March 01, 2024

ICYMI: Warren Chairs Personnel Subcommittee, Highlights Impact of Blast Exposure on Health and Urges DoD to take Action to Protect Service Members

The Department of Defense has a responsibility to protect service members from blast overpressure caused by their own weapons. And to do so, it needs to move beyond just research. It needs to take action.

Video of Hearing (C-SPAN)

Washington, D.C. – On Wednesday, chairing a hearing of the Senate Armed Services Committee Subcommittee on Personnel, U.S. Senator Elizabeth Warren (D-Mass.) highlighted the impact of blast overpressure on American service members and the need for the Department of Defense (DoD) to better protect service members. Blast overpressure, which is pressure that’s caused by a shock wave that exceeds normal atmospheric values, affects thousands of service members by causing detrimental health effects like seizures, hallucinations, headaches, and higher risk of depression and suicide. 

Dr. Samantha McBirney, Professor of Policy Analysis at the Pardee RAND Graduate School, emphasized that while research on this issue continues to evolve, confirmed that we “absolutely” know enough about the risks of blast overpressure to take action to protect service members now.

Dr. McBirney also testified that blast overpressure in service members is often missed or misdiagnosed due to the lack of tracking previous and current cases of the condition. Blast exposure logs that track service members’ exposure to blast overpressure and their history of traumatic brain injury could better help medical personnel to save service members with these conditions in the future. In response to Senator Warren’s questioning, Dr. McBirney confirmed DoD does not currently have the strategies and capabilities needed to mitigate the risks from blast overpressure that are specific to military occupational specialties most at risk, and argued that action on this could protect members. 

Dr. Ross Zafonte, Chief of Traumatic Brain Injury & Health & Wellness Programs at Home Base, discussed how Home Base streamlines and brings together the array of specialists and resources needed to thoroughly examine symptoms of blast overpressure in service members, reducing the number of appointments and overall timeline needed to achieve adequate care and returning members back to active duty as quick and safely as possible. 

Frank Larkin, Chair of Warrior Call and Chief Operating Officer of Troops First, whose son, Ryan Larkin, died by suicide due to the effects of blast overpressure from his time as a Navy SEAL, confirmed that his son’s medical team missed the signs of blast overpressure. 

Dr. Lester Martinez-Lopez, Assistant Secretary for Health Affairs at DoD, in response to Senator Warren’s questions on cognitive testing for service members and its ability to help increase detection of changes in cognitive function, confirmed the Department is actively considering what frequency of testing is best in order to protect service members and improve quality of care. 

Captain Carlos Williams, Director of the National Intrepid Center of Excellence, joined Senator Warren in calling for baseline assessments, like cognitive tests, to be given before members begin training to better analyze how a service member’s brain health changes over time, and to catch cases of blast overpressure. 

Dr. Kathy Lee, Director for Warfighter Brain Health Policy at DoD agreed with Senator Warren on  the importance of DoD establishing a maximum allowable number of rounds for service members to fire that takes into account brain injury risks as a way  to improve service member safety. Ms. Lee also confirmed service members would benefit from establishing weapons use safety limits over longer periods of time.  

The full text of Senator Warren’s opening and closing statements, as well her questioning, can be found below:

Transcript: To receive testimony on traumatic brain injury and blast exposure care
U.S. Senate Committee on Armed Services Subcommittee on Personnel
Wednesday, February 28, 2024 

Senator Warren's Opening Remarks

Senator Warren: This hearing will come to order. I am pleased to welcome you all to today's hearing to receive testimony on the Department of Defense’s efforts to protect service members from blast overpressure.

Service members put their lives and their health on the line when they are in uniform. In return, we have a profound responsibility to make sure that the nation is doing all it can to keep them safe, to prevent battlefield and training casualties — Whoops, thank you. I do not have a functioning mic. Two senators sharing a mic, that could be trouble — Alright. Good. Did we get the other on the record? Just so I got started here.

Service members put their lives and their health on the line when they put on their uniforms. And 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 provide the best possible care for those who are injured. We're holding this hearing… Are we there? Good.

