H. Rept. 104-158 - EXTENSION OF AUTHORITY OF SECRETARY OF VETERANS AFFAIRS TO PROVIDE PRIORITY HEALTH CARE FOR CERTAIN VETERANS EXPOSED TO AGENT ORANGE OR IONIZING RADIATION104th Congress (1995-1996)
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104th Congress Report
HOUSE OF REPRESENTATIVES
1st Session 104-158
_______________________________________________________________________
EXTENSION OF AUTHORITY OF SECRETARY OF VETERANS AFFAIRS TO PROVIDE
PRIORITY HEALTH CARE FOR CERTAIN VETERANS EXPOSED TO AGENT ORANGE OR
IONIZING RADIATION
_______________________________________________________________________
June 26, 1995.--Committed to the Committee of the Whole House on the
State of the Union and ordered to be printed
_______
Mr. Stump, from the Committee on Veterans' Affairs,
submitted the following
R E P O R T
[To accompany H.R. 1565]
[Including cost estimate of the Congressional Budget Office]
The Committee on Veterans' Affairs, to whom was referred the
bill (H.R. 1565) to amend title 38, United States Code, to
extend through December 31, 1997, the period during which the
Secretary of Veterans Affairs is authorized to provide priority
health care to certain veterans exposed to Agent Orange,
ionizing radiation, or environmental hazards, having considered
the same, reports favorably thereon with amendments and
recommends that the bill as amended do pass.
The amendments are as follows:
Strike out all after the enacting clause and insert in lieu
thereof the following:
SECTION 1. AUTHORITY TO PROVIDE PRIORITY HEALTH CARE.
(a) Authorized Inpatient Care.--Section 1710(e) of title 38, United
States Code, is amended--
(1) in paragraph (1), by striking out subparagraphs (A) and
(B) and inserting in lieu thereof the following:
``(e)(1)(A) A herbicide-exposed veteran is eligible for hospital care
and nursing home care under subsection (a)(1)(G) for any disease
suffered by the veteran that is--
``(i) among those diseases for which the National Academy of
Sciences, in a report issued in accordance with section 2 of
the Agent Orange Act of 1991, has determined--
``(I) that there is sufficient evidence to conclude
that there is a positive association between occurrence
of the disease in humans and exposure to a herbicide
agent;
``(II) that there is evidence which is suggestive of
an association between occurrence of the disease in
humans and exposure to a herbicide agent, but such
evidence is limited in nature; or
``(III) that available studies are insufficient to
permit a conclusion about the presence or absence of an
association between occurrence of the disease in humans
and exposure to a herbicide agent; or
``(ii) a disease for which the Secretary, pursuant to a
recommendation of the Under Secretary for Health on the basis
of a peer-reviewed research study or studies published within
20 months after the most recent report of the National Academy
under section 2 of the Agent Orange Act of 1991, determines
there is credible evidence suggestive of an association between
occurrence of the disease in humans and exposure to a herbicide
agent.
``(B) A radiation-exposed veteran is eligible for hospital care and
nursing home care under subsection (a)(1)(G) for any disease suffered
by the veteran that is--
``(i) a disease listed in section 1112(c)(2) of this title;
or
``(ii) any other disease for which the Secretary, based on
the advice of the Advisory Committee on Environmental Hazards,
determines that there is credible evidence of a positive
association between occurrence of the disease in humans and
exposure to ionizing radiation.'';
(2) in paragraph (2)--
(A) by striking out ``Hospital'' and inserting in
lieu thereof ``In the case of a veteran described in
paragraph (1)(C), hospital''; and
(B) by striking out ``subparagraph'' and all that
follows through ``subsection'' and inserting in lieu
thereof ``paragraph (1)(C)'';
(3) in paragraph (3), by striking out ``of this section after
June 30, 1995,'' and inserting in lieu thereof ``, in the case
of care for a veteran described in paragraph (1)(A), after
December 31, 1997,''; and
(4) by adding at the end the following new paragraph:
``(4) For purposes of this subsection and section 1712 of this title:
``(A) The term `herbicide-exposed veteran' means a veteran
(i) who served on active duty in the Republic of Vietnam during
the Vietnam era, and (ii) who the Secretary finds may have been
exposed during such service to a herbicide agent.
``(B) The term `herbicide agent' has the meaning given that
term in section 1116(a)(4) of this title.
