The PACT Act, VA disability screening, cholesterol, and cardiac risks

Posted on May 8, 2025 by Doug Nordman

This post is about living your best life in financial independence… while you still can.

As you veterans know, if we’d realized that we were going to survive our military careers then we would have taken better care of ourselves.

I’ve already posted about the PACT Act to help motivate vets to update their VA disability claims. The “Related articles” section at the bottom of this post has more info about the screening process and why you want to get it done now.

This post is not a cholesterol or a cardiac tutorial. It’s not an organ recital.  However it’s very much an explanation of how your aging process can reveal new conditions which might have a presumptive service connection.  The PACT Act has greatly simplified the process of claiming those service-related conditions.

The information I’m sharing about my health today could turn into yet another update on my VA disability claim– so that my family doesn’t have to go through it (yet again) when I’m even older.

This post is also a guide to living with potentially life-threatening chronic illness(es) while still making the most of whatever time you (think you) have left. I frequently hear from military families (and some survivors…) about the health issues of older vets. I never thought I’d join this club, but sometimes life comes at you fast.

I’m doing well, and I’m very glad to have fully lived my financial independence during the last 23 years. I might still be a time billionaire, and I hope to use it under my own control for as long as possible. If I’d tried to pursue paid employment into even my 50s (let alone my 64th year), my genome would have amplified the workplace stress to shorten my life.

In the immortal lyrics of that classic-rock composer:
“I can’t complain, but sometimes I still do: life’s been good to me so far.”
— 20th-century philosopher Joseph W. F. Walsh.

Our Story So Far

I turned 60 years old in late 2020, during peak pandemic. I didn’t start catching up on my regular annual checkups until early 2023.

Image of a graph of Doug Nordman's cholesterol tests from 1987-2024, showing total cholesterol and LDL-C numbers all getting steadily higher and worse. | MilitaryFinancialIndependence.com

“Not good.”

The first piece of unpleasant news in 2023 was my rising cholesterol levels. As my total cholesterol rose above 200 (and my LDL above 150), my family doctor started discussing weight, diet, and lifestyle.

For those who want to really dig into the details, this 2018 report from the American Heart Association lays out the management of risk factors and cholesterol levels for older adults.  The American College of Cardiology chimed in with their risk estimator for atherosclerotic cardiovascular disease: the dreaded ASCVD Risk Estimator Plus.

I’m consulting a great family doctor (with Tricare Select) in our neighborhood. He’s simultaneously experienced enough in this topic to answer my detailed questions… and humble enough to admit that he doesn’t know everything. I might eventually shift over to our new Oahu VA clinic in Kapolei, but I’m happy so far.

Doctors have way more training and proficiency at these discussions than we patients. I’ll take you through the process with my doc, and hopefully you can extract more benefit from talking with yours.  Sharing this post with them would be just bonus.

My doctor and I started with the statistical flaw where my risk factors dramatically jumped higher between my last day of age 59 to my first day of age 60.

My lifetime risk of cardiovascular disease (atherosclerosis) rose from 46% to… well, the studies stop estimating lifetime risk at age 59. My optimal 10-year risk at age 59 was already 7.4% (“borderline”) while the statistically optimal risk (of surviving a heart attack in the next decade) for that age group was considered to be 5.2%.

The next day (my 60th birthday) my risk spiked up to 8.1% (“intermediate”) and my optimal 10-year risk was 5.7%.

Having the overall risk spike by half of a percentage is bad enough— and yet mine spiked by 0.7 percentage points. “But I didn’t even do anything?!?”

The 2018 AHA study recommended that I take their actions #7 and #8: a bunch of additional testing, maybe an expensive scan, and a prudent dose of a moderate statin.

But what about side effects? Us 1960s Baby Boomers can remember the 1990s when statins had a bad reputation. And would I have to take them for the rest of my life?!?

I might have accused my doctor of earning an affiliate income from selling statins. He’d heard these protests before, and I think he’s had this talk with way too many people who are in far worse condition than me.

Then I pointed out that at age 60 my chance of not having a heart attack was 91.9% (=100 – 8.1).

Image of movie character Dirty Harry Callahan (played by Clint Eastwood) asking a criminal whether he feels lucky enough to be shot by Callahan's gun. | MilitaryFinancialIndependence.com

Less painful than heart attacks?

He’d heard that before, too. He politely riposted that during the next three decades of my life, 91.9%^3 is 78%, which means the risk of having a heart attack before age 90 (let alone surviving it) had risen to 22%. As Dirty Harry Callahan used to ask the gun-toting criminals: “Do you feel lucky? Do you??”

Even more unfortunately, if I managed to hold my same cholesterol levels to age 70 (despite their steady rise since my 40s), the ACC calculator claimed that my statistical risk during the next decade still rose from 8.1% to 17%. At age 80, it rose to 29.2%. Now the odds of not having a heart attack before age 90 had dropped to 54% (= (.919)x(.83)x(.708)).

Image of Jim Carrey's "Dumb And Dumber" character thinking that he has a chance. Spoiler: he doesn't. | MilitaryFinancialIndependence.com

Um, nope.

In other words, if I did nothing then I’d have at least a 46% chance of a cardiac incident by age 90. That’s probably the equivalent of “hope is not a plan” followed by “game over.”

As a mature and responsible 63-year-old, I pretty much stomped out of the doctor’s office to take another grumpy look at my lifestyle. Then I started reading about cholesterol, and my questions on the Millionaire Money Mentor forum also referred me to Dr. Attia’s book “Outlive.”

I’ll refer to that book during the rest of this post. I didn’t enjoy the read because he tells too many long stories on tangential topics, and some of his analysis is still viewed with skepticism from other doctors. However he knows the research and he explains the vocabulary & mechanics, which I re-read several times. He also presents the same material in his podcasts & videos.

Living My Best Weight-loss Life: Slow Travel

As I learned more about cholesterol and cardiovascular disease, we also made our first long trip since the pandemic: seven weeks in Japan, mostly Tokyo & Kyoto.  In between enjoying the country, I plowed through a lot of that Attia book.

During our trip, we walked several miles per day almost every day– even during our down days.  It’s also easy to eat healthy there, especially with kitchens in our lodgings. Over that seven weeks I managed to shed six pounds (admittedly some of it was surfing muscle). My body finally broke through some sort of resistance setpoint, or I finally committed to losing the weight. I realized that I could gently boost my activity level in a sustainable way without chronic injuries.

But then during the final week of our trip I contracted the worst case of sinusitis I’d ever had in my life.  I limped back home and spent several months getting it under control.

Part of the cure was a CT scan of my sinuses to check for other… issues. (That’s medical tact for “polyps, tumors, or lesions.”) To nobody’s surprise, a couple of my sinuses are permanently scarred. If there’s any good news, it turns out that exposure to volcanic ash (resulting in sinusitis) is related to the PACT Act. This CT scan also facilitated raising my VA disability rating to 40%.

Once my sinuses cleared up, I was finally mentally & emotionally ready to re-engage with my family doctor about cholesterol control.

More Cholesterol Tests

In early 2024, as I learned more about cholesterol and talked with my family doctor, we decided to test my lipoprotein(a) and my apolipoprotein B levels. If you haven’t seen these words before, they’re different ways of assessing how your body handles cholesterol (or doesn’t). They’ve been around for a few years, and they’re probably a better indicator of risk than the traditional cholesterol blood tests, but they’re still gaining acceptance. You can review their history in chapter 7 of Attia’s “Outlive” book.

Those blood tests aren’t offered on Oahu but could be shipped to a California lab, and I’d pay a bit more to Tricare Select. During my sinusitis disability claim update with the VA I learned that my cholesterol numbers meant I could get them tested for free by our local VA clinic, so if you’re facing a statins decision then consider discussing it with your VA clinic too.

My Lp(a) came in at 107, “moderate leaning toward too high.” Since it’s largely based on genetics, it would probably not change even if I dramatically changed my lifestyle. “Good luck!”

ApoB came in at 106, also “moderate leaning toward too high.” This can be lowered with various interventions, which leads directly to a discussion about weight, diet, lifestyle, and… statins.

During the previous year I’d shed at least 10 pounds of fat and returned to a weight last seen in high school. My BMI was back under 25. (Well, at 24.99 and dropping.) I was exercising more regularly (now that the sinus infection was finally at bay) and I rebuilt my surfing muscles. The weight, the diet, and the lifestyle are all part of a process that’s going as well as it’s going to go.

The Lp(a) and ApoB were not the results I was seeking. Dirty Harry was right: I’m not lucky.

Coincidentally, the week after those results came back, a family friend (a retired Marine) had urgent triple bypass cardiac surgery. He’s in his mid-50s and he still exercises like, well, a Marine, but he frequently felt tired during the day and had less stamina.

He went to his local clinic on Friday afternoon for a routine checkup. One question led to another, a stethoscope check led to an EKG, and the data was alarming enough that they operated on Monday morning.

He’s recovering just fine with his transplanted cardiac arteries, and I felt like I should pay attention to a less-than-subtle message about risk factors.

