January 8, 2025
Küçükçekmece, Türkiye—The opinion piece below is by Isa Kocher, a New York absentee voter, Turkey resident, severely disabled U.S. Air Force veteran, and member of the Democrats Abroad Global Veterans and Military Families Caucus.
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It’s a well-known medical fact that people with serious disabilities are impacted by a wide range of comorbidities that affect one’s entire state of health. Disabled individuals often have, as a rule, a wide range of health problems not faced by people who do not have those disabilities.
Because of this, service-connected disabled veterans with serious disabilities have the right to be treated for all their health issues, but the Department of Veterans Affairs (VA) Foreign Medical Program (FMP) denies that right explicitly; it rarely, if ever, reimburses disabled veterans’ health care needs for those living overseas.
Sadly, FMP only reimburses disabled veterans for medical care explicitly directly related to their adjudicated, service-connected disability(ies) or non-service-connected disabilities, which were aggravated by adjudicated, service-connected disabilities. Furthermore, VA only reimburses medications approved by the U.S. Food and Drug Administration (FDA). This in itself is a significant barrier to veterans receiving the medical treatment they need because it is nearly impossible for a service-connected veteran living abroad to miraculously obtain FDA-approved medications at their local pharmacy or doctor’s clinic overseas. If there is such a clinic that offers the needed medication or medical device, the next challenge is to see if they will send in a reimbursement claim to the VA or whether this responsibility will fall on the veteran. In either scenario, the reimbursement process is lengthy and often unclear.
In short, the experience of disabled veterans overseas who have to deal with the VA’s inefficient processes is nothing less than traumatizing.
This is in stark contrast to veterans enrolled at VA medical facilities stateside and the Department of Defense’s (DoD) TRICARE program for military retirees who have worldwide-covered, broader healthcare coverage.
Many foreign hospitals and medical care providers will not bill the VA because of the VA’s disastrous history of providing reimbursements months after the veteran abroad actually received care. The disabled American veteran often has to pay in full, in advance, and apply for reimbursement, often beyond our means.
Invoices marked paid must be in English. If a veteran successfully navigates FMP’s complex processes for veterans living abroad, you eventually get a U.S. Treasury check in the mail—and nowhere abroad to cash it.
For the most part, translating, documenting, and mailing your health care documentation costs more than the actual repayment. In many countries, there are no regular postal systems, no local post offices, and no local addresses. Where I lived for several years in Oman, there were no streets in the town where I lived. Going to a post office to mail your invoices to FMP is costly. Sometimes, your only resort is private mail couriers such as DHL, FedEx, or UPS. In my experience, USPS is the slowest and least reliable method for communicating FMP claims with the VA. I’ve had registered mail to a VA Regional Office, its known address, returned “no address found.”
There are huge differences from country to country in health care, health insurance, postal services, and banking services. VA’s FMP ignores that altogether.
VA’s paper check you receive (if received at all) cannot be cashed, and banks may charge 50€ to 100€ for each U.S. Treasury check. Paper checks cannot usually be cashed, often get lost in the mail, and thus cannot be delivered. In Turkey, all VA mail goes to the U.S. military installation in Adana, which is 1,000 kilometers from my home. Virtually no mail from VA arrives at my home, and few checks ever get delivered.
I have been living overseas as a severely disabled U.S. veteran (originally 50% disabled, now 100% permanently and totally disabled) for nearly 40 years. I have been living overseas as a severely disabled U.S. veteran (originally 50% disabled, now 100% permanently and totally disabled) for nearly 40 years. As long as I have had a job, dealing with VA’s FMP and receiving my disability compensation has been a struggle, but now it is impossible at age 81.
If you are employed overseas, you usually get government medical insurance, but after age 60, you are on your own, and the VA abandons you. This is not the promise America made to me and others who served honorably in uniform.
My point is that there needs to be significant changes to VA’s processes. First, the VA needs to pay a lot more attention to disabled veterans living overseas—we are entitled to the same benefits as veterans stateside. Second, FMP needs to be capable of processing claims reimbursements electronically to veterans’ foreign bank accounts. Third, VA needs to consider that FMP claimants cannot possibly find which medical providers abroad have FDA-approved medications and devices in stock. Fourth, reimbursement times desperately need to be shortened. There is no excuse for a veteran living overseas to have to wait a year to be reimbursed with a paper check from the U.S. Treasury which cannot be cashed or deposited anywhere locally. Fifth, FMP needs to reimburse medical providers in a timely manner. There is a reason there are less and less options for disabled veterans abroad to seek medical services from providers who have agreed to foot the bill and deal with VA’s lengthy reimbursement services afterwards. VA’s reputation among medical providers abroad has dwindled, and if there are no improvements to all of FMP’s processes, it is inevitable disabled veterans abroad will continue to suffer through no fault of their own.
C. Isa Kocher 一茶
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The VMF Caucus, proudly consisting of veterans, military family members, and strong allies of veterans and military family causes, has a membership of approximately 1,300 members located in dozens of countries.
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