Below are the first 10 and last 10 pages of uncorrected machine-read text (when available) of this chapter, followed by the top 30 algorithmically extracted key phrases from the chapter as a whole.
Intended to provide our own search engines and external engines with highly rich, chapter-representative searchable text on the opening pages of each chapter.
Because it is UNCORRECTED material, please consider the following text as a useful but insufficient proxy for the authoritative book pages.
Do not use for reproduction, copying, pasting, or reading; exclusively for search engines.
OCR for page 117
Appendix G
VA Phase I} Protocol
UNIFORM CASE ASSESSMENT PROTOCOL (UCAP)
1. Phase I Level Laboratory Evaluations
a. Complete Blood Count (CBC)
b. Urinalysis, and
c. Blood Chemistry- SMA-6
2. Phase II Level Evaluation Protocol. Phase II Level Evaluations are
recommended for those veterans after complete clinically indicated evaluations
are conducted and the physician determines that the patient has an unexplained
illness. Individuals who after completing Phase I or Registry evaluations, have a
disability and do not have a clearly defined diagnosis which explains their
symptoms, must receive the following supplemental baseline laboratory tests
and consultations.
a. Supplemental Baseline Laboratory Tests
(1) CBC,
(2) Sedimentation Rate Ery~rocyte Sedimentation Rate (ESR),
(3) C-Reactive Protein,
(4) Rheumatoid Factor,
(5) Anti-Nuclear Antibody (ANA),
(6) Liver Function,
(7) Creatine Phosphokinase (CPK),
(8) Hepatitis Serology,
117
OCR for page 118
118
ADEQUACYOF THE VA PERSIAN GULFREGISTRYAND UCAP
(9) Human Immunodeficiency (HIV),
(10) Venereal Disease Research Laboratory (VDRL),
(11) B-12 and Folate,
(12) Thyroid Function Test,
(13) Urinalysis, and
(14) Tuberculosis (TB) Skin Test Purified Protein Derivative (PPD).
b. Consultations to include:
(1) Dental, but only if participant's annual screening is not done.
(2) Infectious Disease.
(3) Psychiatry, but only with physician administered instrument.
(a) Structured Clinical Interview for the Diagnostic and Statistical
Manual of Mental Disorders, Third Edition Revised (DSM III-R).
NOTE: Delete modulesfor mania And psychosis.
(b) Clinician Administered Post Traumatic Stress Disorder
(PTSD) Scale (CAPS).
(4) Neuropsychological Testing, but only as indicated by a psychiatry
consult.
c. Symptom-Specific Examination. Individuals who have the following
symptoms should have the listed minimum work-up.
(1) Diarrhea, to include:
(a) Gastrointestinal (GI) consults,
(b) Stool for Ova and Parasites (O&P),
(c) Stool Leukocytes,
(d) Stool Culture,
Stool Volume,
(f) Colonoscopy with biopsies, and
(g) Esophagastroduodenoscopy (EGD) with biopsies and
aspiration.
(2) Abdominal pain to include:
(a) GI consult,
(b) EGD with biopsy and aspiration,
(c) Colonoscopy with biopsy,
(d) Abdominal ultrasound,
(e) Upper Gastrointestinal (UGI) series with small bowel follow
through, and
(f) Abdominal Computed Tomography (CT) Scan.
Headache
(a) Magnetic Resonance Imaging (MRI) of the head, and
(b) Lumbar Puncture (LP) to include:
1. Glucose,
2. Protein,
OCR for page 119
APPENDIX G
119
3. Cell Count,
4. VDRL,
5. Oligoclonal (lgG),
6. Myelin basic protein,
7. Opening pressure, and
8. Neurology
(4) Muscle Aches and/or Numbness
(a) Electromyogram (EMG), and
(b) Nerve Conduction Velocity (NCV).
(5) Memory Loss, only if verified by neuropsychological testing' to
include.
(a) Magnetic Resonance Imaging (MRI),
(b) LP,NOTE: See tests on headache evaluation.
(c) Neurology consult,
(d) Neuro-psychological testing.
(6) Vertigo andlor Tinnitus, to include:
(a) Audiogram,
(b) Electronystamogram (ENG), and
(c) Brainstem Auditory Evoked Response (BAER).
(7) Chronic Fatigue, to include:
(a) Polysomnography, and
(b) Multiple Sleep Latency Test (MSLT).
(8) Chronic Cough and/or Shortness of Breath, to include:
(a) Pulmonary Consult,
(b) Pulmonary Function Test (PFT) with exercise and Arterial
Blood Gases (ABG),
(c) If routine PFTs are negative, perform Methacholine challenge
test, and
(d) Bronchoscopy with biopsy and/or ravage which is to be
considered if PFTs are normal.
(9) Chest Pain and/or Palpitations, to include:
(a) Electrocardiogram (ECG),
(b) Exercise Stress Test, and
(c) Holter monitor.
(10) Skin Rash, to include:
(a) Dermatology consults, and
(b) Consider a biopsy.
(11) Reproductive Concerns, to include for:
(a) Males, an urology consult; and
(b) Females, a gynecology (GYN) consult.
(c) Additional elements recommended for the evaluation of
Persian Gulf veterans with complaints of Reproductive Health
Problems (RHP):
OCR for page 120
120
ADEQUACY OF THE VA PERSIAN GULFREGISTRYAND UCAP
1. Detailed genitourinary history and/or problems, e.g.:
a. Sexual,
b. Genitourinary symptoms,
c. Menstrual,
d. Contraceptive practices,
Pregnancy-related,
f. Conception,
g. Birth defects,
h Congenital disorders,
i. Menopause,
i Prior infections,
k. Prior surgery, and
1. Exposures to toxic agents, etc.
2. Detailed genital/pelvic examination
3. Laboratory and ancillary testing, e.g'
_. Pap tests;and
b. Tests for genitourinary infections.
,. .
4. Urologist consultations for male veterans who have RHP
that cannot be diagnosed or managed successfully by primary
care practitioners.
5. Gynecology consultation for female veterans who have
RHP that cannot be diagnosed or managed successfully by
primary care practitioners.
(d) Additional elements for evaluation of Persian Gulf veterans
with complaints of infertility.
1. Detailed menstrual and reproductive history (such as the
infertility questionnaire utilized by Walter Reed Army
Medical Centered.
2. Semen analysis, e.g.:
a. Volume,
b. pH,
c. Liquefaction,
d. Spend concentration,
e. Motility,
f
Progressive motility,
g. Sperm viability,
h Leukocytes, and
i. Morphology.
3. Referral to an infertility specialist or program.
OCR for page 121
APPENDIX G
121
(e) Additional elements for evaluation of Persian Gulf veterans
with complaints related to bird defects or genetic disorders in
offspring conceived during or after Persian Gulf service.
1. Detailed history of congenital or genetic disorders (such as
the Patient Genetic Screen Questionnaire utilized by Walter
Reed Army Medical Centered.
2. Detailed occupational exposures questionnaire (such as
Worker and Supervisor Questionnaires utilized by National
Naval Medical Centered.
3. Referral to a genetic disease specialist or program.
*For copies of these questionnaires (Items d-1 and e-1 and 29, contact VA
Environmental Agents Service f103A) at 202-565-4183.
OCR for page 122
Representative terms from entire chapter:
medical centered
