Nearly three decades after the Operation Desert Shield and Desert Storm which occurred in the Persian Gulf War (1990-1991), the United States Veteran’s Administration (VA) continues to receive claims for those suffering from Gulf War Syndrome.[1] These claims cover a cluster of symptoms such as Chronic Fatigue Syndrome, Fibromyalgia, functional gastrointestinal disorders, among other lingering and/or undiagnosed illnesses.[2] Quiet, chronic, and difficult to pinpoint, the illness is often relegated to the status of the latter: undiagnosed.
According to the Johns Hopkins Institute of Medicine, the illness affects approximately one-third of Gulf War veterans.[3] Perhaps what is most alarming is that these diagnoses are not limited to veterans who served in the Gulf War of the early 1990s, but present in later generations of soldiers as well – including soldiers not only serving after but born after the Gulf War. Cases of Gulf War Syndrome have been documented in soldiers who served more than a decade more later in operations such as Operation Iraqi Freedom (2003-2010) and Operation New Dawn (2010-2011).[4] The causes of the illness have been attributed to significant environmental hazards, including but not limited to: “smoke from over 750 Kuwaiti oil well fires; pesticide/insecticide use, including personal flea collars; indigenous infectious diseases; nerve gas release; ingestion of pyridostigmine bromide tablets on a daily basis as a nerve gas antidote; and high levels of harmful particulate matter.”[5] The persistence of the diagnosis could also be attributable to the continued use of chemical warfare agents and/or exposure to “depleted uranium...solvents and corrosive liquids, used during repair and maintenance.”[6] Although no explicit compensations exist for the diagnosis, Veteran’s Law Resources[7] cite that veterans may be eligible for special benefits if they have served 6 months or more in any of the following locations (the Southwest Asia Theatre of Military Operations):[8]
• Iraq
• Kuwait
• Saudi Arabia
• The neutral zone between Saudi Arabia and Iraq
• Bahrain
• Qatar
• The United Arab Emirates
• Oman
• Gulfs of Aden and Oman
• Water of the Persian Gulf, Arabian Sea, and the Red Sea
• Airspace above these locations
The Veterans’ Administration’s investment in research on the illness has not yielded any more clarity to the issue in that last decade: “The VA has spent more than $160 million from 1994 through 2015 on research related to Gulf War illnesses and was given another $12.3 million for the research in 2016. Yet, the VA has not added any conditions since 2010 to ones already associated with Gulf War service.”[9]Why has so little progress been made? Among the challenges associated with the illness, Gulf War Syndrome’s lack of a specific definition poses as a major obstacle. Undefined and undiagnosed, this leads to an inadequate provision of medical treatment. If diagnosed, it might be labeled with the catch-all diagnosis of "Chronic Multisymptomatic Illness" (CMI) or the much vaguer title, "Unexplained Medical Illness."[10] Once this happens, the illness' identifiability as "Gulf War Syndrome" is often thrown out like a baby with the bathwater.
The very name itself has been discouraged from use. Arguably, the push not to use this colloquialism strips the illness of what little definition it had: temporality. It would be far worse to succumb the scapegoat of ambiguous labels to side-step a problem than to genuinely continue trying to solve it. It would be far worse to succumb the scapegoat of ambiguous labels to side-step a problem than to genuinely continue trying to solve it. A cluster of diverse but connected symptoms arose from veterans in the Southwest theater in the early 1990s; since then significant numbers of returning veterans have continued to suffer with varied combinations of the same issues. Whether or not an explanation exists, the correlation seems quite strong. Yes, the varied collection of chronic afflictions makes the situation difficult to address, but the temporality embedded in the very name "Gulf War Syndrome" indicates (1) that a trigger was introduced in that time frame (the early 1990s) and (2) that this trigger remains present. Encapsulated in that name is an aspect of accountability that has yet to be resolved.
In the absence of a solution, it is not justifiable to simply strip the illness of its name and hope that these problems may vanish into the amalgam of another-- perhaps even more vague -- problem set inclusive of all chronic or undefined issues. Here, we see a situation with a clear ‘starting point’ but no end in sight. As the line blurs between Chronic Multi-symptom Illness (CMI) and undiagnosed illnesses, assimilating Gulf War Syndrome into the picture is a dilemma which is difficult for patients and problem-solvers alike. Veterans’ doctors are caught in a difficult position as well. Complex cluster symptoms and ambiguity do lend themselves to a justifiable hesitancy. Naturally, this affects doctors, who are doing their utmost to provide precise and purposeful care. It also touches other relevant institutions such as the VA, Tri-Care (US- military insurance company), medical research institutes, and others who may play a role in unraveling the problem. The cumulative result of all these layers of ambiguity and hesitancy has led us to the present status: three decades out with little aid for the first wave of Gulf War Veterans suffering with this related cluster of symptoms, and no answers for the newly afflicted.
