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    Naval Education and Training Command Command Investigation

    Copyright:

    © All Rights Reserved
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    Download as pdf
    2K views196 pages

    Naval Education and Training Command Command Investigation

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    Asbury Park Press
    Naval Education and Training Command Command Investigation

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    © All Rights Reserved
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    ce DEPARTMENT OF THE NAVY "noDALias sneer PeNsACOUn FLOROON38e8220 - sa30 Ser NOOI/O85: 24 Mar 23, From: Commander, Naval Education and Training Command To: Subj Ref Enel File COMMAND INVESTIGATION INTO THE FACTS AND CIRCUMSTANCES REGARDING SAFETY AND MEDICAL OVERSIGHT OF BASIC UNDERWATER DEMOLITIONSEA AIR AND LAND CLASS 352 (a) Vice Chiet of Naval Operations ltr NO9/22U100578 of 31 Aug 22, (b) RDML Benjamin Reynolds, USN, lr of 18 Nov 22 (©) RDML Benjamin Reynolds, USN, lr of 16 Dee 22 (2) NAVSPECWARCOM ir 5830 Ser NOO/LO10 of 24 Feb 23 with encl (2) BUMED ltr5830 Ser NOOJ/13 of 7 Mar 23 (G) Modifications to the Command Investigation (4) Commander, Nava Safety Command ltr 4730 of 19 Oct 22 Risk Training Inspection of 28 Oct 20 (8) 1" Phase Data (10) Naval Heath Research Center Hell Week Report of 2005 (L)BTC Training Mishaps (12) Naval Health Research Center Hell Week Report of 2015 (13) Attrition Data (14) Thomas 8 's Medical Dictionary 28% Ed. Stedman's (13) a 8) fernil of § Nov 22 (17) Mission Citical Team ial of 8 10 Feb22 (18) Memorandum for the Record f 16 Mar 23 (19, Gaprande, Navy Special Warlare Center ir 1200 Ser 00 of 6 Sep 19 sk Training Safety Officer Leter of Designation 20) IRTSO Job Qualification Requirements of 16 May 2019 @ agers Internal Control Assessment 2021 @) anager’ Internal Control Assessment 2022 (23) Annual Safety Reviews from 2018-2022 (@4) BTC DEOCS of April 2021 (25) Clinical Procedures for Safer Patent Care, ection 5.6 Management of Hypoxia (26) Hafen BB, Sharma S (2022), “Oxygen Saturation,” StratPeaes Publishing LC (7) Class 352 Preumonia Medical Records of 4 February 2022, cu ‘Sub: COMMAND INVESTIGATION INTO THE FACTS AND CIRCUMSTANCES REGARDINGSAFETY AND MEDICAL OVERSIGHT OF BASIC UNDERWATER DEMOLITION/SEA AIR AND LAND CLASS 352 1, Fer reference (), Lye directed to convene a command investigatnn nto Naval Special Warfare Command's (NSWC) Basic Training Command (BTC) oversight of Basic Underwater Demolition/Sea Air an} Land (BUD/S) Class 352 as itrelated to SN Kye Mullen's death to include relevent eircurstances associated with the Incideat. I concur with te findings, epinions, ‘and recommendations af the investigating officer as set forth inzeferences(b) and (c), but as modified herein. 2. Loommend RDML Ben, Reynolds and his investigation team for their diligent work. With ‘collective decades of experience and diversity of relevant experis, they took an in-depth look into a premier Navy high risk traning program and provided insight, actionable, and practical recommendations, 43._ A copy ofthis investigation shall be forwarded tothe Vice Chief of Naval Operations (WENO) for action as Seemed appropriate. 4. Independent ofthis investigation, Naval Sefety Command (NAVSAFECOM) and Bureau of ‘Medicine and Surgery (BUMED) are conducting a safety investigation and a quality of eae review, respectively. However, to ensure as thorough a review as possible, I solicited, and incorporated as appropriate, input from NSWC (enclosure (1), BUMED (enelosure (2) and NAVSAFECOM. NAVSAFECOM did not identify any gaps or seams with the fc, opinions, and recommendations contained within eference(b). Finally, enclosure (3) direoss ‘modifications to the flaal report of investigation. 5, Naval Education anf Training Command's (NETC) mission isto recruit tain and deliver those who serve our Nation, fostering them from streetto-Deet by forging civilians into highly skilled, operational, and combat ready warfighiers. We oversee much ofthe taining within the [Navy inluding numerous high risk taining programs, and lead in the delivery of effective, leading-edge frning for naval forces. NSWC BTC is not aligned under NETC therefore we do not provide oversight. It is with this context of experience and expertise that | vas tasked with Convening this investigation into high isk Wining program outside tbe NETC domain. 