ever, 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. VETERANS' ADMINISTRATION, Washington, D. C., June 3, 1958. OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS, Hon. OLIN E. TEAGUE, Chairman, Committee on Veterans' Affairs, House of Representatives, Washington, D. C. DEAR MR. TEAGUE: The following comments are submitted in response to your request for a report by the Veterans' Administration on H. R. 11600, 85th Congress. The purpose of this bill is to authorize outpatient treatment by the Veterans' Administration for non-service-connected disabilities of veterans in receipt of compensation for service-connected disability rated 30 percent or more and to veterans who are in receipt of pension for non-service-connected disability. This would not include outpatient dental treatment, however, which would continue to be subject to the specific limitations of subsection 512 (b) of the Veterans' Benefits Act of 1957, which generally restrict such dental services and treatment to disorders which are service connected and impose additional requirements. Enactment of this proposal would very substantially enlarge the scope of the present outpatient program. Historically, this benefit has been generally limited to treatment of conditions which were incurred or aggravated in the active service. There appears to be no sound reason for making an exception to this policy in favor of veterans who happen to be receiving compensation for a serviceconnected disability of 30 percent or more or war veterans who are receiving pension for non-service-connected disability. As a practical matter, some of those who would seem to be covered by the provision concerning persons in receipt of compensation for a 30 percent or more disability are already eligible for outpatient medical treatment of a non-service-connected disability if it is associated with and held to be aggravating their service-connected conditions. The effect of the bill is to render eligible for treatment civilian disa bilities sustained by this group which are unrelated to, and have no associating effect upon, the service disabilities for which they are being paid compensation. The proposed grant of free medical treatment to veterans on our pension rolls appears to be particularly objectionable because it would give them, in addition to their pension for disability not related to service, another form of assistance generally reserved for persons who have incurred disabilities in the military service. We do not believe that a governmental obligation exists to supplement pension benefits in this manner where the need for medical treatment has no relationship to the veteran's military service. Provision of outpatient services, without regard to service connection of the disability, on the basis that the veteran is receiving compensation for a service disability of 30 percent or more would seem to rest upon a rather arbitrary basis and to produce discriminatory results. A very high percentage of those on the compensation rolls are receiving compensation for disabilities rated 20 percent or less. They would be excluded from the bill and would be denied treatment for the same types of nonservice disorders which, in veterans with higher rated disabilities, could be cared for by the Veterans' Administration if the bill were enacted. Hence, this partial extension of the outpatient program into the area of non-service-connected disabilities would undoubtedly be urged as a precedent for including all of those receiving compensation, regardless of the nature and extent of their service-connected conditions. It is estimated that the annual increase in expenditures for the outpatient program as a result of enactment of this bill will approximate $15 million, and that with the passage of time this will tend to run higher with the probable increase of fee-basis costs and the continuing rise in the number of veterans eligible for disability pension. For the reasons stated, I am unable to recommend favorable action on H. R. 11600. 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 the Bureau concurs in the recommendation against favorable consideration of the bill. Chairman, Committee on Veterans' Affairs, House of Representatives, Washington, D. C. DEAR MR. TEAGUE: This report is submitted, at your request, on H. R. 3630, 85th Congress, a bill to provide an aid and attendance allowance of $200 per month for triple and quadruple amputees, among others, during periods in which they are not hospitalized at Government expense. The bill provides that if a disabled person, as the result of serviceincurred disability, has suffered the anatomical loss or permanent loss of use of both hands and 1 or both of his feet, or of both feet and 1 or both of his hands, and is in need of regular aid and attendance, he shall be paid, in addition to any other compensation authorized, monthly aid and attendance allowance at the rate of $200 except for such time as he may be hospitalized at Government expense. a It is noted that the bill proposes to amend Veterans Regulation No. 1 (a), part I, which, as the committee is aware, was repealed and restated by Public Law 85-56. The appropriate provision for amendment is now section 315 of the latter law. It should be pointed out that although the title of the bill indicates that the proposed additional allowance would be paid to "triple and quadruple amputees," the body of the bill would include all persons whose disabilities involve "permanent loss of use" of 3 or 4 extremities, as well as those involving actual loss. The bill would therefore provide the additional allowance for a number of other groups of disabilities in addition to triple or quadruple amputations. Such other disabilities include spinal-cord injuries, anterior poliomyelitis, brain tumors, multiple sclerosis, other chronic neurological diseases, multiple arthritis, orthopedic conditions involving ankylosis, etc., and various combinations of disabilities. It must also be recognized that certain veterans who do not presently have service-connected loss or loss of use of 3 or 4 extremities will sooner or later manifest such loss or loss of use in the usual course of progress of their respective disabilities. 