Medical treatment

Peace Corps Online: Peace Corps News: Headlines: Peace Corps Headlines - 2003: July 2003 Peace Corps Headlines: July 5, 2003 - PCOL Exclusive: A Volunteer's Courage : Medical treatment: Medical treatment

By Nancy E. Tongue on Monday, July 28, 2003 - 9:58 pm: Edit Post


While employed by the US Federal government, working for the US Peace Corps in Chile between 1980-1982, I contracted an incurable chronic illness, which has irrevocably altered virtually every aspect of my life. In spite of the symptoms, which occur unpredictably and to varying degrees, I have intermittently managed to maintain a fulfilling and meaningful existence including making contributions to society, as is congruent with my belief system. With my master’s degree in applied medical anthropology, I have been employed by Johns Hopkins University to develop AIDS prevention material for Native American communities of the Southwest, and by other agencies to create health education and intervention programs with underserved populations. Prior to the manifestation of my illness, I was director of New York’s Ronald McDonald House, home for children with cancer.

Unfortunately, my government has not fulfilled its promise to provide me with medical care, as long I should need it, in association with my Peace Corps related illness. Although, upon superficial review, the agencies involved appear to have made an effort to help me (and on occasion, actually have), the reality of my daily struggle does not match what appears on the surface. Due to impenetrable labyrinths of Kafkaesque bureaucracies, obtaining medical reimbursement and/or disability payments frequently remains nearly impossible. I have spent 18 years chronicling my own battles with the system, actively struggling to ensure that I maintain a claim, and at the same time, trying to stay well enough to be a functioning and productive member of society. Intermittently, certain members of the Senate and Congress have intervened on my behalf but only when I have been able to devote full time attention to “getting the word out,” issuing a myriad of paperwork and seemingly redundant documentation on difficult to decipher forms, and generating pleas for help. Without perseverance, the possibility of losing housing and losing the components that constitute my life, seem real. I feel that for nearly 18 years I have been placed on the defensive, fighting every step of the way for what I am legally entitled.

US Peace Corps Volunteers are insured by the US Department of Labor, Office of Workers’ Compensation (USDOL/OWCP) federal program for their medical and/or disability benefits. As the employing agency, it would seem that the US Peace Corps should provide some support or services to returned volunteers to aid them in maneuvering the complicated system or at least intervene on behalf of volunteers in need, as the National Park System or other agencies have been known to do. I also feel strongly that the Peace Corps should challenge the US Department of Labor, Office of Workers’ Compensation to act responsibly and predictably in its coverage of returned volunteers.

I continue to fall through the cracks of the USDOL/OWCP systems. Peace Corps has accepted minimal culpability and seems essentially uninterested in advocating for my rights or the rights of other returned volunteers. We have no lobby as veterans do, and are basically left on our own to wade through the system. Clearly, what has been worse than the illness, itself, is the struggle I constantly endure to have my basic needs met by a government program that had guaranteed my ongoing medical care and compensation for episodically being unable to work due to my illness.

In 1991 US Senator Daniel Inouye requested a GAO (government accounting office) investigation through the National Security and International Affairs Division of the “state of health care for current and returned Peace Corps Volunteers” in an attempt to demonstrate the gaps in the medical care for those volunteers who returned with illnesses or injuries. During this era of investigation, there was one individual in a division of the Peace Corps who did work earnestly to intervene with the USDOL on my behalf. She made a small difference for me during her brief tenure, so I know that Peace Corps is capable of effective intervention. Unfortunately, the GAO investigation did little to resolve the ongoing problems, and again, returned volunteers have no advocate.

