Depends on the VA. Is it a desirable location, do they have a ton of applicants for the position, etc? If you're board certified and have been practicing a while, the salary the VA is offering will come nowhere near what you can get in outside systems. You can try, but many are just not going to negotiate as it is handled mostly by HR, and they are the most incompetent people on the planet. Some places can offer some pull with HR decisions, but they are outliers.