    [Senate Hearing 108-676]
    [From the U.S. Government Publishing Office]

           DEPARTMENT OF DEFENSE APPROPRIATIONS FOR FISCAL YEAR 2005

                                  ----------

                             WEDNESDAY, MAY 5, 2004

                                           U.S. Senate,
               Subcommittee of the Committee on Appropriations,
                                                        Washington, DC.
        The subcommittee met at 9:30 a.m., in room SD-192, Dirksen
    Senate Office Building, Hon. Ted Stevens (chairman) presiding.
        Present: Senators Stevens and Inouye.

                           NONDEPARTMENTAL WITNESSES

    STATEMENT OF SUE SCHWARTZ, R.N., CHAIRPERSON, HEALTH
                CARE COMMITTEE, THE MILITARY COALITION

                    OPENING STATEMENT OF SENATOR TED STEVENS

        Senator Stevens. Good morning. We do welcome all of you to
    our public witness hearing. There are 24 witnesses today who
    have indicated each of them wishes to testify or submit a
    statement for the record. To keep us on schedule,
    unfortunately, I must ask that you limit your testimony to not
    more than 4 minutes. We are in session. We are going into
    session now, and we will have votes today.
        We appreciate your interest and want you to know that we do
    carefully review each item that you do present to us. Your
    prepared statements are included in the record already. We ask
    that you summarize those statements.
        As soon as my good friend, Senator Inouye, arrives, we will
    see if he has an opening statement. I do not think he does. But
    why do we not proceed with our first witness and allow my
    friend to make such statements he wants to make.
        The first witness is Sue Schwartz, a registered nurse, and
    Chairperson of the Coalition's Health Care Committee of the
    Military Coalition. Welcome, Ms. Schwartz.
        Ms. Schwartz. Good morning, Mr. Chairman.
        Mr. Chairman and distinguished members of the subcommittee,
    thank you for the opportunity to address you today concerning
    the Military Coalition's views on funding for the defense
    personnel programs. I want to reiterate our deep appreciation
    to the entire subcommittee for the role you played in the
    development of a wide range of landmark health care initiatives
    over the past few years, particularly for Medicare eligibles
    and active duty families. On behalf of our grateful members, we
    say thank you for the leadership your subcommittee gave last
    year directing the Department of Defense (DOD) to take specific
    action to address chronic access problems for TRICARE Standard
    and to begin to address health care needs for the selected
    Reserve.
        We ask the subcommittee's continued emphasis to ensure that
    these enhancements are not only successfully implemented, but
    adequately funded as well.
        DOD officials speak of funding shortfalls in the out-years,
    but there are current problems as well. Bases are turning
    retirees away from their pharmacies, saying this is due to
    budget cuts. In many instances, a retiree or any beneficiary
    may only get a 30-day supply of medication from the military
    pharmacy instead of the usual 90-day supply.
        To control costs, some military pharmacies cut back on
    expensive drugs not on the basic core formulary. Beneficiaries
    then turn to the retail pharmacy to get those medications where
    funds come out of a different pot of money. When funds get
    tighter, it becomes harder to get an appointment. Pharmacy and
    clinic hours get cut. Prime access standards are not met.
    Sometimes beneficiaries are told the schedule is not ready,
    call back in a week, and the queue starts to build.
        Last year the Office of Management and Budget (OMB)
    considered increasing retiree pharmacy cost share
    significantly, even going so far as to propose charging
    retirees for medications obtained in military pharmacies. In a
    memo dated March 26, the United States (U.S.) Army Command
    states there is a significant funding shortfall in their annual
    funding of $250 million to support the war. Many command
    activities have budget execution rates that cannot be sustained
    within current funded levels.
        We ask the subcommittee's continued support in
    appropriating sufficient amounts for the direct and purchased
    care systems so that the defense health program (DHP) budget
    does not have to be balanced on the back of beneficiaries.
        In the last session of Congress, you took the first steps
    to extend to the Guard and Reserve additional TRICARE coverage
    before and after mobilization and to provide TRICARE on a cost-
    share basis for members without access to employer-sponsored
    health care.
        Mr. Chairman, some disturbing news is 6 months have passed
    and DOD has not implemented all these provisions. The Defense
    Department cannot tell us if or when it will be able to
    implement access to TRICARE on a cost-share basis for those
    reservists without health insurance. These programs are
    temporary and the clock is ticking. The authority and funding
    for this legislation expires at the end of the year, but the
    call-ups will not. How can we expect to have a valid test when
    time is running out?
        The coalition urges you to send a strong message that
    health care for the Guard and Reserve and their family members
    is a priority. We ask you to take steps to fully fund the
    permanent expansion of these TRICARE benefits for the Guard and
    Reserve components pre-and post-mobilization. The coalition
    believes we need to enhance health care for the Guard and
    Reserve families because it is a readiness issue. It is a
    quality of life issue to provide affordable health care to
    Reserve families. It will stimulate recruiting and retention
    efforts, and it gives employers of mobilized members financial
    incentives. Dependence on Guard and Reserve personnel will not
    decrease and most likely will grow. Making these health care
    enhancements permanent and fully funded demonstrates that we
    appreciate the service and sacrifice of our citizen soldiers
    and their families.
        We deeply appreciate the subcommittee's ongoing leadership
    and commitment to those who are in uniform today and those who
    have served our Nation in the past.
        I look forward to answering your questions. Thank you.
    Senator Stevens: Is it your position they have not yet covered
    those who have actually been mobilized or those who are being
    demobilized?
        Ms. Schwartz. Sir, the section 702, 703, and 704 of last
    year's National Defense Authorization Act--only section 704 has
    been fully implemented which is the extension of the
    transitional assistance medical program (TAMP), which is the
    temporary extension of benefits post-mobilization. The other
    two sections have not been implemented.
        Senator Stevens. As I understand, it is a very difficult
    thing to do. We will look into it, though, but I did look into
    it a little bit, and it is extremely difficult to do without
    providing a disincentive to employers to maintain health
    insurance for their people who are also members of the Guard
    and Reserve. I thank you for your statement. We are continuing
    to look at that.
        Ms. Schwartz. Thank you, Mr. Chairman. There are no simple
    answers. I appreciate your support.
        Senator Stevens. Thank you.
        [The statement follows:]
                       Prepared Statement of Sue Schwartz
                               executive summary
    Active Force Issues
        Personnel Strengths and Operations Tempo.--The Military Coalition
    strongly recommends restoration of Service end strengths to sustain the
    long-term global war on terrorism and fulfill national military
    strategy. The Coalition supports increases in recruiting resources as
    necessary to meet this requirement. The Coalition urges the
    Subcommittee to consider all possible manpower options to ease
    operational stresses on active, Guard and Reserve personnel.
        Commissaries.--The Military Coalition opposes all privatization and
    variable-pricing initiatives and strongly supports full or even
    enhanced funding of the commissary subsidy to sustain the current level
    of service for all patrons, including Guard and Reserve personnel and
    their families.
        Family Readiness and Support.--The Military Coalition urges funding
    for improved family readiness through education and outreach programs
    and increased childcare availability for servicemembers and their
    families and associated support structure to assist families left
    behind during deployments of active duty, Guard and Reserve members.
    Retirement Issues
        Combat Related Special Compensation Claims Processing.--The
    Military Coalition urges Subcommittee leaders and members to ensure
    that DOD has sufficient funding to provide adequate resources for the
    timely processing of combat related special compensation claims.
    Guard And Reserve Issues
        Selected Reserve Montgomery GI Bill Improvements.--The Military
    Coalition recommends funding to raise SR-MGIB benefit levels to 47
    percent of the active duty MGIB rate and support to allow reservists
    who serve non-consecutive tours of 24 months or more active duty within
    a five-year period to enroll in the active duty MGIB.
    Health Care Issues
        Full Funding For The Defense Health Budget.--The Military Coalition
    strongly recommends the Subcommittee continue its watchfulness to
    ensure full funding of the Defense Health Program, including military
    medical readiness, needed TRICARE Standard improvements, and the DOD
    peacetime health care mission. It is critical that the Defense Health
    Budget be sufficient to secure increased numbers of providers needed to
    ensure access for TRICARE beneficiaries in all parts of the country.
        Pharmacy Cost Shares for Retirees.--The Military Coalition urges
    the Subcommittee to continue to reject imposition of cost shares in
    military pharmacies, oppose increasing other pharmacy cost shares that
    were only recently established, and to provide full funding for the
    Defense Health Pharmacy Program. We urge the Subcommittee to ensure
    that Beneficiary Advisory Groups' inputs are included in any studies of
    pharmacy services or copay adjustments.
        Healthcare for Members of the National Guard and Reserve.--The
    Military Coalition urges the Subcommittee to take action to appropriate
    sufficient funds and support permanent authorization of the Temporary
    Reserve Health Care Program (Sec. 702, 703, and 704 Public Law 108-136)
    to support readiness, family morale, and deployment health preparedness
    for Guard and Reserve servicemembers.
        The Military Coalition urges the Subcommittee to appropriate
    sufficient funds to provide for federal payment of civilian health care
    premiums (up to the TRICARE limit) as an option for mobilized service
    members.
        The Military Coalition recommends the Subcommittee provide
    sufficient funding to permit expansion of the TRICARE Dental Plan
    benefits for Guard and Reserve servicemembers. This would allow all
    National Guard and Reserve members to maintain dental readiness and
    alleviate the need for dental care during training or mobilization.
                                personnel issues
        Mr. Chairman, The Military Coalition (TMC) is most grateful to the
    leadership and members of this Subcommittee for their strong support
    leading to last year's significant improvements in military pay,
    housing allowances and other personnel programs for active, Guard and
    Reserve personnel and their families. But as much as Congress
    accomplished last year, very significant inequities and readiness
    challenges remain to be addressed.
        In testimony today, The Military Coalition offers its collective
    recommendations on what needs to be done to address these important
    issues and sustain long-term personnel readiness.
                              active force issues
        Personnel Strengths and Operations Tempo.--The Coalition is
    dismayed at the Department of Defense's reluctance to accept Congress'
    repeated offers to increase Service end strength to relieve the stress
    on today's armed forces, who are clearly now sustaining an increased
    operations tempo to meet today's global war on terror. While we are
    encouraged by the Army's announcement to temporarily increase their end
    strength by 30,000, we are deeply concerned that Administration-
    proposed plans for selected temporary manpower increases rely too
    heavily on continuation of stop-loss policies, unrealistic retention
    assumptions, overuse of the Guard and Reserves, optimistic scenarios in
    Southwest Asia, and the absence of any new contingency needs.
        Administration and military leaders warn of a long-term mission
    against terrorism that requires sustained, large deployments to Central
    Asia and other foreign countries. The Services simply do not have
    sufficient numbers to sustain the global war on terrorism, deployments,
    training exercises and other commitments, so we have had to recall
    significant numbers of Guard and Reserve personnel. For too many years,
    there has always been another major contingency coming, on top of all
    the existing ones. If the Administration does not recognize when extra
    missions exceed the capacity to perform them, the Congress must assume
    that obligation.
        The Coalition strongly believes that earlier force reductions went
    too far and that the size of the force should have been increased
    several years ago to sustain today's pace of operations. Deferral of
    meaningful action to address this problem cannot continue without
    risking serious consequences. Real relief is needed now. There is no
    certainty that missions will decline, which means that the only prudent
    way to assure we relieve the pressure on servicemembers and families is
    to increase the size of the force.
        Some argue that it will do little good to increase end strengths,
    questioning whether the Services will be able to meet higher recruiting
    goals. The Coalition believes strongly that this severe problem can and
    must be addressed as an urgent national priority, with increases in
    recruiting budgets if that proves necessary.
        Others point to high reenlistment rates in deployed units as
    evidence that high operations tempo actually improves morale. But much
    of the reenlistment rate anomaly is attributable to tax incentives that
    encourage members to accelerate or defer reenlistment to ensure this
    occurs in a combat zone, so that any reenlistment bonus will be tax-
    free. Retention statistics are also skewed by stop-loss policies. Over
    the long run, past experience has shown that time and again smaller but
    more heavily deployed forces will experience family-driven retention
    declines.
        Action is needed now. Failing to do so will only deepen the burden
    of already over-stressed troops and make future challenges to retention
    and recruiting worse.
        The Military Coalition strongly recommends restoration of Service
    end strengths to sustain the long-term global war on terrorism and
    fulfill national military strategy. The Coalition supports increases in
    recruiting resources as necessary to meet this requirement. The
    Coalition urges the Subcommittee to consider all possible manpower
    options to ease operational stresses on active, Guard and Reserve
    personnel.
        Commissaries.--The Coalition continues to be very concerned about
    preserving the value of the commissary benefit--which is widely
    recognized as the cornerstone of quality of life benefits and a valued
    part of the servicemembers' total compensation package.
        During the past year, the Department of Defense announced plans to
    close a number of commissaries, replace the traditional three-star
    officer serving as chairman of the Commissary Operating Board (COB)
    with a political appointee, and require a study on instituting variable
    pricing for commissary products. These proposals are apparently
    intended to save money by reducing the annual appropriation supporting
    the Defense Commissary Agency (DeCA), which operates 275 commissaries
    worldwide. The COB recommendation is also viewed as another indicator
    of DOD's ongoing interest in eventually privatizing the benefit.
        The Coalition supports cost savings and effective oversight and
    management. However, we are concerned about the unrelenting pressure on
    DeCA to cut spending and squeeze additional efficiencies from its
    operations--despite years of effective reform initiatives and
    recognition of the agency for instituting improved business practices.
        The Coalition is particularly opposed to the concept of variable
    pricing, which the Administration acknowledges is aimed at reducing
    appropriated funding. This can only come at the expense of reducing
    benefits for patrons.
        The commissary is a highly valued quality of life benefit not
    quantifiable solely on a dollars appropriated basis. As it has in the
    past, The Military Coalition opposes any efforts to privatize
    commissaries or reduce benefits to members, and strongly supports full
    funding of the benefit in fiscal year 2005 and beyond.
        The Military Coalition opposes all privatization and variable-
    pricing initiatives and strongly supports full or even enhanced funding
    of the commissary benefit to sustain the current level of service for
    all patrons, including Guard and Reserve personnel and their families.
        Family Readiness and Support.--Family readiness is a key concern
    for the approximately 60 percent of servicemembers with families.
    Allocating adequate resources for the establishment and maintenance of
    family readiness and support programs is part of the cost of
    effectively fulfilling the military mission.
        Servicemembers and their families must understand and be aware of
    benefits and programs available to them and who to contact with
    questions and concerns--both at the command level and through the
    respective Service or Department of Defense--in order to effectively
    cope with the challenges of deployment. It is also important to meet
    childcare needs of the military community including Guard and Reserve
    members who are being called to active duty in ever-increasing numbers.
        The Military Coalition urges funding for improved family readiness
    through education and outreach programs and increased childcare
    availability for servicemembers and their families and associated
    support structure to assist families left behind during deployments of
    active duty, Guard and Reserve members.
                               retirement issues
        Combat Related Special Compensation Claims Processing.--The
    Military Coalition applauds Congress for the landmark provisions in the
    fiscal year 2004 National Defense Authorization Act that expand combat
    related special compensation to all retirees with combat-related
    disabilities and authorizes--for the first time ever--the unconditional
    concurrent receipt of retired pay and veterans' disability compensation
    for retirees with disabilities of at least 50 percent. Disabled
    retirees everywhere are extremely grateful for this Subcommittee's
    action to reverse an unfair practice that has disadvantaged disabled
    retirees for over a century.
        However, we are becoming increasingly aware of growing problems
    with combat related special compensation claims processing. Large
    numbers of applicants are waiting six months or more for decisions. The
    Services have acknowledged that the expanded authority will increase
    backlogs even more. The Coalition believes DOD must have sufficient
    funding to meet staffing and other support requirements to ensure
    claims are processed in a reasonable period of time.
        The Military Coalition urges Subcommittee leaders and members to
    ensure DOD has sufficient funding to provide adequate resources for the
    timely processing of combat related special compensation claims.
                            guard and reserve issues
        Selected Reserve Montgomery GI Bill Improvements.--Individuals who
    first become members of the National Guard or Reserve are eligible for
    the Selected Reserve Montgomery GI Bill (SR-MGIB) under Chapter 1606 of
    Title 10 U.S. Code. But SR-MGIB benefits have declined sharply compared
    to active duty benefits and need to be restored.
        During the first fifteen years of the SR-MGIB program (1985-1999),
    benefits maintained 47 percent comparability with the active duty MGIB
    authorized under Title 38. But in the last few years, the SR-MGIB has
    slipped to a 29 percent ratio with the basic program due to benefit
    increases that were enacted only for the active duty program. The drop
    in reserve benefits happened at a time when the Guard and Reserve have
    been mobilized and deployed unlike any other time since World War II.
    In addition, many reservists have been mobilized for more than one
    extended tour of active duty. If the tours add up to 24 months of
    active duty but are served non-consecutively, the reservists are not
    eligible for the active duty MGIB.
        The Military Coalition recommends funding to raise SR-MGIB benefit
    levels to 47 percent of the active duty MGIB rate and support to allow
    reservists who serve non-consecutive tours of 24 months or more active
    duty within a five-year period to enroll in the active duty MGIB.
        Guard/Reserve Family Readiness and Support.--All military families
    experience high stress levels when their military spouses are deployed
    in harms way. National Guard and Reserve families are no exception. In
    their case, however, military base support networks are rarely
    available to them due to their geographic dispersion across the nation.
    The Services and the Defense Department have initiated new programs to
    support the growing needs of reserve component families but more needs
    to be done.
        The Guard and Reserve have increased the number of paid family
    readiness coordinators and established more Family Assistance Centers
    to help volunteers and provide basic information. The challenge is
    providing consistent and reliable information on benefits and services
    across all of the reserve components. For example, the Air National
    Guard employs professional family coordinators but the Army National
    Guard does not. Another concern is the lack of childcare services for
    mobilized Guard and Reserve families.
        The Military Coalition urges adequate funding for family readiness
    services through education and outreach programs, increased childcare
    availability for servicemembers and their families, and associated
    support services to assist families left behind during deployments of
    active duty, Guard and Reserve members.
                               health care issues
        The Military Coalition is most appreciative of the Subcommittee's
    exceptional efforts over several years to honor the government's health
    care commitments to all uniformed services beneficiaries. These
    Subcommittee-sponsored enhancements represent great advancements that
    should significantly improve health care access while saving all
    uniformed services beneficiaries thousands of dollars a year. The
    Coalition particularly thanks the Subcommittee for last year's
    outstanding measures to address the needs of TRICARE Standard
    beneficiaries as well as to provide increased access for members of the
    Guard and Reserves.
        While much has been accomplished, we are equally concerned about
    making sure that subcommittee-directed changes are implemented and the
    desired positive effects actually achieved. We also believe some
    additional initiatives will be essential to providing an equitable and
    consistent health benefit for all categories of TRICARE beneficiaries,
    regardless of age or geography. The Coalition looks forward to
    continuing our cooperative efforts with the Subcommittee's members and
    staff in pursuit of this common objective.
        Full Funding For The Defense Health Budget.--Once again, a top
    Coalition priority is to work with Congress and DOD to ensure full
    funding of the Defense Health Budget to meet readiness needs--including
    graduate medical education and continuing education, full funding of
    both direct care and purchased care sectors, providing access to the
    military health care system for all uniformed services beneficiaries,
    regardless of age, status or location. A fully funded health care
    benefit is critical to readiness and the retention of qualified
    uniformed service personnel.
        The Subcommittee's oversight of the defense health budget is
    essential to avoid a return to the chronic underfunding of recent years
    that led to execution shortfalls, shortchanging of the direct care
    system, inadequate equipment capitalization, failure to invest in
    infrastructure and reliance on annual emergency supplemental funding
    requests as a substitute for candid and conscientious budget planning.
        We are grateful that last year, Congress provided supplemental
    appropriations to meet growing requirements in support of the
    deployment of forces to Southwest Asia and Afghanistan in the global
    war against terrorism.
        But we are concerned by reports from the Services that the current
    funding level falls short of that required to meet current obligations
    and that additional supplemental funding will once again be required.
    For example, we have encountered several instances in which local
    hospital commanders have terminated service for retired beneficiaries
    at military pharmacies, citing budget shortfalls as the reason. Health
    care requirements for members returning from Iraq are also expected to
    strain the military delivery system in ways that we do not believe were
    anticipated in the budgeting process.
        Similarly, implementation of the TRICARE Standard requirements in
    last year's Authorization Act--particularly those requiring actions to
    attract more TRICARE providers--will almost certainly require
    additional resources that we do not believe are included in the budget.
    Addrerssing these increased readiness requirements, TRICARE provider
    shortfalls and other needs will most likely require additional funding.
        The Military Coalition strongly recommends the Subcommittee
    continue its watchfulness to ensure full funding of the Defense Health
    Program, including military medical readiness, needed TRICARE Standard
    improvements, and the DOD peacetime health care mission. It is critical
    that the Defense Health Budget be sufficient to secure the increased
    numbers of providers needed to ensure access for TRICARE beneficiaries
    in all parts of the country.
        Pharmacy Cost Shares for Retirees.--Late last year, the Office of
    Management and Budget (OMB) and the Defense Department considered a
    budget proposal that envisioned significantly increasing retiree cost
    shares for the TRICARE pharmacy benefit, and initiating retiree copays
    for drugs obtained in the direct care system. While the proposal was
    put on hold for this year, the Coalition is very concerned that DOD is
    undertaking a review that almost certainly will recommend retiree copay
    increases in fiscal year 2006.
        It was less than three years ago that Congress authorized and
    appropriated adequate funding for the TRICARE Senior Pharmacy Program
    (TSRx) and DOD established $3 and $9 copays for all beneficiaries.
    Defense leaders highlighted this at the time as ``delivering the health
    benefits military beneficiaries earned and deserve.'' But the Pentagon
    already has changed the rules, with plans to remove many drugs from the
    uniform formulary and raise the copay on such drugs to $22.
        Now, there are new proposals to double and triple the copays for
    drugs remaining in the formulary--to $10 and $20, respectively. One can
    only surmise that this would generate another substantial increase in
    the non-formulary copay--perhaps even before the $22 increase can be
    implemented.
        Budget documents supporting the change rationalized that raising
    copays to $10/$20 would align DOD cost shares with those of the VA
    system. This indicates a serious misunderstanding of the VA cost
    structure, unless the Administration also plans to triple VA cost
    shares. At the present time, the VA system requires no copayments at
    all for medications covering service-connected conditions, and the cost
    share for others is $7.
        The Coalition believes this Subcommittee will appropriate the funds
    needed to meet uniformed services retiree health care commitments if
    only the Administration will budget for it. The Coalition is concerned
    that DOD does not seem to recognize that it has a unique responsibility
    as an employer to those who served careers covering decades of arduous
    service and sacrifice in uniform. Multiple administrations have tried
    to impose copays in military medical facilities, and Congress has
    rejected that every time. We hope and trust that will continue.
        The Coalition vigorously opposes increasing retiree cost shares
    that were only recently established. Congress' recent restoration of
    retiree pharmacy benefits helped restore active duty and retired
    members' faith that their government's health care promises would be
    kept. If implemented, this proposal would undermine that trust, which
    in the long term can only hurt retention and readiness.
        The Military Coalition urges the Subcommittee to continue to reject
    imposition of cost shares in military pharmacies, oppose increasing
    other pharmacy cost shares that were only recently established and to
    provide full funding for the Defense Health Pharmacy Program. We urge
    the Subcommittee to ensure that Beneficiary Advisory Groups' inputs are
    included in any studies of pharmacy services or copay adjustments.
        Healthcare for Members of the National Guard and Reserve.--The
    Military Coalition is most appreciative to Congress for ensuring that
    the Temporary Reserve Health Care Program was included in the fiscal
    year 2004 National Defense Authorization Act. This program will provide
    temporary coverage, until December 2004, for National Guard and Reserve
    members who are uninsured or do not have employer-sponsored health care
    coverage. TRICARE officials plan to build on existing TRICARE
    mechanisms to expedite implementation; however, no one is certain how
    long this will take. Immediate implementation and full funding is
    required.
        The Coalition is grateful to the Congress for their efforts to
    enact Sec. 703 and 704 of the fiscal year 2004 NDAA. Sec. 703--Earlier
    Eligibility Date for TRICARE Benefits for Members of Reserve Components
    provides TRICARE health care coverage for reservists and their family
    members starting on the date a ``delayed-effective-date order for
    activation'' is issued. Sec. 704--Temporary Extension of Transitional
    Health Care Benefits changes the period for receipt of transitional
    health care benefits from 60 or 120 days to 180 days for eligible
    beneficiaries.
        Congress recognized the extraordinary sacrifices of our citizen-
    soldiers, by enacting extending this pre- and post-mobilization
    coverage. Now it's time to recognize the changed nature of 21st century
    service in our nation's reserve forces by making these pilot programs
    permanent and provide full funding.
        The Military Coalition urges the Subcommittee to take action to
    appropriate sufficient funding and support permanent authorization of
    the Temporary Reserve Health Care Program (Sec. 702, 703, and 704
    Public Law 108-136) to support readiness, family morale, and deployment
    health preparedness for Guard and Reserve servicemembers.
        Health insurance coverage varies widely for members of the Guard
    and Reserve: some have coverage through private employers, others
    through the Federal government, and still others have no coverage.
    Reserve families with employer-based health insurance must, in some
    cases, pick up the full cost of premiums during an extended activation.
    Guard and Reserve family members are eligible for TRICARE if the
    member's orders to active duty are for more than thirty days; but, many
    of these families would prefer to preserve the continuity of their
    health insurance. Being dropped from private sector coverage as a
    consequence of extended activation adversely affects family morale and
    military readiness and discourages some from reenlisting. Many Guard
    and Reserve families live in locations where it is difficult or
    impossible to find providers who will accept new TRICARE patients.
    Recognizing these challenges for its own reservist-employees, the
    Department of Defense routinely pays the premiums for the Federal
    Employee Health Benefit Program (FEHBP) when activation occurs. This
    benefit, however, only affects about ten percent of the Selected
    Reserve.
        The Military Coalition urges the Subcommittee to appropriate
    sufficient funds to provide for federal payment of civilian health care
    premiums (up to the TRICARE limit) as an option for mobilized service
    members.
        Dental readiness is another key aspect of readiness for Guard and
    Reserve personnel. Currently, DOD offers a dental program to Selected
    Reserve members and their families. The program provides diagnostic and
    preventive care for a monthly premium, and other services including
    restorative, endodontic, periodontic and oral surgery services on a
    cost-share basis, with an annual maximum payment of $1,200 per enrollee
    per year. However, only five percent of eligible members are enrolled.
        During this mobilization, soldiers with repairable dental problems
    were having teeth pulled at mobilization stations in the interests of
    time and money instead of having the proper dental care administered.
    Congress responded by passing legislation that allows DOD to provide
    medical and dental screening for Selected Reserve members who are
    assigned to a unit that has been alerted for mobilization in support of
    an operational mission, contingency operation, national emergency, or
    war. Unfortunately, waiting for an alert to begin screening is too
    late. During the initial mobilization for Operation Iraqi Freedom, the
    average time from alert to mobilization was less than 14 days,
    insufficient to address deployment dental standards. In some cases,
    units were mobilized before receiving their alert orders. This lack of
    notice for mobilization continues, with many reservists receiving only
    days of notice before mobilizing.
        The Military Coalition recommends the Subcommittee provide
    sufficient funding to permit expansion of the TRICARE Dental Plan
    benefits for Guard and Reserve servicemembers. This would allow all
    National Guard and Reserve members to maintain dental readiness and
    alleviate the need for dental care during training or mobilization.
                                   conclusion
        The Military Coalition reiterates its profound gratitude for the
    extraordinary progress this Subcommittee has made in advancing a wide
    range of personnel and health care initiatives for all uniformed
    services personnel and their families and survivors. The Coalition is
    eager to work with the Subcommittee in pursuit of the goals outlined in
    our testimony. Thank you very much for the opportunity to present the
    Coalition's views on these critically important topics.
    STATEMENT OF JANET RUBIN, M.D., ON BEHALF OF THE
                NATIONAL COALITION FOR OSTEOPOROSIS AND
                RELATED BONE DISEASES
        Senator Stevens. Dr. Janet Rubin. Good morning, Doctor.
        Dr. Rubin. Mr. Chairman, I am Janet Rubin. I am a professor
    in the Department of Medicine at Emory University and a staff
    physician at the Atlanta Veterans Medical Center. I am
    representing the National Coalition for Osteoporosis and
    Related Bone Diseases and I seek your continued support for
    Department of Defense funding of the bone health and military
    medical readiness research program.
        Bone health is an essential element of military readiness.
    Our troops must be ready and able to endure vigorous activity
    during combat training and force operations. Musculoskeletal
    injury is, however, an unfortunate result of training. In
    particular stress fracture accounts for more loss duty days in
    the active duty population than any other injury. Stress
    fractures compromise our military's operational readiness,
    drive up health care costs, and increase personnel attrition.
    The stress fracture takes a soldier out of combat as quickly as
    an entry wound and requires weeks for healing.
        Consider those young people entering basic training. As
    many as 5 percent of male recruits sustain stress fractures. In
    the case of females, the number may rise to as much as 20
    percent, and even trained soldiers who switch from light to
    heavy physical duty are at risk for stress fracture.
        The current bone health and military medical research
    program was developed and funded with the goal of eliminating
    stress fractures in all recruits. The program's successes to
    date are many. I am going to give you a sampling of what we
    have learned and what DOD-funded scientists are pursuing and
    have published in more than 100 publications.
        Recruits are frequently deficient in vitamin D and calcium.
    The optimal level of supplementation of these and other
    vitamins and minerals for active young people is under
    investigation.
        Recruits with family histories of osteoporosis are at
    higher risk for stress fracture. DOD-supported scientists have
    modeled osteoporosis genes in mice, revealing genes that can
    predict bone quality and bone structure. Indeed, bone structure
    plays a critical role in stress fracture. We are only just
    starting to understand how skeletal structure of women differs
    from men. DOD-funded research suggests that the smaller bones
    of women may be underpowered for the weight they bear during
    training, increasing the risk of stress fracture. The training
    of female recruits may, thus, require added bone protective
    strategies.
        Scientists in this program are also trying to understand
    how biomechanical signals cause bone formation and improved
    bone strength during exercise. One DOD-funded study suggests
    that bone fluid flow stimulates bone cells to make stronger
    bones.
        Of course, improving diagnosis of stress fracture is a
    topic of this program, including improvement and
    standardization of noninvasive measurements of bone. We would
    like to be able to better predict incipient fractures. An
    increase in the porosity of bone appears to precede the
    fracture. We hope that detection of this porosity with new
    instrumentation will improve prevention.
        Last, we need to design better treatment algorithms to get
    our soldiers back on their feet and prevent chronic disability
    such as pain and degenerative joint disease. DOD-funded
    scientists are studying both pulsed ultrasound and dynamic
    electrical fields as novel adjuncts to standard rest therapy.
        Mr. Chairman, we are all aware that stress fractures and
    other bone-related injuries erode the physical capability and
    effectiveness of our combat training units. Military readiness
    suffers. A small investment in bone health research can make a
    large contribution to our combat readiness. Therefore, it is
    imperative that the Department of Defense build on these recent
    findings and maintain an aggressive and sustained bone health
    research program at a level of $6 million in fiscal year 2005.
        Thank you.
        Senator Stevens. I understand there are some new techniques
    for inquiring about the osteoporosis and other such bone
    defects. Do you advocate that women recruits be given those
    tests before they enter the service?
        Dr. Rubin. I think it would help to know if their bone
    density was very low. One of the problems that we have in the
    osteoporosis field that, although, for instance, dual x-ray
    absorptiometry (DXA) is the gold standard for measuring bone
    density, it really does not predict bone structure. So it is a
    poor measure of young women in terms of what they can bear. So
    I think it would probably be worthwhile to measure bone density
    in young women, yes.
        Senator Stevens. Thank you very much, Doctor. We appreciate
    your coming.
        [The statement follows:]
                    Prepared Statement of Janet Rubin, M.D.
        Mr. Chairman and Members of the Committee, I am Janet Rubin, M.D.,
    Professor, Department of Medicine, Emory University and Staff Physician
    at the Atlanta Veterans Affairs Medical Center. I am here today on
    behalf of the National Coalition for Osteoporosis and Related Bone
    Diseases to urge your support in maintaining the Bone Health and
    Military Medical Readiness research program within the Department of
    Defense and providing necessary funding to preserve the program. The
    members of the Bone Coalition are the American Society for Bone and
    Mineral Research, the National Osteoporosis Foundation, the Paget
    Foundation for Paget's Disease of Bone and Related Disorders, and the
    Osteogenesis Imperfecta Foundation.
        Bone health is an essential element of military readiness. The goal
    of the Department of Defense (DOD) is to guarantee military readiness
    by keeping our forces trained, equipped and ready to adapt to emerging
    threats. Our troops must be ready and able to endure vigorous activity
    during combat training as well as during force operations. Soldiers are
    always at risk of injury, incapacitation, and degraded performance
    resulting from injuries such as stress fractures--all of which
    compromise the mission, readiness, and budget of the Armed Forces.
        Although the benefits of strenuous physical activity are well
    documented, these activities are also known to incur certain risks.
    Musculoskeletal injury, for example, is the most common morbidity in
    civilian and military populations who participate in physical activity.
    In fact, fractures account for the highest number of lost duty days in
    the active duty population of any injury. These injuries incur a high
    cost to the DOD not only in lost duty days, but in health care, lost
    training time, and attrition of personnel. Ultimately, the operational
    readiness of U.S. military forces is severely compromised.
        Stress fractures are one of the most common and potentially
    debilitating overuse injuries experienced in the military recruit
    population. Stress fractures occur in 0.8 to 5.2 percent of male
    recruits, and from 3 to 21 percent of female recruits. Recent research
    suggests that several factors may contribute to the increased risk for
    stress fracture suffered by women, including the density, shape, and
    size of their bones (which affect bone quality), and their nutritional,
    hormonal and physical conditioning status.
        Lack of physical conditioning affects the United States as a whole,
    along with the military population in particular. An Institute of
    Medicine report published in 1998 by the Subcommittee on Body
    Composition, Nutrition and Health of Military Women concluded that the
    low initial fitness of recruits, both cardiorespiratory and
    musculoskeletal, appeared to be the principal factor in the development
    of stress fractures during basic training. The Committee also concluded
    that muscle mass, strength, and endurance played a critical role in the
    development of stress fracture. Now we know from DOD-funded research
    that bone structure adds to the risk of fracture, along with a history
    of poor diet, lack of exercise, hormonal imbalances and genetic
    factors. Ethnicity also plays a part.
        Isn't basic training good for recruits' health, you may wonder. The
    answer is yes and no. Exercise is important to building bone health,
    but the type of exercise and the transition to new exercise regiments
    play a role in bone strength. Many new recruits, upon arrival for basic
    training, are unaccustomed to intense exercise, particularly strenuous
    running and marching activities. Under normal circumstances, the
    increased demand placed on bone tissue causes the bone to remodel to
    adapt to the new loads, and become stronger in the areas of higher
    stress. However, if the remodeling response of the bone cannot keep
    pace with the repetitive demands placed on a service member during the
    8 to 12 week training period, a stress fracture may result. Without
    proper rest and time to heal, the stress fracture may lead to chronic
    pain and disability.
        Different types of stress fractures require different treatment.
    For example, femoral neck or hip stress fractures can sometimes
    progress to full fractures and interrupt the blood supply to the thigh
    bone portion of the hip joint. This in turn can cause early
    degenerative changes in the hip joint. Physicians consider the femoral
    neck stress fracture to be a medical emergency requiring immediate
    treatment. Researchers have raised concerns regarding the possible
    relationship between increased risk for stress fracture and long-term
    risk of osteoporosis, osteoarthritis, and other bone diseases.
        Like hip stress fractures, stress fractures of the navicular (foot
    bone), anterior cortex of the tibia (front portion of the mid-
    shinbone), and proximal fifth metatarsal (a bone in the foot) are also
    slow to heal. Many of these diagnoses require an affected service
    member cease training for a lengthy period of medical care and
    rehabilitation until the fracture has healed. At one basic training
    location, over 70 percent of the injured soldiers pulled from training
    were diagnosed with overuse bone injuries.
        While stress fracture injury is seen primarily in new recruits,
    anyone who suddenly increases his or her frequency, intensity, or
    duration of physical activity, such as a recently called-up reservist
    is potentially at risk for developing lower body stress fractures.
        The study of bone health is not a simple task, as bone health
    requires a complex interaction between exercise and other factors that
    affect bone remodeling, such as nutrition, hormonal status, genetics,
    and biomechanics. Currently, there is a distinct gap in understanding
    the effects of exercise and other factors on normal bone remodeling in
    a young adult population; more research is needed to determine the best
    types of exercise regimens to build and maintain healthy bone.
    Moreover, an understanding of all factors affecting bone health,
    particularly in young, healthy men and women, is necessary to fully
    describe the physiological response of bone and muscle to the physical
    demands placed on our service members, and to maintain the health and
    military readiness of our service members.
        At this point, Mr. Chairman I would like to identify some of the
    promising studies currently being funded by the DOD:
    Current Studies
        Identifying key mineral and other nutritional levels needed in
    military rations to ensure optimal bone health of recruits:
      --Vitamin D, for example, is known to be deficient in the population
            at large, particularly in sunlight-deprived individuals, and
            yet it, like calcium, is key to bone health. Researchers are
            working to determine the proper level of vitamin D required in
            the military population. A related question is: What levels of
            vitamin D supplementation are necessary to maintain bone
            health?
      --The effect of calcium and calorie intake on the incidence of stress
            fractures in the short term, and osteoporosis in the long term,
            is another subject of investigation.
      --How do caloric restriction and disordered eating patterns--and/or
            related amenorrhea or menstrual period cessation--affect
            hormonal balance and the accrual and maintenance of peak bone
            mineral content is a question also under investigation.
        Researching the association between stress fractures and physical
    training methods, including an examination of past injuries and the
    effects of poor nutrition, lack of exercise, smoking, use of anti-
    inflammatory medications, alcohol and oral contraceptives, all of which
    may negatively affect bone.
        Examining the mechanisms of bone cell stimulation from the flow of
    surrounding fluids during compression (loading) of the bone. As the
    bone is repeatedly compressed due to physical activity, fluid flows in
    a network of spaces; this oscillating fluid flow is a potent stimulator
    of bone cells.
        Comparing recovery times from tibial stress fracture in subjects
    treated with active or placebo-controlled electric field stimulation,
    including evaluation of male and female responses.
        Assessing the fracture healing impact of pulsed ultrasound.
        Attempting to accelerate stress fracture healing time using
    conservative but generally favored treatments of rest from weight
    bearing activity (this averages three months).
        With DOD's critical investment support, the findings are already
    impressive:
      --Poor physical fitness when recruit training is initiated has been
            identified as a strong predictor of injury. This has led to the
            development of a scientifically based intervention to reduce
            injuries at the Marine Corp Recruit Depot. An evaluation of
            this intervention demonstrated an overall reduction in overuse
            injuries and a 50 percent reduction in stress fractures, with
            no decrement in physical fitness at graduation.
      --Muscle elasticity--as measured by ultrasound--has been shown to
            undergo physiological alterations with an abrupt transition to
            a running training program similar to that employed for
            military recruit training. MRI allows for imaging of soft
            tissue and can detect these alterations in muscle structure
            during running. Combining ultrasound characterization with MRI
            scanning of the muscle recruitment during running will
            ultimately enable physicians to pinpoint the relationship of
            muscle elasticity to the level of tibial stress, and,
            ultimately, fracture risk.
      --Being able to assess metabolism and bone growth in humans will
            advance our understanding of bone remodeling: key to building
            and maintaining strong bone. DOD-funded scientists have
            developed a prototype of the highest resolution positron
            emission tomography (PET) devise existing to focus on meeting
            this need for improved assessment.
      --Data suggests that increased bone remodeling precedes the
            occurrence of bone microdamage and stress fractures.
            Researchers found that increases in cortical bone porosity
            precede the accumulation of bone microdamage, suggesting an
            important role of increased intracortical remodeling in the
            development of stress fractures. If we can detect this porosity
            before microdamage occurs, we could prevent stress fractures.
    Areas of Need
        Improved and more sensitive methods are needed for the noninvasive
    assessment of bone metabolism along with standard measurements of bone
    density and other parameters of bone strength to assess normal bone
    remodeling, impending risk of bone injury, and bone responses to
    treatment interventions.
        Structural and biomechanical factors that contribute to tibial
    stress fracture risk need to be explored using recent advances in
    technology to detect microscopic damage to tibial bone structure non-
    invasively, before occurrence of stress fracture injuries.
        We need to determine the relationship between whole bone geometry
    and tissue fragility in the human tibia, testing the linkage between
    geometry, gender, and the occurrence of low-impact bone fractures
    (those that occur with minimum force).
        DOD scientists' research in genetic determinants of bone quality
    may ultimately help protect women and men against musculoskeletal
    injuries. Bone mineral density, while a major determinant of bone
    strength, is just one parameter of bone quality. Both geometric
    characteristics and density of bone are related to bone strength, and
    muscle strength and endurance have been linked to the ability of bone
    to withstand repetitive loading. Thus, susceptibility to stress
    fracture clearly has both bone and muscle components. Research on the
    effects of genetics, diet and nutrition, mechanical load, and other
    factors that might affect bone quality can now be studied using new
    technologies, such as magnetic resonance imaging, peripheral
    quantitative computed tomography, regional DXA, and tibial ultrasound,
    and has the potential to provide great insight into the bone remodeling
    and adaptation process. In addition, new techniques such as virtual
    bone biopsies are under development to provide more critical data.
        Mr. Chairman, stress fractures and other bone related injuries
    erode the physical capabilities and reduce the effectiveness of our
    combat training units, compromising military readiness. A small
    investment in bone health research can make a large contribution to
    combat readiness. Therefore, it is imperative that the Department of
    Defense build on recent findings and maintain an aggressive and
    sustained bone health research program at a level of $6 million in
    fiscal year 2005.

        Senator Stevens. My good friend, the co-chairman, is here.
    Do you have any opening statement, Senator?
        Senator Inouye. No, thank you.
        Senator Stevens. Very well.
        Vice President Howard R. Hall of the Joslin Diabetes Center
    please. Good morning.
    STATEMENT OF HOWARD R. HALL, VICE PRESIDENT, JOSLIN
                DIABETES CENTER
        Mr. Hall. Good morning. Mr. Chairman and Senator Inouye,
    thank you for this opportunity to report on the progress of the
    Joslin Diabetes Center cooperative telemedicine project with
    the DOD and the Veterans Administration (VA) for the diagnosis,
    management, and treatment of diabetes and diabetic retinopathy,
    Army Research, Development, Test and Evaluation (RDT&E) medical
    advanced technology PE0603002A.
        I am Howard Hall of the Joslin Diabetes Center. I am also
    here to request continued level funding at $5 million for this
    collaborative project in fiscal year 2005.
        As both of you know I believe, the Joslin Vision Network
    (JVN) Eye Care and Comprehensive Diabetes Management Program is
    a telemedicine initiative designed to access all people with
    diabetes into cost effective, quality diabetes and eye programs
    across cultural and geographic boundaries with reduced costs.
        I am pleased to report that these innovative JVN eye care
    and diabetes management programs are being deployed not only in
    the DOD but also throughout the Indian Health Service (IHS) and
    VA health care systems. Already we have 52 sites in 18 States
    and the District of Columbia.
        Currently the JVN telemedicine eye care system is the only
    non-mydriatic system available that has been rigorously
    validated, equivalent to the current gold standard for
    retinopathy diagnosis.
        Version 3 of the Joslin eye care is ready for deployment
    this summer and will be simpler and less expensive to operate.
    A new prototype JVN retinal imaging system that is portable and
    50 percent less costly has been developed and is being to
    undergo initial clinical validation.
        Joslin has completed the first phase in the use of
    automated detection of diabetic retinopathy which can increase
    the cost efficiency of the JVN system by 42 percent.
    Recognizing the need to manage total care of diabetic patients
    and to empower better self-management so as to realize a
    prevention of vision loss, the DOD/VA/Joslin collaborative has
    developed the JVN comprehensive diabetes management program
    (CDMP) using web-based interactive technologies.
        By the end of this May 2004, CDMP will be integrated into
    the DOD Healtheforces website for daily use. In addition, CDMP
    is expected to be fully operational for both the VA VISN system
    and in the Indian Health Services in July 2004.
        The CDMP, the comprehensive diabetes management program,
    can result in a three- to seven-fold reduction in health care
    expenses.
        The requested continuation of the current level of funding
    for 2005, $5 million, will provide support for the existing JVN
    eye care system for deployment of the JVN comprehensive
    diabetes management program to participating sites, for
    continued JVN refinements, and quite important, to perform
    critical prospective clinical studies.
        Mr. Chairman, Joslin is pleased to be a part of this
    project for the Department of Defense and we are most
    appreciative of the support that you and your colleagues have
    provided to us. Please know that we would be grateful for
    continued support again this year.
        At this time, I would be pleased to answer any questions
    that you or Senator Inouye may have. Thank you.
        Senator Stevens. Thank you very much, Mr. Hall. I think I
    commented to you before my father was blind because of juvenile
    diabetes. We are pleased to try to work with you.
        Mr. Hall. Try to prevent it so others do not have to have
    that. Thank you.
        [The statement follows:]
                      Prepared Statement of Howard R. Hall
    Introduction
        Mr. Chairman and Members of the Committee, thank you for this
    opportunity to appear before you. I am Howard Hall of the Joslin
    Diabetes Center. I am pleased to present an update on the collaborative
    Joslin Diabetes Project with the Departments of Defense and Veteran's
    Affairs on the health concerns related to diabetes.
        Joslin is extremely appreciative of the funds provided for this
    valuable project in the fiscal year 2004 Defense Appropriations Act.
    Our proposal for fiscal year 2005 funding will allow for the DOD/VA/
    Joslin collaborative to continue to enhance research refinements and
    extend clinical developments of Joslin Vision Network (JVN) Eye Care
    and the Comprehensive Diabetes Management Program (CDMP).
        The Joslin Vision Network (JVN) Eye Care and Comprehensive Diabetes
    Management Program (CDMP) is a telemedicine initiative designed to
    access all diabetes patients into cost-effective, quality diabetes and
    eye care programs across geographic and cultural boundaries at reduced
    costs.
        This DOD/VA/Joslin collaborative is the core foundation for these
    innovative eye care and diabetes management programs that are being
    deployed not only in the DOD but also throughout the IHS and VA health
    care systems.
        Collectively, the JVN is deployed at 52 sites in the District of
    Columbia and the following 18 states: Alaska, Arizona, Florida, Hawaii,
    Idaho, Kansas, Maine, Maryland, Massachusetts, Minnesota, Montana, New
    Mexico, Oklahoma, Pennsylvania, South Dakota, Texas, Virginia, and
    Washington.
    Summary
        This request of $5,000,000 represents the collective costs of
    Joslin and associated expenses of the Department of the Army, RDT&E.
    Fiscal Year 2004 Status Report
                JVN Deployment
        As of January 2004 we have deployed in:
      --The Department of Defense infrastructure: 11 independent remote JVN
            imaging sites, 5 centralized JVN reading center sites. and 2
            coordinating independent JVN servers.
      --The VA system: 8 independent remote JVN imaging sites, 4
            centralized JVN reading center sites, and 2 coordinating
            independent JVN servers.
      --The Joslin Diabetes Center system: 7 JVN imaging sites, and 4 JVN
            reading center sites.
                JVN Validation
        Currently the JVN telemedicine's eye care system is the only non-
    mydriatic (no pupil dilation needed) system available that has been
    rigorously validated and shown to be equivalent to the current gold
    standard for retinopathy diagnosis. The JVN validation study results
    were published in the March 2001 issue of Ophthalmology.
                JVN Application Enhancement
        The JVN application has been refined to use totally non-proprietary
    hardware and software and is fully DICOM and HL7 compliant as well as
    being compliant with HIPAA security standards. Workstations are now
    standard PCs with Microsoft 2000 operating systems interfaced with Agfa
    PACS environment which facilitates direct interfaces to DOD CHS and VA
    VISTA medical record systems.
        Preparing for evolving PC functions, JVN Eye Care Version 3 is
    ready for release this summer. With applications written in
    Microsoft.Net operating system-platform, JVN software becomes modular.
    This software enhancement will facilitate addition of new modules to
    expand JVN value and will make JVN simpler and significantly less
    expensive to operate.
                New JVN Retinal Imaging System
        During the initial Cooperative Agreement Joslin undertook the
    development of a retinal imaging system that overcame the limitations
    identified in current commercially available non-mydriatic retrieval
    funders camera imaging systems. A prototype imaging system that is
    portable and 50 percent less costly has been developed and is being
    readied to undergo initial clinical validation.
                JVN Computer-based Detection of Micro-aneurysms for
                        Screening Digital Retinal Images
        This development effort represents the first phase in the use of
    image analysis to automate identification of retinal lesions in
    diabetic retinopathy. This ability will dramatically improve the
    efficiency of the reading center and based on results from the
    retrospective cost efficiency study will have a significant impact on
    cost savings for the use of the JVN system. This effort has been
    completed and results indicate that automated detection can be achieved
    with a sensitivity and specificity of 70 percent. At this level we can
    expect to increase the cost efficiency of the JVN system by 42 percent.
                JVN Comprehensive Diabetes Management Program (CDMP)
        A focus during the first 5 years of the DOD/VA/Joslin collaborative
    was the recognition of the need to develop the JVN Comprehensive
    Diabetes Management Program (CDMP). This development process was
    focused on care management for the diabetic patient using web-based
    interactive technologies. The driver for this application was the need
    to manage the total care of diabetic patients and to empower better
    self-management so as to realize a prevention of vision loss. The
    development of the CDMP was started in year 3 of the funding cycle. The
    JVN eye care component now becomes a module of the larger CDMP
    application. The CDMP application is now ready to be deployed to
    participating sites.
        By the end of May 2004 CDMP will be integrated into DOD
    HealtheForces website for daily use. In addition CDMP is expected to be
    fully operational in both the VA VISN system and in the Indian Health
    Services in July 2004.
                CDMP Phase Two--Prospective Clinical Studies
        Following upon comprehensive Broad Area Announcement (BAA) DOD
    review process the second major phase of the Cooperative Agreement was
    initiated in October 2003: performing the appropriate prospective
    studies aimed at demonstrating the cost effectiveness and clinical
    efficacy of the combined JVN eye care and diabetes management system.
    This is the critical component of the work as the application will not
    be adopted widely without data demonstrating value in terms of cost
    reduction, increased efficiency in usage and increased clinical
    effectiveness.
        Equally important, this program provides a platform for propagating
    the concept of a shared private medical intranet that assembles a
    ``virtual'' medical record that draws on sources of heterogeneous
    information. The ultimate vision with development of the CDMP within
    the DOD, the VA and Joslin is the ability to facilitate implementation
    of a unified medical record that addresses the security and
    confidentiality implications of web-connecting the nation's clinical
    data.
        The major goals of this continuing project are the establishment of
    a telemedicine system for comprehensive diabetes management and the
    assessment of diabetic retinopathy that provides increased access for
    diabetic patients to appropriate care, that centralizes the patients in
    the care process, that empowers the patient to better manage his
    disease, that can be performed in a cost-effective manner, and that
    maintains the high standard of care required for the appropriate
    management of diabetic patients.
        The DOD/VA/Joslin collaborators have designed prospective clinical
    studies to cover a five year period to enable the appropriate
    collection of data and to allow the expected changes to be measured as
    significant clinical outcomes. The collaborators have written manuals
    of operation for these studies, and submitted protocols for review at
    organization IRBs.
        This next phase of the DOD/VA/Joslin research program will assess
    the usability of the JVN CDMP applications, assess diabetic patients'
    current behaviors, undertake a multi-center CDMP clinical outcomes
    efficacy and cost efficiency study, pursue a prospective study of JVN
    Eye Care cost efficiency and conduct a Multi-center JVN Risk Benefit
    Study.
        First studies are slated to begin in June 2004 with the last study
    to start in December 2004. The 3 year-long studies will be completed by
    January 2008. Data analysis will be done from January 2008 to July
    2008.
        The expectation is that these studies will demonstrate that use of
    JVN eye care and CDMP will result in improvements in care of diabetes
    patients, improvements in patient control of diabetes, reduction of
    risks such as blindness, increased productivity of people with diabetes
    in the workplace and a reduction in utilization of expensive hospital
    care resources such as ER visits and length of stay in hospital.
        It is anticipated the studies will also show that CDMP can result
    in a 3 to 7 fold reduction in health care expenses.
                Fiscal Year 2005 Objectives
        The current level of funding for 2005 ($5,000,000) will provide
    support for existing JVN Eye Care systems; for deployment of the JVN
    Comprehensive Diabetes Management Program (CDMP) to participating
    sites; for continued refinements to the JVN platform; to bring on line
    a new, refined JVN Imaging System; and to perform appropriate and
    critical prospective clinical studies that will allow the DOD/VA to
    further refine and increase their clinical effectiveness and cost
    effectiveness of the combined JVN Eye Care and Comprehensive Diabetes
    Management Program (CDMP).
    Joslin Diabetes Project Requested Fiscal Year 2005 Budget
                Administrative and Management Fees
        Administrative and management fees were addressed on page 231 of
    your Conference Report on H.R. 2658 Department of Defense
    Appropriations Act, 2004. Administrative and management fees assessed
    by DOD at 20 percent take $1,000,000 off the top of project
    appropriations thereby reducing the project's reach and delaying full
    implementation of the endeavor.

    ------------------------------------------------------------------------
                                                                  Amount
    ------------------------------------------------------------------------
    DOD Costs:
        DOD Administrative and Management Costs (@20              $1,000,000
         percent)...........................................
        DOD/VA Participating Sites..........................       1,757,000
                                                             ---------------
          TOTAL DOD/VA Costs................................       2,757,000
                                                             ===============
    Joslin Costs:
        Joslin Vision Network (JVN).........................       1,228,000
        Comprehensive Diabetes Management Program (CDMP)....       1,015,000
                                                             ---------------
          TOTAL Joslin Costs................................       2,243,000
                                                             ===============
          TOTAL Requested Budget............................       5,000,000
    ------------------------------------------------------------------------

        Mr. Chairman, Joslin is please to be a part of this project with
    the Department of Defense and we are most appreciative of the support
    that you and your colleagues have provided to us. Please know that we
    would be grateful for your continued support again this year. At this
    time, I would be pleased to answer any questions from you or any other
    Member of the Committee.

        Senator Stevens. Senator Inouye.
        Senator Inouye. Do you have any estimate as to the number
    of men and women in the military who might be afflicted?
        Mr. Hall. Yes. I think the main thrust for the military--
    there is a chance of people becoming diabetic but most of the
    concern with this was military dependents for the DOD. At the
    same time, the telemedicine comprehensive diabetes management
    program is also being evolved with the Telemedicine and
    Advanced Technology Research Center (TATRIC) into a disease
    management. We are at the stage where this can actually go to
    the front lines.
        That is why we are interested in basically--eye care other
    than diabetes is handled by the portable JVN system, and I am
    just reporting on the diabetes component to you today. I do not
    want to carry it on because with the limited budget we have, as
    indicated in the written testimony, we cannot move out in other
    fields, but we are working on that and I am also looking for
    private funding in that regard.
        Senator Inouye. Thank you, sir.
        Mr. Hall. Thank you.
        Senator Stevens. Thank you very much, Mr. Hall.
        Our next witness is Dr. Christopher Sager, American
    Psychological Association. Good morning, Doctor.
    STATEMENT OF CHRISTOPHER SAGER, Ph.D., ON BEHALF OF THE
                AMERICAN PSYCHOLOGICAL ASSOCIATION
        Dr. Sager. Good morning. Mr. Chairman and Senator Inouye, I
    am Dr. Christopher Sager, Principal Staff Scientist at the
    Human Resources Research Organization. I am submitting
    testimony on behalf of the American Psychological Association,
    APA, a scientific and professional organization of more than
    150,000 psychologists.
        Although I am sure you are aware that a large number of
    psychologists are providing clinical services to our military
    members here and abroad, you may be less familiar with the wide
    range of research conducted by psychological scientists in the
    Department of Defense. Our behavioral researchers work on
    issues critical to national defense with support of the Army
    Research Institute, the Army Research Laboratory, and the
    Office of Naval Research, and the Air Force Research
    Laboratory.
        I would like to address the proposed cuts to the fiscal
    year 2005 human-centered research budgets for these military
    laboratories within the context of the larger Department of
    Defense science and technology (S&T) budget.
        The President's budget request for basic and applied
    research for S&T at DOD in fiscal year 2005 is $10.55 billion,
    a 12.7 percent decrease from the enacted fiscal year 2004
    level. APA joins the Coalition for National Security Research,
    a group of over 40 scientific associations and universities, in
    urging the subcommittee to provide DOD with $12.05 billion for
    S&T in fiscal year 2005. This figure is in line with the
    recommendations of the independent Science Board and the
    Quadrennial Defense Review.
        A portion of this overall defense S&T budget funds critical
    human-related research in the broad categories of personnel,
    training, and leader development; warfighter protection,
    sustainment and physical performance; and system interfaces and
    cognitive processing. Some of my current work, for example,
    focuses on developing measures of characteristics required of
    first-term soldiers and non-commissioned officers in the future
    Army. These efforts will be used to help Army selection and
    promotion systems meet the demands of the 21st century.
        In a congressionally mandated report to this committee, DOD
    reported on the continuing erosion of its own support for
    research on individual and group performance, leadership,
    communication, human-machine interfaces, and decision-making.
    The Department found that the requirements for maintaining
    strong DOD support for behavioral, cognitive, and social
    science research capability are compelling and that this area
    of military research has historically been extremely productive
    with particularly high return on investment and operational
    impact.
        Despite the critical need for strong research in this area,
    the administration has proposed an fiscal year 2005 defense
    budget that would slash funding for human-centered research by
    12 percent. Army, Navy, and Air Force basic behavioral research
    would remain essentially flat for fiscal year 2005 and both the
    Air Force and the Army would sustain deep, detrimental cuts to
    applied behavioral research programs, cuts in the range of 35
    percent. APA urges the committee to, at a minimum, restore
    funding for human-centered research at the fiscal year 2004
    level of $477.89 million.
        In closing, I would like to quote again from the DOD's own
    report to the Senate Appropriations Committee. ``Military
    knowledge needs are not sufficiently like the needs of the
    private sector that retooling behavioral, cognitive and social
    science research carried out for other purposes can be expected
    to substitute for service-supported research, development,
    testing, and evaluation. Our choice, therefore, is between
    paying for it ourselves and not having it.''
        Mr. Chairman, our servicemembers deserve the very best that
    we can give them, and I hope that this subcommittee will
    restore cuts to defense S&T funding and, in particular, the
    human-centered research budget. Thank you. I would be happy to
    answer any questions.
        [The statement follows:]
                 Prepared Statement of Christopher Sager, Ph.D.
        Conflict is, and will remain, essentially a human activity in which
    man's virtues of judgment, discipline and courage--the moral component
    of fighting power--will endure . . . It is difficult to imagine
    military operations that will not ultimately be determined through
    physical control of people, resources and terrain--by people . . .
    Implicit, is the enduring need for well-trained, well-equipped and
    adequately rewarded soldiers. New technologies will, however, pose
    significant challenges to the art of soldiering: they will increase the
    soldier's influence in the battlespace over far greater ranges, and
    herald radical changes in the conduct, structures, capability and ways
    of command. Information and communication technologies will increase
    his tempo and velocity of operation by enhancing support to his
    decision-making cycle. Systems should be designed to enable the soldier
    to cope with the considerable stress of continuous, 24-hour, high-tempo
    operations, facilitated by multi-spectral, all-weather sensors.
    However, technology will not substitute human intent or the decision of
    the commander. There will be a need to harness information-age
    technologies, such that data does not overcome wisdom in the
    battlespace, and that real leadership--that which makes men fight--will
    be amplified by new technology. Essential will be the need to adapt the
    selection, development and training of leaders and soldiers to ensure
    that they possess new skills and aptitudes to face these challenges.
    NATO RTO-TR-8, Land Operations in the Year 2020

        Mr. Chairman and Members of the Subcommittee, I'm Dr. Christopher
    Sager from the Human Resources Research Organization. I am submitting
    testimony on behalf of the American Psychological Association (APA), a
    scientific and professional organization of more than 150,000
    psychologists and affiliates. Although I am sure you are aware of the
    large number of psychologists providing clinical services to our
    military members here and abroad, you may be less familiar with the
    extraordinary range of research conducted by psychological scientists
    within the Department of Defense. Our behavioral researchers work on
    issues critical to national defense, particularly with support from the
    Army Research Institute (ARI) and Army Research Laboratory (ARL); the
    Office of Naval Research (ONR); and the Air Force Research Laboratory
    (AFRL). I would like to address the proposed cuts to the fiscal year
    2005 human-centered research budgets for these military laboratories
    within the context of the larger Department of Defense Science and
    Technology budget.
    Department of Defense (DOD) Science and Technology Budget
        The President's budget request for basic and applied research at
    DOD in fiscal year 2005 is $10.55 billion, a 12.7 percent decrease from
    the enacted fiscal year 2004 level. APA joins the Coalition for
    National Security Research (CNSR), a group of over 40 scientific
    associations and universities, in urging the Subcommittee to provide
    DOD with $12.05 billion for 6.1, 6.2 and 6.3 level research in fiscal
    year 2005. This figure also is in line with recommendations of the
    independent Defense Science Board and the Quadrennial Defense Review,
    the latter calling for ``a significant increase in funding for S&T
    programs to a level of three percent of DOD spending per year.''
        As our nation rises to meet the challenges of a new century,
    including current engagements in Iraq and Afghanistan as well as other
    asymmetric threats and increased demand for homeland defense and
    infrastructure protection, enhanced battlespace awareness and
    warfighter protection are absolutely critical. Our ability to both
    foresee and immediately adapt to changing security environments will
    only become more vital over the next several decades. Accordingly, DOD
    must support basic Science and Technology (S&T) research on both the
    near-term readiness and modernization needs of the department and on
    the long-term future needs of the warfighter.
        Despite substantial appreciation for the importance of DOD S&T
    programs on Capitol Hill, and within independent defense science
    organizations such as the Defense Science Board (DSB), total research
    within DOD has remained essentially flat in constant dollars over the
    last few decades. This poses a very real threat to America's ability to
    maintain its competitive edge at a time when we can least afford it.
    APA, CNSR and our colleagues within the science and defense communities
    recommend funding the DOD Science and Technology Program at a level of
    at least $12.05 billion in fiscal year 2005 in order to maintain global
    superiority in an ever-changing national security environment.
    Behavioral Research within the Military Service Labs
        In August, 2000 the Department of Defense met a congressional
    mandate to develop a Report to the Senate Appropriations Committee on
    Behavioral, Cognitive and Social Science Research in the Military. The
    Senate requested this evaluation due to concern over the continuing
    erosion of DOD's support for research on individual and group
    performance, leadership, communication, human-machine interfaces, and
    decision-making. In responding to the Committee's request, the
    Department found that ``the requirements for maintaining strong DOD
    support for behavioral, cognitive and social science research
    capability are compelling'' and that ``this area of military research
    has historically been extremely productive'' with ``particularly high''
    return on investment and ``high operational impact.''
        Despite the critical need for strong research in this area, the
    Administration has proposed an fiscal year 2005 defense budget that
    would slash funding for human-centered research by 12 percent. Army,
    Navy and Air Force basic behavioral research would remain essentially
    flat in fiscal year 2005, and both the Air Force and Army would sustain
    deep, detrimental cuts to their applied behavioral research programs.
    APA urges the Committee to, at a minimum, restore funding for human-
    centered research at the fiscal year 2004 level of $477.89 million.
        Within DOD, the majority of behavioral, cognitive and social
    science is funded through the Army Research Institute (ARI) and Army
    Research Laboratory (ARL); the Office of Naval Research (ONR); and the
    Air Force Research Laboratory (AFRL). These military service
    laboratories provide a stable, mission-oriented focus for science,
    conducting and sponsoring basic (6.1), applied/exploratory development
    (6.2) and advanced development (6.3) research. These three levels of
    research are roughly parallel to the military's need to win a current
    war (through products in advanced development) while concurrently
    preparing for the next war (with technology ``in the works'') and the
    war after next (by taking advantage of ideas emerging from basic
    research).
        All of the services fund human-related research in the broad
    categories of personnel, training and leader development; warfighter
    protection, sustainment and physical performance; and system interfaces
    and cognitive processing. In addition, there are additional, smaller
    human systems research programs funded through the Office of the
    Secretary of Defense, the Defense Advanced Research Projects Agency
    (DARPA), the Marine Corps, and the Special Operations Command.
        Despite substantial appreciation for the critical role played by
    behavioral, cognitive and social science in national security, however,
    total spending on this research would decrease from $477.89 million
    appropriated in fiscal year 2004 to $421.29 million in the
    Administration's fiscal year 2005 budget, a 12 percent cut. 6.2 level
    applied behavioral research in particular would suffer dramatically
    under the Administration plan. The Air Force's 6.2 program would be cut
    by 19.7 percent, the Army's would be cut by 35 percent, and the Office
    of the Secretary Defense (OSD) program would be cut by 31.3 percent
    (the Navy's program would see a small decrease). In terms of 6.3 level
    research, the Air Force would suffer a 23.4 percent cut and OSD would
    see a 20 percent cut in fiscal year 2005. Basic, 6.1 level human-
    centered research would remain essentially flat as it has for several
    years now.
        Behavioral and cognitive research programs eliminated from the
    mission labs due to cuts or flat funding are extremely unlikely to be
    picked up by industry, which focuses on short-term, profit-driven
    product development. Once the expertise is gone, there is absolutely no
    way to ``catch up'' when defense mission needs for critical human-
    oriented research develop. As DOD noted in its own Report to the Senate
    Appropriations Committee:

        ``Military knowledge needs are not sufficiently like the needs of
    the private sector that retooling behavioral, cognitive and social
    science research carried out for other purposes can be expected to
    substitute for service-supported research, development, testing, and
    evaluation--our choice, therefore, is between paying for it ourselves
    and not having it.''

