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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When I told the CEO of a large corporation that my military service did not come with a large marketing bulls-eye on my back for his or others greed, I meant it. But let’s face the truth, as long as there are ethically challenged business-people, there will be deceitfulness and soldiers along with veterans will be targets. Regardless how old we are, we will have to be vigilant.

Scheme #1; Thank You for Your GI Bill Money, Here is Your Useless Degree:

  About the same time Congress increased the educational benefits for veterans, commercial for profit schools with insignificant or no accreditation have exploded in number across this country. Through the use of a large,  aggressive recruiting force and lots of verbal promises, they focus primarily on veterans while their schools are still new, with no stable or proven teaching staff, no academic history, or reputable accreditations.

  The quality of a school, any school, is measured by the quality of its instructors. “What academic achievements does the staff have?” should be one of the first questions asked. The next concern that should be investigated is the achievements of the graduates. If the graduates can’t find jobs after leaving school, it was all a waste of time and money. Lastly, and most importantly, what are the accreditations the school has earned? Most professional careers demand that the school granting a degree in their field of study have a certain accreditation(s) or its diploma is worth nothing and thus no future employment.

  Look at Sonora McMath’s website :   McMath, a recently retired Army NCO was taken to the cleaners by Argosy University in Seattle. She was promised that a needed accreditation for her diploma would be granted in time for graduation. Instead her program of study was cancelled. She later found out this was a common experience at other commercial schools. She lost her GI Bill money.   

  National Public Radio (NPR) has done thorough investigative reporting on this issue, study their site The last thing a veteran needs to know is that they wasted all of their government educational benefits they earned in service to a greedy diploma mill and they have now missed a major opportunity to advance in life. Stay with the established and time tested traditional schools that have more at stake than your money. Even the VA’s website has warnings posted.

  Scheme #2: We Love Veterans and We Will Educate You on VA Benefits, Just Sign Here:

  In almost every town and city across this country are advertisements for free seminars explaining the VA’s benefits of Pension and Aid & Attendance.  They even promise to make you eligible for these benefits if you do not qualify. They also seem to make many other promises that suggest they have a special relationship with the VA that will speed things up and will always be 100% successful for you.
  They can get you qualified, but at great risk and expense. First, if you are qualified because of financial needs for the VA’s Pension (available to veterans or their widows with wartime service) you do not need these business-people, just contact the VA and/or accredited state or federal service organization yourself; it’s free and ethical. Aid & Attendance is just a higher level/payment of the same benefit.

However, these so-called veterans’ advocates will assist those not eligible by selling various insurances and annuities, thus dropping the person’s financial worth. The advocates call this repositioning; the VA calls it hiding financial worth. Though there are no laws against this practice for the advocate/sales rep., the veteran does commit fraud against the US government for adjusting their financial status  to become eligible for a funded program that was not intended for them. Further jeopardy is incurred because by hiding assets from the VA, the veteran, with the help of the unscrupulous business advocate, most likely endangered their Medicare benefits.   

  Most often these programs put on by patriotic sounding organizations are complicit with adult living centers or retirement communities. As Bill Milford  (a pseudonym for his protection), an accredited national service officer, found out that retirement facilities use these programs as an enticement to bring in elderly veterans or widows to live. He also found out that many, like the Capital Place Adult Retirement community of Olympia, Washington jealously guards and protects these unethical and dangerous programs.

The March issue of the Thurston-Mason Senior News,  published an article by Richard L. Sayre, a Spokane, Washington attorney. In the article Mr. Sayre clearly describes the dangers and the intrigue committed by these veterans’ advocates. He further underlines all the findings of Bill Milford during his work with elderly veterans. This same information was given to Capital Place by Milford and they chose to ignore it.
Scheme #3; Help Me Help Veterans, After I Buy My Cadillac:
There is the report of a non-profit business out of California who solicit donations so they can provide benefits and services to veterans in hospitals. However, this company’s dollar to benefit ratio is about 96/ 4. In other words, for every $100 donated only four dollars reaches the veteran. The president and his wife are on the board of directors in salaried positions of over $200K each. The veteran gets a handcrafted gift worth less than a dollar.
  There is an operation on the East Coast, who  put people on the streets collecting for homeless veterans. The person on the street is wearing a piece of uniform he never wore legitimately, and gets to keep a percentage of whatever he collects, and gives the rest to who ever gave him the camouflage pants. Watch it all on Google some night when the TV is boring.
  My question here is, why not check for yourself and see what charities have the best ratio of donations to income? You can visit and see how your charitable dollars are being spent.
Thom Stoddert, former VA Rating Specialist
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