he was not able to support his family. He had to leave the hospital over the protest of the doctor, in order to try to make a living for his family.

General HINES. I can readily understand, Congressman, where there will be individual cases that seem to point to a decided hardship. I have no suggestion to cure that, unless you desire to open it wide and take in all cases.

Mr. MILLIGAN. Or you might allow him to take treatment and provide some compensation.

General HINES. Yes, that might meet the situation. I have had cases come to my attention-not necessarily misconduct cases, but under the general provisions of the bill-where a man needed hospital care and we were ready to give him that care, but he was in just exactly the position of the man to whom you refer. He could not afford to leave his family long enough and to stay away from his work long enough to take treatment.

Mr. MILLIGAN. The doctor told me that he thought he could bring this man around in good shape if he could get him to take proper

treatment.

The CHAIRMAN. You are referring to cases not connected with the service, however?

General HINES. Yes. I am referring to the general provisions of the act which offers hospitalization to all men.

Mr. BULWINKLE. What about this amendment on page 13? It reads:

Provided further, That when an ex-service man is shown to be suffering with a chronic disease which good medical judgment indicates was incurred or aggravated in the service, such chronic disease shall be held to be of service origin or aggravation, notwithstanding the lack of historical affirmative evidence.

General HINES. That, in effect, gives the bureau medical service a greater discretion in some cases where there is great difficulty in getting a connected medical history. The bureau is in favor of that. Mr. MILLIGAN. In some of these cases, General, it is an impossibility to get a medical history.

General HINES. Yes. I feel that while that provision may increase materially the expense, it is a fair provision, because of all cases we find that it is practically impossible to connect by tracing the medical history, but in the judgment of the doctors, if you left it to their judgment, they would be unanimous in saying that you could safely charge it to the service.

Mr. BULWINKLE. Don't you think that the word "good" should be changed to the word "competent "?

General HINES. Yes; I think that would be a good change.

Mr. SWEET. Would this cover cases where an examination on discharge did not develop the existence of any trouble?

General HINES. Yes; if a later examination should show a disability, and the judgment of the doctors was to the effect that it was of service connection, it would be covered by this provision.

Mr. SWEET. Isn't the point in question the one I gave to you the other day?

General HINES. Yes; the case you had the other day would fall under this provision.

Mr. MILLIGAN. As I understand it, the bureau did not approve the amendment in the first section, striking out that provision. General HINES. No; we are not in favor of that.

Mr. SWEET. You mean on page 12?

Mr. MILLIGAN. Yes.

Mr. HAYDEN. You mentioned the Comptroller before. With reference to the provision on page 13, if you inserted the word "competent" or "good," don't you think he might raise the issue as to whether it was competent?

General HINES. I doubt if he would raise that issue, and if he did I believe we would win on that.

Mr. BULWINKLE. I have thought that you could save trouble by striking the word out entirely.

General HINES. I think "competent" would be a better word. You agree with that, Colonel Miller?

Colonel MILLER. Yes; I think that is better.

Mr. SWEET. Why qualify it at all? Why not leave it "medical judgment"? A man is assumed to have been qualified by his examination and his certificate to practice. Why not say "medical judgment"?

Mr. HAYDEN. If you handle it that way you might say "within the judgment of the medical officer of the bureau."

The CHAIRMAN. I would say that I think there is no question that the phraseology might be improved, but a subcommittee will have eventually to take this anyway, and, working with the bureau, will probably insert the proper phraseology.

Mr. BULWINKLE. If you have an outside doctor, you are going to need the word "competent," but if you have a bureau doctor, you can leave it out.

General HINES. If you had no qualifying word there, if the case happened to be connected and the medical judgment was poor, unless you had some qualifying word, either "good" or "competent," you could not break the connection. In other words, any kind of medical judgment would connect it, and the bureau would have to abide by that ever afterwards.

Mr. ČONNERY. Is it not hard enough to get the doctors to give us any medical judgment on these service connected cases now?

