cause to service-connected death? We certainly think so. We have had trouble getting it through to the Veterans' Administration in our appeals. Victims of severe crime: we had a member in Pennsylvania who was shot to death while he was trying to defend himself in a wheelchair. We did win DIC benefits on that, but again, it is examples of people's disability inhibiting them from protecting lives; life expectancy is shortened. So we hope that this committee will move and pass automatic DIC benefits for total and permanently disabled. We do have two recommended changes, Mr. Chairman. First of all, we are concerned with the wording of 9994 about the natural causes. As I tried to point out earlier, there are other causes besides natural death, I guess: accidents, just simply shortened life expectancy because of disability. I think it is perhaps, again, a vague wording which could cause some problems in the VA administering the program. Second of all, we would reduce the eligibility from 10 years to 1 year. In other words, if a veteran had a total and permanent disability for a period of 1 year or more, he would be automatically presumed service-connected death when he dies. Mr. Chairman, that concludes our statement. Again, I appreciate your time and I appreciate your efforts, Congressman Edgar's efforts, Congressman Guyer's efforts for coming and listening this morning. Thank you. Mr. MONTGOMERY. Thank you, Mr. Roffee. Without objection your full statement will be put in the record. TESTIMONY OF LAWRENCE W. ROFFEE, JR., EXECUTIVE DIRECTOR, Mr. Chairman and distinguished members of the Subcommittee on Compensation and Pension, I am pleased to appear before you today to present the views of Paralyzed Veterans of America on several bills which concern compensation for service connected disabled veterans and survivors. Due to the number of bills being discussed at today's hearings, our comments will be directed toward three of the bills which would have the most impact upon our membership. PVA is very pleased that the Chairman of the Veterans' Affairs Committee, the Ranking Minority Member, and the Chairman of this subcommittee have introduced a bill which would provide for a two-step aid and attendance compensation payment system for certain severely disabled veterans. This concept is one which PVA has supported for a long time, and we are extremely grateful for the interest shown in the two-step A&A proposal by members of this Committee. All of PVA's members are catastrophically disabled. They either have sustained spinal cord injuries or are suffering from severe cases of poliomyelitis, multiple sclerosis, or other debilitating conditions. Consequently, virtually all of them are confined to wheelchairs or are bedridden. Many require assistance with such tasks as getting up in the morning, getting dressed, or even eating. In addition to the expected mental and emotional strain caused by such severe disability, enormous financial pressures often exist as well. Even for those veterans who are relatively independent, such as many low-level paraplegics, the expenses associated with being disabled are high. Of service connected veterans responding to a 1977 survey by PVA, the average amount spent per month for disability-related expenses1 was $508.04. As can be seen by the figures in Table I, however, actual expenses in each category varied considerably depending upon the degree of disability. The current level of aid and attendance probably is sufficient for many catastrophically disabled veterans who are relatively independent. For those 1 This category includes medical expenses, extra household help, medical aid-type services, and miscellaneous disability-related expenses. veterans who are dependent upon others for virtually everything, however, the amount of A&A which is paid under the present compensation law is woefully inadequate. Although it is not a pleasant fact to face, there are many veterans with service connected disabilities who are unable to do anything for themselves. Either because of high-level quadriplegia, multiple amputations, or other catastrophically disabling conditions, these wartime veterans require constant care, twenty-four hours a day. If they do not happen to have independent sources of income or family members who are able to provide around-the-clock care, many of these veterans have no choice but to become permanent residents of institutions such as VA hospitals or nursing homes, since the estimated average cost for constant aid and attendance is $1,500 per month. PVA has approximately 11,000 members located throughout the United States. Of these catastrophically disabled veterans, 60.3 percent have disabilities that are service connected. Of the service connected members, 64.4 percent are paraplegic, 23.4 percent are quadriplegic, and the remaining 12.2 percent suffer from other equally severe disabling conditions. Based upon these figures we would estimate that the number of our service connected members who would require constant aid and attendance is approximately 1,650. This figure is based upon our membership only and does not include those veterans with service connected disabilities who are multiple amputees or who have another equally severe disability. We estimate that 3,000 veterans would be eligible for the higher aid and attendance step. It is on behalf of these veterans who are in need of constant aid and attendance that PVA offers its support of H.R. 10338. However, we would like to make a few technical recommendations for changes to the bill which would help to prevent confusion about the intent of the bill and which will assure that all service connected veterans who need constant aid and attendance are provided with the funds necessary to receive it. Our main concern with the legislative language of H.R. 10338 is that it requires that a veteran be in "need of constant medical aid and attendance." The term "medical" conceivably could include assistance with bathing, dressing, feeding, preparing food, or simply being there in case the veteran required assistance. However, the possibility exists that the term "medically" could be defined in a much narrower sense, in which case many severely disabled veterans who genuinely do need constant aid and attendance would be denied the higher rate of A&A because their needs