After years of nudges toward a comprehensive strategy to deal with traumatic brain injuries, the Pentagon on Wednesday published a plan for its Department of Defense Warfighter Brain Health Initiative.

Overall, the blueprint aims to identify each service member’s baseline brain health, while developing policies to prevent, identify and treat brain damage caused not only by combat, but by repeated shakes and blasts during training.

“The fundamental aspect of the brain health strategy is the ability to monitor a warfighter’s cognition and determine if there is a need to either enhance or restore it, especially if there has been a decrement through a hazardous brain exposure,” according to the plan.

And though it’s less likely that troops serving today will find themselves in active combat, a generation of leaders and veterans will have to deal with the long-term effects of the Global War on Terror.

“Traumatic brain injuries are the signature injuries from recent combat operations,” according to the plan. “These injuries can have short-term or delayed effects on warfighter physical and cognitive performance and health that can lead to degraded readiness, loss of operational capability, lost duty days, and decrease in quality of life.”

The document presents as a more robust framework, or maybe a philosophy, for the department’s brain health efforts going forward.

There are seven distinct lines of effort, each with sub-efforts nested into them, but few concrete details.

There aren’t any deadlines in place, or specific actions to be taken, except for an initial move: to use the existing predeployment neurocognitive assessment program to get a baseline reading of every service’s member’s brain health, with an expectation it will take five years to assess everyone currently serving and those who join up in the mean time.

“The Department must understand an individual’s cognition prior to, and after, a potential exposure to a brain hazard to optimize the cognitive and physical performance of warfighters,” according to the plan.

From there, the plan cascades into efforts to prevent TBIs, as well as track and treat them in the long term, citing the need to use “evidence-based” processes and techniques that are already being researched and implemented in civilian health care.

One of the ways to do that is to evaluate weapons for their potential to cause concussive injuries, the way they’re already tested for other potential bodily harm.

“Currently weapons and weapon systems are evaluated for auditory and/or lung effects because air-filled organs such as ears and lungs are susceptible to overpressure waves,’' according to the plan. “The Department does not have procedures or protocols established to conduct health hazard assessments to evaluate the brain for blast effects; namely blast overpressure effects on physical or cognitive performance.”

Leaders have for years pondered whether repetitive use of weapons, either in training or in combat, could have effects just as serious as those from major trauma.

“Who is going to look at those warriors after they’ve been exposed to that constant pounding and blasts?” retired Senior Enlisted Adviser to the Chairman John Troxell told Military Times in 2019. “And then, over the long haul … how does that morph and show up in the mental health aspect?”

Changing the way the military sees brain health faces some steep cultural opposition, according to surveys used to create the brain health strategy.

Respondents cited “the warrior mindset” and its focus on completing the mission no matter what, discrediting one’s own health in comparison to others with more visible injuries, and concerns about how reducing blast exposure could cut into training.

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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