Gulf War Illness
Ever since 1990 servicemen deployed to the Gulf region have reported chronic illnesses at higher rates than those deployed elsewhere, which is known colloquially as ‘Gulf War Syndrome’. It has also been called variously: ‘Gulf War Illness’, ‘Gulf War Undiagnosed Illness’, and ‘Chronic Multisymptom Ilness’. Similar illnesses have been experienced by veterans of deployments to Afghanistan [165, 187-189].
The Committee on the Development of a Consensus Case Definition for Chronic Multisymptom Illness in 1990-1991 Gulf War Veterans; Board on the Health of Select Populations; Institute of Medicine [173] looked at the research in detail in 2014. It suggested the term: ‘Gulf War Illness (GWI)’ to be most appropriate since the definition of a syndrome was not met, and most of the illnesses had a diagnosis or multiple diagnoses, while the term ‘Chronic Multisymptom Illness’ failed to connect it to veterans of Gulf deployments.
Current science understands little of the mechanisms behind most forms of chronic illness. There are no specific diagnoses, nor any tests, for illnesses specific to Gulf veterans. [234] Studies have therefore to a large degree consisted of statistical analysis of the symptoms experienced by servicemen, mostly those deployed in 1990 - 1991. There have been some attempts to look at the exposures that may be responsible and biological mechanisms at work but they have yet to yield solid conclusions. [160-301]
There is no clear case definition for GWI, statistics only note that veterans of Gulf deployments have been more likely than others to experience almost every chronic diagnosis investigated. One study published in the year 2000 found an increased likelihood of all of 48 conditions assessed [179], another study published in the year 2018 found an increase likelihood of all 56 symptoms analysed. [195]. Across all studies, fatigue, pain, and neurocognitive dysfunction have been widely observed, while gastrointestinal, respiratory, and dermatologic symptoms have also been particularly common.
Two different standards are used for diagnosing GWI, known as the CDC criteria and the Kansas criteria.
The CDC case definition requires a Veteran to have at least two chronic symptoms for longer than six months from:
Pain
Fatigue
Mood/cognition.
The Kansas case definition requires a Veteran to have at least one chronic symptom in three of
Fatigue/ sleep problems
Pain
Neurologic/cognitive/mood
Gastrointestinal symptoms
Respiratory
Skin.
At least one of the symptoms has to be moderate to severe.
There is further discussion of the diagnostic criteria here:
https://www.publichealth.va.gov/exposures/publications/gulf-war/gulf-war-2018/va-dod.asp
Similar illness have been observed in British, Australian, Canadian, and Danish veterans [173].
Women have been found to suffer GWI more commonly then men. [179, 283] Women’s immune systems function slightly differently to men’s immune systems, which may be because a woman’s immune system has to be able to care for an unborn child. One side effect of the differences is that women are more susceptible to autoimmune disease.
Prognosis for GWI sufferers is not good. Follow up studies over the decades show that the illnesses become worse with time, and that ever more Gulf veterans suffer from chronic illness. [177, 178, 181-183, 187, 199, 205, 211, 212, 227, 237-239, 289, 290]
GWI and the Immune System
A number of studies have found altered and impaired immune system function in sufferers of GWI. [160-164, 169, 170, 196, 202, 218, 221, 229] Markers of chronic inflammation and autoimmunity have been observed. Neuroinflammation, which is inflammation in the nervous system, including the brain and spinal cord, has been observed,. [161, 163, 204, 285]
GWI and the Brain
Studies have found altered brain structure and function in sufferers of GWI, alongside inflammatory illnesses which affect the brain. [168, 169,171,191, 193, 263, 200, 209, 219, 225, 226, 233, 264-275]
GWI and Mitochondria
Mitochondria produce energy for cells. Several studies have found harm to the function of mitochondria in GWI victims. [194, 197,203, 214, 216, 220, 232, 291]
GWI and Genetic Variants
Some studies have found that genetic variations which relate to the immune system impact the likelihood and severity of GWI. [166, 167, 168, 169, 246-7, 251, 254, 256, 259, 262] Some of the genetic variations relate to the immune response to bacillus anthracis. [169, 254]
GWI and the Microbiome
The human body is permanently teeming with many species of bacterium, virus, and fungus, far more than have yet been documented, which are known collectively as the microbiome. Most species are benign. Some species in the intestines are essential for digestion. Some species are harmful in excessive numbers and are controlled by a healthy immune system. Some species are deadly and cannot be controlled by the immune system, such as the rabies virus and the HIV.
