Expertise in War-Related Syndromes

The DHCC possesses extensive expertise in the history of, research about, and treatment of post-war syndromes, chronic pain, and Multiple Unexplained Physical Symptoms (MUPS) in veterans. War-related syndromes have been recognized since the Civil War. They are frequently characterized by symptoms such as fatigue, sleep disturbances, forgetfulness, and persistent headaches. Exhaustive medical evaluations have rarely yielded recognized physiologic disease, and many patients appear to be in fair to normal overall health.

Experience from the Gulf War shows that an operation's length and number of battle-related casualties are not good predictors of the development of subsequent post-deployment health concerns. Another lesson learned from the Gulf War is that the military community was not prepared to deal with Gulf War veterans who presented with symptoms that did not fit with a known disease etiology.

DHCC's charter states that "It is crucial that the lessons from the Gulf War experience be applied in improving protection of troops, responding to health concerns and assisting veterans and their family members through difficult transitions." Since its inception, DHCC has met this challenge by implementing the Comprehensive Clinical Evaluation Program (CCEP). A prototype for best practices in the surveillance, evaluation, and treatment of deployment-related health concerns, the program provided exhaustive medical evaluations and a stepped care strategy for veterans reporting health concerns they associated with their Gulf War experience. In 2002, the CCEP transitioned to the DoD/VA Post Deployment Health Evaluation and Management Clinical Practice Guideline (PDH-CPG). Providing structured algorithms for screening, assessing, evaluating, and treating post-deployment health issues, it widens the scope to all deployment veterans and their families as well as incorporating a primary care-based model. In 2003, responding to a directive from General Peake, PDH-CPG implementation was revitalized through a variety of educational outreach products and events.

Another lesson learned from the Gulf War experience was that military clinicians were not sufficiently expert in risk communication techniques to be able to maintain and increase the trust and confidence of veterans whose post-deployment health issues were difficult to diagnose and treat. DHCC has responded to this need in 2003 by providing risk communication training, a daily electronic newsletter with links to risk communication articles, and risk communications literature for specific emerging health issues associated with Operations Enduring Freedom and Iraqi Freedom (OEF, OIF).

DHCC's role as a center of excellence for improving deployment health has grown throughout 2003. DHCC has taken a leadership role in implementing a Care Manager Model and the PDH-CPG Re-Deployment Assessment process to assess and screen sick and injured veterans demobilizing from OEF/OIF to Walter Reed Army Medical Center, DHCC's host organization. DHCC was also asked in 2003 by DoD Health Affairs to "evaluate, promulgate and implement" a medical program for depleted uranium exposure and to provide clinician and patient information materials for Leishmaniasis, another OEF/OIF force health concern.