Comprehensive Clinical Evaluation Program (1994-2002)
In 1994, the DoD implemented the Comprehensive Clinical Evaluation Program (CCEP), which was developed to address Gulf War veterans' concerns about the potential health effects of their service in Operation Desert Shield/Desert Storm. The CCEP was a voluntary diagnostic and treatment program provided in three stages in specialty care clinics for service members who had served in the Gulf War. The CCEP ended in 2002.
Post-Deployment Health Clinical Practice Guideline Program (2002-2014)
In 2002, the CCEP was replaced by the DoD/VA Post-Deployment Health Evaluation and Management Clinical Practice Guideline (PDH-CPG) which was created as the centerpiece for improving the quality of post-deployment health care in the DoD/VA health care systems. The target population was broadened to include not only service members, but also retirees and family members affected by a deployment. The emphasis for the provision of care was moved to the primary care setting, and a clinic visit coding system was initiated to track patients seeking care for deployment-related health concerns and conditions. The guideline was designed to assist primary care clinicians to systematically identify, evaluate and manage the health care for these individuals.
In subsequent years, the Military Health System (MHS) incorporated the major features of the guideline into its standard processes including: developing specific VA/DoD clinical practice guidelines for several deployment-related health concerns (e.g., behavioral health concerns and chronic multisymptom illness (formerly medically unexplained symptoms)); incorporating codes for documenting deployment-related health services into the MHS Coding Guidance; and implementing more comprehensive processes for identifying deployment-related health concerns (e.g., incorporating a deployment question into its electronic health records system, AHLTA, and implementing and expanding the Health Assessment Programs described below). In July 2014, the PDH-CPG was retired.
Health Assessment Programs (1998-Present)
In December 1998, the Joint Chiefs of Staff published uniform, standardized procedures for deployment-related health surveillance and readiness which included the requirement to conduct pre-deployment and post-deployment health assessments for deploying personnel. These health assessments were documented using DD Forms 2795 and 2796 respectively. The Post-Deployment Health Assessment (PDHA) process was enhanced in 2003 in response to Operation Iraqi Freedom and Operation Enduring Freedom deployments and included modification of DD Form 2796 to more thoroughly document post-deployment health and mental health status, deployment-related occupational and environmental exposures, and appropriate referrals for further evaluation and care.
In March 2005, DoD created the Post-Deployment Health Reassessment (PDHRA) program to identify and address health concerns, with specific emphasis on mental health, which had emerged over time since deployment. The PDHRA provided for a second health assessment using DD Form 2900 during the three to six month time period after return from deployment, ideally at the three or four month mark.
In 2006, the Assistant Secretary of Defense (Health Affairs) directed all armed services to ensure that a routine annual Periodic Health Assessment (PHA) was performed on all active-duty members and selected reserve (SELRES) members in order to ensure the medical readiness of the armed forces.
In 2009, Congress mandated that all service members who deploy in connection with a contingency operation receive person-to-person Deployment Mental Health Assessments before deployment and three times after return from deployment.