A Pentagon watchdog warns in a new report that some of the US Navy's elite special warfare boat crews may be returning to dangerous missions and activities with undiagnosed brain injuries due to breakdowns in reporting, screening, and follow-ups. Special Warfare Combatant-craft Crewmen, SWCCs, are an elite special operations force. Aboard fast boats, they support and execute combat missions, such as transporting other special operators, interdicting vessels, and conducting reconnaissance at sea. "SWCCs repeatedly endure severe wave-slamming forces," the Department of Defense's Office of the Inspector General wrote in a report released this week.

"Without an objective, standardized testing mechanism to identify injuries early, symptoms may be masked as routine fatigue," the report said. "Sending service members back to high-risk maritime and riverine environments with undiagnosed [mild traumatic brain injury] can result in degraded operational decision-making." It added that when "operational and training tempos take precedence over medical follow-ups, SWCCs miss critical appointments," making it more difficult to effectively evaluate their conditions.

Traumatic brain injuries are defined as significant health issues caused by external forces like explosions or wave-impact events that can, over time, cause confusion, disorientation, slowed thinking, memory loss, or loss or decreased levels of consciousness. The IG report said SWCCs haven't been regularly filling out TBI exposure forms; a medical officer told investigators that crews often don't fill them out because the paperwork takes hours, affecting rest, recovery, and preparation for future missions. The report said command didn't enforce compliance.

Crew members who have suffered these kinds of injuries said they often don't report their symptoms — or attend follow-up appointments — because of their high-tempo schedules and concerns that recovery time could put more work on other service members. The military's primary concussion screening tool, the Military Acute Concussion Evaluation, Version 2, or MACE-2, didn't appear documented in cases investigators reviewed. Among medical records tied to reported TBI exposures between 2020 and 2026, the investigators found no completed MACE-2 assessments.

The IG report said that the problem is that corpsmen have to first make a subjective decision about whether the symptoms they are seeing are caused by a concussion or are the byproduct of seasickness, dehydration, or sleep deprivation, and there's no set standard for that. In instances where screening is administered, crews told investigators that they can "mask TBI and concussion symptoms by memorizing portions of the MACE-2, potentially reducing the accuracy of the assessment." While medical personnel can alter the test questions to make them much less predictable, this practice isn't required or regularly implemented. Investigators also found almost no evidence that the operators received regular follow-up care.

"Without follow-up care after sustaining a TBI, a SWCC could return to work too soon," the report explained. The findings conclude that crews may have returned to duty while still suffering from undiagnosed or untreated TBIs, which could increase the risk of long-term ailments and negatively impact readiness. The IG report cites one crew member who told the office "that during high operational tempos, a fear exists of being removed from their operational duty on the boat, which would shift the workload to another detachment."

These special boat teams work on a 24-month deployment cycle, including six months of unit-level training.

"With limited manning and four troops in different stages of the cycle, SWCCs feel they cannot consistently report their symptoms without impacting deployment exercises," the report said. These experiences were corroborated by medical personnel, who said rest and recovery are difficult for teams and members often don't attend follow-up appointments because of their demanding schedules. The office recommended the establishment of a standardized, objective TBI checklist, which is being developed with an estimated completion date of December 2027. Similarly, the office said that roadblocks preventing crew members from receiving treatment should be addressed, including the creation of "a mechanism to enforce accountability for special warfare combat crewmen to complete required follow-up treatment and mitigate potential gaps in unit readiness."

These are expected to include reinforced mandatory follow-up appointments and an escalation protocol and be complete by March 2027. Naval Special Warfare Command concurred with the watchdog's recommendations and said it is revising its concussion management approach accordingly, including developing a standardized screening tool for wave-impact and other non-blast concussive events.