(The statement referred to follows:)

STATEMENT OF JOSEPH A. VATER, NATIONAL COMMANDER OF AMERICAN DEFENDERS OF BATAAN AND CORREGIDOR, INC.

I would at this time like to give our reason for requesting Congressman James G. Fulton to introduce the bill now known as H. R. 7711.

Our organization, the Americah Defenders of Bataan and Corregidor, Inc., is composed of men who spent approximately 42 months as Jap POW's. I believe you could say we know of what we speak. While I don't want to bore anyone with the facts that are well known, I would like to enter a few statements in the record of this hearing.

When we were liberated, the United States forces did their best to build the men up to a point so that by the time we returned we looked like "blowed up toads." It is hard to say now if this process was the best. Today, nearly 8 years later, the general health of the former POW's is deteriorating. We are continually receiving letters from the members of our organization relating the failure of their health. These men are confronted with physical ailments that are baffling both the men themselves and medical science. Inasmuch as the medical men of this country would normally never have any experience with these types of ailments, the only intelligent method of evaluating the special problems of the former POW's would be to prove our point-create the study of the health as described in H. R. 7711.

Facts will show that well over 100 cases of schistosomiasis japonica (a bloodstream parasite) have been discovered by Dr. Harry Most, of the Bellevue Medical Center, after they had been passed over by the United States Medical Corps and VA examination. This is only one example where the normal medical examinations failed to show the facts. Naturally the Veterans' Administration cannot rightfully make the proper decision if they are in the dark as to the results of malnutrition and the other prison-camp diseases.

My thoughts are of the many hours of unnecessary suffering endured by our men because no such survey as this had been made earlier. Also, we must remember most of these ailments are of the nature that are prevalent in the Far East, where we seem to be getting in the most trouble lately. While we are backing the extension of the War Claims Commission to include the Korean POW's, they would have been better by far had H. R. 7711 been a law before they returned.

I wish to thank the members of this committee for the opportunity of entering these statements into the proceedings of this hearing.

Mr. VATER. I would also like to say that I think Mrs. Ward gave some very good testimony on our bills, and if possible, Mr. Chairman, could we incorporate some of the testimony that was made at the September 15, 1950, hearing on H. R. 8848 into this record?

Mr. HINSHAW. I cannot say without examining the testimony. Mr. VATER. It is all testimony which was given by medical men and I would like to pass it on to you, if you want to look at it.

Mr. HINSHAW. Yes. If it is acceptable to the committee, I think it will be acceptable for the record, and we will go over it.

Mr. VATER. I have the pages turned where I think are the most important things.

Mr. HINSHAW. Yes; I think we can include that in the testimony. Mr. VATER. It is all a matter of record and the only thing is I think it would be important in the record of this hearing also.

Mr. HINSHAW. I think in view of the fact that it is quite long we better incorporate it in the record by reference and we will refer to this testimony in the course of our record and not copy it again in this record because it is rather expensive to reprint and it is a Government document.

Mr. VATER. As long as we have it in there it is perfectly satisfactory.

I want to thank you gentlemen for your time.

Mr. HINSHAW. Thank you, sir.

Are there any questions?

Mr. SCHENK. No. That was a very good statement, Mr. Chairman. Mr. HINSHAW. We now have Mr. Daley, Director of the Legislative Project Service, and Dr. Mueller, and Mr. Mark Robson, all three of the Veterans' Administration here present.

We would like to know what progress you have been making in your study of these matters and what progress is being made toward a regulation which will declare malnutrition to be a cause of disability.

STATEMENTS OF T. F. DALEY, DIRECTOR, LEGISLATIVE PROJECT SERVICES; DR. C. R. MUELLER, DEPARTMENT OF MEDICINE AND SURGERY; AND MARK S. ROBSON, DEPARTMENT OF VETERANS' BENEFITS, VETERANS' ADMINISTRATION

Mr. DALEY. Mr. Chairman, may I first ask Mr. Robson, who is a representative of the Department of Veterans' Benefits and a member of the Rating Schedule Board, to give you some aspects of our adjudication procedures, with particular reference to the consideration of cases of prisoners of war?

I might say at the outset, that, of course, the prisoners of war, military prisoners of war, veterans of World War II, and of the Korean conflict, are entitled to all of the benefits which are administered by the Veterans' Administration for veterans generally.

Those include a considerable number of benefits-compensation, pension, insurance, various readjustment benefits, education and training, loan guaranty, hospitalization, medical care, domiciliary care, outpatient care, osthetic appliances, cars for amputees, and specially adapted housing for certain classes of disabled veterans.

The whole category of veterans' benefits are, of course, available to all the prisoners of war who meet the requirements of veterans' status, namely, service in a war under proper conditions and separation from service under conditions other than dishonorable.

Mr. HINSHAW. We understand that that is applicable to any member of the Armed Forces.

Mr. DALEY. Any member of the Armed Forces. When we get to the categories of prisoners of war and the special consideration that has been given to them, I am going to ask Mr. Robson to give you the benefit of the adjudication procedures and the special consideration given in the elevation of those cases.

Mr. HINSHAW. I think that before we hear from him we will place in the record the letter from the Veterans' Administration to the chairman of the full committee, Mr. Wolverton, under date of June 8, 1954, and signed by Mr. H. V. Higley, the Administrator, which sets forth in some detail the procedures and so forth that are gone into by the Veterans' Administration.

(The letter referred to follows:)

Hon. CHARLES A. WOLVERTON,

VETERANS' ADMINISTRATION, Washington 25, D. C., June 8, 1954.

Chairman, Committee on Interstate and Foreign Commerce,

House of Representatives, Washington 25, D. C.

DEAR MR. WOLVERTON: Further reference is made to your request for a report by the Veterans' Administration on H. R. 7711, 83d Congress, a bill to provide for a study of the mental and physical consequences of malnutrition and starvation suffered by prisoners of war and civilian internees during World War II and the hostilities in Korea.

The purpose of the bill is to provide for the conduct of medical and scientific research activities to determine the mortality rates and the mental and physical consequences of malnutrition and imprisonment sustained by members of the Armed Forces of the United States and civilian American citizens who were imprisoned by enemies of the United States during World War II or by forces with which the United States has been engaged in armed conflict after June 25, 1950. The arrangements for the research activities would be made by the War Claims Commission, in cooperation with, and with the assistance of the Administrator of Veterans' Affairs and the Secretary of Health, Education, and Welfare. The War Claims Commission would report the results of the research activities to the President for transmittal to the Congress.

Results of the research activities, to the extent practicable, would be used by the War Claims Commission, the Veterans' Administration, and the Department of Health, Education, and Welfare for the purpose of determining:

(1) The procedures and standards to be applied in the diagnosis of the mental and physical condition of former prisoners of war;

(2) The life expectancy of former prisoners of war;

(3) Whether there is evidence to sustain a conclusive presumption of service connection in favor of former prisoners of war for purposes of hospitalization in Veterans' Administration facilities; and

(4) Standards to be applied for the evaluation of claims of American civilian and military personnel based upon the physical and mental consequences of the conditions of their imprisonment, in the event such claims are later made compensable.

The Veterans' Administration is aware of the prisoner-of-war question in respect to determination of service connection and the evaluation of disability and the special medical problems related thereto. The Department of Medicine and Surgery has continued its interest in the special medical problems concerning American and allied veterans who are former prisoners of war. The Department has recognized that these problems, in general, manifest themselves in the incidence of tropical diseases and certain psychiatric disorders, and in the immediate and possible long-term effects of malnutrition. Through the investigations and research studies already completed and those presently under way, medical information has been assembled on the present status of veterans who were subjected to prisoner of war experience, particularly those affected by tropical diseases. The investigations and research in which the Veterans' Administration has been engaged have included the group of veterans who were exposed to the risk of infection with tropical diseases, with special emphasis upon former prisoners of war.

