INSTRUCTIONS 
TO 
EXAMINING SURGEONS FOR PENSIONS 
18 7 3. INSTRUCTIONS 
TO 
EXAMINING SURGEONS FOR PENSIONS. 
Department of the Interior, Pension-Office, 
Washington, D. C 1872. 
SECTION I 
The duty of an examining surgeon, under existing laws, is to examine 
applicants for invalid pensions, persons claiming as invalid dependents, 
for restoration to the pension-rolls, and for increase of pensions; also, 
to examine enrolled pensioners at such stated periods as the law re- 
quires—making no examinations of the four first-named classes without 
special orders from this Office, and in each class using the designated 
blanks, to wit: 
1. 
Examining Surgeon’s certificate in the case of an Original Applicant. 
No. of application, , 
State : , County : , 
Post-Oeeice : , 187 . 
hereby certify that have carefully examined , Applicant’s 
late a , company , regiment , in the service of service. 
the United States, who is an applicant for an invalid pension, by reason 
of an alleged disability resulting from . 
In opinion the said is incapacitated for ob- Degree of dis- 
taining his subsistence by manual labor from the cause above stated, ability. 
Judging from his present condition, and from the evidence before , Origin. 
it is belief that the said disability did originate in the service 
aforesaid in the line of duty. 
The disability is . Probable dura- 
A more particular description of the applicant’s condition is sub- tion. 
joined: 
Height, ; weight, ; complexion, ; age, ; Particular de- 
pulse, ; respiration, . scription. 
Examining Surgeon 4 
2. 
Examining Surgeon’s certificate in the case of an applicant for Renewal of 
Restoration. 
No. of certificate, • 
State : , Counts : , 
Post-Office : , 187 
Applicant’s 
service. 
hereby certify that have carefully examined , 
late a , company , regiment , in the service of 
the United States, who is an applicant for the of an invalid pen- 
sion, by reason of alleged disability resulting from . 
In opinion the said is incapacitated for ob- 
taining his subsistence by manual labor from the cause above stated. 
Judging from his present condition, and from the evidence before , 
it is belief that the said disability did originate in the service 
aforesaid in the line of duty. 
Degree of dis- 
ability. 
Origin. 
Probable dura- 
tion. 
The disability is . 
A more particular description of the applicant’s condition is sub- 
joined : 
Height, ; weight, ; complexion, ; age, ; 
pulse, ; respiration, . 
Particular de- 
scription. 
7 
Examining Surgeon. 
3. 
Examining Surgeon’s certificate in the case of an applicant for Increase of 
Pension. 
No. of certificate, , 
State : , County : , 
Post-Office : , 187 . 
It is hereby certified that ; , formerly a of Captain 
company, in the regiment of , in the war of 
, who is now paid at agency at the rate of dollars 
per month, on account, as he states, of while in the line of duty 
in the military service of the United States, on or about the day of 
•, 18—, at a place called ,in the State or Territory of , 
is still suffering in consequence of said . 
The disability originates entirely from the injury or disease on ac- 
count of which he was originally pensioned, as follows : 
Height, ; weight, ; complexion, ; age, ; 
respiration, ; pulse, . 
Here specify 
the particular 
disease or injury. 
Here state fully 
and accurately 
the character of 
the pensioner’s 
disability, and 
how he is at 
present affected 
thereby; also, 
state whether 
the disability is 
permanent in its 
present degree, 
and whether it 
has been in any 
degree caused or 
protracted by 
vicious habits. 
find bis disability, as described above, to be equal to, and en- 
titling l;im to . 
Examining Surgeon. 
The Surgeon will forward Ms report of examination direct to the Tension-Office, 
whether the pensioner is thought to he entitled to increase or not. 5 
4. 
Surgeon’s certificate of Biennial, Annual, or Semi-annual examination, on which 
the pensioner draws his pension. 
State : , County : , 
Post-Office: , 187 
do hereby certify that have carefully examined , Pensioner’s 
who was a in the war , and was granted an invalid pension service. 
nnder certificate No. ,to he paid now at the agency in ,by Be particular 
reason of alleged disability resulting from , which he states to certificate 
have been received in the line of duty while he was in the militaryx Agency where 
service of the United States. to he paid. 
