This is Julia Hugo Rachel. Like millions around the world I was accused of having a mental illness, had my child taken away from me and spent years in mental and physical agony. Then I found I was not mentally ill but instead had a virus and was cured. There are many people like me and this book, Viral Assault, will show victims, families and friends that there is hope. This is my story.

The American invasion of Iraq in 2003 was a classic all-arms invasion including overwhelming air power, tanks and combined arms maneuvers that simply overwhelmed the defending Iraqi forces. The primary goal was the liberation of Baghdad, the country’s capital city and this was achieved with ease.

But the second order of business, bringing stability to the rest of the country, was an altogether different and much more difficult matter. There was less shock and awe and more a gradual effort to expand the control of the allied forces to the rest of the country. However, the delay also gave the defenders time to prepare and for lawlessness to get a firm grip. Nowhere was this more true than in the city of Fallujah in the heart of the Sunni Triangle which was a focus of support for the deposed Iraqi leadership. 

A year after the invasion, the city had become a haven for disgruntled government troops, smugglers, armed gangs and a population that was united in only one thing: hatred of the American invaders.

On March 31, 2004 a convoy bringing food supplies into the city was ambushed by armed insurgents. A grenade was thrown into an escort vehicle manned by four men from the private security firm Blackwater. As the men scrambled from the vehicle, they were gunned down. Their bodies were then set on fire and dragged through the streets of the city before a jubilant crowd of cheering locals. The charred and mutilated bodies were then strung up from a bridge over the Euphrates for the world to see.

Images of the killings and the gruesome aftermath were beamed around the world and the brutality caused outrage, not least in the White House where President Bush called for action. The result was a decision to engage the insurgents and clean out Fallujah.

Operation Vigilant Resolve began on the night of April 4, 2004 when 2000 Marines surrounded the city. The attacks began with the insertion of special forces under cover of darkness and precision air strikes on four houses in Fallujah that were thought to be the command centers for the insurgents. The initial plan called for a series of swift and decisive movements with special operations preparing the way and Marines following swiftly behind to impose structure and discipline. But, like so many such plans, it did not survive the first contact with the enemy.

The first two battalions of Marines met fierce resistance and two more battalions were swiftly inserted into the fight. Road blockades consisting of Humvees and concertina wire enclosed everyone in the town and as the troops moved house to house and street to street, two main hospitals in the town were closed. 

 “Air bombardments rained on insurgent positions throughout the city, Lockheed AC-130 gunships attacked targets with their Gatling guns and howitzers a number of times. Scout Snipers became a core element of the Marines' strategy, averaging 31 kills apiece in the battle, while PSYOP Tactical Psychological Operations Teams from Tactical Psychological Operations Detachment 910 tried to lure Iraqis out into the open for the Scout Snipers by reading scripts that were aimed at angering insurgent fighters and by blaring AC/DC along with Metallica and other rock music over their loud speakers.”

From April 13 to 15, more large scale fights erupted when rebels attacked U.S. Marines  from within a mosque. The Americans deployed an airstrike and the mosque was destroyed, adding to the destruction of the once developing city. Within the next days, the Americans dropped another bomb, a 2,0000 pound JDAM GPS bomb in the north of Fallujah in attempt to clear another stronghold. The destruction of the mosque and deaths of many civilians caught in the crossfire or the air strikes was causing an international outcry which the US had neither expected nor prepared for.

As the fight dragged on, an unrelated uprising began south of Baghdad. To the many critics around the world, especially in the Arab world, who had opposed the invasion in the first place, it appeared that the conflict was spiraling out of control. Not only that, but the Americans were being portrayed as brutalist invaders.

As the media hype continued and it became clear that America was losing in the court of public opinion, the White House lost its nerve and the Marines were pulled out. It was a humiliating setback and the anti-American press was quick to declare victory. 

Rather than a defeat, the first battle of Fallujah was more of a setback and the Pentagon immediately began planning for a more coordinated assault. But the insurgents were making their preparations as well. Since the U.S. troops had left in the Spring, the number of insurgents in Fallujah had doubled and they prepared to fight what they expected would be a bitterly contested campaign where every foot of ground would be fought over.

“They dug tunnels, trenches, prepared spider holes, and built and hid a wide variety of IEDs. In some locations they filled the interiors of darkened homes with large numbers of propane bottles, large drums of gasoline, and ordnance, all wired to a remote trigger that could be set off by an insurgent when troops entered the building,” one article recalled. “They blocked streets with Jersey barriers and even emplaced them within homes to create strong points behind which they could attack unsuspecting troops entering the building.”

