The top leadership of the Department of Veterans Affairs is in turmoil, after President Donald Trump ousted his first secretary and nominated his personal doctor, who dropped out of consideration amid controversy. Trump has yet to nominate anyone else.
It's not an easy job to fill, as the VA is second in size to only the Defense Department and has more than 375,000 employees and a budget of more than $185 billion. And the new secretary will face pressure to further reduce the time it takes for patients to get appointments, grow the medical staff and improve its services. VA officials say that they have already made dramatic improvements and that the medical care now provided is as good as if not better than what's offered by private hospitals.
As part of an ongoing series, The Washington Post dispatched reporters across the country to talk with veterans about their experiences, what improvements they want to see at their local VA and what sort of leader the department needs.
'The VA is not nearly fixed'
MANCHESTER, N.H. – Keith Ackerson proudly voted for Donald Trump, calling his decision "a no-brainer," but he says the president still has a lot of work to do when it comes to VA.
While there have been some improvements, especially when it comes to holding VA leaders and employees accountable, Ackerson said that he has not seen the "tremendous progress" that Trump has claimed.
It's still difficult to book an appointment at a time that's convenient. He said his doctors seem "spread kind of thin." And he still has to drive almost an hour from his home to get to a medical facility in Manchester, which he describes as "rundown." (The medical center director agrees with this assessment of the facility, which was built in 1948, but he promises that numerous construction projects are underway.)
"The VA is not nearly fixed," said Ackerson, 32, an Army veteran and father of two who lives in Rochester, N.H., and works as a hydraulics technician repairing large vehicles.
Ackerson enlisted in the U.S. Army in 2008 and served two tours in Iraq and Afghanistan. In 2012, Ackerson was driving an armored truck with four passengers from a distant village in Afghanistan to a large forward operating base near the border with Turkmenistan. He passed over a roadside bomb that exploded, tossing the truck into the air.
"I saw black for a minute," he said. "Just black."
Since that day, Ackerson said, he has had headaches, memory loss and chronic right knee pain – which require medication and frequent trips to the Manchester VA Medical Center. He once had to travel to Boston for testing that wasn't offered locally.
Ackerson said that he's lucky to have an understanding employer who gives him time off during the workday for appointments. After serving for eight years, he said, "it's really upsetting" to have to travel so far and wait so long for medical care. He wishes that he could see a doctor outside of VA, maybe someone with an office closer to his home.
"I think we should at least have a choice," he said, as he stopped by VA to pick up a prescription.
He hopes the next VA secretary will be smart and experienced, someone who has already run a health-care system or a major hospital. No one else will do, Ackerson said, because the job is too big, the medical care too important and many of the hospitals too old.
'If it weren't for the VA, I wouldn't be here.'
KINGSVILLE, Texas – Rogelio Cortez doesn't own a car and gets around town on a bicycle. The closest VA is 45 miles away in Corpus Christi and nearly impossible to reach without a car. For years, he hesitated to ask for rides.
"I just gave up," said Cortez, 62, a Navy veteran who has long struggled with mental health issues and alcoholism. "I would get depressed because I didn't have any way to get to the VA, and that would start me to drinking."
About three years ago, Cortez learned that the local American Legion has staffers who drive veterans to appointments for free. Now, when his depression becomes especially heavy or he feels sick, he books an appointment and schedules a ride.
Cortez says that access has helped him stay sober and healthy. He likes and trusts his doctor at VA, and he's impressed with recent renovations at the Corpus Christi facility, along with the installation of an automated system that makes it easier for doctors to pull up a patient's information. His only frustration is that he requested copies of his medical records four months ago and has yet to receive them.
"The VA has always been there for me," he said Monday afternoon. "The times they weren't there, it was usually my fault, because I wasn't ready to be helped. I think the VA could improve by making veterans more aware of the programs that are available for them."
Cortez enlisted in the U.S. Navy right out of high school in 1974 because he wanted to travel. He worked aboard aircraft carriers in the Pacific, doing administrative work, but soon the stress of shipboard life began to take its toll.
"I started hitting the bottle, and I became an alcoholic," he said. "You know those sailors, yeah, buddy."
While in the Navy, he was sent to rehab and was honorably discharged in 1983. He returned home to San Antonio and worked in construction and at a hospital. His alcoholism eventually led to living on the streets for two years in the 1990s. Throughout the years, he has relied on VA programs for housing, food, medical care and counseling.
Cortez, who has been arrested multiple times, including once for domestic violence, said he has now been sober for four years, and he's trying to reconnect with his two adult children. He struggles to survive on about $1,000 per month that he receives from Social Security because his depression is considered a disability.
When it comes to the next VA leader, he hopes Trump will select a person of integrity and compassion.
"If it weren't for the VA, I wouldn't be here," said Cortez, who has never voted. "I would have ended up in a ditch somewhere, drunk and dead."
'Why don't they have the things they need to support their patients?'
WILMINGTON, N.C. – Sharryse Piggott joined the Marines in April 2011, despite her parents urging her not to, because she wanted to earn money for a college education. Last weekend, she graduated from the University of North Carolina Wilmington with an English degree.
"My reason for joining never changed," said Piggott, 26, who was stationed at Camp Lejeune in Jacksonville, N.C., during her four years of service.
After leaving the Marines, she remained in Jacksonville and started going to VA's local outpatient clinic, which didn't have a gynecologist on staff. While 130 of the VA's 170 medical centers now have gynecologists, according to a spokesman, smaller clinics like the one in Jacksonville usually do not.
"I was frustrated at that time, because I was like, 'Why don't they have the things they need to support their patients?' " she said.
