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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That Stupid VCAA Letter
By Thom Stoddert



  You made a claim for benefits to the Veteran’s Benefit Administration and then you get a letter from them that makes no sense what so ever. You may be panicked, confused, frustrated, and/or angry. Do not feel alone, you just got a letter that the VA is required by law to send to all claimants with the purpose of helping the claim. It’s called a “VCAA letter”, sent in accordance with the Veterans Claims Assistance Act.

  These letters are very general; intended to cover every possible situation and rarely address the recipient’s needs. They are supposed to give the veteran information to help in the claims process. However if you can not understand them, what good are they? Hopefully this month’s article will help when you get this piece of mail that is mandated by public law for the VA to send to you.

  The VCAA letter starts off with identifying what you have claimed and gives a little VA law, after this it’s down hill. It asks for evidence you have already sent in. It almost always asks for your DD-214, which in 95% of the cases has already been sent, and they have already verified it. It then asks for you to provide documents that you wouldn’t have and doesn’t really pertain to your claim.


The letter asks you to identify all of the medical treatment that you have received and doesn’t specify for what. You are thinking; “I am submitting a claim for an increase in the rating percentage for my arthritic shoulder, but it seems they want the doctor’s address that treated my cold five years ago.”

  I have seen letters asking a veteran for the names, SSN, and ages of all the children who live with him though he was just making a claim for an increase in the rating percentage of his left knee that he injured in the service thirty-five years before. So now where does a veteran begin to make sense of this?

  First of all, take the VCAA letter only as seriously as it really pertains to you. If this is not your first claim with the VA, they already have a copy of your DD-214 that they have either received form you or was given to them by the Federal Records Repository. They will most likely have verified the accuracy of your character of discharge. So don’t worry about this request too much.


They may ask for additional personal information. If you already have filled out the VA form-526 completely then they have pretty much all the personal information they need from you.  So if they ask for the divorce degree that you got from Mabel in 1951 and it really has nothing to do with your asthma claim; don’t worry about it. First of all, Mabel outlived husband number two and three and lives on the other coast; she doesn’t even know that you have asthma.

  What is very important is providing all of the information
(name, address, telephone, and times/dates) of the medical
providers that have given you treatment for what ever you are claiming. The VA does need this info to support your claim. Unless all of your treatment was at a VA facility, the Regional Office will send you a “release of information” form for each of your previous doctors/clinics giving them permission to release your medical records. This is a time consuming legal requirement that can not be gotten around. So move fast, it is to your benefit.


  The VA will make two attempts to get your private medical records. If the doctor/clinic does not comply, the VA will contact you asking you to obtain them and send them in to the Regional Office. If you get a letter like this,  hustle, it is to your benefit. In the case of VA medical treatment, the Regional Office does not need your permission to obtain your medical records they can simply look them up on the computers.


Suggestion: when you make a claim with the VA, send in copies of the medical records that refer to your claim. Provide them with the names of the clinics/doctors that have treated you for the claimed condition. If you can get copies of the release form, fill them out and send them in with your claim. Write a letter explaining what you have done and why. In the end, you will have saved a lot of time and it may get your claim adjudicated faster because you have furnished much of the evidence needed for the claim development. Remember that 90% of the time used in determining a veteran’s claim is used in the evidence gathering phase.


Very important: if the VA sends you a second letter asking for a specific piece of information, comply quickly even by telephone or fax(though certified mail-return receipt requested is even better). Always include your full name, address and C-file number/social security number in every correspondence. Sending in information with no way to identify who it is from or who it is for, only fills the trash can. I mention it because it happens every day, and the vet later on goes around bitching that the VA lost his records.

  In summary, when you get a VCAA letter, act fast on the requests that do pertain to you and don’t worry about the stuff that does not make sense. If you do make an error the VA will attempt to contact you again and resolve it. But do read the VCAA letter several times.


Thom Stoddert, former VA Rating Specialist
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