In this observational study of sequential yearly Veterans Health Administration electronic health record data from 2005 to 2019, CUD rates increased from 1.38% to 2.25% in states with no cannabis legalization, 1.38% to 2.54% in states that legalized medical use, and 1.39% to 2.56% in states that legalized recreational use. Significant but small effect sizes were found for medical and recreational legalization, accounting for 4.7% and 9.8% of the overall increases in the respective states.