I have recently written to Mr. Gaddi H. Vasquez, Director, US Peace Corps and to Steve Weinberg, MD, Associate Director of Volunteer Support, US Peace Corps with enclosures regarding my illness. Mr. Gaddi H. Vasquez, current director of the Peace Corps, has stated that President Bush intends to double the number of Peace Corps volunteers within the next five years. In an article in the New York Times in August Vasquez noted that there is a “comprehensive system for protecting volunteers, including medical care” and that the “Peace Corps’ highest priority is the health, safety and security of its volunteers.” The point I am trying to make is that we are not just at risk while “in the field” but that many of us continue to suffer injustices after our return that jeopardize our sense of safety at “home,” cause us to question our sense of faith in this nation (which we so earnestly served in our youth), and alter our lives forever. Thus far, my plea to solicit the help of Mr. Vasquez has again landed on deaf ears. The Post Service Office of the Peace Corps states that it is not its mission to help with this sort of issue, leaving me to wonder what their role actually is.

Since Peace Corps employees’ benefits fall under the domain of the US Department of Labor, Federal Department of Workers’ Compensation, we are trapped within a system that is perpetually changing without notification. There is no lawyer, social worker or federal employee who has yet been able to explain to me how the system even works or if one works part-time, what disability one is entitled to and so forth. Nor have I found through my own experience, anything but random treatment. It is a challenging system to negotiate under ideal circumstances but beyond impossible when suffering acute illness. My long-term relationship with this department and its resulting dysfunction demonstrates that there is no cause and relationship between my actions and forms completed and what is paid or accepted by them. There is also no consistency in their actions. Claims examiners are constantly replaced without notification to me, addresses of the department are altered, benefits turned down without explanation and physician’s bills denied without ability to appeal. In recent months, a new national billing office has been established in London, Kentucky, to “cleanse” the USDOL mail of anthrax, I was told. In order to contact my new claims examiner in New York (the one I had last month is now no longer in charge of my claim), I evidently have to send my paperwork to her attention in Kentucky. One is not allowed to phone the examiner directly.

I have numerous examples to support the chaos of having medical bills paid as stated above, but I will use the most recent one here. After being covered for a specific regimen of pain management physical therapy for nearly 14 years, a claims examiner (with no medical training) denied this treatment. When I asked how he could negate something that was authorized and had indeed been paid by his department (with much paperwork and effort on my part) he replied that years of prior errors did not necessitate a continuation of errors. He retroactively denied the prior year’s worth of treatments, and additionally, denied all future treatments. Thus far, I have had no success in learning why the physical therapy coverage was suddenly stopped, nor do I know how to appeal this decision. It had taken me and my physicians years of searching to find a particular modality that was effective in allowing me to function at a moderate level. This left me not only without the ability to pay for ongoing therapy but with a year of unpaid bills to pay, myself.

Additionally, because the USDOL/OWCP has historically been so tardy in its payment to physicians, few practitioners or physicians in the US will accept payment from them directly, and justifiably require payment from the patient. It forces us into a position of accruing tremendous out-of-pocket expenses that we can ill afford and to essentially beg for treatment. In the process, it is easy to lose our sense of self-worth and dignity.

Even if I am eventually successful in obtaining all I am requesting from the USDOL/OWCP I will, quite possibly, never be able to work full time. The most I am eligible to receive in “disability” payments for my Peace Corps illness is calculated at 66.6% of a GS7 government income level capped at 1982 dollars plus cost of living increases (about $15,000). It is difficult to live on this in today’s society. I have not been successful in obtaining an explanation of whether I am entitled to partial disability if I can work part-time. Attempts to work part-time in the past have proven disastrous for me. Such severe errors were made (like dropping my medical and disability payments from the system altogether) that, having no other safety net, I realistically fear ever taking this chance again. In a couple of instances I had to essentially begin my claim again and the amount of partial disability I received was inconsistent and seemingly arbitrary. Surely there exists a formula that should be enforced. One is placed in a situation of either having to be well enough to fully work and take care of oneself, or be sick enough to require full disability. How one can actually subsist on this is yet another matter.

As an unemployed individual, no individual health insurance plan in the US would choose to cover me (or others in my situation) for future medical mishaps, even with exclusionary riders for the Peace Corps’ illnesses, because they deem us as too high a risk. Even if we are successful in obtaining insurance, the premium for an individual policy is at least $300.00/month – a considerable fee for those of us living not much above poverty level. Unless I can work full-time and not need the USDOL/OWCP, I am therefore essentially uninsurable in the US, as the Peace Corps does not offer long term group health insurance for returned, sick or disabled volunteers as, I believe, the veterans association does. My future, in this regard, certainly does not look bright.

