 |
| Pix credit here |
In sum, the absence of a clear case definition for AHIs, uncertainty surrounding the origin of
AHIs, and CIA’s evolving organizational position have greatly complicated CIA’s ability to
consistently and transparently facilitate medical care, provide compensation and other benefits, and communicate clearly about AHIs to the workforce. These challenges will be detailed throughout the remaining findings in the report.
Perhaps nothing serves as a better harbinger of the inversion of power relationships in the emerging systems of governance by techno-bureaucratic caste collectives than the meandering story around what was for a time called Havana syndrome and is now known by its more appropriately banal name: Anomalous Health Incidents (my essays on this long story here: Cuba Sonic Weapons Affair). Future generations may come to understand this episode for an important instance in the movement from a political to a bureaucratic state organization in which liberal democratic institutions shift the locus of their power relations from that between popular sovereigns and their elected officials, t that between the administrative apparatus of a state and the political organs that serve as disciplinary appendages to their operation. This will come to haunt both liberal democratic and Marxist-Leninist systems, though in different ways; and it will ultimately transform that techno-bureaucracy as well, as it transitions from one driven by human cliques to one in which human caretakers serve the virtual systems created to make techno-bureaucracy both more efficient and less "biased."
 |
| Pix credit here |
The turn, or better the inversion of the relationship between the political and administrative apparatus might be gleaned usefully from a recent report distributed (in a public version) by the US Senate Select Committee on Intelligence: Review of the CIA's Efforts to Provide Facilitated Medical Care and Benefits for Individuals Affected by Anomalous Health Incidents: Audits and Projects Report 24-01. The Report is worth a careful read, if only for the careful language used to gently describe the power relations around one of the most innocuous areas of the sonic weapons tale--treatment.
According to the 18-page report, titled "Review of CIA's Efforts to Provide Facilitated Medical Care and Benefits for Individuals Affected by Anomalous Health Incidents [AHIs]," the CIA's response has been marred by inadequate communication and "messaging challenges," inconsistent medical support, delayed compensation and a dismissive attitude toward affected individuals. These failures have hindered efforts to provide proper treatment and left many victims struggling to access benefits. "CIA has provided benefits and compensation to many AHI reporters, but ease of access to these programs has been inconsistent and affected by CIA's organizational position on AHIs," the report states. * * * The report revealed that despite a growing number of cases, the agency was slow to standardize protocols for identifying and treating victims. The report stated that the CIA facilitated AHI-related medical care for nearly 100 CIA-affiliated incidents, but many individuals faced obstacles to timely and sufficient care. (Newsweek)
Perhaps nothing sums up the techno-bureaucratic contradictions into which the apparatus of state is now inevitably than the notion of consumption: for a techno-bureaucracy with collective objectives, individuals are productive forces that must be consumed in order for the apparatus to attain its objectives. Those who are to be consumed may embrace their fate willingly; many, however are taught a valuable lesson about the relationship of the individual to the techno-bureaucratic mass organization. Those who are about to be consumed produce a residual element that eventually will consume the consuming apparatus--distrust.
Distrust of CIA has been a common theme among AHI reporters the Committee interviewed.
Pix credit Nintendo Switch
Many of the AHI reporters with whom Committee staff spoke for this review expressed some
degree of distrust of the Agency, including some who perceived that their career was negatively impacted for reporting an AHI or seeking support related to their AHI. AHI reporters’ distrust took many forms. For example, many AHI reporters who spoke to Committee staff did not trust CIA to act toward them in good faith, which led to them frequently question the motives behind CIA's actions. This distrust was further reinforced by poor communication and a lack of transparency. AHI reporters’ distrust also stemmed from their concerns that CIA’s analytic effort on AHls has not been objective. More than a dozen individuals who spoke to Committee staff questioned the objectivity of CIA’s analytic line on AHIs, its analytic trade craft, or the soundness of its findings. Finally, AHI reporters have also cited “stigma” or fear associated with reporting or talking about AHIs, which could have a chilling effect on future AHI reporting. The Committee assesses that (_’IA could benefit from an examination of how its response t o AHIs has impacted its workforce, to include issues of morale and trust. Report, p. 14).
As compliance oriented cultures become more deeply embedded as the emerging driver of government and the State, and where the political branches increasingly become instruments that are managed by the organs they created to manage objectives and compliance based systems. These systems, in turn represented an innovation that sought to move from the more ancient and personal forms of government--by commands enforced through an apparatus of investigation, prosecution, and judgment, to one that internalized behaviors through systems of punishments and rewards administered through systems overseen by technically proficient "experts". That change, momentous in hindsight, also required a willingness to devolve authority from political to technical organs, and to permit these technical organs to further devolve the burdens of fulfillment to the objects against which they were created. Security, secrets, efficiency and the universalization of policy driven social relations not merely changes power dynamics within government, and between government and those governed, but it also changes the way in which each of these factors in the production of collective order and stability are conceptualized, treated and ordered within a collective. The Sonic Weapons adventure suggests some of the detritus of this transformation--in this case a product of the increasing disjunction between the way things are and the way we used to think they were.
The Report follows below.
 |
| Pic credit here |
Table of Contents
INTRODUCTION .......................................................................................................................... 3
FINDINGS ...................................................................................................................................... 3
1. The unknown nature of AHIs and AHI analytic efforts complicated CIA’s organizational
response to reported incidents ..................................................................................................... 3
II. CIA facilitated AHI-related medical care for nearly 100 CIA-affiliated incidents, but many
individuals faced obstacles to timely and sufficient care ............................................................ 5
Ill. AHI clinical research studies have identified unexplained clusters of symptoms, but CIA
has stopped collecting clinical data on AHls while DOD research efforts continue .................. 7
IV. CIA has provided benefits and compensation to many AHI reporters, but ease of access to
these programs has been inconsistent and affected by CIA’s organizational position on AHIs. 9
V. CIA-s AHI response hampered by communication and messaging challenges ................... 12
VI. CIA's response to ALIIs has negatively affected AHI reporters and led to a trust deficit
with portions of its workforce ................................................................................................... 13
CONCLUSIONS...........................................-............................................................................... 14
RECOMMENDATIONS FOR CIA ............................................................................................. 15
POTENTIAL ACTIONS FOR CONGRESSIONAL CONSIDERATION.................................. 18
INTRODUCTION
The Senate Select Committee on Intelligence (the Committee) has been conducting oversight of
the Intelligence Community’s (IC) response to anomalous health incidents (AHIs) since it first
became aware of U.S. government (USG) personnel, including from the Central Intelligence
Agency (CIA), reporting suspicious health incidents in a foreign location in late 2016 and early
2017. Many, though not all, of these incident reports included similar sensory phenomenon (e.g.,
sounds, directional pressure) and symptoms (e.g., tinnitus, headaches, balance issues, dizziness,
and cognitive challenges). Since that time, there have been hundreds of incidents reported
globally as possible AHIs by USG employees, dependents, and contractors. Many of these
reports come from CIA employees and other CIA-affiliated personnel.
