A-20304, NOVEMBER 2, 1927, 7 COMP. GEN. 308

A-20304: Nov 2, 1927

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FOR TREATMENT PROCURED THROUGH PRIVATE SOURCES IN AN EMERGENCY WHEN NO VETERANS' BUREAU FACILITIES WERE FEASIBLY AVAILABLE. THERE ARE SUBMITTED THE FACTS IN THE CASE OF LESTER G. IT APPEARS THAT THIS CLAIMANT WAS SEPARATED FROM THE MILITARY SERVICE ON JUNE 2. THE CLAIMANT WAS RATED ON MARCH 23. SUBSEQUENT RATINGS WERE MADE CONFIRMING THE RATING OF SERVICE CONNECTION FOR THIS DISABILITY. ANC HE WAS HELD TO BE ENTITLED TO DENTAL TREATMENT. WAS NOT HELD TO BE COMPENSABLE BECAUSE THE DISABILITY WAS RATED AS LESS THAN TEN PERCENT. I DIAGNOSED THE INJURY AS VINCENT'S DISEASE.' "/C) THAT AT THE TIME THIS TREATMENT WAS RENDERED BUREAU FACILITIES WERE NOT FEASIBLY AVAILABLE. "/D) THAT THE TREATMENT RENDERED.

A-20304, NOVEMBER 2, 1927, 7 COMP. GEN. 308

MEDICAL TREATMENT - PRIVATE - WORLD WAR VETERANS UNDER SECTION 202 (9) OF THE WORLD WAR VETERANS' ACT OF JUNE 7, 1924, 43 STAT. 620, AS AMENDED BY SECTION 8 OF THE ACT OF MARCH 4, 1925, 43 STAT. 1307, WORLD WAR VETERANS ENTITLED TO MEDICAL OR HOSPITAL TREATMENT OF A SERVICE-CONNECTED NONCOMPENSABLE DISABILITY, MAY BE REIMBURSED FOR PERIODS ON AND SUBSEQUENT TO JUNE 7, 1924, AND NOT IN EXCESS OF ONE YEAR PRIOR TO FILING CLAIM, FOR TREATMENT PROCURED THROUGH PRIVATE SOURCES IN AN EMERGENCY WHEN NO VETERANS' BUREAU FACILITIES WERE FEASIBLY AVAILABLE, ON THE SAME BASIS AS BENEFICIARIES IN RECEIPT OF DISABILITY COMPENSATION. EMERGENCY DENTAL TREATMENT CONTEMPLATES ONLY THE RELIEF OF PAIN.

COMPTROLLER GENERAL MCCARL TO THE DIRECTOR, UNITED STATES VETERANS' BUREAU, NOVEMBER 2, 1927:

CONSIDERATION HAS BEEN GIVEN TO YOUR LETTER OF OCTOBER 19, 1927, REQUESTING DECISION OF QUESTIONS PRESENTED AS FOLLOWS:

A QUESTION HAS ARISEN AS TO THE AUTHORITY OF THIS BUREAU TO MAKE REIMBURSEMENT UNDER SECTION 202, PARAGRAPH 9, OF THE WORLD WAR VETERANS' ACT AS AMENDED FOR THE COST OF EMERGENCY MEDICAL AND DENTAL TREATMENT OF NONCOMPENSABLE SERVICE CONNECTED DISABILITIES.

IN THIS CONNECTION, THERE ARE SUBMITTED THE FACTS IN THE CASE OF LESTER G. BLAIS, C-1346761. IT APPEARS THAT THIS CLAIMANT WAS SEPARATED FROM THE MILITARY SERVICE ON JUNE 2, 1919, AND THAT HE FILED CLAIM ON JANUARY 7, 1925, ON ACCOUNT OF THE DISABILITY, TRENCH MOUTH, AND FOR CERTAIN OTHER DISABILITIES. THE CLAIMANT WAS RATED ON MARCH 23, 1925, AS ENTITLED TO TREATMENT AND PROSTHESIS WITHOUT COMPENSATION UNDER SECTION 202, PARAGRAPH 9, OF THE ACT AS AMENDED ON ACCOUNT OF VICENTS ANGINA. SUBSEQUENT RATINGS WERE MADE CONFIRMING THE RATING OF SERVICE CONNECTION FOR THIS DISABILITY, ANC HE WAS HELD TO BE ENTITLED TO DENTAL TREATMENT, BUT WAS NOT HELD TO BE COMPENSABLE BECAUSE THE DISABILITY WAS RATED AS LESS THAN TEN PERCENT.

