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
Individual Unemployability Basics

MA long time, and close Army buddy came to me for assistance with his  VA claim for Individual Unemployability (called “I/U” for short). He had spent years dealing with  attacks of Menieres disease.

  It was severe enough that the VA granted him 60% for this disease shortly after leaving the Army. He continued to work for several years  until the stress of his job and severity of attacks became impossible to work around. He then quit his civilian position with the Army and applied to the VA for I/U. That is when  the problems began.

  Individual Unemployability, when awarded,  pays the veteran at the 100% rate regardless of the actual rating percentage. In other words if a veteran is rated at 60% or 70% for medical conditions that the VA has granted the status of service connection; the vet can be paid at the higher 100% level if the medical evidence shows that he or she is made incapable of work by the service connected issues.

  The basic rule for eligibility of this benefit is that the veteran must be rated, awarded service connection, for a single medical issue at 60%; or be rated at 70% for several issues and one of them must be at least 40%. This is called the 60/40 rule. This is the first half of the eligibility requirements. The next  is a little more complicated.

  The veteran must show that he can not work because of his or her service connected medical issues. Though a veteran may have a rating percentage greater than the 60/40 rule; there must be evidence showing that the service related medical issue(s) really does keep the veteran from working and will most likely prevent a return to gainful employment.

  Here is where a lot of vets get turned around.  There are several pitfalls. First; you must be unable to work specifically because of a Service Connected medical issue(s) and will most likely not be able to return to

reasonable employment. As an example; I know of veterans who have been diagnosed with medical condition “B” and no way can  they work and they also are rated at 70% for medical condition “A”. They worked many years at the 70% level and now they can not work. It is the non-service connected issue that makes them unable to work, not the service connected medical issue. Most likely in cases like this a vet will not be granted I/U nor be paid at the 100%.

  Veterans get into trouble here all because of the needed evidence. First, the veteran must not be working. In other words a veteran can not be working, then be awarded I/U and quit at a later date. One of the reasons for this is that a vet  awarded this benefit might continue to work. So the VA has the rule; you can not be employed when you apply for this benefit. In reality it amounts to the fact that you can not be working when they verify your employment status.

  Second; the medical evidence must show the veteran is
not able to work because of the service connected issue or
issues. Often veterans who have retired from the work force
can apply for this benefit if the medical records show that

their service connected conditions would keep them from working if they wanted to. Age is not considered when determining whether the VA grants this award. Therefore a vet who is 67 years old, whose service connected arthritis is so severe he could not work if he wanted to  would qualify.

On the other hand if a veteran’s medical records show that it is heart disease,  not arthritis that keeps him from working, regardless of age, it is a No-Go. Another scenario that back fires in a veteran’s face is when he or she is not working, meets the 60/40 rule, yet employment is still possible. An example that I saw often was that of a very well educated veteran with a service connected issue that would keep him or her unemployable if they were in construction, but not as an accountant with a desk job.

The scenario goes like this: a vet has the education and skills that would provide many work opportunities such as in the medical field.  The veteran gets an increase in the rating percentage that meets the 60/40 rule. So they quit their job and apply for I/U and get refused. The reasoning behind the VA decision is that the medical evidence does show the veteran not being able to work in a physically and emotionally demanding Trauma Room, but there are many opportunities for the vet to take a desk job which is well within the vets ability. Each claim is supposed to be looked at on a case by case basis.

The VA in determining whether to grant Individual Unemployability must also consider the veteran’s age. A veteran, despite all the laws, does have a harder time finding new employment that is within their level of impairment as they get older.  A young vet will generally have less difficulty than a 60 year old, especially with further education.

Education is a factor for the VA when considering the issue for I/U. Veterans with higher levels of education generally have more opportunities to provide themselves with a good income despite their impairment(s). This is a simple fact of life in this country.

The VA is also required to  take into consideration the local economy and recognize its impact on veterans. A downturn in the economy does present fewer opportunities for a veteran with medical impairments.
  A veteran can still apply for special consideration. This is possible when the medical evidence clearly shows that a service connected medical issue(s) does keep the vet from being employed, even when the 60/40 rule is not met.

  Getting back to my friend; what happened to him that made his claim for I/U so hard? The VA wanted verification that the real reason he resigned from his  position was a medical problem that was related to his military time. So they sent a form to his former employer, Madigan Army Medical Center, Fort Lewis. The VA’s request for verification of why he left his job was ignored by them, twice.

  But the battle for evidence was not over. My buddy got several letters from his former colleagues who provided statements attesting to the reason why he left work. The VA in Seattle is fully aware how corrupt the system is at Madigan. So with the statements and his medical records my friend is sure to get a favorable decision from the VA.

Thom Stoddert, former VA Rating Specialist
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