``(C) The term `radiation-exposed veteran' has the meaning
given that term in section 1112(c)(4) of this title.''.
(b) Authorized Outpatient Care.--Section 1712 of such title is
amended--
(1) in subsection (a)(1)--
(A) by striking out ``and'' at the end of
subparagraph (C);
(B) by striking out the period at the end of
subparagraph (D) and inserting in lieu thereof a
semicolon;
(C) by adding at the end the following new
subparagraphs:
``(E) during the period before January 1, 1998, to any
herbicide-exposed veteran (as defined in section 1710(e)(4)(A)
of this title) for any disease specified in section
1710(e)(1)(A) of this title; and
``(F) to any radiation-exposed veteran (as defined in section
1112(c)(4) of this title) for any disease covered under section
1710(e)(1)(B) of this title.''; and
(2) in subsection (i)(3)--
(A) by striking out ``(A)''; and
(B) by striking out ``, or (B)'' and all that follows
through ``title''.
SEC. 2. SAVINGS PROVISION.
The provisions of sections 1710(e) and 1712(a) of title 38, United
States Code, as in effect on the day before the date of the enactment
of this Act, shall continue to apply on and after such date with
respect to the furnishing of hospital care, nursing home care, and
medical services for any veteran who was furnished such care or
services before such date of enactment on the basis of presumed
exposure to a substance or radiation under the authority of those
provisions, but only for treatment for a disability for which such care
or services were furnished before such date.
Amend the title so as to read:
A bill to amend title 38, United States Code, to extend
through December 31, 1997, the period during which the
Secretary of Veterans Affairs is authorized to provide priority
health care to certain veterans exposed to Agent Orange and to
make such authority permanent in the case of certain veterans
exposed to ionizing radiation, and for other purposes.
Introduction
The Subcommittee met on May 11, 1995 and recommended H.R.
1565 to the full Committee. The full Committee met on June 15,
1995 and ordered H.R. 1565, with an amendment in the nature of
a substitute, reported favorably to the House by unanimous
recorded vote.
Summary of the Reported Bill
H.R. 1565, as amended, would:
1. Authorize hospitalization, nursing home care, and
outpatient treatment for herbicide-exposed veterans for three
categories of diseases (suffered by veterans) identified by the
National Academy of Sciences:
(a) those with sufficient evidence of an association
with herbicide exposure;
(b) those with limited/suggestive evidence of
association with herbicide exposure; and
(c) those with inadequate/insufficient evidence to
determine whether an association exists with herbicide
exposure.
2. ``Grandfather'' veterans for continued care of any
condition treated under prior law based on presumed herbicide
exposure.
3. Authorize the Secretary, based on the recommendation of
the Under Secretary for Health, to add to the list of covered
conditions for which treatment is authorized. A disease could
be added based on peer-reviewed research published within 20
months after the most recent National Academy of Sciences
report regarding Agent Orange.
4. Provide eligibility for hospitalization, nursing home
care and outpatient treatment in the case of radiation-exposed
veterans for care of a long list of cancers presumed to be
caused by radiation exposure as well as for any disease for
which the VA determines there is credible evidence of a
positive association between disease occurrence and radiation
exposure.
5. ``Grandfather'' veterans for continued care of any
condition treated under prior law based on presumed radiation
exposure.
6. Provide for priority treatment for both herbicide-
exposed and radiation-exposed veterans.
7. Extend through December 31, 1997 the period during which
the Secretary of Veterans Affairs is authorized to provide
priority health care to herbicide-exposed veterans.
8. Make permanent the authority to treat certain veterans
exposed to ionizing radiation.
Background and Discussion
Public Law 102-4, known as the Agent Orange Act of 1991,
required the VA to enter into an agreement with the National
Academy of Sciences (NAS) to conduct a comprehensive review and
evaluation of the available scientific and medical literature
regarding the health effects of exposure to Agent Orange and
other herbicides used during the Vietnam conflict. This Act
also required not only the review of scientific literature but
also that the NAS evaluate the available scientific evidence
and assess, with respect to each disease suspected of being
associated with exposure to Agent Orange, the strength of the
association or associations and their relative strength and
risk to veterans. This review included 6,420 abstracts of
scientific or medical articles. From this published body of
scientific literature, 230 epidemiological studies were chosen
for detailed review and analysis. Since 1982 the VA has spent
approximately $80 million from Medical Research funds to study
health questions related to exposure to Agent Orange and other
herbicides.
