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USAF reservist battles injury and government insurance system

By Kay B. Day

Col. Doug Strand with Zalmay Khalilzad, then Ambassador to Iraq. Strand said when he was in Iraq he worked directly with Khalilzad’s staff developing strategies to help the Iraqi people with water, electricity, rule of law, elections, and other matters.Col. Doug Strand served for 11 years on active duty in the US Air Force and he has another 8 years on active duty as a reservist. He’s jumped out of planes and he’s served in Iraq. He probably never envisioned himself grappling with serious medical problems and he certainly didn’t envision dealing with the complexities of Tricare, a military health insurance plan. But a few minutes on a hot summer morning changed his life forever.

Strand was traveling on his motorcycle to report for duty as usual in July, 2008. The base was 5 miles from his house. The roads were wet and when he was about to turn, the back tire skidded on the slick pavement.

The good news: he came to a safe stop on a grassy shoulder.

The bad news: the bike fell on his leg, crushing the tibia and fibula.

Strand was treated at a civilian hospital and after surgery, he was sent home a few days later. He had an open incision about 12 inches long on his leg. It would be a month before the incision was surgically closed. He couldn’t stand, dress or bathe without assistance. His wife changed the dressings each day. He ordered bandages, dressings and crutches from Internet websites.

For some reason, placing him on continuous active duty orders—a requirement for the care and provisions he needed—took 7 months. Then there were administrative errors resulting in delinquent orders. Strand said Tricare personnel didn’t know what medical rights were afforded reservists who were injured even if they were on duty. Nothing went according to procedure and there were countless delays.

Completing his paperwork necessitated his traveling to the base 50 times and there was no assistance for transportation. He said, “I was told I would have to pay $500 from a private carrier for each round-trip appointment.”

Strand’s wife Vivian is a small woman—transporting him is next to impossible for her.

Strand said Dept. of Defense regulations actually require members to be placed on orders immediately for treatment and to ensure pay begins within 30 days.

One thing was clear—Tricare wouldn’t provide transportation to or from appointments even when the patient couldn’t stand or walk, much less drive.

And thank God for Internet medical supply companies.

Tricare was the only insurance Strand had, relying as many in the Guard and Reserves do on government employee insurance. He said because of his frequent activations, he hasn’t had a full-time civilian job since 1999. Ironically had Strand not been on active duty, he might have been better off.

The premium-based Tricare Reserve Select coverage would’ve kicked in had he not been activated. But since he was active, that coverage would not apply.

In Strand’s case, the complications and misfires with government regulations had a negative impact on his health.

A condition called Reflex Sympathetic Dystrophy set in. Strand said, “RSD is believed to be the result ofCol. Strand was sent home after surgery with an open incision about 12 inches long on his leg. It was a month before the incision was surgically closed, setting up opportunity for complications. dysfunction in the central or peripheral nervous systems...[it] tricks my brain into thinking I have a brand new fractured leg and my body’s defenses rush to the area causing pain and swelling.” The pain can be excruciating.

As a result of swelling, pulmonary embolisms developed.

And here’s the most frustrating part. Strand said, “If diagnosed and treated in the first few months, RSD can be reversed. Beyond that it progresses through stages of constant pain and swelling, atrophy of bones and muscles, and symptoms can spread anywhere in the body. It is a progressive disease—it gets worse over time.”

For patients with RSD, it is not uncommon for them to plead with a doctor to amputate their injured limb—they believe that will stop the pain. It doesn’t—phantom pain often persists.

Strand said his diagnosis came too late—9 months after the injury—due to delays in military medical care caused by Tricare and paperwork at the Reserves.

As he struggled to heal and as he and his wife Vivian dealt with getting him back and forth to the base for the paperwork, he realized the numerous trips aggravated his wound. How could he elevate his leg when he had to travel back and forth to deal with procedural issues? He doesn’t mention the stress, but there would have been plenty of that as well.

Strand said he discovered the problem he had with his “orders” aren’t unique. “This is happening to the Reserves and Guard in all branches of service,” Strand said. “If these branches complied with already existing laws passed by Congress and regulations written by DoD, there would be few issues with members obtaining healthcare and other entitlements...A sweeping inspection of medical order processes needs to be completed by each service’s Inspector General.”

Enforcement of standards typically falls within the IG’s office Strand said.

He also said staffers mismanage reservists who need medical attention—there’s “little to no accountability.”

Two wars have required more numbers of reservists and Guard than normal times and they are often on active duty for longer periods.

