MEDICAL During the year the vocational medical section in the district office was discontinued and its activities decentralized to the field, as it was found that by eliminating this function in the district office and utiliz ing medical facilities in the field to the fullest extent it was possible to make substantial reductions in the number of medical personnel. The administrative activities of the medical division have been greatly reduced by the absorption by the administration division of records previously maintained, and the transfer of the medical typists in the rating section to the stenographic pool. On receipt of regulation No. 47, which requires permanent ratings wherever possible, every effort was made to comply with its provi sions to the fullest extent. The medical personnel in the district office and the field were repeatedly impressed with the importance of expediting the work and it is believed that no opportunity has been missed to make examination by a board of three and give a permanent rating, if at all possible. The policy was established early in the year of instructing all medical examiners in rating procedure, in order to familiarize them with needs of rating section for complete and comprehensive reports, as well as to enable the district to make a prompt adjustment in medical personnel. The work for the past year in the tuberculosis section gradually increased until the passage of the World War veterans' act June 7, 1924, since which time there has been a great influx in the work of the section-old claims reopened and new claims filed. A clinic is held every Saturday from 10 to 12 for all active cases who are residents of Washington not in hospitals. Lectures and demonstrations are given and physical examinations when indicated. The consolidation of the dental clinic at Baltimore and the clinic at Fort McHenry has resulted in the rendering of more efficient service and a material reduction in the expense of giving dental treatment. All part-time salaried dental examiners on duty at the beginning of the year have been changed to a fee basis in the interests of economy. During the year hospitals and claimants' homes were visited by the chief of the prosthetic section for the purpose of designing and fitting appliances to those claimants who were unable to travel. By the use and operation of the orthopedic shop at Hospital No. 32, a great many appliances were made at a saving of approximately 30 per cent over contract cost. During the year, 2,586 purchase orders were issued by this section. DECENTRALIZED RATING BOARD The decentralized rating board, consisting of two medical referees and a claims medical adjuster (claims examiner), began operations in the fourth district on March 24, 1924, and was created for the purpose of having the physicians who examine claimants also rate their disabilities. Before the organization of this board 30 to 45 days elapsed from the time the claimant was first examined until he was advised as to the results thereof. Under the plan of operation of the decentralized rating board this time has been cut to an average of from 7 to 11 days, and it will be noted therefore that there is a saving of from 20 to 25 days. REHABILITATION A number of changes were made in the rehabilitation division during the past fiscal year; subdistrict rehabilitation boards were established in accordance with General Order No. 257, and many functions of the district office were decentralized to the subdistricts. During the year 100 beneficiaries were certified for training under Section II and 116 under Section III; there were 142 canceled eligibilities under Section II and 1,414 under Section III; there were 1,610 rehabilitated, and of the 657 appeals for further training, 199 were granted. The largest number of agricultural trainees in resident institutions was 120. At present there are 165 men in project training under instruction from three State agricultural colleges, and 40 in placement training. By the installation of an adequate system of checking correspondence courses, a large reduction was made in the number of men in such training. Approximately $6,552 per year was saved by discontinuing the Vocational school located at Camp Holabird, Md., while approximately $58,500 was saved by closing the vocational school at Franklin Street, Baltimore, Md. In November, 1923, the colored blind were transferred from the Maryland Workshop for the Blind to the Columbia Polytechnic Institute, Washington, D. C., the transfer resulting in a saving of approximately $30 per man per month, and in the following of a more definite training program. The establishment of a committee to visit each subdistrict office for the purpose of auditing all training cases, making recommendations toward securing proper rehabilitation and employment, and instituting a proper follow-up to assure prompt compliance with such recommendations proved a great aid in the rehabilitation problem. By placing the responsibility for the delivery of training checks on the rehabilitation staff in the field, it was found possible to deliver "Maintenance and support allowance" checks to the trainees four days sooner than in the past. The entire rehabilitation staff was imbued with the plan of selling rehabilitation to trainees from the start rather than at the end of their training, and were educated into the need of keeping close check on the attendance of trainees and their places of training. The employment service has had an active year, 1,583 trainees having been rehabilitated and satisfactorily employed. On June 30, 1924, 27 rehabilitated trainees were not employed, and only three of those were unemployed because of failure to secure satisfactory employment opportunities; the remaining 24 being unemployed because of personal reasons. The fifth district, at the beginning of the fiscal year, outlined certain definite objectives to be accomplished. These objectives included (a) a continuation of the policy to humanize the work of the bureau, and to this end every possible means was utilized to educate the employees of the district to do their work in serving the beneficiaries of the bureau in a sympathetic and intelligent manner; (b) to carry on to the highest degree the district's policy of economical administration; (c) to continuously promote and further develop the cordial and cooperative relations which existed during the previous fiscal year between the bureau and the cooperating agencies, the interested public, and the disabled men; and (d) in anticipation of possible further decentralization, to educate the staff of the district offices to assume more responsibility, to visualize and handle local problems, and to develop a field staff more familiar with all phases of the bureau's program. During the fiscal year there was a material reduction of the personnel without hampering the efficient administration of the work. The Memphis subdistrict office was consolidated with Nashville, Tenn., and the vocational training school at Chick Springs, S. C., was closed. INSPECTION Five hundred legal investigations were pending action by the inspection service at the beginning of the fiscal year. Their investigations had been pending action from 30 to 180 days. However, by decentralizing the inspection service to the subdistrict offices it was possible to place the work on a current basis and reduce the personnel of this service by four employees. A study of the work accomplished during the fiscal year shows a pending load of only 10 cases and that approximately 2,000 field investigations had been consummated. ADMINISTRATION During the fiscal year the lease and contract unit solicited approximately 1,600 competitive proposals to furnish necessary services required by the bureau and its beneficiaries, and at the end of the year 335 approved contracts were in force. The personnel for this district was reduced from 802 to 685 during the year with a corresponding reduction in the pay rolls of approximately $98,000. AUDITING This section handles the auditing of bills and vouchers for payment. The following table gives some of the important statistics: Number of vouchers on hand July 1, 1923- Number passed to disbursing office for payment. Number of bills on hand: July 1, 1923. June 30, 1924. 1, 744 212 38, 549 3, 356 804 263 90 72 An effort is made to keep the payment of bills on a current basis, and considerable progress was made during the fiscal year, as shown by the above figures. The auditing section handled during the year 14,042 initial and amended awards of disability compensation, which represented payments in the amount of $1,365,487.11. This amount does not include 13,639 active running awards on which monthly checks are issued. DISBURSING During the year the disbursing section issued more than 280,000 checks involving more than $14,567,000. That the volume of work in this section increased during the year is indicated by the fact that the total number of checks issued increased from 17,942 in July, 1923, to 24,855 in June, 1924. It is significant to note that this increased work was taken care of with decreased personnel. CLAIMS Upon receipt of regulation No. 47, providing for permanent ratings, district No. 5 immediately began work along the lines specified in the regulation, with the result that at the close of the fiscal year 1924, 12,802 cases had been reviewed. July 1, 1923, there were 30,610 decentralized and 23,344 new district claims, or a total of 55,954 adjudicated claims assigned to district No. 5. During the fiscal year 1924, 4,001 new claims were received for adjudication; 25,969 disability compensation awards were made during the last 10 months, which resulted in 110,383 checks being mailed to the beneficiaries of the bureau for an amount of $4,738,621.25. The examiners and reviewers handled 468,525 cases during the year and received 77,400 letters, of which 77,317 have been replied to. BOARD OF APPEALS A comparison of the work done by the board of appeals during the fiscal year ending June 30, 1923, with that done during the past year shows a great increase in the work of the board. During the year ending June 30, 1923, 7,972 decisions on appeal cases were rendered. During the past year 11,340 decisions were rendered. Of this number, 6,176 decisions previously rendered were sustained; 3,308 cases were referred to the central office for consideration, showing an increase over 1,985 cases forwarded to central office during the fiscal year ending June 30, 1923. Action by the district board has been withheld on 1,064 cases during the past year in order that additional information which might assist in the proper adjudication of the claims might be obtained; 380 appeals for section 2 training have been made during the past year. Of this number, 108 were allowed and 272 disallowed; 418 appeals for further training after termination have been disallowed and 74 claimants have been granted further training by the board of appeals, making a total of 492 appeals for further training after termination which have been passed upon by the board during the year. This shows an increase over 389 cases which were referred to the board for decisions on appeals for further training after termination during the year ending June 30, 1923. On June 30, 1922, 105 cases were pending action by the board, on June 30, 1923, 57 cases were pending action, whereas on June 30, 1924, only 33 cases were pending action by the board. During the past year, 583 claimants have been granted personal interviews with the district board of appeals, 18 of whom have been issued transportation in order that they might come to Atlanta to appear in person before the board. This shows an increase over 391 claimants who appeared before the board during the year ending June 30, 1923. MEDICAL The personnel of the medical division has been greatly reduced during the fiscal year 1924. This is especially true of the doctors employed on a fee basis. The total medical and dental personnel employed on a fee basis for the fiscal year 1924 was 989. Of this number 112 have been dropped. The medical division accounting subdivision was authorized during the fiscal year 1924. The function of this subdivision is the checking of each examination against the authorization; this action has resulted in a material saving to the bureau, in the stopping of payment for unauthorized examinations, and overpayment on examinations authorized. This subdivision handles approximately 400 vouchers monthly. The amounts of these vouchers are from $5 to $500. The work of the subdivision has been increased to marked degree through the operation of regulation 47. The medical division made a determined effort during the fiscal year 1924 to eliminate the use of contract hospitals and to utilize institutions under the direction of the Veterans' Bureau. At the beginning of the fiscal year 1924 there were 215 patients in contract hospitals in district No. 5. At the close of the fiscal year there were only 23 patients remaining in contract hospitals. |