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(2) Calculi of the kidney, bladder, or gall bladder: Stones or pebbles forming in the organs that cause severe disability. These stones cannot be formed in a short time but require considerable time for formation to reach the disabling stage.

(3) Buerger's disease and Raynaud's disease: Both are characterized by their progressive nature, often resulting in amputation of the parts involved.

(4) Cirrhosis of the liver: A disease of the liver marked by thickening of the elements of the stroma, afterward contracts, producing phy and degeneration. It was thought for many years that this disease was due to misconduct but it is now known to be from causes other than alcohol.

(5) Coccidiomycosis: It is marked in initial stages by symptoms resembling those of pulmonary tuberculosis (San Joaquin Valley fever). This disease is peculiar to the southwestern portion of the United States and is caused by a spore that is found in the desert. Those who trained in that area are potential sufferers from the disease.

(6) Osteomalacia: A disease marked by increasing softness of the bones so they become flexible and brittle leading to deformities. It is attended with rheumatic pains; the patient becomes weak and may die from exhaustion. It occurs chiefly in adults and is due to vitamin D deficiency. This condition could well develop as result of privation suffered by prisoners of war.

(7) Tumors of the cord or peripheral nerves: The present regulations provide service connection for tumors of the brain but no provision for tumors of the cord or peripheral nerves. As the cord and peripheral nerves are a part of the central nervous system, they should be included.

(8) Functional disorders of the nervous system: It is a known fact that great numbers of veterans, particularly those who had combat service and were discharged on points alone did not complain of disabilities of any nature when they were discharged from service but shortly thereafter were found, when examined by competent psychiatrists, to be suffering from functional nervous disorders.

(9) Scleroderma: A disease of the skin in which thickened, hard, rigid, and pigmented patches occur, the connective tissue of the corium and subcutaneous structures being increased, a hide-bound condition resulting. The ordinary form begins in middle life and is often incurable.

The bill, H. R. 3650, introduced by Hon. James T. Patterson, May 28, 1947, provides :

"That where a tropical disease is diagnosed within 1 year of separation from active service as specified therein such disease shall be conclusively presumed to have been incurred in or aggravated by such service."

There are objections to that bill because of its vulnerability in several aspects. (1) "Tropical disease is not defined. Malaria, for instance, is not necessarily of tropical origin. It is endemic in southern Italy and in Sicily. Cholera is not confined to the tropics nor is leprosy. (2) The bill requires that the disease be diagnosed. Many of the so-called tropical diseases have never been seen by the majority of practicing physicians and diagnosis may be difficult in many of them. To require a diagnosis within 1 year of separation from active service might well lead to injustice. (3) Some of the so-called tropical diseases have an incubation period of well over 1 year, for example cutaneous lieshmaniasis may have an incubation period of 18 months. Loiasis to 3 years. Oracontiasis to 14 months. Leprosy to 5 years or more. As a result of the studies made by the medical profession during the war and subsequently it may found that some of the diseases extend even beyond the presently accepted incubation periods.

For these reasons we feel that there should be no hard and fast delimiting date such as 1 year or 2 years in which service connections may be presumed for any of the disabilities. Our proposal is that standard and accepted treatises, together with sound judgment within the realm of reasonable probability and the known facts shall govern service connection.

It will be noted that provision is made in the proposed bill for the granting of service connection for disorders resulting from suppressive therapy. It is known that diseases of the skin, digestive and nervous systems, and the organs of special sense have reacted and will continue to react from suppressive treatment. Such conditions should, therefore, be accorded service connection.

The proposed bill includes an amendment to Veterans' Regulations No. 1 (a), part II, by adding subparagraph (d) to provide for the granting of service connection for the so-called tropical diseases to veterans who are classified as having

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peacetime service in the occupation forces. The diseases are no respecters of persons or time. The armed forces now in occupied zones are equally suspectible to the diseases named as were those who were serving during the period before the President's declaration of the cessation of hostilities, 12 o'clock noon, December 31, 1946. The Nation must maintain a large peacetime Army and Navy and by the same token provisions must be made for the care of those who may incur diseases or disabilities as result of their peacetime service.