Although initial reports led many inside and outside the U.S. government to believe that foreign
adversaries were attacking USG personnel with an acoustic or directed energy device that caused
traumatic brain injury-like symptoms. subsequent intelligence analysis has cast doubt on that
hypothesis. Yet much remains unknown about AHIs. As the U.S. government’s investigative and
research efforts into AHIs continue, the Committee is committed to ensuring that IC personnel
who report an AHI have access to appropriate facilitated medical care and effective mechanisms
to seek the financial compensation and other benefits they may be eligible for under federal law.
To that end, the Committee tasked its non-partisan Audits and Projects staff with reviewing the
effectiveness of CIA’s efforts to provide facilitated medical care, financial compensation, and
other benefits to current and former CIA employees, contractors, and dependents who reported
AHIs (“AHI reporters”). This review culminated in a classified report that the Committee will
issue in early 2025. This unclassified report summarizes the findings of the classified report.
The report is based largely off testimonial evidence provided by CIA officials, other USG
officials, medical professionals who provided care to AHI reporters as part of a facilitated
medical care program, and AHI reporters. When possible, the Committee attempted to
corroborate and/or supplement the testimonial evidence provided with data and documentation.
However, in some instances. Committee staff were not able to resolve certain discrepancies in
the information provided for this review. The Committee also notes that the experiences of the
AHI reporters who spoke with the Committee for this review are not necessarily representative
of the experiences of all AHI reporters at CIA. Regardless, the Committee assesses the concerns
raised by this portion of the workforce are illustrative of the challenges that many AHI reporters
faced in seeking facilitated care and compensation, and they demand CIA’s attention.
FINDINGS
I. The unknown nature of AHIs and AHI analytic efforts complicated CIA’s organizational
response to reported incidents
One question that has plagued both the IC’s attribution efforts and efforts to provide medical
care and compensation for AHI reporters is the most elemental of questions: what is an AHI?
Specifically, the question of how to identify which of the reported AHIs are truly anomalous
incidents potentially caused by a foreign adversary or other external source, and which are
naturally occurring medical conditions or otherwise explainable by environmental or social
factors. has been extremely difficult. While medical providers may be able to effectively treat
individuals’ symptoms without knowing the underlying cause. the question is weightier for CIA
and the AHI reporters themselves, since the existence of and access to facilitated medical care.
benefits. and compensation has been largely predicated upon the hypothesis that AHIs are caused
by a foreign actor “attack- that require the USG to take care of its personnel injured in the line of
duty rather than by naturally occurring medical conditions that should be addressed through
private health care channels.
The foreign adversary “attack" hypothesis formed after the first AHls were reported from Cuba.
The "attack- hypothesis also contributed to initial assessments that AHIs were synonymous with
traumatic brain injuries (TBIs). since the first medical personnel to examine the AHI reporters
from Cuba noted that they presented with signs and symptoms analogous to a TBI. Given the
lack of intelligence on AHIs at the time, CIA adopted the “attack“ and TBI hypotheses as its
working organizational position. This working position led CIA leadership to believe they had to
take action to facilitate medical care and provide certain benefits for their personnel. This
hypothesis also drove Congress to act, including by passing the Helping American Yicfims
Afnicted by Neurological Attacks (HA niNa) Act o/202/–which solidified the connection
between AHIs and brain injuries. 1
However. CIA's initial organizational position was based on real-time reports, initial medical
assessments, and incomplete information rather than finished intelligence analysis. After an
extensive effort to collect and analyze intelligence pertaining to AHI reports. CIA–and the IC
more broadly–established an analytic line that AHls were not likely the result of foreign
adversary "attacks.-- Most notably, the March 2023 Intelligence Community Assessment
concluded, with varying degrees of confidence, that it was "very unlikely-' or ''unlikely" a
foreign adversary was responsible for reported AHIs.2 This analytic line influenced CIA’s
organizational position on AHIs and became one of several factors that affected how the Agency
provided facilitated medical care and other benefits.
While the evolution in CIA-s organizational posture and position was gradual, the Committee
assesses that CIA's January 2022 interim assessment on AHIs was an inflection point; around
that time. CIA made multiple concrete modifications to AHI-related programs and policies that
coincided with, and in some cases were influenced by, this analytic line.
The Committee also notes that AHI reports began to decrease rapidly around October 2021.
which decreased the demand signal for facilitated medical care and some other benefits and
likely also contributed to CIA's changing organizational posture on AHIs.
While the Committee understands why CIA would modify its organizational position on AHIs in
response to new intelligence and other information, the Committee also notes that CIA’s current
position is complicated by the fact that the Intelligence Community Assessment is not definitive
1 Helping ,4merican \'ictinrs Afnicted by Neurological Attacks Act of 202 1 . Pub. L. No. 1 17-46, 135 Stat. 391 (Oct 8, 202 1 )
: National Intelligence Council. Updated Assessment of A nomalous Health Incidents. ICA 2023-02286-B (Mar. I. 2023). Accessed on Oct. 1. 2024 at
https:’'dni.gov,’tlles,/ODNI,'documents/assessments'Updated Assessment of Anomalous Health Incidents.pdf.
4
or final and recognizes that, if new information comes to light, the IC-s assessment could shift.