Coronary Artery Calcium Scores

Since I’d seemed willing to spend money on more tests, my family doctor offered: “We can consider obtaining a coronary CT scan for further risk stratification if you wish.”

A coronary artery calcium score? A direct examination for any evidence of possible cardiovascular disease instead of a bunch of statistics and other obscure cholesterol numbers? Detecting the calcium in the “bad” cholesterol that might be clogging my cardiac arteries?

I’m a nuclear-trained engineer and an experienced investor. Sign me up for that due diligence.

I’ve had X-rays plenty of times, and I’ve had several CT scans & MRIs. Those were all outpatient, and I thought that once again I’d simply walk into a room to stand in front of a screen for 20 minutes and share sea stories with a radiology tech while they got the pictures of my chest.

Um, no. This was still an outpatient procedure at our local hospital, yet it came with a “free” option for inpatient observation if they found serious problems. I got to meet a few of the patients before it was my turn for the test.

If you’re dealing with medical issues and possibly feeling sorry for yourself, then hanging around in the imagery waiting room will quickly recalibrate your attitude into gratitude.

A CAC exam is a series of X-ray images, but they have to work around your heartbeat. While you’re lying inside the scanning cylinder, the software synchronizes the shots to the few milliseconds between heartbeats when your heart has (briefly!) paused. The less your heart moves, and the slower it beats– to a certain point– the sharper the scan. The multiple shots are assembled into a 3D image for further analysis.

There was preparation. I could eat before the exam, but no caffeine because of the effects on heartbeat and blood pressure. They preferred that I show up well-rested and without being still amped up from surfing the dawn patrol. Ideally I wouldn’t have to drive through rush-hour traffic or be under any other stress before the exam. The hospital even has free parking.

Because of the issues with slowing down your heart for a better picture (and perhaps because most candidates for coronary scans are already having cardiac issues) I had a whole team waiting to hear my sea stories.

For those who aren’t familiar with the process, I upgraded to the CT scan with an iodine contrast. The techs poked the IV needle into my arm, injected the contrast solution, spent about 15 minutes fussing over the hardware setup, and did the first set of scans while monitoring my blood pressure. (Apparently people get pretty upset in the machine with a combination of white coat syndrome and claustrophobia. Submarine veterans… might snooze for a bit.) After consulting with the duty doctor, they woke me up decided my blood pressure was good enough (115/60) to administer a nitroglycerin tablet (under my tongue) to dilate my blood vessels. That dropped my BP down to 106/53 with a pulse of 52.

Nitroglycerin dilation feels like a nice buzz at first. Then you remember why you’re buzzing.

After the data was gathered (and once the nitroglycerin had abated) I was thanked for my service and sent home to wait for the final score. The lower, the better. “Zero” is an ideal CAC score.

I logged a 194.

That’s… not terrible… but it’s definitely not good. Cardiologists typically view scores of 100-400 as “moderate calcification.”  The radiologist found “mild non-obstructive coronary artery disease” and “mildly calcified plaque resulting in minimal stenosis of the left anterior descending artery.” My arteries are still a little rubbery, but one part might be crackling with brittleness. If this is considered “mild” and “minimal”, then I’d hate to see them when they’re alarming.

The scan also showed no blood clots and no valve degeneration. (This was how I learned that the scan can detect blood clots and leaky valves.) I guess those are detectable by other means, too, but I don’t want to find out about that either.

There’s tons of research data on coronary artery calcium scores, and the important part is their long-term trend. Mine is possibly “normal for a man of my age”, but my trend is heading in the wrong direction. Or, as my family doc wrote, “You do have some narrowing of your main coronary artery […] which places you at moderate risk for future cardiac events. I recommend that we lower your cholesterol to mitigate risk of progression.”

Shopping For Statins

Now that we had direct evidence of my cholesterol damage (darn it) I shared more discussions about statins on Internet forums and asked a bunch of questions.

Again, one of my concerns rose out of Attia’s “Outlive” book: my family history of dementia and Alzheimer’s Disease (chapter 9).

Very briefly, the body gets cholesterol from three places. One source is ready-to-use cholesterol in the foods we eat, and the second is the liver synthesizing even more of it.  A third source, still controversial, is the brain synthesizing its own cholesterol for its operations. There’s a theory that the brain needs a certain level of desmosterol precursor to sustain its cholesterol production… and to maintain our cognition.

(Yeah, I know.  [Insert joke here about submarine XOs wondering whether I had any cognition in the first place.])

We can control some of our cholesterol by… not eating it. (“A diet high in plants and fiber.”) After that, statins of many varieties (and doses) do a great job of interfering with the liver’s cholesterol production.

However Dr. Attia (and others) are a tad concerned about interfering with the brain’s cholesterol production.  The cognitive research still has conflicting data, but some types of statins can cross the blood-brain barrier to interfere with cholesterol synthesis. If I have concerns about cognition, I should avoid those types of statins. The solution might lie in using hydrophilic statins that don’t cross into the brain and thus do not mess with its desmosterol levels.

How do we monitor desmosterol levels? Well, that’s yet another blood test. I’m beginning to feel like vampire bait.

When I reconvened with my family doc to discuss prescriptions, I asked whether it was worth the time & money to get a baseline level of my desmosterol before starting a statin. He stared back blankly, so I gave him a two-paragraph printout that clarified Attia’s comments on cholesterol synthesis.

The doc was clearly dragging some memories out of cold storage from medical school, and we both agree that Attia is already a tough read. He finally said “I’ll have to take a look at this”, which is a very gratifying comment that I almost never hear from a doctor.

A few days later he e-mailed that the desmosterol research had not yet justified the cost of a test, even if the analysis was available from an Oahu lab. Only one Oahu cardiologist offers the test, but only for their patients– no a la carte pricing. Their gatekeepers wouldn’t even return my phone calls, let alone sample my blood if I drove over there with a stack of $20 bills.

I eventually found the EmpowerDX service (in Ohio) who sent a sample kit to Oahu for a refrigerated FedEx shipment to Boston Heart Diagnostics. (Which turned out to be the same lab the Oahu cardiologist uses.) If the sample’s done right (with about five drops of blood from a finger stick), and shipped correctly, then in a couple weeks you get a desmosterol level from EmpowerDX’s website.

$99 per kit. Having the financial resilience: priceless.

Contact me if you want more details on the Empower process, but it was relatively straightforward.

My desmosterol level was in spec at 1.5mg/L. (Finally, a *good* number for cholesterol!) Now that we had a statin-free baseline, I was ready to go shopping for statin choices.

My 1990s fears of side effects turned out to be overblown.  Almost nobody worries about them anymore. They affect very few people, it’s almost always muscle pains (leg cramps), and the cramps appear either “very quickly” or “never” so the response is simple. The solution is switching to another type of statin or to more exotic (expensive) medications with different cholesterol-inhibiting effects.

Image of rosuvastatin (Crestor) 5mg pill I 29 code statin, only 6mm oval | MilitaryFinancialIndependence.com

1/4″: the size of a carpenter ant.

After more discussion, we chose the entry-level hydrophilic rosuvastatin (Crestor) in the tiniest possible 5mg dose. That should start blocking my liver’s cholesterol production within a couple weeks. It won’t clear the sludge out of my cardiac artery, but ideally it’ll cut the delivery of more sludge.

A 90-day supply from our local pharmacy is a Tricare Select copay of $1.67. (Yes, less than two bucks. Hyperlipidemia is a huge national crisis and a big industry.) I can probably also get a free prescription from the VA, and it eventually shifts to mail-order refills.

The most important part of rosuvastatin? Remembering to take it regularly. I do it with my evening routine.

After a few weeks I’ve had zero side effects, and that means I probably won’t ever have them.  Presumably my liver’s already slowed its cholesterol production.

I have another lipid screening with my doctor soon, and I’ll update this post.

Your Call To Action

In my 20s and 30s, I thought my annual cholesterol checks were a waste of my time. The person I am in my 60s wishes I’d paid more attention. The good news is that I’ve (finally) learned enough to minimize further damage.

Make sure you file your VA disability claim while you’re separating from the service and your memories are relatively recent. (And while the documents are on file!)  Yes it’s hard to start on this with everything else happening in your life, and it gets a lot harder if you wait until you’re separated.  Don’t get stuck in the Fog Of Work.  Even worse (as I’ve learned), you never know when you’ll need to update the claim later.

Try not to repeat my mistakes– you’ll have more chances to live longer.

There are no affiliate links or paid ads in this post.  Try your military base library or local public library before you pay money for these books– in any format.

Military Financial Independence on Amazon:

The Military Guide cover
  • Reach your own financial independence
  • Retire on your terms
  • Success stories and personal checklists
  • Royalties donated to military charities

Use this link to order from Amazon.com!

Raising Your Money-Savvy Family on Amazon:

The Money-Savvy Family cover
  • Reach your own financial independence
  • Teach your kids how to manage their money
  • Specific tactics from my adult daughter
  • Checklists and spreadsheets for your family

Use this link to order from Amazon.com!

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Updated VA disability claim and medical tests
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Lifestyles In Financial Independence: Your Mortality

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Living your financial independence– by making a better workplace?!?

