VETERANS' ADMINISTRATION, OFFICE OF THE ADMINISTRATOR OF VETERANS' AFFAIRS, Hon. RALPH YARBOROUGH, Chairman, Committee on Labor and Public Welfare, DEAR MR. CHAIRMAN: This is in response to your request for a report by the Veterans' Administration on S. 1279, 91st Congress. Section 1 of the bill would amend section 610 of title 38, United States Code, to provide that any disability of a veteran who is a former prisoner of war is presumed to be service connected for the purpose of entitlement to VA hospitalization, including hospital care at VA expense in a foreign country. Section 2 would amend section 612 of title 38 to provide for a similar presumption of service connection for purposes of outpatient care. Under the existing provisions of section 610 of title 38, United States Code, the Administrator, within the limits of Veterans' Administration facilities, may furnish hospital care which he determines is needed to any veteran for a service-connected disability. Hospitalization for a non-service-connected disability, however, may be furnished only if the veteran has wartime service, or service after January 31, 1955, and is unable to defray the expenses of necessary hospital care. With certain exceptions, not here pertinent, section 612 presently provides that veterans are not eligible for outpatient treatment from the Veterans' Administration for a non-service-connected disorder unless it is associated with and held to be aggravating a service-connected condition. Statutory presumptions usually presuppose the existence of certain diseases for a period of time before symptoms or clinically demonstrated manifestations appear. A presumption of service connection for all disabilities regardless of the nature of their onset or whether from causes occurring after service, as proposed by this legislation, is not medically justifiable. The proposed legislation, therefore, presents a policy question as to how far the Government should go in treating a veteran's condition which bears no relation to his service and often occurs years after his discharge from service. In considering this question, it should be kept in mind that former prisoners of war are now given special consideration under the laws administered by the Veterans' Administration. Our regulations and directives also contain liberal provisions with respect to the claim of any such person for disabilities for the purpose of entitlement to VA benefits including medical benefits. Section 354(a) of title 38, United States Code, requires that in the adjudication of service connection for any disability due consideration will be given to the places, types, and circumstances of service. Section 354 (b) provides liberalized criteria for determining service connection of any disease or injury for those veterans who engaged in combat with enemy. Section 612 (b) (3) authorizes unlimited outpatient dental services and treatment, and related dental appliances, for any service-connected condition of a veteran who was a prisoner of war. Veterans' Administration regulations emphasizing the liberality which is accorded in prisoner of war cases include, for example, a S. Rept. 91-486 provision that the development of symptomatic manifestations of a preexisting injury or disease during or closely following a status as a prisoner of war will establish aggravation. Physical examinations of former prisoners of war are conducted with particular thoroughness to discover, if possible, all disabilities common to prisoners of war even where there has been no complaint or prior evidence of such condition, Existing instructions provide that in the evaluation of disabilities resulting from or incident to military service great weight must be assigned to imprisonment or internment under unsanitary conditions or to food deprivation in the service connection of dysentery and other gastrointestinal diseases. All of these considerations permit the Veterans' Administration to reach an equitable decision on the basis of the facts of each individual case, with any reasonable doubt being resolved in favor of the former prisoner of war. The Veterans' Administration believes that special consideration should be given to former prisoners of war and strives to assure that they receive all benefits in full measure under the law. However, we do not think that former prisoner of war status justifies a lifetime of total medical care for conditions having no relation to service. There seems little justification for giving preference solely on this basis when many who underwent comparable privations and hardships, as for example in extended combat, would not be afforded similar consideration. We estimate the cost of this proposed legislation for former prisoners of war, exclusive of persons presently held as prisoners of the North Vietnamese or listed as missing in action, would be approximately $1,017,000 for fiscal year 1970. Of this, $551,000 may be considered for inpatient care and $466,000 for outpatient care. Similar costs could be experienced for each succeeding year through fiscal year 1974. For the reasons indicated above and since we believe that liberal treatment is already being accorded former prisoners of war under existing laws and procedures, the Veterans' Administration recommends that S. 1279 not be favorably considered by your committee. We are advised by the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the administration's program. Sincerely, Hon. RALPH YARBOROUGH, DONALD E. JOHNSON, VETERANS' ADMINISTRATION, Chairman, Committee on Labor and Public Welfare, DEAR MR. CHAIRMAN: On July 17, 1969, the Chief Medical Director of the Veterans' Administration testified on several bills before the Subcommittee on Veterans' Affairs of your committee. One of these