Ronny Jackson withrew his nomination to be VA Secretary last week. (Photo: Tom Williams / CQ Roll Call)

The most obvious problem at the Veterans Affairs Department is that it doesn’t have a secretary. But that leadership vacuum only compounds the deeper issues the VA has spent years trying to overcome.

The big picture: The VA is the second-largest federal agency, with a huge annual budget, and it’s also at the center of a heated political debate. But advocates generally agree about what its needs are.

These are all multi-year problems that did not manifest themselves overnight. At the same time, the VA does not have the continuity of leadership and vision necessary to solve these kind of persistent problems
— John Hoellwarth, communications director of AMVETS

Vacancies: There are around 33,600 job openings at the VA — but that’s a lot better than the 49,300 employees the agency was seeking in May of last year.

  • “The lack of a secretary is just the tip of the iceberg, and it’s representative of a lack of not only leadership but also personnel at the department," said Lou Celli, director of veterans affairs and rehabilitation at the American Legion.

Mental health: "Reducing Veteran suicide is VA’s top clinical priority, and under President Trump, the department is increasing suicide prevention and mental health care efforts," VA spokesman Curt Cashour said.

  • Of the statistical 20 veterans per day who die by suicide, only six are engaged with the VA.
  • Experts and advocates are generally happy with the work the VA has done to address the problem. They say getting more veterans into the system is the next key; the VA has submitted a plan along those lines to the White House.
  • "They've done a Herculean job with the crisis hotline," Celli said. "It is effective and it does work, but I think that the goal is to try to reach these veterans before they reach the level of crisis."'

Electronic medical records: It’s been over year since the VA got started on the contract for a new system that would allow veterans’ health records to seamlessly from the Defense Department to the VA.

  • A final decision is expected “in the coming weeks," Cashour said.

A decision about private care: This issue is by far the most politically explosive.

  • The Obama administration expanded access to non-VA care in the wake of the 2014 VA scandal, allowing veterans to use their benefits with other local providers if they have to wait too long to see a VA doctor.
  • The next secretary will quickly be thrust into a fierce political debate about whether to further privatize veterans’ care.
  • The VA is "kind of like looking at Obamacare or Medicare and throwing war in the middle of it, because it's got this political element and it’s got a lot of money,” said Paul Rieckhoff, executive director of the Iraq and Afghanistan Veterans of America

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