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CCEP Transition

Comprehensive Clinical Evaluation Program (CCEP) And Post-Deployment Health Clinical Practice Guideline (PDH CPG)

Frequently Asked Questions

WHAT WAS THE CCEP?

The Comprehensive Clinical Evaluation Program (CCEP) was instituted by the Department of Defense in 1994 to provide a thorough, systematic clinical evaluation for the diagnosis and treatment of DoD beneficiaries who had medical complaints/conditions which they believed may have been related to their service in the Persian Gulf during Operation Desert Shield/Desert Storm. Enrollment in the CCEP was voluntary. The CCEP was organized into three phases. Phase 1 consisted of a medical history, physical examination and certain specified laboratory tests performed at a local military treatment facility. If the primary care physician determined it was clinically indicated, he or she referred patients to Phase II for further specialty consultations, which were conducted at a Regional Medical Center. Phase III was designed for a small select group of patients who were suffering from chronic debilitating symptoms and consisted of an intensive 3-week evaluation and treatment program at the Gulf War Health Center at Walter Reed Army Medical Center, designed to improve their health status.

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WHAT IS THE PDH-CPG?

The DoD/VA Post-Deployment Health Clinical Practice Guideline (PDH-CPG) is a clinical guideline that was developed to assist primary care clinicians in systematically evaluating and managing individuals seeking care for potentially deployment-related health concerns and conditions. It was implemented in January 2002. The Guideline applies to all DoD beneficiaries who are experiencing health concerns which they consider related to a deployment, including family members. The PDH-CPG consists of three algorithms: 1) assessment of a post-deployment health concern; 2) decision and triage of a patient whose symptoms remain unexplained after evaluation; and 3) management of patients in whom a diagnosis has been established. Use of the PDH-CPG is mandated by DoD (Health Affairs) and includes the military unique vital sign question "Is your health concern today related to a deployment" for every patient at every visit to a primary care provider (except for wellness visits, such as periodic exams and preventive care) as the first step in initiating use of the Guideline algorithms.

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HOW DOES THE PDH-CPG DIFFER FROM THE CCEP?

The CCEP used a process of intensive specialist examinations to evaluate veterans' Gulf War health concerns/conditions. This practice had the advantage of using a "no stone unturned" method of evaluation, however, it separated care for deployment-related symptoms from other health care concerns the veteran may have had, creating a "fragmented" approach to health care. Enrollment in the program was voluntary. The PDH-CPG is a mandatory program which moved health care back into an integrated framework, by focusing care for all health concerns with the Primary Care Manager and requiring that patients at every primary care visit (except wellness) be asked if their health concern is deployment- related.

In January 2002, DoD (Health Affairs) directed the DoD Deployment Health Clinical Center (formerly the Gulf War Health Center) to assume responsibility for coordinating the evaluation of veterans seeking care for post-deployment health concerns using the PDH-CPG. It also directed that all outstanding CCEP evaluations be completed or administratively closed, and all CCEP offices closed as of 1 June 2002.

DHCC initiated implementation of the PDH-CPG at all Military Medical Treatment Facilities with a Worldwide Satellite Broadcast and distribution of a Tool Kit of supporting materials, and continues to support the PDH-CPG through its Web site www.PDHealth.mil and Clinical and Service Member Helplines. Since the Guideline was published, there have been no changes except for a modification of the procedure for coding post-deployment clinic visits.

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WHAT IS THE VA GULF WAR REGISTRY (GWR) EXAMINATION?

The VA Persian Gulf Registry Program was established in 1992 by the Department of Veterans Affairs (VA) to assist in addressing questions about the health concerns of Persian Gulf veterans. It has now been renamed the Gulf War Registry (GWR) Program. Eligibility for the program includes veterans who served on active military duty in Southwest Asia during the Gulf War and continues to the present, including Operation Iraqi Freedom. VHA Handbook 1303.2 defines the eligibility criteria (veterans who served in Afghanistan (Operation Enduring Freedom) are not eligible) and the protocol and procedures for a GWR examination. VA Forms 10-9009a are used to document the examination. Information on the
VA GWR Examination can be found on the VA Web site by clicking here.

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HOW ARE THE GWR EXAMINATION AND THE CEEP RELATED?

The CCEP was based on the VA Persian Gulf Registry Program. In 1994, the DoD and VA met and revised the original Persian Gulf Registry clinical protocol and implemented this revised approach which was called the CCEP by the DoD and the Persian Gulf Registry and Uniform Case Assessment Protocol (now called the GWR Examination) by the VA.

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WHERE CAN I GET ADDITIONAL INFORMATION?

Additional information on the PDH-CPG and the CCEP can be found on the DoD Deployment Health Clinical Center (DHCC) Web site by clicking here.

DHCC is also available to answer questions through email to pdhealth@amedd.army.mil or the following toll free helplines:

Clinicians Helpline: 1-866-559-1627
Service Members Helpline: 1-800-796-9699

Veterans can inquire about a GWR examination at their nearest VA medical center or by calling the VA Gulf War Information Helpline (1-800-PGW-VETS/1-800-749-8387).

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www.PDHealth.mil is the Official Web site of the DoD Deployment Health Clinical Center
Located at Walter Reed National Military Medical Center, Bethesda, MD (MRMC)