6. Overview ‘The highsisk raining program conducted at BUDIS is necessary to achieve the required ‘outcome: fully combet capable special operators. Efforts to mitigate the inherent risk must not ‘be allowed to dull weining effectiveness and thereby create risk to commands and Sai operating in combat environments, Candidates must be pushed close to operational lis ‘ensure they are adequately prepared for combat. However, effective risk management und training suppor systems can and should significantly mitigate injuies and illnesses associated ‘with high isk traning O t ‘Subj: COMMAND INVESTIGATION INTO THE FACTS AND CIRCUMSTANCES REGARDING SAFETY AND MEDICAL OVERSIGHT OF BASIC UNDERWATER DEMOLITION/SEA AIR AND LAND CLASS 352 '. This investigation revealed what is correctly described as an individual and community tragedy and found failures across multiple systems that led to a number of candidates being at a high risk of serous injury. Asstated by CNSWC in enclosure, itis atop priority for NSWC. and the Navy to ensure we lea ftom ths tragedy and take action to prevent i from happening ‘again during assessment, selection and training, For the Navy and the Naval Special Warfare community t improve training and avect preventable injuries, this tagedy must he addressed through sholistic, systemic, and command responsibility fens, not asf this was an individual oF unique event. ._Atits core, the investigation finds that relentless and continuous self-assessment and self conection within all departments of BTC is required. It eveals a near perfect storm of converging factors, factors tht accumulated unidentified and unmitigated risk. Without rigorous ‘oversight and accountability, this high rsk training mission catnat be accomplished effectively and safely. ‘This report found thatthe Navy and NSWC must improve medical processes, proseduresand policies. Enclosures (1) and (2) demonstrate that NSWC and BUMED ere taking ‘actions to address the isues csenvered. The report also found that NSWC must strengthen its high risk training safety program, Finally, NSWC and the Navy must develop en enduring system to educate/aculturate zandiates against the use of Performance Enhancing Drugs (PEDs), anda testing and enfercement mechanism to detec illicit us. 7. 1 concur with the report's ‘our primary findings, which dive the associated recommendations contained inthe report and this endorsement. Due tothe expansiveness ofthis investigation, in ‘his endorsement Ihave orgarized specific comments in sections by subject mater, specifically Instructors and Curriculum, Medical, Safety, and Performance Enhancing Drugs (PEDS). a. Executive Summary and Introduction, | modify as et forth in enclosure (3). ‘Instructors and Curriculum (1) Lodify Findings 2f Fact, Opinions and Recommendations relating to instructors and curriculum as set forth in enclosure 3). I highlight several ofthe findings and recommendations 1s follows. The investigation considered curriculum exceution to ascertain the potential impact ‘on Class 352. White it found be curriculum was sound, it found the increased intensity of execution exacerbated the risk to candidates, through increased fatigue, increased environmental ‘exposure, and reduced interstial recovery time. highlight though thatthe evidence did not indicate these issues were causal in SN Mullen’s death (@) As noted in enclosure (1), theres balance and at to curriculum execution, such that risk s properly mitigated while meeting the purpose of the training, and les experienced instrctors may not folly understand and/or be able to strike this balance. Itis incumbent upon leadership to ensue instructors understand this balance aed execute appropriately, As the report 3 = Subj: COMMAND INVESTIGATION INTO THE FACTS AND CIRCUMSTANCES. REGARDING SAFETY AND MEDICAL OVERSIGHT OF BASIC UNDERWATER DEMOLITION/SEA AIR AND LAND CLASS 352 bighlight, continuous oversigh, self assessment, and sef-comectonis required in overseeing andmenaging training to prevent drift and potentially disastrous consequences. NSWC already hs addressed these isues and made improvements sine Class 352 inthe areas of instructor taining, quliictions experience and curriculum management and execution. Tn enclosure (3), [recommend these changes be assessed to ascertain effectiveness, c. Medical (1) Tmodify Findings of Fact, Opinions and Recommendations relating o Medical asset {orth in enclosure (3). highlight several of the ndings and reeomraendations as follows. This investigation revealed an inadequate medical structure to provide necessary edie] commend land eontol to 8 high sk waining program. {found medical was poorly organized, poorly integrated, and poorly led, and