- DEPARTMENT OF DEFENSE APPROPRIATIONS FOR FISCAL YEAR 2008

[Senate Hearing 110-]
[From the U.S. Government Publishing Office]

DEPARTMENT OF DEFENSE APPROPRIATIONS FOR FISCAL YEAR 2008

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WEDNESDAY, MAY 16, 2007

U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
The subcommittee met at 10 a.m., in room SD-192, Dirksen
Senate Office Building, Hon. Daniel K. Inouye (chairman)
presiding.
Present: Senators Inouye and Stevens.

NONDEPARTMENTAL WITNESSES

STATEMENT OF SHAWN O'NEAIL, ASSOCIATE VICE PRESIDENT,
NATIONAL MULTIPLE SCLEROSIS SOCIETY

STATEMENT OF SENATOR DANIEL K. INOUYE

Senator Inouye. This is our last meeting of the
subcommittee before we markup the fiscal year 2008 Department
of Defense appropriations bill. This morning, we'll receive
testimony, not from agency officials, but from the general
public. Those who have petitioned us to be heard. As you know,
we have many competing witnesses, many members and other
committees, so by consent, all of your full statements will be
made a part of the permanent record of the subcommittee, and I
can assure you, they will be read or studied.
And each witness or group will have 4 minutes to present an
oral presentation, and we appreciate all of you who have taken
time to be with us this morning. Your involvement helps ensure
that our democracy functions as it should, and it was designed
by our Founding Fathers, that it was of the people, for the
people, and by the people. Unfortunately, this morning, there
will be a series of votes, beginning at about 10:45, so at that
time, I will have to call a recess, about an hour.
But, I can assure you that I will be back, and I will hear
every witness, even if it means depriving a little lunch, and
for me, it might help.
So, I would like to call upon the first witness, and the
first witness today is Mr. Shawn O'Neail, the Associate Vice
President of the National Multiple Sclerosis Society.
Mr. O'Neail. Thank you, Chairman Inouye, for allowing me to
provide testimony at this hearing. My name is Shawn O'Neail, I
work with the National Multiple Sclerosis Society, and I am
here today on behalf of more than 400,000 Americans and nearly
26,000 veterans, who live with the devastating effects of
multiple sclerosis, or MS. Together, we ask for your help to
fund MS research through the congressionally directed medical
research programs (CDMRP).
Multiple sclerosis is a chronic, unpredictable, often
disabling disease of the central nervous system. It interrupts
the flow of information from the brain to the body, and stops
people from moving. Every hour, someone new is diagnosed.
MS is the most common neurological disease leading to
disability in young adults. But, despite several decades of
research, the cause remains unclear, and there is no cure.
The symptoms of MS range from numbness and tingling, to
blindness and paralysis. These problems can be permanent, or
they can come and go. In either case, MS requires lifelong
therapy, and unfortunately, the cost is often financially
prohibitive. The Food and Drug Administration approved drugs
for MS range from $16,000, to more than $25,000 annually.
Testimony from U.S. veterans, along with evidence from
recent studies, suggests that combat veterans could have an
increased risk of developing multiple sclerosis. Dr. Mitch
Wallin is a neurologist who is currently treating veterans with
MS at the Department of Veterans Affairs (VA), MS Centers of
Excellence in Baltimore, and is a professor at Georgetown
University.
Dr. Wallin recently published a formal professional
hypothesis, stating that gulf war veterans were at an increased
risk for developing MS, because of their exposure to
neurotoxins. Dr. Wallin hopes to explore this hypothesis
through research at the VA. Dr. Wallin also authored a letter
to the chairman and ranking member of this subcommittee on
March 12, urging you to support funding for MS research,
through the CDMRP.
Other evidence of note includes, the annals of neurology
recently identified 5,345 cases of MS among U.S. veterans, that
was deemed ``service connected'' and the congressionally
mandated Research Advisory Committee on Gulf War Veterans
Illness (RAC), found evidence that supports a probable link
between exposures to neurotoxins and a development of
neurological disorders. Further, RAC recommended more Federal
funding to study the negative effects of neurotoxins on the
immune system.
Before I close, I want to share a story of one veteran.
Paul Perrone is a 42-year-old father from New Hampshire, a
retired U.S. Air Force sergeant, and veteran of the Persian
Gulf war. Paul was diagnosed with MS in August 1998. Initially,
Paul was diagnosed by the military with chronic fatigue
syndrome--many people with MS are often misdiagnosed. However,
after developing optic neuritis, a civilian doctor recommended
an MRI, which led to his current MS diagnosis.
It has been Paul's absolute conviction that an
environmental agent triggered his MS, either through
inoculations, or exposure to neurotoxins during his combat
service. Paul is just one of the many veterans who are fighting
on this personal battle. There is not time this morning to
outline all of the stories we have learned over the past
several months, but the cases of MS among U.S. veterans are
certainly evident, and now emerging evidence supports this
potential link. Now, we just need to provide the necessary
resources.
The DOD has a responsibility to identify and research all
of the diseases that could be related to military service,
including MS. On April 5, Senators Obama and Coleman sent the
subcommittee a letter with 21 of your colleagues' signatures,
urging you to support a $15 million appropriation for MS,
through the CDMRP. The cause, progress, or severity of symptoms
related to MS cannot yet be predicted or cured, but advances in
research and treatment can help. With your commitment to more
research, we can move closer to a world free of MS. Thank you
for your consideration.
Senator Inouye. Do you believe that with continued
research, we may be able to find a cure for MS?
Mr. O'Neail. We're very hopeful. There has been some
progress in regards to the treatments, but they still remain
very difficult to tolerate themselves, and as I mentioned,
very, very expensive.
Senator Inouye. Thank you very much, Mr. O'Neail.
Mr. O'Neail. Thank you.
[The statement follows:]

Prepared Statement of Shawn O'Neail

INTRODUCTION

Thank you Chairman Inouye, Ranking Member Stevens and distinguished
Members of the Committee, for allowing me to provide testimony at this
hearing.
My name is Shawn O'Neail and I work with the National Multiple
Sclerosis Society. I am here today on behalf of the more than 400,000
Americans and nearly 26,000 U.S. veterans who live with the devastating
effects of multiple sclerosis or MS. Together, we ask for your help to
fund MS research under the Congressionally Directed Medical Research
Programs (CDMRP).

NO CURE FOR MULTIPLE SCLEROSIS

Multiple sclerosis is a chronic, unpredictable, often-disabling
disease of the central nervous system. It interrupts the flow of
information from the brain to the body and stops people from moving.
Every hour someone new is diagnosed. MS is the most common neurological
disease leading to disability in young adults. But despite several
decades of research, the cause remains unclear, and there is no cure.
The symptoms of MS range from numbness and tingling to blindness
and paralysis. MS causes loss of coordination and memory, extreme
fatigue, emotional changes, and other physical symptoms. These problems
can be permanent, or they can come and go.
The National MS Society recommends treatment with one of the FDA-
approved ``disease-modifying'' drugs to lessen the frequency and
severity of attacks, and to help slow the progression of disability.
But unfortunately, the cost is often financially prohibitive. The FDA-
approved drugs for MS range from $16,000 to $25,000 a year, and the
treatment will continue for life.

MULTIPLE SCLEROSIS AND U.S. VETERANS

Testimony from individual veterans, along with evidence from recent
studies, suggests that Gulf War veterans could have an increased risk
of developing multiple sclerosis.
Dr. Mitch Wallin is a neurologist who currently treats veterans
with MS at the Department of Veterans Affairs' MS Center of Excellence
in Baltimore and is a professor at Georgetown University. Dr. Wallin
recently published a formal professional hypothesis stating that
deployed Gulf War veterans are at an increased risk for developing MS
because of exposure to neurotoxins.
Dr. Wallin plans to explore this hypothesis through research at the
VA. Based on existing research and his work with veterans living with
MS, Dr. Wallin authored a letter to the Chairman and Ranking Member of
this subcommittee urging you to support funding for MS research in the
CDMRP. Some of the research includes:
--The Annals of Neurology recently identified 5,345 cases of MS among
U.S. veterans that were deemed ``service-connected.''
--The Congressionally-mandated Research Advisory Committee on Gulf
War Veterans' Illnesses (RAC) found evidence that supports a
probable link between exposures to neurotoxins and the
development of neurological disorders. Further, RAC recommended
more federal funding to study the negative effect of
neurotoxins on the immune system.
--A recent epidemiological study found an unexpected, two-fold
increase in MS among Kuwaiti residents between 1993 and 2000.
This rapid increase in an area of the world with previously low
incidence rates for MS further suggests an environmental
trigger for MS. Possible triggers include exposure to air
particulates from oil well fires, vaccines, sarin, or
infectious agents.
As news circulates of a potential link between MS and military
service, more and more veterans have been coming forward with their
stories and symptoms. They uncover a unique health concern among our
veterans, and they represent the possibility that something in the
environment could trigger this disease--which could unlock the mystery
of MS.

SERGEANT PAUL PERRONE'S STORY

Paul Perrone is a 42-year-old father from New Hampshire. A retired
U.S. Air Force Sergeant and veteran of the Persian Gulf War, Paul was
diagnosed with MS in August 1998.
Initially, Paul was diagnosed by the military with chronic fatigue
syndrome, asthma, and rhinitis. Many people with MS often are
misdiagnosed at first. However, his symptoms worsened. He had extreme
fatigue and vertigo. Although Paul loved his work with the Air Force,
he no longer felt healthy enough to remain on active duty. Paul asked
for an Air Force medical evaluation board and eventually was medically
retired from the Air Force in 1994.
Then, after developing optic neuritis in one eye, a civilian doctor
recommended an MRI, which led to his current MS diagnosis. Paul is a
passionate and extremely well-informed veteran on nearly every aspect
of the military, gulf-war syndrome, veterans' benefits--and MS. It has
been his absolute conviction that an environmental agent triggered his
MS either through inoculations or exposure to neurotoxins during his
combat service.
Paul is just one of many veterans who are fighting this personal
battle. Many more stories are untold, or many individuals might not
want to come forward. But the cases of MS among U.S. veterans are
certainly evident. And now emerging research supports this potential
link.
For the nearly 26,000 veterans, and for many more individuals with
MS nationwide, more research is critical. Dr. Wallin and others might
be on the heels of identifying an environmental trigger. Now we just
need to pinpoint what and how.

THE NEED FOR MORE MS RESEARCH

Given all the evidence, we strongly believe that the Department of
Defense (DOD) has a responsibility to identify and research all
diseases that could be related to military service, including MS. On
April 5, Senators Obama and Coleman sent the subcommittee a letter with
21 of your colleagues' signatures urging you to support this $15
million appropriation for MS research under the Congressionally
Directed Medical Research Programs (CDMRP).
The cause, progress, or severity of symptoms in any one person
living with MS cannot yet be predicted or cured. But advances in
research and treatment can help. We appreciate your consideration. With
your commitment to more research, we can move closer to a world free of
MS. Thank you.

Senator Inouye. May I now call upon Dr. Chuck Staben of the
University of Kentucky.

STATEMENT OF DR. CHUCK STABEN, Ph.D., ASSOCIATE VICE
PRESIDENT FOR RESEARCH AND ACTING HEAD,
OFFICE OF THE VICE PRESIDENT FOR RESEARCH,
UNIVERSITY OF KENTUCKY ON BEHALF OF THE
COALITION OF EPSCoR/IDEA STATES
Dr. Staben. Thank you, Senator, and any members of the
subcommittee. My name is Chuck Staben, and I am the acting head
of the Office of the Vice President for Research at the
University of Kentucky.
Today I am testifying on behalf of the Coalition of EPSCoR
States, a nonprofit organization that promotes the importance
of a strong science and technology infrastructure and works to
improve the research competitiveness of States that have,
historically, received the least amount of Federal research
funding, including States that the subcommittee members
represent.
Thank you for the opportunity to testify today, regarding
the DOD Science and Engineering Basic Research Program budget,
and more specifically, a critical component of that budget,
EPSCoR.
Members of this subcommittee, thank you for your past
support of the DEPSCoR Program, I express the support of the
coalition for returning funding for this very successful
research program to the $20 million of several years ago.
Furthermore, on behalf of our 21 States and two
territories, I ask the members of this subcommittee to reject
the administration's proposed plan to terminate the DEPSCoR
Research Program. DEPSCoR States represent 20 percent of the
U.S. population, 25 percent of the research and doctoral
universities, and 18 percent of the Nation's scientists and
engineers.
With the support of this subcommittee, DEPSCoR has provided
critical, competitive support to research which satisfies peer
review requirements to proposals that address priorities
identified by the DOD through their broad agency announcements
for the program.
In Kentucky, which is a leading State in the aluminum
industry, researchers on a recent project worked closely with
the Navy on aluminum alloys and fabrication techniques,
critical to shipbuilding. We fully anticipate that the methods
they developed will be used by the Navy in its ship programs.
Research in Kentucky, and other EPSCoR States can lead
directly to deployed improvements, but without the impetus that
DEPSCoR provides, we may not make the advances required, or
contribute as fully as we are capable to supporting DOD.
Last year, the administration's fiscal year 2007 budget
proposed a budget for DEPSCoR for fiscal year 2008 of $9.8
million, reflecting the administration's commitment to
continuing the DEPSCoR Program. This year, the administration,
instead, proposed to begin a 3-year sunset of the program, by
reducing DEPSCoR from $9.4 million in fiscal year 2007, to $5.8
million in fiscal year 2008.
This decrease will not reduce spending, the administration
proposes to move the funding from the DEPSCoR Program to the
National Defense Education Program. No spending reduction, or
cost saving is captured under the administration's planned
DEPSCoR sunset, but the funds will further centralize to non-
DEPSCoR States.
The administration stresses the need for research to
support the warfighter, and challenges DEPSCoR's contribution
to this effort. DEPSCoR grants support the warfighter, because
they are competitively chosen to respond to the DOD's announced
needs and priorities from the Air Force Office of Scientific
Research, the Army Research Office, and the Office of Naval
Research. This research has produced many deployable advances,
even from a relatively small program. These advances include:
design of more efficient helicopter rotors, securing critical
software security, better wireless communication for
warfighters, and many more advances.
Mr. Chairman, I respectfully ask that you and the
subcommittee fund DEPSCoR in fiscal year 2008 at the $20
million level that sustained the program before the funding
reductions. Prior to the decrease in funding, DEPSCoR produced
many more research awards, benefiting DOD priorities. Between
fiscal year 1998 and fiscal year 2001, 283 projects in 20
States were funded. Since the program reductions, only 97
projects have been funded in the past 4 years. This past year,
only $7 million was granted to 13 academic institutions in only
nine States.
Funding reductions have already impacted DOD research in my
home State of Kentucky. In the last 4 years, only three DEPSCoR
projects have been funded, even as research in Kentucky
tripled.
Now, more than ever, we must invest in research programs
that support national security, and improve our readiness and
capability. Funding DEPSCoR in fiscal year 2008 at $20 million
will return the program to the level necessary to achieve these
objectives that were envisioned by the original authorizing
legislation.
Through the DEPSCoR Program, the DEPSCoR States continue to
make significant research contributions, and this increased
funding is required to sustain the program. Thank you very
much.
Senator Inouye. Well, Thank you very much, Dr. Staben.
[The statement follows:]

Prepared Statement of Dr. Chuck Staben

Mr. Chairman and Members of the Subcommittee, my name is Dr. Chuck
Staben and I am the Associate Vice President for Research and Acting
Head of the Office of the Vice President for Research at the University
of Kentucky. I am testifying on behalf of the Coalition of EPSCoR
States, which is a non-profit organization that promotes the importance
of a strong science and technology research infrastructure, and works
to improve the research competitiveness of states that have
historically received the least amount of federal research funding.
Thank you for the opportunity to testify today regarding the
Department of Defense science and engineering basic research program
budget, and more specifically a critical component of that budget, the
Defense Experimental Program to Stimulate Competitive Research
(DEPSCoR) \1\. I would like to sincerely thank the members of this
Subcommittee for your past support of the DEPSCoR program, and secondly
to express the support of the Coalition for returning funding for this
very successful research program to the $20 million plus levels of
several years ago. On behalf of our 21 states and 2 territories, I
would ask the Members of this Subcommittee to reject the
Administration's proposed plan to terminate the DEPSCoR research
program and transfer funds to education activities.
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\1\ Alabama, Alaska, Arkansas, Delaware, Hawaii, Idaho, Kansas,
Kentucky, Louisiana, Maine, Mississippi, Montana, Nebraska, Nevada, New
Hampshire, New Mexico, North Dakota, Oklahoma, Puerto Rico, Rhode
Island, South Carolina, South Dakota, Vermont, Virgin Islands, West
Virginia, and Wyoming.
States in bold letters are eligible for the DEPSCoR program. All of
the states listed above are also eligible for the EPSCoR program.
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The Defense EPSCoR program was initially established in Public Law
103-337 with two important policy objectives. First, DEPSCoR ensures a
national research and engineering infrastructure by enhancing the
capabilities of institutions of higher education in DEPSCoR states.
Secondly, DEPSCoR develops, plans and executes competitive, peer-
reviewed research and engineering work that supports the needs of the
Department of Defense. Our battlefields, our intelligence gathering and
analysis capacity, our procurements and maintenance activities are
increasingly driven by and dependent upon advances in research and
technology development.
As the members of this Subcommittee know, EPSCoR states have a vast
reservoir of talent and capacity. They represent 20 percent of the U.S.
population, 25 percent of the research and doctoral universities, and
18 percent of the nation's scientists and engineers. The EPSCoR program
is critical to ensuring that we maintain a national infrastructure of
research and engineering by providing much needed funding to these
leading universities and scientists.
Perhaps most importantly, DEPSCoR represents federal research money
well spent. With the support of this Subcommittee, DEPSCoR has provided
critical research dollars competitively to institutions which satisfy
peer-review requirements in proposals that address priorities
identified by the Department of Defense, through Broad Agency
Announcements (BAAs) for this program.
In Kentucky, DEPSCoR has funded 15 research projects since 1993. In
a recent project, researchers worked closely with the Navy on aluminum
alloys and fabrication techniques critical to shipbuilding. We fully
anticipate this research and testing methods will be used by the Navy
in its ship programs. Additionally, we have also participated in non-
DEPSCoR funding, so we have expertise. DOD funded research developed an
anti-sniper device now in the prototype stage under consideration by
the Marine Corps. Research in Kentucky can lead directly to deployed
improvements. However, without DEPSCoR, we cannot make the advances we
want to make or contribute as fully as we are capable.
I would now like to highlight a few DEPSCoR-funded success stories
of research projects in other states that have, and are presently
contributing to our National defense interests.
Alaska
Sea-Ice Upper Ocean Interactions: Observations and Modeling.--The
University of Alaska, Fairbanks researchers are investigating the spin-
up and spin-down of the upper ocean in response to storms. The
observational system will measure surface-to-bottom and density
structure, offering a unique opportunity to expand our understanding of
how the ocean couples surface mesoscale variability and wave excitation
to the underlying ocean on the intermediate depth continental shelves.
This study, for the Navy, will improve real-time prediction systems for
ship navigation and submarine surfacing in seasonally ice-covered
regions, such as the Arctic and the Sea of Okhotsk in the Western
Pacific and the Labrador Sea/Gulf of St. Lawrence in the northwestern
Atlantic.
West Virginia
Intelligent Agents for Reliable Operation of Electric Warship Power
Systems.--The objective of this Navy research is to design distributed
intelligent control agents for reliable operation of integrated
electronic power systems of modern electric warships. In the event of
scheduled load changes or unforeseen disturbances, the power system is
expected to operate at a minimum level of performance in areas that
could be mission critical and thus result in saving lives. This system
will consist of at least three layers: (i) an electrical network, (ii)
a computer, control, and communication network, and (iii) a human
operator. To make this critical infrastructure operational and
efficient, one will have to develop tools and methodologies that
combine information technology, control and communication and power
systems engineering. Thus, an interdisciplinary team of investigators,
with expertise in power, control, computer science, and mathematics
will work together on these methodologies. The success of this research
will have an impact on reliable operation of electric power systems of
an electric warship, as well as on the education of the next generation
of power system engineers.
Fieldable Rapid Bioagent Detection: Advanced Resonant Optical
Waveguide and Biolayer Structures for Integrated Biosensing.--This
research for the Navy will direct detection strategies suitable for
handheld unit implementation and applicable to a broad spectrum of
agents are central to effective protection and response scenarios for a
range of threats from sophisticated biowarfare agents to simple
biocontamination of potable and domestic water supplies. Integrated
optical techniques based on evanescent wave interaction have received
considerable attention and study as a means to effectively interrogate
biolayer surface target binding in direct detection devices. This
proposal defines a balanced, tightly coupled interdisciplinary research
program for modeling, analysis, and synthesis efforts to establish an
analytical and experimental understanding of the interdependence of
bio-layer and coupled resonant optical waveguide design necessary to
quantify intrinsic limits of detection, optimize realizable extrinsic
performance, and extend the versatility of this important new class of
devices.
Vermont
Heterogeneous Catalysis of Chemical Warfare Agent Simulants Using
Porous Inorganic Supports.--DEPSCoR-funded work in Vermont involves the
development of catalysts that can decompose chemical warfare agents to
non-toxic compounds. The University of Vermont has explored methods by
which contaminated equipment could be treated in a non-destructive way
so that the equipment could be returned to the battle area, which would
minimize the downtime experienced due to a chemical attack. In
particular, there are currently very few techniques available to treat
the types of sensitive equipment (electronics, objects with complex
geometries such as keyboards, etc.) on which the modern ``warfighter''
has come to rely, and the university is specifically studying materials
and methods for this application. Finally, protection (prior to an
attack) and decontamination (after an attack) are often based on
related technologies, and the university is also exploring the
development of materials that could be incorporated into fabrics and
polymers to be used for troop protection. The university has
established several connections with industrial partners to discuss
commercial development of our materials.
Dispersed Microslug Formation for Discrete Satellite Microthruster
Propellant Delivery.--DEPSCoR is funding the development of a
miniaturized propulsion system which will be integrated into next-
generation small satellites currently being developed by the Air Force
and NASA. These satellites will have masses of under 20 kg and will
operate in cluster formations (aka, ``formation flying'') and be
capable of executing mission requirements not easily performed by a
single satellite.
The value of nanosats to the Department of Defense is derived from
it ability to provide enhanced satellite capabilities for supporting
ground-based troops, aircraft and naval vessels. This support will come
primarily in the form of enhanced space-based reconnaissance and
communications. Nanosats in particular offer the ability to quickly
deploy large numbers of autonomous and effectively ``disposable''
satellites into space at low cost. Reconnaissance nanosats may be
deployed to provide detailed coverage of a particular combat theater
for short periods of time (6-12 months).
In addition to these projects, DEPSCoR research in other states has
included: design of helicopter rotors (Alaska); prediction of river
currents for Navy operations (Oklahoma); effect of DOD personnel
exposure to universal military fuel (Oklahoma); improving prediction of
atmospheric conditions to reduce weather related accidents (Oklahoma);
securing critical software systems (Vermont & Oklahoma); nerve agent
detection (Oklahoma); enhancing stored energy density for weapons
(Idaho); development of small engines that operate on universal
military fuel (Idaho); improving wireless communication for warfighter
systems (South Carolina); acquisition and interpretation of sensor data
(South Carolina); effect of exposure of military personnel to extreme
physical and climatic conditions (Montana); preventing laser damage or
destruction to aircraft optical guidance systems (Montana); increasing
durability of lightweight composite materials (Montana); increasing
information carried by radar signals (Montana); developing Air Force
supported small plastic air-vehicles (Montana); and ultrafast optical
communications and data processing (Vermont).
Mr. Chairman and Members of the Subcommittee, the Administration's
budget proposes terminating the DEPSCoR program over the next three
years and moving funds into education programs. The critical research
conducted in DEPSCoR states, mentioned above, demonstrates why the
Administration's proposal must be reconsidered by this Subcommittee.
Last year, the Administration's fiscal year 2007 budget proposal
showed an out-year funding level for DEPSCoR in fiscal year 2008 of
$9.839 million, thus reflecting the Administration's commitment to
continuing the DEPSCoR program. This year, the Administration instead
proposes to begin a three year sunset of the program by reducing
DEPSCoR funding from $9.478 million enacted in fiscal year 2007 to
$5.878 million in fiscal year 2008, far less than the $9.8 million
contemplated for fiscal year 2008 in last year's budget submission.
This decrease in funding is due to the Administration proposing to
move funding from the DEPSCoR program to the National Defense Education
Programs (NDEP). The budget justification for NDEP reflects this new
money and in fact reflects significant out-year growth in the NDEP
program. Thus, no spending reduction or cost-saving is captured under
the Administration's planned DEPSCoR sunset. And more importantly, the
plan simply moves money that was originally destined for critically
underfunded states to a national program, thus abandoning one of the
central policy objectives of DEPSCoR, which is to maintain a national
research infrastructure.
The Administration stresses the need for research to support the
``warfighter'' and challenges DEPSCoR's contribution to this effort. As
noted in the research programs I listed earlier, DEPSCoR research
clearly supports the warfighter and our national security needs by
addressing weapon system improvement, chemical and biological agent
detection, high-speed data and communication transmission, and physical
condition studies critical to deployed military personnel. Furthermore,
DEPSCoR grants necessarily support the warfighter because they are
competitively chosen to reflect the Defense Department's announced
needs and priorities. DEPSCoR supports specific research needs
identified by the Air Force Office of Scientific Research (AFOSR), the
Army Research Office (ARO) and the Office of Naval Research (ONR).
Mr. Chairman, every state has important contributions to make to
the nation's competitiveness and every state has scientists and
engineers that can contribute significantly to supporting the research
needs of the Department of Defense. DEPSCoR ensures that every state
does just that.
Mr. Chairman and Members of this Subcommittee, on behalf of my
colleagues in the coalition of EPSCoR states, I respectfully ask that
you fund DEPSCoR in fiscal year 2008 at the $20 million level that
sustained the program before the funding reductions of recent years.
Prior to the decrease in funding, DEPSCoR was funded at a $20+ million
level and produced many more research awards benefiting DOD priorities
than it is able to support today, including many of the examples cited
above. Between fiscal year 1998 and fiscal year 2001, 283 projects in
20 states were funded, 81 in fiscal year 2000 alone. However, since the
program reductions, only 97 projects have been funded in the past four
years. This past year, DOD awarded $7 million to 13 academic
institutions in nine states to perform research in science and
engineering, under the fiscal year 2007 DEPSCoR program. The
constrained funding is severely limiting the ability of the EPSCoR
states to contribute vital research that supports our national defense
needs, and we have heard that DOD may start to restrict the number of
proposals from each state for lack of funding.
Funding reductions have impacted Department of Defense research, in
my home state of Kentucky. In the last four years only three research
awards have been funded (zero in the last two years) compared to
sixteen awards between fiscal year 1998-fiscal year 2001.
Mr. Chairman, these cutbacks have created a critical research
shortfall. Now more than ever we must invest in research programs that
will support our national security and will improve our readiness and
defense capabilities in the future. Funding DEPSCoR in fiscal year 2008
at $20 million will return the program to the level necessary to
achieve the objectives envisioned by the original authorizing
legislation--to build and sustain a national research and engineering
infrastructure and to support critical Department of Defense
priorities. Furthermore, the matching requirements actually bring more
funds to bear from the states to these national programs than does
regular funding.
We are making significant research contributions but the budget
cuts are wrecking the program.
Thank you for your time and for the opportunity to testify before
the Subcommittee.

Senator Inouye. The vice chairman of the subcommittee
wishes to----
Senator Stevens. Well, I apologize, I had a meeting with
the people from the War College, as a matter of fact. I don't
want to make an opening statement.
Thank you very much, sorry to miss your comments.
Senator Inouye. Our next witness is Dr. John Leland,
Director of the University of Dayton Research Institute and
Chair of ASME's DOD Task Force, representing the American
Society of Mechanical Engineers.

STATEMENT OF DR. JOHN LELAND, Ph.D., DIRECTOR,
UNIVERSITY OF DAYTON RESEARCH INSTITUTE AND
CHAIR, AMERICAN SOCIETY OF MECHANICAL
ENGINEER'S DEPARTMENT OF DEFENSE TASK FORCE
Dr. Leland. Thank you, Chairman Inouye, Senator Stevens,
good morning. Again, I am John Leland, Chair of the American
Society of Mechanical Engineers (ASME) DOD Task Force, and
Director of the University of Dayton Research Institute. I'm
pleased to have this opportunity to provide comments to this
subcommittee on the fiscal year 2008 Department of Defense
budget request.
The American Society of Mechanical Engineers is a 120,000
member professional organization focused on technical,
educational, and research issues. Our Nation's engineers play a
critical role in national defense through research discoveries,
and technology development for military systems. Therefore, my
comments will focus on the DOD science and technology budget.
The fiscal year 2008 request for defense, science and
technology is $10.93 billion, which is $2.74 billion, or 20
percent, less than the fiscal year 2007 appropriated amount.
Under the requested DOD budget, science and technology
funding would drop from 2.5 percent, to only 2 percent of the
overall DOD budget, or total obligational authority. Clearly,
this budget is inadequate to meet the needs of our Nation.
At a minimum, $13.2 billion is required to meet the 3
percent of total obligational authority guideline for science
and technology. Six point one basic research funding supports
science and engineering research and graduate technical
education at universities in all 50 States.
Technical leaders and corporations and Government
laboratories developing current weapons systems were educated
under basic research programs funded by the DOD. Failure to
invest in sufficient resources in basic and applied research
oriented toward education will reduce innovation and weaken the
future scientific and engineering workforce of our country.
Six point two applied research has also funded the
education of many of our best defense industry engineers. As
Director of the University of Dayton Research Institute, I
understand full well the importance of these funds for
developing our future scientists and engineers. More than 250
students have the opportunity to work on defense research
programs each year at the Research Institute, and many more
enjoy opportunities through local defense-oriented companies.
Failure to properly invest in applied research would stifle
a key source of technological and intellectual development.
Many proposed reductions to individual science and technology
research programs are severe, and will certainly have negative
impacts on future military capabilities.
As an example, the Army's Materials Technology Program 2008
request is only $18 million, compared to a 2007 appropriated
amount of $60 million. Critical research will be halted if this
70 percent reduction is enacted, because this program funds
research to develop improved body armor and lightweight vehicle
armor to protect troops against improvised explosive devices
(IED).
Fortunately, Congress has recognized that such budget cuts
are not in the best interest of our country, and has
appropriated additional resources to maintain effective science
and technology programs.
Investments in science and technology directly effect the
future of our national security. We urge this subcommittee to
support an appropriate amount of $13.1 billion, or 3 percent of
total obligational authority, for science and technology
programs.
This request is consistent with recommendations contained
in the 2001 Quadrennial Defense Review and made by the Defense
Science Board, as well as by senior Defense Department
officials, and commanders from the Air Force, Army, and Navy
who have voiced support for future allocation of 3 percent as a
worthy benchmark for science and technology funding.
The American Society of Mechanical Engineers appreciates
the difficult choices that Congress must make in this
challenging budgetary environment. I strongly believe, however,
that there are critical shortages in DOD science and technology
budget requests, specifically in those areas as for basic and
applied research, and technical education are critical to the
defense of our Nation.
I thank the subcommittee for its ongoing support of Defense
science and technology.
Senator Inouye. Thank you very much, Doctor. I can assure
you that the subcommittee agrees with you. We are concerned
with the diminishing national pool of engineers, and at a time
when we need them, we should be encouraging them. So, your
words are well taken, sir.
Dr. Leland. Thank you very much.
Senator Inouye. Thank you very much.
[The statement follows:]

Prepared Statement of Dr. John E. Leland

INTRODUCTION

Good morning. My name is John Leland. I am the current Chair of the
ASME DOD Task Force and Director of the University of Dayton Research
Institute and I am pleased to have this opportunity to provide comments
to this Subcommittee on the fiscal year 2008 budget request for the
Department of Defense.
ASME is a 120,000 member professional organization focused on
technical, educational and research issues. Engineers play a critical
role in research and technology development to address, and produce the
military systems required for national defense. Therefore, my comments
will focus on DOD's Research, Development, Test and Evaluation (RDT&E)
and Science and Technology (S&T).

DOD REQUEST FOR SCIENCE AND TECHNOLOGY

The fiscal year 2008 budget request for Defense Science and
Technology (S&T) is $10.930 billion, which is $2.74 billion less than
the fiscal year 2007 appropriated amount of $13.677 billion and
represents a 20 percent reduction. The S&T portion of the overall DOD
spending of $481 billion would drop from 2.5 percent to 2 percent from
the previous budget requested by the administration. Clearly, this
budget request is inadequate to meet the country's need for robust S&T
funding.
The fiscal year 2008 request, if implemented, would represent a
significantly reduced investment in Defense S&T. I strongly urge this
committee to consider additional resources to maintain stable funding
in the S&T portion of the DOD budget. At a minimum, $13.2 billion, or
about $2.1 billion above the President's request is required to meet
the three percent of Total Obligational Authority (TOA) guideline
recommended by a National Academies study and set in the 2001
Quadrennial Defense Review and by Congress.
Basic Research (6.1) accounts would decrease from $1.56 billion to
$1.42 billion, a 8.7 percent decline. While basic research accounts
comprise only a small percentage of overall RDT&E funds, the programs
that these accounts support are crucial to fundamental, scientific
advances and for maintaining a highly skilled science and engineering
workforce.
Basic research accounts are used mostly to support science and
engineering research and graduate, technical education at universities
in all 50 states. Almost all of the current high-technology weapon
systems, from advanced body armor, vehicle protection system, to the
global positioning satellite (GPS) system, have their origin in
fundamental discoveries generated in these basic research programs.
Proper investments in basic research are needed now, so that the
fundamental scientific results will be available to create innovative
solutions for future defense challenges. In addition, many of the
technical leaders in corporations and government laboratories that are
developing current weapon systems, ranging from the F-35 Joint Strike
Fighter to the suite of systems employed to counter Improvised
Explosive Devices (IED's), were educated under basic research programs
funded by DOD. Failure to invest sufficient resources in basic,
defense-oriented research will reduce innovation and weaken the future
scientific and engineering workforce. The Task Force recommends that
Basic Research (6.1) be funded at a minimum level of $1.7 billion.
Applied Research (6.2) would be reduced from $5.32 billion to $4.36
billion, an 18 percent reduction. The programs supported by these
accounts apply basic scientific knowledge, often phenomena discovered
under the basic research programs, to important defense needs. Applied
research programs may involve laboratory proof-of-concept and are
generally conducted at universities, government laboratories, or by
small businesses. Many of the successful demonstrations led to the
creation of small companies, that were aided by the Small Business
Innovative Research (SBIR) programs. Some devices created in these
defense technology programs have dual use, such as GPS, and the
commercial market far exceeds the defense market. However, without
initial support by Defense Applied Research funds, many of these
companies would not exist. Like 6.1 Basic Research, 6.2 Applied
Research has also funded the educations of many of our best defense
industry engineers. Failure to properly invest in applied research
would stifle a key source of technological and intellectual development
as well as stunt the creation and growth of small entrepreneurial
companies.
The largest reduction would occur in Advanced Technology
Development (6.3), which would experience a 22.3 percent decline, from
$6.436 billion to $4.999 billion. These resources support programs
where ready technology can be transitioned into weapon systems. Without
the real system level demonstrations funded by these accounts,
companies are reluctant to incorporate new technologies into weapon
systems programs.
Several of the proposed reductions to individual S&T program
elements are dramatic and could have negative impacts on future
military capabilities. An example is the reduction in the Army's
Materials Technology program (PE0602105A). The fiscal year 2007
appropriated amount was $60 million and the fiscal year 2008 request is
for $18 million. Many worthwhile programs will not be funded if this
two-thirds reduction is enacted. This line item funds research in a
range of critical materials technologies, including improved body armor
to protect troops against improvised explosive devices (IEDs) and in
developing light weight armor for vehicle protection, such as is needed
for the Future Combat System (FCS). With the problems faced in Iraq
with IEDs and the need for lighter armor for the FCS it does not seem
wise to cut materials research. Fortunately in the past few years the
United States Congress has recognized that such cuts are not in the
best interest of the country, and has appropriated additional resources
to maintain healthy S&T programs in critical technologies.

DOD REQUEST FOR RDT&E

The Administration requested $78.996 billion for the Research,
Development, Test and Evaluation (RDT&E) portion of the fiscal year
2008 DOD budget. These resources are used mostly for developing,
demonstrating, and testing weapon systems, such as fighter aircraft,
satellites, and warships. This amount represents growth from last
year's appropriated amount of $78.231 billion of about 1 percent.
Therefore, when adjusted for inflation, this represents a reduction of
about 0.8 percent percent in real terms. Funds for Operational Test and
Evaluation (OT&E) function remain low, where the proposed funding of
$180 million is little more than half of the 2005 appropriated amount
of $310 million. The OT&E organization was mandated by Congress, and is
intended to insure that weapon systems are thoroughly tested so that
they are effective and safe for our troops.

DOD REQUEST FOR THE UNIVERSITY RESEARCH INITIATIVE (URI)

The University Research Initiative (URI) supports graduate
education in Mathematics, Science, and Engineering and would see a $35
million decrease from $281 million to $246 million in fiscal year 2008,
a 14.5 percent reduction. Sufficient funding for the URI is critical to
educating the next generation of engineers and scientists for the
defense industry. Since the URI programs were developed, the services
have not given a high priority to these programs. A lag in program
funds will have a serious long-term negative consequence on our ability
to develop a highly skilled scientific and engineering workforce to
build weapons systems for years to come. While DOD has enormous current
commitments, these pressing needs should not be allowed to squeeze out
the small but very important investments required to create the next
generation of highly skilled technical workers for the American defense
industry. Although URI is reduced in the fiscal year 2008 request, the
National Defense Education program (NDEP) is expected to increase from
$19 million this year to $44 million.

REDUCED S&T FUNDING THREATENS AMERICA'S NATIONAL SECURITY

Science and technology have played a historic role in creating an
innovative economy and a highly skilled workforce. Study after study
has linked over 50 percent of our economic growth over the past 50
years to technological innovation. The ``Gathering Storm'' report
places a ``special emphasis on information sciences and basic
research'' conducted by the DOD because of large influence on
technological innovation and workforce development. The DOD, for
example, funds 40 percent of all engineering research performed at our
universities. U.S. economic leadership depends on the S&T programs that
support the nation's defense base, promote technological superiority in
weapons systems, and educate new generations of scientists and
engineers.
Prudent investments also directly affect U.S. national security.
There is a general belief among defense strategist that the United
States must have the industrial base to develop and produce the
military systems required for national defense. Many members of
Congress also hold this view. A number of disconcerting trends, such as
outsourcing of engineering activities and low participation of U.S.
students in science and engineering, threaten to create a critical
shortage of native, skilled, scientific and engineering workforce
personnel needed to sustain our industrial base. Programs that boost
the available number of highly educated workers who reside in the
United States are important to stem our growing reliance on foreign
nations, including potentially hostile ones, to fill the ranks of our
defense industries and to ensure that we continue to produce the
innovative, effective defense systems of the future.

RECOMMENDATIONS

In conclusion, I thank the committee for its ongoing support of
Defense S&T. The ASME DOD Task Force appreciates the difficult choices
that Congress must make in this tight budgetary environment. I believe,
however, that there are critical shortages in the DOD S&T areas,
particularly in those that support basic research and technical
education that are critical to U.S. military in the global war on
terrorism and defense of our homeland.
The Task Force recommends the following:
--We urge this subcommittee to support an appropriation of $13.1
billion for S&T programs, which is 3 percent of the overall
fiscal year 2008 DOD budget. This request is consistent with
recommendations contained in the 2001 Quadrennial Defense
Review and made by the Defense Science Board (DSB), as well as
senior Defense Department officials and commanders from the Air
Force, Army, and Navy, who have voiced support for the future
allocation of 3 percent as a worthy benchmark for science and
technology programs.
--We also recommend that the committee support the University
Research Initiative (URI) by restoring funds for the program to
the fiscal year 2006 level of $272 million for fiscal year
2008. A strong investment in advanced technical education will
allow the Nation's armed services to draw from a large pool of
highly-skilled, native-born workers for its science and
engineering endeavors.
This statement represents the views of the ASME Department of
Defense Task Force of ASME's Technical Communities and is not
necessarily a position of ASME as a whole.

Senator Inouye. Our next witness is Lieutenant General
Dennis M. McCarthy, United States Marine Corps, retired,
Executive Director of the Reserve Officers Association of the
United States (ROA).
General McCarthy.

STATEMENT OF LIEUTENANT GENERAL DENNIS M. McCARTHY,
UNITED STATES MARINE CORPS (RETIRED),
NATIONAL EXECUTIVE DIRECTOR, RESERVE
OFFICERS ASSOCIATION OF THE UNITED STATES
General McCarthy. Senator Inouye, Senator Stevens, thank
you very much for the opportunity to testify. I would just make
four points this morning.
We have long-advocated, and continue to advocate fully
funding the training and equipment accounts of the Reserve
components of all of the services. I think you--this
subcommittee knows very well that this funding is essential,
not just to the readiness, but to the recruiting and retention
success that the Reserve components will have. The great young
people that we've recruited, and the ones that we want to
retain, will not sit around empty training centers, twiddling
their thumbs because they don't have the right kind of
equipment.
Second, the Secretary of Defense has announced, and I think
rightly so, a 1-year mobilization period for all components,
but this really, mostly impacts the Army, which has previously
used longer periods.
To successfully deploy, these forces are going to have to
be trained in advance of mobilization. This means they have to
have the equipment in their home training centers, if they're
going to be ready when they actually are mobilized and called
to active duty. There will not be time for lengthy
predeployment training on a 1-year cycle.
Third, I believe that the subcommittee has seen, I believe
history will support the idea that, if the Congress wants funds
to go to the Reserve components to buy equipment that will stay
with the Reserve components. The only successful way that we
seem to have done that is through the National Guard, Reserve,
and equipment account. That earmarks equipment, doesn't let it
get lost, doesn't let it get subsumed into larger equipment
accounts, keeps it identifiable with the Reserve components,
and we urge the Congress to take steps to adequately fund the
equipment accounts of the Reserve components through the
National Guard and Reserve equipment appropriations (NGREA)
process.
Last, we have made a recommendation, a request of the
subcommittee to consider funding for 1 year a--essentially,
pilot project of a law center, that would enable use to
continue what we've been doing--what ROA has been doing, out of
its own budget, in providing guidance, education, counseling,
referral services to service members who have employment-
related legal problems. Service members who come back and find
difficulties with their employers, and have to make a claim
under the USERRA Act, and we have been, we've been trying to
provide counseling services. If we had some funding in this, I
believe we could do a substantially better job.
I think the subcommittee knows that employers around the
country have done an absolutely marvelous job, and the numbers
of these cases are relatively small. But, if we think about it,
with 600,000 Reserves, and members of the National Guard
mobilized, if even 1 or 2 percent of them have problems with
their employers, that's a significant number of cases that need
to be resolved. And, we think we can do some real good with the
Law Center.
So, that's my fourth point, I thank the subcommittee for
the opportunity to appear, and we appreciate the support that
the Congress has provided.
Thank you, Senator.
Senator Inouye. I can assure you, General, that the
subcommittee is very much concerned about, first, the training
and properly equipping our Reserve officers and men. In fact,
in the supplemental appropriation, provisions made for that.
And, as for your project, we will give it our most serious
consideration.
General McCarthy. Thank you, Senator.
Senator Inouye. Thank you, sir.
[The statement follows:]

Prepared Statement of Lieutenant General Dennis M. McCarthy

The Reserve Officers Association of the United States (ROA) is a
professional association of commissioned and warrant officers of our
nation's seven uniformed services, and their spouses. ROA was founded
in 1922 during the drawdown years following the end of World War I. It
was formed as a permanent institution dedicated to National Defense,
with a goal to teach America about the dangers of unpreparedness. When
chartered by Congress in 1950, the act established the objective of ROA
to: ``. . . support and promote the development and execution of a
military policy for the United States that will provide adequate
National Security.'' The mission of ROA is to advocate strong Reserve
Components and national security, and to support Reserve officers in
their military and civilian lives.
The Association's 70,000 members include Reserve and Guard
Soldiers, Sailors, Marines, Airmen, and Coast Guardsmen who frequently
serve on Active Duty to meet operational needs of the uniformed
services and their families. ROA's membership also includes officers
from the U.S. Public Health Service and the National Oceanic and
Atmospheric Administration who often are first responders during
national disasters and help prepare for homeland security. ROA is
represented in each state with 55 departments plus departments in Latin
America, the District of Columbia, Europe, the Far East, and Puerto
Rico. Each department has several chapters throughout the state. ROA
has more than 505 chapters worldwide.
ROA is a member of The Military Coalition where it co-chairs the
Tax and Social Security Committee. ROA is also a member of the National
Military/Veterans Alliance. Overall, ROA works with 75 military,
veterans and family support organizations.

DISCLOSURE OF FEDERAL GRANTS OR CONTRACTS

The Reserve Officers Association is a private, member-supported,
congressionally chartered organization. Neither ROA nor its staff
receive, or have received, grants, sub-grants, contracts, or
subcontracts from the federal government for the past three fiscal
years. All other activities and services of the Association are
accomplished free of any direct federal funding.
President: CAPT Michael P. Smith, USNR (Ret.) (410-693-7377) cell.
Staff Contacts:
Executive Director: LtGen. Dennis M. McCarthy, USMC (Ret.) (202-
646-7701).
Legislative Director, Health Care: CAPT Marshall Hanson, USNR
(Ret.) (202-646-7713).
Air Force Affairs, Veterans: LtCol Jim Starr, USAFR (Ret.) (202-
646-7719).
Army, QDR/G-R Commission: LTC Robert ``Bob'' Feidler (Ret.) (202-
646-7717).
USNR, USMCR, USCGR, Retirement: Mr. Will Brooks (202-646-7710).

ROA PRIORITIES

The Reserve Officers Association CY 2007 Legislative Priorities
are:
--Assure that the Reserve and National Guard continue in a key
national defense role, both at home and abroad.
--Reset the whole force to include fully funding equipment and
training for the National Guard and Reserves.
--Providing adequate resources and authorities to support the current
recruiting and retention requirements of the Reserves and
National Guard.
--Support citizen warriors, families and survivors.
Issues to help FUND, EQUIP, AND TRAIN
Advocate for adequate funding to maintain National Defense during
GWOT.
Regenerate the Reserve Components (RC) with field compatible
equipment.
Fence RC dollars for appropriated Reserve equipment.
Fully fund Military Pay Appropriation to guarantee a minimum of 48
drills and two weeks training.
Sustain authorization and appropriation to National Guard and
Reserve Equipment Account (NGREA) to permit flexibility for Reserve
Chiefs in support of mission and readiness needs.
Optimize funding for additional training, preparation and
operational support.
Keep Active and Reserve personnel and Operation & Maintenance
funding separate.
Equip Reserve Component members with equivalent personnel
protection as Active Duty.
Issues to assist RECRUITING AND RETENTION
Support incentives for affiliation, reenlistment, retention and
continuation in the RC.
Fund referral recruiting programs for the National Guard and
Reserve Services.
Pay and Compensation:
Differential pay for DOD federal employees.
Professional pay for RC medical professionals.
Eliminate the 1/30th rule for Aviation Career Incentive Pay, Career
Enlisted Flyers Incentive Pay, Diving Special Duty Pay, and Hazardous
Duty Incentive Pay.
Education:
Return MGIB-Selected Reserve to 47 percent of MGIB-Active.
Health Care:
Extend military coverage for restorative dental care for up to 180
days following deployment.
Spouse Support:
Repeal the SBP-Dependency Indemnity Clause (DIC) offset for both AC
and RC survivors.
national guard & reserve equipment & personnel accounts
Key Issues Facing the Armed Forces Concerning Equipment
Procure the best quality equipment for fighting troops.
Ensure that the right quantity is funded to avoid shortfalls.
Make sure that new/renewed equipment reaches the warriors allowing
them to: Fight, Train, Respond.
Reserve Component Equipping Sources
Funded Procurement.
National Guard and Reserve Appropriations (NGREA).
Supplemental.
The above are preferred means to equip. Tracking of appropriated or
supplemental funds are difficult for DOD to track. Dollars targeted to
the Reserve Component don't always reach where intended. As NGREA is
controlled by each Reserve Component (RC) Chief, NGREA funding does
provide an audit trail.
--Cascading of equipment from Active Component.
--Cross-leveling.
This type of equipment transfer provides some units with outmoded
``hand me down'' equipment. These are discredited processes that have
failed in the past. Transfer of equipment downgrades readiness for some
units to improve the readiness of other units.
--Depot maintenance and overhaul of equipment.
Most equipment being overhauled is combat damaged, or has fallen
outside maintenance standards. Such equipment must be stripped down and
rebuilt completely. The process is slow; almost as long as to build
from scratch. Equipment is backlogged for units needing equipment for
readiness. Costs are about 75 percent of replacement costs.
Resetting the Force
By resetting or reconstitution of the force, ROA means the process
to restore people, aircraft and equipment to a high state of readiness
following a period of higher-than-normal, or surge, operations.
Operations Iraqi Freedom and Enduring Freedom are consuming the
Active and Reserve Component force's equipment. Wear and tear is at a
rate many times higher then planned. Battle damage expends additional
resources.
Many equipment items used in Southwest Asia are not receiving
depot-level repair because equipment items are being retained in
theater. The condition of equipment items in theater will likely
continue to worsen and the equipment items will likely require more
extensive repair or replacement when they eventually return to home
stations.
In addition to dollars already spent to maintain this well-worn
equipment for ongoing operations, the Armed Forces will likely incur
large expenditures in the future to repair or replace (reset) a
significant amount of equipment when hostilities cease. The services
are currently funding their reset programs in large part through the
use of supplemental appropriations.
Personnel
Training.--When Reserve Component personnel participate in an
operation they are focused on the needs of the particular mission,
which may not include everything required to maintain qualification
status in their military occupation specialty (MOS, AFSC, NEC).
There are many different aspects of training that are affected:
--Skills that must be refreshed for specialty.
--Training needed for upgrade but delayed.
--Ancillary training missed.
--Professional military education needed to stay competitive.
--Professional continuing education requirements for single-managed
career fields and other certified or licensed specialties
required annually.
--Graduate education in business related areas to address force
transformation and induce officer retention.
Loss.--There are particular challenges that occur to the force when
a loss occurs during a mobilization or operation and depending on the
specialty this can be a particularly critical requirement that must be
met.
--Recruiting may require particular attention to enticing certain
specialties or skills to fill critical billets.
--Minimum levels of training (84 days basic, plus specialty
training).
--Retraining may be required due to force leveling as emphasis is
shifted within the service to meet emerging requirements.
End Strength
ROA recommends a freeze on reductions to the Guard and Reserve
manning levels. ROA urges this subcommittee to fund the following
personnel levels.

