A-3 Justification SOCOM Brain Health Policy 19-01.pdf

UNITED ST ATES SPECIAL OPERATIONS COMMAND

OFFICE OF THE COMMANDER

7701 TAMPA POINT BLVD.

MACDILL AIR FORCE BASE, FLORIDA 33621-5323

POLICY MEMORANDUM 19-01

MEMORANDUM FOR SEE DISTRIBUTION

SUBJECT: Comprehensive Strategy for Special Operations Forces Warfighter Brain Health

1. References.

a Deputy Assistant Secretary of Defense (SECDEF) memo. Designation of the JTS as a Defense Center of Excellence. dated 19 June 2013.

b. Department of Defense Directive (DODD) 5124.02, SUBJECT: Under Secretary of Defense for Personnel and Readiness (USD(P&R)), dated 23 June 2008.

c. DOD Instruction (DODI) 6040.47, Joint Trauma System (JTS), dated 28 September 2016.

d DODI 6490.11, DOD Poli<.,y Guidance.for Management of Mild Traumatic Brain Injury/Concussion in the Deployed Selling, Change I, dated I I June 2018.

e. DOOi 6490.13. Comprehensive Policy on Traumatic Brain Inju,y-Related Neurocognilive Assessments by the Military Services, dated 31 March 2017.

f. House of Representatives (H.R.) 2810, Section 734, FY/8 National Defense Authorization Act.

g. Joint Publication 4-02, Join/ Health Services Incorporating Change l , dated 28 September 2018.

h. JTS Clinical Practice Guidelincs,2018.

i. Memorandum from the Assistant SECDEF (Health Affairs). Traumatic Brain Injury:

Updated Definition and Reporting, dated 6 April 201 S.

j. Technical Manual (TM) J-23.25 (field Manual J-23.25) Shoulder-Launched Munitions including Change 1. dated 14 December 20 I 0.

k. U.S. SECDEF Memorandum. SUBJECT: Comprehensive Strategy and A ction Plan for Wmjighler Brain l-leallh, dated I October 2018.

l USSOCOM Chief of Staff (COS) Memorandum for Vice Director. Office of the Joint Staff dated 24 April 2018, SUBJECT: Traumatic Brain Injury Reporting/or Special Operations Forces.

socc SUBJECT: Comprehensive Strategy for Special Operations Forces Warfighter Brain Health

m. Directive-type Memorandum 17-004, DOD Expeditionary Civilian Workforce, 15 January

2017.

n. USSOCOM Directive 70-l , Acquisition Management System Policy dated 20 March 20 18.

2. Purpose. Implement a USSOCOM Comprehensive Strategy for Special Operations Forces (SOF) Warfighter Brain Health in accordance with (IA W) references (a) through (n).

1 Applicability. This po licy memorandum (PM) is applicable to Headquarters, U.S. Sp(:cial Operations Command (HQ USSOCOM), all USSOCOM Components, Joint Special Operations Command, and all Theater Special Operations Commands.

4. Background. Traumatic Brain Injury (TB!), particularly mild TRI (mTBI), often referred to as a concussion, is a signature injury of our military's conflicts and has s ignificantly increased in incidence since 9/ 11. Over 80 percent (%) of the TBI exposure accounted for within Department of Defense (DOD) reporting have been characterized as mTBI. These injuries can result from acute or repetitive impact, blast exposure, and acceleration or deceleration forces. Even though these injuries may be classi fied as mild. early diagnosis and treatment is essential, for optimal results. The effects of mTBI/TBI are myriad including the fo llowing symptoms, but not limited

to. changes in mood, headaches. dizziness, fatigue, difficulty sleeping, degraded cognitive performance, ncurologic deficits, and intracranial lesions. The potential long-term effects of exposures on brain health are unknown. Our pursuit of superior lethality and upholding the SOF truth of ''humans are more important than hardware." must be matched by a commitment to understanding. preventing, diagnosing, and treating TB I. This policy is intended to surveil SOF warfighters throughout their careers in terms of their exposures (including blast), TBI histories.

and cognitive/mental health status.

