DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Hon. OLIN E. TEAGUE, PUBLIC HEALTH SERVICE, Washington, D. C., June 16, 1958. Chairman, Committee on Veterans' Affairs, House of Representatives, Washington, D. C. DEAR MR. CHAIRMAN: This reply is in response to your letter of June 3 which raised specific questions on multiple sclerosis and on psychoses in relation to provisions of law governing the statutory presumptions of service connection for specified diseases and conditions. You have also asked whether the 3-year presumptive period for tuberculosis and the 1-year period for other diseases listed in the presumption sections of Public Law 85-56 should be extended to longer periods. Multiple sclerosis.-Although considerable information continues to be accumulated on multiple sclerosis the cause of the disease is still unknown. It is uncertain whether multiple sclerosis is a disease entity (i. e., due to a direct sequence of events with a single precipitating cause) or whether it is a syndrome of several disease entities due to a variety of causes. The "latent" period for multiple sclerosis is also unknown; i. e., we do not know how much time must elapse from exposure to a predisposed or precipitating cause to the onset of initial symptoms. Additional relevant information may be obtained in the next few years from a combined research project by the National Research Council, the National Institutes of Health, and the Veterans' Administration on the epidemiology and prognosis of multiple sclerosis. At the present time, however, no new facts are available which would warrant changing the 2-year presumptive period. You have also asked, "Can it be stated categorically that a man who develops multiple sclerosis within 5 years after his discharge from the service did not develop the disease in the service?" Because of the long period of remissions which are known to occur in this disease, it is highly probable there would be some men who develop their original symptoms of illness (e. g., acute retrobulbar neuritis) during their service, but who would not develop other symptoms which would lead to the diagnosis of multiple sclerosis until several years later. However, because acute retrobulbar neuritis (and the same could be said for many other symptoms) is well recognized as one of the initial disabilities of multiple sclerosis, there would be no problem in a man's justifying his multiple sclerosis as having occurred during his service time even, as so often happens, if he had a complete recovery from his retrobulbar neuritis while in the service. The questions you have raised might also be interpreted as to whether exposure to some unknown factor of military life would have resulted in the development of the disease even 5 years later. No direct answer can be given to this point. We do not know whether exposure is necessary in the period immediately preceding the earliest onset of symptoms or whether exposure in childhood, adolescence, or even several months or years prior to onset is required. It might be pointed out that we are also not in a position to determine whether individuals developing multiple sclerosis within 5 years after entering the service were likewise predisposed in their civilian life and were destined to developed the illness whether in the service or not. Psychoses. No new evidence is available which would support a change in the 1-year presumption period. As is well recognized, there are many conflicting theories as to the genesis of psychoses, which range from the genetic-biological to those which are sociopsychological in nature. Almost all of them employ a predisposition to the illness which dates back to early life. It is reasonably safe in assuming that if a psychosis had not developed within 1 year after the termination of military service, the events of service life could hardly be regarded as having precipitated the reaction. Other diseases on the list in Public Law 85-56.—In general, the Public Health Service does not believe a change in the presumption period is required for any of the diseases listed, with the possible exception of leprosy. The presumptive period in leprosy might be extended to 5 years or longer in order to give individuals who had been stationed in areas of the world where the disease is known to exist a reasonable period in which the disease process may manifest itself clinically or be amenable to clinical diagnostic procedures. In view of the tremendous import to the Government in terms of compensation related to the diseases listed in the presumption section in Public Law 85-56, the Committee on Veterans' Affairs may wish to consider asking the Veterans' Administration to constitute groups of experts in the various disease categories to discuss those in their sphere of cognizance. Because of the complexity of causative factors in many of these diseases and the lack of definitive data, no one individual can provide satisfactory answers to the questions listed in your letter. It seems desirable, therefore, to bring together a number of experts in each disease category in order that they may discuss the problem and arrive at an opinion formed from joint discussions and