A copy of this letter and copy of the proposed bill are being forwarded to Hon. James T. Patterson, Representative from Connecticut. Sincerely,

QUINTUS E. CAMP,

For the Conferees. THE AMERICAN LEGION :

H. D. SHAPIRO, M. D.
C. W. STEVENS.

HARRY HAYDEN.
THE DISABLED AMERICAN VETERANS :

CLAYTON L. WOOD, M. D.
F. M. SULLIVAN.

QUINTUS E. CAMP.
THE REGULAR VETERANS' ASSOCIATION :

W. M. FLOYD.

VICTOR E. DEVEREAUX. THE VETERANS OF FOREIGN WARS OF THE UNITED STATES :

ELMER P. RICHTER.

JOHN C. WILLIAMSON. AMVETS (AMERICAN VETERANS OF WORLD WAR II):

ROBERT E. MCLAUGHLIN,

Å BILL To amend Veterans Regulation Numbered 1 (a), parts I and II, as amended, to

establish a presumption of service connection for chronic and tropical diseases Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That subparagraph (c) of paragraph Í, pårt I, Veterans Regulation Numbered 1 (a), as amended, is hereby amended by substituting a colon for the period at the end thereof and adding the following: Provided further, That the term "chronic disease" as used in this paragraph shall include: anemia, primary; arteriosclerosis; arthritis; bronchiectasis; calculi of the kindey, bladder or gall bladder; cardiovascular-renal disease, including hypertension, Buerger's disease and Raynaud's disease; cirrhosis of the liver; coccidiomycosis; endocarditis; diabetes, mellitus; endochrinopathiès ; epilepsies ; Hodgkin's disease; leukemia, nephritis; osteitiš, deformans; osteomalacia ; organic diseases of the nervous system including tumors of the brain, cord, or peripheral nerves; functional disorders of the nervous system; sclerodermà; tuberculosis, active; tumors, malignant; ulcers, peptic (gastric or duodenal), and such other chronic diseases as the Administrator of Veterans Affairs may add to this list : And provided further, That tropical diseases such as cholera ; dysentery, amebic or bacillary; filariasis ; fungus diseases; lieshmåniasis; leprosy ; loiasis; malaria; black water fever; onchocerciasis; oroya fever; oracontiasis (or dracontiasis); pinta ; plague; relapsing fever; schistosomiasis ; yaws; yellow fever, and others, and the resultant disorders or diseases of the integumentary, digestive, special sense or nervous systems because of supressive therapy shall be accorded service connection when shown to exist to a degree of ten per centum or more within the incubation period thereof as set out in standard and accepted treatises. Nothing in this paragraph shall be construed to prevent service connection for any of the diseases or disorders herein cited when shown subsequent to the delimiting date if sound judgment, within the realm of reasonable probability and the known facts, indicates the existence of the disease or disorder within the time limit herein provided, the benefit of all reasonable doubt to be resolved in favor of the veteran.

SEC. 2. Veterans Regulation Numbered 1 (a), part II, paragraph I, as amended, is hereby amended by adding subparagraph (d) thereto, said paragraph to read as follows: That for the purpose of paragraph I (a) hereof, any person who served in the military or naval service for six months or more and was honorably discharged therefrom and contracts a tropical disease such as cholera ; dysentery, amebic or bacillary ; filariasis; fungus diseases; lieshmaniasis; leprosy; loiasis; malaria; black water fever; onchoncerciasis; oroya fever; oracontiasis (or dracontiasis) ; pinta; plague; relasping fever; schistosomiasis; yaws; yellow fever and others and the resultant disorders or diseases of the integumentary, digestive, special sense or nervous systems because of suppressive therapy shall be deemed to have incurred such condition in service when shown to exist to a degree of ten per centum or more within the incubation period thereof as set out in standard and accepted treatises. Nothing in this paragraph shall be construed to prevent service connection for any of the diseases or disorders herein cited when shown subsequent to the delimiting date if sound judgment within the realm of reasonable probability and the known facts, indicates the existence of the disease or disorder within the time limit herein provided, the benefit of all reasonable doubt to be resolved in favor of the veteran.

