Members of the military's combat specialties experienced higher suicide rates than other troops -- and the broader American public -- in the waning years of the War on Terror, according to numbers delivered by the Pentagon to Congress this month. The worst-hit jobs included career fields with high operational tempo and occupational exposure to explosions.

Between 2011 and 2021, the enlisted job groupings with the highest suicide rates were armored and amphibious vehicle crew members, infantry, combat engineers, explosive ordnance disposal and divers, combat operations control troops, and artillerymen assigned to both guns and rocket units, according to the data. All of those specialties saw suicide rates at least 50% higher than the general population during that period.

The numbers were contained in a report the Defense Department submitted to Congress comparing suicide rates across military career fields. The report, dated July 23 and delivered to lawmakers seven months after a congressional deadline, represents the military's first official by-job suicide data since a 2010 task force report^[1]. It was publicly released Wednesday.

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To calculate suicide rates for 2011 to 2022, Pentagon researchers combined data for military specialties based on a master list of career fields. Active-duty and reserve deaths were included, and the rates adjusted by sex and age in order to allow meaningful comparisons with the general U.S. population. For their comparisons to the broader civilian population, the report excluded 2022 military numbers as the authors didn't have access to broader general population suicide data for that year.

What Congress received was mostly a data dump, according to Katherine Kuzminski, a defense expert at the Center for a New American Security, or CNAS, think tank.

"[The authors of the report] didn't really provide any analysis or storytelling," she said.

But Kuzminski, who heads CNAS' Military, Veterans and Society program, said there was an obvious theme: Jobs where troops are deployed more frequently and face greater exposure to low-level blasts experienced higher suicide rates between 2011 and 2022.

Chart depicting the six occupational groupings with the highest suicide rate.

The data alone cannot prove that those factors are causing the increased suicides, she cautioned, noting that those fields may also have experienced higher rates of casualties.

In recent months, lawmakers have intensified their scrutiny of the Pentagon's suicide prevention efforts, questioning whether the military has adequately accounted for some suicide risk factors, such as occupational blast wave exposure and operational tempo.

Concern over the role of brain injuries in military suicide rates -- fueled in part by reports from Military.com^[3] and The New York Times^[4] -- led to hearings on Capitol Hill and a series of legislative proposals^[5] meant to address the issue. In May, lawmakers asked a government watchdog agency^[6] to investigate what Pentagon officials knew about brain injury risk, when they knew about it, and what they did to reduce the risk.

Similarly, a March 2024 Army Times^[7] investigation that discovered high recent suicide rates in the Army^[8]'s overworked armor community inspired Congress to double down on demands for Wednesday's suicide data. Although the Army quickly announced changes to its deployment^[9] model for tank units, the House Armed Services Committee directed the DoD to study its force structure in Europe, where the service's armor brigades regularly deploy due to a lack of permanently based armor units.

Sen. Angus King, I-Maine, said in a phone interview that the report "is not a panacea, but it gives [the Pentagon] a way to target resources and understand where the higher risks are." He added that the information will also help Congress provide critical oversight of military suicide prevention work.

"We can have all the studies in the world. We can have all the data. We can have recommendations," the senator said. "Implementation is as important as vision, and I want to see how this is going to be executed, and I'm going to keep on them to be sure it is executed properly."

The report falls short of the standard set by Congress in its 2023 defense policy bill. Lawmakers ordered the Pentagon to provide suicide data dating back to Sept. 11, 2001, broken out by year, specific job code, and duty status. The data provided in the report only covers 2011 through 2022, and it fails to analyze the numbers by year, specific occupational specialty, and active or reserve component membership.

The report's authors claimed they could not provide authoritative data predating 2011 because the Pentagon "did not have a standardized reporting methodology," and restrictions on analyzing suicide data with small sample sizes led them to decline to assess the by-year, by-component, or by-job code rates. The report argued these figures "are highly sensitive to small changes over time, and are unreliable for comparison."

