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13328

FE D E R A L REG ISTER, Thursday, September 30, 1943

firmed by proper notation of the exam connection on the basis of aggravation ining officer as result of his examination. will be conceded in case there is any b Clear and unmistakable means increase in disability during active serv obvious or manifest. Accordingly, evi ice resulting from the injury or disease dence which makes it obvious or manifest, manifested on the record, except where that the injury or disease under consider contrary to clear and unmistakable facts ation existed prior to acceptance and en including medical principles.
rollment for service will satisfy the re b In considering the question of ag quirements of the statute.
gravation, attention is invited to the c Regardless of the period of war fact that by reason of the amendment service, medical judgment alone, as dis of paragraph a 2, 35.011, greater tinguished from well established and ac weight attaches te the report of exam cepted medical principles, "Ssnot suf ination at the time of entrance into ficient to rebut sound condition at the active service than heretofore. Also, time of entrance into active military that paragraph a 4, 35.011, is service, nor will admitted history of modified to the extent that medical prior disease by the veteran or mem judgment alone, as distinguished from bers of his family suffice, although they well established and accepted medical may serve as leads for further develop principles, is no longer sufficient to sup ment.
port a finding of natural progress.
d The provisions of subparagraphs Further, that medical or surgical treat 1, 2 and 3 of-this paragraph are ment furnished during service for pre subject to the following: There are cer existing conditions does not of itself tain medical principles so well and uni establish increase in disability; how versally recognized as definitely to con ever, increase in severity necessitating stitute fact, and when in accordance treatment, unless actually improved with these principles existence prior to thereby, may do so. Discovery or nota entrance into service is established, no tion of healed residuals of former in further additional or confirmatory facts jury or disease, without evidence of ac are necessary. For example, with nota tive pathology during service, does not tion or discovery, during service, of reflect increased disability. Mere re residual conditions, such as scars, healed currences within a short period after en fractures, absent or resected parts or trance into active service, as of epileptic organs, supernumerary parts, congenital seizures, seasonal asthma, recurrent dis malformations, fibrosis evidencing for locations, etc., do not establish increase merly active tuberculosis, with no evi in the degree of disability. There are dence of the pertinent antecedent active certain diseases, including new growths injury or disease during service, the es including most endocrine disturbances, tablished facts arp so convincing as to but not hyperthyroidism or diabetes impel the conclusion the residual con ffiellitus, epilepsy, arteriosclerosis, and dition existed prior to entrance into ac hypertrophic degenerative arthritis, tive service, without further proof of commonly designated osteoarthritis, this fact. Similarly, manifestation of which in the absence of pertinent local lesions or symptoms of chronic disease injury or abrupt and sudden pathologi from date of enlistment, or so close to cal developments do not of themselves that date that the disease could not have reflect increase in severity. On the originated in so short a period, will be other hand advancement of conditions accepted as clear and unmistakable proof such as peptic ulcer, atrophic arthritis, that the disease existed prior to en diabetes mellitus, active pulmonary trance into active service. Likewise, tuberculosis, bronchial asthma not es manifestation of disease within less than tablished as seasonal, and dementia the minimum incubation period after praecox with any sudden alteration enlistment will be accepted as showing of personality, can be expected from inception prior to service.
the unusual exertion, exposure, emo 3.
It is contemplated that in claimstional stress or strain or other adverse based upon recent military or naval serv influence nf the service. Acute infec ice and discharge on account of dis tions, as pneumonia, active rheumatic ability, development of evidence as to fever even though recurrent, acute prior existence and severity of injury or pleurisy, acute ear disease, and sudden disease, either by correspondence, social developments, as hemoptysis, lung col survey, or field examination, will not be lapse, ulcer, decompensating undertaken when the acceptable evi heart perforating disease, coronary occlusion or dence of record, including well estab thrombosis, cerebral hemorrhage, occur lished and generally accepted medical in service are service incurred or principles will permit either favorable ring shown by clear and adjudication or denial. Development by aggravated unless evidence that there was no correspondence, etc., will be resorted to unmistakable increase in severity during service. Even only when there are definite indications though prior existence of a condition not in file of a disabling condition at the noted by report of examination at time time of enlistment, as severe as, or more of entrance into active service may be severe than, the condition at discharge, established by clear and unmistakable which, however, require confirmation by evidence, the records and affidavits of clear and unmistakable evidence to be physicians, hospitals, or institutions can acceptable. Under no circumstances will not be accepted to controvert the report a claim be developed merely to establish of examination at the time of entrance prior episodes of disease or injury which into active service as to the severity of may have cleared up leaving no actual the preexisting condition, unless the evi dence constitutes clear and unmistak disability at the time of enlistment, able showing to the contrary.
a Where notation or clear and un c Under 35.011, as amended, no mistakable evidence shows that a disease pension is payable if the-disability is the or injury existed prior to service, service result of the persons own misconduct.

Hence question of service connection for misconduct conditions either by incur rence or aggravation under 35.011, as amended, is not involved. In the event question of innocent incurrence or ag gravation of misconduct condition arises, cases will be submitted to central office!
attention director of the appropriate service, for disposition.
4. Determinations as to service con nection for chronic diseases on account of World War II service will be made in accordance with the provisions of 2.1080 and 2.1088. Hospital confirma tion of diagnosis of chronic diseases initially made after discharge from World War H service will be required, in disability claims.
a In considering the listed chronic diseases, the following points should be borne in mind. Rheumatic fever has no causative relationship to atrophic or hypertrophic arthritis. Epidemic en cephalitis is -an acute infectious disease having a period of incubation limited to three weeks; however, early episodes may be mistaken for influenza or other acute infectious disease. Endocarditis and myocarditis, as active diseases, are acute, prostrating complications of infections, particularly rheumatic fever; chronic types are rarely, if ever, recognized; in-.
active types, as valvular lesions, myocar dial damage, etc., must be considered for service connection on the basis of the status of the disease when active or on the basis of actual decompensation during service. Glomerular, or par enchymatous, nephritis is a complication of acute infectious disease. Neph rosclerosis, or interstitial nephritis, is closely associated with arteriosclerosis and is typically chronic. Among the or ganic diseases of the nervous system, many, for example, anteriopoliomyelitis and spinal meningitis, are typically of acute onset. The psychoses must be viewed in relationship to the disease, if any, with which they are associated. No type of psychoneurosis is included in the list of chronic diseases.
5. The discussion of reasonable doubt, page 2, 1933, schedule for rating disabilities, will be borne in mind in resolving doubts in favor of veterans when applying the policies and prin ciples outlined above as to sound condi tion at the time of examination, accept ance and enrollment, and aggravation.
Also, in all matters of service connection, due consideration shall be given to the places, types and circumstances of the veterans service.
6. The application of the foregoing in structions carrying into effect the pur pose and intent of section 9 b, Public No. 144, 78th Congress, will be in full accord with the principles involving clear and unmistakable evidence and burden of proof enunciated in Public 141, 73rd Congress.
7. The effective date of ratings and awards made pursuant to paragraph a 2, 35.011, as amended, will be de termined in accordance with the provi sions of Instruction I, section 16 and 17, Public No. 144, 78th Congress. Septem ber 4,1943. Pub. Law 144, 78th Cong..
seal
F rank T. H ines,
Administrator.
F. R. Doc. 43-15800; Filed, September 7,1943;
4:30 p. m.l