The Updated Abridged Diagnostic Guidance for Doctors and Patients: The Havana Syndrome and its AHIs, Version 2.0

Replaces the Guidance Published on November 10, 2024

What This Guidance is Not. This is not a description of symptoms and complaints associated with “Havana Syndrome” and its Anomalous Health Incidents (AHIs). Every patient is encouraged to write down their complaints, their occurrence, and any other other characteristics of your experience honestly and accurately. We understand that many physicians are still not informed about this condition (or not informed properly), and that you might have to take on the role of an educator, or move onto a physician who is informed.

How to Approach a Physician re. Getting Diagnosed Properly. I strongly advise you not to ask a physician for a specific diagnosis. This is not a good strategy. What you should ask for is to make a correct diagnosis. You can also ask a physician to differentiate your complaints and findings with the effects of Exposure to Direct Pulsed EM Energy (not weapons! because your doctor is not a weapons specialist!). If this is not on the “menu” of differential diagnoses, ask to to include it.

When You Receive a Diagnosis That is Not What You Were Expecting, ask doctor how specifically the diagnosis was made, and how it was differentiated with other conditions including Exposure to Direct Pulsed EM Energy. This is the conversation every patient deserves to have, and the doctor must walk you through the diagnostic process. Only then you have a chance to have a proper conversation, and having a correct diagnosis.

1. Write down the symptoms you are experiencing for your physicians. Don’t rely on your memory.

2. If you are experiencing acute attacks (aka AHI, or Anomalous Health Incidents) describe them separately from the complaints present when you are not experiencing acute episodes (2019 CDC report describes “Havana Syndrome” as a bi-phasic disorder, with Initial phase, and Secondary Phase).

   1. It is important to describe how complaints are connected: are they occurring suddenly? simultaneously? Do you have a sense of directionality during this attack (for example, if you hear a sound, can you tell which direction it is coming from)?

   2. If you are experiencing vibrating pressure, describe it in details, - where do you feel it, what’s the intensity, and whether you can tolerate it. Sensation of vibrating pressure is called buffeting. It is uniquely linked to the exposure to EM pulses when no mechanical source is present.

   3. If you are experiencing sudden attacks, describe duration of the attacks and how often they occur, where you experience them, and whether moving to another location disrupts the attack.

3. Describe how you feel when you are not experience attacks. Do you have balance issues, hearing problems, vision issues, headache, problem concentrating and remembering, etc.?

4. If you start your diagnostic journey with a general practitioner, you need to discuss diagnostic criteria as described in Hoffer 2018.

   1. Draw physician’s attention to the fact that “Havana Syndrome” is a novel medical condition because the symptoms occur simultaneously, and with a sense of directionality.

   2. Four Core Characteristics of AHIs are detailed in the Intelligence Community Expert Panel Assessment, September 2022.

   3. General practitioner should also check for signs of concussion (although “Havana Syndrome” is not a physical trauma, but rather a non-kinetic form of brain injury due to pulses of EM energy).

   4. Blood can be checked for biomarkers of the cellular damage to the neurons and damage to the Blood-Brain Barrier (BBB) such as neurofilament light chain (NfL) protein, glial fibrillary acidic protein (GFAP), and Ubiquitin C-terminal hydrolase L1 (UCH-L1). These markers are significantly elevated after a non-kinetic attack (or concussion), and change over time.

   5. Measuring for biomarkers of inflammation and glutathione in the blood could be indicative of EM assault, however, these tests are non-specific and found in many chronic inflammatory conditions.

5. Your next stop should be a visit to otoneurologist (or neurootologist) often called a dizziness doctor, or dizzy doc. This is where validation begins. Specific vestibular (balance) tests , and how they need to be evaluated, are described in Hoffer, 2018.

6. Visit to a neurologist should also entail, among other things:

   1. Checking for signs of concussion. Signs of concussion may be present, even though the symptoms are experienced without a mechanical trauma to the head.

