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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Stoddert Assignment Berlin
Square 1 At the VA
by Thom Stoddert

  Recently at a reunion I realized that most veterans simply do not understand the benefits they have earned, and justly qualify for.. The scope of VA benefits goes beyond just getting a check each month for an injury incurred in the service. Consideration should also be given to  how a service connected medical condition affects other medical conditions, your family, your employment, and your education. The more you understand the more effective you can be in dealing with the Dept. of Veteran Affairs.
  We all know the VA is a massive bureaucracy, but it can be dealt with all by your self without lawyers
and congressmen. All it takes is a  little understanding of some basic

1)Service-connection of a chronic injury or disease is granted when  there is evidence of it having been
caused by military service, or if it  arose during military service. This is a legal determination that only the VA can give to any medical  condition.

2)Compensation is payable for a  chronic medical injury or disease that was incurred in the service or as result of military service when it has been granted the status of service-connection.

3)Secondary medical conditions that have been incurred because of a service-connected condition or made worse by a service-connected condition can also be granted service-connected status and compensation paid.

4)Service connected conditions are eligible for VA hospital treatment regardless of the percentage granted to the condition, FREE.

5)Greater percentages granted for service-connected conditions, can result
in further benefits to the veteran and his family.

6)Consideration of a disability is based on how it affects the whole person in their social and occupational efforts and the rating percentage is applied by the use of a standardized Rating Schedule that is a part of federal law.

  Everything is hinged on evidence. 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.

1)Evidence is usually seen in your service medical records, but statements from former NCOs, Officers, or witnesses can be accepted, especially if during a period of combat.

2)The VA is responsible for getting records in possession of another government agency.

3)You must identify any after service medical records/evidence so that the VA can try to obtain them on your behalf.

4)In some unusual cases the veteran  must obtain and present the evidence  to the VA in support of their case.

5)Evidence must meet at least basic
legal requirements of credibility.
The Infamous “Agent Orange” Issue
The VA, the Air Force, the Institute of
National Health, and others have extensively
researched the effects of exposure to this
herbicide. As a result there is a list of cancers and diseases that will receive service connection automatically. Cancers of the prostate gland and diabetes are especially prevalent among Viet Nam
veterans and have been associated with
Agent Orange exposure. Agent Orange conditions receive service connection with evidence that you were in Viet Nam, and a diagnosis of any of the recognized conditions.  When there is a diagnosis of an Agent Orange presumptive cancer, the VA will grant service connection at 100%, plus possible additional benefits, during periods of active treatment and convalescence. Afterwards the residual effects will be evaluated and compensated.

  Diabetes is compensated based on evidence of the types of treatments and hospitalization. Secondary issues resulting from diabetes, such as heart disease, peripheral neuropathy, and retinitis are often granted service-connection.

  However, remember, exposure to Agent Orange in itself is not a compensable condition. You don’t get money for just having been exposed to Agent Orange. You must have a disability related to it. Hint: unless your boots hit the ground in one of the recognized contaminated areas; the VA will not recognize presumptive exposure.

Agent Orange Presumptive Illnesses:
1.Chloracne (must occur within 1 year of exposure to Agent Orange) 2.Non-Hodgkin’s lymphoma 3.Soft tissue sarcoma (other than osteosarcoma, chondrosarcoma, Kaposi’s sarcoma, or mesothelioma)
4.Hodgkin’s disease 5.Porphyria cutanea tarda (must occur within 1 year of exposure)6.Multiple myeloma 7.Respiratory cancers, including cancers of the lung, larynx, trachea, and bronchus 8. Prostate cancer 9.Acute and subacute transient peripheral neuropathy (must appear within 1 year of exposure and resolve within 2 years of date of onset)10.Type 2 diabetes 11.Chronic lymphocytic leukemia
Newly added:hairy cell and other B-cell leukemias, Parkinson's disease, and ischemic heart disease.

PTSD is a mental health condition that actually changes the physical structure of certain organs in the brain due to excessive high levels of stress and adrenaline. The symptoms are chronic, vary over time, and can adversely affect your behavior and health. If you think you suffer from this condition go to the nearest VA Vets Center or VA  hospital requesting treatment and evaluation. Don’t forget your spouse, family members, and close friends
are useful allies when dealing with this condition. Another hint: don’t claim service connection for this
issue just because you had a “bad hair day” in the service and you have not planned well for retirement. Your fellow vets will look at you funny.

  The VA will provide compensation when there is evidence of an in-service stressor event and a
current diagnosis of this condition. The evidence for a verifiable service related stressor is most often provided for by your DD-214. This is because it shows the receipt of a Combat Infantry Badge and/or other combat related awards, duty assignments, and military occupational skill identifiers. 
  The more you know and understand about this condition, the more you can deal successfully with it. So do your research by starting with your family, the VA treatment centers, and the Internet.

  Additional Benefits
  There are many, many additional benefits that are available to veterans and their families. Here are a few:
1) Additional compensation can sometimes be paid when service-connected disabilities reach certain levels of impairment.
  A)Loss of or loss of use of a paired organ such as a foot, leg, or eye.
  B)Loss of bowel and bladder control due to a service-connected condition.
C)Multiple high percentages assigned to service connected conditions.

2)Educational benefits can be granted when;
A)The veteran has service-connected conditions that interfere with employment and rated greater than 20%.
B)The veteran is rated at 100% or evaluated Individually Unemployable; therefore family members can receive educational benefits.

3)Pensions for veterans and/or surviving spouse;
A)The surviving spouse can be eligible for a program called D.I.C.,  if the veteran dies of a service
connected condition or has been  rated 100% for ten years prior to  death.
B)The veteran can be given a pension if non-service connected  medical conditions prevent
employment, regardless of age,  and if certain income levels are verified. At least one day of war-time is also mandated.
C)A surviving family member can be granted a pension if the veteran had war-time service and meets certain income (a lack of) requirements.
4)Burial benefits can be paid at different levels depending on whether or not the veteran died of a service-connected condition, or was rated at 100%.
5)Health care benefits are available at different levels for both the veteran and family members depending on the level of disability recognized.
6)Medical equipment and appliances for service-connected conditions can also be provided.
7)Insurance plans and various loans for homes, farms, and businesses are available.

Summary suggestions and resources
  Evidence is the very essence of any claim to the VA. An application for any benefit must meet the requirements for that benefit and have the supporting evidence. Evidence must always meet the legal standard of being credible. In some cases the standard must be at least to the level of a reasonable doubt.
  Though not absolutely needed, having a good Veterans Service officer who is well trained can prove invaluable to developing the evidence needed for your claim. Veteran Service Officers can be found at VFWs, DAVs, American Legions, AmVets, and other organizations. Their services are for free regardless of membership. Just find one who has been nationally trained by their organization.
  Any correspondence you receive from the VA must be read carefully and as many times as needed. A veteran’s service officer is helpful in explaining any letters you have received. If your claim has been denied, a letter will explain why it was denied and will indicate how the decision can be reversed.
The Department of Veterans Affairs

Everything, all the laws, regulations, benefits, and more are here.

VA Vets Center
Located in most large cities
These are excellent places for information and treatment

PTSD information
A good additional site to go to.

“Nam Vet” and “Down Range”
Books by Chuck Dean, 173rd Abn, 1966-67,

“Nam Vet” and “Down Range”Books by Chuck Dean, 173rd Abn, 1966-67,
Point Man International
Just do web search, multiple sites for the various local outposts.

Thom Stoddert, former VA Rating Specialist
Bio Here

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