WASHINGTON, July 24, 2000 (GulfLINK) - Part of the reason it has been so difficult to determine the causes of Gulf War illnesses is a lack of complete pre-war medical records for service members and veterans who have developed symptoms. If a new medical program the Department of Defense is testing proves successful, that problem will not exist for future war fighters.

Doctors at the Naval Medical Research Center in Bethesda, Md., and the Naval Health Research Center in San Diego, Calif., are investigating the use of a baseline medical database to evaluate the health of military members and veterans. Navy Capt. Kenneth Craig Hyams, M.D., says a working group of health professionals from the departments of Defense, Veterans Affairs and Health and Human Services has been collaborating on this project together since 1996 to develop the Recruit Assessment Program.

"This is clearly one of the lessons learned from our inability to answer Gulf War health questions. We need greater baseline data to understand changes in veterans' conditions after they return from dangerous deployments," said Hyams.

In fact, lessons learned from the Gulf War resulted in a complete review of doctrine, policy, oversight and operational practices for force health protection and military medical surveillance. Surveillance in this case means gathering information about both the health risks present in the environment that our forces are deploying to and the health status of service members. Hyams says that in today's volatile world, surveillance shouldn't wait until after the decision is made to send our forces overseas.

"Once a wartime deployment occurs, it's difficult or impossible to go back and get that information," continued Hyams. "Preparing for deployment can be an extremely rushed and stressful time. It's hard to get detailed and accurate health data once troops begin preparing for a potentially life threatening mission."

One way to avoid those pitfalls is to collect baseline health data at recruitment and integrate this data with health information collected periodically during servicemembers' careers. Such a database would also help doctors understand service-related medical problems from other causes of ill health. Without a complete record of the health status of recruits when they enter the military, it's difficult to identify service related health hazards - occupational and environmental risks - in the future. This is a lesson learned from the Gulf War as military doctors are still trying to determine the causes of unexplained symptoms among these veterans.

Due to the need for improved health surveillance, military planners want to create a system to track and maintain medical information about soldiers, sailors, airmen and Marines throughout their military careers. The first step will be to gather health data as recruits enter the service, including a complete medical history, family history, occupational exposures and risk factors. The RAP project will do just that with a RAP questionnaire. That form, filled out by each recruit, will establish a baseline health status for every servicemember on initial entry.

"We're already implementing the RAP at the Marine Corps Recruit Depot in San Diego and the Naval Recruit Training Command in Great Lakes, Illinois," says Hyams. Future plans include testing the form at the Air Force's Basic Military Training facility at Lackland Air Force Base as well. Hyams says that the RAP is not a major departure from current medical practices.

"HMO's routinely collect baseline data," he says. "And in the military, similar baseline information is already collected from recruits on Standard Form 93 and Standard Form 88, but their data is not computerized."

The RAP, which is still being refined, is an electronically scannable paper questionnaire which recruits fill out during their first week of training. A copy of the questionnaire will be added to each service member's medical folder, while the original is fed into a computerized database. That process, when applied to more than 250,000 incoming recruits every year, will require the use of cutting edge computer technology.

"We're testing a new generation of software and hardware for rapid scanning of large amounts of data," Hyams says. "That's being done at the Navy Recruit Training Command in Great Lakes, Ill., where the concept of automated medical inprocessing of recruits was pioneered in the SHIP program."

If successful, the questionnaire will provide accessible medical data to both DoD and VA doctors. In future years it will be the beginnings of what is called a longitudinal database, which allows a view of active duty military and veterans' health over time. Linking the RAP with other DoD and VA health records will create one of the world's largest longitudinal databases. Longitudinal research allows doctors to see trends in health problems in a population. It will help the military medical community better understand differences between service members' pre- and post- deployment health conditions.

"Longitudinal surveillance has to have a baseline and this is where it all begins. So, it's part of the more comprehensive surveillance system in force health protection."

The information collected will not only be used for research purposes, but also in preventative medicine and to improve clinical care.

"For example, this information will allow DoD and the VA to specifically target women who need mammograms," Hyams says, "because they'll know which ones have a family history of breast cancer."

Over time, the database could greatly benefit future veterans as well. In order to determine eligibility for disability claims, the VA needs to know if a person's condition changed after they entered the military. Too often, the necessary records don't exist, or can't be found. The RAP could be a solution.

"Most young troops coming in will be healthy and have no complaints," Hyams says. "This will document that fact very clearly in the computerized database. So when health problems develop later in the military career or when a person enters the VA system, seeking health care, this documentation will be available to support veterans' claims."

And he says the ability to see the long term changes in an individual veteran's health will help military and VA doctors make better diagnoses and offer better health care.

Military planners believe that routine collection of medical data from recruits could have a substantial impact on health care and illness prevention for military members and veterans. They say both DoD and the VA would benefit from the program by more accurately determining which health problems are related to military service. And questions about potentially harmful exposures during military service could then be more quickly and conclusively resolved, allowing for the development of improved prevention strategies.

Other nations have had similar problems determining the causes of their own Gulf War veterans' illnesses and may also benefit from this type of program. Australian, Canadian and British military leaders have expressed interest in the RAP, and in the case of Canada, a proposal is being drawn up for a baseline health data program to improve medical surveillance of their troops.

Personnel from the departments of Defense, Veterans Affairs and Human and Health Services are working to make sure surveillance goals can be realistically achieved for American troops and veterans. Hyams says they should have enough information to make a recommendation concerning whether or not the RAP should be implemented throughout DoD sometime next year.