The battle for Shal Mountain, dubbed “Operation Rugged Sarak,” went from Oct. 8-15, 2011. Shal Mountain sat above Shal Valley and controlled two important supply routes, one vital to coalition forces for resupply and one critical to insurgent smuggling between Pakistan and Afghanistan.
The insurgents controlled the mountain for years, but the men of B Company, 2-27th Infantry Regiment, decided to finally wrest control of it from the Taliban after two U.S. convoys were attacked from there, killing two soldiers. The battle for the summit would rage for eight days.
Specialist Jeffrey Conn was the Army medic who responded to the second convoy attack and was the medic on top of Shal Mountain during the fight for the summit. On the mountaintop, he would earn a Silver Star for saving the lives of at least nine U.S. and Afghan soldiers while also taking the lives of many insurgents — at least 12 in a single attack.
With 2019 upon us, a look back at 2018’s most memorable moments might give us some good perspective when facing the new year’s challenges. A lot happened in 2018 in the military-veteran community and each event serves to remind us that the things that affect us most can affect the world around us just as much.
It’s a testament to how important the work of the U.S. military really is.
Air Force gets OCPs, Army gets Pinks and Greens
The Air Force finally ditched the ill-conceived Airman Battle Uniform and adopted the Army’s Operational Camouflage Pattern to the resounding joy of airmen everywhere. Just like with the old BDU, the only difference will be the color of the lettering on the velcro patches — the Air Force lettering is brown while the Army sports black.
The Army also adopted its World War-II throwback jersey to be the official uniform of everyday wear by 2028 to pay homage to the U.S.’ “Greatest Generation.”
The Army’s new weapons
The Army also moved to replace the M249 squad automatic weapon and the M4A1 carbine with weapons that use a more powerful round than the NATO 5.56mm. The service will adopt a 6.8mm round in line with the results of a 2017 small arms ammunition study.
This came after the Army sought to find out why some M4 and M4A1 variants were firing unexpectedly. The problem turned out to be a glitch in the weapon’s selector switch, which got caught between the semi- and automatic settings. Some 3,000 weapons failed their inspections.
The U.S. military’s “Sky Penis”
“Stop drawing d*cks everywhere” became the order of the year in the U.S. military after two West Coast Marines drew a phallic object in the sky during aerial maneuvers. After the the initial incident, a rash of attempted copycats followed until a B-52 squadron commander based out of North Dakota was relieved of duty for explicit ground-based drawings.
The U.S. Coast Guard has been begging for a new icebreaker for years. Tears of joy were heard from Cape May to the Arctic Circle when 0 million was finally earmarked for that purpose. Unfortunately for the Coast Guard, the Department of Homeland Security moved that money to fund the southern border wall in November.
Defense Secretary Mattis’ lethality initiative began Jan. 1, 2018.
The military gets more lethal
In January, Secretary of Defense James Mattis unveiled his new national defense strategy aimed at making the U.S. military more deadly and agile. This means a change in preparation for small, low-level conflicts to great power competition, ending a period of “strategic atrophy.”
President Trump awarded the Medal of Honor to Army medic Ronald Shurer II in October, 2018.
Medals of Honor
President Trump awarded five Medals of Honor this year to combat veterans living and dead to those involved in a history of conflicts, from World War II to Afghanistan. Those recognized for valor in 2018 were Air Force Tech. Sgt. John Chapman, Army 1st Lt. Murl Conner, Army Medic Ronald Shurer II, Marine Sgt. Maj. John Canley, and U.S. Navy Special Operator Britt Slabinski.
Staff Sgt. Dylan Elchin was one of three killed in action by an improvised explosive device in Andar, Ghazni Province, Afghanistan in November 2018.
Military members lost in 2018
Thirty servicemembers were killed supporting U.S. military operations worldwide in 2018, from Jan. 1 through Dec. 2, 2018.
