Signal Corps in 1917-18. General Pershing on arrival in France in 1917 perceived at once that he would need some 300 women telephone operators, mostly able to speak French. Army Regulations of 1917 specified that a member of the Army, other than a nurse, must be a male.

The General did not stop and wait until he could get the law changed. His Army officers at his direction simply swore them into the Army. Overseas, they were under strict Army discipline; wore Army uniforms and insignia.

When the war was over, these women went back to civilian work or to that of housewives, raising babies and such. Their war work was done.

Not until many years later did it occur to them that they were veterans and should be so classed. Only about 60 of the approximate 300 of these telephone girls of 1918 are alive today. Numerous bills have been introduced to give them veterans' status. They have repeatedly been turned down on the grounds that they were civilians on contract status. Last year Brock Adams, then a Representative from the State of Washington, now Transportation Secretary, when he entered a bill proposing veterans' status for the women, called upon the Pentagon to produce a copy of a contract with any of these women. The Pentagon could not produce one for the simple reason that none existed. The women were sworn directly into the Army.

We feel a deep injustice has been done to this group of fine women, and hope this committee will give genuine consideration when a bill reaches you.

Reverting to the issue of pension for veterans of World War I, we would point out that veterans of all wars previous to World War I received a pension. Veterans of World War II and later conflicts have received bounteous benefits. These facts leave 1917-18 men standing alone and largely overlooked. We cannot feel they are less deserving than other veterans. Had veterans of 1917-18 reIceived what later veterans have been granted by their government, we would agree to the philosophy of "needs" only in granting a pension. But they have not received such benefits. At the risk of boring you with repetition from previous years, we would again point out that the World War I veteran received $60 on day of discharge; later an average of $547.50 in adjusted service certificate compensation. Sixty dollars in 1919 would just about pay for a suit of civilian clothes. And these two sums totaling $607.50 were all he received in the way of a reward for service. Because of the vicious depression of the thirties many veterans had to borrow on their certificates at high rates, and never realized the face value.

World War II veterans under the GI education aid legislation received $16,576,939,000. They and later veterans have received nearly 40 billion dollars in educational aid alone.

Our World War I veterans do not begrudge this aid to later veterans. A fraction of these billions would have been a vast aid to World War I men had it been available to further their education. It is generally agreed that their educational level was about sixth grade. It is undoubtedly accountable for the fact that so many of them are in dire straits today. World War I men were too early for fine pension plans in effect today. Also their age made many of them too late to realize maximums in social security.

We know a vast number of them are hard pressed to exist. A general pension of around $150 a month would be a heavenly gift to great numbers of them.

Our numbers are dropping rapidly. Not one-fifth of those who went to war in 1917-18 are alive today. Fifteen years from now their average age will be that of the Spanish-American War Veterans-around 96, and 15 years hence only about 12,000 of them will be on Earth.

To benefit this dwindling band, a pension will have to come soon. We repeat that we would have no grounds on which to plead for a pension had our people enjoyed benefits approaching those bestowed on later veterans. It is too late to send World War I men off to school at $250 or more a month. The only path toward partial equity is a pension. We hope this committee can come to this conclusion.

Your committee has before it S. 317 by Senator McGovern and S. 450 by Senator Durkin, both of which would establish a general pension of $150 a month for a veteran with a dependent; $135, if alone. Our organization would be happy with either bill or one akin.

We are hopeful that you can agree with the logic of our argument on this pension phase. Thank you.

Respectfully,

HAROLD B. SAY,
Legislative Director,

Veterans of World War I of the U.S.A.

LETTER OF TRANSMITTAL

PARALYZED VETERANS OF AMERICA,
Washington, D.C., March 18, 1977.

Hon. ALAN CRANSTON,

Chairman, Committee on Veterans' Affairs, U.S. Senate,
Washington, D.C.

