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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Stoddert Assignment Berlin
An Informative War Memorial Torpedoed By Pettiness & Politics

By Thom Stoddert
                                                                              

   A project that was to memorialize both American and Vietnamese veterans of that war was initiated by members of the Vietnamese veteran community with strong support of American born veterans and the Washington State Department of Veterans’ Affairs (WaDVA). Even the governor’s husband weighed in on this issue. First Mike, as he is affectionately known, is a Viet Nam War vet and passionate for veterans’ issues. Until?  You guessed it: politics, dishonesty, a nose or two out-of-joint, and a little bit of racism got the whole project torpedoed.
 
  The current wall-like memorial is a dignified black marble slab with a break that forms a map of South Viet Nam in the middle. It lists all of the names of soldiers from Washington State who died there. It was planned to have three flag poles erected and a plaque under a statue of a grieving South Vietnamese soldier with a tribute to both American born and South Vietnamese born veterans.  The new project would have enhanced the original memorial with a greater explanation of what happened over there.

Why am I writing about this? It’s not about Chuck Manley, of Tumwater, WA who felt he was left out of the second phase of the project. It’s not even about the hurtful statements he made, but could not or would not verify; the back room politics that were used that hurt, really hurt a lot of good people; or the childish behavior acted out in the WaDVA conference room. I am not going discuss how a few petty politicians from the Washington State Legislature were motivated by their next election’s success caused them to run interference.  Finally,  I am not going to discuss the racist accusations made; especially those that justify this country deserting the Vietnamese because of the corruption in their government. Have those folks forgotten about Henry Kissinger, Robert McNamara, now senator John Kerry, former presidents Johnson and Nixon?

Instead, I want to discuss how a war memorial teaches American citizens about duty, honor and self sacrifice; those virtues by which freedom is gained and protected. When I volunteered to work with other patriots in displaying the Traveling Viet Nam Memorial Wall, I quickly learned  just how ignorant most Americans are of that war which still maintains a grip on the American psyche. It’s no wonder, my son’s high school history book had only one paragraph on the subject, with a picture of hippies protesting.

  I hear so much rhetoric about American heroes, they thank you for your service, hand you your free dinner on Veteran’s Day, and they fail to show proper respect when the American Anthem is played. For many of us who were in the military during Viet Nam, this jingoism is empty. Back then we were “shit,” now we are heroes? Many vets like myself worry if the political climate changes again how  the young guys will deal with it, especially the disabled.  I have seen many, many bumper stickers with “Freedom isn’t free,” but what does it mean?

The Viet Nam War was about more than just several armies in combat; it was about the freedom of self determination of a people. The freedom from the rule of a few ambitious power-crat tyrants such as Ho-Chi Minh, Nikita Khrushchev and Chairman Mao. Freedom is not living in fear of your own government, such as what happened at Waco and Ruby Ridge. It’s about not having to conform in both actions and thoughts to  political correctness.

  The war affected much of the world and most missed what it was really about: supporting those who want to be self-determinate.

  Every day I would ask myself why the communists did not come over the wall in Berlin. After all , every good communist believed it was their duty to liberate the workers of the world and thus enslave them to a few career politicians.  More than ever we need that lesson now in this country.

The ones that are best able to teach what freedom is and the cost of it are the American-Vietnamese and war veterans who have seen personally the brutality and oppression of an authoritarian government. Certainly not journalists, lawyers, politicians or even college professors. because they have all failed to teach what freedom really is, nor have they put their necks on the line and paid in blood. Today it is not just communism, it is the political correctness that is rampant in this country. In England, it is the government that tells the people how much Tylenol they can purchase at any one time, or if they can have a life saving operation. In Germany, it is the government telling people they will be taxed to support the less efficient countries.
  A war memorial should not be just a rock with a long  list of forgotten names. It should tell of why the sacrifices were made. It should teach what those sacrifices were, what the results were, and about freedom of self determination. They should focus on freedom  from abuse by career politicians, a war we  are losing in this country now.

Washington State could   have had a memorial that worked for that goal except for the narrow-mindedness of a career politician named Pam Roach.

  Let me explain it this way. There are lots of WW
II memorials. But do they explain the pain the marines and sailors went through to keep the cruel Japanese militarist from abusing Americans like they did the Chinese? Do history books reveal the suffering of the American soldiers as they destroyed Hitler so he couldn’t conquer and  round up various populations in our country as he did in every other country he conquered?  Can we trust today’s journalist and teachers to write about what our soldiers are really fighting against in Afghanistan? NO!
  A war memorial should not only honor the sacrifices and the fallen, but teach future generations what happened. That is not what happened in Washington State. Yes, there were some valid opposing  feelings, but small-mindedness is what prevailed.
Thom Stoddert, former VA Rating Specialist
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