at we, in the Board of Veterans' Appeals, are not in disagreement the concepts that the chairman of the committee expressed in etter coming to us, as to what is a proper finding of fact and usion of law. This is what we are endeavoring to do in all of our

ond, we furnished you with a copy of the published guidelines we have for our people to follow.

. KORNEGAY. But in this particular case, Mr. Stancil, there are utely no findings of fact or conclusions of law.

. STANCIL. No, that was deficient in that regard. The only that I can say in its defense is that it did incorporate, by refe, a prior decision.

reading the two together the picture is a little bit better, but it vas an inadequate decision from that standpoint.

. KORNEGAY. Were there findings of fact and conclusions of law ⇒ prior decision?

I

.STANCIL. I do not know whether it was written before we ed writing decisions in that format or not, Mr. Kornegay. scertain that when I get back to the office.

. GLEASON. Mr. Kornegay, by my previous statement I did not to imply that there would not be times in the future when such occurrence as this might not occur.

mean, everything is of a human element, and this could well be, my basic philosophy, Congressman, is that this committee, doing what you are doing right now, can exercise greater control over proper administration of the Board of Veterans' Appeals than if re an independent court.

r. KORNEGAY. We do not want control over the Board.

r. GLEASON. Well, I know, and I did not mean "control" in that

T. KORNEGAY. Well, I understand that, but let me go on. ow, Mr. Administrator, Public Law 87-666 requires that the ant be furnished a brief statement of the facts and the law icable to the case under appeal.

Ou now favor this law, judging from your statement on page 14r. GLEASON. Yes, sir.

r. KORNEGAY (continuing). Yet under date of May 25, 1961, you sed the chairman of the committee that "weighing all factors, we ot if the procedure here proposed would be sufficiently beneficial stify its adoption.

der the circumstances we are unable to recommend favorable consideration.

o you still oppose this procedure or does the Veterans' Adminison and its officials, charged with the administration of this act, erely believe in this new law and are they making an effort to see - it works?

[r. GLEASON. Well, Mr. Kornegay, of course this is a tremendous inistrative burden and, of course, this happens out in the field. his is not a direct result of the Board of Veterans' Appeals itself. Ir. KORNEGAY. This is in the regional offices?

Ir. GLEASON. That is right, and the only thing I can say, which I mpted to say earlier, Congressman, was that 2 years ago I cerly did not know as much about the Veterans' Administration as I w today, and we all learn by experience.

experience I have gained these past 2 years, I would definitely favor it. Mr. KORNEGAY. All right, sir.

Now, Public Law 87-671 permits the use of independent medical experts by the Board of Veterans' Appeals.

At the time that you formerly reported on this matter, on April 5, 1961, you urged that favorable action be deferred until the completion of a small pilot project on the subject.

As the bill passed the House, it was made mandatory that the Veterans' Administration accept the finding of the independent medical expert.

You thereafter informally advised that you would not object to the enactment of this proposal if it were made optional and not binding upon the Veterans' Administration.

Do you plan to fully utilize the powers authorized by Public Law 87-671

Mr. GLEASON. I already have, Congressman.

Mr. KORNEGAY. Let me finish the question.

And may this committee expect that the views of independent medical experts will be adhered to or will they be disregarded?

Mr. GLEASON. It will certainly be adhered to, Congressman, and I think that many of the members of this committee know that I have pursued this point.

Mr. KORNEGAY. Now, in that connection, that is with reference to the independent medical expert, I have a letter here from the Veterans' Administration, in the form of a report, which reports the results of a survey which was made by the Veterans' Administration.

As I understand it, they picked 30 cases which had been denied. And these 30 cases were submitted to both the independent medical experts and the Department of Medicine and Surgery of the Veterans' Administration.

In 15 of those cases both the IME and the Chief Medical Director opinions were unfavorable.

In seven cases the IME and the CMD opinions were favorable to the claimant.

And in three cases the IME was favorable and in four cases the CMD was favorable; the other case was unfavorable, and there was a split opinion on it.

