Department Of Defense Policy Research Articles

Balancing Expectations: Navigating Medically Necessary Torso Procedures with Cosmetic Components in the Military Healthcare System.

Surgeons performing federal insurance-financed procedures involving medically necessary and cosmetic components must navigate patient expectations to avoid postoperative disappointment. This challenge is amplified in military healthcare, where different surgical specialties concurrently address the same diagnosis, while the Department of Defense policy on cosmetic fees and TRICARE's definition of excluded services adds further complexity. With the increasing prevalence of elevated body mass index, focus is directed toward diagnoses involving the torso, specifically gynecomastia in male individuals, and diastasis of the rectus abdominis muscles (DRAM) in female individuals. The study involves a team of experienced board-certified surgeons conducting a narrative review of surgical procedures addressing gynecomastia and DRAM. Relevant literature from 2000 to 2023 is reviewed, focusing on patient satisfaction regarding outcome of medically necessary and cosmetic aspects. For gynecomastia, distinguishing between true and pseudogynecomastia is critical. A protocol is presented based on the Simon classification, offering evidence-based guidelines for surgical interventions. Similarly, for DRAM, a minimally invasive approach balances deployment readiness and surgical recovery. The presence of a symptomatic panniculus, however, requires more invasive intervention. The downstream ramification of limited Current Procedural Terminology codes for these interventions is discussed. In medically necessary procedures funded through federal health plans such as TRICARE, the primary goal is functional improvement, not the final torso contour. Clear communication and preoperative counseling are crucial to managing patient expectations. Providers in military healthcare must navigate the complex landscape of patient expectations, policy guidelines, and duty readiness while maintaining the standard of care.

A comparison of fracture response in female and male lumbar spine in simulated under body blast component tests

Underbody blasts (UBB) from mines and improvised explosive devices in military combat can cause debilitating spine injuries to vehicle mounted soldiers. Due to the exclusion of females in combat roles in prior US Department of Defense policy, UBB exposure and injury have predominantly affected male soldiers. Recent policy changes have opened many combat roles to women serving in the US Military (Carter, 2015) and have increased the need to understand the injury potential for female Warfighters. The goal of this study was to investigate the fracture response of adult female lumbar spines compared to adult male spines in UBB relevant loading to identify potential differences in either fracture mechanism or force. Results are presented for 15 simulated UBB spine compression tests using three small female (SF), five large female (LF), and seven mid-sized male (MM) post-mortem human subjects (PMHS). These PMHS groups align to 5th- and 75th-percentile female and 50th-percentile males, based on height and weight from the 2012 Anthropometric Survey of U.S. Army Personnel (Gordon et al., 2014). Both small females and large females (similar in size to the males) were included to assess the role of size and/or sex in the response. Tests were conducted at Virginia Tech on a cam-driven linear compression rig, which included a 6-axis load cell and ram accelerometer to evaluate the fracture. Fracture was visualized through high-speed x-ray video. All female and male spines exhibited similar fracture initiation at the end plates and progression through the vertebral body. The resulting severe compression and burst fractures were representative of reported theatre injuries (Freedman et al., 2014). Mean axial fracture forces were −4182 ± 940 N (SF), −6225 ± 1180 N (LF), −5459 ± 1472 N (All Females) and −7993 ± 2445 N (MM). The SF group was found to have statistically significant differences in mean fracture force compared to both LF and MM groups, while no significant difference was found between LF and MM groups, although the mean force at initial fracture was lower for the LF group. The All-Females group Fz mean was significantly different from the MM group. These data suggest that the significant difference in weight between the SF and LF groups, did have an influence on the Fz outcome, when controlling for sex. Conversely, controlling for size in the LF and MM comparison, sex did influence the mean Fz, but was not statistically significant. Groups with combined sex and size differences, however, did show significant differences in mean Fz. Further study is warranted to understand whether sex or size has a larger effect on fracture force. Mean ram displacement (spine compression) values at fracture initiation were −6.0 ± 5.3 mm (SF), −4.4 ± 0.8 mm (LF), −5.0 ± 3.0 mm (All Females), −6.2 ± 4.5 mm (MM). Spine compression did not seem to be largely influenced by either sex or size, and none of the groups was found to have significant differences in mean displacement values.

