Mr. BIRDSALL. Most of them would get the $150 rate.

Mr. EVINS. As a matter of fact, the 9,000 that you referred to are already being compensated.

Mr. BIRDSALL. Are receiving benefits; yes, sir; of $60, $72, or $120 per month.

Mr. EVINS. One further thing, Mr. Birdsall, for the record. Would you review briefly-perhaps you did touch upon it-just when the first law on the presumption of service connection developed? Was that in 1950? Give us a brief history for the record of that.

Mr. BIRDSALL. Do you mean chronic constitutional diseases, or the presumptions on

Mr. EVINS. Presumptions of service connection.

Mr. BIRDSALL. Originally, Mr. Chairman, the presumption was in the 1921 act. That was Public Law 47, Sixty-seventh Congress. Mr. EVINS. What did that cover?

Mr. BIRDSALL. That established the neuropsychiatric presumption arising within 2 years, 10 percent within 2 years, for neuropsychiatric disease. The next change was to extend that to 3 years by the act of March 4, 1923. That was a 3-year presumption. That is neuropsychiatric disease. This does not include your tuberculosis.

The presumption, then, in the act of June 7, 1924—and I might give you that as amended; I thought probably you would be asking that question. Section 200 of the World War Veterans Act, 1924, as amended and in effect prior to the Economy Act, provided for a presumption of service connection for World War I veterans where 10-percent or more disability arose prior to January 1, 1925, from any one of the following diseases: Neuropsychiatric disease, spinal meningitis, active tubercular disease, paralysis agitans, encephalitis lethargic, or amebic dysentery.

The presumption was conclusive as to active tuberculosis or spinal meningitis, and in all the other cases it was rebuttable by clear and convincing evidence.

The same section also included a conclusive presumption of soundness at the time of entry into the service except for certain conditions that were noted at the time of entry. This particular section that I mentioned of the World War Veterans Act was repealed by the Economy Act of March 20, 1938, and then restored with limitations by the act of March 28, 1934, Public Law 141 of the Seventy-third Congress.

Among other things, the conclusive presumption on active tuberculosis and spinal meningitis became rebuttable and presumption of soundness became rebuttable.

Mr. EVINS. In 1924 it was substantially liberalized and the number of diseases specifically enumerated, more so than in the year 1921, when it originated.

Mr. BIRDSALL. After the Economy Act-that is, the promulgation of the regulations-Veterans Regulation No. 1-A, which carries the eligibility for wartime service connection and peacetime service connection, contained a provision that had long been in the regulations of the Veterans' Administration, former Veterans' Bureau, in fact. It is traced way back to probably 1921.

It is predicated on individual letters sent to field offices at that time, wherein they stated that in sound medical judgment a particular

constitutional disease could very well be assumed to be due to service if it arose to a 10-percent degree in 1 year. Those were later on assembled and they promulgated a regulation, 111, as I recall the number— I believe it is accurate that established this generally for certain chronic diseases; and that is where your list originated for chronic diseases that this committee later on as it then stood was enacted into law.

Those diseases accumulated on the basis of study and were incorporated in the 1925 schedule of disability ratings. They had two lists of such diseases. That was rebuttable presumption.

However, when the regulations were originally promulgated by the President under the Economy Act, under the authority contained in the Economy Act, there was a presumption of such chronic constitutional diseases included, rebuttable presumption, 10 per cent within 1 year. That is the particular presumption that received such thorough review by the committee, and on the basis of which you got information from the Veterans' Administration with reference to the specific disease involved. And then, on your further study, these exceptions that I mentioned before were made to the 1 year.

That presumption, for example, statutory on the different diseases under the World War Veterans Act, of course, included cases of tuberculosis, for example, where the condition may have arisen after January 1, 1925, because they could go back and in a moderately advanced tuberculosis case say it must have been active at least 9 months before that. The same way with far advanced, probably a year.

So, the presumption in the far-advanced cases really amounted to December 31, 1925. That is not true as to the disease you are dealing with here, psychosis.

Mr. EVINS. There is no objection, as far as you know on the part of the Veterans' Administration, to including psychosis on the list?

Mr. BIRDSALL. It is on the list, sir. It is not specifically in the law, but is in our regulation for 1-year presumption. I might state also, as a matter of information to the committee-and it is in our reportthat of course under this new law, Public Law 239, which gives a flat presumption for hospitalization, out-patient treatment is more liberal than what your existing bill would be.

