Human performance optimization, or HPO, is intended to improve health and readiness force-wide. Operator Syndrome, meanwhile, is a clinical construct that describes the cumulative health effects experienced by special operations personnel.

Comprehensive assessments of the two will require Pentagon leadership and the advisory council to establish a standardized, evidence-informed framework to assess special operations and other combat-focused jobs susceptible to cumulative operational injuries within the military health system.

The advisory council’s success will depend on both the recommendations it produces and its ability to develop a coherent, scalable framework for service members with suspected Operator Syndrome across the MHS.

Along the way, the council has a unique chance to shift the MHS from a fragmented, symptom-based approach to one that addresses cumulative effects of operational service through holistic, multidisciplinary care.

The value of this approach has been demonstrated by existing human performance and operator health programs such as the U.S. Special Operations Command’s Preservation of the Force and Family (POTFF) and the Army’s Holistic Health and Fitness (H2F) program.

Right now, the advisory council has an opportunity to leverage decades’ worth of lessons learned from these programs to establish evidence-based clinical standards for continuous evaluation and refinement.

As the science of Operator Syndrome evolves, this framework should function as a learning health system, with new evidence informing ongoing updates that improve health, function, and operational readiness.

Dr. Chris Frueh’s foundational work first introduced Operator Syndrome in 2020 as a multisystem effect resulting from allostatic load and cumulative operational exposure. This work has driven multidisciplinary research to develop standardized methods for its characterization and assessment.

One example of this ongoing work is the collaborative development and preliminary validation of a standardized self-report instrument to assess Operator Syndrome-related symptom patterns.

The Operator Syndrome Symptom Scale–Self Report, or OSSS-SR, is guided by existing scientific literature, multidisciplinary clinical expertise and principles of patient-reported outcomes. This multisystem screening tool is designed to identify common symptom patterns affecting the mind and body and to support occupational performance and overall health among operators.

Currently advancing to its next phase of development, the OSSS-SR includes items for the empirical evaluation of multiple symptom domains across physical, mental, physiological and other performance health systems.

As the advisory council establishes its agenda, it should actively encourage and leverage similar collaborations. The future of military medicine depends not only on government-led initiatives but also on strategic partnerships that unite operational experience and clinical expertise.

Ongoing research efforts, meanwhile, also reinforce an important implementation challenge.

A validated clinical framework should guide these new screening initiatives. Recognizing Operator Syndrome as a military health priority is an important first step, but sustainability will depend on the Pentagon’s ability to build the scientific infrastructure that supports evidence-based decision-making. The Pentagon should treat investment in measurement science as a foundational priority.

Implementing screening before establishing a validated clinical framework introduces avoidable risks. Without standardized assessment methods and evidence-based referral criteria, identification of Operator Syndrome will likely vary across providers and military treatment facilities, leading to inconsistent clinical decision-making, unnecessary referrals and missed opportunities to identify service members who would benefit from comprehensive multidisciplinary care.

These challenges are not unique to Operator Syndrome. Similar concerns have been raised by certain organizations — such as the Endocrine Society — about broad population-based testosterone screening.

The Endocrine Society supports targeted testing for individuals with specific symptoms and risk factors, emphasizing that no single symptom or biomarker should serve as the basis for identifying cumulative operational injury, and that laboratory findings should be interpreted in an appropriate clinical context to avoid unnecessary intervention.

While expanded screening may facilitate earlier identification of health concerns, testosterone testing should serve as the starting point — not the endpoint — of clinical evaluation.

Combining testosterone results with a comprehensive medical history, a validated assessment tool such as the OSSS-SR and additional laboratory testing provides a more complete picture of physiological dysfunction and supports more targeted, multidisciplinary care.

A holistic screening framework supports treatment of the impacts of occupational performance. This is essential for military readiness and retention and can improve screening and continuity of care during and after service.

Addressing Operator Syndrome through a single symptom or isolated laboratory value, such as relying on testosterone testing alone, or by evaluating the broader physiological systems increases the likelihood that the underlying condition will remain inadequately addressed.

Council members must understand military healthcare, its operational systems and clinical outcomes, and how to optimize health and wellness to enhance lethality.

Extensive research on Operator Syndrome and the development of a self-report instrument have emphasized the need for multidisciplinary expertise to enhance holistic assessments of special operations personnel.

It is imperative, therefore, that physical and psychological assessments and treatments be evidence-based and include continuous, cumulative diagnostics throughout a military member’s entire career.

The Pentagon must prioritize selecting a multidisciplinary group of health and policy specialists when evaluating the proposed advisory council’s nominated members. Relying on a single viewpoint for an entire advisory panel is as ineffective as isolating a single symptom in a comprehensive diagnosis.

Ultimately, ensuring warfighters can respond to conflict at a moment’s notice requires a fully functioning mind-body connection that supports both health and readiness.

Mackenzie Witt, Pepper Phillips, MPH, and KayleighBealer, MS, are with A-G Associates, which partners with federal agencies, public health systems, and mission-driven organizations to turn strategies into results across behavioral health, military and veteran wellbeing, and systems transformation.

Jennifer Byrne, OTD, and Kelli Cabrera, OTD, are with 5by5 Performance Therapy, an organization committed to contributing to blast-injury and operator-centric research and academia to improve knowledge and understanding of the Special Operator family’s strengths and challenges.

I have never deployed for the United States Navy.