        The following are brief descriptions of critical behavioral
    research funded by the military research laboratories:
        Army Research Institute for the Behavioral and Social Sciences
    (ARI) and Army Research Laboratory (ARL).--ARI works to build the
    ultimate smart weapon: the American soldier. ARI was established to
    conduct personnel and behavioral research on such topics as minority
    and general recruitment; personnel testing and evaluation; training and
    retraining; and attrition. ARI is the focal point and principal source
    of expertise for all the military services in leadership research, an
    area especially critical to the success of the military as future war-
    fighting and peace-keeping missions demand more rapid adaptation to
    changing conditions, more skill diversity in units, increased
    information-processing from multiple sources, and increased interaction
    with semi-autonomous systems. Behavioral scientists within ARI are
    working to help the armed forces better identify, nurture and train
    leaders. One effort underway is designed to help the Army identify
    those soldiers who will be most successful meeting 21st century
    noncommissioned officer job demands, thus strengthening the backbone of
    the service--the NCO corps.
        Another line of research at ARI focuses on optimizing cognitive
    readiness under combat conditions, by developing methods to predict and
    mitigate the effects of stressors (such as information load and
    uncertainty, workload, social isolation, fatigue, and danger) on
    performance. As the Army moves towards its goal of becoming the
    Objective Force (or the Army of the future: lighter, faster and more
    mobile), psychological researchers will play a vital role in helping
    maximize soldier performance through an understanding of cognitive,
    perceptual and social factors.
        ARL's Human Research & Engineering Directorate sponsors basic and
    applied research in the area of human factors, with the goal of
    optimizing soldiers' interactions with Army systems. Specific
    behavioral research projects focus on the development of intelligent
    decision aids, control/display/workstation design, simulation and human
    modeling, and human control of automated systems.
        Office of Naval Research (ONR).--The Cognitive and Neural Sciences
    Division (CNS) of ONR supports research to increase the understanding
    of complex cognitive skills in humans; aid in the development and
    improvement of machine vision; improve human factors engineering in new
    technologies; and advance the design of robotics systems. An example of
    CNS-supported research is the division's long-term investment in
    artificial intelligence research. This research has led to many useful
    products, including software that enables the use of ``embedded
    training.'' Many of the Navy's operational tasks, such as recognizing
    and responding to threats, require complex interactions with
    sophisticated, computer-based systems. Embedded training allows
    shipboard personnel to develop and refine critical skills by practicing
    simulated exercises on their own workstations. Once developed, embedded
    training software can be loaded onto specified computer systems and
    delivered wherever and however it is needed.
        Air Force Research Laboratory (AFRL).--Within AFRL, Air Force
    Office of Scientific Research (AFOSR) behavioral scientists are
    responsible for basic research on manpower, personnel, training and
    crew technology. The AFRL Human Effectiveness Directorate is
    responsible for more applied research relevant to an enormous number of
    acknowledged Air Force mission needs ranging from weapons design, to
    improvements in simulator technology, to improving crew survivability
    in combat, to faster, more powerful and less expensive training
    regimens.
        As a result of previous cuts to the Air Force behavioral research
    budget, the world's premier organization devoted to personnel selection
    and classification (formerly housed at Brooks Air Force Base) no longer
    exists. This has a direct, negative impact on the Air Force's and other
    services' ability to efficiently identify and assign personnel
    (especially pilots). Similarly, reductions in support for applied
    research in human factors have resulted in an inability to fully
    enhance human factors modeling capabilities, which are essential for
    determining human-system requirements early in system concept
    development, when the most impact can be made in terms of manpower and
    cost savings. For example, although engineers know how to build cockpit
    display systems and night goggles so that they are structurally sound,
    psychologists know how to design them so that people can use them
    safely and effectively.
    Summary
        On behalf of APA, I would like to express my appreciation for this
    opportunity to present testimony before the Subcommittee. Clearly,
    psychological scientists address a broad range of important issues and
    problems vital to our national security, with expertise in
    understanding and optimizing cognitive functioning, perceptual
    awareness, complex decision-making, stress resilience, and human-
    systems interactions. We urge you to support the men and women on the
    front lines by reversing another round of dramatic, detrimental cuts to
    the human-oriented research within the military laboratories.
        Below is suggested appropriations report language which would
    encourage the Department of Defense to fully fund its behavioral
    research programs within the military laboratories:
                             department of defense
        Behavioral Research in the Military Service Laboratories.--The
    Committee recognizes that psychological scientists address a broad
    range of important issues and problems vital to our national security
    through the military research laboratories: the Air Force Office of
    Scientific Research, the Army Research Institute and Army Research
    Laboratory, and the Office of Naval Research. Given the increasingly
    complex demands on our military personnel, psychological research on
    leadership, decision-making under stress, cognitive readiness,
    training, and human-technology interactions have become even more
    mission-critical, and the Committee strongly encourages the service
    laboratories to reverse cuts made to their behavioral research
    programs. A continued decline in support for human-centered research is
    not acceptable at a time when there will be more, rather than fewer,
    demands on military personnel, including more rapid adaptation to
    changing conditions, more skill diversity in units, increased
    information-processing from multiple sources, and increased interaction
    with semi-autonomous systems.

        Senator Stevens. Well, we will look into that cut. It is
    sort of a different type of reduction. We do not have any
    support for it yet, but we will inquire into it.
        Senator Inouye.
        Senator Inouye. Mr. Chairman, recently our attention has
    been focused on prisoner abuse. Would your studies have been
    able to detect flaws in one's character?
        Dr. Sager. Senator Inouye, that is an excellent question. A
    lot of the research I am personally involved with has to do
    with the personal characteristics required of enlisted soldiers
    in the Army. Among those are measures of conscientiousness and
    other psychological constructs that are very important to that.
    Yes, I think they would contribute to predicting problems and
    preventing problems in that area. However, research in that
    domain is very difficult and the Army is setting the standards
    in a lot of ways in that domain.
        Senator Inouye. Thank you. Thank you, Mr. Chairman.
        Senator Stevens. Thank you very much. We appreciate your
    testimony.
        Our next witness is Kenneth Galloway, the Dean of
    Vanderbilt University, appearing for the Association of
    American Universities (AAU). Good morning, Dean.
    STATEMENT OF KENNETH F. GALLOWAY, DEAN, SCHOOL OF
                ENGINEERING, AND PROFESSOR OF ELECTRICAL
                ENGINEERING, VANDERBILT UNIVERSITY ON
                BEHALF OF THE ASSOCIATION OF AMERICAN
                UNIVERSITIES
        Dr. Galloway. Good morning. Mr. Chairman, Senator Inouye, I
    am Kenneth F. Galloway, Dean of the School of Engineering and
    Professor of Electrical Engineering at Vanderbilt University. I
    appear before you today on behalf of the Association of
    American Universities which represents 60 of America's most
    prominent public and private research universities. I have
    submitted a statement for the record and will briefly summarize
    the key points.
        I greatly appreciate this opportunity to testify in support
    of basic research and applied research funded in the research,
    development, testing, and evaluation section of the defense
    appropriations bill. I would like to thank Chairman Stevens,
    Ranking Member Inouye, and the members of the subcommittee for
    your past support of defense science and technology programs
    and specifically for basic and applied research sponsored by
    DOD and conducted at our Nation's universities. Your ongoing
    support of these programs is greatly appreciated.
        As the subcommittee begins work on the 2005 defense
    appropriations bill, the AAU offers the subcommittee two major
    recommendations.
        The first recommendation is that the committee support
    defense S&T at a level equal to 3 percent of the total defense
    budget. This has been recommended by both the Defense Science
    Board and the Quadrennial Defense Review. The core S&T programs
    include basic, applied, and advanced technology development,
    the 6.1 and 6.2 and 6.3 items. These investments are important
    to ensuring the technological superiority of America's military
    forces.
        The second recommendation addresses strengthening support
    of basic research. Today that support has declined to less than
    12 percent of DOD S&T funding. This has occurred as DOD has
    shifted some of its focus from support of fundamental, long-
    range research to meeting more immediate, short-term defense
    objectives.
        In the early 1980's the basic research portion was nearly
    20 percent of total defense S&T. The AAU supports increasing
    the competitively awarded defense research sciences and
    university research initiative program elements in 2005 by $95
    million. The association also endorses continued growth and
    applied research at the 4.6 percent rate approved by Congress
    last year.
        Now, why do we think these recommendations are important?
    DOD-funded research at universities is concentrated in fields
    where advances are most likely to contribute to national
    defense. DOD accounts for 68 percent of Federal funding for
    university research in electrical engineering, 32 percent for
    computer sciences, 50 percent for material science and
    engineering, more than 50 percent for mechanical engineering,
    and 29 percent for ocean sciences. Additionally, DOD provides a
    significant amount of support for graduate students in critical
    defense fields.
        Examples of technologies in use today that have benefitted
    from university-based research include the global positioning
    system, GPS; the thermobaric bomb, or bunker buster; laser
    targeting systems that give us precision weapons; lightweight
    body armor; radar-evading materials, the internet; night vision
    and thermal imaging; unmanned aerial vehicle control; bio and
    chemical sensors. DOD investments in basic and applied research
    made these technologies available to the warfighter today.
        Many research efforts underway at universities and national
    laboratories around the country will lead to development of new
    technologies that will ensure our Nation's military superiority
    tomorrow.
        To conclude, the Nation must not sell short tomorrow's
    warfighters by undercutting research today. The AAU urges the
    subcommittee to strongly support the basic and applied science
    behind the best fighting force in the world.
        Again, I would like to thank the subcommittee for continued
    support of the Department of Defense research and urge members
    to sustain and grow the S&T programs that make such an
    important contribution to our national security. Thank you very
    much.
        [The statement follows:]
                   Prepared Statement of Kenneth F. Galloway
        Mr. Chairman and members of the subcommittee: I am Kenneth F.
    Galloway, Dean of the School of Engineering and Professor of Electrical
    Engineering at Vanderbilt University. I appear before you today on
    behalf of the Association of American Universities, which represents 60
    of America's most prominent public and private research universities in
    the United States.
        I greatly appreciate this opportunity to testify today in support
    of basic research (6.1) and applied research (6.2) funded in the
    Research, Development, Testing and Evaluation (RDT&E) section of the
    Department of Defense (DOD) appropriations bill. I would also like to
    thank Chairman Stevens, Ranking Member Inouye, and the members of the
    subcommittee for past support of Defense Science and Technology (S&T)
    programs and specifically for basic and applied research sponsored by
    DOD and conducted at our nation's universities. Your ongoing support of
    these programs is recognized and greatly appreciated.
        As the subcommittee begins its work on the fiscal year 2005 defense
    appropriations bill, the AAU offers the subcommittee two major
    recommendations.
        Support Defense S&T at 3 percent of the total defense budget.--AAU
    supports recommendations by the Defense Science Board (1998) and the
    Quadrennial Defense Review (2001) to devote 3 percent of the DOD budget
    to core S&T programs. The core S&T programs include basic (6.1) and
    applied (6.2) research and advanced technology development (6.3) in the
    Army, Navy, Air Force, and Defense-Wide accounts. These investments are
    key to ensuring the future safety and technological superiority of
    America's military forces.
        Strengthen support of basic research.--In the early 1980's, basic
    research accounted for nearly 20 percent of total defense S&T funding.
    Today, that support has declined to less than 12 percent, as DOD has
    shifted some of its focus from support of fundamental, long-term
    research to meeting more immediate and short-term defense objectives.
        To begin to restore basic research funding to its effective
    historic levels, AAU supports increasing the competitively awarded
    Defense Research Sciences and University Research Initiative program
    elements in fiscal year 2005 by $95 million. The association also
    endorses continued growth in applied research at the 4.6 percent rate
    approved by Congress last year, which would be an increase of
    approximately $205 million.
    Why defense research is important to universities (and universities are
            important to defense research)
        DOD is the third largest federal sponsor of university-based
    research after the National Institutes of Health and the National
    Science Foundation. More than 300 universities and colleges conduct
    DOD-funded research and development. Universities receive more than 54
    percent of defense basic research funding and a substantial portion of
    defense applied research support.
        DOD funded research to universities is concentrated in fields where
    advances are most likely to contribute to national defense. DOD
    accounts for 68 percent of federal funding for university electrical
    engineering, 32 percent for computer sciences, 50 percent for
    metallurgy and materials engineering, and 29 percent for ocean
    sciences. DOD also sponsors fellowships and provides a significant
    amount of support for graduate students in critical defense fields such
    as computer science and aerospace and electrical engineering.
    Why investing in DOD research is important to the nation
        If we do not invest adequately in DOD research, we will delay or
    even prevent the development of technologies that would provide
    critical protection to our future warfighters and make them more
    effective in the field. We need only look at how past knowledge and
    discoveries generated at U.S. universities have made major
    contributions to the nation's defense efforts. Examples of technologies
    used by troops today include the following.
      --The Global Positioning System (GPS) is one of the greatest assets
            to the modern warfighter. GPS provides a precision of location
            that was unimaginable decades ago, enabling military leaders to
            pinpoint targets in a way that increases lethality and
            minimizes collateral damage. The system also enables commanders
            to know the precise location in the field of their human and
            material assets. This crucial battlefield resource was
            developed from fundamental physics research in atomic clocks.
      --The Thermobaric Bomb, or the ``bunker buster,'' has been used in
            recent military campaigns in Afghanistan and Iraq. The new
            technology was transformed from a laboratory concept to an
            operational battlefield technology in less than three months.
            As Rear Admiral Jay Cohen of the Office of Naval Research noted
            in his statement for a hearing of the Senate Emerging Threats
            and Capabilities Subcommittee in April, 2002: ``Such speed was
            possible because the science was done before the need became
            urgent.''
      --The ability of today's soldiers to fight in urban environments has
            been profoundly increased by the use of lightweight and easily
            deployed laser targeting systems. Troops today can discreetly
            and precisely target a location, providing a critical
            capability for increasingly frequent urban conflicts. Decades
            ago, military research offices supported the fundamental
            research that led to the development of the laser.
      --Lightweight Body Armor, a new technology developed for the
            Department of Defense, can stop 30-caliber armor piercing
            bullets yet has an aerial density of only 3.5 pounds per square
            foot. To make the new self-adjusting reinforced helmets and
            body armor, which can be tailored to fit the mission,
            researchers used a new boron-carbide ceramic plate that weighs
            10 to 30 percent less than conventional armor and delivers
            equal or greater protection.
        There are many other examples of discoveries and technologies made
    possible through university-based defense basic research:
      --THE INTERNET started as ARPANET, which connected major universities
            through the world's first packet-switched network. This
            technology translated into a robust communications network
            designed to protect the nation in the event of full attack.
      --NIGHT VISION and thermal imaging technology make it possible for
            the U.S. Army to use forward-looking infrared detectors to spot
            enemy forces and roll into combat in pitch-blackness.
      --UNMANNED AERIAL VEHICLES enable the warfighter to effectively and
            affordably suppress enemy air defenses and conduct surveillance
            missions without placing pilots at risk. University researchers
            recently executed the most complex maneuver ever performed by
            an unpiloted helicopter. This breakthrough could provide a new
            tool for military reconnaissance and weapons delivery in
            challenging terrains such as mountainous and urban areas.
      --BIO-SENSORS detect the presence of a biological or chemical agent.
            University researchers helped design a sensor that can
            determine the presence of anthrax spores, enabling officials to
            differentiate quickly between hoaxes and real threats.
        Many research projects underway at universities and national labs
    around the country will lead to development of new technologies to
    ensure the nation's military superiority in the future. For example, at
    Vanderbilt University, our AFOSR-supported research on Survivable
    Electronics for Space and Defense Systems is leading to more resilient
    microelectronic devices to be used in defense systems. These devices
    are susceptible to damage and mission failure from radiation emanating
    from a variety of sources. Vanderbilt research will enable electronics
    designers to develop more reliable systems for defense applications and
    to deploy more advanced technologies in challenging radiation
    environments.
        Another example of Vanderbilt research, sponsored by DARPA funding,
    is the Monopropellant-Powered Actuation for a Powered Exoskeleton
    Project. Vanderbilt researchers are developing a lightweight system to
    power and control a wearable structure that will enable warfighters to
    carry up to 300 pounds for 12 hours. This power system uses high-
    intensity hydrogen peroxide to deliver many times more power than
    batteries, at manageable temperatures, with completely benign emissions
    of water and oxygen.
        Other examples of DOD sponsored research occurring at other
    universities around the county include:
      --Semiconductors--The United States has been able to capitalize on
            increased computing capacity to provide an economic and
            military edge over other countries. But the U.S. computer-chip
            industry is quickly approaching the physical limits of the
            chip-making process. Without major research advances, the
            semiconductor industry's ability to sustain the pace of
            innovation could come to a halt in 10-15 years.
      --Nanotechnology research promises both miniaturization of existing
            equipment and the potential for new materials, properties, and
            devices. Much of the current research is focused on improving
            the survival and comfort of soldiers. The 140-pound pack and
            cotton fatigues worn by infantry today could be transformed
            into a lightweight battlesuit able to protect the warfighter
            from enemy and environmental threats. At the same time, these
            suits could monitor health, help treat injuries, enable
            communications, and enhance performance.
      --Explosives Detection Devices are an example of basic research
            efforts where additional investments are still needed. Nuclear
            quadropole resonance (NQR) technology detects and identifies
            specific molecules, such as nitrogen, in explosives. The
            technology has been adapted to detect landmines, roadside
            explosives, and terrorist bombs in such places as Bosnia and
            Iraq. But more research is needed to further transform and
            refine the military's traditional explosive detection systems.
      --Self-Healing Technology research addresses medical limitations on
            the battlefield, including a lack of supplies, diagnostic and
            life-support equipment, and time for treatment. Research
            efforts underway will accelerate healing time and reduce
            casualties.
                                   conclusion
        The nation must not sell short tomorrow's warfighters by
    undercutting research today. AAU urges the subcommittee to strongly
    support the basic and applied science behind the best fighting force in
    the world.
        Again, I would like to thank the subcommittee for its continued
    support of Department of Defense research and urge members to sustain
    and grow the S&T programs that make such an important contribution to
    our national security.

        Senator Stevens. Well, Dean, you raise an interesting
    conundrum because very clearly we have some systems coming on
    that we will have to postpone if we do not cut other places. We
    have the F-22, the V-22, Stryker, the Joint Strike Fighter. I
    think you make a good point, but on the other hand, none of the
    research you are talking about will be available by the time we
    either win or lose completely the war on terrorism in the
    Middle East. So I think you have requested a very difficult
    thing from us. The decision to defer basic research and instead
    apply the funding to moving new equipment like the armored high
    mobility multi-purpose wheeled vehicle (HMMWV), et cetera is a
    very clear decision Congress has already made. But we will look
    at your request.
        Dr. Galloway. I understand it is a very difficult time.
        Senator Stevens. It is difficult.
        Senator Inouye.
        Senator Inouye. The military has done well in developing
    body armor technology, and as a result, comparatively there are
    very few thoracic injuries. But we have an overabundance of
    amputations of all limbs, plus head injuries. Are you
    researching anything that would cover arms, legs, heads?
        Dr. Galloway. Senator, I am not aware of that work, but I
    will look into that and find you a reply.
        Senator Inouye. Thank you, sir.
        Senator Stevens. The Senator is correct. We noticed just an
    overwhelming change in the type of injuries that our people are
    coming home with. They are coming home, but they are coming
    home minus a lot of limbs and real serious head injuries, eye
    injuries. We have got to develop a better protection overall
    for our people. That type of basic research certainly would
    support.
        Thank you very much, Dean.
        Dr. Galloway. Thank you.
        Senator Stevens. We will now turn to Master Chief Joseph
    Barnes, United States Navy. He appears as the National
    Executive Secretary for the Fleet Reserve Association. Good
    morning, Chief.
    STATEMENT OF MASTER CHIEF JOSEPH L. BARNES, USN (RET.),
                NATIONAL EXECUTIVE SECRETARY, FLEET RESERVE
                ASSOCIATION
        Mr. Barnes. Good morning, Mr. Chairman. Mr. Chairman,
    Senator Inouye, and other distinguished members of the
    subcommittee, the Fleet Reserve Association (FRA) appreciates
    the opportunity to present its views on the 2005 defense
    budget. My name is Joe Barnes. I am the National Executive
    Secretary for the Fleet Reserve Association and also co-chair
    of the Military Coalition's Personnel Committee.
        Before I address several priority issues, I want to thank
    this distinguished subcommittee for its leadership, support,
    and strong commitment to important quality of life programs
    benefitting servicemembers, reservists, military retirees and
    their families.
        FRA strongly recommends full funding for the defense health
    program and adequate appropriations to continue revitalizing
    the TRICARE Standard program. The association also believes
    TRICARE should be available for all reservists and their
    families on a cost-sharing basis. When finally implemented, the
    temporary Reserve health care program will provide coverage
    only through December 2004 for reservists who are unemployed or
    do not have employer-sponsored health care. FRA urges
    appropriations to make this program permanent and that it
    become the basis for a broader program for all reservists.
        FRA also supports appropriations necessary to implement the
    3.5 percent across-the-board increase on January 1, 2005.
        The association also strongly supports continued progress
    toward closing the military pay gap. Unfortunately, DOD's
    proposal for targeted pay increases for senior enlisted
    personnel and certain officer grades were not included in the
    administration's budget request. At a minimum, FRA supports
    funding pay increases at least comparable to the annual
    employment cost index.
        Adequate service end strengths are important to maintaining
    readiness. If force size is inadequate and OPTEMPO too heavy,
    the performance of individual servicemembers is affected. FRA
    believes that there are inadequate numbers of uniformed
    personnel to sustain the war effort and other operational
    commitments. This situation also creates considerable stress on
    the families of service personnel. It appears that DOD is very
    concerned with the cost of personnel, to the extent that it is
    reluctant to increase service end strengths.
        The military survivor benefit plan provides an annuity to
    surviving spouses equal to 55 percent of covered retired pay.
    This amount is reduced to 35 percent when the beneficiary
    begins receiving Social Security. FRA was instrumental in the
    enactment of this program in the early 1970's and strongly
    supports reform legislation to increase the annuity and funding
    the program at the intended 40 percent level rather than the
    current level of approximately 19 percent.
        When authorized, FRA supports funding for full concurrent
    receipt of military retired pay and VA disability compensation,
    increased Reserve Montgomery G.I. Bill (MGIB) education
    benefits which are currently funded well below the authorized
    level, funding for family awareness and support and spouse
    employment opportunities, which are integral to the well-being
    and retention of the active and Reserve servicemembers, and
    supplemental Impact Aid funding for school districts with large
    numbers of military-sponsored students.
        FRA strongly supports funding to maintain the commissary
    benefit at the current level and restates its continuing
    opposition to privatization.
        Finally, FRA advocates retention of the full, final months
    retired pay by the retiree's surviving spouse and the extension
    of the dislocation allowance to retiring servicemembers.
        If authorized, the association asks for your support for
    these proposals which have also been endorsed by the Military
    Coalition. Thank you again, Mr. Chairman, for the opportunity
    to present the association's recommendations for fiscal year
    2005.
        Senator Stevens. Thank you very much, Chief. That is a long
    list. Some of us who have been around for a while understand
    continuing to pay into a retirement fund, but that has been
    tried before. It has really not been accepted by Congress so
    far.
        Senator Inouye.
        Senator Inouye. Well, Mr. Chairman, we all recognize the
    heavy reliance upon Reserves and Guards in this war, so I can
    assure you that we are looking at this very carefully.
        Mr. Barnes. Thank you, Senator.
        Senator Stevens. Thank you very much, Chief.
        [The statement follows:]
              Prepared Statement of Master Chief Joseph L. Barnes
                                  introduction
        Mr. Chairman and other distinguished Members of the Subcommittee:
    The Fleet Reserve Association (FRA) is grateful for the opportunity to
    present its military personnel goals for fiscal year 2005. Before
    continuing, I want to express deep appreciation on behalf of the
    Association's membership for the quality of life improvements
    implemented over the past few years for our Nation's men and women in
    the Uniformed Services. What this august group has done for our active
    duty, reserve, and retired service members is not only superlative but
    unusually generous for Congress in comparison with the previous two to
    three decades.
        In the active force, the plea is for increased funding to
    compensate for the arduous operational and personal tempos thrust upon
    the members of the uniformed services. Others prefer better housing,
    perhaps increased child-care programs, or any of the many programs and
    benefits available to them and their families. Reservists support
    enhanced retirement benefits, special pays, and increased MGIB
    proceeds. The retired community seeks funding for the Uniformed
    Services Survivor Benefit Plan (USSBP), full concurrent receipt of
    military retirement pay and VA service connected payments, and a
    reasonable access to health care services.
                             active duty component
        Pay.--Always number one in most surveys completed by FRA and the
    active forces is pay. This distinguished Subcommittee, alerted to this
    fact for the past six years, has improved compensation that, in turn,
    enhanced the recruitment and retention of uniformed personnel in an
    all-volunteer environment. Adequate and targeted pay increases for
    middle grade and senior petty and noncommissioned officers have
    contributed to improved morale and readiness. With a uniformed
    community that is more than 50 percent married, satisfactory
    compensation relieves much, if not all the tension brought on by
    operational and personal tempos.
        For fiscal year 2005, the Administration has recommended a 3.5
    percent across the board basic pay increase for members of the Armed
    Forces. This is commensurate with the 1999 formula to provide increases
    of 0.5 percentage points greater than that of the previous year for the
    private sector. With the addition of targeted raises, the formula has
    reduced the pay gap with the private sector from 13.5 percent to 5.2
    percent following the pay increase programmed for January 1, 2005.
        FRA, however, is disappointed that the Office of Management and
    Budget (OMB) is opposed to targeted pay increases for certain enlisted
    and officer pay grades. This in the face of the Defense Department's
    projected recommendation to affect targeted pays along the line of
    those authorized for fiscal year 2004. Targeting pay hikes for fiscal
    year 2005 and fiscal year 2006 will aide the Department's quest to
    increase basic pay for career personnel to equal those in the private
    sector earned by workers having similar education and experience
    levels.
        FRA urges the Subcommittee to fund the authorized pay increase for
    fiscal year 2005, and ensure that uniformed members of the Public
    Health Service (USPHS) are included in the pay increase.
                               retired component
        Survivor Benefit Plan.--FRA has experienced a greater concern for
    improving the Uniformed Services Survivor Benefit Program (USSBP) than
    any issue on its website (www.fra.org). With an average age of 68 on
    the Association's membership roll, the concern is justified. Most
    convincing is the need to revise the language in the current Plan to
    reduce the ``social security offset'' that penalizes annuitants at a
    time when the need is the greatest. Then there are the many members,
    age 70 and older, who have been paying into the Plan for more than 30
    years with the only relief more than four years into the future.
        Although Congress has adopted a time for USSBP participants to halt
    payments of premiums (when payments of premiums equal 30 years and the
    military retiree is 70 years of age) the date is more than four years
    away. Military retirees enrolling on the initial enrollment date (1972)
    will this September be paying premiums for 32 years, by 2008, thirty-
    six years.
        FRA recommends and urges the Subcommittee to provide funding for
    the restoration of the value of service members participating in the
    Uniformed Services Survivor Benefit Plan (USSBP) by increasing the
    survivor annuity over a ten-year period to 55 percent, and the date
    2008 to October 31, 2004 when certain participants attaining the age of
    70 and having made payment to the Plan for at least 30 years are no
    longer required to make such payments.
        Basic Allowance for Housing (BAH).--In concert with The Military
    Coalition, FRA supports revised housing standards that are more
    realistic and appropriate for each pay grade. Many enlisted personnel
    are unaware of the standards for their respective pay grade and assume
    they are entitled to a higher standard than authorized.
        FRA extends appreciation to the Subcommittee for acting a few years
    ago to reduce out-of-pocket housing expenses for service members.
    Responding to the Subcommittee's leadership on this issue, the
    Department of Defense proposed a similar phased plan to reduce median
    out-of-pocket expenses to zero by fiscal year 2005. This aggressive
    action to better realign BAH rates with actual housing costs is having
    a real impact and providing immediate relief to many service members
    and families who are strapped in meeting rising housing and utility
    costs.
        The Association applauds the Subcommittee's action, and is in hope
    that this plan is funded for fiscal year 2005. Unfortunately, housing
    and utility costs will become more expensive, and the pay comparability
    gap, while diminished over recent years--thanks to the Subcommittee's
    leadership--continues to widen. Members residing off base face higher
    housing costs, along with significant transportation costs, and relief
    is especially important for junior enlisted personnel who do not
    qualify for other supplemental assistance.
        FRA urges the Subcommittee to provide the necessary appropriations
    to eliminate out-of-pocket housing expenses in fiscal year 2005.
        Basic Allowance for Subsistence (BAS).--FRA is grateful for the
    establishment of a food-cost-based standard for BAS and repealing the
    one percent cap on BAS increases. There is more to be done to permit
    single career enlisted members greater individual responsibility in
    their personal living arrangements. In this regard, the Association
    believes it is inconsistent to demand significant supervisory,
    leadership and management responsibilities of noncommissioned and petty
    officers, but still dictate to them where and when they must eat their
    meals while at their home duty station.
        FRA urges the Subcommittee to fund the necessary appropriations to
    repeal the statutory provision limiting BAS eligibility to 12 percent
    of single members residing in government quarters.
        Force Size/Readiness/OPTEMPO/PERSTEMPO.--Force size, readiness,
    OPTEMPO, and PERSTEMPO should be addressed simultaneously. Readiness
    cannot be achieved at the high level demanded if force size is
    inadequate in numbers, OPTEMPO is too heavy and PERSTEMPO is affecting
    the performance of individual service members. FRA believes that all
    are suffering due to a shortage of uniformed members. Once again, DOD
    apparently is so concerned with the cost of personnel that it is
    reluctant to increase manpower strengths when it's obvious to FRA and
    others there is a need for more troops. If DOD says there is no
    requirement for more troops than authorized, then why did three of the
    military services recently issued stop-loss orders to many of their
    uniformed personnel? ``It reflects the fact that the military is too
    small,'' says Charles Moskos, a leading military sociologist, ``which
    nobody wants to admit.''
        The Department played an integral role in having Congress give
    birth to the All-Volunteer Force. As such, it must stay the course
    realizing that people who volunteer to lay down their lives and limbs
    will not do so at the same level of compensation offered their
    predecessors of the WWII-Vietnam era. Today 50 percent or more of our
    military personnel are married and have families. It costs money to
    enfold these families under the military's social umbrella. If the
    United States desires an all-volunteer armed force, it will have to pay
    the price. Paying the price will allow the Department to increase the
    size of its uniformed force in order to relieve the pressure of lengthy
    deployments, long hours on duty, and family concerns, each having its
    own negative effect on readiness. One service chief stated that he
    would spend every dollar available to ``modernize'' his service (how
    many years now?), but not one cent more for people. Such a statement
    seems incredible when one knows historically that final victory is in
    the hands of the people.
        FRA recommends that the military services be afforded the
    opportunity to determine the size of its forces and the number of
    personnel necessary to perform the mission. However, when it appears
    that an increase is captive to the choice of more weapons systems over
    manpower, Congress should appropriate adequate funds to add more
    uniformed numbers to the strength of the armed forces.
        Impact Aid.--FRA is most appreciative for the Impact Aid authorized
    in previous Defense measures but must urge this Subcommittee and its
    full Committee to support a substantial increase in the funding for
    schools bearing the responsibility of educating the children of
    military personnel and federal employees. Current funds are not
    adequate to ably support the education of federally sponsored children
    attending civilian community elementary schools. Over the years,
    beginning with the Nixon Administration, funding for Impact Aid has
    decreased dramatically. For example, in the current fiscal year the
    Military Impacted Schools Association (MISA) estimates Impact Aid is
    funded at only 60 percent of need according to law. Our children should
    not be denied the best in educational opportunities. Impact Aid
    provides a quality education to the children of our Sailors, Marines,
    Coast Guardsmen, Soldiers, and Airmen.
        FRA implores Congress to accept the responsibility of fully funding
    the military Impact Aid program. It is more important now to ensure our
    service members, many serving in harm's way, they have little to
    concern with their children's future but more to do with the job at
    hand.
        Dislocation Allowance (DLA).--Moving households on government
    orders can be costly. Throughout a military career, service members
    endure a number of permanent changes of station (PCS). Too often each
    move requires additional expenses for relocating to a new area far
    removed from the service members' current location.
        Odd as it may appear, service members preparing to retire from the
    Armed Forces are not eligible for dislocation allowances, yet many are
    subject to the same additional expenses they experienced when effecting
    a permanent change of station during the 20 or more years of active
    duty spent earning the honor to retire. In either case, moving on
    orders to another duty station or to retire are both reflective of a
    management decision. Retiring military personnel after completing 20
    years of service is advantageous to the Armed Forces. It opens the
    ranks to much younger and healthier accessions.
        FRA recommends appropriating funds for the payment of dislocation
    allowances to members of the Armed Forces retiring or transferring to
    an inactive duty status such as the Fleet Reserve or Fleet Marine
    Reserve, who perform a ``final change of station'' move of 50 or more
    miles.
        MGIB-SR.--The Selected Reserve MGIB has failed to maintain a
    creditable rate of benefits with those authorized in Title 38, Chapter
    30. Other than cost-of-living increases, only two improvements in
    benefits have been legislated since 1985. In that year MGIB rates were
    established at 47 percent of active duty benefits. This past October 1,
    the rate fell to 27 percent of the Chapter 30 benefits. While the
    allowance has inched up by only 7 percent since its inception, the cost
    of education has climbed significantly.
        FRA stands four square in support of the Nation's Reservists. To
    provide an incentive for young citizens to enlist and remain in the
    Reserves, FRA recommends to Congress the pressing need to enhance the
    MGIB-SR rates for those who choose to participate in the program.
        Concurrent Receipt.--The fiscal year 2003 National Defense
    Authorization Act (NDAA) authorizes a special compensation that
    establishes a beachhead to authorizing full concurrent receipt, a term
    for the payment of both military non-disability retired pay and any VA
    compensation for service-connected disabilities without a reduction in
    one or the other payment. The fiscal year 2004 NDAA expanded the
    beneficiary list to include those retired service members with at least
    a 50 percent compensatory service-connected disability. Although FRA is
    appreciative of the effort of Congress to address the issue, it fails
    to meet the resolution adopted by the Association's membership to seek
    full compensation for both length-in-service military retirement and VA
    compensation. Currently, the receipt of VA compensation causes a like
    reduction to a retired service member's military retired pay. This
    leads to the belief, and well-deserved, that retired service members,
    earning retired pay as a result of 20 years or more of service, are
    forced to pay for their own disablement.
        Most disabilities are recognized after the service member retires.
    Some are discovered while the member is still performing active duty or
    as the result of a retirement physical. However, it is to the benefit
    of the Department of Defense to retire the member without compensation
    for any disability. Instead, the member is directed to the Department
    of Veterans' Affairs for compensatory relief for the damages incurred
    by the member while serving the Nation in uniform.
        FRA encourages Congress to take the helm and fully fund concurrent
    receipt of military non-disabled retirement pay and veterans'
    compensation program as currently offered in S. 392 introduced by
    Senator Harry Reid (Nev.). Congress should remember that U.S. service
    members, more so than any collective group, not only had a major hand
    in the creation of this Nation, but have contributed for more than 227
    years to the military and economic power of the United States.
        Cost of Living Adjustments (COLA).--Recent threats to curtail or
    halt cost of living adjustments (COLAs) have been lobbed in the
    direction of military retired pay and related payments such as survivor
    benefit annuities. Once again, Congress is urged to keep its promise
    that military retired pay will maintain its purchasing power based on
    increases in the Consumer Price Index (CPI).
        One must recall that the wisdom of Congress initiated the COLA
    program in lieu of the ``re-computation'' system. Re-computation was a
    term used to describe adjustments to military retired pay prior to the
    1970s. Military retirees received retirement pay adjustments each time
    active duty pay was increased. This system guaranteed the service
    member if he/she retired at a certain percentage of active duty pay,
    that pay would maintain the same percentage factor to active duty pay
    throughout retirement. In 1963, Congress--concerned with a heightened
    number of retired WWII members on the retired roll--decided to switch
    to the CPI method.
        Conversely, COLA protection is the paramount reason military
    retirees make an irrevocable decision to elect significant reductions
    in retired pay to provide surviving spouses and children with an
    annuity following the retiree's death. The most compelling reason for
    the decision is that the guaranteed inflation protection made the
    Uniformed Services Survivor Benefit Plan (USSBP) a superior alternative
    to life insurance policies. The sequestration of COLA funds violate
    that guarantee and greatly diminishes the value of the USSBP.
        FRA recommends that Congress--if it reduces the fiscal year 2005
    budget--not target military and federal retirees' retirement pay. Such
    action is discriminating and contrary to the promise made by Congress
    to maintain the purchasing power of military retirement pay. Full
    funding for the Defense Health Budget: Once again, a top FRA priority
    is to work with Congress and DOD to ensure full funding of the Defense
    Health Budget to meet readiness needs--including Graduate Medical
    Education (GME) and continuing education, full funding of both direct
    care and purchased care sectors, providing access to the military
    health care system for all uniformed services beneficiaries, regardless
    of age, status or location. A fully funded health care benefit is
    critical to readiness and the retention of qualified uniformed service
    personnel.
        FRA is concerned with reports from the Services that the current
    funding level falls short of what is required to meet current
    obligations and that additional supplemental funding will once again be
    required. For example, the association has encountered several
    instances in which local hospital commanders at Malcom Grove Medical
    Center, Andrew Air Force Base, Md. Dewitt Army Medical Center,
    Arlington, Va., Bethesda Naval Medical Center, Bethesda, Md., have
    terminated service for retired beneficiaries, citing budget shortfalls
    as the reason. Health care requirements for members returning from Iraq
    are also expected to strain the military delivery system in ways that
    are not anticipated in the budgeting process.
        Similarly, implementation of the TRICARE Standard requirements in
    fiscal year 2003 Defense Authorization Act--particularly those
    requiring actions to attract more TRICARE providers will certainly
    require additional resources that appear not to be in the current
    budget request.
        The FRA strongly recommends the Subcommittee continue to ensure
    full funding of the Defense Health Program, to include military medical
    readiness, needed TRICARE Standard improvements, and the DOD peacetime
    health care mission. It is critical that the Defense Health Budget be
    sufficient to secure increased numbers of providers needed to ensure
    access for TRICARE beneficiaries in all parts of the country.
        Pharmacy Cost Shares for Retirees.--In 2003, the Office of
    Management and Budget (OMB) and the Defense Department considered a
    budget proposal that envisioned significant increases in retiree cost
    shares for the TRICARE pharmacy benefit, and initiating retiree copays
    for drugs obtained in the direct care system. While the proposal was
    put on hold for this fiscal year, FRA is concerned that DOD is
    undertaking a review that almost certainly will recommend retiree copay
    increases in fiscal year 2006.
        Thanks to the efforts of this Subcommittee, it was less than three
    years ago that Congress authorized the TRICARE Senior Pharmacy Program
    (TSRx). DOD established $3 and $9 copays for all beneficiaries. Defense
    leaders highlighted this at the time as ``delivering the health
    benefits military beneficiaries earned and deserve.'' But the Pentagon
    already has changed the rules and will remove many drugs from the
    uniform formulary and raise the copay on such drugs to $22.
        The FRA vigorously opposes increasing retiree cost shares that were
    only recently established. Congress' recent restoration of retiree
    pharmacy benefits helped restore active duty and retired members' faith
    that their government's health care promises would be kept. If
    implemented, this proposal would undermine that trust, which in the
    long term, can only have adverse affects on retention and readiness.
        The FRA urges the Subcommittee to continue to reject imposition of
    cost shares in military pharmacies and oppose increasing other pharmacy
    cost shares that were recently established.
        Healthcare for Members of the National Guard and Reserve.--The FRA
    is grateful to this Subcommittee for ensuring that the Temporary
    Reserve Health Care Program was included in the fiscal year 2004
    National Defense Authorization Act. This program will provide coverage,
    through December 2004, for National Guard and Reserve members who are
    unemployed or do not have employer-sponsored health care coverage.
    TRICARE officials plan to build on existing TRICARE mechanisms to
    expedite implementation; however, no one is certain how long this will
    take. Immediate implementation is required, and a permanent program
    must be established.
        Health insurance coverage varies widely for members of the Guard
    and Reserve: some have coverage through private employers, others
    through the Federal government, and still others have no coverage.
    Reserve families with employer-based health insurance must, in some
    cases, pick up the full cost of premiums during an extended activation.
    Although TRICARE ``kicks in'' at 30 days activation, many Guard and
    Reserve families would prefer continuity of care through doctors and
    their own health insurance. Being dropped from private sector coverage
    as a consequence of extended activation adversely affects family morale
    and military readiness and discourages some from reenlisting. Many
    Guard and Reserve families live in locations where it is difficult or
    impossible to find providers who will accept new TRICARE patients. The
    FRA urges the authority for federal payment of civilian health care
    premiums (up to the TRICARE limit) for dependents of mobilized service
    members.
        Dental readiness is another important aspect of readiness for Guard
    and Reserve personnel. Currently, DOD offers a dental program to
    Selected Reserve members and their families. During the recent
    mobilization, soldiers with repairable dental problems were having
    teeth extracted at mobilization stations in the interests of time and
    money instead of having the proper dental care administered earlier.
    Congress responded by passing legislation that allows DOD to provide
    medical and dental screening for Selected Reserve members who are
    assigned to a unit that has been alerted for mobilization in support of
    an operational mission, contingency operation, national emergency, or
    war. During the initial mobilization for Operation Iraqi Freedom, the
    average time from alert to mobilization was less than 14 days, not
    sufficient time to improve dental readiness. In some cases, units were
    mobilized before receiving their alert orders. This lack of notice for
    mobilization continues, with many reservists receiving only days of
    notice before mobilizing.
        The TRICARE Dental Plan benefits should be expanded for Guard and
    Reserve service member. This would allow all National Guard and Reserve
    members to maintain dental readiness and alleviate the need for dental
    care during training or mobilization.
        The FRA urges: making the Temporary Reserve Health Care Program
    permanent and expanding coverage to all members of the National Guard
    and Reserve Component and their families on a cost-sharing basis;
    allowing federal payment of civilian health care premiums for the
    families of deployed reservists who choose to keep their civilian
    healthcare; and expansion of the TRICARE Dental Plan for National Guard
    and Reserve service members in order to ensure medical readiness and
    provide continuity of coverage to members of the Selected Reserve.
                                   conclusion
        FRA is grateful for the opportunity to present its goals for fiscal
    year 2005. If there are questions or a need for further information,
    please call Bob Washington, FRA Director of Legislative Programs, at
    703-683-1400.
    STATEMENT OF ARTHUR B. BAGGEROER, MASSACHUSETTS
                INSTITUTE OF TECHNOLOGY ON BEHALF OF THE
                CONSORTIUM FOR OCEANOGRAPHIC RESEARCH AND
                EDUCATION
        Senator Stevens. Our next witness is Arthur Baggeroer. Is
    that right? Is that close enough? He is from the Massachusetts
    Institute of Technology (MIT) and the Consortium for
    Oceanographic Research and Education. Good morning, sir.
        Dr. Baggeroer. Thank you, Senator. Chairman Stevens,
    Senator Inouye, I want to thank you for the opportunity to
    appear before you this morning and for the strong support you
    and your committee have shown for basic research within the
    Navy. My name is Arthur Baggeroer, and I appear on behalf of
    the 76 members of the Consortium on Oceanographic Research,
    which does include the University of Alaska and Hawaii and is
    commonly called CORE.
        I am Ford Professor of Engineering at MIT and one of the
    Secretary of the Navy (SECNAV) Chief of Naval Operations (CNO)
    Chairs for Ocean Science in the Departments of Ocean and
    Electrical Engineering at MIT.
        Since its founding in 1946, the Office of Naval Research
    has been one of the Nation's leading supporters of high-risk,
    cutting-edge basic research. America's oceanographers were and
    continue to be active partners with the Office of Naval
    Research in providing today and tomorrow's sailors and marines
    with the tools necessary to continue to be the finest
    warfighters in the world. However, when we look to the coming
    decades, we are deeply concerned that the Navy's robust support
    for high-risk basic research is deteriorating.
        Bold, high-risk, cutting-edge basic research has been a
    crucial component of the Navy's battlespace superiority for
    many decades. It is easy to enumerate a very long list. Much of
    the research conducted decades ago deployed in the fleet today
    was once high-risk and cutting-edge. None of the researchers
    could have imagined its application in Iraq or Afghanistan. It
    was not focused on specific applications. But without it and
    without the support that made it possible, our soldiers,
    sailors, airmen, and marines would not have had the
    technological edge they enjoy on the battlefield.
        I am sure that you are aware of the global war on terrorism
    is presenting the Navy with new and challenging threats. The
    threats must be addressed by robust support for science and
    technology.
        There are a number of scientific challenges I outlined in
    my written testimony, but I want to take a few moments to
    discuss the threats posed by a couple, the proliferation of
    quiet diesel and electric air independent propulsion submarines
    in littoral operations.
        These vessels or submarines are being purchased by many
    states, the most prevalent being the Russian Kilo 4 class of
    acquired by China and Iran and the German 200 series. These
    boats are as quiet as a modern nuclear class submarine. While
    limited in endurance and speed, they are clearly useful near
    the coastal waters of a country for anti-surface warfare and
    ASW and present a significant threat and challenge. The input
    of basic oceanography, unmanned undersea vehicles and novel
    communications are part of the paradigm for detecting,
    tracking, and localizing these boats. While some of these
    components may emerge as incremental improvements to existing
    ones, the Navy now needs bold technologies to survey in near
    real time the ocean environment, as well as fixed acoustic
    systems to maintain persistent monitoring of important
    operational regions. Enabling these innovations for use by
    future officers are now part of the Office of Naval Research
    (ONR) charter. Reduced commitments to this basic research now
    just mortgages the future for combatting this threat.
        I would also like to note that it is crucial for the Navy
    to maintain a vigorous scientific research program to enhance
    its mine countermeasures in littoral operations.
        Finally, as operations increase in the littorals and the
    adjacent shelves, it is vital that the Navy support the science
    necessary to effectively characterize this region so the fleet
    can effectively operate.
        While basic research has served the warfighter, its
    prominence in the defense S&T portfolio has declined
    dramatically. It is no longer enjoying the robust support it
    did in decades past. In the early 1980's, basic research stood
    at over 17 percent of S&T funding. As we discussed earlier,
    significant payoffs were seen. Unfortunately, now basic
    research stands below 12 percent of the S&T funding. It is
    crucial that we ensure robust support of DOD S&T so that we
    have the capabilities to confront the challenges and threats of
    the future battlefield. It is toward this goal that the basic
    research should be and is directed but also with this goal in
    mind that all funding decisions should be made.
        Specifically, CORE recommends returning the basic research,
    or 6.1, to the end of cold war levels, 16 percent of S&T, by
    fiscal year 2009.
        The new resources associated with these increases should be
    directed to two basic research accounts where the majority of
    the competitively awarded funds are accessible: the university
    research initiative, URI, and the defense research science,
    DRS.
        Since the end of the cold war, basic research has paid its
    part of the peace dividend. As we enter another era of
    prolonged conflict, we strongly urge you to reenergize the
    Department's support for basic research.
        Thank you again for the opportunity to bring these
    important issues to your attention. I welcome the opportunity
    for any questions.
        [The statement follows:]
                   Prepared Statement of Arthur B. Baggeroer
        Chairman Stevens, Ranking Member Inouye, and Members of the Defense
    Subcommittee of the Senate Appropriations Committee, I want to thank
    you for the opportunity to appear before you this morning and for the
    strong support you and your committee have shown for basic research
    within the Navy.
        My name is Arthur B. Baggeroer and I appear of behalf of the 76
    member institutions of the Consortium for Oceanographic Research and
    Education, commonly referred to as CORE. I am the Ford Professor of
    Engineering and Secretary of the Navy/Chief of Naval Operations Chair
    for Ocean Science in the Departments of Ocean and Electrical
    Engineering at the Massachusetts Institute of Technology. Some of
    CORE's other members include Woods Hole Oceanographic Institution, Penn
    State, Texas A&M, Scripps Institution of Oceanography and the
    Universities of Alaska, Hawaii, Southern Mississippi, New Hampshire,
    Texas, South Carolina, and California at San Diego. Our membership
    represents the nucleus of American academic oceanographic research.
        Since its founding in 1946, the Office of Naval Research has been
    one of the nation's leading supporters of high-risk cutting edge basic
    research. The Office has supported the research of fifty Nobel
    laureates. It has participated in breakthrough discoveries in areas
    such as lasers, precision timekeeping, and molecular biology. Without
    question the past five decades have seen the ONR fulfill its mission:
    ``To plan, foster and encourage scientific research in recognition of
    its paramount importance as related to the maintenance of future naval
    power, forced entry capability, and the preservation of national
    security.''
        America's oceanographers were and continue to be active partners
    with the Office of Naval Research in providing today and tomorrow's
    sailors and marines with the tools necessary to continue to be the
    finest warfighters in the world. When we look back at the past fifty
    years, we see a history of courageous investment and bold discoveries
    that paved the path to the end of the Cold War and have provided the
    technology base for today's fleet. However, when we look to the coming
    decades, we are deeply concerned that the Navy's robust support is
    deteriorating.
        Bold, high-risk cutting edge basic research has been a crucial
    component of the Navy's battlespace superiority for decades. For
    example, basic research into packet switching laid the foundation for
    what we know as the Internet and is the fundamental science behind the
    technology underlying net-centric warfare, an increasingly important
    asset to the Navy and Marine Corps.
        As you may know, basic research supported by the Navy led to the
    development of the laser. These discoveries led directly to the advent
    of small, easily handled lasers that allow soldiers, sailors, airmen
    and marines to precisely locate targets and provide coordinates for
    sailors and airmen to deliver munitions to targets.
        All of the underlying research for these systems was high-risk and
    cutting edge when it was conducted decades ago and none of the
    researchers could have imagined its application in Iraq or Afghanistan.
    It was not focused on specific applications. But without it and without
    the support that made it possible, our soldiers, sailors, airmen and
    marines would not have had the technological edge they enjoy on the
    battlefield.
        While the Cold War is thankfully an artifact of history, and many
    of the threats it posed to the Navy have receded, the Global War on
    Terrorism presents the Navy with a new and equally challenging suite of
    threats: threats that must be addressed by robust support for science
    and technology.
        Of particular concern to the Navy are the challenges of littoral
    warfare, the threats posed by submerged mines, and the proliferation of
    quiet diesel submarines. Academic oceanographers are working to help
    the Navy meet all these challenges.
        As you may be aware, sonar system performance in the littoral is
    extremely complex. Presently we cannot reliably predict transmission
    losses, a key component of the sonar equation, in these regions. The
    seabed dominates this problem leading to a ``range curtain''
    attenuating acoustic energy of threat submarines and limiting the
    Navy's detection and tracking capability.
        Better understanding of the geology and geoacoustics of the seabed
    are critical to the successful deployment of ships and sensors. Also
    complicating operations in the littoral is wave phenomena, more
    pronounced in the littoral, which limit sonar performance. Finally,
    ambient noise produced by high density fishing fleets and commerce lead
    to very cluttered displays of the local acoustic environment--
    complicating everything from ASW to the safe surfacing of a submarine.
    Clearly this is a complicated environment for the Navy to operate in.
    Addressing the uncertainties and challenges in this crucial environment
    will require a reinvigorated regime of academic oceanographic research.
        In addition to the challenges posed by littoral combat are the
    threats posed to the fleet by submerged mines. Mine countermeasures and
    clearance is a similarly complicated problem. Currently the Navy faces
    a situation where cheap mines, costing less than $1,000, can impede the
    operation of a battle group or access to a port. Currently, countries
    make mines that appear to be an ``acoustic rock,'' i.e. they have
    virtually all the physical attributes of a natural rock. Nevertheless,
    dolphins can identify the threats but no current technology can. The
    basic science of what are the distinguishing acoustical features of an
    actual rock and ``acoustic one'' are vital for routine mine
    countermeasures and clearance and prompt execution of Naval operations.
        Finally, the availability of modern diesel electric submarines is
    one of the greatest threats to Naval operations. These vessels are
    being purchased by many states, the most prevalent being the Russian
    Kilo 4 class acquired by China and Iran and the German 2xx classes.
    These boats are as quiet as a modern nuclear class submarine. While
    limited in endurance and speed, they are clearly useful near the
    coastal waters of a country. The ASW threat is a significant challenge
    and the input of basic oceanography, unmanned undersea vehicles (UUV's)
    and novel communications, are part of paradigm for detecting, tracking
    and localizing these boats. While some of these components may emerge
    as incremental improvements to existing ones, the Navy needs bold new
    technologies to survey in near real time in the ocean environment as
    well as fixed acoustic systems to maintain persistent monitoring of
    important operational regions. Enabling these innovations for use by
    future officers are part of ONR's charter. Reduced commitments to the
    basic research now needed just mortgages the future for combating this
    threat.
        These are all hard basic research issues, issues that will take
    time to solve, but issues that are essential to the safe and effective
    operation of the fleet.
        While basic research played a critical role in winning the Cold
    War, faithfully served the warfighter in Iraq and Afghanistan and
    unquestionably will play a critical role in the global war on
    terrorism, its prominence in the Defense S&T portfolio has declined
    dramatically with the end of the Cold War. It no longer enjoys the
    robust support it did in decades past.
        In the early 1980's basic research stood at over seventeen percent
    of S&T funding. As we discussed earlier, significant payoffs were seen.
    This era of robust support for basic research paid off in technologies
    such as UAVs (sea, air, land), thermobaric bombs, communications
    systems, materials used in protection vests and battlefield medicine
    advances.
        Unfortunately, basic research now stands at below 12 percent of S&T
    funding. Equally important funding levels have slipped below levels
    required to maintain the stability and the readiness of the future
    defense technical workforce and innovative military discoveries. It is
    crucial that we ensure robust support for DOD S&T so that we have the
    capabilities to confront the challenges and threats of the future
    battlefield. It is toward this goal that basic research should be, and
    is, directed. It is also with this goal in mind that all funding
    decisions should be made.
        Specifically, CORE recommends returning 6.1 (basic) research to end
    of Cold War levels (16 percent of S&T) by fiscal year 2009 and
    recommends establishment of measurements to link the research
    enterprise with the acquisition and requirements communities to ensure
    that additional resources are directed toward identified capability
    gaps.
        The new resources associated with these increases should be
    directed to two basic research accounts where the majority of the
    competitively-awarded funds are accessible: the University Research
    Initiative (URI) and Defense Research Sciences (DRS). Sixteen percent
    is not the high water mark for basic research in the S&T total, but a
    practical place to start in putting these programs on the path to
    recovery.
        Since the end of the Cold War, basic research has paid its part of
    the peace dividend. As we enter another era of prolonged conflict, we
    strongly urge you to reenergize the department's support for basic
    research.
        In addition to our concerns about the funding levels for basic
    research and S&T generally is the focus of research at the Office of
    Naval Research. We are concerned that pressures outside of ONR may be
    leading the office in a direction that departs from its traditional
    aggressive support for high-risk basic research. We are distressed that
    the 6.1 account, which is supposed to be discovery oriented basic
    research, is increasingly becoming short-term product-driven applied
    research. Let me be clear, we firmly believe that applied research and
    advanced technology development are crucial parts of RDT&E, but it is
    imperative that there be robust basic research discoveries, if we
    expect to have the scientific underpinnings for the pioneering
    innovations in the 6.2 and beyond programs.
        The essential contribution of basic science to the capabilities of
    the Navy After Next, is jeopardized by statements that the Navy's basic
    research program will be ``integrated with more applied S&T to promote
    transitions of discoveries.'' ``Integrat[ion] with more applied S&T''
    is could send the message that program managers and scientist should
    not focus on long term high-risk projects.
        RADM Jay Cohen, Chief of Naval Research, recently clearly outlined
    the importance of basic science to the warfighter. When asked how
    science serves the Navy he responded:

        In the 1970s, a researcher proposed an effort to measure time more
    accurately . . . by a couple of orders of magnitude. At the time, the
    Navy was skeptical about investing in measuring time; after all, the
    Navy has been the timekeeper of the nation with the atomic clock at the
    Naval Observatory in Washington, D.C. Well, when you can measure time
    more accurately, you know position more accurately. That is the basis
    for precision navigation. The debate went on for weeks, and the Navy
    anguished over whether it should make the investment. Well, from having
    made the decision to invest, today we enjoy the Global Positioning
    System (GPS). Think about how that one idea has changed warfare. Think
    about the other uses of that technology, war-winning capability for the
    military and enhancements for commercial navigation. Think about the
    difference in capability from the 1970s, when the idea was first
    proposed, to Operation Iraqi Freedom.

        Our fear is that because of the direction ONR has been given to
    focus on shorter term projects, a proposal like the one RADM Cohen
    mentioned most likely would be rejected today.
        The focus on integration of discovery-oriented basic research with
    more application driven research is having a negative impact on the
    quality of naval basic research by creating a risk-averse atmosphere in
    both the universities and with program management and officers within
    the Navy. The avowed focus on integration with development, is
    discouraging researchers from pursuing bold and innovative ideas, lines
    of research that often take years to complete and whose practical
    application, while profound, is often decades out; and is forcing them
    instead to focus on pursuing research that they know will result in
    products. While it will surely be high quality research, it will not be
    type research that will result in breakthroughs in understanding.
        High-risk research that shows the promise of transformational
    discoveries is prone to failure before it yields a pioneering
    discovery. It is only by pushing the boundaries, constantly taking
    risks, and looking for the bold idea, not the slight innovation, that
    scientists will make the discoveries that will lead to the next laser,
    tomorrow's global positioning system, or the net-centric warfare of
    2030.
        Additionally, the research community and Congress need to impress
    upon Navy and Marine Corps leadership that while the basic research ONR
    supports today will not deliver combat commanders a product they can
    deploy in the next few years, it will afford the Lieutenants and
    Captains under their command profoundly more robust weapons systems
    when they are Admirals and Generals. It is because of an aggressive
    regime of basic research thirty years ago, when today's military
    leaders were junior officers, that they have such an effective and
    diverse suite of combat systems available to them to prosecute their
    mission. Working together, Congress and the research community must
    communicate to the Secretary, the CNO and the Commandant, that basic
    research is essential to the fleet and is a Congressional priority, and
    that if they do not give ONR the ability and direction to pursue an
    aggressive regime of high-risk cutting edge basic research now, the
    nation will be shortchanging our sons and daughters, the sailors and
    marines of tomorrow.
        Again, thank you for the opportunity to bring these important
    issues to your attention. I welcome the opportunity to answer any
    questions.