The defenders also had a formidable armory that was in part comprised of weapons the Marines had left behind when they retreated. They also had M14s, M16s, body armor, RPGs and a huge amount of mines and IEDs. 

The second battle of Fallujah was code-named Operation Phantom Fury and began on November 7, 2004. Together, the U.S., Iraqi and British forces amounted to about 13,500, with about 6,500  U.S. Marines, 1,500 Army soldiers and 2,500 Navy servicemen. The Iraqi troops added about 2,000 to the total as well as the added backup of aircraft and Marine and Army artillery battalions. 

Phantom Fury was a classic combined arms operation and this time around did not underestimate the enemy and also paid sufficient attention to the media to ensure that the story of the fight was largely told by the journalists embedded with the advancing allied forces.

As usual, special forces were sent in ahead of conventional ground operations and had specific missions of assassination and sabotage. As soon as they entered the city, they gained early insight into just how hard the battle to come was going to be. The insurgents had prepared to fight not just house by house but room by room. It was going to be close combat warfare the likes of which had not been seen since the Vietnam war.

“On Nov. 16, the Marine advance began meeting heavy resistance along phaseline Isabel — the city was divided into phase lines with male and female names used to denote direction. Faced with a determined enemy that would often boobytrap and mine the buildings they were in, the battalion ramped up its use of air support, and the ensuing barrage earned the nickname “Hurricane Isabel,” one Marine recalled

The battalion’s three forward air controllers along with a team of Navy SEAL joint terminal attack controllers worked … to call in 35 airstrikes on 24 targets, destroying all but four in the span of six hours. That’s roughly six airstrikes every hour and included attack runs from AC-130 gunships and warplanes dropping 500-pound bombs. The sheer number of airstrikes was anything but typical.” 

One such soldier in the second battle, Marine Lt. Col. Mike Zacchea was a senior advisor to the 5th Battalion of the Iraqi Army (the first American to have such a job) and was to have a pivotal role. Zacchea led his men from the front and was fighting house to house against booby-traps and insurgents who seemed determined to die for their cause. While moving from one building to the next, Zacchea had his shoulder broken by a rocket-propelled grenade that exploded just behind him. As he hit the ground, chips of concrete blew into his face from sniper bullets fired from nearby high rise apartments.  

“They’d try to get one Marine down in an open area and try to lure the other Marines to come get him and then they’d pick them off,” he explained. “I was the bait in the trap.” 

Two other Marines managed to pull the badly wounded Zacchea to safety and he elected to stay with his men rather than be evacuated to Germany for the treatment his broken body needed. 

By January, the U.S. troops had secured the destroyed city but at heavy cost to both sides. The second battle of Fallujah proved to be the bloodiest of the war and the bloodiest battle involving American troops since the Vietnam War. U.S. forces casualties totaled 54 killed and 425 wounded in the initial attack in November, and by the near-end of December when the operation was officially concluded, the casualty number had risen to 95 killed and 560 wounded.

In Fallujah, mosques were damaged, but coalition forces reported that 66 out of the city's 133 mosques had been discovered to have “significant amounts of insurgent weaponry.”  As for the civilians, one report found that over the course of each of the battles in Fallujah, Operation Vigilant Resolve and Operation Phantom Fury, 200,000 people were internally displaced within Iraq.

While the physical scars on civilians and soldiers alike were hard to bear, the aftermath in terms of mental and physical trauma has lingered on long past the end of American engagement in Iraq. 

Zacchea returned home where he earned a Bronze Star for valor and a Purple Heart for his injuries sustained during the war. He retired from the military but found, like so many others, that the real struggle was only just beginning. He found that it had become hard to separate combat from peacetime civilian life. While he remember very little of the combat itself, his wife found that he was prone to sporadic bouts of violence and that he had become a man she often did not recognize. So bad did the violence become that on one occasion she hid in the bathroom while her husband, convinced that she was an Iraqi insurgent, tried to set fire to the house.

Forced into treatment, Zacchea was diagnosed with Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI) and after treatment, he made it his mission to help others who struggled as he had. Zacchea is now working at the University of Connecticut in Hartford operating a "boot camp" for other disabled veterans to help improve their lives as his was by therapy. 

