The Defense Department has a mandate to look into the consequences of troops’ exposure to blasts from shoulder-fired weapons, after a 2018 study suggested that repeated impact can cause traumatic brain injuries, and all of the consequences that go along with them.

Research shows that even mild traumatic brain injury can increase aggression and impulsivity, a dangerous mix for troops already dealing with all of the stressors that come with serving. The hope is to develop processes for education and testing on the ground, so that any issues are prevented or dealt with as early on as possible.

But that will be complicated, officials told Military Times on Tuesday, because of the difficulty in tracking and treating invisible injuries.

“Just as you go into the doctor to get your cholesterol check, or for spot checks, we’re going to check your brain as well,” Jane Horton, a senior adviser to the defense undersecretary for personnel and readiness.

Last year, the Center for a New American Security released a report finding that shoulder-fired weapons cause small brain injuries, which can compound over time.

The study also found that these types of injuries are widely under-reported, because of the stigma associated with an invisible injury.

Congress responded by putting a provision in that year’s defense authorization bill requiring the Pentagon to study the effects of shoulder-fired weapons on the brain, and to document service members’ exposure for future reference and study.

These insidious kinds of injuries aren’t just a medical readiness issue, Horton said, but could affect how troops operate in combat.

“A lot of times people think, again the future of warfare is heavy weaponry," she said. "But it’s actually out-thinking, out-smarting the enemy.”

The program they are putting together, she said, will also have more of an operational than a medical goal.

“We want the commanders to be the ones who are actually leading this and telling their service members that this is important,” she said.

Research is focusing particularly on the special operations community, Horton said, building off of work Special Operations Command has already been doing on blast exposure.

Some leaders, like deputy SOCOM commander Adm. Tim Szymanski, have already volunteered to take time off and be evaluated the National Intrepid Center of Excellence in Bethesda, Maryland, she added.

‘Some pretty unsavory incidents’

During the Battle of Raqqa in 2017, the senior enlisted adviser to the chairman of the Joint Chiefs of Staff visited some special operations units who were teamed up with the Syria Democratic Forces to take the city back from ISIS.

There wasn’t a quiet moment in the six hours he was on the ground, Command Sgt. Maj. John Troxell said, remembering the constant outgoing mortar, artillery and rocket fire.

“Who is going to look at those warriors after they’ve been exposed to that constant pounding and blasts?” he said. “And then, over the long haul … how does that morph and show up in the mental health aspect?”

Special operators make a good test population, Troxell said, because of the nature of their work and the frequency with which they’re exposed to blasts both in training and downrange.

The Pentagon is also sharing its discoveries with partner nations, who have both spent nearly two decades deploying to the Middle East and are dealing with the same sorts of reluctance to find out something’s wrong.

“When you come from quite stoic warrior cultures – indigenous Maori, Viking, Celts – it’s quite hard to make yourself vulnerable,” Warrant Officer Class One Mark Mortiboy, the New Zealand Defence Force’s senior enlisted adviser, told Military Times.

And in the United Kingdom, where research and programs for troops grappling with post-traumatic stress are still in their early stages, they’re looking for answers on the connection between brain health and behavioral health.

“Mental health wasn’t really talked about until about 15 years into Afghanistan,” Warrant Officer Class One Glenn Haughton, the UK’s top enlisted adviser, said.

It’s already well known that lack of sleep and nutrition while deployed can wreak havoc, Mortiboy added.

“The cumulative effects of that have led to some pretty unsavory incidents, and poor decision making, bad target recognition,” he said.

Throwing in long-simmering brain damage adds another dimension.

As efforts to study brain health have gotten underway, both the Navy and Army’s spec ops organizations have launched internal reviews over the past year or so, and the total SOCOM organization was due in October to wrap up a second wide-reaching review in the same amount of time.

Good order and discipline has been at the tip of senior officials’ and lawmakers tongues this year, as more incidents of misconduct downrange came to light and President Trump sought clemency for three service members ― two convicted of war crimes and one scheduled for trial.

Defense Secretary Mark Esper has ordered a department-wide review of battlefield ethics and professionalism, he told reporters in November, to make sure that training on conduct is sufficient, and allegations are properly handled and adjudicated.

Putting programs in place is one part of the effort to understand brain health, Horton said. but outreach and education will be just as important.

Not only is there a stigma attached to getting help for injuries you can’t see, there is a fear of damaging your career because of it.

"Our service members see their friends that were next to them, to their right and to their left, who may have lost a limb or some other injury – and so they discredit, ‘Hey, I may have a head injury,’ " Horton said.

And though it’s unusual for someone to be taken out of training or off of a deployment schedule because they’e gotten checked out, she said, the perception that they will be is still strong.

It’s better to get checked out sooner, she said, rather than later, after the wheels are already falling off.

Meghann Myers is the Pentagon bureau chief at Military Times. She covers operations, policy, personnel, leadership and other issues affecting service members.

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