Congress passed a sweeping new set of mandates on brain safety in the military Wednesday, requiring the Pentagon to set new safety limits for troops’ blast exposure, track and report exposures throughout their careers, modify existing weapons to reduce the danger and, for the first time, take brain safety into account when designing new weapons.
The new requirements are part of the $895 billion military spending bill, known as the National Defense Authorization Act, which the Senate approved on Wednesday. It cleared the House last week.
The provisions on brain safety reflect a broad shift in how Congress and the military view the hazard of blast exposure, also called overpressure. Evidence mounted this year that service members are at risk of developing brain injuries from repeatedly firing their own weapons and from high-performance equipment like speedboats and fighter jets, but the military often has missed the problem.
“It’s been a hard fight to get to this point,” Senator Elizabeth Warren, the Massachusetts Democrat who introduced the measures, said in an interview. “Finally, there was widespread acknowledgment of a problem with blast overpressure and what it’s doing to the brains of our service members.”
The annual spending bill contains hundreds of provisions governing military pay, the purchase of new equipment and other expenditures, and it is often used to direct military leaders to address Congressional priorities. At times it has also become a battleground for social issues.
The provisions on blast exposures and brain health require the military to focus on an issue that it has largely ignored for decades.
In the past, weapons blasts that were not strong enough to leave someone immediately concussed generally were considered safe. The military gave little thought to how repeated exposure to such blasts from firing heavy weapons like howitzers, mortars and rocket launchers might gradually damage brain tissue.
Lawmakers said that emerging research, combined with sustained reporting about the issue in The New York Times, and a mass shooting in Maine, committed by an Army Reserve soldier whose brain was found to have signs of blast-related injury, prompted both the Pentagon and the Congress to reconsider the hazards.
“This is one of those things that went on for years and years, and I don’t think people connected the dots,” Senator Angus King of Maine said in an interview. “Now the dots are right in front of our eyes.”
One eye-opener, he said, was Sgt. First Class Robert Card II, who killed 18 people and then himself in Lewiston, Maine, in October 2023. He had been exposed to thousands of blasts during his service as a weapons and grenade instructor, and had shown signs of psychosis for months before turning violent. After his death, his brain was tested at Boston University and found to have extensive damage of a distinctive type that researchers said was consistent with blast exposure.
“It was clear we needed more than thoughts and prayers,” Mr. King said. “We need to make a very deliberate effort to understand what happened and prevent it from happening again.”
Mr. King, an independent who caucuses with the Democrats, and Senator Jerry Moran, Republican of Kansas, introduced a separate bill to require the Department of Veterans Affairs to study and report on the connection between repeated blast exposure and mental illness, and to improve diagnosis and care.
The symptoms of brain injury from repeated blast exposure, which can include insomnia, anxiety and depression, among other issues, have often been misdiagnosed in the military as post-traumatic stress disorder or as noncombat-related mental health problems. The underlying physical injuries were routinely missed.
To reach a diagnosis of service-connected traumatic brain injury, military doctors have required that the patient experienced an identifiable injury event, like the explosion of a roadside bomb. With troops who were routinely exposed to blast waves, there often was no such event to point to, so brain injuries went undocumented.
The bill would require the military to standardize and improve the detection, treatment and reporting of those injuries.
The military has already taken a number of actions this year to begin to address the problem. In August, the Defense Department released comprehensive new requirements to reduce and track exposure, including baseline brain function screening for all new troops. Since that time, 36,000 troops have been assessed.
The Army has set new training rules for mortars and other heavy weapons, limiting how many rounds troops can fire each day. And it has begun to spread weapons training out over several weeks, instead of clustering it in a few blast-intensive days, in an attempt to give troops’ brains time to recover between exposures.
The Marine Corps fielded a few virtual training simulators that allow Marines to practice some skills without being exposed to blasts.
At the same time, the military is making changes to some existing weapons. In October, the Army showcased a new breaching explosive that aims more of the weapon’s door-busting blast away from the soldiers using them.
“For a long time, there has been not much progress, and we’re finally getting somewhere — but I think we still have aways to go,” said Frank Larkin, a former Navy SEAL who has pushed for years to raise awareness of blast exposure and who helped draft the new provisions in the bill.
Mr. Larkin took up the issue after the death of his son Ryan Larkin, who struggled with symptoms of an undiagnosed brain injury after years of service in the Navy SEALs, including as an instructor for shoulder-fired recoilless rifles. Ryan Larkin died by suicide in 2017, and an autopsy revealed extensive damage in his brain.
“Ryan kept saying something was wrong, but no one would listen,” Mr. Larkin said. “My hope is that no one has to go through that again.”
The new Pentagon requirements are a step in the right direction, he said, but the military still faces serious obstacles in understanding and addressing the problem.
It remains unclear what the threshold is for blasts to damage brain tissue. Nor do researchers know yet whether the particular shape of the blast wave, exposure to several waves over a short period of time, or the genetics of the person exposed may make brain injury more likely.
No one has yet devised a reliable, objective way to detect cumulative blast-related injury in living brains; it can now be confirmed only postmortem. So while Congress is ordering the Pentagon to track the injuries, the military has no foolproof way to identify which troops are injured.
Established treatment procedures are limited largely to mitigating symptoms. There is as yet no approved therapy to directly heal damaged brain tissue.
“This brain health stuff is truly a national security issue,” Mr. Larkin said. “Our ability to think on our feet is what gives us an edge. We need to take this seriously, because it’s already impacting recruitment and retention. People need to see we will take care of our force and their families.”
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