"It's a long journey [going] from a guy who set his house on fire because he thought his wife was an insurgent to helping other disabled veterans make their own transition," he said. 
PTSD is now well recognized as an illness and there are many definitions, all of which have the same general themes: A common anxiety disorder that develops after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Family members of victims also can develop the disorder. PTSD can occur in people of any age, including children and adolescents. More than twice as many women as men experience PTSD following exposure to trauma. Depression, alcohol or other substance abuse, or other anxiety disorders frequently co-occur with PTSD.

The diagnosis of PTSD requires that one or more symptoms from each of the following categories be present for at least a month and that symptom or symptoms must seriously interfere with leading a normal life:
Reliving the event through upsetting thoughts, nightmares or flashbacks, or having very strong mental and physical reactions if something reminds the person of the event.
Avoiding activities, thoughts, feelings or conversations that remind the person of the event; feeling numb to one's surroundings; or being unable to remember details of the event.
Having a loss of interest in important activities, feeling all alone, being unable to have normal emotions or feeling that there is nothing to look forward to in the future may also be experienced.
Feeling that one can never relax and must be on guard all the time to protect oneself, trouble sleeping, feeling irritable, overreacting when startled, angry outbursts or trouble concentrating.

These symptoms may be very familiar to anyone who has seen combat but PTSD has grown to become an all-embracing term too often used by the medical profession as a diagnosis where nothing else comes readily to mind. Today, PTSD often comes mental illness or physical infection in part because it is such an easy diagnosis and so consigns people to a life of therapy where a different treatment would actually provide a cure.

I will deal with PTSD in more detail later in this book but for now, I would like to go back to America’s first intervention in Iraq after that country invaded Kuwait in August 1990. After the invasion and subsequent annexation of Kuwait, an alliance between almost 40 nations and headed up by the United States waged war on Iraq in what is now known as the Persian Gulf War. 

Allegedly, Iraqi leader Saddam Hussein invaded Kuwait to “pay off debts incurred during Iraq's eight year war with Iran.” The same day, the United Nations denounced the invasion and demanded withdrawal of the Iraqi troops. When the troops were not extracted,  United Nations Iraq-Kuwait Observation Mission (UNIKOM) created Resolution 678, saying “if Iraq had not fully implemented by 15 January 1991 all of the Council's resolutions relating to the occupation of Kuwait, Member States cooperating with Kuwait's legitimate Government were authorized to use "all necessary means" to compel Iraq to do so and restore international peace and security in the area.”

The January 15 deadline came and went, By the time ground combat began at the end of February, there were 670,000 total troops from 28 countries in theater with nearly 425,000 from the United States 

Operation Desert Storm began with air attacks against Iraq, targeting communications networks, weapons plants, oil refineries and more. “The coalition... benefited from the latest military technology, including Stealth bombers, Cruise missiles, so-called “Smart” bombs with laser-guidance systems and infrared night-bombing equipment.” 

Within three days of the ground campaign beginning, Iraq agreed to comply with all UN resolutions and Kuwait was liberated. Although America only suffered 147 deaths in combat, tens of thousands of soldiers returning from the theater began complaining of an unusual number of illnesses that seemed to have no common cause.

Gulf War Illness (GWI) also known as Gulf War Syndrome (GWS) is characterized by VA findings as persistent memory and concentration problems, chronic headaches, widespread pain, gastrointestinal problems, and other chronic abnormalities not explained by well-established diagnoses. The disease affects approximately 25-32% of American veterans from the Gulf War.  Even today, not all of its effects are known, and new problems associated with the disease are encountered regularly. 

Though its symptoms are similar to that of Post Traumatic Stress Disorder (PTSD), studies have indicated the illness is not a result of combat or other stressors like PTSD, but rather a result of neurotoxic exposures. For that reason, GWI is too often lumped in with PTSD and misdiagnosed more often than correctly identified.

Dr. Robert Haley of the University of Texas Southwest Medical Center has been studying Gulf War Illness for over 22 years, most of it funded by the Texan billionaire Ross Perot.  His years of research and findings narrowed the two possible causes for GWI. 

The first possibility was the use of pills called pyridostigmine bromide which were given to troops multiple times a day to negate the effects of chemical weapons used during the war. But instead of protecting the troops, the capsules had long term negative side effects.  

“They were taking it three times a day because it has been shown in animal models to reduce the mortality rate from chemical weapons by at least 50 percent. That's if you take it before the exposure,” Dr. Haley said. “If you take it after the exposure or both go on concurrently during that time, then the pyridostigmine actually makes the toxic effects worse. That wasn't known at that time.”

Though the use of these capsules was well intentioned, their long term effects have wreaked havoc on the veterans once they returned home, leaving the vets with severe medical issues.

