the diognosis at the time of the first attack. The definition of the disease presupposes that there will be remissions and exacerbations. Many physicians, therefore, consider it unwise to make a definite diagnosis at the time of the first attack, and prefer to wait until evidence of new lesions develop. I do not believe it is possible to set any definite limit of time for the diagnosis of multiple sclerosis. Sincerely yours, H. HOUSTON MERRITT, M. D. NEW ENGLAND CENTER HOSPITAL-PRATT DIAGNOSTIC CLINIC, Mr. JOHN W. BILL, Disabled American Veterans, Newark, N. J. DEAR MR. BILL: The delay in answering your letter has been a measure of the amount of work that I must do in the busy days of winter and spring. I am entirely in agreement with your concept that the initial attack of multiple sclerosis may appear under other guises and there may be many years intervening between the initial attack and subsequent difficulties. It is also true that the initial incident is misdiagnosed in a great proportion of instances. I am sure that in my own practice I have seen patients in whom the initial attack may well have occurred during service but went unrecognized. Sincerely, Mr. JOHN W. BILL, JOHN F. SULLIVAN, M. D. UNIVERSITY OF CALIFORNIA MEDICAL CENTER, National Service Officer, Disabled American Veterans, National Service Office, VA Regional Office, Newark, N. J. DEAR MR. BILL: I respond to your letter of November 19, addressed to Dr. Gustave S. Ross. I presume that this refers to me. It is noted that your organization is “endeavoring to have the law amended or so worded that veterans suffering from multiple sclerosis could establish their claims within at least 5 years." I find this a most difficult kind of a question to answer and do not believe that you should take my statements as being authoritative. I am willing to give you the following opinion: Multiple sclerosis is an intermittently progressive disorder of the nervous system affecting young adults and causing varied degrees of disability and invalidism. There are no known causes and there is no known treatment. There is no reason to believe that service in the Armed Forces is any more provocative or injurious than activities in civilian life. Insofar as I know, there never has been established a definite relationship between any case of multiple sclerosis and any definite activity on the part of the patient. There are a large number of veterans who have multiple sclerosis, some who developed it in service and some of whom developed it after being discharged from the service. If a person develops multiple sclerosis after discharge from the service, no medical data can be brought which would convincingly show that the attack of multiple sclerosis was due to any activity while in the service. Under the existing laws, as I understand, the veterans receive Federal compensation for a large number of physical conditions which are not legitimately attached to service in the Armed Forces, because the law is written in such a way to have them compensated if the physical disability occurs within some temporary relationship to the service. If the Federal legislature, in its political wisdom, is willing to accept this kind of a response, then of course multiple sclerosis should also be included. On the basis of my professional beliefs, the law as it is now written―occurring within 3 years seems reasonable to me. I do not believe that a person whose first attack of multiple sclerosis occurred 5 years after discharge from the service should be compensated on the assumption that the nervous system disorder was in any way induced by activities in the Armed Forces. It is correct, however, to say that there may be as long as 5 to 7 years between recognizable attacks in the early phase of multiple sclerosis. Recognizing that this is not the kind of information that you desire, I nevertheless submit it for your consideration. Sincerely yours, AUGUSTUS S. ROSE, M. D., Professor of Medicine (Neurology). THE UNIVERSITY OF CHICAGO, Mr. JOHN W. BILL, DEPARTMENT OF MEDICINE, National Service Officer, Disabled American Veterans, VA Regional Office, Newark, N. J. Dear Mr. BILL: Your letter to the chancellor of the University of Chicago concerning the diagnosis of multiple sclerosis has been referred to me for an answer. I can say that in my experience, it is often difficult and sometimes impossible to make a diagnosis of multiple sclerosis with assurance in the early stages of the disease. Yours very truly, JOHN W. BILL, RICHARD B. RICHTER, M. D., THE NEW YORK TIMES, National Service Officer, National Service Office, VA Regional Office, Newark, N. J. MY DEAR MR. BILL: I have now received your letter of January 3 with a copy of your letter of November 20 which I had not seen before. I have read your letter with interest but I do not believe I could make a statement to support your contention regarding that "it is humanly impossible to diagnose multiple sclerosis." First, I am not a neurologist and such a statement would fall within the province of that medical specialty; second, it would be inappropriate for me to make such a statement for use in supporting Federal legislation since I am consultant to the Veterans' Administration, Office of Vocational Rehabilitation and several other Federal agencies. Sincerely, Mr. JOHN W. BILL, HOWARD A. RUSK, M. D. MONTEFIORE HOSPITAL, New York, N. Y., September 3, 1957. Disabled American Veterans, Newark, N. J. DEAR MR. BILL: I have your letter of July 26 in which you solicit my comments regarding multiple sclerosis. The diagnosis of multiple sclerosis is sometimes difficult and in some instances cannot be made with certainty until the patient has been observed for monthsor even years. This, however, does not affect the establishment of service connection for afflicted veterans provided that symptoms which in retrospect were those of multiple sclerosis had their onset during service or within 2 years following discharge. Presently, then, the establishment of service connection is a problem only for those veterans whose symptoms had their onset in excess of 2 years following discharge from the Armed Forces. Revision of the present rule to allow presumption of service connection if the onset is in excess of 2 years