Sgt. Jason Mitchell McClary • Staff Sgt. Dylan Elchin • Sgt. 1st Class Eric Edmond • Capt. Andrew Ross • Sgt. Leandro Jasso • Maj. Brent Taylor • Sgt. James Slape • Staff Sgt. Diobanjo Sanaugustin • Sgt. Maj. Timothy Bolyard • CWO3 Taylor Galvin • Sgt. 1st Class Reymund R. Transfiguracion • Sgt. 1st Class Christopher Celiz • Staff Sgt. James Grotjan • Cpl. Joseph Maciel • Petty Officer 1st Class Matthew Holzemer • Staff Sgt. Alexander Conrad • Staff Sgt. Conrad Robbinson • Spc. Gary Conde • Master Sgt. Jonathan Dunbar • Staff Sgt. Dashan Briggs • Staff Sgt. Carl Enis •Capt. Andreas O’Keeffe • Master Sgt. William Posch •Master Sgt. Christopher Raguso • Capt. Mark Weber • Capt. Christopher Zanetis • Sgt. 1st Class Maitland D. Wilson • Sgt. Christina Schoenecker • Spc. Javion Sullivan • Sgt. 1st Class Mihail Golin
President Trump met with North Korean leader Kim Jong Un on Jun. 12, 2018.
All’s quiet on the Korean front
With improved relations between the U.S. and North Korea, President Trump ordered a stop to the joint American-South Korean military exercises on the Korean Peninsula. In Trump’s words, it was “inappropriate” to continue the war games while asking North Korea to disarm itself of its nuclear weapons. Trump’s orders were not met with universal acclaim among retired military leaders.
President Trump signed an order creating the U.S. Space Force in June 2018.
The Space Force
The U.S, military got its sixth branch of service in 2018, even if it was in name only. With funding sources as of yet unknown, the President ordered the creation of the Space Force to ensure American dominance of Space in June 2018.
President Trump announces withdrawal from Afghanistan
It came as a shock to the defense community when the President announced he would order a large withdrawal of troops from Afghanistan and a complete withdrawal of U.S. forces in Syria. The fallout of the decision included the resignation of Defense Secretary James Mattis.
The United States has substantial air, land, and sea forces stationed in South Korea
As well as several units based in Japan and the western Pacific earmarked for a Korean contingency. Together, these forces far exceed the firepower of North Korea’s armed forces and represent a powerful deterrent not just against Pyongyang but any potential adversary in the region.
A U.S. Army M109A6 Paladin deployed in support of Combined Joint Task Force – Operation Inherent Resolve. (Photo: U.S. Army Spc. Christopher Brecht)
The first U.S. forces that would be involved in a North-South Korean conflict are those currently based in South Korea. On the ground, the U.S. Army rotates a new armored brigade into South Korea every nine months — currently the 2nd Brigade Combat Team, 1st Cavalry Division. Each brigade is manned by 3,500 soldiers and consists of three combined arms battalions, one cavalry (reconnaissance) battalion, one artillery battalion, one engineer and one brigade support battalion. Armored brigade combat teams typically consist of approximately 100 M1A2 Abrams tanks, 100 M2A3 Bradley infantry fighting vehicles and eighteen M109-series self-propelled howitzers.
The army in South Korea also maintains the 2nd Infantry Division’s Combat Aviation Brigade, equipped with approximately sixty Apache attack helicopters, Blackhawk, and Chinook transports. The 210th Artillery Brigade, equipped with M270 Multiple Launch Rocket Systems provides long-range artillery fire, while the 35th Air Defense Artillery Brigade provide Patriot missile coverage of Osan and Suwon Air Force Bases. The 35th Brigade also operates the AN/TPY-2 missile defense radar and six Theater High Altitude Area Defense (THAAD) launch vehicles recently sent to the country to beef up anti-missile defenses.
The other major component of American power in Korea is U.S. tactical aviation. The U.S. Air Force maintains the 51st Fighter Wing at Osan Air Base, consisting of the 25th Fighter Squadron at equipped with A-10C Thunderbolt II ground attack jets and the 36th Fighter Squadron with F-16C/D Fighting Falcon fighters (about forty-eight aircraft in all). The 8th (“Wolfpack”) Fighter Wing at Kunsan Air Base consists of the 35th and 80th Fighter Squadrons, which fly a total of forty-five F-16C/Ds. The A-10Cs have the mission of close air support, while the F-16C/Ds are responsible for air interdiction, close air support, and counter-air.
Beyond the Korean Peninsula, the United States maintains an array of forces ready to intervene. U.S. military forces in Japan include the forward-deployed aircraft carrier USS Ronald Reagan, two guided missile cruisers and seven guided missile destroyers. Many of the cruisers and destroyers have ballistic missile defense capability although two of the destroyers, Fitzgerald and McCain, are out of action due to collisions with civilian merchantmen. The Reagan and surface warships are all based at Yokosuka, Japan.