DEAR SENATOR CRANSTON: As I am sure you are aware, it has been the tradition for veterans' organizations to appear before your committee to present their annual legislative recommendations. Accordingly, we are enclosing PVA's Annual Testimony Information Packet which we ask to be submitted for the record. We at PVA realize that all Senators work under a very heavy schedule. We also realize that part of the intent behind the Senate Committee Reorganization was to reduce the number of committee meetings. With this in mind, PVA will do its part. We will withdraw our request to appear before the committee this spring. We would, however, like to appear before the committee sometime in October 1977. In addition to submitting our Information Packet for the record, we will send one to each member of the committee. We will also make copies available to the committee staff.

Thank you for your continued interest and leadership in veterans' legislation. We look forward to working with you in the coming years.

Sincerely,

Enclosure.

LAWRENCE W. ROFFEE, Jr.,
Legislative Director.

STATEMENT OF EDWARD R. JASPER, PRESIDENT, PARALYZED VETERANS OF AMERICA Mr. Chairman, distinguished members of the Committee on Veterans' Affairs, it is an honor to present the legislative priorities of the Paralyzed Veterans of America.

As I am sure you gentlemen are aware, PVA is an organization of men and women veterans who have suffered a traumatic spinal cord injury or disease. We are entering our 31st year of existence with almost 11,000 members in 29 local chapters.

In the past few years our organization has grown tremendously. We have created a technology and research foundation which is funded for this year alone for 4 of a million dollars. This money will be used to sponsor medical, technological and rehabiltative research into spinal cord injuries. We have developed a national program aimed at the removal of architectural barriers and the creation of physical barrier free environments for all disabled individuals. Our national service program now has 105 service officers representing veteran's claims to the VA. Additionally, our service officers work closely with hospitalized veterans in the VA's Spinal Cord Injury Centers. PVA itself is in the process of reorganizing. We are on our way to becoming a business-like nonprofit corporation serving our members.

Our catch word now is "professionalism" in all of our activities. We feel we have been successful in many areas. We still have a long way to go. However, our pattern of development to professionalism indicates our present legislative

concerns.

Thirty years ago paralyzed veterans were only interested in staying alive, which was then 18 months. Medical science has obviously learned to allow us to lead almost normal lives.

In the mid-years of PVA's development, health care was still our primary interest. But as we found we could live out of hospitals income maintenance be

came a concern.

Now, health care and health maintenance continues to be our primary concern. We still do have serious medical conditions. However, now these "conditions" need not be disabilities. It is possible for an individual with a spinal cord injury to reach his or her full potential as a human being and lead a satisfying and productive life as a full member of the American society.

It is towards this goal that PVA has oriented all of its programs including our veterans' legislative priorities. Veterans should no longer be stuck in hospitals. That is a waste of human life and a drain on VA resources. Nor can we just continue to put dollars in pockets; that creates dependence. We seek medi

cally stable and independent veterans fully reintegrated into society as productive members. In a word, total rehabilitation is our goal.

As we outline our suggestions for legislative changes to reach this goal, I ask you to keep three things in mind. First, PVA does not claim to know all the answers or even all the questions. We are willing to work-that means working with you gentlemen and using yours' and your staff's expertise. We also will work with the VA.

Secondly, as we see our goal, all of the veterans' programs are related. Quality health care is necessary. That is related to sufficient income compensation to lead a financially independent life. That can be achieved only with adequate rehabilitation. Essentially, all veterans' programs must be viewed as a coordinated service. A change in one service affects another service.

Thirdly, some of the specific recommendations and problems we point out today may not involve legislative changes. We see it as our duty to inform this committee on these problems and of our actions and suggestions dealing directly with the Veterans' Administration.

