Conflict of Interest

The system is actually fairly decent by design it is the application of the regulations that gets problematic. Right now, with the war going on, the system is way over-taxed and people are cutting corners at the expense of soldiers. (Body Armor saved so many live that the death toll was far lower than initial estimates in Iraq. This lower death rate was coupled with an astoundingly higher wounded rate than anticipated, so now the medical system must pick-up a much larger patient load than they had prepared for.) Different individuals interpret regulations wording different ways. Policies at one hospital do not translate to other hospitals. The rank structure of the army can interfere when one doctor out-ranks another but the lower ranking doctor has better training and experience. When patients are referred to civilian doctors sometimes there are problems because the military just operates so differently than common civilian practice is used to.

The major overlying problem is a conflict of interest between the medical profession working inside the military profession. The doctors are charged with helping patients and are bonded by medical ethical standards. The army is only interested in treating soldiers until they can either return to duty or must be separated from service. What happens is that soldiers are lost in-between the two systems (military and medical) with little guidance and no one to really fight for their rights.
Ordinarily the soldier's chain of command would be the soldier's advocate, but once hurt, a soldier is treated completely differently. An injured soldier is a dormant asset. A fighting unit must choose whether or not to help the soldier heal or to push the soldier away in order to get a replacement (units are only allowed certain numbers of soldiers and must maintain certain strength levels). Fortunately there are Medical Hold Companies where the soldier is not a dormant asset to any specific unit but is in a holding pattern to either heal and return to duty or heal and leave the army. However, now the soldier's chain of command is too closely tied to the doctors. In our case (and the case of the others here) our "case manager" or patient advocate, works directly for the provider/administrator we're having problems with - now we have no voice. So, we go straight to the hospital commander.
Our whole situation is so fucking nuts that we have to explain it over and over again to everyone. When we start telling the story every listener assumes that we have dealt with rationally thinking/acting individuals who may have just made decisions that we disagree with. By the end of our second or third time explaining the circular logic of the hospital staff our audience usually loses any faith in the army medical system. I can't say I blame them.
Not every Medical Hold in the army may have these problems but I assure you the web pages of those hospitals are not going to advertise "abandon all hope ye who enter!"

There is little to no accountability of providers in this hospital. Military doctors must often choose between needs of the patient and needs of the army. As a professional, serving two masters must be incredibly difficult for doctors -- I do not envy their position at all. I have noticed a trend of doctors leaving the army in high numbers and not just to pursue higher paying practices. Budget constraints, which are a major factor in medical care, are not set by medical professionals but by politicians.

- Ragin' Ranger Out

Government Accountability

I was getting ready to make some phone calls this morning and realised I may be talking to people that need more than just my opinion and my own personal evidence. Believe it or not some people think I am an isolated case and that I "slipped through the cracks" of the system. First of all the system is broken. Second of all there are people forcing us through cracks that need not be in place and are fixable if the right people care enough to fix the problem.

These studies by the Government Accountability Office (GAO) prove that troops feeling "screwed by the system" are not isolated incidents.

When I make my calls today I intend to discuss some of the information I read in these - I haven't finished reading them yet but will post comments when I do read them.

The Army times ran an article about one of these reports a few months ago. It was on page 16 or 18 of the issue about Dress Blues. It wasn't referenced on the front page so I doubt many people read it - I almost missed it myself.


This one is titled Improved Oversight Needed to Ensure Consistent and Timely Outcomes for Reserve and Active Duty Service Members
http://www.gao.gov/new.items/d06362.pdf
It is the GAO Report to Congressional Committees


This one is titled Ensuring Consistent and Timely Outcomes for Reserve and Active Duty Service Members
http://www.gao.gov/new.items/d06561t.pdf
It is the GAO Testimony before the Subcommittee on Military Personnel, Committee on Armed Services, House of Representatives

- Ragin' Ranger Out

Better than a standard congressional complaint

I got this email from a friend the other day. Might as well take advantage of the election cycle when people at least *act* like they care.

Hiya-
I've had a bad day, but hopefully it will mean good things for you.
I'm sorry, but I have to tell you a boring story before I get to the part
about you. We have a lot of close races for Congress right now in CT.
Congressman Rob Simmons has an ad out featuring a "mother" who says that he
got weapons for her son's reserve unit. That irritated me 'cause in 2003 I
wrote to him asking that he do his part to either get equipment to soldiers
or stall 'til soldiers had the right equipment and the response basically
accused me of lacking patriotism.
Anyhoo, I e-mailed his office and I sent the same e-mail to the office
of his competitor. Funny, when it wasn't an election year it was months
before I got a response in the form of a letter. Now it only took about a
half-hour to get a personal phone call. First from his chief of staff and
then from the Congressman personally.
The response was frustrating, but I'm sure you're familiar w/ all that.
At one point he tried to smooth it over by acknowledging that Chris was
home now. However, it's not OK 'cause from what I can tell the situation
has not improved for troops overseas. Also, our reasons for leaving were
mainly healthcare and education, not the war, and those have not improved at
all. All the good soldiers have left for those same reasons and my fear is
if another 9/11 happens all that we'll have to defend us are the dopes.
Also, as I told the congressman troops who were severly injured are only
being offered 10% disability and the Army is consistently playing games to
prevent people from leaving.
Now here's the part that you're interested in. Even if you are not from
CT, There is someone in Rob Simmon's office who is taking on the cases of
mistreated soldiers. His name is K. Robert Lewis (aka. K.Bob) his # is
(860) 886-0139 and his e-mail is Krobert.lewis@mail.house.gov . He'll probably ask you for a privacy release to investigate.
I'm sure that you've been down this road before, but at the end of our
conversation he seemed serious about helping.