In the press release accompanying the Intelligence Community Assessment, Director of National
Intelligence Avril Haines acknowledged that IC agencies have gaps in their knowledge given the
challenges of collecting on foreign adversaries.3 Despite this uncertainty, the Committee notes
that CIA started rolling back AHI-focused efforts more than a year before its dedicated
investigative effort was complete and the March 2023 Intelligence Community Assessment was
issued.
Seven years after the first AHI reports in Havana, during which time the IC engaged in sustained
intelligence collection and analysis efforts and medical personnel conducted various types of
clinical research studies on AHI reporters. there remains no definitive answer to the question
''what is an AHI?” However, there is now broad acknowledgement across the U.S. government,
medical, and research communities that not all of the reported AHIs have the same cause–and
that many reported AHIs are likely attributable to naturally occurring medical conditions,
environmental exposures, or psycho-social factors.
In sum, the absence of a clear case definition for AHIs, uncertainty surrounding the origin of
AHIs, and CIA’s evolving organizational position have greatly complicated CIA’s ability to
consistently and transparently facilitate medical care, provide compensation and other benefits,
and communicate clearly about AHIs to the workforce. These challenges will be detailed
throughout the remaining findings in the report.
II. CIA facilitated AHI-related medical care for nearly 100 CIA-affiliated incidents, but
many individuals faced obstacles to timeIY and sufficient care
CIA lacks a holistic, organic infrastructure and legal authorities analogous to DOD’s military
health system. However, due to the unique and challenging circumstances of AHIs, CIA took
concerted action to facilitate medical care, including evaluation and treatment, for many CIA
employees, dependents, and contractors at various external and nongovernment medical facilities
(“facilitated treatment programs’'), such as Walter Reed’s National Intrepid Center of Excellence
and several other medical facilities, including some within the greater Washington D.C.
metropolitan area. The Committee notes that much of this care was provided in the middle of the
COVID-19 pandemic, which presented compounding challenges for CIA medical officers trying
to facilitate this care. However, the Committee assesses that AHI reporters’ ease of access to
facilitated treatment programs, as well as the care they received, also depended on several
variables, including when and where they reported an AHI (e.g., in a foreign or domestic
location), and how the timing of their reports aligned with CIA-s preparedness to respond and its
evolving organizational posture and position on AHIs.
3 Avril D. Haines, Director of National Intelligence Statement on the Intelligence Community Assessment on AHls,
Office of the Director of National Intelligence News Release No. 2-23 (Mar. 1, 2023). Accessed on Oct. 1, 2024 at https://dni.gov/index.php/newsroom/press-releases/press-releases-2023/3674-dni.statement-on-the-intelligence-community-assessment-on-ahis- 1 692377389.
5
Despite CIA’s actions to establish facilitated medical treatment optionsp many AHI reporters
experienced delayed, denied, or pre-conditioned care. For example, some AHI reporters:
• experienced long wait times to access facilitated treatment options;
• were denied facilitated care by a CIA care adjudication board;
• perceived that their access to facilitated medical care was contingent on their willingness
to participate in a NIH clinical research study;
• felt undue pressure to provide their medical records to CIA in order to gain access to
facilitated medical care, and were resistant because they feared the Agency would
“weaponize” their information or try to use the records to “discredit” their AHI reports9
such as by “pinning” their AHI experience on a minor pre-existing condition; and.
• felt that CIA tried to discourage them from seeking facilitated care, particularly as CIA’s
organizational position on AHIs evolved.
Finally, domestic AHI reporters as a group faced unique challenges accessing facilitated care
compared to overseas reporters.
In some cases, these obstacles stemmed from factors not entirely within CIA’s control, such as
long wait times for DOD to grant Secretarial Designation approval or spikes in AHI reporting
that overwhelmed the capacity of the facilitated treatment programs.4
However, the Committee assesses that some of the challenges noted above are due, in part, to the
fact that CIA has not established clear and documented policies, guidance, and criteria for how it
refers AHI reporters to facilitated treatment programs, including who would be referred, under
what conditions, and to which facility. This exacerbated the already-vexing situation and led to a
lack of clarity and consistency in how facilitated treatment was provided.
While monthly AHI reports from CIA-affiliated individuals peaked in the fall of 2021 and have declined markedly since then, the Committee nevertheless assesses that CIA may not be well-
postured to respond to future AHI reports and to facilitate quick, accessible. high-quality medical care for those who need it, particularly in the case of another AHI cluster. Among other
concerns, the U.S. government’s process for rdporting, investigating, and adjudicating new AHI
reports is unclear, and CIA has moved away from an AHI-specific framing towards a broader
focus on “counterintelligence-related health incidents,” which includes AHIs and other types of health incidents potentially associated with foreign intelligence activities (e.g., poisonings, drink-
spiking.) CIA is also no longer conducting AHI baseline medical assessments or post-AHI medical assessments, the future of its facilitated treatment options is unclear, and there are
ongoing questions about what type of long-term medical care the existing cohort of AHI
reporters may need for their chronic conditions. The Committee assesses that
counterintelligence-related health incidents will be around for a long time, so CIA needs a
sustained posture to address such incidents and to improve its medical tradecraft. CIA should be
more organizationally prepared for the possibility that a large volume of AHI reports–or
similar types of threats to the workforce–could arise in the future and overwhelm CIA’s
4 The DOD Secretarial Designation process authorizes DOD to provide medical care for non-DOD beneficiaries in emergency situations.
6
capacity to respond on a case-by-case basis by, among other things, developing appropriate
written policies and comprehensive plans for how it would respond to such threats.
Finally, AHIs have presented CIA’s medical organizations with unprecedented challenges9 and
the Committee recognizes that many medical officers, support staff, and case managers have
responded to AHI reporters’ needs in the best way that they knew how given the complexity of
the situation. In late 2020, CIA established a temporary AHI cell to coordinate all aspects of
CIA’s response to AHIs, including medical care, collection, and analysis. CIA’s Center for
Global Health Services has integrated some capabilities from this AHI cell that will be beneficial
going forward, such as its case management systems. However, the Center for Global Health
Services has not deliberately and systematically conducted a lessons learned review of CIA’s
AHI medical response, to include documenting lessons learned, best practices, areas of
challenge, impacts to the workforce, and actions needed to better prepare the organization to
respond to future threats to the workforce. It is critical for CIA to undertake a comprehensive
lessons learned review and document its findings to inform its response to future threats to its
workforce–AHI or otherwise.
