Quora Question: What Is "Gulf War Syndrome"?

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Answer from Jon Davis, Sergeant of Marines, two tours in Iraq.

The best way that I have heard it described is a series of medical ailments from fatigue, muscle pain, cognitive problems, rashes and diarrhea to "functional impairment, repeated clinic visits and hospitalizations, chronic fatigue syndrome-like illness, posttraumatic stress disorder, and greater persistence of adverse health incidents" that affects a massive number of deployed individuals from the Gulf War of 1991 and is now being used to describe many of the veteran's ailments of today.
 
What is probably going on is that, during deployment, the body experiences severe stress compared to normal life. This stress, along with being in a foreign environment, makes one vulnerable to foreign diseases, with new stresses cause any number of predictable bodily ailments. Usually they are not something that one would consider to be major health issues that could be healed, at max, within two years. However, since they all happen within a very short time and under extreme conditions, they have exponentially negative effect on the body. These triggers have a way of cumulating to a point where they become almost impossible for many professionals to adequately treat or even accurately diagnose. You might consider it something like death by a thousand cuts.

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Answer from Carter Moore, VA headquarters employee (2008-2013).

Because "Gulf War Syndrome" has been difficult to pin down, the official designation has become "Chronic Multisymptom Illness," or sometimes "Medically Unexplained Chronic Multisymptom Illness." In fact, there have been so many definitions over the years as the scale of the disease has evolved, there's been a recent study to determine just what to call it.

As the designation, if lack of definition, suggests, the symptoms associated with the illness are very broad and could be connected to any number of causes. For example, the Department of Veterans Affairs considers the following conditions to be connected to service in the Gulf War and Operations Iraqi Freedom and New Dawn (because whatever conditions triggered the illness in 1990 were still there through 2011):
 

• Chronic Fatigue Syndrome, a condition of long-term and severe fatigue that is not relieved by rest and is not directly caused by other conditions.
• Fibromyalgia, a condition characterized by widespread muscle pain. Other symptoms may include insomnia, morning stiffness, headache, and memory problems.
• Functional gastrointestinal disorders, a group of conditions marked by chronic or recurrent symptoms related to any part of the gastrointestinal tract. Functional condition refers to an abnormal function of an organ, without a structural alteration in the tissues. Examples include irritable bowel syndrome, functional dyspepsia, and functional abdominal pain syndrome.
• Undiagnosed illnesses with symptoms that may include but are not limited to: abnormal weight loss, fatigue, cardiovascular disease, muscle and joint pain, headache, menstrual disorders, neurological and psychological problems, skin conditions, respiratory disorders, and sleep disturbances.

So basically, CMI encapsulates severe fatigue, muscle and abdominal pain, memory loss and psychological disorders, respiratory issues, gastrointestinal disorders, weight loss, and skin conditions that cannot be explained through any other illness.

If you're keeping track, that list pretty well covers the entire body.

Complicating this is that there's no consistency in how veterans who are suffering from CMI acquired their illnesses - or the extent of them. Some veterans present with very specific conditions that are isolated to regions of the body, and others require whole-body treatment. Some were involved in direct combat operations, and some were not.

Early research efforts by the VA into CMI, then commonly "Gulf War Syndrome," focused intensely on whether the conditions could be explained by psychological disorders alone, much to the ire of veterans who were suffering very real, physical ailments. As a result, Congress created the Gulf War Research Advisory Committee to provide oversight to VA's Gulf War research programs.

Because of the variety of symptoms and the range of ways veterans are presented with them, as others alluded to in their answers, there's no known cause for all of this although many have been proposed. The Department of Veterans Affairs contracts with the Institute of Medicine (by law) to do bi-annual reviews of research into illnesses associated with service in the Gulf War. None of these reviews have been able to suggest either a cause or cure. The most recent of these reports came out and said the following:
 

Despite considerable efforts by researchers in the United States and elsewhere, there is no consensus among physicians, researchers, and others as to the cause of CMI. There is a growing belief that no specific causal factor or agent will be identified.

This remains a subject of ongoing debate, however, and has resulted in significant fighting between VA, the GWRAC, Congress, and the veteran community at large. This year, for example, a bill was introduced to Congress to realign the GWRAC to give it more independence after VA made significant changes to the GWRAC's membership and reporting requirements which were seen by the community at large as the Department's attempt to stifle further research in this field.

And regardless of whether a cause or cure will ever be identified, VA has had challenges delivering treatment to the satisfaction of the veterans suffering from CMI. In 2009, VA organized a Department-wide task force† to review its response to CMI and developed a number of recommendations for improvement. However, as with its approach to research, reaction by the community about the efficacy of the task force has been guarded (at best).

All this goes to show that everyone - from those suffering to the medical professionals treating and researching it - is at a bit of a loss for what caused CMI, its complexity, and how to treat it.
 

† Disclosure: I was an observer on the task force from 2010 until I left VA in 2013.

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