- DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2010

[House Hearing, 111 Congress]
[From the U.S. Government Publishing Office]

DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2010

_______________________________________________________________________

HEARINGS

BEFORE A

SUBCOMMITTEE OF THE

COMMITTEE ON APPROPRIATIONS

HOUSE OF REPRESENTATIVES

ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
________
SUBCOMMITTEE ON DEFENSE
JOHN P. MURTHA, Pennsylvania, Chairman
NORMAN D. DICKS, Washington C. W. BILL YOUNG, Florida
PETER J. VISCLOSKY, Indiana RODNEY P. FRELINGHUYSEN, New Jersey
JAMES P. MORAN, Virginia TODD TIAHRT, Kansas
MARCY KAPTUR, Ohio JACK KINGSTON, Georgia
ALLEN BOYD, Florida KAY GRANGER, Texas
STEVEN R. ROTHMAN, New Jersey HAROLD ROGERS, Kentucky
SANFORD D. BISHOP, Jr., Georgia
MAURICE D. HINCHEY, New York
CAROLYN C. KILPATRICK, Michigan

NOTE: Under Committee Rules, Mr. Obey, as Chairman of the Full
Committee, and Mr. Lewis, as Ranking Minority Member of the Full
Committee, are authorized to sit as Members of all Subcommittees.
Paul Juola, Greg Lankler, Sarah Young, Linda Pagelsen, Paul Terry,
Kris Mallard, Adam Harris, Ann Reese, Brooke Boyer, Tim Prince, Matt
Washington, B G Wright, Chris White, Celes Hughes, and Adrienne Ramsay,
Staff Assistants
Sherry L. Young, Administrative Aide
________
PART 4
Page
Defense Health Program........................................... 1
Fiscal Year 2010 Air Force Posture............................... 199
Navy and Marine Corps Posture.................................... 259
Army Posture..................................................... 355
Statements for the Record........................................ 435
________

Printed for the use of the Committee on Appropriations

PART 4--DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2010
?

DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2010

_______________________________________________________________________

HEARINGS

BEFORE A

SUBCOMMITTEE OF THE

COMMITTEE ON APPROPRIATIONS

HOUSE OF REPRESENTATIVES

ONE HUNDRED ELEVENTH CONGRESS
FIRST SESSION
________
SUBCOMMITTEE ON DEFENSE
JOHN P. MURTHA, Pennsylvania, Chairman
NORMAN D. DICKS, Washington C. W. BILL YOUNG, Florida
PETER J. VISCLOSKY, Indiana DAVID L. HOBSON, Ohio
JAMES P. MORAN, Virginia RODNEY P. FRELINGHUYSEN, New Jersey
MARCY KAPTUR, Ohio TODD TIAHRT, Kansas
ROBERT E. ``BUD'' CRAMER, Jr., ROGER F. WICKER, Mississippi
Alabama JACK KINGSTON, Georgia
ALLEN BOYD, Florida
STEVEN R. ROTHMAN, New Jersey
SANFORD D. BISHOP, Jr., Georgia

U.S. GOVERNMENT PRINTING OFFICE
56-286 WASHINGTON : 2010

COMMITTEE ON APPROPRIATIONS

DAVID R. OBEY, Wisconsin, Chairman

NORMAN D. DICKS, Washington JERRY LEWIS, California
ALAN B. MOLLOHAN, West Virginia C. W. BILL YOUNG, Florida
MARCY KAPTUR, Ohio HAROLD ROGERS, Kentucky
PETER J. VISCLOSKY, Indiana FRANK R. WOLF, Virginia
NITA M. LOWEY, New York JACK KINGSTON, Georgia
JOSE E. SERRANO, New York RODNEY P. FRELINGHUYSEN, New
ROSA L. DeLAURO, Connecticut Jersey
JAMES P. MORAN, Virginia TODD TIAHRT, Kansas
JOHN W. OLVER, Massachusetts ZACH WAMP, Tennessee
ED PASTOR, Arizona TOM LATHAM, Iowa
DAVID E. PRICE, North Carolina ROBERT B. ADERHOLT, Alabama
CHET EDWARDS, Texas JO ANN EMERSON, Missouri
PATRICK J. KENNEDY, Rhode Island KAY GRANGER, Texas
MAURICE D. HINCHEY, New York MICHAEL K. SIMPSON, Idaho
LUCILLE ROYBAL-ALLARD, California JOHN ABNEY CULBERSON, Texas
SAM FARR, California MARK STEVEN KIRK, Illinois
JESSE L. JACKSON, Jr., Illinois ANDER CRENSHAW, Florida
CAROLYN C. KILPATRICK, Michigan DENNIS R. REHBERG, Montana
ALLEN BOYD, Florida JOHN R. CARTER, Texas
CHAKA FATTAH, Pennsylvania RODNEY ALEXANDER, Louisiana
STEVEN R. ROTHMAN, New Jersey KEN CALVERT, California
SANFORD D. BISHOP, Jr., Georgia JO BONNER, Alabama
MARION BERRY, Arkansas STEVEN C. LaTOURETTE, Ohio
BARBARA LEE, California TOM COLE, Oklahoma
ADAM SCHIFF, California
MICHAEL HONDA, California
BETTY McCOLLUM, Minnesota
STEVE ISRAEL, New York
TIM RYAN, Ohio
C.A. ``DUTCH'' RUPPERSBERGER,
Maryland
BEN CHANDLER, Kentucky
DEBBIE WASSERMAN SCHULTZ, Florida
CIRO RODRIGUEZ, Texas
LINCOLN DAVIS, Tennessee
JOHN T. SALAZAR, Colorado
PATRICK J. MURPHY, Pennsylvania

Beverly Pheto, Clerk and Staff Director

(ii)

DEPARTMENT OF DEFENSE APPROPRIATIONS FOR 2010

----------

Thursday, May 21, 2009.

DEFENSE HEALTH PLAN

WITNESSES

ELLEN EMBREY, DEPUTY ASSISTANT SECRETARY OF DEFENSE FOR FORCE HEALTH
READINESS AND PROTECTION
LIEUTENANT GENERAL ERIC SCHOOMAKER, ARMY SURGEON GENERAL AND COMMANDER,
U.S. ARMY MEDICAL COMMAND
VICE ADMIRAL ADAM M. ROBINSON, SURGEON GENERAL OF THE NAVY
LIEUTENANT GENERAL JAMES G. ROUDEBUSH, SURGEON GENERAL OF THE AIR FORCE
VICE ADMIRAL JOHN M. MATECZUN, COMMANDER, JTF CAPMED
BRIGADIER GENERAL PHILIP VOLPE, DEPUTY COMMANDER, JTF CAPMED

Introduction

Mr. Murtha. The committee will come to order.
We appreciate this distinguished panel. Mr. Young is caught
in traffic. He has a long ways to travel, but there has been
nobody more involved than he and his wife. And I assume all
three of you have heard from his wife periodically, all four,
if there is something wrong. But I appreciate her dedication to
the military and dedication to make sure that people are taken
care of, and we appreciate what you folks do.
As I said to you privately, lately when I go to the
hospitals there are a lot less patients there, but I hear
nothing but compliments. In fact, when I stopped at Landstuhl,
two patients were having babies, so those were the only two
patients that I saw. So that was a real change from the time I
went and they didn't have air-conditioning.
But we appreciate--we think you put the money to good use
that we have added, and we compliment you on the fact that you
have added money this year, and we don't have to make up for
that $1 billion that you were short every year.
But with that, I will ask Ms. Embrey to give her opening
statement, and any other statements we will put in the record
or let you say a few words, and we will put your full statement
in the record.
If you will summarize it for us.

Summary Statement of Ms. Embrey

Ms. Embrey. Mr. Chairman, Mr. Dicks, Mr. Moran. I am
honored to be today to present the priorities of the Military
Health System (MHS) in its Fiscal Year 2010 budget.
America's Armed Forces are our country's greatest strategic
assets, and apart from defending the Nation, DOD has no higher
priority than to provide the highest quality health care and
support to our force and its families. Secretary Gates has said
that at the heart of the all-volunteer force is a contract
between the United States of America and the men and women who
serve, a contract that is legal, social, and sacred.
When young Americans step forward of their own free will to
serve, he said, they do so with the expectation that they and
their families will be properly taken care of. And we
wholeheartedly agree.
Indeed, the MHS has one overarching mission: to provide
optimal health services in support of our military's mission
anytime, anywhere.
Today, the Military Health System serves more than 9.4
million beneficiaries. In addition to ensuring force health
protection and delivering the full range of beneficiary health
services, the military health system provides world-class
medical education, training and research and support to
military and humanitarian assistance operations at home and
abroad.
In addition to sustaining a fit and healthy protected
force, our goals include achieving the lowest possible rate of
death, injury and disease during military operations;
delivering superior follow-up care that includes smooth
transition to the Department of Veterans Affairs; and to build
healthy and resilient individual family and communities and
improve access to high-quality, cost-effective care.
I want to especially thank this committee and you, Mr.
Chairman, for your leadership and support, financially and
otherwise, as we strive to provide the best possible care for
our forces and their families. Your support for them and
especially for our combat wounded, ill, and injured is greatly
appreciated.
While there is always much more to be done, I believe we
have made significant progress towards our goals. I have
provided this information in some detail in my formal
statement, which is submitted for the record.
I briefly would like to discuss a broad summary of the
Unified Medical Budget request for 2010. DoD's total budget
request for health care in 2010 is $47.4 billion. This includes
the Defense Health Program; wounded, ill and injured care and
rehabilitation; military personnel; military construction and
Medicare-eligible retiree health care.
The largest portion of the budget request, $27.9 billion,
is requested for the Defense Health Program, which includes $27
billion for operations and maintenance, $300 million for
procurement, $600 million for military-relevant medical
research and development.
For military personnel, the budget request includes $7.7
billion to support more than 84,000 military personnel who
provide health-care services to our forces around the world,
including those involved in air or medical evacuation,
shipboard and undersea medicine, and global humanitarian
assistance and response.
Funding for military construction includes $1 billion for
23 medical construction projects in 16 locations, including two
of the Department's highest construction priorities: Phase 1 of
a hospital replacement project in Guam, and Phase 1 of a new
ambulatory air care center at Lackland Air Force Base, Texas.
The estimated normal costs for the Medicare-eligible
retiree health care fund in the budget request is 10.8 billion,
which includes payments for care and Military Treatment
Facilities (MTFs), to provide health-care providers, and to
reimburse the services for military labor used in the provision
of health-care services.
For wounded, ill, and injured service members, the budget
request includes $3.3 billion for enhanced care, new
infrastructure and research efforts to mitigate the effects of
traumatic stress and traumatic brain injuries.
The Secretary funded all Fiscal Year 2010 medical
requirements identified by the Service medical departments and
the TRICARE Management Activity. It is important to note that
the budget does not include any benefit reform savings, and
beneficiary enrollment fees and copays remain unchanged.
MTF efficiency savings, previously assumed, have been fully
restored to the Services medical departments and previously
programmed mil-to-civ conversions are being restored in
accordance with the Fiscal Year 2008 National Defense
Authorization Act (NDAA). Pursuant to this restoral, the
Services have submitted memorandums of agreement to restore
5,443 billets in Fiscal Year 2010.
Mr. Chairman, the MHS is doing the very best we can for the
men and women who give everything they have for each one of us.
We can never fully repay them for their sacrifices on our
behalf. We can and will continue to do all that we can to
protect and strengthen their health, heal their wounds, and
honor their courage and commitment to our Nation.
I look forward to answering your questions.
[The statement of Ms. Embrey follows:]

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Summary Statement of General Schoomaker

General Schoomaker. Mr. Chairman, Ranking Member Young,
distinguished members of the Defense Subcommittee, thank you
for the opportunity to discuss Army medicine and the Defense
health program.
Army medicine in the past few years, due in no small
measure to this committee and your leadership, sirs, and in
general this year, is well funded in fiscal year 2010.
The President has requested sufficient funding to support
the growth in Army end strength, wounded, ill, and injured
care, traumatic brain injury and psychological health programs,
and specialized casualty care.
The medical treatment facility efficiency wedge, as it was
called, was fully restored and, as Ms. Embrey has commented,
all military-to-civilian conversions were reversed. We received
partial rebasing for the workload increases we have achieved
since 2003, but expect the balance to come in this year of
execution.
Facilities sustainment is funded at 100 percent. We have
added significant funding to the human capital programs to
include our civilian hiring incentives, our three Rs,
recruiting, retention and relocation; our health profession and
scholarship program and loan repayment, and continuation of
civilian nurse loan repayment and special civilian salary
rates.
While the Presidents's budget is adequate, fiscal year 2010
may present some financial challenges for Army medicine as new
and expanded missions emerge to meet the increasing health-care
requirements of the Army at war.
I strongly believe that we must focus on building health
and resilience and in conducting science-driven, evidence-based
practices, focusing on the ultimate clinical outcomes when bad
things happen to good people and they fall off the balance of
good health, such as with combat wounds, injuries, serious
illnesses and the like.
Sir, before the meeting, we were talking about the utility,
for example, of scanning procedures for, say, colon cancer. And
good evidence-based practices would always look at whether that
procedure, when applied to patients, truly does extend life and
find disease earlier. If it is just technology that has not
added value, that is what we talk about when we talk about
evidence-based practices and optimal outcomes. I believe that
this approach will ultimately lead to the best results for our
Army and military community and the most cost-effective system
of health and health-care delivery.
I would also like to comment upon the efforts to prevent,
to mitigate, to identify, manage and treat behavioral health
consequences of service in uniform and those arising from
frequent deployments, from long family and community
separations, and the exposures to the rigors of combat.
Army leaders at all levels recognize that combat and
repeated deployments are difficult for soldiers and stress our
families, especially the short dwell times between deployments.
We are making bold, sustained efforts to improve the
resilience of the entire Army and family and to reduce the
stigma associated with seeking mental health care. We want to
provide multidisciplinary care that addresses specific
behavioral health-care needs, both promptly and expertly.
We are resolved to prevent adverse social outcomes
associated with military service in combat, such as driving
while intoxicated and family violence.
Suicides are unacceptable losses of our soldiers. Realizing
that the loss of even one soldier to suicide is one too many,
we are looking closely at the factors involved. Rather than
post-traumatic stress disorders, as one might expect, we
continue to see that fractured relationships and work-related
stressors are the major factors in soldier suicides.
We have numerous coordinated and integrated initiatives in
place to help soldiers and their families. Key among them is a
new comprehensive soldier fitness initiative which is being led
by the Chief of Staff himself and is being implemented by
Brigadier General Rhonda Cornum, an Army medical department
general officer.
This improves the resilience of the soldier and the whole
family, really, by focusing on five areas of fitness and
resilience: physical, emotional, spiritual, social and family.
I believe that your leadership has heard about this, and I
certainly will expand upon that today if you desire.
In closing, I want to thank one of my colleagues at the
table. I mentioned it sir, informally. This is one of our
wingmen, Jim Roudebush's last hearings. He has been a terrific
partner in military medicine and we certainly admire his
service. He is leaving behind a soldier in uniform assigned to
and a Stryker brigade in Fort Lewis, for which we are very
grateful, and we wish him the very best.
I would thank the committee for their terrific support of
the Defense health program and Army medicine. Thank you for
holding this hearing and for your continued support of Army
medicine and the entire medical force.
Thank you.
[The statement of General Schoomaker follows:]

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Summary Statement of Admiral Robinson

Mr. Murtha. Admiral Robinson.
Admiral Robinson. Mr. Murtha, Mr. Young, distinguished
members of the Committee, since I testified last year we have
seen the emergence of impressive changes and unique challenges
to this Nation and the global community.
Navy Medicine continues on course because our focus has
been and will always be providing the best health care for our
Soldiers, Marines, and their families while supporting the
CNO's Maritime Strategy.
Our Navy Medicine team is flexible enough to participate in
overseas contingency operations, homeland defense missions,
humanitarian civil assistance missions, disaster relief
missions, while at the same time providing direct health care
to our Nation's heroes and to their families and those who have
worn the cloth of the Nation.
In spite of all the missions we are currently prepared to
participate in, we are continuously making the necessary
changes and improvements to meet the requirements of the
biggest consumer of our operational health-support efforts, the
Marine Corps.
Currently we are realigning medical capabilities to support
operational forces in emerging theaters of operation. Our Navy
humanitarian efforts have continued to grow, and this year we
will visit sites in the U.S. Pacific and Southern Command's
areas of operation.
We will not be deploying the USS DUBUQUE because of an
outbreak of H1N1 in the past several weeks. We are, however,
working on other alternatives; and in fact, a USNS ship has
been named the USS BYRD to replace the USS DUBUQUE. Our
Nation's humanitarian efforts serve as a unique opportunity to
positively impact the perception of the United States and our
allies by other nations, so this is a critical part of of the
CNO's strategic initiatives.
We continue to make improvements to meet the needs of
Sailors and the Marines who have become injured while serving
in theater or training at home. Over the last year, Navy
medicine significantly expanded services so that the wounded
warriors have access to timely, high-quality care.
In addition, Navy Medicine's concept of care is always
patient- and family-focused. We never lose our perspective in
caring for our beneficiaries. Everyone is a unique human being
in need of individualized, compassionate, and professionally
superior health care.
At our military treatment facilities, we recognize and
embrace the military culture and incorporate that into the
healing process. The Bureau of Medicine and Surgery Wounded
Warrior Regiment medical review team and the Returning Warrior
Workshop supports Marines and Navy Sailor reservists by
focusing on key issues faced by personnel during their
transition from deployment to home. Navy and Marine Corps
liaisons at medical treatment facilities aggressively ensure
that orders and other administrative details such as extending
reservists are completed.
Much attention has been focused on ensuring service
members' medical conditions are appropriately addressed upon
return from deployment. The predeployment health assessment,
PDHA, is one mechanism used to identify physical and
psychological health issues prior to deployment. The post-
deployment health assessment and the post-deployment health
reassesment, PDHRA, help to identify employment-related health-
care concerns on return to home station, and 90 to 180 days
post-deployment.
Navy Medicine's innovative deployment health centers,
currently in 17 high Fleet and Marine Corps concentrations
areas, support the health deployment assessment process and
serve as easily accessible nonstigmatizing portals for mental-
health care. The centers are staffed with primary care and
mental-health providers to address deployment-related health
issues such as traumatic brain injury, post-traumatic stress
and substance misuse.
Navy Medicine's partnership with the Department of Veterans
Affairs medical facilities is evolving into a mutually
beneficial partnership. This coordinated care for our warriors
who transfer to or are receiving care from a Veterans
Administration facility ensures their needs are met and their
family concerns are addressed.
Working closely with the Chief of Naval Personnel, medical
recruiting continues to be one of the top priorities for 2009.
In spite of successes in the HPSP Medical and Dental Corps
recruitment, meeting our direct accession missions still
remains a challenge. I anticipate increased demand for Medical
Service Corps personnel with respect to individual augmentation
missions supporting the current mission in Iraq and
Afghanistan, and the planned humanitarian assistance and
unexpected disaster relief missions that we will certainly
have.
These demands will impact the Medical Corps Service
specialties linked to mental, behavioral, and rehabilitative
health and operational support such as clinical psychiatrists,
social workers, occupational therapists, physicians assistants
and physical therapists.
For the first time in 5 years Navy Nurse Corps officer
gains in 2008 outpaced losses. Despite the growing national
nursing shortage and the resistance of the civilian nursing
community to the recession, the recruitment and retention of
nurses continues to improve.
It is important to recognize the unique challenges before
Navy Medicine at this particularly critical time for our
Nation. Growing resource constraints for Navy Medicine are
real, as is the increasing pressure to operate more efficiently
without compromising health-care quality and workload goals.
The Military Health System continues to evolve, and we are
taking advantage of opportunities to modernize management
processes that will allow us to operate as a stronger
innovative partner within the Military Health System.
Chairman Murtha, Ranking Member Young, I want to express my
gratitude on behalf of all of Navy Medicine, uniformed,
civilian contractor, and volunteer personnel who are committed
to meeting and exceeding the health-care needs of our
beneficiaries.
I would also like to take a moment to thank General
Roudebush, sitting to my left, who has been a wonderful
partner. He has been a wonderful professional to work with, and
most of all, he has been a great friend to have. And we will
miss him, as General Schoomaker has already alluded to.
So happy retirement to you and thank you very much. He has
been an excellent wingman.
Thank you again for providing me this opportunity to share
with you Navy Medicine's mission and what we are doing today.
It has been my pleasure to testify before you and I look
forward to answering your questions.
Thank you.
[The statement of Admiral Robinson follows:]

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Mr. Murtha. General Roudebush.

Summary Statement of General Roudebush

General Roudebush. Thank you. Chairman Murtha, Ranking
Member Young, distinguished members, it is a pleasure to be
here before you today. This is my last time. It has been a
privilege to be part of this process, to have the opportunity
to share issues, concerns, opportunities with you, and to
invariably receive your full attention, your full support, and
the unflagging intent and vector to assure that every soldier,
sailor, airman, and marine has the care that they need, as well
as their family members. And we truly thank you for that, sir.
Air Force medicine contributes significant capability to
the joint warfight in combat, casualty care, wartime surgery
and air and medical evacuation.
On the ground at both the Air Force Theater Hospital at
Balad and the Craig Joint Theater Hospital in Bagram, we are
leading numerous combat casualty care initiatives that will
positively impact combat and peacetime medicine for years to
come.
Air Force surgeons have laid the foundation for a state-of-
the-art in-the-field vascular operating room at Balad, the only
DOD facility of its kind. Their use of innovative technology
and surgical techniques has greatly advanced the care of our
joint warfighter and coalition casualties. And their work with
their Army and Navy brothers and sisters have truly rewritten
the book on combat casualty care in our theater of operation.
To bring our wounded warriors safely and rapidly home, our
critical care medical transport teams provide unique ICU care
in the air, within DOD's joint en route medical care system. We
continue to improve the outcomes of the CCAT wounded warrior
care by incorporating lessons learned in the clinical practice
guidelines and modernizing the equipment to support the
mission.
This Air Force unique expertise pays huge dividends back
home as well. When Hurricanes Katrina and Rita struck in 2005,
Air Force Active Duty, Guard, Reserve and medical American
personnel were in place conducting lifesaving operations.
Similarly, hundreds of members of this Total Force team were in
force in September of 2008 when Hurricane Gustav struck the
Louisiana coast and when Hurricane Ike battered Galveston,
Texas less than 2 weeks later.
During Hurricane Gustav, Air Mobility Command coordinated
the movement of more than 8,000 evacuees, including 600
patients. Air crews transported post-surgical and intensive-
care unit patients from Texas area hospitals to Dallas medical
facilities. I am truly proud of this incredible team effort.
The success for our Air Force mission directly correlates
with our ability to build and maintain a healthy, fit, force at
home and in theater. Always working to improve our care, our
Family Health Initiative establishes an Air Force medical home.
This medical home optimizes health-care practice within our
family health-care clinics, positioning a primary care team to
better accommodate the enrolled population and streamline the
processes for care and disease management. The result is better
access, better care and better health.
The psychological health of our airmen is critically
important as well. To mitigate their risk for combat stress
symptoms and possible mental health problems, our program known
as Landing Gear takes a proactive approach with symptom
recognition both pre- and post-deployment.
We educate our airmen to recognize risk factors in
themselves and others, along with a willingness to seek help,
is the key to effectively functioning across the deployment
cycle and reuniting and reintegrating with their families.
Likewise, we screen carefully for traumatic brain injury at
home and at our forward-deployed medical facilities. To respond
to our airmen's needs, we have over 600 Active Duty and 200
civilian and contract mental health providers.
This mental-health workforce has been sufficient to meet
the demand signal that we have experienced to date. That said,
we do have challenges with respect to Active Duty psychologist
and psychiatrist recruiting and retention. And we are pursuing
special pays and other initiatives to try to bring us closer to
100% staffing in these two specialties. And we thank you for
your support in this critically important endeavor.
For your awareness, over time we have seen an increased
number of airmen with post-traumatic stress disorder; 1,758
airmen have been diagnosed with PTSD within 12 months from
return of deployment from 2002 to 2008. As a result of our
efforts at early PTS identification and treatment, the vast
majority of these airmen continue to serve with the benefit of
support and treatment.
Understanding that suicide prevention lies within and is
integrated into the broader construct of psychological health
and fitness, our suicide prevention program, a community-based
program, provides the foundation for our efforts.
Rapid recognition, active engagement at all levels, and
reducing any stigma associated with help-seeking behavior are
the hallmarks of our program. One suicide is too many and we
are working hard to prevent the next.
Sustaining the Air Force Medical Service requires the very
best in education and training for our professionals. In
today's military, that means providing high-quality programs
within our system as well as strategically partnering with
academia, private sector medicine, and the VA to assure that
our students, residents, and fellows have the best training
opportunities possible.
While the Air Force continues to attract the finest health
professionals in the world, we still have significant
challenges in recruiting and retention. We are working closely
with our personnel and recruiting communities using accession
and retention bonus plans to ensure full and effective staffing
with the right specialty mix to perform our mission today and
tomorrow.
At the center of our strategy is the Health Profession
Scholarship Program. HPSP is our most successful recruiting
tool, but we are also seeing positive trends in retention from
our other financial assistance programs and pay plans. Again,
thank you for your unwavering support in this critical
endeavor.
In summary, Air Force medicine is making a difference in
the lives of airmen, soldiers, sailors, marines, family
members, coalition partners and our Nation's citizens. We are
earning their trust every day. And as we look to the way ahead,
I see a great future for the Air Force Medical Service built on
a solid foundation of top-notch people, outstanding training
programs, and strong partnerships.
It is indeed an exciting, challenging, and rewarding time
to be in Air Force medicine and, indeed, in military medicine.
I couldn't be more proud of my Air Force and Joint Medical
Team. We join our sister services in thanking you for your
enduring support, and I look forward to your questions.
[The statement of General Roudebush follows:]

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Mr. Murtha. Mr. Young.

Remarks of Mr. Young

Mr. Young. Mr. Chairman, thank you very much. First let me
apologize for being late for the beginning of the hearing; but
for me to get to work, I have got to travel on probably the
heaviest traffic highway in the world, and there were three
accidents on that highway this morning.
Mr. Chairman, I want to welcome the Surgeons General. In
one of our previous hearings with the Surgeons General, I made
the comment that I complimented the witnesses for the really
outstanding medical care that our military troops and their
families receive in the military hospitals.
And I will tell you, I took a couple of really tough
blogger hits, because it was right about the time when there
were some negative stories about one of our hospitals. But I
will do it again today. I will tell you that Mr. Murtha and I
have visited your hospitals so many times, and I think he would
agree that we have actually seen miracles take place at your
hospitals; miracles, at least from the layman's perspective.
And I just want to compliment you for the military medical
care that you provide for our troops and for their families. No
one is perfect. We certainly aren't perfect, but you just do a
really good job.
But Jim Roudebush, the last time I saw Jim Roudebush,
Admiral Robinson, was at your hospital at Bethesda about 3
weeks ago, and he was in his flight suit. I don't know if he
was getting ready to fly off somewhere but I tell you what:
That flight suit fit him just like it did about 30 years ago
when he first put it on.

MILITARY MEDICINE

Jim, I know the Air Force will miss you; military medicine
will miss you.
Military Medicine has done a really good job promoting the
United States and the generosity of the American people around
the world.
And one of the early projects of this committee was the
creation of the hospital ships, the USNS MERCY and the USNS
COMFORT. But I have learned some interesting information,
because we send the USNS MERCY and USNS COMFORT around the
world to natural disasters that are not related to any military
operations, but we still do it. And I think it speaks well for
the United States, but it also helps those who have been
injured and who become sick because of those natural disasters.
But I am getting some word that maybe the Navy has to pick
up the cost of even those non-Navy, non-military operations.
And, Admiral, I wonder if you might explain that to us. In
fact, does that come out of your regular budget that you would
use for treating military troops?
Admiral Robinson. Congressman Young, humanitarian and civil
assistance missions are actually funded out of Fleet Forces
Command in Norfolk, so the humanitarian missions are funded in
that regard. What I have testified before is a nuance of that
goes something like this: As we staff the humanitarian civil
assistance missions and over the course of the last year we
have done approximately 130,000 outpatient visits and about
1,400 in-patient visits from around the world the workload of
those visits isn't captured by any of the data systems that we
use in DoD. And so as my men, women, corpsmen, nurses,
physicians, and Medical Corps dentists leave the medical
treatment facilities to go do those missions, and as we then
backfill with contractors--which is also paid for--the workload
often doesn't reflect the additional work that those men and
women are doing; and therefore, as we get into our pay-for-
performance systems, how we will calculate moneys back to the
Military Treatment Facilities (MTFs).
Often, I actually end up being taxed for those humanitarian
civilian assistance. So I have previously testified to that and
that is, I think, what you are alluding to in terms of the
impact on the Military Health System and specifically on Navy
Medicine.
Mr. Young. Well, that maybe explains the effect of what you
are not able to do for our troops in the Navy hospitals.
Admiral Robinson. Well, I would say that, in fact, we are
not negatively affected by our ability to do the care and do
the missions that we have. But I would suggest that as we look
at our workload and as we look at metrics that help explain the
efficiency of particularly our hospitals, our MTFs, what you
will find is that instead of not being as efficient--which
often is reflected in the workload data because the workload
data, as I said, that is being done on USNS MERCY, USNS COMFORT
and other humanitarian assistance missions isn't being
captured--instead of being less efficient, I actually think we
are more efficient.
But specifically as we look at the inefficiencies that can
occur, we only get graded as not being as efficient, but we
also get taxed by not being able to participate in the
compensation and the pay-for-performance, so the PPS becomes an
issue. So we send people, we do missions and we still get taxed
for that. And I just bring that up because I think that is a
real factor in Navy Medicine.
Mr. Young. Well, let me direct this question to all three
of you, or all four of you. The budget, I personally think that
the budget is a little--the budget request is lacking in some
of the needs for military service-wide. Are there any things
that you all need that are not in the budget request that would
become an unfunded requirement?
Ms. Embrey. As you know, sir, I am performing the duties. I
am not currently on appointment of the current administration,
so I am serving in an acting capacity. They call it performing
the duty. I think I won't be performing the duties much longer
if I identified anything other than the needs of the
President's budget.
Mr. Young. No, I understand that. But we are not going to
tell the President what you tell us.
General Schoomaker. Well, sir, I will echo Ms. Embrey's
comments. As I said in my opening statement, Army medicine is
sufficiently funded in the fiscal year 2010 budget. But I think
you are asking us to give you an assessment, our gut check on
where we think we are taking risks.
If I would say that probably if there is an area that I am
concerned about, it is that you all have been extraordinarily
generous in helping us reverse several decades of
undercapitalization of our physical plants, our hospitals, our
clinics. You heard the list from all of us of what you have
done for us.
But our initial outfitting and transition cost associated
with that, we call them IO&T costs, are funded in the budget
year.
So with the increased use of--that is, more users coming
into our system, more unique Social Security numbers, more
unique individual patients, and with our patients who are
enrolled in our system using it more frequently, that is a good
thing in the sense that people have reduced stigma to get
mental health, so they have been coming in and are using it
more.
Wounded and ill and injured soldiers, much like Vice
Admiral Robinson commented about the military unique missions
of the Navy, in Army medicine we are caring for close to 10,000
wounded, ill and, injured soldiers. They take a significantly
larger amount of care.
And so with this growth in care competing with initial
outfitting, I think there is some risk there, sir. But I would
have to say at this point in time we are sufficiently budgeted.
Admiral Robinson. I would echo what Ms. Embrey has said
already. I would also suggest that and Navy Medicine is fully
funded also.
I would suggest that as we look at the DHP, though, the
private sector care moneys, I am not suggesting that they are
not fully funded, but that is a risk area because we on the
MHS, we in the Active Duty side, don't really have visibility
of those amounts of funds, so those are types of issues that
come into play.
I don't know that that is going to be an issue. It is just
that the visibility is lacking from my point of view, so I
can't see that.
So that would be my only comment.
General Roudebush. Sir, I would agree we are adequately
funded. But I think it is also going to be challenging this
year, challenging next year. We are operating at a very high
ops tempo with the mil-to-civ billets coming back on our books.
As we work to fill those with military personnel, we are
working to be sure that we keep those gaps filled by other
means, whether it is just short-term overhires, whatever the
methodology.
But we wanted to assure that we maintain ready access and
that we are, in fact, able to provide that care. So it does
provide a challenge.
I would like to offer an observation, however. I think you
and we are especially well-served by your staffers, who really
engage with us at a variety of levels, quite often as that
early warning radar to pick up the issues as they are emerging
and working through.
So we find that as we do deal with items that come about, I
believe we are well-served on both sides. But I believe we will
get there this year and continue to deliver the care that our
beneficiaries, men and women, so richly deserve.
Mr. Young. Again, thank you very much for being here. Thank
you very much for the good job that our military medical
professionals provide for our troops.
Mr. Chairman, I have additional questions, but I will wait
for another turn. Thank you very much.
Mr. Murtha. Mr. Dicks.

