Duluthian Daniel Knight has a piece of shrapnel lodged behind his right ear, in the narrow space between his skull and his brain. “It was too dangerous to remove at the time.”
That time was 1968. Apollo 8 was about to orbit the moon. Martin Luther King and Bobby Kennedy were assassinated. Viet Cong had just launched the Tet Offensive and, for Knight, it was the year his boat was attacked.
Knight served in the Navy from 1965 to 1991. He has three Purple Hearts to go along with three war injuries. Another bullet lodged shrapnel in his left thumb—though not for long. “I just yanked it out,” he says with a smile and a shrug, as if plucking lint from his sweater. More shrapnel in his left shoulder was removed, but not by him.
The night his ship was attacked, a flying piece of metal struck him in the head as the boat capsized. He was underwater for nearly four minutes—nothing compared to the three months he spent in a coma. He was 21 years old.
Now age 70, he’s still dealing with the military, trying to utilize the healthcare services provided by the United States Department of Veterans Affairs (VA), which treated him for Post-Traumatic Stress Disorder when he first returned from combat. “I got that help for over a year. I needed to get my demons out.” He voluntarily terminated treatment when he felt ready.
Now, 50 years after he fought in Vietnam (though only 30 years since he retired from the Navy), Knight has suffered a stroke, undergoes ongoing kidney dialysis, has had both knees completely reconstructed, and needed a hip replacement after he returned from a hospital stay still feeling weak. He fell in the shower and his wife, Judy, couldn’t catch him in time. He broke his hip.
His most recent surgery left him in a rehabilitation center for three months. His physical therapist contacted the VA to get approval for two extensions to allow him to stay longer, but he still didn't feel ready to leave.
He receives kidney dialysis three times a week, which leaves him exhausted for the rest of the day. “All I do is go to the hospital and lay at home.”
Judy has been by his side through all of it. A retired nurse, she helps with everything from getting him out of bed to bathing. But providing 24/7 care is draining—and she receives no pay for it. “Other folks can get in-home nurse practitioners. They’re usually paid for by the VA. But I’m already a nurse. Couldn’t I be somehow compensated for the time I spend taking care of my husband?”
But the chances of becoming a paid family caregiver seem unlikely. Judy says it’s amazing if they can even reach anyone at the VA Health Administration. “We have to get pre-approved before seeking any kind of treatment. But I’ll sit on the phone for nearly an hour trying to get a hold of someone—and that happens every single time.”
The VA contracts with clinics and health practitioners. The only facility within a 50-mile radius of Duluth is the Twin Ports VA Clinic. According to the agency’s online interactive map, the average wait time to be seen at the Twin Ports clinic is six days, which is exactly how long it took Daniel to get in after his May 25 surgery.
But it’s not so much the wait time that frustrates the Knights. It's the difficulty speaking to someone when they need to know whether they are approved for care.
The closest facility for more serious procedures is in Minneapolis, which is a hindrance to those with limited transportation. Not only that, but once you do finally reach someone at the VA, it’s possible your medical visit will be denied, often for vague reasons.
“Honestly, the VA healthcare system can be complex to figure out,” says Chris Roemhildt, Outreach Coordinator at the Vet Center in Duluth. “It can be quite daunting.”
Healthcare for veterans is supposed to be based on a priority system, but it’s not entirely clear how priority is determined. There are eight levels, which are assigned when applying to the healthcare network. Priority 1 is for “veterans with VA-rated service-connected disabilities 50% or more disabling” and “veterans determined by VA to be unemployable due to service-connected conditions.”
Priority 2 is for veterans with a “30-40% disabling” condition. Priority 3 includes former prisoners of war and veterans awarded the Purple Heart, such as Daniel Knight.
The lowest level, priority 8, are “Veterans with gross household income above the VA and the geographically-adjusted income limits for their resident location and who agree to pay copays.”
It’s possible to fall into more than one category, in which case, the “VA will always place you in the highest priority group [for which] you are eligible,” according to its website.
The care that correlates with each level is equally confusing. Even though they know their priority level, the Knights still have to call in before every doctor visit or medical need to find out whether it is covered. For example, Judy asked for an electric wheelchair because Daniel cannot operate a manual one by himself. It was denied.
“They said [electric] wheelchairs are only for people with missing limbs. But I know someone who is in a similar situation as Dan. He isn’t missing any limbs, and he got an electric wheelchair. It doesn’t make sense.”
The Veterans Health Administration was established in 1865 by President Abraham Lincoln as a national “asylum” for soldiers and sailors. In 1873, it was renamed the National Home for Disabled Volunteer Soldiers, which provided housing and medical care to thousands of Civil War veterans. This became the template for the current federal veterans’ hospitals.
Today, the VA is the largest integrated healthcare system in the United States. Its medical centers serve nine million veterans per year. In the ’90s, the VA underwent significant downsizing, reducing its staff by 10,000, even as its patient caseload increased 104 percent.
Scandal was inevitable. In 2014, wait times at VA health facilities were so bad that 40 service members died waiting for care, and VA staff were “manipulating” records to cover it up. More than 120,000 veterans were forced to wait so long the VA simply lost track of them.
The agency launched initiatives to improve access to its care. In 2016, the New England Journal of Medicine published “Restoring Trust in Veterans Healthcare,” “reaffirm[ing] the core mission to provide quality care to Veterans, and to offer that care as soon as possible to Veterans how and where they desire to receive that care.”
But you could have fooled Daniel Knight. He recently spent three months at the Twin Ports VA Clinic instead of the treatment center in Superior, where the dialysis machine is connected to the bed, so he doesn’t have to keep getting in and out. But the Superior clinic doesn’t have a contract with the VA, so he didn’t receive approval to get his treatment there. Instead, he recuperated in a room that had no air conditioning in June.
At least dialysis kept him cold. Judy suffered the full brunt of the heat in her daily visits. “I was always sweating and exhausted when I was there. The nurses were great, but it’s like any other nursing home, short of help.”
The Knights don’t think they’re asking too much, especially considering Daniel’s service to his country. “I wish that the VA could just stop and say, ‘Dan, how’s he doing? Let’s take care of him.’ But they just don’t do that because there’s so many of us. I’m not getting all of the benefits I need. I’m just one of several million vets that they have to deal with and they don’t have the time.”
The Knights are about ready to give up on the VA. They already have secondary insurance, but would need approval from the VA to receive Medicare—and then if they aren’t approved at a reasonable rate, they would likely be unable to afford the treatment Daniel continues to need.
Yet despite it all—the injuries, and the ongoing treatments, and the subpar benefits provided by an American public that constantly gives lip service to honoring our military—Daniel would still re-enlist if he had it to do all over again. “It’s the most important thing I’ve ever done in my life. I wouldn’t change it, even with all the frustration I’m dealing with now.”