[House Hearing, 110 Congress]
[From the U.S. Government Publishing Office]
[H.A.S.C. No. 110-152]
CHALLENGES ASSOCIATED WITH ACHIEVING FULL DENTAL READINESS IN THE
RESERVE COMPONENT
__________
HEARING
BEFORE THE
OVERSIGHT AND INVESTIGATIONS SUBCOMMITTEE
OF THE
COMMITTEE ON ARMED SERVICES
HOUSE OF REPRESENTATIVES
ONE HUNDRED TENTH CONGRESS
SECOND SESSION
__________
HEARING HELD
APRIL 23, 2008
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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OVERSIGHT AND INVESTIGATIONS SUBCOMMITTEE
VIC SNYDER, Arkansas, Chairman
JOHN SPRATT, South Carolina W. TODD AKIN, Missouri
LORETTA SANCHEZ, California ROSCOE G. BARTLETT, Maryland
ELLEN O. TAUSCHER, California WALTER B. JONES, North Carolina
ROBERT ANDREWS, New Jersey JEFF MILLER, Florida
SUSAN A. DAVIS, California PHIL GINGREY, Georgia
JIM COOPER, Tennessee K. MICHAEL CONAWAY, Texas
HANK JOHNSON, Georgia GEOFF DAVIS, Kentucky
JOE SESTAK, Pennsylvania
Sasha Rogers, Research Assistant
Tom Hawley, Professional Staff Member
Mark Parker, Staff Assistant
C O N T E N T S
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CHRONOLOGICAL LIST OF HEARINGS
2008
Page
Hearing:
Wednesday, April 23, 2008, Challenges Associated with Achieving
Full Dental Readiness in the Reserve Component................. 1
Appendix:
Wednesday, April 23, 2008........................................ 27
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WEDNESDAY, APRIL 23, 2008
CHALLENGES ASSOCIATED WITH ACHIEVING FULL DENTAL READINESS IN THE
RESERVE COMPONENT
STATEMENTS PRESENTED BY MEMBERS OF CONGRESS
Akin, Hon. W. Todd, a Representative from Missouri, Ranking
Member, Oversight and Investigations Subcommittee.............. 2
Snyder, Hon. Vic, a Representative from Arkansas, Chairman,
Oversight and Investigations Subcommittee...................... 1
WITNESSES
Bodenheim, Col. Mark, USA, Chief, Reserve Component Mobilization
and Demobilization Operations, U.S. Army Dental Command........ 5
Hart, Col. Deborah L., USAF, Mobilization Assistant to the Air
Force Assistant Surgeon General for Dental Services, Office of
the Surgeon General, U.S. Air Force............................ 10
Krause, Capt. Kerry J., USN, Reserve Affairs Officer, U.S. Navy
Dental Corps................................................... 8
Martin, Col. Gary C., USAF, Chief, Dental Care Branch, TRICARE
Management Activity............................................ 3
Sproat, Col. David, USA, Chief Surgeon, Army National Guard...... 7
APPENDIX
Prepared Statements:
Akin, Hon. W. Todd........................................... 33
Bodenheim, Col. Mark......................................... 39
Hart, Col. Deborah L......................................... 62
Krause, Capt. Kerry J........................................ 58
Martin, Col. Gary C.......................................... 34
Snyder, Hon. Vic............................................. 31
Sproat, Col. David........................................... 53
Documents Submitted for the Record:
[There were no Documents submitted.]
Questions and Answers Submitted for the Record:
Dr. Snyder................................................... 73
CHALLENGES ASSOCIATED WITH ACHIEVING FULL DENTAL READINESS IN THE
RESERVE COMPONENT
House of Representatives,
Committee on Armed Services,
Oversight and Investigations Subcommittee,
Washington, DC, Wednesday, April 23, 2008.
The subcommittee met, pursuant to call, at 2:28 p.m., in
room 2212, Rayburn House Office Building, Hon. Vic Snyder
(chairman of the subcommittee) presiding.
OPENING STATEMENT OF HON. VIC SNYDER, A REPRESENTATIVE FROM
ARKANSAS, CHAIRMAN, OVERSIGHT AND INVESTIGATIONS SUBCOMMITTEE
Dr. Snyder. The hearing will come to order.
Good afternoon. Welcome to the Subcommittee on Oversight
Investigations hearing, the first hearing to discuss the
challenges associated with achieving full dental readiness in
the Guard and Reserve. And before proceeding with my opening
statement, I want to acknowledge all of the work that the staff
and the members did on our report on the Provincial
Reconstruction Teams. I just went on the Web site for the House
Armed Services Committee. It is on the Web site. So if anybody
wants to read it, they can. There will be hard copies coming
out later. It is armedservices.house.gov for those people that
are interested.
The Reserve component is transforming from a strategic to
an operational reserve. We need to give our men and women in
the Guard and Reserve the tools they need to take up this
mission. The most important thing they bring to the table is
themselves, their health and the mental and dental readiness of
the force. Oral health is an often overlooked, but as we are
learning, extremely important aspect of overall pre-deployment
readiness. The Department of Defense (DOD) has said that 95
percent of military personnel, active and Reserve, should fall
into Class 1 or Class 2 dental fitness categories, meaning that
they are healthy enough to deploy.
Right now none of the services are meeting these goals
through the Reserve component, but the Army and Marine Corps
have struggled the most. It is a public health issue for the
country, but it is also a readiness issue for our military.
Only 43.2 percent of the Army National Guard and 50.6 percent
of the Army Reserve is currently ready to deploy. Only 77.7
percent of the Marine Corps Reserve is ready to deploy. But
since none of the services are meeting the DOD goal, I hope we
are going to figure out why today.
Today we will hear about some of the challenges the
services face and how they are facing them. I hope we will hear
some good ideas about how these issues can be addressed in the
future. I know that the Army National Guard's 39th Infantry
Brigade in my home district in Arkansas struggle with many of
these challenges when they recently deployed to Iraq for their
second tour, and these challenges occurred during their first
tour several years ago also. I am proud of their hard work and
the creative ways in which they accomplished the pre-
mobilization and readiness mission under adverse conditions,
but they encountered additional challenges at the mobilization
station, and we still have work to do.
Improving dental readiness rates in the Reserve component
will require a combination of command emphasis, accountability
on the part of the individual services, service members,
incentives and possibly programmatic changes. That is why we
are here. That is what we are here to talk about today, and I
look forward to having a good discussion.
I also want to acknowledge the presence with us today of
Congressman Buyer, who is the ranking member on the House
Veterans' Affairs Committee, and he and I have talked about
dental issues on and off for some time. And I would ask
unanimous consent that he be allowed to participate. Now, I
would like to hear Mr. Akin's opening statement for any
comments he would like to make.
[The prepared statement of Dr. Snyder can be found in the
Appendix on page 31.]
STATEMENT OF HON. W. TODD AKIN, A REPRESENTATIVE FROM MISSOURI,
RANKING MEMBER, OVERSIGHT AND INVESTIGATIONS SUBCOMMITTEE
Mr. Akin. Thank you, Mr. Chairman.
Thank you witnesses for joining us here today.
The hearing clearly demonstrates the value of our
subcommittee and the good we can do for our men and women in
uniform. At first glance, dental readiness may not seem to be a
subject Congress would focus on. And, in fact, I don't remember
any previous hearings on the topic. Upon great reflection,
though, all would conclude that the dental readiness is a very
timely and critical topic. Armies throughout history have
suffered more casualties from sickness than from combat-
inflicted wounds, and today's military forces are no exception.
Indeed, medical and dental readiness are key components of
ensuring units are ready to deploy and effectively perform
their missions in combat. Our witnesses are well grounded in
the challenges of ensuring members of the Army, Navy, Marine
Corps and Air Force Reserve components are dentally ready to
deploy and in the effectiveness of Department of Defense and
individual service approaches to this issue. I would not want
to be in their shoes. I cannot imagine a more difficult job
than theirs, find ways to entice relatively juvenile Reserve
component service members, most on limited income, to undergo
periodic dental examination and treatment with sometimes
minimal reimbursement so they can deploy to Iraq for 12 or 15
months.
Frankly, I am surprised that anyone goes to the dentist
with a command tour in Iraq as a reward of compliance. In
reviewing your testimony, I understand that each component
faces somewhat different obstacles and has chosen to manage the
problem in different ways. I look forward to hearing about your
programs, any recommendations that you would have and how we in
Congress can help to make your job easier. Thank you very much.
And thank you, Mr. Chairman.
[The prepared statement of Mr. Akin can be found in the
Appendix on page 33.]
Dr. Snyder. Thank you, Mr. Akin.
We are pleased to have with us today Colonel Gary Martin,
United States Air Force, the chief of the Dental Care Branch of
TRICARE management activity; Colonel Mark Bodenheim, the chief
of the Reserve Component Mobilization and Demobilization
Operations, U.S. Army Dental Command; Colonel David Sproat, the
chief surgeon of the Army National Guard; Captain Kerry Krause,
the Reserve Affairs Officer for the U.S. Navy Dental Corps;
Colonel Deborah Hart, mobilization assistant to the Air Force
assistant surgeon general for dental services, Office of the
Surgeon General, United States Air Force.
It is my understanding that none of you have testified
formally before Congress before; is that correct? Well, I want
you to relax. You may feel a little pinch. You may hear some
strange sounds and smell some funny smells, but ignore them. We
are going to play some music for you to help you relax. I have
always wanted to say that to dentists. This was my chance.
Now, we appreciate you all being here. Your written
statements, without objection, will be made a part of the
record, and I will have Sasha put on the light. When you see it
go red, if you have got more things to tell us, we want you to
go ahead. But it is just to give you an idea of when five
minutes have gone by. We anticipate there will be votes some
time in the next 10, 15, 20 minutes, which will interrupt us.
