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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I Hope This Upsets You!

By Thom Stoddert

  I hope this month’s article really “pisses off” at least a few people. This is because what I am about to discuss hurts us all, every one of us who deals with the VA. No, I am not going to shred the VA; there is enough of that already. I am going to share some emails I was privy to recently that were distributed to some service offers/veteran advocates.  They illustrate some of the major reasons the VA is messed up and it’s because our fellow veterans are jamming up the system.

Recently, I was given copies of emails from a highly placed National Service Officer (NSO) for a western state; he works shoulder to shoulder with a Regional Office. The emails were written by a very well respected former combat marine and 110% steadfast veterans’ advocate. There was no fluffy rhetoric, just real life issues discussed because the VA is overwhelmed. It takes more than a year in his state to get a decision and it will take 5 to 7 years to get an answer on an appeal. Claims are reviewed by inexperienced Raters and exams are done by non-VA contracted physicians.

The emails when read between the lines explained that those local service officers who write claims for veterans need to be much wiser and frugal when asking for rating increases, submitting appeals, or including too many issues. In other words just don’t forward a claim because a veteran asks you to do so; keep it to the basics and keep it simple.

One of the explanations provided by the VA to the NSO for its slowness was the effect of the “Nehmer Laws.” Nehmer was a veteran that brought a law suit against the VA (the original purpose is forgotten). However, because some federal judge made a ruling  without using any common sense, the VA got stuck with a ton of time consuming requirements for each day. Without the Nehmer rules a Rating Specialist could almost triple his/her daily productivity. This is just one example how the federal courts have hurt us.
  You can see Nehmer in action by all those nonsense letters vets get each month about a claim. Those letters that only confuse the issues for claimants and waste  VA  resources.

  Another example is a few years ago the Vietnam Veterans of America sued the VA over a procedural practice and won. The results were that the VA was not allowed to fully rate any claimed issue that would be denied for one year. The results were that the VA was not allowed to fully rate certain claimed issues that would be denied for one year.  In other words the veteran could only get a partially worked claim with no decisions being made on any issue in the claim that would most likely be denied. The claim was only partial leaving the veteran waiting even longer for a decision on all of his/her issues that were filed with the VA.After the other major service organizations came to the rescue with common sense, the VFW, AmVets, DAV got a bill through the House, the Senate and on President Bush’s desk in record time (an election year) to essentially over ride the judge; the VA still had to reprocess all those claims again. The wasted time, money, and resources was horrendous. Over a month’s worth of claims had to be reworked with resources that could have been spent on new claims. How long was it before that lost time was caught up, if ever?

From what I personally saw, from what other VA employees told me, and what other vets have complained about, most claimed issues, especially from older vets, will result in a denial of the benefits claimed. Why? The veteran expected to be given service connection of a medical issue without the needed evidence. The doctors who treated them, the hospitals where they stayed, the treatment records no longer exist after 40 years. The evidence is not there. But what does the veteran do when he gets an answer he doesn’t like? He starts an appeal or files for another issue.

What is often seen is a veteran who did not plan for retirement well or he/she wants a little more money; so they file for an increase in benefits for a service connected condition or submit a claim for an issue completely unrelated to their military service. Guess what? The VA saw a rise in the number of claims in proportion to the economy going south. So next time you hear someone bitching that they did not get what they wanted from the VA ask yourself, “Are they just poor planners looking for handout?” Every week I am asked “How do I get some money for PTSD or TBI,” not “How do I get care for something hurting me?”

The VA compensation system is BROKEN! It was broken by the stupidity of bureaucracies, the courts, but mostly by whining veterans with an inflated sense of entitlement. How can we start to fix this?

  First, never file a claim unless you have the evi-
dence to support the claim, or you know, really know, that the VA can get it if it is a federal document. Send in the evidence with the claim or as much of it as you can. For your own good make their job easier.

  Second, don’t request an increase in benefits for a worsening condition unless it really has worsened. Look at the last rating letter it will document how you are eligible to get a higher rating percentage.
  Finally, read the rating letter very carefully before you make an appeal or file a Notice of Disagreement. It will tell
you exactly what you need for a successful claim. Request the VA to look at the claim again when you correct the errors within one year before the decision becomes final.
  The VA is not perfect, in fact, it is made up of human beings like us. Some work their hearts out for vets, others are oxygen thieves. By far, the VA really does try hard in its commitments. As vets, we need to do our part. We are 90% of the problem

Thom Stoddert, former VA Rating Specialist
Bio Here

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