III. AHI clinical research studies have identified unexplained clusters of symptoms, but
CIA has stopped collecting clinical data on AHIs while DOD research efforts continue
There have been various clinical research efforts designed to advance the USG’s understanding
of AHIs. All of these studies have identified unexplained clusters of symptoms, but all of these
efforts have also been inconclusive and have faced limitations that augur for additional
research–even the NIH study, which the ICA referenced as a key factor underpinning its
analytic judgment .
The IC’s understanding of AHIs is based, in part, on several cornerstone clinical research studies
on AHI reporters, including a study from the University of Miami, two studies from the
University of Pennsylvania, and two studies from NIH. All of these studies indicate that. at the
group level, AHI reporters have clusters of symptoms and diagnoses that cannot be easily
explained.
The University of Miami and the University of Pennsylvania (UPenn) studies found that AHI
reporters had a range of reported symptoms and clinical findings suggestive of a brain injury.
UPenn's unpublished research–which UPenn officials said they did not try to publish because
they felt that a USG researcher tried to publicly “undermine“ their findings–found that all of the
group-level differences were driven by a subset of the AHI population in treatment. The ICA
questioned the validity of the studies’ findings due to medical and academic critiques of their
methodologies. Concerns about the UPerm study indicated a need for more methodologically
robust research, leading to the initiation of the NIH study.
The NIH study found that AHI reporters did not show significant differences in most tests of
auditory, vestibular, cognitive, or visual function from controls that would indicate a brain injury
occurred. However, its data also indicated that a segment of the AHI population did differ from
the control group in two notable areas. Specifically, the NIH data revealed that 28% of AHI
7
reporters had presented with functional neurological disorders, specifically persistent postural
perceptual dizziness (PPPD), compared to only one of the controls. The NIH study also found
that 25% of the AHI population had cataracts in contrast to zero controls.5
The ICA used preliminary findings from the NIH study as a key factor underpinning its analytic
judgement, noting that the study does not substantiate the existence of a novel medical syndrome
among AHI individuals who reported AHI incidents and that data do not indicate that AHI
reporters experienced a consistent set of physical injuries such as TBI. Thus, by inference, AHls
could not have been caused by a foreign adversary because there was no clinical evidence that
AHI reporters. at the group level, differed in any meaningful way from the control population.
However, the Committee notes that a notable portion of AHI participants in the NIH study had
unexplained PPPD and cataracts. While the exact causes of PPPD are unknown, the condition is
often triggered by an acute insult or injury to the vestibular system. The lead NIH researcher told
Committee staff that they do not know what caused PPPD in the AHI reporters, but that “the
presence of PPPD could be consistent with a directed energy etiology for AHIs.’- Notably, the
NIH study was suspended in August 2024 due to complaints from participants that CIA had
coerced their participation in the study, among other reasons.
Recently, DOD has initiated several new clinical research efforts with the goal of addressing
previous research limitations, collecting enough data to develop a usable case definition for
AHIs. and providing insight into potential treatment pathways. For example, the Defense Health
Agency will be conducting a research study to analyze data from AHI patients who have been
treated in the military health system. This research protocol consists of three lines of effort: (1) a
retrospective interrogation of existing patient data; (2) a continuation of the NIH research study;
and (3) prospective studies on new AHI cases to test criteria and develop diagnostic tools. CIA
has not yet signed a Memorandum of Agreement with the Defense Health Agency allowing its
personnel’s historical data to be included in the study. Because CIA employees and other
affiliated personnel comprise an important part of AHI medical data, not including them in the
registry could significantly hamper research efforts.
DOD-s Uniformed Services University is also working to launch a “Point of Injury'’ AHI
Prospective Study. This study will be led by a team of doctors who will seek to collect medical
data on a reported AHI from any USG agency within 72 hours of an event, anywhere in the
world. This study is intended to fill a major gap in AHI clinical studies by collecting data in the
acute stage. CIA officials told Committee staff that DOD has not yet briefed them on this effort.
so CIA has not shared information with its employees about how to participate.
Finally, CIA has halted its own internal clinical research efforts related to AHIs. Specifically, the
Agency stopped promoting pre-AHI baseline medical assessments in December 2021 and
5 NIH officials told Committee staff that the study did not reflect whether the AHI population with cataracts developed those cataracts before or after experiencing an AHI; NIH officials noted that AHI participants may have had asymptomatic cataracts prior to their AHI. The study did not track the number of control patients who might have had asymptomatic cataracts. as the controls did not see an ophthalmologist during the study. However, zero control patients reported having cataracts.
8
stopped conducting post-AHI medical assessments in January 2022. As a result, CIA may be
missing out on important clinical data that could advance its understanding of AHIs.
Collectively, the research efforts discussed in this section are vital to advance the U.S
government’s understanding of, and response to, AHIs. Such research is necessary to support
the development of a case definition, identify potential diagnostic tools and treatment protocols,
develop potential countermeasures, support the IC’s broader analytic investigation, and refine
eligibility criteria for AHI-related facilitated medical care and benefits. including HAVANA Act
payments. The IC in general, and CIA in particular, should continue to support such efforts.
IV. CIA has provided benefits and compensation to many AHI reporters, but ease of access
to these programs has been inconsistent and affected by CIA’s organizational position on
AHls
CIA-affiliated AHI reporters are eligible for various benefits to help with their conditions. Some
of these–such as the Overseas Medical Benefits Program6 and the Federal Employees
Compensation act (FEC A–also known as workers’ compensation)–provide support to all USG employees, whereas others–such as the Expanded Care Program, and Agency leave policies-
are specific to CIA. CIA often utilizes Agency-specific policies and programs to supplement USG-wide programs or address a gap in these programs. However, the Committee assesses that
CIA began limiting access to certain AHI-related benefits in late 2021 and early 2022–more
than a year before the Intelligence Community Assessment was issued.