But we will go as far as we can with opening statements.
So, Colonel Martin, we will begin with you.
STATEMENT OF COL. GARY C. MARTIN, USAF, CHIEF, DENTAL CARE
BRANCH, TRICARE MANAGEMENT ACTIVITY
Colonel Martin. Thank you, Mr. Chairman, and distinguished
members of the subcommittee. I thank you for your strong
interest in improving the dental readiness of Reserve and
National Guard service members.
As the chief of the Dental Care Branch of the TRICARE
Management Activity, I am responsible for the management of the
various Department of Defense dental programs that provide care
to beneficiaries. Today I will provide a brief explanation of
DOD's Oral Health and Readiness Classification System, discuss
the current state of Reserve component dental readiness and
give an overview of dental programs available to Reserve
component members.
For over 24 years, DOD has successfully gauged the dental
readiness of the active and Reserve components through the Oral
Health and Readiness Classification System. The various
classifications in this system are:
Dental Class 1, individuals with a current dental
examination who do not require dental treatment or
reevaluation, healthy service members who are worldwide
deployable.
Dental Class 2, individuals with a current dental
examination who have oral conditions, diseases that require
non-urgent care or reevaluation. These are oral conditions
which are likely to result in a dental emergency within 12
months. These service members are also worldwide deployable.
Dental Class 3, individuals who require urgent or emergent
dental treatment that if not accomplished will likely result in
a dental emergency within 12 months. Class 3 individuals are
not worldwide deployable.
And Dental Class 4, individuals who have not obtained
periodic dental examinations or patients with an unknown dental
classification. Class 4 individuals are not worldwide
deployable.
Over the past 12 months, Individual Medical Readiness
reports for the Reserve component have not shown any
significant change. None of the services meet the DOD goal of
95 percent dental readiness. As of January 2008, the Army
National Guard was at 43.2 percent; Army Reserve 50.6 percent;
Marine Corps Reserve, 77.7 percent; Air Force Reserve, 84.9
percent; Air Force National Guard, 88.8 percent; and the Navy
Reserve was 90.0 percent.
The majority of the Class 3 dental conditions in our
service members are a result of dental decay, which is a
chronic infectious disease. To properly treat and prevent
dental decay, individuals at high risk for this disease must
modify their diets and eating behaviors and practice good daily
oral hygiene. If these measures are not taken, dental decay may
recur, often resulting in more extensive treatment needs such
as a larger filling, root canal, and/or a crown, and just a
little pinch.
Several studies have validated the importance of DOD's Oral
Health and Readiness Classification System. A published study
by the Tri-Service Center for Oral Health showed that the
dental emergency rate for Class 3 personnel is 8.8 times higher
than personnel in Class 1 and 3.9 times higher than the rate in
Class 2 personnel. A recent report on 900 Air Force personnel
deployed for 120 days found that only 1.7 percent received any
needed dental care during the deployment. Almost 65 percent of
these personnel were dental Class 1 when deployed. If we deploy
personnel in good oral health, their chances for a dental
emergency during the deployment are significantly reduced.
There are several programs available to improve the dental
health of the Reserve component members. I would like to
highlight those programs for you today. For Reserve component
members without employee-sponsored dental insurance, DOD offers
the TRICARE Dental Program (TDP), a comprehensive dental
insurance program for active duty family members, Reserve
component members and their families. Over the past 2 years
about 8 to 10 percent of eligible Reserve members have enrolled
in this program. The Air Guard has the highest enrollment with
21.8 percent. The lowest enrollment rate is in the Marine Corps
Reserve at only 2.8 percent. The government pays 60 percent of
the monthly premium, and the reservist pays 40 percent.
Currently the reservist pays a low monthly premium of $11.58.
The TDP provides an annual maximum payment for dental services
of $1,200 with cost shares for the more expensive procedures,
such as root canals, crowns and extractions. Most preventive
services, like cleanings and exams, are covered at 100 percent
and do not count toward the annual maximum payment.
For Fiscal Year 2007, 71.6 percent of the reservists
enrolled in the TRICARE Dental Program utilized at least one
covered procedure. The TDP network of dentists is quite large
with over 84,434 participating dental offices. This includes
63,555 general dentist locations and 20,769 specialist
locations.
In addition, the Reserve Health Readiness Program provides
dental care for reservists. This program has a network of
contracted dentists that provide dental exams and Class 3
treatment needs to assist reservists in achieving and
maintaining dental readiness. During the past 12 months,
approximately 180,000 reservists received their annual dental
exam and 7,500 Class 3 patients received the required dental
care in this program; 92 percent of the reservists who received
their exams and treatments were Army.
Reservists on 90-day activation orders are eligible for
dental care at the same level as active duty service members.
The majority of this dental care is provided in military dental
treatment facilities, when needed. Referrals are also made to
dentists in the private sector.
The Transitional Assistance Management Program, commonly
referred to as TAMP, includes a dental benefit for recently
deactivated or separated military members. This program
provides space-available care in military dental treatment
facilities for 180 days from the date of leaving active duty
status. Unfortunately, few facilities have space available to
treat these members. But reservists who are deactivated and who
will remain in the Reserves are eligible to enroll in the
TRICARE Dental Program.
Finally, all service members who are separated from active
duty receive a certificate of release or discharge from active
duty. A section of this form documents whether there are any
dental conditions requiring treatment that DOD could not
provide prior to separation. If treatment is required, the
member may apply for Veterans Affairs (VA) treatment within 180
days from release from active duty. On average, about 18
percent of eligible deactivated reservists have utilized this
benefit over the past 3 years.
Mr. Chairman, distinguished subcommittee members, thank you
for your interest in improving the dental readiness of our
National Guard members and reservists. As you can see, the
department offers several options to improve the dental
readiness of these service members. We look forward to your
continued support as we work together to improve the oral
health of Reserve component members. I will be happy to answer
any questions that you may have.
[The prepared statement of Colonel Martin can be found in
the Appendix on page 34.]
Dr. Snyder. Thank you, Colonel Martin.
Colonel Bodenheim.
STATEMENT OF COL. MARK BODENHEIM, USA, CHIEF, RESERVE COMPONENT
MOBILIZATION AND DEMOBILIZATION OPERATIONS, U.S. ARMY DENTAL
COMMAND
Colonel Bodenheim. Yes, Mr. Chairman and distinguished
members of the committee, I want to thank you for allowing me
to speak to you about Army Reserve component dental readiness.
In my written testimony, I have outlined an extensive
historical perspective of dental readiness for the Army active
and Army Reserve components. To summarize, by the first Gulf
War, active component units were able to deploy with minimal
pre-deployment dentistry requirements due to their high levels
of baseline dental readiness, while at the same time Army
Reserve component units arrived at extremely high rates of
unreadiness. This happened again at the beginning of the global
war on terror.
Since 2004, the Army active and Reserve component dental
subject matter experts have cooperated to improve dental
readiness report rates to the mobilization platforms by
standardizing exam protocols and documentation, the validation
process at the mobilization platform and storage of digitized
dental information for further use. These improvements have
reduced no-go rates to the mobilization platforms from 87
percent no-go in 2004 to the present rates that you see in
table one in Fiscal Year 2006 and 2007.
During the first half of Fiscal Year 2008, more dramatic
improvements occurred, especially by the Army National Guard
brigade combat teams (BCTs). And I attribute these improvements
in dental readiness due to a combination of, first, Army
command emphasis directed to the BCT commanders, initiation of
the Reserve component dental readiness systems early in the
alert phase, and diligent work done by the State dental
surgeon.
In table two, you can see, of my written testimony, you can
see a comparison on the BCT units and smaller size units. And
you can see that the smaller size units report with less
favorable rates of dental readiness. And I attribute this to
less command emphasis and a larger percent of cross-leveling
from non-alerted units that are not eligible for Dental Fitness
Class 3 (DFC 3) care. As an example, over 6 percent of the 39th
BCT was cross-leveled as replacement soldiers after reporting
to Camp Shelby after the main body had reported, and over 26
percent of those were DFC 3. I use this example to point out a
major issue. Army Reserve component soldiers may be mobilized
with short notice at any time. And if not afforded DFC 3 care,
regardless of alert status, prior to mobilization, then they
lose training time at the mobilization platform remedying those
DFC 3 conditions.
For the first half of Fiscal Year 2008, it is estimated
that over 3,500 10-hour duty days had been lost remedying DFC 3
conditions of mobilization platforms. In my written testimony,
I have described a present mobilization and demobilization
operating procedures, and I will refer you there for the
details of those operations in their present format. In my
written testimony, I have described the challenges to achieving
better Army Reserve component dental readiness. And suffice it
to say, the challenges are complex and will require a multiple
set or dashboard of solutions.
Within his first 100 days, the Army surgeon general
directed a complete review of the Army Reserve component dental
readiness system, and the assistant surgeon general for forced
projection assembled a multicomponent work group in March 2008
to conduct a capabilities-based assessment and develop a
prioritized list of courses of action. These courses of action
are currently being worked through the Army leadership.
In conclusion, I want to thank you, Mr. Chairman, and the
distinguished members of the subcommittee for your interest and
support in improving Army Reserve component dental readiness
and in maintaining our human weapon system, our soldiers.
Thank you.
[The prepared statement of Colonel Bodenheim can be found
in the Appendix on page 39.]
Dr. Snyder. Thank you, Colonel.
Colonel Sproat.
STATEMENT OF COL. DAVID SPROAT, USA, CHIEF SURGEON, ARMY
NATIONAL GUARD
Colonel Sproat. Chairman Snyder, Ranking Member Akin,
distinguished members of the committee, thank you for this
opportunity to come before you to address concerns of the
dental readiness of the soldiers of the Army National Guard.
