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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Don't Be Stupid, Get the Truth
Thom Stoddert

Veterans keep making stupid mistakes when dealing with the VA while a simple understanding of the VA  would keep the frustration levels way down from the start. Understanding the basics of how the VA worksalso goes a long way in insuring the benefits sought will be successfully awarded.

Recently I was at my Viet Nam re-union when our commander asked me to talk to a fellow trooper. After talking to the veteran for a few moments, I realized he was very confused about the VA. It seems that a VA hospital employee told him that his Combat Infantry Badge would guarantee him a 100% rating evaluation for PTSD. No matter what we said to him, we could not get through to him that this was not so, thus elevating his frustration level toward the VA and at the re-union. Where did he go wrong?

First of all the vet did not realize that the VA is made up of several departments just like with the Department of Defense with the Army, Navy and Air Force. Often the different departments of VA do not communicate well. There is the Cemetery Dept., it handles burial benefits. Then there is the Hospital Administration that provides medical benefits.  Finally, there is the Veteran’s Benefits Administration (VBA). This department is the Regional Office in each state that determines what benefits the other departments can give to a veteran. The VBA determines whether the applicant is even eligible for medical care, burial benefits, or compensation. It is the VBA, through the various Regional Offices, that a veteran applies to for service connection of a medical condition, which allows the hospital to treat free. The VBA can make the determination that a person who  received a less than honorable discharge is not eligible for any VA benefits or medical treatment. Therefore, it is the federal laws under which the VBA operates that a veteran must comply with in order to receive benefits. The Veteran’s Hospital Administration has its federal laws that it works under in order to provide medical services.

All of this just to say a hospital employee, no mater how well intentioned, will rarely understand the workings of the Regional Office. The veteran at the re-union was given bad information.

Secondly, a combat medal has no effect on the rating percentage that is awarded for any medical condition.  I keep hearing from veterans, “I have a Combat Infantry Badge, they should have given me a 100% for PTSD,” or I hear, “I have two campaign ribbons from Viet Nam, why did they deny me service connection for PTSD”? The answer is simple, campaign ribbons are not awards for direct participation in combat. Campaign ribbons signify that the vet was attached to a unit that was in combat or supported combat operations. It does not signify the individual was in combat. A combat medal such as the Combat Infantry Medal or the Combat Action Ribbon does identify the individual as having been in combat. These medals also meet the VA’s first requirement for service connection of PTSD, that a verified in-service stressor be identified. In other words, combat medals provide evidence of a stressor that led to PTSD and it was incurred in service, nothing more, and nothing less.

Finally, the veteran at my re-union had a very closed mind. It was like a steel block, nothing the commander or I told him would make a dent in what he believed was true. I have met many vets like that. They have been given wrong information, most often from a friend who is flat out wrong. Yet, because what they have been  told is more beneficial than the truth, they won’t give up the myth. The VA and VA laws are complex, so be willing to give up half truths for the real information. Stay away from “sh** house lawyers” and get the get info from the best source, the VA. Even  after working there for several years I still check with friends at the VA for accuracy.

Thom Stoddert, former VA Rating Specialist
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