The sense of not being heard eventually breaks the spirit. My intense physical pain has been comparable to the psychological abuse of being forced, without individual power, to wait for the unknown for decisions made by bureaucrats unfamiliar with my illness. I find it difficult to survive never knowing what news my mailbox will bring concerning arbitrary decisions that the USDOL/OWCP will make regarding my medical treatment and my income. I am no longer willing to be silent. There are surely many hundreds more out there in a similar situation as it has been estimated that approximately 500 Peace Corps volunteers return each year with illnesses or injuries. We need a voice and we need change in the system.

By on Monday, July 28, 2003 - 11:25 pm: Edit Post

Thanks for that contribution. I will write a feedback later. This type of letter is so needed. Daniel

By J Roberts ( - on Saturday, October 25, 2003 - 5:14 pm: Edit Post

Hi Nancy,

I don't know if you will see this all these months later, but I can totally identify with you on this. I have been disabled fromthe Peace Corps for almost twenty years and have battled with bureauracy for the entire time. My doctors tell me all the stress adds to my health problems but I too see no solution. I remain on disability holding my breath every time I have to have any contacy with OWCP. Too bad, Daniel, whoever he is never wrote back.

My congressional representative has tried to intervene for me and got nowhere. I am not eligible for SSDI and Medicare because I was young and had not worked enough covered time to be eligible. I feel like I'm between a rock and a hard place all the time.

I just learned today that the individual health insurance I have struggled to keep is being increased from $500 to $700 a month so I will no longer have any coverage for other health problems as I join the growing group of uninsured.

Do you know if we had worked for the Peace Corps, instead of volunteered., such as health directors, country leaders etc. we would be entitled to receive health insurance. But because we did not have health insurance in country, where it would have been worthless of course, we are not eligible for it. Also, which totally irritates me, if a person is married they are able to receive 75% instead of 66%. And isn't it insulting how little monetary value the government places on our work?

OK, I'm getting carried away but am excited to hear from someonw who has suffered from the same difficulties I have, and all we wanted as idealistic young people, was to help others. Now we need help and can't get it.

By ( - on Sunday, October 26, 2003 - 8:39 am: Edit Post

I want to be thoughtful in my response.

I can be reached at 978-462-3868.


I too have gone through created medical problems from service. I have never received benefits. We are still trying to change it. Robert and Nancy will you speak to Congress about your issues if we are called to speak about FECA and its lack of compensation to Volunteers and the need for personnel at Peace Corps who have gone through the DOL and have empathy for their colleagues and the people they served with?

By tim h ( - on Saturday, May 29, 2004 - 8:16 pm: Edit Post



By daniel ( - on Sunday, May 30, 2004 - 11:42 am: Edit Post

Shame on the Peace Corps for this kind of indignity. Shame! It is the Peace Corps responsibility not the DOL. Now they are passing the buck to an insurance carrier and won't ansewer the phone on these claims.

By daniel ( - on Sunday, May 30, 2004 - 11:53 am: Edit Post


If you have office space, a secretary, fax machine, Lateral files that can hold the amount of paper work to start an office. A budget of 30,000 per annum to start your claim will probably be necessary, then you will be on equal footing with the government.

Get a lawyer if you can let them handle your case or go to law school and become a lawyer.

Peace Corps is ruining people's lives in the medical claims. They are also covering up thousands of cases and use FECA to fire healthy employees and volunteers. It is an arcane system.

Civil rights violations happen in these circumstances all the time.

God will save judgement on this program and its injustice to the families of volunteers.


