II 

118TH CONGRESS 

2D SESSION S. 4109 

To amend title 10, United States Code, to clarify roles and responsibilities 

within the Department of Defense relating to subconcussive and concussive brain injuries and to improve brain health initiatives of the Department of Defense, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

APRIL 11 (legislative day, APRIL 10), 2024 

Ms. WARREN (for herself, Ms. ERNST, Mr. TILLIS, Mr. KING, Mr. KAINE, Mr. 

SCOTT of Florida, Ms. HIRONO, Mrs. GILLIBRAND, Ms. DUCKWORTH, 

Mr. CARDIN, Ms. COLLINS, and Mr. MULLIN) introduced the following 

bill; which was read twice and referred to the Committee on Armed Services 

A BILL 

To amend title 10, United States Code, to clarify roles and 

responsibilities within the Department of Defense relating to subconcussive and concussive brain injuries and 

to improve brain health initiatives of the Department 

of Defense, and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Blast Overpressure 

5 Safety Act’’. 


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1 SEC. 2. ROLES AND RESPONSIBILITIES FOR COMPONENTS 

2 OF THE OFFICE OF THE SECRETARY OF DE3 FENSE RELATING TO BRAIN INJURIES FROM 

4 CONCUSSIVE AND SUBCONCUSSIVE BLASTS. 

5 (a) FINDINGS AND SENSE OF CONGRESS.— 

6 (1) FINDINGS.—Congress finds the following: 

7 (A) Research conducted by the Depart8 ment of Defense underscores that concussive 

9 and subconcussive brain injuries can arise not 

10 only from combat scenarios but also from rou11 tine training exercises. 

12 (B) Even when adhering to established 

13 safety guidelines, the act of firing or being ex14 posed to the firing of heavy weapons, grenades, 

15 and breaching during training sessions can po16 tentially lead to cognitive impairments, particu17 larly affecting aspects such as delayed verbal 

18 memory, visual-spatial memory, and executive 

19 function. 

20 (C) Traumatic brain injuries have become 

21 the signature wound of members of the Armed 

22 Forces from the Global War on Terrorism gen23 eration. 

24 (D) Special Warfare Operator 1st Class 

25 Ryan Larkin and Sergeant First Class Michael 

26 Froede both suffered traumatic brain injuries 


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1 during their rigorous training and multiple 

2 combat deployments and were tragically lost to 

3 suicide as a result of their wounds. Their sto4 ries highlight the critical issues surrounding 

5 traumatic brain injury within the military and 

6 the subsequent risk of suicide among affected 

7 individuals. 

8 (E) This Act honors the sacrifices of Spe9 cial Warfare Operator 1st Class Ryan Larkin 

10 and Sergeant First Class Michael Froede, as 

11 well as the thousands of affected members of 

12 the Armed Forces by expediting the efforts of 

13 the Department of Defense to mitigate, iden14 tify, and treat traumatic brain injuries within 

15 the Armed Forces. 

16 (2) SENSE OF CONGRESS.—It is the sense of 

17 Congress that— 

18 (A) Congress commends the Department 

19 of Defense for its efforts to implement meas20 ures consistent with modern science to limit the 

21 occurrence of concussive and subconcussive 

22 brain injuries among members of the Armed 

23 Forces and facilitate the rehabilitation of those 

24 recovering from service-related traumatic brain 

25 injuries; and 


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1 (B) the Secretary of Defense should sus2 tain those efforts while also enhancing overall 

3 knowledge and protection against brain injuries. 

4 (b) ESTABLISHMENT OF ROLES.—The Secretary of 

5 Defense shall establish the roles and responsibilities of 

6 components of the Office of the Secretary of Defense for 

7 the mitigation, identification, and treatment of concussive 

8 and subconcussive brain injuries and the monitoring and 

9 documentation of blast overpressure exposure as follows: 

10 (1) The Under Secretary of Defense for Per11 sonnel and Readiness shall be responsible for, not 

12 later than one year after the date of the enactment 

13 of this Act— 

14 (A) establishing a baseline neurocognitive 

15 assessment to be conducted during the acces16 sion process of members of the Armed Forces 

17 before the beginning of training; 

18 (B) establishing annual neurocognitive as19 sessments to monitor the cognitive function of 

20 such members to be conducted— 

21 (i) at least every three years as part 

22 of the periodic health assessment of such 

23 members; 

24 (ii) as part of the post-deployment 

25 health assessment of such members; and 


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1 (iii) prior to separation from service 

2 in the Armed Forces; 

3 (C) ensuring all neurocognitive assess4 ments of such members, including those re5 quired under subparagraphs (A) and (B), are 

6 maintained in the electronic medical record of 

7 such member; 

8 (D) establishing a process for annual re9 view of blast overpressure exposure logs and 

10 traumatic brain injury logs specified in para11 graph (2)(A) for each member of the Armed 

12 Forces during the periodic health assessment of 

13 such member for cumulative exposure in order 

14 to refer members with recurrent and prolonged 

15 exposure to specialty care; and 

16 (E) establishing standards for recurrent 

17 and prolonged exposure. 

18 (2) The Assistant Secretary of Defense for 

19 Readiness shall be responsible for, not later than one 

20 year after the date of the enactment of this Act, the 

21 following: 

22 (A) Establishing and maintaining blast 

23 overpressure exposure logs and traumatic brain 

24 injury logs for every member of the Armed 

25 Forces. 


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1 (B) Integrating those logs into the Indi2 vidual Longitudinal Exposure Record (as de3 fined in section 1171(b) of title 38, United 

4 States Code) for such member. 

5 (C) Including in those logs at least the fol6 lowing: 

7 (i) The number of previous exposures 

8 to blast overpressure, including the number 

9 of exposures per unit of time, date, blast 

10 overpressure in pounds per square inch, 

11 and number of times the member of the 

12 Armed Forces fires, uses, or is exposed to 

13 weapons that cause blast overpressure. 

14 (ii) Any residual physical, mental, or 

15 emotional effects resulting from such expo16 sure. 

17 (iii) The source of the exposure, activ18 ity when the exposure occurred, whether it 

19 occurred during training or deployment, 

20 and any other relevant context of such ex21 posure. 

