B-5971, APRIL 15, 1940, 19 COMP. GEN. 859

B-5971: Apr 15, 1940

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MEDICAL TREATMENT - OFFICERS' RESERVE CORPS PYORRHEA IS NOT A DISEASE CONTRACTED "IN LINE OF DUTY WHILE ON ACTIVE DUTY. RECORDS OF THE DEPARTMENT SHOW THAT LIEUTENANT DONAN WAS ON ACTIVE DUTY WITH THE CIVILIAN CONSERVATION CORPS FROM APRIL 16. " AND RECOMMENDATION WAS MADE FOR . THAT THE DISEASE WAS CONTRACTED IN LINE OF DUTY AND WAS NOT DUE TO MISCONDUCT. THE REPORT OF THE BOARD WAS APPROVED BY THE WAR DEPARTMENT ON FEBRUARY 24. AS IS NECESSARY FOR THE APPROPRIATE TREATMENT OF SUCH * * * DISEASE. LIEUTENANT DONAN IS ENTITLED TO TREATMENT AT PUBLIC EXPENSE UNTIL THE DISABILITY RESULTING FROM THE DISEASE CANNOT BE MATERIALLY IMPROVED BY FURTHER TREATMENT. THE DEPARTMENT IS IN RECEIPT OF YOUR DECISION B-4634.

B-5971, APRIL 15, 1940, 19 COMP. GEN. 859

MEDICAL TREATMENT - OFFICERS' RESERVE CORPS PYORRHEA IS NOT A DISEASE CONTRACTED "IN LINE OF DUTY WHILE ON ACTIVE DUTY," WITHIN THE MEANING OF THE ACT OF JUNE 15, 1936, 49 STAT. 1507, PROVIDING FOR MEDICAL TREATMENT, ETC., OF MEMBERS OF THE OFFICERS' RESERVE CORP, UNDER SPECIFIED CONDITIONS, FOR DISEASES SO CONTRACTED.

ASSISTANT COMPTROLLER GENERAL ELLIOTT TO THE SECRETARY OF WAR, APRIL 15, 1940:

THERE HAS BEEN CONSIDERED YOUR LETTER OF SEPTEMBER 5, 1939, AS FOLLOWS:

REQUEST HAS BEEN MADE BY ST LIEUTENANT DAVID C. DONAN, JR., FA RESERVE, NOW INACTIVE, FOR DENTAL TREATMENT ON ACCOUNT OF PYORRHEA CONTRACTED WHILE ON ACTIVE DUTY WITH THE CIVILIAN CONSERVATION CORPS.

RECORDS OF THE DEPARTMENT SHOW THAT LIEUTENANT DONAN WAS ON ACTIVE DUTY WITH THE CIVILIAN CONSERVATION CORPS FROM APRIL 16, 1936, TO OCTOBER 15, 1938; THAT PHYSICAL EXAMINATION UPON RELIEF FROM ACTIVE DUTY SHOWED THAT HE HAD "PERIODONTOCLASIA, MEDIUM," AND RECOMMENDATION WAS MADE FOR ,TREATMENT BY HOME DENTIST.' ON NOVEMBER 25, 1938, LIEUT. DONAN REQUESTED TREATMENT AT GOVERNMENT EXPENSE. A BOARD OF OFFICERS, CONVENED UNDER THE PROVISIONS OF PAR. 2E (1), AR 35-3420, FOUND THAT HE DEVELOPED PYORRHEA WHILE ON EXTENDED ACTIVE DUTY WITH THE CIVILIAN CONSERVATION CORPS, AND THAT THE DISEASE WAS CONTRACTED IN LINE OF DUTY AND WAS NOT DUE TO MISCONDUCT. THE REPORT OF THE BOARD WAS APPROVED BY THE WAR DEPARTMENT ON FEBRUARY 24, 1939.

ACT OF JUNE 15, 1936 (49 STAT. 1507), PROVIDES IN PERTINENT PART AS FOLLOWS:

" * * * MEMBERS OF THE OFFICERS' RESERVE CORPS * * * WHO * * * CONTRACT DISEASE IN LINE OF DUTY WHILE ON ACTIVE DUTY UNDER PROPER ORDERS IN TIME OF PEACE * * * SHALL, UNDER SUCH REGULATIONS AS THE PRESIDENT MAY PRESCRIBE, BE ENTITLED, AT GOVERNMENT EXPENSE, TO SUCH HOSPITALIZATION, REHOSPITALIZATION, MEDICAL AND SURGICAL CARE, IN HOSPITAL AND AT THEIR HOMES, AS IS NECESSARY FOR THE APPROPRIATE TREATMENT OF SUCH * * * DISEASE, UNTIL THE DISABILITY RESULTING FROM SUCH * * * DISEASE CANNOT BE MATERIALLY IMPROVED BY FURTHER HOSPITALIZATION OR TREATMENT, * * * .' UNDER THE TERMS OF THE STATUTE QUOTED, LIEUTENANT DONAN IS ENTITLED TO TREATMENT AT PUBLIC EXPENSE UNTIL THE DISABILITY RESULTING FROM THE DISEASE CANNOT BE MATERIALLY IMPROVED BY FURTHER TREATMENT.

