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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Understanding Basic VA Benefits
Thom Stoddert

Never inflate which benefits you may have earned or why you are qualified to receive them. Currently there is talk of rejecting claims that lack rational or legal basis before they get to any VA Regional Office.  Claims that the VA has wasted countless hours and dollars responding to, may no longer be considered in the future, so VA may have more time to work valid claims .

As an example: I was once asked by a veteran to file a claim for diabetes secondary to the Agent Orange (A/O). After driving twenty-five miles and wasting several hours, I learned he had never been directly exposed to A/O, but he did think his father may have been in Viet Nam. I also learned that his father was the only adult male on both sides of this vet’s family who did not have diabetes. Was this an appropriate claim to file with the VA? This veteran did not even have the most basic understanding needed for his claim.

There is also the case of a veteran who supported his claim for dental care by exaggerating (actually outright lied) that he was combat medic in Viet Nam. It was explained to him that dental care is more of a hospital issue than it is a claimable issue for compensation in 99% of cases, and that having been a medic in Viet Nam, even if it was documented in his DD-214, was not appropriate evidence in his case.

Again, he was wasting my time and the VA’s by trying to push through something he was not eligible for, nor did he have any evidence for the benefit being sought. I have a suspicion he already knew this but was trying to manipulate me to get what he wanted.

We all know the VA is an overloaded bureaucracy, but it can be dealt with all by your self without lawyers and congressional representatives. All it takes is a little understanding of some basic concepts:

1) Service-connection of an injury or disease is granted when there is evidence of it having been incurred in the service or arising during military service. The condition must  be currently present before it receives a compensable level of rating percentage. Only a VA Regional Office can confer this legal status on a claim.
2) Compensation is the money payable for a chronic medical injury or disease that was incurred in the service or as a result of military service when it has been granted the status of service-connection.
3)   Pension (non-service pension) is a benefit for eligible veterans with war-time service and proven financial needs. There are requirements for proof of financial hardship. The evidence must  also show these vets are disabled from non-service connected medical conditions.
4) Dental issues may be compensated (granted service connection) and given treatment when there is evidence of jawbone loss or tooth loss due to trauma in the service. Normal tooth decay is almost never service connectable. However, routine dental treatment can be provided by a VA medical facility based on the space available.
5) Other medical conditions that have been incurred because of a service-connected condition or made worse by a service-connected condition, may also be granted
the status of service-connection and compensation paid.
6) A high rating percentage granted for service-connected conditions, can result in further benefits to the veteran and his family. These may be educational, medical and/or additional compensation.
7) Consideration of a disability is based on how it affects the whole person in their social and occupational efforts and a percentage is applied by the use of a standardized Rating Schedule that is a part of federal law.

Everything is focused on the evidence and what it shows. 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. 
Thom Stoddert, former VA Rating Specialist
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