In a time of war and the highest OPTEMPO in recent history, it is
wrong to make cuts to the end strength of the Reserve Components. The
Commission on National Guard and Reserve will be examining Reserve
Force Structure, and will make recommendations as to size in its report
to the Congress in October 2007.
Readiness
As the committee understands, readiness is a product of many
factors, including the quality of officers and enlisted, full staffing,
extensive training and exercises, well-maintained weapons and
authorized equipment, efficient procedures, and the capacity to operate
at a fast tempo. The pace of wartime operations has a major impact on
service members.
The Defense Department does not attempt to keep all active units at
full wartime readiness. Units are rated at five different levels of
readiness. Many are capable of meeting the bulk of wartime missions,
where others can meet a major portion of the wartime tasking. The two
lowest levels exist where units require resources and/or training to
undertake wartime missions. The last group may require mission and
resource changes and is not prepared to go to war.
The risk being taken by DOD by not resetting the returning Active
and Reserve units is that their readiness may be reduced because of
missing equipment, and without authorized equipment their training
levels will deteriorate. Loss of the ability to train also hurts
retention efforts.

UNFUNDED ARMY REQUIREMENTS

The Army National Guard and Army Reserve have made significant
contributions to ongoing military operations, but equipment shortages
and personnel challenges have increased and, if left unattended, may
hamper the reserves' preparedness for future overseas and domestic
missions.
To provide deployable units, the Army National Guard and the Army
Reserve have transferred large quantities of personnel and equipment to
deploying units, an approach that has resulted in growing shortages in
nondeployed units. Also, reserve units have left significant quantities
of equipment overseas and DOD has not yet developed plans to replace
it.
The Department of Defense (DOD) faces the unprecedented challenge
of sustaining large-scale, long-duration operations with an all-
volunteer military force. In addition, DOD's homeland defense missions
have taken on higher priority, and National Guard forces have state
responsibilities for homeland security activities as well as their
traditional roles in responding to natural disasters.
The Army National Guard reports that its average units have about
40 percent of their required equipment, and the Army Reserve reports
that its units have about half of the modern equipment they need to
deploy.
Readiness challenges have occurred because the Army reserve
components' role has shifted from a strategic reserve force to an
operational force that is being used on an ongoing basis. However, DOD
has not fully reassessed its equipment, personnel, and training needs
and developed a new model for the Reserves appropriate to the new
operational environment.
The Army is implementing an Army Force Generation (ARFORGEN) model
through which reserve units' readiness will be increased as units move
closer to eligibility for deployment. However, the Army has not fully
determined the equipment, personnel, and training that units will
require at each stage of the cycle or fully identified the resources to
implement its plans. Funding of $1.6 billion for modularity through
ARFORGEN is required.
Dual Use Equipment.--The tragedy in Greensburg, Kansas only
highlights a problem faced by National Guard and Army Reserve units.
Some Governors state that their disaster relief, following an
emergency, is likely hampered because much of the equipment usually
positioned around their states is in Iraq. Reserve Component units are
being sent overseas with their equipment, but when they come home, the
gear often stays in the war zones.
During a disaster, the capability to respond is measured by the
availability of equipment.
Under DOD equipping plans, numerous items that are in the allowance
from the Table of Organization and Equipment (T/O&E) have dual-use;
intended for both overseas and homeland security purposes. These
shortages could also adversely affect reserve units' ability to perform
homeland defense missions and provide support to civil authorities in
the event of natural disasters or terrorist attacks.
As of June of last year, Army National Guard units had left more
than 64,000 pieces of equipment worth more than $1.2 billion overseas.
The Army Reserve has 14,000 items in need of inspection, repair and
overhaul, and needs $742 million to replace stay behind equipment.
Depot maintenance faces a $372 million shortfall.
Compatible Equipment.--Much of the Guard and Reserve do not have
priority for the newest and most modern equipment. Much of the
equipment is older and not compatible with the Active Army. While the
substitute items may be adequate for training, this equipment must not
be allowed in the theater of operation as they might not be compatible
to other operating units, and may not sustain logistically.
75 percent of the Army Reserve's light medium trucks are not
Modular Force compatible or deployable.
50 percent of the medium line haul tractors do not support single
fleet policy and aren't integral to training and operational
efficiency.

[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Army Reserve Unfunded Modernization Vehicle Requirements--
$1.826 Billion:
Light-medium trucks (LMTV) 2.5 Ton Truck............. 425
Medium Tactical Vehicle (MTV) 5.0 Ton Truck.......... 761
Truck Cargo PLS 10x10 M1075.......................... 106
PLS Trailer.......................................... 25
High Mobility Multi-Purpose Wheeled Vehicle (HMMWV).. 304
High Mobility Multi-Purpose Wheeled Vehicle, up- 133
armored.............................................
Truck Tractors Line Haul (M915A3).................... 71
Army National Guard Top Equipment Shortfalls:
HMMWV................................................ 1,610.6
Family of Medium Tactical Vehicles................... 5,198.1
High Terrain Vehicles--HEMTT/LHS/PLS................. 1,201.2
M916A3 Light Equipment Transporter................... 191.8
Tactical Trailers.................................... 137.9
M917A2 Dump Truck.................................... 67.4
CH-47F Chinook Helicopter............................ 6,678.0
Communications Systems (JNN, SINCGARS, HF)........... 1,997.2
UAV Systems (Shadow, Raven).......................... 270.0
Small Arms........................................... 248.8
------------------------------------------------------------------------

AIR FORCE EQUIPMENT PRIORITIES

ROA continues to support military aircraft Multi-Year Procurement
(MYP) for more C-17s and more C-130Js for USAF. The Air Force Reserve
(AFR) mission is to be an integrated member of the Total Air Force to
support mission requirements of the joint warfighter.

[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Air Force Reserve Unfunded Requirements:
C-5A Galaxy:
Airlift Defensive System (ADS)................... 17.3
Large Aircraft Infrared Countermeasures (LAIRCM). 67.8
Structural Repairs (2) aircraft.................. 22.0
C-130 Hercules:
Large Aircraft Infrared Countermeasures (LAIRCM) 56.6
C-130H..........................................
Large Aircraft Infrared Countermeasures (LAIRCM) 22.2
C-130J..........................................
Secure Multi-Band Jam Resistant Radio AN/ARC-210. .8
C-17 Globemaster: Large Aircraft Infrared 41.8
Countermeasures (LAIRCM)............................
F-16 Fighting Falcon: Secure Multi-Band Jam Resistant 6.0
Radio AN/ARC-210....................................
B-52H Stratofortress: Secure Multi-Band Jam Resistant 1.3
Beyond Line of Sight Radio..........................
Developing Airmen: Air National Guard/A.F. Reserve 1.4
Test Center (AATC) support..........................
------------------------------------------------------------------------

Air Force Reserve needs $10 million in unfunded depot purchased
equipment maintenance. Funding to support restoration and modernization
of facilities is $89 million per year.
Air National Guard Unfunded Equipment Requirements
Priority 1 equipment requirements by the Air National Guard total
$500 million. This includes medical, communications, logistics,
transportation, explosive ordnance, civil support teams, maintenance,
security, and aviation requirements. Some examples are:

[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Cell phone Restoral Small SATCOM for data and voice, 10.0
first response..........................................
Expeditionary Medical System (EMEDS) purchases........... 24.2
SF Individual body armor (IBA) Helmets................... 1.7
Night Vision equipment (PVS-14), security................ 5.0
HH-60 Panoramic Night Vision Systems..................... 1.3
HC/MC 130 Multi Function Color Display................... 2.7
EC-130J Commando Solo conversion......................... 1.0
C-130 Virtual Electronic Combat System (VECTS) trainer... 1.0
F-15 IC Central Computer (VCC+) upgrade.................. 1.0
Advanced Targeting Pods.................................. 5.2
Helmet Mounted Cueing System (HMCS)...................... 1.0
Virtual Threat Recognition and Avoidance Trainer......... 1.0
Senior Scout MCT......................................... 1.0
C-40 C (Boeing 737)...................................... 85.0
------------------------------------------------------------------------

NAVY RESERVE EQUIPMENT PRIORITIES

The Active Reserve Integration (ARI) aligns Active Component and
Reserve Component units to achieve unity of command. Naval Reservists
are aligned and fully integrated into their AC supported commands.
Little distinction is drawn between AC and RC equipment. Some unique
missions remain that need support.
C-40 A Combo cargo/passenger Airlift (4)--$330.0 million.
--The Navy requires a Navy Unique Fleet Essential Airlift Replacement
Aircraft. This aircraft was designated as the C-40A and needs
to replace the aging C-9 fleet. The maximum range for the C-40A
is approximately 1,500 miles more than the C-9.
--The C-40A will accommodate 121 passengers, or eight pallets of
cargo, or a combination configuration consisting of 3 pallets
and 70 passengers. The C-40A is able to carry 121 passengers or
40,000 pounds of cargo, compared with 90 passengers or 30,000
pounds for the C-9. In addition, the maximum range for the
Clipper is approximately 1,500 miles more than the C-9. The
Navy has a fleet 21 aging C-9; the Marine Corps has two C-9
aircraft. The Navy has ordered nine C-40A's, seven of which
were Congressional add-ons.
Civil Engineering Support Equipment, Tactical Vehicles,
Communications Equipment and other Table of Allowance items
supporting--$38.0 million.
--Naval Coastal Warfare (NCW) Units
--Explosive Ordnance Disposal (EOD) Units
--Naval Construction Forces (NCF)
--Navy Equipment Logistics Support Groups (ELSG)
C-130, C-9, and C-40A upgrades and spare equipment--$69.7 million.

MARINE CORPS RESERVE EQUIPMENT PRIORITIES

The Marine Corps Reserve faces two primary equipping challenges,
supporting and sustaining its forward deployed forces in the Global War
On Terrorism while simultaneous resetting and modernizing the Force to
prepare for future challenges. Only by equally equipping and
maintaining both the Active and Reserve forces an integrated Total
Force will be seamless.
Priorities to support and sustain USMCR forces:
Obtain latest generation of Individual Combat and Protective
Equipment including: M4 rifles, Rifle Combat Optic (RCO) scopes, Helmet
pad systems, Small Arms Protective Insert (SAPI) plates, and Night
Vision Goggles.
Simulation Training Devises.
Adequate funding to Operation and Maintenance accounts to sustain
training and Predeployment operations.
Priorities to reset and modernize USMCR forces:
Procure principal end-items necessary to reestablish Training
Allowance to conduct home training.
Equip two new Light Armored Reconnaissance Companies.
Procure satellite/long-haul communication equipment shortfalls.
Update legacy aircraft.
Deployed unit equipment readiness rates remain high (95 percent).
Ground equipment mission readiness rates for non-deployed Marine Forces
Reserve Units average 85 percent based on Training Allowance. Reduced
readiness results from shortages in home station Training Allowance.
There is approximately a 10 percent readiness shortfall across the
Force for most equipment.
Restoration and Modernization (R&M) funding continues to be a
challenge for the USMCR, due to its $16.5 million backlog across the
Future Years Defense Plan (FYDP) and an overall backlog of $52.6
million. More than 50 percent of USMC Reserve Centers are over 40 years
old and 35 percent over 50 years old.

NATIONAL GUARD AND RESERVE EQUIPMENT APPROPRIATION

Prior to 1997, the National Guard and Reserve Equipment
Appropriation 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 for mobilization.
With the war, 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. The Reserve Components would benefit greatly from
a National Military Resource Strategy that includes a National Guard
and Reserve Equipment Appropriation.
To optimize the readiness of the Guard and Reserve it is also
imperative to maintain separate Reserve funds from the Active duty.

ROA LAW CENTER

The Reserve Officers Association's recommends the development of a
Servicemembers Law Center, tasked to advise Active and Reserve
servicemembers who have been subject to legal problems that occur
during deployment.
Justification.--Recruiting of prior service members into the
Reserve Component is on the decline because service members leaving
active duty fear ramification of ongoing deployments on new civilian
careers. A legal center would help:
--Recruit.--Encourage new members to join the Guard and Reserve by
providing a non-affiliation service to educate prior service
members about USERRA and SCRA protections.
--Retain.--Work with Active and Reserve Component members to counsel
about Former Spouses Protection Act, USERRA and SCRA for the
recently deployed facing legal problems.
Law Center's Services
Counseling.--Review cases, and advise individuals and their lawyers
as to legitimacy of actions taken against deployed active and reserve
component members.
Referral.--Provide names of attorneys within a region that have
successfully taken up USFSPA, USERRA and SCRA issues.
Promote.--Publish articles encouraging law firms and lawyers to
represent service members in USFSPA, USERRA and SCRA cases.
Advise.--File Amicus Curiae, ``friend of the court'' briefs on
servicemember protection cases.
Educate.--Quarterly seminars to educate attorneys a better
understanding of USFSPA, USERRA and SCRA.
ROA could incorporate the legal center into the newly remodeled ROA
Minuteman Memorial building. ROA would set-aside office spaces. ROA's
Defense Education Fund would hire an initial staff of one lawyer, and
one administrative law clerk to man the Servicemembers Law Center to
counsel individuals and their legal representatives.
Anticipated startup cost, first year: $750,000.

CIOR/CIOMR FUNDING REQUEST

The Interallied Confederation of Reserve Officers (CIOR) was
founded in 1948, and its affiliate organization, The Interallied
Confederation of Medical Reserve Officers (CIOMR) was founded in 1947.
The organization is a nonpolitical, independent confederation of
national reserve associations of 16 signatory countries of the North
Atlantic Treaty Organization (NATO), representing over 800,000 reserve
officers.
CIOR supports four programs to improve professional development and
international understanding. Dues do not cover these programs and
individual countries help fund the events. The Department of the Army
as Executive Agent hasn't been funding these programs.
Military Competition.--The CIOR Military Competition is a strenuous
three day contest on warfighting skills among Reserve Officers teams
from member countries. These contests emphasize military activities
relevant to the multinational aspects of current and future Alliance
operations.
Language Academy.--The two official languages of NATO are English
and French. As a non-government body, operating on a limited budget,
the Academy offers intensive courses in English and French and affords
national junior officer members the opportunity to become fluent in a
second language.
Partnership for Peace (PfP).--Established in 1994 with the focus of
assisting NATO PfP nations develop reserve officer and enlisted
organizations according to democratic principles. CIOR's PfP Committee
supports the advancement of a balanced civil-military leadership. CIOR
PfP Committee also assists participating countries in the Military
Competition.
Young Reserve Officers Workshops are arranged annually by the NATO
International Staff (IS). Selected issues are assigned to joint
seminars through the CIOR Defense and Security Issues (SECDEF)
Commission, allowing junior grade officers to analyze Reserve concerns
relevant to NATO in a combined environment.

CONCLUSION

DOD is in the middle of executing a war and operations in Iraq are
directly associated with this effort. The impact of the war is
affecting the very nature of the Guard and Reserve, not just the
execution of Roles and Missions. Without adequate funding, the Guard
and Reserve may be viewed as a source to provide funds to the Active
Component. It makes sense to fully fund the most cost efficient
components of the Total Force, its Reserve Components.
At a time of war, we are expending the smallest percentage of GDP
in history on National Defense. Funding now reflects about 3.9 percent
of GDP. ROA has a resolution urging that defense spending should be 5
percent to cover both the war and Homeland Security. While these are
big dollars, the President and Congress must understand that this type
of investment is what it will take to equip, train and maintain an all-
volunteer force for adequate National Security.
The Reserve Officers Association, again, would like to thank the
subcommittee for the opportunity to present our testimony. We are
looking forward to working with you, and supporting your efforts in any
way that we can.

Senator Inouye. Our next witness is Captain Marshall
Hanson, of the United States Naval Reserve, Co-Director of the
National Military and Veterans Alliance.

STATEMENT OF CAPTAIN MARSHALL HANSON, UNITED STATES
NAVY (RETIRED), CO-DIRECTOR, NATIONAL
MILITARY AND VETERANS ALLIANCE
Captain Marshall. Mr. Chairman, Senator Stevens, the
National Military and Veterans Alliance (NMVA) is very grateful
for the invitation to testify to you about our views and
suggestions concerning defense funding and issues.
The NMVA is made up of 30 associations of serving members,
veterans, families and survivors, that represent 3.5 million
members. The alliance supports a strong national defense.
While the NMVA recognizes that the subcommittee is working
under budget restraints, the alliance urges the President and
Congress to increase defense spending to 5 percent of the Gross
Domestic Product during times of war to cover procurement, and
prevent unnecessary personnel end-strength cuts.
Further, the NMVA supports funding increases in support of
the end-strength boost on the Active duty component to the Army
and Marine Corps that has been recommended by defense
authorizers. Current Army policy has changed a deployment from
12 to 15 months, a larger force will help our young warriors
have the ability to stay longer at home in between these
deployments.
Recruiting and retention is paramount in the global war on
terrorism, and today's youth will be judging how our veterans
of today's wars are treated. So, the NMVA supports bonuses and
incentives to encourage people to join.
One program that we would like the subcommittee to support,
is a Guard recruiting program, where a Guardsman is paid $1,000
referring a new member to a recruiter, and then paid another
$1,000 if that individual goes to basic training. We think this
is a very successful program, the Guard are very excited to be
able to do their own recruiting, it's helped the Guard get the
end numbers, and we'd like to see this program extended and
funded to the rest of the Federal Reserve component.
The last point that I want to touch upon, deals with the
survivor benefit plan (SBP), and dependency and indemnity
compensation (DIC) offset. Our widows of members who are killed
in the line of service are still being penalized, and this
offset is basically taking SBP funds away from them that their
warrior purchases an annuity, because it's being displaced by
the DIC payment.
The alliance supports Senator Nelson's bill which would
offset, and eliminate this injustice. But, if funding tends to
be restricted, the alliance is also open to a phased-in
implementation of a SBP/DIC offset that has been suggested in
the House Armed Services Committee.
The alliance thanks the subcommittee for our opportunity to
testify before you. You continue to be leaders in the area of
advocacy for Defense, and we applaud your nonpartisan approach
that you take to these important issues.
And, we stand by for any questions, or any way we can help
the subcommittee.
Senator Inouye. As you well know, Senator Stevens and I are
the few remaining combat veterans of World War II, and as such,
we appreciate your words. We'll do our very best.
Captain Marshall. Thank you, sir.
Senator Inouye. Thank you, sir.
Senator Stevens. Senator, can I ask--how many members are
part of your association?
Captain Marshall. My association--I represent the National
Military and Veterans Alliance, and we represent 3.5 million
members who belong to the 30 associations that make up the
alliance.
Senator Stevens. And what's their age bracket?
Captain Marshall. Excuse me, sir?
Senator Stevens. What is their age bracket?
Captain Marshall. The age bracket goes from, from
everywhere from age 18, to new recruits, all the way up to
retirees that are veterans of World War II.
Senator Stevens. Thank you, thank you.
Senator Inouye. Thank you very much.
[The statement follows:]

Prepared Statement of Captain Marshall Hanson

NATIONAL MILITARY AND VETERANS ALLIANCE

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 member
organizations are: American Logistics Association; American Military
Retirees Association; American Military Society; American Retirees
Association; American World War II Orphans Network; AMVETS (American
Veterans); Armed Forces Marketing Council; Catholic War Veterans; Gold
Star Wives of America, Inc.; Japanese American Veterans Association;
Korean War Veterans Foundation; Legion of Valor; Military Order of the
Purple Heart; Military Order of the World Wars; Military Order of
Foreign Wars; National Assoc. 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 Citizens League; Tragedy
Assist. Program for Survivors; Uniformed Services Disabled Retirees;
Veterans of Foreign Wars; Vietnam Veterans of America; Women in Search
of Equity.
These organizations have over three and a half million members who
are serving our nation or who have done so in the past, and their
families.

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 overall goal of the National
Military and Veterans Alliance is a strong National Defense. In light
of this overall objective, we would request that the committee examine
the following proposals.
While the NMVA highlights the funding of benefits, we do this
because it supports National Defense. A phrase often quoted ``The
willingness with which our young people are likely to serve in any war,
no matter how justified, shall be directly proportional as to how they
perceive the Veterans of earlier wars were treated and appreciated by
their country,'' has been frequently attributed to General George
Washington. Yet today, many of the programs that have been viewed as
being veteran or retiree are viable programs for the young veterans of
this war. This phrase can now read ``The willingness with which our
young people, today, are willing to serve in this war is how they
perceive the veterans of this war are being treated.''
This has been brought to the forefront by how quickly an issue such
as the treatment of wounded warriors can be brought to the national
attention.
In a long war, recruiting and retention becomes paramount. The
National Military and Veterans Alliance, through this testimony, hopes
to address funding issues that apply to the veterans of various
generations.

FUNDING NATIONAL DEFENSE

NMVA is pleased to observe that this year; the Congress is
discussing how much should be spent on National Defense. The Alliance
urges the President and Congress to increase defense spending to 5
percent of Gross Domestic Product during times of war to cover
procurement and prevent unnecessary personnel end strength cuts. In
addition, while the debate on Iraqi policy is important, the Alliance
would like to stress that resulting legislation should be independent
and not included as language in Defense Appropriation bill. Supporting
the troops includes providing funding for their missions.

PAY AND COMPENSATION

Our serving members are patriots willing to accept peril and
sacrifice to defend the values of this country. All they ask for is
fair recompense for their actions. At a time of war, compensation
rarely offsets the risks.
The NMVA requests funding so that the annual enlisted military pay
raise equals or exceeds the Employment Cost Index (ECI).
Further, we hope that this committee continues to support targeted
pay raises for those mid-grade members who have increased
responsibility in relation to the overall service mission. Pay raises
need to be sufficient to close the civilian-military pay gap.
NMVA would apply the same allowance standards to both Active and
Reserve when it comes to Aviation Career Incentive Pay, Career Enlisted
Flyers Incentive Pay, Diving Special Duty Pay, Hazardous Duty Incentive
Pay and other special pays.
The Service chiefs have admitted one of the biggest retention
challenges is to recruit and retain medical professionals. NMVA urges
the inclusion of bonus/cash payments (Incentive Specialty pay IPS) into
the calculations of Retirement Pay for military health care providers.
NMVA has received feedback that this would be incentive to many medical
professionals to stay in longer.

FORCE POLICY AND STRUCTURE

End Strength
The NMVA supports funding increases in support of the end strength
boosts of the Active Duty Component of the Army and Marine Corps that
have been recommended by Defense Authorizers. New recruits need to be
found and trained now to start the process so that American taxpayer
can get a return on this investment. Such growth is not instantaneously
productive.
The NMVA would like to also put a freeze on reductions to the Guard
and Reserve manning levels. With the Commission on the Guard and
Reserve now active, it makes sense to put a moratorium on reductions to
End Strength until after they report back to Congress with
recommendations. NMVA urges this subcommittee to at least fund to last
year's levels.

SURVIVOR BENEFIT PLAN (SBP) AND SURVIVOR IMPROVEMENTS

The Alliance wishes to deeply thank this Subcommittee for your
funding of improvements in the myriad of survivor programs.
However, there are still two remaining issues to deal with to make
SBP the program Congress always intended it to be: Ending the SBP/DIC
offset and moving up the effective date for paid up SBP to October 1,
2006.
SBP/DIC Offset affects several groups. The first is the family of a
retired member of the uniformed services. At this time the SBP annuity
the servicemember has paid for is offset dollar for dollar for the DIC
survivor benefits paid through the VA. This puts a disabled retiree in
a very unfortunate position. If the servicemember is leaving the
service disabled it is only wise to enroll in the Survivor Benefit Plan
(perhaps being uninsurable in the private sector). If death is service
connected then the survivor loses dollar for dollar the compensation
received under DIC.
SBP is a purchased annuity, available as an elected earned employee
benefit. The program provides a guaranteed income payable to survivors
of retired military upon the member's death. Dependency and Indemnity
Compensation (DIC) is an indemnity program to compensate a family for
the loss of a loved one due to a service connected death. They are
different programs created to fulfill different purposes and needs.
A second group affected by this dollar for dollar offset is made up
of families whose service member died on active duty. Recently Congress
created active duty SBP. These service members never had the chance to
pay into the SBP program. But clearly Congress intended to give these
families a benefit. With the present offset in place the vast majority
of families receive NO benefit from this new program, because the vast
numbers of our losses are young men or women in the lower paying ranks.
SBP is completely offset by DIC payments.
Other affected families are service members who have already served
a substantial time in the military. Their surviving spouse is left in a
worse financial position that a younger widow. The older widows will
normally not be receiving benefits for her children from either Social
Security or the VA and will normally have more substantial financial
obligations (mortgages etc). This spouse is very dependent on the SBP
and DIC payments and should be able to receive both.
Thirty Year Paid-Up SBP.--In the fiscal year 1999 Defense
Authorization Act Congress created a simple and fair paid up provision
for the Survivor Benefit Plan. A member who had paid into the program
for 30 years and reached the age of 70 could stop paying premiums and
still have the full protection of the plan for his or her spouse.
Except that the effective date of this provision is October 1, 2008.
Many have been paying for as long as 34 years.
The NMVA respectfully requests this Subcommittee fund the SBP/DIC
offset and 30 year paid-up SBP if authorized.

CURRENT AND FUTURE ISSUES FACING UNIFORMED SERVICES HEALTH CARE

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 health care provided to the active duty
members, their families, survivors and Medicare eligible retirees of
all the Uniformed Services. The improvements have been historic.
TRICARE for Life and the Senior Pharmacy Program have enormously
improved the life and health of Medicare Eligible Military Retirees
their families and survivors. It has been a very successful few years.
Yet there are still many serious problems to be addressed:
Wounded Warrior Programs
As the committee is aware, Congress has held a number of hearings
about the controversy at Walter Reed Army Medical Center. The NMVA will
not revisit the specifics. With the Independent Review Group and the
Dole/Shalala Commission recommending the closure of Walter Reed, an
emphasis needs to be placed on the urgency of upgrades at Bethesda, and
the new military treatment hospital at Fort Belvoir.
The Alliance does support funding for the wounded warriors,
including monies for research and treatment on Traumatic Brain Injuries
(TBI), Post Traumatic Stress Disorder, the blinded, and our amputees.
The nation owes these heroes an everlasting gratitude and recompense
that extends beyond their time in the military. These casualties only
bring a heightened need for a DOD/VA electronic health record accord to
permit a seamless transition from being in the military to being a
civilian.
Full Funding for the Defense Health Program
The Alliance applauds the Subcommittee's role in providing adequate
funding for the Defense Health Program (DHP) in the past several budget
cycles. As the cost of health care has risen throughout the country,
you have provided adequate increases to the DHP to keep pace.
Full funding for the defense health program is a top priority for
the NMVA. With the additional costs that have come with the deployments
to Southwest Asia, Afghanistan and Iraq, we must all stay vigilant
against future budgetary shortfalls that would damage the quality and
availability of health care.
With the authorizers having postponed the Department of Defenses
suggested fee increases, the Alliance is concerned that the budget
saving have already been adjusted out of the President's proposed
budget. NMVA is confident that this subcommittee will continue to fund
the DHP so that there will be no budget shortfalls.
The National Military and Veterans Alliance urges the Subcommittee
to continue to ensure full funding for the Defense Health Program
including the full costs of all new programs.
TRICARE Pharmacy Programs
DOD's rationalize for suggesting pharmacy fee increase as it costs
the government twice as much for a drug through the TRICARE Retail
Pharmacy program (TRRx) than it does for the same drug through the
TRICARE Mail Order Pharmacy Program (TMOP). DOD believes the rise in
the TRRx co-payments will increase revenue and force beneficiaries
migrate to the TMOP program, where the costs for their prescriptions
are lower.
NMVA may understand the motives for this change, but has concerns
about how it is being implemented. Often times the retail pharmacy
network is the only source to immediately fill a prescription, as many
pharmacy beneficiaries are unable to go to a military clinic for the
initial prescription. To truly motivate beneficiaries to a shift from
retail to mail order adjustments need to be made to both generic and
brand name drugs co-payments.
Ideally, the NMVA would like to see the reduction in mail order co-
payments without an increase in co-payments for Retail Pharmacy, but
NMVA suggests that if pharmacy co-payments are adjusted that: (1) the
higher retail pharmacy co-payments not apply on an initial
prescription, but on refills of a serial maintenance prescription, and
(2) if co-payments must be raised on retail pharmacy, that both generic
and brand name mail order prescriptions be reduced to zero dollar co-
payments.
The National Military and Veterans Alliance urges the Subcommittee
to adequate fund adjustments to co-payments in support of
recommendations from Defense Authorizers.
TRICARE Standard Improvements
TRICARE Standard grows in importance with every year that the
Global War on Terrorism continues. A growing population of mobilized
and demobilized Reservists depends upon TRICARE Standard. A growing
number of younger retirees are more mobile than those of the past, and
likely to live outside the TRICARE Prime network.
An ongoing challenge for TRICARE Standard involves creating
initiatives to convince health care providers to accept TRICARE
Standard patients. Health care providers are dissatisfied with TRICARE
reimbursement rates that are tied to Medicare reimbursement levels. The
Alliance was pleased and relieved by the Administration's and Congress'
recent corrections and improvements in Medicare reimbursement rates,
which helped the TRICARE Program.
Yet this is not enough. TRICARE Standard is hobbled with a
reputation and history of low and slow payments as well as what still
seems like complicated procedures and administrative forms that make it
harder and harder for beneficiaries to find health care providers that
will accept TRICARE. Any improvements in the rates paid for Medicare/
TRICARE should be a great help in this area. Additionally, any further
steps to simplify the administrative burdens and complications for
health care providers for TRICARE beneficiaries hopefully will increase
the number of available providers.
The Alliance asks the Defense Subcommittee to include language
encouraging continued increases in TRICARE/Medicare reimbursement
rates.
TRICARE Retiree Dental Plan (TRDP)
The focus of the TRICARE Retiree Dental Plan (TRDP) is to maintain
the dental health of Uniformed Services retirees and their family
members. Several years ago we saw the need to modify the TRDP
legislation to allow the Department of Defense to include some dental
procedures that had previously not been covered by the program to
achieve equity with the active duty plan.
With ever increasing premium costs, NMVA feels that the Department
should assist retirees in maintaining their dental health by providing
a government cost-share for the retiree dental plan. With many retirees
and their families on a fixed income, an effort should be made to help
ease the financial burden on this population and promote a seamless
transition from the active duty dental plan to the retiree dental plan
in cost structure. Additionally, we hope the Congress will enlarge the
retiree dental plan to include retired beneficiaries who live overseas.
The NMVA would appreciate this Committee's consideration of both
proposals.

NATIONAL GUARD AND RESERVE HEALTH CARE

Funding Improved TRICARE Reserve Select
It is being suggested that the TRICARE Reserve Select healthcare
plan be changed to allow the majority of Selected Reserve participate
at a 28 percent co-payment level with the balance of the premium being
paid by the Department of Defense.
NMVA asks the committee to continue to support funding of the
revised TRICARE Reserve Select program.
Mobilized Health Care--Dental Readiness of Reservists
The number one problem faced by Reservists being recalled has been
dental readiness. A model for healthcare would be the TRICARE Dental
Program, which offers subsidized dental coverage for Selected
Reservists and self-insurance for SELRES families.
In an ideal world this would be universal dental coverage. Reality
is that the services are facing challenges. Premium increases to the
individual Reservist have caused some junior members to forgo coverage.
Dental readiness has dropped. The Military services are trying to
determine how best to motivate their Reserve Component members but feel
compromised by mandating a premium program if Reservists must pay a
portion of it.
Services have been authorized to provide dental treatment as well
as examination, but without funding to support this service. By the
time many Guard and Reserve are mobilized, their schedule is so short
fused that the processing dentists don't have time for extensive
repair.
The National Military Veterans Alliance supports funding for
utilization of Guard and Reserve Dentists to examine and treat
Guardsmen and Reservists who have substandard dental hygiene. The
TRICARE Dental Program should be continued, because the Alliance
believes it has pulled up overall Dental Readiness.
Demobilized Dental Care
Under the revised transitional healthcare benefit plan, Guard and
Reserve who were ordered to active duty for more than 30 days in
support of a contingency and have 180 days of transition health care
following their period of active service.
Similar coverage is not provided for dental restoration. Dental
hygiene is not a priority on the battlefield, and many Reserve and
Guard are being discharged with dental readiness levels much lower than
when they were first recalled. At a minimum, DOD must restore the
dental state to an acceptable level that would be ready for
mobilization, or provide some subsidize for 180 days to permit
restoration from a civilian source.
Current policy is a 30 day window with dental care being space
available at a priority less than active duty families.
NMVA asks the committee for funding to support a DOD's
demobilization dental care program. Additional funds should be
appropriated to cover the cost of TRICARE Dental premiums and co-
payment for the six months following demobilization if DOD is unable to
do the restoration.

OTHER RESERVE/GUARD ISSUES

MGIB-SR Enhancements
Practically all active duty and Selected Reserve enlisted
accessions have a high school diploma or equivalent. A college degree
is the basic prerequisite for service as a commissioned officer, and is
now expected of must enlisted as they advance beyond E-6.
Officers to promote above O-4 are expected to have a post graduate
degree.
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 a college education.
Education is not only a quality of life issue or a recruiting/
retention issue it is also a readiness issue. Education a Reservist
receives 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. MGIB-SR has not even been increased
by cost-of-living increases since 1985. In that year MGIB rates were
established at 47 percent of active duty benefits. The MGIB-SR rate is
28 percent of the Chapter 30 benefits. Overall the allowance has inched
up by only 7 percent since its inception, as the cost of education has
climbed significantly.
The NMVA requests appropriations funding to raise the MGIB-SR and
lock the rate at 50 percent of the active duty benefit. Cost: $25
million/first year, $1.4 billion over ten.
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 jobs make bonuses a
necessary tool for the DOD to fill essential positions. Though the
current bonus program is useful there is a change that needs to be
addressed to increase effectiveness.
The National Guard has been quite successful with a referral
program, where National Guard members are paid $1,000 for referring an
individual to join the Guard. Another $1,000 is paid if that individual
makes it into basic training. This has proved quite successful in the
Army National Guard attaining its end strength of 350,000.
The NMVA supports expanding and funding the referral program to the
federal Reserve Components.
Reserve/Guard Funding
We are concerned about ongoing DOD initiatives to end ``two days
pay for one days work,'' and replace it with a plan to provide 1/30 of
a Month's pay model, which would include both pay and allowances. Even
with allowances, pay would be less than the current system. When
concerns were addressed about this proposal, a retention bonus was the
suggested solution to keep pay at the current levels. Allowances differ
between individuals and can be affected by commute distances and even
zip codes. Certain allowances that are unlikely to be paid uniformly
include geographic differences, housing variables, tuition assistance,
travel, and adjustments to compensate for missing health care.
The NMVA strongly recommends that the reserve pay system ``two days
pay for one days work,'' be funded and retained, as is.
Ensure adequate funding to equip Guard and Reserve at a level that
allows them to carry out their mission. Do not turn these crucial
assets over to the active duty force. In the same vein we ask that the
Congress ensure adequate funding that allows a Guardsman/Reservist to
complete 48 drills, and 15 annual training days per member, per year.
DOD has been tempted to expend some of these funds on active duty
support rather than personnel readiness.
The NMVA strongly recommends that Reserve Program funding remain at
sufficient levels to adequately train, equip and support the robust
reserve force that has been so critical and successful during our
Nation's recent major conflicts.

ARMED FORCES RETIREMENT HOMES

Following Hurricane Katrina, Navy/Marine Corps residents from AFRJ-
Gulfport were evacuated from the hurricane-devastated campus and were
moved to the AFRH-Washington D.C. campus. Dormitories were reopened
that are in need of refurbishing.
NMVA urges this subcommittee to fund upgrades to the Washington
D.C. facility, and also provide funding to rebuild the Gulfport
facility.

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 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 submit these issues of crucial concern to our collective
memberships. Thank you.

Senator Inouye. Our next witness is Mr. Seth Benge,
Legislative Director, Associations for America's Defense.
Welcome, sir.

STATEMENT OF SETH BENGE, DIRECTOR OF LEGISLATION,
RESERVE ENLISTED ASSOCIATION ON BEHALF OF
THE ASSOCIATIONS FOR AMERICA'S DEFENSE
Mr. Benge. Senator Inouye, Senator Stevens, thank you for
having me here on behalf of the Associations for America's
Defense, or A4AD, to share our concerns about equipment.
My name is Seth Benge, I'm a Legislative Director for the
Reserve Enlisted Association. As a sergeant in the Marine Corps
Reserve, I was deployed in 2007 to Iraq, currently I'm an
officer candidate for the Pennsylvania Army National Guard.
A4AD looks at national defense, equipment, force structure,
policy issues not normally addressed by the military support
community. We would like to thank the subcommittee for their
ongoing stewardship on issues of defense.
First I am going to speak about Guard and Reserve
equipment. With the new Department of Defense policy on
deployment cycles, it has become even more important that
equipment get to the various individual Reserve units. In
addition to the premode training, and the ability to respond to
a domestic emergency or terrorist attack, also has been
hampered by equipment shortfalls.
As always, our military will do everything to accomplish
these missions, but response time is measured by equipment
readiness. More money put into re-equipping the Guard and
Reserve is needed, but funding through the services has not
been effective, because most of it lacks the kind of oversight
needed.
One source of funding--the National Guard and Reserve
equipment appropriations--would solve this problem. The NGREA
gives the Reserve chiefs and Congress the control needed to
track equipment funds. A4AD would like to see the National
Guard and Reserve equipment appropriations funded at higher
rates.
In the current supplemental, it has been proposed that $1
billion be added to the NGREA. Our industrial base requires
large lead-times to produce needed equipment. Using the
supplemental to fund NGREA causes delays in getting equipment
to the Reserve units. This year, the money needed for the Guard
and Reserve equipment should go directly into the National
Guard and Reserve equipment appropriations in the regular
budget cycle.
Our current experiences have taught us that the Guard and
Reserve are needed to engage in almost any conflict. It also
taught us that we need to make some changes to the way we equip
the Reserve components. Now is the time to get the process
right.
Next year, two programs that directly benefit both Active,
and Reserve troops in the field. The Soldier Enhancement
Program, and the similar Marine Enhancement Program, provides
the capability for innovative, fast and flexible equipping of
servicemen and women. Through these programs, the military has
made advancements to individual protection, and to our soldiers
and marines lethality. Everything from weapons optics, to
uniforms, to ration to body armor have been developed through
this system. This year, the Soldier Enhancement Program has an
unfunded requirement of $18.8 million.
Finally, the joint improvised explosive device defeat fund
is a program that develops not only the equipment to defeat
IEDs, but also the tactics, techniques, and procedures. This
fund is essential to react to an adaptive enemy, and should be
fully funded, along with covering the unfunded requirement of
$152.9 million in current counter-IED devices.
Thank you, again, for this opportunity to testify before
the subcommittee. Included in our written testimony is a list
of unfunded equipment.
Senator Inouye. Thank you very much, Mr. Benge.
Senator Stevens. No, you're right, we're working on it,
that's for sure.
We are working very hard on that, on the subjects you
discussed.
Mr. Benge. Yes, sir, I appreciate that. And so do our, my
fellow soldiers. We all appreciate your hard work.
[The statement follows:]

Prepared Statement of Seth Allan Benge

ASSOCIATIONS FOR AMERICA'S DEFENSE

Founded in January of 2002, the Association for America's Defense
is an adhoc group of Military and Veteran Associations that have
concerns about National Security issues that are not normally addressed
by The Military Coalition (TMC), and the National Military Veterans
Alliance (NMVA). The participants are members from each. Among the
issues that are addressed are equipment, end strength, force structure,
and defense policy.
Participating Associations
Air Force Association
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
Navy League of the United States
Naval Reserve Association
Reserve Enlisted Association
Reserve Officers Association
The Retired Enlisted Association

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.
The Association for America's Defense is an adhoc group of eleven
military and veteran associations that have concerns about national
security issues that are not normally addressed by either The Military
Coalition, or the National Military and Veterans Alliance. Among the
issues that are addressed are equipment, end strength, force structure,
and defense policy.
A4AD, also, cooperatively works with other associations, who
provide input while not including their association name to the
membership roster.

CURRENT VERSUS FUTURE; ISSUES FACING DEFENSE

The Associations for America's Defense would like to thank this
subcommittee 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 continues to set the example.
Your committee faces numerous issues and decisions. You are
challenged at weighing people against technology, and where to invest
dollars. Multi-generations of weapons are being touted, forcing a
competition for limited budgetary resources.
Members of A4AD group are concerned that hasty recommendations
about U.S. Defense policy could place national security at risk.
Careful study is needed to make the right choice. A4AD is pleased that
Congress and this subcommittee continue oversight in these decisions.
In recent years the military has been recreated to fight a new kind
of warfare. Great strides have been made in providing the right
equipment to the right people at the right time and in the tactics that
are employed. There is still more to be done though and it is essential
to incorporate the lessons learned from the campaigns in Iraq and
Afghanistan into our current and future decisions.
Rapid Fielding Initiative
When the Army first moved into Afghanistan in 2002, years of anemic
funding for troop equipment sent many deploying Soldiers shopping for
their own hydration systems, navigation tools, and other gear, and
forced units to scrounge for optics and tripods. Then, a program called
the Rapid Fielding Initiative (RFI), developed under Program Executive
Office (PEO) Soldier, overhauled the Army's acquisition process to get
effective equipment quickly into the hands of Soldiers in theater.
Now, with the drumbeat of the Army Force Generation (ARFORGEN)
deployment rhythm gaining momentum across the operating Army, senior
Army planners decided in November to align their innovative soldier-
equipping program to synchronize with ARFORGEN. That directive formally
moves the priority of RFI to ensure that all units preparing to deploy,
Active and Reserve Component alike, receive the program's 58 items of
basic gear before heading out. RFI's previous focus extended across the
entire operating Army, including some forces not on a deployment
roster.
It appears that the Army will complete its original RFI mission of
providing enhanced Soldier capabilities to the operating Army by the
end of fiscal year 2007, but Soldier equipment requirements continue
beyond that. In addition equipment will continue to be upgraded, new
equipment will continue to be developed and there will be a need to get
this in the hands of our servicemen and women.
The spending surge of RFI has been possible only because of
supplemental Global War on Terrorism (GWOT) funding. The lessons
learned on how to produce and field essential equipment at an
accelerated rate need to be institutionalized. The military cannot
afford to loose the knowledge on how to be flexible and agile when
equipping soldiers. If the goal of the Department of Defense is to make
deployments predictable, then issuing the equipment and other
requirements to support the model should be predictable, too.
To ensure predictable and quantifiable funding, future RFI programs
should be included in the Department of Defense annual budget and the
Department should study using this program across all the services.
Airlift
Air Mobility Command assets fly 36,478 hours per month and
participate in major operations including earthquake and hurricane
relief, Operation Enduring Freedom, Operation Iraqi Freedom, Operation
Noble Eagle, and SOUTHCOM. Their contributions in moving cargo and
passengers are absolutely indispensable to American warfighters in the
Global War on Terrorism. Both Air Force and Naval airframes and air
crew are being stressed by these lift missions.
As the U.S. military continues to become more expeditionary, it
will require more airlift. DOD should complete the planned buy of 180
C-17s, and add an additional 60 aircraft at a rate of 15 aircraft per
year to account to ensure an adequate airlift force for the future and
allow for attrition--C-17s are being worn out at a higher rate than
anticipated in the Global War on Terrorism.
DOD should also continue with a joint multi-year procurement of C-
130Js and press ahead with a C-5 Reliability Enhancement and Re-
engining Program test to see where airlift funds may be best allocated.
The Navy and Marine Corps need C-40A replacements for the C-9B
aircraft. The Navy requires Navy Unique Fleet Essential Airlift. The
maximum range for the C-40A is approximately 1,500 miles more than the
C-9 with a greater airlift capacity. The C-40A, a derivative of the
737-700C is a Federal Aviation Administration (FAA) certified, while
the aging C-9 fleet is not compliant with either future global
navigation requirements or noise abatement standards that restrict
flights into European airfields. Twenty-two aircraft remain to be
replaced.
Tankers
In need for air refueling is reconfirmed on a daily basis in
worldwide DOD operations. A significant number of tankers are old and
plagued with structural problems. The Air Force would like to retire as
many as 131 of the Eisenhower-era KC-135E tankers by the end of the
decade.
DOD and Congress must work together to replacement of these
aircraft. A replacement could come in the form of a hybrid tanker/
airlifter aircraft, which when produced could ``swing'' from one
mission to the other as required. Congress should also look at re-
engining a portion of the KC-135 fleet as a short-term fix until newer
platforms come online.
Procurement F-22, F-35, MV-22A, C-40A and a replacement for the KC-
135 needs to be accelerated and modernized, and mobility requirements
need to be reported upon.
Navy Fleet Size
The current number of ships in the fleet has dropped to 278 ships.
The Chief of Naval Operations, Admiral Mike Mullen, has set the target
for the new fleet at 313 ships.
The Administration procurement rate has been too low. In order to
raise the number of ships the Navy will need more money to build ships.
In addition, industrial capacity needs to become a major focus. The
rate at which ships are built needs to be re-examined so that we keep
industrial lines open, saving the nation money in the long run. This
should result in stable funding of the current Annual Long-Range SCN
Plan.
A4AD favors a fleet no smaller than 313 ships because of an added
flexibility to respond to emerging threats. Congress should explore
options to current construction methods of ship design, configuration,
and shipbuilding that have created billion dollar destroyers.