Dental readiness of our citizen soldiers is a critical
element in our ability to meet Army deployment requirements. As
you know, the Army National Guard's transition to an
operational force has dramatically increased demands on your
citizen soldiers. Historically, our soldiers and leaders relied
on a lengthy mobilization process to address dental readiness
issues.
In February 2007, the Department of Defense implemented a
12-month mobilization policy. This policy is good for the Guard
and takes soldiers away from their families and employers for
less time. However, dental readiness must now be addressed at
the home station.
The Army National Guard medical team in conjunction with
our U.S. Army Dental Command colleagues has successfully
managed this transition. Since the beginning of the fiscal
year, States have prepared 5 brigade combat teams for
deployment, sending their units to the mobilization (MOB)
station over 90 percent dentally ready. For example, the 39th
from Arkansas arrived at Camp Shelby in January with 92 percent
of their soldiers dentally ready. This is a tremendous
improvement from their last mobilization in October 2003, when
the average readiness of a Guard unit reporting to MOB station
was 13 percent. This improvement has enabled commanders to
focus on collective training and maximize the boots-on-ground
time in theater.
To ensure mission success, this same approach is being used
this year by Pennsylvania's 56th Striker BCT and 28th Combat
Aviation Brigade, New Jersey's 50th infantry BCT, North
Carolina's 30th Heavy BCT and the 56th/36th Infantry BCT from
Texas. The same programs, policies and procedures that have
been used to ready these BCTs for deployment need to be applied
to our force as a whole.
The challenge before the Army National Guard is the low
level of baseline dental readiness. Only 43 percent of the
force is dentally ready to deploy. Few Army National Guard
guardsmen have private dental insurance, and only seven percent
participate in the TRICARE Reserve Dental Program. Truly
Herculean efforts must be applied by the states once a unit is
alerted to achieve full dental readiness.
To overcome these challenges, the Army National Guard in
collaboration with the Office of the Surgeon General, U.S. Army
Dental Command, the U.S. Army Reserve has developed a plan to
improve baseline readiness that has been approved by the Army
Guard leadership. This plan provides dental treatment for our
soldiers outside of alert. Under the Army Selected Reserve
Dental Readiness System, or ASDRS, states can provide dental
treatment to soldiers through local contracts or the Tri-
Service Reserve Health Readiness Program, or RHRP. The U.S.
Army Dental Command's First Term Dental Readiness Program will
identify dental issues that must be corrected and ASDRS will
then enable our soldiers to be treated at home.
As recommended by the commission on the National Guard and
Reserve, there should be incentives and enforcement of dental
readiness. Guardsmen should not take unpaid leave to go to the
dentist. Providing two medical readiness days per soldier is an
incentive for soldiers to complete readiness requirements and a
way for commanders to ensure compliance. The Unit Status Report
and the Medical Protection System or MEDPROS provides leaders
with the ability to track a unit's dental readiness.
Increasing and sustaining dental readiness of the Guard
requires appropriate staffing. The Army National Guard Dental
Corps is currently less than 60 percent strength, and 40
percent of those remaining dentists are retirement eligible.
The Department of Defense has requested that Congress increase
the retirement age of National Guard Medical Corps and Dental
Corps officers from 64 to 68. The President's budget request
now before Congress also seeks an increase in the level of
full-time manning of our force. This is critical. We urge the
Congress to support these proposals.
This is a very exciting time to be in the Guard. The Army
National Guard has deployed over 300,000 dentally ready
soldiers in support of the Nation since September 11, 2001.
Even so, we can do better. The Army National Guard is committed
to improving our dental readiness. I am grateful for this
opportunity to appear before the subcommittee and look forward
to answering your questions.
[The prepared statement of Colonel Sproat can be found in
the Appendix on page 53.]
Dr. Snyder. Thank you, Colonel.
Captain Krause.
STATEMENT OF CAPT. KERRY J. KRAUSE, USN, RESERVE AFFAIRS
OFFICER, U.S. NAVY DENTAL CORPS
Captain Krause. Chairman Snyder, distinguished members of
the committee, good afternoon and thank you for this
opportunity to present to you today about the Navy's mission,
that of ensuring dental readiness for all its Marines and
sailors, both Reserve and active. Dental readiness is a state
where a sailor or Marine is ready to deploy and likely not to
experience a dental emergency while away from home.
When a recruit is assessed, an initial exam is performed,
and he or she is classified according to his or her dental
disease. Annual exams are required for both Reserve and active
component sailors and Marines. It is a triage system that
prioritizes care based on the level of disease. A sailor or
Marine is operationally dentally ready, ODR, if he or she falls
into either Class 1, no disease, or Class 2, diseases unlikely
to cause a dental emergency within 12 months.
The goal, as stated by the Office of the Secretary of
Defense for Health Affairs is for all services to reach 95
percent ODR. There is currently no Navy-specific mandate. Over
the past 3 years, incoming Navy and Marine Corps recruits have
entered boot camp at an average ODR of 29 percent. At the Navy
and Marine Corps boot camps, Navy dentistry has maintained a
heavy dental presence that focuses on reaching the 95 percent
goal before our recruits go back to Reserve status or reach
their duty stations. While we have fallen short of the 95
percent goal in the last few years, we have maintained an ODR
in the 80th percentile.
Historically through 2002, ODR percentage across the Navy
has been in the mid 90's or above. Since 2002, however, it has
fallen to 86, 87 percent as we shift resources to focus on
personnel who are getting ready to deploy. For the Navy
Reserve, of the 16,193 service members who are still drilling
and have mobilized, they were 91 percent operationally dentally
ready, with 1.5 being considered Class 3.
For the Navy's active component, the last 112 shifts that
have deployed have all had an ODR above 95 percent. Over the
first quarter of Fiscal Year 2008, the overall ODR for the
Marine Corps Reserve was 77.7 percent with 6.5 percent being
considered Class 3. Our efforts to focus on deploying Marines
and reservists have paid off, and the last two battalions to
deploy in 2007 went out at greater than 95 percent ODR. Active
duty Marine units deployed at 90 to 97 percent ODR.
The Reserve challenges to ODR include dental officer and
technician retention and recruiting and the loss of 17 percent
of the Reserve Dental Corps billets. As the Navy Reserve Dental
Corps becomes smaller, providing regular exams has become a
challenge. We are meeting this challenge by using contract
dentists, offering more incentives to retain and recruit,
hosting dental stand downs for units to get exams all at one
time and having traveling dental teams to go to remote
locations.
In addition, there is a perception by reservists that the
cost of the TRICARE Dental Program, $11.58 a month plus 20
percent cost share for fillings, is prohibitive. We are
addressing this issue by increasing our education efforts for
reservists on the value of this program.
To maintain our ODR goals with decreased Reserve and Active
Dental Corps personnel, we have increased the use of private-
sector dentists through the Military and Medical Support Office
Program, MMSO. This shift in care of the private sector has
increased the MMSO costs over the past 4 years from $3.7
million in 2004 to $34 million in 2007. Retaining Dental Corps
Officers in Reserve and active components has been increasingly
difficult in recent years. Almost 70 percent of junior officers
are leaving active duty after they complete their first
obligated tour and are not affiliated with the active Reserve.
One of the major issues has been dental assistant support,
which is now beginning to improve. Another motivator for
getting out of the service has been the rates of promotion and
pay for Dental Corps officers. Promotion issues are improving,
and we are hopeful the trend will be maintained. In addition,
recent improvements by the National Defense Authorization Act
increased additional special pay, ASP, for junior dental
officers by $6,000 to $10,000 or $12,000 based on years of
service. We expect this increase in the ASP will have a
positive impact on retention. Today, with this increased pay,
an active duty dentist in Washington, D.C., with 4 years of
experience earns about $95,000 plus benefits.
Improvements to Dental Corps accession bonuses for Reserve
and active duty and stipends for Reserve scholarship programs
have recently improved, and we thank you for your support. We
are optimistic these enhancements have improved our recruitment
efforts, as we at this point in the fiscal year expect to meet
our accession goals. Currently, we are almost 100 percent ahead
of where we were at this time last year. In the Reserve corps,
we have already gained 14 new dental officers compared with 2
in Fiscal Year 2007.
Chairman Snyder, members of the committee, thank you again
for the opportunity to testify before you and share with you
how Navy dentistry is ensuring sailors' and Marines' dental
readiness is our number-one priority. We appreciate your
efforts to improve our recruitment and retention, as well as
your interests in this very important issue. I stand prepared
to answer any of your questions.
Thank you.
[The prepared statement of Captain Krause can be found in
the Appendix on page 58.]
Dr. Snyder. Thank you, Captain.
Those were votes. But we have plenty of time to do your
opening statement, Colonel Hart, and probably get at least one
question or two in. So, Colonel Hart.
STATEMENT OF COL. DEBORAH L. HART, USAF, MOBILIZATION ASSISTANT
TO THE AIR FORCE ASSISTANT SURGEON GENERAL FOR DENTAL SERVICES,
OFFICE OF THE SURGEON GENERAL, U.S. AIR FORCE
Colonel Hart. Mr. Chairman and esteemed members of the
committee, I appreciate the opportunity to appear before you
today to discuss the dental readiness of the Air National Guard
and Air Force Reserve.
The ARC or Air Reserve Component Medical and Dental
Services exist and operate within an Air Force culture of
accountability where medics work directly for the line of the
Air Force. Our home station facilities form the foundation from
which the ARC provides combatant commanders a fit and healthy
force. Our emphasis is on fitness, prevention, and surveillance
so that we can be ready to be deployed if need be in less than
72 hours.
Air Guard and Reserve dental readiness is at 89 and 86
percent, respectively. These statistics represent a steady
upward trend over the past year and compare favorably to the
Department of Defense goal of 95 percent. Our steadily
improving dental readiness is attributable to many factors.
First and foremost is command emphasis and support at all
levels. The ARC holds unit commanders and individual service
members responsible for the members' readiness to deploy and
provides policies to ensure dental readiness.
We have several methods an ARC member can receive their
annual dental exam: by a military dentist, a civilian or
TRICARE Dental Plan participating dentist, or by contractor
dentists through the Reserve Health Readiness Program.
Although medical squadrons track dental readiness rates,
each ARC unit also has a nonmedical unit health monitor who
tracks upcoming and overdue medical and dental needs. This
creates ownership of medical readiness within the unit itself
and has had an extremely positive effect on our readiness.
ARC compliance policies may be the most effective of our
tools to steadily improve readiness. Air reservist or guardsmen
in dental Class 3, requiring urgent or emergent dental
treatment, are placed on a medical profile and cannot have
orders cut to deploy while profiled. Members are given a
limited time frame to correct their dental deficiencies.
Failure to have the required treatment can lead from profiling
to administrative discharge of the member.
Commanders do have the authority to grant a waiver to allow
deployment of a member in dental Class 3, but this is extremely
rare. All ARC units have regular health service inspections,
and units with deficient programs are identified to line
commanders, who are held accountable for the medical and dental
readiness of their units.
Another tenet of our success has been the full alignment
with the active duty Air Force Dental Service in using the same
Web-based reporting and tracking tool, the Dental Data System
Web, or DDSW.
Some challenges do remain for the ARC to be able to
steadily improve our dental readiness, but the cost of meeting
standards can sometimes be prohibitive, especially for the
lower-ranking enlisted personnel. Even with TRICARE Dental Plan
available, many U.S. areas have limited networks of dental
providers. Furthermore, due to time constraints and rigors of
basic military training and technical school, access to new
accessions for dental treatment is very limited and usually
consists of palliative care for urgent needs.
Currently, there is no Transitional Assistance Management
Program, or TAMP, available for dental care following
deployment. And although the ARC and the active duty Air Force
units use the same Web-based reporting tool, we are not yet set
up to implement the electronic dental record, or AHLTA, which
will surely improve accuracy of readiness as reservists and
guardsmen transition from inactive to active status and back
again.
To improve dental readiness, Reserve and Guard units can
utilize dentists from other units for support. Higher
headquarters monitors readiness statistics, conducts site
visits and provides assistance where needed. Geographically
separated, remote or understaffed units can utilize contractor-
supported dental exams.
Increased emphasis by commanders and unit health monitors
and recruiters to inform Reserve and Guard members of the
benefits presently provided under the Reserve Health Readiness
Program may also improve readiness. We are also considering the
introduction of a pre-accession dental screening exam to
determine the dental class of an individual, which could help
alleviate the problem of ARC members arriving on base, non-
deployable, Dental Class 3, after completion of basic and
technical training.
Last, we fully support implementing the electronic dental
record in the ARC as it becomes available for deployment.
In closing, Mr. Chairman, we are proud of our
accomplishments and continued improvement of the Air Force
Reserve and Air National Guard dental readiness rates. We thank
you and the members of your subcommittee for your interest and
support and look forward to your help in continuing that
improvement. Thank you.
[The prepared statement of Colonel Hart can be found in the
Appendix on page 62.]
Dr. Snyder. Thank you.
Sasha will go ahead and put me on the five-minute clock
here, and we will go through our five-minute rule here.
The noise you heard there was we have one vote, perhaps
followed by a series of votes. It is not clear yet. So we will
have to take a break here probably after my questions. But we
should have time to get in my five minutes.
I wanted to say, first of all, I appreciated your, both
written and oral, statements. It is not, as one pointed out, it
is not a simple challenge that you have before you. And, of
course, in some ways, the challenge you have reflects the fact
that we as a Nation haven't solved a lot of health care issues,
including dental. So you are ending up with a representative
sample of our population that doesn't have the kind of dental
health we need.
I think some people when they heard about this thought that
somehow this is a bit of a trivial problem. But, I mean, just
for emphasis, the whole purpose of this is to avoid dental
emergencies for people you are sending to a war zone for 7, 12
or 15 months. And I can't imagine being in the mountains of
Afghanistan or some place in Iraq with a big dental abscess,
trying to figure out how I am going to get that resolved, get
it treated. Not to mention you then are pulling someone away
from their unit and causing a disruption of their unit.
And then, as a couple of you pointed out, the second issue
is if you have to deal with this during the pre-mobilization
period, which is--or the pre-deployment period, we talked about
the 3,500 10-hour days lost or the 5,000 10-hour days lost. We
call them due dates, but for most people, they are training
days. That means they are being pulled away from training for a
war zone.
And then the third part, I guess, is quality of life. I
can't imagine sending somebody over there and cavalierly
saying, well, you have got a big hole in your mouth, but we
don't have time to do that right now, tough it up for 12
months. I mean, that is not the kind of country--we have
learned that that is short-sighted.
So this is a very important issue in terms of accomplishing
the kind of goals we want for our national security and foreign
policy.
Colonel Bodenheim, you, on page 10, of your written
statement, you make the comment there, we need to enforce
current policy. Now, several of you have called for different
changes. Talk to me about that. Is there a way--if we made no
changes at all--to solve this problem just by enforcing current
policy? Or is that an unrealistic goal?
Colonel Bodenheim. Current policy allows for an annual exam
regardless of alert status. But if a soldier is found to be DFC
3, Dental Fitness Class 3, during that exam and they are not in
an alert status, they have no way of getting that care done at
no cost to themselves. And so it does not solve the problem for
the large group of un-alerted mobilized Reserve--of
nonmobilized Reserve but not alerted, and the large number of
cross-leveling that goes on is causing that loss of training
time at the mobilization platforms. And that is unpredictable,
and the only way to solve that is to have the care system that
is there all the time, regardless of the alert status.
Dr. Snyder. Captain Krause, you discussed the boot camp
issue, that, I believe, the number of 80 percent in boot camp.
Now, is that correct currently?
Captain Krause. When they come in, they come in at 29
percent.
Dr. Snyder. And when they leave, currently about 80
percent?
Captain Krause. That is correct, 80 percent.
Dr. Snyder. That would seem to me, recalling my boot camp
days, when I couldn't go to the bathroom without somebody
ordering me to, you have got a captive audience there. Why is
that only 80 percent? These are not people that are going to be
pulled away for deployments. I mean, you have got them there
for probably three months. Why has that been a difficult--why
are we missing one out of five of those people?
Captain Krause. Well, thank you, chairman. Let me say this.
It is probably more like 86 percent, and that is on the active
side. Again, they have a lot of things that they have to
accomplish in the boot camp, and they are busy, and they don't
have a lot of time for dental. And we try to fit them in and
get as much done as we can when we can. It is not that they are
free to come to dental at any time during their training. They
basically are busy. That is why they are there, to learn. The
dental piece of it is--we push it as they come in from the day
they come in, and we do it as much as we can as we can.
Dr. Snyder. Well, we will pursue that later. My time has
expired. What we will do is recess for the votes. I am sorry. I
can't predict how long this will be. We have several staff
members that can help you with any phone needs you have or if
you need a private room or something. And we also have other
staff, we have Jeanette James and David Kildee from Personnel
Subcommittee. We have Art Wu here from the Veterans' Affairs
Committee. They may have some questions to pick your brain
while we are doing recess. We will be recessed.
[Recess.]
Dr. Snyder. We will go ahead and resume. I think that we
are okay. We have already kept you almost into supper time, but
I think that we are okay for a while now. Unfortunately, our
members, for a hearing that started at 2:30, I figure after
4:30 they could have other things; so we will probably not have
as good a response as we did early on, but I apologize for
that.
And as soon as he is ready, we will recognize Mr. Akin.
Mr. Akin. Just one second.
Dr. Snyder. Sure.
Mr. Akin. I certainly appreciate your all waiting around
for quite a while. We have that happen in committees. All of a
sudden they call votes, and we are not always sure when they
are going to do it. So it does tend to break things up.
I guess my question, and one that we have been talking
about a little bit, is the transition of whose responsibility
is what? So I am thinking about somebody that is--let's say
they are on Reserve for some particular moment, and as they are
on Reserve, I would guess that Reserve people, their dental
care is paid for out of their own pocket. Is that typically the
case?
This is somebody that is going to be called up and then he
is going to serve, so if you start at the beginning, when they
are on Reserve, who pays for the dental care when he is just on
Reserve? Anybody want to answer the question?
Colonel Martin. I will start with if the individual is
enrolled in the TRICARE dental program, then certain procedures
like an exam and a cleaning will be covered by that dental
plan, and they will not pay for any of that process.
Mr. Akin. So a Reserve, somebody who is on Reserve, could
have that insurance?
Colonel Martin. Yes, sir.
Mr. Akin. Okay. If they didn't have that, then they would
normally just pay for it out of their own pocket?
Colonel Martin. Yes, sir.
Mr. Akin. Then they get called up. And let's say if they
were not paying attention to their teeth, they are young and
bullet-proof or something like that, if you took that scenario,
then you would give them a dental exam probably when they came
in. And then, let's say, for instance, they might have a cavity
or two or something like that.
So that would mean--would that be like Level 3?
Colonel Martin. Yes, sir.
Mr. Akin. Okay. So then you would send them to a dentist,
and it might be, say, an Air Force or an Army dentist or
something like that; or it might be somebody that you contract
with, either which way. Would that be what would probably
happen next?
Colonel Martin. Yes, sir.
Mr. Akin. And you would try to fit that in in their
training as they are getting ready to be deployed or something
like that. Is that typically when that would happen?
Colonel Martin. I think, for the majority of times, that
would be correct, that when they get ready to be mobilized,
different assets will come into play as far as to take care of
their dental needs.
