Abstract: Improving access to and promoting the uptake of lung cancer screening (LCS) remains a priority within the Veterans Health Administration (VHA) due to its potential to enhance early lung cancer detection and reduce mortality rates. However, the high incidence of false-positive pulmonary nodules on low-dose CT (LDCT) poses risks of overdiagnosis and unnecessary procedures, particularly within the veteran population. This study aimed to evaluate the prevalence of LCS, the application of the Lung CT Screening Reporting and Data System (Lung-RADS), and the subsequent outcomes in VHA patients who underwent percutaneous lung biopsies (PLBs) from fiscal year 2017 to fiscal year 2022. Data were collected from the VHA Corporate Data Warehouse, with a focus on PLB cases following an LCS. Our findings indicate a significant increase in the use of Lung-RADS over the study period, with a rising proportion of PLBs performed on patients who had undergone an LCS within the previous year. Nearly 90% of these cases showed Lung-RADS scores consistent with a biopsy recommendation, demonstrating high compliance with LCS guidelines. The increasing adoption of Lung-RADS is likely contributing to more accurate risk stratification and improved patient care, although challenges remain in ensuring consistent coding and application across all VHA facilities. The study underscores the importance of continued monitoring and refinement of LCS practices to optimize patient outcomes and minimize unnecessary procedures.