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Neuromodulation is increasingly being employed in active-duty Service Members, but there are no standards regarding access or retention in the military, with disparities in both receipt of treatment and disposition. The US Department of Defense endorsed the need for guidelines, and a 9-member tri-service task force developed them, with final endorsement of answers to the eight questions occurring in April 2026. These guidelines prioritized retention on active duty and were created using modified US Preventive Services Task Force grading of evidence standards. Key findings are that neuromodulation cannot be reliably used to reduce opioid intake; that psychopathology, central sensitization, and opioid use are associated with poor outcomes; the evidence is insufficient to support routine psychological screening in low-risk individuals; and that decisions on retainability and deployability should be made on a case-by-case basis, integrating clinical data, device management considerations, and the specific operational requirements of the individual’s military role, with input from a Service Member’s command. The committee recommends that Service Members on high doses of opioids be tapered before a trial, that temporary but not permanent stimulators can be considered for military personnel involved in medical boards who want to remain on active duty, and that Service Members should be retained on active duty with no restrictions barring certain areas of responsibility and military occupational specialties (eg, dive and explosive ordnance specialists, special operations) if they are able to physically and mentally perform their duties in garrison for 6 months. For space, aviation, combat arms, and submarine specialists, the ability to continue in one’s military occupational specialty should be decided on a case-by-case basis (figure 1).