As an active-duty sailor, saying that feels disingenuous. My time in the Navy has only been on shore duty. My understanding of deployment comes mostly from hearing other sailors’ stories: months away from family, long watches, missed holidays, repetitive days, port calls and the odd feeling of watching life go on from afar.

But those of us who have not deployed are paying attention.

We see ships like the USS Gerald R. Ford come back after 326 days at sea. We remember the USS Nimitz and its strike group finishing a 321-day deployment during the pandemic.

We hear about deployments getting longer, and sailors having to adjust to timelines that go far beyond what was expected when they left.

Nearly a year at sea is difficult to comprehend for anyone. Eventually, many of us will be the next ones walking across the brow. This means extended deployments are not just a concern for those going through them now. The whole Navy needs to get its people ready for them.

The Navy exists to go to sea. Deployments are not an aberration from naval service; they are fundamental to it. Ships must be where the country needs them, and sometimes circumstances will require sailors to remain there longer than anyone originally planned.

Knowing this, we should take preparation even more seriously.

Preparation should start before a sailor ever deploys. Commands can be honest about what months at sea are really like. Not only about the Navy’s mission, but also about the daily routines and pressures. Experienced sailors know things you can’t learn from a PowerPoint. We should draw more on their experience when getting sailors ready.

We should also recognize that the quality of life aboard ship is part of readiness.

On a short trip at sea, small problems might be easy to ignore. But over eight, nine, 10, or 11 months, those problems become part of daily life.

Things like working water, clean bathrooms, soap, other basic hygiene supplies, chances to sleep and clean living spaces are not extras. They are the foundation. They are the basics that help sailors keep doing tough jobs.

It belongs partly to leadership, but it also belongs to the sailors themselves. Caring for the ship should always be part of our culture. Cleaning up after ourselves, keeping spaces in good shape, reporting problems instead of ignoring them, respecting shared sleeping and work areas and treating equipment properly are all small ways to be professional. Over many days at sea, these small actions add up. So does neglect, unfortunately.

Taking care of sailors and taking care of ships are closely linked. When a crew lives on a ship for most of a year, these things can’t be separated. The ship is their workplace, their way to travel, their defense, their dining hall and their home for a while.

If we expect the ship to endure, we have to maintain it. If we expect the crew to endure, we have to sustain them.

I can’t tell a sailor who’s done a 10-month deployment what it’s like. I haven’t had that experience. But I can listen to those who have and think about what their stories mean for sailors like me who might go to sea in the future.

The lesson I take from them is not that the Navy should stop deploying. It is that endurance cannot be the only plan. If the mission sometimes entails long deployments, the Navy should prepare sailors for that, both mentally and professionally. This means ensuring basic living standards are met, maintaining the ship, and fostering a culture where sailors know that caring for their ship and for each other go hand in hand. That ensures sailors will have some enthusiasm for the next deployment.

A 300-day deployment will never be easy. We should not pretend that it is. But when sailors are asked to stay at sea that long, we can make sure they leave the pier prepared for more than just their job. We can make sure they are ready to endure, and that the ship is ready to endure with them.

Editor’s Note: The views expressed are those of the author and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, or U.S. government.

It was only a month after the roadside bombing. I was still in Landstuhl Regional Medical Center, Germany, in June 2006, undergoing successive rounds of surgery. Rods protruded from my limbs, keeping the broken bones of my right forearm and left thigh immobile until the doctors could complete a series of bone grafts and insert the titanium screws and bars so that my broken extremities would hold on their own.

It was an exhausting and painful process, made easier by the hours of relief spent with my wife, Michele. Unfortunately, the peace between surgeries and checkups was sometimes interrupted by visitors. Privately, I was not enthused. I knew I should have been more gracious and appreciative that people cared about wounded soldiers and wanted to show their support. I was sure there were men and women who had suffered through extended hospital stays and could’ve dearly used some company.

But I just wanted to be left alone with Michele, whom I almost widowed a few days before. On May 25, 2006, an explosive force projectile hit the M114 up-armored Humvee I was in. It killed my commander, Capt. Douglas DiCenzo, and the vehicle gunner, Spc. Robert Blair, and severely wounded the driver, Spc. Matt Owens, and me.

For the first week or so, I put on an upbeat attitude for everyone who showed up. But soon I started asking the hospital staff to turn people away, no offense intended. Some were musicians I didn’t listen to or athletes who played sports I didn’t care about. Maybe even a couple of actors from shows I never watched.

I can only speculate as to their motives. The celebrities were not followed by PR teams or photographers; they weren’t trying to burnish their image. Rather, they appeared to be attempting something genuinely humane and patriotic. I bore them no ill will, but I’d always been ambivalent about pop culture icons on a normal day. The days in Landstuhl were far from normal. Being nearly incinerated pegged my natural introversion at 11 and broke the knob off.

Obviously, I couldn’t turn away senior officers, though I was not sure they even wanted to be there. My own division commander seemed eager to pin the Purple Heart on my pillow and get the hell out of my hospital room. Perhaps it was the smell—no one likes the stench of disinfectant masking the remnants of various bodily fluids. That early in the war, maybe he wasn’t used to being around the wounded. Regardless, he couldn’t wait five minutes for my wife to make it back from the cafeteria down the hall, so she didn’t even attend my “awards ceremony,” such as it was.