Securing Commercial Satellites for Military Operations: A Cybersecurity Supply Chain Framework

The increased reliance on commercial satellites for military operations has made it essential for the Department of Defense (DoD) to adopt a supply chain framework to address cybersecurity threats in space. This paper presents a satellite supply chain framework, the Cybersecurity Supply Chain (CSSC) Framework, for the DoD in the evaluation and selection of commercial satellite contracts. The proposed strategy is informed by research on cybersecurity threats to commercial satellites, national security concerns, current DoD policy, and previous cybersecurity frameworks. This paper aims to provide a comprehensive approach for safeguarding commercial satellites used by the DoD and ensuring the security of their supporting components. Inspired by the National Institute of Standards and Technology (NIST) 800-171 requirements and the DoD’s future Cybersecurity Maturity Model Certification (CMMC) process, the two-part framework significantly streamlines the NIST requirements to accommodate small businesses. It also extends key NIST requirements to commercial-off-the-shelf (COTS) suppliers. The CSSC Framework complements the CMMC certification process by addressing the need for cybersecurity requirements for all subcontractors supporting a commercial space asset. The framework incorporates a scoring process similar to CMMC scoring, granting points to a subcontractor for meeting the cybersecurity requirements outlined by the framework. In addition, the framework creates a space architecture overview that details the overall bid score and establishes a matrix based on individual requirements. This model and matrix allow DoD acquisition personnel to closely analyze each contract bid, comparing the subcontractor's strengths and weaknesses to other bidders. The CSSC Framework will allow the DoD to apply NIST standards to subcontractors who do not meet the requirements for CMMC certification.

Analysis of the U.S. Military Trauma System in Accordance With Doctrinal Levels of Warfare.

In recent conflicts, the Joint Theater Trauma System (JTTS) led the systematic approach to improve battlefield trauma care, substantially contributing to the unprecedented survival of combat casualties. The Joint Trauma System (JTS) was codified in 2016 to preserve the lessons learned and functions of the JTTS, including the Department of Defense Trauma Registry. Concurrently, Combatant Commands (CCMD) were directed to establish CCMD Trauma Systems (CTS) "modeled after the JTTS" and to maintain a baseline of core functions intended to rapidly scale as needed. The complex nature of both CCMDs and the military trauma system has challenged the full implementation of the CTS. Analyzing the historical experiences of the JTTS, JTS, and CTS within a military doctrinal framework might enable the further success of the military trauma system. The strategic, operational, and tactical levels of warfare, in accordance with Joint Publication 1-0, Doctrine of the Armed Forces of the United States, and Joint Publication 3-0, Joint Operations, established the analytic framework for this study. The literature regarding the JTTS, CTS, and JTS was reviewed for relevant information concerning organizational structure and functions of trauma system performance improvement (PI) capabilities. A comprehensive analysis was performed using a thematic approach to evaluating descriptive data contained within the collected data set. Deployed trauma system PI tasks, functions, and responsibilities were identified, defined, and correlated according to the respective levels of warfare. The comprehensive analysis revealed both discrete and overlapping tasks, functions, and responsibilities of the trauma system PI capabilities at each of the three levels of warfare. Strategic-level actions were categorized according to 12 distinct themes: reduce mortality; strategic reporting; centralized trauma registry; strategic communications; centralized organization; direct support to CCMDs; Department of Defense policy and doctrine; strategic-level PI; clinical practice guidelines; training and readiness standards; force structure, standardization, and interoperability; and research and development. Operational-level actions were categorized according to seven distinct themes: theater trauma system policies and requirements; theater trauma system leadership; stakeholder coordination; theater communication; theater standards for readiness and skill sustainment; trauma system planning; and medical logistics support. Tactical-level actions were categorized according to seven distinct themes: trauma system personnel; PI; documentation enforcement and patient care data collection; tactical planning recommendations for employing medical assets; research support; communication and reporting; and training and skills sustainment. The deployed U.S. military trauma system requires a robust PI capability to optimize combat casualty care. Policy updates, a joint military trauma system doctrine, and force design updates are necessary for deployed military trauma system PI capabilities to function optimally across all levels of warfare.

Cheaper tobacco product prices at US Air Force Bases compared with surrounding community areas, 2019

IntroductionIn March 2017, the US Department of Defense (DoD) implemented a policy requiring all military stores to set tobacco prices equal to ‘prevailing prices’ in the ‘local community’ adjusted for...

Associations of Low-Inflammatory Dietary Patterns With Psychological Health and Wellbeing During Weight Loss in Military Family Dependents

ObjectivesEmerging evidence suggests that anti-inflammatory dietary patterns may improve depression, stress, and quality of life. Similar benefits are observed during weight loss interventions; however, the effect of combining these dietary patterns with weight loss is not clear. We evaluated the association between dietary inflammation and measures of psychological health in female military dependents with overweight and obesity during a behavioral weight loss intervention. MethodsParticipants (n = 120) received a 6-month intervention recommending dietary patterns with an anti-inflammatory profile. An energy-adjusted dietary inflammatory index (DII) score was calculated from 28 food components collected using 3 interviewer-administered multiple-pass 24-hour recalls at each study time point. A negative score indicates a lower-inflammatory dietary pattern, and a positive score indicates a pro-inflammatory pattern. Self-reported symptoms of depression, stress, general health, vitality, and psychological quality of life were measured by validated questionnaires. Multivariable linear mixed models were used to assess the association between 6-month changes in DII and each outcome and were adjusted for age, ethnicity, military rank of spouse, body weight, and physical activity. ResultsOn average, females were 42.2 ± 11.8 years old with a body mass index of 34.9 ± 6.4 kg/m2. The average DII score was 0.07 (range: –4.3, 3.0) at baseline. Six-month improvements in DII scores (i.e., for a 1-unit reduction) were associated with fewer self-reported symptoms of depression (β: –0.87; 95% confidence interval: –1.43, –0.31; P = 0.003) and stress (–0.85; –1.44, –0.26; P = 0.005), as well as higher general health (0.57; 0.23, 0.91; P = 0.001), vitality (0.45; 0.12, 0.77; P = 0.008), and psychological quality of life (0.33; 0.11, 0.55; P = 0.004). No significant associations between weight loss or physical activity and any outcome were observed in these models that included the DII. ConclusionsAnti-inflammatory dietary patterns are associated with beneficial effects on a range of psychological health and wellbeing measures independent of weight loss. Funding SourcesJean Mayer USDA Human Nutrition Research Center on Aging Doctoral Scholarship; Department of Defense (DoD) grant W81XWH-14–2-0005 (SBR). Author views do not reflect official DoD or Army policy.

Tiers for Education and Training in Global Health for Military Engagement.

This article describes four tiers for knowledge required by U.S. military personnel to effectively execute global health activities. Department of Defense policy does not identify a formal global health education path for personnel responsible for global health activities. Department of Defense must implement formal education programs to improve mission success and favorable health outcomes.

The Current and Future State of Department of Defense (DoD) Microbiome Research: a Summary of the Inaugural DoD Tri-Service Microbiome Consortium Informational Meeting.

The Tri-Service Microbiome Consortium (TSMC) was recently established to enhance collaboration, coordination, and communication of microbiome research among Department of Defense (DoD) organizations. The TSMC aims to serve as a forum for sharing information related to DoD microbiome research, policy, and applications, to monitor global advances relevant to human health and performance, to identify priority objectives, and to facilitate Tri-Service (Army, Navy, and Air Force) collaborative research. The inaugural TSMC workshop held on 10 to 11May 2017 brought together almost 100 attendees from across the DoD and several key DoD partners. The meeting outcomes informed attendees of the scope of current DoD microbiome research efforts and identified knowledge gaps, collaborative/leveraging opportunities, research barriers/challenges, and future directions. This report details meeting presentations and discussions with special emphasis on Tri-Service labs' current research activities.

