Soldier’s tale a cautionary one about medical records
BAUMHOLDER, Germany — Barry Siddall lives with his mother in South Bend, Ind.
By his own account, the 28-year-old is barely hanging on: No job or any real prospects for a job. No car. No education. He is, Siddall says, “a burden on my family.”
Not long ago, Barry Siddall was a soldier, with responsibilities and a purpose in life. Now, all he has to show for five years of service is a bad back, and a dependence on morphine and Percocet, a narcotic similar to codeine.
What makes Siddall’s story different from other soldiers’ is that so much went so wrong. Not horribly wrong on the battlefield. Freaky wrong: A freak injury. Discovery of a congenital defect. Lost medical records. Contradictory findings. Unlucky timing.
Because, like many soldiers, he didn’t understand the system, he wasn’t able to help himself much. But neither did the system help him. Siddall’s is a cautionary tale about the limits of medicine, the limits of bureaucracies: “Muddy,” is the way Dr. (Lt. Col.) Jeffrey Lawson, commander of Baumholder’s clinic, describes the situation.
In April 2003, while posted to the 2nd Infantry Division in South Korea, Siddall was carrying a bed, unloading furniture for his barracks, when he slipped on a step.
He only fell three steps, but the 75 pounds of frame, headboard and footboard were too much for his back. When he tried to do a physical training test a week later, he got to 42 sit-ups when his grader stopped him because his back was grinding “like a pile of acorns getting run over by truck,” Siddall said. “I couldn’t move.”
He ended up in the base clinic. What happened after the accident was the first misstep. Siddall didn’t get a “line-of-duty determination,” a unit-level report on the injury, Lawson said.
Without that report, it would be more difficult to connect the injury to his service.
“I didn’t know what a ‘line of duty’ was,” Siddall said. “When they asked me for that later, I said, ‘What is that?’ ”
The accident put Siddall on what became a permanent profile — limited-duty status.
But with the profile, his Army career started unraveling. In the combat-arms world, soldiers will do anything to avoid going on profile. They are often seen as shirkers and deadbeats, especially those without visible injuries.
In the eyes of his fellow soldiers, he’s a dirtbag, Siddall said. Luckily, in South Korea, he had a supportive first sergeant, who made him his driver: “I didn’t get treated that badly.”
When he transferred to the 1st Armored Division’s 1st Battalion, 6th Infantry Regiment in Baumholder, he ended up training at Grafenwöhr and Hohenfels, trying to cope with the pain. Ultimately, he ended up assigned to the arms room, lifting heavy weapons.
No doctors dispute Siddall is in a lot of pain. An X-ray revealed the soldier has scoliosis, or curvature of the spine, a congenital defect, Lawson said.
Siddall’s is a mild curvature, so the doctors who performed his enlistment physical may not have seen it, he said. But scoliosis makes Siddall susceptible to back problems, perhaps the trickiest of physical ailments to diagnose and treat, according to Lawson.
A certain number of patients require surgery. For others, the problem goes away on its own. And for the rest, all doctors can do is try to control the pain, Lawson said. Doctors had tried steroid injections to his spine and a nerve block. Nothing worked. Finally, they prescribed Percocet, as well as a patch, similar to a nicotine patch, that administers morphine into Siddall’s system every day.
At least one doctor at Landstuhl Regional Medical Center recommended a medical evaluation board, or MEB. In an MEB, at least two physicians evaluate the soldier’s medical history and decide whether the problem is treatable, or if the soldier is unfit for duty.
But it took from Jan. 13, 2005, until August 2005 for the completion of the MEB. And it was less than conclusive. “It came back, ‘No disability, but unfit for duty,’” Siddall said. “I was scratching my head and saying, ‘Huh?’”
In the meantime, his pain was getting worse, as was his luck.
Before he could go to the next step, a Physical Evaluation Board, or PEB, the clinic lost most of his records.
There are about 250,000 patients in the Europe Regional Medical Command, at three hospitals and 26 clinics, according to command officials. During 2005, about 434 records were misplaced, or about 0.2 percent. They include those kept by the patient in violation of regulations, misfiled or sent to the wrong facility.
Siddall had records back to only 2005 in the packet submitted for the PEB, and nothing back to the original 2003 accident. “Everyone said it would be OK … that a narrative summary would suffice,” Siddall said.
The board — composed of medical personnel and line officers — ignored the MEB recommendation. It found that Siddall’s scoliosis was a “pre-existing” condition and he wasn’t eligible for medical retirement or benefits.
“We thought his condition was incurred on active duty,” Lawson said. “But the PEB came back that it was pre-existing.”
Siddall could have appealed the PEB, but didn’t, giving up any claims, including a severance, Lawson said. Because it’s such a lengthy process, he would have separated from the Army during the appeal until he reupped. And if he had lost the PEB appeal, he could have been found fit for duty and sent to Iraq, toting around weapons in a drug-induced fog, Siddall said.
The narcotics extend his pain-free periods from 20 minutes to full days. But his speech is sometimes thick, his mental processes dulled.
So he decided to leave the military with nothing: “I was depressed and distressed. I needed out.” Now he’s trying to wean himself, skipping days, “but doing that, I hurt more. But it’s something I have to do.”
Lawson agrees: “He has to get off the narcotics, or it’s something he’s going to be fighting for the rest of his life.”
If he had some financial help, he could get a car and a job, then use his benefits as the child of a wounded veteran (his father was wounded in Vietnam) to start college.
With his health problems, no one will give him a job, which means no one will rent him an apartment or give him a car loan.
Right now, his only hope is that the Veterans Administration will look at what documents he has left and give him disability benefits.
It’s likely he’s eligible for a service-connected stipend, said Jose Llmas, a VA spokesman in Washington, D.C. Even if the Army has denied a medical claim, former soldiers can file for a service-connected disability, Llmas said. “The VA is not the Department of Defense.”
Asked how he sees himself in six months, Siddall said one word.
As records go electronic, GIs still need to keep copies
Barry Siddall’s case comes just as the Army is in a transition period from hard-copy medical records to a new $1.2 billion electronic health care record keeping system.
The Composite Health Care System II, or ALTA, digitizes records, making them accessible to military care providers worldwide. Though the program already is in place at many post clinics, including Baumholder’s, an integrated, universal system isn’t scheduled to be completed in the United States until 2014, according to Department of Defense documents.
Even with the new system, soldiers should periodically ask for copies of their medical files, said Lt. Col Jeff Lawson, commander of Baumholder’s clinic. Even digital databases can fail or fall victim to viruses, he said.
Patients must get backup hard copies periodically in case something goes wrong.
To avoid his fate, soldiers “have to make copies of everything,” Siddall said. “Every time you go to the doctor, or get medical records, make copies. Keep a copy for yourself.”
“If you don’t take care of yourself, nobody will.”
If you’re hurt, get a line of duty determination — an immediate evaluation of what happened. You may need it if you have future complications.Soldiers also must have a better understanding of their post-service benefits through VA, and what documents they’ll need.Soldiers also must be tenacious when medical rulings go against them. Appeals take time and patience. But if they’re convinced they’re right, they must appeal or they’ll lose those disputed benefits forever.— Terry Boyd