Capt. Eric K. Shinseki was in pain and a sedative-induced fog when a trauma nurse spoke to him at an Army evacuation hospital in 1970 in Da Nang, Vietnam. He’d been helicoptered there for emergency surgery after tripping a land mine that blew off half his foot.

Army doctors at home will want to amputate the entire foot, the nurse told him.

“They are going to give you a lot of reasons why they think this must happen,” she said. The real reason, she warned, was that the Army lacked a prosthetic for a forefoot amputation and taking the whole foot would be easier. If Shinseki wanted to keep his ankle, he would have to fight for it.

Shinseki did fight, angering the stateside Army orthopedic surgeon, a colonel. In the end, the captain’s determination won out.

“We reached an agreement to keep my ankle and try to fit a prosthesis to my injuries, rather than the other way around,” Shinseki would later say. Intense rehabilitation followed, allowing him to stay in the Army and rise to the rank of general.

The nurse “gave me choices no one else was willing to give me, and it has made all the difference in how I have been able to live my life,” Shinseki said.

The episode revealed a truth about Shinseki: Taking the path of least resistance isn’t his style.

He is 71 now, nearing the start of his sixth year as secretary of veterans affairs — serving longer than any of his predecessors — and fighting new battles stateside. Overseeing a behemoth of bureaucracy, Shinseki is leading VA as it tries to shed ancient, paperbound systems and revolutionize how it serves veterans.

That revolution has been a struggle, most notably with VA’s disability claims backlog.

Shinseki has been lambasted over the department’s enormous inventory of claims, which reached a peak of 900,000 in March and, though now in steep decline, can still leave veterans waiting close to a year for resolution.

His efforts have won him praise — and some calls for his resignation.

The department has been regularly excoriated on “The Daily Show with Jon Stewart,” with even Shinseki’s deliberate speaking style satirized. “No wonder things take forever over there,” Stewart quipped.

It was Shinseki, in fact, who brought more attention to the long-standing backlog, declaring three years ago that VA would eliminate it by the end of 2015. He then added nearly a million new claims to the process by broadening veteran eligibility.

“Even if I have to build the backlog in order to end it, that’s the right thing to do and we’re going to do it,” Shinseki said in an interview.

“Some of the things being raised are things that Ric put out there himself,” White House Chief of Staff Denis McDonough said. “This is a very public way to hold himself accountable. It’s not a traditional hallmark of Washington, D.C.”

Huge challenges

With 335,000 employees, VA is second in size only to the Defense Department among federal agencies. It is well funded, having seen its budget increase 40 percent to $140 billion since President Obama took office.

And its major challenges go far beyond the disability backlog. The number of veterans who received VA treatment for post-traumatic stress disorder and other mental health issues reached 1.3 million last year, up 400,000 since 2006. An average of 22 veterans a day commit suicide. Tens of thousands of veterans remain homeless, and as he did with disability claims, Shinseki set a 2015 deadline to get all of them off the street.

Shinseki travels frequently, visiting regional offices and VA facilities, pushing and prodding staff and visiting with veterans.

Shinseki’s encounter with the nurse in Vietnam shaped how he views VA’s role in delivering medical care. “I’m always reminded to get over the notion that health care is only delivered by doctors,” Shinseki said during a recent visit to the VA medical center in Hampton, Va.

Shinseki toured a new clinic for female veterans, stopping in the hallway to talk with a psychiatrist.

“There’s a huge demand, and we don’t have enough staff,” the doctor told Shinseki. The clinic had one psychiatrist and three psychologists for 500 patients.

Shinseki turned to the medical center and mental health directors accompanying the tour.

“Did we not know we were going to have this requirement [for more doctors]?” he asked.

Officials explained that VA already had authorization to hire six psychiatrists and two psychologists at the Hampton facility. The jobs were supposed to have been filled by the end of September. But the deadline had been missed, and it would take up to another six months.