THE CLAIMANT SECURED UNAUTHORIZED DENTAL TREATMENT DURING THE PERIOD FROM OCTOBER 20, 1924, TO FEBRUARY 24, 1925, AND A CLAIM FOR REIMBURSEMENT HAS BEEN SUBMITTED IN THE AMOUNT OF $15 IN FAVOR OF THE CLAIMANT AND $10 IN FAVOR OF DR. J. A. HANSON COVERING THE ENTIRE COST OF SERVICES RENDERED BY DR. HANSON. THE CLAIM HAS BEEN CONSIDERED BY THE ACTING MEDICAL DIRECTOR, AND THE FOLLOWING FINDING HAS BEEN MADE:

"/A) THE CLAIMANT HAS A SERVICE CONNECTED DENTAL DISABILITY; NAMELY, VINCENT'S DISEASE OF A NONCOMPENSABLE DEGREE AS EVIDENCED BY THE RATING SHEET ATTACHED, DATED MARCH 29, 1927.

"/B) THE CLAIMANT RECEIVED THE EMERGENCY DENTAL RELIEF FOR THIS SERVICE CONNECTED DISABILITY, VINCENT'S DISEASE, CONSISTING OF CHROMIC ACID SPRAYS (40) AS TREATMENT FOR THIS SERVICE CONNECTED DISABILITY AS EVIDENCE BY DR. HANSON'S AFFIDAVIT, DATED JANUARY 15, 1926: "UPON PHYSICAL EXAMINATION I FOUND THE FOLLOWING: MEMBRANES ON GUMS BETWEEN TEETH, FETID BREATH, ULCERS VERY PAINFUL TO TOUCH. SORE THROAT AND GENERAL MALAIS. I DIAGNOSED THE INJURY AS VINCENT'S DISEASE.'

"/C) THAT AT THE TIME THIS TREATMENT WAS RENDERED BUREAU FACILITIES WERE NOT FEASIBLY AVAILABLE.

"/D) THAT THE TREATMENT RENDERED, NAMELY, CHROMIC SPRAYS, UNDER DATES OF OCTOBER 20-NOVEMBER 6, 1924, DAILY EXCEPT SUNDAY, ALSO NOVEMBER 10, 17, 19, 20, 22, 24, AND 28, DECEMBER 1, 2, 5, 8, 10, 22, 27, 1924, JANUARY 5, 9, 14, 19, 23, 1925, AND FEBRUARY 2, 10, 23, AND 24, 1925, AND THE EXTRACTION OF "RIGHT UPPER FIRST BICUSPID AND SECOND MOLAR AND UPPER LEFT SECOND MOLAR- UNDER DATE OF FEBRUARY 4, 1925, WAS OF AN EMERGENCY NATURE. THE SCALING AND PROPHYLAXIS ARE NOT CONSIDERED EMERGENCY TREATMENT.

"/E) THAT THE FEE CHARGED FOR THE CHROMIC-ACID SPRAYS RENDERED IN THE EMERGENCY TREATMENT OF VINCENT'S DISEASE IN THE AMOUNT OF $0.50 PER SPRAY IS CONSIDERED FAIR AND REASONABLE AND THAT A CHARGE OF $3.00 FOR THE THREE EXTRACTIONS MENTIONED IN THE FOREGOING PARAGRAPH IS CONSIDERED REASONABLE AND JUST FOR THIS EMERGENCY TREATMENT RENDERED.'

THE VOUCHERS HAVE BEEN CONSIDERED AND HAVE BEEN RECOMMENDED FOR APPROVAL BY THE ACTING MEDICAL DIRECTOR, FOLLOWING THE PROVISIONS OF BUREAU REGULATION. (REGULATION NO. 117.)

