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
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Saudi Syndrome from a VA Perspective
by Thom Stoddert
12 08
  When the troops started returning after Desert Storm there were a host of complaints made to  government agencies for various for symptoms of illness. There was much talk of Saudi Vets actually dying from unknown conditions marked by symptoms that doctors could not provide a diagnosis for. The VA did recognize there was a problem, but was unsure how to handle it at first.

  Traditionally if a soldier developed an illness or injury that was linked to their service, the diagnosed condition was evaluated and given the status of Service Connection. Compensation was paid to the veteran based on the evidence the medical documents provided. The problem for the VA was evaluating something that couldn’t be diagnosed.
  Researchers looked at every thing from sand mites, to spirochetes native to the Middle East, to depleted Uranium. An answer for the veterans who served at the various locations in the Persian Gulf region has not been found.

  In a local newspaper, there was an article describing how various research organizations have not come up with any explanation, except that the evidence may indicate there is no “Saudi Syndrome.”  The same news article reported that other health studies now indicate that Saudi vets experience multi-system illnesses at a rate twice that of none deployed veterans. I personally agree to some extent. I have come across too many men and woman who complain of pain or burning during intercourse since they or their spouse were deployed in the Gulf. I researched this further and discovered this complaint is far more common than ever expected.
  The Dept. of Veteran Affairs has come up with certain guidelines for what is called “Saudi Syndrome.” If a Desert Storm veteran presents with a symptom or grouping of symptoms for which a diagnosis cannot be given, then the symptoms will be service connected based on their debilitating effect.

A common scenario is of a veteran complaining of pain and swelling in his knees. The pain is a subjective complaint; it cannot be repeated or observed in a clinical setting. Nevertheless, the swollen knees are objective symptoms that any clinician can observe and describe. The usual tests are run and a diagnosis cannot be made. Yet the knees are still swollen and painful.

The VA should grant service connection for the symptom(s) and evaluates as if there was an actual diagnosis given.  This is true even if the symptoms appear after a reasonable period of time after the veteran has left the theater of operations.

So how does a veteran file a claim for “Saudi Syndrome”? Just like any other claim except the veteran points out what the issue/complaint is and that there has been no diagnosis made for it, nor is it a part of a larger diagnosed medical condition.  The VA will do two things; attempt to obtain the veteran’s service medical records and gather up the civilian medical records identified by the veteran.

The VA is responsible by law to obtain any military medical records. The veteran is responsible to identify any appropriate civilian medical treatment records to the VA.

  Once there is sufficient medical documentation the VA Regional Office will most likely schedule a medical exam for the purpose of confirming and measuring the amount of disability the undiagnosed condition presents. A Rating Decision will be made to determine if service connection is granted or denied. If the decision is favorable, a monetary award will be determined. If the claim is denied service connection; then information will be provided for why it was denied and how to over come the denial.

What are some of the pitfalls claiming service connection for a medical issue believed to be resultant of service in Desert Storm? There are some, so a vet will need to be extra careful and start planning and building the evidence before they actually file a claim.

  First, a lack of proof that the veteran was actually in the Kuwaiti Theater of Operations (KTO) will kill the claim before it even gets to the Rating Board. The vets DD-214 should be the best source to fulfill this requirement. The VA is aware many vets who received the campaign ribbons had never set foot on or sailed in the KTO. Therefore, have secondary information ready, such as pictures, copies of orders, and/or a history of the unit assigned to.

The medical evidence must not be exclusive to other evidence or insufficient. The medical documents must show there is an undiagnosed condition and that it was not there before deployment to the KTO. For complaints, especially issues such as pain, there will be a need for the medical records to show continuity of complaints. There should be documentation of a problem beginning during or shortly after leaving the KTO and it  continuing to this day. The thought here is “quantity”, as in many visits to the doctor over the years.

Several things the vet should think about that would help the claim’s success. Consider talking to a doctor about what is bothering him or her and see if it really meets the diagnosed requirement. Before actually filing a claim, the vet should plan and assemble the claimed issue(s) with the appropriate evidence.  A service officer (States often have knowlegable VSOs) can help in understanding the legal jargon of the VA. With or without a service officer’s help, the veteran must read, and re-read any correspondence from the VA for complete understanding. These simple steps are laborious, but they will ensure a much higher likelihood of a successful claim.

  Also keep this in mind; service connected medical issues can serve as the basis of benefits for a vet’s family.
Thom Stoddert, former VA Rating Specialist
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