show me the money

Below is a link to a page that helps calculate disability pay from the
Army and VA, and how those payments relate to one-another.
I have only included the severance pays from the Army - it is the most
common form of Army Medical Separation Compensation. About 90% of all
medical separations are severance based (0% - 20%). Retirement is
effective from 30% and higher. Retirement warrants an entirely separate
calculation process.

Hotline

The Army has put up a hotline for soldiers and family members to call with concerns about the MEB/PEB process.
The number is 1-800-984-8523
Overseas DSN: 312-328-0002
Stateside DSN: 328-0002

email: wsfsupport@conus.army.mil

Link to [Flyer]

Flyer Text:
The purpose of the hotline is two-fold:
    -To offer wounded, injured, or ill Soldiers and their family members a way to share concerns on the quality of patient care.
    - To provide senioer Army leaders with visibility on medically-related issues so they can properly allocate resources to better serve Soldiers and families.

The hotline is an avenue to gather information about medical care as well as suggest ways we can improve our medical support systems.

The hotline has not been established to circumvent the chain of command, but rather to give Soldiers and family members an additional means to resolve medical-related issues.  Any type of retribution directed towards those who use the hotline will not be tolerated.

-End flyer text

I wonder how flooded this phone line has been.
I'll be calling soon . . .

what's it take

http://www.thenation.com/doc/20070409/kors
Is America in denial?
I hope not.  In fact, I don't think it is.  I think some politicians are in denial, or they're just good liars - that's a tough one.
I've said before that I probably wouldn't believe the stories I tell if I hadn't lived them - the medical treatment of troops in the military is literally unbelievable.  This story makes me very sad.
I won't do it much justice trying to describe it, but it illustrates how medical conditions are used by MEB officials to kick troops to the curb and leave them behind.
If I hadn't seen this happen I might not believe it myself - but now I encourage all troops to tape record conversations with their providers - it's perfectly legal - just watch out - THEY might say you're paranoid or something . . .

playing doctor

Sometimes I feel like I'm watching an episode of Whose Line is it, Anyway when I'm looking at the standard procedures of evaluating the medical fitness of soldiers in the Army. Total confusion, total "cover my ass," total ad-hoc, and inconsistent application of Army Regulations.
First of all GAO has already called this an "overly complex system" but still the system remains in place, unchanged.
So who determines the actual disability ratings for a soldier? WOW, that's a loaded question.
The Physical Evaluation Board (PEB) is made up of three people, only ONE of the three needs to be a doctor, and they are the final authority for determining the disability rating a soldiers will receive upon exiting the Army. That's according to Army Regulation 635-40 Section IV, Chapter 4-17 paragraph b. Check it out
But where do they get the information to make such an important decision?
Referral to the PEB comes from determinations made by the MEB after a long, often ugly process that soldiers must endure. The system really isn't all that bad - once understood. The problem is that the administrators are corrupt as all hell.
The PEBLOS will tell soldiers things like "the VA will take care of you," or any other of a series of lies that will encourage soldiers to hurry-up and leave the military, even if the soldier will lose benefits in the process.
One PEBLO had the audacity to tell me that my wife "didn't deserve a second opinion," and that she just needed to "learn to deal with her disability."
So who are these PEBLOS who "play doctor" or try to "play god" with patients' medical care, future benefits, and their lives - they are AGENTS OF A GOVERNMENT SYSTEM. They don't represent anyone's interest accept the Army's - and that means saving money - even at soldiers' expense.
And to make matters worse, severely injured soldiers at Army Community Hospitals, like at Fort Benning (Martin ACH), Ft. Campbell (Blanchfield) and many others, are seen by Primary Care Providers (PCMs) who are General Family Practicioners, Physician Assistants, or Nurse Practicioners. These PCMs write the MEB - the document used by the PEB to determine the disability rating a soldier will receive. These PCMs are NOTORIOUS for falsely recording patients' conditions. These PCMs lack the specialized training often required to properly describe and document the ACTUAL condition that a soldier suffers - yet the PCM can over-rule the opinion of any specialist, and the PEBLO will send the botched MEB forward. Sure a soldier can appeal - but why put a soldier through the extra work of appealing, why not just properly document the condition in the first place.
My opinion, and I share this with many others, is that the "agents of the system" (PCMs, PEBLOS, etc.) hope that soldiers will quit asking for help, will get worn down by the system, accept defeat, maybe even believe that the VA will help. They want the soldier to sign away their benefits and leave the Army.
One quality control mechanism I propose is instead of rating a hospital's performance on how fast soldiers get booted, rate that hospital NEGATIVELY for every appeal it generates. Army Medical Command Officials should want to know why certain hospitals have left more soldiers dissatisfied than other hospitals. HOLD THE LEADERSHIP ACCOUNTABLE!!