AS PREVIOUSLY STATED, THE QUESTION HAS BEEN RAISED AS TO WHETHER REIMBURSEMENT MAY BE MADE PARTICULARLY IN VIEW OF CERTAIN DECISIONS OF THE COMPTROLLER GENERAL. (DECISIONS OF COMPTROLLER GENERAL A.D. 7682, OCTOBER 31, 1923; A 6546, DECEMBER 30, 1924; A 7583, MARCH 12, 1925; A 12553, FEBRUARY 23, 1926; A 14521; JUNE 17, 1926; A 17439, MARCH 2, 1927.) THESE DECISIONS IN EFFECT STATE THAT THE RIGHT TO REIMBURSEMENT AS A BENEFICIARY OF THE VETERANS' BUREAU IS INCIDENT ONLY TO THE AWARD OF DISABILITY COMPENSATION. HOWEVER, IT WILL BE NOTED THAT THESE DECISIONS HAVE REFERENCE TO CASES IN WHICH THE SERVICES FOR WHICH REIMBURSEMENT IS CLAIMED WERE RENDERED PRIOR TO JUNE 7, 1924.

IN THIS CONNECTION, REFERENCE MAY BE MADE TO THE SPECIFIC LANGUAGE OF SECTION 202, PARAGRAPH 9, OF THE WORLD WAR VETERANS' ACT AS AMENDED. THIS SECTION RELATES TO SERVICE CONNECTED NONCOMPENSABLE DISABILITIES, AND THE LAST PROVISO OF SAID SECTION PROVIDES IN EFFECT THAT WHEN AN EMERGENCY DEVELOPS OR HAS DEVELOPED REQUIRING IMMEDIATE TREATMENT OR HOSPITALIZATION ON ACCOUNT OF SUCH INJURY OR DISEASE, AND NO BUREAU FACILITIES ARE OR WERE THEN FEASIBLY AVAILABLE AND IN THE JUDGMENT OF THE DIRECTOR DELAY WOULD BE OR WOULD HAVE BEEN HAZARDOUS, THE DIRECTOR IS AUTHORIZED TO REIMBURSE SUCH BENEFICIARY THE REASONABLE VALUE OF SUCH SERVICE RENDERED FROM SOURCES OTHER THAN THE BUREAU. THIS STATUTORY PROVISION FOR REIMBURSEMENT BY ITS LANGUAGE CLEARLY APPEARS TO RELATE TO THOSE CASES WHERE THE CLAIMANT IS SUFFERING FROM A SERVICE CONNECTED DISABILITY OF NONCOMPENSABLE DEGREE. PRIOR TO THIS ENACTMENT REIMBURSEMENT FOR UNAUTHORIZED MEDICAL EXPENSES WAS AUTHORIZED IN COMPENSABLE CASES BY THE DECISIONS OF YOUR OFFICE AND UNDER THE PRACTICE OF THIS BUREAU. THEREFORE, THIS STATUTORY PROVISION FOR REIMBURSEMENT BY ITS LANGUAGE AND BY ITS INCORPORATION AS A PART OF SECTION 202, PARAGRAPH 9, OF THE ACT AS AMENDED WOULD APPEAR TO BE AUTHORITY FOR THE REIMBURSEMENT IN NONCOMPENSABLE SERVICE CONNECTED DISABILITIES WHERE THE OTHER REQUIREMENTS OF THE STATUTE HAVE BEEN MET.

IN THIS CONNECTION, THE FOLLOWING SPECIFIC QUESTIONS ARE SUBMITTED FOR YOUR CONSIDERATION AND DECISION:

(A) WHETHER OR NOT THE DECISIONS OF YOUR OFFICE ARE APPLICABLE IN ALL CLAIMS FOR REIMBURSEMENT COVERING UNAUTHORIZED TREATMENT PROCURED IN IGNORANCE OF RIGHTS OR EMERGENCY OR ONLY SUCH CLAIMS AS INVOLVE TREATMENT PRIOR TO JUNE 7, 1924.

(B) WHETHER SECTION 202 (9) OF THE WORLD WAR VETERANS' ACT AS AMENDED CONTAINS AUTHORITY TO MAKE REIMBURSEMENT OR PAYMENT FOR THE COST OF EMERGENCY MEDICAL TREATMENT OF NONCOMPENSABLE SERVICE CONNECTED DISABILITIES.

(C) WHETHER IF SECTION 202 (9) OF THE WORLD WAR VETERANS' ACT AS AMENDED AUTHORIZES REIMBURSEMENT FOR EMERGENCY MEDICAL TREATMENT OF NONCOMPENSABLE SERVICE CONNECTED DISABILITIES AFTER JUNE 7, 1924, THE BUREAU IS LIMITED TO THE RETROACTIVE PERIOD OF ONE YEAR PRIOR TO FILING CLAIM UNDER SECTION 210 IN MAKING SUCH REIMBURSEMENT, OR CAN REIMBURSEMENT BE MADE PRIOR TO THAT DATE?

(D) WHETHER DENTAL TREATMENT IS IN THE SAME CATEGORY AS MEDICAL TREATMENT WITHIN THE MEANING OF THE FOREGOING DECISIONS.

SECTION 10 OF THE WORLD WAR VETERANS' ACT OF JUNE 7, 1924, AND AS AMENDED BY THE ACT OF JULY 2, 1926, 44 STAT. 790, IMPOSES THE RESPONSIBILITY UPON THE DIRECTOR OF THE VETERANS' BUREAU FOR THE PROPER MEDICAL AND HOSPITAL CARE OF PERSONS ENTITLED THERETO UNDER THE PROVISIONS OF THE ACT, AND HE IS THEREIN AUTHORIZED TO UTILIZE GOVERNMENTAL FACILITIES OTHER THAN THOSE UNDER THE VETERANS' BUREAU, AND, IN ADDITION THERETO, IF AND WHEN NECESSARY, HE IS AUTHORIZED TO MAKE ARRANGEMENTS FOR HOSPITALIZATION THROUGH OTHER MEANS, SUCH AS CONTRACTS WITH STATE, MUNICIPAL, OR, IN EXCEPTIONAL CASES, PRIVATE HOSPITALS.

SUBPARAGRAPH (3) OF SECTION 202 (ACT OF JULY 2, 1926, 44 STAT. 795) AND SUBPARAGRAPH (6) OF THE SAME SECTION (ACT OF JUNE 7, 1924, 43 STAT. 619, AS AMENDED BY THE ACT OF MARCH 4, 1925, 43 STAT. 1306) AUTHORIZE MEDICAL AND HOSPITAL TREATMENT AS INCIDENT TO THE RECEIPT OF DISABILITY COMPENSATION.

SUBPARAGRAPH (9) OF THE SAME SECTION (ACT OF JUNE 7, 1924, 43 STAT. 620, AS AMENDED BY SECTION 8 OF THE ACT OF MARCH 4, 1925, 43 STAT. 1307), WITH WHICH WE ARE PARTICULARLY CONCERNED HEREIN, PROVIDES AS FOLLOWS:

IN ADDITION TO THE CARE, TREATMENT, AND APPLIANCES NOW AUTHORIZED BY LAW, SAID BUREAU SHALL ALSO PROVIDE, WITHOUT CHARGE THEREFOR, HOSPITAL, DENTAL, MEDICAL, SURGICAL, AND CONVALESCENT CARE AND TREATMENT AND PROSTHETIC APPLIANCES (INCLUDING SUCH DENTAL APPLIANCES AS MAY BE FOUND REASONABLY NECESSARY BY THE DIRECTOR) FOR ANY MEMBER OF THE MILITARY OR NAVAL FORCES OF THE UNITED STATES, NOT DISHONORABLY DISCHARGED, DISABLED BY REASON OF ANY WOUND OR INJURY RECEIVED OR DISEASE CONTRACTED, OR BY REASON OF ANY AGGRAVATION OF A PREEXISTING INJURY OR DISEASE, SPECIFICALLY NOTED AT EXAMINATION FOR ENTRANCE INTO OR EMPLOYMENT IN THE ACTIVE MILITARY OR NAVAL SERVICE WHILE IN THE ACTIVE MILITARY OR NAVAL SERVICE OF THE UNITED STATES ON OR AFTER APRIL 6, 1917, AND BEFORE JULY 2, 1921: PROVIDED, THAT THE WOUND OR INJURY RECEIVED OR DISEASE CONTRACTED OR AGGRAVATION OF A PREEXISTING INJURY OR DISEASE, FOR WHICH SUCH HOSPITAL, DENTAL, MEDICAL, SURGICAL, AND CONVALESCENT CARE AND TREATMENT AND PROSTHETIC APPLIANCES (INCLUDING SUCH DENTAL APPLIANCES AS MAY BE FOUND REASONABLY NECESSARY BY THE DIRECTOR) SHALL BE FURNISHED, WAS INCURRED IN THE MILITARY OR NAVAL SERVICE AND NOT CAUSED BY HIS OWN WILLFUL MISCONDUCT: PROVIDED, THAT WHERE A BENEFICIARY OF THE BUREAU SUFFERS OR HAS SUFFERED AN INJURY OR CONTRACTED A DISEASE IN SERVICE ENTITLING HIM TO THE BENEFITS OF THIS SUBDIVISION, AND AN EMERGENCY DEVELOPS OR HAS DEVELOPED REQUIRING IMMEDIATE TREATMENT OR HOSPITALIZATION ON ACCOUNT OF SUCH INJURY OR DISEASE, AND NO BUREAU FACILITIES ARE OR WERE THEN FEASIBLY AVAILABLE AND IN THE JUDGMENT OF THE DIRECTOR DELAY WOULD BE OR WOULD HAVE BEEN HAZARDOUS, THE DIRECTOR IS AUTHORIZED TO REIMBURSE SUCH BENEFICIARY THE REASONABLE VALUE OF SUCH SERVICE RECEIVED FROM SOURCES OTHER THAN THE BUREAU.