Without a doubt, ambiguity is a complicating factor that makes both diagnosis and treatment difficult. On these grounds, the delays for answers may be justifiable, but they cannot become a cop-out. In the absence of any readily available solution or treatment, there has been a wide reaching yet subtle campaign to dissuade individuals from using the term "Gulf War Syndrome" in exchange for the more nebulous "Medically Unexplained Illness." Superficially this may seem benign, but when hundreds of millions of dollars have been pumped into finding a solution, and the best answer offered is to change the name of the problem, that is not acceptable. Assigning political incorrectness to a colloquialism formerly used by the government itself actually strips the illness of what little definition it had: its temporality. It also masks the phenomenological element that reveals that whatever catalyst was present in the Persian Gulf War environment is still very much present in the lives of today's soldiers and young veterans. If it were not, the U.S. Department of Veterans Affairs would not have issued the following statement: “These 'presumptive' illnesses must have appeared during active duty in the Southwest Asia theater of military operations or by December 31, 2021 and be at least 10 percent disabling.”[11]This 'generous' deadline – extending into the future --- suggests that this is not an issue confined to past service. Note that this is not a deadline to report such issues, but the window within which these afflictions could be acquired.
Clearly, this illness is not relegated to the Persian Gulf War, even if that's where the issue surfaced. Here, we see a situation which has shifted from ‘phenomenological’ to ‘persistent’ within a specific demographic who began sufferingsimilar symptoms at the same time. To me, that is a puzzle which should be explored, not ignored. As a society, we must ask ourselves: (1) Why are new waves veterans acquiring Gulf War Syndrome, and how can the total population of patients with this illness be helped? (2) Secondly, is there an agenda behind the changing of the name from "Gulf War Syndrome" to "Unexplained Medical Illness," and if so, what is it?
As a final disclaimer, I would like to remind that this article is neither a medical reference, nor an attack on the efforts of any organizations in place to help veterans. Rather, it is a social admonition not to take 'the easy way out' by obscuring a deeply rooted problem with a turf-level label. It is no secret that wheels of bureaucracy turn slowly; at times it can even feel that the bureaucratic vehicle drives on square wheels – in ungraceful lurches toward progress – but progress is very possible if we as a civil society do not allow important issues to be sidelined on grounds of convenience. Advocating for the dis-use of certain terminology suggests that, in the absence of a viable solution, Gulf War Syndrome may be one of many chronic illnesses that bureaucracies find easier to 'normalize' than to solve. The vanishing of “Gulf War Syndrome” as a title is not due to the resolution of these problems, but rather to the gradual changing of its name. However, a lack of medical explanation is not, nor ever will be, tantamount to a lack of medical need.
References
[1] “Gulf War Service - Public Health.” VA - Health Care - Public Health - Military Exposures. US Department of Veterans Affairs. Accessed November 9, 2019. https://www.publichealth.va.gov/exposures/gulfwar/military-service.asp .
[2] “Gulf War Syndrome .” Veterans’ Health Care. Military.com. Accessed November 8, 2019. https://www.military.com/benefits/veterans-health-care/gulf-war-syndrome.html .
[3] “Gulf War Syndrome.” Health - Conditions and Diseases. Johns Hopkins Medicine. Accessed November 7, 2019. https://www.hopkinsmedicine.org/health/conditions-and-diseases/gulf-war-syndrome.
[4] “Operation New Dawn.” USARMY, August 31, 2010. https://www.army.mil/article/44526/operation_new_dawn .
[5] “Getting Veterans (VA) Disability for ‘Gulf War Syndrome.’” Chisholm Chisholm & Kilpatrick LTD. Veteran's Law Resources. Accessed November 7, 2019. https://cck-law.com/types-of-va-disabilities/gulf-war-syndrome/ .
[6] Gulf War Syndrome.” Health - Conditions and Diseases. Johns Hopkins Medicine. Accessed November 7, 2019. https://www.hopkinsmedicine.org/health/conditions-and-diseases/gulf-war-syndrome.
[7] “Getting Veterans (VA) Disability for ‘Gulf War Syndrome.’” Chisholm Chisholm & Kilpatrick LTD. Veteran's Law Resources. Accessed November 7, 2019. https://cck-law.com/types-of-va-disabilities/gulf-war-syndrome/ .
[8] “Gulf War Veterans' Medically Unexplained Illnesses - Public Health.” VA - Health Care - Public Health - Military Exposures - Gulf War Veterans' Illnesses - Gulf War Veterans' Medically Unexplained Illnesses. US Department of Veterans Affairs . Accessed November 9, 2019. https://www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp .
[9] Wentling, Nikki. “Report: VA Claims for Gulf War Illness Denied 80 Percent of the Time.” Stars and Stripes. Accessed November 7, 2019. https://www.stripes.com/news/pacific/report-va-claims-for-gulf-war-illness-denied-80-percent-of-the-time-1.477436 .
[10] US Department of Veterans Affairs, and Veterans Health Administration. “VA.gov: Veterans Affairs.” Protect your health, December 17, 2013. https://www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp .
[11] “Gulf War Veterans' Medically Unexplained Illnesses - Public Health.” VA - Health Care - Public Health - Military Exposures - Gulf War Veterans' Illnesses - Gulf War Veterans' Medically Unexplained Illnesses. US Department of Veterans Affairs . Accessed November 9, 2019. https://www.publichealth.va.gov/exposures/gulfwar/medically-unexplained-illness.asp .