after making application but before he has received payment, it is provided that the amount of his adjusted service credit shall be paid to his dependents, but not before March 1, 1925. Where payment is made to dependents, it is further provided that the payments shall be made in 10 equal quarterly installments, unless the total amount of the payment is less than $50, in which case it shall be paid on the first installment date.

Public No. 197, Sixty-eighth Congress, approved June 5, 1924, authorized the director of the United States Veterans' Bureau, subject to the approval of the President, to provide additional hospital out-patient dispensary facilities for patients of the United States Veterans' Bureau, and facilities for a permanent national training school at a cost not exceeding $350,000 for the blind who are beneficiaries of the United States Veterans' Bureau. For carrying this into effect it was authorized that there be appropriated the sum of $6,850,000, to be immediately available and to remain available until expended. While this authority was granted, the actual appropriation of the $6,850,000 was included in the general deficiency bill, which failed of passage during the last days of the session adjourned June 7, 1924. The appropriation of these funds will go far in rounding out the permanent hospital construction program of the bureau. While these funds will furnish to some extent additional hospital facilities, their primary intent is to replace existing unsatisfactory, temporary or leased facilities.

Public No. 242, Sixth-eighth Congress, approved June 7, 1924, known as the World War veterans' act of 1924, was an act to consolidate, codify, revise and reenact the laws affecting the establishment of the United States Veterans' Bureau and the administration of the war risk insurance act as amended, and the vocational rehabilitation act as amended. Among the many liberalizing features of this act, the following are briefly noted:

An ex-service man who is shown to have or, if deceased, to have had prior to January 1, 1925 a neuropsychiatric disease, an active tuberculous disease, paralysis agitans, encephalitis lethargica, or amoebic dysentery, developing a 10 per cent degree of disability, or more, shall be presumed to have acquired his disability in service, or to have suffered an aggravation of a preexisting similar disability in service, and this presumption shall be conclusive in cases of active tuberculous diseases, but in all other cases said presumption shall be rebuttable by clear and convincing evidence. Previously the establishment of automatic service connection was limited to the development of a tuberculous or neuropsychiatric disease within three years after discharge.

The amount of death compensation paid monthly to widows, and to widows and children, was increased.

Any ex-service man shown to have a tubercular disease of a compensable degree and who has been hospitalized for a period of one year, and who has reached a condition of complete arrest of his disease, and who is discharged from further hospitalization, shall be rated as temporarily and totally disabled, and such rating shall not be decreased within a period of six months.

Any ex-service man shown to have a tubercular disease of compensable degree, and who has been hospitalized for a period of one year and who, in the judgment of the director, will not reach a condition

of arrest by further hospitalization, and whose discharge will not be prejudicial to the beneficiary or his family, and who is not, in the judgment of the director, feasible for training, shall upon his request be discharged from hospitalization and rated as temporarily totally disabled, said rating to continue for a period of three years.

The permanent loss of use of both feet, or both hands, or both eyes shall be considered on the same basis as the actual loss and shall be rated as permanently totally disabled. Compensation for the loss of sight of both eyes is raised from $100 per month to $150 per month, and the loss of hearing of both ears shall be rated permanent and total. A nurse or attendant, at a cost not exceeding $50 per month, is provided if the disabled veteran is so helpless as to be in constant need of a nurse or attendant, where previously but $20 per month, was allowed for this service, except if the disabled person were blind legless, or armless and in constant need of this service.

The hospital facilities under the jurisdiction of the bureau are made available for every honorably discharged veteran of the Spanish-American War, the Philippine insurrection, the Boxer rebellion, or the World War suffering from a neuropsychiatric or tuberculous condition, paralysis agitans, encephalitis lethargica, or amoebic dysentery, or the loss of sight of both eyes, regardless of whether such ailments or diseases are due to military service or otherwise, including traveling expenses, as granted to those receiving compensation and treatment under prior legislation. The director is further authorized, so far as he shall find that existing Government facilities permit, to furnish hospitalization and necessary traveling expenses to veterans of any war, military occupation, or military expedition since 1897, not dishonorably discharged, without regard to the nature or origin of their disabilities, and preference to admission to any Government hospital for hospitalization under the above provision is to be given to those veterans who are financially unable to pay for hospitalization and necessary traveling expenses.

