[H. R. 3439, 80th Cong., 1st sess.]

A BILL To raise the limit on the amount of annual income from other sources which may be received by the widow or child of a veteran of World War I or II without disqualifying such widow or child for a pension for the non-service-connected death of such veteran

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, That section 1 (c) of the Act entitled "An Act to compensate widows and children of persons who died while receiving monetary benefits for disabilities directly incurred in or aggravated by active military or naval service in the World War", approved June 28, 1934, as amended, is amended

(1) by striking out "$1,000" and inserting in lieu thereof "$2,000"; and (2) by striking out "$2,500" and inserting in lieu thereof "$4,000".

[H. R. 3650, 80th Cong., 1st sess.]

A BILL To amend Veterans Regulation Numbered 1 (a), part I, as amended, to establish a conclusive presumption of service incurrence of 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 I, part I, Veterans Regu'ation 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 where a tropical disease is diagnosed within one 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." Mr. MATHEWs. The committee will come to order.

We are holding hearings this morning on the following bills: H. R. 1200, H. R. 3349, which have reference to tuberculosis; H. R. 1352, H. R. 2566, H. R. 295, H. R. 460, which have reference to income limitations; H. R. 1453, which has reference to presumptive service-connected disabilities; and H. R. 3650, which has reference to conclusive presumption of 1 year on tropical diseases.

Now, are there any Members of the House here sponsoring these bills that want to be heard, first?

Is Mr. Patterson here?

Mr. PATTERSON. Here.

Mr. MATHEWS. Very well. Suppose we take up, first, the last one on the list, H. R. 3650. I will hear Mr. Patterson's statement.

STATEMENT OF HON. JAMES T. PATTERSON, MEMBER OF CONGRESS FROM FIFTH CONGRESSIONAL DISTRICT, STATE OF CONNECTICUT

Mr. PATTERSON. Mr. Chairman and gentlemen of the committee, first, I will say that in my estimation this is a sound bill, and it is going to take care of men that have served in the Tropics during this past war that have contracted malaria but with an incubation period of a year or probably a little more before this disease actually broke out on them.

Now, in my own case, I know that during the war I was taking suppressive medicine to control the infection of malaria in me, but since then it periodically breaks out. Now, there are many men that during the war took suppressive medicine and had never received an attack while in the service, but the moment they were back here in the States and discharged and off suppressive medicines the infection broke out, and this particular bill here is going to take care of those boys who were infected while on active duty in foreign countries.

Mr. MATHEWS. Are there any questions the committee members want to ask?

Mr. VAIL. Are there any statistics to indicate how many veterans are infected that way?

Mr. PATTERSON. Well, that is a hard one to get actual figures on. because there are a lot of boys that right at the present time, who have this infection in their blood stream but have not come down with the malaria because they are still under suppressive medicines, from what I understand from doctors, it will take a period of 1 or 2 years before some cases develop. Perhaps this bill, the way it is written, is not long enough for the period of incubation. Maybe it should be an assumption of fact that if a man, having served in the Tropics during the war, and, say, lives in the North, where we do not have malaria, and then comes down with it, should be considered as having contracted the infection while on active duty.

There are other diseases, for instance, leprosy, which a man may contract in Asia, and it may take 5 to 10 years for it to break out. When I wrote this bill I did not realize that until I talked to some doctors.

Mr. MATHEWS. Well, may I interrupt you? Does the gentleman know that the way they are treated on Veterans' Administration schedules shows that the doctors realize that. They have certain periods of incubation within which, if they find the disease develops, they hold that it is automatically service connected. It goes back to that period of time, if a man came out of service out of the Tropics. Do you know that?

Mr. PATTERSON. No; I did not know that.

Mr. MATHEWS. Well, I think somebody from the VA will have some information on it. However, your bill will make it conclusively service. connected?

Mr. PATTERSON. Service connected. That is right.

Mr. MATHEWS. Now, would you have any objection to an additional provision in there which would protect the present rating schedule? For instance, that schedule, I think, is 5 years for leprosy, which they consider an incubation period. You would not want this to affect that period?

Mr. PATTERSON. No, indeed.

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Mr. MATHEWS. In other words, there should be a proviso in the bill that that does not affect their schedule where the incubation would be longer?

Mr. PATTERSON. No; I would not want that.

Mr. MATHEWS. You would be willing to clarify that if the bill were passed; is that correct?

