Traumatic Brain Injury Prevention Efforts Included in Must-Pass Defense Bill

An U.S. Navy MRI technologist conducts an MRI scan of a patient's brain
An U.S. Navy MRI technologist conducts an MRI scan of a patient's brain on Aug. 3, 2020. (U.S. Navy photo by Mass Communication Specialist Seaman Luke Cunningham)

Efforts to improve care and research for service members suffering from brain injuries are included in both the Senate and House versions of the annual must-pass defense policy bill, raising the chances more support for those troops could be on the way.

The Pentagon would be required to set safety thresholds for blast exposure and a standard for waiving the thresholds; create training for service members on symptoms of blast exposure and brain injuries; and evaluate how modifying existing weapons could reduce injuries, under the version of the National Defense Authorization Act, or NDAA, approved by the House last week.

The text of the Senate NDAA has not yet been released, but a summary of the bill advanced last week by the Senate Armed Services Committee said it includes several provisions aimed at improving the Pentagon's approach to treating, caring for and researching injuries related to blast exposure.

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The Senate bill "requires DoD to update blast overpressure safety thresholds, to establish a standardized treatment program and policies to encourage service members to seek help, to modify existing weapons to reduce exposure, and to establish strategies to protect those most at risk," Sen. Elizabeth Warren, D-Mass., who chairs the committee's personnel subpanel, said at a meeting of her subcommittee last week.

The measures in the NDAA come after Warren; fellow committee member Sen. Joni Ernst, R-Iowa; and House Armed Services Committee member Rep. Ro Khanna, D-Calif., previously introduced a stand-alone bill amid growing concerns about the risks of blast overpressure, which is any pressure caused by a shockwave that is over the normal pressure in the atmosphere.

    A growing body of evidence is showing that troops are at risk of exposure to potentially dangerous blasts not just from enemy attacks but also from routine military activities such as repeatedly firing artillery, and that brain injuries from those exposures are causing devastating symptoms for service members and veterans. has reported extensively on evidence that traumatic brain injury, or TBI, is linked to an increased risk of suicide among veterans and that Pentagon officials squandered opportunities to get ahead of the issue.

    Last year, The New York Times also reported on hallucinations, seizures, suicide risks and other symptoms among troops who fired artillery during the war against the Islamic State terror group.

    At a hearing earlier this year, Pentagon officials vowed to collect more data on troops' exposure to blasts. But they also said more research would be needed before taking some of the steps that lawmakers were advocating for, such as more frequent cognitive testing and defining safety limits for using certain weapons.

    That stance angered lawmakers who wanted immediate action and prompted Warren, Ernst and Khanna to introduce the Blast Overpressure Safety Act in April.

    "The department needs to take more urgent action to mitigate blast overpressure and support service members," Warren, Ernst, Khanna and other lawmakers wrote in a letter to a government watchdog last month. "Otherwise, troops will continue to struggle to get the care they need and deserve."

    While the House NDAA includes elements of the blast exposure legislation, Khanna proposed adding more when the House debated the defense bill last week. Specifically, he filed amendments to create a comprehensive brain health program specifically for Special Operations Command and to establish a National Intrepid Center of Excellence to prevent and treat TBI.

    Khanna's proposed amendments did not get votes in the House, but the chamber did approve a pair of amendments from Rep. Bill Pascrell, D-N.J., to study commercially available diagnostic tools for TBI and the feasibility of allowing troops to use transitional and residential brain injury treatment facilities.

    The Senate's bill, meanwhile, would establish a "Defense Intrepid Network for Traumatic Brain Injury and Brain Health" as a program of record, according to the Senate Armed Services Committee's summary. It would also authorize a four-year special operations "demonstration program" on brain health and brain trauma, said Warren, who voted against the full NDAA during the committee's closed-door debate last week.

    The full Senate still needs to approve its NDAA, and then the House and Senate will have to iron out the differences between their respective bills, but inclusion in both bills increases the likelihood that the final product will include improvements for TBI care. Negotiations on the compromise NDAA are expected to stretch through the summer and fall.

    Related: Watchdog Investigation of Pentagon Traumatic Brain Injury Efforts Requested by 22 Lawmakers

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