General HINES. You would not want me to agree entirely with that, because we have many doctors who work very hard to connect these cases.

Mr. MILLIGAN. Would not the presumption be that if there is the medical opinion of a doctor in the bureau, it would be a good medical judgment?

General HINES. Yes. But we do use at times other doctors.

Mr. BULWINKLE. There may be some civilian medical judgment. Mr. BROWNING. General, under this provision as drawn here, would the bureau physicians have the authority to determine whether the outside doctor who made the connection was a good medical authority or not?

General HINES. No; they would not. They could not question the standing of an outside doctor. They might question the exercise of the judgment. The question of service connection, however, would not be decided by an outside physician. The good medical judgment referred to is that of bureau physicians.

Mr. MILLIGAN. As I understand it, this would not be for the purpose of accepting the judgment of some outside doctor, but the opinion of the doctor in the bureau?

General HINES. It will be to accept the medical judgment of the boards that are designated to make those examinations. In some cases where boards are in localities where we do not have at all times a full-time specialist, but a man who serves when a case that requires a specialist comes up, those men would be members of the board. But I feel that in all those cases they are selected with such care that you would be safe in saying that their judgment is correct.

Mr. BROWNING. This provision would not allow a man to make out a case by his family physician?

General HINES. No.

Mr. CONNERY. General, on page 12, do I understand that the bureau wants that provision left just as it was in the law, with reference to willful misconduct?

General HINES. Yes, sir; I feel that section 200 as it now stands. should be left so.

Mr. LUCE. Is this provision retroactive?

General HINES. Yes; it would be retroactive as written.

Mr. LUCE. Have you any estimate of the cost?

General HINES. We estimate as best we can. It is a difficult thing to estimate the additional cost, but our estimate of all diseases and conditions included is $12.224,000 a year additional. This figure, of course, is a maximum one.

Mr. BROWNING. It would not be retroactive as to payments, would it?

General HINES. No; I think it would be retroactive up to the restrictions made by the existing provisions on retroactive payments. Mr. MILLIGAN. General, referring to page 12, would the bureau object to that section providing that constitutional lues be included with the ones enumerated there?

General HINES. If you do that, you may as well open it all up, because the definition of constitutional lues is very broad.

Mr. MILLIGAN. I do not think it is so very broad. It refers to a specific and definite disease.

General HINES. But it includes practically all the misconduct diseases, or could include them all. I am afraid the bureau would have to recommend against that.

The CHAIRMAN. If there are no further questions, we will proIceed to section 6.

General HINES. Section 6 eliminates the provision that the dependency of the father and mother must arise within five years after the death of the person.

This amendment is proposed by the American Legion. The bureau finds that 5,809 claims in all were disallowed because no dependency could be shown.

There are no figures available as to the number of claims disallowed because dependency did not arise within five years after the soldier's death.

1

I am not familiar with the principal reasons that caused the Legion to pass that resolution. I have a feeling that five years is a reasonable time in which to show dependency, although I can

readily understand how there would be cases, probably meritorious cases, where such a showing could not be made in five years.

The bureau has not had called to its attention, so far as I know personally, any great number of cases of hardship which have arisen under the present law.

Unless there is a showing of great injustice being done in a material number of cases, I would recommend against the changing of that provision.

In other words, the bureau feels that we should not change the provision of the existing law simply to cover one or two cases. If there is a general showing of the weakness of the legislation, we feel it should be changed.

Mr. BROWNING. You have not had an opportunity as yet to know whether it works a hardship or not?

General HINES. Hardly. The new law has been in effect, as you know, only a short time.

Mr. MILLIGAN. This does not prevent a showing that the dependency did arise within five years, but it merely limits it to the fact that it must have arisen within five years.

General HINES. Yes. I would prefer to leave the bureau's recommendation in that way. We are opposed to the changing of any part of this law simply to take in one or two cases. If there was any showing of a general hardship, then we would favor a change. Mr. MILLIGAN. If you cut this limitation out, it merely puts the dependents on a pension.

