Similar to the way the National Football League is addressing brain injuries among its players by testing their neuropsychological health at the beginning and end of each season, the Pentagon has in recent years ordered all service members to complete cognitive evaluations before combat deployments, as well as after any blast injuries — such as from an enemy improvised bomb explosion. These tests are used to measure troop readiness, though, and are not necessarily entered into the soldier, sailor, airman or Marine’s medical records. At the joint-service explosive ordnance disposal school at Eglin Air Force Base in Fort Walton Beach, Fla., that is about to change.
For the first time, all incoming students at the United States military’s bomb disposal school in Florida will complete a computer-based test to assess their cognitive abilities. It is not designed to measure their ability to complete the demanding course; instead, it will serve as a baseline reading of their neurological health before they enter a career field in which exposure to powerful explosions is part of the job description.
[Sign up for the weekly At War newsletter to receive stories about duty, conflict and consequence.]
The Pentagon’s E.O.D. force is small, numbering just under 6,500 officer and enlisted technicians across the Army, Navy, Air Force and Marine Corps, but they have one of the highest deployment rates in the entire military and are in constant demand to disable and destroy the improvised bombs used by various insurgent forces. As a result, it is not uncommon to find mid-ranking technicians who have made a half-dozen or more combat deployments, defused hundreds of improvised bombs and have also been exposed to dozens of powerful blasts at close range. Explosions such as these produce blast overpressure, sometimes called a shock wave, which is a wall of dense air formed by rapidly expanding gases that damage soft tissues like brain matter. As it races outward in all directions at once, this overpressure can reflect off walls and terrain features, punch through windows and harm bystanders even when they are taking care to protect themselves from an explosion.
ImageCreditSpecialist Sarah K. Anwar/U.S. Army photo
The military’s E.O.D. technicians were regularly exposed to blasts in peacetime as they disposed of dud or unserviceable munitions on controlled ranges, but 18 years of sustained combat has meant that these men and women are often much closer to explosions and are afforded less protection from them. This has led to some technicians suffering traumatic brain injuries, and those wounds may be linked to cognitive problems that arise earlier than they ordinarily would among their civilian counterparts of the same age, according to the Defense and Veterans Brain Injury Center. Across the services, nearly 316,000 service members have sustained at least a mild brain injury since 2000, but their effects aren’t always apparent.
“To make it through E.O.D. school, it’s a higher standard mentally and physically” than for other military careers, said Navy Capt. Dean Muriano, who took command of Naval School Explosive Ordnance Disposal in May. “Their mental and physical abilities are all among the top 25 percent of the people who can get into the military.” So, even if a technician’s cognitive abilities appear normal for their age group later in life, Muriano said, without a baseline reading made at the beginning of their career with which to compare it, it’s not possible to capture the full extent of a cognitive decline.
Muriano compared the idea behind baseline neuropsychological assessments to how the military has long addressed the issue of hearing loss. To gauge their hearing, every person who joins the military completes a battery of tests called an audiogram, in which they step into a soundproof booth, put on a set of headphones and listen to a series of tones of varying frequencies and pitch. Pentagon policy requires periodic follow-up audiograms, and if a service member’s hearing is found to have declined past a certain point, they may be removed from working in areas with high background noise — such as engine rooms on ships, or near jet aircraft.
The assessment will begin before the end of September for the incoming classes of E.O.D. students, Muriano said. But such tests are too late to catch the full extent of harm suffered by technicians exposed to massive blasts long before the Sept. 11, 2001, attacks.
ImageCreditMeggan Haller for The New York Times
Todd Sheckley spent 23 years in Navy E.O.D. and he struggled to understand why he was having trouble piecing together information or making plans after his retirement from the service in 2011. “I’ve been married for 26 years so my wife has been there to see the changes,” Sheckley said. “Normal people wouldn’t be able to tell.”
With deployments to Bosnia, Kosovo, Afghanistan and countries around the Middle East, Sheckley destroyed large amounts of captured enemy munitions regularly. But it was most likely while serving in the Philippines in the early 1990s that he suffered his most significant brain injury. As the United States was closing its longstanding base at Subic Bay, Navy leaders decided to destroy immense stockpiles of obsolete explosive shells in situ rather than send them back to the States for disposal. Sheckley and his team ended up working for months, setting off about 200 explosions each day on a demolition range. When they set off each explosion, Sheckley said, he and his teammates were in an open bunker, “but you could still feel the vibration and the shock wave coming over and around.” After years of being told he didn’t have any trauma to his brain by the Department of Veterans Affairs, Sheckley was finally diagnosed with a traumatic brain injury at a specialty clinic at Washington University in St. Louis.
Since going through bomb-disposal training himself in 2000, Muriano has seen a growing consensus among military leaders and the medical community that repetitive exposure to blasts may have a cumulative effect that has not been fully quantified. He thinks the services may ultimately require guidelines and restrictions similar to those applied to service members who work around nuclear reactors and other potential sources of ionizing radiation. There are limits for daily exposure, those for single incidents where someone is accidentally exposed to higher levels of radiation and a hard limit for how much radiation someone is allowed to absorb while trying to rescue a human life. Above a certain level of accumulated dosage, a person may be prevented from working near radiating sources ever again.
While the E.O.D. school’s new cognitive testing process will help the military better understand the risks of blast exposure, it will probably offer only one data point on a complicated subject that the military does not yet fully understand: how much blast is too much, especially for repeated incidents over time.
“I don’t know if we’ve ever had empirical data on what’s safe and what’s not safe,” Muriano said. “We’ve got a long way to go to learn and to understand the effects of what we do to our brains.”
SOURCE : https://www.nytimes.com/2019/08/27/magazine/bomb-disposal-brain-injury.html