The Veterans' Administration does not recommend the enactment of H.R. 3408. Advice has been received from the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the administration's program. Sincerely, W. J. DRIVER, Administrator. VETERANS' ADMINISTRATION, OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS, Hon. OLIN E. TEAGUE, Chairman, Committee on Veterans' Affairs, DEAR MR. CHAIRMAN: The following comments are submitted on H.R. 181, 89th Congress, as requested. The bill proposes to extend from 1 to 7 years the presumptive period following the date of separation from active wartime service during which amyotrophic lateral sclerosis becoming manifest to a degree of 10 percent or more shall, subject to rebuttal, be considered to have been incurred in or aggravated by such service. Existing law provides, with respect to veterans who have served at least 90 days during a period of war, that a chronic disease (other than active tuberculosis, multiple sclerosis and Hansen's disease) or a tropical disease (as those terms are defined in 38 U.S.C. 301) 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 and Hansen's disease a 3-year presumptive period is provided and for multiple sclerosis the period is 7 years. A 1-year tropical disease presumption is the only presumption extended to veterans who served during peacetime and it is required that they have served for 6 months or more. Direct service connection may be granted for chronic and tropical diseases which did 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 38 U.S.C. 354(a), 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 (38 U.S.C. 354 (b)) 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 shall 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 of the contrary. ***” Amyotrophic lateral sclerosis is a disease involving the degeneration of the nerve cells either in the brain, the brain stem, or the spinal cord, and is characterized by atrophy and fibrillation of the muscular system of the body. It occurs, generally, in the older age group and is a steadily progressive and devastating illness. I am advised that the onset of amyotrophic lateral sclerosis from initial symptom to unequivocal recognition is rarely more than 3 to 6 months. It follows, we feel, that the provision of existing law authorizing the grant of service connection for amyotrophic lateral sclerosis (as a chronic disease) becoming manifest to a degree of 10 percent or more within 1 year from the date of separation from service is quite adequate. Since the life expectancy of a person with this disease is much less than 7 years, we do not believe that there is any justification from a medical or scientific standpoint for a factual presumption that amyotrophic lateral sclerosis which first manifests itself as long as 7 years after the termination of wartime service is in any way related to that service. The most recent liberalization of the presumption provisions of 38 U.S.C. 312 was by Public Law 87-645 which, in part, extended the multiple sclerosis presumption from 3 to 7 years. Although there is a similarity in nomenclature between the two diseases, there is no known medical relationship between multiple sclerosis and amyotrophic lateral sclerosis. The pathological findings are completely different. Whereas multiple sclerosis is a disease of the myelin sheath occurring generally in young people and usually involving a number of remissions and exacerbations, amyotrophic lateral sclerosis, as noted above, is a disease of the nerve cells themselves; generally occurs in the older age group; and is steadily progressive in nature. We have no data readily available that will permit identification of the cases that this proposal might benefit. Hence, we are unable to furnish any estimate of the cost of the bill, if enacted. The Veterans' Administration believes that the existing provisions of law and Veterans' Administration regulations are adequate to permit service connection of amyotrophic lateral sclerosis in those cases in which it is warranted. Accordingly, we recommend that H.R. 181 be not favorably considered by your committee. Advice has been received from the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the administration's program. Chairman, Committee on Veterans' Affairs, DEAR MR. CHAIRMAN: The following report on H.R. 1762, 89th Congress, is submitted in accordance with your request. The bill would amend 38 U.S.C. 312 to establish for veterans who have served at least 90 days during a period of war a presumption that poliomyelitis developing a 10-percent degree of disability 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. Certain chronic and tropical diseases are generally not detected until symptoms appear long after the initial infection occurs. Because of this, existing law provides, generally, that a chronic disease (other than active tuberculosis, multiple sclerosis, and Hansen's disease (leprosy)) becoming manifest to a degree of 10 percent or more within 1 year from the date of separation from active wartime service shall, subject to rebuttal, be considered to have been incurred in or aggravated by such service. With respect to Hansen's disease and all types of active tuberculosis, a 3-year presumptive period is provided, and for multiple sclerosis the period is 7 years. These presumptions require at least 90 days' active service during a period of war as defined in title 38, United States Code. A similar 1-year 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. Poliomyelitis, however, is an acute viral infection and not a chronic disease. Studies have shown that it first manifests itself after an incubation period which averages less than 2 weeks-and does not exceed a maximum of 5 weeks. These studies have also disclosed that in the paralytic type of poliomyelitis, signs of paralysis will appear a few days after the acute attack begins. In considering a claim for service connection of poliomyelitis in the case of veterans of both wartime and peacetime service, the Veterans' Administration applies the foregoing incubation guides liberally. The standard, however, has deliberately been kept flexible. Thus, should the evidence warrant, service connection can be granted in the exceptional