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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How to Begin a Successful Claim with the VA
By Thom Stoddert
I am frequently asked, “How do I make a claim with the VA? I was in the Army 40 years ago and never contacted the VA, so how do I begin?” Now I am left thinking, “You’re up the creek buddy with a tiny paddle, should not have waited so long.” Instead I tell the vet some basic information; starting with “Don’t confuse the medical treatment facilities with the Regional Office’s benefit’s administration. Then I explain the VA’s form 21-526.
The VA form 21-526, Application for Compensation and/or Pension, is the axel in which the wheels turn for benefits, compensation, and/or medical treatment, thus it is a long, multi-page document. You will need this form completed to start benefits, fortunately it is needed only once in your life time. Once this form is completed and sent in, the VA then builds a Claims File (C-file) that will last longer than you will, since it is a permanent federal record. Every correspondence you have ever sent to or received from the VA Regional Office will be in that C-file. The C-file is also supported/backedup with electronic databases. Be aware the form 21-526 is available on line at the VA’s website (called VONAPP) as well as paper. Once the VA has the 526, your initial claim(s) begins on that day. So any favorable decisions are paid from the day the Regional Office has your completed 526.
Does the form 21-526 need to be 100% completed? No. Obviously certain information is no longer appropriate or obtainable. You may not even have a copy of your DD-214, the VA can still verify service dates and even obtain a copy of your discharge. So send in all the information that you can give them.
Hint: have any other major documentation ready before starting the 526 so you can have ready the relevant information from them. The VA will want to know about your children, marriages, disabilities, and any other federal benefits. My suggestion is to obtain a paper copy first, fill it in with a pencil and then file on line. That way you can best prepare this document for the VA and not have to rely on the regular mail service (ALWAYS use certified return receipt mail). Mistakes are easily tolerated by the VA, but never, ever lie on this form; it will be found out.
Do you need to fill out a 526 each time you file a claim for benefits? No. Once this is done, it is done for life. So, if you need to file a claim to the VA for a new issue or an increase in benefits, simply send a signed letter to the Regional Office. They will take from there.
Will your spouse or widow need to complete a 526? No, not if you have already done so. If you never did, the widow(er) may not have to, depending on the benefits being sought.
If you don’t know or cannot remember if you filled out a 526, just call 1-800-827-1000 and ask if they have a file completed on the veteran for whom you are seeking benefits.
The next major issue to be considered when filing a claim for benefits with the VA is the evidence you will need that will support the issue being claimed. Since that is a whole other article, I will just say; evidence is needed to support any claimed issue. The evidence must show a link between whatever chronic condition you have now to your military service time. So plan your evidence carefully.
Finally, what can you expect after the VA receives your claim? You expect to wait a long time, because there are so many, many veterans in real need of help, not to mention the lowlifes trying to freeload off the system with silly claims and it’s hard to staff people with a good working knowledge of medicine, the military, and VA law.
However, the VA will send you forms that require you to give them permission to obtain your private medical records, if there are any. They will ask for information they think they need and they will ask for information you know they already have. So don’t be rattled if they ask for a marriage certificate you don’t have when you filed a claim for a knee injury. Just tell them you don’t have it and rate your claim with the evidence on hand; that is if you know they have all the evidence they need. This step is not the VA delaying for time; it came from a stupid court case that only made things worse.
If the VA offers you an “express” rating decision and you just got out of the service, take it. It has been my experience that this best serves the new veteran and does not preclude filing a second claim at any time if the service connected condition really worsens. Older veterans should stay with the old system. This is because you may need to file a notice of disagreement or request reconsideration of a recent decision, not allowed with an express rating. Many old injuries are difficult to prove service related. Therefore you may need to use the rating letter to overcome any denials, request a re-evaluation with new evidence or file a notice of disagreement (NOD).
In summary: don’t wait to file a claim. Time is not on your side and be aware how VA benefits may affect your family members.
Thom Stoddert, former VA Rating Specialist
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