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circulated, public concern grew. Both the Department of Defense (DoD) and the Department of Veterans Affairs (VA) developed a registry to track the health of Persian Gulf veterans and clinical programs to diagnose and treat program participants. In June 1994, the DoD instituted the Comprehensive Clinical Evaluation Program (CCEP), the purpose of which is to diagnose and treat active-duty military personnel who have medical complaints they attribute to service in the Gulf.
In 1994, the DoD asked the Institute of Medicine (IOM) to assemble a group of medical and public health experts to evaluate the adequacy of the CCEP. This committee met four times and prepared three reports between October 1994 and January 1996 (IOM 1995, 1996a,b). A general discussion of this committee's findings appears in the section entitled, "CCEP: The Initial IOM Report" (page 8). A complete list of the first CCEP committee's recommendations appears in Appendix A. Given these recommendations and an analysis by the DoD of information derived from the CCEP, the IOM was asked to continue its review of the CCEP with special emphasis on three areas: (1) approaches to addressing individuals with difficult-to-diagnose or ill-defined conditions, (2) diagnosis and treatment of stress and psychological or psychiatric conditions, and (3) identifying health problems of those who may have been exposed to nerve agents.
Given the intense interest in and concern about the potential health effects of possible exposure to nerve agents, DoD asked the committee to focus first on addressing the health problems of those who may have been exposed to such agents. To do so, a 1-day workshop was held at 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.