Decoupling Diagnosis from Attribution: A Path Forward for Civilian Havana Syndrome Victims

Since its emergence in 2016 among U.S. diplomats in Cuba, Havana Syndrome/Anomalous Health Incidents (AHIs) has sparked intense debate regarding medical findings, causal mechanism, and intelligence attribution.

Intelligence attribution has been a key hindering factor for the recognition of the diagnosis by the US Government, serving as an excuse to ignore diagnosed cases, and a reason to push them into the psychogenic category. This challenge has been addressed by identifying genuine validated AHI1 cases in the 2024 NIH study (different from AHI2 cases that lack neuro-vestibular validation using Hoffer 2018 criteria). Further, our re-analysis of the NIH data reveals subtle but consistent brain changes in AHI1 patients, strengthening the case for a real diffuse brain injury syndrome.

The AHI1 phenotype, defined by Hoffer et al. (2018) based on the original Havana cohort, includes objective neuro-vestibular deficits: ocular-motor abnormalities (e.g., convergence insufficiency, impaired anti-saccades) and vestibulo-ocular reflex impairments, often with otolith dysfunction in nearly 100% of cases. These findings rule out pure psychogenesis and distinguish AHI1 from AHI2 (non-specific symptoms without objective markers).

Further elucidating the AHI1 phenotype, Balaban et al. (2020) identified distinctive convergence eye movements in Havana Syndrome patients, revealing a novel and unique pattern separable from classic mild traumatic brain injury (mTBI), and from psychogenic explanations.

Neuroimaging supports this: Verma et al. (2019) found reduced white-matter volume, microstructural changes, and salience network hypoconnectivity in AHI1 cases [8]. Our re-analysis of the 2024 NIH study focusing on 43 AHI1 patients vs. 48 controls confirms reduced functional connectivity in the salience network (adjusted p ≈ 0.02) and trend-level white-matter alterations (e.g., 2-3% lower return-to-axis probability in corpus callosum).

Civilian Registry documents similar patterns in diagnosed U.S. residents, with incidents on domestic soil. Yet, without an Intelligence stamp of approval on the attribution, they are simply dismissed. This brings us to the need for decoupling of the medical diagnosis of Havana Syndrome/AHI1 from the attribution discussions. Not because attribution is not important, but because it hinders medical inquiry into a genuine novel neurological threat.

Decoupling aligns with medical ethics, public health needs, and scientific integrity priorities in the following ways:

1. Ethical Imperative: Patient-Centered Care. Diagnosis should prioritize clinical evidence over external validation. Requiring attribution forces victims (especially civilians) to prove who, how, and why they were attacked, which is inconceivable for technology that doesn’t require line-of-sight. Decoupling allows physicians to confidently use Hoffer’s criteria (oculomotor/otolithic), qEEG, or MRI connectivity metrics for differential diagnosis. Patients diagnosed with objective deficits should not be exposed to gaslighting which comes with questioning attribution, especially when Intelligence Agencies demonstrated time after time that they are unqualified to answer attribution questions.

2. Improved Access and Ending Discrimination. Federal employees access the DOD-implemented AHI Registry and compensation via the HAVANA Act and Department of Labor bulletin, but civilians do not. Both treat verified AHI as a form of TBI (although diverging from classic mTBI). CDC guidance is all over the place - from the 2019 FOIA-released Report hinting on brain injury in the initial cases to the 2022 FOIA-released but completely classified internal guidance, to an official response that Havana syndrome is “out of scope” for CDC. Decoupling would enable CDC to issue public criteria, reporting pathways, properly track diagnosed civilian cases, and end blatant and irresponsible discrimination that exists between federal employees (and their dependents) and their civilian counterparts whose diagnoses were made using precisely the same criteria. Reminder: none of the medical diagnoses of diplomats included questions of attribution. Attribution questions have always been treated outside of clinical findings and differential diagnosis framework.

3. Scientific Advancement Attribution debates stifled research into the syndrome. The 2024 NIH study was halted due to coercion, highlighting how intelligence priorities contaminated medical efforts. Decoupling would allow truly independent studies to take place, concentrating on already established AHI1 findings, including civilians, and focusing on salience network hypoconnectivy, corpus callossum and cerebellum regions, without classified constraints.

4. Public Health Response AHI1 cases represent a novel non-kinetic diffuse brain injury pattern (different from classic mTBI) aligned with pulsed RF exposure causation, independent of how or who enabled such exposure. Decoupling will allow CDC/NIH to deem it as reportable diagnosis, issuing advisories. Our 2025 petitions to CDC/NIH demand this.

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TL;DR: Havana Syndrome, or Anomalous Health Incidents (AHIs), represents a distinct clinical phenotype characterized by acute neurological symptoms followed by chronic deficits. Despite mounting evidence of objective brain changes in validated cases (AHI1), diagnosis remains entangled with intelligence efforts to attribute actors. This coupling hinders medical progress, denies care to victims, and perpetuates controversy. We advocate for decoupling: Medical diagnosis should rely solely on clinical criteria, independent of attribution.

• Classified barriers must not eclipse medical/clinical truth.

• Clinical evidence supports a genuine syndrome irrespective of attribution.

• Intelligence meddling, exemplified by flawed assessments, internal splits, and contradictory statements, perpetuates the “psychogenic explanation” where it has been excluded.