[House Report 104-158]
[From the U.S. Government Publishing Office]



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].
          * * * * * * *
                                   -