quantify your quality of life

The MEB tries to assess troops condition by assigning a number - a percentage - to which that troop is unable to perform "normal" activities.
Unfortunately disability rating has become quite murky.
There are Functional Assessments available for the military to use and more accurately assess a troop's disability, but not too many troops go through those assessments.  Instead, the MEB generates a percentage based on medical records.
Activities of Daily living are a decent measure for a troop to describe how an injury affects them on a daily basis.  [This page] has an ADL worksheet that a troop can use to better describe their limitations.  A form such as this can be very helpful in a situation where a troop may disagree with what the MEB states.
This form makes a great attachment to any MEB Appeal.

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!!

Making the problem worse

Everyone's hoppin' and poppin' in DC now trying to looks busy, trying to look like they care, trying to make it look like they have been doing their jobs all along.
Stop trying to cover your tracks!! You're wasting time generating lies for press releases, just fix the problems.
The major problem that is destroying the medical system right now is the leadership. It just plain sucks. And there is no accountability of that leadership. The President answers to NO ONE - he's made that crystal clear, but with all that authority, where is his responsibility.
And then the head of the VA has obviously had his head up someone's ass, if not his own.

After meeting with the president, Nicholson defended the Veterans Administration, but acknowledged there is room for improvement.

"When you're seeing over 1 million patients a week, you have to be very good, and if there is any one patient who doesn't get the care that they deserve, that's unacceptable," Nicholson said

He said his agency is hiring 100 new patient advocates who will help troops returning from war deal with the bureaucracy.

"The American people can feel very good about the health care system that their VA is providing to veterans," Nicholson said, "but if there is a case where a veteran gets lost in the system, or suffers anxiety or their family does as a result of something we're not doing, that is unacceptable."

From:

Bush: No Tolerance for Medical Neglect

By DEB RIECHMANN

The Associated Press
Wednesday, March 7, 2007; 1:46 PM

By saying a patient is not getting the necessary care he is basically admitting that his whole organization is a failure.

And now he's hiring 100 more "advocates." The VA doesn't have advocates. The VA has bureaucrats. If a patient is to have a proper advocate - a person who will actually look out for the Patient's BEST INTEREST - not the interest of the institution, then that advocate cannot come from within the VA PERIOD!

The DAV (Disabled American Veterans) and the VFW help Vets fight the VA bullshit - THEY have advocates and representatives that act on patients' behalves.

And why are we changing the subject to the VA, anyway? Their system is in desperate need of repair, too, but Walter Reed is TOTALLY separate from the VA.

The problems at WRAMC are with ACTIVE DUTY Soldiers - and WRAMC is supposed to help them heal to a STABLE STATE where then the VA can help provide further medical care after the soldier leaves the service.

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.

You do the math

So Bush wants to take this opportunity to talk about how he has grown the VA budget under his administration -- Way wrong answer for those paying attention. He forgot to mention that the budget increase (decrease) is due to the increased co-pays and the decreased per-vet spending for the VA. The numbers of disabled Vets are growing faster than the budget is increasing, so claiming to increase the budget is BULLSHIT!!

Bush also will emphasize in the address that more than 1 million veterans have been brought into the Veterans Administration health care system since 2001 and that his fiscal 2008 budget proposal includes a request for more than $86 billion for veterans' services, representing a 77 percent increase since he took office.

---Bush Orders Review of Service Members' Care
By William Branigin

Washington Post Staff Writer
Friday, March 2, 2007; 5:18 PM

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)

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