Baylor University Institute of Biomedical Studies researcher Lea Steele and her colleagues produced a study last year showing the link between the PB pills and genetics as key factors in the development of GWI in veterans. 

“The scientists found that veterans with a gene variant that complicates their bodies' efforts to metabolize chemicals in anti-nerve agent pills — pyridostigmine bromide, or PB — were up to 40 times more likely to have Gulf War illness symptoms than those who took the pills or were exposed but had a different gene variant.”

The study went on to explain that, though the findings are only in the early stages, a soldier's genetic makeup was a dependant in how the pills affected them. For some, the pb pills did their job of protecting against chemical warfare and other chemical agents, while for one in four soldiers, long term effects were extreme. 

Because the pills work by introducing a low-level toxin as a buffer against other toxic gasses, short term use only produces productive side effects, protecting the taker from contamination by nerve agents. The problems began to show later, after the pills had run their course and when they interacted with other toxins or different gene forms. 

"If you look at sick veterans versus healthy veterans ... the number of people who had the gene variation was not different,” Steele said in an interview with Military Times. “But when we looked at exposures, that's where we saw the big difference. That tells us it’s a gene-environment interaction." 

The pills were prescribed in 21-tablet blister packs, with prescribed dosage as one 30-mg tablet every 8 hours. They were thought to have the ability to protect the troops against nerve agents they may be exposed to during the war, keeping the troops healthy even in toxic environments. But why were these pills chosen?

According to PBS, prescription of the pill to the veterans “was based largely on the extensive cumulative experience with this drug in patients with myasthenia gravis,  a condition caused by a breakdown in communication between nerves and muscles.

Though not all people reported health issues upon, or years after, taking PB pills, the problem arose when the pills were ingested with low levels of exposures to of the insect repellent DEET and the insecticide permethrin.  The chemicals are often referred to as cofactors in contributing to Gulf War Illness. 

After the war, animals were tested using varying doses of the insecticides in the presence of pb to test if the effects could have impacts humans.  

A U.S. Department of Agriculture researcher used cockroaches in their experiment and found that it took just one fourth as much PB to kill cockroaches when of a sublethal dose of DEET was present.  Later research on chickens found that “PB given at near lethal levels could increase the toxicity of DEET and permethrin.” The chickens from that study were later reported to have nerve damage as a result. Finally, a 1995 study by the DOD study showed small increases in the death rates associated with DEET and permethrin  in rats with rats caused by PB.

But PB mixed with insecticides weren’t the only factors at work in the Gulf War. Troops were also exposed to nerve gas in the bombing of stockpiles towards the end of the war, a mission that may be the main offender in understanding GWI. 
Sarin is “ is a colorless, odorless liquid, used as a chemical weapon owing to its extreme potency as a nerve agent. It is generally considered as a weapon of mass destruction.” The deadly nerve agent works when a chemical called acetylcholine builds up in the body, causing the person to suffocate from lung muscle paralysis. 

The Atlantic lays the chemical anatomical course out in layman's terms to describe the terrible process. When infected with sarin, the host is killed by the accumulation of  normal neurotransmitters telling the nerves to do the normal things they do but in excess. Unlike normal, the neurotransmitters lifetime is a matter of milliseconds, making the effect quick and deadly. But this process differs depending on the amount of sarin that is introduced as well as a variety of other factors which came into play during the Gulf War. 

In March of 1991, because Iraq was known to have stockpiled chemical and biological weapons, the U.S. bombed the chemical weapons storage sites near Baghdad in Kamisiyah. Even though many organizations had banned stockpiling of such substances at the time, the country still had a few locations where the chemicals were stored. 

The U.S. planes swept in to drop their bombs on two Iraqi storage facilities containing sarin and mustard gas in the early months of 1991, blowing the toxic fumes into the air and filling the sky with noxious fumes. As the gas rose into the boundary level above the earth, an air current transported the toxin some 300 miles. The fallout was shifted overnight at high altitude before making its way back down to earth over Saudi Arabia where many of the allied forces were based.  

“In the next morning’s rainfall on our troops, everybody was exposed to a crippling level of sarin,” Dr. Haley said, painting the scene of early days of the war.

Upon further research, Dr.Haley and colleagues discovered a gene called PON1, a protein coding gene, and its connection to the infected troops during the Gulf War. With a strong form of the gene, the soldier is resistant to the gas, but with a weak form, a person will be very susceptible to low-level nerve agent. 

