By Andrew Ortuzar, Defense Health Agency

Key leaders in the military, federal, civilian, and private sectors presented the latest research on addressing challenges to warfighter healthcare at the “State of the Science Symposium in Health Services Research in the Military Health System.” The event was co-hosted by Uniformed Services University’s Center for Health Services Research and the Defense Health Agency’s Military Health Systems Research Program, April 8-9, 2026, in Bethesda, Maryland.

In his opening remarks, Dr. Richard Shoge, director of DHA’s MHSRP, outlined the program’s vision.

“Military Health System research is a direct force multiplier for achieving the DHA director’s combat support mission. We’re not just conducting research for the sake of knowledge; we are actively solving problems to enhance warfighter readiness and lethality.”

Shoge said the future of military medicine is being shaped by technology, with DHA leading the way.

“The Department of War’s Artificial Intelligence Strategy and the DHA’s new Data Strategy are game changers. By treating our data as the critical strategic asset it is, we are unlocking unprecedented opportunities for research.”

The event’s first presenter, DHA Deputy Director Dr. David J. Smith, discussed the agency’s four lines of effort — the fundamental structure of DHA’s operational framework laid out by Director Vice Adm. Darin K. Via:

  • Deliver warfighter medical readiness: “Everything we do in the Defense Health Agency is combat support,” Smith said. He emphasized the importance of addressing musculoskeletal injuries and mental health issues, the “two biggest entities that create non-deployability. This requires a system that is responsive and does what it needs to do in an appropriate amount of time.”
  • Deliver medical warrior currency: Smith highlighted the effort to increase over 65 care at DHA’s largest institutions along with partnerships with the Department of Veterans Affairs and with civilian providers as key to boosting readiness of the medical force, pointing to the historic launch of Walter Reed National Military Medical Center’s collaboration with Kaiser Permanente. “Where we’ve got capacity, we need the volume … they get a high-quality institution, and we get the sets and reps,” Smith said, adding the agency’s work with the VA is “a good value for us and good value for the VA and the taxpayer.”
  • Deliver joint warfighting capabilities: Citing the importance of blood supply and “making sure that we have that lifesaving commodity,” Smith stressed the importance of logistics in definitive care and joint trauma support that impact survivability and lethality.
  • Deliver the healthcare enterprise beneficiaries deserve: Looking ahead, Smith described a new “organizational muscle movement” within DHA called the “Office of Warfighter Health Advantage.” This office will bring together data experts, health informatics specialists, innovators, and strategists who are tasked with enhancing systems to provide high-quality care to all beneficiaries. The goal is to create an “innovation cell with SWAT teams that go and help when metrics are stuck, executing intensive forms of continuous process improvement.”

These components work together to improve warfighter medical readiness, aligning with the DHA vision, Smith said.

“Medical readiness and combat support is our job — No. 1. It’s also what differentiates us from other healthcare entities across the United States.”

Modeling musculoskeletal combat casualty care Dr. Andrew Schoenfeld, a researcher from Harvard University, outlined limitations in treating conditions such as musculoskeletal injuries in a future large-scale combat operation.

In previous combat operations in places like Iraq and Afghanistan, Schoenfeld explained, U.S. air superiority enabled the rapid evacuation of casualties, yet in a future conflict, “it can’t be taken for granted that air evacuation assets like helicopters” will be able to transport the wounded from any site.

“This is of critical importance when considering drones, which have revolutionized what (future combat operations) may look like at the front,” he said.

To address these challenges, Schoenfeld’s team proposed a solution called “the flying column,” a rapid-deployment unit capable of providing combat care to bridge the distance to the front line.

“It’s very important to realize what (future combat operations) would take for U.S. forces in the next conflict, and how we can best secure ourselves to support them medically,” he said.

Physical therapy for the rehabilitation of amputation Dr. Andrea Crunkhorn, chief of clinical affairs at the Extremity Trauma and Amputation Center of Excellence, presented the initial results of a scoping review of physical therapy protocols for rehabilitation of lower limb amputation — highlighting need for specialty specific protocols within the MHS.

“The CPGs are multidisciplinary, and they apply across the entire continuum of care — which means they are very broad,” she said. Clinicians lack pragmatic guidance for rehabilitating patients with lower limb amputations, Crunkhorn noted, and while military hospitals and clinics have postsurgical guidelines, they can vary and “are not necessarily universal.”