Mr. Akin. I am just thinking, my own son is a captain in
the Marines, and as I recall, before he was deployed they
always had--sort of everybody was working up and getting used
to working together. So that would be the time probably they
would get the dental care, which would bring them up to a Level
1 or 2 or something like that, right?
Colonel Martin. Yes.
Mr. Akin. And then they are deployed for some number of
months, right?
Now, during the time that they are actually called up then,
in a way, financially that is the responsibility of the service
that has called them up. Is that right?
Colonel Martin. That is correct, sir.
Mr. Akin. Okay. And then when, let's say, they have been in
Iraq for a year or 14 months or something like that and they
come back, now at that point if they had something going on,
let's say got some cavities because they drank too much Coke
over in Iraq or something like that, then whose responsibility
would it be to provide that dental care?
Would that still be the active force or would that come out
of DOD?
Colonel Martin. I would need to go back a little bit. It
really depends upon their status in Defense Enrollment
Eligibility Reporting System (DEERS). If they are still on
active duty status, then all their dental needs are going to be
taken care of by the active duty benefit which--most of us can
be taken care of inside of our military dental treatment
facilities.
Once they leave active duty status----
Mr. Akin. Once they were deployed, if they were Reserve and
they were deployed, wouldn't they be called active duty then?
Colonel Martin. Yes, they would.
Mr. Akin. Because--I am kind of confused because I have run
into people that, you know, they are sort of halfway active and
halfway citizen, and I can't keep all the conditions straight.
Okay, so--but if they are deployed, they are active duty
then, then they would be the responsibility of whichever branch
they were in?
Colonel Martin. Yes, sir.
Mr. Akin. Or maybe would you--would at times an Army guy go
to a Air Force dentist or whatever?
Colonel Martin. Yes.
Mr. Akin. Whatever the logical, close dental facility
depending upon their situation, up to the time when they are no
longer active or they are going back, probably to their Reserve
unit, I would assume. So up to that day they are still the
regular military.
And then when they go back to the Reserve unit, then would
that mean that they would go back to either that insurance
policy they had or they would just pay for their own dental
care themselves?
Colonel Martin. Yes, sir. But there is also a benefit--if
they serve for more than 90 days, there is also a VA benefit
that they can also receive.
Mr. Akin. So let's take our scenario they have been in Iraq
for a year or something. Then they have been over 90 days, so
then they would qualify; they wouldn't pay for everything out
of their own pocket, it would be under the VA care then?
Colonel Martin. That is correct. If their discharge papers
say all their dental care was not completed prior to discharge,
they could take that paperwork and submit it to the VA.
The VA then would notify them of their eligibility. And
then they can get that treatment taken care of at no cost to
them.
Mr. Akin. I am sorry, I am running over my time.
Dr. Snyder. That is okay.
Mr. Akin. Do they typically have a dental exam when they
come back? Or is that something they could request?
Colonel Martin. I think, sir, it depends upon the----
Mr. Akin. The unit?
Colonel Martin [continuing]. The units. And I would have to
defer to the services to be able to answer that specific
question.
Mr. Akin. Does anybody know if it is policy one way or the
other?
Colonel Bodenheim. This is Colonel Bodenheim.
No exam is given during the demobilization process with our
current policy.
Mr. Akin. Say that again.
Colonel Bodenheim. No exam is given during the
demobilization process with our current policy. If somebody
comes back and they say that they have an emergency situation,
they are treated by that dental treatment facility before they
are REFRAD, or released from active duty. The demobilization
period is about a four-to-six-day period. And in the
demobilization process at this time there are about one or two
hours for a unit to be processed through the dental
administrative process for demobilization.
Mr. Akin. So, from a practical point of view, let's say I
come back and let's say I have had a tooth that has been
bothering me; I don't know what is going on with it.
Just maybe a regular soldier, would they probably then be
looked at and given an exam and then a determination--say he
had some cavities from drinking my Coke too much. Would you
actually pick that up then?
Colonel Bodenheim. Sir, what we would do is, if the soldier
said that they had a condition that was causing them an
emergency problem at that time, we would fix the emergent
condition.
Mr. Akin. Would that mean--I am just saying, you have a
cavity; maybe it is not an emergency, your tooth is just sore
or you suspect there may be a problem. Would that be an
emergency per se or not?
Colonel Bodenheim. That would not be an emergency.
Mr. Akin. It would not?
Colonel Bodenheim. Yes.
Mr. Akin. So they might have some cavities and probably
they would not be taken care of then until they actually were
out. Is that probably what would happen?
Colonel Bodenheim. That is correct, sir.
Mr. Akin. Okay. So--but it is a fairly clear line if they
get medical or dental care while they are on active, then it is
an active duty responsibility. As soon as they are out, then--
okay.
When they usually come back, though, on Reserve, isn't it a
pretty short period of time when they actually get back in
country and they are released? Is that pretty quickly, just
like a week or so?
Colonel Bodenheim. Yes, sir. It is a four-to-six-day
demobilization period.
Mr. Akin. Right. Okay.
Well, I think--I will do a follow-up.
Thank you, Mr. Chairman.
Dr. Snyder. Mr. Buyer for five minutes.
Mr. Buyer. Thank you.
Colonel Bodenheim, when I came to San Antonio and you and
three other officers testified with regard to this--I don't
know what you call it, the Army Dental Care System Overview
Support?
Now that you have had an opportunity to reflect and you
have also given testimony to Art Wu several times, upon your
reflection, is it fair to say that you knew the numbers were
not fair and accurate as they were testified to me when I was
in San Antonio?
Colonel Bodenheim. Sir, is this concerning the
demobilization----
Mr. Buyer. Yes.
Colonel Bodenheim [continuing]. Process for the 1st through
the 34th?
Mr. Buyer. Yes.
Colonel Bodenheim. Sir, my personal opinion is that the
numbers are not--not incorrect; they are just a different way
of looking at how the costs for that process were arrived at.
Mr. Buyer. So is it fair to say that you were then
following orders in that you were to make this program as
costly as possible?
Colonel Bodenheim. That is incorrect, sir. There were other
courses of action that were actually more expensive.
Mr. Buyer. So you, though, presented to me a study that
said that a dental exam and radiographs, if you were to do it
at demobilization, would be $307, which is at the 95th
percentile times 100 for the country.
Now, you can play wordsmith all you like, because others
have already gone back in and looked at this and said, yes,
these are bad numbers. Now, I am not your commander, so I am
going to be straight up with you, because if I were your
commander, I would prefer charges against three field grade
officers and one general officer in the Army Dental Corps. I
would.
Fraud is a very serious charge. Another serious charge is
called ``the intent to deceive.''
You see, what you guys didn't know down there in San
Antonio, what you do know now, is that this study was something
that was created by the Surgeon General, Kiley then, and
myself. So what you did in your little gamesmanship down there
to sort of protect your idea of, Oh, we will do the
contracting; at the same time we will utilize the VA.
You guys really messed up. You really have messed up bad.
Now, what hurts, what hurts the most is, soldiers aren't
getting taken care of. Now, from the Army's point of view--
perhaps the Army now has this perspective, because you made it
very clear to me when you said--not you, but it was Colonel
Hanson, with General Czerw sitting right next to him, who
looked me in the eye, saying, upon demobilization, ``not our
mission.'' Said in such a strong, forceful, and yet almost
arrogant tone, ``not our mission.''
Okay. That is why I have had some conversations here with
the chairman of this committee, because we in the VA then
become your bill payer. The purpose here is really for Army to
take care of Army.
Now, when I look at this statement, I have been around long
enough to know this statement is very poor that you have
given--the written statement is very poor, because what is
missing here, Colonel, somebody has scrubbed this thing.
Whether it was scrubbed through the Surgeon General's Office or
through OSD or the Office of Management and Budget (OMB), it is
really scrubbed.
Oh, I get the wordspeak at the end about solution sets and
initiatives. That doesn't tell me anything. I also see where
you embrace the existing provider contracts. I suppose that
tells me that you really embrace Logistics Health Incorporated
(LHI). Would that be accurate? The Dental Corps--you want to
really embrace the LHI contract? Is that accurate?
Colonel Bodenheim. Sir, I, personally speaking, I don't
care what contractor is used to ensure dental readiness for our
Army Reserve and Army Guard soldiers.
Mr. Buyer. Who should be providing that dental care,
Colonel?
Colonel Bodenheim. It should be a multifactorial situation.
First of all, for the active component, when soldiers are
coming into basic training----
Mr. Buyer. On demobilization (demob).
Colonel Bodenheim. On demob, we should be able to provide
it, as much as we can, within the four-to-six-day period. But
again, Dental Command (DENCOM) does not determine what goes on
in those four to six days.
Mr. Buyer. Does DENCOM still embrace ``not our mission''?
Colonel Bodenheim. We believe it is our mission----
Mr. Buyer. So your testimony now has changed. Why has it
changed?
Colonel Bodenheim. Personally speaking, it has changed
because we think it is the right thing to do in order to reset
the entire force and to improve the dental readiness of both
components.
Mr. Buyer. All right. Then I suppose, personally, upon your
reflection there at the moment, you recognized that what was
done here was wrong.
I will ask for further questions with regard to the reset,
because it is 1 year plus 90 days.
Dr. Snyder. We will go around again, Mr. Buyer.
Colonel Sproat, I wanted to ask you on the first page of
your written statement, and you mentioned it in your oral
statement, you refer to the 39th and you say, ``To ensure
mission success, the same processes and techniques are being
used this year,'' and you list some other units.
Give us a list, what do you consider to be the processes
and techniques that the 39th used that you think should be used
elsewhere or are being used elsewhere? Specifically, what are
those processes and techniques?
Colonel Sproat. Yes, sir.
Each of our states is unique in terms of their makeup, in
terms of their geography, in terms of their dispersion of
guardsmen. And so there is really no one set solution that we
can apply to the Nation. We depend on the states to develop
courses of action for each of their populations to be able to
get these units ready.
