Abstract: As of August 2025, the Veterans Health Administration (VHA) Spinal Cord Injuries and Disorders (SCI/D) system of care provides state-of-the-art specialty medical care for 24,560 United States Veterans living with SCI/D and multiple sclerosis and motor neuron disease with spinal cord involvement. This article reviews the history of VHA SCI/D care to show how VHA's early adoption of rehabilitation innovations and lifetime management not only improved Veterans' outcomes but also contributed to its evolution as a world leader in SCI/D research, training, and comprehensive life-long care. This review traces events that shaped the current VHA SCI/D System of Care as it evolved from housing and pensions for disabled Veterans after the US Civil War to the present-day foundational service within one of the largest health care, research, and medical training systems in the world.This history highlights VHA's longstanding commitment to providing comprehensive, world-class services for Veterans and their families and reinforces its leadership and commitment to cutting-edge research on treatments, potential SCI/D cures, and innovations in precision medicine, training, and technology for all people living with SCI/D.