The website cspan. Org. We leave it to take you bye to capitol hill for a hearing on traumatic brain injuries in the u. S. Military. Youre watching live coverage of the Senate Armed ServicesCompany Hearing on ■ . Okay. I just got started here. Service members put their lives and their health on the line when th put on their uniforms. In return we have a profound responsibility to make sure that the nation is doing all that it can to keep them safe, to prevent battlefield and training casualties and to q provide the best possible care. We are holding this hearing. Are we there . Good. We are holding this hearing because meeting the responsibilities when it comes to traumatic brain injuries and other injuries that result from pressure that is caused by a shock wave that exceeds norm atmospheric values have been the signature with wounds of the war with iraq and afghanistan. But, there are also injuries incurred in training here at home. They are invisible but service causing headaches, seizures, hallucinations and ultimately significantly increased risk of depression and suicide. Over the course of just three months in 2023, dod ided tbi treatment to Service Members nearly 50,000 times. The more we learn, the more we come to understand that blast exposure is an ongoing threat to individual Service Members, the moral readiness of our entire force. I appreciate the support that i have had on this issue from Ranking Member scott, from senator t and other members of this committee. I secured a longterm study of blast Defense Authorization act and i worked blast overpressure and secure additional requirements to track blast overpressure the f nda. Dod is working to implement this legislation but we have still have significant problems. Last year, york times reported on heightened brain injury risk for u. S. Troops fighting isis. Four artillery batteries assigned to the region assigned more weapon than any military, american artillery since the vietnam war. The result was that each of these units had members with serious blast overpressure injuries. And each had at least one member that committed suidthese ryan, a navy seal deployed to iraq and afghanistan, subjected to blasts from his own weapon over the course his career. And later died by suicide. His father, mr. Frank warkan is today to discuss the harm that blast overpressure caused to the soldiers and their families. Even when dod made policy changes, the changes were not evident on the deliver shock waves, well above safety thresholds were still widely used. Training did not and special Operation Forces were not issued blast exposure gages, the gages that are needed to track the threat they faced. So, dod, and congress, both have a lot to do. Here is my agenda to address th problem. First, we need to establish mitigation strategies specific to the Service Member roles that are at risk for blast overpressure. Second, we must require dod to create blast exposure and traumatic br all Service Members and integrate these logs into their va and dod health care records. Third, the department of defense should partner with innovative evidencebased programs like home base, to ■ care they need. And i am going to have to brag here for just a minute. Homebase is a Nonprofit Organization founded by Massachusetts General Hospital and the Boston Red Sox to take care of the invisible wounds of veterans, Service Members, military families and families of the fallen. Homebase has clinics in massachusetts and in florida, Ranking Member scott states. Homebase has a brain health and Trauma Program specifically designed for special operations, veterans and Service Members where it has been leading innovative treatments for veterans with co occurring Substance Abuse and Mental Health conditions. As we work through this years ndaa i want to support this programs work. And i appreciate the doctors from homebase joining us today. One more item. We need to make sure that thres number of rounds that Service Members can safely ■n this includes consideration of exposure over an extended period of time. Dod must do its part and Congress Must do our part. So, to our witnesses, welcome, and thank you for appearing. We are going to have two panels consist af outside witnesses to provide their perspective on where dod and the services are falling short, on protecting Service Members from blast overnqpressu professor of policy analysis at the party rand graduate school. Chief of traumatic brain injury and health and uvness programs at homebase, and frank larkin, chief operating officer, troops first foundati the National Warrior call day initiative. The second panel will consist of officials from department of defense and walter reed is tackling this issue. We will have defense of health affairs. Kathy lee, director of war fighter brain policy at dod, and captain carlos williams, director of the National Intrepid Center at walt walter reed. I want to thank senator warren, chairwoman of th committee and subcommittee. And thank her for caring about this issue and fochairwoman, wa for holding this hearing. It is one of the most common injuries sustained by Service Members. In , 20,000 military personnel were diagnosed. 