Missouri committee hears bill to fund hyperbaric oxygen therapy for veterans with traumatic brain injury

Representative Chris Brown, sponsor of House Bill 262, told the House Committee on Veterans and Armed Forces that the bill would create the Veterans Traumatic Brain Injury Treatment and Recovery Act, a fund administered by the Missouri Veterans Commission to reimburse clinics that provide hyperbaric oxygen therapy (HBOT) to veterans at no cost to the patient.

"The V.A. don't cover it. Private insurance doesn't cover it," Brown said, summarizing the access problem he described to the committee. He said a full course of treatment is typically 30–40 "dives" and estimated about $175 per dive, or roughly $7,000 for a full course.

Why it matters: HBOT proponents told the committee that some veterans with TBI or post-traumatic stress disorder (PTSD) have limited treatment options, face long waits or cannot find facilities willing to treat brain injuries because Medicare, the Department of Veterans Affairs and many insurers do not list HBOT as an approved therapy for those conditions.

Supporters offered medical and personal testimony. Retired Air Force surgeon Dale Hudson (testimony identifying him as retired senior mass surgeon) cited published studies and RAND and JAMA statistics on TBI and veteran suicide risk in arguing for more treatment options. Combat veteran Trey Warren said he has tried VA care without benefit and has been suicidal three times in the last three years; he said he has funding to pay for HBOT but cannot find Missouri facilities that will accept him for brain-related treatment because of coverage and malpractice concerns. "I have funding to receive HBOT, but I can't find a medical facility near me that will let me in due to it not being approved for my brain issues," Warren told the committee.

A treating clinician, Dr. Brooks Travis, a Columbia chiropractor who has offered HBOT for five years with a clinical partner, described typical treatment regimens and side effects. He said hospital-grade hard-shell chambers and higher pressures (2.0–2.5 ATA) are generally used for clinical courses of 25–40 sessions and that most common complications are ear or sinus barotrauma and claustrophobia.

Committee members questioned costs, evidence and program structure. Representative Scott Miller and others asked whether the program should start as a pilot at existing VA or veterans clinics, or be time-limited if the Food and Drug Administration or VA later adopts HBOT for TBI. Representative Jameson and Representative Boucher pressed Brown on the bill's fiscal note: Brown said a fiscal estimate of roughly $500,000 annually to administer the fund was likely high and that initial seed funding could range from $100,000 to several million depending on scope; he suggested $2–$5 million as a start-up appropriation to gather data on effectiveness and participation.

Brown said Oklahoma and other states have enacted similar funds. He also said HBOT is already used for a variety of approved conditions and is becoming more mainstream in sports and other areas, but that coverage gaps keep it from being broadly available to veterans for TBI and PTSD.

Outcome and next steps: The committee held a public hearing, received testimony from multiple witnesses and took no recorded vote during the session. Representative Brown closed the hearing and the committee moved to other business.

Context and limits: Witnesses and the sponsor described program mechanics that would require the Veterans Commission to set eligibility criteria for veterans, facilities and practitioners and approve reimbursement. Committee members repeatedly asked for more empirical outcome data and cost estimates; the transcript records committee direction to collect and share additional information but no formal committee motion or amendment was recorded during the hearing.