Posted on April 24, 2025 by Doug Nordman

This seems counterintuitive, doesn’t it?  Why would anyone want to celebrate their financial independence by making work better?

Of course you could quit paid employment as soon as you reach FI, but you might also decide to keep working as long as you find it challenging & fulfilling (and maybe even fun).  Better still, the workplace is a great opportunity to… work on… shifting your mindset from the scarcity mentality (a frequent motivation  behind saving & investing for FI) to one of greater abundance.

When you begin your journey to financial independence, you spend a lot of time & effort realigning your spending with your values.  You also put your thoughtful effort into maximizing your savings rate without sliding across the line into deprivation.

Once you’re on track for your financial independence, you can start using some of your money to improve your life now instead of deferring your gratification until later.

It’s even better when you can use that money to boost your shipmates and your troops, not just your own life or your net worth.

A few years ago, a leader who ran the Dept of Defense’s Financial Readiness program spoke at a conference:

“Take care of your people. How do you want to be remembered by your troops? When they were struggling, did you reach out with your hand to that person and… throttle them? Or did you help them lift themselves up out of their problem?”

He says it better than I ever will, but over two decades earlier I used his idea during my career.

Image of illustrated The Laws Of The Navy from Naval History and Heritage Command. The Laws of the Navy Plate III (of four) of an edition of the poem by Rear Admiral Ronald A. Hopwood, C.B., Royal Navy, published by W.R. Deighton & Sons, London, England, during the World War I era. It is illustrated by etchings by Lieutenant Rowland Langmaid, R.N., depicting scenes of the contemporary British Navy. The poem originally appeared in the Army and Navy Gazette, 23 July 1896. | MilitaryFinancialIndependence.com

Gilding thy ship.

47 years ago (accompanied by thousands of other midshipmen) I memorized a ridiculous number of verses of “The Laws Of the Navy” written in 19th-century prose. One of them was:

“Dost deem that thy vessel needs gilding,
And the dockyard forbear to supply?
Place they hand in thy pocket and gild her,
There be those who have risen thereby.”

Let me disclaim that the poem is talking about buffing up the brightwork after the shipyard has already fixed the holes in the hull and replaced a few other essentials. You want to make sure they’re doing their job before you start spending your own money on improving your workplace life.

As long as you’re in uniform you’ll still have to work within the military logistics system (especially the financial and supply parts) to get the essentials of your success.

Yet once you’ve mastered the basics of your mission, there may be times when you can gild your own vessel. It’s a lot easier than grappling with the chain of command to convince them of your initiative and vision.

In the end, you might not even spend any of your money.

Here’s the sea story:

At the end of my career I was an instructor at a submarine training command. It was my second training command and I had five years of experience in military training management. (Those last three words are oxymoronic on several levels of chaos.)  Coincidentally, my spouse and I had just reached our financial independence (assets of 25x our annual expenses, the 4% Safe Withdrawal Rate) by about 75 cents.

We were basking in the happy glow of accomplishing our goal, and we were both overflowing with the warm fuzzy feelings of FI gratitude & optimism.

Image of sample tools from Navy Microminiature Repair course (2M) troubleshooting the backplane of a circuit board | MilitaryFinancialIndependence.com

It was popular.

One of my training department’s courses was six weeks of microminiature repair for nuclear-reactor electronics technicians. (These were mid-grade sailors, usually E-5s with 4-6 years of experience.) It was a very intense class with 12-hour days and lots of hands-on repair labs. It was not only essential for reactor safety (and for keeping submarines on missions) but also an important promotion milestone. (“No pressure!”) We had a lot of demand for the course and there was a big spotlight on us to maintain a high graduation rate.

The course may (still) be taught at very few sites, which means that young adults have to travel from their homeport to one of the training sites.

If the military base’s barracks are full then the students are sent to an off-base hotel, and they’re also entitled to a food & transportation allowance. Our problem at the training command was that (for various reasons, usually last-minute schedule changes) many commands sent their students to Pearl Harbor without any advance travel funds– and sometimes even without a government travel card.

Servicemembers in their 20s (some with rudimentary financial skills) were expected to float the Navy’s travel expenses for six weeks before reporting back to their commands to file travel claims that take months for reimbursement… a process which has been broken for at least 40 years.

Even worse, the hotel was miles away from Pearl Harbor and the sailor was usually too young to rent an affordable auto. They could ride a bus (or a taxi) but the base gate was still several miles from our classroom. The galley was also a long walk from our building, and it was easier to pack your own meals… if you had the time, transportation, & money to shop for groceries.

By Day #3 of our training, it was pretty clear to our instructors which students had been sent to us without adequate funding. Students who are tired, hungry, and distracted are not learning.

At this point we’d drive the student over to the military base’s finance office for an advance on their travel expenses, but the finance office usually needed 3-4 business days to deposit funds in the student’s checking account. More time was wasted in getting grants from our local Navy-Marine Corps Relief Society.

I never succeeded in fixing any of those issues… but I was newly FI and I had discretionary cash. Back in 1999, just three years before retiring from active duty, I might have also had an attitude that contrition is easier than permission.

This logistics problem reminded me of a practice from both of my submarines.  If one of our crew had too much to drink on liberty, we didn’t want them driving while intoxicated.  Instead the boats’ Duty Chief Petty Officers had an envelope in their safe with $100.  Taxi drivers all over the harbors knew that submarines would pay the cab fare of sailors who didn’t have enough liberty money left for the ride.

Of course most crew members were reluctant to use the program for fear of getting in trouble with the chain of command, but the Chiefs worked hard to lift them up instead of throttling them.  In any case it was far better than getting a ride from Shore Patrol, or, even worse, the local police.

U.S. military officers aren’t supposed to lend money to junior personnel, and they’re prohibited from lending to enlisted.  Yet they’re also trusted to manage multi-million-dollar budgets– and to spend cash from command funds.

I couldn’t fix the travel bureaucracy, but I knew how to fix a temporary cashflow problem.  I could risk losing the money to gild my ship, too.

One morning I created my our department’s… official… Command Travel Reimbursement fund: I put $200 of my personal cash (crisp $20 bills) in an… official… brown Navy Department envelope and stored it in my office safe. I shared my plan with our chief petty officers (chiefs make the Navy run) and they agreed to to support the charade.

(Pro tip: in retrospect I probably should have told our Executive Officer about my initiative, although at the time I didn’t see the point of spending my time on the discussion. Refer back to my contrition & permission attitude.)

The CTR fund worked great.

The instructor would bring the student to my office and inform me they were taking them to get their advance travel from base finance.  I’d open my safe, hand the envelope to the instructor, and say: “Here’s the Command Travel Reimbursement fund to tide them over. Please make sure they return the $200 when they get their advance travel funding.”

On the way to the base finance office, the instructor would reinforce this to the student. It was usually an E-6 or E-5 instructor telling a junior sailor something like “Nords really trusts us with this CTR fund, and it’s saved a lot of our students from failing the class. The travel system’s broken but he’s trying to fix it, and in the meantime we’d better not screw this up. Give us back the money as soon as you get the advance travel deposit so that we can help the next student in your situation.”

This continued flawlessly for the rest of my tour. The worst risk I ever took was $600. (It was a bad week for three students, and I needed all three envelopes.) The money always came back by the following week.

Once this system was in autopilot I moved on to solving other problems. However I’d neglected to consider the speed & power of the submarine sailor scuttlebutt network.

Our chiefs supported my fiction about the CTR fund, but they didn’t share that backstory with their other instructors.  About two years into this scheme an instructor (from another department) was griping about their unfunded students to an instructor from our department. Of course they were outside of the hearing of their chiefs, and our instructor said “You guys should use the CTR fund— we use it all the time and it works great!”

Sure enough, a few hours later the XO overheard the talk about the CTR fund from another lieutenant commander. He’d been asked for access by his lieutenant, who’d heard about it from his chief, who’d received the request from a junior instructor.

The XO and I got along well, and we were both good at our jobs.  He probably wasn’t surprised by my latest display of personal initiative, but he also felt that I’d jumped a little too far out in front of our command policy.  The following week at our department head meeting, with a dozen other department heads seated around me, the XO looked down the table and waited for me to take a swig from my coffee cup.

With impeccable timing he said: “So Nords, please educate your fellow department heads about our Command Travel Reimbursement fund. I can’t seem to find that instruction in my file cabinet.”

I almost choked on my coffee.

As I wiped up the mouthful I’d just spewed on the table, I explained what I’d done and why it worked so well.  The other department heads nodded and looked inquisitively at the XO.  Maybe he used his own money for his CTR like I had, but I wasn’t going to ask.  I kept using my money for our department’s CTR fund, and the XO never asked me about it again.  Maybe the other department heads started their own CTR funds, but at least they didn’t ask me to subsidize them.

When I retired from the command, I left my $200 in our office’s safe and turned the system over to my relief. I included that reference to The Laws Of The Navy verse “Dost deem that thy vessel needs gilding…”

A few years after I retired, my cousin (an Army Ranger) graduated from another institution which made their cadets memorize at least as many ridiculous paragraphs of military trivia.  During a quiet moment after the pomp & circumstance had abated (and before the celebrations started)… I mentioned The Laws Of The Navy poetry and handed him his own envelope (full of cash) to gild his first platoon.