By Rick Rhodes ( - on Monday, August 09, 2004 - 2:00 pm: Edit Post

There is no doubt something is broken, and perhaps shameful, when injured RPCVs are conveniently (for the purposes of Peace Corps) passed from the PC to the Department of Labor’s (DOL) Office of (Federal) Workers’ Compensation Programs (OWCP). I was placed on Workers’ Comp for a short while after medically separating from the PC. But over the past 19 months, I’ve lost the equivalent of six OWCP Appeals, primarily based on an ‘incomplete’ report by an OWCP contract doctor, who saw me for a total of about two minutes –and for three separate conditions. In my file, there is also a load of very credible statements by other medical professionals who have countered this OWCP contract doctor –stating such things like I had no knee problems before the Peace Corps, my knee problems had to have occurred while I was in the Peace Corps, etc., etc. I’ve had five knee operations, including the near-equivalent of three total right knee replacements in the relatively short time that I’ve been a RPCV. Neither the DOL nor the Peace Corps have paid for any of these five needed operations. To this day, and four years removed from the Peace Corps, both my knees are really messed-up and painful. I need walking devices, and can’t climb or descend stairs. I also need to devote about 30+ hours/week to knee self-therapy just to keep my pods from getting worse –thus making it near impossible to hold a regular 9-to-5 post-Peace Corps job. Most thankfully, I’m also a veteran and have the local VA hospital as my health care safety net.

If it weren’t so sobering, the reasons for OWCP’s denials to my claims would be laughable. But, I really don’t think the claims examiners (and probably worse –their supervisors) at OWCP are the morons many of us in this section make them out to be. For OWCP’s purpose, the few injured RPVC’s are lumped-in perhaps thousands of other ‘injured’ federal employees. With OWCP’s agenda-driven policy to deny claims, I suspect OWCP makes little-to-no distinction between a low-risk injured federal employee (who may have dropped a filing cabinet on his/her foot) and a high-risk injured Peace Corps Volunteer (suffering from a major mishap). But if that federal employee’s claim is denied by OWCP, and the employee is still injured, that federal employee can still return to his/her place of work. If that federal employee returns to work badly injured enough, it’s a likely relatively simple process getting a disability retirement via other government channels. And he/she can get this benefit even if the injury was NOT in the line of duty! On the other hand, the small percent of OWCP claimants who are government VOLUNTEERS –and most of them ARE injured on the job –cannot return to their former place of work. Furthermore, I’ll dare suggest that a very high number of Peace Corps-related injuries go unreported (to Peace Corps and to OWCP). Most RPCVs are still in their 20’s and 30’s when they return to the US. If and when these ‘young and very employable’ RPCVs discover latent Peace Corps-related injuries, I’ll bet their post-Peace Corps employer’s health coverage program unintendedly picks up the medical bills associated with that employee’s former Peace Corps injuries. However, older and less-employable RPCVs, like myself, don’t have such options. And thanks to my Peace Corps knee injuries, I’m now uninsurable! Hey, we all passed a fairly stringent physical exam (that many others had failed) just before we were permitted to Volunteer for the Peace Corps.

I believe there needs to be Congressional legislation establishing another agency, or perhaps a small sub-agency within DOL or the Peace Corps, that is specifically tasked to care for injured RPCV’s (and perhaps other injured government Volunteers –e.g., VISTA). Unless really pressured, the politicians running the Peace Corps or DOL won’t advocate this –they got a ‘good making-no-waves thing’ going with the present system. Please, write to your Congressman, Senators, local newspapers, and anybody else, infusing your own heartbreaking experiences, of why legislation is needed to create a separate (and very low budget –and in my opinion, those funds ought to come out of OWCP’s fat hide) governmental entity –but external from OWCP –to alleviate some of the pain and suffering of injured RPCVs.

By daniel ( - on Monday, August 09, 2004 - 8:52 pm: Edit Post


I am sorry to hear about your knee problems. You are right on with the description and none sense endured after service with health care. The whole system is completely broken.

Rick, I will not explain plans we have to help with these dilemmas on this web site. However, my telephone number is the following and I can give you some contacts in the Congress who will at least be responsive to reforms with Peace Corps health and safety. my number is the following 978-462-3868.

With all the dilemmas you have had, envision an agency that works and put a budget to it. You may find if you put together the plan many RPCV's with OWCP/Peace Corps FECA problems may sign on to your plan.


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