deliberations. The Public Health Service has a number of experts on these various diseases and would be happy to make them available for participation in such discussions. I hope these comments will be helpful to the committee. If the Public Health Service can be of further assistance, we will be glad to cooperate in any way we can. Sincerely yours, JOHN D. PORTERFIELD, Summary of bills considered in subcommittee hearings Bill number and author H. R. 65: Mr. Teague of Texas-Jan. 3, 1957. Explanation Grants to VA employees in Philippines similar benefits to those given Foreign Service officers. Provides automatic payment of compensation for statutory award for loss of creative organ. Grants each combat veteran who was awarded Purple Heart a service-connected disability of 10 percent. Prohibits severance of compensation, pension or insurance which have been in effect for 10 or more years. Grants $180 annually for clothing allowance to service-connected veterans with an amputation requiring prosthetic appliance. Provides 3-year presumption for leprosy instead of present 1 year. Provides 3-year presumption for chronic and tropical diseases in lieu of present 1 year. Provides 2-year presumption for malignant tumors instead of present 1 year. Provides 3-year presumption for multiple sclerosis (presently 2 years); psychoses (now 1 year); and malignant tumors (now 1 year). Provides 3-year presumption for multiple sclerosis (presently 2 years) and psychoses (now 1 year). Provides 3-year presumption for arthritis (now 1 year), psychoses (now 1 year) and multiple sclerosis (now 2 years). Provides automatic payment of compensation for statutory award for loss of creative organ. Pays $200 additional monthly compensation to triple and quadruple amputees during periods in which they are not hospitalized at Government expense. Increases the burial allowance from $150 to $250. Presumes injury or disease to be incurred in line of duty in absence of service department certificate to the contrary. Provides 10-percent disability rating for any veteran with Purple Heart award. An injury 30 percent or more disabling incurred from unauthorized handling of seemingly ineffective missiles shall not be considered willful misconduct. Provides 3-year presumptive period of multiple sclerosis (now 2 years) and chronic functional psychoses (now 1 year). Provides statutory award of $47 monthly for deafness of both ears. Defines the terms "wife" and "dependent" as including a dependent husband and the term "widow" to include a widower for the purposes of VA laws. Presumes service connection for hospitalization and outpatient care for World War II and Korean veterans who develop at any time an active psychosis provided the veteran actually participated in combat. Prohibits severance of service connection which has been in effect for 10 or more years. Provides conclusive presumption of service connection for idiopathic convulsive seizures which occur within 6 months from time of discharge. Authorizes Administrator to fix special rate of compensation for existing rates are inadequate for disability. Provides compensation parity for female veterans who have dependent husbands. H. R. 7573: Mr. Teague of Provides 1-year presumption of service con- nection for meningitis. Summary of bills considered in subcommittee hearings-Continued Bill number and author Explanation H. R. 9671: Mrs. Kee-Jan. 7, Increases burial allowance from $150 to $250.1958. H. R. 9710: Mr. Robsion- H. R. 9726: Mr. Smith of H. R. 9730: Mr. Teague of H. R. 9896: Mr. Aspinall (by H. R. 10029: Mr. Teague of H. R. 10134: Mr. Winstead- H. R. 10461: Mr. Teague of Texas (by request)-Feb. 3, 1958. H. R. 10462: Mr. Teague of H. R. 10748: Mr. Beckworth- H. R. 10797: Mr. Teague of H. R. 10798: Mr. Teague of H. R. 11343: Mr. Cramer (by H. R. 11528: Mr. Holland- H. R. 11801: Mr. Fino-Apr. H. R. 11837: Mr. Saylor-Apr. 2, 1958. H. R. 12056: Mr. Siler-Apr. H. R. 12096: Mr. Abernethy- Increases burial allowance from $150 to $250....... Prohibits severance of service connection when Provides 3-year presumption for multiple Provides 2-year presumption for organic heart Prohibits severance of service connection for Broadens class of beneficiaries under Survivors Prohibits severance of service connection Provides that any disability incurred after 90 Grants death compensation to certain widows Freezes as of Jan. 1, 1958 the VA schedule for Gives usual presumptions to World War I vet- Prohibits severance of service connection Prohibits reduction in disability ratings which H. R. 12383: Mr. Addonizio- Provides 7-year presumption of service con- H. R. 12636: Mr. Moulder- H. R. 12651: Mr. Gubser (by H. R. 12874: Mr. Moulder- H. R. 12927: Mr. Teague of nection instead of present 2 year period. Presumes to be service connected the death of (1) was rated totally disabled for 12 con- (2) was rated totally disabled for 10 or Furnishes or replaces clothing damaged by -413, 415, 420, 330, 411, 2770, 3630, 3867, 3971, 4214, 5322, 7088, 7448, 10461, 10462, Presumptions of service connection_. 924, 929, 1143, 3822, 3973, 6421, 6984, 7573, 9896, 10029, 10797, 11528 9726, 10134, 10748, 11837, 12056, 12096, 12383, 12636, 12873, 12874 |