II 118th CONGRESS 2d Session S. 4109 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. Short title This Act may be cited as the Blast Overpressure Safety Act . 2. Roles and responsibilities for components of the Office of the Secretary of Defense relating to brain injuries from concussive and subconcussive blasts (a) Findings and sense of Congress (1) Findings Congress finds the following: (A) Research conducted by the Department of Defense underscores that concussive and subconcussive brain injuries can arise not only from combat scenarios but also from routine training exercises. (B) Even when adhering to established safety guidelines, the act of firing or being exposed to the firing of heavy weapons, grenades, and breaching during training sessions can potentially lead to cognitive impairments, particularly affecting aspects such as delayed verbal memory, visual-spatial memory, and executive function. (C) Traumatic brain injuries have become the signature wound of members of the Armed Forces from the Global War on Terrorism generation. (D) Special Warfare Operator 1st Class Ryan Larkin and Sergeant First Class Michael Froede both suffered traumatic brain injuries during their rigorous training and multiple combat deployments and were tragically lost to suicide as a result of their wounds. Their stories highlight the critical issues surrounding traumatic brain injury within the military and the subsequent risk of suicide among affected individuals. (E) This Act honors the sacrifices of Special Warfare Operator 1st Class Ryan Larkin and Sergeant First Class Michael Froede, as well as the thousands of affected members of the Armed Forces by expediting the efforts of the Department of Defense to mitigate, identify, and treat traumatic brain injuries within the Armed Forces. (2) Sense of Congress It is the sense of Congress that— (A) Congress commends the Department of Defense for its efforts to implement measures consistent with modern science to limit the occurrence of concussive and subconcussive brain injuries among members of the Armed Forces and facilitate the rehabilitation of those recovering from service-related traumatic brain injuries; and (B) the Secretary of Defense should sustain those efforts while also enhancing overall knowledge and protection against brain injuries. (b) Establishment of roles The Secretary of Defense shall establish the roles and responsibilities of components of the Office of the Secretary of Defense for the mitigation, identification, and treatment of concussive and subconcussive brain injuries and the monitoring and documentation of blast overpressure exposure as follows: (1) The Under Secretary of Defense for Personnel and Readiness shall be responsible for, not later than one year after the date of the enactment of this Act— (A) establishing a baseline neurocognitive assessment to be conducted during the accession process of members of the Armed Forces before the beginning of training; (B) establishing annual neurocognitive assessments to monitor the cognitive function of such members to be conducted— (i) at least every three years as part of the periodic health assessment of such members; (ii) as part of the post-deployment health assessment of such members; and (iii) prior to separation from service in the Armed Forces; (C) ensuring all neurocognitive assessments of such members, including those required under subparagraphs (A) and (B), are maintained in the electronic medical record of such member; (D) establishing a process for annual review of blast overpressure exposure logs and traumatic brain injury logs specified in paragraph (2)(A) for each member of the Armed Forces during the periodic health assessment of such member for cumulative exposure in order to refer members with recurrent and prolonged exposure to specialty care; and (E) establishing standards for recurrent and prolonged exposure. (2) The Assistant Secretary of Defense for Readiness shall be responsible for, not later than one year after the date of the enactment of this Act, the following: (A) Establishing and maintaining blast overpressure exposure logs and traumatic brain injury logs for every member of the Armed Forces. (B) Integrating those logs into the Individual Longitudinal Exposure Record (as defined in section 1171(b) of title 38, United States Code) for such member. (C) Including in those logs at least the following: (i) The number of previous exposures to blast overpressure, including the number of exposures per unit of time, date, blast overpressure in pounds per square inch, and number of times the member of the Armed Forces fires, uses, or is exposed to weapons that cause blast overpressure. (ii) Any residual physical, mental, or emotional effects resulting from such exposure. (iii) The source of the exposure, activity when the exposure occurred, whether it occurred during training or deployment, and any other relevant context of such exposure. (iv) The treatment that the member sought and received in connection with such exposure. (v) The number of concussive and subconcussive brain injuries, including traumatic brain injuries, sustained. (vi) The severity of concussive and subconcussive brain injuries, including traumatic brain injuries, sustained. (vii) Other head trauma, regardless of whether it requires the treatment of a medical provider. (3) The Inspector General of the Department of Defense shall be responsible for— (A) not later than two years