President Donald Trump revealed via Twitter on March 28 that he had ousted Veterans Affairs Secretary David Shulkin and planned to nominate the White House doctor, Rear Admiral Ronny Jackson, for the job.
Jackson, a Navy physician, has no administrative experience, which may make his confirmation process problematic for the White House, given the massive size of the Department of Veterans Affairs, or VA, which operates the largest integrated healthcare system in the U.S.
While Jackson is awaiting Senate confirmation, Robert Wilkie, the undersecretary of defense for personnel and readiness at the VA, will step in as acting secretary, Trump said in a tweet.
Speculation had been growing for weeks that Shulkin had lost favor with Trump and would soon be out of a job at the VA.
The problem started when the VA's Office of Inspector General, or OIG, launched an investigation into Shulkin's travel to Europe last year, which cost taxpayers over $122,300 and included some sightseeing activities. Shulkin had also brought his wife along on the trip at the government's expense, which the VA's OIG determined was wrongly covered by taxpayers.
In addition, the VA OIG found that Shulkin had improperly accepted tickets to see a tennis match at Wimbledon in the U.K.
Shulkin's excursion sparked more fury over costly travel at taxpayers' expense by several members of Trump's administration, including now-former Health and Human Services Secretary Tom Price, who resigned on Sept. 29, 2017, after his expensive jet travel had been revealed.
In a statement emailed to reporters, Trump thanked Shulkin for his service and the "many great things we did together at Veterans Affairs, including the VA Accountability Act that he was helpful in getting passed."
On Twitter, Sen. Jon Tester, D-Mont., said Shulkin had "served honorably on behalf of veterans as a physician and as secretary of the VA, including progress in improving the VA's delivery of healthcare and benefits to our veterans."
Sen. Johnny Isakson, R-Ga., chairman of the Senate Committee of Veterans' Affairs, said Shulkin had made a "tremendous impact toward improving the lives of veterans during his time at the U.S. Department of Veterans Affairs."
"He has been instrumental in all that we have accomplished in the last year," Isakson stated.
Jackson came into the public spotlight in January when he defended Trump as being "very healthy," insisting he would remain so for the duration of his presidency.
He also said he had "absolutely no concerns" about Trump's cognitive ability or his neurological functions — something that was brought into question when Sen. Bob Corker, R-Tenn., said the president "has not yet been able to demonstrate the stability, nor some of the competence that he needs to demonstrate in order to be successful."
Other lawmakers, including other Republicans, had also questioned Trump's mental capacity and cognition.
Jackson graduated from Texas A&M University with a bachelor of science in marine biology and received his medical degree from the University of Texas Medical Branch. He started active duty in the Navy in 1995 at the Portsmouth Naval Medical Center in Virginia, where he completed his internship in transitional medicine.
He is qualified in submarine and hyperbaric medicine and completed a residency in emergency medicine.
Jackson served in Iraq before being selected in 2006 during the George W. Bush administration to serve as a White House physician.
President Barack Obama chose Jackson to serve as the physician to the president — a job he continued in when Trump entered the White House.
But Jackson has no experience running a large bureaucratic system — let alone one that provides services to about 20 million Americans and employs over 350,000 full-time workers.
The VA is comprised of three major administrations: the Veterans Health Administration, or VHA; the Veterans Benefits Administration; and the National Cemetery Administration.
The VHA has over 1,200 facilities and provides care to over 9 million military veterans.
In addition to healthcare services, the VA provides disability compensation, vocational rehabilitation, education assistance, home loans and life insurance to military veterans. It also provides burial and memorial benefits to eligible veterans and family members at 135 national cemeteries.
The VA also has had its share of scandals, including one involving falsified records of patient wait times at medical facilities.
In February 2014, a whistleblower alleged that 40 veterans died waiting for a VA medical facility appointment, which triggered a broader review by the agency's OIG. Because the whistleblower did not provide the names of those 40 patients, the VA's OIG said in an August 2014 report that it could not conclude wait times led to those people dying.
The watchdog did, however, determine a number of veterans had received poor quality medical care.
The scandal led to the resignation of then-VA Secretary Eric Shinseki. Former Proctor & Gamble chief Robert McDonald stepped into the position.
But Trump decided not to keep McDonald and opted to put Shulkin — who was Obama's undersecretary for health at the VA — in the top job.
Shulkin, however, was not the only person considered for the position. Toby Cosgrove, who is now the former CEO of the Cleveland Clinic Foundation, was among the contenders in 2017, but he took himself out of the running, saying he had commitments to fulfill at the medical institution.
Cosgrove, however, revealed a few months later that he planned to step down as CEO, though he continues to remain an adviser to the Cleveland Clinic.