We have innumerable cases of that kind, and it frequently takes outside expert medical opinion to put these cases over under present law. Not all individuals have that opportunity, only a very small percentage. I would say less than 1 percent will bring in a medical wit

ness.

The Government has its doctors who determine what the disease is, but the veteran usually does not have his doctor, Mr. Devereux.

Mr. JONES. I believe you classified them as insane cases. Is that right?

Dr. SHAPIRO. It is a term that is generally used. We do not use "insanity" very much. It is a legal term.

Mr. JONES. I believe that is all.

Mr. EVINS. Mr. Devereux?

Mr. DEVEREUX. No questions.

Mr. EVINS. If the language "functional psychosis" were used, that would limit it only to the extreme cases?

Dr. SHAPIRO. In essence almost altogether to the dementia praecox cases and the manic-depressive cases, with occasionally one of the very more unusual types of functional psychosis. We have a few others, but they are such a small percentage I have not enumerated them.

Mr. JONES. Dr. Shapiro, of course naturally we do not know very much about the definition of these different diseases. Into what group would the group fall where they have hallucinations and delusions? Dr. SHAPIRO. That could be common either to the organic or the functional psychosis. Either one of them could have hallucinations or delusions.

You see, in a psychosis we have an individual who has a mental disorder of the severe type, where all forms of these adaptations, social, religious, professional, all are disrupted in a total disorganization of the personality; whereas in the psychoneurosis, the so-called hysterical cases or the neurasthenic cases, the man has emotional difficulties. He is usually aware of the fact that he is nervous or that he has an expression of a disease which he may think to be organic or he may realize is merely functional. It is a less serious disease.

Mr. JONES. Doctor, you made a very good witness. You gave me some idea of something I did not know very much about.

Mr. EVINS. Do you gentlemen have any further observations or statements you wish to make?

Dr. SHAPIRO. Our bill did include tuberculosis and multiple sclerosis, but I do not think you would care to hear on that this morning. Mr. KENNEDY. Might I have the record show we were accompanied this morning by Mr. Adolph Bremer, of Winona, Minn., one of the national vice commanders of the American Legion.

Mr. EVINS. We are very pleased to have you with us.

Mr. KENNEDY. Also by Dr. Norman R. Booher, of Indianapolis, Ind., who is the vice chairman of our national rehabilitation commission.

Mr. EVINS. We are also very glad to have Dr. Booher, from Indianapolis, with us. Thank you very much, all of you gentlemen. Thank you very kindly for your testimony.

The committee will call Mr. Downer of the VFW, and anyone else he may have with him from the Veterans of Foreign Wars. We are very pleased to have you, Mr. Downer. We are always glad to have you represent the VFW and greatly value your testimony.

STATEMENT OF A. M. DOWNER, ASSISTANT LEGISLATIVE REPRESENTATIVE OF THE VETERANS OF FOREIGN WARS OF THE UNITED STATES

Mr. DOWNER. Mr. Chairman, I am A. M. Downer, assistant legislative representative of the Veterans of Foreign Wars of the United States. I do not have a prepared statement this morning, but with the permission of the committee I hope I can completely and briefly express to you the views of the Veterans of Foreign Wars.

In the beginning I should like to say that the last national encampment of the Veterans of Foreign Wars called for legislation to establish a 3-year presumption for psychosis. The bill now under consideration, H. R. 5891, conforms with the views of the Veterans of Foreign Wars except for that variation.

Our reasoning in supporting a presumption for psychosis is simply that, as is well known, the origin, cause or causes, and development of psychosis are so obscure that to impose upon the veteran the burden of affirmatively establishing his psychosis is service-connected imposes upon him an impossible burden. The proposed legislation merely shifts the burden of proof so that the veteran can establish service connection.

If in fact his psychosis is not service-connected, the presumption can be rebutted and service connection will be denied. If the presumption cannot be rebutted, then of course there is a doubt as to its service connection.

Under the announced policies of the Veterans' Administration, all doubts are to be resolved in favor of the veteran. Consequently, the effect of this legislation is only to enact into law what is now administrative practice. It is justified, therefore, not only by present practice but also by the fact that the enactment of the law would create greater uniformity in the application of what is now practice. Uniformity is the very heart of justice and the very basis of the English common-law system. Consequently, I can see no objection to the proposed legislation.