after the date of the enactment of this Act, submitting to Congress a report (in unclassified form, but with a classified annex as necessary) evaluating the establishment and maintenance of the logs required under paragraph (2), including the cumulative exposure annotated in the blast overpressure exposure logs and traumatic brain injury logs, as well as the compliance of the Department of Defense with Department policies to address the brain health of members of the Armed Forces; (B) not later than 10 days after submitting the report under subparagraph (A), making available to the public the unclassified portion of the report; and (C) beginning on the date that is three years after the date of the enactment of this Act— (i) evaluating the continued fulfillment by the Department of the requirements under paragraph (2), including the cumulative exposure annotated in the blast overpressure exposure logs and traumatic brain injury logs, as well as the compliance of the Department with Department policies to address the brain health of members of the Armed Forces; (ii) not later than December 31 of each year, submitting to Congress a report (in unclassified form, but with a classified annex as necessary) containing the results of such evaluation; and (iii) not later than 10 days after submitting each report under clause (ii), making available to the public the unclassified portion of such report. (4) The Under Secretary of Defense for Acquisition and Sustainment shall be responsible for, not later than one year after the date of the enactment of this Act, the following: (A) Establishing the minimization of exposure to blast overpressure as a performance parameter when drafting requirements for new weapons systems that produce blast overpressure for the Department of Defense. (B) Establishing a requirement that any entity under contractual agreement with the Department as part of the defense weapons acquisition process shall provide to the Department blast overpressure measurements and safety data for any weapons system procured from such entity that produces blast overpressure and exceeds the maximum exposure limit set by the Department. (C) Establishing a requirement that any test plan for a weapons system incorporate testing for blast overpressure measurements and safety data. (D) Not later than December 31 of each year, publishing on a publicly available website, including govinfo.gov or successor website, a report that includes— (i) blast overpressure measurements and safety data for weapons systems of the Department, including how those systems have been tested and in what environments; and (ii) plans to improve protection for exposure by members of the Armed Forces to in-use weapons systems with unsafe levels of blast overpressure and exposure. (c) Coordination The officials specified in paragraphs (1), (2), (3), and (4) of subsection (b) shall coordinate and align their plans and activities to implement such subsection among themselves and with the Secretaries of the military departments. (d) Briefings and reports (1) Implementation briefing Not later than 180 days after the date of the enactment of this Act, and every 180 days thereafter, the Secretary of Defense shall provide to the congressional defense committees a briefing on the plans, associated timelines, and activities conducted to implement subsection (a). (2) Report on concussive and subconcussive brain injuries (A) In general Not later than 180 days after the date of the enactment of this Act, and annually thereafter, the Secretary of Defense shall submit to the congressional defense committees a report on— (i) concussive and subconcussive brain injuries caused during military operations, including combat operations, among members of the Armed Forces, including information on— (I) the Armed Force of the member; (II) the name of the operation; (III) the location within the area of responsibility; (IV) the number of concussive and subconcussive brain injuries caused; (V) the severity of concussive and subconcussive brain injuries caused; (VI) the treatment received for a concussive or subconcussive brain injury; (VII) whether a member of the Armed Forces was medically retired from service due to a concussive or subconcussive brain injury; (VIII) whether a member of the Armed Forces died by suicide after sustaining a concussive or subconcussive brain injury; and (IX) the source of the injury, including the activity conducted when the injury occurred; and (ii) concussive and subconcussive brain injuries caused during training events among members of the Armed Forces, including information on— (I) the Armed Force of the member; (II) the type of training; (III) the location of the training; (IV) the number of concussive and subconcussive brain injuries caused; (V) the severity of concussive and subconcussive brain injuries caused; (VI) the treatment received for a concussive or subconcussive brain injury; (VII) whether a member of the Armed Forces was medically retired from service due to a concussive or subconcussive brain injury; (VIII) whether a member of the Armed Forces died by suicide after sustaining a concussive or subconcussive brain injury; and (IX) the source of the injury, including the activity conducted when the injury occurred. (B) Form Each report submitted under subparagraph (A) shall be submitted in unclassified form, but may include a classified annex. (C) Public availability Not later than 10 days