may not fall under a stricter definition of the term "medical." In order to avoid this potential semantic problem, PVA recommends that the wording of H.R. 10338 be changed to the following: Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, that section 314 (r) of title 38, United States Code, relating to rates of service connected disability compensation, is amended to read as follows: "(r) if any veteran, otherwise entitled to the compensation authorized under subsection (o) or the maximum rate authorized under subsection (p) "(1) is in need of regular aid and attendance, such veteran shall be paid, in addition to such compensation, a monthly aid and attendance allowance at the rate of $600 per month, subject to the limitations of section 3203 (e) of this title, or "(2) is in need of constant aid and attendance because of severe helplessness, such veteran shall be paid in addition to such compensation, a monthly aid and attendance allowance at the rate of $900 per month, subject to the limitations of section 3203 (e) of this title. For the purpose of section 334 of this title, such allowance shall be considered as additional compensation payable for disability :". The above change in wording is preferable to the wording in H.R. 10337 because VA regulations already define the terms used in the changed version, as opposed to the more ambiguous term "medical." For example, "regular aid and attendance" is defined in VAR 1352(4). In addition, the term "helpless" is used in the definition. Consequently, PVA would urge that this Committee adopt the recommended changes in legislative language in order to assure that all eligible veterans who require constant aid and attendance will be entitled to the higher amount. We would also like to compliment the Committee on the increases for service connected veterans and dependents which have been proposed under H.R. 10337. This bill would provide for a 6.5 per cent increase in disability compensation for disabled veterans, and would increase the rates of dependency and indemnity compensation for their survivors. The 6.5 per cent figure appears to be tied in to the projected cost-of-living increases for the economy as a whole. We hope, however, that this Committee will leave itself the option of providing a 7.5 per cent cost-of-living increase should economic conditions change by October 1, 1978. Congress as a whole, and this Committee in particular, have always recognized and expressed their gratitude to those veterans who became disabled while fighting for their country. The increases proposed in H.R. 10337 are certainly in line with this record of rewarding wartime disabled veterans for their sacrifices. We would like to take this opportunity to again express our views concerning the method of awarding DIC benefits. Despite the fact that service connected disabled veterans are compensated on the basis of disability, survivors of those who lost their lives in service to their country are compensated based upon the pay grade of the person upon whose death entitlement is predicated. This method of awarding survivors benefits can create severe hardships for widows and children of certain deceased veterans. An obvious example for PVA to use is the example of a veteran who became totally and permanently disabled during wartime service and then later died of his service connected injuries. Despite the fact that his family would have been receiving benefits based upon total disability prior to his death, the survivor's benefits would be based upon his pay grade from his prior service. If the deceased veteran had been an enlisted men at a low pay grade, his family would be unable to continue in the lifestyle provided them as a result of the veteran's service-connected disability. Although DIC certainly was not intended as a needs-based program, the way in which the benefit stucture is set up actually tends to create dependency in cases such as the above. Quite frankly, we do have a solution to this particular dilemma. However, we urge the Committee to seriously consider eliminating the deceased veteran's pay grade as the criterion for establishing DIC benefit levels. One possibility would be to award the same benefits to all survivors, regardless of the military rank of the deceased. Nevertheless, the present benefit structure should be examined in an effort to find a more appropriate solution. The third bill upon which we would like to comment is H.R. 9994, which would provide that the survivors of a veteran who was rated totally and permanently service connected disabled for a period of at least ten years would be entitled to DIC as though the veteran had died from a service connected disability. PVA has long held the position that there should be automatic presumption of service connected death for any veteran who has been totally and permanently disabled. In the case of veterans with spinal cord injuries, the disability does shorten their life expectancy. According to John L. Kurtzhe in the September, 1975 issue of Experimental Neurology, the life expectancy of SCI victims is considerably less than the normal life expectancy, and life expectancy decreases significantly according to severity of disability." (Table II) In an article in The Canadian Medical Association Journal of April 20, 1968, it is shown that the cause of death often is directly related to the disability (Table III). Thus, with a spinal cord injury, minor medical conditions can quickly become fatal. With these considerations we do not believe there is any credence to the argument that presuming service connected death would dilute the honor and tribute to those killed in action. It has also been suggested that one should look at the financial status of the deceased veteran's spouse and family. Did the veteran leave an estate? Were there significant insurance policies? Would the surviving family be well provided for? The implication seems to be that if the total and permanently disabled veteran left the family well provided for the presumption of service connected death and payment of DIC benefits could be questioned. PVA fails to see the rationale of this line of thought. There is no income limitation for payment of DIC benefits to spouses of veterans who died in service. Is there a difference in needs of the spouses here and the spouses of totally and