Piggott eventually switched to the VA's medical center in Wilmington, about an hour south of Jacksonville, and was stunned at the difference. The facility is much larger and has many more employees and volunteers who are eager to provide directions or assistance. Piggott gushes about her doctor and describes the atmosphere as being "like a family." She can't think of a single bad experience she has had.
"The VA just needs more people to work for them, so they can better accommodate the veterans who go there," Piggott said.
She would like to see more VAs operate like the one in Wilmington, and she's opposed to any efforts to privatize even part of the VA. David J. Shulkin, who in March was fired as VA secretary, has accused the Trump administration of wanting to have private-sector businesses take over some of VA's roles. (VA Press Secretary Curt Cashour said Wednesday there is no effort underway to privatize the VA.)
"After stuff becomes private, it's a little harder to catch the bad things that happen," said Piggott, who voted for Hillary Clinton for president in 2016. "And you want to be able to come to a place and know they have your best interests at heart."
'They look at me like, "Who do you think you are?" '
HELENA, Mont. – When Sonny Bass returned to his hometown in rural Nebraska after spending 27 months in Vietnam and being wounded twice, he felt judged and disrespected for having volunteered to fight in the unpopular war. Looking to escape, he moved to Montana in 1975.
Yet Bass said he often feels again disrespected, but in a different way, when he goes to the VA Medical Center at Fort Harrison in Helena.
"When I walk in and make a request, they look at me like, 'Who do you think you are?' " said Bass, 68, a soft-spoken member of the Sicangu Lakota Tribe and retired electrician who wears his long silver hair in a ponytail.
"I'm not a draftee. I enlisted. I volunteered for combat twice," he continued. "I raised my right hand, and I was ready to give my life for my country. I damn near did."
Bass lives in Jefferson City and travels to VA several times a month. He said that it can take a few weeks to see a specialist. In addition to his injuries from combat, Bass has suffered a few back injuries after a tree fell on him in 1997 when he was cutting wood. Bass said that he has had several surgeries to replace and repair joints and that for years he has been trying to persuade his doctors to operate on his back.
Bass, who voted for Jill Stein for president in 2016, said Trump seems to have little knowledge or concern about veterans' issues. He praised Sen. Jon Tester, a Democrat who represents Montana, for raising concerns about Jackson. Tester has long made the needs of veterans one of his top priorities, Bass said, and he trusts the senator's assessment of Jackson.
"When he says something about the VA, it has a little more credence with me," said Bass, who plans to vote for Tester. "Someone like Tester knows the problem, and he's on the level of the problem. The other guys are not on the same level."
Bass has heard that VA has pumped money into some of its medical centers, which are now stocked with the latest technology, but he hasn't seen any significant change at his own VA. The system has a number of construction projects that are in various stages of design or planning, according to the VA, including some major expansions.
Medical centers like his need much more funding so they can hire more staff to further reduce wait times for patients, he said. And staffers need to treat all veterans with respect, he said, to not judge, to show compassion.
'My own shame was my obstacle'
SAN DIEGO – Noel Williamson was two weeks away from finishing a Navy SEAL qualification training course in 2011 when he was arrested for driving under the influence of alcohol.
A commanding officer kicked him out of the prestigious training and, eight months later, he was given an honorable discharge.
"I was used as an example that it didn't matter how far in training you were, if you had an alcohol-related incident, you were done," said Williamson, who is now 31.
He was ashamed and didn't seek out treatment at VA. He thought that help was there for veterans who fought in Iraq or Afghanistan "and had seen some heavy stuff."
"My own shame was my obstacle," he said. "I just felt unworthy."
Instead, he kept drinking and using marijuana to suppress his feelings.
Williamson, who was born in Australia and grew up in California, enlisted in the Navy in 2004 because he wanted to be part of the "battle of good versus evil" he saw after the Sept. 11, 2001, attacks. He shipped out to boot camp two weeks after graduating high school.
He worked on aircraft carriers around the world and dreamed of becoming a Navy SEAL. On his first try, he couldn't make it through the physically demanding "hell week." While working the San Diego, he had a son, got married, reenlisted, got another chance to try out to become a SEAL – and made it through the initial rounds of training.
But then, as he went through a divorce, he drove while drunk and "all that stuff just disappeared." After he left the military, he kept drinking and got two more DUIs, the latest one in May 2017 when he led police on a brief high-speed chase and then crashed into a pole in Carlsbad, Calif.
"I felt so disgraceful that I left the military because I got a DUI," said Williamson, who still has a high-and-tight military haircut. "The insanity part was I was drinking to deal with that."
The crash was featured on the local news. He lost his job and his apartment and was sentenced to five months in prison. A few months into that sentence, he transferred to a specialized therapeutic program for veterans. He's now living at the Veterans Village of San Diego, a nonprofit organization that helps homeless veterans and receives some funding from VA grants.
Williamson has been sober for 11 months, is working with a therapist and attending Alcoholics Anonymous and Narcotics Anonymous meetings. He shares an apartment with two roommates and works part-time at a CrossFit gym. He hopes to soon complete his college degree. The village provides structure, drug tests and, perhaps most importantly, support.
As he rebuilds his life, Williamson has started going to the local VA and sharing his experiences on social media. He hopes the next VA secretary has military experience, and he hopes that more veterans will realize that they are worthy of the help VA offers.
"You hear stories that with the VA, 'Oh it takes you forever.' So that's a deterrence in itself," said Williamson, who did not vote in the last presidential election and considers himself apolitical. "The biggest thing is, there is help readily available, and it works, and it's OK to receive help."
The Washington Post's Keith O'Brien from Manchester, N.H., Mary Lee Grant from Kingsville, Texas, Rory Laverty from Wilmington, N.C., Kathleen McLaughlin from Helena, Mont., and Gidget Fuentes from San Diego contributed.