THE DEPARTMENT IS IN RECEIPT OF YOUR DECISION B-4634, JULY 21, 1939, WHEREIN YOU HELD THAT ST LIEUTENANT ROBERT E. PATNAUDE, CAV-1RES., WHO CONTRACTED DIABETES MELLITUS IN LINE OF DUTY WHILE ON ACTIVE DUTY WITH THE CIVILIAN CONSERVATION CORPS, WAS NOT ENTITLED, UNDER THE PROVISIONS OF ACT OF JUNE 15, 1936, TO MEDICINES AND PERIODIC CHECK-UP AT PUBLIC EXPENSE SUBSEQUENT TO TERMINATION OF ACTIVE DUTY, SINCE THE EVIDENCE SHOWED THAT THE OFFICER HAD RECEIVED MAXIMUM BENEFITS OF HOSPITALIZATION AND TREATMENT, INSOFAR AS REMOVAL OF THE CAUSE OF DISABILITY IS CONCERNED, PRIOR TO TERMINATION OF ACTIVE DUTY. THE SURGEON GENERAL, IN EXAMINATION OF THE DONAN CASE, HAS STATED THAT SINCE LIEUTENANT DONAN APPARENTLY RECEIVED NO TREATMENT IN CONNECTION WITH THE DIAGNOSIS OF PYORRHEA PRIOR TO HIS DISCHARGE FROM ACTIVE DUTY IT COULD NOT BE SAID THAT HE HAD RECEIVED MAXIMUM BENEFITS OR REACHED THE MAXIMUM IMPROVEMENT POSSIBLE, AS IN THE PATNAUDE CASE; THAT THE CASES WERE CONSIDERED OTHERWISE ANALOGOUS IN THAT THE DISEASES WERE CHRONIC AND HAD NO KNOWN "CURE"; AND THAT IN ALL PROBABILITY LIEUTENANT DONAN WOULD REQUIRE PERIODIC TREATMENT AND CHECK-UP FOR MANY YEARS TO COME, OR UNTIL HIS TEETH WERE ULTIMATELY LOST THROUGH EXTRACTION. THE SURGEON GENERAL HAS STATED FURTHER THAT THE X-RAY OF THE PATIENT'S MOUTH INDICATES THAT THE $50 ESTIMATE OF THE CIVILIAN DENTIST FOR THE TREATMENT NOW STATED TO BE NECESSARY IS REASONABLE.

IN THE EVENT LIEUTENANT DONAN IS ENTITLED AT PUBLIC EXPENSE TO DENTISTRY NOW STATED TO BE NECESSARY ON ACCOUNT OF PYORRHEA CONTRACTED IN LINE OF DUTY WHILE ON ACTIVE DUTY, AND FOR WHICH HE HAS APPARENTLY RECEIVED NO TREATMENT PRIOR TO TERMINATION OF ACTIVE DUTY, THE ADDITIONAL QUESTION ARISES WHETHER THE COST THEREOF IS PROPERLY CHARGEABLE TO CIVILIAN CONSERVATION CORPS FUNDS OR TO FUNDS OF THE ORGANIZED RESERVES. IN THIS CONNECTION, ATTENTION IS INVITED TO THE FACT THAT SALARIES OF RESERVE OFFICERS ON DUTY WITH THE CIVILIAN CONSERVATION CORPS AND EXPENSES FOR THEIR TREATMENT (IF ANY) WHILE ON SUCH DUTY ARE CHARGEABLE TO CIVILIAN CONSERVATION CORPS FUNDS (SEE PARS. 101 AND 112D, C.C.C. REGULATIONS, WAR DEPARTMENT, ISSUE OF DECEMBER 1, 1937), WHILE THE SALARIES OF RESERVE OFFICERS ON DUTY WITH THE REGULAR ARMY AND ACCOUNTS FOR THEIR TREATMENT ARE CHARGEABLE TO FUNDS FOR THE ORGANIZED RESERVES.