after submitting a report under subparagraph (A), the Secretary of Defense shall make the unclassified portion of the report available to the public, including by publishing the report on the govinfo.gov website, or successor website. (3) Report on discharges related to concussive and subconcussive brain injuries (A) In general Not later than 180 days after the date of the enactment of this Act, and annually thereafter, the officials specified in paragraphs (1) and (2) of subsection (b) and the Secretary of Defense shall submit to the congressional defense committees a report on members of the Armed Forces who were discharged administratively or punitively and had a concussive or subconcussive brain injury, including a traumatic brain injury, including information on— (i) whether the injury or injuries occurred during combat operations or training and the associated combat operations or training incident; (ii) the severity of the injury or injuries; (iii) if any such injury was combat related, the name of the operation; (iv) the treatment sought and received for the injury or injuries; (v) the number of discharge upgrade requests in connection with such an injury or injuries that have been made; and (vi) the number of such discharge upgrade requests that have been approved. (B) Form Each report submitted under subparagraph (A) shall be submitted in unclassified form, but may include a classified annex. (C) Public availability Not later than 10 days after submitting a report under subparagraph (A), the Secretary of Defense shall make the unclassified portion of the report available to the public, including by publishing the report on the govinfo.gov website, or successor website. (4) Report on medical providers trained in concussive and subconcussive brain injuries (A) In general Not later than 180 days after the date of the enactment of this Act, and annually thereafter, the Secretary of Defense shall submit to the congressional defense committees a report on medical providers within the Defense Health Agency who are trained in traumatic brain injury or concussive and subconcussive brain injuries as a sub-specialty of neurology, including information on— (i) the number of such providers, disaggregated by location; (ii) the billets of such personnel; (iii) the number of medical personnel currently participating in training or a fellowship relating to traumatic brain injury or concussive and subconcussive brain injuries; and (iv) the strategy of the Department of Defense to increase the number of medical providers trained in traumatic brain injury or concussive and subconcussive brain injuries as a sub-specialty of neurology. (B) Public availability Not later than 10 days after submitting a report under subparagraph (A), the Secretary of Defense shall make the report available to the public, including by publishing the report on the govinfo.gov website, or successor website. (5) Report on efforts to coordinate with allies and partners (A) In general Not later than 180 days after the date of the enactment of this Act, and annually thereafter, the Secretary of Defense shall submit to the congressional defense committees a report on the efforts of the Department of Defense to share and coordinate on blast injury and subconcussive and concussive brain injury research efforts with allies and partners of the United States, which shall include information on— (i) the activities coordinated with such allies and partners to better prevent, mitigate, and treat injuries from blast exposure; and (ii) recommendations to improve future collaboration with such allies and partners, including administrative and data structures. (B) Public availability Not later than 10 days after submitting a report under subparagraph (A), the Secretary of Defense shall make the report available to the public, including by publishing the report on the govinfo.gov website, or successor website. (e) Definitions In this section: (1) Congressional defense committees The term congressional defense committees has the meaning given that term in section 101(a)(16) of title 10, United States Code. (2) Contractual agreement The term contractual agreement includes a contract, grant, cooperative agreement, and any other similar transaction or relationship. (3) Neurocognitive assessment The term neurocognitive assessment means a standardized cognitive and behavioral evaluation using validated and normed testing performed in a formal environment that uses specifically designated tasks to measure cognitive function known to be linked to a particular brain structure or pathway, which may include a measurement of intellectual functioning, attention, new learning or memory, intelligence, processing speed, and executive functioning. (4) Traumatic brain injury The term traumatic brain injury means a traumatically induced structural injury or physiological disruption of brain function as a result of an external force that is indicated by new onset or worsening of at least one of the following clinical signs immediately following the event: (A) Alteration in mental status, including confusion, disorientation, or slowed thinking. (B) Loss of memory for events immediately before or after the injury. (C) Any period of loss of or decreased level of consciousness, observed or self-reported. 