(Interview 11/2010. Oil on linen, 40 ins. x 30 ins.)
"I have been trying to respond to you sooner. The fact is I didn’t exactly know how to explain all that has occurred. I have stopped using the Veteran’s Affairs medical as much as possible.
"The VA became a complete and utter nightmare under the last administration.
"Between the lack of adequate care and the ten years plus of prescribing me opiates my life became more of a hardship than my injuries. I lost an entire life. The VA had advised me to stay on the medication or my pain and other symptoms would get worse. I chose to go against there advice and voluntarily decided to stop taking the pain medication. Since then I have to rely on medical marijuana for my symptoms and pain. I have to pay for it myself since the VA doesn’t recognize it as a medication.
"I hope all is well with you and thank you for inquiring.
I write in the story below that Miguel suffered a disabling concussion while on active duty in the US Coast Guard. When we met he was an associate pastor studying for a masters degree in psychology and social work.
The year was 2010. I was not thinking like a journalist even just a little bit. The painting series was still new. I was trying to perfect being a good listener. When the subject told me that the military's Tricare program covered his hefty healthcare needs, I dutifully recorded the information and defined Tricare for the story. But I did not take the opportunity to explain how Tricare exists in the greater veteran care landscape. It's complicated.
Before doing this research, I threw around the acronym VA to mean the all-inclusive term for veterans' health insurance. If you were in the armed services, the VA took care of you. Turns out not to be the whole picture.
The Veteran's Administration (VA) became the Department of Veteran's Affairs (VA) when President Reagan elevated the program to a cabinet level position. The Veteran's Health Administration (VHA) is part of the Department of Veteran's Affairs. The VHA is a kind of national health service, the largest integrated health system in the US. The VHA provides medical care for the US armed forces.
Not all military personnel get their healthcare services through the VHA. The Defense Health Agency manages Tricare, a Department of Defense healthcare program. Several Tricare plans provide health coverage to millions of current and former uniformed service members and their families.
Eligibility requirements differ between the VHA and Tricare programs. Some vets qualify for both programs.
The subject was clear he was enrolled in Tricare. He said he "had no out-of-pocket" expenses. Was he enrolled in Tricare Prime? Was he a Tricare/VHA dual eligible? I don't know.
One important note. Although Tricare and the Veteran's Health Administration are two different programs, they share the Veteran Affairs health network. Since 1995 all VA health care facilities are a part the TRICARE network providers. The subject talks about using the VHA network with his Tricare insurance.
The original concept for the portrait stories was to have them read like police reports. I thought facts alone would sway people. I learned that the opposite is true. People like personal touches like names. This is Miguel.
(from a 2010 interview)
Disabled Veteran of United States Coast Guard, Age 34, Insured
The subject is an associate pastor working for ordination. He is also studying for a master’s degree – a dual degree in social work and psychology.
The subject suffered a severe concussion in 2001 while on-duty for the Coast Guard. He has veterans health insurance called Tri-Care. He has no out-of-pocket expenses.
Tricare is a Department of Defense program that provides health benefits for military personnel and their families.
The subject believes the Veteran's Administration's (VA) doctors misdiagnosed and mishandled his brain injury. He received no follow-up care until a year later when he suffered a second concussion and experienced symptoms of brain damage -- loss of photographic memory, diminished motor skills, a convulsion.
The subject became very pro-active in his care and went to see his XO (executive officer). They met with the captain who then authorized a consultation at Walter Reed Army Medical Center. The subject also received permission to get a second opinion from civilian doctor. (The subject's Tricare military insurance plan allowed him to see a Walter Reed military doctor as well as a civilian doctor if pre-approved.)
Doctors determined that the delayed treatment for the first injury caused permanent brain damage.
The subject suffers from neuropathy, cervicalgia, post-traumatic stress disorder and severe migraine headaches. The subject has received cervical epidurals, steroids and pain medication.
The subject received 70% of his salary then 100% after a year of treatment. The subject is very unhappy about the time it took for the Veteran's Administration to approve the benefit.
The subject sees a polytrauma team of doctors 1-2 times/week. He participated in an acupuncture study for pain control. He saw noticeable improvement but funding ended. The subject cannot afford to continue acupuncture 3 times/week at $69 per visit. He has seen an increase in pain medication since he stopped the acupuncture sessions.
The subject qualifies for vocational rehabilitation. This means that the VA pays the subject's tuition followed by support in finding a job or starting a business. The subject knows he could have returned to the Coast Guard if the first medical team correctly diagnosed and treated his brain trauma.
But he also knows, having been injured in the line of duty, the VA is responsible for his care for life. The subject also appreciates that his local VA has a working partnership with the doctors of a renowned teaching hospital in a major city.