According to a 2021 study in Brain Sciences, as many as 200,000 Gulf War veterans show symptoms of Gulf War Illness. The study showed that Gulf War veterans demonstrate higher rates of memory problems, fatigue, chronic pain, and gastrointestinal problems than the population at large.
The study also suggested that Gulf War veterans experience earlier onset of age-related chronic diseases such as high blood pressure. Researchers found that the extended use of pesticides on the skin and sustaining a mild traumatic brain injury during the war are strongly associated with symptoms of Gulf War Illness (GWI).
"These results clearly show that GWI was not a result of stressors such as combat exposure, but rather are due to toxic wounds from exposures during the war that affects the brain and appear to be additive," noted Kimberly Sullivan, the lead researcher on the study. "We believe these types of combined exposures, or 'multiple-hits' to the brain, as well as potential genetic susceptibility, may be why some veterans developed chronic GWI symptoms after these exposures, while others did not."
Gulf War Illness, sometimes called Gulf War Syndrome, has been a topic of study and controversy since the 1990s when veterans of Desert Shield and Desert Storm started reporting unusual health issues.
In the decades since the first Gulf War, it has become clear that serving in the Persian Gulf increased the risk of certain multi-symptomatic health conditions, some of which are profoundly disabling. The causes are still ambiguous, but continued research may answer why so many veterans have been disabled after Gulf War service.
Gulf War Illness
Gulf War Illness isn't a single disease or diagnosis. It's a catch-all label applied to a collection of symptoms that Gulf War veterans exhibit. The symptoms follow loose patterns but have no identifiable cause. The primary common trait among people with the symptoms is their time in the Gulf Wars.
The chronic multi-symptom illness associated with Gulf War service includes an array of symptoms and conditions. The VA characterizes them as:
- Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS): a condition causing chronic, severe fatigue unrelated to other conditions.
- Fibromyalgia: a condition causing widespread muscle pain. Other symptoms may include insomnia, headache, morning stiffness, and memory problems.
- Functional gastrointestinal disorders: chronic or recurrent gastrointestinal (GI) tract problems. Here, the abnormal function of GI tract organs does not involve structural alteration of the tissues. Examples include functional dyspepsia, irritable bowel syndrome (IBS), and functional abdominal pain syndrome.
Symptoms of Gulf War Syndrome may include abnormal weight loss, headache, cardiovascular disease, fatigue, muscle and joint pain, menstrual disorders, psychological problems, neurological problems, skin conditions, sleep disturbances, and respiratory disorders.
The VA considers these multi-symptom illnesses a presumptive disability related to Gulf War service, so there is no need to demonstrate a link between service and disability. Gulf War service is defined as serving for at least 90 days in the Southwest Asia theater of operations anytime from August 2, 1990, to the present. That includes service in:
- Gulf of Aden
- Gulf of Oman
- Saudi Arabia
- The United Arab Emirates (UAE.)
- Waters of the Persian Gulf, the Red Sea, and the Arabian Sea
- The neutral zone between Iraq and Saudi Arabia
- The airspace above these locations
Any service member who left the military under other than dishonorable circumstances is eligible. In addition to the service criteria, veterans must show they meet three additional criteria:
- The symptoms began between a period of active duty in Southwest Asia theater of military operations and December 31, 2026.
- Symptoms have lasted for six months or more.
- Symptoms cause a disability rating of 10% or greater.
Causes of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
The direct causes of multi-symptom illness in Gulf War veterans are not entirely clear. Experts suggest that there are multiple factors affecting veteran health.
- Exposure to chemical warfare agents, such as nerve gas. Pyridostigmine bromide, which was given to service members as a preventive measure, may also have adverse health effects.
- Psychological factors, including post-traumatic stress disorder. Veterans who served in combat have high rates of accompanying psychiatric disorders.
- Other chemical exposure such as smoke from oil well fires or depleted uranium. Exposure to pesticides, solvents, and corrosive liquids used during repair and maintenance are all linked to health issues.
Symptoms of Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
To qualify for benefits, a veteran needs an affirmative diagnosis of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). The symptoms of the condition include:
- Fatigue that is not the result of an activity
- Fatigue that does not get better with rest
- Fatigue that interferes with normal activity
- Fatigue that increases after any level of activity
- Difficulty sleeping, despite fatigue
- Trouble with concentration and memory
- Dizziness or weakness when standing up
- Muscle and/or joint pain
- Night sweats
- Shortness of breath
- Tender armpit or neck lymph nodes
- Frequent sore throat
- Digestive issues
- Allergies / sensitivity (odors, foods, chemicals, noise, light)
- Muscle weakness
- Irregular heartbeat
Veterans may have all symptoms of ME/CFS or only a few. The symptoms may vary over time, with some symptoms fading to be replaced by others. Any combination of these symptoms that persist for six months or more could be a sign of ME/CFS.