A number of studies in behalf of the health and welfare of former prisoners of war have been undertaken or financially supported by the Veterans' Administration. The major study, which has been undertaken with the assistance and cooperation of the National Research Council, is designed to ascertain whether and to what extent the health of World War II veterans who were formerly prisoners of war may have been permanently impaired, and with what specific aspects of their prison experience such impairments may be associated. The differentials being estimated are of two kinds: (1) between former prisoners of war and those whose service was most nearly comparable in terms of environmental stress but who never became prisoners; and (2) between former prisoners of war and the veteran population generally.

Systematic data has been gathered and tabulations and analyses are being prepared as to:

1. Mortality: This covers date and cause of death and any autopsy findings. Mortality rates are being calculated for each sample, with due regard for age, and compared as to homogeneity. The size of any differentials is being estimated. If mortality is found to be sufficiently high to warrant its use, a life table will be created for the former prisoners of war. Cause of death will also be the subject of statistical comparisons.

2. Morbidity: Hospitalizations in the Veterans' Administration system and elsewhere have been recorded as to date of onset, duration, diagnoses made, and major operations. Hospitalization rates are being calculated and the samples compared as to homogeneity, both rates for all causes and for such specific causes or groups of causes as prove of interest. Duration of hospitalization is being compared and proportions of time spent in hospital for all causes calculated for comparison.

3. Disability: Veterans' Administration disability ratings are being systematically recorded as to date, diagnosis, and amount for each. The veteran's opinion is being obtained as to any tendency for his health to interfere with his work. Comparison between former prisoners of war, veterans whose service in World War II closely paralleled that of the former prisoners of war in all respects except prisoner of war status, and veterans generally, is being made as to distribution of the total combined percentage rating, as to the proportions with ratings for specific diseases and groups of diagnoses, and as to median ratings for such diagnoses as are found to be of particular interest. They are also being compared as to the proportions stating that their work capacity has been impaired by poor health.

4. Work record: Data is being compiled as to number of days lost from work because of sickness or other specified reasons for sample time periods. This data is being converted into an appropriate statistical index.

5. Adjustment: Veterans' Administration folders have been reviewed for evidence of emotional and other adjustment as spontaneously revealed therein. Comparison between former prisoners of war and other veterans with comparable service and veterans generally is being made as to proportions exhibiting evidence of specific maladjustments, as to marital status and as to size of family. In addition to the foregoing, specific aspects of experience of former prisoners of war are being studied for apparent effect on subsequent health.

It is anticipated that the study described above, which has been in progress since 1951, will be completed soon after the beginning of the next fiscal year. A wealth of information will then become available on many phases of this subject and the Veterans' Administration will be in a better position to determine if further studies are necessary, and if necessary, the direction in which they should proceed.

The claims programs of the Veterans' Administration in cooperation with its medical and appellate programs have concerned themselves with the problems of the prisoner-of-war group since the demobilization. Each claim is adjudicated on the best available and procurable evidence. Regulations have been issued which direct Veterans' Administration personnel charged therewith to handle these cases equitably and liberally. Provision is made for priority of physical examination, and medical examiners are directed to report fully respecting manifestations which might relate to or result from prisoner-of-war experience. By way of illustration, the present instructions to examiners include the following significant directions:

Neuropsychiatric examination will be accomplished in each case in special reference to manifestations of metabolic origin, neurasthenoid character, or other syndrome consequent to malnutrition, avitaminosis, exposure, or other circumstances under which the veteran was held as a POW. The examiners should feel a special obligation to ascertain and report any causes of reduced efficiency, whether or not expressible in formal diagnostic nomenclature. A common complaint is that although weight has been regained, weakness and fatigability continue. This should be reported on as accurately as possible. Retinitis is not uncommon following malnutrition. With history of intestinal disease, or unexplained underweight condition, tests for intestinal parasites should be routine. The existence of any chronic disease which may be associated with the circumstances of imprisonment should be carefully checked and reported on. (VA Regulation 1185 (B) (4).)

