Former Obama chief of staff McDonough helms the VA: An exclusive look at his leadership

WASHINGTON − It’s one of the most iconic photos from Barack Obama’s eight years in the White House: There’s the president, looking grave in the Situation Room as he and a small group of aides watch a live feed of the special operations forces raid that killed al Qaeda leader Osama bin Laden.

The small room is packed with two Cabinet secretaries, top generals and Obama’s vice president, Joe Biden. And there, sitting opposite Obama, just to the right of Hillary Clinton, his eyes – like everyone else’s – riveted to the screen, is Denis McDonough.

McDonough was deputy national security adviser when Navy SEALs descended on the terrorist mastermind’s lair in Pakistan. He went on to serve as Obama’s chief of staff, where he spent four years running the executive branch.

With that resume, the clean-cut Minnesotan could have scored many jobs at the dawn of Joe Biden's presidency. Instead, Biden appointed him to take the reins of the Department of Veterans Affairs, where McDonough promised to restore trust in a perpetually maligned agency that has faced long-standing criticism.

“I just remember watching what we were able to witness there and thinking to myself: ‘I wish the country could see what I can see,’” McDonough, 54, told USA TODAY, recalling the Bin Laden raid. “There’s so much second guessing whether the country can do big things and I’ve seen time again − that night and here at VA − that we do big things and we do them well."

McDonough is entering his fourth year leading the largest integrated health care network in the country, fighting for the same men and women he watched deploy to war zones as a top national security and presidential aide.

But it hasn’t been without challenges. McDonough has been tasked with handling a tsunami of benefit claims after the rollout of the biggest expansion to veterans benefits in decades, providing care during a global pandemic, reducing backlogs of claims, addressing hot-button social issues and modernizing records to standardize quality of care.

Through it all, McDonough says his mission has remained the same: Be transparent, be accountable and fight like hell for vets.

“Our job is to make sure that they get access to the care and the benefits that they've earned and that's what we do here every day,” he said. “Not always perfectly, that's for darn sure. But we take it deadly seriously.”

'Running to the problems'

The VA has a muddy track record when it comes to caring for the 9 million enrolled veterans.

The agency for decades has received complaints over inadequate health care, wait times for benefits and excessive spending.

The VA saw two secretaries and three acting secretaries during former President Donald Trump's single term. The turmoil of VA leadership during the Trump administration − which led to Trump firing one VA secretary via Twitter − aligned with several controversies related to ethics violations and fighting among senior leaders.

But the VA has long vexed secretaries of both parties. Now, it's McDonough's turn as he faces challenges including high rates of veteran suicide, continued backlogs, problems transitioning to electronic health records and finding ways to establish relationships with veterans who are new to the VA system as benefits expand.

McDonough has been straightforward from the start − success at the VA is measured by whether veterans feel like they’re getting timely access to world-class health care and the benefits they’ve earned.

“We do that by running to the problems, not away from them,” he told USA TODAY.

Hacking away at the backlog

The VA is also working to tackle a continued backlog of benefits claims. As of mid-February, around 387,000 claims have been pending for more than 125 days.

But Veterans of Foreign Wars Washington Office Executive Director Ryan Gallucci, who served in Iraq, said the VA has set clear expectations regarding the time to process claims. He has not heard recent complaints from veterans regarding the time it takes to get benefits.

“Given the volume and the total workload that it's taking up, that the average days to complete is 150 days, I view that as positive,” said Gallucci, whose organization has 1.4 million members. “I think anyone who tries to present it as otherwise just completely misunderstands the disability claims process and the actual experience of veterans who go through it.”

Kyle McAlister, a marine veteran who visits a VA clinic in Charlotte, North Carolina, said he hasn't had issues with the backlog.

“Especially over the last few years, I would say it's been noticeable − the improvement and the quality and continuity, especially in the mental health clinic,” the 31-year-old said.

Tackling veterans' mental health

Under McDonough’s leadership, the VA established the shortened Veterans Crisis Line – dial 988 and then press 1 – for veterans to connect quickly with crisis support 24/7. The agency has fielded more than 1.1 million calls, texts and chats since July 2022.

But Justin Brown, the CEO of a bipartisan veteran advocacy firm, Nimitz Group, said the VA has been "behind the times" in their approach to veteran suicide.

“We're not being very proactive in trying to find ways to help veterans live a higher quality of life, earlier in life, including in military service,” Brown, a Navy veteran, said.

McDonough acknowledges that mental health is a fundamental pillar in VA care. The agency is working to innovate mental health care in a post-COVID world by connecting veterans via telehealth to mental health providers in areas that are lacking resources.

The VA has also started to modernize all records − an effort to ensure veterans have complete electronic records regardless of location.

It’s currently deployed in five hospitals but in “reset mode,” McDonough said. There have been significant problems at these facilities that the U.S. Government Accountability Office found contributed to patient safety risks.

“We’re trying to prove that the underlying technology actually works,” McDonough said, adding that the VA won’t deploy the system to other locations until it’s working properly.