S. Discussion. Results from Neurocognitive Assessment Tools (NCAT), comprehensive histories and blast exposure monitoring can assist leadership with decision making by providing data for the early detection and treatment of injury. This policy, over the course of an Operator's entire career, will surveil exposures, objective cognitive performance. subjective symptoms, and objective data on cumulative blast exposure. This program, as part of a greater USSOCOM effort to capture longitudinal exposures, aims to proactively sustain and extend the lifecycle o four Forces and ensure optimal healthcare for our warfighters during and after service. The USSOCOM Surgeon, in close collaboration with the Directorate of Preservation o f the Force and Family (POTFF) and SOF Acquisition, Techno logy and Logistics (SOF AT &L), Directorate of Science and Techno logy (SOF AT &L-ST), will continue efforts to evaluate and advocate other techno logies and provide recommendations to inform and affect changes to this policy.

6. Definitions.

a TBI. Traumatic brain injury is a traumatically induced structural injury or phys iological disruption of brain function as a result o f an external force that is indicated by new onset or worsening of at least one of these clinical signs immediately following an event:

( 1) Any alteration in mental status (e.g., confusion. disorientation, slowed thinking).

(2) Any loss of memory for events immediately before or after the injury.

(3) Any period of decreased or loss of consciousness, observed or self-reported.

b. Neurocognitivc Assessment Tool (NCAT). A library of computer-based assessments of cognitive domains including attention. concentration, reaction time, memory. processing speed.

and decision-making. It may be used serially to assess changes in cognitive status over time.

c. Automated Ncuropsychological Assessn1ent Metrics (ANAM). One o f several commercially avai lable neurocognitive tools.

d Comprehensive Assessment and Symptom History (CASH). Comprehensive history taking interview and series of brief questionnaires, administered by medical personnel, in order to obtain exposure histories and subjective symptoms.

e. SOF Warfighter. For the purposes of this policy. SOF warfighters are defined as personnel ·who have undergone Assessment and Selection (A&S) and who have received specialized qualification training for assignment to a unit within USSOCOM. Inclusion of at-risk SOF enablers and DOD civilians may be included based on unit policy.

f. SOF Enabler. Personnel assigned to USSOCOM by their respective Services that do not require A&S and specialized qualification training.

7. Policy and Procedures.

a Neurocognitive Baseline Testing. All SOF warfighters will undergo computerized neurocognitive assessment testing using a NC AT.

( I) The USSOCOM designated NCAT is the Automated Neuropsychological Assessment Metrics, Version 4 Mil Expanded (ANAM4), until such time as evolving science. technology capabilities and medical best practices inform a change in policy.

(2) Testing will be administered after completion of A&S at the start of SOF qualification training. Units w ill test all SOF qualified warfighters without a documented NCAT.

(3) SOF warfighters will be non-deployable until a baseline ANAM4 is recorded. DODI

6490.13 requires a pre-deployment neurocognitive assessment. using ANAM4. within 12 months before deployment for all personnel.

(4) The USSOCOM designated NCA Twill be repeated at least every 3 years after initial baseline testing and following a diagnosed concussion or mTBI IA W reference (e).

(5) Units will report completion rates of neurocognitive testing to the USSOCOM COS via USSOCOM Office of the Command Surgeon (SOCS-SG) on the first duty day of the month until otherwise directed. NCA T baselining will be I 00% complete 6 months after the date of this policy memorandum.

(6) NCA Ts wi II be used to screen for cognitive changes as part of a clinical evaluation and will not be used as a standalone diagnostictool.

(7) Data w ill be uploaded into the database as prescribed by the designated NCA T until such time as automated entry into the electronic health record (EHR) is available.

b. CASH. All SOF warfighters will undergo a CASH.

(I) CASH will be administered within 12 months after completion of qualification courses.