22 (iv) The treatment that the member 

23 sought and received in connection with 

24 such exposure. 


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1 (v) The number of concussive and 

2 subconcussive brain injuries, including 

3 traumatic brain injuries, sustained. 

4 (vi) The severity of concussive and 

5 subconcussive brain injuries, including 

6 traumatic brain injuries, sustained. 

7 (vii) Other head trauma, regardless of 

8 whether it requires the treatment of a 

9 medical provider. 

10 (3) The Inspector General of the Department of 

11 Defense shall be responsible for— 

12 (A) not later than two years after the date 

13 of the enactment of this Act, submitting to 

14 Congress a report (in unclassified form, but 

15 with a classified annex as necessary) evaluating 

16 the establishment and maintenance of the logs 

17 required under paragraph (2), including the cu18 mulative exposure annotated in the blast over19 pressure exposure logs and traumatic brain in20 jury logs, as well as the compliance of the De21 partment of Defense with Department policies 

22 to address the brain health of members of the 

23 Armed Forces; 

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1 ing available to the public the unclassified por2 tion of the report; and 

3 (C) beginning on the date that is three 

4 years after the date of the enactment of this 

5 Act— 

6 (i) evaluating the continued fulfill7 ment by the Department of the require8 ments under paragraph (2), including the 

9 cumulative exposure annotated in the blast 

10 overpressure exposure logs and traumatic 

11 brain injury logs, as well as the compliance 

12 of the Department with Department poli13 cies to address the brain health of mem14 bers of the Armed Forces; 

15 (ii) not later than December 31 of 

16 each year, submitting to Congress a report 

17 (in unclassified form, but with a classified 

18 annex as necessary) containing the results 

19 of such evaluation; and 

20 (iii) not later than 10 days after sub21 mitting each report under clause (ii), mak22 ing available to the public the unclassified 

23 portion of such report. 

24 (4) The Under Secretary of Defense for Acqui25 sition and Sustainment shall be responsible for, not 


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1 later than one year after the date of the enactment 

2 of this Act, the following: 

3 (A) Establishing the minimization of expo4 sure to blast overpressure as a performance pa5 rameter when drafting requirements for new 

6 weapons systems that produce blast over7 pressure for the Department of Defense. 

8 (B) Establishing a requirement that any 

9 entity under contractual agreement with the 

10 Department as part of the defense weapons ac11 quisition process shall provide to the Depart12 ment blast overpressure measurements and 

13 safety data for any weapons system procured 

14 from such entity that produces blast over15 pressure and exceeds the maximum exposure 

16 limit set by the Department. 

17 (C) Establishing a requirement that any 

18 test plan for a weapons system incorporate test19 ing for blast overpressure measurements and 

20 safety data. 

21 (D) Not later than December 31 of each 

22 year, publishing on a publicly available website, 

23 including govinfo.gov or successor website, a re24 port that includes— 


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1 (i) blast overpressure measurements 

2 and safety data for weapons systems of the 

3 Department, including how those systems 

4 have been tested and in what environ5 ments; and 

6 (ii) plans to improve protection for ex7 posure by members of the Armed Forces to 

8 in-use weapons systems with unsafe levels 

9 of blast overpressure and exposure. 

10 (c) COORDINATION.—The officials specified in para11 graphs (1), (2), (3), and (4) of subsection (b) shall coordi12 nate and align their plans and activities to implement such 

13 subsection among themselves and with the Secretaries of 

14 the military departments. 

15 (d) BRIEFINGS AND REPORTS.— 

16 (1) IMPLEMENTATION BRIEFING.—Not later 

17 than 180 days after the date of the enactment of 

18 this Act, and every 180 days thereafter, the Sec19 retary of Defense shall provide to the congressional 

20 defense committees a briefing on the plans, associ21 ated timelines, and activities conducted to implement 

22 subsection (a). 

23 (2) REPORT ON CONCUSSIVE AND SUBCONCUS24 SIVE BRAIN INJURIES.— 


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1 (A) IN GENERAL.—Not later than 180 

2 days after the date of the enactment of this 

3 Act, and annually thereafter, the Secretary of 

4 Defense shall submit to the congressional de5 fense committees a report on— 

6 (i) concussive and subconcussive brain 

7 injuries caused during military operations, 

8 including combat operations, among mem9 bers of the Armed Forces, including infor10 mation on— 

11 (I) the Armed Force of the mem12 ber; 

13 (II) the name of the operation; 

14 (III) the location within the area 

15 of responsibility; 

16 (IV) the number of concussive 

17 and subconcussive brain injuries 

18 caused; 

19 (V) the severity of concussive and 

20 subconcussive brain injuries caused; 

21 (VI) the treatment received for a 

22 concussive or subconcussive brain in23 jury; 

24 (VII) whether a member of the 

25 Armed Forces was medically retired 


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1 from service due to a concussive or 

2 subconcussive brain injury; 

3 (VIII) whether a member of the 

4 Armed Forces died by suicide after 

5 sustaining a concussive or subconcus6 sive brain injury; and 

7 (IX) the source of the injury, in8 cluding the activity conducted when 

9 the injury occurred; and 

10 (ii) concussive and subconcussive 

11 brain injuries caused during training 

12 events among members of the Armed 

13 Forces, including information on— 

14 (I) the Armed Force of the mem15 ber; 

16 (II) the type of training; 

17 (III) the location of the training; 

18 (IV) the number of concussive 

19 and subconcussive brain injuries 

20 caused; 

21 (V) the severity of concussive and 

22 subconcussive brain injuries caused; 

23 (VI) the treatment received for a 

24 concussive or subconcussive brain in25 jury; 


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1 (VII) whether a member of the 

2 Armed Forces was medically retired 

3 from service due to a concussive or 

4 subconcussive brain injury; 

5 (VIII) whether a member of the 

6 Armed Forces died by suicide after 

7 sustaining a concussive or subconcus8 sive brain injury; and 

9 (IX) the source of the injury, in10 cluding the activity conducted when 

11 the injury occurred. 

12 (B) FORM.—Each report submitted under 

13 subparagraph (A) shall be submitted in unclas14 sified form, but may include a classified annex. 