“Sure enough, the guys who have the weak form of it are the ones that have Gulf War Illness,” Dr. Haley said. 

In this case, troops own genetic makeups were working against them, reacting to chemicals accidentally given by their very own government. And though the infection was not on purpose, in face Dr. Haley calls the event “the largest friendly fire instant in history,” the cover up and decision to ignore its effects was not coincidental. 

One veteran Denise Nichols, the vice chairman of the National Vietnam and Gulf War Veterans Coalition recalled the symptoms of GWS and the day she noticed something wasn’t quite right in her witness testimony hearing in 2007. 

“I can tell you now that the symptoms of Gulf War illness began to appear when we hit Riyadh and then as we moved forward thru KKMC to our forward location.  We just were not fully aware of what the symptoms were representing at the time.  We had rashes, visual sensitive to light, joint aches, urinary urgency, and diarrhea occurring.  When you are in a desert environment and you are at war your job and duty comes first.  We also had weird accidents I called them the clumsy/stupidity type accidents…falling from stairs of buses is but one example and then the weird ones of troops breaking training and handling explosive ordnance they found.  We also had respiratory problems surfacing but again a lot of these symptoms were downplayed.  And of course all the tens of thousands of alarms which were going off and we were being told that they were false.  We had had our first round of anthrax shots in Riyadh and being a nurse I insisted that it be documented on my international immunization record.

“The symptom that I believe we all missed was the mental irritability/mental cognitive/neurological functioning changes that began to surface when we hit Riyadh.  This showed up in weird behavior that I now can attribute to behavior much like Brain Concussion cases where you have a change in mental cognitive and behavior functioning.  This was not PTSD!” 

On returning from the war, the government and VA refused to acknowledge the effects veterans were experiencing as more than a form of PTSD associated with their time in the war. The PB pills and inadvertent sarin poisoning were left out of the picture, while naysayers targeted the stress of being in a battle zone for the aftermath.  

The VA denied that poisonous gas had even been used in the war or that US troops had been exposed. Intelligence was available to show that the allies had specifically targeted Saddam Hussein’s stockpiles of chemical and biological weapons. After all, the troops had been issued with protective gear and providing with prescriptions to counter the effects of the nerve agents that Iraq had been expected to use. Even so, the VA took the position that no exposure could have happened. At stake in their diagnosis was a potential liability of billions of dollars in expensive treatment. Far simpler to go for the default of PTSD and mental therapy.

Veterans began coming forward in September of 1993 to describe that chemicals had indeed been used, yet still the VA pushed back, citing the CIA as a source for their judgment. The Pentagon got involved in 1996 and announced that a meager 300-400 U.S. troops near Kamisiyah may have been exposed to chemicals.

At the time, the numbers were small, but as veterans continued to push, insisting the VA and others were trying to cover the truth, support grew. In November, estimate numbers of Gulf War veterans affected mounted when a new Pentagon estimated up to 20,000 troops were near the Kamisiyah stockpile when it was destroyed. 

At the end of 1996 and early in 1997, the British Defense Ministry launched a study of possible link between chemicals and chronically ill British veterans. But then came a step back when US Defense Secretary William J. Perry called perceptions of a Pentagon cover-up of evidence linking veterans' illnesses to chemical weapons “dead wrong.”

In January, the Presidential Advisory Committee on Gulf War Veterans' Illnesses reported no conclusive evidence linking illnesses to chemical or biological weapons, but that the Pentagon “did not act in good faith” in its investigation of GWI. Next, “Senate Veterans' Affairs Committee gained permission to examine Gen. Schwarzkopf's personal notes and Secretary Perry again denied knowledge of a Pentagon cover-up.”

It wasn’t until the end of January 1997, six years after the war, that the “VA study suggests a direct link between severe joint pain, a symptom of Gulf War Syndrome, and chemical weapons released at Kamisiyah. This was the first official acknowledgment by a federal agency of such a link.” 

Dr. Roberta White of Boston University, who investigates the effects of pollutants on brain function, has dedicated much of her studies to the effects of chemical exposures associated with Gulf War Illness. She has even retrieved evidence of brain damage associated with exposure to the nerve agent. In turn, the question of “why wouldn’t the government and VA want to produce the truth?” has been on her plate for a while. 

“There is then a lot of political and other pressure to acknowledge these illnesses so many years after the war. It parallels agent orange (in the Vietnam War),” Dr. White said. “It costs a lot of money to compensate people for these thing if you admit.”

