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sonant with accepted medical principles and medical judgment. The regulation provides in part that determinations"should be based on thorough analysis of the evidentiary showing and careful correlation of all material facts, with due regard to accepted medical principles pertaining to the history, manifestations, clinical course, and character of the particular injury or disease or residuals thereof.”

Fundamentally, service connection means establishment of the incurrence of the injury or disease or aggravation of a preexisting injury or disease resulting in disability coincidentally with the period of active military, naval, or air service. In determining whether a disability appearing during wartime service is service connected, the mentioned presumption of sound condition at the time of entry into service is applied. When, after careful consideration of all procurable evidence in the case, a reasonable doubt arises regarding service connection, such doubt is resolved in favor of the veteran.

As noted, H.R. 230 states that it would provide a "stronger" presumption of soundness. If it is enacted, the presumption could be rebutted, with respect to disabilities not noted at the time a man enters service but which are detected within the first 90 days, by clear and unmistakable evidence which demonstrates preservice origin, without aggravation (existing law). But if the disabilities are first discovered thereafter, they could be deemed not attributable to service only if it were established by affirmative evidence that they had a preservice origin and were not aggravated beyond normal progress of the condition. The "affirmative evidence" it would require would appear to demand documentary evidence of an established diagnosis prior to service with clear clinical and laboratory findings sufficient for rating purposes. It would apparently preclude the use of medical judgment and sound medical principles in rebutting the presumption of soundness.

There are many disabilities which are susceptible of concealment for 90 days, including most of the psychoneuroses, epilepsy, migraine, kidney disorders, arthritis, visual and auditory conditions, diabetes mellitus; in fact, virtually any disability that is not readily apparent to the eyes. Under 10 U.S.C. 1219, a serviceman may not be required to sign a statement relating to origin of disability, and any such statement he has signed against his own interest is of no force and effect. If the stringent standard of proof the bill proposes is enacted, it can be expected that claimants will elect, quite naturally, to remain silent rather than to furnish the Government avenues to pursue in an attempt to develop "affirmative evidence.” It follows that H.R. 230 would place the Government in the position of paying compensation for disabilities in fact unrelated to service.

If the Government were able to determine the date and place of a preservice diagnosis and were able to obtain a report of that examination, it is highly unlikely that the report would contain sufficient laboratory and clinical findings to permit a decision as to the degree of disability, a necessity in resolving the question of aggravation. This follows from the fact that private physicians' examinations, primarily concerned with treatment, normally report the existence of a disorder with little description of the impairment of function resulting. If it were found to be sufficiently diagnostic and descriptive for rating purposes and if an increase beyond the normal progress of the disability were shown from the date of the preservice diagnosis, there would still be a question as to whether the aggravation occurred prior or subsequent to the man's entry into service. It necessarily follows that in order to rebut the proposed presumption of soundness the Government would have to obtain an authoritative diagnosis and description of a preservice disability made at a date nearly coinciding with the date on which the claimant entered service. The practical effect of the proposal would be to create an irrebuttable presumption of soundness, except as to disabilities noted at the time of entry into service or disabilities detected within the first 90 days.

The Veterans' Administration has no valid basis for determining the number of cases that would be affected or the probable cost effect of H.R. 230, if enacted.

In the light of the existing liberal provisions of law (including the presumption of soundness of 38 U.S.C. 311) and regulations on the subject of service connection of wartime disabilities, we do not believe there is any sound basis for establishing, as proposed by H.R. 230, what in effect would amount in practically all cases to a conclusive presumption of soundness. Accordingly, the Veterans' Administration recommends that the bill 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 and that the Bureau recommends strongly against enactment of H.R. 230. Sincerely,

W. J. DRIVER, Administrator.

VETERANS' ADMINISTRATION,
OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS,

Washington, D.C., March 22, 1965.
Hon. OLIN E. TEAGUE,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN: This report is submitted, in response to your request, on seven 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, 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, including the reinfection type of pulmonary tuberculosis, a 3-year presumptive period is provided. With respect to multiple sclerosis, a 7-year presumptive period is provided.

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.

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

Disease

Years

H.R. 182.
H.R. 183.
H.R. 539.
H.R. 1170.
H.R. 1744.
H.R. 2921.
H.R. 2822.