20,000 members of our litary diagnosed with a traumatic brain injury. Over 84 classified as mild that is known as a concussion. If any of us, when you raise kids and they have a concussion, it scares the living daylights out of you. Missing from day, Service Members exposed to lowlevel blasts that do not diagnose as a concussion, repeat exposure to lowlevel blasts can cause Similar Services of severe cases of tbi. We know lowlevel from firing explosives can cause concentration, memoryeased hand eye coordination, each issue can be serious and disrupt a persons life. There remains a great deal of exposure to the blasts that we do not know. Health care providers can treat those exposed to blasts where necessary. We have actually taken action to do that in the 2018 National Defense authorizatioacthe department of defense to conduct a medical study on blast overpressure exposure. The on the study, this hearing presents an opportunity to look at the work. Legislation required the study that follows individuals over ua an extended period of time to include three specific elements. First, the department was to monitor and record and blast pressure exposure. The second in the sty was to assess it including blast exposure, history and to a Service Members medical record. The last was to review÷r the safety precautions of heavy weapon training in research to blast exposure. In reviewing the final report submitted this past december it is clear they have more work to do. Monitoring and record blast exposures for military personnel. A few 100 soldiers an marines were fitted with devices. While thpamay be feasible to record blast information in a Service Members medical record. Now i would like to learn more how the Department Plans to conduct the Business Case analysis. Important issue that believe the department is committed to getting it right and tbi center of excellence e excellent initiatives that i hope will provide the military with the information better to understand the effectw of repetitive blast exposure. The exposure to lowlevel blasts will be a risk for many of our combat troops, but, if we can do better, if better quantify the type and number of blasts that have the potential to cause significant perhaps permanent injuries, then, we camake better decisions how best to accomplish a particular mission. I would like to hear from the witness what congress do to ensure the department of defense has the resources it needs to conduct the plan and where we can had help. It is about the well being of the input on the uniform that are closest to the frontline of combat and every Service Member diagnosed with tbi. We owe it to them to ensure and their families to ensure when they go in harms way they are well trained, have the right protective equipment and utilizing the manner chief objective with an understanding of the risk involved. I want to thank you for all of the witnesses for being here today and look forward to your testimony and again i want to thank senator warren for putting this together. Thank you. Chairwoman, warren, Ranking Member, scott, members of the committee. Good afternoon. And thank you for the opportunity to testify today. My name is dr. Samantha mcber flrks ie. Am mcbernie. My research at rand and the university of california berkeley and the x,ty of Southern California has focused on traumatic brain injury. Impact and blast overpressure. Today, i would like to speak to you about repeated exposure to lowlevel military blasts that are lowlevel t exposures experienced while fulfilling military occupational duties. Evidence suggests they are exposed to the blasts in blast overpressure or the pressure wave from the source of the explosion. It can cause subconcussive injuries that are not detectable and would as a tbi. Exposure to blast overpressure can occur in combat and training as has already been mentioned. Ring training t can b breaching exercises and the firing of increasingly powerful Weapon Systems, such as the coilless rifle and the at4. To provide perspective on the level of exposure some Service Members have, one study found up to blasts experienced by breaching instructors exceeded the recommended exposure limit. Studies shown that the effect of repeated lowlevel blast exposure can cause symptoms similar to tbi. While a variety of effects have been linked to lowlevel blast exposure as senator warren and scott have mentioned, there remains a lack of evidence this is the ated exposure to difficult of diagnose. The very nature of lowlevel blast exposure and the fact that it is one single event that causes an issue but rather a cumulative effect of repeated effects over time. Symptodo not manifest immediately that makes it unlikely that repeated exposureas the cause. Injuries vastly under reported among Service Members, exceeding the issue of proper diagnose further. There is also a lack of research about the military occupational specialty at greatest risk to lowlevel blasts. There is no doubt certain occupational specialties are more exposed there is little data to support it. Little understanding of direct impact of lowlevel blast has on the health of Service Members in different occupational specialties f it is perfectly effective but can not be delivered in time it is not useful. This quote from a 2019rand report perfectly describes the current state and the reason many of us are here today. As a Research Community we clearly see the Additional Research needs to be done. However, there are steps that the dod can take now to better protect Service Members against blastinduced injury. I highlight four in my written testimony and i would like to bring your attention to e of them. The maintenance of blast records t should include number of exposures, the context of each exposurand any physical or mental or emotional