Further south, Sasebo, Japan is the home of the amphibious assault ship USS Bonhomme Richard and the ships of its amphibious task force. Together, this amphibious force can lift a marine infantry battalion reinforced with armor, artillery and aviation assets collectively known as Marine Expeditionary Unit. Sasebo is also the home of the 7th Fleet’s four minesweepers. The result is a well-balanced force that can execute a wide variety of missions, from ballistic missile defense to an amphibious assault.
Farther north in Japan, the U.S. Air Force’s 35th Fighter Wing is located at Misawa, Japan. The 35th Wing specializes in suppressing enemy air defenses (SEAD) and is trained to destroy enemy radars, missile systems, and guns to allow other friendly aircraft a freer hand in flying over the battlefield. The wing flies approximately forty-eight F-16C/Ds split among the 13th and 14th Fight Squadrons. Near Tokyo, the USAF’s 374th Airlift Wing at Yokota Air Base flies C-130 Hercules, C-130J Super Hercules, UH-1N Huey and C-12J Huron aircraft.
Marine Corps units are spread out across Japan, with Marine fixed-wing aviation, including a squadron of F-35B Joint Strike Fighters, tankers, and logistics aircraft stationed at MCAS Iwakuni, the only Marine Corps air station on mainland Japan. Three squadrons of Marine helicopter units are stationed at MCAS Futenma on the Japanese island of Okinawa. Marine ground forces include the 4th Marines, a marine infantry regiment with three battalions, and the 12th Marines, an artillery regiment with two battalions of artillery.
Also on Okinawa is the sprawling Kadena Air Base, home of the 44th and 67th fighter squadrons, both of which fly the F-15C/D Eagle fighter. Kadena is also home to a squadron of K-135 Stratotanker aerial refueling aircraft, a squadron of E-3 Sentry airborne early warning and control (AWACS) aircraft, and two rescue squadrons. Farther from a potential Korean battlefield (but still in missile range) Kadena would act as a regional support hub for American airpower, with AWACS aircraft monitoring the skies and controlling aircraft missions while tankers refueled bombers, transports, and aircraft on long-range missions.
The next major American outpost in the Pacific, Guam, is home to Submarine Squadron 15, four forward-deployed nuclear attack submarines supported by the permanently moored submarine tender USS Frank Cable. Naval special warfare units are also based on the island. An army THAAD unit was deployed to the island in 2013 to protect against North Korean intermediate range ballistic missiles.
Guam is also home to Andersen Air Force Base. Andersen typically hosts a variety of heavy aircraft, including B-1B Lancer strategic bombers from Pacific Command’s Continuous Bomber Presence Mission, KC-135 tankers and RQ-4 Global Hawk drones. Andersen served as a jumping off point for bomber raids against North Vietnam and today would see a surge of B-1B, B-2A and B-52H bombers from the continental United States in the event of a flare-up in Korea.
U.S. forces in the northwest Pacific are considerable, amounting to two ground combat brigades, approximately seven wings of fighters and attack aircraft, a handful of strategic bombers, an aircraft carrier, submarines, hundreds of cruise missiles and an amphibious assault task force. That already formidable force can be swiftly augmented by even more combat forces from Hawaii, Alaska, and the continental United States, including F-22A Raptors, airborne troops, and more aircraft carriers, submarines, and bombers. It is a robust, formidable, adaptable force capable of taking on a variety of tasks, from disaster relief to war.
Army 1st Lt. Michael Behenna was convicted of killing an al-Qaeda suspect in a combat zone during a 2008 deployment to Iraq. A military court sentenced the officer to 25 years in prison, though an appellate court noted his argument of self-defense. The former lieutenant was paroled in 2014, but won’t be going back to prison. On May 6, 2019, President Donald Trump signed a full pardon for the soldier.
Behenna led a platoon in Iraq while working counterinsurgency operations in Salahuddin province. One day in April 2008, a convoy led by Behenna was returning to base with two captured suspects when it was hit by an IED. Two soldiers were killed, many more were wounded, and the convoy lost two vehicles. The next month, his unit received intelligence that the man responsible for that attack was named Ali Mansur Mohamed. They also learned where Mohamed lived.
The suspect’s house was immediately raided by Behenna and his men, who found an RPK heavy machine gun, Syrian passports, and a cache of ammunition. The Army took Ali Mansur Mohamed into custody and turned him over to intelligence agencies.
But the suspect was released less than two weeks later. Behenna would be in charge of returning him to his home.
Behenna after his 2014 parole.
