1. Office of Public Health & Environmental Hazards RETURNING VETERANS WITH HEALTH CONCERNS AND EMERGING PROBLEMS War Related Illness & Injury Study Center (WRIISC) NJ VA Healthcare System

2. The War Related Illness and Injury Study Center (WRIISC) A national program in the Department of Veterans Affairs (VA) to address post-deployment health issues from the First Gulf War. The War Related Illness and Injury Study Center (WRIISC) A national program in the Department of Veterans Affairs (VA), initially established in 2001 to address post-deployment health issues from the First Gulf War.

3. ABOUT THE WRIISC Deployed Veterans have unique healthcare issues and concerns. The WRIISC now serves Veterans from any era or conflict with war related illnesses and injuries through clinical assessments, education, and research.

4. WRIISC REGIONAL MAP

5. WHO CAN WE HELP?  Complex health history with no clear cause  medically unexplained symptoms—MUS  Concerns about deployment-related exposures  Environmental  Occupational  Local work up inconclusive or unavailable

6. CLINICAL EVALUATIONS  Comprehensive Interdisciplinary Evaluation  Focus is on symptoms and improving function.  Two-three day evaluation as pre-determined by WRIISC clinical team  Environmental Exposure Consults  Comprehensive available for Veterans of any conflict - No referral necessary and phone consults available.  eConsults  Medical record review with individualized recommendations for next steps prior to other WRIISC evaluations

7. CLINICAL EVALUATION COMPONENTS  History and Physical  Psychological Evaluation  Neuropsychological Evaluation  Environmental Exposure Assessment  Social Work Interview  Education Session  Complementary and Alternative Medicine (CAM)  Labs, X-ray's, EKGs, PFTs

8. EXPOSURE ASSESSMENT  Occupational and environmental medicine physicians conduct exposure evaluations  Also done as a stand alone service to any Veteran of any era  Can be done over the telephone for Veterans living around the U.S.

9. TREATMENT ROADMAP  Team meeting with Veteran and family members  Written recommendations  Veteran and Primary Care Provider  Hand off to home team  Follow up care provided at referring VA facility

10. WRIISC FOLLOW UP  Social Work calls at 1mo, 6 mo and 1 year  How are you doing?  Barriers to recommendation implementation?  Symptom management?  How satisfied?

11. CLINICAL STATISTICS  Comprehensive evaluations in more than 1200 veterans to date  Patient Satisfaction Surveys overwhelmingly positive  Top 3 health concerns of Veterans: Musculoskeletal pain, fatigue, lack of sleep

12. EDUCATION  Environmental Exposures and Assessment  Medically Unexplained Symptoms  PTSD  mTBI  Reintegration  Risk Communication

13. COMMUNITY ENGAGEMENT Referrals Clinical Care Research Knowledge that Benefits Veterans Education & Outreach

14. WRIISC RESEARCH  Basic Science Studies  Physiological Studies  Behavioral studies  Complementary- Alternative Medicine  Clinical Treatment Trials  Health Services Research

15. SUMMARY 1.Primary WRIISC components are:  Clinical evaluations  Research  Education 2.The WRIISC provides holistic, multi-disciplinary clinical care to help deployed Veterans of any era improve their health, function, and quality of life. 3.Research is informed by clinical experience 4.Education is informed by clinical experience and research 5.We engage the community of Veterans and other stakeholders directly

16. WRIISC CONTACT INFO  NJ WRIISC: 1-800-248-8005 or WRIISC.NJ@VA.GOV WRIISC.NJ@VA.GOV  CA WRIISC: 1-888-482-4376 orWRIISC.CA@VA.GOV orWRIISC.CA@VA.GOV  DC WRIISC: 1-800-722-8340 or WRIISC.DC@VA.GOV WRIISC.DC@VA.GOV  www.warrelatedillness.va.gov www.warrelatedillness.va.gov

18. Questions??