OTHER ISSUES

Increasing End Strength
Op tempo and deployment rotation will begin to wear. The official
position of rotation of 1 year deployed for three years duty for active
duty and 1 year in six for the Guard and Reserve are targets, but not
yet reality. Both the Administration and Congress have now called for
an increase in Army and Marine Corps end strength. These increases will
have many peripheral effects. These new recruits will need to be
trained and equipped. The Air Force and Navy will be responsible for
moving and supplying these troops. Any unfunded end-strength increases
would put readiness at risk.
The A4AD supports funding increases in support of the end strength
boosts of the Active Duty Component of the Army and Marine Corps that
have been recommended by Congress and the Administration.
Now is not the time to be cutting the Guard and Reserve. Incentives
should be utilized to attract prior service members into a growing
reserve. Additionally, a moratorium on reductions to End Strength of
the Guard and Reserve should be put into place until Commission on the
Guard and Reserve can report back to Congress with recommendations.
The A4AD would like to also put a freeze on reductions to the Guard
and Reserve manning level.
Regeneration/Resetting of Equipment
A4AD would like to thank this committee for the regeneration money
that was included in the Supplemental.
Aging equipment, high usage rates, austere conditions in Iraq, and
combat losses are affecting future readiness. Equipment is being used
at 5 to 10 times the programmed rate.
Additionally, to provide the best protection possible for Soldiers
and Marines in the combat theater, many units have left their equipment
behind for follow-on units, and are returning with no equipment.
Without equipment on which to train after de-mobilization, readiness
will become an issue.
The Army, Army Reserve, Army National Guard, Marines and Marine
Forces Reserve need continued funding by Congress for equipment
replacement.
Counter-measures to Improvised Explosive Devices (IED)
A4AD would like to commend the committee for supporting enhanced
countermeasures for air and ground troops now deployed. For ground
troops, the biggest threat to safety continues to be the IED. The
previous effectiveness of these attacks would suggest that future
enemies of the United States will incorporate these tactics into their
doctrine. Defeating these attacks requires a comprehensive approach.
The military needs to have a formulation that includes human
intelligence, armor and electronic countermeasures.
The focus recently has been on the MRAP vehicle and its improved
survivability, A4AD supports purchasing MRAPs. We also encourage the
Committee to look at continuing funds for the purpose of researching,
purchasing and deploying more electronic countermeasures. In this way
we can provide more comprehensive protection for our troops on the
battlefield.
On May 1, the U.S. Army Times newspaper reported that ``Iraqi
insurgents are launching four times as many attacks with improvised
explosive devices than in 2003''. However, due to countermeasures,
``only one in five IED attacks kills or injures U.S. troops'', Pentagon
spokesperson Christine Devries said. While she did not provide casualty
figures, Davies said that one in nine U.S. soldiers injured by an IED
attack dies. The work in creating IED-Counter measures has been
effective but is not yet complete.
Continued emphasis is needed for the procurement of sufficient
quantities of electronic countermeasures to protect personnel deployed
in the battle space.
Aircraft Survivability Equipment
Air crews face non-traditional threats used by non-conventional
forces and deserve the best available warning and countermeasure
equipment available to provide the greatest degree of safety possible.
The majority of funds have been expended on fixed aircraft protection;
approximately 75 percent of U.S. air losses have been rotary wing.
A4AD hopes that the Committee will continue to support the purchase
and deployment of warning and countermeasures systems with an emphasis
on rotary wing aircraft across all of the services and insure that the
latest and most advanced versions of these protections are made
available to all units now deployed or slated for deployment in the
future--be they active duty, Guard or Reserve.
Maintaining the National Guard and Reserve Equipment Appropriations
One of the most important issues with regards to Guard and Reserve
Equipment is tracking the appropriated money from Congress to the
Reserve Components. This theme has been highlighted on several
occasions from sources in the Assistant Secretary of Defense for
Reserve Affairs office to LTG Steve Blum, Director National Guard
Bureau. It is important to note that the Reserve Chiefs,
overwhelmingly, indicate that Reserve specific equipment is needed more
now, than ever. Along with this the services need to maintain unit
cohesion, which means reserve specific equipment for reserve specific
units. From A4AD's perspective, integration and cross-leveling is
decreasing the readiness and training for Reserve personnel. Therefore,
we have to maintain reserve specific equipment and reserve units if we
are going to continue to be ready for the operational reserve force now
and well into the future. The best method to ensuring that this happens
is to fund the Guard and Reserve through the National Guard and Reserve
Equipment Appropriations (NGREA).
The NGREA reached a high of $2.5 billion in fiscal year 1991 then
dropped over the next decade. Recently Congress has been inclined to
add more money to the NGREA, $1.2 billion in fiscal year 2006, this
trend should continue. The money given to the Reserve Components in
this manner allows the Reserve Chiefs the maximum amount of flexibility
and Congress more oversight. The National Guard and Reserve Equipment
Appropriations (NGREA) is vital to guaranteeing that the Guard and
Reserve has funding to procure essential equipment that has not been
funded by the services.
A4AD asks this committee to continue to provide appropriations for
unfunded National Guard and Reserve Equipment Requirements. To
appropriate funds to Guard and Reserve equipment would help emphasize
that the Active Duty is exploring dead-ends by suggesting the transfer
of Reserve equipment away from the Reservists.

UNFUNDED EQUIPMENT REQUIREMENTS
[The services are not listed in priority order.]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Air Force:
Aircraft Recapitalization and Modernization.......... $2,602
Combat Search and Rescue (CSAR) Capability 24
Enhancement.........................................
Common Vertical Lift Support Platform (CVLSP)........ 250
Force Protection Equipment........................... 4.2
Miniature Air Launched Decoy & Jammer (MALD-J)....... 14
Air Force Reserve:
C-5A Airlift Defense system (ADS).................... 17.3
C-130H LAIRCM (Large Aircraft I/R Counter Measures).. 56.6
C-17 LAIRCM.......................................... 41.8
C-130J LAIRCM........................................ 22
C-5 Structures....................................... 22
Air Guard:
A-10/F-15/F-16 Block 42 reengining................... 1,400
F-15 Active Electronically Scanned Array radar....... 400
A-10/F-15/F-16 Helmet Mounted Cueing Systems......... 223
C-130/C-5/C-17/KC-135 LAIRCM/IRCM Testers............ 919
New C-38s............................................ 200
Army:
MRAP (GSTAMIDS)...................................... 2,249
Stryker.............................................. 775.1
Counter-IED Systems.................................. 152.9
Javalin.............................................. 184.2
Ammo Production Base................................. 190.5
Army Reserve (Total Unfunded Modernization Vehicle
Requirements $1.826 billion):
Light-medium trucks (LMTV) 2.5 Ton Truck............. 425
Medium Tactical Vehicle (MTV) 5.0 Ton Truck.......... 761
Truck Cargo PLS 10x10 M1075.......................... 106
High Mobility Multi-Purpose Wheeled Vehicle (HMMWV).. 304
High Mobility Multi-Purpose Wheeled Vehicle, up- 133
armored.............................................
Army Guard:
High Mobility Multi-Purpose Wheeled Vehicle (HMHWV).. 1,610.6
Family of Medium Tactical Vehicles (FMTV)............ 5,198.1
High Terrain Vehicles (HEMTT/LHS/PLS)................ 1,201.2
Night Vision (AN/PAS-13, AN/VAS-5)................... 1,912.4
Communication Systems (JNN, SINCGARS, HF)............ 1,997.2
Marine Corps:
MRAP................................................. 2,800
Electronic Attack (EA) UAV........................... 10
Anti-Sniper Infrared Targeting System (ASITS)........ 9.8
Tactical Remote Sensor System (TRSS)................. 3.4
Marine Corps Reserve:
Obtain latest generation of Individual Combat and
Protective Equipment including:
M4 rifles
Rifle Combat Optic (RCO) scopes
Helmet pad systems
Small Arms Protective Insert (SAPI) plates
Night Vision Goggles
Priorities to reset and modernize USMCR forces:
Procure principal end-items necessary to
reestablish Training Allowance to conduct home
training
Equip two new Light Armor Reconnaissance
Companies
Procure satellite/long-haul communication
equipment shortfalls
Update legacy aircraft
Simulation Training Devises
Navy:
LPD-17............................................... 1,700
T-AKE................................................ 1,200
Joint IED Defeat (JIEDDO) Sustainment................ 9
F/A-18E/F/G.......................................... 720
Critical ASW Enhancements............................ 96
Navy Reserve:
C-40 A Combo cargo/passenger Airlift (4)............. 330
Civil Engineering Support Equipment, Tactical 38
Vehicles, Communications Equipment and other Table
of Allowance items supporting.......................
Naval Coastal Warfare (NCW) Units
Explosive Ordnance Disposal (EOD) Units
Naval Construction Forces (NCF)
Navy Equipment Logistics Support Groups (ELSG)
C-130, C-9, and C-40A upgrades and spare equipment... 69.7
------------------------------------------------------------------------

CONCLUSION

A4AD is a working group of military and veteran associations
looking beyond personnel issues to the broader issues of National
Defense.
Cuts in manpower and force structure, simultaneously in the Active
and Reserve Component are concerns in that it can have a detrimental
effect on surge and operational capability.
This testimony is an overview, and expanded data on information
within this document can be provided upon request.
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 Inouye. Our next witness is Dr. William Strickland,
representing the American Psychological Association.
Dr. Strickland.

STATEMENT OF DR. WILLIAM J. STRICKLAND, Ph.D., VICE
PRESIDENT, HUMAN RESOURCES RESEARCH
ORGANIZATION, ON BEHALF OF THE AMERICAN
PSYCHOLOGICAL ASSOCIATION
Dr. Strickland. Good morning, Mr. Chairman, Senator
Stevens. I'm Bill Strickland, Vice President of the Human
Resources Research Organization. I'm testifying today on behalf
of the American Psychological Association, or APA, a scientific
and professional organization of more than 145,000
psychologists and affiliates.
For decades, psychologists have played vital roles within
the Department of Defense, as providers of clinical services to
military personnel and their families, and as scientific
researchers, investigating issues ranging from airplane cockpit
design, to human intelligence gathering.
Psychologists today bring critical expertise to meeting the
needs of our military and its personnel. In our written
testimony, you will find APA's request to restore and increase
funding for important training programs that impact deployed,
and returning military personnel and their families.
This morning, I will focus on APA's request that Congress
reverse administration cuts to the DOD science and technology
budget, and maintain support for important behavioral science
research within DOD.
The President's budget request for 2008 continues a
familiar process. The administration slashes defense research
programs, and it's left to the Congress to restore an
investment in military mission-related research.
As you've already heard, and know, the administration's
fiscal year 2008 request includes deep cuts to the Defense S&T
account, which would fall to $10.9 billion, a cut of over 20
percent from the enacted fiscal year 2007 level. APA requests a
total of $13.8 billion for S&T in fiscal year 2008, to return
S&T funding just to its 2006 level.
Behavioral research identified by the Defense Science Board
(DSB) as critical will be cut unless funds are restricted to
the overall S&T account. In its 2007 report on 21st century
strategic technology vectors, the DSB identified a set of four
operational capabilities, and the enabling technologies needed
to accomplish future military missions. Of the four
capabilities identified by the DSB for priority funding from
DOD, the first was ``mapping the human terrain.''
The DSB called for a significant reinvestment in social and
behavioral research within DOD. In particular, the DSB called
for increased DOD research in cognition and decision making,
individual and team performance, behavioral, social and
cultural modeling, and human system collaboration. These are
areas that DOD cannot afford to ignore.
Behavioral research traditionally has been supported by the
Army Research Institute, the Office of Naval Research and the
Air Force Research Laboratory. These military labs need
sustained, basic, and applied research funding in 2008 to
expand their reach further into effectively mapping the human
terrain.
Finally, APA is concerned with the potential loss of human-
centered research programs within DOD's Counter-Intelligence
Field Activity (CIFA). Within CIFA, the behavioral sciences
directorate provides a home for research on counterintelligence
issues ranging from models of insider threat, to cyber-security
and detection of deception. CIFA psychologists consult with the
military services to translate findings from behavioral
research directly into enhanced, counterintelligence operations
on the ground.
APA urges the subcommittee to provide ongoing funding in
2008 for CIFA's behavioral science directorate, and its
research programs that provide direct support for military
counterintelligence, and counterterrorism operations.
On behalf of APA, I urge the subcommittee to support the
men and women on the future front lines, by reversing yet
another round of detrimental cuts to the Defense S&T account,
and its human-oriented research projects.
Thank you very much.
Senator Inouye. Thank you very much, Doctor. As you well
know, this subcommittee was the first to recognize the validity
and importance of psychologists.
Dr. Strickland. Yes, sir, we appreciate that.
Senator Inouye. And we listen to your words.
Dr. Strickland. Thank you very much.
Senator Inouye. Thank you, sir.
[The statement follows:]

Prepared Statement of William J. Strickland, Ph.D.

Mr. Chairman and Members of the Subcommittee, I'm Dr. Bill
Strickland, former Director of Human Resources Research for the Air
Force and current Vice President of 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 145,000 psychologists and affiliates.
For decades, psychologists have played vital roles within the
Department of Defense (DOD), as providers of clinical services to
military personnel and their families, and as scientific researchers
investigating mission-targeted issues ranging from airplane cockpit
design to human intelligence-gathering. More than ever before,
psychologists today bring unique and critical expertise to meeting the
needs of our military and its personnel. APA's testimony will focus on:
(1) increasing funding for the Center for Deployment Psychology (CDP);
(2) reversing Administration cuts to the overall DOD Science and
Technology (S&T) budget; and (3) maintaining support for important
behavioral sciences research within DOD.
Need for Mental and Behavioral Health Services in DOD
Thousands of military personnel, including those returning from
ongoing conflicts overseas, are struggling with mental health issues
such as Post-Traumatic Stress Disorder (PTSD), depression and substance
abuse. In a recent study released by Walter Reed Army Institute of
Research (2006), one out of six soldiers and Marines who returned from
Iraq screened positive for mental illnesses, a prevalence nearly twice
that observed among soldiers surveyed before deployment. Returning
Reservists and National Guardsmen may be even more likely than their
military colleagues to have difficulty accessing established mental
health services for geographic reasons. APA is concerned that these
service members' (and their families') mental health needs may go
unmet, or that they will seek care through civilian providers with
limited or no experience in treating these populations.
Center for Deployment Psychology
Because of this concern, the Center for Deployment Psychology (CDP)
was established in fiscal year 2006 as a new tri-service training
consortium designed to better prepare psychologists to meet the mental
and behavioral health needs of service members returning from combat
and operational environments and their families. The Tri-Service CDP,
housed at the Uniformed Services University of the Health Sciences, is
the coordinating center for a network of military psychology internship
training sites at ten regional DOD health facilities nationwide. CDP
programs currently are open to both military and civilian
psychologists, and eventually other health professionals will be
included as well.
Through a variety of training formats, ranging from a four-day
Continuing Education program to a nearly three-week intensive training
course, the CDP program trains military and civilian psychologists to
better evaluate and treat combat-injured and combat-experienced service
personnel.
Initial funding for CDP in fiscal year 2006 was $3.4 million, which
was cut to $2.9 million in fiscal year 2007. In fiscal year 2008, APA
requests $6 million to restore funding for the CDP program and expand
its services. This vital expansion includes funds to: (1) continue the
program of training activities currently supported by the CDP; (2)
create mobile training teams to expand training for military and
civilian psychologists, including Department of Veterans Affairs
psychologists and other health providers; (3) initiate the use of
teleconferences, online learning and web casts and increase web access
for disseminating information much more widely to military personnel
and their families; and (4) support research activities to expand our
knowledge of the psychological and emotional impact of deployment and
evaluate the impact of CDP programs.
DOD Research
Just as a large number of psychologists provide high-quality
clinical services to our military service members stateside and abroad,
psychological scientists within DOD conduct cutting-edge, mission-
specific research critical to national defense.
In terms of the overall DOD S&T budget, the President's request for
fiscal year 2008 was the first step in a process that unfortunately has
become very familiar over the last decade: the Administration slashes
defense research programs and it is left to the Congress to restore
funding and appropriately grow the investment in military mission
research. In its fiscal year 2008 budget request, the Administration
included large increases for weapons development but correspondingly
deep cuts in the defense S&T account, which would fall to $10.9
billion, a 20.1 percent or $2.7 billion decrease from the enacted
fiscal year 2007 level. DOD basic research funding would see an 8.7
percent cut, bringing it down to $1.4 billion in the President's
request, and applied research support would be cut by 18 percent, for a
total of $4.4 billion in fiscal year 2008. DARPA's budget would be
decreased by 1 percent to $3.1 billion.
The President's budget request for basic and applied research at
DOD in fiscal year 2008 is $10.9 billion, a drastic 20.1 percent or
$2.7 billion cut from the enacted fiscal year 2007 level. APA joins the
Coalition for National Security Research (CNSR), a group of over 40
scientific associations and universities, in urging the Subcommittee to
reverse this cut. APA requests a total of $13.8 billion for Defense S&T
in fiscal year 2008, to return S&T funding to its fiscal year 2006
level. DOD behavioral research identified by the Defense Science Board
as critical will be cut without restoring funds to the overall S&T
account.
Behavioral Research within the Military Service Labs and DOD
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), with additional, smaller human
systems research programs funded through the Office of the Secretary of
Defense, the Defense Advanced Research Projects Agency (DARPA), and
DOD's Counterintelligence Field Activity (CIFA).
The 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.
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.''
Defense Science Board Calls for Priority Research in Social and
Behavioral Sciences
This emphasis on the importance of social and behavioral research
within DOD is echoed by the Defense Science Board (DSB), an independent
group of scientists and defense industry leaders whose charge is to
advise the Secretary of Defense and the Chairman of the Joint Chiefs of
Staff on scientific, technical, manufacturing, acquisition process, and
other matters of special interest to the Department of Defense.
In its recently-released 2007 report on ``21st Century Strategic
Technology Vectors,'' the DSB identified a set of four operational
capabilities and the ``enabling technologies'' needed to accomplish
major future military missions (analogous to winning the Cold War in
previous decades). In identifying these capabilities, DSB specifically
noted that ``the report defined technology broadly, to include tools
enabled by the social sciences as well as the physical and life
sciences.'' Of the four priority capabilities and corresponding areas
of research identified by the DSB for priority funding from DOD, the
first was defined as ``mapping the human terrain.''
The following quote from this report highlights the need for
significant investment in social and behavioral science research within
DOD to address this critical need for increased knowledge about the
human elements of the battlespace:

``Unlike during the Cold War when the United States focused on one
major, relatively slow-changing but individually formidable adversary,
in the current era and the foreseeable future, U.S. military forces
will be called upon to perform a wide range of missions. These include
major combat, counter-insurgency, stability and reconstruction,
countering weapons of mass destruction, homeland defense, and disaster
relief. These varied missions present different challenges calling for
highly adaptive military forces. One common feature of these missions
is the increased responsibility placed on junior leaders and the small
teams they lead . . .
``Perhaps most central is to gain deeper understanding of how
individuals, groups, societies and nations behave and then use this
information to (1) improve the performance of U.S. forces through
continuous education and training and (2) shape behavior of others in
pre-, intra- and post-conflict situations. Key enablers include
immersive gaming environments, automated language processing and human,
social, cultural and behavior modeling.'' DSB calls this ``mapping the
human terrain,'' ``human terrain preparation,'' and says it's one of
four ``critical capabilities and enabling technologies identified . . .
[as] a coherent starting point for a science and technology strategy
that will address 21st century security challenges.''

In particular, DSB calls for increased DOD research in cognition
and decision-making, individual and team performance, behavioral/
social/cultural modeling, and human/system collaboration, saying: ``It
is an area that DOD cannot afford to ignore. DOD needs to become more
familiar with the theories, methods and models from psychology.'' These
areas of behavioral research traditionally have been supported by the
military research laboratories, which need more funding in fiscal year
2008 to expand their reach even further into ``the human terrain.''
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.
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.
Maintaining Behavioral Research During CIFA Reorganization
APA also is concerned with the potential loss of invaluable human-
centered research programs within DOD's Counterintelligence Field
Activity (CIFA) due to a current reorganization of CIFA's structure and
personnel strength. Within CIFA, the Behavioral Sciences Directorate
provides a home for research on counterintelligence issues ranging from
models of ``insider threat'' to cybersecurity and detection of
deception. The psychologists also consult with the three military
services to translate findings from behavioral research directly into
enhanced counterintelligence operations on the ground.
APA urges the Subcommittee to provide ongoing funding in fiscal
year 2008 for CIFA's Behavioral Sciences Directorate and its research
programs in light of their direct support for military intelligence
operations.
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 modeling
behavior of individuals and groups, understanding and optimizing
cognitive functioning, perceptual awareness, complex decision-making,
stress resilience, recruitment and retention, 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
overall defense S&T account and the human-oriented research projects
within the military laboratories and CIFA. We also urge you to support
military personnel and their families even more directly by restoring
and increasing funds for the Center for Deployment Psychology.
As our nation rises to meet the challenges of 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.
As noted by the DSB in its report on defense research priorities,
the ``focus is technology. But the human dimensions still dominate,
especially in the irregular challenges facing the nation today.''
Below is suggested appropriations report language for fiscal year
2008 which would encourage the Department of Defense to fully fund its
behavioral research programs within the military laboratories:

DEPARTMENT OF DEFENSE

Research, Development, Test and Evaluation
Behavioral Research in the Military Service Laboratories.--The
Committee notes the increased demands on our military personnel,
including high operational tempo, leadership and training challenges,
new and ever-changing stresses on decision-making and cognitive
readiness, and complex human-technology interactions. To help address
these issues vital to our national security, the Committee has provided
increased funding to reverse cuts to basic and applied psychological
research through the military research laboratories: the Air Force
Office of Scientific Research and Air Force Research Laboratory; the
Army Research Institute and Army Research Laboratory; and the Office of
Naval Research.

Senator Inouye. Our next witness is Ms. Fran Visco,
President of the National Breast Cancer Coalition.

STATEMENT OF FRAN VISCO, J.D., PRESIDENT, NATIONAL
BREAST CANCER COALITION
Ms. Visco. Good morning, Mr. Chairman, Senator Stevens.
As you know, I'm a 19-year breast cancer survivor, a wife
and mother, and President of the National Breast Cancer
Coalition, which is a coalition of more than 600 organizations
from across the country, and tens of thousands of individuals.
And, on behalf of our membership, I want to thank you for your
continuing support of the DOD peer-reviewed breast cancer
research program. You have both been leaders in maintaining the
integrity of this program, and making it the success it is
today.
However, we still do not have the answers we need for
breast cancer. We have made progress, but we do not have
answers. And nothing shows us that more than the fact that last
week, the Vice President of the Board of the National Breast
Cancer Coalition was diagnosed with metastatic breast cancer
after 16 years from her initial diagnosis. We do not know how
to cure this disease, and we certainly don't know how to
prevent it.
Karen Loss, a woman who sits on the panel that oversees the
DOD Program, and also a volunteer for our organization, and a
retired military woman, living with metastatic disease, and
becoming more ill as the days go by.
This program is where the answers lie. Women and their
families across the country believe that. This is where our
hope is. This program has been astounding. The collaboration
that has resulted among the military, the scientific community
and the patient advocacy community across the country is
unprecedented. I have been told over and over again by members
of the military that the model that this program sets has been
copied by the military in other areas. This model that the DOD
Breast Cancer Program has set has also been copied by other
States, and by other countries.
The program has been objectively evaluated twice by the
National Academy of Sciences and both times they have lauded
the program, not just for its successes, but for the way it
operates. This program is transparent--everything that is
funded with taxpayer dollars is open to the country--you can go
onto the website and see every proposal that has been funded.
And every 2 years, the program reports to the public where
their tax dollars have gone, and what the progress is in the
research that we funded.
This program is efficient--90 percent of the funds go to
research. The administrative costs are not quite 10 percent. It
fills gaps in traditional research mechanisms, this is the
program that can respond very quickly to what's happening in
the scientific world--looking at areas of nanotechnology,
looking at not just how to treat metastatic breast cancer, but
also what causes metastatic breast cancer. Looking at possible
vaccines to prevent and treat breast cancer--how do we prevent
breast cancer without drugs? Looking at issues of health
disparities.
This program must continue, and we truly appreciate your
leadership in making that happen over the past years. Again,
this is where our hope is, and we look forward to continuing to
work with you, to make certain the program maintains its
integrity, efficiency and success.
I thank you very much.
Senator Inouye. I thank you very much, Ms. Visco. I'm
certain very few people are aware that the father of the Breast
Cancer Research Program in the Department of Defense is Senator
Stevens.
Ms. Visco. We are certainly aware of that.
Senator Inouye. It really had to be in some other
subcommittee, but we decided we have the money, so we'll fund
you.
Ms. Visco. Yes, we really, we truly appreciate it, and it
has made such a difference, not just in breast cancer, but in
other diseases as well.
Senator Inouye. And I lost my wife of 57 years about 1 year
ago and, of cancer, so I take it personally now.
Ms. Visco. I'm very sorry. Thank you.
Senator Inouye. So you're a--got support here.
Senator Stevens. And, I'm an 18-year survivor of prostate
cancer, so far, but I should tell you, you know, that the
difficulty is, these are earmarks. Every time you hear someone
talking against congressional earmarks, ask them if they know
about breast cancer.
Ms. Visco. Yes, we have that conversation over and over
again----
Senator Stevens. Thank you.
Ms. Visco. And this, as you know, is an incredibly well-
run, efficient, competitive program. So, we appreciate your
support of that. Thank you.
Senator Inouye. 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 the opportunity to talk to you about a
program that has made a significant difference in the lives of women
and their families. You have shown great determination and leadership
in 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. Chairman Inouye and Ranking Member Stevens,
we have appreciated your personal support of this program in the past.
I am hopeful that you and your Committee will continue that
determination and leadership.
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 again for the opportunity to testify.
I know you recognize the importance of this program to women and
their families across the country, to the scientific and health care
communities and to the Department of Defense. Much of the progress in
the fight against breast cancer has been made possible by the
Appropriations Committee's investment in breast cancer research through
the DOD BCRP. This program has launched new models of biomedical
research that have benefited other agencies and both public and private
institutions. It has changed for the better the way research is
performed and has been replicated by programs focused on other
diseases, by other countries and states. To support this unprecedented
progress moving forward, we ask that you support a separate $150
million appropriation for fiscal year 2008. In order to continue the
success of the program, you must ensure that it maintain its integrity
and separate identity, in addition to the requested level of funding.
This is important not just for breast cancer, but for all biomedical
research that has benefited from this incredible government program. In
addition, as Institute of Medicine (IOM) reports concluded in 1997 and
2004, there continues to be excellent science that would go unfunded
without this program. It is only through a separate appropriation that
this program is able to continue to focus on breast cancer yet impact
all other research, rapidly respond to changes and new discoveries in
the field and fill the gaps created by traditional funding mechanisms.
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.
As you know, the National Breast Cancer Coalition is a grassroots
advocacy organization made up of hundreds of 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, 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

The DOD Peer-Reviewed Breast Cancer Research Program has
established itself as a 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 IOM. Because there is little
bureaucracy, the program is able to respond quickly to what is
currently happening in the scientific community. Because of its
specific focus on breast cancer, it is able to rapidly support
innovative proposals that reflect the most recent discoveries in the
field. It is responsive, not just to the scientific community, but also
to the public.
Since its inception, this program has matured into 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 integral part of this program has been the
inclusion of consumer advocates at every level. As a result, the
program has created an unprecedented working relationship between the
public, scientists and the military, and ultimately has led to new
avenues of research in breast cancer. Since 1992, over 977 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 strategic plan for 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 ensures 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 Concept Awards bring funding even earlier in the process
of discovery. These 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 and Concept grants are uniquely
designed to dramatically advance our knowledge in areas that offer the
greatest potential. IDEA and Concept grants are precisely the type of
grants that rarely receive funding through more traditional programs
such as the National Institutes of Health and private research
programs. Therefore, they complement, and do not duplicate, other
federal funding programs. This is true of other DOD award mechanisms as
well.
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 Award 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 giving them the necessary resources to
pursue a highly innovative vision toward ending breast cancer.
These are just a few examples of innovative approaches at the DOD
BCRP that are filling gaps in breast cancer research. Scientists have
lauded the program and the importance of the various award mechanisms.
In 2005, Zelton Dave Sharp wrote about the importance of the Concept
award mechanism.

``Our Concept grant has enabled us to obtain necessary data to
recently apply for a larger grant to support this project. We could
have never gotten to this stage without the Concept award. Our eventual
goal is to use the technology we are developing to identify new
compounds that will be effective in preventing and/or treating breast
cancer . . . Equally important, however, the DOD BCRP does an
outstanding job of supporting graduate student trainees in breast
cancer research, through training grants and pre-doctoral fellowships .
. . The young people supported by these awards are the lifeblood of
science, and since they are starting their training on projects
relevant to breast cancer, there is a high probability they will devote
their entire careers to finding a cure. These young scientists are by
far the most important `products' that the DOD BCRP produces.'' --
Zelton Dave Sharp, Associate Professor, Interim Director/Chairman,
Institute of Biotechnology/Dept. Molecular Medicine, University of
Texas Health Science Center (August 2005)

Indeed, in April of 1999, John Niederhuber, now the Director of the
National Cancer Institute (NCI), said the following about the program
when he was Director of the University of Wisconsin Comprehensive
Cancer Center:

``Research projects at our institution funded by the Department of
Defense are searching for new knowledge in many different fields
including: identification of risk factors, investigating new therapies
and their mechanism of action, developing new imaging techniques and
the development of new models to study [breast cancer] . . . Continued
availability of this money is critical for continued progress in the
nation's battle against this deadly disease.''

Scientists and consumers agree that it is vital that these grants
are able to continue to support breast cancer research--$150 million
for peer-reviewed research will help sustain the program's momentum.
Moreover, the DOD BCRP 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 award mechanism brings together 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, networks to
facilitate clinical trials, and training of 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.
Another example of innovation in the program is in the area of
imaging. One DOD BCRP awardee developed a new use for medical
hyperspectral imaging (MHSI) technology. This work demonstrated the
usefulness of MHSI as a rapid, noninvasive, and cost-effective
evaluation of normal and tumor tissue during a real-time operating
procedure. Application of MHSI to surgical procedures has the potential
to significantly reduce local recurrence of breast tumors and may
facilitate early determination of tumor malignancy.
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.

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 fulfills an important niche by focusing
on research that is traditionally under-funded. This was confirmed and
reiterated in two separate IOM reports released in 1997 and 2004. 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 $1.94
billion in appropriations. From its inception through fiscal year 2005,
4,674 awards at over 420 institutions throughout the United States and
the District of Columbia have been granted. Approximately 200 awards
will be granted for fiscal year 2006. 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 and
filling in the gaps in breast cancer research. Scientific achievements
that are the direct result of the DOD BCRP grants are undoubtedly
moving us closer to eradicating breast cancer.
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
9,500 publications in scientific journals, more than 10,000 abstracts
and more than 350 patents/licensure applications. The federal
government can truly be proud of its investment in the DOD BCRP.

INDEPENDENT ASSESSMENTS OF PROGRAM SUCCESS

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 several
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. They published another
report on the program in 2004. Their findings overwhelmingly encouraged
the continuation of the program and offered guidance for program
implementation improvements.
The 1997 IOM review of the DOD Peer-Reviewed Breast Cancer Research
Program commended the program, stating, ``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. The 2004 report reiterated these same statements and indicated
that is important for the program to continue. It is imperative that
Congress recognizes the independent evaluations of the DOD Breast
Cancer Research Program and reiterates its own commitment to the
program by appropriating the funding needed to ensure its success. The
program's design--both its programmatic and peer review, as well as
consumer involvement--and the program's successes have been applauded
in several publications throughout the years, including: Breast
Disease; Science; and the Journal of Women's Health and Gender-Based
Medicine.

TRANSPARENT AND ACCOUNTABLE TO THE PUBLIC

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 2005 Era of Hope meeting, all BCRP award recipients from the
past two years were invited to report their research findings, and many
awardees from previous years were asked to present advancements in
their research. Themes for the 2005 meeting included: Understanding
Risk--A Different Perspective; Understanding Who Needs Intervention and
Understanding Treatments--Effectively Treating Primary and Metastatic
Disease. The meeting also featured grant recipients who have delved
into the topic of breast cancer heterogeneity. For example, gene
expression profiling technologies have allowed researchers to identify
several breast cancer ``types.'' Recognition of the heterogeneous
character of breast cancer will allow for better selection of patient
subgroups for clinical trials testing targeted therapies. Other
researchers presented their research on many important topics ranging
from the usage of nanotechnology to find and treat breast cancer to
identifying and destroying progenitor breast cancer cells to developing
better clinical trials that still ensure patient safety and make sure
that treatments are safe.
The DOD Peer-Reviewed Breast Cancer Research Program has attracted
scientists across a broad spectrum of disciplines, launched new
mechanisms for research and has continued to facilitate new thinking in
breast cancer research and research in general. A report on all
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. From 1992 with the launch of our ``300
Million More Campaign'' that formed the basis of this program to date,
NBCC activists have appreciated your support.
Over the years, our members have shown their continuing support for
this program through petition campaigns, collecting more than 2.6
million signatures, and through their advocacy on an almost daily basis
around the country asking for support of the DOD BCRP.
As you know, there are three million women living with breast
cancer in this country today. This year more than 40,460 will die of
the disease and nearly 240,510 will be diagnosed. We still do not know
how to prevent breast cancer, how to diagnose it truly early or how to
cure it. While the mortality rate seems to be decreasing, it is not by
much and it is not for all groups of women. It is an incredibly complex
disease. We simply cannot afford to walk away from these facts, we
cannot go back to the traditional, tried and not so true ways of
dealing with breast cancer. We must, we simply must, continue the
innovative, rapid, hopeful approach that is the DOD BCRP.
Two weeks ago 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, representing
groups in their communities and speaking on behalf of tens of thousands
of others, were here as part of our efforts to end breast cancer. The
overwhelming interest in and dedication to eradicating 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 tell
their members of Congress about the vital importance of continuing the
DOD BCRP.
Since the very beginning of this program in 1992, Congress has
stood with us in support of this important investment in the fight
against breast cancer. In the years since, Chairman Inouye and Ranking
Member Stevens, 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 has been initiated by the
Appropriations Committee. 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 the
program at $150 million and maintain its integrity. This is 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 all women and their families, and especially to the 3
million women in the United States living with breast cancer.

Senator Inouye. Our next witness is Dr. Joan Lappe, of
Creighton University, on behalf of the National Coalition for
Osteoporosis and Related Bone Disease.

STATEMENT OF DR. JOAN LAPPE, Ph.D., CLINICAL SCIENTIST,
OSTEOPOROSIS RESEARCH CENTER, CREIGHTON
UNIVERSITY, ON BEHALF OF THE NATIONAL
COALITION FOR OSTEOPOROSIS AND RELATED BONE
DISEASES
Dr. Lappe. Mr. Chairman, Senator Stevens. We greatly
appreciate the opportunity to discuss the need for continued
funding of the Department of Defense Bone Health and Military
Readiness Program, I'll refer to that as the Bone Health
Program.
The Bone Coalition, the Coalition for Osteoporosis and
Related Bone Diseases, is committed to reducing the impact of
bone diseases through expanded research.
The mission of the Department of Defense Bone Health
Program is to advance bone physiology research that can lead to
strategies to improve bone health, reduce stress fractures
during physically intensive training, and have our military
personnel ready for combat deployment.
An effort currently underway is targeting the elimination
of stress fractures, which cause significant morbidity and can
even lead to permanent disability, particularly the hip
fractures that can occur in these young recruits.
Stress fractures are among the most common injuries in
military recruits. The incidents range from about 5 percent in
males, to as high as 21 percent in female recruits. The recent
increase in military recruitment has led to an upsurge in the
total number of stress fractures reported.
An additional concern is that soldiers who are returning
from lengthy deployments are sustaining stress fractures in
unprecedented numbers.
The impact of stress fractures on the military is
significant. In the U.S. Army, 40 percent of men, and 60
percent of women who sustain a stress fracture, do not complete
their basic training. At one U.S. Army training base alone, an
estimated $26 million was lost for soldiers discharged from
training before, during a 1-year period. Now, the cost averages
more than $34,000 per soldier discharged, and that does not
include the cost of healthcare.
Research funded by the Bone Health Program has already been
very productive. For example, research-based recommendations to
decrease the training, marching, and running volume has led to
a decrease in stress fracture incidents. In the first study of
its kind, our research group found that vitamin D and calcium
supplementation reduced the incidents of stress fractures in
young females by 25 percent. There are examples of studies that
are currently in progress, include--there's a study to
establish sort of a risk factor profile, so that you could
target individuals who are going to be at high risk. Also,
we're exploring gender differences in the response to active
training.
We need further research that includes better description
of relationships between stress fractures and the gaits of the
recruit, their carriage patterns, their biomechanics, how they
fall on their legs. We need studies to improve bone quality in
those high-risk interventions, and we want to take a look at
pre-basic training exercise programs, more dietary
supplementation, and also a new technology called ``whole body
vibration.''
We also need to determine the efficacy of different
treatments that could increase healing of stress fractures.
Some things that are being considered are parathyroid hormone,
ultrasound, and again, whole body vibration.
Though small in size, the Bone Health Program is providing
the military with realistic solutions that protect, sustain and
enhance soldier performance, and skeletal health across a
continuum of military operations.
Mr. Chairman, and Senator Stevens, stress fractures
continue to be a critical obstacle to military readiness, and
timely deployment. It's imperative that the Department of
Defense build on recent findings, and maintain an aggressive
and sustained Bone Health Program.
The Coalition for Osteoporosis and Related Diseases is
asking that you fund this for $5 million in 2008.
Thank you for your time and attention.
Senator Inouye. Thank you very much, Dr. Lappe.
[The statement follows:]

Prepared Statement of Dr. Joan Lappe

Mr. Chairman and Members of the Committee: I am Joan Lappe, Ph.D.,
a clinical scientist at the Creighton University Osteoporosis Research
Center in Omaha, NE and I am testifying on behalf of the National
Coalition for Osteoporosis and Related Bone Diseases (the Bone
Coalition).
The Bone Coalition is most appreciative of this opportunity to
discuss with you the need for continued funding of the Bone Health and
Military Medical Readiness program within the Department of Defense.
The Bone Coalition is committed to reducing the impact of bone
diseases through expanded basic, clinical, epidemiological and
behavioral research leading to improvement in patient care. The
Coalition participants are prominent national bone disease
organizations--the American Society for Bone and Mineral Research, the
National Osteoporosis Foundation, the Osteogenesis Imperfecta
Foundation, and The Paget Foundation for Paget's Disease of Bone and
Related Disorders.
The mission of the Bone Health and Military Medical Readiness
program is to advance bone physiology research that may lead to
strategies to improve bone health of men and women, reduce stress
fracture rates during physically intensive training, and have our
military personnel ready for combat deployment.
An effort currently underway is targeting the elimination of stress
fractures. A stress fracture is an overuse injury. It occurs when bones
are repetitively loaded over short periods without sufficient time for
adaptation and repair. It is seen most often among persons who are
involved in physical activity to which they are not adapted. The first
injury, as well as re-injury, can lead to chronic problems. In
addition, some of these stress fractures, particularly of the hip, lead
to permanent disability.
Stress fractures are among the most common overuse injuries seen in
military recruits. The incidence in males ranges from 0.2-5.2 percent.
The incidence in females is higher, ranging from 1.6-21.0 percent.
The recent increase in military recruitment has led to an upsurge
in the total number of stress fracture cases reported. An additional
concern is the increased number of documented stress fracture injuries
over the last two years in soldiers who have recently returned from
lengthy deployment. Anecdotal reports from troop medical clinics
indicate that these soldiers are sustaining stress fractures in
unprecedented numbers.
The impact of stress fractures is significant. Recent data obtained
from the Bone Health and Military Medical Readiness (BHMMR) program
indicate that:
--In the U.S. Army, 40 percent of men and 60 percent of women
trainees with stress fracture do not complete basic training.
--At one U.S. Army training base alone, an estimated $26 million was
lost in training costs for the 749 soldiers discharged from
training over a one year period.
--This is more than $34,000 per soldier and does not include costs
related to health care.
The Department of Defense recognized the severity and magnitude of
stress fractures within its population and commissioned the Institute
of Medicine (IOM) to examine the incidence of stress fractures in
military basic training. In particular, the IOM was asked to address
why the incidence of stress fractures in military basic training was
greater for women than men. IOM's findings were published in 1998 and
concluded that the prevalence of stress fracture has a marked impact on
the health of service personnel, imposing a significant financial
burden on the military by delaying completion of the training of new
recruits. It further 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.
Stress fractures and other bone related injuries erode the physical
capabilities and reduce the effectiveness of our combat training units,
compromising military readiness. Research conducted by the Bone Health
and Military Medical Readiness program is highly focused on research
areas that are a direct result of the physical demands that our service
members are required to undergo in training and deployment.
Research Results
To date, the results of research funded under the Bone Health and
Military Medical Readiness program have led, for example, to
recommendations to reduce running and marching volume during recruit
training. The changes to basic combat training, implemented by the
Physical Fitness School and the Center for Health Promotion and
Preventive Medicine and input from the U.S. Army Research Institute of
Environmental Medicine and the BHMMR program, have led to a decline in
stress fracture incidence.
In addition, studies have revealed an association between bone size
and observed gender differences in stress fracture incidence. Lower
bone/muscle ratio of the calf was associated with increased stress
fracture risk in women. Biomechanical factors may also contribute to
stress fracture incidence, and might be corrected through gait
retraining. Studies using new imaging technology indicate that exercise
may result in changes in bone strength through changes in geometry.
In the first of a kind study, Vitamin D and calcium supplementation
in new Navy recruits was found to decrease stress fracture incidence by
25 percent.
With a sufficient funding level, the Bone Health program can build
on these results and research efforts currently underway.
Studies Currently in Progress
Utilization of data from all relevant BHMMR and Defense Women's
Health Initiative studies to establish a risk factor profile for stress
fracture injury. This model will be used to identify individuals at
risk for stress fracture. Science-based, targeted intervention programs
can then be implemented in an effort to prevent stress fracture injury
in these susceptible recruits.
Exploration of gender differences in the physiological response to
strenuous exercise during strenuous training programs in a military
population, with an emphasis on prevention of stress fracture injury.
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
risk factors for stress fracture, interventions to improve bone
quality, advances in imaging technologies and interventions to speed
bone healing.
Future Research Needs
Risk Factors for Stress Fractures.--Research that relates stress
fracture injury with: quantifiable training regimens; bone geometry and
density; load carriage; gait patterns (march cadence, running, etc);
tibial biomechanics. Validation studies in a recruit population are
also indicated prior to use and implementation of the model in an
active-duty population.
Interventions to Improve Bone Quality.--Gender studies are of
special interest, given the persistent gender differences that have
been observed in studies. Laboratory based intervention studies,
followed by large-scale interventions in a military population are
necessary to test the effectiveness of proposed interventions in
decreasing stress fracture injury. Indicated interventions for
individuals susceptible to injury include, but are not limited to
modified load carriage requirements; gait and march formation
modifications; gait retraining; pre-basic training exercise programs;
dietary supplementation; and whole-body vibration.
Interventions to Speed Bone Healing.--Determine the efficacy of
interventions such as therapeutic modalities (i.e. ultrasound),
pharmacological treatments (i.e. PTH, IGF), and mechanical loading
(i.e. targeted exercise, whole body vibration) to accelerate stress
fracture healing and return to duty in injured recruits.
These studies, along with other DOD studies in progress, will
determine the most cost-effective approach to diagnosis and treatment
of stress fracture. An improved understanding of these injuries will
also form the basis of potential preventive measures.
Recommendation
Though small in size, the Bone Health and Military Medical
Readiness program is providing the military with realistic solutions
that protect, sustain and enhance soldier performance and health across
the continuum of military operations and training.
Mr. Chairman and members of the Committee, stress fractures
continue to be a critical obstacle to military readiness and time
deployment. Therefore it is imperative that the Department of Defense
build on recent findings and maintain an aggressive and sustained Bone
Health and Military Medical Readiness program. The National Coalition
for Osteoporosis and Related Bone Diseases urges you to fund this
program at a level of $5 million in fiscal year 2008.
We appreciate the opportunity to testify before the Committee.

Senator Inouye. Our next witness is Ms. Kathleen Moakler,
Director of Government Relations, National Military Family
Association.
Welcome, Ms. Moakler.