General HINES. Yes.

The CHAIRMAN. We will proceed to section 7, if there are no further questions.

General HINES. Section 7 provides $50 per month to be awarded . to cases of tuberculosis where they have reached the point of arrest. This provision was discussed last year and the statement of the bureau is made on pages 249 and 250 of the hearings.

Since the hearings last year, and for the reason that the Bureau stated, that we felt that a man was disabled to some degree, but that the medical service at that time was not prepared to definitely state the degree, I though it desirable to submit the question to the medical council, which is made up of the best advisory talent the bureau is able to get.

The question was put to the medical council as to what degree, in their judgment, a man who had had tuberculosis was disabled when he reached the point of arrest, and I would like to read their comment on that matter.

Regarding the resolution that when such person has reached that degree of classification as arrested, he shall be rated as permanent partial, 50 per cent, the tuberculosis group of the medical council decided as follows:

For purposes of the Veterans' Bureau, the committee is of the opinion that any person who has had a recognizable tuberculosis, has a permanent handicap of not less than 25 per cent. The new rating schedule of the bureau provides a range of arrested tuberculosis of from permanent partial, 10 per cent, up to permanent partial, 33% per cent, depending upon the occupation.

There are certain occupations, such as clericl awork in a sanitary office, in which the possibility of reactivity of tuberculosis is very slight. There are types of occupation, which by reason of the environmental hazard, dust, lint, dampness, etc., or the laborious exactions of the task do predispose to reactivation. Hence, the range in the ratings.

It will be noted that the medical council has this thought in mindThese remarks I am now reading are from the Medical DirectorIt is noted that the medical council had this thought in mind in making its recommendation.

It is believed that the ratings which have now been devised are sufficiently adequate and fair. They distinctly liberalize the ratings heretofore in use, inasmuch as quite commonly heretofore a rating of less than 10 per cent was given for arrested tuberculosis.

They are not merely liberal in the percentages assigned, but they are liberal in the principle applied. To explain:

Compensation is not payable for a disease or injury in itself, but for the disability resulting from such disease or injury as measured in terms of reduction in earning capacity. The question arises, just what disability is there from arrested tuberculosis? Is it an experssed or latent disability? For the most part, it is latent, a potential disability, one not actually evidenced.

I have here this morning Doctor Cooley, of the medical service, who more than any one individual in the bureau is responsible for the development of the new rating table. I would like to ask at this point that Doctor Cooley elaborate upon what I have read, with reference to this statement of the medical director, dealing solely with this one question which is before the committee that is, the degree that these men should be rated, if rated at all, permanently.

The CHAIRMAN. Without objection, Doctor Cooley will be heard. STATEMENT OF DR. MARTIN COOLEY, ASSISTANT EXECUTIVE OFFICER, MEDICAL SERVICE

Doctor COOLEY. The director has covered the general principle. The thought which we were elaborating here was the idea that what we really have is a latent rather than an expressed condition.

After all, our problem is to measure disability, and in theory we have here not really an expressed disability. We are paying upon an assumption, rather than upon an exact state of facts.

We are paying the man on the thought that he might develop something, not upon the ground that he has already presented something which expressed a disability. That is the general thought.

The assumption that all cases of tuberculosis must necessarily reactivate is not well grounded. If that were true, gentlemen, practically the world would be full of consumptives. It is a very widespread condition. Practically every body that comes to the autopsy table shows a sign of tuberculosis. The streets are full of men with arrested tuberculosis. They go about their business. They die of other intercurrent conditions. We can not, therefore, assume that every case of tuberculosis must necessarily reactivate. The question of reactivation is essentially a question of environment. I might point out to you also that the terms of our new rating schedule make it impossible for us to consider this on an average basis. We must necessarily consider the occupation, recognizing those which are predisposed to reactivation. That is what we

measure.

General HINES. May I interrupt you to take you rating table and show by example just one or two cases and what the range would be.