In other words, your bill is patterned after the general presumptive provisions, which means that the man, to get a chronic-constitutionaldisease presumption, must have served 90 days, must not have been due to willful misconduct, and is a rebuttable presumption. Under 239 there is no rebuttal. It is a conclusive presumption of service connection. There is no willful-misconduct bar at all, and there is no requirement that he must have served 90 days in order to get the pre- · sumption.

Mr. EVINS. Those are two additional reasons why this bill should be enacted into law for the purposes of uniformity.

Mr. Devereux, do you have any questions?

Mr. DEVEREAUX. No; I do not.

Mr. EVINS. Mr. Jones?

Mr. JONES. I notice in a memorandum here-I should know more about it, but I have just had the opportunity to make a cursory study of it-it says it would add quite a bit to the expense. In what way? Do you have any estimate of the cost of this?

Mr. BIRDSALL. The estimate, of course, Congressman Jones, of cost has to do largely with the increase. That is, your pension, for example, where rate is $60, as to those who are now on a permanent and total basis for pension purposes. If they became service-connected and were totally disabled, they would receive $150. There would be a cost. factor there.

Of course, your dependents would also come in in the cases of deceased veterans.

Mr. EVINS. You pointed out that the 9,000 veterans who are already receiving disability compensation are already taken care of. Mr. BIRDSALL. Yes, sir.

Mr. JONES. Do you recommend this?

Mr. BIRDSALL. Congressman, the Veterans' Administration does not, under General Gray's policy, recommend for or against; but we certainly want to be certain that you get everything we have in the way of information. We are very happy to have the questions asked that were asked this morning, because it helps us to give you the full information, and then justice is the result of that.

Mr. JONES. You know, we always ask that question. We frequently do not get any answer to it, but I like to propound it myself.

Mr. EVINS. Dr. Davidson, or Mr. Robson, do you have any statement that you want to add to Mr. Birdsall's testimony?

Mr. ROBSON. I do not believe I can add anything, Congressman, to Mr. Birdsall's statement, unless you have some specific question you would like to ask, which I might answer, pertaining to my particular work in the Veterans' Claims Service.

Mr. EVINS. Dr. Davidson?

Dr. DAVIDSON. I have no statements.

Mr. DEVEREUX. I would like to ask a question.

Mr. EVINS. Mr. Devereux.

Mr. DEVEREUX. In arriving at a conclusion as to whether or not the condition of a particular man is service-connected, is the final word given by the Veterans' Administration medical personnel? May the man concerned be represented by civilian personnel or outside personnel in the discussion of his case?

Mr. ROBSON. A veteran may have representation by any of the representatives of the accredited service organizations; or he may, if he so wishes, have an attorney appear for him—or anyone, in fact. We do not bar any representation.

Mr. DEVEREUX. How about a civilian doctor, somebody who is not connected, I should say, with the Veterans' Administration?

Mr. ROBSON. He may bring a civilian doctor, and it often is done by the veteran's representative himself, one of the men of the accredited organizations, if he feels that he can win his case by bringing in a physician from the outside or any other witness. He is at perfect liberty to do so.

Mr. EVINS. I believe that is all, Mr. Birdsall, and gentlemen. Thank you very much. We appreciate your testimony.

The committee is going to call Mr. Miles Kennedy, legislative representative of the American Legion. Mr. Kennedy, if you have any other members of the American Legion with you, we will be glad to have them, too.

STATEMENT OF MILES KENNEDY, NATIONAL LEGISLATIVE DIRECTOR, AMERICAN LEGION, ACCOMPANIED BY T. 0. KRAABEL, DIRECTOR, NATIONAL REHABILITATION COMMISSION, AMERICAN LEGION, AND DR. HYMAN D. SHAPIRO

Mr. KENNEDY. Mr. Chairman and gentlemen of the committee; my name is Miles D. Kennedy. I am the national legislative director of the American Legion. I do not intend to offer any technical testimony myself, Mr. Chairman, but with your permission I would like to introduce just for a brief preliminary statement-it will be very brief— Mr. T. O. Kraabel, who is the director of the national rehabilitation. commission of the American Legion.

Then, later on, Mr. Chairman, with your permission, I would like to introduce Dr. Hyman D. Shapiro, who will give the technical testimony and I will qualify Dr. Shapiro at that time.