        Senator Stevens. We appreciate your testimony, but you are
    referring to the 1980's and the strategic defense initiative
    (SDI) period, and after the Soviet downfall, what the public
    demanded was a peace dividend. That dividend was in the form of
    a reduction of a lot of the expenditures that were associated
    in being prepared to counter the activities of the Soviet
    Union. So I think you are requesting something we just cannot
    do.
        Senator.
        Senator Inouye. At this moment, our ground forces are
    benefitting from unmanned air vehicles and unmanned ground
    vehicles. Do we have anything close to being operational
    underwater?
        Dr. Baggeroer. Senator, we do have unmanned underwater
    vehicles and they are currently part of the research agenda as
    to how to use them effectively in regions where you would not
    want to put a very valuable asset.
        In response to Senator Stevens, we certainly do understand
    the peace dividend. Our goal is to maintain the technological
    edge for the next generation, and we certainly well understand
    the constraints on the country while it is now fighting a war
    both in Iraq and on terrorism.
        Senator Inouye. Thank you, sir.
        Senator Stevens. Thank you very much. I appreciate your
    comments, but the Joint Strike Fighter came out of the research
    of the 1980's, and it will not be fielded until about 2017 if
    we keep it on schedule. We cannot keep it on schedule and go
    back to your research budgets.
        Dr. Baggeroer. The cycle time on an acquisition is a
    frustration to us too.
        Senator Stevens. Thank you very much.
        Next, Major General Robert McIntosh, Executive Director,
    Reserve Officers Association of the United States. Good
    morning, sir.
    STATEMENT OF MAJOR GENERAL ROBERT A. McINTOSH, UNITED
                STATES AIR FORCE RESERVE (RET.), EXECUTIVE
                DIRECTOR, RESERVE OFFICERS ASSOCIATION OF
                THE UNITED STATES
        Mr. McIntosh. Good morning, Senator. Mr. Chairman, Senator
    Inouye, the 75,000 members of the Reserve Officers Association
    (ROA) from all five branches of the armed forces thank you for
    this opportunity to speak today.
        Many of America's citizen warriors are continually being
    asked to repair their disrupted civilian lives after
    mobilization and then return to military duty on a repetitive
    basis.
        We believe that legislative changes should be targeted
    toward retaining and recruiting the best citizen soldiers,
    sailors, airmen, marines, and coast guardsmen.
        Despite the work to date by the Congress and the Department
    of Defense, much remains to be done to ensure Reserve and
    National Guard recruiting and retention remain healthy in the
    future. We must preserve one of America's greatest resources:
    its skilled and dedicated citizen military.
        Several important initiatives would enable our Nation's
    Reserve components to optimize their support of national
    defense and of national security. For your consideration, ROA's
    formal written testimony includes a detailed description of
    several needed changes and improvements. The following is a
    partial list of these initiatives.
        Full health care options for the selected Reserve and their
    families.
        Tax credit for employers.
        A formal National Guard and Reserve equipment appropriation
    process.
        Reducing the antiquated age 60 Reserve retirement
    eligibility criteria.
        Improving Montgomery GI Bill provisions.
        Repairing the one-thirtieth rule for special incentive and
    skill pay by making the compensation qualification-based.
        Increasing reenlistment bonuses.
        And repairing the unfair degradation of survivor benefits
    at age 62.
        Many of these initiatives not only affect Reserve readiness
    and the individual reservists but also impact employers,
    spouses, and families. For example, offering TRICARE for
    Reserve component members acts as an incentive for employers to
    continue to hire reservists. Family and civilian employment
    considerations are having a remarkable influence on whether
    citizen soldiers choose to remain in the military.
        Some in the Pentagon have been quoted in the media as
    stating that the Reserve components are becoming unaffordable.
    Even after factoring into the budget the cost of TRICARE
    eligibility for all selected reservists and their families, the
    cost of better incentive and retirement programs, citizen
    soldiers remain a highly cost effective national asset. The
    question should not be whether we can afford to bring pay and
    benefits for the Reserve and Guard to a more equitable
    standard, to a standard that reflects how we use our Reserve
    components. Rather, the proper question is can we afford not to
    take the necessary actions that will ensure the preservation of
    our citizen military, a force composed of some of the most
    skilled and talented men and women in America.
        Time permitting, I look forward to taking your questions,
    and thank you again for the opportunity to testify.
        [The statement follows:]
             Prepared Statement of Major General Robert A. McIntosh
        ROA believes that Congress, the Department of Defense and most
    military support associations have common interests and commitments
    when it comes to supporting the troops who are engaged in this war, and
    we are certainly showing proper solidarity and avoiding partisan
    politics that might question certain decisions relative to the war.
    ROA, like our sister associations, will stay firm in our commitment to
    back the civilian and military leaders as they operationally execute
    the war on terrorism and actions in Iraq. ROA will continue to support
    the troops in the field in any way we can.
        In recent years there have been several improvements in health
    care, pay system, family support, mobilization and demobilization
    problems. Even with recent improvements there remains a great deal yet
    to be done. ROA's mantra is and will continue to be as follows: the
    application of TRICARE for the selected Reserve, reduce retirement age
    eligibility; the elimination of the 1/30th rule; the updating of
    Montgomery GI Bill provisions, tax credit for employers; increased
    bonuses for reenlistments, the repair of the age 62 survivor benefit
    degradation, and an official acknowledgement of the National Guard and
    Reserve equipment account (NGREA).
        Recently a debate has begun. The debate is about whether the
    Reserve Components are becoming too expensive and pricing themselves
    ``out-of-the-market.'' From a historical perspective it is interesting
    to note that the argument about cost of Reserve and National Guard
    incentives, benefits, and readiness postures also became quite intense
    at the end of WW II. To quote from a 1948 ROA Headquarters Bulletin,
    the subject of non-disability retirement for civilian officers: ``The
    National Guard Association and the Reserve Officers Association are
    working very closely together in connection with this legislation as it
    is essential that the proper type bill be presented for consideration
    by Congress.'' Another quote from a late 1940s ROA news letter, ``We
    civilian soldiers, have a real task ahead of us. There are battles to
    be won on the home front, not only now but for many years to come. This
    can only be done by means of organization.'' That ``retirement bill,''
    as it became to be called, was the genesis of the current age 60
    retirement benefit for all members of the National Guard and Reserve.
    At that time, just as now, there were those who said that Reserve
    Component retirement benefit additions would be unaffordable and would
    necessitate long-term costs. Also similar to today's discussion, the
    leadership on Capitol Hill, immediately after WW II, was keenly aware
    of the importance of a viable Reserve Component. Congress clearly
    understood the important value of the bond between America's citizen
    and its military that results from using citizen soldiers in most
    phases of military actions. More recently the Abrams' Doctrine was a
    force build philosophy after Vietnam--a philosophy that matured into a
    policy and became a fundamental planning factor in creating today's
    Total Force.
        In 2004, we find ourselves again confronted with protecting one of
    America's greatest assets--the Reserve Components. It should be no
    surprise that recruiting and retaining an all-volunteer force require a
    different approach than was required for yesteryear's drafted force.
    Maintaining medical readiness, family medical considerations, and
    updating retired pay eligibility criteria are now important to our
    citizen warriors. Reservists fully understand their duty and are proud
    to be serving. However, many in the National Guard and Reserve are
    weighing the factors that affect remaining in the military. They want
    change and they deserve change. And, yes, some of these needed changes
    do cost money. If we wait until recruiting and retention numbers drop,
    then we will immediately be faced with a crisis beyond just scrambling
    to bring in the right numbers of people. It takes a minimum of two
    years to train and equip a person to the point that they can do their
    job without direct supervision. Experience has and should remain a core
    strength of the Reserve Components.
        Regarding the transformation and force structure rebalancing
    initiatives by the Services and DOD, the Reserve Officers Association
    acknowledges that continuous force structure change is appropriate, and
    we support these efforts in concept, but at the same time, we have
    significant concerns. We urge careful consideration and understanding
    of the attributes of a properly balanced Total Force. ROA is concerned
    that the rush to control personnel costs and to reduce the demand for
    Reservists to be in early deployment units could lead to flawed force
    structure planning. ROA acknowledges that some changes in structure and
    mission assignment are appropriate, however, the overall cost
    effectiveness of having a robust and experienced Reserve Component
    force to compliment a more expensive regular force must be considered
    carefully before eliminating or shifting significant numbers of Reserve
    Component billets.
        ROA fully understands that when citizen soldiers are used for an
    extended period there is a substantial personnel cost--a cost of war.
    The statement that ``while mobilized a Reservist or Guardsmen costs as
    much as an active component member'' is not in dispute. On the other
    hand, the citizen soldier cost over a life cycle (mobilized when needed
    and placed into a trained and ready to go posture when not recalled) is
    far less than the cost of an active component soldier. Additional cost
    savings are found when prior service training, developed skills, and
    experience are retained by having adequate numbers of Reserve billets
    across the spectrum of military missions.
        Even after factoring into the budget the cost of TRICARE
    eligibility for all selected Reservists and their families and the cost
    of better incentive and retirement programs, citizen soldiers remain a
    highly cost effective national asset.
        The starting point of any discussion about affordability should be
    that the Reserve Components provide large portions of our total
    military capability in many mission areas for a small fraction of the
    Service and DOD total budget. When the nation needs surge capability
    incrementally, the National Guard and Reserve cost single digit
    percentages and return double-digit mission accomplishment. Also,
    civilian skills that are needed by today's military and are resident in
    citizen warriors are often not adequately considered in force structure
    planning. If the wrong force transformation decisions are made in a
    rush to reduce personnel costs, and if the balance between Reserve
    Component forces and the more expensive active force is inefficient,
    the results will be a less capable and a smaller Total Force. The high
    costs of personnel turnover and of retraining should also be fully
    considered when judging the affordability of solving compensation
    issues for both the Active and the Reserve Components.
        There will be a residual impact on retention of stop loss personnel
    and the continued robust use of National Guard and Reserve personnel in
    the war on terrorism. We are months, if not years, away from knowing
    the true consequences to Reserve Component recruiting and retention.
    ROA believes that absent the improvements we have outlined, there will
    be substantial difficulty in sustaining the high caliber citizen
    warrior force we enjoy today--a force comprised of some of our nation's
    ``brightest and best.''
        TRICARE for Reserve Components.--The fiscal year 2004 NDAA
    authorized TRICARE for Reservists to provide health coverage for
    unemployed Reservist or those unable to get insurance. This legislation
    will address previously identified mobilization and retention issues
    within the services.
        ROA urges Congress to permanently establish the current TRICARE
    program for Selected Reserve and certain Individual Ready Reserve
    categories that are unemployed or not eligible for healthcare.
        Reduce Retirement Age Eligibility for Reservists.--Currently the
    Reserve Components are the only Federal entity that does not receive
    their earned retirement annuity at the time they have completed their
    service. Reducing the retirement eligibility age would close the gap
    between completion of service and collection of annuity.
        ROA urges Congress to reduce the age when a Reserve Component
    member is eligible for retirement pay to age 55 and make retirement
    below age 60 optional.
        Authorize Tax Credits for Employers of Reservist.--Reservist
    employers often shoulder the burden of extra costs to support National
    Defense through the participation of their employees in the military.
    Support by employers of members in the Reserve Component enables the
    Total Force. Today's increased OPTEMPO makes employer support more
    important than ever. Employer pressure is listed as one of the top
    reasons for Reservists to quit.
        ROA urges Congress to support employer tax credits as a way to help
    offset costs associated with employees' Reserve activities and
    reinforce employer support.
        Pay Differential.--While there was once a clear and distinct line
    between Active and Reserve forces, as the two components merge into a
    continuum of forces, the argument for greater parity of benefits
    becomes increasingly compelling. The following areas of pay still are
    governed without parity between Active Duty and Reserve Components:
    Aviation Career Incentive Pay, Hazardous Duty Incentive Pay, Career
    Enlisted Flyers Incentive Pay, Special Duty Assignment Pay, Foreign
    Language Proficiency Pay, and Diving Special Duty Pay.
        ROA urges Congress to delete the 1/30th rule for those areas of pay
    that require Reserve Component personnel to maintain the same
    qualification levels as active duty.
        Raise the Survivor Benefit Plan (SBP) age 62 Benefit.--Public Law
    99-145 replaced the Social Security offset system with a ``two-tier''
    system for those who first become retirement-eligible after September
    30, 1985, but under which survivors' benefits will automatically be
    reduced from 55 percent to 35 percent upon survivors' attaining age 62.
        ROA urges Congress to restore the SBP age 62 benefit from 35
    percent back to 55 percent.
        Just as there is a need to ensure the Reserve Component force is
    properly funded so is there a need to equip them to the Joint Force
    Command specifications. Currently Reserve equipment requirements are
    prioritized with active duty requirements. In most instances the
    Reserve priorities do not make it within the realm of being funded.
        Before 1997, the National Guard and Reserve Equipment Appropriation
    (NGREA) was a critical resource to ensure adequate funding for new
    equipment for the Reserve Components. The much-needed items not funded
    by the respective service budget were frequently purchased through this
    appropriation. In some cases, it was used to bring unit equipment
    readiness to a needed state of state for mobilization. Frequently, the
    funds were used to purchase commercial off-the-shelf items that units
    were unable to obtain through traditional sources. However, in 1997 an
    agreement between the administration and Congress eliminated the
    account with the objective of the Active Component providing the needed
    funds through their individual appropriations.
        The Reserve and Guard are faced with mounting challenges on how to
    replace worn out equipment, equipment lost due to combat operations,
    legacy equipment that is becoming irrelevant or obsolete, and, in
    general, replacing that which is gone or aging through normal wear and
    tear. Today, the ability to use NGREA funds for cost effective
    acquisition is non-existent. An analysis has shown that with the
    implementation of the post-1997 policy, procurement for the Reserve
    Components has decreased. In fiscal year 2004, procurement for the
    Reserve Components' percentage of the DOD procurement budget is at its
    second lowest in recorded history at 3.19 percent. This comes even
    after Congress added $400 million for NGREA. Meanwhile, procurement for
    the Active Component continued to realize consistent real growth from
    fiscal year 1998 through fiscal year 2009 at 108.6 percent.
        In the past, ``cascading'' equipment from the Active Component to
    the Reserve Component has been a reliable source of serviceable
    equipment. However, the changes in roles and missions that have placed
    a preponderance of combat support and combat service support in the
    Reserve Components has not left much to cascade. Also, funding levels,
    rising costs, lack of replacement parts for older equipment, etc. has
    made it difficult for the Reserve Components to maintain their aging
    equipment, not to mention modernizing and recapitalizing to support a
    viable legacy force.
        The Reserve Components would benefit greatly from a National
    Military Resource Strategy that includes a National Guard and Reserve
    Equipment Appropriation.
    Army
        The Army Reserve's list of unresourced equipment requirements
    closely mirrors the fiscal year 2004 list. However, it is important, in
    the light of on-going operations with equipment losses due to combat,
    fair wear and tear, and needed modernized equipment to meet mission
    requirements, that a number of these unresourced requirements are
    enumerated.

    ------------------------------------------------------------------------
                                                                 Fiscal Year
                                                     Shortfall     2005 Buy
    ------------------------------------------------------------------------
    Light Medium Tactical.........................        1,845          600
    Medium Tactical Vehicles......................        7,161          800
    Movement Tracking Systems.....................        9,463        2,075
    All Terrain Lift System (Atlas)...............          173          100
    HMMWV (Plain).................................        3,833          600
    HMMWV (Up Armored)............................          898          100
    Night Vision Image System.....................       22,797        7,000
    Tactical Fire Fighting Truck..................           62           10
    ------------------------------------------------------------------------

        These items are just part of a long list of equipment needed by our
    Army Reserve units to perform their wartime mission for the Total
    Force. Although the sum total of these requirements is considerable,
    the rebalancing of the forces between Active and Reserve Components
    will likely produce effects on the Total Force. And, as mentioned
    earlier, the lack of resources in the NGREA will make it difficult to
    make up and critical shortfalls that occur in the short term.
    Navy
        Total Naval Reserve equipment procurement has steadily declined
    from $260 million in fiscal year 1997 to about $35 million in fiscal
    year 2002, with NGREA and congressional add-ons virtually disappearing
    and equipment shrinking precipitously. Congress recognized the problem
    and increased NGREA funding to $400,000 in fiscal year 2004. As a
    result of the Global War on Terrorism, and the ongoing support by Naval
    Reservists to Active Duty Commands, ROA feels that this upward trend
    must continue.

                              [Dollars in millions]
    ------------------------------------------------------------------------
                  Unfunded Equipment                    Cost       Quantity
    ------------------------------------------------------------------------
    C-40A Transport Aircraft......................       $130.0            2
    NWC and NCF Tactical Trucks...................         36.0  ...........
    NAVELSF Communications Equipment..............         13.0  ...........
    MH-60 Helicopter..............................         66.0            2
    F/A-18 AT-FLIR targeting pods.................         16.0            6
    C-130T Avionics Modernization Program.........         40.0  ...........
    F/A-18 A+block 2 Mod, Radar upgrades..........         53.0           10
    F/A-18 A+CATM/Captive Carry Assets............          3.0  ...........
    Littoral Surveillance Sys/Joint Fires Network.         30.0            1
    F/A-18 Armament Equipment.....................          8.0  ...........
    F-5 Block Upgrade.............................         10.0  ...........
    E2C Navigation Upgrade........................         16.0            6
    ------------------------------------------------------------------------

    Marine Corps

                            [In millions of dollars]
    ------------------------------------------------------------------------
                                                                     Cost
    ------------------------------------------------------------------------
    F/A-18A ECP-583 (12 USMCR aircraft)........................         70.0
    CH-53E Helicopter FLIR.....................................         45.0
    NBC and Initial Equipment Issue (Reserves).................          7.3
    KC-130 Upgrades............................................         10.5
    CH-53E Upgrades $3.3 million...............................         38.0
    CH-53E Aircrew Procedure Trainer (APT) Flight Simulator....         12.8
    AH-1W Aircrew Procedures Trainer (APT) Flight Simulator....         10.0
    Supplemental Aviation Spares Package.......................          7.0
    ------------------------------------------------------------------------

    Air Force
        C-5: Fund Part A and Part B installation of C-5A Airlift Defensive
    Systems of $83 million for 32 aircraft to provide a greater degree of
    survivability to both aircraft and aircrew and promote common
    operational utility between active duty and reserve forces. Restore
    procurement of C-5 Avionics Modernization Program (AMP) kits cut in
    fiscal year 2004 and those needed in fiscal year 2005 for 60 kits.
        C-9A: Designate C-9 aircraft with the primary mission of aero-
    medical support and allow those aircraft to support VIP/SAM, OSA, Team
    Travel and other mission support areas during low demand times and to
    support increasing the C-9 fleet at Scott AFB with three C-9Cs from
    Andrews Air Force Base, Maryland when they retire their aircraft in
    fiscal year 2005.
        C-17: Increase procurement of C-17 Globemaster III aircraft by at
    least 42 additional aircraft at a rate of 15 to 18 aircraft per year,
    which will ensure an adequate airlift force in the future; and program
    new production C-17 aircraft into the AFR.
        C-40C: Increase procurement of C-40 aircraft by at least six
    additional aircraft to ensure an adequate special mission airlift force
    for the AFR by at least two C-40s per year for three years.
        C-130J: Authorize and appropriate funds for the C-130J Multiyear
    Procurement in fiscal year 2005 and accelerate acquisition for Reserve
    units in Pennsylvania, Minnesota, and Mississippi.
        LITENING PODS: Support $7.8 million to procure 5 LITENING Pods
    toward the multiyear procurement of 30 pods for $43.8 million.
        APN-241 Radar: Support $7 million to procure 8 APN-241 Radar
    upgrades.
        AFR F-16 Helmet Mounted Cuing System: Support $9 million to procure
    approximately 40 night vision goggles toward the multiyear procurement
    of 80 for $20.6 million.
        Fund F-16 Block 25/30/32 to stay viable for employment in modern
    combat using precision guided munitions, and operating against modern
    threat aircraft equipped with helmet cued weapons.
        Information Technology: Support $2.5 million toward a total
    requirement of $54.7 million.
        Pararescue Jumper Equipment: Support $0.7 million toward a total
    requirement of $9.1 million.
        Vehicle Requirements: Support $2 million toward a total requirement
    of $10.6 million.
        Pathfinder Force Protection: Support $9 million toward a total
    requirement of $55.5 million.
        Motor Vehicles for Medical: Support $2.8 million to procure 44
    vehicles.
        Hydrant Fueling Trucks: Support $1.4 million to procure 9 vehicles.
    Other Army Requirements
        The Army Reserve faces critical funding shortfalls in several key
    areas. The shortfalls come in the pay and allowances accounts totaling
    $348.4 million and the operations and maintenance accounts totaling
    $180 million.
      --Of these requirement shortfalls, the most critical is $281 million
            in Inactive Duty Training (IDT), which will prohibit the Army
            Reserve from meeting its peacetime statutory requirement for 48
            drills. Even though there is some cost avoidance due to
            mobilizations, it will not reach the level required to
            successfully conduct the critical training that soldiers need
            for individual and unit readiness. Based on current estimates,
            the Army Reserve would be forced to cease training by late
            spring or early summer 2005.
      --In the area of professional development, the Army Reserve is funded
            at only slightly more than 50 percent of its $148.6 million
            requirement. These funds are needed to meet the Chief of Staff
            of the Army's established goal of 85 percent in military
            specialty training and professional development. The Chief,
            Army Reserve, briefed the Senate Armed Services Committee that
            the goal would be achieved by the end of fiscal year 2005. This
            shortfall will cause the Army Reserve not to meet the 85
            percent goal.
      --Insufficient resources are available to fund the Army Reserve's
            portion of the DOD integrated worldwide common-user network for
            exchanging secure and non-secure data. The funding shortfall of
            just over $33 million is crucial to meet the challenges of
            expanding key command and control applications and service
            demands, increase security requirements and increase network
            capability to insure needed connectivity.
      --Army Reserve Base Operations (BASOPS) required funding is $73.5
            million short of its $355.4 million requirement or 74 percent.
            To provide a viable program which includes such critical items
            as civilian pay, leases, utilities, and custodial contracts, it
            is imperative that BASOPS be funded at least at the 95 percent
            level to insure that those BASOPS items which require 100
            percent funding can be met.
      --Antiterrorism, Force Protections, and Installation Preparedness for
            the Army Reserve minimum essential funding level of $67.6
            million is under funded by 46 percent. This funding is critical
            to the Army Reserve meeting mandated DOD requirements and
            maintaining minimum Force Protection standards for Army Reserve
            facilities worldwide. As Active Component bases are prepared to
            meet increased threats, Reserve Component facilities, which are
            located in thousands of local communities, become a lucrative
            target for those that consider military capability as a
            criminal or terrorist target.
      --Army Reserve environmental programs that are a ``must fund'' are
            unfunded by $33.4 million or 44 percent. As a result, legally
            mandated requirements and the requirements of executive orders
            will not be met. Legal consequences could possibly restrict use
            on training lands at Army Reserve installations such as Forts.
      --The Army Reserve Defense Health Program Accrual is funded at 98
            percent of the $680 million requirement. However, the $7.1
            million shortfall is the result of DOD actuarial studies that
            establish accrual rates based on ``full-time'' and ``part
            time'' personnel. The accrual rates for fiscal year 2005
            increased considerably in both categories. Analysis indicates
            that the rate change will leave the Army Reserve with this
            critical shortfall. This is an item of considerable
            congressional interest, and the rate change creates a
            significant effect on all three military services.
      --Family Programs are a critical to Reserve Component soldiers and
            their families. Active Component soldiers and families, for the
            most part, live in close communities on military installations
            where it is possible to maintain a bond between the soldiers,
            their families, and their units. Many Reserve soldiers do not
            even live in the same communities as their units. Keeping
            families informed and supported can be difficult, particularly
            in more rural areas. In fiscal year 2004, the Army Reserve's
            family programs suffered a $3.9 million shortfall from a
            requirement of $7.5 million. In fiscal year 2005 this shortfall
            is $5.6 million. The Reserve Officers Association recommends
            full funding of the $15.4 million requirement for Army Reserve
            Family Programs to provide essential services to soldiers and
            their families and to facilitate the Army Reserve's ability to
            adequately prepare soldiers for deployments and help families
            to become self-reliant.
    Other Requirements
        Reserve Personnel Appropriation: Last year the Reserve Components
    took cuts in their RPA requirement based on the previous year's usage.
    These unfunded requirements came at a time when many personnel were
    either demobilized or released from stop-loss hence enabling them to
    complete their RPA requirements. Additionally, the services are now
    faced with implementing the Secretary of Defense's transformation
    decisions resulting in conversion and upgrade requirements for school
    and special tours. ROA members have been contacting us to report
    anecdotally that their training location has run out of money for
    funding their requirements (discretionary (non-mission/support)
    activity, and especially OJT and upgrade training, is now at a
    standstill at most units for this fiscal year).
        The unknown in determining the level of challenge to be overcome in
    the rest of fiscal year 2004 is the continually changing variant of
    demobilization. The initial planning, based on active duty MAJCOM-
    planned demobilizations, assumed large-scale numbers of returnees in
    February and March. At this point, there seems to be some slippage in
    that projection, which will affect Reserve participation activities
    between now and the end of the fiscal year.
        Reconstitution: The services will also need to perform a
    reconstitution assessment to determine the results of the mobilization.
    In terms of training consideration will need to consider: Skills that
    must be refreshed for specialty, training needed for upgrade but
    delayed, ancillary training missed, Professional continuing education
    requirements for single-managed career fields and other certified or
    licensed specialties required annually, and professional military
    education needed to stay competitive.
        To summarize, the question should not be whether we can afford to
    bring pay and benefits for the Reserve and Guard to a more equitable
    standard--to a standard that reflects how we use our Reserve
    Components. Rather, the proper question is can we afford not to take
    the necessary actions that will ensure the preservation of our citizen
    military--a force composed of the some of the most skilled and talented
    men and women in America.

        Senator Stevens. I note that you recommend that certain
    individual ready Reserve categories that are unemployed or not
    eligible for health care have TRICARE permanently. Now, how do
    you determine who are the certain individuals and those who are
    not eligible for health care?
        Mr. McIntosh. Actually what we are proposing and what we
    advocate is TRICARE for the entire selected Reserve as an
    option for anyone who is a drilling combat-ready reservist.
        Senator Stevens. Most of those people are employed by small
    businesses, many of whom do provide health care. The minute we
    did that, that would be an advantage that other portions of the
    economy do not have. I do not really understand why that should
    be the case. Why should a person that is retired and in the
    ready Reserve enjoy the benefits of being on active duty?
        Mr. McIntosh. Senator, since we are mobilizing reservists
    repetitively, we want to retain and recruit the best Americans
    to be in our Reserve force. We believe the opportunity to sign
    up for TRICARE versus the cost of medical care in their
    civilian lives is an opportunity we ought to take and will pay
    great dividends in the future. When a reservist, for example,
    returns from numerous deployments and is thinking about leaving
    the Guard and Reserve, if they are invested in TRICARE have
    children that are using that or a spouse that is using that,
    they will be much less likely to leave. So we are really
    recruiting and retaining the family as a whole picture here
    relative to medical care.
        Senator Stevens. Is that not a disincentive to staying on
    active duty? More people will go into the ready Reserve and not
    stay on active duty.
        Mr. McIntosh. Actually we have not studied that completely.
    I believe it would not be an incentive for people to leave the
    active force and join the Reserve. I think people leave the
    active force for many, many reasons, and I would not see them
    leaving because they know they could retain TRICARE even after
    they left. But it is a fair question, Senator.
        Senator Stevens. Thank you.
        Senator Inouye.
        Senator Inouye. Thank you very much. I just wanted to note
    that many of your suggestions should be made to the authorizing
    committee. I am certain you have done that.
        Mr. McIntosh. And it is, Senator, and we are aware of that.
    Thank you, though.
        Senator Stevens. Thank you very much, General. Appreciate
    your coming.
        Our next witness is Tom McKibban, President of the American
    Association of Nurse Anesthetists. Good morning, sir.
    STATEMENT OF TOM L. MCKIBBAN, CERTIFIED REGISTERED
                NURSE ANESTHETIST, MS, PRESIDENT, AMERICAN
                ASSOCIATION OF NURSE ANESTHETISTS
        Mr. McKibban. Good morning. Chairman Stevens and Senator
    Inouye, good morning and thank you for the opportunity to
    testify today. My name is Tom McKibban. I am a certified
    registered nurse anesthetist, better known as a CRNA, and
    President of the American Association of Nurse Anesthetists,
    known as the AANA. The AANA represents more than 30,000 CRNA's,
    including 497 active duty CRNA's, and 742 reservists in the
    military. As of May 2003, more than 360 CRNA's were deployed in
    the Middle East providing anesthesia care on ships, on the
    ground, and for U.S. special forces operations.
        Today maintaining adequate numbers of active duty CRNA's is
    of utmost concern for the Department of Defense to meet its
    military medical readiness mission. For several years, the
    number of CRNA's serving in active duty has fallen somewhat
    short of the number authorized by the DOD. This is complicated
    by strong demand for CRNA's in both the public and private
    sectors. The AANA appreciates this committee's continued
    support for the funding, the incentive special pay (ISP) for
    CRNA's to address this issue.
        The considerable gap between civilian and military pay was
    addressed in the fiscal year 2003 Defense Authorization Act
    with an ISP increase from $15,000 to $50,000. At this time we
    would request full funding to increase ISP to $50,000 for all
    services to recruit and retain CRNA's.
        To ensure military medical readiness, we must have
    anesthesia providers that can work independently and be
    deployed at a moment's notice. For this reason, the AANA is
    concerned about a 2003 proposed rule to include
    anesthesiologist assistants, known as AA's, as authorized
    providers under the TRICARE program. The rule is under review
    by the OMB. The TRICARE proposal demands two providers, an
    anesthesiologist and an AA, provide military personnel and
    dependents the same care that either an anesthesiologist or
    nurse anesthetist can provide alone. There is insufficient
    evidence of the safety and cost effectiveness of AA's to
    authorize these providers into the TRICARE program.
        Last, the AANA is proud to announce the establishment of a
    joint VA/Defense Department program in nurse anesthesia
    education. This program cost effectively makes use of the
    existing U.S. Army School of Nurse Anesthesia, Fort Sam
    Houston, to educate CRNA's for both the VA and the U.S. armed
    services. This joint nurse anesthesia graduate program begins
    this June in San Antonio, Texas.
        In conclusion, the AANA believes that the recruitment and
    retention of CRNA's in the services is critical to our men and
    women in uniform. Funding an increase in the ISP will help meet
    this challenge.
        Also, we believe that recognizing AA's under TRICARE will
    not improve medical readiness of the DOD.
        Last, we commend and thank this committee for your
    continued support for CRNA's in the military.
        I will be happy to answer any questions you may have. Thank
    you.
        [The statement follows:]
                     Prepared Statement of Tom L. McKibban
        The American Association of Nurse Anesthetists (AANA) is the
    professional association representing over 30,000 certified registered
    nurse anesthetists (CRNAs) in the United States, including 497 active
    duty CRNAs and 742 reservists in the military. The AANA appreciates the
    opportunity to provide testimony regarding CRNAs in the military. We
    would also like to thank this committee for the help it has given us in
    assisting the Department of Defense (DOD) and each of the services to
    recruit and retain CRNAs.
                  background information on nurse anesthetists
        Let us begin by describing the profession of nurse anesthesia, and
    its history and role with the military medical system.
        In the administration of anesthesia, CRNAs perform the same
    functions as anesthesiologists and work in every setting in which
    anesthesia is delivered including hospital surgical suites and
    obstetrical delivery rooms, ambulatory surgical centers, health
    maintenance organizations, and the offices of dentists, podiatrists,
    ophthalmologists, and plastic surgeons. Today CRNAs participate in
    approximately 65 percent of the anesthetics given to patients each year
    in the United States. Nurse anesthetists are also the sole anesthesia
    providers in more than 65 percent of rural hospitals, assuring access
    to surgical, obstetrical and other healthcare services for millions of
    rural Americans.
        CRNAs have a personal and professional commitment to patient
    safety, made evident through research into our practice. In our
    professional association, we state emphatically ``our members' only
    business is patient safety.'' Safety is assured through education, high
    standards of professional practice, and commitment to continuing
    education. Having first practiced as registered nurses, CRNAs are
    educated to the master's degree level and meet the most stringent
    continuing education and recertification standards in the field. Thanks
    to this tradition of advanced education, the clinical practice
    excellence of anesthesia professionals, and the advancement in
    technology, we are humbled and honored to note that anesthesia is 50
    times safer now than 20 years ago (National Academy of Sciences, 2000).
    Research further demonstrates that the care delivered by CRNAs,
    physician anesthesiologists, or by both working together yields similar
    patient safety outcomes. In addition to studies performed by the
    National Academy of Sciences in 1977, Forrest in 1980, Bechtholdt in
    1981, the Minnesota Department of Health in 1994, and others, Dr.
    Michael Pine MD MBA recently concluded once again that among CRNAs and
    physician anesthesiologists, ``the type of anesthesia provider does not
    affect inpatient surgical mortality'' (Pine, 2003). Thus, the practice
    of anesthesia is a recognized specialty in nursing and medicine. Both
    CRNAs and anesthesiologists administer anesthesia for all types of
    surgical procedures from the simplest to the most complex, either as
    single providers or together.
                       nurse anesthetists in the military
        Since the mid-19th Century, our profession of nurse anesthesia has
    been proud to provide anesthesia care for our past and present military
    personnel and their families. From the Civil War to the present day,
    nurse anesthetists have been the principal anesthesia providers in
    combat areas of every war in which the United States has been engaged.
        Military nurse anesthetists have been honored and decorated by the
    United States and foreign governments for outstanding achievements,
    resulting from their dedication and commitment to duty and competence
    in managing seriously wounded casualties. In World War II, there were
    17 nurse anesthetists to every one anesthesiologist. In Vietnam, the
    ratio of CRNAs to physician anesthesiologists was approximately 3:1.
    Two nurse anesthetists were killed in Vietnam and their names have been
    engraved on the Vietnam Memorial Wall. During the Panama strike, only
    CRNAs were sent with the fighting forces. Nurse anesthetists served
    with honor during Desert Shield and Desert Storm. Military have CRNAs
    provided critical anesthesia support to humanitarian missions around
    the globe in such places as Bosnia and Somalia. In May 2003,
    approximately 364 nurse anesthetists had been deployed to the Middle
    East for the military mission for ``Operation Iraqi Freedom'' and
    ``Operation Enduring Freedom.''
        Data gathered from the U.S. Armed Forces anesthesia communities'
    reveal that CRNAs have often been the sole anesthesia providers at
    certain facilities, both at home and while forward deployed. For
    decades CRNAs have staffed ships, isolated U.S. bases, and forward
    surgical teams without physician anesthesia support. The U.S. Army
    Joint Special Operations Command Medical Team and all Army Forward
    Surgical Teams are staffed solely by CRNAs. Military CRNAs have a long
    proud history of providing independent support and quality anesthesia
    care to military men and women, their families and to people from many
    nations who have found themselves in harms way.
        When President George W. Bush initiated ``Operation Iraqi Freedom''
    CRNAs were immediately deployed. With the new special operations
    environment, new training was needed to prepare our CRNAs to ensure
    military medical mobilization and readiness. Major General Barbara C.
    Brannon, Assistant Surgeon General, Air Force Nursing Services,
    testified before this Senate Committee on April 28, 2004, to provide an
    account of CRNAs on the job overseas. She stated, ``Major Kathyrn
    Weiss, a CRNA from Hurlbert Field, deployed with the Army's 10th
    Special Forces Group to Northern Iraq to provide frontline emergency
    medical capabilities in an imminent danger area within the range of
    enemy artillery. The team was recognized by the award of the Bronze
    Star for their meritorious achievements. Major Weiss is just one
    example of the tremendous capability of our CRNAs.''
        In the current mission ``Operation Iraqi Freedom'' CRNAs will
    continue to be deployed both on ships and ground, as well as U.S.
    special operations forces. This committee must ensure that we retain
    and recruit CRNAs now and in the future to serve in these military
    overseas deployments.
    crna retention and recruiting--how this committee can help the defense
                                   department
        In all of the Services, maintaining adequate numbers of active duty
    CRNAs is of utmost concern. For several years, the number of CRNAs
    serving in active duty has fallen somewhat short of the number
    authorized by the Department of Defense. This is further complicated by
    strong demand for CRNAs in both the public and private sectors.
        However, it is essential to understand that while there is strong
    demand for CRNA services in the public and private healthcare sectors,
    the profession of nurse anesthesia is working effectively to meet this
    workforce challenge. The AANA anticipates growing demand for CRNAs. Our
    evidence suggests that while vacancies exist, there is not a crisis in
    the number of anesthesia providers. The profession of nurse anesthesia
    has increased its number of accredited CRNA schools, from 85 to 88 the
    past two years. The number of qualified registered nurses applying for
    CRNA school continues to climb, with each CRNA school turning away an
    average of 23 qualified applicants in 2002. The growth in the number of
    schools, the number of applicants, and in production capacity, has
    yielded significant growth in the number of nurse anesthetists
    graduating and being certified into the profession. The Council on
    Certification of Nurse Anesthetists reports that in 1998, our schools
    produced 942 new graduates. By 2003, that number had increased to
    1,474, a 56 percent increase in just five years. The growth is expected
    to continue. The Council on Accreditation of Nurse Anesthesia
    Educational Programs (COA) projects that CRNA schools will produce an
    estimated 1,900 graduates in 2005.
        This Committee can greatly assist in the effort to attract and
    maintain essential numbers of nurse anesthetists in the military by
    their support of increasing special pays.
    The Incentive Special Pay for Nurses
        According to a March 1994 study requested by the Health Policy
    Directorate of Health Affairs and conducted by the Department of
    Defense, a large pay gap existed between annual civilian and military
    pay in 1992. This study concluded, ``this earnings gap is a major
    reason why the military has difficulty retaining CRNAs.'' In order to
    address this pay gap, in the fiscal year 1995 Defense Authorization
    bill Congress authorized the implementation of an increase in the
    annual Incentive Special Pay (ISP) for nurse anesthetists from $6,000
    to $15,000 for those CRNAs no longer under service obligation to pay
    back their anesthesia education. Those CRNAs who remain obligated
    receive the $6,000 ISP.
        Both the House and Senate passed the fiscal year 2003 Defense
    Authorization Act conference report, H. Rept. 107-772, which included
    an ISP increase to $50,000. The report included an increase in ISP for
    nurse anesthetists from $15,000 to $50,000. There had been no change in
    funding level for the ISP since the increase was instituted in fiscal
    year 1995, while it is certain that civilian pay has continued to rise
    during this time. The AANA is requesting that this committee fund the
    new increase for the ISP at $50,000 for all the branches of the armed
    services to retain and recruit CRNAs now and into the future.
        There still continues to be high demand for CRNAs in the healthcare
    community leading to higher incomes, widening the gap in pay for CRNAs
    in the civilian sector compared to the military. The fiscal year 2003
    AANA Membership survey measured income in the civilian sector by
    practice setting. The median income in a hospital setting is $120,000,
    anesthesiologist group $108,000, and self-employed CRNA $140,000
    (includes Owner/Partner of a CRNA Group). These median salaries include
    call pay, overtime pay, and bonus pay. These salaries are still higher
    than the median CRNA's salary of $84,000 across all military service
    branches.
        In civilian practice, all additional skills, experience, duties and
    responsibilities, and hours of work are compensated for monetarily.
    Additionally, training (tuition and continuing education), healthcare,
    retirement, recruitment and retention bonuses, and other benefits often
    equal or exceed those offered in the military.
        Rear Admiral Nancy Lescavage, Director of the Navy Nurse Corps, and
    Commander of the Naval Medical Education and Training Command testified
    before this Senate Committee at an April 30, 2003 hearing:

        ``The increase of the maximum allowable compensation amount for
    Certified Registered Nurse Anesthetist Incentive Special Pay (CRNA ISP)
    and the Nurse Accession Bonus (NAB) in the fiscal year 2003 National
    Defense Authorization Act will further enhance our competitive edge in
    the nursing market.''

        Salaries in the civilian sector will continue to create incentives
    for CRNAs to separate from the military, especially at the lower grades
    without a competitive incentive from the military to retain CRNAs.
    Therefore, it is vitally important that the Incentive Special Pay (ISP)
    be increased to $50,000 to ensure the retention of CRNAs in the
    military.
        AANA thanks this Committee for its support of the annual ISP for
    nurse anesthetists. AANA strongly recommends the continuation and an
    increase in the annual funding for ISP from $15,000 to $50,000 for
    fiscal year 2005. The ISP recognizes the special skills and advanced
    education that CRNAs bring to the Department of Defense healthcare
    system.
    Board Certification Pay for Nurses
        Included in the fiscal year 1996 Defense Authorization bill was
    language authorizing the implementation of a board certification pay
    for certain healthcare professionals, including advanced practice
    nurses. AANA is highly supportive of board certification pay for all
    advanced practice nurses. The establishment of this type of pay for
    nurses recognizes that there are levels of excellence in the profession
    of nursing that should be recognized, just as in the medical
    profession. In addition, this pay may assist in closing the earnings
    gap, which may help with retention of CRNAs.
        While many CRNAs have received board certification pay, there are
    many that remain ineligible. Since certification to practice as a CRNA
    does not require a specific master's degree, many nurse anesthetists
    have chosen to diversify their education by pursuing an advanced degree
    in other related fields. But CRNAs with master's degrees in education,
    administration, or management are not necessarily eligible for board
    certification pay since their graduate degrees are not in a clinical
    specialty. To deny a bonus to these individuals is unfair, and will
    certainly affect their morale as they work side-by-side with their
    less-experienced colleagues, who will collect a bonus for which they
    are not eligible. In addition, in the future this bonus will act as a
    financial disincentive for nurse anesthetists to diversify and broaden
    their horizons.
        AANA encourages the Defense Department and the respective services
    to reexamine the issue of awarding board certification pay only to
    CRNAs who have clinical master's degrees.
     dod/va resource sharing: va-dod nurse anesthesia school university of
                texas houston health science center, houston, tx
        The establishment of a joint VA-Department of Defense program in
    nurse anesthesia education holds the promise of making significant
    improvements in the VA CRNA workforce. This will improve retention of
    VA registered nurses, while cost-effectively making use of existing
    U.S. government programs and the U.S. Army nurse anesthesia school.
    This VA nurse anesthesia graduate program begins this June at the
    Army's Fort Sam Houston Nurse Anesthesia program in San Antonio, Texas.
    This VA nurse anesthesia program creates three openings for VA
    registered nurses to apply to and earn a Master of Science in Nursing
    (MSN) in anesthesia granted through the University of Texas Houston
    Health Science Center. Three students are enrolled for the program
    start date June 2004.
        The 30-month program is broken down into two phases. Phase I, 12
    months, is the didactic portion of the anesthesia training at the U.S.
    AMEDD Center and School (U.S. Army School for Nurse Anesthesia). Phase
    II, 18 months, is clinical practice education, in which VA facilities
    and their affiliates would serve as clinical practice sites. The agency
    will use VA hospitals in Augusta, Georgia, and Dayton, Ohio. Similar to
    military CRNAs who repay their educational investment through a service
    obligation to the U.S. Armed Forces, graduating VA CRNAs would serve a
    three-year obligation to the VA health system. Through this kind of
    Department of Defense-DVA resource sharing, the VA will have an
    additional source of qualified CRNAs to meet anesthesia care staffing
    requirements.
        We are pleased to note that both the U.S. Army Surgeon General and
    Dr. Michael J. Kussman, MD MS FACP (Department of Veterans' Affairs
    Chief Consultant, Acute Care) approved funding to start this VA nurse
    anesthesia school. With modest levels of additional funding, this joint
    VA-Defense Department nurse anesthesia education initiative can grow
    and thrive, and serve as a model for meeting other VA workforce needs,
    particularly in nursing.
        DOD and VA resource sharing programs effectively maximize
    government resources while improving access to healthcare for Veterans.
                     update: inclusion of aas under tricare
        The U.S. Department of Defense has proposed authorizing
    anesthesiologist assistants (AAs) as providers of anesthesia care under
    the TRICARE health plan for military personnel and dependents, in a
    proposed rule published in the Federal Register April 3, 2003. (68 FR
    16247, 4/3/2003). The regulation is now being reviewed at the Office of
    Management of Budget (OMB) as of February 9, 2004. There still has been
    no congressional review about adding these new providers, and no
    assessment of their safety record or cost-effectiveness.
        The AANA has several objections to this proposal. First, there is
    insufficient evidence of the safety and cost-effectiveness of AAs to
    authorize these providers into the TRICARE program. DOD has not
    sufficiently demonstrated what benefit TRICARE may gain by recognizing
    AAs as an authorized provider. As we understand this matter, AAs (in
    the very limited number of states that license their practice) may
    administer anesthesia only under the close and immediate medical
    direction of anesthesiologists. The TRICARE proposed rule does not
    define this type of medical direction of AAs. In addition,
    correspondence from TRICARE says an AA would be an ``extra pair of
    hands'' for an anesthesiologist, suggesting one-to-one constant
    supervision in the operating room. By contrast, both experience and
    anesthesiologists themselves say ``direct supervision'' implies a
    scheme in which AAs are supervised by someone some distance away, not
    necessarily in the operating room.
        Even so, the TRICARE proposal demands two providers, an
    anesthesiologist and an AA, to provide military personnel and
    dependents the same care that either an anesthesiologist or nurse
    anesthetist could provide alone. The agency's proposal to introduce AAs
    into TRICARE is further undermined by AAs' lack of diffusion within the
    healthcare system. Since AAs' introduction 30 years ago, only seven
    states have thought it prudent to provide AAs separate licensure or
    certification and only two schools exist to train them. Last, the
    proposal has drawn the opposition of 37 retired military and Veterans
    organizations and the 5.5 million members of The Military Coalition,
    and several members of the House and Senate.
        The proposed rule to introduce AAs under TRICARE is not in response
    to a shortage of anesthesia providers. Further Congressional review is
    required on the safety and cost-effectiveness of AAs before they are
    recognized under TRICARE.
                                   conclusion
        In conclusion, the AANA believes that the recruitment and retention
    of CRNAs in the Services is of critical concern. The efforts detailed
    above will assist the Services in maintaining the military's ability to
    meet its wartime and medical mobilization through the funding of an
    increase in ISP. Also, we believe that the inclusion of improperly
    supervised Anesthesiologists Assistants (AAs) in the TRICARE system
    would impair the quality of healthcare for our military personnel and
    dependents, and should not be approved. Last, we commend and thank this
    committee for their continued support for CRNAs in the military.

        Senator Stevens. I have two questions. One is, how often is
    the special pay bonus to be paid in your judgment if it is
    raised to $50,000?
        Mr. McKibban. I believe it is a yearly, sir.
        Senator Stevens. A yearly?
        Mr. McKibban. A yearly ISP, yes.
        Senator Stevens. Is there reenlistment yearly? I do not
    understand. Normally that is a reenlistment bonus. Do you sign
    up for just 1 year?
        Mr. McKibban. No. I believe this is a yearly special pay
    for their specialty to ensure that they continually will serve
    in the military, sir.
        Senator Stevens. Is that master's degree requirement a
    matter of law or a matter of regulation?
        Mr. McKibban. I believe it is a matter of regulation. It is
    law. I am sorry, sir.
        Senator Stevens. I am compelled to say what Senator Inouye
    said to the previous witness. I am afraid you have asked us to
    do two things not within the jurisdiction of this committee. We
    do not handle the legislation. Changes in the law should be
    addressed to the Armed Services Committee. I hope you will
    present those requests to them.
        Senator Inouye.
        Senator Inouye. Yes. What is the current shortage of nurse
    anesthetists in the armed forces?
        Mr. McKibban. Number-wise? The Army and the Air Force--I do
    not have the exact numbers. Last week we were just notified
    that now the Navy is predicting a shortage in the Navy side of
    it too, sir.
        Senator Inouye. So there is a shortage but you are not
    aware of the number.
        Mr. McKibban. I do not have the exact number, no, sir.
        Senator Inouye. Thank you, sir.
        Senator Stevens. Thank you very much, Mr. McKibban.
    Appreciate it.
        Mr. McKibban. Thank you.
        Senator Stevens. Our next witness is Ms. Joyce Raezer,
    President of the National Military Family Association. Good
    morning, ma'am.
    STATEMENT OF JOYCE WESSEL RAEZER, DIRECTOR, GOVERNMENT
                RELATIONS, THE NATIONAL MILITARY FAMILY
                ASSOCIATION
        Ms. Raezer. Thank you, Mr. Chairman. I am not the
    President. I am representing the President today. Our President
    is Candace Wheeler. I am the Director of Government Relations.
        The National Military Family Association (NMFA) thanks you
    and Senator Inouye for the opportunity to speak about the
    quality of life of military families and the service members.
        With other members of the Military Coalition, NMFA is
    grateful for your leadership last year in securing increased
    funding for family support programs such as the family advocacy
    program and for pay and allowances to help offset the
    extraordinary demands of military service. Military families
    were most grateful to Congress for extending last year's
    increases to imminent danger pay and family separation
    allowance through December 2004. We hope Congress will make
    these increases permanent, and even if not made permanent, that
    funding will be provided to keep the family separation
    allowance at or near the current level for all eligible service
    members. Family separation allowance is not combat pay.
    Additional expenses families incur when the service member is
    assigned away from home are not based on a service member's
    assignment location. To the family, gone is gone.
        Longer and more frequent deployments are indications that
    our force is stretched thin. Military families are also
    stretched too thin.
        Our message to you today, however, is simple. Funding
    directed toward family readiness works. Funding you have helped
    to provide supports additional National Guard family assistance
    centers, more child care, increased staffing and programming
    directed to families of deployed service members, and return
    and reunion programs. New DOD programs such as Military One
    Source will make even more counseling and other assistance
    available, especially to isolated families.
        Funding directed toward family support is making a
    difference but it is still sporadic. Consistent levels of
    targeted funding are needed, along with consistent levels of
    command focus on family support, professional backup for the
    volunteers carrying the largest load of family support, and
    additional help for isolated Guard and Reserve families and
    families with special needs. Preventive mental health resources
    must be more accessible for families and service members over
    the long term.
        A significant element of family readiness is quality
    education for military children despite the challenges posed by
    ever-moving students and situations where the military parent
    is deployed or in harm's way. Now more than ever, we ask that
    you ensure both DOD and civilian schools educating military
    children have the resources to meet the counseling, staffing,
    and program challenges arising from new, ongoing, and changed
    missions, especially when deployments are extended. Families in
    Europe, for example, where some service members' Iraq tours
    were recently extended are concerned that funds will not be
    available for summer school this year. They need to know that
    the DOD schools can provide programs their children need.
        We applaud the increased partnerships between military
    commanders, DOD officials, and school officials to promote
    quality education for military children. The successful joint
    venture education initiative in Hawaii and the new military
    student website are just two examples of how folks are working
    together to provide more information to parents, commanders,
    and educators about issues affecting military children and to
    further partnerships to support children.
        Because Impact Aid is not fully funded, NMFA recommends
    increasing the DOD supplement to Impact Aid to $50 million to
    help civilian districts better meet the additional demands
    placed on them and the children they are charged to educate.
        NMFA also asks that you ensure the defense health system
    has adequate funding to make the challenges it faces. NMFA is
    concerned that the cost of performing additional duties under
    the new TRICARE contracts will be one strain too many,
    especially for the direct care system that is already dealing
    with a multitude of stressors such as maintaining readiness,
    mobilizing Guard and Reserve members, and implementing new
    benefits. Some military treatment facilities are cutting back
    on hours or services at exactly the time when they are supposed
    to be pulling in more care under the new TRICARE contracts. How
    can the new contracts function to the benefit of beneficiaries
    if they are designed to do one thing and that one thing is
    blocked?
        The future of successful initiatives such as family-
    centered care is in jeopardy if the direct care system must
    avert central funding to other demands. Please ensure not only
    the defense health system is funded to fulfill its
    responsibilities, but also that oversight is sufficient to
    prevent harm to beneficiaries during a transition process to
    new contracts that are supposed to help them.
        Mr. Chairman, the concern you and Senator Inouye have
    expressed today sends an important message to service members
    and their families. Congress understands the link between
    military readiness and the quality of life of the military
    community. Strong families ensure a strong force. Thank you for
    your work in keeping our families and force strong.
        [The statement follows:]
                   Prepared Statement of Joyce Wessel Raezer
        The National Military Family Association (NMFA) is the only
    national organization whose sole focus is the military family and whose
    goal is to influence the development and implementation of policies
    which will improve the lives of those family members. Its mission is to
    serve the families of the Seven Uniformed Services through education,
    information and advocacy.
        Founded in 1969 as the Military Wives Association, NMFA is a non-
    profit 501(c)(3) primarily volunteer organization. NMFA today
    represents the interests of family members and the active duty, reserve
    components and retired personnel of the seven uniformed services: Army,
    Navy, Air Force, Marine Corps, Coast Guard, Public Health Service and
    the National Oceanic and Atmospheric Administration.
        NMFA Representatives in military communities worldwide provide a
    direct link between military families and NMFA staff in the nation's
    capital. Representatives are the ``eyes and ears'' of NMFA, bringing
    shared local concerns to national attention.
        NMFA receives no federal grants and has no federal contracts.
        NMFA's web site is located at http://www.nmfa.org.
        Mr. Chairman and Distinguished Members of this Subcommittee, the
    National Military Family Association (NMFA) would like to thank you for
    the opportunity to present testimony on quality of life issues
    affecting servicemembers and their families. NMFA is also grateful for
    your leadership in the 1st Session of the 108th Congress in securing
    increased funding for essential quality of life programs, such as
    National Guard and Reserve family support and the Family Advocacy
    Program, as well as pay and allowances, such as the increased Family
    Separation Allowance, that help to offset the extraordinary demands of
    military service. NMFA thanks Congress for providing funds for
    servicemember's R&R travel, additional child care, and schools that
    educate military children.
        As a founding member of The Military Coalition, NMFA subscribes to
    the recommendations contained in the Coalition's testimony presented
    for this hearing. In this statement, NMFA will expand on a few issues:
    Pay and allowances; health care; family support, including the unique
    needs of Guard and Reserve families; and education for military
    children.
    Pay and Allowances
        Servicemembers and their families appreciate the dramatic
    improvements in military compensation achieved over the past several
    years. The combination of across-the-board raises at the level of the
    Employment Cost Index (ECI) plus 0.5 percent and targeted raises for
    certain ranks have improved their financial well-being. The five-year
    plan, ending in fiscal year 2005, to increase Basic Allowance for
    Housing (BAH) has been especially beneficial for military families
    living in high cost of living areas.
    Family Separation Allowance
        Military members and their families were most grateful to Congress
    last year for including increases in Family Separation Allowance and
    Imminent Danger Pay in the fiscal year 2003 Supplemental Appropriations
    bill. They were relieved when these increases were authorized and
    funded to continue through December 2004, yet alarmed that last fall's
    debate over both the amount of Family Separation Allowance and who
    should receive it is surfacing again. NMFA understands DOD is looking
    at the wide range of pays and allowances in order to determine their
    proper mix and use. We believe, however, that the amount of Family
    Separation Allowance must remain the same for all eligible
    servicemembers, no matter where they are deployed. Family Separation
    Allowance is not combat pay--it is paid in recognition of the
    additional costs a family endures when a servicemember is deployed. It
    helps pay for the additional long distance phone calls the deployed
    servicemember and family make; it pays for the car or home repairs the
    servicemember performs when at home; it pays for the tutoring a child
    needs when the family chemistry or algebra expert is deployed. These
    costs are not incurred just by the families of servicemembers in a
    combat zone; whether the servicemember is in Iraq, Afghanistan, on a
    ship in the Pacific, or on an unaccompanied tour in Korea, to the
    family, ``gone is gone!''
        NMFA must also note that, while families of deployed servicemembers
    face similar costs of separation no matter where the servicemember is
    deployed, other pay and benefits change dramatically. Servicemembers
    deployed to certain combat zones not only receive Imminent Danger Pay
    and other combat-related pays, but also are entitled to certain tax
    advantages. Servicemembers in other locations, such as Korea or on
    board ships outside combat zones, do not receive the same tax
    advantage. Thus, their families have similar expenses to meet with less
    income. To these families, last year's increase in Family Separation
    Allowance was an especially welcome relief to tight family budgets.
        NMFA asks this Subcommittee to ensure that funding is continued to
    sustain the increased level of Family Separation Allowance for all
    eligible servicemembers. NMFA also asks Congress to consider indexing
    the Family Separation Allowance to inflation so that we do not have to
    wait for another war for this allowance to be increased again.
    Health Care
        This year, NMFA is focused on health care transition issues and the
    costs to the defense health system imposed by these issues: the
    transition to the new TRICARE contracts, Guard and Reserve family
    members' transition to the TRICARE benefit when the servicemember is
    called to active duty, and the transition that occurs during the return
    and reunion process as servicemembers and their families adjust to the
    end of a deployment.
    Transition to New TRICARE Contracts
        NMFA's concerns during the transition to the new TRICARE
    contracts--the first contract handoff occurs on June 1--revolve around
    the ability of the Defense Health System to ensure beneficiaries can
    access care in a timely manner and the ability of the system to
    maintain continuity of care. NMFA is concerned that the direct care
    system may not be able to fulfill its new responsibilities under the
    new contracts while working so hard to meet readiness requirements
    related to deployments and force health protection, care for wounded
    and injured servicemembers, and care for the active duty families,
    retirees, and survivors enrolled in TRICARE Prime to primary care
    managers in their facilities. Under the new contracts, military
    treatment facilities (MTFs) will be responsible for appointing, which
    is often done by the TRICARE managed care support contractors under the
    current contracts. MTFs must also fill the void created by the
    departure of key medical personnel currently provided by the TRICARE
    contractors under resource sharing arrangements. These arrangements end
    on the day health care delivery begins under the new TRICARE contracts,
    as the responsibility for them shifts from the TRICARE contractor to
    the MTFs. NMFA is pleased that DOD has offered MTFs the opportunity of
    a bridge process to work with outgoing and incoming contractors to keep
    resource sharing providers in place until establishing their own
    arrangements. Unfortunately, NMFA has heard most MTFs are not taking
    advantage of this bridge option and are looking at other contracting
    options that will not preserve the continuity of care and access
    currently enjoyed by patients. The relationships resource sharing
    personnel have developed with patients in places such as Madigan Army
    Medical Center, where the pediatric clinic is staffed entirely by
    resource sharing, should not be severed abruptly at a time when this
    continuity of care is needed most.
        NMFA is concerned that the costs of performing additional duties
    under the new TRICARE contracts will be one strain too many for a
    direct care system dealing with a multitude of stressors. NMFA is
    hearing that several MTFs are cutting back on pharmacy or clinic hours,
    eliminating contract staff, or capping TRICARE Prime enrollment even as
    they are forced to commit more personnel to support deployments, ensure
    newly-mobilized Guard and Reserve members are medically-ready to
    deploy, and care for wounded servicemembers returning from Iraq and
    Afghanistan. Cutbacks in the direct care system can result in one of
    two scenarios. An MTF may appeal to the ``patriotism'' of active duty
    families, survivors, retirees and their families by telling them that
    appointments are currently not available and asking them to wait. Or,
    if it chooses to ensure that TRICARE Prime access standards are met, it
    may be forced to send beneficiaries into the civilian purchased care
    networks for their care, probably at a greater cost to the government.
        When each of the current twelve regions started delivery of
    services under TRICARE in the mid to late 1990s, significant problems
    for beneficiaries developed. Over the ensuing years, most of the
    problems have been identified and corrected. The acceptance of and
    satisfaction with TRICARE Prime, the HMO piece of TRICARE, has steadily
    increased among beneficiaries. The transition to the new contracts must
    not once again put TRICARE at the top of concerns at beneficiary
    forums. Just as servicemembers are stretched thin with repeated
    deployments and time away from home, families are under increased
    stress. Problems accessing health care or difficulty in obtaining
    accurate information on how to do so should not be an additional part
    of this equation. The promise of TRICARE was that in times of high
    military operations tempo the purchased care system could pick up the
    slack when MTFs were stretched thin because of military optempo. This
    promise can only be kept if the defense health program is fully funded
    to meet its medical readiness mission and to provide the employer-
    sponsored health care benefit. Further, it must incorporate enough
    flexibility to permit funding to be moved between the two segments as
    needed to ensure beneficiary access to quality care and to provide that
    quality care in the most cost-effective setting possible.
    Guard and Reserve Health Care
        NMFA is grateful to Congress for its initial efforts to enhance the
    continuity of care for National Guard and Reserve members and their
    families. Unfortunately, as discussed in the statement submitted by The
    Military Coalition, the temporary health care provisions enacted in the
    fiscal year 2004 NDAA have not yet been implemented. Information and
    support are improving for Guard and Reserve families who must
    transition into TRICARE; however, NMFA believes that going into TRICARE
    may not be the best option for all of these families. Guard and Reserve
    servicemembers who have been mobilized should have the same option as
    their peers who work for the Department of Defense: DOD should pay
    their civilian health care premiums. The ability to stay with their
    civilian health care plan is especially important when a Guard or
    Reserve family member has a special need, a chronic condition, or is in
    the midst of treatment. While continuity of care for some families will
    be enhanced by the option to allow Guard and Reserve members to buy
    into TRICARE when not on active duty--if ever implemented--it can be
    provided for others only if they are allowed to remain with their
    civilian health insurance. Preserving the continuity of their health
    care is essential for families dealing with the stress of deployment.
    Post Deployment Health for Servicemembers and Families
        The Services recognize the importance of educating servicemembers
    and family members about how to effect a successful homecoming and
    reunion and have taken steps to improve the return and reunion process.
    Information gathered in the now-mandatory post-deployment health
    assessments may also help identify servicemembers who may need more
    specialized assistance in making the transition home. Successful return
    and reunion programs will require attention over the long term. Many
    mental health experts state that some post-deployment problems may not
    surface for several months after the servicemembers return. NMFA is
    especially concerned about the services that will be available to the
    families of returning Guard and Reserve members and servicemembers who
    leave the military following the end of their enlistment. Although they
    may be eligible for transitional health care benefits and the
    servicemember may seek care through the Veterans' Administration, what
    happens when the military health benefits run out and deployment-
    related stresses still affect the family? As part of its return and
    reunion plan, the military One Source contracts will help returning
    servicemembers and families access local community resources and to
    receive up to six free face-to-face mental health visits with a
    professional outside the chain of command. NMFA is pleased that DOD has
    committed to funding the counseling provided under the One Source
    contract and is implementing this counseling for servicemembers and
    families of all Services.
        Post-deployment transitions could be especially problematic for
    servicemembers who have been injured and their families. Wounded
    servicemembers have wounded families and, just as it will take some
    time for servicemembers physical wounds to heal, it will take time for
    the emotional wounds to heal. These servicemembers have received
    excellent care through military hospitals. In many cases, their
    families have also received superior support services through the
    hospitals' family assistance personnel. The medical handoff of the
    servicemember to the VA is steadily improving and the VA and DOD are
    working well together to improve the servicemembers' continuity of
    care. Ensuring the handoff to the VA or community-based support
    services needed by the wounded families is just as important.
        The new round of TRICARE contracts must provide standardized ways
    to access health care across all regions and emphasize providing
    continuity of care to beneficiaries during the transition from old to
    new contracts. The Defense Health System must be funded sufficiently so
    that the direct care system of military treatment facilities and the
    purchased care segment of civilian providers can work in tandem to meet
    the responsibilities given under the new contracts, meet readiness
    needs, and ensure access for all TRICARE beneficiaries. Families of
    Guard and Reserve members should have flexible options for their health
    care coverage that address both access to care and continuity of care.
    In addition, accurate and timely information on options for obtaining
    mental health services and other return and reunion support must be
    provided to families as well as to servicemembers.
    Family Support
        Since our testimony before this Subcommittee last year, NMFA is
    pleased to note the Services continue to refine the programs and
    initiatives to provide support for military families in the period
    leading up to deployments, during deployment, and the return and
    reunion period. Our message to you today is simple: funding directed
    toward family support works! We have visited installations that
    benefited from family support funding provided through the wartime
    appropriations. This money enabled the National Guard Bureau to open
    additional Family Assistance Centers in areas with large numbers of
    mobilized Guard and Reserve members. It enabled the Services to provide
    additional child care for active duty families through their military
    child development centers and Family Child Care providers and to work
    on developing arrangements with child care providers in other locations
    to serve Guard and Reserve families. It enabled military family centers
    to hire additional staff and to increase programming and outreach to
    families of deployed servicemembers. It improved the ability of
    families to communicate with deployed servicemembers and enhanced
    Service efforts to ease servicemembers' return and reunion with their
    families.
        Funding directed toward family support is making a difference, but
    still sporadically. Consistent levels of targeted funding are needed,
    along with consistent levels of command focus on the importance of
    family support programs. NMFA remains concerned that installations must
    continue to divert resources from the basic level of family programs to
    address the surges of mobilization and return. Resources must be
    available for commanders and others charged with ensuring family
    readiness to help alleviate the strains on families facing more
    frequent and longer deployments. As the mobilization and de-
    mobilization of Guard and Reserve members continues, support for their
    families remains critical.
        Projected force numbers for the second rotation of troops under
    Operation Iraqi Freedom call for 40 percent to be Guard and Reserve
    members. This number does not include servicemembers called up for duty
    in Operation Enduring Freedom in Afghanistan and those who continue to
    serve in Bosnia. National Guard and Reserve families often find
    themselves a great distance from traditional military installation-
    based support facilities. They may also be far from the Guard armory or
    reserve center where their servicemember trains. How then does the
    family learn about all their active duty benefits or receive answers
    about how to follow the rules? Continued targeted funding for Family
    Assistance Centers and other support programs is essential to assist
    these families in their transition from the civilian to military life.
    What's Needed for Family Support?
        Family readiness volunteers and installation family support
    personnel in both active duty and reserve component communities have
    been stretched thin over the past 2\1/2\ years as they have had to
    juggle pre-deployment, ongoing deployment, and return and reunion
    support, often simultaneously. Unfortunately, this juggling act will
    likely continue for some time. Volunteers, whose fatigue is evident,
    are frustrated with being called on too often during longer than
    anticipated and repeated deployments. We now hear from volunteers and
    family members whose servicemembers are serving in a second long
    deployment to a combat zone since the war on terrorism began. Family
    member volunteers support the servicemembers' choice to serve; however,
    they are worn out and concerned they do not have the training or the
    backup from the family support professionals to handle the problems
    facing some families in their units. Military community volunteers are
    the front line troops in the mission to ensure family readiness. They
    deserve training, information, and assistance from their commands,
    supportive unit rear detachment personnel, professional backup to deal
    with family issues beyond their expertise and comfort level, and
    opportunities for respite before becoming overwhelmed. NMFA is pleased
    that the Army is establishing paid Family Readiness Group positions at
    many installations dealing with deployments to provide additional
    support to families and volunteers--more of these positions are needed.
        NMFA knows that the length of a deployment in times of war is
    subject to change, but also understands the frustrations of family
    members who eagerly anticipated the return of their servicemembers on a
    certain date only to be informed at the last minute that the deployment
    will be extended. Other than the danger inherent in combat situations,
    the unpredictability of the length and frequency of deployments is
    perhaps the single most important factor frustrating families today.
    Because of the unpredictable nature of the military mission, family
    members need more help in acquiring the tools to cope with the
    unpredictability. A recent town meeting in Europe was held for family
    members of soldiers who were among the 20,000 troops recently extended
    for ninety more days. The commander of U.S. Army Europe heard first-
    hand of the disruptions caused by this extension to families who only a
    few weeks before had been sitting in reintegration briefings and
    planning how to spend the time during the servicemembers' promised
    block leave. Now, these families face changes in move dates and fears
    they will not be settled at new assignments before school starts.
    Activities for children--including summer school--are now needed more
    than ever. School principals who thought parents would be home for
    graduation must arrange for video teleconferences to Iraq so that
    parents can still participate in the event. Families who purchased
    plane tickets for block leave trips back to the states must now seek
    refunds. Rear detachment personnel, family readiness volunteers and
    family center staff who were also looking forward to down time must now
    work harder to ensure that support is available for families in their
    charge.
    Joint Family Support: An Idea Whose Time Has Come
        NMFA applauds the increase in joint coordination to improve family
    readiness that has occurred over the past few years. As the military
    becomes more ``joint,'' it makes sense to use a joint approach to
    family support, providing consistent information and using scarce
    personnel and other resources to the best advantage. A start in
    improved joint family readiness support has been DOD's establishment of
    a common web portal with links to military Service, private
    organization, and other useful government sites
    (www.deploymentconnections.org). All active and reserve component
    personnel and their families can now access the ``One Source'' 24-hour
    information and referral service. One Source provides information and
    assistance, not just for post-deployment concerns, but also in such
    areas as parenting and child care, educational services, financial
    information and counseling, civilian legal advice, elder care, crisis
    support, and relocation information. The service is available via
    telephone, e-mail, or the web and is designed to augment existing
    Service support activities and to link customers to key resources, web
    pages and call centers. It is also available to family center staff,
    many of whom tell NMFA that they regard it as a useful tool to expand
    the assistance they can provide families. One Source is operated for
    the military Services by a civilian company that provides similar
    Employee Assistance Programs for private industry. Early statistics on
    use indicate that servicemembers and families are accessing One Source
    primarily for everyday issues and basic information about military
    life. Military families who use One Source, including spouses who
    testified before the House Military Construction Appropriations
    Subcommittee in February, are pleased with the support and information
    provided.
        While NMFA believes One Source is an important tool for family
    support, it is not a substitute for the installation-based family
    support professionals or the Family Assistance Centers serving Guard
    and Reserve families. NMFA is concerned that in a tight budget
    situation, family support staffing might be cut under the assumption
    that the support could be provided remotely through One Source. The One
    Source information and referral service must be properly coordinated
    with other support services, to enable family support professionals to
    manage the many tasks that come from high optempo. The responsibility
    for training rear detachment personnel and volunteers and in providing
    the backup for complicated cases beyond the knowledge or comfort level
    of the volunteers should flow to the installation family center or
    Guard and Reserve family readiness staff. Family program staff must
    also facilitate communication and collaboration between the rear
    detachment, volunteers, and agencies such as chaplains, schools, and
    medical personnel.
        NMFA applauds the various initiatives designed to meet the needs of
    servicemembers and families wherever they live and whenever they need
    them and requests adequate funding to ensure continuation both of the
    ``bedrock'' support programs and implementation of new initiatives.
    Higher stress levels caused by open-ended deployments require a higher
    level of community support. Family readiness responsibilities must be
    clearly delineated so that the burden does not fall disproportionately
    on volunteers.
    Education for Military Children
        A significant element of family readiness is an educational system
    that provides a quality education to military children, recognizing the
    needs of these ever-moving students and responding to situations where
    the military parent is deployed and/or in an armed conflict. Children
    are affected by the absence of a parent and experience even higher
    levels of stress when their military parent is in a war zone shown
    constantly on television. The military member deployed to that
    dangerous place cannot afford to be distracted by the worry that his or
    her child is not receiving a quality education. Addressing the needs of
    these children, their classmates, and their parents is imperative to
    lowering the overall family stress level and to achieving an
    appropriate level of family readiness. But it does not come without
    cost to the local school system.
        NMFA is pleased to report that most schools charged with educating
    military children have stepped up to the challenge. They are the
    constant in a changing world and the place of security for military
    children and their families. The goal, according to one school
    official, ``is to keep things normal for the kids.'' The schools' role
    is to ``train teachers in what to look for and deal with what they
    find.'' NMFA received many positive stories from parents and schools
    about how the schools have helped children deal with their fears, keep
    in touch with deployed parents, and keep focused on learning. We have
    also heard stories of schools helping each other, of schools
    experienced in educating military children and dealing with deployment-
    related issues providing support for school systems with the children
    of activated Guard and Reserve members. In the process, many schools
    have increased the understanding of their teachers and other staff, as
    well as their entire communities, about issues facing military
    families.
        The Department of Defense is supporting this effort in several
    significant ways. Late last year, DOD launched a new education website
    (www.militarystudent.org) to provide information on a variety of
    education topics to parents, students, educational personnel, and
    military commanders. Its information is especially valuable for schools
    and families dealing with the issues of deployment for the first time.
    NMFA is also pleased to report that other Services are following the
    Army's lead and hiring full-time School Liaison Officers at certain
    installations. The Army not only has School Liaison Officers at all
    locations, but has also expanded to provide these information services
    to the reserve components, recruiters and other remotely-assigned
    personnel and their families.
        NMFA applauds DOD initiatives to work with states to ease
    transition issues for military children and to ensure that military
    leaders and school officials are working together to provide high
    quality education for all their community's children. Hawaii's
    education officials are working closely with the Pacific Command
    through the Joint Venture Education Forum (JVEF). The JVEF has helped
    officials target Impact Aid and DOD supplement funding where most
    needed, marshaled military support to improve school facilities and
    sponsor school programs, conducted training sessions about the military
    for school personnel, and established model peer mentoring programs
    where students can help incoming military children acclimate to their
    new school. We believe such coordination between the military and the
    state and local entities charged with educating military children will
    bring an increased awareness to civilian neighborhoods about the value
    the military brings to their communities. To the military Services,
    this collaboration will bring a better awareness of the burden being
    shouldered by local taxpayers to educate military children. To military
    children and their parents, this collaboration shows that quality
    education is a shared priority between the Department of Defense and
    their local schools.
        NMFA is appreciative of the support shown by Congress for the
    schools educating military children. It has consistently supported the
    needs of the schools operated by the DOD Education Activity (DODEA),
    both in terms of basic funding and military construction. Congress has
    also resisted efforts by a series of administrations to cut the Impact
    Aid funding so vital to the civilian school districts that educate the
    majority of military children. NMFA is also appreciative of the
    approximately $30 million Congress adds in most years to the Defense
    budget to supplement Impact Aid for school districts whose enrollments
    are more than 20 percent military children and for the additional
    funding to support civilian school districts who are charged with
    educating severely disabled military children. NMFA does not believe,
    however, that this amount is sufficient to help school districts meet
    the demands placed on them by their responsibilities to serve large
    numbers of military children. Additional counseling and improvements to
    security are just two of needs faced by many of these school districts.
    NMFA requests this Subcommittee to increase the DOD supplement to
    Impact Aid to $50 million so that the recipient school districts have
    more resources at their disposal to educate the children of those who
    serve.
    DODEA
        Department of Defense schools are located in overseas locations
    (DODDS) and on a small number of military installations in the United
    States (DDESS). The commitment to the education of military children in
    DOD schools between Congress, DOD, military commanders, DODEA
    leadership and staff, and especially military parents has resulted in
    high test scores, nationally-recognized minority student achievement,
    parent involvement programs and partnership activities with the
    military community. This partnership has been especially important as
    the overseas communities supported by DODDS and many of the
    installations with DDESS schools have experienced high deployment
    rates. DOD schools have responded to the operations tempo with
    increased support for families and children in their communities.
        While DOD schools have been immune from some of the constraints
    besetting civilian schools affected by state and local budget
    pressures, military families served by DOD schools have expressed
    concerns in recent years about DOD rescissions that cause cuts in
    maintenance, staff development, technology purchases and personnel
    support and also forced the elimination of some instructional days in
    some districts. NMFA is hearing concerns that DODDS will not be able to
    fund summer school this summer. Given the high deployment levels and
    deployment extensions affecting some communities in Europe, we know
    that children will need this opportunity for learning and involvement
    with their peers more than ever. We ask that Congress work with DOD to
    ensure DOD schools have the resources they need to handle their
    additional tasks.
        NMFA also asks this Subcommittee to understand the importance
    military parents attach to schools that educate their children well.
    DOD is currently preparing a Congressionally-requested report to
    determine whether it could turn some DDESS districts over to
    neighboring civilian education agencies. While NMFA does not object to
    the concept of a report to determine whether school systems are
    providing a quality education, using tax dollars well, or are in need
    of additional maintenance or other support funding, we are concerned
    about the timing of the study and the reaction it has caused in
    communities already dealing with the stress of the war and deployments.
    Families in these communities wonder why something that works so well
    now seems to be threatened. NMFA attended an October 2003 community-
    input forum sponsored by the Director of DODEA. We were impressed not
    just with the strong support commanders and other community leaders
    gave to these schools, but also with the efforts they had made to reach
    out to local civilian schools to improve education for all military
    children.
        NMFA applauds the DOD vision that the Department focus on quality
    education for all military children. We have stated for years that DOD
    needs to do more to support civilian school districts educating most of
    the 85 percent of military children who do not attend DOD schools. We
    believe, however, that shifting children from highly successful,
    highly-resourced DOD schools to neighboring districts may cause more
    harm than good to both military children and their civilian peers.
    Adding to the stress in military communities also harms the education
    of military children. NMFA does not know what DOD's final
    recommendations will be. We encourage Members of Congress to study
    those recommendations closely before making any decision that could
    damage the educational success the DDESS schools have achieved.
        Schools serving military children, whether DOD or civilian schools,
    need the resources available to meet military parents' expectation that
    their children receive the highest quality education possible. Because
    Impact Aid from the Department of Education is not fully funded, NMFA
    recommends increasing the DOD supplement to Impact Aid to $50 million
    to help districts better meet the additional demands caused by large
    numbers of military children, deployment-related issues, and the
    effects of military programs and policies such as family housing
    privatization. Initiatives to assist parents and to promote better
    communication between installations and schools should be expanded
    across all Services. Military children must not be placed at a
    disadvantage as State and Federal governments devise accountability
    measures.
    Strong Families Ensure a Strong Force
        Mr. Chairman, NMFA is grateful to this Subcommittee for ensuring
    funding is available for the vital quality of life components needed by
    today's force. As you consider the quality of life needs of
    servicemembers and their families this year, NMFA asks that you
    remember that the events of the past 2\1/2\ years have left this family
    force drained, yet still committed to their mission. Servicemembers
    look to their leaders to provide them with the tools to do the job, to
    enhance predictability, to ensure that their families are cared for,
    their spouses' career aspirations can be met, and their children are
    receiving a quality education. They look for signs from you that help
    is on the way, that their pay reflects the tasks they have been asked
    to do, and that their hard-earned benefits will continue to be
    available for themselves, their families, and their survivors, both now
    and into retirement.