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. These higher rates range from $309 to $450 per month, according to the severity of the condition. 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. Such rates were last increased by the first session of this Congress under Public Law 85-168. The $200 additional allowance proposed by the bill, 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. In view of the indeterminate factors involved, the Veterans' Administration is unable to submit an 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. 3630 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 the Bureau strongly recommends against enactment of the proposed legislation. Sincerely yours, SUMNER G. WHITTIER, OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS, Hon. OLIN E. TEAGUE, VETERANS' ADMINISTRATION, Washington, D. C., June 5, 1958. Chairman, Committee on Veterans' Affairs, House of Representatives, Washington, D. C. DEAR MR. TEAGUE: This report on H. R. 11528, 85th Congress, is submitted at your request. The purpose of section 1 of the bill is to extend entitlement to the presumption of service connection for chronic or tropical diseases becoming manifest within a year from discharge (within 2 years for multiple sclerosis and within 3 years for active tuberculous disease) for veterans who served for any period of time provided they were in the active service on November 11, 1918, the date on which the armistice was signed. Benefits which might flow from such service connection include disability and death compensation, outpatient treatment, and priority for hospitalization. The purpose of section 2 of the bill is to authorize the payment of non-service-connected disability or death pension to otherwise eligible veterans of World War I, or their dependents, regardless of length of service, provided they were in the active service on November 11, 1918. Section 313 of the Veterans' Benefits Act of 1957 restates a provision of law that has been in effect since 1933 requiring as a basis of entitlement to the presumption of service connection for a chronic disease that there must have been 90 days or more of active service during a period of war. For compensation purposes, "World War I" means the period beginning on April 6, 1917, and ending on November 11, 1918 (or April 1, 1920, if there was service in Russia), and also includes any period of service performed by a veteran after November 11, 1918, and before July 2, 1921, if he served in the active service after April 5, 1917, and before November 12, 1918. Accordingly, all of the 90 days must not necessarily have been served before the end of hostilities. Under the bill, however, service of 1 day, if it occurred on November 11, 1918, would suffice. Under title IV of the Veterans' Benefits Act of 1957 a veteran of World War I, World War II, or the Korean conflict is eligible for pension, subject to certain income limitations, if he is permanently and totally disabled from non-service-connected disability not the result of willful misconduct or vicious habits. He must either have served in the active military, naval, or air service for a period of 90 days or more during the applicable period and have been discharged under conditions other than dishonorable, or have been discharged for a service-connected disability. Non-service-connected death pension is also provided for otherwise eligible widows and children of deceased veterans of World War I, World War II, or the Korean conflict. The length of service requirements are the same as those prescribed for the disability pension program. For pension purposes "World War I" includes the same periods of service as described above for compensation purposes. The requirement of 90 days' active military, naval, or air service has been generally recognized by the Congress as a prerequisite to the payment of pension either to the veterans or dependents of deceased veterans of the Civil War, Spanish-American War (including the Philippine Insurrection and the Boxer Rebellion), World War I, World War II, or the Korean conflict. It is required that the veteran must have served 90 days or more in the applicable period, or if such veteran served less than 90 days, he must have been discharged from service as a result of disability incurred in service in line of duty. While service pension at lower rates is provided for certain veterans of the Spanish-American War group based upon 70 days' service, the widows and children of those veterans have never been granted service pension based upon that limited extent of service. The enactment of H. R. 11528 would extend potential eligibility to a particular group of World War I veterans and their dependents for benefits in the fields of compensation, medical care, and pension where the length of service requirements cannot be met, but it can be established that the veterans were in the active service on the date of November 11, 1918. It would, of course, be discriminatory against other presently ineligible World War I veterans whose service was of considerably greater duration, as well as veterans of other war periods similarly situated. The Veterans' Administration does not have adequate data upon which to base a worthwhile estimate of the cost of the bill, if enacted. It is my view that the existing World War I length of service requirements for the benefits concerned are reasonable and that the precedential liberalization proposed by H. R. 11528 cannot be justified. 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 H. R. 11528 would not be in accord with the program of the President. Sincerely yours, SUMNER G. WHITTIER, VETERANS' ADMINISTRATION, OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS, Hon. OLIN E. TEAGUE, Washington 25, D. C., June 4, 1958. Chairman, Committee on Veterans' Affairs, House of Representatives, Washington 25, D. C. DEAR MR. TEAGUE: The following comments are furnished in response to your request for a report by the Veterans' Administration on H. R. 6421, 85th Congress. |