Conversely, some of the other officers were almost reverent. One lieutenant colonel’s eyes were dewy when he looked at me, and he spoke in a tone I would reserve for someone who actually did something impressive. I just … didn’t die.

It was odd treatment, to say the least, for a second lieutenant like me. I held the most awkward rank in the United States Army—allegedly in charge as a 22-year-old despite little life experience and a total lack of tactical expertise. If you overplayed your hand as a second lieutenant, you risked irrelevance by appearing heedless and failing to earn your soldiers’ trust. But if you underplayed your hand, you risked irrelevance as an empty uniform in the formation, effectively a sock puppet and paperwork rubber stamp for noncommissioned officers.

All this to say, just about nobody holds a second lieutenant in awe. Being subject to reverent, deferential tones from anyone else in a uniform from any rung below or above on the ladder was, to put it mildly, a culture shock.

That same misty-eyed lieutenant colonel wanted me to chat with his son, a high school senior who was applying to West Point. I was unsure of the assignment. Was I supposed to be an inspiration because I had put on a brave face despite being wounded? Or was I a cautionary tale to get the young man to consider the risks of service? The poor boy looked as awkward as I felt when he came to visit me, still a bit hazy from a recent surgery. Lord only knows what I told him.

I do not remember the officer’s or his son’s name. I sometimes wonder if that kid ended up going to West Point after all. If so, I hope he had a good career.

The respect felt unwarranted. Doug DiCenzo and Robert Blair deserve to be remembered as heroes. The infantrymen, medics, doctors, PAs, and nurses who saved my and Owens’ lives are heroes.

But all I did was survive. After the blast, I was lying in a crater, with a broken arm and leg, high on adrenaline. The most I managed to do was prop myself up enough to wave down the medic.

I didn’t feel even a bit heroic. I felt like a wreck being held together by duct tape and wishful thinking.

There’s one class of visitor I didn’t turn away, however: Vietnam veterans who came to chat with service members who had been medevaced. They handled the situation with the greatest ease. They had seen comrades mangled by combat, and all seemed to instinctively understand the inevitable conflicting emotions that those of us who survived contended with.

They also grappled with a war where strategic goals shifted amorphously over the years, and popular sentiment waxed and waned greatly from its onset to its height. In reality, all wars are full of moral ambiguities once you get past the surface, but Vietnam vets were handed a conflict lodged in the gray both in reality and in the public consciousness.

They did their duty despite getting screwed over at every turn. They often fought in conditions that made anything I endured in Iraq look tame in comparison. Sure, I got pretty jacked up in a war that is difficult to classify as an unequivocal victory, but at least my country loved me to pieces when I got home. My dad’s generation got no such support.

On May 28th, one year to the date of my commissioning, another Vietnam vet visited me. He also happened to be Chairman of the Joint Chiefs of Staff Gen. Peter Pace, who came with his wife. I was ragged, unshaven, and had a graduated jar of my own urine on a table between us because the doctors needed to measure my output for some reason or other.

“You look like you’ve been through it, lieutenant,” he said, good-naturedly.

“Well, sir, Baghdad isn’t Hue city, but it wasn’t exactly fun,” I responded.

Gen. Pace had given a speech during my senior year at West Point, and I remembered from his biography that he’d commanded a rifle platoon during the Tet Offensive in Hue. The city saw the most intense urban combat of the Vietnam War.

“Tet was rough, but at least we actually got to fight back,” he said.

With those words, Gen. Pace voiced a frustration that I and many veterans felt during Operation Iraqi Freedom and Operation Enduring Freedom, which were dominated by improvised explosive devices. Killing the enemy isn’t fun or even gratifying, but it is cathartic to, as Gen. Pace put it, “fight back.” It was a catharsis that many soldiers, including me at that point in my career, were denied.

Of course, it was also a double-edged sword since some soldiers suffer moral injury from the act of killing. It’s not something I’ve personally struggled with, but I have friends who do.

The conversation flowed easily for more than two hours. Gen. Pace and his wife, Lynne, told us anecdotes of their early married life in the Marine Corps, which drew laughter from me and Michele. Despite the huge gap in age and seniority, the interaction felt natural; it was a sharp contrast to uncomfortable reverence or the disinterested box-check visit from my own division commander.

Gen. Pace had nearly four decades of service in the Marine Corps to my one year in the Army. The moment had an arc that somehow felt right amid all the wrongness. The torch passed from one generation to another sometimes illuminates a tangled morass, but it is passed down in good faith and allegiance, nonetheless.

In time, the surgeons completed their good work, and I was allowed to return to my quarters in Germany. In a stroke of divine providence, Michele and I occupied first-floor housing. I have no idea how I would’ve navigated stairs on the walker I still needed then. I was able to work with the rear detachment on limited duty in between the fiendish ministrations of the physical therapists.

I frequently returned to Landstuhl for follow-up X-rays and reevaluations. Every few weeks, they cut the casts on my arm and leg back a few inches. I learned to walk normally, then to jog, then to run and march under a ruck again. The unit returned from Iraq, and I was simply one officer among many in my battalion.

Even as we prepared for the next combat deployment, it was a relief to be out of the petting zoo and back with my fellow line animals.

My little sister has been in the military for 19 years, serving in Germany, U.S. territories, South Carolina, and elsewhere. Since February, she’s called a base in the Middle East home.