3. Improvements to brain health initiatives of Department of Defense (a) Brain health initiatives (1) In general Part II of subtitle A of title 10, United States Code, is amended by inserting after chapter 55 the following new chapter: 55A Brain health initiatives Sec. 1110n. Definition of traumatic brain injury. 1110n–1. Warfighter Brain Health Initiative. 1110n. Definition of traumatic brain injury In this chapter, the term traumatic brain injury means a traumatically induced structural injury or physiological disruption of brain function as a result of an external force that is indicated by new onset or worsening of at least one of the following clinical signs immediately following the event: (1) Alteration in mental status, including confusion, disorientation, or slowed thinking. (2) Loss of memory for events immediately before or after the injury. (3) Any period of loss of or decreased level of consciousness, observed or self-reported. 1110n–1. Warfighter Brain Health Initiative (a) In general The Secretary of Defense, in consultation with the Secretaries concerned, shall establish a comprehensive initiative for brain health to be known as the Warfighter Brain Health Initiative (in this section referred to as the Initiative ) for the purpose of unifying efforts and programs across the Department of Defense to improve the cognitive performance and brain health of members of the Armed Forces. (b) Objectives The objectives of the Initiative shall be the following: (1) To enhance, maintain, and restore the cognitive performance of members of the Armed Forces through education, training, prevention, protection, monitoring, detection, diagnosis, treatment, and rehabilitation, including through the following activities: (A) The establishment of a program to monitor cognitive brain health across the Department of Defense, with the goal of detecting any need for cognitive enhancement or restoration resulting from potential brain exposures of members of Armed Forces, to mitigate possible evolution of injury or disease progression. (B) The identification and dissemination of thresholds for blast exposure and blast overpressure safety and associated emerging scientific evidence that— (i) cover brain injury, lung injury, and impulse noise; (ii) measure impact over 24-hour, 72-hour to 96-hour, monthly, annual, and lifetime periods; (iii) ensure that the thresholds are low enough that they are not associated with cognitive deficits after firing; (iv) include thresholds that account for the firing of multiple types of heavy weaponry and use of grenades in one period of time; (v) include minimum safe distances and levels of exposure for observers and instructors; and (vi) include limits for shoulder-fired heavy weapons. (C) The modification of high-risk training and operational activities to mitigate the negative effects of repetitive blast exposure. (D) The identification of individuals who perform high-risk training or occupational activities for purposes of increased monitoring of the brain health of such individuals. (E) The development and operational fielding of non-invasive, portable, point-of-care medical devices, to inform the diagnosis and treatment of traumatic brain injury. (F) The establishment of a standardized monitoring program that documents and analyzes blast exposures that may affect the brain health of members of the Armed Forces. (G) The consideration of the findings and recommendations of the report of the National Academies of Science, Engineering, and Medicine published in 2022 and entitled Traumatic Brain Injury: A Roadmap for Accelerating Progress (relating to the acceleration of progress in traumatic brain injury research and care), or any successor report, in relation to the activities of the Department relating to brain health. (H) The establishment of policies to encourage members of the Armed Forces to seek support for brain health when needed, prevent retaliation against such members who seek care, and address other barriers to seeking help for brain health, including due to the impact of blast exposure, blast overpressure, traumatic brain injury, and other health matters. (I) The modification of existing weapons systems to reduce blast exposure of the individual using the weapon and those within the minimum safe distance. (2) To harmonize and prioritize the efforts of the Department of Defense into a single approach to brain health. (c) Thresholds for blast exposure and overpressure safety (1) Deadline (A) In general Not later than two years after the date of the enactment of the Blast Overpressure Safety Act , the Secretary of Defense shall identify and disseminate the thresholds for blast exposure and blast overpressure safety and associated emerging scientific evidence required under subsection (b)(1)(B). (B) Update Not less frequently than every five years, the Secretary of Defense shall update the thresholds for blast exposure and blast overpressure safety and associated emerging scientific evidence required under subsection (b)(1)(B). (2) Central repository Not later than two years after the date of the enactment of the Blast Overpressure Safety Act , the Secretary of Defense shall establish a central repository of blast-related characteristics, such as pressure profiles and common blast loads associated with specific systems and the environments in which they are used, that is available to members of the Armed Forces and the public and includes the information described in subsection (b)(1)(B). (3) Waivers (A) Protocols Not later than two years after the date of the enactment of the Blast Overpressure