We're holding this hearing because DoD is not meeting its responsibilities when it comes to traumatic brain injuries and other injuries that result from firing weapons. Injuries from blast overpressure, the pressure that's caused by a shock wave that exceeds normal atmospheric values, have been the signature wounds of the wars in Iraq and Afghanistan. But there are also injuries incurred in training here at home. They are invisible, but they affect thousands of service members, causing headaches, seizures, hallucinations, and ultimately, significantly increased risks of depression and suicide.

Over the course of just three months in 2023, DoD provided 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 the health of individual service members, and to the well-being, the morale, and the readiness of our entire force.

I appreciate the support I have had on this issue from Ranking Member Scott, from Senator Ernst, from Senator Tillis and from other members of this committee. I secured a long-term study of blast overpressure injuries in the 2018 National Defense Authorization Act, and I've worked with Senator Ernst to introduce legislation on blast overpressure, and to secure additional requirements to track blast overpressure injuries in the FY 2020 NDAA. DoD is working to implement this legislation, but we still have significant problems.

Last year, the New York Times reported on heightened brain injury risks for U.S. troops in Syria fighting ISIS. Four artillery batteries assigned to the region fired more weapons 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 suicide.

These deaths are a tragedy. Ryan, a Navy SEAL deployed to Iraq and Afghanistan was subject to significant blasts from his own weapons over the course of his career, and later died by suicide. His father, Mr. Frank Larkin, is here today to discuss the harm that blast overpressure has caused to service members and to their families.

The Times also revealed that even when DoD had made policy changes to address risks, those changes were not evident on the ground. Weapons known to deliver shockwaves well above safety thresholds were still widely used. Training did not involve basic safety measures, and special operations forces were not issued blast exposure gauges– the gauges that are needed to track the threats they faced. So DoD and Congress both have a lot to do.

Here's my agenda to address this problem. 

First, we need to establish mitigation strategies specific to the service member roles that are most at risk for blast overpressure. Second, we must require DoD to create blast exposure and traumatic brain injury logs for all service members and integrate these logs into their VA and DoD health care records. Third, the Department of Defense should partner with innovative, evidence-based programs, like Home Base, to help service members get the care they need.

And I'm going to have to brag here for just a minute. Home Base 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. 

Home Base has clinics in Massachusetts and in Florida, Ranking Member Scott's state. Home Base has a comprehensive 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 year's NDAA. I want to support this program’s work, and I appreciate Dr. Zafonte from Home Base joining us today. 

One more item, we need to make sure that DOD sets a threshold on the maximum number of rounds that safe– that service members can safely fire, and that this includes consideration of exposure limits 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're going to have two panels today. The first panel will consist of outside witnesses to provide their perspective on where DoD and the services are falling short on protecting service members from blast overpressure. Dr. Samantha McBirney, Professor of Policy Analysis at the Pardee RAND graduate school, Dr. Ross Zafonte, Chief of Traumatic Brain Injury and Health and Wellness Programs at Home Base, and Frank Larkin, Chief Operating Officer of Troops First Foundation and lead of the National Warrior Call Day Initiative.

The second panel will consist of officials from the Department of Defense and Walter Reed to hear how DoD is tackling this issue. We'll have Dr. Lester Martinez-Lopez, Assistant Secretary of Defense for Health Affairs, Kathy Lee, Director of Warfighter Brain Health Policy at DoD, and Captain Carlos Williams, Director of the National Intrepid Center of Excellence at Walter Reed National Military Medical Center. I will now turn to Ranking Member Scott for his comments to open this hearing.

Panel 1, Round 1: Blast Exposure Logs & Military Occupational Specialties

Senator Warren: Thank you, Mr. Larkin. I appreciate your being here and sharing this story. I’m sorry for your loss, and I'm sorry for the treatment your son, Ryan, received.

I think you said it right: traumatic brain injuries are considered, quote “the signature wound” of our wars in Iraq and Afghanistan. While improvised explosive devices, IEDs, may have caused some of these medical injuries, a military medical research study found that, for troops with mild traumatic brain injury, quote, “the most important cause of brain injury was the long term exposure to explosive weapons.”

In 2011, the Defense Advanced Research Projects Agency determined that 75% of the troops' blast exposure in Afghanistan was coming from their own weapons. The effects of blast overpressure are terrible– including memory loss, increased risk of dementia, and substance abuse problems. But despite the severity of these impacts on service members' health, when these problems are diagnosed, blast exposure is rarely identified as a potential cause.