In opinion the said pensioner’s disability, from the cause aforesaid, State whether 
continues. ‘ T*o' 
A more particular description of the pensioner’s condition is sub- its’ present de- 
joined: gree. 
Height, ; weight, ; complexion, ; age, ; Particular de- 
respiration, ; pulse, . scnption. 
7 
Examining Surgeon. 
4*. 
Surgeon’s certificate of examination in case of Dependent Relative. 
Claim No. . 
State : , County: , 
Post-Office : , 187 
I hereby certify that I have carefully examined , who 
claims pension as the dependent of , who is alleged 
to have died , and in my opinion, based on such examination and 
a personal acquaintance with him for years, the said 
is, and has been, physically incapacitated for the support of himself and 
family, the nature, degree, and duration of his disability being as 
follows: 
Here present a 
full and explicit 
statement as to 
the nature of the 
disability, and the 
particular man- 
ner and degree in 
which it has in- 
terfered with his 
procuring a sub- 
sistence, from 
prior to the son’s 
enlistment and 
death to the pre- 
sent date, giving 
his occupation 
and approximate 
age. If the facts 
are not within 
your personal 
knowle’ge, please 
to so state, and 
give your best 
judgment as to 
the probable du- 
ration and extent 
of the disability. 6 
SECTION 11. 
The salient points to be kept in view during these examinations are 
as follows: 
1. What disability, if any, actually exists ? 
2. If a disability exists, in what degree does it disable the applicant 
from subsisting by manual labor ? 
3. What are the reasonable probabilities of the disability having re- 
sulted from service in the military or naval services of the United States, 
judging from the history given? 
4. How far do the habits of the applicant seem to affect his disability, 
both as regards its origin and continuance? 
5. What is the probable duration of the disability ? 
6. The claimant’s statements and hospital experience are not wanted 
in the certificate, but a description of the disability only, which should 
be full, precise, and clearly stated. 
In all these inquiries it will be necessary to receive the applicant’s 
statements with patience and due allowance; yet justice requires that no 
rate of pension shall be recommended on any mere statement of physi- 
cal disqualification, unsustained by the existence of such structural 
changes or pathological conditions as are known to accompany the par- 
ticular form of injury or disease complained of. 
SECTION 111. 
In estimating the degree of disability some rules may be laid down, 
though many injuries and diseases can only be estimated from the cir- 
cumstances surrounding the specific cases. 
A. —The disuse (uot permanent) of a limb, or a disease equivalent 
thereto, will be rated at total, or eight dollars per month. 
B. —The permanent disuse or loss of a limb, or a disease or wound of 
a permanent character equivalent thereto, will be rated at third grade, 
or eighteen dollars per month, the statement being made in terms that 
said disease or wound uis equivalent to the loss of a hand or foot for pur- 
poses of manual labor f and permanent in that degree. 
C. —The loss of both feet, or of one hand and one foot, or a permanent 
disability equivalent thereto, disabling from all manual labor entitles 
the subject to the rating of second grade, or twenty-four dollars per 
month. 
B.—The loss of the sight of both eyes, of both hands, or a per- 
manent and total disability in the latter, or a permanent and total 
disability rendering the claimant so helpless as to require the con- 
stant aid and attendance of another person, entitles him to the 
rating of first grade, or thirty-one dollars and twenty-five cents per 
month. 7 
The following is a table of “total” pensions: 
ARMY PENSIONS UNDER ACT JULY 14, 1862. 
Lieutenant colonel, and higher grades $3O 
Major 25 
First lieutenant 17 
Second lieutenant 15 
Surgeons (*) 
Paymasters (*j 
Non-commissioned officers, musicians, and privates 8 
NAVY PENSIONS UNDER ACT JULY 14, 1862. 