put candidates at significant risk. While there was an sceumulation of unidentiGed risk in multiple arees at the time of Class 352, the flaws in the ‘medial progr likely had the most direct impact on the health and well being ofthe members ‘of Class 352, and specifically, to SN Mullen. ‘The medical program that was in place atthe time of Class 352 didnot afford adequate and/or coondinated oversight. Instead, the flawed structure fd inadequate leadership created a disconnected and inconsistent flow of information to proper ‘authorities positioned to make informed risk determinations. (@) Pneumonia isa serious, but known, identifiable, treatable, and preventable hazard in BUDYS training. Inetentveness to pneumonia is a major eror in oversight ereating serious risks to health for our candidates going through BUDS, A field guide andlor speciticteining for NSWCmedical perzonne! on how to disambiguate pneumonia from SIPE is necessary a8 are ‘more thorough evaluations. In enclosure. (3), I directed a minor change to Recommendation 11 to specifically address ths issue. (@) Post-Class 352 Changes. While changes have been made since completion of Class 352; the investigation provides additional recommendations necessary to provide adequate ‘oversight, communication and training for medical personnel. In accordance with enclosures (1) fand (2), incorporate additional recommendations to be included as Recommendations 29 ‘through 34 as detailed in enclosure G3). (4) Theinvestigation found BUDYS candidates to be reluctant to sock medical care, worried thet doing would put this continustion in raining at risk, and are driven by a desire to remain in training often a all costs. As this report and the follow-on endorsemen's highlight, ‘holistic approach i required, not only by building culture of trust with te eaniddates and Snstuctors es wll as trust with medical, but in revising the curriculum and evaluating how NSIVC trains ifs instructor, medieal personne, and contractors regarding stident aitudes ant ‘selFreport decision making. Iago recoramend, nd incorporate int the report at enclosure (3). review of Navy and DoD policy to evaluate what responsfility mediéal personnel curently have, or should have, to ascess patient capability for sel-assessment, reporting and decision ‘making regarding their care when ina physically or mentally degraded state. & c Co = ‘Subj: COMMAND INVESTIGATION INTO THE FACTS AND CIRCUMSTANCES: REGARDING SAFSTY AND MEDICAL OVERSIGHT OF BASIC UNDERWATER DEMOLITION/SEA AIR AND LAND CLASS 352 a. Satety (1) I modify Findings of Fact, Opinions and Recommendations telating to Safety asset forth in enclosure (3). Lhighlght several ofthe findings and recommendations as follows. While the saety program met mininum administrative requirements, it was not suitably robust forthe egree of risk inherent to the BUDS taining program. The safety program as implemented at ‘the time of Class 352 was not managed and executed consistently and didnot properly assess accumulating risk, hazards and available rtigations. The investigation revesled a degree of ‘complacency and insuficien: attentiveness o & wide range of important inputs meant io keep the students safe. NSWC must tuild a successful program that balances the need to provide ET Physician's Assistant 4) The Primary Care Division was responsible for administering and executing the daily operations of the NSWCEN Medical Clini to include sick call. mediealsereenings. and physica exams. 'b) The Primary Cate Division is staffed with three Naval offices (v0 physicians. one physician's assistant and seven enlisted stall ‘embers. one af whom isan DC ©) The Clinic is equipped tothe standard of an outpatient general medicine clinic and is augmented with onsite X-Ray capability 2) ‘The Sports Medicine/Physieal Therapy Division, witha gapped leadership bile 8) The Sports Medicine Physical Therapy Division is stafed with one enlisted member and two contracted physical thenpists, ') This Division is responsible for he treatment and chabiltation of stl? and candidates with musculoskeletal injures. 