The Crossroads of Special Operations

Thursday, May 13, 2021


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Our military has almost 200-thousand troops deployed around the world. We are still at war in Afghanistan, Iraq and Syria..
The number of U.S. military injuries and deaths tops 58-thousand for just the Iraq and Afghanistan wars alone. That doesn’t count suicides and a related, silent destroyer you probably haven’t heard much about that’s of growing concern: concussions our warriors get in training and in action. Today, we begin with Ryan’s story… an elite Navy SEAL whose sacrifice may help save others, even in civilian life.


Frank Larkin was Sergeant at Arms—the chief law enforcement officer—for the U.S. Senate until last March.
That’s him leading President Trump into the State of the Union address…
Larkin is also an American warrior— he was a member of the Navy’s elite Sea, Air and Land special operations team known as the SEALs.

His son Ryan followed in his footsteps— also a highly-decorated Navy SEAL who did four combat tours in Iraq and Afghanistan.

Last October, Ryan was laid to rest at Arlington National Cemetery.
This is the story of a high-performing, highly  rated Navy SEAL who served his nation with valor, became injured as a result of that service, and was left behind. He had made statements such as, “You know, it’s going to take guys killing themselves before the system wakes up that they’ve got a problem.” He also said that, “I’m not going to live to an old age. I’m broken inside. Something’s wrong inside my head. Nobody’s listening.”

At age 29, Ryan took his own life.

On the morning of Sunday, April 23rd, we had come home from an overnight trip and found that he had taken his life in the basement of our home. Ryan was dressed in his SEAL Team 7 t-shirt.  He had illuminated a shadow box that contained his ribbons, medals, and other insignia.

Ryan long believed he suffered Traumatic Brain Injury from concussions during his military service. But he was unable to get the diagnosis or effective treatment.
He said, “If anything ever happens to me, I want my body used for Traumatic Brain research.” So on that horrible day of April 23rd, on his behalf, donate his brain for that study.

Ryan’s story and the analysis of his donated brain tissue are helping open doors…revealing how a soldier’s post traumatic stress may be exacerbated—  or even caused — by brain injuries.
Can you just give an example of the sorts of things they’re exposed to that can cause them concussive injuries or brain injury?
Ryan was a sniper, so he fired high caliber sniper weapons. The 50-caliber category use an awful lot of pressure. Exposure to IEDs of which the battlefield was littered with IEDs…
…Indirect fire from enemy mortars, firing our own mortars back at the enemy in combat. There’s a variety of sources that can cause concussive effects that ultimately could result in damage.
Because the damage is invisible on regular MRI scans, doctors long lumped the mysterious suffering of brain-injured troops under the catchall of “Post Traumatic Stress Disorder.”

But a sea change began in 2011.

What new do you know today since 2011 about this?
Probably more has been discovered from 2010 to today than in the entire history of science before 2010, because there’s been so much interest and attention focused on this problem.

Neurologist David Brody heads up Traumatic Brain Injury research at the Uniformed Services University. He helped lead a landmark study in 2011.

Before that, Traumatic Brain Injury, a concussion, was something you just shrugged off. “Are you hurt? Are you injured?” You just got back up and went back at, both in sports and the military, and in real life. We recognized around that time that there were real serious consequences of concussive traumatic brain injury that there was a lot more injury than people had previously recognized.

Dr. Brody and his team were first to use a new MRI technique called “diffuser tenser imaging” on soldiers. That allowed them to examine axons, the most vulnerable part of the brain, where long wires transmit information like celery stalks move water.

But after injury, the brain’s axons become like celery soup— same color, smells like celery— but now water diffuses in all directions. We can use diffuser tenser imaging to tell the difference between celery and celery soup in the brain.

The results were shocking. Brains that looked normal on regular MRI scans were obviously damaged when imaged using the new technique. Dr. Brody found abnormalities in nearly one third of the soldiers who’d been injured in blasts.

How many men and women in the military do you think are subjected to this potential type of injury, whether they’re in the training or they’re actually out in the field being exposed to this?
The official numbers are that there’s about 375,000 U.S. military service members [00:05:00] that have had traumatic brain injury from 2001 until the present. We think the real numbers may be substantially higher than that. It’s probably maybe twice that many.
What percentage is that of the military?
Dr. Brody: Some estimates are that between 10 and 20% of deployed military service members have a brain injury during [00:05:30] their deployment.

The findings led to new military directives on how to detect and treat brain injury from explosive concussions. Yet heroes like Ryan are still slipping through the cracks years later… He never even had an exam using the special MRI technique.
That’s not something that a regular doctor can just order. I think he had conventional scans, as far as I can tell.

How did it come to your attention that he perhaps had brain injury?
It’s when he had the second, third tours that were back-to-back,, that we noticed that he wasn’t the Ryan that we saw enter the Navy. The wheels kind of came off. We saw an amplification of the anxiety. We saw depression ebb and flow. He was having problems with disorganization. A lot more issues with memory. Alcohol played a role. As he was trying to get to sleep, he was not having a lot of success with the medications that they were putting him on.
He started suffering what I call is systematic injury of, you know, they started hanging labels on him. Substance abuser, alcohol abuser, prescription drug abuser, treatment failure, operationally unfit. This just created more wounds. For somebody that had literally been a top-rated operator,to now have to wear these labels was something that was very much a struggle for him.

Ryan’s journal reveals desperation and despair: “I need treatment for [Post Traumatic Stress Disorder] PTSD & [Traumatic Brain Injury] TBI,” he wrote. And speaking of his honorable but forced discharge: “I have been separated from everything that I love..”

Ryan’s brain revealed telltale scars of concussive injury visible under a microscope after death.

Even if he’d been diagnosed with Traumatic Brain Injury in life— there’s no cure. Only intensive treatment for symptoms: headaches, mood disorders and sleep problems.

What would you say is an important key to someone like Ryan Larkin, who’s seeking help and feeling all these things you describe, and things aren’t working for him?
I’m not sure if there’s any one key, but the biggest thing is compassion and not giving up on the patients [00:20:30] and not giving up on the families. We’re working really hard to find new MRI methods that will be able to see that scarring right at the junction between gray and white matter that I mentioned earlier. But we’re not there yet. There’s clearly a lot more research needs to be performed before we’re able to make a definite diagnosis of somebody like Ryan Larkin while he’s alive, and that’s the ultimate goal.

When we return.. A look at how the science is pushing changes in combat training..  and the impact it could have on all of us in civilian life, too.


When we began investigating Traumatic Brain Injury in our troops, it sounded a -lot- like the highly-publicized controversy over NFL concussions. So why has there been so little public discussion about our troops? As it turns out, the military science could have important applications for civilian life.

Just before this year’s Super Bowl 52, the National Football League released figures on how many concussions had been reported during the season: 291—a number on the rise.

“Look, it’s like smoking cigarettes— playing pro football, you shouldn’t need a surgeon general’s report to know it’s bad for you.”
Concern over sports concussions is prompting change at every level… down to pee-wee leagues.

But the number of NFL concussions is dwarfed by the lesser-publicized problem of Traumatic Brain Injury from concussions in the military… estimated at well beyond 22-thousand per year

To look at what’s happening with the NFL attention on concussions and the military attention on concussions. What are your observations about that?
I’ve been involved directly in both of them.

Dr. David Brody is a lead researcher of Traumatic Brain Injury in the military.

Before I came here, I was at Washington University in St. Louis. I was the director of one of the retired player care programs for National Football League players. I saw quite a few retired NFL players in my clinic and took care of them as my patients. There are a lot of similarities between the retired players and the military service members. There’s also some substantial differences. The other thing that’s different is that sports concussions occur in basically a friendly environment. No one’s shooting at you. The guy next to you didn’t get blown up and lose both legs. The guy on the other side of you didn’t get killed.  The combination of injury and the stress of war is completely different.
And worse.

By definition, war is chaos. But the military is moving quickly to limit exposure on the field of fire they -can- control: Training.

I’m sure I got it as much from training, because the type of equipment that we use is going to give it to you.

Dave hall is a former Navy SEAL who continued to serve even after he almost lost his leg in a 2004 explosion in Iraq.

My friends, my peers that have it, I think you almost have to fall off the edge and survive it,Otherwise, it’s so insidious, it’s like being gassed in your sleep. You don’t really know that that’s what it is that’s encroaching on your life.

The head the Naval Special Warfare Command is addressing the growing concerns by calling for a list of changes including:
– Limiting and monitoring explosive training
– Identifying and treating Traumatic Brain Injuries earlier
– And what would be one of the most important initiatives: baseline screening.

That means establishing the health of the soldier’s brain on the front end to have something to compare it to later.
I just think monitoring it is one thing. Getting a baseline of people that are coming in and seeing, okay, where was the place where they diverged? [00:11:00]

Hall says addressing the issue head on… is necessary to keep the U.S. military strong.

Ultimately, I think the force is going to hit a point where the word gets out there to these young men. There’s so many young men that are super fit that want to be SEALs because we’re like legend in popular culture right now. When that shifts to, “Hey, you know that’s a really bad career path, you’re probably going to come in, your brain’s not going to be right, and if you start acting a little bit squirrely, the leadership is probably going to throw you out with a characterization that you can’t probably even get a job washing cars in a parking lot.”

The science and solutions are a work in progress. But something that could ultimately help civilians, too:
Why does this matter to you? This matters to you because if you have a son or a daughter has concussion after a soccer game or football or car accident or a fall or assault//we need to be able to detect it so that we can treat it appropriately in the future. Just as in all of history war has led to advances…we hope that this technology we’re learning about to visualize the invisible wounds of war will translate to improve concussion care for everyone, of young, our families, in civilian care.

Dave Hall  sees Ryan Larkin as a hero—he’s the Navy SEAL who tried to flag the problem… ultimately took his own life…and donated his brain to Traumatic Brain Injury research.

But looking at the whole thing now, you go, “Oh my god, this guy had the moral courage to say, ‘Hey, I have a problem.’” And I think a lot of it was because he saw it happening to his peers as well and thought, “Well, if you’re not going to say something, I will. And then maybe we’ll all get helped.”
Ryan served his country honorably. He was a brave, young man. It almost strikes me as if he was killed in action.
Frank Larkin: He was. He just didn’t die right away.

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