15 (C) PUBLIC AVAILABILITY.—Not later 

16 than 10 days after submitting a report under 

17 subparagraph (A), the Secretary of Defense 

18 shall make the unclassified portion of the report 

19 available to the public, including by publishing 

20 the report on the govinfo.gov website, or suc21 cessor website. 

22 (3) REPORT ON DISCHARGES RELATED TO CON23 CUSSIVE AND SUBCONCUSSIVE BRAIN INJURIES.— 

24 (A) IN GENERAL.—Not later than 180 

25 days after the date of the enactment of this 


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1 Act, and annually thereafter, the officials speci2 fied in paragraphs (1) and (2) of subsection (b) 

3 and the Secretary of Defense shall submit to 

4 the congressional defense committees a report 

5 on members of the Armed Forces who were dis6 charged administratively or punitively and had 

7 a concussive or subconcussive brain injury, in8 cluding a traumatic brain injury, including in9 formation on— 

10 (i) whether the injury or injuries oc11 curred during combat operations or train12 ing and the associated combat operations 

13 or training incident; 

14 (ii) the severity of the injury or inju15 ries; 

16 (iii) if any such injury was combat re17 lated, the name of the operation; 

18 (iv) the treatment sought and received 

19 for the injury or injuries; 

20 (v) the number of discharge upgrade 

21 requests in connection with such an injury 

22 or injuries that have been made; and 

23 (vi) the number of such discharge up24 grade requests that have been approved. 


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1 (B) FORM.—Each report submitted under 

2 subparagraph (A) shall be submitted in unclas3 sified form, but may include a classified annex. 

4 (C) PUBLIC AVAILABILITY.—Not later 

5 than 10 days after submitting a report under 

6 subparagraph (A), the Secretary of Defense 

7 shall make the unclassified portion of the report 

8 available to the public, including by publishing 

9 the report on the govinfo.gov website, or suc10 cessor website. 

11 (4) REPORT ON MEDICAL PROVIDERS TRAINED

12 IN CONCUSSIVE AND SUBCONCUSSIVE BRAIN INJU13 RIES.— 

14 (A) IN GENERAL.—Not later than 180 

15 days after the date of the enactment of this 

16 Act, and annually thereafter, the Secretary of 

17 Defense shall submit to the congressional de18 fense committees a report on medical providers 

19 within the Defense Health Agency who are 

20 trained in traumatic brain injury or concussive 

21 and subconcussive brain injuries as a sub-spe22 cialty of neurology, including information on— 

23 (i) the number of such providers, 

24 disaggregated by location; 

25 (ii) the billets of such personnel; 


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1 (iii) the number of medical personnel 

2 currently participating in training or a fel3 lowship relating to traumatic brain injury 

4 or concussive and subconcussive brain inju5 ries; and 

6 (iv) the strategy of the Department of 

7 Defense to increase the number of medical 

8 providers trained in traumatic brain injury 

9 or concussive and subconcussive brain inju10 ries as a sub-specialty of neurology. 

11 (B) PUBLIC AVAILABILITY.—Not later 

12 than 10 days after submitting a report under 

13 subparagraph (A), the Secretary of Defense 

14 shall make the report available to the public, in15 cluding by publishing the report on the 

16 govinfo.gov website, or successor website. 

17 (5) REPORT ON EFFORTS TO COORDINATE

18 WITH ALLIES AND PARTNERS.— 

19 (A) IN GENERAL.—Not later than 180 

20 days after the date of the enactment of this 

21 Act, and annually thereafter, the Secretary of 

22 Defense shall submit to the congressional de23 fense committees a report on the efforts of the 

24 Department of Defense to share and coordinate 

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1 sive brain injury research efforts with allies and 

2 partners of the United States, which shall in3 clude information on— 

4 (i) the activities coordinated with such 

5 allies and partners to better prevent, miti6 gate, and treat injuries from blast expo7 sure; and 

8 (ii) recommendations to improve fu9 ture collaboration with such allies and 

10 partners, including administrative and data 

11 structures. 

12 (B) PUBLIC AVAILABILITY.—Not later 

13 than 10 days after submitting a report under 

14 subparagraph (A), the Secretary of Defense 

15 shall make the report available to the public, in16 cluding by publishing the report on the 

17 govinfo.gov website, or successor website. 

18 (e) DEFINITIONS.—In this section: 

19 (1) CONGRESSIONAL DEFENSE COMMITTEES.— 

20 The term ‘‘congressional defense committees’’ has 

21 the meaning given that term in section 101(a)(16) 

22 of title 10, United States Code. 

23 (2) CONTRACTUAL AGREEMENT.—The term 

24 ‘‘contractual agreement’’ includes a contract, grant, 


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1 cooperative agreement, and any other similar trans2 action or relationship. 

3 (3) NEUROCOGNITIVE ASSESSMENT.—The term 

4 ‘‘neurocognitive assessment’’ means a standardized 

5 cognitive and behavioral evaluation using validated 

6 and normed testing performed in a formal environ7 ment that uses specifically designated tasks to meas8 ure cognitive function known to be linked to a par9 ticular brain structure or pathway, which may in10 clude a measurement of intellectual functioning, at11 tention, new learning or memory, intelligence, proc12 essing speed, and executive functioning. 

13 (4) TRAUMATIC BRAIN INJURY.—The term 

14 ‘‘traumatic brain injury’’ means a traumatically in15 duced structural injury or physiological disruption of 

16 brain function as a result of an external force that 

17 is indicated by new onset or worsening of at least 

18 one of the following clinical signs immediately fol19 lowing the event: 

20 (A) Alteration in mental status, including 

21 confusion, disorientation, or slowed thinking. 

22 (B) Loss of memory for events imme23 diately before or after the injury. 

24 (C) Any period of loss of or decreased level 

25 of consciousness, observed or self-reported. 


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1 SEC. 3. IMPROVEMENTS TO BRAIN HEALTH INITIATIVES OF 

2 DEPARTMENT OF DEFENSE. 

3 (a) BRAIN HEALTH INITIATIVES.— 

4 (1) IN GENERAL.—Part II of subtitle A of title 

5 10, United States Code, is amended by inserting 

6 after chapter 55 the following new chapter: 

7 ‘‘CHAPTER 55A—BRAIN HEALTH 

8 INITIATIVES 

‘‘Sec. 

