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
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Scams, Scams, and VA Benefits  (Aid & Attendance, & Death Pensions).


  One of the first things I learned in the Army is that everyone, and I mean everyone, had their eyes on your wallet; now it is no different. It is now a lot slicker and even harder to avoid than when you are a 19 year old with a wallet full of cash. This article is going to be part one of a series dealing with issues that are being researched by me, the feds and state Attorney Generals. It is also intended to help vets and/or spouses with legitimate claims with the VA.

  So I will give my disclaimer now; “If I offend
anybody, tough sh+t,  sue  me not The Veterans’ 
Voice newspaper, because I write for the veteran and their families.” I am fed up of false veterans, false charities, and false service organizations. I am the sole person responsible for what I will write. So let’s start.

  The VA has several benefit programs which can lead to higher levels of benefits. The Pensions (veteran or survivor) that can lead into the higher levels of benefits are available to all veterans (survivor) if certain criteria are met. Basically the veteran must have:
1)A discharge (DD-214) other than dishonorable.
2)The veteran must have had one day of recognized time during a period of war. The periods of war are set by Congress. There must be 90 days or more of service, in some cases it must be two years.
3)Pension is a needs based program for veterans or their survivors. The amount is individually determined by the VA and only the VA.
4)The veteran must be permanently disabled or over 65 years of age.

These are the basic rules anybody can find in the VA Handbook of Federal Benefits, on the VA website, or from any legitimate veterans service organization. These are the well known organizations such as the VFW, the American Legion, the DAV, AmVets, and a few others. If you never heard of them, do not trust them. If you are still unsure call the VA at 1-800-827-1000. I am always available for questions about the legitimacy of a service organization, visite my page at www.theveteransvoice.com.

A great deal has recently been discussed about the VA’s “new and improved Pension.” It is not a new program that can get you more money. It is not a secret program. It is just not as well known as the other benefits. So this disperses a lot of false information being put out by the news media and scam artists.

The new and improved pension replaces the old program only in the way the amount of the benefit is calculated. If you apply now, your claim for pension will be calculated under the “new” method now in place by law. Essentially only the way the amount is calculated has changed, not the amount that may be available.
 
The calculations are made from the statements (or documents if asked for) provided by the claimants. They take in to consideration Social Security benefits, other retirement benefits, minus certain essential expenses. This is then deducted from the level set by Congress. Simply put, Pension helps the veteran reach a financial level that Congress thinks is just above poverty. Thus one beneficiary may get more than their neighbor. Despite what some are indicating, there is no set amount you will receive, only the limit and this is rare.

There is a program/benefit for survivors called Death Pension or the widow’s pension. It is available to unmarried children under 18 or 23 (if in school) and unmarried spouses. It has the same eligibility requirements as for veterans; a good discharge, war time service and such.
 
Now that we have discussed the Pensions, let’s look at a third program called Dependency and Indemnity Compensation (DIC). This program is available to the veteran’s survivors (spouse and minor children) if they died of a service connected issue or died after being rated permanent and totally (P&T) disabled for ten or more years. This is lowered to five years if the veteran was rated P&T from date of discharge.
 
There are also higher levels of compensation, Housebound and Aid and Attendance and they also seem to have become an issue; a very sensitive issue in some states. To which I warn, if anyone first approaches you on this subject and it smells in the least peculiar, don’t trust it, period. No VA claimant ever needs to pay for assistance, listen to an associated sales solicitation, or respond to a hint that a donation will help their claim. There may be a serious ethics issue with these actions that are very concerning to the feds, state AGs, and service officers.

Housebound and Aid/Attendance are extra amounts of money paid to a veteran or their spouse when they receive Pension or Dependency and Indemnity Compensation (DIC). If you receive either DIC or Pension and you become essentially housebound you are eligible for higher level of payments. If you are in need of a higher level of skilled medical care, such as nursing home care, you are most likely eligible for Aid and Attendance level of payments. Housebound and Aid/Attendance payment levels are available to recipients of a Pension or DIC. I say this because I was recently told about a widow who was refused help in filing for Aid and Attendance because she was receiving DIC.

  How do you apply for these benefits, very easy, write, call, email the VA. The most common form needed is the VA form 21-526, application for compensation and/or pension. Even a simple letter or telephone call is sufficient to get things going. The VA will send any special documents you need to help. Once a claim is filed it is a waiting game, unless you can show financial hardship. There are NO shortcuts, there are NO mountains of forms to wrestle with, NOR are there any groups that have a special program or knowledge to expedite things. Veteran service officers focus on veterans and insurance agents focus on business.

Next issue I will focus on particular groups that I think are running unethical scams and how they are operating.

Thom Stoddert, former VA Rating Specialist
Bio Here

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