The Bureau of the Budget advises that there is no objection to the submission of this report to the Committee.

Sincerely yours,

OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS,

Hon. OLIN E. TEAGUE,

Washington, D.C., August 12, 1959.

Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, D C.

DEAR MR. TEAGUE: The following report on H.R. 7945, 86th Congress, is submitted as requested.

The bill would amend existing law pertaining to wartime disability compensation (subsec. (r) of sec. 314, title 38, United States Code) to provide an additional amount of $150 per month as an aid and attendance allowance for all periods during which a disabled veteran is not hospitalized at Government expense, if he is in need of such aid and attendance and is otherwise entitled to one of the specific statutory awards ($309 to $401) under subsection (1) through (n) of section 314 of title 38. The present law on this subject, enacted last year, limited payment of the $150 additional allowance under the stated condition to disabled veterans otherwise entitled to the maximum award ($450 in wartime cases) for certain combinations of major disabilities.

The rates of compensation authorized by section 314 of title 38 are applicable to veterans of the Spanish-American War group, World War I, World War II, and the Korean conflict. They are also payable if the specific disabilities were incurred in line of duty as the direct result of armed conflict or while engaged in extrahazardous service, including service under conditions simulating war. The rates of compensation payable for comparable disabilities incurred in regular peacetime service are 80 percent of the wartime rates (38 U.S.C. 334). As the committee is aware, service-connected disabilities are rated under a schedule which is designed to reflect the average impairment in earning capacity brought about by such disabilities. Disabilities rated as 100 percent, or totally disabling, warrant the payment of compensation in the amount of $225 monthly (in wartime cases). However, by specific statutory provisions the Congress has authorized substantially higher amounts of monthly compensation for disabilities, such as contemplated by the bill, involving the loss or loss of use of two or more of the extremities, blindness, and other conditions which render a person so helpless as to be in need of regular aid and attendance.

The need for regular aid and attendance has been taken into consideration by the Congress in establishing, and from time to time increasing, the mentioned special rates which are substantially higher than the basic rate for total disability. As we advised the committee last year in our report on the similar bill which became Public Law 85-782, the proposed additional allowance, also for the purpose of providing regular aid and attendance, would, during the period a

veteran was not hospitalized by the Government, result in a pyramiding of benefits for the same losses.

At present, subsection (r) of section 314 of title 38 (as enacted by Public Law 85-782, August 27, 1958) authorizes the additional monthly aid and attendance allowance for veterans who are otherwise entitled to the maximum statutory rate of $450 monthly (or $360 in peacetime cases). The maximum rate is payable for total deafness combined with total blindness, or for a combination of two or more other severely disabling conditions which include loss or loss of use of two or more extremities, blindness, being permanently bedridden, or so helpless as to need regular aid and attendance. The service-connected disabilities, enumerated in subsection (1) through (n) of section 314 and which the bill would include for an additional allowance of $150 per month, currently are assigned compensation rates ranging from $309 to $401 per month. These conditions are generally less severely disabling than the multiple or combined disabilities for which the maximum rate of $450 monthly is provided. The Veterans' Administration does not have available data upon which to base an accurate estimate of the cost of the bill, if enacted. As indicated above, the Congress has provided liberal rates of monthly compensation substantially higher than the basic rate for total disability in consideration of certain severe types of disabilities which by their nature may require regular aid and attendance. The additional allowance proposed by the bill, which is based on the same factor of need for aid and attendance, does not appear to be justified. Accordingly, the Veterans' Administration is unable to recommend favorable consideration of H.R. 7945 by your committee.

The Bureau of the Budget advises that there is no objection to the submission of this report to the committee and that the Bureau concurs in the recommendation that the legislation not be given favorable consideration.

Chairman, Committee on Veterans' Affairs, House of Representatives, Washington, D.C.

DEAR MR. TEAGUE: The following report on H.R. 307, H.R. 2431, H.R. 2858, H.R. 3724, and H.R. 5989, 86th Congress, is submitted as requested.

The purpose of the bills is to extend the periods of time during which certain chronic and tropical diseases developing after separation from service are presumed to be service connected in origin.

H.R. 307 is identical with H.R. 12096, 85th Congress. H.R. 2431 is similar in purpose to H.R. 415, 85th Congress. H.R. 2858, H.R. 3724, and H.R. 5989 are similar in purpose to H.R. 9896, 85th Congress. The Veterans' Administration submitted a report to the committee, copy enclosed, on all of the mentioned similar bills of the 85th Congress on June 3, 1958 (Committee Print No. 203). The

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substantive views expressed in that report may be considered as applicable to the subject five bills in the 86th Congress.

It should be further noted, however, that the question of extending the presumptive period for service connection of multiple sclerosis, the purpose, in part, of H.R. 2858, H.R. 3724, and H.R. 5989 was recently considered by your committee in connection with H.R. 267, 86th Congress, which was enacted as Public Law 86-187. This law extended the presumptive period to 3 years.

The Bureau of the Budget advises that there is no objection to the submission of this report to the committee.

Sincerely yours,

SUMNER G. WHITTIER,

Administrator.

[No. 203]

COMMITTEE ON VETERANS' AFFAIRS, HOUSE OF REPRESENTATIVES

VETERANS' ADMINISTRATION,

OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS,

Hon. OLIN E. TEAGUE,

Washington, D.C., June 3, 1958.

Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, D.C.

DEAR MR. TEAGUE: This report is submitted, in response to your request, on 12 bills designed to extend for varying periods and for various diseases existing provisions of law under which certain chronic and tropical diseases developing after separation from service are presumed to be service connected in origin.