‘‘1110n. Definition of traumatic brain injury. 

‘‘1110n–1. Warfighter Brain Health Initiative. 

9 ‘‘§ 1110n. Definition of traumatic brain injury 

10 ‘‘In this chapter, the term ‘traumatic brain injury’ 

11 means a traumatically induced structural injury or physio12 logical disruption of brain function as a result of an exter13 nal force that is indicated by new onset or worsening of 

14 at least one of the following clinical signs immediately fol15 lowing the event: 

16 ‘‘(1) Alteration in mental status, including con17 fusion, disorientation, or slowed thinking. 

18 ‘‘(2) Loss of memory for events immediately be19 fore or after the injury. 

20 ‘‘(3) Any period of loss of or decreased level of 

21 consciousness, observed or self-reported. 

22 ‘‘§ 1110n–1. Warfighter Brain Health Initiative 

23 ‘‘(a) IN GENERAL.—The Secretary of Defense, in 

24 consultation with the Secretaries concerned, shall establish 


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1 a comprehensive initiative for brain health to be known 

2 as the ‘Warfighter Brain Health Initiative’ (in this section 

3 referred to as the ‘Initiative’) for the purpose of unifying 

4 efforts and programs across the Department of Defense 

5 to improve the cognitive performance and brain health of 

6 members of the Armed Forces. 

7 ‘‘(b) OBJECTIVES.—The objectives of the Initiative 

8 shall be the following: 

9 ‘‘(1) To enhance, maintain, and restore the cog10 nitive performance of members of the Armed Forces 

11 through education, training, prevention, protection, 

12 monitoring, detection, diagnosis, treatment, and re13 habilitation, including through the following activi14 ties: 

15 ‘‘(A) The establishment of a program to 

16 monitor cognitive brain health across the De17 partment of Defense, with the goal of detecting 

18 any need for cognitive enhancement or restora19 tion resulting from potential brain exposures of 

20 members of Armed Forces, to mitigate possible 

21 evolution of injury or disease progression. 

22 ‘‘(B) The identification and dissemination 

23 of thresholds for blast exposure and blast over24 pressure safety and associated emerging sci25 entific evidence that— 


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1 ‘‘(i) cover brain injury, lung injury, 

2 and impulse noise; 

3 ‘‘(ii) measure impact over 24-hour, 

4 72-hour to 96-hour, monthly, annual, and 

5 lifetime periods; 

6 ‘‘(iii) ensure that the thresholds are 

7 low enough that they are not associated 

8 with cognitive deficits after firing; 

9 ‘‘(iv) include thresholds that account 

10 for the firing of multiple types of heavy 

11 weaponry and use of grenades in one pe12 riod of time; 

13 ‘‘(v) include minimum safe distances 

14 and levels of exposure for observers and in15 structors; and 

16 ‘‘(vi) include limits for shoulder-fired 

17 heavy weapons. 

18 ‘‘(C) The modification of high-risk training 

19 and operational activities to mitigate the nega20 tive effects of repetitive blast exposure. 

21 ‘‘(D) The identification of individuals who 

22 perform high-risk training or occupational ac23 tivities for purposes of increased monitoring of 

24 the brain health of such individuals. 


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1 ‘‘(E) The development and operational 

2 fielding of non-invasive, portable, point-of-care 

3 medical devices, to inform the diagnosis and 

4 treatment of traumatic brain injury. 

5 ‘‘(F) The establishment of a standardized 

6 monitoring program that documents and ana7 lyzes blast exposures that may affect the brain 

8 health of members of the Armed Forces. 

9 ‘‘(G) The consideration of the findings and 

10 recommendations of the report of the National 

11 Academies of Science, Engineering, and Medi12 cine published in 2022 and entitled ‘Traumatic 

13 Brain Injury: A Roadmap for Accelerating 

14 Progress’ (relating to the acceleration of 

15 progress in traumatic brain injury research and 

16 care), or any successor report, in relation to the 

17 activities of the Department relating to brain 

18 health. 

19 ‘‘(H) The establishment of policies to en20 courage members of the Armed Forces to seek 

21 support for brain health when needed, prevent 

22 retaliation against such members who seek care, 

23 and address other barriers to seeking help for 

24 brain health, including due to the impact of 


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1 blast exposure, blast overpressure, traumatic 

2 brain injury, and other health matters. 

3 ‘‘(I) The modification of existing weapons 

4 systems to reduce blast exposure of the indi5 vidual using the weapon and those within the 

6 minimum safe distance. 

7 ‘‘(2) To harmonize and prioritize the efforts of 

8 the Department of Defense into a single approach to 

9 brain health. 

10 ‘‘(c) THRESHOLDS FOR BLAST EXPOSURE AND

11 OVERPRESSURE SAFETY.— 

12 ‘‘(1) DEADLINE.— 

13 ‘‘(A) IN GENERAL.—Not later than two 

14 years after the date of the enactment of the 

15 Blast Overpressure Safety Act, the Secretary of 

16 Defense shall identify and disseminate the 

17 thresholds for blast exposure and blast over18 pressure safety and associated emerging sci19 entific evidence required under subsection 

20 (b)(1)(B). 

21 ‘‘(B) UPDATE.—Not less frequently than 

22 every five years, the Secretary of Defense shall 

23 update the thresholds for blast exposure and 

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1 ing scientific evidence required under subsection 

2 (b)(1)(B). 

3 ‘‘(2) CENTRAL REPOSITORY.—Not later than 

4 two years after the date of the enactment of the 

5 Blast Overpressure Safety Act, the Secretary of De6 fense shall establish a central repository of blast-re7 lated characteristics, such as pressure profiles and 

8 common blast loads associated with specific systems 

9 and the environments in which they are used, that 

10 is available to members of the Armed Forces and the 

11 public and includes the information described in sub12 section (b)(1)(B). 

13 ‘‘(3) WAIVERS.— 

14 ‘‘(A) PROTOCOLS.—Not later than two 

15 years after the date of the enactment of the 

16 Blast Overpressure Safety Act, the Secretary of 

17 Defense shall establish and implement protocols 

18 to require waivers in cases in which members of 

19 the Armed Forces must exceed the safety 

20 thresholds described in subsection (b)(1)(B), 

21 which shall include a justification for exceeding 

22 those safety thresholds. 