Her team identified several areas where standardized protocols are needed:

  • Setting time-based goals by establishing clear timelines, such as achieving independent mobility by week two and prosthesis use by weeks six to eight
  • Comprehensive physical training for areas such as abdominals, glutes, balance, range of motion, cardiovascular fitness, and coordination
  • Assisting patients in managing the new, additional cognitive load required in using a prosthesis

She emphasized standards must also incorporate mental health considerations. “There’s a lot of post traumatic stress disorder, a lot of depression,” she noted, “These need to be woven into how we’re managing patients.”

Crunkhorn is leading the charge to consolidate the findings from the scoping review and integrate them into the protocols from military hospitals and clinics to create updated, comprehensive guidelines.

“We’re in the midst of that process now,” she said, adding “once we have all of the data extracted and analyzed, we’ll sit down with clinicians from the three Advanced Rehabilitation Centers for consensus on integrating the new information.”

The three ARCs handle prosthetic fabrication and will become Amputations and Prosthetics Centers of Excellence, under the James M. Inhofe National Defense Authorization Act for Fiscal Year 2023.

“Once we have that consensus the process is for each ARC to review and approve internally with the rehab team and their surgeons,” Crunkhorn added.

Enhancing measurement-based mental health Dr. Brett Litz, a clinical psychologist from Boston University, advocated for “measurement-based care” in MHS and VA treatment for PTSD.

This model uses repeated assessment of symptoms to track progress and collaboratively adjust treatment when it is not working, avoiding treatment failure, promoting change, and empowering patients to be active participants in their care.

“The promise of it really is to leverage data to improve the quality of care,” Litz explained. “(Patients) would be better consumers of care if they knew it was tracked and they ostensibly asked the question, ‘Are they getting what they need from this?’”

“Tracking progress is a collaboration between the patient and the clinician, so that really needs to change,” he added, and stressed harmonizing the benchmarks for “clinically significant change” across the DOW and VA. For example, Litz suggested a new data-centric focus for the healthier, mission-ready MHS population.

“It might be better to track functioning — job performance, job satisfaction, how things are going in the family,” he said, “Rather than necessarily mental health symptoms, it should be explicit that the targets are mission readiness.”

Adjustment disorders in active duty service women Adjustment disorders are the most frequently diagnosed mental health condition in the U.S. military, yet knowledge on the topic remains limited, according to Maj. Dynasty Stokes, a U.S. Air Force women’s health nurse practitioner and Ph.D. student at the Ohio State University College of Nursing. Stokes detailed the findings of a study examining adjustment disorder among active duty service women.

Between 2016 and 2020, adjustment disorders accounted for nearly 31% of all mental health diagnoses in the military, with service women being twice as likely as service men to receive the diagnosis. Stokes noted its significance as a potential precursor to more severe conditions like major depressive disorder and PTSD, and its association with a higher risk of suicide attempts and death by suicide.

Yet despite its prevalence, “active duty service women and military healthcare professionals remain underrepresented in research on adjustment disorder,” Stokes explained, and the diagnosis is sometimes used as a “placeholder diagnosis” to allow individuals access to care or because it is more palatable to clients and more adaptable within sensitive occupational contexts than a more severe diagnosis.

To mitigate this issue, she recommended DHA provide clear guidance on the definition and management of adjustment disorders, valid and reliable screening tools be integrated into MHS GENESIS, and future research must employ more robust methods to better understand the disorder’s trajectory, outcomes, and effective interventions.

“There is a need for standardizing diagnostic approaches and more research is needed to improve prevention, identification, and treatment,” Stokes concluded.

Military Health System Research Program mission ahead The program is at a pivotal juncture, aiming to foster collaborative research capability that supports DHA as a combat support agency. Achieving this vision, Shoge noted, requires a joint effort.

“The goal will be to break down data silos that have existed for decades, improve data access, as well as ensure the data meets quality standards.” This provides researchers with “unprecedented access to larger, more integrated datasets,” creating the “foundational infrastructure needed to truly leverage advanced analytics, AI (artificial intelligence), and machine learning.”

Shoge said the Military Health System Research Program, in partnership with the USU Center for Health Services Research, is prioritizing research “that solves joint-force challenges and forges strategic partnerships to ensure the MHS remains at the cutting edge.”