Mr. MATHEWS. The bills we will take up now are H. R. 1200, 1696, 2499, 2621, 3349, 3418, 3437.

We will hear the representatives from the Veterans' Administration.

STATEMENT OF HENRY Q. BROOKS, VETERANS' ADMINISTRATION

Resumed

Mr. BROOKS. Mr. Chairman, I don't know that I can add very much to what has already been said about these bills by the proponents. They have pretty well described the practice of the Veterans' Administration with regard to tuberculosis. It is true that World War I veterans do have a statutory award for tuberculosis, service connected. It is now $60 a month.

Mr. MATHEWS. Yes. Mr. BROOKS. They have the benefit of a presumption. It is manifestation of tuberculosis to a 10-percent degree before January 1, 1945.

Mr. MATHEWS. That would be about 6 years after the conclusion of the war?

Mr. BROOKS. Yes.

Mr. MATHEWS. What have you to say about the existing conditions as to World War I and whether it should become applicable to World War II ?

Mr. BROOKS. The existing condition as to World War I, of course, they do not have this statutory award. We rate them as has been described, active tuberculosis in hospital, 100 percent. We continue that for 6 months, after that, at 50 percent, for 41/2 years, then for 5 years at 30. Then he may be continued at 30 or at 20, depending upon the residuals. It is entirely service connected. Mr. MATHEWS. Either actually or presumtively? Mr. BROOKS. There is no presumption for World War II.

Mr. MATHEWS. What was done with regard to World War I veterans, and your experience based on that, of course, that is over. Nobody can qualify now under that, further.

Mr. "BROOKS. I think our experience has been that many, many cases have been, shall we say, completely cured, and that the man really has an annuity of $60 a month without disability.

Mr. MATHEWS. What I am trying to get at, Mr. Brooks, have you taken any position with regard to the World War II situation, whether or not there should be a similar provision of the World War II veterans as for the World War I veteran, after 6 years after the stoppage of the fighting, or when the war is over, or a particular date, or anything of that sort! Have you any suggestions?

Mr. BROOKS. We would oppose it.
Mr. MATHEWS. Any time, any whatsoever?
Mr. BROOKS. Yes, sir.

Mr. MATHEWS. On what grounds would you oppose it?

Mr. BROOKS. In the matter of service connection for World War II veterans. They have a 2-year regulatory presumption at this time, depending upon the advancement of the condition. I mean by that, they will be given, shall we say, 15 months if the condition is minimal, 18 months if it is advanced to another stage, and 2 years if it is far advanced, we will give him service connection.

Mr. MATHEWS. Is that a present act of Congress or is that under veterans regulation?

Mr. BROOKS. It is under veterans regulation, having the effect of law.

Mr. MATHEWS. Those that were passed by the Congress, having the effect of law ?

Mr. BROOKS. You remember when Public 2 was passed. There was a series of regulations signed by President Roosevelt.

Mr. MATHEWS. You are referring to 1 (a)? Mr. BROOKS. Yes, sir, and paragraph I (c). Mr. MATHEWS. And 1 (c)? Mr. BROOKS. Yes. Mr. MATHEWS. You think that is sufficient to do justice to World War II veterans?

Mr. BROOKS. Yes, sir. Furthermore, from our experience, we would not advocate and would rather oppose a statutory award for arrested tuberculosis. We think that favors a particular group of tuberculosis. Perhaps there are other conditions which are equally meritorious. Of course, there has been considerable advance in medical science. Dr. Wolford is here. He can explain that.