5) The Mena Heals Dyson LATE oo eid paychologist, 8) The Mental Health Division is staffed with two ational active duty psychologists, 1b) Additionally the staff includes « General Schedule (GS) civilian psychologist a contacted psychologist. a contracted psycho! a contracted data analyst and a civilian nurse ease manage, tech, ©) The department addresses all behavioral health and psychological ‘complains or concerns from candidates and sta 1) Additionally tthe time of Class 382 they performed the psychological sercening for High Risk Instructor Dy. This role is now filled bythe Primary Cate Division and IDCs at ATCIBTC 463, Atthe time of Class 35: the BTC Medical Department structure, leadership, and responsibil BTC was commanded at the time of Class 352 by CAPT Bradley Geary. sho weed ‘over to CAPT Timothy Sulick on 3 June 2022. (Enel 56) 28 ‘SUBF; COMMAND INVESTIGATION INTO THE FACTS AND CIRCUMSTANCES REGARDING SAFETY AND MEDICAL OVERSIGHT OF BASIC UNDERWATER DEMOLITION/SEA AIR AND LAND (BUD/S) CLASS 352 b. By NSWCEN instruction, the BTC Medical Department was a detached healthcare ‘medical department of the NSWCEN Medical Department, but was treated in practice as 8 separate entity, [Encls 154, 173: ReFab] «e. BIC Medical was located inside the main BTC building, onboard NAB Corona Went 46] 4. The BTC Medical Department is manned solely by corpsmen, contracted EMT. pparamedis, and contracted athletic trainer. It isnot billeted for nor does it have an sesigned Medical Oicer. (Ret ab, at] La 6 MMII» BTC Nes Dearne Hea pared dnt oth BC “Commanding Offer ahd was responsible to the BTC CO for proper execution of medical suppot to BUDIS evolitions. [Ret a] MERRIE she NSWATC Medical Department Head, was solely responsible fo: [Reta 1) Advising the command on all medical and administrative mates. particularly thote involving procedure, methodology. and procurement. 2) Serving as an administrative advisor tothe commanding office forall aspects of tae medical department 3), Managing ll BTC medical staf: both administratively and operationally 4) Serving sa training observer. evaluator. and resouree fo ensure medical sta areable to conduct effective phase medical taining as required 5) Serving as a liaison with ouside medical entes in regards to patent status and medical programs as diected by the BTC Commande. 6) Reviewing authority forall EAPS within BTC. 7) Ensuring BTC corpsmen maintain all proficencies and requirements for Corpsmen Centitietion, 1V, Performance Enhancing Drugs und Supplements 64, Performance enhancing drugs and supplements (PEDS) are defined broadly as substances 2» @ oO ra) Any (oa ‘SUBJ: COMMAND INVESTIGATION INTO THE FACTS AND CIRCUMSTANCES REGARDING SAFETY AND MEDICAL OVERSIGHT OF BASIC UNDERWATER, DEMOLITIONISEA AIR AND LAND (BUDIS) CLASS 352 used by healthy individuals, otherwise absent of disease. to enhance performance in physical ‘cognitive, or other desired areas. [Enel 48] 65. The rsk fom the use of PEDS range fom the kaown effets of Food and Drug Administration (FDA) approved deus to unpredictable and potentially life-threatening eects oF non FDA approved FEDS purchased dicctly from manufacturers oF distributors and not Validated fr benef party rset in independent studies, [Enc 8 ‘66. Due to the Dietary Supplement Health and Education Act of 1994, the FDA has limited ‘oversight of many supplements, Under this Act [Enel 48] 8, Manufacturers and distributors of dietary supplements and ingredients are prohibited fiom marketing products that are adulerated or misbranded. That means that these Fims te responsible for evaluating the safety and labeling of their products before marketing to ensure ‘that they meet al the requirements ofthe Federal Food, Drug. and Cosmetic Act as amended by DSHEA and FDA Regulations. (Enel 48] ». FDA has the authority to the action against any adulterated or misbranded dietary supplement product alter it reaches the market [Enel 48] 167. The United States Anti Doping Ageney (\ISADA) isa signatory to the World Anti Doping “Agency (WADA) which produces a ist of PEDS prohibited for use by athletes competing ia ‘certain events. The purposes ofthe World Anti ping Code and the World Anti Doping Program which supports it are: (Enel 48) a. To protect she athlete's furdamemtal right to participate in a doping fie sport and thus promote health fainess, and equity For athletes worldwide, and [Encl 48), b. To ensure harmonized, coordinated and elfetive anti-doping programs a the ierational and national level with regard othe prevention of doping including education deterrence detection, enforcement, rd of law, [Enel 48) Common PEDS Wa. ects, and Knowa Risks ‘68, Anurogens, Androgens include testosterone or its derivatives that have similar molecule sirgture and effets on the body. Ancrogens are availabe by prescription by a variety of| fferent routes for administration andare use to treat testicular dysfunction (hypoganadisn) tnd gender transition, [Enel 48] a. _Eifeets of Androgens: Androgens have an anabolic (building) eect on muscle ‘bone, and other oryans, meaning