[No. 27] COMMITTEE ON VETERANS' AFFAIRS, HOUSE OF REPRESENTATIVES VETERANS' ADMINISTRATION, Washington 25, D. C., March 30, 1953. Hon. EDITH NOURSE ROGERS, Chairman, Committee on Veterans' Affairs, House of Representatives, Washington 25, D. C. DEAR MRS. ROGERS: This is in reply to your requests for reports on H. R. 25 and H. R. 1573, identical bills of the 83d Congress, each entitled, "A bill to amend subparagraph (c), paragraph I, part I, of Veterans Regulation No. 1 (a), as amended, to establish a presumption of service connection for chronic and tropical diseases becoming manifest within 3 years from separation from service." The purpose of the bills is to extend from 1 to 3 years after separation from active wartime service or service on and after June 27, 1950, the period during which recourse may be had to the rebuttable presumption of service connection provided by law for certain chronic diseases, hereinafter listed. H. R. 25 and H. R. 1573 are identical with H. R. 306, 82d Congress, on which the Veterans' Administration submitted a report to your committee under date of September 27, 1951 (Committee Print No. 186), and with H. R. 6258, 81st Congress, on which the Veterans' Administration reported under date of December 23, 1949 (Committee Print No. 184). Notwithstanding the title, it is noted that the amendment proposed by the bills would not affect the existing provisions of law which provide a rebuttable presumption of service connection for certain tropical diseases and the resultant disorders or diseases originating because of therapy administered in connection with such diseases, or as a preventative thereof, when shown to exist within 1 year after separation from active wartime service or service on and after June 27, 1950, or at a time when standard and accepted treatises indicate that the incubation period thereof commenced during active wartime service or service on and after June 27, 1950. Further, the bills would not affect the present 1-year presumptive service connection now afforded by law as to tropical diseases for peacetime veterans. The present law governing presumptive service connection for chronic diseases (Veterans Regulation No. 1 (a), pt. I, par. I, subpar. (c), as amended), provides generally that a chronic disease (other than active pulmonary tuberculosis and multiple sclerosis) becoming manifest to a degree of 10 percent or more within 1 year from the date of separation from active service, shall be considered to have been incurred in or aggravated by such service, notwithstanding there is no record of evidence of such disease during the period of active service, if the person suffering from such disease served 90 days or more in the active service, except where there is affirmative evidence to the contrary, or evidence to establish that an intercurrent injury or disease which is a recognized cause of such chronic disease has been suffered between the date of discharge and the onset of the chronic disease, or the disability is due to the person's own willful misconduct. With respect to active pulmonary tuberculosis a 3-year presumptive period is provided and for multiple sclerosis a 2-year period. These presumptions are applicable to veterans of the Spanish-American and subsequent wars (World War II veterans are the chief group) and, because of the provisions of Public Law 28, 82d Congress, May 11, 1951, to persons who shall have served in the active service on and after June 27, 1950, and prior to such date as shall thereafter be determined by Presidential proclamation or concurrent resolution of the Congress. The statutory 1-year period for presuming service connection is presently applied with respect to the following diseases recognized as chronic: Anemia, primary; arteriosclerosis; arthritis; atrophy, progressive muscular; brain hemorrhage; brain thrombosis; bronchiectasis; calculi of the kidney, bladder, or gall bladder; cardiovascular-renal disease, including hypertension; cirrhosis of the liver; coccidioidomycosis; diabetes mellitus; encephalitis lethargica residuals; endocarditis; endocrinopathies; epilepsies; Hodgkin's disease; leprosy; leukemia; myasthenia gravis; myelitis; myocarditis; nephritis; other organic diseases of the nervous system; osteitis deformans (Paget's disease); osteomalacia; palsy, bulbar; paralysis agitans; psychoses; purpura idopathic, hemorrhagic; Raynaud's disease; sarcoidosis; scleroderma; sclerosis, amyotrophic lateral; syringomyelia; thromboangiitis obliterans (Buerger's disease); tuberculosis, active (other than pulmonary); tumors, malignant, or of the brain or spinal cord or peripheral nerves; ulcers, peptic (gastric or duodenal). With respect to active pulmonary tuberculosis, the presumptive period was increased from 1 to 3 years by Public Law 573, 81st Congress, June 23, 1950, and the presumptive period