Warren, Ernst, Tillis Press Pentagon to Protect Service Members from Blast Overpressure

Letter

Dear Secretary Austin:
We write to learn more about the Department of Defense's current efforts to protect service
members' brain health, particularly in ensuring that military operations do not result in blast
overpressure that can lead to depression, crippling headaches, hallucinations, and suicide.
Traumatic Brain Injury (TBI) was the "signature wound" of our wars in Iraq and Afghanistan.
While many of these injuries were a result of improvised explosive devices (IEDS),even
repeated common or routine training unrelated to combat "may also have impacts on [central
nervous system] structure, function, and development, as well as on the broader health of
military service members." DoD studies found "some servicemembers experience cognitive
deficits in delayed verbal memory, visual-spatial memory, and executive function after firing
heavy weapons, even within allowable limits" and "that those who were in career fields with
more blast exposure had an increased risk of developing anxiety disorders, depression,
migraines, substance abuse problems, dementia and a number of psychiatric disorders including
schizophrenia."Another recent DoD study estimated "up to 22% of troops from recent conflicts
suffered from mild traumatic brain injury, or mTBI, and the most prevalent cause was long-term
exposure to explosive weapons."

Brain injury risks were also elevated for troops in Syria combating the Islamic State of Iraq and
Syria (ISIS) during 2016 and 2017.A recent New York Times (Times) investigation found that
efforts to limit the number of active duty troops in Syria meant that those who did serve in the
region fired "far more rounds per crew member… than any American artillery battery had fired
at least since the Vietnam War."All four of the artillery batteries the Times investigated had at
least one suicide, with some batteries having several.An Army-funded study also found that
exposure to blasts also puts service members at a higher risk for developing Alzheimer's disease,
even if they did not have a TBI. The findings "explain those many blast-exposed individuals
returning from war zones with no detectable brain injury, but who still suffer from persistent
neurological symptoms, including depression, headaches, irritability and memory problems." In
addition to risks to brain health, the Times investigation found TBI damage "can cause
communication with other organs to malfunction." Dozens of young veterans complained of
"elevated, irregular heartbeats and persistent, painful problems with their digestion."

A Marine Corps review of one unit confirmed that after firing "an unusually high number of
artillery rounds" in 2017 that Marines "suffered a higher rate of Traumatic Brain Injuries (TBI)
than the rest of the artillery community" and that "this operational tempo could result in the
artillery community suffering injuries faster than combat replacements can be trained to replace
them." The review also found knowledge of ways to mitigate blast overpressure and
recognition of symptoms of blast overpressure, was "extremely limited" and that the long-term
impacts "are seemingly ignored."

A Defense Health Agency study found that "in the days after firing rockets, they [troops] had worse memories and reaction times, worse coordination, lower cognitive and executive function, and elevated levels of proteins in their blood that are markers of brain injury." These findings
are particularly troubling since it could impact combat operations. Additionally, researchers measuring blast pressure from roadside bombs in Afghanistan have also found that "75 percent
of the troops' [blast] exposure was coming from their own weapons."

Senator Warren secured a provision in the fiscal year 2018 National Defense Authorization Act
(NDAA) to require a longitudinal study on the impact of blast overpressure, including a review
of safety precautions to protect service members. In 2018, Senator Warren and Senator Ernst
introduced the Blast Exposure and Brain Injury Prevention Act of 2018 to improve research on
traumatic brain injury, speed the development of therapies to treat TBI, and enable the DoD to
better track and prevent blast pressure exposure.At the time Senators Warren and Ernst
introduced that bill, DoD estimated more than 370,000 service members had received a first time
diagnosis of TBI since 2000; the incidence of TBI is now approaching nearly half a million.
Ongoing challenges with diagnosing these injuries indicates that the real numbers may even be
higher.

Senator Warren also secured a provision in the fiscal year 2020 NDAA requiring documentation
of exposure in service members' records. We understand the Department is close to
implementing this requirement more than three years later, but the Times investigation
revealing that "[t]roops say they see little being done to limit or track blast exposure" further
underscores the urgency of this matter.

To assess the effectiveness of current policy and identify opportunities to support the DoD in its
efforts to address causes and effects of TBI, please answer the following questions no later than
February 27, 2024:
1. In 2019, the Marine Corps published the Blast Overpressure Effects Report, and in 2022,
the Department of Defense established the Warfighter Brian Health Initiative. In
response to these studies, have any of the services implemented changes to its training or
operational practice? If so, what changes were made?
2. Have the other service branches conducted similar research on the effects of blast
overpressure? If so, what has this research revealed?
a. Which units in each service branch has this research or other information
identified as being at high-risk of blast overpressure?
3. The Marine Corps and Army stated that they "now have programs to track and limit
crews' exposure" to blasts. Please provide information on these programs.
a. What information does the Marine Corps and Army provide to service members
regarding these programs?
b. What criteria are used to limit exposure to weapons with high concussive forces,
like crew-served weapons and conduct ranges that expose service members to
concussive forces for blast exposure?
c. Have any other services developed similar programs to track and limit exposure?
Please provide information on these programs and the information that is
provided to service members regarding these programs.
4. When are baseline neuropsychological assessments performed using Automated
Neuropsychological Assessment Metrics and other assessment method?
a. Are there any communities or military operationally specialties that establish
baseline before pre-deployment health assessment? If so, what communities and
when?
5. What steps has SOCOM taken to reduce blast exposure?
a. How often does SOCOM use the Carl Gustaf rocket launcher, other crew-served
weapons, and conduct ranges that expose service members to concussive forces,
and how does it determine when there is sufficient reason to use it?
b. What is SOCOM doing to ensure that these safety steps to reduce blast exposure
are being followed?
6. Special Operations Command claimed in 2019 that it would provide gauges measuring
blast exposure "to all of its operators, but four years later, only those taking part in
research studies have them." When will the command be able to provide gauges to all
operators, and what are the challenges the command faces by not being able to provide
the gauges to all operators at this time? What is the cost of providing gauges to all
operators?
7. What steps are each of the service branches taking to ensure service members have
gauges to measure blast exposure?
a. Which service members receive these gauges?
b. How does each service use these gauges to determine whether its service
members are being exposed to unsafe levels of blast exposure?
8. What information do each of the service branches provide commanders and service
members regarding the risk of blast overpressure and TBIs? Please provide a copy of the
information and guidelines.
9. Given that "[m]ost of the affected gun crew members are not out of the military," what
steps are the service branches taking to:
a. inform commanders and service members about the impact of blast overpressure,
especially during training, provide the supplied information and guidelines;
b. test and monitor for symptoms of injuries from blast overpressure both after
deployment and as a result of training; and
c. provide adequate mental health care and other health care support to the service
members?
10. When does the Department expect to complete implementation of the provision under the
FY 2020 NDAA requiring documentation of exposure in service members records?
11. How does DoD and the Department of Veterans Affairs coordinate on addressing blast
overpressure, including screening for symptoms?
12. What programs and services on blast overpressure and TBIs does the Department offer to
assist service members as they transition from active service?
a. How does it coordinate with the Department of Veterans Affairs in providing
these services?
We also request that you provide our offices with a briefing on the Warfighter Brain Health
Initiative and the Department's latest efforts to address TBI no later than February 1, 2024.

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