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Gulf War Illness

A long-lasting mix of symptoms — fatigue, pain, memory and concentration problems, stomach trouble, headaches, and skin or breathing complaints — that affects many veterans of the 1990–1991 Gulf War. The cause isn’t clear, but the VA recognizes it and offers care, a free registry exam and benefits.

If you are a veteran in crisis, or worried about one, contact the Veterans Crisis Line: dial 988 then press 1, or text 838255. It is free, confidential and open 24/7 (Veterans Crisis Line, VA).

Call 911 for new chest pain or discomfort, or shortness of breath, which can be signs of a heart attack (CDC), and for sudden signs of a stroke — numbness or weakness in the face, arm or leg, especially on one side; confusion or trouble speaking; trouble seeing or walking; or a sudden severe headache with no known cause (CDC). Don’t put these down to Gulf War Illness.

What is Gulf War Illness?

Many veterans of the 1990–1991 Gulf War (Operations Desert Shield and Desert Storm) came home with a cluster of long-lasting symptoms that tests can’t fully explain. The VA calls this chronic multisymptom illness, medically unexplained illness or Gulf War veterans’ illnesses — all commonly known as Gulf War Illness, or GWI (VA Research). It avoids the older name “Gulf War syndrome” because the symptoms vary so widely (VA Public Health).

The VA acknowledges GWI as a health condition, with symptoms lasting more than six months that may not be easily explained (Veterans Health Library, VA). No test can diagnose it; clinicians take a thorough history, examine you and check for other illnesses that might better explain your symptoms (VA and DoD guideline, patient summary).

Common symptoms

Many veterans with GWI also have post-exertional malaise: pain and fatigue that worsen after even minor physical or mental effort (VA Research). The symptoms overlap with ME/CFS, fibromyalgia and irritable bowel syndrome, which the VA and DoD guideline treats together under chronic multisymptom illness (VA and DoD guideline, 2021). Guides to IBS, headaches and PTSD are coming.

How common is it?

Nearly 700,000 U.S. troops deployed to the Gulf in 1990–1991. Citing a 2020 Department of Defense report, VA Research estimates that GWI affects 175,000 to 250,000 of them. Rates are higher in the Army and Marine Corps than the Navy and Air Force, higher among enlisted personnel, and highest among troops who served close to combat (VA Research). The figure depends on the definition: studies using the CDC definition found the illness in 29–60% of Gulf War veterans, depending on the group studied, and the stricter Kansas definition found it in 34% of the Kansas veterans first studied (VA and DoD guideline, 2021).

What causes it? What has been studied

Despite much research, the cause is not clear. Possibilities under study include exposure to nerve agents, pesticides and other toxins; problems with the immune system, nerves or mitochondria (the energy-producing parts of cells); an interaction between genes and exposures; or a combination (Veterans Health Library, VA).

  • Pyridostigmine bromide (PB) pills were given to protect troops against the nerve agent soman. How much each person took isn’t known, because the pills were self-administered and rarely recorded (VA Public Health).
  • Pesticides, including lindane on uniforms and DEET on the skin, were used as insect repellents (VA Public Health).
  • Experts disagree about these two. In 2008 the Research Advisory Committee on Gulf War Veterans’ Illnesses found evidence of an association between PB and pesticides and the illness. A 2010 National Academies report disagreed, finding the evidence not sufficient to show that any specific drug, toxin, smoke plume or other agent caused it. The VA has concluded the evidence doesn’t support an association with PB or pesticides (VA Public Health, VA Public Health).
  • Sarin. After the 1991 cease-fire, U.S. troops demolished a depot at Khamisiyah, Iraq, that held sarin rockets; the Department of Defense concluded some ground forces were likely exposed to very low levels. A 2004 review found research doesn’t show long-term nerve problems from low levels that cause no symptoms at the time (VA Public Health).
  • Oil-well fire smoke from fires set by Iraqi forces in 1991 hung low over some troops. It irritates the eyes, nose, throat, skin and lungs, mostly temporarily; research so far doesn’t show long-term health problems from it (VA Public Health).

