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.

Sincerely,
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  
Question:
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

Answer:
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
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Getting Extra Help From The VBA
By Thom Stoddert


There are many, many issues with the VA claim process that  may not make sense to the average claimant. So they go to the wrong person or organization to get help. Some issues being claimed are complicated and very convoluted Here are few actual events that I observed as an employee of the VA and later as a service officer.

  I was told of a widow who was left destitute by her spouse, a Viet Nam veteran, when he died suddenly of a brain tumor. The widow filed a claim for pension benefits based on “cause of death.” She felt the veteran’s brain tumor was caused by Agent Orange. Unfortunately, according to law, she was denied benefits. Neither the VA nor anyone else  has confirmed any link between exposure to Agent Orange and brain cancer.

  The medical records documented that the vet collapsed on a Monday and refused any medical treatment. The next day he collapsed again and was taken to the hospital where he was sedated for an MRI. The MRI  showed a brain tumor so advanced that he had only hours or days to live. In fact he never recovered from the sedation and died without regaining consciousness. 

  A VA employee suspected that Post Traumatic Stress Disorder (PTSD) was the real culprit not Agent Orange. The veteran had been in treatment for many years for PTSD and had a well established history of symptoms, especially anger related issues toward authority. The VA employee knew that brain cancer does not develop overnight and there must have been some signs and symptoms weeks and maybe months prior to his death.

  The train of thought became that the veteran did have cancer symptoms, but because of his anger towards people-in-power, he hid his symptoms. The widow was encouraged to get statements from her husband’s physicians that his cancer was most likely a prolonged condition and that his symptoms existed long before he died. Then if she gets another statement from the PTSD counselors arguing that the vet had an anger problem and it would be typical of him to reject treatment. Now the widow has a case that PTSD hindered him from seeking the needed help in time to save or prolong his life. She should have a successful claim with the VA because the experts have lined up the facts for her.

The lesson here is that expert medical opinions and experienced common sense should prevail and usually do. But what happens when they do fail? Do you go to a Congressman/woman? I don’t think so.

  I sat next to the Congressional Team for six months at a VA Regional Office. I learned how they operated. Claimants that filed a complaint with the local Senator or Congress-person did have their claims significantly slowed. It was not done in retaliation, but simply getting a politician involved added another layer of time consuming work.

  Many, many times I saw a disgruntled vet use a politician’s office expecting to see the VA get punished, forced into giving benefits, or expediting  a claim. I even saw bone-heads threaten the VA with a congressional inquiry; thinking that would have the desired affect on the VA. In reality it is like teaching a dog to sing opera; it makes you look stupid and it annoys the dog, in this case, the politician. In the mean time the VA takes it all in stride, just like it has for over 60 years.

It works like this; first stage, development of evidence; second stage is the decision; and then notification of the award or decision to the vet. If a politician is involved the process goes like this; the claim file is pulled out of circulation and researched for an answer to be given to the politician’s office. When the congressional team communicates back to the senator or congress-person and the veteran is responded to, then the file is put back in line, delayed. Nobody else can work on the claim if the congressional team has the file, they have priority.
 
The claim is not worked on while the congressional team is providing explanations to the politician’s office. In greater than 95% of the congressional inquiries, the veteran would have been better served by not starting a complaint.

The lesson learned here; unless you know the VA screwed-up, don’t try to punish or intimidate them. If you have a significant question or concern; set up an appointment to review your claims file (C-file) with a knowledgeable person at the local Regional Office as the widow did. While there, take notes and ask questions. This will be far more beneficial than calling a politician.   
 
Consider this; if you have a service organization as a power of attorney, contact their office at the local Regional Office of the VA., ask them to assist you in reviewing your file. The major service organizations such as the VFW, AmVets, and the American Legion almost always have an office alongside the VA.
 
Lastly I want to caution you about where to get help or information. A few months ago a major military newspaper published some very significant misinformation. Later at a re-union, a vet assured me over and over that he was entitled to a rating of 100% for PTSD because he had a Combat Infantry Badge; his buddy had told him so and therefore he was correct and the VA was wrong. I will confess that I have been in error and had to go back to friends in the VA to get the right info. I have known many, many knowledgeable people on VA affairs and yet only one true expert on VA laws/procedures.
Thom Stoddert, former VA Rating Specialist
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