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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How the VA Does Not Work
by Thom Stoddert

If this last month is any guideline for me, I will have to believe most veterans have a lot of misunderstanding about how the VA functions and thus are hampered in dealing with the VA for both claims and getting treatment.

  For instance, I have heard about several vets who went to a VA medical facility for treatment. Sometimes a helpful staff member would suggest that the veteran make a claim, or in other cases make sure the veteran knows that the injury or illness is able to be service connected. In either situation the veteran waits

and waits and waits. Then he or she finally calls the 1-800 phone line and speaks to a VA employee and is told there is no record anywhere of that claim ever being made. Now it has been a year or more and the vet is very angry believing the VA has lost his claim. He/she blows, they are frustrated and they let everyone know how the VA screwed them. In reality, all of this could have been avoided; if they had used just a little bit of common sense. 

Generally, a claim for benefits or an increase in benefits specifically must be made by the veteran with his or her signature. A visit to a medical facility should not be considered by a veteran to be claim even if a staff member/employee suggests there may be one. So get the appropriate paperwork done and then sign it. 

However, again generally speaking, the exception to this is when a veteran spends 21 days or more in the hospital for an already service connected issue. The VA hospital is supposed to notify the Regional Office that the veteran was hospitalized for an excess of 20 days for treatment of a condition that is service connected. In this case a Rating Decision should be given. In reality, write the Regional Office, regardless, and tell them you were in the hospital (civilian, military, or VA) and get the temporary increase in benefits. Try not to assume anything. 

Medical treatment at a VA treatment facility does not confer the status of “service connection”  on a medical problem. “Service connection” is the legal status conferred on a claim and can only be made by  a Regional Office and only by a rating decision. 

  Often vets get the VA medical benefits mixed up with the “Tri-Care” program. The truth is that Tri-Care was the Clinton Administration’s attempt at health care reform that resulted in the feds breaking a long standing promise to military retirees. Tri-Care is an integration of for profit civilian health care corporations into the military health care programs. It has very little to do with 99.9% of veterans or their care. It does affect active duty and military retirees. 

Over and over again I have pointed out that evidence is the foundation of all benefits awarded to veterans. There must be evidence of a chronic medical issue being linked to a veteran’s active military service. Once medical problems have been service connected, other benefits, such as education, can be awarded. 

Evidence most frequently comes from military service records, especially medical records. When these are missing evidence can come from other sources such as witnesses, photos, news stories, and old letters to home. The source of the evidence is less important than the credibility of it. A statement from your wife, who stands to benefit financially with a favorable decision is not as credible as your former supervisor in the service. Such was the case of a veteran whose wife signed a document attesting his tinnitus was so bad she could hear the ringing in his ears even across the house in the kitchen. In the mean time a disinterested third party once described the working conditions at a particular flight hanger so well that the VA was able to award service connection for hearing loss to a sailor with a clerical job who would not have normally been exposed to excessive noise. 

When writing to the VA, keep remarks short, sweet, and to the point. Adding drama to any correspondence only lowers your credibility. If there are implausible aspects of your story, explain them in simple terms and then get some sort of collaborative evidence to submit at the same time. 

Be careful where you get your advice. I have seen too many vets upset with the VA because they did not do what their buddy said the VA should have done. Sounds stupid, but I met a guy who refused to listen to me,  a former VA Rating Specialist, when I told him that the VA does not automatically grant a 100% Rating Percentage for PTSD even to veterans with a Combat Infantry Badge. He was adamant because his buddy told him that is what the VA is supposed to do. The VA operates by the laws Congress gives them and then manages them.

  This brings us to one final and very important point; read and re-read all that the VA sends you. Determine what is appropriate for your case. The VA, which sometimes is over managed by the courts, will send out letters that are most often very general and non specific, letters asking for marriage certificates or DD-214s when you know that you already gave them. When you get a letter with multiple fonts and disconnected paragraphs then you got one of these “VCAA” letters. They are far less important than any Rating Decision letters. The decision letters need to be read very carefully. They give you a lot of information most people don’t even read. However they are supposed to give you information to overcome any denial of benefits and/or how to increase benefits. 

Thom Stoddert, former VA Rating Specialist
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