The 4 Biggest Challenges the Next VA Secretary Faces

We now know who will in­her­it the broken Vet­er­ans Af­fairs De­part­ment, but fix­ing the agency’s bur­eau­crat­ic night­mare will be no easy task.

Pres­id­ent Obama on Monday af­ter­noon nom­in­ated Robert Mc­Don­ald, a former CEO at Procter & Gamble who re­tired from the com­pany in 2013. And though vet­er­ans ad­voc­ates and law­makers alike hope that Mc­Don­ald will be able to use the ma­na­geri­al skills he honed in the private sec­tor to whip the de­part­ment in­to shape, he must pri­or­it­ize the VA’s many mov­ing parts.

Here are some of the biggest chal­lenges fa­cing Mc­Don­ald, as­sum­ing he is con­firmed by the Sen­ate.

Stop the bleed­ing: Let’s not fool ourselves: Mc­Don­ald is be­ing brought in to clean up a cata­stroph­ic mess.

The de­part­ment has suffered through scan­dal after scan­dal as gov­ern­ment in­vest­ig­at­ors un­cov­er evid­ence of na­tion­wide ma­nip­u­la­tion of data on how long vet­er­ans wait to re­ceive med­ic­al care at VA fa­cil­it­ies as well as al­leg­a­tions of vet­er­ans dy­ing while wait­ing for care.

And, most likely, with in­vest­ig­a­tions still on­go­ing — in­clud­ing crim­in­al al­leg­a­tions of fraud — there are more rev­el­a­tions to come.

Al­though the scan­dal — and the be­ha­vi­ors that caused it — pred­ate Mc­Don­ald’s nom­in­a­tion, vet­er­ans ad­voc­ates ar­gue that the easi­est way he could do harm would be to not be hon­est about how deep the scan­dal goes.

“Ac­cess­ib­il­ity and ac­count­ab­il­ity are the key,” said John Raughter, a spokes­per­son for the Amer­ic­an Le­gion, when asked how Mc­Don­ald should bal­ance a scan­dal he had no part in cre­at­ing.

But simply mak­ing sure things don’t get any worse won’t be enough.

Fix the VA’s “cor­ros­ive cul­ture”: It’s an ill-defined prob­lem with even more am­bigu­ous an­swers on how to fix it, and it is — without a doubt — Mc­Don­ald’s biggest chal­lenge.

The fo­cus on the VA cul­ture, in­clud­ing a damning re­port re­leased Fri­day from White House ad­viser Rob Nabors and act­ing Sec­ret­ary Sloan Gib­son — has spot­lighted the ma­nip­u­la­tion of wait times by hos­pit­al staff as well as the wide­spread prob­lems with per­son­nel ac­count­ab­il­ity.

And though the buck stops with Mc­Don­ald, he has plenty of people who would like to tell him ex­actly what to do. This in­cludes law­makers and a grow­ing num­ber of ad­voc­ates who want the VA sec­ret­ary to have great­er fir­ing power — par­tic­u­larly over seni­or of­fi­cials, who they say have al­lowed the secret wait lists to ex­ist for years as they faced pres­sure to meet dead­lines handed down from the top.

At the same time, ad­voc­ates want the VA to hire more doc­tors and in­crease vet­er­ans’ ac­cess to private health care. They also want law­makers to give the de­part­ment more money, something Rep. Jeff Miller, who heads the House Vet­er­ans’ Af­fairs Com­mit­tee, has sug­ges­ted won’t solve the deep­er crisis at the VA.

The Flor­ida Re­pub­lic­an wrote in an op-ed last week that giv­ing the VA more money “is merely a short-term, emer­gency solu­tion de­signed to deal with a bona fide emer­gency that VA cre­ated.”

And though law­makers have been fo­cused on the re­cent health care scan­dal, vet­er­ans ad­voc­ates be­lieve the prob­lems at the de­part­ment spread far bey­ond its med­ic­al fa­cil­it­ies. For ex­ample, the U.S. Of­fice of Spe­cial Coun­sel an­nounced earli­er this month that it will look in­to al­leg­a­tions of re­tali­ation against 37 VA whistle-blowers, which could muzzle fu­ture com­plaints.

“The re­tali­ation against whis­tleblowers — that’s a cul­tur­al prob­lem that needs to be ad­dressed,” Raughter said.

And be­ne­fits work­ers also have to tackle the moun­tain of fre­quently over­looked pay and pen­sion claims — namely an in­creas­ing num­ber of ap­peals that can leave vet­er­ans in limbo for an av­er­age of two and a half years.

Win back vet­er­ans’ trust: Mc­Don­ald is a sur­prise pick by any­one’s ac­count. Scan the many lists pub­lished on who could be the next VA sec­ret­ary, and you’ll no­tice one thing pretty quickly: He isn’t on any of them.

Vet­er­ans ser­vice or­gan­iz­a­tions have com­plained that they have felt they were left out of the loop by the VA as it faces one of its worst scan­dals in re­cent his­tory. They hope Mc­Don­ald will change this.

“He will need to reach [out] to VSOs and oth­er lead­ing ad­voc­ates for vets. The White House did not reach out to VSOs dur­ing their search pro­cess, and we hope they will now. The VA can­not do it alone,” Paul Rieck­hoff, founder of Ir­aq and Afgh­anistan Vet­er­ans of Amer­ica, said in a state­ment.

The Amer­ic­an Le­gion was an early back­er of the push for Eric Shin­seki to resign, com­ing out ahead of the wave of law­makers who would even­tu­ally call for him to step down.

While Mc­Don­ald is him­self an Army vet­er­an, he doesn’t fol­low the trend of tap­ping a top mil­it­ary of­fi­cial to lead the de­part­ment. Mc­Don­ald will “have to move quickly to show he is com­mit­ted to and un­der­stands the post-9/11 gen­er­a­tion of vet­er­ans,” Rieck­hoff said.

“We think that restor­ing trust is the No. 1 chal­lenge ahead of him,” Raughter said.

In many ways, Mc­Don­ald will have to prac­tice jug­gling his pri­or­it­ies to vet­er­ans while also keep­ing the de­part­ment on track to reach two key de­part­ment goals next year: End­ing the back­log of dis­ab­il­ity com­pens­a­tion and pen­sion claims and stop­ping vet­er­ans’ home­less­ness.

“They’re far, far short of the goal to elim­in­ate vet­er­ans home­less­ness.”¦ We hope to see them con­tin­ue to make pro­gress,” he said.

Don’t say any­thing stu­pid: Of course, to be­come the lucky per­son re­spons­ible for all of these chal­lenges, Mc­Don­ald has to get over one cru­cial hurdle — Sen­ate con­firm­a­tion.

So far law­makers are ex­press­ing hope that he can cure the VA’s many ills. Or they are at least — in the case of Sen­ate Vet­er­ans’ Af­fairs Com­mit­tee Chair­man Bernie Sanders — hold­ing off on pub­licly form­ing their opin­ion on Mc­Don­ald un­til after they meet with him.

But the VA is cur­rently a polit­ic­al light­ning rod, and law­makers have shown little tol­er­ance for VA of­fi­cials who they think are try­ing to down­play how ser­i­ous the crisis is that is now fa­cing the de­part­ment.