“Can you guys help me here, and just push this hard?” Shinseki said.

“We actually look at each of those vacancies every Friday, so we’re . . . ” said Michael Dunfee, the medical center director, but Shinseki quietly interrupted.

“I’m not asking you to look at them every Friday. I’m asking you to find a way to fill it.”

Drawn to service

His supporters include veterans groups often critical of VA. “He’s an outstanding, transformational leader,” said Tom Tarantino, policy director for Iraq and Afghanistan Veterans of America. “Certainly, the VA today is considerably different than the VA in 2008.”

But critics question whether Shinseki is the right man to modernize the department, portraying him as a relic, haplessly presiding over a hidebound bureaucracy.

“His detractors, who are legion among the generation of Iraq and Afghanistan veterans, say he lacks the creativity and leadership skills to deal with Veterans Affairs’ mind-boggling problems,” Time magazine’s Joe Klein wrote in March, calling on Shinseki to resign.

After a lifetime in which he has overcome racial discrimination and physical disability, Shinseki takes the long perspective on the shots directed his way.

“I guess if I were running for political office I’d be antsy about it,” he said.

Shinseki, whose Japanese grandparents emigrated from Hiroshima at the turn of the 20th century to the Hawaiian island of Kauai, was classified an enemy alien upon his birth in 1942. Following the Japanese attack on Pearl Harbor a few months earlier, Americans of Japanese ancestry were stripped of their rights as citizens.

Yet Shinseki was drawn to military service, raised on stories of legendary units of Nisei, second-generation Japanese Americans who distinguished themselves in World War II combat despite discrimination.

“I have stood on their shoulders all my life,” he has said.

He attended West Point and served two tours in Vietnam, suffering wounds each time. Following a long recovery learning to walk again, Shinseki rose to command the 1st Cavalry Division and later the U.S. Army Europe.

As Army chief of staff, he is best known for his prediction during congressional testimony prior to the 2003 invasion of Iraq that the U.S. occupation might require far more troops than the Pentagon planned. Shinseki later told Defense Secretary Donald H. Rumsfeld that his comments were misinterpreted, but war opponents lionized the general.

When Shinseki retired after 38 years in the Army in 2003 as the highest-ranking Asian American in U.S. military history, Rumsfeld did not attend the ceremony.

During the next five years, Shinseki served on corporate boards and associations, and then President-elect Obama asked him to be VA secretary.

“No one will ever doubt that this former Army chief of staff has the courage to stand up for our troops and our veterans,” Obama said at the time.

For Shinseki, taking the job was completing a journey, giving him a chance, he said, “to take care of the youngsters I went to war with, and the youngsters I sent to war as chief of staff.”

What puzzled him most was the fate of some of those youngsters, facing issues such as mental illness, substance abuse and homelessness.

“I know them as the kids who went to Korea, the kids who went to Vietnam, and I just know what they did,” he said.

“What happened to them? You have to assume it’s less about them and more about us. What did we miss? And that’s why you set goals, to end the backlog, and end homelessness. By setting those goals, it forces you to go back and challenge all the assumptions you may have about how we do our business.”

‘Not dusting my hands off’’

Shinseki’s promise in February 2010 to eliminate the disability backlog by 2015 with a 98 percent accuracy rate was an ambitious goal. And he admits he jumped in without knowing how vast the problem was.

“I’ve spent all my life setting targets and never really knowing what the real enemy situation is,” he said. “You find out when you walk over what it really was.”

Disturbed that many Vietnam veterans exposed to Agent Orange couldn’t receive disability benefits, Shinseki expanded eligibility for those with three diseases associated with the toxic herbicide. That added more than a quarter-million cases.

New conditions associated with Gulf War illness were also allowed — meaning another quarter-million claims. And Shinseki allowed benefits for any combat veteran diagnosed with PTSD. Another 500,000 claims.

