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a position paying $1,100 a year, or even $1,200 a year, $100 a month, which is not very much at all, would be ineligible to receive any pension. Hence, we should raise the income limitation.

Mr. Mathews. May I ask you how you arrive at the specific figures in your bill, $2,000 and $3,000?

Mr. BLATNIK. These figures are based on the income needs of the individual.

Mr. MATHEWE. I am asking you how did you arrive at these particular figures ?

Mr. BLATNIK. Well, they are what I consider a reasonably satisfactory income. I believe that the average income would be anywhere from $2,400 to $2,600 for the average person.

Mr. MATHEWS. Are there any questions by any member of the committee?

Mr. BLATNIK. I might add that the lowest recommendation from veterans' organizations was $1,800; that is, raise the income limitation from $1,000 to $1,800. The highest recommendation was $2,400, and we took a good average around $2,000, based on the recommendations from these organizations.

Mr. MATHEWS. Are there any further questions?
Thank you, Mr. Blatnik.
Mr. BLATNK. Thank you, Mr. Chairman.

Mr. MATHEWS. Are there present any other Members of Congress sponsoring these bills?

I have been notified that Mr. Schwabe will send a statement or a transcript of his for the record for the bill H. R. 295.

If there are no further witnesses to be heard on this bill, we will go to H. R. 3650, having to do with tropical diseases. There are some witnesses that want to be heard on that, I understand.

Mr. Kraabel.


REHABILITATION COMMITTEE, THE AMERICAN LEGION Mr. KRAABEL. Mr. Chairman, we appreciate very much the opportunity of being heard on these bills. We do not have a covering mandate on the subject matter of H. R. 3650. However, it happens that among our witnesses, and among the witnesses of the brother organization, Disabled American Veterans, there are three men expert in claims and rating and medicine who contributed much to the thinking and philosophy of the improved 1945 schedule for disability ratings back in 1942 and 1943. In fact, these three gentlemen, working together with other experts, and with the VA, did draw up much of the present provisions in the 1945 schedule, and in that schedule, as the chairman pointed out, are provisions and protections in the matter of not only tropical diseases but other diseases and disabilities arising from endemic areas. If it is the pleasure of the committee to hear from these gentlemen, the Legion would be glad to have them speak or answer your questions on the subject matter of H. R. 3650.

We did have an opportunity of talking to Congressman Patterson before the hearing so that he understands the points he brought out and the points the committee will undoubtedly develop further as they go into that particular provision.

Mr. MATHEWS. I will be very glad to hear them, and, in connection with this bill, I would like to say I have just received a report from the Veterans' Administration, which none of the committee has as yet had a chance to read, and might I suggest, Mr. Kraabel, that you consult with Congressman Patterson over the matter and see if you can work out some suggestion with regard to it.

Mr. KRAABEL. We shall be very glad to be available to Congressman Patterson or the committee at any time on that.

Mr. MATHEWS. In other words, I, speaking personally, would like to have whatever is necessary in connection with the present regulations of the Veterans' Administration. If they adequately cover these cases, of course, no legislation would be necessary. On the other hand, if there are some cases which are not covered, and cannot be covered, and if legislation can be enacted which would both reasonably protect the Government and the veterans, we would like to report that legislation out. At least, I would, myself.

Mr. KRAABEL. I think the experience since 1942, Mr. Chairman, on these points has brought out to our claims people that there are additional protective features that might be possible, and that probably they would want them by legislation not to do a violence to or impair in any way that which is already in the regulatory provisions.

Mr. MATHEWş. Very well. We would be glad to hear from the people you have.

Mr. KRAABEL. I think that is about all we would say on the point unless you have questions on it.

Mr. MATHEWS. Did I understand you to say you had some medical men here who would testify on it?

Mr. KRAABEL. We have Dr. H. D. Shapiro, our senior medical consultant, if they desire to ask him on the point.

Mr. MATHEWS. I will ask you this question, Doctor: In your opinion, is there now, in addition to the present rating schedule and regulations of the Veterans Administration, a necessity for legislation to cover cases which might not be covered by those existing regulations and schedules but which deserve to be and should be covered.