Mr. PATTERSON. Yes. I think there are some doctors here that will be able to give you a better insight on the particular diseases than I can. I am a Congressman and not a doctor.

Mr. MATHEWS. But, as I understand it, if they are from the VA they can clarify this: That if the disease manifests itself so that they could see it within this incubation period after the discharge, or after the time he was in the Tropics, they recognize it as service connected? Mr. PATTERSON. Yes.

Mr. MATHEWS. They can correct me if I am wrong on that.

Mr. PATTERSON. Of course, that is regulation, and I would like to bring it in so it would be law so it could never be waived.

Mr. MATHEWS. Then you would have to cover every disease in the special incubation period.

Mr. PATTERSON. I thought I was covering them all when I said "all tropical diseases."

Mr. MATHEWS. Yes; but you make it 1 year. Now, on leprosy, for instance, it is 5 years. Some others it is 18 months.

Mr. PATTERSON. I will amend my bill and take the 1-year clause out and make it correspond to the incubation period in each particular

case.

Mr. MATHEWS. If you made it 5 years for leprosy, then it would be unreasonable as to diseases which manifest themselves within the period of a year.

Mr. PATTERSON. Well, would 5 years cover them all?

Mr. MATHEWS. There are different periods, as I understand it; they run from 6 months to a year up to 5 years in various diseases.

Mr. PATTERSON. Well, then, I don't see how you are going to get around that to cover all tropical diseases.

Mr. MATHEWS. Well, I think maybe that can be clarified when the medical men testify and we can get a clear picture.

Mr. PATTERSON. Because if you say it is 6 months for one disease and 10 years for another.

Mr. MATHEWS. Five years, maximum.

Mr. PATTERSON. If we made it 5, would that include all tropical diseases?

Mr. MATHEWS. Might I read into the record from the rating schedule of the Veterans' Administration, 1945 edition, page 64?

I will ask the stenographer to copy that in the record. (The matter referred to is as follows:)

SYSTEMATIC CONDITIONS

(P. 64, Schedule for Rating Disabilities, 1945 edition)

1. Tropical diseases.-The following tropical diseases, among others, may require attention in view of incidence in areas of foreign service: Cholera; dysentery (amebic); dysentery (bacillary); filariasis (Bancroft's type); hookworm infection; leishmaniasis; malaria, blackwater fever; onchocerciasis; oroya fever; pinta; plague; relapsing fever; schistosomiasis; yaws; yellow fever. Medical rating specialists should familiarize themselves, from standard treatises, with the locality, incubation period, and residuals of these tropical diseases. Amebic dysentery and schistosomiasis are to be rated under the digestive system; oriental sore and espundia (Old World cutaneous and American mucocutaneous leishmaniasis) pinta and vergua peruana, a late residual of oroya fever, under the diseases of the skin; and onchocerciasis under the sense organs.

2. Incubation period of tropical diseases.--Tropical diseases having long incubation periods are kala-azar (visceral leishmaniasis) which may extend to 4 months, oriental sore (cutaneous leishmaniasis) which may extend to 18 months, some of the filariases which may extend to 9 months. Others are loiasis (Calabar swelling), to 3 years; oracontiasis (Guinea worm disease), to 14 months; and leprosy, to 5 years or more. The period for amebic dysentery may extend to several months. When considering service connection for tropical disease not of record during service, tropical residence other than during military service must always be considered, and standard texts consulted as to locality of endemicity, early symptoms and course, period of incubation, and so forth.

3. Malaria.—In rating disability for malaria, once identified by clinical and laboratory methods, or by clinical methods alone where the disease is endemic, the clinical course of the disease, the frequency and severity of recurrences, the necessity for and the reaction to medication, should be the basis of evaluation, not the presence or absence of parasites. When there have been relapses

following the initial course of treatment, further relapses are to be expected, and for some time the veteran must be given the benefit of the doubt as to unexplained fever of short duration, controlled by quinine or other specific for malaria. When the service included active duty in an area where malaria was endemic, especially any tropical service, whether or not suppressive treatment was given, even in the absence of clinical malaria in service, the active disease, initially manifest within 6 months of relief from tropical service, or cessation of suppressive treatment (if given), which ever was later, will be service connected, unless due to infection incurred after discharge.

Mr. MATHEWS. That is what I mean, Mr. Patterson, when I say that there are various periods of incubation already recognized by the Veterans' Administration on the rating schedule.