23 ‘‘(B) TRACKING SYSTEM.— 

24 ‘‘(i) IN GENERAL.—Not later than 

25 two years after the date of the enactment 


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1 of the Blast Overpressure Safety Act, the 

2 Secretary of Defense shall establish a De3 partment of Defense-wide tracking system 

4 for waivers described in subparagraph (A), 

5 which shall include data contributed by 

6 each of the Secretaries concerned. 

7 ‘‘(ii) REPORT.— 

8 ‘‘(I) IN GENERAL.—Not less fre9 quently than once each year by De10 cember 31 of that year following the 

11 establishment of the tracking system 

12 required under clause (i), the Sec13 retary of Defense shall submit to the 

14 Committees on Armed Services of the 

15 Senate and the House of Representa16 tives a report on waivers described in 

17 subparagraph (A) that includes— 

18 ‘‘(aa) the number of waivers 

19 issued, disaggregated by Armed 

20 Forces; 

21 ‘‘(bb) the justifications pro22 vided for each waiver; 

23 ‘‘(cc) a description of actions 

24 taken by the Secretary concerned 

25 to track the health effects on 


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1 members of the Armed Forces of 

2 exceeding safety thresholds de3 scribed in subsection (b)(1)(B), 

4 document those effects in medical 

5 records, and provide care to 

6 those members; and 

7 ‘‘(dd) a description of the 

8 medical care received by those 

9 members in response to exceeding 

10 these safety thresholds. 

11 ‘‘(II) PUBLIC AVAILABILITY.— 

12 The Secretary of Defense shall make 

13 the information contained in each re14 port submitted under subclause (I) 

15 available to the public, including on 

16 the govinfo.gov website, or successor 

17 website, not later than 10 days after 

18 the report is submitted under such 

19 subclause. 

20 ‘‘(d) FORMAL TRAINING REQUIREMENT.— 

21 ‘‘(1) IN GENERAL.—The Secretary of Defense 

22 shall ensure that training described in paragraph (2) 

23 is required for members of the Armed Forces before 

24 training, deployment, or entering other environments 


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1 determined to be high-risk by the Secretary con2 cerned. 

3 ‘‘(2) TRAINING DESCRIBED.—Training de4 scribed in this paragraph is training on the fol5 lowing: 

6 ‘‘(A) Thresholds for blast exposure and 

7 blast overpressure safety and associated emerg8 ing scientific evidence required under subsection 

9 (b)(1)(B). 

10 ‘‘(B) Symptoms of exposure to blasts or 

11 blast overpressure. 

12 ‘‘(C) Symptoms of traumatic brain injury. 

13 ‘‘(e) STRATEGIES FOR MITIGATION AND PREVEN14 TION OF BLAST EXPOSURE AND OVERPRESSURE RISK

15 FOR HIGH-RISK INDIVIDUALS.—In carrying out the Ini16 tiative, not later than one year after the date of the enact17 ment of the Blast Overpressure Safety Act, the Secretary 

18 of Defense shall establish strategies for mitigating and 

19 preventing blast exposure and blast overpressure risk for 

20 individuals most at risk for exposure to high-risk training 

21 or high-risk occupational activities, which shall include— 

22 ‘‘(1) a timeline and process for implementing 

23 those strategies; 


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1 ‘‘(2) a determination of the frequency with 

2 which those strategies will be updated, at a rate of 

3 not less frequently than every five years; and 

4 ‘‘(3) an assessment of how information regard5 ing those strategies will be disseminated to such in6 dividuals, including after those strategies are up7 dated. 

8 ‘‘(f) ANNUAL BUDGET JUSTIFICATION DOCU9 MENTS.—In the budget justification materials submitted 

10 to Congress in support of the budget of the Department 

11 of Defense for each fiscal year (as submitted with the 

12 budget of the President under section 1105(a) of title 31), 

13 the Secretary of Defense shall include a budget justifica14 tion display that includes all activities of the Department 

15 relating to the Initiative. 

16 ‘‘(g) ANNUAL REPORTS.— 

17 ‘‘(1) IN GENERAL.—Not later than March 31, 

18 2025, and not less frequently than annually there19 after, the Secretary of Defense shall submit to the 

20 Committees on Armed Services of the Senate and 

21 the House of Representatives a report that includes 

22 the following: 

23 ‘‘(A) A description of the activities taken 

24 under the Initiative and resources expended 

25 under the Initiative during the prior fiscal year. 


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1 ‘‘(B) The number of members of the 

2 Armed Forces impacted by blast overpressure 

3 and blast exposure in the prior fiscal year, in4 cluding— 

5 ‘‘(i) the number of members who re6 ported adverse health effects from blast 

7 overpressure or blast exposure; 

8 ‘‘(ii) the number of members exposed 

9 to blast overpressure or blast exposure; 

10 ‘‘(iii) the number of members who re11 ceived treatment for injuries related to 

12 blast overpressure or blast exposure, in13 cluding at facilities of the Department of 

14 Defense and at facilities in the private sec15 tor; 

16 ‘‘(iv) regarding treatment for blast ex17 posure, blast overpressure, or subconcus18 sive or concussive brain injuries at the Na19 tional Intrepid Center of Excellence, an In20 trepid Spirit Center, or an appropriate 

21 military medical treatment facility— 

22 ‘‘(I) the number of members on 

23 the waitlist for such treatment; 


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1 ‘‘(II) the average period of time 

2 those members are on that waitlist; 

3 and 

4 ‘‘(III) the average number of 

5 days between when an appointment is 

6 requested and the actual appointment 

7 date; and 

8 ‘‘(v) the type of care that members re9 ceive from facilities of the Department of 

10 Defense and the type of care that members 

11 receive from facilities in the private sector. 

12 ‘‘(C) A summary of the progress made 

13 during the prior fiscal year with respect to the 

14 objectives of the Initiative under subsection (b). 

15 ‘‘(D) A description of the steps the Sec16 retary is taking to ensure that activities under 

17 the Initiative are being implemented across the 

18 Department of Defense and the military depart19 ments. 

20 ‘‘(2) PUBLIC AVAILABILITY.—The Secretary of 

21 Defense shall make the information contained in 

22 each report submitted under paragraph (1) available 

23 to the public, including on the govinfo.gov website, 

24 or successor website, not later than 10 days after 

25 the report is submitted under such paragraph.’’. 


