It must be recognized, however, that regardless of these actions, it will never be possible to fully compensate in a material way for the hardships and the privations experienced by prisoners of war and their families.

While recognizing the adversities experienced by prisoners of war, the Department of Defense and the Nation should not lose sight of those others who have served their country in the Armed Forces, including those who died, as well as those who have suffered major disability in the course of their service. They have also suffered and are entitled to the gratitude of the Nation for the contributions they have made and the losses they have suffered.

The Department of Defense believes that to the extent that material benefits can compensate for the hardships and privations suffered by prisoners of war and their families, those benefits have already been provided. Those particular benefits together with the wide range of benefits available generally to other veterans of service in the Armed Forces, will to the extent possible enable retired prisoners of war to resume their rightful place in the American society.

For these reasons, the Department of Defense would not favor enactment of S. 799.

The Office of Management and Budget advises that, from the standpoint of the administration's program, there is no objection to the submission of this report for the consideration of the committee.

Sincerely,

L. NIEDERLEHNER, Acting General Counsel.

[No. 84]

COMMITTEE ON VETERANS' AFFAIRS, U.S. SENATE

VETERANS' ADMINISTRATION,

OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS,
Washington, D.C., December 17, 1973.

Hon. VANCE HARTKE,

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

DEAR MR. CHAIRMAN: We are pleased to respond to your request for a report on S. 799, 93d Congress.

According to its title, the bill proposes "adjustment assistance" to Vietnam era prisoners of war. Specifically, it would deem them to have a service-connected disability within the meaning of section 310 of title 38, United States Code, providing for disability compensation. Without regard to disability, a special rate of compensation would be authorized-$40 monthly for each year, or portion thereof, that the individual was detained as a prisoner of war, not to exceed $200 per month. Such compensation would be in addition to compensation for disability payable by the Veterans' Administration.

Under current law, the Administrator of Veterans' Affairs is required to adopt and apply a schedule of ratings of reductions in earning capacity from specific injuries or combinations of injuries. The law provides that the ratings shall be based, as far as practicable, upon the average impairment of earning capacity resulting from such injuries in civil occupations. Under existing Veterans' Administration procedures for evaluating the disability resulting from injuries and diseases, the rating assigned to disabled veterans, including former prisoners of war, are based on the extent or severity of the disabling manifestations in the individual case.

Former prisoners of war are given special consideration under the laws administered by the Veterans' Administration and our regulations and directives also contain liberal provisions with respect to the claim of any such person for disability compensation or other benefits based on service-incurred or service-aggravated disability. Section 354(a), title 38, U.S. Code, requires that in the adjudication of serviceconnection for any disability, due consideration will be given to the places, types and circumstances of service. Section 354 (b) provides liberalized criteria for determining service-connection of any disease or injury for those veterans who engaged in combat with the enemy. Also, section 312(c) of said title 38, provides that in the case of any veteran who while a prisoner of war suffered from dietary deficiencies, forced labor, or inhumane treatment, certain diseases or psychosis manifested within a prescribed period after such service, shall be considered to have been incurred in or aggravated by such service, notwithstanding that there is no record of such disease during the period of service for purposes of disability compensation.

Veterans' Administration regulations emphasizing the liberality which is accorded prisoner of war cases include, for example, a provision that the development of symptomatic manifestations of a preexisting injury or disease during or closely following a status as a prisoner of war will establish aggravation. Physical examinations of former prisoners of war are conducted with particular thoroughness and all disabilities common to prisoners of war are searched for even when no specific complaint is made. Veterans' Administration instructions provide that in the evaluation of disabilities resulting from, or incident to, military service great weight must be assigned to imprisonment or internment under unsanitary conditions or to food deprivation in the service-connection of dysentery and other gastrointestinal diseases. All of these considerations permit the Veterans' Administration to reach an equitable decision on the basis of the facts of each case, with any reasonable doubt resolved in favor of the former prisoner of war. S. 799 would create an exception to the statutory requirement that ratings shall be based, as far as can be practicably determined, on impairment of earning capacity. It would be discriminatory against all other veterans whose disabilities are rated in accordance with that concept. Since the bill applies only to Vietnam era prisoners of war, it would also discriminate against former prisoners of other war periods. The Veterans' Administration believes that special consideration should be given to former prisoners of war, and strives to assure that they will receive compensation and other benefits in full measure under existing law. The Veterans' Administration does not think, however, the fact that a veteran was a prisoner of war, standing alone, justifies a guaranteed disability rating (contrary to fact) which would be compensable at up to $200 monthly. Moreover, since the proposed bill has nothing to do with the veteran's disability, it would be improper to interject into the disability compensation program monetary benefits"adjustment assistance"-as proposed by this measure.

