WASHINGTON >> An open letter from a senior Republican senator to the nation’s veterans in which he castigates the leadership of veterans organizations prompted a brutal war of words over the Memorial Day weekend, including a promise from the Veterans of Foreign Wars that its "hat in hand" approach to Congress will turn more combative.

The controversy over delayed access to care at Department of Veterans Affairs hospitals over the weekend veered away from allegations of incompetence at the top of the agency toward a broader fight over resources and the future of government health care for an expanding pool of veterans.

The issue carries risk for Republicans because they could be left with a politically difficult effort to privatize at least some veterans’ health care or to pump more money into a system covering about 2.8 million veterans of the wars in Iraq and Afghanistan, an option veterans groups have demanded but Republican leaders have resisted.

"What we need to establish now is how we can provide high quality, timely health care to all of our veterans, period," said Sen. Bernard Sanders, I-Vt., the chairman of the Senate Veterans Affairs Committee, who is preparing legislation for Senate consideration in the coming weeks. "At a time when we have a major primary care crisis, how do we make sure the VA gets the staffing they need?"

The open letter, from Sen. Richard M. Burr of North Carolina, the ranking Republican on the Senate Veterans Affairs Committee — and the groups’ responses — pushed the conflict into the open.

Burr, angry that only the American Legion has called for the resignation of the veterans affairs secretary, Eric Shinseki, accused the groups of being "more interested in defending the status quo within VA, protecting their relationships within the agency, and securing their access to the secretary and his inner circle," than in helping members.

The Veterans of Foreign Wars, the Disabled American Veterans and the Paralyzed Veterans of America hit back hard.

"For years, the VFW has come to Congress with hat in hand, and for years we’ve heard the same old story," the heads of the veterans group wrote to Burr. "You can be assured, Senator, that you’ve done a superb job in showing us the error in our ways. You can also be assured that in the future, we will spend a substantial percentage of our time seeking to inform our members and our constituents of the repeated failure to act by our elected officials."

To that sentiment, the national president and the executive director of the Paralyzed Veterans of America added, "Perhaps you should have shared with all veterans in your ‘open’ letter that you cared so much about their health care that you were not actually present during the testimony that the VSO representatives provided, and you did not ask a single question." VSO stands for veterans service organizations.

Burr, along with other senior Republicans like Sen. John Cornyn of Texas, the No. 2 Republican in the Senate, has called on Shinseki to resign, a demand echoed by the American Legion but not by other veterans groups or by Speaker John A. Boehner of Ohio.

But beneath the fight over Shinseki’s future is a potentially larger war over the Veterans Affairs health care system itself. Over the weekend, the Obama administration said it would allow more veterans to get access to care through private health facilities to ease the backlog at the VA’s 152 medical centers and 900 community care facilities.

Republican lawmakers in the House and the Senate are pushing further. Rep. Jeff Miller of Florida, the chairman of the House Veterans Affairs Committee, will introduce legislation this week to give any veteran unable to obtain a VA appointment within 30 days the option to go outside the system at the department’s expense.

"For the full basket of reforms to take place at the VA, there has to be some level of competition," Burr said in an interview Monday. "The problems seem to be so systemic, and in some cases, so cultural, that unless there’s a model that gives veterans some ability to decide where to go, I don’t think we will have the means to meet the needs of current veterans, let alone future veterans."

Veterans groups maintain that the VA’s services for spinal cord injury, blinded care, amputee care and other trauma cannot be matched by private facilities. Over the past two to three years, Veterans Affairs has had a net gain of 1.5 million patients, 200,000 of them with post-traumatic stress disorder and traumatic brain injuries, according to Sanders.

Relations between the organizations and Senate Republicans have been strained since February, when Republicans blocked a vote on broad veterans legislation, written by Sanders, that would have bolstered health and dental care, authorized 27 new clinics and medical facilities, added to veterans education programs, and dealt with veterans who suffered sexual trauma while in the military.

Republicans complained that Democratic leaders were not allowing them to amend the bill. But at heart is a budget fight. Republican leaders say that Veterans Affairs is plagued by inefficiency and poor management, not insufficient funds. For the past five years, Congress has largely given President Barack Obama what he has requested, and the VA has had hundreds of millions of unspent dollars at the end of each year to roll into the next.

Burr spared the American Legion, saying, "It is clear that the Legion has been listening to its membership."

He then all but called for a purge of the other veterans groups.

"I fear that change within the VA will not be possible unless and until these organizations also reconsider their role, as well as the nature of their relationship with the VA," he wrote.

The responses were unusually personal. Bill Lawson, the national president of the paralyzed veterans group, and Homer S. Townsend Jr., the executive director, criticized Burr for supporting the filibuster of the veterans bill in February, and said, "You clearly represent the worst of politics in this country."

William A. Thien, the commander in chief of the VFW, and John E. Hamilton, the adjutant general, pointed to a staff with more than 47 combat deployments in Vietnam, Somalia, Iraq and Afghanistan, four Purple Hearts, 16 Air Medals, Bronze Stars and other honors.

"I suggest you compare the more than exorbitant amount of days off you receive, including virtually the whole month of August, two weeks around Easter/Passover, and certainly not a single five-day workweek, to the oftentimes long, arduous hours they put forth every week of the year," the letter said.

"Clearly I hit a nerve," Burr said. "I think they’ve shown more outrage toward my open letter than outrage than toward the current crisis at the VA."

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