proposals is S. 1279, which would provide that any disability of a veteran who is a former prisoner of war would be presumed to be service connected for purposes of hospitalization and outpatient care. During the hearing the subcommittee chairman asked for the Veterans' Administration's position assuming S. 1279 were amended in S. Rept. 91-486 committee to provide for a rebuttable presumption of service connection for the purpose of these medical benefits. In our July 17, 1969, report on S. 1279 we stated that a presumption of service connection for all disabilities, regardless of the nature of their onset or whether from causes occurring after service, is not medically justifiable. We intended that view to be applicable to chronic diseases having an insidious onset as well as to acute conditions of infectious or traumatic origin and chronic disabilities of intercurrent infectious or traumatic origin. The expiration of a period of time, which is usually computed in terms of years, between an experience and the manifestations of symptoms of unknown pathogenesis would ordinarily rebut any concept of etiological relationship. Making the presumption rebuttable would, therefore, categorically negate the effect of the proposed law where there has been a substantial lapse of time. We are also gravely concerned lest the grant of a rebuttable presumption of service connection for medical benefits would provide a precedent for demands by former prisoners of war or other groups for expansion of the presumption to cover claims for compensation or other benefits. An extension of medical benefits to former prisoners of war for virtually all disabilities on the basis of a rebuttable presumption would tend to destroy the meaning of the term "service connection". Since its inception, this term has had a special meaning which has rarely been diluted. We strongly recommend against any further inroads on the fixed and accepted concept of service connection. We are unable to estimate the benefit costs if such an amendment were enacted into law. The administrative cost would be approximately $215,000 annually. For the reasons stated, I am unable to recommend favorable consideration of this alternative proposal. We are advised by the Bureau of the Budget that there is no objection to the presentation of this report from the standpoint of the administration's program. Sincerely, DONALD E. JOHNSON, Administrator. CHANGES IN EXISTING LAW In compliance with subsection (4) of rule XXIX of the Standing Rules of the Senate, changes in existing law made by the bill, as reported, are shown as follows (existing law proposed to be omitted is enclosed in black brackets, new matter is printed in italic, existing law in which no change is proposed is shown in roman): S. Rept. 91-486 602. Presumption relating to [psychosis] certain disabilities. § 602. Presumption relating to [psychosis] certain disabilities (a) For the purposes of this chapter, any veteran of World War II, the Korean conflict, or the Vietnam era who developed an active psychosis (1) within two years after his discharge or release from the active military, naval, or air service, and (2) before July 26, 1949, in the case of a veteran of World War II, or February 1, 1957, in the case of a veteran of the Korean conflict, or before the expiration of two years following termination of the Vietnam era in the case of a Vietnam era veteran, shall be deemed to have incurred such disability in the active military, naval, or air services. (b) For the purposes of this chapter, the disability of any veteran of a war or of service after January 31, 1955, shall be deemed to be serviceconnected if (1) there are no medical records available to the Veterans' Administration for the period of such veteran's active military, naval, or air service; (2) there is no medical record available to the Veterans' Administration for such veteran showing the results of any physical examination which was required by law or regulation, in effect at the time of such veteran's discharge or release from active duty, to be given members of the Armed Forces immediately prior to discharge or release from active duty; or (3) for any period of time during his active military, naval, or air service such veteran (A) was held as a prisoner of war, or (B) while in line of duty was forceably detained or interned by a foreign government or power; unless the Administrator can show by clear and convincing evidence that such disability was not incurred in or aggravated in line of duty by such veteran while serving in the active military, naval, or air service. * о S. Rept. 91-486 Mr. CRANSTON, from the Committee on Labor and Public Welfare, submitted the following REPORT [To accompany H.R. 11959] The Committee on Labor and Public Welfare, to which was referred the bill (H.R. 11959) to amend chapters 31, 34, and 35 of title 38, United States Code, in order to increase the rates of vocational rehabilitation, educational assistance, and special training allowance paid to eligible veterans and persons under such chapters, having considered the same, reports favorably thereon with an amendment in the nature of a substitute and a title amendment and recommends that the bill as amended do pass. COMMITTEE AMENDMENTS The amendments are as follows: Strike out all after the enacting clause as follows: That section 1504(b) of chapter 31 of title 38, United States Code, is amended to read as follows: "(b) The subsistence allowance of a veteran-trainee is to be determined in accordance with the following table, and shall be the monthly amount shown in column II, III, or IV (whichever is applicable as determined by the veteran's dependency status) opposite the appropriate type of training as specified in column I: 35-475 0-69 -1 |