IT IS REQUESTED THEREFORE THAT YOU GIVE THESE MATTERS YOUR CONSIDERATION AND ADVISE THE DEPARTMENT OF YOUR DECISION ON THE FOLLOWING POINTS:

(1) WHETHER UNDER THE ACT OF JUNE 15, 1936, LIEUTENANT DONAN IS ENTITLED TO TREATMENT FOR PYORRHEA NOW STATED TO BE NECESSARY.

(2) IN THE EVENT THE ANSWER TO THE FOREGOING QUESTION IS IN THE AFFIRMATIVE, DECISION IS REQUESTED AS TO THE FUNDS TO BE CHARGED WITH THE EXPENSE INCIDENT TO HIS TREATMENT, THAT IS, CIVILIAN CONSERVATION CORPS OR ORGANIZED RESERVES FUNDS.

ACCORDING TO THE FACTS PRESENTED IT APPEARS THAT THE RESERVE OFFICER HAD BEEN ON CONTINUOUS ACTIVE DUTY WITH THE CIVILIAN CONSERVATION CORPS FOR FIVE CONSECUTIVE 6-MONTH TOURS, TOTALING 2 1/2 YEARS, AND IT IS INTIMATED, ALTHOUGH NOT DEFINITELY STATED, THAT THERE WAS NO TREATMENT FURNISHED INCIDENT TO A DISABILITY THE RESULT OF THE DENTAL CONDITIONS SPECIFIED IN YOUR LETTER. IT IS UNDERSTOOD THAT THE CONDITION KNOWN AS "PYORRHEA," INVOLVING THE TEETH AND GUMS, IS AN ABNORMAL CONDITION IN THE HUMAN BODY. AS TO ITS CAUSE, WARD, J. AM. DENTAL ASSO. 1923 X, 477, SAYS:

THE FOREMOST UNDERLYING CAUSE OF PYORRHEA IS, FIRST NOT TRAUMATIC OCCLUSION BUT INHARMONIOUS OCCLUSION BROUGHT ABOUT BY INHARMONIOUS SHAPES OF THE ARCHES, INHARMONIOUS TOOTH FORMS, AND WEAR OF THE OCCLUSAL SURFACES OF THE TEETH. THAT IS, ORDINARILY THE PREDISPOSING CONDITIONS WHICH USUALLY OR FREQUENTLY PRODUCE THE CONDITION DESCRIBED AS PYORRHEA DEVELOP DURING CHILDHOOD AND ARE PRESENT WHEN THE PERSON REACHES MANHOOD. IT IS UNDERSTOOD THAT THE EARLY STAGE OF THE CONDITION IS NOT ORDINARILY DISCOVERABLE AND THAT THE CONDITION SLOWLY BECOMES APPARENT AS THE INHARMONIOUS OCCLUSION CREATES THE IRRITATION INDUCING THE INFLAMMATION OF THE PERIDENTAL MEMBRANE. ALSO, IT IS UNDERSTOOD THAT, USUALLY, ONE TREATMENT OR A SINGLE COURSE OF TREATMENTS WILL NOT PERMANENTLY RELIEVE THE CONDITION AND THAT UNLESS TREATMENTS ARE SUCCESSFUL THE CONDITION WILL, IN MOST CASES, RESULT IN THE LOSS OF TEETH NECESSITATING PROSTHESIS. THEREFORE, IT WOULD BE DIFFICULT, IF NOT IMPOSSIBLE, TO DETERMINE WHETHER A PERSON WITH SUCH A PREDISPOSITION HAD OR DID NOT HAVE PYORRHEA WHEN AFTER ATTAINING HIS MAJORITY, HE ENTERED ON ACTIVE DUTY AS AN OFFICER OF THE RESERVE CORPS.

IN VIEW OF THE CAUSE AND COURSE OF DEVELOPMENT OF PYORRHEA AS UNDERSTOOD AND AS INDICATED ABOVE THE CONCLUSION MUST BE THAT IT IS NOT A DISEASE CONTRACTED "IN LINE OF DUTY WHILE ON ACTIVE DUTY" WITHIN THE MEANING OF THE PROVISION OF THE ACT OF JUNE 15, 1936, QUOTED IN YOUR LETTER, SUPRA. ACCORDINGLY, YOUR FIRST QUESTION IS ANSWERED BY SAYING THAT LIEUTENANT DONAN IS NOT ENTITLED TO TREATMENT FOR PYORRHEA AT THE EXPENSE OF THE UNITED STATES. HENCE, IT IS NOT NECESSARY TO ANSWER YOUR SECOND QUESTION.