        Senator Stevens. Well, we travel a lot and we find the
    results of your work, and we thank your family association very
    much for what you are doing in really bringing to the families
    knowledge of what we are trying to do and what we have been
    able to achieve. So we will examine your statement in greater
    detail and we thank you very much for the statement.
        Senator Inouye.
        Senator Inouye. Well, I agree with the chairman that a
    strong family system equals a strong military.
        Ms. Raezer. Thank you, Mr. Chairman, and thank you, Senator
    Inouye.
        Senator Stevens. Our next witness is retired Captain
    Marshall Hanson of the United States Navy Reserve, Chairman of
    the Association for America's Defense.
        Oh, pardon me. I am reading the wrong one. We will go to
    Melanie K. Smith, Director of the Lymphoma Research Foundation.
    You are next. Sorry about that.
    STATEMENT OF MELANIE K. SMITH, DIRECTOR, PUBLIC POLICY
                AND ADVOCACY, LYMPHOMA RESEARCH FOUNDATION
        Ms. Smith. Thank you. Mr. Chairman and Senator Inouye, it
    is my pleasure to appear before you today to request that you
    expand the congressionally directed medical research program to
    include research on the blood cancers. I am Melanie Smith,
    Director of Public Policy and Advocacy for the Lymphoma
    Research Foundation (LRF), a voluntary health agency that funds
    lymphoma research and provides education and support services
    to individuals with lymphoma and their families and friends. On
    behalf of LRF, thank you for the opportunity to testify today.
        This subcommittee is to be commended for its leadership in
    funding special research programs at the Department of Defense
    with a particular emphasis on cancer research. We realize that
    at the time that these programs were initiated, they were a
    departure from the national defense programs generally funded
    by the subcommittee. Over time, they have become model research
    programs that complement the research efforts of the National
    Institutes of Health (NIH) and that are hailed by patient
    advocates because they allow meaningful consumer input in the
    planning of the research portfolio and their view of research
    proposals.
        We understand that the subcommittee is carefully evaluating
    the congressionally directed medical research program (CDMRP)
    and has asked the Institute of Medicine to consider options for
    expanding the funding of these research ventures potentially
    through public-private partnerships. In light of this
    evaluation and the difficult Federal budget situation, it may,
    on first consideration, seem illogical for LRF to propose an
    expansion of CDMRP. However, we think that an investment in
    blood cancer research will complement and strengthen the
    existing blood cancer program at CDMRP and that the benefits of
    a blood cancer research program will far exceed the financial
    commitment to it.
        We make this bold statement based on the history of cancer
    research and treatment. We believe that directing funds to
    blood cancer research will yield benefits not only for blood
    cancer patients but also for patients that have been diagnosed
    with solid tumors. Advances in the treatment of the blood
    cancers have generally been of direct benefit to those with
    solid tumors.
        For example, many chemotherapy agents that are now used in
    the treatment of a wide range of solid tumors were originally
    used in the treatment of blood cancers. The strategy of
    combining chemotherapy with radiation therapy began in the
    treatment of Hodgkin's disease and is now widely used in the
    treatment of many solid tumors. Many recently developed
    therapeutic interventions like monoclonal antibodies that
    target and disable antigens on the cell surface are thought to
    be responsible for cell proliferation began in the blood
    cancers but are now thought to hold promise for breast,
    prostate, ovarian, and other forms of cancer.
        Each year approximately 110,000 Americans are diagnosed
    with one of the blood cancers. More than 60,000 will die in
    2004 and 700,000 Americans are living with these cancers. Taken
    as a whole, the blood-related cancers are the fifth most common
    cancer behind lung, breast, prostate, and colorectal cancer.
        The causes of the blood cancers remain unknown. With regard
    to Hodgkin's lymphoma and non-Hodgkin's lymphoma, immune system
    impairment and exposure to environmental carcinogens,
    pesticides, herbicides, viruses and bacteria may play a role.
    The linkage between exposure to one particular herbicide, Agent
    Orange, and the blood cancers has been established by the
    Committee to Review the Health Effects in Vietnam Veterans of
    Exposure to Herbicides, a special committee of the Institute of
    Medicine (IOM). This panel was authorized by the Agent Orange
    Act of 1991 and has issued four reports on the health effects
    of Agent Orange. The committee has concluded that there is
    sufficient evidence of an association between exposure to
    herbicides and chronic lymphocytic leukemia (CLL), non-
    Hodgkin's lymphoma and Hodgkin's lymphoma, and there is limited
    or suggestive evidence of an association between herbicide
    exposure and multiple myeloma.
        The IOM panel does not have the responsibility to make
    recommendations about Veterans Administration benefits, but the
    VA has, in fact, responded to these reports by guaranteeing the
    full range of VA benefits to Vietnam veterans who have the
    diseases that have been linked to herbicide exposure, including
    CLL, Hodgkin's lymphoma, and non-Hodgkin's lymphoma.
        In fiscal years 2002, 2003, and 2004, the subcommittee
    funded a research program at the Department of Defense that
    supports research on one particular kind of leukemia called
    chronic myelogenous leukemia, or CML. This form of leukemia has
    been much in the news because of the development of Gleevec, a
    drug that has been hailed as a possible cure for the disease.
    We applaud the subcommittee for its commitment to a program of
    CML research. We would recommend that this program, which has
    received total funding of slightly less than $15 million over
    the last 3 years, be continued and that a parallel initiative
    be launched that would fund all other types of blood cancer
    research or that the CML program be expanded to fund research
    on all forms of blood cancer, perhaps with a special set-aside
    for CML.
        We believe that an investment of $16 million in a new blood
    cancer research program would have the potential to enhance our
    understanding of the blood cancers, viral and environmental
    links to these diseases and contribute to the development of
    new treatments.
        The subcommittee can strengthen the overall CDMRP cancer
    research efforts and contribute to development of new
    treatments for people with a blood cancer and those with solid
    tumors. We believe an investment in blood cancer research would
    be a wise one.
        We greatly appreciate the opportunity to present this
    proposal to you today. Thank you.
        Senator Stevens. Thank you very much.
        Questions, Senator?
        Senator Inouye. No.
        Senator Stevens. Thank you very much.
        Ms. Smith. Thank you.
        [The statement follows:]
                     Prepared Statement of Melanie K. Smith
        Mr. Chairman and Members of the Subcommittee, it is my pleasure to
    appear before you today to request that you expand the Congressionally
    Directed Medical Research Program to include research on the blood
    cancers. I am Melanie Smith, Director of Public Policy and Advocacy of
    the Lymphoma Research Foundation (LRF), a voluntary health agency that
    funds lymphoma research and provides education and support services to
    individuals with lymphoma and their families and friends.
        This Subcommittee is to be commended for its leadership in funding
    several special research programs at the Department of Defense (DOD),
    with a particular emphasis on cancer research. We realize that, at the
    time these programs were initiated, they were a departure from the
    national defense programs generally funded by the Subcommittee. Over
    time, they have become model research programs that complement the
    research efforts of the National Institutes of Health and that are
    hailed by patient advocates because they allow meaningful consumer
    input in the planning of the research portfolio and the review of
    research proposals.
        We understand that the Subcommittee is carefully evaluating the
    CDMRP and has asked the Institute of Medicine (IOM) to consider options
    for expanding the funding of these research ventures, potentially
    through public-private partnerships. In light of this evaluation and
    the difficult federal budget situation, it may on first consideration
    seem illogical for LRF to propose an expansion of CDMRP. However, we
    think that an investment in blood cancer research will complement and
    strengthen the existing blood cancer programs at CDMRP and that the
    benefits of a blood cancer research program will far exceed the
    financial commitment to it.
        We make this bold statement based on the history of cancer research
    and treatment. We believe that directing funds to blood cancer research
    will yield benefits not only for blood cancer patients but also for
    patients that have been diagnosed with solid tumors. Advances in the
    treatment of the blood cancer have generally been of direct benefit to
    those with solid tumors. For example, many chemotherapy agents that are
    now used in the treatment of a wide range of solid tumors were
    originally used in the treatment of blood cancers. The strategy of
    combining chemotherapy with radiation therapy began in the treatment of
    Hodgkin's disease and is now wisely used in the treatment of many solid
    tumors. Many recently developed therapeutic interventions, like
    monoclonal antibodies that target and disable antigens on the cell
    surface that are thought to be responsible for cell proliferation,
    began in the blood cancers but are now thought to hold promise for
    breast, prostate, ovarian, and other forms of cancer. Research on the
    blood cancers has also contributed to knowledge about staging cancer,
    as the concept of cancer staging to accurately define disease severity
    and target appropriate therapy began in lymphoma and is now used in all
    cancers.
        We believe that there are additional facts that justify a DOD
    investment in blood cancer research, including the potential links
    between military service and development of certain blood cancers. For
    example, exposure to Agent Orange has been associated with blood
    cancers. Possible exposures to other toxins might also be linked to
    development of blood cancers, and an enhanced blood cancer research
    program will help us understand these links.
        In the remainder of my statement, I will briefly provide additional
    information about the blood cancers, research on the possible causes of
    these cancers, and the benefits of expanding the current leukemia
    research program to include all blood cancers.
    The Blood Cancers
        Each year, approximately 110,000 Americans are diagnosed with one
    of the blood cancers. More than 60,000 will die from these cancers in
    2004, and 700,000 Americans are living with these cancers. Taken as a
    whole, the blood-related cancers are the 5th most common cancer, behind
    lung, breast, prostate, and colorectal cancer.
        There have recently been some significant advances in the treatment
    of the blood cancers. In 2001, the targeted therapy called Gleevec was
    approved for treatment of chronic myelogenous leukemia, and this drug
    is also approved for use in gastrointestinal stromal tumor (GIST). Two
    new radioimmunotherapies have been approved for patients with
    refractory NHL, and a new proteasome inhibitor for treating multiple
    myeloma was approved in 2003. These treatments represent progress in
    the fight against the blood cancers, but there is much work still to be
    done.
        Although there have recently been declines in the number of new
    cases and deaths associated with many forms of cancer, the trend is
    different for non-Hodgkin's lymphoma and multiple myeloma. The
    incidence of non-Hodgkin's lymphoma has nearly doubled since the
    1970's, and the mortality rate from non-Hodgkin's lymphoma is
    increasing at a faster rate than other cancers. One can see that,
    despite scientific progress, there is much to be done to improve blood
    cancer treatments. We are pleased by any step forward, but our goal is
    still a cure of the blood cancers. We acknowledge that this is a
    scientifically difficult goal, but it must remain our objective. A DOD
    program could accelerate the achievement of this goal and may also
    benefit survivors with other forms of cancer.
    The Link Between Blood Cancers and Military Service
        The causes of the blood cancers remain unknown. With regard to
    Hodgkin's lymphoma and non-Hodgkin's lymphoma, immune system impairment
    and exposure to environmental carcinogens, pesticides, herbicides,
    viruses, and bacteria may play a role. The linkage between exposure to
    one particular herbicide--Agent Orange--and the blood cancers has been
    established by the Committee to Review the Health Effects in Vietnam
    Veterans of Exposure to Herbicides, a special committee of the IOM.
    This panel was authorized by the Agent Orange Act of 1991 and has
    issued four reports on the health effects of Agent Orange. The
    committee has concluded that ``there is sufficient evidence of an
    association between exposure to herbicides'' and chronic lymphocytic
    leukemia (CLL), non-Hodgkin's lymphoma, and Hodgkin's lymphoma, and
    there is limited or suggestive evidence of an association between
    herbicide exposure and multiple myeloma.
        The IOM panel does not have responsibility to make recommendations
    about Veterans Administration (VA) benefits, but the VA has in fact
    responded to these reports by guaranteeing the full range of VA
    benefits to Vietnam veterans who have the diseases that have been
    linked to herbicide exposure, including CLL, Hodgkin's lymphoma, and
    non-Hodgkin's lymphoma. These benefits include access to VA health
    care. There are now, unfortunately, a number of Vietnam veterans who
    are receiving VA health care for treatment of CLL, non-Hodgkin's
    lymphoma, and Hodgkin's lymphoma, and DOD-sponsored research on these
    diseases has the potential to improve the survival and the quality of
    life for these veterans.
    Potential Risks of Blood Cancers in the Future
        We all acknowledge that we live in a very complicated age, where
    those in the military are at risk of exposure to chemical and
    biological agents. The evidence suggests that immune system impairment
    and exposure to environmental carcinogens, pesticides, herbicides,
    viruses, and bacteria may play a role in the development of Hodgkin's
    lymphoma and non-Hodgkin's lymphoma. It is therefore possible that, if
    our troops were exposed to chemical or biological weapons, they might
    be placed at increased risk of development of non-Hodgkin's lymphoma,
    Hodgkin's lymphoma, or one of the other blood cancers.
        We strongly recommend that we invest now in research to understand
    the potential links between pesticides, herbicides, viruses, bacteria,
    and the blood cancers. The enhanced investment now may contribute to a
    deeper understanding of these possible linkages and to the development
    of strategies to protect those who suffer such exposures. A greater
    commitment to the research and development of new blood cancer
    therapies is also critically important if we anticipate that there may
    be more individuals, including those in the military, who suffer from
    those cancers as a result of service-connected exposure.
    The Current DOD Chronic Myelogenous Leukemia Program
        In fiscal year 2002, fiscal year 2003, and fiscal year 2004, the
    Subcommittee funded a research program at DOD that supports research on
    one particular kind of leukemia, called chronic myelogenous leukemia,
    or CML. This form of leukemia has been much in the news because of the
    development of Gleevec, a drug that has been hailed as a possible cure
    for the disease. We applaud the Subcommittee for its commitment to a
    program of CML research. We would recommend that this program, which
    has received total funding of slightly less than $15 million over the
    last three years, be continued and that a parallel initiative be
    launched that would fund all other types of blood cancer research, or
    that the CML program be expanded to fund research on all forms of blood
    cancer, perhaps with a special set-aside for CML.
        We believe that an investment of $16 million in a new Blood Cancer
    Research Program would have the potential to enhance our understanding
    of the blood cancers and their links to chemical, viral, and bacterial
    exposures and to contribute to the development of new treatments. There
    are several promising areas of therapeutic research on blood cancers,
    including research about ways to use the body's immune system to fight
    the blood cancers, research on the development of less toxic and more
    targeted therapies than traditional chemotherapy agents, and research
    that will allow physicians to diagnose the specific type and subtype of
    blood cancers.
        The Subcommittee can, through a modest enhancement of the existing
    CDMRP, strengthen the overall CDMRP cancer research effort and
    contribute to development of new treatments for people with a blood
    cancer and those with solid tumors. In an age of severe fiscal
    constraints, the Subcommittee is understandably reluctant to increase
    its commitment to the CDMRP. However, an investment in blood cancer
    research would be a wise one.
        We appreciate the opportunity to present this proposal to you and
    would be pleased to answer your questions.

        Senator Stevens. Our next witness is Captain Marshall
    Hanson.
    STATEMENT OF CAPTAIN MARSHALL HANSON, UNITED STATES
                NAVAL RESERVE (RET.), CHAIRMAN,
                ASSOCIATIONS FOR AMERICA'S DEFENSE (A4AD)
        Mr. Hanson. Good morning, Mr. Chairman, Senator Inouye. The
    Associations for America's Defense are very grateful to testify
    today.
        A4AD looks at national defense, equipment, force structure,
    funding and policy issues, not normally addressed by the
    military support community. We would like to thank this
    committee for the on-going stewardship on issues of defense. At
    a time of war, its pro-defense and non-partisan leadership sets
    the example.
        Support for our deployed troops in Iraq and Afghanistan are
    of primary importance and warrant top priority. A4AD would like
    to highlight some areas of emphasis.
        As a Nation we need to be supplying our troops with the
    initial issue equipment needed in training and later in combat.
    A well-equipped soldier or marine is better prepared. Our
    associations are pleased with improvements in personnel
    protection over the past year. We credit both Congress and DOD
    leadership with increased armor protection provided soldiers in
    combat. Yet, troops preparing for Iraq are being given empty
    vests in which to train. Every soldier, Guardsmen or marine
    should receive an armored vest with initial issue, allowing
    them to go through basic and advanced combat training in full
    battle attire.
        Good protection goes beyond steel and Kevlar. U.S. ground
    forces are under attack from improvised explosive devices (IED)
    on a routine basis. Countermeasure technology is available and
    should be funded to provide protection from attacks by jamming
    the electronic signals that detonate IED's.
        From 1984-2001, 90 percent of worldwide combat aircraft
    losses were attributable to shoulder fired missiles. Aircraft
    have proven vulnerable in Iraq. Funding should be made
    available for the next generation of electronic aircraft
    survival equipment to reduce the risk to personnel and
    equipment.
        The Pentagon is recommending the repeal of separate budget
    requests for procuring Reserve equipment. A combined equipment
    appropriation for each service will not guarantee needed
    equipment for the National Guard and Reserve components. We ask
    this committee to continue to provide appropriations against
    unfunded National Guard and Reserve equipment requirements.
    Included in our written testimony is a list of unfunded
    equipment for the Reserve components and the National Guard.
        Equipment is only as good as the people who use it. A4AD
    believes the administration and Congress must make it a high
    priority to maintain, if not increase, end strengths of already
    overworked military forces.
        The associations have additional concerns on how the Guard
    and Reserve are being utilized by the Pentagon and see a move
    away from the traditional mission of the Guard and Reserves to
    an operational part-time fighting force. A congressionally
    mandated comprehensive review of current Guard and Reserve
    roles and missions, and the proposed realignment of both the
    Army and Navy is needed, before these forces are hollowed out.
        We would like to thank you for your ongoing support of the
    Nation, the armed services, and the fine young men and women
    who defend our country. I stand by for questions, and feel free
    in the future to contact us if you have any additional
    concerns.
        Senator Stevens. Well, we do thank you for your emphasis
    and we are trying to really reach the same goals you have
    outlined. I am not sure we have the money to do it all, but we
    thank you very much for your suggestions.
        Senator.
        Senator Inouye. I agree with you, sir, and I think we have
    reached that 4 percent minimum when you add the supplemental in
    there. But we will do our best.
        Mr. Hanson. Thank you.
        Senator Stevens. Thank you very much.
        [The statement follows:]
                     Prepared Statement of Marshall Hanson
                                  introduction
        Mister Chairman and distinguished members of the Committee, The
    Associations for America's Defense (A4AD) are very grateful for the
    invitation to testify before you about our views and suggestions
    concerning current and future issues facing the defense appropriations.
        Founded in 2002, the Association for America's Defense is a
    recently formed adhoc group of eleven Military and Veteran Associations
    that have concerns about National Security issues that are not normally
    addressed by The Military Coalition, and the National Military Veterans
    Alliance. The participants are members from each. Among the issues that
    are addressed are equipment, end strength, force structure, and defense
    policy. Collectively, we represent about 2.5 million members.
        Association of Old Crows, Enlisted Association National Guard of
    the United States, Marine Corps Reserve Association, Military Order of
    World Wars, National Association for Uniformed Services, Naval Enlisted
    Reserve Association, Naval Reserve Association, Navy League of the
    United States, Reserve Officers Association, The Retired Enlisted
    Association, and Veterans of Foreign Wars.
        Collectively, the preceding organizations have over two and a half
    million members who are serving our nation, or who have done so in the
    past. The number of supporters expands to beyond five million when you
    include family members and friends of the military.
        A4AD, also, cooperatively works with other associations, who
    provide input while not including their association name to the
    membership roster.
                    current and future issues facing defense
        The Associations for America's Defense would like to thank this
    Committee for the on-going stewardship that it has demonstrated on
    issues of Defense. At a time of war, its pro-defense and non-partisan
    leadership sets the example.
        In keeping with this, A4AD would like to submit what its membership
    feel are the top equipment related issues for the Armed Forces.
    Initial Issue Combat and Personnel Protection
        Initial Issue.--Unfunded requirements remain. It includes the
    following items: Small Arms, Protective Inserts (SAPI), Outer Tactical
    Vests (OTV), Individual Load Bearing equipment (ILBE), All Purpose
    Environmental Clothing System (APECS), Lightweight Helmet (LWH),
    Modular General Purpose Tent System, Modular Command Post System,
    Lightweight Maintenance Enclosures, and Ultra Light Camouflage Net
    System. These help in training, and later in combat.
        General Property and Support equipment.--Sun, wind and dust
    goggles, mosquito netting, field showers, field tarps and multi-faith
    chaplain's kits. Upgrade from the M16A2 service rifle to the M4 Carbine
    should continue as it is a lighter and better version of the M-16.
    Lightweight, Air-Mobile, Rapid Deployable, Hard-Wall Shelter (HELAMS)
    are a lightweight, self-deployable, hard-wall mobile shelter. Lessons
    learned from Operation Iraqi Freedom show that tents did not perform
    well in the hostile environment of the desert.
        Personnel Protection.--Gen. Michael Hagee, the Marine Corps
    commandant, and Gen. Peter Schoomaker, the Army chief of staff, said
    that they are working together to provide the best possible protection
    for their personnel who will be taking over the dangerous security and
    stability duties in Iraq.
        General Schoomaker is supplying the Interceptor body armor to about
    three-fourths of the U.S. troops heading to Iraq, and plans to have the
    interceptor body armor now over there in sufficient numbers for
    everybody else. All of the protective gear will be kept in the combat
    zone to supply all active Army, National Guard and Army Reserve
    personnel in Iraq and Kuwait. The Marine Corps' requirements are
    included in these numbers.
        General Hagee said that the 25,000 Marines who went into Iraq will
    have about 3,000 hardened trucks and Humvees, including those provided
    by the Army. General Shoomaker has also shared that there are three
    assembly sites in Iraq and Kuwait, which is retrofitting Humvees and
    trucks with armor plating.
        Position Statement.--The A4AD associations are pleased with
    improvements in personnel protection over the past year. We credit both
    the Congressional and DOD leadership with increased quantities in body
    armor, armoring kits and hardened vehicles.
        A4AD would like to highlight a continued need for personnel
    protection. Procurement needs to be expanded to include troops that are
    stateside. Troops training for Iraq were given empty vests in which to
    train, without armored plates. Every soldier, guardsmen or marine
    should receive an armored vest with initial issue, permitting them to
    go through basic and advanced combat training in full battle attire.
    Hardened vehicles should be included in training because of different
    driving characteristics.
        It has been noted that all 8,400 armor kits should have been done
    by April 30th. On March 11, commanders on the ground in Iraq asked the
    Pentagon for another 856 add-on armor Humvee kits; 236 truck kits,
    including FMTVs; and 800 gun-truck armor kits. But Pentagon leaders
    have not addressed the request; because of funding concerns.
        Position Statement.--There will be no funding or requisitions for
    these additional armor kits after April 30th. Supplemental funding is
    needed for these additional requirements.
    Counter-measures to Improvised Explosive Devices
        Currently in Iraq, U.S. ground forces and our coalition allies are
    coming under attack from Improvised Explosive Devices (IED's) on a
    routine basis. These devices are cobbled together from unexploded
    ordinance or from explosives left behind after the collapse of the
    former regime. Many are activated while ground troops pass a particular
    point using radio signals generated from electronics as simple as a
    garage door opener or as sophisticated as a cellular telephone.
    Countermeasure technology is now available for installation on
    unarmored personnel carriers like Humvees to provide protection from
    attacks by jamming the electronic signals that detonate IED's.
        A limited quantity of this technology has been deployed, but this
    is not enough. All future procurement should require the installation
    of similar jamming technology to provide protection to ground forces
    now, and in future deployments. Additional research and development
    should be initiated immediately to enhance and expand the personal
    security benefits of this type of technology against similar future
    threats.
        Position Statement.--Immediate emphasis is needed for the
    procurement of sufficient quantities of countermeasures to protect
    every unarmored personnel carrier now deployed in the battle space.
    Aircraft Survivability Equipment
        Much media attention has been paid to the problem of air
    survivability for helicopters in Iraq and Afghanistan. In the past,
    Congress has examined the anti-missile defense systems that need to be
    retrofitted into many of our deployed helicopters.
        Position Statement.--With the cancellation of the Comanche
    helicopter program by the Army, it has been reported that funding for
    this program would be re-programmed toward reviewing, upgrading and
    installing countermeasure protections on Army helicopters. Congress
    should quickly approve this request.
        From 1984-2001, ninety percent of worldwide combat aircraft losses
    were attributable to Shoulder Fired Missiles. Also called MANPAD (Man
    Portable Air Defense Systems), these are most often heat-seeking
    missiles, employing sensors that home in on the airplane's infrared
    signature, likely the engine. Their ability to accurately target
    aircraft from as far as 3 miles and as high as 20,000 feet makes them
    very difficult to protect against.
        Fixed wing aircraft are also flying in theatre: C-5s, C-9s, C-17s,
    C-40As and C-130s. Most military aircraft, including transports, are
    equipped with sensors that can detect incoming missiles and can drop
    flares to deflect the heat-seeking missiles or chaff to spoof those
    that are radar-guided.
        Approximately 50 percent of the Air Mobility Command fleet has
    anti-missile defensive systems. But 100 percent of AMC's C-17s (105
    aircraft), and 90 percent of the C-130s (approximately 500) are so
    equipped. The C-130, C-17 and C-5 fleets have flare-based
    countermeasures systems. Used in combat drops, the C-17's cockpit floor
    is sheathed with Kevlar to protect the pilots against ground fire. Only
    a handful of C-17s are being equipped with a new laser countermeasure
    system, called LAIRCM. Many C-130s have electronic warning receivers,
    using sensors in the nose and tail and chaff. The tanker fleets of KC-
    135s and KC-10s have no defensive systems.
        Because of the high power settings all transport jet aircraft are
    vulnerable to MANPADS when in approach or after take-off climb phase of
    flight.
        In January, an Air Force C-5 transport plane carrying 63 troops was
    struck by a surface-to-air missile as it left Baghdad Airport but
    managed to land safely. In December an Air Force C-17 cargo and troop
    transport plane was hit by a surface-to-air missile after takeoff from
    Baghdad with a crew of three and 13 passengers. Several unsuccessful
    attacks were made on C-103 aircraft in 2003.
        Chaff and flares typically are employed to deflect heat-seeking
    missiles. In Baghdad, flares are often fired in a precautionary mode
    when landing. Confidence in these basic missile defense systems is not
    absolute. Pilots are flying evasively to reduce further risk. ``High
    and fast'' is one tactic reported to minimize aircraft exposure to the
    ``bad guys''.
        New technologies and tactics utilized by non-traditional combatants
    have stretched the effectiveness of existing countermeasure systems for
    fixed and rotary wing aircraft in the battle space. Recent events in
    Iraq have demonstrated the vulnerability of our aircraft to attack from
    ground fire, rocket propelled grenades, and MANPADS, or shoulder-fired
    missiles.
        Advancements in technology allow upgrade missile defense systems.
    Newer ``aircraft survivability equipment,'' or ASE, can be described as
    integrated countermeasure dispensing systems that include detection
    equipment, threat adaptive computer, and deployable decoys. Another
    system includes a new laser countermeasure system; called LAIRCM where
    the computer guided intense light interferes with the missile guidance.
        These systems are designed to provide the capability of automatic
    or pilot commanded response, and works alone or in coordination with
    other countermeasures defensive systems to defeat Air Interceptor (AI),
    Anti-Aircraft Artillery (AAA), and Surface-to-Air Missiles (SAMs).
        The Army Guard is flying unarmed and unarmored twin engine
    aircraft, called the C-23 Sherpa and C-12 Hurons with passengers and
    cargo from Kuwait into Iraq. It is essentially a commercial airplane in
    a combat theater. The Sherpa crews are counting on installing defensive
    chafe and flare devices similar to those used on C-130s and designed to
    decoy a missile away from the target.
        Position Statement.--Congress should immediately fund the
    installation and/or upgrade of countermeasure systems in all fixed and
    rotary wing aircraft in the battle space to provide the greatest degree
    of protection for the U.S. warfighter.
        Anti-explosive foams.--Military aircraft can be as vulnerable as
    civilian airplanes to threats other than missiles. A tracer bullet into
    a fuel tank can have disastrous effects. One solution is to retrofit
    the aircraft fuel tanks with a foam lining that is anti-explosive. The
    density of the foam captures most projectiles, and fumes or fuel are
    protected from heat and spark. This is a low cost upgrade.
        Other protective measures.--IR suppression, ECM, fuel tank fire
    suppression, night vision lighting (NVL), DECM/CIRCM, aircraft, and
    aircrew personnel armor and self-defense, and paratroop door armor.
        Position Statement.--Appropriated monies should include simpler
    self-protective measures as well as more sophisticated. Aircraft
    survival is a full range package.
    Maintaining the National Guard and Equipment List
        In the recent authorization bill submission to Congress, the
    Department of Defense is requesting that National Guard and Reserve
    equipment accounts be merged with that of the parent service.
        A single equipment appropriation for each service would not
    guarantee that the National Guard and Reserve Components would get any
    new equipment. The National Guard and Reserve Equipment Account (NGREA)
    is vital to ensuring that the Guard and Reserve has some funding to
    procure essential equipment that has not been funded by the services.
    Dollars intended for Guard and Reserve Equipment might be redirected to
    Active Duty non-funded requirements.
        This action would essentially end Congressional support of Guard
    and Reserve equipment accounts and severely reduce its ability to
    ensure that National Guard and the Reserve Components receive adequate
    funding to perform their missions and maintain readiness. Neither the
    National Guard nor Reserve would have the funds to pay for equipment
    that has not been programmed by the parent services. This will lead to
    decreased readiness.
        This move is reminiscent of the attempt by DOD, last year, to
    consolidate all pay and O&M accounts into one appropriation per
    service. Any action by the Pentagon to circumvent Congressional
    oversight should be resisted.
        Position Statement.--We ask this committee to continue to provide
    appropriations against unfunded National Guard and Reserve Equipment
    Requirements. To appropriate funds to Guard and Reserve equipment would
    help emphasize to the Active Duty that it is exploring dead-ends by
    suggesting the transfer of Reserve equipment away from the Reservists.
    Unfunded Equipment Requirements
        This last year, this working group provided input for equipment for
    both Active duty, and the Reserve and Guard. With the Armed Forces
    engaged in the Global War on Terrorism, it is not the time for debate
    on equipment needs for the regular forces.
        Position Statement.--Unfunded AD requirements have been submitted
    to Congress and should be supported at best levels.
        $6.0 billion for the Army, $2.5 billion for the Navy, $2.4 billion
    for the Air Force, and $1.3 billion for the Marine Corps.
        Reserve Component requirements are provided for the major four of
    the uniformed services. The services are not listed in priority order.
                Top Guard and Reserve Equipment Requirements:

                            [In millions of dollars]
    ------------------------------------------------------------------------
                                                                     Amount
    ------------------------------------------------------------------------
    Air Force Reserve:
        C-40's Medivac [replaces aging C-9A] (4).................      261.3
        Large aircraft I/R Counter Measures......................       42.9
        B-52 Litening II Targeting Pod...........................        7.8
        A-10 Litening Targeting Pod..............................       37.7
        C-130 APN-241 Radars.....................................       38.9
    ------------------------------------------------------------------------

        Litening ER is a self-contained, multisensor laser target
    designating and navigation system that enables pilots to detect and
    identify ground targets for highly accurate delivery of both
    conventional and precision-guided weapons.

                            [In millions of dollars]
    ------------------------------------------------------------------------
                                                                  Amount
    ------------------------------------------------------------------------
    Air Guard:
        C-17's (per aircraft)...............................             184
        C-40C Special Mission Aircraft (1)..................              65
        Fire Vehicle Replacements (per year)................              15
        Patient Decontamination Assemblages.................             3.4
        Regional Equipment Operators Training Site..........              12
    Army Reserve:
        Light Medium Tactical Vehicles [LMTV] (600).........              92
        Medium Tactical Vehicles [MTV] (800)................             146
        Movement Tracking System [MTS] (2005)...............              25
        Multi-band Super Hi Frequency [SHF] Terminal (38)...             114
        High Frequency [HF] Radio (1,255)...................              53
        All Terrain Lifting Army System [ATLAS] (100).......              10
    Army Guard:
        High Mobility Multi-Purpose Wheeled Vehicle (HMMWV).  ..............
        Single Channel Ground Air Radio System (SINCGARS)...  ..............
        Heavy Expanded-Mobility Tactical Truck (HEMTT)......  ..............
        Family of Medium Tactical Vehicles (FMTV)...........  ..............
        Military Tactical Generator Sets....................  ..............
    Reserve Marine Corps:
        F/A-18 ECP--583 Upgrade (combined AD/RC)............              63
        CH-53E HNVS ``B'' Kits (Forward Looking Infrared)               46.2
         (combined AD/RC)...................................
        Initial Issue equipment.............................              10
        General Property and Support Equipment..............               3
        Depot Level Maintenance Program.....................             6.4
    Naval Reserve:
        Littoral Surveillance System, LSS coastal defense                 19
         (1)................................................
        Naval Coast Warfare Boats (28)......................              45
        P-3C AIP Kits (2)...................................              29
        F/A-18 ECP-560 Upgrades (8).........................              24
        C-40 A Inter-theater Transport (2)..................             130
        C-130 Propeller Upgrade Modification Program [PUMP]   ..............
         and ground tools...................................
    ------------------------------------------------------------------------

    Reserve Commission/Comprehensive Review of the Guard and Reserve
        A number of the services are reviewing and suggesting major changes
    to their Reserve Component. A4AD is concerned that ongoing manpower
    reviews are being budget driven where the bottom line dollar will
    undercut effective mission accomplishment. The Active Duty services are
    anxious to ``transform'' their Reserve without Congressional oversight.
        Position Statement.--If our Active Duty leadership makes
    unfortunate choices, there is a potential of unnecessary Defense costs
    for Congress to remedy. A Congressional mandated comprehensive review
    of the current Guard and Reserve issues, roles and missions, along with
    realignment and integration plan of both the Army and Navy is very much
    needed. We believe that the best way to address these issues is through
    a Congressionally mandated Commission on Guard and Reserve
    Transformation Issues for the 21st Century.
    Maintaining or Increasing End Strength
        Issues.--The United States is at War. While Secretary of Defense
    Rumsfeld has publicly opposed increases, and claims there are no plans
    for reduction, within DOD there is subtle pressures are to be found
    encouraging personnel cuts.
        A4AD has continuing concerns about the mismatch between reducing
    active duty and reserve force strengths and the increasing mission
    requirements. While retention remains at record highs, and military
    members seem ready and willing to make personal sacrifices on behalf of
    their country in the War on Terrorism, this luxury of manpower will not
    last. If the current Active Duty end strength was adequate, the demand
    for Reserve and Guard call-up would not be so urgent.
        A4AD believes the Administration and Congress must make it a high
    priority to maintain if not increase end strengths of already
    overworked military forces, even though DOD seems to want to work these
    forces even harder.
        Position Statement.--End strengths need to be closely examined by
    both the House and Senate as a first step in addressing this situation.
    We also solicit your input and support for maintaining or increasing
    end strength in future debates.
    The 4 percent solution
        Issue.--Despite increases in the Defense budget, demands will be
    outstripping the availability of dollars. As money begins to be
    reprogrammed into Research and Development, the active duty programs
    will be stressed by perceived shortfalls. Resulting covetous possession
    will distort long term planning as planners seek to preserve favorite
    programs, surrendering the vulnerable and obsolete as a means to
    maintain the ``strong''. Such acquisitiveness will stifle innovation,
    and eradicate retention.
        The Armed Forces are an instrument of National Security and
    Defense, and are in affect an insurance policy to this Country; as
    demonstrated by events since 9/11/2001. Americans should be willing to
    invest as much into defense as we do into the personal insurance
    policies.
        Position Statement.--A4AD urges the President of the United States
    and members of Congress to continue to increase defense spending to a
    minimum of 4 percent of Gross Domestic Product.
                                   conclusion
        A core of military and veteran associations is looking beyond
    personnel issues to the broader issues of National Defense. As a group,
    we will continue to meet in the future, and hope to provide your
    committee with our inputs.
        Thank you for your ongoing support of the Nation, the Armed
    Services, and the fine young men and women who defend our country.
    Please contact us with any questions.

        Senator Stevens. Our next witness is David Evans from
    Illinois Neurofibromatosis. Thank you.
    STATEMENT OF DAVID EVANS ON BEHALF OF ILLINOIS
                NEUROFIBROMATOSIS, INC.
        Mr. Evans. Thank you, Mr. Chairman and Senator Inouye, for
    this opportunity to appear before you today to present this
    testimony to the subcommittee on the importance of continued
    funding for neurofibromatosis, NF, a terrible genetic disorder
    associated with military purposes and closely linked to common
    diseases widespread among the American population.
        I am David Evans representing Illinois Neurofibromatosis,
    Inc., which is a participant in our national coalition of NF
    advocacy groups. I have lived with NF my entire life. Although
    I have not suffered any of NF's more severe symptoms, I have
    experienced rude comments and harassment my entire life. On
    July 4, 1996, I was threatened with arrest if I would not leave
    a water park in Crestwood, Illinois. After other patrons
    complained to the owner, he informed me that I looked terrible
    and should wear a shirt or leave. I explained NF to him and
    assumed the matter was settled. Later, however, he brought in
    the police and I was forced to leave. As a result of this
    experience, I have become active in Illinois NF, Inc. and have
    been on the board of directors since 1997.
        NF is a genetic disorder involving uncontrolled growth of
    tumors along the nervous system which can result in terrible
    disfigurement, deformity, deafness, blindness, brain tumors,
    cancer, and death. NF can also cause abnormalities such as
    unsightly benign tumors across the entire body and bone
    deformities. In addition, one-half of the children with NF
    suffer from learning disabilities. It is the most common
    neurological disorder caused by a single gene. While not all NF
    patients suffered from the most severe symptoms, all NF
    patients and their families live with the uncertainty of not
    knowing whether they will be seriously affected one day because
    NF is a highly variable and progressive disorder.
        Approximately 100,000 Americans have NF. It appears
    approximately in 1 every 3,500 births and strikes worldwide
    without regard to gender race or ethnicity. It is estimated
    that 50 percent of the new cases result from spontaneous
    mutation in an individual's genes and 50 percent are inherited.
    There are two types of NF: NF1, which is more common; and NF2,
    which primarily involves acoustic neuromas and other tumors,
    causing deafness and balance problems. NF research will benefit
    over 150 million Americans in this generation alone because NF
    has been directly implicated in many of the most common
    diseases affecting the general population.
        NF research is directly linked to military purposes because
    NF is closely linked to cancer, brain tumors, learning
    disabilities, heart disease, brain tissue degeneration, nervous
    system degeneration, deafness, and balance. Because NF
    manifests in the nervous system, this subcommittee in past
    report language has stated that the Army supported research on
    NF includes important investigations into genetic mechanisms
    governing peripheral nerve regeneration after injury from such
    things as missile wounds and chemical toxins. For the same
    reason, this subcommittee also stated NF may be relevant to
    understanding Gulf War Syndrome and to gaining a better
    understanding of wound healing. Today NF research includes
    important investigations into genetic mechanisms which involve
    not just the nervous system but also other cancers.
        Recognizing NF's importance to both the military and the
    general population, Congress has given the Army's NF research
    program strong bipartisan support. The Army program funds
    innovative, groundbreaking research which would not otherwise
    have been pursued and has produced major advances in NF
    research. The program has brought new researchers into the
    field of NF, as can be seen by the nearly 60 percent increase
    in applications in the past year alone. Unfortunately, despite
    this increase, the number of awards has remained relatively
    constant over the past couple of years, resulting in many
    highly qualified applications going unfunded.
        Because of the enormous advances that have been made as a
    result of the Army's NF research, research in NF has truly
    become one of the great success stories in the current
    revolution of molecular genetics, leading one major researcher
    to conclude that more is known about NF genetically than any
    other disease. Accordingly, many medical researchers believe NF
    should serve as a model to study all diseases.
        Mr. Chairman, the Army's highly successful NF research
    program has shown tangible results and direct military
    application with broad implications for the general public. Now
    in that critical area of clinical translation research,
    scientists closely involved with the Army program have stated
    that the number of high quality scientific applications justify
    a much larger program. Therefore, increased funding is now
    needed to take advantage of promising avenues of investigation
    to continue building on the success of this program and to fund
    translational research, thereby continuing the enormous return
    on the taxpayers' investment.
        I am here to respectfully request an appropriation of $25
    million in the fiscal year 2005 Department of Defense
    appropriations bill for the Army neurofibromatosis research
    program. This is a $5 million increase over the fiscal year
    2004 funding level of $20 million.
        Thank you for your support of this program and I appreciate
    this opportunity to testify to the subcommittee.
        Senator Stevens. Would you please provide for the record
    the monies received for NF from any other Government source
    such as NIH? We would appreciate it.
        Mr. Evans. From NIH?
        Senator Stevens. Will you also provide for the record--I
    want it for the record, not now, thank you.
        Mr. Evans. Okay, we will provide that to you.
        Senator Stevens.--how many members of the armed services
    have NF.
        Mr. Evans. Although we know there are members of the armed
    services, we do not have a number.
        Senator Stevens. Senator Inouye.
        Senator Inouye. No questions.
        Senator Stevens. Thank you very much.
        Mr. Evans. Thank you.
        [The information follows:]
                       Prepared Statement of David Evans
        Thank you, Mr. Chairman, for the opportunity to appear before you
    today to present testimony to the Subcommittee on the importance of
    continued funding for Neurofibromatosis (NF), a terrible genetic
    disorder directly associated with military purposes and closely linked
    too many common diseases widespread among the American population.
        I am David Evans, representing Illinois Neurofibromatosis, Inc.,
    which is a participant in a national coalition of NF advocacy groups. I
    have lived with NF my entire life. Although I have not suffered any of
    NF's severe symptoms, I have experienced the social problems caused by
    being afflicted with NF. I have endured rude comments and harassment my
    entire life. On July 4, 1996 I was threatened with arrest if I would
    not leave a water park in Crestwood, Illinois. After other patrons
    complained to the owner; he informed me that I looked ``terrible'' and
    should wear a shirt or leave. I explained NF to him and assumed the
    matter was settled. Later however, he brought in the police and I was
    forced to leave. As a result of this experience I became active in
    Illinois NF, Inc. and have been on the board of directors since 1997.
        Mr. Chairman, I am requesting increased support, in the amount of
    $25 million, to continue the Army's highly successful NF Research
    Program (NFRP). The program's great success can be seen in the
    commencement of clinical trials only ten years since the discovery of
    the NF1 gene. Now, with NF in the expensive but critical era of
    clinical and translational research, scientists closely involved with
    the Army program have stated that the number of high-quality scientific
    applications justify a much larger program.
    What is Neurofibromatosis (NF)?
        NF is a genetic disorder involving the uncontrolled growth of
    tumors along the nervous system which can result in terrible
    disfigurement, deformity, deafness, blindness, brain tumors, cancer,
    and/or death. NF can also cause other abnormalities such as unsightly
    benign tumors across the entire body and bone deformities. In addition,
    approximately one-half of children with NF suffer from learning
    disabilities. It is the most common neurological disorder caused by a
    single gene. While not all NF patients suffer from the most severe
    symptoms, all NF patients and their families live with the uncertainty
    of not knowing whether they will be seriously affected one day because
    NF is a highly variable and progressive disease.
        Approximately 100,000 Americans have NF. It appears in
    approximately one in every 3,500 births and strikes worldwide, without
    regard to gender, race or ethnicity. It is estimated that 50 percent of
    new cases result from a spontaneous mutation in an individual's genes
    and 50 percent are inherited. There are two types of NF: NF1, which is
    more common, and NF2, which primarily involves acoustic neuromas and
    other tumors, causing deafness and balance problems. NF research will
    benefit over 150 million Americans in this generation alone because NF
    has been directly implicated in many of the most common diseases
    affecting the general population.
    NF's Connection to the Military
        NF research is directly linked to military purposes because NF is
    closely linked to cancer, brain tumors, learning disabilities, heart
    disease, brain tissue degeneration, nervous system degeneration,
    deafness, and balance. Because NF manifests itself in the nervous
    system, this Subcommittee, in past Report language, has stated that
    Army-supported research on NF includes important investigations into
    genetic mechanisms governing peripheral nerve regeneration after injury
    from such things as missile wounds and chemical toxins. For the same
    reason, this subcommittee also stated that NF may be relevant to
    understanding Gulf War Syndrome and to gaining a better understanding
    of wound healing. Today, NF research now includes important
    investigations into genetic mechanisms which involve not just the
    nervous system but also other cancers.
    The Army's Contribution to NF Research
        Recognizing NF's importance to both the military and to the general
    population, Congress has given the Army's NF Research Program strong
    bipartisan support. After the initial three-year grants were
    successfully completed, Congress appropriated continued funding for the
    Army NF Research Program on an annual basis. From fiscal year 1996
    through fiscal year 2004, this funding has amounted to $130.3 million,
    in addition to the original $8 million appropriation in fiscal year
    1992. Between fiscal year 1996 and fiscal year 2003, 361 proposals were
    received, of which 119 awards have been granted to researchers across
    the country. The Army program funds innovative, groundbreaking research
    which would not otherwise have been pursued, and has produced major
    advances in NF research, such as the development of advanced animal
    models, preclinical therapeutic experimentation and clinical trials.
    The program has brought new researchers into the field of NF, as can be
    seen by the nearly 60 percent increase in applications in the past year
    alone. Unfortunately, despite this increase, the number of awards has
    remained relatively constant over the past couple of years resulting in
    many highly qualified applications going unfunded.
        In order to ensure maximum efficiency, the Army collaborates
    closely with other federal agencies that are involved in NF research,
    such as NIH and the VA. Senior program staff from the National Cancer
    Institute (NCI) and the National Institute of Neurological Disorders
    and Stroke (NINDS), for example, have sat on the Army's NF Research
    Program's Integration Panel which sets the long-term vision and funding
    strategies for the program. This assures the highest scientific
    standard for research funding while ensuring that the Army program does
    not overlap with other research activities.
        Because of the enormous advances that have been made as a result of
    the Army's NF Research Program, research in NF has truly become one of
    the great success stories in the current revolution in molecular
    genetics, leading one major researcher to conclude that more is known
    about NF genetically than any other disease. Accordingly, many medical
    researchers believe that NF should serve as a model to study all
    diseases.
    Future Directions
        The NF research community is now ready to embark on projects that
    translate the scientific discoveries from the lab to the clinic. This
    translational research holds incredible promise for NF patients, as
    well as for patients who suffer from many of the diseases linked to NF.
    This research is costly and will require an increased commitment on the
    federal level. Specifically, increased investment in the following
    areas would continue to advance NF research and are included in the
    Army's NF research goals:
      --Clinical trials
      --Development of drug and genetic therapies
      --Further development and maintenance of advanced animal models
      --Expansion of biochemical research on the functions of the NF gene
            and discovery of new targets for drug therapy
      --Natural History Studies and identification of modifier genes--such
            studies are already underway, and they will provide a baseline
            for testing potential therapies and differentiating among
            different phenotypes of NF
      --Development of NF Centers, tissue banks, and patient registries.
    Fiscal Year 2005 Request
        Mr. Chairman, the Army's highly successful NF Research Program has
    shown tangible results and direct military application with broad
    implications for the general population as well. The program is now
    poised to fund translational and clinical research, which is the most
    promising yet the most expensive direction that NF research has taken.
    The program has succeeded in its mission to bring new researchers and
    new approaches to research into the field. Therefore, increased funding
    is now needed to take advantage of promising avenues of investigation,
    to continue to build on the successes of this program, and to fund this
    translational research thereby continuing the enormous return on the
    taxpayers' investment.
        I am here today to respectfully request an appropriation of $25
    million in your fiscal year 2005 Department of Defense Appropriations
    bill for the Army Neurofibromatosis Research Program. This is a $5
    million increase over the fiscal year 2004 level of $20 million.
        Mr. Chairman, in addition to providing a clear military benefit,
    the DOD's Neurofibromatosis Research Program also provides hope for the
    100,000 Americans like me who suffer from NF, as well as the tens of
    millions of Americans who suffer from NF's related diseases such as
    cancer, learning disabilities, heart disease, and brain tumors. Leading
    researchers now believe that we are on the threshold of a treatment and
    a cure for this terrible disease. With this Subcommittee's continued
    support, we will prevail.
        Thank you for your support of this program and I appreciate the
    opportunity to present this testimony to the Subcommittee.
                                     ______

                                                          May 17, 2004.
    Senator Ted Stevens,
    Chairman, Senate Appropriations Subcommittee on Defense, 119 Dirksen
            Senate Office Building, Washington, DC 20510.
        Dear Chairman Stevens: Thank you for the opportunity to testify
    before the Senate Appropriations Subcommittee on Defense regarding the
    Army's Neurofibromatosis Research Program (NFRP). Neurofibromatosis
    (NF) is a terrible genetic disorder directly associated with military
    purposes and closely linked to many common diseases affecting
    approximately 150 million Americans.
        As I discussed in my testimony, Neurofibromatosis (NF) research is
    directly linked to military purposes because it is closely linked to
    cancer, brain tumors, learning disabilities, memory loss, brain tissue
    degeneration and regeneration, nervous system degeneration and
    regeneration, deafness, balance and healing after wounding. Indeed, the
    House Defense Appropriations Subcommittee in a prior year underscored
    the importance of NF research to the military by stating in Report
    Language that Army-supported research on NF includes important
    investigations into genetic mechanisms governing peripheral nerve
    regeneration after injury from such things as missile wounds and
    chemical toxins, and is important to gaining a better understanding of
    wound healing.
        As a result of the huge success of the highly acclaimed NFRP,
    researchers are now engaged in translational research which will
    directly benefit the military, NF patients and close to 150 million
    Americans in the general population who suffer from NF's many related
    disorders.
        Most importantly, the Army's NFRP does not fund the same kind or
    level of research as NIH. Rather the Army's NF medical research program
    funds much more aggressive, higher risk and innovative research from
    which the real breakthroughs in science come, including funding NF's
    first clinical trials, therapeutic experimentation, development of
    advanced mouse models, natural history studies as well as encouraging
    the development of consortia and bringing researchers from other fields
    into NF research. To ensure coordination and avoid duplication or
    overlap, the director of NF research at NINDS sits on the Army's
    Integration Panel for NF as have other NIH officials in the past.
        The NFRP has been widely acclaimed by the NF research community,
    and just in the past year, it received nearly 60 percent more
    applications than the year before. Thanks to the NFRP, we are now at
    the threshold of treatments and a cure for this devastating illness and
    its related disorders. There is no question that the Army NF Program
    has accelerated the rate of progress by many years and has resulted in
    research advances that otherwise might never have occurred. Because of
    the enormous advances that have been made as a result of the Army's NF
    Research Program, research in NF has truly become one of the great
    success stories in the current revolution in molecular genetics,
    leading one major researcher to conclude that more is known about NF
    genetically than any other disease. Accordingly, many medical
    researchers believe that NF should serve as a model to study all
    diseases.
        Neurofibromatosis (NF) is really two genetically distinct
    disorders. Both disorders affect males and females equally and people
    of all races and ethnic groups. Half of the people with NF do not have
    a family history of the disorder. Neurofibromatosis type 1 (NF-1),
    which is the most common, affects 1 in 4,000 births. Neurofibromatosis
    type 2 (NF-2) affects 1 in 40,000.
        In order to ensure maximum efficiency, the Army coordinates and
    collaborates closely with other federal agencies that are involved in
    NF research, such as the National Institutes of Health (NIH) and the
    Department of Veterans Affairs (VA). In fiscal year 2004 approximately
    $19.4 million went to complimentary NF Research at the various
    institutes at NIH, including NCI ($5.6 million), NINDS ($6.3 million),
    NICHD ($0.8 million), NEI ($0.3 million), NIDCD ($2.0 million), NHGRI
    ($3.8 million), NCRR ($0.4 million), and NHLBI. This funding however,
    typically funds more traditional, less innovative and more basic
    orientated research than the Army Program.
        Recognizing the importance of the NFRP to military and civilian
    populations, as well as its strong track record in advancing NF
    research on a limited budget, Congress has consistently funded the NFRP
    over the past decade, rising to a level of $20 million in fiscal year
    2004. The program enjoys bipartisan support, including strong support
    in the House of Representatives and the Senate.
        The Army's Congressionally Mandated NF Research Program (NFRP) has
    furnished the figures of 124 cases of NF reported in 2003 and 731
    seeking treatment among all Services active duty military and their
    dependents during the last 10 years. However, the number of cases of
    known NF in the military is really not the issue but rather, the
    enormous implications advances in NF research have for direct military
    purposes such as healing after wounding, brain tissue regeneration,
    memory loss, nerve tissue regeneration, balance problems, hearing loss,
    blindness, as well as its direct connection to cancer, brain tumors,
    heart disease and cognitive disorders which affect the general
    population as well.
        Because of the characteristics of NF and the wide range of
    manifestations and varying degrees of severity, NF is difficult to
    diagnose. In addition, the symptoms are progressive over the
    individual's lifetime and many applicants to military service are
    unaware that they have NF until later in adulthood. Therefore NF is
    frequently missed in admitting physicals and is often not diagnosed
    until military service is completed. Fourteen year Army veteran Ted
    Yates, who is featured in the attached Stripe article, is a prime
    example of one who had his military career cut short because of NF.
        Mr. Chairman, I respectfully invite your attention to all the
    invaluable information provided by the Army regarding the NFRP on its
    website: http://cdmrp.army.mil.
        Thank you for your attention, and I hope this answers any questions
    you may have. If you or your staff wishes to talk further, you can
    speak with me at (847) 290-5025, or with my Washington representatives
    Ed Long and Katie Weyforth at (202)544-1880.
                Sincerely,
                                                        David H. Evans.
                                     ______