No reduction in compensation shall be made retroactive, and no reduction or discontinuance of compensation shall be made effective until the first day of the third calendar month next succeeding that in which such reduction or discontinuance is determined.

Where previously the law permitted the director to extend the time one year for good cause shown after the five-year limitation in which a claim for compensation might be filed, the new law extended this period to two years.

Where any beneficiary of the bureau suffers, or has suffered, any injury or aggravation of an existing injury as a result of training, hospitalization, or medical or surgical treatment awarded to him by the director, and not the result of his misconduct, and such injury or aggravation of existing injury results in additional disability or death of such beneficiary, it is provided that benefits shall be awarded to the veteran, or his dependents, in the same manner as though such disability, aggravation, or death was the result of military service during the World War.

It is further provided that the receipt of a gratuity, pension or compensation by a widow or parent on account of the death of any person shall not bar the payment of compensation on account of the death of any other person. Where overpayment has been made through no fault of the beneficiary, and where no fraud is involved,

it is provided that collection of these overpayments shall not be pressed where such collection would defeat the purpose of the law. These acts are printed in full in the appendix and special phases are discussed in the text of each of the services concerned where sufficient experience has obtained to make this practicable.

BUREAU ACTIVITIES

Throughout the text of this report there are included statistical analyses and tabulations descriptive of the details of operation and the benefits granted. While a résumé of certain outstanding facts with reference to benefits dispensed are given in the following pages, this résumé concerns itself only with general totals, and students of the system of veterans' relief are urged to examine carefully the detailed data compiled, for it is only through a study of these tabulations that an adequate picture of the extent and quality of relief furnished can be obtained.

DEATH AND DISABILITY COMPENSATION

Through June 30, 1924, 958,307 compensation claims had been filed. During the past year 40,447 compensation claims were filed, averaging approximately 3,370 per month. Of these new claims filed, 4,658 were claims for death compensation and 35,819 for disability compensation. At the end of the fiscal year, 11,446 were pending adjudication, indicating that approximately 98.8 per cent of all compensation claims filed to date had been adjudicated. Of all cases adjudicated, there have resulted 461,377 awards, of which number 391,621 have been disability compensation awards and 69,756 have been death compensation awards; 377,172 disability compensation claims and 108,312 death compensation claims have been disallowed; 237,008 awards for death and disability were active on June 30, 1924, representing monthly payments aggregating $8,131,000. Of these total awards, 57,971 were for death compensation, representing monthly payments aggregating $1,482,765, and 179,037 were disability compensation awards, representing monthly payments aggregating $6,648,270. The average monthly payments for active death awards is $25.58 and the average monthly disability compensation award is $37.13.

ACTIVE DISABILITY COMPENSATION AWARDS

In considering disability compensation awards, which are determined by the percentages assigned to the disabilities suffered by a beneficiary by medical referees in accordance with a rating schedule called for in the act, it is pertinent to draw attention to the change in method of procedure of rating resulting from the passage of the World War veterans' act of June 7, 1924, making it necessary to apply two distinct schedules as to service connection and retroactive ratings, one based on the war risk insurance act as amended, and the other upon the World War veterans' act. The provisions of section 202 (4) of the new act call for the preparation of a new schedule of disability ratings. The rating schedule heretofore in use was based upon average impairments of earning capacity with reference to the industrial field as a whole, with no relation to the claimant's par

ticular vocation. Previously, if the claimant were prevented from following his prewar or postwar occupation, he was entitled to Vocational training in order to rehabilitate him and, consequently, no economic injustice was done by basing disability compensation upon the average impairment of earning capacity. However, the new law specifically requires that the bureau shall adopt and apply ratings "based as far as practicable upon the average impairments of earning capacity resulting from such injuries in civil occupation similar to the occupation of the injured man at the time of his enlistment." Accordingly, the individual occupational factor must now be taken into account in rating disabilities. To meet this requirement, the preparation of a new schedule of disability ratings has been commenced. It will involve a survey and grouping of many thousands of specialized occupations in American industry, and the inherent difficulties of the work are increased by the scarcity of precedents. To expedite the preparation of this new schedule, arrangements are being made for the cooperation of an advisory board of actuarial specialists, and the work thereon will be pushed as rapidly as its volume and technical complexity permit.