- Ragin' Ranger Out

re-fighting the last war . . . AGAIN!

Below is the link to a very sad article from Newsweek about the psychological impact war has on the individual.
The war never really goes away from those who have been there. This article highlights the affect the current war is having on Veterans of previous wars, Vietnam in particular. I guess they are the living proof that the wars have a lot in common.

http://www.msnbc.msn.com/id/14966290/site/newsweek/

There is only so much a vet can do to distance themself from a past they would rather forget -- but they can't un-see or un-do, or un-hear, or un-feel, or un-taste, or un-smell. It is part of us and we all act differently based on the relative stress levels we endured. I'm no shrink but I have seen people drastically change after some experiences over there.



- Ragin' Ranger Out

The World a Soldier Sees

Just a picture of the world a soldier sees. I looked through that windsheild with that frame for about 4 months until we moved into an airplane hanger. It was home. I burned a Yankee Candle on the dash to smell something other than burning shit and piss and other contributors to 3rd world stench. I didn't mind living in the truck -- I kind of liked the solitude, at least when it was quiet, and it was often quiet.



- Ragin' Ranger Out

MEB NARSUM Appeals

When writing an appeal to an MEB NARSUM it can be very difficult to not get personal in writing style. It is important to remember that the people reading the appeal probably don't care about your personal life and don't care for your opinion of some doctor. I haven't heard many service members compliment doctors, it is a rarity. (I will compliment my doctor -- he did a wonderful job re-attaching my arms so that they stay in the socket -- I am very pleased with what he did).
It is important to not stoop to a level of "attack mode," but to very carefully and professionally point out errors with what the doctor "may have missed," in describing your condition.

Open nice and politely by saying something like: "After reviewing my MEB and NARSUM I am concerned that my condition is not fully described in a manner that will allow the reviewing doctors to have an accurate understanding of my condition."
Then list all the things that you saw that are wrong and describe, professionally, why it's wrong. "According to AR 40-501," is a great way to start describing why your condition is not properly documented. Attach updated records that support your claims. Make this easy for the reviewers: "my NARSUM states that I have ___, however, according to AR 40-501 my condition should be documented as _____. The attached records from a visit with Dr. ___ describe why this should be changed.

An EXTREME for instance: If a patient had their left arm amputated and the doctor wrote "patient has limited functionality of upper extremity." The very first step is to locate the paragraph in AR 40-501 that references amputations and explain that because the arm is gone, a better description is: "quote from regulation." Though it may be tempting to write something like: "This doctor is totally incompetent and grossly misdiagnosed my amputated arm condition as mere 'loss of functionality in upper extremity,' he obviously does not care how my disability rating reflects my condition."

Yes, the second statement sounds awesome in the court of public opinion and with your buddies in the barracks, but the MEB bureaucrats will label you a whiner and your appeal will be taken less seriously.

Another great problem in military medicine is the 2nd opinion debate. What constitutes a second opinion and where is a second opinion guaranteed? I'm still trying to find a definition of both cases and when I do I will post it, but right now I don't know.
However, if your PCM tries to say that you had a second opinion and you don't think you did, think about the credentials of the providers you did see.

AN EXTREME For example: If your PCM is a proctologist (ass doctor) by specialty and is counting his opinion about a brain tumor as your first opinion and the opinion of your orthopedic doctor as a second opinion, you may be able to build a case for why neither of these counts as an opinion.
A brain tumor patient should probably see a brain-tumor doctor, an ass doctor, as a PCM, should first write a referral for the patient to see a brain-tumor doctor -- that should count as opinion #1. If the patient is not satisfied by the recommendation to have their knee scoped to cure the brain tumor, the PCM (ass doctor) should write a referral for a second opinion by another brain-tumor doctor - this time a case manager should intervene and double check that the brain-tumor doctor has the specialized training and qualifications necessary to diagnose and treat the condition and act in the best interest of the patient.
PCMs can certainly count as a first opinion in many cases but for some serious and complicated cases the opinions of specially trained experts are essential to providing the best care possible.

In closing the appeal a good way to sign off is to just say words to the effect of "I feel that my above recommendations are needed to describe my condition. I have attached the following documents that support my claims: list of records that you have that were either lost or are from outside providers, or were created after the dictation was written." Then, if needed: "I respectfully request the opportunity to see another specialist for a second evaluation and opinion of my condition," or "I am still pending further tests and evaluations that may change the nature of diagnoses in my MEB."

It is important to sound confident and professional. Don't stoop to their level.
Also keep in mind that anything not listed on your MEB will probably be denied by the VA. You can still appeal the VA, but its a time consuming process and a pain in the ass.

This next paragraph can be confusing, I had trouble writing it, to much regulatory bull shit involved in government money. Every case is different and I suggest talking to a veteran's advocacy group before getting anxious about money situations but the bottom line is simple: if the gov't can find a way to not pay the will find it.

This is a warning shot, this can and has happened:
NOT having conditions listed on your MEB can also work in your favor with the VA. The VA withholds the total value of any money a vet received from severance pay -- some gov't jibber-jabber codes payments intended to go to vets from the VA as "already paid" by DoD (DFAS), and instead of VA money going to vets it goes to DoD. What the gov't is saying is that the severance pay was just an advance on a vet's disability payments by the VA. To get severance from the DoD and then get disability from VA would be considered "double-dipping) So, if a vet has been discharged at less than 30% disabled (by their active component), but due to a laundry list of conditions, all VA compensation for those conditions will be withheld until the severance is "paid back." If a vet is discharged for less than 30% with only one condition they can claim their additional conditions with the VA and not have that compensation withheld. Cases over 30% are even more complex, I'm not going to try to explain it -- go to the VA site to get confused, sorry.

- Ragin' Ranger Out