Captains, commanders, surgeons, (ranking as lieutenant commander, commander, 
or captain,) paymasters, (ranking as lieutenant commander, commander, or cap- 
tain,) chief engineers, (ranking as lieutenant commander, commander, or captain,) 
lieutenant commanding, and master commanding 30 
Lieutenants, surgeons, (ranking as lieutenant,) paymasters, (ranking as lieuten- 
ant,) chief engineers, (ranking as lieutenant,) passed assistant surgeons 25 
Professors of mathematics, masters, assistant surgeons, assistant paymasters, and 
chaplains 20 
First assistant engineers and pilots 15 
Passed midshipmen, midshipmen, captain’s and paymaster’s clerks, second and 
third assistant engineers, masters’ mates, gunners, boatswains, carpenters, and 
sail-makers, (warrant officers are all specified herein) . 10 
All petty officers and other persons not above named 8 
F.—Officers and privates may be rated for disabilities in any degree 
less than “total” not below one-fourth; in the instance of a private, 
the rate may be stated as one-fourth, three-eighths, one-half, five-eighths, 
three-fourths, seven-eighths, as the case requires; and, in like manner, 
the rating of an officer’s disability may be stated at any point from one- 
fourth to the full amount established by law, in accordance with the 
facts. 
Eatings that involve fractional parts of a dollar, as one-third or two- 
thirds of private’s total, should be avoided. None of the grades described 
in paragraphs B, C, and 1), are subject to fractional rating. 
Gr.—The loss of the sight of an eye is a one-half disability. The loss of 
an index finger or great toe is three-eighths; of a thumb, one-half; of a 
finger or one of the smaller toes, each one-fourth. Yet these ratings are 
not absolute, for a tender cicatrix would increase them. Single hernia, 
uncomplicated, one-half; double hernia, three-fourths; but may be rated 
higher in proportion to the disability produced. 
The results of operations in the carpus or metacarpus, tarsus or meta- 
tarsus, will be estimated in accordance with the utility of the remain- 
ing structures for purposes of manual labor. No general rule can be 
* Pensions allowed to surgeons and paymasters, under the act of July 14, 1862, will he according to 
the rate provided for the rank in which they held commissions, and that rank expressed in the pension 
certificate and notification. 8 
laid down. Syme’s and analogous operations, if perfectlysuccessful, should 
not, necessarily, leave a limb sufficiently disabled to bring it within the 
rating of disability prescribed by the act of June 6,1866, and June 8,1872; 
while an unsuccessful attempt may have left it fully as great a disability 
as would an amputation in the leg. The question of deformity must be 
considered from two points of view; an injury resulting in much deform- 
ity will generally disable by reason of structural change, and deformity 
may be in itself a bar to obtaining opportunity for subsistence by manual 
labor at the customary price of said labor. 
H.—Certificates are forwarded direct to this office, in all cases except- 
ing those of periodical examinations, which are sent to the Pension- 
Agent, for whose information and guidance they are intended, with the 
number of the certificate marked on the envelope, thus: “102,000,77 
(nothing more;) and in every instance the surgeon will keep the records 
of his action on the blanks furnished him for that purpose, which records 
will thenceforth become public property in his custody. 
Certificates, and all official statements, will be addressed, unpaid, as 
follows: 
The Commissioner of Pensions, 
Washington, JD. C. 
For Medical Division. 
I.—Certificates of examinations are required to be made in the hand- 
writing of the examining surgeon, duly signed, numbered, and indorsed; 
and if erased or interlined, such alterations will be certified to. 
K.—When an applicant alleges two or more causes of disability, each 
will receive attention and be rated separately. This is very necessary, 
from the fact that several disabilities are often stated to have risen in 
the service, of which legal evidence of origin therein may exist only as 
to one. 
If a disability is found to exist, which probably originated in the ser- 
vice, but is not named in the order for examination, it may be described, 
but must, invariably, be separately rated. 
hi. B.—lt may here be remarked that certificates are daily returned 
to surgeons for correction or completion. The following are the errors 
usually fallen into: 
Number of claim not given. 
Certificates not signed or dated. 
Disabilities not rated separately. 
Disabilities not rated at all. 
Description of wound or disease insufficient for purposes of evidence. 
The blanks not filled and indorsed. 
The attention of examining surgeons is respectfully invited to the 
following minor points of detail, and adoption requested on the ground 
of convenience: 9 
Certificates slionld be signed at tbe place indicated in tlie blanks, 
then folded in four equal folds, and the indorsements filled in. 
The blank space at top of certificate is for the surgeon’s address, not 
the claimant’s. The date should accompany the address. 
