Shulkin is an internist who has led the sprawling veterans health system, the country’s largest, since last year. In keeping Shulkin, Trump passed over the current secretary, Robert McDonald, a Republican appointed by President Obama in 2014 to lead the agency after a scandal over fudged wait times for medical appointments. The large veterans service organizations had pushed Trump to keep McDonald in the job.

It is unclear how Shulkin will approach Trump’s biggest priority for veterans: A significant expansion of VA medical care to private doctors outside the system.

During his campaign, Trump called VA a “broken” system that treats illegal immigrants “better than our vets.”