In the coming year, the Veterans Benefits Administration must tackle a backlog of more than 200,000 disability claims and ready itself for more applications as additional veterans become eligible under future legislative proposals.
At the Veterans Health Administration, a new undersecretary will face scrutiny from a commission studying the Department of Veterans Affairs' health system and will oversee the maturation of the Mission Act -- the legislation that lets veterans go to private providers and requires the department to ensure timely access to care.
Facing the weight of what Sen. Jerry Moran, R-Kan., described as "among the most important appointed positions" in the federal government, Dr. Shereef Elnahal, the VA's nominee for undersecretary for health, and Ray Jefferson, nominated as undersecretary for benefits, fielded tough questions during a confirmation hearing that touched on appointment wait times, medical marijuana, hospital closures and the disability claims backlog and included queries on their character and experience.
"My personal journey as a disabled veteran and an amputee has given me a firsthand understanding and appreciation for the needs that our veterans have and the challenges they may experience as they seek services from VA," Jefferson, a former Army Ranger who lost five fingers to a grenade in a training accident in 1999, told members of the Senate Veterans Affairs Committee.
"I believe VA is a national treasure, and that this is true because of its people," Elnahal said in his opening statement. "I believe VHA can be the best health care system in the nation."
Jefferson, a 1988 graduate of the U.S. Military Academy who holds two graduate degrees from Harvard, held leadership positions in the Army, in federal and state government and in the private sector before he was appointed in 2009 by President Barack Obama to lead the Veterans Employment and Training Service at the Department of Labor.
In that position, he organized a partnership with the U.S. Chamber of Commerce and worked with organizations to help launch the Hiring Our Heroes initiative, resulting in the hiring of 617,000 veterans and military spouses, and he led the effort to overhaul the Defense Department's Transition Assistance Program.
But he left the position under a cloud, having been accused by subordinates of a procurement contract impropriety, to include steering a lucrative consulting contract to a former colleague -- an allegation that was substantiated by an inspector general's investigation. Eight years later, however, the Department of Labor's inspector general reversed the decision, concluding that none of the charges should have been substantiated and Jefferson should not have been asked to resign.
On Wednesday, he responded to concerns expressed by Republican senators on the panel about the allegations, saying that he spent his entire savings to clear his name and that the original investigators had been unaware that two of the informants had lied to higher-ups in previous investigations.
Jefferson said he spent the money on a legal team "for two primary reasons: one, because I value my integrity as a veteran, and secondly, because I have hoped to one day have the privilege of serving our nation again."
Jefferson said as undersecretary, he would prioritize reducing the backlog of more than 200,000 claims; improve programs for veterans on transition, education and employment; and enhance performance among the VA workforce through training and technology.
"My life's purpose is to help people in organizations to dream big, overcome their challenges and achieve their potential," said Jefferson, who currently leads a Singapore-based leadership consultancy group.
Elnahal, a graduate of Johns Hopkins University who earned a joint medical degree and MBA from Harvard, has led University Hospital in Newark, New Jersey, since 2019. He previously served as assistant deputy undersecretary for health for quality, safety and value at the VA from 2016 to 2018.
If confirmed, he would be the first permanent holder of the position in five years, since it was vacated by Dr. David Shulkin, who was promoted to VA secretary.
Elnahal has also worked as New Jersey's health commissioner, and cited his experience, as well as his encounters with veterans and military doctors, as reasons he respects and wants to return to public office.
According to Elnahal, working in a hospital where Army Reserve clinicians deployed to assist with the patient load and alongside National Guard members in field hospitals, he has been reminded "what these heroes in uniform do for us every day."
"If confirmed, this opportunity would be my own way of paying that service forward to veterans across the nation," Elnahal said.
He pledged to ensure that the VHA has a "culture of respect and accountability" similar to one instilled at his current job; vowed to be more transparent with appointment wait time data; improve oversight of physician credentials; and address issues such as problems with the department's new electronic health records system and access to mental health treatment.
In his role as New Jersey health commissioner, he expanded access to medical marijuana to patients with certain conditions, including veterans, and said he would work under federal law to discuss furthering research on cannabis for certain health conditions at the VA.
"I did serve as an advocate for the program across the board for all patients who are eligible for specific conditions," Elnahal said. "But the intersection with federal law was not something I had to contend with, so that would be a layer of issues I would have to address if confirmed."
Senators did not indicate how they would vote on the two nominations, but despite concerns over Jefferson's investigation, they praised him for his military service and sacrifice for his fellow soldiers.
They also praised Elnahal for his extensive experience running a public health system and turning around an ailing medical center.
"Many members have said thank you for your willingness to serve. I want to thank you and the committee members for the thoughtful dialogue today," said Committee Chairman Sen. Jon Tester, D-Montana.
A vote on the nominations has yet to be scheduled in the Senate.
-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter @patriciakime.