I desire to invite your special attention to the following statement in my report of last year (1898): One of the great disadvantages in the adjudication of claims is the requirement that examining surgeons shall rate disabilities, because of the want of uniformity in the rates they recommend. It is the experience of every medical examiner and reviewer that the surgeons' ratings are misleading and unfair, and far better results would be obtained and much greater justice done to claimants if examining sureons would lay more stress on a thorough examination and less on ratings in their ertificates. Surgeons, as a rule, lay too much stress on ratings and omit or restrict the more important matter-a thorough description, a complete pen picture of the claimant's disabilities. Another year's experience emphasizes this statement. As an assurance to the claimant (who under the law may either in person or by attorney examine the certificates of medical examination) that the members of the board of surgeons are his friends, the ratings of many boards are not only unreasonably extravagant, but perfectly ridiculous. For instance, one board rates a claimant For thin abdominal walls and tenderness over colon and stomach. 17 "It is the opinion of this board that he should receive full invalid rating." When asked to explain their meaning, they reply "We mean $17 a month.” In reply to a communication from this Bureau in regard to the extravagant ratings in this claim, the president of the board of surgeons stated that the "board had not always been harmonious on the degree of rating," and moreover had given "much more attention to description of diseased conditions than to ratings." It will be interesting to compare the original rates with the rates as amended: For inflamed rectum, two piles one-half inch in diameter, and an ulcer threefourths inch in diameter 24 For alleged eczema and dizziness (none shown on examination) 17 24 Total..... Another board rates 123 For full and prominent abdomen. Enlarged liver with some tenderness For 7 or 8 small piles size of split peas Alleged slight numbness of right leg, no loss of motion or power For a fullness in region of kidneys, urine normal Total...... $14 10 14 17 10 71 Another board closes each of six certificates of examination that were made the same day with the statment that the claimant is totally disabled for the performance of manual labor and recommends a rate of $30 per month, yet in no case was a single disability rated more than $12, and nearly all of them from $3 to $8 per month. Another board recommends a rating of $30 per month in each of six examinations made the same day, and yet rates the disabilities from $2 to $12 per month. One board recommends a rating of $17 per month for alleged "total loss of sexual instinct." Such cases could be multiplied ad nauseam. These are quoted to show that in many instances the ratings made by some boards are absurd. Either the whole system of ratings by boards should be done away with-and this is by far the better plan-or else boards should be instructed in the proper method of rating both under the laws and the established practice of the office. This lack of knowledge as to what is required to make a certificate acceptable and of value in the adjudication of a claim accounts for the return of so many certificates for amendment. In this connection your attention is invited to the fact that out of 211,620 certificates of examination received in the Bureau, 23,916 (over 11 per cent) had to be returned for amendment. During the year 29,160 orders for medical examination were returned to the Bureau for the rea son that claimants failed to appear for examination within the specified time. This is over 13 per cent of the whole number (223,824) of orders issued during the year. Claimants are given three months from date of order to report for medical examination. It happens very frequently that claimants complain because their claims are not adjudicated, when the delay is due to their failure to report for medical examination. If claimants could be made to appreciate the necessity of complying with the requests of the Bureau, much of the complaint because of the delay and much of the delay would cease. Certificates of medical examination which have been returned for amendment are called for, if not returned within a reasonable time. This has necessitated the preparing and mailing of 2,500 circulars. The same course is pursued in the case of outstanding orders for medical examination in which the specified time has expired. About 2,000 circular calls were made for this purpose. In the case of eighteen boards and single surgeons who neglected to forward their certificates or return expired orders, it became necessary to refer lists of outstanding orders and certificates in their hands to the chief of the special examiners' division, with the request that the papers be secured by a special examiner. Reports have been received relative to all of these boards. By your direction orders to these eighteen boards and single surgeons were suspended because of their gross neglect of duty. During the fiscal year 4,965 original claims under the general law were admitted and 4,270 were rejected. Other claims admitted under this law numbered 19,091, while 24,283 were rejected. The rates in 66 claims were reduced and in 26 the pensioners' names were dropped from the rolls. Nineteen thousand seven hundred and sixty-four claims were returned with medical opinions and 15,750 examinations were ordered. Under the act of June 27, 1890, there were 27,627 original claims admitted and 19,667 rejected. Other claims admitted under this act numbered 14,334, and 27,706 were rejected, including claims under the act of March 6, 1896; the rates in 21 claims were reduced and in 23 the pensioners' names were dropped from the rolls; 9,738 examinations were ordered and 24,330 claims were returned with medical opinions. The number of appeal claims considered was 1,903. The total number of orders issued by this division was 223,824, of which number 4,399 were to specialists, 1,615 to civil surgeons, 13 to surgeons of the United States Army, and 617 to foreign surgeons, while 3,223 were for home or special examinations, making 9,867 orders issued with special instructions. Of these 9,867 orders, 8,501 certificates were received and 1,366 are outstanding. There were 187,608 surgeons' certificates accepted, 23,916 returned for amendment, and 96 rejected. The total number of examinations approved for payment was 149,486, and the amount paid therefor was $766,542.30. Two thousand eight hundred and forty-one letters were typewritten and 135,000 envelopes addressed. During the year 498 books containing records of examinations were returned to the Bureau by boards and single surgeons. About 1,000 circulars were sent in reply to Congressional inquiries. Accompanying this report is a tabulated statement of the work performed during the fiscal year. Very respectfully, Hon. H. CLAY EVANS, Commissioner of Pensions. J. F. RAUB, Medical Referee. Report of claims acted upon by the medical division for the fiscal year ended June 30, 1899. Number of orders issued and certificates of examination received and amount paid for Certificates rejected 26, 474 27, 202 223, 824 187, 608 23, 916 96 Orders returned, claimants having "failed to appear" 29, 160 149, 486 $766, 542. 30 Number of orders issued and certificates of examination received (special classes). TABLE NO. 26a.-Number, by States, of boards of examining surgeons, single surgeons, and specialists, within the classified and the unclassified service, June 23, 1899. SIR: I have the honor to submit the following consolidated report of the work of the Board of Review for the fiscal year ended June 30, 1899: Number of claims admitted of all classes Total number of claims with final action 85,845 107, 919 193, 764 |