WASHINGTON, DC — While traumatic brain injury (TBI) and its impact on the lives of servicemembers and veterans have received considerable attention, most of that attention has focused on TBIs incurred during combat.
An unknown but considerable number of TBI cases are received not from explosions in combat but from the blast overpressure yielded by firing large weapons, however, including those fired in training, according to a new report. This overpressure can have an accumulated impact over time, resulting in brain injury that can easily go unrecognized.
According to a RAND Corp. study, servicemembers can be in danger of developing a TBI even when firing weapons within their recommended limits. The study found that up to 32% of blasts experienced by breaching instructors exceeded the recommended exposure limit.
“There remains a lack of evidence linking repeated exposure to injury,” explained Samantha McBirney, PhD, a RAND policy analyst, at a Senate Armed Services Subcommittee on Personnel hearing recently. “One reason for this is the difficulty of diagnosis. The nature of low-level blast exposure and the fact that it is not one single event that causes an issue. [That] complicates injury recognition. Symptoms typically do not manifest immediately. Additionally, injury is vastly underreported among servicemembers.”
There also is a lack of research into which occupational specialties are at greatest risk, she added, suggesting that some specialties, such as breachers and munitions range instructors, are almost certainly among the most in danger.
The two biggest recommendations that came out of the RAND analysis were the creation and maintenance of blast-exposure records, allowing DoD to better track the frequency of low-level blast exposure, and updating weapon information with blast exposure-related characteristics.
McBirney even suggested that DoD consider embedding researchers within training and deployed units.
“As our weapons system continue to be more advanced and increasingly powerful, low-level blasts will remain an increasing challenge for servicemembers,” she said. “Addressing the issue of repeated exposure to these blasts necessitates action and collaboration between DoD and the research community.”
Some members of Congress have taken the RAND study’s recommendations to heart and are urging DoD to move to prevent these slow-developing TBIs from occurring.
“[These wounds] are invisible, and they affected thousands of servicemembers, causing headaches, seizures, hallucinations and, ultimately, increased risks for depression and suicide,” declared Subcommittee Chair Sen. Elizabeth Warren (D-MA). “In just three months in 2023, DoD provided TBI treatment to servicemembers nearly 50,000 times. The more we learn, the more we come to understand that blast exposure is an ongoing threat to the health of individual servicemembers, well-being, morale and readiness of our entire force.”
Warren is calling on DoD to create blast exposure and traumatic brain injury logs for all servicemembers, to integrate these logs into their VA and DoD healthcare record, and to establish mitigation strategies specific to the servicemember roles most at risk for blast overpressure.
According to DoD leaders, the department already is working to better track the impact of long-term blast exposure on servicemembers. Beginning this year, new enlistees will be given regular cognitive assessments to monitor potential impacts.
However, those tests are scheduled to occur only once every 5 years, a frequency that Warren said she found unacceptable.
“It seems to be, given what else we know and given how catastrophic the implications of untreated TBI can be, we ought to be erring on the side of at least collecting this data annually,” she said. “Waiting 5 years to test is just not often enough.”
Warren also pointed out that the maximum allowable number of rounds a servicemember can fire in training does not take into account brain injury. DoD officials agreed that this needed to be corrected.
“It’s imperative we have an allowable number of rounds for all the weapons systems that we currently use … to be able to look at the brain,” said Kathy Lee, director of DoD’s Warfighter Brain Health Policy. “Historically it’s been through ear and lung; however, we are looking at what the brain effects are and will follow suit with our policies as such.”
Warren concluded the hearing by saying that both DoD and Congress need to do better and that this will “be an issue we take up during the next round of NDAA negotiations.”