effects. This would allow the dod to better track the frequency and high ialties, and determine the connection between exposure and Health Outcomes and develop strategies to mitigate exposure and training environments ultimately these records can be used to develop an index score to gauge the he our weapon sys to be advanced and increasingly powerful, lowlevel military occupational blasts will remain an enduring challenge for Service Members. Addressing the repeated exposure to the blast has action and collaboration between the dod and the Research Community. By implementing the recommendations as outlined, alongside continued Research Efforts to close knowledge gap, the dod can take significant strides towards better protecting the health and well being of our Service Members. Thank you and i look forward to your questions. Px i am here to talk about traumatic brain injury care and exposure. My career has been lives of peo traumatic brain injury. The department of Harvard Medical SchoolGeneral Hospital and brigham and Womens Hospital and to the staff, years i served as the Homebase Program directing the brain injury program. I actually see the patients as blast overpressure as we just heard is a sudden onset of a pressure wave from explosions for training and deployment and breaching buildings and from impro vised explosives. Tbi can have a wide range of effects, sometimes appear immediately they may take weeks to occur. 40 of brain injuries later screened positive for Psychological Health conditions. Our research ■;noted elevated 1 year rift of hypertension, cardiac disease, hor thormonal dysfunction even among the youngest patients. We are located in massachusetts which i am proud to say is a native floridian, satellite locations in florida and arizona and operate one of the oldest and most impactful private sector in the nation. For 15 years we served as an incubator for it. Allowing us to leverage the facult homebase bridges the gap between research and clinical care. Now, in 2018, we were approached by the Naval Warfare with a complex set of problems facing navy seals. We quickly developed a brain injury and polyTrauma Program. It is named combat or the comprehensive brain and Health Treatment program. Modeled after programs we elite and it has specialist treatments, evaluation and care active duty operators. Home base has treated nearly 1,000 special operators through our intensive programs. 71. 9 of combat participants are active duty and the overwhelming returned to active duty. We currently have 178 active duty special operators be screer combat. Puerto rico including 53 patient from massachusetts, 60 from florida, from connecticut, 22 from hawaii, 278 from virginia, 4 from illinois, one from alaska d car the combat program is highly efficient and compressed into fiveday model of care. Patients of 9 providers. This may expand grossly related to diagnosic and images and other studies. In summary we are grateful for the support of congress, especially chairwoman warren has shared this prm. Rtnership a provided. The program is successful and the demand for care is growing at a steady pace. Based on my experi■oence field and treating patients at homebase, i would recommend the department of defense consider the following options. Invest in a developed tool to measure the funding 3 [low microphone ]. Thank you for the opportunity foallowing me to testify. I am happy to answer questions [low audio ]. As a former navy seal we are starting the day. Subtuggeds by traumatic brain in the decision for injury for the past 20 years fighting the war on terror following the combat for iraq and afghanistan, that manifest in difficulty sleeping, nightmares, anxiety, hypervisual. He stopped smiling. He sought help but not what he needed. When the condition became complicated and the proposed solutions did not work, it pushed him out. It created more deep wounds. Year after he was honorably discharged from the navy he ended his life. He said something is wrong with my head. No one is listening, they keep telling me i am crmedications t provided but did not help. It did not get to the root cause of the challenge [no audio ] no audio ] he was given 40different medications. He never received a clinical diagnosis. He made me promise if anything ever happened to him he wanted his body donated to the tbi research. He then turned to me, no, dad, it will take more guys to kill themselves before the system wakes up and sees the problem. His body was donated. Two months later we learned he had undiagnosed brain injury related to repeated blast exposure. He was hurt, not crazy. He was right all along. Our medical enterprises could not and still can not see it in living war fighter roar veteran. They are hurt, they are not broken. They break when they are cut away from their teammates, they units they given it all. They spent 3 billion on Mental HealthSubstance Abuse, suicide prevention, ptsd and other war fighter assistance programs, i give ■ plus, c minus, at best, for the lack of measurable impact for those that need answers. Those with the plate dirt level, war fighters we promised to take care of and not leave behind. Blast exposure is the key threat to warrior brain ■heth and represents Significant NationalSecurity Threat to our force readiness and resiliency. However, whatever solutions we come up with, it can not impact our operational effectiveness or legality on the battlefield. We need to do it smarter and take down the risk on the front end.