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
"Fighting for Our Veterans-Supporting Our Troops"
  Proudly Serving All Branches & All Eras Since 1999
Mondo Times
When You Need A Service or Product, Please Remember Your Supporters!
Bookmark and Share
VA 101: The Basics
Know & Understand VA Benefits
A.O. My Perspective
VA Rating Schedule
Understanding Basic VA Benefits
Evidence Is Everything With the VA
Don't Be Stupid,                 Get the Truth
Veterans For Peace....???
Stoddert Assignment Berlin
The ABC’s of Individual Unemployability
It’s All About the Evidence

Almost every day I hear veterans say they were turned down for such-n-such claim, because the VA did not believe them. Don’t be upset with the VA if you did not provide the needed evidence. (It’s not like your fellow vets would ever lie to the VA with unsubstantiated stories.) You, yes you, have to sit down and evaluate the evidence that is being submitted. Ask yourself:  Will it make sense to anyone with normal intelligence? Why should you do this? It is your claim and no one will care more about it than you, so take complete responsibility for it.

  Contact a veterans’ service claims officer for help. There are Veterans of Foreign Wars, American Legion, AmVet meeting halls in every burg, village and/or city near you. Find one you feel comfortable with, but never forget you are your own best advocate.

  I once saw a copy of a unit yearbook with some photos circled sent in by a veteran to support his claim. The vet then declared that the VA now has all the evidence needed to give him a favorable decision. These were supposed to be the actual pictures of the people who beat the “snot” out of him; leaving him with a permanent case of PTSD. In his mind that was all the evidence needed. In reality, the VA only had a copy of a unit’s yearbook. There were no other documents such as medical records to support, collaborate, or even suggest his story of being assaulted in the service was true, nor did the veteran have records showing that he was being treated for PTSD. Do you see where I am going with this? The pictures proved nothing, and the claimant had no other supporting evidence.

  I often see where a claimant or family member describes in great detail what a wonderful human being the veteran is. They even describe how patriotic and how well the vet served his country. These statements do not make the veteran more eligible for a favorable decision from the VA, nor does it put pressure on the rater to grant benefits. This type of evidence does not allow the VA to pay compensation for a medical condition. When you really think about it, this is only subjective, or non-factual, evidence based on a person’s feelings. There must be evidence of a chronic medical condition existing and evidence that the military service was the cause or made it worse.

  Evidence must be factual - it must be objective. In other words, it is not based on feelings or beliefs. Many young vets are angry that they did not get a good decision from the VA for their claim for Traumatic Brain Injury (TBI). In almost every case that I have seen, they were denied benefits because the evidence does not support what they are claiming, or they do not have documented evidence that links the claimed injury to the service.

  What is recommended in cases like this? Lay statements. Several letters with the signatures of witnesses who will confirm the event is good evidence; as long as they do not contradict each other. These letters are even more effective if the writers send them in, independently of each other, directly to the Regional Office.

  If the veteran is no longer in contact with former members of his or her unit, use The membership allows a veteran to go on-line and search for his or her old units and any former members of that unit. Thus, former colleagues can be found and requests for witness statements can be made.  In some cases a name is not recognized, but the service time is right as to when the accident occurred. Someone might remember it and some details.

  Evidence must be believable and conclusive to the ordinary reasonable person, and it does not have to always be buddy statements, it can be almost anything. Rule of thumb: The weaker the evidence, the more you will need to collaborate. Don’t rely on the VA’s fifty-fifty rule, or the “likely as, as not” concept. Two: Have a third disinterested party revue the evidence for you, because assumptions you may make carry very little weight with the VA. That is just the way life is, so the extra attention to evidence development is well worth it. Lastly, do a little research on the medical issue, the VA’s regulations, or the related history of the issue.  Good Luck.

Thom Stoddert, former VA Rating Specialist
Bio Here

How the VA Does Not Work
No need to log in to add comments
Saudi Syndrome from a VA
Finding Supporting Evidence
Healing, Reunions and Branson, MO
The Rating Schedule and Special Monthly Compensation
Ordinary Info that Every One Screws Up!
Scams & VA Benefits       Part 1
Scams & VA Benefits       Part 2
Scams & VA Benefits       Part 3
VA Ratings Basics
VA Ratings for Hearing
VA Benefits Basics 10
Veteran’s Overcoming Common VA Errors
VA Math
s, DIC and Pension
gger than Most Realize
PTSD Coach
Hearing Loss compensation
Aid and Attendance, Pension, Without Strings Attached
I Hope This Upsets You!
Special Cases of Unemployability
Corruption At Madigan
An Informative War Memorial Torpedoed By Pettiness & Politics
Nigerian Banker's Corruption Surpassed by Army Hospitals
An Informative War Memorial Torpedoed By Pettiness & Politics