Units will administer a CASH to all SOF qualified warfighters without a documented CASH.

(2) CASH data will be uploaded into a designated database. Until such time in which a database is available to allow automated entry into the EHR is available, CASH data will be scanned and entered manually into the existing EHR.

(3) CASH will be updated at least every 5 years.

(4) Units will report completion rates of CASH to the USSOCOM COS via USSOC'OM SOCS-SG on the first duty day of the month unti l otherwise directed. Initial CASH will be I 00% complete 12 months after resources become available.

c. Blast Exposure Monitoring.

(I) USSOCOM personnel who may be exposed to blast in combat and/or training shall wear the Black Box® Biometrics Blast Gauge TM System (NSN 6665-01-632-3508, 6665-01-665-8243), if and when available. Examples of blast inc lude. but are not limited to, explosive breaching. mine detonation, mortars and artillery firing, grenades (including flashbangs). and shoulder-fired munitions. Alternate systems may be identified as they are tested and validated for effectiveness by the USSOCOM SOCS-SO and/or applicable Program Management Office.

(2) USSOCOM personnel with blast exposure that exceeds moderate and severe thresholds which causes a yellow or red indicator light on the blast gauge will be evaluated by medical personnel at the earliest possible opportunity.

(3) Failure of a blast gauge to reveal a yellow or red indicator light due to moderate or severe blast exposure will not be used to rule out TBI due to blast exposure or impact. Any service member who reports symptoms of TB! after blast exposure or impact will be evaluated by medical personnel at the earliest possible opportunity with every attempt to perfonn the evaluation immediately and/or within 6 hours' time frame.

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(4) Cumulative data from blast gauges of personnel exposed to blast in combat and/or training will be downloaded at a minimum of eve ry 6 months and placed in a designated database, once established for longitudinal exposure tracking. Until a database is established units wi ll store data locally if possible.

8. Training Limitations for Shoulder-Fired Munitions. Overpressure and noise created by firing shoulder-launched munitions requires special precautions during training. To reduce these hazards. firers must observe the firing limitations shown in Enclosure I , Tables.

9. Working Group. USSOCOM Command Surgeon shall charter and chair a working group including. at a minimum, USSOCOM POTFF, SOF AT&L, and Service Component representation to outline the parameters necessary to transition applicable portions of this policy into either Service common or SOF-Pecu liar Program of Record IA W reference (n). The working group shall be entitled the SOF Protection. Assessment. Rehabilitation, and Treatment of Neuro health (SPARTAN) working group.

a SPARTAN will address, at a minimum the following:

(I) Basis of procurement and issue plan for fielding of blast gauges.

(2) Mechanism for computer-based NCAT and CASH.

(3) Mechanism to record computer-based NCA T results. blast exposure data. and CA SH into the EHR.

(4) Identification of knowledge gaps for action by USSOCOM SOF AT&L.

(5) Automated mechanism to report and monitor NCA T, CASH and blast gauges compliance and readiness requirements.

b. SPARTAN working group will in form the Defense Veteran' s Brain Injury Center(DVBIC) and the JTS on significant data collection and analysis outcomes. SPARTAN will coordinate with JTS for a USSOCOM Functional Combatant Command specific Clinical Practice Guidelines. if deemed necessary.

c. In conjunction with the SOF Biomedical Research and Advisory Group, SPARTAN will have a secondary mission to draft, staff, and publish documents necessary to identify and pursue solutions to SOF capability shortfalls and provide subject matter expert assessment and feedback of associated products. proposals, and activities.

d. SOFA T & L will provide materiel solutions against identified and validated requirements for protection of brain health.

