Rear Adm. Ronny L. Jackson would come to the Department of Veterans Affairs with little administrative experience to prepare him for running the government's second largest agency, with 370,000 employees and a budget of nearly $200 billion.
In addition to the immense task of dealing with day-to-day operations of the sprawling VA, Jackson, the appointed personal physician to President Donald Trump, will also be thrust into open political warfare between White House political appointees and the major Veterans Service Organizations (VSOs) over the privatization of VA health care.
Questions about Jackson's qualifications and the core mission of the VA could make for stormy confirmation hearings before the Senate Veterans Affairs Committee, which itself has devolved into competing camps on how much leeway vets should have in choosing private care.
"We think the White House has a tall order ahead of it in showing that this doctor is qualified to lead a $200 billion agency," said Joe Chenelly, national executive director of American Veterans, or AmVets, the fourth-largest VSO.
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House and Senate Democrats have also questioned whether Jackson, as an active-duty officer who has been nominated for a second star, would be too beholden to Trump as commander in chief. Jackson reportedly has said he will retire from the Navy if confirmed by the Senate.
As a White House physician in the past three administrations, Jackson has received glowing reviews from Democrats and Republicans for his professionalism and dedication.
Alyssa Mastromonaco, deputy White House chief of staff under former President Barack Obama, sent out a Tweet saying: "There is no one better than Ronny. No one. He is a saint and patriot."
Jackson, 50, of Levelland, Texas, joined the service in 1995 at the Portsmouth Naval Medical Center in Virginia, according to his Navy biography. He is a Navy diver and parachutist, in addition to his medical work.
He graduated from Texas A&M University in 1991 with a Bachelor of Science degree in Marine Biology, and went to medical school at the University of Texas Medical Branch, graduating in 1995.
After completing his first year of residency training in 1996, he went on to become the honor graduate of the Navy's Undersea Medical Officer Program in Groton, Connecticut. He was rated "uniquely qualified" in submarine and hyperbaric medicine.
Jackson's next assignment was as an instructor at the Naval Diving and Salvage Training Center in Panama City, Florida.
After that, he was officer in charge and diving medical officer at Explosive Ordnance Disposal Mobile Unit 8 in Sigonella, Italy, and diving safety officer at the Naval Safety Center in Norfolk.
Upon completing his residency in 2004, he was assigned as clinical faculty in the Emergency Medicine Residency Program at the Naval Hospital in Portsmouth, Virginia. And in 2005 he joined Combat Logistics Regiment 25, 2nd Marines, at Camp Lejeune, North Carolina.
Jackson in 2006 deployed in support of Operation Iraqi Freedom as the emergency medicine physician in charge of resuscitative medicine for a forward-deployed Surgical Shock Trauma Platoon in Taqaddum, Iraq.
While still in Iraq, Jackson was selected as a White House physician. In that post, he has directed the Executive Health Care for the Cabinet and senior staff, and served as physician supervisor for the Camp David Presidential Retreat.
Jackson has been a White House physician under Presidents George W. Bush, Barack Obama, and now Trump, and was appointed "Physician to the President" by Obama. He has maintained that title with Trump.
His awards include the Defense Superior Service Medal, the Legion of Merit, the Navy/Marine Corps Commendation Medal (four awards), and the Navy/Marine Corps Achievement Medal (three awards), as well as other individual, unit and campaign awards, the Navy said.
He is also designated as a diving and undersea medical officer, naval parachutist, Fleet Marine Force Warfare qualified officer, and submarine warfare qualified medical officer.
As Trump's doctor, Jackson conducted the president's physical in January at the Walter Reed National Military Medical Center in Bethesda, Maryland, and made headlines at a White House briefing with his thumbs-up report on Trump's fitness and "good genes."
Jackson found Trump to be in "excellent health," while stating that he could stand to lose 10 to 15 pounds.
"It's called genetics," Jackson told reporters. "Some people have just great genes. I told the president that if he had a healthier diet over the last 20 years he might live to be 200 years old."
In a statement announcing that he was firing VA Secretary Dr. David Shulkin and nominating Jackson to replace him, Trump said that Jackson "is highly trained and qualified and, as a service member himself, he has seen firsthand the tremendous sacrifice our veterans make and has a deep appreciation for the debt our great country owes them."
The outgoing Shulkin said of Jackson in a New York Times op-ed and in an NPR interview, "I know him well. He's honorable and cares a great deal about veterans. I think he wants to do the right thing and will work hard to do that, and I will personally help him in any way possible."
-- Richard Sisk can be reached at Richard.Sisk@Military.com.