General HINES. Here is a table before me which I think will cover that pretty well. We have it in various forms covering that information. I understand what you wish. You want to have shown the various degrees of disability with the rates paid and the number of persons drawing that rate of compensation.

Mr. RANKIN. Yes. One reason for asking that question is that I continually hear people at home and over the country complaining that men are drawing $135 and $140 a month. I presume those are men who have insurance?

General HINES. Yes. A man would draw $157.50 per month, if he was permanent and total, and also had insurance.

Mr. RANKIN. If he had full insurance?

General HINES. That would be a $10,000 policy and a rating of permanent and total.

Mr. RANKIN. In order to draw $80 a month, what degree of disability must he have?

General HINES. He has a temporary total degree of disability. That man may have dependents which would bring the amount received by him over $80.

Mr. RANKIN. But not over $100?

General HINES. Yes; it would run to over $100 in some cases. The average is $86 for temporary total cases.

Mr. RANKIN. That includes t. b. and neuropsychiatric cases?

General HINES. It would not make any difference what the disability was, if he was temporarily and totally disabled, the amount would vary depending upon the number of dependents the man had; whether he had a wife and a certain number of children, or a dependent mother or dependent father, etc.

Mr. RANKIN. How often do you have temporary and total disability cases reexamined?

General HINES. If they went into a hospital for observation, the period might be as short as 30 or 60 days; but the regular periodical examinations run from six months to a year.

Mr. RANKIN. Will you insert the table I refer to in the record? General HINES. We have an order governing that, which I shall be glad to insert in the record, which shows what the regulations with reference to examination of men are.

Subject: Reexamination of beneficiaries for revision of ratings.

The following General Order is hereby promulgated, effective April 3, 1924, for observance by all officers and employees of the United States Veterans' Bureau:

1. Cases rated on a temporary basis.-In each case it will be estimated by the physician making the examination what period should elapse before it is probable there will be a change in the disabling condition sufficient to call for a rerating. At the end of this period the benefiiciary shall be reexamined, provided, however, that the period between examinations shall in no instance be longer than one year. Medical officers rating or rerating these cases shall consider the recommendation of the physician making the examination and will in each instance endorse the rating sheet to show the date of reexamination.

2. Cases rated on a total and permanent basis.—(a) Those cases of statutory total and permanent disability due to an anatomical loss, defined in section 302 (3) of the war risk insurance act as amended, are not to be subjected to

reexamination except in connection with rerating for double total and permanent disability. Medical officers rating these cases will not endorse rating sheets for reexamination.

(b) Those cases of statutory total and permanent disability not due to an anatomical loss, defined in section 302 (3) of the war risk insurance act as amended, as rendering the beneficiary helpless and permanently bedridden, shall not be subjected to reexamination for rerating unless it is clearly evident there is such improvement in the condition of the beneficiary as to make it probable that a total and permanent rating is no longer justified, or, unless a reexamination is necessary in connection with a re-rating for double total and permanent rating. Medical officers rating these cases will not endorse rating sheets for reexamination.

(c) Those cases in which a permanent total rating has been made for conditions other than those falling under statutory ruling as defined in section 302 (3) of the war risk insurance act as amended will be subjected to reexamination when it is evident that the disability has decreased to a degree that probably justifies a lower rating or when there is an additional disability that probably justifies a double total and permanent rating, provided that the following procedure will apply in addition to the above:

(1) Reexamination of claimants classified under this paragraph c will be made at least once in two (2) years unless the claimant is residing continuously in a hospital at the instance of the bureau. Medical officers shall indorse rating sheets to show date of reexamination, i. e., two years from date of rating.

(2) If the beneficiary is being hospitalized by or at the instance of the Bureau, reexamination shall be made when such hospitalization is to be terminated or suspended for any reason. An annual progress report for each period of a year since the last examination or progress report shall be requested by the district manager and furnished by the medical officer in charge of the hospital.

3. Cases dated on a partial and permanent basis.-Claimants with a disability rated on a partial and permanent basis shall be reexamined only when it has become evident that the disabling condition has changed to an extent sufficient to probably justify a change in rating. Medical officers rating cases partial and permanent shall not endorse the rating sheets for reexamination.

