The Veterans' Administration is not aware of any medical or other basis for a distinction between pulmonary and nonpulmonary forms of tuberculosis with respect to the statutory presumptive period for finding service connection under the Veterans Regulations. Enactment of the bill would place all tuberculous diseases on a parity for this purpose, assuming, of course, that its scope is limited to active types of the disease.

It is not possible to furnish an accurate estimate of the cost of the bill, if enacted, in view of the indeterminate factors involved. However, as the number of veterans who would benefit from the bill's enactment is believed to be relatively small, the cost involved would probably not be great.

Advice has been received from the Bureau of the Budget that although there would be no objection to the submission of the report to the committee the Bureau of the Budget recommends against favorable consideration of the bill by the committee.

Sincerely yours,

CARL R. GRAY, Jr., Administrator.

[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. Î, 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 appli

cable 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 of 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 service-incurred 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-serviceconnected 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.

Chairman, Committee on Veterans' Affairs,

House of Representatives, Washington, D. C.

DEAR MRS. ROGERS: This is in reply to your request for a report by the Veterans' Administration on H. R. 2575, 83d Congress, a bill to increase the monthly rates of disability compensation payable to veterans.

The purpose of the bill is to authorize an increase in the basic rates of compensation for service-connected disabilities (provided according to gradations of disability from 10 to 100 percent) which are payable to veterans under Public Law 2, 73d Congress, March 20, 1933, as amended, and the statutory Veterans Regulations. The so-called "statutory awards" for specific disabilities and combinations of disabilities would not be increased.

The increases proposed by the bill range in wartime cases from $3 monthly for disability of 10 percent to $15 monthly for total disability (100 percent). As peacetime rates of compensation are established by law at 80 percent of wartime rates, the former rates would also be increased. The increased rates would be effective from the first day of the second calendar month following enactment of the bill.

Disability compensation payable under Public Law 2, as amended, is available to otherwise eligible veterans who served in the Armed Forces on or after April 21, 1898. However, a substantial number of World War I veterans are in receipt of disability compensation under the World War Veterans' Act, 1924, as restored, with limitations, by Public Law 141, 73d Congress, March 28, 1934. It should be noted that the bill in its present form would not increase the basic or other rates of compensation payable to such veterans.

The monthly basic rates of compensation for service-connected disability payable to all veterans were last increased by section 1 of Public Law 356, 82d Congress, approved May 23, 1952, which authorized an increase of 5 percent for disability rated 10 percent to 49 percent and an increase of 15 percent for disability rated 50 percent to 100 percent. The percentage increases granted by Public Law 356 were applied to basic rates previously established under section 3 (a) of Public Law 339, 81st Congress, October 10, 1949, and Public Law 436, 81st Congress, October 29, 1949 (for so-called Public Law 141 cases). The rates under Public Law 339, those under Public Law 356, 82d Congress, and the proposed increased rates under H. R. 2575, 83d Congress, are shown in the following table:

The proposed rates under H. R. 2575 represent in all categories an increase of 25 percent above the rates established under Public Law 339, 81st Congress. In disability cases rated from 10 percent to 40 percent the proposed rates under H. R. 2575 represent an increase of approximately 19 percent above the present rates under Public Law 356, 82d Congress, while the rates for cases rated from 50 percent to 100 percent (total) would be increased by approximately 9 percent.

It is estimated that the bill, if enacted, would increase benefits payable to approximately 1,881,200 veterans at an additional cost for the first fiscal year of approximately $147,142,000. The distribution cost by groups of veterans affected is as follows:

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 proposed legislation, providing for a general increase in the basic rates of disability compensation, 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 service-connected disability rated 10 percent to 49 percent in lieu of the 5-percent 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 extra hazardous service are shown in the following comparative table: