(The paper referred to is as follows:)

STATEMENT OF NATIONAL REHABILITATION DIRECTOR T. O. KRAABEL, THE AMERICAN LEGION, ON H. R. 1200, EIGHTIETH CONGRESS, TO THE SUBCOMMITTEE ON COMPENSATION AND PENSIONS, COMMITTEE ON VETERANS' AFFAIRS, HOUSE REPRESENTATIVES

OF

On January 21, 1947, by request of the American Legion, the Honorable James T. Patterson, Member of Congress of Connecticut, introduced in the House of Representatives H. R. 1200, Eightieth Congress, first session, which was referred to the Committee on Veterans' Affairs.

On behalf of the American Legion, the result of further careful study of the subject, I desire at this time to offer a substitute bill in which agreement was reached by three veterans' organizations in a conference following hearings of this subcommittee last Thursday, June 12. As presently proposed, as follows, the bill will best accomplish the result sought.

The bill reads:

"A BILL To provide a minimum rating for service-connected cases of arrested tuberculosis "Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That any ex-service person shown to have had an active tuberculous disease which is or shall be held to be the result of active military or naval service, who in the judgment of the Administrator of Veterans' Affairs has reached a condition of complete arrest of his disease, shall receive compensation based upon a rating of not less than 50 percentum therefor: Provided, however, That nothing in this provision shall deny a beneficiary the right to any higher rating otherwise provided: Provided further, That no ratings under this Act shall be retroactive."

In national convention assembled in Chicago in 1945 and in San Francisco in 1946, the American Legion adopted resolution seeking to place veterans of World Wars I and II on a parity in the matter of payment by the Veterans Administration of disability compensation upon attainment of complete arrest of a service-connected active tuberculous disease.

The American Legion was sponsor of the World War Veterans' Act of 1924, and fostered subsequent amendments dictated by experience. The original act, Public Law 242, Sixty-eighth Congress, approved June 7, 1924, and the amendatory act of March 4, 1925, Public Law 628, Sixty-eighth Congress, contained no provision in section 202 (7) for a statutory compensation rating or award for a service-connected arrested tuberculosis.

Painstaking research by medical advisors to the Legion's national rehabilitation commitee over this period of 1924 and 1925, and experience gained throughout the United States by the organization's representatives assisting veterans in prosecution of claims, caused the American Legion to seek in the Congress a protective provision in the nature of a minimum monthly compensation award for World War I veterans suffering from a directly or presumptively serviceconnected tuberculous disease of which complete arrest had been attained.

Careful study had shown that these disabled veterans experienced real difficulty in competing, under ordinary conditions of life, with persons who had had no such active disease process. In attempting to earn a livelihood they found they could not keep up the pace set by fellow wage earners not so handicapped. Either they were obliged to find less remunerative employment in an occupation in which they lacked skill, but in which less stress was endured, or they reactivated the disease process by the struggle in competitive effort and then became unemployable and decreased their life expectancy.

It was to enable this disabled group to select an occupation that would restore an earning capacity commensurate with that which existed prior to incurrence of the handicap of an arrested tuberculosis that the Sixty-ninth Congress, following the hearing of exhaustive testimony of representatives of the American Legion and of the Veterans' Administration's predecessor agency, the United States Veterans' Bureau, enacted Public Law 325, approved July 2, 1926. This amended section 202 (7) of the World War Veterans' Act of 1924 so that provision was made as to World War I cases:

"That any ex-service person shown to have had a tuberculous disease of a compensable degree, who in the judgment of the director has reached a condition of complete arrest of his disease, shall receive compensation of not less than $50 per month

*

The Claims Statistics Service of the Veteran's Administration Central Office has a record of 39,798 World War I veterans who today are paid monthly a statutory award for a service-connected arrested tuberculosis. By virtue of the increased rates granted through approval August 7, 1946, of Public Law 662 enacted by the Seventy-ninth Congress the monetary benefit payable monthly in these cases is now $60 when the service connection is direct and $45 when the service connection is presumptive.

It is recognized that the Congress has not yet seen fit to accept the Legion's proposal for full payment of disability compensation in presumptively serviceconnected cases (H. R. 1325, 80th Cong., 1st sess.) so that only three-fourths of the full rate is paid, when the service connection is presumptive, in accordance with the provisions of Section 28, Public Law 141, Seventy-third Congress, approved March 28, 1934.