I’ve known her location and her proximity to danger for months, but it had felt like she wasn’t really there. Iran seemed intent on attacking bases other than hers, and American casualties were rare. Our conversations were often about how bored she was. The lousy food. How unbearable the heat and the flies are.

Sometimes I send her articles and ask if what I’m reading about is happening near her. If she answers, it’s usually to tell me not to believe everything I see. But she doesn’t tell me much. She doesn’t want me to worry and can’t tell me information she’s not authorized to share. There are many reasons; none of them let me sleep better at night.

My sister and I couldn’t be more different. Growing up, I cared about good grades, college, and building a fairly traditional life, whereas she spent high school partying and then working while she figured out her path.

When we were young, our differences created distance in our relationship, but when my sister joined the Air Force — creating an actual, physical distance — it somehow brought us closer.

We haven’t lived in the same state in almost 20 years, but we talk and text almost every day. When she’s on leave from the military, it’s at my house. We’re now as close as two sisters can be. When her spouse suddenly died two years ago, I was in the car almost immediately, driving 13 hours to be with her.

It wasn’t until she was badly injured by a drunk driver while stationed overseas that I learned what it’s like to worry about her from so far away.

She was supposed to be home by Memorial Day. “Start looking for a lake house,” she told me. It made no sense without firm dates, but I still looked. Then Memorial Day passed, as did the next anticipated date in June. Now her departure date is at the end of August. But we both know that date isn’t any more real than the others.

On a Monday in July, I texted her a picture of the French toast I had cooked. She responded with a funny GIF and told me to fuck off because she’s tired of rice. She sent me a picture of some gray hair she found and I sent her a picture of mine. This is what middle-aged sisters send each other when they’re 6,000 miles apart.

Later that week, she video called me at 7:30 p.m. my time. It was 2:30 a.m. for her, and so dark that I could barely make out her helmet and vest. She calmly told me her base had just been hit. Her friend was in the dorm that was struck. He survived, but she didn’t know much more.

She turned around the camera for the briefest of moments to show me the dark sky and the pinkish-purplish smoke. She had heard over the radio that there were casualties.

The distance is not new, but the worry is different now. A few days ago, my sister was merely danger-adjacent. Now she has survived an attack on her base that killed three Americans. My heart and my concentration are gone. My phone’s primary use? News alerts and texts from my sister.

I don’t want to constantly ask if she’s alive. That’s morbid. But I need to know that she’s alive. I recently asked her if she was scared. In 19 years of service, it was the first time I ever asked her that.

“Yes, of course,” she wrote back. “Anyone saying different is lying.”

The news cycle is very slow. I knew what happened for almost 24 hours before it was in the media. So I scrolled through TikTok looking for something funny to send her — because when she hearts it, I know that she’s OK.

Here in the United States, we debate this war in the abstract — whether the Iranian regime is evil, if we should even be there, whether this administration made the right call.

My sister doesn’t get the abstract version. So I will keep sending her pictures of my food, the dogs, and funny TikTok videos — so she knows how much she is loved, and I know that she’s still there.

This War Horse reflection was edited by Kim Vo, fact-checked by Trey Strange, and copy-edited by Mitchell Hansen-Dewar.

Karen Marks is the founder of Design Your Support, where she helps e-commerce brands build better customer support. She lives outside Buffalo, New York, with her husband and two sons. Her sister has served in the military for 19 years, first in the Air Force and now in the Air National Guard.

Sometimes it changes the outcome of a battle. Sometimes it means the difference between life and death. Eisenhower credited his meteorologists as one reason the Allied invasion of Normandy succeeded. They gave him the information he needed to make a decision at a moment when weather meant the difference between victory and defeat.

This underpins a simple reality: Weather does not accommodate the mission. The mission accommodates the weather.

That is why the Pentagon should be paying attention to the El Nino forecast now. Whatever one’s views on long-term climate trends, the military still has to operate in the weather it actually experiences. And the weather forecast for the second half of 2026 is giving the Department of Defense something commanders rarely get before disruption arrives: months of notice.

On June 12, the National Oceanic and Atmospheric Administration (NOAA) declared that El Nino had formed, and current forecasts suggest it may become a very strong event by fall or winter, one of the strongest in the modern record.

That means significant warming of the Pacific Ocean will influence the broad weather patterns we experience through the rest of the year. It cannot tell us when and where extreme weather will hit, but it is a significant threat indicator.

NOAA is forecasting a below-normal Atlantic hurricane season. At the same time, El Nino conditions tend to shift typhoon activity eastward in the Pacific, toward Guam and the Marianas.

The region’s exposure is not hypothetical. This year, Guam and the Northern Marianas have already been hit by two major typhoons. Typhoon Sinlaku brought widespread blackouts, flooding, and infrastructure damage in April. Super Typhoon Bavi followed in July, its eye passing over Rota, leaving severe outages and flooded roads on Guam and Saipan while thousands were still recovering from the first storm.

Whatever the forecast holds, these storms are a reminder of what installations in the region face. The El Nino outlook says: Be ready for more.

The Pacific is not the only concern. El Nino is also expected to reshape weather across the United States as the year progresses, especially this winter.

NOAA’s historical outlooks associate El Nino with a stronger southern storm track: wetter conditions across the southern tier of the country; a greater risk of heavy rain and flooding in parts of California, the Gulf Coast and the Southeast; and a generally warmer northern tier.

