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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Ordinary Info that Every One Screws Up!
By Thom Stoddert

There are no secret benefits or conspiracies at the VA and the scope of VA benefits goes beyond just getting a check each month for an injury incurred in the service. Further consideration should always be given to how a service connected medical condition affects other medical conditions, your family, your employment, and your education. The more you understand, the more effective you can be in dealing with the Dept. of Veteran Affairs. Don’t let others give you the information, get it yourself especially if there is money involved.

To begin with the Department of Veteran Affairs is made up of three different administrations. Just as the Department of Defense is made up of the Navy, the Army, and such; so the VA is made up of the Cemetery Administration, the Hospital Administration (VHA), and the Benefits Administration (VBA). Most of the benefits are provided through the various Regional Offices of the VBA located in each state. The local medical facilities or hospitals simply provide medical treatment. Trust me on this one- they don’t communicate very well to each other.

1)“Service-Connection” of a chronic injury or disease is granted when there is evidence of it having been caused by military service or arising during military service. Only a VA Regional Office can confer the legal status of “service connection.” A well meaning receptionist at the hospital cannot give this legal status, nor can a doctor treating you. Most of all, you cannot confer “service connection” on a medical issue even if you and the entire Army knows about it. Service connection can only be applied for by you and it can only be granted by a member of the Regional Office’s rating board.

2)Compensation is payable for a chronic medical injury or disease that was incurred in the service or as result of military service when it has been granted the status of service-connection. It is a complicated process that is accomplished through the use of the Rating Schedule, the VA law passed by congress over the years.

3)Secondary medical conditions that have been incurred because of a service-connected condition or a non-service connected condition made worse by a service-connected condition can also be granted service-connected status and compensation paid.

4)Service connected conditions are eligible for FREE VA hospital treatment regardless of the percentage granted to the condition.

5)The higher a percentage granted for service-connected conditions, may result in further benefits to the veteran and his family.

6)Consideration of a disability’s rating percentage is based on how it affects the whole person in their social and occupational capacities.

Service connection and the subsequent compensation is weighed on the quality of the evidence. There must be evidence of a disease or injury having been incurred in service. There must be evidence of that condition existing now. There must be evidence that the present condition is linked to that injury or disease that was incurred in the military.

1)Evidence is usually seen in your service medical records, but statements from former NCOs, Officers, or witnesses can be accepted, especially if during a period of combat. Use the internet, it is full of good information that is easy to verify. You must also identify any after service medical evidence so that the VA can try to obtain them on your behalf.

2)Evidence must meet at least basic legal requirements of credibility. Tons of paper, repetitive copies of the same information or lack of it, and/or threats of going to a congressman will not guarantee a favorable decision. The evidence must be credible, complete, and accurate. In other words the evidence must connect the dots.

Additional benefits

There are many, many additional benefits that are available to veterans and their families. A few are listed here:

1)Additional compensation can sometimes be paid when service-connected disabilities reach certain levels of impairment. Special Monthly Compensation (SMC) will be paid when:
2)There is a loss of or loss of use of a paired organ such as a foot, leg, or eye,
3)A loss of bowel and bladder control due to a service-connected condition,
4)Multiple high percentages assigned to service connected conditions that are above 60%.
5)Educational benefits can be granted when;
a)The veteran has service-connected conditions that interfere with employment and rated greater than 20%.
b)The veteran is rated at 100% or evaluated Individually Unemployable, then family members can receive educational benefits.

6)Pensions for veterans and/or surviving spouse;
a)The surviving spouse can be given a pension, called D.I.C., if the veteran dies of a service connected condition or has been rated 100% for ten years prior to death.
b)The veteran or their widow can be given a pension if non-service connected medical conditions prevent employment, regardless of age, and if certain income levels are verified. But the veteran must have a least one day of service during a period of war.

7)Burial benefits can be paid at different levels depending on why the veteran passed away.

8)Health care benefits (free) are available at different levels for the veteran depending on the overall level of rating disability recognized.

9)Medical equipment and appliances for service-connected conditions can also be provided.

10)Insurance plans and various loans for homes, farms, and businesses are available.

Though not absolutely needed, having a good Veterans Service officer who is well trained can prove invaluable to developing the evidence needed for your claim. Veteran Service Officers can not be replaced by your own research and questions.
Any correspondence you receive from the VA must be read carefully and as many times as needed. If your claim has been denied, a separate letter called a Rating Decision will explain why it was denied and will indicate how the decision can be reversed.

Thom Stoddert, former VA Rating Specialist
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