Our first concern in the area of VA health care is a problem which requires immediate attention and action by this committee. As I am sure you are aware, Public Law 94-581, The Veterans Omnibus Health Care Act of 1976, contained a technical and conforming amendment to section 612(g) of title 38 which has the effect of abolishing the fee basis health care program for over 300,000 veterans. This is a severe blow to many catastrophically disabled veterans who live a considerable distance from a VA hospital or other Federal facility. If the VA were to even have to pay the cost of transporting these veterans to the nearest facility, the total cost would be greater than continuing with a fee basis program. We urge this committee to quickly consider legislation to strike the words "within the limits of Veterans' Administration facilities" from section 612(g) of title 38 USC. If this is not practical, as it would grant many non-service-connected veterans a full fee basis program, we hope language can be inserted to retain the fee basis program for those veterans drawing pension and Aid and Attendance or who are housebound.

HOSPITALS

At the end of the Revolutionary War, Congress recognized certain responsibilities to those who served in our military force. Foremost among those responsibilities was the provision of medical and health services to the war injured. Under your watchful eye this recognition of moral obligation has evolved into a nationwide system of hospitals and clinics administered by the Veterans' Administration for all veterans. Millions of veterans rely upon the VA medical system to ease their pain and discomfort. Many of these, such as the 11,000 members of PVA, depend upon the VA for life itself. This intense level of medical involvement compels us to continually examine and evaluate how well the system is meeting the needs of the paralyzed veteran.

As an organization we are striving to improve our methods of examining, evaluating and reporting as well as recommending improvements in the quality of care provided by the Veterans' Administration. Historically we have served as a conduit of information to Congress as to the circumstances of paralyzed veterans. As PVA grows in stature, we have undertaken to provide more indepth information. We have developed new research tools to gather appropriate data which is synthesized into workable documents that you and the Veterans' Administration can use to measure efficiency and effectiveness of programs. In the area of medical care we have recently begun to survey all VA Spinal Cord Injury Centers to amass needed facts on patient census, staffing levels and management procedure. These on-site examinations have provided us with valuable information as to conditions within hospitals relative to facilities, patient and staff morale, social problems and, in general, the overall quality of care provided spinal injured veterans. In the recent past, we conducted a methodical examination of the prosthetic need of a certain group of quadriplegic veterans living outside the hospital environment. This information was provided to the VA and is resulting in significant improvements in the provision of prosthetic equipment. PVA's ability to get to the people quickly through the aforementioned methods and other means place us in a position of responsibility. We have a responsibility to you and all disabled veterans to not only report the facts and methods of obtaining these facts, but to make valid recommendations as to methods of improvement and for new programs.

What are we realizing from our investigation? At this time, we cannot give a complete answer, but there is enough information to begin our reporting process. For reasons of simplicity, we shall separate our findings into two categories: Health Care in the hospital setting and Health Care outside the hospital setting. Research over the past few months has revealed the following conditions within the hospital environment:

(Qualified experts have reported that certain VA Spinal Cord Injury Centers:

1. Suffer from a lack of doctors and nurses aides.

2. Understaffed with general physicians.

3. Have no planned progressive rehabilitation program.

4. Seriously deficient urological care.

5. Question as to the value of certain surgical procedures.

6. Chronic alcoholism and chronic drug abuse.

7. Psychiatric consultation less than satisfactory.

8. Very high number of nursing positions unfilled.

9. Many hospitals having 100 percent or greater turnover in nursing aides each year.

10. Unnecessary urological infections a common occurence.

11. Inadequate space.

12. No privacy for patients and patient areas poorly designed and possibly unsafe.

13. Serious deficiencies in care for acutely ill SCI patients in certain hospitals.

14. Insufficient physical therapy.

15. Undue friction between certain ancillary services within the SCI care envelope.

16. Minimal teaching involvement of the SCI service.

17. No research programs.

18. Insufficient consultation in orthodics.

19. In one hospital the total actual expenditure for urological and physical medicine and rehabilitation consultation amounts to $40 weekly.

To date, we have surveyed seven hospitals to acquire a comprehensive patient census. From this census we hope to learn about the veteran being treated in SCI Centers. This examination process has been in effect for only one month and all relevant data has yet to be processed, but we can begin to show you some comparative figures from two of the hospitals' first surveyed.

