Smart folks, including the good doctor, know that the appointment was patronage by Trumpster himself, master of patronage.
Who knows what the VA even is? One group does, smart people like the good doctor, and most other smart people, all of whom know he is basically unqualified, including the good doctor himself.
The great mass of little Browns who pay his salary have no clue, they are not even seeing this picture. Everyone, including the good doctor himself, knows this.
So why is he faking it in the picture? Why doesn't he just acknowledge the patronage appointment? Faking it makes him look mentally ill, delusional about who and what he is, like that Kushner kid.
This is a common problem with Swampsters, they often appear weirdly out of context as they fake it, like they suffer serious delusions. Jerry Brown avoids the problem, he tells he truth in riddles, and skips the delusions. Most of the other politicians out here, like Gavin, are simply blithering idiots.
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