By Kay B. Day
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.
REGULATIONS CALL FOR ORDERS IMMEDIATELY
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 of 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 REALIZED HE ISN'T ALONE
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.