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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Stoddert Assignment Berlin
Aid and Attendance, Pension, Without Strings Attached

By Thom Stoddert

            Since I wrote the articles on scams against veterans, I have become a target from all across this country from financial planners trying to justify their ambitions with patriotism; corporations defending their greed with vague threats and deception; and businesses wanting endorsements for their services. To them I say, “ Don’t tell me about your patriotism and your business till your neck has been on the line for this country.”

  Recently, I wrote to two businessmen and told them that they are not really doing veterans any favors by holding seminars announcing the VA’s so-called little known benefit of Pension and Aid/Attendance. I know I rained on their parade and they got a reply that they did not expect. However, I, and many other vets do not feel they are truly doing any good with strings being attached.

  First of all, we probably have all seen those advertisements for seminars informing veterans about little known benefits and since theses folks are so patriotic they will tell veterans and widows all about those benefits and even help them qualify if they are not eligible.

  The fact is the VA has dozens of benefits from education to small business programs. The VA is limited in time and resources to find ways to put out all the information on all the benefits; so they focus on the main ones, education, home loans, and compensation. Therefore, it is up to you to ask around. That means going to a reputable source that has no financial interests, getting on the Internet, and/or asking friends.

  Pension is a program that the VA has for war time vets/widows keeping them from being below the national poverty level. Pension is one of several entry programs that can provide higher paying benefits such as House-Bound and Aid/Attendance. It is intended to provide financial relief in time of need when the veteran or widow is not eligible for any for service connected rating percentages or DIC.

  The eligibility requirements for a pension are simple:  be a war time vet or a widow of a vet whosefinancial worth is below the poverty level. If you are under 65, you must be so disabled from non-service connected medical conditions to be unable to work. If over 65, regardless of health, you must be under the poverty level set by Congress. The VA will pay whatever amount needed to bring you up to the poverty level. In some rare cases the VA will provide Pension instead of compensation for a service connected condition. This is when the veteran is qualified for Pension and it will provide more than the service connected medical issues will.

  There is no free meal ticket here; the veteran or widow is qualified or they are not. Many businesses say they will help you qualify, but can place the veteran or widow at risk with not only with the VA, but with the IRS and Social Security Administration. 

  What these businesses do is to sell certain financial products that make the veteran appear financially stable one day and impoverished the next. In others words they hide or reposition the veterans’ or widows’ assets. It appears to be a tempting offer, but what the IRS or SSA may define as assets are different than the VA’s definition and that is where the trouble begins. Further, the VA is in contact with the other agencies and periodically check on the beneficiary later in life and benefits can be sometimes be lost or denied.

  After the pension, compensation and DIC is where the Aid and Attendance programs or payment levels starts up. Thus a higher level of payment can be made for Pension when there is a need shown for higher level of skilled medical care. This is why many adult living centers host the free seminars. A financial planner, or such, points to the benefits and to the assisted living facility, who in return hosts the seminar. These are the most legitimate ones, if you can call them that.

  The truth is, higher payments made at the level of Aid/Attendance can be reached not only by being in receipt of Pension, but also when a widow is in receipt of Dependants Indemnity Compensation (DIC) and when the veteran has the need shown for higher medical skilled care for a service connected condition(s). But before that, the VA recipient may be eligible for House-Bound level of payments when their medical issues keep them at home unable to leave unassisted. So avoid the patriotism, it’s still a for profit business.

  Often there is deceit and claims “misfiled” by unscrupulous patriots and admirers of veterans. Pension and Aid/Attendance are the only VA benefits that can benefit them directly or indirectly; so they don’t discuss the other VA programs. Often the veteran/widow is better served by a claim for compensation or DIC. However these national and local businesses will never go there and really fully advocate for the veteran or widow.  So find a real veterans’ advocate.

  None of us spent all night on some duty in the rain without sleep, or ate some food that would gag a maggot, so we could be the target of a marketing program with a patriotic name. Learn the facts about what the VA has to offer.  New programs are coming out all the time. Financial planning starts as soon as possible with the whole family working together with individual experts.

Thom Stoddert, former VA Rating Specialist
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