It was on the way back to Ali Mansur Mohamed’s home that things started to go south. Behenna and his convoy stopped outside of the town of Baiji, where Behenna, a sergeant under his command, and an Iraqi interpreter began to question Mansur. They removed his clothes, cut his handcuffs and ordered him to sit before questioning him about the April attack on the Behenna’s convoy.
After some time and questioning, Lt. Behenna finally pulled the trigger and fired the shot that killed the suspected insurgent. They covered up the corpse with a grenade. Behenna was charged with murder in July 2008. In 2010 a jury found Behenna guilty of unpremeditated murder and sentenced him to 25 years. That was later reduced to 15, of which he served fewer than five.
The Northern Iraqi oil town would later be captured by ISIS.
But none of that matters now, as the President’s executive order of clemency is a full pardon for the onetime military officer. Behenna admitted to the killing at his trial, saying Mansur moved to try and take his sidearm from him. A government witness found Mansur’s wounds corroborated the self-defense story, but the evidence was not presented in his court-martial.
The Oklahoma native has been working as a farmhand since his release from the Disciplinary Barracks at Fort Leavenworth.
Elon Musk is pushing SpaceX’s more than 7,000 employees to not waste any time after its first crewed space launch.
A little over a week ago, the rocket company successfully sent two astronauts to the International Space Station on an historic mission that may last nearly four months. But now the CEO is directing SpaceX to quickly switch gears, according to an internal email first obtained and reported by CNBC.
Musk told SpaceX employees to work full steam ahead on Starship, a reusable rocket designed to one day land on the moon for NASA and take up to 100 people at a time to Mars.
“Please consider the top SpaceX priority (apart from anything that could reduce Dragon return risk) to be Starship,” Musk wrote in the email, according to the report.
SpaceX did not immediately respond to Business Insider’s request for confirmation and comment on the email.
But Musk has said the company may need to build about 20 large prototypes before SpaceX can attempt to launch one into orbit.
To the moon, Mars, and beyond
In hopes of speeding up Starship’s progress, Musk’s email alluded to incentivizing employees from the company’s Los Angeles headquarters and Florida facility to “consider spending significant time” in Boca Chica, Texas, where Starship’s production complex is. (Business Insider previously reported the rocket company was hiring a project coordinator to help run a “SpaceX Village” with 100 rooms, lounge parties, volleyball tournaments, rock climbing, and more.)
Before a high-profile presentation about Starship from Boca Chica, Musk received pressure in September from NASA Administrator Jim Bridenstine. Bridenstine tweeted about his excitement for Starship but said it was “time to deliver” on sending astronauts to space using the older Crew Dragon and Falcon 9 system.
Now that Behnken and Hurley are in orbit, Musk appears intent on putting SpaceX’s full force into Starship. The system is in the running with NASA to land astronauts and supplies on the moon in the mid-2020s.
On Friday, Musk also confirmed that he still hoped to launch the first crew to Mars in a Starship vehicle in mid-2024 — ostensibly as the start of an effort to populate the red planet.
The Bangor, Washington-based USS Michigan (SSGN 727) will soon put to sea and submerge with a crew that includes four female NCOs and 34 junior enlisted women, marking the first time the Navy has deployed a submarine with women in the enlisted ranks.
The female sailors will be divided between the Gold and Blue crews of the guided-missile submarine.
According to the Kitsap Sun newspaper, the USS Michigan has undergone a $6 million retrofit to build out the crew quarters and heads to accommodate the female crew, including converting a bunkroom into shower space, splitting the aft washroom to allow for a shower and head combination and a watchstander head, and creating a new bunkroom from the old crew’s study.
The chief petty officers will bunk together two or three to a room, while the other women will split into nine-person bunkrooms and share a head, the newspaper said.
The Navy opened up the all-male submarine force several years ago to female sailors and deployed its first crew with women officers in 2011.
The USS Michigan’s crew is made up of 15 officers and about 140 enlisted sailors. The female enlisted submariners were chosen from 113 applicants, the Kitsap Sun reported.
The Navy reportedly plans to add as many as 550 female sailors to the submarine service by 2020.
Chuck Sweeney left the Navy as a commander in 1980, after a 22-year pilot career that included 200 combat missions, 4,334 flight hours, and 757 carrier landings.
In one week of that career, Sweeney earned three Distinguished Flying Crosses, awarded for “heroism or extraordinary achievement in aerial flight,” for his actions over Vietnam.
Sweeney, president of the national Distinguished Flying Cross Society, spoke with Insider about the unusual way he got his start as a carrier pilot, his time fighting in Vietnam, and the week he was awarded three DFCs in September 1972.
