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«Table of Contents Contents Executive Summary Introduction Overarching Concept Clinical Care: Leveraging Veteran-Centric Specialty Services in Primary ...»

-- [ Page 1 ] --

Draft for Public Comment

2011 Report of

The Department of Veterans Affairs

Gulf War Veterans’ Illnesses Task Force

to

The Secretary of Veterans Affairs

This page intentionally left blank

Table of Contents

Contents

Executive Summary

Introduction

Overarching Concept

Clinical Care: Leveraging Veteran-Centric Specialty Services in Primary Care............ 12

Background:

Current Efforts:

Plan:

Metrics and Accountability:

Clinical Education and Training: Putting Clinical Knowledge into Practice

Background:

Current Efforts:

Plan:

Metrics and Accountability:

Veteran Benefits: Delivering Compensation and Pension and Fiduciary Services........ 17 Background:

Current Efforts:

Plan:

Metrics and Accountability:

Veteran Outreach: Improving Communications to Gulf War Veterans

Background:

Current Efforts:

Plan:

Metrics and Accountability:

Partnerships: Improved Data Sharing with the Department of Defense (DoD).............. 23 Background:

Current Efforts:

Plan:

Metrics and Accountability:

Ongoing Scientific Reviews and Population Based Surveillance: Taking Advantage of Untapped Sources of Data Related to Veterans’ Health

Background:

Current Efforts:

Plan:

Metrics and Accountability:

Research and Development: Encouraging Targeted Efforts

Background:

Current Efforts:

Plan:

Metrics and Accountability:

APPENDIX A – Veterans Affairs GWVI Research

APPENDIX B – Draft Gulf War Veterans Illnesses Provider Pocket Guide

APPENDIX C – Research Advisory Committee for Gulf War Veterans Illnesses.......... 41 APPENDIX D – Gulf War Steering Committee Members

APPENDIX E – Gulf War Veterans’ Illnesses Task Force Members

APPENDIX F – GWVI Web sites and Links

Executive Summary

The Gulf War Veterans Illnesses Task Force (GWVI-TF) was formed to ensure that the Department of Veterans Affairs (VA) maintained a focus on the unique issues of Veterans of the 1990-1991 Gulf War. The Persian Gulf War is legally defined in title 38 U.S.C. § 101(33) as beginning on August 2, 1990, and ending on the date thereafter prescribed by Presidential proclamation or by law. While the term "Gulf War Veterans" could refer to all Veterans of conflicts during this period, including Veterans of Operation Iraqi Freedom, and subsequent conflicts, the GWVI-TF target population is Veterans who were deployed on the Operation Desert Shield and/or Operation Desert Storm components of the 1990 - 1991 Gulf War, hereafter referred to as the Gulf War.

In August 2009, the Secretary of VA directed a comprehensive review of the Department’s programs to support this population of Veterans, develop an overarching action plan to advance their services, and ultimately improve their satisfaction with the quality of services and support VA provides. One year later, the GWVI-TF prepared its first annual report. The report broadly reviewed programs and efforts and identified seven areas where VA service improvement was necessary. The report also developed an initial roadmap to transform the care and services delivered to Gulf War Veterans.





Over the past year, the GWVI-TF has refined this initial roadmap and taken concrete steps to improve care and services to Gulf War Veterans. The work has proceeded around a premise that the efforts must become a part of the culture and ongoing operations of VA and not simply the purview of a special Task Force. To accomplish this outcome, the GWVI-TF adopted a slightly revised framework for organizing and synchronizing its efforts. That framework serves as the overarching template for this

report. The framework is composed of the following lines of effort:

Clinical Care: Leveraging Veteran-Centric Specialty Services in Primary Care Clinical Education and Training: Putting Clinical Knowledge Into Practice Veteran Benefits: Delivering Compensation and Pension and Fiduciary Services Veteran Outreach: Getting Out the Word and Listening to the Feedback Partnerships: Improved Data Sharing with the Department of Defense Ongoing Scientific Review and Surveillance: Taking Advantage of Untapped Sources of Data Related to Veterans’ Health Research and Development: Encouraging Targeted Efforts

Clinical Care: Leveraging Veteran-Centric Specialty Services in Primary Care

One of the most substantial additions to the framework is the Clinical Care line of effort.

Clinical health care for Gulf War Veterans is one of the most critical services VA can provide. This line of action is directly supported by Clinical Education and Training to ensure VA providers are well prepared to care for this population. Clinical Care also benefits from research and development and Ongoing Scientific Review and Surveillance which inform and direct the best in evidence-based healthcare. The GWVI-TF has developed a prototype for a networked Gulf War Clinic which will be implemented at the Salt Lake City Veterans Affairs Medical Center (VAMC) in the coming year. The clinic will link subject matter experts and clinical specialists with primary care providers to optimize the care delivered to these patients. Teaching aids, referral networks, and other collaborative processes will be exercised in this effort.

