FUTURE HOSPITAL AND DOMICILIARY CONSTRUCTION

At the close of this fiscal year construction work was in progress on 45 major projects involving additional beds. These projects, together with the approximate dates for completion, are as follows:

The 9,710 additional beds to be acquired as the result of work in progress on June 30, 1939, were distributed by types as follows: Neuropsychiatric, 4,161; general medical and surgical, 2,895; and domiciliary, 2,654.

In addition, work was completed in June on two projects providing a total of 206 additional beds. These beds, however, were not available to patients prior to the close of this fiscal year. The projects together with the number and type of beds provided are as follows: Chillicothe, Ohio, 96 neuropsychiatric beds, and Huntington, W. Va., 110 general beds.

The approved new construction program of the Veterans' Administration for which funds are available but which had not been placed under contract by June 30, 1939, is as follows:

Practically all of the projects now under construction are being accomplished from funds provided by grant from the Public Works Administration. The projects not under contract on June 30, 1939, will be accomplished from funds made available in the 1940 Independent Offices Act and unobligated balances remaining in prior appropriations for the Veterans' Administration.

As shown in another section of this report, there were available on June 30, 1939, in all facilities controlled by the Veterans' Administration, 54,779 hospital and 16,345 domiciliary beds, a total of 71,124 beds of both types. Upon completion of new construction for which funds are available, it is estimated there will be 63,110 hospital and 19,464 domiciliary beds, a combined total of 82,574 or 11,450 in excess of the number on June 30, 1939.

OPERATING AND PER DIEM COSTS FOR HOSPITAL AND DOMICILIARY

FACILITIES

During this year the net operating expense for all hospital and domiciliary facilities controlled by the Veterans' Administration totaled $53,205,919.47, of which $47,987,899.37 was for hospital and $5,218,020.10 for domiciliary facilities. This amount does not include expenditures for new construction, betterments, structural alterations undertaken for preservation of buildings, maintenance and operation of personnel quarters, nonexpendable equipment, furniture and furnishings, or those for the diagnostic centers at San Francisco, Calif., and Hines, Ill. Throughout the year there was a daily average of 49,147 patients of all types under treatment, and a daily average of 15,709 beneficiaries receiving domiciliary care, as compared with 45,639 and 13,514, respectively, during the fiscal year 1938.

The per diem cost of operation for hospital facilities used principally for the treatment of tuberculosis was $3.97, for those used exclusively for the treatment of neuropsychiatric diseases, $1.90, and for those used largely for the treatment of general medical and surgical conditions, $3.59. Collectively the per diem cost of operation for hospital facilities of all types was $2.68. The per diem cost of operation for domiciliary facilities for this year was $0.91.

PHYSICAL EXAMINATIONS AND OUT-PATIENT TREATMENT

During the fiscal year, this Administration made a total of 1,127,162 physical examinations for out-patient purposes, a decrease of 1,425 in the number accomplished during the preceding year. Of the examinations made during this year 1,108,758 were medical and 18,404 or 2 percent were dental. Approximately 99 percent of the medical, and 91 percent of the dental examinations were made by physicians and dentists on a salary basis, as compared with 99 and 90 percent, respectively, during the fiscal year 1938. The comparatively few physical examinations made by designated physicians on a fee basis comprised, for the most part, simple general examinations not requiring the services of a specialist or laboratory examination, or those for which the claimants or beneficiaries were not physically or mentally able to travel to the nearest facility, and it was more economical to employ a designated physician in the local community than to travel a physician of the facility to and from the homes of the claimants or beneficiaries.

Treatments furnished during the year totaled 1,079,663, as compared with 994,968 for the preceding fiscal year, an increase of 84,695. Of the treatments furnished during this year 979,332 or approximately 91 percent were medical and 100,331 or 9 percent were dental. Approximately 88 percent of the medical and 94 percent of the dental treatments were furnished by physicians on a salary basis, as compared with 87 and 93 percent, respectively, during the fiscal year ending June 30, 1938.

DENTAL ACTIVITIES

as

During the fiscal year dental care was provided for 57,254 hospital patients, 11,537 domiciliary members, and 3,735 out-patients in clinics maintained by the Veterans' Administration. This total of 72,526 beneficiaries were treated at an actual cost of $938,537, compared with the treatment of 66,897 veterans at a cost of $904,381 for the previous fiscal year. Had these services been secured through the medium of private practitioners, the estimated cost would have been $1,807,389. Thus, a saving of $868,852 was effected by the operation of dental clinics by this Administration. In addition, dental treatment was given to 521 enrollees of the Civilian Conservation Corps in the amount of $2,028. The cost per case of furnishing this relief during 1939 was $13.03, as compared with $13.52 in 1938 and $25.93 in 1930.

The number of patients being referred to private dentists, to save expense of transportation to a field station of the Veterans' Administration, has decreased. During 1939 treatment was authorized to private practitioners for 1,841 beneficiaries in the amount of $75,889, as compared to 2,000 such beneficiaries in 1938 at a cost of $82,133.

Beneficiaries are availing themselves in increasing numbers of the authority for rehospitalization for the completion of dentures to replace teeth extracted as a medical necessity during a previous episode of hospitalization. During the year 3,000 beneficiaries were rehospitalized for this purpose, for whom 5,594 artificial dental appliances were constructed. A total of 28,887 artificial dentures were constructed and 7,971 repaired in the dental clinics of the Veterans' Administration during the year, an increase of 2,824 new dentures and 856 repaires over the previous year.

On June 30, 1939, there were 165 full time dental officers on duty, as compared with 161 at the close of the fiscal year 1938.

