Brain health has historically been defined in terms of human performance optimization. The most accepted and familiar aspect of human performance in the military has been the physical performance (e.g., agility, endurance, strength within the context of carrying a 50 pound rucksack as parameters) of the warfighter. Cognition plays a key functional role in a warfighter’s overall performance capabilities. Thus, to successfully defend our Nation, we must optimize physical and cognitive performance to enhance and maintain force readiness.
There is emerging evidence to suggest exposure to repetitive blast overpressure in training and in the deployed setting may have an effect on warfighters’ physical and cognitive performance. 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. 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. Section 734 of the National Defense Authorization Act (NDAA) for Fiscal Year 2018, “Longitudinal medical study on blast pressure exposure of members of the Armed Forces,” directed the Secretary to conduct a longitudinal medical study on blast pressure exposure for Service members (SM), to include members who train with any high overpressure weapon system. Concerns for brain health and repetitive blast exposures prompted a memorandum by the Deputy Secretary of Defense on October 1, 2018, which directed the Under Secretary of Defense for Personnel and Readiness (USD(P&R)) to develop a Department-wide comprehensive strategy and plan to optimize brain health and counter traumatic brain injury (TBI). The US Special Operations Command (USSOCOM) led with its policy, “Comprehensive Strategy for Special Operations Forces Warfighter Brain Health,” February 14, 2019, aligning operational and medical components to address this issue.
Prior to these policies, there have been successful but disparate brain health efforts within the Department. The Warfighter Brain Health (WBH) Initiative is a joint effort between operational and medical communities with the focus to optimize warfighter brain health, immediately detect brain injury when it occurs and combat its effects on warfighters, their families, line leaders/commanders, and their communities at large.