Safety Act , the Secretary of Defense shall establish and implement protocols to require waivers in cases in which members of the Armed Forces must exceed the safety thresholds described in subsection (b)(1)(B), which shall include a justification for exceeding those safety thresholds. (B) Tracking system (i) In general Not later than two years after the date of the enactment of the Blast Overpressure Safety Act , the Secretary of Defense shall establish a Department of Defense-wide tracking system for waivers described in subparagraph (A), which shall include data contributed by each of the Secretaries concerned. (ii) Report (I) In general Not less frequently than once each year by December 31 of that year following the establishment of the tracking system required under clause (i), the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report on waivers described in subparagraph (A) that includes— (aa) the number of waivers issued, disaggregated by Armed Forces; (bb) the justifications provided for each waiver; (cc) a description of actions taken by the Secretary concerned to track the health effects on members of the Armed Forces of exceeding safety thresholds described in subsection (b)(1)(B), document those effects in medical records, and provide care to those members; and (dd) a description of the medical care received by those members in response to exceeding these safety thresholds. (II) Public availability The Secretary of Defense shall make the information contained in each report submitted under subclause (I) available to the public, including on the govinfo.gov website, or successor website, not later than 10 days after the report is submitted under such subclause. (d) Formal training requirement (1) In general The Secretary of Defense shall ensure that training described in paragraph (2) is required for members of the Armed Forces before training, deployment, or entering other environments determined to be high-risk by the Secretary concerned. (2) Training described Training described in this paragraph is training on the following: (A) Thresholds for blast exposure and blast overpressure safety and associated emerging scientific evidence required under subsection (b)(1)(B). (B) Symptoms of exposure to blasts or blast overpressure. (C) Symptoms of traumatic brain injury. (e) Strategies for mitigation and prevention of blast exposure and overpressure risk for high-Risk individuals In carrying out the Initiative, not later than one year after the date of the enactment of the Blast Overpressure Safety Act , the Secretary of Defense shall establish strategies for mitigating and preventing blast exposure and blast overpressure risk for individuals most at risk for exposure to high-risk training or high-risk occupational activities, which shall include— (1) a timeline and process for implementing those strategies; (2) a determination of the frequency with which those strategies will be updated, at a rate of not less frequently than every five years; and (3) an assessment of how information regarding those strategies will be disseminated to such individuals, including after those strategies are updated. (f) Annual budget justification documents In the budget justification materials submitted to Congress in support of the budget of the Department of Defense for each fiscal year (as submitted with the budget of the President under section 1105(a) of title 31), the Secretary of Defense shall include a budget justification display that includes all activities of the Department relating to the Initiative. (g) Annual reports (1) In general Not later than March 31, 2025, and not less frequently than annually thereafter, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report that includes the following: (A) A description of the activities taken under the Initiative and resources expended under the Initiative during the prior fiscal year. (B) The number of members of the Armed Forces impacted by blast overpressure and blast exposure in the prior fiscal year, including— (i) the number of members who reported adverse health effects from blast overpressure or blast exposure; (ii) the number of members exposed to blast overpressure or blast exposure; (iii) the number of members who received treatment for injuries related to blast overpressure or blast exposure, including at facilities of the Department of Defense and at facilities in the private sector; (iv) regarding treatment for blast exposure, blast overpressure, or subconcussive or concussive brain injuries at the National Intrepid Center of Excellence, an Intrepid Spirit Center, or an appropriate military medical treatment facility— (I) the number of members on the waitlist for such treatment; (II) the average period of time those members are on that waitlist; and (III) the average number of days between when an appointment is requested and the actual appointment date; and (v) the type of care that members receive from facilities of the Department of Defense and the type of care that members receive from facilities in the private sector. (C) A summary of the progress made during the prior fiscal year with respect to the objectives of the Initiative under subsection (b). (D) A description of the steps the Secretary is taking to ensure that activities under the Initiative are being implemented across the Department of Defense and the military departments. (2) Public availability The Secretary of Defense shall make the information