Mr. EVINS. The VFW mandate asked for a 3-year service-connection presumption?

Mr. DOWNER. Yes, sir; that is correct.

Mr. EVINS. Do you agree with the testimony that Dr. Shapiro has just given regarding changing the legislation from active psychosis to functional psychosis?

Mr. DOWNER. Mr. Chairman, my personal view is that to do so would complicate the legislation, create further problems in interpretation. I think it is very simple and understandable as it is. The word "psychosis" has a clear, definite, and established meaning, as also does the word "active." I cannot see where "active" either adds or detracts anything to "psychosis."

But if we get into further limitations of the word "psychosis", by "functional" or "organic," I am afraid that it will result in subsequent difficulties. If a psychosis is organic and the organic cause of the psychosis did not occur during service, that fact can then be shown and the presumption rebutted and the psychosis would not be serviceconnected.

So it seems to me that the language as used in the bill is adequate. Mr. EvINS. If a man has a psychosis, he is just as bad off whether it is organic or functional, if it is active.

Mr. DOWNER. Yes, sir.

Mr. EVINS. And if it is due to syphilis or willful misconduct that would be established and proven and would be a bar, would it not? Mr. DOWNER. That is correct; yes.

Mr. EVINS. Mr. Devereux?

Mr. DEVEREUX. No questions.

Mr. EVINS. Mr. Jones, any questions?

Mr. JONES. Mr. Downer, would it not be easier, though, as Dr. Shapiro says, to prove this if you confined it to functional psychosis? Could you not come down to the proof easier and get out of the field, not of speculation, but of difficulty of proof, you might say?

Mr. DOWNER. Mr. Jones, I am not a specialist in mental disorders, but in my opinion it seems to me that that would complicate rather than simplify.

Mr. JONES. You think it would complicate it?

Mr. DOWNER. Yes, sir.

Mr. JONES. According to your version of it, it would cover, then, more or less all 9,000 of these cases instead of 60 percent of them.

Mr. DOWNER. My opinion is, Mr. Jones, that any psychosis should carry the presumption of service connection, the rebuttable presumption. If the cause of the psychosis can be established as having occurred outside of the military service, then the psychosis would not be service connected. The presumption would have been rebutted. It is the same language as is in the present law as to the 1-year presumption applicable to psychosis at the present time.

Mr. EVINS. Any further questions, Mr. Jones?

Mr. JONES. No. We would get into a long discussion, although I do not quite agree with you on that question of proof. I think Dr. Shapiro is coming down to a real serious case, one more than just nervous excitement, you know. There might be cases where clearly presumption should be extended, where a man who is mentally ill would be entitled to presumption. If he has some clearly dangerous disease, then of course he is entitled to presumption almost on the face of it.

Mr. EVINS. Thank you, Mr. Downer, for your very excellent statement. The committee appreciates your testimony.

The committee will next call Mr. Charles E. Foster. We are very glad to have you, Mr. Foster. We are always pleased to have your testimony. You may proceed in your own fashion.

STATEMENT OF CHARLES E. FOSTER, ASSISTANT LEGISLATIVE DIRECTOR, DISABLED AMERICAN VETERANS

Mr. FOSTER. My name is Charles E. Foster. I am the assistant legislative director for the Disabled American Veterans.

First I want to say, Mr. Chairman, we appreciate the opportunity to come here and state what we believe to be a sound position with respect to the bills under consideration by your committee this morning. Since 1946-47 the DAV has become increasingly aware of the necessity for a presumption of service connection for the disease of psychosis.

Our Nation-wide claims service has been confronted time and time again with cases that they are convinced in their own mind had their origin in the service, or as a result of the service; but because of a lack of definite proof or because of the lack of evidence such as referred to by Dr. Shapiro in his very fine statement, they are unable to serviceconnect these cases.

This committee, as a matter of fact in the first session of this Congress, passed a bill which would to a large extent have alleviated this condition. Unfortunately, it was changed in the Senate, and in the manner in which it was amended in the Senate, enacted into law.

I think it was Public Law 239, if my recollection is correct. That law establishes a service connection for the disease of psychosis for a period of 2 years following service for purposes of hospitalization only, but not for purposes of compensation. We were very aggrieved by the action of the Senate in doing that. We think it was extremely unfair.