The bill proposes the conduct of research for the purpose of determining whether there is evidence to sustain a conclusive presumption of service connection in favor of former prisoners of war for purposes of hospitalization in Veterans' Administration facilities.

As previously indicated, a most liberal policy has been adopted by the Veterans' Administration in the adjudication of the prisoner-of-war cases and service connection for disability is granted even though under certain circumstances in prisoner-of-war cases such disability may manifest itself subsequent to the presumptive period otherwise provided. It should be pointed out that as individuals, veterans and nonveterans alike, advance in age, they become subject to the same diseases and causes of death. Thus, veterans who have been prisoners of war, combat veterans, other veterans, and the nonveterans, may expect to die of circulatory failure, cancer, and various degenerative diseases. To concede all these causes of disability and death common to all groups, to prisoner-of-war service in a limited group, at least from the standpoint of existing indications and knowledge, could not be rationalized. Apart from the foregoing observations which suggest certain imponderables which would need to be considered and overcome in connection with this proposed item of research, there is the serious question whether a conclusive presumption of service connection in favor of former prisoners of war solely for the purpose of hospitalization in Veterans' Administration facilities would establish a precedent for extending such presumption by law to other groups and other benefits.

In summary, it may be stated that existing standards and procedures of the Veterans' Administration permit liberal disposition of the claim of any former prisoner of war to hospitalization, outpatient treatment, and compensation benefits. As stated, investigation and research by the Veterans' Administration are continuing, including studies and analyses of the relationship of malnutrition from the standpoint of causes of disease which may manifest itself in the future. Personnel, facilities, and records required for this research as to veterans are available to the Veterans' Administration to a greater degree than to any other agency of the Government. The utilization of these studies appears to be the primary responsibility of the Veterans' Administration and experience indicates that studies related to the welfare of veterans can best be pursued by the Veterans' Administration itself with occasional consultation with and assistance of specialists of the professional divisions of the Department of Health, Education, and Welfare or from the country at large.

If legislative provision for the study proposed by the subject bill is considered desirable by the Congress, it would appear to be more advantageous to place the responsibility for the study with respect to former prisoners of war with the Veterans' Administration and with respect to former civilian internees with the Public Health Service, Department of Health, Education, and Welfare, as it is understood that the War Claims Commission does not have comparable medical staff or facilities. However, in view of the continuing research activities of the Veterans' Administration, there is for serious consideration by the committee whether there exists any need or justification for legislation of this character with respect to matters affecting the benefit programs for veterans administered by this agency.

Because of the indeterminate factors involved, the Veterans' Administration is unable to make an estimate of the cost of the bill if enacted.

For the foregoing reasons, I am unable to recommend favorable consideration of H. R. 7711 by the committee.

Advice has not as yet been received from the Bureau of the Budget as to the relationship of this legislation to the program of the President. However, this report is transmitted without such advice in view of your subcommittee hearing on H. R. 7711, 83d Congress, scheduled (according to the latest Congressional Record Digest for 10 a. m. Tuesday, June 8, 1954.

Sincerely yours,

H. V. HIGLEY, Administrator.

Mr. HINSHAW. I would like to read just one important paragraph of that letter. This is a paragraph from page 5:

As previously indicated, a most liberal policy has been adopted by the Veteran's Administration in the adjudication of the prisoner-of-war cases, and service connection for disability is granted even though under certain circumstances in prisoner-of-war cases such disability may manifest itself subsequent to the presumptive period otherwise provided. It should be pointed out that as individuals, veterans and nonveterans alike, advance in age, they become subject to the same diseases and causes of death. Thus, veterans who have been prisoners of war, combat veterans, other veterans, and the nonveterans, may expect to die of circulatory failure, cancer, and various degenerative diseases.