HYPERBARIC OXYGEN THERAPY

Mr. Dicks. I want to compliment you for the incredible job
that is being done. I mean, just the survival rate, I think, is
an amazing feat, and its improvement over years is quite
impressive.
I wanted to go back, this is a question I asked before when
we had an earlier hearing, with regard to the hyperbaric oxygen
therapy treatment. Ms. Embrey, the text of your testimony is
nearly verbatim from your previous testimony before the
committee in March.
Has any progress been made in getting this trial underway?
Ms. Embrey. Yes, sir. I wish Loree Sutton was here so she
could give you exactly the details. But we have worked with the
Services and with our outside experts to develop a protocol. We
have three different sites where we are planning to do that.
Because the Food and Drug Administration (FDA) has
identified oxygen in the hyperbaric chamber as an
investigational new drug for this kind of treatment, we need to
seek their authority to use that in this protocol. When FDA
gives us that authority, then we can begin to execute----
Mr. Dicks. Would you tell the committee, again, in what
circumstances this would be utilized; or maybe one of the
Admirals, Generals, could do it?
Ms. Embrey. I am sorry, in----
Mr. Dicks. When would you use this? Under what
circumstances would this be used?
Ms. Embrey. Well, the Navy uses it routinely for diving
issues. But for the purposes that you are talking about, we are
talking about this as a treatment for traumatic brain injuries
and other mental health symptoms.
Mr. Dicks. And it has been prescribed. You can do--it has
been utilized. It has been quite effective, I am told.
Ms. Embrey. Doctors have the ability to identify, because
of their personal relationship with their patients, anything
that they believe in their judgment would assist them in
achieving a better outcome.
And so they have the authority to use and prescribe
alternative therapies. Even if they are an off-label use,
hyperbaric chambers are safe for certain things. The challenge
is that we don't know, there is no evidence currently that
indicates that putting a person who has had a traumatic brain
injury in a hyperbaric chamber may or may not do harm evidence-
wise.
The reason we are doing these studies is to make sure that
we do no harm.
Mr. Dicks. Are the studies underway yet?
Ms. Embrey. In one site I believe they are, sir.
General Roudebush. Sir, if I can comment, we initiated a
study at Wilford Hall beginning back in February, which will be
completed within a year's time, which uses hyperbaric oxygen
with pre- and post-neurocognitive testing to see if, in fact,
there is a beneficial effect.
I think the more definitive study is the study that Ms.
Embrey refers to, wherein the FDA has identified hyperbaric
oxygen as an investigative--as a new drug, if you will. And we
are just on the verge of getting their approval and moving
forward with this study.
True, there have been anecdotal reports of the benefits of
hyperbaric oxygen, but there has not been a thoroughly prepared
and conducted study to see if, in fact, that is the case. And
that is precisely what we are doing, and actually doing it in a
very aggressive manner, to get this done as expeditiously as we
can.
Mr. Dicks. Admiral, do you have any comment on this? The
Navy is the reservoir of expertise on this.
Admiral Robinson. The Navy helped facilitate a meeting in
which many of the professionals who have contributed to the
hyperbaric oxygen therapy literature came together with other
professionals, who have been doing a great deal of work with
neuroscience and with the effects of different modalities,
treatments, medications and also oxygen on neural and brain
tissue.
We did that in the January-February timeframe. We spent 2
days. It was widely attended by these professionals. It was
very informative.
From that, we have gone out with Air Force, the Wilford
Hall study, also with Louisiana University--LSU, and others, in
fact--to try to find the best method of doing a prospective
randomized trial that we could utilize to make sure that if we
say that hyperbaric oxygen is a therapy for traumatic brain
injury, that we can prove that and that we can write clinical
practice guidelines that can be utilized across the United
States--actually, across the world--because to put the
imprimatur of a success on a therapy that has not been proven
in the standard medical methodology, it has been proven in
terms of anecdotal information--
Mr. Dicks. Let me just ask you on that point.
Admiral Robinson. Yes.
Mr. Dicks. Has there ever been any adverse consequence
where it has been prescribed and utilized, has there been any
adverse consequence?
Admiral Robinson. None that I have ever heard of,
Congressman Dicks. But that doesn't necessary nearly mean it
hasn't occurred; it just means that I don't know about it.
People who tend to give anecdotal information often don't
necessarily tell all of the story, which is the reason that in
medicine--which is prospective, randomized, multidisciplinary,
and also multicentered--evidence-based trials are necessary to
make sure that we can get the best evidence to go with the
clinical practice guidelines.
The end result is, whatever I say is going to work for a
Sailor, Airman, Marine, Soldier, a Coast Guardsman or their
family member; but if whatever I say works from a Navy
perspective or from an Army or Air Force perspective, we really
base that on randomized, prospective, reproducible data that we
can live with and build practice guidelines on. That is what we
don't have yet.
Mr. Dicks. How long do you think this will take?
Admiral Robinson. I would anticipate--this is going very
rapidly--I would say probably within the next 18 to 24 months
we may have some evidence of how hyperbaric oxygen therapy is
working in the trials that we have going. But that is a guess.
I am not quite sure.
General Schoomaker. Sir, and I will add to that, everything
that has been said by my colleagues is exactly our position on
this. I think one of the frustrations here is that hyperbaric
oxygen has been around for many, many years.
Mr. Murtha. Would you explain for the committee what we are
talking about here?
General Schoomaker. Sir, this is pressurized. This is
putting a patient, with staff support, because it is fairly
labor-intensive, into a high-pressure environment where the
oxygen pressure around the patient and what is breathed in
their lungs is higher than sea level.
So when you are recovering, for example, from a deep diving
problem, what we call the bends, you have to be put back into
an environment where you push, literally, air and oxygen and
nitrogen back into the body to then slowly decompress them and
reverse the problem.
In cases of resistant infection where we have bacteria that
are growing deep in wounds, where we think if we raise the
oxygen retention we may encourage wound healing, it has been
used in that setting as well.
But in this setting, sir, it has never been demonstrated to
be effective in a standard way where we know, number one, who
are we treating? We are already having difficulty separating
mild brain injury from post-traumatic stress because the
symptoms are so overlapping. And then what are the total
outcomes of that, positive and negative?
As Dr. Robinson said--I agree totally--unless you do a
careful study you don't know if you are doing harm, and there
are potentials for harm.
One of the frustrations we have had with this is a
technology which has been around for decades, and concussions
which have occurred on sports fields and on highways for
decades has never been studied by this group. And when we
offered, through your generosity, money to do careful studies,
nobody came forward with credible research proposals that we
do.
Finally, the military services said, enough, we are going
to conduct the research. And that is what we are doing.
Mr. Murtha. I appreciate that. Mr. Tiahrt.

WOUNDED WARRIOR TRANSITION

Mr. Tiahrt. Thank you, Mr. Chairman. I was recently up at
Fort Riley and not long after that I went pheasant hunting with
some soldiers that were in the Wounded Warrior unit. We had a
great day. I spent all day with them. Some of the things they
were going through I wasn't aware of, I don't think many
Americans are aware of, especially in the area of TBI where we
understand the long-term impact of having their brain jostled
around.
The good thing about the MRAPs, for example, is we have a
lot higher survivability rate. One of the downsides is, though,
that these soldiers going through two or three or four major
explosions like that can impact their brain because of the
impact to it.
And would you explain so that we better understand what a
Wounded Warrior transition unit is, like the one we have at
Fort Riley?
General Schoomaker. Yes, sir. The Army today has 36 such
units across the Army and nine what we call community-based
warrior transition units. These are special units that were
developed after the problems were highlighted earlier of the
transitional care that takes place from in-patient, outpatient,
and beyond the traditional VA system and back into private
medicine, or VA medicine, or back into uniform.
What we realized was that we had world-class, even cutting-
edge patient care, and we had established outpatient practices,
but very, very rudimentary. And, in fact, we had forgotten many
of the lessons of earlier wars, where we transitioned patients
successfully from in-patient to outpatient care, and then back
into uniform or into private life or continued care, if
required.
So we stood up a number of units actually staffed by
nonmedical soldiers from all backgrounds. Young officers and
enlisted, we trained them how to do that. We have put nurse
case managers in place and primary care managers, physicians,
nurse practitioners, physicians assistants, who provide primary
care assistance. And that triad, then, is responsible for
carrying the soldier, in a sense, with family, along the
traditional pathway.
Currently we have 7,700, roughly, soldiers in the warrior
transition units; wounded, ill, and injured soldiers. About 15
percent combat-wounded. About 50 percent are evacuated with
other medical problems. About 30 percent identify problems like
concussive injury or post-traumatic stress after they return.
And about 30 percent are, frankly, injuries, illnesses that are
not associated with the deployment, but may be training
injuries or cancers or heart disease or other problems that
soldiers are prone to, or motor vehicle accidents.
That is the construct, and it is working quite well. Our
focus this year, now that we have set these units up and have
staffed them successfully and standardized their practices, is
to focus on what we call the comprehensive transition plan,
which is a soldier- and family-developed plan for what they
want to do, where they are going to go with this injury or
illness, how we are going to recover them and get them back
into uniform. And that is our highest priority, to get them
back in uniform, if possible, or transition them back into
private life, into the VA system if necessary.
Does that answer the question, sir?
Mr. Tiahrt. Yes, it does. Thank you. It was a very good
explanation.
There are some instances around the country where there is
a high discipline rate for these wounded soldiers that come
back. And some bases have a different rate than others. Fort
Drum, New York has every month, one out of 76 soldiers are
going through article 15. In Kansas, where we have this Wounded
Warrior transition unit, it is only 1 out of 309.
And I think it is because they have focused on working with
these folks who have come back, and my personal experience in
meeting one of these soldiers, a young sergeant had been
through six explosions, he told me he has trouble reasoning
with things he didn't before, like small calculations. He now
carries a calculator around in his pocket because small
addition problems is one evidence.
There was an article done by the AP back in March. I don't
know if you are familiar with it or not, but it highlights how
some bases are not working with these soldiers as well as
others. And I would like you--it is called Disciplined Wounded
Warriors--I would like you to check out that article, because I
think there is a problem about being consistent in the military
and helping these folks transition back to either Active Duty,
full time, or back to civilian life.

MILITARY MEDICAL RECORDS

The last thing I wanted to ask you about, in both the
military medical records and in private sector or health-care
records, we are moving towards electronic medical records.
But I have noticed that in the VA, and certainly in the
private sector, there is no standard interface for these
different electronic record programs that are out there. So you
can have, within the VA, somebody's military records or health-
care records--excuse me--not being read when they change to a
different facility.
They may be working at one of our remote clinics and then
when they come into the VA hospital, there is not always a
connection that is usable. In the private sector it is the same
thing. Now, in any government program, they always have an
interface control document that manages all the interfaces
between the working systems.
Yet I don't think we have one in any of the services when
it comes to medical records. And yet we are seeing services
develop these medical records. So I would suggest somewhere
inside the services--and I think you guys would be the logical
initiator in this--develop an interface control document so
that when medical records software is developed, it has the
ability to interface with other softwares that are trying to do
the same task.
General Schoomaker. Yes, sir. Let me comment very quickly,
first, on discipline rates. We are very concerned about
installation-focused allegations that we are not sensitive to
medical problems of soldiers who may have been brought up for
administrative or nonjudicial punishment.
We have very active policies that soldiers not undergo
administrative actions or nonjudicial punishment without a very
thorough incorporation of their medical history and problems.
Brigadier General Gary Cheek, who commands the Warrior
Transition Command overseeing all these units and their
standard practices, has just completed a review of nonjudicial
punishment at nine different installations. While we don't
direct them, they can't direct that installation commanders or
warrior transition commanders employ a kind of standard
approach, because every case stands on its own, he is very
reassuring that in fact our policies are working out there.
Commanders are taking into account the medical conditions and
problems of soldiers before implementing or taking
administrative and nonjudicial action.
Quickly on the electronic health record, sir, we do have
with the VA system a standard interface. In fact, we have a
Bidirectional Health Information Exchange. Now it is called
BHIE. It isn't to where we want it right now. We have very good
exchange of information to the four polytrauma centers where
the most severely injured soldiers are being sent.
General Schoomaker. But you are absolutely right. We do not
have with the private sector, to include our purchased care
partners that were referred to by my colleagues earlier--we do
not have a standard interface with thousands of practices and
hospitals out there, and this is a national problem.
Mr. Tiahrt. Thank you, Mr. Chairman.
Mr. Murtha. We have two panels today.

CONTINGENCY PLAN

Mr. Moran. Except that what happens, Mr. Chairman, as you
particularly will know, in the National Capital region affects
the ability of this panel to carry out its mission. There is a
relationship here.
I would like to ask Ms. Embrey, I understand the
constraints you already explained. I don't think you ought to
be worried about your job, but you are doing a fine job, but
what if we don't make the deadline for Walter Reed in time? I
know we talk about another panel who is focused on the weeds in
this garden, but I want you to look at the larger picture,
because many of us feel there are some very serious problems
that need to be addressed if we are not able to achieve what
needs to be achieved in what is now a pretty short period of
time. We are talking really a year and a half. And as far as I
can see, you are not going to meet that deadline, so that is
going to have a major impact on all the operations you are
responsible for. What are your contingency plans, Ms. Embrey?
Ms. Embrey. Officially I think my contingency plan is to
press harder and faster with the current program. But truly the
contingency plan is when we get closer, we realize that as a
Department we can't--we understand what the negative and
positive effects are of where we are, and at a point in time we
need to inform people about, you know, what they are and how we
can come together to work through those problems. But right now
we have a plan, we are committed to meeting it, and we are
working it very hard.
Mr. Moran. I know you are working hard, I know you have a
plan, and I know you are committed to meeting it. In fact, when
we tried to inject some judgment into the process, somebody
over at DoD threatened to veto the whole bill if we suggested
that you might extend the deadline so that we can actually
achieve this transition in a reasonable period of time. That
was probably true--or somebody like that. But he is gone now.
Mr. Murtha. He is gone now.
Mr. Moran. He is gone now. So now we are going to find out
who reports to who.
Ms. Embrey. We recognize we report to you.

CENTERS FOR EXCELLANCE

Mr. Moran. There you go. I will wait until the chairman at
least. Certainly, Vice Admiral Kearney understands that behind
you there. Some of the problems here at Walter Reed, we are
going to get into the nitty-gritty with the next panel, but we
love the Centers for Excellence, you are doing a great job. But
the space that you provided for the Centers for Excellence in
the new facilities are considerably smaller than the space you
have now; isn't that right? How is that going to affect Centers
for Excellence, which we like, which undoubtedly would need to
expand to deal with the needs?
Ms. Embrey. Centers of Excellence institutes and centers
and the concept of how we are going to implement that across
the Department, is actively being discussed now. Centers of
Excellence may not necessarily need to have brick and mortar. A
Center of Excellence by its terms implies that if you have a
Center of Excellence, the other places aren't excellent, and we
don't want that. We want to have a mechanism by which to ensure
that the whole system is apprised and kept current on the best
possible practices and deliver the best possible care anywhere.
So the physical location and the brick-and-mortar location at
Bethesda right now for the Defense Center of Excellence for
Traumatic Brain Injury and Psychological Health, the location
of the Defense Center of Excellence for Vision, I believe, is
also going to be there. But there are going to be other
locations and hubs throughout our system.
Mr. Moran. I understand that, but I have a suspicion that
in order to meet this arbitrary deadline, you are trying to
stuff stuff into Fort Belvoir and the new--the other new
hospital that you are building. Instead of looking for the most
excellent design, you are just trying to figure out the
expedient way to meet, again, the deadline. But I won't argue
about that, I just want to raise it as an issue.
Apparently the Surgeon General wanted to comment on that.
General Schoomaker. The only comment I would like to make,
in addition to the fact that in every forum where we jointly go
out, for example, in new Belvoir or the new Walter Reed
National Military Medical Center, and is true throughout the
BRAC process, we take a pause and say, no kidding, are we on
track; are we going to run into problems? In every one of those
fora, we have been assured by engineers and designers and the
people building these things that we are going to meet the
deadlines.
The second point I would like to make, and I hope it is
developed in the next panel, is there has been a lot of focus
on this new Walter Reed National Medical Center at the Bethesda
campus, but, in fact, the beauty of the JTF CapMed--and with
apologies, Vice Admiral Madison, I hope I am not putting words
in your mouth here--but is that we have 500,000 beneficiaries
in the Greater Metropolitan Washington area in 37 facilities,
from Carlisle Barracks, Pennsylvania, to Quantico and Belvoir,
the National Military Medical Center, Meade and others. And it
is the coordination of care across this very dynamic
metropolitan area, and to follow the movement of our families
and soldiers and sailors, airmen and marines to the places
where they can live and they can come.
So frankly, I am as excited or almost more excited about
the new Belvoir, which has got tremendous capacity, and which
is going to take some of the capacity and some of the
functional elements of the centers for breast cancer, prostate
cancer, heart disease, amputee recovery and the like and
distribute those to where we can best serve the public. So this
is a coordinated plan for the entire metropolitan area. We are
too focused on one institution within that bigger plan.
Mr. Moran. We want you to do it right.
General Schoomaker. Yes, sir.
Mr. Moran. Mr. Surgeon General. And to do that, you ought
not have an arbitrary time line that fits an arbitrary decision
of September of 2011, that is the whole point. And we are up
against people who say, well, you may be right in terms of
judgment, it is just that I have been given a job, so I am
going to do the job come hell or high water. So that is our
concern.

TRICARE

Let me ask a more general issue here. I have to obviously
get into the Walter Reed stuff, but one of the problems that we
are facing is that a lot of our soldiers and families after
they return, they go back in the field, but we have long-term
responsibility for their medical care. There is a high level of
diabetes, obesity, lack of physical fitness once they get out
of the military, and we wind up paying for that through
military health-care programs, particularly TRICARE.
What are you doing in terms of preventive efforts to save
us money to deal with some of these almost endemic problems
with families, and particularly the soldiers who just don't
maintain their physical fitness regimen?
Ms. Embrey. In 2003, we developed a system to track the
individual medical readiness of folks across the force, Active
Duty and Reserve component. And we measure whether or not they
have been assessed both physically and dentally and mentally on
an annual basis. We assess people's health status through
screenings, predeployment and postdeployment, twice.
We also have engaged in campaigns based on information and
trends in utilization of alcohol, substance abuse of various
types, tobacco principally. We have looked at obesity as an
issue, and we have stepped up campaigns through the line who
owns those programs for us and runs them for us. Each Service
has significant programs that are addressing those issues. Some
are more effective than others. We still do have an obesity
problem, but frankly it is because we recruit folks who have
these issues. And part of it is addressing cessation of those
bad and risky behaviors.
We also have introduced and will be introducing in the next
60 days pilot programs to incentivize people to engage in more
healthy behaviors, paying people to go to the gym and to not
smoke and to do different things. It is a pilot. It is detailed
in my testimony, and I outline some of the highlights of it,
and I can give you more information about those. But that is a
pay for--it is incentivized pay for outcomes that we are trying
to achieve.
Mr. Moran. It is just what I was looking for. You didn't
mention it in your summary, so I didn't realize it was in your
testimony. That is exactly what we ought to be doing. It is a
small fraction of the cost of taking care of them, obesity and
all kinds of other problems that are behaviorally related.
TRICARE is going through the roof, and a little bit of money to
incentivize them to be healthy now is going to save us billions
in the long run. Thank you, Ms. Embrey.
General Schoomaker. If I could just comment quickly, I
think at the execution within hospitals and clinics, we have to
incentivize commanders and clinics to do that, too. This is a
problem in American health care. What we have been doing in
Army medicine for the last 4 or 5 years is to shift the pay for
performance toward population health and toward preventive
measures. In the last 2 years, we have 50,000, roughly, over-65
patients we care for. When we started this campaign, 25 percent
of them, roughly, had their vaccination for common pneumococcal
vaccine complete. We started incentivizing commanders and
clinics that if you can raise the vaccination levels higher, we
will pay you for it. We pay generously, handsomely, if they are
brought to the emergency room with pneumonia or admitted; why
don't we pay better if you prevent it? And now we are at 85
percent vaccinated.
General Roudebush. Sir, if I might add, Congressman Murtha
has been instrumental in helping us establish diabetes outreach
with UPMC and Wilford Hall, and, in fact, we have identified a
cadre of folks. We are employing strategies and methodologies,
and we are starting to see beneficial outcomes. So there is, I
think, an active program to improve the health, improve the
outcomes and ultimately certainly cut costs, but most
importantly improve the health.
Mr. Moran. Thank you.
Mr. Murtha. Mr. Rogers.

VISION CENTER OF EXCELLENCE

Mr. Rogers. Mr. Chairman, I know you want to get to the new
panel, so I will be brief. I don't know who can answer this.
Let me ask you about the Vision Center of Excellence, which I
understand is in the works. What can you tell us about that?
Ms. Embrey. It is a very high priority for us. We have
appointed a director. We found a temporary location. We have
five employees from the VA who are joining us. They have just
visited the spaces. They have been in effect for a short time,
but they haven't really gotten off the ground too well,
primarily because we were authorized a considerable amount of
money, but not appropriated any for that purpose. And so we
took some money out of hide this last year to try to get it
started, but we have a full complement of funds to expand and
engage more fully an operating center.
Mr. Rogers. When will that be in operation?
Ms. Embrey. By next year. It is operating now, but next
year we will have it fully operating.
Mr. Rogers. Now, would you integrate with the VA?
Ms. Embrey. Yes. Actually we just brought over five VA
folks to actually staff the current temporary location in
Skyline, and they are going to be moving over in the next
couple of weeks. So we have five VA folks working in the center
with the DoD folks.
Mr. Rogers. Here is a problem: a constituent of mine, a
young soldier who was injured about his head and face by an
IED, but got out and had some vision in his right eye, but none
in the other; enrolled in school, college, and then developed a
problem. He had had operations in Germany at Walter Reed with
head injuries; went to the VA hospital in Lexington, Kentucky,
because he had had an infection and swelling bad. And the VA
hospital there could not operate because they did not have the
records of what they had done to him in Walter Reed in Germany,
and he lost his eye, what was left of his eye, so he is blind
now, because apparently they could not get access to the
military records of his previous treatment at the Army
hospitals. Will that be remedied in this process?
Ms. Embrey. Sir, I think the access to records, images
particularly, we are working on a standard with the VA to
ensure a standard exchange of imaging so that people can see.
Right now there is no standard for medical imaging in any
health-care environment. So what we are trying to do, by this
fall we intend to have a standard that will enable rapid
sharing of imaging anyplace in our system. But in the meantime,
we had been working around by sending information, FedEx-ing
and other kinds of things, but I am not familiar with this
particular case, so if you would like to comment.
General Schoomaker. I am very familiar with the case. I
have spoken with the patient and reviewed all the records. Not
to in any way discount the challenges of exchanging information
between different systems, I have to say, sir, our review and
the VA's review concluded that this was not a problem of
exchange of medical records. In fact, the physician involved in
the VA hospital had the entire medical record at his disposal.
It happened to be a hard copy record.
So I don't want to back away from the problem that was
raised earlier about the bidirectional exchange of the
information and a digital record. That is our goal, and we do
continue to work through problems there. But in this particular
case, that young soldier's continued problem with vision,
despite how the media has depicted it, frankly did not revolve
around the exchange of medical records.
Mr. Rogers. Well, I am glad to hear your report.
Let me conclude by saying that it just seems
incomprehensible to me that the VA hospitals and the military
hospitals have not had their records shared a long time ago.
That seems a basic, elementary problem; do you not agree?
General Schoomaker. Yes, sir. I think that all of us are
frustrated by the pace at which this has taken place. I do also
know that we are probably, in terms of national landscape of
this problem, at the leading edge of solving problems for the
Nation in this exchange of information. If it is problematic
for us as two big, large Federal systems, we have no trouble
within the military side, then out there in all of the
practices and all of the different mom-and-pop operations
around the electronic health record, it is truly problematic.
So we are trying to solve some of these problems to demonstrate
how it can and should be done.
Mr. Rogers. What can we do to help with that problem?
General Roudebush. Sir, if I may comment, sir, and go back
to Congressman Tiahrt's question about interface. Secretary
Gates and Secretary Shinseki have taken a personal and very
active interest in this in terms of mandating driving towards a
common solution; not down-selecting to VistA or down-selecting
to AHLTA, but going to a service-oriented architecture that
gets to the interfaces, the architectures and the basic
taxonomy that allows you to link these systems to get to a
truly transparent and interchangeable health-care record that
just has one record wherever that patient finds themselves.
Now, we live in the greater context of American medicine.
So as we move this along, we do need to do it with policy,
processes and practices that are consonant with what we see in
the private sector. And it is slow, and it is frustrating, but
I think in terms of the last probably 2 to 3 months, we have
seen more focus, the right focus, in my view, moving us towards
that common solution. In the meantime we will continue to work
the day-to-day interfaces.
Mr. Murtha. The gentleman's time has expired. We are going
to dissolve this panel. I ask that Mr. Bishop and Ms.
Kilpatrick ask the first questions of the next panel.
Thank you very much.
Mr. Bishop. Mr. Chairman, can I ask the next panel the
questions I wanted to ask this panel?
Mr. Dicks. Are they going to stay?

Introduction

Mr. Murtha. Welcome, gentleman. Gentlemen, we appreciate
your patience. Next year I think we will separate the panel,
because there is nobody more involved in health care that this
subcommittee. Bill Young, his wife, myself. I just was out to
Bethesda the other day, only a couple of patients, I am glad to
hear that. But we can take a lot of credit for what has
happened in health care, and we certainly do, but we appreciate
and are gratified by the result. Of course, here we are talking
about the region, and Mr. Moran has left.
Mr. Moran. I am right here. I am trying to do my job here.
Mr. Murtha. I appreciate it.
Mr. Dicks. Don't get him started.
Mr. Murtha. If you could abbreviate your statements and let
us get right to questions, because the Members obviously have
all kinds of concerns about what is going on here in the
region. And we depend on Mr. Moran to make sure he takes care
of those problems, so we appreciate your coming before the
committee.
Mr. Young, do you have any comments?
Mr. Young. No, Mr. Chairman, I am anxious to hear the
statements.

Summary Statement of Admiral Mateczun

Admiral Mateczun. Thank you, Chairman Murtha, Ranking
Member Young, committee members. Thank you for the opportunity
to share with you the Department's progress on realigning
medical assets in the National Capital Region to create an
integrated delivery system; a fully integrated, jointly
operating and staffed health-care region. This transformation
will allow DoD and the services to capitalize on their
collective strengths; maintain high levels of readiness;
provide second-to-none, world-class health care to
servicemembers, retirees and their families.
Being responsible for delivering this integrated, world-
class health care in the National Capital Region Joint
Operating Area, JTF CapMed will operate two jointly manned
treatment facilities comprising nearly 10,000 individuals, more
than 3 million square feet clinical and administrative space,
providing 465 beds of inpatient capability.
To achieve this we must oversee the transition of
operations from the current Walter Reed Army Medical Center and
National Naval Medical Center to the new Walter Reed National
Military Center and to the Fort Belvoir Community Hospital.
Our primary mission is the delivery of health-care
services, including casualty care. The National Capital Region
currently is our Nation's primary casualty reception site, and
we have significant and world-class capabilities at Walter Reed
Army Medical Center. The prosthetic capabilities are second to
none in the world and are leading the world, as is the
abilities, the capabilities at the National Naval Medical
Center today to provide care for open traumatic brain injuries
that are returning to our country.
The Aeromedical Staging Facility at Malcolm Grow is an
extraordinarily capable facility, the best Aeromedical Staging
Facility, I believe, today, and together they compromise a
seamless reception capability for those patients that are
returning on C-17s from across the world.
Fortunately, as the Chairman points out, casualty rates for
complex trauma care are significantly down in the NCR; however,
the number of psychological health cases is increasing at the
same time. So we have seen a switch in the emphasis of the care
that we need to deliver, but not in the need to be able to
provide care for the wounded warriors who are returning here.
Mr. Murtha. Does that include inpatient and outpatients?
Admiral Mateczun. Yes, sir, it does.
We will continue to have capability to maintain this
capability to receive casualties in the National Capital Region
during transition to these new facilities and throughout the
entire BRAC operation. We will, in fact, have significant new
capabilities, including a comprehensive cancer center, which
puts together many of the centers of which this committee, in
particular members of this committee, have been so helpful in
making sure that we maintain these capabilities. It will bring
together the ability for the Trauma Registry--I'm sorry, the
Bone Marrow Registry, Congressman Young, to bring those
together with the Comprehensive Cancer Center in a way that has
never been done before within the military health system.
There are also significant new capabilities at the Fort
Belvoir Community Hospital. In fact, out of the 500,000
beneficiaries that live in the region, about half of them live
in the southern half of the region, and that Fort Belvoir
Community Hospital will grow to a 120-bed facility with
significant new capabilities, including linear accelerators for
oncology care, for radiation oncology and cardiac
catheterization. So significant new capabilities there.
I will abbreviate any statement. I would be remiss as we
near Memorial Day if I did not remember the 221 service medical
members who have made the ultimate sacrifice in their service
of both country and their fellow soldiers, sailors, airmen,
marines, Coast Guardsmen. Your support, your extraordinary
support, pays great honor to their service, and I will conclude
my statement.

Summary Statement of General Volpe

General Volpe. Chairman Murtha, Ranking Member Young,
committee members, good morning. Thank you for giving us an
opportunity to share with you the great effort that is made by
the Department to enhance the health care in the National
Capital Region. As we forge a new frontier in military medicine
in the National Capital Region by leveraging joint solutions
and initiatives, we are committed to ensuring a more effective
and more efficient delivery of health care.
For the first time in history, the Department will deliver
health care in a fully integrated region, and JTF CapMed will
oversee through operational control the first two truly joint
hospitals at the Walter Reed National Military Medical Center
at Bethesda as well as the Fort Belvoir Community Hospital in
Virginia.
The two hospitals will be jointly staffed, jointly
operated, jointly led and jointly governed. Servicemembers,
veterans and their families will be better served by being able
to receive their health care in a regional system which
leverages the outstanding capabilities that each service has to
offer.
We at JTF CapMed are very mindful that the massive
transformation in the National Capital Region comprises more
than BRAC alone and is a conglomerate of numerous complex
initiatives. While BRAC provided the initial stimulus to
realign the military health system resources within the
National Capital Region, the Department utilized and will
continue to utilize it as an opportunity to transform,
integrate and reengineer how we deliver health care in the
region.
I will abbreviate much of my opening statement, but I would
like to mention finally that the real beauty of JTF CapMed is
that it is a mechanism to integrate health care across the
three services' medical system, to leverage the common
capabilities that each service has to offer, while still
respect unique requirements that each service must maintain. We
are very proud to have an open working relationship with the
three services, and the Assistant Secretary of Defense of
Health Affairs, those on the Joint Staff in OSD, and there are
procedures in place for us to work through the challenges that
we face and to capitalize on the opportunities to improve the
delivery of health care. The fact is that we all have a very
common goal and culture of providing warriors and their
families the world-class health care that they deserve.
Again, thank you for allowing us to share in the progress
and the transformational efforts in the National Capital
Region, and submitted the rest of my comments in the written
statement, and look forward to your questions.
[The joint statement of Admiral Mateczun and General Volpe
follows:]

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Mr. Murtha. General, you didn't mention the committee. You
mentioned all the work you guys are doing. This is the first
time that I remember that you stepped up to the table and put
enough money in the budget. I mean, this committee has been in
the forefront of health care, and you just gloss over that like
we weren't even there.
General Volpe. Sir, we are greatly appreciative of all the
support by you, the Chairman, the Ranking Member and all the
committee members through the years in the military.
Mr. Murtha. Beverly Young ever talk to you about any of
this health care?
General Volpe. No, sir.
Mr. Murtha. She is slipping.
Mr. Young. If we give Beverly his name, I am sure she will.
Mr. Murtha. Mr. Bishop.

PTSD

Mr. Bishop. Thank you, Mr. Chairman.
May I just mention from the previous panel some concerns I
had for the record. With regard to Lieutenant General
Schoomaker's testimony, he had stated in his opening testimony
that the fractured relationships and not PTSD account for or
are related to many of the suicides, and I found that a little
bit incredulous because many times the suicides relate to
relationships that became fractured as a result of PTSD. And I
was wanting for the record the Department to submit any studies
that have been done to track the relationship and to test the
relationship between fractured relationships and PTSD, because
there is, I think, a great deal of likelihood that the
underlying causes of the suicides relate to the PTSD as well as
the multiple deployments that strain those familiar
relationships.
And also, Ms. Embrey stated that doctors may prescribe
whatever treatment they want if they think it will help the
servicemember, and I think that, for the most part, folks have
done that. The witness that was a three-star general who got
the hyperbaric oxygen treatment for injuries he sustained and
swears by it anecdotally, I might add. And I know that there is
a need for the establishment of medically and scientifically
proven studies, General Schoomaker, but if, in fact, these
anecdotal studies document some benefit from the hyperbaric
oxygen treatment, it would appear that if the doctors made--if
it is made known to them that they do, in fact, as Ms. Embrey
suggests, have leeway to recommend or prescribe some of these
treatments, it perhaps would help the thousands of our Army and
Marine soldiers suffering--who are suffering from PTSD, the
spinal injuries and other nerve damage injuries which
anecdotally suggest can be cured or definitely treated with the
hyperbaric oxygen treatments.
Now, getting to the subject of this panel, I would just
like to ask, I think it was in the appropriations report, in
the language entitled ``Medical Care in the National Capital
Region,'' the committee expressed concern that in spite of the
significant cost increases at the new Walter Reed, funding
still had not been included for a number of facilities that
already exist at the current Walter Reed center. And the
planners hadn't solved the ingress and the egress problems and
how that will be accomplished for patients and staff, given the
fact that the patient and staff population will virtually
double in a little more than 2 years.
Has the report been completed with regard to that? Have
those ingress and egress problems been solved? Do you have a
plan that speaks to that? When will the construction be
completed for each of the two facilities? And when can the
staff at Walter Reed be notified of their future employment,
and vice versa, I guess, at Bethesda?
There are a number of these issues that we are concerned
about. If you would sort of address those, I would be
appreciative.
Admiral Mateczun. Thank you, Congressman Bishop.
There is a 2721 NDAA 2009 report which was delivered 2 days
ago, which includes an integrated master schedule of over
10,000 line items on tasks that must be accomplished to
coordinate and finish these moves. That report, that integrated
master schedule will lead to a master transition plan, which we
will be completing this summer which have all the steps
outlined, and that will be in fulfillment of the 1674
requirement of the NDAA 2008.
Mr. Bishop. It was delivered to the committee, or it was
delivered to the Secretary; to whom was it delivered?
Admiral Mateczun. To the committee, sir. And so that may
answer some of those questions.
In terms of being able to reach with 10,000 individuals
that we have, and a fair number of them moving primarily out of
Walter Reed and into both Bethesda and Fort Belvoir, we have
significant resources devoted to try to make sure that we are
letting them know in a timely way where they might be going.
There is a guaranteed placement program available under the
BRAC. We do need all of the workforce that we have today to be
distributed amongst those two hospitals of the future.
The demanding documents themselves, we are in the process
of finalizing coordination within the Department. And so once
those two documents are finalized, we will know each of the
positions at those hospitals, and then we will be able to start
the process of working through who will fill each of those
positions.
Mr. Bishop. What about the equipment; how much of the major
equipment at Walter Reed is going to be utilized at the new
Walter Reed or at Fort Belvoir? And how much additional
equipment is going to be required, have to be procured for each
of those transitions?
Admiral Mateczun. The Army's JTARA team did a review of all
the equipment in the National Capital Region. About $50 million
of the equipment that exists at Walter Reed today of the major
equipment will be reusable within the new facilities. There is
about a $400 million----
Mr. Bishop. Fifty thousand dollars?
Admiral Mateczun. Fifty million dollars.
There is about a $400 million initial outfitting and
transition cost of the two new facilities. Those are included
in the budget that was just--the President's budget that was
just submitted.
Mr. Bishop. So that $400 million includes the movement of
the existing equipment that you will be able to continue to
use, as well as acquisition or the procurement of new equipment
for the new facilities.
Admiral Mateczun. Yes. Our strategy is to have a single
contractor that does all of that, which is the norm out in the
civilian world today.
Mr. Bishop. What is the planned disposition for the
existing facility there on 14th Street?
Admiral Mateczun. Sir, I would have to go to the Department
and get an answer. I believe that the BRAC law requires that
the facilities be turned over to the General Services
Administration, and that the General Services Administration
make disposition.
Mr. Bishop. Will it be part of your budget to do the
cleanup and disposition, or that will be totally--normally
under BRAC we have to do some cleanup. That is under the
military construction bill. Usually there is a significant lag
time for the cleanup, but it has to be budgeted and
implemented, and, of course, it has to be paid for.
Admiral Mateczun. Yes, sir. The business plan details on
that I don't know. I am not responsible for executing the
closure of Walter Reed. The move-out, I am responsible for it.
But we will take that and come back with an answer for you.
[The information follows:]

The Army is responsible for the disposition and cleanup of the
existing Walter Reed Army Medical Center (WRAMC). Current plans call
for a Federal to Federal transfer of the 113 acres of WRAMC main post.
The General Services Administration (GSA) has requested 34 acres and
the Department of State the remaining 79 acres. The Department of State
has recently amended their request asking for only 18 acres. The Deputy
Assistant Secretary of the Army for Installations and Housing is
working with GSA to see if GSA is interested in amending their request
for the now remaining 61 acres. If no interest is found, the 61 acres
will be declared surplus.
The extent of clean up is partially dependent on the future use of
the facility (e.g. Federal tenants vice non-Federal tenants). However,
regardless of who the future owners will be, DoD must terminate its
Nuclear Regulatory Commission (NRC) license. The current estimate is
approximately $14M to decommission all locations where radiological
substances have been used and terminate the NRC license in order to
release all buildings for unrestricted use. Estimates were based on the
NRC-required Decommissioning Funding Plan of 2005.

Mr. Bishop. Thank you.
Thank you, Mr. Chairman.
Mr. Murtha. Mr. Hinchey.

REMARKS OF MR. HINCHEY

Mr. Hinchey. Thank you, Mr. Chairman.
And I want to thank you both for all the important work
that you do and the way in which you oversee all the work that
a lot of other people do. But as we know, no matter what we do
and how focused we are on it, nothing is perfect. There are a
lot of issues that come up and a lot of problems that result. I
know particularly over the last couple of years, you have
really been doing a lot of really good work.
We have all had experience within the last few years of
constituents of ours coming back from situations in Iraq and
elsewhere and the consequences that they face. And in one
particular case--more than one, but I have one in mind
particularly because of the very dire circumstances. The guy
was almost killed, but because of the very good medical
attention he got instantly in Iraq and in Germany, and then
over here it declined, but nevertheless he has improved
significantly, but there has been declining attention that has
been focused on him. And I think that the circumstances there
are that somebody who is no longer going to be functional in
the context of the military, or maybe not even particularly
functional in any context, may not be getting attention. And so
I think that is something we really need to look at.

MEDICAL MALPRACTICE

There is another aspect, too, I just wanted to draw
attention to, and that is back in the 1950s, maybe 1953, where
the issue of medical malpractice was dealt with in a way that
made--or eliminated responsibility, frankly, for medical
malpractice. So we know that in the human context, no matter
what we are doing, even in military and maybe even more so in
military situations because of the tough circumstances that we
have to experience in the military from time to time, that it
may be more likely for military people to get disease, get
normal kinds of things that anybody is subject to. And whether
or not that is true, we know that at least it is going to be
average for human beings, for normal people.
And what I have seen happen is that people who get sick,
including specific dire elements like cancer, are not attended
to effectively, and in some cases, even as I have seen the
presence of cancer in people, even though the evidence of it is
so apparent, has not been dealt with, not been admitted to, not
been addressed in any way. So I am just wondering what you
might be thinking about this.
I think that there are some things that we have to do here
in the Congress to deal with this more effectively, and I just
wonder what you may be thinking, particularly with regard to
trying to as much as possible eliminate medical malpractice. We
have not been able to do that, eliminate medical malpractice,
in the normal medical circumstance for citizens, in normal
hospitals and anyplace across the country. And I am from New
York, and we haven't been able to do it there.
But this is something that I think needs attention, and I
think that the situation of medical malpractice may be worse in
the military than it is out in the general public. And I am
just wondering what you think and what we need to do to address
that problem.
Admiral Mateczun. Congressman Hinchey, I will respond in
some background ways, tell you what we are doing in the
National Capital Region and what is happening in the military.
The malpractice rates, I think, in the military are not
higher than they are out in the civilian world. There are
statistics that go back years that take a look at the
denominator of all the practice and the number of cases where
we have actually made a settlement or reported somebody to the
National Practitioner Data Bank.
I think the route to quality, the route to improvement is
by reducing variation particularly in the way we practice, and
elevating the standards so that here in the Capital Region, for
instance, as we take a look at working across all of the
hospitals and clinics that we have--I will just take a
procedure, conscious sedation, what you get when you go to the
dentist, or when you are getting a colonoscopy or other
procedures, can be done in 37, if not 57, different ways just
in a couple of facilities. So one of the ways to improve is to
make sure that we are doing it all the same way in an evidence-
based way across all of those clinics that we have within the
NCR, just as a quick example of how we might be able to, in an
integrated delivery system, provide the care that these
beneficiaries need.
Also we need to integrate that care consistently across
them. So cancer care needs to be the same no matter what your
entry point is into the system. So just a couple of examples on
how to improve care.
General Volpe.
General Volpe. Yes, sir. Thank you.
There are a few things that I think are fairly inherent to
our military health system in all of the services, and that is
between our fairly strict recruiting standards, our graduate
medical education programs are second to none, and that is
pretty much shown out on national board examinations in various
specialty areas. And all of our physicians and clinicians do a
magnificent job in leading the Nation in those scores. And our
credentialing processes and procedures and maintenance of
certification is also second to none throughout our system.
So from a quality aspect of the clinician that is in the
military, we believe this is the best quality system there is,
and I believe that is one of the reasons why Admiral Madison
mentioned that our malpractice rate is less than what it would
be in the general population.
Mr. Hinchey. So do you think, as it is out in the rest of
the country, that the people who deliver health care within the
military context should be held accountable for medical
malpractice escalations?
Admiral Mateczun. They are held accountable for medical
malpractice escalations.
Mr. Hinchey. They are not held legally accountable.
Admiral Mateczun. The providers have the same actions taken
against them.
You may be referring to the Feres doctrine.
Mr. Hinchey. Yes.
Admiral Mateczun. Feres doctrine is beyond my expertise in
answering the questions. I think we would be glad to take it
back and get a written response back to you.
[The information follows:]

The Feres Doctrine is a legal doctrine that prevents Service
members who are injured as a result of military service from filing
claims against the federal government under the Federal Tort Claims
Act. However, as stated below this does not mean that providers in
military treatment facilities are not held responsible for care
provided.
The Department of Defense (DoD) Military Health System (MHS) holds
medical practitioners responsible for care provided. Even though they
are not financially liable, their continued eligibility to practice
medicine is at risk. There are several layers to the practitioner
quality assurance program.
When a MHS beneficiary experiences an unanticipated outcome or
adverse event, risk management and patient safety subject matter
specialists collaborate to identify, analyze, and appropriately report
these events. Processes are in place (for example, incident reporting
and occurrence screens) to identify adverse events. Immediate action is
taken to ensure patients, staff, and visitors are protected from
additional injury and minimize the untoward effects of the event.
Every healthcare adverse event involving a MHS patient (Active Duty
Service member or other TRICARE beneficiary) is reviewed whether or not
harm occurs to the patient. The risk manager, patient safety officer,
senior clinical staff, and MTF attorney, if available, will collaborate
to determine the appropriate investigative processes for the adverse
event. An adverse event that resulted in harm to the patient and
presents a possible financial loss to the Federal Government (a
malpractice claim or death/disability payment) is referred to as a
potentially compensable event (PCE) and is investigated by the Risk
Management Program. Significantly involved providers are identified and
informed that a review of the PCE will take place.
A standard of care (SOC) review is conducted on the event in
question with all significantly involved providers being considered.
The SOC investigation includes a professional review of the care with a
determination as to whether the SOC was ``met'' or ``not met.'' Claims
of alleged malpractice filed under the Federal Tort Claims Act, the
Military Claims Act, or the Foreign Claims Act (Title 10 U.S.C.,
Chapter 163) (reference (c)), or death or disability payments are
documented, tracked, and analyzed to determine contributory causes.
Every alleged malpractice claim and every death or disability of a
military member as a result of healthcare services includes a SOC
determination for each significantly involved practitioner.
If a malpractice payment is made, or a death/disability payment
related to healthcare is awarded, the Surgeon General will ensure a
thorough and unbiased review of the facts of the case to determine if
any of the significantly involved healthcare practitioner(s) did not
meet the SOC. Reasonable cause to initiate an adverse privileging
action includes, but is not limited to, a single incident of gross
negligence, especially if it causes death or serious bodily injury, a
pattern of inappropriate prescribing, a pattern of substandard care,
abuse of legal or illegal drugs, and significant unprofessional
conduct.
Our MTFs' SOC reviews, Risk Management Program, provider
credentialing, and privileging and adverse actions meet the
accreditation standards of the Joint Commission or the Accreditation
Association for Ambulatory Health Care.

Mr. Hinchey. If someone experiences medical malpractice,
and they get seriously ill and even die, they, if they are
still alive, or their family after they die cannot legally hold
accountable the instrumentation of medical malpractice that
caused the serious illness or the death.
Admiral Mateczun. Yes, sir. We, I think, looking at it from
our side, on the provider side, look at the compensation that
they get. I am not an expert on it. I can tell you that as
providers, we do hold them accountable. If they have had
malpractice, they are reported to the National Practitioner
Data Bank, and their privileges are removed or changed.
Mr. Hinchey. Thank you. It is something we need to pay
attention to. I thank you very much.
Mr. Murtha. Well, now, without objection, we go to Mr.
Moran.

PLAN FOR MOVING MEDICAL FACILITIES

Mr. Moran. Thank you very much, Mr. Chairman.
As the panelists know, you required a comprehensive report
to be delivered to this subcommittee so that we could have some
confidence that the move from the three medical facilities into
the two medical facilities would be done not just on time,
which is not our major concern, but would be done right.
Now, we got late, very late, the report yesterday, within
the last couple of days. Was it yesterday? Anyway, it was just
a short while ago. But nevertheless, our superb staff,
particularly Mr. Horner, has gone through it. But it is not
adequate, it is not a comprehensive plan. What we were looking
for is what steps need to be taken by when so that you can get
this done without our warriors being adversely impacted by the
move. And you gave us this broad picture without adequate
specificity.
I think you may want to have your staff talk to Mr. Horner,
and he will tell you what it is we envision. We thought it was
clear. But, for example, we would like to know how much it is
going to cost. One of the things that concerns us is that BRAC
in 2005 had a number of cost estimates, costs saved, and what
it would cost us, and all of those estimates have been wrong,
all of them. It said that it would cost $20 billion, and now we
are told it is $32 billion. It said that we would save $36
billion, and now we are told we are lucky if we save $4 billion
annually. That was the broad picture. There are 230 locations
as a result of BRAC that have to be completed, and we are being
told they are all going to be completed within the last 2 weeks
of September 2011, including the realignment of Walter Reed
Hospital. So you are going right up to the deadline. There is
no plan B, and that is the concern of the committee and has
been all along.
Now you can, first of all, respond, would the original
savings and payback period from the transition to Walter Reed,
are those numbers still accurate, the cost and the savings?
Admiral Mateczun. No, sir.
Mr. Moran. No, they are not. Do you have new numbers?
Admiral Mateczun. Yes, sir. We can provide those to you.
The COBRA estimates were not anywhere near what this project is
going to cost.
Mr. Moran. Well, Mr. Chairman, so here we are again. The
BRAC estimates were nowhere near what it is actually going to
cost us and what savings are going to be achieved. But again,
we asked for a report; those numbers are not in the report.
I don't want to give you a hard time, because I know you
were given an impossible mission, and to some extent you are
the messenger of what we expected would be bad news in terms of
adequate implementation. But that report was supposed to
include cost estimates. So now, yes, we do need those cost
estimates to be provided--this is a the committee that provides
the money. We don't want to be told at the 11th hour, unless
you give us all this extra money, we can't get it done. So,
yes, we need those estimates.
Can you tell us----
Mr. Murtha. Let me reinforce what the gentleman is saying.
I went to the BRAC hearings. I very much opposed to closing
down Walter Reed. Well, I lost that battle, but I remember
distinctly they said it would cost $232 million to close it
down. That was the figure that they gave. Principi, who was the
Chairman, said the same thing: He was concerned about it. All
of us were concerned about it. But over and over from the
Defense Department we get inadequate figures, and then the
taxpayer has to pay. Something happens, you come to us,
representing the taxpayer, we do, and then we have to fork over
money which we didn't anticipate, which then makes it very
difficult to solve our budget problem.
So you need--and I told the Secretary of Defense this
yesterday--you need to go back and start to get accurate
figures for us so that we have a better estimate of how we can
put a budget together. For instance, there was a $2\1/2\
billion shortfall in personnel costs. We have two or three
hearings, two or three meetings in addition to the hearings
about the military shortfall, we couldn't get it until the last
minute exactly what those figures were.
Now, we have 15 people on our staff. It is impossible for
us to have oversight, so we depend on you to give us that kind
of information so that we can put together a logical budget.
So with that, I yield back to Mr. Moran.

ACCESSABILITY TO FACILITIES BY PERSONNEL

Mr. Moran. Thank you, Mr. Chairman.
We have some problems. I know you are supposed to be
looking at this, but I know they seem minor. The personnel, the
employees at these facilities. One thing, for example, it is at
a Metro stop at Bethesda. There is no Metro stop where they are
going at Fort Belvoir. Have any of them been notified as yet
where they will be going within a year and a half?
Admiral Mateczun. No, sir. Until we have the actual manning
documents themselves, which are 3,000 people, 3,200 people out
at Fort Belvoir, 6,000 at Bethesda, we can't say this is the
spot you are going to.
I can tell you in general the vast majority of civilian
personnel will be accommodated where they would like to be. We
surveyed the workforce at Walter Reed. Approximately 10 to 15
percent of them plan on taking retirement or some other BRAC-
related eligibility, which would remove them from the
workforce, and we estimate in our last run-through--this is a
preliminary number--90 percent of the them would be able to
stay north where they needed or if they wanted to stay north;
i.e., at the Bethesda campus. We need to incentivize the other
personnel, if we need to, to go down to Fort Belvoir, although
Colonel Callahan has been doing a great job in recruiting
people to come down there as part of the workforce.
Mr. Moran. I appreciate that, but I need to underscore this
again. We have a year and a half. None of the people have been
told where they are going. Most of them are going to Fort
Belvoir, but most in Bethesda want to stay in Bethesda, and you
are telling them they can't. You are also telling us that 15
percent of them were going to drop out and take retirement. We
have expanded facilities, we have a greater need for personnel,
and yet 15 percent them are going to leave.
Our concern is the quality of care provided to the
residents, the patients. So I don't know how you are going to
get the new people to staff these expanded medical facilities
when 15 percent have already notified you they are leaving, and
the majority at Bethesda are going to stay at Bethesda when
most are supposed to be going to Fort Belvoir.
I know my time is up, but these are issues that we need
resolved, and you have been given an impossible task. The
problem is the subcommittee made it clear this is impossible.
And if the highest priority is the care of the patients, then
we are going to fall short. And now we have a year and a half,
and we are very much concerned that inadequate planning and
certainly the estimates we demanded have not been provided, and
they need to be.
Thank you, Mr. Chairman.
Mr. Murtha. Mr. Young.

COMBINING ARMY AND NAVY HOSPITALS

Mr. Young. Mr. Chairman, thank you very much.
In following the same line that Mr. Moran has initiated,
General Volpe, you said that you had the two hospitals, and you
don't have to respond to this, but my question is is one of
them a Navy hospital, or is one an Army hospital, or are they
both hybrid?
General Volpe. Sir, we have the approval from the
Department that both of these facilities will be joint. They
will be placed on a joint table of distribution, which is a
document that allows the commander of that facility to be
responsible for all the people that are working in that
facility regardless of what service that they are in. So we are
able to get unity of effort through unity of command in those
facilities and have one person responsible for the good, the
bad and ugly that occurs in that facility.
Mr. Young. You said, General, that two hospitals are
jointly staffed, jointly managed and jointly governed. Somebody
has to be in charge. When it is jointly, who is in charge?
General Volpe. Sir, there will be a commander that is
selected. It will either be by a rotational basis or nomination
basis that is yet to be determined, but we have to work with
the services on that process to do that. It will be under the
operational control of JTF CapMed.
Mr. Young. Will there be a super commander that would be in
charge of both facilities, Fort Belvoir and Bethesda?
Admiral Mateczun. Yes, sir. That is the joint task force.
Mr. Young. Do we know who that is?
Admiral Mateczun. That is me, sir.
Mr. Young. And then each hospital will have a commander?
Admiral Mateczun. Yes, sir.
Mr. Young. Will Army and the Navy share those roles?
Admiral Mateczun. That is one of the options, yes, sir,
either to do it on a rotational basis or a nominative basis
like all their joint positions.
Mr. Young. Outside of the normal grumbling that takes place
at any kind of merger whether it is military, civilian,
political, whatever, and I am sure you have heard some of that,
Mr. Moran has indicated some, is the merger going well, is it
on track?
Admiral Mateczun. Yes, sir, it is. And I would like to say
that our concern, our primary concern, is and will always be
the health care that we deliver. If we were not able to meet
any of the deadlines that we think are out there, I would have
no hesitancy about telling you about that and asking for your
help.
Mr. Murtha. Let me just interrupt Mr. Young. We need you to
give us a plan.
Now, first time I heard we would have 35 different
installations. My wife told me the other day, look over there,
that is going to be part of the new Walter Reed. I didn't know
that. I mean, I had no idea. It is along 95.
She may be wrong. She is not wrong very often, but you
know, the wives talk to each other. And I don't say she is
wrong, she is probably right. But the point I am making, we
need to see what you are going to do here and what it is going
to cost. That is what we need.
Now, we shift money to military construction, in many
cases, because they need the money. So give us a plan so that
we can live with it and figure out, in increments, what needs
to be done.
Because what Mr. Moran is worried about is not going to
happen--I mean it is going to happen as he predicts, unless you
have the funding that is necessary in order to implement this.
And all of us want to do the same thing. All of us want to have
the money that is necessary for the troops to make sure there
is care for not only the troops coming back, the troops that
need care that have been back, and also the retirees, because
there are so many of them in this general vicinity.
Okay, that is it. Without objection, the committee adjourns
until after the recess.
[Clerks note.--Questions submitted by Mr. Bishop and the
answers thereto follow:]

Question. LTG Schoomaker, you stated in your opening statement that
``fractured relationships not PTSD account for a majority of the
numerous suicides in the U.S. Army;'' however, how can you be sure? Has
an extensive study been done on the impact PTSD has on relationships
and on families? If so what are the results?
Answers. Completed suicide is one of the leading causes of death
among U.S. Soldiers, and suicide behaviors lead to unnecessary Soldier
and family suffering. Based on our own data and what has been published
in the peer reviewed literature, relationship issues are a very
important factor in suicides. According to the most recent published
DoD Suicide Event Report (DoDSER), 50% of individuals who committed
suicide in 2007 had a failed spousal relationship (15% had a failed
``other'' relationship). By contrast, since 2003 only 5.5% of
individuals who committed suicide had a medical encounter with a
diagnosis of post traumatic stress disorder (PTSD).
According to analyses of Army suicides conducted by the Army's
Center for Health Promotion and Preventive Medicine, there were 650
potential Army suicides from 1 Jan 2003--15 Apr 2009. Overall, 273/650
or 42% had a record of an outpatient encounter for a behavioral health
diagnosis. Of the 650 suicides since 2003, 36 (5.5%) had a record of an
outpatient encounter with a diagnosis of PTSD. That is very similar to
the overall percentage of Soldiers with PTSD. Adjustment disorders
(20.6%), mood disorders (17.7%), and substance abuse (16.3%) were the 3
most common categories of outpatient behavioral health encounters among
those who committed suicide.
Intuitively, the notion that premorbid psychological/marital
status, PTSD, suicide, and family pathology are intimately connected
seems reasonable. PTSD is also thought to disturb the family system in
those Families with good premorbid adjustment and to exacerbate
pathology in those Families with maladaptive premorbid adjustment.
These disturbed family interactions can increase the distress
experienced by service members suffering from PTSD. Chronically
increasing distress on the part of the service member may then cause
increased family disturbance, and a downwardly spiraling vicious cycle
results. The inability to escape this cycle may be a contributor to
suicidal behaviors, especially among members with limited coping skills
due to psychopathology and/or cognitive limitations. Although PTSD may
be a contributing factor to the increase in suicides, by itself it does
not explain the rising rates.
Question. LTG Schoomaker, on page 9, of your written testimony for
record you state that the Chief of Staff of the Army, General Casey,
has identified several shortcomings in his own Army health experience
and that the ``Army does not routinely assess all the elements of
weilness, fitness, and human performance, other than the physical.''
Part of wellness is mental fitness. Mental fitness is compromised
during PTSD. You have admitted that the Army does not routinely assess
weliness or mental health in your testimony. How can you say that PTSD
and suicides are not related?
Answer. Historically, the Army did not routinely assess all the
elements of wellness, fitness, and human performance, other than the
physical. We identified this as a shortcoming and have been developing
a new approach to total fitness. On October 1, 2008 the Army
established the Comprehensive Soldier Fitness Program with a mission to
develop and institute a holistic, resiliency-building fitness program
for Soldiers, Families, and Army civilians. The program focuses on
optimizing five dimensions of strength: Physical, Emotional, Social,
Spiritual, and Family. This holistic approach to fitness will enhance
performance (capability) and build resilience (capacity) of the Force
in this era of persistent conflict and high operational tempo.
PTSD may be a contributing factor to the increase in suicides, but
by itself it does not explain the rising rates. While this disorder
draws significant media attention, it is only one of many behavioral
health diagnoses that impact Soldiers and their Families. According to
analyses of Army suicides conducted by the Army's Center for Health
Promotion and Preventive Medicine, between 2003 and April 2009, a total
of 650 potential suicides were committed by Army personnel. Overall,
273/650 or 42% had a record of an outpatient encounter for a behavioral
health diagnosis. Of the 650 suicides since 2003, 36 (5.5%) had a
record of an outpatient encounter with a diagnosis of PTSD. That is
very similar to the overall percentage of Soldiers with PTSD.
Adjustment disorders (20.6%), mood disorders (17.7%), and substance
abuse (16.3%) were the 3 most common categories of outpatient
behavioral health encounters among those who committed suicide.
Question. LTG Schoomaker, on page 9 of your testimony you state
that ``The Army does not always link available life skills and
performance programs and interventions with Soldiers and Families until
the need has been demonstrated by a negative behavior. And the Army
does not teach Soldiers about the potential for post traumatic growth,
nor give Soldiers the opportunity to validate their post traumatic
growth during Post Deployment assessments.'' If the Army does not teach
nor give Soldiers the opportunity to measure post traumatic growth or
the lack of growth, how can you state before this committee that Post
traumatic Stress Disorder (PTSD) is not related directly or indirectly
to suicides? Your opening statement and your written statements
contradict themselves and cause serious concern about the thoroughness
that the Army is approaching the suicide epidemic within its ranks.
What is your plan to start looking at PTSD and its relationship to
suicides and the strain that PTSD puts on families? Please submit for
record your plan and the results of any study done concerning PTSD and
suicide.
Answer. Suicide is a tragic event and the Army is making a
concerted effort to provide a holistic approach to address the
increasing number of these events. Under the direct leadership of Vice
Chief of Staff of the Army (VCSA), General Peter Chiarelli, the Army's
holistic approach addresses not only suicide, but the underlying issues
and factors that may contribute to the problem, including post
traumatic stress. In March 2009, the VCSA established and chartered the
multi-disciplinary Suicide Prevention Task Force. In April 2009 the
Task Force published the Army Campaign Plan for Health Promotion, Risk
Reduction, and Suicide Prevention. This Campaign Plan puts the Army on
an aggressive schedule to address about 250 tasks related to doctrine,
organization, training, materiel, leadership, personnel, and
facilities. The plan also gives installation, garrison and military
treatment facility commanders a checklist of items to guide immediate
improvements in programs and services for Soldiers based on best
practices gleaned from installation visits. Field commanders
immediately notify the VCSA of every suspected suicide. He conducts a
monthly review on every Soldier suicide with commanders and a Senior
Review Group. The review challenges leaders and helps to share lessons
learned to improve outreach efforts for Soldiers. This recurring review
ensures the Army maintains an intense focus at the highest levels of
leadership and allows for sharing information and learning from
individual cases.
On October 1, 2008 the Army established the Comprehensive Soldier
Fitness (CFS) Program with a mission to develop and institute a
holistic, resilience-building fitness program foroldiers, Families, and
Army civilians. The program focuses on optimizing five dimensions of
strength: Physical, Emotional, Social, Spiritual, and Family. This
holistic approach to fitness will enhance the performance (capability)
and build resilience (capacity) of the Force in this era of persistent
conflict and high operational tempo. One goal of the CSF program is to
enhance post-traumatic growth.
The Army is working closely with some of the Nation's foremost
experts on suicide prevention, to include the National Institute of
Mental Health, to ensure their efforts reflect the most current mental,
behavioral and psychological health research and treatments. This five
year, longitudinal study will help identify modifiable risk and
protective factors associated with suicide, mental disorders, and
psychological resilience, by evaluating Soldiers across all phases of
Army service. The goal of the study is to identify intervention options
based on empirically-identified risk factors.
In March 2009, the Office of the Surgeon General engaged the RAND
Arroyo Center to design and carry out a longitudinal study of Army
families. This study, currently in the design phase, will recruit and
follow 3000 married Soldiers and their Families across all phases of
deployment. The objective is to assess the impact of deployment on Army
families by measuring several outcomes including health, marital and
family functioning, and child wellbeing. The study is due to begin in
the fall 2009 (following receipt of all necessary approvals and
information for recruitment) and will gather data regularly over three
years. Findings from the first wave should be available by early 2010.
Question. Ms. Embrey has stated that doctors can prescribe whatever
treatment they desire if they believe that it would help the service
member. In a previous appearance before this subcommittee she noted
that alternative treatments such as yoga were being utilized to help
treat patients. Why is there a resistance among the various service
Surgeon Generals against the use of the hyperbaric chamber to treat
Traumatic Brain Injury (TBI)?
LTG Roudebush's Answer. The Air Force Medical Service is open to
new and progressive treatments for those with TBI; however, the
Department of Health and Human Services has not yet approved HBOT
hyperbaric chamber (HBOT) therapy for the treatment of traumatic brain
injury (TBI) as a covered condition, due to the lack of supporting
evidence for its clinical efficacy. There is some evidence that this
treatment may improve survival in those with serious TBI although there
is no evidence yet that HBOT improves functional outcomes in acute
severe TBI. Overall, based on a thorough review of all available
scientific information, there does not appear to be adequate support
for the recommendation of HBOT in the acute or chronic management of
individuals with TBI. As a result, HBOT is not currently considered the
standard of care for TBI. The Defense Center of Excellence for
Psychological Health and TBI issues is sponsoring a large, multi-site,
randomized clinical trial with Food and Drug Administration
investigational new drug to answer the question of HBOT (hyperbaric
chamber) efficacy. We are fully engaged with the Defense Center of
Excellence in order to initiate this effort as soon as possible and
look forward to the outcomes. There are also two other Defense
Department level pilots studies that have recently begun. These and
future studies will assure that we are utilizing safe and effective
treatments for our patients with TBI.
Question. Ms. Embrey has stated that doctors can prescribe whatever
treatment they desire if they believe that it would help the service
member. In a previous appearance before this subcommittee she noted
that alternative treatments such as yoga were being utilized to help
treat patients. Why is there a resistance among the various service
Surgeon Generals against the use of the hyperbaric chamber to treat
Traumatic Brain Injury (TBI)?
LTG Schoomaker's Answer. I am very supportive of conducting high
quality clinical trials to determine the effectiveness of hyperbaric
oxygen therapy (HBOT) for traumatic brain injury (TBI). According to a
review of the medical literature, the clinical evidence remains
insufficient to prove effectiveness of HBOT for TBI. The Department of
Health and Human Services has not approved use of HBOT for the
treatment of TBI as a covered condition due to the lack of supporting
evidence for clinical efficacy. There is evidence from trials in humans
to support that HBOT may improve survival, but not functional outcomes,
in cases of acute severe TBI. There are no high quality clinical trials
in humans of HBOT for acute mild TBI or for sub-acute or chronic
complications from TBI of any severity.
Question. Ms. Embrey has stated that doctors can prescribe whatever
treatment they desire if they believe that it would help the service
member. In a previous appearance before this subcommittee she noted
that alternative treatments such as yoga were being utilized to help
treat patients. Why is there a resistance among the various service
Surgeon Generals against the use of the hyperbaric chamber to treat
Traumatic Brain Injury (TBI)?
Admiral Robinson's Answer. While yoga is an essentially risk-free
activity, there is risk associated with the use of hyperbaric oxygen
therapy (HBOT). This is dramatically evidenced by a chamber fire on May
1, 2009 at Ocean Hyperbaric Neurological Center in Lauderdale by the
Sea that resulted in 90% second and third degree burns to a four-year-
old patient, and the death of his grandmother on May 2, 2009 who
accompanied him in the chamber. This tragedy involved a child being
treated for cerebral palsy, like TBI, a condition for which HBOT is not
a recognized treatment. No validated scientific evidence or peer
community review has established that hyperbaric oxygen is either safe
or effective in the treatment of traumatic brain injury. To this end,
three DoD supported clinical trials are underway and/or under
development to evaluate the feasibility and efficacy of hyperbaric
oxygen therapy for this indication. Scientifically determining whether
hyperbaric oxygen is efficacious in treating traumatic brain injury is
an essential first step in establishing the potential risk/benefit
ratio of this therapy.
Question. I have heard several of the service Surgeon Generals
describe anecdotal reports of success using the hyperbaric chamber to
treat TBI. Please provide the committee a list and report of these
anecdotal successes of the hyperbaric chamber treatments for TBI
treatment and provide a report of your current medically approved
method. What is the status of your medical validation of the hyperbaric
chamber for use as a treatment of TBI? How long has this validation
been underway and how long will it take to complete? Please provide the
committee with these answers.
LTG Roudebush's Answer. The anecdotal reports primarily come from
civilian providers, most notably Dr. Paul Harch at Louisiana State
University. He presented some of his cases at the Defense Center of
Excellence sponsored HBO2 in Traumatic Brain Injury (TBI) Consensus
Conference held in Alexandria, VA, in early December 2008. Dr. Harch
would need to be separately contacted for any details as he has not as
yet published them, at least to our knowledge.
The Air Force Medical Service is open to new and progressive
treatments for those with TBI, however, the Department of Health and
Human Services has not yet approved hyperbaric chamber (HBOT) therapy
for the treatment of TBI as a covered condition, due to the lack of
supporting evidence for its clinical efficacy. There is some evidence
that this treatment may improve survival in those with serious TBI
although there is no evidence yet that HBOT improves functional
outcomes in acute severe TBI. The Defense Center of Excellence for PH
and TBI issues is sponsoring a large, multi-site, randomized clinical
trial with Food and Drug IND to answer the question of HBOT efficacy.
We are fully engaged with the Defense Center of Excellence in order to
initiate this effort as soon as possible and look forward to the
outcomes. There are also two other Department of Defense level pilots
studies that have recently begun. These and future studies will assure
that we are utilizing safe and effective treatments for our patients
with TBI.
Question. I have heard several of the service Surgeon Generals
describe anecdotal reports of success using the hyperbaric chamber to
treat TBI. Please provide the committee a list and report of these
anecdotal successes of the hyperbaric chamber treatments for TBI
treatment and provide a report of your current medically approved
method. What is the status of your medical validation of the hyperbaric
chamber for use as a treatment of TBI? How long has this validation
been underway and how long will it take to complete? Please provide the
committee with these answers.
LTG Schoomaker's Answer. The Defense Centers of Excellence (DCoE)
for Psychological Health and Traumatic Brain Injury sponsored a
consensus conference in December 2009 regarding Hyperbaric Oxygen
Therapy (HBOT) in TBI. Over 60 subject matter experts from the
Department of Defense (DoD), Department of Veterans Affairs (VA), and
academia attended. The DCoE directed the HBOT in TBI Steering Committee
to conduct a clinical research trial to investigate the efficacy of
HBOT for Service members with mild to moderate TBI. The study, titled
``Hyperbaric oxygen applied late after mild to moderate traumatic brain
injury: A prospective multicenter double-blind randomized controlled
trial,'' is anticipated to begin in Aug 2009, pending approval from the
Food and Drug Administration (FDA). Institutional Review Board (IRB)
approval is close to completion. Study completion is anticipated within
18 months. This study is a Phase 3 or definitive clinical trial
intended to answer the important question of efficacy. The entire
project represents a unique ``joint'' approach to rapidly conduct
urgently needed clinical research. The study will enroll 300 active
duty subjects at four DoD clinical HBOT sites (WHMC/Brooks City Base,
TX; Ft Carson, CO; Ft Hood, TX; and Camp Pendleton Marine Base, CA).
Baseline and outcome assessments will be conducted at Ft Carson, CO.
Three complementary ``pilot'' or phase 2 studies are also underway
that could also show efficacy. First, a study by Dr. Lindell Weaver,
LDS Hospital/Intermountain Medical Center, Salt Lake City, UT titled
``Hyperbaric oxygen for brain injury''. This began in 2003 to study the
feasibility of hyperbaric oxygen for patients with persistent chronic
TBI sequelae greater than one year following brain injury. Second, a
study by Dr. Jason Cho, Wilford Hall Medical Center and Brooke Army
Medical Center, San Antonio, TX titled ``Treatment of moderate to mild
cognitive dysfunction caused by TBI with hyperbaric oxygen therapy
(HBOT)''. This study has enrolled 10+ subjects with a target of 50
subjects, 25 treated and 25 sham treated subjects with diagnosis of TBI
and perception of cognitive dysfunction. Third, a study by Dr David
Cifu, Virginia Commonwealth University/Medical College of Virginia
Hospital, Richmond, VA titled ``Hyperbaric Oxygen Therapy (HBO2T) for
Post-Concussive Symptoms (PCS) after mild TBI: A Randomized, Double
Blinded, Sham-Controlled, Variable Dose, Prospective Trial'' is
anticipated to begin in summer 2009 and be complete within six months.
The DoD is committed to rapidly, but safely, determining the
efficacy of HBOT for mild to moderate TBI. Findings from these studies
may warrant a new standard of care for patients with chronic TBI,
justify future research, and change reimbursement policy regarding HBOT
for TBI.
Question. I have heard several of the service Surgeon Generals
describe anecdotal reports of success using the hyperbaric chamber to
treat TBI. Please provide the committee a list and report of these
anecdotal successes of the hyperbaric chamber treatments for TBI
treatment and provide a report of your current medically approved
method. What is the status of your medical validation of the hyperbaric
chamber for use as a treatment of TBI? How long has this validation
been underway and how long will it take to complete? Please provide the
committee with these answers.
Admiral Robinson's Answer. Navy medicine has no anecdotal
information from the use of hyperbaric medicine to treat TBI. There
have been no treatments performed on TBI patients in Navy operational
hyperbaric chambers that have received Navy medicine authorization.
Currents studies include:
1. The Air Force at Wilford Hall has been conducting clinical
trials using hyperbaric oxygen for TBI since January 2009. Air Force is
currently still enrolling subjects. Completion is projected at one year
after initiation but may be delayed due to recruitment difficulties.
2. DARPA has funded a VA Richmond Virginia study headed by Dr.
David Cifu, a nationally recognized TBI expert. It is awaiting final
IRB approval prior to initiation. This study will use the Naval
Operation Medicine Institute hyperbaric chamber facility in Pensacola,
Florida. Start projected August 2009 and completion in one year.
3. Defense Center of Excellence for Psychological Health and
Traumatic Brain Injury is pending final IRB approval for a very large
multicenter study utilizing Navy mobile fly away recompression chambers
and mobile standard Navy double lock chambers placed at Ft Carson, CO;
Ft Hood, TX; and Camp Pendleton Marine Base, CA, in addition to use of
the fixed hyperbaric facility at Brooks City-Base, TX. This study is
currently pending completion of IRB review and is projected to start
mid-August 2009 based on chamber availability. Hyperbaric trials are
expected to be completed in one year's time.
Question. The Army and its integrated healthcare partners and
providers are manned at 60% of the current mental healthcare need.
PTSD, TBI, Mental and Behavioral Health are being treated in variant
ways throughout the DOD, VA, and civilian healthcare systems. There are
currently no mechanisms to control the quality of care, certify the
standardization of patient centric evidence-based best practices, and
knowledge to ensure the integration of culturally competent care by
Physicians and Allied Health Providers. Thus, the service members,
their families, and our veterans are being sub-optimally screened,
diagnosed, treated and managed by mental Healthcare Physicians and
Allied Health Providers. The lack of core universal patient centric
training is resulting in poor outcomes. For example, there are sub-
populations of the military community that may be disproportionately
impacted by PTSD, TBI, Mental and Behavioral Health conditions. It is
critical to recognize that 46% of the Army's enlisted ranks are between
17-25 years of age. This age range is medically classified as
adolescence (10-25 years) and will require Mental Healthcare Physicians
and Allied Health Providers to be uniformly trained in the age
appropriate related care management. Does the military have providers
trained to look at this age group? Does the military provide cultural
competency training for its providers so that they can recognize
cultural traits that impact the diagnosis of PTSD or TBI?
LTG Roudebush's Answer. It's an excellent point that a large
percentage of military members are between 18 and 25 years of age. In
fact, 38.9 percent of active duty Air Force members are below the age
of 26, including 45.2 percent of our enlisted force. The American
Psychiatric and Psychological Associations, as well as the National
Association of Social Workers, have stated that there is a critical
shortage of child and adolescent mental health providers in the United
States. Currently 10 percent of Air Force psychiatrists are Child and
Adolescent Fellowship trained, while all our psychiatry residents
receive child and adolescent training and are licensed to provide care
to this age group. The majority of active duty clinical social workers
receive Air Force facilitated age appropriate training throughout their
careers as part of their annual continuing medical education, as well
as age appropriate training being part of their graduate degree
programs. Active duty clinical psychologists are trained in child and
adolescent treatment as part of their post-doctoral internships, and we
have fellowship trained child psychologists serving in our Educational
and Developmental Intervention Services program sites.
All Council on Social Work Education accredited graduate schools
must include course work in cultural diversity as well as being
considered a core competency for clinical social workers. The American
Psychological Association also requires all accredited graduate degree
programs to include course work in cultural diversity.
In general, civilian accreditation agency guidelines such as the
2008 Joint Commission require staff participation in education and
training specific to the needs of the patient population served by the
medical facility whether inpatient or outpatient. The patient
population is inclusive of all age groups and addresses cultural
diversity of patients and staff members.
Other means of training include professional standards of practice,
licensure, certification, and continuing education. Pre-deployment and
cultural specific orientation programs help familiarize deploying
medical members prior to arriving ``in-country''.
Recognition, diagnosis, and care of all patients returning with
possible PTSD or TBI are a high priority of military medical staff.
Pre- and Post-Deployment Health Assessments are required for all
deploying personnel and are reviewed closely. Additionally, multiple
education and training initiatives have been initiated for medical
staff to more rapidly recognize PTSD or TBI and provide timely and
appropriate care for our returning warriors.
Question. The Army and its integrated healthcare partners and
providers are manned at 60% of the current mental healthcare need.
PTSD, TBI, Mental and Behavioral Health are being treated in variant
ways throughout the DOD, VA, and civilian healthcare systems. There are
currently no mechanisms to control the quality of care, certify the
standardization of patient centric evidence-based best practices, and
knowledge to ensure the integration of culturally competent care by
Physicians and Allied Health Providers. Thus, the service members,
their families, and our veterans are being sub-optimally screened,
diagnosed, treated and managed by mental Healthcare Physicians and
Allied Health Providers. The lack of core universal patient centric
training is resulting in poor outcomes. For example, there are sub-
populations of the military community that may be disproportionately
impacted by PTSD, TBI, Mental and Behavioral Health conditions. It is
critical to recognize that 46% of the Army's enlisted ranks are between
17-25 years of age. This age range is medically classified as
adolescence (10-25 years) and will require Mental Healthcare Physicians
and Allied Health Providers to be uniformly trained in the age
appropriate related care management. Does the military have providers
trained to look at this age group? Does the military provide cultural
competency training for its providers so that they can recognize
cultural traits that impact the diagnosis of PTSD or TBI?
LTG Schoomaker's Answer. I respectfully dispute the allegation that
we do not have mechanisms to control the quality of care, certify the
standardization of patient centric evidence-based best practices, or
knowledge to ensure the integration of culturally competent care. The
Army Medical Department Center and School (AMEDD C&S) provides training
that includes instruction by the foremost experts in the field of Post
Traumatic Stress Disorder which include Dr. Foa and her team providing
insight regarding Prolonged Exposure; Dr. Resick and her team with a
focus of expertise in Cognitive Processing Therapy; and Dr. Silver and
his team who provide training for providers on Eye Movement
Desensitization & Reprocessing. These experts provide ongoing
consultation for the AMEDD C&S instructors and selected students
currently being trained to become subject matter experts (SME) in
evidence based research practices for the Army. The treatment protocols
being used and taught have been identified as proven evidence-based
therapies by the American Psychiatric Association and American
Psychological Association and are approved clinical practice guidelines
of the Departments of Veterans Affairs and Defense. These patient-
centric, evidence-based practices are being widely used in the Army,
the Veterans Health Administration, and across the Department of
Defense. These three treatment protocols have proven to provide solid
research outcomes for effective treatment of trauma injuries of
patients from diverse backgrounds and age-groups.
The AMEDD C&S provides the most up-to-date, current, and effective
on-line training addressing the issues of PTSD and Trauma Brain Injury
(TBI). This training is required for all social workers and nurses, and
is also available to all medical providers. This Distributive Learning
product includes 12 modules that are readily available and located on
the Military Health System (MHS) learning portal. This portal has
modules addressing issues related to PTSD and families; general cross-
cultural considerations; and PTSD training for the Primary Care
Clinician. This training is a required pre-requisite for behavioral
health personnel to attend formal clinical training.
The behavioral health professional working in the Army is
accustomed to working with the 17-25-year-old Soldiers. The percentage
of Soldiers in this age group is not a new phenomenon. It is not
unusual for providers to adjust their assessment and treatment
interventions to various age groups based on their training. Even
though age, culture, at risk populations, and trends are addressed in
the AMEDD C&S curriculum, the curriculum developers are consistently
and continually reviewing current literature and tapping the extensive
knowledge base provided by their consultants for ways to improve
courses and programs. Our curriculum is systematically updated to
incorporate lessons learned, new processes and approaches, and
adjustments to ensure age-appropriateness of the content and teaching
methodology. The AMEDD C&S is in the process of assessing and
evaluating numerous courses to determine whether or not there is a need
to create formal uniform lesson plans to specifically focus on the 17-
25 age group.
Lastly, the Army Medical Department has a process to ensure
credentialing of medical treatment facilities (MTF) responsible for
providing clinical experiences of students. Much of the accreditation
responsibility rests with each MTF and includes ensuring that providers
are credentialed based on age competency levels. Supporting
documentation such as diplomas, licensing certificates, letters of
recommendation, and proof of training are required. This requirement
supports our declaration that our Soldiers and their Families are
receiving the best treatment possible from qualified staff.
Question. The Army and its integrated healthcare partners and
providers are manned at 60% of the current mental healthcare need.
PTSD, TBI, Mental and Behavioral Health are being treated in variant
ways throughout the DOD, VA, and civilian health care systems. There
are currently no mechanism to control the quality of care, certify the
standardization of patient centric evidence-based best practices, and
knowledge to ensure the integration of culturally competent care by
Physicians and Allied Health Providers. Thus, the service member, their
families, and our veterans are being sub-optimally screened, diagnosed,
treated and managed by mental Healthcare Physicians and Allied Health
Providers. The lack of core universal patient centric training is
resulting in poor outcomes. For example, there are sub-populations of
the military community that may be disproportionately impacted by PTSD,
TBI, Mental and Behavioral Health conditions. It is critical to
recognize that 46% of the Army's enlisted ranks are between 17-25 years
of age. This age range is medically classified as adolescence (10-25
years) and will require Mental Healthcare Physicians and Allied Health
Providers to be uniformly trained in the age appropriate related care
management. Does the military have providers trained to look at this
age group? Does the military provide cultural competency training for
its providers so that they can recognize cultural traits that impact
the diagnosis of PTSD or TBI?
Admiral Robinson's Answer. By providing decentralized, primary
care-centric, and multi-disciplinary healthcare services, Navy
Medicine's psychological health (PH) program reduces Mental Health
stigma, establishes and supports evidenced-based best practices, and
ensures culturally competent healthcare practices. Utilizing a
Deployment Health, readiness-based model understandable to all service
members irrespective of age, Deployment Health Clinic providers
involved with warrior care are provided supplemental training to help
reduce stigma, foster cultural tolerance, and offer evidenced-based
practices. Navy Medicine does employ mental health providers
specifically trained in child and adolescent care. Navy Medicine is
profoundly aware of the additional challenges related to the healthcare
needs of the 17-25 year age group--inclusive of higher suicide risk,
motor-vehicular accident rate, and substance abuse predilection; and
contributes regularly to these efforts through line-sponsored Cross
Functional Teams. Fiscal Year 2008 saw the establishment of the Navy
Operational Stress Control (OSC) program. Navy Medicine is actively
supporting this line-owned program to build resilience and reduce
mental health stigma across the broader Navy/Marine Corps culture,
including various training programs that address age, ethnic and
socioeconomic differences as well as various provider-specific training
programs. Cultural Diversity is a CNO initiative. Navy Medicine
augments these efforts in two ways: (a) Education and training for
individual Sailors and Marines that normalizes MH care and appreciation
of cultural diversity across the military and civilian population, and
(b) education and training for healthcare providers that establishes
evidence-based practices and supports cultural diversity.

[Clerk's note.--End of questions submitted by Mr. Bishop.
Questions submitted by Mr. Murtha and the answers thereto
follow:]

Question. It is the Committee's understanding that there is a
national shortfall of psychiatrists and other mental health providers.
Is the Department of Defense (DoD) utilizing web-based clinical
mental health resources to help compensate for this personnel
shortfall?
Answer. The DoD has several ongoing initiatives to address web-
based technologies. On June 1, 2009, TRICARE Management Activity (TMA)
issued a contract modification to its three Managed Care Support
Contractors, identifying a 60-day implementation timeline to institute
the following requirements:
Develop a 24/7 web-based educational and TRICARE employee
assistance program counseling via interactive audio-visual
telecommunications to Service members and their families; and,
Develop a network of originating sites capable of
providing telemedicine/telepsychiatry care.
DoD is using web-based mental health resources to provide both pre-
clinical and clinical services and to ensure that technology is fully
leveraged across the spectrum of care for mental health concerns. It is
expected that such resources will augment the overall range of services
in the Military Health System, and may help to compensate for
shortfalls in clinical personnel at some sites. Resources such as
afterdeployment.org, realwarriors.net, and MilitaryOneSource provide a
range of ``pre-clinical'' psycho-educational, self-assessment, and
self-care resources for warriors, veterans, and military families.
TMA is revising its policy manual to reimburse network providers
for clinical services using synchronous audio and visual technologies
including web-based care. It is anticipated that this policy revision
will increase the number of web-based clinical resources.
Mental health providers within military medical treatment
facilities are evaluating web-based services such as Defense Connect
Online to provide clinical care between facilities. Currently, there
are several initiatives underway to evaluate and expand this capacity,
most of which are led by the National Center for Telehealth and
Technology, a Center in the Defense Centers of Excellence for
Psychological Health and Traumatic Brain Injury.
Question. What are the challenges in utilizing web-based clinical
mental health resources relative to face-to-face visits with mental
health professionals?
Answer. Web-based clinical mental health resources can be either
``pre-clinical,'' entailing educational support and stress- and other
self-management tools (e.g., afterdeployment.org), or ``clinical,'' in
which counseling services are rendered in real time by a credentialed
provider. For web-based clinical applications, telemedicine is
generally safe and efficacious but that telemental health delivered
directly into a user's home raises concerns about safety and the
management of potential high-risk behaviors. Traditional face-to-face
counseling provides a relatively secure setting in which safeguards can
be quickly implemented regarding such high-risk concerns.
We have initiated a demonstration project to provide a telemental
health component that includes real time clinical services delivered by
a credentialed provider from the provider's location to a supervised
originating site. The TRICARE Managed Care Support Contractors will
establish multiple originating locations to allow users to access
telemental health services.
Question. How has the Department of Defense (DoD) utilized web-
based clinical mental health resources for Guard and Reserve soldiers?
Answer. Resources such as afterdeployment.org, realwarriors.net,
NationalResourceDirectory.org, and MilitaryOneSource provide a range of
web-based ``pre-clinical'' psycho-educational, self-assessment, and
self-care resources for warriors, veterans, and military families--
whether Active Duty, Guard, or Reserve. These resources are available
24/7, linked to triage call centers, and are easily accessed.
The TRICARE Management Activity issued a contract modification to
the three Managed Care Support Contractors to institute 24/7 web-based
educational and TRICARE employee assistance program counseling via
interactive audio-visual telecommunications to Service members and
their families, and to develop a network of originating sites capable
of providing telemedicine/telepsychiatry care.

Fiscal Year (FY) 2010 Defense Health Program (DHP)

Question. Madame Secretary, David Chu, then Undersecretary of
Defense for Personnel and Readiness, testified on the FY 2007 DHP
budget that the projected total military health spending to pay for all
health-related costs including personnel expenses, and the contribution
to fund retiree health costs to be $39 billion. The FY 2010 budget
request, including all costs associated with the DHP is $46.8 billion.
This request is $7.8 billion above the estimate in 2007.
What accounts for the increase?
Answer. The Department's continued commitment to the care of its
troops and their families accounts for the increase. This is most
evident by adding baseline funding for traumatic brain injury and
psychological health, wounded, ill, and injured, and enduring
requirements for Overseas Contingencies Operations which have been
historically funded by way of supplemental appropriations. Significant
restoration and modernization funding was added to ensure energy
efficient, state of the art military treatment facilities.
Additionally, funding is increased to meet growing healthcare costs
driven by greater demands for healthcare due to both increased users
and higher utilization of benefits.
Question. What does this figure include?
Answer. The $46.8 billion reflects the Military Health System's
total Unified Medical Program. The specific amounts which comprise this
number are included in the table below. The DHP Appropriation includes
Operation and Maintenance (O&M), Research, Development, Test, and
Evaluation (RDT&E), and Procurement budget activities. Costs outside of
the DHP include Military Construction (MILCON), Medicare Eligible
Retiree Healthcare Fund (MERHCF), salaries for Military Personnel
(MILPERS), and Base Realignment and Closure (BRAC).

[In millions of dollars]
------------------------------------------------------------------------
FY 2010
Appropriation President's
Budget
------------------------------------------------------------------------
O&M........................................................ $26,968
Procurement................................................ 322
RDT&E...................................................... 613
MILCON..................................................... 1,042
MERHCF..................................................... 9,104
MILPERS.................................................... 7,672
BRAC....................................................... 1,076
------------
Total Cost of Military Healthcare...................... 46,798
------------------------------------------------------------------------

UNIFIED MEDICAL PROGRAM WITH NORMAL COST CONTRIBUTION LESS BRAC
[In millions of dollars]
------------------------------------------------------------------------
FY 2010
Approp;riation President's
Budget
------------------------------------------------------------------------
O&M........................................................ $26,968
Procurement................................................ 322
RDT&E...................................................... 613
MILCON..................................................... 1,042
MERHCF Normal Cost Contribution............................ 10,751
MILPERS.................................................... 7,672
------------
Total Cost of Military Healthcare...................... 47,368
------------------------------------------------------------------------

Question. What factors are increasing the cost of the total
program?
Answer. From a Military Health System perspective, the major cost
drivers increasing the cost of the DHP are increased users of the
benefit, increased utilization by these users, and healthcare
inflation. Simply put, TRICARE is an excellent healthcare benefit which
is extremely cheap by any standard and satisfaction rates are very
high. With the help of the Congress, we have significantly improved
restoration and modernization, sustainment, and construction of
facilities to provide world class healing environments for our wounded,
ill, and injured, and invested substantially in increased staff to
improve access. Finally, we have added significant research funding to
our baseline request focused on the signature wounds of the current
battlefield.
Question. Were the pharmacy copayments assumed as well, even though
in previous years the dollar totals have not been reached?
Answer. The FY 2010 President's Budget, Private Sector Care (PSC)
controls only assume that portion of pharmaceutical costs that the
Department historically pays. In other words, PSC pharmaceutical costs
reflect the drug costs less the copayments made by the beneficiaries.
This question does not apply to the In-House Care Pharmacy program
as beneficiaries are not required to make copayments for
pharmaceuticals dispensed in military treatment facilities.

Military Healthcare System

Question. The military medical services continue to adapt to the
changing needs of military members and their families, but one of the
major issues is recruiting and retention of qualified healthcare
personnel. A problem faced in previous years was access to facilities
and promptness of care.
Can you please explain how each of you has made adjustments to
address access to facilities and improve the care received?
Ms. Embrey's Answer. We have established a network of private care
providers to augment the MTF's capability and capacity around each
military treatment facility (MTF). When an MTF cannot satisfy the
demand for healthcare, it uses the established referral process to
obtain timely care for TRICARE beneficiaries from private care sources.
As a result of the combination of MTF and network healthcare resources,
TRICARE is able to provide its beneficiaries timely access to care.
LTG Schoomaker's Answer. The Army Medical Command (MEDCOM) has
directed significant attention and effort over the last year to
improving access to care. The Surgeon General published an Access to
Care (ATC) Campaign Plan containing eleven focus areas that cover a
wide spectrum of ATC and customer service issues.
Increasing access to enrolled beneficiaries is a specific focus
area. This initiative benefits all enrolled beneficiaries, to include
new recruits, potential re-enlistees, and their families. An emphasis
on enrollment capacities and patient assignment to Primary Care
Providers by name ensures that all beneficiaries enrolled to an MTF are
assured timely medical care from their Primary Care Manager using the
most appropriate healthcare venue: ``The right provider, at the right
time, in the right venue.'' Ensuring our MTFs' capabilities align with
the number of beneficiaries assigned improves access by reducing over-
enrollment in inadequately staffed facilities. Our goal is to ensure
each MTF tracks daily to ensure they have Primary Care Providers
available to meet our enrolled beneficiaries' needs. MTFs are required
to offer beneficiaries a referral to the TRICARE civilian network when
the MTF is unable to provide care within access to care standards.
Another key and closely related element is reducing administrative
burdens on health care providers, to ensure they are available for
patient care. MEDCOM is also increasing beneficiary awareness and
understanding of the various ways to obtain care and the processes
involved, including how to obtain appointments by phone and via the
Internet (TRICARE On-Line).
Admiral Robinson's Answer. Navy Medicine has revised its Access to
Care (ATC) Strategy to provide Medical Treatment Facilities (MTFs) and
clinics a framework to implement and sustain a systemic, proactive, and
responsive access plan that meets or exceeds beneficiary expectations
and ATC standards. The ATC strategy and Access to Care Management
Policy for Navy Medicine Military Treatment Facilities are designed to
ensure the most optimal patient and family-centered care. With strong
senior leadership and support, the policy articulates roles,
responsibilities, and expectations for all of Navy Medicine.
LTG Roudebush's Answer. The Air Force Medical Service (AFMS) is in
the midst of deployment of a Family Health Initiative model to improve
medical operations for providers and beneficiaries. The model provides
greater access for patients, improved Primary Care Manager (PCM)
continuity, and a simplified process for appointments. This model has
lowered the number of enrolled beneficiaries from 1,500 per PCM to
1,250 to increase continuity, quality of health care, and to retain
greater numbers of family practitioners. Additionally, the AFMS has
streamlined the hiring of contract and GS providers to increase the
supply of appointments to its beneficiaries.
The AFMS has developed a set of comprehensive metrics. Measures
address access to care for TRICARE beneficiaries, to include Wounded
Warriors and their families, to determine if services at Air Force
Military Treatment Facilities (MTFs) are provided within
congressionally enacted access standards. The access standards are 1
day for urgent care, 7 days for routine appointments, and 28 days for
specialty care.
If capacity does not exist or the care cannot be provided within
the access to care standards in accordance with 32 CFR 199.17, AFMS
MTFs are directed to refer their enrollees to the network for not only
specialty care, but for primary, urgent and routine care. To ensure
that this arrangement is running optimally, the Air Force Surgeon
General has requested the Air Force Audit Agency audit primary care,
urgent and routine network care referrals in Fiscal Year 2010 to see if
network capacity is available and to determine if any inefficiency in
the process can be found.
Question. How can this Committee help the Military Health System
remain vital?
Ms. Embrey's Answer. This Committee has been extremely helpful in
providing direction and resources to the Defense Health Program (DHP)
for improvements to facilities and access, enhancements to healthcare,
and case management for our wounded, ill, and injured Service members,
as well as enhancements to our baseline research efforts. We are
extremely grateful for the marvelous support this committee has
provided.
The largest problem we face is the escalating cost of the
healthcare benefit and its impact to the Department's other competing
missions. The current benefit structure is a bargain, and includes no
mechanism to maintain balance between the Government and the
beneficiary share of healthcare costs. We must engage in open dialogue
with the Congress and explore options to restore the fiscal balance to
the DHP and reduce the burden of healthcare costs to the Department.
LTG Schoomaker's Answer. The Committee has been exceptionally
generous and supportive in recent years. That generosity has enabled
significant improvements in our Service Medical Departments. The most
important thing the Committee can do is to continue to recognize and
support the value that robust Service Medical Departments bring to the
Department of Defense and the Nation. Capable Service Medical
Departments are essential for promoting the health and optimal clinical
outcomes for our beneficiaries, recruiting and retaining medical
personnel, as well as training and sustaining essential skills. Robust
Service Medical Departments produce strong and ready military forces in
support of the Nation and optimize the care, rehabilitation, and
transition of our wounded, ill, and injured Soldiers. Specifically, to
remain robust we must have the resources necessary to invest in
infrastructure and human capital in order to generate the comprehensive
healthcare capacity required to meet the needs and expectations of the
Department and our beneficiaries.
Recent investment in facility infrastructure has been without
precedent. However, additional funding in facility renovation and
modernization, information technology infrastructure, capital equipment
and Military Construction (MILCON) is still beneficial and necessary.
Almost a third of Army hospitals are over 50 years old, and another
third are 25-50 years old. They require continued renovation and
modernization to operate effectively. Our information technology
infrastructure needs to keep pace with the technology we employ in
cutting edge healthcare. We must have the procurement and operating
funds necessary to equip our new facilities and recapitalize equipment
beyond its useful life. Our older hospitals must be replaced because
they cannot be effectively renovated to the outpatient based healthcare
delivery model used today. The recent increase in the medical MILCON
program significantly addressed some of our pressing needs. We also
continue work towards recapitalizing medical clinics, dental clinics,
medical research and force protection type facilities (blood
processing, preventive medicine, etc).
Healthcare relies almost completely on skilled people to deliver a
service. To attract and retain the people we need we must invest in
human capital. We must offer people rewarding work in a safe and
professional environment. We must adequately train and compensate them.
Today there is keen competition in most markets for the highest quality
uniformed, civil service, and contract medical-nursing professionals,
administrative staff (such as contracting officers, safety and surety
experts, technical specialists and the like), and scientists. We must
have the funding available to offer competitive wages as well as
civilian and military incentives in the form of recruiting and
retention bonuses, scholarships, and loan repayments. Funding the
authorized civilian pay raise is one critical action in this area.
A robust Service Medical Department not only delivers healthcare to
the sick or injured, it also provides extensive and effective health
promotion and prevention services. Attempts to resource the Services
only for coded healthcare payable by commercial sector insurance
companies threatens the resources necessary to provide the
comprehensive health programs that our military requires. We need
continued support to expand the comprehensive health and Soldier
fitness programs that truly strengthen our Army.
We must also continue to recognize the effects of protracted
overseas contingency operations on our military. The demand for and
utilization of healthcare services is on the rise. The Service Medical
Departments must be funded to build the capacity necessary to meet that
demand within reasonable access standards while improving quality and
patient satisfaction. Managing the care of our beneficiaries within the
Service Medical Departments is the best value option for the long term.
Carry over authority is a key provision that provides much needed
flexibility to meet changing demands in the medical community.
Supporting this authority at no less than 2% of appropriated amounts
would be of significant benefit. The carry over authority serves to
help us optimize resources in support of new programs such as Traumatic
Brain Injury, Brain Health, Warrior Transition and Care Program, Army
Substance Abuse Program, and other Wounded Ill and Injured initiatives.
Admiral Robinson's Answer. One of the major challenges facing Navy
Medicine, and the Military Health System in general, is meeting the
operational wartime requirements while at the same time providing a
well-deserved health care benefit within the funding constraints of the
Defense Health Program. Since the inception of the TRICARE program,
overall cost-sharing elements have remained the same in spite of
increasing health care costs and expanding benefits. To address these
challenges, the Department of Defense (DoD) needs congressional
authority to change fees and co-payments in an effort to maintain both
a generous health care benefit and a fair and reasonable cost-sharing
arrangement between beneficiaries and the DoD.
Additionally, Navy Medicine welcomes the Committee's continued
support in maintaining the right workforce to deliver medical
capabilities across the full range of military operations, through the
appropriate mix of accession, retention, education, and training
incentives.
LTG Roudebush's Answer. People are our most critical asset and it
is, therefore, imperative that the Air Force Medical Service recruit
and retain the very best. The Health Professions Scholarship Program
(HPSP) is our most successful recruiting tool, and we are seeing early
positive trends in retention from our other financial assistance and
pay plans. The Fiscal Year 2009 Defense Appropriations bill
appropriated of $13 million to support the Air Force Reserve portion of
HPSP. This appropriation was critical in maintaining a viable program
this year.
We also appreciate the tremendous support provided to modernize our
aging Air Force medical infrastructure. Your continued strong support
of our recapitalization and sustainment, restoration and modernization
initiatives will allow us to deliver quality care in state-of-art
facilities.
Question. Are there any claims or reimbursement issues/delays
relating to the beneficiary population? If so, please explain the
problems and what you are doing to rectify the situation.
Ms. Embrey's Answer. There are no claims processing issues or
delays relating to the TRICARE beneficiary population. The TRICARE
Managed Care Support Contracts include a requirement for compliance
with stringent claims processing accuracy and timeliness standards. The
contractors provide guarantees that they will meet these standards and
are subject to financial penalties for falling short. They have
consistently operated at or above the standards, placing TRICARE among
the leading health plans in claims processing performance.
A key principle of the Department of Defense's activity in
reimbursement design has been the protection of access to services. The
statute requires that TRICARE reimbursement rates be determined, to the
extent practicable, in accordance with the same reimbursement rules as
apply to payments for similar services by Medicare. In the following
circumstances waivers of this requirement are permitted by statute and
used to ensure adequate access to care:
Network Waivers--If it is determined that higher rates
are necessary to ensure availability of an adequate number and mix of
qualified network providers, TRICARE can increase reimbursement to the
lesser of (a) an amount equal to the local fee for service charge or
(b) up to 115 percent of the CHAMPUS Maximum Allowable Charge.
Locality Waivers--If it is determined that access to
specific healthcare services is severely impaired, higher payment rates
can be applied to all similar services performed in a locality. Payment
rates can be established through the addition of a percentage factor to
an otherwise applicable payment amount, by calculating a prevailing
charge, or by using another Government payment rate.
LTG Schoomaker's Answer. The Office of The Army Surgeon General
supports expedited claims processing under the TRICARE program. Timely
claims processing is essential to ensure provider willingness to
participate in the TRICARE program. Further, this has a relational
impact on beneficiary access to civilian care. We are not aware of any
issues or delays in the claims reimbursement process. Furthermore,
there continues to be multiple sources of information to assist
beneficiaries in this process. The TRICARE web site has a separate
claims information web page where beneficiaries can obtain relevant
information and check the status of a claim. DoD continues to
administer the Debt Collection Assistance Officer (DCAO) program which
helps beneficiaries needing assistance to resolve claims issues/
problems.
Admiral Robinson's Answer. Navy Medicine is committed to ensuring
beneficiary claims are properly and promptly processed. Through the
Beneficiary Counseling and Assistance Coordinator (BCAC) and Debt
Collection Assistance Officer (DCAO) Programs, we have made great
progress with addressing claims and reimbursement issues and delays
with the support of our Managed Care Support Contractors. A challenge
remains with enrollment and eligibility of our Reserve Component (RC)
members when activated and de-activated. Gaps in coverage due to the
Service members' lack of understanding of the benefit structure, and
their lack of timely enrollment can result in ``gaps'' in coverage
which ultimately result in unpaid claims. Navy Medicine continues to
promote education and awareness through the BCAC, DCAO as well as
information shared during Transition Assistance Program (TAP) classes
which are provided to all exiting Service members.
LTG Roudebush's Answer. We are not aware of claims or reimbursement
issues that would negatively affect a beneficiary's access to care in
the Continental U.S. TRICARE Private Sector Claims processing has
improved substantially over the past several years. With few
exceptions, the vast majority of TRICARE network claims are processed
and paid within 30 days or less. The very few that are not paid within
30 days are usually due to incorrect personal information on the
beneficiary's claim form, or involve claims that may potentially
involve third party liability payers and thus require more thorough
legal reviews, or are high dollar claims which require medical review
due to their complexity.
At our overseas locations where there is no TRICARE network, we are
working with the TRICARE Management Activity on refining host-nation
medical claims payments to overseas providers to ensure good
relationships with those healthcare providers who support us with a
steady-state continuum of care for our forces and their families
stationed overseas.
Question. What has been done to increase efficiencies in healthcare
delivery?
Ms. Embrey's Answer. Efficiencies have been achieved in the
delivery of healthcare in the direct care and purchased care sectors
through a variety of mechanisms. These include leveraging information
technology, enhancing the pharmacy program, improved customer service
and claims processing, and partnering with our Managed Care Support
Contractors (MCSCs) to improve business processes. Benefits achieved
from each of these are discussed below.
Information Technology
TRICARE has improved its health information technology systems to
facilitate the rapid exchange of health information. These systems are
designed to improve data management and to streamline applications and
processes, thereby making access to services and benefits for our
beneficiaries easier, faster, and more secure. Examples include: secure
electronic health records (document medical conditions, prescriptions,
diagnostic tests); online enrollment and information updates; online
drug comparisons with the Uniform Formulary Search Tool (lists
medication availability and alternatives, compares costs, provides drug
information); and, automated patient safety with the Pharmacy Data
Transaction Service (tracks all prescriptions whether filled through a
Military Treatment Facility, network, or mail order pharmacy, reducing
the likelihood of adverse drug to drug interactions or duplicate
treatments).
Pharmacy Program Enhancements
TRICARE fills more than 100 million prescriptions annually for the
6.6 million beneficiaries who use their pharmacy benefit. The TRICARE
Mail Order Pharmacy (TMOP) is the largest commercial mail-order account
within the pharmacy industry. It takes only seven minutes for a
beneficiary to telephonically convert a prescription from the retail to
mail order pharmacy system. Although beneficiaries with other health
insurance (OHI) for prescription drugs must first file with their
primary payer, once completed, their claim can be filed electronically
with TRICARE when using a TRICARE retail network pharmacy. Due to an
online, real-time coordination of benefits (COB) program, there is no
longer a need to file a paper claim. The COB program is managed by
Express Scripts and other Department of Defense (DoD) contractors.
Express Scripts is one of the nation's largest Pharmacy Benefit
Management companies. The COB program simplifies the reimbursement
process for beneficiaries who have drug benefit coverage with multiple
sources and saves DoD an estimated $1 million annually in claims
processing costs. The implementation of the on-line COB program allows
pharmacies to submit both primary and secondary coverage online for
TRICARE beneficiaries, resulting in the beneficiary incurring little or
no out-of-pocket expenses. Prior to the COB program, beneficiaries
would have to pay for expenses not covered by their primary health
insurance and then file a manual claim after the fact for reimbursement
under TRICARE for their secondary coverage.
Although TMOP and its predecessor, the National Mail Order
Pharmacy, have been available to DoD beneficiaries since the late
1990s, they have never been heavily used. TMOP offers benefits to both
DoD and its beneficiaries since DoD negotiates prices that are
considerably lower than those for retail drugs and the beneficiary
receives up to a 90-day supply for the same copayment as a 30-day
supply at a retail pharmacy. Concerned that beneficiaries were not
taking advantage of a good benefit, DoD launched a marketing campaign
in February 2006 to increase beneficiary awareness of the benefits
offered by the TMOP. As a result, utilization increased from 26.2
percent in Fiscal Year (FY) 2006 to 30 percent in FY 2007.
Customer Service and Claims Processing
The number of claims processed continues to increase, reaching more
than 158 million in FY 2007. The processing of retained claims for the
past six years continues to exceed the TRICARE performance standard of
95 percent retained claims processed in 30 days.
TRICARE continues to work with providers and claims processing
contractors to increase processing of claims electronically, rather
than in mailed, paper form. Electronic claims submissions use more
efficient technology requiring less transit time between the provider
and payer, are usually less prone to errors or challenges, and usually
result in prompter payment to the provider. The TRICARE Regional
Offices have been actively collaborating with the MCSCs to improve the
use of electronic claims processing.
The percentage of non-TRICARE for Life claims processed
electronically for all services increased to more than 85 percent in FY
2007, up 4 percentage points from the previous year, and more than 27
percentage points since FY 2004.
The congressionally mandated TRICARE Encounter Data (TED) record
system collects, verifies, and tracks billions of dollars annually in
purchased care claims and encounter data for the Military Health
System. TEDs are submitted by TRICARE claims processing contractors in
batches for processing, and volumes frequently exceed more than one
million records a day. TED's automated prompt processing of purchased
care claims data records is a measurable incentive for more health
providers to accept and treat over nine million TRICARE beneficiaries.
TED helps ensure that purchased care claims reimbursement is faster and
more efficient by tracking claims immediately after submission, posting
payments and denials, and systematically following up on unpaid claims.
The result is shorter billing cycles and reimbursements paid within 30
days, one of the fastest claims processing cycles in the healthcare
industry. In FY 2006, nearly 177 million TED records were processed for
an estimated Government expenditure of more than $13 billion.
Electronic Surveillance System for Early Notification of Community-
based Epidemics (ESSENCE) Medical Surveillance
DoD has developed an improved version of ESSENCE, a Web-based
syndromic surveillance application, to examine DoD healthcare data for
rapid or unusual increases in the frequency of certain syndromes. An
increase in frequency may be a sign of diseases occurring during
possible outbreaks of communicable illnesses or from the possible use
of biological warfare agents. Earlier identification of a disease
outbreak may allow for an earlier intervention and a reduced incidence
of illness.
LTG Schoomaker's Answer. Of the three Services, the Army delivers
healthcare most efficiently. In fiscal year 2008, the Army Medical
Department (AMEDD) delivered more than 49% of the outpatient and 53% of
the inpatient healthcare provided by the DoD Service Medical
Departments with only 43% of the funding. Additionally, the AMEDD had
the lowest cost per disposition and lowest cost per visit of the three
services, 17% and 13% below the service averages respectively. The
AMEDD continues to concentrate on improving access to healthcare and
was able to provide over 1.1 million more outpatient encounters to our
beneficiaries in FY08 than we did just two years prior. In the past
five years we have achieved an 11.6% increase in total healthcare
output. That represents care that did not go to the TRICARE contractor
but instead remained in the direct care system where we were able to
continue providing high quality, well-managed healthcare documented in
our electronic health record.
To help achieve efficiency, MEDCOM uses the Balanced Scorecard
strategic management system as the principal tool by which to guide and
track the Command to improve operational and fiscal effectiveness, and
better meet the needs of patients, customers, and stakeholders. One of
our strategic objectives is to Optimize Resources and Value. An
initiative to help achieve this is the implementation of Lean Six Sigma
(LSS). Our command-wide LSS Program is a leader among the Army and
fuels continuous performance improvement through data-driven decision-
making and strategically-aligned project execution.
Additionally, we have implemented a process that aligns resources
to outputs and outcomes to incentivize efficient and effective
operations. This methodology is known as the Performance Based
Adjustment Model (PBAM) and has recently won recognition from Army as a
best practice. The PBAM provides financial incentives for improvements
in access, efficiency, healthy outcomes, and patient satisfaction. It
has contributed not only to efficiency gains but also to quality gains.
Since October 2006 the percentage of our beneficiary population that
meets the Healthcare Effectiveness Data and Information Set (HEDIS)
screening criteria for the nine preventive medicine HEDIS metrics has
steadily climbed from less than 29% to greater than 48%. Pneumococcal
vaccinations for the over-65 beneficiaries alone increased from less
than 24% to greater than 80%. The AMEDD continues to seek effective
strategies and incentives that optimize resources and value.
Admiral Robinson's Answer. Navy Medicine issued revised policy on
Access to Care, ``Navy Medicine Policy 09-004-Access to Care Management
Policy for Navy Medicine Military Treatment Facilities (MTFs).'' This
policy provides tools to help MTF Commanding Officers ensure efficient
MTF business processes that support access to care (ATC) are developed
and implemented. These business processes are designed to identify and
eliminate barriers to accessing care, and optimize patients' ability to
get needed care in a timely manner. This policy directs MTF Commanding
Officers to implement consistent business processes and guidance
endorsed by all the Surgeons General. The policy establishes
standardized roles, responsibilities, definitions, and guidance for
implementing, sustaining, and managing ATC throughout Navy Medicine.
The implementation of the processes and procedures in the policy are a
central component of MTF access processes.
LTG Roudebush's Answer. The Air Force Medical Service is making
continuous progress in improving the efficiency of our healthcare
delivery through partnerships between our medical treatment facilities
and Veterans Affairs (VA) facilities; and also through vigorous
activities to enhance processes in our hospitals and clinics.
We continue to add new joint initiatives with the VA, sharing
facilities, specialty services to improve access and provide a broader
range of services for both beneficiary populations. These initiatives
are good for the patients and help ensure our specialists provide the
full range of clinical care needed for their own currency. We meet
regularly with our VA counterparts through the Department of Defense
Healthcare Executive Council to review new initiatives.
In October 2008, we stood up the Air Force Medical Operations
Agency (AFMOA) in San Antonio, Texas to consolidate support and
oversight to healthcare operations for all 75 Air Force hospitals and
clinics. A prime driver for this action was the intent to enhance
efficiency through standardized processes in our healthcare operations
aimed at improving quality of care and getting the most clinical
production from resources. AFMOA is now applying efficiency tools such
as Lean and Six Sigma in two major Air Force-wide initiatives: the
Family Health Initiative and the General Surgery Currency/Operating
Room Efficiency Project.
The Family Health Initiative reconfigured primary care staffing and
established standard procedures that are improving access, improving
continuity of care and enhancing coordination of care for patients with
complex health disorders. This initiative implements the Patient
Centered Medical Home concept in Air Force Family Health Clinics.
Implementation began in 2008 and will be completed at all Air Force
medical treatment facilities by 2012.
The General Surgery Currency/Operating Room Efficiency Project
developed a standard approach to improving access for surgical
consultations and increasing the utilization of operating rooms. This
project employs innovative metrics to monitor progress in maximizing
use of the clinical capacity in our hospitals. The project will improve
access for patients needing surgical care while also ensuring the
clinical currency of surgeons, critical care physicians, nurses and
technicians needed for aeromedical evacuation and deployed trauma care.
AFMOA is currently considering other projects focused on quality,
efficiency and clinical currency. A review of Air Force Medical Service
manpower and funding standards is under way to provide the tools to
optimally match distribution of resources to requirements driven by the
mission and demand for healthcare. We will use the results of this
review to strategically provide resources at locations where healthcare
demand needs to be met, while providing clinical currency opportunities
needed for the readiness of our physicians, nurses, and technicians.
Our medical treatment facilities and AFMOA maintain strong working
relationships with their Army and Navy counterparts and the TRICARE
Regional Offices to ensure a coordinated, unified effort to provide
services in each location.

Navy Specific Medical Issues

Question. Does the President's Budget submission for fiscal year
2010 reflect what you need for combat casualty care?
Answer. Yes, based on current requirements. A portion of funding
that had been provided via Supplementals has been added to our program
of record budget control, beginning in Fiscal Year 2010. If
requirements increase in the future, additional funding may be required
to continue the same level of patient care.
Question. How has the Navy adjusted its medical end-strength, both
operationally and for beneficiaries, to account for the recent growth
in Marine Corps?
Answer. Marine Corps (Blue in Support of Green) Operational End
Strength Plus Up by Medical Corps and Fiscal Year:

ANNUAL GROWTH BY FY
----------------------------------------------------------------------------------------------------------------
Designator/Rate FY07 FY08 FY09 FY10 FY11 Total
----------------------------------------------------------------------------------------------------------------
Medical Corps................................. 17 17 116 13 122 155
Dental Corps.................................. ......... 18 6 ......... 6 30
Med Svs Corps................................. 2 7 23 4 7 43
Nurse Corps................................... ......... ......... 6 1 9 16
Subtotal ``O''................................ 9 32 51 8 44 144
Subtotal ``E'' (HM)........................... 68 356 169 27 144 764
-----------------------------------------------------------------
Total..................................... 77 390 220 35 188 908
----------------------------------------------------------------------------------------------------------------

CUMMULATIVE GROWTH BY FY
----------------------------------------------------------------------------------------------------------------
Designator/Rate FY07 FY08 FY09 FY10 FY11
----------------------------------------------------------------------------------------------------------------
Medical Corps............................................ 7 14 30 33 55
Dental Corps............................................. 0 18 24 24 30
Med Svs Corps............................................ 2 9 32 36 43
Nurse Corps.............................................. 0 0 6 7 16
Subtotal ``O''........................................... 9 41 92 100 144
Subtotal ``E'' (HM)...................................... 68 424 593 620 764
------------------------------------------------------
Total................................................ 77 465 685 720 908
----------------------------------------------------------------------------------------------------------------

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In-House Medical Care

Question. The Department has been using the ``Efficiency Wedge'' to
encourage the Services to treat more patients at the military treatment
facilities (MTFs). This practice withholds some healthcare funding
centrally. Funds are released based on the Services' success in
achieving throughput at their MTFs.
Please describe the Department of Defense budgeting practice known
as the ``efficiency wedge.''
Answer. A valuation study based on workload produced by the MTFs in
Fiscal Year (FY) 2003 revealed that the cost to provide services in the
direct care system generally exceeds the cost to purchase the care
through the Private Sector Care network. To contain costs, a negative
wedge was removed from Service budgets and was phased in over the
period FY 2005 to FY 2009, based on each Service's relative efficiency.
The intent was for the Services to carefully analyze the costs to
produce care versus purchase care from the private sector and shape the
care delivered in the direct care system based on the most cost
effective delivery method.
The primary reason our direct care facilities exist is to provide
healthcare training for medical personnel who must be prepared to
deploy anywhere in the world to provide medical support to our Armed
Forces. Thus, inherently there will be significant inefficiency in such
a system. Each year, the Service Surgeons General sought relief from
Congress for the negative wedge included in their respective programs.
The Congress consistently restored significant amounts of the wedge
through the appropriations process. The Department understood
Congressional guidance and, effective with the FY 2010 budget request,
fully restored all funding removed based on inefficiency.
Question. What issues arise from these efficiencies? Please be
specific.
Answer. The removal of the wedge was intended to align quality care
with the most cost-effective venue, whether that is in the military
treatment facilities (MTFs) or through the Managed Care Support
Contract network. Achievement of that goal requires buy-in and precise
analytical work. Such buy-in was never fully achieved and, as the
Operational Tempo of current operations increased, along with the
casualties from ongoing operations, efficiency became a very low
priority. There were claims that the wedge forced the Services to
remove capacity, which resulted in care shifting from the MTFs to the
managed care network. An opposing view would be that the beneficiary
chose to receive care through the managed care network and has freedom
of choice since 2004 when the requirement to obtain a non-availability
statement from the MTF to receive care through the network was removed.
Question. Does this hinder your budgeting process?
Answer. Health Affairs' role has always been to ensure the taxpayer
receives maximum value for their contribution to the Department of
Defense. In principle, the efficiency wedge was appropriate to match
resources to the value of care produced in the Direct Care System. As
workload declines and facilities are downsized or closed, the
responsible action in the best interest of the American taxpayer is to
align the funding where the demand for healthcare exists, either in the
military treatment facilities or in the private sector.
Question. Is the amount provided in the budget request sufficient
for the Services?
Answer. The funding requested in Fiscal Year 2010 is sufficient for
all three Services. Each of the Surgeons has testified in support of
this statement.
Question. How else have you been increasing workload at the
military treatment facilities?
Answer. Comparing overall workload between Fiscal Year (FY) 2003
and FY 2008, the Army has increased workload while the Navy and Air
Force have declined. However, each Service has committed to increasing
their overall productivity by reconfiguring or adding infrastructure,
optimizing provider/support staff mix, and working to recapture
workload where it makes financial and clinical sense. As their workload
increases, they are reimbursed financially via the Prospective Payment
System in which additional workload is rewarded with additional
funding.
Question. Has lack of personnel or infrastructure played any role
in decreased workload?
Answer. Personnel deployments, unavailability of suitable
replacements, and hiring lag all adversely affect workload.
Infrastructure limitations may also hinder workload productivity.
However, the Services continue to work aggressively to overcome these
challenges and increase workload where it makes clinical and financial
sense.
One way we attempt to mitigate the impact is by providing
additional funding. In Fiscal Year (FY) 2008, we provided roughly $207
million via the Overseas Contingency Operations Supplemental
Appropriations to hire contractors and temporary civilians for medical
backfill, to replace deploying members. In FY 2009, we anticipate
providing up to $224 million in such funding. Congress and the
Department have, in recent years, committed substantial additional
funds to sustainment, restoration, and modernization which offered the
Services an opportunity to improve their infrastructure. Additional
workload is also rewarded with additional funding via the Prospective
Payment System which provides resources that can be used to modify or
increase available space.
Question. Has the funding Congress provided for Facilities,
Sustainment, Restoration and Modernization (FSRM) increased the ability
of the medical facilities writ large increase workload capacity?
Answer. FSRM funding provided to the Defense Health Program has
enabled significant repair, restoration, and modernization of our aging
military treatment facilities. This work has generally facilitated
workload capacity, improved functionality, and enhanced the appearance
and aesthetic environment at many of our locations. Ultimately, the
improvements are accomplished to improve patient outcomes, enable
better clinical performance, and generally enhance our beneficiaries'
healthcare experiences.

Evaluating the Condition of Healthcare Facilities

Question. What have you done to evaluate the quality of medical
care being provided at medical treatment facilities?
Ms. Embrey's Answer. We have a robust mechanism to ensure the
quality of healthcare delivered in our military treatment facilities
(MTFs). We utilize nationally recognized quality metrics to continually
assess the care provided and to identify opportunities for improvement
in both the inpatient and outpatient settings. All MTFs are required to
maintain accreditation by an approved healthcare accrediting
organization. The Joint Commission and Accreditation Association for
Ambulatory Health Care survey the MTFs to meet this requirement.
Additionally, MTFs are inspected through specific program
accreditations/certifications such as blood bank, laboratory, and
mammography. These accreditation and certification processes facilitate
our ability to ensure our performance is consistent with national
civilian healthcare standards.
We are involved in a number of national initiatives focused on
healthcare quality, including the Centers for Disease Control and
Prevention National Healthcare Safety Network, National Surgical
Quality Improvement Program, National Perinatal Information Center, and
the Agency for Healthcare Research and Quality (AHRQ) quality and
patient satisfaction indicators. In collaboration with AHRQ, we
developed and nationally disseminated TeamSTEPPS, an evidence-based
teamwork system aimed at optimizing patient outcomes by improving
communication and teamwork skills among healthcare professionals.
Clinical subject matter experts from the Department of Veteran
Affairs and the Department of Defense work collaboratively to develop
and maintain current clinical practice guidelines based on ever
evolving scientific evidence. Clinical quality studies are conducted
annually through a contract with a civilian organization to assist us
with the assessment and improvement of the care we provide. In addition
to the system-wide quality activities noted, each MTF and parent
Service monitors the quality and safety of healthcare delivered in our
MTFs. Information from the MTFs is shared via the Service
Representatives on established collaborative working groups and forums.
This infrastructure is designed to ensure maximum communication of
quality related information and knowledge exchange.
LTG Schoomaker's Answer. We have a robust mechanism to ensure the
quality of healthcare delivered in our military treatment facilities
(MTFs). We use nationally recognized quality metrics to continually
evaluate the care provided and to identify opportunities for
improvement in both the inpatient and outpatient settings. All MTFs are
required to maintain Joint Commission accreditation. Additionally, MTFs
are inspected through specific program accreditations/certifications
such as blood bank, laboratory, and mammography. These accreditation
and certification processes facilitate our ability to ensure our
performance is consistent with national civilian healthcare standards.
We are involved in a number of national initiatives focused on
healthcare quality including the Centers for Disease Control and
Prevention National Healthcare Safety Network, National Surgical
Quality Improvement Program, National Perinatal Information Center, and
the Agency for Healthcare Research and Quality (AHRQ) quality and
patient satisfaction indicators. In collaboration with AHRQ, we
developed and nationally disseminated TeamSTEPPS, an evidence-based
teamwork system aimed at optimizing patient outcomes by improving
communication and teamwork skills among health care professionals. The
Army Medical Department serves as the Department of Defense (DoD) lead
for the development of evidence based clinical practice guidelines in
collaboration with the Department of Veterans Affairs. Clinical quality
studies are conducted annually through a DoD contract with a civilian
organization to assist us with the assessment and improvement of the
care we provide. In addition to the system-wide quality activities
noted, each MTF monitors the quality and safety of healthcare delivered
in our MTFs. Information from the MTFs is reported to Headquarters,
Army Medical Command and shared with the other Services through
Military Health System level quality committees. This infrastructure is
designed to ensure maximum communication of quality related information
and knowledge exchange.
Admiral Robinson's Answer. Navy Medicine's Quality Assurance system
provides continuous monitoring of the quality of healthcare delivered
in our military treatment facilities (MTFs) by using nationally
recognized quality metrics for assessment of the care provided and
identification of opportunities for improvement. Navy Medicine actively
participates in DoD sponsored national initiatives including the
Centers for Disease Control and Prevention National Healthcare Safety
Network and the National Perinatal Information Center.
In addition, all Navy Medicine's hospitals and clinics are
evaluated using the same Joint Commission (TJC) standards as US
civilian hospitals. TJC focuses on improving the safety and quality of
healthcare provided to the public by accrediting healthcare
organizations and offering healthcare improvement services. Navy
hospitals and clinics are accredited, while individual healthcare
providers are licensed and certified. As active participants in TJC
accreditation process, we embrace TJC standards that focus on
maintaining the clinical skills of our providers. TJC standards include
the Focused Provider Performance Evaluation (FPPE) and Ongoing Provider
Performance Evaluation (OPPE) programs.
To maintain an infrequently used skill, a provider may be assigned
to another facility for temporary duty where the patient volume and MTF
capacity and capability exist. In the event that a specific medical
procedure cannot be safely supported with the required staff and
resources at a facility, clinical privileges to perform that procedures
will not be granted to the provider and the medical procedure will not
be performed.
Upon a provider's transfer to another MTF, the provider
participates in FPPE to assure clinical competency. Navy Medicine
quality scope is broad and includes: partnering with external
organizations that evaluate Navy Medicine's clinical programs;
maintaining robust internal programs that focus on risk management,
patient safety and patient advocacy; establishing personal
relationships with each patient who becomes a vital member of the
health care team; and facilitating continuing education efforts for all
staff members.
LTG Roudebush's Answer. The Air Force Medical Service (AFMS) uses
multiple measures and agencies to evaluate and sustain our high quality
of medical care. Overall quality is assessed through National
Accreditation Agencies--The Joint Commission (TJC) and the
Accreditation Association for Ambulatory Health Care. These two
agencies validate our compliance with clinical quality assurance and
allow comparison with civilian healthcare agencies. Second, we
participate in several national initiatives including Centers for
Disease Control and Prevention, The National Surgical Quality
Improvement Program, the National Perinatal Information Center and the
Agency for Healthcare Research and Quality quality and satisfaction
indicators. Third, we follow national metrics for inpatient care
through TJC's ORYX measurements and outpatient care through the Health
Employer Data Information Set published by the National Committee for
Quality Assurance. Within the AFMS, we centrally participate, track,
and publish ``Lessons Learned'' from each Root Cause Analysis review of
all significant medical incidents, and from each Medical Incident
Investigation. Finally, each Medical Treatment Facility performs at a
minimum one Failure Effects Analysis a year. These are also tracked
centrally and lessons shared throughout the Air Force.
Question. Have you evaluated the physical state of your facilities?
Ms. Embrey's Answer. At least once every three years all of our
medical treatment and research facilities are inspected, the physical
state evaluated, and documented. Deficiencies are addressed as funds
become available.
LTG Schoomaker's Answer. Yes, every three years all medical
facilities (category 500 buildings) and medical research facilities are
evaluated by an engineered assessment to determine system component
deficiencies and years remaining of service life. The data is used to
formulate annual objectives for funded programs. Activities review and
update facility deficiency data annually for appropriate priorities and
costs associated with the deficiencies. Annual investment plans are
created in conjunction with the updated analysis.
Admiral Robinson's Answer. Per the FY 2008 National Defense
Authorization Act (NDAA) (Section 1648), Bureau of Medicine and Surgery
(BUMED) activities inspect military medical treatment facilities (MTFs)
and specialty medical care facilities. The inspections are conducted by
BUMED annually using standards and checklists developed by the Senior
Oversight Committee, Line of Action (LOA) 5 Working Group in 2007.
In addition, the material condition of BUMED's facilities has
historically been inspected by professional engineering teams once
every three years using a single inspection service provider and a
common set of evaluation criteria that are consistent with all
applicable codes and standards. Sustainment Restoration and
Modernization (SRM) requirements identified during the inspection
process are documented in single web accessible database using the COTS
product VFA facility.
All of BUMED's hospitals participate in the accreditation process
for the Joint Commission. The accreditation process is continuous,
data-driven and focuses on operational systems critical to the safety
and quality of patient care.
At the activity level, facility management personnel conduct zone
inspections as required with non facilities management personnel
assigned to the activity (typically E-7 and above corpsman),
participate in fire inspections, and review deficiencies identified by
maintenance personnel (government or contractor) while performing
preventative maintenance inspections (PMIs).
LTG Roudebush's Answer. Yes. The Air Force Health Facilities
Division, at a minimum, conducts biennial comprehensive assessments of
our medical facilities worldwide to determine adequacy of clinical
space, patient access, and reliability of facility infrastructure.
Deficiencies identified and validated through these visits, and those
identified locally, are continually prioritized and addressed as funds
become available.
Question. What changes/improvements have you made to your medical
care continuum and/or facilities with all of the Facilities
Sustainment, Restoration, and Modernization (FSRM) provided by this
Committee? What is the status of any backlog?
Ms. Embrey's Answer. The age and dated designs of many of our
facilities create numerous obstacles to providing modern world-class
healthcare. Functional modifications and infrastructure repairs are
necessary to optimize the delivery of state-of-the-art healthcare to
our beneficiaries. In addition to routine annual utility and
infrastructure upgrades across the entire inventory, we have begun
renovations to create more efficient layouts of clinical, ancillary,
and support spaces in our facilities. The funding provided has
stabilized backlog growth.
LTG Schoomaker's Answer. The committee's support of the Army's
healthcare facilities and infrastructure has been superb and has
enabled the Army to provide consistently reliable facilities across the
medical care continuum. Over the past several years this funding has
allowed the Army to eliminate a majority of its backlog of critical
infrastructure deficiencies, ensuring our mechanical, electrical and
other critical building systems continue to operate reliably every day.
Besides the millions of dollars of improvements to our hospitals and
medical clinics, the Army was also able to drastically improve the poor
conditions of nine of our dental clinics and seven of our veterinary
clinics.
Admiral Robinson's Answer. With the FSRM provided by the Committee,
Navy Medicine has executed and/or is planning to execute construction
contracts to perform various repairs and restorations throughout Navy
Medicine. For example, Navy Medicine is planning to execute a contract
to complete the renovation of the Wounded Warrior Barracks at Naval
Medical Center San Diego, CA; and also to restore the Heating,
Ventilating, and Air Conditioning (HVAC) systems at Naval Hospital
Yokosuka, Japan and Naval Health Clinic Whiting Field, FL.
Annual major facility projects programming is approximately $100M
per year. The FSRM provided by the Committee supplemented Navy
Medicine's Fiscal Year 2009 budget for facility changes/improvements to
ensure that we stayed consistent with the annual programming
requirement.
LTG Roudebush's Answer. Since 2007, one third of our medical sites
have benefited from increased FSRM funding for modernization. In
addition to routine annual utility and infrastructure upgrades across
the entire inventory, we have begun renovations to create more
efficient layouts of clinical, ancillary and support spaces in our
facilities. The age and outdated designs of many of our facilities
create numerous obstacles to providing modern world-class healthcare.
Functional modifications and infrastructure repairs are necessary to
optimize the delivery of state-of-the-art healthcare to our
beneficiaries.
The Air Force Medical Service has a $298.7 million backlog of
currently identified sustainment, restoration and modernization
projects.
Question. Please explain how the services' ``case manager'' will
effect the medical care of wounded or ill service members.
LTG Schoomaker's Answer. The Army's Warrior Care and Transition
Program, established two years ago, uses a team approach to case
management referred to as the Triad of Care. Each wounded, ill, or
injured Soldier (Warrior in Transition) in the program is assigned to a
triad consisting of a Primary Care Manager (usually a Physician), a
Nurse Case Manager, and a Squad Leader. This team, along with the
Soldier and the Soldier's family, work together to coordinate the care
and support each Warrior in Transition receives to ensure a
coordinated, directed, and effective approach to recovery,
rehabilitation, and reintegration either back to duty or prepared to
transition to productive private citizen and veteran status.
Central to the management of medical care for Warriors in
Transition is the Comprehensive Transition Plan (CTP). The CTP serves
as each Soldier's road map on the way to recovery and integration. The
CTP is developed by the Warrior in Transition with the support of a
multidisciplinary team of medical, rehabilitative, and behavioral
health professionals, chaplains, social workers, and the Soldier's
Triad of Care. With the CTP to which to refer, review, and follow, the
entire care team is able to work in concert to deliver the most
effective outcome for each Soldier. This is the true value of case
management--a comprehensive assessment and approach to help each
Soldier reach his or her desired goal. Along the way to this goal, the
Triad of Care continues to manage the process by regularly evaluating
each Soldier's progress, making any necessary adjustments in approach
to keep the process moving forward, and functioning as the rudder that
steers each Soldier along the way to recovery.
Effective case management ensures timely and efficient use of
resources; keeps the process of care and recovery moving in the desired
direction; allows timely and effective intervention to avoid
unnecessary delay or concern; and in no small way provides the
reassurance and confidence all Soldiers or Family need to feel truly
valued and reassured that their best interests are being addressed.
Within the Triad of Care, this translates to regular and frequent
assessment of each Soldier's plan, ongoing dialogue with the Soldiers
themselves, and immediate intervention as necessary to coordinate care
delivery, resolve issues, and keep everyone informed and focused.
Admiral Robinson's Answer. Case Management affects the medical care
of Wounded, Ill, and Injured service members in a positive way. Case
managers provide the Wounded, Ill, and Injured member with
individualized care that is specific to the needs of the service member
and those of his or her caregivers.
A comprehensive assessment in conjunction with the
multidisciplinary health care team is performed to determine the
service member's needs. Based on the assessment, an individualized plan
of care is developed; the plan consists of quality, cost-effective
interventions that will help the Wounded, Ill, and Injured service
member in the journey towards recovery and reintegration. To ensure
agreement and compliance, the patient and/or caregiver reviews and
signs off on the plan of care. Case managers coordinate care and assist
service members as they navigate through the healthcare system
resulting in defragmentation of care, appropriate utilization of
resources, and optimization of recovery. The Medical Care Case Managers
collaborate with Navy Safe Harbor and USMC Wounded Warrior Regiment
Recovery Care Coordinators and Non-medical Care Managers to support
Sailors, Coast Guardsmen, Marines, and their families holistically.
A smooth transition of care either to another facility, i.e.
Veterans Administration Medical Centers or a different healthcare
setting is coordinated by the case manager. Contact is made between the
transferring case manager and the receiving case manager to exchange
pertinent information and ensure the patient's seamless transition of
care and recovery needs.
LTG Roudebuch's Answer. The Services' case managers use a
collaborative process to assess, plan, implement, coordinate, monitor
and evaluate care and services to best meet the complex healthcare
needs of wounded or ill service members. This is accomplished through a
process of continuous communication with the patient, family members,
and healthcare providers, and the identification of best available
resources within the service member's community to promote highest
quality, cost-effective outcomes.
Military case management programs are designed to help wounded and
ill service members achieve optimal level of wellness, enhance quality
of life, improve patient and family satisfaction with medical services,
minimize complications of catastrophic injury, and obtain optimal self-
management and independence. To accomplish these outcomes, case
management programs are built to achieve specific goals:
Adopt strategies to provide integrated services
Coordinate care, ensuring continuity and compliance
with treatment regimens
Enhance collaboration with interdisciplinary
healthcare team members
Ensure timely and effective interventions
Improve patient and family satisfaction with the
healing process
Minimize fragmentation of care
Provide high quality, cost-effective care
The complex health needs of wounded or ill service members, which
may be physical, behavioral, emotional and/or educational in nature,
require the intense coordination and collaboration of military case
managers to ultimately return the service member to his or her highest
possible level of wellness and personal independence in an expeditious
manner.
Question. Can the Surgeons General provide some examples of how
combat casualty care has evolved since the beginning of OEF/OIF? How
have services been expanded/adapted to meet the needs of our wounded
warriors?
LTG Schoomaker's Answer. Since the beginning of these operations,
the Army has made great strides in increasing the survivability of our
wounded and injured Soldiers on the battlefield. Basic first aid
equipment prior to the start of the war was just a bandage issued to a
Soldier. Currently, each soldier is issued an Individual First Aid Kit
(IFAK) that contains a haemostatic dressing (Combat Gauze), tourniquet
(Combat Application Tourniquet), adhesive tape, nasopharyngeal airway,
and gloves. Providing the correct tools addresses the two leading
causes of death on the battlefield: severe hemorrhage and an inadequate
airway. Using these tools, we have expanded the concept of first aid
and buddy care, as first responders often provide the critical life
saving steps. Army Medicine played an important role in the
improvements to the Mine Resistant Ambush Protected (MRAP) ambulance,
Army Combat Helmet, Combat Arms Ear Plugs, Improved Outer Tactical
Vest, and Fire Retardant Army Combat Uniform. 25,000 Warrior Aid and
Litter Kits (WALK) have been procured to support current combat
operations. The WALK is stowed onboard vehicles to be used by the first
responder. The WALK complements the IFAK and the Combat Life Saver Bag.
It contains a foldable litter and the tools to treat and overcome the
three most common causes of preventable combat deaths on the
battlefield (hemorrhaging, tension pneumothorax, and inadequate
airway).
The MRAP-Ambulance provides increased protection to our crews and
patients. To make the MRAP-Ambulance the most capable ground ambulance
in the Army today, we integrated ``spin-out'' technology from the
Future Combat System Medical Vehicles. The combat medic is able to
leave the Forward Operating Bases to conduct medical evacuation
missions and can provide world class en-route care to wounded Soldiers.
Army Medicine also developed Casualty Evacuation Kits (CASEVAC) for
both the MRAP and High Mobility Multipurpose Wheeled Vehicle (HMMWV)
ambulances to increase capability. These efforts provided the combat
medic with field ambulances built for survivability in the challenging
environment of asymmetric warfare.
Our Soldier/Medics, including Physicians, Nurses, and Corpsmen,
receive the highest level of pre-deployment trauma training ever
provided. It is a critical link between standard medical care and the
intense battlefield environment Soldiers face in the current conflicts.
By recreating the high-stress situations medics will face in Iraq and
Afghanistan, this training allows for the refinement of advanced trauma
treatment skills and sensitization to hazardous conditions, thereby
allowing medics to increase their confidence and proficiency in
treatment.
To improve upon the care and support provided to our Wounded, Ill,
and Injured, the Army Developed the Warrior Care and Transition Program
(WCTP). In just two years, the WCTP has made extraordinary inroads
toward transforming the way the Army cares for wounded, ill, and
injured Soldiers and their Families. The Army has robustly resourced 36
Warrior Transition Units and 9 Community Based Warrior Transition
Units, established a proven approach to care management through the
triad of care concept, centralized support to Warriors in Transition
and their Families by co-locating support services in Soldier Family
Assistance Centers, and implemented the Comprehensive Transition Plan
approach to help Soldiers plan and attain their recovery goals.
Admiral Robinson's Answer. The most significant evolution of
theater medical care for injured Sailors and Marines has been the
widespread teaching and application of Tactical Combat Casualty Care
(TCCC). It is becoming increasingly apparent in 2009 that the basic
tenets of TCCC are sound and have been successful on the battlefield.
For example, the 75th Ranger Regiment reported that of 482 casualties
in Iraq and Afghanistan (including 31 fatalities), there were no
preventable deaths identified in Ranger units. This unit has a long-
standing standard of teaching TCCC to every combatant in their units,
so that the most critical life-saving interventions such as tourniquets
can be accomplished by every one of their unit members.
Perhaps the most successful single TCCC intervention has been the
widespread re-introduction of tourniquet use on the battlefield.
Despite not going to the GWOT with modern tourniquets, U.S. military
troops now routinely carry well-made tourniquets into combat.
Tourniquets have now been documented to be remarkably effective at
saving lives in casualties with isolated extremity trauma. Other TCCC
interventions such as nasopharyngeal airways, oral antibiotics, needle
decompression of tension pneumothorax, and surgical airways when needed
have not only proven effective, but have also helped to reduce both the
training requirements and the medical equipment load out carried by
combat medical personnel compared to previous battlefield trauma
management techniques.
In addition to in theater care that has previously been addressed,
enhanced care coordination and access to psychological health care
through primary and specialty care ensures highest quality of care to
our Wounded, Ill and Injured. Emphasis on destigmatized portals of care
to meet the needs of wounded warriors and their families, coupled with
cooperation in care with the VA has improved availability and quality
of care.
LTG Roudebush's Answer. One example is the development of a Joint
Theater Trauma System (JTTS), initiated in 2003 in Operation Iraqi
Freedom (OIF) with the establishment of a joint data registry (Joint
Theater Trauma Registry--JTTR), and progressing to an improved
regionalization of trauma care. The JTTS includes coordinated placement
of medical/surgical specialists and a process improvement program. It
has improved global collaboration across all levels of care and
rehabilitation via satellite multimedia communications and cultivated
numerous clinical practice guidelines with broad concurrence across
military and civilian specialty areas.
As another example, the advancement of damage control concepts
through ongoing research and data collection has contributed to the
development of new massive transfusion protocols (patients requiring
more than ten units of blood) incorporating increased ratios of blood
products (red blood cells, plasma, platelets) and the use of fresh
whole blood when components are not available. This has allowed
survival rates greater than 70 percent. These damage control concepts
have now been extended to the immediate recovery period and critical
care units. Casualty care has also benefitted from modifications in
wound management concepts due to our recent experience with extensive
tissue damage and contamination, to include abdominal wound management
with progressive closure of the abdominal wall via multiple operations
ad irrigation with a large amount of saline fluids. The use of negative
pressure wound devices (also known as vacuum assist devices) has led to
lower infection rates, less pain and decreased workload on nurses/
technicians from dressing changes.
We have reinstituted the use of the tourniquet as part of the
hemorrhage control algorithm. Tourniquets were considered heresy after
Vietnam in both civilian and military practice. However, tourniquet use
in OIF/OEF has led to a significant reduction in mortality from
extremity hemorrhage. In addition, there has been an adjustment of
hemorrhagic control adjuncts, for example, adding combat gauze as a
first line therapy and removing other adjuncts deemed to have adverse
outcomes or less effectiveness based on research and data collection.
Since the beginning of OEF/OIF, there has been the development of
Burn Resuscitation Guidelines. The development of these guidelines was
in response to over-resuscitation (large volumes of fluids) of burn
patients, resulting in significant complications ad mortality. The new
guidelines have significantly reduced complications such as abdominal
compartment syndromes and infections, as well as mortality.
The Air Force Medical Service has taken an active role in adapting
to challenges of the battle injured and then adapting our care through
the spectrum of care delivery to maximize wellness. The U.S.'s casualty
fatality rate for OIF and OEF is the lowest that it has ever been,
compared to previous U.S. wars and conflicts. The high survival rates
are directly related to improved individual body armor as well as a
combination of medical efforts including full implementation of damage
control resuscitation and surgery concepts, improved critical care,
advanced hemostatic devices and agents, coordinated pre-deployment
battlefield injury care training, and increased joint medical
interoperability. The AFMS contributes to this outstanding achievement
through its support of two Level III Air Force Theater Hospitals,
Expeditionary Medical Support, Army Forward Surgical Teams, and Joint
Forces Special Operations missions. Advancement in the care of
battlefield injury continues to emerge from the area of operations and
expand to civilian trauma practice, including the concept of
transfusing equal ratios of pack red blood cells to plasma in massive
blood transfusion situations. This revolutionary concept has led to 80
plus percent survival rates.
One adaptation of our healthcare service to meet the needs of the
Wounded Warrior is an enhanced focus on our Airmen and their
psychological health. Exposure to battlefield trauma places airmen at
risk for combat stress symptoms and possible mental health problems
such as depression or post-traumatic stress disorder. To support our
Airmen, the Air Force has taken a proactive approach of education,
symptom recognition, and encouraging help-seeking. One example is the
Landing Gear program, which is based on the metaphor that, no matter
how powerful an aircraft is in the air, properly functioning landing
gear is necessary to safely launch (i.e., deploy to war) and recover
(i.e., redeploy to home station). In the same way, Airmen are taught
that recognizing risk factors in themselves and others along with a
willingness to seek help is the key to functioning effectively across
the deployment cycle. During pre-deployment, Landing Gear training
explains deployment stress, the deployed environment, typical
reactions, ways to manage stress, and how to get help if needed. During
reintegration and reunion the program lays the foundation for what to
expect after deployment and facilitates a smooth reentry into work and
family life. The Air Force is using programs such as this to build upon
our Wingman Culture. For Airmen, being a Wingman means recognizing when
other Airmen are distressed and having the courage to care and become
involved.
Question. Do you have any concerns about delivery of healthcare
services to family members in the direct care system?
Ms. Embrey's Answer. We continue to assess the healthcare needs of
family members utilizing the direct care system as well as the ability
of the system to meet those needs. The Military Health System (MHS)
leadership recognizes the continuing challenge of providing timely,
consistent access to care at our installations. This will remain an
area of focus for the MHS in the year ahead.
LTG Schoomaker's Answer. One of the first concerns I identified as
Army Surgeon General was our inadequate facility infrastructure.
Investment in our facility infrastructure over the last two years has
been without precedent and I thank the Congress and this Committee for
its generous support. Continued funding in facility renovation and
modernization, information technology infrastructure, capital
equipment, and Military Construction (MILCON) is still beneficial and
necessary to deliver healthcare in the direct care system.
While we have made significant progress improving the functionality
of our aged facility inventory, I am concerned that the number of
providers deploying to support ongoing Overseas Contingency Operations
creates turbulence in the access and delivery of services to Soldiers
and their Families. We have attempted to mitigate this turbulence
through a variety of methods, including increased employment of
civilian providers and contract providers. We have established a Human
Capital Distribution Plan to assess, plan, implement, and evaluate the
military, civilian, and contracted personnel resources to optimize
support of healthcare in the direct care system.
I have made access to care and beneficiary satisfaction key
priorities. My command has implemented an aggressive Access to Care
Campaign Plan containing eleven focus areas that cover a wide spectrum
of access and customer service issues. Among the focus areas are the
alignment of treatment facility capacity with the number of enrolled
beneficiaries; improving provider availability; and leveraging
technology for efficiencies to include managing clinic appointment
schedules.
One area where I have no concerns is quality care. The quality of
health care rendered at our military treatment facilities is absolutely
first-rate. All Army hospitals are accredited by The Joint Commission,
which also accredits civilian hospitals. Outcome studies of the
National Quality Management Program, a DoD-sponsored program that
monitors military facilities, show military care usually meets or
exceeds civilian benchmarks. Civilian professionals on residency review
committees generally regard the Army graduate medical education as
among the best in the nation. The board certification passing rate for
graduates of Army residency and fellowship programs is 96 percent on
the first try, well above the national average. Approximately 93
percent of Army physicians eligible for specialty board certification
are certified.
Admiral Robinson's Answer. Patient and family-centered care is Navy
Medicine's core concept of care, ensuring that the patient is provided
the right health care service, at the right time, at the right place,
with the right provider. It identifies each patient as the essential
participant in his or her own health care and recognizes the vital
importance of the family, military culture, and the chain of command in
supporting our patients. Navy Medicine is constantly monitoring and
evaluating the quality and timeliness of the health care provided to
beneficiaries. In response to this monitoring and evaluation, Navy
Medicine has revised its Access to Care (ATC) Strategy to provide
Medical Treatment Facilities (MTF) and clinics a framework to implement
and sustain a systemic, proactive, and responsive access plan that
meets or exceeds beneficiary expectations and ATC standards. The ATC
strategy and Access to Care Management Policy for Navy Medicine
Military Treatment Facilities are designed to ensure the most optimal
patient and family-centered care. With strong senior leadership and
support, the policy articulates roles, responsibilities, and
expectations for all of Navy Medicine. Navy Medicine has also
established quality processes to meet the highest standards of
healthcare possible for our Nation's honored warriors and their
families.
Additionally, Navy Medicine is implementing and evaluating a ``best
practice'' model of health care delivery, the patient and family-
centered Medical Home Model, in two of our major medical centers. The
Medical Home Model is a concept of care that includes a team of
physicians, nurses, and support staff providing care to their enrolled
patients. The Medical Home Model guarantees access to the care giving
team for urgent health care needs within 24 hours, monitors the health
needs of patients and proactively contacts them for convenient follow-
up care that includes hassle-free appointment scheduling.
Some challenges do exist within the direct care system to include
limited specialty care services at some MTF related to specialties
deploying in theater however, Navy Medicine is actively addressing this
challenge by augmenting services through other direct care sources and
through the TRICARE managed care support contractors. In addition, Navy
Medicine is actively engaged to identify and lower administrative
barriers between other federal agencies and civilian institutions to
provide seamless integration of care for our patients.
LTG Roudebush's Answer. For decades the Air Force Medical System
has ingrained a continuous process to positively improve access and
quality in the direct care system. With the high operations tempo and
deployments the challenge of meeting access within the direct care
system has been met in partnership with Managed Care Support
Contractors. Quality continues to be monitored and validated through
National Accreditation Agencies--The Joint Commission and The
Accreditation Association for Ambulatory Health Care. These two
agencies validate our compliance with clinical quality assurance and
allow comparison with civilian healthcare agencies.
Our Managed Care Support Contract (MCSC) partners ably respond to
the challenges of maintaining the best health care services for our
beneficiaries. The MCSCs supplements the care available in the direct
care system with both network and non-network civilian healthcare
professionals, hospitals, pharmacies, and suppliers to provide better
access and high-quality service, while maintaining the capability to
support military operations. We have leveraged the MCSC to ensure our
families are provided timely access to quality healthcare delivery.
The TRICARE Operations and Patient Administration Flights at the
local Medical Treatment Facilities participate in regularly schedule
forums with the MCSCs to discuss any challenges with the delivery of
healthcare within the region, addressing both quality and access. Any
concerns that cannot be resolved at the lower level are then elevated
to the TRICARE Regional Offices for resolution.
The AFMS has a check and balance system to ensure both access and
quality health care services are continuously monitored and improved.

Ongoing Operations

Question. What percentage of care for activated soldiers and
dependents is in the base budget? What percentage is requested in
supplemental?
Answer. Our estimated Fiscal Year (FY) 2009 Operation and
Maintenance (O&M) funding, excluding supplemental funds, is $24.6
billion. Our anticipated FY 2009 O&M supplemental funding is $1.6
billion. Thus, roughly 94% of our O&M funding is in the regular O&M
appropriation and 6% is via the supplemental appropriation. These
percentages are representative of previous years.
Question. If there is no supplemental, how would you fund the care
for our Service members at facilities like Landstuhl, Walter Reed,
Balboa, and Brooke Army Medical Centers?
Answer. Providing high quality, accessible healthcare is our number
one priority and most important obligation. This is especially true
with respect to our most fragile beneficiaries, the wounded, ill and
injured soldiers, sailors, airmen, and Marines. In the absence of a
supplemental appropriation, we would redirect the required amount of
funding from available resources to support the direct healthcare
requirements. This strategy would have a resounding, negative impact on
the Military Health System programs that had funding removed.
Question. Would you continue to fund the expanded Military Amputee
Care Program and the Army Burn Unit?
Answer. Funding for amputee care centers and burn units was
``baselined'' in the Defense Health Program budget beginning in Fiscal
Year 2010 and are no longer dependent upon supplemental funding for
their day-to-day operations.
Question. How would you cover the healthcare expenses of the Active
Duty and Reserve Components' dependents and families related to
Operation Iraqi Freedom/Operation Enduring Freedom?
Answer. Providing high quality, accessible healthcare is our number
one priority and most important obligation. In the absence of a
supplemental appropriation, we would redirect available resources, as
required, to support direct healthcare requirements. This strategy
would have a resounding, negative impact on the Military Health System
programs that had funding removed.
Question. How would the necessary medical supplies such as
bandages, blood supply, and equipment be supplied to theater and
funded?
Answer. Additional costs for medical supplies are included in the
Department's supplemental appropriation request for Overseas
Contingency Operations (OCO). The majority of these requirements are
generated by models and planning factors based upon the number of
personnel, types of units deployed, and the types of contingency
operations expected during the deployment. The funding included in the
OCO supplemental for supplies is allocated to the Military Services or
to the Defense Health Program depending where the costs are incurred.

Additional Troops in Iraq

As a result of the President's Afghanistan strategy review, the
Secretary of Defense has increased forces for Operation Enduring
Freedom by 21,000 including 17,000 combat troops and 4,000 trainers.
Question. How will additional troops deployed to Afghanistan affect
the Military Health System (MHS) and its ability to treat the families
and dependents?
Answer. When our medical personnel deploy, we generally lose
capability in the military treatment facility (MTF) supporting the
deployment. However, in advance of the deployment, MTF commanders work
with the TRICARE Managed Care Support Contractors to either provide
physicians and ancillary staff to work in the MTF and refine the
civilian TRICARE network to ensure that needed care is available,
either in the MTF or in the network.
The MHS is structured so that the purchased care subsystem augments
MTFs by expanding, as necessary, to absorb overflow of workload from
the direct care subsystem when the MTFs experience increases in demand
for services or reduction in capability and/or capacity due to staff
deployments. The efficacy of this structure has been proven throughout
deployments, with data from a number of sources--formal surveys of
providers and beneficiaries, monitoring of TRICARE customer service
logs, regular meetings with the Military Coalition, data showing the
capacity of TRICARE purchased care to absorb a tremendous increase in
mental health workload since 9/11--all indicating that the MHS has been
functioning as designed, with no systemic problems preventing our
beneficiaries from accessing purchased health care services. We
anticipate this to continue when additional deployments to Afghanistan
occur.
Question. What additional medical personnel will be needed to
support the additional troop presence in theater?
Answer. The number and skills of medical personnel in theater is
dependent upon the size and missions of the Forces assigned, which
require operational decisions, not medical decisions. Therefore, the
Joint Staff and the Combatant Commander determine the need and assign
the staffing requirement to the Service components. The Services would
determine which medical resources were available and assign specific
units.

Additional Troops in Afghanistan

Question. What additional medical evacuation capabilities will be
required?
Answer. In January 2009, United States Central Command (USCENTCOM)
submitted two requests for forces to increase the capability currently
in Afghanistan. The Joint Staff, in conjunction with United States
Forces Afghanistan (USFOR-A) and USCENTCOM, conducted further analysis,
and based on those recommendations, sourced additional medical
evacuation (MEDEVAC) and surgical assets to further augment the medical
and evacuation capabilities in Afghanistan. To cover the period prior
to the arrival of the main augmentation forces, including the Combat
Aviation Brigade, a MEDEVAC ``bridging strategy'' was put in place with
the intent to immediately increase MEDEVAC capability in theater prior
to the arrival of these assets. By March 2009, the MEDEVAC Bridging
Solution assets were in place and operating in Regional Commands (RC)
East and South.
The requested Forward Surgical Teams, Level III Augmentation
Package, Medical Command and Control Headquarters (HQs) and additional
MEDEVAC Company have arrived in theater and are conducting operations.
USCENTCOM continues to evaluate the performance of these medical assets
through their transition into theater and assumption of the medical
support mission. To do this, USCENTCOM has instituted weekly reporting
of MEDEVAC performance, which is briefed to the USCENTCOM commander.
MEDEVAC missions that do not meet standards are analyzed to determine
the cause(s) which led to the missed standard and, when appropriate,
what actions are being taken to resolve identified problems. Overall
MEDEVAC mission times have been decreasing since the addition of the
Combat Aviation Brigade and its MEDEVAC Company, and we expect to see
further improvements to RC East (RC-E) and RC South (RC-S) as the
basing footprint and MEDEVAC procedures continue to be refined in
theater.
Approximately 90 days after the arrival of the final combat units,
there will be enough data collected to determine whether there are
sufficient assets in place in RC-E and RC-S to support the increased
theater requirements in these areas and achieve the Secretary of
Defense directed MEDEVAC standard of 60 minute mission completion time.
However, as International Security Assistance Force and USFOR-A
continue to expand operations farther into RCs West and North, the
preliminary assessment is that additional resources will be required to
meet the 60-minute standard in these two RCs. This Request for Forces
is still being refined by USFOR-A and will be forwarded to the Joint
Staff for sourcing once it has completed formal vetting within CENTCOM
HQs.

Deployment of Medical Units and Personnel

Question. Recent military medical deployments, in particular for
Operation Enduring Freedom, have shown we do not deploy the same way we
train. For instance, there are different systems in place for medical
reset and replenishment during exercises versus combat operations.
How do you propose to resolve the differences between medical
training and deployment?
Answer. Medical training can be divided into two types. Doctrinal
training, oriented toward support of the war fighter in any theater,
provides a framework for medical support of combat operations in any
theater. This training insures both the medical community and the line
understand in medical lockstep during the initiation of a new operation
because there is little room for misunderstandings during that time.
Initial deploying medical units then generally deploy as they train.
As the operation continues, doctrine may give way to local
situational requirements. This adaptability is a strength of the United
States military. New units rotating in will have the second type of
medical training--pre-deployment training--which considers and includes
local requirements; thus those units will also deploy as they train.
The progress of medical technology is rapid and we push the latest
capabilities to the most needed deployment locations. This may leave
the exercise facilities with something different. However, focuses of
exercise training are process and standards of operation, so medical
providers can adapt and apply their training to whatever equipment is
available at the deployed location.
Question. What shortfalls currently exist within the Military
Health System that relate to the Global War on Terrorism and ongoing
operations in and around the area of responsibility?
Answer. Additional costs related to the Global War on Terrorism are
included in the Department's supplemental appropriation request for
Overseas Contingency Operations (OCO). The majority of these
requirements are generated by models and planning factors based upon
the number of personnel, types of units, and the types of contingency
operations expected during the deployment. The funding included in the
OCO supplemental is allocated to the Military Departments or to the
Defense Health Program based upon where the costs are incurred.
Question. How are the costs of training medical personnel
reimbursed to the Services?
Answer. Additional costs for medical training are included in the
Department's supplemental appropriation request for Overseas
Contingency Operations (OCOs). The majority of these requirements are
generated by models and planning factors based upon the number and
types of personnel and units deployed and the types of contingency
operations expected during the deployment. The funding included in the
OCO supplemental for training medical personnel is allocated to the
Military Departments or to the Defense Health Program based upon where
the costs are incurred.
Question. How are the Services reimbursed for resupplying combat
medical units?
Answer. Additional costs for medical supplies are included in the
Department's supplemental appropriation request for Overseas
Contingency Operations. The majority of these requirements are
generated by models and planning factors based upon the number and
types of personnel and units deployed, and the types of contingency
operations expected during the deployment. Medical costs are included
in these generated requirements and are allocated to the Military
Departments or to the Defense Health Program based upon where the costs
are incurred.
Question. What is the monthly burn rate for healthcare before and
during Operation Iraqi Freedom/Operation Enduring Freedom?
Answer. Baseline funding for the Defense Health Program (DHP)
represents the cost of providing healthcare in a normal peacetime
environment; that is, exclusive of major contingencies or wartime
operations. Because the Department has funded contingency operations by
means of emergency wartime supplemental appropriations, it is possible
to calculate the average monthly expenditures for both normal
operations and for contingency/wartime operations.

--------------------------------------------------------------------------------------------------------------------------------------------------------
($Millions) 2000 2001 2002 2003 2004 2005 2006 2007 2008
--------------------------------------------------------------------------------------------------------------------------------------------------------
Defense Health Program Operation & Maintenance 10,524 12,411 16,384 18,113 20,181 22,355 25,852 23,694 25,316
Monthly Average............................................... 877 1,034 1,365 1,509 1,682 1,863 2,154 1,975 2,110
Global War on Terror.......................................... 0 0 0 705 888 1,063 1,090 1,073 1,461
Monthly Average............................................... ........ ........ ........ 59 74 89 91 89 122
-----------------------------------------------------------------------------------------
Total..................................................... 10,524 12,411 16,384 18,818 21,069 23,418 26,942 24,767 26,777
Monthly Average........................................... 877 1,034 1,365 1,568 1,756 1,952 2,245 2,064 2,231
--------------------------------------------------------------------------------------------------------------------------------------------------------

Question. What problems still exist, if any, with pre- and post-
deployment examinations and Service members' medical records?
Answer. At this time, the two important electronic systems used to
document the assessments and to provide medical care (electronic
medical records) do not communicate with each other. The Pre- and Post-
Deployment Assessments, as well as the Post-Deployment Health
Reassessments are captured electronically, but they are not in the
individual's electronic medical record. The original copies of the
assessments are filed in the permanent (hard copy) of the individuals'
medical records. We are working to close this gap. In the future,
medical providers will be able to view the health assessments whenever
they treat the Service member.
Question. What solutions has Health Affairs discussed to alleviate
some of the costs that the Services themselves are having to bear?
Answer. Costs the Services are bearing are funded via supplemental
appropriations. Additional costs associated with the deployment of
medical units and personnel are included in the Department's
supplemental appropriation request for Overseas Contingency Operations.
The majority of these requirements are generated by models and planning
factors based on the number and types of personnel and units deployed
and the types of contingency operations expected during the deployment.
Medical costs are included in these generated requirements and are
allocated to the Military Departments or to the Defense Health Program
based upon where the costs are incurred.
Question. Has the quality of care at military treatment facilities
(MTFs) decreased with the number of men and women being called to
support the ongoing operations?
Answer. The quality of care within MTFs has not decreased although
many men and women are supporting the ongoing operations. The Strategic
Plan, developed in concert with the Surgeons General and the Joint
Staff supports the MHS mission (to provide optimal health care
services--anytime, anywhere) and is designed to support MTF operations
during periods of sustained deployment of personnel. Through adherence
to, and application of, the principles of the MHS strategic planning
tool, the Balanced Scorecard, we have demonstrated positive results in
both quality of care measures and through beneficiary satisfaction
surveys.
Question. What has been done to maintain the level of care at the
Military Treatment Facilities (MTFs)?
Answer. The Military Health System was designed to provide optimal
health services in support of our Nation's military mission. National
security necessitates the deployment of military medical professionals
to operational settings. One way we attempt to mitigate the impact on
Military Treatment Facilities (MTFs) of deploying military medical
professionals is by providing additional funding to them, via Overseas
Contingency Operations Supplemental Appropriations, to hire contractors
and temporary civilians to ``backfill'' the deployed Service members.
In FY 2008, we provided roughly $207 million in such funding, in FY
2009 we anticipate providing up to $224 million. However, since we
cannot fully replace the deployed staff, even with reservists and
contracted healthcare providers, we must also rely on our network of
civilian providers established by our Managed Care Support Contractors
(MCSCs). The TRICARE networks provide eligible beneficiaries with
access to a global network of private-sector healthcare providers,
hospitals, and pharmacies. The network providers are fully
credentialed, highly qualified providers, and the hospitals are
accredited by a nationally recognized healthcare accreditation
organization. The healthcare provided in each network is monitored by
the MCSCs under their own quality management programs with oversight by
TRICARE Management Activity (TMA) regional offices. Additionally,
ongoing monitoring by an external contractor through the National
Quality Monitoring Contract assesses and reports to TMA on the care
provided by the MCSCs.

Combat Casualty Care and Body Armor

Question. Body armor has done a good job of saving lives but has
changed the types of injuries treated by the healthcare system. The
killed-in-action rate in Afghanistan and Iraq is half what it was in
World War II and a third less than Vietnam and Desert Storm. This is
due to the battlefield medical teams doing a better job of stabilizing
the wounded and getting them to doctors. Also, the Department has
recorded the highest casualty survivability rate in modern history with
more than 90% of those wounded surviving. Also, the added protection
can cause additional strain on the body that was not previously
experienced.
Due to the types of injuries, have you had to change the types of
medical personnel in theater? If so, how?
Ms. Embrey's Answer. Body armor has improved protection of the
trunk (including the neck), leaving the head, and extremities
(shoulders to fingers, hip joint to toes) at relatively greater risk
for injury. This means that extremity injuries have become more common,
as have survivable head injuries. Traditionally, orthopedic surgeons
have cared for extremity injuries, but general surgeons in theater have
adapted, so we have maintained the skills needed.
With the rise in survivable head injuries, we have added
neurosurgeons and neuromedically trained support personnel (nurses and
technicians). The rise in complexity of surviving casualties and the
use of intensive care providers for post-operative intensive care
(freeing surgeons to continue operating) have increased the requirement
for intensive care staff, both medical and nursing.
LTG Schoomaker's Answer. The Army Medical Department conducts
regular and repeated assessments of our medical performance on the
battlefield and in deployed environments. These assessments cover the
full range of doctrine, organization, training, materiel, leadership,
personnel, and facilities. We have made modifications and improvements
to each of these aspects over the course of seven years of combat.
While the basic types of medical units deployed has not changed
(combat medics, aeromedical evacuation assets, front line medical
companies, forward surgical teams, and combat support hospitals), we
have added critical care physicians and trauma surgeons to our
hospitals. We have also added a dedicated Deputy Chief of Staff
position at our hospitals to relieve the Chief of Surgery from most
administrative responsibilities, allowing the Chief of Surgery to focus
on clinical matters. With respect to other medical personnel in
theater, we have added a physical therapist to each maneuver Brigade
Combat Team to help these warfighters address physical readiness issues
and prevent them from wearing down due to the rigors of combat
operations, to include the strain caused by protective equipment. We
also augment our Combat Support Hospitals with extra physical
therapists to care for the injured and wounded and help expedite their
return to duty. Additionally, we have focused attention on delivery of
behavioral healthcare in theater by reinstituting a psychiatrist on the
Division Surgeon's staff, increasing the number of behavioral health
providers, and improving the distribution of behavioral health
providers across the battlefield.
Admiral Robinson's Answer. The combination of improved body armor
and the extensive use of Improvised Explosive Devices in the current
conflict have led to some different patterns of injury and
survivability, especially with increased rates of severe extremity
injuries and traumatic brain injuries. However, the medical personnel
taking care of injured Service Members in theater, including surgeons,
primary care physicians, and corpsmen/medics are well trained in the
entire spectrum of casualty care. As such, there has not been a need to
change the types of medical personnel deployed into theater due to
injury type sustained by Service Members.
That having been said, there is also an increased recognition of
combat stress as an issue that impacts operational readiness. This
recognition has led to an increased number of mental health
professionals being deployed into theater since the beginning of the
current conflicts.
LTG Roudebush's Answer. In the past three years, we have been
fairly stable with our overall capabilities and injury types have not
driven major changes in our deployed personnel, yet some additions have
been made to work with the local population, which comprises approx 2/3
of our care at our large facilities. Such examples include addition of
pediatric and OB/GYN providers. Additionally in response to lessons
learned, our critical care staffing has evolved.
We have made numerous advances in education and training,
equipment, and protocols. Other advances include the use of
tourniquets, far-forward surgery, access to medical evacuation,
heightened awareness of sequelae of injury (e.g., Traumatic Brain
Injury), advances in orthopedics, limb salvage techniques to include
early fasciotomy, control of hypothermia, fresh whole blood and full
component therapy.
The largest level III hospitals have been staffed to capabilities
which closely mimic the best trauma hospitals in the States, to include
vascular and thoracic surgery, burn and virtually every surgical
subspecialty minus organ transplantation. With the increase in
capability we've also vastly increased the support to these specialties
to include quantitative and qualitative improvements in imaging (CT,
angiography), use of blood and blood products, medications, laparoscopy
and other minimally invasive techniques, etc.
We have added new personnel roles such as the Trauma Czar, a highly
skilled trauma-trained subspecialist, who coordinates and directs the
symphony of trauma care with many other subspecialists. This role has
been advanced by Air Force medicine at Balad and subsequently Bagram as
another example of improvement in the delivery of trauma care that has
evolved over time. The current status of this innovation is the
development of a formal Trauma Czar course at the Joint Theater Trauma
System (JTTS) with inputs from military and civilian experts.
Data collection has also been a component in improvements in
personal protective equipment, vehicle improvements, resuscitation, and
many local and system-wide policy and procedure improvements.
And last but not least, the development and implementation of an
integrated JTTS with in-theater medical personnel supported by a
Continental U.S. based organization utilizing a state of the art
Defense Department Trauma Registry to conduct continuous performance
improvement and rapidly make changes to the system to improve care of
the wounded is an innovation probably never thought of prior to 2001.
We continuously assess the needs/capabilities required and have
already shifted one of our JTTS nurses from Balad to Bagram to meet the
increased volume of patients in Afghanistan. As the focus shifts to OEF
and the change in operations tempo, additions are already being made to
mirror what was in place at Balad, such as trauma/critical care
surgeons and other subspecialty/critical care providers.
Advances in blood availability and use are another example of
response to lessons learned. Blood and blood products have been pushed
far forward in theater, with state of the art equipment and training to
support their use. This brings out the point that not just physician
staffing has changed based on the volume and types of injuries, but
nursing and ancillary staffing has advanced as well.
Question. How have you changed the training and equipment for the
combat lifesaver compared to training and equipment carried prior to
Operation Iraqi Freedom and Operation Enduring Freedom?
LTG Schoomaker's Answer. The training for Combat LifeSavers (CLS)
has never been more necessary. CLS serve as the bridge between self-
aid/buddy aid and the Combat Medic. The Army Medical Department
continuously incorporates lessons learned from OIF/OEF to enhance the
program's relevance and effectiveness. Prior to OIF/OEF, the combat
lifesaver program was fundamentally a first aid course. The program
focused on preventive medicine, dehydration, use of intravenous (IV)
fluids as a primary method of trauma resuscitation, and tourniquet
application as a final option. IV training consumed 70% of the
available course training time. The program was trained at the unit
level under local supervision of the organic combat medics and
physician assistants. The generally accepted basis of allocation was
one combat lifesaver per squad, crew, or equivalent size element.
As a direct result of OIF/OEF the CLS program is now aligned with
the principles of Tactical Combat Casualty Care (TC3). The emphasis has
shifted from a basic first aid course to a generalized operational
medicine course aimed at treating preventable causes of battlefield
deaths. This fundamental change in the program has aligned the CLS with
the combat medic, strengthening medical cohesion. The CLS program has
undergone additional modifications as a direct result of OIF/OEF,
including:
The basis of allocation of CLS has increased from one per
squad to 100% of the Force.
Tourniquets are used as a primary means of controlling
extremity bleeding (#1 cause of death in current operations).
Combat gauze (a hemostatic dressing) is used for
controlling hemorrhage of non-compressible injuries.
Training now includes airway skills to include proper body
positioning and placement of a nasopharyngeal airway.
Training includes use of a 14-gauge needle for needle
decompression. Injuries to the chest, resulting in significantly
troubled breathing are associated with a tension pneumothorax
(collapsed lung). Introduction of a needle into the chest to relieve
the pressure is a lifesaving procedure formerly taught only to medics.
Question. How have you changed the training and equipment for the
combat lifesaver compared to training and equipment carried prior to
Operation Iraqi Freedom and Operation Enduring Freedom.
Admiral Robinson's Answer. The most significant evolution of
theater medical care for injured Sailors and Marines has been the
widespread teaching and application of Tactical Combat Casualty Care
(TCCC). It is becoming increasingly apparent in 2009 that the basic
tenets of TCCC are sound and have been successful on the battlefield.
For example, the 75th Ranger Regiment reported that of 482 casualties
in Iraq and Afghanistan (including 31 fatalities), there were no
preventable deaths identified in Ranger units. This unit has a long-
standing standard of teaching TCCC to every combatant in their units,
so that the most critical life-saving interventions such as tourniquets
can be accomplished by every one of their unit members.
Perhaps the most successful single TCCC intervention has been the
widespread re-introduction of tourniquet use on the battlefield.
Despite not going to the GWOT with modern tourniquets, U.S. military
troops now routinely carry well-made tourniquets into combat.
Tourniquets have now been documented to be remarkably effective at
saving lives in casualties with isolated extremity trauma. Other TCCC
interventions such as nasopharyngeal airways, oral antibiotics, needle
decompression of tension pneumothorax, and surgical airways when needed
have not only proven effective, but have also helped to reduce both the
training requirements and the medical equipment load out carried by
combat medical personnel compared to previous battlefield trauma
management techniques.
Question. How have you changed the training and equipment for the
combat lifesaver compared to training and equipment carried prior to
Operation Iraqi Freedom and Operation Enduring Freedom.
LTG Roudebush's Answer. The Air Force Medical Service in 2005
fielded a completely updated Improved First Aid Kit (IFAK) providing
our warfighters increased life-saving capabilities. The new Hemorrhage
Control (Combat Application Tourniquet and Hemostatic Bandage) and
Airway Management supplies are the newest additions found in the IFAK.
The Combat Application Tourniquet is a one-piece unit which allows one-
handed application for hemorrhage control. Quickclot Combat Gauze, also
included, can be fit to any size or shape wound, to include penetrating
wounds, and immediately stops life-threatening bleeding. A
nasopharyngeal airway tube was added to the IFAK and allows our airmen
to establish an airway, when needed. Previous First Responder First Aid
Kits had few of these new critical combat casualty components.
Our Self Aid and Buddy Course added these improvements to its
curriculum. In this course our airman are taught to use these additions
to their first aid kit, increasing the individual's capability to
provide buddy care and provide intervention for the two leading causes
of death on the battlefield, severe hemorrhage and inadequate airway.
In addition, the Self Aid and Buddy Course has been improved to
increase the emphasis on ``Wingman Responsibilities'' for Post-
Traumatic Stress Disorder symptoms as well as suicidal airmen.
Highlighting these responsibilities enables those individuals outside
the wire to look after each other, particularly when no mental health
capability is immediately available.
Question. Can the Surgeons General provide some examples of how
combat casualty care has evolved since the beginning of OEF/OIF?
LTG Schoomaker's Answer. Since the beginning of these operations,
the Army has made great strides in increasing the survivability of our
wounded and injured Soldiers on the battlefield. Basic first aid prior
to the start of the war was just a bandage issued to a Soldier.
Currently, each soldier is issued an Individual First Aid Kit (IFAK)
that contains a haemostatic dressing (Combat Gauze), tourniquet (Combat
Application Tourniquet), adhesive tape, nasopharyngeal airway, and
gloves. Providing the correct tools addresses the two leading causes of
death on the battlefield: severe hemorrhage and an inadequate airway.
Using these tools, we have expanded the concept of first aid and buddy
care, as first responders often provide the critical life saving steps.
Hemorrhage and temperature control are critical for the survival of
a wounded soldier. The emerging emphasis is on patient warming and has
become the preferred modality of care on the battlefield. Fluid
replacement on the battlefield is no longer recognized as the immediate
treatment of choice for blood loss in trauma related battlefield
injuries. Thermo regulation through the use of a warming blanket with
an internal heat source instead has become the recommended standard of
care.
Combat Lifesavers are non-medical Soldiers who are given
specialized training to augment the combat medic. The Combat Lifesaver
has been a force multiplier for many years but has recently been
provided enhanced training to address severe hemorrhage, airway
management, chest decompression, and patient warming. The Combat
Lifesaver bag and components have seen a physical change as well. A new
bag design has been introduced to provide users with quicker access to
components. In addition, a large strap cutter was added for patient
vehicle extraction and rapid clothing removal.
Army Medicine played an important role in the improvements to the
Mine Resistant Ambush Protected (MRAP) ambulance, Army Combat Helmet,
Combat Arms Ear Plugs, Improved Outer Tactical Vest, and Fire Retardant
Army Combat Uniform. 25,000 Warrior Aid and Litter Kit (WALK), have
been procured to support current combat operations. The WALK is stowed
onboard vehicles to be used by the first responder. The WALK
complements the IFAK and the Combat Life Saver Bag. It contains a
foldable litter and the tools to treat and overcome the three most
common causes of preventable combat deaths on the battlefield
(hemorrhaging, tension pneumothorax, and inadequate airway). The MRAP-
Ambulance provides increased protection to our crews and patients. To
make the MRAP-Ambulance the most capable ground ambulance in the Army
today, we integrated ``spin-out'' technology from the Future Combat
System Medical Vehicles. The combat medic is now able to leave the
Forward Operating Bases to conduct medical evacuation missions and can
provide world class en-route care to wounded soldiers. Medicine also
developed Casualty Evacuation Kits (CASEVAC) for both the MRAP and HMMV
ambulances to increase capability. These efforts provided the combat
medic with field ambulances built for survivability in the challenging
environment of asymmetric warfare.
Last and perhaps most important, our Soldier/Medics, including
Physicians, Nurses, and Corpsmen, receive the highest level of pre-
deployment trauma training ever provided. It is a critical link between
standard medical care and the intense battlefield environment Soldiers
face in the current conflicts. By recreating the high-stress situations
medics will face in Iraq and Afghanistan, this training allows for the
refinement of advanced trauma treatment skills and sensitization to
hazardous conditions, thereby allowing medics to increase their
confidence and proficiency in treatment. Army Medicine remains on the
forefront of medical technology and training ensuring that the finest
soldiers in the world receive the finest medical care on the
battlefield.
Admiral Robinson's Answer. The most significant evolution of
theater medical care for injured Sailors and Marines has been the
widespread teaching and application of Tactical Combat Casualty Care
(TCCC).
In addition to in theater care that has previously been addressed,
enhanced care coordination and access to psychological health care
through primary and specialty care ensures highest quality of care to
our Wounded, Ill and Injured. Emphasis on destigmatized portals of care
to meet the needs of wounded warriors and their families, coupled with
cooperation in care with the Department of Veteran Affairs has improved
availability and quality of care.
LTG Roudebush's Answer. One example is the development of a Joint
Theater Trauma System (JTTS), initiated in 2003 in Operation Iraqi
Freedom (OIF) with the establishment of a joint data registry (Joint
Theater Trauma Registry--JTTR), and progressing to an improved
regionalization of trauma care. The JTTS includes coordinated placement
of medical/surgical specialists and a process improvement program. It
has improved global collaboration across all levels of care and
rehabilitation via satellite multimedia communications and cultivated
numerous clinical practice guidelines with broad concurrence across
military and civilian specialty areas.
As another example, the advancement of Damage Control Concepts
through ongoing research and data collection has contributed to the
development of new massive transfusion protocols (patients requiring
more than 10 units of blood) incorporating increased ratios of blood
products (red blood cells, plasma, platelets) and the use of fresh
whole blood when components are not available. This has allowed
survival rates greater than 70 percent. These damage control concepts
have now been extended to the immediate recovery period and critical
care units. Casualty care has also benefitted from modifications in
wound management concepts due to our recent experience with extensive
tissue damage and contamination, to include abdominal wound management
with progressive closure of the abdominal wall via multiple operations
and irrigation with a large amount of saline fluids. The use of
negative pressure wound devices (also known as vacuum assist devices)
has led to lower infection rates, less pain and decreased workload on
nurses/technicians from dressing changes.
We have reinstituted the use of the tourniquet as part of the
hemorrhage control algorithm. Tourniquets were considered heresy after
Vietnam in both civilian and military practice. However, tourniquet use
in OIF/OEF has led to a significant reduction in mortality from
extremity hemorrhage. In addition, there has been an adjustment of
hemorrhagic control adjuncts, for example, adding combat gauze as a
first line therapy and removing other adjuncts deemed to have adverse
outcomes or less effectiveness based on research and data collection.
Since the beginning of OEF/OIF, there has been the development of
Burn Resuscitation Guidelines. The development of these guidelines was
in response to over-resuscitation (large volumes of fluids) of burn
patients, resulting in significant complications and mortality. The new
guidelines have significantly reduced complications such as abdominal
compartment syndromes and infections, as well as mortality.
Question. How have services been expanded/adapted to meet the needs
of our wounded warriors?
Ms. Embrey's Answer. We have expanded and adapted many services to
meet the needs of our wounded Service members. One example is our
tremendous focus to return amputees to pre-injury (or close as
possible) levels of performance. Prosthetic technology, surgical
approaches to amputee care, rehabilitation science and techniques have
combined to produce new approaches to maintaining or even exceeding
pre-injury capabilities. Another example is the capability to rapidly
transport critical casualties from the theater of operations to
definitive care military medical centers in the United States. This
rapid transport promotes early intervention by well trained and
experienced specialty care teams and continuity of care. Ultimately,
this rapid transport to a stateside care location provides continuity
of care for the Service member from surgery through to recovery.
We have expanded support services to assist Service members and
their families in financial and other matters while in recovery and
transition, either back to the Force or into civilian life. The
Services have all implemented programs to ensure appropriate care and
assistance, and a new pilot program has improved the transition from
the Department of Defense to the Department of Veterans Affairs'
responsibility within the Disability Evaluation System for both
Departments.
LTG Schoomaker's Answer. The transformation of Warrior Care began
in April 2007 with the development of the Army Medical Action Plan
(AMAP), which outlined an organizational and cultural shift in how the
Army cares for its wounded, ill, and injured Soldiers. Over the past 23
months, the AMAP evolved into the Army Warrior Care and Transition
Program (WCTP), fully integrating Warrior Care into institutional
processes across the Army. In just two years, the WCTP has made
extraordinary inroads toward transforming the way the Army cares for
wounded, ill, and injured Soldiers and their Families. The Army has
robustly resourced 36 Warrior Transition Units and 9 Community Based
Warrior Transition Units, established a proven approach to care
management through the triad of care concept, centralized support to
Warriors in Transition and their Families by co-locating support
services in Soldier Family Assistance Centers, and implemented the
Comprehensive Transition Plan approach to help Soldiers plan and attain
their recovery goals. True to the Army's credo of never leaving a
fallen comrade, and with the support of Congress, we have begun the
process of building Warrior Transition Complexes to create a safe and
accessible environment to accomplish the enduring mission of caring for
our brave men and women who have freely sacrificed their well-being in
defense of freedom.
In coordination with the Department of Veterans Affairs, the
Defense Centers of Excellence for Psychological Health and Traumatic
Brain Injury (TBI), and the Defense and Veterans Brain Injury Center--
the Army continues to expand resources dedicated to TBI research and
treatment. For most TBI cases, our Soldiers and family members can
expect a full recovery with no lasting mental or physical effects.
Receiving prompt care is a key to returning to the highest functional
level possible. Thanks to generous congressional funding, the Army is
at the forefront of TBI treatment, care, and support. From improved
training for our providers, to expanded screening and treatment at our
forward combat medical facilities, to additional personnel, resources
and training for our primary care physicians, nurse case managers, and
our wide variety of specialists, Soldiers and Families affected by TBI
have access to the full range of Army support.
Service members who have lost limbs as a result of wounds received
in Afghanistan or Iraq are receiving the best medical care available in
state of the art facilities at Walter Reed and Brooke Army Medical
Centers. As part of the Armed Forces Amputee Care Program,
multidisciplinary teams from more than a dozen specialties work
together to address the psychological, social, vocational, and
spiritual needs of our Soldiers, marines, sailors, and airmen, in
addition to their physical rehabilitation. Over the past decade, a
cultural shift has occurred within the military, giving individuals
with limb-loss the opportunity to stay on active-duty service. Advances
in medical, surgical and rehabilitative care, as well as prosthetic
design, help individuals achieve this goal. Whether or not the Soldier
desires, or has the ability, to remain on active duty service, the Army
is committed to helping all amputees reach their maximal function and
return to the highest possible quality of life.
Admiral Robinson's Answer. Navy Medicine has supported a number of
programs to meet the increasing needs of our wounded warriors. In
Fiscal Year 2008, $31.95 Million of Psychological Health-Traumatic
Brain Injury (PH-TBI) supplemental funds supported the contracting of
187.5 positions enterprise-wide. This effort has been expanded in
Fiscal Year 2009 to $47.37 Million to support the contracting of 411
positions (including the continuation of Fiscal Year 2008 positions)
enterprise-wide. Increased staffing at the MTF level has facilitated
the creation of new wards and clinics such as the TBI and Related
Disorders (TBIRD) at Naval Hospital Camp Pendleton (NHCP), the
Comprehensive Combat Casualty Care Center at Naval Medical Center San
Diego (NMCSD), and the addition of a new PH-TBI ward at National Naval
Medical Center (NNMC). Unprecedented success has also been achieved
with the formation of an ``Admin Cell'' at NNMC that tracks entry and
exit of patients into the system, maximizes capture of Relative Value
Units (RVU), and reports on treatment efficacy. Other successes include
increased inpatient and outpatient encounters (26,000 mental health
visits at Naval Hospital Camp Lejeune (NHCL) this past year), improved
capability to provide evidence-based group therapies, and increased
outreach to Individual Augmentee/Global War on Terrorism Support
Assignments (IA/GSA) personnel.
Additional supplemental funds enhanced existing services or
addressed existing gaps. Receiving a total of $10.5 Million in Fiscal
Year 2008 and Fiscal Year 2009, the Naval Center for Combat and
Operational Stress Control (NC COSC) offers Post Traumatic Stress
Disorder (PTSD) specialized knowledge and intervention, research
support, interactive website, and houses a library for OSC content and
best practices. NC COSC implemented OSC Training at the IA Combat,
Command Leadership, and Senior Enlisted levels and hosted the February
2009 Defense Centers of Excellence (DCoE) for PH-TBI Quarterly Planning
Summit. Navy Medicine used $2.99 Million in Fiscal Year 2008 to provide
psychological health outreach coordinators and support staff at the
five Navy Regional Reserve Component Commands (RCCs). The outreach
teams act as a ``safety net'' for Navy Reservists and their families
(who are at risk for not having their stress injuries identified and
treated in an expeditious manner) and improve their overall mental
health. The Reserve outreach teams received $6.53 Million in Fiscal
Year 2009 to support the continuation of the Navy component and to
expand services to include the Marine Corps Reserves. Navy Medicine has
also taken new steps to support the Marine Corps Wounded Warrior
Regiment with Fiscal Year 2008 and Fiscal Year 2009 total of $2.04
Million. Funds support the provision of clinical services staff to:
support a comprehensive psychological health and TBI program which
ensures that every Marine and Sailor assigned to a Marine Corps unit
receives the best prevention, identification, and treatment available;
assist in developing policies and implementing procedures; and
facilitate clinical assessment and management of individual cases.
LTG Roudebush's Answer. The Air Force Medical Service (AFMS) has
taken an active role in adapting to challenges of the battle injured
and then adapting our care through the spectrum of care delivery to
maximize wellness. The U.S. casualty fatality rate for Operation Iraqi
Freedom (OIF) and Operation Enduring Freedom (OEF) is the lowest that
it has ever been, compared to previous U.S. wars and conflicts. The
high survival rates are directly related to improved individual body
armor as well as a combination of medical efforts including full
implementation of damage control resuscitation and surgery concepts,
improved critical care, advanced hemostatic devices and agents,
coordinated pre-deployment battlefield injury care training, and
increased joint medical interoperability. The AFMS contributes to this
outstanding achievement through its support of two Level III Air Force
Theater Hospitals, EMEDS, Army Forward Surgical Teams, and Joint Forces
Special Operations missions. Advancement in the care of battlefield
injury continues to emerge from the area of operation and expand to
civilian trauma practice, including the concept of transfusing equal
ratios of pack red blood cells to plasma in massive blood transfusion
situations. This revolutionary concept has led to 80 plus percent
survival rates.
One adaptation of our healthcare service to meet the needs of the
Wounded Warrior is an enhanced focus on our Airmen and their
psychological health. Exposure to battlefield trauma places airmen at
risk for combat stress symptoms and possible mental health problems
such as depression or post-traumatic stress disorder. To support our
Airmen, the Air Force has taken a proactive approach of education,
symptom recognition, and encouraging help-seeking. One example is the
Landing Gear program, which is based on the metaphor that, no matter
how powerful an aircraft is in the air, properly functioning landing
gear is necessary to safely launch (i.e., deploy to war) and recover
(i.e., redeploy to home station). In the same way, Airmen are taught
that recognizing risk factors in themselves and others along with a
willingness to seek help is the key to functioning effectively across
the deployment cycle. During pre-deployment, Landing Gear training
explains deployment stress, the deployed environment, typical
reactions, ways to manage stress, and how to get help if needed. During
reintegration and reunion the program lays the foundation for what to
expect after deployment and facilitates a smooth reentry into work and
family life. The Air Force is using programs such as this to build upon
our Wingman Culture. For Airmen, being a Wingman means recognizing when
other Airmen are distressed and having the courage to care and become
involved.
Question. What are the new, emerging technologies that make the
combat lifesaver more effective in saving the lives of Military
personnel?
Ms. Embrey's Answer. ``Combat Lifesaver'' (CLS) is a term used to
designate a level of emergency response training. A CLS is a non-medic
soldier with moderate emergency medical training who can provide care
at the point of wounding. The CLS is instructed in various techniques
to treat and stabilize injuries related to combat. The CLS doctrine was
developed to increase survivability in combat environments where the
combat medic may not be readily available. Skills of the CLS include
basic casualty evaluation, airway management, chest injury and
collapsed lung management, bleeding control, intravenous drip therapy,
and medical evacuation requests.
The greatest contributing factor in increasing the effectiveness of
CLS is improved training. Now, all soldiers are trained to CLS level.
That training has been enhanced with the development of simulators for
life saving procedures. Research continues to develop more realistic
simulators that mimic the physiologic responses of the body to both
injury and treatment.
Supplies needed to perform the life saving interventions are
contained in the Individual First Aid Kit. Issued to each soldier, the
kit consists of a tourniquet, combat gauze (impregnated with a material
to stop bleeding), a nasal airway, and other supplies. It replaces the
single gauze bandage previously issued to each soldier.
The majority of preventable deaths may be saved by stopping
bleeding. The research community is engaged to improve tourniquet
devices and application guidelines, improve hemostatic bandages to
treat external bleeding, and investigating new, emerging technologies
to stop internal bleeding.
Once the bleeding is stopped, the CLS can start intravenous lines
for fluid replacement. Starch based fluids that are equally as
effective at replacing lost blood volume as saline solutions are the
product of efforts to identify the most appropriate agents to be added
to standard resuscitation treatments. Work continues to identify better
fluids with increased capabilities to:
Control the degree of inflammation following trauma
Maintain adequate transportation of oxygen to the tissues
Restore/maintain normal blood clotting capability
Recent studies have established early control of pain can result in
improved long-term outcomes for combat casualties. A nasal spray for
relief of acute pain that could be administered by CLS is nearing Food
and Drug Administration approval.
Evacuation of casualties to the next level of care is facilitated
by the Warrior Aid and Litter Kit (WALK). This kit, carried on tactical
vehicles, includes a large supply of first aid supplies and a
collapsible litter. Having the litter available on site reduces the
time required to load a casualty onto the evacuation platform
(helicopter, ground ambulance, or other vehicle).
Control of body temperature is important in treating casualties.
Even in a desert environment, casualties need support to maintain a
satisfactory temperature. The Hypothermia Prevention and Management
Kit, a space blanket type sleeping bag with a self contained chemical
heat source, provides a simple method of keeping patients warm and is
available in the WALK.
LTG Schoomaker's Answer. ``Combat Lifesaver'' is a term used to
designate a level of emergency response training. A Combat Lifesaver
(CLS) is a non-medic Soldier with moderate emergency medical training
to provide care at the point of wounding. The CLS is instructed in
various techniques to treat and stabilize injuries related to combat,
to include, but not limited to, blast injury, amputation, severe
bleeding, penetrating chest injuries, simple airway management, and
evacuation techniques. The CLS doctrine was developed as an effort to
increase survivability in combat environments where the combat medic
may not be readily available. Skills of the CLS include basic casualty
evaluation, airway management, chest injury and collapsed lung
management, controlling bleeding, intravenous drip therapy, and
requesting medical evacuation.
The greatest contributing factor in increasing effectiveness of CLS
is improved training. Where previously there were a few CLS in troop
units, now all Soldiers are trained to that level. That training has
been enhanced with the development of simulators for life-saving
procedures. Research continues into developing more realistic
simulators that mimic the physiologic responses of the body to both
injury and treatment.
Supplies needed to perform the life-saving interventions are
contained in the Individual First Aid Kit (IFAK). Issued to each
Soldier, the kit consists of a tourniquet, Combat Gauze (impregnated
with a material to stop bleeding), a nasal airway, and other supplies.
The IFAK replaces the single gauze bandage previously issued.
The majority of preventable deaths may be saved by stopping
hemorrhage. The research community is engaged in a continuous process
of improving tourniquet devices and application guidelines,
continuously improving hemostatic bandages to treat external bleeding,
and focusing on new, emerging technologies to stop internal bleeding.
Once the bleeding is stopped, CLS start intravenous lines for fluid
replacement. Starch based fluids that are equally as effective at
replacing lost blood volume as saline solutions are the product of the
continuous process of identifying the most appropriate agents to be
added to standard resuscitation treatments. Work continues to identify
better fluids with increased capabilities to:
Control the degree of inflammation following trauma
Maintain adequate transportation of oxygen to the tissues
Restore/maintain normal blood clotting capability
Recent studies have established early control of pain can result in
improved long-term outcomes for combat casualties. A nasal spray for
relief of acute pain which could be administered by CLS is nearing FDA
approval.
Evacuation of casualties to the next level of care is facilitated
by the Warrior Aid and Litter Kit (WALK). This kit, carried on tactical
vehicles, includes a large supply of a wide array of first aid supplies
and a collapsible litter. Having the litter available on site reduces
the time required to load a casualty onto the evacuation platform
(helicopter, ground ambulance, or other vehicle).
Control of body temperature is important in treating casualties.
Even in a desert environment, casualties need support to maintain a
satisfactory temperature. The Hypothermia Prevention and Management
Kit, a space blanket type sleeping bag with a self contained chemical
heat source, provides a simple method of keeping patients warm and is
available in the WALK.
Admiral Robinson's Answer. The Marine Corps Combat Lifesaver is
trained in techniques to minimize blood loss, control hemorrhaging,
treat for shock, maintain an open airway, treat broken bones, and
evacuate casualties. Training also covers identifying and treating
bleeding wounds, bone fractures, burns, and several complications
caused by wounds typically incurred on the battlefield. Naval Medical
RDT&E has a focus area in combat casualty care that focuses on
equipment and techniques that enhance these basic skills.
Naval Medical R&D has responded to identified needs for far forward
care in:
Hemostatic Agents for Treatment of Life-Threatening Hemorrhage:
Marine Corps Systems Command (MARCORSYSCOM) sponsored the Naval Medical
Research Center (NMRC) Combat Casualty Care Directorate to assess 12
different hemostatic formulations to include current standard of care
preparations HEMCON and QuikClot. The QuikClot Combat Gauze\TM\ was
judged superior to all other hemostatic preparations. The report to the
Committee for Tactical Combat Casualty Care in February and April 2008,
along with results from Army investigators, led to a recommendation to
deploy Combat Gauze as the hemostatic preparation of choice. The
results were transitioned to the MARCORSYSCOM Sponsor for USMC
Individual First Aid Kit (IFAK) deployment.
Maintaining an open airway: Cricothyrotomies, a technique for
maintaining an open airway, are reported to be a problem during forward
care of casualties. Interviews with conventional and SOF first
responders have indicated that the existing capability is often
compromised during field operations. The Navy, USMC, and Army, working
with a commercial partner, have a device in late Test & Evaluation that
shows great potential for enhancing this critical capability. The
Cric\TM\ Cricothyrotomy Kit allows one-handed operation to illuminate
(visible or IR), incise, spread, and hold open the incision for
insertion of a breathing tube. The two current versions are amenable
for use in the hospital or by EMTs. A military version is planned for
FY10 introduction.
LTG Roudebush's Answer. Likely, the biggest technological
contributions to more effective first aid on the battlefield are the
evolution and fielding of hemostatic dressings, the Combat Application
Tourniquet and changes guidelines via the Committee on Tactical Combat
Casualty Care that emphasize the early application of tourniquets, and
improved IV fluids such as Hextand. From a research and development
perspective, Air Combat Command is engaged in several initiatives to
improve combat medic effectiveness.
Blood Pharming will provide the capability to produce a ready
supply of fresh, universal donor packed red blood cells in theater.
Theoretically this system will produce an unlimited blood supply
without risk of infectious disease transmission, and can be located at
an air head or near the theater of operations, reducing shipping and
distribution times and significantly improving blood freshness.
The Field Intravenous Fluid Reconstitution device will result in a
Food and Drug Administration-approved IV solution at deployed locations
for immediate use or storage. The concept is to transport IV bags with
salt, glucose and lactated ringers dry powder concentration, and
reconstitute in theater with sterile, Food and Drug Administration-
approved water generated on site from the local military water supply.
The Deployable Oxygen Generation System--Small (DOGS-S) device
(also mentioned as a response to question MUR017) is being designed to
concentrate ambient oxygen (21 percent) into 93 percent therapeutic
oxygen and continuously supply this oxygen product directly to
patients. DOGS-S will fit into a medium-size medical rucksack, be one
man-portable, and used on the ground or in aircraft. DOGS-M is in the
production phase with five units expected for delivery in July 2009.
Natural Language Processing is companion software to the electronic
health record that processes text files and extracts medical data
elements and automatically populates a database. The information and/or
trends identified from the database strengthen medical surveillance and
enhance command situational awareness of overall health of the
population at risk.

Aeromedical Evacuation

Question. Aeromedical evacuation is distinctly an Air Force
mission, and a critical component of the Air Force's global reach
capability.
What makes aeromedical evacuation distinctly different today vice
the 1991 Gulf War?
Answer. The Air Force's responsive aeromedical evacuation system is
built on universally qualified aeromedical crews augmented by critical
care air transport teams flying on non-dedicated aircraft under a
unified mobility command and control structure. After the 1991 Gulf
War, U.S. military doctrine evolved to adopt a new casualty replacement
policy, smaller medical presence in theater and overseas, and movement
of stabilized casualties versus the Gulf war paradigm of ``only stable
patients fly air evac''. Today's aeromedical evacuation (AE) system
allows for unprecedented flexibility because AE crews are not qualified
on specific airframes but are universally qualified to provide care in
the air on any mobility aircraft. Through the use of alert aircraft and
In System Selects (diverting an aircraft) urgent patients are being
transported on average within seven hours and priority patients within
nine hours. Not only are patients in general being moved back to the
Continental U.S. quicker than any time in history, the movement of the
most severely injured/ill patients is done rapidly with the integration
of critical care transport teams in deployed aeromedical evacuation
units marrying specialized clinical capability with the AE crews and
aircraft. As a result, medical support for OIF/OEF has required one
tenth the beds and one fifth the medical personnel in theater returning
patients to the U.S. in one seventh the time than during the 1991 Gulf
War. Since September 11, 2001, the aeromedical evacuation system has
moved over 64,000 patients including almost 12,000 battle-injured; the
battle-injured movements alone exceed all patients moved during the
Gulf War.
aeromedical evacuation today vice 1991
Today, aeromedical evacuation and Critical Care Air Transport Team
synergy allows Intensive Care Unit level ``Care In The Air'' 24/7
anywhere, anytime.
Today, if Mobility Air Forces airframes can land there, we can
deliver aeromedical evacuation/Critical Care Air Transport Team
capability there.
Today, aeromedical evacuation unit type codes are far lighter,
leaner, and rapidly deployable in a few hours; Aeromedical Evacuation
Liaison Teams, Mobile Aeromedical Staging Facilities, Aeromedical
Evacuation Operations Teams, bringing secure redundant communications,
enabling patient regulation from far forward, austere locations.
Today, our rapid aeromedical evacuation capability of moving
patients in one to three days from the area of responsibility to
Continental U.S. has made the benchmarks of the past obsolete. In the
past a tactical evacuation of 7 days and strategic evacuation of 7 to
14 days was ideal.
Today, aeromedical evacuation missions with leveraged Air to Air
Refueling can execute nonstop missions for cases such as burn patients
from Balad Air Base to Brook Army Medical Center, San Antonio in less
than 24 hours.
Today, the C-17 Globemaster III supports the highest standards of
aeromedical evacuation capability; integral oxygen, lighting,
temperature control, a very high quality care environment, with
critical range, speed and refueling capabilities.
Question. The Committee understands that the Air Force is exploring
advanced technologies to monitor the condition of pilots in flight and
to improve health outcomes for patients during aerovac operations. Can
you provide some examples of the type of projects being undertaken by
the Air Force Health Services?
Answer. The Air Force Research Laboratory Human Performance
Directorate and Human Performance Integration Directorates under the
711th Human Performance Wing do not currently have any projects related
to the monitoring of the condition of pilots during flight. Routinely,
our flight surgeons take all precautionary measures to ensure the
readiness of pilots with annual physical examinations, ophthalmologic
exams, stress tests, and centrifuge exercises, so that if a pilot's
physiology changes, or a new disease diagnosed, flight surgeons can
take appropriate action for the sake of flight safety.
The Air Force Medical Service has a number of efforts underway to
improve health outcomes for patients during aeromedical operations.
The Vacuum Spine Board was procured recently and fielded for use by
Critical Care Air Transport Teams. The Patient Proning Device, a
related initiative, will provide the ability to rotate patients to
provide comfort, alleviate pressure, or provide therapeutic treatments
is underway.
The Patient Isolation Unit will provide Air Mobility Command the
capability to isolate and treat biologically contaminated patients in
the aeromedical evacuation (AE) system. The Food and Drug
Administration-approved Patient Isolation Unit will expand the
capability to allow AE teams to safely move contaminated/contagious
patients safely.
The Aeromedical Evacuation Electronic Medical Record (AE EMR) will
provide documentation of medical history and care, storage, retrieval,
and forwarding of those records generated while the patient is
transiting the AE system. The AE EMR will ensure AE providers have the
needed patient information to make diagnostic and treatment decisions
during transport, and information will also be available to medical
staff at receiving fixed medical facilities in real time for enhanced
continuity of care.
Question. The Committee understands that monitoring the condition
of patients during aerovac operations presents challenges. Are there
research efforts underway to improve the technology used to monitor
patients during aerovac.
Answer. The Air Force Medical Service (AFMS) is moving critically
injured patients on aeromedical evacuation (AE) missions with great
success. Still, the AE environment poses unique challenges while caring
for these intensive care unit type patients on the back of a cargo
aircraft. High noise levels (average of 85 decibells) can interfere
with voice recognition, obscure audible signals and alarms on
equipment, and increase crew fatigue. Usually, AE missions fly at an
altitude to maintain cabin pressures of about 8,000 feet. Decreased
oxygenation inherent at altitude can worsen some medical conditions
making monitoring that much more important. Monitoring patients during
flight is both crucial and difficult, and the AFMS has several
initiatives underway to improve technology used to monitor patients
during AE.
Air Mobility Command's number one priority is an Enroute Critical
Care System (ECCS). This system will integrate equipment required to
care for most critical care patients into one patient movement
platform. It consists of capabilities to provide: (1) Physiologic
Monitoring (heart rate, respiration/breathing rate); (2) Hemodynamic
Monitoring and Intervention (blood pressure, shock); (3) Ventilation;
(4) Oxygen; (5) Fluid Resuscitation; and (6) Flexible Power
Utilization. The monitoring aspects of the ECCS will also include
alarms to alert the medical team to changes in condition that require
re-assessment of the patient to guide medical decision making. This is
a validated initiative and is scheduled to begin operational test and
evaluation in Jan 2010.
Non-Invasive Monitoring for Traumatic Brain Injury (TBI) will
provide new triage/screening, diagnostic, and monitoring capabilities
for TBI patients in far forward locations, during evacuation and
recovery. It should provide early definitive diagnosis of TBI.
Additionally, TBI will be monitored during AE missions for any
progression in severity to guide care and documentation of a patient's
condition. Current invasive type monitors could subject the patient to
infections where a non-invasive monitor would mitigate that risk. This
initiative is currently in the requirements validation process.
The Acoustic Stethoscope will greatly enhance the ability to hear
diagnostic quality heart, lung, and bowel sounds, and take manual blood
pressures during AE missions. Currently, at times, it is extremely
difficult to adequately monitor these important diagnostic measures due
to high ambient noise levels on the flight line and in the air, but
developments in noise cancelling technologies will ensure a drastic
improvement. This initiative is currently in the requirements
validation process.
A Non-Invasive Compartment Syndrome Monitor will measure and
monitor tissue perfusion and compartment pressures. It is thought that
altitude contributes to the development of compartment syndrome, a
condition that can lead to loss of a limb due to decreased circulation.
Research is underway for a device to prevent or detect compartment
syndrome and to help guide a medical decision for surgical
intervention.