STATEMENT OF KATHLEEN MOAKLER, DIRECTOR, GOVERNMENT
RELATIONS, NATIONAL MILITARY FAMILY
ASSOCIATION
Ms. Moakler. Good morning, Mr. Chairman, Senator Stevens.
Thank you for inviting the National Military Family Association
(NMFA) to come today, and tell you of the concerns of military
families, and the issues that affect their quality of life.
Today's military families are required to be in a constant
state of readiness. With the increased number of deployments,
and the extension of some deployments, families need
coordinated programs, and a support system that creates a
strong foundation for family readiness.
Families are in different stages with each deployment. The
support they receive must adapt to those stages. The
professional staff and volunteers who care for these families
require proper training, and must be equipped to sustain the
support.
DOD and service programs like Military One Source, and
Military Family Life Counselors that have proven successful in
supporting families, need to be properly resourced. Innovative
new programs dealing with the unique needs of individual
augmentees are helping young people cope with deployment, or
are addressing reintegration, like the Army's Battle Mind
Program, need to be funded.
Families tell NMFA that shortfalls in installation
operations funding make the challenges of military life more
difficult. NMFA asks this subcommittee to ensure critical base
operations programs are adequately funded for the service
members and families who depend on them. Child care is always a
top concern. Innovative programs are needed to match the round
the clock work hours of service members, whose op tempo at home
makes them almost deployed in place.
Respite care for the suddenly single parent, whose spouse
is deployed, is an urgent need as well. We urge this
subcommittee to make sure that the resources for providing
child care are funded to meet the requirements of military
families.
NMFA encourages this subcommittee to increase the DOD
supplement to impact aid to $50 million, to help districts meet
the additional demands caused by the effects of base
realignment and closure (BRAC), and global rebasing. We ask
that all school districts experiencing a significant growth in
their military student populations, be eligible for the
additional funding currently available only to districts with
an enrollment of at least 20 percent military children. Some
districts will be receiving military children for the first
time, yet their need is still great.
As the war continues, families' need for a full spectrum of
mental health services continues to grow. While the need grows,
TRICARE reimbursement rates for mental healthcare providers
have been cut in some regions. Sufficient funding to provide
for the ongoing mental health needs of service members and
their families should be considered.
We ask this subcommittee to fund research into the
emotional, educational, and employment-related challenges
affecting military families. Research funding is also needed to
assess the long-term effects of post traumatic stress disorder
(PTSD), and traumatic brain injury, the signature wound of this
war.
NMFA thanks this subcommittee for its continued funding for
a robust, military healthcare system. This healthcare system,
which showed signs of stress before the start of the global war
on terrorism, is now significantly taxed. Military treatment
facilities must be funded, to ensure that their facilities are
optimized to provide high-quality, coordinated care that is
easily accessed by military beneficiaries, including wounded
service members and their families.
Some military families are being asked to move to
installations that are incapable of providing critical support
and services to them. Funding is necessary to provide the
support for gating installations. As we have seen with recent
news reports about Walter Reed, anticipation of closure can
impact facilities and services at the closing installation, as
well.
NMFA urges Congress to fully fund the joint venture between
Walter Reed, Bethesda, and Fort Belvoir to keep it on schedule.
Authorized BRAC and rebasing construction, and quality of life
initiatives must be fully funded, and on the promised
timetable.
Military family support and quality of life facilities and
programs require dedicated funding, not emergency funding.
Military families are being asked to sustain their readiness.
The least their country can do is make sure their support
structure is consistently sustained, as well.
Thank you, and I look forward to your questions.
Senator Inouye. Your program is absolutely essential if we
are to successfully recruit and retain qualified personnel. We
thank you very much.
Ms. Moakler. Thank you, sir.
Senator Stevens. Thank you.
[The statement follows:]

Prepared Statement of Kathleen Moakler

The National Military Family Association (NMFA) is the only
national organization whose sole focus is the military family. The
Association's goal is to influence the development and implementation
of policies that 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 National Military Wives Association, NMFA is
a non-profit 501(c)(3) primarily volunteer organization. NMFA
represents the interests of family members and survivors of active
duty, reserve component, 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 does not have or receive federal grants or contracts.
NMFA's website is: 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 today on the quality of life of
military families. Once again, we thank you for your focus on the many
elements of the quality of life package for service members and their
families: access to quality health care, robust military pay and
benefits, support for families dealing with deployment, and special
care for the families of those who have made the greatest sacrifice.
In this statement, NMFA will address issues related to military
families in the following areas:
Family Readiness
Today's military families are required to be in a constant state of
readiness. They are either preparing for deployment, experiencing a
deployment, or recovering from a deployment for a short time until it
is time to prepare for another one. Family readiness calls for
coordinated programs and the information delivery system necessary to
create a strong foundation of family preparedness for the ongoing and
unexpected challenges of military family life. Those who provide the
support, both professional and volunteer, should be well-trained.
Consistent services should be available: adequate child care, easy
access to preventative mental health counseling as well as therapeutic
mental health care, employment assistance for spouses, and youth
programs that assist parents in addressing the concerns of children
during deployment and separation.
The Nation has an obligation to support the quality of life for
service members and their families not only because it is the right
thing to do, but also because strong quality of life programs aid in
the retention of a quality force. At a recent hearing, Master Chief
Petty Officer of the Navy (MCPON) Joe R. Campa, Jr. summed up the
importance of caring for families: ``Quality of life does affect
retention and it impacts recruiting. Young Americans deciding whether
the Navy is right for them look at quality of life initiatives as
indicators of the Navy's commitment to sailors and their families. Our
goal is to leave no family unaccounted for or unsupported. Our vision
of today's Navy family is one who is self-reliant yet well connected to
our Navy community and support programs.''
Ensuring Robust Family Programs and Installation Operations
Support
In this sixth year of the Global War on Terror (GWOT), as many
service members and families are experiencing their second or third
deployments, family readiness is more imperative than ever. The needs
of and support required for the family experiencing repeated
deployments are often different from those of the first deployment. The
family that was childless in the first deployment may have two toddlers
by now. Middle schoolers have grown into teenagers with different
needs. Parents age and the requirements of the ``sandwich generation''
grow. Commanders cannot assume that ``experienced'' families have the
tools they need to weather each new deployment successfully. The end
strength increases in the Army and Marine Corps will bring many new
families needing to learn the basics of military life and family
support while experiencing their first deployments.
Recently, top military family program leaders from across the
Services gathered at the Family Readiness Summit convened by Assistant
Secretary of Defense for Reserve Affairs Thomas Hall to answer tough
questions on how to work better together. While focusing on the reserve
component, delegates agreed that communication across the Services and
components is key to bringing families the best support possible.
Effective use of technology and partnering with community agencies were
listed as best practices, along with Military OneSource and the use of
volunteers. Challenges identified included the need for consistent
funding for family programs and full-time support personnel to help
avoid burnout for the full-time staff and volunteers. Some participants
expressed concern that current funding is tied to current operations
and worried those funds will not always be available. Participants also
identified the need for clear, non-confusing nomenclature for programs
that families could recognize regardless of Service or component.
Everyone saw reintegration as a challenge and expressed concern that
the single service member not be forgotten in the process. Outreach to
parents, significant others, and other family members is essential in
helping the service member recover from the combat experience.
Families and the installation professionals who support families
tell NMFA shortfalls in installation operations funding are making the
challenges of military life today more difficult. Families are grateful
for the funding increases Congress has provided since the start of the
GWOT for deployment related programs, such as counseling, family
assistance for National Guard and Reserve families, and expanding
access to child care services. However, the military families who
contact NMFA, as well as many of our more than 100 installation
volunteers, tell us they are worried about consistent funding levels
for these programs, as well as for core installation support programs:
family center staffing, support for volunteer programs, maintenance on
key facilities, and operating hours for dining halls, libraries, and
other facilities.
Shortages in base operation funding are nothing new. What seems to
make the crisis worse are war needs which have exacerbated the negative
effects of a long history of cutbacks. Deployed service members expect
their installation quality of life services, facilities, and programs
be resourced at a level to meet the needs of their families. Cutbacks
hit families hard. They are a blow to their morale, a sign that perhaps
their Service or their nation does not understand or value their
sacrifice. They also pile on another stressor to the long list of
deployment-related challenges by making accessing services more
difficult. Families are being told the cutbacks are necessary to ensure
funds are available for the GWOT, and in the case of Army communities,
the ongoing Army transformation. Just when they need quality of life
programs most, families should not be asked to do without. Their
commanders should not have to make the choice between paying
installation utility bills or providing family support services.
NMFA asks Congress to direct the Department of Defense to maintain
robust family readiness programs and to see that resources are in place
to accomplish this goal. We ask this Subcommittee to ensure critical
base operations programs are adequately funded for the service members
and families who depend on them.
Caring for Military Children and Youth
At a recent hearing, the Service Senior Enlisted Advisors put child
care in the top two of their quality of life concerns. Frequent
deployments and long work hours make the need for quality affordable
and accessible child care critical. We thank Congress for making
additional funding available for child care since the beginning of the
GWOT. We also applaud several of the innovative ways the military
Services have attempted to meet the demand:
--Navy's 24 hour child care centers in Virginia and Hawaii.
--Purchase of additional child care slots in private or other
government agency facilities.
--Partnerships with provider organizations to connect military
families with providers.
--Additional funding provided by Congress to make improvements to
temporary facilities to increase the number of child care slots
on military installations.
While these efforts have helped to reduce the demand for child
care, the Services--and families--continue to tell NMFA more child care
spaces and innovative assistance with the high cost of off installation
care are needed to fill the ever-growing demand.
Multiple deployments have also affected the number of child care
providers, both center and home based. Child and Youth Service (CYS)
programs have historically counted heavily on the ranks of military
spouses to fill these positions. Service CYS programs report a growing
shortage of spouses willing to provide child care as the stress of
single parenting and the worry over the deployed service member takes
its toll. The partnerships between the Services and the National
Association of Child Care Resource and Referral Agencies (NACCRRA) are
helping and have grown over the past two years; however, not all
families qualify for the subsidies and not all programs are the same.
In addition, funding for these critical programs has been provided
under supplemental appropriations, families have come to depend upon
these programs and Congress must ensure that funding remains available
for their continuation.
Innovative strategies are also needed when addressing the
unavailability of after hour (before 6 A.M. and after 6 P.M) and
respite care. Families often find it difficult to obtain affordable,
quality care, especially during hard-to-fill hours and on weekends.
Both the Navy and the Air Force have piloted excellent programs that
provide 24-hour care. The Navy has 24-hour centers in Norfolk and
Hawaii, which provide a home-like atmosphere for children of Sailors
working late night or varying shifts. The Air Force provides Extended
Duty Child Care and Missile Care (24 hour access to child care for
service members working in the missile field). These innovative
programs must be expanded to provide care to more families and funding
for these programs must be sufficient to ensure the same level of
quality provided in traditional child development programs.
NMFA urges Congress to ensure resources are available to meet the
child care needs of military families.
Education of Military Children
As increased numbers of military families move into some
communities due to Global Rebasing and BRAC, their housing needs will
be met further and further away from the installation. Thus, military
children may be attending school in districts whose familiarity with
the military lifestyle may be limited. Educating large numbers of
military children will put an added burden on schools already hard-
pressed to meet the needs of their current populations. Impact Aid has
traditionally helped to ease this burden; however, the program remains
under-funded. NMFA was disappointed to learn the DOD supplement to
Impact Aid was funded at a compromise level of $35 million for fiscal
year 2007. An additional $10 million was provided to school districts
with more than 20 percent military enrollment that experience
significant shifts in military dependent attendance due to force
structure changes, with another $5 million for districts educating
severely-disabled military children. While the total funding available
to support civilian schools educating military children is greater than
in recent years, we urge Congress to further increase funding for
schools educating large numbers of military children. This supplement
to Impact Aid is vital to school districts that have shouldered the
burden of ensuring military children receive a quality education
despite the stresses of military life.
NMFA also encourages this Subcommittee to provide additional
funding for school districts experiencing growth available to all
school districts experiencing significant enrollment increases and not
just to those districts meeting the current 20 percent enrollment
threshold. We also urge you to authorize an increase in the level of
this funding until BRAC and Global Rebasing moves are completed. The
arrival of several hundred military students can be financially
devastating to any school district, regardless of how many of those
students the district already serves. Because military families cannot
time their moves, they must find available housing wherever they can.
Why restrict DOD funding to local school districts trying to meet the
needs of military children simply because they did not have a large
military child enrollment to begin with?
NMFA asks Congress to increase 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. We also ask Congress to
allow all school districts experiencing a significant growth in their
military student population due to BRAC, Global Rebasing, or
installation housing changes to be eligible for the additional funding
currently available only to districts with an enrollment of at least 20
percent military children.
Spouse Education and Employment
Studies show the gap between the financial well-being of military
families and their civilian peers is largely due to the frequent moves
required of the military family and the resulting disruptions to the
career progression of the military spouse. In a 2005 report by the RAND
Corporation, researchers found that military spouses, when compared to
their civilian counterparts, were more likely to have graduated from
high school and have some college. Yet the RAND study found that
civilian counterparts tended to have better employment outcomes and
higher wages. Surveys show that a military spouse's income is a major
contributor to the family's financial well-being and that the military
spouse unemployment rate is much higher (10 percent) than the national
rate.
With a concern that spouses desiring better careers will encourage
service members to leave the military, DOD is acknowledging the
importance of efforts to support spouse employment. Recent DOD
initiatives include the collaboration between DOD and Department of
Labor (DoL), which focuses on:
--establishing Milspouse.org, a resource library for military spouse
employment, education and relocation information,
--establishing One Stop Career Centers near major military
installations (Norfolk, Virginia; San Diego, California; Fort
Campbell, Kentucky),
--expanding opportunities for Guard and Reserve members and military
spouses to access training and education grants,
--exploring options with states to offer unemployment compensation to
military spouses when unemployment is the result of a permanent
change of station (PCS) move, and
--to improve reciprocity for state certifications and licensing
requirements.
Unfortunately, funds for this promising collaboration have run out.
NMFA believes this lack of funding is a significant blow to the promise
of these early initiatives. We also believe the Department of Labor is
best positioned to provide the coordination necessary with states and
other agencies to promote opportunities for military spouse employment.
DOD has also sponsored a partnership with Monster.com to create the
Military Spouse Career Center and recently announced the availability
of free career coaching through the Spouse Employment Assessment,
Coaching and Assistance Program (SEACA). Improvements in employment for
military spouses and assistance in supporting their career progression
will require increased partnerships and initiatives by a variety of
government agencies and private employers. These programs depend upon
continued funding availability. Many of them are currently being funded
as pilot projects.
NMFA asks that the partnership between DOD and DoL be realigned to
give DoL the authority to serve military spouses through legislative
changes designating military spouses as an eligible group for funds for
training and education. Furthermore, NMFA asks Congress to ensure that
successful pilot programs are converted to long-term, permanent
programs with regular funding streams.
Mental Health
As the war continues, families' need for a full spectrum of mental
health services--from preventative care to stress reduction techniques,
to individual or family counseling, to medical mental health services--
continues to grow. As service members and families experience numerous
lengthy and dangerous deployments, NMFA believes the need for
confidential, preventative mental health services will continue to
rise. It will also remain high for some time even after military
operations scale down in Iraq and Afghanistan. NMFA has seen progress
in the provision of mental health services, access to those services,
and military service member and family well-being. In some cases,
however, the progress is ongoing and barriers to quality mental health
care remain.
As pointed out in a report by the American Psychological
Association, scholarly research is needed on the short- and long-term
effects of deployment on military families, especially the children. We
urge this Subcommittee to fund research agreements with qualified
research organizations to expand our Nation's knowledge base on the
mental health needs of the entire military family: service members,
spouses, and children. Solid research on the needs of military families
is needed to ensure the mix of programs and initiatives available to
meet those needs is actually the correct one.
We ask this Subcommittee to encourage DOD to expand research into
the emotional, educational, and deployment-related challenges affecting
military families.
Family Health
NMFA thanks this Subcommittee for its continued funding for a
robust military health care system. We ask Members of Congress to
remember the multi-faceted mission of this system. It must meet the
needs of service members and the Department of Defense (DOD) in times
of armed conflict. The Nation must also acknowledge that military
members, retirees, their families, and survivors are indeed a unique
population with unique duties, who earn an entitlement to a unique
health care program. We ask you to recognize that the military health
care system, which showed signs of stress even before the start of the
Global War on Terror, is now significantly taxed.
MTFs must have the resources and the encouragement to ensure their
facilities are optimized to provide high quality, coordinated care for
the most beneficiaries possible. They must be held accountable for
meeting stated access standards. If funding or personnel resource
issues are the reason access standards are not being met, then
assistance must be provided to ensure MTFs are able to meet access
standards, support the military mission, and continue to provide
quality health care.
NMFA asks all Members of Congress to hold DOD accountable for
providing access to quality care to all TRICARE beneficiaries and to
ensure the system is adequately resourced to provide that access.
TRICARE Fees--What's the Answer?
Last year's proposal by DOD to raise TRICARE fees by exorbitant
amounts resonated throughout the beneficiary population. Beneficiaries
saw the proposal as a concentrated effort by DOD to change their earned
entitlement to health care into an insurance plan. NMFA appreciates the
concern shown by Members of Congress last year in forestalling any
premium increase, emphasizing the need for the Department to institute
more economies, and suggesting further investigation of the issue
through a report by the Government Accountability Office and the
creation of a task force on the future of military health care. We
appreciate your recognition of the need for more information about the
budget assumptions used by DOD, the effects of possible increases on
beneficiary behavior, the need for DOD to implement greater
efficiencies in the Defense Health Care Program (DHP), and the adequacy
of the DHP budget as proposed by DOD.
NMFA remains especially concerned about what we believe is DOD's
continued intention to create a TRICARE Standard enrollment fee.
Charging a premium (enrollment fee) for TRICARE Standard moves the
benefit from an earned entitlement to an opportunity to buy into an
insurance plan. Standard is the only option for many retirees, their
families, and survivors because TRICARE Prime is not offered
everywhere. Also, using the Standard option does not guarantee
beneficiaries access to health care. DOD has so far not linked any
guarantee of access to their proposals to require a Standard enrollment
fee.
DOD's proposal last year to increase TRICARE Prime enrollment fees,
while completely out-of-line dollar wise, was not unexpected. In fact,
NMFA had been surprised DOD did not include an increase as it
implemented the recent round of new TRICARE contracts. NMFA believes
DOD officials continue to support large increased retiree enrollment
fees for TRICARE Prime, combined with a tiered system of enrollment
fees and TRICARE Standard deductibles. NMFA believes any tiered system
would be arbitrarily devised and would fail to acknowledge the needs of
the most vulnerable beneficiaries: survivors, wounded service members,
and their families.
Acknowledging that the annual Prime enrollment fee has not
increased in more than 10 years and that it may be reasonable to have a
mechanism to increase fees, NMFA last year presented an alternative to
DOD's proposal should Congress deem some cost increase necessary. The
most important feature of this proposal was that any fee increase be no
greater than the percentage increase in the retiree cost of living
adjustment (COLA). If DOD thought $230/$460 was a fair fee for all in
1995, then it would appear that raising the fees simply by the
percentage increase in retiree pay is also fair. NMFA also suggests it
would be reasonable to adjust the TRICARE Standard deductibles by tying
increases to the percent of the retiree annual COLA.
NMFA believes tying increases in TRICARE enrollment fees to the
percentage increase in the retiree Cost of Living Adjustment (COLA) is
a fair way to increase beneficiary cost shares should Congress deem an
increase necessary.
Wounded Service members Have Wounded Families
Traumatic Brain Injury (TBI) is the signature wound for Operation
Enduring Freedom and Operation Iraqi Freedom injured service members.
Long-term effects and appropriate treatment for this condition have not
been adequately assessed. NMFA is concerned with DOD's decision to cut
funding for basic research by 9 percent and 18 percent for applied
research. Accurate diagnosis and proper treatment for TBI requires
forward leaning initiatives by DOD and VA founded on solid research.
When designing support for the wounded/injured in today's conflict,
the ``government''--whether in the guise of commander, non-commissioned
officer, Service personnel office, a family assistance center, an MTF,
or the VA--must take a more inclusive view of military families and
remember that a successful recovery depends on caring for the whole
patient and not just the wound. It is time to update TRICARE benefits
to meet the needs of this population by allowing medically-retired
wounded service members and their families to retain access to the set
of benefits available to active duty families during a transitional
period following the service member's retirement. These benefits would
include the ability to enroll in TRICARE Prime Remote and to continue
coverage of a disabled family member under the Extended Care Health
Option (ECHO).
To support wounded and injured service members and their families,
NMFA recommends that Congress extend the three-year transitional
survivor health care benefit to service members who are medically
retired and their families and direct DOD to establish a Family
Assistance Center at every MTF caring for wounded service members.
Families in Transition
Military families are in a constant state of movement. Through the
years, the knowledge that the family would be relocated every two or
three years was a constant. Now, there are many different types of
transitions. The closing of installations in Europe is forcing families
back to the states into communities that may not have the
infrastructure and housing to support them. As service members return
from combat and reintegrate with their families and employers, all
parties need to have the tools to help in the reintegration process.
Survivors--the military families who have sacrificed the most--deserve
our Nation's long-term support. What needs to be done to help service
members and families in transition?
Base Realignment and Closure, Global Rebasing, and
Transformation
As DOD relocates and rebases units, it must be conscious that the
further it moves families from an installation and the military
community, the more it degrades their ability to benefit from the
support of that military community. The current BRAC and rebasing
initiatives will result in disruption and upheaval for the families
affected. Military families accept this fact as a reality of the
lifestyle they have chosen. What they cannot, and should not, be asked
to accept is that they will be asked to move as ordered to a receiving
installation that is incapable of providing critical support and
services to them. Moving is stressful for any family. It is critical
the government does not amplify this stress by allowing the process to
move forward without the funding for necessary infrastructure and
facilities to support these families. This critical funding is needed
to provide health care, education, housing, child care, and family
support programs and facilities for these gaining installations. The
Army alone requires thirty new child care centers simply to maintain
the level of care currently available on losing installations. Military
families must be assured that services are in place before they arrive
at their new military community.
NMFA strongly asserts that the authorized BRAC and rebasing
construction and quality of life initiatives must be fully funded.
Survivors
NMFA still believes the benefit change that will provide the most
significant long-term advantage to the financial security of all
surviving families would be to end the Dependency and Indemnity
Compensation (DIC) offset to the Survivor Benefit Plan (SBP). Ending
this offset would correct an inequity that has existed for many years.
Those who give their lives for their country deserve more fair
compensation for their surviving spouses. We urge Congress to intensify
efforts to eliminate this unfair ``widow's tax'' this year.
NMFA believes several other adjustments could be made to the
Survivor Benefit Plan. These include allowing payment of SBP benefits
into a trust fund in cases of disabled children and allowing SBP
eligibility to switch to children if a surviving spouse is convicted of
complicity in the member's death.
NMFA recommends the DIC offset to SPB be eliminated to recognize
the length of commitment and service of the career service member and
spouse and relieve the spouse of making hasty financial decisions at a
time when he or she is emotionally vulnerable.
Pay and Compensation
NMFA thanks Members of this Subcommittee for their recognition that
service members and their families deserve a comprehensive benefit
package. In addition, service members and their families appreciate the
regular annual pay increases and targeted raises, over the past several
years. In most cases, military pay is on par with civilian pay for
equivalent education levels. NMFA asserts, however, that while the DOD
policy of paying at the seventieth percentile has made significant
progress in alleviating the pay gap, military service is a unique
profession, which requires unique dedication and sacrifice. Perhaps the
establishment of pay rates at the seventieth percentile does not
adequately reflect the value our Nation places on the dedicated service
of our men and women in uniform. NMFA urges funding for a pay increase
of not less than 4 percent for fiscal year 2008. We further urge that
future increases consider the unique character of military service and
consider the establishment of pay rates at the eightieth percentile.
Families and Community
Higher stress levels caused by open-ended and multiple deployments
require a higher level of community support. We ask Congress to ensure
a consistent level of resources to provide robust quality of life,
family support, and the full range of preventative and therapeutic
mental health programs during the entire deployment cycle: pre-
deployment, deployment, post-deployment, and in that critical period
between deployments.
Military families share a bond that is unequaled in the civilian
world. They support each other through hardship, deployments, PCS
moves, and sometimes, the loss of a loved one. The military community
is close knit and must be so. It is imperative that our Nation ensure
the necessary infrastructure and support components are in place to
support families regardless of where they happen to be located
geographically. More importantly, we ask you and other Members of
Congress to ensure that the measures undertaken today in the interest
of cutting costs and improving efficiency do not also destroy the sense
of military community so critical to the successful navigation of a
military lifestyle.
Educating families on what support is being provided helps reduce
the uncertainty for families. Preparation and training are key in
reaching families and making sure they are aware of additional
resources available to them. While NMFA appreciates the extraordinary
support that was made available to address the special needs of the
families during deployment extensions and the recent ``Surge'', our
Nation must ensure this level of support is available to all families
day in and day out. Military family support and quality of life
facilities and programs require dedicated funding, not emergency
funding. Military families are being asked to sustain their readiness.
The least their country can do is make sure their support structure is
consistently sustained as well. Strong families equal a strong force.
Family readiness is integral to service member readiness. The cost of
that readiness is an integral part of the cost of the war and a
National responsibility. We ask Congress to shoulder that
responsibility as service members and their families shoulder theirs.

Senator Inouye. Our next witness is Ms. Sherry Black,
Executive Director of Ovarian Cancer National Alliance.
Ms. Black.

STATEMENT OF SHERRY SALWAY BLACK, EXECUTIVE DIRECTOR,
OVARIAN CANCER NATIONAL ALLIANCE
Ms. Black. Good morning, Mr. Chairman, Senator Stevens.
Thank you for inviting me, once again, to speak before this
subcommittee.
I am the Executive Director of the Ovarian Cancer National
Alliance, and I am testifying on behalf of the 172,000 ovarian
cancer survivors, which I am lucky to be one.
I am pleased to be here on behalf of survivors, patients,
and our many friends who have lost their battle to ovarian
cancer, to urge you to continue to support the Department of
Defense, congressionally directed research program in ovarian
cancer.
According to the American Cancer Society, more than 22,000
women will be diagnosed with ovarian cancer, and approximately
15,000 will lose their lives to this disease this year.
Ovarian cancer causes more deaths than all other cancers of
the female reproductive tract combined, and is the fifth
highest cause of cancer deaths among women.
Currently, almost one-half of the women diagnosed with
ovarian cancer die within 5 years. Seventy-five percent are
diagnosed in stages 3 and 4. When detected early, as I was, the
5-year survival rate increases to more than 90 percent, but
when detected in the late stages, the 5-year survival rate
drops to 29 percent.
Ovarian cancer survival rates have not made the appreciable
gains that other cancers have. One reason is the lack of an
early screening or diagnostic test. Yet, Federal funding for
ovarian cancer research has remained flat. We need continued
and increased research funding to assure that effective
screening and diagnostic tests are developed, and ideally, to
identify who is high risk, and how ovarian cancer can be
prevented in the first place.
The Ovarian Cancer Research Program (OCRP) has been funded
at $10 million since 2004, and has never been appropriated more
than $12 million in its 10 year history. We know that critical
research, which takes many years to bear fruit, is on the cusp
of significant findings. Additional investment now is vital for
future research into prevention, diagnosis, and treatment.
Since its inception, the OCRP has developed a
multidisciplinary research portfolio that encompasses
prevention, early detection, diagnosis, pre-clinical
therapeutics, quality of life, and behavioral research
projects. The OCRP strengthens the Federal Government's
commitment to ovarian cancer research, and supports innovative
and novel projects that propose new ways of examining
prevention, early detection, and treatment.
The program also attracts new investigators into ovarian
cancer research, and encourages proposals that address the
needs of minority, elderly, low income, rural, and other
underrepresented populations.
Today, ovarian cancer researchers are still struggling to
develop the very first ovarian cancer screening test. With
traditional research models largely unsuccessful, the
innovative grants awards by the OCRP are integral to moving the
field of research forward. The OCRP has been responsible for
the only two working animal models of ovarian cancer, models
that will help unlock the keys to diagnosing and treating
ovarian cancer.
In 2007, researchers announced the discovery of a potential
biomarker, that may be used in ovarian cancer screening. Only
with sufficient funding will the realization of a desperately
needed screening test be possible.
The program's achievements have been documented in numerous
ways, included 253 publications in professional journals and
books, 330 abstracts and presentations, and nine patents. Due
to research grants, the program has attracted 25 new
researchers to the field--this is critical. Investigators
funded through the OCRP have yielded several crucial
breakthroughs in the study of prevention.
The alliance is joined by our partner, the Society of
Gynecologic Oncologists, and the many people affected by this
disease. We urge the subcommittee to increase Federal funding
on ovarian cancer by appropriating $20 million to the
Department of Defense Ovarian Cancer Research Program for
fiscal year 2008.
The alliance is celebrating its 10th anniversary this year.
As we conclude our first decade of action, we look forward to a
future of hope. This hope is made possible, in part, by
advances in medicine discovered through the OCRP.
I thank you very much for your leadership on this issue.
Senator Inouye. As indicated earlier, Senator Stevens and I
are on your side. We'll do our best.
Ms. Black. Thank you very much.
[The statement follows:]

Prepared Statement of Sherry Salway Black

Mr. Chairman, Ranking Member and Members of the Subcommittee, thank
you for inviting me to speak. I am Sherry Salway Black, Executive
Director of the Ovarian Cancer National Alliance (the Alliance). I am
testifying on behalf of the 172,000 ovarian cancer survivors, of which
I am lucky to count myself. I am pleased to be here on behalf of
survivors, patients and our many friends who lost their battle to
ovarian cancer to urge you to continue to support the Department of
Defense (DOD) Congressionally Directed Medical Research Program (CDMRP)
in ovarian cancer. The Ovarian Cancer Research Program (OCRP) and the
Alliance have worked for the past 10 years to improve the lives of
women with ovarian cancer, and their families. We are joined in our
request by the doctors who deliver patient care, the Society of
Gynecologic Oncologists. Great strides have been made in this previous
decade, but without an increase in research funds, progress will stall.
As we move forward into our second decade, we have hope for the future
of treatment, patient care, survivorship and research.
According to the American Cancer Society, more than 22,000 women
will be diagnosed with ovarian cancer and approximately 15,000 will
lose their lives to the disease this year. Ovarian cancer causes more
deaths than all the other cancers of the female reproductive tract
combined, and is the fifth highest cause of cancer deaths among women.
Currently, almost half of the women diagnosed with ovarian cancer die
within five years. When detected early, the five-year survival rate
increases to more than 90 percent, but when detected in the late
stages, the five-year survival rate drops to 29 percent.
The majority of women with ovarian cancer are diagnosed in Stages
III or IV, when survival rates are lower. Ovarian cancer survival rates
have not made the appreciable gains that other cancers have. One key
reason for this is the lack of an effective screening or early
diagnosis test.
Yet, federal funding for ovarian cancer research has remained flat.
We need continued and increased research funding to assure that
effective screening and diagnostic tests are developed, and ideally to
identify who is at high-risk and how ovarian cancer can be prevented in
the first place. The OCRP has been funded at $10 million since 2004,
and has never been appropriated more than $12 million in its 10-year
history. We know that critical research, which takes many years to bear
fruit, is on the cusp of significant findings. Additional investment
now is vital for future research into prevention, diagnosis and
treatment. Therefore, we respectfully recommend that this Subcommittee
appropriate $20 million to the OCRP for fiscal year 2008.

THE OVARIAN CANCER RESEARCH PROGRAM

Funding history
The Ovarian Cancer Research Program (OCRP) was established in 1997
in response to the advocacy efforts of the ovarian cancer movement. The
stated mission is to eliminate ovarian cancer by promoting
``innovative, integrated multidisciplinary research efforts that will
lead to a better understanding, detection, diagnosis, prevention and
control of ovarian cancer.'' The program was initially appropriated
$7.5 million. In its first eight years, the OCRP has distributed more
than $79 million for research. In 2005 the OCRP was only able to fund 7
percent of the proposals, and in 2006 was limited to 15 percent of the
proposals. The OCRP operates with less than 10 percent in
administrative costs, making this a highly efficient program.
Cutting-edge research being done by grantees of the program has
moved us forward: researchers now better understand the disease, have
identified possible biomarkers for screening tests, are exploring
targeted therapies, and are moving us closer to our goal of conquering
ovarian cancer. Without additional funding, we fear that researchers
will fail to investigate ovarian cancer, and our medical progress will
stall.
Process
The program uses an Integration Panel to provide a two-tier review
process in which scientific and non-scientific advisors interact.
Patient advocates are always included in the review process. The
Integration Panel, based on input from advocates, scientists and
clinicians, identifies areas where research should be conducted. The
inclusion of patient advocates adds a necessary perspective by ensuring
that the focus is on understanding and conquering the disease in a way
that will be helpful to patients. The goal of the OCRP is to use
science directly to help ovarian cancer patients and those at risk--not
just for the sake of a scientific exercise.
More important, the process allows funding of research that is high
risk, but high reward, and would not otherwise be funded. One example
of such research is investigation into a much-needed screening test
through the presence of a biomarker BCL-2, and the discovery that
hormones found in oral contraceptives reduce the risk of ovarian
cancer. Researchers without proven track records may receive grants
from the OCRP--many of these research projects have gone on to be
funded by the National Institutes of Health after the initial OCRP-
funded research is completed.
Grants are awarded to fund innovative research or to establish
research resources. These research resources are available to
Historically Black Colleges and Universities/Minority Institutions and
are awarded to foster collaborations between the researchers at the
minority institution and other institutions.
Collaboration between institutions is an important aspect of this
program. Projects have leveraged DOD awards with National Institutes of
Health (NIH) programs or other institutions, both domestically and
internationally. For example, one award linked researchers at the Fox
Chase Cancer Center with scientists at Delaware State University to
study lasers as an early detection tool for ovarian cancer.
Many of the results from the CDMRP are translatable to other
cancers. For example, a study funded by DOD, NIH and Komen for the Cure
discovered the existence of cancer stem cells. These cancer stem cells
may hold the key to preventing cancer recurrence. Another study is
testing a patient's breath for cancer. The research has proven
successful for breast and lung cancers. Currently, specially trained
dogs can smell biochemicals in patients' breath that indicate early
lung and breast cancers correctly in over 85 percent of cases.
Results
Since its inception, the OCRP has developed a multidisciplinary
research portfolio that encompasses etiology, prevention, early
detection/diagnosis, preclinical therapeutics, quality-of-life, and
behavioral research projects. The OCRP strengthens the federal
government's commitment to ovarian cancer research and supports
innovative and novel projects that propose new ways of examining
prevention, early detection and treatment. The program also attracts
new investigators into ovarian cancer research, and encourages
proposals that address the needs of minority, elderly, low-income,
rural and other under-represented populations.
Today, ovarian cancer researchers are still struggling to develop
the first ovarian cancer screening test. With traditional research
models largely unsuccessful, the innovative grants awarded by the OCRP
are integral in moving the field of research forward. The OCRP has been
responsible for the only two working animal models of ovarian cancer--
models that will help unlock keys to diagnosing and treating ovarian
cancer. In 2007, researchers announced the discovery of a potential
biomarker that may be used on ovarian cancer screening. Only with
sufficient funding will the realization of a desperately-needed
screening test be possible.
The program's achievements have been documented in numerous ways,
including 253 publications in professional medical journals and books,
330 abstracts and presentations given at professional meetings, and
nine patents, applications and licenses granted to awardees of the
program. Due to research grants, the program has attracted 25 new
researchers to the field, 18 of whom are still working on ovarian
cancer. Investigators funded through the OCRP have yielded several
crucial breakthroughs in the study of prevention and detection,
including:
--Creation of a human ovarian tissue bank
--Development of chicken model to study susceptibility to ovarian
cancer
--Use of rhesus monkey model to study contraceptives and vitamin A
analog in prevention of ovarian cancer
--Detection of a possible biomarker (BCL-2) screening tool to detect
ovarian cancer through urine samples
--Development of a potential screening tool to determine chemotherapy
sensitivity in ovarian cancer patients
--Use of new bioinformatics tools to identify different sets of genes
for different types of ovarian cancer tumors
--Development of radio-therapeutics for advanced ovarian cancer
treatment
--Discovery of a receptor expression level as a possible indicator of
aggressive ovarian cancer tumor behavior
--Discovery of potential method to overcome oncogene-associated
chemo-resistance in ovarian cancer cells
--Continued focus on ovarian cancer screening tools
--Development of radiation therapies for metastatic ovarian cancer
--Discovery of production of certain enzymes by ovarian cancer cells;
this discovery may lead to the development of vaccines for
recurrent ovarian cancer.

CONCLUSION

The Alliance is joined by our partner, the Society of Gynecologic
Oncologists, in making this request. We urge the Subcommittee to
increase federal funding on ovarian cancer by appropriating $20 million
to the Department of Defense Ovarian Cancer Research Program for fiscal
year 2008. As we conclude our first decade of action, we look forward
to a future of hope. This hope is made possible, in part, by advances
in medicine discovered through the OCRP. I thank you for your
leadership on this issue.

Senator Inouye. Our next witness is Dr. Sven-Erik Bursell,
Joslin Diabetes Center.
Did I pronounce it correctly?

STATEMENT OF DR. SVEN-ERIK BURSELL, DIRECTOR,
TELEHEALTH RESEARCH, JOSLIN DIABETES CENTER
Dr. Bursell. You did a wonderful job, sir. Thank you.
Mr. Chairman, thank you for this opportunity to report on
the progress of Joslin Diabetes Center's cooperative
telemedicine project with the Department of Defense, Veterans
Health Administration, and the University of Hawaii for
providing a healthcare delivery platform for the connect-care
management and treatment of people with diabetes, and for
providing appropriate eye care to prevent blindness from
diabetic retinopathy.
This program can serve as a national model for providing
cost-efficient and appropriate, high-quality care for all
people with diabetes.
I am Sven-Erik Bursell, the Director of Telehealth Research
at Joslin Diabetes Center. This Telehealth program represents a
collaborative research and development effort that is being
successfully translated into clinical programs, represented by
the VA national tele-retinal screening initiative, and
implementation of successful clinical programs to provide
diabetes care to Native Americans, Native Alaskans, and Native
Hawaiians.
The innovative eye care program that is a module of our
larger diabetes management platform is the only clinically
validated, nonmedriatic system that is being successfully
deployed in 70 sites in 23 States and is accessed by over
100,000 people with diabetes, into appropriate eye care. This
has directly resulted in significant savings of sight for these
people with diabetes.
This clinical application will also be the first outside
application to be integrated into the new DOD, electronic
medical records system, ALTA. And, its initial usage will be in
the Walter Reed Army Medical Center network, and in the
Lackland Air Force network in San Antonio. This integration
will be completed this year.
Additionally, the larger diabetes management program is
currently in use in community health centers in Hawaii, South
Carolina, and Massachusetts, and will be implemented in the
Indian Health Service this year. Six month data from our
Community Health Centers Program showed that patients in this
system see a significant improvement in their control of
diabetes, such as blood glucose levels, as well as a
significant reduction in the level of daily stress they
experience in managing their diabetes.
We're asking for continuation funding of $5 million in
fiscal year 2008 to complete a series of nine multicenter
clinical trials, aimed at determining the clinical efficacy and
cost efficiency of various components of our diabetes
management application. The data from these completed studies
will provide direct, medical and economic evidence to validate
the sustainability of the program.
In addition to completing these studies, we will also
initiate new research efforts into automated diabetic
retinopathy, diagnostic support systems, computer-assisted
decision support for medical management of diabetes, migration
of the system into a personal health record that will leverage
home monitoring, automated lifestyle decision support, and the
use of streaming video, entertaining education that can go
directly to the cell phone.
These research efforts, we expect, to rapidly translate
into our existing clinical programs, to further empower people
with diabetes to live a normal life.
Mr. Chairman, thank you for your attention, and our
appreciation to be part of this project with the Department of
Defense, as well as the support of you and your colleagues. We
will be grateful for the continued support again this year, for
this unique and extremely productive collaborative effort.
Thank you, sir.
Senator Inouye. I can assure you that we'll do our very
best.
Dr. Bursell. Thank you very much.
[The statement follows:]

Prepared Statement of Dr. Sven-Erik Bursell

INTRODUCTION

Mr. Chairman and Members of the Committee, I would like to thank
you for the opportunity to submit written testimony on behalf of the
Diabetes Care and Treatment Project: A Joslin Telemedicine Initiative.
We are extremely appreciative of the funds provided for this valuable
project in the fiscal year 2007 Defense Appropriations Act. The results
of this work can be immediately translated into providing coordinated
care for returning servicemen, as well as providing cost effective care
for all people with diabetes. In fact, the interoperable and
interactive platform that we have developed for diabetes care and care
of other chronic diseases can provide a model for national programs.
For example, the Veterans Affairs has initiated their National
Teleretinal screening program based on the research and development
work derived from this funding.

SUMMARY

This request of $5,000,000 represents the collective costs of the
participating organizations (Joslin Diabetes Center, Walter Reed Army
Medical Center, Boston Veterans Affairs Campus, and the University of
Hawaii) in this collaborative consortium of expertise and associated
expenses of the Department of the Army, RDT&E.

FISCAL YEAR 2007 STATUS REPORT

The problem that we are faced with is that diabetes is a
significant and growing public health problem and it disproportionately
affects certain social groups especially Native Americans, Native
Hawaiians and Native Alaskans. Additionally, care is unevenly provided
in the United States, especially in rural/remote areas and to
minorities. At this time the current health care system does not have
the ability to manage all people with diabetes, and we know that
diabetes-related complications can be slowed or prevented with
appropriate care. This project has developed a new web-based health
information technology (HIT)--the Comprehensive Diabetes Management
Program (CDMP)--designed to provide even and comprehensive care to
people with diabetes. This project is also examining the value derived
from the adoption and utilization of the CDMP at multiple sites with 8
research projects. Several cross most sites that include the Joslin
Diabetes Center, the VA Boston Healthcare System, the Walter Reed Army
Medical Center network and the University of Hawaii with program
implementation at 3 Community Health Centers in Hawaii.
This Diabetes Telehealth application was initially focused on the
delivery of quality eye care to the right patients at the right time.
The aim was to prevent blindness caused by diabetes and to provide
health care delivery tools for diabetes and other chronic diseases for
a clinically effective and cost efficient platform for connected care
for all American people.

TELEHEALTH EYE CARE PROGRAM

This program was the earliest of our implemented diabetes care
programs developed through this funding. Currently the application has
accessed over 100,000 patients at approximately 70 sites in 23 states
in the United States including Hawaii and Alaska. We are currently
planning deployment of the Telehealth application including the eye
care application in the Lackland Air Force Base network in San Antonio
in May 2007.
The eye care program has been clinically validated as being
diagnostically equivalent to current clinical gold standards for eye
examination and has been shown to be a cost effective method of eye
care delivery.

TELEHEALTH DIABETES MANAGEMENT APPLICATION PROGRESS

Work on the development of an interactive comprehensive diabetes
management program was initiated in 2001. It involved leaders in
diabetes clinical management, education, lifestyle modification and
medical informatics from the Joslin Diabetes Center, the Department of
Defense, the Veterans Affairs and the Indian Health Services. The
rationale for this effort was the recognized need to be able to provide
a continuum of care for diabetic patients in contrast to the current
more disjointed care that is provided. This need was further
highlighted by recent results from the Diabetes Prevention Program
(DPP). These patients were randomized to either intensive life style
modification, metformin or placebo treatment. After follow up of 4.6
years, life style modification reduced the progression to diabetes by
58 percent. Moreover, the development of diabetes was reduced by 31
percent. The results indicated that one of the primary reasons for the
success of this study was the implementation of a case management
program. This is exactly what we have developed for the CDMP, namely a
care manager centric interactive and interoperable application that
provides more continuous and immediate contact between patients, care
managers and physicians over secure websites. It is anticipated that
the development of the interactive web-based education and behavior
modules will provide the largest potential benefit with respect to
motivating patients to set reasonable goals for their management of
diabetes, and thus maximize the clinical benefit.
The collaborative currently runs 9 clinical trial research projects
actively that are taking place at 4 sites. These each entail testing
some aspect of the Comprehensive Diabetes Management Program for
clinical efficacy and cost efficiency, namely the CDMP Eye care
program, the Behavioral Assessment Tool (BAT), and the digital
photography component of the nutrition module.
The completion of these studies has been deemed critical to provide
the medical evidence to support a sustainable program. The expectations
are that this program will provide significant reductions in health
care dollars expenses while maintaining a high quality of care as
assessed through a reduction in complications such as blindness from
diabetes. The data from these studies can provide compelling evidence
to third party payors as to the effectiveness of the program since
medical reimbursement is a critical factor in sustaining the program.
The use of this program will also increase the access of patients to
appropriate care and provide a very powerful tool that will empower
patients to improve their own management of their diabetes. During the
2007 funding period, active patients in the program will be followed
for all the proposed studies and data collection and interim analyses
will be ongoing.
Philosophically this management program has been developed to
facilitate an interactive and continuous connection between patient and
care team. This gives it the ability to aggregate clinical data from
diverse sources, electronic medical record systems, lab systems and
data from the home through the use of home monitoring devices. In this
way the system is able to present data to a physician in a medically
relevant manner that allows a patient doctor communication to occur
over most of the short patient visits. The robust clinical decision
support system also rapidly identifies patients at risk or who have
other medical issues that need to be addressed. It is expected that the
management and health care delivery services provided through this
application will allow a primary care practitioner to appropriately
manage patients with chronic disease, such as diabetes, for longer
periods of time before having to refer patients to more expensive
subspecialty services that result in very cost efficient care and the
savings of health care dollars.

FISCAL YEAR 2008 OBJECTIVES

CDMP Eye Care Application Enhancements
We will continue our research and development efforts to improve
retinal image quality and provide computer assisted support with
respect to automated detection of retinal lesions and automated
diagnosis based on identification of these lesions. We will also begin
to develop a system to provide computer assisted decision support for
best practice treatment and management plan options, based on diagnosis
of level of diabetic retinopathy and the level of risk associated with
the patients diabetes in general. This neural network approach will
rapidly increase the efficiency of the system for providing eye
diagnoses and medically relevant treatment plan options and will have a
critical impact on the sustainability of the program.
Comprehensive Diabetes Management Program (CDMP)
The current system utilization is more physician centric. However,
the platform allows a migration to modules that provide a patient
centric personal health record that is also interoperable and will
harmonize care across the health care arena. Over the coming years our
work will focus on moving the system into a more open source
environment so that it becomes available to everyone license free.
A major research thrust will be to develop a neural net engine that
automates treatment plan options based on available medical information
and evidence based clinical guidelines. In this manner the physician
can be rapidly guided to treatment plan options and can decide to
choose one of the presented options or develop a different plan.
We will also focus on enriching the personal health record
component of the applicant through a series of automated lifestyle
decision support systems. In this way, instead of the patient having to
go through options and make decisions, the system automatically
provides the patient with healthy lifestyle options and the patient
just has to choose whatever option the patient likes. Thus we expect
that patient decisions regarding the management of the patients'
chronic disease will become much more seamless and gives the patient
time to focus on decisions involving a more normal lifestyle in the
absence of a chronic disease.
Behavior is the Key to Health Maintenance
While behavior-driven goals are easy to define they are difficult
to implement in the current medical paradigm. A typical doctor visit in
the United States allows only three minutes of direct interaction with
a patient. As we better understand the profound role of individual
behavior in the maintenance of health and in the onset and progression
of disease, it is clear that the effective management of those
behaviors is the Holy Grail of modern health management. Human
behaviors are notoriously difficult to change. We change slowly and
incrementally, and change comes as the result of understanding--truly,
deeply understanding the positive impact our behaviors will have on the
quality and length of our lives.
We expect to significantly impact patient behaviors through the use
of novel education applications that are a major thrust of our
continuing research and development. This will focus on the arena of
providing medical education in a manner that will resonate with the
patient. The concept here is to provide education and decision support
in an engaging video format coupled with a learning system that starts
to recognize particular patient's preferences. For example, based on
patient data collected during the day on nutrition, (images of meals
taken over cell phone) exercise, and blood glucose values, it will be
possible to provide video clips of different meals that adhere to
patient treatment plan and lifestyle. When a patient clicks on a meal
beam a TV format video, onto the patient TV in the kitchen, of how to
cook the meal.
Other CDMP research areas will focus 4 topics as outlined below:
--The continuing development of the nutrition module to include
algorithms identifying nutritional risk based on patient food
intake with decision support to improve nutritional behaviors.
This will also include interactive patient advice with respect
to recipe choices, portion sizes and food choices.
--Provide a wide variety of home monitoring devices to the patient
that can be connected wirelessly to a home computer for
transmission to the CDMP application.
--Integration of a Hypertension Management Module working in
collaboration with the Veterans Administration.
--The development of a cognitive assessment tool. This is an
important aspect of being able to help a patient manage
diabetes. For example if a patient is non compliant to a method
for changing smoking cessation, the patient is non-compliant
because the patients are not ready to change or are because
they do not understand what is being asked of him or her.
--The development of a mental health care service delivery module. In
diabetes there is an almost complete lack of appropriate
management of mental health care. During this funding cycle we
will develop a CDMP module that facilitates delivery of mental
health care services to a patient with diabetes.
--The development of a predictive modeling algorithm that will allow
the CDMP care manager to predict significant clinical adverse
events, with decision support tools that will allow the care
manager to potentially prevent the adverse event from
occurring.

PROGRAM COSTS
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
DOD Admin & Mgmt Costs (@20 percent).................... $1,000,000
Participation Expenses (Includes costs for ongoing 1,757,000
studies and addition of new sites).....................
Joslin Expenses (Includes costs for studies and support 1,173,000
as well as on going research and development efforts
for improved retinal imaging)..........................
Shared CDMP Costs involved in continuing development of 1,070,000
new modules and computer assisted diagnostic support as
well as study related costs for the ongoing cost
benefit and clinical benefit studies...................
---------------
TOTAL, Joslin Diabetes Center..................... 5,000,000
------------------------------------------------------------------------

Mr. Chairman, Joslin is pleased to be a part of this project with
the Department of Defense and we are grateful for 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.

Senator Inouye. Our next witness is John R. Davis,
Director, Legislative Programs of The Fleet Reserve
Association.
Mr. Davis.

