What is a VA cash-out refinance?
It's a new VA loan that pays off your existing mortgage and, if you choose, returns part of your equity as cash at closing, per VA.gov. It works on any current loan type, not just VA loans, and it is for a home you occupy as your primary residence.
Veterans use it three ways: pulling equity for a real need (a roof, a renovation, tuition), consolidating expensive debt, or simply moving a conventional or FHA loan into the VA structure with no monthly mortgage insurance. The VA's refinance protections apply, including fee disclosures and a net tangible benefit standard, so the new loan has to actually serve you, not just generate a closing. That's a standard I'd hold anyway.
VA cash-out vs IRRRL: which one?
Simple split: if you just want a lower rate or payment on an existing VA loan, the IRRRL streamline is built for that. If you need cash out, or you're refinancing a non-VA loan into a VA loan, cash-out is the tool, per VA.gov.