4. The foregoing instructions in no way apply to examinations in connection with treatment, prosthesis, training, etc., or for purposes of any kind other than rerating.

5. All orders and instructions in conflict herewith are modified accordingly. Nothing contained herein shall be construed as conflicting with regulation No. 47, dated July 23, 1923.

FRANK T. HINES, Director.

UNITED STATES VETERANS' BUREAU,
March 12, 1925.

REGULATION NO. 98

Subject: Permanent ratings.

By virtue of the authority conferred in section 5 of the World War veterans' act, 1924, the following regulation is hereby issued, effective March 27, 1925, relative to permanent ratings of disability for compensation purposes under the World War veterans' act, 1924, canceling and superseding sections 7090, 7091, 7092, 7093, 7094, 7095, and 7096 of Veterans' Bureau regulations to read as follows, and to be incorporated in Veterans' Bureau regulations as sections 7090 to 7093, inclusive.

FRANK T. HINES, Director.

REGULATIONS, UNITED STATES VETERANS' BUREAU, 1925 CHAPTER VII

SEC. 7090. All cases in which it is indicated that the disability has reached a stationary level and is reasonably certain to continue throughout the claimant's life, shall be rated on a permanent basis. (Veterans' Bureau Regulation No. 98, effective March 27, 1925.)

SEC. 7091. Ratings and awards for permanent disability, except cases rated by central office under existent regulations shall be made in regional offices. The notice of award for permanent disability to the claimant will contain a notice of his right of appeal. Veterans' Bureau Regulation No. 98, effective March 27, 1925.)

SEC. 7092. All claimants whose disabilities may be considered as permanent in nature by an examining physician, a member of a claims and rating board, will be thoroughly examined by not less than three physicians at least one of whom should be a specialist in the major disability of the claimant, in order that the full nature and extent of the disability or disabilities upon which to base or refuse a permanent rating may be accurately and authoritatively determined. When a regional claims and rating board makes a permanent rating on a case, thereafter the claimant may have the case reviewed only on appeal or on application for increase accompanied by evidence showing changed conditions. (Veterans' Bureau regulation No. 98, effective March 27, 1925.) SEC. 7093. No beneficiary whose disability has been given a permanent rating, either total or partial, shall be reexamined except as follows:

(a) Upon request of the beneficiary or his duly authorized representative, accompanied by evidence showing changed conditions.

(b) Claimants carrying a permanent total disability award for active tuberculosis, pulmonary or otherwise, will be reexamined at intervals of 18 months, and such reexaminations will be made by a board in accordance with the provisions of section 7092 above.

(c) In connection with treatment, prosthesis or training. These examinations are not to be used for rating purposes, and no permanent rating shall be altered upon such an examination in the absence of approval of central office. (d) When reexamination is ordered by central office, as a result of information showing changed conditions furnished by regional manager. (Veterans' Bureau regulation No. 98, effective March 27, 1925.)

Mr. FITZGERALD. If there is no objection, we will hear from Doctor Crossman.

STATEMENT OF DR. EDGAR 0. CROSSMAN, MEDICAL DIRECTOR, VETERANS' BUREAU

Mr. FITZGERALD. Doctor Crossman, will you state your connection with the Veterans' Bureau?

Doctor CROSSMAN. I am medical director there at this time.

Mr. FITZGERALD. And you have been connected with the bureau how long?

Doctor CROSSMAN. Since April 1st, 1923.

Mr. FITZGERALD. Doctor, will you take up in your own way, the medical situation at the bureau with reference especially to the medical personnel, and make such suggestions as you wish to make to the committee, based on your experience.

Doctor CROSSMAN. The question that would naturally rise in anybody's mind, I presume-at least in the mind of anyone who was not here last year is as to why the director is asking for a special commission for physicians and not for the other personnel in the bureau.

The answer to that, I think, is that it is a question of supply and demand. There is a shortage of physicians, as you well know, throughout the country. There are thousands less physicians being graduated now than there were 20 years ago. In many country towns they are paying a bonus in order to secure the service of physicians.

I think the other point is, as the director mentioned yesterday, the fact that about every phase of a case has some sort of a medical slant. It is therefore important that the medical service be recruited

83103-26-PT 1-8