The VA system is a little more complicated that some folks seem to think. Disability ratings range from 10% to 100% and not all are deemed
service connected. A 100%
service connected means free care, but the process of being awarded 100% service connected is uneven at best. For those with non service connected disability there is a charge for VA
health care, but it is by the day; so if you have one appointment on a day or multiple appointments a day you pay the same and the VA can (and usually will) schedule multiple appointments on the same day.
The increase of foreign born
health care employees at the VA simply mirrors the increase of foreign born
health care workers in the national health care system. Part of the problem is being a doctor is no longer as attractive to Americans as it use to be, but to foreign nationals it is still a very attractive system. The bottom line is the American population is aging and more folks are in need of health care at a time when there are fewer folks who want jobs providing health care. There has also been a big increase in the portion of vets who are applying for service connected disability. In WWII Gen. Patton famously slapped someone for what would now be diagnosed as PTSD. Not saying these folks do not have real problems, just that the system is being overloaded.
More to the OP's point contacting some flavor of VA service rep is the first step. My experience was that the doctors at the VA made it very clear to me my condition was service connected and the first service rep I connected pushed it through as quickly as he could, but it did take close to five years. On the other hand I know of folks the doctors felt had problems that were not service connected and they got less help from the service rep. Not saying you should give up if the doctors and service rep
brushes you off, just that you will have a longer harder path.
Another issue mentioned is how much you and your primary care doctor relate. I had the same primary care doctor for 17 years, but she retired and in the last five years I have had five different ones. Same goes for her nurse who you normally have to speak to for triage. My primary care nurse lasted even longer and we were on a first name basis. Now they seem to change every time I visit.
Which leads to the issue of living on a boat, traveling, and as a result having different health care folks every time you visit. Not only does this make it harder to progress in getting service connected, but (at least in my view) lesser quality health care as well.
My
advice would be to move to some place on the
Florida Gulf close to military bases, with a warm climate, low cost of living, access to the
water and establish a good relationship with the VA folks. Once you get a stable situation with the VA then start cruising.