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Article History

Received: 19 February 2025

Accepted: 14 April 2025

First Online: 26 May 2025

Declarations

:

: All work was performed at Armed Forces Health Surveillance Division. This study was reviewed by the Component Office for Human Research Protections (COHRP), the Defense Health Agency (DHA) Office of Research Protections (ORP) and they determined that the study does not constitute research (EIRB Reference Number: 974029).

: The views expressed in this manuscript are those of the author(s) and do not necessarily reflect the official policy of the Department of Defense, Defense Health Agency, or the U.S. Government.

: Data was obtained from the Defense Manpower Data Center (DMDC) and were accessed using the Defense Medical Surveillance System (DMSS), a central repository of medical surveillance data for the U.S. Armed Forces. Staff at the Armed Forces Health Surveillance Division have access to DMSS per job requirement.

: The authors declare no competing interests that are relevant to the content of this article.