With your permission now, sir, I would like to introduce Mr. T. O. Kraabel.

Mr. EVINS. You may proceed. We are very glad to have you, Mr. Kraabel.

Mr. KENNEDY. I want to thank you gentlemen for extending the invitation to permit us to present our witnesses before you this morning.

Mr. EVINS. We are always glad to have you. We always welcome you, and we rely greatly upon the point of view of the American Legion and our other fine organizations. Mr. Kraabel.

Mr. KRAABEL. Mr. Chairman, gentlemen, thank you very much. The preliminary statement I wanted to make has reference to the actions and studies by members of this organization, lay people and doctors alike, before we find expression or recommendation on these points that we think are pertinent and important to the cause of

veterans.

Around 600 or 700 practicing service officers throughout the country since the period of World War II have noticed the impact of mental disturbance among many of those who served. Immediately after the war there was quite a hectic time. Demobilization was at a rapid pace. The country was flooded by returning people, around 12,000,000 in a year's time. The Veterans' Administration nearly bogged down under the pressure. Our own service was whipped in a way. We did not have sufficient personnel to look after the demands that came to

us.

But as the months passed they did get on their feet and leveled off and had opportunity to make studies. They consummated, we might say, in three resolutions that came to the Miami national convention last fall: One related to the nonpulmonary tuberculosis; one with reference to multiple sclerosis; and one to the subject matter of the bills before you.

These resolutions are products of studies and experience not only by lay service officers, but in consultation with their medical colleagues, friends, and committee members. They also write in to the National Rehabilitation Commission, where we have a staff of three doctors; and come to conferences in the area and the national gatherings; and refer questions to the medical advisory board of 10 outstanding doctors of the country.

They are pretty well fortified before they make these recommendations, and it all stems from the viewpoint of the couse of the disabled veteran.

If the question were asked us-Mr. Kennedy, myself, or Dr. Shapiro, as representatives of the American Legion-we are in favor of the enactment of the bill H. R. 5892, or H. R. 5891, as the committee may decide; and our main witness to that end is, of course, our senior medical consultant.

I want to make this preliminary statement as to the results of a Nation-wide study, and experiences among service officers and medical people alike. Thank you.

Mr. KENNEDY. Mr. Chairman, just so I might qualify for the record Dr. Shapiro, his full name is Dr, Hyman D. Shapiro. He is the senior medical consultant to the national rehabilitation commission of the American Legion. Dr. Shapiro has been duly licensed to practice medicine in and by the District of Columbia since 1919. He has been with this division of the American Legion continuously since 1927. He is thoroughly conversant with the problems presented by the type of legislation before you.

He is an associate clinical professor of neurology at the George Washington Medical School here in the District. He is a diplomat of the American Board in both neurology and psychiatry, and he was formerly medical member of the Commission on Mental Health in the District Court of the United States for the District of Columbia. I now present Dr. Shapiro, Mr. Chairman and gentlemen. Mr. EVINS. We are glad to hear you, Dr. Shapiro.

Dr. SHAPIRO. Mr. Chairman and members of the subcommittee, I appreciate the opportunity to appear before you and give you the American Legion's viewpoint as to why there should be enactment of either of the two bills which are under consideration today.

The American Legion favors H. R. 5891, which seeks to increase the 1-year period of presumption for service connection for "active psychosis" from a 1-year to a 2-year period.

As I understand it, this session was called for the consideration of H. R. 5891. I would like to ask the chairman's permission at this time to direct my remarks also to H. R. 5892, which was introduced by the chairman on January 8, 1952, the same date on which H. R. 5891 was introduced.

H. R. 5892 is in line with the American Legion's mandate, which asks for a 3-year presumptive period for the phychoses. Certainly what I have to say in favor of the 3-year presumption should hold good for a 2-year presumption, as sought in H. R. 5891.

At the outset I would suggest eliminating the term "or active psychosis" as stated in line 6 of H. R. 5891, and would suggest the insertion of the term "or functional psychosis." My reason is that the term "active" used to modify the word "psychosis" is redundant, because if an individual has a psychosis, one definitely understands the individual to have an active mental disease.

I would also limit the extension of presumption to those psychoses of "functional" origin, that is, those where no definite organic cause is ascertainable.

I would like to interject at this time that all the 9,000 cases that were mentioned on the rolls for pension purposes would not be in