There is a whole group of contract vehicles that are
available to them, organic personnel to the unit that can be
utilized to get those folks ready. We at the National Guard
Bureau basically collect the best practices from each of these
BCTs as they go through this process and then make sure that we
learn as an organization how to do this best.
Dr. Snyder. What are those best practices?
Colonel Sproat. The best practices are early identification
of the soldiers. Upon alert, making sure that every soldier has
had an exam. Ideally, they have had that exam before alert. And
then using the authority and the funding that we have to
provide dental treatment for those soldiers during that alert
phase, long before they go to the mobilization station.
The goal is that units should not train soldiers that are
not medically deployable, so that basically we don't invest in
them in training if they end up being medically nondeployable
in the end state.
Dr. Snyder. Colonel Martin, the TRICARE benefit is
essentially what, it is about $11-or-so a month, and then the
maximum amount that can be paid is $1,200. Is that correct?
Colonel Martin. Yes, sir. Yes, Mr. Chairman.
Dr. Snyder. So you are investing $130 or $140 to offset the
possible expense of $1,200. Is that a fair way of looking at
it?
Colonel Martin. Mr. Chairman, it is pretty fair, but there
is also the part that I want to note is for preventive care;
that doesn't count toward that $1,200.
Dr. Snyder. That's right.
Colonel Martin. So it is a little bit higher amount of
benefit that you get for that amount of money.
Dr. Snyder. And how do you--it seems like there are two
issues. One issue is, why haven't more people taken advantage
of that? The second issue is, even if somebody has insurance, a
lot of people don't like going to the dentist.
Now, how do you think both those issues ought to be
addressed?
Colonel Martin. Yes, Mr. Chairman.
The first is that, in my written testimony, it was 8 to 10
percent are currently enrolled in the program.
Dr. Snyder. Very low.
Colonel Martin. It is very low. There have been certain
surveys, though, that have shown that reservists report that
they have dental insurance either through their employment or
their spouse's employment. So there is--upwards of 60 to 70
percent say they have some type of dental insurance.
The demographics of young people, a lot of them, you know,
their teeth are not the most important thing right then. And
so, you know, the value they place on having--paying $11 to
have the dental insurance is probably not, you know, to the
level where they say, okay, yes, I will sign up for that
program. So those are some of the factors that work into why,
you know, that percentage is low, in the 8 to 10 percent.
We are doing everything we can to improve it. In fact, we
incentivized our current contractor with an award fee if they
can improve that percentage. And they have done quite a bit of
marketing to that group to increase the rates.
To the second question, as to why do certain groups not
utilize, nationwide, those who have dental insurance, it is
about--a little over 50 percent actually will utilize a dental
service. For the TDP it is much higher, at 71 percent.
Part of that, I think, is self-selection. People who are
enrolling in the program know they have a dental need, and so
they pay that money, and then they are going to go use it. And
so that is why I think you have a little bit higher utilization
rate for that group of people.
Dr. Snyder. Colonel Bodenheim, was it you that talked about
this review that is going on with General Schoomaker?
Colonel Bodenheim. Yes, sir.
Dr. Snyder. You discussed that?
Now, that started--like, last month, sometime in March?
Colonel Bodenheim. That is correct, sir.
Dr. Snyder. What is going to be the product that comes out
of that? Is there going to be a written report that will be
available to all of us, or what is going to be the end result
of that?
Colonel Bodenheim. Yes, sir.
The prioritized list of initiatives is working through the
Army leadership at this time.
Dr. Snyder. And so you anticipate there will be a report
that will be shared publicly and with the Congress and----
Colonel Bodenheim. That is correct, sir.
Dr. Snyder. And do you anticipate that will be sometime
toward the end of May?
Colonel Bodenheim. I was told that it should be within 90
days.
Dr. Snyder. From--within 90 days from when it started,
which was in March. So my math is pretty good.
There may be some things in there that we can be helpful
with during the Defense bill markup. But that is going to be
around the same time.
Do any of you have a report--I think some of you did, but
specific legislative changes? One of you mentioned--I guess
you, Captain Krause--about the need for additional full-time
personnel. But are there specific legislative changes that we
need to make or consider making?
We will just go down the line, starting with you, Colonel
Martin.
Colonel Martin. The only one that I would--and this is in
my opinion; the only one I would be interested in would be a
little clarification in the TAMP dental benefit language that
is currently out there, so that we could provide the
appropriate--a more clear benefit for those who are being
deactivated.
Dr. Snyder. Colonel Bodenheim.
Colonel Bodenheim. I would not want to comment on any
legislative changes until the Army leadership has worked
through the initiatives.
Dr. Snyder. Colonel Sproat.
Colonel Sproat. Sir, we had the two: the increase in age
from 64 to 68 for our dentists, and then full-time manning for
the Army National Guard.
Dr. Snyder. Right.
Captain Krause.
Captain Krause. I stand by what he said.
Dr. Snyder. Colonel Hart.
Colonel Hart. I have nothing to offer.
Dr. Snyder. The two days medical readiness that I think you
mentioned, that does not require a legislative change?
Colonel Sproat. No, sir. That is Army policy.
Dr. Snyder. Mr. Akin for five minutes.
Mr. Akin. I don't have any further questions.
Dr. Snyder. Mr. Buyer for five minutes.
Mr. Buyer. Thank you.
You know, Colonel Bodenheim, in answer to my first question
about, did you know that these numbers were not fair and
accurate, you thought for a moment and your answer was, ``It
was a method.'' You are right. In any form of enterprise,
especially when foolishness occurs, there are different types
of methods that are used.
Now, it is whether the method is credible or not is the
question. Right? So the credibility of the Army Dental Corps
with regard to how you handle this initiative is a question.
Now, others have had the opportunity to scrutinize your
work product. They find it highly unusual and an aberration of
customary practice. Now, that was either ordered to be done,
somebody used some type of curious math for a purpose, and it
was to deceive, I believe.
Now, you guys didn't know that Congress was involved in
this, so obviously it was going to the surgeon general. At the
time this was a surgeon general who then gets dismissed, and
you guys must be tickled to death. Gee, this is going to go
away, because it is not our mission. Even though now today you
are telling me it is your mission.
You see, you guys are not out of the woods. I want you to
know that. Because when you go on back down to San Antonio and
they tell you, hey, how did it go up in Washington, you are not
out of the woods. You are not out of the woods because, I
suppose, I am upset.
Anybody that cares about their soldiers, making sure they
get the proper care, should be upset, especially if we are
going to make it part of the Army Force Generation (ARFORGEN)
model.
Now, these initiatives that you don't want to talk about, I
am not foolish, I can almost see this, we have got the
leadership of the Army Dental Corps going, I don't like this
study, we don't want to do demob, it is not our mission, we
will cook the books, we will show the decision-making
authorities it is not cost-effective.
You get caught. Then those who catch you go, oh, my, we had
better do an assessment.
I asked your dental chief, what is this capabilities gap?
See, I came to San Antonio with pure intent to fund
capabilities gap and work cooperatively with the gentleman
behind me, because I work with him also on the VA. That is not
how I was treated.
Now I learn in your testimony that you have done your,
quote, ``capabilities assessment.'' Has that been complete, yes
or no?
Colonel Bodenheim. That capabilities assessment is still
working through the Army leadership, sir.
Mr. Buyer. Okay. Working through the Army leadership. So it
has been completed, but not signed off; that is what that
means. So there is a number already attributed to this, but you
are not willing to give it to the Armed Services Committee
because somebody hasn't signed off. Okay.
You see, General Cody was going to come over here and tell
me, but I asked him not to do that, because I wanted him not to
testify to me in my position as the VA. I am working
cooperatively with the Armed Services Committee. That is
extremely important. That is why I said, you guys are not out
of the woods. You are in more trouble than you could ever
imagine.
The credibility of the Army Dental Corps, it just bothers
me so much. I have so many dentists in my family. I grew up as
a kid, watching; my dad and I ready to go on a float trip and
go fishing, and we can't because somebody has showed up who got
his teeth knocked out in a Little League game. And the kid
wasn't my dad's patient, but he takes care of him.
It is like you are going to take care of your active duty
soldiers. But those guardsmen and reservists, they are not your
patients; we will take care of them on premobilization
(premob), but on demob, we are going to have somebody else take
of care of them. We will have contractors take care of them, we
will have the VA take care of them.
No, they are Army green. If we are going to buy into the
ARFORGEN model, it all gets caught in the cycle; we here in
Congress are prepared to do that.
So here is my message when you go back to San Antonio. You
tell the general down there, stop fighting us and be
forthright. No games. Tell him that for me?
Colonel Bodenheim. Yes, sir.
Mr. Buyer. No games.
Now, I don't know where this is going to go. We will let
the investigations continue. I can tell you how disappointed I
was when Art Wu went back down a second time, and individuals
whom he then spoke to had feigned memory.
Oh, I have been a prosecutor and I have been a defense
lawyer, so I understand what feigned memory is. I don't recall,
I don't have recollection, that may not be how it happened,
that's not what I understood what was said.
Just be careful, okay?
Colonel Bodenheim. Yes, sir.
Dr. Snyder. I wanted to ask, the issue on the readiness of
our Reserve component; I think it is an important issue. I
think it came up twice with the 39th, and we have talked about
that. You all think it is an important issue.
Are we making too big a deal about it? The bottom line is,
it gets done. They get mobilized. Teeth get fixed adequately.
Have you all done a cost analysis about whether the investment
would get us where we would ideally like to be at the time of,
you know, alert and mobilization? Is that going to be so cost
prohibitive we are better off by sticking with our kind of
scrambling-around method as we look for processes for the units
to meet this goal?
I am playing a bit of devil's advocate. Does anybody have
any comment there?