PENSIONS AND COMPENSATION

VETERANS

Civil War.-Out of a total of 2,213,365 that served in the Union forces in this war, which terminated 74 years ago, pensions were being paid to 3,516 veterans on June 30, 1939. This represents a reduction of 1,532 in the number of veterans since June 30, 1938. Of those on the pension roll at the close of this year, 313 were in receipt of $75 per month, one $85 per month, as authorized by the act of June 9, 1930, while 3,142 were being paid $100 per month and 2, $125 per month by reason of being helpless or blind or so nearly helpless or blind as to require the regular aid and attendance of another person. The balance of the pension roll consisted of 25 veterans who were in receipt of pension under the general laws for service-connected disabilities and 33 veterans who were beneficiaries of special acts of Congress. The disbursements for pensions to veterans during this fiscal period totaled $4,622,304.21, as compared with $6,448,253.46 for the previous year, a reduction of $1,825,949.25. There were 10 claims. filed during this year. The average age of veterans receiving pensions at the close of this year was 94.

Indian wars. On June 30, 1939, pensions were being paid to 2,525 veterans on account of Indian war service, and the disbursements for this purpose amounted to $1,854,131.99 during this fiscal year. This represents a decrease of 289 in the number of veterans on the roll June 30, 1938, and a decrease of $35,030 in disbursements over last year. There were 83 new claims filed during this year. The average age of veterans receiving pensions at the close of this year was 79.

Spanish-American War, Boxer Rebellion, and Philippine Insurrection. The number of veterans on the roll at the close of this fiscal year was 165,710 as compared with 170,755 on June 30, 1938, a decrease of 5,045. The disbursements for this purpose during 1939 totaled $105,065,718.76 as compared with $98,850,424.84 in 1938, an increase of $6,215,293.92.

Of the 165,710 veterans on the roll, 163,912 were receiving pension payments for disabilities of nonservice origin or for age, 1,686 for conditions determined to be the result of service, and 112 were special act cases.

On June 30, 1939, the average monthly value of all pension awards for non-service-connected disabilities or age was $52.48; for serviceconnected disabilities, $73.84; and for special act cases, $23.34.

In addition to 165,710 veterans of this war on the roll at the close of this year, there were on the same date 18 veterans who were formerly classed as Spanish-American War veterans, but who are now receiving payments at peacetime rates. The average monthly value received by this group on June 30, 1939, was $27.94. An analysis of the service-connected group by type of major disability indicates that 4 percent are suffering from tuberculosis, 10 percent from neuropsychiatric conditions, and 86 percent are classed as general medical and surgical cases. The average monthly value for these groups is as follows: Tuberculosis, $83.49; neuropsychiatric, $85.07; and general medical,

$72.03. In the non-service-connected group 140,881 cases, or 86 percent of the total, are receiving pensions because of disabilities. The average monthly pension in these cases is $51.95. In addition, 23,031 veterans, or 14 percent of the total, are receiving pensions by reason of age, the average monthly payments being $55.72. A study of the age of all Spanish-American War veterans shows that 64 percent are between 55 and 65 years of age.

It will be recalled that toward the close of the 1938 fiscal year Congress enacted Public, No. 541, Seventh-fifth Congress, which provided a pension of $60 monthly upon attainment of the age of 65 years for soldiers, sailors, or marines of the Spanish-American War, Philippine Insurrection, or Boxer Rebellion who served honorably for 90 days between April 21, 1898, and July 4, 1902, both dates, inclusive, and to nurses of the Spanish-American War, Philippine Insurrection, and Boxer Rebellion who served honorably for 90 days between April 21, 1898, and February 2, 1901, unless prior to the completion of 90 days' service within the respective periods the designated persons were discharged for disability incurred in the service in line of duty. This act also provided pension of $100 monthly for any soldier, sailor, marine, or nurse with service as defined above who was then or should thereafter become, on account of age or physical or mental disabilities, helpless or blind or so nearly helpless or blind as to need or require the regular aid and attendance of another person. Since the enactment of the law 35,758 claims have been filed, of which increased benefits were allowed in 30,520, disallowed in 3,790, and 1,218 claims are in process of adjudication, and 230 claims are pending action by the veteran. Of the 34,310 claims, the adjudication of which has been completed, benefits were allowed in 30,520, or in 89 percent of the total completed.

World War service-connected.-Compensation was being paid on June 30, 1939, to a total of 342,072 veterans suffering from disabilities directly or presumptively connected with service during the World War, an increase of 1,482 in the number on the roll at the beginning of this fiscal period. Of those on the roll at the close of this year 252,204 were receiving payments under Public, No. 141, and 89,868 under Public, No. 2, approved March 20, 1933. There were 228,305 of the group under Public, No. 141 receiving full payments, 21,207 receiving 75 percent of the World War rates as presumptive cases, and 2,692 in which part of the payment was made at the full rate and part at 75 percent of the rate, depending on the service connection of two or more disabilities. The disbursements during this year totaled $166,948,863.01 as compared with $166,875,363.36 in 1938, an increase of $73,499.65. An analysis of the major disabilities for which this compensation is being paid discloses that neuropsychiatric diseases are the disabling cause in 19.69 percent of the awards, tuberculosis in 16.27 percent, and general medical and surgical conditions in 64.04 percent. The average monthly payments by types, based upon the value of awards at the close of this year, were as follows: Neuropsychiatric, $50.65; tuberculosis, $53.36; and general medical and surgical, $33.23. The average monthly payment for all types was $39.93. Additional compensation was being paid on account of dependents in 37,294 cases in which the veteran was rated on a temporary basis at an average of $7.55 per case per month. These dependents included 34,806 wives, 77,047 children, and 2,120 parents. On June 30, 1939, there were 2,754 disabled veterans to whom compensation