As certificates become part of public records, the importance of using 
good, durable, black ink, is obvious. 
All certificates should be transmitted the day after the examination 
is made, and mailed in one envelope marked “Certificates.” 
All accounts should be sent at the last day in each month, mailed in 
a separate envelope and marked “'Accounts.” With the accounts, and 
in the same envelope, should be sent the orders of the Commissioner of 
Pensions for the examination, as without these orders the accounts can 
not be audited, or payment directed; they are the only vouchers needed 
for the accounts. Should, however, a certificate be found insufficient 
or unsatisfactory, it will be returned to the surgeon, and the fee for the 
examination will not be allowed until an acceptable certificate is fur- 
nished. 
Personal explanations or particular reports and opinions should never 
be inclosed with other matter, but mailed in an envelope marked 
“ Special ; ” this is often very necessary from the fact that communica- 
tions are made by surgeons in their capacity of confidential advisers of 
the Office. 
Eequisitious for blanks should also be mailed and marked distinctly. 
SECTION IV. 
L.—Certificates should state clearly in what the increased disability 
consists ; the claimant’s statement, unsupported, of increased pain is 
not a ground for increase. In cases where the surgeon regards the 
rating as too low, although no increase of the disability may have 
occurred, it is proper for him to give the correct rating, with his reasons 
therefor. 
EXAMINATIONS FOE INCREASE 
SECTION V. 
M.—Biennial examinations of Army and Navy invalid pensioners are 
provided for by act of Congress approved March 3, 1859, on every alter- 
nate odd year, the next being due September 4, 1873. At these 
examinations the only question to determine is the continuance of the 
disability on account of which the claimant was originally pensioned; 
no other disability must be described or rated. The rating must be 
stated on the monthly account, Form 7, as well as on the certificate, 
and care be taken that the statements correspond. The certificate must 
be sent to the pension-agent at whose office the pensioner is payable, 
on the same day that the examination is made. If it be delayed over 
PERIODICAL EXAMINATIONS. 10 
twenty-four hours, the pensioner will be at liberty to submit himself to 
another surgeon for examination, whose certificate will be acted upon, 
and to whom the fee will be paid. 
Periodical examinations may be required by the terms of the certifi- 
cate, and will continue to be made until two biennial periods shall have 
passed subsequently to the date on which the certificate issued, and not, 
as heretofore, from date of commencement of pension. Thus, “if a pen- 
sion certificate bears date prior to March 4, of a biennial (odd) year, an 
examination will be due upon the payment to September 4, and will 
take effect from the 4th of June next preceding. Annual and semi-an- 
nual examinations will govern the preceding quarterly payment, instead 
of the semi-annual payment.” 
Where annual or semi-annual examinations may have been ordered, 
they will cease to be made after the expiration of two biennial periods 
in each case. 
Every pensioner is subject to the biennial examinations, whose pen- 
sion certificate does not, in express terms, exempt him therefrom. 
The examining surgeon can reduce the pension when he finds that the 
degree of disability is less than at the former periodical examination, 
but he cannot increase the pension ; an increase can only be allowed 
after a formal application therefor by the pensioner, and the approval 
of an increased rate by the Commissioner. 
The foregoing applies alike to Army and Navy pensions. 
SECTION VI. 
BOARDS OF EXAMINING SURGEONS. 
Boards of examining surgeons have been organized in all the large 
cities of the Union. The number of members composing these boards 
is from two to five, according to the exigencies of the service. 
When a board is composed of two members only, the duties of presi- 
dent and treasurer, or secretary and treasurer, will devolve on one 
person. 
Unless a board of surgeons is composed of more than three members, 
the signature of each member will be attached to the certificates made. 
This rule will be invariable, excepting when waived for unavoidable 
causes—absence or sickness—and then the reason why the certificate is 
not signed by the full board will be stated on the back thereof. 
The presence and signature of each examining surgeon, however, is 
required to insure his payment. 
Boards will examine only on the first Wednesday in each month, un- 
less otherwise specially instructed. 
SECTION VII. 
EXAMINATION OF ARTIFICIAL LIMBS. 