The findings of the NAS provide for the first time a
framework based on scientific evidence on which determinations
of eligibility for health care can be based. H.R. 1565, as
amended, proposes to incorporate those findings. It would do so
by identifying certain specific diseases for which known,
limited, and even doubtful statistical associations of exposure
would be considered service-incurred for treatment purposes.
The bill would authorize VA to provide treatment even for the
diseases where science provides insufficient evidence to
determine whether there is any relationship between the
diseases presented by the veteran and exposure to herbicides.
It also would ``grandfather'' those veterans who have been
previously treated at the VA for conditions which the NAS has
now found evidence indicating no association to exist between
the disease and exposure to herbicides for continued VA care of
these conditions. Included in this category would be skin
cancer, gastrointestinal tumors, bladder cancer, and brain
tumors.
The bill would also provide special eligibility in the case
of radiation-exposed veterans for care of a long list of
cancers as well as for any diseases for which the VA determines
there is credible evidence of a positive association between
disease occurrence and radiation exposure. The bill's
``grandfather'' clause would also permit VA to continue to care
for illnesses for which veterans previously or currently
receive care at the VA even though no positive association
between the disease occurrence and radiation exposure has been
found.
Under this bill both groups of veterans would receive
substantially expanded outpatient services for covered
conditions on a priority basis.
It is the view of the Committee that the Academy's findings
provide a basis upon which to establish sound yet compassionate
public policy with regard to those veterans exposed to
herbicides during their military service in Southeast Asia. The
agreed upon compromise, which was accomplished in the spirit of
bipartisanship, reflects the strong view of the Committee that
veterans deserve every benefit of the doubt with regard to
health conditions that may result as part of their military
service. H.R. 1565, as amended, would provide a 20-month window
for the consideration of new peer-reviewed, published research
not previously considered by the NAS. In the event such a study
provides credible evidence suggestive of an association between
a disease and exposure to Agent Orange, the Secretary, based on
the recommendations of the Under Secretary for Health, could
authorize VA treatment for that condition.
The provisions of H.R. 1565, as amended, draw on language
adopted by the House in passing H.R. 3313 in the 103rd
Congress.
PERSONAL EXPLANATIONS
Congressman Spence has informed the Committee that he was
not present at the markup because he was floor manager for H.R.
1530, the National Defense Authorization Act for Fiscal Year
1996, which was being considered by the House at the same time.
He has informed the Committee that had he been present for the
recorded vote on H.R. 1565, as amended, he would have voted
aye.
Congressmen Clement and Baesler were present for the markup
but not at the time of the recorded vote on H.R. 1565, as
amended, because they were unavoidably detained. They have
informed the Committee that, had they been present for the vote
on H.R. 1565, as amended, they would have voted aye.
Congressman Schaefer was not present for the markup of H.R.
1565, as amended, because he was unavoidably detained. He has
informed the Committee that had he been present for the
recorded vote, he would have voted aye.
SUMMARY OF NAS FINDINGS ON AGENT ORANGE EXPOSURE
The following is a summary listing of the four categories
established by the National Academy of Sciences and the
relative strength of each condition in regard to its
association between the specific condition and exposure to
herbicides.
Sufficient Evidence of an Association
Evidence is sufficient to conclude that there is a positive
association.
Soft tissue sarcoma
Non-Hodgkin's lymphoma
Hodgkin's disease
Chloracne
Porphyria cutanea tarda (in genetically susceptible
individ-
uals)
Limited/Suggestive Evidence of Association
Evidence is suggestive of an association between herbicides
and the outcome but is limited because chance, bias, and
confounding could not be ruled out with confidence.
Respiratory cancers (lung, larynx, trachea)
Prostate cancer
Multiple myeloma
Inadequate/Insufficient Evidence to Determine Whether an Association
Exists
The available studies are of insufficient quality,
consistency, or statistical power to permit a conclusion
regarding the presence or absence of an association.