For the military, that is not an academic forecast. It means installations across the South and Southwest may have to contend with more flooding, more drainage and access problems and more interruptions to training and maintenance, just as they are already operating through a punishing summer.

Heat stress remains part of the story as well.

Training bases in the South already face more days above safe thresholds for strenuous outdoor activity. El Nino will not create that problem, but it arrives on top of it, extending a year in which commanders may have to manage both the immediate effects of extreme heat and the prospect of a wetter, stormier winter ahead.

Years ago, after Hurricane Michael devastated Tyndall Air Force Base in 2018, I asked the base commander what he would have done if he had six months’ warning that the storm was coming. His answer was revealing. He did not begin with a five-year military construction plan or a new regulatory framework. He talked about operations. He would have done more hurricane drills. He would have made sure his people knew what to do. He would have prepared the force to absorb the shock.

That is the right way to think about this El Nino forecast. Six months of warning is not enough time to redesign a vulnerable installation. It is enough time to prepare to operate through disruption.

For commanders and installation leaders, that preparation is not mysterious. It means testing continuity plans and making sure the mission-essential functions of a base can continue if normal operations are interrupted. It means checking backup power, fuel, water, communications, drainage and access routes before a storm or heat emergency exposes the weakness for you. It means revisiting training calendars and work-rest cycles in places where extreme heat is increasingly likely to interfere with readiness. And it means asking the basic operational question: If a storm takes this installation offline for a week, what absolutely has to keep functioning?

The larger lesson is not limited to this one forecast.

El Nino will pass, but the baseline it returns to is not the baseline of thirty years ago. Each of these events now arrives atop a warmer ocean atmosphere, which means the same seasonal pattern delivers more water, more heat and stronger storms than its predecessors did. That is not a policy argument; it is an input to planning.

Another seasonal forecast will take this one’s place. Another storm season will come. Another heat wave will test the assumptions built into training schedules and installation operations. The military does not have the luxury of ignoring those warnings because they arrive under the label of “weather” rather than “war.” The weather is part of the operating environment. It always has been.

The Pentagon cannot control the weather, but it can use the intelligence it has been given. El Nino is a threat warning. The military should treat it like one.

John Conger served as the U.S. principal deputy under secretary of defense (comptroller) from December 2015 to January 2017.

In May 2026, South Carolina enacted Act 186 with overwhelming bipartisan support. Under an Americans with Disabilities Act framework, the law guarantees that autistic children can receive medically necessary behavioral health support, specifically Applied Behavior Analysis (ABA) therapy, inside public-school classrooms.

It was designed to ensure that no child must forfeit their public education to access required medical care.

Yet, active-duty military families stationed at Joint Base Charleston and across the state are being stripped of this protection.

The Defense Health Agency (DHA), operating through TRICARE’s Autism Care Demonstration (ACD), continues to enforce a rigid “School Exclusion” rule.

Under this administrative posture, TRICARE completely cuts off provider reimbursement the moment a behavior technician steps onto public school property. While civilian families with commercial insurance benefit from state law protections, military families face an impossible ultimatum: Either pull their children out of public school to maintain therapy in a clinical setting or drop medically necessary care so their children can attend school alongside their peers.

The operational cost of this bureaucratic conflict is staggering.

Summer 2026 field survey data from The Military Family Advocacy Group reveals that 100% of surveyed active-duty, mid-career operators navigating these TRICARE autism denials are actively planning early separation from military service.

When a specialized EOD technician or fighter pilot is consumed by an exhausting administrative war at home just to secure standard healthcare for their child, mission focus fractures and unit lethality suffers. The military spends millions of dollars and years of specialized training to build these operators, only to lose them over a TRICARE setting restriction.

Adding insult to injury is the financial cost-shift onto local taxpayers.

Denied in-school coverage by TRICARE, 80% of surveyed military families have been forced to enroll their dependents onto state-funded Medicaid waivers to cover essential care. This shifts an estimated $6,383 annual net tax burden per child directly onto South Carolina taxpayers for care that a federal defense program should be providing.

This systemic breakdown is not inevitable; it is the result of administrative intransigence.

In 2025, a comprehensive report by the National Academies of Sciences, Engineering, and Medicine (NASEM) recommended that the Defense Health Agency discontinue the 12-year ACD “demonstration” status, authorize ABA as a standard TRICARE Basic benefit, remove arbitrary setting exclusions and eliminate onerous assessment mandates.

Because the Defense Health Agency has repeatedly failed to self-correct or adopt these independent scientific recommendations, Congress must step in.

As lawmakers finalize the fiscal 2027 National Defense Authorization Act, they must include statutory language that legally compels the secretary of defense to terminate the ACD demonstration status, align TRICARE with NASEM standards and prohibit the Defense Health Agency from restricting medically necessary care based on geographic or educational settings.

South Carolina has done its part to protect military children. It is now time for federal lawmakers to enforce those protections, end the school exclusion rule and preserve the readiness of our total force.

Mariah Wilkins is the executive director and principal policy advisor of The Military Family Advocacy Group.

The intent — a stronger, more capable force — is a good one. Policies built on good intentions, however, can still go wrong, and this one deserves careful scrutiny before it is implemented at scale.

The goal of having a more effective military is understandable, but the question remains whether the science supports the strategy.

