Sudden cardiac arrest/death (SCA/D) are uncommon but potentially catastrophic events in military service members, occurring most often during physically demanding training and operational activities. Compared with similarly aged athletic populations, service members experience higher rates of SCD, highlighting the unique risks inherent in military service. Although cardiovascular (CV) screening can identify many at-risk individuals, it does not prevent all acute CV events. In athletic populations, improvements in emergency preparedness including cardiopulmonary resuscitation (CPR) training, rapid automated external defibrillator (AED) use, and rehearsed emergency action plans (EAPs) have been associated with significant improvements in survival following sports-related SCA. However, despite similar exertional demands, standardized CV-specific EAPs are inconsistently established and implemented across military settings. Existing policies emphasize physical readiness and emergency response capabilities, yet substantial variability remains regarding formalized planning for CV emergencies that occur during military activities. Importantly, military environments differ substantially from traditional athletic venues. Physical training (PT) and operational missions often occur in austere locations with limited medical resources, evacuation constraints, environmental extremes, and reliance on other service members as initial responders. Additionally, service members may be required to engage in prolonged exertion, load carriage, water-based activities, or remote operations that may delay recognition and treatment of SCA. These unique factors necessitate military-specific CV EAPs that extend beyond traditional competitive athlete frameworks and incorporate adaptable emergency response strategies for diverse tactical environments. Accordingly, the broad adoption of structured but flexible CV EAPs across the U.S. military represents a practical and meaningful opportunity to improve survival after SCA.

Relative Energy Deficiency in Sports (RED-S) is a clinical syndrome characterized by low caloric intake relative to energy expenditure, resulting in a cascade of endocrine, metabolic, and musculoskeletal consequences. In females, hallmark features include decreased bone mineral density and menstrual dysfunction, though the syndrome affects multiple organ systems in both sexes. We present the case of a 22-year-old active-duty military member who suffered recurrent stress fractures, irregular menstrual cycles, and chronic fatigue that impacted her duty status. She was noted to have a long history of non-intentional calorie restriction and was eventually diagnosed with RED-S. Treatment consisted of a multidisciplinary approach, resulting in objective improvement in bone density and a successful return to full duty status. This case highlights the importance of early diagnosis and appropriate treatment of RED-S among military members to decrease morbidity and prevent limitations to military readiness and career progression.

Tertiary interdisciplinary pain rehabilitation programs (IPRPs) provide integrated, comprehensive pain rehabilitation using an evidence-based biopsychosocial approach delivered by teams offering multi-modal care. A 2009 Veterans Health Administration (VHA) Directive mandated implementation of Commission on Accreditation for Rehabilitation Facilities (CARF) accredited IPRPs in each Department of Veterans Affairs (VA) service network. Commission on Accreditation for Rehabilitation Facilities accreditation included regular program surveys to reinforce continuous quality and improvement standards. IPRPs are integral to the VHA's capacity to provide a stepped-care model including advanced pain diagnostics and functional rehabilitation to best meet the needs of veterans with complex chronic pain. Recently, VHA ended its enterprise-wide contract with CARF International for accreditation across all programs. The absence of a formal external accreditation process created a gap in sustaining quality oversight and may put VA IPRPs at risk for closure or losing their relevance as tertiary pain care centers. As such, the VA national Pain Management, Opioid Safety, and Prescription Drug Monitoring Program (PMOP) is launching an initiative to ensure governance, sustainability, and alignment with VHA and PMOP strategic priorities. PMOP's provision of oversight, support, and strategic direction is critical as the VA continues to sustain the highest quality standard for pain management and rehabilitation in the post-CARF era. This commentary will discuss current PMOP initiatives for VA IPRPs to address gaps left by the absence of the CARF accreditation framework.