This is a situation that I think this committee is going to have to take under advisement, and study and ask the Veterans' Administration to answer some specific questions and bring about some corrections for these problems.

You asked questions, that I presume you will ask me, on our service officer's finding benefits to widows, the adjudication process difficult. Yes, we are. Surprisingly enough, it's occurring on local levels, but not occurring on the central office level.

There is a letter, a document, that's come out of benefits, that's very liberal in presuming service-connected death.

I was somewhat surprised this morning that the Benefits Director did not bring this point out. It brings out such areas as suicide, accident, as you would assume that the people I represent, because of their disability, do suffer a great deal of accidents. More so then you might expect.

Suicide is very high among the severely disabled veterans, not only the parapelegics, but those that have multiple amputations, those who are blind, and those with brain damage.

So, the VA, based on a central office decision, has been very liberal in providing service-connected death.

This does not hold true on the local level. Somehow the bureaucracy seems to fail in its transmittal of human feelings down the line.

Hopefully, if you would adapt and accept your proposal on serviceconnected death based on total, permanent disability alone, this would alleviate a lot of the problems.

It would stop the necessity for veterans organizations, such as ours, and the others that spoke today, to have to carry a case through various levels of appeal to get the proper determination on the case.

If we do get the case, we will most likely win the case, but the problem is

Senator TALMADGE. If you will yield at that point. What percentage of these cases are won, affirmatively, that you're referring to?

Mr. MAYE. In the cases we've handled recently, I can only think of one that we've lost that we've had to handle on the level here at the central office.

Senator TALMADGE. What you're saying then is that this bill would primarily speed up the payment of DIC to the beneficiaries if they did not have to have the case adjudicated?

Mr. MAYE. Yes, sir.

Senator STONE. They win them, anyway.

Mr. MAYE. Right.

The bill really is not out of line with VA's policy on the central office level.

If there are any other questions, I would be more than glad to try to answer.

Senator TALMADGE. I understood you to say that the adjudication delay, in the cases that you referred to specifically, took as long as 9 months.

The administration has requested reducing the personnel in the Veterans' Administration, that is the adjudication offices, by some 500. I suppose that you, and your organization, would be opposed to that? Mr. MAYE. Absolutely, sir.

We work with people inside on the regional office level and on the central office level, and their feeling is it should be reversed. They need more people to adjudicate claims.

If you had a 30-percent increase in total claims filed in a year, you don't reduce your staff in order to keep up the process. You've got to reverse the situation.

You've got to ask people to handle the caseload.

Now, at such a point in time that the caseload begins to drop off, then you can consider a reduction in staff.

Senator TALMADGE. Senator Stone.

Senator STONE. You heard the VA report this morning in response to my question, that they would be willing to do a computer survey of location of the paralyzed veterans.

I wonder if you'd be kind enough to watch that for us, and if that's not properly done, to let our staff know.

Mr. MAYE. Yes, sir; I might make a comment on that.

That question has been asked before, and I appreciate what you've done. His answer was somewhat elusive in that he said, yes, we can try it.

We have been told that they cannot identify the spinal cord injured veteran from that printout, that they can only identify what compensation and what statutory awards he has, whether it's a loss of use of, or loss of legs, or there's no specific way to identify if he's a spinal cord injured or a double amputee, or whatever.

Senator STONE. He gave us a different answer this morning, and if they revert to the type of answers you were getting before this answer this morning, if you would tell our staff, I know we'd be interested in either having them back or writing, or visiting with them to see whether there's some way the computers can do the job. Mr. MAYE. Yes, sir; we will.

Senator STONE. You're entitled to that information, as we are. Mr. MAYE. We're primarily hoping that the Veterans' Administration will get the information so they can make appropriate plans for hospitals and necessary physicians, et cetera.

Senator TALMADGE. Thank you very much, Mr. Maye.

[The aid and attendance survey referred to earlier follows:]

AID

INTRODUCTION

This survey was undertaken to determine a realistic cost of aid and attendance for the severely disabled veteran, the veteran who must rely upon the service of others in order to remain free from an institutional environment.

