National Center for Military Deployment Health Research (1999) / Chapter Skim
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2 Background
2 Background
Pages 9-25
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From page 9... ...
The committee also reviewed the charter for the newly designated Military and Veterans Health Coordinating Board. Representatives of veterans' organizations shared their perspectives on the goals for a national center to study war-related illnesses and postdeployment health issues.
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From page 10... ...
found that combat exposure was significantly related to reports of recent and chronic mental disorders, recent hernia and chronic ulcer, recent eczema and chronic rash, deafness, chronic infective and parasitic disease, and chronic back disorders, as well as to symptoms and signs of ill-defined conditions. Two major contributions to the investigation of war-related illnesses resulted from research into the health problems of Vietnam veterans: (1)
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From page 11... ...
Its cause was thought to be stress (Hyams et al., 19964. Health problems reported following the Gulf War include a wide variety of symptoms similar to those found in acute combat stress reaction, PTSD, and chronic fatigue.
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During the course of that investigation, questions were raised about the ability of the DoD and VA to collect adequate information about, keep good health records on, and produce reliable and valid data to monitor the health care and compensation status of ill Gulf War veterans. Additionally, it was perceived that because public confidence and trust in these agencies was low, the value of the center might be impaired if it was housed or run by either department.
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From page 13... ...
The Center for the Study of Military Health envisioned in this legislation was to: · evaluate and monitor interagency coordination on issues relating to postdeployment health concerns of members of the armed forces, including outreach and risk communication, record keeping, research, utilization of new technologies, international cooperation and research, health surveillance, and other health-related activities; · evaluate the health care provided to members of the armed forces both before and after their deployment on military operations; · provide and direct training of DoD and VA health care personnel in the evaluation and treatment of postdeployment diseases and health conditions; and · recommend to DoD and VA ways to improve health care, including improvements in the monitoring and treatment of members of the armed forces. With different versions of the legislation in the House and the Senate, and with very different perspectives on how to approach this issue, the legislation was referred to a conference committee.
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From page 14... ...
The Academy was directed to report on its recommendations to the secretaries of Veterans Affairs, Defense, and Health and Human Services, and to the Committees on Veterans' Affairs of the Senate and House of Representatives, not later than one year after the date of the enactment of this Act. MILITARY AND VETERANS HEALTH COORDINATING BOARD In 1998, the Executive Office of the President issued a Presidential Review Directive that emphasized the need for a coordinated program of research that could include "deployment health related research, population-based troop health assessments before, during, and after deployments, and epidemiological research to determine whether deployment-related exposures are associated with postdeployment health problems" (Executive Office ofthe President, 1998, p.
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The RWG also makes recommendations concerning appropriate responses and actions to research findings and maintains an ongoing review of the status of compliance with recommendations of external review bodies regarding research. The third working group of the Board is the Health Risk Communication Working Group which will provide recommendations and coordination for the health-risk communication efforts of the DoD, VA, and HHS for military members, veterans, deployed civilians, and their families.
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Issues of concern to Gulf War veterans include delayed responses by the VA and DoD in addressing potential exposures to hazardous chemicals and other substances, as well as such data issues as the need in future deployments for collecting more thorough exposure data. 1 .r NATIONAL RESEARCH CENTERS Department of Defense Centers for Deployment Health In early 1999, the Defense Authorization Bill for fiscal year 1999 (Public Law 105-261)
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The mission of the proposed centers is to: · manage the Comprehensive Clinical Evaluation Program and the Specialized Care Program with related quality improvement, service evaluation, and continuing medical education efforts; · conduct clinical research evaluating risk factors, etiologies, new treatments, and prevention strategies targeting deployment health concerns; · develop risk-communication interventions and evaluations; · conduct surveillance for patterns and risk factors for illnesses, injuries, and symptoms; · plan, coordinate, and conduct epidemiological analysis of medical surveillance data relevant to specific deployments; · conduct epidemiological studies investigating the longitudinal health experience of previously deployed military personnel, and develop and evaluate health surveillance strategies; and · conduct longitudinal studies of health outcomes, including studies of reproductive outcomes, involving both personnel on active duty and those who have left military service. Deployment Health Clinical Center The first of the three centers identified by the DoD is the Deployment Health Clinical Center, located at Walter Reed Army Medical Center and built upon the work of the Gulf War Health Center.
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From page 18... ...
Funding for this center is provided by the DoD Director of Defense Research and Engineering through the Army Medical Research and Materiel Command. The goals of this center are to: · manage epidemiological studies investigating the longitudinal health experience of previously deployed military personnel, and develop and evaluate appropriate health surveillance strategies; and · develop a research portfolio of studies of symptoms, hospitalizations, reproductive outcomes, mortality, and other health outcomes for all DoD beneficiaries, including those on active duty as well as retirees, and dependents.
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DMSS will be designated as the DoD Deployment Health Medical Surveillance Center. The information contained in the DMSS ranges from preinduction data (including initial HIV tests, and limited medical information from the military entrance processing station)
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It is the Veterans Health Administration that carries out the VA's health-related research and development activities. Under the VA's chief research and development officer, there are four research services: medical research, health services research and development, rehabilitation research and development, and cooperative studies.
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From page 21... ...
Additionally, four environmental hazard centers were established in 1994 to focus on health concerns of Gulf War veterans. The Rehabilitation Research and Development Service addresses the minimization of disability and restoration of function in veterans disabled by trauma or disease and funds six centers of excellence that focus on geriatric rehabilitation; functional electrical stimulation; healthy aging with disabilities; mobility; auditory research; and amputation, prosthetics, and limb loss prevention.
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Geriatric Research, Education, and Clinical Centers. The Geriatric Research, Education, and Clinical Centers were implemented by the VA in 1975 to address health care issues for the aging veteran population.
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While the topics are quite different, there are a number of cornerstone elements of this program that may be relevant for establishing national centers on war-related illness and postdeployment health issues. These elements include: · Focused strategic goals.
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Finally, each center would be responsible for developing and coordinating effective health-risk communication programs that provide military personnel, veterans, and their families with up-to-date information about postdeployment health issues. The center (or centers)
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BACKGROUND 25 oversee the funding process, and work closely with the Military and Veterans Health Coordinating Board and the advisory committee. The background information discussed in this chapter was useful to the committee as it deliberated on its findings (Chapter 3)
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