after discharge is not justified on medical grounds, in my opinion. It is regrettable indeed that the cause and cure of multiple sclerosis are at present unknown to us. I have every confidence that both of these problems ultimately will be solved and investigation in a number of centers are working to this end. Treatment of patients must of necessity be limited to those symptoms which are aided by medications or physical measures and often considerable relief can be afforded in specific instances. I trust that the foregoing will be of some value to you and if you have other questions concerning this problem, I shall be happy to attempt to answer them. Cordially yours, TIFFANY LAWYER, Jr., M. D. Mr. JOHN W. BILL, THE NEW YORK HOSPITAL, Disabled American Veterans, National Service Officer, Newark, N. J. DEAR MR. BILL: This will acknowledge receipt of your letter of August 19 with reference to the problem of the diagnosis of multiple sclerosis. I have read the various opinions offered to you, and I am essentially in accord with that expressed by Dr. Houston Merritt, with minor changes. One cannot state with certainty the length of time between the onset of multiple sclerosis as a disease process and the earliest possible moment at which a diagnosis of multiple sclerosis can be made. In the majority of patients the nature of the symptoms at the onset and the characteristic remissions and exacerbations, make it possible to establish the diagnosis within a relatively short period, that is, within less than 2 years. In other cases, the symptoms may be of a minor nature, may clear up rapidly, and may not be followed by new symptoms, or evidence of new lesions in the nervous system, for a period of several to many years. A competent neurologist can usually make the diagnosis at the time of the first attack. The definition of the disease presupposes that there will be remissions and exacerbations. Many physicians, therefore, consider it unwise to make a definite diagnosis at the time of the first attack, and prefer to wait until evidences of new and multiple lesions develop. As regards the service connected aspect of mu'tiple sclerosis, it is my opinion that such service connection must depend upon evidence that the patient had one or more symptoms or signs of multiple sclerosis during the period of his military service, whether or not at that time these manifestations were recognized as those of multiple sclerosis by his military physician. Sincerely yours, HAROLD G. WOLFF, M. D. Professor of Medicine (Neurology), Cornell University Medical College. GEORGETOWN UNIVERSITY MEDICAL CENTER, JOHN W. BILL National Service Officer, VA Regional Office, 41 Central Avenue, Newark, N. J. DEAR MR. BILL: In reply to your letter of March 12, I have discussed this matter with the members of my department, particularly those who are most interested in the problems of multiple sclerosis, and the following is a résumé of our feelings in this matter: The medical association opposed a similar bill in the 2d session of the 84th Congress, 1956. The idea of presumption is illogical on two grounds: (a) It assumes that the disease can be present for many years without any objective or subjective signs or symptoms. This is not acceptable reasoning. If the presumptive period is increased, all ex-servicemen who have had no sign of disease in the service and who sub`equently develop multiple sclerosis will be included, since they will fall into the age group of highest incidence of the disease. (b) It will still not necessarily include all the cases of multiple sclerosis, since long remissions, even as long as 5 years are possible. It is agreed that something should be done to give a fair consideration to those who have mild signs and symptoms of multiple sclerosis in the service, but it seems a more realistic solution to the problem would be: 1. To see that men in the service are advised to report promptly any ailments so that it appears on their medical records and can be referred to later if necessary after discharge. 2. That review boards be set up so that cases can be analyzed by neurologists. In most of the cases where an injustice exists it came about from review boards refusing or failing to correctly analyze information at their disposal. Veterans review boards should be made up of specialists in various fields to review cases in their fields. It is erroneous to suggest that 5 to 7 years are needed to make a diagnosis of multiple sclerosis. While it is true that many cases are not definitely diagnosed for several years, nevertheless, the presumptive diagnosis is often made at the time of the first symptoms. With the increased use of special spinal fluid tests, the diagnosis can be presumed in about 75 percent of the cases as early as the first week of the disease. Therefore the answer is not to increase the presumptive period, but to fight for adequate and competent review boards, Veterans' Administration or civilian. To be sure that inductees are prompt to report illness and that adequate records which can be referred to later are kept by the military installations. I sincerely hope that this is of help to you. FRANCIS M. FORESTER, M. D. TESTIMONY OF HON. ROBERT H. MICHEL ON H. R. 4214 Mr. Chairman and members of the committee. At the very outset, I should like to thank you for scheduling a hearing on H. R. 4214, the bill I introduced to provide additional compensation for veterans having the service-incurred disability of deafness of both ears. Some time ago, I met a young man who belongs to the same Disabled American Veterans chapter to which I belong in Peoria, Ill., and I was astonished to learn from him through our conversation that even though suffering from a complete loss of hearing as a result of his war service, he was not receiving a statutory disability award. This young man was exposed to considerable gunfire and the noise of aircraft. There was no history of ear disease nor associated illness before his entry into the service. This young man has been examined by the best qualified doctors in the country on ear disease, including Drs. Walsh, Rosen, and Shambaugh. Dr. Morris H. Cohen, of Peoria, who was also treating the patient, indicates in a letter to the DAV-which, incidentally, I