I hope you can use my new tradition to help your troops help themselves.  And if you’re also feeling the warm glow of abundance from financial independence, feel free to pass down your own traditions.

There are no affiliate links or paid ads in this post.  Try your military base library or local public library before you pay money for these books– in any format.

Military Financial Independence on Amazon:

The Military Guide cover
  • Reach your own financial independence
  • Retire on your terms
  • Success stories and personal checklists
  • Royalties donated to military charities

Use this link to order from Amazon.com!

Raising Your Money-Savvy Family on Amazon:

The Money-Savvy Family cover
  • Reach your own financial independence
  • Teach your kids how to manage their money
  • Specific tactics from my adult daughter
  • Checklists and spreadsheets for your family

Use this link to order from Amazon.com!

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Posted in Career, Financial Independence, Money Management & Personal Finance, Sea Stories | Leave a comment

“Why Do We Start Our Financial Independence With Two Years’ Expenses In Cash?”

Posted on April 10, 2025 by Doug Nordman

 

Are you ready to launch into your new financially-independent life, but nervous about how the money’s going to work out?

You’re not alone. I’m getting a lot of questions about Sequence Of Returns Risk.

Image of FIRECalc with 124 years of historical data for 100% equities showing only a few retirement investments failures over 30 years. | MilitaryFinancialIndependence.com

FIRECalc’s close enough, right?

People are familiar with the 4% Safe Withdrawal Rate, yet we all worry about its potential failures. “Safe” isn’t enough reassurance whenever there have been failures. We humans will still obsess over a single failure even after 99 consecutive successes.

I wrote about this issue a decade ago, and now we’ll add more nuance to the discussion. Bill Bengen, the creator of what became the 4% SWR, has even more reassuring news that I’ve appended to the end of this post.

 

A reader writes:

“Nords, will you please remind me again?
If today is the start of my financial independence, and:
– my retirement account is invested 100% in stocks, and
– 4% is $100K which is equal to my my annual expenses in retirement, and
– I want to keep two years of expenses in cash to guard against Sequence Of Returns Risk, and
– I have little to no cash in savings and no Social Security yet,

… how much do I withdraw today? $300K?”

Believe it or not, this question is common among all levels of wealth. It comes from young veterans living on their VA disability compensation or military pensions (with very little savings), and it comes from multi-millionaires in their 50s who are concerned (wrongly or rightly) about making those millions last for the rest of their lives.

For example, a surprising number of these issues come up on the Millionaire Money Mentors forum. In general, we members are very good at building wealth by earning, or saving, or investing. For some in the group, earning is a superpower… and the fear of losing that money is kryptonite to their financial independence.

Some of the forum’s higher-earning members might not be particularly skilled at saving or investing, and they’ve never been frugal. (In their strong defense, as long as they keep earning they don’t need to optimize those other skills.) Wealth builds very quickly when your annual income is $400K-$750K and your spending is $100K/year. The savings rate takes care of itself, and the investing toward financial independence can have a lower growth rate because the annual contributions are so high.

Meanwhile my spouse and I have been FI for over two decades, and I still read all of the financial research. With our inflation-fighting military pensions, VA disability compensation, and cheap healthcare, our wealth has become self-perpetuating for the rest of our lives. How did we stay FI without starting at multiple millions of dollars?!?  How long can our dynastic wealth propagate among our descendants?

Even when people become millionaires from accumulation, we’re still human. We all have the same questions (and fears) about spending our wealth in a sustainable manner.

The emotions of behavioral financial psychology seem to be even stronger at a high net worth, perhaps because many millionaires found it relatively easier to earn their wealth than to preserve it. (“Easy come, easy go”…?) We don’t have to feel sorry for people with a high net worth, but everyone struggles with the concept of “enough.”

If your workplace is not stressing you mentally or emotionally, and your body can handle your avocation, then why would you want to stop? Nothing’s compelling you to quit.

If your work is challenging & fulfilling, and people are emptying dumpsters of money into your checking account, then Just One More Year is very appealing.

When you find it easy to trade life energy for money (because you’re good at earning it), then it’s scary to stop at $5M net worth because “we have to make this money last for the rest of our lives!” And besides “… we want to travel without feeling poor.”

 

Conceptual Errors:

Image of overcomplicated asset allocation that's totally unnecessary for avoiding Sequence Of Returns Risk in financial independence. | MilitaryFinancialIndependence.com

Nope, too complicated.

Before we dive into the details of a two-year cash stash, let’s avoid the common misunderstandings.

First, this tactic means that you’re easing into your financial independence with a (slightly) more conservative asset allocation. You’ve guarding against SORR with an asset allocation of two years’ expenses in cash.  For example, that reduces your asset allocation (before FI) from 100% equities to (starting FI) 92% stocks and 8% cash.

We don’t know how long you’ll want to do this, but researchers estimate 10-15 years. At the end of that time, your investments would have grown faster than inflation while your spending (at the 4% Safe Withdrawal Rate) has grown with inflation. The net result of the investment compounding means that around 8-10 years into your FI lifestyle with the 4% SWR, your actual withdrawals for that coming year will be lower than 4%.

If your withdrawal rate drops below 4% (because your investments grew faster) then you’ve avoided SORR during the 30-year timeframe of the 4% SWR.

For some of us, that 30 years is longer than our life expectancy. For others, if you’re eligible for Social Security then you’ll never run out of money.

Second, this cash tactic is not intended to last longer than a recession.

It’s only two years’ expenses in cash, even if the recession lasts a few years longer. It’s intended to give your stocks a couple years of breathing room (no withdrawals) before you have to start selling some of them for your FI expenses.

You might not even sell your stocks at a loss, although a bear market (by one definition) means that you’ll sell them for at least 20% less than they were worth last year.

Third: some of your shares have grown with years of unrealized capital gains.  Now you can sell older shares (with more capital gains) offset by selling the newer shares you bought just before reaching FI (which might have capital losses). You’ve sold in a tax-efficient manner and your income taxes are lower, which means you’re already reducing your FI expenses.

Fourth (This is a big one.): Humans are not spending robots.

When you’re looking at your account balances during an emotionally grinding bear market, you’re inevitably tempted to reduce or delay some discretionary spending.

Math & logic says the 4% SWR will recover from the losses. But until that happens, it’s perfectly fine to reduce expenses if it makes you feel better and helps you sleep at night.

Fifth and finally, you’re deliberately holding this cash stash in a checking account, money-market account, or high-yield savings account. The yields on these accounts mostly suck (and lose a little each year to inflation), which is the penalty we pay for having totally liquid assets.

It’s tempting to chase the yield on these by trawling the Internet for high-paying CDs or even short-term bond funds.

Please don’t chase yield. It hurts to watch this money earning next to nothing (and lagging inflation), but it’s short-term money. Lower yields (on less than 8% of your investments) will not significantly hurt your overall returns. Especially if that low-yielding cash is the first asset you spend each year.

If you feel compelled to waste your time tinkering at the margins by chasing yield, you could try to ladder some of that second year of cash in three-year CDs or even TIPS.  This creates feel-good taking-action endorphins, and the early-redemption penalties for breaking a CD (in a bear market or recession) are smaller at terms of 1-3 years.

(Before anybody goes there, real estate is not cash: it’s an asset whose cashflow reduces your net expenses. If you have a vacancy, you have less cashflow.
And also: precious metals and cryptocurrencies are not FDIC-insured cash either.)

 

How “Two Years’ Expenses In Cash” Really Works

Getting back to that reader’s question: you’ve reached financial independence with an asset allocation of 100% equities. Now you plan to start your $100K/year spending with two years’ expenses in cash, so you sell $200K worth of your stocks.

(Yes, you’ll almost certainly have capital gains on those shares, and you’ll probably pay capital-gains taxes on them. This expense is part of your budget for the 4% SWR.)

You put $100K in your checking account to spend during the next 12 months. You could also put that in a high-yield savings account or in money markets.

You leave the other $100K of cash in a savings account for spending during Year #2. You’d make similar cash choices among HYSAs, MMs, or short-term CDs.

At the end of Year #1, you have $100K of cash somewhere among checking accounts, HYSAs, MMs, and CDs. Now it’s time to start Year #2 of your FI.

If the stock market is up for Year #1 then you’d replenish your two years’ expenses.

(Yes, “up” means at least +0.01%. Don’t over-think this part.)

Recall that the 4% SWR only withdraws 4% during the first year. After that, the heuristic means that you raise each subsequent year’s withdrawal by the previous year’s inflation. You can use any reasonable source for that number, and the standard rate of inflation is the Consumer Price Index from the U.S. Bureau of Labor Statistics.

(Again, even if you’re one of my fellow submariners: don’t over-think it.)

If inflation was 3% during Year #1 then you’d cash out enough stocks to have a total of $206K cash (= [ 2 x $100K x (1 + .03)]) for the next two years. You’d put $103K in your checking account (for spending during Year #2) and leave the other $103K in your savings account.