                         [From Stripe, August 28, 1992]

                      Veteran Copes With Genetic Disorder
       disease takes two distinct forms; undetectable until tumors begin
                  (By Barry Reichenbaugh, Stripe staff writer)
        For Ted Yates, it's been a source of lasting pain.
        First he bore the emotional pain of watching his mother endure
    years of a disease people knew very little about. Then his adult life
    brought physical pain as he discovered he also had the same disease. It
    came to be known as neurofibromatosis.
        Through it all he has persisted.
        Yates recently spent a week at Walter Reed Army Medical Center for
    some routine testing and to record some comments for an educational
    video about the condition affecting his body.
        As an Army major with a masters degree in civil engineering, his
    career was cut short by a loss of hearing resulting from
    neurofibromatosis 2.
        Neurofibromatosis is a genetic condition that causes tumors to form
    on nerves anywhere in the body. The condition occurs in two distinct
    forms. NF-1 causes coffee-colored spots on the skin and both internal
    and external tumors which may disfigure a person's appearance: NF-2
    frequently causes brain and spinal tumors which can lead to loss of
    hearing, sight and balance.
        The disorders are sometimes inherited and sometimes the result of
    spontaneous mutation, according to existing information on
    neurofibromatosis. There is no test for either form of NF, no way to
    prevent the disease, and no cure. The disease is lesser-known than
    Muscular Distrophy, Tay-Sachs and Huntington's Disease, but it affects
    more people.
        ``The thing's so traumatic,'' Yates says. ``People have facial
    paralysis, they can't hear, their eyes don't operate properly, like me
    they're clumsy. They go into the bedroom and sit. And it's hidden.''
        Yates and two brothers inherited the disorder from their mother,
    who died in her sixties while undergoing an operation for the removal
    of tumors.
        He says doctors had no idea he had NF-2 when he had his first tumor
    removed in 1965 at age 25. He wasn't severely affected by the disorder
    and continued his Army career for another decade. Operations for tumors
    affecting his acoustic nerves in the late 1970s led to complete
    deafness and his medical retirement from the Army after 14 years of
    service.
        His last operation was in 1984. Since then, because tumors can
    recur at any time, Yates has periodic Magnetic Resonance Imaging scans
    done around his head and spine to detect new growths.
        The tumors that people who have NF commonly develop can cause
    constant pain. The external tumors can severely disfigure the skin and
    cause mental anguish on top of the physical pain.
        ``One thing I learned early on is that people in our society put
    too much emphasis on appearance,'' says Yates. ``And once they see your
    face . . . they pity you. They want to kind of get away from you.
    Nobody has wanted to talk about NF . . . now we do.''
        Awareness is getting better, says Mary Ann Wilson of
    Neurofibromatosis, Inc., but her organization and others continue their
    efforts to educate medical professionals and the public. NF, Inc., is a
    national not-for-profit organization in Mitchellville, Md. ``Through
    educating the public we also promote tolerance toward people who have
    NF, especially the ones who look different and who have the multiple
    tumors,'' says Wilson.
        She says NF, Inc., is producing an educational videotape about the
    disorder, its symptoms and its affect on people and their families.
    Starting this fall the video will be shown at medical facilities and
    schools to physicians, social workers, genetic counselors and the
    public. Wilson's group is actively involved in attracting funding and
    support for continued research in hope of finding a cure for the
    disorders.
        The National Institute of Health is working to find the origin of
    NF-2. Researchers there have traced the NF-2 genetic trail through
    several generations of Yates' family.
        ``Mr. Yates' family is a very large family, and that makes it
    useful for these kinds of studies,'' says Dr. Dilys Parry, a clinical
    genetics researcher with the National Institute of Health in Bethesda,
    Md. ``To try to map a gene you need to have affected and unaffected
    individuals in two and preferably three or more generations. His family
    alone provided us enough information to map the gene.
        ``We know the chromosome the gene is on,'' says Parry. ``We have
    some DNA markers that we know are near the gene, but we don't have the
    gene yet.''
        Parry says once researchers have the gene they can figure out what
    the normal gene is doing and what went wrong to cause NF-2. With that
    knowledge, she says, they may be able to develop therapeutic methods to
    prevent tumors from growing.
        One tragic aspect of both NF-1 and NF-2 is that since there's no
    test to uncover the disorders before tumors first appear, people with
    NF can pass the disorder on to their children before they know they
    have it themselves.
        ``The one thing that ties all of us together,'' says Wilson,
    ``whether NF-1 or NF-2, is the unpredictability of the condition. You
    don't know if your children have it until it manifests itself.''
        ``Once you know you have NF you can probably go two ways--you can
    either accept it or reject it,'' says Yates. ``And if you accept, it
    you really don't need anybody's help to cope. If you reject it you
    do.''
        Yates is one of those people who accepts the disorder but doesn't
    let it keep him housebound. In addition to spending his time in his
    woodworking shop and tending his vegetable garden and fruit trees,
    Yates has touched the lives of scores of young people in his home of
    Enterprise, Ala., through his involvement in youth soccer. Two of his
    YMCA teams have earned state championships.
        ``I really enjoy seeing kids develop,'' answers Yates when asked
    what he likes about coaching soccer. ``You take 15 individuals and you
    can mold them into a team. You can see them get better--team-wise and
    individually.
        ``What they're learning is a little about life--they're learning
    that they can't do everything by themselves--it takes somebody else
    involved to really get a job done.''
        That's also how Yates sees his life with NF-2.
        ``You really have to fight depression all the time,'' he says.
    ``It's hanging right there on your shoulder all the time. I stay busy.
    I push myself. If I get up and I don't feel good and I think I'm not
    going to do anything today--I'll say `no, you're going to do
    something,' and then I'll start doing something.''
        He says he gets encouragement from his wife, Laraine, his family
    and friends, including friends made here at Walter Reed during numerous
    visits over the years.
        The Neurosurgery Clinic staff at WRAMC sees several patients with
    neurofibromatosis, says Capt. James Ecklund, M.D., chief resident in
    neurosurgery. Yates, he says, has ``a fairly complex case'' of NF-2 in
    that he has ``a lot of tumors.'' But despite his condition, says
    Ecklund, Yates copes very well with his problems.
        ``He's a wonderful guy,'' says Ecklund. ``He's doing well in spite
    of his deafness. He's an excellent reader of lips.'' .
        Yates says he appreciates the treatment he gets every time he comes
    to Walter Reed.
        ``I've been coming here since 1983,'' says Yates, ``and no matter
    who's here, they've all been good to me. I can't say enough about the
    staff here. The people who've been here a while know me and they treat
    me real good. It's just like homecoming when I come up here. They're
    all glad to see me and want to know how I'm doing.''
                                     ______

           Neurofibromatosis: Inherited, Caused by Genetic Mutations
                  (By Barry Reichenbaugh, Stripe staff writer)
        There are two genetically distinct forms of neurofibromatosis: NF-1
    and NF-2.
        Both forms are genetic disorders of the nervous system that can
    cause tumors to form on the nerves anywhere in the body, at any time,
    according to educational literature prepared by Neurofibromatosis,
    Inc., of Mitchellville, Md.
        Neither form of the disease can be passed on by contact.
    Neurofibromatosis is either inherited, or it develops by some
    unexplained genetic mutation. All races and both sexes are equally
    affected.
        NF-1 (formerly called Recklinghausen's Disease) occurs in about one
    in 4,000 births and is characterized by:
      --Multiple cafe-au-lait colored spots on the skin;
      --Tumors of varying sizes on or under the skin;
      --Freckling in the underarm or groin area.
        Some people with NF-1 have mild symptoms and live relatively normal
    lives. Others have many nerve fiberous lumps on the face and body.
    Changes in hormone levels during puberty or pregnancy can increase the
    problem. Kids with NF-1 sometimes have learning disabilities and speech
    problems, seizures and can be hyperactive.
        NF-2, or bilateral acoustic neurofibromatosis, occurs in about one
    in 50,000 births and is characterized by:
      --Tumors affecting the hearing nerves, often resulting in hearing
            loss and balance problems;
      --Tumors of the brain or spinal cord and skin;
      --Unusual cataracts of the eye occurring at an early age.
        Signs of NF-2 usually appear after puberty. People with NF-2 may
    lose their hearing or sight, experience headaches, dizziness and
    balance problems.
        An affected person has a 50 percent chance of passing the disorder
    on to each offspring. Neurofibromatosis 1 and 2 may be associated with
    bone deformation, hearing loss, vision impairment, and seizures.
        People who do not have neurofibromatosis cannot pass the disease on
    to their children.
        For more information on neurofibromatosis, contact Mary Ann Wilson
    at (301) 577-8984, TDD (301) 461-5213, or write to NF, Inc., Mid-
    Atlantic chapter, 3401 Woodridge Court, Mitchellville, MD 20721-2817.

        Senator Stevens. Our next witness is Benjamin Butler,
    Legislative Director for the National Association of Uniformed
    Services. Good morning, sir.
    STATEMENT OF BENJAMIN H. BUTLER, LEGISLATIVE DIRECTOR,
                NATIONAL ASSOCIATION FOR UNIFORMED SERVICES
        Mr. Butler. Mr. Chairman, Senator Inouye, the National
    Association for Uniformed Services is very grateful for the
    invitation to testify before you about our views and
    suggestions concerning defense funding issues. I would like to
    highlight part of my written testimony pertaining to military
    health care.
        We would like to thank the subcommittee and the full
    Appropriations Committee for its leadership in the past,
    resulting in TRICARE improvements for all military medical
    beneficiaries. However, we must again urge that the Senate
    provide full funding of the defense health program.
        A recent action in the Washington, DC, area illustrates the
    impact that funding can have on health care. According to a
    document from a medical treatment facility (MTF) commander in
    the Washington, DC, area, ``Our Nation is at war. As a result,
    this is an exceptional tight fiscal year for which no
    supplemental funding is anticipated.''
        Consequently, within the local military health care
    network, enrollment in TRICARE Prime for new enrollees is
    restricted to active duty and active duty family members only.
    New retirees and family members under age 65 may enroll only
    with a civilian primary care manager.
        In addition, certain special services within the network
    are limited and beneficiaries may not have access to urology,
    physical therapy, and optometry, and for certain the Fort
    Belvoir ear, nose, and throat clinic because of its closure.
        We are concerned that what is happening locally within the
    Washington, DC, area will be duplicated across the country and
    within all MTF and TRICARE networks.
        And these actions go beyond just patient access. For
    example, it affects the entire military medical department.
    Doctors need to have access to patients with medical conditions
    to practice and develop their skills. Without patient access
    and skill development of doctors and teams required for
    delivery of high quality general and specialized procedures,
    there is a tremendous adverse effect on military medical
    readiness. Especially affected are fields like cardio surgery,
    urology, general surgery, ophthalmology, and internal medicine.
        Our concerns are that urologists, general surgeons, and
    other doctors will be reduced to treating routine situations on
    an active duty only population within the United States, and if
    this happens, how can DOD interest military doctors in
    remaining on active duty?
        Most retirees and their family members under the age of 65
    joined TRICARE Prime to continue care in the military system.
    Forcing them out of the military care denies them the care they
    want and the military doctors the full range of patients they
    need for their training and skills.
        Many in military medicine have been concerned for years
    about the eroding patient base. Closing TRICARE Prime to
    retirees and their family members on base accelerates the
    erosion of the referral base to military medical centers where
    most of the specialized training takes place.
        Funding shortfalls that cause MTF commanders to cut off
    retirees from direct military medical care and that force them
    to seek care in the civilian sector has the potential of
    harming the military medical departments.
        Mr. Chairman, the overall goal of the National Association
    of Uniformed Services (NAUS) is a strong national defense. We
    believe that comprehensive, lifelong medical care for all
    uniformed services beneficiaries, regardless of age, status, or
    location, furthers this goal. As evidenced by the recent
    changes in the military health care system locally, none of
    these goals can be achieved without adequate funding and
    without the people to work on, the skills that are so important
    to our military doctors could diminish.
        Thank you, Mr. Chairman.
        [The statement follows:]
                    Prepared Statement of Benjamin H. Butler
                                  introduction
        Mister Chairman and distinguished members of the Committee, The
    National Association for Uniformed Services (NAUS) is very grateful for
    the invitation to testify before you about our views and suggestions
    concerning the following defense funding issues:
                  survivor benefits program (sbp) improvements
    Age 62 Survivor Benefits Program Offset
        The National Association for Uniformed Services primary survivor
    goal is the elimination of the age 62 Survivor Benefit Program annuity
    offset. This would increase the annuity from 35 percent to the original
    55 percent. Not only were many of the earliest enrollees not provided
    the full explanation of the benefits and the Social Security Offset,
    but the Federal Government provides a substantially higher annuity with
    no offset for federal Civil Service survivors annuities.
        Position: We urge the committee to provide funding for the annuity
    increase as described in S. 1916, and end the often-devastating effects
    of the offset.
    30 Year Paid-Up Status
        A secondary goal is the acceleration of the paid-up provisions by
    changing the effective date from October 1, 2008 to October 1, 2004,
    one year beyond the 30th anniversary of the program. Enrollees who have
    reached the age of 70 and have paid their SBP premiums for more than 30
    years (360 payments) are already being penalized.
        Position: We ask that you provide funding to allow those early
    enrollees to be allowed this relief as described in S. 2177.
    Survivor Benefits Program/Dependency and Indemnity Compensation Offset
        Currently, if the retired military sponsor, who enrolled in the
    Survivor Benefits Program, dies of a service-connected disability, the
    surviving spouse is eligible for both the SBP annuity and Dependency
    and Indemnity Compensation (DIC) from the Department of Veterans
    Affairs. However, the SBP annuity is offset by the full amount of the
    DIC annuity. Each program's purpose is different, SBP's goal is to
    provide for the loss of the sponsors earned retired pay, and DIC's goal
    is to provide the surviving spouse compensation for the loss of their
    spouse due to injuries caused by his/her service to the country.
        Position: The National Association for Uniformed Services strongly
    urges funding for S. 585.
                      military exchanges and commissaries
        Issue One.--Why would the Department of Defense want to reduce the
    commissary benefit at its greatest time of need? The answer is money.
    DOD wants to reduce the subsidy for the commissary system that provides
    food and other essentials to troops and families around the world,
    which will end up in the military community losing the benefit.
    Examples of this include a recent proposal studied by DOD to implement
    a policy of variable pricing at military commissaries that would
    actually reduce the savings to the military customer. While the
    variable pricing study requested by DOD does not seem to offer a
    favorable recommendation, we are concerned that additional bad ideas
    like this will be generated in the future that will ultimately hurt the
    benefit.
        NAUS understands the importance of saving scarce taxpayer's
    dollars. Every taxpayer dollar collected must be used wisely to keep
    down the amount of taxes the government collects; this is only common
    sense. Therefore, every government agency, department or system must be
    as efficient as possible. For example, the leaders of the commissary
    system have been and are continuing to make internal changes to improve
    efficiencies and reduce overhead operating costs. DOD should be setting
    goals, not mandating changes.
        Position: The National Association for Unformed Services strongly
    urges you to continue to provide the funding for the Commissary Subsidy
    to sustain the current services. Commissaries are a key component of
    the military pay and compensation package. Any action that reduces the
    benefit means a diminished quality of life and more out of pocket
    costs.
        Issue Two.--The Department of Defense is planning the consolidation
    of the Armed Services three-exchange services into one single entity,
    though still retaining the ``look and feel'' of each store and
    maintaining the service culture to which the patrons are accustomed.
    The goal again, is to save money by elimination of redundant overheads,
    delivery systems, and the power of economy of scaling purchasing.
        Position: NAUS does not endorse a consolidation, especially if
    consolidation is for consolidation's sake. Streamlining, improving
    internal operations and implementation of cost saving measures must not
    reduce the value of the benefit. NAUS supports funding for system
    studies, but not an accelerated consolidation.
        current and future issues facing uniformed services health care
        The National Association for Uniformed Services would like to thank
    the Sub-Committee and the Full Appropriations Committee for its
    leadership in the past for providing the landmark legislation extending
    the Pharmacy benefit and TRICARE system to Medicare eligible military
    retirees, their families and survivors, making the lifetime benefit
    permanent, establishing the DOD Medicare Eligible Retiree Health Care
    Fund, reducing the catastrophic cap and making other TRICARE
    improvements. However, we must again urge that the Senate provides full
    funding of the Defense Health Program.
        A recent action in the Washington, DC area illustrates the impact
    that funding can have on the health care benefit. According to a
    document from a MTF commander in the Washington, DC area, which may
    duplicate similar notices issues by other MTF commanders around the
    country, ``Our nation is at War. As a result, this is an exceptional
    tight fiscal year for which no supplemental funding is anticipated.''
        Consequently, within the Fort Belvoir Health Care Network, which is
    a part of the Walter Reed Army Medical Center network, enrollment in
    TRICARE Prime for new enrollees is restricted to Active Duty (AD) and
    Active Duty Family Members (ADFM) only. New retirees and family
    members, under age 65, may enroll only with a civilian primary care
    manager. Furthermore, enrollment in TRICARE Plus (for retirees/family
    members over 65) is no longer available to new enrollees, or the Prime
    enrollees aging into Medicare.
        In addition, certain special services within the network are
    limited and beneficiaries may not have access to Urology, Physical
    Therapy, and Optometry; and, for certain the Fort Belvoir Ear Nose and
    Throat clinic because of its closure.
        We are concerned that what is happening locally within the
    Washington, DC area will be duplicated across the country and within
    all MTF and TRICARE Networks.
        And, these actions go beyond just patient access. For example it
    affects the entire military medical department. For example, doctors
    need to have access to patients with medical conditions to practice and
    develop their skills. Without patient access and skill development of
    doctors and teams required for delivery of high quality general and
    specialized procedures--there is a tremendous adverse affect on
    military medical readiness. Especially affected are fields like
    cardiothoracic surgery, urology, general surgery, ophthalmology and
    internal medicine. Does the military have no further need for doctors
    treating Ear, Nose and Throat problems?
        Other concerns are:
      --How will the remnants of the military medical departments be able
            to take care of troops involved in the various theaters of
            operations that are or will be involved in fighting the War on
            Terror?
      --Will urologist/general surgeons be reduced to treating routine
            situations on an active duty only population within the United
            States?
      --If so, how can DOD interest them in remaining on active duty? Most
            retirees and their family members under the age of 65 join
            TRICARE-Prime to continue care in the military system. Forcing
            them out of military care denies them the care they want and
            doctors the full range of patients they need for their training
            and skills.
      --What about the retired Medical Corps officers that were lured to
            return as civilian doctors to staff MTFs?
        Many in military medicine have been concerned for years about the
    eroding patient base. Closing TRICARE-Prime to retirees and their
    family members at the base level accelerates the erosion of the
    referral base to military medical centers where most of the specialized
    training takes place.
        Funding shortfalls that are more than likely a reaction to a mid-
    term budget review and other DOD imposed restrictions that causes MTF
    commanders to cut off retirees from direct military medical care and
    that forces them to seek care in the civilian sector has the potential
    of harming the military medical departments.
        We are also concerned about staffing MTFs with ``temporary'' hire
    physicians. After witnessing an ever changing medical program that has
    no job security, what kind of physician can be found to work in such an
    environment? Would they be the ones at the end of their careers that
    are anxious to leave at the first sign of trouble or a better job?
    Additional questions also arise concerning the time, money, and effort
    was used to secure contract physicians in the first place.
        Not all retirees are old. Many are retiring at the 20-year point
    between the ages of 37-42. Others, many who are now patients at our
    military medical centers are being treated for wounds received in Iraq
    and other places, and will be placed on the retired list while they are
    in their very early 20's or 30s. What reaction can we expect from these
    wounded troops after being told that if they stay in the military or
    are medically retired will be persona non grata in the direct care
    system at age 65?
        Mr. Chairman, the overall goal of the National Association for
    Uniformed Services is a strong National Defense. We believe that
    comprehensive, lifelong medical and dental care for all Uniformed
    Service beneficiaries regardless of age, status or location furthers
    this goal. As evidenced by the recent changes in the military health
    care system locally none of these goals can be achieved without
    adequate funding, and without the people to work on, the skills that
    are so important to our military doctors could diminish.
    FEHBP
        The National Association for Uniformed Services has been a long
    time proponent of legislation that would provide military personnel the
    option of participating in the Federal Employees Health Benefit
    Program. Though confident that the TRICARE program and the TRICARE for
    Life program will be successful, because they are an outstanding value
    for most beneficiaries, in a few cases, the TRICARE/TRICARE for Life
    options may not be the best choice, or may not be available for the
    eligible beneficiary. For that reason, we believe the FEHBP option
    should be enacted. Providing the FEHBP, as an option would help
    stabilize the TRICARE program, provide a market based benchmark for
    cost comparison and be available to those for whom TRICARE/TRICARE for
    Life is not an adequate solution.
        Position: NAUS strongly urges the committee to provide additional
    funding to support a full FEHBP program for military personnel as an
    option.
    Include Physician and Nurse Specialty Pay in Retirement Computations
        Results of a recent Active Duty Survey show that pay and benefits
    are the most important factors impacting retention. Improving specialty
    pay/bonuses and including specialty pay/bonuses in retired pay
    calculations would aid retention. Therefore, prompt action to retain
    these and other highly skilled medical professionals is needed.
        Position: The National Association for Uniformed Services requests
    funding to allow the military physicians and nurses to use their
    specialty pay in their retirement computations. The military services
    continue to lose top quality medical professionals (doctors and nurses)
    at mid-career. A major reason is the difference between compensation
    levels for military physicians and nurses and those in the private
    sector.
    Permanent ID Card for Dependents Age 65 and Over
        One of the issues stressed by NAUS is the need for permanent ID
    cards for dependents age 65 and over. With the start of TRICARE for
    Life, expiration of TFL-eligible spouses' and survivors' military
    identification cards, and the threatened denial of health care claims,
    causes some of our older members and their caregivers' significant
    administrative and financial distress.
        Formerly, many of them who lived miles from a military installation
    or who lived in nursing homes and assisted living facilities just did
    not bother to renew their ID card at the four-year expiration date.
    Before the enactment of TFL, they had little to lose by doing so. But
    now, ID card expiration cuts off their new and all-important health
    care coverage.
        A four-year expiration date is reasonable for younger family
    members and survivors who have a higher incidence of divorce and
    remarriage, but it imposes significant hardship and injustice to the
    more elderly dependents and survivors.
        NAUS is concerned that many elderly spouses and survivors with
    limited mobility find it difficult or impossible to renew their
    military identification cards. A number of seniors are incapacitated
    living in residential facilities, some cannot drive, and many more do
    not live within a reasonable distance of a military facility. Often the
    threat of loss of coverage is forcing elderly spouses and survivors to
    try to drive long distances to get their cards renewed. Renewal by mail
    can be confusing and very difficult for beneficiaries or their
    caregivers. The bottom line is that those who cannot handle the
    daunting administrative requirements to renew their ID card every four
    years potentially face a significant penalty.
        Position: NAUS urges that the Subcommittee direct the Secretary of
    Defense to authorize issuance of permanent military identification
    cards to uniformed services family members and survivors who are age 65
    and older, with appropriate guidelines for notification and surrender
    of the ID card in those cases where eligibility is ended by divorce or
    remarriage.
                                   conclusion
        Mr. Chairman and distinguished members of the Sub-Committee, we
    want to thank you for your leadership and for holding these hearings
    this year. You have made it clear that the military continues to be a
    high priority and you have our continuing support.

        Senator Stevens. Well, I certainly wish we had the funding.
    We might be able to meet some of these requests today. But I do
    think you have got a point.
        Do you know the cost of using the Federal Employees Health
    Benefits Program (FEHBP) in lieu of the TRICARE option?
        Mr. Butler. We have that information available. I will
    provide it for the record, Mr. Chairman.
        Senator Stevens. I would like to see that.
        Also, have you requested the military ID cards before? I
    think that is a very valid idea. They should have them anyway
    to have access to military facilities if they want to seek
    medical care at such a facility when they are traveling. Have
    you asked for that before?
        Mr. Butler. Asked for military identification (ID) cards?
        Senator Stevens. Yes, for uniformed service family members
    and survivors who are 65 and older. Have you asked for that
    before?
        Mr. Butler. Yes, we have. We have presented that in
    testimony before with the over 65 that have a hard time getting
    their ID cards renewed. We believe when they turn 65, that it
    should be indefinite at that time.
        Senator Stevens. We would support that. I am not sure we
    can do it or whether it should go to the Armed Services
    Committee, but it is a good suggestion.
        Senator.
        Senator Inouye. No questions.
        Senator Stevens. Thank you very much. Enjoyed your
    testimony.
        Our next witness is Harry Armen, President-elect, American
    Society of Mechanical Engineers.
    STATEMENT OF HARRY ARMEN, PRESIDENT-ELECT, AMERICAN
                SOCIETY OF MECHANICAL ENGINEERS
        Mr. Armen. Good morning. My name is Harry Armen. I am
    President of the American Society of Mechanical Engineers, a
    120,000 member engineering society founded in 1880. I have 39
    years of experience in the defense aerospace industry.
        We appreciate the opportunity to appear before your
    subcommittee to present our views on the importance of science,
    engineering, and technology programs sponsored by the DOD,
    programs that are critically important to fundamental
    scientific advances and to the next generation of highly
    skilled scientists and engineers. I want to specifically thank
    this subcommittee and you, Mr. Chairman, and you, Senator
    Inouye, for the ongoing support that you have shown for the DOD
    science and technology programs.
        The stated goal of the administration and Congress is to
    maintain defense S&T funding at 3 percent of the defense
    budget. This would require $12.1 billion for fiscal year 2005.
    We urge you to support this level of funding to enhance both
    the security and the economic vitality of the Nation.
        While we appreciate your continued support for the overall
    program, we remain very concerned about the growing level of
    investments in near-term applied R&D at the expense of long-
    term investments in basic research. We urge you to reverse the
    declining percentage of funding that supports basic research
    within the S&T portfolio.
        In the early 1980's basic research was 20 percent of that
    portfolio. That level has declined to less than 12 percent. We
    strongly urge this subcommittee to support basic research that
    will lead to the next generation of advances in defense
    technology and ultimately to fielded systems. Here is why.
        Reductions in the basic research budget will have adverse
    consequences on the development of the science and engineering
    workforce. DOD basic research and graduate education programs
    are tightly linked. The failure to invest now to sustain these
    programs will reduce the number and quality of students who
    become engineers and scientists in the future. I cannot impress
    upon you enough that this is an urgent situation, one that
    keeps me and should keep the members of the subcommittee awake
    at night. We are simply not attracting the best and brightest
    of our young students to enter the field of defense R&D.
        Furthermore, unlike in the past, engineering students from
    abroad are not planning to remain in the United States after
    graduation, but are instead planning to return to their home
    countries to explore opportunities there. While the commercial
    industry is able to utilize talent from abroad, the defense
    industry cannot.
        A recent RAND study concluded that two-thirds of all
    Federal R&D funding that went to institutes of higher learning
    in 2002 was provided by the Department of Health and Human
    Services. Most of that went to life sciences. In sharp
    contrast, the DOD provided 7 percent. Our students followed the
    dollars.
        We have an opportunity now to reverse the situation by
    attracting the best and the brightest young minds to consider a
    career in defense R&D. I urge the members of the subcommittee
    to continue your support to strengthen DOD science,
    engineering, and technology programs. It will require your
    continued commitment and attention to defense R&D to ensure
    that our best engineering and scientific minds are once again
    willing to apply their talents to meeting the future defense
    needs of this Nation.
        I thank you for the opportunity to offer our views.
        [The statement follows:]
                       Prepared Statement of Harry Armen
        The ASME DOD Task Force of the Inter-Council Committee on Federal
    Research and Development (ICCFRD) is pleased to provide this testimony
    on the Research, Development, Test and Evaluation (RDT&E) and the
    Science, Engineering and Technology (SET) programs within the fiscal
    year 2005 budget request for the Department of Defense. We appreciate
    the opportunity to provide input on these areas that are critical to
    the national security and economic vitality of the United States.
    Introduction
        ASME is a nonprofit, worldwide engineering Society serving a
    membership of 120,000. It conducts one of the world's largest technical
    publishing operations, holds more than 30 technical conferences and 200
    professional development courses each year, and sets many industrial
    and manufacturing standards. The work of the Society is performed by
    its member-elected Board of Governors through five Councils, 44 Boards,
    and hundreds of Committees operating in 13 regions throughout the
    world.
        ASME's DOD Task Force (herein referred to as ``the task force'') is
    comprised of university and industry members who contribute their
    engineering and policy expertise to review the DOD budget and
    legislative requests. The Task Force believes it is uniquely qualified
    to evaluate budget and policy issues in the area of DOD's science,
    engineering and technology development programs. This analysis is
    provided as a public service and we are proud to contribute to a better
    public policy-making process.
    DOD Research, Development, Test and Evaluation Accounts
        The Administration requested $68.9 billion for the Research,
    Development, Test and Evaluation (RDT&E) portion of the fiscal year
    2005 DOD budget. These resources are used mostly for developing,
    demonstrating, and testing weapon systems, such as fighter aircraft and
    warships. This amount represents growth from last year's appropriated
    amount of about 6 percent, and is historically the highest funding
    level for overall engineering activities, even when adjusted for
    inflation. Therefore, even with new requirements generated from the
    transformational military, missile defense, and the war on terrorism,
    this funding level appears to be sufficient to develop, demonstrate,
    and bring military systems to the production phase that will be
    required in the near future. Hence, the Task Force supports the overall
    funding request for RDT&E.
    DOD Science, Engineering and Technology Accounts
        A relatively small fraction of the total RDT&E budget is allocated
    for the core Science, Engineering and Technology (SET) programs.
    Specifically, the Administration's proposed SET request is $10.55
    billion, 15 percent of the RDT&E total, and 15 percent lower than the
    fiscal year 2004 appropriated level of $12.5 billion. The Task Force is
    very concerned with the proposed significant reductions in the SET
    accounts, particularly in the areas of basic research and in programs
    that fund advanced science, mathematics, and engineering education.
        There are three (3) components to the SET budget: basic research
    (6.1), applied research (6.2), and advanced technology development
    (6.3). The Administration's request in all three of these areas is less
    than present funding levels.
        The request for basic research (6.1) is $1.3 billion, 5 percent
    lower than the fiscal year 2004 appropriated amount of $1.4 billion.
    Basic research is less than 12 percent of the SET budget, and less than
    2 percent of the RTD&E total, and yet the programs supported by this
    account are critically important to fundamental scientific advances and
    to the next generation of highly skilled scientists and engineers.
    Almost all of the current high-technology weapon systems, from laser-
    guided, precision weapons, to the global positioning satellite (GPS)
    system, have their origin in fundamental discoveries generated by these
    defense-oriented, basic research programs. Proper investments in basic
    research are needed now, so that the fundamental scientific results
    will be available to create innovative solutions to future defense
    needs of this country. Over the last 40 years, more than half of all
    mechanical and electrical engineering graduate students have been
    funded under these DOD basic research programs. Many of the technical
    leaders in corporations and government laboratories which are
    developing current weapon systems, such as the F-22 and the Joint
    Strike Fighter, were educated by fellowships and/or research programs
    funded by DOD basic research programs. Failure to invest sufficient
    resources in basic, defense-oriented research could reduce innovation
    and weaken the future S&E workforce.
        The request for applied research (6.2) is $3.9 billion, 14 percent
    below the fiscal year 2004 funding level of $4.4 billion. The programs
    supported by this account are generally intended to take basic
    scientific knowledge, perhaps phenomena discovered under the basic
    research programs, and apply them to important defense needs. These
    programs may involve laboratory proof-of-concept and are generally
    conducted at universities and government laboratories. Some devices
    created in these defense technology programs have duel use, such as
    GPS, and the commercial market far exceeds the defense market. Many
    small companies that fuel job growth in many states obtained their
    start in defense programs, but later broaden their market. However,
    without initial support many of these companies would not exist.
    Failure to properly invest in applied research would prevent many ideas
    for devices from being tested in the laboratory, and would stunt the
    creation and growth of small entrepreneurial companies.
        The request for advanced technology development (6.3) is $5.3
    billion, 17 percent lower than the present funding level of $6.3
    billion. These resources support programs that develop technology to
    the point that they are ready to be used in weapon systems. Generally
    without real system-level demonstrations, which are funded by these
    accounts, companies are reluctant to incorporate new devices into
    system development programs.
        The Congress in general, and this subcommittee specifically, has
    acted in recent years to increase funding in the DOD SET accounts, and
    we thank you for your support. The oft-stated goal of both the
    Administration and Congress is to maintain defense SET funding at 3
    percent of the overall defense budget. This would require $12.1 billion
    for the SET accounts for fiscal year 2005, which is an increase of
    approximately $1.6 billion above the Administration's request. We
    recommend you support this level of funding to maintain stable funding
    in the SET portion of the DOD budget. This level of funding will
    enhance the long-term security and economic vitality of our country.
        We further recommend that the Administration and Congress undertake
    a five-year program to reverse the declining percentage of funding
    within the SET portfolio that supports basic research. This is
    precisely the type of work that yielded discoveries used today in
    weapons systems, platforms and protective gear successfully fielded to
    save lives. In the early 1980s, basic research accounted for nearly 20
    percent of SET funding. This level has declined to less than 12 percent
    of the SET budget and less than 2 percent of the overall RDT&E budget.
    We encourage the Committee to reverse this downward trend in
    investments in the basic ideas that are going to lead to tomorrow's
    advances in defense technology.
    Science and Engineering (S&E) Workforce
        The DOD supports 37 percent of all federal research in the computer
    sciences and 44 percent of all engineering research, as well as
    significant shares of research in mathematics and oceanography. DOD's
    impact is even greater in several engineering sub-disciplines such as
    electrical engineering and mechanical engineering. DOD funds research
    in these disciplines for their contributions to national defense, but
    this research is also a key source for major innovations in the
    civilian economy. Through their research, engineers and scientists are
    helping to prepare the U.S. military to be ready for the new threats it
    faces in the 21st century, including nuclear, chemical, biological, and
    other asymmetric threats such as terrorism and cyber attacks.
        A December 2003 National Science Board report titled ``The Science
    and Engineering Workforce: Realizing America's Potential'' stated, ``.
    . . demographics data indicate that participation of U.S. students in
    science and engineering will decline if historical trends continue in
    S&E degree attainment by our college-age population. At the same time,
    retirements of scientists and engineers currently in the workforce will
    accelerate over the coming years.''
        Reductions in the SET budgets have potential adverse consequences
    on the development of the S&E workforce. DOD basic research and
    graduate education programs are tightly linked by design. The failure
    to invest now to sustain these programs will reduce the number and
    quality of engineers and scientists in the future. Many of the highly
    trained and competent people that emerge from these research programs
    contribute directly to the design and development of defense systems.
    Still others, who receive advanced technical educations as a result of
    these programs, but who do not work directly in the defense industry,
    make contributions to national security by enhancing America's economy.
        There is also a growing and alarming trend in many industries to
    outsource engineering and other highly-skilled service activities to
    foreign workers. In the past outsourcing was largely driven by cost
    considerations and was limited to low-cost, low-skilled workers.
    However, there is an emerging trend to outsource highly skilled
    engineering workforce products such as software and systems design and
    integration. It is not clear that a U.S. based defense contractor,
    relying heavily on engineers and scientists in other countries,
    represents a domestic capability. Domestic content legislation for
    defense procurement makes little or no sense if the engineers that
    design the systems ultimately reside outside the United States.
        The Task Force believes that protectionist measures will not be
    able to serve the long-term policy objective of having the capability
    to design, develop, and manufacture defense systems within the United
    States. In order to assure this capability, sufficient manpower,
    particularly those with the critical skills needed for creating
    advanced defense systems, needs to be available in sufficient numbers
    in the United States. Therefore, prudent investments in programs that
    create a robust, domestic supply of engineers and scientist with
    masters and doctoral level educations is in the national interest.
        As the Administration and Congress respond to and prepare for
    terrorism, increasing funding for DOD's SET Programs is vital. These
    programs protect the stability of the Nation's defense base, strive to
    maintain technological superiority in our future weapons systems, and
    educate new generations of scientists, engineers, mathematicians, and
    skilled technicians who maintain our position as the world's
    technological leader.
    Conclusion
        In Summary, the Task Force supports the overall RDT&E request of
    $68.9 billion, but urges the subcommittee to increase the science,
    engineering and technology (SET) component accounts by $1.6 billion to
    $12.1 billion. The proposed 15 percent reduction in science,
    engineering and technology funding would stifle innovation needed for
    future defense systems and have a detrimental impact on the production
    of scientists and engineers, with advanced technical degrees, required
    to develop military systems in the years to come. In addition, we
    recommend that the Administration and Congress undertake a five-year
    program to reverse the declining percentage of funding within the SET
    portfolio that supports basic research.

        Senator Stevens. Well, thank you very much. Your
    organization did visit us, and we had some conversations about
    mechanical engineering dropping behind in terms of investment
    for R&D.
        Are you into nanotechnology at all in terms of your
    applications in the military field?
        Mr. Armen. We are starting to, yes, sir. Yes, we are with
    new material systems and new coatings. Yes.
        Senator Stevens. Senator Inouye.
        Senator Inouye. No questions.
        Senator Stevens. You have a point and I think we should
    look closely at that because it is true that the foreign
    students we are assisting in their education are not staying
    with us, but they are not basically in your field either. So I
    think we should do our best to attract more people into this
    type of research for the military.
        Mr. Armen. Thank you very much, Mr. Chairman.
        Senator Stevens. Thank you.
        Our next witness is Seth Allan Benge of the National
    Military Veterans Alliance. Good morning, sir.
    STATEMENT OF SETH ALLAN BENGE, LEGISLATIVE DIRECTOR,
                RESERVE ENLISTED ASSOCIATION ON BEHALF OF
                THE NATIONAL MILITARY VETERANS ALLIANCE
        Mr. Benge. Good morning, Mr. Chairman. Mr. Chairman,
    Senator Inouye, as Legislative Director for the Reserve
    Enlisted Association, it is an honor for me to testify on
    behalf of the National Military and Veterans Alliance. The
    alliance is an umbrella group made up of 29 military retiree
    veterans and survivor associations with almost 5 million
    members.
        Our concerns are many, but our time is brief, so I will
    discuss a few issues that deal directly with our Nation's
    Reserve forces. There are some subjects that we believe will
    need to be addressed and will require funding from this
    committee.
        During testimony before this committee, the Reserve chiefs
    have recognized the Montgomery GI Bill for selected Reserves as
    an important recruiting and retention tool, but the GI bill for
    reservists has not kept pace with the ever-rising costs of
    education. In 1985, when this education assistance was first
    legislated, it was 47 percent of the active duty benefit. Today
    that percentage is down to only 27 percent. Eventually this
    lagging will have a dampening effect on its usefulness. It is
    important that we begin to correct this problem by starting to
    incrementally raise the monthly rates. The alliance requests
    appropriations funding to raise the monthly payment of the
    title 10 Montgomery GI Bill and lock that rate at 50 percent of
    the chapter 30 benefit.
        Another effective tool to keep quality men and women in our
    Reserve forces are bonuses. Here also the Reserve program has
    fallen behind. The law creates a limit on the amount that can
    be paid out to members of the Reserves. Currently this cap is
    set at $5,000 per reservist. This amount, in some cases, simply
    is not enough. These bonuses are used to keep men and women in
    mission-critical military occupational specialties that are
    experiencing falling numbers or are difficult to fill. The
    operational tempo, financial stress, and civilian competition
    for these jobs makes bonuses a necessary program for the
    Department of Defense to fill essential programs.
        Another point for consideration is that Guard and Reserve
    members are not eligible for Reserve bonuses while mobilized,
    but neither are they eligible for active duty bonuses. This
    catch-22 means that reservists are denied the opportunity to
    receive bonuses tax-free like their active duty brother. This
    would help offset losses in pay. The alliance would like to see
    the Reserve chiefs receive the funds and the authority to award
    bonuses above the $5,000 limit and we support extending the
    bonus authority to Reserve component members who have 14 to 20
    years in service.
        The National Military Veterans Alliance thanks you for
    having this hearing and listening to our concerns. Our written
    testimony deals with many additional areas. We hope that you
    will consider these points when finalizing your appropriation
    bills this year. Again, thank you, Mr. Chairman. Thank you for
    your attention.
        [The statement follows:]
                     Prepared Statement of Seth Allan Benge
                                  introduction
        Mister Chairman and distinguished members of the Committee, the
    National Military and Veterans Alliance (NMVA) is very grateful for the
    invitation to testify before you about our views and suggestions
    concerning defense-funding issues.
        The Alliance was founded in 1996 as an umbrella organization to be
    utilized by the various military and veteran associations as a means to
    work together towards their common goals. The Alliance's organizations
    are: American Logistics Association; American Military Retirees
    Association; American Military Society; American Retirees Association;
    American WWII Orphans Network; AMVETS; Association of Old Crows;
    Catholic War Veterans; Class Act Group; Gold Star Wives of America;
    Korean War Veterans Foundation; Legion of Valor (Washington Capital
    Region); Military Order of the Purple Heart; Military Order of the
    World Wars; National Assn for Uniformed Services; National Gulf War
    Resource Center; Naval Enlisted Reserve Association; Naval Reserve
    Association; Paralyzed Veterans of America; Reserve Enlisted
    Association; Reserve Officers Association; Society of Military Widows;
    The Retired Enlisted Association; TREA Senior Citizen League; Tragedy
    Assistance Program for Survivors; Uniformed Services Disabled Retirees;
    Veterans of Foreign Wars; Vietnam Veterans of America; and Women in
    Search of Equity.
        The preceding organizations have almost five million members who
    are serving our nation, or who have done so in the past and their
    families.
        The overall goal of the National Military and Veteran's Alliance is
    a strong National Defense. In light of this overall objective, we would
    request that the committee examine the following proposals.
        The National Military and Veterans Alliance must once again thank
    this Committee for the great strides that have been made over the last
    few years to improve the benefits of the Reserve components and their
    families. The improvements in health care, pay system, family support,
    mobilization and demobilization problems have been historic. It has
    been a very successful few years. But there are still many serious
    problems to be addressed:
                              mgib-sr enhancements
        The current Montgomery G.I. Bill dates back to President Franklin
    Roosevelt signing the ``Servicemen's Readjustment Act of 1944''. The
    G.I. Bill seeks to fulfill six purposes for the reserve forces: (1) to
    provide educational assistance program to assist in the readjustment of
    members of the Armed Forces to civilian life; (2) to extend the
    benefits of a higher education to qualifying men and women who might
    not otherwise be able to afford such an education; (3) to provide for
    vocational readjustment and to restore lost educational opportunities
    to those service men and women; (4) to promote and assist the All-
    Volunteer Force program and the Total Force Concept of the Armed Forces
    and to aid in the recruitment and retention of highly qualified
    personnel for both the active and reserve components of the Armed
    Forces; (5) to give special emphasis to providing educational
    assistance benefits to aid in the retention of personnel in the Armed
    Forces; and (6) to enhance our Nation's competitiveness through the
    development of a more highly educated and productive work force.
        Approximately 7.8 percent of the enlisted Reservists have a
    Bachelors degree or higher. This makes the Montgomery G.I. Bill for
    Selective Reserves (MGIB-SR) an important recruiting and retention
    tool. With massive troop rotations the Reserve forces can expect to
    have retention shortfalls, unless the government provides incentives
    such as those that would counter the negative effects of having placed
    a college education in abeyance. Education is not only a quality of
    life issue or a recruiting/retention issue it is also a readiness
    issue. Education a Reservist receives while either in a university or a
    trade school enhances their careers and usefulness to the military. The
    ever-growing complexity of weapons systems and support equipment
    requires a force with far higher education and aptitude than in
    previous years.
        The problem with the current MGIB-SR is that the Selected Reserve
    MGIB has failed to maintain a creditable rate of benefits with those
    authorized in Title 38, Chapter 30. Other than cost-of-living
    increases, only two improvements in benefits have been legislated since
    1985. In that year MGIB rates were established at 47 percent of active
    duty benefits. This past October 1, the rate fell to 27 percent of the
    Chapter 30 benefits. While the allowance has inched up by only 7
    percent since its inception, the cost of education has climbed
    significantly.
        Position: The NMVA requests appropriations funding to raise the
    MGIB-SR and lock the rate at 50 percent of the active duty benefit.
                                    bonuses
        Guard and Reserve component members may be eligible for one of
    three bonuses, Prior Enlistment Bonus, Reenlistment Bonus and Reserve
    Affiliation Bonuses for Prior Service Personnel. These bonuses are used
    to keep men and woman in mission critical military occupational
    specialties (MOS) that are experiencing falling numbers or are
    difficult to fill. During their testimony before this committee the
    reserve chiefs addressed the positive impact that bonuses have upon
    retention. This point cannot be understated. The operation tempo,
    financial stress and civilian competition for these jobs makes bonuses
    a necessary tool for the Department of Defense to fill essential
    positions. Though the current bonus program is useful there are three
    changes that we have identified that need to be made to increase its
    effectiveness.
        The primary requirement for eligibility and payment of a bonus upon
    reenlistment is that the member must have completed less than 14 years
    of total military service and not be paid more than one six-year bonus
    or two three-year bonuses under this section. This 14-year total
    military service restriction and the limitation on the number of
    bonuses paid, effectively limits the opportunities for career
    reservists to obtain bonuses past 20 years of service and may be a
    disincentive for continuing service in the Reserve component beyond 20
    years. Increasing the eligibility for reenlistment bonuses to 20 years
    of total military service and increasing the number of bonuses that can
    be paid under this section could expand the available force pool, as
    mid-level enlisted reserve members could take advantage of the new
    bonus criteria. Using a 20 year service cutoff instead of a 14 year
    period would encourage selected experienced mid-level subject matter
    experts to reenlist to established high year of tenure or mandatory
    separation dates; should members accept this incentive and reenlist, it
    could boost each service's retention effort in critical skill areas. As
    each Service uses members of the selected reserve in different
    capacities, each Service Secretary may use this new authority as
    required as a force management tool.
        The law also creates a limit on the amount that can be paid out to
    reservists. Currently this cap is at $5,000 per reservists. This amount
    in some cases simply isn't enough. Active duty personnel can receive
    multiple bonuses in amounts upwards of $20,000. The inequity between
    these two amounts is increased even further when taken into
    consideration that Guard and Reserve members are not eligible for
    reserve bonuses while mobilized, but neither are they eligible for
    active duty bonuses. This ``catch 22'' means that two members of the
    Armed Forces, one active one reserve, could be working side-by-side in
    Iraq in a mission critical area. The active duty personnel can reenlist
    and receive a tax-free bonus while the reservist would receive no bonus
    at all. This is a glaring wrong that needs to be corrected.
        Position: The Alliance would like to see the Reserve Chiefs receive
    the funds and the authority to go above the $5,000 limit, an increase
    in eligibility from 14 to 20 years and the ability for reservists to
    receive bonuses while on active duty orders.
                         tricare for reserve components
        A 2002 General Accounting Office (GAO) report indicated that
    possibly 20 percent of the Guard and Reserves do not have adequate
    health insurance. This means up to 150,000 enlisted Reservists and
    their families could be without health insurance. This has a
    potentially devastating effect on the lives of our Reservists. Lack of
    continuity of care during mobilization creates a disincentive for
    reenlistment. In addition, all military members are expected to
    maintain the same health and physical fitness as Active Duty yet they
    are required to fund their own medical coverage. Beyond the quality of
    life issues lays another grave concern. That is the readiness of our
    Reserve Components. With such a large portion of the reserves without
    healthcare and physicals that are only required once every five years
    the number of Guard and Reserve that are unfit for deployment at any
    given time is uncertain. At this moment the government is paying and
    training servicemen and women that when called into action could not
    go.
        The fiscal year 2004 National Defense Authorization Act authorized
    a one-year program to extend premium-based TRICARE coverage to Selected
    Reserve members (and certain members of the Individual Ready Reserve
    (IRR) subject to presidential recall) that are not eligible for
    employer-sponsored health coverage. When it finally takes effect, the
    temporary TRICARE program will provide health care to many of our Guard
    and Reserves. The Department of Defense has announced that this program
    will begin but has not set a start date. When it is finally implemented
    DOD has only $400 billion to draw on to pay for the start-up and to
    then cover eligible reservists and their families.
        Position: The Alliance urges the Congress to provide the money to
    make this current temporary program permanent and to extend it to allow
    all Selected Reserve members and certain IRR members access to premium-
    based TRICARE coverage when they are not on Active Duty. In addition,
    these members should have the option of having the government pay some
    share of any employer-provided health coverage during periods of recall
    to active service.
                                 bah vs. bah ii
        Under the current pay system there are two Basic Allowances for
    Housing (BAH) rates, one for active duty and one for reservists that
    are mobilized for 139 days or less. When reservists reach the 140-day
    line they start to receive full BAH, reservists that are called for
    training and other assignments that last less than this artificial
    barrier lose money. The assumptions that were made when this system was
    placed into effect in 1983 are no longer valid. Reservists often travel
    away from home for assignments. Since some of these are short
    assignments it is not practical for reservists to uproot their
    families, consequently at times reservists are keeping two residences.
        In the Department of Defense Report to Congress ``Reserve Personnel
    Compensation Program Review'' the department stated that to completely
    eliminate the 140-day threshold, it would cost $162 million annually.
    This report acknowledges that as a matter of equity the 140-day
    threshold should be eliminated. The department's suggestion to reduce
    the threshold for payment of BAH, rather than BAH II, to no more than
    30 days is a cost saving option, but it does not address the fact that
    any time based standard for receiving the allowance is artificial in
    nature and saves money at a cost to the individual servicemen and
    woman.
        Position: The NMVA requests that the funds and language be included
    that would eliminate this artificial and unreasonable difference in the
    BAH that reservists are paid.
                reduce retirement age eligibility for reservists
        Over the last two decades, more has been asked of Guardsmen and
    Reservists than ever before. The nature of the contract has changed;
    Reserve Component members would like to see recognition of the added
    burden they carry. Providing an option that reduces the retired with
    pay age from 60 to 55 years carries importance in retention,
    recruitment, and personnel readiness. Some are hesitant to endorse this
    because they envision money would be taken out of other entitlements,
    benefits, and Guard and Reserve Equipment budgets. The National
    Military and Veteran's Alliance recommends that Reserve retirement with
    pay be allowed prior to age 60, but be treated like Social Security
    retirement offset, at lower payments when taken at an earlier age. If a
    Reservist elects to take retired pay at age 55, it would be taken at an
    actuarially reduced rate, keeping the net costs at zero.
        Most of the cost projected by DOD is for TRICARE healthcare, which
    begins when retirement pay commences. Again following the Social
    Security example, Medicare is not linked to Social Security payments.
        Position: The National Military and Veterans Alliance suggests that
    TRICARE for Reservists be decoupled from pay, and eligibility remain at
    age 60 years with Social Security as a model, Reservists understand the
    nature of offsetting payments. The only remaining expense in this
    proposal would be the administrative startup costs and adjustments to
    retirement accrual contributed to the DOD retirement accounts.
                                   conclusion
        Mr. Chairman and distinguished members of the Subcommittee the
    Alliance again wishes to emphasize that we are grateful for and
    delighted with the large steps forward that the Congress has affected
    the last few years. We are also very appreciative of recent changes
    that impact our ``citizen soldiers'' in the Guard and Reserve. But
    there is still work to be done to improve health care programs for all
    qualified beneficiaries, and benefits and mission funding for our
    Guardsmen and Reservists. We understand that all of these issues don't
    fall under the direct purview of your subcommittee. However, we are
    aware of the continuing concern all of the subcommittee's members have
    shown for the health and welfare of our service personnel and their
    families. Therefore, we hope that this subcommittee can further advance
    these suggestions in this committee or in other positions that the
    members hold. We are very grateful for the opportunity to speak on
    these issues of crucial concern to our members. Thank you.

        Senator Stevens. Thank you very much.
        Senator Inouye.
        Senator Inouye. How would you justify making TRICARE
    permanent for reservists?
        Mr. Benge. Sir, earlier it was pointed out that it would be
    the same as for active duty, and that would be true, but for
    reservists, the physical standards are also the same for active
    duty. So I would justify it not only as a retention tool, as a
    benefit, but also as a readiness issue to ensure that our
    reservists are physically ready to be mobilized.
        Senator Inouye. Thank you.
        Senator Stevens. To follow on that, how long would you do
    that? You can stay in the Reserve until you are 60, can you
    not?
        Mr. Benge. Yes, sir. I would have to look at the numbers to
    see what would be affordable. Ideally you would want it
    indefinitely. Right now gray area retirees are not eligible for
    TRICARE. They are not eligible until 65.
        Senator Stevens. We can attest to the fact that as you get
    older, you need more medical care.
        Mr. Benge. Yes, sir.
        Senator Stevens. But as you get older, you are not going to
    be called up. So I think we would like to understand this. How
    long do you think this should go on? Just think about it and
    give us a statement, will you?
        Mr. Benge. Yes, sir.
        Senator Stevens. Thank you very much.
        Our next witness is Martin B. Foil, a member of the Board
    of Directors of the National Brain Injury Research, Treatment,
    & Training Foundation. Good morning, sir.
    STATEMENT OF MARTIN B. FOIL, JR., MEMBER, BOARD OF
                DIRECTORS, NATIONAL BRAIN INJURY RESEARCH,
                TREATMENT, & TRAINING FOUNDATION (NBIRTT)
        Mr. Foil. Good morning. Mr. Chairman, Senator Inouye, it is
    good to be back. It is always a pleasure to come and testify on
    behalf of the defense and veterans head injury program (DVHIP)
    which provides state-of-the-art medical care and rehab to
    active duty military personnel.
        As of March 31, DVHIP has treated over 350 troops injured
    in the global war on terrorism. Traumatic brain injury (TBI) is
    a leading combat concern in modern warfare. Previously
    accounting for up to 25 percent of combat casualties, today we
    think the incidence rate is between 40 and 70 percent.
        It is higher for several reasons in hostilities. One, the
    use of more effective body armor and improved trauma care has
    saved more lives. The higher incidence of blast injuries,
    increasing numbers of gunshot wounds to the face, and the
    medical personnel are more aware of the significance of TBI and
    are more likely to identify it.
        Chairman Stevens, as you so eloquently stated on the Senate
    floor last Wednesday, our combat medics regularly perform
    miracles by providing lifesaving care during the critical
    golden hour. The combat medics are performing miracles, but so
    are the doctors and rehab specialist in the DVHIP.
        As the front-page article in the Washington Post reported
    last week, what most soldiers sustaining brain injury tell
    their doctors is they want to go back to their unit. Sergeant
    Colin Rich was shot in the head in Afghanistan in December
    2002. He is one, who with the care of DVHIP, was able to do
    just that. Within 1 year, he returned to active duty, including
    a stint in Iraq. He spoke at the Brain Injury Awareness Day on
    Capitol Hill last October, along with Warrant Officer John Sims
    who sustained a closed head injury during the battle of
    Baghdad. His Blackhawk helicopter was shot down, but while he
    managed to get his men out before the crash, he went down with
    the helicopter. In the days after Sims' injury, he was not
    expected to live, and yet today he is getting his life back
    little by little, having worked today with the Judge Advocate
    General (JAG) Corps as part of the cognitive rehab program at
    the Virginia NeuroCare (VANC), a core component of DVHIP.
        While these are heroic stories, as you know, not everyone
    can return to life as before. DVHIP staff are aware of the
    danger of premature return to duty and how critical it is to
    identify brain injuries when many other injuries like
    amputations are so much more obvious.
        That is why DVHIP this year is asking for $7 million to
    continue treating and screening injured soldiers strategically
    placing specialized clinicians in medical treatment facilities
    throughout the Nation in order to provide the continuity of
    care from battlefield to rehab back to active duty. This
    funding is needed to continue training combat medics and
    surgeons, general medical officers, and reservists in the best
    practices of traumatic brain injury care. So I respectfully
    request your support of the $7 million in the DOD
    appropriations bill under health affairs for operation and
    maintenance for fiscal year 2005.
        Thank you, Mr. Chairman and Mr. Inouye. I would be happy to
    answer any questions.
        [The statement follows:]
                   Prepared Statement of Martin B. Foil, Jr.
        My name is Martin B. Foil, Jr. and I am the father of Philip Foil,
    a young man with a severe brain injury. I serve as a volunteer on the
    Board of Directors of the National Brain Injury Research, Treatment and
    Training Foundation (NBIRTT) \1\ and Virginia NeuroCare in
    Charlottesville, Virginia (VANC).\2\ Professionally, I am the Chief
    Executive Officer and Chairman of Tuscarora Yarns in Mt. Pleasant,
    North Carolina.\3\
    ---------------------------------------------------------------------------
        \1\ NBIRTT is a non-profit national foundation dedicated to the
    support of clinical research, treatment and training.
        \2\ VANC provides brain injury rehabilitation to military retirees,
    veterans and civilians through an innovative and cost effective day
    treatment program.
        \3\ I receive no compensation from this program. Rather, I have
    raised and contributed millions of dollars to support brain injury
    research, treatment, training and services.
    ---------------------------------------------------------------------------
        On behalf of the thousands of military personnel that receive brain
    injury treatment and services annually, I respectfully request that $7
    million be added to the Department of Defense (DOD) Health Affairs
    budget for fiscal year 2005 under Operation and Maintenance for the
    Defense and Veterans Head Injury Program (DVHIP).
    Traumatic brain injury is a leading combat concern in modern warfare.
            Previously accounting for up to 25 percent of combat
            casualties, today the incidence of TBI may be as high as 40-70
            percent of casualties.
        The incidence of traumatic brain injury (TBI) is believed to be
    greater now than in previous hostilities for a number of reasons: (1)
    The use of effective body armor has saved more lives; (2) medical
    personnel are more aware of the significance of mild closed TBIs and
    concussions and are therefore more likely to identify them; and (3) the
    incidence of blast injuries in Iraq and Afghanistan is high.
        As a result, the current incidence of TBI sustained in theater is
    expected to be higher than in previous conflicts. Major General Kevin
    C. Kiley, Commanding General of the Walter Reed Army Medical Center
    (WRAMC) and the North Atlantic Regional Medical Command said at the
    October 2003 Congressional Brain Injury Task Force Awareness Fair on
    Capitol Hill that as many as 40-70 percent of casualties have the
    possibility of including TBI.\4\ The incidence of TBI was recently
    discussed at a two day conference held by the DVHIP along with the
    Joint Readiness Clinical Advisory Board on March 23-24, 2004, and
    evidence was presented that 61 percent of at-risk soldiers seen at
    WRAMC were assessed to have TBIs. While this does not reflect the
    entire population of wounded in action, the high percentage suggests
    that brain injury acquired in theater is an increasing problem that
    needs to be addressed.
    ---------------------------------------------------------------------------
        \4\ Schlesinger, Robert, ``Brain Injuries Take Toll on U.S.
    Soldiers,'' The Boston Globe, October 16, 2003.
    ---------------------------------------------------------------------------
    The Defense and Veterans Head Injury Program (DVHIP)
        Established in 1992, the DVHIP is a component of the military
    health care system that integrates clinical care and clinical follow-
    up, with applied research, treatment and training. The program was
    created after the first Gulf War to address the need for an overall
    systemic program for providing brain injury specific care and
    rehabilitation within DOD and DVA. The DVHIP seeks to ensure that all
    military personnel and veterans with brain injury receive brain injury-
    specific evaluation, treatment and follow-up. Clinical care and
    research is currently undertaken at seven DOD and DVA sites and one
    civilian treatment site.\5\ In addition to providing treatment,
    rehabilitation and case management at each of the 8 primary DVHIP
    centers, the DVHIP includes a regional network of additional secondary
    veterans' hospitals capable of providing TBI rehabilitation, and linked
    to the primary lead centers for training, referrals and consultation.
    This is coordinated by a dedicated central DVA TBI coordinator and
    includes an active TBI case manager training program.
    ---------------------------------------------------------------------------
        \5\ Walter Reed Army Medical Center, Washington, DC; James A. Haley
    Veterans Hospital, Tampa, FL; Naval Medical Center San Diego, San
    Diego, CA; Minneapolis Veterans Affairs Medical Center, Minneapolis,
    MN; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA;
    Virginia Neurocare, Inc., Charlottesville, VA; Hunter McGuire Veterans
    Affairs Medical Center, Richmond, VA; Wilford Hall Medical Center,
    Lackland Air Force Base, TX.
    ---------------------------------------------------------------------------
    As of March 31, 2004 \6\ more than 350 combat casualties from the
            Global War on Terrorism have been served by DVHIP.
    ---------------------------------------------------------------------------
        \6\ The attached article on the complexity of treating brain-
    injured soldiers in Iraq, which appeared on the front page of The
    Washington Post on Tuesday, April 27, 2004 notes that ``in April, 900
    soldiers and Marines have been wounded in Iraq.'' The official number
    of troops treated by DVHIP has only been calculated as of March 31,
    2004.
    ---------------------------------------------------------------------------
        Congressional support over the years has helped create the existing
    DVHIP infrastructure that has been critical in evaluating and caring
    for active duty personnel who are being injured in Operation Iraqi
    Freedom (OIF) and Operation Enduring Freedom (OEF). Thorough
    evaluation, referral for appropriate clinical supports, prompt
    discharge to home or military unit, and focus on returning service
    members to active duty have been the primary goals of the clinical care
    provided to these war fighters. Additional service members have been
    identified who were cared for and promptly discharged back to their
    units. DVHIP is working with the appropriate military institutions to
    ensure that these individuals will be actively followed to ensure they
    receive specialized clinical care and follow-up as needed.
        WRAMC and Bethesda Naval Hospital (for Marines) have been the main
    destinations of injured personnel sent from Iraq and Afghanistan via
    Landstuhl Regional Medical Center in Germany. According to data from
    the Office of the Surgeon General, approximately 70 percent of those
    wounded in action are sent to the general surgery or orthopedic surgery
    services at the receiving medical center because of the most severe
    injuries of the individual. Because the most common cause of wounded in
    action is currently blast injury, DVHIP is working with the Command at
    WRAMC to screen all of the incoming wounded who have been injured in
    blast, falls or motor vehicle accident. An estimated 61 percent of
    those screened at WRAMC were identified as having sustained a traumatic
    brain injury.
    Examples of Military Personnel Injured, Treated and Returning to Work
        The following are examples of injured active duty military
    personnel who recently received care provided by the DVHIP:
        First Sgt. Colin Robert Rich, A Company, 1st Battalion 504th
    Parachute Infantry Regiment, was shot in the head on December 28, 2002
    while serving in Afghanistan. Rich received initial acute care at a
    hospital in Germany within 15 hours of being shot and arrived at WRAMC
    on January 4, 2002 where he was cared for by DVHIP staff before being
    discharged home on January 16, 2002. Rich continues to receive follow
    up care from DVHIP and spoke before Members of Congress at the October,
    2003 Congressional Brain Injury Task Force Awareness Fair. Rich
    returned to limited active duty in December of 2003.
        Warrant Officer John Sims, U.S. Air pilot and member of the
    Maryland Guard was piloting a Black Hawk helicopter in Iraq when his
    helicopter went down, and he suffered brain injuries. His wife was
    initially told he probably would not survive. After being admitted to
    WRAMC, he was cared for at the Richmond VA hospital before being
    transferred to Virginia Neurocare, DVHIP's civilian community reentry
    treatment site. Although he has made remarkable recovery, his ability
    to pilot a plane again is in doubt. Simms also spoke before Members of
    Congress at the October 2003 Congressional Brain Injury Task Force
    Awareness Fair.
        PFC Alan Lewis was driving a Humvee in Baghdad on July 16, 2003 in
    Iraq when an explosive device tore off his legs. Lewis was identified
    as a potential TBI patient through DVHIP screening and was found to
    have sustained a mild TBI. DVHIP clinical staff helped him cope with
    memory problems and other neurobehavioral difficulties from his head
    injury throughout the rehabilitation process. He has been an articulate
    spokesperson for the dedication and resolve of our fighting force and
    the potential for recovery after a serious injury.
        These are just a few examples of what DVHIP does for hundreds of
    military personnel each year; from being ready to care for injured
    troops in the acute care setting to neuro-rehabilitation involving the
    entire patient to full community integration.
    Improving Medical Care, Training and Diagnostics
        Along with the Joint Readiness Clinical Advisory Board (JRCAB) at
    Fort Detrick, DVHIP co-sponsored a first-of-its-kind conference
    entitled ``Neurotrauma in Theater: Lessons Learned from Iraq and
    Afghanistan.'' The conference brought together neurosurgeons,
    neurologists, physician assistants, medic, nurses and general medical
    officers who served in Iraq and Afghanistan. Expert opinion from every
    branch of the armed forces was shared and debated. In addition to
    helping address immediate needs and guide future research for the
    safety of the Active Duty, the conference informed a specialty
    neurotrauma panel with recommendations going to the Office of the
    Surgeon General.
        A recurring theme throughout the neurotrauma conference was the
    need for training for management of closed head injury. Education of
    corpsmen and other military medical providers on concussion care
    continues to be one of the primary objectives at the DVHIP at Camp
    Pendleton. Standardized educational programs are being developed this
    year by the DVHIP educational core in order to reach a greater number
    of medical providers. DVHIP plans to make these educational materials
    available on its website to enhance this outreach and provide
    information to providers in austere locations where travel for on-site
    training would not be possible.
        In anticipation of large numbers of troops returning home in July,
    the DVHIP screening process has been developed into a manual in order
    to assist physicians at military sites without a DVHIP component. A
    DVHIP Web-based patient assessment was also developed for physicians at
    distant sites who would like to incorporate this in their clinical
    practice.
        Another way that DVHIP is assisting military and VA providers in
    treating individuals with TBI is by disseminating thousands of copies
    of ``Heads Up: Brain Injury in Your Practice Tool Kit,'' a new
    physician tool kit to improve clinical diagnosis and management of mild
    TBI. The kit was developed by the Centers for Disease Control and
    Prevention in collaboration with DVHIP. This past year DVHIP also
    teamed up with the Veterans Health Administration to produce an
    independent TBI study program as part of the Veterans Health
    Initiative. This program offers any military or VA physician Continuing
    Medical Education credits for its completion. An online version ensures
    that clinicians serving in theater can receive up-to-date training in
    TBI care.
    Additional DVHIP Accomplishments and Ongoing Research Initiatives
        Provided successful rehabilitation and return to work and community
    re-entry for active duty military personnel and veterans.
        Established an archive of military neurotrauma cases and statistics
    from military physicians who were deployed to Afghanistan, Kuwait, and
    Iraq. These data are still being reviewed and complied into a single
    archive that will be available for military use.
        Developed The War on Terrorism Brain Injury Registry to identify
    individuals with brain injury and examine clinically relevant issues in
    the management of brain injury sustained in theatre. These records will
    provide the basis for future efforts to follow these individuals to
    understand better the longer term implications of these injuries.
        Submitted a proposal to determine if an enhanced program of
    telephonic nursing will improve the outcome of Active Duty with mild
    brain injury. Establishing effectiveness of telephonic nursing will be
    critical to treating individuals who are at distance from other care
    providers, thus serving soldiers and saving taxpayer money.
        Ongoing studies are being conducted with Army paratroopers and
    cadets and U.S. Marines at Fort Bragg, West Point, and Camp Pendleton.
    These studies are investigating brief evaluation instruments for use on
    the battlefield to determine which injured service members require
    immediate treatment and which can return to duty. The goal of these
    studies is to preserve our nation's fighting strength while conserving
    medical resources for those injured and requiring treatment.
        Completed enrolling patients in a research protocol on functional
    rehabilitation versus cognitive rehabilitation for severe brain injury.
        A randomized controlled study of sertraline for post concussive
    syndrome is being carried out in all DVHIP military and VA sites. This
    study targets the symptoms of irritability, depression and anxiety
    which many soldiers report after TBI.
        Published a study on the recovery pattern from concussion from the
    West Point boxing study in Neurosurgery (Bleiberg, et al, May, 2004),
    an epidemiologic study on TBI in Fort Bragg paratroopers (Ivins et al,
    Journal of Trauma, October 2003), and an invited editorial on the
    effects of concussion (Warden, Neurology, May 11, 2004).
        Developed a free standing website www.dvbic.org to provide
    information for clinical providers, patients and family members.
        Added TBI specific questions to WRAMC's Post-Deployment
    Questionnaire which is administered to all soldiers who were recently
    deployed and sent to WRAMC.
    Additional funding is needed in fiscal year 2005 to address the
            following needs:
        Continue to provide clinical care of active duty personnel and
    veterans:
      --Expand clinical capacity to meet the need to care for an increasing
            number of injured military personnel and veterans.
      --Increase use of DVHIP resources by medical assets at other military
            and veteran sites with large troop/vet concentrations, e.g., by
            web-based initiatives, medical staff presentations by DVHIP
            personnel, etc.
      --Implement TBI outpatient clinics at DVHIP lead centers. As the
            needs of the returning veterans after blast injury are expected
            to be largely outpatient, the DVHIP will be prepared to meet
            those needs.
      --Ensure all necessary care has been received by military personnel
            and veterans who have sustained brain injuries by using the
            DVHIP Registry to identify individuals in need of additional
            treatment and support.
        Continue military and veteran specific education and training:
      --Develop an algorithm for return to duty management to be used by
            first responders in the military. These management guidelines
            will be based on new data analysis from existing concussion
            studies at West Point, Fort Bragg, and Camp Pendleton.
      --Report to the U.S. Army the findings from the War on Terrorism
            Brain Injury Registry regarding incidence of closed head injury
            and the impact of early wound closure in penetrating brain
            injury.
      --Disseminate evidence-based guidelines on pharmacological management
            of neurobehavioral consequences of brain injury.
      --Expand the content and services of the DVHIP website. Future
            website applications will include enhanced educational
            materials and the capability to make referrals and gain access
            to care.
        Military and Veteran Relevant Clinical Research:
      --Determine the incidence of brain injury from the most commonly
            occurring blast injuries.
      --Initiate a VA multi-center trial to provide the first evidence on
            the effectiveness of cognitive rehabilitation and stimulant
            medication early in recovery from severe brain injury.
      --Conduct the study of enhanced protection from parachute injury by
            field-testing approved novel helmet configurations at Fort
            Bragg.
      --Implement the feasibility study of biomarkers in mild brain injury
            and injury recovery in collaboration with Ron Hayes, Ph.D. at
            the Evelyn F. and William L. McKnight Brain Institute at the
            University of Florida.
      --Extend outcomes research through the evaluation of long-term work
            and duty status in DVHIP rehabilitation trial participants.
    DVHIP Support for Families after Brain Injury
        Every military commander and soldier knows the importance of taking
    care of their families so that they may focus on performing their
    critical duties. This is especially important in times of conflict, as
    demonstrated during Operation Iraqi Freedom. When soldiers sustain
    brain injuries in conflict, taking care of families is even more
    important. This is because the impact of brain injury on the family is
    particularly traumatic, in that not only life and death are at stake,
    but there are also significant disruptions to family systems for months
    or years thereafter as the rehabilitation and recovery process ensues.
    DVHIP family support groups provide a great deal of assistance,
    education, and information to families. For example, the family support
    program at the Tampa VA also holds bi-annual reunions in which former
    patients and families come from around the country.
    Conclusion
        There is no greater time than today to support injured personnel
    sustaining brain injuries. There is nothing more patriotic than caring
    for the men and women who serve our country and protect our interests.
    Our men and women in uniform are sustaining brain injuries and need
    brain injury specific care and state of the art treatment and
    rehabilitation. The incidence of TBI is higher in theater than it has
    ever been in history, and the numbers of injured personnel present a
    challenge to the military medical system. DVHIP continues to be an
    important part of the military health care system and needs additional
    funding to continue its work.
        Please support $7 million for the DVHIP in the fiscal year 2005
    Defense Appropriations bill in the DOD Health Affairs budget under
    Operation and Maintenance to continue this important program.