The historical roots and future directions for military law and policies on rape and sexual assault

ABSTRACTThe time in which rape has been a crime tried in the military criminal justice system is remarkably short. For much of the nation’s history, military members accused of common law crimes were tried in civilian courts established under Article III of the Constitution. The exception was during periods when the nation was at war. A continuous jurisprudence of military rape law did not begin until the late 1980s. Since that time, an avalanche of sexual assault scandals, legislation, task forces, and commissions have driven the issue to the forefront of public interest. While change was glacially slow for decades, the last 10 years have brought about some of the most dramatic changes in military justice since the Uniform Code of Military Justice (UCMJ) was established in 1950—changes driven almost entirely by the sexual assault debate. Congressionally chartered advisory committees like the Defense Task Force on Sexual Assault in the Armed Forces, the Response Systems to Adult Sexual Assault Crimes Panel, and the Judicial Proceedings Since Fiscal Year 2012 Amendments Panel have recommended many of the reforms to law and policy now in place regarding the military’s response to sexual assault allegations. Nonetheless, several key reforms are still waiting, including improved collection of sexual assault data and program performance metrics and a more precise definition in Department of Defense policy of what conduct constitutes sexual assault.

Defense and Veterans Brain Injury Center: The First 25 Years

Defense and Veterans Brain Injury Center: The First 25 Years

Publicly Available Information: Modernizing Defense Open Source Intelligence

As the realm of Publicly Available Information continues to be codified by the U.S. Department of Defense (DoD), it is time to redefine the Open Source Intelligence (OSINT) discipline to leverage the digital data domain effectively. This article recommends focusing on the modernization and redefinition of Defense OSINT to yield the best results. It highlights the value of the proliferation of OSINT sources in the Digital Age. This article recommends professionalizing Defense OSINT by establishing an enlisted military OSINT occupation, identifying specialized OSINT skills for recruitment, documenting OSINT best practices, standardizing Defense OSINT training, establishing a service lead to leverage industry experts, and updating all relevant DoD policy and Service regulations. It also includes a brief account of policymakers urging these types of changes.

Transforming Transformers into Militainment: Interrogating the DoD‐Hollywood Complex

AbstractThis article examines how the U.S. Department of Defense (DoD) and Hollywood collaborated to manufacture the blockbuster films Transformers (T) and Transformers: Revenge of the Fallen (TRF) to sell in global markets and to sell a positive image of DoD personnel, policy, technology, and practice to the world. T and TRF are global militainment films made by the “DoD‐Hollywood complex” to make money in markets and put the U.S. military before the world in a positive light. To show how, the article's first section defines the “DoD‐Hollywood complex,” presents a brief 20th‐century history of its formation, and describes the current DoD institutions, policies, and practices that fuse DoD publicity agencies to Hollywood filmmakers. The second section highlights how DoD assisted T and TRF's production and contemplates why Hollywood solicited DoD support. The third section shows how T and TRF put DoD in a positive light. The conclusion addresses some of the consequences of T and TRF with regard to democratic theory. By showing T and TRF to be global militainment commodities, this article interrogates the nexus of “reel” and “real” U.S. military power and sheds light on how DoD interacts with Hollywood studios to influence how it gets screened by entertainment media and seen by global spectators.

Evaluating MEDEVAC Force Structure Requirements Using an Updated Army Scenario, Total Army Analysis Admission Data, Monte Carlo Simulation, and Theater Structure.

In this study, we re-evaluate air ambulance requirements (rules of allocation) and planning considerations based on an Army-approved, Theater Army Analysis scenario. A previous study using workload only estimated a requirement of 0.4 to 0.6 aircraft per admission, a significant bolus over existence-based rules. In this updated study, we estimate requirements for Phase III (major combat operations) using a simulation grounded in previously published work and Phase IV (stability operations) based on four rules of allocation: unit existence rules, workload factors, theater structure (geography), and manual input. This study improves upon previous work by including the new air ambulance mission requirements of Department of Defense 51001.1, Roles and Functions of the Services, by expanding the analysis over two phases, and by considering unit rotation requirements known as Army Force Generation based on Department of Defense policy. The recommendations of this study are intended to inform future planning factors and already provided decision support to the Army Aviation Branch in determining force structure requirements.

Capitol Hill Fellowship Gives Resident Insider’s View of Legislative Process

Back to table of contents Previous article ViewpointsFull AccessCapitol Hill Fellowship Gives Resident Insider’s View of Legislative ProcessEllyn Johnson, M.D.Ellyn JohnsonSearch for more papers by this author, M.D.Published Online:26 Sep 2014https://doi.org/10.1176/appi.pn.2014.10a29It’s been a pleasure and a privilege to serve as the 2014 APA Jeanne Spurlock Congressional Fellow the last six months. The fellowship provides psychiatry residents, fellows, and early career psychiatrists an opportunity to work in a congressional office on federal health policy.The fellowship was created in honor of the late Jeanne Spurlock, M.D., who was an APA deputy medical director and head of the Office of Minority and National Affairs, as well as a staunch advocate for children and minorities. My fellowship experience gave me the opportunity to serve on the House Armed Services Committee (HASC) Subcommittee on Personnel. The fellowship started with lots of background reading on the current reorganization of the military health system, which culminated in a hearing on this topic. I wrote the educational background material for the committee members, the opening remarks of the subcommittee chair, and many of the questions posed to the witnesses. I served as the subject-matter expert during meetings with medical special-interest groups pursuing a relationship with the Department of Defense (DoD) or seeking TRICARE coverage of specific therapeutic modalities. I was surprised at how often I was called on to review the evidence base of therapeutic modalities that had grabbed the attention of members of Congress. This showed me the importance of a well-organized political action strategy to get your issues taken seriously by elected officials. Although my recommendations weren’t always accepted, lawmakers appreciated the presence of a neutral physician able to translate the medical literature into lay terms, especially in the area of mental health treatment. In light of the committee’s oversight function, we had many briefings with DoD and the military services’ leaders around their efforts on suicide prevention, improvment of the Armed Forces’ mental health overall, sexual-assault response and prevention, the opening of combat positions to women, and more efficient collaboration with the Veterans Administration, among other topics. Each fiscal year, the HASC is responsible for passing the National Defense Authorization Act, which sets DoD policy as a companion to the annual appropriations bill that releases funding for defense spending. As the bill cycle heated up, I focused on reviewing and giving recommendations on proposed health care legislative provisions, many of which focused on military mental health. I received a priceless education in diplomacy as I discussed my concerns and recommendations with House members’ staffs and sought compromises that stayed as true as possible to the medical literature in the setting of complex political considerations. My time on the HASC really challenged my clinical and research interpretation skills in ways I did not expect. I also wrote many health-related parts of the bill, including spotlighting the forward-thinking suicide and resilience research that the Army is currently conducting. The bill recently passed the House.The mentoring and guidance I received during my fellowship was unmatched. Working under the direction of committee staff, I fully participated in all subcommittee activities and was accepted as a member of the team.Congressional staff are far more accessible and interested in their constituents then they receive credit for. We had meetings and gave professional recommendations regardless of political affiliation or personal views. My eyes were opened to how powerful special-interest lobbies can be, not from the backroom deals seen on television, but by organized grassroots efforts energized by a common issue. There is no excuse for psychiatrists, and all mental health care providers, to be politically inactive on the local, state, and national levels. Lawmakers need mental health care experts to inform policymaking, and our patients need political advocates. I challenge you to become politically active through APA, your district branch, and the APA Political Action Committee (APAPAC). I want to give special thanks to the staff in the Department of Government Relations and my subcommittee staff leader for her generous mentorship and teaching. ■Ellyn Johnson, M.D., was a resident at the Medical College of Georgia at Georgia Regents University when she began her fellowship and is now on active duty in the U.S. Air Force. ISSUES NewArchived

A Real-World Network Modeling Project

The Operations Research Department at the Naval Postgraduate School educates experienced junior military officers in state-of-the-art operations research methods. As part of the educational program all officers go through a standard graduate course on network modeling. Within that course, students complete a class-long network modeling project of a real-world infrastructure system that solidifies their understanding of operations research concepts and moves the learning experience beyond the classroom. Through the project, students abstract their real-world problems into mathematics, repeatedly evaluate the connection between the mathematics and reality, and reason about the model results. The project has educational, research, and practical benefits. On occasion, students make discoveries of such significance that we have contacted the infrastructure system operators with briefings on the student analysis results. Some student projects have eventually influenced Department of Homeland Security and Department of Defense policy. We detail what makes the network modeling project work, and how to implement it in other universities.

When Addiction Co-Occurs With Traumatic Brain Injury

When Addiction Co-Occurs With Traumatic Brain Injury

Formalizing the Ban: My Experience in the Reagan Administration

The repeal of Don't Ask, Don't Tell (DADT) is a success story. As of September 20, 2011, one of the most egregious cases of modern day government-sanctioned discrimination has been overturned. But my (Lawrence Korb) involvement with military policy toward gays and lesbians began early in our country's journey toward open service—18 years before the creation of DADT and 30 years before the Obama Administration successfully opened the armed forces to gay and lesbian service members. In 1981, I joined the Pentagon shortly after the Carter administration announced a new Pentagon policy stating that “homosexuality is incompatible with military service” (U.S. Naval Institute [USNI], 2011). As Assistant Secretary of Defense for Manpower, Reserve Affairs, Installations, and Logistics, the responsibility of writing the directive to implement this ban fell to my office. In this article, I detail my recollections from this period in American military history: the codification of the gay ban in U.S. Department of Defense policy.

Application of Systems Engineering to USAF Small Business Innovative Research (SBIR)

The US Air Force Small Business Innovation Research (SBIR) program is a vital element of the Air Force Research Laboratory (AFRL) portfolio. The SBIR program funds early-stage R&D projects at small technology companies that support a US Department of Defense (DoD) need and have the potential for commercialization in private sector and/or military markets. We report on research measuring the application of Systems Engineering (SE) and the degree of Systems Engineering applied in SBIR projects through analysis of subject-matter expert (SME) interviews. SMEs were sampled from AFRL as well as other USAF organizations. The research methodology assessed the current application of SE in SBIR as well the SE expectations government offices have for SBIR projects. The research specifically examined current US DoD and US Air Force Systems Engineering Policy and found that it does not adequately address SBIR projects. SE processes are not well documented within the community. We then identified applicable SE tasks found in Air Force SE policy and suggest a tailored Systems Engineering approach for SBIR projects. We present a SBIR SE checklist recommended for use by SBIR program managers tailored according to the phase and scope of any SBIR project.

A Pilot Online Survey Assessing Risk Factors for HIV Acquisition in the Navy and Marine Corps, 2005–2010

The Department of Defense policy Don't Ask, Don't Tell (DADT) ended in September, 2011. The Navy Bloodborne Infection Management Center conducted a post-DADT pilot survey of HIV seroconverters identified when the DADT policy was in effect. Sailors and Marines newly diagnosed as HIV positive from 2005 to 2010 were invited to participate in an online survey. A structured questionnaire elicited risk information about the 3-year period before HIV diagnosis. Respondents reported engaging commonly in same sex sexual activity, having concurrent partners, and poor condom use for anal sex. In this first post-DADT repeal report of self-reported behaviors, male-to-male sexual contact was a much more common mode of infection than previously reported. Several opportunities for primary prevention messaging now possible after DADT repeal are evident.

A Pilot Online Survey Assessing Risk Factors for HIV Acquisition in the Navy and Marine Corps, 2005-2010

The Department of Defense policy Don't Ask, Don't Tell (DADT) ended in September, 2011. The Navy Bloodborne Infection Management Center conducted a post-DADT pilot survey of HIV seroconverters identified when the DADT policy was in effect. Sailors and Marines newly diagnosed as HIV positive from 2005 to 2010 were invited to participate in an online survey. A structured questionnaire elicited risk information about the 3-year period before HIV diagnosis. Respondents reported engaging commonly in same sex sexual activity, having concurrent partners, and poor condom use for anal sex. In this first post-DADT repeal report of self-reported behaviors, male-to-male sexual contact was a much more common mode of infection than previously reported. Several opportunities for primary prevention messaging now possible after DADT repeal are evident.