   2. Discussing results of testing for blood biomarkers of neuronal damage (after an attack, and over time).

   3. Neuro-psychological evaluation can be utilized in order to assess the degree and the pattern of cognitive impairment, when present.

   4. fMRI DTI (Diffusion Tension imaging) can be utilized. Using this method, researchers at UPenn detected statistically significant difference in white matter tracks among AHI victims versus control (JAMA 2019). Neurologist might be aware of the more recent NIH study published on the same topic (JAMA 2024). Please, inform your neurologist that the study is under investigation due to unethical coercion of patients into the clinical trial that skewed the results, making the conclusion of the study invalid (“NIH Cancels ‘Havana Syndrome’ Research”, CNN, 2024)

   5. qEEG with swLoreta is an electric neuroimaging method that can show disruption in neural networks of the brain directly (as opposed to indirectly, as in fMRI DTI). This is a supporting method. It is not required for establishing the diagnosis of“Havana Syndrome”: https://www.targetedjustice.com/qeeg.html

7. Considering the nature of the condition you might be sent to a neurologist who specializes in Brain Injuries. You must communicate that the nature of your potential injury is non-kinetic. Brain Injury is almost entirely associated with concussion which is a kinetic form of injury.
   
   To summarize, diagnostic criteria for “Havana Syndrome” and it AHIs are best described in Hoffer, 2018. Four Core Characteristics are described in the Intelligence Community Expert Panel Assessment, September 2022. Supporting methods collated from multiple source, are described in this abridged guidance, as above.

   
   DOD has its own diagnostic form (DHA 244) which is not freely available to the general public, or civilian physicians. There is no information available of how the form has been validated.
   
   “Havana Syndrome” is not found in the ICD-10 (International Classification of Diseases). Best description of this condition is NKBI (Non-Kinetic Brain Injury). Although NKBI is not in the current classification, efforts are being made to add it to the next edition of the ICD.
   
   At this time, the following disease codes could be used (A and B for Acute Events, C and D for chronic condition):

   A. S06.9*** - Acute Brain/intracranial injury, other, Unspecified, without loss of consciousness

   B. S06.89** - Acute Brain/Intracranial Injury, Other, Specified as non-kinetic

   C. G93.40** - Chronic Encephalopathy, Unspecified.

   D. G93.49** - Chronic Encephalopathy, Specified as non-kinetic.

Using these codes in conjunction with “Havana Syndrome” diagnosis is important for proper tracking and analysis of this novel condition by your Health Department, and the CDC. To address inconsistencies in “Havana Syndrome” reporting, a Civilian Registry has been created by Targeted Justice. If you are diagnosed by a physician, you are encouraged to submit your case to CivilianRegistry@protonmail.com

For more detailed information, including a list of physicians known to diagnose and differentiate this condition please visit https://www.targetedjustice.com/dr-len-ber-md.html

At the time of writing this guidance, the list consists of

1. Dr. Michael E. Hoffer, MD. Department of Otolaryngology, University of Miami. 1120 NW 14th St floor 5
   Miami FL 33136 ; Phone ‭(305) 243-3564‬

2. Lydia Shajenko, MD. 725 River Road, Suite 55, Edgewater, NJ 07020. Phone: (210) 679-8485; e-mail a.clinical@gmail.com

3. Drs. Jennifer Eichert, Au.D. and Howard T. Mango, Au.D., Ph.D. Newport-Mesa Audiology Balance and Ear Institute, CA. Website: www.dizziland.com Phone (949) 274-8399

4. Edmund Grant, MD - Neurologist, 13801 Bruce B Downs Blvd Suit 401, Tampa, FL, 33613, Phone ‭(813) 971-8811‬

And finally, here is a list of additional papers, presentations and Reports that I generated in connection with the diagnostic guidance that you and your physician might find useful:

1. Presentation at the 12th Global Forensic Webinar, November 2024 https://www.researchgate.net/publication/386134936

2. Article in a peer-reviewed journal, AMS, Feb 2025 https://www.researchgate.net/publication/387291365

3. The Civilian Registry Report, January 2025 https://www.researchgate.net/publication/387759199