Military health leaders updated the Senate Armed Services Committee on the Department of Defense’s traumatic brain injury and blast exposure state of research and practice during a hearing on Feb. 28.
Dr. Lester Martínez-López, assistant secretary of defense for health affairs; Kathy Lee, director of the Warfighter Brain Health Initiative, or WBHI; and U.S. Navy Captain (Dr.) Carlos Williams, director of the Defense Health Agency’s National Intrepid Center of Excellence, outlined the latest updates to the SASC personnel subcommittee.
The WBHI began executing in June 2022 to improve TBI research, speed the development of therapies to treat TBI, and enable the DOD to better track and prevent blast pressure exposure. Military Health System news about the WBHI is available on the Warfighter Brain Health Hub.
DOD gives the highest priority to researching the impacts of TBI and blast overpressure exposure on service members and translating methods into practice through a joint effort between military operational and medical forces. Martínez described this process as iterative and agile.
“We recognize, however, that more research and insight is needed in both the care and research dimensions to better understand the risk, how to protect warfighters, and how to treat brain injuries more effectively,” he said. “We look at how to refine for broader effectiveness when they do not work as expected, review why, and modify them to invest in research to advance alternative solutions.”
“We communicate these insights not because we believe they are a full, foolproof solution, but rather enable collective action through shared knowledge,” Martínez said. “We seek to integrate solutions for the future as we provide recommendations to inform and affect change to safety, doctrine, and policy.”
The DOD panel answered a number of questions about DOD policies on brain health protections and care as part of the WBHI, including:
- Starting baseline cognitive assessments once recruits are accepted into the military but haven’t yet begun training, which will expand this summer
- Standardized cognitive assessments at precise intervals over the course of one’s military career
- Guidelines to the number of weapons rounds to avoid unnecessary brain exposures to blast overpressure
- More emphasis on weapons manufacturers building in blast overpressure exposure thresholds
- Learning more about the length of time to rest post--mild TBI, or concussion) from weapons fired by service members
- Updates to the Nov. 4, 2022, interim guidance DOD memo on a maximum allowable blast overpressure exposure limit of 4 pounds per square inch with more instructions to protect service members
- Business-case analysis of blast monitoring
- Off-the-shelf wearables pilot for blast gauges
- Investigating symptom-based reporting of TBI
The WBHI and DOD “absolutely think it's imperative that we have an allowable number of rounds for all the weapons systems that are commonly used, so that we can avoid unnecessary blast exposure in our service members,” Lee said. In 2022, DOD directed developing rounds limits for each weapon system.
“We believe that this also gives us an opportunity to be able to ensure the usage is correct with regard to proximity, stand-off distances, and all those safety pieces can come together. Our policies are moving in that direction to be able to protect the brain,” she stated. Lee noted round limitation measurement has been measured with hearing damage historically. “However, we are looking at what the brain effects are and will follow suit with our policies.”
NICoE’s Williams said measuring and treating TBI requires “precision medicine” and “targeted therapy” individualized to each service member.
“That's one of the things that we want to look at, is looking at what type of modalities are out there that can be developed to allow a patient to focus on their individual symptoms. But we have to know what that baseline is first for that individual ... each person is different.” As DOD and NICoE continue to do research, “I think we can get there soon,” Williams suggested.
Personnel Subcommittee Chair Sen. Elizabeth Warren concluded the DOD panel, saying, “The Department of Defense needs to do better. We need to identify those who are most at risk for TBI because of the particular work they do. We need to collect better data. We need to do all of this on a much faster timetable. Congress also needs to do better. We need to make sure that you have the resources to do your work.”
Partners Seeking Better Outcomes
Before the DOD panel, the subcommittee heard from a group representing nonprofit organizations, associations, and advocates committed to improving brain health in the military population. They testified on gaps in research, neurological and other physiological effects of TBI, ongoing research, and the significance of partnering with the DOD.
Frank Larkin, a military veteran and chief operating officer of Troops First Foundation, a national advocacy group for military suicide prevention and brain trauma research, addressed the brain health and mental health aspects of TBI and blast exposure.
“Blast exposure is a key threat to warrior brain health and potentially represents a significant national security threat to our force readiness and resiliency,” he said.
Larkin is a former U.S. Navy SEAL. His son Ryan, also a U.S. Navy SEAL, died by suicide.
During the hearing, Lee, the DOD’s WBHI’s director, praised Larkin as one of a concerned family of people working to protect and care for service members.
“We're a family and we're going to take care of you, Mr. Larkin, as part of our team. We're all in this together with the same mission to take care of our people and take care of service members that make that sacrifice."
Prepared Testimony and Hearing Video