Dr. SHAPIRO. There are, Mr. Mathews.
Mr. MATHEWS. Would you explain that?

Dr. SHAPIRO. As a matter of fact, we made a submission to the Veterans' Administration covering this subject on the 26th of May 1947, on the basis of complaints emanating from the field, from our field people. We have not as yet had an answer to that and, of course, I do not think the Veterans' Administration has had sufficient time to study and answer it. The thing that I think ought to be gotten over to the committee is the question of suppressive treatment of malaria. We have heard a great deal about the men who actually manifested their disease through service, but there are many men who, because of suppressive therapy, never did manifest the disease while they were in the service, but because of the continued use of atropine, or whatever therapy was used, did not manifest their disease.

Now, the Veterans' Administration has the 1-year presumption on malaria. We do have individuals who have lived in nonmalarial areas all their lives, other than the time they spent in the Tropics, or in other areas where malaria is endemic as well as in the service. These people lived in sections of the country, and we have had complaints from Wyoming, Montana, Idaho, and places of that kind where there is no malaria. The man would get his first manifest attack within a year following discharge from the service. Because of the impassibility of roads in winter

conditions, or because of inaccessibility of a doctor 40 or 50 miles away, he may not be able to furnish satisfactory proof to the Veterans' Administration at that time, and perhaps not until after a year. Well, in these cases, unless the man has filed a claim within a year after discharge, he is precluded from receiving benefits. In other words, only in malaria and in tropical diseases, as I understand it, is there any time limit within which a man can file, provided he did not have a medical record.

Isn't that correct? In other words, the tropical diseases are singled out in putting a time limit as to when a man can file a claim for these benefits if he has no medical record in service, and we think that is a bar that should be removed.

Chairman ROGERS. May I ask a question? Is it not true, Doctor, that during the war a man's relative or wife stated that he had malaria, and the man's case was rated, and recently in the last few months such a service connection could be broken? All the men in my district who had malaria were given a rating.

Dr. SHAPIRO. Of course, he could get a rating if he had a medical record showing a number of attacks in service, and after that his rating would be dependent on his demonstrating medically in the frequency of these attacks.

Chairman Rogers. They took the wife's affiidavit. Now, it must be physician's. That happened in Boston in case after case.

Dr. Shapiro. That is what we are trying to get over, that once the disease is established, that the statement of the veteran or his family or another interested party as to recurrent attacks of fever should be accepted in these areas where the service of a doctor cannot be obtained because of climatic conditions, or where the doctor cannot be reached during the time of these attacks.

Chairman ROGERS. May I ask one more question ?
Mr. MATHEWS. Surely.

Chairman Rogers. You see, the boys made no effort, Doctor, because the veteran had given a statement through his wife that he had these attacks.

Mr. MATHEWS. Doctor, in part of the statement I read in the record, there is something about suppressive treatment, and that is covered to a certain extent in the schedules; is it not?

Dr. SHAPIRO. Well, it is, but here is the thing: The man is only given a 1-year period after discharge within which to prove his malaria.

Mr. MATHEWS. You think that is one of the main things?

Dr. SHAPIRO. That is one of the main things, and that is what I want to bring out: A man who develops malaria within 365 days after he has been in a malarial zone is entitled to service connection, but the man who develops it after 365 days is out. Now, this was brought out by our legal advisory board. They suggested at the time that the 1-year period was rather arbitrary and would be short, too short in certain periods, and asked that we make further researches with established Government agencies. Accordingly, I contacted the United States Public Health Service, the National Institute of Health, and they have recently set up a newly created tropical disease division under the heading of Dr. Willard Wright. I spoke to Dr. Wright, and he was of the opinion that a 1-year period would be rather arbitrary to cover all possible cases, and he told me he had consulted with Dr. Cooper, who is doing the actual work in it, and they felt that a period of 2 years, or even 3 years, would not be too long to cover those people who were under suppressive therapy, and then later developed attacks from malaria.

In view of the available evidenee, in other words, it is not inconceivable that a man may manifest an attack of malaria even 3 years after he has been under suppressive treatment. He says that the 12 months' period provided in VA issues was arbitrary, or perhaps too short a period, and one cannot be dogmatic in such a 1-year period to protect all cases.