provided for the disease or multiple sclerosis was increased from 1 to 2 years by Public Law 174, 82d Congress, October 12, 1951. From a medical viewpoint, the 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 generally incurred within a reasonable time after the 1-year 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. Introduction of a presumptive period beyond that which can be justified on a sound medical basis results in additions to the service-connected rolls of many cases where the condition actually arose after discharge or release from active service, but the Government is unable to secure affirmative evidence to establish that fact. Accordingly, there appears to be no sound medical justification for extending the present statutory period for presumption of service connection for all chronic diseases from 1 to 3 years as proposed in the bills. As indicated, H. R. 25 and H. R. 1573 are identical with bills previously introduced in the 81st and 82d Congresses, and they have not been revised in form to take cognizance of the subsequent enactments of Public Law 573, 81st Congress, and Public Law 174, 82d Congress (extending the presumptive period to 3 years for active pulmonary tuberculosis and to 2 years for multiple sclerosis, respectively). Accordingly, if the law is amended as proposed by the bills, retaining the existing proviso with respect to active pulmonary tuberculosis and multiple sclerosis, the period for active pulmonary tuberculosis (3 years) will be repetitious and the period for multiple sclerosis (2 years) will be more restrictive than the proposed 3 years for chronic diseases generally. If such effect is not intended, the bills should be clarified. In addition to granting service connection for compensation purposes in a very large number of cases, the proposed legislation, 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 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 non-service-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 group affected because of the service-connected status which would be granted to them. Existing law and regulations generally limit outpatient treatment to those requiring such treatment for service-connected disabilities. The staffing problem in connection with furnishing hospital treatment and outpatient treatment has become progressively more difficult. In addition to the critical recruitment situation, the Veterans' Administration has been adversely affected by the mounting needs of the Armed Forces for medical personnel. For example, between June 1, 1950, and January 16, 1953, 3,846 medical personnel were separated from the Veterans' Administration to enter on extended active duty with the Armed Forces. This number included 865 physicians, 91 dentists, 837 nurses, and 2,053 persons in other categories, of which numbers only 59 physicians, 23 dentists, and 88 nurses have been released and reappointed in the Veterans' Administration. The shortage of medical and other hospital personnel is not limited to those available to the Veterans' Administration hospitals but is a problem for the country at large. Merely to house patients in an institution without providing suitable and adequate treatment is not in accord with modern concepts of adequate medical and hospital care. The Veterans' Administration has no available data upon which to estimate the number of veterans who will be able to establish service connection of their disabilities under the provisions of the proposal. Payments for disability compensation range from $15.75 to $172.50 monthly under percentage gradations of disabilities from 10 percent to 100 percent, increased to a maximum of $400 as to specific serviceincurred disabilities in excess of total disability, with additional allowances for dependents in those cases where the disability is rated as 50 percent or more. Furthermore, the enactment of either bill would entitle an unknown number of dependents of deceased veterans to monthly payments of death compensation from $75 upward to widows and children and payments to dependent parents. Pension from $48 upward, depending upon the number of children, is payable in certain cases to widows and children of World War II veterans who have a service-connected disability at the time of death which would be compensable if 10 percent or more in degree but who die as the result of a non-service-connected disability. In addition to the foregoing, vocational rehabilitation (under Public Law 16, 78th Cong., as amended, and Public Law 894, 81st Cong., as amended) will be available in certain cases where service connection is established under the proposed legislation It is not possible to furnish an estimate of the cost of either bill, if enacted, because of the many unknown and variable factors. However, in the light of the above-mentioned benefits that would flow