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to their service in the Gulf. Commonly reported problems include fatigue, moodiness, memory loss, muscle and joint pain, shortness of breath, and rashes (Fukuda et al. 1998; Iowa Persian Gulf Study Group 1997).

A number of efforts have been undertaken by individual veterans, veterans' service organizations, academia, Congress, federal agencies, private-sector organizations, and others to investigate the possible causes of and treatments for the illnesses experienced by Gulf War veterans. This work includes clinical efforts aimed at understanding the nature of the illnesses and the effectiveness of potential treatments, population-based studies on the health status of Gulf War veterans, research on the potential health effects of the agents that were present in the Gulf War, advocacy efforts, and policy efforts on compensation and health care for Gulf War veterans.

CLINICAL REGISTRIES

In response to concern about possible illnesses, the VA and DoD developed special diagnostic programs. The VA program was begun in 1992 and is divided into two phases—the Persian Gulf Registry and the Uniform Case Assessment Protocol (UCAP). The Registry Exam includes basic laboratory tests and a complete medical history that records time of onset of symptoms or condition, intensity, degree of physical incapacitation, and details of any treatment received through the time of examination. The UCAP provides for additional examination and testing for those veterans who are found to have a disability but no clearly defined diagnosis that explains their health problems. Four Gulf War Referral Centers offer inpatient stays to treat serious health problems not diagnosed in the first two phases. Referral Centers provide multidisciplinary consultations, serial examinations, and treatment that is focused on individual patient needs.

The DoD clinical diagnostic program implemented in 1994 is similar to that of the VA and is called the Comprehensive Clinical Evaluation Program (CCEP). The CCEP is also a two-phase process, the first of which is conducted at the primary care level and consists of a medical history, physical examinations, and laboratory tests. Veterans may be referred to Phase II for specialty consultations if the primary care physician determines such referral is indicated. The Specialized Care Center at Walter Reed Army Medical Center provides additional evaluation, treatment, and rehabilitation for patients suffering from chronic debilitating symptoms.

As of October 2000, more than 80,000 Gulf War veterans had participated in the VA registry program, while DoD reports having completed examinations on almost 39,000 as of December that year.



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