If the stock market was down at the end of Year #1 then you’d leave your stocks alone and keep spending your remainder of the cash stash during Year #2.

If the stock market is up at the end of Year #2 from the beginning of that year, then you replenish your fund of two years’ expenses. You’ve had two years of inflation now, so you’d cash out 2 x $100K x (1+.03)^2… or whatever the CPI was during those two years.

If the stock market is down still more at the end of Year #2 (and now you’re out of cash) then you grit your teeth and sell enough stocks for one more year of expenses.

If the stock market is down yet even more again at the end of Year #3 then you sell enough stocks (again) for one more year of expenses.

In this example, by the end of Year #3 we’re in a record-breaking recession. You’d be tempted to introduce variable spending by either cutting expenses or earning part-time income. You’d cheer yourself up by remembering that your cash stash gave your stocks two years to avoid the worst of the recession before you had to sell some of them, so you’ll probably pull through anyway.

If the stock market is up at the end of Year #3 from the beginning of that year (or up at the end of Year #4, or whenever) then you replenish your two-year cash stash by selling stocks. Since you depleted your cash stash earlier and currently have zero cash, you reload your stash by selling enough stocks to support the next two years of your expenses.

 

Thanks, Nords, But Sheesh– How Long Do We Keep This Up?

Again, we don’t know precisely how long you’ll do this, but it’s typically (80% of history) for a decade. It’ll be closer to 10 years than 15.

By the beginning of Year #11, your investments would have grown faster than inflation while your spending (at the 4% SWR) has grown with inflation. This is likely even if you’ve just survived your first recession of your FI.

The net result of the investment compounding means that your actual withdrawals for that coming year— the amount of the 4% SWR withdrawal for that year divided by your latest net worth– would be lower than 4%.

Any inflation-adjusted annual withdrawal rate below 4% is going to last for longer than 30 years… and at 3.5% it’s highly likely to last for at least 60 years. This is reassuring if you’re in your 20s, and for everyone else it’s an estate-planning challenge in dynastic wealth.

Before you math majors (and submarine engineers) pipe up, here’s another issue: if 3.5% is going to last for at least 60 years, then why is financial independence at 4%? Why not keep working for a little while longer, like, for example, say, “just one more year”?

Because you’re working too long to end up with too much money.

Look at the FIRECalc graphic at the top of this post, and see how many of those 124 runs end up with multimillions.

Let that sink in for a while.  Millionaires have trouble with this idea too.

4% is “enough” for your self-determined expenses, and during the next 10-20 years it’ll compound to “more than enough.”

If you keep working beyond the 4% SWR tripwire then you’re trading life energy (which you might not have) for more assets (that you definitely will not need).

The *only* failure mode of the 4% SWR is Sequence Of Returns Risk. That *only* happens with 4-5 years of high inflation, or from an unprecedented decade of stock-market losses accompanied by robotic spending.

Instead of working another decade to get to a 60-year SWR, you have enough at the tripwire of the 4% SWR. While the two-year cash stash helps you avoid SORR during your first decade, the growth of your investments will take care of making your wealth last for the rest of your life.

Once you reach your financial independence, feel free to keep working if you find it challenging & fulfilling. However you won’t need the money, and you never know how much time you have left.

If I was in your situation (even in my 20s), then I’d start exploring all of my interests– and I’d cut back from full-time work.

 

Side Notes:

1. William Bengen, the original researcher of the 4% Safe Withdrawal Rate, knew that stocks would recover their value after a bear market or a recession. He later determined that the most common failures of the 4% SWR are caused by 6-7 years of high inflation.

(That link is cued up to the part of the video discussing the risk of 4-5 years of inflation at 6%-8%.)

2. Some of you math majors (and submarine engineers) will notice that you’re entering Year #2 with $100K (plus a little interest) but inflation has pushed your expenses up to $103K/year, so now you run out of cash in late December of Year #2. The answers to this math are:
– rounding error, don’t worry about it, or
– lumpy expenses, you probably weren’t going to run out anyway, or
– if this keeps you awake at night then do your own math for your version of “two years of expenses.” That could be something like “three-year rolling compounded average inflation of 2%-3%/year.”

3. If your asset allocation is less than 100% equities, this technique works all the way down to 60% equities and 40% bonds. Create your initial cash stash by selling some of your bonds, and feel free to keep spending the bonds after the cash is gone. See the links to a related post (below) about a rising equity glidepath.

 

Your Call To Action

If you’re within five years of declaring your financial independence, you have plenty of time to get ready for Sequence Of Returns Risk.  It’s also the right time to think about your new life after FI.

Role-play your feelings now for your first FI bear market or recession.  How will you feel when the market drops 10% in a month?  25% in a quarter?  You’ll probably stop watching the financial media, but how will you feel about your dwindling cash stash?

Write down your plan for getting through the next decade of bear markets and recessions.  Run retirement simulations and even build your own spreadsheets if it helps boost your confidence.  You’ll refer to these records as soon as the markets drop 10%, and you’ll feel reassured about staying with your asset allocation.

 

 

There are no affiliate links or paid ads in this post.  Try your military base library or local public library before you pay money for these books– in any format.

 

Military Financial Independence on Amazon:

The Military Guide cover
  • Reach your own financial independence
  • Retire on your terms
  • Success stories and personal checklists
  • Royalties donated to military charities

Use this link to order from Amazon.com!

Raising Your Money-Savvy Family on Amazon:

The Money-Savvy Family cover
  • Reach your own financial independence
  • Teach your kids how to manage their money
  • Specific tactics from my adult daughter
  • Checklists and spreadsheets for your family

Use this link to order from Amazon.com!

 

 

Related articles:
“OMG What If The 4% Safe Withdrawal Rate Fails?!?”
“Can a Rising Equity Glidepath Save the 4% Safe Withdrawal Rate Over a 60 Year Retirement?”
What Everyone Gets Wrong About the 4% Rule | Bill Bengen, Father of the 4 Percent Rule
How Should I Invest During Retirement?

Posted in Financial Independence, Money Management & Personal Finance | 2 Comments

Yet Another John Hancock Long-Term Care Insurance Update

Posted on March 27, 2025 by Doug Nordman

Me, a decade ago: “John Hancock made my father’s long-term care insurance claim the worst financial experience ever.”
John Hancock LTC team, a decade later: “Hey Nords, hold our beer.”

Image of a December 2024 letter from John Hancock Long-Term Care insurance team notifying Estate Of Dean Nordman of remaining benefits from a 2011 claim that finished paying in 2014. | MilitaryFinancialIndependence.com

10 Years Later.

This letter claiming to be from John Hancock arrived in December 2024, just before the holidays.

“Upon a recent review of your… long-term care insurance policy, insured and administered by John Hancock, we have discovered there are still benefits remaining, even though your claim ended on 10/5/2014 and your coverage was terminated.
To help make sure you receive correspondence as soon as possible, please contact our dedicated service area at 888-[redacted] at your earliest convenience to confirm we have your current information. This will also help us verify that this policy’s remaining benefits will be delivered as intended.”

Yeah, right. Nice try, scammers.

Yet why would John Hancock address the letter to “Estate Of”? (After the claim ended, Dad lived another three years in memory care before Alzheimer’s Disease killed him.)  They could have simply addressed the letter to my father or directly to me, his conservator.

Frankly it wasn’t worth my time to answer this suspect letter (even if it turned out to be legitimate), but half of Dad’s estate belongs to my brother.  He’s financially independent too, and he probably wouldn’t care about the money. Yet I still felt the sense of obligation, and my conscience would nag me.

Except… if this was a scam, then how did they know the policy number and the expiration date of the benefits?  Well played, phishers.

 

I searched the Internet.

The letter was signed by a John Hancock executive who has a Linkedin account. Other search engines seemed to confirm that there was such a person, although their public info was easy to clone into a phishing hook.

I looked up John Hancock’s corporate “Contact us” number and spent 45 minutes with two different representatives.  The first one couldn’t help but eventually transferred me to the long-term care insurance call center. That rep could see the letter on their system and confirmed that the number was legit. They also volunteered that the LTC department was reviewing old claims, but they had no further insight.

I decided to call the toll-free 888 number, which felt like time-traveling to the 1990s.  It went directly to voicemail, and here’s the full transcript:
“Welcome to the long-term care operations team. Please leave your full name, LTC ID, and/or claim number and we will call you back as soon as possible.”

John Hancock couldn’t even make the time to identify their corporate name, or offer an e-mail address, or provide a fax(!) number.

I left three voicemails during the next 24 hours, and I couldn’t tell that anyone bothered to check it.

My Internet search also turned up John Hancock’s $26.3 million settlement with New York over canceled insurance policies.  Suddenly I could completely understand why the company was calling me about a 10-year-old claim from Denver. Maybe I should notify the Colorado insurance commissioner of my experience?