A fee of one dollar and fifty cents will be allowed for one examination 
in each case of an artificial limb furnished to an invalid soldier or sailor. 11 
The examination is to he made after the completion of the limb, and at 
the time of its adjustment. Examination by one member of a board is 
sufficient. 
SECTION VIII. 
ACCOUNTS. 
I.—Accounts for examinations of applicants for pension and increase of 
pension must be rendered in duplicate, upon Form 5, at the close of each 
month direct to the Pension-Office, (in the same manner as the certifi- 
cates,) accompanied by the order for the examination. If thus forwarded, 
accounts will be immediately examined, and one approved copy returned 
to the surgeon, who will sign the duplicate receipts, Form 6, and inclose 
the whole to the pension-agent designated therein for payment. 
No accounts will be approved unless the order of the Office to the sur- 
geon accompanies it. Names of applicants examined must be alphabeti- 
cally arranged. Each account will embrace all those examined during 
a month, and none others. 
If for “increase,” add, in right-hand column, opposite the name, “For 
increase, certificate No. —lf u original,” give company and regiment. 
ll.—Accounts for periodical examinations of pensioners will also be pre- 
pared in duplicate, Form 7, immediately after the close of each month, 
and forwarded simultaneously, one copy to this office, and the other 
accompanied by duplicate receipt, Form 8, to the pension-agent by whom 
the pension is payable for payment. With the check for the payment 
of the fee, the pension-agent will return the postage incurred in sending 
the certificates to the agency. 
As the pension-agent has the necessary means for auditing the 
account only while the vouchers of the pensioner are in his possession, 
which by law he is required to forward to the accounting officer within 
ten days from the close of the month, surgeons must render their accounts 
promptly at the close of each month, else they will be returned unpaid; in 
which case the only relief will be by application to the Third Auditor to 
examine the vouchers and audit the accounts, causing delay and incon- 
venience to the surgeon, and trouble to the Government. 
Names of pensioners must be alphabetically arrahged. All those who 
have been examined in the month and payable at the same agency will 
be embraced in one account, and none others. Surnames should precede 
Christian names, the latter written out in full. Initial or middle letters 
should be carefully given. 
The certificate ntimber should be plainly given, and the rate must 
correspond with that set forth in the certificate, and each correctly 
express the estimate of the degree of pensioners disability; an error in 
either is disastrous to the pensioner. Hundreds of pensioners at the 
biennial examinations of 1869 were subject to an unjust and uninten- 
tional reduction by the inadvertence of examining surgeons in this 
respect. 12 
Settlements.—As periodical certificates (Form 4) are now sent by mail 
direct to the pension-agent, he is prepared to audit the account as soon 
as the certificate is received. 
lll.—Accounts for special examinations of pensioners will be rendered 
and paid upon Form 9, in the same manner and under the same general 
instructions as accounts for applicants, paragraph I. Prepare the 
account according to the head-note on the blank. 
IY.—Fees for examinations by surgeons not holding appointments as 
examiners from this Office, will be collected of the claimants. 
BLANKS. 
The following is a list of blanks furnished for the use of examining 
surgeons: 
Pamphlet of instructions, 
1. Certificate of original or primary examination of an APPLICANT 
for a pension. 
2. Certificate of examination for renewal or restoration of a pension 
under act July 14, 1862. 
3. Certificate of examination for increase of a pension under act June 
6, 1866. 
4. Certificate of periodical examination of pensioners. 
4J. Surgeon’s certificate of examination in case of dependent relative. 
o. Alphabetical list or account for primary examinations of APPLI- 
CANTS, or for the increase of a pension, under any act, on a quarter- 
sheet. 
o. (Large.) Same as preceding, on a half sheet. 
6. Duplicate receipts to accompany (5) accounts. 
7. Alphabetical list or account of fees for periodical examinations of 
pensioners, on a quarter-sheet. 
7. (Medium.) Same as preceding, on a half-sheet. 
7. (Large.) Same as preceding, on a full sheet. 
8. Duplicate receipts to accompany (7) accounts. 
9. Accounts for special examinations, with travel. 
10. For civil surgeons. 
A form of requisition for blanks will be furnished on application. 
It is believed that if the foregoing instructions be first thoroughly 
understood, and then followed, no uncertainty or vexation need ever 
arise, and that, consequently the surgeon need never apply for advice 
in particular cases. 
