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Adequacy of the VA Persian Gulf Registry and Uniform Case Assessment Protocol (1998)
Institute of Medicine (IOM)

Page
155
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Page
155
Front Matter (R1-R12)
Executive Summary (1-14)
Introduction (15-18)
The Institute of Medicine's Persian Gulf Activities (19-20)
The Dapartment of Veterans Affairs Persian Gulf Registry and Uniform Cse Assessment Protocol (21-28)
Committee on the Evaluation of the Department of Veterans Affairs Uniform Case Assessment Protocol (29-32)
Findings and Recommendations (33-50)
Conclusion (51-52)
References and Selected Bibliography (53-54)
Appendix A: Health Consequences of Service During the Persian Gulf War: Initial Findings and Recommendations for Immediate Action (55-66)
Appendix B: Health Consequences of Service During the Persian Gulf War: Recommendations for Research and Information Systems (67-78)
Appendix C: Evaluation of the U.S. Department of Defense Persian Gulf Comprehensive Clinical Evaluation Program: Overall Assessment and Recommendations (79-96)
Appendix D: Adequacy of the Comprehensive Clinical Evaluation Program: Nerve Agents (97-104)
Appendix E: Adequacy of the Comprehensive Clinical Evaluation Program: A Focused Assessment (105-112)
Appendix F: VA Phase I Protocol (113-116)
Appendix G: VA Phase II Protocol (117-122)
Appendix H: Persian Gulf Registry Code Sheet (123-134)
Appendix I: VA Persian Gulf Bi-Monthly Report (135-140)
Appendix J: Examples of Persian Gulf Registry Follow-Up Letters (141-144)
Appendix K: VA Monitoring Instrument for Appropriate Medical Care (145-154)
Appendix L: Annual Persian Gulf Conference Agenda (155-162)
Appendix M: Site Visit Questions (163-166)
Appendix N: Summary of Responses to Requests for Information (167-184)
Appendix O: Questions Related to Traumatic Exposure (185-186)
Appendix P: Patient Satisfaction (187-192)

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A. . ppencllx L1 Annual Persian Gulf Conference Agenda EMPLOYEE EDUCATION SYSTEM ST. LOUIS EDUCATION CENTER presents COURSE NO. 97-NP HEALTH CONSEQUENCES OF PERSIAN GULF SERVICE JUNE 3 - , 1997 In cooperation with THE OFFICE OF EMPLOYEE EDUCATION OFFICE OF PUBLIC HEALTH AND ENVIRONMENTAL HAZARDS AND ENVIRONMENTAL AGENTS SERVICE DEPARTMENT OF VETERANS AFFAIRS PLACE Hyatt Regency, 200 South Pine Avenue, Long Beach, California 155

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156 ADEQUACY OF THE VA PERSIAN GULF REGISTRY AND UCAP PURPOSE This program is designed to provide an update on the latest information available Tom the clinical and scientific studies of Persian Gulf veterans' illnesses. It will focus on infonnation needed to enhance clinical skills in the evaluation and management of Gulf War veterans. OBJECTIVES At the conclusion of this program, participants will be able to: 1. describe current Persian Gulf War (POW) veterans' programs available Trough VA and British and Canadian military forces; 2. discuss the Presidential Advisory Committee's recommendations and government responses 3. use the assessment, treatment, and communication approaches presented during the program in their work with PGW veterans; 4. provide a comprehensive Persian Gulf Veteran's program including occupational exposure assessments, clinical and C&P exams, and the management of special issues in the care of the PGW veteran; 5. include psychosocial aspects as a part of the assessment and treatment of the PGW veteran; and 6. apply relevant research studies' findings con ceming Gulf War veterans' illnesses to their medical care and treatment. EXPECTED Each participant will use the information presented to OUTCOMES enhance the evaluation and treahnent of PGW veterans. TARGET This conference is designed for VA Medical Center AUDIENCE Persian Gulf physicians and clinical staff and selected readjustment counseling staff. Additional participants will be selected by the Office of Public Health and Environmental Hazards on a space available basis.