SUBPARAGRAPH 10 OF THE SAME SECTION (ACT OF JUNE 7, 1924, 43 STAT. 620, AS AMENDED BY THE ACTS OF MARCH 4, 1925, 43 STAT. 1307, AND JULY 2, 1926, 44 STAT. 796) PROVIDES FOR HOSPITALIZATION OF VETERANS OF ANY WAR, ETC., WITHOUT REGARD TO THE NATURE OR ORIGIN OF THEIR DISABILITY.

REVIEW OF THESE STATUTORY PROVISIONS DISCLOSES THAT THERE ARE THREE GENERAL CLASSES OF MEDICAL AND HOSPITAL TREATMENT AUTHORIZED, VIZ:

(1) AS INCIDENT TO RECEIPT OF DISABILITY COMPENSATION.

(2) FOR SERVICE-CONNECTED NONCOMPENSABLE DISABILITIES NOT INCIDENT TO ANY OTHER BENEFITS UNDER THE STATUTE.

(3) VETERANS OF ANY WAR, ETC., FOR ANY DISEASE OR DISABILITY, WITHOUT REGARD TO THE NATURE OR ORIGIN THEREOF.

IT HAS BEEN REPEATEDLY HELD THAT MEDICAL AND HOSPITAL TREATMENT UNDER THE WAR RISK INSURANCE ACTS AND THE WORLD WAR VETERANS' ACT WAS TO BE FURNISHED IN KIND PRIMARILY THROUGH GOVERNMENTAL AGENCIES AND SUBSEQUENT TO AUTHORIZATION BY THE VETERANS' BUREAU. THIS IS EQUALLY APPLICABLE TO ALL THREE CLASSES OF TREATMENT. BUT THE STATUTE CLEARLY RECOGNIZES THAT UNDER CERTAIN CIRCUMSTANCES THE FIRST TWO CLASSES OF TREATMENT MAY BE FURNISHED THROUGH OTHER THAN GOVERNMENTAL FACILITIES. THE THIRD CLASS IS, GENERALLY SPEAKING, A SERVICE AUTHORIZED TO BE FURNISHED ONLY IN KIND THROUGH GOVERNMENTAL FACILITIES.