The really important part of every claim for invalid pension is the 
surgeon's certificate, which practically amounts to a voucher for the dis- 
bursement of the public moneys. It is, therefore, of the first importance 
that it be carefully and thoughtfully constructed, particular care being- 
taken to cover all the ground indicated by the printed marginal notes on the blanks furnished. In its construction the following points should 
always be borne in mind: 
1. To make it full in medical or surgical detail. It is not a mere 
statement of diagnosis that is wanted, but a description of disease or 
injury, organs and structures involved, pathological lesions, structural 
changes, &c., and then a careful statement as to how the subject’s power 
to perform manual labor is interfered with. In a word, such a state- 
ment in detail of the case, as upon which alone a surgeon in this Office 
could fix the degree of disability. By far a majority of certificates now 
furnished the Office are lacking in “particular description,” many of 
the surgeons seeming to think that mere diagnosis is enough. 
2. When two or more disabilities are described, each should be (sepa- 
rately) rated as if it were the only one existing. This comprehends 
only such cases as in which each disability depends upon a separate 
cause, and which, therefore, might be recovered from, leaving another 
or others. The necessity for such ratings depends upon the fact that 
(as stated in the body of the instructions) it not unfrequently happens 
that of two or more disabilities described by the surgeon, only one is 
alleged by the claimant. 
3. When 3d grade ($18) is recommended, the surgeon, after his 
“ particular description,” should in every case say “equivalent to loss of a 
hand or foot for jmrposes of manual labor.” The mere recommendation 
of $lB is not enough. What constitutes a disability “ equivalent to 
loss of a hand or foot for purposes of manual labor” is a question of 
wide latitude, and it is desirable that the surgeon should always express 
his opinion in terms. 
4. In recommending increase the reason for so recommending should 
always be stated, either that original rating was unjustly low, the dis- 
ability remaining unchanged, or that there has been actual increase of 
disability. When the latter is given, it should be carefully stated in 
what the increased disability consists. In some instances in which 
the surgeon has never before seen the claimant it may seem difficult to 
estimate a change in disability ; nevertheless, careful inquiry, it is be- 
lieved, will in every case put the officer in possession of very desirable 
information in aid of decision of the claim. 
5. The degree of disability should always be estimated in dollars in 
addition to the ordinary fractional statement of the “Total.” This will 
avoid the confusion growing out of the phrase “totally incapacitated,” 
which may mean $31.25, $24, or $B, as determined by further state- 
ments. 
The careful observance of the foregoing suggestions will always pre- 
vent the vexation to the surgeon and delay growing out of the return 
of certificates; ninety per cent., at least, of the certificates now returned 
daily, being deficient in one or the other of the particulars enumerated. 
It will be noticed that a new class of examinations has been formally 14 
provided for, viz, dependents. The necessary blanks have been pre- 
pared for the examination of this class, and will be issued immediately. 
The certificates of examination and the accounts therefor should be 
forwarded precisely as in invalid claims. 
Touching the recent requirement of the surgeons to verify the charac- 
ter for truth and veracity and the professional standing of physicians 
testifying in claims pending before the Office, it is explained that in 
many instances the claim turns upon the evidence of these witnesses. 
It is therefore important that their character and professional standing 
be certified to this Office. To secure this end the question is referred to 
the examining surgeons already known, already agents of the Office, and 
located as variously as the witnesses. 
In inquiring as to the professional standing of such witnesses it is 
not intended to ask their standing in the school of medicine to which 
the surgeon certifying is attached, but their standing in the school to 
which they themselves belong. Are they recognized as reputable prac- 
titioners in their respective communities and by their confreres of the 
same school of medicine'? It is known that in some instances it is dif- 
ficult for the surgeon to acquire the information requisite to his certi- 
fying, but it is believed that, except in very rare instances, a little inquiry 
will put him in possession of all that the Office deems desirable. 
Examining surgeons are recognized as confidential agents of the Office. 
In no instance should they communicate what they have recommended, 
or intend to recommend, to a claimant. All communication with the 
Office should be regarded as under the seal of the strictest confidence. 
J. H. BAKEE, 
Commissioner.