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APPENDLYL 157 PROGRAM Monday, June 2, 1997 SCHEDULE 6:00- Registration Regency Ballroom Lobby 8:00 pm Tuesday, June 3, 1997 Moderator: Frances M. Murphy, MD, MPH 7:00 am Registration General Session 8:00 8:15 9:15 9:45 Break Regency Ballroom Lobby Regency Ballroom Welcome Susan Mather' MD Update on VA PGW Programs Frances M. Murphy, MD, MPH Update on British PGW Programs Col. Timothy P. Finnegan, MBBS, MSc, FFOM Update on Canadian PGW Programs Lt. Col. Kenneth C. Scott, MD 10:15 Presidential Advisory Committee Report and Recommendations Joyce C. Lashof; MD 10:45 Alternative Hypotheses for Causation of Persian Gulf War Veterans' Illnesses Robert H. Roswell, MD 1 1:15 War Syndromes and Their Evaluation Kenneth Craig Hyams, MD 1 1:45 Panel Discussion Moderator: Frances ~ Murphy, MD, MPH Col. Timothy P. Finnegan, BSc, MBBS, MSc, FFOM Kenneth Craig Hyams, MD Joyce C. Lashof; MD

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158 ADEQUACY OF THE VA PERSIAN GULF REGISTRY AND UCAP Robert H. Roswell, MD Lt. Col. Kenneth C. Scott, MD 12:30 Lunch 30 3:00 Concurrent Sessions 1. Physiologic Effects of Traumatic and Non-Traumatic Stress *horelir~eA/B Moderator: Theresa L. King, PA-C Matthew J. Friedman, MD, PhD 2. The Tokyo Subway Incident of 20 March 1995 Regency Ballroom Moderator: Frances ~ Murphy, MD, MPH Annetta P. Watson, PhD 3. Health Risk Communication to Persian Gulf Veterans Harbor A/B/C Moderator: Donald J. Rosenblum, Max R. Lum, E.Ed., M.P.A. Timothy L. Tinker, DrPH, MPH 4. Compensation and Pension Exams for Persian Gulf Veterans' Diagnosed and Underdiagnosed Illnesses *eaview B Moderator: Steven Oboler, MD Steven A. Cumbea Stephen C. Hunt, MD Steven Oboler, MD 5. Occupation and Exposure History-Taking Techniques Seaview C Moderator: Susan H. Mather, MD, MPH Melissa A. McDiarmid, MD, MPH Break Concurrent Sessions Continue Adjourn

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APPENDIX L 159 6:00- Poster Session and Reception 7:00 p.m. Wednesday, June 4, 1997 Moderator: Susan Masher, MD General Session 8:00 am VA Mortality Study Han K. Lang, DrPH 8:30 9:00 10:00 Regency Ballroom CDC Survey of Iowa Persian Gulf Veterans Drue Barrett, PhD NHRC Hospitalization Studies Among Persian Gulf Veterans Cdr. Gregory C. Gray, MD, MPH NHRC Study of Birth Defects Among Children of Persian Gulf Veterans Cdr. Gregory C. Gray, MD, MPH Break 10:30 Health Effects of Pyridostigmine Bromide Summary of Findings to Date Col. Michael A. Dunn, MD 1 1:15 1 1:45 12:30 pm Lunch VA's Depleted Uranium Program Melissa A. McDiarmid, MD, MPH Panel Discussion Moderator: Frances M. Murphy, MD, MPH Drue Barrett, PhD Col. Michael A. Dunn, MD Cdr. Gregory C. Gray, MD Han K. Rang, DrPH Melissa A. McDiarmid, MD, MPH

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160 ADEQUACY OF THE VA PERSIAN GULF REGISTRY AND UCAP 1:30 3:00 3:30 Concurrent Sessions 1. Occupational and Exposure History Taking Techniques Seaview C 2. Answers to Commonly Asked Questions of Persian Gulf Veterans~ase Presentations and Interactive Forum Regency Ballroom Moderator: Frances ~ Murphy, MD, MPH Arnold B. Gorin, MD Frances M. Murphy, MD, MPH 3. It Takes a Village: Community Based Supportive Services for Persian Gulf Veterans and Family Members Beacon B Moderator: Donald J. Rosenblum Harry P. Becnel, PhD Peter J. Ehlich Robert S. Key Norma King-Joiner Steven Longoria T. Patrick McGregor 4. Compensation and Pension Exams for Persian Gulf Veterans' Diagnosed and Underdiagnosed IllnessesBeacon A Moderator: Steven Oboler, MD Steven A. Cumbea Stephen C. Hunt, MD Steven Oboler, MD 5. DoD Incident Investigation-A Status ReportShoreline A/B Moderator: John Kraemer Lt. Col. Dee Dodson Morris Break Panel Discussion Moderator: Frances M. Murphy, MD, MPH Steven A. Cumbea Arnold B. Gorin, MD Susan H. Mather, MD, MPH Robert M: White, JD

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APPENDIX L 161 4:45 Concluding Remarks and Meeting Summary Frances ~ Murphy, MD, MPH 5:00 pm Evaluation/Awarding of Certificates/ Conclusion

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regency ballroom