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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Evidence Is Everything With the VA
Thom Stoddert

When making a claim with the VA always keep in mind you must have evidence to support   your request. Over and over I hear from angry veterans “they denied my claim.” When in reality the vet is at fault for not providing reasonable evidence to support the claim.  I spend 90% of my time with veterans working entirely on this essential issue.

Once a veteran submitted a claim to the VA for service connection of PTSD subsequent to having been assaulted by his fellow service members, his claim was denied for several reasons:

There was no medical evidence in the vet’s service medical record (that the VA had obtained on   his behalf) of ever having been injured. The veteran did not provide any evidence of his own as instructed by his state’s Regional Office. A year or two later he submitted new evidence consisting of pages copied from a year book that had individual pictures high-lighted with fluorescent yellow. These pictures were accompanied by a statement from the vet saying these were his fellow service members who had assaulted him and now we had the evidence we needed to give him the favorable decision that he demanded, and I mean demanded. Can you see the weakness in all of this?

At this point you may be thinking each vet is not cookie cut and molded. Thus evidence comes in many forms focused on the needs of each veteran. So what evidence does the VA need?

The basic requirements for evidence that the Veteran’s Benefits Administration needs is fairly simple. Something happened on active duty and it is still causing you problems. Now there must be evidence linking your ailment to what happened on active duty. Evidence links both the present and the past.

For issues such as arthritis of the joints it’s pretty simple. You were inured in service and now there is traumatic arthritis. You identify to the VA that you were injured playing unit sports, etc. The VA then obtains your service medical records and finds that you were injured playing in a game. Your present doctor gives a history of complaints and diagnosis.

But what about when you get hurt and there are no records because you went to your good buddy the Medic. I have seen many vets get favorable decisions when they submitted good lay statements from people who witnessed the injury, or treated the injury. Former commanders, NCOs, medics, and/or several folks who witnessed the same thing are excellent sources of evidence. People who stand to benefit from any favorable decision are not usually considered good lay witnesses.

How do you locate former members of your unit? There are many easy ways that do not trespass any privacy laws. Go to and you will find links to some of my favorite sites for this. Go to your old unit and see if there is any one you remember or who remembers you. Establish contact and see if that person remembers the incident and will write a statement.

Do an internet search for your unit and repeat the above process. Most units do have some sort of reunion functions. Old letters to friends and family carry very valuable credible for proof.  I have also seen old newspapers do the trick for a deserving vet.

Sometimes there is no clear link between what you have and what happened in the service. This is when a written opinion of an expert explaining why your disease is linked to Agent Orange exposure in Viet Nam. This is just one example, but an expert opinion with a credible explanation usually works for all issues.

Frequently I have seen claims for PTSD denied for lack of a credible stressor event. This is when a lay statement from a former buddy comes in. Another example; a vet was in the artillery and as such would not receive a Combat Infantry Badge. Yet he was in frequent fire fights protecting  his firebase. The VA denied his claim for lack of proof of a verifiable stressor such as a combat award. But the vet provided details as to the time he was in the unit that was attacked. He provided time, places, details and the name of key personnel he served under. All of his information was verified through the various methods that VA has and granted him a favorable decision.

In almost all cases when a claim has been denied, it usually is the lack of good strong credible evidence. So that is where you start if you submit an appeal or a notice of disagreement. Plan your evidence carefully. 
Thom Stoddert, former VA Rating Specialist
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