ARMY MEDICINE EXPLAINED?

This links to a page that helps explain the Army Medical Separation Process.
It can only HELP explain the system - the system is so confusing that even the administrators make mistakes sometimes. Actually I think they "make mistakes" on purpose, but that's my cynical nature, I guess.
What is the difference between the MEB, PEB, and MMRB?

PUBLIC AWARENSS

Hey, don't get confused yet. I still haven't SCRATCHED THE SURFACE of the VA stuff yet.
AND REMEMBER, THE VA IS A TOTALLY DIFFERENT SYSTEM, AND COMPLETELY SEPARATED FROM THE ARMY SYSTEM.
BUT YES, ABSOLUTELY, BOTH NEED TO BE FIXED!!!!

More confilcts of interest

I know I already mentioned this once before but the conflicts of interest in Military Medical Care have come into the spotlight again.
At WRAMC soldiers did not feel they had any advocate - their case managers, doctors, nurses, chains of command, even the Medical Evaluation Board Liaisons seemed to have the system as a priority over the current and future care of the soldiers.
Baffling how this can happen.

But it was an MEB officer that told me my wife didn't deserve any further medical treatment - that worker had to sit through "sensitivity training" - probably just the annual required training of any hospital worker - when I voiced my opinion that her attitude was potentially harmful to the health of other soldiers and their families.

It was almost funny to hear GEN Cody talk about the MEB, PEB, and VA processes of disability rating. It's so fucking confusing. Yet soldiers only get a few days to weigh their options once given access to their rating paperwork. It takes weeks to grasp the ins-and-outs of that complex system, and "no one" can ever seem to explain it to confused patients. The MEB officers hide behind their position and case workers are too closely tied to the hospital command structure.

Case managers need to be patient advocates, not another obstacle. We had a wonderful case manager here, until it became clear that she was actually HELPING patients - then her supervisor - a Lieutenant Colonel limited the contact she could have with patients - the LTC was more interested in a faster moving system - never mind medical duties to help troops heal.

Plan? What Plan?

When I was in Ranger School I can remember one of the best lessons I ever learned. I was the Platoon Sergeant for a mission and had to write paragraph 4 of the OPORD (Operations Order – this is the tool used by the Army in planning any mission). I barely did anything with the OPORD, that was up to the Platoon Leader to write, I was just going to make sure everyone was awake (food and sleep deprivation at Ranger School made us all want to catch some zz's whenever we could). One of the Ranger Instructors approached me wanting to know what I was doing. I told him I was making sure everyone was awake. He told me to get to work on the OPORD paragraph 4 – that was my job for now. Without skipping a beat he began to explain the importance of the P4 tasks. To that point we had really only focused on Paragraphs 1-3, the actual operation itself. Paragraph 4 was for all the behind the scenes, non-flashy stuff. But Paragraph 4 is probably, as I now know, the most essential Paragraph to the OPORD. This paragraph includes the Medical Evacuation Plan (MEDEVAC). What this RI explained to me was that this Paragraph fueled a soldiers motivation to fight hard and not cower behind his rucksack when the bullets start flying. If a soldier knows that they will be cared for if shot, or worse, the will fight harder knowing that. The Ranger Creed obligates us to “Never leave a fallen comrade,” and the details of the MEDEVAC plan enhance soldiers’ faith that leaders will not only not abandon them, but have a plan to take care of them, especially in the “golden hour,” where life hangs in the balance.