Statutory awards for arrested tuberculosis were not increased by 15 per centum June 1, 1944, by Section 1. Public Law 312, Seventy-eighth Congress, approved May 27, 1944, when other service-connected disability compensation rates in World War I and II veterans' cases were so adjusted, as the language of the section specifically excepted the "special awards and allowances fixed by law."

The Seventy-first Congress amended section 202 (7) in Public Law 522 approved July 3, 1930 to make further provision for cases of arrested tuberculosis, adding this sentence in the section:

"The director is hereby authorized and directed to insert in the rating schedule a minimum rating of permanent partial 25 per centum for arrested or apparently cured tuberculosis." This referred to the Schedule of Disability Ratings, 1925, then in use.

The Veterans' Administration has of record 4,442 veterans of World War I in receipt of monthly monetary benefits based upon such a rating who have no entitlement to the statutory award because other than an arrested tuberculosis has never been conceded to be service connected. With the increase granted, effective September 1, 1946, the disability compensation payment to $30 in the directly service-connected case, $22.50 in the presumably service-connected case. For those veterans of World Wars I and II whose tuberculosis disease is service-connected by virtue of Public Law 2, Seventy-third Congress, approved March 20, 1933, and Veterans' Regulation 1 (a), as amended, issued thereunder, there is no statutory rating or award.

The Administrator of Veterans' Affairs, by virtue of authority conferred upon him by Veterans' Regulation Numbered 3 (a), promulgated the "Schedule for Rating Disabilities, 1945 Edition." Public Law 458, Seventy-ninth Congress, approved June 27, 1946 made ratings, based upon this schedule, effective as of the first day of April 1946.

The following provision is made on page 76 of this schedule under Diagnosis Code 6724:

Tuberculosis, pulmonary, chronic, arrested, or inactive, advancement unspecified : Following moderately advanced or far-advanced active tuberculosis, with history of activity over a period of 5 years, including at least 18 months hospitalization, with continued dyspnea on exertion, debility, and chronic invalidism.

NOTE. The above rating, though assigned on a permanent basis, will be subject to reexamination in 30 months. For 6 months following hospitalization on account of active pulmonary tuberculosis_For a further 41⁄2 years__

For a further 5 years-

NOTE. The 50-percent, 30-percent, and 20-percent rating for arrested or inactive pulmonary tuberculosis will not be combined with ratings for other respiratory disability. Following thoracoplasty, the rating will be for tuberculosis pleurisy (see pleurity, following empyema) or for rib resection combined with the rating for collapsed lung. Following faradvanced active lesions, the permanent rating will be 30 percent. Following moderately advanced lesions, the permanent rating, after 10 years, will be 20 percent, provided there is continued disability, dyspnea on exertion, impairment of health, etc., otherwise.

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100

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30

When hearings opened on H. R. 1200 last Thursday, June 12, the senior medical consultant, H. D. Shapiro, M.D., of the American Legion, presented the medical testimony in support of a statutory minimum rating for arrested tuberculosis as now proposed. Dr. Shapiro is on my staff, is with me today, and, if the Chair desires, will answer any further questions, that may arise in the minds of the

committee, pertaining to the medical aspects of this proposed legislation. I shall comment briefly, as a layman, on the salient features of the bill so that there will be a complete understanding of the objective.

The American Legion adheres to its fixed policy that there must be a substantial basis and need for any legislation which the organization sponsors. The bill requires that the tuberculous disease must have been active, as the basis for service connection, prior to attainment of arrest, before the proposed minimium rating is assigned. Such cases as the 4,442 mentioned previously would not be comprehended in that an active process preceding complete arrest must be established. The 39,798 cases cited would be included.

I cannot furnish an estimate of the number of veterans who would benefit. It would, and should be, a substantial number. The Veterans' Administration, with full access to the best available data covering the over-all picture, should be in position to furnish the committee a reasonable estimate of the probable number of veterans affected and of the possible annual cost.

The chairman voiced in the June 12 hearing his personal desire that, insofar as it was feasible and possible, there be a common basis for award of benefits to veterans of all wars and their dependents. It will be noted that the rating of not less than 50 percent would be applicable in the adjudication of claims for disability compensation of veterans of all wars and of peacetime service.