As I wrote in my 2014 post, John Hancock had attempted to terminate the insurance claim while it was still $6175 short of a full payout.  During 2011-14 their claims reimbursement procedure was so laughably chaotic that I built a tracking spreadsheet. (I used their numbers in my father’s 1992 policy and from their 2011 approval letter of the claim.) When I sent them a copy of my spreadsheet, 19 days later they deposited the money in his checking account ($6175.20, to be precise) and followed up with a letter:
“Based on a review of the file, we are honoring your request for payment.”

 

Finally, The Callback

In early January 2025, two weeks later, they eventually checked their voicemail. I was in the middle of yardwork, and (as usual) I was listening to my phone’s classic rock music on my hearing aids. I recognized the 617 area code (“Boston– oh that could be John Hancock!”) and picked up.

The good news is that the caller from the LTC team knew there was a five-hour time difference, and they avoided the classic Mainland mistake of calling at 3 AM.

The other news is that by calling– instead of e-mailing or sending a letter– they didn’t leave a record which could be subpoenaed by a lawsuit.

The LTC team member acknowledged my voicemail and asked for a complete set of my father’s estate paperwork:

    • his will,
    • the executor’s appointment letter,
    • the probate records, and
    • IDs from the heir(s).

I guess their legal staff wanted to make sure the money went to the right heirs, even though their correspondence file already showed that I was the fiduciary son who had to deal with them for the three years that they were paying the claim. Especially for the part where they tried to short my father by $6175.

I explained that my conservator’s appointment ended with my father’s death in 2017 and his assets were passed by beneficiary designations. His will was filed but never probated (and never had an executor) because it wasn’t required. His estate was closed in 2018 after I filed his estate income-tax returns.  I didn’t even need to open an estate checking account.

Today all I have is my father’s death certificate and my archived copies of my conservator’s filings with the probate court.  Maybe the Denver probate court still has them too.

The LTC team member said that my father’s beneficiary designations didn’t meet their requirements. I was already antagonized so I lit up and shared my feelings: in 2011-14 their entire claims process left our family feeling victimized, and their scammy phishing 2024 letter (with its sketchy toll-free phone number to an unprofessional voicemail) brought back my trauma emotions all over again.

I amped up my military voice to emphasize that John Hancock had already been given their second chance in 2014 to pay the claim correctly, and today I didn’t feel obligated to prove I was still an heir of his estate.  And because I’m a nuclear submarine veteran, I pointed out that a decade of neglect should include compensation for interest & inflation.

I concluded by demanding that unless they were ready to send the money to me right now, then I was ready to talk with my estate lawyer and the state insurance commissioner’s office.

The team member said they’d consult their lawyers for guidance and let me know how they wanted to proceed. I doubt that I was talking with the person who signs the checks.

I had one more question.
Me: “Before we finish this call, do you have any information on how much money we’re talking about?”
LTC: “Let me look in the file… it’s a sum between $10K and $20K.”
Me: “Thank you. Please e-mail me when you have a response. I’d rather not talk on the phone.”

Image of logo for Sterling & Tucker LLP law firm for estate planning in Honolulu, Hawaii. | MilitaryFinancialIndependence.com

Hawaii estate planning.

I e-mailed my lawyer (Michelle Hobus of Sterling & Tucker) with a summary and asked to discuss it with her on a Zoom call.  She does outstanding estate planning.

 

Another Callback?!?

Four days later, the John Hancock LTC team member… called me again. (This time I was waiting in line for an auto safety inspection and had plenty of time to chat.) I reminded them of my “Do Not Call” preference, and they asked for my lawyer’s e-mail address.

I explained that I was waiting to hear back from my lawyer, and I asked what information the LTC team wanted to share with us.

The LTC team member said that in 2024 when they reviewed my father’s claim, they found my 2014 letter which told them that they were $6175 short.

The team member said that they agreed with my spreadsheet and wanted to send me the $6175 plus interest. Then they began explaining to me (yet again) why John Hancock needed the legal documentation to prove that I was the heir.

I (politely) interrupted their script to inform them that we’d already received the final payment.

The team member said John Hancock had no record of paying it.

When I affirmed that they’d already electronically deposited the $6175 into my father’s checking account in late 2014, they said there was no record of its deposit.

I felt the gaslighting.

On the other hand, John Hancock had screwed up before. Incompetent accounting is not a crime.

I reminded the LTC team member (once again) that I was my father’s conservator and I knew he’d received the deposit. We’d already paid his long-term care expenses with their final deposit and then, since the claim was exhausted, we moved on to private pay for nearly three more years.

I could have shared that I properly documented their deposit in my conservator’s 2014 report to the Denver probate court. If I did that, though, they would have asked for a copy for their record. After the way I’d been treated over the last few weeks… I felt no obligation to volunteer my help.

I told the LTC team member that I thought we had nothing further to discuss.

They said that they felt sorry for all of the trouble they’d put me through and they wanted to make it right.

At this point you may be wondering whether it crossed my mind to let them send me the $6175… again… maybe this time with a record of its payment.

They’ve certainly earned the karma backlash, but my brother and I are financially independent. We don’t need the money.

At that point I had two thoughts:
1. I was even angrier that they made me re-live this experience just to admit once more (and prove yet again) that they couldn’t handle their own accounting.
2. They’d still insist on estate & probate records which had never existed.

Then I had a horrifying third thought: in a few years a new member of the LTC team would review that file yet again (possibly with more diligence?), and realize that they’d paid out $6175 twice. They’d want their money back, and I’d have to re-live this conversation all over again.

Ever since I was a midshipman I don’t lie, cheat, or steal– and in this case, doing the right thing was easy.

I said that I appreciated the feelings of the LTC team, and we had nothing further to discuss.

They tactfully pushed back that if I’d just give them the proof of being my father’s heir, then they could…

I told them that I wasn’t going to fix John Hancock’s accounting errors. I suggested that they should discuss this whole issue with the team, decide on the right thing to do, and then do it. We had nothing further to discuss.

After more pushback I repeated that paragraph. I think they got the hint.

(Spoiler:  They didn’t get the hint.)

We agreed that if John Hancock ever wants to contact me again, they’ll e-mail me. Sure they will.

(Spoiler:  They did.)

After we finished our call I e-mailed our estate-planning lawyer, reported the update, and apologized for wasting her time. She graciously accepted my apology and didn’t even bill me.

 

But wait, there’s still more.

A week later (after I cooled off) I drafted this blog post.  I finally formatted it and scheduled it to post in early March.

Two days before the blog post went live, my Gmail inbox had a message from “noreply” with subject “[MLIencryptPII].”  I’m an experienced blogger, and these are usually spam or phishing invoices. A lot of them get past my e-mail filters, and I delete them without reading.

However I was still squinting while sipping my first cup of tea, and the “encrypt” letters seemed to be more creative than the usual invoice scam. I opened the e-mail, and I’m glad I did.

It was actually from “noreply@jhancock.com” through a Microsoft Office 365 encryption program. Gmail didn’t seem upset, and neither did my PC’s virus scanner, so I clicked through. I had to click a second link for an e-mailed unlock code (a really good spearphishing tactic!) before I could finally see an Outlook page with a tiny thumbnail of a PDF from… John Hancock Insurance.

At least they didn’t mail cryptic form letters, or ask me to leave voicemail at sketchy toll-free numbers, or call my phone. But only John Hancock could make e-mail even harder.

Image of screenshot of an encrypted letter from John Hancock Insurance offering to pay a "settlement" of $8298.60 each to me and my brother for the $6175 benefit that they'd already sent to us a decade ago. | MilitaryFinancialIndependence.com

10 years’ interest at 5.4% APY.

They might be struggling to understand that “do the right thing” part too.

This settlement letter was accompanied by a three-page release assuring John Hancock that we would not file a claim or take any other legal action.  (But it’s not a non-disclosure agreement!)  “All we have to do” is notarize our signature, mail it in, and wait for the check.

At least they’re no longer insisting on proof that I’m the heir to my father’s estate.  Yet I don’t think John Hancock’s LTC insurance team would know the right thing to do if it reared up and bit them in the assets.

Interestingly, I’ve never told them the [redacted] name of my brother. I’ve never even mentioned that I have a brother, because I thought they’d shift targets and start pestering him too. John Hancock must have done that research because they managed to spell his (unusual) name correctly.

Since I apparently failed to preserve my brother’s privacy, I forwarded my copy of the (decrypted) e-mail to him with a summary of Hancock’s letters & calls. Then I went surfing followed up a few hours later with a phone call. As usual, my call went straight to his voicemail.

I should mention that I haven’t talked with my brother in nearly seven years, and his last e-mail was four years ago. Bro doesn’t use the Internet, and he would never have clicked on John Hancock’s encrypted links. I don’t know how John Hancock would have discovered his e-mail address, which he only checks every few weeks. He moved out of Colorado years ago and (wisely) he doesn’t send out change-of-address cards when he moves.

He called me back a bit later, and of course he hadn’t even read my e-mail yet, so I reviewed our story so far.

I avoided telling him what I thought we should do, but he immediately had the same reflex reaction: we’re not accepting their offer.

I have to admit that he reached his conclusion a lot faster than me.

It irks me greatly that John Hancock knows they don’t owe us any money– and yet they still want to buy our compliance to shield themselves from hypothetical legal action.

