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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Healing, Reunions
and Branson,MO

  Reunions have an undeserved reputation as a party of middle-aged men acting like twenty-year olds. However, Branson, Missouri disproved that idea.  Branson, the most veteran friendly community ever,  hosted our get together, forty years after we left Viet Nam, thus supporting a lot of healing and reinforcing old and new friendships. I think the dynamics  behind this  is important to all veterans, especially combat veterans.

  For many years after I left Nam and the combat, I thought about the whole experience; most of my feeling were on dark side. So when I got a call one evening from a former platoon sergeant inviting me to a reunion, I was taken back and rather excited. It quickly faded as I thought about it all.  Do I want to go and see these people again? Will they want to see me? Is this all going to re-inflame a lot of old, bad memories?

  I have been to several since then. I have learned much each time. I found out that almost every one of the other troopers had a lot of anxiety and trepidation going for the first time. In every case they were glad they ignored their fears and did attend. Old antagonisms were gone and now became a source of laughter. Friendships, fostered years ago, were deepened and new relationships formed. More and more brought their wives and family to each of the subsequent gatherings.

Thus a new dimension has developed. The two guys, who somewhat mentored me when I got to Nam, have married wonderful women, who themselves, have become very good friends. Over the years we have lost men, and now their widows are welcomed, even though the trooper passed away years before the first reunion was ever held. They have become part of our family, enriching us.
The underlying theme has been, “what we were then and what we are now.” We used the reunions to teach and explain to each other and our families what we went through. We could now confide to each other what we could not even admit to ourselves then. It was freeing and exhilarating; and now we were sharing this all with our family, those we loved the most. 

As one example; Don from Arizona, one of the guys I got to know for the first time this summer because he rotated in, the same month I left Nam. (Remember Viet Nam did not have unit rotations, but individual replacements.) Don confided to me of the bitterness he had after Viet Nam and now the lack of ease he feels when thanked for his military service.    This hit home for me, as I dislike it when a stranger comes up to me as a veteran and starts thanking me for my service. I could not share it forty years ago; why now? I never shared this with anybody for fear of sounding like a bitter old man. But I was not alone; many others felt this way and shared it.

  But what does all of this have to do with the Stone Castle Inn and Conference Center, Branson, Missouri? Much! In Branson, veterans are welcomed. You do, in truth, feel welcomed and safe.   Even further; David and Deborah Hartman, managers of the Stone Castle, truly worked hard to provide for our group as well as the other military units that met. Not an easy task with all the requests and needs that were placed on them.

After the reunion was over I was chatting with Deborah  making a plug for them in the next article of the “The Veterans Voice”. She said that would be nice, but for me to remember, the focus is always on the veteran and getting the healing of meeting together once again. She refocused me on the real value of reunions, officers, NCOs, soldiers, their families, and their loved ones being one and caring for each other by learning, sharing, and laughing. 

Thom Stoddert, former VA Rating Specialist
Bio Here

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