permanently disabled? We think not. We doubt that totally and permanently disabled veterans have been able to accumulate significant estates. Section IV of the VA study of Claims Filed for Dependency and Indemnity Compensation certainly does not give the impression that spouses denied DIC benefits were by any means well off. 2 Experimental Neurology, Volume 48, Number 3. September, 1975. We believe that the spouse of a deceased totally and permanently disabled veteran deserves automatic DIC benefits for another reason. That spouse helped the veteran live with a long and severe disability. We believe the surviving spouse deserves recognition. It is for the above reasons that we offer our wholehearted support for the concepts embodied in H.R. 9994. We would like to raise several questions about specific wording of this bill that might exclude service connected veterans who actually should be covered by the presumption of service connection, however. Our first question relates to the requirement in line 8 of H.R. 9994 that the veteran must die from natural causes. While medical complications often do cause premature death among SCI victims, other accidental deaths occur because of the reduced mobility of a person who is totally and permanently disabled. For example, a wheelchair-bound person literally is trapped if a fire occurs in his building and he is not on an entrance level. Since elevators do not operate during a fire, a person in a wheelchair must remain where he is, and thereby face additional risks to his life. A PVA member recently died after an automobile accident and was thrown into the ditch by the impact of the crash. Although the bruises he sustained were considered minor, this veteran was a quadriplegic. He had been travelling in a sparsely-travelled area, so no one saw him there or assisted him. The veteran froze to death as a direct result of his inability to move. Another PVA member in New Mexico was robbed and beaten by a taxi cab driver who had know that the PVA member had just cashed his compensation check. After beating the veteran, he threw him out of the cab. Again, no one noticed the veteran and he was unable to go for help by himself. This veteran died of exposure, whereas he might have survived if he had not been disabled and could get help. While these deaths clearly are not natural deaths, the fact that they occurred can be directly attributable to reduced mobility caused by the disabling condition. Would the families of such victims therefore be denied DIC benefits due to the fact that the veteran did not die of "natural" causes? Our second question concerns the proposed requirement that a veteran must have been totally and permanently disabled for ten or more years in order for his survivors to receive DIC benefits. We are concerned that this 10 year require⚫ment will be applied too strictly to veterans whose families clearly would have been eligible if the veteran had been able to survive another year or two. Surely the intent of this provision is not to deny survivors of quadriplegics DIC benefits after having cared for a severely disable spouse for eight or nine years? In order to avoid the situations described in this section of our testimony, PVA suggests that the eligibility period be reduced from the proposed limit of ten years to one year. We also recommend that the following language be adopted as a substitute to the language proposed in H.R. 9994: A bill to amend title 38 of the United States Code to provide that the survivors of a veteran who was rated totally and permanently service connected disabled for a period of at least one year would be entitled to dependency and indemnity compensation as though the veteran had died from a service connected disability. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That section 410 (a) of Chapter 13 of Title 38, United States Code, is amended to read as follows: "(a) The Administrator shall pay dependency and indemnity compensation to the widow, children, and parents of any veteran who dies after December 31, 1956, and who 66 66 "(1) dies from a service connected or compensable disability; or (2) was at the time of his death in receipt of or entitled to receive compensation for a service connected disability total and permanent in nature, which disability was so rated for not less than one year prior to such death. The standards and criteria for determining whether or not a disability is service connected shall be those applicable under Chapter 11 of this title." PVA also would like to indicate its support of H.R. 11530, which would increase the rate of compensation payable to veterans who have lost three extremities as the result of a service connected disability. We believe that the proposed bill is both desirable and necessary to assist those veterans with multiple injuries with the high expenses associated with such disabilities. The bills that are being discussed today are of vital importance to service connected veterans and dependents. The very fact that these bills have been introduced and are being considered by this Committee is ample proof of the concern of the Committee for the well-being of those who fought for their coun try. Again, thank you for your continuing interest in the needs of catastrophically disabled veterans and for providing us with this opportunity to present our positions on the proposed bills. TABLE 1. DISABILITY-RELATED EXPENSES PVA MEMBERS WITH SERVICE-CONNECTED DISABILITIES TABLE 11.-ESTIMATED YEARS OF LIFE EXPECTANCY AFTER TRAUMATIC SCI ACCORDING TO AGE AND TYPE Hon. RAY ROBERTS, DEAR MR. CHAIRMAN: PVA was pleased to have the opportunity to express our organization's position at the recent Compensation, Pension and Insurance Subcommittee hearings of the Veterans' Affairs Committee concerning proposed changes in the compensation and DIC program. Due to the fact that a number of bills were being considered for these hearings, we addressed only those bills which would affect directly our membership. However, we would like to submit for the record our priorities with respect to the proposed bills as well as our official position on each of the bills which were presented at the hearings. We also would like to take this opportunity to thank the members of the Subcommittee on Compensation, Pension and Insurance for the interest they have |