Dr. McBirney, you have studied this issue for 15 years now. Why is it so difficult to detect when blast overpressure is causing the types of symptoms that we're talking about here in our service members?

Dr. Samantha McBirney, Professor of Policy Analysis at the Pardee RAND Graduate School: That's a great question, Senator Warren, and a question that so many people within the research community are committed to answering. It really comes back to the nature of the injury itself. We're not looking at an injury that's caused by one isolated event. The fact that it's caused by repeated exposure to very low level blasts that perhaps might happen throughout the course of an entire military career, really complicates injury recognition. Add to that the fact that symptoms typically don't manifest immediately, as was mentioned, and it becomes increasingly difficult to link symptoms to repeated exposure.

Senator Warren: Go ahead, sorry, I just want to say, I want to pick up on this because I think this is a really important point about the challenge in trying to diagnose because of the very nature of what the injury looks like. It's not a single moment in time where this happens. And so I just want to pick up, and let's see if we can take this forward, we need to know how often, I take it from your, your testimony, we need to know how often service member has been exposed to blast overpressure to give medical personnel the information that they need to identify and treat the underlying cause of their symptoms. 

Now, so far, the DoD only has blast exposure data, for a total of 500 service members. We're missing data, obviously, for a whole lot more. Tracking this information through blast exposure and traumatic brain injury logs for all service members would be a good start, but we also need to pay special attention to service members that are at especially high risk for blast exposure. Some military occupational specialties, MOS’s, such as training instructors, are significantly more likely to be exposed to blasts during training or operations. The Marine Corps found that the artillery community is also at particularly high risk, and that high rates of exposure could lead them, quote, “to suffering injuries faster than combat replacements can be trained to replace them.”

So, Dr. McBirney, I wanted to give you another chance in this as we're trying to push this forward. 

Does DoD currently have the strategies it needs to mitigate the risks from blast overpressure that are specific to each of the military occupational specialties that are most likely to be exposed?

Dr. McBirney: I can't say I'm aware of any of those strategies. And, in addition to that, a lot of the folks with whom I interact on a very regular basis, with boots on the ground, in these communities that are at risk of significant exposure, are additionally unaware of such strategies.

Senator Warren: Okay. So, anything more you want to say about what DoD should be doing in this space? I want to make sure I’ve given you a chance here.

Dr. McBirney: No, thank you, Senator. I think really, Mr. Larkin and I were discussing prior to this, I think if my– if I could choose the key takeaway for today, it would be to not let perfection interfere with progress. I think everyone here is looking for the right solution, and what we really want to be sure of is that we don't wait too long to implement what we think is a perfect solution. There's a lot of research that still needs to be done. Coming from the research community, I'm always a supporter of more research. That being said, we can also be looking to implement solutions, study said solutions, while they're being implemented, at the same time.

Senator Warren: So, let's focus on that for just a second. Just a little bit more about the idea of collecting the data as we go along so at least it's a first step in getting the information that we need.

I understand this is a gap that DoD needs to fill. And I understand that it's more challenging to limit service member blast exposure during combat, but there's no excuse for DoD to continue to expose service members to unnecessary levels of blast overpressure during training. This is obviously an area where we could make change. And it's clear that there's a lot we need to do to protect our service members from blast exposure. But DoD, it goes to your point, Dr. McBirney, DoD constantly says, “we need more research, we need more research!” And I'm a data nerd– I always want more research. But I am very concerned about the idea that we're going to put off treatment.

So let me put the question more specifically to you. And that is, do you think we know enough now about the risks of blast overpressure to service members' health to start taking action now?

Dr. McBirney: In short, absolutely. Yes.

Senator Warren: Alright, so we do know enough. So there are a number of steps DoD could take to help us get more data so that we can understand this over time, but more importantly, a number of steps they could take right now in terms of treatment. And I've talked long enough so I will come back to you later on this, Dr. Zafonte, and Mr. Larkin.

Panel 1, Round 2: Blast Exposure Logs & Home Base

Senator Warren: I have another round of questions I want to ask. If Scott does, if anyone else does, we are glad to do it. 

I want to pick up on what Mr. Larkin was talking about, trust. Service members who have been affected by blast overpressure are not getting the help they need, and the question is why not? I will go back to the New York Times article because it does give us some on the ground anecdotes that people are experiencing. 