Other possible exposures include vaccines, depleted uranium, sand and dust, noise and extreme heat (VA Public Health). The guideline also lists factors associated with chronic multisymptom illness, including obesity, smoking, alcohol misuse, past trauma or PTSD, combat deployment and chemical exposures (VA and DoD guideline). “Associated” doesn’t mean “caused by” — and it doesn’t mean the illness is imagined.

For benefits, the cause doesn’t have to be settled: the VA presumes certain unexplained illnesses are related to Gulf War service without regard to cause (VA Public Health). See Getting VA care and benefits below. Vietnam-era veterans can read our Agent Orange guide.

Served in the Gulf? Even if you feel well, you can ask for a free Gulf War Registry health exam (VA Public Health), and discuss your exposure concerns with your provider (Veterans Health Library, VA). PACT Act questions: call 800-698-2411 (TTY 711) (VA).

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) No single cure. Ruling out other illnesses, then treating the symptoms that matter most to you under the 2021 VA and DoD guideline: CBT and mindfulness, exercise for widespread pain, and certain medicines, within a whole-health plan. The Gulf War Registry exam is free. Gulf War veterans can get enhanced VA health care eligibility; care for a VA-rated service-connected condition has no copay. 2026 compensation for a veteran alone runs from $180.42 (10%) to $3,938.58 (100%) a month. Eases symptoms for some veterans but doesn’t cure GWI. In the largest trial, 18.5% of veterans offered CBT improved their physical function, compared with 11.5% on usual care.
Chiropractic Hands-on care for back, neck and joint pain. The VA offers it to enrolled veterans by referral. About $50–$150 an adjustment without insurance ($15–$50 with); first visits $100–$250. Part of the VA benefits package. May help musculoskeletal pain. The guideline found too little evidence to recommend for or against manual therapies, and we found no chiropractic studies in GWI.
Acupuncture Fine needles for pain and other symptoms, including ear acupuncture. The VA covers it when the care team agrees it fits. About $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90. Covered by the VA when the care team approves it. The guideline suggests it for fibromyalgia-like pain. Two trials in Gulf War veterans reported benefits, but neither compared it with sham acupuncture.
Herbal medicine No herb or supplement is proven for GWI. Coenzyme Q10 has been tested in one small trial. Cost estimate being researched. Mixed early results that need a larger trial. Supplements can interact with medicines — check with your clinician or pharmacist first.
Massage therapy Gentle or medical massage for muscle tension, stress and pain. The VA covers medical massage when the care team agrees it fits. About $50–$90 for 45–60 minutes at clinics and spas; $60–$120 with an independent therapist. Covered by the VA when the care team approves it. Often relaxing, with short-lived benefits. Evidence for multisymptom illness is very low quality, and we found no massage trials in GWI.
MBHA Wellness Coach VA Whole Health goals (“what matters to you”), gentle graded activity and pacing, sleep, food, peer support, booking the registry exam and keeping records for a claim. Cost estimate being researched. Supports your medical care and daily life. It doesn’t treat GWI and never replaces your care team.

Approach 1 of 6

Conventional medicine (AMA)

There is no cure for GWI. More than $500 million has been spent on GWI research, but no cures or condition-specific treatments have been found (review, Military Medical Research, 2019). What the VA offers is a guideline for managing the symptoms (Veterans Health Library, VA): the 2021 VA and DoD Clinical Practice Guideline for the Management of Chronic Multisymptom Illness (VA and DoD guideline, 2021).

1. A whole-health, shared plan

The guideline asks clinicians to take a patient-centered, whole-health approach — treatment based on your needs and preferences — and to make decisions with you, in line with your values and goals (VA and DoD guideline). Together you build a plan to manage symptoms and help you do more of your daily activities (VA and DoD guideline, patient summary).

2. Talking therapies

  • Cognitive behavioral therapy (CBT) is suggested for symptoms like fibromyalgia, IBS or ME/CFS. In the largest trial, of 1,092 Gulf War veterans, 18.5% of those offered CBT improved their physical function by a set amount after a year, compared with 11.5% on usual care (VA and DoD guideline). CBT supports coping; it doesn’t mean the illness is “in your head”.
  • Mindfulness-based therapies are also suggested, and emotion-focused therapy may be considered for fibromyalgia- or IBS-like symptoms (VA and DoD guideline).

