And so it was that the recently identified findings I brought with me to the pentagon, epidemiologic data collected downrange, would be a punch to the gut of the leader of our Navy, to our highest ranking active duty member of the US Navy , none other than the Chief of Naval Operations (CNO). Accompanied by the Navy Surgeon General, my 15 min of fame—or is that infamy—briefing the CNO and his entire court in the sumptuously appointed private “E” Ring briefing room, on the mental health status of a high risk group of Sailors, as if time stood still, grew to 30 min, 45 min, an hour, or more.

Entering the room and repeating my new mantra to myself, a meditation on self-preservation, “please don’t shoot the messenger!” I knew the findings I carried with me, data collected and analyzed, would not be well received. Would these findings—unclassified health care data, gleaned from an at-risk population based behavioral health surveillance—at least in senior leadership’s mind, conjure up a failure of covenant responsibility and possibly forever contribute to for my wahrhol-esq fifteen minutes of CNO briefing fame?

The Surgeon General (SG), concerned not just for the welfare of the Sailors we identified at immediate risk, but how CNO would respond, rehearsed the brief with me, going over and over the data as we knew it, imploring me to “stay on script.” I have a habit of enriching the discussion, even more so with flag and general officers. On more than one occasion my naïve offering of “too much information” culminated in gentle, but telegraphic, under the table kicks by lesser ranked officers reminding me to confine my digression to the topic immediately at hand.

As the Bureau of Medicine and Surgery’s inaugural Combat and Operational Stress Control Consultant, Acting Director of Psychological Health , and clinical psychiatrist, I’ve completed more deployments, both combat and peacetime, than most Navy Psychiatrists rack up their entire career. With over a quarter century of operational medicine , I knew my findings would not be contested simply from the perspective of credibility. Furthermore, the MPH on my signature line meant that it was my job to identify occupational hazards: combat missions which put those who the CNO was specifically entrusted to protect at undue risk, whether that was attributable to lack of experience, leadership, training, or equipping. Not that there is ever an “acceptable” risk of developing a condition such as PTSD following service to this great country, however we are at war, and the length of war, chronicity of exposure, periodicity and extant nature of deploying, justify the roles and responsibilities of the COSC Consultant.

Even before I finished my presentation, upon seeing the morbidity stats sampled from an entire detachment of Sailors, CNO spoke, his court listening intensely. Dropping their heads in mutual and unanticipated disgust “How could we let this happen?” CNO spoke, admonishing his court. Surveyed using the same instrument (language and ranks slightly modified for Sailors) as the Mental Health Advisory Team, or MHAT, my findings indicated profound psychological injury, far in excess of front line infantry soldiers and surpassing the psychological impact of the most intense combat exposure.

How could Detainee Operations be so traumatic? Why should a battalion of Individual Augments, typically reservists made up from a broad sampling of rates, ranks, ages, Reserve Centers, backgrounds, and military experiences be so profoundly impacted by their mission of guarding OIF/OEF detainees down range? With Post Traumatic Stress Disorder and Depression scales “off the charts,” it is little wonder that only a few months before, I received a distress call from the AO (Area of Operations). The Officer-in-Charge of a guard force of Navy reservists-turned-Individual Augments, had assumed command of battalion of reservists cobbled together, deployed to CENTCOM to replace an Army unit of MPs.

How did we get to this point? Several weeks earlier, across the pond, I was not aware that my collaboration with the Army’s Mental Health Assessment Team, well circulated in behavioral health circles and with data published in the New England Journal of Medicine NEJM [1], would offer hope to the Officer-in-Charge of a battalion of Sailors. Speaking over poor quality DSN line, after first confirming that my lieutenant and I had conducted MHAT analogous surveillance of deployed Marines and Sailors, this OIC inquired if we could conduct an immediate epidemiologic assist visit—the tactical equivalent of popping smoke, the herald of a red star cluster. What would follow would be an unprecedented expedited request for surveillance.A subsequent series of programs and deployments to identify other at-risk populations would usher in and presage an entirely new concept in population based, preventive medicine championed throughout Navy Medicine writ large. Like an archeologist discovering artifact, now uncovered, our epidemiological findings, dusted-off and held to sunlight, contributed a critical piece of the puzzle, shameful as it be. On time and definitely on target, clinical observations from a population of guards accomplished what good science yearns to do: create hypothesis which, once tested and validated, guide efforts which improve the quality of life. PTSD underpinnings unearthed.

To accomplish the tasking of guarding detainees , the Navy would ask erstwhile sonar techs, aviation bosun mates, structural mechanics, even yeoman (administrative staff) to leave their ships, subs, flight decks, and indestructible Steelcase desks, don Army ACUs, qualify on service weapons (M4 automatic rifle and M9 Berretta pistol), mobilize onto active duty with 180-day orders , and receive just-in-time detainee ops training. “Fall in,” was followed by, “aye-aye, sir,” over and over again … Oh, the things you can find if you don’t stay behind … Following my briefing to CNO, I didn’t stay behind long, either.

In their defense, senior Navy leadership, and for this matter, probably the Air Force too, knew not the perils endured by Individual Augments, much less the psychological consequences of Detainee Operations . In theory, parts are parts; TDY is TDY (or as it is called in the Navy, TAD). Why shouldn’t the Navy offer up US Navy personnel to assist the army in their effort to mend holes and patch thread-bare platoons, companies and even battalions. And holes there were: by early 2007, there were approximately 12,000 Navy personnel filling Army jobs in the USA, Iraq, Afghanistan, Cuba and the Horn of Africa. By 2008, about the time I received that sentinel call (heralded by the popping of smoke) more than 10,000 “sandbox sailors” (the pejorative moniker this group of dedicated Sailors were sometimes called) found themselves in receipt of IA orders. The utilization and demand for IAs could not be understated. Quite stunningly, according to the Defense Technical Intelligence Command, DTIC, since 9/11, the total number of sandbox sailors deployed throughout theater, actually surpassed the total number of Sailors deployed upon all Navy ships.

An Individual Augmentee is a formally defined as a US military member assigned to a unit such as a battalion or company, as a temporary duty assignment (TAD/​TDY) . Individual Augmentees can be used to fill shortages or can be used when an individual with specialized knowledge or skill sets is required. As a result, Individual Augmentees included members from other branches of service similarly plucked from their military family (and personal family), cleaved from the comfort and support of their organic command. The IA system was used extensively in the Iraq War, though with some criticism. Individual Augments served in vital roles, typically inferred by their more traditional Navy roles such as USMC support, maritime security, port security, cargo handling, Seabees, and even, Joint Task Forces. However, it was the not-so-traditional occupations such as, Civil Affairs, Provincial Reconstruction, and perhaps the most insidiously damaging job, Detainee Operations which garnered my concern.