                   [From the Washington Post, April 27, 2004]

                           The Lasting Wounds of War
        roadside bombs have devastated troops and doctors who treat them
                                 (By Karl Vick)
        BAGHDAD--The soldiers were lifted into the helicopters under a
    moonless sky, their bandaged heads grossly swollen by trauma, their
    forms silhouetted by the glow from the row of medical monitors laid out
    across their bodies, from ankle to neck.
        An orange screen atop the feet registered blood pressure and heart
    rate. The blue screen at the knees announced the level of postoperative
    pressure on the brain. On the stomach, a small gray readout recorded
    the level of medicine pumping into the body. And the slender plastic
    box atop the chest signaled that a respirator still breathed for the
    lungs under it. At the door to the busiest hospital in Iraq, a wiry
    doctor bent over the worst-looking case, an Army gunner with coarse
    stitches holding his scalp together and a bolt protruding from the top
    of his head. Lt. Col. Jeff Poffenbarger checked a number on the blue
    screen, announced it dangerously high and quickly pushed a clear liquid
    through a syringe into the gunner's bloodstream. The number fell like a
    rock.
        ``We're just preparing for something a brain-injured person should
    not do two days out, which is travel to Germany,'' the neurologist
    said. He smiled grimly and started toward the UH-60 Black Hawk thwump-
    thwumping out on the helipad, waiting to spirit out of Iraq one more of
    the hundreds of Americans wounded here this month.
        While attention remains riveted on the rising count of Americans
    killed in action--more than 100 so far in April--doctors at the main
    combat support hospital in Iraq are reeling from a stream of young
    soldiers with wounds so devastating that they probably would have been
    fatal in any previous war.
        More and more in Iraq, combat surgeons say, the wounds involve
    severe damage to the head and eyes--injuries that leave soldiers brain
    damaged or blind, or both, and the doctors who see them first
    struggling against despair.
        For months the gravest wounds have been caused by roadside bombs--
    improvised explosives that negate the protection of Kevlar helmets by
    blowing shrapnel and dirt upward into the face. In addition, firefights
    with guerrillas have surged recently, causing a sharp rise in gunshot
    wounds to the only vital area not protected by body armor.
        The neurosurgeons at the 31st Combat Support Hospital measure the
    damage in the number of skulls they remove to get to the injured brain
    inside, a procedure known as a craniotomy. ``We've done more in eight
    weeks than the previous neurosurgery team did in eight months,''
    Poffenbarger said. ``So there's been a change in the intensity level of
    the war.''
        Numbers tell part of the story. So far in April, more than 900
    soldiers and Marines have been wounded in Iraq, more than twice the
    number wounded in October, the previous high. With the tally still
    climbing, this month's injuries account for about a quarter of the
    3,864 U.S. servicemen and women listed as wounded in action since the
    March 2003 invasion.
        About half the wounded troops have suffered injuries light enough
    that they were able to return to duty after treatment, according to the
    Pentagon.
        The others arrive on stretchers at the hospitals operated by the
    31st CSH. ``These injuries,'' said Lt. Col. Stephen M. Smith, executive
    officer of the Baghdad facility, ``are horrific.''
        By design, the Baghdad hospital sees the worst. Unlike its sister
    hospital on a sprawling air base located in Balad, north of the
    capital, the staff of 300 in Baghdad includes the only ophthalmology
    and neurology surgical teams in Iraq, so if a victim has damage to the
    head, the medevac sets out for the facility here, located in the
    heavily fortified coalition headquarters known as the Green Zone.
        Once there, doctors scramble. A patient might remain in the combat
    hospital for only six hours. The goal is lightning-swift, expert
    treatment, followed as quickly as possible by transfer to the military
    hospital in Landstuhl, Germany.
        While waiting for what one senior officer wearily calls ``the
    flippin' helicopters,'' the Baghdad medical staff studies photos of
    wounds they used to see once or twice in a military campaign but now
    treat every day. And they struggle with the implications of a system
    that can move a wounded soldier from a booby-trapped roadside to an
    operating room in less than an hour.
        ``We're saving more people than should be saved, probably,'' Lt.
    Col. Robert Carroll said. ``We're saving severely injured people. Legs.
    Eyes. Part of the brain.''
        Carroll, an eye surgeon from Waynesville, Mo., sat at his desk
    during a rare slow night last Wednesday and called up a digital photo
    on his laptop computer. The image was of a brain opened for surgery
    earlier that day, the skull neatly lifted away, most of the organ
    healthy and pink. But a thumb-sized section behind the ear was gray.
    ``See all that dark stuff? That's dead brain,'' he said. ``That ain't
    gonna regenerate. And that's not uncommon. That's really not uncommon.
    We do craniotomies on average, lately, of one a day.''
        ``We can save you,'' the surgeon said. ``You might not be what you
    were.''
        Accurate statistics are not yet available on recovery from this new
    round of battlefield brain injuries, an obstacle that frustrates combat
    surgeons. But judging by medical literature and surgeons' experience
    with their own patients, ``three or four months from now 50 to 60
    percent will be functional and doing things,'' said Maj. Richard
    Gullick. ``Functional,'' he said, means ``up and around, but with
    pretty significant disabilities,'' including paralysis.
        The remaining 40 percent to 50 percent of patients include those
    whom the surgeons send to Europe, and on to the United States, with no
    prospect of regaining consciousness. The practice, subject to review
    after gathering feedback from families, assumes that loved ones will
    find value in holding the soldier's hand before confronting the
    decision to remove life support.
        ``I'm actually glad I'm here and not at home, tending to all the
    social issues with all these broken soldiers,'' Carroll said.
        But the toll on the combat medical staff is itself acute, and
    unrelenting.
        In a comprehensive Army survey of troop morale across Iraq, taken
    in September, the unit with the lowest spirits was the one that ran the
    combat hospitals until the 31st arrived in late January. The three
    months since then have been substantially more intense. ``We've all
    reached our saturation for drama trauma,'' said Maj. Greg Kidwell, head
    nurse in the emergency room.
        On April 4, the hospital received 36 wounded in four hours. A U.S.
    patrol in Baghdad's Sadr City slum was ambushed at dusk, and the battle
    for the Shiite Muslim neighborhood lasted most of the night. The event
    qualified as a ``mass casualty,'' defined as more casualties than can
    be accommodated by the 10 trauma beds in the emergency room.
        ``I'd never really seen a `mass cal' before April 4,'' said Lt.
    Col. John Xenos, an orthopedic surgeon from Fairfax. ``And it just kept
    coming and coming. I think that week we had three or four mass cals.''
        The ambush heralded a wave of attacks by a Shiite militia across
    southern Iraq. The next morning, another front erupted when Marines
    cordoned off Fallujah, a restive, largely Sunni city west of Baghdad.
    The engagements there led to record casualties.
        ``Intellectually, you tell yourself you're prepared,'' said
    Gullick, from San Antonio. ``You do the reading. You study the slides.
    But being here . . .'' His voice trailed off. ``It's just the sheer
    volume.''
        In part, the surge in casualties reflects more frequent firefights
    after a year in which roadside bombings made up the bulk of attacks on
    U.S. forces. At the same time, insurgents began planting improvised
    explosive devices (IEDs) in what one officer called ``ridiculous
    numbers.''
        The improvised bombs are extraordinarily destructive. Typically
    fashioned from artillery shells, they may be packed with such debris as
    broken glass, nails, sometimes even gravel. They're detonated by remote
    control as a Humvee or truck passes by, and they explode upward. To
    protect against the blasts, the U.S. military has wrapped many of its
    vehicles in armor. When Xenos, the orthopedist, treats limbs shredded
    by an IED blast, it is usually ``an elbow stuck out of a window, or an
    arm.''
        Troops wear armor as well, providing protection that Gullick called
    ``orders of magnitude from what we've had before. But it just shifts
    the injury pattern from a lot of abdominal injuries to extremity and
    head and face wounds.''
        The Army gunner whom Poffenbarger was preparing for the flight to
    Germany had his skull pierced by four 155 mm shells, rigged to detonate
    one after another in what soldiers call a ``daisy chain.'' The shrapnel
    took a fortunate route through his brain, however, and ``when all is
    said and done, he should be independent. . . . He'll have speech,
    cognition, vision.''
        On a nearby stretcher, Staff Sgt. Rene Fernandez struggled to see
    from eyes bruised nearly shut. ``We were clearing the area and an IED
    went off,'' he said, describing an incident outside the western city of
    Ramadi where his unit was patrolling on foot.
        The Houston native counted himself lucky, escaping with a
    concussion and the temporary damage to his open, friendly face. Waiting
    for his own hop to the hospital plane headed north, he said what most
    soldiers tell surgeons: What he most wanted was to return to his unit.

        Senator Stevens. Tell us a little bit about this foundation
    of yours, will you please, Mr. Foil? I noticed you are located
    in Charlottesville.
        Mr. Foil. Yes. Are you talking about Virginia NeuroCare or
    the NBIRTT?
        Senator Stevens. NBIRTT.
        Mr. Foil. It is a program that Dr. Zitney and I and several
    other interested people set up a number of years ago really to
    work with people in brain injury around the country, focused
    primarily on two issues. One is a better quality of life and a
    search for a cure. So we look at both ends of the spectrum: one
    over here taking care of the person who has had traumatic brain
    injury and helping them to a quality of life that we all aspire
    to; and over here, in research looking for a way to cure the
    problem.
        Senator Stevens. Where are you located?
        Mr. Foil. I live in Concord, North Carolina, sir.
        Senator Stevens. Where is this foundation located?
        Mr. Foil. Well, to be honest with you, where we hang up our
    hat.
        Senator Stevens. Where you are.
        Mr. Foil. Yes, sir.
        Senator Stevens. What about this VANC which you tell us is
    in Charlottesville. What is your relationship to that?
        Mr. Foil. That is Virginia NeuroCare. That is a facility
    run primarily for people with brain injury in Charlottesville
    and that is run by Dr. Zitney. I have nothing to do with that.
        Senator Stevens. Do you do anything with military people?
        Mr. Foil. Oh, absolutely. These people we referred to here
    in the book, both of those were at Virginia NeuroCare. The one
    who was shot in the head has been returned to active duty. He
    is now in North Carolina. And the helicopter pilot is still
    there working with the JAG Corps to rehabilitate himself fully
    to go back to active duty.
        I do not know how many we have got there, but there is a
    number. He has got about 10 or 15 patients from the military.
    We have a lot more opportunities to take people than we have
    got the ability to handle them.
        Senator Stevens. Well, that is what Senator Inouye and I
    worry about. The demand is up.
        Mr. Foil. The demand is very high and the facilities are
    very low. I myself, Senator, am building a facility in North
    Carolina where we hope to take soldiers as soon as it is
    completed, and we hope to have it open by the summer of next
    year.
        Senator Stevens. Is there a national group behind you?
        Mr. Foil. We are trying to take it national, but we do not
    have the money to do it yet. It is all not-for-profit. We do
    not ask the Government for money. This is just on our own. I
    put $5 million of my own money in this.
        Senator Stevens. Well, thank you very much. We are very
    concerned about the area you are in.
        Mr. Foil. You have every right to be concerned.
        Senator Stevens. The two of us would like to meet with some
    of your people soon to see what we might do to help you expand
    the availability of this care throughout our country.
        Mr. Foil. We appreciate that. We would like to do that. We
    have been asked to put a place in Fayetteville. We have been
    asked to put a place in Norfolk, Virginia. I think there are
    opportunities all over this country to do that and we are
    successful, Senator.
        Senator Stevens. Well, there is no question about it. Forty
    to seventy percent casualties you indicate.
        Mr. Foil. Yes, sir, and I think it is closer to 70 percent
    than it is to 40 percent.
        Senator Stevens. But that is a national thing, and with due
    respect, people from Alaska cannot quite make it down your way.
        Mr. Foil. We would be happy to put one in Alaska, Senator.
        Senator Stevens. We want to see what we can do to get----
        Mr. Foil. We would love to have one in Hawaii as well.
        Senator Stevens. So why do you not come meet with Senator
    Inouye and me and let us see what we can do to help you.
        Mr. Foil. Yes, sir. I will be glad to set that up and we
    will be back in touch with you. Thank you for your attention.
        Senator Stevens. Thank you very much. I appreciate your
    presence.
        Senator Inouye.
        Senator Inouye. No questions.
        Senator Stevens. The next witness is James Bramson,
    Executive Director of the American Dental Association. Good
    morning, Doctor.
    STATEMENT OF JAMES B. BRAMSON, D.D.S., EXECUTIVE
                DIRECTOR, AMERICAN DENTAL ASSOCIATION
        Dr. Bramson. Good morning, Mr. Chairman and Senator Inouye.
    I am Dr. Jim Bramson, the Executive Director of the American
    Dental Association (ADA). Thank you for the opportunity to
    testify today about dental programs that directly relate to the
    dental readiness of our servicemen and women.
        During World War II, more than 20 percent of the 2 million
    selectees did not meet dental requirements. In fact, this was
    the number one reason for rejection. Dental disease today
    continues to have an impact on military personnel. A 2002 DOD
    report stated that 34 percent of military personnel on active
    duty required dental care prior to deployment. Army Chief of
    Staff General Peter Schoomaker testifying last year stated that
    there were ``real problems in dental readiness,'' and he
    discussed the rotation of troops and the activation of Army
    Guard and Reserve personnel. Having enough dentists to treat
    active duty personnel is vital to keeping soldiers healthy and
    ready.
        An abscessed tooth clearly is one of mankind's most painful
    experiences, but for military personnel in a combat zone or on
    a fighter plane or in a submarine, an oral infection can only
    compromise their ability to complete their missions.
        Since the late 1990's, the dental corps has had trouble
    recruiting and retaining dental officers. One reason is the
    large pay differential between uniform and civilian dentists. A
    second reason is graduation student loan debt, which now
    averages nearly $110,000 per student. From exit interviews with
    dentists, we know they would say they would stay in the
    military if offered loan repayment. One Air Force captain said,
    if you evaluate my salary, subtract my sizeable student loan
    payments, I end up taking home the equivalent of what a staff
    sergeant of 8 years makes. And the result is that the military
    is operating at about 12 percent below dental manpower levels.
        To address this situation, the ADA recommends an additional
    $6 million per year for 3 years to allow 66 targeted health
    professions scholarship program (HPSP) dental scholarships per
    year per service. This funding would be to attract new recruits
    and it could also be used for loan repayment.
        Military dental research has had a well-established history
    with both the Army and the Navy. Their mission is to reduce the
    incidence and impact of dental disease on deployed troops. This
    research is unique and because of the global war on terrorism,
    it is on the cutting edge.
        The Army focuses on improving materials to protect the
    troops not only from oral disease but also from injury or
    hostile fire. Almost one-half of the injuries reported in Iraq
    and Afghanistan are head, neck, and eye trauma. Army dental
    researchers are developing a lighter, thinner bullet-proof face
    shield to replace the current head gear that is hot and heavy.
        In Bosnia, the Army found that over 15 percent of the
    deployed troops had dental emergencies and that 75 percent of
    those emergencies were plaque-related oral disease such as gum
    infections. The Army researchers are working on an easy and
    cost effective way to help with an anti-plaque chewing gum
    which could be included in every meal, ready-to-eat (MRE) or
    mess kit.
        Navy dental research is focused on the immediate delivery
    of dental care in the field. Those researchers have continued
    to make progress on the development of a rapid, noninvasive
    salivary diagnostic instrument for the detection of diseases
    and biological agents.
        I have here with me today a hand-held prototype of this
    device. So for those of you in the room who suffered through
    the painful anthrax swab tests 3 years ago, you waited up to 2
    weeks to get your results. This device which analyzes the
    antibodies in saliva will make those experiences obsolete. You
    put saliva in this little receptacle here, add the reagent, and
    wait about 90 seconds for the results.
        Now, these are just a few of the examples of the dental
    research projects being conducted at the Great Lakes facility.
    All of these have a direct relationship to combat medicine. All
    are targeted to improve the oral health of deployed personnel,
    and they can lead to enormous cost savings.
        The ADA strongly recommends that these research activities
    be funded at $6 million.
        Thank you again for the opportunity to testify today. Our
    written statement has additional details, and I would be glad
    to answer any questions.
        Senator Stevens. Well, thank you very much. We have noted
    those comments. Most of your requests really affect the
    Military Construction Subcommittee, not this subcommittee. We
    will call those to their attention. I do not know if you plan
    to appear before them or not.
        But we clearly share your feeling that these efforts to
    reconstruct the damage done to faces, to jaws, et cetera--there
    must be really improvement in the facilities. So we will have
    to talk to your association after talking to the Military
    Construction Subcommittee.
        Dr. Bramson. We will be happy to talk to you, Senator.
        Senator Stevens. We will do that. We promise we will get
    back to you.
        Senator Inouye.
        Senator Inouye. I will join the chairman on that.
        Senator Stevens. Thank you very much. Appreciate it.
        [The statement follows:]
                 Prepared Statement of James B. Bramson, D.D.S.
        Good morning, Mr. Chairman and members of the subcommittee. I am
    Dr. James Bramson, Executive Director of the American Dental
    Association (ADA), which represents over 149,000 dentists nationwide.
    As of September 30, 2003, there were 3,126 dentists in the military
    services. Thank you for the opportunity to testify to discuss
    appropriations for Department of Defense dental and oral-health related
    programs. My primary purpose today is to bring to your attention
    programs that directly relate to the dental readiness of our men and
    women in uniform and the efforts being made to achieve and maintain
    their dental health.
        The Public Health Service's first study of the military draft in
    World War II determined that more than 20 percent of the two million
    selectees did not meet Selective Service dental requirements. At the
    time of Pearl Harbor, ``dental defects'' led all physical reasons for
    rejection of recruits. Dental disease today continues to have an impact
    on military deployment in the Global War On Terrorism. General Peter J.
    Schoomaker, Army Chief of Staff, testified before the Senate Armed
    Services Committee on November 19, 2003 and stated ``. . . quite
    frankly we [have] real problems in dental readiness . . .--'' as he
    discussed the rotation of troops and the activation of Army Guard and
    Reserve personnel. The DOD's 2002 Survey of Health Related Behaviors
    Among Military Personnel reported that 34 percent of military personnel
    on active duty required dental care prior to deployment. What isn't
    said in the report is whether the dental care was completed prior to
    deployment and whether the treatment was of a temporary nature.
        An abscessed tooth may be one on mankind's most painful
    experiences. While most Americans have been fortunate enough to have
    never experienced a toothache, those who have know that there is little
    else that one can think about when it happens. Imagine that toothache
    in a combat zone, or while flying a fighter, or in a submarine. The ADA
    is concerned that too many soldiers, sailors, airmen and marines are
    being deployed at risk for these problems--not only because of the
    unnecessary pain they may have to endure but also the impact of that
    pain on their ability to complete their mission.
                          funding for dental readiness
        Since the late 1990s, the dental corps have had difficulty in
    recruiting and retaining dental officers. One reason is the pay
    differential between uniform and civilian dentists. The Center for
    Naval Analysis Health Professions Retention-Accession Study I stated
    that: ``. . . the uniformed-civilian pay gap in 2000 dollars was
    substantial, averaging $69,000 per year for general dentists and
    $113,000 per year for specialists . . .'' A second reason is student
    loan debt. Many junior officers carry more than $100,000 (the national
    average is $116,000) in loans. Without loan repayment, dentists have a
    hard time making monthly payments on an 03's pay. The result is that
    all the dental corps are operating below their authorized manpower
    levels. The Department of Defense reported that all three services are
    below strength by almost 12 percent (September 2003). This figure masks
    the fact that over the past few years unfilled dental officer
    authorizations are often transferred to other medical officer corps.
        This comes at a time when dental care needed by the troops has not
    substantially decreased. In fact, with the activation of Guard and
    Reserve personnel, the demand has increased. As a result of these
    demands there has been a substantial increase in payments, in the
    millions of dollars, to private practice dentists paid through the
    Military Medical Support Office at Great Lakes Naval Training Center
    (primarily for active duty personnel) and the Federal Strategic Health
    Alliance Program known as Feds-HEAL (for activated Guard and
    Reservists). In fiscal year 2000, the military purchased $13 million of
    dental care for active duty personnel. That account is projected to
    reach $49 million in fiscal year 2004. While some of this additional
    expense is a result of the activation of Guard and Reserve personnel, a
    significant portion of these expenses is a direct result of the
    reduction of dental officers required to maintain the dental readiness
    of the active duty members. The ADA is aware that the issue of
    recruiting and retention special pays and bonuses has been studied
    within the Department of Defense, but currently nothing is being
    developed in response to these previous reports.
        The ADA believes it is time to address dental officer
    authorizations before the damage to the military dental corps reaches a
    crisis level. We, therefore, recommend additional targeted funding for
    Health Professions Scholarship Program (HPSP) dental scholarships to
    attract new dentist recruits. This additional funding could also be
    used for loan repayment to retain current military dentist as allowed
    by law.
                            military dental research
        The Army first began formal dental research with the establishment
    of the Army Dental School in 1922, which was a precursor to the
    establishment of the U.S. Army Institute of Dental Research in 1962.
    The Navy Dental Research Facility at Great Lakes was established in
    1947, which subsequently became the Naval Dental Research Institute in
    1967 (now known as the Naval Institute for Dental and Biomedical
    Research). In 1997, both activities were co-located at Great Lakes as a
    result of the Base Realignment and Closure activities of 1991. These
    research programs share common federal funding and a common goal to
    reduce the incidence and impact of dental diseases on deployed troops.
    This is unique research that is not duplicated by the National
    Institutes of Health or in the civilian community.
        The Army focuses on improving materials to protect the troops, not
    only from the effects of oral disease but also from injury or hostile
    fire. Almost half of the injuries reported in Iraq and Afghanistan are
    head, neck and eye trauma. Army researchers are developing a lighter,
    thinner anti-ballistic face shield to replace the current headgear that
    weighs almost 8 pounds and is hot to wear. This is analogous to the
    development of the lighter and more effective body armor currently
    being used by our ground troops in Afghanistan and Iraq.
        Plaque-related oral disease, including trench mouth, account for as
    much as 75 percent of the daily dental sick call rate in deployed
    troops. Even soldiers who ship out in good oral health can become
    vulnerable to these severe gum diseases if stationed in combat areas
    where access to good oral hygiene is difficult. An easy and cost
    effective way to address these conditions is the development of an
    anti-plaque chewing gum, which could be included in every meals ready
    to eat (MRE) or mess kit.
        For troops stationed in desert combat zones, dehydration is a
    serious problem. Often the soldier is not aware that there is a problem
    until he or she is debilitated, obviously not a good thing in a hostile
    environment. The Army researchers have been working on developing a
    sensor to monitor hydration rates that could be bonded to a soldier's
    tooth. Health care personnel at a remote site could monitor the sensor
    and alert the deployed forces to administer fluids before the situation
    becomes critical.
        Navy research focuses more on the immediate delivery of dental
    care. For instance, keeping the war fighter in the field is a high
    priority. Navy researchers are developing dental materials that are
    more compact and portable, that can be used by non-dental personnel to
    manage a wide variety of urgent dental problems. Last year in Iraq, a
    Marine line commander in the field had to have a temporary filling
    replaced 3 or 4 times. This required a trip to a field dental clinic
    and the services of a dentist, taking this commander away from his
    troops. A new dental material being developed by the Navy will allow a
    corpsman to replace these temporary fillings on the spot and without
    the need for the commander to spend time away from his troops and the
    mission. A lesson learned from this situation is that the currently
    available dental materials are not strong enough for the field
    environment, especially the desert climate. More research is needed to
    perfect this far-forward field dental dressing, but once perfected, it
    can be used by other agencies like NASA or the Indian Health Service,
    which also operate in remote areas.
        Naval researchers have continued to make progress on the
    development of rapid, hand-held, non-invasive salivary tests for the
    detection of military relevant diseases, such as tuberculosis and
    dengue fever, as well as for biological warfare agents. A prototype
    model of such a hand-held unit developed by the Navy researchers at
    Great Lakes is being tested. This unit will be able to test for
    numerous chemical and biological agents and provide troops in the field
    a positive or negative determination within a matter of minutes. The
    implications for Homeland Security are quite obvious.
        Last, but not least, the Iraqi war environment has identified an
    additional research area: the effects of sand on dental equipment. The
    unique composition of the sand in Iraq has caused dental equipment to
    break down and fail in the field. Because the sand in Iraq is stickier
    and more like talcum powder than grittier American sand, the Iraqi sand
    tends to cling to instruments and equipment. Navy researchers are
    analyzing the effects of the Iraqi sand on the portable dental
    equipment with the goal of developing new mobile delivery systems that
    can be used in the desert environment. This research has obvious
    implications for medical equipment or any equipment that is easily
    fouled by the desert sands.
        These are just a few of the dental research projects being
    conducted at the Great Lakes facility. All have a direct relationship
    to combat medicine, are targeted to improve the oral health of deployed
    personnel and can lead to enormous cost savings for forces in the
    field. Furthermore, while the Army and the Navy do not duplicate the
    research done by the National Institute of Dental and Craniofacial
    Research, many of their findings will have implications within the
    civilian community or other Federal Agencies. The ADA strongly
    recommends that the funding for the Army and Navy dental research
    activities at Great Lakes be funded at $6 million to expedite this
    research for the deployed forces.
                  other military dental appropriations issues
        There are two other matters that the ADA would like to bring to the
    Committee's attention and are related to issues discussed during the
    Committee's April 28th hearing with the Surgeon Generals. First, we are
    concerned about the dental care for our returning troops through the
    Veteran's Administration. Following Desert Storm deactivated Reserve
    and Guard personnel were authorized a dental benefit upon separation.
    Fortunately, both the length of the Gulf War and the need for
    activating Reserves and Guard were limited. Approximately $17 million
    was spent to provide this dental care. Once again, the Veteran's
    Administration is anticipating that a significant number of returning
    Reservists and Guard personnel will require and be authorized dental
    care upon their release from active duty in the Global War on
    Terrorism. And since the Reserve and Guard activations are projected to
    remain significant for the foreseeable future, then the demand for
    dental care following deactivation will also continue. While the exact
    amount of money required for this care is not yet known, the ADA
    believes that it will easily exceed the $17 million required following
    Desert Storm and for a sustained basis.
        The second issue relates to a military construction project for the
    dental clinic at Lackland Air Force Base. Some of the soldiers who have
    suffered head and neck injuries in Iraq are being treated at Lackland
    for facial reconstruction. Oral surgeons there are using the highly
    sophisticated computer programs to make 3-D images to recreate
    shattered jaws.
        The proposed construction will consolidate all dental activities on
    Lackland AFB and Kelly AFB to the Dunn Dental Clinic. There are
    currently two separate dental treatment activities at Lackland: MacKown
    Dental Clinic and Dunn Dental Clinic. The MacKown Clinic is 44 years
    old and has long outlived its usefulness. It predates the current Joint
    Commission on Accreditation of Healthcare Organizations (JACHO),
    Occupational Safety and Health Administration (OSHA) and infection
    control standards. The MacKown Clinic also houses three of the Air
    Force's dental specialty training programs that have outgrown that
    facility significantly over the last twenty years. The clinic at Kelly
    Air Force Base will be closed as a result of highway construction. The
    patients currently seen at Kelly will now be seen at the Dunn Clinic
    and there is insufficient capacity to absorb these patients.
        The planned addition to the existing Dunn Dental Clinic building
    will provide an additional 90 dental treatment rooms on two floors that
    meet current ambulatory surgery codes. The proposed facility will also
    provide space for a dental laboratory to meet regional dental workload
    demands, support the dental resident training, and dental research
    currently part of the MacKown facility. The new addition will also
    provide necessary classroom space and suitable audio-visual,
    teleconference, and distance learning capabilities. The ADA requests
    that the Committee appropriate $1.5 million for the design phase of
    this construction project.
        The ADA thanks the Committee for allowing us to present these
    issues related to the dental and oral health of our great American
    service men and women.

        Senator Stevens. Our next witness is Captain Robert Hurd,
    Congressional Liaison for the United States Naval Sea Cadet
    Corps. Good morning.
    STATEMENTS OF:
            CAPTAIN ROBERT C. HURD, UNITED STATES NAVY (RET.),
                CONGRESSIONAL LIAISON, UNITED STATES NAVAL SEA CADET CORPS
            PETTY OFFICER 1ST CLASS KYLE DALY, UNITED STATES NAVAL SEA
                CADET CORPS

        Mr. Hurd. Good morning, Mr. Chairman, Senator Inouye. I
    would like to thank the committee for the tremendous support of
    our program and our 10,000 cadets, one of whom, Petty Officer
    1st Class Daly will make our statement this morning.
        Senator Stevens. Fine. Nice to have you here, sir.
        Mr. Daly. Mr. Chairman, Senator Inouye, good morning. I am
    United States Naval Sea Cadet Corps Petty Officer 1st Class
    Kyle Daly, leading petty officer of the Hospital Corpsman,
    Master Chief, U.S. Navy (HMCM) William Marsh Battalion as well
    as a sophomore at a Catholic high school in Hyattsville,
    Maryland. It is an honor and a privilege to speak to you today
    on behalf of the Naval Sea Cadet Corps.
        There are now over 10,000 young men and women, ages 11 to
    17, across the United States and its territories proudly
    wearing the same uniform I wear before you today. They are
    supported by over 2,500 adult volunteer Naval Sea Cadet Corps
    officers, instructors, and midshipmen.
        The United States Naval Sea Cadet Corps is a
    congressionally chartered youth development and education
    program supported by the Navy League and sponsored by the Navy
    and Coast Guard. The program's main goals are the development
    of young men and women, promoting interest and skill in the
    areas of seamanship and aviation, while instilling a strong
    sense of patriotism, integrity, self-reliance, honor, courage,
    and commitment, along with other qualities which I believe will
    mold strong moral character and self-discipline in a drug-and
    gang-free environment.
        After completing recruit training, sea cadets may choose
    from an almost infinitely wide variety of 2-week training
    courses in their following summers, including training aboard
    Navy and Coast Guard vessels. We drill one weekend per month
    and complete Navy correspondence courses for advancement, this
    being the basis for accelerated promotion if a cadet should
    choose to enlist in the Navy or Coast Guard.
        Four hundred eighty-two former sea cadets now attend the
    U.S. Naval Academy. Between 400 and 600 enlist in the armed
    services annually, pre-screened, highly motivated and well-
    prepared. Prior sea cadet experience has been proven to be an
    excellent indicator of a potentially career success rate both
    in and out of the military. Whether or not a cadet chooses a
    service career, we all carry forth the values of citizenship,
    leadership, and moral courage that I believe will benefit
    ourselves and our country.
        The major difference between this and other federally
    chartered military youth programs is that the sea cadets are
    responsible for their own expenses, including uniforms, travel,
    insurance, and training costs, which can amount to $400 to $500
    a year. The corps, however, is particularly sensitive to its
    policy that no young man or woman is denied access to this
    program due to their socioeconomic status. Some units are
    financed in part by local sponsors.
        This support, while greatly appreciated, is not enough to
    sustain all cadets. All federally appointed funds over the past
    4 years have been used to help offset cadets' out-of-pocket
    training costs, as well as to conduct background checks for the
    adult volunteers. However, for a variety of reasons, including
    inflation, an all-time high cadet enrollment, base closures and
    reduced base access due to terrorist alerts, reduced the float
    training due to the situation in Iraq. The current amount of
    funding support can no longer sustain the program.
        The Sea Cadet Corps considers it a matter of urgency that
    we respectfully request your consideration and support through
    the authorization of appropriations in the full amount of $2
    million for the 2005 fiscal year.
        I regret that this time precludes our sharing the many
    stories that Captain Hurd has shared with members of your
    staffs this year, pointing out the many acts of courage,
    community service, and successful youth development of my
    fellow sea cadets, as well as those who are so gallantly
    serving our armed forces in Iraq, Afghanistan, and around the
    world. These stories and many more like them are unfortunately
    the youth stories that you do not always read about in the
    press.
        I thank you for this opportunity to speak today. I, as does
    the entire Sea Cadet Corps, appreciate your past and continued
    support of this fine program. It would be my pleasure to answer
    any questions you might have at this point.
        Senator Stevens. Well, thank you very much. Captain Hurd,
    you brought a fine representative of your organization.
        Mr. Hurd. Yes, sir.
        Senator Stevens. You remind me of the first time I
    testified before Congress. I read the third sentence and said,
    ``period.''
        I had memorized it so well. You know, one of those things.
        But we do appreciate what you said. We appreciate who you
    represent and congratulate you for your ambition to be part of
    the Navy.
        Mr. Daly. Thank you very much, sir.
        Senator Stevens. Captain, thank you. We do not need
    anything more than what you produced. We will assist you in
    every way we can.
        Mr. Daly. Thank you very much, sir.
        Senator Stevens. Senator Inouye.
        Senator Inouye. No. Just congratulations.
        [The statement follows:]
                  Prepared Statement of Captain Robert C. Hurd
    Request
        Funded since fiscal year 2001, continued Congressional
    appropriation in the Navy Recruiting Budget (O&M Navy--Title II, Budget
    Activity 3) of the un-funded budget requirement is essential for
    continuation of the present level of Naval Sea Cadet training as well
    as to allow expansion into more communities. Unlike other federally
    chartered military youth groups, the Sea Cadets pay for almost all
    their own program costs, including uniforms, training costs, insurance
    and transportation to/from training. Funding to offset Cadet out-of-
    pocket training costs at a level commensurate with that received by
    other federally chartered military related youth programs, is needed to
    increase access by America's youth regardless of economic or social
    background and to develop the fine citizens our country needs and
    deserves.
    Background
        At the request of the Department of the Navy, the Navy League of
    the United States established the Naval Sea Cadet Corps in 1958 to
    ``create a favorable image of the Navy on the part of American youth.''
    On September 10, 1962, the U.S. Congress federally chartered the Naval
    Sea Cadet Corps under Public Law 87-655 as a non-profit civilian youth
    training organization for young people, ages 13 through 17. A National
    Board of Directors, whose Chairman serves as the National Vice
    President of the Navy League for Youth Programs, establishes NSCC
    policy and management guidance for operation and administration. A
    Vice-Chairman of the Board serves also as the Corps' National
    President. A full-time Executive Director and small staff in Arlington,
    VA administer NSCC's day-to-day operations. These professionals work
    with volunteer field representatives, unit commanding officers, and
    local sponsors. They also collaborate with Navy League councils and
    other civic, or patriotic organizations, and with local school systems.
    NSCC Objectives
        Develop an interest and skill in seamanship and seagoing subjects.
        Develop an appreciation for our Navy's history, customs,
    traditions, and its significant role in national defense.
        Develop positive qualities of patriotism, courage, self-reliance,
    confidence, pride in our nation and other attributes, which contribute
    to development of strong moral character, good citizenship traits and a
    drug-free, gang-free lifestyle.
        Present the advantages and prestige of a military career.
        Under the Cadet Corps' umbrella is the Navy League Cadet Corps
    (NLCC); a youth program for children ages 11 through 13. While it is
    not part of the federal charter provided by Congress, the Navy League
    of the United States sponsors NLCC.
        NLCC was established ``. . . to give young people mental, moral,
    and physical training through the medium of naval and other
    instruction, with the objective of developing principles of patriotism
    and good citizenship, instilling in them a sense of duty, discipline,
    self-respect, self-confidence, and a respect for others.''
    Benefits
        Naval Sea Cadets experience a unique opportunity for personal
    growth, development of self-esteem and self-confidence. Their
    participation in a variety of activities within a safe, alcohol-free,
    drug-free, and gang-free environment provides a positive alternative to
    other less favorable temptations. The Cadet Corps introduces young
    people to nautical skills, to maritime services and to a military life
    style. The program provides the young Cadet the opportunity to
    experience self-reliance early on, while introducing this Cadet to
    military life without any obligation to join a branch of the armed
    forces. The young Cadet realizes the commitment required and routinely
    excels within the Navy and Coast Guard environments.
        Naval Sea Cadets receive first-hand knowledge of what life in the
    Navy or Coast Guard is like. This realization ensures the likelihood of
    success in military service. For example, limited travel abroad and in
    Canada may be available, as well as the opportunity to board Navy and
    Coast Guard ships, craft and aircraft. These young people may also
    participate in shore activities ranging from training as a student at a
    Navy hospital to learning the fundamentals of aviation maintenance at a
    Naval Air Station.
        The opportunity to compete for college scholarships is particularly
    significant. Since 1975, 166 Cadets have received financial assistance
    in continuing their education in a chosen career field at college.
    Activities
        Naval Sea Cadets pursue a variety of activities including
    practical, hands-on and classroom training, as well as field trips,
    orientation visits to military installations, and cruises on Navy and
    Coast Guard ships and small craft. They also participate in a variety
    of community and civic events.
        The majority of Sea Cadet training and activities occurs year round
    at a local training or ``drill'' site. Often, this may be a military
    installation or base, a reserve center, a local school, civic hall, or
    sponsor-provided building. During the summer, activities move from the
    local training site and involve recruit training (boot camp),
    ``advanced'' training of choice, and a variety of other training
    opportunities (depending on the Cadet's previous experience and
    desires).
    Senior Leadership
        Volunteer Naval Sea Cadet Corps Officers and Instructors furnish
    senior leadership for the program. They willingly contribute their time
    and efforts to serve America's youth. The Sea Cadet Corps programs
    succeed because of their dedicated, active participation and commitment
    to the principles upon which the Corps was founded. Cadet Corps
    officers are appointed from the civilian sector or from active, reserve
    or retired military status. All are required to take orientation,
    intermediate and advanced Officer Professional Development courses to
    increase their management and youth leadership skills. Appointment as
    an officer in the Sea Cadet Corps does not, in itself, confer any
    official military rank. However, a Navy style uniform, bearing USNSCC
    insignia, is authorized and worn. Cadet Corps officers receive no pay
    or allowances. Yet, they do deserve some benefits such as limited use
    of military facilities and space available air travel in conjunction
    with carrying out their training duty orders.
    Drug-Free and Gang-Free Environment
        One of the most important benefits of the Sea Cadet Program is that
    it provides participating youth a peer structure and environment that
    places maximum emphasis on a drug and gang free environment. Supporting
    this effort is a close liaison with the U.S. Department of Justice Drug
    Enforcement Administration (DEA). The DEA offers the services of all
    DEA Demand Reduction Coordinators to provide individual unit training,
    as well as their being an integral part of our boot camp training
    programs.
    Training
                Local Training
        Local training, held at the unit's drill site, includes a variety
    of activities supervised by qualified Sea Cadet Corps Officers and
    instructors, as well as Navy, Coast Guard, Marine and other service
    member instructors.
        Cadets receive classroom and hands on practical instruction in
    basic military requirements, military drill, water and small boat
    safety, core personal values, social amenities, drug/alcohol abuse,
    cultural relations, naval history, naval customs and traditions, and
    nautical skills. Training may be held onboard ships, small boats or
    aircraft, depending upon platform availability, as well as onboard
    military bases and stations. In their training, cadets also learn about
    and are exposed to a wide variety of civilian and military career
    opportunities through field trips and educational tours.
        Special presentations by military and civilian officials augment
    the local training, as does attendance at special briefings and events
    throughout the local area. Cadets are also encouraged, and scheduled,
    to participate in civic activities and events to include parades,
    social work, and community projects, all part of the ``whole person''
    training concept.
        For all Naval Sea Cadets the training during the first several
    months is at their local training site, and focuses on general
    orientation to, and familiarization with, the entire Naval Sea Cadet
    program. It also prepares them for their first major away from home
    training event, the two weeks recruit training which all Sea Cadets
    must successfully complete.
        The Navy League Cadet Corps training program teaches younger cadets
    the virtues of personal neatness, loyalty, obedience, courtesy,
    dependability and a sense of responsibility for shipmates. In
    accordance with a Navy orientated syllabus, this education prepares
    them for the higher level of training they will receive as Naval Sea
    Cadets.
                Summer Training
        After enrolling, all sea cadets must first attend a two week
    recruit training taught at the Navy's Recruit Training Command, at
    other Naval Bases or stations, and at regional recruit training sites
    using other military host resources. Instructed by Navy or NSCC Recruit
    Division Commanders, cadets train to a condensed version of the basic
    course that Navy enlistees receive. The curriculum is provided by the
    Navy, and taught at all training sites. In 2003 there were 22 Recruit
    training classes at 19 locations, including 3 classes conducted over
    the winter holiday school break. These 20 plus nationwide regional
    sites are required to accommodate the increased demand for quotas and
    also to keep cadet and adult travel costs to a minimum. Over 2,600
    Naval Sea Cadets attended recruit training in 2003, supported by
    another 240 adult volunteers.
        Once Sea Cadets have successfully completed recruit training, they
    may choose from a wide variety of advanced training opportunities
    including basic/advanced airman, ceremonial guard, seamanship, sailing,
    amphibious operations, leadership, firefighting and emergency services,
    submarine orientation, seal and mine warfare operations, Navy diving,
    and training in occupational specialties including health care, legal,
    music, master-at-arms and police science, and construction.
        The Naval Sea Cadet Corps is proud of the quality and diversity of
    training opportunities offered to its' Cadet Corps. For 2003
    approximately 8,000 ``training opportunities'' were formally advertised
    for both cadets and adults. Another 900 ``opportunities'' presented
    themselves through the dedication, resourcefulness and initiative of
    the adult volunteer officers who independently arranged training for
    cadets onboard local bases and stations. This locally arranged training
    represents some of the best that the NSCC has to offer and includes the
    consistently outstanding training offered by the U.S. Coast Guard. The
    total cadet and adult opportunity for 2003 stood at about 9,000 quotas,
    including all recruit training. Approximately 8,000 NSCC members, with
    about 7,000 being cadets, stepped forward and requested orders to take
    advantage of these training opportunities. Cadets faced a myriad of
    challenging and rewarding training experiences designed to instill
    leadership and develop self-reliance. It also enabled them to become
    familiar with the full spectrum of Navy and Coast Guard career fields.
        This ever-increasing participation once again reflects the
    popularity of the NSCC and the positive results of federal funding for
    2001 through 2003. The NSCC continues to experience increased recruit
    and advanced training attendance of well over 2,000 cadets per year
    over those years in which federal funding was not available. The events
    of 9/11 and the resulting global war against terrorism did preclude
    berthing availability at many bases and stations; however, the NSCC
    continued to grow as other military hosts offered their resources in
    support of the NSCC. While recruit training acquaints cadets with Navy
    life and Navy style discipline, advanced training focuses on military
    and general career fields and opportunities, and also affords the
    cadets many entertaining, drug free, disciplined yet fun activities
    over the entire year. One result of this training is that approximately
    10 percent of the Midshipman Brigade at the U.S Naval Academy report
    having been prior Naval Sea Cadets, most citing summer training as a
    key factor in their decision to attend the USNA.
                Training highlights for 2003
        The 2003 training focus was on providing every cadet the
    opportunity to perform either recruit or advanced training during the
    year. To that end, emphasis was placed on maintaining all new training
    opportunities developed over the last several years since federal
    funding was approved for the NSCC. This proved to be a significant
    challenge with reduced available berthing at DOD bases as a result of
    recalled reservists and deployment of forces in the war on terrorism.
    Regardless, we were successful in most of our plans. Included among
    these were classes in sailing and legal (JAG) training, expanded SEAL
    orientation opportunity, SCUBA classes, more seamanship training
    onboard the NSCC training vessels on the Great Lakes, and additional
    honor guard training opportunities. Other highlights included:
      --Expanded recruit training opportunity by increasing recruit
            training evolutions from 15 in 2002 to 22 in 2003.
      --Kept cadet training cost to $30 for 1 week and $60 for 2 weeks plus
            transportation; only a $5 and $10 increase over 2002, all
            during a period of escalating costs and increasing enrollment
            while the grant was maintained at $1 million.
      --Expanded use of Army and State National Guard facilities to
            accommodate demand for quotas for recruit training.
      --Maintained expanded recruit training and advanced training
            opportunity higher than any prior year.
      --Improved adult professional development and education through much
            needed updates of the NSCC Officer Professional Development
            courses.
      --Added first class ever with Navy Explosive Ordnance Disposal/Mobile
            Diving Salvage Units in Norfolk, Virginia.
      --Nearly doubled the number of MAA classes and doubled the number of
            cadets taking this training.
      --Maintained expanded YP training on the Great Lakes.
      --Maintained placement of cadets onboard USCG Barque Eagle for two,
            three week underway orientation cruises.
      --Maintained placement of cadets aboard USCG stations, cutters, and
            tenders for what many consider among the best of the training
            opportunities offered in the NSCC.
      --Continued the popular, merit based, International Exchange program
            although reduced for Asian countries due to the SARS concern.
      --Graduated over 290 cadets from the NSCC Petty Officer Leadership
            Academies, (POLA).
      --Maintained placement of Cadets onboard USN ships under local orders
            as operating schedules and opportunity permitted.
      --As has been the case in all prior years, once again enjoyed
            particularly outstanding support from members of the United
            States Naval Reserve, whose help and leadership remains
            essential for summer training.
                International Exchange Program (IEP)
        The NSCC continued in 2003, for the second year, its' redesigned
    and highly competitive, merit based, and very low cost to the cadet,
    International Exchange Program. Cadets were placed in Australia, United
    Kingdom, Sweden, Netherlands, and Bermuda to train with fellow cadets
    in these host nations. The NSCC and Canada did maintain their
    traditional exchanges in Nova Scotia and British Columbia, and the NSCC
    hosted visiting cadets in Norfolk and at Fort Lewis, WA for two weeks
    of U.S. Navy style training.
                Navy League Cadet Training
        In 2003, almost 1,350 Navy League Cadets and escorts attended Navy
    League Orientation Training at 17 sites nationwide. The diversity in
    location and ample quotas allowed for attendance by each and every
    League Cadet who wished to attend. Approximately 250 League cadets and
    their escorts attended advanced Navy League training where cadets learn
    about small boats and small boat safety using the U.S. Coast Guard's
    safe boating curriculum. Other advanced Navy League training sites
    emphasize leadership training. Both serve the program well in preparing
    League cadets for further training in the Naval Sea Cadet Corps, and
    particularly for their first ``boot camp.'' The continuing strong
    numbers of participants for both Orientation and Advanced training,
    support not just the popularity of the NSCC program but also the
    positive impact the federal training grant has had in helping cadets
    afford the training and helping them take advantage of the increased
    opportunities available to them.
                Training Grants
        Through local sponsor support and the federal grant, almost every
    Cadet who desired to attend summer training had the opportunity. This
    milestone is a direct result of the strong NLUS council and sponsor
    support for NSCC/NLCC cadets to participate in the Corps' summer
    training.
    Scholarships
        The Naval Sea Cadet Corps Scholarship program was established to
    provide financial assistance to deserving Cadets who wished to further
    their education at the college level. Established in 1975, the
    scholarship program consists of a family of funds: the NSCC Scholarship
    Fund; the Navy League Stockholm Scholarship; the San Diego Gas &
    Electric Fund; grants from the Lewis A. Kingsley Foundation; and the
    NSCC ``named scholarship'' program, designed to recognize an
    individual, corporation, organization or foundation.
        Since the inception of the scholarship program, 176 scholarships
    have been awarded to 166 Cadets (includes some renewals) totaling over
    $192,900.
    Service Accessions
        The Naval Sea Cadet Corps was formed at the request of the
    Department of the Navy as a means to ``enhance the Navy image in the
    minds of American youth.'' To accomplish this, ongoing training
    illustrates to Naval Sea Cadets the advantages and benefits of careers
    in the armed services, and in particular, the sea services.
        While there is no service obligation associated with the Naval Sea
    Cadet Corps program, many Sea Cadets choose to enlist or enroll in
    Officer training programs in all the Services.
        Annually, the NSCC conducts a survey to determine the approximate
    number of Cadets making this career decision. This survey is conducted
    during the annual inspections of the units. The reported Cadet
    accessions to the services are only those that are known to the unit at
    that time. There are many accessions that occur in the 2-3 year
    timeframe after Cadets leave their units, which go unreported. For
    example, for the year 2000, with about 80 percent of the units
    reporting, the survey indicates that 564 known Cadets entered the armed
    forces during the reporting year ending December 31, 2002. Of these, 30
    ex- Sea Cadets were reported to have received appointments to the U.S.
    Naval Academy. Further liaison with the USNA indicates that in fact,
    there are currently 482 Midshipmen with Sea Cadet backgrounds--almost
    10 percent of the entire Brigade. Navy accession recruiting costs have
    averaged over $11,000 per person, officer or enlisted, which applied to
    the number of Sea Cadet accessions represents a significant financial
    benefit to the Navy. Equally important is the expectation that once a
    more accurate measurement methodology can be found, is, that since Sea
    Cadets enter the Armed Forces as disciplined, well trained and
    motivated individuals, their retention, graduation and first term
    enlistment completion rates are perhaps the highest among any other
    entry group. USNA officials are currently studying graduation rates for
    past years for ex-Sea Cadets as a group as compared to the entire
    Brigade. Their preliminary opinion is that these percents will be among
    the highest. It is further expected that this factor will be an
    excellent indicator of the following, not only for the USNA, but for
    all officer and enlisted programs the Sea Cadets may enter:
      --Extremely high motivation of ex-Cadets to enter the Service.
      --Excellent background provided by the U.S. Naval Sea Cadet
            experience in preparing and motivating Cadets to enter the
            Service.
      --Prior U.S. Naval Sea Cadet Corps experience is an excellent pre-
            screening opportunity for young men and women to evaluate their
            interest in pursuing a military career. This factor could
            potentially save considerable taxpayer dollars expended on
            individuals who apply for, then resign after entering the
            Academy if they decide at some point they do not have the
            interest or motivation.
      --U.S. Naval Sea Cadet experience prior to entering the Service is an
            excellent indicator of a potentially high success rate.
        Data similar to the above has been requested from the United States
    Coast Guard Academy and the United States Merchant Marine Academy.
        Whether or not they choose a service career, all Sea Cadets carry
    forth learned values of good citizenship, leadership and moral courage
    that will benefit themselves and our country.
    Program Finances
        Sea Cadets pay for all expenses, including travel to/from training,
    uniforms, insurance and training costs. Out-of-pocket costs can reach
    $500 each year. Assistance is made available so that no young person is
    denied access to the program, regardless of social or economic
    background.
        Federally funded at the $1,000,000 level in fiscal years 2001,
    2002, and 2003, and at $1,500,000 in fiscal year 2004 (of the
    $2,000,000 requested), these funds were used to offset individual
    Cadet's individual costs for summer training, conduct of background
    checks for adult volunteers and for reducing future enrollment costs
    for Cadets. In addition to the federal funds received, NSCC receives
    under $1,000,000 per year from other sources, which includes around
    $250,000 in enrollment fees from Cadets and adult volunteers
    themselves. For a variety of reasons, at a minimum, this current level
    of funding is necessary to sustain this program and the full $2,000,000
    would allow for program expansion:
      --All-time high in number of enrolled Sea Cadets (and growing) and
            general inflation.
      --Some bases denying planned access to Sea Cadets for training due to
            increased terrorism threat level alerts and the associated
            tightening of security measures--requiring Cadets to utilize
            alternative, and often more costly training alternatives.
      --Reduced availability of afloat training opportunities due to the
            Navy's high level of operations related to the Iraq war.
      --Reduced training site opportunities due to base closures.
      --Non-availability of open bay berthing opportunities for Cadets due
            to their elimination as a result of enlisted habitability
            upgrades to individual/double berthing spaces.
      --Lack of available ``Space Available'' transportation for group
            movements and lack of on-base transportation, as the Navy no
            longer ``owns'' busses now controlled by the GSA.
        Because of these factors, Cadet out-of-pocket costs have
    skyrocketed to the point where the requested $2,000,000 alone would be
    barely sufficient to handle cost increases.
        It is therefore considered a matter of urgency that the full amount
    of the requested $2,000,000 be authorized and appropriated for fiscal
    year 2005.

