Abstract: BACKGROUND: US Veterans experience higher rates and worse outcomes for head and neck squamous cell carcinoma (HNSCC) compared to civilians. Geographic and socioeconomic barriers remain unclear. METHODS: This retrospective descriptive study analyzed VA data nationwide (2012-2022), identifying Veterans with HNSCC using ICD codes. Subsites included oral cavity, oropharynx (OPC), hypopharynx, larynx, and nasopharynx. Rurality, deprivation, and travel distances were assessed. RESULTS: Among 75,453 Veterans with HNSCC, 36% lived in rural areas, with travel times of 94 min to tertiary VA facilities. Approximately 32% had high deprivation (area deprivation indices [ADI] ≥ 75). OPC cases increased from 26.3% in 2012 to 46% in 2022, while laryngeal cancers declined. OPC patients were less deprived (p<0.001) but had similar travel distances and rurality compared to non-OPC patients. CONCLUSION: Overall, Veterans experience high deprivation, long travel times, and over one-third live in rural communities, highlighting potential barriers to access and equity among Veterans with HNSCC.