On June 30, 1924, there were being paid monthly 179,037 awards of compensation, carrying monthly payments aggregating $6,648,270. This number represents a net decrease of 4,053 awards since June 30, 1923, although 35,819 new claims were filed during the past fiscal year. The decrease in the number of active awards in spite of the increased number of claims filed, is due mainly to the fact that many claimants who had temporary disabilities have entirely recovered, or others have died as a result of disabilities incurred in service. It is also true that a large percentage of the claims filed since June 30, 1923, have been disallowed because no service connection could be established primarily as a result of the long period between discharge and the filing of the claim. The provisions of the act of June 7, 1924, will make it possible to allow many of these claims through the application of the presumptive period to automatically establish service connection in instances of tuberculous and neuropsychiatric diseases.

On June 30, 1923, there were 183,090 active awards, of which 81 per cent were rated on a temporary basis. A regulation was issued on July 27, 1923, making it necessary to review all temporary awards with a view to putting them on a permanent basis wherever possible. Claimants were to be examined by a board of three physicians and a permanent award made whenever it appeared reasonably certain that the disability had reached a stationary level. This regulation provided further for the discontinuance of future examination in cases of permanent ratings after an examination by a board of three, thereby relieving the claimant of the necessity of frequently reporting for examination, and producing in the mind of the claimant a certain stability resulting from the realization that a definite amount of money was coming to him periodically. Where the beneficiary's condition grew worse after a permanent rating was established, it was provided that a new rating might result. This regulation has decreased the number of examinations ordered, and thus, incidentally, has resulted in a material saving in the cost of examination service. As a direct result of this regulation the percentage of permanent awards has increased from 19 per cent on June 30, 1923, to 41 per

cent on June 30, 1924. Permanent total awards have shown an increase of 2,954 since June 30, 1923, whereas the temporary total awards have shown a decrease of 7,082. Some of these temporary total awards have changed to a permanent and total basis, while others were put on a permanent partial basis, as the physical condition of the beneficiary may have indicated. There are now active 73,718 permanent awards, which is an increase of 39,372 since June 30, 1923.

The period during which compensation was first paid in 57 per cent of the awards active on June 30, 1924, was from January, 1919, to January, 1920. Forty-four per cent of all awards active on June 30, 1924, were rated between 10 and 20 per cent disabling, while 68 per cent of all active compensation awards were rated less than 50 per cent. Of all active temporary partial awards, 70,253, or 84 per cent, were rated less than 50 per cent and 90 per cent of the permanent partial awards were rated less than 50 per cent.

Table No. 98 gives for all active disability compensation cases as of June 30, 1924, the degree of impairment by number receiving percentage ratings within groups of 10, and the amounts of monthly payments involved. These data are distributed according to temporary and permanent disabilities, and also as to partail and total disabilities.

ACTIVE DEATH COMPENSATION AWARDS

There were 57,971 active death compensation awards as of June 30, 1924. Of this number 36,051 of the deceased veterans, whose dependents were receiving compensation, died of disease while, 18,430 were killed in action. In 38,057 cases awards were being paid to dependent parents, involving a monthly payment of $850,495. The total monthly payment of compensation to dependents of deceased veterans is $1,482,765, the average award being $25.58. These awards are paid for approximately 91,000 dependents, including widows, children, mothers, and fathers. Of the 57,971 deceased veterans whose dependents were receiving compensation on June 30, 1924, all but 8,791 were receiving payments of insurance in addition to compensation, which means that 85 per cent of these veterans were insured either by contract or term insurance or by United States Government life insurance. Of the number insured, 45,423 were under United States Government term insurance, 3,031 were under automatic insurance, 637 under United States Government life and 89 were insured by both United States Government term and United States Government contract life insurance.

INSURANCE

United States Government life insurance is issued in seven forms or plans of insurance, namely, nonparticipating yearly renewable term insurance and participating ordinary life, 20 and 30 payment life, 20 and 30 endowment, and endowment at age 62 insurance. The yearly renewable term insurance was provided to afford protection without extra war hazard premium at the lowest possible cost to the armed forces of the United States during the World War, and thereafter until converted into one of the six forms of participating insurance above mentioned, which provide cash, loan, extended, and paid-up insurance values. Under provisions of the law the conver