A Marine Corps officer who is leading an artillery unit was quoted in this story saying he was experiencing severe headaches and small seizures, but was worried that his injuries would not be acknowledged because there was no documentation that he was exposed to anything serious. We have talked some about the importance of record-keeping and how that could fundamentally change what happens in this area. 

I want to talk about where we are right now and the consequences of the failure to diagnose early and what that means. Mr. Larkin, you are focused on this more than anyone. I think you said in your written testimony that you estimate about 80% of your son's exposure occurred during training. Is that right? 

Frank Larkin, Chair, Warrior Call and Chief Operating Officer, Troops First: Yes, and if you talk to other veterans that have trained in combat, have been in combat, they will pretty much confirm the majority of their exposures was in the training environment, an environment that we can control. 

Senator Warren: So, if I can ask you – we know about what happened to Brian because you donated his brain postmortem and they were able to do an analysis. Can you explain what happened when Ryan was still alive and whether you and your family got the appropriate support that Ryan needed, as he clearly demonstrated he was in increasing trouble? 

Mr. Larkin: One thing I didn't share about Ryan is after he passed, what we found on his computer where he downloaded numerous studies on blast exposure and TBI and also was researching the medications he got. I did not like what he did, I did not support what he did, but I have grown to understand why he did it. It was for his teammates. He was going to prove that something was wrong. When he went to get help, he did it more for his teammates then himself. We didn't know what we didn't know. I think a lot of people were trying to do their best for him, the best that they could, but maybe all the wrong way, because we lacked the science, lacked the knowledge. TBI was not mentioned, or very little. It was not taken seriously because they could not see it. We still can't see this level of injury in a living operator, a living warfighter. 

Within the medical enterprise, if you don't have a blood marker that alerts you, like a heart attack -- we look at heart enzymes and so forth -- that alert us there is muscle damage and we see an EKG that tells us things are going wrong in the heart. We don't have that right now and it handicaps our ability to triage these folks early on in the evolution to your point. 

The opportunity here, I don't know if my colleagues would agree, but the opportunity we have is to get to this early, not wait until it gets to a catastrophic point in this disease process, where things have gone too far. 

Senator Warren: So let me just pick up on this. I understand that this is hard to diagnose. I understand we would like to start as early in the process as we can. But there is another feature that we have some control over right now, that when someone has any concern, who is the advocate to make sure they get the help they need? 

My sense of this is it is just a patchwork. You get sent there, then you end up someplace else, and the patient is put in the position of having to advocate for a diagnosis that it is not the patient's responsibility or expertise to have to make. 

I am grateful that Ryan did what he did in order to help his teammates, but ultimately we have a bigger responsibility here. I want to know if you can speak just a little bit to the notion that starting now, before we have perfect information, that we need a single way for people to go into this system, to be able to raise a hand and say, 

I have problems, like the Marine that’s quoted in the New York Times piece, and know there will be one person who will advocate and at least get them to the best possible treatment that we can. Can you speak to that, Mr. Larkin? 

Mr. Larkin: Yes, and the number one word I would pick out is listen. 

The system needs to listen to those folks as they step forward. This is a leadership problem and we need to educate leadership as to what is going on so they can properly usher these folks down the right paths so we can start a level of treatment that is one-size-fits-one, not one-size-fits-all. 

I think as our medical capabilities develop, we are going to get better and better at doing that. Again, Ryan became disenfranchised. He became adversarial because the system turned on him, a system he depended on, a system I depended on. This was my community too. 

This is why I am here today. I realize this isn't a perfect world, but the ultimate grader of what we do or not do are the veterans, warfighters, and their families. Are we doing the right thing for them? 

Senator Warren: I very much appreciated that and appreciate your comments. 

I want to go to the treatment part of this. Dr. Zafonte, you work at Home Base, and Home Based tries to be the one place that brings people in and gives a response, that's on the side of our service member, not hostile to our service member. 

You are on the front lines, you see people with TBI every day. Can you talk a little bit about how Home Base has organized itself and what you are seeing and what kind of needs you have? 

Dr. Zafonte: Thank you for the excellent question. 

I think we see ourselves as a partner with DOD and that we are auxiliary in an imported and differential way. An important and differential way. We take a look at the whole person. 

