The Department of Veterans Affairs (VA) has officially kicked off its search for two of the agency’s most critical leadership positions: the undersecretary for health and the undersecretary for benefits.

Announced Monday, the move comes at a pivotal moment as the VA navigates through sweeping reforms aimed at reshaping the delivery of health care and benefits for millions of veterans, families, caregivers, and survivors.

Unlike most senior federal positions that can be directly appointed by the president, these two roles require candidates to be vetted and recommended by specially appointed commissions.

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These panels are composed of community advocates, industry professionals, and former VA officials, ensuring a broad and informed perspective in the selection process.

VA Secretary Doug Collins emphasized the importance of the commissions’ role in sustaining and expanding ongoing department initiatives.

“VA Deputy Secretary Paul Lawrence will chair both commissions and help find leaders who will continue implementing a number of reforms to improve VA services for veterans, families, caregivers and survivors,” Collins said in a statement.

Key Roles at a Critical Time

The undersecretary for health will be tasked with overseeing more than 1,300 VA medical facilities nationwide, shaping health care policies, and coordinating emergency health plans—responsibilities that became especially prominent during the COVID-19 pandemic.

The position was most recently held by Dr. Shereef Elnahal under the Biden administration. Until a new appointee is confirmed by the Senate, Deputy Undersecretary for Health Steven Lieberman will continue serving in an acting capacity.

Simultaneously, the VA is searching for a permanent undersecretary for benefits.

This role supervises the distribution of benefits to approximately 6 million veterans, as well as their family members and caregivers.

The scope includes managing disability compensation, education benefits, and the widely used VA home loan program.

Michael Frueh, the department’s Principal Deputy Under Secretary for Benefits, is currently filling the position in an acting capacity following the departure of Joshua Jacobs.

Learning from the Past

The process of appointing a permanent undersecretary for health has historically presented challenges. During President Donald Trump’s first term, the position remained unfilled by a Senate-confirmed leader after Dr. David Shulkin was promoted to VA Secretary.

Temporary appointees cycled through the role for four years, contributing to instability in one of the department’s most vital divisions.

Now, as President Trump embarks on his second term, VA leaders say they are determined to avoid repeating history.

The selection commissions are being established as part of a broader effort to execute the administration’s reform-driven agenda, which has already begun to reshape key VA policies.

A Shift in Direction

Among the early reforms already underway, VA leaders cited several major policy reversals and new initiatives:

• Phasing out gender dysphoria treatment for transgender veterans, a move the department describes as a cost-saving measure.
• Ending telework and remote work across the VA in an effort to boost in-person efficiency.
• Shutting down diversity and inclusion programs, another effort the administration says will reduce costs.
• Resuming the rollout of a new electronic health record (EHR) system, paused under the previous administration, with full deployment scheduled to restart in 2026.
• Breaking disability claims processing records, with the department reporting more claims processed this fiscal year than ever before.

These moves have drawn sharp criticism from veterans advocacy groups and labor unions, which argue the changes prioritize cost-cutting over veteran well-being.

Staffing Cuts Raise Concerns

The search for permanent leadership also comes as Secretary Collins reviews plans to reduce the VA’s workforce by 17% — equivalent to around 80,000 employees.

The department maintains that the reductions are necessary to increase operational efficiency and cut down on bureaucratic bloat.

However, opponents argue that such drastic cuts could have a devastating impact on the VA’s ability to provide timely health care and process benefits. With staffing already strained in many facilities, critics fear that reducing the workforce could slow down services and increase wait times for veterans in need.

The Road Ahead

The selection process for both undersecretary roles is expected to span several months.

Once the commissions put forward their recommendations, nominees must still face Senate confirmation — a process that can add months more to the timeline.

In a notable twist, President Trump retains the authority to reject the commissions’ recommendations entirely and order them to restart their search.

In the meantime, acting officials Lieberman and Frueh will continue to lead their respective departments during what could be a transformative, yet turbulent, period for the VA.

As the agency embarks on this high-stakes leadership search, millions of veterans and their families are watching closely, hoping that whoever is chosen will balance reform with compassion — and keep their best interests at the center of the VA’s mission.

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