A veterans group has blasted the Department of Veterans Affairs over leaked internal documents showing dozens of medical facilities performing at below-average levels.

USA Today obtained the documents and published them Wednesday, revealing the secret system.

The VA had previously refused to make the ratings public, claiming the system is for internal use only. It rates each of the VA’s medical centers on a scale of one to five, with one being the worst.

Roughly 45 facilities — many in the Upper Midwest and the Northeast — performed at an above-average rating, the report said, while 40 were below average.

The worst performing centers are in Dallas and El Paso, Texas, and in Nashville, Memphis and Murfreesboro, Tenn.

The documents also show that some medical centers have not improved despite scandals and scrutiny from Congress. The Phoenix VA still sits at a one-star rating despite a 2014 scandal revealing veterans died while waiting for care and that staff manipulated wait-time data there and at other VA hospitals across the country.

The VA announced last October it plans to allocate $28 million to the Phoenix center in addition to its annual budget.

VA Undersecretary for Health David Shulkin told USA Today that the ratings system is primarily for internal use and that the public should avoid seeing it as a ranking tool.

“It is essentially a system within VA to see who’s improving, who’s getting worse, so we can identify both,” he told the newspaper. “My concern is that veterans are going to see that their hospital is a "one" in our star system, assume that’s bad quality, and veterans that need care are not going to get care. And they’re going to stay away from hospitals and that’s going to hurt people.”

Shulkin said 120 facilities have shown improvement since he assumed his position in July 2015, and that all one-star facilities have shown some improvement, except for the VA medical center in Detroit.

Concerned Veterans for America, a veteran advocacy group that has been critical of the VA, released a statement condemning the findings. CVA Executive Director Mark Lucas said the ratings system underscores continuing problems in the organization and that the VA is not committed to transparency.

“By keeping this rating system secret, the VA was admitting that preserving the illusion of competency matters more to them than actually serving veterans — and the VA fails at both,” Lucas said. “The lengths to which the VA will go to hide its own bad performance should disturb veterans and American taxpayers alike.”

hlavac.tyler@stripes.com