President-elect Trump’s decision on Wednesday to nominate David Shulkin, undersecretary for health at the Department of Veterans Affairs, to lead the embattled agency was a move that may have satisfied some of his skeptics — but it left veterans advocates who had hoped for radical change feeling stunned and confused.

After dedicating a significant portion of his campaign toward criticism of the VA’s recent failures, Trump’s choice of a senior VA leader who has participated in some of the very same practices he once blasted came as a surprise to several people who have been involved in shaping his reform plans.

One source described himself as “flabbergasted.” Another said he was “just in shock.” And while some offered cautious optimism that Shulkin might prove to be more reform-minded than his fellow VA leaders, they wondered why Trump would elevate someone who is deeply representative of the VA status quo.

Dan Caldwell, vice president for legislative affairs at Concerned Veterans for America, said he hoped Shulkin would embrace the proposals Trump has put forward, but suggested the surprising appointment created some uncertainty.

“It’s hard to say right now,” Caldwell told the Washington Examiner of the implications of Shulkin’s nomination. “The president-elect has laid out a pretty ambitious VA reform agenda and … we hope that [Shulkin] embraces it, because we strongly support where the president-elect stands.”

Trump’s selection of Shulkin marks the first time a high-profile Obama appointee has been asked to stay on board in the new administration.

A number of veterans groups had pressured Trump to retain VA Secretary Bob McDonald, with some pointing to the gains the VA had made under McDonald’s leadership since the 2014 wait time crisis that felled his predecessor.

Shulkin, an accomplished doctor, is a relative newcomer to the VA, having received a nomination to the agency from Obama in March 2015.

But his short tenure has not been without its controversies.

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Shulkin has been accused of misrepresenting facts about the VA in testimony before Congress on multiple occasions.

In December 2015, an attorney for a VA employee wrote to Sen. Johnny Isakson, chairman of the Senate Veterans Affairs Committee, and informed him that Shulkin had provided “inaccurate” information about the VA’s failure to fire two officials who had come under criminal investigation for their alleged involvement in manipulating wait times, covering up delays in healthcare and retaliating against whistleblowers.

The VA inspector general’s office also alerted the House Veterans Affairs Committee to Shulkin’s misstatements, according to the Arizona Republic.

In response to questions about why the VA had placed the pair of officials on paid leave instead of firing them outright, Shulkin had argued before the Senate VA Committee that his agency was barred from questioning the officials due to an ongoing investigation. A lawyer representing one of the accused VA officials noted the Justice Department had actually concluded its investigation into the official months earlier, and argued Shulkin had been aware of this when he cited the criminal probe as an excuse for why the official had not yet been fired from the VA.

In April 2016, Shulkin disputed a Daily Caller report during a congressional hearing by telling the House Veterans Affairs Committee that a VA official who had been convicted of armed robbery was fired from her position at the agency. However, he was forced to admit much later in the hearing upon further questioning that the woman had actually been reinstated to a VA job after she got out of jail.

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As the undersecretary for health, Shulkin also oversaw a continuation of delays in care at some VA facilities. Just one day before Trump tapped Shulkin to serve as the new VA secretary, for example, the Office of Special Counsel substantiated a Phoenix VA whistleblower’s allegations that dozens of veterans at the Arizona had hospital had faced excessive wait times and at least one had died as a result.

While groups such as the American Legion and AmVets celebrated the nomination of Shulkin, who will be the first VA secretary never to have served in the military, some reform advocates expressed doubt that Shulkin could upend a system he helped create.

One source close to the issue said it’s unlikely Shulkin will have the “appetite” to fire people he has worked alongside for nearly two years.

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