Thomas W. Stoddert, US Army Retired, is right on every point and I applaud his courage to write a very exacting letter.  My tenure at Madigan Army Medical Center as the NCOIC of the Department of Medicine made me aware of mismanaged policies and management issues.  I worked with a wonderful staff of professionals and paraprofessionals who conducted themselves very appropriately and courteously, with politeness, knowledge, experience and timeliness.  However, all of our efforts were frequently clouded by the frustrations of personnel shortages, ancillary demands of personnel, frustrations secondary to multi-echelon mismanagement issues, and numerous other problems.

The Department of Medicine includes 13 separate sections, clinics, and sub-departments, each with specific medical missions comprised of doctors, PA's, nurses, medical technicians, and support personnel, including military and civilian staff.  Some clinics have direct access through central appointments while many others required a referral from the primary care provider.  All too often miscommunication between various services and ancillary personnel would complicate scheduling problems.  An appropriate example: Patient "A" might be scheduled to see doctor "Z" in a specific clinic, but Dr. Z had to cancel all appointments because he/she had to support another military mission somewhere else on post or deploy to another country.

Frequently, the appointment schedule confusion was not because of medical staffing, but due to Central Appointments or Tri-Care issues for providing less than appropriate information to the patient and the provider.  Regardless who was at fault, the senior enlisted member of each clinic, section or department always tried to resolve relevant matters at the lowest level before involving the members of the Patient Representative Office and Patient Affairs Office. 

As the NCOIC or the department, I coordinated with the Patient Representative Office and Patient Affairs Office and designed placard's which identified the OIC and NCOIC of each clinic, section and department with a current photograph and a customer service statement bent on resolving problems or complaints at the lowest level.  The commanding general at the time accepted the design and ordered that it be implemented throughout the hospital.  The implementation was done in 2000 and I hope it is still in place. I am confident that the NCO's and OIC's at each level are fully capable of resolving conflicts and complaints, providing they get support from the senior management of medical care at Madigan Army Medical Center.

On the other hand, I and many others have all too often witnessed many frustrated and dissatisfied patients and family members who lack the patience to allow the system to work as it is designed.  These patients complain every chance they get and they become very loud and ugly about it, making treats, breaching the chain of command, and writing letters and memos to anyone who will listen.  The members of the Patient Representative Office and Patient Affairs Office do everything possible to bring providers and patients to a equitable arrangement, resolve appointment conflicts and ultimately bend-over-backwards.  Still, the patient complains and will ultimately use the same tactic every time they feel the need, regardless of how well or how often they have been treated with the same professional level of care that all patients and family members are given.

I am not blind and I do not wear rose colored glasses.  I know there are problems with the management of care at Madigan Army Medical Center and other military medical facilities.  However, there is no single mission in the military service that is as resource intensive as the medical mission on a daily basis.  Then the medical facilities must comply with and satisfy military and civilian laws, protocols, standards, inspections, and funding agencies.  All of this while still supporting the military missions of deployments, training, education, reassignments, and command emphasis issues. 

So, yes, a problem exists, but it will take the collective initiative of the soldier's at each facility to make the improvements, with the support of the Army Medical Corp senior management and mass influence of money and personnel.

Alan B. Candia
U.S. Army (Ret.)   

Reader's Response Below
Thank you for your courage to tell it like it is!   The General is a good person but what can one person do?   Do you know who the members of her so-called command group are?   The Deputy Commander for Administration is ineffective, disinterested, weak and lame.   The Deputy Commander for Clinical Services is pretty smart but he is a poor leader, has no clue what his subordinates are supposed to do and he is leaving in a few weeks.   The Deputy Commander for Nursing is also lame and she is about to retire.   The Hospital Sergeant Major is also about to retire!    In addition to the problems you described, there are many others.   For example, I wish someone would approach Mr. and Ms. Horrell  and ask them what they know about nepotism and the merit system!   Madigan is a wonderful institution and has many great people but the fat, ineffective and overstaffed upper management needs to replaced and realigned now!  

Husband of a very concerned member of the Madigan Team  
I am rated 100% unemployability. My ratings are as follows.
30% for chlorache from Agent Orange exposure
30% for PTSD
40% for diabetes
It also says on my award letter, "No Future Exams."
My question is do you think they can re-examine me in the future and take away my benefits?
Thank You,
Bob Clark

Bob, Thanks for writing in to the "Veteran's Voice."

The VA can require a future exam at any time  if they feel there may be an issue of fraud or if a   gross mistake was made. But generally in cases like yours where they say no future exams,
they mean just that.

The VA can, if they have sufficient reason, propose to lower a rating percentage only if they        believe you may have gotten better or something has happened and they have to review
certain awards. This can happen as an example as the result of a mandate from Congress. The   issue of PTSD, was getting a lot of nasty attention by the national press and the VA went back   and started looking at this issue when it was awarded to  non-combat veterans.

However, the general rules are basically after five years, service connection can not rescinded,   but the rating percentage can be lowered; after ten years there can be no reduction in the rating percentage or severance of a service connected condition unless there was fraud.

