In a report released February 11, Institute of Medicine researchers said veterans of the 1991 Persian Gulf War are at a higher risk for developing a number of physical and mental health conditions. These include post-traumatic stress, anxiety, depression, digestive problems, chronic fatigue syndrome and Gulf War illness. The latter is an umbrella term used to describe undiagnosed symptoms in Gulf War veterans.

The IOM panel examined studies on the prevalence of various diseases in Gulf War veterans as well as those who did not deploy. They then categorized them on a spectrum ranging from “sufficient evidence of a causal relationship” to “inadequate or insufficient evidence to determine an association.”

According to the committee, the over $500 million in government-funded research on Gulf War veterans between 1994 and 2014 has provided little overall insight into the war’s health effects. Although evidence for Gulf War illness has increased in recent years, there has been a lack of progress in determining its causes and understanding how to treat it. The debilitating disease’s wide range of symptoms include fatigue, joint and muscle pain, headaches, gastrointestinal problems and skin rashes.

The IOM committee recommended the VA continue to monitor aging Gulf War veterans for degenerative brain diseases that take a long time to develop, such as amyotrophic lateral sclerosis (ALS), Parkinson’s and Alzheimer’s. The focus should shift to personalized care for veterans and treatment of the illness, as well as its mind-body connection.

However, veterans advocates who suffer from Gulf War-related illnesses expressed outraged at the report. They argued it reflects the panel’s bias toward the VA and selectivity in choosing the studies to review.