The philosophy which guided this gathering of data is that aid and attendance is paid in order to alleviate the financial burden placed upon the catastrophically disabled veteran as a result of sums of money paid for services required because of the veteran's unique medical and physical situation. As long as such expenses are not adequately met by aid and attendance payments, the veteran's life style is unduly suppressed or his physical health becomes subject to neglect.

Of course, the specific needs associated with different types of disabilities vary. Also, among veterans with similar physical losses, the specific needs for aid and attendance will vary according to the activities of the individual. Because of the complexity of efforts which would be associated with individual determination of aid and attendance needs, this survey centered on costs which would undoubtedly be incurred by a paralyzed veteran who has only limited functions of his extremities and, as most paralyzed veterans, loss of bowel and bladder control. The assumption is that such a veteran desires to live independently of institutional and charitable efforts.

A further assumption is that the paralyzed veteran described above does not want to become a physical or financial burden upon his family, relatives or neighbors. The services in the following paragraphs are based on essential services required for the veteran's well being and physical health.

SERVICES REQUIRED

Although a paralyzed veteran with maximum hospital benefits and a stable condition does not require the attention of a licensed nurse, certain physical aspects of the veteran's care require that an aide has at least some medical training. The services are defined below:

Physical Therapy or Exercise: Most paralyzed veterans require some type of range of motion exercises to keep their paralyzed extremities from contracting or becoming rigid. Such exercises also aid blood circulation and help reduce the possibility of skin ulcers. Also there is evidence that good muscle tone in the lower extremities helps reduce heart fatigue. Thus passive exercises are an essential part of the paralyzed veteran's health care.

Personal Care: Many paralyzed veterans cannot comb their hair, shave, dress themselves or eat without assistance. Also they must be helped from the bed to their chair and back. Thus personal care services involve those activities which help the paralyzed veteran get up and around, keep a well groomed appearance, and engage in everyday activities. There are also some health care aspects of personal care services. For instance, while in bed paralyzed persons should be turned about every three hours to reduce the possibility of skin ulcers or bedsores.

Personal Hygiene: Since most paralyzed veterans have lost the function of their bowels and bladder, they must rely upon specific techniques to aid the excretory functions associated with these organs. For the veteran described above, bowel and

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bladder techniques require the assistance of an aide. Often the lower bowel has to be evacuated manually. The use of enemas or suppositories may suffice; however, an aide must perform the necessary tasks. The evacuation of urine may be promoted by external or indwelling catheterization. An indwelling catheter requires frequent changing by someone who is trained. Neglect of the services required with the indwelling catheter can result in death. The external catheter must be changed about every 24 hours to reduce the possibility of skin lesions and infection. Equipment associated with bladder evacuation must be kept clean, disinfected, and deodorized for the veteran's well being.

Bathing would also be included in personal hygiene services for obvious reasons. Also a trained aide can recognize certain clinical signs of medical complications associated with paraplegia.

Travel: Spontaneity of travel is impossible for the paralyzed veteran. Every trip must be well planned or the replication of a previous trip. The outside world is not barrier free. The veteran in a wheelchair must be helped up and down curbs, up and down steps, and up and down steep inclines. Someone must help the paralyzed veteran carry groceries, parcels and luggage. If traveling any distance in a private vehicle, the veteran is subject to being isolated over night if a mechanical failure disables the vehicle. He cannot walk to a service station or phone booth. Changing tires is beyond the ability of most paralyzed veterans, they are at the mercy of passers-by if a companion is not available.

Household Care: If the severely disabled veteran wishes to maintain a home, there are many services pertaining to home care or housekeeping which he cannot do. Therefore, someone must assist him with cleaning, cooking and laundry.

SURVEY METHOD

In order to determine a reasonable estimate of the costs which would be incurred for the services described above, 56 randomly selected agencies in 12 states and the District of Columbia were contacted. Since most of the services listed would require individuals with some medical health care training or experience, all the agencies contacted offered personnel who were trained or licensed health care aides. Representatives from each agency contacted were asked which services their personnel were competent or able to perform within the following outline:

1. Physical

INQUIRY OUTLINE

a. Range of Motion, or
b. Passive Exercise

2. Personal Care

a. grooming
b. dressing