The collapse of Rear Adm. Ronny Jackson's nomination to lead the Veterans Affairs Department leaves the VA rudderless, and awaiting its fourth secretary in four years.
Jackson withdrew earlier this week under a cloud of allegations — which he denies — that he drank on duty, mishandled prescription medications and verbally abused his staff.
A former Pentagon official, Robert Wilkie, has been acting secretary since David Shulkin was fired in March after an 87-page report by the VA's inspector general found he had misused taxpayer funds while on an official trip to Europe.
"Our community is exhausted by the unnecessary and seemingly never-ending drama," said Paul Reickhoff, with Iraq and Afghanistan Veterans of America. "VA's reputation is damaged, staff is demoralized, momentum is stalled and the future is shockingly unclear."
Three consequences of an agency in limbo: many initiatives to improve veterans care are stalled, a debate over how much the VA should use private care is unresolved, and the key veterans' service organizations in Washington feel sidelined by the White House.
Bipartisan legislation to improve the VA has been waiting on the hill for months. One bill would review the VA's infrastructure, identifying unused or underused buildings. Another would expand a stipend program for caregivers. A $16 billion deal to purchase a new electronic medical record system is on hold. Perhaps even a bigger deal is the a consolidation of the VA's many systems for reimbursing private care, including the Choice program, which is slated to run out of funds by the end of May if Congress doesn't act.
But increasing the use of private care is controversial. The previous VA secretary, David Shulkin, says he was fired in part because he refused to privatize the VA enough for political rivals in the White House. That rivalry spilled into the open in February, and it was unclear for months who had the president's support.
Most of the major veterans' organizations lined up behind Shulkin whom they considered a moderate technocrat, but President Trump apparently didn't heed them. He ignored them again when he nominated White House Physician Ronny Jackson, says Sherman Gillums with AMVETS.
"President Trump's removal of the secretary with no real plan in place as to who would replace him – there was no semblance of stability," said Gillums, "And we're not talking about a situation where you can afford to wait."
Now vets groups are hoping they can help suggest — and possibly vet — the president's next choice to prevent another unnecessary scandal. But it's not clear they're being invited to the table.
AMVETS Executive Director Joe Chenelly took to Twitter to make the case, " I implore President Trump to speak with outside stakeholders before making his next nomination."
Other vets groups have been more cautious after taking a public stand in favor of Shulkin and being ignored.
The American Legion's National commander Denise Rohan obliquely praised the former VA leadership.
"The VA has made significant improvements in modernizing and realigning the department since 2014 and was headed in the right direction under the past two incumbents. Our nation's veterans deserve a strong, competent and experienced secretary to lead this vitally important department," she said.
The recent turmoil only adds to the VA's image problem, even though VA care often outperforms the private sector.
"The dysfunction that has plagued VA leadership the past few weeks is tarnishing the work of those 350,000 dedicated VA employees and damaging the department's reputation, which has improved vastly in the last few years," said Garry Augustine of Disabled American Veterans.
While veterans' organizations sound the alarm that talent is leaving the department — and there are more than 30,000 vacancies to fill — the VA released an alternate view just hours before Jackson's nomination finally sank.
"Under VA's new leadership, which is now firmly aligned with President Trump and his priorities, the department's operations have improved in many ways," read the statement from Press Secretary Curt Cashour. "In a number of cases, employees who were wedded to the status quo and not on board with this administration's policies or pace of change have now departed VA."