Despite his awards, “I’m no different than most other people,” Sweeney said in the 2017 documentary “Distinguished Wings over Vietnam.”
“I just happened to be at the right place at the wrong time.”
“I have a lot of friends who said they were interested in flying early on, and they always wanted to be a pilot,” Sweeney told Insider. “I really didn’t. I wasn’t against it. I just never thought about it.”
But after he was drafted in 1958, he decided to join the Navy “and see the world.”
His first assignment took him to Naval Air Station Patuxent River in Maryland as an aeronautical engineer — not exactly one of the exotic destinations Sweeney had in mind.
Sweeney first flew the S-2E anti-submarine aircraft, then volunteered to be an attack pilot, flying the A-4 Skyhawk, while he was earning a master’s degree in aeronautical engineering at the Naval Postgraduate School in Monterey, California.
“They were losing a lot of pilots,” in Vietnam, Sweeney told Insider. “They were being killed or captured.”
After combat missions in Vietnam and Laos, Sweeney trained pilots in Lemoore, California. But his shore duty didn’t last long.
In July 1972, he was sent to the USS Hancock to replace Cmdr. Frank Green, the executive officer of Attack Squadron 212, who was missing in action after his aircraft was shot down.
“The next morning, I was flying my first strike against North Vietnam,” Sweeney told Insider. “Back in those days, things were happening fast.”
Sweeney’s first DFC came after a high-stakes rescue in the waters just off North Vietnam.
Lt. William Pear’s aircraft was hit and landed in the treacherous territory, and Sweeney coordinated his rescue from the cockpit of his A-4, even as he himself was under anti-aircraft fire.
“Most of the time, if you landed over North Vietnam, 99 times out of 100, you’d be captured,” Sweeney said. “But we got him back and kept him out of the Hanoi Hilton.”
Pear was the last A-4 pilot to be rescued during the Vietnam War, Sweeney said in an interview for the Distinguished Flying Cross Society Oral History Collection in 2005.
Days later, Sweeney led aircraft from the Hancock in a strike and was awarded his second Distinguished Flying Cross.
“We had 35 aircraft going after a target in North Vietnam, and I was leading the whole strike,” he said.
“I had planned numerous strikes and led them in training, but this was the real thing,” Sweeney said in a 2005 oral interview in the book “On Heroic Wings.”
They successfully completed the strike but met frightening resistance. North Vietnamese MiGs took off and headed toward Sweeney’s strike group, although they eventually stood down, and the group was under heavy anti-aircraft fire.
“For doing the job that I was trained to do I was awarded my second DFC,” Sweeney said in “On Heroic Wings.”
Sweeney’s third DFC came the next day, when he led three other aircraft in an alpha strike on the outskirts of Hanoi.
On a strike that close to the North Vietnamese capital, “You knew the defenses were going to be heavier,” Sweeney said.
Sweeney and other pilots dodged North Vietnamese surface-to-air missiles (SAMs) as they headed to their target, a major railyard.
“The rule was, to avoid being hit, when [the SAM] looked like a flying telephone pole, you made this maneuver around it, kind of away from it,” Sweeney said.
“Lo and behold, this thing” — the SAM— “came up, and as it got closer, I thought ‘Oh, this has Chuck Sweeney’s name on it.'”
Sweeney managed to avoid the missile but got separated from the rest of his group and caught up just as they were preparing to attack their target.
Sweeney’s group hit a loaded train and avoided even more anti-aircraft fire as they headed back to the USS Hancock.
Fitness. The word conjures mental images of tight lycra clothing, 5K finish lines, and overcrowded rooms filled with clanking weights and the pungent odor of sweat. Fitness, however, is much simpler than what is being sold to you. Fitness is health, plain and simple — the pursuit of which is a lifetime endeavor.
The concept of improving fitness almost always focuses directly on the improvement of the physical body. However, mental and spiritual health play equally important parts in the equation. Setting the proper intention — the purpose of one’s physical pursuit is as important, if not more so, than the physical movement itself.
When it comes to fitness, goals are paramount. There are three simple questions you need to ask yourself:
Where do I want to be?
Where am I currently?
What is the healthiest path from No. 2 to No. 1?
(Photo by Marty Skovlund, Jr./Coffee, or Die Magazine)
Your goals are your own. They should not exist for anyone else, and should be clearly identified so a path to achievement can be established. Let’s say your goal is to squat 200 pounds. Why? How does that number improve your quality of life? Numerical goals are not wrong so long as you can identify the reason. For example, if you aspire to be an EMT who will regularly need to hoist a 200-pound person, the goal serves you well.