All this to say, if you got a fair rating and they have said no future exams, just run with it. The  VA does not like to hassle vets when they do not need to.

Now, the down side, FYI. The VA does  routinely check up to see if you are working and so does    the Social Security Administration. They both allow you some grace in making some extra income because they know staying home vegetating is harmful. However, 100% unemployability is just that and both agencies frown on a veteran receiving benefits because they can not work and then go out and work full time. So check carefully and see what they allow you. I was told recently that these rules may have changed not too long ago.

Assuming you are not working you may want to consider doing volunteer work in the community and/or working with veterans. Here is where the fun starts. The VA, through the education department,  will sometimes purchase items to make a veteran's life more meaningful. In my case they helped me purchase computer equipment so that I can write like I am now and aid other veterans. Now that there is a war on, there are many opportunities to use your talents and experiences for others, particularly other vets.

So good luck and welcome home.
Thom Stoddert
The Veterans Voice
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  Finding Supporting Evidence

Many, many times I hear from veterans saying they were turned down for such-n-such VA claim because the VA did not believe them.. Don’t be upset with the VA if you did not provide the needed evidence. It’s not like your fellow vets would ever lie to the VA with unsubstantiated stories. You, yes you, have to sit down and evaluate the evidence that you are submiting. Ask yourself, “Would this make sense to someone with normal intelligence?
I once saw a copy of a unit yearbook with some photos circled sent in by a veteran to support his claim. The vet then declared that the VA now has all the evidence needed to give him a favorable decision. These were supposed to be the actual pictures of the people who beat the “snot” out of him; leaving him with a permanent case of PTSD. In his mind that was all the evidence needed. In reality the VA only had a copy of a unit’s yearbook. There were no other documents to support, collaborate, or even suggest his story of being assaulted in the service was true.  Do you see where I am going with this? The pictures proved nothing and the claimant had no other supporting evidence.

In order to claim compensation from the government, via the VA, for a chronic medical condition or other benefits, there must be evidence linking the condition (benefit) to your military service. The more time that has passed since the claimed event happened to you, the harder it will be to show the link  through the usual means. Often you will have to rely on “witness-statements” also called “buddy-letters.” Getting a statement from a witness describing what happened to you is easy if you know where they are now and real hard if you don’t..

  To illustrate this point here’s a worst-case scenario: Let’s say that in 1964 a vet was in a traffic accident on the autobahn while in a convoy in Germany, mangling his back. He was rough and tough so he only went on sick call once. He has no service medical records showing treatment and most of the bases in Germany are now closed. The soldiers he served with are long gone and many have since passed away. But he should not give up hope yet, there are many excellent resources to find people you were stationed with and they can provide excellent first hand evidence for you, may be lots of it. membership allows a veteran to go on-line and search for his or her old units and any former members of that unit. Thus former colleagues can be found and requests for witness statements can be made.  In some cases a name is not recognized but the service time is right as to when the accident occurred. Someone might remember it and some details.

Viet Nam was a long time ago, but every casualty is listed on the memorial web site, along with some basic dates and information. Often former mutual friends will leave a memorial statement and details. Thus your former comrades can be located.

Old military records are a wealth of information. Often the military cut “block orders.” So they listed dozens of soldiers, with their SSA number and/or the home-of-address. Armed with this information and a little help from the local sympathetic Social Security office, an old friend can be found. Social Security numbers usually begin with two or three digits that are pretty specific for a state. As an example people whose numbers begin with zero are usually from New England.
The Navy has a very good system of having a web page for almost every ship, along with lists of former crews. I have often located the web-master for these ships and was given pretty good information to help a veteran with his claim. The Army also has many web sites for former and present units. 

The Marines almost always have a reunion somewhere at one time or another for every unit, especially the combat units. They provide a walking library of evidence to help you. 

Don’t rule out sources from other places or units. Sometimes something happens and it is big enough that everyone hears about it. I met a few cannon-cockers a few years ago that were on the next Fire Support Base over from FSB Ripcord. They rememberd very clearly the fire support missions from FSB Barbara for Ripcord where I was at. I was then able to write a statement for one of them and also locate the former battery commander for a statement.

Caution here: the VA once got a claim from a vet for PTSD. To support his claim he listed the names of several casualties that he claimed he witnessed being killed. When the VA went back to verify it all, they found that the veteran was assigned to a unit that was in a completely different province and unit than the causalities. Because of the obvious fraud, any future claims from him will always be looked at very closely.
Evidence must be believable and conclusive to the ordinary reasonable person and it does not have to always be buddy statements. Rule of thumb: the weaker the evidence, the more you will need to collaborate. Don’t rely on the VA’s fifty-fifty rule or the “likely as, as not” concept. Two: have a third disinterested party revue the evidence for you. Assumptions you may make carry very little weight with the VA. That is just the way life is, so the extra attention to evidence development is well worth it in the long run.
Thom Stoddert, former VA Rating Specialist
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