        Senator Stevens. Our next witness is Heather French Henry,
    Miss America 2000, for the National Prostate Cancer Coalition.
        Being a prostate cancer survivor, I am pleased to see you,
    but I do not think you have any risk.
    STATEMENT OF HEATHER FRENCH HENRY, MISS AMERICA 2000 ON
                BEHALF OF THE NATIONAL PROSTATE CANCER
                COALITION
        Ms. Henry. No, I do not. Thank goodness.
        Mr. Chairman and Senator Inouye, I would like to thank you
    for the opportunity to come and speak before you today. Of
    course, I am Heather French Henry, former Miss America 2000.
    But before I was Miss America, I was the daughter of a disabled
    Vietnam veteran, and for years, even before my Miss America
    career, had the privilege of working with veterans all across
    the country and especially those who had prostate cancer as a
    direct result from Agent Orange.
        Now, I never thought, after working with all those
    veterans, that I would have prostate cancer within my family.
    Fortunately, my father has not been diagnosed with prostate
    cancer as a veteran, but my husband, former Lieutenant Governor
    of Kentucky and an orthopedic surgeon, is a prostate cancer
    survivor.
        You can imagine. I was 8 months pregnant, about 1\1/2\
    weeks away from delivering our second child, when he sat me
    down to tell me that he had been diagnosed with prostate
    cancer. The ``cancer'' word, the big ``C'' word we call it, in
    any family, when it is brought up, is scary let alone to an 8-
    month pregnant woman.
        Now, fortunately, Stephen and I had some knowledge of
    prostate cancer just because he was a physician. However, it is
    ironic that as a physician, he was not aware of his extensive
    family history of prostate cancer because prostate cancer just
    is not widely discussed. It is not like breast cancer which has
    become even a table topic at dinner discussion, but prostate
    cancer, of course, is not widely discussed among men, let alone
    other family members within their family or their friends.
        Steve and I had a difficult task. How do you deal with your
    husband having prostate cancer who is a public figure? How do
    you deal with that in media? Because, of course, as you know,
    media speculation is not good on any front when it comes to a
    public career. Steve and I decided that we would be very open.
    Now, we were having to deal with this personally, as well as
    publicly while he was still in office. We decided to be very
    open with his prostate cancer, and the press conference that we
    held took us 2\1/2\ hours to explain to members of the media
    just what prostate cancer was and how it could be treated and
    the various forms of treatment and the alternatives that
    Stephen had. We wanted to destroy any myth whatsoever about
    speculation about his life, his career, any of his future, but
    it took us 2\1/2\ hours to do that.
        Now, why did it take us 2\1/2\ hours? Gentlemen, I do not
    need to tell you that awareness of any issue is much needed,
    but without the funding for research--with that funding comes
    along the awareness. What we are asking today is that you help
    those out there by increasing the funding to $100 million to
    the DOD prostate cancer research program.
        I am sitting before you today as a wife of a prostate
    cancer survivor, but also as a public servant who has had to
    deal with this publicly. We choose to do that just to provide
    hope for men out there and their families that we were going to
    be advocates. Stephen and I have started the Kentucky Prostate
    Cancer Coalition within Kentucky. The grassroots support just
    is not there for prostate cancer, and most of that has to do
    because of the lack of funding for prostate cancer research.
        Now, fortunately, Stephen came through his surgery that he
    had at Johns Hopkins University Hospital successfully, and I
    did not breathe a sigh of relief until his first prostate
    specific antigen (PSA) test which came out with excellent
    results. But even then, his doctor who did his surgery could
    not clearly identify the future of prostate cancer. A gentleman
    who does this surgery probably 1,700 times during 1 year says
    to me we cannot tell you what the future of prostate cancer is
    because there is not enough research and funding out there
    because this disease is constantly changing.
        That is my fear, is that we are not going to be able to
    provide hope for all of the men out there and their families
    about the future of prostate cancer, and the younger
    generations that, of course, it is hitting. My husband who was
    49 when he was diagnosed speculates to have had it when he was
    47. Other friends of ours are getting it at 39 and in their
    40's. So we are just asking for funding to be able to project
    into the future.
        As you know, prostate cancer is the most commonly diagnosed
    cancer within men, accounting for 230,000 cases, 30,000 deaths
    in 2004. Like Stephen, many of those will be diagnosed in their
    40's and 50's. But that is why Stephen and I are here today
    with the National Prostate Cancer Coalition (NPCC).
        To properly fight the war on prostate cancer for families
    like mine, your committee must restore $100 million to the
    Department of Defense prostate cancer research program
    administered by the congressionally directed medical research
    program. Of course, in 2001, it was $100 million, but it had
    been bumped down to $85 million. So we are really just asking
    to restore that final step needed, of course, to conduct human
    clinical trials research. That is so important because without
    that extra $15 million, how do we advance into the research and
    technology of this?
        My husband chose a radical surgery and it is one of several
    forms of treatment, which of course was successful. But with
    all current primary treatments for the disease, there are side
    effects, but without the $100 million, the program is unable to
    test new treatments and thus get new products to patients that
    may not impair the quality of their lives.
        Thanks to your leadership, the congressionally directed
    medical research program has become the gold standard for
    administering cancer research. The program cannot fight the war
    against prostate cancer on its own, and last year the committee
    requested that the Defense Department, in consultation with the
    Institute of Medicine, evaluate ways for the program to
    collaborate with the private sector, which of course is so
    needed. Both the NPCC and I and my husband agree. Through
    public and private partnerships prostate cancer research can
    work collectively and strategically to produce new
    preventatives, diagnostics, and treatments to improve the
    quality of their life for prostate cancer patients like my
    husband.
        Prior to your directive, NPCC began discussing methods of
    public-private partnerships when it convened, along with the
    DOD prostate cancer research program and the National Cancer
    Institute, the Prostate Cancer Research Funders Conference in
    2000.
        The Prostate Cancer Research Funders Conference brings
    together representatives of all Government agencies that fund
    prostate cancer research, along with their counterparts in the
    private sector, which I cannot even tell you how important that
    is. Other participants include the Veterans Health
    Administration, the Centers for Disease Control and Prevention,
    and the Food and Drug Administration, Canadian and British
    Government agencies, and private foundations and organizations
    and representatives from the industry. Members of the
    conference have come together to focus on shared objectives and
    address commonly recognized barriers within the research.
    Through this collaborative approach, we can create a unified
    front to finally beat prostate cancer once and for all.
        Again, on behalf of my entire family, NPCC, and all of
    those prostate cancer patients, I want to thank you for
    allowing me to be here today and for your leadership already.
    Most importantly in the future, I want to be able to tell my
    two little girls that a disease that their daddy had is no
    longer a killer of men. So we are not only asking you to
    provide this research money for men everywhere, but also for
    their wives, their sons, and of course, their daughters. So
    thank you for letting me be here today. I want to encourage you
    to restore that research funding for a much needed disease.
        Senator Stevens. Thank you very much.
        Questions, Senator?
        Senator Inouye. I think we should note that Senator Stevens
    is the father of the defense prostate cancer research program.
        Senator Stevens. Thank you very much.
        Ms. Henry. Thank you. Appreciate it.
        [The statement follows:]
                   Prepared Statement of Heather French Henry
        Mr. Chairman and distinguished members of the committee, thank you
    for the opportunity to share my thoughts. My name is Heather French
    Henry, and I was crowned Miss America in 2000. I am here today on our
    behalf of my husband, my children and families all over America who
    have been touched by prostate cancer.
        I was pregnant with our second child when I found out that my
    husband, Stephen, then the Lieutenant Governor of Kentucky, had
    prostate cancer. In fact, I was two weeks away from my delivery date
    when he sat me down to tell me about his diagnosis. As a young married
    couple, the thought of prostate cancer or any form of cancer, was not
    even in our wildest imagination. After all, Stephen was the picture of
    health for a forty-nine year old man. He was active. He played
    basketball. He could even out run me on his worst day!
        Ironically, my husband is a physician. One might think that doctors
    should be on top of their health status! However, one peculiar night, I
    discovered Steve in pain, sitting on the steps holding his hand to his
    chest. Usually not one prone to dramatics, I was immediately concerned.
    Stephen went to the hospital and began a long stream of physicals over
    a period of two weeks. One physical after another showed my husband in
    good health until the day he received the results of a prostate-
    specific antigen (PSA) test. Only because of a simple unrelated chest
    pain did my husband take the initiative to get tested and find out
    about his PSA level. Had he not gone to the doctor at all, his
    diagnosis may still be unknown. Prostate cancer is a silent killer, and
    men must be encouraged to be vigilant in detecting it.
        Following the results of his PSA test, we began to wonder if
    Stephen's family had a history of the disease. After a call to his
    mother, we found out that his father had prostate cancer later in his
    life. If a man has one close relative with prostate cancer, his risk of
    the disease doubles; with two relatives, the risk increases fivefold.
    Therefore, it should have been no surprise that Stephen's chances of
    developing the disease were significant--but it was.
        Once I found out about my husband's prostate cancer I couldn't help
    but think, as an eight-month pregnant woman of 28, ``my husband has
    CANCER!'' I felt terrified which was magnified a thousand times by my
    pregnant condition. The hardest part was that we had to be silent about
    his condition because of the media. If prostate cancer was something
    that was widely understood and recognized, such as breast cancer, I
    don't feel that we would have had to be so cautious. However, because
    of the great misunderstanding and lack of knowledge the media and the
    public have about the disease, we had to strategize about how to deal
    with this situation, not only personally but publicly.
        I certainly was in no condition to deal with all of this, but
    prostate cancer doesn't wait for the ``right'' time. It added so much
    stress to my already aching mind and body that I feared it might affect
    my delivery. Fortunately, it didn't, and we are once again a happy
    family.
        Two days before he had surgery, Stephen held a press conference for
    all of the Kentucky media. It was the longest press conference in which
    I had ever participated. It became evident there was a lack of
    knowledge that even the press had about the seriousness of prostate
    cancer. We spent almost two hours describing prostate cancer, how it
    affected us as a family and how it could be treated. So much had to be
    explained and we wanted everyone on the same page. The last thing we
    wanted was for the press to speculate about Steve's cancer, his job, or
    even his life. We held the press conference to create awareness,
    educate and add hope to those families out there that may be struggling
    with prostate cancer. The next day we left for Johns Hopkins Medical
    Center in Baltimore.
        Stephen decided after educating himself and seeking the advice of
    friends and colleagues that he would choose the most aggressive route
    of surgery. Getting mixed views about timelines for surgery and knowing
    time was no friend to any cancer, Stephen wanted to act quickly. Three
    weeks after our daughter was born Stephen underwent surgery. Coupled
    with the fact that I had just given birth and really needed to have the
    baby with me, this was an extremely hard time for our family.
        I am usually a very strong woman emotionally and spiritually but
    not the day of Stephen's surgery. When we arrived at the hospital I was
    immediately told I could not take my infant daughter into the surgical
    wing. So there I was stuck in the lobby of one of the largest hospitals
    in the country with a newborn baby, a husband with cancer, and I was
    mentally lost. All I could do was sit and cry silently in the lobby
    while people walked by adding nods of compassion. I had no idea how the
    surgery would go. Reinforcing the lack of public discussion on the
    disease, no one could give us a clear story about the most affective
    treatments. What if the surgery didn't work? What if the cancer had
    spread? What if I was going to lose the love of my life and be left
    alone with two children? What if my children had to grow up not knowing
    what a wonderful man their father was?
        No one knows when his or her time on earth is going to end, and I
    was not ready for Steve's name to be called. I eventually called a
    friend to fly up to Baltimore to pick up my daughter after Stephen's
    surgery was over. But my despair continued.
        Even though the doctor seemed hopeful, my heart felt bleak. All
    that kept ringing through my head was the doctor describing about how
    prostate cancer evolves and changes with time and that he could make no
    predictions because more research needed be done to become more
    familiar with the nature of prostate cancer. It was nothing short of a
    nightmare for me. Ironically, between the two of us, Stephen handled it
    much more gracefully than I did. Four days after a successful surgery,
    we returned to Kentucky.
        I will never forget my husband's reaction to me asking if he would
    like a wheel chair for the walk through the airport. His pride was
    clearly hurt. Surgery was one thing, but the aftermath post operation
    is quite another. Stephen was to keep his catheter in for a few weeks,
    and that made the flight home quite memorable. The look on his face
    when I asked to tie his shoes was a clear indication that he did not
    want people to know or feel sorry for him. This outraged me. It
    concerned me that the masses didn't know more about prostate cancer and
    that my husband, or any man, could not feel comfortable dealing with
    his condition. It was one thing to talk about having prostate cancer
    but quite another to show people up front a post-operative face. It was
    not an easy flight, nor were the next weeks at home trying to make my
    husband rest. Unfortunately, his demeanor at that time reflects the
    overall attitude of many men and society: a reluctance to openly
    address prostate cancer and the need to be screened.
        Life didn't really seem to show a ray of hope to me until his first
    post-operative PSA test. His results were excellent! I finally breathed
    a sigh of relief. Steve was fortunate. He had caught his prostate
    cancer early, but others we know have not been so lucky.
        Prostate cancer is the most commonly diagnosed cancer in men,
    accounting for 33 percent of all cancer cases in men. Like Stephen,
    approximately 230,000 men will learn they have prostate cancer in 2004.
    Many of those diagnosed will be in their 40s and 50s. Roughly 30,000
    will die from the disease. As we have seen, those with a family history
    of prostate cancer are more susceptible to the disease. Also, veterans
    and others exposed to defoliants and African American men remain at
    higher risk. Currently, there is no cure for advanced or metastasized
    prostate cancer.
        I feel that because my husband is a doctor he was able to make wise
    decisions about his cancer. However, not everyone who currently has or
    will be diagnosed with prostate cancer is a doctor or will even have
    access to a doctor.
        The reason I am here today sharing my personal story with you is to
    encourage you to make an appropriate investment in prostate cancer
    research to help find a cure. We hear slogans everyday about ``races
    for the cure'' but the eradication of prostate cancer will never see
    its day unless it is talked about and taken seriously with proper
    funding for research. That's why, my husband and I have partnered with
    the National Prostate Cancer Coalition (NPCC). We know that an
    investment in research leads to better prevention, detection and
    treatment--and that greater understanding and awareness of the disease
    leads to hope--hope that the millions of men who will be diagnosed with
    prostate cancer have the chance at a long healthy life with their
    families.
        Among men, prostate cancer is rarely discussed, and when it is,
    it's done ``behind closed doors.'' My own husband was not even fully
    aware of his family history. Prostate cancer is not something to be
    ashamed of; it is a disease that needs to be recognized. Just as breast
    cancer has become a common dinner table topic, so should prostate
    cancer.
        I have worked for many years with Vietnam veterans who have
    prostate cancer as a result of Agent Orange exposure but I never
    thought I would encounter it in my family. Having long been a champion
    of veterans' issues, including the work done through my own foundation,
    I have seen the burden this disease places on those who have protected
    our freedom. The Department of Veterans Affairs (VA) estimates that
    there are roughly 23.5 million male veterans living in the United
    States. That means approximately 3.9 million veterans will be diagnosed
    with prostate cancer. The Veterans Health Administration currently
    estimates that nearly 5,800 patients in its system are diagnosed with
    prostate cancer each year. This nation must do all it can to keep these
    men from harm's way, after they have done the same for all Americans.
    What I am asking from you today is to take care of the men who served
    in uniform, past present and future.
        The Department of Defense (DOD) estimates that the direct health
    care costs of prostate cancer on the military are expected to be over
    $42 million in fiscal year 2004. Nearly 85 percent of the current
    1,465,000 serving in America's military are men. That means that about
    200,000 servicemen will be diagnosed with prostate cancer--without
    additional consideration of service related environmental factors that
    may increase risk of the disease. The DOD refers to itself as America's
    largest company; it must protect its employees from a killer that will
    affect 14 percent of its workforce.
        Whether in battle or peacetime, the lives of men all over this
    country depend on your decisions. You have the unique opportunity to
    provide a brighter future for millions of men and families through
    prostate cancer research. With proper funding we can find a way to end
    the pain and suffering caused by prostate cancer.
        To properly fight the war on prostate cancer for families like
    mine, your committee must appropriate $100 million for the DOD
    Congressionally Directed Medical Research Program's (CDMRP) Prostate
    Cancer Research Program (PCRP). As stated in its fiscal year 1997
    business plan, PCRP needs at least $100 million to conduct human
    clinical trial research. My husband chose to have a radical
    prostatectomy, one of several forms of treatment available for prostate
    cancer. Yet, as with all current primary treatments for the disease,
    there are many side effects. Without $100 million, the program is
    unable to test new treatments and thus get new products to patients
    that may not impair the quality of their lives. Without such
    investment, the pipeline remains closed, meaning that valuable prostate
    cancer research remains stuck in laboratories instead of at work in
    clinics.
        Thanks to your leadership, CDMRP has become the gold standard for
    administering cancer research. Prostate cancer advocates and scientists
    throughout this nation have long applauded the program and its peer and
    consumer driven approach to research. PCRP is a unique program within
    the government's prostate cancer research portfolio because it makes
    use of public/private partnerships, awards competitive grants for new
    ideas, does not duplicate the work of other funders, integrates
    scientists and survivors and uses a unique perspective to solve
    problems. Its mission and its results are clear. Each year, the program
    issues an annual report detailing what it has done with taxpayer
    dollars to fight prostate cancer. PCRP's transparency allows people
    like us and others affected by prostate cancer to clearly see what our
    government is doing to fight the disease.
        The PCRP structure is based on a model developed by the National
    Academy of Sciences' Institute of Medicine. Its mission and its
    philosophy for awarding research grants reflect that of DOD's Defense
    Advanced Research Projects Agency (DARPA). The DARPA model, performance
    through competition and innovation, was praised in President Bush's
    fiscal year 2005 budget. This DARPA-esque approach to cancer research
    allows PCRP to identify novel research with large potential payoffs and
    to focus on innovative methods that do not receive funding elsewhere.
        One of the strongest aspects of the program is PCRP's Integration
    Panel. The panel is composed of those who know prostate cancer research
    and the issues facing it: scientists, researchers, and prostate cancer
    survivors, just like Stephen. This peer and consumer driven model
    allows the program to select grants based on merit and their
    translational benefit while incorporating the views of those who need
    research the most, prostate cancer patients. No other publicly funded
    cancer research entity effectively brings together all those with a
    stake in curing prostate cancer.
        This committee requested last year that DOD, in consultation with
    the Institute of Medicine, evaluate collaborations with the private
    sector (Senate Report 108-87). Both NPCC and I agree. Through public-
    private partnerships, prostate cancer researchers can work collectively
    and strategically to produce new preventives, diagnostics and
    treatments to improve the quality of life for prostate cancer patients
    like Stephen. Prior to your directive, NPCC began discussing methods
    for public-private partnerships when it convened, along with the
    National Cancer Institute and DOD, the Prostate Cancer Research Funders
    Conference in 2000.
        The Prostate Cancer Research Funders Conference brings together
    representatives of all the government agencies that fund prostate
    cancer research along with their counterparts in the private sector.
    Participants include NIH/NCI, DOD, the Veterans Health Administration,
    the Centers for Disease Control and Prevention, the Food and Drug
    Administration, Canadian and British government agencies, private
    foundations/organizations and representatives from industry. Members of
    the Conference have come together to focus on shared objectives and
    address commonly recognized barriers in research.
        As a co-convener of the conference, PCRP plays an important role in
    shaping its priorities. Currently, federal agencies participate
    voluntarily, but they can opt in or out based on the tenure of
    executive leadership. For the conference to be successful, federal
    agencies engaged in prostate cancer research should, in our opinion, be
    required to participate, and we ask for your leadership to make that
    happen. Moreover, Congress must also offer sufficient incentives for
    the private sector to participate. Incentives that do not compromise
    the autonomy or integrity of PCRP's peer review structure. I firmly
    believe that a collaborative, multifaceted approach to prostate cancer
    research can bring about better results in a more timely fashion.
        Mr. Chairman, we have done remarkable work and are making progress.
    Public-private collaboration and new scientific discoveries are moving
    us toward a better understanding of how prostate cancer kills, but, for
    our work to be worthwhile, it must be translated into tangible goals
    and results for patients. The War on Cancer must be funded
    appropriately so researchers can get new drugs to the patients who need
    them. For this to happen PCRP needs $100 million to fund human clinical
    trials research.
        On behalf of my entire family, prostate cancer patients everywhere,
    and NPCC I thank you for your time. Thanks to your leadership, I will
    one day be able to tell my children that a disease their daddy has is
    no longer a killer of men.

        Senator Stevens. Our next witness is Daniel Puzon, Director
    of Legislation, Naval Reserve Association.
    STATEMENT OF CAPTAIN IKE PUZON, UNITED STATES NAVAL
                RESERVE (RET.), DIRECTOR OF LEGISLATION,
                NAVAL RESERVE ASSOCIATION
        Mr. Puzon. Mr. Chairman, Senator Inouye, thank you for this
    opportunity. On behalf of my 22,000 members and 86,000 naval
    reservists, we thank you.
        We are obviously in a climate of increased utilization and
    sacrifice by our Guard and Reserve, as you have heard today. We
    are aware of those sacrifices. Our three main equity issues on
    personnel are, as others have said, selective Reserve
    Montgomery GI bill improvement, TRICARE for our selected
    reservists, and some type of parity or improvements on
    retirement. Our most pressing concern is equipment, end
    strength, and force structure.
        The fact that we have recalled 360,000 Guard and Reserve
    members is a true testament of their surge ability and their
    need in our service and also to their readiness and also to the
    requirement to have a healthy Reserve component in all our
    services. They have proved that they are cost effective and
    they add ``just in time'' might when our Nation calls.
        The performance and efforts of today's military is without
    question. We foresee that the reliance on the Guard and Reserve
    will continue this way for some time in execution of our
    national security strategy and evolving homeland security
    strategy. Reserve components again are providing for our Nation
    and they have proven they are affordable.
        The Guard and Reserve is oftentimes the first bill payer in
    any attempt to balance the budget. The recent use of F-18's and
    HCS-4 helicopters, coastal warfare, and multiple other Guard
    and Reserve units, but most notably in the Navy Reserve units
    have been targeted for decommissioning. Again, we embrace
    change in the Naval Reserve Association but we do not embrace
    the elimination. These people that have served are coming back
    from Operation Iraqi Freedom and finding out their unit is
    going to be decommissioned. We think that is a travesty for our
    Nation and for the naval reservists.
        As you know, the Navy is involved from the top down in
    relooking at what billets are needed and not needed. What is
    not being looked at is how those people that are being
    reassigned will be trained. It is going to be hard to be
    trained if you are in middle America and you need to go to
    Norfolk or San Diego. That has not been addressed and is not
    being addressed and is not being funded.
        When our Nation called on these service members in the
    Naval Reserve, they responded. Now, they are finding out these
    units they used to belong to are on the block to be cut. We
    think this needs to be looked at.
        As you know, reservists and Guardsmen are willing to make
    large sacrifices and sacrifices in employment unexpectedly.
    Reservists have shown this time and time again. They will
    volunteer when asked. They will do anything you ask them to do.
        The way the Reserve is used in successful military
    operations is essential to what America is doing. What we are
    asking is are these initiatives, the road we are going down,
    are they the right ones for our national military strategy and
    our homeland security strategy. Is it the right direction? Is
    it sound defense? We are learning lessons, and we hope that the
    Secretary of Defense and the service departments learn those
    lessons.
        Finally, we would like to urge Congress to continue to
    resource the National Guard and Reserve equipment accounts.
    That is the only way Guard and Reserve will keep maintaining
    front line equipment or any equipment in some cases.
        We also think you should address the idea of maintaining
    the force level for the Naval Reserve because if you do not, it
    will be gone. We are a slippery slope, down to 40,000
    reservists in the Naval Reserve. That is again another
    travesty.
        Finally, we encourage you to consider a commission for the
    Guard and Reserve for the 21st century. There are way too many
    issues out there that address this country that the Guard and
    Reserve can do and will do, and this is the only way to get to
    it is through a congressionally mandated commission.
        Thank you for your time.
        Senator Stevens. Well, thank you very much. You make some
    great points. We have labored long and hard to ensure that the
    total force was there, and it has been there. Guard and Reserve
    is part of the total force. You have a very interesting
    suggestion for a commission for the 21st century.
    Unfortunately, I think that is an Armed Services Committee
    problem, but we will work with them. I think it is a good
    suggestion. Thank you very much.
        Mr. Puzon. Yes, sir.
        Senator Stevens. Senator Inouye.
        Senator Inouye. Thank you.
        Senator Stevens. Thank you very much.
        [The statement follows:]
                     Prepared Statement of Daniel I. Puzon
        Chairman Stevens, Senator Inouye and distinguished members of the
    subcommittee, on behalf of our 22,000 members, and in advocacy for the
    86,000 active Naval Reservists we are grateful for the opportunity to
    submit testimony, and for your efforts in this hearing.
        Today, a climate of continued utilization and sacrifice for our
    Guardsmen and Reservists has encircled our nation. We are all more
    aware of sacrifices of our armed forces in Iraq including our Guardsmen
    and Reservists. Our Guard and Reserve personnel are serving 365 days a
    year and have suffered in these casualties. These are the times that
    bring the issue of parity between the active component personnel and
    reserve component personnel to the forefront and into question.
        The three main equity personnel issues important to the Naval
    Reserve Association members is: (1) Selective Reserve MGIB
    improvements, (2) TRICARE for Selected Reservists, and (3) some type of
    parity on early retirement.
        Our most important issue is end strength and force structure.
        We do not have to remind the Congress why you needed to provide for
    these Guard and Reserve forces, but it is noted that it is a good thing
    you did, or where would we be today--by calling on them to go and serve
    in every major conflict that we have experienced in recent memory. As
    of today--350,000 Guard and Reserve members recalled since September
    11, 2001, is a true testimony of their surge-ability and readiness, and
    of the requirement to have a healthy reserve component in all our
    services. These are the forces that add ``just in time'' combat might
    when our Nation calls. Judged by this metric of combat might, they are
    cost-effective and efficient resources.
        The performance and efforts of today's military is without question
    in the forefront of our national and international news. Without
    question our armed forces is at the height of military prominence and
    involvement in our national security strategy. We foresee that this
    reliance will remain this way, as long as we are in this protracted war
    on terrorism, and executing both the National Security Strategy and
    evolving Homeland Security Strategy. Truly our Reserve Components are
    providing for the defense of our nation and proven that they are
    affordable!
        Yet, while these affordable Guard and Reserve forces are fighting
    the war in Iraq and being used throughout the world in peace keeping
    missions, there are some who believe that they add little value; that
    resources authorized and appropriated by Congress could be used better
    somewhere else. The Guard and Reserve is often time the first payer in
    any attempt to balance the budget. In the Navy, dedicated Naval Reserve
    equipment that has been used in this recent war (F-18's, HH-60's,
    Coastal Warfare small boats) is being eliminated and Reserve units have
    been targeted for decommissioning. VFA-203 is scheduled for
    decommissioning in June 2004, however, their sister squadron (VFA-201)
    recently deployed, fought in OIF, and broke all active component
    wartime records. Because they are the Naval Reserve they are being
    decommissioned. The fact that the equipment and personnel would be
    needed in a larger conflict (Korea, China), or could be utilized in
    Homeland Security is of little matter. Some of this is being mislabel
    as transformational, and some of it is being engineered to occur as an
    outcome under BRAC. For these and other reasons Congress must remain
    engaged in maintaining our Reserve and Guard Components.
        We respectfully call on Congress to review and question current
    Transformation and rebalancing efforts because of the aforementioned
    and the following;
      --Guard and Reserve service members are responding without question,
            or hesitation.
      --Guard and Reserve service members' families are responding without
            question.
      --Guard and Reserve service members' employers are responding without
            question.
      --Guard and Reserve hardware units that you have appropriated have
            responded and are responding without question.
      --Guard and Reserve hardware units have performed at and above
            standards and actually above any active component standard.
      --Naval Reserve members and their families as a whole, view
            transformation and active reserve integration acceptable, but
            understand that this means they will no longer have real units,
            with Required Operating Capabilities, and Programmed Operating
            Capabilities justifications. How Reservists will be trained is
            a detail that hasn't been answered under current plans.
      --Successful transformation of a reserve component is rarely
            completed, solely with DOD or service input. Outside assistance
            is necessary to achieve the right mix and right balance.
      --Current situations and emerging threats, clearly shows that we need
            a healthy Naval Reserve force with equipment and with units.
        Rarely has there been this massive effort of organizational--
    equipment, personnel, cultural, and resource--transformation at the
    same time our country is engaged in a global war on terrorism, homeland
    security defense, and several protracted wars overseas.
        As you know, the Navy is occupied from the top down and ground up
    in transformation of the Navy and Fleet response--developing
    expeditionary forces, redoing training matrices, procuring new
    technologies that will transform Naval war fighting efforts, and now at
    the same time, implementing massive change of including the Naval
    Reserve service, in active training matrices.
        This is all being done, when our nation called upon the service
    members of the Naval Reserve--they responded, and now they are finding
    out their units are going to no longer exist--because we need
    supposedly more efficient, more effective, capabilities based surging
    forces. These Naval Reserve Forces cost 50 percent less than any active
    duty members or unit. They maintain their readiness--directed and
    reported by active components, at an overall higher sustained rate over
    time than their active counterpart. The Naval Reserve force knows it
    must change, and some instances understands better business practices
    much better than any active member. However, they are now--under the
    microscope of change, with more to loose than any active force member.
        Reservists are willing to sacrifice family and employment to serve
    their country, unexpectedly. Reservists have shown us time and time
    again that they'll volunteer when asked, despite the impact of their
    personal and professional life. This service beyond self is not
    appreciated by many on the Active side or in DOD. Yet, they are being
    used again and again.
        Rather than confront budget appropriators, the Active Components
    have been content to fill their force shortfalls with Reserve manpower,
    and this has been arguably good for the country, according to the
    Department of the Navy.
        If there is a raw nerve among Reservists, it is caused by how
    individuals are being utilized, and how often that individual is being
    called up. Pride and professionalism is a large factor in the profile
    of a Reservist as it is with any individual member of the Armed
    Services. They want to be used how they have been trained, and they
    want to be used and complement the Active Forces. Recall and proper use
    of reservists needs constant monitoring and attention. We agree that
    transformation of legacy personnel manpower program is overdue. But,
    Congressional involvement in force structure transformation is
    mandatory, along with outside independent involvement to ensure our
    country does have this affordable and cost efficient capability.
        In today's American way of war, the way a Reservist is used and
    recalled is vital to successful military operations, and essential to
    gaining the will of America. This has proven its worth over and over,
    and is relevant.
        The question we are asking is: ``Are the DOD legislative
    initiatives, rebalancing efforts of the Department of Navy--taking us
    in the right direction for a sound Military and a strong National
    Defense?'' We hope that DOD is learning lessons from the past to avoid
    repeating old mistakes in the future, and the Naval Reserve Association
    stands ready to assist in turning lessons learned into improved policy.
        Leaving nothing to chance however, we strongly urge Congress to
    legislate:
      --Resources for maintaining a strong Naval Reserve Force through the
            NGREA per the attached priority list for the Naval Reserve
            Force;
      --Appropriations language that maintains end strength and restores
            unit structure for the Naval Reserve at fiscal year 2003-04
            levels; and
      --Establish a Commission on the Transformation of Guard and Reserve
            of the 21st Century. The transformation of our military is
            dynamic and includes the extended utilization of the Guard and
            Reserve Forces. We feel it is time for Congress to take a
            thorough look at these issues with a commission in order to
            address the many problems that we are experiencing with our
            Guard and Reserve Forces. A Congressional commission is
            warranted to review these issues properly.
        Mr. Chairman and distinguished members of the committee, thank you
    for this opportunity. Details of specific issues of concern by our
    Association follow; we hope you can help address them.
                              equipment ownership
        Issue: An internal study by the Navy has suggested that Naval
    Reserve equipment should be returned to the Navy. At first glance, the
    recommendation of transferring Reserve Component hardware back to the
    Active component appears not to be a personnel issue. However, nothing
    could be more of a personnel readiness issue and is ill advised.
    Besides being attempted several times before, this issue needs to be
    addressed if the current National Security Strategy is to succeed.
        Position: The overwhelming majority of Reserve and Guard members
    join the RC to have hands-on experience on equipment. The training and
    personnel readiness of Guard and Reserve members depends on constant
    hands-on equipment exposure. History shows, this can only be
    accomplished through Reserve and Guard equipment, since the training
    cycles of Active Components are rarely if ever--synchronized with the
    training or exercise times of Guard and Reserve units. Additionally,
    historical records show that Guard and Reserve units with hardware
    maintain equipment at or higher than average material and often better
    training readiness. Current and future war fighting requirements will
    need these highly qualified units when the Combatant Commanders require
    fully ready units.
        Reserve and Guard units have proven their readiness. The personnel
    readiness, retention, and training of Reserve and Guard members will
    depend on them having Reserve equipment that they can utilize,
    maintain, train on, and deploy with when called upon. Depending on
    hardware from the Active Component, has never been successful for many
    functional reasons. The NRA recommends strengthening the Reserve and
    Guard equipment in order to maintain--highly qualified trained Reserve
    and Guard personnel.
        Our suggested priority for fiscal year 2005 NGREA:

                                                  [Dollars in millions]
    ----------------------------------------------------------------------------------------------------------------
     Pri              Equipment                Cost       No.                           Remarks
    ----------------------------------------------------------------------------------------------------------------
       1 Littoral Surveillance System           $19          1  Procure additional LSS.
          (LSS)
       2 Naval Coastal Warfare Boats             45         28  Procure 28 boats.
       3 P-3C AIP Kits                           29          2  Achieve commonality.
       4 F/A-18 Mod, ECP 560                     24          8  Upgrade F/A-18A PGM capability.
       5 MH-60S Aircraft                         84          4  Replacement for HH-60H Aircraft.
       6 F-5 Radar Upgrade                        7          6  Upgrade to APG-66 radar.
       7 C-40A Transport Aircraft             1,140          2  Replace aging C-9 with C-40A.
       8 F/A-18 Advanced Targeting FLIR         168         12  FLIR's for all Reserve F/A-18 Aircraft.
       9 P-3C BMUP Kits                         467          4  Achieve commonality.
      10 FLIR kits (AAS-51Q) for SH-60B          56          4  Procure 4 FLIR (AAS-51-Q) for SH-60B
    ----------------------------------------------------------------------------------------------------------------

                                   personnel
    Selective Reserve MGIB improvements
        Issue: Currently SelRes MGIB benefits are at 19 percent of active
    duty entitlements.
        Position: This shows clearly the priority of SelRes service
    members. This benefit should be higher and closer to the 48 percent
    mandated benefit. We must consider upgrading this benefit for those
    members that are responding to our nations call.
    Temporary Recall of Reserve Officers (Three Years or Less)
        Issue: To properly match the Reserve officer's exclusion from the
    active duty list as provided for by 10 U.S.C. 641(1)(D) with a
    corresponding exclusion from the authorized grade strengths for active
    duty list officers in 10 U.S.C. 523. Without this amendment, the active
    component would have to compensate within their control grades for
    temporary recalled Reserve officers who are considered, selected and
    promoted by RASL promotion selection boards. This compensation causes
    instability in promotion planning and a reduction in ``career'' ADL
    officer eligibility and promotion for each year a Reserve officer
    remains on ``temporary'' active duty. Therefore, Naval Reservists are
    temporarily recalled to active duty and placed on the ADL for
    promotional purposes. End result--failure of selection due to removal
    from RASL peer group.
        Position: Strongly support grade strength relief for the small
    percentage of Reserve officers who would possibly be promoted while
    serving on temporary active duty. Granting relief is a Win-Win
    situation. By removing the instability in promotion planning for the
    active component, Reserve officers can be issued recall orders
    specifying 10 USC 641(1)(D) allowing them to remain on the RASL for
    promotion purposes.
    Healthcare
        Issue: Healthcare readiness is the number one problem in mobilizing
    Reservists. The governments own studies shows that between 20-25
    percent of Guardsmen and Reservists are uninsured.
        Position: We applaud the efforts of the TRICARE Management
    Activity. TMA has a strong sense of which the customer is. They
    emphasize communications, and are proactive at working with the
    military associations. Congress took decisive action in establishing
    the temporary Healthcare program for Guard and Reserve Forces during
    the fiscal year 2004 NDAA. NRA would like to see a continued effort at
    implementing the established TRICARE Health plan for uninsured drilling
    Reservists, and establishing this program as a permanent program.
    Early Reserve Retirement
        Issue: A one sided debate is being held through the press on
    whether changes should be allowed to Guard and Reserve to lower the
    retirement payment age. The Defense Department study on this issue was
    non conclusive.
        Position: Over the last two decades and recently more has been
    asked of Guardsmen and Reservists than ever before. The nature of the
    contract has changed; Reserve Component members need to see recognition
    of the added burden they carry. Providing an option that reduces the
    retired with pay age to age 55 carries importance in retention,
    recruitment, and personnel readiness.
        The Naval Reserve Association suggests a cost neutral approach to
    this issue that would not be that ``expensive.''
        The Naval Reserve Association recommends for discussion/debate that
    Reserve Retirement with pay prior to age 60 be treated like taking
    Social Security retirement early--if you elected to take it at say age
    55, you take it at an actuarially reduced rate.
        Most of the cost projected by DOD is for TRICARE healthcare, which
    begins when retirement pay commences. Again, if one takes Social
    Security before reaching age 65 they are not eligible for Medicare. NRA
    suggests that TRICARE for Reservists be decoupled from pay, and
    eligibility remains at age 60 years.
        At a minimum, the committee should consider the various initiatives
    and the cost neutral approach during the debate.
                                force structure
    Roles and Missions
        Issue: Pentagon study has highlighted that the Guard and Reserve
    structure, today, is an inherited Cold War relic. As a result, the
    Guard and the Reserve organization has become the focus of
    ``transformation.'' While it won't be denied that there could be a need
    for change, transformation for transformation sake could be
    disadvantageous. Visionaries need to learn lessons from the past,
    assimilate the technology of the future, and by blending each,
    implement changes that improve war fighting.
        Position: Navy has yet to deliver a Vision of use of and equipping
    of the Naval Reserve Force. A Commission on the Transformation of the
    Guard and Reserve for the 21st Century is warranted.
    The Reserve Component as a Worker Pool
        Issue: The view of the Reserve Component that has been suggested
    within the Pentagon is to consider the Reserve as of a labor pool,
    where Reservist could be brought onto Active Duty at the needs of a
    Service and returned, when the requirement is no longer needed. It has
    also been suggested that an Active Duty member should be able to rotate
    off active duty for a period, spending that tenure as a Reservist,
    returning to active duty when family, or education matters are
    corrected.
        Position: The Guard and Reserve should not be viewed as a
    temporary-hiring agency. Too often the Active Component views the
    recall of a Reservist as a means to fill a gap in existing active duty
    manning. Voluntary recall to meet these requirements is one thing,
    involuntary recall is another.
        The two top reasons why a Reservist quits the Guard or Reserve is
    pressure from family, or employer. The number one complaint from
    employers is not the activation, but the unpredictability of when a
    Reservist is recalled, and when they will be returned.
    100 Percent Mission Ownership
        Issue: Department of Defense is looking at changing the reserve and
    active component mix. ``There's no question but that there are a number
    of things that the United States is asking its forces to do,'' Rumsfeld
    said. ``And when one looks at what those things are, we find that some
    of the things that are necessary, in the course of executing those
    orders, are things that are found only in the Reserves.''
        Position: America is best defended through a partnership between
    the government, the military and the people. The Naval Reserve
    Association supports the continued recognition of the Abrams Doctrine,
    which holds that with a volunteer force, we should never go to war
    without the involvement of the Guard and Reserve, because they bring
    the national will of the people to the fight. While a review of mission
    tasking is encouraged, the Active Component should not be tasked with
    every mission, and for those it shares, no more heavily than their
    Reserve counterparts. Historically, a number of the high percentage
    missions gravitated to the Reserve components because the Active Forces
    treated them as collateral duties. The Reserve has an expertise in some
    mission areas that are unequaled because Reservists can dedicate the
    time to developing skills and mission capability, and sharing civilian
    equivalencies, where such specialization could be a career buster on
    Active Duty.
    Augmentees
        Issue: As a means to transform, a number of the services are
    embracing the concept that command and unit structure within the
    Reserve Component is unnecessary. Reservists could be mustered as
    individual mobilization augmentees and be called up because often they
    are recalled by skills and not units.
        Position: An augmentee structure within the Naval Reserve was
    attempted in the 1950's/1960's, and again in the 1980's. In one word:
    Failure! Reservists of that period could not pass the readiness test.
    The image of the Selected Reservists, sitting in a Reserve Center
    reading a newspaper originates from the augmentee era. Some semblance
    of structure is needed on a military hierarchy. Early on, Naval
    Reservists created their own defense universities to fill the training
    void caused by mission vacuum.
    Business Initiative
        Issue: Many within the Pentagon feel that business models are the
    panacea to perceived problems with in military structure.
        Position: Reservists have the unique perspective of holding two
    careers; many with one foot in business and one foot in the military.
    The Naval Reserve Association suggests caution rather than rush into
    business solutions. Attempted many times in the past, business models
    have failed in the military even with commands that proactively
    support.
        Among the problems faced are:
      --Implementing models that are incompletely understood by director or
            recipient.
      --Feedback failure: ``Don't tell me why not; just go do it!''
      --The solution is often more expensive than the problem.
      --Overburdened middle management attempting to implement.
      --Cultural differences.
      --While textbook solutions, these models frequently fail in business,
            too.
    Closure of Naval Reserve Activities
        Issue: Discussion has emerged, suggesting that a large number of
    Naval Reserve Centers and Naval Air Reserve Activities be closed, and
    that Naval Reservists could commute to Fleet Concentration Areas to
    directly support gaining commands and mobilization sites.
        Position: The Naval Reserve Association is opposed to this plan for
    the following reasons.
        A. The Naval Reserve is the one Reserve component that has Reserve
    Activities in every state. To close many of these would be cutting the
    single military tie to the civilian community.
        B. The demographics of the Naval Reserve is that most of the
    commissioned officers live on the coasts, while most of the enlisted
    live in the hinterland, middle America. The Naval Reservists who are
    paid the least would have to travel the farthest.
        C. The active duty concept of a Naval Reserve is a junior force, a
    structure based upon enlisted (E1-E3s) and officers (O1-O2's) billets
    that can't be filled because the individuals haven't left the fleet
    yet. When the Coast Guard ``transformed'' its Reserve force, it was a
    forced a restructuring that RIFFed many senior officer and enlisted
    leadership from the USCGR ranks, and caused a number of years of
    administrative problems.
        D. If training at fleet concentration centers was correctly
    implemented, the Navy should bear the expense and burden of
    transportation and housing while on site. Additionally, at locations
    such as Naval Station Norfolk, the overlap of Active Duty and Reserve
    training has shown an increased burden on Bachelor Quarters and messing
    facilities. Frequently, Reservists must be billeted out on the economy.
    With these extra costs, training would prove more expensive.
        E. Such a plan would devastate the Naval Reserves; retention would
    plummet, training and readiness would suffer.
                                    summary
        NGREA and Commission on Guard and Reserve Forces for the 21st
    Century are the most important issues. Congress must maintain parity
    for equipment, because the active component will not. If our country is
    going to use the Guard and Reserve in the manner we are currently
    doing, Congress must provide the resources, the active component is
    not. Finally, a congressionally mandated Commission to study these
    vital National Security issues is needed to provide guidance to the
    balancing and transformation that is occurring.
        The Four ``P's'' can identify the issues that are important to
    Reservists: Pay, Promotion, Points, and Pride.
        Pay needs to be competitive. As Reservists have dual careers, they
    have other sources of income. If pay is too low, or expenses too high,
    a Reservist knows that time may be better invested elsewhere.
        Promotions need to be fairly regular, and attainable. Promotions
    have to be through an established system and be predictable.
        Points reflect a Reservist's ambitions to earn Retirement. They are
    as creditable a reinforcement as pay; and must be easily tracked.
        Pride is a combination of professionalism, parity and awards: doing
    the job well with requisite equipment, and being recognized for ones
    efforts. While people may not remember exactly what you did, or what
    you said, they will always remember how you made them feel.
        If change is too rapid anxiety is generated amid the ranks. As the
    Reserve Component is the true volunteer force, Reservists are apt to
    vote with their feet. Reservists are a durable affordable resource only
    if they are treated right. Navy plans do not provide for these key
    points and do not treat the reservist correctly. Current conditions
    about the world highlights the ongoing need for the Reserve Component
    as key players in meeting National Security Strategy; we can't afford
    to squander that resource.

        Senator Stevens. Next is Dr. Jerome Odom, Provost of the
    University of South Carolina.
    STATEMENT OF DR. JEROME ODOM, PROVOST, UNIVERSITY OF
                SOUTH CAROLINA ON BEHALF OF THE COALITION
                OF EPSCoR STATES
        Dr. Odom. Thank you, Mr. Chairman, Senator Inouye. I
    appreciate the opportunity to submit the testimony regarding
    the Defense Department's basic scientific research program and
    the Defense Experimental Program to Stimulate Competitive
    Research, which is better known as DEPSCoR.
        I am the Executive Vice President for Academic Affairs and
    Provost at the University of South Carolina, and I want to
    speak today in support of both the Defense Department's science
    and engineering research program and an important component of
    that research, the DEPSCoR program. This statement is submitted
    on behalf of the Coalition of EPSCoR States and the 21 States
    and Puerto Rico that participate in EPSCoR. EPSCoR stands for
    Experimental Program to Stimulate Competitive Research, and Mr.
    Chairman, Alaska is an EPSCoR State, and Senator Inouye, Hawaii
    is an EPSCoR State as well.
        The coalition wishes to be associated with the statement of
    the Coalition for National Security Research in support of
    additional funding for defense research and development. The
    coalition strongly urges the administration and Congress to
    provide a robust and stable fiscal year 2005 investment for
    science and technology programs in the Department of Defense.
    This subcommittee has long demonstrated its strong support for
    the Department's science and technology research which have
    produced the innovations and technological breakthroughs that
    have contributed to ensuring that our fighting men and women
    have the best available systems and weapons to support them in
    executing their national defense missions. The bench science
    that this subcommittee has wisely supported in our Nation's
    universities has produced significant benefits for the people
    in the field and on the front lines.
        The Coalition of EPSCoR States strongly supports the
    Department's budget request for basic research. The DEPSCoR
    program is a small but significant part of this larger program.
    The coalition recommends that Congress appropriate $25 million
    to the Defense Department's budget for the DEPSCoR program.
        EPSCoR itself is a research and development program that
    was initiated by the National Science Foundation and is now
    supported by most Federal agencies that fund research. Through
    a merit review process, EPSCoR is improving our Nation's
    science and technology capability by funding research
    activities of talented researchers at universities and
    nonprofit organizations in States that historically have not
    received significant Federal research and development funding.
    EPSCoR is a catalyst for change and is widely viewed as a model
    Federal-State partnership.
        The DEPSCoR program helps build national infrastructure for
    research and education by funding research activities in
    science and engineering fields important to national defense.
    The DEPSCoR program also contributes to the States' goals of
    developing and enhancing their research capabilities while
    simultaneously supporting the research goals of the Department
    of Defense. Research proposals are only funded if they provide
    the Defense Department with research in areas important to
    national defense. The DEPSCoR States have established an
    impressive record of research that has directly contributed to
    our Nation's security interests.
        I would like very much to be able to give you some
    examples. They are in the written testimony and all of the
    DEPSCoR States have made major contributions to defense
    research.
        The DEPSCoR program improves the abilities of institutions
    of higher education to develop, plan, and execute science and
    engineering research that is competitive under DOD's peer
    review system and provides technological products that serve
    the needs of the Department of Defense. In order to ensure that
    the broadest number of States is providing unique and high-
    value research to the Department, the DEPSCoR States propose to
    augment the current program within the parameters of the
    Department's legislative authority.
        Currently awards are provided to mission-oriented
    individual investigators from universities and other
    institutions of higher education. The program, as it is
    currently implemented, has not taken into account the
    significant benefits that can be derived from individual
    investigators pooling their efforts to provide clusters of
    research that meet the ever-increasing challenges and needs of
    the Department and the services.
        I would just like to say to close we would request $10
    million for the investigator grants and $15 million for these
    clusters for a total of $25 million for DEPSCoR. I sincerely
    thank you for your consideration of that request.
        Senator Stevens. Well, we are very familiar with your
    program and we thank you very much for what you are doing.
        Dr. Odom. Thank you.
        Senator Stevens. Do you have any questions?
        Senator Inouye. No, Mr. Chairman.
        Senator Stevens. We are familiar with it in our own States.
    Thank you very much.
        Dr. Odom. Thank you very much.
        [The statement follows:]
                     Prepared Statement of Dr. Jerome Odom
        Mr. Chairman and members of the Subcommittee, I thank you for the
    opportunity to submit this testimony regarding the Defense Department's
    basic scientific research program and the Defense Experimental Program
    to Stimulate Competitive Research (DEPSCoR).
        My name is Jerome Odom. I am the Provost of the University of South
    Carolina. I am here today to speak in support of both the Defense
    Department's science and engineering research program and an important
    component of that research, the Defense Department's Experimental
    Program to Stimulate Competitive Research (EPSCoR). This statement is
    submitted on behalf the Coalition of EPSCoR States and the twenty-one
    states and Puerto Rico that participate in EPSCoR.\1\
    ---------------------------------------------------------------------------
        \1\ Alabama, Alaska, Arkansas, Delaware, Hawaii, Idaho, Kansas,
    Kentucky, Maine, Montana, Nebraska, Nevada, North Dakota, Oklahoma,
    South Carolina, South Dakota, Vermont, West Virginia, Wyoming, Puerto
    Rico, and Virgin Islands.
    ---------------------------------------------------------------------------
        The Coalition wishes to be associated with the statement of the
    Coalition for National Security Research in support of additional
    funding for Defense research and development. The Coalition strongly
    urges the Administration and Congress to provide a robust and stable
    fiscal year 2005 investment for the Science and Technology programs of
    the Department of Defense (DOD). This Subcommittee has long
    demonstrated its strong support for the Department's science and
    technology research, which have produced the innovations, and
    technological breakthroughs that have contributed to ensuring that our
    fighting men and women have the best available systems and weapons to
    support them in executing their national defense missions. The bench
    science the Subcommittee has wisely supported in our Nation's
    universities and laboratories has produced significant benefits for the
    people in the field and on the front lines. The Coalition of EPSCoR
    States strongly urges you to maintain a stable investment in the
    Department's science and technology (S&T) efforts.
        The Coalition of EPSCoR States strongly supports the Department's
    budget request for basic research. The Defense EPSCoR program is a
    small, but significant, part of this larger program. The Coalition
    recommends that Congress appropriate $25 million to the Defense
    Department's budget for the Defense Experimental Program to Stimulate
    Competitive Research (Program Element PE 61114D).
        EPSCoR is a research and development program that was initiated by
    the National Science Foundation. Through a merit review process, EPSCoR
    is improving our Nation's science and technology capability by funding
    research activities of talented researchers at universities and non-
    profit organizations in states that historically have not received
    significant Federal research and development funding. EPSCoR helps
    researchers, institutions, and states improve the quality of their
    research capabilities in order to compete more effectively for non-
    EPSCoR research funds. EPSCoR is a catalyst for change and is widely
    viewed as a ``model'' federal-state partnership. EPSCoR seeks to
    advance and support the goals of the program through investments in
    four major areas: research infrastructure improvement; research cluster
    development and investigator-initiated research; education, career
    development and workforce training; and outreach and technology
    transfer.
        The Defense Experimental Program to Stimulate Experimental Research
    (DEPSCoR) was initially authorized by Section 257 of the fiscal year
    1995 National Defense Authorization Act (Public Law 103-337). The
    Defense Department's EPSCoR program helps build national infrastructure
    for research and education by funding research activities in science
    and engineering fields important to national defense. DEPSCoR's
    objectives are to:
        Enhance the capabilities of institutions of higher education in
    eligible States to develop, plan, and execute science and engineering
    research that is competitive under the peer-review systems used for
    awarding Federal research assistance; and
        Increase the probability of long-term growth in the competitively
    awarded financial assistance that universities in eligible States
    receive from the Federal Government for science and engineering
    research.
        The Defense EPSCoR program contributes to the states' goals of
    developing and enhancing their research capabilities, while
    simultaneously supporting the research goals of the Department of
    Defense. DEPSCoR grants are based on recommendations from the EPSCoR
    state committees and the Department's own evaluation and ranking.
    Research proposals are only funded if they provide the Defense
    Department with research in areas important to national defense. The
    DEPSCoR states have established an impressive record to research that
    has directly contributed to our Nation's security interests. If you
    will allow me, I would like to highlight some of DEPSCoR's success.
        In my state of South Carolina, researchers from Clemson University
    have produced communications protocols to enhance the effectiveness of
    radio networks on the battlefield. Researchers are focused on the
    development of protocols for mitigating the limitations of radio
    devices of widely disparate capabilities that will be required in
    future tactical communication networks used by the Army. The new
    technique will yield a significant improvement in performance and allow
    for more robust radio system operation for the Army. The University of
    South Carolina has completed a study to help the Navy revolutionize
    data processing methods for battlefield operations through the use of
    sophisticated mathematical techniques. Funded by the Navy, the research
    project, carried out at the internationally recognized Industrial
    Mathematics Institute of the University of South Carolina, develops
    state of the art compression methods that can be used in a variety of
    military scenarios including: automated target recognition, mission
    planning, post battlefield assessment, intelligence and counter
    intelligence.
        University of Alabama researchers have conducted important work to
    reducing gearbox noise in Army helicopters. By reducing the noise
    levels, the crew will be more alert and able to communicate more
    effectively while in such a vehicle, thus improving safe operation of
    the rotorcraft. Additionally, reducing structural vibrations can
    decrease fatigue damage in the rotorcraft.
        Montana State University has received funding from the Air Force to
    conduct research into protecting pilots and sensors from attack from
    laser weaponry. This project is of particular interest for protecting
    pilots using Night Vision Goggles (NVG), for laser range finders and
    target designators.
        University of Nevada at Reno investigators are exploring novel
    military applications for non-lethal weaponry for use by the Air Force.
    This research could be used for ultimately developing ``stunning/
    immobilizing'' weapons that do not rely on chemicals and that do not
    cause human injury. University of Nevada researchers are working on a
    project to mitigate the noise in the drive systems of ships and
    submarines. The mitigation of noise and the accompanying vibration will
    significantly improve stealth performance of naval vessels.
        North Dakota State University obtained funding to develop
    mechanisms that allow the Navy's unmanned airborne vehicles (UAVs) to
    carry out mission tasks with little external supervision and control.
    The development of this technology will lead to individual or teams of
    UAVs efficiently carrying out search, surveillance, reconnaissance, and
    delivery of weapons missions in the presence of enemy threat and
    without risk to the lives of military personnel. University of North
    Dakota researchers received Army funding to develop weather models for
    improving the availability of weather information worldwide.
    Improvements in satellite technology research will lead to a better
    forecasting tool that can be utilized by Army personnel to help
    maximize their advantage in a battlefield or homeland defense
    environment. North Dakota State obtained funding from the Navy to
    conduct a project to lengthen the life of ship structures. This
    research will lead to significant savings in military spending on
    marine fuel, maintenance and replacement of ships.
        University of Vermont researchers conducted a study to decompose
    chemical warfare agents such as mustard gas in a safe and
    environmentally sustainable system. This method is similar to one used
    in industry to remove toxic compounds from the smokestacks of coal-
    burning plants. This process can decompose nearly 100 percent of half
    mustard from a gas sample. The chemical by-products of this process are
    environmentally friendly and non-toxic. Similar technologies can be
    used to decompose sarin, soman, and VX stimulants.
        The Defense Experimental Program to Stimulate Competitive Research
    (DEPSCoR) has been established within DOD to build national
    competitiveness for academic research and education by providing
    funding in science and engineering fields of vital importance to DOD's
    mission. The program improves the abilities of institutions of higher
    education to develop, plan and execute science and engineering research
    that is competitive under DOD's peer-review system and provides
    technological products that serves the needs of the Department of
    Defense and the Uniformed Services. In order to ensure that the
    broadest number of states is providing unique and high value research
    to the Department, the DEPSCoR states propose to augment the current
    program within the parameters of the Department's legislative
    authority.
        Currently, awards are provided to mission-oriented individual
    investigators from universities and other institutions of higher
    education. The individual investigators conduct extremely important
    research that has practical military applications. The program as it is
    currently implemented has not taken into account the significant
    benefits that can be derived from individual investigators pooling
    their efforts to provide ``clusters'' of research that meet the ever
    increasing challenges and needs of the Department and the Services. The
    current program could also benefit from an approach that maximizes the
    number of the 21 DEPSCoR states that receive funding for important
    defense-related projects thus ensuring that these states remain engaged
    in cutting edge research that enhances national defense.
        Working in close consultation with the appropriate officials at the
    Department of Defense, DEPSCoR states propose restructuring the program
    into two components. The first component would retain the current
    program whereby the 21 eligible states (and individual investigators)
    are invited, through their NSF EPSCoR Committee, to compete for
    research awards in areas identified by the Department and the Services.
    The second and new component would award funding to mission-oriented
    ``centers''. These centers of defense excellence would be mission
    oriented interdisciplinary areas to build defense research capacity.
    Under this model, a single university or institution of higher learning
    would be awarded a DEPSCoR grant and would manage the various
    investigators charged with providing interdisciplinary defense
    research. In order to ensure the broadest possible participation of
    DEPSCoR states, only four individual awards and two center awards could
    be active for each state over a three-year period at any one time.
        To achieve important defense research objectives of both components
    of the program, the DEPSCoR states need the program to be funded at $25
    million for fiscal year 2005 with approximately $10 million obligated
    to the individual investigator awards and $15 million for the mission-
    oriented centers initiative. This twin approach to funding important
    research will significantly enhance the Department's ability to tap
    into the best ideas that the DEPSCoR states have to offer in support of
    the Nation's security needs. We are currently in discussions with the
    managers at the Office of Defense Research regarding the proposed
    restructuring of the composition of DEPSCoR.
        The Defense Department's Experimental Program to Stimulate
    Competitive Research is a wise and worthwhile investment of scarce
    public resources. It will continue to contribute significantly to
    efforts to build scientific and engineering research efforts in support
    of national defense needs.
        Finally, the Coalition of EPSCoR States believes a $25 million
    Defense EPSCoR program with the modifications suggested will ensure
    that Federal dollars are being used in a cost-effective way and that
    the EPSCoR states are contributing to the Nation's Defense efforts.
    Thank you for your consideration of this request.