STATEMENT OF JOHN R. DAVIS, DIRECTOR, LEGISLATIVE
PROGRAMS, THE FLEET RESERVE ASSOCIATION
Mr. Davis. Thank you.
Mr. Chairman, The Fleet Reserve Association (FRA) wants to
thank you, and the entire subcommittee for your work to improve
military pay, improve healthcare, and enhance other personnel,
retirement, and survivor programs.
This year, with even more than $100 billion in pending
supplemental appropriations for the Iraq and Afghanistan
conflict, the United States will still spend only about 4
percent of its GDP on defense, as compared to 9 percent
annually in the 1960's.
FRA strongly supports funding to support the anticipated
increases in end-strengths for 2008, since the current end-
strength is not adequate to meet the demands of fighting the
war on terror, and sustaining other operational commitments.
Sailors, marines and Coast Guardsman serving in Operation
Iraqi Freedom/Operation Enduring Freedom must be fully armed
with the best protective devices available for their personal
safety. A top priority for FRA is adequate funding for, and
receipt of those protective devices, including: vehicle
protection, armor and electronic equipment to disrupt IEDs for
every uniformed service member in theater.
FRA strongly supports adequate funding for the Defense
Health Program. In order to meet readiness needs, fully fund
TRICARE and improve access for all beneficiaries, regardless of
age, status, or location, FRA believe the Defense Department
must investigate and implement other options to make TRICARE
more cost effective as an alternative to shifting the cost to
retiree beneficiaries under the age of 65.
The proposed 2008 budget includes cuts in healthcare
funding based, apparently, on the assumed implementation of
drastically higher fees for military retirees. FRA questions
why DOD assumed authorization of the fee hikes before the
ongoing studies are complete.
FRA strongly urges the subcommittee to restore the funding
in lieu of TRICARE fee increases. FRA believes funding
healthcare benefits for all beneficiaries are part of the cost
of defending our Nation.
FRA supports the annual Active duty increases that are at
least one-half of 1 percent above the employment cost index.
For 2008, the administration recommended only a 3-percent
across-the-board pay increase for members of the Armed
Services, which is equal to the employment compensation index.
Adequate pay contributes to improved morale, readiness, and
retention. The value of adequate pay cannot be overstated.
Better pay will reduce family stress, especially for the junior
enlisted. The current year pay increase, which was 2.2 percent,
was the smallest increase since 1994. Military pay and benefits
must reflect the fact that military service is very different
from the work in the private sector.
Also, reforming and updating the Montgomery GI bill is
important, and aids in the recruitment and retention of high-
quality individuals for service in the Active and Reserve
forces. If authorized, FRA also strongly supports funding
improvements to concurrent receipt of military retired pay, and
VA disability compensation. Also, retention of a full month's
pay, for retired pay, by the retiree's surviving spouse.
These proposals have also been endorsed by the full
military coalition.
Thank you, again, Mr. Chairman, for allowing me the
opportunity to present the association's recommendations, and I
stand ready to answer any questions you may have.
Senator Inouye. Well, as you are well aware, recruiting and
retention are our major concerns at this moment.
Mr. Davis. Yes, sir.
Senator Inouye. And I can assure you that your program
helps in that element, so we'll do our very best, sir.
Mr. Davis. Thank you very much.
[The statement follows:]

Prepared Statement of John R. Davis

THE FRA

The Fleet Reserve Association (FRA) is the oldest and largest
enlisted organization serving active duty, Reserves, retired and
veterans of the Navy, Marine Corps, and Coast Guard. It is
Congressionally Chartered, recognized by the Department of Veterans
Affairs (DVA) as an accrediting Veteran Service Organization (VSO) for
claim representation and entrusted to serve all veterans who seek its
help.
FRA was established in 1924 and its name is derived from the Navy's
program for personnel transferring to the Fleet Reserve or Fleet Marine
Corps Reserve after 20 or more years of active duty, but less than 30
years for retirement purposes. During the required period of service in
the Fleet Reserve, assigned personnel earn retainer pay and are subject
to recall by the Secretary of the Navy.
FRA's mission is to act as the premier ``watch dog'' organization
in maintaining and improving the quality of life for Sea Service
personnel and their families. FRA is a leading advocate on Capitol Hill
for enlisted Active Duty, Reserve, retired and veterans of the Sea
Services.
FRA also is a major participant in The Military Coalition (TMC) a
35-member consortium of military and veterans organizations. FRA hosts
most TMC meetings and members of its staff serve in a number of TMC
leadership roles, including co-chairing several committees.
FRA celebrated 82 years of service in November 2006. For over eight
decades, dedication to its members has resulted in legislation
enhancing quality of life programs for Sea Services personnel and other
members of the Uniformed Services while protecting their rights and
privileges. CHAMPUS, now TRICARE, was an initiative of FRA, as was the
Uniformed Services Survivor Benefit Plan (USSBP). More recently, FRA
led the way in reforming the REDUX Retirement Plan, obtaining targeted
pay increases for mid-level enlisted personnel, and sea pay for junior
enlisted sailors. FRA also played a leading role in obtaining predatory
lending protections for service members and their dependents in the
fiscal year 2007 National Defense Authorization Act.
FRA's motto is: ``Loyalty, Protection, and Service.''

OVERVIEW

Mr. Chairman, the Fleet Reserve Association thanks you and the
entire Subcommittee for your strong and unwavering support of funding
programs important to active duty, Reserve Component, and retired
members of the uniformed services, their families, and survivors. The
Subcommittee's work has greatly improved military pay, eliminated out-
of-pocket housing expenses, improved health care, and enhanced other
personnel, retirement and survivor programs. This support is critical
to maintaining readiness and is invaluable to our uniformed services
engaged throughout the world fighting the global War on Terror,
sustaining other operational commitments and fulfilling commitments to
those who've served in the past.
This year, even with the more than $100 billion in pending
supplemental appropriations for Iraq and Afghanistan, the United States
will still spend only four percent of its GDP on defense. From 1961-
1963, the military consumed 9.1 percent of GDP annually. According to
many experts the active duty military has been stretched to the limit
since 9/11, and has expanded by only 30,000 personnel. FRA strongly
supports funding to support the anticipated increased end strengths in
fiscal year 2008 since the current end strength is not adequate to meet
the demands of fighting the War on Terror and sustaining other
operational commitments. ``Measuring governmental costs against the
economy as a whole is a good proxy for how much of the nation's wealth
is being diverted to a particular enterprise.'' \1\
---------------------------------------------------------------------------
\1\ John Cranford, CQ Weekly, February 10, 2007; ``Political
Economy: High, and Low, Cost of War''.
---------------------------------------------------------------------------
Over the past several years, the Pentagon has been constrained in
its budget even as it has been confronted with rising personnel costs,
aging weapon systems, worn out equipment, and dilapidated facilities.
This statement lists the concerns of our members, keeping in mind
that the Association's primary goal is to endorse any positive safety
programs, rewards, quality of life improvements that support members of
the uniform services, particularly those serving in hostile areas, and
their families, and survivors.
Sailors, Marines, and Coast Guardsman serving in Operation Iraqi
Freedom (OIF) and Operation Enduring Freedom (OEF) must be fully armed
with the best protective devices available for their personnel safety.
A top priority for FRA is adequate funding for, and receipt of those
protective devices; including vehicle protection, armor and electronic
equipment to disrupt IEDs for every uniformed member serving in
theater.

HEALTH CARE

Full Funding for the Defense Health Program.--FRA strongly supports
adequate funding for the Defense Health Program in order to meet
readiness needs, fully fund TRICARE, and improve access for all
beneficiaries regardless of age, status or location.
FRA believes that the Defense Department must investigate and
implement other options to make TRICARE more cost-efficient as
alternatives to shifting costs for TRICARE Standard and other health
care benefits to retiree beneficiaries under age 65. Cost-saving
options include:
--Negotiating discounts with drug manufacturers, or mandating federal
pricing;
--Eliminate mail-order co-pays to boost use of this lowest cost
option for beneficiaries to receive prescription medications;
and
--Accelerate DOD/VA cost sharing initiates to ensure implementation
of a seamless transition.
The proposed fiscal year 2008 budget includes a $1.86 billion
health care funding cut based apparently on the assumed implementation
of drastically higher fees for younger military retirees. There have
been no enrollment fee hikes since TRICARE was established in 1995, and
this proposed cost shifting to beneficiaries is nearly 250 percent more
than the annual savings predicted by DOD last year ($735 million). FRA
questions why DOD assumed authorization of the fee hikes before the
Task Force on the Future of Military Health Care issues a preliminary
report and prior to the Government Accountability Office (GAO) audit of
the data and methodology DOD used to determine increased fees outlined
in 2006. FRA strongly urges the Subcommittee to restore the $1.86
billion funding in lieu of TRICARE fee increases.
Higher health care fees for retirees will significantly erode the
value of retired pay, particularly for enlisted retirees who retired
prior to larger and targeted recent pay adjustments enacted to close
the pay gap. Military service is very different from work in the
corporate world and requires service in often life threatening duty
assignments and the associated benefits offered in return must be
commensurate with these realities.
FRA is grateful to both the House and Senate Budget Committees for
providing head room in fiscal year 2008 to restore adequate funding
without huge fee increases for beneficiaries. Funding health care
benefits for all beneficiaries is part of the cost of defending our
Nation.

PROTECT PERSONNEL PROGRAMS

Active Duty Pay.--FRA supports annual active duty pay increases
that are at least 0.5 percent above the Employment Cost Index (ECI)
along with targeted increases for mid career and senior enlisted
personnel to help close the remaining four percent pay gap between
active duty and private sector pay.
For fiscal year 2008, the Administration recommended only a three
percent across the board pay increase for members of the Armed
Services.
Adequate and targeted pay increases authorized in recent years for
middle grade and senior petty and noncommissioned officers have
contributed to improved morale, readiness, and retention. The value of
adequate pay cannot be over stated. Better pay will reduce family
stress, especially for junior enlisted and reduce the need for military
personnel use of short-term pay day loans unaware of the ruinous long-
term impact of excessive interest rates.
The 2.2 percent across the board basic pay increase for members of
the Armed Forces for fiscal year 2007 is the smallest increase since
1994 and an issue within the career force. In addition, certain grades
received targeted pay increases on April 1, 2007 totaling between 2
percent and 5 percent.
Military pay and benefits must reflect the fact that military
service is very different from work in the private sector.
BRAC and Rebasing.--Adequate resources are required to fund
essential quality of life programs and services at bases impacted by
BRAC and rebasing initiatives. FRA is concerned about sustaining
commissary access, MWR programs and other support for service members
and their families particularly at installations most impacted by these
actions. These include Guam, where a significant number of Marines and
their families are being relocated from Okinawa. The shortage of funds
is curtailing or closing some of the activities while the costs of
participating in others have recently increased. Regarding Navy fitness
centers, the biggest challenge is updating older fitness structures and
providing the right equipment, and ensuring availability of trained
staff.
Family Readiness and Support.--FRA supports funding for a family
readiness and a support structure to enhance family cohesion and
improve retention and recruitment. DOD and the services must provide
information and education programs for families of our service members.
Spousal and family programs have been fine tuned and are successfully
contributing to the well-being of this community. The Navy's Fleet and
Family Centers and the Marines' Marine Corps Community Services (MCCS)
and the family services programs are providing comprehensive, 24/7
information and referral services to the service member and family
through its One Source links. One Source is also particularly
beneficial to mobilized Reservists and families who are unfamiliar with
benefits and services available to them.
Child and Youth Programs.--MCPON Joe Campa testified before the
House Appropriations Subcommittee on Military Construction and Veterans
Affairs on February 9, 2007 and stated that a top Navy issue is the
need for more childcare facilities. ``We are currently providing close
to 69 percent of the need right now, but with more single parents, dual
military couples and surge deployments, childcare is very important,
and it's critical to our mission accomplishment.'' Currently, the
Navy's program cares for over 31,000 children six months to 12 years in
227 facilities, and in 3,180 on and off base licensed child development
homes. Access to childcare is important and FRA urges Congress to
authorize adequate funding for this important program.
Other top Navy requirements are the need for more homeport/ashore
barracks, and improved health care access via more providers in certain
fleet concentration areas.
As an integral support system for mission readiness and
deployments, it is imperative these programs be adequately funded and
continued to be improved and expanded to cover the needs of both
married and single parents.
Spousal Employment.--The Association urges Congress to continue its
support of the military's effort to affect a viable spousal employment
program and to authorize sufficient funds to assure the program's
success. Today's all-volunteer environment requires the services to
consider the whole family. Spousal employment is important and can be a
stepping-stone to retention of the service member--a key participant in
the defense of this Nation.
Active Duty and Reserve Component Personnel End Strengths.--FRA
strongly supports adequate end strength to win the War on Terror and to
sustain other military commitments around the world. Inadequate end
strengths increase stress on the military personnel and their families
and contribute to greater reliance on the Guard and Reserves. FRA
welcomes the Administration's request for 92,000 additional personnel
(27,000 Marines and 65,000 Army) and urges authorization of
appropriations to cover the associated short and long term costs.
Education Funding.--FRA strongly supports funding for supplemental
Impact Aid for highly impacted school districts. It is important to
ensure our service members, many serving in harm's way, have less
concern about their children's education and more focus with the job at
hand. Impact Aid funding for local schools educating military children
is frozen at the fiscal year 2006 level in the Department of Education
and the Administration's fiscal year 2008 request is set at the same
level ($1,228,453,000) despite rebasing plans and significant
anticipated Army and Marine Corps end strength increases in the coming
years.
The Montgomery GI Bill (MGIB) program must be adequately funded
since it is important and aids in the recruitment and retention of
high-quality individuals for service in the active and Reserve forces;
assists in the readjustment of service men and women to civilian life
after they complete military service; extends the benefits of higher
education (and training) to service men and women who may not be able
to afford higher education; and enhances the Nation by providing a
better educated and more productive workforce. Double-digit education
inflation is dramatically diminishing the value of MGIB, and despite
recent increases, benefits fall well short of the actual cost of
education at a four-year public college or university. In addition,
thousands of career service members who entered service during the
Veterans Education Assistance Program (VEAP) era, but declined to
enroll in that program (in many cases, on the advice of government
education officials) have been denied a MGIB enrollment opportunity.
Reform of PCS Process.--FRA appreciates that the long delayed
implementation of the Families First program which will provide full
replacement value reimbursements for damaged household goods moved
during service members PCS relocations will be implemented in May 2008.
This program must be adequately funded and FRA continues to support
resources necessary to ensure full implementation and the continuation
of this program.

RESERVE ISSUES

FRA stands foursquare in support of the Nation's Reservists. Due to
the demands of the War on Terror, Reserve units are now increasingly
being mobilized to augment active duty components and last year more
than 5,000 Navy Reserve Sailors were serving in the desert. And
wherever active-duty Marines are engaged around the world, Marine
Reservists are there.
Inadequate benefits for Reservists and the Guard can only undermine
long-term retention and readiness. And because of increasing demands on
these personnel to perform multiple missions abroad over longer periods
of time, it's essential to improve compensation and benefits packages
to attract recruits and retain currently serving personnel.
Health Care.--FRA supports adequate funding for TRICARE Reserve
Select to sustain the benefit on an optional basis for all selected
Reservists and families on a cost-sharing basis. FRA also supports
funding to increase subsidy levels for TRICARE coverage for drilling
Reserve members not yet mobilized and establishing one premium for all
members of the Guard and Reserve who continue to be drilling members.
Consistency of health care benefits and continuity of care are major
concerns for Reserve personnel and their families.
Retirement.--If authorized, FRA supports funding to support a
reduction in the age when Reserve members are eligible for retirement
pay, particularly for those members who have experienced extended
mobilizations at great sacrifice to their civilian careers.
Family Readiness.--FRA supports resources to allow increased
outreach to connect Guard and Reserve families with support programs.
This includes increased funding for family readiness, especially for
those geographically dispersed, not readily accessible to military
installations, and inexperienced with the military. Unlike active duty
families who often live near military facilities and support services,
many Reserve families live in civilian communities where information
and support is not readily available. Congressional hearing witnesses
have indicated that many of the half million mobilized Guard and
Reserve personnel have not received transition assistance services they
and their families need to make a successful transition back to
civilian life.
Other Issues.--FRA is pleased to see improvements to the Survivor
Benefit Program (SBP) and concurrent receipt in the House Personnel
Subcommittee mark up of the fiscal year 2008 National Defense
Authorization Act. If authorized, the Association asks that the
Subcommittee provide funding necessary to cover the increase costs of
the enhancements in these two important programs.

CONCLUSION

FRA is grateful for the opportunity to present the organization's
views to this distinguished Subcommittee. The Association reiterates
its profound gratitude for the extraordinary progress this Subcommittee
has made in advancing a wide range of military personnel benefits and
quality-of-life programs for all uniformed services personnel,
retirees, their families and survivors.
Thank you.

Senator Inouye. I must call this hearing to a short recess,
because we have a vote pending. There will be four votes on the
floor, all stacked up, and so we should be able to reconvene in
an hour.
So, with that, the hearing is recessed for 1 hour, and the
first witness upon our return will be Chief Petty Officer James
Phillips.
Our next witness is Chief Petty Officer James Phillips,
United States Naval Sea Cadet Corps.
Captain Hurd. Mr. Chairman, it's my honor to introduce
Chief Phillips, who is the Petty Officer of the Year, selected
out of 10,000 Sea Cadets every year, and quite a privilege.
Senator Inouye. Congratulations.

STATEMENT OF CHIEF PETTY OFFICER JAMES PHILLIPS, UNITED
STATES NAVAL SEA CADET CORPS
ACCOMPANIED BY CAPTAIN ROBERT C. HURD, UNITED STATES NAVY (RETIRED),
NAVAL SEA CADET CORPS

Chief Phillips. Mr. Chairman, good morning. I'm Naval Sea
Cadet Corps Chief Petty Officer James Phillips, lead Petty
Officer of the Warrior Division in Doseville, Georgia, as well
as a senior at New Creations Center.
It is an honor to address you on behalf of the Naval Sea
Cadet Corps. There are now between 9,000 and 10,000 young men
and women, ages 11 to 17, and adult volunteers, proudly wearing
the Naval Sea Cadet uniform in 371 units throughout the
country.
We are a congressionally chartered youth development and
education program, sponsored by the Navy League of the United
States, and supported by the Navy and Coast Guard.
The program's main goals are the development of young men
and women, while promoting interest and skill in seamanship and
aviation, and instilling a sense of patriotism, courage,
commitment, self-reliance, and honor, along with other
qualities that mold strong moral character, and self-discipline
in a drug, and gang-free environment.
After completing boot camp, Sea Cadets choose from a
variety of 2-week summer training sessions, including training
aboard Navy and Coast Guard ships. During my tour in the Naval
Sea Cadets, I have attended 15 advanced summer and spring
training sessions. During the year, we drill one weekend a
month, and may complete Navy correspondent courses for
advancement, this being the basis for the accelerated
promotion, if a cadet should choose to enlist in the Navy, or
Coast Guard, after leaving the program.
Almost 500 former Sea Cadets now attend the U.S. Naval
Academy. This past year, over 12 percent of the entering fleet
class were ex-cadets. Approximately 500 former cadets annually
enlist in the Armed Services, pre-screened, highly motivated,
and well-prepared. Prior Sea Cadets experience has proven to be
an excellent indicator of a potentially higher career success
rate, both in and out of the military. My current plans for the
future are that I plan to work toward becoming a military
doctor.
Whether or not we choose a service career, we all carry
forth the forged values of good citizenship, leadership, and
moral courage that we believe will benefit us and our country.
A major difference between this, and other federally chartered
youth programs, is that we are all responsible for our own
expenses, including uniforms, travel, insurance, and training
costs, which can amount to $400 to $500 a year. The Corps,
however, is particularly sensitive that no young person is
denied access to the program, because of socio-economic status.
Some units are financed, in part, by local sponsors. Yet,
this support--while greatly appreciated--is not sufficient to
support all cadets. Federal funds over the past years have been
used to help offset cadets out-of-pocket training costs,
however, for a variety of reasons, current funding can no
longer adequately sustain the program. These include:
inflation, base closures and reduced base access, reduced
afloat training opportunities, lack of previously provided
transportation, on-base berthing and base transportation,
increased need-based support for the cadets.
We respectfully request your consideration and support, our
funding request of $300,000, that will allow for the full
budgeted amount of $2 million requested for next year.
Unfortunately, time precludes sharing the many stories that
Captain Hurd has shared with your staff this year, pointing out
the many acts of courage, community service, and successful
youth development of my fellow Sea Cadets, as well as those ex-
cadets who are serving in armed forces in Iraq, Afghanistan,
and around the world. These stories, and many more like them,
are unfortunately the stories that you do not always hear about
in the press.
Thank you for the opportunity to speak to you today. I, and
the entire Sea Cadet Corps, appreciate your support for this
fine program, that has meant so much to me over the past 6
years, and which will continue to influence me for the rest of
my life.
Senator Inouye. Once again, congratulations, sir. And, this
patriotic program is worthy of our support.
Chief Phillips. Thank you, sir.
Senator Inouye. Thank you very much.
Chief Phillips. Thank you.
[The statement follows:]

Prepared Statement of Captain Robert C. Hurd

REQUEST

It is respectfully requested that $300,000 be appropriated for the
NSCC in fiscal year 2008, so that when added to the Navy budgeted
$1,700,000 will restore full funding at the $2,000,000 level. Further,
in order to ensure future funding at the full $2,000,000 requirement,
consideration of including the following conference language is
requested:

``Congress is pleased to learn that Navy has funded the U.S. Naval
Sea Cadet Corps in the fiscal year 20078 budget as urged by the Senate
and House in the 2007 Defense Budget Conference Report. Conferees
include an additional $300,000 for the U.S. Naval Sea Cadet Corps, that
when added to the $1,700,000 in the fiscal year 2008 budget request
will fund the program at the full $2,000,000 requested. Conferees urge
the Navy to continue to fund this program and increase the POM level to
$2,000,000 for the U.S. Naval Sea Cadet Corps.''

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
full-time Executive Director and small staff in Arlington, Virginia
administer NSCC's day-to-day operations. These professionals work with
volunteer regional directors, unit commanding officers, and local
sponsors. They also collaborate with Navy League councils and other
civic, or patriotic organizations, and with local school systems.
In close cooperation with, and the support of, the U.S. Navy and
U.S. Coast Guard, the Sea Cadet Corps allows youth to sample military
life without obligation to join the Armed Forces. Cadets and adult
leaders are authorized to wear the Navy uniform, appropriately modified
with a distinctive Sea Cadet insignia.
There are currently over 367 Sea Cadet units with a program total
of over 8,200 participants with over 2,200 adult volunteer Officers and
Instructors.

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 should they opt for a career in military service. For example,
limited travel abroad and in Canada may be available, as well as the
opportunity to train onboard 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, 197 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
classroom, practical and hands-on 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 effort to serve America's youth. The 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 NSCC insignia, is
authorized and worn. Cadet Corps officers receive no pay or allowances.
Yet, they do derive some benefits, such as limited use of military
facilities and space available air travel in conjunction with carrying
out 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
program.
Among a variety of awards and ribbons that Cadets can work toward
is the Drug Reduction Service Ribbon, awarded to those who display
outstanding skills in the areas of leadership, perseverance and
courage. Requirements include intensive anti-drug program training and
giving anti-drug presentations to interested community groups.

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 and Coast Guard 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, Navy history, naval customs and traditions and
other nautical skills. Training may be held aboard ships, small boats
or aircraft, depending upon platform availability. 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 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-oriented 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
training that Navy enlistees receive. The curriculum is provided by the
Navy and taught at all training sites. In 2006 there were 23 recruit
training classes at 21 locations, including two classes conducted over
the winter holiday break and another held over spring break. About
eighteen nationwide to twenty-two regional sites are required to
accommodate the steady demand for quotas and also to keep cadet and
adult travel costs to a minimum. Approximately 2,000 cadets attended
recruit training in 2006 supported by another 350 adult volunteers.
A Cadet who successfully completes recruit training is eligible for
advanced training in various fields of choice. Cadets can experience
the excitement of ``hands-on'' practical training aboard Navy and Coast
Guard vessels, ranging from tugboats and cutters to the largest
nuclear-powered aircraft carriers. Female Cadets may also train aboard
any ship that has females assigned as part of the ship's company.
Qualified Cadets choose from such Sea Cadet advanced training as basic/
advanced airman, ceremonial guard, seamanship, sailing, SEAL training,
amphibious operations, leadership, firefighting and emergency services,
Homeland security, mine warfare operations, Navy diving submarine
orientation and training in occupational specialties, including health
care, legal, music, master-at-arms and police science and construction.
The Cadet Corp programs excel in quality and diversity of training
offered, with more than 7,000 training orders carried out for the 2006
summer training program. Cadets faced a myriad of challenging training
opportunities designed to instill leadership and develop self-reliance,
enabling them to become familiar with the full spectrum of Navy and
Coast Guard career fields.
This steady and continuing participation once again reflects the
popularity of the NSCC and the positive results of federal funding for
2001 through 2006. The NSCC still continues to experience an average
increased recruit and advanced training attendance of well over 2,000
cadets per year over those years in which federal funding was not
available.
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
summer. The popularity of the training continues to grow not with just
overall numbers but also as evidenced with numerous cadets performing
multiple two week training sessions during the summer of 2006.
Training highlights for 2006.--The 2006 training focus was once
again 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 traditional and new training opportunities
developed since federal funding was approved for the NSCC. These
include more classes in sailing and legal (JAG) training, expanded SEAL
training opportunity, more SCUBA and diving training classes, more
seamanship training onboard the NSCC training vessels on the Great
Lakes, more aviation related training and additional honor guard
training opportunities. Other highlights included:
--Maintained national recruit training opportunity for every cadet
wanting to participate with 21 recruit training evolutions in
2006.
--Extended cadet training opportunity beyond the traditional summer
evolutions to now include advanced and recruit training classes
over the Thanksgiving high school recess, the Christmas recess
and the spring recess. During 2006, 12 additional classes over
these school breaks were conducted with 725 cadets
participating. They were supported by another 104 adult
volunteers.
--Maintained NSCC's aggressive NSCC Officer Professional Development
Program, with three different weekend courses tailored to
improving volunteer knowledge and leadership skills. Over 500
volunteers attended 2006 training at 32 different training
evolutions.
--Continued for a second year, NSCC's new naval engineering class for
NSCC cadets at Navy's Training Command, Great Lakes, IL.
--Once again placed cadets onboard USCG Barque Eagle for a summer
underway orientation training cruise.
--Maintained NSCC's expanded seamanship training on the Great Lakes
with 4 underway cruises onboard 2 NSCC YP's and the NSCC
torpedo retriever ``Grayfox''.
--Further enhanced NSCC cadet opportunity for advanced training in
the medical field through the expanded medical ``first
responder'' training at Naval Hospital Great Lakes, IL, and
continuing the very advanced, unique ``surgical tech'' training
at the Naval Medical Center in San Diego, CA.
--Developed and implemented NSCC's first 3 week summer training
course in Joint Special Operations Command Orientation at Fort
Pickett, VA. 37 cadets graduated from this course in 2006.
--Continued NSCC's maritime focus through its expanded sail training
with basic, intermediate and advanced sailing classes offered
in San Diego, CA and 2 additional classes on board ``tall
ships'' in Newport, RI.
--Continued to place cadets aboard USCG stations, cutters, and
tenders for what proves to be among the best of the individual
training opportunities offered in the NSCC.
--Placed cadets onboard USN ships under local orders as operating
schedules and opportunity permitted.
--Promoted cadets' orientation of the U.S. Naval Academy and the U.S.
Coast Guard Academy by offering tuition offsets to cadets
accepted into either academies summer orientation program for
high school juniors (NASS or AIM). 20 cadets participated in
2006.
--Again, as in prior years, enjoyed particularly outstanding support
from members of the United States Naval Reserve, the Army, and
National Guard, whose help and leadership remains essential for
summer training.
International Exchange Program (IEP)
For 2006 the NSCC again continued its' highly competitive, merit
based, and very low cost to the cadet, International Exchange Program.
Cadets were placed in Australia, United Kingdom, Sweden, Netherlands,
Hong Kong, Scotland, Russia, and Bermuda to train with fellow cadets in
these host nations. The NSCC and Canada maintained their traditional
exchanges in Nova Scotia and British Columbia, and the NSCC hosted
visiting international cadets in Newport, RI and at ANG Gowen Field,
Boise, ID, for two weeks of NSCC sponsored training.
Navy League Cadet Training
In 2006, approximately 984 Navy League cadets and escorts attended
Navy League Orientation and Advanced Training nationwide. Participation
in 2006 was somewhat less than 2005 by about 150 cadets, surmised to be
attributable to reduced enrollments as a result of the on-going war in
Iraq. This is a total of approximately 350 fewer cadets than in 2004.
Regardless, the diversity in location and ample quotas allowed for
attendance by each and every League cadet who wished to attend. Of
these, approximately 217 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 recruit training.
International Exchange Program
For 2006 the NSCC again continued for the fifth 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, Hong Kong, Korea and Bermuda to
train with fellow cadets in these host nations. The NSCC and Canada
maintained their traditional exchanges in Nova Scotia nad British
Columbia and the NSCC hosted visiting cadets in Newport, RI and at ANG
Gowen Field in Boise, ID for two weeks of NSCC sponsored training. New
in 2005 were exchanges to Saint Petersberg, Russia and also to
Scotland.
Navy League Cadet Training
In 2005, over 1,120 Navy League Cadets and escorts attended
orientation training at 17 different sites. This diversity in location
made training accessible and reasonably available to each Cadet who
wished to attend. Over 373 League Cadets and escorts attended advanced
training at several sites. The advanced program was developed in
recognition of the need to provide follow-on training for this younger
age group to sustain their interest and to better prepare them for the
challenges of Naval Sea Cadet Corps training. Navy League Cadets who
attend recruit orientation training are exceptionally well prepared for
Sea Cadet ``boot camp.''
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; and the NSCC ``named
scholarship'' program, designed to recognize an individual,
corporation, organization or foundation. Since the inception of the
scholarship program, 209 scholarships have been awarded to 197 Cadets
(includes some renewals) totaling over $256,500.
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 presentations
illustrate 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.
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.
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 which occurs during the
period January through March. The reported accessions to the services
are only those known to the unit. There are many accessions that go
unreported, that occur 2-5 years after Cadets leave their units. With
about 80 percent of the units reporting, the survey indicates that 566
known Cadets entered the Armed Forces during the reporting year ending
December 31, 2005. This is an increase over the previous years'
accessions. Each Cadet entering the Armed Forces is a disciplined,
well-trained individual and progresses much better than those with no
experience. Attritions of former cadets prior to their completion of
obligated service is very low compared to other entrees.

------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
U.S. Naval Academy (2006).................................... 148
U.S. Military Academy........................................ 6
U.S. Coast Guard Academy..................................... 5
U.S. Air Force Academy....................................... 3
U.S. Merchant Marine Academy................................. 10
NROTC........................................................ 41
OCS Navy..................................................... 8
OCS Army..................................................... 11
OCS Air Force................................................ 3
OCS Marine Corps............................................. 3
USNA Prep School............................................. 1
Navy-Enlisted................................................ 169
U.S. Coast Guard-Enlisted.................................... 15
Marine Corps-Enlisted........................................ 72
Army-Enlisted................................................ 48
Air Force-Enlisted........................................... 6
National Guard-Enlisted...................................... 17
----------
Total.................................................. 566
------------------------------------------------------------------------

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 year's 2001,
2002, and 2003, and at $1,500,000 in fiscal year 2004 and $1,700,000 in
2005 (of the $2,000,000 requested), and $2,000,000 in fiscal year 2006
all of these fund 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 fund received, NSCC receives under $700,000 per
year from other sources, which includes around $226,000 in enrollment
fees from Cadets and adult volunteers. 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.
--General inflation of all costs.
--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.
--Lack of on-base transportation, as the navy no longer ``owns''
busses now controlled by the GSA.
--Navy outsourcing of messing facilities to civilian contractors
increases the individual Cadet's meal costs.
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 2008.

Senator Inouye. Our next witness is Mr. Rick Jones,
Legislative Director, National Association for Uniformed
Services.

STATEMENT OF RICK JONES, LEGISLATIVE DIRECTOR, NATIONAL
ASSOCIATION FOR UNIFORMED SERVICES
Mr. Jones. Chairman Inouye, Ranking Member Stevens, it's an
honor to testify before so distinguished a veteran of World War
II, and it's a privilege to be invited before your
subcommittee.
My association is very proud of the job this generation of
Americans is doing. What they do is vital to our security, and
the debt we owe them is enormous.
Mr. Chairman, quality healthcare is a strong incentive for
a military career. At a time when we are relying on our Armed
Forces, the Defense Department's recommendations to reduce
military healthcare spending by $1.8, $1.9 billion is deeply
disappointing.
The plan DOD proposes would, as you know, double or even
triple annual fees for retirees and families, and would greatly
diminish the value of the benefit earned by retirees for a
military career. My association asks you to ensure full funding
is provided to maintain the value of the healthcare benefit
that's provided these men and women, willing to undergo the
hardships of a military career. What we ask is what is best for
our service men and women.
Mr. Chairman, a long war fought by an overstretched force
gives us a warning. There are simply too many missions, and too
few troops. To sustain the service, we must recognize that an
increase in troop strength is needed, and it must be resourced.
We ask, also, that you give priority to funding operations and
maintenance accounts. To reset, recapitalize and renew the
Force.
The National Guard, for example, has virtually depleted its
equipment inventory, causing rising concern about its capacity
to respond to disasters at home, or to train for its missions
abroad. Another matter of great interest to our members is the
plan to re-align and consolidate military health facilities in
the national capital region, specifically, Walter Reed Medical
Center in Washington, DC.
To maintain Walter Reed's base operation support and
medical services, we request that funds be in place to ensure
that Walter Reed remains open, fully operational, and fully
functional until the planned facilities at Bethesda and Fort
Belvoir are in place already to give uninterrupted care to our
catastrophically wounded soldiers.
Our wounded warriors really deserve our Nation's best, most
compassionate healthcare. They earned it the hard way, and with
application of proper resources, we know the Nation will
continue to hold the well-being of these soldiers and their
families in one of our highest priorities.
The development of an electronic medical record remains a
major goal. My association calls on you to continue to push, as
you have in the past, DOD and VA to follow through on
establishing a bi-directional, interoperable, electronic
medical record. The time for foot-dragging is over.
We also call on the subcommittee to fund a full spectrum of
traumatic brain injury care, recognizing that TBI is a
signature injury of the current conflict. We need to recognize
that the care is needed for patients suffering from mild to
moderate brain injuries, as well. The approach to this problem
requires resources, and we trust you'll take a look at that.
We encourage the subcommittee to ensure that funding for
the Defense Department's prosthetic research is adequate to
support the full range of programs needed to meet the needs of
current, disabled veterans.
As you know, the Uniformed Services University of the
Health Sciences is the Nation's Federal School of Medicine and
Graduate School of Nursing. We support the university, and
request adequate funding be provided to ensure continued
accredited training, especially in the area of chemical,
biological, radiological, and nuclear response.
Mr. Chairman, we thank you so very much for your service to
this Nation, your efforts, your hard work, we look forward to
working with you, and thank you for this opportunity to support
our courageous troops.
Senator Inouye. I can assure you, Mr. Jones, that we
support your position.
Mr. Jones. Thank you, sir.
[The statement follows:]

Prepared Statement of Rick Jones

Chairman Inouye, Ranking Member Stevens, and members of the
Subcommittee, good morning. It is a pleasure to appear before you today
to present the views of The National Association for Uniformed Services
on the 2008 Defense appropriations bill.
My name is Richard ``Rick'' Jones, Legislative Director of The
National Association for Uniformed Services (NAUS). And for the record,
NAUS has not received any federal grant or contract during the current
fiscal year or during the previous two years in relation to any of the
subjects discussed today.
As you know, Mr. Chairman, The National Association for Uniformed
Services, founded in 1968, represents all ranks, branches and
components of uniformed services personnel, their spouses and
survivors. The Association includes all personnel of the active,
retired, Reserve and National Guard, disabled veterans, veterans
community and their families. We love our country, believe in a strong
national defense, support our troops and honor their service.
Mr. Chairman, the first and most important responsibility of our
government is the protection of our citizens. As we all know, we are at
war. That is why the defense appropriations bill is so very important.
It is critical that we provide the resources to those who fight for our
protection and our way of life. We need to give our courageous men and
women everything they need to prevail. And we must recognize as well
that we must provide priority funding to keep the promises made to the
generations of warriors whose sacrifice has paid for today's freedom.
At the start, I want to express a NAUS concern about the amount of
our investment in our national defense. At the height of the War on
Terror, our current defense budget represents only a little more than 4
percent of the gross national product, as opposed to the average of 5.7
percent of GNP in the peacetime years between 1940 and 2000.
We cannot look the other way in a time when we face such serious
threats. Resources are required to ensure our military is fully
staffed, trained, and equipped to achieve victory against our enemies.
Leaders in Congress and the administration need to balance our
priorities and ensure our defense in a dangerous world.
Here, I would like to make special mention of the leadership and
contribution this panel has made in providing the resources and support
our forces need to complete their mission. Defending the United States
homeland and the cause of freedom means that the dangers we face must
be confronted. And it means that the brave men and women who put on the
uniform must have the very best training, best weapons, best care and
wherewithal we can give them.
Mr. Chairman, you and those on this important panel have taken
every step to give our fighting men and women the funds they need,
despite allocations we view as insufficient for our total defense
needs. You have made difficult priority decisions that have helped
defend America and taken special care of one of our greatest assets,
namely our men and women in uniform.
And NAUS is very proud of the job this generation of Americans is
doing to defend America. Every day they risk their lives, half a world
away from loved ones. Their daily sacrifice is done in today's
voluntary force. What they do is vital to our security. And the debt we
owe them is enormous.
The members of NAUS applaud Congress for the actions you have taken
over the last several years to close the pay gap, provide bonuses for
specialized skill sets, and improve the overall quality of life for our
troops and the means necessary for their support.
Our Association does, however, have some concerns about a number of
matters. Among the major issues that we will address today is the
provision of a proper health care for the military community and
recognition of the funding requirements for TRICARE for retired
military. Also, we will ask for adequate funding to improve the pay for
members of our armed forces and to address a number of other challenges
including TRICARE Reserve Select and the Survivor Benefit Plan.
We also have a number of related priority concerns such as the
diagnosis and care of troops returning with Post Traumatic Stress
Disorder (PTSD) and Traumatic Brain Injury (TBI), the need for enhanced
priority in the area of prosthetics research, and providing improved
seamless transition for returning troops between the Department of
Defense (DOD) and the Department of Veterans Affairs (VA). In addition,
we would like to ensure that adequate funds are provided to defeat
injuries from the enemy's use of Improvised Explosive Devices (IEDs).
Military Quality of Life: Health Care
Quality health care is a strong incentive to make military service
a career. The Defense blueprint for military healthcare raises serious
concern. DOD recommends saving $1.8 billion through sharp increases in
TRICARE fees and higher copays for pharmaceuticals for 3.1 million
retirees under age 65 and their families.
To achieve these savings, Defense officials would institute the
plan proposed last year. That plan triples annual enrollment fees for
TRICARE Prime next October for officers, to $700 from $230 a year for
individuals and to $1,400 from $460 per year for families. For retired
E-6 and below, the fee would jump nearly fifty percent, to $325/$650
from $230/$460. And for E-7 and above, the jump would more than double
to $475/$950 from $230/$460.
Defense officials also suggest the establishment of a TRICARE
Standard enrollment fee and an increase in the annual amount of
deductible charges paid by retirees using Standard coverage. The
standard beneficiary already pays a 25 percent cost share (and an added
15 percent for non-participating providers). Should Congress approve
the DOD request to increase deductibles and initiate an annual fee, the
value of the benefit earned by military retirees using Standard would
be greatly diminished.
DOD officials also recommend changes in TRICARE retail pharmacy
copayments. Their ideas call for increasing copays for retail generic
drugs to $5 from $3 and for retail brand drugs to $15 from $9. The
copayment for non-formulary prescriptions would remain at $22. By the
way, these would also affect over-age 65 retirees who use TRICARE for
Life.
The assertion behind the proposals is to have working-age retirees
and family members pay a larger share of TRICARE costs or use civilian
health plans offered by employers. Frankly, we are deeply troubled that
DOD would aim to discourage retirees from using their earned benefits
with the military medical system.
The National Association for Uniformed Services is certainly not
comfortable with DOD estimates that by 2011, if the changes were made,
144,000 retirees currently enrolled in the TRICARE programs would bail
out and go to a State or private plan and an estimated 350,000 people
who earned the benefit would never come into it.
The DOD plan would drive half a million military retirees to make a
choice that they might otherwise not want to make to reduce its costs
this year by $1.8 billion. It is not only an extremely poor way to
treat military families in times of peace or war; it is unfair,
unbalanced, and would push 500,000 retirees out of TRICARE, the benefit
they earned through a military career.
Mr. Chairman, the National Association for Uniformed Services asks
you to ensure full funding is provided to maintain the value of the
healthcare benefit provided those men and women willing to undergo the
hardships of a military career.
The provision of quality, timely care is considered one of the most
important benefits afforded the career military. What Congress has done
reflects the commitment of a nation, and it deserves your wholehearted
support.
We urge the Subcommittee to take the actions necessary for honoring
our obligation to those men and women who have worn the nation's
military uniform. Confirm America's solemn, moral obligation to support
our troops, our military retirees, and their families. They have kept
their promise to our Nation, now it's time for us to keep our promise
to them.
Military Quality of Life: Pay
For fiscal year 2008, the Administration recommends a 3 percent
across-the-board pay increase for members of the Armed Forces. The
proposal is designed, according to the Pentagon, to keep military pay
in line with civilian wage growth.
The National Association for Uniformed Services calls on you to put
our troops and their families first. Our forces are stretched thin, at
war, yet getting the job done. We ask you to express the nation's
gratitude for their critical service, increase basic pay and drill pay
one-half percent above the administration's request to 3.5 percent.
Congress and the administration have done a good job over the
recent past to narrow the gap between civilian-sector and military pay.
The differential, which was as great as 14 percent in the late 1990s,
has been reduced to just under 4 percent with the January 2007 pay
increase.
However, we can do better than simply maintaining a rough measure
of comparability with the civilian wage scale. To help retention of
experience and entice recruitment, the pay differential is important.
We have made significant strides. But we are still below the private
sector.
In addition, we urge the appropriations panel to never lose sight
of the fact that our DOD manpower policy needs a compensation package
that is reasonable and competitive. Bonuses have a role in this area.
Bonuses for instance can pull people into special jobs that help supply
our manpower for critical assets, and they can also entice ``old
hands'' to come back into the game with their skills.
The National Association for Uniformed Services asks you to do all
you can to fully compensate these brave men and women for being in
harm's way, we should clearly recognize the risks they face and make
every effort to appropriately compensate them for the job they do.
Military Quality of Life: Allowances
The National Association for Uniformed Services strongly supports
revised housing standards within the Basic Allowance for Housing (BAH).
We are most grateful for the congressional actions reducing out-of-
pocket housing expenses for servicemembers over the last several years.
Despite the many advances made, many enlisted personnel continue to
face steep challenge in providing themselves and their families with
affordable off-base housing and utility expenses. BAH provisions must
ensure that rates keep pace with housing costs in communities where
military members serve and reside. Efforts to better align actual
housing rates can reduce unnecessary stress and help those who serve
better focus on the job at hand, rather than the struggle with meeting
housing costs for their families.
Military Quality of Life: Allowances
The National Association for Uniformed Services urges the
Subcommittee to provide adequate funding for military construction and
family housing accounts used by DOD to provide our service members and
their families quality housing. The funds for base allowance and
housing should ensure that those serving our country are able to afford
to live in quality housing whether on or off the base. The current
program to upgrade military housing by privatizing Defense housing
stock is working well. We encourage continued oversight in this area to
ensure joint military-developer activity continues to improve housing
options. Clearly, we need to be particularly alert to this challenge as
we implement BRAC and related rebasing changes.
The National Association for Uniformed Services also asks special
provision be granted the National Guard and Reserve for planning and
design in the upgrade of facilities. Since the terrorist attacks of
Sept. 11, 2001, our Guardsmen and reservists have witnessed an upward
spiral in the rate of deployment and mobilization. The mission has
clearly changed, and we must recognize they account for an increasing
role in our national defense and homeland security responsibilities.
The challenge to help them keep pace is an obligation we owe for their
vital service.
Increase Force Readiness Funds
The readiness of our forces is declining. The long war fought by an
overstretched force tells us one thing: there are simply too many
missions and too few troops. Extended and repeated deployments are
taking a human toll. Back-to-back deployments means, in practical
terms, that our troops face unrealistic demands. To sustain the service
we must recognize that an increase in troop strength is needed and it
must be resourced.
In addition, we ask you to give priority to funding for the
operations and maintenance accounts where money is secured to reset,
recapitalize and renew the force. The National Guard, for example, has
virtually depleted its equipment inventory, causing rising concern
about its capacity to respond to disasters at home or to train for its
missions abroad.
Walter Reed Army Medical Center
Another matter of great interest to our members is the plan to
realign and consolidate military health facilities in the National
Capital Region. The proposed plan includes the realignment of all
highly specialized and sophisticated medical services currently located
at Walter Reed Army Medical Center in Washington, DC, to the National
Naval Medical Center in Bethesda, MD, and the closing of the existing
Walter Reed by 2011.
While we herald the renewed review of the adequacy of our hospital
facilities and the care and treatment of our wounded warriors that
result from news reports of deteriorating conditions at Walter Reed
Army Medical Center, the National Association for Uniformed Services
believes that Congress must continue to provide adequate resources for
WRAMC to maintain its base operations' support and medical services
that are required for uninterrupted care of our catastrophically
wounded soldiers and marines as they move through this premier medical
center.
We request that funds be in place to ensure that Walter Reed
remains open, fully operational and fully functional, until the planned
facilities at Bethesda or Fort Belvoir are in place and ready to give
appropriate care and treatment to the men and women wounded in armed
service.
Our wounded warriors deserve our nation's best, most compassionate
healthcare and quality treatment system. They earned it the hard way.
And with application of the proper resources, we know the nation will
continue to hold the well being of soldiers and their families as our
number one priority.
Department of Defense, Seamless Transition Between the DOD and VA
The development of electronic medical records remains a major goal.
It is our view that providing a seamless transition for recently
discharged military is especially important for servicemembers leaving
the military for medical reasons related to combat, particularly for
the most severely injured patients.
The National Association for Uniformed Services calls on the
Appropriations Committee to push DOD and VA to follow through on
establishing a bi-directional, interoperable electronic medical record.
Since 1982, these two departments have been working on sharing critical
medical records, yet to date neither has effectively come together in
coordination with the other.
The time for foot dragging is over. Taking care of soldiers,
sailors, airmen and marines is a national obligation, and doing it
right sends a strong signal to those currently in military service as
well as to those thinking about joining the military.
DOD must be directed to adopt identical electronic architecture
including software, data standards and data repositories as used at the
Department of Veterans Affairs. It makes absolute sense and it would
lower costs for both organizations.
If our seriously wounded troops are to receive the care they
deserve, the departments must do what is necessary to establish a
system that allows seamless transition of medical records. It is
essential if our nation is to ensure that all troops receive timely,
quality health care and other benefits earned in military service.
To improve the DOD/VA exchange, the hand-off should include a
detailed history of care provided and an assessment of what each
patient may require in the future, including mental health services. No
veteran leaving military service should fall through the bureaucratic
cracks.
Defense Department Force Protection
The National Association for Uniformed Services urges the
Subcommittee to provide adequate funding to rapidly deploy and acquire
the full range of force protection capabilities for deployed forces.
This would include resources for up-armored high mobility multipurpose
wheeled vehicles and add-on ballistic protection to provide force
protection for soldiers in Iraq and Afghanistan, ensure increased
activity for joint research and treatment effort to treat combat blast
injuries resulting from improvised explosive devices (IEDs), rocket
propelled grenades, and other attacks; and facilitate the early
deployment of new technology, equipment, and tactics to counter the
threat of IEDs.
We ask special consideration be given to counter IEDs, defined as
makeshift or ``homemade'' bombs, often used by enemy forces to destroy
military convoys and currently the leading cause of casualties to
troops deployed in Iraq. These devices are the weapon of choice and,
unfortunately, a very efficient weapon used by our enemy. The Joint
Improvised Explosive Device Defeat Organization (JIEDDO) is established
to coordinate efforts that would help eliminate the threat posed by
these IEDs. We urge efforts to advance investment in technology to
counteract radio-controlled devices used to detonate these killers.
Maintaining support is required to stay ahead of the changing enemy and
to decrease casualties caused by IEDs.
Defense Health Program--TRICARE Reserve Select
Mr. Chairman, another area that requires attention is reservist
participation in TRICARE. As we are all aware, National Guard and
Reserve personnel have seen an upward spiral of mobilization and
deployment since the terrorist attacks of Sept. 11, 2001. The mission
has changed and with it our reliance on these forces has risen.
Congress has recognized these changes and begun to update and upgrade
protections and benefits for those called away from family, home and
employment to active duty. We urge your commitment to these troops to
ensure that the long overdue changes made in the provision of their
heath care and related benefits is adequately resourced. We are one
force, all bearing a full share of the load.
Department of Defense, Prosthetic Research
Clearly, care for our troops with limb loss is a matter of national
concern. The global war on terrorism in Iraq and Afghanistan has
produced wounded soldiers with multiple amputations and limb loss who
in previous conflicts would have died from their injuries. Improved
body armor and better advances in battlefield medicine reduce the
number of fatalities, however injured soldiers are coming back
oftentimes with severe, devastating physical losses.
In order to help meet the challenge, Defense Department research
must be adequately funded to continue its critical focus on treatment
of troops surviving this war with grievous injuries. The research
program also requires funding for continued development of advanced
prosthesis that will focus on the use of prosthetics with
microprocessors that will perform more like the natural limb.
The National Association for Uniformed Services encourages the
Subcommittee to ensure that funding for Defense Department's prosthetic
research is adequate to support the full range of programs needed to
meet current and future health challenges facing wounded veterans. To
meet the situation, the Subcommittee needs to focus a substantial,
dedicated funding stream on Defense Department research to address the
care needs of a growing number of casualties who require specialized
treatment and rehabilitation that result from their armed service.
We would also like to see better coordination between the
Department of Defense Advanced Research Projects Agency and the
Department of Veterans Affairs in the development of prosthetics that
are readily adaptable to aid amputees.
Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI)
The National Association for Uniformed Services supports a higher
priority on Defense Department care of troops demonstrating symptoms of
mental health disorders and traumatic brain injury.
It is said that Traumatic Brain Injury (TBI) is the signature
injury of the Iraq war. Blast injuries often cause permanent damage to
brain tissue. Veterans with severe TBI will require extensive
rehabilitation and medical and clinical support, including neurological
and psychiatric services with physical and psycho-social therapies.
We call on the Subcommittee to fund a full spectrum of TBI care and
to recognize that care is also needed for patients suffering from mild
to moderate brain injuries, as well. The approach to this problem
requires resources for hiring caseworkers, doctors, nurses, clinicians
and general caregivers if we are to meet the needs of these men and
women and their families.
The mental condition known as Post Traumatic Stress Disorder (PTSD)
has been well known for over a hundred years under an assortment of
different names. For example more than sixty years ago, Army
psychiatrists reported, ``That each moment of combat imposes a strain
so great that . . . psychiatric casualties are as inevitable as gunshot
and shrapnel wounds in warfare.''
PTSD is a serious psychiatric disorder. While the government has
demonstrated over the past several years a higher level of attention to
those military personnel who exhibit PTSD symptoms, more should be done
to assist service members found to be at risk.
Pre-deployment and post-deployment medicine is very important. Our
legacy of the Gulf War demonstrates the concept that we need to
understand the health of our service members as a continuum, from pre-
to post-deployment.
The National Association for Uniformed Services applauds the extent
of help provided by the Defense Department, however we encourage that
more resources be made available to assist. Early recognition of the
symptoms and proactive programs are essential to help many of those who
must deal with the debilitating effects of mental injuries, as
inevitable in combat as gunshot and shrapnel wounds.
We encourage the Members of the Subcommittee to provide for these
funds and to closely monitor their expenditure and to see they are not
redirected to other areas of defense spending.
Armed Forces Retirement Home
The National Association for Uniformed Services encourages the
Subcommittee's continued interest in providing funds for the Armed
Forces Retirement Home (AFRH). As you know, more than half of the
residents in the Gulfport home were evacuated for care and treatment to
the Washington, DC, home the day after Hurricane Katrina struck and
damaged the Mississippi facility in August 2005. We applaud the staff
and residents at the Washington facility for stepping up to the
challenge of absorbing the change, and we recognize that challenges
remain in the transformation.
We urge the Subcommittee to continue its help in providing adequate
funding to alleviate the strains on the Washington home. Also, we
remain concerned about the future of the Gulfport home, so we urge your
continued close oversight on the recently signed memorandum of
understanding between the General Services Administration and design-
build contractors for the Gulfport home. And we thank the subcommittee
for the provision of $221 million to build a new Armed Forces
Retirement Home at the present location of the tower, which is
scheduled for demolition this summer.
The National Association for Uniformed Services also asks the
Subcommittee to closely review administration plans to sell great
portions of the Washington AFRH to developers. The AFRH home is a
historic national treasure, and we recommend that Congress find an
alternate means to continue providing a residence for and quality-of-
life support to these deserving veterans without turning most of this
pristine campus over to developers.
Uniformed Services University of the Health Sciences
As you know, the Uniformed Services University of the Health
Sciences (USUHS) is the nation's federal school of medicine and
graduate school of nursing. The medical students are all active-duty
uniformed officers in the Army, Navy, Air Force and U.S. Public Health
Service who are being educated to deal with wartime casualties,
national disasters, emerging diseases and other public health
emergencies.
The National Association for Uniformed Services supports the USUHS
and requests adequate funding be provided to ensure continued
accredited training, especially in the area of chemical, biological,
radiological and nuclear response. In this regard, it is our
understanding that USUHS requires funding for training and educational
focus on biological threats and incidents for military, civilian,
uniformed first responders and healthcare providers across the nation.
Joint POW/MIA Accounting Command (JPAC)
We also want the fullest accounting of our missing servicemen and
ask for your support in DOD dedicated efforts to find and identify
remains. It is a duty we owe to the families of those still missing as
well as to those who served or who currently serve. And as President
Bush said, ``It is a signal that those who wear our country's military
uniform will never be abandoned.''
In recent years, funding for the Joint POW/MIA Accounting Command
(JPAC) has fallen short, forcing the agency to scale back and even
cancel many of its investigative and recovery operations. NAUS supports
the fullest possible accounting of our missing servicemen. It is a duty
we owe the families, to ensure that those who wear our country's
uniform are never abandoned. We request that appropriate funds be
provided to support the JPAC mission for fiscal year 2008.
Appreciation for the Opportunity to Testify
As a staunch advocate for our uniformed service men and women, The
National Association for Uniformed Services recognizes that these brave
men and women did not fail us in their service to country, and we, in
turn, must not fail them in providing the benefits and services they
earned through honorable military service.
Mr. Chairman, The National Association for Uniformed Services
appreciates the Subcommittee's hard work. We ask that you continue to
work in good faith to put the dollars where they are most needed: in
strengthening our national defense, ensuring troop protection,
compensating those who serve, providing for DOD medical services
including TRICARE, and building adequate housing for military troops
and their families, and in the related defense matters discussed today.
These are some of our nation's highest priority needs and we ask that
they be given the level of attention they deserve.
The National Association for Uniformed Services is confident you
will take special care of our nation's greatest assets: the men and
women who serve and have served in uniform. We are proud of the service
they give to America every day. They are vital to our defense and
national security. The price we pay as a nation for their earned
benefits is a continuing cost of war, and it will never cost more nor
equal the value of their service.
We thank you for your efforts, your hard work. And we look forward
to working with you to ensure we continue to provide sufficient
resources to protect the earned benefits for those giving military
service to America every day.
Again, the National Association for Uniformed Services deeply
appreciates the opportunity to present the Association's views on the
issues before the Defense Appropriations Subcommittee.