In the conference last Thursday of veterans' organizations, it was decided that the provisions of this bill should be applicable alike to the cases of veterans of all wars and of peacetime service, having service connections established so that disability evaluations are based upon appropriate rating schedules. As it is sound legislation for one group, medically and economically, it s sound for all.

In the June 12 hearing, Veterans Administration spokesmen mentioned an issue being coordinated in that agency which would provide for the continuance of a full compensaton award for a period up to 2 years upon attainment of complete arrest, after a veteran has had hospital treatment, from which discharged with maximum benefit, for a service-connected, active tuberculous disease.

Undoubtedly, there will be limitations imposed in the regulation as to duration of the award within the 2-year period, as to conditions of employment in which the veteran may engage, and presumably, periodical medical examinations and follow-up within the period will be required. As Dr. Shapiro has told you our medical advisory board carefully considered and voiced approval, in the monthly meeting held April 10, 1947, of such a proposal as contemplated by the Veterans' Administration. With this committee's approval the pertinent extract of the minutes of that meeting have been inserted in the record of hearings on this bill.

The first proviso of this bill would not preclude the assignment of such a total rating for the period mentioned, or the assignment of any rating in excess of 50 percent, whether partial or total, as might be deemed equitable in the individual case. Conceivably there will be in the future, as there have been in the past and are now, beneficiaries who will continue, for many years or for a lifetime to be held to be permanently and totally disabled by reason of tuberculosis even though complete arrest of the active disease has been reached because the damage done is so extensive that these veterans cannot hope ever to engage in a substantially gainful occupation continuously.

It is the obvious desire of the Congress that there be compensation awarded for each service-connected disability of compensable degree. Provision for a minimum rating for arrested tuberculosis rather than a minimum monthly award, will permit recognition for compensation purposes of each service-connected disability. On the basis of a rating of not less than 50 percent, this rating for arrested tuberculosis may be combined, under the tables in the disability rating schedules with the percentage evaluations for other disabilities of service origin. A veteran might have, for example, a service-connected residual disability resulting from shrapnel wounds sustained in combat evaluated at 20 percent; a deafness occasioned by the trauma of the concussion of the shell burst disabling to the extent of 10 percent; organic heart disease of 10 percent degree; and malaria of 10 percent degree; in addition to the tuberculosis. Granted that arrested tuberculosis should have a minimum percentage evaluation, of disability of 50, there would then be disabilities of the degrees of 50, 20, 10, 10, and 10. The Schedule for Rating Disabilities, 1945 edition, grants that there is a combined partial disability of 71 percent, which would be adjusted to 70 percent to meet the compensation rate table. The monthly disability compensation award would

recognize that there are five service-connected disabilities, not just one, and the amount payable would be $96.60.

This would not be the case were a minimum statutory award established. The statutory award for arrested tuberculosis, payable in World War I veterans' cases, was provided as recognition of the minimum disability compensation payment required as protection for those disabled by this disease. However, considering the example cited, payment of the $60 statutory award for arrested tuberculosis would actually deny compensation recognition of the disabilities named-wound residuals, deafness, heart disease, and malaria, although each increased the handicap suffered the result of service.

In closing I want to express my personal appreciation, and the appreciation of the organization I represent, the American Legion, for this opportunity of presenting the views of the Legion on the subject matter now being considered and for the exacting and meticulous effort the committee expends in weighing the merits of all proposals made in the interest of effecting the rehabilitation of veterans and their dependents.

Mr. MATHEWS. You may give me three more copies of your statement, Mr. Kraabel, if you will, for the other members of the committee. Mr. KRAABEL. I will. Here they are.

Mr. STANDISH. Here is a telegram, Mr. Mathews, that was sent to the chairman of the full committee.

Mr. MATHEWS. Thank you. It is from Kendall E. Emerson, managing director, National Tuberculosis Association, and it will be inserted in the record.

(The telegram is as follows:)

Hon. EDITH N. ROGERS,

SAN FRANCISCO, CALIF., June 18, 1947.

