•  Recommend how best to disseminate this information throughout the VA to improve the care and benefits provided to veterans.

•  Recommend additional scientific studies and research initiatives to resolve areas of continuing scientific uncertainty.

•  Recommend such legislative or administrative action as the IOM deems appropriate in light of the results of its review.


A multipronged approach was used to respond to the charge. A Systematic review was conducted to evaluate the scientific literature on therapies to eliminate or alleviate the symptoms associated with, or that define, CMI. Because many people who have CMI also have other unexplained conditions with shared symptoms (such as CFS, fibromyalgia, and IBS) and may have comorbid conditions (such as depression and anxiety), treatments recommended in guidelines or supported by evidence as summarized in systematic reviews for these related and comorbid conditions also were reviewed to identify any treatments potentially beneficial in people who have CMI.

Managing patients who have CMI involves more than administering a therapy. It requires a broader view of treatment. To explore other aspects of care, the committee drew on multiple sources (such as the scientific literature, government reports, care programs used by organizations, an analysis of social media, and testimony from veterans and their families) so that it could make recommendations to VA about improving its model of care for veterans who have CMI, educating VA clinicians to improve their knowledge about how to care for these patients, and improving communication between clinicians and patients who have CMI.


The committee’s findings, conclusions, and recommendations are in five major categories:

1.  Treatments for CMI.

2.  The VA health care system as it is related to improving systems of care and the management of care for veterans who have CMI.

3.  Dissemination of information through the VA health care system about caring for veterans who have CMI.

4.  Improving the collection and quality of data on outcomes and satisfaction of care for veterans who have CMI and are treated in VA health care facilities.

5.  Research on diagnosing and treating CMI and on program evaluation.

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