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
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  Across this country veterans are uniting and fighting back against unethical business practices being enacted against them by various business schemes. Grass-root organizations are being built up with networks of veterans; elder advocates - such as AARP; and several state and federal agencies joining in the effort. The plan is to expose these businesses, share information to all other concerned parties, and get legislation passed.

  The problem started when lawyers, financial planners, and so-called veteran advocates were giving seminars, calling vets on the phone, and even speaking at various functions. They claim to help veterans and their widows take advantage of the VA’s Pension program and/or Aid & Attendance benefits by selling them their financial products. Unfortunately, after that the veteran or the widow are on their own in the future and in trouble with VA and Medicare while the so-called advocates still have their money and large commissions.

  “Pretty much every Vet who I’ve met after being entangled in this is mortified when they realize what was going on.  They all were told it was legal, sanctioned by VA and the advisor was ‘licensed’ by the VA to bring them such proposals ….” As Dick Sayre, a highly respected elder law attorney, from Spokane, WA, described in an email, “You are now in the worst possible of all worlds. You have Aid and Attendance, but it is not enough to pay for your care. You need Medicaid, and but for the transfer to access Aid and Attendance, you likely could have qualified, but now you cannot. The cost of care for you now is not $2,000 per month. It is $9,000 per month, and you cannot access your money, nor transfer it into exempt status to qualify for Medicaid. To get Aid and Attendance, you’ve guaranteed that you and your family will descend into poverty, all the while the nice salesperson made a healthy profit from talking you into this strategy.”

  To illustrate this even more in a signed affidavit collected by Bill Milford (pseudonym), an accredited Service Officer with the Veterans of Foreign Wars, in Fife, WA, shared this from Richard and Kathleen of Normandy Park, WA, “At the last meeting we met with Mahalla (Mary Mahalla-Murphy of the Veteran’s Assistance Association, Seattle) and their attorney Tracy Wall. Mahalla asked us for a check for $25,000 for an irrevocable trust and we said we don’t have that much in our checking account. Mahalla got huffy and said to the attorney, “Well it looks like we are not going to get the check tonight so let’s go.” Then the attorney asked us for $2,000 for her services, and that was a “break” she was giving us. Richard asked her what the $2,000 was for and she said, “You never know what the government will want.”

In Utah, The Salt Lake Tribune reported on June 6, 2012, “… (Terry) Schow, executive director of the Utah Department of Veteran Affairs, collected the stories of seven exploited veterans and submitted them at a Wednesday hearing of the Senate Special Committee on Aging.

From Alexandria, VA, came a story on Jun 06, 2012 (BUSINESS WIRE) -- The Assisted Living Federation of America (ALFA) today offered a statement for the record to the U.S. Senate Special Committee on Aging, which is holding a hearing Wednesday afternoon into the exploitation of seniors who apply for veterans pension benefits administered by the U.S. Department of Veterans Affairs (VA). On Wednesday morning, the Government Accountability Office (GAO) issued a report outlining problems with the VA pension program that allow for it to become a marketing tool to sell inappropriate financial instruments to elderly veterans.
The initial investigations that took place last spring in Washington D.C. were kept under wraps for months. As information was gathered by various state Attorney Generals, Sen. Wyden of Oregon legislative staff, the General Accounting Office, and others, in preparation for the hearings, concern was for the powerful and well financed interests being tipped off. The American Association of Wartime Veterans, probably the largest of the so-called advocacy groups is well staffed with legal advice.

  During one discussion with Bill Milford and other members of the Seattle area Pension/Aid&Attendance Project committee, they kept stressing that if only more veterans would come forward and give their stories more pressure and exposure could be exerted to enact the needed legislation for protection from the unscrupulous.

  Lloyd Burroughs of the National Association of Black Veterans explained even if a veteran or widow was involved in one of these programs and now in trouble with the VA or Medicare, they and other accredited service organizations may be able to intervene on their behalf.

  If you believe that you have been hurt by a scheme similar to the above, please contact one of the federally charted service organizations near you, such as the Veteran of Foreign Wars, or your state Department of Veteran Affairs, and there is always the VA itself at 1-800 327- 1000. You can email Bill Milford at

Thom Stoddert, former VA Rating Specialist
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