(CNN) -- For years, the US Department of Veterans Affairs had been roiled by mishaps, setbacks and controversies. But recently, several veterans and their family members told CNN, they believed the department was finally improving.
Now, with all the political turmoil surrounding the appointment of a new secretary, they're not so sure.
President Donald Trump announced last month that Secretary David Shulkin would be replaced with White House physician Rear Admiral Ronny Jackson -- a nomination that was fraught with controversy until he withdrew last week.
Like military families across the United States, US Army veteran Matthew Pennington and his wife Marjorie believe the VA needs a strong leader to manage its 170 medical centers and 1,061 outpatient sites, which serve more than 9 million veterans each year.
"We're worried," Marjorie, her husband's caregiver, told CNN. "We need direction. We need somebody to be there. Yes, we have people at the lower levels, but they need guidance."
Shawn Moore, whose husband served seven combat tours in Afghanistan, said she's fed up with political back-and-forth over the VA secretaryship, and that the search for a head of the department is eclipsing the needs of veterans and their families.
"You're talking about people's lives, and when you put a political spin on it and focus on people's political agenda, you are forgetting about the veteran and the family members," she said.
'We can't just stay in limbo'
Matthew Pennington was deployed three times after enlisting in the Army in 2001 -- once to Afghanistan and twice to Iraq. In April 2006, during his third deployment, he was struck by a roadside bomb and his left leg was amputated below the knee. Now he lives with the effects of post-traumatic stress disorder (PTSD) and a traumatic brain injury.
The couple resides in Maine, where Matthew relies on the VA for medical services and his retirement pay and benefits. While Marjorie serves as his caregiver, she also works for Code of Support Foundation, where she helps other veterans navigate the VA and its many programs.
Neither of them are happy about the upheaval that has gripped the VA in recent weeks. "It's just a sign of the times ... we live in," Matthew said of the recent turmoil at the VA, alluding to wider dysfunction in Washington.
To Matthew, Jackson's nomination reeked of "cronyism," he said, like other Trump appointments.
Marjorie was particularly upset by allegations that Jackson improperly handed out prescription drugs to White House staffers. She was glad when he withdrew his nomination Thursday, and said she respected him for it.
"That's a serious issue," said Marjorie. She said that Matthew became suicidal in 2007 as a result of being on too much prescribed psychiatric medication. That's the last thing veterans need, she said.
There were also allegations that Jackson had created a negative work environment and was intoxicated during an overseas trip.
In a statement announcing his withdrawal, Jackson said all of the allegations of improper behavior were "completely false and fabricated."
Ultimately, Matthew doesn't believe the President will pick anyone for the job that he's happy with. "It's swayed by the party, and it's going to be somebody who's affiliated with him," he said, "as opposed to somebody who can do the job and do it well."
"I would like to see the President hold to his promise of making things better for our veterans and their family members," Marjorie said, noting his 2016 campaign promise to reform the VA.
"We can't just stay in limbo."
'We don't have anyone'
Kristen Rouse served three tours in Afghanistan for a combined total of 31 months. Now stateside, she advocates for veterans and their families as the founding director of the NYC Veterans Alliance.
"This past week has been really nuts," Rouse told CNN.
Rouse was "hopeful" about Jackson's nomination, despite concerns that the White House doctor did not have the necessary experience to lead the VA, the government's second-largest bureaucracy. "Maybe someone knew something that I didn't," she recalled thinking at the time.
But now, with no stable head of the VA or even a nominee, Rouse said she's concerned that ongoing efforts to reform the VA will slow.
In recent years, the VA has been engulfed in scandal. Veterans have complained of long wait times and delayed care. In 2014, CNN reported that a VA system in Phoenix maintained a secret list of patient appointments, which hid the fact that some patients were waiting months to be seen for treatment. The resulting scandal eventually led to the resignation of then-Secretary Eric Shinseki.
"We have ongoing needs," Rouse said. "We need for the VA to keep getting better. We need for VA systems and personnel to adapt to new digital systems. We still have long wait times. We still have staffing shortages."
Robert Wilkie of the Department of Defense is currently serving as interim secretary, but he also has duties as the under secretary of defense for personnel and readiness.
What veterans who rely on the VA need, Rouse said, is a stable leader to reassure them that the department will continue to address the VA's shortcomings. "We don't have anyone to tell us that right now," she said.
Trump 'doesn't understand us'
As a Vietnam veteran who was exposed to Agent Orange, Wayne Smith relies on the VA to monitor his health. "It's a very real, integral part of my life," said Smith, a former combat medic who's now on the board of directors of the Iraq and Afghanistan Veterans of America.
Smith called the President's handling of Shulkin's firing "sloppy." Shulkin has repeatedly insisted that he was fired from his role via one of Trump's tweets, while the White House said he resigned.
Smith also said Jackson's nomination added "insult to injury." He wanted to give Jackson the benefit of the doubt, but it quickly became clear that he was not prepared to manage the VA.
"I mean, President Trump says -- and in his mind, maybe he believes it's true -- but he says he really cares about veterans," Smith said. "But he doesn't understand us."
"We're not simply something to wave the flag at when we're politically convenient, and that's how it feels."
The recent "chaos," Smith said, has strengthened his resolve to fight and ensure "competent leadership" is put in place at the VA.
"It's not about an individual," Smith said. "It's not about Secretary Shulkin or anyone else, it's about having competent service, competent leadership. I don't care if they are a Republican or a Democrat."
'They have no leadership or direction'
Shawn Moore tried to learn everything she could about caring for veterans after she met her husband, Bryan, a US Army veteran who served for 23 years.
She thought her training as a police officer would prepare her for the challenges of caring for him, she said -- but she was wrong.
Her husband struggles with PTSD, Moore told CNN, and he attempted suicide in August 2017. He gets support for both his mental health and his back issues at the VA medical center in Leavenworth, Kansas. The couple also attends conjoint therapy through the VA "to better understand both our roles in the journey of PTSD," Moore said.
Moore and her husband also started Caregivers on the Homefront, an organization that supports the people and families who care for America's veterans.
She told CNN she was "devastated" by Shulkin's firing. "I really thought that he was putting the VA on a good path," she said.
Moore didn't have much of an opinion about Jackson's nomination, she said, but she was excited that it looked like Shulkin would be replaced quickly. But as allegations of professional misconduct emerged, she became concerned that it appeared the White House did not properly vet him.
"Now the VA is in turmoil again, because they have no leadership or direction, which affects the veteran, which affects the family."
Moore wants to see a new leader who's familiar with veterans and their families, someone who will "stand up to the BS" and get something to done, she said, though no one will be perfect.
"What we are looking for and what Washington is looking for are two different things," Moore said.