Senator Inouye. Our next witness, Mr. George Dahlman,
Senior Vice President for Public Policy, the Leukemia and
Lymphoma Society.

STATEMENT OF GEORGE DAHLMAN, SENIOR VICE PRESIDENT FOR
PUBLIC POLICY, LEUKEMIA AND LYMPHOMA
SOCIETY
Mr. Dahlman. Thank you, Mr. Chairman, for giving us this
opportunity. My name is George Dahlman, I'm here today to
represent and testify on behalf of the Leukemia and Lymphoma
Society and hundreds of thousands of blood cancer patients
across the country. I'm also the parent of a leukemia survivor.
Over the past 56 years, this society has been dedicated to
finding a cure for blood cancers, that's leukemia, lymphoma,
and myeloma. We are both--we are the largest blood cancer
organization in the world and we're actually the second largest
cancer organization in the country after the American Cancer
Society.
Our main focus is really on funding research. We'll fund,
in 2007, approximately $65 million in grants. We provide a wide
range of services to people with blood cancer, their caregivers
and family, at 64 chapters around the country.
As you may know, there have been impressive strides in
curing childhood cancer and a few years ago there was a new
pill developed called Gleevec, which has really developed a new
paradigm in targeted treatments of cancer, generally. We are
proud--the society is proud to play a role in developing that
drug and--but there's still a lot of work to be done. A lot of
blood cancers still have bad outlooks. And, the Department of
Defense's congressionally directed medical research program is
an important part of that.
Right now in this year, about 130,000 Americans will be
diagnosed with some form of blood cancer and approximately
65,000 of those will die this year. The society and its other
blood cancer partners believes this is important medical
research to the Department of Defense for a number of reasons.
First, research on blood cancers had significance relevance
to the Armed Forces because the incidence of these cancers is
substantially higher among individuals with chemical and
nuclear exposure. Higher incidences of leukemia have long been
substantiated in extreme nuclear incidents in both military and
civilian populations. And, recent studies prove that individual
exposures, for example, to chemical agents such as Agent Orange
in the Vietnam war, also developed blood cancers.
Second, research in blood cancers traditionally pioneered
treatments in other cancers. Just like Gleevec, the first
chemotherapy and bone marrow transplants are two good examples
of treatments first developed in blood cancers that are now
applied to others. And Congress recognized that relevance. Over
the past 6 years, they have appropriated $4.5 million annually
for one type of leukemia program and members of the
subcommittee know the great distinction of the CDMRP is its
cooperative and collaborative process that incorporates
different experts and patients in the field.
Furthermore, over the last 6 years, blood cancers have been
one of a number of diseases eligible for research funding under
the DOD's Peer-review Medical Research Program. But as of the
continuing resolution in February, the leukemia program itself
and the incorporation of the blood cancers as an eligible
disease to be sponsored under the peer-reviewed program, were
both dropped.
Mr. Chairman, with all due respect to our colleagues
fighting a broad range of cancers that are represented in this
program and, certainly not to diminish their significance, a
cancer research program designed for application to military
and national security needs would invariably begin with a
strong blood cancer research foundation. DOD research on blood
cancers addresses the importance of preparing for civilian and
military exposure to weapons being developed by hostile nations
and to aid in the march to more effective treatments for all
who suffer from these diseases.
Recognizing that, this year a group of 34 members of
Congress have requested that the program be funded at $10
million and expanded in scope to include all blood cancers.
And, the very least, especially for this subcommittee, we
strongly believe that a blood cancer program should at least be
eligible for funding under the Peer-reviewed Medical Research
Program. That's not a guarantee of funding, but simply the
ability to compete.
Subcommittee members might be interested in knowing that we
had, the society had been in discussions with CDMRP on
collaborative opportunities in team science, which we are, have
a great deal of experience in. And, the society, because of our
extensive research portfolio, is interested in pursuing
opportunities for public/private partnerships with the
Department of Defense. That question was raised by this
subcommittee in 2003, and was the subject of an Institute of
Medicine report in 2004, and the society continues to believe
that a collaborative venture holds great promise.
DOD research on other forms of cancer, blood cancers
address the importance of civilian and military exposure to the
weapons being developed across the world and to aid in the
effective treatment of people who suffer those. And, we
respectfully request support for this funding in the fiscal
year 2008 appropriations bill.
Thank you.
Senator Inouye. This is, cancer is a matter of personal
concern to most of our members. Thank you very much.
Mr. Dahlman. Thank you.
[The statement follows:]

Prepared Statement of George Dahlman

INTRODUCTION

Mr. Chairman and members of the committee, my name is George
Dahlman, Senior Vice President, Public Policy for The Leukemia &
Lymphoma Society. I am pleased to appear today and testify on behalf
the Society and the almost 800,000 Americans currently living with
blood cancers and the 130,000 who will be diagnosed with one this year.
Every 10 minutes, someone dies from one of these cancers--leukemia,
lymphoma, Hodgkin's disease and myeloma.
During its 58-year history, the Society has been dedicated to
finding a cure for the blood cancers, and improving the quality of life
of patients and their families. The Society has the distinction of
being both the nation's second largest private cancer organization and
the largest private organization dedicated to biomedical research,
education, patient services and advocacy as they pertain to blood-
related cancers.
Our central contribution to the search for cures for the blood
cancers is providing a significant amount of the funding for basic,
translational and clinical research. In 2007, we will provide
approximately $65 million in research grants. In addition to our
research funding role, we help educate health care and school
professionals as needed and provide a wide range of services to
individuals with a blood cancer, their caregivers, families, and
friends through our 64 chapters across the country. Finally, we
advocate responsible public policies that will advance our mission of
finding cures for the blood cancers and improving the quality of life
of patients and their families.
We are pleased to report that impressive progress is being made in
the effective treatment of many blood cancers, with 5-year survival
rates doubling and even tripling over the last two decades. More than
90 percent of children with Hodgkin's disease now survive, and survival
for children with acute lymphocytic leukemia and non-Hodgkin's lymphoma
has risen as high as 86 percent.
Just five years ago, in fact, a new therapy was approved for
chronic myelogenous leukemia, a form of leukemia for which there were
previously limited treatment options, all with serious side-effects--
five year survival rates were just over 50 percent. Let me say that
more clearly, if six years ago your doctor told you that you had CML,
you would have been informed that there were limited treatment options
and that you should get your affairs in order. Today, those same
patients have access to this new therapy, called Gleevec, which is a
so-called targeted therapy that corrects the molecular defect that
causes the disease, and does so with few side effects. Now, five year
survival rates are as high as 96 percent for patients newly diagnosed
with chronic phase CML.
The Society funded the early research that led to Gleevec approval,
as it has contributed to research on a number of new therapies. We are
pleased that we played a role in the development of this life-saving
therapy, but we realize that our mission is far from realized. Many
forms of leukemia, lymphoma and myeloma still present daunting
treatment challenges. There is much work still to be done, and we
believe that the research partnership between the public and private
sectors--as represented in the Department of Defense's Congressionally
Directed Medical Research Program--is an integral part of that
important effort and should be further strengthened.

THE GRANT PROGRAMS OF THE LEUKEMIA & LYMPHOMA SOCIETY

The grant programs of the Society have traditionally been in three
broad categories: Career Development Program grants, Translational
Research Program grants, and Specialized Centers of Research Program
grants. In our Career Development Program, we fund Scholars, Special
Fellows, and Fellows who are pursuing careers in basic or clinical
research. In our Translational Research Program, we focus on supporting
investigators whose objective is to translate basic research
discoveries into new therapies.
The work of Dr. Brian Druker, an oncologist at Oregon Health
Sciences University and the chief investigator responsible for
Gleevec's development, was supported by a Translational Research
Program grant from the Society.
Our Specialized Centers of Research grant program is intended to
bring investigators together to form new research teams focused on the
discovery of innovative approaches to treating and/or preventing
leukemia, lymphoma, and myeloma. The awards go to those groups that can
demonstrate that their close interaction will create research synergy
and accelerate our search for new and better treatments.
Dr. Druker is certainly a star among those supported by the
Society, but our support in the biomedical field is broad and deep.
Through the Society's research grant programs, we are currently
supporting more than 380 investigators at 134 institutions in 34 states
and 12 other countries.
Not content with these extensive efforts, the Society is launching
a new Therapy Acceleration Program intended to proactively invest in
promising blood cancer therapies that are in early stages of
development by industry, but which may not have sufficient financial
support or market potential to justify private sector investment. In
addition, the Society will use this program to further facilitate the
advancement of therapies in development by academic researchers who may
not have the spectrum of resources or expertise to fulfill the
potential of their discoveries. Directed early phase clinical trial
support in this funding program will further advance new and better
treatments for blood cancer treatments.

IMPACT OF HEMATOLOGICAL CANCERS

Despite enhancements in treating blood cancers, there are still
significant research challenges and opportunities. Hematological, or
blood-related, cancers pose a serious health risk to all Americans.
These cancers are actually a large number of diseases of varied causes
and molecular make-up, and with different treatments, that strike men
and women of all ages. In 2007, more than 130,000 Americans will be
diagnosed with a form of blood-related cancer and almost 65,000 will
die from these cancers. For some, treatment may lead to long-term
remission and cure; for others these are chronic diseases that will
require treatments across a lifetime; and for others treatment options
are still extremely limited. For many, recurring disease will be a
continual threat to a productive and secure life.
A few focused points to put this in perspective: (DB--I would
reorder these 3, 1, 4, 5, 2 for logical flow)
--Taken together, the hematological cancers are fifth among cancers
in incidence and fourth in mortality.
--Almost 800,000 Americans are living with a hematological malignancy
in 2007.
--Almost 52,000 people will die from hematological cancers in 2007,
compared to 160,000 from lung cancer, 41,000 from breast
cancer, 27,000 from prostate cancer, and 52,000 from colorectal
cancer.
--Blood-related cancers still represent serious treatment challenges.
The improved survival for those diagnosed with all types of
hematological cancers has been uneven. The five-year survival
rates are:

------------------------------------------------------------------------
Percent
------------------------------------------------------------------------
Hodgkin's disease............................................ 87
Non-Hodgkin's lymphoma....................................... 64
Leukemias (total)............................................ 50
Multiple Myeloma............................................. 33
Acute Myelogenous Leukemia................................... 21
------------------------------------------------------------------------

--Individuals who have been treated for leukemia, lymphoma, and
myeloma may suffer serious adverse consequences of treatment,
including second malignancies, organ dysfunction (cardiac,
pulmonary, and endocrine), neuropsychological and psychosocial
aspects, and poor quality of life.
--For the period from 1975 to 2003, the incidence rate for non-
Hodgkin's lymphoma increased by 76 percent.
--Non-Hodgkin's lymphoma and multiple myeloma rank second and fifth,
respectively, in terms of increased cancer mortality since
1973.
--Lymphoma is the third most common childhood cancer and the fifth
most common cancer among Hispanics of all races. Recent
statistics indicate both increasing incidence and earlier age
of onset for multiple myeloma.
--Multiple myeloma is one of the top ten leading causes of cancer
death among African Americans.
--Hispanic children of all races under the age of 20 have the highest
rates of childhood leukemias.
--Despite the significant decline in the leukemia and lymphoma death
rates for children in the United States, leukemia is still the
leading cause of death in the United States among children less
than 20 years of age, in females between the ages of 20 and 39
and males between the ages of 60-79.
--Lymphoma is the fourth leading cause of death among males between
the ages of 20 and 39 and the fifth leading cause of death for
females older than 80. Overall, cancer is now the leading cause
of death for U.S. citizens younger than 85 years of age,
overtaking heart disease as the primary killer.
possible environmental causes of hematological cancers
The causes of hematological cancers are varied, and our
understanding of the etiology of leukemia, lymphoma, and myeloma is
limited. Extreme radiation exposures are clearly associated with an
increased incidence of leukemias. Benzene exposures are associated with
increased incidence of a particular form of leukemia. Chemicals in
pesticides and herbicides, as well as viruses such as HIV and EBV,
apparently play a role in some hematological cancers, but for most
cases, no environmental cause is identified. Researchers have recently
published a study reporting that the viral footprint for simian virus
40 (SV40) was found in the tumors of 43 percent of NHL patients. These
research findings may open avenues for investigation of the detection,
prevention, and treatment of NHL. There is a pressing need for more
investigation of the role of infectious agents or environmental toxins
in the initiation or progression of these diseases.

IMPORTANCE TO THE DEPARTMENT OF DEFENSE

The Leukemia & Lymphoma Society, along with its partners in the
Lymphoma Research Foundation, the Multiple Myeloma Research Foundation
and the International Myeloma Foundation, believe biomedical research
focused on the hematological cancers is particularly important to the
Department of Defense for a number of reasons.
First, research on blood-related cancers has significant relevance
to the armed forces, as the incidence of these cancers is substantially
higher among individuals with chemical and nuclear exposure. Higher
incidences of leukemia have long been substantiated in extreme nuclear
[a1]incidents in both military and civilian populations, and recent
studies have proven that individual exposure to chemical agents, such
as Agent Orange in the Vietnam War, cause an increased risk of
contracting lymphoid malignancies. Of note, bone marrow transplants
that have been developed to treat blood-related cancers were first
explored as a means of treating radiation-exposed combatants and
civilians following World War II.
Secondly, research in the blood cancers has traditionally pioneered
treatments in other malignancies. Cancer treatments that have been
developed to treat a blood-related cancer are now used or being tested
as treatments for other forms of cancer. Combination chemotherapy and
bone marrow transplants are two striking examples of treatments first
developed for treating blood cancer patients. More recently, specific
targeted therapies have proven useful for treating patients with solid
tumors as well as blood-related cancers.
From a medical research perspective, it is a particularly promising
time to build a DOD research effort focused on blood-related cancers.
That relevance and opportunity were recognized over the last six years
when Congress appropriated $4.5 million annually--for a total of $28
million--to begin initial research into chronic myelogenous leukemia
(CML) through the Congressionally Directed Medical Research Program
(CDMRP). As members of the Subcommittee know, a noteworthy and
admirable distinction of the CDMRP is its cooperative and collaborative
process that incorporates the experience and expertise of a broad range
of patients, researchers and physicians in the field. Since the CML
program was announced, members of the Society, individual patient
advocates and leading researchers have enthusiastically welcomed the
opportunity to become a part of this program and contribute to the
promise of a successful, collaborative quest for a cure.
Unfortunately, the CML program was not included in January's
Continuing Resolution funding other fiscal year 2007 CDMRP programs.
This omission seriously jeopardizes established and promising research
projects that have clear and compelling application to our armed forces
as well as pioneering research for all cancers. As if to add insult to
injury, blood cancers were also not included as eligible conditions to
be the subject of grants under the DOD's Peer-Reviewed Medical Research
Program--inexplicably reversing a six-year precedent and eliminating a
critical avenue of investigation with direct application to military
service.
With all due respect to our colleagues fighting a broad range of
malignancies that are represented in this program--and certainly not to
diminish their significance--a cancer research program designed for
application to military and national security needs would invariably
include a strong blood cancer research foundation. DOD research on
blood cancers addresses the importance of preparing for civilian and
military exposure to the weapons being developed by several hostile
nations and to aid in the march to more effective treatment for all who
suffer from these diseases. This request clearly has merit for
inclusion in the fiscal year 2008 legislation.
Recognizing that fact and the opportunity this research represents,
a bipartisan group of 30 Members of Congress have requested that the
program be reconstituted at a $10 million level and be expanded to
include all the blood cancers--the leukemias, lymphomas and myeloma.
This would provide the research community with the flexibility to build
on the pioneering tradition that has characterized this field.
The Leukemia & Lymphoma Society strongly endorses and
enthusiastically supports this effort and respectfully urges the
Committee to include this funding in the fiscal year 2008 Defense
Appropriations bill.
We believe that building on the foundation Congress initiated over
the past six years should not be abandoned and would both significantly
strengthen the CDMRP and accelerate the development of all cancer
treatments. As history has demonstrated, expanding its focus into areas
that demonstrate great promise; namely the blood-related cancers of
leukemia, lymphoma and myeloma, would substantially aid the overall
cancer research effort and yield great dividends.

Senator Inouye. Our next witness is Mr. Martin B. Foil,
representing the Board of Directors of the National Brain
Injury Research, Treatment, & Training Foundation.

STATEMENT OF MARTIN B. FOIL, MEMBER, BOARD OF
DIRECTORS, NATIONAL BRAIN INJURY RESEARCH,
TREATMENT, & TRAINING FOUNDATION
Mr. Foil. Chairman Inouye, it's good to be here. Good to
see you again, sir. As you know or may remember, I'm the father
of a severely brain injured young man and a member of the Board
of Directors of the National Brain Injury Research, Treatment,
& Training Foundation, and also a veteran.
I'm here today to request a plus-up of $12.5 million in
funding for the DVBIC, the Defense Veterans Brain Injury Center
and the Brain Injury Program, Head Injury Program. We already
have $7 million in the DOD's budget, but this plus-up will fund
the program at $19.5 million. As you know and as we've heard
today among our colleagues, TBI is a signature injury of the
global war on terror. These blasts from improvised explosive
devices in Iraq and Iran and, well, Iraq and Afghanistan are
causing our, are harming our troops at an alarming rate.
Blast injury, unlike a sports injury, you know, harms the
whole body. It takes in everything. It's not like anything
we've ever seen, it can't be compared to anything else. We need
more research to understand the biomechanics of blast injury to
develop best practices for the optimum treatment and rehab.
The DVBIC, our Center for Excellence for clinical care,
military education, and treatment, relevant clinical research
for the DOD and VA, is our definitive source for assessing TBI
in the theater, and also for tracking TBI. The DVBIC staff has
seen and treated some 2,000 troops involved in the global war
on terror. Research at Fort Carson reveals that over 28 percent
of our returning service members have tested positive for
possible brain injury. Nineteen percent of our military TBIs
are severe, they require long-term support and without
interventions, such troops are relegated to nursing homes.
That's absolutely not the right place.
Military needs to provide care for up to 1 year for these
people with moderate and severe injuries. Twelve and one-half
million would fund such care through Project Hope for Troops,
with altered states of consciousness resulting from TBI. Dr.
George Zitnay, the founder of DVBIC in Denver, has just
returned from Landstuhl, and George, could you stand up?
George actually made rounds in Landstuhl while he was
there. He saw first hand the grave need for more TBI
specialists and resources. NBIRTT strongly supports the plan
offered by the congressional brain injury task force to improve
treatment and research in the military. It recommends a blast
injury Center of Excellence, pre-deployment, cognitive baseline
development, better training for front-line medics, funding for
care coordinators at each State to prevent gaps in care,
community reentry programs, cooperative efforts with veterans
organizations, medical rehab advocacy research.
Well, despite the numbers of troops returning, there has
not been a compensatory increase in professionals to treat. The
healthcare providers need to be trained to understand and treat
unique issues involved with TBI. It is a difficult thing, with
self-diagnosis you just can't do that. Stigma remains a
problem.
Mr. Chairman, I respectfully request your support of the
$12.5 million for 2008. I want to thank you for your
leadership. We hope you will continue to support our efforts to
provide the best possible care for our brave men and women.
Thank you.
Senator Inouye. Your request is reasonable, and I think
very important. And I can assure we're going to do everything
possible to see that it is carried out.
Mr. Foil. Thank you very much and thank your subcommittee.
[The statement follows:]

Prepared Statement of Martin B. Foil, Jr.

My name is Martin Foil 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\ Professionally, I am the Chief Executive
Officer and Chairman of Tuscarora Yarns in Mt. Pleasant, North
Carolina.\2\
---------------------------------------------------------------------------
\1\ NBIRTT is a non-profit national foundation dedicated to the
support of clinical research, treatment and training.
\2\ 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 sustaining brain
injuries, I respectfully request $19.5 million be provided in the
Department of Defense (DOD) Appropriations bill for fiscal year 2008
for the Defense and Veterans Brain Injury Center (DVBIC). This request
includes the $7 million in the DOD's POM, and an additional $12.5
million to allow the important work of the program to continue during
this critical time in the War on Terrorism.
TBI is the signature injury of the Global War on Terror
It is now common knowledge that blasts from improvised explosive
devices (IEDs) in Iraq are causing traumatic brain injuries (TBIs) in
many of our service men and women at an alarming rate. From numerous
media stories, including the special report by Bob Woodruff of ``ABC
News'' about his own experiences with TBI to the Congressional hearings
on the Walter Reed Army Medical Center scandal to the report of the
Department of Veterans Affairs' Task Force on Global War on Terror
Heroes, there is acknowledgement that not enough is being done to care
for our injured troops.\3\
---------------------------------------------------------------------------
\3\ We await the reports of the Army Surgeon General's Task Force
on Traumatic Brain Injury which we expect to be released May 17, 2007,
and the Task Force headed by former Senator Bob Dole and former HHS
Secretary Shalala, to be released in July, 2007.
---------------------------------------------------------------------------
NBIRTT has long been an advocate for improved research, treatment
and training in TBI in the military and civilian sectors. While we
would like to see improvements, we continue to support the good work
being done by the experts in TBI at DVBIC. NBIRTT supports many
proposals that seek to address the shortfalls in the DOD and VA health
care systems, but cautions against recreating systems that are already
in existence. It is NBIRTT's view that any and all efforts to improve
TBI research and care be built around the work of the DVBIC.
DVBIC is the DOD-VA TBI Center of Excellence
The DVBIC, formerly known as the Defense and Veterans Head Injury
Program (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
DVBIC seeks to ensure that all military personnel and veterans with
brain injury receive brain injury-specific evaluation, treatment and
follow-up.
DVBIC staff have seen and treated some 2,000 military personnel
involved in the Global War on Terror. Research at Fort Carson revealed
28 percent of returning service members tested positive for possible
TBI. 19 percent of military TBIs are severe, requiring life long
support, and without intervention, such troops are relegated to nursing
homes.
Clinical care and research is currently undertaken at seven DOD and
DVA sites and two civilian treatment sites. In addition to providing
treatment, rehabilitation and case management at each of the nine
primary DVBIC centers,\4\ the DVBIC 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.
---------------------------------------------------------------------------
\4\ 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; Laurel Highlands Neuro-Rehabilitation
Center, Johnstown, PA.
---------------------------------------------------------------------------
All DVBIC sites have maintained and many have increased treatment
capacity. This has been a direct response to the influx of patients
seen secondary to Operation Iraqi Freedom (OIF) and Operation Enduring
Freedom (OEF). WRAMC receives more casualties from theater than all of
the other military treatment facilities (MTFs) in the continental
United States. Patients are often seen at WRAMC within a week or two
after injury and many of these patients have multiple injuries (e.g.,
TBI, traumatic amputations, shrapnel wounds, etc.). To meet the
increased demand, screening procedures were developed by DVBIC
headquarters and clinical staff. The DVBIC clinical staff reviews all
incoming casualty reports at WRAMC and screens all patients who may
have sustained a brain injury based on the mechanism of injury (i.e.,
blast/explosion, vehicular accident, fall, gunshot wound to the head,
etc.).
DVBIC has reached out to screen troops returning from the field to
make sure no one with a brain injury falls through the cracks. Teams
from DVBIC have been sent to Fort Dix, Fort Campbell, Fort Knox, Camp
Pendleton, Fort Carson, Fort Irwin, Fort Bragg, Tripler Army Medical
Center and others as requested by base commanders. Teams have also
traveled to Landstuhl Regional Medical Center in Germany to provide
evaluation and treatment on an ongoing basis.
The DVBIC developed a screening tool, called the MACE (Military
Acute Concussion Evaluation) for use in all operational settings,
including in-theater and it is now widely used. DVBIC has also
developed management guidelines for mild, moderate, and severe TBI in-
theater, and established a telemedicine network linking DVBIC's
military and VA sites.
While DVBIC clinical and educational programs remain its backbone,
the program has conducted research into the effects of blast on the
brain, the therapeutic use of nano-particles, and enhanced head
protection using novel materials in conjunction with the conventional
helmet.
NBIRTT urges funding for the DVBIC to:
--Enhance its Care Coordination Network in order to better serve
patients with TBI throughout the country.
--Build and implement a web-based care coordination and patient
tracking program to improve its ability to provide
comprehensive follow-up to a population whose cognitive
impairments place them at increased risk of loss to follow-up.
Use of this advanced technology will assist its network in
providing a more integrated, seamless support structure and
will also improve its ability to monitor patients' progress.
--Augment clinical care targeted for the largest military bases with
individuals with TBI will be implemented.
--Expand TBI Surveillance Operational Data from OIF/OEF as more
military sites participate to help create a more comprehensive
picture of the scope of TBI occurring in the current theatres
of operation.
DVBIC is the definitive source for TBI tracking for DOD Health
Affairs. With necessary funding, NBIRTT expects DVBIC to continue to
function as the DOD-VA TBI Center of Excellence for clinical care,
military education, and treatment-relevant clinical research.
Improvements Are Needed To Assure A Continuum of Care
The DVBIC is an important tool to assure a continuum of care, but
it requires an increased level of POM funding and a solid commitment by
the DOD to assist in improving the military and VA health care systems.
Since many of the soldiers with brain injuries will have life long
needs resulting from their injuries, we need to make sure community
services are available wherever the soldier lives. This can be done
through local case management program and linkage to DVBIC sites.
NBIRTT also supports a proposal by the National Association of State
Head Injury Administrators (NASHIA) to connect returning service
personnel with state resources in their home states (copy attached).
Persons with TBI may have difficulty with self diagnosis and
because of cognitive impairments are at greater risk of not following
up for outpatient care. In addition, town hall discussions by the Army
Surgeon General's Task Force on TBI have revealed that stigma remains
an obstacle for troops to admit they may have sustained a TBI. For
these reasons, there is an increased need for family resources and
support.
Last year we requested funding for the DVBIC to improve treatment
capacity, particularly at the community reentry level, and an expanded
care coordination system that meets the special needs of persons with
TBI and their families and is widely distributed across the country.
NBIRTT emphasizes that the need is all the greater this year.
The Congressional Brain Injury Task Force's Road Map for a Continuum of
Care Based on a Proposal for Supplemental Funding for TBI
NBIRTT strongly supports the plan offered by the Congressional
Brain Injury Task Force, to improve TBI treatment and research in the
military. Entitled the ``National Collaborative Plan for Military
Traumatic Brain Injury (TBI) Within the Tri-Services'' it provides for
baseline pre-injury cognitive evaluation and post-injury TBI diagnosis,
evaluation, screening, treatment, and neuro-rehabilitation to the time
of re-entry in to the active duty military or re-entry into the local
community with follow-up services. The plan encompasses all branches of
the military (i.e., Army, Navy, and Air Force) including National Guard
and Reserves plus collaboration with the VA, civilian partners and
veterans/military organizations at the national, state and community
level. The idea is to create a network of services for military
personnel with TBI and their families. The plan is as follows:
--Pre-deployment Cognitive Baseline Development.--In order to better
understand the impact of blast exposure and other situations
that may cause brain injury including mild TBI a cognitive pre-
test will be performed by all military personnel prior to
deployment. A protocol that utilizes novel computer technology
will be used for establishing a baseline similar to what is
currently used in sports at the high school, college and
professional level. Off-the-shelf systems, (e.g., ``Detect'',
``ImPaCT'', or ``CNS Vital Signs'') will require only minor
modifications for this purpose. Through brief cognitive
assessment prior to deployment followed by screening upon
return, the accurate measurement of exposure to blast injury
and potential mild TBI will be enhanced. This will reduce the
number of false positives (incorrect diagnosis of TBI) and
false negatives (failure to diagnose TBI) that occur with post-
blast exposure screening only.
--Care, training and assessment in theatre.--Staff training for
frontline medics will be provided on the battlefield evaluation
of concussion and the symptoms of blast injury. This will
include development of a concussion tool, utilization of the
MACE, and development of protocols for removal from duty to
prevent second concussion syndrome. In addition, the
battlefield evaluation of post traumatic stress disorder (PTSD)
will be included. The clinical guidelines for management will
be updated and made available for all trauma specialists.
Staffing at Landstuhl Regional Medical Center will be increased
to provide brain injury specialist and care coordination. Post
Deployment coordination-Screening instruments will be used to
screen all returning personnel to determine if further
neuropsychological testing is required to make the
determination that a brain injury has occurred.
--Military care and acute management of TBI.--All programs will
follow both JACHO and CARF standards for the treatment and
rehabilitation of TBI. At WRAMC, a complete interdisciplinary
team of brain injury specialists will be employed to establish
a state of the art comprehensive care and neurorehabilitation
center. In addition, care coordinators, neuropsychologists and
mental health specialists will be integral to the brain injury
team. At the Bethesda Naval Hospital, a platform will be
provided to establish a state-of-the-art brain injury center.
Interdisciplinary brain injury specialist staffing will be
provided at every military hospital throughout the country to
insure proper treatment of survivors of TBI. Care coordinators
will be stationed at military sites to link services.
--Specialized care center.--Four centers will be established across
the country to provide complete medical and neurorehabilitation
for the most severely brain injured persons. At the centers,
patients may stay up to one year for comprehensive
Neurorehabilitation and will be provided cutting edge therapies
available to maximize any potential for recovery of function.
This proposal includes Project Hope in Johnstown that will
specialize in stimulating recovery in those patients which are
minimally conscious, locked-in, or in a persistent vegetative
state.
--Civilian DVBIC core sites.--Four community re-entry programs to
serve active duty military personnel which require additional
treatments prior to returning to active or return to home upon
military discharge will be created utilizing state-of-the-art
technology and cognitive rehabilitation. These will be in
addition to existing sites in Charlottesville, Virginia and
Johnstown, Pennsylvania.
--Care Coordinators.--These specialists will be responsible for
preventing any gaps in care of brain injured service personnel
and to maintain the highest level of therapeutic intensity
until discharge. The Care Coordinators will cooperate with
state and community partners, as well the Reserve and National
Guard, for the seamless delivery of services. Every state will
have at least one care coordinator specialized for that
particular state.
--Education and Training.--Despite the overwhelming numbers of
service personnel returning with TBI, there has not been a
compensatory increase in trained professionals to treat them.
Additional healthcare professionals are needed to be trained in
order to understand and treat the brain injured service
personnel returning from OIF and OEF. This will include
training local professionals in rural areas so that they can
attend to the needs of head injured veterans and/or participate
as a mentor during tele-rehabilitation sessions. Seminars
should be held to train care coordinators on the intricacies of
the available services in each state. DVBIC will conduct an
international meeting of experts in the fields of TBI
(including imaging, physiatry, pharmacology, neuro-
rehabilitation, neuropsychology, assistive technologies, and
molecular biology, etc.) to gather recent treatment modalities,
applications, and research to improve outcome in military
personnel injured in OIF and OEF.
--TBI Research.--There is a current dearth of research in several
areas of brain injury therapy. This includes telemedicine-
related neuro-rehabilitation, stimulation therapy for patients
with disorders of consciousness (DOC), development of neuro-
protectants, development of new generations of treatments that
would be adjuncts or enhancements for neuro-rehabilitation, and
development of application technologies in the areas of
imaging, screening, telemedicine, and diagnostics.
--Extramural cooperative program with veterans' organizations,
medical, rehabilitation, advocacy, and research communities
(e.g., CDC, NIH, NASHIA, BIAA, DAV).
--Blast Injury Center.--A center of excellence in research will be
established to better define, and understand the patho-
physiological impact of blast injury on the brain. The center
will conduct research leading to better protective helmets and
other technological tools, and to develop treatment materials
for better outcomes. The center will collaborate with leading
research institutions, universities, biotechnology companies,
and pharmaceuticals.
--Providing the administrative structure personnel, benefits,
oversight for financial expenditures, and preparation of
progress reports and evaluation of programmatic effectiveness.
This plan was produced in anticipation of some $450 million for TBI
in the War Supplemental for fiscal year 2007 earlier this spring. The
Conference Report to the bill that was vetoed included some $600
million for TBI and PTSD. NBIRTT acknowledges that the final funding
level is yet to be determined, but in the meantime supports the work of
the DVBIC within this plan. DVBIC would continue to be the center of
all DOD and VA coordination efforts and implementation of best
practices throughout the wider military and VA systems.
While efforts to make significant system wide changes are underway,
we should look to build upon the work that has already been done by the
experts currently in the field.
$19.5 million is needed in fiscal year 2008 for the DVBIC
Since the Global War on Terror began, there has not been a steady,
consistent, reliable funding stream for the work of the DVBIC. While
efforts are underway to gain a permanent commitment from the Pentagon
to support this important work, we urge your support for adequate
funding in fiscal year 2008. NBIRTT applauds the work of the Senate
Appropriations Subcommittee on Defense to include substantial funding
for TBI in the War Supplemental. Ideally, we would like to see a
permanent increase in the DOD's POM for TBI so that plus-up requests
and supplementals can be used to address emergencies and not basic
needs. At this juncture, however, $12.5 million is needed for DVBIC
merely to continue research, treatment and training in TBI.
Please support $19.5 million for the DVHIP in the fiscal year 2008
Defense Appropriations bill under AMRMC, Fort Detrick to continue this
important program.
Role of State Government in Serving Returning Soldiers with Traumatic
Brain Injury
Introduction
Recently, national attention has focused on the need for improved
treatment and care for soldiers returning from Iraq and Afghanistan
with traumatic brain injuries. Most of this focus has been on the acute
and rehabilitation care provided by the Department of Defense and
Veterans Brain Injury Center (DVBIC), the Veterans Administration (VA)
Polytrauma Rehabilitation Centers and the VA health care system.
Congressional hearings have also been held on transitioning between and
among these programs through care coordinators who have been placed
within key programs of these systems. While this attention is certainly
well deserved, little commentary has been provided on those soldiers
who require long-term care, services and community supports offered by
state and local governmental programs.
Thus, this paper has been developed to initiate discussion and to
further collaboration among all federal, state and local entities that
may be involved in some aspect of assessment and identification,
rehabilitation, long-term care, service coordination, community and
family supports for individuals who are serving in our military and are
at risk of experiencing the consequences of a traumatic brain injury
(TBI), as well as other co-occurring conditions (Post Traumatic Stress
Disorder and substance abuse). The intent is to ensure that returning
soldiers receive the necessary services in a coordinated fashion, and
that all local, state and federal resources are maximized and used
effectively.
Background
Over the past 20 years, several states have developed service
delivery systems to meet the needs of individuals with traumatic brain
injury and their families. These systems generally offer information
and referral, service coordinators, rehabilitation, in-home support,
personal care, counseling, transportation, housing, vocational and
return to work and other support services that are funded by state
appropriations, designated funding (trust funds), Medicaid and by
programs under the Rehabilitation Act. These services may be
administered by programs located in the state public health, vocational
rehabilitation, mental health, Medicaid, developmental disabilities or
social services agencies.
To help states to further expand, improve and coordinate service
delivery the TBI Act of 1996, as amended in 2000, provides federal
funding to the U.S. Department of Health and Human Services, Health
Resources and Services Administration (HRSA) for the State Grant
Program. Currently, almost all states receive TBI Act funding. The
federal program also contracts with the National Association of State
Head Injury Administrators (NASHIA) to provide technical assistance to
states through the TBI Technical Assistance Center, which has also
become a clearinghouse of information and materials available to assist
states in developing ``best practices''. NASHIA was created in the
early 1990s by state government employees responsible for public brain
injury policies, programs and services.
How can states help returning soldiers?
State TBI programs can help families, soldiers and the VA to
identify or screen for traumatic brain injury, assess needs of soldiers
with traumatic brain injury, provide information on TBI and available
resources, and provide and coordinate services. Of particular concern
to states are soldiers, who may not be initially identified by the VA
system, yet experience the consequences of a traumatic brain injury
long after they return home. As a result, state TBI and disability
systems may be the point of contact for information and referral for
these families and returning soldiers. Some of these returning soldiers
may not be affiliated with military installations and, therefore, may
not seek health care from the VA, but rather from their own family care
physician. Their physicians may not even know to inquire about their
time in Iraq or Afghanistan to determine if their symptoms could
possibly be stemming from a TBI, or even to be able to distinguish TBI
from Post Traumatic Stress Disorders (PTSD).
Combined screening for TBI and PTSD could be especially beneficial
and should be considered by all potentially involved agencies, since
the symptoms overlap, the treatments differ, and both can be seriously
disabling. Through collaboration among state and local mental health
and substance abuse programs, TBI state programs may be able to promote
collaborative screening efforts.
There are a few states that are addressing the needs of returning
soldiers from various angles. Two states, New York and Massachusetts,
are currently conducting efforts to identify soldiers with TBI and link
them to needed resources and services. Both of these states are using
federal grant funds administered by the U.S. Health Resources and
Services Administration (HRSA) for these efforts. In Massachusetts the
Statewide Head Injury Program under the Brain Injury & Statewide
Specialized Community Services Department, known as SHIP, administered
by the Massachusetts Rehabilitation Commission is partnering with the
Veterans Administration, Veterans Organizations, TBI providers and the
Brain Injury Association of Massachusetts in conducting outreach,
information and referral services.
Other state TBI programs that offer service coordination and array
of support services are collaborating with their state Veterans
Commissions and the National Guard to solve individual problems. States
are also fielding calls from families, participating in state
conferences on PTSD and TBI, and at least one state vocational
rehabilitation agency has entered into a MOU with the Veterans
Administration. Several groups have also developed materials on TBI for
returning soldiers, including Massachusetts and New York.
Recommendations
Collaboration among states, NASHIA, federal agencies (DVBIC, VA and
Centers for Disease Control and Prevention) and military branches
should include:
--Developing and disseminating screening questions to help alert
families and soldiers that have symptoms associated with TBI,
who have not been previously identified. These efforts should
be coordinated with efforts to screen for PTSD and substance
abuse problems.
--Disseminating information on available state and community
resources and supports, including state TBI service
coordinators who coordinate a myriad of federal and state
resources to support individuals to live and work in the
community.
--Training and disseminating information on TBI as the result of war-
related injuries to civilian medical providers, local
physicians, social workers and mental health community centers.
--Availing existing resources, such as telerehabilitation programs
that provide evaluation and expertise to providers in rural
areas, family support information and resources, family
training, etc.
--Communicating and partnering with state advisory boards on TBI and
lead state agencies as to the needs of returning soldiers who
may not be accessing the VA, but may be in need of the array of
community and family supports, in order for states to plan and
address how to meet those needs.
--Communicating and partnering with state task forces on the needs of
returning soldiers to ensure that TBI, as well as PTSD and
substance abuse are included in these deliberations.
--Partnering with all veterans and state brain injury systems to pool
and maximize state and federal resources to ensure that
resources are available when their family member returns home.
For further information contact Kenneth H. Currier, Executive
Director, NASHIA at 301-656-3500 or [email protected].

Senator Inouye. Our next witness is Dr. Andrew Pollack of
the American Academy of Orthopedic Surgeons, together with Ms.
Kimberly Dozier of CBS News.

STATEMENT OF DR. ANDREW N. POLLACK, M.D., ORTHOPEDIC
SURGEON, UNIVERSITY OF MARYLAND MEDICAL
CENTER AND CHAIR, EXTREMITY WAR INJURIES
PROJECT TEAM, AMERICAN ACADEMY OF
ORTHOPEDIC SURGEONS
ACCOMPANIED BY KIMBERLY DOZIER, CBS NEW CORRESPONDENT

Mr. Pollack. Mr. Chairman, thank you for the opportunity to
testify today. I'm Andy Pollack, an orthopedic surgeon in shock
trauma at the University of Maryland Medical Center in
Baltimore. I represent the American Academy of Orthopedic
Surgeons and our special effort to advocate for the peer-
reviewed orthopedic extremities research program.
This critical program is operated by the Defense
Department. I'm fortunate to be accompanied today by CBS News
correspondent, Kimberly Dozier. She's one of those rare
individuals willing to put herself in harm's way to chronicle
the work of our American servicemen and women in Iraq. She's an
inspiration on many different levels, and I'm one of the many
surgeons who's had the privilege to have worked with her.
Please allow me to introduce Kimberly Dozier.
Ms. Dozier. Mr. Chairman, amputation, debridement,
acinetobacter, and heterotrophic ossification, there are words
that I never wanted to learn, much less experience. But a 500-
pound car bomb last Memorial Day changed that. My rapid-fire
education started in Baghdad, as it does for so many injured
troops.
More than 80 percent of the wounded coming out of Iraq and
Afghanistan have injuries exactly like mine, and more of us are
surviving than ever before in any other conflict and medical
miracles are happening every day. The fact that I'm here is
testament to that.
But that also means that we are living long enough to
develop secondary conditions that doctors have rarely seen
before, much less done research on how to treat. Now, some of
them you've heard of. In terms of amputation, they thought they
would have to take off one or both of my legs, but they took a
chance. One of my legs, by the time I'd reached Landstuhl, had
turned black. They gave it an extra day and it proved that it
could work, came back. The next time they see a situation like
mine, they might give it another 24 to 48 hours before taking
the limb off.
Debridement is what they did to the burned tissue from my
hips to my ankles, courtesy of the 130 millimeter round
illumination shell that made up the bulk of the car bomb. Now,
it's a process of removing dead tissue from the living, but it
depends on the instincts of each particular surgeon to decide
what's viable and what's not. The fact that the surgeons, in my
case, were able to salvage much of the quads in my femurs,
means that I can walk and run almost normally. You get a
different surgeon, you get a different outcome, and that all
depends on their research.
Acinetobacter is a normally harmless bacteria found in
Iraqi soil and throughout Europe, but give it in--blow it into
the injuries of an immune-compromised person and it can become
deadly. It's multidrug resistant. In my case, as in the case of
many of the troops I've met, I had to choose between continuing
on the one medication that treats it, but risking losing my
kidneys, to which this drug is toxic, or going off of the drug
and hoping for the best. In my case, I was lucky, my body
fought back and I kept my kidneys.
Heterotrophic ossification--say that 10 times fast--we
don't know why the body does it, but when it heals bones
shattered by blasts, it often goes a little haywire, and the
bones keep going, keep healing, turning into coral that spikes
into your muscles. The only way to take it out right now, is to
chisel it out and that means a second long-term surgery and it
doesn't mean the bone won't come back. Then you've got to
radiate the area, that's more risk.
Now, all of that was fairly easy to fix, in my case. I was
lucky. The two soldiers on either side of me had it much worse.
Sergeant Justin Ferrar had his knee, part of it blown out. They
had to put in a cadaver's patella. That means you've got to
immobilize the leg for a long time. Justin is still using a
cane, I'm not. Staff Sergeant Reed, on the other side of me, he
got his knee blown out. In a normal situation you could do
total knee replacement. In a blast injury, that doesn't work.
There's too much infection. He had to choose between having one
solid leg or amputation. He chose amputation so he could go
back to active duty.
Now, these are the battles troops face when they come home,
and the battles that the medical profession is fighting on our
behalf, and they need your help. Thank you.
Mr. Pollack. As you heard from Ms. Dozier, over 80 percent
of war injuries now involve the extremities, often severely
mangled and multiple injuries to the arms and legs. As in
Kimberly's case, most wounds are caused by exploding ordinance.
This targeted research program is desperately needed to provide
information that will lead to improvement in quality of life
for our injured heroes. The funding you provide is being well
spent. The new knowledge we gain advances our ability to better
understand and better treat these serious injuries.
Mr. Chairman, you've recognized the urgent need to support
this important peer-reviewed program over the past 2 years and
most recently in the fiscal year 2007 supplemental
appropriations bill, and we're most grateful for that support.
Based on the level of scientific need and the amount of
unfunded research still outstanding, our goal is to see this
program receive an operating level of $50 million per year. We
most sincerely thank you and the entire subcommittee for your
vision and leadership in responding to this appeal. We strongly
urge your continued support.
Senator Inouye. As one who has some experience in this
area, I can assure you of our support.
But with all the medical miracles that we are now
experiencing and enjoying, one has caused us much trouble. For
example, in World War II, it took a little while to be
evacuated.
In my case, I left the front at 3 o'clock in the afternoon
and I was in the field hospital at midnight. Today, the same
injury very likely would be in a hospital within 30 minutes. As
a result, many, many survive, unlike World War II, they did not
survive. In my hospital, I can recall only one double amputee.
Double amputations are commonplace now, and I agree with you.
Our personnel is inadequate, our resources are inadequate, and
we will do what you say is right.
Thank you very much, Ms. Dozier.
Mr. Pollack. Thank you, Mr. Chairman.
[The statement follows:]

Prepared Statement of Andrew N. Pollak, M.D.

