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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Assignment Berlin
By Thomas Stoddert
Tales from the Lighter Side:

  This is less a funny story than it is the observations of international politics by a young soldier who had too many hormones,  too much curiosity, and had an attitude left over from Viet Nam. Nam was simple for an infantryman; you screwed up you died; there were lots of bad commies in the mountains, in the villages, in the trees, and you shot them; the good commies were laid out in rows and heads counted. Berlin had lots of commies, but it was not a simple affair any more.

  When I left Nam the First Sgt. told me I would be in jail the first week I was in Germany. He will never know how close to the truth he came. I showed up at the replacement station at Ft. Dix, hung over, a day late, unshaven, and wearing a uniform that was stored in a duffle bag for over a year. When I presented the clerk a copy of my orders to Germany, he told me I was one day AWOL. I told him I was also very hung over and sarcastically asked if he was going to send me back to Nam after he bent my dog-tags. Ignoring me, he pointed to a map of Germany on the wall behind and asked me where I wanted to be stationed. After I got over the profound shock of having a choice in the matter, the first time ever, I asked about duty in Berlin.

  It didn’t take a rocket scientist to realize, while looking at the map; that Berlin was an isolated city 110 miles behind the “Iron Curtin.” Translated; no field duty, no living outdoors up to my butt in snow; just simple, routine “Wall Duty” for the next year in a beautiful modern European city. Yes! Send me.

Then he told me I have to be accepted for duty in Berlin, it was a special assignment. So the bubble burst, my head continued to ache, and I was hungry for something other than beer. Ten minutes later the clerk informed me I was on my way to Berlin. I never found out what those standards were, or if there were any. The 3rd Battalion, 6th Infantry, Berlin Brigade had every personality type, size, IQ, and criminal status you could think of. That year they even tried to promote me to sergeant, I refused because I was having too much fun and would have had to act like an adult.

The 3rd/6th Inf. was also preparing for a “zone trip.” So two weeks after I  reached Berlin, I was instead in Hohenfels, Bavaria up to my butt in snow. Each infantry battalion would travel twice a year to training ranges in West Germany. These movements, because of the travel through Soviet occupied East Germany, were very meticulously planned, coordinated, and completed. We went through several briefings of what our behavior should be, what we should do and what we would allow the commies to do.

The members of the convoy were not to allow any Soviet to remove any thing from a vehicle or to enter a vehicle. We Americans, were not to photograph any of the passage from Berlin to Helmstead or to have cameras, radios and/or personal items visible to a Russian. In other words, there will be no confrontations and no political incidents between us and the commies. We won’t take any sh**, but neither will we give them an excuse to start something. An understanding of the history of Berlin after WWII would explain the seriousness and silliness of all this and it was mostly serious stuff; three Germans were shot to death for trying to get over the wall that year.

The first phase of the trip we pulled into a large open area on the side of the autobahn that entered into the Russian controlled highway. From there the Russians would perform their political games of doing “safety checks” on all of our vehicles, while taking their time about it. It was all a silly political game the East and the West played and we were the pawns; unfortunately it sometimes did get evil.

  So while I sat there behind the steering wheel of my gun jeep, I could see an old WWII style tank up on a large pedestal. I knew from orientation that was the first Russian battle tank to enter Berlin in April 1945. I also knew it was probably the only tank that survived all the friendly fire the Russian inflicted on themselves while trying to kill Hitler. The Russians were good at building memorials to the Soviet Red Army and putting them all around the city and this was just another one for all to see despite the fact they killed more of themselves than Nazis.

  As I sat in the jeep I could see commie pawns walking around and in between the trucks, then I heard a familiar clicking sound. I looked over to the team leader who had his instamatic camera up and was taking pictures of the Soviet Officer who was leaning against the canvass door of the jeep. My boss was discretely getting pictures of the Russian’s butt. How the doofuss never heard the camera getting shots of his back pockets I will never know.

The Team Leader who had been in Berlin for a couple of years knew the routine. But I was seriously questioning his sanity when he told me to take a picture of the tank on the pedestal. I looked at him unbelieving as he was about to start an international incident between the Warsaw Pact and NATO armies with an instamatic picture of a Russian’s ass. Commies are well known not to like photographs of anything other than their glorious leaders. Now he wants me to pull out my large Yashika Electra – 35mm and make even more camera noise. After some prompting I finally extracted the camera out from where I stored it and got a very good picture of the tank and the jeep’s steering wheel.

Standing in front of some General with the battalion commander, the company commander and the platoon leader all waiting to murder me, was not an attractive thought. I was seriously not into international incidents; I was a just humble infantryman and this was fun. This incident was one of many that I witnessed that year.

Several weeks later I came across three trucks full of Russians. Unlike their colleagues back at check-point Bravo, these guys were falling all over themselves to shake our hands. We were not able to talk or make friends with them because they were in trucks, we were in jeeps, and both convoys were doing about 40 mph down the old autobahn near Magdeburg, in the German Democratic Republic of happy people. I thought about this meeting many times and have come to the conclusion that politicians can screw-up a soldier’s friendliest drunk any day or night. If we Yankee imperialist were left alone with all those blond, fair skinned, specially selected commies it would have been three days before any one was sober enough to salute any one from any country.

  In the mean time real people, not soldiers, in real cities all across Eastern Europe wished they had the freedom of self determination without Socialism, Fascism and/or Communism, with out the politicians who used those schemes for personal power. I then understood what Viet Nam was supposed to have been about.

Thom Stoddert, former VA Rating Specialist
Bio Here

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Tank on end