Trump's high-stakes decision for VA secretary

President-elect Trump made few campaign promises more passionately than his pledge to gut the mismanaged Department of Veterans Affairs and offer servicemen and servicewomen the dignified treatment they deserve, but his ability to deliver those results will likely depend on the people he chooses to lead the agency.

With more than 300,000 employees, the VA is the largest federal agency by personnel, aside from the Defense Department. It is the fifth-largest agency by budget. And much of that sprawling bureaucracy has succumbed to backlog, waste and even corruption as veterans increasingly find themselves waiting longer for worse care.

"We think it is absolutely critical that you have somebody as VA secretary that has the backbone and the courage to stand up to the VA bureaucracy," said Dan Caldwell, vice president of policy at Concerned Veterans for America. "You need someone who understands how entrenched and how resistant to change many mid-level and upper-level managers in the VA are."

Caldwell said the current VA secretary, Robert McDonald, was "almost instantly absorbed" by the bureaucracy of the department and "sadly, [he] became its biggest defender."

Trump has not yet indicated who might be on his list of contenders for VA chief. As of Monday, he has only filled the top jobs at the CIA and the Department of Justice.

However, Rep. Jeff Miller, chairman of the House Veterans Affairs Committee, is rumored to be under serious consideration for the job. Other names floated for the position include former Govs. Rick Perry and Mitt Romney, the latter of whom is most often discussed in connection with Secretary of State.

Whoever takes the helm of the VA will have a daunting task ahead of them to implement the sweeping reforms Trump spent the past year promising to bring to the broken agency. On Obama's watch, the VA suffered the biggest scandal of its 86-year history when whistleblowers exposed the existence of secret patient waiting lists in 110 facilities around the country.

Those secret lists concealed the fact that thousands of veterans were enduring long stretches of time before they could see a doctor. Some veterans died while they waited.

In the aftermath, VA Secretary Eric Shinseki was forced to resign, his ouster billed as a preview of the personnel purge that would restore the agency to its mission.

But that purge never happened. Most VA employees caught manipulating wait-time data were simply suspended, reprimanded or left untouched. The VA only fired nine people over their involvement in the nationwide scheme.

Miller, who is retiring from the House in January, said Trump's VA reform proposals amount to "basic common sense," which he said VA leaders have rejected.

"The prospects for Department of Veterans Affairs reform under a Trump administration are significant," Miller told the Washington Examiner. "Instead of trying to sugarcoat VA's challenges like the Obama administration has done for much of the last eight years, President-elect Trump will fight hard to overcome them. And instead of catering to the special interests that are blocking efforts to address VA's number one problem – its notorious lack of accountability – President-elect Trump has made clear that reforming the department's broken civil-service system is a top priority."

Miller has said he would be open to running the VA if Trump offered him the position.