case that does not fall precisely within the incubation guide and, additionally, our criteria may be easily adjusted to accord with any new medical findings. Because of the unknown factors involved, we are unable to estimate the cost of this bill, if enacted. On the basis of the latest medical findings, the Veterans' Administration believes that there is no justification for a factual presumption that poliomyelitis which first manifests itself as long as 1 year after the termination of wartime service is in anyway related to that service. The current Veterans' Administration rating principles and practices are much more realistic and, we feel, are entirely adequate to permit the service connection of this acute infectious disease in those cases in which it is warranted. Accordingly, the Veterans' Administration recommends that H.R. 1762 be not favorably considered by your committee. Advice has been received from the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the administration's program. DEAR MR. CHAIRMAN: The following comments are submitted on H.R. 1507, 89th Congress, as requested. The bill, if enacted, would presume for purposes of chapters 11 and 17 of title 38, United States Code, that any disability incurred by any veteran who was held as a prisoner of war by the Japanese for 2 years or more during World War II and who was not furnished the quantity and quality of food to which he was entitled under the Geneva Convention of 1929 shall be considered to be a service-connected disability. The mentioned chapters deal with serviceconnected compensation benefits and hospital, medical, and domiciliary care, respectively. Former prisoners of war suffering from service-connected disabilities are entitled, under existing law, to payments of disability compensation and to needed hospital, medical, and domiciliary care under criteria applicable to service-connected disabled war veterans generally. In addition, former prisoners of war are given special consideration under the laws administered by the Veterans' Administration, and our regulations and directives also contain liberal provisions with respect to the claim of any such person for disability compensation or other benefits based on service-incurred or aggravated disability. Section 354 (a) of title 38, United States Code, requires that in the adjudication of service connection for any disability due consideration will be given to the places, types, and circumstances of service. Section 354 (b) provides liberalized criteria for determining service connection of any disease or injury for those veterans who engaged in combat with the enemy. Veterans' Administration regulations emphasizing the liberality which is accorded prisoner-of-war cases include, for example, a provision that the development of symptomatic manifestations of a preexisting injury or disease during or closely following a status as a prisoner of war will establish aggravation. Physical examinations of former prisoners of war are conducted with particular thoroughness. Further, existing instructions provide that, in the evaluation of disabilities resulting from or incident to military service, great weight must be assigned to imprisonment or interment under unsanitary conditions, or to food deprivation, in the service connection of dysentery and other gastrointestinal diseases. The bill, in referring to "disabilities," would apply to both injuries and diseases. It is not entirely clear whether the presumption of service connection that the bill would establish with respect to disabilities incurred by a former prisoner of war could be rebutted by affirmative evidence that the disabilities were not incurred in or aggravated by his World War II service or would, to the contrary, be a conclusive presumption. It would seem that the provisions of 38 U.S.C. 313 would permit the rebuttal of service connection for diseases, but would permit rebuttal in the case of injuries only if they stemmed from the veteran's willful misconduct. In any event, however, since the proposal does not specify any time limit within which the disability must occur, it is apparent that injuries as well as diseases, incurred many years following the veteran's discharge from service, would be presumed to be service connected. It could be argued-notwithstanding the bill's limitation to chapters 11 and 17 of title 38-that, since any disability incurred by a former prisoner of war is service connected, the death of that veteran from such service-connected disability would entitle his survivors to dependency and indemnity compensation under chapter 13 of title 38. Prisoners of war during World War II were granted $1 per day compensation for failure of the enemy to provide food of the quality and quantity provided by the Geneva Convention of 1929 one of the eligibility criteria of H.R. 1507— and $1.50 per day compensation for being forced to perform labor or being subjected to inhumane treatment in violation of the Geneva Convention (Public Law 896, 80th Cong., as amended). Prisoners of war during the Korean conflict received similar benefits under Public Law 615, 83d Congress. These grants were not considered duplication of payment, and were in addition to any other benefits payable by reason of active service. The Veterans' Administration believes that special consideration should be given to former prisoners of war and strives to assure that they will receive compensation, medical and hospital care, and other benefits in full measure under existing law. However, we do not think that the fact that a veteran was a prisoner of war justifies establishing a presumption—and certainly not a conclusive presumption-that any disease or injury he may ever incur is service connected. The enactment of the bill would be discriminatory, establishing a separate standard for a special group. Because of unknown factors involved, the Veterans' Administration is unable to furnish any estimate of the cost of this bill, if enacted. For the reasons stated, the Veterans' Administration recommends that H.R. 1507 be not favorably considered by your committee. Advice has been received from the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the administration's program. Sincerely, Hon. OLIN