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1 (b) CONFORMING AND CLERICAL AMENDMENTS.— 

2 (1) CLERICAL AMENDMENT.—The table of 

3 chapters at the beginning of title 10, United States 

4 Code, and at the beginning of part II of subtitle A 

5 of such title, is amended by inserting after the item 

6 relating to chapter 55 the following new item: 

‘‘55A. Brain health initiatives ................................................................1110n.’’. 

7 (2) CONFORMING REPEAL.—Section 735 of the 

8 James M. Inhofe National Defense Authorization 

9 Act for Fiscal Year 2023 (Public Law 117–263; 10 

10 U.S.C. 1071 note) is repealed. 

11 (c) INITIAL BRIEFING AND REPORT ON NATIONAL

12 INTREPID CENTER OF EXCELLENCE.— 

13 (1) IN GENERAL.—Not later than 150 days 

14 after the date of the enactment of this Act, the Sec15 retary of Defense shall provide to the congressional 

16 defense committees a briefing and submit to the con17 gressional defense committees a report on the pa18 rameters of the program of record established under 

19 section 1110n–3 of title 10, United States Code, as 

20 added by subsection (a). 

21 (2) CONGRESSIONAL DEFENSE COMMITTEES

22 DEFINED.—In this subsection, the term ‘‘congres23 sional defense committees’’ has the meaning given 

24 that term in section 101(a)(16) of title 10, United 

25 States Code. 


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1 SEC. 4. PILOT PROGRAM RELATING TO MONITORING OF 

2 BLAST COVERAGE. 

3 (a) AUTHORITY.—The Secretary concerned may con4 duct, as part of the initiative established under section 

5 1110n–1 of title 10, United States Code, as added by sec6 tion 3, a pilot program under which the Secretary con7 cerned shall monitor blast overpressure exposure through 

8 the use of commercially available, off-the-shelf, remote 

9 measurements, and document and evaluate data collected 

10 as a result of such monitoring. 

11 (b) LOCATIONS.—Monitoring activities under a pilot 

12 program conducted pursuant to subsection (a) shall be 

13 carried out in each training environment that the Sec14 retary concerned determines poses a risk for blast over15 pressure exposure. 

16 (c) DOCUMENTATION AND SHARING OF DATA.—If 

17 the Secretary concerned conducts a pilot program pursu18 ant to subsection (a), the Secretary concerned shall— 

19 (1) ensure that any data collected pursuant to 

20 such pilot program that is related to the health ef21 fects of the blast overpressure exposure of a member 

22 of the Armed Forces who participated in the pilot 

23 program is documented and maintained by the Sec24 retary of Defense in an electronic health record for 

25 the member; and 


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1 (2) to the extent practicable, and in accordance 

2 with applicable provisions of law relating to data pri3 vacy, make data collected pursuant to such pilot pro4 gram available to other academic and medical re5 searchers for the purpose of informing future re6 search and treatment options. 

7 (d) DEFINITION OF SECRETARY CONCERNED.—In 

8 this section, the term ‘‘Secretary concerned’’ has the 

9 meaning given such term in section 101 of title 10, United 

10 States Code. 

11 SEC. 5. SPECIAL OPERATIONS BRAIN HEALTH AND TRAUMA 

12 PROGRAM. 

13 (a) IN GENERAL.—Chapter 55A of title 10, United 

14 States Code, as added by section 3, is amended by adding 

15 at the end the following new section: 

16 ‘‘§ 1110n–2. Special operations brain health and trau17 ma program 

18 ‘‘(a) IN GENERAL.—The Commander of the United 

19 States Special Operations Command (in this section re20 ferred to as the ‘Commander’), in coordination with the 

21 Secretary of Defense, shall conduct an intensive, com22 prehensive brain health and trauma program (in this sec23 tion referred to as the ‘Program’) to provide coordinated, 

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1 ment initiation, and aftercare coordination in a highly con2 densed model for special operations forces. 

3 ‘‘(b) EVIDENCE-BASED TREATMENT.—In carrying 

4 out the Program, the Commander shall provide evidence5 based physical, mental, and behavioral health care and 

6 counseling for traumatic brain injury, blast overpressure, 

7 blast exposure, and psychological or neurological condi8 tions that are common among members of the special op9 erations forces. 

10 ‘‘(c) POPULATION SERVED.—In carrying out the Pro11 gram, the Commander shall provide the health care and 

12 counseling specified in subsection (b) to members of the 

13 special operations forces and family members of such 

14 members. 

15 ‘‘(d) EVALUATION, TESTING, AND TREATMENT.— 

16 The Program shall include the following: 

17 ‘‘(1) Evaluations by health care providers in the 

18 areas of brain injury medicine, neuropsychology, 

19 clinical psychology, psychiatry, neuroendocrinology, 

20 sports medicine, musculoskeletal medicine, vestibular 

21 physical therapy, neuroimaging, and hormonal eval22 uation. 

23 ‘‘(2) Metabolic testing, cardiovascular testing, 

24 and cerebrovascular testing. 


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1 ‘‘(3) Treatment relating to headaches, sleep 

2 interventions and medication, injection-based thera3 pies for musculoskeletal pain, cognitive rehab, vestib4 ular physical therapy, and exercise programming. 

5 ‘‘(e) COORDINATION.—In carrying out the Program, 

6 the Commander shall coordinate with private sector non7 profit healthcare organizations that have the capacity and 

8 infrastructure to provide the care and services required 

9 under the Program. 

10 ‘‘(f) MEDICAL RECORDS.—In carrying out the Pro11 gram, the Commander shall coordinate with the Director 

12 of the Defense Health Agency and the Secretaries of the 

13 military departments to ensure that the treatment received 

14 through the Program is documented in the medical 

15 records of members of the Armed Forces.’’. 

16 (b) CLERICAL.—The table of sections at the begin17 ning of chapter 55A of such title, as amended by section 

18 3, is amended by adding at the end the following new item: 

‘‘1110n–2. Special operations brain health and trauma program.’’. 