Testosterone replacement therapy is an important treatment for men with true hypogonadism, a carefully diagnosed medical condition. But expanding hormone screening across hundreds of thousands of healthy service members represents a significant shift in military medicine — one that deserves far more public discussion than it has received.

The military has always embraced innovation, but medicine is different. Good intentions are not enough. Before introducing any intervention on a broad scale, policymakers should be confident that the benefits outweigh the risks for the entire force.

So, does the evidence actually show testosterone makes troops more lethal or better fighters? Not clearly.

The Army’s own research is instructive. In the service’s first Optimizing Performance for Soldiers study, men given weekly testosterone injections during a simulated combat energy deficit preserved more lean muscle than men on placebo, but their physical performance declined at about the same rate as the untreated group.

The hormone helped the body hold onto muscle, but did not translate into better fighting performance. Put simply: the case that testosterone will make service members deadlier hasn’t been made.

It’s also worth considering what a low testosterone reading often actually represents. A low laboratory value may reflect the normal physiological demands of military service rather than a chronic hormonal disorder.

Sleep deprivation, combat deployments, chronic stress, obesity, alcohol use and intensive physical training can all temporarily suppress testosterone levels. Low testosterone is often a symptom rather than the underlying problem.

If the Department of Defense wants to build a stronger military, investments in sleep, nutrition, physical conditioning, behavioral health and recovery science are likely to produce broader and more lasting benefits than widespread hormone replacement.

Without careful evaluation, including repeat testing and assessment for reversible causes, many healthy service members could be labeled as testosterone deficient and begin long-term treatment they may never have needed. That decision carries consequences.

Once testosterone therapy begins, the body’s own production is suppressed. Fertility may decline. Testicular atrophy can occur. Some men become dependent on continued treatment because normal hormone production does not fully recover.

Ongoing monitoring is required to watch for elevated red blood cell counts, prostate-related concerns, sleep apnea and other potential complications. Researchers continue to study the long-term cardiovascular effects, particularly in younger, healthier populations.

Behavioral effects deserve equal attention. Testosterone influences mood, confidence, motivation and aggression. When appropriately prescribed, these effects may improve quality of life in men with genuine deficiency. But unnecessary treatment, or excessive hormone levels, may increase irritability, impulsivity, emotional volatility or impaired judgment in susceptible individuals.

In a military that depends on discipline, restraint and sound decision-making under extreme pressure, even uncommon adverse effects warrant careful consideration.

Testosterone therapy has an important place in modern medicine. That is indisputable. The key issue, though, is whether routine screening and expanded hormone treatment across one of America’s healthiest working populations will strengthen military readiness or create long-term health challenges that outweigh the expected benefits.

Many of these issues will need to be addressed by the Department of Veterans Affairs after the service member transitions to civilian life.

America’s military superiority has never depended on a laboratory value. It is built on leadership, training, discipline, resilience and the judgment of the men and women who serve. Those remain the greatest sources of our strategic advantage.

David Shulkin, MD, was secretary of the U.S. Department of Veterans Affairs during the first Trump Administration and served as VA’s under secretary of health during the Obama Administration.

The hard truth is this: America cannot dominate the modern battlefield if the Department of War does not know where its critical materials, components and software come from.

A fighter jet, missile battery, naval vessel, radar system, drone or armored vehicle does not begin on the factory floor of a prime contractor. It begins with minerals, metals, magnets, chips, chemicals, software, castings and forgings — thousands of components moving through supply chains that stretch across the world. In a major defense program, those chains may run five or six tiers deep, while government visibility often stops at the first or second.

That gap is the danger. America’s vulnerabilities are buried in the lower tiers — the subcontractors and vendors supplying specialty metals, electronics, chemicals, software and raw materials that Washington is not watching.

And that is exactly where President Trump’s new executive order, “Securing America’s Defense Supply Chains and Ensuring Domestic Acquisition of Critical Materials,” strikes.

For too long, Washington has pretended a weapons system is “American” if final assembly happens in America — even when critical inputs come from foreign adversaries or suppliers vulnerable to foreign ownership, control or influence. That fiction may satisfy a lobbyist. It will not survive a war.

Congress recognized the danger in 10 U.S.C. 4872, which restricts acquiring covered materials from covered nations. But laws are only as strong as their enforcement — and waiver culture, contractor convenience, and bureaucratic inertia have hollowed out those rules.

That era is over. The Trump policy is simple and tough: end the loose waiver process, expose hidden supply chains, vet the lower tiers, qualify trusted sources and hold contractors accountable.

Beginning January 1, 2027, waivers under 10 U.S.C. 4872(c)(1) and (e) will no longer be business as usual. A contractor seeking relief must identify the noncompliant source, document exhaustive efforts to find compliant material or prove none was available, lay out the steps to remove it from the supply chain and commit to a strict timeline.

Failure to qualify a domestic source will not count as “non-availability” unless the contractor shows active, adequately funded and ongoing efforts to qualify one. In plain English: No more, “We tried nothing, and we’re out of options.”

To expose hidden supply chains, the order directs the Secretary of War to begin rulemaking requiring contractors to map critical supply chains for national-security acquisitions identified by the department — from raw materials to the end products delivered to the military — through a tier-by-tier bill of materials tracing components, parts, software and materials back to their origins.