I think Mr. Larkin captured it brilliantly. Somebody is not just a psychological illness, but we bring multiple specialists to bear for a very intense evaluation that might take months or years in a standard environment and try to immerse them in a team-based behavior where we listen to the patient's and develop a programmatic plan to treat them. If we can't treat the microscopic injury right away, let's treat their symptoms and get them relatively well. 

Senator Warren: I am so proud of the work that home-based does and really want to underscore their importance. There are things we can do. If I could have you underscore it again, Dr. Zafonte, you actually return people to active duty military service. Can you say more about that? 

Dr. Zafonte: I am happy to. 

One of the most extraordinary things, especially for our special operators is the very high degree of return to duty, return to the force. As a person, that's what they want to do. They want to be well and go back to their teammates and contribute at a high level, and indeed that is the goal. The goal is being able to give people agency over their own health again and that's what we do. High rates of return. Large numbers of people are still waiting for service, which we hope to provide, and we see this as a means of enhancing programmatic excellence and serving as that bridge for midcareer, early career people who really need a bolus of help. 

Senator Warren: Early and accurate intervention. I appreciate the work you do. Senator Scott? 

Panel 2: Round 3 - Monitoring Brain Health & Weapons Safety Limits 

Senator Warren: So, I appreciate that DOD has begun to take steps toward mitigating the risks associated with traumatic brain injury. 

Starting this year, new troops will be given regular cognitive assessments to help monitor potential impacts from blast exposure on their brain health. This will help medical providers recognize brain injuries and changes in cognitive function more quickly and it will help service members get the clinical help that they need. I am glad that DoD is taking this critical step. But it is important that we do this right. 

Captain Williams, your organization, the National Intrepid Center of Excellence, works with service members with TBIs and other invisible wounds of war. As you know, one of the, and we've discussed here repeatedly today, one of the most significant ways that troops are exposed to blast overpressure is through training. 

To ensure that we're accurately monitoring the impact of blast exposure on service members' brain health, would it be helpful to give a cognitive test before the service member begins training and firing weapons?

Captain (Dr.) Carlos D. Williams, USN, Director, National Intrepid Center of Excellence: Thanks, senator for the question. And thank you for the opportunity to talk about this important issue. Absolutely, yes. So let me start off by saying yes, it's critically important.

Baselining is something that we utilize in all aspects of medicine for surveillance, we utilize it prior to treatment, we utilize it prior to modalities that we know cause risk. So we have moved to now, this year, we hope to move to all members once they join the military and before they start that initial military training, they get cognitive testing. They get cognitive testing because we know that the highest risk of TBIs in the military is in the training environment. And so it will be valuable, we want to use the same precision medicine we've been using in the past for other modalities that we do with TBI. 

Senator Warren: Okay, so if the baseline assessment is not starting until after training, that it's not an accurate measure of the service members’ brain  health changes over time, we're going to miss the front end of this. And as we have talked about, the importance of isolating the problem early is absolutely critical. So to make sure that we're able to detect signs of cognitive decline due to blast exposure, we've got to do this assessment before the training starts. 

Second thing, we also need to do regular tests of service members’ cognitive health after the baseline assessment. While Special Operations Command will conduct these tests every three years, DoD is currently planning to retest troops only every five years. 

Dr. Martinez, you are responsible for assessing the effects of and improving how DoD tracks blast pressure exposure. Would annual cognitive testing for service members help increase the chance that we detect changes in cognitive function and detect them earlier, when intervention would be more effective? 

Lester Martinez-Lopez, Assistant Secretary of Defense for Health Affairs, Department of Defense: Ma’am, as a Department, we are looking into this. I think if there's value into doing it every year, we don't know. So maybe three years, maybe five years, there's more data and more science that we need to look into? I'm not looking at 10 year research, I'm looking at short term research to figure out what would be the best frequency of doing the test. Not only that, but what kind of other testing we should add to the battery to assess the condition of the soldiers, service members. 

Senator Warren: So I just want to say I feel a little bit frustrated here that Special Operations Command already clearly says five years is not enough, they’re at three. And frankly, until we have better data, I don't know why we wouldn't be saying let's do an annual test and see what we can detect. 

