The Pentagon’s blueprint for curtailing military suicides, captured in 100-plus pages and 127 recommendations to Defense Secretary Lloyd Austin, is noteworthy for what it lacks — scant if any reference to preventing, better diagnosing and treating traumatic brain injuries, also known as TBIs.

Brain injuries are widespread among post-9/11 service members and veterans and are believed to be a significant contributor to suicidal behavior.

The document compiled by the so-called Suicide Prevention and Response Independent Review Committee forms the military’s response to the tragic problem gripping the military and veterans. From it will flow new preventative approaches and programs for addressing behavioral and mental health issues among service members — all important, to be sure.

But nowhere among the recommendations is there acknowledgment of a growing body of evidence that service members can be suffering from an aggregation of brain injuries over their military careers that can spiral into suicidal crisis.

An Iraq and Afghanistan war veteran shows brain scans from medical procedures he had done, outside the US Capitol in Washington, D.C., on August 1, 2022.

An Iraq and Afghanistan war veteran shows brain scans from medical procedures he had done, outside the US Capitol in Washington, D.C., on August 1, 2022. Green represents portions of the brain affected by toxic brain injury, blue represents traumatic brain injury, yellow represents anxiety and depression, and red represents post traumatic stress.(Photo by STEFANI REYNOLDS/AFP via Getty Images)

Traumatic brain injuries — which can be mild to severe and occur in training as well as combat — are suspected as a significant cause of suicidal behavior. A study published in the journal JAMA Network Open last month was the latest and one of the largest to shed light on the relationship between brain injuries in the U.S. military and suicide.

In the expansive assessment of 860,892 soldiers, “individuals with a history of military-identified TBI had significantly higher rates of new-onset mental health conditions than those without TBI. Increased risk for suicide was associated indirectly (through new-onset mental health diagnoses) and directly with history of TBI,” researchers found.

The study echoes findings from a far-reaching Navy-led analysis released earlier this year. Research published in the journal Frontier on Neurology found that exposure to munitions blast waves from combat and training may be causing brain injuries that result in serious and often deadly ailments such as depression, post-traumatic stress disorder (PTSD) and suicide.

In their analysis of data collected between 2011 and 2013 from 138,949 service members, researchers found that service members exposed to repeated incoming enemy blast waves had higher risks for PTSD and depression than those exposed to only one incoming blast or no blast.

Repeated exposure to both enemy blast waves and blasts during training or combat also increased the risks of migraines and PTSD.

Years of prior research with animals have already documented an association between exposure to pressure waves from munitions blasts, known as overpressure, and behaviors mimicking depression. But the new findings are particularly important because they validate that the same phenomenon is occurring in U.S. military members, echoing what some advocates for veterans have been saying all along as suicide rates have dramatically climbed.

“The current research suggests a similar pattern in humans, which may also inform our understanding of the possible associations between overpressure and suicide that has been posited elsewhere,” researchers from the Naval Health Research Center found.

All of which points to having in place effective monitoring of military forces for brain injuries. But there, too, the military is failing service members. A report from the Department of Defense’s oversight chief acknowledged the armed forces are inept at screening for traumatic brain injuries and for following up with those who suffer from them.

Taken together, the medical studies and the inspector general’s findings are a window into the suicide tragedy. They indicate that many service members may be suffering from brain injuries, while at the same time the military is bad at diagnosing them. The lack of effective screening and follow-up, combined with the prevalence of brain injuries, often described by military officials as the signature injury of the Afghanistan and Iraq conflicts, could at least partially explain the suicide crisis.

Military leaders are finally beginning to take more seriously the issue of blast waves in combat and training, this after 20-plus years in the global war on terror and as suicide rates among vets and service members have soared. Last August, for example, the Pentagon published a plan for its Department of Defense Warfighter Brain Health Initiative. It seeks to develop policies that prevent, identify and treat brain damage caused by combat or by repeated shakes and blasts during training.

But much more must be done. An essential first step is for Secretary Austin’s suicide prevention team to prioritize bringing on board medical experts versed in brain injuries unique to service members and work with them and the imaging industry to develop much more effective diagnostic tools.

Somewhere today a service member or veteran is ailing and will be treated for depression, PTSD or behavioral issue when what they are suffering from, and what is steering them to a suicidal precipice, is undiagnosed brain injury. That’s a tragedy within a tragedy.

Frank Larkin is a former Navy SEAL and served as the 40th U.S. Senate Sergeant at Arms. He is the father of a Navy SEAL son who died by suicide. Larkin is chair of Warrior Call. Follow Warrior Call on Facebook and X.

Veterans in need of emergency counseling can reach the Veterans Crisis Line by dialing 988 and selecting option 1 after connecting to reach a VA staffer. In addition, veterans, troops or their family members can also text 838255 for help, or visit VeteransCrisisLine.net for assistance.

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