“Some reservists and Guard are returning from war zones with injuries. They are removed from orders and sent home without being processed through the disability evaluation system resulting in no pay or medical benefits. Being unable to work, they can lose their jobs, their homes and then their families.”

Strand also points out if a patient can’t walk or drive, some sort of transportation needs to be arranged.

Somehow, he’s kept a sense of humor. “I could win any ugly legs contest—hands down!” he told friends on Facebook.

But he’d really like to see the government address problems he and others in the Reserves or Guards face when they have a medical problem. His illness was complicated by countless paperwork glitches and delays in the treatment he needed. Others may experience the same, put in a position to fight not only the injury but also the government healthcare system.

“This has got to stop,” he said.

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Reader Comments (24)

I have RSD or CRPS, too... and I totally sympathize with him. God Bless you and your family and may HE give you the strength to keep on fighting!

February 5, 2010 | Unregistered CommenterSandy L

I fully agree that this has to stop. I too have RSD and know what you are going through. My doctor has come up with something that has helped me. We must all hold tight to our faith because the research is on going. My heart goes out to you and well as my husbands and my prayers. Tell you wife that I think she is an angel because only an angel can handle a spouse with RSD.

February 5, 2010 | Unregistered CommenterPat Cearley

Five years ago today my daughter got RSD, even though she was treated immediately it went into a full body extreme case within one year. She has been having ketamine treatments, which have saved her life. Dr. Ronald Harbut is in the Pain Management VA office in Arkansas and he is wonderful, expert in RSD. Doesn't sound like you qualify as a vet, but he is worth talking to. God bless you.

February 5, 2010 | Unregistered Commentercatherine

I am a disabilities from rsd,crps ,spred .God bless u alls your families trees and friends .every ones who know please help him and his family in any way and ,or take someones who can help him.Thanks yous so much ,God bless alls of u .

February 5, 2010 | Unregistered Commentern.nimsaneh,Maryland

I feel your pain Sir, I too went through the same process you went through almost 20 years ago after I developed RSD/CRPS. I thought I was mistreated by supervisors and medical personnel because of my rank and/or my race. However, after reading other articles about other soldiers I figured that my case had nothing to do with me.
The Air Fore tried very hard to kick me out without giving me any compensation and assigned a brutal and rude MSGT Teri Kirkbride who insulted my dignity and interrogated me almost everyday putting others to follow me and the stress he put me through aggravated my condition even tho I gave him letters from my military doctors and civilian doctors stating to live me along otherwise I might ended up on permanent disability which I now am due to his ignorance.
The RSD/CRPS spread all over my body and now I'm wheelchair bound and bed ridden most of the time due to excruciating burning pain.

February 6, 2010 | Unregistered CommenterSabino Deodanes

Glad to hear that things are changing for you now, Col. Strand!! I hope that your wife is recovering well and feeling less anxious about your illness. I have under-treated RSD/CRPS as well, so I understand the frustration that comes with a poorly understood medical disorder.
For others that may read these posts, your local VFW may be able to help where your military system drops the ball. I was concerned when I read his story, and called Col. Strand's local post to arrange for some help that was not being offered through Tricare or the VA hospitals. I learned what a mighty force the VFW really is when a soldier is in trouble. Maybe someone else will benefit from contacting their own VFW post.

February 6, 2010 | Unregistered CommenterSusan Diamond

Col. Strand, I wrote you this morning and forgot to tell you that as a veteran you are entitled to see a doctor at any VA hospital and I would like to mention Steve DeBoever, a Federal Advocate who represents veterans at the DOD, Social Security, and at VA with exemplary record. He is a DAV Officer and he is also a VFW Officer. He represented me at my VA hearing and I received a very good rating. Better than when other VFW rep.s represented me when I got only 30% then 70% His phone number is 530 688-0461 or at spdeboever@prodigy.net
you will not go wrong if you let him be your representative. You can read more about him on my website. Good luck to you Sir and may God bless your wife for her invaluable support.
Sabino Deodanes Ret. SSGT USAF

February 6, 2010 | Unregistered CommenterSabino Deodanes

Thank you all so much for your kind words of encouragement. I just said a special prayer for all our troops who are having similar issues, and believe Angels are on their way to help.

February 7, 2010 | Unregistered CommenterCol Doug Strand

I am an Army Reservist also injured while on Active Duty. I was diagnosed in Aug 2007 with RSD from a fall back in July 2006. I have been trying to get medical assistance from the military since I was diagnosed.

Its very tough.

