As the Senate considers Robert Wilkie's nomination for VA secretary, veterans groups worry that the agency's leadership gap has slowed its work.
President Trump fired David Shulkin as secretary of the Department of Veterans Affairs in late March. Three months later, the department is still without a permanent leader, as the Senate has only now begun considering the nomination of a new secretary.
The Senate Veterans' Affairs Committee is holding a confirmation hearing this week for Robert Wilkie, who is President Trump's second nominee to replace Shulkin.
Some advocacy groups say the shakeup has interrupted progress at the VA and left veterans uncertain about what's next for their care.
"We do want to impress upon the administration that these gaps in leadership that we've faced for several months now within the VA is so deeply troubling for veterans and for advancing our most pressing issues," said Melissa Bryant, the chief policy officer of the Iraq and Afghanistan Veterans of America.
Shulkin's departure was especially disappointing for Ron Brown, the president of the National Gulf War Resource Center. Since 2009, the group has helped veterans with Gulf War Illness, a group of ailments caused by toxic exposures during deployment.
An estimated 40 percent of Gulf War veterans suffer from the condition, which can manifest as chronic fatigue, fibromyalgia and gastrointestinal problems, among other issues.
Brown says Shulkin was an ally in the effort to improve the VA's claims process for Gulf War Illness. The former secretary helped advance one of Brown's highest priorities: making it easier for Gulf War veterans with brain cancer to receive VA benefits without having to go through the difficult process of proving their disease is related to their military service.
"Many veterans do not have military service treatment records," Brown said. "So therefore, they can't produce that evidence."
Shulkin pushed the White House Office of Management and Budget to consider adding brain cancer to a list of conditions that automatically qualify for compensation. But Brown doesn't know where that effort stands now. He had his last email exchange with Shulkin in April.
"Dear Dr. Shulkin, I wanted to thank you for the opportunity I had working with you during your time at the VA," wrote Brown.
Shulin responded: "Thank you Ron. I will always support your work. I am just disappointed we did not get it done before I left."
V.A. Without A Leader
President Trump nominated his personal physician, Rear Adm. Ronny Jackson, to replace Shulkin. But Jackson withdrew amid questions about his qualifications and past behavior. Wilkie, the undersecretary of defense for personnel and readiness, was tapped to become the VA's acting secretary. Weeks later, the President announced that he was nominating Wilkie for the permanent role.
As he awaited his confirmation hearing, Wilkie stepped down as acting secretary. Former VA Chief of Staff Peter O'Rourke moved into the acting secretary role.
Brown said that when he tried to reach Wilkie during his stint as acting secretary, emails went unreturned and an appointment got pushed back. While other members of VA senior leadership have been more accessible, Brown said they've been less forthcoming.
"Nobody gives much information," Brown said. "I don't know if they're not allowed to or what."
Another Gulf War veterans' advocate, Dave Winnett, said he's not surprised things have slowed down since the VA is without a long-term leader.
"I was very disappointed because every time you have a change of leadership, a change of command, there's this air of uncertainty. You don't know how things are going to play out," he said.
VA spokesman Curt Cashour, in a written statement, said VA is communicating regularly with veterans service organizations. The acting secretary met with eight of the major ones in May.
"Acting Secretary Wilkie made a deliberate decision to host individual meetings in order to maximize dialogue with these groups," Cashour wrote.
But in spite of that, some veterans service organizations say they need more from VA. Iraq and Afghanistan Veterans of America has pushed the VA for a short-term plan to carry veterans - and their advocates - through the transition.
"The VA secretary sets the tone and the culture for the VA in ensuring that veterans are receiving the care and benefits they need," Bryant said. "The secretary's the one who determines what the way forward should be."
New secretary will face challenges
The vacancy at the top comes at an especially critical time, according to Bryant. In June, President Trump signed the MISSION Act, which is designed to give veterans more options for where they can get medical care - allowing them, in some cases, to visit physicians outside the VA system.
Bryant says IAVA was pleased to see the legislation pass, but isn't sure who's overseeing the reform effort.
"The challenge for the VA side - what we want to ensure sound leadership can be in place for - is the monitoring and implementation of that bill."
Bryant said it's critical that the law balances investment in the VA along with investment in outside care.
Joe Plenzler, of the American Legion agreed, pointing out that more than 33,000 job jobs are vacant within the VA system.
"It's almost 10 percent of their total end strength," Plenzler said. "The more that these vacancies go on, the less capacity VA has to treat veterans - the more they have to push veterans out onto community care, which is more expensive."
Cashour, the VA spokesman, said concerns about custodianship of the MISSION Act are unfounded.
"The regulations governing the implementation of the MISSION Act won't be completed until long after a permanent secretary is in place," he said. "VA will remain transparent as we develop the plan"
For now, though, veterans groups remain frustrated that the vacancy remained unfilled for so long.
"The role of the VA secretary is critical to the lives of veterans," Bryant said.
This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans. Funding comes from the Corporation for Public Broadcasting and the Bob Woodruff Foundation.