Take an honest, comprehensive look at your current fitness level. Avoid self-criticism and identify the areas which can use the most improvement. Can you push and pull your body weight through various planes of movement repetitively and with ease? Does each of your joints flex and extend to an appropriate degree without pain? I know blood pressure and cholesterol levels aren’t as sexy to consider as what your abs look like, but they are undeniably factors that will sooner inhibit your quality of life than any aesthetic variance will.
Identify your weakness, then attack it with verve. Experienced triathletes know this concept well. For those with a strong swim and a weak run, it is much more enjoyable to practice swimming. This does little to improve race results or fitness in general though. That weakness may be flexibility, balance, or elevated levels of stress.
Knowing where you are and where you want to be doesn’t mean anything without establishing a reasonable path from one to the other. This is the angle of the ladder you will climb to your goal. Time plays a crucial factor in this. If your goal is to squat that 200 pounds but you currently have physical difficulty getting off the couch, the goal is still achievable when the proper number of rungs are implemented at appropriate intervals.
Does the pursuit of your goal require detriment to other aspects of your health? If your goal is to complete a marathon for the sake of doing so and your training plan omits components of strength, power, speed, or agility, you may get to the finish line a little faster — but you are ultimately working against your own fitness.
If you can identify where you currently are and where you want to be but are unsure how to get from one to the other, fear not. In the coming weeks and months, I will address pertinent aspects of fitness programming, equipment, and ideology. Wherever you may be, let’s improve our fitness — and our quality of life, together.
This article originally appeared on Coffee or Die. Follow @CoffeeOrDieMag on Twitter.
Staff Sgt. Eugene Leonard served in the Marine Corps during World War II and was wounded in action. But he never lost a love for aviation, also serving in the Air Force and as an airplane mechanic in his civilian life.
Staff Sgt. Eugene Leonard (Youtube screenshot)
So, for his 99th birthday, one friend decided to pick up the former Marine’s spirits after Leonard became a widower and moved to the Phoenix area, Fox10Phoenix.com reported.
What was selected for that task was another World War II veteran — a restored B-17 Flying Fortress bomber.
In a day and age where we lose 492 World War II veterans a day, according to the National World War II Museum, those few remaining are a link to the heroic history of that conflict.
The same can be said for the planes. In this case, one World War II vet was able to give another one a brief pick-me up.
Here is Fox10Phoenix’s report on Staff Sgt. Leonard’s flight:
Frontline medics and providers delved into the military’s latest paradigm shift of traumatic brain injury assessment and treatment March 7, 2019, at the Warfighter Brain Health Training Symposium at Madigan Army Medical Center.
“The need for training this year is greater than most years because just about every standard system that we use in our assessment and management of TBI are being overhauled based on the latest state of the science,” said Maj. (Dr.) Joseph Kamerath, the director of the TBI and Intrepid Spirit Center at Madigan.
A warfighter brain health memo issued last fall by Patrick Shanahan, acting Secretary of Defense, when he was serving as the Deputy Secretary of Defense established a commitment to understanding, preventing, diagnosing, and treating TBI in all of its forms, and the 2018 Defense Authorization Act also called for expanding blast research.
“We’re in an environment where we understand that the effects on readiness are greater than we ever thought, the numbers of service members sustaining TBI continue to be high despite the decreased operative tempo, and that we need to put a bigger emphasis on preventing TBI, and when people do have a TBI, mitigating the effects to maximize not only their wellness but our military readiness,” Kamerath said.
Director of the TBI and Intrepid Spirit Center at Madigan Maj. (Dr.) Joseph Kamerath.
He spoke to an audience of primarily frontline providers such as primary care managers and medics, who he called “the backbone of far-forward military health care.”
Researchers presenting at the symposium emphasized the key role of medics in early detection and treatment of TBIs as being influential in the long-term health of service members.
Although years past the height of the wars in Iraq and Afghanistan, TBIs are still a substantial issue affecting readiness, with nearly 18,000 new TBI diagnoses in the Department of Defense in 2017.
Current research is developing evidence that the long-term symptoms of mild TBIs, or concussions, may be more prevalent than previously thought.
“We used to say 85 percent are going to be fine; 85 percent of mild TBIs are (going to be) 100 percent better,” said Kamerath.