        Senator Stevens. Our last witness is Ms. Fran Visco,
    President of the National Breast Cancer Coalition. Good
    morning.
    STATEMENT OF FRAN VISCO, J.D., PRESIDENT, NATIONAL
                BREAST CANCER COALITION
        Ms. Visco. Good morning, Mr. Chairman. Good morning,
    Senator Inouye. I am a 17-year breast cancer survivor and I am
    privileged to lead the National Breast Cancer Coalition, a
    coalition of more than 600 member organizations from across the
    country and 70,000 individuals.
        We have submitted written testimony that gives you some of
    the successes of the Department of Defense breast cancer
    research program, so I am not going to go into that detail. I
    am here to thank you for your ongoing support of this program
    and to once again assure you that these dollars are being
    incredibly well spent. We are here to ask for level funding to
    continue the program.
        As you know, the overhead for this program is exceedingly
    low. It is incredibly flexible and able to respond to changes
    in science on an annual basis. It is a program that is
    transparent and accountable to the public. The information of
    what this program funds and how it works is freely available.
    The website for the program lists everything that the program
    has funded. Every other year, there is a meeting called the Era
    of Hope, which is one of the few times where the Government
    actually reports to the taxpayer exactly where every dollar
    goes.
        The collaboration among the scientific community, the
    consumer community, and the United States Army has set a model
    for further collaborations. General Martinez Lopez has told us
    that so much of what we come up with in the DOD breast cancer
    research program and the collaborations he has used as a model
    for other biomedical research programs and other programs at
    Fort Detrick. The collaborations that have sprung up between
    world renowned scientists and the United States Army are
    unprecedented as a result of this program.
        Most importantly, it truly has the trust and the faith and
    the support of the American public. This program is a model, a
    model that has been copied by other countries, by other
    biomedical research funding programs, by foundations, by so
    many others to support innovative breast cancer and other
    research.
        This program complements the existing traditional funding
    streams. This program rewards innovation. It looks at new ideas
    and concepts that ultimately become traditional research
    proposals that are funded by the National Cancer Institute and
    the National Institutes of Health. It identifies individuals
    with great vision and promise early in their career and gives
    them the funding to allow them to create new technologies and
    new approaches to eradicating breast cancer. There is no other
    program like the DOD breast cancer program.
        Again, we are so grateful for your continued support. Thank
    you very much.
        Senator Stevens. Thank you very much. We appreciate your
    coming to see us and for your visit to our offices.
        Senator Inouye.
        Senator Inouye. I would like to note, Mr. Chairman, that
    this is another congressional initiative program that you
    began.
        Ms. Visco. Yes.
        Senator Inouye. Thank you very much, sir.
        Ms. Visco. And we are very grateful to him for that. Thank
    you.
        [The statement follows:]
                     Prepared Statement of Fran Visco, J.D.
        Thank you, Mr. Chairman and members of the Appropriations
    Subcommittee on Defense, for your exceptional leadership in the effort
    to increase and improve breast cancer research. You and your Committee
    have shown great determination and leadership in searching for the
    answers by funding the Department of Defense (DOD) Peer-Reviewed Breast
    Cancer Research Program (BCRP) at a level that has brought us closer to
    eradicating this disease.
        I am Fran Visco, a breast cancer survivor, a wife and mother, a
    lawyer, and President of the National Breast Cancer Coalition (NBCC).
    On behalf of NBCC, and the more than 3 million women living with breast
    cancer, I would like to thank you for the opportunity to testify today.
        The DOD BCRP's 12 years of progress in the fight against breast
    cancer has been made possible by this Committee's investment in breast
    cancer research. To continue this unprecedented progress, we ask that
    you support a $150 million appropriation for fiscal year 2005. The
    program was reduced from $175 million to $150 million three years ago
    as part of an across-the-board cut in congressionally directed health
    programs. However, there continues to be excellent science that goes
    unfunded, which is why we believe that the BRCP should be appropriated
    level funding of $150 million for fiscal year 2005.
        As you know, the National Breast Cancer Coalition is a grassroots
    advocacy organization made up of more than 600 organizations and tens
    of thousands of individuals and has been working since 1991 toward the
    eradication of breast cancer through advocacy and action. NBCC supports
    increased funding for breast cancer research, increased access to
    quality health care for all women, and increased influence of breast
    cancer activists at every table where decisions regarding breast cancer
    are made.
               overview of the dod breast cancer research program
        In the past 12 years, the DOD Peer-Reviewed Breast Cancer Research
    Program has established itself as model medical research program,
    respected throughout the cancer and broader medical community for its
    innovative and accountable approach. The groundbreaking research
    performed through the program has the potential to benefit not just
    breast cancer, but all cancers, as well as other diseases. Biomedical
    research is being transformed by the BCRP's success.
        This program is both innovative and incredibly streamlined. It
    continues to be overseen by a group of distinguished scientists and
    activists, as recommended by the Institute of Medicine (IOM). Because
    there is no bureaucracy, the program is able to respond quickly to what
    is currently happening in the scientific community. It is able to fill
    gaps with little red tape. It is responsive, not just to the scientific
    community, but also to the public.
        Since its inception, this program has matured from an isolated
    research program to a broad-reaching influential voice forging new and
    innovative directions for breast cancer research and science. The
    flexibility of the program has allowed the Army to administer this
    groundbreaking research effort with unparalleled efficiency and
    effectiveness.
        In addition, an inherent part of this program has been the
    inclusion of consumer advocates at every level, which has created an
    unprecedented working relationship between advocates and scientists,
    and ultimately has led to new avenues of research in breast cancer.
    Since 1992, more than 600 breast cancer survivors have served on the
    BCRP review panels. Their vital role in the success of the BCRP has led
    to consumer inclusion in other biomedical research programs at DOD.
    This program now serves as an international model.
        It is important to note that the DOD Integration Panel that designs
    this program has a plan of how best to spend the funds appropriated.
    This plan is based on the state of the science--both what scientists
    know now and the gaps in our knowledge--as well as the needs of the
    public. This plan coincides with our philosophy that we do not want to
    restrict scientific freedom, creativity or innovation. While we
    carefully allocate these resources, we do not want to predetermine the
    specific research areas to be addressed.
                          unique funding opportunities
        Developments in the past few years have begun to offer breast
    cancer researchers fascinating insights into the biology of breast
    cancer and have brought into sharp focus the areas of research that
    hold promise and will build on the knowledge and investment we have
    made. The Innovative Developmental and Exploratory Awards (IDEA) grants
    of the DOD program have been critical in the effort to respond to new
    discoveries and to encourage and support innovative, risk-taking
    research. The IDEA grants have been instrumental in the development of
    promising breast cancer research. These grants have allowed scientists
    to explore beyond the realm of traditional research and have unleashed
    incredible new ideas and concepts. IDEA grants are uniquely designed to
    dramatically advance our knowledge in areas that offer the greatest
    potential.
        IDEA grants are precisely the type of grants that rarely receive
    funding through more traditional programs such as the National
    Institutes of Health, and academic research programs. Therefore, they
    complement, and do not duplicate, other federal funding programs. This
    is true of other DOD award mechanisms as well.
        For example, the Innovator awards are structured to invest in world
    renowned, outstanding individuals, rather than projects, from any field
    of study by providing funding and freedom to pursue highly creative,
    potentially breakthrough research that could ultimately accelerate the
    eradication of breast cancer. The Era of Hope Scholar is intended to
    support the formation of the next generation of leaders in breast
    cancer research, by identifying the best and brightest independent
    scientists early in their careers and give them the necessary resources
    to pursue a highly innovative vision towards ending breast cancer.
        Also, Historically Black Colleges and Minority Universities/
    Minority Institutions Partnership Awards are intended to provide
    assistance at an institutional level. The major goal of this award is
    to support collaboration between multiple investigators at an applicant
    Minority Institution and a collaborating institution with an
    established program in breast cancer research, for the purpose of
    creating an environment that would foster breast cancer research, and
    in which Minority Institute faculty would receive training toward
    establishing successful breast cancer research careers.
        These are just a few examples of innovative approaches at the DOD
    BCRP that are filling gaps in breast cancer research. It is vital that
    these grants are able to continue to support the growing interest in
    breast cancer research--$150 million for peer-reviewed research will
    help sustain the program's momentum.
        The DOD BCRP also focuses on moving research from the bench to the
    bedside. A major feature of the awards offered by the BCRP is that they
    are designed to fill niches that are not offered by other agencies. The
    BCRP considers translational research to be the application of well-
    founded laboratory or other pre-clinical insight into a clinical trial.
    To enhance this critical area of research, several research
    opportunities have been offered. Clinical Translational Research Awards
    have been awarded for investigator-initiated projects that involve a
    clinical trial within the lifetime of the award. The BCRP expanded its
    emphasis on translational research by offering five different types of
    awards that support work at the critical juncture between laboratory
    research and bedside applications.
        The Centers of Excellence mechanism bring together consortia of the
    world's most highly qualified individuals and institutions to address a
    major overarching question in breast cancer research that could make a
    major contribution towards the eradication of breast cancer. These
    Centers put to work the expertise of basic, epidemiology and clinical
    researchers; as well as consumer advocates to focus on a major question
    in breast cancer research. Many of these centers are working on
    questions that will translate into direct clinical applications.
                            scientific achievements
        The BCRP research portfolio is comprised of many different types of
    projects, including support for innovative ideas, infrastructure
    building to facilitate clinical trials, and training breast cancer
    researchers.
        One of the most promising outcomes of research funded by the BCRP
    was the development of Herceptin, a drug that prolongs the lives of
    women with a particularly aggressive type of advanced breast cancer.
    This drug could not have been developed without first researching and
    understanding the gene known as HER-2/neu, which is involved in the
    progression of some breast cancers. Researchers found that over-
    expression of HER-2/neu in breast cancer cells results in very
    aggressive biologic behavior. Most importantly, the same researchers
    demonstrated that an antibody directed against HER-2/neu could slow the
    growth of the cancer cells that over-expressed the gene. This research,
    which led to the development of the drug Herceptin, was made possible
    in part by a DOD BCRP-funded infrastructure grant. Other researchers
    funded by the BCRP are currently working to identify similar kinds of
    genes that are involved in the initiation and progression of cancer.
    They hope to develop new drugs like Herceptin that can fight the growth
    of breast cancer cells.
        Several studies funded by the BCRP will examine the role of
    estrogen and estrogen signaling in breast cancer. For example, one
    study examined the effects of the two main pathways that produce
    estrogen. Estrogen is often processed by one of two pathways; one
    yields biologically active substances while the other does not. It has
    been suggested that women who process estrogen via the biologically
    active pathway may be at higher risk of developing breast cancer. It is
    anticipated that work from this funding effort will yield insights into
    the effects of estrogen processing on breast cancer risk in women with
    and without family histories of breast cancer.
        One DOD IDEA award success has supported the development of new
    technology that may be used to identify changes in DNA. This technology
    uses a dye to label DNA adducts, compounds that are important because
    they may play a role in initiating breast cancer. Early results from
    this technique are promising and may eventually result in a new marker/
    method to screen breast cancer specimens.
        Investigators funded by the DOD have developed a novel imaging
    technique that combines two-dimensional and three-dimensional digital
    mammographic images for analysis of breast calcifications. Compared to
    conventional film screen mammography, this technique has greater
    resolution. Ultimately, this technique may help reduce the number of
    unnecessary breast biopsies.
        Despite the enormous successes and advancements in breast cancer
    research made through funding from the DOD BCRP, we still do not know
    what causes breast cancer, how to prevent it, or how to cure it. It is
    critical that innovative research through this unique program continues
    so that we can move forward toward eradicating this disease.
                            federal money well spent
        The DOD BCRP is as efficient as it is innovative. In fact, 90
    percent of funds go directly to research grants. The flexibility of the
    program allows the Army to administer it in such a way as to maximize
    its limited resources. The program is able to quickly respond to
    current scientific advances, and is able to fill gaps by focusing on
    research that is traditionally underfunded. It is responsive to the
    scientific community and to the public. This is evidenced by the
    inclusion of consumer advocates at both the peer and programmatic
    review levels. The consumer perspective helps the scientists understand
    how the research will affect the community, and allows for funding
    decisions based on the concerns and needs of patients and the medical
    community.
        Since 1992, the BCRP has been responsible for managing nearly $1.68
    billion in appropriations, from which 3,671 awards for fiscal year
    1992-2002 were distributed. Approximately 400 awards will be granted
    for fiscal year 2003. The areas of focus of the DOD BCRP span a broad
    spectrum and include basic, clinical, behavioral, environmental
    sciences, and alternative therapy studies, to name a few. The BCRP
    benefits women and their families by maximizing resources; the program
    offers awards that fill existing gaps in breast cancer research.
    Scientific achievements that are the direct result of the DOD BCRP are
    undoubtedly moving us closer to eradicating breast cancer.
        From the program's inception through fiscal year 2002, the BCRP has
    funded research at 3,459 institutions in all 50 states and the District
    of Columbia. I would like to submit a chart for the record that
    demonstrates how the funding has been distributed through fiscal year
    2002.
        The outcomes of the BCRP-funded research can be gauged, in part, by
    the number of publications, abstracts/presentations, and patents/
    licensures reported by awardees. To date, there have been more than
    6,200 publications in scientific journals, more than 4,200 abstracts
    and 140 patents/licensure applications.
        The federal government can truly be proud of its investment in the
    DOD BCRP.
                       positive feedback on the dod bcrp
        The National Breast Cancer Coalition has been the driving force
    behind this program for many years. The success of the DOD Peer-
    Reviewed Breast Cancer Research Program has been illustrated by two
    unique assessments of the program. The IOM, which originally
    recommended the structure for the program, independently re-examined
    the program in a report published in 1997. Their findings
    overwhelmingly encouraged the continuation of the program and offered
    guidance for program implementation improvements.
        The 1997 IOM review of the DOD Peer-Review Breast Cancer Research
    Program commended the program and stated that, ``the program fills a
    unique niche among public and private funding sources for cancer
    research. It is not duplicative of other programs and is a promising
    vehicle for forging new ideas and scientific breakthroughs in the
    nation's fight against breast cancer.'' The IOM report recommended
    continuing the program and established a solid direction for the next
    phase of the program. It is imperative that Congress recognizes the
    independent evaluations of the DOD Breast Cancer Research Program, as
    well as reiterates its own commitment to the program by appropriating
    the funding needed to ensure its success. The IOM report has laid the
    groundwork for effective and efficient implementation of the next phase
    of this vital research program. Now all it needs is the appropriate
    funding.
        The DOD Peer-Reviewed Breast Cancer Research Program not only
    provides a funding mechanism for high-risk, high-return research, but
    also reports the results of this research to the American people at a
    biennial public meeting called the Era of Hope. The 1997 meeting was
    the first time a federally funded program reported back to the public
    in detail not only on the funds used, but also on the research
    undertaken, the knowledge gained from that research and future
    directions to be pursued. The transparency of the BCRP allows
    scientists, consumers and the American public to see the exceptional
    progress made in breast cancer research.
        At the 2002 Era of Hope meeting, all BCRP award recipients from
    fiscal years 1998-2000 were invited to report their research findings,
    and many awardees from previous years were asked to present
    advancements in their research. Scientists reported important advances
    in the study of cancer development at the molecular and cellular level.
    Researchers presented the results of research that elucidates several
    genes and proteins responsible for the spread of breast cancer to other
    parts of the body, and, more importantly, reveals possible ways to stop
    this growth. The meeting, which marked the 10th anniversary of the
    program, also featured grant recipients who are working towards more
    effective and less toxic treatments for breast cancer that target the
    unique characteristics of cancer cells and have a limited effect on
    normal cells. The next meeting will be held in June 2005.
        The DOD Peer-Reviewed Breast Cancer Research Program has attracted
    scientists with new ideas and has continued to facilitate new thinking
    in breast cancer research and research in general. Research that has
    been funded through the DOD BCRP is available to the public.
    Individuals can go to the Department of Defense website and look at the
    abstracts for each proposal at http://cdmrp.army.mil/
    bcrp/.
               commitment of the national breast cancer coalition
        The National Breast Cancer Coalition is strongly committed to the
    DOD program in every aspect, as we truly believe it is one of our best
    chances for finding cures and preventions for breast cancer. The
    Coalition and its members are dedicated to working with you to ensure
    the continuation of funding for this program at a level that allows
    this research to forge ahead.
        In May 1997, our members presented a petition with more than 2.6
    million signatures to congressional leaders on the steps of the
    Capitol. The petition called on the President and the U.S. Congress to
    spend $2.6 billion on breast cancer research between 1997 and the year
    2000. Funding for the DOD Peer-Reviewed Breast Cancer Research Program
    was an essential component of reaching the $2.6 billion goal that so
    many women and families worked for.
        Once again, NBCC is bringing its message to Congress. Just last
    week, many of the women and family members who supported the campaign
    to gather the 2.6 million signatures came to NBCCF's Annual Advocacy
    Training Conference here in Washington, D.C. More than 600 breast
    cancer activists from across the country joined us in continuing to
    mobilize our efforts to end breast cancer. The overwhelming interest
    in, and dedication to eradicate this disease continues to be evident as
    people not only are signing petitions, but are willing to come to
    Washington, D.C. from across the country to deliver their message about
    their commitment.
        Since the very beginning of this program in 1992, Congress has
    stood in support of this important investment in the fight against
    breast cancer. In the years since, Mr. Chairman, you and this entire
    Committee have been leaders in the effort to continue this innovative
    investment in breast cancer research.
        NBCC asks you, the Defense Appropriations Subcommittee, to
    recognize the importance of what you have initiated. You have set in
    motion an innovative and highly efficient approach to fighting the
    breast cancer epidemic. What you must do now is support this effort by
    continuing to fund research that will help us win this very real and
    devastating war against a cruel enemy.
        Thank you again for the opportunity to submit testimony and for
    giving hope to the 3 million women in the United States living with
    breast cancer.

                        ADDITIONAL SUBMITTED STATEMENTS

        [Clerk's Note.--Subsequent to the hearing, the subcommittee
    has received statements from Dennis Duggan of The American
    Legion, MSGT (Ret.) Morgan D. Brown, Manager, Legislative
    Affairs, Air Force Sergeants Association, and the American
    Museum of Natural History which will be inserted in the record
    at this point.]
                   Prepared Statement of The American Legion
        Chairman Stevens and distinguished Members of the Subcommittee: The
    American Legion is grateful for the opportunity to present its views
    regarding defense appropriations for fiscal year 2005. The American
    Legion values your leadership in assessing and appropriating adequate
    funding for quality-of-life, readiness and modernization of the
    Nation's armed forces to include the active, Reserve and National Guard
    forces and their families, as well as quality of life for military
    retirees and their dependents. We realize that many of the personnel
    decisions come from your colleagues on the Armed Service Committee;
    however, your Subcommittee continues to play a significant role in the
    Nation's defense.
        Since September 2001, the United States has been involved in two
    wars--the war against terrorism in Operations Iraqi Freedom and
    Enduring Freedom. American fighting men and women are proving that they
    are the best-trained, best-equipped and best-led military in the world.
    As Secretary of Defense Donald Rumsfeld has noted, the war in Iraq is
    part of a long, dangerous global war on terrorism. The war on terrorism
    is being waged on two fronts: overseas against armed terrorists and the
    other here protecting and securing the Homeland. Indeed, most of what
    we, as Americans, hold dear are made possible by the peace and
    stability, which the armed forces provide.
        The American Legion continues to adhere to the principle that this
    Nation's armed forces must be well-manned and equipped, not just to
    pursue war, but to preserve and protect peace. The American Legion
    strongly believes that past military downsizing was budget-driven
    rather than threat focused. Once Army divisions, Navy warships, and Air
    Force fighter wings are eliminated or retired from the force structure,
    they cannot be rapidly reconstituted regardless of the threat or
    emergency circumstances. Although active duty recruiting has achieved
    its goals, the Army's stop-loss policies have obscured retention of the
    active and reserve components. Military morale undoubtedly has also
    been adversely affected by the extension of tours in Iraq.
        The Administration's budget request for fiscal year 2005 totals
    $2.4 trillion and authorizes $402 billion for defense or about 19
    percent of the budget. The fiscal year 2005 defense budget represents a
    seven percent increase in defense spending over the current funding
    level. It also represents 3.6 percent of the Gross Domestic Product,
    more than the 3.5 percent in the fiscal year 2004 budget. Active duty
    military manpower end strength is 1.388 million, only slightly changed
    from fiscal year 2003. Selected Reserve strength is 863,300 or reduced
    by about 25 percent from its strength levels during the Gulf War of 13
    years ago.
        Mr. Chairman, this budget must advance ongoing efforts to fight the
    global war on terrorism, sustain and improve military quality-of-life
    and continue to transform the military. A decade of overuse of the
    military and its under-funding will necessitate sustained investments.
    The American Legion believes that this budget must also address:
    increases in the military end strengths of the Services; accelerate
    ship production; provide increased funding for the concurrent receipt
    of military retirement pay and VA disability compensation for disabled
    military retirees; and improve survivors benefit plan (SBP) for the
    retired military survivors.
        If we are to win the war on terror and prepare for the wars of
    tomorrow, we must take care of the Department's greatest assets--the
    men and women in uniform. They are doing us proud in Iraq, Afghanistan
    and around the world.
        In order to attract and retain the necessary force over the long
    haul, the active duty force, Reserves and National Guard will continue
    to look for talent in an open market place and to compete with the
    private sector for the best young people this nation has to offer. If
    we are to attract them to military service in the active and reserve
    components, we need to count on their patriotism and willingness to
    sacrifice, to be sure, but we must also provide them the proper
    incentives. They love their country, but they also love their
    families--and many have children to support, raise, and educate. We
    have always asked the men and women in uniform to voluntarily risk
    their lives to defend us; we should not ask them to forgo adequate pay
    and allowances and subject their families to repeated unaccompanied
    deployments and sub-standard housing as well.
        With the eventual lifting of the stop-loss policy, there may be a
    personnel exodus of active duty and reserve components from the Army.
    Retention and recruiting budgets may need to be substantially increased
    if we are to keep, and recruit, quality service members.
        The President's 2005 defense budget requests $104.8 billion for
    military pay and allowances, including a 3.5 percent across-the-board
    pay raise. It also includes $4.2 billion to improve military housing,
    putting the Department on track to eliminate most substandard housing
    by 2007--several years sooner than previously planned. The fiscal year
    2004 budget lowered out-of-pocket housing costs for those living off-
    base from 7.5 percent to 3.5 percent in 2004 so as to hopefully
    eliminate all out-of-pocket costs for the men and women in uniform by
    2005. The American Legion encourages the Subcommittee to continue the
    policy of no out-of-pocket housing costs in future years.
        Together, these investments in people are critical, because smart
    weapons are worthless to us unless they are in the hands of smart,
    well-trained soldiers, sailors, airmen, Marines and Coast Guard
    personnel.
        American Legion National Commanders have visited American troops in
    Europe, the Balkans and South Korea, as well as a number of
    installations throughout the United States, including Walter Reed Army
    Medical Center and Bethesda National Navy Center. During these visits,
    they were able to see first hand the urgent, immediate need to address
    real quality-of-life challenges faced by service members and their
    families. Commanders' have spoken with families on Womens' and Infants'
    Compensation (WIC), where quality-of-life issues for service members,
    coupled with combat tours and other heightened operational tempos, play
    a key role in recurring recruitment and retention efforts and should
    come as no surprise. The operational tempo and lengthy deployments,
    other than combat tours, must be reduced or curtailed. Military
    missions were on the rise before September 11, and deployment levels
    remain high and the only way, it appears, to reduce repetitive overseas
    tours and the overuse of the Reserves is to increase military end
    strengths for the services. Military pay must be on par with the
    competitive civilian sector. Activated Reservists must receive the same
    equipment, the same pay and timely health care as active duty
    personnel. If other benefits, like health care improvements,
    commissaries, adequate quarters, quality childcare, and Impact Aid for
    education or DOD education are reduced, they will only serve to further
    undermine efforts to recruit and retain the brightest and best this
    Nation has to offer.
        The budget deficit is about $374 billion, the largest in U.S.
    history, and it is heading higher perhaps to $500 billion. National
    defense spending must not be a casualty of deficit reductions.
        increasing end strengths and balancing the active/reserve force
                                   structure
        The personnel system and force structure currently in use by the
    United States Armed Forces was created 30 years ago, in the aftermath
    of the Vietnam War. By the mid-1980's, the All Volunteer Force (AVF)
    became the most professional, highly qualified military the United
    States had ever fielded. With 18 Army divisions and 2.1 million on
    active duty, we were geared for the Cold War and that preparedness
    carried over into the Persian Gulf War. Whenever Reservists were
    called-up for the Persian Gulf War or peacekeeping, in the Balkans or
    Sinai, they were never kept on duty for more than six months. In fact,
    many Reservists volunteered to go. This system began to breakdown after
    September 11, 2001 with an overstretched Army which only had ten
    divisions which included a mix of infantry, armor, cavalry, air
    assault, airborne, mechanized and composite capabilities. The
    Quadrennial Defense Review, released one month after the September 11
    attacks, did not alter the mix of active duty and Reserve units. Nor
    did the plans for the invasion of Iraq. The Defense Department admitted
    that rebalancing the way Reserve forces were used was to be a top
    priority. DOD also said that it had seen no evidence to support calls
    to increase the size of the active Army from its current level of
    480,000. The Reserves still account for 97 percent of the military's
    civil affairs units, 70 percent of its engineering units, 66 percent of
    its military police and 50 percent of its combat forces. Moreover, the
    size of the active duty Army has shrunk to 34 percent of the total U.S.
    military and is currently proportionally smaller than at any time in
    its history. This split in the active and Reserve forces have led to
    four major problems, which has been exacerbated by the inability of the
    United States to get troop contributions from other nations.
        First, the Army is severely overstretched and is actively engaged
    with hostile forces in two countries. It has nearly 370,000 soldiers
    deployed in 120 countries around the globe. Of its 33 combat brigades,
    24 (or 73 percent) are engaged overseas. This leaves the United States
    potentially vulnerable in places like the Korean Peninsula, and it
    means that many combat units are sent on back-to-back deployments or
    have had their overseas tours extended unexpectedly.
        Secondly, the failure to increase active forces and reorganize the
    military's personnel and force structures resulted in National Guard
    and Reserve units being mobilized without reasonable notice nor
    equipping. A Maryland National Guard MP battalion, for example, has
    been mobilized three times in the last two years.
        The third problem created by these mobilizations is that many of
    the Reservists have been called up without proper notice and kept on
    duty too long and happen to be police officers, firefighters and
    paramedics in their civilian lives. When these personnel are called for
    military service and kept active for long periods, besides jeopardizing
    their employment, it can reduce the ability of their communities to
    deal with terrorism.
        The fourth problem with the current system is that it has led to a
    decline in the overall readiness of the Army. In fiscal year 2003, the
    Army had to cancel 49 of its scheduled 182 training exercises. The
    first four divisions returning from Iraq in the first five months of
    this year will not be combat-ready again for at least six months since
    their equipment has worn down, troops have worn down and war-fighting
    skills have atrophied while they were doing police work. Through its
    stop-loss measures, the Army has prevented 24,000 active duty troops
    and some 16,000 reservists from leaving its ranks. The Army Reserve
    missed its reenlistment goals for fiscal year 2003.
        Former Assistant Secretary of Defense Lawrence Korb recommends
    three major steps to correct these imbalances: First, the balance of
    active and Reserves must take place even during a war. Forces needed
    for occupation duty, such as military police, civil affairs and
    engineers should be permanently transferred to active duty. Secondly,
    the size of the Army should be quickly increased by at least two more
    divisions or 40,000 spaces. Third, given the threat to the American
    homeland, DOD cannot allow homeland security personnel to join the
    National Guard and Reserves.
        The American Legion supports these recommendations, in particular,
    by permanently increasing the end strengths of the United States Army
    by two additional divisions or by at least 40,000 personnel. The Army
    simply does not have enough division-size units to adequately
    accommodate rotation of units in Iraq in a timely manner and without
    units becoming non-combat ready when they return home.
        Apparently, DOD has resisted making these changes because of the
    expenses they would incur. But given the size of the overall defense
    budget--$420 billion--the money could be found if Congress and DOD
    reordered its priorities.
        By 2007, the Army expects to have created a modern Army by moving
    to brigade-based organizations, rather than division-based. The Army's
    current 33 brigades will expand to as many as 48 brigade units of
    action, which will include five Stryker brigades. The National Guard
    would have the same common design as the Army. To accomplish these
    planned changes, the Army will temporarily add 30,000 spaces to help
    form the new organizations. However, The American Legion understands
    that about 7,000 service members of the 30,000 would be holdovers from
    the stop-loss policy. DOD also anticipates continuing to call Guardsmen
    and Reservists to active duty, which indicates a continuing unit and
    manpower shortage.
                                quality-of-life
        The major national security concern continues to be the enhancement
    of the quality-of-life issues for active duty service members,
    Reservists, National Guardsmen, military retirees, and their families.
    During the last congressional session, President Bush and Congress made
    marked improvements in an array of quality-of-life issues for military
    personnel and their military families. These efforts are visual
    enhancements that must be sustained for active duty personnel,
    Guardsmen and Reservists.
        In previous defense budgets, the President and Congress addressed
    improvements to the TRICARE system to meet the health care needs of
    military beneficiaries; enhanced Montgomery GI Bill educational
    benefits; and elimination of the disabled veterans' tax for severely
    disabled military retirees. For these actions, The American Legion
    applauds your strong leadership, dedication, and commitment. However,
    major issues still remain unresolved: the issue of concurrent receipt
    of full military retirement pay and VA disability compensation without
    the current dollar-for-dollar offset for all disabled retirees needs to
    be resolved, as well as the need to improve survivors' benefits by
    eliminating the 20 percent offset at age 62.
        The American Legion will continue to convey that simple, equitable
    justice is one reason to authorize and fund concurrent receipt.
    Military retirees are the only Federal employees who continue to have
    their retired pay offset with VA disability compensation. Also,
    proponents claim that the unique nature of military service, given
    their sacrifices and hardships, should merit these retirees receiving
    both military retired pay and VA disability compensation. For the past
    decade, many veterans' programs have been pared to the bone in the name
    of balancing the budget. Now, military retirees must pay premiums to
    TRICARE for full health care coverage for themselves and their
    immediate family members. The American Legion feels it is time that
    retirees receive compensation for these fiscal sacrifices. Likewise,
    military survivors have their survivors' benefits reduced from 55
    percent to 35 percent when they become social security eligible.
        Often, VA service-connected disability compensation is awarded for
    disabilities that cannot be equated with disabilities incurred in
    civilian life. Military service rendered in defense, and on behalf, of
    the Nation, deserves special consideration when determining policy
    toward such matters as benefits offsets. The American Legion believes
    it is a moral and ethical responsibility to award disability
    compensation to the needs of disabled veterans, given the sacrifices
    and hardships they incurred during honorable military service to the
    Nation. We are also aware that many of the disabled retirees receive
    retirement pay that is beneath established poverty levels and by
    definition in Title 38 are ``indigent'' veterans.
        Mr. Chairman, The American Legion and the armed forces owe you and
    this Subcommittee a debt of gratitude for your strong support of
    military quality-of-life issues. Nevertheless, your assistance is
    needed now more than ever. Positive congressional action is needed in
    this budget to overcome old and new threats to retaining the finest
    military in the world. Service members and their families continue to
    endure physical risks to their well-being and livelihood, substandard
    living conditions, and forfeiture of personal freedoms that most
    Americans would find unacceptable. Worldwide deployments have increased
    significantly and the Nation is at war: a smaller armed force has
    operated under a higher operational tempo with longer work hours,
    greater dangers, and increased family separations. The very fact that
    over 300,000 Guardsmen and Reservists have been mobilized since
    September 11, 2001 is first-hand evidence that the United States Army
    has needed at least two more active divisions for nearly a decade.
        Throughout the draw down years, military members have been called
    upon to set the example for the nation by accepting personal financial
    sacrifices. Their pay raises have been capped for years, and their
    health care system has been overhauled to cut costs, leaving military
    families with lessened access to proper health care. The American
    Legion congratulates the Congress for their quality-of-life
    enhancements contained in past National Defense Authorization Acts. The
    system however, is in dire need of continued improvement.
        Now is the time to look to the force recruiting and retention
    needs. Positive congressional action is needed to overcome past years
    of negative career messages and to address the following quality-of-
    life features:
      --Closing the Military Pay Gap With the Private Sector.--The previous
            Chairman of the Joint Chiefs of Staff stated that the area of
            greatest need for additional defense spending is ``taking care
            of our most important resource, the uniformed members of the
            armed forces.'' To meet this need, he enjoined Members of
            Congress to ``close the substantial gap between what we pay our
            men and women in uniform and what their civilian counterparts
            with similar skills, training and education are earning.'' But
            11 years of pay caps in previous years took its toll and
            military pay continues to lag behind the private sector at
            about 5.4 percent. With U.S. troops battling terrorism in Iraq
            and Afghanistan, The American Legion supports at least a 3.5
            percent military pay raise. The American Legion believes the
            gap should be erased within three years or less.
      --Basic Allowance for Housing (BAH).--For those who must live off
            base, the payment of BAH is intended to help with their out-of-
            pocket housing expenses. Secretary of Defense Rumsfeld set a
            goal of entirely eliminating average out-of-pocket housing
            expenses. This committee has taken strong steps in recent times
            to provide funding to move toward lowering such expenses by
            2005. Please continue to work to keep the gap closed between
            BAH and the members' average housing costs during future years.
      --Commissaries.--Several years ago, DOD had considered closing some
            37 commissary stores worldwide and reducing operating hours in
            order to resolve a $48 million shortfall in the Defense
            Commissary Agency. Such an effort to reduce or dismantle the
            integrity of the military commissary system would be seen as a
            serious breach of faith with a benefit system that serves as a
            mainstay for the active and reserve components, military
            retirees, 100 percent service-connected disabled veterans, and
            others. The American Legion urges the Congress to preserve full
            federal subsidizing of the military commissary system and to
            retain this vital non-pay compensation benefit. The American
            Legion recommends the system not be privatized or consolidated;
            and that DECA manpower levels not be further reduced. The
            American Legion would oppose any attempts by DOD to impose
            ``variable pricing'' in commissaries.
      --DOD Domestic Dependents Elementary and Secondary Schools (DDESS).--
            The American Legion is concerned about the possible transfer of
            DDESS, which is the target of an ongoing study in DOD. The
            American Legion urges the retention and full funding of the
            DDESS as they have provided a source of high quality education
            for children attending schools on military installations.
                               reserve components
        The advent of smaller active duty forces reinforces the need to
    retain combat-ready National Guard and Reserve forces that are
    completely integrated into the Total Force. The readiness of National
    Guard and Reserve combat units to deploy in the war on terrorism will
    also have a cost in terms of human lives unless Congress is completely
    willing to pay the price for their readiness. With only ten active Army
    divisions in its inventory, America needs to retain the eight National
    Guard divisions, in heightened readiness postures, as its life
    insurance policy.
        Reliance on National Guard and Reserve forces has risen 13-fold
    over the pre-Gulf War era. This trend continues even though both
    reserve and active forces have been cut back 30 percent and about 25
    percent, respectively, from their Cold War highs. In addition, since
    the terrorist attacks on the American homeland on September 11, 2001,
    more than 300,000 Guard and Reserve troops have been activated to
    support homeland defense and overseas operations in the war on terror.
    Soon, 40 percent of the forces in Iraq will consist of activated
    reservists.
        National Guard and Reserve service today involves a challenging
    balancing act between civilian employment, family responsibilities, and
    military service. Increasingly, National Guard and Reserve families
    encounter stressful situations involving healthcare, economic
    obligations, and employer uncertainty. Much was accomplished last year
    for the Guard and Reserves. Benefit issues of particular concern in
    this area include:
      --Review and upgrade the Reserve compensation and retirement system
            without creating disproportional incentives that could
            undermine active force retention; change the retirement age
            from 60 to 55 for Guardsmen and Reservists;
      --Continue to restore the tax deductibility of non-reimbursable
            expenses directly related to Guard and Reserve training;
      --Reduce the operations tempo; increase Army force levels; allocate
            adequate recruiting and retention resources;
      --Streamline the Reserve duty status system without compromising the
            value of the compensation package;
      --Improve Reserve Montgomery GI Bill (MGIB) benefits proportional to
            the active duty program;
      --Allow Reservists activated for 12 months or longer to enroll in the
            active duty MGIB;
      --Allow the Guard and Reserve to accrue for retirement purposes all
            points earned annually;
      --Make TRICARE permanently available to all drilling Guardsmen and
            Reservists and their families;
      --Give tax credits for employers who choose to make up the difference
            between military pay and Reservists salary when they are
            activated;
      --Growing concerns are that the Reserve Components, especially the
            National Guard, are being overused in contingency and
            peacekeeping operations, as these service members have regular
            civilian jobs and families as well. The National Guard also has
            state missions in their home states. The American Legion
            understands that retention rates and, therefore, strength
            levels are falling in those states, which have deployed or
            scheduled to deploy Guardsmen overseas. Governors of these
            states continue to express concern that state missions will not
            be accomplished. The National Guard from 44 states has had a
            presence in 35 foreign countries.
        The American Legion is also supportive of all proposed quality-of-
    life initiatives that serve to improve living and working conditions of
    members of the Reserve components and their families.
                         other military retiree issues
        The American Legion believes strongly that quality-of-life issues
    for retired military members and families also are important to
    sustaining military readiness over the long term. If the Government
    allows retired members' quality-of-life to erode over time, or if the
    retirement promises that convinced them to serve are not kept, the
    retention rate in the current force will undoubtedly be affected. The
    old adage that ``you enlist a recruit, but you reenlist a family'' is
    truer today than ever as more career-oriented service members are
    married or have dependents.
        Accordingly, The American Legion believes Congress and the
    Administration must place high priority on ensuring that these long-
    standing commitments are honored:
      --VA Compensation Offset to Military Retired Pay (Retired Pay
            Restoration).--Under current law, a military retiree with
            compensable, VA disabilities cannot receive full military
            retirement pay and VA disability compensation. The military
            retiree's retirement pay is offset (dollar-for-dollar) by the
            amount of VA disability compensation awarded. The American
            Legion supports restoration of retired pay (concurrent receipt)
            for all disabled military retirees. We would like to thank the
            Subcommittee for authorizing concurrent receipt for disabled
            retirees rated 50 percent and higher and for including
            Temporary Early Retirement Authority (TERA) retirees as well as
            disabled retired Reservists who are receiving retired pay for
            longevity. The American Legion is also grateful for the
            Enhanced Combat-Related Special Compensation (CRSC), which was
            enacted in the fiscal year 2003 National Defense Authorization
            Act. Mr. Chairman, we have a long way to go in extending
            concurrent receipt to those disabled retirees for longevity
            rated 50 percent and less; and including TERA retirees in CRSC
            eligibility; and by extending concurrent receipt to those
            disabled retirees who were medically retired before reaching 20
            years of service. The American Legion has visited Walter Reed
            Army Medical Center on numerous occasions to talk with wounded
            and injured young soldiers, many with amputated limbs suffered
            as a result of combat action in Iraq and Afghanistan. They too
            are prohibited from receiving both military retirement pay for
            their physical disability and VA disability compensation. This
            puts an additional financial strain on these severely disabled
            soldiers and their families. The American Legion is extending
            its Family Support Network to these soldiers and their families
            when they are medically retired from the service. The purposes
            of these two compensation elements are fundamentally different.
            A veteran's disability compensation is paid to a veteran who is
            disabled by injury or disease incurred or aggravated during
            active duty military service. Monetary benefits are related to
            the residual effects of the injury or disease or for the
            physical or mental pain and suffering and subsequently reduced
            employment and earnings potential. Action should be taken this
            year to provide full compensation for those military retirees
            who served both more than and fewer than 20 years in uniform
            and incurred service-connected disabilities. Disabled military
            retirees are the only retirees who pay for their own disability
            compensation from their retirement pay; and they cannot receive
            both military disability retirement pay and VA disability
            compensation. It is time to completely cease this inequitable
            practice. What better time to authorize and fund concurrent
            receipt for all disabled retirees than during this period of
            War.
      --Social Security Offset to the Survivors' Benefits Plan (SBP).--The
            American Legion supports amending Public Law 99-145 to
            eliminate the provision that calls for the automatic offset at
            age 62 of the military SBP with Social Security benefits for
            military survivors. Military retirees pay into both SBP and
            Social Security, and their survivors pay income taxes on both.
            The American Legion believes that military survivors should be
            entitled to receipt of full Social Security benefits, which
            they have earned in their own right. It is also strongly
            recommended that any SBP premium increases be assessed on the
            effective date of, or subsequent to, increases in cost of
            living adjustments and certainly not before the increase in SBP
            as has been done previously. In order to see some increases in
            SBP benefits, The American Legion would support an improvement
            of survivor benefits from 35 percent to 55 percent over a ten-
            year period. The American Legion also supports initiatives to
            make the military survivors' benefits plan more attractive.
            Currently, about 75 percent of officers and 55 percent of
            enlisted personnel are enrolled in the plan.
      --Reducing the Retired Reservist age from 60 to 55.--The American
            Legion believes that retirement pay should be paid sooner as
            members of the Guard and Reserve are now being used to replace
            active duty forces in Afghanistan and Iraq and are projected to
            become 40 percent of total forces in those theaters. Similarly,
            these retirees and their dependents should be eligible for
            TRICARE health care and other military privileges when they
            turn 55.
      --Military Retired Pay COLAs.--Service members, current and future,
            need the leadership of this Subcommittee to ensure Congress
            remains sensitive to long-standing contracts made with
            generations of career military personnel. A major difficulty is
            the tendency of some to portray all so-called ``entitlement''
            programs, including military retirement, as a gratuitous gift
            from the taxpayer. In truth, military retired pay is earned
            deferred compensation for accepting the unique demands and
            sacrifices of decades of military service. The military
            retirement system is among the most important military career
            incentives. The American Legion urgently recommends that the
            Subcommittee oppose any changes to the military retirement
            system, whether prospective or retroactive that would undermine
            readiness or violate contracts made with military retirees.
      --The SBP Veterans Dependency and Indemnity Compensation (DIC) Offset
            for Survivors.--Under current law, the surviving spouse of a
            retired military member who dies from a service connected
            condition and the retiree was also enrolled in SBP, the
            surviving spouse's SBP benefits are offset by the amount of DIC
            (currently $948 per month). A pro-rated share of SBP premiums
            is refunded to the widow upon the member's death in a lump sum,
            but with no interest. The American Legion believes that SBP and
            DIC payments, like military retirement pay and disability
            compensation, are paid for different reasons. SBP is elected
            and purchased by the retiree based on his/her military career
            and is intended to provide a portion of retired pay to the
            survivor. DIC payments represent special compensation to a
            survivor whose sponsor's death was caused directly by his or
            her uniformed service. In principle, this is a government
            payment for indemnity or damages for causing the premature loss
            of life of the member, to the extent a price can be set on
            human life. These payments should be additive to any military
            or federal civilian SBP annuity purchased by the retiree. There
            are approximately 27,000 military widows/widowers affected by
            the offset under current law. Congress should repeal this
            unfair law that penalizes these military survivors.
                                  conclusions
        Thirty years ago America opted for an all-volunteer force to
    provide for the national security. Inherent in that commitment was a
    willingness to invest the needed resources to bring into existence a
    competent, professional, and well-equipped military. The fiscal year
    2005 defense budget, while recognizing the War on Terrorism and
    Homeland Security, represents another good step in the right direction.
        What more needs to be done? The American Legion recommends, as a
    minimum, that the following steps be implemented:
      --Continued improvements in military pay, equitable increases in
            Basic Allowances for Housing and Subsistence, military health
            care, improved educational benefits under the Montgomery G.I.
            Bill, improved access to quality child care, impact aid and
            other quality-of-life issues. The concurrent receipt of
            military retirement pay and VA disability compensation for all
            disabled retirees needs to be authorized and funded. The
            Survivors' Benefit Plan needs to be increased from 35 to 55
            percent for Social Security-eligible military survivors.
      --Defense spending, as a percentage of Gross Domestic Product, needs
            to be maintained at least 3.5 percent annually which this
            budget does achieve.
      --The end strengths of the active armed forces need to be increased
            to at least 1.6 million for the Services and the Army needs to
            be increased by two more divisions.
      --The Quadrennial Defense Review strategy needs to call for enhanced
            military capabilities to include force structures, increased
            end strengths and improved readiness, which are more adequately
            resourced.
      --Force modernization needs to be realistically funded and not
            further delayed or America is likely to unnecessarily risk many
            lives in the years ahead;
      --The National Guard and Reserves must be realistically manned,
            structured, equipped and trained, fully deployable, and
            maintained at high readiness levels in order to accomplish
            their indispensable roles and missions. Their compensation,
            health care, benefits and employment rights need to be
            continually improved.
      --Although the fiscal year 2004 Supplemental Appropriations increased
            funding to purchase body armor and armored HMMVV's, we are very
            disappointed by numerous news accounts of individuals buying
            their own body armor and recommend increased funding.
        Mr. Chairman, this concludes The American Legion statement.
                                     ______

           Prepared Statement of the Air Force Sergeants Association
        Mr. Chairman and distinguished committee members, on behalf of the
    135,000 members of the Air Force Sergeants Association, thank you for
    this opportunity to offer the views of our members on the military
    quality-of-life programs that affect those serving (and who have
    served) our nation. AFSA represents active duty, Guard, Reserve,
    retired, and veteran enlisted Air Force members and their families.
    Your continuing effort toward improving the quality of their lives has
    made a real difference, and our members are grateful. Listed below are
    several specific goals for which we hope this committee will
    appropriate funds for fiscal year 2005 on behalf of current and past
    enlisted members and their families. As always, we are prepared to
    present more details and to discuss these issues with your staffs. This
    presentation includes many items reflecting the communication we
    receive from our members, and it offers an insight into perceived
    inequities within the military compensation program.
                         military pay and compensation
        Enlisted military members receive lower pay and lower allowances
    for food and housing. To put it simply, enlisted members are paid the
    least in basic pay, and are expected to spend less for their food and
    to house their families. Of course, this simply means they will have to
    spend more ``out of pocket'' to protect their families. Obviously,
    enlisted members want no less than commissioned officers for their
    families to live in good neighborhoods and to attend good schools. So,
    enlisted members are forced to make this happen by spending more of
    their basic pay--because their allowances are inadequate. We urge this
    committee to support more equitable compensation/allowance levels for
    enlisted members, with emphasis on targeted increases for senior NCOs
    to more fairly compensate them for their responsibilities and the
    military jobs they do for their nation. Some specific areas that we
    hope the committee will examine:
      --Provide Hazardous Duty Incentive Pay (HDIP) for military
            firefighters. DOD and all services have reached agreement on
            this and are ready to support and fund it. The committee can
            easily verify this through military legislative liaison
            contacts and through service leadership. AFSA believes this pay
            is long overdue for these military servicemembers who serve
            under incredible risk--even during peacetime. If any military
            occupational specialty should receive HDIP, military
            firefighters should receive it. It would cost $9.4 million per
            year to provide this funding for all services. It is strongly
            endorsed by this association and by the associations in the
            Military Coalition. We urge the committee to make this happen--
            this year.
      --Reform military pay to more equitably reflect enlisted
            responsibilities in relation to the overall Air Force mission.
            Further targeting is warranted.
      --Make the recent increases in Family Separation Allowance ($250),
            and Imminent Danger Pay ($225) permanent. These levels are
            reasonable and more reflective of the financial burdens of
            those serving and those left at home.
      --Provide Assignment Incentive Pay to those stationed in Korea.
            Military and government leaders often speak of the imminent
            danger posed by the North Koreans and how the troops stationed
            there are at the ``tip of the spear,'' forming the front lines
            of our defenses. These brave men and women should receive some
            type of special pay or tax advantage. Perhaps the answer is to
            mandate an amount of the Assignment Incentive Pay signed into
            law during the 107th Congress.
      --Establish a standard, minimum reenlistment bonus at the time of
            reenlistment for all enlisted members regardless of component,
            time-in-service, or AFSC. We often hear from our members that
            it is demotivating that subordinates often receive bonuses,
            while those who lead them do not. In fact, such bonuses are
            generally not offered after the 15th year of service. While we
            realize that such bonuses are nothing more than force
            manipulation tools, it would be proper to provide some level of
            bonus each time a military member commits to put his/her life
            on the line for an additional extended period of military
            service.
                              educational benefits
        While a number of issues must be addressed in relation to the
    Montgomery G.I. Bill, we realize they do not specifically fall under
    the jurisdiction of this committee. However, it is imperative that
    those (from that era) who did not enroll in the old Veterans
    Educational Assistance Plan get an opportunity to enroll in the
    Montgomery G.I. Bill. Many are now retiring after devoting a career of
    military service, yet they have no transitional education benefit.
    Additionally, military members give more than enough to this nation
    that they should not have to pay $1,200 into the Montgomery G.I. Bill
    in order to use it. Members ought to be able to transfer their G.I.
    Bill benefits to their family members--perhaps as a career incentive
    (e.g., after serving 12 or 14 years). The 10-year benefit limitation
    after separation needs to be repealed; it is unfair to enlisted members
    and serves no purpose other than to discourage use of this important
    benefit. We ask that you provide the funding necessary to enact these
    changes to the MGIB. In addition, we ask this committee to:
      --Eliminate any service Tuition Assistance caps. As military members
            increase their education levels, they are able to progressively
            increase their contribution to the mission. As has often been
            said, every dollar this nation spends on education returns many
            fold in the contribution the more-educated citizen (military
            member) makes to society and the U.S. economy.
      --Ensure full funding of the Impact Aid Program. This committee is
            forced to address the Impact Aid issue each year. It has had to
            do so regardless of the Administration in power. In order to
            protect the families (especially the children) of military
            members, we ask you to continue your great work in providing
            Impact Aid funding.
      --Enhance the Selected Reserve Montgomery G.I. Bill (SR-MGIB)
            benefit. AFSA asks this committee to provide the funding
            necessary to increase the value of the SR-MGIB to ensure it
            measures up to 47 percent of the value of the active duty MGIB.
            This was the congressional intent when the SR-MGIB began. At
            the present time, the SR-MGIB is only worth 29 percent of the
            MGIB. We ask you to support increasing the value of the SR-MGIB
            and establishing an automatic indexing with the active duty
            program. Additionally, we ask you to provide the necessary
            funding which would allow Guardsmen and Reservists to use the
            SR-MGIB beyond the current 14-year duration of the program.
            They should be able to use the program during their time of
            service and for a reasonable period after they have completed
            their military obligation.
      --Provide military members and their families in-state tuition rates
            at federally supported state universities. Military members are
            moved to stations around the world at the pleasure of the
            government. Yet, they are treated as visitors wherever they go.
            Fairness would dictate that, for the purposes of the cost of
            higher education, they be treated as residents so that they can
            have in-state rates at federally supported colleges and
            universities in the state where they are assigned. We would ask
            this committee to exert the necessary influence to require
            federally supported institutions to consider military members
            assigned in their state as ``residents,'' for the purposes of
            tuition levels.
                    air national guard and air force reserve
        The role of the Guard and Reserve (G&R) has increased dramatically.
    Our military establishment simply could not execute the War on
    Terrorism nor this nation's worldwide military operations without the
    direct participation of G&R members. We learned much after 9/11 as
    mobilization took place and as G&R members were increasingly deployed.
    The following initiatives have been called for by AFSA members. Many of
    these are equity issues. AFSA believes that each of the items is the
    right thing to do.
      --Reduce the earliest G&R retirement age from 60 to 55. It is simply
            wrong that these patriots are the only federal retirees that
            have to wait until age 60 to fully enjoy retirement benefits.
            While we realize that DOD considers this a budgetary burden, it
            is the right thing to do. Additionally, it would allow for
            greater movement from rank-to-rank since most G&R promotions
            are by vacancy. While there are many bills on the table (many
            inspired by budgetary considerations rather than doing the
            right thing), we urge this committee to fully support S. 1035,
            sponsored by Senator Jon Corzine. That bill would provide full
            retirement benefits as early as age 55.
      --Provide full (not fractioned) payment of flying, hazardous duty,
            and other special pays; i.e., eliminate ``1/30'' rules. These
            ``fractioned'' allowances are wrong. They denigrate the service
            and the risk faced by members of the Guard and Reserve. We ask
            the committee to fund these important ``risk-based'' allowances
            on the same basis for G&R members as they are paid for active
            duty members.
      --Provide BAH ``Type 1'' to all G&R members TDY or activate,
            including those activated or TDY for less than 139 days. Unlike
            an active duty member, G&R members typically have civilian
            employment and always return to their residence upon completion
            of military duty. Their house payment does not go away.
            Providing full BAH to deployed G&R members would allow them to
            adequately protect their investment in their homes and the
            financial wellbeing of their families, if applicable.
      --Provide G&R First Sergeants and Command Chief Master Sergeants with
            full, special duty assignment pay on the same basis it is paid
            to active duty members. Like active duty members, the
            extraordinary duties and expenses of these two groups of
            leaders does not take place only during duty hours. G&R First
            Sergeants and Command Chiefs have duties throughout the month
            (whether they are ``officially'' on duty or not). For that
            reason, equity would call for this special pay to be paid on
            the same basis as it is for active duty enlisted leaders.
                              retirement benefits
        AFSA applauds this committee for its support of the partial
    resolution to the Concurrent Receipt issue included in Section 641 of
    the fiscal year 2004 NDAA and the expansion of Combat-Related Special
    Compensation under Section 642. Despite the specter of a veto threat
    throughout the year and intense political wrangling, in the end the
    right thing was done. The principle has now been established in law.
    Congress has recognized that retirees who are disabled by their
    military service should be allowed to collect the full retirement pay
    they earned through long-term honorable service to the nation. They
    also ought to receive just compensation for maladies caused by military
    service--injuries that will have an impact on their employability and
    their quality of life during their remaining days on Earth. Now, AFSA
    urges that the effort shift toward restoring military retired pay for
    those with disabilities of 40 percent and lower. We ask the committee
    to help establish a timetable to address this important issue for those
    with VA disability ratings of 40 percent and lower.
                    morale, welfare and recreation programs
        These programs form an essential part of military life. They build
    a sense of community, enhance morale, promote fitness, provide support
    to family members left behind when the military member is deployed, and
    financially support military families. It is extremely important that
    this committee support full funding of Child Development Centers. These
    facilities are not a luxury, they are absolutely necessary for the
    completion of this nation's military mission.
                         housing and shipment programs
        The process of shipping military personal property has historically
    been a nightmare for military service members. They have had to accept
    that their personal goods will be lost, stolen, or damaged. In fact,
    that is a normal part of nearly every military move. One reason that
    military household goods have been treated so shoddily is that carriers
    are selected based on ``low bid''--not high quality and/or customer
    satisfaction. Also, the claims process to recover the financial loss
    caused by loss or damage is so cumbersome that many people don't bother
    to file a claim. Those who do file a claim soon learn that they will be
    reimbursed only a fraction of the cost of the actual loss or damage. We
    recommend this committee appropriate funds to specifically address the
    following housing and shipment-related issues.
      --Provide a household goods weight allowance for military spouses to
            accommodate professional books, papers, and/or equipment needed
            to support employment of military spouses. Because the majority
            of military spouses now work (especially in enlisted families),
            it is appropriate that they be afforded a weight allowance to
            accommodate their professional documents, books, and supplies.
            This would be in keeping with DOD's recent focus on ``family
            readiness.'' This allowance would also support such things as
            supplies for family in-home day care, etc.
      --Authorize reimbursement for alternate POV storage. If advantageous
            to the government, reimburse transportation expenses for
            members to take their POVs to a location other than a
            commercial storage facility when PCSing (e.g., to leave the
            vehicle with a relative). Currently, when a member is sent
            overseas to a location where the government will not ship a
            POV, the government must pay to store the vehicle and reimburse
            the member for mileage accumulated while taking the POV to a
            commercial storage facility. Sometimes it would cost the
            government less to reimburse a member for driving his/her
            vehicle to store it at no cost at a relative's or friend's
            home. On top of that, the government would not have to pay the
            storage fees! Of course, those who got reimbursed for taking
            their vehicle to other than a commercial storage facility would
            waive the government storage benefit. In many cases this
            approach would save the government money, as well as passing
            the common sense test.
      --Provide all military members being reassigned to CONUS or OCONUS
            locations the option of government-funded shipment or storage
            of a second privately owned vehicle. Current demographics,
            family employment realities, and average number of family
            vehicles justify making this change. This would be seen as a
            positive step forward, particularly for enlisted military
            members. For them, a privately owned vehicle is a major
            investment in their overall financial well-being. Leaving a
            vehicle behind is usually not an option since few enlisted
            members can afford to store one. As such, a PCS move can have a
            significantly onerous financial impact on an enlisted family.
            Especially if they are forced to sell their vehicle.
            Additionally, because both spouses have to work to support the
            family, we are forcing the family to purchase a second vehicle
            at the PCS location--often at overseas locations where the
            vehicles are significantly overpriced.
                               survivor benefits
        AFSA appreciates this committee's attention to the needs of those
    left behind when a current or past military member passes away. The
    spouses of military members also serve their nation, facing the rigors
    of that lifestyle, and always being aware that their military spouse
    has agreed to the ultimate sacrifice. It is important that we correct
    some inequities that military survivors face.
        Eliminate the age 62 Survivor Benefit Plan annuity reduction. We
    urge you to take action to eliminate the unfair Survivor Benefit Plan
    (SBP) ``Widows Tax.'' A widow's SBP annuity is reduced by 36 percent
    when she reaches age 62. Before age 62, she receives 55 percent of the
    deceased military retiree's base retirement pay; at age 62, it drops to
    35 percent of the base retirement pay. This is a financially
    devastating blow to many survivors, many of whom are on fixed incomes.
    On top of that it is just plain wrong!
        When Congress passed SBP in 1972, the intent was for the retiree to
    pay 60 percent of program costs, with a 40 percent government subsidy.
    However, due to miscalculations and annuitant changes, the government
    subsidy now is just 19 percent. The retiree is paying 81 percent of SBP
    costs! In 1989 when the subsidy had dropped to just 28 percent,
    Congress reduced premiums to readjust the government's fair share. With
    the government subsidy only 19 percent, a major readjustment is needed
    immediately. One can only imagine the requests that would come from DOD
    if the situation were reversed. One very fair way to rectify the
    situation would be to raise the modest survivor annuities. Many
    military members were misled to believe that the survivor's annuity
    would be 55 percent for life. Many are shocked when they find that the
    annuity will drop to 35 percent at age 62. Additionally, there is no
    such reduction in the federal civilian SBP which is much more highly
    subsidized. It is wrong that the most senior military survivors are not
    protected in a similar manner.
      --Accelerate the fully-paid-up status for SBP and RSFPP participants
            who have reached age 70 and have paid into the program 30
            years. When Congress passed the paid-up provision five years
            ago, it set the effective date at 2008. While that change will
            be welcomed by those who reach age 70 around that time, many
            more will no so benefit. In fact, many current SBP enrollees
            will have to have paid more than 35 years at the time that
            their program is considered paid up. AFSA urges this committee
            to support changing the paid-up effective date to the date of
            enactment of the Fiscal Year 2005 National Defense
            Authorization Act.
      --Allow Dependency and Indemnity Compensation (DIC) widows to remarry
            after age 55 without losing their entitlement. Last year
            Congress took a great step forward by allowing such widows to
            remarry after age 57 without losing their benefit. We ask the
            committee support making that ``age 55'' to make DIC consistent
            with all other federal programs.
                                  health care
        Military health care and readiness are inseparable, and military
    members and their families must know that no matter where they are
    stationed or where the families live, their health care needs will be
    taken care of.
      --Improve the dependant and retiree dental plans. We often hear that
            the dependent dental insurance plan is a very, poor one.
            Additionally, retirees complain that the retiree dental plan is
            overpriced, provides inadequate coverage, and is not worth the
            investment. This is important because military retirees were
            led to believe they would have free/low cost, comprehensive,
            lifetime military dental care. We urge this committee to
            appropriate additional funding to improve the quality and
            adequacy of these two essential dental plans.
      --Increase provider reimbursement rates to ensure quality providers
            in the TRICARE system. Perhaps the greatest challenge this
            committee faces toward keeping the military health care system
            viable is retaining health care providers in the TRICARE
            networks. This challenge goes hand-in-hand with that which is
            faced by Medicare. If we do not allow doctors to charge a fair
            price for services performed, they will not want to participate
            in our program. If they do not participate, the program will
            fail. We have had many members say that they know of doctors
            that will not treat them because the doctor does not respect
            nor accept TRICARE. Further questioning usually indicates that
            the doctors do not welcome TRICARE patients because they have
            to accept significantly less reimbursement for their services.
            That begs the question--why should they? We urge this committee
            to consider increasing the CHAMPUS Maximum Allowable Charge to
            higher levels to ensure quality providers stay in the system.
      --Provide Guard and Reserve members and their families with a
            comprehensive TRICARE benefit. This is critical to ensure the
            deployability of the member, and it is important that his/her
            family is protected when the military member is away from home
            serving his/her nation. We owe these patriots a comprehensive
            program.
        Mr. Chairman, thank you for this opportunity to present some of the
    challenges faced by enlisted military members. As you know, they ask
    little in return for serving their nation. The items they ask us to
    bring to you, such as those above, would provide equity in some cases
    and program improvement in others. On behalf of the members of the Air
    Force Sergeants Association, we ask you to include consideration of
    these items in your deliberations as you formulate your mark-up for the
    Defense portion of the fiscal year 2005 Appropriations Act. We would be
    happy to provide more information or to answer any questions you might
    have on these important matters.
                                     ______

          Prepared Statement of the American Museum of Natural History
    About the American Museum of Natural History
        The American Museum of Natural History [AMNH] is one of the
    nation's preeminent institutions for scientific research and public
    education. Since its founding in 1869, the Museum has pursued its
    mission to ``discover, interpret, and disseminate--through scientific
    research and education--knowledge about human cultures, the natural
    world, and the universe.'' With nearly four million annual visitors--
    approximately half of them children--its audience is one of the largest
    and most diverse of any museum in the country. Museum scientists
    conduct groundbreaking research in fields ranging from all branches of
    zoology, comparative genomics, and bioinformatics to earth, space, and
    environmental sciences and biodiversity conservation. Their work forms
    the basis for all the Museum's activities that seek to explain complex
    issues and help people to understand the events and processes that
    created and continue to shape the earth, life and civilization on this
    planet, and the universe beyond.
        More than 200 Museum scientists, led by 46 curators, conduct
    cutting-edge research programs as well as fieldwork and training.
    Scientists in five divisions (Anthropology; Earth, Planetary, and Space
    Sciences; Invertebrate Zoology; Paleontology; and Vertebrate Zoology)
    are using leading technologies to sequence DNA and create new
    computational tools to retrace the evolutionary tree, document changes
    in the environment, make new discoveries in the fossil record, and
    describe human culture in all its variety. The Museum also conducts
    undergraduate, graduate, and postdoctoral training programs in
    conjunction with a host of distinguished universities.
        The Museum's collections of more than 32 million specimens and
    artifacts are a major resource for Museum scientists as well as for
    more than 250 national and international visiting scientists each year.
    Including endangered and extinct species as well as many of the only
    known ``type specimens,'' or examples of species by which all other
    finds are compared, the collections provide an irreplaceable record of
    life on earth and the critical baseline resources for 21st century
    research in life, earth, environmental, and other sciences. The Museum
    has also recently expanded its collections to include biological
    tissues and isolated DNA maintained in a super-cold tissue facility.
    Preserving genetic material and gene products from rare and endangered
    organisms that may become extinct before science fully exploits their
    potential, this frozen tissue collection is an invaluable research
    resource in many fields, including genetics, comparative genomics, and
    biodefense.
        The Museum interprets the work of its scientists, addresses current
    scientific and cultural issues, and promotes public understanding of
    science through its renowned permanent and temporary exhibits as well
    as its comprehensive education programs. These programs attract more
    than 400,000 students and teachers and more than 5,000 teachers for
    professional development opportunities. The Museum also takes its
    resources beyond its walls through the National Center for Science
    Literacy, Education, and Technology, launched in 1997 in partnership
    with NASA.
    Advancing Department of Defense Science Goals
        The Department of Defense (DOD) safeguards the nation's security
    and is committed to the research, tools, and technology that will
    ensure the capabilities needed to counter 21st century security threats
    most effectively and efficiently. With its highest priority winning the
    global war on terrorism, DOD supports research development to prepare
    for and respond to the full range of terrorist threats, including
    bioterrorism. The American Museum, in turn, is home to preeminent
    programs in molecular biology, comparative genomics, and computation
    that closely tie to DOD's research goals for advancing the nation's
    security and defense capabilities, including biodefense and protection
    of troops in the field.
        Genomic science is critical to the nation's defense interests.
    Moreover, studying genomic data in a natural history context makes it
    possible to more fully understand the impacts of new discoveries in
    genomics and molecular biology. Genomes of the simplest organisms
    provide a window into the fundamental mechanics of life, and
    understanding their natural properties and their evolution (for
    example, the evolution of pathogenicity in bacteria) can help to solve
    challenges in biodefense and bring biology and biotechnology to bear in
    defense applications.
        The American Museum's distinguished molecular research programs are
    deeply engaged in genome research aligned with DOD's various research
    thrusts, and, as discussed below, its unique expertise in evolutionary
    analysis is particularly relevant in these areas. In the Museum's
    molecular laboratories, in operation now for eleven years, more than 40
    researchers in molecular systematics, conservation genetics, and
    developmental biology conduct genetic research on a variety of study
    organisms, utilizing state of the art sequencers and other advanced
    technologies. The labs also nourish the Museum's distinguished training
    programs that serve up to 80 undergraduates, doctoral, and postdoctoral
    trainees annually.
        Advanced computation is also critically important in understanding
    and responding to threats of bioterrorism. The Museum is a leader in
    developing vital computational tools, as parallel computing is an
    essential enabling technology for phylogenetic (evolutionary) analysis
    and intensive, efficient sampling of a wide array of study organisms.
    Museum scientists have constructed an in-house 900-CPU computing
    facility that is the fastest parallel computing cluster in an
    evolutionary biology laboratory and one of the fastest installed in a
    non-defense environment. Their pioneering efforts in cluster computing,
    algorithm development, and evolutionary theory have been widely
    recognized and commended for their broad applicability for biology as a
    whole. The bioinformatics tools Museum scientists are creating will not
    only help to generate evolutionary scenarios, but also will inform and
    make more efficient large genome sequencing efforts. Many of the
    parallel algorithms and implementations (especially cluster-based) will
    be applicable in other informatics contexts such as annotation and
    assembly, breakpoint analysis, and non-genomic areas of evolutionary
    biology and other disciplines.
    Institute of Comparative Genomics
        Building on its strengths in molecular biology, genomics science,
    and computation, in 2001 the Museum launched the Institute for
    Comparative Genomics. The importance of the comparative approach cannot
    be overstated, as investigating genomics with a natural history
    perspective enlarges our understanding of the evolutionary
    relationships among organisms including threat agents and
    pathogenicity, and ultimately, of humans, medicine, and life itself.
    Equipped with DNA sequencers in its molecular labs, vast biological
    collections, researchers with expertise in the methods of comparative
    biology, the computing cluster, and the new frozen tissue collection,
    the Institute is positioned to be one of the world's premier research
    facilities for mapping the genome across a comprehensive spectrum of
    life forms.
        The Institute is establishing a distinguished research record in
    areas of core concern to DOD. Museum scientists are leading major new
    international research projects in assembling the ``tree of life,'' and
    have obtained a patent for an innovative approach to analyzing
    microarray data, which can be used to support more accurate diagnosis
    of pathogens or physiological states that would reduce or interfere
    with human performance. Current projects also include: tracing the
    evolution of pathogenicity and transfer of disease-causing genes over
    time and between species with NIH and DOE support; building a
    comprehensive database of all known finished and incomplete genomes of
    microbial species; developing computational and phylogenetic techniques
    to analyze chromosomal sequence data; developing effective methods of
    culturing difficult to culture species as well as new methods for
    obtaining embryos for antibody staining; and conducting whole genome
    analysis of disease causing microorganisms to understand the
    evolutionary changes that take place in a genome to make it more or
    less virulent. The methodologies, approaches, and algorithms developed
    in all these projects can be extended and applied fruitfully to a
    variety of questions involving pathogens that pose a threat to military
    and civilian populations, including pathogen identification and
    inactivation and host-pathogen interactions.
    Federal Partnership
        So as to contribute the unique capacities of its Institute of
    Comparative Genomics, the Museum proposes a federal partnership with
    DOD to advance common goals in areas including the Biological Sciences
    program in DARPA's Defense Research Sciences, committed to protecting
    our military forces and the public from bio-warfare attacks; and the
    Army Research Office's Life Sciences emphasis in Molecular Genetics and
    Genomics (Research; Development, Test, and Evaluation, Army account;
    Medical Advanced Technology subaccount). The following are examples of
    programs we propose to undertake in key areas where the research and
    training work of Museum scientists supports DOD's fundamental missions:
      --Field identification of vectors of pathogenicity.--Involving DNA
            barcoding of insect vectors and their pathogens, this project
            promises a major innovation in field technology for identifying
            and fighting insect borne diseases. The initiative will lead to
            the development of a handheld device that rapidly and
            accurately identifies insect vectors of infectious diseases.
            Adaptable to any number of biological identification problems,
            the specific focus is on insect vectors of malaria, West Nile,
            and trypanosomiasis. The project entails developing: a
            reference collection of insect vectors, a DNA barcoding method
            to type vectors and their pathogens, and the field-based
            barcoding tool (most likely using microarray technologies) for
            identifying insect vectors and pathogens.
      --Utilizing bacterial genomics to understand the evolution of
            pathogenesis.--This project uses the HACEK group of bacterial
            pathogens as a model system to understand the role of
            horizontal gene transfer (HGT) in the evolution of pathogenesis
            and may provide important clues relevant to new efforts in
            pathogen origin and deactivation.
      --Novel computational approaches to understanding pathogenicity.--
            Biology presents a number of problems of extreme computation
            complexity known as NP-hard problems. One such problem is the
            determination of evolutionary trees, the basis for the
            understanding of the origination and loss of biological
            features, including the origin and loss of pathogenicity. The
            Museum proposes to apply a new approach that uses statistical
            physics analogues, such as the quantum mechanical process of
            particle decay, to model NP-hard problems in evolutionary tree
            construction. Through this approach, we hope to aid in the
            design of novel algorithmic approaches to long-standing
            biological problems, generating new insight into processes such
            as the evolution of pathogenicity.
        The Museum seeks $5 million for its Institute for Comparative
    Genomics to partner with DOD to advance these shared research goals for
    combating bioterrorism and to contribute its singular capacities to
    research critical to the nation's defense. The Museum intends to
    support the initiatives with funds from nonfederal as well as federal
    sources and proposes to use the requested $5 million to advance
    research and training programs in microbial genomics research and
    computation.

                              SUBCOMMITTEE RECESS

        Senator Stevens. Thank you very much. Appreciate your being
    here and the testimony of all the witnesses this morning.
        We are going to reconvene our subcommittee next Wednesday,
    May 12, when we will hear from the Secretary of Defense and the
    Chairman of the Joint Chiefs of Staff. The subcommittee is in
    recess until that time.
        [Whereupon, at 11:40 a.m., Wednesday, May 5, the
    subcommittee was recessed, to reconvene at 9 a.m., Wednesday,
    May 12.]