I guess I should be flattered that my integrity is worth almost $8300 to them?

This could be their attempt to fend off another class-action lawsuit by settling with as many clients as possible before the subpoenas arrive. I searched online for another hour but I don’t have the access or subscriptions to know whether any new legal action is pending. I’d hate to settle for $8300 and then (a year later) have the Colorado insurance commissioner ask me for a deposition.

(If you’re in the Colorado insurance commissioner’s office, or if you can research pending lawsuit filings, please let us know what you find!)

The hard part about this “settlement” (which they shouldn’t have offered in the first place) is that their money could have come from another client who was shorted on their claim and never checked John Hancock’s math. Or a client whose claim was inappropriately denied. Or a client who let their policy lapse because it was too expensive or… you get the point.

Like I wrote a decade ago, I won’t buy long-term care insurance either.

This offer feels transactional and uses what feels like tainted money. I’ve gone over the release with a lawyer, and it does not prohibit me from blogging about it.

I’d be happy to donate Hancock’s money to charity, but I don’t trust them to even buy us off. I’m concerned that they’d come back another decade later to report that they’d fixed their bookkeeping and want us to return their settlement. Or, even worse, they’d lose their record of this payment too.  Or, worst of all, that they someday contact my heir about my father’s estate.

I want nothing to do with them.

My brother’s waiting for a few more weeks to see whether he gets a letter or e-mail too, and he’ll let me know if he changes his mind.  (I’ve known him his whole life.  I doubt he’ll change his mind.)  As you can tell from this post, I’d rather snark freely than sell out my editorial privilege due to their incompetence.

 

Your Call To Action:

Thank you for reading. Writing this post has been helpful keyboard therapy… and I hope it helps you make an informed decision on your personal long-term care plans.

Regardless of your long-term care planning, I hope you’re also pursuing your financial independence today so that someday you don’t feel compelled to accept an unrefusable offer.

Let us know how we can help.

 

 

 

There are no affiliate links or paid ads in this post.  Try your military base library or local public library before you pay money for these books– in any format.

 

Military Financial Independence on Amazon:

The Military Guide cover
  • Reach your own financial independence
  • Retire on your terms
  • Success stories and personal checklists
  • Royalties donated to military charities

Use this link to order from Amazon.com!

Raising Your Money-Savvy Family on Amazon:

The Money-Savvy Family cover
  • Reach your own financial independence
  • Teach your kids how to manage their money
  • Specific tactics from my adult daughter
  • Checklists and spreadsheets for your family

Use this link to order from Amazon.com!

 

Related articles:
Why I Won’t Buy Long-Term Care Insurance
Alzheimer’s Care Financial Update
Geriatric financial management update

Posted in Insurance, Money Management & Personal Finance, What Do You DO All Day?!? | 2 Comments

Medical Tourism at Bangkok’s Bumrungrad Hospital (2025 update)

Posted on March 13, 2025 by Doug Nordman

Whether or not you’re financially independent, when was your last physical exam?

This post updates our medical tourism travels for our third visit to world-famous Bumrungrad Hospital.

Image of Bangkok night skyline from a balcony by a Sukhumvit hotel | MilitaryFinancialIndependence.com

Awesome skyline nights.

If you’ve never been there (or in Thailand) then please read this 2014 post first for more context about our Bangkok trips.

And of course if you want to see the rest of our 29 days in Bangkok, feel free to stalk my (totally public) Facebook album.  All of the photos have captions, because I really dig seeing these FB memories for years after we’re back home.

As I wrote on this blog over a decade ago, the two biggest obstacles to financial independence are inflation and healthcare– yet everyone (especially military retirees) seems to have more options for handling inflation.

Healthcare is complicated, especially for vets who aren’t supported by the VA or by retiree Tricare. Fortunately medical tourism is one of the global solutions to healthcare expenses: if Bangkok is not part of your travel plans then
you can still pay for outstanding medical care in Europe, South America, Mexico, or the rest of Latin America.

I’ve also learned that if you’re eligible for Tricare Select, then you might even get back most of your money. Thank you to the readers who recommended filing a claim: Gordon Hembree, Nick Makrides, John Kim, and everyone else who chimed in about Tricare reimbursements.

 

Tricare Prime

I’ve been a military retiree for 23 years, and we’ve spent most of that time on Tricare Prime. It’s a good program, especially if you’re raising active teens. Yet you quickly learn that if you neglect to get a referral from your primary care manager, then Tricare Prime might regretfully decline to pay your claim.

In 2014, during one of our family trips to Bangkok in our Tricare Prime years, we tried one of Bumrungrad Hospital’s comprehensive physical exams. Hypothetically we could have requested a referral from our Oahu PCM, but we didn’t even try. Instead we were happy to pay what seemed like a very reasonable fee for concierge medical care. In 2016 we repeated the process.

That was it for a while, because before we got around to our next Bangkok trip: pandemic. That set us back a few years, because medical tourism only works if you can travel.

In 2022 when my spouse started her Reserve pension, we empty-nesters belatedly realized that we could also switch to Tricare Select. We greatly appreciate the flexibility of visiting any ol’ doctor without authorizations or referrals, yet we were also still in our old Prime mindset of seeking referrals & pre-authorizations.

 

Tricare Select… Going Overseas

In 2024 when we decided to make our first Bangkok trip in eight years, it never even occurred to us to chat with Tricare.

At age 64, I was still way behind on my routine medical maintenance. In addition, a cardiopulmonary checkup suddenly seemed like a Really Good Idea. We might have been emotionally affected by the news that a friend, a retired Marine who seemed ready to live forever, had just gone through triple bypass surgery. (He’s doing fine now.) I already have a little calcium sludge in one of my cardiac arteries, and I wondered how that would show up on an EKG during a treadmill stress test.

I wanted to learn what cardiovascular symptoms to watch out for in case (um, just as an example) they happened to manifest on a longboard during heavy-duty North Shore winter surf.

My spouse and I have been married for 38 years, so I’ll spill a little more tea about her side of our medical tourism: she’s not a big fan of regular physical exams. (I can hear our daughter rolling her eyes already.) In my spouse’s defense, she’s disgustingly healthy (especially compared to my genome) and she’s gotten away with her attitude for decades.

Since 2022 I’d been politely (well, all right, maybe rather bluntly) nagging her to get even a routine post-pandemic checkup. She offered a compromise: if we visited Bangkok again then she’d do a Bumrungrad concierge physical.

I bought our (non-refundable) plane tickets before she could reconsider.

 

Back In Bangkok

Image of Bangkok's Bumrungrad Hospital main entrance, including the side building where their physical exams are conducted. | MilitaryFinancialIndependence.com

Concierge medicine.

Although Bumrungrad is still using the same building, they’ve updated their process since 2016.

This time, the biggest challenge was arranging appointments (and payments) online. The Bumrungrad website wants to charge a credit card before picking the appointment, and when I logged in from Oahu then my Costco Citi Visa kept timing out at Bangkok Bank’s site.

I never solved that problem.

Instead, on our first morning in our Bangkok apartment we walked over to Bumrungrad, and they had plenty of appointments over the next few days. (If I read their spreadsheet correctly, it looked like they handle about 150 patients per day from all around the world.) The hospital’s cashier had no problem charging my credit card in person, either.

Image from Bangkok's Bumrungrad Hospital website showing that Tricare health insurance is accepted for their services. | MilitaryFinancialIndependence.com

Bumrungrad takes Tricare!

That afternoon I wrote about our appointments in my Facebook feed, and I was greatly surprised to learn from a couple of vets that at least 75% of the expense might be covered by Tricare Select. D’oh!

Sure enough, Bumrungrad’s website lists Tricare as an insurer.

After a protracted in-person discussion with Bumrungrad’s cashier about referrals & authorizations, we decided that I’d pay up front and we’d file our own claims.

 

The Comprehensive Vitality Programs

It turned out that my spouse and I are still healthy. Mostly.

This time I signed up for the “Comprehensive Male Vitality” package. This was by far my most comprehensive (and expensive) exam ever, and it adds a body composition analysis. (Electrical impedance, not a DEXA scan.) It also includes a hormone screening which might guide my future choices in supplements.

Both my spouse and I are amused by the stock photos marketing accompanying their packages. After extensive parsing of the options (not based on the photos), she chose the basic “Comprehensive Program Female” version.

The U.S. military’s Defense Health Agency could still outsource all their physicals to a Bumrungrad crew. At the very least they should license the hospital’s new tracking software that moves us smoothly among the stations.

My 2016 Bumrungrad checkup used clipboards with our headshots. The staff could use the photo to look around the waiting area and quietly walk over to us to discuss next steps.

Image of a printout from the Tanita Body Composition Analyzer showing details of my body weight, muscle mass, and fat distribution | MilitaryFinancialIndependence.com

Motivation.

In 2024 we had a one-page checklist, barcoded wristbands, and a pager. We moved through all of the stations in under three hours, and sometimes they were waiting for me at the next one before I finished the previous one. I rarely waited more than five minutes between stations, and the results populated the database as we went through the gantlet. The longest delay was 15 minutes after the last exam while we changed from scrubs back into street clothes and waited (at the buffet lounge) for our chat with the family doctor.

