The Department of Veterans Affairs, which provides services for nearly 10 million veterans each year, currently handles health care, benefits and burials for those who have served. But nomination battles and standards of care haven’t always been the most controversial thing about the V.A.—for years, Americans couldn’t decide whether they wanted to support veterans at all.

It would take centuries, and a tragic world war, to convince the United States to form a department that cared for its vets.

Fights over pensions began after the Revolutionary War

Veterans, even those with disabilities, weren’t always perceived as returning heroes. From the beginning, the United States struggled with how to deal with soldiers’ needs after combat was through.

William R. Werne and Anita Bloom, both whose legs became paralyzed in combat, practice walking exercises as part of their rehabilitation training program at the Veterans Administration Hospital, in the Bronx, 1944. (Credit: Bettmann Archive/Getty Images)

Though the new nation tried to induce recruits to sign up with assurances of bonuses and pensions, it didn’t keep its promises to America’s first veterans. The Continental Congress pledged money to anyone wounded in the Revolutionary War, but the cash-strapped Articles of Confederation Congress didn’t follow through.

As historian Lester D. Langleynotes, this wasn’t exactly popular among the troops, many of whom had lost their limbs during the war. “The bitterness over the pensions…nearly brought on a military coup,” he writes. Tension about pensions mounted between army men, who felt they had been forgotten, and civilians, who felt that pensions were government giveaways.

The War Pension Act of 1818

After dragging its feet for 35 years after the Revolutionary War concluded in 1783, Congress finally addressed the issue of how to care for America’s veterans with the War Pension Act of 1818. Thanks to a combination of relative prosperity and romantic sentiment toward the now distant revolution, the publicsupported pensions for veterans “ in reduced circumstances.”

However, once it was passed, the number of claims astonished Congress. Almost immediately, benefits were cut and Congress tried to crack down on fraudulent claims.

Meanwhile, wounded veterans had no health care system to fall back on. Early hospitals were crude and unsanitary, and veterans’ care wasn’t guaranteed. In 1811, 20 cents a month began to be deducted from sailors’ paychecks. Eventually, it built theNaval Asylum in Philadelphia, the first naval hospital and retirement facility in the United States.

It took until 1851 for the Army to open a similar facility. The U.S. Soldiers Home was funded without any money from the U.S. Treasury; soldiers’ salaries and private donations paid for the Washington, D.C. facility.

VIDEO: Impact of the Civil War

The Civil War was a long and gruesome conflict that claimed more than 620,000 lives and had lasting effects on military and civilian survivors.

The Civil War was a major turning point in veterans’ care

The Civil War tore the nation apart and left hundreds of thousands of wounded soldiers in its wake. Sixty thousand menbecame amputees during the war, soldiers returned with ongoing complications of starvation and wartime diseases, and many men who did survive lived with what would now be diagnosed asPTSD. Military hospitals ran out of room for patients, hosting them in makeshift tents and discharging them as soon as it was safe.

During the war, the U.S. Sanitary Commission ran temporary homes for disabled soldiers, but once the war ended it looked like they would have nowhere to go. Debates raged over whether to support disabled soldiers through pensions or state care. Then, in 1865, Congresscreated the National Home for Disabled Volunteer Soldiers as a nod to the men who had given their health in exchange for their service—thefirst of 11 such homes that cared for veterans of the Civil War and other conflicts.

It was the beginning of a new era of veteran care that depended largely on facilities known as soldiers’ homes. Veterans’ organizations, private groups and states began their own homes where vets could receive treatment and live. Over time, veterans of other wars could access treatment there.

Wounded soldiers outside a brick hospital building in Fredericksburg, Virginia, 1864. (Credit: James Gardner/Buyenlarge/Getty Images)

Civil War pensions became the world’s largest welfare system

Since soldiers’ homes were only available for long-term care, veterans had to patch together treatment and often self-funded their own care. Once again, disbursing pensions to them became a fraught political minefield.

The American public was sympathetic to the plight of Civil War veterans, but it couldn’t agree on what or how much the federal government owed them, saysCasey N. Hedstrom, a Ph.D. candidate at Princeton University whose dissertation examines Civil War pensions.

“Massive entitlement programs are always contentious,” says Hedstrom. “The pension system was the biggest welfare system in the world at that point; at its height it accounted for one third of the federal government’s budget.”

Meanwhile, visibly disabled veterans reminded the public of the human cost of the war. “The trope of the veteran with his ’empty sleeve’ came to symbolize the individual who had sacrificed his body for the nation,” says Hedstrom. “But how veterans were received depended on their class, their race, and the nature of their disability.”

Additionally, a large group of Civil War veterans was excluded from veterans’ benefits entirely: former Confederate soldiers. It took until 1958 for Confederates to be officially considered war veterans in the United States.

Injured soldiers at Walter Reed General Hospital in Washington, D.C.1918. (Credit: GHI/Universal History Archive/Getty Images)

World War I inspires a federally funded health care system for vets

It took the First World War for the United States to change the way it cares for veterans. Men returning from the war suffered from shell shock, the health effects of chemical warfare, and other ailments—and this time, the nation couldn’t bear to look away. From that point on, America’s veterans would benefit from a federally funded health care system.

As soon as the war started, Congress began to focus on rehabilitating veterans. As wounded men flooded home, it began to invest in vocational rehabilitation and disability compensation. The new specialty of rehabilitation medicine was seen as a way to help individuals recover instead of languishing in a state of “collective dependency.”

In 1921, Congress established the Veterans Bureau; in 1924, it extended hospitalization benefits to veterans of every war, regardless of their disabilities.In 1930, Congress established the Veterans Administration. According to the V.A., federal spending on veterans rose 62 percent between 1924 and 1932.

The Bonus Army demanding their war bonus payments on the steps of the Capital while the Senate debates their case. (Credit: MPI/Getty Images)

The V.A.’s first controversy

It didn’t take long for the newly formed department to run into trouble. In 1924, Congress had promised veterans of World War I bonuses that could only be redeemed in 1945. As the Great Depression ravaged the country, though, many veterans became destitute and wanted to cash in on their bonuses early.

Tens of thousands of war veterans calling themselves the “Bonus Army” descended on Washington to demand payment. They set up camp at the Anacostia Flats and marched on Washington. Then, on July 28, 1932, President Herbert Hoover ordered the Army to force the marchers out of the capital. Though they dispersed peacefully (and were eventually compensated sooner than planned), their march helped make the public more aware of the challenges facing veterans.

It wasn’t a moment to soon: As veterans’ services expanded under President Franklin D. Roosevelt’s administration, the nation entered another world war. This time, the country was more united in its desire to help returning veterans.

World War II didn’t mark the end of controversies over how to support veterans: For years, the Department of Veterans Affairs, as it’s now called, has confronted questions about whether and how it serves the needs of veterans. But its very existence marks a change in how Americans perceived the people who fought its wars.

Today, most Americans can agree that it’s worth supporting veterans—even if they differ on who should lead the charge.