Their approach contrasts with that adopted by the 2009-10 DoD Task Force on the Prevention of Suicide by Members of the Armed Forces, the last major effort to carve out job-specific data. The congressionally chartered task force's final report provided suicide data detailing annual deaths for every military occupational specialty across the different branches.

Kuzminski, the CNAS expert, argued the new report's consolidation of data could mask critical trends. She said that lumping together personnel generalists and recruiters^[10], for example, "doesn't tell me what is the individual rate of the 'recruiting and counseling' [subgroup]. There's probably far fewer recruiters than broader personnel [specialists]."

The Senate's draft defense policy bill for fiscal 2025 includes a King-authored provision to make Wednesday's report a permanent annual requirement for the Pentagon.

King described the report's numbers as a starting point, saying that "what [DoD] produced is still significant," and the numbers will accumulate over time if his proposal to make the report a permanent annual requirement becomes law.

Now, the senator wants to see results.

"My concern on this suicide study is that I don't want it to just be interesting data," said King. "I want it to guide action."

The full report containing data on suicide by specialty can be found here^[11].

Veterans and service members experiencing a mental health emergency can call the Veteran Crisis Line, 988 and press 1. Help also is available by text, 838255, and via chat at VeteransCrisisLine.net.

-- Davis Winkie is an investigative reporter who focuses primarily on the military and veterans. Davis, a Military Times and CNN alum, was a finalist for the 2023 Livingston Award for Local Reporting and shared the Society of Professional Journalists' 2023 Sunshine Award with colleagues from The Texas Tribune, ProPublica and The Marshall Project.

Related: Overall Military Suicide Rate Dropped, But Active-Duty Deaths Increased Slightly, Pentagon Reports^[12]

Civilian federal employees, contractors and family members identified as having "Havana Syndrome" -- mysterious symptoms that began, for many, overseas after hearing a loud noise, accompanied by instantaneous earaches and headaches -- face difficulties receiving medical care in the military health system as allowed by law.

For a report published Monday, Government Accountability Office analysts interviewed 65 of the 334 people who qualify for Defense Department medical care for their condition, referred to as "anomalous health incidents" by the U.S. government, and found they've faced troubles navigating the system, scheduling appointments, and receiving medical hardware, medications and support.

According to the Government Accountability Office, the affected CIA, State Department and FBI employees and others have not received clear guidance from the DoD about their medical care and often rely on one another to navigate the maze of facilities, including the National Intrepid Center of Excellence for traumatic brain injury^[1] in Bethesda, Maryland; Walter Reed National Military Medical Clinic; and regular military hospitals and other facilities.

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Many of those interviewed for the GAO review said they had little support and faced difficulties getting appointments at military hospitals as they qualify for care only on a space-available basis. They added they couldn't reach anyone to make appointments at the National Intrepid Center of Excellence.

"Some patients stated they had waited so long for a response from the [National Intrepid Center of Excellence] that they had essentially given up on the military health system and were pursuing treatment in the civilian sector," GAO analysts wrote in "Havana Syndrome: Better Patient Communication and Monitoring of Key DoD Tasks Needed to Better Ensure Timely Treatment."^[3]

Several State Department employees at the U.S. Embassy in Havana, Cuba, began suffering in 2016 from headaches, tinnitus, hearing loss, vertigo and cognitive dysfunction after hearing a loud noise that came from one direction, according to sufferers.

Reports from other U.S. government employees, contractors and family members followed after similar incidents and experiences in China, Russia, Poland, Colombia and elsewhere overseas, as well as in the U.S., including Washington, D.C.

Studies into the possible causes have reached differing conclusions. In a report declassified in February 2022, a panel of intelligence community experts said that pulsed radiofrequency energy could be responsible for symptoms, while an Intelligence Community Assessment published in March 2023 found that most federal agency members believed it was unlikely the incidents were targeted energy attacks by a foreign adversary. That report concluded the symptoms likely were the result of a conventional illness or preexisting condition.

In 2022 and 2023, Congress passed two laws that required the DoD to furnish medical treatment to affected employees and family members at locations that included the National Intrepid Center of Excellence and certain military treatment facilities.

