003 to November 2004.

2. "(Nicholson) was doing ... what the White House directed him to do. I would argue we were sending guys off, they are coming back horribly maimed. We have to recognize VA is part of the ongoing cost of war."

KENNETH KIZER, Former VA undersecretary on James Nicholson's 2005 assurance that it didn't need more money.

3. "Are they really reaching out to the medical staff at the major VA hospitals and really understanding their needs? No."

LINDA BILMES, Harvard professor and former Commerce Department official under President Clinton, on how VA leaders handle the agency's budget request.

4. VA leaders "went out of their way to withhold information from Congress and the public. They were concealing the escalating human and financial cost of the war."

PAUL SULLIVAN, Former VA manager who said he warned in 2005 that without more staff and money, veterans filing benefits claims would suffer backlogs.

More budget challenges loom. Only a third of the troops sent to Iraq or Afghanistan have been discharged, said Paul Rieckhoff who heads a group of Iraq and Afghanistan Veterans.  "We're going to have a huge wave of people coming home that are going to need help," Rieckhoff said, "and we're not ready."

Earlier this month, Nicholson again had a chance to lobby Congress. He told a House panel that the VA is "adequately staffed." The chairman of the House Veterans Affairs Committee replied that if Nicholson said that to veterans' groups, they would "boo you off the stage."

Those groups have called for an additional $105 million to hire staff, particularly nurses. They've written that "staffing levels are frequently so marginal that any loss of staff can result in a critical staffing shortage and present significant clinical challenges."

Salisbury and Asheville

Here are some ways the two main veterans hospitals in the Charlotte area have struggled with their budgets. To read the Observer's stories about problems with patient care, go to www.charlotte.com/va

• Asheville workers told federal inspectors in June 2005 that the hospital's desire to stay under budget meant that "needed nurses and physicians have not been hired and, therefore, care compromised."

• Organizers of a National Nurses Day protest in Washington in 2005 highlighted Salisbury, saying long-term care nurses were each responsible for 60 patients and often forced to work double-shifts.

• The Salisbury hospital's former top radiologist, Dr. Paul Karmin, said exams such as MRIs were sometimes backlogged for months, but management ignored his requests for workers.

• At one point in 2001, more than 6,000 patients waited for appointments with primary care doctors in Salisbury, according to minutes from a meeting of hospital managers.

Staff writers Stella M. Hopkins and Karen Garloch contributed.