Average age of patient--

Time elapsed from date of injury until first entered VA hospital__

'Bronx VA
Hospital

46 years 5 months

5 years 3.5 months

Long Beach VA Hospital 45 years 3 months

2 years 2.4 months 11 years 7.2 months

It is too early to say what these statistics mean. It is alarming to note that the time reported to have elapsed from the date of injury until they entered a VA hospital for the first time was 5 years and 3.5 months in one instance, and

2 years 2.4 months in another. The questions that come to mind in both cases is what happened in that long time period? Who provided the initial medical care? Why wasn't he transferred to a VA SCI Center? Who paid the bills? Did this long period between injury and entering a VA hospital have any effect upon individual recovery or upon the rehabilitation process?

When this survey is completed, we are sure it will generate more questions than it answers. With your aid and that of the VA, we will begin to search for those answers also.

Another segment of the examination of the VA SCI Center is the survey of the personnel working directly with the SCI service. Our data is incomplete and so inconclusive at this time we cannot make any valid statements other than it is of significant note that the number of personnel reported to be working with the SCI service and that constitute the staffing ratio reported to the VA Central Office differs greatly from those people observed by our survey team as having any direct contact or providing any direct support to that service. In one instance the number of personnel observed and the number reported differed by a ratio of two reported to one observed. Such disparity, varying in degree, seems to be consistent from hospital to hospital. If, in that analysis, this discrepancy between reported and observed personnel holds true it may be of significant importance for the VA provides funds for a staffing ratio of 2:1 for the SCI service and funds of 1.5:1 for the overall hospital system. It may be the funding system is being abused and/or needs to be changed to reflect actual staffing ratios.

Still a third part of PVA's SCI Center survey is an admitted subjective evaluation of VA management procedures. Until we complete the surveying of all centers we cannot make any judgments as to program consistency or content. At such time it is complete, this information will be made available.

The second major area of our health care research falls outside the hospital environment. On the surface this may seem inconsistent or even contradictory to purpose of evaluating VA medical and health care delivery systems. But due to the permanent nature of a spinal cord injury and the individual need to live as normal a life style as possible it becomes necessary to begin separating certain medical services from the confines of a hospital and make them available through outpatient clinics, home delivery services or fee paid services. Also the extensive need of every paraplegic for certain prosthetic devices, supportive softwares, and pharmaceuticals make for an ongoing program of medical health care delivery for the remainder of his life.

The most successful VA program of placement of severely disabled veterans back into the home environment has been the Hospital Based Home Care Service. As a supplement to this testimony you will find enclosed a brief background paper titled "Hospital Based Home Care Programs In Relation To The Veterans' Administration." The success of this program inspired the spinal cord injury service to institute a similar program, the spinal cord injury home care unit. The purpose of such a program was to provide certain severely paralyzed veterans the necessary medical and aid to daily living services necessary for life and that these services be provided in the individual's home by a visiting team of health care specialists. Where it has been instituted and administered properly, it has met with overwhelming success. The cost reduction to the Veterans' Administration has been astounding. The national average for maintaining a veteran in a bed within the spinal cord injury unit is $128 per day. The average cost of maintaining a paralyzed veteran under the spinal cord injury home care unit varies from a high of $33.25 per day in Chicago to a low of $15.11 per day in Richmond, Va. It must be noted that the system in Richmond, although designated as a spinal cord injury home care unit, only 15 of the 39 patients in that program are spinal cord injuries. An example of confusing and/or inappropriate reporting for purposes of acquiring funds.

In last year's legislation, Congress wisely provided for the modification of certain necessary rooms and entrances of the veteran's place of dwelling in order to further enhance the placement of individuals into the home care unit. At this early date it cannot be determined how much impact this has had on the outpatient programs.

PVA, through its chapters, has been actively involved in assisting veterans to find alternatives to living in a hospital. We established halfway houses a number of years ago to assist in the transition from hospital to home environment. Under study now is a proposal between PVA and the VA to open still more of these facilities where the VA can provide the necessary Home Care Units to support the individual's physical needs.