Malignant tumors.
Psychoses

..do
Heart disease
Reinfection type of pulmonary tuberculosis.
Malignant tumors
Psychoses.

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 38 U.S.C. 354), 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.

Existing law (38 U.S.C. 354) further provides :

"In the case of any veteran who engaged in combat with the enemy in artive 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 in. currence 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 Law 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, including outpatient treatment, to 2 years (Public Law 239, 82d Cong.), and in 1953 extended the presumptive period for all other types of active tuberculosis to 3 years (Public Law 241, 83d Cong.). In 1959 the presumptions for multiple sclerosis and Hansen's disease (leprosy) were extended to 3 years (Public Laws 86–178 and 86–188). Finally in 1962 the presumption for multiple sclerosis was extended to 7 years (Public Law 87–645).

In addition to granting service connection for disability compensation and dependency and indemnity compensation 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 service-connected conditions, and this may be provided in hospitals under the direct control of the Veterans' Administration, through bed allocations 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 nonservice-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 diagnosed 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 any of these proposals 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 and that the Bureau recommends strongly against enactment of these measures. Sincerely,

W.J. DRIVER, Administrator.

VETERANS' ADMINISTRATION,
OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS,

Washington, D.C., March 22, 1965.
Hon. OLIN E. TEAGUE,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN: This report is submitted, in response to your request, on seven 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, 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, including the reinfection type of pulmonary tuberculosis, a 3-year presumptive period is provided. With respect to multiple sclerosis, a 7-year presumptive period is provided.

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

Disease

Years

H.R. 182.
H.R. 183.
H.R. 539.
H.R. 1170.
H.R. 1744.
H.R. 2821.
H.R. 2822

Malignant tumors
Psychoses

do
Heart disease.
Reinfection type of pulmonary tuberculosis.
Malignant tumors.
Psychoses.-

2 2 3 3

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 38 U.S.C. 354), 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.

Existing law (38 U.S.C. 354) 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 or 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 cound medical judgment, was incorporated in veterans regulations promulgated under Public Law 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 81st Cong.), and in 1951 a further presi nption 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, including outpatient treatment, to 2 years (Public Law 239, 82d Cong.), and in 1953 extended the presumptive period for all other types of active tuberculosis to 3 years (Public Law 241, 83d Cong.). In 1959 the presumptions for multiple sclerosis and Hansen's disease (leprosy) were extended to 3 years (Public Laws 86–187 and 86–188). Finally in 1962 the presumption for multiple sclerosis was extended to 7 years (Public Law 87-645).

In addition to granting service connection for disability compensation and dependency and indemnity compensation 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 service-connected conditions, and this may be provided in hospitals under the direct control of the Veterans' Administration, through bed allocations 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 nonservice-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 diagnosed 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 any of these proposals 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 and that the Bureau recommends strongly against enactment of these measures. Sincerely,

W.J. DRIVER, Administrator.

VETERANS' ADMINISTRATION,
OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS,

Washington, D.C., April 16, 1965.
Hon. OLIN E. TEAGUE,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, D.C.

DEAR MR. CHAIRMAN: This is in reply to your request for a report on H.R. 1169, 89th Congress.

The general purpose of the bill is to increase monthly rates of death compensation payable to eligible widows, children, and parents of veterans dying from service-connected causes.

The bill is identical with proposals which have been introduced in prior Congresses. A recent example is H.R. 4405, 88th Congress, which was pending before your committee at the close of that Congress.

Under the provisions of 38 U.S.C. 321 and 341, death compensation is authorized for service-connected death occurring prior to January 1, 1957. The monthly rates of wartime death compensation provided by 38 U.S.C. 322 follow. The figures in parentheses show the changes proposed by H.R. 1169; Widow with no child, $87 ($122) ; widow with one child, $121 ($147), with $29 ($25) for each additional child; no widow, one child, $67 ($70); no widow, two children, $94 ($100); no widow, three children, $122 ($130), with $23 ($25) for each additional child; one dependent parent, $75 ($82.50); two dependent parents $40 ($.50) each. Under 38 U.S.C. 342, rates of peacetime death compensation are 80 percent of the wartime rates, adjusted to the nearest dollar.

Thus enactment of the bill would result in increased death compensation for all on the rolls except widows with more than seven children. The rates for this small group of widows would be slightly decreased. For example, a widow

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