Colonel Bodenheim. Sir, I will speak to that.
What we need to get out of is the idea of what I call
``just-in-time dentistry.'' That is not the right thing for
soldiers. So when you take a soldier to a mobilization platform
and they are still in DFC 3 condition, not only are they losing
training hours, but they are getting a lot of dentistry done in
a short amount of time; and that is not the right way to treat
soldiers.
What we need is a continuous, flowing system that allows
Reserve component soldiers access to no-cost dental care on a
year-round basis, because we never know when an unalerted
soldier is going to be cross-leveled as a replacement to a unit
and then becomes an obstacle to the training of that unit.
For instance, on the 39th replacements that came after the
main body had successfully validated, many of those soldiers
had less than 30 days of training, or about a 30-day training
period before they went off with their main unit. If those
soldiers are not fixed or do not have the ability to be fixed
at no cost prior to that time, then we are being unfair to that
soldier to miss those training hours.
Dr. Snyder. The issue of recruiting and retention of
dentists, how are we going to solve that?
Colonel Sproat. Sir, we have a program that is
predecisional, but I can share with you that the Army National
Guard takes the crisis very seriously. We plan to use state
active duty dollars to put----
Dr. Snyder. If I may interrupt, we consider the recruitment
and retention of dentists a crisis?
Colonel Sproat. Sir, we are getting there. When we have 60
percent of our dental billets filled, and 40 percent of those
people are retirement eligible, when they are faced with a
deployment, they may drop their papers. The numbers decrease
every day.
Dr. Snyder. I interrupted you. Please continue.
Colonel Sproat. Yes, sir.
We have a new program for medical and dental students where
we put them on active duty at their medical or dental school as
a recruiter. This is a Guard program, and basically they
recruit their fellow students.
We pay them as second lieutenants. They receive a housing
allowance. They do not receive any tuition assistance, but this
enables them to have a good standard of living while they are
in dental school or medical school. And then they can also take
advantage of additional Guard programs when they are in their
residency programs or their training programs to pay back their
tuition.
So we think this is an innovative program that is in the
last stages of approval. And we think that is going to be a
very good fix five to six years from now when we have those
graduates coming into the Guard.
Dr. Snyder. Do any of you have any comments about the
issue--I think it was mentioned by more than one of you--on the
issue of medical records and electronic medical records? Is
that exacerbated in the area of dentistry, the issue of
transferability of medical records? Does anybody have any
comments?
Colonel Bodenheim. Sir, I will comment.
As far as electronic dental records, you saw my written
testimony that DENCLASS, originally created for the Army
National Guard as an electronic exam system record and tracking
system, will be expanded to the U.S. Army Reserve; as well, the
Reserve Health Readiness Program will use it.
One of the number one reasons for soldiers presenting as a
no-go at a mobilization site is due to missing records or parts
of missing records. And so we will be able to solve many of
those issues of reexamining a person because we don't have a
record showing their DFC rating and the ability to validate
that record.
Dr. Snyder. You have anything further?
Mr. Akin. Just to piggyback on your statement, you said the
best way to handle dental care is on a consistent basis. You
don't just do this emergency and then let it run for 10 years
and find you got a mouthful of trouble when you come back.
Is the implication of that, then, that you would have
people who were on Reserve covered? Are you saying they would
be covered under some type of dental care then?
Colonel Bodenheim. Well, currently a soldier is permitted
to have an annual exam regardless of their alert status. Upon
alert, they are allowed to get DFC, or Dental Fitness Class, 3
treatment done at that time.
What I am stating is that we need to expand this to
unalerted soldiers so that we do not have the problem with
cross-leveled soldiers or replacements, causing lost training
time at mobilization sites, and to get us out of the just-in-
time dentistry mode, which is not how any of us would want to
be treated in our own treatment.
Mr. Akin. So you are saying somebody who has not been
activated, but is in Reserve.
Currently, my understanding is, they can be covered one of
two ways: Either they have this insurance that goes up to
$1,200, or they are just paying for it out of their pocket, or
maybe their employer gives them something or whatever it is.
Colonel Bodenheim. That is correct.
Mr. Akin. And you are saying, you would like to see those
people making sure they all have got solid dental care, so that
they don't carry the dental problem in as soon as you activate
them.
I think that's what you are saying, right?
Colonel Bodenheim. That is correct, sir. And no cost to the
soldier.
Mr. Akin. At no cost.
So who is going to pay for it then, would you say? Who
would pay for that program then? Or is that something that is
in your plan?
Colonel Bodenheim. Those would be part of the initiatives
working through the Army leadership.
Mr. Akin. Okay. And so--but can you say who would pay for
that? Is that going to be a Department of Defense expense or
would that come from somewhere else?
Colonel Bodenheim. I would like to take that question for
the record.
Mr. Akin. Okay. That's fine as far as I am concerned. Thank
you.
That's all I have, Mr. Chairman.
[The information referred to was not available at the time
of printing.]
Dr. Snyder. Mr. Buyer has a final question.
Mr. Buyer. Thank you. Really there are two.
There is a demob reset question. And when you go back and
said, okay, it is our mission, the numbers were recalculated,
it shows that this--that the dental exam study, once they
recalculated the numbers, showed that it was cost-effective,
i.e., then success.
Can you tell me whether there was any planning done to do
future-type actions against brigades, to do future demob for
brigade-size assets that are returning based on the success of
this study?
Colonel Bodenheim. We have plans that are available to do
reset based upon this study.
Mr. Buyer. Okay. All right. Wait a minute. Then based on
the study. Wow. Okay.
So now, wow, that testimony that you did down in San
Antonio, that was all a mistake? Now that they have been
recalculated, you have now bought into, yes, it is cost-
effective, it is our mission; and planning for that success is
occurring right now is your testimony?
Colonel Bodenheim. Sir, what I meant to say is that we know
the number of personnel that it would take, the facilities, et
cetera, in order to do the mission.
Mr. Buyer. All right.
The demob reset, is it 1 year plus 90 days is the demob
reset? Do you know what the demob reset is?
Colonel Bodenheim. I am unsure of the question.
Mr. Buyer. Can you turn and ask somebody who may know?
Colonel Bodenheim. At present it is 180 days.
Mr. Buyer. Are you kidding me? When did this occur?
Colonel Bodenheim. This occurred recently.
Mr. Buyer. How recent? You were 1 year plus 90 days. Now
you have gone to 180 days. Was that an evidence-based decision
or did somebody capriciously push it off another 90 days?
Colonel Bodenheim. I do not know that answer, sir.
Mr. Buyer. Who made the policy decision to push it another
90 days?
Colonel Bodenheim. I cannot answer that question.
Mr. Buyer. You cannot answer it because you know and won't
tell me, or you do not know what the answer is?
Colonel Bodenheim. I do not know what the answer is, sir.
Mr. Buyer. See, Mr. Chairman, this is really pretty
concerning, because if the Army is basically--first of all, it
is concerning when they do an annual plus 90 days because they
are then saying that the 90 days is an acceptable level of
neglect.
Now--the acceptable level of neglect is now another 90
days, which is 180 days before you can ever do a
reclassification. That means the Army active duty dental corps
is not going to be doing dentistry for our guardsmen and
reservists.
What is the justification--give me your personal opinion;
that is what you like to give--give me your personal opinion on
why 180 days is a good policy or not.
Colonel Bodenheim. My personal opinion, sir, is I was
surprised by the 180 days.
I cannot answer where it came from because I do not know.
Mr. Buyer. Okay. If you are surprised, would you advocate
to change it, to change that policy?
Colonel Bodenheim. I would advocate to change it.
Mr. Buyer. You bet. All right.
I yield back, Mr. Chairman. That needs to be changed.
Dr. Snyder. Gentlemen, thank you all for being here. We
kept you about 2-1/2 hours. I apologize for the votes.
Members may have some questions for the record.
Dr. Snyder. We certainly would like to hear the results as
your decision-making process completes itself with General
Schoomaker and others; and I hope you will share that with the
committee.
We are adjourned.
[Whereupon, at 5:03 p.m., the subcommittee was adjourned.]
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A P P E N D I X
April 23, 2008
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PREPARED STATEMENTS SUBMITTED FOR THE RECORD
April 23, 2008
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[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
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QUESTIONS AND ANSWERS SUBMITTED FOR THE RECORD
April 23, 2008
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QUESTIONS SUBMITTED BY DR. SNYDER
Dr. Snyder. Is there anything you didn't have an opportunity to
share during the hearing that would be valuable to the subcommittee's
enquiry? Please provide the subcommittee with any further written
testimony or data you think is relevant.
Colonel Martin. I would like to add a few comments regarding
available dental programs that I covered in my written testimony. I
believe these comments may be relevant to potential outcomes that may
arise from this hearing.
In my written statement, with regard to deactivated Reserve
Component members, I wrote, ``If treatment is required, the member may
apply for Department of Veterans Affairs (VA) treatment within 180 days
of release from active duty. On average, about 18 percent of eligible
deactivated reservists have utilized this benefit over the past three
years.''
Although the VA benefit was mentioned in my written testimony, it
was not discussed further during the hearing. Outpatient dental
benefits are provided by the VA, according to law. Per VA Health Care
Fact Sheet 164-3, ``Outpatient Dental Treatment,'' dated March 2008, it
is noted that ``Effective January 28, 2008, recently discharged
veterans with a service-connected non-compensable dental condition or
disability who served on active duty 90 days or more and who apply for
VA dental care within 180 days of separation from active duty, may
receive a one-time treatment for dental conditions, if the dental
condition is shown to have existed at the time of discharge or release
and the veteran's certificate of discharge does not indicate that the
veteran received necessary dental care within a 90-day period prior to
discharge or release.'' VA Health Care Fact Sheet 164-3 can be found at
www.va.gov/healtheligibility/Library/pubs/Dental/Dental.pdf. Although
underutilized, this is a current dental benefit available to many
deactivated Reserve Component members. Increased utilization could have
an effect on Reserve Component dental readiness.