I may say, in the service-connected conditions, we now contemplate a proposal whereby we would continue the total rating up to a maximum of 2 years, under strict medical supervision, and while a veteran is pursuing a course of medical rehabilitation, under medical supervision, with reports coming to us at stated intervals. We think with this added provision which has practically reached agreement within the administration, we would adequately take care of the service-connected cases.

Mr. MATHEWS. Are there any questions?

Mr. PRICE. Mr. Brooks, you said a great many of the ones on the rolls of World War I were actually drawing an annuity, although they have no disability. What percentage of the men who are getting this compensation would you put in that class?

Mr. BROOKS. Well, I would put a considerable number, CongressMr. PRICE. Just an estimate, it would be rough, I know. What percentage would you say? Mr. BROOKS. Better than 50. Mr. PRICE. Better than 50 ?

Mr. BROOKS. Perhaps. I can mention the case of my own brother, if you

would like, who had it. He is absolutely cured and has worked every day since he was cured. He was laid up for 14 months.

May I suggest that Dr. Wolford is here?

Mr. MATHEWS. All right. We will have him next. Thanks for coming

Mr. BROOKS. Thank you.
Mr. MATHEWS. Dr. Wolford is from the Veterans' Administration.
Dr. Wolford.

man.

STATEMENT OF DR. ROY A. WOLFORD, ASSISTANT CHIEF, TUBER

CULOSIS DIVISION, DEPARTMENT OF MEDICINE AND SURGERY, VETERANS ADMINISTRATION

Mr. MATHEWS. Doctor, you are here representing the Veterans' Administration ?

Dr. WOLFORD. Yes, sir. It is indeed a privilege to appear before the subcommittee. - I will try to be as brief as possible.

Our feeling is, medically, that we have ample provision in existing legislation to adequately compensate the tuberculous veteran. We would like-we hope that the compensation structure

Mr. MATHEWS. Doctor, will you speak a little louder, please? There are a number of people back of you who are very much interested in what you have to say. I want them to hear you.

Dr. WOLFORD. Thank you. I will try to bring it out a little louder.

To repeat, we feel, medically, that there is ample provision in the present legislation to adequately compensate the tuberculous veteran. We are keenly interested, of course, primarily, in the rehabilitation of these veterans. We would like to see compensation so given that it would lead to this rehabilitation. We hope that we can keep the compensation on a medical basis for that reason; that we can make changes in the compensation structure as medical experience dictates from time to time.

We believe that the first provision of paying compensation for a veteran while he has active disease is taken care of in our schedule of rating. As Mr. Brooks has said, we are, or have, after a very careful study, brought out a proposed regulation which will permit us to pay full compensation to a veteran who has been discharged from our hospitals with medical advice as an arrested case, or in an arrested eliņical status for 2 years after his discharge.

in other words, as you remember, presently, at the end of 6 months that man is reexamined, and if his condition is still arrested, his compensation is reduced. But if he will enter into a rehabilitation program and take adequate follow-up contact, then we feel that that compensation should proceed for at least two more years, providing he is being examined from time to time.

After World War I there may have been some justification for a statutory award for pulmonary tuberculosis. That was due primarily, or was based primarily, I should say, on a number of reasons. You will remember after World War I that there was no search for tuberculosis among veterans. That is, the Veterans' Administration took patients who came to them with tuberculosis and treated them. They had no follow-up measures instituted. A man left the hospital and that is the last the Veterans' Administration heard of him until he decided to come back in the hospital again.

Mr. MATHEWS. At that point, may I interrupt. Was it not a fact also that no X-ray pictures were taken when men went into the service, in World War I? Is that right?

Dr. WOLFORD. That is right. Not only that, X-ray at that time wasn't even given consideration in the diagnosis of tuberculosis. Consequently, we got a number of cases rather late in their disease, a large percentage of them were far advanced, moderately advanced, and we rarely saw the minimal case.

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