Depression, anxiety and PTSD deserve treatment in their own right — see our Depression and Anxiety guides. A PTSD guide is coming.

3. Exercise and movement

For widespread, fibromyalgia-like pain, the guideline suggests physical exercise, and yoga or tai chi. In the large Gulf War trial, a weekly exercise program didn’t improve physical function overall but did ease fatigue, distress, thinking problems and mental health, though not pain (VA and DoD guideline). The guideline makes no exercise recommendation for ME/CFS-like symptoms. Because research is still working out how much exercise worsens GWI symptoms (VA Research), start gently and adjust to how you respond — see pacing in our Chronic Fatigue guide.

4. Medicines, by symptom

We name classes only; your prescriber decides on any medicine and dose.

  • Pain: for fibromyalgia-like pain, the guideline suggests an SNRI antidepressant or pregabalin, and suggests against anti-inflammatory painkillers (NSAIDs). It recommends against long-term opioids for chronic pain (VA and DoD guideline).
  • IBS-like bowel symptoms: for constipation not helped by osmotic laxatives, it suggests certain prescription medicines (linaclotide or plecanatide); without constipation, a short course of the antibiotic rifaximin. For several other bowel medicines it found too little evidence to decide (VA and DoD guideline). See our Digestion guide; an Irritable Bowel guide is coming.
  • Fatigue: it recommends against stimulants for ME/CFS-like fatigue (VA and DoD guideline).
  • Sleep: the 2021 guideline makes no recommendation on sleep medicines, so sleep problems are worked through with your clinician.

5. Help for hard-to-diagnose symptoms

The VA’s War Related Illness and Injury Study Center (WRIISC) offers in-person and telehealth evaluations for veterans with chronic, unexplained symptoms or complex exposures (WRIISC, VA). You need a referral from your VA primary care provider and must be enrolled in VA health care (VA Public Health), and earlier work-ups may need to be done first (WRIISC).

What it costs

  • Gulf War Registry exam: free (VA Public Health). Exams to check your risk of health problems linked to military service carry no copay (VA).
  • VA health care: veterans who served in Southwest Asia during the Gulf War between August 2, 1990 and November 11, 1998 can qualify for enhanced eligibility, which places them in a higher priority group; your priority group affects how much, if anything, you pay (VA). Care related to a VA-rated service-connected disability has no copay (VA).
  • Disability compensation (2026, veteran alone): from $180.42 a month at a 10% rating to $3,938.58 a month at 100%, with more for dependents (VA).
  • Care outside the VA: cost estimate being researched.

How well it works — what to expect

Treatment aims to ease the symptoms that bother you most, not to cure. Gains in trials are real but modest. New symptoms deserve a fresh look rather than being put down to GWI.

Find a medical doctor in our directory

Approach 2 of 6

Chiropractic

Chiropractic care doesn’t treat GWI itself, but many veterans use it for back, neck and joint pain. It is part of the VA’s standard medical benefits package, by referral from a VA primary care or specialty provider; facilities without an on-site clinic arrange community care. VA chiropractors offer education, active rehabilitation, spinal manipulation and other manual therapies, and some also provide acupuncture (VA Chiropractic Program).

What the research says

The VA and DoD guideline found insufficient evidence to recommend for or against manual therapies — spinal manipulation, mobilization and osteopathic manipulation — for multisymptom illness. The evidence was very low quality and not from military populations (VA and DoD guideline, 2021). A PubMed search found no studies of chiropractic care or spinal manipulation in Gulf War Illness.

Tell your chiropractor about all your symptoms and diagnoses, and check with your doctor before starting hands-on care.

What it costs

Outside the VA, an adjustment is about $50–$150 without insurance and $15–$50 with it, and a first consultation $100–$250 without insurance (MedicalCostInfo). Through the VA, your cost depends on your priority group.

Find a chiropractor in our directory

Approach 3 of 6

Acupuncture

Acupuncture is in the VA medical benefits package when your care team considers it appropriate, offered on site, by telehealth or through community providers (VA Whole Health). The VA also uses “battlefield acupuncture”, with small needles in the ear to ease pain (VA Pain Management).

