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The Veterans Voice
"Fighting for Our Veterans-Supporting Our Troops"
Proudly Serving All Branches & All Eras Since 1999
Mondo Times
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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
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
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  
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
Thom Stoddert
KAZMIERCZAK
VA 101: The Basics
Know & Understand VA Benefits
A.O. My Perspective
VA Rating Schedule
Understanding Basic VA Benefits
Evidence Is Everything With the VA
Don't Be Stupid,                 Get the Truth
Veterans For Peace....???
Stoddert Assignment Berlin
The ABC’s of Individual Unemployability
Little Known Tidbits
from VA
  By Thom Stoddert


   The Department of Veteran Affairs has dozens of benefits that cannot be given an adequate description either by the VA’s own “Handbook of Benefits” or this article, but there is a book called “What Every Veteran Should Know” that is updated yearly, published by Veterans Information Service of East Moline, Illinois.

  Though this book is not an official VA document, it is still one of the most comprehensive resources and strives hard for accuracy. However, this article will address a few of the more accessible services available to veterans on a daily basis.

  Understand a veteran can be enrolled in the VA’s health system and the military’s Tri-Care simultaneously if the veteran is a retired service member.

  Access to medical care at a VA medical facility is either mandatory or discretionary. This is determined by what category a veteran may fit into when he or she enrolls into the VA Health Care system. Categories are based on priorities, such as the amount of disability compensation already received by the vet, military history, and financial need. Mandatory categories provide some free care, for others, all care is free. Some categories (usually discretionary) require portions of the care received be paid for by the veteran - co-payments which are very cheap.

  The veteran may be able to receive medications free or at a significantly lower cost than other sources.  The VA can provide medications based on a service connected condition (mandatory) or with a co-payment (discretionary) based on the category assigned  when enrolled into the system.  The medications are mailed to the veteran each month.

  Veterans - bad dreams – nightmares, seems like this is a favorite theme for the news media, telling of some vet haunted by nightmares.  However, the VA made a discovery a few years back that seems to have been relegated to the back room of medicine. Prazosin, to the rescue.  This is cited from the internet, “ Prazosin…This medication has shown to be effective in treating severe nightmares in children and people with PTSD symptoms.[4] Veterans have also been treated successfully at Seattle's VA Puget Sound Health Care System (VAPSHCS) for sleep disturbance related to PTSD…” , Wikipedia. Trust me- it works, I have used it periodically for years.

  Dental care is available in the same manner - using the category system. Dental care is very expensive and for soldiers just discharged this may be a big help while trying to re-establish themselves back into the community. The dental program may provide financial relief while readjusting to civilian life and the impoverished till stabilized.

  Nursing Home assistance can  sometimes be provided under programs administered by the federal VA or your State’s Department of Veteran Affairs.

  Then there are the TES programs for enrolled veterans that try to assist veterans to live as independently as achievable. In other words, vets are taught to work around their disabilities and be as productive as possible. Within these series of programs there are several that focus on poly-trauma, spinal cord injuries, traumatic brain trauma (TBI), and post traumatic stress disorder (PTSD). Eligibility requirements for these programs are best answered by the local  VA Benefit’s Office in each state or the hospital system at the various locations near you.

  One program that is often overlooked is Vocational Rehab also known as Chapter 31. The scenario that often takes place is that  a veteran, almost any age, struggling to improve their earning potential, contacts the VA benefits office (the Regional Office) in Seattle and applies for this program. A guidance counselor is provided, testing is completed to assess interests and skills, and then suggestions are made that are in the best interests of the vet.

  Once in the program all tuition, books, and supplies are taken care of. A financial allowance is provided along with all medical and dental care. A veteran stays in the program until they complete the certificate or degree. Follow up is pretty much till the veteran is gainfully employed. The basic eligibility requirement is the veteran is rated for compensation at the 20% level and the academic goals are reasonable.

  Travel pay is paid when the distance to a VA medical facility is not nearby and is based on mileage from home to the treatment facility when there is an appointment. The rules for this benefit frequently change, but it does help substantially with the cost of gas.

  Vet Centers are found in many large communities. They provide mental health services to veterans. These services may be for PTSD, traumatic brain injury, or just readjustment issues related to the veterans military time. They are all about “making things happen for the veteran.”

  Though the spouse may not be a veteran, there are benefits that may be available for them under certain circumstances. These can range from education, medical insurance, and in some cases medical assistance.  Please note some spouses are not eligible for VA medical insurance if they are eligible the military’s Tri-Care program. Also keep in mind things like burial and education.

  Knowledge is power, so search around to see if the VA has something that may meet a need in the veteran’s life.

  The rules and requirements are numerous and can be confusing, so here are some suggestions: Stay away from any one that may want  direct or indirect access to your finances or focuses only on one VA benefit. If you find an expert such as Military Retiree Services, the American Legion, or other such chartered veteran organization get a second opinion. They are very well intentioned but they do make mistakes. If you cannot speak to someone in person, do call the VA benefits office at 1-800-827-1000 or the hospital system at 1-800-329-8387.

  Don’t think globally only, consider local  outlets for help and referrals.  Every county has a Veteran’s Advisory Board that often acts as a local informationresource guide. Some of the best resources are volunteer groups. Often not heard of, but they are made up of veterans helping veterans. Never stop searching till you find what you need!  
Thom Stoddert, former VA Rating Specialist
Bio Here
How the VA Does Not Work
Saudi Syndrome from a VA
Finding Supporting Evidence
Healing, Reunions and Branson, MO
The Rating Schedule and Special Monthly Compensation
Ordinary Info that Every One Screws Up!
Scams & VA Benefits       Part 1
Scams & VA Benefits       Part 2
Scams & VA Benefits       Part 3
VA Ratings Basics
VA Ratings for Hearing
VA Benefits Basics 10
Veteran’s Overcoming Common VA Errors
VA Math
s, DIC and Pension
gger than Most Realize
PTSD Coach
Hearing Loss compensation
Aid and Attendance, Pension, Without Strings Attached
I Hope This Upsets You!
Special Cases of Unemployability
Corruption At Madigan
An Informative War Memorial Torpedoed By Pettiness & Politics
Nigerian Banker's Corruption Surpassed by Army Hospitals
It’s All About the Evidence
Scams, Shams, and Deceit
Scams, Shams, and Deceit
Care With Compassion?
A “Combat” Clerk Typist More
Roger Flygare Should Apologize More
Care With Compassion?
Madigan Corrunption
VA Unemployability