title: Post-deployment Multi-symptom Disorder rehabilitation: An integrated approach to rehabilitation.
abstract: BACKGROUND
  Veterans and active duty service members returning from Operation New Dawn and those having returned from Operations Iraqi and Enduring Freedom frequently report the presence of overlapping, co-morbid symptom clusters consisting of chronic pain, mild cognitive complaints, and posttraumatic stress symptoms/disorder or mood disturbance. This presentation has been called Post-deployment Multi-symptom Disorder (PMD) and its implications not only impact various functional domains, but have also influenced a system/continuum of care to rise to meet the challenges of treating PMD. This continuum is based on innovation informed by evidence-based therapies, systemic limitations, and a focus on functional improvement rather than diagnostic classification.
  
  
  OBJECTIVE
  The purpose of this paper is to describe the symptomatic, functional and systemic challenges inherent to PMD conceptualization and treatment.
  
  
  METHODS
  The constituent clusters of PMD are defined and exemplified, its functional impact is illustrated, and a continuum of care at a large southeastern Veterans Affairs (VA) hospital offering an interdisciplinary approach to integrated rehabilitation is described. Three case examples are provided that that underscore the importance of vocation for improved behavioral health and quality of life.
  
  
  CONCLUSIONS
  The case examples demonstrate how vocational rehabilitation services are an integral component of PMD treatment.}
authors.affiliation: James A. Haley Veterans' Hospital, Tampa, FL, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Bosco
authors.affiliation: James A. Haley Veterans' Hospital, Tampa, FL, USA University of South Florida, Tampa, FL, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Murphy
authors.affiliation: James A. Haley Veterans' Hospital, Tampa, FL, USA University of South Florida, Tampa, FL, USA.
authors.forename: Walter E
authors.initials: WE
authors.lastname: Peters
authors.affiliation: James A. Haley Veterans' Hospital, Tampa, FL, USA University of South Florida, Tampa, FL, USA.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Clark
mesh_terms: D000328:Adult; D059350:Chronic Pain / Q000523:psychology / Q000534:rehabilitation; D003072:Cognition Disorders / Q000523:psychology / Q000534:rehabilitation; D015897:Comorbidity; D005260:Female; D006801:Humans; D054542:Iraq War, 2003-2011; D008297:Male; D011788:Quality of Life / Q000523:psychology; D013313:Stress Disorders, Post-Traumatic / Q000523:psychology / Q000534:rehabilitation; D014728:Veterans / Q000523:psychology*
keywords: Co-morbid symptomology; behavioral health; chronic pain; posttraumatic stress disorder; rehabilitation