Because of the various parameters of my exam, I had to fast for 12 hours (not even drinking water) beforehand. Once we did the blood draw and the body composition test, I had a bottle of water. I had my late brunch (a gourmet menu!) after I finished the rest of the exam.

This was my first-ever body composition analysis, and I’m sure they threw in some feel-good vibes. The analysis claims that my metabolic age is a whippersnapper 49 years old. The rest of this image can be summarized as “surfing muscles.”

It was interesting that the machine immediately noted my left leg is slightly shorter than my right— due to my left knee’s bone-on-bone cartilage erosion. The doctor also got mildly excited about my chest X-ray showing a little thoracic spondylosis, with the possibility of my left leg eventually messing up my spine and my right hip. The vertebrae curve is very slight, and I’m pretty sure I’ve seen it on X-rays for at least 30 years. Now we know what to watch for during the next 30 years, because I’m certainly in no hurry to replace my left knee.

The very next step after the body composition analysis was five test tubes of blood with a large-caliber needle. The phlebotomist even noted that my hemoglobin was low, and smiled with relief when I asked if it could be due to donating blood (on Oahu) a week before flying to Bangkok. I didn’t even think to mention it until they asked about my iron consumption. Of course when I left that station my hemoglobin was even lower.

The lipid panel flagged my higher cholesterol numbers (again, *sigh*), and it already included a check of my Lp(a) lipoprotein risk factor. (In Hawaii medicine, Lp(a) is an extra test that has to be outsourced to a California lab.) The family doc started to gently ease into the statin discussion, so I volunteered my ApoB protein number and my coronary artery calcium score. (Those are topics for a whole ‘nother post.) He’d never heard of desmosterol in the brain’s cholesterol synthesis (another topic for that future organ-recital post) but he agreed with my Oahu doc on starting 5mg of rosuvastatin. This is fine.

 

Treadmills and EKGs

I’ve always enjoyed Bumrungrad’s treadmill test & EKG. Judging from the reactions and comments of the techs, I suspect that most of their (less fit) patients struggle and end up hitting their target heartrate in only a few minutes.

In a possibly-related fitness coincidence, they still limit the treadmill to patients of less than 150(!) kilos. Yeah, I started the treadmill test last November at 83 kilos– but then I walked off more fat in Bangkok and four months later I’m at 78 kilos for my first time since 1970s high school. Surfing for life, dude.

Once the EKG electrodes were attached to my chest, my sitting pulse rate was 52 bpm. They decided that (at my age) my treadmill target would be 132. (When I’m using a treadmill, I keep my pulse around 125.) All of the parameters are displayed next to the treadmill, so I could watch the numbers as they cranked up the speed & incline.

As I watched the display I discovered that if I stretched out my stride a bit then I could actually slow down my accelerating pulse. They seemed a little surprised that my heartrate was taking so long to get up there.

It was all fun&games, chatting with the staff about the numbers– until I had a premature atrial contraction* which briefly spiked the EKG to 173 bpm.

*(I had to look up that term.)

This is apparently not unusual, or at least they’ve seen it before.

The monitor changed its font color from green to a wall of red, a beeper went off, a tech suddenly put a supporting hand on my back, a doctor teleported into the room, and another tech backed off the treadmill speed.

The cardiologist crowd huddled around the EKG printout. “Please keep walking, sir. How do you feel? Ahhhh, all right, that looks fine now.”

A minute later they decided everything was fine and we rolled on. My heartrate reached 132 bpm at just short of 10 minutes, with a 14-degree incline and a slow jogging speed. The post-treadmill analysis decided I’d had a “skipped beat” or a PAC instead of atrial fibrillation.

That was a fun conversation to listen in on, especially if you’ve heard about afib from your… older friends.

The rest of the checkup stations were routine.

 

Reviews And Reports

Later I learned that a friend (living in Bangkok) is the marketing genius who persuaded the JW Marriott catering staff to sponsor the upgrade of Bumrungrad’s buffet services in the patient lounge. (Thank you again, MikeH, we enjoyed it!) It was all yummy, and the attendants ensured that I didn’t even have to make my own cappuccinos.

Once again, the most valuable part of this exam was reviewing everything with a family doctor for nearly 45 minutes. He patiently answered all of my questions, especially when he heard me sling some of his technical vocabulary. (I was probably clogging the patient pipeline with my questions.) He even walked me through hormone chemistry to suggest that I might benefit from more DHEA.

They e-mailed our detailed records two weeks later, and I can go over those with my Oahu family doc for a second opinion. I’m not sure that my decision-making skills (let alone my life choices) would benefit from restoring my testosterone levels to those of my 20s or 30s, but I’m willing to do the experiment.

My spouse’s exam went well, too, although there were a couple of questions for further research. I’m still (politely yet firmly) nagging her about the followup: “As your most likely future first responder and primary caregiver, dear…”

It’s her story to tell, although there’s a 75% chance that everything is fine. Just fine.

For the rest of you military families, it’s worth repeating another of my decade-old paragraphs: if you’re a servicemember who’s a little concerned about symptoms that may affect your eligibility for submarine pay (or any other specialty pay), then consider an off-the-record trip to Bumrungrad. You’ll have to burn leave, but a few months of that specialty pay will cover your expenses.

Even if you’re in the Reserves or National Guard, you can obtain education & reassurance about your future without feeling stigmatized. Perhaps you’ll avoid the risk of being unfairly benched by your service while the military docs do further research. I’m sorry that the American military healthcare system discourages full disclosure about our concerns, but its higher priority is force readiness– not so much our personal issues between career and health.

We will return to Bumrungrad in a few years. Next time I’ll be ready with my Medicare* card and my Tricare For Life supplemental insurance.

*(Medicare won’t reimburse outside the U.S., of course, but I’m just about finished with Tricare Select.)

 

 

Tricare Select Paid For (Almost All Of) It!

I’ll repeat a couple paragraphs for those who may be skimming the headers.

During this Bangkok trip, I posted about our Bumrungrad visit and showed the receipts.  (That’s part of my totally public Facebook album. Feel free to browse.) Before the end of the day, my Facebook friends began telling me that we could get Tricare to pay for the exams.

I spent more time on Bumrungrad’s website, and sure enough: they take Tricare.

I doubt that Tricare Prime would have authorized a referral, but Tricare Select lets us choose any medical provider.

The Bumrungrad staff was very polite with my Tricare questions, but it was clear that they were not eager to file the claim for us. We weren’t worried– we could file our own claim when we got back home.

The wheels of Tricare’s bureaucracy turned very slowly, but eventually they reimbursed us.

Let me pause for a moment to mention that this was the first time I have ever– in my entire life– filed a Tricare claim.

I started with my timing mistake of sending the claim to my Tricare Select Western Region contractor on 24 December, only a (holiday) week before they surrendered their contract to the new provider. I’m sure the old contractor was overwhelmed with a surge of last-minute claims– and perhaps a bit disgruntled about losing the contract– so I was unsurprised by a total absence of response for a month.

At the end of January, we finally got a couple of letters announcing that our claims had been punted over to the Tricare Overseas Program.

It may look like a rookie mistake– and it was my rookie claim– but there’s nothing in any of the Tricare websites that tells a Tricare Select sponsor to file with Tricare Overseas if they just happen to be passing through an overseas area during their slow travel.

In early March (69 days after I filed) our checks arrived. We paid $2507.98 up front and received $2229.16 on the claims for an 89% reimbursement. Tricare Overseas disallowed a few procedures as “not medically necessary” or “noncovered” and diverted another $150 to our deductible.

Mahalo nui loa hana hou to the alert readers who reminded me about Tricare Select claims!

Once again, I can stop worrying about reimbursement bureaucracy (and insurance companies!) and continue managing the rest of my longevity.

 

 

 

There are no affiliate links or paid ads in this post.  Try your military base library or local public library before you pay money for these books– in any format.

 

Military Financial Independence on Amazon:

The Military Guide cover
  • Reach your own financial independence
  • Retire on your terms
  • Success stories and personal checklists
  • Royalties donated to military charities

Use this link to order from Amazon.com!

Raising Your Money-Savvy Family on Amazon:

The Money-Savvy Family cover
  • Reach your own financial independence
  • Teach your kids how to manage their money
  • Specific tactics from my adult daughter
  • Checklists and spreadsheets for your family

Use this link to order from Amazon.com!

 

 

Related articles:
Why You File Your Veterans Disability Claim (Not Just How)
What Happens When (Not Just How) You File Your VA Disability Claim
What The VA Really Does With Your Disability Claim
What Happens After Your VA Disability Claim Has Been Approved
Medical Tourism at Bangkok’s Bumrungrad Hospital
Lifestyles In Financial Independence: Your Mortality
Economic Refugees at RetireEarlyLifestyle.com

Posted in Financial Independence, Insurance, Military and Veterans Benefits, Money Management & Personal Finance, What Do You DO All Day?!? | Leave a comment