And if the data show us that three years is often enough interval to be able to detect changes, that's fine. But it seems to me, given what else we know and given how catastrophic the implications of untreated TBI can be, that we ought to be erring on the side, at least of collecting these data annually. So, I really want to push on this, waiting five years to test is just not often enough. 

Another way that DoD needs to show that it's serious about protecting service members from blast overpressure is by establishing effective weapon use safety limits. We had some conversation about this earlier. In 2022, DoD directed the services to establish a maximum allowable number of rounds for service members to fire to mitigate blast overpressure injury risk. 

Now, good start. But I see two problems with this. First, the limits don't include brain injury risk. Blast pressure, experts have raised concerns that this means that our current safety thresholds are built on things like whether or not it's likely to cause your eardrum to burst. They're very old guidelines, and they are not about traumatic brain injury. 

Ms. Lee, you're in charge of overseeing DoD’s Warfighter Brain Health policy. Why is it important that DoD establish a maximum allowable number of rounds for service members to fire that takes into account brain injury, as well as injury just to the ears?

Kathy M. Lee, Director, Warfighter Brain Health Policy, Department of Defense: Senator Warren, thank you so much for the question. And thanks for having us here today to be able to talk about Warfighter Brain Health, blast overpressure, and traumatic brain injury. 

This is an excellent question, we absolutely, it's imperative that we have an allowable number of rounds for all the weapons systems that are commonly used, so that we can avoid unnecessary blast exposure in our service members. 

We believe that this also gives us an opportunity to be able to ensure the usage is correct, the position, crew position, proximity and all those pieces can come together, our policies are moving in that direction to be able to look at the brain. As you mentioned, historically, it's been through ear and lung. However, we are looking at what the brain effects are and will follow suit with our policies as such. 

Senator Warren: So again, I want to say I feel a little bit of frustration here. I appreciate that you are working on establishing these limits. But we’ve got to get this off the ground on. 

Now we know enough to start moving in the right direction. My office has heard stories of service members having to take their own initiative in setting limitations for their troops. We've got training instructors who just say, I've decided that's enough. And that's not enough to get this job done. 

So again, I urge you. Better to make your best estimate and get started on forcing these weapons manufacturers to start collecting these data so that they will be able to give us limits on how they can be used. 

One more concern here. It's how we measure these weapons’ use safety limits. DoD’s own studies found that it took 72 to 96 hours to resolve service members’ cognitive deficits after firing heavy weapons. So that's about how long it appears before people are back to their original steady state. But DoD guidelines say they're only going to test for the first 24 hours. 

Ms. Lee, could service members benefit from establishing weapons use safety limits for longer periods of time, like 72 hours? 

Ms. Lee: Yes, ma'am. We are looking to expand that timeframe so that we allow for those differences that are coming up with blast overpressure. So that is again where our policies, the direction that our policies are headed, so that we can cover that time period. 

We are firmly committed to early detection, provides the opportunity to treat, and that maximizes our outcome. 

Senator Warren: Well, I hope you do this soon. 

The Department of Defense Inspector General has raised concerns that Military Health System providers are not consistently providing a 72 hour follow up appointment for patients with mild TBIs. So, clearly, a longer time frame is something that DoD itself recognizes is important and that we need to get done. 

Look, I get it. This is hard, and I am grateful that you're doing the work you're doing. I want to be a partner but a partner that urges you to move faster and deliver more for our service members as quickly as possible. 

We need to do better for our troops and we need to do it right now.

Closing Statement

Senator Warren: I want to thank you all, all of our witnesses, for being here today. I want to thank you for the work you do everyday. 

My takeaways from this are that the Department of Defense needs to do better. We need to identify those who are most at risk for TBI because of the particular work they do, and we need to collect better data, and we need to do all of this on a much faster time table.

Congress also needs to do better. 

We need to make sure that you have the resources to do your work, and we also need to make sure that those who are treating TBI, like Home Base, have the resources they need. It is shameful that there are active duty military who have what appears to be TBI and they cannot be treated because the resources simply are not there. A waiting list at a place like Home Base is our failure. We need those resources and we need the capacity to be able to treat those who have suffered brain injuries because of their service to our nation. We owe that to our service members. 

So, again, thank you all for being here. I want to thank the senators who have been here. I want to thank my partner, Senator Scott, in this, and this will be an issue we take up during the next round of NDAA negotiations.

Thank you.