Mr. PATTERSON. For instance, I understand they do not know too much about filariasis that we all picked up in the Tropics. They can arrest it, but they cannot cure it. Now, why couldn't a fellow that served in the Tropics have one of these worms or bugs, or whatever they are, in his system after serving in the Tropics, later on in life, say, after 5 years, have it break out on him, then how would he prove it was service connected, if we are going to limit it to 5 years?

Mr. MATHEWS. You mean there should be some period during which if the disease manifests itself it should be considered as service connected without any refutation at all? That is, absolute assumed service connection?

Mr. PATTERSON. Yes. In the wisdom of the committee, would it be 5 years?

Mr. MATHEWS. Well, that, of course, the committee would have to consider, but the point I think you are trying to make is there should be a certain period up to which there would be a conclusive presumption of service connection.

Mr. PATTERSON. That is right. That is exactly what I want to do with it.

Mr. MATHEWs. Do you have some questions?

Mr. SARBACHER. Is it not true, Mr. Patterson, that the records were in such a condition during the war that in many cases it was shown that a man had one attack of malaria, whereas actually he might have had five or six while serving in the Tropics?

Mr. PATTERSON. In my own case I had eight attacks of benign tertian and one of malignant malaria, and I think they have me recorded for six and one. Now, in many cases boys that were with me would come down with malaria while they were still in action, and all they would do was take their suppressive medicine and carry on, and probably never even report it, or go to a corpsman and ask for some atropine and just doctor themselves. I know you saw the same thing.

Mr. SARBACHER. What I am particularly concerned about with reference to this particular disease of malaria is the fact that many of us went through the Tropics and had malaria and had no record in our health record books of such attacks, and I believe that the Veterans' Administration's physicians rely very heavily on the background as shown by your health record book. I know many cases. so far where they do not show any attacks of malaria that the man has a very uphill fight to prove that he has it, inasmuch as the diseaseitself is so peculiar. You may have it for 1 or 2 days and then be all right for 8 months.

I would like to see in this particular bill a proviso or amendment of some description to protect all the men that were exposed to the disease so that they would have a fair opportunity, without relying entirely on the health record book, which I know in my particular case is incomplete, too.

Mr. PATTERSON. That is the purpose of this bill. Right today we have a lot of boys that are coming down with malaria, and when they report to veterans' doctors, they say, "Well, I have malaria, but it is not in the record book." So I am showing that if they report within a year, which now I realize is not quite long enough-but we will take this, now, as a yardstick-if they report to a doctor in Veterans' Administration within a year after being discharged from the service with malaria, then there is a question in the doctor's mind, because he has the boy's health record, and there is no indication of malaria while on active duty, and then he wonders whether he got it in some part of the United States, and it is hard to prove a serviceconnected disability.

Now, I know right up in my own part of the country, in New England, where we do not have malaria, a lot of the boys are coming down with the infection, and there is a question there of whether it is a service-connected disability. For instance, they tell you to stay in a cold climate. Well, after being in the Tropics and taking suppressive medicine for a period of over 2 years or more, the bug is still in your system, and then when you get home in a cold climate and relax, the bug is excited, or whatever they call it, and shoots into the blood stream, and the first thing you know you have a chill; and the result is that the boys are coming down with malaria, and there is nothing to protect them.

I think they should be taken care of somehow.

Mr. SARBACHER. I can fully appreciate your views, because according to my health record I am a three-time loser, and I have had malaria five times. However, I would like to see, shall we say, the Government protected somewhat inasmuch as many of these Tropic islands, as you know well, did not have the Anopheles mosquitoes. In other words, if a man could show by his service record that he was in the Pacific, period, and you could show by his records that he had been down 1 or 2 days, how could they prove definitely that he did or did not have it?

Mr. PATTERSON. Just from my own experience, I know that every time I have had an attack they can just take a little blood out of my finger and they find the malaria bug.

Mr. SARBACHER. That I will ask the doctors, but I believe from my own background it is not always possible to tell positively.

Mr. PATTERSON. That is for a medical man to testify to.

Mr. SARBACHER. The point I am referring to is, in the man's service record it would show what island he was on. In certain parts of the Pacific there were not any Anopheles mosquitoes, were there? Mr. PATTERSON. That is right.

Mr. SARBACHER. In other words, I would not want to allow just anyone to come in and get this treatment when they may not have contracted the disease in the Pacific.

Mr. PATTERSON. I do not think we had any Anopheles mosquitoes on Iwo. I know on Guadalcanal we had more men come down with malaria than anything else.