10. TRI reporting.

a Potentially concussive events (PCE) and concussions will be reported and treated IA W reference (d) and (I).

b. All individually identifiable information collected on services members wi ll be protected as outlined in reference (d).

t 1. Responsibilities.

a Component Commanders. Ensure all SOF Warfighters receive a baseline NCAT and CASH. Track compliance rates for your command and subordinate commands.

b. Unit Commanders. Ensure all SOF Warfighters receive a periodic NCAT at least every 3 years and/or within 12 months of deployment. Ensure proper evaluation of potentially concussive events occurs as close to the time of injury as possible, IA W reference (d). Ensure education for TBI awareness, recognition (signs, symptoms) and reporting for all subordinate leaders and service members.

c. Senior Medical Officer. Ensure medical personnel are aware and knowledgeable of the policy requirements. Ensure medical personnel are trained and proficient in evaluation of PCEs using Military Acute Concussion Evaluation. Version 2. until such time evolving science.

technology capabilities and medical best practices inform a change in policy.

12 Additional Guidance.

a Commanders, Surgeons. and Officers in Charge (OICs) at lower echelons are authorized to implement more stringent local policy at their discretion.

b. Commanders, Surgeons, and OICs at lower echelons are authorized to broaden the definition of SOF warfighters.

11 Proponent. The proponent for this PM is the USSOCOM Office of the Command Surgeon (SOCS-SG). This policy expires 2 years from the date of publication or upon inclusion into or creation of a USSOCOM publication.

(SOCS-SG)

I Encl as

DISTRIBUTION: A, B. C. D

RAYMOND A. THOMAS Ill General, U.S. Army Commander

ENCLOSURE I

RANGE FIRING LIMIT A TIO NS

TABLE A: RANGE FlRING LlMlTATIONS DURING TRAINING.

MUNITION ASSOCIATED MAXIMUM ROUNDS THAT MAY BE FIRED

MATERIAL IN A 24-HOUR TRAINING PERIOD

Prone I

Ml41 BDM TM 9-1340-228-10 , ::>ttt111g 0

Kneeling 3

Standing s Prone D

Ml36 AT4 TM 9- 131 5-886-12 Sitting I

Kneeling 3

Standing 3

Prone 70 Ml36AI AT4CS TM 9-1315-255-13 Outdoor (with Sitting 0 single ear Kneeling 14 protection) Standing 28

Prone 0 Indoor (with Sining 0 ~ombat earplugs)

Kneel ing D

Standing I

M72A2/A3 TM 9-1340-2 14-1 0 f4 (for Soldier firing the munition and personnel

M72A7 TB 9-I 340-230-1 3 rwithin 20 meters or the launcher. given that properly 'itted, approved earplugs are worn)

NOTE: Shoulder-launched munitions TMs ex.plain four firing positions: standing, kneeling.

sitting. and prone. Although shoulder-launched munitions can be tired from the four positions. the sitting and prone positions increase the chances that blast/overpressure will injure the firer.

Soldiers should bt: trained on assuming the four firing positions, but only live fire from the standing and kneeling positions.

ENCLOSURE 1 (Cont.)

RANGE FIRING LIMJTATIONS

TABLE B: RANGE FIRING LIMITATIONS DURING TRAINING FOR M3/M3Al

CARL GUSTAV) TM 9-1015-262-10.

FIRING POSITION

ROUND TYPE (FIRING FROM FOXHOLE OR ENCLOSURE IS PROHIBITED)

STANDING KNEELING SITTING PRONE

TP 552 6 rounds 6 rounds 2 rounds 0 rounds HEAT 55 1C RS 6 rounds 4 rounds 6 rounds 6 rounds HE 441D RS 10 rounds 4 rounds 3 rounds 9 rounds HEDP 502 RS IO rounds 4 rounds 3 rounds 9 rounds

ADM 40 1

6 rounds 6 rounds 3 rounds 4 rounds (all variants) SMOKE469B 4 rounds 6 rounds 4 rounds 2 rounds ILLUM 545C 6 rounds 6 rounds 6 rounds 0 rounds TPT 141 IO rounds 4 rounds 3 rounds 9 rounds SCA 5538 33 rounds 33 rounds 33 rounds 33 rounds ASM 509 6 rounds 6 rounds 6 rounds 6 rounds