U.S. Marine Corps Sgt. Maj. Troy Black recognizes that traumatic brain injuries can be a part of being in the military.

“There is no way to remove stress from combat. There is no way to remove concussions or TBI from combat,” said the 19th sergeant major of the Marine Corps on “Picking Your Brain,” a podcast from the Traumatic Brain Injury Center of Excellence.

Black joined U.S. Navy Capt. Scott Cota, branch chief of TBICoE, and moderator Amanda Gano on the podcast to raise awareness and educate service members about TBI and the resources available to recover from injuries.

The interview covered topics such as how service members should reach out if there’s an issue, and how warfighter brain health is a key factor in the Marines.

Concussions and TBIs are a significant health issue which affect service members and veterans during times of both peace and war. Between 2000-2023, there were a total of 468,424 first-time cases of TBI in the military worldwide, with just over 80% being considered mild TBI.

Warfighters May not Talk about TBI

As a Marine, Black has encountered numerous potentially concussive events and has “led by example by seeking care for his injuries,” said Cota.

Black noted he has lived through several concussive related events, and would have himself checked out if he felt something was wrong, but acknowledged not all service members do the same.

• Stigma of weakness or unfitness for duty
• Fear of judgment
• Misconceptions about TBI
• Perception of mental health issues
• Cultural norms
• Unrecognized TBI

“Stigma first starts with the individual,” said Black. “Ask for help. Be open with it. The invisible injuries are as important as the visible injuries.”

Black commented that there have always been concussive events in the military and on the battlefield throughout history, which has led to a better understanding of TBIs.

“In the last 20 years, we now have technology and [an] understanding of TBIs that are different now,” said Black. “The knowledge, the capability, the communities’ ability to understand the brain differently, has changed. But concussions have not.”

“What we have learned over time is that every time you are around an event, [TBIs] just culminate,” he added.

Black mentioned that TBI doesn't always occur after just one event; it is often this culmination of several events. These events do not always happen on the battlefield; they often happen at garrison during training.

“All the small events add up,” said Black. “All these things compound.”

Diagnosing TBI More Rapidly

Cota mentioned that things like triage tools, and more rapid decision making in the field are needed to diagnose TBI more efficiently and quickly.

“Our big thing on the MHS side is looking for resources to help with recovery to get you at your optimum level,” said Cota. “The resources throughout MHS and that we offer here at TBICoE, can assist with understanding TBI and how to recover from TBI.”

“So, it's just a matter of requesting that support, and they can easily do that across the spectrum,” Cota said.

MHS medics are also trained in the Military Acute Concussion Evaluation 2. MACE 2 was created to quickly evaluate a warfighter for a TBI, and is a standardized exam used to evaluate mild TBI, or concussion, in a combat or other deployed settings.

The Automated Neuropsychological Assessment Metric has also been a game-changer, according to Black.

“Getting the baseline at pre deployment, then at post deployment–that was phenomenal,” said Black. “That is an advance. We must learn about how the brain works.”

Black also noted that sometimes being able to recognize TBI in yourself or others is important, even in stressful situations.

“The responsibility of the individual is to say, ‘Yeah, my bell's rung. I got to pull out of here for a minute until I can recover,’” said Black.

Common Symptoms of Possible TBIs

• Confusion
• Difficulty finding words
• Difficulty making decisions
• Memory loss
• Poor concentration
• Slowed thinking
• Anxiety
• Feeling depressed
• Irritability
• Mood Swings
• Balance problems
• Nausea and vomiting
• Dizziness
• Fatigue
• Headaches
• Ringing in Ears
• Sensitivity to light
• Blurred or double vision

Getting Diagnosed Improves Readiness

“Our job is to ensure someone can be in the fight. Not to find reasons to remove them from the fight,” said Black.

Setting an example is important for a Marine, Black noted.

“Know your Marines and look out for their welfare,” said Black. “When we communicate with each other, when we are open, we can help.”

Cota mentioned that a cultural shift is happening in the U.S. Marine Corps and has been “supportive with individuals getting assistance no matter what it is for.”

“We want to share knowledge and real experiences so that the warfighter understands that it is important to maintain cognitive capability as well as physical, mental and social capability,” said Cota.

“The acting, thinking, ready, capable, resourced and trained individuals in the military are the difference between success and failure in combat or warfare with any enemy,” said Black. “We train, we fight, we win. That’s what we do.”

TBICoE resources for providers can be found here and for service members and families here.

Listen to the entire episode of “Picking Your Brain” with Black on DVIDS.