The Phoenix Veterans Affairs office is still improperly canceling veterans’ appointments, has built up a new backlog of cases — and at least one veteran is likely dead because of it, the department’s inspector general said in a new report Tuesday.

Two years after they first sounded the alarm about secret waiting lists leaving veterans struggling for care at the Phoenix VA, investigators said some services have improved, and they cleared the clinic of allegations that top officials ordered staff to cancel appointments.

But confusion and bureaucratic bungling are still prevalent, some veterans are waiting a half-year or longer for treatment, and staff are still canceling appointments for questionable reasons.

More than 200 veterans died while waiting for appointments in 2015, and investigators said at least one veteran would likely have been saved if the clinic had gone ahead with his consultation.

“This patient never received an appointment for a cardiology exam that could have prompted further definitive testing and interventions that could have forestalled his death,” the inspector general said.

The VA is still reeling from an initial 2014 report that found top executives cooked their books, canceling appointments and shifting others onto secret wait lists to try to make their backlogs appear less drastic, hoping to earn performance bonuses.

The problems were first reported at the Phoenix VA, where dozens of veterans died while waiting for care, but investigators found similar secret wait lists and botched care at clinics across the country.

Department Secretary Eric K. Shinseki was ousted and new Secretary Bob McDonald was brought in to make improvements in the Veterans Health Administration (VHA), the branch of the department that provides care to nearly 9 million beneficiaries.

Congress has also acted, passing a law that gives veterans who have been waiting too long for appointments the chance to seek care at a non-VA facility on taxpayers’ dime. But lawmakers said the new report is proof that President Obama and Mr. McDonald need to start firing bad employees if they want to clean up the department.

“VA’s performance in Phoenix and across the nation will never improve until there are consequences up and down the chain of command for these and other persistent failures,” said House Committee on Veterans’ Affairs Chairman Jeff Miller, Florida Republican.

He faulted the inspector general’s report for not naming names, saying without “clear lines of accountability,” the problems won’t be solved.

Sens. John McCain and Jeff Flake, Arizona’s U.S. senators, said the findings show the need for even more private options for care. The two Republicans said the choice-card program should be open to all veterans regardless of how long they have waited for an appointment or how far they live from a VA facility.

Matt Dobson, Arizona state director of Concerned Veterans for America, said the VA “is failing veterans because of its toxic leadership.”

“Arizona veterans are now on our seventh director in three years in Phoenix — we haven’t had a competent leader here in years,” Mr. Dobson said in a statement. “How can veterans expect to see anything but continued wait times and scandal when there is zero accountability for these so-called ‘leaders’? If the VA won’t hold their own employees accountable, Congress must.”

The VA, in its official reply to the inspector general’s report, insisted it’s improved things over the last few years despite lingering problems. Undersecretary for Health David J. Shulkin said they’ve cut the number of patients who wait more than 90 days for an appointment by 64 percent, and most of the ones that have been waiting aren’t considered urgent.

Dr. Shulkin also said that in some cases, the veterans have actually received the case but the department’s records aren’t up to date.

“VHA is strongly committed to developing long-term solutions that mitigate risks to the timeliness, cost-effectiveness, quality and safety of the Department of Veterans Affairs (VA) health care system,” he said.

Whistleblowers had lodged a long list of complaints against the Phoenix VA, including that clinic executives instructed staffers to cancel pending consultations.

Investigators said they could not prove that allegation, but said they found poor communication left staffers uncertain about how to handle some appointments, which led to them being canceled. Nearly 25 percent of specialty care consultations were “inappropriately discontinued.”

In some cases the VA employees didn’t give a reason for the cancellation. In others, the veteran missed the appointment and VA employees didn’t bother to follow up and reschedule — breaking agency rules that require at least two no-shows or multiple attempts at rescheduling before an appointment could be expunged.