PACT Act expands benefits

Jim Roberts spent one year in Vietnam serving in the U.S. Army where he drank water out of streams and bought locally grown food from villagers. This led the 77-year-old to seek care from the VA decades later over concerns of exposure to Agent Orange − an infamous toxic defoliant used during the Vietnam War that can cause cancer and other diseases.

“The area I was in in Vietnam was the second most heavily dosed with Agent Orange,” Roberts told USA TODAY.

The VA has granted billions of dollars in toxic exposure benefits to more than half a million veterans and survivors exposed to burn pits and chemicals since the PACT Act was signed into law in 2022. The legislation marked the largest expansion of veterans assistance and benefits in decades.

More than 5 million veterans, like Roberts, have been screened for toxic exposures, according to the VA. 

For McDonough, the passage of the PACT Act posed both an immense opportunity and a heavy lift. He began the largest outreach campaign in the history of the VA – despite concerns that the agency may become overwhelmed − to contact veterans eligible for benefits, even texting those who have never visited a VA health center.

“I think they're really proactive. They didn’t just pass a law, sit back, hope it reached veterans by osmosis and then went from there,” Joe Plenzler, a Marine Corps veteran, told USA TODAY of the PACT Act rollout. Plenzler also serves as communications adviser for the nonprofit group We the Veterans and Military Families.

The Veterans Benefits Administration started aggressively hiring, creating the largest workforce the administration has ever had and the highest growth rate in personnel in the past two decades. The agency also started a weekly public dashboard showing the current backlog, wait times and the number of veterans who have made claims.

The VA is currently beating projections for timely access to benefits applied for under the PACT Act. At the end of fiscal year 2023, the agency was processing claims 12 days faster than the prior year, according to the department.

“That transparency has been very empowering for VA, but I think also creates the opportunity for accountability to our veterans and that's the real bottom line for us,” McDonough said.

VA tackles abortion, transgender issues

The VA changed a longstanding reproductive health policy in 2022 to provide abortion counseling and, in certain circumstances, abortions to female veterans. The decision received backlash from Republicans in Congress and is currently facing several legal challenges in states that have restrictive abortion laws.

With women being the fastest growing cohort of veterans using VA services, McDonough said it was an obvious decision for how the agency should address abortion care.

“I really face no choice,” he said. “We need to make sure that our veterans have access to the full suite of care when they’re facing those questions about their reproductive options.”

The VA has also received backlash over its decision to support transgender veterans by providing hormone treatments. While some critics say it’s a step too far, others are frustrated McDonough hasn’t gone far enough to provide gender-affirming care as part of veterans' health benefits.

But McDonough said the agency has yet to make the next step in that process.

"We're preparing to be in a position to provide gender-affirming surgery as well," he said. "We're in the process of developing rules to do that."

The VA secretary says he's staying out of the culture wars.

“I'm not sure what the politics of it all are … but that's somebody else's job," he says. "I don't do politics in this job."

'Get it right this time'

While there are still challenges, the VA is setting all-time records for delivering care and benefits to veterans under McDonough’s leadership.

And many are taking notice.

“For the past three years, I’ve seen the VA professionalize and enhance its role in the VSO space,” Tiffany Ellett, the director of Veterans Affairs and Rehabilitation at the American Legion, said.

Veteran advocacy groups told USA TODAY McDonough’s background in public service and working in the national security sphere at some of the highest levels of government is helping him lead the troubled agency.

But McDonough has never served in the armed forces, making him only the second VA secretary in history who is a non-veteran. He thought it would cost him the job.

“I just figured that’d be a problem,” he said. The Senate confirmed McDonough by a vote of 87 – 7.

Former Secretary of State John Kerry, a Vietnam veteran who worked with McDonough during Obama's second term, said McDonough is "unbelievably earnest with a fierce sense of right and wrong."

"If you’re a problem solver by nature and you’ve been White House chief of staff and seen how the bureaucracy can move, then you have a unique perspective to try and make it work better for those who deserve it most," he told USA TODAY in a statement.

Allison Jaslow, the CEO of Iraq and Afghanistan Veterans of America, said many veteran advocates were surprised when Biden picked McDonough to serve as the next VA secretary. But Jaslow, who worked with McDonough in the White House, said he is a patriot and a “man of character” who is in it for the right reasons.

“To even be willing to step up and serve such a complicated agency I think is a credit to his character and commitment to public service,” Jaslow, an Iraq War veteran, said.

McDonough said his focus throughout the next year is to continue to form relationships with veterans, specifically those who have never given the VA a chance or previously did not have a good experience with the agency.

“We are bound and determined to get it right this time. It’s the most important thing we can do,” he said.

He recounted a meeting with a veteran at a facility in Tennessee who was wearing a Vietnam veteran hat. McDonough told the vet, “Welcome home.”

“He began to cry,” McDonough said. “He said, ‘Nobody’s ever said that to me.’ Imagine that, 50 years since he returned from Vietnam and nobody has ever said that to him. That’s the obligation we have − to take care of those guys. And we will.”

This article originally appeared on USA TODAY: Inside Denis McDonough's Department of Veterans Affairs leadership