National Center for Military Deployment Health Research

Lyla M. Hernandez, Catharyn T. Liverman, and Merwyn R. Greenlick, Editors

Committee on a National Center on War-Related Illnesses and Postdeployment Health Issues

Division of Health Promotion and Disease Prevention

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.



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National Center for Military Deployment Health Research National Center for Military Deployment Health Research Lyla M. Hernandez, Catharyn T. Liverman, and Merwyn R. Greenlick, Editors Committee on a National Center on War-Related Illnesses and Postdeployment Health Issues Division of Health Promotion and Disease Prevention INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C.

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National Center for Military Deployment Health Research NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. This project has been funded entirely with federal funds from the Department of Veterans Affairs, under Contract No. V101(93)P-1637. The views presented are those of the Institute of Medicine Committee on a National Center on War-Related Illnesses and Postdeployment Health Issues and are not necessarily those of the funding organization. International Standard Book Number 0-309-06630-1 Additional copies of this report are available from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, DC 20055. Call (800) 624-6242 or (202) 334-3313 in the Washington metropolitan area), or visit the NAP on-line bookstore at www.nap.edu. For more information about the Institute of Medicine, visit the IOM home page at www.iom.edu. Copyright 1999 by the National Academy of Sciences. All rights reserved. Printed in the United States of America The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatliche Museen in Berlin.

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National Center for Military Deployment Health Research COMMITTEE ON A NATIONAL CENTER ON WAR-RELATED ILLNESSES AND POSTDEPLOYMENT HEALTH ISSUES MERWYN GREENLICK (Chair), Professor and Chair, Department of Public Health and Preventive Medicine, Oregon Health Sciences University School of Medicine DAN BLAZER II, J.P. Gibbons Professor of Psychiatry and Behavioral Sciences, Duke University Medical Center DENNIS HOGAN, Director, Population Studies and Training Center, Brown University ISABEL HOVERMAN, Clinical Assistant Professor of Medicine, University of Texas Medical Branch at Galveston, and Austin Internal Medicine Associates KERRY KILPATRICK, Professor and Chair, Department of Health Policy and Administration, University of North Carolina at Chapel Hill, School of Public Health RICHARD KURZ, Dean and Professor, Department of Health Administration, St. Louis University School of Public Health PENNY PIERCE, Assistant Professor, University of Michigan School of Nursing, and Faculty Associate, Survey Research Center, Institute for Social Research GUTHRIE TURNER, Chief Medical Consultant, Division of Disability Determination Services, State of Washington PETER WHITEHOUSE, Professor of Neurology, Psychiatry, Organizational Behavior, and Ethics, Alzheimer Center, Case Western Reserve University School of Medicine Study Staff LYLA HERNANDEZ, Study Director CATHARYN LIVERMAN, Study Director KYSA CHRISTIE, Project and Research Assistant PATRICIA SPAULDING, Project Assistant KATHLEEN STRATTON, Acting Director, Division of Health Promotion and Disease Prevention DONNA D. DUNCAN, Division Assistant

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National Center for Military Deployment Health Research Acknowledgments The committee wishes to express its appreciation to the many individuals who contributed to the completion of this project. We especially want to thank the following workshop presenters who provided the committee with a wealth of information: Craig Hyams, Ralph Ibson, Susan Edgerton, William Cahill, Kim Lipsky, James Riddle, Charles Engel, Karl Friedl, Frank Garland, Frances Murphy, Han K. Kang, Matthew Friedman, Tim Gerrity, Marsha Goodwin, William Brew, Matthew Puglisi, Paul Sullivan, and Lynn Preston. This report has been reviewed in draft form by individuals chosen for thief diverse perspectives and technical expertise, in accordance with procedures approved by the NRC's Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making the published report as sound as possible and to ensure that the report meets institutional standards for objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process. We wish to thank the following individuals for their participation in the review of this report: Margit L. Bleecker, Center for Occupational and Environmental Neurology, Baltimore, MD Larry R. Churchill, University of North Carolina at Chapel Hill Maureen Henderson, University of Washington Gilbert S. Omenn, University of Michigan William A. Satariano, University of California Berkeley William J. Schull, University of Texas Health Science Center William Ray True, St. Louis University Medical Center

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National Center for Military Deployment Health Research While the individuals listed above have provided constructive comments and suggestions, it must be emphasized that responsibility for the final content of this report rests entirely with the authoring committee and the institution.

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National Center for Military Deployment Health Research Contents     EXECUTIVE SUMMARY   1     VA Proposal   2     National Center   3     Conclusion   6 1   INTRODUCTION   7     Structure of the Report   8 2   BACKGROUND   9     War-Related Illnesses and Postdeployment Health   9     Legislative History   11     Military and Veterans Health Coordinating Board   14     The Views of Veterans   15     National Research Centers   16     VA Plans for a National Center on War-Related Illnesses   24 3   FINDINGS   26 4   RECOMMENDATIONS   30     Assessment of the VA Proposal   31     Establishing a National Center   32     Scope and Focus   32     Organizational Placement   33     Structure   37     Funding   46     Sustaining the National Center   46 5   CONCLUSION   47

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National Center for Military Deployment Health Research     REFERENCES   49     APPENDIXES     A   Workshop Agenda   51 B   Public Law 105-368: The Veterans Program Enhancement Act of 1998, Section 103. National Center on War-Related Illnesses and Post-Deployment Health Issues   53