Chairman Inouye, Vice Chairman Stevens, Members of the Senate
Defense Appropriations Subcommittee, thank you for the opportunity to
testify today. I am Andrew N. Pollak, M.D., and I speak today on behalf
of the American Academy of Orthopaedic Surgeons (AAOS), of which I am
an active member, as well as on behalf of military and civilian
orthopaedic surgeons involved in orthopaedic trauma research and care.
I am Chair of the Academy's Extremity War Injuries and Disaster
Preparedness Project Team, immediate past-chair of its Board of
Specialty Societies, and a subspecialist in orthopaedic traumatology. I
am Associate Director of Trauma and Head of the Division of Orthopaedic
Traumatology at the R Adams Cowley Shock Trauma Center and the
University of Maryland School of Medicine. My Division at Shock Trauma
is responsible for providing education and training in orthopaedic
traumatology to residents from eight separate training programs
nationally, including the Bethesda Naval, Walter Reed Army and Tripler
Army orthopaedic residency programs. In addition, Shock Trauma serves
as the home for the Air Force Center for Sustainment of the Trauma and
Readiness Skills (CSTARS) program. I also serve as a Commissioner on
the Maryland Health Care Commission and on the Board of Directors of
the Orthopaedic Trauma Association.
Accompanying me is CBS News Correspondent Kimberly Dozier, who is
recovering from severe wounds to her legs and head. Kimberly sustained
these extremity injuries last Memorial Day on the streets of Baghdad
while covering American soldiers on patrol with Iraqi security forces.
She had been imbedded with the Army's 4th Infantry Division. The patrol
was the victim of a car bombing which critically injured Kimberly and
killed her cameraman, soundman, a U.S. Army captain they were following
and his Iraqi translator.
As one of the many doctors who have worked with Kimberly, I am
happy to say her recovery is progressing well. She is one of those rare
individuals willing to put herself in harm's way to chronicle the work
of our brave American servicemen and women in Iraq.
Please allow me to take this opportunity today to thank the Members
of this Subcommittee for your vision and leadership in providing
significant new funding for the Peer Reviewed Orthopaedic Extremity
Trauma Research Program in the fiscal year 2007 Supplemental
Appropriations Bill and urge your continued support for this critical
effort in the future.
I will discuss the spectrum of orthopaedic trauma being sustained
by U.S. military personnel in Iraq and Afghanistan and offer a
perspective on the importance of orthopaedic extremity research in
providing new clinical knowledge that will enable improved treatments
for soldiers suffering from orthopaedic trauma. Finally, I will provide
an update on the progress of the Peer Reviewed Orthopaedic Extremity
Trauma Research Program, which is administered by the Medical Research
and Materiel Command's U.S. Army Institute of Surgical Research
(USAISR).
It is important to point out that unique to this conflict is a new
type of patient, a warfighter with multiple and severely mangled
extremities who is otherwise free of life-threatening injury to the
torso because of improvements in protective body armor. Current
challenges that often compound the injuries include serious infections
due to the nature of the injuries and the environment where they are
sustained, the need for immediate transport for more complex surgery,
the need for better medical understanding of the internal effects of
blast injury, and the need for a joint service database that
encompasses the multilevel spectrum of orthopaedic extremity injury
care.
Orthopaedic Trauma from Operation Iraqi Freedom and Operation Enduring
Freedom
The likelihood of surviving wounds on the battlefield was 69.7
percent in WWII and 76.4 percent in Vietnam. Now, thanks in part to the
use of body armor, ``up-armored'' vehicles, intense training of our
combat personnel and surgical capability within minutes of the
battlefield, survivability has increased dramatically to 90.2 percent
as of February 2007.
The Armed Forces are attempting to return significantly injured
soldiers to full function or limit their disabilities to a functional
level in the case of the most severe injuries. The ability to provide
improved recovery of function moves toward the goal of keeping injured
soldiers part of the Army or service team. Moreover, when they do leave
the Armed Forces, these rehabilitated soldiers have a greater chance of
finding worthwhile occupations outside of the service to contribute
positively to society. The Army believes that it has a duty and
obligation to provide the highest level of care and rehabilitation to
those men and women who have suffered the most while serving the
country and our Academy fully supports those efforts.
It probably comes as no surprise that the vast majority of trauma
experienced in Iraq and Afghanistan is orthopaedic-related, especially
upper and lower extremity and spine. A recent article in the Journal of
Orthopaedic Trauma reports on wounds sustained in Operation Iraqi
Freedom (OIF) and Operation Enduring Freedom (OEF) based on data from
the Joint Theater Trauma Registry, a database of medical treatment
information from theater of combat operations at U.S. Army medical
treatment facilities. From October, 2001 through January, 2005, of
1,566 soldiers who were injured by hostile enemy action, 1,281 (82
percent) had extremity injuries, with each solider sustaining, on
average, 2.28 extremity wounds. These estimates do not include non-
American and civilians receiving medical care through U.S. military
facilities. (Owens, Kragh, Macaitis, Svoboda and Wenke.
Characterization of Extremity Wounds in Operation Iraqi Freedom and
Operation Enduring Freedom. J Orthopaedic Trauma. Vol. 21, No. 4, April
2007. 254-257.)
An earlier article reported on 256 battle casualties treated at the
Landstuhl Regional Medical Center in Germany during the first two
months of OIF, finding 68 percent sustained an extremity injury. The
reported mechanism of injury was explosives in 48 percent, gun-shot
wounds in 30 percent and blunt trauma in 21 percent. As the war has
moved from an offensive phase to the current counter-insurgency
campaign, higher rates of injuries from explosives have been
experienced. (Johnson BA. Carmack D, Neary M, et al. Operation Iraqi
Freedom: the Landstuhl Regional Medical Center experience. J Foot Ankle
Surg. 2005; 44:177-183.) According to the JTTR, between 2001 and 2005,
explosive mechanisms accounted for 78 percent of the war injuries
compared to 18 percent from gun shots.
While medical and technological advancements, as well as the use of
fast-moving Forward Surgical Teams, have dramatically decreased the
lethality of war wounds, wounded soldiers who may have died in previous
conflicts from their injuries are now surviving and have to learn to
recover from devastating injuries. While body armor does a great job of
protecting a soldier's torso, his or her extremities are particularly
vulnerable during attacks.
Characteristics of Military Orthopaedic Trauma
At this point we are approaching 40,000 casualties in the Global
War on Terror. As mentioned earlier, the vast majority have injuries to
their extremities--often severe and multiple injuries to the arms,
legs, head and neck. Most wounds are caused by exploding ordinance--
frequently, improvised explosive devices (IEDs), rocket-propelled
grenades (RPGs), as well as high-velocity gunshot wounds. Military
surgeons report an average of 3 wounds per casualty.
According to the New England Journal of Medicine, blast injuries
are producing an unprecedented number of ``mangled extremities''--limbs
with severe soft-tissue and bone injuries. (``Casualties of War--
Military Care for the Wounded from Iraq and Afghanistan,'' NEJM,
December 9, 2004). The result of such trauma is open, complex wounds
with severe bone fragmentation. Often there is nerve damage, as well as
damage to tendons, muscles, vessels, and soft-tissue. In these types of
wounds, infection is often a problem. According to the JTTR, 53 percent
of the extremity wounds are classified as penetrating soft-tissue
wounds, while fractures compose 26 percent of extremity wounds. Other
types of extremity wounds composing less than 5 percent each are burns,
sprains, nerve damage, abrasions, amputations, contusions,
dislocations, and vascular injuries.
Military versus Civilian Orthopaedic Trauma
While there are similarities between orthopaedic military trauma
and the types of orthopaedic trauma seen in civilian settings, there
are several major differences that must be noted.
With orthopaedic military trauma, there are up to five echelons of
care, unlike in civilian settings when those injured are most likely to
receive the highest level of care immediately. Instead, wounded
soldiers get passed from one level of care to the next, with each level
of care implementing the most appropriate type of care in order to
ensure the best possible outcome. The surgeon in each subsequent level
of care must try to recreate what was previously done. In addition, a
majority of injured soldiers have to be ``medevaced'' to receive care
and transportation is often delayed due to weather or combat
conditions. It has been our experience that over 65 percent of the
trauma is urgent and requires immediate attention.
Injuries from IEDs and other explosive ordnance in Iraq and
Afghanistan differ markedly from those of gunshot wounds sustained in
civilian society. The contamination, infection and soft-tissue injury
caused by exploding ordnance requires more aggressive treatment and new
techniques, especially when the individual is in proximity to the blast
radius.
Soldiers are usually in excellent health prior to injury. However,
through the evacuation process they may not be able to eat due to
medical considerations resulting in impaired body nitrogen stores and
decreased ability to heal wounds and fight infections. This presents
many complicating factors when determining the most appropriate care.
The setting in which care is initially provided to wounded soldiers
is less than ideal, to say the least, especially in comparison to a
sterile hospital setting. The environment, such as that seen in Iraq
and Afghanistan, is dusty and hot, leading to concerns about
sterilization of the hospital setting. For example, infection from
acinetobacter baumanni, a ubiquitous organism found in the desert soil
of Afghanistan and Iraq, is extremely common. In addition, the surgical
environment is under constant threat of attack by insurgents. Imagine
teams of medical specialists working in close quarters to save an
injured serviceman while mortars or rockets are raining down on the
hospital. In fact, a considerable percentage of the care provided by
military surgeons is for injured Iraqis, both friendly and hostile.
Finally, the surgical team is faced with limited resources that make
providing the highest level of care difficult.
While, as I have stated, there are many unique characteristics of
orthopaedic military trauma, there is no doubt that research done on
orthopaedic military trauma benefits trauma victims in civilian
settings. Many of the great advancements in orthopaedic trauma care
have been made during times of war, such as the external fixateur,
which has been used extensively during the current conflict as well as
in civilian care.
Future Needs of Orthopaedic Extremity Trauma Research
An important development in this scientific effort has been the
convening of two major Extremity War Injury Symposia in January of 2006
and 2007. These widely attended medical conferences in Washington, D.C.
brought together leading military and civilian clinicians and
researchers to focus on the immediate needs of personnel sustaining
extremity injuries. Presentations and discussions at the conferences
confirmed that there is tremendous interest in the military and
civilian research community and much unmet research capacity in the
nation at military and civilian research institutions.
These extraordinary scientific meetings were a partnership effort
between organized orthopaedic surgery, military surgeons and industry.
They were attended by key military and civilian physicians and
researchers committed to the care of extremity injuries. The first
conference addressed current challenges in the management of extremity
trauma associated with recent combat in Iraq and Afghanistan. The major
focus was to identify opportunities to improve the care for the sons
and daughters of America who have been injured serving our nation. The
second focused on the best way to deliver care at all five of the
military's echelons of treatment. Proceedings from the 2006 symposia
were published by our Academy last year and the proceedings from the
2007 meeting will be published shortly. Both include a list of
prioritized research needs which I will summarize:
--Timing of Treatment.--Better data are necessary to establish best
practices with regard to timing of debridement, timing of
temporary stabilization and timing of definitive stabilization.
Development of animal models of early versus late operative
treatment of open injuries may be helpful. Prospective clinical
comparisons of treatment groups will be helpful in gaining
further understanding of the relative role of surgical timing
on outcomes.
--Techniques of Debridement.--More information is necessary about
effective means of demonstrating adequacy of debridement.
Current challenges, particularly for surgeons with limited
experience in wound debridement, exist in understanding how to
establish long-term tissue viability or lack thereof at the
time of an index operative debridement. Since patients in
military settings are typically transferred away from the care
of the surgeon performing the initial debridement prior to
delivery of secondary care, opportunities to learn about the
efficacy of initial procedures are lost. Development of animal
models of blast injury could help establish tissue viability
markers. Additional study is necessary to understand ideal
frequencies and techniques of debridement.
--Transport Issues.--Clinical experience suggests that current air
evacuation techniques are associated with development of
complications in wound and extremity management although the
specific role of individual variables in the genesis of these
complications is unclear. Possible contributing factors include
altitude, hypothermia and secondary wound contamination.
Clinical and animal models are necessary to help develop an
understanding of transport issues. Development, testing and
approval of topical negative pressure devices for use during
aeromedical transport should be facilitated.
--Coverage Issues.--Controlled studies defining the role of timing of
coverage in outcome following high-energy extremity war
injuries are lacking. Also necessary is more information about
markers and indicators to help assess the readiness of a wound
and host for coverage procedures. Both animal modeling and
clinical marker evaluation are necessary to develop
understanding in this area.
--Antibiotic Treatments.--Emergence of resistant organisms continues
to provide challenges in the treatment of infection following
high-energy extremity war injuries. Broader prophylaxis likely
encourages development of antibiotic resistance. In the context
of a dwindling pipeline of new antibiotics, particularly those
directed toward gram-negative organisms, development of new
technologies to fight infection is necessary. This patient
population offers opportunity to assess efficacy of vaccination
against common pathogens. Partnerships with infectious disease
researchers currently involved in addressing similar questions
should be developed.
--Management of Segmental Bone Defects.--A multitude of different
techniques for management of segmental bone defects is
available. These include bone transport, massive onlay grafting
with and without use of recombinant proteins, delayed allograft
reconstruction, and acute shortening. While some techniques are
more appropriate than others after analysis of other clinical
variables, controlled trials comparing efficacy between
treatment methods are lacking. Variables that may affect
outcome can be grouped according to patient characteristics
including co-morbidities, injury characteristics including
severity of bony and soft-tissue wounds, and treatment
variables including method of internal fixation selected.
Evaluation of new technologies for treatment of segmental bone
defects should include assessment of efficacy with adequate
control for confounding variables and assessment of cost-
effectiveness.
--Development of an Animal Model.--A large animal survival military
blast injury model is necessary to serve as a platform for
multiple research questions including: VAC v. bead pouch v.
dressing changes; wound cleaning strategy; effect of topical
antibiotics; modulation of inflammatory response; timing of
wound closure; and vascular shunt utilization.
--Amputee Issues.--Development and validation of ``best practice''
guidelines for multidisciplinary care of the amputee is
essential. Treatment protocols should be tested clinically.
Studies should be designed to allow for differentiation between
the impacts of the process versus the device on outcome.
Failure mode analysis as a tool to evaluate efficacy of
treatment protocols and elucidate shortcomings should be
utilized. Clinically, studies should focus on defining
requirements for the residual limb length necessary to achieve
success without proceeding to higher level amputation. Outcomes
based comparisons of amputation techniques for similar injuries
and similar levels should be performed. Use of local tissue
lengthening and free tissue transfer techniques should be
evaluated. In the context of current results and increasing
levels of expectation for function following amputation,
development of more sensitive and military appropriate outcomes
monitors is necessary.
--Heterotopic Ossification.--This condition, known as ``H.O.'' by the
many soldiers who experience it, is abnormal and uncontrolled
bone growth that often occurs following severe bone destruction
or fracture. Animal models of heterotopic ossification should
be utilized to develop early markers for heterotopic
ossification development that could identify opportunities for
prevention. Better information is needed about burden of
disease including prevalence following amputation for civilian
versus military trauma and frequency with which symptoms
develop. Treatment methods such as surgical debridement, while
effective, necessarily interrupt rehabilitation. Prevention
could expedite recovery and potentially improve outcome.
--Data Collection System.--A theme common to virtually all
discussions on research and patient care for our soldiers has
been the need for access to better longitudinal patient data.
Current patient care processes both in theatre and at higher
echelon care centers do not include data captured in a way that
allows simple electronic linkage of medical records from one
level of care to the next. At least two electronic medical
records systems are in use, and they are not necessarily
compatible with one another. Any electronic medical record used
should be web based to allow for linkage of patient data from
the earliest echelon of documented care through the VA system.
The system must be user friendly and not cumbersome to
encourage entry of information critical to outcomes analysis.
An example of one system with some of the necessary components
is the current Joint Patient Tracking Application (JPTA). The
system unfortunately lacks integration with a trauma registry
or database to allow for retrospective or prospective analyses
of specific injuries and treatments. Funding is necessary for
platform development, information systems infrastructure and
data entry personnel.
Stories from the frontlines
There have been many heroic stories of injured soldiers struggling
to regain function and to return to normal life, or even back to
service. A story highlighted in a March 2005 National Public Radio
(NPR) series titled ``Caring for the Wounded: The Story of Two
Marines,'' followed two Marines injured in Iraq: 1st Sgt. Brad Kasal
and Lance Cpl. Alex Nicoll. Lance Cpl. Nicoll had to have his left leg
amputated as a result of his injuries from gunshot wounds. Nicoll has
undergone physical therapy at Walter Reed to adjust to his new
prosthetic leg, made from graphite and titanium. While Sgt. Kasal was
so seriously injured that he lost four inches of bone in his right leg,
due to medical advances in limb salvaging, he did not have to have his
leg amputated. Kasal underwent a bone growth procedure, called the
Illizarov Technique, which grows the bone one millimeter a day.
The Iraq war has created the first group of female amputees. Lt.
Dawn Halfaker is one of approximately 11 military women who have lost
limbs from combat injuries in Iraq, compared to more than 350 men. She
lost her arm to a life- threatening infection, after sustaining major
injuries, along with another soldier, when on a reconnaissance patrol
in Baqouba, Iraq, a rocket-propelled grenade exploded inside her
armored Humvee. Maj. Ladda ``Tammy'' Duckworth lost both legs when a
rocker-propelled grenade slammed into her Black Hawk helicopter near
Balad. Juanita Wilson, an Army staff sergeant, lost her left hand when
an improvised bomb exploded near her Humvee on a convoy mission north
of Baghdad. All three women are successfully moving forward in military
or civilian careers.
Bone problems, seldom seen in soldiers from previous wars who have
lost limbs, have complicated recoveries for Iraq and Afghanistan-
stationed soldiers. Heterotopic ossification has developed in nearly 60
percent of the first 318 amputees treated at Walter Reed Army Medical
Center. Over 70 patients from across the military have been treated for
H.O. at Brooke Army Medical Center. Rarely occurring in civilian
amputees, high-intensity blasts, which can shred muscles, tendons and
bone, appears to stimulate adult stem cells to heal damage, but repair
signals often go awry. Advances in body armor resulting in higher
survival rates and ability to preserve more damaged tissue, have lead
to the high number of ``H.O.'' cases where little research exists on
how to treat the condition among amputees. (``Bone condition hampers
soldiers' recovery,'' USA TODAY, February 12, 2006.)
These stories clearly illustrate the benefits of, and need for,
orthopaedic extremity trauma research for America's Soldiers, Sailors,
Airmen and Marines.
The Peer Reviewed Orthopaedic Extremity Trauma Research Program
Your Congressional action initiated this targeted, competitively-
awarded research program where peer reviewers score proposals on the
degree of (1) military relevance, (2) military impact, and (3)
scientific merit. Military orthopaedic surgeons are highly involved in
determining the research topics and evaluating and scoring the
proposals. This unique process ensures that research projects selected
for funding have the highest chance for improving treatment of
battlefield injuries. The AAOS and military and civilian orthopaedic
surgeons and researchers are very grateful that your Subcommittee
created the Peer Reviewed Orthopaedic Extremity Trauma Research Program
in the fiscal year 2006 Defense Appropriations Bill. The program is
administered by the Medical Research and Material Command's research
program at the U.S. Army Institute of Surgical Research (USAISR) at
Fort Sam Houston, Texas. This is the first program created in the
Department of Defense dedicated exclusively to funding peer-reviewed
intramural and extramural orthopaedic trauma research. Having the
program administered by the USAISR ensures that the research funding
follows closely the research priorities established by the Army and the
Armed Forces, and ensures collaboration between military and civilian
research facilities. USAISR has extensive experience administering
similar grant programs and is the only Department of Defense Research
laboratory devoted solely to improving combat casualty care.
The design of the program fosters collaboration between civilian
and military orthopaedic surgeons and researchers. Civilian researchers
have the expertise and resources to assist their military colleagues
with the growing number of patients and musculoskeletal war wound
challenges, to build a parallel research program in the military.
Civilian investigators are interested in advancing the research and
have responded enthusiastically to engage in these efforts, which will
also provide wide ranging spin-off benefits to civilian trauma patients
as well.
It is important to note that military orthopaedic surgeons, in
addition to personnel at the U.S. Army Medical Research and Materiel
Command, Fort Detrick, have had significant input into the creation of
this program and fully support its goals. Appropriations for this
program are building a stronger focus of a core mission in the military
to dedicate Department of Defense research resources to injured
soldiers.
The program's first Broad Agency Announcement (BAA) for grants was
released on February 13, 2006, and identified the following basic,
transitional and clinical research funding priorities: improved healing
of segmental bone defects; improved healing of massive soft tissue
defects; improved wound healing; tissue viability assessment and wound
irrigation and debridement technologies; reduction in wound infection;
prevention of heterotopic ossification; demographic and injury data on
the modern battlefield and the long-term outcomes of casualties (i.e.
joint theatre trauma registry); and improved pre-hospital care of
orthopaedic injuries.
Close to 100 pre-proposals were received for consideration, with 76
invited to compete with a full proposal. This number is relatively high
considering the shortened time period that was available for submitting
pre-proposals. An upper limit of $500,000 was established for any one
grant, to give a reasonable number of grantees an opportunity to
participate. Ordinarily grants would generally be awarded for much
higher amounts to support the research required. Larger multi-
institutional studies had to limit what they were proposing.
Sixty proposals were evaluated and found meritorious and militarily
relevant, however only 14 grants could be funded for their first year
of research based on available funding. The amount that would have been
needed to fund the remaining 46 grants totals $44,852,549.
A second BAA was issued March 29, 2007 based on funding provided in
the fiscal year 2007 Appropriations bill. USAISR staff estimate that
only an additional 4 or 5 grants will be awarded after second-year
costs of the initial multi-year grants are covered. If the fiscal year
2007 Supplemental Appropriations Bill is enacted, significant new
funding would allow for a broader scope of work and multi-institutional
collaboration.
Conclusion
With orthopaedic trauma being the most common form of trauma seen
in military conflicts, it is crucial that there be funding dedicated
specifically to the advancement of orthopaedic trauma research. The
AAOS has worked closely with the top military orthopaedic surgeons, at
world-class facilities such as the U.S. Army Institute of Surgical
Research, Brooke Army Medical Center, and Walter Reed Army Medical
Center to identify the gaps in orthopaedic trauma research and care and
the needs are overwhelming.
There is a profound need in the nation for this targeted medical
research to help military surgeons find new limb-sparing techniques to
save injured extremities, avoid amputations and preserve and restore
the function of injured extremities. Research supported by civilian
agencies such as the National Institutes of Health has contributed to
the general orthopaedic science base over the years, but the current
war has presented orthopaedic surgeons with a unique situation with
very specific new problems and injuries not seen in civilian medical
practice. Thus the urgent need for an immediate, robust and targeted
effort to improve care for our injured service men and women.
I hope that I have given you a well-rounded perspective on the
extent of what orthopaedic trauma military surgeons are seeing and a
glimpse into the current and future research for such trauma. Military
trauma research currently being carried out at military facilities,
such as WRAMC and the USAISR, and at civilian medical facilities, is
vital to the health of our soldiers and to the Armed Forces' objective
to return injured soldiers to full function in hopes that they can
continue to be contributing soldiers and active members of society.
The 17,000 members of our Academy thank you for sustaining the Peer
Reviewed Orthopaedic Extremity Trauma Research Program this year. While
Congress funds an extensive array of medical research through the
Department of Defense, with over 80 percent of military trauma being
orthopaedic-related, no other type of medical research would better
benefit our men and women serving in the Global War on Terror and in
future conflicts. Especially because this program is only in its early
stage, continuity is critical to its success.
Mr. Chairman and Mr. Vice Chairman, the American Academy of
Orthopaedic Surgeons, as well as the entire orthopaedic community,
stands ready to work with this Subcommittee to identify and prioritize
research opportunities for the advancement of orthopaedic trauma care.
Military and civilian orthopaedic surgeons and researchers are
committed to advancing orthopaedic trauma research that will benefit
the unfortunately high number of soldiers afflicted with such trauma
and return them to full function. We applaud the action taken by your
Committee in the fiscal year 2007 Supplemental Appropriations to
provide significantly increased funding to cover the backlog of
unfunded research capacity. This investment to improve treatment for
our soldiers will be well spent. It is imperative that the federal
government--when establishing its defense health research priorities in
the future--continue to ensure that orthopaedic extremity trauma
research remains a top priority.

Senator Inouye. And now may I call upon, Rear Admiral Casey
Coane, United States Navy, retired, Executive Director Naval
Reserve Association.
Admiral, welcome, sir.

STATEMENT OF REAR ADMIRAL CASEY W. COANE, UNITED STATES
NAVY (RETIRED), EXECUTIVE DIRECTOR, NAVAL
RESERVE ASSOCIATION
Admiral Coane. Chairman Inouye, on behalf of our 23,000
members and in advocacy for the 70,000 Navy Reservists serving
today, it is certainly our privilege to appear before you today
and we appreciate this opportunity.
There are a number of issues that are on the Navy unfunded
and Navy Reserve unfunded list that, we believe, deserve your
attention. And, we have indicated those in our written
testimony. I'm going to use my time today to address just one
that we consider critical, in terms of capability for the Navy
to carry out its mission.
That issue is the continuing purchase of the C-40 Clipper
aircraft, which is scheduled to replace the remaining 17 DC-9
series aircraft that currently average more than 31 years of
service. The C-40 is significantly more capable with respect to
payload, fuel efficiency, and range. These aircraft and the
Navy C-130s are the sole source of Navy organic intra-theater
airlift. They are all fully scheduled to support time-critical
Navy missions. Unfortunately, procurement has been deferred in
the budgetary process, with only four anticipated to be
purchased between now and fiscal year 2013.
This is where you can help. The Navy has a habit of
prioritizing its front-line carrier strike aircraft high and
all other aircraft much lower on the ladder. The result is a
continuing shift of those other programs to the right in the
budget years until a true crisis or a tipping point finally
overwhelms us. That is exactly what happened to the P-3
replacement program, and the entire Reserve P-3 community was
dismantled to keep the Active Force flying until the new P-8
can arrive. The bottom line is, the company is accepting risk
in that program. We are on the verge of the same sort of crisis
in the DC-9/C-40 replacement program, which directly affects
combat effort, and we ask you to intervene.
Last week, I asked Secretary Winter what the Navy needed to
do to get out of this cycle of continued deferment. And, he
responded that the Navy needed a comprehensive aircraft
procurement plan like the 30-year ship building plan that is
receiving a lot of acclaim here. That plan, the naval aviation
capabilities 2030 plan, is in development, but we won't have it
in time to solve this problem.
Allow me to tick off just a few of the facts of the DC-9
program. It is fragile. They are old, 31-plus years. Commercial
airlines get rid of their aircraft--and I was a commercial
airline pilot--they get rid of their aircraft at 20 years,
partly because of cycles accumulated, but primarily because at
that point in the life cycle the maintenance cost curves turn
sharply upward.
That is what accelerated the departure of the Navy F-14
fighter--maintenance costs. A recent inspection of the DC-9
resulted in an unplanned strike of that aircraft and more will
follow. Between 2009 and 2012, they will all be noncompliant
with European airspace requirements. And the cost to make them
compliant is truly prohibitive, new engines, new avionics, et
cetera. This will take the aircraft out of the Mediterranean
theater where we have permanent detachments now. This is a huge
issue.
The DC-9 cannot operate in Iraq in the summer heat, the C-
40 can. The DC-9 cannot cross the African continent unrefueled
as Ambassador Negroponte recently found out, the C-40 can. The
DC-9 frequently cannot make the leg from Hawaii to Japan
against the wind with any kind of meaningful load, the C-40 has
no such restrictions. DC-9 pilot training is done in the
aircraft using nearly 50 percent of its flight ability. Almost
100 percent of C-40 training is done in the simulators, saving
millions of dollars and allowing 95 percent of its availability
for mission scheduling.
We urge you to purchase at least four C-40 aircraft in the
fiscal year 2008 budget cycle. That is our testimony subject to
your questions, sir.
Senator Inouye. Admiral, we understand your problem very
well because this subcommittee is now faced with many
procurement problems.
For example, it has nothing to do with the Naval Reserves,
but in the supplemental appropriations bill, which we are now
considering, there's $1 billion for the purchase of Humvees.
And in the fiscal year 2008 bill, there's a request for $2.9
billion for Humvees. Last week, the Acting Navy Secretary
announced that they will replace all Humvees with MRAPs. So,
where do we stand, do we keep Humvees or do we have MRAPs? And
who's going to pay for the MRAPs?
So, your problem is one of many with us, but we will try
our best to resolve them.
Admiral Coane. Yes, sir, we appreciate that consideration.
Senator Inouye. Thank you.
[The statement follows:]

Prepared Statement of Rear Admiral Casey W. Coane

THE NAVY RESERVE ASSOCIATION

The Naval Reserve Association traces its roots back to 1919, and is
devoted solely to service to the Nation, Navy, the Navy Reserve and
Navy Reserve officers and enlisted. It is the premier national
education and professional organization for Navy Reserve personnel, and
the Association Voice of the Navy Reserve.
Full membership is offered to all members of the services and Naval
Reserve Association members come from all ranks and components.
The Association has just under 23,000 members from all fifty
states. Forty-five percent of the Naval Reserve Association membership
is drilling and active reservists and the remaining fifty-five percent
are made up of reserve retirees, veterans, and involved civilians. The
National Headquarters is located at 1619 King Street Alexandria, VA.
703-548-5800.

DISCLOSURE OF FEDERAL GRANTS OR CONTRACTS

The Naval Reserve Association does not currently receive, has not
received during the current fiscal year, or either of two previous
years, any federal money for grants. All activities and services of the
Association are accomplished free of any direct federal funding.
Chairman Inouye, Senator Stevens and distinguished members of the
subcommittee: On behalf of our 23,000 members, and in advocacy for the
70,000 active Navy Reservists and the mirrored interest of Guard and
Reserve personnel, we are grateful for the opportunity to submit
testimony, and for your efforts in this hearing.
We very much appreciate the efforts of this subcommittee, the full
Committee on Appropriations and like committees in the House of
Representatives to support our deployed personnel and their families.
Your willingness to address current and pressing issues facing
Guardsmen and Reservists affirms their value to the defense of our
great nation. Your recognition of these men and women as equal partners
in time of war stands you well in the eyes of many. Our young Navy
Reservists indicate to us that they are watching and waiting to see our
actions to address their concerns. Your willingness to look at issues
related to the use of the Guard and Reserve on the basis of fairness
sets the Legislative Branch well above the Executive Branch which
seemingly develops its positions on the basis of cost.
That said, there are many issues that need to be addressed by this
Committee and this Congress. However, there is one specific issue that
I wish to address of utmost importance for this year's budget. The
requirement for C-40A for the Navy's Air Logistics Program.
First:
--It is the Navy's only world-wide intra-theater organic airlift,
operated by the U.S. Navy.
--Navy currently operates 9 C-40As, in three locations: Fort Worth,
Jacksonville, San Diego.
--A pending CNA study--substantiates the requirements for 31-35 C-
40As to replace aging C-9s.
Second:
--CNO, SECNAV, and DOD support the requirement for at least 4 more C-
40As with a fiscal year 2008 Unfunded List (See Attachment #1).
--Commander, Naval Air Force 2007 Top Priority List stated the
requirement for at least 32 aircraft.
--These four C-40As sought in the fiscal year 2008 budget, keep the
Navy replacement of C-9s alive, and maintains the production
line of the C-40A.
Third:
--Current average age of remaining C-9s that the C-40 replaces is: 36
years!
--There will be no commercial operation of the C-9s or derivates by
2011.
--C-9s cannot meet the GWOT requirement, due to MC rates, and
availability of only 171 days in 2006.
--Modifications required to make C-9s compliant with stage III Noise
compliance, and worldwide Communications/Navigation/
Surveillance/Air Traffic Management compliance--are cost
prohibitive.
--There are growing indications that the availability and Mission
Capability rates of the C-20Gs, stationed in Hawaii and
Maryland, need to be addressed for GWOT requirements (See
Attachment #2).
Fourth:
--737 Commercial Availability is slipping away, if we do not act now;
loss of production line positions in fiscal year 2008-09--due
to commercial demand would slip to 2013, and increase in DOD,
Service expenditures.
--Lack of DOD, Navy activity on C-40 this fiscal year 2008, could
potentially mean loss of the C-40A for the Navy.
The C-40A is a time critical transportation capability for the
Naval Wartime effort and DOD emergent operational requirements. It also
provides critical peacetime operational support. The C-40A is the
replacement for the C-9B.
The C-40A meets or betters all operational requirements of the
Navy, and most importantly--can operate in the changing civilian arena
of CNS/Air Traffic Management Phase I and Phase II requirements,
allowing the aircraft to fly in any airspace of the future. The
aircraft can operate with cargo, with passengers, or with a combination
of cargo and passengers meeting many different logistical requirements.
Resource constraints have moved this critical asset to the right in
funding lines, and this could impact: carrier and expeditionary asset
deployments, and critical transportation of high value cargo to
Combatant Commanders areas of responsibilities. Sliding the funding to
the right is not a good option with the increasing civilian demand for
production line positions. To restart the C-40A line production, after
it is closed would be extremely costly to the Department of Defense,
and the Navy.
Without your direct and immediate input on this critical Navy and
Navy Reserve requirement, the requirement will be lost, and if needed
would cost two to three times more for the taxpayers.
--The C-9 Full Mission Capability and Mission Capability has
decreased dramatically.
--Most interestingly and surprisingly--the C-20G aircraft (a
commercial derivative of the Gulfstream 5 aircraft) full
mission capability and mission capabilities has decreased to:
--FMC--1994 97.1 percent to a low of 2006 72.0 percent.
--MC--1994 97.1 percent to a low of 2006 68.9 percent.
--You can see--the operational requirements have impacted the C-
20G.
Additionally:
People join the Reserve Components to serve their country and
operate equipment. Recruiting and retention issues have moved to center
stage for all services and their reserve components. In all likelihood
the Navy will not meet its target for new Navy Reservists and the Navy
Reserve will be challenged to appreciably slow the departure of
experienced personnel this fiscal year. We've heard that Reserve Chiefs
are in agreement, expressing concern that senior personnel will leave
in droves.
Besides reenlistment bonuses which are needed, we feel that
dedicated Navy Reserve equipment and Navy Reserve units are a major
factor in recruiting and retaining qualified personnel in the Navy
Reserve.
Overwhelmingly, we have heard Reserve Chiefs and Senior Enlisted
Advisors discuss the need and requirement for more and better equipment
for Reserve Component training. The Navy Reserve is in dire need of
equipment to keep personnel in the Navy Reserve and to keep them
trained. Approximately 4,500 Navy Reserve personnel are on recall each
and every month since 9/11. We must have equipment and unit cohesion to
keep personnel trained. This means--Navy Reserve equipment and Navy
Reserve specific units with equipment.
In recent statements, the Chairman of the Commission on the
National Guard and Reserve Components has stated that cross-leveling
and lack of equipment is breaking the Reserve Components abilities to
be an operational reserve force. I feel that the Navy Reserve should
maintain up-to-date unit equipment, if we are to be able to respond to
mobilization.
The following are critically needed for the Navy Reserve to respond
to continued mobilization, and is supported by the Chief of Navy
Reserve unfunded program requirements: Naval Coastal Warfare Equipment;
Explosive Ordnance Disposal Equipment; Naval Construction Force
Equipment; and Navy Expeditionary Logistics Support Equipment.(See
Attachment # 3).
We ask you to fund this Navy Reserve equipment, and that you fund
the NGREA accounts that are critical for supporting Reserve forces in
today's Global War on Terrorism. Naval Reserve units are engaged in
this Global War, and these units, the people, and their families are
responding to Combatant Commanders calls. We must maintain the proper
equipment for these Navy Reserve units and Navy Reserve Sailors. The AC
will not do it, yet will call on them to respond. Only through the
NGREA will your citizen-Sailors be able to respond to the needs of the
Nation and Combatant Commanders.
In summary, we believe the Committee needs to address the following
issues for Navy Reservists in the best interest of our National
Security:
--First and foremost, fund four (4) C-40A for the Navy Reserve, per
the unfunded list; we must replace the C-9s and replace the C-
20Gs in Hawaii and Maryland.
--Increase funding for Naval Reserve equipment in NGREA
--Naval Coastal Warfare Equipment
--Explosive Ordnance Disposal Equipment
--Establish an End-strength cap of 79,500 SelRes (66,000) and FTS
(13,500) as a floor for end strength to Navy Reserve manpower--
providing for surge-ability and operational force.
We thank the committee for consideration of these tools to assist
the Guard and Reserve in an age of increased sacrifice and utilization
of these forces.

ATTACHMENT 1.--POM-08 UNFUNDED PROGRAM LIST
[In millions of dollars]
------------------------------------------------------------------------
Fiscal year
ITEM TITLE (Program/Issue) 2008
------------------------------------------------------------------------
1 LPD-17 1,696.00
2 T-AKE 1,200.00
3 Joint Improvised Explosive Device Defeat 8.70
(JIEDDO) Sustainment
4 Critical ASW Enhancements 95.70
5 F/A-18E/F/G 720.00
6 MH-60R 140.00
7 MH-60S 207.00
8 C-40A 332.00
9 T-6B 23.60
10 MK XII /MKXIIA IFF 68.70
11 LCAC Sustainment and Personnel Transport Modules 27.80
(PTMs)
12 Transit Protection System 21.40
13 MPS Lease Buyout 432.00
14 AMRAAM (AIM-120D) Inventory 72.73
15 Facility Sustainment 240.00
16 Coronado Homeport Ashore Bachelor Quarters 75.00
17 Japan Homeport Ashore Bachelor Quarters 151.00
18 Fitness Center, Pearl Harbor, HI 45.00
19 Aircraft Depot Maintenance 77.00
20 Navy Recruiting Advertising 29.00
-----------------
Total 5,662.63
------------------------------------------------------------------------

ATTACHMENT 2.--C-20G FMC AND MC RATES
[In percent]
------------------------------------------------------------------------
Year FMC MC
------------------------------------------------------------------------
1994.............................................. 97.15 97.15
1995.............................................. 93.59 95.08
1996.............................................. 93.40 93.86
1997.............................................. 72.57 83.95
1998.............................................. 87.14 93.26
1999.............................................. 94.61 95.50
2000.............................................. 85.05 91.09
2001.............................................. 89.09 93.48
2002.............................................. 82.03 85.29
2003.............................................. 92.62 94.01
2004.............................................. 86.40 93.90
2005.............................................. 81.72 86.81
2006.............................................. 68.86 71.99
------------------------------------------------------------------------

ATTACHMENT 3.--CHIEF OF NAVY RESERVE UNFUNDED PRIORITY LIST--FISCAL YEAR 2008 NAVY RESERVE UNFUNDED PROGRAM REQUIREMENTS LIST
[Dollars in millions]
--------------------------------------------------------------------------------------------------------------------------------------------------------
Fiscal year 2008 Fiscal year
Fiscal year 2007 NGRER CNO UPL NGRER CNR APPN Title (Program) 2008
--------------------------------------------------------------------------------------------------------------------------------------------------------
1............................. 1................ 1............... 1............... OPN............. Naval Coastal Warfare Equipment... $11.0
2............................. 2................ 2............... 2............... OPN............. Explosive Ordnance Disposal Table 4.9
of Allowance Equipment.
3............................. 3................ 3............... 3............... OPN............. Naval Construction Force Equipment 16.1
6............................. 6................ 4............... 4............... OPN............. Navy Expeditionary Logistics 6.0
Support Group Equipment (NAVELSG).
5............................. 4................ 5............... 5............... APN............. C-40A............................. 371.0
7............................. 5,7,8,10......... 6............... 6............... APN............. C-130 Upgrades.................... 33.3
8............................. N/L.............. 7............... 7............... APN............. C-9 Upgrades...................... 32.0
N/L........................... N/L.............. 9............... 8............... APN............. C-9 Interior and engine upgrades.. 15.0
N/L........................... N/L.............. N/L............. 9............... APN............. C-40A............................. 4.2
9............................. N/L.............. 10.............. 10.............. APN............. F-5 Radar and EA jammer upgrades.. 56.1
------------
Total....................... 549.6
--------------------------------------------------------------------------------------------------------------------------------------------------------

Senator Inouye. The next witness is Dr. Don Coffey,
National Prostate Cancer Coalition. I'm sorry Senator Stevens
is not here, he is a survivor, as you know.

STATEMENT OF DR. DONALD S. COFFEY, Ph.D., MEMBER,
NATIONAL CANCER ADVISORY BOARD, NATIONAL
CANCER INSTITUTE, DEPARTMENT OF HEALTH AND
HUMAN SERVICES, ON BEHALF OF THE NATIONAL
PROSTATE CANCER COALITION
Dr. Coffey. Mr. Chairman, listening to these problems that
you must face, I salute you. This is most difficult.
I'm honored to speak to you because 8 days ago I watched
you receive an award from the American Association of Cancer
Research on their 100th anniversary for your long-time effort
in behalf of doing something about cancer in this country and
in the world. And, so I salute you for that.
I'm Don Coffey, I was elected President of that
organization several years back, and I was also 47 years doing
research at Johns Hopkins on prostate cancer.
President Bush recently appointed me for a 6-year term to
his National Cancer Advisory Board. So, I've been involved with
the Department of Defense Prostate Cancer Program all the way
back, 10 years ago, when it first got underway. And I must tell
you, this has been one of the most effective programs that I've
seen.
It does not repeat a lot of the research going on at the
National Cancer Institute. And I'm here today on behalf of the
National Prostate Cancer Coalition, who's asked me to come and
address you. And what they're requesting is that the money in
prostate cancer, which as you know, is one of the devastating
diseases for many males in this country--one of the highest
cancer rates, about 33 percent, of the cancers are here, and
one out of six men will get prostate cancer in their lifetime.
What they are requesting is that these funds--since 1997--
have been decreasing and they have come from $100 million down
to $80 million. So, we've lost $20 million in this incredible
program. They're requesting that this be replaced, the $20
million, to bring it back to $100 million.
Now, what does that mean? It means that we have received--
the Department of Defense's Prostate Cancer Program--receives
about 1,100 applications for research in this field. Now, that
wouldn't have been possible a few years ago, there was
practically nobody working in this, and they really stimulated
a vast amount of research. But they can only fund 200. And of
those others, over 200 of those, an equal number, are
outstanding from bright young investigators, these unique types
of grants. And, we're requesting that the $20 million be
restored so we can bring those grants back to a reasonable
level of funding.
I want to remind everyone that I go all the way back. I was
in the field a decade or so before President Nixon declared the
war on cancer in this country. And at that time, 40 percent of
all the grants that were approved, found to be worthy, were
funded. Now, that number is down, as you heard, to about 20
percent and now it's even fallen below 10 in some programs for
young people, and things at the National Cancer Institute.
So I really want to stress my congratulations to this
subcommittee for having formed this program, and how effective
it is. And, I will end by saying, I'm just going to share two
things with you, I could have picked 100.
As you know, the death rate is falling for prostate cancer
and one of the things is we've got to find out what causes
this. Example, if you're from the rural area of China--and I've
worked very closely and set up the United States-Chinese
Urological Research Society with China earlier, with the
leaders in China. And what happens if you're born in that area,
you have very little chance of getting prostate or breast
cancer as you age.
But, if you move to Hawaii it jumps, and if you move to the
mainland United States, it jumps again. And by the second
generation, it is very high. This has been traced to some
things that we're coming down on, related to how we process
foods and some protective factors. The way we process foods by
burning them, the meats, produces a carcinogen that is one of
the most strongest carcinogens that we have seen for prostate
cancer.
And, so I would like to thank you. I know I could go on and
on, but time is short, sir. I want to thank you for all you do
for this Nation, for cancer, and we hope you can restore these
prostate cancer funds. Thank you.
Senator Inouye. It may be of interest to people here, this
subcommittee will be considering budget requests in excess of
$716 billion during this session. And we will have to somehow
find the money to do this. And Senator Stevens and I are pretty
good jugglers, so we will get it.
[The statement follows:]

Prepared Statement of Donald S. Coffey, Ph.D.

Chairman Inouye, Ranking Member Stevens and distinguished members
of the committee, I am Dr. Donald S. Coffey. I am the former Director
of Research at Johns Hopkins University, Brady Urological Institute in
Baltimore, the past-president of the American Association for Cancer
Research and also The Society for Basic Urologic Research. I have
recently been appointed to the National Cancer Advisory Board at the
National Cancer Institute (NCI).
I very much appreciate this opportunity to be able to speak once
again to you about important issues in cancer research. Today, I am
testifying on behalf of the National Prostate Cancer Coalition about a
research program for prostate cancer eradication. That program is among
the Department of Defense (DOD) Peer Reviewed Cancer Research Programs,
which, taken together, have effected unique advances for the health and
well-being of millions of Americans. I am here to request a long
overdue funding increase to these innovative and successful programs.
I have been involved in prostate cancer research for 47 years,
eleven years before the inception of the National Cancer Act by
President Richard Nixon in 1971. I have a first hand understanding of
how far we have come toward eliminating suffering and death due to this
disease, and much of our success has been contributed uniquely by the
DOD special research program. I ask you to adequately support the
program.
Prostate cancer is the most commonly diagnosed non-skin cancer in
American men. It accounts for roughly 33 percent of all male cancer
cases. More than 230,000 men will learn they have prostate cancer in
2007. About 27,000 will die from the disease. One in six men will get
prostate cancer at some point in his life. For those with a family
history of prostate cancer and African American men this number becomes
1 in 3.

BACKGROUND

For a decade, the Department of Defense (DOD) Prostate Cancer
Research Program (PCRP) has funded over 1,455 awards and granted over
$636 million in funding to universities, hospitals, not-for-profit
institutions, private industry and state and federal agencies targeted
toward eliminating prostate cancer. The Prostate Cancer Research
Program has developed a multidisciplinary research portfolio that
encompasses both basic and clinical research aimed at preventing,
detecting, treating and improving the quality of life by those
afflicted with prostate cancer. The funding strategy of the PCRP
complements awards made by other agencies and specifically avoids
duplication of long-term basic research supported by the National
Institutes of Health.
In a unique fashion, the PCRP incorporates a peer reviewed and
programmatic review process. This two-tier review process ensures the
scientific merit of proposals and that the program meets the goals of
actual cancer patients and survivors. A decade of successful innovative
research and cost efficiency has encouraged Congress to continue this
program. Grant requests fall into 11 areas including Idea Development,
Clinical Trial Development, and Health Disparity Research.
Since its inception in 1997, the Prostate Cancer Research Program
(PCRP) has been an environment in which creative ideas and first rate
research have been able to flourish by urging investigators to come up
with innovative ideas that will return results.