NOTWITHSTANDING THE ABSENCE OF ANY EXPRESS PROVISION OF LAW, WELL ESTABLISHED PRECEDENT OF THIS OFFICE RECOGNIZED, FOR PERIODS PRIOR TO JUNE 7, 1924, THAT IN THE FIRST CLASS OF TREATMENT, VIZ, WHEN GIVEN BENEFICIARIES INCIDENT TO THE RECEIPT OF DISABILITY COMPENSATION, REIMBURSEMENT WAS AUTHORIZED FOR TREATMENT PROCURED THROUGH PRIVATE SOURCES IN AN EMERGENCY OR IN IGNORANCE OF RIGHTS TO GOVERNMENTAL TREATMENT. THIS RIGHT WAS NEVER RECOGNIZED AS TO THE SECOND OR THIRD CLASS OF TREATMENTS. BECAUSE THE PROVISION OF SUBPARAGRAPH (9) OF SECTION 202, ABOVE QUOTED, RECOGNIZED ONLY EMERGENCY CLAIMS, IGNORANCE OF RIGHTS TO GOVERNMENTAL TREATMENT IS NO LONGER CONSIDERED FOR PERIODS SUBSEQUENT TO JUNE 7, 1924, AS A PROPER BASIS FOR ANY REIMBURSEMENT CLAIM. (SEE 5 COMP. GEN. 655). AS THE STATUTORY PROVISION WHICH NOW EXPRESSLY RECOGNIZES REIMBURSEMENT CLAIMS FOR TREATMENT PROCURED THROUGH PRIVATE SOURCES IN AN EMERGENCY WHEN VETERANS' BUREAU FACILITIES ARE NOT FEASIBLY AVAILABLE IS FOUND IN THE SUBPARAGRAPH AUTHORIZING THE SECOND CLASS OF TREATMENT, IT IS CLEAR THAT PERSONS ENTITLED TO TREATMENT OF THAT CLASS--- THAT IS, FOR A SERVICE-CONNECTED NONCOMPENSABLE DISABILITY--- MAY BE REIMBURSED FOR TREATMENT PROCURED THROUGH PRIVATE SOURCES IN ANY EMERGENCY,WHEN NO VETERANS' BUREAU FACILITIES WERE FEASIBLY AVAILABLE, ON THE SAME BASIS AS BENEFICIARIES IN RECEIPT OF DISABILITY COMPENSATION. BUT AS THE RIGHT HAS NEVER BEEN RECOGNIZED FOR PERIODS PRIOR TO JUNE 7, 1924, WITH RESPECT TO THE SECOND CLASS OF TREATMENT, THERE WOULD APPEAR TO BE NO LEGAL BASIS NOW FOR ALLOWING CLAIMS OF THIS CHARACTER FOR ANY PERIODS PRIOR TO THAT DATE.

THE SPECIFIC QUESTIONS SUBMITTED WILL BE ANSWERED IN THE ORDER STATED:

(A) THIS QUESTION HAS BEEN ANSWERED IN THE GENERAL STATEMENTS HEREINBEFORE MADE.

(B) YES.

(C) YES. REIMBURSEMENT IN THE FIRST AND SECOND CLASSES OF TREATMENT SHOULD BE ON THE SAME BASIS. IT WOULD BE UNREASONABLE TO SUPPOSE THAT THE CONGRESS WOULD HAVE INTENDED TO GRANT A GREATER PRIVILEGE WITH RESPECT TO MEDICAL AND HOSPITAL TREATMENT TO BE GIVEN TO VETERANS WHOSE DISABILITIES ARE NONCOMPENSABLE THAN TO VETERANS WHOSE DISABILITIES ARE COMPENSABLE. (D) YES. IN THIS CONNECTION, HOWEVER, IT HAS BEEN HELD THAT EMERGENCY DENTAL TREATMENT CONTEMPLATES ONLY THE RELIEF OF PAIN. (3 COMP. GEN. 248, 250.)

IN THE CASE OF LESTER G. BLAIS THE FACTS SUBMITTED DISCLOSE THAT HE HAD A SERVICE-CONNECTED NONCOMPENSABLE DISABILITY; THAT HE RECEIVED EMERGENCY DENTAL RELIEF, THE NATURE OF WHICH AS DESCRIBED WOULD REASONABLY APPEAR TO HAVE BEEN FOR THE RELIEF OF A PAINFUL CONDITION; THAT THE PERIOD INVOLVED- -- OCTOBER 20, 1924, TO FEBRUARY 24, 1925--- WAS LESS THAN ONE YEAR PRIOR TO THE RATING MADE ON MARCH 23, 1925, AND CONSEQUENTLY ONE YEAR PRIOR TO FILING OF CLAIM; THAT THE ENTIRE PERIOD WAS SUBSEQUENT TO JUNE 7, 1924; AND THE VETERANS' BUREAU HAS FOUND THAT NO BUREAU FACILITIES WERE FEASIBLY AVAILABLE.

ON THE BASIS OF YOUR SUBMISSION REIMBURSEMENT OF THE NECESSARY EXPENSES INCURRED FOR THE EMERGENCY TREATMENT WOULD BE AUTHORIZED.