contained in each report submitted under paragraph (1) available to the public, including on the govinfo.gov website, or successor website, not later than 10 days after the report is submitted under such paragraph. . (b) Conforming and clerical amendments (1) Clerical amendment The table of chapters at the beginning of title 10, United States Code, and at the beginning of part II of subtitle A of such title, is amended by inserting after the item relating to chapter 55 the following new item: 55A. Brain health initiatives 1110n. . (2) Conforming repeal Section 735 of the James M. Inhofe National Defense Authorization Act for Fiscal Year 2023 ( Public Law 117–263 ; 10 U.S.C. 1071 note) is repealed. (c) Initial briefing and report on National Intrepid Center of Excellence (1) In general Not later than 150 days after the date of the enactment of this Act, the Secretary of Defense shall provide to the congressional defense committees a briefing and submit to the congressional defense committees a report on the parameters of the program of record established under section 1110n–3 of title 10, United States Code, as added by subsection (a). (2) Congressional defense committees defined In this subsection, the term congressional defense committees has the meaning given that term in section 101(a)(16) of title 10, United States Code. 4. Pilot program relating to monitoring of blast coverage (a) Authority The Secretary concerned may conduct, as part of the initiative established under section 1110n–1 of title 10, United States Code, as added by section 3, a pilot program under which the Secretary concerned shall monitor blast overpressure exposure through the use of commercially available, off-the-shelf, remote measurements, and document and evaluate data collected as a result of such monitoring. (b) Locations Monitoring activities under a pilot program conducted pursuant to subsection (a) shall be carried out in each training environment that the Secretary concerned determines poses a risk for blast overpressure exposure. (c) Documentation and sharing of data If the Secretary concerned conducts a pilot program pursuant to subsection (a), the Secretary concerned shall— (1) ensure that any data collected pursuant to such pilot program that is related to the health effects of the blast overpressure exposure of a member of the Armed Forces who participated in the pilot program is documented and maintained by the Secretary of Defense in an electronic health record for the member; and (2) to the extent practicable, and in accordance with applicable provisions of law relating to data privacy, make data collected pursuant to such pilot program available to other academic and medical researchers for the purpose of informing future research and treatment options. (d) Definition of Secretary concerned In this section, the term Secretary concerned has the meaning given such term in section 101 of title 10, United States Code. 5. Special operations brain health and trauma program (a) In general Chapter 55A of title 10, United States Code, as added by section 3, is amended by adding at the end the following new section: 1110n–2. Special operations brain health and trauma program (a) In general The Commander of the United States Special Operations Command (in this section referred to as the Commander ), in coordination with the Secretary of Defense, shall conduct an intensive, comprehensive brain health and trauma program (in this section referred to as the Program ) to provide coordinated, integrated, multi-disciplinary specialist evaluations, treatment initiation, and aftercare coordination in a highly condensed model for special operations forces. (b) Evidence-Based treatment In carrying out the Program, the Commander shall provide evidence-based physical, mental, and behavioral health care and counseling for traumatic brain injury, blast overpressure, blast exposure, and psychological or neurological conditions that are common among members of the special operations forces. (c) Population served In carrying out the Program, the Commander shall provide the health care and counseling specified in subsection (b) to members of the special operations forces and family members of such members. (d) Evaluation, testing, and treatment The Program shall include the following: (1) Evaluations by health care providers in the areas of brain injury medicine, neuropsychology, clinical psychology, psychiatry, neuroendocrinology, sports medicine, musculoskeletal medicine, vestibular physical therapy, neuroimaging, and hormonal evaluation. (2) Metabolic testing, cardiovascular testing, and cerebrovascular testing. (3) Treatment relating to headaches, sleep interventions and medication, injection-based therapies for musculoskeletal pain, cognitive rehab, vestibular physical therapy, and exercise programming. (e) Coordination In carrying out the Program, the Commander shall coordinate with private sector non-profit healthcare organizations that have the capacity and infrastructure to provide the care and services required under the Program. (f) Medical records In carrying out the Program, the Commander shall coordinate with the Director of the Defense Health Agency and the Secretaries of the military departments to ensure that the treatment received through the Program is documented in the medical records of members of the Armed Forces. . (b) Clerical The table of sections at the beginning of chapter 55A of such