Derrick Van Orden says a chart of the VHA's current structure does not make any sense

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VA consolidates its health care networks from 18 to five and caps staffing; Collins says it cuts bureaucracy, and critics say the caps strain veterans' care

On December 15, 2025, the Department of Veterans Affairs announced a reorganization of the management structure of the Veterans Health Administration, which runs the VA's hospitals and clinics. The VA calls the effort the Restructure for Impact and Sustainability Effort, or RISE, and describes it as its largest transformation in more than 30 years. It shrinks the VA's regional health care networks, known as Veterans Integrated Service Networks or VISNs, from 18 to five, adds health service areas beneath them and gives VHA Central Office responsibility for policy, financial management and oversight. The VA said the changes would take 18 to 24 months. The VA also lifted its health care hiring freeze in January 2026 but gave each network a baseline number of positions that it can exceed only with approval from a central hiring committee, and it removed vacant positions from its rolls. VA officials told senators the caps correct overhiring; Gregory Goins, the VHA's acting chief operating officer, said 14 percent staff growth against 6 percent workload growth was unsustainable. Secretary Doug Collins says the reorganization is not a reduction in force and that staffing at medical centers and clinics will not change. Republican committee chairs Mike Bost and Jerry Moran back the plan's aims, though Bost has his own bill for eight networks, and Moran said he would not want a cap to be the determining factor if problems develop. Democrats on both veterans' committees, and Kenneth Kizer, who designed the network structure in the 1990s, say the plan lacks detail and comes on top of large staff losses. Sen. Maggie Hassan told Collins that doctors and nurses are not overhead. As of November 13, 2026, the VA lists five networks on its website, which GAO says changed on July 15, 2026, and its RISE page says no offices or positions will be eliminated through the restructure.