Abstract: Ending veteran homelessness remains a priority within the U.S. Department of Veteran Affairs (VA). Efforts over the past decade have led to encouraging declines in veteran homelessness but have required significant funds and resources. Analysis of clinical characteristics and utilization patterns of veterans accessing VA homeless programing can clarify the needs of and inform treatment for this subset of the veteran population. Veterans were categorized according to low, moderate, or high rates of VA homeless service use from 2005 to 2024 (N = 1,086,852) and compared based on demographic profiles, documented mental health diagnoses, and use of nonhomeless VA services, such as rehabilitation and mental health services, during the same time frame. Veterans with high (vs. moderate or low) VA homeless service utilization had significantly higher rates of documented psychiatric diagnosis, particularly severe mental illness, substance use disorders, and personality disorders, and had 2-3 times greater odds of utilizing services through Veterans Justice Programs, emergency services, primary care, and other VA programs and 46% greater odds of utilizing rehabilitation services. Despite these patterns, the frequency of nonhomeless VA service use was low across groups, suggesting potentially minimal sustained engagement with these services. Adapting interventions to meet the co-occurring needs of this population by prioritizing connection to and sustained engagement with nonhomeless VA programing may help homeless veterans benefit from the VA's comprehensive health care system.