should like to have included with my testimony-that the boy has "total disability of both ears." I have been advised "off the record" that our pilots are under constant danger of incurring similar disability because of the noise produced by our jet engines. I am sure we all realize that the Air Force or any other branch of service would not submit a statement emphasizing the danger of a particular assignment even though it be obviously hazardous duty. Because it is obvious, there is no need to advertise the point, but each man takes a calculated risk and I think we ought to take a look into the periscope and provide for the future of those who might likewise suffer complete loss of hearing as a result of their service. The case of the young man in my district is not an isolated one. Since introducing this legislation, I have received a number of letters from veterans in all sections of the country who are suffering from complete loss of hearing and who have urged me to press for favorable consideration of my bill. I am sure the chairman and the distinguished members of this committee have received communications from those individuals and veterans' organizations seeking passage of H. R. 4214 and the companion bill in the Senate, S. 1611. Incidentally, Mrs. Eleanor Roosevelt devoted her nationally syndicated column of February 13, 1958, to this measure. Subparagraph (k) of paragraph II, part I, Veterans Regulation Numbered 1 (a) as amended, states, if the disabled person, as the result of serviceincurred disability, has suffered the anatomical loss or use, in varying degrees, of various body organs and appendages, the rate of compensation shall be increased by $47 per month for each such loss or loss of use, but in no event to exceed $420 per month. It seems only logical and fair that this same rate should be applied to the compensation given to veterans having the serviceincurred disability of deafness of both ears since we are giving it to those who have injured their creative organs, feet, hands, eyes, and buttocks. To my mind, complete loss of hearing is just as tragic a loss as the aforementioned disabilities, and I sincerely hope the committee will give favorable consideration to this measure and report it to the House. Re Richard Moss. DISABLED AMERICAN VETERANS, 704 Commercial National Bank Building, PEORIA, ILL., December 31, 1956. Peoria, Ill. GENTLEMEN: This patient has requested that we forward the results of a recent examination to you. Mr. Moss was seen in my office on December 5, 1956, with a history of progressive hearing loss first noted while in service in World War II. There is a history of exposure to gunfire and the noise of aircraft. There was no other history of ear disease nor associated illness which might account for the hearing loss. The patient has been seen by some of the best authorities in the country on ear disease including Drs. Rosen, Walsh, and Shambaugh, all of whom have advised the patient that there is no therapy of value. It is obvious that the patient does not accept this conclusion, and is constantly seeking some help as these patients in desperate circumstances sometimes do. In talking to the patient it was evident that he was lip-reading and using the speech of someone with severe nerve deafness with its peculiar monotone. Physical examination from an ENT standpoint was not remarkable. Functional tests with tuning fork and audiometer revealed total loss on the right with questionable hearing on the left with reading around 100 db. for air conduction in that ear. I must conclude that this patient has a profound deafness which if my findings are correct would give him total disability in both ears. There is present a peculiar personality makeup which I mention because of the possibility of functional aspects to the hearing loss. While I do not believe at this moment that this patient is malingering, I do feel compelled to mention this possibility because of the peculiar personality involved. I would strongly recommend that this patient be reexamined by one of the men mentioned above so that they may compare the present findings with the previous examination and also to consider the possibility of functional loss as mentioned. Very sincerely yours, MORRIS H. COHEN, M. D. Mr. DORN. We are delighted to have with us this morning our distinguished colleague from Colorado and member of this committee, Mr. Aspinall. STATEMENT OF HON. WAYNE N. ASPINALL, A UNITED STATES REPRESENTATIVE FROM THE STATE OF COLORADO Mr. ASPINALL. Mr. Chairman, first I wish to thank you personally for permitting me to make my statement this time this morning in order that I may get to another committee. I appreciate the opportunity to appear today in support of my bill, H. R. 9896, which I introduced early in this session at the request of the American Legion. I would like to add, Mr. Chairman, I have been a member of the American Legion since early 1919, being a charter member of Lincoln Post No. 50, Department of Colorado. The bill seeks to provide that the disease of multiple sclerosis shall be presumed to have been incurred or aggravated in the service if it is diagnosed within 3 years of the date of discharge of the veteran. The present law on this subject is 2 years, and this 2-year provision was provided several years ago after this committee had made a rather full study of the disease of multiple sclerosis and had obtained considerable testimony from officials of the Public Health Service. This disease, Mr. Chairman, is one of the most difficult diseases to diagnose. Medical sicence had made great strides and all of us acclaim the progress which has been made. However, because of difficulties inherent in diagnosing multiple sclerosis I think the Congress is fully warranted in extending the presumptive period for 1 additional year. I think it should be borne in mind, too, that the basic premise of veterans' laws is that doubt should be resolved in favor of the veteran and in such a serious disease as this certainly it is better to err on the side of generosity than to be too restrictive in application of the law. The second disease covered by my bill is officially described as chronic functional psychoses. The present limitation on this disease |