Mr. MATHEWS. Since this is a presumptive provision, do you think there should be fixed conditions showing that the man served in an area infested with malaria while he was in the service?

Dr. SHAPIRO. I will go even further. The American Legion believes that a man should cbtain service connection upon the merits of a particular case. If he could show that he had later lived in an area endemic to malaria, the Government should be given the right of rebuttal. When I speak of the Government being allowed to rebut it, I do not think they should be allowed to rebut merely upon medical judgment itself, but should have clear and unmistakable evidence that the men lived or traveled within a certain period in a malarial infested area, and if he was not under suppressive treatment after that time it can be presumed that he would come down with malaria after a relatively short period of time.

Mr. MATHEWS. Why do you say that it sometimes takes 3 years to develop !

Dr. SHAPIRO. Because he was under suppressive treatment.

Mr. MATHEWS. In the case of the 3-year limitation there should be a provision that the man has had suppressive treatment?

Dr. SHAPIRO. That is right. In other words, all that treatment with atropine was, the men developed the disease but not at a clinical level. They took the atabrin, which kept the disease at a subclinical level. The malarial parasite was in his system but was kept suppressed by the drug that he took.

Now, there was one other question brought up by the Congressman here about certain islands not having malaria. I am well aware of that. I served in this war, too, and took care of many cases evacuated from the Pacific. I served on the Pacific coast. There have been areas in the so-called tropics where the malaria was not endemic but where airplane transportation could have brought the mosquito .within a certain period of time before the disease could die out and so infest a man, and as you know there was considerable airplane travel, and it is a well-known fact that the airplane is a means of transporting disease, not only with the type of mosquito, the Anopheles, that transmits malaria, but also the yellow fever.

Also, we have certain ports of entry for things coming in from the tropics for that purpose. That is an added fact that I think should be considered. It is conceivable that there would not be many such cases, though.

Mr. SARBACHER. For instance, in a specific case, a man that takes atabrin—now, every time I feel that backache, or a slight ache, I take some atabrin. Is it possible to build up some immunity in your own body so that the disease would not show over a long period of time? In other words, you build up such an immunity with atropine, or, as you say, they keep it at a subclinical level, that your attack at a clinical stage would never develop?

Dr. SHAPIRO. It is possible with long use of atropine that you can keep the disease to a subclinical level. However, we do know that the continued use of atabrin can lead to certain complications much worse than malaria. By keeping the disease at a subclinical level you do not let your body develop immunity. I know of no immunity which can develop against malaria. I am not an expert on the subject, but I doubt if any expert will say that you can build up an immunity to it.

Mr. MATHEWS. Are there any further questions?

I might say this: None of the subcommittee are medical men. I think we would appreciate a letter from the Veterans' Administration on just the point that you think should be covered in a bill like this.

Mr. KRAABEL. We have this submission we made May 26, Mr. Chairman, but not as yet their response and analysis of it, and with the permission of the VA, if later these can be made a nart of the record we will be glad to let you have them. I am sure the VA will permit.

Mr. MATHEWS. I would be glad if you would transmit to the VA the fact that the subcommittee would like to have them answer it as fast as possible.

Mr. KRAABEL. Very well.
Mr. PRICE. Mr. Chairman, may I ask a question?

Doctor, you do think that some legislation on this matter can be accomplished ?

Dr. SHAPIRO. Unless it can be accomplished administratively, and that is what we would like to do.

Mr. MATHEWS. Well, we would like you to make that request of the Veterans' Administration.

Mr. KRAABEL. We will be very glad to.

Mr. MATHEWS. Maybe it will not be necessary to pass legislation at this session.

Mr. KRAABEL. Mr. Stevens, our assistant director, has something to say.

Mr. MATHEWS. Very well.


Mr. STEVENS. Mr. Chairman, you quoted paragraph 2 from page 64, of the Schedule for Rating Disabilities, 1945 edition. I brought copies of the entire page. I believe it would be helpful if it is inserted in the record in its entirety.

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