Hepatobiliary cancers
Nasal/nasopharyngeal cancer
Bone cancer
Female reproductive cancers (cervical uterine ovarian)
and
breast cancer
Renal cancer
Testicular cancer
Leukemia
Spontaneous abortion
Birth defects
Neonatal/infant death and stillbirths
Low birthweight
Childhood cancer in offspring
Abnormal sperm parameters and infertility
Cognitive and neuropsychiatric disorders
Motor/coordination dysfunction
Peripheral nervous system disorders
Metabolic and digestive disorders (diabetes, changes in
liver enzymes, lipid abnormalities, ulcers)
Immune system disorders (immune modulation and
autoimmunity)
Circulatory disorders
Respiratory disorders
Limited/Suggestive Evidence of No Association
Several adequate studies, covering the full range of levels
of exposure that human beings are known to encounter, are
mutually consistent in not showing a positive association
between exposure to herbicides and the outcome at any level of
exposure.
Skin cancer
Gastrointestinal tumors (stomach cancer, pancreatic
can-
cer, colon cancer, rectal cancer)
Bladder cancer
Brain tumors
Oversight Findings
No oversight findings have been submitted to the Committee
by the Committee on Government Reform and Oversight.
Congressional Budget Office Cost Estimate
The following letter was received from the Congressional
Budget Office concerning the cost of the reported bill:
U.S. Congress,
Congressional Budget Office,
Washington, DC, June 21, 1995.
Hon. Bob Stump,
Chairman, Committee on Veterans' Affairs,
House of Representatives, Washington, DC.
Dear Mr. Chairman: The Congressional Budget Office has
prepared the enclosed cost estimate for an amendment in the
nature of a substitute to H.R. 1565, a bill to amend title 38,
United States Code, to extend through December 31, 1997, the
period during which the Secretary of Veterans Affairs is
authorized to provide priority health care to certain veterans
exposed to Agent Orange and to make such authority permanent in
the case of certain veterans exposed to ionizing radiation, and
for other purposes, as ordered reported by the House Committee
on Veterans' Affairs on June 15, 1995.
The bill would not affect direct spending and thus would
not be subject to pay-as-you-go procedures under section 252 of
the Balanced Budget and Emergency Deficit Control Act.
If you wish further details on this estimate, we will be
pleased to provide them.
Sincerely,
June E. O'Neill.
Director.
Enclosure.
CONGRESSIONAL BUDGET OFFICE COST ESTIMATE
1. Bill number: Amendment in the nature of a substitute to
H.R. 1565.
2. Bill title: A bill to amend title 38, United States
Code, to extend through December 31, 1997, the period during
which the Secretary of Veterans Affairs is authorized to
provide priority health care to certain veterans exposed to
Agent Orange and to make such authority permanent in the case
of certain veterans exposed to ionizing radiation, and for
other purposes.
3. Bill status: As ordered reported by the House Committee
on Veterans' Affairs on June 15, 1995.
4. Bill purpose: The bill would extend expiring authorities
under which the Department of Veterans Affairs provides
inpatient and outpatient medical care to veterans whose
conditions have been associated with exposure to certain
harmful substances during military service.
5. Estimated cost to the federal government:
[By fiscal year, in millions of dollars]
------------------------------------------------------------------------
1995 1996 1997 1998 1999 2000
------------------------------------------------------------------------
Spending Under
Current Law:
Budget
Authoritya..... 125 0 0 0 0 0
Estimated
Outlays........ 125 18 1 0 0 0
Proposed Changes:
Authorization
Levelb......... 0 105 111 46 23 25
Estimated
Outlays........ 0 90 109 55 27 24
Spending Under
H.R. 1565:
Authorization
Levela b....... 125 105 111 46 23 25
Estimated
Outlays........ 125 108 110 55 27 24
------------------------------------------------------------------------
a The 1995 figure is the amount appropriated for programs authorized by
the bill.
b This estimate assumes an enactment date of October 1, 1995. Enactment
before that date could result in additional authorization of
appropriations in 1995.
6. Basis of estimate:
Under current law, the Department of Veterans Affairs (VA)
provides medical treatment to veterans for disabilities
associated with exposure to Agent Orange and ionizing
radiation.
VA treats these veterans for certain diseases whether or
not sufficient evidence connects the conditions to the
exposure.
This bill would extend VA's authority to provide medical
treatment to veterans exposed to Agent Orange through December
1997, but would limit treatment to conditions the National
Academy of Sciences has deemed positively or suggestively
associated with exposure, or for which there is not enough
evidence to permit a conclusion. Diseases for which limited or
suggestive evidence shows no association would not be treated
unless credible evidence of suggestive association is found.