The present law governing presumptive service connection for chronic diseases provides generally that a chronic disease (other than active tuberculosis and multiple sclerosis) becoming manifest to a degree of 10 percent or more within 1 year from the date of separation from active service shall, subject to rebuttal, be considered to have been incurred in or aggravated by such service. With respect to all types of active tuberculosis a 3-year presumptive period is provided and for multiple sclerosis a 2-year period.

These presumptions require at least 90 days' active service during a period of war as defined in the Veterans' Benefits Act of 1957. Ă similar presumption is applicable to tropical diseases and is available to wartime and peacetime veterans, but the latter must have had 6 months or more service.

The following table sets forth the mentioned bills, the diseases to which each pertains, and the presumptive period which each proposes to extend for the purposes of service connection:

Most of the bills propose amendments to Veterans Regulation No. 1(a), part I, having been introduced before the enactment of the Veterans' Benefits Act of 1957 (Public Law 85-56) which repealed and restated that regulation. The current provisions in that act dealing with presumption of service connection are contained in title III.

Direct service connection may be granted for chronic and tropical diseases which do not become manifest within the presumptive periods mentioned when the evidence of record is deemed adequate to warrant a finding of service connection. In such cases, under the directive originally contained in Public Law 361, 77th Congress, December 20, 1941 (now sec. 354, Public Law 85–56) —

where a veteran is seeking service-connection for any disability due consideration shall be given to the places, types, and circumstances of his service as shown by his service record, the official history of each organization in which he served, his medical records, and all pertinent medical and lay evidence.

The law further provides:

In the case of any veteran who engaged in combat with the enemy in active service with a military, naval, or air organization of the United States during a period of war, campaign, or expedition, the Administrator is authorized and directed to accept as sufficient proof of service connection of any disease or injury alleged to have been incurred in or aggravated by such service satisfactory lay or other evidence of service incurrence or aggravation of such injury or disease, if consistent with the circumstances, conditions, or hardships of such service, notwithstanding the fact that there is no official record of such incurrence or aggravation in such service, and, to that end, shall resolve every reasonable doubt in favor of the veteran. Service connection of such injury or disease may be rebutted by clear and convincing evidence to the contrary. * * *

The 1-year presumptive period for the service connection of a chronic disease, previously covered by regulation based upon sound medical judgment, was incorporated in veterans regulations promulgated under Public No. 2, 73d Congress, in 1933. In 1948 Congress specified certain diseases which, among others, should be deemed chronic, but did not extend the uniform 1-year presumptive period (Public Law 748, 80th Cong.). It was not until 1950 that an exception to the general rule was made in the case of active pulmonary tuberculosis (Public Law 573, 81st Cong.), and in 1951 a further presumption was authorized in the case of multiple sclerosis (Public Law 174, 82d Cong.). In 1951 the Congress extended the presumptive period for an active psychosis for the limited purposes of hospital and medical treatment, and in 1953 extended the presumptive period for all other types of active tuberculosis to 3 years. The committee will, no doubt, wish to give careful consideration to the problem of whether the proposed extensions of the presumptive periods for certain diseases will be urged as a precedent for extending the presumptive period for many other chronic diseases.

In addition to granting service connection for disability and deathcompensation purposes in a substantial number of cases, the bills, if enacted, would confer the same priority right in such cases to hospitalization by the Veterans' Administration which is now afforded by law to veterans having directly service-connected conditions. Under existing law, the Veterans' Administration is required to furnish hospital care to eligible veterans needing such care for serviceconnected conditions, and this may be provided in hospitals under the direct control of the Veterans' Administration, through bed allo

cations in other Government hospitals, or in appropriate cases by contract with State, municipal, or private institutions. By contrast, veterans suffering from non-service-connected disabilities may be furnished hospital care by the Veterans' Administration only if beds are available in Veterans' Administration or other Federal Government hospitals. Further, admission of non-service-connected cases is generally conditioned on the inability of the applicant to defray the cost of hospitalization as established by an affidavit procedure. The bills would also have the effect of providing outpatient treatment for the groups affected because of the service-connected status which would be granted to them under the bills. Existing law and regulations generally limit outpatient treatment to those requiring such treatment for service-connected disabilities.

It is not possible to furnish an estimate of the cost of each bill, if enacted, in view of the many unknown and variable factors. However, as to those bills dealing with certain prevalent diseases the cost could be very substantial.

From a medical viewpoint, present provisions of the law and regulations on this subject are considered quite liberal and ample provision is made for those diseases that have a long incubation period, In addition, there are administrative provisions whereby chronic diseases generally incurred within a reasonable time after the present presumptive period following active military service can be and are handled on an individual basis where there is a likelihood that the condition or disease had its inception during military service. Accordingly, the Veterans' Administration does not recommend favorable consideration of these proposals by your committee.

Advice has been received from the Bureau of the Budget that there would be no objection to the submission of this report to the committee and that enactment of any of these bills would not be in accord with the program of the President.

Sincerely yours,

SUMNER G. WHITTIER,

Administrator.

Hon. OLIN E. TEAGUE,

VETERANS' ADMINISTRATION, Washington, D.C., January 4, 1960.

Chairman, Committee on Veterans' Affairs,

House of Representatives, Washington, D.C.

DEAR MR. TEAGUE: The following report is submitted on H.R. 3044, H.R. 3045, and H.R. 3046, 86th Congress.

The first two bills would conclusively presume the death of any veteran to be service connected (for the purpose of monetary death benefits) if the veteran had a service-connected total disability rating in effect and on record with the Veterans' Administration on or after the age of 62 years (H.R. 3044) or for 10 or more years on or after the age of 50 years (H.R. 3045). H.R. 3046, which is limited in application to World War I veterans, would presume a serviceconnected death for the same purpose if the veteran had such a rating in effect (1) for a period of 12 or more years; (2) for 10 or more years on or after the age of 50 years; or (3) on or after the age of 64 years.