Concerned Veterans for America, a group of policy advocates funded by the billionaire Koch brothers that wants to shrink the size of federal bureaucracies including the Department of Veterans Affairs, appears to have won a major victory with President Donald Trump’s firing of David Shulkin as VA secretary.

Trump announced by tweet he wants his personal physician at the White House, Navy Rear Adm. Ronny L. Jackson, to run the government’s second largest department.

Jackson’s bio sheet shows no executive level experience to justify the pick. However, Trump sees Jackson almost daily and the 50-year-old physician praised the president’s health effusively at a White House press conference in January.

Shulkin, a holdout from the Obama administration and a competent Cabinet secretary who Trump had extolled openly and often during his first year as president, saw his support within the administration deteriorate in recent months.

In a New York Times commentary Thursday, Shulkin said VA has become “entangled in a brutal power struggle, with some political appointees choosing to promote their agendas instead of what’s best for veterans. These individuals, who seek to privatize veteran health care as an alternative to government-run V.A. care, unfortunately fail to engage in realistic plans regarding who will care for the more than 9 million veterans who rely on the department for life-sustaining care.”

At the urging of major veteran organizations, Shulkin resisted the influence of Concerned Veterans for America alumni, hired at the White House staff and at Fox News. CVA and its supporters want to see more VA health care dollars shifted from modernizing and staffing VA hospitals and clinics to subsidizing private sector care, or offering health insurance, so veterans can use community providers.

Traditional veteran groups argue that VA medical centers and clinics must be fully staffed and resourced to ensure timely care and to protect VA-unique expertise in treating wounds of war. The private sector, they maintain, can’t match VA for coordinated veterans care or for providing poly-trauma care, prosthetic and orthotic services, treating post-traumatic stress and traumatic brain injury, caring for spinal cord injuries or rehabilitating veterans who lose hearing or sight.

But Shulkin’s standing to fight for VA programs and budgets was weakened in February when the VA inspector general issued a scathing report on travel abuses by Shulkin and staff on a 10-day trip to Denmark and London last July. The trip cost VA more than $122,000 and included Shulkin’s wife and much sightseeing, along with a gift of tickets to the Wimbledon tennis tournament.

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