The DoD asked the Institute to continue its evaluation of the CCEP with special attention to three issues: (1) approaches to addressing difficult-to-diagnose individuals and those with ill-defined conditions; (2) the diagnosis and treatment of stress and psychiatric conditions; and (3) the assessment of health problems of those who may have been exposed to low levels of nerve agents. This new committee (CCEP 2) was also asked to consider whether there are medical tests or consultations that should be added to the CCEP to increase its diagnostic yield. The following diagram describes the output of the two CCEP committees.

Because of growing concern about the health problems of those veterans who may have been exposed to low levels of nerve agents, the DoD asked the committee to address this issue first. A 1-day workshop was held during which leading researchers and clinicians presented the latest scientific and clinical information regarding possible health effects of low-level exposure to nerve agents and chemically related compounds, as well as the tests available to measure the potential health effects of such exposures. Because there is little available research documenting long-term health effects of low-level exposure to nerve agents, speakers were asked to address the kinds of effects that might exist. These potential effects included neurological problems such as peripheral sensory neuropathies and psychiatric effects such as alterations in mood, cognition, or behavior.

The committee concluded that, overall, the CCEP provides an appropriate screening approach to the diagnosis of a wide spectrum of neurological diseases and conditions. The issue of psychological and psychiatric problems will be addressed in greater detail in the upcoming workshops and the final committee report.

The committee agreed that, given the possibility of low-level exposure to nerve agents, certain refinements in the CCEP would enhance its value. Although these refinements need not be applied retrospectively, the committee hopes implementation will be rapid so that as many new enrollees as possible will benefit from the improved system. Refinements include:

  • improved documentation of the screening used during Phase I for patients with psychological conditions such as depression and posttraumatic stress disorder (PTSD);
  • improved documentation of neurological screening used during both Phase I and Phase II of the CCEP;


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