In other words, in 7 out of 30 there was unanimous agreement among the medical authorities, and on another 7 there was a split opinion.

That totals 29 cases and one apparently is still outstanding.

So there you have 29 cases that had been denied, as I understand it, by the Board of Veterans' Appeals and here are the medicalMr. GLEASON. That was not 29 denied by the Board of Veterans' Appeals though.

Mr. KORNEGAY. What did you say?

Mr. GLEASON. That was not 29 denied by the Board of Veterans' Appeals, though.

Mr. KORNEGAY. Well, who were they denied by?

Mr. STANCIL. That was the test, I believe, that was conducted while you were considering the independent medical expert law, and cases were put into this test procedure by both the department of Veterans' Benefits and the Board of Veterans' Appeals, the greater

er coming from the Compensation and Pension Service in the rtment of Veterans' Benefits.

Ose cases, which were submitted to the Chief Medical Director o the independent medical expert from the Board of Veterans' als, were cases that came up on regular appeals, not cases that ad previously denied.

. KORNEGAY. In other words, they were referred out before you I them and passed on them?

. STANCIL. That is right, with the exception, I believe, of some cases or so that the committee specifically requested be included e study that did constitute cases previously denied by the Board, he bulk of them were cases coming up for consideration either e Compensation-Pension Service or in the Board of Veterans' als at the time that the test was conducted.

. KORNEGAY. They had, of course, been denied in the regional s?

. STANCIL. In the field offices, yes, sir. At least those coming e the Board of Veterans' Appeals had been denied in the regional

S.

nceivably, the others could have been up for advisory opinions had had no action taken on them.

. CLEASON. But they had not been denied by the Board of als.

r. KORNEGAY. Well, I stand corrected on that.

r. GLEASON. Congressman, may I ask: Would you read me the ses again, as to who had approved, the IME, as compared to the f Medical Director?

r. KORNEGAY. The IME and the Chief Medical Director both ered unfavorable opinions in 15 cases.

he independent medical expert and the Chief Medical Director ered favorable opinions in seven cases.

he IME was favorable and the CMD was unfavorable in three s, and the CMD was favorable and the IME unfavorable in four

e cases.

r. GLEASON. Well, now, may I take it in the reverse order, gressman?

the four cases that the Chief Medical Director was favorable we do not have to go to an IME if the Chief Medical Director rendered a favorable decision.

at stops it right there.

ow in the three cases that the Chief Medical Director was unrable and the independent medical expert rendered a favorable sion, this, of course, overruled the Chief Medical Director.

n the seven, where they were both favorable, there was no need o to an IME because the Chief Medical Director had already l favorably.

Ir. KORNEGAY. So that gives you 14 of the 29 cases.

Ir. GLEASON. Well, it just leaves 3 actually out of the 29, Consman, that had to be forwarded to an independent medical

ert.

Ir. KORNEGAY. Well, of course, this is――

Ir. GLEASON. There was no benefit gained at all

Ir. KORNEGAY. This was a study made?

Ir. GLEASON. Yes.

Mr. GLEASON. That is right, but out of the 29 though-I would just like to point out that out of the 29 only 10 percent of them really could have benefited by going to an independent medical expert. All the others would have benefited automatically just through the Chief Medical Director.

Mr. KORNEGAY. Except those 15 that were turned down by both? Mr. GLEASON. Well, this you see, there was no benefit gained by going-I do not quite make myself clear

Mr. KORNEGAY. Yes, I understand.

Mr. GLEASON. There was no beneficial gain to the individual veteran by going forward. I mean, we gained in the knowledge that we were sustained by independent medical experts with the decision of the Chief Medical Director but, actually, the veteran himself did not gain except in 10 percent of the cases under study.

Mr. KORNEGAY. I see your point there, Mr. Administrator.

Now, let me ask you this: Have these cases been passed on by the Board of Veterans' Appeals now?

Mr. GLEASON. I really cannot tell you.