What the research says

  • The VA and DoD guideline suggests manual acupuncture for fibromyalgia-like symptoms — a weak recommendation, based mainly on a review of trials in people with fibromyalgia (VA and DoD guideline, 2021).
  • A 2016 trial randomized 104 Gulf War veterans to six months of individualized acupuncture from experienced community acupuncturists, or to a two-month wait before starting. At six months the first group reported better physical function and less pain. There was no sham (placebo) group, and 85 veterans finished (Conboy et al., PLoS One, 2016).
  • A 2023 VA trial of 149 veterans with GWI combined mindfulness meditation and ear acupuncture for eight weeks, compared with health education. The combined group had better mental-health functioning and less fatigue, depression and overall symptom severity. With two therapies given together, it can’t show what acupuncture added on its own (Breneman et al., Global Advances in Integrative Medicine and Health, 2023).

Safety and cost

Few complications have been reported; problems have come from non-sterile needles and poor technique, and the FDA requires sterile, single-use needles (NCCIH). Cash prices run about $125–$230 for a first private visit and $90–$185 for follow-ups; community clinics about $50–$90 (The Pricer). Through the VA it is covered when your care team approves it.

Find an acupuncturist in our directory

Approach 4 of 6

Herbal medicine

No herb or supplement has been proven to treat GWI. The VA and DoD guideline recommends none, and found too little evidence to recommend for or against soluble fiber supplements for IBS-like symptoms (VA and DoD guideline, 2021).

Coenzyme Q10 (CoQ10)

  • A small 2014 trial gave 46 veterans with GWI one of two doses of CoQ10 or a look-alike placebo for about three and a half months, without anyone knowing which. On the main measure, self-rated general health, there was no significant benefit for the group as a whole. Among the men (85% of participants), the lower dose improved self-rated health and physical function compared with placebo. The authors called for a larger trial (Golomb et al., Neural Computation, 2014).
  • VA Research lists a larger phase III placebo-controlled trial of CoQ10 in GWI among its funded projects (VA Research). Until results are published, CoQ10 remains unproven.

Interactions and safety

  • CoQ10 may interact with the blood thinner warfarin and with insulin, and may not suit some cancer treatments (NCCIH).
  • Asian ginseng, often sold for energy, might interact with some medicines; talk with your health care providers first (NCCIH).
  • Be wary of “detox” programs. The guideline set aside a small trial of daily exercise, sauna and proprietary supplements because too much changed at once to judge any one part (VA and DoD guideline).
  • Bring every supplement to your appointments. We don’t list doses here.

Approach 5 of 6

Massage therapy

Massage doesn’t treat GWI, but it can reduce stress and muscle tension, which may ease pain (VA Pain Management). Medical massage is in the VA benefits package when your care team considers it appropriate, delivered on site or through community providers (VA Whole Health).

What the research says

The VA and DoD guideline found insufficient evidence to recommend for or against deep tissue massage for fibromyalgia-like symptoms. The studies, almost all in women with fibromyalgia, were mostly at high risk of bias; several types of massage seemed helpful, but effects were often short-lasting, with no evidence of harm. Massage is covered by the VA for pain but not by TRICARE (VA and DoD guideline, 2021). A PubMed search found no massage trials in Gulf War Illness.

Safety and cost

Rare serious side effects such as blood clots, nerve injury and broken bones have been reported, some with vigorous deep tissue massage or in older adults (NCCIH). If effort or scents make you worse, ask for gentle pressure, a shorter session and unscented oils — see our Chemical Sensitivity guide. Prices run about $50–$90 for 45–60 minutes at clinics and spas, or $60–$120 with an independent therapist (CostHelper).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach doesn’t treat GWI. The aim is to help you live well alongside it, working with your care team, never replacing it.

Start with what matters to you

VA Whole Health centers on “what matters to you, not what is the matter with you” (VA Whole Health). The VA’s Personal Health Inventory asks whether you’re sleeping enough to feel refreshed, eating foods that nourish you and surrounded by people you care about; you can complete it alone or with a VA Health and Wellness Coach (VA Whole Health). An MBHA coach can help you take your goals to your VA team.