CIA modified the Overseas Medical Benefits Program to enable the use of its benefits for
overseas AHI reporters in 2017 and established a benefits program for domestic AHI reporters in
2021 to address their acute-stage medical needs.7 However, CIA only provided these benefits to
a few domestic AHI reporters before suspending the program in late 2021. It also suspended the
modifications to Overseas Medical Benefits Program in March 2022. CIA officials told
Committee staff that they could reactivate the Overseas Medical Benefits Program policy
changes and the domestic program benefits if “necessary,” although it is not clear under what
conditions they would do so. CIA also provided excused absence leave to many AHI reporters to
aid their treatment and recovery, but the Committee assesses that these leave policies were
considerably more generous for those who reported AHIs in the first foreign location than for
those AHI reporters who came after, and these policies were not well documented or
communicated.
AHI reporters are eligible to apply for Department of Labor (DOL)-administered workers
compensation. which is the U.S. government's “exclusive remedy” to provide medical care and
6 The Overseas Medical Benefits Program is a Department of State program that provides medical benefits, secondary payer benefits for out-of-pocket medical expenses for employees and eligible family members under certain conditions, and leave benefits to employees, contract employees, eligible detailees, and eligible family members injured or ill while on an overseas assignment. Under 50 U.S.C. § 3505(b)( 1 ), CIA is authorized to pay allowances and benefits comparable to those paid to members of the Foreign Service, which enables CIA to utilize the Overseas Medical Benefit Program authorities.
7 This program was an internal CIA benefits program that provided benefits analogous to the Overseas Medical Benefits Program for CIA personnel who reported AHIs domestically.
9
financial compensation to injured workers. DOL recognized that workers’ compensation was a
poor fit for AHIs given their unclear origin. but took steps to facilitate access for AHI reporters.
Specifically, DOL issued guidance to simplify the process, introduce more consistency across the
U.S. government, and ease the “burden of proof’ for applicants.8 For instance, this guidance
established that if the employing agency certified that a reported AnI occurred, or did not contest
the employee’s assertion that it occurred, then the employee was deemed to have met the Fact of
Injury-Factual element of a workers’ compensation claim.9
However, support from an employee’s home agency remains important to substantiate a
workers’ compensation claim. Yet as of December 3 1, 2023, CIA had not concurred with the
Fact of Injury-Factual element of any AHI reporters’ workers’ compensation claim since the
reports from the first foreign location, consistent with its analytic line that AHIs are very unlikely
to be attributable to a foreign adversary. Moreover, CIA has chosen to weigh in on every Fact of
Injury-Factual element of AHI reporters’ workers’ compensation claim since the reports from the
first foreign location, even though the Agency is not required to do so and many USG agencies
do not. Finally, DOL officials told Committee staff that CIA has often not provided claims
examiners access to all documentation necessary to robustly adjudicate claims. Collectively, this
resulted in AHI reporters from CIA having lower approval rates for workers’ compensation
claims than AHI reporters from other USG agencies–only 21% of CIA AHI applicants had been
approved for workers’ compensation as of December 3 1, 2023, in contrast to 67% of AHI
applicants from other USG agencies, in aggregate.
Some CIA AHI reporters with reportedly severe injuries told Committee staff that being denied
workers’ compensation has prevented them from seeking disability benefits and led them to
retire early, apply for medical disability retirement, cobble together various types of leave
(including Leave Without Pay), or work through their injuries.
8 Specifically, DOL issued FEC A Bulletin 22-03 in January 2022 with guidance to claims examiners for how to process AHI claims. See DOL, Processing Claims for Anomalous Health Incidents ( AHI) Under the Federal Etnplovees Compensation Act (FECA). FEC A Bulletin NO. 22-03 (Jan. 12, 2022).
9 in general, to substantiate a workers’ compensation claim, a claimant has to establish that they sustained a personal injury while in the performance of duty. For a claim to be accepted, it must meet five basic elements:1. Timeliness of filing. An employee generally has three years from the date of injury (for a traumatic injury)
or from the date that an employee realizes they have a workplace injury (for an occupational disease filing).
2. Individual is a federal civilian employee. Contractors and family members of USG employees are not covered under the FEC A process.
3. Fact of Injury. Fact of injury has two parts and both are required to meet the requirements of this element.i. (U) Fact of Injury-Factual. This refers to establishing that a specific injury or accident occurred.
Both the employee and the employing agency provide statements regarding the alleged injury.
ii. (U) Fact of Injury-Medical A medical condition must be diagnosed in connection with an injury. The applicant’s medical provider certifies the medical aspect of the injury.
4. Performance of Duty. This element requires that an injury and/or medical condition must have arisen during the course of employment and within the scope ofcompensable work factors. In other words, the injury is considered to have occurred for activities for which the person is employed.
5. Causal Relationship. This element requires that the Fact of Injury-Factual and Fact of Injury-Medical be causa11y related, i.e. that the work-related injury caused, aggravated, accelerated or precipitated the claimed condition. This step rules out pre-existing conditions that could explain the reported injury.
10
Because of the concerns DOL officials noted during the Committee’s review, DOL’s approach to
adjudicating CIA AHI reporters' workers' compensation claims has recently changed.
Specifically, CIA officials told Committee staff that a number of AHI reporters have been
approved for AHI workers’ compensation claims since December 3 1, 2023–the cutoff date for
this review’s quantitative data collection and analysis. A DOL official explained that DOL, in
partnership with CIA, has taken “significant steps“ to properly review and adjudicate CIA AHI
reporters- workers' compensation claims. DOL-s efforts have included offering targeted
guidance and discussion, inviting questions from CIA’s Workers Compensation Division staff
and providing “thorough, policy-backed responses“ and “enhancing the scrutiny” with which
DOL assesses CIA’s preliminary decisions.
In contrast to its position on workers’ compensation, CIA has generally made its Expanded Care
Program more accessible to AHI reporters. The original Expanded Care Program process
required applicants to provide documentation substantiating the circumstances of their injury–
which many AHI reporters told Committee staff was an impossible bar to meet, given the
unknown nature of their AHIs–and no AHI reporters other than the cohort from the first foreign
location were approved for the program under the original process. However, the new Expanded
Care Program process, which took effect in May 2023, lowered the threshold for entry, resulting
in relatively high approval rates for claims adjudicated under the revised criteria. As of
December 3 1, 2023, more CIA AHI reporters had been approved for Expanded Care Program;
all but one of these reporters have also received HA FINd Act payments.
