Military hunts for answers to mysterious brain injuries among troops

Shortly after former Army Specialist Stephen Smith returned home from Syria in 2018, he woke up to the sound of children’s voices in the other room. Another time, he thought he heard someone trying to break into his house.

Smith, 32, who lives alone in Alexandria, Louisiana, said there were other strange symptoms that began during his deployment, including painful migraines and persistent short-term memory loss. Suicidal thoughts lingered.

“I had to take earmuffs and put them over my head to stop every little noise possible. And then I fell asleep right next to the toilet. And I would do that probably twice a week,” he said.

By the time Smith was hitting Islamic State targets nightly with mortar fire – he estimates he fired thousands of rounds in a three-month period -- the military had already spent a decade studying what large explosions -- like firing heavy artillery -- might do to the brain, including fielding experimental helmet sensors with troops in Afghanistan.

Smith wasn’t aware of any of that.

“They thought that I was just not drinking enough water, maybe not getting enough electrolytes. And so, I would think … maybe they're right. Maybe I'm smoking too many cigarettes,” said Smith, who has since been diagnosed with residual traumatic brain injury and post-traumatic stress syndrome.

After two decades of war, an unknown number of troops are suffering from mysterious neurological issues that researchers suspect could be linked to blasts caused by their own weapons, including door charges, mortar fires and anti-tank weapons.

The Defense Department insists they are making gains on addressing the issue. U.S. Special Operations Command says it’s racing to test new technologies and change how troops train for combat. The Pentagon also has announced new rules for cognitive testing and exposure to heavy weapons. And senior officials say service members are now being taught how to recognize blast overpressure symptoms.

“We fully understand that there is no time to waste in making tangible changes based on the information gathered so far,” said Ashish Vazirani, acting under secretary of Defense for personnel and readiness. “The department is not waiting for research to be complete before making changes and is already taking practical actions to reduce risks.”

Still, advocates say that specialized long-term treatment can be tough to find for many former service members, particularly if symptoms don't surface until after they leave the service. Gaps in research also make it unclear whether enough is being done to protect younger troops in the future.

"Give them a blank check" to fix it all, Smith said.

Something no MRI can detect

Brain scans of 30 active-duty special operations forces found that the more troops were exposed to blasts, the more changes were seen in the brain. But researchers don't know what those changes mean exactly, or why some people exposed to blast waves are impacted with memory loss and other symptoms, while others aren't.

There’s also still no way of diagnosing blast wave injuries to the brain, which researchers believe is different than the kind of sudden concussive trauma seen in roadside blasts or among football players that can often be detected through a blood test.

Researchers also don't know why some people exposed to blast waves are impacted with memory loss and other symptoms, while others aren't.

Overall, the Defense Department estimates there are some 440,000 service members considered at high risk of blast exposure due to the types of jobs they do.

“The bottom line is that we have not proved cause and effect and no reliable diagnostic test for repeated blast brain injury exists today,” said Dr. Brian Edlow, a neurology professor at Harvard who helped to lead the military-funded study on active-duty special operations troops at Massachusetts General Hospital.

That lack of a diagnostic test is leaving many former service members in limbo.

Justin Andes, who left the Army in 2021 after firing what he estimates to be 12,000 mortars in three years, is still trying to get a diagnosis for a traumatic brain injury in the hopes it will cover specialized care at a VA treatment program in Pittsburgh.

Andes and his wife Kristyn say his personality changed dramatically after his service, with persistent short-term memory loss, hearing problems and impulse issues that weren’t present before joining the Army. But proving a traumatic brain injury without a single concussive event has been difficult, he said.

“I didn't even go overseas. It was all just training,” said Andes.

What Special Forces soldiers are doing differently now

At a remote training base in Fayetteville, North Carolina, U.S. Army Special Forces are testing new technologies to measure blast exposure and changing how they train to reduce exposure.

“Shoot houses,” where commandos practice breaching doors and close-quarters combat, have been redesigned to lessen the blast waves from their weapons. Rubber walls now replace concrete and steel. Roofs are raised to release pressure into the open air.

To reduce overpressure when breaching doors, officials there began 3D printing a new device called a Muchete that redirects the energy from door charges.

Helmets also are being redesigned, with engineers looking at improved helmet sensors and possibly spray foam as one way to absorb pressure waves.

Troops on base have begun wearing scarves or balaclavas when firing weapons, due to research that found it’s likely blast waves enter the skull through cavities in the skull like the ear, nose and mouth. Training schedules also now account for blast exposure, giving troops breaks in between certain drills that use heavy blasts like door charges.

“It's a very complex problem. We have science now to provide some clues, but, quite honestly, it's still very much an unknown,” said Maj. Allison Brager, a command research psychologist for the John F. Kennedy Special Warfare Center at Fort Liberty.

With answers expected to take as much as a decade, Brager said the new approach is focused on prioritizing brain health the same way you might an expensive weapon system.

“When you think about the complexities of our jobs and decisions we’re asked to make, that requires the human brain,” she said. “And we need to preserve, protect and optimize and even enhance the human brain as much as possible.”

What happens next?

Officials say these kinds of “best practices” being developed by Army Special Forces and other special operations units are starting to make their way to conventional forces and across the broader military.

Starting next year in a potentially significant move, the military will require baseline cognitive tests for everyone entering the service, regardless of whether they will deploy. There are also new rules for how close troops should stand to certain weapons in training.

In the meantime, Smith says he believes his injuries have changed his brain to make him more creative. He is now studying art therapy and focused on his mental health, including avoiding drugs and alcohol, which can worsen symptoms.

Andes says he's focused on fatherhood and trying to figure out a long-term treatment plan. But he is hesitant to seek out even low-paying jobs out of concern his memory will fail him or he'll get too frustrated.

“I didn't plan on being stuck dilly-dallying around my house the rest of my life rather than having a career … I'm hoping to do things,” Andes said.

If you are struggling with thoughts of suicide or worried about a friend or loved one, call or text the Suicide & Crisis Lifeline at 988 for free, confidential emotional support 24 hours a day, seven days a week.