The shittily planned Iraq war had no Paragraph 4. The only large scale logistics have been pocket padding to high-paying politicos. The only MEDEVAC plan is failing. Look only as far as any Army hospital to see the sad state of affairs for wounded soldiers. They are the forgotten ones. Those who live on impaired are forgotten and further punished with he burdens of their injuries and the sketchy medical care they receive. And once the VA takes over – shit, where do I start.

How long will it be before soldiers realize that there is no MEDEVAC plan and they lose the will to fight at all?

Too little too late

Where does the buck stop??
So Weightman was only in Command for 6 months -- who was there 6 months ago and what did they do about this? Those kinds of structural problems don't happen in a few months - we're talking years of abandonment.
What next? What happens after this knee-jerk reaction settles? Will there be follow-up but the administration? Walter Reed is supposed to be the Flag Ship of Army medicine.
Actually the problems at Reed are fairly simple when considering the problems at other hospitals - the ones out of range of national reporting - like here at Ft. Campbell.

These failures are directly linked to the administrations failures in the preparation for war.

WRAMC ain't the first

In September, 2004 I left the 101st Airborne Division and became a MEDDAC soldier in the Medical Hold Company. I was awaiting separation from the Army because of injuries I received while deployed. My wife was also having serious medical problems (BUT THAT'S AN ENTIRELY DIFFERENT STORY).
When I came over to the Ft. Campbell Hospital, Blanchfield Army Community Hospital (BACH) I was offered a company command. The Troop Commander, a Major, was an energetic and compassionate leader - I had a great deal of respect for her and wanted to accept the job. Especially after she discussed what my duties and responsibilities would entail:
The Medical Hold barracks were horrible. Much like the ones at WRAMC now featured all over the news they were full of mold, mildew, asbestos, and deteriorating construction - holes in walls, broken window frames - these were not suitable for soldiers. There was no handicap access and no elevators - and, like at WRAMC, these soldiers were severely disabled I walked through these barracks and wanted to help get them fixed.

The Troop Commander had been working on getting these fixed since they had taken command but to no avail.
I did not accept the company command - my wife's health had deteriorated too much. If I took command I would either abandon her, or be in a position where I could let soldiers down - I was not willing to accept either of these outcomes. I helped with the company in a limited capacity and took care of my wife.
The soldier's barracks situation improved before my wife was granted access to the care she needed in order to heal.

When we requested work orders on these dilapidated buildings the housing office would explain that because the barracks were so old, and marked for destruction, funding could not be approved to renovate or otherwise fix the problems. New construction on-post had priority over old construction - understandable - but it didn't address the current housing problems.

Eventually, after many false starts, the Troop Commander found ways to correct the problem as much as possible. She found ways to get repair work done. Some soldiers moved to a hotel off-post. The soldiers got moved to a better building almost a year later. But better than what? What is considered acceptable? They just moved to a somewhat better building. It's still old and falling apart and won't get renovated, either.

AND I KNOW SHE BROUGHT THESES PROBLEMS HIGH UP THE CHAIN OF COMMAND.
She did her job but found little support from above.

But Ft. Campbell is getting a new command center - it looks nice, IT's HUGE!! Lot's of money going into that development.

The Army is about people, soldiers, not about machinery or equipment. What good will that equipment be if there are no more soldiers left to use it?

accountability

Walter Reed's Commander just got canned, NOW WHAT?
In the reports yesterday soldiers at WRAMC were being punished for their leaders' failures. The First Sergeant was fired, and now the 2-star General got fired, too.
I wonder about the people in-between . . .
There is quite a large gap in rank-structure and accountability between the Company 1SG and Hospital Commander.
BUT - the burden of Command is great and a new commander may be the right start. I trust that the investigators will discover many systematic failures as well as human failures in this whole mess - after all, someone has to design, implement, and oversee this broken system.
The President was at WRAMC a few months ago. Having prepared for VIP guests at various-level functions I can assume that the preparations made prior to the President's visit included making sure all the "bad things" were covered over.
So, while I believe our President is failing in many ways, in this instance I would not be surprised if the military shielded themselves from looking bad.
And that just goes back to integrity and the lack there-of at high levels of the military chain of command. The really good leaders, the ones who put their troops before themselves, usually get passed-over and forgotten. But that's another rant for another day.
Instead I am left to ponder what will become of military medicine - this shit storm may be the catalyst of change so desperately needed.
The Army Times is doing a great job tracking the problems with disability ratings and other issues surrounding the Medical Evaluation Board (MEB) process.
Hopefully the new governmental leadership will start doing what they were selected to do - fix the broken shit the current administration won't admit is broken.

