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
Tools For Healing-PTSD Coach

By Thom Stoddert

  It’s not often we see something new, exciting, and incredibly simple  that works come out of the VA. That is exactly what the VA's National Center for PTSD and the Department of Defense’s National Center for Telehealth and Technology have given Vets diagnosed with PTSD -a great tool for management. What is even more sophisticated about this is that it will be on your smart-phone and be where ever and whenever you need it.

  This free application called “PTSD Coach” is an app you can download to your  i-Phone via i-Tunes, and by the time this goes to press, programs/applications for the Android operating system’s smart phones will also have been made available to the vet, family, and public.

  When I first heard about PTSD Coach, from a veteran friend, I was skeptical till I checked it out. I even contacted the VA’s Mr. Craig Manning for more information, which he most graciously gave.  The more I learned, the more excited I became!

  I  lost my job as a VA Rating Specialist when I could no longer manage my PTSD symptoms; maybe with this tool, events would have been different for me with a better ending. Also consider this: many vets go to counseling for years, and most, just by human nature almost immediately forget  what they have learned. Now this may be a game changer.

  This application provides strategies that clinicians, VA counselors, veteran groups, and even “battle-buddies,” have traditionally used in supporting others with PTSD.  On the home page The application begins with education, what PTSD is and does. Then it moves on to self assessment, then a management plan(s) for help, finally directions in getting in to treatment with direct communication connections for crises support. All these sections are located on the buttons of each screen page.

  The self assessment portion is one very valuable tool that empowers and brings the user into managing their feelings and attitudes. Remember that life is 90% attitude toward the other 10% that is thrown at you. Having an idea what is going on inside oneself and having the tools to deal with it  hanging on to your belt or in your pocketbook doesn’t get any better. Though it is not intended to replace face to face counseling, it is sort of like having a Veterans’ Center in your pocket when you most likely will need it. 

  The management tool, or as they call it “an action,” is very dynamic and comprehensive. It addresses your symptoms and provides choices to counter act them. The scope of choices appears to be significant even using modalities not often seen.

  What I like the best is the overall flexibility that is built into this application, such as being able to choose which symptom management tools best suit you and your needs being offered to you in order of its success, or your choice. In other words you can mold this application to fit your needs; not a one size fits all type of program.

  Maybe the best evidence of  how good this working concept is shown by the number of downloads PTSD Coach and other similar apps have already gotten – well into the thousands. PTSD Coach is backed by two experienced agencies and a lot of PhD’s. On the down side, PTSD Coach, to my knowledge, doesn’t deal with the spiritual aspects as well as the Military Ministry’s, “The Combat Trauma Healing Manual, “ by Chris Adsit. But that is nothing new. Still I would not be here writing about PTSD Coach if I was not greatly impressed by it.

For more info call (802) 296-6300 or Google: PTSD Coach.

Thom Stoddert, former VA Rating Specialist
Bio Here

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