At 26, Reno Roethle is going through a time of life when people make big decisions - about careers, lovers, moves.
But he's got a big obstacle.
His surgically repaired lip, damaged in 2007 by a blast in Sadr City, Baghdad, doesn't look or work quite right. Half of his lower lip is white, due to skin grafts used to repair it, and it's flat so sometimes he drools.
It's not exactly the look a handsome, 20-something bachelor seeks. After first giving me permission to take his photo, he changed his mind.
"I do feel awkward a lot of times, pretty much everywhere I go," he told me at a Tucson coffee shop where we met Thursday.
This would be his ninth - and hopefully last - surgery to repair the damage caused by shrapnel slamming through his left jaw as he drove an Army Humvee through the Baghdad slum.
"I'm tired of it. I just want to have this last stuff done and be on my way," he said.
But first he must clear that big obstacle, the same one thousands of veterans are facing: delays at the Veterans Affairs medical centers. It's an issue nationwide, as warriors return from today's conflicts in the Middle East and Vietnam-era veterans grow old.
On Wednesday, the Department of Veterans Affairs ordered that claims processors work overtime hours to reduce the backlog in disability claims. Last month, U.S. Rep. Ann Kirkpatrick, a Flagstaff Democrat who also represents Marana and Pinal County, introduced a bill that would make the Defense Department transfer service members' records to the VA in electronic form, in order to speed their approval.
As of the end of March, the VA had 885,068 claims pending, of which 69 percent were more than 125 days old - the threshold at which they're considered backlogged.
In Roethle's case, he has already qualified for disability and is living on the payments. His problem is that he's requested to have the surgery performed by a non-VA surgeon. A California group called Rebuilding America's Warriors has arranged for a specialist in facial plastic surgery, Dr. Salvatore Lettieri in Phoenix, to perform the surgery, but Roethle first needs the OK from his VA physician in Tucson.
About a month after his doctor was presented with the request, he still has no answer.
Roethle, who grew up in Glenwood in eastern New Mexico but moved here in 2010, says he wants Lettieri to do the surgery for two main reasons: It takes so long to get a VA surgeon to do the procedure, and even then it's unlikely the person assigned would be a specialist in maxilofacial surgery. Maggie Lockridge, who founded Rebuilding America's Warriors, said she sought out Lettieri because he's one of the best.
The surgeon would take tissue from inside Roethle's mouth and build up the flat, white part of his lower lip, Roethle said.
"When it's something they recommend or they want done, they're all about it," Roethle said of his VA doctors. "But when it's something I want done, they delay."
By email, a VA spokesman in Washington, D.C., said this of cases like Roethle's:
"The local VA medical facility has criteria to determine whether non-VA care may be used. If a veteran is eligible for certain medical care, the VA hospital or clinic should provide it as the first option. If they can't - due to a lack of available specialists or extraordinary distances from the veteran's home - the VA may consider non-VA care in the veteran's community. Non-VA care is not an entitlement program or a permanent treatment option."
Tucson's Southern Arizona VA Healthcare System is considered one of the better ones. Today, the local VA is receiving a "performance excellence" award, just the latest of several honors it has received.
Roethle acknowledges he hasn't always been the best patient. During his three years at Walter Reed Medical Center in Maryland, he missed appointments sometimes. Now he's a bit lax about accepting VA treatment for his post-traumatic stress disorder, which also keeps him from moving forward.
"There's visible scars, but my mind also is scarred in a way that makes stuff difficult," he said quietly.
When a veteran like Roethle works up the courage to ask the VA to help him move forward, the VA ought to leap to it. If removing one obstacle only gives him the chance to confront the next one, so be it.
Contact columnist Tim Steller at firstname.lastname@example.org or 807-8427. On Twitter: @senyorreporter