they promote consirctive metabolic effets, Androgens improve athletie performance and strength [Encl 48] b. Adverse effects of androgens: Adverse elleets include but are ot limited to 30 ‘SUBJ: COMMAND INVESTIGATION INTO THE FACTS AND CIRCUMSTANCES REGARDING SAFETY AND MEDICAL OVERSIGHT OF BASIC UNDERWATER oe DEMOLITION/SEA AIR AND LAND (BUDIS) CLASS 352 re) emporary of permanent suppression of native production of testosterone. erthrocytosis, ‘@angerous elevations in red blood cell production) clots, severe aene,tendiniisupture increased LDL ("aad cholesterol") decreased HDL ("good cholesterol), high blood pressure, aggressive behavior, rage o violerce, psychiatric disorders, infections such as HIV or hepatitis if Ihe individual is using unapprovedlor non-sterile sources, diminished sperm production, shrinkage of testicles, liver abnormalities, and tumors. [Enel 48] 69, Human growth hormone, Human growth hormone isa naturally occurring hormone produced inthe pituitary gland. ts available by prescription and is administered by injection. [Athletes use growth hormones to improve muscle mass and ahletie performance and decrease fat mass. [Enel 48] 14. Effects of human growth hormone: Human growth hormone hasan anabolic (building) effect on muscle, bone, and the internal organs. (Enel 48] b. Adverse effects of human growth hormone: Adverse effects include but ate not limited to Joint pain, muscle weakness, Mud retention, diabetes vision problems, carpal tunnel syndrome, enlarged heart (cardiomegaly), and byperension. (Enel 48], 70, Erythropoietin: Erythropoiet nis produced inthe kidneys and inereases red blood cell mass. | is available by prescription for injection to treat patients with severe kidney disease and @ anemia. (Enel 48) o 8. Effects f erythropoidin: Athletes take erythropoietin to improve the movement of ‘oxygen to muscles. Erythropoietin is known to improve athlete performanee in endurance events. (Enel 48], »b, Adverse effects of erythropoietin: Erythropoietin was used commonly by ‘competitive cyclists in the 1990s and allegedly contributed to 18 deaths. Adverse effects include but are not limited to risk of stoke, heart attack, and the development of clots in the lang vasculature, (Enel 48] 71. Creatine. Creatine serves to nctease the production of the man energy source in mu {adenosine triphosphate oF ATP). Its available asa supplement powder over the counter. Creatine use is not banned by ether the USADA or WADA, but itis anon-FDA approved supplement purchased directly fm the manufacturer or distributor subject to the same risks as any other supplement obtained inthis manner. [Enel 48] 8. Effects of creatine, Creatine might improve athlete performance for very brief repetitive bouts of high intensity exercise, It doesnot seem 10 improve aerobie performance in endurance exercise [Encl 48), b. Adverse effets of ereatine. Adverse effets include abdominal discomfort heart rhythm abnormalities, dehy dation, muscle eramping, kidney dysfunction, chakdomyolysis @ (imusele breakdown), seizures, fid retention, and weight gain. [Enel 48] ; en 7 an ‘SUBJ: COMMAND INVESTIGATION INTO THE FACTS AND CIRCUMSTANCES REGARDING SAFETY AND MEDICAL OVERSIGHT OF BASIC UNDERWATER DEMOLITIONISEA AIR AND LAND (BUDIS) CLASS 352 72, Aromatase Inhibitors. Aromatase inhibitor are used in medica! therapy as adjuncts forthe lwcatment and prevention of estrogen dependent cancers. Aromatase inhibitors ae altractve {0 aetes seeking to build muscle or bone due to theie secondary effects of elevating cirewbating testosterone levels by enhancing production of testosterone and inhibiting is degradation, An ‘example of a commonly preseribed aromatase inhibitor is anastrozole, [Enel 48) a. Effects of aromatase inhibitors: modest elevation in testosterone in men with fant muscle buldingand some improvements in ahletic performance. Ene! 48] b._ Adverse efeets of aromatase inhibitors: Adverse effects include but ate not nites to hot flashes. ite, mod disturbances, nausea and vomiting, weakness, awhrleias. ‘depression. high blood pressure, osteoporosis, peripheral edema, and fractures. (Encl 48] 73, Selective Androgen Receptor Modulators (SARMS): SARMS are drugs that aet in varying ‘degrees on androgen receptors. They have similar effects to androgens on the bady. There are studies looking at potential clinical applications but as of today SARMS are not FDA approved for any medical condition. Despite this lack of FDA approval, SARMS are popular with athletes and available for purchas: directly trom manufacturers and distributors, The use of SARMS