Military Med system FUBAR -- part 3 (5? 67?)

But it also should not have taken newspaper articles to bring change to outpatient conditions at Walter Reed. And while filthy conditions at Building 18 are a temporary problem for these veterans, lowball settlements may leave soldiers and their families impoverished for life.

-- Washington Post Editorial, "Rotten Homecoming" -- 21 FEB 07

I find it nearly impossible to explain how this stuff can happen, when family or friends ask. If I'm bitching about how frustrated I am with being denied treatment or only getting it after a 3-year fight, it's understandably bizarre. I got tired of trying, because it always ends up in, "Well why don't you just...(..)?"

Which would work in any OTHER HMO.
And which wouldn't be necessary if more of the leadership were more interested in patient care and troops' well-being, than number-crunching and avoiding conflict with unethical practitioners.

Here's the systematic issue:

The biggest problem is: most of us wounded, maimed or disabled get
stuck at our shitty little "Army Community Hospitals" (ABHs) on our
own posts--away from the specialty clinics, support programs &
publicity of Walter Reed. Honestly, I'm horrified things got so bad
at Walter Reed, thank god for WaPo--but those articles exposed maybe
5% of the systematic failure to do right by injured troops.

It kills me how the Pentagon makes it sound like all "severely
injured" troops are getting care at Walter Reed. Or its sister-Army
Medical Centers (AMCs).
Bullshit--it's where a severely injured troop goes ONLY if he/she's
wicked lucky, Knows Someone or has a dramatic external injury. The
rest of us "severely injured" hospital-bunnies would all but pull out
a buddy's IV to get to Walter Reed. It's like Xanadu, heaven, a place
of wonder.
The difference? At Medical Centers like WallyWorld you get, you
know, medical treatment along with your
moldy/infested/condemned barracks... Rumor has it: the troops are
sometimes even treated like patients instead of weaklings or shitbags.
WOW!

The majority of us-- shrapneled digestive systems, organ failures,
traumatic brain injuries, spinal cord issues, single-arm amputations,
or whatever (even cancer) get scattered around the country, out of the
public eye (i.e., in little army towns with no investigative
reporters). At these ACHs, hospital administrators can deny
treatment, falsify records, or otherwise screw us with no
repercussions that I've seen, ever.

To be fair: most of the people at these Army Community Hospitals on
tactical/"grunt" posts are AWESOME. Many are army wives or formerly
troops themselves. 90%+ are professional, sweet, and busting their
ass to keep things going. They're so exhausted from dealing with
overcrowded clinics and increasingly pissed off patients, I truly
don't know how they stay sane. I submit "Good Job!" reports on them
whenever possible.

The problem, as usual in a bureaucracy, lies with:
A. Pentagon bean-counters (generals or senior civilians)
shortchanging the outlying hospitals to fund whatever rusty-ass
Artillery system got porked in again this year
B. Hospital admin types (senior officers) who pretend everything's
SUPER instead of grabbing their sack and addressing , or
C. A few unithical & power-trippy doctor or nurse (usually one in
charge of a clinic) too senile, incompetent, ambitious or psychotic
for the whole "medical care" thing

Of course, they're the "authority" or "professionals" so they're the
ones who get to give all the official input. We start thinking we're
just crazy, til we figure out the odds of simultaneous, identical mass
hallucinations are slim. Even on wacky pain meds.

