Letters

WASHINGTON, DC – Today, House Committee on Veterans’ Affairs Chairman Mike Bost (R-Ill.), released the following letter he sent to Department of Veterans Affairs (VA) Secretary Denis McDonough regarding VA Undersecretary for Health, Dr. Shereef Elnahal’s, failed leadership at the Veterans Health Administration (VHA) which has had a direct, negative impact on the delivery of care and services to veterans, their families, and their survivors and must be immediately addressed.

“On Dr. Elnahal’s watch, the management, standard of care, and work environment has allegedly deteriorated at health systems throughout VHA, most alarmingly at the Loma Linda Healthcare System, the Hampton Virginia Healthcare System, and the Eastern Colorado Healthcare System,” Chairman Bost wrote in his letter. “Ineffective leadership at the top has undermined the confidence of veterans and employees, and we are seeing its ripple effects throughout the organization.”

Since being appointed and confirmed to serve as Under Secretary for Health in July 2022, Dr. Elnahal has repeatedly demonstrated his inability to effectively manage VHA.  As evidenced by scandals like VHA’s payments of critical skill incentive bonuses to nearly all VHA executives located in Washington D.C., and the countless VHA employees who have contacted the committee to express concerns with the work environment, level of service, and care to our nation’s veterans that is being performed under Dr. Elnahal’s watch at VA Medical Centers throughout the country.

Full text of the letter Chairman Bost sent can be found here and below:

Dear Mr. Secretary:

I am writing to express my concern over Dr. Shereef Elnahal’s performance as Undersecretary for Health at the Department of Veterans Affairs (VA). Specifically, over the past two years, Dr. Elnahal has consistently failed to meet the high standards expected of a VA Undersecretary by displaying poor judgment and the inability to effectively manage the Veterans Health Administration (VHA).

For the first time in memory, VHA has implemented nationwide hiring restrictions and is desperately cutting a wide range of projects and programs. Despite consistently receiving 100 percent of its budget request and more than $32 billion in supplemental appropriations over the past four years, VHA’s budget is in disarray. In addition to Chief Financial Officer Jon Rychalski, who recently left the Department, Dr. Elnahal bears responsibility for this budgetary mismanagement. 

Dr. Elnahal’s inability to effectively manage VHA is also demonstrated by his actions approving the Critical Skill Incentive (CSI) bonus payments. For nearly six months, VHA methodically planned, implemented, and distributed CSI bonuses, ranging from around $39,000 to more than $100,000, to nearly every senior executive in the VHA Central Office (VACO). Dr. Elnahal allowed these bonus payments to occur without informing you, without adequately following relevant VA policy, and without adhering to the law. I know you agree this is clearly unacceptable. Dr. Elnahal’s comments to the VA Office of Inspector General (OIG) during its CSI bonus payment investigation were equally concerning. Throughout his comments, Dr. Elnahal made clear his lack of knowledge of the basic inner workings of the administration he is tasked with leading, including no awareness of the number of CSI bonus payments to senior executives he approved.  On top of this, I am concerned Dr. Elnahal may have provided misleading information about his availability to testify at the Committee’s June 4, 2024, hearing on the CSI investigation—only to appear at public events the next week and thereafter. Rather than explaining his actions and taking responsibility before Congress and the American people, he filled his schedule attending and speaking at various events. These are not the actions of a true leader.

Dr. Elnahal has also exhibited poor judgement in his past misguided comments on community care. Dr. Elnahal has compared the VA community care program to an “easy button” that VA should reduce its reliance on.  Dr. Elnahal also stated how VA must offer every single internal VA care option to veterans before VA “default[s] to the community.”  Such comments are contrary to the plain letter and Congress’s intent in the VA MISSION Act of 2018, and they undermine veterans’ rights and law. As you know, community care exists to provide veterans with options for where to receive the healthcare that best suits their needs. No executive branch official, including Dr. Elnahal, has the authority to ignore or reinterpret the law.

Dr. Elnahal’s poor judgment and inability to effectively manage VHA was further showcased by the recent handling of the “V-J Day in Times Square” photo ban. As you know, in early March 2024, a VHA Veterans Integrated Services Network (VISN) memorandum, which Dr. Elnahal allegedly agreed with, instructed VISN directors to remove this iconic photo from display in all VHA facilities. In your June 13, 2024, letter to me on this topic, you admitted the memorandum should not have been issued, VHA made this decision without your knowledge or approval, and that you rescinded the memorandum immediately. As the leader of VHA, Dr. Elnahal should have been aware and astute enough to realize the memo was problematic. Additionally, Dr. Elnahal should have confirmed the memorandum, which would have made a significant policy decision if implemented, went through the appropriate review process, including ensuring it received your approval, prior to it being released to VISNs.

On Dr. Elnahal’s watch, the management, standard of care, and work environment has allegedly deteriorated at health systems throughout VHA, most alarmingly the Loma Linda Healthcare System, the Hampton Virginia Healthcare System, and the Eastern Colorado Healthcare System. Ineffective leadership at the top has undermined the confidence of veterans and employees, and we are seeing its ripple effects throughout the organization. I look forward to hearing how you plan to address Dr. Elnahal’s poor leadership to ensure our nation’s veterans, their families, and their survivors can have trust in the VHA they have earned.

Sincerely,

MIKE BOST

Chairman