In a hearing on February 23, 2016 before the U.S. House of Representatives Committee on Veterans’ Affairs Subcommittee on Oversight and Investigations, Gulf War Veteran and director of Veterans for Common Sense Anthony Hardie spoke of the bureaucratic lag and subversion  by the VA. 

“For those of us involved in fighting for the creation and enactment of these laws, they seemed
clear and straightforward, with a comprehensive, statutorily-mandated plan that would guarantee research, treatments, appropriate benefits, and help ensure that lessons learned from our experiences would result in never again allowing what happened to us to happen to future generations of warriors.”

The legislation included a long list of known Gulf War exposures with an underlying assumption that the VA was to presume exposure to all of them, and then, with the assistance of the National Academy of Sciences (NAS), evaluate each exposure for associated adverse health outcomes in humans and animals.

In turn, the VA Secretary would consider the reports by the NAS’s Institute of Medicine (IOM),
“and all other sound medical and scientific information and analyses available,” and make
determinations granting presumptive conditions. There was a new guarantee of VA health care.
There would also be a new national center for the study of war-related illnesses and post-deployment health issues, which would conduct and promote research regarding their etiologies, diagnosis, treatment, and prevention and promote the development of appropriate health policies, including monitoring, medical recordkeeping, risk communication, and use of new technologies.

There was to be an effective methodology for treatment development and evaluation, a medical
education curriculum, and outreach to Gulf War veterans. Research findings were to be
thoroughly publicized. To ensure the federal government’s proposed research studies, plans, and
strategies stayed focused and on track, VA was to appoint a research advisory committee that
included Gulf War veterans – presumably those who were ill and affected – and their

The creation of this “national center” never actually happened. The long list of
toxic exposures never led to a single exposure-related presumption. Many of the exposures were never even considered, and those that were didn’t include evaluation of the health effects in laboratory animals with respect to likely health outcomes in ill Gulf War veterans. The research never led to effective, evidence-based treatments and indeed had little treatment focus until after Congress established a treatment-focused research program outside of VA.

And only after significant pressure and a change in Administrations did VA finally establish the
research advisory committee (RAC) – more than three years after the statutorily mandated
January 1, 1999 deadline. But, VA then systematically ignored its recommendations, and
diminished its findings. When it sharpened its criticism of VA’s failures related to Gulf War
veterans, VA staff led measures to substantially diminish its charter and discharge all of its

But the cost factor isn’t the only one that kept the VA interested in lumping GWI with PTSD.

With an unidentified illness such as GWI, the VA does not have to provide care more than something simple and inexpensive like group therapy. If GWI were like PTSD, then this approach might work, but GWI is a completely different illness with different causes and effects. GWI is not a result of stress or anxiety but rather a treatable illness. 

 Dr. Haley also identified another possibile VA advantage for keeping a diagnosed GWI off the table.

“There may be military advantage in not acknowledging that a quarter of our troops were incapacitated by low-level nerve agent,” he said. 

But the advantages to keeping GWI under wraps don’t stop there.

Keeping the diagnosis of these troops in a simply psychological category also makes it easier for it to be dismissed or called disreputable. 

“ multiple chemical sensitivity in chronic fatigue syndrome or fibromyalgia,” Dr. Haley said. “Most doctors don't acknowledge them or believe there are really ill or that they are psychological.”

A study highlighted on shows general internal medicine doctors are more likely than mental health care workers to affirm GWI is caused by mental illness.  The veterans are then treated for a problem they don’t even have ensuring that those truly sick never receive the treatment they deserve. 

"It's particularly frustrating for patients when they are bounced back and forth between clinicians and psychologists", said co-director of the Gulf War Clinic Dr. Ralph D. Richardson. 

The other issue is that of being taken seriously by the physician. A patient can be complaining of symptoms that seem to line up perfectly with one disorder, but still be suffering from something completely different. 

“All those are illnesses that you might say are disreputable diseases that most doctors don't acknowledge them or believe there are really ill or that they are psychological,” Dr. Haley added. 

Though it seems like a pattern of thousands of veterans complaining of the same issue would be hard to ignore, Dr.Haley doesn’t blame the physicians for failing to recognize the epidemic. Instead he finds that the VA, which deals with veterans and their health issues on a daily basis and is the main resource for such help, should be the ones who pinpoint recurrences of similar symptoms. 

“Of course, doctors what they do is they treat patients one at a time,” Dr. Haley said. “They don't look for trends of their business.”