E. TEAGUE, W. J. DRIVER, Administrator. VETERANS' ADMINISTRATION, Washington, D.C., March 23, 1965. OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS, Chairman, Committee on Veterans' Affairs, DEAR MR. CHAIRMAN: The following report on H.R. 1141, 89th Congress, is submitted in accordance with your request. The bill would amend 38 U.S.C. 356 to provide a permanent rating of 50 percent for veterans who have suffered from active service-connected tuberculosis for 10 or more years. Under the Schedule for Rating Disabilities, which the Veterans' Administration utilizes in determining the degree of a given veteran's loss of earning capac ity, active tuberculosis-whether minimal, moderately advanced, or far advanced-is rated as 100 percent disabling, which rating continues during the period of activity and for 2 years thereafter. Upon the expiration of this period, if the rating board is of the opinion that the arrest or inactivity of the disease cannot be maintained under the ordinary conditions of life, the 100-percent evaluation may be continued as an extraschedular rating. Following the 2-year period of inactivity, if the veteran's condition does not justify a continuation of a 100-percent evaluation, 38 U.S.C. 356 requires a rating of 50 percent for the succeeding 4 years without the necessity of establishing any physical or economic impairment. Following this period, the law requires a 30-percent rating for a further period of 5 years. If the veteran had faradvanced lesions, this 30-percent rating is permanent, and if there had been moderately advanced lesions and there is continued disability, a 20-percent permanent rating is assigned after the 5-year period. Otherwise, the final evaluation is zero percent. Another provision of law (38 U.S.C. 314(q)) provides a minimum disability compensation award of $67 monthly for war veterans whose active tuberculous disease has reached a condition of complete arrest. Since this rate exceeds the $58 monthly rate of wartime compensation payable for 30-percent disability, the $67 minimum rate is paid to veterans in lieu thereof following the 4-year period during which the arrested tuberculosis is rated as 50 percent disabling. This $67 award continues for life. H.R. 1141, if enacted, would require a permanent rating of 50 percent, and payment of disability compensation based on such evaluation (currently $107 monthly, at wartime rates) for any veteran who has suffered from active tuberculosis for a period of 10 years, even though the disease has reached a state of complete arrest. As a practical matter, in view of the advances made in medical technology, it is highly unlikely today that tuberculosis would remain active for a period of 10 years. In almost all cases, application of modern medicines and techniques would effect arrest in a much shorter period of time. It follows that this bill, in general, would benefit a relatively few veterans who incurred tuberculosis prior to the advent of present-day treatment of that disease. From a medical standpoint, impairment due to tuberculosis can be determined only by a periodic evaluation of the individual's condition. It does not follow that because a person has had active tuberculosis for 10 or more years he will thereafter remain 50 percent or more incapacitated. The Veterans' Administration Schedule for Rating Disabilities follows the requirements of 38 U.S.C. 355 that ratings be based, as far as practicable, upon the average impairment of earning capacity resulting from such injuries in civil occupations. The veteran with inactive tuberculosis is evaluated on this basis, or in accordance with evaluations presently contained in the law, discussed above, if they provide a higher evaluation. The bill would compensate veterans beyond their true economic impairment and would be discriminatory as to other groups whose disabilities are rated in accordance with actual economic impairment. We believe that the graduated reduction of disability ratings and the $67 minimum award provided under existing law quite adequately compensate veterans with inactive tuberculosis for any impairment it may cause in their earning capacity. Adequate data that would permit identification of those veterans who have suffered from active tuberculosis over a period of 10 or more years are not readily available. Therefore, the Veterans' Administration is unable to estimate the cost of H.R. 1141, if enacted. The Veterans' Administration does not believe that there is any justification for the enactment of H.R. 1141. Advice has been received from the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the administration's program. Sincerely, W. J. DRIVER, Administrator. VETERANS' ADMINISTRATION, OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS, Hon. OLIN E. TEAGUE, Chairman, Committee on Veterans' Affairs, DEAR MR. CHAIRMAN: The following comments on H.R. 230, 89th Congress, are submitted in response to your request. The bill, as stated in its title, proposes to establish a "stronger presumption of soundness under certain conditions in wartime cases." It would amend 38 U.S.C. 311 to provide that any disability diagnosed during a period of war after continuous service of 90 days shall be presumed to have been incurred in military service unless it is established by affirmative evidence" that the disability existed prior to enlistment and was not aggravated beyond the normal progress of the disease. Section 311 now provides that for the purposes of determining basic entitlement to wartime disability compensation "*** every veteran shall be taken to have been in sound condition when examined, accepted, and enrolled for service, except as to defects, infirmities, or disorders noted at the time of the examination, acceptance, and enrollment, or where clear and unmistakable evidence demonstrates that the injury or disease existed before acceptance and enrollment and was not aggravated by such service." The Veterans' Administration has interpreted (VA Regulation 1304 (B)) the "clear and unmistakable evidence of preservice origin of the injury or disease necessary to overcome the presumption of soundness as meaning "obvious and manifest" evidence. To be clear and unmistakable, the evidence must be con |