In my written testimony, I also described the eligibility and
enrollment of Reserve Component members in the TRICARE Dental Program
(TDP). The TDP is a program that allows Reserve Component members to
maintain continuity of dental care in both pre-activated and
deactivated status. Unfortunately, Reserve Component enrollment is very
low. Service feedback has indicated that enrollee cost shares may have
an effect on the low enrollment of Reserve Component members.
Dr. Snyder. Is there anything you didn't have an opportunity to
share during the hearing that would be valuable to the subcommittee's
enquiry? Please provide the subcommittee with any further written
testimony or data you think is relevant.
Colonel Bodenheim. During the testimony, I did not have the
opportunity to clarify the career cycle of an Army Reserve Components
(RC) Soldier and outline the ideal associated dental readiness
maintenance system required to achieve an operationalized, dentally fit
Army RC which minimizes ``just in time'' dentistry at the mobilization
platform, poor dental health of cross leveled Soldiers and the
subsequent loss of training time that I outlined during my testimony.
Dental disease is not a fixed health condition such as an appendix,
which upon infection, requires removal one time for a successful health
outcome, but is a persistent disease process requiring a continuum of
care in order to reach a consistent baseline of successful deployment
dental readiness. As an example of the persistent nature of dental
disease, the 1/34th BCT from Minnesota was deployed from Camp Shelby,
MS at a 100% dental readiness status [Dental Fitness Class (DFC) 1 and
2] but demobilized at Ft. McCoy with a DFC 3 rate of over 9%.
Each RC Soldier enters the Army through Initial Entry Training
(IET) which consists of a combination of Basic Combat Training followed
by Advanced Individual Training (AIT). Some RC Soldiers complete both
their Basic and AIT training consecutively, but significant percentages
complete their training using a split training option over a two year
period. RC Soldiers are not considered deployable until they have
completed both parts of their training. During IET, the Army Dental
Care System (ADCS), under the operational command of the U.S. Army
Dental Command (DENCOM), examines and treats IET Soldiers (both AC and
RC) within the First Term Dental Readiness (FTDR) program. The future
goal (FY 2011) is to return Soldiers to their units in a 95% DFC 1 or
DFC 2 status upon completion of their IET.
After IET, RC Soldiers return to their unit and are integrated into
the Army Force Generation (ARFORGEN) process. The ARFORGEN process is
used to manage the force and ensure the ability to support demands for
Army forces. The Army Selected Reserve (SELRES) goal is to maintain
dental readiness at the 95% DFC 1 or DFC 2 level within the ARFORGEN
cycle and outside of alert for mobilization, by using the Army SELRES
Dental Readiness System (ASDRS) which provides the policy authorization
for RC unit commanders to maintain the dental readiness (annual exams
and DFC 3 treatment) of their Soldiers through the Reserve Health
Readiness Program (RHRP), a DOD contracted medical/dental readiness
provider network, Army National Guard (ARNG) direct contracts, or RC
military dental personnel.
Upon mobilization alert, units improve their dental readiness,
currently averaging approximately 73%, by using the same contracted
entities in the ASDRS program under contingency operations. Upon
mobilization, the ADCS validates the dental readiness of mobilized RC
Soldiers at the mobilization station, determines their GO (DFC 1 or 2)
or NO GO (DFC 3 or 4) status and deploys them at 100% GO status. The RC
Soldier is deployed and receives necessary theatre care from deployed
dental assets to sustain the fight. Upon re-deployment, the RC Soldier
demobilizes and receives a dental examination within the ADCS (mission
to be initiated in July 2008). DFC 3 conditions identified during the
examination and which cannot be treated during the short 4-6 day
demobilization timeline are documented on a voucher system. The Soldier
returns to his/her unit and their voucher is managed under the
contracted entities of the ASDRS to complete DFC 3 treatment. The
ARFORGEN and associated dental readiness maintenance cycle of the
Soldier is completed. Throughout the cycle, the RC Soldier's dental
readiness radiographic and exam data will be captured and archived into
the Army Dental Digital Repository (ADDR) as well as the RC electronic
exam record and tracking system, DENCLASS. These electronic systems
will be synchronized during the summer of 2008 and will reduce the
duplication of processes and resources throughout the RC dental
readiness maintenance cycle.
Each consecutive phase of the dental readiness cycle depends upon
the previous phase's success in implementing its dental readiness
mission. Phases that are not implemented or poorly implemented reduce
the effectiveness of the previous phase due to the chronic nature of
dental disease because dental treatment increases in complexity and
cost in direct proportion to the amount of time the dental condition
remains untreated. Operationalization of the RC force should ideally
include a continuous dental readiness maintenance program throughout
the career cycle of the Soldier.
Dr. Snyder. Please provide an update of the Army's progress toward
implementing a plan to address low dental readiness rates. Please
provide documentation of decisions and implementation plans.
Colonel Bodenheim. On May 27, 2008, the Army Chief of Staff
approved a plan to address RC Soldiers' dental examinations and
readiness care through the Defense Health Program (DHP) during period
in which the Soldiers' duty status entitles them to active duty dental
care. In addition to the period of active duty dental care while the
Soldier is at the mobilization platform, these periods will mainly
occur during Initial Entry Training through the First Term Dental
Readiness (FTDR) program and through the Dental Demobilization Reset
(DDR) at demobilization sites. In anticipation of a MEDCOM Operational
Order (OPORD) directing the DDR mission, the DENCOM:
1. Initiated a warning order during a 4 June VTC to its
Regional Dental Commanders.
2. Is prepared to create and issue a DENCOM OPORD upon receipt
of the MEDCOM OPORD.
3. Is prepared to create an All Army Activities (ALARACT) to be
staffed in order to coordinate support with other Army
commands.
4. Briefed a Contingency Operation Plan on 4 June, to the
Deputy Surgeon General outlining general DDR operational plans
and FTDR general plans.
5. Chief of Information Management is identifying IM/IT
equipment requirements.
6. Chief of RC Mobilization/Demobilization Operations and the
Special Staff to the Assistant Surgeon General (Force
Projection) Lean Six Sigma Certified Black Belt jointly
identified on 5 June the detailed patient and digital
information DDR processing flow requirements. This includes the
creation of a digital voucher that can be transferred to the
ASDRS. The DENCOM Chief of Information Management was briefed
on the digital information requirements and began work on those
requirements.
7. Is initiating Dental equipment purchases. As examples,
equipment is being ordered for the new Camp Shelby SRP dental
station and the new Camp Atterbury dental clinic.
The Army SELRES Dental Readiness System (ASDRS) will focus
resources on RC Soldiers most likely to be mobilized and called to
active duty. Elements of the ASDRS program can also be employed to
address dental readiness needs identified during the DDR examination.
The Army National Guard is currently conducting demonstration projects
to evaluate the effect of the ASDRS program on training and readiness.
The United States Army Reserve, through a dental Ready Response Reserve
Unit (R3U) pilot program, will perform a pre-mobilization dental
readiness mission in late July. The Army is addressing RC dental
readiness through multiple approaches using AC and RC dental personnel
as well as contracted solutions.
Dr. Snyder. Is there anything you didn't have an opportunity to
share during the hearing that would be valuable to the subcommittee's
enquiry? Please provide the subcommittee with any further written
testimony or data you think is relevant.
Colonel Hart. I have nothing further to add to the previously
submitted testimony.
Dr. Snyder. Is there anything you didn't have an opportunity to
share during the hearing that would be valuable to the subcommittee's
enquiry? Please provide the subcommittee with any further written
testimony or data you think is relevant.
Captain Krause. Retention of Active Duty (AD) and Reserve Component
(RC) dentists has become an increasing concern. 70% of all dentists
leave AD between three and six years with most choosing not to join the
Reserves, which has also contributed to the Reserve shortages.
In FY07, the direct care dentist manpower (AD, Government Schedule
and contract) dropped to approximately 1160. Even with the increased
utilization of the Military Medical Support Office (MMSO), Operational
Dental Readiness (ODR) could not be maintained at our goal of 95%. ODR
is currently at 89%.
The 220+ RC dental officers when on two week Annual Training (AT)
orders primarily work at the recruiting centers assisting the AD force.
The reduced Reserve Dental Force size has resulted in decreased ability
to provide AT and Active Duty for Special Work (ADSW) surge support to
AD dental treatment facilities at Great Lakes, Marine Corps Recruit
Depot (MCRD) SD, MCRD Parris Island, and Marine Corps Bases (MCBs)
Camps Pendleton and Lejeune. On drilling weekends, RC dentists
primarily do examinations on reserve units to help identify dental work
the reservists need to obtain (offered through the Tricare Dental Plan
(TDP)).
In the FY08 NDAA, Congress prohibited further medical and dental
conversions. Currently, Navy Medicine plans to restore approximately
130 active duty dental officers and over 500 assistant billets from
FY10-13. This should help improve direct care treatment. Recruitment
for AD and RC is improving considerably with increased bonuses and
retention is also expected to improve.
Reserve Dental Officers have Navy training, knowledge, and
experience. They can provide accurate, cost effective, quality dental
support to the Active and Reserve Force. To meet the dental support
requirements of the Navy the size of the RC Dental Force would also
need to be increased.
Dr. Snyder. Is there anything you didn't have an opportunity to
share during the hearing that would be valuable to the subcommittee's
enquiry? Please provide the subcommittee with any further written
testimony or data you think is relevant.
Colonel Sproat. Thank you for the opportunity to appear before the
Committee and present the views of the Army National Guard. I believe
my written and oral testimony adequately addressed the needs and
concerns of the Army National Guard.