Chairman, Committee on Veterans' Affairs,

House of Representatives, Washington, D. C.:

The board of directors of the National Tuberculosis Association and its medical section representing over 3,000 physicians in annual session at San Francisco on June 17 expressed their opposition to the following bills before your committee: H. R. 1200, 1696, 2621, 3349, and 3418. In the opinion of the board provisions guaranteeing adequate individualized medical treatment and rehabilitation for the requisite number of years will accomplish more for the health and welfare of the veteran than the legislation proposed in the foregoing bills. With this in mind we have today adopted resolution recommending to the Administrator of Veterans' Affairs administrative medical changes within the present law providing for the extension of the period of compensation following discharge with arrest beyond 6 months. Copies of this telegram are being sent to members of your committee, the Administrator of Veterans' Affairs, and the national headquarters of service organizations.

KENDALL E. EMERSON,

Managing Director, National Tuberculosis Association, 1790 Broadway, New York 19, N. Y.

Mr. KRAABEL. Mr. Chairman, I have a supplemental statement I would like to make.

Mr. MATHEWS. Mr. Kraabel.

Mr. KRAABEL. I understand that the conference held at your invitation also treated H. R. 1200 and that this statement is a product of the conference rather than of any one organization, with the exception of one organization, which wants to be heard on it specially. Is that right?

Mr. MATHEWS. That is, I understand, the Veterans of Foreign Wars. That is the reason I asked if there was anyone here from that organization. I wanted to give them a chance to be heard on their side. Thank you for that information.

Mr. CAMP. You have incorporated the statement into the record on tropical diseases

Mr. Mathews. Was there a letter from you on that?

Mr. Camp. Mr. Kraabel.

Mr. JONES. There was a letter from Mr. Kraabel on that.

Mr. MATHEWs. It will be incorporated, too.

(The papers referred to are as follows:)

Hon. FRANK A. MATHEWS, Jr.,

THE AMERICAN LEGION, Washington 6, D. C., June 13, 1947.

Member of Congress, Old House Office Building,

Washington, D. C.

DEAR FRANK: I feel that I should report to you the result of the conference of veterans' organizations, which followed the hearing by your committee Thursday, June 12.

In conference were representatives of the American Legion, Veterans of Foreign Wars of the United States, Disabled American Veterans, and Regular Veterans Association. Casey Jones, of the staff of the Committee on Veterans' Affairs, presided.

The four organizations agreed on a substitute draft pertaining to chronic diseases to accomplish the purpose sought by the Honorable James T. Patterson, M. C., who introduced H. R. 3650.

The VFW did not agree with the American Legion, DAV, and RVA on the proposed substitute for H. R. 1200, which Mr. Patterson introduced on behalf of the American Legion. There is complete agreement, with the exception of the VFW, with the draft which is attached for your information, which will provide a rating of not less than 50 percent for a service-connected arrested tuberculosis. Representing in the conference the American Legion were Harry Hayden, of the legislative division, and Charles W. Stevens and H. D. Shapiro, M. D., of the rehabilitation division; the VFW, John C. Williamson and Elmer Richter; the DAV, Francis M. Sullivan, Clayton Wood, M. D., and Q. E. Camp; the RVA, William F. Floyd and Victor E. Devereaux.

Kindest personal regards.

Sincerely yours,

T. O. KRAABEL, National Director,

A BILL To provide a minimum rating for service-connected cases of arrested tuberculosis

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That any ex-service person shown to have had an active tuberculosis disease which is or shall be held to be the result of active military or naval service, who in the judgment of the Administrator of Veterans' Affairs has reached a condition of complete arrest of his disease, shall receive compensation based upon a rating of not less than 50 per centum therefor: Provided, however, That nothing in this provision shall deny a beneficiary the right to any higher rating otherwise provided: Provided further, That no ratings under this Act shall be retroactive.

Mr. MATHEW. Is there anyone here that wants to be heard on these tuberculosis bills? If not, is there anyone who wants to be heard on the income-limitation bills?

Mr. STANDISH. The Veterans of Foreign Wars want to be heard on it. They had to go to another meeting on the Committee on Civil Service, and they will be here later.

Mr. MATHEWs. We will defer it, if there is nobody here at the present time wanting to be heard on either of these various tuberculosis bills or the income limitations bills that haven't been heard

Mr. STANDISH. The Amvets want to be heard, also, and Mr. McLaughlin is on his way up here.