“We all say PTSD is as old as combat, yet in our process we were putting the burden of proof on the veteran to validate how and specifically when PTSD struck,” he said. “It often times was asking a veteran to document what they couldn’t.”

Fueled also by Iraq and Afghanistan veterans entering the system, the backlog soared. The inventory was 391,000 when Obama took office in 2009, and 879,000 by 2012.

Slowly, the reforms — including a $519 million paperless system to replace the antiquated paper process — have begun to kick in, and the inventory has dropped by 34 percent since March.

“I’m not dusting my hands off and saying this is a done deal,” Shinseki told reporters Thursday. But VA, he noted, is on track to meet a goal many thought unreachable.

Tough issues

By his own admission, Shinseki knew little about homelessness or its causes. But in partnership with Housing and Urban Development Secretary Shaun Donovan, he embraced a “housing first” strategy, which places veterans into permanent supportive housing, then treats them for underlying issues such as substance abuse and mental ailments.

The two departments have housed more than 45,000 formerly homeless veterans. The numbers of homeless veterans counted in annual surveys decreased 17 percent between 2009 and 2012, and Shinseki estimates another 10 percent decrease in 2013.

More than 50,000 veterans are still on the streets, and Shinseki concedes he may miss his deadline. But his efforts have won bipartisan praise. “That’s the one where he can claim the most progress,” said Rep. Jeff Miller (R-Fla.), chairman of the House Veterans Affairs Committee.

Shinseki has increased spending on mental health care by nearly 57 percent since 2009, to about $6.5 billion annually. The number of veterans seeking mental health care from VA has soared, from 927,000 in 2006 to 1.3 million in 2012. The rate of suicide is frighteningly high, and Shinseki makes no bold promises.

“This is one of those areas I’ve learned to be cautious, because there’s a lot here we don’t know, and we have to be better at it,” he said.

VA was criticized in September for not picking up on Navy Yard shooter Aaron Alexis’s mental health issues when he sought treatment for insomnia at VA emergency rooms. Shinseki declined to comment; the department says it handled the matter properly.

The secretary told VA mental health workers in Hampton that early intervention is the key to treating veterans with PTSD. “They need quality health care, education and jobs — and not to be ostracized,” he said.

“I don’t care what you read in the newspapers,” he said. “They are not damaged goods.”

After Shinseki spoke, Richard Smith, a Navy veteran, came up to shake his hand. Smith was diagnosed with PTSD following his Gulf War service.

“I felt like he knew personally what I was going through,” Smith said.

A final search

Veterans groups and members of Congress were relieved by Shinseki’s decision to stay for Obama’s second term, counter to speculation he would retire to spend more time with his wife, Patricia, and their family.

“There’s an inertia-laden culture at the VA that doesn’t like change,” IAVA’s Tarantino said. By staying, Shinseki “showed that he was going to be here until they started moving.”

Shinseki has not slowed his travel, viewing it as key to getting VA employees to buy into his goals. He used to tell workers to “come to work every day with your knife between your teeth” until he was advised to tone down the war analogies.

The travel also helps him pursue a personal quest: finding the nurse who “got my head screwed on right in 1970 coming out of Da Nang.”

He was only in the Da Nang hospital three or four days. He never knew the nurse’s name and has only a dim memory of her face. But he clearly remembers her stern instructions to keep rotating his ankle. It would freeze up otherwise, she told him, and he would lose it.

The ball of gauze wrapped around his open wound felt like sandpaper if he moved it, Shinseki said, and that nurse never seemed to go off shift.

“So every time I heard or saw her coming, I started rotating that ankle just as fast and hard as I could. Painful,” the secretary told a group of students this year.

He has told her story a few times in speeches to nurses associations and graduating classes, and picked up a few clues to her identity. “I will find her on my watch as secretary,” he said. “If she’s out there, I will find her.”

Shinseki added, “Being secretary of VA is closure for a lot of things I’ve done in my life, but she would be amongst the very special opportunities to say thank you.”