19 (c) REPORT AND BRIEFING ON IMPLEMENTATION OF

20 SPECIAL OPERATIONS TRAUMATIC BRAIN INJURY PRO21 GRAM.— 

22 (1) REPORT ON PROGRAM.— 

23 (A) IN GENERAL.—Not later than Decem24 ber 31, 2025, the Commander of the United 

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1 nation with the Secretary of Defense, shall sub2 mit to the Committee on Armed Services of the 

3 Senate and the Committee on Armed Services 

4 of the House of Representatives a report on the 

5 special operations brain health and trauma pro6 gram required under section 1110n–2 of title 

7 10, United States Code, as added by subsection 

8 (a), which shall include— 

9 (i) the benefits of the program to 

10 members of the Armed Forces and their 

11 families; 

12 (ii) the number of members assisted 

13 by such program; 

14 (iii) the type of treatment received 

15 under such program; 

16 (iv) the rate of members of the Armed 

17 Forces returning to duty after receiving 

18 treatment under such program; 

19 (v) how the Commander is coordi20 nating with the Director of the Defense 

21 Health Agency and the Secretaries of the 

22 military departments to update records of 

23 members of the Armed Forces with treat24 ment received under such program; and 


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1 (vi) whether and how the program 

2 should be expanded to include other vul3 nerable populations within the Armed 

4 Forces; 

5 (B) PUBLIC AVAILABILITY.—The Secretary 

6 of Defense shall make the information con7 tained in the report submitted under subpara8 graph (A) available to the public, including on 

9 the govinfo.gov website, or successor website, 

10 not later than 10 days after the report is sub11 mitted under such subparagraph. 

12 (2) COMPTROLLER GENERAL REPORT AND

13 BRIEFING.—Not later than 180 days after the date 

14 of the enactment of this Act, the Comptroller Gen15 eral of the United States shall brief the Committee 

16 on Armed Services of the Senate and the Committee 

17 on Armed Services of the House of Representatives 

18 on the implementation of section 1110n–2 of title 

19 10, United States Code, as added by subsection (a), 

20 with a report to follow at a mutually agreed upon 

21 date. 

22 SEC. 6. NATIONAL INTREPID CENTER OF EXCELLENCE. 

23 (a) IN GENERAL.—Chapter 55A of title 10, United 

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1 tion 5, is further amended by adding at the end the fol2 lowing new section: 

3 ‘‘§ 1110n–3. National Intrepid Center of Excellence 

4 ‘‘(a) IN GENERAL.—Not later than 120 days after 

5 the date of the enactment of the Blast Overpressure Safe6 ty Act, the Secretary of Defense shall establish the Na7 tional Intrepid Center of Excellence (in this section re8 ferred to as the ‘Center’) as a program of record subject 

9 to milestone reviews and compliance with the requirements 

10 under this section. 

11 ‘‘(b) DUTIES.—The duties of the Center are as fol12 lows: 

13 ‘‘(1) To provide interdisciplinary care to pre14 vent, diagnose, treat, and rehabilitate members of 

15 the Armed Forces with traumatic brain injury, post16 traumatic stress disorder, symptoms from blast over17 pressure or blast exposure, and other mental health 

18 conditions. 

19 ‘‘(2) Support and conduct research and edu20 cation on traumatic brain injury, post-traumatic 

21 stress disorder, blast overpressure or blast exposure, 

22 and other mental health conditions. 

23 ‘‘(c) CHILDCARE.—Childcare services shall be made 

24 available for individuals seeking help through the National 

25 Intrepid Center of Excellence. 


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1 ‘‘(d) ANNUAL REPORT.— 

2 ‘‘(1) IN GENERAL.—Not later than one year 

3 after the date of the enactment of the Blast Over4 pressure Safety Act, and annually thereafter, the 

5 Secretary of Defense shall submit to the Committees 

6 on Armed Services of the Senate and the House of 

7 Representatives a report that shall include, for the 

8 year covered by the report— 

9 ‘‘(A) the number of individuals to whom 

10 the Center has provided services; 

11 ‘‘(B) the number of individuals who return 

12 to active duty in the Armed Forces after receiv13 ing services from the Center, and the stage in 

14 their career at which they seek treatment at the 

15 Center; 

16 ‘‘(C) the number of individuals whose fam17 ilies are able to participate in programs pro18 vided by the Center; and 

19 ‘‘(D) the number of individuals on a 

20 waitlist for treatment at the Center and the av21 erage period those individuals are on the 

22 waitlist. 

23 ‘‘(2) PUBLIC AVAILABILITY.—The Secretary of 

24 Defense shall make the information contained in 

25 each report submitted under paragraph (1) available 


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1 to the public, including on the govinfo.gov website, 

2 or successor website, not later than 10 days after 

3 the report is submitted under such paragraph.’’. 

4 (b) CLERICAL.—The table of sections at the begin5 ning of chapter 55A of such title, as amended by sections 

6 3 and 5, is amended by adding at the end the following 

7 new item: 

‘‘1110n–3. National Intrepid Center of Excellence.’’. 

8 SEC. 7. MANDATORY TRAINING ON HEALTH EFFECTS OF 

9 CERTAIN BRAIN TRAUMA. 

10 (a) IN GENERAL.—Chapter 55A of title 10, United 

11 States Code, as added by section 3 and amended by sec12 tions 5 and 6, is further amended by adding at the end 

13 the following new section: 

14 ‘‘§ 1110n–4. Mandatory training on health effects of 

15 certain brain trauma 

16 ‘‘Not less frequently than once every two years, the 

17 Secretary of Defense shall provide to each medical pro18 vider and training manager of the Department of Defense 

19 mandatory training with respect to the potential health ef20 fects of blast overpressure, blast exposure, and traumatic 

21 brain injury.’’. 

22 (b) CLERICAL.—The table of sections at the begin23 ning of chapter 55A of such title, as amended by sections 


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1 3, 5, and 6, is amended by adding at the end the following 

2 new item: 

‘‘1110n–4. Mandatory training on health effects of certain brain trauma.’’. 

