Sec. 731. Blast pressure safety and brain health
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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 amended, in subsection (b)(1)— in subparagraph (B)— by striking the period at the end and inserting that— ; and by adding at the end the following new clauses: cover brain injury, lung injury, and impulse noise; measure impact over 24-hour, 72-hour to 96-hour, monthly, annual, and lifetime periods; ensure that the thresholds are low enough that they are not associated with cognitive deficits after firing; include thresholds that account for the firing of multiple types of heavy weaponry and use of grenades in one period of time; include minimum safe distances and levels of exposure for observers and instructors; and include limits for shoulder-fired heavy weapons. ; by inserting, after subparagraph (G), the following new subparagraphs:
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. The evaluation of how modifications to existing weapons systems may reduce injuries to individuals within the minimum safe distance of such weapons systems that arise from blast overpressure in the use of such weapons systems. .
Such section is further amended by striking subsection
(g)and inserting the following: In this section: 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. 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: Alteration in mental status, including confusion, disorientation, or slowed thinking. Loss of memory for events immediately before or after the injury. Any period of loss of or decreased level of consciousness, observed or self-reported. The term Secretary concerned has the meaning given such term in section 101 of title 10, United States Code. . Such section is further amended, in subsection (c), by striking fiscal years 2025 through 2029 and inserting fiscal years 2025 through 2030 . Such section is further amended— by striking subsections
(e)and (f); by redesignating subsections (c), (d), and
(g)as subsections (g), (h), and (i), respectively; and by inserting, after subsection (b), the following new subsections: Not later than two years after the date of the enactment of the National Defense Authorization Act for Fiscal Year 2025, 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). Not less frequently than every five years, the Secretary of Defense shall review and, if the Secretary determines it appropriate, update, the thresholds for blast exposure and blast overpressure safety and associated emerging scientific evidence required under subsection (b)(1)(B). Not later than two years after the date of the enactment of the National Defense Authorization Act for Fiscal Year 2025, 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 includes the information described in subsection (b)(1)(B). Not later than two years after the date of the enactment of the National Defense Authorization Act for Fiscal Year 2025, 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. Not later than two years after the date of the enactment of the National Defense Authorization Act for Fiscal Year 2025, 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. Not later than December 31 of each of the five years beginning in the 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— the number of waivers issued, disaggregated by armed force; the justifications provided for each waiver; 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 a description of the medical care received by those members in response to exceeding these safety thresholds. 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. Training described in this paragraph is training on the following: Thresholds for blast exposure and blast overpressure safety and associated emerging scientific evidence required under subsection (b)(1)(B). Symptoms of exposure to blasts or blast overpressure. Symptoms of traumatic brain injury. In carrying out the Initiative, not later than one year after the date of the enactment of the National Defense Authorization Act for Fiscal Year 2025, 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— a timeline and process for implementing those strategies; a determination of the frequency with which those strategies will be updated, at a rate of not less frequently than every five years; and an assessment of how information regarding those strategies will be disseminated to such individuals, including after those strategies are updated. Not later than March 31, 2025, and not less frequently than annually thereafter through 2030, 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 description of the activities taken under the Initiative and resources expended under the Initiative during the prior fiscal year. The number of members of the armed forces impacted by blast overpressure and blast exposure in the prior fiscal year, including— the number of members who reported adverse health effects from blast overpressure or blast exposure; the number of members exposed to blast overpressure or blast exposure; 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; 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— the number of members on the waitlist for such treatment; the average period of time those members are on that waitlist; and the average number of days between when an appointment is requested and the actual appointment date; and 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. A summary of the progress made during the prior fiscal year with respect to the objectives of the Initiative under subsection (b). 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. . 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: 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— establishing a baseline neurocognitive assessment to be conducted during the accession process of members of the Armed Forces before the beginning of training; establishing neurocognitive assessments to monitor the cognitive function of such members to be conducted— at least every three years as part of the periodic health assessment of such members; and as part of the post-deployment health assessment of such members; ensuring all neurocognitive assessments of such members, including those required under clauses
(i)and (ii), are maintained in the electronic medical record of such member; establishing a process for annual review of blast overpressure exposure and traumatic brain injury logs 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 establishing standards for recurrent and prolonged exposure. 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: Establishing and maintaining blast overpressure exposure logs and traumatic brain injury logs for every member of the Armed Forces. Including in those logs at least the following: 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. Any residual physical, mental, or emotional effects resulting from such exposure. 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. The treatment that the member sought and received in connection with such exposure. The number of concussive and subconcussive brain injuries, including traumatic brain injuries, sustained. The severity of concussive and subconcussive brain injuries, including traumatic brain injuries, sustained. Other head trauma, regardless of whether it requires the treatment of a medical provider. The Inspector General of the Department of Defense shall be responsible for— 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 subparagraph (B), 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; beginning on the date that is three years after the date of the enactment of this Act— evaluating the continued fulfillment by the Department of the requirements under subparagraph (B), 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; and not later than December 31 of each year 2025 through 2030, submitting to Congress a report (in unclassified form, but with a classified annex as necessary) containing the results of such evaluation. The Under Secretary of Defense for Acquisition and Sustainment shall be responsible for, not later than one year after the date of enactment of this Act, the following: Ensuring that the minimization of exposure to blast overpressure is considered as a performance parameter when drafting requirements for the Department of Defense for new hand-held, shoulder-launched, or crew-served, weapons systems that produce blast overpressure. In a case in which minimization of exposure to blast overpressure is not included as a performance parameter under clause (i), the Under Secretary shall document the rationale for its exclusion and retain such documentation and supporting materials for purposes of clause (v). Establishing a requirement that any entity under contractual agreement with the Department as part of the defense weapons acquisition process for a weapons system described in clause
(i)shall provide to the Department blast overpressure measurements and safety data for any weapons system that produce blast overpressure and exceed the department set maximum exposure limit procured from such entity. Establishing a requirement that any future test plan for a weapons system described in clause
(v)incorporates validation and verification testing of blast overpressure measurement and safety data provided by defense contractors in accordance with clause (iii). Retaining and make available to personnel with appropriate access all— blast overpressure measurements and safety data for weapons systems of the Department, including how those systems have been tested and in what environments; and 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. The officials specified in paragraph
(1)shall coordinate and align their plans and activities to implement such subsection among themselves and with the Secretaries of the military departments. Not later than 180 days after the date of the enactment of this Act, and annually thereafter through 2030, the Secretary of Defense shall provide to the Committees on Armed Services of the Senate and House of Representatives a briefing on the plans, associated timelines, and activities conducted to implement paragraph (1). Not later than 180 days after the date of the enactment of this Act, and annually thereafter through 2030, the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and House of Representatives a report on— concussive and subconcussive brain injuries caused during military operations, including combat operations, among members of the Armed Forces, including information on— the Armed Force of the member; the name of the operation; the location within the area of responsibility; the number of concussive and subconcussive brain injuries caused; the severity of concussive and subconcussive brain injuries caused; the treatment received for a concussive or subconcussive brain injury; whether a member of the Armed Forces was medically retired from service due to a concussive or subconcussive brain injury; whether a member of the Armed Forces died by suicide after sustaining a concussive or subconcussive brain injury; and the source of the injury, including the activity conducted when the injury occurred; and concussive and subconcussive brain injuries caused during training events among members of the Armed Forces, including information on— the Armed Force of the member; the type of training; the location of the training; the number of concussive and subconcussive brain injuries caused; the severity of concussive and subconcussive brain injuries caused; the treatment received for a concussive or subconcussive brain injury; whether a member of the Armed Forces was medically retired from service due to a concussive or subconcussive brain injury; whether a member of the Armed Forces died by suicide after sustaining a concussive or subconcussive brain injury; and the source of the injury, including the activity conducted when the injury occurred. Each report submitted under clause
(i)shall be submitted in unclassified form, but may include a classified annex. Not later than 180 days after the date of the enactment of this Act, and annually thereafter through 2030, the officials specified in paragraph and the Secretary of Defense shall submit to the Committees on Armed Services of the Senate and House of Representatives 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— whether the injury or injuries occurred during combat operations or training and the associated combat operations or training incident; the severity of the injury or injuries; if any such injury was combat related, the name of the operation; the treatment sought and received for the injury or injuries; the number of discharge upgrade requests in connection with such an injury or injuries that have been made; and the number of such discharge upgrade requests that have been approved. Each report submitted under subparagraph
(A)shall be submitted in unclassified form, but may include a classified annex. 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 Committees on Armed Services of the Senate and House of Representatives 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— the number of such providers, disaggregated by location; the billets of such personnel; the number of medical personnel currently participating in training or a fellowship relating to traumatic brain injury or concussive and subconcussive brain injuries; and 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. 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. 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 titled, Evaluation of the DoD’s Management of Traumatic Brain Injury (DODIG-2023-059). 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 paragraph (1). 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. The review required by paragraph
(1)shall include the following: 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. 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. 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. 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. Any other finding the Comptroller General considers relevant. Not later than 180 days after the date of the enactment of this Act, the Comptroller General shall brief the Committees on Armed Services of the Senate and the House of Representatives, and the Committee on Transportation and Infrastructure of the House of Representatives, on the review required by paragraph (1), with a report to follow on a mutually agreed upon date. In this section, the terms neurocognitive assessment and traumatic brain injury have the meanings given such terms in 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), as amended by this section.
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