title, as amended by section 3, is amended by adding at the end the following new item: 1110n–2. Special operations brain health and trauma program. . (c) Report and briefing on implementation of special operations traumatic brain injury program (1) Report on program (A) In general Not later than December 31, 2025, the Commander of the United States Special Operations Command, in coordination with the Secretary of Defense, shall submit to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives a report on the special operations brain health and trauma program required under section 1110n–2 of title 10, United States Code, as added by subsection (a), which shall include— (i) the benefits of the program to members of the Armed Forces and their families; (ii) the number of members assisted by such program; (iii) the type of treatment received under such program; (iv) the rate of members of the Armed Forces returning to duty after receiving treatment under such program; (v) how the Commander is coordinating with the Director of the Defense Health Agency and the Secretaries of the military departments to update records of members of the Armed Forces with treatment received under such program; and (vi) whether and how the program should be expanded to include other vulnerable populations within the Armed Forces; (B) Public availability The Secretary of Defense shall make the information contained in the report submitted under subparagraph (A) available to the public, including on the govinfo.gov website, or successor website, not later than 10 days after the report is submitted under such subparagraph. (2) Comptroller General report and briefing Not later than 180 days after the date of the enactment of this Act, the Comptroller General of the United States shall brief the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives on the implementation of section 1110n–2 of title 10, United States Code, as added by subsection (a), with a report to follow at a mutually agreed upon date. 6. National Intrepid Center of Excellence (a) In general Chapter 55A of title 10, United States Code, as added by section 3 and amended by section 5, is further amended by adding at the end the following new section: 1110n–3. National Intrepid Center of Excellence (a) In general Not later than 120 days after the date of the enactment of the Blast Overpressure Safety Act , the Secretary of Defense shall establish the National Intrepid Center of Excellence (in this section referred to as the Center ) as a program of record subject to milestone reviews and compliance with the requirements under this section. (b) Duties The duties of the Center are as follows: (1) To provide interdisciplinary care to prevent, diagnose, treat, and rehabilitate members of the Armed Forces with traumatic brain injury, post-traumatic stress disorder, symptoms from blast overpressure or blast exposure, and other mental health conditions. (2) Support and conduct research and education on traumatic brain injury, post-traumatic stress disorder, blast overpressure or blast exposure, and other mental health conditions. (c) Childcare Childcare services shall be made available for individuals seeking help through the National Intrepid Center of Excellence. (d) Annual report (1) In general Not later than one year after the date of the enactment of the Blast Overpressure Safety Act , and annually thereafter, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and the House of Representatives a report that shall include, for the year covered by the report— (A) the number of individuals to whom the Center has provided services; (B) the number of individuals who return to active duty in the Armed Forces after receiving services from the Center, and the stage in their career at which they seek treatment at the Center; (C) the number of individuals whose families are able to participate in programs provided by the Center; and (D) the number of individuals on a waitlist for treatment at the Center and the average period those individuals are on the waitlist. (2) Public availability The Secretary of Defense shall make the information contained in each report submitted under paragraph (1) available to the public, including on the govinfo.gov website, or successor website, not later than 10 days after the report is submitted under such paragraph. . (b) Clerical The table of sections at the beginning of chapter 55A of such title, as amended by sections 3 and 5, is amended by adding at the end the following new item: 1110n–3. National Intrepid Center of Excellence. . 7. Mandatory training on health effects of certain brain trauma (a) In general Chapter 55A of title 10, United States Code, as added by section 3 and amended by sections 5 and 6, is further amended by adding at the end the following new section: 1110n–4. Mandatory training on health effects of certain brain trauma Not less frequently than once every two years, the Secretary of Defense shall provide to each medical provider and training manager of the Department of Defense mandatory training with respect to the potential health effects of blast overpressure, blast exposure, and traumatic brain injury. . (b) Clerical The table of sections at the beginning of chapter 55A of such title, as amended by sections 3, 5, and 6, is amended by adding at the end the following new item: 1110n–4. Mandatory training on health effects of certain brain trauma. . 