The American Legion further investigated this issue in March 2016 in the article 25 Years After the Persian Gulf War: An Assessment of VA's Disability Claims Process with Respect to Gulf War Illness. 

In it, they discussed the difficult nature of identifying unknown or not well studied diseases and the effect that plays in the VA cover ups and further medical attention. 

“Medical professionals, doctors and examiners, by their nature are used to providing clear, defined diagnoses.  Gulf War Illness defies this trend and creates as much confusion for the doctors as it does for the veteran who is experiencing the symptoms.  Due to the complexity of Gulf War Illness, a veteran’s diagnosis may have changed multiple times during the course of their claim.  VA raters are not medical specialists; often, they are unaware that the rapidly changing diagnoses are all essentially descriptions of the same condition.  Moreover, the situation is further complicated by the fact that a medical professional rendered a diagnosis; once a diagnosis is provided, by definition, it is no longer an undiagnosed illness and therefore not subject to the regulations created to help Gulf War veterans obtain service connection.” 

Without the support of medical professionals, veterans were left without a viable cure, without an answer and without hope. In the eyes of the law, without a diagnosis, there is nothing to be done because the first step is having a name on the problem, a name that can go into the record books and be more easily identified and subsequently cured. 

With PTSD as the general health bucket into which so many veterans with GWI are placed so arbitrarily, a patient has just two options:

They must know the diagnosis was incorrect and seek a second opinion. However, most veterans aren't in the medical profession, and don’t have the medical knowledge to spot when something has been missed.  
They can go along, trusting that their doctor has meticulously identified the true cause of their troubles and given them the correct diagnosis. This is not to say that all doctors aren’t trying their best and obeying the laws of their practice, but it is to say that it isn’t always easy when an illness masquerades as PTSD. 

“If the doctors don't believe it, what should the policy people do?” Dr. Haley said. “They added a lot to it. Then, there is the perfect war syndrome.”

To makes things more difficult, to prove they are part of the subset that suffers from GWI, veterans must fall into the following category as defined by the VA to receive the benefits and assistance associated with the illness. 

“Gulf War Veterans who develop Chronic Fatigue Syndrome (CFS) do not have to prove a connection between their illnesses and service to be eligible to receive VA disability compensation. CFS must have emerged during active duty in the Southwest Asia theater of military operations or by December 31, 2016, and be at least 10 percent disabling.”

The trouble with this definition though, is the diagnosis itself: Chronic Fatigue Syndrome. If veterans are misdiagnosed with the easier-to-say and much-better-known PTSD, they are rendered ineligible for the care and perks that come with a correct diagnosis. Their fate is once again left in the hands of those who may not even know that what they have exists. 

While some veterans, with nowhere else to turn, simply accepted an empty diagnosis, others refused to be hushed. 

In a further statement by Hardie before the U.S. House of Representatives Committee on Veterans’ Affairs Subcommittee on Oversight and Investigations, he addressed the struggle and spoke of his return to the United States after deployment and the staggering effect of GWI on him and his fellow soldiers. 

“We faced a new battle, a much longer war – a war to obtain effective healthcare and
VA assistance from entrenched government officials who seemed intent on proving there was
nothing wrong with so many Gulf War veterans, that it was all in our heads, just stress, the same as after every war.”

Hardie recalled the promises made by the VA to health care for “war-related illnesses and post deployment health issues, including diagnosis, treatment, monitoring, medical recordkeeping, risk communication, and use of new technologies.” But he also described the bureaucracy as VA officials drug their feet and blockaded laws that they had promised to pass. 

“Instead, we learned that enactment of those laws was just another battle in our long war,” Hardie said in his testimony. 

Despite the stalling of the VA and Department of Defense (DoD), Congress was a key factor in the recent movement towards repercussion for Gulf War veterans and sufferers of GWI. 
The Congressionally Directed Medical Research Program (CDMRP) are directed in a two part system. The first group is testing treatments which focus on improving the health, and the other section focuses on treatment options by testing exposure and measure health. There is currently no treatment for GWI, but the path towards finding medication is on its way. But veterans in need of treatment face roadblock after roadblock in their search for help.

By the VA’s own numbers, at least 80% of Gulf War Illness claims are denied. With such a high rejection rate, most cases of GWI are going undetected which excludes possible patients who could be tested for cures. To make matters worse, the Military Times reported “ill veterans say the department is dismissive of their complaints and has actively sought to undermine their efforts to get treatment and compensation for their disabling diseases.” 