February 7, 2010 | Unregistered CommenterChris

Dear Col Strand,
No human being should be treated in the fashion you or others in our very own armed services are treated. It saddens me that you fight for those very bureaucrats freedom only to be let down and start a new fight on a new grounds with crps. I also suffer with crps and was dx early within 2 months and although mine is a florid case It has remained in one limb. I feel if you had had the proper medical treatment without the added stress you may have had a much better outcome. Not all crps/rsd responds positively to early dx and tx but you will never know as you were denied such treatment. God bless your wife and yourself for staying strong. Lets pray your voice is heard to help others. You are in my thoughts and prayers.

February 8, 2010 | Unregistered CommenterDebbie Fisher

Col. Strand,

Each time I read of someone's experience with RSD/CRPS I am saddened by what I know they are going through as I, too, have RSD and have had since March, 2000. It is now full body. The pain is more than anyone should have to bear and worse, there is no cure for this condition.

Because RSD/CRPS is so misunderstood or not known about at all there are many who are suffering and often not getting the treatment they need as in your case. Most often if a person is treated early on then perhaps RSD can be put in remission but if not then chronic suffering becomes our way of life.

The delays in your treatment is unconscionable. I have met two soldiers from Ft. Knox who developed RSD and they were separated from other patients, not allowed to be seen by others.

In the last few months I have been receiving ketamine treatments and they are helping me very much. I hope that you find something that will help make your pain more tolerable.

Kudos to your wife for standing by you. You have a great attitude, it will help you through the challenges ahead.

My thoughts & prayers are with you,

February 10, 2010 | Unregistered CommenterCarolyn Clemons

First of all I'd like to thank you for fighting for our country and being a part of the military. I have had RSD for almost a year now, in my leg as well. I know the daily battles and struggles that all of us face as victims of this horrible disorder. I hope your voice is heard by those in control of the medical treatment for those who serve our country- you are our country's most valuable assets and there is no reason that you were denied treatment. I found out I had RSD 6 months after the surgery that caued it, but that was apparently too late because i have had very little response to any treatment. But there is still hope for all of us, that one day a treatment will work. Until then, my thoughts are with you and your wife.

February 11, 2010 | Unregistered CommenterCourtney

I'm a military veteran who got RSD from a car wreck. With no insurance I was forced to turn to the VA for medical treatment. My VA doctor looked at my chart for mere moments then stated "maybe your Christian god can help you". Not knowing how to treat my pain I was given 90mg of morphine daily and labelled as a "drug seeking patient". Five years and a lawyer later I now have Medicare and access to a real doctor who immediately took me off morphine and put me on a med that works much better. I'm now doing a little better but I'm addicted to opiates. The Medicare system is far from perfect but it got me off opiates and for that I'm truely grateful. I pray this disease, the VA, and Medicare all get cured very soon. I'm sick and tired of feeling like I've been set on fire and struck by lightning at the same time.

February 11, 2010 | Unregistered CommenterBrian Morris

Col. Strand,

I am so sorry that you are getting treated with such disrespect. So much for "taking care of our own."
I, too, am a Tri-care patient. My husband is active duty USAF. My personal experience with them is no where near what you are experiencing. I do, however, have a hard time finding MD's on their list who treat RSD patients. For some reason, MD's aren't wanting to team up with Tri- Care as a provider. hhmmm

GOD bless you and your wife. This is very hard on a marriage. Unfortunately, I know this first hand. My husband bailed on me, after being diagnosed. "It's just not fun anymore," was his reason.
Keep up the good fight. As RSD patients, we simply can't back down.

February 11, 2010 | Unregistered CommenterShaun Skerbitz

I am angry! That no one is taking Reflex Sympathetic Dystrophy more seriously! Not even our own doctor's! Either they do not know how to handle the disease and prescribe all sorts of medications like the patient was some sort of guinea pig or run tests that amplify this disease! The biggest line from a doctor? "Let's try this!"

What we, the patients need is new protocal in screening for this disease, proper and timely diagnoses, with treatment that is suited just for that patient!

It would be great just have the medical society, period, to take this disease very seriously. I would love to have everyone walk in the shoes of an RSD patient for one hour!

I am certain that there would be change!