8. Annual briefing on Individual Longitudinal Exposure Record (a) In general Chapter 55 of title 10, United States Code, is amended by adding at the end the following new section: 1110c. Annual briefing on Individual Longitudinal Exposure Record (a) In general Not less frequently than annually, the Secretary of Defense, in consultation with the Secretary of Veterans Affairs, shall provide the appropriate committees of Congress a briefing on— (1) the quality of the databases of the Department of Defense that provide the information presented in the Individual Longitudinal Exposure Record; and (2) the usefulness of the Individual Longitudinal Exposure Record in supporting members of the Armed Forces and veterans in receiving health care and benefits from the Department of Defense and the Department of Veterans Affairs. (b) Elements Each briefing required by subsection (a) shall include, for the period covered by the report, the following: (1) An identification of potential exposures to occupational or environmental hazards, including blast overpressure and blast exposure, captured by the current systems of the Department of Defense for environmental, occupational, and health monitoring, and recommendations for how to improve those systems. (2) An analysis of the quality and accuracy of the location data used by the Department of Defense in determining potential exposures to occupational or environmental hazards by members of the Armed Forces and veterans, including blast overpressure and blast exposure, and recommendations for how to improve the quality of such data if necessary. (c) Definitions In this section: (1) Appropriate committees of congress The term appropriate committees of Congress means— (A) the Committee on Armed Services and the Committee on Veterans' Affairs of the Senate; and (B) the Committee on Armed Services and the Committee on Veterans' Affairs of the House of Representatives. (2) Individual Longitudinal Exposure Record The term Individual Longitudinal Exposure Record has the meaning given such term in section 1171(b) of title 38. . (b) Clerical amendment The table of sections at the beginning of chapter 55 of title 10, United States Code, is amended by inserting after the item relating to section 1110b the following new item: 1110c. Annual briefing on Individual Longitudinal Exposure Record. . (c) Conforming repeal Section 802 of the Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act of 2022 ( Public Law 117–168 ; 10 U.S.C. 1071 note) is repealed. 9. Review of blast-related brain injury research and other efforts of the Department of Defense (a) Review (1) In general The Comptroller General of the United States shall conduct a review of the research and other efforts of the Department of Defense on traumatic brain injury, including injuries related to blast overpressure or blast exposure. (2) Matters To be included The review required by paragraph (1) shall include the following: (A) A description of the research conducted by the Department of Defense on traumatic brain injury, the entities involved in that research, and efforts to coordinate that research internally and externally. (B) A description of any improvements identified by that research related to the prevention, diagnosis, and treatment of blast-related brain injuries and an assessment of the implementation of those improvements. (C) An evaluation of the efforts of the Department to protect members of the Armed Forces from retaliation for seeking care for the prevention, diagnosis, or treatment of traumatic brain injury, blast overpressure, or blast exposure, including any gaps in or barriers to those efforts. (D) An evaluation of the list maintained by the Department of the military occupational specialties most at-risk for blast overpressure and blast exposure and whether additional at-risk occupational specialties should be included. (E) Any other finding the Comptroller General considers relevant. (b) Briefing and report Not later than 180 days after the date of the enactment of this Act, the Comptroller General shall brief the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives on the review required under subsection (a), with a report to follow on a mutually agreed upon date. (c) Definition of traumatic brain injury In this section, the term traumatic brain injury means a traumatically induced structural injury or physiological disruption of brain function as a result of an external force that is indicated by new onset or worsening of at least one of the following clinical signs immediately following the event: (1) Alteration in mental status, including confusion, disorientation, or slowed thinking. (2) Loss of memory for events immediately before or after the injury. (3) Any period of loss of or decreased level of consciousness, observed or self-reported. 10. Implementation of Inspector General recommendations to manage traumatic brain injury care (a) Implementation Not later than December 31, 2025, the Secretary of Defense shall implement the recommendations contained in the report of the Inspector General of the Department of Defense entitled, Evaluation of the DoD’s Management of Traumatic Brain Injury (DODIG–2023–059). (b) Briefing Not later than April 1, 2025, the Secretary of Defense shall provide to the Committee on Armed Services of the Senate and the Committee on Armed Services of the House of Representatives a briefing on the progress of the Secretary in carrying out the implementation required under subsection (a).