An unbalanced microbiome has been linked to chronic illness, and may be both a cause and symptom of chronic illness as is discussed on the page ‘Some Science’. It is an area of science which has advanced considerably over recent decades but there is still a lot more to learn. A number of studies have found an altered microbiome in GWI sufferers. [215, 228, 291, 293, 294, 295, 299, 300]
GWI and Vaccinaton
Back in 2008, the Research Advisory Committee on GWI concluded:
‘that the evidence suggested that receipt of multiple vaccinations contributed to the development of chronic symptoms in U.S. Gulf War era veterans.’ [3]
It also noted:
‘There is relatively little scientific research, however, that has provided clear information on the potential for the anthrax vaccine, or other vaccinations received by Gulf War veterans, to produce chronic symptoms similar to those of Gulf War illness. Receipt of multiple vaccines over a brief time period, prior to and during deployment, has also been suspected as a possible contributor to Gulf War illness. But relatively little research has specifically assessed the development of chronic symptoms following receipt of numerous vaccines, particularly the specific shots received by Gulf War personnel.' [3]
Since then there has been little further study of the question, and a number of broad assessments of evidence of the causes of GWI have not even mentioned vaccination. [286-288]
A handful of studies have added to the evidence that vaccination, including anthrax vaccine specifically, is a factor in causing the illnesses. Anthrax antigen has also been found in the serum of veterans with GWI, along with an increased likelihood of genetic variations which influence the immume system in sufferers. It has been proposed that persistent antigems from the vaccine can cause chronic illness when the immune system is unable to clear them. Research is ongoing. [163, 164, 167, 169, 170, 172, 248-250, 255, 258,260, 280, 284]’
An analysis of the most thorough studies was done in 2019 which gave a good synopsis of them, but almost all of the studies it referenced had already been completed prior to the review in 2008. [240-245, 276-278]
The VA and GWI
The VA presumes certain unexplained chronic symptoms that follow service in most areas of the Middle East on or since August 2nd 1990 to be caused by the deployment. The list of countries, which changes for deployments on or after September 11th 2001, is in the link below.
The VA is vague as to exact detail with regards to which diagnoses qualify, but they include:
Chronic fatigue syndrome
Fibromyalgia
Functional gastrointestinal disorders
Other symptoms which may be presumptive to Gulf service include:
Abnormal weight loss
Fatigue
Cardiovascular signs and symptoms
Muscle pain
Joint pain
Headache
Menstrual disordersNeurological and neuropsychological problem
Gastrointestinal problems
Skin conditions
Respiratory disorders
Sleep disturbances.
This is the relevant web page:
https://www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp
Additionally, those who served in much of the region are presumed to have been exposed to ‘burn pits or other toxins’. Those who deployed in the airspace above the region also qualify, as to those who deployed to the following seas: Arabian Sea, Gulf of Aden, Gulf of Oman. The Neutral zone between Iraq/Saudi Arabia, Persian Gulf, and the Red Sea. Again, the list changes on September 11th 2001.
The list of presumptive diagnoses is different:
Asthma that was diagnosed after service
Chronic bronchitis
Chronic obstructive pulmonary disease (COPD)
Chronic rhinitis
Chronic sinusitis
Constrictive bronchiolitis or obliterative bronchiolitis
Emphysema
Granulomatous disease
Interstitial lung disease (ILD)
Pleuritis
Pulmonary fibrosis
Sarcoidosis
Brain cancer
Gastrointestinal cancer of any type
Glioblastoma
Genitourinary cancer
Head cancer of any type
Hematologic and lymphatic cancers
Lymphoma of any type
Melanoma
Neck cancer of any type
Pancreatic cancer
Reproductive cancer of any type
Respiratory (breathing-related) cancer of any type
More details on the various cancers can be found here:
https://www.va.gov/resources/presumptive-cancers-related-to-burn-pit-exposure/
The details are complex and change periodically so the VA web site should be checked for the latest specifics.