February 11, 2010 | Unregistered CommenterRita Horner

Update on my current TRI CARE EXPERIENCE. Lets see, I was at the base office, in tears with pain so intense I couldn't stand it. I had to make an appt with a MD I don't like! There aren't any around. I was told the hard copy is being faxed over (as I was standing there) to the TRI CARE OFFICE , marked ASAP. I was told I would receive a phone callI today to scheedule. I called at 1630 and they still haven't received it. I whole heartedly agree! RSD patients need help. I don't want to be bogged down with narcotics; I have a family and little girl that deserves a mother. My origin was left knee, 2005. Basically in remission for the last 1 1/2. Seven weeks ago I had undergone emergency colon surgery. Thanks to my surgeon not knowing about RSD, (and I was in no capacity to remember) I didn't get a nerve block. After being gutted like a fish, I now have RSD in my new incision; a branding iron to my stomach. "No, it's not RSD. I've never had RSD in the stomach, before, " says a resident. IDIOT!!

February 12, 2010 | Unregistered CommenterShaun Skerbitz

i think it is a shame that our government would allow any soldier who fought for our country to suffer like this without doing everything they could to help. perhaps if they spent less money on helping other countries and helped our own country (especially our soldiers), we would not have this problem. after all, our soldiers risk their own lives for our country, one would think they deserve to be treated like heroes and kings. IT IS AN ABSOLUTE OUTRAGE!

February 12, 2010 | Unregistered Commenterchristie scott

I have had RSD since 2000 when I was 14 years old. I went into remission starting in 2003, but then relapsed in 2006. My neurologist switched me from Neurontin to Lyrica which I am really happy about. I broke my ribs in June, and the RSD has since moved to my chest. It's hard to deal with having to bundle up for the cold when it hurts to have even a tshirt touching me. Trying to get it under control again, but my neurologist doesn't want to up my Lyrica anymore than it's already been upped. :-\ I wish there was a definite medication or treatment that worked for EVERYONE.

God bless, everyone. I hope for a pain-free Valentine's Day weekend.

February 12, 2010 | Unregistered CommenterKerry

Hello Doug
I heard you on the radio yesterday and It just made me sick as to how you have been treated..I can not believe this people don"t see whats going on.. There are so many DR"s that don"t know about RSD as you know..I was first told It was all In my head. Well they found out different. I have had RSD for 15 years now and unti this last DR I was not treated..Had to live with the pain.. Have a very good DR now and hope and pray that you find the same thing..It really will make a difference In you life..Bless you and your wife for we do know how hard It Is..I have a jewel of a hubby. I thank god every day for him..Take care and hope that you get some pain relive soon...HUG"S to you and your family.. Judy Greene

February 13, 2010 | Unregistered CommenterJudy Greene

Keep fighting the good fight. Maybe one day someone will listen and help those who have gone through this.

February 14, 2010 | Unregistered CommenterToolgirly

Col Strand,
Thank you for sharing your story. My husband has RSD and we understand the emotional and physical pain associated with it. We also understand how misunderstood this disease is in the medical system. I would expect pain specialists and neurologists would know how to treat the disease properly but most do not. I wish you luck. My heart goes out to you and your wife. God bless.

February 14, 2010 | Unregistered CommenterRachelle Gapinski

I have had RSD for over 3 years now. This horrible disease has destroyed what was once my very active, productive and wonderful life. At 40, I thought my life was amazing. At 43, I fear my life is over. Why this is happening to me, I cannot say. But I WILL say that when men and women such as Col. Strand and others fight for our nation and are injured as a direct result of their service, they deserve the very best medical care. They should not be denied anything given their sacrifice. RSD is a demoralizing condition. It robs people of their power, their dignity and their sense of self-- for people who are accustomed to being strong and capable, there is no worse disease. The ONLY thing worse than having RSD is to be without HELP. Our returning service men and women deserve better than this. Bless Col. Strand for his service, and his wife as well. You are both in my prayers.

February 15, 2010 | Unregistered CommenterMarisa DeMaio

My fellow Rsd friends,
I can sympathize with all of you. I fell out of a display at work almost two years ago, chipping my elbow. I was put in a brace for 6 weeks, then thru ot/pt for another couple of months till I started complaining of pain in the elbow area. The ortho dr assumed it was my nerve having scar tissue around it. Surgery was performed to move the ulnar nerve. After that, my upper arm swelled two times its size. The ortho dr thought it was a bloodclot, did ultrasound nothing. I had a routine drs appointment with my regular physican. I showed him and he dx it as RSD as soon as he seen it. I was floored. I was like what is that...My life from that point forward was never the same. Hours I spent researching till I had my neruro appointment. And as suspected, I did intead have this crippling diease..Nerve blocks, meds, ot and pt, nothing worked. So, they finally told me the next step is a spinal cord stimulator. Surgery once more.. It has helped some, but I am still in pain alot. It has now spread from one arm to the other , and possilbly my knee and thigh. There is not a day that does not go by that I dont have pain somewhere. Burning in my elbow and the site where my stimulator scar is. I am scared that one day I will become disabled. That one morning may be the morning that I wont be able to move. I am 38 years old, I feel like I am 70. The coldness, color changing, pain, difficulty in doing just everyday things are so very hard to cope with. I do not wish this diease on my worse enemy. No one knows the true meaning pain unless heaven forbid they experience a chronic pain syndrome such as Rsd. It is not something that is in your head, it is a real and true diease that needs awareness brought to it. So please pass the word...THIS IS REAL PAIN... God Bless you all..