We think that to deprive a man of compensation at a time when he is more in need of it than at any other time of his life is extremely unfair and inequitable. We feel that if a man is going to be serviceconnected for a disability, he should in all fairness be service-connected for all purposes, for hospitalization, for out-patient treatment; and particularly for purposes of compensation and for all other benefits under laws administered by the Veterans' Administration.

With respect to the two bills under consideration here this morning, H. R. 5891 and H. R. 5892, our organization has for the past 2 years adopted resolutions at our national conventions urging a 3-year period of presumption for the disease of psychosis. That is, for 3 years following the man's separation from the service; and we do feel therefore that the bill H. R. 5892 is the better of the two bills which are under consideration here today.

I would like to refer just briefly to the question which has been raised here as to the rebuttability of this presumption. As an organzed veterans' organization, which has been appearing before the Veterans' Administration in claims work for a good many years, and before the committees of Congress, we feel that the Government should at all times have the opportunity to rebut cases which are granted a presumption. We do not think that these presumptions should be nonrebuttable.

In other words, we take the position that if a man has a bona fide disability which was incurred in service or as a result of his service, it should be service-connected. But we do not like to see cases that smack of fraud or misrepresentation service-connected because in the long run that will inure to the disadvantage of all veterans, and particularly all disabled veterans.

Therefore, we feel that any presumption should be rebuttable by clear and convincing evidence which would show that the man is not entitled to a service-connection.

That about concludes our views on the bill. We would like to see this committee give it favorable and early consideration and to grant a presumption for a period of 3 years for all purposes.

Mr. EvINS. Mr. Foster, to further amplify Mr. Birdsall's testimony on the period of service presumption, at least one body of the Congress may have made an error in not going far enough. Could you elaborate

on your reasons for your views for a 3-year period of presumption for service-connection?

Mr. FOSTER. Yes. The rehabilitation committees at our conventions in considering this problem have realized that very little is known of the disease of psychosis. Medical science admits that they do not know what the causes are, and they do not know what the cure is. Certainly I am in no position, and I do not think the Members of Congress or members of this committee feel that they are in any position, to say whether it should be a 1-year, or 2-year, or 3-year period.

The 3-year period, I do not believe, can be justified on any sound medical theory. Where the 3-year period first originated, I do not know. But in the absence of any contrary evidence either affirmatively or negatively, we have to arrive at some period of time.

As was pointed out earlier this morning, in World War I the presumptive period for psychosis was January 1, 1925, I believe, which was a much greater period than this 3-year period. We are not asking for that, but we feel that 3 years, based on the experience that we have had in claims work, would be, with the information and knowledge that is presently available, a fair period of time in which to conclude that the disease was service-connected.

Mr. EVINS. If it had been developed in the service or had been aggravated by the service, that could certainly soon be ascertained, but psychosis might take some years for its development. The testimony is that it sometimes develops very slowly.

Mr. FOSTER. I think that is quite true, Mr. Evins. I keep referring to Dr. Shapiro. He made a very fine explanation of the disease, and, of course, he is an expert in that field and so recognized. But I think his description of the stresses and strains and emotional conditions which a man undergoes in the service certainly led to a lot of these cases, which may develop many months or many years after separation from the service.

Mr. EVINS. Do you have any testimony you wish to offer on the question of functional or organic or active?

Mr. FOSTER. I cannot qualify as an expert in that field, Mr. Evins, but I think the term "functional" certainly would give adequate protection and would be a meritorious addition to the bill in its present form.

As I understand it, if a man has an organic disease or a psychosis from organic causes, and that organic cause can be attributed to the service, it is going to be service-connected. Whereas on the functional side, if it is a psychosis developing from a functional cause, it is difficult to say whether or not it developed in the service.

I think it would be a worthy addition to the bill.
Mr. EVINS. General Devereux, any questions?

Mr. DEVEREUX. No; I have no questions to direct to him.
Mr. EVINS. Mr. Jones?

Mr. JONES. If the presumption can be invoked in all of these cases, then you say it can be rebutted. Do I understand you to say rebutted by clear and convincing evidence? Is that the rule? Or is that a ruling of the department, or how would it be rebutted? Not beyond any reasonable doubt, of course.

Mr. FOSTER. I would say by clear and convincing evidence.

Mr. EVINS. I think Dr. Shapiro gave a very good statement in support of what you have said regarding the difficulties of proof, which