According to the report, 34% of those eligible for health care were either CIA or worked in the Office of the Director of National Intelligence; 29% were with the Defense Department; 16% were State Department; and 11% were FBI employees. The remainder were classified as "other" and included some 15 children.

Those who received care through the U.S. military -- 50 patients -- and were interviewed by GAO told officials that they were grateful for the treatment from providers familiar with their experiences. Nearly half said their symptoms had improved as a result of treatment.

But many said they never received guidance on how to access care and faced challenges getting onto base, receiving medications and making timely appointments.

By law, the DoD also was to maintain a registry of affected patients, collect data and information that would be used to help drive treatments, and establish processes for caring for patients through a network of specialty facilities, the Intrepid Spirit Centers, at U.S. military bases across the country.

But those tasks have not been completed, according to the GAO.

"DoD has created a plan to address some access concerns of [anomalous health incident] patients, but it contains uncertain time frames and lacks monitoring provisions," the report states.

The GAO noted that, because its analysts interviewed only volunteers from the patient community, the findings may not represent the experiences of all those affected.

The watchdog recommended that the DoD provide written guidance such as a handbook, as a way to educate patients on their care; develop a small cadre of health providers and administrators to manage cases and care for patients; and work to fill provider vacancies by shortening the length of time it takes to onboard new employees such as nurse navigators.

The Defense Department agreed with the recommendations, with Seileen Mullen, principal deputy assistant secretary of defense for health affairs, writing in a response to the report that the DoD is piloting a handbook to guide patients and will finalize it by early fiscal 2025. She said it also is developing monitoring capabilities and maintains a "coordination cell" at the National Intrepid Center for this group of patients.

According to the report, the patients feel stigmatized by their conditions, and many are reluctant to seek care, given the reaction they have received at work after disclosing that they were affected. Nearly half the patients GAO analysts interviewed said they faced difficulties at work -- losing assignments, being placed on leave, having their security clearance renewals delayed, or being referred for psychological care.

Several patients said they did not tell their supervisors of their exposure out of concern that it would negatively affect their careers.

Studies published in March by the National Institutes of Health found that affected patients had no evidence of brain injury. Using magnetic resonance imaging and blood biomarkers for brain injury, researchers examined more than 80 patients with Havana Syndrome and compared them with a control group, finding "no significant differences."

In an accompanying editorial, Dr. David Relman, a professor at Stanford University School of Medicine who also has engaged in research on anomalous health incidents, said that drawing conclusions from this study that "nothing happened" would be "ill-advised."

Noting conditions such as Gulf War Illness, chronic fatigue syndrome and long COVID-19 that initially were viewed with skepticism and suspected to be psychological, not physiological, Relman said institutions must examine their own biases, address shortcomings in research and treat patients.

"Prejudice and poorly supported assumptions must be set aside. Clear and timely public communication is essential. The delivery of appropriate nonjudgmental care must be initiated without delay," Relman wrote.

Related: New Study Finds No Brain Injuries Among 'Havana Syndrome' Patients^[4]

A new Pentagon survey of military families with special needs members found that less than half were satisfied and 57% were dissatisfied or had no opinion about the Exceptional Family Member Program, or EFMP, though reactions varied by military branch.

The Defense Department surveyed 100,000 active-duty troops enrolled in EFMP from November 2022 through March 2023 to gauge satisfaction with programs for special needs families provided by the military services.

EFMP is designed to help families access specialty medical care and services, including educational support, for those with a member who is disabled or has complex medical requirements.

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The survey found that most of those enrolled reported satisfaction with or had no opinion of the program. But just half said they had received support from their commands for EFMP needs in the previous year, and more than one-third reported dissatisfaction with a key purpose of the program -- to help families during permanent change of station^[2] moves.

According to the results released last week, 43% said they were satisfied with the program, while 33% said they were dissatisfied; the remainder had no opinion. Roughly 59% of Navy^[3] respondents expressed satisfaction -- the highest rate for any service -- while just 39% of Army^[4] respondents reported high levels of contentment. Fifty-eight percent of Marines and 35% of Air Force^[5] respondents said they were happy with their programs.