I just don't know how to get help for all of us at outlying hospitals.
I've tried. Others here have worn themselves out trying. How do you
raise hell in Pudunk, Kentucky/Tennessee border for Peter's sake. ANY
suggestions would be genuinely appreciated. Congressionals get shot
down as fast as...quail-hunting partners. We're not allowed to sue
for malpractice (not that most of us would...but the threat might help
quality control)

Recovery Ops

I'm glad the lid finally got blown off the military covering-up the failures of the administration. These problems so recently brought to light about WRAMC (Walter Reed Army Medical Center) are only superficial. Taco Bell has rats and roaches. The real problem is the leadership's failure to take corrective action. These problems have been known for a long time.
Good leaders are not just the lucky people who have no problems during their periods of responsibility. (Though many generals and high-power politicians have either been so lucky, or have done a hell-of-a-job covering things up) The best leaders are the ones who can take horrific problems and conditions and make the situation better. It will take leadership beyond the capability of those currently in charge to fix this problem.
This should be investigated - letting conditions get this bad is dereliction of duty. But to say that leadership knew nothing of the problems adds insult to injury - quite literally in this case.
Either the high-up leaders didn't care enough to inspect all facilities, facility managers lied to higher-up leaders, or the higher-up leaders knew, and did nothing to fix matters. Each of these possibilities demonstrate the dire circumstances within the DoD's management of military medical practices.

What is more - Walter Reed is hallowed ground for injured troops - it's a MEDCEN (Medical Center), in the middle of Washington D.C.!!! The outlying community hospitals in the Army don't have nearly what WRAMC can provide. Soldiers in outlying hospitals live in worse conditions (yeah, I've seen them and smelled the puke left in the asbestos filled hallways by cancer patients returning from chemo and radiation treatment, and I've seen the moldy showers where burn-victims and amputees have to bathe) and there is no spotlight to fix them!!

These troops have returned home from war with life-changing wounds and injuries and the administration continues their "fight the war on the cheap" mentality by cutting corners on health care.

And why can't soldiers make a cause for this themselves? Why is it that these men and women fought a faceless, far-off enemy and can't stick-up for themselves? Easy - they have no weapon, and no support. The majority of seriously injured troops returning to these piss-poor conditions are low-ranking and have little-to-no family or financial support. Battling the physical injuries and psychological trauma of their injuries and the PTSD most likely linked to that injury leaves our combat-trained service members in an unsupported position. They have no recourse against shitty medical care and have no one to guide them through the red-tape involved in transitioning from active duty to the civilian world. Sure there are benefits and programs linked to service - but what good are these services when they are not made accessible to vets and families who would most benefit from them. Besides, most of these vets-to-be just want to get on with their lives - they aren't the type to wallow in misery.

Hopefully this WRAMC shitstorm won't stop in DC - so many more military hospitals need the spotlight turned on. Hospital leaders need to be held accountable for their neglect of troop health.


So if it takes the press corps to motivate the leadership of "this great Nation" so be it - our troops deserve better treatment and their leadership lacks the character, the moral courage and the intestinal fortitude to find a way to provide it.

Washington Post Article

http://www.washingtonpost.com/wp-dyn/content/article/2007/02/17/AR2007021701172.html

Here is the beginning:

Soldiers Face Neglect, Frustration At Army's Top Medical Facility

By Dana Priest and Anne Hull

Washington Post Staff Writers
Sunday, February 18, 2007; Page A01

Behind the door of Army Spec. Jeremy Duncan's room, part of the wall is torn and hangs in the air, weighted down with black mold. When the wounded combat engineer stands in his shower and looks up, he can see the bathtub on the floor above through a rotted hole. The entire building, constructed between the world wars, often smells like greasy carry-out. Signs of neglect are everywhere: mouse droppings, belly-up cockroaches, stained carpets, cheap mattresses.

This is the world of Building 18, not the kind of place where Duncan expected to recover when he was evacuated to Walter Reed Army Medical Center from Iraq last February with a broken neck and a shredded left ear, nearly dead from blood loss. But the old lodge, just outside the gates of the hospital and five miles up the road from the White House, has housed hundreds of maimed soldiers recuperating from injuries suffered in the wars in Iraq and Afghanistan.

Guide to helping soldiers and their families through Army Medicine

Here is a link to a handbook that looks to be a good resource for helping soldiers and their families deal with the many stresses that come from injuries and wounds from military service. There is a lot of great information in this book that I hope can find its way into the hands of many otherwise confused soldiers and family members.

[Our Hero Handbook]


- 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