This is not paperwork. It is battlefield preparation. If a missile system depends on a foreign-controlled supplier, the Department of War needs to know before the shooting starts. If a naval platform relies on a sole-source supplier vulnerable to bankruptcy, takeover, cyber disruption or production bottlenecks, that risk must be surfaced and mitigated. If a supply chain runs through an adversary-controlled chokepoint, that is a strategic exposure, not an accounting detail.

To vet the lower tiers, contractors must screen suppliers and subcontractors supporting critical supply chains for financial risk; foreign ownership, control or influence; and manufacturing and supply risk. They must report significant risks and fix them on a strict, tracked timeline.

On trusted sources, the message is blunt: qualify or replace. For decades, contractors have hidden behind slow qualification processes while adversary-linked suppliers stayed embedded in America’s defense industrial base. No more.

Contractors relying on supply chains that include materials or components supplied by unreliable foreign suppliers must promptly qualify and use alternatives, consistent with law, safety, mission requirements and contract terms. The Department of War will speed the testing and qualification of new sources and materials. And when outdated regulations block rapid qualification for defense production, those roadblocks must come down.

On the accountability front, national security contracting is not a game of hide-the-ball. Contractors that fail to qualify required alternatives can lose task orders, contract options or the contract itself. And contractors who commit fraud, deliberately mislead the government, or knowingly or willfully fail to implement approved mitigation plans face every lawful action and contractual remedy the secretary deems appropriate, with possible referral to the Attorney General.

The broader message of this new Trump administration EO should be clear. America’s arsenal of democracy begins in the mine, the refinery, the forge, the foundry, the chemical plant, the semiconductor fab and the machine shop.

Peace through strength requires strength through secure supply chains: American weapons built with domestic, allied, and trusted materials; sunlight, enforcement, qualification and accountability.

And one overriding rule for every defense contractor: Never put an American warfighter at risk because an adversary-linked supplier was buried five tiers down.

Peter Navarro is the White House Senior Counselor for Trade and Manufacturing.

Yet every year, just as many of our most experienced aviators are ready to lead squadrons, mentor younger pilots and shoulder greater responsibility, too many choose to leave active duty. That should concern every American because this is no longer simply about pilot retention. It is about preserving one of our nation’s greatest strategic advantages.

As a former U.S. Navy helicopter pilot, the wife of a retired Navy fighter pilot who proudly served for two decades, and the representative of Virginia’s Second District, home to Naval Air Station Oceana and the East Coast’s Master Jet Base, I know this community well. I know what it takes to earn Wings of Gold, the sacrifices military families willingly make, and the extraordinary demands our nation places on those who defend it.

Most fighter pilots don’t leave because they’ve stopped believing in the mission. Too often, they leave because, by the halfway point of a career, years of deployments, relentless operational tempo, missed birthdays and anniversaries, family separation and uncertainty about the future have taken a cumulative toll. They still want to serve. Our challenge is ensuring that a full career in uniform remains a path they can realistically choose.

There is no single reason fighter pilots leave active duty. Compensation matters. So do family stability, aging infrastructure, quality of life and competitive civilian opportunities. Looking at any one of those issues in isolation misses the point. Together, they determine whether an experienced aviator believes the Navy can remain not only a calling, but a career.

The consequences extend far beyond an empty cockpit. Every experienced fighter pilot who leaves takes with them years of judgment, tactical expertise, leadership and operational knowledge that cannot be recreated overnight. Some would become instructors. Others would become department heads, commanding officers, air wing leaders and the mentors responsible for preparing the next generation. We don’t just lose another pilot, we lose the leaders who would have developed the pilots behind them.

That is why fighter pilot retention is no longer simply a military personnel issue. It is a strategic imperative.

For nearly four years, I have warned that readiness begins long before an aircraft leaves the runway. That is why I have fought for investments at Naval Air Station Oceana, from replacing aging fuel infrastructure to improving quality of life for service members and their families.

Those efforts were never simply about fixing facilities. They were about strengthening military readiness. We cannot expect America’s best fighter pilots to dedicate decades to defending this nation while overlooking the conditions in which they live, work and raise their families.

The good news is that our military is moving in the right direction.

Under President Donald Trump and Secretary Pete Hegseth, our armed forces have renewed their focus on the warrior ethos, readiness and winning wars. Combined with the extraordinary work of Navy recruiters across the country, the Navy has exceeded its recruiting goals after several difficult recruiting years. That success proves something important: When America focuses on the right priorities, we can solve hard problems.

Now we must do the same for retention.

Recruiting and retention are different challenges. Recruiting brings exceptional young Americans into uniform. Retention ensures they remain long enough to become the experienced leaders our military depends on.

We cannot recruit our way out of a retention problem.

Recognizing the urgency of this challenge, I fought to include a provision in the House version of the fiscal 2027 National Defense Authorization Act requiring the Navy to conduct a comprehensive assessment of fighter pilot retention. That assessment is an important first step because we need an honest understanding of why we are losing experienced aviators and where we must improve.

But that assessment cannot become the end of the conversation. It must become the beginning.

We already know many of the pressures our aviators face. We know there is no single solution. Bonuses matter, but they are not enough. Infrastructure matters. Family stability matters. Operational tempo matters. Career flexibility matters. Quality of life matters. None of these challenges exists in a vacuum, and none will be solved in isolation. If we are serious about retaining experienced fighter pilots, we have to be just as serious about rethinking how we support them throughout an entire career.