Based on Department of Defense data on the 566 Vietnam era prisoners of war who have been released, it is estimated that the cost of S. 799, if enacted, would be in the magnitude of $1.2 million per year. In the light of all of the foregoing, the Veterans' Administration opposes enactment of S. 799.

Advice has been received from the Office of Management and Budget that there is no objection to the presentation of this report from the standpoint of the Administration's program.

Sincerely,

32-022 O 74-6

DONALD E. JOHNSON,

Administrator.

[No. 85]

COMMITTEE ON VETERANS' AFFAIRS, U.S. SENATE

EXECUTIVE OFFICE OF THE PRESIDENT,

Hon. VANCE HARTKE,

OFFICE OF MANAGEMENT AND BUDGET,
Washington, D.C., December 21, 1973.

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

DEAR MR. CHAIRMAN: This is in response to your request of April 17, 1973 for the views of this Office on S. 799, a bill "To provide adjustment assistance to Vietnam era prisoners of war."

In reports to your Committee, the Department of Defense and the Veterans Administration state their reasons for recommending against enactment of S. 799. We concur with the views expressed by the agencies in those reports. Accordingly, we recommend against enactment of S. 799.

Sincerely,

WILFRED H. ROMMEL, Assistant Director for Legislative Reference.

Senator TALMADGE. Our first witness is Hon. John Sparkman of Alabama to testify on his bill S. 1575. Senator, you may proceed.

STATEMENT OF HON. JOHN SPARKMAN, A U.S. SENATOR FROM THE STATE OF ALABAMA

Senator SPARKMAN. Mr. Chairman, I greatly appreciate the opportunity to appear before the subcommittee in support of my bill, S. 1575.

As the committee knows, section 314 (k) of title 38, United States Code, provides compensation to veterans who, as a result of a serviceconnected disability, and I quote, "suffer the anatomical loss or loss of use of one or more creative organs, or one foot, or one hand, or both buttocks, or blindness of one eye, having only light perception, or has suffered complete organic aphonia with constant inability to communicate by speech, or deafness of both ears, having absence of air and bone conduction," unquote. My bill simply adds to this list of anatomical losses the loss or loss of use of a kidney.

Mr. Chairman, it may be true that a veteran can live a relatively normal life with one healthy, functioning kidney. However, when a person loses a kidney, his chances of avoiding the dangerous and highly expensive treatment for total kidney failure is reduced by 50 percent. Approximately 55,000 persons die each year in the United States as a result of kidney disease. Many more thousands are kept alive by a technique known as hemodialysis, or more commonly known as the use of a kidney machine. Dialysis in a hospital costs on the average between $35,000 and $40,000 per year. Dialysis in an ambulatory care facility generally runs between $14,000 and $20,000 per year. The least expensive form of dialysis—that is, using the kidney machine in the home-runs between $12,000 and $20,000 for the first year (much of this being for the purchase of equipment and for training the patient in its use) and between $4,000 and $6,000 per year after that. Should an individual suffering from total kidney failure be fortunate enough to obtain a successful kidney transplant, such an operation costs approximately $15,000 and, if there are no unusual complications, the cost of followup treatment, examinations, drugs, et cetera, runs approximately $1,000 per year thereafter.

I realize that much of this medical care may be available to veterans in the VA hospitals. In a case where the veteran loses one kidney as a result of a service-connected injury or illness and is left with one healthy kidney, and in later years he loses the use of the remaining kidney, not as a result of a service-connected injury or illness, he may be eligible to receive dialysis treatment or a transplant in a VA hospital. However, those veterans whose total kidney failure is serviceconnected have a priority in the use of the kidney machines.

As the committee may know, in the use of dialysis, the patient must be hooked up to the kidney machine for 8 hours, three times a week. Otherwise, he dies. The kidney machines are not always available at VA hospitals when they are needed. And even if the machines were always available, Mr. Chairman, consideration should be given to the danger, the discomfort, and the physiological limitations an individual suffering from total kidney failure must endure.