https://www.va.gov/disability/eligibility/hazardous-materials-exposure/specific-environmental-hazards/
Any veteran who has served in one of the eligible areas of the middle east can receive a VA medical exam specific to the long term illnesses that can develop, known as a Gulf War Registry exam. The link is here:
https://www.publichealth.va.gov/exposures/gulfwar/benefits/registry-exam.asp
The VA lists the following possible toxic exposures that veterans may have been exposed to:
Burn pits and other toxic exposures in Afghanistan, Iraq, and certain other areas.
A large sulfur fire at Mishraq State Sulfur Mine near Mosul, Iraq.
Hexavalent chromium at the Qarmat Ali water treatment plant in Basra, Iraq.
Pollutants from a waste incinerator near the Naval Air Facility at Atsugi, Japan.
Only one toxic exposure has been common to all of the deployment areas, which is anthrax vaccine, but it is not on the list.
Chronic fatigue syndrome, which is also known as myalgic encephalomyelitis, muscle and joint pain, headaches, skin symptoms, and sleep disturbances have hundreds of VAERS reports each following anthrax vaccine; while many of the other conditions also have numerous VAERS reports.
Treatment for GWI
The VA has made some suggestions as to treatment, but they are extremely limited in scope.
A document: VA/DoD Clinical Practice Guideline for the Management of Chronic Multisymptom Illness is here:
https://www.healthquality.va.gov/guidelines/mr/cmi/
A synopsis is here:
https://www.mayoclinicproceedings.org/article/S0025-6196(22)00065-9/fulltext
There are longstanding issues with regard to VA health practitioners being unaware of the available information surrounding GWI, so veterans may need to investigate the subject themselves rather than rely on their doctors. One investigation published in 2021 noted that:
'Healthcare providers reported speaking with Veterans about CMI and environmental exposures despite feeling they have minimal to no knowledge of these topics.' [296]
Another investigation in 2020 found that there was an: ‘absence of consistent communication within the Department of Veterans Affairs (VA) system’ and that ‘personalized care that was limited to validation.’ [298]
Another in 2021:
'Veterans reported that providers are not adequately trained on treatment of GWI and do not believe Veterans' descriptions of their illness. Veterans reported taking up self-advocacy, doing their own research on their condition, and resigning themselves to decrease engagement with VA healthcare or seek non-VA care. The study's findings suggest institutional level factors have a profound impact on perceptions of care and the patient-provider relationship.' [297]
Research Projects into GWI
There are some research projects which look for veterans of the Gulf War in 1990 / 1991:
One is the Boston Biorepository, Recruitment and Integrated Network for GWI, which does its work in both Boston and Miami:
https://sites.bu.edu/bbrain/
https://apps.dtic.mil/sti/html/trecms/AD1120923/index.html
Another is the Gulf War Illness Clinical Trials and Interventions Consortium.
https://www.nova.edu/inim/research-studies/gulf-war-illness.html
https://pubmed.ncbi.nlm.nih.gov/34015289/
Assistance with a Disability Claim
There are two disability procedures for a veterans, one with the branch of service for a disability retirement, and one with the VA.
A disability retirement should be granted by the chain of command when warranted. If for any reason it has not been done properly then a veteran can apply to have his record corrected. Further information can be found here:
Private lawyers can assist with filing the claim, which if granted should also pay the legal fees.
A disability claim is filed separately with the VA. Every serviceman coming to the end of his active service should be contacted by the VA, if it does not happen then a veteran can make contact through one of the VA clinics throughout the country, or through the US embassy in another country. Some charities and private lawyers exist to assist with the process, and further web sites exist to try to simplify a notoriously bureaucrratic and inefficient procedure. The VA is also notorious for being adversarial in evaluating disability claims, which it is not supposed to be but the government knows that few veterans awarded too much money will hand it back.
It is vital to verify all information provided by all sources, including the VA itself. This is a link to one such charity:
This is a privately run web site to assist veterans becoming oriented with the VA system: