The Department of Veterans Affairs’ problems don’t start at the top with the secretary. Nor do the problems begin with the frontline clinical and administrative staff. They start with "the Middle" and propagate upward and downward along the lines of accountability that are to be shared at all levels. For that reason, the Middle is not just a problem, but will perhaps be the most serious problem that awaits the Trump administration’s pick for VA secretary.
An article outlining this issue was written by Paralyzed Veterans of America Executive Director Sherman Gillums, Jr. and published in Task and Purpose on December 27, 2016: