The Relation of Earning Power to Award 
 of Compensation for Disability Incurred in 
 Military or Naval Service 
 
 A Memorandum on the Pensions Practice oi Other Nations 
 
 Prepared at the request of the Bureau of War Risk Insurance 
 by the Red Cross Institute for Crippled and Disabled Men 
 
 By Douglas C. McMurtrie 
 
 niYmnr 
 
 
 JUN 21 
 
 mm 
 
 New York 
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The Relation of Earning Power to Award of Compensation 
 for Disability Incurred in Military or Naval Service 
 
 One of the most important factors in the administration of compensation or 
 pensions for disability incurred in military or naval service is the determination as 
 to whether or not earning capacity shall influence the amount of the award. 
 
 Because the fundamental object of national pensions has been to compensate 
 a man for a loss in effectiveness and capability due to active service, it has been 
 a natural deduction that the amount of the pension should be based on the actual 
 reduction in earning power, and that where an injured man has been able to return 
 to employment in which he earns as much or more than he did before the injury, 
 no prejudice to effectiveness has ensued, and no pension, therefore, should be paid. 
 
 On the argument that the country should not be expected to pay compensation 
 for an economic handicap when no economic handicap exists, the practice of making 
 pension dependent on earning power might be regarded as sound, were it not for 
 a vital social consideration. A man returns from the war with health or strength 
 impaired, and is awarded a pension based on the average expectation of loss of 
 earning power of a man in his physical condition. Being a man of character and 
 ambition, however, he is not content to remain idle, so he seeks assiduously for a 
 job which he can fill, finds it, and starts to work. Upon making report of his earn¬ 
 ings—though his state of health be no better, and perhaps worse—his pension 
 is suspended. It is certain that an average man who has once lost his compensa¬ 
 tion on account of getting a job will never make the same mistake again. 
 
 Yet it is infinitely to the advantage of the community that the idle man shall 
 be set to work; that the inactive consumer be made a producer. And the loafer 
 in the making is a much greater liability to the community than the obligation for 
 the pension payments. This consideration has led, in experience, to the almost 
 universal decision that pension should not be influenced adversely by a man’s 
 earnings; that the injured ex-service man should receive every encouragement to 
 return to employment. 
 
 There is another argument in favor of this decision: that impaired physical con¬ 
 dition always involves personal inconvenience, and usually imposes limitations on 
 range of activity in both work and play. This is a distinct loss to the individual, 
 and it seems fair that the government should pay compensation on this basis alone. 
 The man who has developed active tuberculosis in the military service can never 
 again be quite free from the bondage of a hundred precautions. Life will not mean 
 quite as much as it did before. The soldier who has lost one leg through ampu¬ 
 tation will forever be subject to the inconvenience of his stump chafing in hot 
 weather, and he will never again be able to play a game of tennis, although he may 
 be able to attain a weekly wage as great as that earned prior to enlistment. 
 
 1 2 ] 
 
7 Qk 
 
 3S/- 
 
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 With respect to cases of specific permanent disability, whether partial or total, 
 there has been practical unanimity of decision among the belligerent nations that 
 compensation award should be fixed and irrevocable, and not influenced by earnings 
 or earning power. The specific disabilities are typified by amputations, blind¬ 
 ness, etc. The ruling of the United States has been clear and satisfactory with 
 respect to such disabilities.* 
 
 With respect to non-specific disabilities the decision has not followed quite 
 the same rule, and compensation has been cancelled in some cases when it was 
 shown the claimant had returned to work. Among the non-specific disabilities are 
 scores of a medical nature, typically represented by pthisis, cardiac insufficiency, 
 kidney difficulties, etc. Should these disabilities also be compensated on the basis 
 of medical evidence alone, without respect to the current earnings of the claimant? 
 It is possible that the experience of the allied nations may provide evidence helpful 
 to a wise determination on this point. 
 
 As will be evident from the subjoined memoranda on the pensions practice of 
 our allies, there has been substantially complete unanimity of decision that earning 
 should have no influence on the award in cases of non-specific as well as in cases 
 of specific disabilities. 
 
 Most of the countries learned early that such a ruling must be made if there 
 were to be any degree of success with the programs of re-education looking toward 
 returning the injured men as self-supporting members of the community. Great 
 Britain altered her practice later than the others, but meanwhile developed a most 
 convincing demonstration of the necessity of the change. And once the important 
 decision was made, there was energetic educational effort, through posters, leaflets, 
 press articles, and the like, to bring the ruling to the knowledge of the men in 
 military and naval service. 
 
 The general consensus of experience has, in effect, developed the principle that 
 pensions or compensation authorities have no concern whatever in the earnings of 
 the claimant, and that the amount of the individual’s earnings should not even be 
 asked. The corollary to this principle is, of course, that the award should be 
 based wholly on medical or surgical record or examination. 
 
 The following memoranda on the practice of several countries have been pre¬ 
 pared in the Research Department of the Red Cross Institute for Crippled and 
 Disabled Men. The source of the data is in all instances indicated by footnotes. 
 
 FRANCE 
 
 Up to the passage of the new French pension law in March of this year, a French 
 soldier, disabled as a result of service, received either a pension or a gratuity. Pensions 
 were governed by the law of 1831 and were granted only for a disability which was 
 adjudged incurable and of a certain degree of gravity. 1 Indemnities for lesser disabilities 
 and for disabilities of any degree which could not be definitely pronounced incurable 
 
 1 Loi. 11 avril, 1831, art. 12, 13, 14. In: Valentino, Ch. Militaires blesses et infirmes. Reformes, 
 gratifications, et pensions. Paris, 1918, p. 47-48. 
 
 [ 3 ] 
 
were governed by the decree of March 24, 1915, and were called renewable gratuities. 
 By this decree renewable gratuities were divided into eight classes, corresponding to 
 proportional decreasing reductions of the normal working capacity. Total abolition 
 of the working capacity, 80 per cent, reduction, or 60 per cent, reduction, not, however, 
 incurable, entitled a man to a gratuity of the first, second, or third class, respectively. 
 Reductions of from 50 to 10 per cent., incurable or not, entitled to gratuities of the 
 fourth to the eighth class. 2 The disability had to occasion at least 10 percent, reduction 
 of the working capacity to be entitled to any gratuity; if it occasioned 60 per cent, or 
 over, and was incurable, it entitled to a pension. 
 
 The amounts of the different classes of gratuities were fixed by the same decree, 
 modified by the decree of December 29, 1917. They ranged for a private soldier from 
 100 francs a year for a 10 per cent, disability to 1,200 francs for total disability. For 
 the same degree of disability they conformed to the scale of pensions. 
 
 In the new pension law the word gratuity is replaced by temporary pension, and the 
 only distinction between the permanent pension and the temporary pension is in the 
 matter of incurability. A man is entitled to a permanent pension “when the disability 
 caused by the wound or sickness is recognized to be incurable”; to a temporary pension 
 “when the disability is not recognized to be incurable.” 3 This new law also abolishes 
 the eight classes of gratuities and the old pension scale, and grades permanent and tem¬ 
 porary pensions by a scale of disability increasing by fives from 10 to 100 per cent. 4 
 The amounts range, for a private, from 240 to 2,400 francs a year. 
 
 The amount of the gratuity, now called the temporary pension, has depended 
 wholly upon the man’s physical condition, that is, upon the gravity of his injury, as 
 determined by the medical examiners of the Discharge Commission. It has been the 
 duty of the examiners to pronounce on the origin, gravity, and curability of the dis¬ 
 ability, and on the basis of the facts to propose the man for a certain pension or gratuity. 5 
 In deciding what reduction of the working capacity is occasioned by a given condition, 
 or in other words what should be the amount of the indemnity, the medical examiners 
 were first instructed ( Instruction du 20 avril 1915) to refer to the figures established by 
 the application of the workmen’s compensation law. 6 It was soon seen, however, that 
 such instructions were insufficient to secure uniformity in the estimation of disabilities; 
 men with the same injuries were differently rated by different physicians. To avoid 
 the injustice and the inevitable demands for revision resulting from this situation, 
 the Commission Consultative Medicate of the War Department drew up a table ( Guide - 
 Bartme des Invalidity) which listed in detail the different injuries and indicated the 
 corresponding reduction of working capacity. The object, as the introduction to the 
 tables states, was not to impose upon the examining physicians a fixed evaluation of 
 each injury but to furnish, as the name implied, a guide which would contribute toward 
 securing uniformity. 
 
 2 Decret du 24 mars, 1915. In: Dalloz. Guerre de 1914. Documents officiels. Paris, 1915, iv, 50-51. 
 
 3 Obelliane, E. Les pensions des victimes de la guerre. Nouvelle loi du 31 mars 1917 sur les pensions 
 militaires. Paris, 1919, p. 6. 
 
 4 Ibid., p. 8. 
 
 6 Valentino, Ch. Militaires blesses et infirmes. Reformes, gratifications, et pensions. Paris, 1918, 
 p. 106-107. 
 
 9 France. Ministlre de la Guerre. Guide-bareme des invalidites. Paris, 1917, p. 3. 
 
 14] 
 
Diseases which may have been contracted or aggravated by reason of service are 
 included in the table, but the French practice in the early days of war was to consider 
 disability caused by disease non-attributable and to discharge such cases without pen¬ 
 sion. The new law makes sickness attributable unless the state can prove the contrary. 7 
 A new Guide-Bareme has been issued to go with the new pension law. 
 
 The renewable gratuity was granted for two years, and at the end of that time the 
 recipient was required to appear before the Discharge Commission and to undergo a new 
 medical examination. On the basis of the findings of the doctors the gratuity was then 
 renewed for another two years—at the same rate if there had been no change in the 
 condition, at a higher rate if the condition were worse, at a lower rate if it had improved. 
 If the disability was recognized to be incurable, the gratuity was converted into a life 
 pension; in case of a cure, it was discontinued entirely. 8 
 
 The temporary pension of the new law is similarly granted and reviewed, but after 
 four years at the most the condition of the pensioner is to be considered permanent and 
 the temporary pension either converted into a permanent one or discontinued. The 
 new law also provides that “any recipient of a temporary pension who experiences a 
 new complication or an aggravation of his disability can without waiting for the expira¬ 
 tion of the two-year period send in a demand for revision which must be acted upon 
 within two months.” 9 
 
 It is apparent, therefore, that the amount of the gratuity or temporary pension is 
 not, either when it is first granted or when it is renewed, conditioned by what the man 
 does or will earn. On this point M. Alexandre Lefas, deputy from Ille-et-Vilaine, in 
 a report on French pensions presented to the Inter-Allied Conference in London in May 
 of 1918, is specific and clear. He says: “Note that in virtue of the military laws the 
 pension or gratuity due a disabled man is calculated solely on the basis of his disability 
 and his rank, without consideration of what he may still earn by working.” 10 Speaking 
 before the Conference, M. Lefas added, “We have a medical table which fixes the rate 
 of disability according to the wound. As a matter of fact what is considered is not the 
 incapacity for work; for the disability pension is independent of the wages the man may 
 earn by working and should be the same for all men of the same rank who have the 
 same wound.” 11 
 
 The fear that the pension would be reduced if the earning capacity were increased 
 operated, however, during the early years of the war to deter many disabled soldiers from 
 taking re-educational training, and it was necessary for the government to combat this 
 fear by repeated announcement of the real facts. A notice prepared by the Office Na¬ 
 tional des Mutiles et Reformes de la Guerre with the object of inducing more men to enter 
 the re-educational schools, and signed by the two presidents of the Office, the Minister 
 
 7 Obelliane, E. Les pensions des victimes de la guerre. Nouvelle loi du 31 mars 1917 sur les pensions 
 militaires. Paris, 1919, p. 7. 
 
 8 Valentino, Ch. Militaires blesses et infirmes. Reformes, gratifications, et pensions. Paris, 1918, 
 p. 139-140. 
 
 9 Obelliane, E. Les pensions des victimes de la guerre. Nouvelle loi du 31 mars 1917 sur les pensions 
 militaires. Paris, 1919, p. 7. 
 
 10 Inter-Allied Conference (the) on the After-Care of Disabled Men. Reports presented to 
 the conference. London, 1918, p. 27. 
 
 11 Inter-Allied Conference (the) on the After-Care of Disabled Men. Supplement to volume 
 of reports. London, 1918, p. 24. 
 
of Labor and the Under-Secretary of State for the Health Service, states that “whatever 
 their trade or their earnings, in no case will the pension of wounded soldiers be dimin¬ 
 ished [through re-education], even if they earn more than before being wounded.” 12 
 Another notice on conditions of admission into vocational schools, issued by the Depart¬ 
 mental Committees and based on circulars of the Ministers of War and the Interior, 
 says: “The amount of the pension depends solely on the medical declaration of dis¬ 
 ability. In no case can it be modified by reason of the fact that the beneficiary has 
 been re-educated. The amount of the gratuity may always be revised, in accordance 
 with the functional condition, whether the soldier is re-educated or not.” 13 This prin¬ 
 ciple was finally made law by being incorporated in the Re-educational Act of January 
 2, 1918, article eight of which reads: “In no case can the amount of the pension be 
 reduced because of vocational re-education or readaptation to work.” 14 
 
 GREAT BRITAIN 
 
 Previous to the issuance of the Royal Warrant of 1917, British pensions were based 
 upon the decrease in earning capacity caused by the disablement. 1 Upon his discharge 
 a disabled soldier appeared before a medical board which made a rough estimate of his 
 decreased earning capacity and awarded a corresponding temporary pension. After 
 a time, perhaps in six months, he would be re-examined, and if his earning power had 
 been increased through training or he had been able to secure remunerative employment, 
 his pension might be decreased. 
 
 The new Warrant discarded this principle and based the amount of the pension 
 entirely upon the soldier’s rank and the degree of his physical impairment. 2 In a schedule 
 attached to the Warrant certain specific injuries are graded as from 20 to 100 per cent, 
 disabling, and the pensions corresponding to these different degrees of disablement are 
 fixed. For other injuries and for disease it is provided that the pension shall be “assessed 
 at the degree in the schedule which is held most closely to represent the disablement 
 corresponding to the injury or disease.” 3 The pension scale ranges for a private soldier 
 from 5s 6 d to 21s 6d a week. Men whose disablement is assessed at less than 20 per cent, 
 receive a gratuity, or temporary allowance, depending in amount on the extent of the 
 disablement but not to exceed £200. 4 
 
 The pensions granted under this Warrant may be either permanent or temporary. 
 A permanent pension is granted when the disability is fixed and permanent: that is, 
 when no change for the better or worse may be expected. A temporary pension is granted 
 
 12 France. Office National des MutilSs et Reformes de la Guerre. Bulletin no. 1. Annee 1916. Paris, 
 
 1917, p. 11. 
 
 13 Ibid., p. 167. 
 
 14 France. Office National des Mutiles et ReformSs de la Guerre. Bulletin no. 3. Premier semestre 
 
 1918. Paris, 1918, p. 3. 
 
 1 Williams, Basil. Pensions. Recalled to Life, London, 1917, i, 97. 
 
 2 Great Britain. Ministry of Pensions. The drafts of a royal warrant and of an order in council 
 for the pensions of soldiers and sailors disabled and of the families and dependants of soldiers and sailors 
 deceased in consequence of the present war. London, 1917, (cd. 8485), p. 11. 
 
 3 Ibid., art. 1. 
 
 4 Ibid., art. 7. 
 
 [ 6 ] 
 
at the rate appropriate to the temporary disablement when the disablement has not 
 reached its final condition. 5 
 
 These provisions remain unchanged by the Royal Warrant of 1918. 
 
 The amount and kind of disablement pension due a man are determined by a Medi¬ 
 cal Board on the basis of a medical examination and the case history. Men who receive 
 temporary pensions are thereafter re-examined periodically—usually at intervals of 
 from six months to a year—by Medical Boards, and their pensions are reassessed to 
 correspond to any change that may have occurred in the degree of disability. As soon 
 as the condition is judged permanent, a permanent pension is granted. 6 If the dis¬ 
 ability becomes worse before the time set for re-examination, the Local War Pensions 
 Committee, on the advice of its medical referee, can make advances to the man until 
 the next reassessment. 
 
 The Warrant of 1917 states expressly that “when a permanent pension has been 
 granted it shall not be altered on account of any change in the man’s earning capacity, 
 whether resulting from training or other cause.” 7 The men evidently feared, however, 
 that their temporary pensions might be on reassessment decreased. To reassure them 
 on this point, a pamphlet issued by Major Robert Mitchell, Director of Training for 
 the Ministry of Pensions, on the advantages of training contains this statement: “Let 
 it be distinctly understood that no reduction whatever to your disablement pension can 
 be made on account of anything you may earn. A disablement pension, temporary 
 or permanent, is based solely on the degree of disability and will not in any way be 
 affected by the amount of a man’s wages.” 8 
 
 A man’s earnings come into the question only if he applies for an alternative pension 
 in lieu of a disablement pension. An alternative pension may be granted on appli¬ 
 cation to a man who shows that his minimum pension with children’s allowances, added 
 to the earnings of which he remains capable (if any), is less than his pre-war earnings. 
 He may then receive a sum which added to his present average earnings will bring his 
 income up to his pre-war earnings to a maximum of 50.?, plus half of any pre-war earnings 
 between 505 and 1005 a week. 9 
 
 During a discussion of pensions in Parliament in September, 1917, Mr. Barnes, then 
 Minister of Pensions, was asked by a member: “Is it a fact that the only case in which a 
 Medical Board can ask a man his actual earnings is where they are fixing an alternative 
 pension?” Mr. Barnes’ answer, “That is the only case,” is unequivocal. 10 
 
 An official statement by the Ministry of Pensions published in the London Times 
 of February 20, 1919, takes up the question of alleged reduction of pensions. As a clear 
 and explicit statement of pension procedure it is worth quoting in full. 
 
 5 Ibid., art. 5 (1). 
 
 6 Lefevre, J. The handy guide to war pensions, gratuities and allowances. How granted and how 
 obtained. Maidstone, 1918, p. 6. 
 
 7 Great Britain. Ministry of Pensions. The drafts of a royal warrant and of an order in council 
 for the pensions of soldiers and sailors disabled and of the families and dependants of soldiers and sailors 
 deceased in consequence of the present war. London, 1917, art. 5 (2). 
 
 8 Mitchell, Robert. To disabled sailors and soldiers. A few notes on the advantages of training 
 for your future career. London, 1918, p. 4. 
 
 9 Great Britain. Ministry of Pensions. The drafts of a royal warrant and of an order in council 
 for the pensions of soldiers and sailors disabled and of the families and dependants of soldiers and sailors 
 deceased in consequence of the present war. London, 1917, art. 3. 
 
 10 War Pensions Gazette, London, 1917, i, 57. 
 
 [ 7 ] 
 
It has been repeatedly stated in various quarters that disabled men on going before medical 
 boards have their pensions cut down, the implication being that a deliberate policy of reducing pen¬ 
 sions has been instituted. The allegation is entirely unfounded. Disablement pensions are provi¬ 
 sionally awarded for a period—it may be three months, six months, or a year—at a rate corresponding 
 to the degree of disability ascertained by medical examination. On re-examination at the end of the 
 period (or before the expiry of the period in some cases, as, for instance, when the man’s condition 
 has been reported by the local medical referee to have become worse) the disability may be reassessed. 
 
 Disablement pensions being based upon the principle of compensation for injury or disease 
 arising out of war service, a disappearance or abatement of the injury or disease and the return, 
 or partial return, to normal health necessarily involve a corresponding reduction of the pension. 
 Where the pension has been reduced as the result of medical examination it is because the medical 
 board have certified an improvement in health. If, on the other hand, the man’s state of health is 
 found to have become worse owing to injury or disease arising out of his war service, a higher rate of 
 pension is awarded. If the deterioration in health occurs before the date originally fixed for re¬ 
 examination, the local War Pensions Committee, acting on the local medical referee’s report, may, 
 until the re-examination, make advances representing the difference between the pension the man 
 is receiving and the pension to which his actual condition would entitle him. These advances are 
 recoverable only when the medical referee’s report is upheld. 
 
 The re-examination actually takes place some weeks before the expiration of the period for which 
 pension is granted, and improvement in health does not mean an immediate reduction of pension, but 
 a reduction only from the date (some weeks later) when the former pension expires. 
 
 It is important to remember that the pensions with which the Ministry of Pensions deals are 
 granted because of disablement, not because of service in the war. 
 
 BELGIUM 
 
 The Belgian pension law of April 5, 1917, was passed as a temporary measure to 
 be superseded when the country should be delivered and restored. There is, therefore, 
 no object in analyzing its provisions. 
 
 ITALY 
 
 The Italian pension law of May 20,1917, divides disabilities into ten classes according 
 as they diminish the man’s capacity for profitable work from 10 to 100 per cent. A man 
 with a disability which falls into one of the first eight classes receives a life pension of 
 from 378 to 1,260 lire a year, with supplementary allowances if he is totally disabled and 
 needs an attendant. For disabilities of the ninth and tenth classes a temporary allow¬ 
 ance equal to a pension of the eighth class is granted for a period of from six months to 
 six years. 1 
 
 When the gravity of the disability or its permanent character cannot be definitely 
 determined, the law authorizes the grant of a temporary pension based on the regular 
 pension scale. This may be granted for a period of not less than one year or more than 
 five; at the end of the allotted period it may be renewed, converted into a life pension, 
 or discontinued. After eight years have passed, the condition must be considered per¬ 
 manent and the pension either made permanent or discontinued. 2 
 
 1 Per le pensioni privilegiate di guerra. Rassegna di Assicurazioni e Previdenza Sociale, Roma, 1917, 
 iv, 1268-1285. 
 
 2 Ibid., p. 1272. 
 
 [ 8 1 
 
A large number of specific disabilities are listed under the ten classes, but the law 
 recognizes that there will be cases not therein included and provides that these shall 
 be “ascribed to the class which contains disabilities causing an equivalent diminution 
 of the capacity for profitable work.” 8 Additional directions on the assessment of non- 
 specified disabilities are contained in a circular issued by the Inspector of the Military 
 Health Department to the District Directors of the Department. This directs the 
 examining doctors whose duty it is to determine “by analogy” the class of non-specified 
 disabilities to base their decision upon a consideration of the “diminished functional 
 ability resulting from loss of organs, limbs, or parts of limbs or from functional dis¬ 
 turbances.” 4 
 
 It is evident, therefore, that the amount of the pension depends on the doctors’ 
 estimation of the physical disability. That it may not be reduced on account of anything 
 the man may earn is expressly stated in article nineteen of the pension law, which reads: 
 “In accordance with the present law there can be no change in the pension granted to a 
 disabled soldier whatever degree of re-education he may have attained or whatever 
 employment he may have secured.” 5 False reports on this matter have created in the 
 Italian soldier as in his comrades of the other warring countries a reluctance to take 
 training, and it has been necessary for the government to combat these reports by num¬ 
 erous published statements. For example, a propaganda booklet issued by the ‘National 
 Board’ to inform disabled soldiers of government measures in their interest contains 
 the following: “Disabled soldiers should know that the pensions granted them by the 
 state can never be in any way diminished or discontinued whatever the recipients may 
 earn by their labor or employment.” 6 
 
 CANADA 
 
 Canadian pensions are divided into twenty classes and are awarded in direct pro¬ 
 portion to the degree of disability, which is graded from 5 to 100 per cent. The amount 
 of a pension of the first class, or a 100 per cent, disability pension, is $600 a year; of a 
 class 20 pension, for 5 per cent disability, $30. A permanent disability of less than 5 per 
 cent, entitles to a gratuity of not more than $100. 1 
 
 A man’s percentage of disability is determined by the Board of Pension Commis¬ 
 sioners on the basis of a report of his medical examination before discharge and other 
 details of his condition. The percentage that any disability bears to total disability has 
 been carefully calculated by experts. 2 For example, in the case of pulmonary tubercu¬ 
 losis the following table has been drawn up to serve as a guide in estimating the dis¬ 
 ability percentage: 
 
 3 Ibid., p. 1270. 
 
 4 Ibid., p. 1284. 
 
 6 Protezione ed assistenza degli invalidi della guerra. Rassegna di Assicurazioni e Previdenza Sociale, 
 Roma, 1917, iv, 970. 
 
 6 Opera Nazionale per la Protezione e l'Assistenza degli Invalidi della Guerra. Agli invalidi 
 della guerra. Roma, 1918, p. 13. 
 
 1 Canada. Parliament. Pension regulations for those serving in the naval forces of Canada and the 
 Canadian expeditionary force during the present war. Ottawa, 1917. 
 
 2 Reconstruction, December, 1918, p. 12. 
 
 1 9 ] 
 
TABLE FOR ESTIMATING INCAPACITY IN PULMONARY TUBERCULOSIS 
 
 N. B. When it is considered advisable, medical officers will make an estimate of disability graded 
 at any percentage other than that named in the table. The terminology used, and its assigned interpre¬ 
 tation, is that employed by the National Association for the Prevention of Tuberculosis. 
 
 Class 
 
 Condition 
 
 Clinical Description 
 
 Employability 
 
 Percentage of 
 Disability 
 
 1 
 
 Not improved 
 
 
 
 100 
 
 2 
 
 Improved 
 
 Where there has been improve¬ 
 ment sufficient to allow the use of 
 the term. 
 
 These cases will, in all likeli¬ 
 hood, relapse on any but the 
 lightest kind of work. During 
 the first six months, at least, 
 disability should be consid¬ 
 ered as total. 
 
 100 
 
 3 
 
 Quiescent 
 
 No constitutional symptoms; 
 tubercle bacilli may be present or 
 not; stationary or better in physi¬ 
 cal signs, all the foregoing having 
 been present at least two months. 
 
 Practically an active case 
 under ordinary conditions of 
 life, and should rest at least 
 75 per cent, of his time, in 
 order to carry on in fair health 
 —hence a minimum of 80 per 
 cent, for the first six months. 
 
 80-100 
 
 4 
 
 Apparently 
 
 arrested 
 
 Signs of a healed lesion without 
 any symptoms for three months. 
 
 Should rest half of his time. 
 
 50-80 
 
 5 
 
 Arrested 
 
 Signs of a healed lesion without 
 relapse at end of six months under 
 ordinary living conditions. 
 
 Should rest one-quarter of 
 his time. 
 
 25-50 
 
 6 
 
 Apparently 
 
 cured 
 
 Signs of a healed lesion without 
 relapse at end of two years under 
 ordinary living conditions. 
 
 Only limitation of employ- 
 ability is that he should avoid 
 certain occupations involving 
 undue exposure to dust and 
 debilitating conditions. 
 
 
 Note. In estimating disability the fibrosis and destruction of lung tissue, debility, and tendency to 
 relapse must be taken into account. 
 
 All pensions, except in those cases where the disability is obviously permanent, are 
 subject to periodical review. If, in reviewing a case, the medical advisors of the Board 
 of Pension Commissioners find that the man’s condition has improved or grown worse, 
 they reduce or raise the estimate of his disability percentage, and he receives a corres¬ 
 ponding decrease or increase of pension. “A pension lasts as long as the disability for 
 which it was awarded exists.” 3 
 
 Increased earnings cannot effect a reduction of the pension. On this point the 
 Pension Regulations contain the following explicit statement: "No deduction shall be 
 made from the amount awarded to any pensioner owing to his having undertaken work 
 or perfected himself in some form of industry.” 4 In other words, to quote Reconstruction, 
 the official bulletin of the Department of Soldiers’ Civil Re-establishment: “A pension 
 is compensation for disability, not payment for incapacity in any particular line or branch 
 
 8 Reconstruction, December, 1918, p. 13. 
 
 4 Canada. Parliament. Pension regulations for those serving in the naval forces of Canada and the 
 Canadian expeditionary force during the present war. Ottawa, 1917, p. 4. 
 
 [ 10 1 
 
of work—so a pensioner need not worry that his pension will be reduced if and when he 
 finds employment, or fits himself for a trade, or takes up any other means of earning a 
 livelihood.” 6 
 
 GERMANY 
 
 The German war pensions for privates and non-commissioned officers are governed 
 by the pension law of 1906. Under this law the pension is composed of several parts. 
 There is, in the first place, the military annuity {Militdr rente) , which is a pension varying 
 according to the degree of disability and to military rank. The law fixes for each rank 
 the amount of the annuity for total disability, and the annuity is in each case granted as 
 a percentage of that amount according to the degree of disability as determined by the 
 military medical pension boards. No annuity is paid if the disability is less than 10 per 
 cent. 
 
 There are, in addition, several supplementary allowances. The war allowance 
 {Kriegszulage) is paid to all those who are entitled to the military annuity as a result 
 of disability incurred in and as a result of war service; its amount (fifteen marks monthly) 
 is fixed irrespective of the degree of disability and of military rank. 
 
 The disability allowance ( Verstiimmelungszulage ) is also paid as a fixed monthly 
 amount (twenty-seven marks), irrespective of military rank, to those who have suffered 
 certain serious injuries: the loss of a hand, of a foot, the loss of speech, deafness in both 
 ears. Men blinded in both eyes receive a double allowance, as do also those who have lost 
 two limbs; in fact, the allowance is cumulative, and a soldier who has been totally blinded 
 and, in addition, has lost both arms and both legs, should receive six times the normal 
 amount. 1 The allowance may also be granted whenever the use of a limb has been im¬ 
 paired to such an extent as to make the impairment equivalent to a loss of the limb; or 
 when one eye has been lost and the other has a vision less than one-half of normal; or 
 when the man has suffered any other serious impairment of his health that necessitates 
 permanent attendance by another person; in cases of mental disease requiring institu¬ 
 tional treatment or of serious illness the amount of the allowance may be increased up 
 to fifty-four marks a month. 
 
 There are also allowances of a less general importance, as, for instance, the old age 
 allowance {Alterszulage) which is given to men of fifty-five years and over whose annual 
 income is less than 600 marks; the air service allowance {Luftdienstzulage)\ the tropical 
 service allowance (Troppenzulage) , and so on. 
 
 Of the several component parts of the pension, one, namely the war allowance, 
 cannot be reduced under any circumstances and is paid as a fixed amount as long as the 
 military annuity is paid, that is as long as there is a disability of 10 per cent, or more. 
 
 The disability allowance may be granted either permanently, if the injury may 
 by its nature be expected to be permanent, or for the duration of the injury. The former 
 is evidently the case for amputations. On the contrary, the allowance may frequently 
 be but temporary when granted for serious disease; in this case, moreover, the granting is 
 optional with the authorities, and the man has no legal claim to the allowance. 
 
 8 Reconstruction, December, 1918, p. 13. 
 
 1 Schweyer, Franz. Deutsche Kriegsfiirsorge. Berlin, 1918, p. 75. 
 
 1 11 1 
 
The military annuity is subject to revision and may, upon an application of the 
 recipient or by a ruling of the authorities, be increased, reduced, or withdrawn, if there 
 has been a “substantial change” in the conditions that determined its being granted. 
 Applications for an increase of the annuity may be made at any time. A downward 
 revision or a withdrawal may take place only once in a year. 2 “Substantial change” has 
 been defined in instructions issued in 1909 as a change in the degree of disability equal 
 to at least 10 per cent, of total disability. 3 
 
 The pension is thus partly fixed and partly variable, and the relative importance of 
 the two portions varies according to individual cases. In amputation cases the portion 
 that remains fixed will, as a rule, be considerable. Thus, for instance, a private who 
 has lost a limb and whose disability has been estimated at 50 per cent., is granted an 
 annuity of 270 marks, which will be liable to revision with every change in his condition; 
 against this the portion that will remain fixed is equal to the combined amount of the 
 war and disability allowances, namely 504 marks. On the contrary, in cases of internal 
 disease no disability allowance is granted as a rule, and consequently the variable portion 
 of the pension bears a much higher ratio to the fixed one. 
 
 The question as to whether the amount of the annuity depends upon the man’s 
 physical condition only, or whether and to what extent it may be affected by the fact 
 of his employment and by an increase in his earnings, cannot be definitely answered. 
 To denote the disability on which the annuity is based, the pension law uses the term 
 Erwerbsunfahigkeit —incapacity for gainful work. This is frequently interpreted as 
 referring to physical incapacity only. Thus, one of the foremost authorities on the 
 problem of the disabled soldier states that “a substantial change cannot be seen in the 
 fact alone that the disabled soldier is able to work for wages or that he succeeds in the 
 course of time in attaining better wage conditions. We only have such a change when 
 the physical condition of the man has permanently and substantially improved.” 4 * The 
 same interpretation, though in a less categorical form, is given in a pamphlet issued by 
 the Prussian War Ministry for the information of disabled soldiers: “The evaluation of 
 the degree of incapacity is based mainly upon the physical condition of the injured as 
 determined by the injury, and not upon his general condition or upon his trade activities 
 or the earnings derived from them. The supposition that the resumption of trade activi¬ 
 ties may in itself have as a result a decrease or a withdrawal of the pension is altogether 
 wrong.” 6 
 
 In determining the degree of incapacity in amputation cases the effect of artificial 
 limbs is taken into consideration. A higher temporary pension may be granted while 
 the man is waiting for adequate artificial limbs to be supplied. 6 
 
 On the other hand, it was possible to no less an authority than Professor Konrad 
 Biesalski to state that the annuity “is fixed according to the impairment of the earning 
 
 2 Germany. Preussisches Kriegsministerium. Obersicht iiber Versorgungs- und Fiirsorge- Angelegen- 
 heiten der Mannschaften. Berlin, 1918, p. 14. 
 
 3 Adam, M. Mannschaftsversorgung. Berlin, 1918, p. 68-69. 
 
 4 Schweyer, Franz. Deutsche Kriegsfiirsorge. Berlin, 1918, p. 78. 
 
 6 Germany. Preussisches Kriegsministerium. Ubersicht iiber Versorgungs- und Fiirsorge- Angelegen- 
 heiten der Mannschaften, Berlin, 1918, p. 6. 
 
 • Ibid., p. 15. 
 
 [ 12 ] 
 
capacity, just as in the case of industrial accidents, and this annuity may under circum¬ 
 stances be withdrawn, namely when the man works and thus proves that his earning 
 capacity is no longer limited.” 7 
 
 As a matter of fact, though it has been generally recognized in Germany that the 
 'pension psychosis’ is the greatest obstacle to the rehabilitation of the disabled, and though 
 continuous efforts have been made to overcome it by dispelling the idea that rehabili¬ 
 tation means a decreased pension, there never has been given a definite pledge, such as 
 those given in France or in Italy, that the pension would under no circumstances be 
 affected by the earnings. The assurances that have been given in Germany are much 
 more moderate and more cautious. 
 
 A Prussian ministerial circular of September, 1915, states that "a decrease or a 
 withdrawal of the annuity can only take place in the case of a substantial increase of the 
 earning capacity [underscored in the text]; to what extent employment in a gainful occu¬ 
 pation may be considered as proof of such an increase cannot be stated in a general way.” 
 The circular further points out that the payment of the war allowance will continue as 
 long as the earning capacity of the man is impaired to any measurable extent; no change 
 in the amount of the disability allowance is as a rule possible. Therefore in cases of 
 amputation, for instance, the man, “in addition to an annuity corresponding to the degree 
 of disability,” will receive the two supplementary allowances, “irrespective of the income 
 he may derive from gainful employment.” “The authorities concerned have been re¬ 
 quested, in order to facilitate an unimpeded return of the disabled to civilian life and not 
 to interfere with their vocational training and readaptation to work, which in some cases 
 may require considerable time, not to fix too short periods for the revision of the pension.” 8 
 
 In the official publication of the Prussian War Ministry devoted to the problems of 
 disabled soldiers we find mention of several provisions made to overcome the apprehension 
 of the men that to take up remunerative work may mean a reduction or a loss of the 
 pension; these provisions include assurance given to the men who may take up work 
 before the pension procedure has been completed that their earnings during the inter¬ 
 vening period will not affect the amount of the pension; the maintaining of the principle 
 that revisions shall not take place more than once a year and a recommendation to extend 
 this period, whenever this may be necessary r to two or three years or even more; the 
 issuing of special certificates to those men whose injury does not permit to expect a 
 restoration of their earning capacity to over 90 per cent, of normal, to the effect that no 
 complete withdrawal of their pension will ever take place. 9 
 
 Paul H. Peris, of the Siemens-Schuckert plant, who has been active in readapting 
 disabled soldiers to factory work gives the following statement of the relation of the 
 pension to earning capacity: “The idea is frequently found among disabled soldiers that 
 they will lose their pension if they enter employment. This idea is wrong. The war 
 allowance continues as long as there remains any reduction of earning capacity due to 
 war service; the disability allowance is paid as long as there is disability, which, as a 
 
 7 Biesalski, Konrad. Die ethische und wirtschaftliche Bedeutung der Kriegskriippelfursorge. 
 Leipzig, 1915, p. 17-18. 
 
 Fechner. Die Hinterbliebenen- und Kriegsbeschadigten-Fiirsorge in Kriegs- und Friedenszeiten. 
 Berlin, 1915, iii, 5-7. 
 
 9 Von Langerman and Erlencamp. Versorgungsfragen im Kriege. Amtliche Mitteilungen fur 
 Kriegsbeschadigte oder versorgungsberechtigte Militarpersonen und fur Hinterbliebene von Heeresangehorigen. 
 Berlin, 1917, i, 45. 
 
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general rule, means for life. As to the military annuity, it can only be decreased or 
 withdrawn if there has taken place a substantial change in the condition that had deter¬ 
 mined the granting of the pension. Substantial change there is when the physical condi¬ 
 tion of the disabled man has substantially improved, or when he has become so much 
 accustomed to his sickness or infirmity that the impairment of his earning capacity has 
 become less, as, for instance, through habituation to artificial limbs, or when his earning 
 capacity has increased through additional training. A decrease of the pension is always 
 conditioned upon the change in the degree of disability being of at least 10 per cent. The 
 military administration has repeatedly assured that the prescriptions regarding the change 
 of the amount of the pensions of the disabled would be enforced with the greatest benevo¬ 
 lence. No disabled soldier should fear that his annuity might be reduced by the amount 
 of his wages.” 10 
 
 There is one provision in the pension law by which the amount of the pension is 
 directly affected by the fact of employment. If, namely, the disabled man enters civil 
 service the payment of the portion of his pension which is equal to 20 per cent, or less of 
 that for total disability, and of that portion which exceeds 60 per cent, of that for total 
 disability, is suspended for the duration of his employment. However, an order of the 
 Imperial Chancellor, issued during the war, has exempted from this provision all state 
 and municipal employees. 11 
 
 In direct relation to earnings is the so-called supplementary pension ( Zusatzrente) 
 which may under certain conditions be paid out of a special fund created during the war 
 to disabled soldiers to cover the difference of their pre-war earnings and their present 
 total income. 12 
 
 10 Perls, Paul H. Wiederertiichtigung schwerbeschadigter Kriegsteilnehmer in der Werkstatt. 
 Zeitschrift fur Krtippelfursorge, Leipzig, 1917, x, 298-299. 
 
 11 Fiirsorge fiir Kriegsteilnehmer , Berlin, 1917, iii, 165. 
 
 13 Vom Krieg zur Friedensarbeit, Berlin, 1917, iii, 35; Schweyer, Franz. Deutsche Kriegsfiirsorge. 
 Berlin, 1918, p. 99. 
 
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