However, AHI reporters have cited several challenges with aspects of the new Expanded Care
Program process. For example, some AHI reporters face challenges getting physicians to fill out
the Eligibility Questionnaire for Injuries to the Brain form, which is required to finalize an
Expanded Care Program application. Specifically, some AHI reporters have struggled to get their
medical providers to attest that the AHI reporter experienced a TBI or “acute onset of new,
persistent, partially or totally disabling neurologic symptoms“ demonstrated by imaging studies
or other exams and that required active medical treatment for 12 months or more. Challenges
with this form have prevented many AHI reporters from finalizing an application to the program,
and approximately 30% of all Expanded Care Program applications were pending as of
December 3 1, 2023 due, in part, to these challenges.
In addition, the Expanded Care Program’s requirement that an AHI reporter generally undergo
12 months of active medical treatment before being eligible for the Expanded Care Program
delays AHI reporters from accessing the program’s case management services, medical
reimbursement benefits, and adjustment of monthly compensation for those on workers
compensation total disability. This is a notable contrast to CIA’s handling of all other Agency
applicants to the program for conventional injuries, who can apply for the Expanded Care
Program immediately after their injury.
CIA has made good progress in implementing HA FHNH Icr authorities as compared to other
US(, agencies. Congress has recently further facilitated access by adopting a provision in the
National Defense Authorization Act .for Fiscal Year 2024 clarifying that AHI reporters do not
have to first seek workers’ compensation benefits before applying for a HA FHNH Act payment
11
and adopting another provision in the same bill enabling CIA to make more timely payments by
permitting the Agency to use reprogrammed funds to make HA r,4NH HcI payments.
Finally, the Committee found that the relationship between workers’ compensation and the
Expanded Care Program creates challenges for both CIA and AHI reporters. CIA is now in an
untenable position wherein it does not concur with the facts reported in its employees’ workers
compensation claims for an AnI, but often does approve Expanded Care program claims for the
same AHI report. The Committee recognizes that Congress likely influenced this inconsistent
policy position by encouraging CIA to implement its Expanded Care Program authorities and
issue HA F/4NH Act payments, but also notes that this inconsistency is unsustainable. Several CIA
AHI reporters told Committee staff, for instance, that they have used their Expanded Care
Program approvals to appeal their workers’ compensation denials.
V. CIA’s AHI response hampered by communication and messaging challenges
CIA’s communication about its facilitated medical care, benefit, and compensation programs
was a significant point of concern for AHI reporters. Many of the AHI reporters Committee staff
interviewed cited communication challenges related to medical care and compensation programs.
These AHI reporters told Committee staff that CIA did not consistently provide adequate and
timely information about medical care, benefits, and compensation programs, which the
Committee assesses is due, in part, to frequent changes in programs. AHI reporters also
expressed concern about a lack of proactive and timely communication from case managers,
difficulty getting information in writing, and unclear and potentially misleading communications
about the NIH study. among other things. Additionally, the Committee assesses that CIA’s
failure to establish clear and consistent referral policies for facilitated care programs hindered its
ability to transparently communicate with AHI reporters about these programs and who was
eligible. In-the absence of sufficient official communication from CIA, AHI reporters filled the
void with information gained through informal AHI support networks–but this information was
not always accurate. As a result of these challenges, some AHI reporters experienced delayed or denied access to facilitated care programs, inconsistent access to benefits due to ad hoc decision-
making at many levels of the Agency, confusion or reluctance to apply for compensation programs, and increased stress and frustration, among other issues.
More broadly, CIA has struggled with messaging around AHIs as its organizational position
evolved from the original “attack“ narrative–which CIA officials later said harmed the AHI
population by leading people to believe that their disparate health conditions were attributable to
a foreign adversary–to its current position, based on the March 2023 Intelligence Community
Assessment, that it is “very unlikely“ that a foreign adversary is responsible for AHIs and that
most AHls are likejy the result of medical. social, and environmental factors. While the attack
narrative began as a hypothesis asserted by AHI reporters and those who responded to the initial
AHI reports, and then echoed by the media and senior leaders, CIA initially took several actions
that cemented this framing and that continue to have ripple effects even now. CIA medical
officers told Committee staff that, looking back, they did not believe that the illnesses of the first
12
cohort of AHI reporters were psychogenic. but they acknowledged that the attack framing led
people to believe that their disparate health issues were part of a coordinated attack.
In 2021, officials from CIA’s AHI cell that was investigating AHIs said that they were charged
with the task of overcoming the significant “anchoring and confirmation bias” lingering from the
early attack and subsequent TBI narratives, and noted that this bias had affected the workforce
and influenced congressional overseers and the general public. Since then, CIA has taken various
steps to signal to the workforce that its original attack narrative was incorrect, including its
analytic conclusions as expressed in the March 2023 Intelligence Community Assessment.
Several CIA AHI reporters said that they viewed these steps as CIA trying to “close the book on
AHIs
This report does not assess the veracity of either narrative, and the Committee recognizes that
some evolution is to be expected given the nature of the incidents. However, the Committee
assesses that CIA's communication about the incidents was often reactionary and poorly
coordinated, resulting in portions of its workforce becoming polarized, emotional, and
distrustful. The Committee also assesses that CIA bears much of the responsibility for these
communication challenges, as the Agency failed at many turns to develop a clear, coordinated.
and consistent policy for communicating on this topic with its workforce. Moreover, CIA has
never undertaken a comprehensive organizational review of its communications and messaging
on the AHI issue, including how they have affected the workforce. The findings of such a review
could prove useful in addressing some of the harm that has been done to the workforce related to
AHIs and in better preparing CIA for future scenarios in which the Agency has to communicate
with its workforce about an ambiguous and/or emotionally-charged topic.
