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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Agent Orange- My Perspective
Thom Stoddert

FACT: Agent Orange was a smelly, oily, water based chemical. It was sprayed just like a crop duster over a field. The plane or helicopter flew low (under 500 feet) and slow and the chemical was quickly dissolved in the ground just like in a Kansas farm. In other words the ones I saw operated just like a crop duster on any farm.

These are actual stories told to me when I worked at the VA and my response:

"I was exposed to A/O when it leaked in the submarine that we were transporting the barrels in.”
How did they find the room for the barrels in a sub anyway?

"My C-141 flew under the 'bird' that was spraying it; right through the mist.”
The air turbulence would have caused a crash, the pilot of the C-141 would have been grounded- I don't think so.

"My aircraft carrier was engulfed by the spray while sailing 15 miles off shore.”
The aircraft spraying it must have missed theground by more than fifteen  miles.

"I have developed an Agent Orange skin condition from sexual contact with men who returned from Viet Nam.”
These were later diagnosed to be ordinary STDs.

My favorite: The VA examiner asks the veteran, "Did you ever eat food contaminated by Agent Orange?"  For some reason the answer is always, "Yes I did.” But let's see if my memory serves me right. I ate food out in the field; it came out of a little green can. I ate food on the firebases; it came out of large green can. I ate food in the mess halls; it usually came out of a metal can under a metal roof. I never sat under the aerial spraying enjoying my beans and franks, nor did I flavor them with some local Vietnamese dirt. I think I missed something, cause I was no different than the them.

The VA, the Air Force, The Institute of National Health, and others have extensively researched the effects of exposure to this herbicide. As a result there is a list of cancers and diseases that will receive service connection automatically if the evidence shows that you were in Viet Nam or another area where it was known to have been sprayed.

The lists are easy to come by. They are posted on the VA websites as well as most veteran sites.  In the case of Diabetes, two out three research projects found a slightly higher occurrence of diabetes in Viet Nam veterans than non-Nam vets. So the VA decided to err on the side of safety and add diabetes to the presumptive list of Agent Orange medical conditions even though the evidence was inconclusive.

To gain service connection for an A/O related condition the evidence must document that you were most likely exposed to herbicides while in the service and you now have one of the medical conditions listed.  Because veterans never lie or exaggerate the VA must, I repeat, must have evidence to indicate that you were exposed to herbicides. Usually evidence of duty in Viet Nam is sufficient as shown by:

1. Military paperwork.

2 Medical documentation.

3. Pictures that are clearly of Viet Nam with the veteran in it.

4. Letters with a Viet Nam APO or certain FPOs.

5. Lay statement from former NCOICs or officers.

For the Korean Vets the military has supplied the list of units and the times herbicide was sprayed along the DMZ in Korea and this list continues to grow. If your military records document that you were with a listed unit when it was along the DMZ when it was sprayed and you have a recognized A/O illness, you should receive service connection for the condition and any secondary issues.

The VA also knows that some vets may have been on a "hey you roster" some sergeant had and you got detailed to drive up to somewhere along the DMZ to deliver some warm chow. You were not listed on any of the recognized units the VA has been given, but the "unofficial evidence" can work for you also.

Maybe the most important concept to understand related to Agent Orange or any other hazardous material is that an exposure in and of itself is not something that can be service connected by the VA. Exposure is not- I repeat- is not a medical condition. The medical illness or disease caused by that exposure is service connectable by the VA. As an example: we are all exposed to the sun. It doesn't mean anything unless that exposure results in a cancer or sunburn. Same thing with Agent Orange. Unless there is evidence of a probable or actual exposure and there is a medical condition that credible evidence links  to that exposure, there is no valid claim.

Seriously; stay focused and be real. The VA is not trying to deny you anything you deserve, just have the evidence. Read everything the VA sends you again and again carefully, and then do what they ask. They will give you the requirements and the information that your claim will need in order to be given a favorable decision. Don't bullsh_t the VA; this also becomes a permanent part of your VA record.
Thom Stoddert, former VA Rating Specialist
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