White House adviser Rob Nabors said last month that leadership at the Department of Veterans Affairs needs to do a better job of taking advice from field employees — he also recommended cracking down on staff who brush aside problems.

“The tone at the top should encourage employees to speak up about problems, but also to think of and be a part of solutions,” Nabors said in a review he submitted to President Obama.

President Obama walks with VA secretary nominee Robert McDonald. (REUTERS/Kevin Lamarque).

The report followed news that the Office of Special Counsel, a federal agency that protects whistleblowers, was investigating widespread allegations of retaliation against VA personnel who came forward to report wrongdoing.

After Obama selected former Procter & Gamble chief Robert McDonald to lead the troubled agency last month, we published a survey asking VA workers what advice they would give the department’s next secretary.

Sheila Galliart, a medical technologist with the VA’s Oklahoma City medical center, agreed that the future agency head needs to engage more with rank-and-file workers.

“Go into facilities and TALK to the people who do the actual labor; not just GS-15 and above folks,” she said. “Start with housekeepers, unit clerks, payroll clerks, etc.”

Galliart also said the VA should spread the wealth when it comes to handing out performance awards for meeting benchmarks. “The employees themselves get nothing when the demands are met; the director gets all the glory and the cash,” she said.

Eric Konicki, a medical officer with the VA’s Cleveland medical center, said the department should trim its central-office staff to “1990’s levels” and hire more clinicians to treat veterans. “This will enhance access and improve care by freeing the field staff from completing reports so they can take care of veterans,” he said.

(Scott Olson/Getty Images)

Konicki cited a recent New England Journal of Medicine article by doctors Kenneth Kizer and Ashish Jha that said VA central-office staff has “grown markedly — from about 800 in the late 1990s to nearly 11,000 in 2012.”

Kizer served as VA undersecretary for health during the Clinton administration, while Jha is a staff doctor at the VA’s Boston medical center and professor at the Harvard School of Public Health.

Jason Usry, a VA legal administrative employee from Charleston, S.C. who worked at a VA call center for about a year and a half, said bureaucratic rules often delay processing of benefits. “The agency’s culture can be hopelessly bureaucratic at times,” he said.

As one example, Usry said the VA requires veterans whose decision letters were lost in the delivery process to request replacement letters through regional offices rather than through VA call centers.

“Even if we knew it went to the wrong address, even if we knew the veteran would never get it because it was already returned to sender, we simply weren’t allowed to send it back out,” Usry said. “Not only can the call-center agent not resend the letter, but they can’t even tell the veteran what the decision was so he knows if to appeal, or what to appeal.”

Some of our survey respondents were not VA employees, but their comments were nonetheless thought-provoking.

Tim Albright, a retired Social Security Administration manager whose military-veteran son waited about 18 months for the VA to process his disability claim for mental-health treatment, said the consequences of waiting for medical care are often more serious those that those associated with waiting for benefits.

“The VA can pay retroactive cash benefits once a claim is approved, but it cannot provide retroactive health care benefits,” Albright said. “The damage done by going 200 days without medical treatment will have permanent lifetime damages to a veteran’s health, including increased suffering and, in some cases, death.”

Albright recommended that the VA automatically give patients temporary Medicare cards and bill the costs back to the department when their wait times reach “a period of months.”

“This could be set up within a few weeks using the 1,300 nationwide Social Security offices,” the former federal worker wrote. “SSA has the software in place to identify all VA applicants, including their W-2 info, which would verify their military service. All they would need is a daily file from the VA identifying critically delayed claims and medical request.”