Mr. STANCIL. You are still talking about

Mr. KORNEGAY. Yes, sir; these 29 that we have the figures on. Mr. STANCIL. A certain number of them, yes. All of those that were before the Board then, plus those in which appeals were subsequently filed, would have been decided by the Board.

I anticipate your question perhaps I do not have the answer as to what happened to that specific group. I could probably get it.

Mr. KORNEGAY. Well, I do not know whether you can answer this or not, Mr. Stancil, but let me ask it anyway. In this group, where there were favorable opinions from both the IME_and_the CMD or one or the other, were awards made by the Board of Veterans' Appeals?

Mr. STANCIL. I would have to check the specific list of cases, but my impression is that the answer to your question is "Yes."

I remember one specifically where the Chief Medical Director and the independent medical expert were in conflict in which an allowed decision was written.

This is the only one that specifically comes to my mind of having reached us with that conflict. But I would believe, assuming the medical opinion was based on the complete record, that a favorable opinion from an expert of that caliber would create a reasonable doubt at least, if not a certainty, even though there might be a conflict in medical opinion.

COUNSEL. Mr. Chairman, if I may

Mr. DORN (presiding). Mr. Patterson.

COUNSEL. The whole purpose of the law under discussion is to encourage independent medical review. It is of no significance, Mr. Gleason, whether these cases were denied in the Board of Veterans' Appeals or by a regional office. The important thing is and was that they were denied. As you know, cases which are decided in the field and in the Board of Veterans' Appeals do not automatically go to the Chief Medical Director for review. The purpose of this law is to permit such a review by an independent medical expert where it is requested and where you or your representative agrees to such a review.

e cases involved in the study to which reference has been made, selected by the VA or were submitted at the request of individual pers of Congress or at the specific request of the chairman of this ittee. In many instances, the Board of Veterans' Appeals has reluctant and, in at least one case I can recall, refused to submit dical question to the Chief Medical Director for appraisal; the on of the Board being that its physicians were sufficiently well fied to make the decision.

gardless of what interpretation may be placed upon the results e study, the fact remains that in a minimum of three cases the has made a favorable ruling. I assume a favorable decision will ade to the veteran. This may represent only 10 percent out of O cases under your interpretation. I submit, Mr. Administrator, this is highly significant and particularly so in view of the large ber of cases decided by the Board of Veterans' Appeals.

. GLEASON. That is right.

t, Mr. Chairman, since we have had this law, and the discussion ar ago about it, the Administrator has not been reluctant

-soever.

e case can always be appealed to the Administrator for final ion and the Administrator has never been reluctant to engage Dendent medical experts on any requested.

r. DORN (presiding). Mr. Kornegay, any further questions? T. KORNEGAY. Yes, sir.

r. DORN. Go ahead.

r. KORNEGAY. In the latter group here, Mr. Stancil, would the ts of those four cases, that is where the Chief Medical Director - a favorable opinion and the independent medical experts gave infavorable opinion, would that create some dilemma for the d of Veterans' Appeals?

r. GLEASON. Well-if I might interrupt-they never would have ordinarily to the independent medical expert because once it was d favorably by the Chief Medical Director

r. KORNEGAY. That would stop right there in the ordinary course ases, I understand that, but I was thinking about these four cases

[r. DRIVER. What he said about the other cases would seem to ly to these, too.

Ir. STANCIL. I think one thing needs to be said about this.

ou assign the case to the Chief Medical Director or the indedent medical expert because you desire or need, in a case, expert lical opinion evidence

Ir. KORNEGAY. Yes, I was just thinking about these four cases that you were using in your study.

Mr. STANCIL. My impression is that if they had favorable medical nions on the crucial point, that the cases were paid.

Mr. KORNEGAY. Now, in the field of Government insurance, Mr. ministrator, we do have judicial review, in a certain sense, and t is

Mr. GLEASON. Well, that is on contracts.

Mr. KORNEGAY. Yes, that is right; on contracts.

Mr. GLEASON. But not on claims.

Mr. KORNEGAY. No, not on claims, but on the contract itself.