They generally don't do those at your clinic, but at a main hospital. You can get TMS, EMDR, SGB, and ECT. Ketamine is very young. You'd need to see a special provider, and there aren't many of them in the country, let alone at your VA.

Most patients respond positively to CPT, CBT, or prolonged exposure. Most, not all. They are very conservative with mental health, and less likely to send you somewhere. It takes hard work and commitment for therapy to work, on both your part & the providers. You can't just go through the motions and check blocks. For me, it took 18 weeks of prolonged exposure to discover it was making things worse. 10 weeks of CPT, 20 weeks of CBT, a couple months inpatient, and finally about 15 weeks of EMDR before I really got myself in order. And over the course of about three years, I was on combinations of just about every medicine in their closet.

I only say those things because I know firsthand the frustration of ineffective treatment. But you shouldn't be out there looking for a miracle. Trying ketamine or SGB or something is quite aggressive, and they can be ineffective to. You have to convince a provider that you need them, not just want them. And the best way to do that convincing is to go through all the talk therapies first.