Clinical Education and Training: Putting Clinical Knowledge into Practice

The GWVI-TF Clinical Education and Training effort focused on improving VA’s ability to put critical clinical knowledge and expertise at the point of care. Where the Clinical Care work was aimed at synchronizing specialty and primary health care, this effort was in direct support, providing necessary clinical education, training, and subject matter expertise. The Veterans Health Administration (VHA) Office of Public Health created a series of training modules now universally available online for patients and clinicians.

Additionally, VA hosted a series of exposure seminars to enhance clinician knowledge about the health impacts of various environmental exposures. In the coming year, again in direct support of Clinical Care, this effort will publish an environmental health pocket card for primary care providers and collaborate in the formal development/improvement of a three tiered network of care presented in the prototype clinic for Gulf War health care.

Veteran Benefits: Delivering Compensation and Pension and Fiduciary Services

As research and environmental study evolves or new legislative and regulatory provisions are written regarding illnesses for Gulf War Veterans, the VA Compensation Service of the Veterans Benefits Administration (VBA) performs necessary rule-making and develops field training to support the changes. To further assist Gulf War Veterans, Compensation Service developed two training letters designed to inform and instruct regional office personnel on development and adjudication of disability claims based on Southwest Asia service. VA also completed a regulation to add functional gastrointestinal disorders to the list of disabilities that are presumed to have resulted from service in the Gulf War. The final rule was published and became effective on August 15, 2011. VBA continues to work with the VA/Department of Defense (DoD) Deployment Health Working Group to identify environmental exposures whether related to the Gulf War or elsewhere. Finally, VBA worked with the VHA on an effort to develop and execute a separation health assessment with DoD, an effort that is intended to reduce the future burden of proving service connection that Veterans often must bear when seeking recognition for exposure-related illnesses and injuries years after service.

Veteran Outreach: Getting Out the Word and Listening to the Feedback

VA is dedicated to improving the lives of Veterans of all eras and their eligible family members and survivors by providing them with the benefits and services they have earned. Research shows there is a lack of awareness when it comes to specific services, and Gulf War Veterans continue to require and rightfully expect timely and accurate information about VA’s efforts to support them. VA has worked to develop a proactive and systematic effort for providing this important information and assistance on VA’s services and benefits. As a clearinghouse of Gulf War Veterans Illnesses (GWVI) information, VA maintained the Gulf War Veterans' Illnesses Web site (http://www.publichealth.va.gov/exposures/gulfwar/) as a source of information for Veterans, healthcare providers, and other stakeholders. VA conducted a number of GWVI specific outreach events and published news releases for key events during the past year. Moving forward, VA’s outreach efforts for GWVI will increasingly leverage evolving technology and social media and work to significantly improve transparency regarding VA’s work for this important Veteran population.

Partnerships: Improved Data Sharing with the Department of Defense (DoD)

DoD and VA provide health care and benefits to the same population at different times in their lives. Environmental exposures occur during active duty whereas the potential clinical consequences can manifest later when the former Servicemember is a Veteran.

For this reason it is critical that VA and DoD share clinical and exposure data. The GWVI-TF continued to build robust relationships with DoD, through such forums as the Deployment Health Working Group, to ensure timely and thorough access to data related to military service. The experiences of the Gulf War Veterans continue to influence the development of ongoing data sharing efforts with DoD which should aid both Gulf War Veterans as well as generations of Veterans who follow.

Ongoing Scientific Review and Surveillance: Taking Advantage of Untapped Sources of Data Related to Veterans’ Health Ongoing scientific review is critical to understanding the environment that impacts health. There are Veterans’ health-related data available from sources other than studies conducted by VA. Having access to and understanding these data sources is important in comprehending the complex array of adverse health effects associated with deployment. VA has developed and maintained active participation in ongoing longitudinal reviews and surveillance projects including the Centers for Disease Control and Prevention/National Center for Health Statistics’ National Health and Nutrition Examination Survey, the DoD Millennium Cohort Study, and the VA National Study for a New Generation of U.S. Veterans. These programs help VA identify Gulf War Veteran health trends through focused comparisons with broader populations. VA has also engaged in more focused surveillance and epidemiologic research regarding Gulf War through the additional study of Neurological Disease, a 30,000 Veteran study of 1990Gulf War Veterans, and ongoing Depleted Uranium and Toxic Embedded Fragment Surveillance Center and Registry work. Much of this work is longitudinal in nature (some continuing out into 2022), but results and findings from some are expected to be published in peer reviewed publications in the coming year.

Research and Development: Encouraging Targeted Efforts

Through the Office of Research & Development (ORD), VA funds research that will further the goal of improving the health and lives of Veterans who have GWVI, the complex of chronic symptoms that affect Veterans of the 1990-1991 Gulf War. To improve specific management of the GWVI portfolio of research, ORD actively pursued staffing additions to support these efforts. ORD continued to support and advertise requests for proposals for GWVI research and collaborate with VA, DoD, and other research activities through professional collaboration events and forums. Additionally, with support from the Gulf War Research Steering Committee and input from the Research Advisory Council for Gulf War Veterans’ Illnesses, a GWVI Research Strategic Plan was drafted. This plan, combined with the targeted staffing changes, is expected to provide focus and accountability to this research portfolio.



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