Page images
PDF
EPUB

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 provid generally, that 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.

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 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 présumptive 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 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 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 86–187 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' Administratiou 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

to the presentation of this repo from the sta oint 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 with eight children currently is paid $324 monthly ($121 plus 7 times $29) under 38 U.S.C. 322; whereas under the bill she would be paid $322 monthly ($147 plus 7 times $25).

Chapter 13 of title 38, United States Code (dependency and indemnity compensation), restates the substance of the Servicemen's and Veterans' Survivor Benefits Act (Public Law 881, 84th Cong., Aug. 1, 1956). This act established a new and modernized benefits program of dependency and indemnity compensation for survivors of veterans dying from service-connected causes on or after January 1, 1957, thus superseding the old death compensation program.

Survivors of veterans who died before January 1, 1957, who were entitled to death compensation may elect to receive the new benefits or may continue to receive death compensation. The authority to continue on the death compensation rolls was undoubtedly provided to preclude a reduction of monetary benefits which could have resulted in some instances if đependency and indemnity compensation was made the exclusive program. I see no justification for enhancing this advantage of the protected group.

Although an election to receive depenedency and indemnity compensation may be made at any time, once validly made it is irrevocable. It appears from the election provision that the law contemplated death compensation would become a declining program. We doubt that it was expected that such benefits would thereafter be increased or extended. Accordingly, I feel that enactment of the bill would be a distinct departure from the original concept of the dependency and indemnity compensation program.

It is estimated that the bill would benefit approximately 171,700 wartime cases and 7,200 peacetime cases—a total of 178,900 cases—the first year, at an additional cost for that year of approximately $23,649,000. It is believed that the additional cost will decrease for the next 4 years to approximately $16,500,000 in the fifth year.

In line with the foregoing, we do not believe the bill should receive favorable consideration.

The Bureau of the Budget advises that there is no objection to the presentation of this report from the standpoint of the administration's program. Sincerely,

W. J. DRIVER, Administrator.

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

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

DEAR MR. CHAIRMAN: The following comments are submitted in response to your request for a report by the Veterans' Administration on H.R. 1508, 89th Congress.

The bill would liberalize outpatient dental treatment benefits by eliminating the present statutory requirement that benefits for noncompensable serviceconnected dental disabilities generally be afforded on a one-time completion basis.

Currently outpatient dental treatment is limited to the following dental conditions or disabilities: (1) Service connected and compensable in degree; (2) service connected but not compensable in degree if shown to have been in existence at time of discharge and if application for treatment is made within 1 years after discharge except where a disqualify discharge or release has been corrected by competent authority, application may be made within 1 year after date of correction; (3) due to combat wounds or other service trauma or of a former prisoner of war; (4) associated with or aggravating disability from some other service-connected disease or injury; or (5) from which a veteran of the Spanish-American War or Indian wars is suffering.

Treatment of noncompensable service-connected dental conditions is limited by law to a one-time completion basis unless the services are unacceptable within the limitations of good professional standards. However, the one-time treatment provision does not apply to former prisoners of war, to those whose dental disabilities are due to combat wounds or other service trauma, or to Spanish-American War and Indian wars veterans.

These limitations on dental treatment came into the law permanently on June 16, 1955, with the passage of Public Law 83, 84th Congress. Previously,

« PreviousContinue »