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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VA 101: The Basics
Thom Stoddert

Any  "knowledge is power" and so it is very much with the Department of Veteran Affairs. The more you understand, the more you can help yourself and your fellow veterans. Understanding some basic information about the VA is essential in filing a successful claim and receiving any due benefits justifiably earned.

In the coming months I intend to write a series of articles based on my experiences working with veterans and my job as a member of a VA Rating Board. My motivation for this is two fold. I am now a 100% disabled veteran. I served as an infantryman in Viet Nam with D troop, 2/17th Cavalry, 101st Abn., in Berlin looking over the wall for a year,  and as a medic in Desert Storm with the 12th Evac. Hospital. I am motivated by my pictures of friends KIA, the faces of frightened wives of deploying reservist, and the memories of the great guys I drank with for days on end while sharing their experiences.

Finally I am grateful to the Department of Veteran's Affairs for employing me even though they let me go when I could no longer control the symptoms of service connected medical conditions. Now I have the time to write and support other veterans through  “The Veterans’ Voice.” I am also a veteran's service officer (VSO) working out of my brief case going to where the veterans are.

We all know the VA is a massive bureaucracy,  but how many people know the VA is divided into three branches that don't really talk to each other very well? There is the Veteran's Health (hospital) Administration. Then there is the Cemetery Administration who manages the National Cemeteries. Let's not go there any time soon. Finally the Veteran's Benefits Administration (the VBA) consisting of Regional Offices in each state. At the Regional Offices claims are decided, rating percentages are assigned, and eligibility for other benefits are awarded that affect benefits.

The national service organizations are another very important slice in the pie. These are better known as the VFW, the American Legion, The Viet Nam Veteran's of America, and Amvets. They are not a part of the VA, but interface with and sometimes oppose the VA for what they believe is best for veterans. These folks come in two flavors. The National Service Officers (NSOs) who are very well trained and experienced with working with the VA. Then there are the Veteran Service Officers (VSOs). They are usually volunteers who  have some training and usually work at meeting halls. Finally there are the various state, county, and local veteran groups. All with different agendas and resources. In any case these organizations are there for you. I'm not silly enough to believe they are all effective and beneficial. What I am saying is that there are plenty of sincere and dedicated resources out there available to the veteran to act as his/her advocate. Find one that fits  you.

The next question that may be on your mind: How do I make a claim with the VA? First let me explain what a claim is as there is some confusion with this subject. When a service member is injured or becomes sick on active duty the medical issue(s) must become a chronic condition. The symptoms of this active duty incurred medical condition must be evident after leaving the service. Any medical condition that is shown by evidence to have been incurred in service and is still evident after military service should receive the legal status of being "service connected." Once a medical issue has been granted service connection a monetary award will be determined.  Only a VA Regional Office can determine if an issue is granted  "service connection."

Now, how does a veteran ask for service connection of a medical condition? There are several ways. You can write the regional office stating that you want to file a claim for service connection of whatever medical condition you believe was incurred or aggravated during military service. They will then send you a VA form 21-526. A veteran can also go to a national service organization to be helped by a NSO or a volunteer VSO. I recommend this very much. You can even go on-line, no snail mail, to WWW.VBA.VA.GOV and fill out the 21-526 there. Let me warn you-  it is one very long form, I suggest you get help; here is where your spouse can really contribute. Once the VA has your claim they will immediately start working on it. You will receive other forms that ask you for more information  to develop your claim. The VA will make every effort to locate and obtain your service medical records and any private medical records you have identified. If they can not get them they will tell you. Please understand this very important point in VA law: there must be credible evidence to support any claim before the VA can make a decision in the veteran's favor.

The VA is not a government agency with secret conspiracies to fraud veterans of their well earned benefits as I have heard over and over again; it is an overworked government agency that for many legitimate reasons is slow. It is a bureaucracy that does make mistakes because it is staffed with human beings. That is why service organizations exist. Find one that works for you.  Consider them free lawyers. Read, read, and reread any letters the VA sends you. If you still have  questions find help. Always respond to the VA when they ask for information.

My future articles will be based on my experiences having worked with many veterans and seeing their needs. Remember "knowledge is power" and thus armed, your dealings with the VA will be more successful.

Thom Stoddert, former VA Rating Specialist
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