These diseases include gastrointestinal cancers, skin cancers,
bladder cancers, and brain tumors. According to VA, the cost
for treating veterans exposed to Agent Orange is currently
about $100 million a year. Using incidence rates to exclude
diseases that would no longer be treated, VA projects that
costs under this bill would be about $85 million a year.
The bill would limit treatment for veterans exposed to
ionizing radiation similarly to the way it would limit
treatment for Agent Orange cases, but it would permanently
extend VA's authority to provide care. Treatment costs for
veterans exposed to ionizing radiation are now about $25
million a year. Under this bill, the cost would be about $20
million a year.
VA officials do not expect research in the near term to
show sufficient evidence of association between the diseases
excluded by this bill and exposure to Agent Orange or
radiation. If research would show such a connection, costs
could be closer to current expenditures.
This estimate assumes that the amounts authorized will be
appropriated for 1996 and future years. It also assumes, based
on historical trends, that the number of veterans treated under
this authority will remain relatively stable over the five-year
period, but that costs increase because of inflation. Outlays
after 1996 are estimated according to historical spending
patterns.
7. Pay-as-you-go considerations: The Balanced Budget and
Emergency Deficit Control Act of 1985 sets up pay-as-you-go
procedures for legislation affecting direct spending or
receipts through 1998. This legislation would not affect direct
spending or receipts. Therefore, it has no pay-as-you-go
implications.
8. Estimated cost to state and local governments: None.
9. Estimate comparison: None.
10. Previous CBO estimate: None.
11. Estimate prepared by: Mary Helen Petrus.
12. Estimate approved by: Paul N. Van de Water, Assistant
Director for Budget Analysis.
Inflationary Impact Statement
The enactment of the reported bill would have no
inflationary impact.
Changes in Existing Law Made by the Bill, as Reported
In compliance with clause 3 of rule XIII of the Rules of the
House of Representatives, changes in existing law made by the
bill, as reported, are shown as follows (existing law proposed
to be omitted is enclosed in black brackets, new matter is
printed in italics, existing law in which no change is proposed
is shown in roman):
TITLE 38, UNITED STATES CODE
* * * * * * *
PART II--GENERAL BENEFITS
* * * * * * *
SUBCHAPTER II--HOSPITAL, NURSING HOME OR DOMICILIARY CARE AND MEDICAL
TREATMENT
* * * * * * *
Sec. 1710. Eligibility for hospital, nursing home, and domiciliary care
(a) * * *
* * * * * * *
[(e)(1)(A) Subject to paragraphs (2) and (3) of this
subsection, a veteran--
[(i) who served on active duty in the Republic of
Vietnam during the Vietnam era, and
[(ii) who the Secretary finds may have been exposed
during such service to dioxin or was exposed during
such service to a toxic substance found in a herbicide
or defoliant used in connection with military purposes
during such era,
is eligible for hospital care and nursing home care under
subsection (a)(1)(G) of this section for any disability,
notwithstanding that there is insufficient medical evidence to
conclude that such disability may be associated with such
exposure.
[(B) Subject to paragraphs (2) and (3) of this subsection, a
veteran who the Secretary finds was exposed while serving on
active duty to ionizing radiation from the detonation of a
nuclear device in connection with such veteran's participation
in the test of such a device or with the American occupation of
Hiroshima and Nagasaki, Japan, during the period beginning on
September 11, 1945, and ending on July 1, 1946, is eligible for
hospital care and nursing home care under subsection (a)(1)(G)
of this section for any disability, notwithstanding that there
is insufficient medical evidence to conclude that such
disability may be associated with such exposure.]
(e)(1)(A) A herbicide-exposed veteran is eligible for
hospital care and nursing home care under subsection (a)(1)(G)
for any disease suffered by the veteran that is--
(i) among those diseases for which the National
Academy of Sciences, in a report issued in accordance
with section 2 of the Agent Orange Act of 1991, has
determined--
(I) that there is sufficient evidence to
conclude that there is a positive association
between occurrence of the disease in humans and
exposure to a herbicide agent;
(II) that there is evidence which is
suggestive of an association between occurrence
of the disease in humans and exposure to a
herbicide agent, but such evidence is limited
in nature; or
(III) that available studies are insufficient
to permit a conclusion about the presence or
absence of an association between occurrence of
the disease in humans and exposure to a
herbicide agent; or
(ii) a disease for which the Secretary, pursuant to a
recommendation of the Under Secretary for Health on the
basis of a peer-reviewed research study or studies
published within 20 months after the most recent report
of the National Academy under section 2 of the Agent
Orange Act of 1991, determines there is credible
evidence suggestive of an association between
occurrence of the disease in humans and exposure to a
herbicide agent.
