Background: Recent studies have identified a significant and increasing disparity in survival amongst AA and Caucasian patients diagnosed with MM in the United States, and a concomitant disparity in access to novel chemotherapy and stem-cell transplant. We sought to investigate whether this disparity holds at the VA, which does not use a fee-for-service model. Methods: We used the VA’s nationwide Corporate Data Warehouse to identify patients diagnosed with MM from 1999 to 2017, as well as their age, race, therapy at induction, and stem-cell transplant status. We compared overall survival between AA and Caucasian using Cox models. We assessed differences in treatment patterns using chi-squared tests. Results: We identified 15,717 patients diagnosed with MM, including 3,254 AA and 8,845 Caucasian patients. The median age at diagnosis was 65.6 years for AA and 70.1 for Caucasian (P<1e-15). As age has a substantial effect on overall survival, we adjusted our survival analysis for age at diagnosis. We found no difference in age-adjusted overall survival between AA and Caucasian, measured by hazard ratio of risk of death among AA relative to Caucasian (HR 0.99, 95% CI 0.94-1.05, P=0.69). However, among patients younger than 65 at diagnosis, we observed a significant decrease in age-adjusted risk of death for AA compared to Caucasian patients (HR 0.86, 95% CI 0.79-0.94, P=0.001). In patients >65 years, survival was similar between the 2 groups. The difference in younger population was not explained by access or utilization of the novel agents. We observed no racial disparity at the VA in the use of novel agents at induction (IMiD or PI), with 82.5% of AA patients and 81.5% of Caucasian patients receiving novel therapy (P=0.21); or in use of stem-cell transplant (10.1% of AA and 9.1% of Caucasian patients; P=0.09). Conclusions: No racial disparity was observed in overall survival or treatment patterns at the VA. Taken with previous research that does show these disparities in other US healthcare systems, this suggests that these disparities may be due primarily to economic factors, including cost of therapy, rather than factors related to disease biology.