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Title page 1

Contents 3

Highlights 2

Letter 6

Background 9

Blast Overpressure Exposure and Brain Health 10

DOD's Work on Blast Overpressure Exposure and Brain Health 11

DOD Required Cognitive Assessments and Exposure Tracking, Among Other Things 14

DOD Has Begun Implementing Requirements but Reported Implementation Challenges for Cognitive Assessments and Exposure Tracking 20

DOD Has Taken Steps to Implement Requirements in Fiscal Year 2025 21

DOD Reported Resource Challenges Implementing Cognitive Assessment Requirements 23

DOD Reported Resource Challenges Implementing Exposure Tracking Requirements 28

DOD Has Taken Steps to Help Address Factors Affecting Service Members' Decisions to Seek Treatment 32

Service Members at Selected Installations Identified Several Factors That Can Affect Seeking Care for Blast-Related Effects 32

DOD and the Military Departments Have Actions Underway to Help Encourage Service Members to Seek Treatment 35

Conclusions 39

Recommendations 40

Agency Comments 40

Appendix I: Selected Ongoing DOD Research Efforts Related to Blast Overpressure Exposure 44

Appendix II: Information on Special Operations Forces and Related Efforts on Managing Blast Overpressure Exposure 46

Appendix III: Information on DOD's Implementation of Blast Overpressure Requirements, as of Fiscal Year 2025 48

Appendix IV: DOD Cognitive Assessment Program 53

Appendix V: Comments from the Department of Defense 57

Appendix VI: GAO Contact and Staff Acknowledgments 61

Tables 4

Table 1. Requirements for Managing Brain Health Risks from Blast Overpressure Outlined in DOD Policy Memorandum Published August... 15

Table 2. Examples of DOD Actions in Fiscal Year 2025 to Address Requirements for Managing the Brain Health Risks from Blast Overpressure 22

Table 3. DOD Research Efforts Related to Blast Overpressure Exposure Reported by Officials 45

Table 4. Implementation Status of Selected DOD Requirements for Managing the Effects of Blast Overpressure, as of Fiscal Year 2025 50

Table 5. Military Department Completion of Requirements for Cognitive Assessments for New Service Members, as of Fiscal Year 2025 55

Table 6. Military Department Completion of Required Baseline Cognitive Assessments for High-Risk Service Members by end of Fiscal Year 2025 55

Figures 4

Figure 1. Illustration of Training Environment with Blast Overpressure-Producing Weapons 10

Figure 2. Examples of Weapon Systems Known to Produce Higher Levels of Blast Overpressure and Military Occupations That Frequently... 17

Figure 3. Illustration of How DOD Blast Overpressure Reference and Information Guide May Be Used by Service Members, October 2024 19

Figure 4. Overview of DOD's Cognitive Assessments for New and High-Risk Service Members in Fiscal Year 2025 24

Figure 5. Examples of Information from Service Members about Factors That Affect Their Decision to Seek Treatment for the Brain Health... 35

Figure 6. Fact Sheet for Service Members on Blast Overpressure Developed by DHA 36

Figure 7. Cognitive Assessment Briefing Room and Testing Site at a Selected Military Installation, as of 2025 54

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