That will require creativity. It will require challenging assumptions that have existed for decades. It will require Congress, the Department of Defense, Navy leadership, military communities and the American people to recognize that retaining experience is every bit as important as recruiting talent. The same determination that helped reverse the recruiting crisis must now be applied to preserving the experience that makes our military the finest fighting force in the world.

America’s competitors understand that our military advantage is measured by more than the number of aircraft on the flight line. It is measured by the experience, judgment and leadership of the men and women who fly them. That experience takes years to build, but it can be lost one retirement, one resignation and one difficult career decision at a time.

We know what is at stake. Now we must come together, with urgency, creativity, and resolve, to ensure that America’s best fighter pilots can continue doing what they have always wanted to do: serve their country.

Because America cannot surge experience.

Rep. Jen Kiggans, R-Va., is a U.S. congresswoman representing Virginia’s second district. She served for 10 years as a U.S. Navy helicopter pilot.

That calculus has changed. Adversaries have invested in the capabilities needed to interdict supply lines — long-range fires, drones, electronic warfare, anti-ship weapons, proxy networks that can reach ports, rail corridors, and staging areas far from any front. The vulnerability of the logistics infrastructure that sustains combat power is no longer an abstract concern, it is the operational problem of this moment, and it is not unique to the Middle East. The supply chain as battlespace is the defining characteristic of modern conflict.

These same adversary investments are driving sustained, high-tempo combat operations that can burn through critical munitions inventories — precision strike missiles, air defense interceptors, long-range fires — at rates that take years to replenish. What once looked like an abstract readiness concern is now headline news. In this environment, knowing precisely where every asset is, protecting it with optimized precision, and integrating that picture into combat planning isn’t a modernization initiative, it’s a necessity. We have the technology for that comprehensive, near real-time common operating picture (COP), we just need to link it.

The technology is here

Episodic tracking — the military’s primary in-transit visibility approach for 30 years — was built for a different operational environment. It tells you when cargo passes a fixed reader but, in a contested environment that’s not visibility, it’s a guess.

Mesh networking changes the equation entirely. Battery-powered tags form ad hoc networks, relaying location and condition data through mobile gateways to satellite uplinks, delivering near real-time asset visibility across any mode of transportation without fixed infrastructure. The architecture is hardened for contested environments: tags can suppress their own emissions when the threat environment demands it and come back online automatically based on location; communications are encrypted; the network uses frequency hopping to resist targeting. It works in the field, across truck, rail, and sea, at scale.

Once materiel is deployed, AI-enabled platforms can now fuse asset locations, threat data, terrain, unit capabilities, and route status into a single real-time operating picture — and model the consequences of protection decisions before forces are committed. Optimization engines evaluate and analyze the full picture to recommend courses of action. Auto-tasking allocates units as conditions change. What once required significant, manual staff effort across disconnected systems can now be accomplished in a unified interface, fast enough to match the pace of combat. This capability, too, is proven and operational.

A COP across the lifecycle

Taken separately, each capability is valuable. Taken together, they represent something the joint force has never had: a COP that ties where a resource is to what the force can do with it. A COP that follows every resource — equipment, ammunition, fuel, sustainment — from depot to forward position, continuously informing protection requirements and enabling smarter combat decisions as the picture evolves.

Consider what that means in practice. A commander knows not just that a critical shipment departed a depot — but precisely where it is, in near real time, as it moves through rail yards, ports, and contested sea lanes. When the threat picture shifts, the protection platform immediately recalculates coverage, recommends reallocation and flags gaps. When assets reach a forward position, the same data that tracked them in transit feeds directly into combat planning. Inventory is not an estimate, it is a fact, integrated into every decision downstream.

That integration matters most when inventories are under pressure. Modern conflicts are consuming critical munitions inventories faster than they can be replenished, eliminating the margin for waste — misrouted shipments, unprotected convoys, planning based on stale inventory data — disappears. A COP does more than improve efficiency. It prevents the compounding losses that turn a supply shortfall into a capability gap.

This is a different theory of how logistics and operations relate to each other. The traditional model treats supply chain management and combat planning as sequential — logistics delivers, operations consume. The integrated model treats them as continuous and interdependent. The COP does not end at the depot gate or the port of embarkation. It persists through the entire lifecycle of a resource, from production to employment, updating in real time and driving decisions at every echelon.

Commanders who can continuously see their assets can redirect them before disruptions become crises. Protection cells who can see the full logistics picture — not just unit positions but the routes, schedules, and vulnerabilities of the supply chain itself — can defend it proactively rather than reactively. And planners who can query actual inventory rather than projected inventory can design operations around ground truth, not assumptions that dissolve on contact.

We get to choose

The threat environment that made this architecture necessary is no longer theoretical. From the Strait of Hormuz to the U.S. Pacific Command, adversaries are investing in the precise capabilities designed to disrupt sustainment, fracture visibility, and exploit delay between detection and decision.

The technology to close those gaps already exists, and the operational need is visible. What remains is the decision to connect these systems deliberately, under a unified architecture with the processes and authorities to move at the speed the threat demands.

Robert Yon is LMI’s vice president, Sensor Mesh. Yon leverages his experience as a former USMC officer to identify technology solutions for the military’s greatest challenges, with an emphasis on addressing logistics. As VP, Sensor Mesh, he leads the implementation of LMI’s SPECTR asset visibility tool, and oversaw its recent successful deployment during USTRANSCOM’s Turbo Fusion exercise.