Fortunately, some higher ups were not willing to sit back and watch as the VA denied veterans the rightful services and care they should be granted after serving their country. 

In that same address to the House of Representatives, former chairman of the Research Advisory Committee on Gulf War Veterans Illnesses James Binns verbally attacked the VA in his statement, calling into question their seriousness when it comes to the rights and health of Gulf War Veterans. 

“With respect to Gulf War veterans’ health, VA pays no more attention to Congress than it does to science,” Binns said. “Congress has ordered report after report from the Institute of Medicine (IOM), specifying in law the work to be done.  However, VA has consistently failed to contract for what Congress actually ordered.” 

As Binns pointed out, with the help of the IOM, the VA was able to deny “any connection between toxic exposures and the shattered health of Gulf War veterans, and promote the discredited 1990’s VA position that their illness is largely psychiatric.” 

And when it came to conducting the actual studies commissioned by Congress, the deception continued.

One such study was to test thirty-three toxic substances and medications on animal subjects which troops were exposed to during their time in the Gulf War. However, the VA was able to subvert the test by excluding animal testing as a method of research. Thus, no IOM report was able to link the toxins to any health issues.

The infractions continued when the VA contracted a committee of doctors with no Gulf War veteran treatment experience, when Congress specifically requested medical professionals who had. It happened again when the VA only allowed the IOM use of the VA’s own data in research of neurological problems in Gulf War veterans, Post-9/11 Global Operations veterans, etc. The IOM eventually declined to even take on the study because of insufficient data for testing. 

As violations of Congress’ requests continued, Dr. Victor Dzau, president of the IOM, received a letter from Binns, Beatrice A. Golomb, a Professor of Medicine at University of California San Diego,  Rev. Joel C. Graves, a retired U.S. Army Captain,  Marguerite L. Knox, a colonel in the South Carolina Army National Guard, and William J. Meggs, the Professor and Chief of the Division of Toxicology at Brody School of Medicine at East Carolina University. 

The letter detailed the disparity of the 2016 Gulf War and Health committee as “grossly imbalanced toward the 1990’s government position that Gulf War veterans have no special health problem — just what happens after every war, related to psychiatric issues, and not environmental exposures.”

The letter continued, citing the fear of its writers of the well being of Gulf War veteran patients.

“Reviving this discredited fiction will cause veterans’ doctors to prescribe inappropriate psychiatric medications, and will misdirect research to find effective treatments down blind alleys — an unconscionable breach of the duty owed to veterans and expected of the Institute of Medicine.”

Viewing the tumultuous process through the eyes of veterans like Hardie or Nichols though, rather than former advisory board members, puts the struggles into perspective. 

At the end of her testimony, Nichols made a plea for action, saying “ I thank the Committee for having this hearing it is long overdue and we hope that it stimulates not only more hearings and a response to our funding needs but also to real action that fixes the broken system we enter in 1990-91.”  

And in his testimony, Hardie described the process and fight that he and many other veterans of the Persian Gulf War went through on the road to proper reconciliation, and it became clear that this is not just the fight of those in the Gulf War, but all of those lumped into a category where they do not belong for sake of simplicity or at the hands of those who don’t want to pay up.  

The plight of sufferers of GWI or GWS extends beyond the walls of the military into the civilian world, where it is easier to tell someone their illness is all in their head rather than in an actual bug in their brain. 

The GWI tragedy and the appalling behavior of the VA, which is led by military officers but controlled by politicians, is a national scandal. It is too easy to tar veterans with the brush of mental illness rather than to confront the reality of the aftermath of the Gulf Wars. The fact that the VA – a body funded by taxpayers including veterans – can so willfully ignore evience, veterans and the expressed will of Congress is extraordinary. The fact that nobody has been held accountable is a sad commentary on the power of an indolent bureaucracy and the impotence of both veterans groups and their allies in Congress.

But, this is more than just a tale of government incompetence at multiple levels. There are millions of men and women who have been lumped together under the general heading of “mentally ill” as a convenient way of evading the diagnosis of more complex illnesses. This unnecessary suffering has caused suicides, abuse, depression and the destruction of previously happy families.

I experienced so much of this trauma first hand but I am a fighter and I was fortunate to find friends and allies on my journey. Far too many others were not so blessed.

This is Julia Hugo Rachel. Next week, I’ll be telling you more of my personal journey when I first discovered I was ill and what it was like to enter the nightmare of the healthcare system.

One woman’s journey into medical hell and the lessons that will help cure millions.


Julia Hugo Rachel