VI. CIA’s response to AHIs has negatively affected AHI reporters and led to a trust deficit
with portions of its workforce
The Committee assesses that CIA’s response to AHIs has had negative effects on the morale and
wellbeing of many AHI reporters and has contributed to a trust deficit between CIA and portions
of its workforce. Specifically, the Committee assesses that there were tensions between the AHI
cell’s role investigating the source of AHIs and the role it played adjudicating requests for
medical care and/or benefits. For example, CIA’s analysis disconnrming the “attack” hypothesis
coincided with, and in some cases influenced. the availability of medical treatment and certain
compensation benefits. Unlike at many other USG agencies, CIA’s counterintelligence analysts
were given a voice in processes that informed care and benefit decisions. The Committee
assesses that, since CIA’s analytic position is that it is “very unlikely-- that a foreign adversary is
responsible for reported AHIs, then counterintelligence analysts’ involvement in such
determinations has made it difficult at times for AHI reporters’ claims to be adjudicated on their
individual merits.
Additionally, many AHI reporters experienced a significant moral injury as a result of how they
perceived CIA’s treatment of them. Medical providers who Committee staff spoke with from
each of the facilitated medical treatment facilities raised this issue and noted its effect on
13
patients’ recoveries, including patients’ increased stress about not being believed and feeling that
they had to advocate for themselves.
Distrust of CIA has been a common theme among AHI reporters the Committee interviewed.
Many of the AHI reporters with whom Committee staff spoke for this review expressed some
degree of distrust of the Agency, including some who perceived that their career was negatively
impacted for reporting an AHI or seeking support related to their AHI. AHI reporters’ distrust
took many forms. For example, many AHI reporters who spoke to Committee staff did not trust
CIA to act toward them in good faith, which led to them frequently question the motives behind
CIA's actions. This distrust was further reinforced by poor communication and a lack of
transparency. AHI reporters’ distrust also stemmed from their concerns that CIA’s analytic effort
on AHls has not been objective. More than a dozen individuals who spoke to Committee staff
questioned the objectivity of CIA’s analytic line on AHIs, its analytic tradecraft, or the
soundness of its findings. Finally, AHI reporters have also cited “stigma” or fear associated with
reporting or talking about AHIs, which could have a chilling effect on future AHI reporting. The
Committee assesses that (_’IA could benefit from an examination of how its response to AHIs has
impacted its workforce, to include issues of morale and trust.
CONCLUSIONS
As noted throughout this report, AHIs are a vexing problem that defy an easy solution. This
Committee recognizes that the uncertainty surrounding AHIs created a challenging environment
for the U.S. government in general and the CIA in particular to operate in–both in terms of
intelligence collection and analysis and in caring for affected personnel. CIA deserves credit for
standing up facilitated medical care and benefit programs under these conditions.
While the ic has assessed that it is “very unlikely” or “unlikely“ that AHIs are attributable to
foreign adversary attac.ks9 there remain many unanswered questions about these incidents given
information and research gaps. Moreover, U.S. adversaries are likely developing directed energy
technologies that may plausibly explain some of the reported SYmptoms commonIY associated
with AHls. Finally9 USG personnel do continue to report AHIs–though at a much lower rate
than in 2021.
Given all this9 the Committee’s position is that the IC must remain objective and must continue
to actively collect intelligence: conduct analysis, and pursue information that could shed light on
AHI reports in general and foreign adversary emerging technologies, to include directed energy
weapons in particular. us(, agencies and laboratories should also continue research to both (1 )
understand emerging technologies that could produce the signs and symptoms described by AHI
reporters and (2) identify potential biological markers of AHIs. The IC should fully support these
research efforts.
It can take years or even decades for some medical mysteries–such as Gulf War Syndrome or
the health effects of Agent Orange–to be solved. This Committee does not want the IC to repeat
previous US(, mistakes of withholding medical care and other support because it does not yet
fully understand the mysterious health conditions its personnel are reporting. Thus, this
Committee urges CIA to maintain access to facilitated medical care and benefit programs for
14
employees and other affiliated personnel who have reported an AHI previously or who may
report an AHI in the future–regardless of its current analytic line–and to adopt several guiding
principles while doing so :
1. Good program management best practices–identify clear eligibility criteria for
programs and document policies and procedures, and develop robust and consistent
record-keeping protocols;
2. Mitigate potential tensions between CIA’s intelligence collection and analytic
responsibilities and its responsibility to care for its workforce–given all that remains
unknown about AHIs, err on the side of caution and defer to an AHI reporter’s account
of their incident unless CIA has definitive evidence to the contrary. consistent with other
USG agencies’ handling of AHI reports; create reasonable firewalls between CIA's
intelligence collection and analytic investigation into AHIs and its handling of
employees’ individual AHI reports;
3. Equity and consistency–ensure AHI reporters have similar access to benefit programs
such as workers’ compensation and Expanded Care Program that other CIA employees
and affiliated personnel enjoy, and that they have access regardless of location or other
variables; and
4. Transparency with the workforce–communicate clearly and frequently to bolster trust
and improve morale.
The Committee is making numerous specific recommendations to CIA in response to its findings
in this report and that are rooted in these guiding principles.
Finally, the Committee wants to emphasize that CIA’s facilitated medical care and benefit
programs need not be locked in stone. As the U.S. government learns more about AHls, CIA can
and should modify both the programs and benefits offered as well as the eligibility criteria and
application processes for those programs. In the meantime, as research continues, the IC must err
on the side of providing more facilitated medical care and support to it employees and other affIliated personnel rather than less. This should be the default position for all of CIA’s AHI-related efforts.
