The Department of Veterans Affairs is in the midst of a very serious crisis. The political and reputational fallout from the 2014 patient scheduling scandal exposed the further destabilization of the veterans' policy subgovernment consisting of VA, the congressional veterans' affairs committees, and large veterans' service organizations. This subgovernment, historically referred to as the "iron triangle," was among the most stable and insular domestic policy arenas in the six decades following World War II. Since the 1990's a steady trend towards extreme partisan polarization has characterized both chambers of Congress. This dynamic gradually politicized an array of domestic policy realms. While veterans' policy was long immune to the worst of these trends, events during the 112th and 113th Congresses (2011-2015) illustrate the encroachment of partisan politicization into a once relatively nonpartisan issue area. This phenomenon was visible in both the Republican controlled House and the Democratic controlled Senate. Simultaneous with the politicization of veterans' issues, the stature and influence of large veterans' service organizations such as the American Legion and VFW continue to decline. Although these groups were considered nearly invincible and achieved impressive legislative triumphs in the decades following World War II, events in the 113th Congress demonstrate their diminished power in a destabilized subgovernment. Inexorable demographic factors such as a declining veteran population and falling membership converge with the rise of narrowly focused veterans' advocacy groups that compete for public attention and finite philanthropy. The trends contributing to the decline of traditional VSOs were several decades in the making, but events throughout 2014 put these developments in stark relief. The continued destabilization of the veterans' subgovernment has profound consequences for the Veterans Health Administration. Events throughout the 113th Congress suggest that VA failed to appreciate changes within the subgovernment and adapt accordingly. In the 114th Congress and beyond, VHA can anticipate the continuation of highly politicized congressional oversight while the influence of traditional VSOs continues to decline. Expanded calls for the further privatization of VHA services are expected and these efforts will be increasingly backed by corporate lobbying expenditures. While VA itself cannot reverse trends affecting other elements of the veterans' subgovernment, it has options that can improve the effectiveness of its congressional outreach efforts and repair its severely damaged relationships with legislators and VSOs. It can also cultivate new surrogates to augment the traditional VSOs and reach expanded audiences from their unique perspectives. Implementing the necessary institutional "shift in mind" to navigate this changed environment will not be easy for VHA, but the shared vision outlined by VA's new Secretary, Robert McDonald, shows much promise. As a leading health care organization, VHA is fundamentally a learning organization and can leverage many of the best cultural attributes that facilitated its medical care transformation in the 1990s to reevaluate its role within a destabilized and changing policy subgovernment.

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