RESEARCH HIGHLIGHTS

The DOD PCRP has conducted several studies on the impact of diet,
nutrition, and lifestyle that could ultimately prevent prostate cancer
from developing or spreading. Over the ten years that the PCRP has
operated, the program has funded 50 projects that received a total of
$20.25 million in research support for early prevention.
One example is a study which is designed to look at the role of
Selenium and Vitamin E in prostate cancer in prevention.
In 2003, Dr. Yan Dong, a researcher at the Roswell Park Cancer
Institute in Buffalo, New York began a study to look at the impact of
Selenium and Vitamin E on genes that are potential tumor suppressors.
The amazing results from this three-year study could potentially lay
the groundwork for developing a customized selenium intervention
strategy as part of the treatment for men at high risk of prostate
cancer.
It is important to note that this research effort followed the NCI
Selenium and Vitamin E Chemoprevention Trial (or SELECT) which
initially found these chemicals can prevent the onset and growth of
prostate cancer.
At Johns Hopkins, we have a distinguished history in prostate
cancer prevention research. For example, several of my colleagues have
been interested in studying the role of soy proteins and chemicals in
broccoli as preventives--or in the role of carbon deposits in well-
cooked meat as a stimulant to cancer development.
Prevention research conducted at the DOD PCRP could interface with
and contribute to other important organ site cancer research. While
Selenium research will potentially impact the course of prostate
cancer, it will also likely have a role in lung cancer and colon cancer
prevention as well.
But, most important, the DOD PCRP program is structured to be a
``first responder'' for special needs in prostate cancer research.
While the National Institutes of Health and the National Cancer
Institute are structured to lay battalions into the nation's war on
cancer, this unique research program puts special forces into crucial
research targets, something the larger agencies may find hard to do.
The Prostate Cancer Research Program conducted by the Department of
Defense through the Congressionally Directed Medical Research Programs
(CDMRP) is setting the bar for administering cancer research. Prostate
cancer advocates and scientists continue to praise this program and its
unique peer and consumer driven approach to research. PCRP is a special
program within the government's prostate cancer research portfolio
because it makes significant use of public/private partnerships,
quickly awards competitive grants for new ideas and does not duplicate
the work of other research funders. Its mission and its results are
clear. Each year, the program issues an annual report detailing what it
has done to fight prostate cancer. This transparency allows taxpayers--
among them prostate cancer survivors--to clearly understand what this
government entity is doing to fight the disease. Additionally, only 10
percent of the funding for these programs goes towards administrative
costs.
Unfortunately despite excellent reviews from all communities
regarding achievements and fiscal efficiency, funding to this
innovative program has been substantially reduced from $100 million in
fiscal year 2001 to $80 million in fiscal year 2007. In fiscal year
2006, 1,117 proposals were received and only 207 funded. Of the 910
proposals remaining over 200 met the standards set by the DOD PRCP but
were turned away due to funding constraints. What if one of these
researchers held the knowledge to discover the cause of prostate
cancer?
According to its business plan laid out in 1998, the DOD PRCP
should be receiving over $200 million to fully meet its potential. We
call on this committee to take a bold step forward and open the
opportunities for this program to progress as the original founders had
intended and increase funding to the PCRP by $20 million in fiscal year
2008.

REQUEST

To properly fight the war on prostate cancer, I respectfully
request this committee appropriate $100 million for the DOD
Congressionally Directed Medical Research Program's (CDMRP) Prostate
Cancer Research Program (PCRP).
Mr. Chairman, the prostate cancer community has done remarkable
work. This work is continuing to make progress. Public-private
collaboration and new scientific discoveries are moving us toward a
better understanding of how prostate cancer develops and kills, but, it
must continue to develop. Investments in research now make the
difference to future patients and their families. The War on Cancer
must be funded appropriately so researchers can find new treatments,
test them in the clinical setting and deliver them to patients.
On behalf of the prostate cancer patient community and the National
Prostate Cancer Coalition, I thank you for your time and ask you to
continue to help funding the war against this terrible disease.

Senator Inouye. Our next witness is Ms. Sue Vento, a member
of the Board of Directors of the Mesothelioma Research
Foundation.
Welcome back, ma'am.

STATEMENT OF SUSAN VENTO, MEMBER, BOARD OF DIRECTORS,
MESOTHELIOMA RESEARCH FOUNDATION
Ms. Vento. Good afternoon, Chairman Inouye.
Thank you so much for the opportunity to be here less than
2 weeks before Memorial Day to address a fatal disease
afflicting our military veterans and many others.
My name is Sue Vento. I serve on the Board of Directors of
the Mesothelioma Applied Research Foundation, the national
nonprofit collaboration of researchers, physicians, advocates,
patients, and families dedicated to advancing medical research
to improve treatment for mesothelioma.
Please consider the irony--a hard working science teacher
who went on to become a leading national advocate for workers
and for the environment, dies suddenly because of an
environmental carcinogen he was exposed to in the workplace.
This future Member of Congress grew up in a large Italian and
German family on St. Paul's east side, the second oldest of
eight children. From an early age, he learned the importance of
hard work from his parents as he delivered newspapers and
bussed tables in a hotel restaurant. Later he worked at
factories and a brewery in order to pay his college tuition to
become a science teacher. At 30, he was elected to the
Minnesota State House. Six years later he was elected to his
first of 12 terms in the U.S. House of Representatives, where
he served on the Resources and Banking Committees. His name was
Bruce Vento, he was my best friend, and my husband.
In January 2000, Bruce was on a congressional trip. He
mentioned on one of our evening phone calls that he wasn't
feeling well. He noted a shortness of breath and back pain.
Immediately upon returning, he went to the House physician and
was then taken to Bethesda Naval Hospital. The following day,
Bruce was told he had lung cancer. He flew home that evening
and we spent the weekend talking about how best to proceed. He
decided he wanted to see specialists at the Mayo Clinic in
Rochester, Minnesota for further testing. On January 29, Bruce
was told that he did not have lung cancer, but instead was
diagnosed with pleural mesothelioma.
Mesothelioma is a diffused tumor of the linings of lungs,
abdomen, or heart, which kills approximately 3,000 Americans
each year and many thousands more worldwide. It relentlessly
invades the tissues of the chest and abdomen, crushing the
lungs and causing excruciating pain in most afflicted patients
at the end of their lives. The average survival for individuals
with mesothelioma is only 1 year.
Bruce's diagnosis was puzzling because the cause of
mesothelioma is exposure to asbestos. Bruce racked his brain to
determine where he could have been exposed to this deadly
carcinogen. He later recalled those jobs at the factories and
the brewery during the 1960s. His exposure to asbestos was
similar to that of millions of Americans, who have also been
exposed in their work and home settings.
Until its fatal toxicity became fully recognized, asbestos
was widely utilized in this country because of its
fireproofing, insulating, filling, and bonding properties.
Starting in the late 1930s and through the late 1970s, the Navy
used asbestos extensively. It was used in engines, nuclear
reactors, decking materials, pipe covering, hull insulation,
valves, pumps, gaskets, boilers, distillers, evaporators, soot
blowers, air conditioners, rope packing, and brake and clutches
on winches. In fact, it was used all over Navy ships, even in
living spaces, where pipes were overhead, and in kitchens where
asbestos was used in ovens, and in the wiring of appliances.
Aside from Navy ships, asbestos was also used on military
planes, on military vehicles, and as insulating material in
Quonset huts and living quarters.
As in Bruce's case, thousands of veterans have been
stricken with mesothelioma many years after their exposure to
the substance. On Valentine's Day 2000, surgeons removed
Bruce's right lung, the lining of the lung, and one-half of his
diaphragm. At the end of March, he began chemotherapy, followed
by 6 weeks of radiation therapy. Following the completion of
the radiation, we were confident that Bruce was through the
worst of it. But within a few weeks, we were told that the
cancer had spread to Bruce's other lung. In September, we were
urged to arrange for hospice care, which we did the next day.
On a beautiful autumn morning, the morning of October 10, just
8\1/2\ months after being diagnosed, Bruce died at our home
with his family at his side.
Since Bruce's death, I have learned about other victims of
the disease. Many of them veterans of our Nation's armed
services. Approximately one-third of today's mesothelioma
victims served in the United States on Navy ships or in
shipyards. These Navy victims include former Chief Naval
Officer, Admiral Elmo Zumwalt, Jr., who led the Navy during
Vietnam and was renowned for his concern for enlisted men.
Despite his rank, prestige, power, and leadership in protecting
the health of Navy servicemen and veterans, Admiral Zumwalt
died in January 2000, just 3 months after being diagnosed with
mesothelioma.
Lewis Deets was another veteran stricken with mesothelioma.
Four days after turning the legal age of 18, Lewis joined the
Navy. He served in the Vietnam war from 1962 to 1967 as a ship
boiler man. For his valiance in combat operations against the
guerilla forces in Vietnam, Lewis received a letter of
commendation and the Navy Unit Commendation Ribbon for
exceptional service.
In December 1965, while Lewis was serving aboard the U.S.S.
Kitty Hawk in the Gulf of Tonkin, a fierce fire broke out. The
boilers filled with asbestos were burning. Two sailors were
killed and 29 were injured. Lewis was one of the 29 injured. He
suffered smoke inhalation while fighting the fire. After the
fire, he helped rebuild the boilers, replacing the burned
asbestos blocks. In 1999, he developed mesothelioma and died
just 4 months later at age 55.
Bob Tragget is a 56-year-old retired sailor who was
diagnosed with mesothelioma a few years ago. Bob was exposed to
asbestos as a sailor in the U.S. Navy from 1965 to 1972, proud
to serve his country aboard a nuclear submarine whose mission
was to deter a nuclear attack upon our country. To treat his
disease, Bob had what today is, what is today, state of the art
for mesothelioma treatment. He had 3 months of systemic
chemotherapy with a new and quite toxic drug combination. Then
he had a grueling surgery to open up his chest, remove his
sixth rib, amputate his right lung, remove the diaphragm and
parts of the linings around his lungs and his heart. After 2
weeks of post-operative hospitalization to recover and still
with substantial pain, he had radiation, which left him with
second degree burns on his back, in his mouth, and in his
airways. Recently, the tumor returned on Bob's left side, but
he continues the battle.
Regrettably, mesothelioma has been an orphan disease in
medical research. Three years ago the first treatment for
mesothelioma patients was approved by the FDA. Even this
approved treatment, which is regarded as the new standard of
care, is associated with only a 3-month survival advantage in
the majority of cases, which are detected in an advanced state.
Hence, funding for early detection and improved treatment of
this disease is critically important.
With a huge Federal investment in cancer research through
the National Cancer Institute and $3.75 billion spent in
biomedical research through the Department of Defense
Congressionally Directed Research Program since 1992, we are
making important progress in the treatment of many types of
cancers and other diseases. But for mesothelioma, the National
Cancer Institute has provided limited funding in the range of
only $1.7 to $3 million annually over the course of the last 5
years. And the Department of Defense does not yet invest any
mesothelioma research, despite the pronounced military service
connection.
Advancements in the treatment of mesothelioma have lagged
far behind other cancers. On behalf of families like mine,
impacted by mesothelioma, I urge you to direct the Department
of Defense to please include mesothelioma as an area of
emphasis in the DOD's peer-reviewed medical research program.
Inclusion in the list of the congressionally identified
priority research areas will enable mesothelioma researchers to
compete for Federal funds, based on the scientific merit of
their work. This will provide urgently needed resources to
explore new treatments and build a better understanding of this
disease.
Admiral Zumwalt and Lewis Deets would not have wanted you
to remember them by the cancer that took their lives, nor would
Bruce. Indeed, Congress can be inspired by these men and take
up the challenge of identifying a cure for a disease that
particularly impacts our Nation's veterans. Veterans like Bob
Tragget, who are now struggling with mesothelioma.
Navy personnel and shipyard workers exposed decades ago are
developing the disease today. Many others are being exposed now
and will develop the disease in 10 to 50 years. While active
asbestos usage is not as heavy today as in the past, even low-
dose incidental exposures can cause mesothelioma, as my family
learned when Bruce was stricken.
On behalf of the Mesothelioma Applied Research Foundation,
I appeal to you for your help in ensuring a vigorous Federal
response to mesothelioma and I thank you for your
consideration.
Senator Inouye. I have a 16-inch incision on my chest. I
was scheduled for a pneumonectomy, and so I know something
about this.
Ms. Vento. Yes, you do.
Senator Inouye. Thank you very much.
[The statement follows:]

Prepared Statement of Susan Vento

SUMMARY

Mesothelioma is a deadly cancer which is caused by exposure to
asbestos. In 2000, this long-overlooked disease took the life of
Congressman Bruce Vento of Minnesota, who had served in the House of
Representatives for twelve terms. His wife, Sue Vento, has become a
passionate advocate for increased investment in mesothelioma research.
Today, on behalf of the Mesothelioma Applied Research Foundation, Ms.
Vento comes before the Senate Defense Appropriations Subcommittee to
urge the subcommittee to direct the Department of Defense (DOD) to
include mesothelioma as an area of emphasis in the DOD's Peer Reviewed
Medical Research Program. Inclusion in the list of Congressionally
identified priority research areas will enable mesothelioma researchers
to compete for federal funds to assist in identifying more effective
treatments for this challenging cancer.
Chairman Inouye, Ranking Member Stevens, and distinguished members
of the U.S. Senate Defense Appropriations Subcommittee: Thank you for
this opportunity, less than two weeks before Memorial Day, to address a
fatal disease afflicting our military veterans and many others--
mesothelioma. My name is Sue Vento, I serve on the Board of Directors
of the Mesothelioma Applied Research Foundation, the national nonprofit
collaboration of researchers, physicians, advocates, patients and
families dedicated to advancing medical research to improve treatments
for mesothelioma.
Consider the irony: A hard working science teacher who went on to
become a leading national advocate for workers and the environment dies
suddenly because of an environmental carcinogen he was exposed to in
the workplace.
This future Member of Congress grew up in a large Italian and
German family on St. Paul's Eastside, the second oldest of eight
children. From an early age, he learned the importance of hard work
from his parents as he delivered newspapers and bussed tables in a
hotel restaurant. Later, he worked at factories and a brewery in order
to pay his college tuition to become a science teacher. At 30, he was
elected to the Minnesota State House. Six years later, he was elected
to his first of 12 terms in the U.S. House of Representatives, where he
served on the Natural Resources and Banking Committees. He was Bruce
Vento; he was my best friend and my husband.
There was little that ever slowed down Bruce. He was a very active
person--traveling almost every weekend back to Minnesota's 4th
Congressional District to meet with constituents and to do his best as
their representative in the U.S. House. In mid-January 2000, Bruce was
on a Congressional trip. He mentioned on one of our evening phone calls
that he wasn't feeling well--he noted a shortness of breath and back
pain. Immediately upon returning he went to the House physician and was
then taken to Bethesda Naval Hospital. The following day, Bruce was
told he had lung cancer.
He flew home that evening, and we spent the weekend talking about
how best to proceed. He decided he wanted to see specialists at the
Mayo Clinic in Rochester, Minnesota, for further testing. On the
morning of January 29th, 2000, Bruce was told that he did not have lung
cancer, but instead he was diagnosed with pleural mesothelioma.
Mesothelioma is a diffuse tumor of the linings of the lungs,
abdomen or heart which kills approximately 3,000 Americans each year,
and many thousands more worldwide. It relentlessly invades the tissues
of the chest and abdomen, crushing the lungs and causing excruciating
pain in most afflicted patients at the end of their life. The average
survival for individuals with mesothelioma is only one year.
Bruce's diagnosis was puzzling because the cause of mesothelioma is
exposure to asbestos. Bruce wracked his brain to determine where he
could have been exposed to this deadly carcinogen. He later recalled
those jobs at the factories and the brewery during the early 1960's.
His exposure to asbestos was similar to that of millions of Americans
who have also been exposed in their work and home settings. Until its
fatal toxicity became fully recognized, asbestos was widely utilized in
the United States because of its fireproofing, insulating, filling and
bonding properties.
Starting in the late 1930's and through the late 70's the Navy used
asbestos extensively. It was used in engines, nuclear reactors, decking
materials, pipe covering, hull insulation, valves, pumps, gaskets,
boilers, distillers, evaporators, soot blowers, air conditioners, rope
packing, and brakes and clutches on winches. In fact it was used all
over Navy ships, even in living spaces where pipes were overhead and in
kitchens where asbestos was used in ovens and in the wiring of
appliances. Aside from Navy ships, asbestos was also used on military
planes, on military vehicles, and as insulating material on quonset
huts and living quarters. As in Bruce's case, thousands of veterans
have been stricken with mesothelioma many years after their exposure to
the substance.
On Valentine's Day, surgeons removed Bruce's right lung, the lining
of the lung, and half of his diaphragm. At the end of March he began
chemotherapy followed by six weeks of radiation therapy. Following the
completion of the radiation, we were confident that Bruce was through
the worst of it. But within a few weeks, we were told that the cancer
had spread to Bruce's other lung. On September 25th, we were urged to
arrange for Hospice care, which we did the next day. On the beautiful,
autumn morning of October 10, 2000--just ten months after being
diagnosed, Bruce died at our home with his family at his side.
Since Bruce's death, I have advocated for more medical research on
behalf of mesothelioma patients and their families because the threat
of this deadly cancer remains very real. Through my work on the Board
of the Mesothelioma Applied Research Foundation, I have learned about
other victims of the disease--many of them veterans of our nation's
armed services. Approximately one-third of today's mesothelioma victims
served the United States on Navy ships or in shipyards. A study at the
Groton, Connecticut shipyard found that over one hundred thousand
workers had been exposed to asbestos over the years at just this one
worksite. Because of the ten to fifty year latency of the disease, many
of the millions of exposed servicemen and shipyard workers are just now
developing mesothelioma.
These Navy victims include former Chief Naval Officer Admiral Elmo
Zumwalt, Jr., who led the Navy during Vietnam and was renowned for his
concern for enlisted men. Despite his rank, prestige, power, and
leadership in protecting the health of Navy servicemen and veterans,
Admiral Zumwalt died the same year as Bruce, just three months after
being diagnosed with mesothelioma.
Lewis Deets was another veteran stricken with mesothelioma. Four
days after turning the legal age of eighteen, Lewis joined the Navy. He
served in the Vietnam War for over four years, from 1962 to 1967, as a
ship boilerman. For his valiance in combat operations against the
guerilla forces in Vietnam he received a Letter of Commendation and The
Navy Unit Commendation Ribbon for Exceptional Service. In December
1965, while Lewis was serving aboard the U.S.S. Kitty Hawk in the Gulf
of Tonkin, a fierce fire broke out. The boilers, filled with asbestos,
were burning. Two sailors were killed and 29 were injured. Lewis was
one of the 29 injured; he suffered smoke inhalation while fighting the
fire. After the fire, he helped rebuild the boilers, replacing the
burned asbestos blocks. In 1999, he developed mesothelioma and died
four months later at age 55.
Commander Harrison F. Starn Jr., joined the Navy before college to
serve in World War II, then became an officer and served in the Korean
War, the Cuban missile crisis and the Vietnam War. During his career he
served aboard a cruiser, destroyers and landing-troop ships, all of
which had heavy asbestos. After retiring from the Navy, he opened a
scuba diving center in Virginia, and actively supported fire
departments, rescue squads and law-enforcement agencies. This patriot
died last year of mesothelioma at the National Naval Medical Center in
Bethesda.
Bob Tregget is a 56 year old retired sailor who was diagnosed with
mesothelioma a few years ago. Bob was exposed to asbestos as a sailor
in the U.S. Navy from 1965 to 1972, proud to serve his country aboard a
nuclear submarine whose mission was to deter a nuclear attack upon the
United States. To treat his disease, Bob had what today is the state of
the art for mesothelioma treatment. He had three months of systemic
chemotherapy with a new, and quite toxic, drug combination. Then he had
a grueling surgery, to open up his chest, remove his sixth rib,
amputate his right lung, remove the diaphragm and parts of the linings
around his lungs and his heart. After two weeks of postoperative
hospitalization to recover and still with substantial postoperative
pain, he had radiation, which left him with 2nd degree burns on his
back, in his mouth, and in his airways. Recently, the tumor returned on
his left side, but Bob is hanging on.
Approximately 23 million Americans have been occupationally exposed
to asbestos over the past 50 years and are now at risk. There is grave
concern now for the heroic first responders from 9/11 who were exposed
to hundreds of tons of pulverized asbestos at Ground Zero and
throughout the city. The destruction wrought by Katrina has potentially
exposed countless more. Asbestos is virtually omni-present in all the
buildings constructed before the late 1970s. Asbestos exposures have
been reported among the troops now in Iraq. The utility tunnels in the
U.S. Capitol building may have dangerous levels. For those who could
develop mesothelioma as a result of these exposures, the only hope is
effective treatment.
Regrettably, mesothelioma has been an orphan in medical research.
Until three years ago, there was not even one treatment for
mesothelioma approved by the FDA as better than doing nothing at all.
Even this approved treatment, which is regarded as the new standard of
care, is associated with only a three month survival advantage in the
majority of cases which are detected in an advanced state. Hence,
funding for early detection and improved treatment of the disease is
critically important.
Since 1999, research and advocacy for mesothelioma has been
championed by the Mesothelioma Applied Research Foundation, which has
awarded over $4 million in seed money grants to the brightest
investigators around the world. Researchers are learning which genes
and proteins can give a signature for the disease, and which of these
also control the pathways that will turn a normal cell into a
mesothelioma. Now we need the federal government to partner with us in
order to make sure that promising findings receive the funding
necessary to be fully developed into effective treatments for patients.
With the huge federal investment in cancer research through the
National Cancer Institute, and $3.75 billion spent in biomedical
research through the Department of Defense Congressionally Directed
Research Program since 1992, we are making important progress in the
treatment of many types of cancer and other diseases. But for
mesothelioma, the National Cancer Institute has provided virtually no
funding, in the range of only $1.7 to $3 million annually over the
course of the last five years, and the Department of Defense does not
yet invest in any mesothelioma research despite the pronounced
military-service connection. Advancements in the treatment of
mesothelioma have lagged far behind other cancers.
Therefore, on behalf of families like mine directly impacted by
mesothelioma, I urge the subcommittee to direct the Department of
Defense to include mesothelioma as an area of emphasis in the DOD's
Peer Reviewed Medical Research Program. Inclusion in the list of
congressionally identified priority research areas will enable
mesothelioma researchers to compete for federal funds based on the
scientific merit of their work. This will provide urgently needed
resources to explore new treatments and build a better understanding of
this disease.
My husband Bruce Vento, Admiral Zumwald, Commander Starn and Lewis
Deets would not have wanted you to remember them by the cancer that
took their lives. Instead, Congress can be inspired by these men and
take up the challenge of identifying a cure for a disease that
particularly impacts our nation's veterans--veterans like Bob Teggett
who are now struggling with mesothelioma. Navy servicemen and shipyard
workers exposed decades ago are developing the disease today. Many
others are being exposed now and will develop the disease in 10 to 50
years. While active asbestos usage is not as heavy today as in the
past, even low-dose, incidental exposures can cause mesothelioma as my
family learned when Bruce was stricken.
On behalf of the Mesothelioma Applied Research Foundation, I appeal
to you for your help in ensuring a vigorous federal response to
mesothelioma. Thank you for you consideration.

Senator Inouye. Our last witness is Mr. D. Michael Duggan,
Deputy Director of the American Legion National Security
Commission.
Welcome, Mr. Duggan.

STATEMENT OF D. MICHAEL DUGGAN, DEPUTY DIRECTOR,
AMERICAN LEGION NATIONAL SECURITY
COMMISSION
Mr. Duggan. Thank you very much, sir. Good afternoon. We
thank you for this great opportunity. As the Nation's largest
organization of war time veterans, I and my organization thank
you and your subcommittee for over the years, continuing to
fund Defense budgets and especially at higher levels during
times of war. The Armed Forces and our men and women in uniform
know they can count on you, and this particular subcommittee as
well, and that is deeply appreciated.
According to the Department of Defense, fiscal year 2008
Defense budget would advance ongoing efforts to prevail in the
global war on terrorism, defend the homeland against threats,
maintain America's military superiority, and to support
military members and their families. The American Legion
believes that this budget must also continue to increase active
Army and Marine Corps end-strengths. Our major concerns are
that we hope the Army is, in fact, not being broken, not only
by this war, but by their load strength and trying to do too
much with too few.
We also urge the full funding of TRICARE healthcare
programs and not to have DOD TRICARE fees increased. Continue
to increase and support military quality of life issues to
include a 3.5-percent military pay raise, in lieu of the 3
percent administration's requested pay raise level.
Severely wounded service members recovering in military
hospitals, such as Walter Reed Army Medical Center and Bethesda
Navy Hospital, need to receive the very best of care,
particularly for traumatic brain injuries, the signature wound,
not only for their treatment, but of course, for their
research. Combat stress also needs more help, we think, as well
as post-traumatic stress disorders, as well as, of course,
therapies for missing or prosthetic limbs, as well.
DOD, we think has to do a better job, though, in
interfacing with the Department of Veterans Affairs. We would
like to see also, the Wounded Warrior Program fully funded, as
well, too. That is a really worthwhile program. The military's
medical evaluation boards, the PEBs and MEBs.
And, we feel as military disability retirement process has
to be seriously reformed. And perhaps, even the rating and the
evaluation of airmen and soldiers be done, not by the military
necessarily, but by the VA, which has a lot more experience in
rating and evaluation, as well, too.
Walter Reed is still a national treasure. Despite its
shortcomings and it's the only military hospital in the world,
we believe, that can treat up to 1.1 million outpatients, as
well as some 26,500 inpatients and an increasing, over 3,000
severely wounded soldiers who are still coming in. We think,
therefore, particularly during the war years, that Walter Reed
should not be torn down, that it should be renovated to the
best that it can, the space and whatever it needs to still be
able to support that staggering workload, as well.
As a matter of fact, the American Legion signed a
memorandum of understanding with Walter Reed, so as to provide
a manned office there to assist military members in
transferring from military healthcare to veterans healthcare.
Other than that, Senator, thank you for your continued
support. We would ask, also and urge, that there be any
additional funding or full funding for the POW/MIA structures
as well, too, for their, so that they can continue their
recovery operations, as well as fund any new initiatives, such
as the issuance of electronic beepers to service members who
are going into combat and could wind up being captured or
missing in action.
Finally, I would be remiss if I didn't ask for continued
funding support for the concurrent receipt of military retired
pay and veterans disability compensation, as well as the
elimination of the SBP/DIC offset, which has affected so many
military survivors and widows over the years.
Again sir, thank you for your leadership, thank you for
being a great veteran, and thank you for this opportunity.
Senator Inouye. Thank you very much.
[The statement follows:]

Prepared Statement of D. Michael Duggan

Mr. Chairman: The American Legion is grateful for the opportunity
to present its views on defense appropriations for fiscal year 2008.
The American Legion values your leadership in assessing and authorizing
adequate funding for quality-of-life (QOL) features 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.
Since September 2001, the United States has been involved in the
war against terrorism in Operations Iraqi Freedom and Enduring Freedom.
American fighting men and women are again proving they are the best-
trained, best-equipped and best-led military in the world. As Secretary
of Defense Robert Gates 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 insurgents and at home protecting
and securing the Homeland. Casualties in the shooting wars, in terms of
those killed and seriously wounded, continue to mount daily. Indeed,
most of what we as Americans hold dear is made possible by the peace
and stability that the Armed Forces provide by taking the fight to the
enemy.
The American Legion adheres 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 the peace. The American Legion strongly
believes past and current military downsizing were budget-driven rather
than threat-focused. Once Army divisions, Navy warships and Air Force
fighter squadrons are downsized, eliminated or retired from the force
structure, they cannot be reconstituted quickly enough to meet new
threats or emergency circumstances. The Active-Duty Army, Army National
Guard and the Reserves barely met their recruiting goals, and the
Army's stop-loss policies have obscured retention and recruiting needs.
Clearly, the active Army is struggling to meet its recruitment goals.
Military morale undoubtedly has been adversely affected by the
extension and repetition of Iraq tours of duty for active duty, and
now, National Guard units alerted for their second tour.
The Administration's fiscal year 2008 budget requests more than
$481 billion for defense or about 17 percent of the total budget. The
fiscal year 2008 defense budget represents a 11.3 percent increase in
defense spending over current funding levels. It also represents about
4.0 percent of our Gross National Product. Active duty military
manpower end-strength is now over 1.55 million. Selected Reserve
strength is about 863,300 or reduced by about 25 percent from its
strength levels during the Gulf War of 16 years ago.
Mr. Chairman, this budget must advance ongoing efforts to prevail
in the global war on terrorism, defend the homeland against threats,
maintain America's military superiority, and to support Servicemembers
and their families. A decade of over-use of the military and past
under-funding, necessitates a sustained investment. The American Legion
believes the budget must continue to increase Army and Marine Corps
end-strengths, fully fund Tricare programs, accelerate improved Active
and Reserve Components' quality of life features, provide increased
funding for the concurrent receipt of military retirement pay and VA
disability compensation (``Veterans Disability Tax'') and elimination
of the offset of survivors benefit plan (SBP) and Dependency and
Indemnity Compensation (DIC) ``Widow's Tax'' that continues to penalize
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 of Defense's greatest
assets--the men and women in uniform. They do us proud in Iraq,
Afghanistan and around the world. They need our help. Therefore, The
American Legion urges this Subcommittee and this Congress to continue
to fund the war effort in Iraq and Afghanistan as well as our troops
and their families.
In order to attract and retain the necessary force over the long
haul, the active duty force, reserves and National Guard 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 forego adequate pay and allowances, adequate
health care and subject their families to repeated unaccompanied
deployments and sub-standard housing as well. Undoubtedly, retention
and recruiting budgets need to be substantially increased if we are to
keep and recruit quality service members.
The President's fiscal year 2008 defense budget requests over $10.8
billion for military pay and allowances, including a 3.0 percent
across-the-board pay raise. This pay raise is inadequate and needs to
be increased to 3.5 percent so as to close the pay gap. It also
includes billions to improve military housing, putting the Department
on track to eliminate most substandard housing several years sooner
than previously planned. The fiscal year 2007 budget further lowered
out-of-pocket housing costs for those living off base. The American
Legion encourages the Subcommittee to continue the policy of no out-of-
pocket housing costs in future years and to end the military pay
differential with the private sector.
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.
The American Legion National Commander has visited American troops
in Europe and the Far East as well as a number of installations
throughout the United States, including Walter Reed Army Medical Center
and Bethesda National Naval Medical Center. During these visits, he was
able to see first-hand the urgent, immediate need to address real
quality of life challenges faced by service members and their families.
Severely wounded service members who have families and are convalescing
in military hospitals clearly need to continue to receive the best of
care, particularly for PTSD, Traumatic Brain Injuries and therapies;
and the DOD interface with the VA must be more seamless. Also, the
medical evaluation board process needs to be reformed and expedited so
that military severance and disability retirement pays will be more
immediately forthcoming. The soldiers' best interests must be fairly
represented before the medical evaluation boards. To this end, The
American Legion has established an office at Walter Reed AMC to assist
the medical evaluation system and the transition of discharging
patients to the VA. Our National Commanders have spoken with families
on Women's and Infants' Compensation (WIC) which is an absolute
necessity to larger military families. Quality-of-life issues for
service members, coupled with combat tours and other operational
tempos, play a role in recurring recruitment and retention efforts and
should come as no surprise. The operational tempo and lengthy
deployments, to include multiple combat tours, must be reduced or
curtailed. Military missions were on the rise before September 11 and
deployment levels remain high. The only way to reduce repetitive
overseas tours and the overuse of the reserves is to increase, recruit
and fill active and reserve Army and Marine Corps end-strengths.
Military pay must be on a par with the competitive civilian sector.
Activated reservists must receive the same equipment, the same pay and
timely health care as active duty personnel. The Reserve Montgomery GI
Bill must be as lucrative as the MGI Bill for active duty personnel. If
other benefits, like health care improvements, commissaries, adequate
quarters, quality child care and impact aid for 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.
Despite frequent visits to Walter Reed Army Medical Center, The
American Legion was shocked and disappointed by the publicized
shortcomings that surfaced at Walter Reed. Clearly, the first
priorities are to beef up its military medical staff, improve its
facilities, expand its treatment and living space, and most
importantly, evaluate and improve the Medical Evaluation Board process:
Clearly, the MEB/PEB process is too time-consuming and too often
inappropriate judgments and ratings are being rendered and appear to be
shortchanging the troops. The military MEB/PEB process must be reformed
in favor of a system which fairly rates and compensates disabled
soldiers while affording these disabled soldiers the retirement
benefits they so rightly earned and deserved.
Walter Reed Army Medical Center is a National Treasure, not merely
the Army's flagship hospital. Two years ago, Walter Reed AMC treated
over 1.1 million Army outpatients, and 26,500 inpatients and hundreds
of severely wounded soldiers from the combat zones. Walter Reed
continues to treat Active Army, Army Reservists, Army National
Guardsmen, and Army military retiree veterans and their families. There
is no other military or civilian medical center or hospital in the
United States that can treat patients of this magnitude or severity;
and Walter Reed has been doing this since the turn of the last century.
Frankly, The American Legion has overwhelmingly opposed having
Walter Reed on the Base Realignment and Closure (BRAC) List, and
continues to oppose its closure. The American Legion recommends, in
light of the emergent need to renovate the Medical Center, that Walter
Reed be removed from the BRAC list and that military construction
funding be dedicated for major phased-in renovations of the Medical
Center, rather than constructing other medical facilities and tearing
Walter Reed down. This appears to be the practical and economical thing
to do especially during time of war when severely wounded soldiers need
the best in medical care.
As a major step toward resolving the problems brought to light at
Walter Reed AMC, The American Legion signed a Memorandum of
Understanding with Walter Reed which will establish an office there to
assist in the transition of wounded service members from Department of
Defense to the Department of Veterans Affairs. The American Legion also
supports the retention of the Armed Forces Institute of Pathology, on
the grounds of Walter Reed as an absolute necessity and is valued both
to the Department of Defense and the Department of Veterans Affairs.
To step up efforts to bring in enlistees, all the Army components
are increasing the number of recruiters. The Army National Guard sent
1,400 new recruiters into the field last February. The Army Reserve is
expanding its recruiting force by about 80 percent. If the recruiting
trends and the demand for forces persist, the Pentagon under current
policies could eventually ``run out'' of reserve forces for war zone
rotation, a Government Accountability Office expert warned. The
Pentagon projects a need to keep more than 100,000 reservists
continuously over the next three to five years. The Defense
Appropriations bill for fiscal year 2005 provided the funding for the
first year force level increases of 10,000. The Army's end-strength
increased 30,000 and the Marine Corps end-strength increased 3,000.
The budget deficit is projected to be over $427 billion which is
the largest in U.S. history, and it appears to be heading higher
perhaps to $500 billion. National defense spending must not become a
casualty of deficit reduction.

FORCE HEALTH PROTECTION (FHP)

As American military forces are again engaged in combat overseas,
the health and welfare of deployed troops is of utmost concern to The
American Legion. The need for effective coordination between the
Department of Veterans Affairs and the DOD in the force protection of
U.S. forces is paramount. It has been fifteen years since the first
Gulf War, yet many of the hazards of the 1991 conflict are still
present in the current war.
Prior to the 1991 Gulf War deployment, troops were not
systematically given comprehensive pre-deployment health examinations
nor were they properly briefed on the potential hazards, such as
fallout from depleted uranium munitions they might encounter. Record
keeping was poor. Numerous examples of lost or destroyed medical
records of active duty and reserve personnel were identified. Physical
examinations (pre/and post-deployment) were not comprehensive and
information regarding possible environmental hazard exposures was
severely lacking. Although the government had conducted more than 230
research projects at a cost of $240 million, lack of crucial deployment
data resulted in many unanswered questions about Gulf War veterans'
illnesses.
The American Legion would like to specifically identify an element
of FHP that deals with DOD's ability to accurately record a service
member's health status prior to deployment and document or evaluate any
changes in his or her health that occurred during deployment. This is
exactly the information VA needs to adequately care for and compensate
service members for service-related disabilities once they leave active
duty. Although DOD has developed post-deployment questionnaires, they
still do not fulfill the requirement of ``thorough'' medical
examinations nor do they even require a medical officer to administer
the questionnaires. Due to the duration and extent of sustained combat
in Operations Iraqi Freedom and Enduring Freedom, the psychological
impact on deployed personnel is of utmost concern to The American
Legion. VA's ability to adequately care for and compensate our nation's
veterans depends directly on DOD's efforts to maintain proper health
records/health surveillance, documentation of troop locations,
environmental hazard exposure data and the timely sharing of this
information with the VA.
The early signs of Combat Stress, PTSD, and the Traumatic Brain
Injuries must be detected early-on and completely treated by the
military and the VA. The entire medical issue of Traumatic Brain
Injuries (TBIs) needs to be recognized, reported, treated and
researched. The American Legion strongly urges Congress to mandate
separation physical exams for all service members, particularly those
who have served in combat zones or have had sustained deployments. DOD
reports that only about 20 percent of discharging service members opt
to have separation physical exams. During this war on terrorism and
frequent deployments with all their strains and stresses, this figure,
we believe, should be substantially increased.

MILITARY QUALITY OF LIFE

Our 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 the Congress
made marked improvements in an array of quality of life issues for
military personnel and their families. These efforts are vital
enhancements that must be sustained.
Mr. Chairman: During this period of the War on Terrorism, more
quality of life improvements are required to meet the needs of
servicemembers and their families as well as military retiree veterans
and their families. For example, the proposed 3.0 percent pay-raise
needs to be significantly increased. The 3.1 percent military
comparability gap with the private sector needs to be eliminated; the
improved Reserve MGIB for education needs to be completely funded as
well; combat wounded soldiers who are evacuated from combat zones to
military hospitals need to retain their special pays, and base pay and
allowances continued at the same level so as not to jeopardize their
family's financial support during recovery. Furthermore, the medical
evaluation board process needs to be reformed and fair and considerate
of the soldiers' best interest so that any adjudicated military
severance or military disability retirement payments will be
immediately forthcoming; recruiting and retention efforts, to include
the provision of more service recruiters, needs to be fully funded as
does recruiting advertising. The Defense Health Program and, in
particular, the Tricare healthcare programs need to be fully funded.
The Defense Department, Congress and The American Legion all have
reason to be concerned about the rising cost of military healthcare.
But it is important to recognize that the bulk of the problem is a
national one, not a military specific one. It is also extremely
important, in these days of record deficits, that we focus on the
government's unique responsibility and moral obligation to fully fund
the Defense Health program, particularly its Tricare programs, to
provide for the career military force that has served for multiple
decades under extraordinarily arduous conditions to protect and
preserve our national welfare. In this regard, the government's
responsibility and obligations to its servicemembers and military
retirees go well beyond those of corporate employers. The Constitution
puts the responsibility on the government to provide for the common
defense and on the Congress to raise and maintain military forces. No
corporate employer shares such awesome responsibilities.
The American Legion recommends against implementing any increases
in healthcare fees for uniformed services and retiree beneficiaries.
Dr. William Winkenwerder, the former Assistant Secretary of Defense
(Heath Affairs), briefed The American Legion and other VSOs/MSOs that
rising military healthcare costs are ``impinging on other service
programs.'' Other reports indicate that the DOD leadership is seeking
more funding for weapons programs by reducing the amount it spends on
military healthcare and other personnel needs. The American Legion
believes strongly that America can afford to, and must, pay for both
weapons and military healthcare. The American Legion also believes
strongly that the proposed defense budget is too small to meet the
needs of national defense. Today's defense budget, during wartime, is
about 4 percent of GDP, well short of the average for the peacetime
years since WWII. Defense leaders assert that substantial military fee
increases are needed to bring military beneficiary costs more in live
with civilian practices. But such comparisons with corporate practices
is inappropriate as it disregards the service and sacrifices military
members, retirees and families have made in service to the nation.
The reciprocal obligation of the government to maintain an
extraordinary benefit package to offset the extraordinary sacrifices of
career military members is a practical as well as moral obligation.
Eroding benefits for career service can only undermine long-term
retention and readiness. One reason why Congress enacted Tricare for
Life is that the Joint Chiefs of Staff at the time said that inadequate
retiree healthcare was affecting attitudes among active duty troops.
The American Legion believes it was inappropriate to put the Joint
Services in the untenable position of being denied sufficient funding
for current readiness needs if they didn't agree to beneficiary benefit
cuts.
Reducing military retirements budgets, such as Tricare healthcare,
would be penny-wise and pound-foolish when recruiting is already a
problem and an overstressed and overstrengthened force is at increasing
retention risks. Very simply the DOD should be required to pursue
greater efforts to improve Tricare and find more effective and
appropriate ways to make Tricare more cost-effective without seeking to
``tax'' beneficiaries and making unrealistic budget assumptions.
Likewise, military retiree veterans as well as their survivors, who
have served their Country for decades in war and peace, require
continued quality of life improvements as well. First and foremost, The
American Legion strongly urges that FULL concurrent receipt and Combat-
Related Special Compensation (CRSC) be authorized for disabled retirees
whether they were retired for longevity (20 or more years of service)
or military disability retirement with fewer than 20 years. In
particular, The American Legion urges that disabled retirees rated 40
percent and below be authorized CRPD and that disabled retirees rated
between 50 percent and 90 percent disabled be authorized non-phased-in
concurrent receipt. Additionally, The American Legion strongly urges
that ALL military disability retirees with fewer than 20 years service
be authorized to receive CRSC and VA disability compensation provided,
of course, they're otherwise eligible for CRSC under the combat-related
conditions. The funding for these military disability retirees with
fewer than 20 years is a ``cost of war'' and perhaps should be paid
from the annual supplemental budgets.
Secondly, The American Legion urges that the longstanding inequity
whereby military survivors have their survivors benefit plan (SBP)
offset by the Dependency and Indemnity Compensation (DIC) be
eliminated. This ``Widows' Tax'' needs to be corrected as soon as
possible. It is blatantly unfair and has penalized deserving military
survivors for years. A number of these military survivors are nearly
impoverished because of this unfair provision. As with concurrent
receipt for disabled retirees, military survivors should receive both
SBP AND DIC. They have always been entitled to both and should not have
to pay for their own DIC. The American Legion will continue to convey
that simple, equitable justice is the primary reason to fund FULL
concurrent receipt of military retirement pay and VA disability
compensation, as well as the SBP and DIC for military survivors. Not to
do so merely perpetuates the same inequity. Both inequities need to be
righted by changing the unfair law that prohibits both groups from
receiving both forms of compensation.
Mr. Chairman: The American Legion as well as the armed forces and
veterans continue to owe you and this Subcommittee a debt of gratitude
for your continuing support of military quality of life issues.
Nevertheless, your assistance is needed in this budget to overcome old
and new threats to retaining and recruiting the finest military in the
world. Service members and their families continue to endure physical
risks to their well-being and livelihood as well as the forfeiture of
personal freedoms that most Americans would find unacceptable.
Worldwide deployments have increased significantly and the Nation is at
war. 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 desperately needs to increase its end-strengths and
maintain those end-strengths so as to help facilitate the rotation of
active and reserve component units to active combat zones.
The American Legion congratulates and thanks Congressional
subcommittees such as this one for military and military retiree
quality of life enhancements contained in past National Defense
Appropriations Acts. Continued improvement however is direly needed to
include the following:
--Completely Closing the Military Pay Gap with the Private Sector:
With U.S. troops battling insurgency and terrorism in Iraq and
Afghanistan, The American Legion supports a proposed 3.5
percent military pay raise as well as increases in Basic
Allowance for Housing (BAH).
--Commissaries: 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 for use by
active duty families, reservist families, military retiree
families and 100 percent service-connected disabled veterans
and others.
--DOD Domestic Dependents Elementary and Secondary Schools (DDESS):
The American Legion urges the retention and full funding of the
DDESS as they have provided a source of high quality education
for military children attending schools on military
installations.
--Funding the Reserve Montgomery GI Bill for Education.
--Providing FULL concurrent receipt of military retirement pay and VA
disability compensation for those disabled retirees rated 40
percent and less; providing non-phased concurrent receipt for
those disabled retirees rated between 50 percent and 90 percent
disabled by the VA; and authorizing those military disability
retirees with fewer than 20 years service to receive both VA
disability compensation and Combat-Related Special Compensation
(CRSC).
--Eliminating the offset of the survivors benefit plan (SBP) and
Dependency and Indemnity Compensation (DIC) for military
survivors.

OTHER QUALITY OF LIFE INSTITUTIONS

The American Legion strongly believes that quality of life issues
for retired military members and their families are augmented by
certain institutions which we believe need to be annually funded as
well. Accordingly, The American Legion believes that Congress and the
Administration must place high priority on insuring these institutions
are adequately funded and maintained:
--The Uniformed Services University of the Health Sciences: The
American Legion urges the Congress to resist any efforts to
less than fully fund, downsize or close the USUHS through the
BRAC process. It is a national treasure, which educates and
produces military physicians and advanced nursing staffs. We
believe it continues to be an economical source of CAREER
medical leaders who enhance military health care readiness and
excellence and is well-known for providing the finest health
care in the world.
--The Armed Forces Retirement Homes: The United States Soldiers' and
Airmen's Home in Washington, D.C. and the United States Naval
Home in Gulfport, Mississippi, have been under-funded as
evidenced by the reduction in services to include on-site
medical health care and dental care. Increases in fees paid by
residents are continually on the rise. The medical facility at
the USSAH has been eliminated with residents being referred to
VA Medical Centers or Military Treatment Facilities such as
Walter Reed Army Medical Center. The Naval Home at Gulfport,
Mississippi was destroyed by Hurricane Katrina, The American
Legion recommends that the Congress conduct an independent
assessment of the USSAH facilities and the services being
provided with an eye toward federally subsidizing the Home as
appropriate. The facility has been recognized as a national
treasure until recent years when a number of mandated services
had been severely reduced and resident fees have been
substantially increased.
--Arlington National Cemetery: The American Legion urges that the
Arlington National Cemetery be maintained to the highest of
standards. We urge also that Congress mandate the eligibility
requirements for burial in this prestigious Cemetery reserved
for those who have performed distinguished military service and
their spouses and eligible children.
--2005 Defense Base Realignment and Closure Commission: The American
Legion was disappointed that certain base facilities such as
military medical facilities, commissaries, exchanges and
training facilities and other quality of life facilities were
not preserved for use by the active and reserve components and
military retirees and their families. The American Legion urges
the phased-in renovation and the retention of Walter Reed
particularly for the duration of the War

THE AMERICAN LEGION FAMILY SUPPORT NETWORK

The American Legion continues to demonstrate its support and
commitment to the men and women in uniform and their families. The
American Legion's Family Support Network is providing immediate
assistance primarily to activated National Guard families as requested
by the Director of the National Guard Bureau. The American Legion
Family Support Network has reached out through its Departments and
Posts to also support the Army' Wounded Warrior program (AW2). Many
thousands of requests from these families have been received and
accommodated by the American Legion Family across the United States.
Military family needs have ranged from requests for funds to a variety
of everyday chores which need doing while the ``man or woman'' of the
family is gone. The American Legion, whose members have served our
nation in times of adversity, remember how it felt to be separated from
family and loved ones. As a grateful Nation, we must ensure than no
military family endures those hardships caused by military service, as
such service has assured the security, freedom and ideals of our great
Country.

CONCLUSIONS

Thirty-four years ago, America opted for an all-volunteer force to
provide for the National Defense. Inherent in that commitment was a
willingness to invest the needed resources to bring into existence and
maintain a competent, professional and well-equipped military. The
fiscal year 2008 defense budget, while recognizing the War on Terrorism
and Homeland Security, represents another good step in the right
direction. Likewise our military retiree veterans and military
survivors, who in yesteryear served this Nation for decades, continue
to need your help as well.

Senator Inouye. Today we've received testimony from 26
witnesses, and it may surprise you to know that most of them
supported programs that are considered evil--add-ons, and
earmarks. Most of the programs that you have supported today
are in those categories--either earmarks or add-ons--which is
to show that the Constitution is still correct, the Congress
does have a role to play in establishing the budget.
Mr. Duggan. Absolutely.
Senator Inouye. And, I can assure you that we were not
elected to be rubber stamps.
Mr. Duggan. Thank you, sir.

CONCLUSION OF HEARINGS

Senator Inouye. With that, the scheduled hearings have now
been completed, and this subcommittee will now consider the
bill. And, we will stand in recess, subject to the call of the
Chair.
[Whereupon, at 12:50 p.m., Wednesday, May 16, the hearings
were concluded, and the subcommittee was recessed, to reconvene
subject to the call of the Chair.]