For years, Master Sgt. Eric Starr’s headaches would hit like clockwork. Every day at around 1 p.m., the pain would start at the back of his head. By the end of the day, he said his head felt like it was in a vice. The rest of him didn’t feel much better.
“My body always felt like I went 10 rounds with Mike Tyson,” said Starr, a Special Forces soldier working at the John F. Kennedy Special Warfare Center and School on Fort Bragg.
Starr said his mood would also swing drastically, and that he was often irritable. A small trigger would turn jokes into yelling.
For physicians from Fort Bragg’s Intrepid Spirit Center, the installation’s brain health clinic, Starr’s symptoms pointed to one likely cause: a traumatic brain injury (TBI).
A singular incident didn’t cause Starr’s traumatic brain injury. Instead, his TBI likely stemmed from the accumulated trauma from shooting round after round of artillery fire over his 14 deployments and the training needed to prepare for them.
Research increasingly links blast overpressure, the shock waves produced by firing large artillery weapons like the howitzer, with damage to service members’ brain health. The U.S. Department of Veterans Affairs described the shock waves as causing “invisible injuries” to the brain in a 2022 press release. A recent Army study shared with Military.com showed that “simply standing near mortars can significantly disrupt the autonomic nervous system,” which is responsible for automatic body functions like breathing and heart rate.
“Turns out you get your bell rung a lot more at home station than you do overseas half the time,” Starr said.
While the Army has studied the effects of blast overpressure for over two decades, the service branch is increasing its efforts to understand its impact on soldiers. In June, the Army launched a new study into how soldiers react to different overblast pressure exposures. It is also starting a Warfighter Brain Health Task Force later this summer to examine how soldiers’ jobs impact their brain health.
“People are the Army’s greatest asset, and the Army prioritizes soldier health and well-being, particularly brain health,” an Army spokesperson told CityView. “This includes prevention, post-injury care, and restoration, aiming to minimize any long-term negative outcomes.”
While waiting for the Army’s research, physicians at Fort Bragg’s Intrepid Spirit Center’s Return to Forces program use current best practices to treat soldiers like Starr who already have traumatic brain injuries. From art therapy to pain management to sleep rehab, the center’s multidisciplinary team addresses the symptoms of TBIs to help soldiers return to work.
“Without sounding cliché, it absolutely saved my life,” Starr said.
Returning to the force
Every month, Return to Forces Program Director Lt. Cmdr. Philip Kapatos and other physicians at the Intrepid Spirit Center read over a list of new research on traumatic brain injuries and brain health to find the latest breakthroughs in prevention and treatment.
“It’s an exciting time to be a clinician,” Kapatos said. “Seeing how much we’ve learned over the last 10 years, and the direction that prevention and treatment are progressing to, it’s exciting to see.”
Kapatos has used those reports to develop new treatments for cohort after cohort of soldiers in the Return to Forces program. The program is reserved for soldiers under the Special Operations Command and treats up to 48 per year, broken into eight cohorts of six soldiers.
For four to six weeks, depending on the program’s requirements at the time, the soldiers’ only job is treatment. All day, every day, physicians from a range of specialties help soldiers identify their symptoms and test different treatments to alleviate them. A yoga therapist helps with mindfulness and stretching, a sleep therapist identifies sleep issues, and a mental health professional teaches soldiers coping mechanisms.
“It’s a shotgun blast method,” Starr explained, who went through the Return to Forces program in 2023. “I’m gonna hit you with all kinds of stuff and we’re gonna see what sticks.”
Since the program is time limited, Kapatos said the key to its success is quickly determining which treatments are alleviating a soldier’s symptoms. He said the Return to Forces program team meticulously tracks the effectiveness of each treatment to determine which to keep.
Out of all the treatments Starr tried, he said he didn’t expect art therapy to be one of the most effective.
“I still can’t draw stick figures straight,” Starr said. “But it was a vehicle of expression. It was being able to actually sit down with somebody and ask yourself hard questions, and then take a deep dive into the crazy puzzle factory and see what comes out the other side.”
Holistic care is a large part of the Return to Forces program since many symptoms of traumatic brain injuries can’t be parsed out from other cognitive issues, Kapatos said. Last year, the Army started giving cognitive baseline assessments to soldiers in basic training and cadets before they commission to help physicians determine what’s being impacted should a soldier’s brain be injured.
A soldier’s treatment doesn’t end once they complete the Return to Forces program — it sets them up for a long healing journey.
“What it does is help give you tools to continue that therapy and that management after the fact,” Starr said.
Increased awareness and advocacy surrounding brain health
Starr has seen soldiers and their leaders take concussions, traumatic brain injuries and the impact of blast overpressure more seriously over his more than two decades in the Army. He said it’s much more common for soldiers to step away and get treated.
“It’s actually applauded if you do it,” Starr said, adding that several members from his unit sought out the services at the Intrepid Spirit Center after he explained their benefits.
The Intrepid Spirit staff helps soldiers identify symptoms of overblast pressure, since they are so vast, Kapastos said. He said staff explain to units that, while some symptoms go away with a good night’s sleep, those that persist require treatment.
“The earlier the identification, the earlier the treatment and the better the treatment and the more targeted the treatment,” Kapatos said.
Studies into injury mechanisms like overblast pressure will improve prevention and medical care for soldiers, the Army spokesperson said.
“Research on blast overpressure continues to be a priority for the Army,” the spokesperson said. “As blast overpressure research progresses, findings will refine and improve treatment strategies.”
While Starr is thankful for the increased prioritization of soldiers’ brain health, he understands that the Army is a dangerous job.
“We’re training smarter, but, at the end of the day, it’s an inherently risky job,” Starr said. “There’s no way you’re going to ever 100% remove risk.”
CityView Reporter Morgan Casey is a corps member with Report for America, a national service program that places journalists into local newsrooms. Morgan’s reporting focuses on health care issues in and around Cumberland County and can be supported through the News Foundation of Greater Fayetteville.