RECOMMENDATIONS FOR CIA
1 CIA should develop written policies for medical care and benefit programs associated with
AHIs and other counterintelligence-related health incidents that include clear eligibility
criteria and adjudication processes for determining how access to such programs will be
provided to individuals who seek these benefits. These policies should be made available to
CIA employees and the congressional intelligence committees. As research into AHIs
progresses, CIA should periodically review these policies to ensure that these benefit
programs and the criteria used to determine eligibility reflect the U.S. government’s latest
understanding of AHIs. Specifically :
a. CIA should develop a written policy for how it will provide access to facilitated medical care programs for those with reported AHIs or other counterintelligence-
15
related health incidents that clearly details the criteria9 evaluations9 and processes that
CIA will use to make such determinations.
b. CIA should develop a written policy that details the Overseas Medical Benefit
Program benefits that are available to AHI reporters or others affected by
counterintelligence-related health incidents, including the:i. circumstances under which the Overseas Medical Benefit Program policy
modifications that were previously made for AHI reporters will again take
effect; and
ii. criteria and processes that CIA will use to determine who is eligible for
Overseas Medical Benefit Program benefits related to AHls or other
counterintelligence-related health incidents.
c. CIA should develop a written policy that details the benefits that are available to
domestic AHI reporters, including the criteria and processes that CIA will use to
determine who is eligible for such benefits.
d. CIA should develop a written leave policy specific to individuals affected by AHIs or
other counterintelligence health incidents that details the types and amounts of leave
available to individuals affected by such incidents for treatment and recovery>
including the criteria and processes that CIA will use in making determinations about
who is eligible and details regarding how such leave can be used.
2. CIA should conduct a comprehensive organizational assessment of CIA’s response to
reported AHIs to identify lessons learned, best practices. areas of challenge, effects on the
workforce, and actions needed to better prepare the organization to respond to future threats
to the workforce. The results of this review should be made available to CIA employees and
to the congressional intelligence committees. Specific focus areas of this review should
include:
a. CIA’s medical response to AHIs and associated support provided to AHI reporters;
b. CIA’s communication with AHI reporters about care and benefit programs;
c. CIA’s messaging to the workforce about AHls; and,
d. AHI-related workforce impact, morale, and trust.
3. CIA’s Center for Global Health Services should develop and document a comprehensive and
resource-informed plan for how it will provide, facilitate, and/or support medical evaluations
and acute and long-term care for individuals affected by AHIs or counterintelligence-related
health incidents, including contingency plans for responding to clusters or other larger-scale
incidents. This plan should also consider additional actions CIA could take to facilitate
communication between AHI reporters and their private medical providers. This plan should
be informed by CIA’s policies for counterintelligence-related incidents, including AHIs, and
comprehensive internal review, and be provided to the congressional intelligence
cornmrttees.
4. CIA should establish a voluntary baseline evaluation for AHIs and other counterintelligence-
related health incidents that includes relevant biomarkers and is integrated into its entry-on-
duty and permanent change-of-station medical exams. The data from these evaluations
16
should become part of the individual’s medical file for their personal clinical reference. Data
could also be used to support ongoing research efforts (with individual consent). CIA should
update these baseline exams as the U.S. government learns more about conditions associated
with AHls or other counterintelligence-related health incidents, including the relevant
biomarkers.
5. CIA should re-establish and offer a standard post-AHI evaluation to all AHI reporters who
request one. This evaluation should be aligned to the baseline evaluation for comparative
data purposes. The data from these evaluations should become part of the individual’s
medical file for their personal clinical reference. Data could also be used to support ongoing
research efforts (with individual consent). CIA should update these post-AHI evaluations as
the U.S. government learns more about conditions associated with AHIs, including the
relevant biornarkers.
6. CIA should establish a Memorandum of Agreement with the Defense Health Agency to
enable CIA-affiliated personnel to voluntarily provide their medical data to DOD to support
its AHI-related research–including, but not limited to, the Joint Trauma Registry.
7. CIA should develop written policies, procedures, and criteria for informing and referring
willing CIA-affiliated personnel who report an AHI through Agency channels to USG
research efforts into AHIs, such as DOD-s “Point of Injury” AHI Prospective Study or any
other USG study.
8. Given the unknown nature of AHIs and consistent with the practice of several other USG
agencies, CIA should adopt a more neutral policy regarding its Fact of Injury-Factual input
for AHI-related workers’ compensation claims. This could include adopting a policy of not
weighing in on the Fact of Injury-Factual component of the claim unless CIA has definitive
evidence that a reported AHI is due to pre-existing or naturally occurring medical conditions
or environmental factors.
9. (,-IA should revise Expanded Care Program regulations to enable CIA-affiliated individuals
to immediately apply to the program after experiencing an AHI in order for them to access
case management services, secondary medical payer benefits, and adjustment of monthly
compensation for those on workers’ compensation total disability, and then subsequently
apply for a HA rANd Act payment after 12 months of treatment if the individual meets the
criteria for a “qualifying injury to the brain” at that time.
10. CIA should develop a comprehensive, consolidated, and easily accessible listing of AHI-
related care and benefit programs that CIA employees and contractors may be eligible for,
including links to related policies, points of contact, frequently asked questions by program,
and any other additional information needed for the individuals to access these programs.
a. Within the information pertaining to workers’ compensation, CIA should make clear
to all employees that they do not have to have experienced an AHI in a government
facility to be eligible to apply for workers’ compensation benefits.
17
b. Within the information pertaining to Expanded Care Program, CIA should clearly
communicate to applicants that all diagnostic codes pertaining to their AHI must be
listed on the application form, and that they are able to submit application forms from
more than one physician.
11. CIA should develop an unclassified, comprehensive, and consolidated packet of materials for
dependents. former employees and contractors, and any other individual without access to
CIA's internal system that provides information about the AHI-related care and benefit
programs that they may be eligible for, including related policies, cover-consistent points of
contact, frequently asked questions by program, and any other additional information needed
for the individuals to access these programs.
POTENTIAL ACTIONS FOR CONGRESSIONAL CONSIDERATION
1. Congress could consider codifying into law the two FEC A bulletins pertaining to AHI-
related claims–specifically FEC A Bulletin 22-03 and FEC A Bulletin 24-04–to ensure the guidance facilitating access to workers- compensation for AHI reporters cannot be easily revoked.
2. Congress could consider amending Expanded Care Program authorities to enable CIA
employees to bypass workers' compensation and apply directly to Expanded Care Program
for AHI-related medical conditions.
3. Congress could consider amending Expanded Care Program authorities to enable CIA to
provide an adjustment of monthly compensation for CIA-affiliated personnel who are
deemed totally disabled in connection with their AHI under the auspices of any federal
disability program, including workers’ compensation, medical disability retirement, and
Social Security.
No comments:
Post a Comment