from its enactment, it is apparent that the cost would be very great. Advice has been received from the Bureau of the Budget that although there would be no objection to the submission of the proposed report to the committee the enactment of the legislation extending the period for statutory presumption of service-connected disability would not be in accord with the program of the President. Sincerely yours, CARL R. GRAY, Jr., Administrator. [No. 29] COMMITTEE ON VETERANS' AFFAIRS, HOUSE OF REPRESENTATIVES VETERANS' ADMINISTRATION, Washington 25, D. C., March 30, 1953. Hon. EDITH NOURSE ROGERS, Chairman, Committee on Veterans' Affairs, House of Representatives, Washington 25, D. C. DEAR MRS. ROGERS: This refers to your request for a report on H. R. 2468, 83d Congress, a bill to promote equal treatment for disabled veterans by providing that the increase in compensation granted by the first section of the act of May 23, 1952, shall be 15 percent in all cases, without regard to degree of disability. The purpose of the bill is to amend, retroactively, section 1 of Public Law 356, 82d Congress, approved May 23, 1952, to provide a 15-percent increase in all monthly rates of compensation for serviceconnected disability rated 10 percent to 49 percent in lieu of the 5percent increase provided by that law. Enactment of the bill would result in retroactive disability compensation payments to veterans with disabilities rated 10 percent to 49 percent, from July 1, 1952 (the effective date for the increased rates authorized by Public Law 356, 82d Cong.), based on the difference between the amount of the proposed 15-percent increase and the amount of the 5-percent increase currently authorized. Prior to the enactment of Public Law 356, the general practice and policy of the Congress was to grant compensation and increases in compensation for disabilities less than total in amounts having the same ratio to the amount provided for total disability as the degree of disability bears to total disability. Under that formula identical percentage increases were formerly granted for all basic rates of disability compensation. In connection with the change in such policy reflected by Public Law 356, the following statement of Senator George during the Senate consideration of the bill, H. R. 4394, may be pertinent: The question naturally arises, Why increase those rates by 15 percent, and increase the rates applicable to veterans who are disabled less than 50 percent by only 5 percent? We have followed in this respect the provisions of the House bill. This particular feature of the bill has the approval of the Budget Bureau. That, I think, must have had some influence on the decision of the House. However, there is this to be said—and it should be borne carefully in mind: Veterans who are disabled not more than 49 percent are able to do a considerable amount of work. They are not totally and permanently disabled. If their disability ranges from 10 percent up to 40 or 49 percent, they still may perform useful services and may contribute very largely to their own support. But a veteran who is disabled more than 50 percent, up to total disability, and who draws $150 under our present_law, is probably unable to work. He is not able to contribute to his support. In a few rare instances a veteran who is disabled, say, 55 or 60 percent, or perhaps somewhat more, may be able to make some contribution to his support. But we all know that in this present age a man who is at least 50 percent disabled has a very poor chance of obtaining employment, in the first place, and, in the second place, he labors at a very great disadvantage. So we agreed with the House on this provision of the bill, that is to say, that veterans having service-connected disability ranging from 10 to 49 percent should have an increase of 5 percent in their present compensation, and veterans who had a disability of 50 percent, up to 100 percent, should have an increase of 15 percent in the compensation which they are presently receiving (Congressional Record, April 3, 1952, p. 3422). The proposed increases in the present rates payable for disability incurred in wartime service, service on or after June 27, 1950, or while engaged in extrahazardous service are shown in the following comparative table: The rates of compensation payable for disability incurred in peacetime service are established by law at 80 percent of the wartime rates. Because of the retroactive effect of the bill, an estimate of its cost, if enacted, is presented for both fiscal year 1953 and fiscal year 1954. The estimated cost for the fiscal year 1953, most or all of which would be retroactive, is $53,232,000. The estimated cost for the fiscal year 1954 is $54,012,000. The distribution by wars of the estimated cost of the bill for each of the fiscal years 1953 and 1954 follows: |