February 15, 2010 | Unregistered CommenterJess Maloy

To who it may Concern,

hi my name is Kelly. I have had RDS/CRPS since 10-10-08. I stepped off a hay ride while I was working it and thought I twisted my ankle. Turns out I have a torn tendon, oschondral lesion, nerve damage, drop foot and RSD/ C.R.P.S.
I have not been able to walk since then. I have been in a wheel chair. I have tried a dyno splint, regular splint, air cast, cam walker ,physical therapy, aqua therapy ,bier blocks, lumbar sympathetic blocks,steriods, bone stimulator, oxygen chamber, TMR, tens unit and presently use a sneaker which is 5 sizes bigger then my right foot. I am on a whole host of meds for my rsd/ CRPS
Sometimes my foot,ankle, calf and knee get so swollen I cant wear the sneaker with the brace on it.
I sleep with a small plastic brace on my ankle so I don't bump my foot at night. If I don't take my pain meds I am in severe pain all day and all night. If I do take my pain meds I am in less pain but I am a zombie.
I am in a wheel chair ( I cant walk)..
this is a crippling, very painful disease and along with that comes depression. No one understanding the pain I'm in. Feeling helplessness. isolation and frustration. I wasn't a dancer or anything but I did enjoy walking my dog and going out to the movies or just walking the boardwalk with friends. I don't even want to be around people anymore. They don't know how to act around me. Do they help? do they not? I've become an emotional wreck
physical therapy 3 days a week and aqua therapy 3 days a week.. is the only reason why I even come out of the house. and I seriously don't think after these past 15 months that either of the therapy is working.
My foot, ankle shin calf knee and all the way up my left leg is always cold. I find it hard to get my body warm due to the coldness

just a few other facts you should know. I am divorced and live on my own in Heritage Manor which is an elderly and handicapped facility in Harrington Delaware. I am the youngest resident in this community. I have a set of twin boys who are 21 years old / out on their own. One in Brooklyn NY and the other in Maryland. My mom and sister are alive and well In New York. My sister on long island and my mother in Breezy Point NY. I have no family around me at all.
My lifeline, my sanity is saved by my precious dog who unlike friend and family just simply understand that I am in pain. she is there for me wether I have had a good day or a bad day. when she feels I am upset or crying due to pain she will bring me her teddy bear and lay her head on my lap. I cant walk her. I roll my wheel chair to the back door and let her out while I sit on the porch and watch her.

considering the painful days I have had which kick me into a depression, not unlike others. I too have thought about ending the pain threw suicide

. I am 41 years old. I was over weight to begin with and with the lack of moving I have gained more weight. I am a diabetic on insulin. Yet, I am a fighter. I try to hard to do things without help. I am too independent for my own good. I have good days and bad days.

I have always worked two jobs , thus also the fact when I got hurt at the hay ride. I was a full time night audit clerk and part time monitor on a hay ride. Here I sit 16 plus months later, haven't worked , haven't walked since that day in October 2008. Now, I receive workers comp. waiting for what they consider a fair settlement. a settlement that is supposed to last me the rest of my life in pain and needing things like special shoes, wheel chair, cushions for the chair, crutches, ted stockings ect...

I have been approved for Para transit to get me around.
I have a high school education, a certificate in teachers aide, medical secretary and computer software specialist. I hold a commercial drivers licence with a passenger enforcement and a taxi enforcement and here I sit. wasting my days away. waiting on my hearing for social security because I cant work. from the moment my foot gets out of the bed, even sitting up, it starts to swell and turn colors and then pain sets in. numerous pain meds gets me threw the day.. one painful minute at a time.
Just to help one person, just one person. achieve more painless moments in a day is a success.
thank you for your time and understanding
Kelly virdin

February 17, 2010 | Unregistered Commenterkelly virdin
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