is prohibited by the WADA. [Encl 48] a. Effects of SARMS. SARMS produce anabolic (building) effects primarily or imusele, bone, and other cesans. (Enel 48) b, Adverse effets of SARMS. Side eects of SARMS includ effects on the _zasruinestinal system, eevation of liver enzymes. adverse effects on HDI. ("Zo0d cholesterol an have also been assoc ated with side fees including liver Failure. However most SARMS ‘sold fom unauthorized distributors are impure, contain unapproved drugs or substances. and many are inaccurately labeled. Adulterated SARMS can have unpredictable negative efits on the body. depending on the combination of substances. [Enel 48) 74, Phosphodiesterase Inhibitors: Athletes using androgens oF their analogues commonly use posphodiesteras (Viagra) for impeoved bload Mow 10 muscles inhibins such as silent ‘during strength traning or ther times when the desire isto increase blood flow to musees| such as during altitude taining and swimming, Usees may also combine these with popular workout supplements. The risk of swimmers induced pulmonary edema has been showa tobe reduced by the controlled use of phosphodiesterase inhibitors, [Enel 48] 4 Effects of phosphodiesterase inhibitors: Phosphodiesterase inhibitors improve blood How to muscles and may improve performance in strength raining, Phosphodiesterae inhibitors also may reduce pressures in blood vessels in the lungs without compromising exercise dynamics snd reduce the risk of sw immer’ induced pulmonary edema (SIPE). [Encl 48) b,_ Adverse effects of phosphodiesterase inhibitors: Misuse of phosphodiestease inbitrs can include severe low. blood pressure. eatdiovasculae collapse, and death, Combi Dhosphodiesterae inibitors with itaes is panicularly dangerous wiven the potential for 2 Sui: COMMAND INVESTIGATION IvTO THE FACTS AND CIRCUMSTANCES RECRRDING SAFETY AND MEDICAL OVERSIGHT OF BASIC UNDERWATER @ DEMOLITIONSEA AIR AND LAND (BUDIS) CLASS 52 © significant decreases in blood pressure and perfusion of the ert. [Enel 48], IV.B, Effects of PEDS Use during Training 17. PEDS use during high-intensity physical training poses serious health risk to candidates General effects include: (Encl $0] ‘a. Negative side effets to the cardiovascular system by means of dretl altering ‘he heart muscle, blood vessels, and elevating blood pressure. (Enc $0] b._ Negative side effect tothe endocrine system by means of directly altering hormonal coneenteations oF metbolism. [Enel $0}, ._ Negative effects tothe gastrointestinal system including liver damage ad file [net 50} 44. Negative effet othe immune sytem including the possibilty of suppressing immune system funetion and increasing susceptibility to infection. (Enel SO] IndreefTets cased by enabling individual to push beyond nocalphysilogc @ limits with the potential consequences of induced rhythms. Enel 31 oO Risks from other eonstiqents in PEDS that are not Food and Drug Administration (FDA) approved. These PEDS are obtained directly from manufacturers and distributors with 1 independent validation of purity, effets, and safety. [Encl 48] 16, The elfee of PEDS and the risk they present othe individual depend on factors including the production source, purity. and validity of the drug or produc. the dase and duration of us. the underlying health of the service member, and the environmental Factors ofthe person's lifestyle. (Ene $3] 1V.C. Department of Defense and Navy Policy on PEDS 77. The wrongful use, possession, distribution, or introduction onto an installation of anabolic steroids is prohibited forall service members by Antcle 1122, Uniform Code of Miltary Justice. (Ent 54) 78. Navy poliey further controls the use of PEDS by service members in references (c) nd (9. 29. The Screary of the Navy has prohibited the wrong se oF possession af any homonal Shane elated to testosterone tht promotes acl grth By DON petsonve. oro any hug sls androgenrecepor modulator (SARND, grt hormone oF maskng agen oO imended cohen of cone the use of aaoli seroide This stron was ia age atthe ¢ 3 ea) An GG SUBI: COMMAND INVESTIGATION INTO THE FACTS AND CIRCUMSTANCES. REGARDING SAFETY AND MEDICAL OVERSIGHT OF BASIC UNDERWATER. DEMOLITIONISEA AIR AND LAND (BUDIS) CLASS 352 time of Class 352 and has not been updated. [Rete] 80, From 2009 to 2022, the Chief of Naval Operations also prohibited the let use of drugs or hommonal substances related to testosterone that promote musele growth, This insiruction 64s updated on 28 March 2022 as part of routine revision, and now prohibits the ict use of any

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