Graded activity and pacing

Movement helps many veterans, and the guideline suggests exercise, yoga or tai chi for widespread pain (VA and DoD guideline). But if effort leaves you worse a day later, pacing comes first: find a level you can repeat on bad days, build up only slowly when stable, and plan rest. See our Chronic Fatigue guide.

Sleep, food and stress

Peer support

VA staff and veteran peers can support your Whole Health journey, including through the “Taking Charge of My Life and Health” course (VA Whole Health).

Paperwork: the registry exam and your claim

  • Book the free Gulf War Registry exam through your local VA Environmental Health Coordinator (VA Public Health).
  • Keep records: your DD214 and deployment papers, a symptom diary, test results and letters from every clinician. You have up to a year from when the VA receives your claim to send evidence, and an online application you finish within 365 days keeps the date you started it (VA).
  • Get help: an accredited attorney, claims agent or Veterans Service Organization representative can help you file (VA).

Another approach

Getting VA care and benefits

Conditions the VA presumes are linked to Gulf War service

For a presumptive condition, you don’t have to prove your service caused it; you only need to meet the service requirements (VA). They include:

  • Undiagnosed and multisymptom illnesses, diagnosed on active duty or any time after, when you have been ill for at least 6 months: chronic fatigue syndrome, fibromyalgia, functional gastrointestinal disorders, medically unexplained chronic multisymptom illness, and other undiagnosed illnesses (VA). Functional gastrointestinal disorders include IBS and functional dyspepsia; undiagnosed illnesses can involve fatigue, pain, headache, heart-related signs, weight loss, menstrual, nerve, memory, digestive, skin, breathing and sleep problems (VA Public Health).
  • Nine infectious diseases, including malaria, Q fever and West Nile virus, with time limits for most (VA).
  • Burn pit and toxic exposure conditions added by the PACT Act (see below).

Where you served: for undiagnosed illnesses, the VA recognizes service on or after August 2, 1990 in Iraq, Kuwait, Saudi Arabia, Bahrain, Qatar, Oman, the UAE and nearby waters, as well as several other countries including Afghanistan; check VA’s list. You must not have a dishonorable discharge. If your condition or location isn’t listed, you can still apply with more evidence (VA).

The free Gulf War Registry exam

VA health care

Under the PACT Act, Gulf War veterans can enroll in VA health care without applying for disability benefits first, if they meet the basic service and discharge requirements. Every enrolled veteran gets a toxic exposure screening, repeated at least every 5 years, which points you to benefits, registry exams and clinical resources (VA). Health care questions: 877-222-8387 (VA Public Health).

Filing a disability claim

File online, by mail on VA Form 21-526EZ, in person or with an accredited representative. You don’t have to send evidence, but sending your documents speeds things up, and the VA may schedule a claim exam (VA). If you were denied before and your condition is now presumptive, you can file a Supplemental Claim (VA). Dependents and survivors may also be eligible for benefits (VA Public Health).

Another approach

Burn pits and the PACT Act

Burning trash and other waste in open pits was common in Iraq, Afghanistan and other parts of Southwest Asia. The smoke can irritate the eyes, throat, skin and lungs, usually temporarily, but veterans who were closer or exposed longer may be at greater risk of longer-term problems, including some cancers (VA Public Health).

The 2022 PACT Act added more than 20 presumptive conditions for Gulf War–era and post-9/11 veterans: several cancers (including brain, head and neck, gastrointestinal, kidney, pancreatic, reproductive and respiratory cancers, lymphoma and melanoma) and lung and airway conditions such as asthma diagnosed after service, chronic bronchitis, COPD, chronic sinusitis and rhinitis, emphysema and pulmonary fibrosis (VA). Exposure is presumed for service on or after August 2, 1990 in places including Iraq, Kuwait, Saudi Arabia and Somalia, and on or after September 11, 2001 in places including Afghanistan, Djibouti and Syria (VA). If your claim was pending when a condition was added, you don’t need to do anything (VA).

Since 2024, people who served in these areas between 1990 and August 2021 are added to the Airborne Hazards and Open Burn Pit Registry automatically from DoD records. It is optional and doesn’t affect your care or benefits (VA Public Health). Chronic multisymptom illness isn’t limited to 1990–1991: some service members from other deployments report it too (VA and DoD guideline).

Member stories

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Sources

This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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