(B) A radiation-exposed veteran is eligible for hospital care
and nursing home care under subsection (a)(1)(G) for any
disease suffered by the veteran that is--
(i) a disease listed in section 1112(c)(2) of this
title; or
(ii) any other disease for which the Secretary, based
on the advice of the Advisory Committee on
Environmental Hazards, determines that there is
credible evidence of a positive association between
occurrence of the disease in humans and exposure to
ionizing radiation.
(C) Subject to paragraphs (2) and (3) of this subsection, a
veteran who the Secretary finds may have been exposed while
serving on active duty in the Southwest Asia theater of
operations during the Persian Gulf War to a toxic substance or
environmental hazard is eligible for hospital care and nursing
home care under subsection (a)(1)(G) of this section for any
disability, notwithstanding that there is insufficient medical
evidence to conclude that such disability may be associated
with such exposure.
(2) [Hospital] In the case of a veteran described in
paragraph (1)(C), hospital and nursing home care may not be
provided under subsection (a)(1)(G) of this section with
respect to a disability that is found, in accordance with
guidelines issued by the Under Secretary for Health, to have
resulted from a cause other than an exposure described in
[subparagraph (A), (B), or (C) of paragraph (1) of this
subsection] paragraph (1)(C).
(3) Hospital and nursing home care and medical services may
not be provided under or by virtue of subsection (a)(1)(G) [of
this section after June 30, 1995,], in the case of care for a
veteran described in paragraph (1)(A), after December 31, 1997,
or, in the case of care for a veteran described in paragraph
(1)(C), after December 31, 1995.
(4) For purposes of this subsection and section 1712 of this
title:
(A) The term ``herbicide-exposed veteran'' means a
veteran (i) who served on active duty in the Republic
of Vietnam during the Vietnam era, and (ii) who the
Secretary finds may have been exposed during such
service to a herbicide agent.
(B) The term ``herbicide agent'' has the meaning
given that term in section 1116(a)(4) of this title.
(C) The term ``radiation-exposed veteran'' has the
meaning given that term in section 1112(c)(4) of this
title.
* * * * * * *
Sec. 1712. Eligibility for outpatient services
(a)(1) Except as provided in subsection (b) of this section,
the Secretary shall furnish on an ambulatory or outpatient
basis such medical services as the Secretary determines are
needed--
(A) to any veteran for a service-connected disability
(including a disability that was incurred or aggravated
in line of duty and for which the veteran was
discharged or released from the active military, naval,
or air service);
(B) for any disability of a veteran who has a
service-connected disability rated at 50 percent or
more;
(C) to any veteran for a disability for which the
veteran is in receipt of compensation under section
1151 of this title or for which the veteran would be
entitled to compensation under that section but for a
suspension pursuant to that section (but in the case of
such a suspension, such medical services may be
furnished only to the extent that such person's
continuing eligibility for medical services is provided
for in the judgment or settlement described in that
section); [and]
(D) during the period before December 31, 1995, for
any disability in the case of a veteran who served on
active duty in the Southwest Asia theater of operations
during the Persian Gulf War and who the Secretary finds
may have been exposed to a toxic substance or
environmental hazard during such service,
notwithstanding that there is insufficient medical
evidence to conclude that the disability may be
associated with such exposure[.];
(E) during the period before January 1, 1998, to any
herbicide-exposed veteran (as defined in section
1710(e)(4)(A) of this title) for any disease specified
in section 1710(e)(1)(A) of this title; and
(F) to any radiation-exposed veteran (as defined in
section 1112(c)(4) of this title) for any disease
covered under section 1710(e)(1)(B) of this title.
* * * * * * *
(i) The Secretary shall prescribe regulations to ensure that
special priority in furnishing medical services under this
section and any other outpatient care with funds appropriated
for the medical care of veterans shall be accorded in the
following order, unless compelling medical reasons require that
such care be provided more expeditiously:
(1) * * *
* * * * * * *
(3) To a veteran [(A)] who is a former prisoner of
war[, or (B) who is eligible for hospital care under
section 1710(e) of this title].
* * * * * * *
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