Single and repeated high-level blast, low-level blast, and new-onset self-reported health conditions in the U.S. Millennium Cohort Study: An exploratory investigation.

Evidence Atlas

Belding, Jennifer N, Kolaja, Claire A, Rull, Rudolph P et al. · Frontiers in neurology · 2023 · DOI

Quick Summary

This study followed a large group of U.S. military personnel and veterans to investigate whether exposure to blast pressure—both from single or repeated high-level blasts and occupational low-level blast exposure—was associated with new health diagnoses. Researchers found that blast exposure was linked to several conditions including chronic fatigue syndrome, PTSD, hearing loss, depression, and nerve damage. The study suggests that repeated blast exposure may carry greater health risks than single exposure, and that combinations of different blast exposures may increase risks further.

Why It Matters

This large prospective study provides evidence that blast exposure is associated with new-onset chronic fatigue syndrome and related conditions (peripheral neuropathy, depression, hearing loss), which are clinically relevant to understanding potential causative factors and comorbidity patterns in patients with blast exposure history. For ME/CFS researchers, the documented association between overpressure exposure and chronic fatigue syndrome suggests a potential environmental or physiological mechanism worth investigating further.

Observed Findings

Single and repeated high-level blast (HLB) exposure were each associated with new diagnoses across 25 and 29 medical conditions respectively.
Repeated HLB exposure conferred significantly greater risk than single HLB for five diagnoses including PTSD and depression.
Occupational risk of low-level blast (LLB) exposure was associated with 11 new diagnoses including PTSD and significant hearing loss.
Chronicfatigue syndrome, peripheral neuropathy, hearing loss, depression, vision loss, sinusitis, and reflux were among the conditions associated with overpressure exposure.
Combined HLB and LLB exposure showed significant interactions for migraines, PTSD, and impaired fecundity.

Inferred Conclusions

Overpressure exposure from single or repeated blast events increases risk of multiple clinical diagnoses, with repeated exposure conferring greater risk than single exposure.
Multiple forms of blast exposure (both high-level and occupational low-level) may have cumulative or synergistic adverse health effects.
Blast-related health impacts extend beyond trauma-related psychiatric disorders to include systemic conditions (hearing loss, chronic fatigue, anemia, reflux).
Public health surveillance and occupational safety initiatives targeting blast-exposed military personnel are warranted to monitor and prevent adverse health outcomes.

What This Study Does Not Prove

This study demonstrates associations between blast exposure and new diagnoses but does not establish causation—other factors associated with military service could explain the observed relationships. The use of self-reported diagnoses rather than confirmed medical records or objective diagnostic testing means conditions were not verified by clinical assessment. Occupational classification as a proxy for LLB exposure is imprecise and does not measure individual-level blast exposure.

Metadata

DOI: 10.3389/fneur.2023.1110717
PMID: 37025202
Review status: Machine draft
Evidence level: Single-study or moderate support from human research
Last updated: 8 April 2026

About the PEM badge: “PEM required” means post-exertional malaise was an explicit required diagnostic criterion for participant inclusion in this study — not that PEM was studied, observed, or discussed. Studies using criteria that do not require PEM (e.g. Fukuda, Oxford) are tagged “PEM not required”. How the atlas works →

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Evidence Atlas

Single and repeated high-level blast, low-level blast, and new-onset self-reported health conditions in the U.S. Millennium Cohort Study: An exploratory investigation.

Quick Summary

Why It Matters

Observed Findings

Inferred Conclusions

What This Study Does Not Prove

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