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
Widow Benefits, DIC and Pension
By Thom Stoddert
  The VA’s benefits for widows/widowers can be substantial, especially with an economic recession going on and because too many veterans did not plan well for their later years providing for their survivors. I’ll illustrate this with two stories that are lessons for all of us.

The first widow’s husband died of complications from diabetes. She went to the VA armed with information that veterans or immediate family members of veterans who had served in Viet Nam could automatically receive compensation for medical issues due to presumptive exposure to Agent Orange. Since her husband had passed away from diabetes and had served in Viet Nam, she requested widow’s benefits from her state’s Regional Office. She was very angrily disappointed when she found out she was not eligible for pension nor the higher benefit of Dependants Indemnity Compensation (DIC).

  A veteran’s surviving spouse, minor children, and possibly parents can receive a VA pension when two requirements are met. First, the veteran must have completed two years of honorable service with at least one day of war time service. Second, pension is income based. In other words if the survivors have income that does not come up to the federal poverty level, benefits will be paid. Pension only covers the distance between specific forms of income as determined by federal law and the poverty level. Though this point changes often, it doesn’t offer a whole lot in the way of money; but it is better than nothing.

In the mean time another woman, whose husband (also a Viet Nam veteran) died of a brain tumor, was made aware of possible benefits by VA employees. She was first made aware that she qualified for Pension; instead she was awarded the higher benefit of DIC that pays about $13, 848.00 a year ($1154 monthly - basic rate).
The DIC is a large improvement over Pension; so why the difference? It now becomes a little more complicated.

DIC is available to the spouses, minor children, and sometimes even parents of a veteran when he or she dies of a medical issue that has been granted the legal status of “service connection.” It also can be awarded when a veteran has died after being rated at 100% for ten years or has been granted Individual Unemployability, also for ten years.

People and families do
not exist in a vacuum
and our modern society
promotes the environment
of bureaucracies. So the
first widow did not get
the benefit she believed
was hers, while the
second woman came
away with more help
than expected. One
veteran died of a
disease that the VA
normally service connects
even years after leaving
the service; while the other died of a non-service connectable illness, nothing to do with his military service. What really happened behind the scenes is a lesson for all veterans and their loved ones.

The first widow, whose husband died of an Agent Orange related disease subsequent to his duty in Viet Nam, was denied benefits because he was never in Viet Nam despite his stories to his wife. His service records documented that he was born in 1956 and entered the service in 1974. Thus it was unlikely he was in a time frame to be able to be shipped out to Southeast Asia, but she never did the math. Even more significant, his military records did not show any where that he was ever closer to Saigon than Honolulu. In the end, the woman was without benefits and learned her husband who had left her a widow had lied to her over a very serious issue.

  Despite two angrily worded claims to the VA that only resulted in the same explanation, she did not and would not receive benefits. There was no documentation or evidence to support her requests (demands) for benefits. She could not claim “cause of death due to presumptive exposure to Agent Orange.”

  The second widow was successful because she had the evidence needed to show that her husband’s service connected PTSD did result in effecting the quality of care he received for the brain cancer that killed him. Brain cancer incurred over forty years after leaving the Army is not a service connectable medical issue under present VA law. Yet the second widow assisted by good information showed through medical documentation that her husband had rejected medical care. The refusal of medical care that could have resulted in a cure or a prolongation of life was motivated by the veteran’s very severe PTSD symptoms. So when the VA’s Regional Office had the evidence that allowed them to grant benefits, the second widow was awarded a reasonable income for the rest of her life. The first widow did not even meet the income  requirements for a pension.

It’s also good to know that there are other benefits that can be granted for eligible surviving family members. Some of these include educational and medical benefits. To start understanding all of this, obtain a copy of the VA Benefits Handbook, available at veteran service organizations, online at, or just phone 1-800-327-1000 in any state. Another very good resource is Jim Strickland’s “ultimate answer” site located on our homepage.

Thom Stoddert, former VA Rating Specialist
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