[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 4109 Introduced in Senate (IS)]

<DOC>






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.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Blast Overpressure Safety Act''.

SEC. 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.

SEC. 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:

                ``CHAPTER 55A--BRAIN HEALTH INITIATIVES

``Sec.
``1110n. Definition of traumatic brain injury.
``1110n-1. Warfighter Brain Health Initiative.
``Sec. 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.
``Sec. 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.

SEC. 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.

SEC. 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:
``Sec. 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.

SEC. 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:
``Sec. 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.''.

SEC. 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:
``Sec. 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.''.

SEC. 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:
``Sec. 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.

SEC. 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.

SEC. 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).
                                 <all>