However, he said researchers are now finding that a certain percent of that 85 percent are experiencing more subtle symptoms, such as changes in vision, headaches, sleep, and concentration.
“One of the really unique things that’s been recognized is that in the coming several months after sustaining a mild traumatic brain injury, a soldier or a college athlete is twice as likely as their peer to sustain a lower extremity musculoskeletal injury be that hip, knee or ankle,” he said.
A potential reason could be that the subtle balance deficits caused by a TBI may make people more likely to sustain an injury.
From there, the math to TBIs affecting readiness is simple. Twice the rate of musculoskeletal injuries, which are one of the greatest health concerns which affect warfighter readiness, means that even the subtle mid- and long-term effects of TBIs could have real mission impacts. In other words, if readiness matters and TBIs affect readiness, then understanding the best way to assess, treat and mitigate the risks of TBIs also matter, Kamerath said.
“We are working to develop the best ways to make sure that they get back in the fight without sustaining injuries and maximize the readiness of our force,” he said.
One of the ways to better treat TBIs is to get patients to specialists faster. Historically, TBI specialty clinics cared for patients living with the chronic effects of TBI, who may have been referred after months of related symptoms. Now, the standard is that if a patient experiences an uncomplicated TBI yet is not improving seven days later to refer them to TBI specialists, who in turn are committed to seeing patients within seven days of the referral.
U.S. Army Pfc. Shawn Williams of the 1st Stryker Brigade Combat Team, 25th Infantry Division based in Fort Wainwright, Alaska, gives the thumbs-up to members of his unit as he is evacuated after being injured by a roadside bomb.
(Photo by U.S. Navy Lt. j.g. Haraz N. Ghanbari)
“With more and more evidence suggesting that early rehab can be helpful to mitigate long-term effects, the push now is to change our model,” said Kamerath. “This is really the right way forward to get people in early, getting them into see the appropriate specialist early, so that they can get the care that’s needed.”
Other speakers addressed the long-term effects of TBIs, including the increased levels of disabilities experienced by blast concussion patients compared to those with non-blast TBIs one year after their initial injuries.
Dr. Christine MacDonald, an associate professor of neurological surgery at the University of Washington, explained that her longitudinal study found that 74 percent of concussive blast patients still experienced health reductions five years after their injuries. The best early predictors of these long-term reductions include being at an older age at the time of injury, having a TBI diagnosis, experiencing greater depression symptoms, exhibiting a slower reaction time, and demonstrating less word generation (aka verbal fluency).
Another study presented by Dr. Jesse Fann, a professor of psychiatry and behavior sciences and adjunct professor of rehabilitation medicine and epidemiology at the University of Washington, found a long-term increased risk of dementia for people with TBIs.
“The impact of a TBI is higher when you have a TBI earlier in life,” said Fann.
He shared that more severe TBIs also increase the risk of later developing dementia. While only 0.4 percent of the people studied had dementia due to TBI, that statistic is still significant given the large number of people who eventually do suffer from dementia, he said.
While the symposium included long-term potential effects of TBIs, it also offered medical providers tools that they can use now to better assess TBIs with the hope that better detection leads to better treatment.
While the Military Acute Concussion Evaluation is the standard for TBI screenings, the older algorithms are being replaced by the Concussion Management Tool, according to Kamerath. It is also incorporating the Vestibular/Ocular Motor Screening. Other new tools include the BrainScope One Device.
“When we get patients with TBI, our biggest concern is if it’s life-threatening now,” said Maj. Nicholas Koreerat, a clinical specialist in orthopedic physical therapy.
He briefed on the BrainScope One Device, which detects if bleeding occurs in the brain after a traumatic brain injury. Before the military began using it, the options to treat suspected brain bleeds downrange where to either “wait and see” or medevac the patient for a CT scan. However, if service members are medevaced unnecessarily, operational effectiveness decreases as aircraft are diverted for unneeded medevacs. Due to its high rate of sensitivity, the BrainScope increases the effectiveness and accuracy of determining treatment for patients who may experience brain bleeds, Koreerat said.
(US Army photo)
Another frontline screening tool now available is the Vestibular/Ocular Motor Screening, presented by Maj. Katrina Monti, the senior physician assistant for the 1st Special Forces Group (Airborne). The six-minute screening tool assesses headache, dizziness, nausea, and fogginess following specific maneuvers used to cluster TBI-associated symptoms. Monti explained that 60 percent of concussions result in these vestibular symptoms, and that patients tend to have poorer outcomes and longer recovery times with these symptoms as well.