3 SEC. 8. ANNUAL BRIEFING ON INDIVIDUAL LONGITUDINAL 

4 EXPOSURE RECORD. 

5 (a) IN GENERAL.—Chapter 55 of title 10, United 

6 States Code, is amended by adding at the end the fol7 lowing new section: 

8 ‘‘§ 1110c. Annual briefing on Individual Longitudinal 

9 Exposure Record 

10 ‘‘(a) IN GENERAL.—Not less frequently than annu11 ally, the Secretary of Defense, in consultation with the 

12 Secretary of Veterans Affairs, shall provide the appro13 priate committees of Congress a briefing on— 

14 ‘‘(1) the quality of the databases of the Depart15 ment of Defense that provide the information pre16 sented in the Individual Longitudinal Exposure 

17 Record; and 

18 ‘‘(2) the usefulness of the Individual Longitu19 dinal Exposure Record in supporting members of the 

20 Armed Forces and veterans in receiving health care 

21 and benefits from the Department of Defense and 

22 the Department of Veterans Affairs. 

23 ‘‘(b) ELEMENTS.—Each briefing required by sub24 section (a) shall include, for the period covered by the re25 port, the following: 


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1 ‘‘(1) An identification of potential exposures to 

2 occupational or environmental hazards, including 

3 blast overpressure and blast exposure, captured by 

4 the current systems of the Department of Defense 

5 for environmental, occupational, and health moni6 toring, and recommendations for how to improve 

7 those systems. 

8 ‘‘(2) An analysis of the quality and accuracy of 

9 the location data used by the Department of Defense 

10 in determining potential exposures to occupational or 

11 environmental hazards by members of the Armed 

12 Forces and veterans, including blast overpressure 

13 and blast exposure, and recommendations for how to 

14 improve the quality of such data if necessary. 

15 ‘‘(c) DEFINITIONS.—In this section: 

16 ‘‘(1) APPROPRIATE COMMITTEES OF CON17 GRESS.—The term ‘appropriate committees of Con18 gress’ means— 

19 ‘‘(A) the Committee on Armed Services 

20 and the Committee on Veterans’ Affairs of the 

21 Senate; and 

22 ‘‘(B) the Committee on Armed Services 

23 and the Committee on Veterans’ Affairs of the 

24 House of Representatives. 


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1 ‘‘(2) INDIVIDUAL LONGITUDINAL EXPOSURE

2 RECORD.—The term ‘Individual Longitudinal Expo3 sure Record’ has the meaning given such term in 

4 section 1171(b) of title 38.’’. 

5 (b) CLERICAL AMENDMENT.—The table of sections 

6 at the beginning of chapter 55 of title 10, United States 

7 Code, is amended by inserting after the item relating to 

8 section 1110b the following new item: 

‘‘1110c. Annual briefing on Individual Longitudinal Exposure Record.’’. 

9 (c) CONFORMING REPEAL.—Section 802 of the Ser10 geant First Class Heath Robinson Honoring our Promise 

11 to Address Comprehensive Toxics Act of 2022 (Public 

12 Law 117–168; 10 U.S.C. 1071 note) is repealed. 

13 SEC. 9. REVIEW OF BLAST-RELATED BRAIN INJURY RE14 SEARCH AND OTHER EFFORTS OF THE DE15 PARTMENT OF DEFENSE. 

16 (a) REVIEW.— 

17 (1) IN GENERAL.—The Comptroller General of 

18 the United States shall conduct a review of the re19 search and other efforts of the Department of De20 fense on traumatic brain injury, including injuries 

21 related to blast overpressure or blast exposure. 

22 (2) MATTERS TO BE INCLUDED.—The review 

23 required by paragraph (1) shall include the fol24 lowing: 


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1 (A) A description of the research con2 ducted by the Department of Defense on trau3 matic brain injury, the entities involved in that 

4 research, and efforts to coordinate that research 

5 internally and externally. 

6 (B) A description of any improvements 

7 identified by that research related to the pre8 vention, diagnosis, and treatment of blast-re9 lated brain injuries and an assessment of the 

10 implementation of those improvements. 

11 (C) An evaluation of the efforts of the De12 partment to protect members of the Armed 

13 Forces from retaliation for seeking care for the 

14 prevention, diagnosis, or treatment of traumatic 

15 brain injury, blast overpressure, or blast expo16 sure, including any gaps in or barriers to those 

17 efforts. 

18 (D) An evaluation of the list maintained by 

19 the Department of the military occupational 

20 specialties most at-risk for blast overpressure 

21 and blast exposure and whether additional at22 risk occupational specialties should be included. 

23 (E) Any other finding the Comptroller 

24 General considers relevant. 


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1 (b) BRIEFING AND REPORT.—Not later than 180 

2 days after the date of the enactment of this Act, the 

3 Comptroller General shall brief the Committee on Armed 

4 Services of the Senate and the Committee on Armed Serv5 ices of the House of Representatives on the review re6 quired under subsection (a), with a report to follow on 

7 a mutually agreed upon date. 

8 (c) DEFINITION OF TRAUMATIC BRAIN INJURY.—In 

9 this section, the term ‘‘traumatic brain injury’’ means a 

10 traumatically induced structural injury or physiological 

11 disruption of brain function as a result of an external force 

12 that is indicated by new onset or worsening of at least 

13 one of the following clinical signs immediately following 

14 the event: 

15 (1) Alteration in mental status, including confu16 sion, disorientation, or slowed thinking. 

17 (2) Loss of memory for events immediately be18 fore or after the injury. 

19 (3) Any period of loss of or decreased level of 

20 consciousness, observed or self-reported. 

21 SEC. 10. IMPLEMENTATION OF INSPECTOR GENERAL REC22 OMMENDATIONS TO MANAGE TRAUMATIC 

23 BRAIN INJURY CARE. 

24 (a) IMPLEMENTATION.—Not later than December 

25 31, 2025, the Secretary of Defense shall implement the 


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1 recommendations contained in the report of the Inspector 

2 General of the Department of Defense entitled, ‘‘Evalua3 tion of the DoD’s Management of Traumatic Brain In4 jury’’ (DODIG–2023–059). 

5 (b) BRIEFING.—Not later than April 1, 2025, the 

6 Secretary of Defense shall provide to the Committee on 

7 Armed Services of the Senate and the Committee on 

8 Armed Services of the House of Representatives a briefing 

9 on the progress of the Secretary in carrying out the imple10 mentation required under subsection (a). 

Æ 


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