Diagnosing Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
This complex condition may be difficult to diagnose because the symptoms are similar to other conditions. In addition, there is no test to confirm ME/CFS. Veterans may need to see multiple doctors to rule out other causes for their symptoms.
When seeking care for symptoms related to ME/CFS, veterans should mention their history of Gulf War service. Doctors might be more likely to connect symptoms to ME/CFS if they have that information.
In addition, veterans can keep a journal of symptoms, daily activities, medications they take each day, daily sleep, and food. This may help doctors recognize a pattern of chronic fatigue.
Veterans or caregivers should bring complete medical records to appointments with new doctors whenever possible. This can help doctors avoid duplicating tests, and it might provide additional insight to speed up a diagnosis.
You need not be diagnosed through the VA to be eligible for benefits. However, keeping copies of all medical records from non-VA doctors is highly beneficial. That information will be helpful when applying for compensation from the VA.
Treatment for Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)
There is no treatment for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). Doctors can offer solutions that mitigate some symptoms, but the underlying condition has no cure.
Veterans with ME/CFS may receive treatment to manage pain and help regulate sleep. For veterans with concentration and memory problems, the medication used to treat ADHD may be helpful.
Many veterans with ME/CFS benefit from counseling and treatment to manage the mental health effects of the condition. Depression, stress, and anxiety are common among people with chronic disabilities. Mental health conditions can exacerbate the overall effects of CE/MFS. The emotional toll can harm a veteran's close relationships.
Modifying activities and schedules and learning to avoid overexertion are helpful for many people with ME/CFS. This often means that veterans with this disability can no longer work regular hours. They may have trouble taking care of a home or family members. Some people with ME/CFS require home health care to assist them with personal care during episodes of severe symptoms.
The combined effects of ME/CFS symptoms and the need to manage the condition means that this Gulf War illness can be a full-time job in and of itself. Veterans and their caregivers are often in need of significant support.
Additional Opportunities for Gulf War Veterans
Even if veterans have not had health challenges after their time in the military, they can participate in ongoing efforts to learn about the effects of Gulf War service. These opportunities do not provide financial benefits. Instead, veterans share their recollections about their service for a database of veteran information.
Gulf War Registry
Veterans who served during Operation Desert Storm, Operation Desert Shield, Operation New Dawn, or Operation Iraqi Freedom are eligible for a Gulf War Registry exam. This is not an exam to determine eligibility for disability payments. This medical exam will be part of research on the health effects of Gulf War service. The registry is run by the Department of Defense.
Veterans who participate will meet with a health care provider for a comprehensive exam that includes an exposure and medical history, laboratory tests, and a physical exam. Health professionals from the VA will discuss the results with the veteran in person. Veterans will also receive the information in a follow-up letter.
The purpose of the registry is to collect information about veterans' long-term health. The data is used to identify patterns and understand the causes of health conditions resulting from service in the Gulf Wars.
If you develop health problems in the future or if the registry wants more information, you may be eligible for another exam.
Burn Pit Registry
Gulf War veterans may have been exposed to airborne hazards. That term refers to any contaminant or potentially toxic substance that veterans may have breathed. Gulf War veterans may have been exposed to contaminants, including:
- Smoke and fumes from open burn pits
- Sand, dust, and particulate matter
- General air pollution common in certain countries
- Fuel, aircraft exhaust, and other mechanical fumes
- Smoke from oil well fires
Researchers are conducting ongoing studies of the effects of airborne hazards like burn pits and other military environmental exposures. The research aims to understand the potential long-term health effects of burn pit exposure and provide veterans with appropriate care.
Gulf War veterans can join the Burn Pit Registry whether they have symptoms or not. Veterans can fill out an online survey without needing medical exams or official military records. Participation is voluntary and does not affect pending VA disability claims.
Get Help Applying for Benefits
In 1994, Congress simplified the process of applying for benefits for certain diagnoses related to the Gulf War service. It listed certain health conditions as presumptively caused by Gulf War service. Veterans demonstrating symptoms of those conditions, including ME/CFS, should receive benefits.
Despite the intent to provide disability payments for veterans disabled by Gulf War-related illnesses, the VA has not always correctly awarded benefits. A 2017 GAO study showed that the VA approved benefits for 17 percent of Gulf War veterans, meaning more than 80 percent of claims were denied. That's three times lower than approval for claims for other disabilities.
Then GAO found that VA staff were inadequately trained in confirming Gulf War-related illnesses. Staff was not providing veterans with follow-up information when claims were denied, so veterans had difficulty appealing the decisions. The VA is in the process of implementing recommended changes to better serve Gulf War veterans.
In the meantime, veterans wishing to appeal a denial of a claim for disability for Gulf War illnesses such as ME/CFS can contact an experienced attorney to assist them in appealing a successful claim.