“The big takeaway for me from that presentation was just how easy it is to implement some of the new tools that are coming out from the research that we’re seeing in the field, in deployment or other real-life settings, not just in clinics and hospitals,” said Kasey Zink with the Geneva Foundation, which funds research like the VOMS tool.
Others learned that just because TBI assessment tools may be easy to use, other factors may serve as barriers to screening.
In fact, underreporting mild TBIs occurs in the field because of lack of awareness — service members may not know which symptoms are related to concussions — and because they sometimes don’t want to be taken off their teams, even temporarily, for medical observation or treatment, said Monti. The key, she said, was in part greater education of the troops on mTBIs, to include awareness that earlier reporting can lead to faster improvement of symptoms and earlier return to duty.
War correspondent Sebastian Junger, most famous for his documentaries “Restrepo” and “Korengal” that followed paratroopers in the Korengal Valley, has teamed up with Nick Quested to create a new documentary with National Geographic detailing the hell that is life in ISIS-controlled territory.
“Hell on Earth: The Fall of Syria and the Rise of ISIS” is cut together from over 1,000 hours of footage, most of it filmed inside the so-called caliphate.
This 13-minute teaser tells the story of families trying to escape, at first with smugglers and then on their own when their smuggler is caught by ISIS.
(Be warned that some of the images in the documentary are disturbing)
Previous reporting has shown how ISIS maintains control in its territory, how it makes its money, and how it recruits and deploys fighters.
None of it is good.
Torture and public executions are used to keep populations cowed, and money is raised through debilitating taxes, sex slavery, robbery, and other pursuits. And its fighters are recruited through international networks and then deployed at half pay or less, often as undertrained frontline fighters that amount to little more than human shields.
As of August 2019, 25% of the 4.7 million veterans had a service-connected disability (and, given: how difficult it is to pursue a disability rating, how few veterans even know about it as an option and how many feel discouraged or guilty about even applying, we can assume that many more live with conditions that would qualify them for a rating). While the federal government often treats pain with prescription medications, many veterans are now turning to CBD for pain relief.
Cannabis (most commonly known as marijuana or hemp) has three major components: cannabinoids, terpenoids and flavonoids. The two major components of marijuana cannabinoids are tetrahydrocannabinol (THC) and cannabidiol (CBD). While THC has a psychoactive effect, doctors and scientists have been able to procure CBD by itself, which is non-psychoactive (in other words, it won’t get you “high”) and has many promising medicinal properties.
As federal and state restrictions on marijuana evolve, more and more people have access to cannabis products. Forbes predicted the CBD market alone to increase to $20 billion by 2024 as people turn to it for its medicinal properties. While there are a lack of human studies due to federal restrictions, animal studies and user testimonials suggest that CBD is a very promising pharmaceutical agent to treat pain, inflammation, seizures and anxiety with very few side effects and low potential for abuse.
How does it work?
According to Harvard Health, as CBD interacts with the endocannabinoid, inflammatory and nociceptive (pain sensing) systems, it exerts pain-relieving effects throughout the body. Users report improvement in physical function, sleep, well-being and improvement in pain or stiffness.
CBD is still an emerging medicine and there are potential side effects such as sleepiness, lightheadedness, and, rarely, liver problems. It’s also difficult to trust whether a product contains the amount of CBD advertised, so it’s always important to test out new products with caution and to speak with a physician before trying new medications.
“CBD should also be part of an overall pain management plan that includes non-medication options (such as exercise) and psychological support,” reminds the Senior Faculty Editor of Harvard Health Publishing, Robert H. Shmerling, MD.
What product is right for me?
CBD comes in many forms including liquid, capsule, edibles and topical. There are many different factors to consider when trying a new product, including flavor, absorption rate, quality and experience. It may also take some trial and error to determine how potent you want your product to be and how you want to imbibe.
You will absorb CBD at a different rate if you ingest it than if you apply it topically to your body. One of the fastest absorption methods is placing a CBD tincture under your tongue but a more effective method to ease chronic pain might be daily use of a CBD massage oil.
The best thing to do is start small. A bath bomb might contain 200mg of CBD — but if you tried to drink that much you might regret the experience. A 5 – 25mg drink is probably a better starting range (and pay attention to serving sizes so you don’t accidentally overdo it).
Finally, if you’re experiencing chronic pain, talk to your doctor about experimenting with CBD. They may not be able to actually advocate for its use, but they can talk to you about risks or conflicts with your current medications.