In terms of leadership, 50% of respondents said their chain of command had provided support with EFMP within the previous year; one-quarter said they never received help. Thirty-five percent of Army respondents said they never got any help, while 57% of Navy personnel said they "always or often" got help with the program from their chains of command.

EFMP is a mandatory program managed by the individual services for families with special needs. Last June, in response to military family advocates and Congress on the disparities in programs across the services, the Defense Department issued guidance to standardize the service-run programs^[6], which not only varied from branch to branch but also across installations.

The new DoD guidelines aim to enhance the programs across-the-board, from improving the enrollment process to ensuring that families get a handoff from one EFMP support office to another during a move -- guidance designed to reduce wait time for medical care and services during the switch.

The policies also are meant to improve the assignment coordination process, ensure that EFMP support providers reach out to participants at least once a year, and standardize respite care -- assistance provided to families to give them a break.

The survey, which was conducted before the DoD released the standardization memo, was meant to provide information and data on military families' experience with the programs, according to Tomeshia Barnes, associate director of the DoD's Office of Special Needs.

The survey helped identify gaps in EFMP services that are vital parts of the program, including disparities in the understanding of respite care services and issues with permanent change of station moves. One-third to 40% of respondents reported not getting any help during a PCS^[7] move.

Barnes said that response will guide additional requirements for the services to ensure families receive support from one installation to another.

"Enhancing and improving the Exceptional Family Member Program is a priority for the department," Barnes said last week during an interview with Military.com. "It's important to us that we hear from military families."

The survey was provided to active-duty service members via email and had a 13% response rate, roughly the same as the last Status of Forces Survey by the Pentagon in 2022, which provides a snapshot of overall experiences of active-duty troops.

EFMP survey respondents were an average age of 37 and had roughly 14 years of military service. Roughly 70% said they had a child enrolled in EFMP while 46% said their spouse was enrolled and 1% had an enrolled parent. The biggest reasons for enrolling were for medical services -- 74% were for medical needs and 27% for medical and education services -- while 12% needed educational accommodations only.

Of the 12,620 respondents, 43% were Army, 30% were Air Force, 20% were Navy, and 7% were Marine Corps^[8].

While EFMP requires mandatory enrollment, military personnel have been known to avoid participating because they think it will hinder their careers by restricting assignments only to locations where services are available for their family member. Barnes said the survey showed that 78% of respondents indicated they had never had to relocate without their families for their careers, and the program really had no impact -- positive or negative -- on a member's decision to stay in the military.

"It doesn't have that negative impact. ... We think that's something very important to highlight that we paid attention to, and it's also something we will continue to pay attention to," Barnes said.

Another bright spot in the results was families' opinions of their EFMP program offices, with the overwhelming majority saying that, when they needed support from their caseworkers, the experience was professional, with employees familiar with local resources and able to tailor programs to their unique needs.

"Those are the things that we truly want to hear, and I know that family support providers want to hear, [and] that the military services want to hear," Barnes said.

She said the Pentagon will use the data to identify areas of concern and improve the program, including new guidance on oversight and monitoring. The information will help identify trends of success and weakness.

Barnes added that the DoD-wide guidance was issued after assessing the best practices of the branch programs and the Pentagon will continue to tweak the programs to improve services.

Earlier this year, the Army announced the creation of a central office for its EFMP program to coordinate health care, military moves, education and additional services for enrollees.

The service recognized it needed to improve its program based on feedback from enrollees, according to Agnes Schaefer, assistant secretary of the Army for manpower and reserve affairs, who added that improving the quality of life of soldiers and their families is the service's top priority.

"We are listening and working to take necessary steps that continue to improve the Army EFMP to best serve our Army community," Schaefer said in a statement in March. "There is more work to be done, but we are excited to share this important step with the force."

Related: DoD's Failure to Standardize Exceptional Family Member Program Leaves Gaps in Services, Watchdog Finds^[9]