Morale

Question. Generals, when asked the question, in prior hearings,
``how is morale in your branch of service'', each of you replied that
morale was very high. The ongoing operations continue to dominate the
news and consequently the thoughts and concerns of American citizens.
Operational tempo is high and extended deployments have made direct and
lasting impacts on service members and their families.
Based on these continuing and challenging conditions, how would you
describe morale in your service today?
LTG Schoomaker's Answer. I would still describe morale in the Army
as high. Our Soldiers and Families are doing remarkably well while
serving during very stressful times. They continue to impress and
inspire me. The data support my assessment. The Sample Survey of
Military Personnel (SSMP) is conducted on behalf of the Army G-1 each
Spring and Fall. Key findings from the Fall 2008 survey are summarized
for career intent, morale, reasons for leaving the Active Army before
retirement, and quality of life/job satisfaction. Results on officers'
and enlisted Soldiers' plans to stay in the Army are improving (more
positive). Morale is steady. For both officers and enlisted Soldiers,
``Amount of time separated from family'' continues to be the primary
reason for leaving or planning to leave the Army before retirement.
Satisfaction levels with quality of life (well-being) and job
satisfaction are increasing for both officers (25 of 58 factors) and
enlisted Soldiers (15 of 58). Most notable are increases in
satisfaction with ``Quality/Availability of Army family programs'' and
``Level of educational benefits.''
Admiral Robinson's Answer. Between 2000 and 2008, morale has
improved substantially among both enlisted and officer personnel. In
2000, 14 percent of enlisted personnel and 27 percent of officers rated
command morale as ``very high'' or ``high.'' In 2008, 31 percent of
enlisted personnel and 56 percent of officers rated morale as ``very
high'' or ``high.'' The three factors most affecting positive morale
among both officer and enlisted personnel are; quality of shipmates,
immediate supervisors, and educational programs. Other factors cited
include compensation and health care benefits.
LTG Roudebush's Answer. Morale remains high across the Air Force
Medical Service. A significant number of Air Force medical technicians
have enlisted since the start of Operations IRAQI/ENDURING FREEDOM.
There have been 16,648 new medics from calendar year 2002-2009.
Retention remains high, with all enlisted primary Air Force Specialty
Code (AFSC) manned at (as of June 2009) greater than 91 percent (107
percent overall). Eleven (of 17) enlisted medical AFSCs currently earn
selective reenlistment bonuses, continuing our ability to retain
quality, motivated medics. The transition to Air Expeditionary Force
(AEF) banding from AEF cycles will continue to provide greater
stability and predictability of deployments for the majority of our
enlisted forces. Mental health technician) are our sole enlisted AFSC
in a 1:2 dwell in AEF Band D and manning is at 95 percent.
Question. What steps have you taken to ensure that families of our
service members are adequately cared for during the Global War on
Terrorism?
LTG Schoomaker's Answer. In support of the Army Family Covenant, in
November 2008, Army Medicine leaders signed the Army Warrior Healthcare
Covenant, reaffirming our commitment to provide world-class care to
wounded Soldiers and their Families. The covenant pledges sustained
care that is commensurate with the sacrifices that Soldiers and
Families have made. It provides for first-rate care in a healing
environment for recovery, rehabilitation, and reintegration. It is Army
Medicine's goal for all of our patients to feel valued, empowered, and
comfortable talking with us about any healthcare concerns they and
their families face.
As further support of the Army Family Covenant, I have made access
to care and beneficiary satisfaction two of Army Medicine's key
priorities. We are implementing an aggressive Access to Care Campaign
Plan containing eleven focus areas that cover a wide spectrum of access
and customer service issues. Among the focus areas are the alignment of
treatment facility capacity with the number of enrolled beneficiaries;
improving provider availability; and, leveraging technology for
efficiencies to include managing clinic appointment schedules.
Admiral Robinson's Answer. DOD and Navy Medicine are committed to
providing quality health care for the families of our service members
supporting the Global War on Terrorism. Below are examples:
Patient and Family Centered Care is Navy Medicine's core
concept of care. Our collective efforts focus on providing
beneficiaries with a quality healthcare experience that integrates the
resources of our MTFs and the purchased care system (Managed Care
Support Contractors.)
Navy Medicine Strategic Goals have been refined and
aligned with an emphasis placed on meeting or exceeding patient quality
expectations while providing convenient access, lasting results,
preventive health, and the mitigation of health risk. Additionally,
patients are encouraged to be active participants in their healthcare.
We recognize the vital importance of the family, military culture, and
the chain of command in supporting the families of our service members.
Each military treatment facility (MTF) and clinic has a
health benefits advisor (Beneficiary Counseling and Assistance
Coordinator--BCAC) to assist beneficiaries in using their health care
benefit by providing accurate and timely information and guidance on
how best to use our health care system. There is enhanced coordination
with our purchased care system (Managed Care Support Contractors) to
ensure continuity of care when medical providers deploy in support of
operational requirements.
Navy Medicine has actively supported and integrated both
the Navy Safe Harbor Program and the Marine Wounded Warrior Program to
enhance the overall care of our wounded ill and injured.
Navy Medicine provides support to dependent children
through a full spectrum of child and adolescent psychological health
services at major CONUS medical centers, as well as overseas hospitals
which have exceptional family member programs, such as Okinawa and
Yokosuka.
Navy Medicine leverages the Ombudsman Program to promote
healthy and self-reliant families. The Ombudsman serves as a critical
information link between command leadership and Navy families. They are
trained to disseminate information both up and down the chain of
command, including official Department of the Navy and command
information, command climate issues, psychological health information,
return/reunion/reintegration initiatives, and local quality of life
(QOL) improvement opportunities.
LTG Roudebush's Answer. The Air Force Medical Service (AFMS) has a
broad range of activities that directly support the Airmen and their
families in both the delivery of healthcare as well as quality of life
support programs.
To ensure medical care is meeting our beneficiaries' needs, the
AFMS has an aggressive Veterans Administration/Department of Defense
sharing agreement strategy. These programs capitalize on healthcare
services of the Federal Healthcare delivery system ensuring direct
support of our families. Sharing agreements are economically beneficial
and provide access to services that may not be available in either the
Department of Defense or the Veterans Administration as independent
entities.
Our Managed Care Support Contract (MCSC) partners ably respond to
the challenges of maintaining medical combat readiness while providing
the best health care services for our beneficiaries. The MCSC
supplements the care available in the direct care system with both
network and non-network civilian healthcare professionals, hospitals,
pharmacies, and suppliers to provide better access and high-quality
service, while maintaining the capability to support military
operations. We have leveraged the MCSC to ensure our families are
provided timely access to quality care delivery.
The AFMS is undertaking a refinement of the delivery of Primary
Care through the Family Health Initiative. Two goals have been
established for this program: enhance our delivery of services to our
population, and enhance the complexity of the patients seen. The Family
Health Initiative utilizes a patient-centered medical home model to
provide adequate staffing. This model makes coordination of all a
patient's care the primary focus of the team and is lead by a family
practice physician with an assigned support staff ready to meet the
patient's needs.
Medical Treatment Facilities and assigned staff are an integral
part of the Integrated Delivery System and the Community Action
Information Board, which actively works programs in support of our
families. An ongoing action plan between the Airmen and Family
Readiness Centers and the Medical Treatment Facilities allow the
community to weave a fabric of programs that are both preventive and
supportive to lessen the impacts of deployments and high ops tempo.
Question. What are your medical concerns for the deployment of new
soldiers?
LTG Schoomaker's Answer. My major medical concerns for new Soldiers
are behavioral health, musculoskeletal, and asthma conditions that
exist prior to enlistment. The best data on new Soldiers (recruits) is
available from the Accessions Medical Standards and Research Activity,
Walter Reed Army Institute of Research. They track the attrition of
Service Members for medical and other reasons.
In Fiscal Year 2008 the Army discharged 1,959 Soldiers for
conditions that existed prior to service. This was out of 80,517
enlisted accessions including both non-prior and prior service. The
number of EPTS discharges by diagnosis include 445 (22.7%) for
behavioral health, 510 (26.0%) for musculoskeletal, and 130 (6.6%) for
asthma. All other diagnoses totaled 874 (44.6%).
Initial analysis has concluded that the medical accession screening
and waiver process is efficient in identifying individuals with
potentially disqualifying conditions and determining that waivers can
be offered for at least the common conditions without degrading
deployment of the affected individuals.
Admiral Robinson's Answer. (Admiral Robinson's assuming re-directed
for Sailors and Marines and that ``new'' refer to new deployments and
not the age or rank of the service member):
With respect to mental health:
Social support is a demonstrated protective factor that insulates
Sailors and Marines with respect to important deployment outcomes like
acute stress response (ASR), Post-Traumatic Stress Disorder (PTSD), and
Depression. Unmitigated Operational Stress compounded by multiple
combat deployments may play a role in weakening social support at home
and in the family. Failed relationships ultimately translate into
divorce, isolation from friends and family, and, as a proximate cause,
suicidality.
Social support for Navy Individual Augmentees (IAs) is especially
worrisome given that IA Sailors often deploy to units where the Sailor
has few, if any, established social bonds. Whereas the Sailor might not
be ``new'' to the force, previously inexperienced roles, novel job
descriptions, and new unit affiliation contribute to operational
stress. Further, IA sailors return to commands where the majority of
people have not shared their experience. In particular, a specific type
of IA assignment known as a Global Support Assignment (GSA), requires
that both the Sailor, and if applicable their family, undergo a
deployment in-between two duty stations. Consequently, the GSA Sailor
and his or her family lose social bonds with their old duty station and
face the challenges of relocation--replete with the re-establishment of
new and often unfamiliar support systems. To counter these Individual
Augment related concerns, a recently established Command Individual
Augment Coordinator (CIAC) position now oversees deployment related
readiness, support, and transition for this population of warrior.
While multiple deployments carry with it specific mental health
risks, too little combat experience is also a known risk factor for
another unique set of mental and physical health risks. Sailors and
Marines deploying to Iraq and Afghanistan for the first time, and in
particular IA Sailors, require realistic training in order to prepare
to enter the combat zone for the first time, a situation that
reinforces the maxim of ``train like you fight, fight like you train.''
With respect to General Medical Health Issues:
Navy Medicine shares with the public the concern that burn-pits in
the Areas of Operation may impart unknown health risks to exposed
Sailors and Marines. Navy Medicine aggressively supports on-going and
continuous health surveillance for exposure related concerns.
LTG Roudebush's Answer. The Air Force is concerned about the
medical needs of all of its deploying airmen regardless of level of
experience or age. In that regard the Air Force Medical Service
conducts pre- and post-deployment screening to assess the health and
well being of the force both with new deployers and those who have
greater experience. The pre-screening process for deployers is designed
to provide all necessary preventive health measures, immunizations as
an example, that are required for the area of operations in question.
All Airmen, regardless of experience, are afforded multiple
opportunities to seek medical and mental health care before, during and
after deployment to ensure both their physical and mental well-being.

Mental Health

Question. The Committee has great concern about mental health and
post-traumatic stress disorder (PTSD) that affect our Military Service
members and families. In all of your statements, you state that the
Department of Defense has made great progress in this area.
How much is currently being spent on mental health?
Answer. Although, the Defense Health Program does not budget by the
type of patient care, it is possible to estimate future expenses based
upon historical execution and then add planned funding enhancements.
The following table includes the Fiscal Year (FY) 2008 execution and
projected expenditures on Mental Health services by the military
treatment facilities in the Direct Care System and Private Sector Care
(PSC) for all beneficiary categories. It includes estimated
enhancements that are a result of the Department's and Congress'
emphasis on Psychological Health (PH) initiatives. The Department has
made sufficient funding available to meet all established requirements
in support of PH.

[In thousands of dollars]
------------------------------------------------------------------------
FY 2008 FY 2009 FY10
Source of Care Estimated Estimated Estimated
Costs Costs Costs
------------------------------------------------------------------------
Direct Care...................... $658,746 $691,684 $726,268
PSC.............................. 541,946 569,043 597,495
PH Enhancements.................. 261,795 392,349 471,793
--------------------------------------
Total Estimated Mental Health 1,462,487 1,653,076 1,795,556
Costs.........................
------------------------------------------------------------------------

Notes: Inflation assumed at 5% for both Direct Care and Private
Sector Care. Enhancement is from PH funding appropriated in FY 2008 and
FY 2009 and added to the baseline in program review.

Question. What types of programs and funding across the Services
are there for substance abuse, mental healthcare programs for military
and dependents, as well as access to care and outreach programs?
Answer. Behavioral health and substance use disorder treatment are
available for Military Service members and their families at military
treatment facilities (MTFs) and through the TRICARE network. Care
provided at MTFs may vary depending on the size of the facility. In
addition, a number of programs have been developed to increase access
to care and to provide education and support to Service and Family
Members.
Services available at MTFs
Service Members can receive assessment and treatment for a full
range of problems or conditions, including mental health and substance
use disorders, at MTFs. Family member services at MTFs vary from clinic
to clinic based on the number of MTF behavioral health providers. If
services are not available at the MTF for family members, they can
access services through the TRICARE network. The Department of Defense
(DoD) has also partnered with the Department of Health and Human
Services in order to increase access to care at MTFs through the
assignment of mental health providers who are Commissioned Officers in
the United States Public Health Service to MTFs.
Services available through the TRICARE Network
PSYCHOTHERAPY
TRICARE covers both outpatient and inpatient
psychotherapy.
In addition to individual psychotherapy, TRICARE covers:
Group Therapy, Family Therapy, Collateral Visits (a non-treatment visit
to gather information and implement treatment goals), Play Therapy (a
form of individual psychotherapy used to diagnose and treat children
with psychiatric disorders), and Psychological Testing (when provided
in conjunction with otherwise covered psychotherapy).
ACUTE INPATIENT PSYCHIATRIC AND RESIDENTIAL TREATMENT CARE
Acute inpatient psychiatric care may be covered on an
emergency or nonemergency basis.
Residential treatment center care provides extended care
for children and adolescents with psychological disorders that require
continued treatment in a therapeutic environment.
INPATIENT SUBSTANCE USE DISORDER REHABILITATION
An inpatient rehabilitation center is a facility that
provides medically monitored, 24 hours per day, seven days per week,
interdisciplinary, addiction-focused treatment to adolescents and/or
adults who have psychoactive substance use disorders.
PARTIAL HOSPITALIZATION
Partial hospitalization provides interdisciplinary
therapeutic services at least three hours per day in any combination of
day, evening, night, and weekend treatment programs. These services are
available for individuals with both mental health disorders and
substance use disorders.
Access to care in the TRICARE network:
To ensure that family members can access mental health without
barriers, TRICARE allows eight outpatient visits for family member
beneficiaries with no preauthorization or referral required each fiscal
year for mental health treatment. A family member beneficiary can self
refer for these first eight outpatient mental health visits.
Beneficiaries may receive psychological testing and medication
management visits at the same time that are not counted against the
eight unmanaged visits. Additional treatment beyond eight sessions may
be authorized if needed.
Prevention/Outreach
In addition, a number of programs have been developed by the DoD
and the Services that provide education, support, and out reach to
Service members and their families. These include:
afterdeployment.org at http://www.afterdeployment.org/.
This comprehensive web resource, developed under the direction of the
DoD, deploys state-of-the-art Internet-based education, assessment,
skill-building and treatment tools that can be used by Service members
alone; used in conjunction with primary care manager support; or used
in conjunction with mental health care providers. Users have access to
online assessments, learning tools, and proven self-help strategies to
help participants understand their adjustment concerns and engage in
self-initiated help for their behavioral health problems, including
symptoms related to post-traumatic stress. The site is designed to
attract and serve Reserve, National Guard, and Active Duty Service
members and their family members who have not yet sought medical care
and are not receiving treatment, though it is expected that the
resources offered at the site will be extremely useful to those persons
who are already in treatment. Problem-focused programs (sleep, anger,
depression, stress, etc.) are tailored to meet the needs of Service
members and their families.
The Mental Health Self-Assessment Program (MHSAP) at https://
www.militarymentalhealth.org/welcome.asp. MHSAP is a voluntary,
anonymous mental health and alcohol screening and referral program
offered to families and Service members affected by deployment or
mobilization. It is offered online 24/7, as well as through in-person
events. The MHSAP is funded by the DoD's Office of Health Affairs.
Family Assessment for Maintaining Excellence Initiative. This pilot
project provides voluntary, mental wellness and healthy relationship
assessment for Active Duty Service members and their spouses. There are
six components of the program: awareness, education, screening,
evaluation, follow up, and public awareness.
Fleet and Family Support Centers/Marine Corps Community Service
Centers/Health and Wellness Centers on Bases (and other similar
services). Provide stress and anger management classes, mental health
assessment, individual and group counseling, family counseling and
other related services. These all provide opportunities for Service
members and their families to uncover stress-related symptoms, speak
with mental health professionals about those symptoms, and seek/receive
guidance on means to obtain.
MilitaryOneSource at http://www.militaryonesource.com/. In addition
to offering 24/7 information and resources, Military OneSource can
provide a referral to in-person counseling. When there is a need, a
consultant can refer a Service member or eligible family member to a
licensed professional counselor in the local community for face-to-face
counseling sessions at no cost to the Service member or their family
members. The benefit addresses short-term concerns only and is limited
to twelve sessions per identified issue. It is not designed to address
long-term issues such as child and spouse abuse, suicidal ideation, and
mental illness. Individuals in need of long-term treatment are referred
to a military treatment facility and/or TRICARE for services. The fact
that clients see the Military OneSource provider for 12 sessions does
not impact the beneficiary's ability to access mental health treatment
under TRICARE.
Question. Admiral, the Navy has established 13 Deployment Health
Clinics to facilitate health assessments for post-deployment physical
and mental health concerns. Can you give the Committee a brief update
as to what you are seeing at those clinics?
Answer. Navy Medicine increased the number of Deployment Health
Centers (DHCs) to 17 during Fiscal Year 2008 to expand the capacity for
easily accessible non-stigmatizing deployment related healthcare. With
a multidisciplinary staff of primary care and mental health providers,
the DHCs complement services that are offered in the military treatment
facility or in garrison at the unit level. Since inception, the DHCs
have accomplished over 150,000 patient encounters. Approximately 50% of
the visits were for deployment health assessments and individual
medical readiness requirements. Psychological healthcare accounted for
nearly 25% of the encounters, while another 25% were for various
deployment related health concerns.
Question. With the establishment of second mental health
assessments for soldiers, specifically the Reserve Components returning
from theater, who will be performing this type of work? How will the
non-military doctors and nurses performing these assessments be
financially compensated?
Answer. The Department of Defense manages a Reserve Health
Readiness Program contract to provide the Post-Deployment Health
Reassessment (PDHRA) to the Reserve Component Service members who have
returned from a deployment. A mental health assessment is a significant
portion of the PDHRA. The non-military physicians and nurses performing
the PDHRA under this contract are paid with appropriated funds through
this contract.
Question. How much funding is included in the Fiscal Year (FY) 2010
budget submission for psychological health (PH) and traumatic brain
injury (TBI)?
Answer. In FY 2010, the Defense Health Program (DHP) baselined
additional Operation and Maintenance funding for TBI/PH initiatives.
Funding added for PH is $472 million and $178 million for TBI. This
includes all funding for all components, including the Defense Centers
of Excellence, to pay for all initiatives and programs.

Development and Manufacturing of Biological Countermeasures

Question. The need for the Nation to be prepared for chemical,
biological, radiological, and nuclear attacks has been clear for
decades. Based on the unmet needs for biologic production capability,
the Defense Advanced Research Projects Agency has been studying the
requirements necessary for a dedicated capability.
What is the role of the Defense Health Program (DHP) in helping to
assess threats with respect to chemical, biological, radiological, and
nuclear attacks?
Answer. Chemical, biological, radiological, and nuclear (CBRN)
threat assessments are performed and validated by the Joint Staff, the
Services, and the Intelligence community. The DHP does not have a
direct role in performing CBRN threat assessments, but provides
assistance in two ways. The DHP provides subject matter expertise (when
requested) to help the Joint Staff, Services, and Intelligence
community assess health impacts of CBRN threats. The DHP (through
funding) and the Services are responsible for operating the United
States' military medical treatment facilities (MTFs) throughout the
world. These MTFs are required to be familiar with potential CBRN
threats in their areas and prepare for them through training and
exercises.
Question. What is the relationship between the Defense Health
Program (DHP) and the Defense Advanced Research Projects Agency (DARPA)
to address unmet needs for biologic production capability?
Answer. DARPA and DHP medical research and development programs are
coordinated so that the DHP can leverage DARPA's basic research for
subsequent transition to applied research and advanced development.
DARPA is also a principal member of the Armed Services Biomedical
Research Evaluation and Management Committee that is co-chaired by the
Assistant Secretary of Defense for Health Affairs.
Over the past 16 years, the Department of Defense (DoD) has
evaluated perceived gaps in DoD biodefense and vaccine production
facilities. In more recent years, the Department of Health and Human
Services (HHS) and DoD have contracted with emerging biotechnology
innovators and contract manufacturers for successful advanced
development and manufacturing of a number of biodefense medical
countermeasures. Existing contractors are capable of delivering
required products and many are investing heavily in production
facilities in the United States, which increases capacity and further
addresses perceived capability gaps. A 2007 survey of the
biopharmaceutical contractor manufacturing industry indicates that
installed processing capacity increased by 14% since 2006 and the trend
is expected to continue for the next few years (``Biopharmaceutical
Contract Manufacturing: Recent Industry Growth,'' S. Wheelwright,
American Pharmaceutical Outsourcing).
The DARPA effort to evaluate the need for a dedicated manufacturing
capability was completed in 2008. In July 2008, in response to the
DARPA study, the Special Assistant to the President for Biodefense and
Senior Director for Biodefense at the Homeland Security Council
requested that HHS and DoD conduct an analysis of alternatives (AoA)
``to identify the optimal facilities and operating model for addressing
the gap in production and manufacturing of medical countermeasures
against weapons of mass destruction threats in a manner that provides
the best long-term value to the United States Government.'' The
independent AoA focuses on the advanced development, Food and Drug
Administration approval, and sustainment phases for biodefense
countermeasures. The DARPA recommendation is only one possible long-
term alternative being assessed by DoD and HHS.
Question. What is the current situation with the Department's
mission to protect military personnel against biological weapons?
Answer. The Department of Defense (DoD), through the Joint Project
Manager Chemical Biological Medical Systems (CBMS) of the Joint Program
Executive Office for Chemical and Biological Defense, is procuring
anthrax vaccine, smallpox vaccine, and vaccinia immune globulin (treats
rare but serious adverse events associated with smallpox vaccine). CBMS
is also developing a plague vaccine and a botulinum toxin vaccine, both
in Phase 2 clinical trials. In Fiscal Year 2010, CBMS will initiate
advanced development efforts on a filovirus vaccine to protect against
weaponized Ebola and Marburg viruses. Additionally, DoD has fielded the
Joint Biological Agent Identification and Diagnostic System (JBAIDS)
worldwide and to all Services. The JBAIDS is a deployable laboratory
analytical system that provides rapid and highly accurate
identification of ten different biological threat agents in clinical,
food, and environmental samples.
Question. What is the current assessment of the threat of
biological weapons?
Answer. The threats from chemical, biological, radiological, and
nuclear attacks are validated and compiled in a classified report,
which is subsequently released by the Chairman of the Joint Chiefs of
Staff. Agents relevant to a specific geographic area of responsibility
that are identified in the Joint Chiefs of Staff (JCS) classified
threat list are available from the Defense Intelligence Agency.
However, there are many other Department of Defense organizations
involved in evaluating biological agent threats to United States Forces
and military installations.
Question. How many countermeasure vaccines have been produced?
Answer. The Joint Project Manager Chemical Biological Medical
Systems of the Joint Program Executive Office for Chemical and
Biological Defense is obtaining Food and Drug Administration approval
of the anthrax vaccine, smallpox vaccine, and vaccinia immune globulin
(treats rare but serious adverse events associated with smallpox
vaccine).
Question. What is the current manufacturing capability for
biodefense countermeasures?
Answer. The 2007 survey of the biopharmaceutical contract
manufacturing industry, (``Biopharmaceutical Contract Manufacturing:
Recent Industry Growth'', S. Wheelwright, American Pharmaceutical
Outsourcing, May 2008, p. 16) indicates that installed processing
capacity increased by 14 percent since 2006, and the trend is expected
to continue for the next few years. Another recent industry survey
found that over the next five years, contract manufacturing
organizational capacity for biopharmaceutical products is expected to
expand by 91 percent for cell culture and 33 percent for microbial
fermentation (``Very Large Scale Monoclonal Antibody Purification: The
Case for Conventional Unit Operations,'' B. Kelley, Biotechnology
Progress 23 (5): 995-1008, 2008). From these recent studies,
pharmaceutical contract manufacturing organizations are projected to
expand capacity more than the integrated biotechnology industry.
Capacity has transitioned from a period of relative undersupply to one
of moderate oversupply. Based on this assessment, there is ample
capacity to manufacture biodefense medical countermeasures.
The greater challenge remains the discovery and development of
biodefense medical countermeasures, to include demonstrating their
effectiveness in representative model systems so that manufacturers can
obtain approval from the Food and Drug Administration (FDA). The FDA
ruling titled, ``New Drug and Biological Products; Evidence Needed to
Demonstrate Effectiveness of New Drugs When Human Efficacy Studies Are
Not Ethical or Feasible,'' commonly referred to as the ``Animal
Efficacy Rule,'' amended the FDA's drug and biologic regulations to
``allow appropriate studies in animals in certain cases to provide
substantial evidence of effectiveness of new drug and biological
products used to reduce or prevent the toxicity of chemical,
biological, radiological, and nuclear substances.'' Although given
relatively little attention since it was promulgated, the Animal
Efficacy Rule creates a new regulatory paradigm for measuring efficacy
by permitting FDA to approve drugs and biologics for counterterrorism
uses based on animal data when it is unethical or unfeasible to conduct
human efficacy studies.
Question. To what extent is this a problem with advanced
development and manufacturing?
Answer. The Department of Defense (DoD) has not encountered
problems securing the capability or capacity to develop and manufacture
vaccines from established contractors. In fact, recent industry studies
and market research have identified excess industry capacity available
for advanced development and manufacture of these types of products.
The Joint Project Manager Chemical Biological Medical Systems of the
Joint Program Executive Office for Chemical and Biological Defense has
received significant interest from the pharmaceutical industry
(including large companies) for future development efforts.
The greater challenge remains the discovery and development of
biodefense medical countermeasures, to include demonstrating their
effectiveness in representative model systems so that manufacturers can
obtain approval from the Food and Drug Administration (FDA). The FDA
ruling titled, ``New Drug and Biological Products; Evidence Needed to
Demonstrate Effectiveness of New Drugs When Human Efficacy Studies Are
Not Ethical or Feasible,'' commonly referred to as the ``Animal
Efficacy Rule,'' amended the FDA's drug and biologic regulations to
``allow appropriate studies in animals in certain cases to provide
substantial evidence of effectiveness of new drug and biological
products used to reduce or prevent the toxicity of chemical,
biological, radiological, and nuclear substances.'' Although given
relatively little attention since it was promulgated, the Animal
Efficacy Rule creates a new regulatory paradigm for measuring efficacy
by permitting FDA to approve drugs and biologics for counterterrorism
uses based on animal data when it is unethical or unfeasible to conduct
human efficacy studies.
Question. Has the Department involved academic institutions and
industry to help expand its capabilities?
Answer. Recent industry studies and market research have identified
an excess of industry capacity available for advanced manufacturing
process development and manufacture of medical countermeasures. The
Department of Defense (DoD) has received significant interest from
academia and the pharmaceutical industry to participate in future
development efforts, including interest from large pharmaceutical
companies. In recent years, the Department of Health and Human Services
(HHS) and DoD have contracted with emerging commercial biotechnology
innovators and contract manufacturers for successful advanced
manufacturing process development for the manufacturing of biodefense
medical countermeasures. Existing contractors are capable of delivering
required products and many are investing heavily in production
facilities in the United States, which has the potential to increase
capacity and further address perceived capability gaps. In addition,
DoD broad agency announcements have resulted in numerous contract and
grant awards to academic institutions. DoD also participates in the HHS
venues targeted at academia and industry, such as the upcoming
Chemical, Biological, Radiological, and Nuclear Medical Countermeasures
Workshop for 2009.
Question. How much has been spent to date on biodefense
countermeasures?
Answer. Between program inception in Fiscal Year 1997 and May 2009,
the Department of Defense has spent $968 million on Research,
Development, Test and Evaluation (advanced development funding) and
$546 million on procurement of biodefense vaccines and diagnostics.
This does not include science and technology efforts and procurement of
biodefense therapeutic medical countermeasures such as ciprofloxacin,
doxycycline, and non-medical biodefense countermeasures not managed by
the Joint Project Manager Chemical Biological Medical Systems of the
Joint Program Executive Office for Chemical and Biological Defense.
Question. What is the biodefense surge capability if we receive a
threat? Attack?
Answer. The Department of Defense currently maintains stockpiles of
licensed vaccines to support full force protection. Advanced
development vaccine programs of the Chemical Biological Medical Systems
of the Joint Program Executive Office for Chemical and Biological
Defense are designed to support full force requirements. Many existing
manufacturers are not working at full capacity and in the event of an
emergency; the Defense Production Act could be used to issue contracts
with the ``highest national urgency'' designation for the expansion of
production capabilities for critical security needs.
Question. How has other legislation such as Bioshield affected the
fielding of such biological countermeasures? Is legislation without a
funding mechanism a hindrance more than a help?
Answer. While Bioshield funding does not support the Department of
Defense (DoD) procurement requirements, it does support the procurement
of biodefense medical countermeasures for the Strategic National
Stockpile (SNS). DoD and the Department of Health and Human Services
are collaborating through the SNS to ensure civilian and military
requirements are met and to reduce government costs.
Legislation without a funding mechanism is a hindrance because it
causes us to take funding from existing programs to cover new efforts.

Centers of Excellence

Question. These centers are nationally recognized and have enabled
military medicine to be in the forefront in the advancement of modern
medical care. The Congress directed that funds for operation be
included in the Fiscal Year (FY) 2010 submission.
How much money is included for the operation of each of these
Centers of Excellence in the FY 2010 President's Request?
Answer. The table below identifies the amount of funding requested
for the Centers of Excellence Congress directed to be included in the
FY 2010 submission:

------------------------------------------------------------------------
FY 2010
Program Funding
(millions)
------------------------------------------------------------------------
Breast Cancer Center........................................ $5.310
Gynecological Cancer Center................................. 4.820
Integrative Cardiac Health.................................. 3.380
Pain and Neuroscience....................................... 4.000
Integrated Translational Prostate........................... 3.490
-----------
Total..................................................... 21.000
------------------------------------------------------------------------

Question. Why is the amount in the 2010 budget less than last
year's amount?
Answer. The five Centers of Excellence are resourced at the Fiscal
Year (FY) 2010 levels based upon the availability of funds within the
Defense Health Program. A review of the Centers of Excellence will be
conducted during FY 2010 to assess the mission of the Centers and the
type and amount of funding to accomplish that mission. The assessment
will also consider the capability of the Centers of Excellence mission
to support translational biomedical/clinical research.
Question. Which of the five Centers of Excellence (Breast Care,
Gynecological, Prostate, Integrated Cardiac Health, Pain, and
Neuroscience) named in the 2009 appropriations report are included in
the design of the new Walter Reed National Medical Center?
Answer. All five Centers of Excellence are currently included in
the design of the new Walter Reed National Medical Center.
Question. How much space is included in this design?
Answer. The amount of space planned for each of the centers in the
Defense Centers of Excellence (DCoE) is as follows:

------------------------------------------------------------------------
Space (sq.
CoE ft.)
------------------------------------------------------------------------
Breast Care................................................ 7,100
Gynecological.............................................. 4,520
Prostate................................................... 7,000
Integrated Cardiac Health.................................. 8,141
Neuroscience:
Chronic Pain........................................... 5,777
Acute Pain............................................. 1,803
ARAPMI *............................................... TBD
------------
\34,341
sq. ft.
------------------------------------------------------------------------
* Army Regional Anesthesia and Pain Management Initiative.

Question. How does the amount of space planned compare with that
currently available at Walter Reed Army Medical Center (WRAMC)?
Answer. The following table depicts the amount of planned space at
Walter Reed National Naval Medical Center (WRNNMC) compared with
currently available space at WRAMC:

------------------------------------------------------------------------
Planned
\Current Space
Centers of Excellence Space WRNNMC Difference
WRAMC (sq. (sq. ft.)
(sq. ft.) ft.)
------------------------------------------------------------------------
Breast Care............................ 3,209 7,100 +3,891
Gynecological.......................... 5,578 4,520 -1,058
Prostate............................... 8,619 7,000 -1,619
Integrated Cardiac Health.............. 9,569 8,141 -1,429
Neuroscience:
Chronic............................ 2,750 5,777 +3,027
Acute.............................. 620 1,803 +1,183
ARAPMI *........................... 4,000 TBD TBD
------------------------------------------------------------------------
* Army Regional Anesthesia and Pain Management Initiative.

Question. Why is the amount of space less than is currently
provided?
Answer. The Breast Care and Pain Centers of Excellence actually
gain space. The small reduction in space provided for Gynecological/
Oncology, Prostate, and Integrated Cardiac Health Centers of Excellence
is due to three primary factors:
1. There is more effective use of shared spaces in the new design.
Support spaces including clean utility, soiled utility, waiting, staff
lounges, and other support functions are shared across departments
where practical thus reducing the total area required for each
department.
2. The corridors in the new outpatient building (Building A) are
sized to business occupancy standards (5'0'') versus many of the
existing healthcare occupancy corridors (8'0''), as appropriate. This
significantly reduces the gross area required by each department.
3. Third, the new design is custom sized for individual room
requirements whereas, in the existing Centers of Excellence, individual
components were laid into available rooms which met and/or often
exceeded the actual requirement. For example, there are offices and
exam rooms in former patient bedrooms which are much larger than
required for the office and exam functions. The physical layout
provides rooms that are designed specifically for their individual
function and closely follow Department of Defense Space Planning
Guidelines for each space.

Medical Scholarships

Question. This situation continued in 2007 with roughly the same
number of scholarships available and the same number and percentages
awarded. In 2008, the Department of Defense instituted a Critical
Skills Accession Bonus (CSAB). As a result, the Department was able to
fill virtually all the available scholarships.
Please provide a brief description of the CSAB program for each
Service.
Answer. This CSAB provides a one time $20,000 bonus for Health
Professions Scholarship Professions students when accessed into the
military (at the beginning of medical or dental school). The Air Force
uses the program for medical students, while the Army and Navy use it
for both medical and dental students. Section 663 of the National
Defense Authorization Act for Fiscal Year 2008 (Public Law 110-181),
provides the authority for the accession bonus.
Question. What are the reasons that the Services had to resort to
providing a bonus in addition to a scholarship to attract medical
personnel?
Answer. The Army and the Navy were not filling their Health
Profession Scholarship Program positions. The Air Force filled their
positions but had fewer applicants. Some of the possible reasons are:
A decline in pool of male medical school students (higher
mix of females with less propensity to serve).
Perceptions of Operation Iraqi Freedom/Operation Enduring
Freedom negatively affecting interest in serving in the Military.
A 2004 study by the Association of American Medical
Colleges reported that 60% of medical students' families are in the top
20% of incomes,\1\ suggesting these medical students are less in need
of a scholarship.
---------------------------------------------------------------------------
\1\ Jolly, P. Medical School Tuition and Young Physician
Indebtedness. AAMC 2004.
---------------------------------------------------------------------------
Question. Why did the Navy decrease the number of available
scholarships from 300 in previous years to 225 in fiscal year 2008?
Answer. In early 2007, when the fiscal year 2008 Medical Corps
Health Professions Scholarship Program (HPSP) accession goal was
established, Navy was configuring our physician pipeline to meet end
strength reductions associated with planned military to civilian
conversions.
Question. How many scholarships is the Navy awarding in 2009 and
how many are proposed in this fiscal year 2010 budget?
Answer. Navy is awarding 245 Health Professions Scholarship Program
(HPSP) scholarships plus 25 Health Sciences Collegiate Program (HSCP)
scholarships in 2009. HPSP and HSCP scholarship goals for FY2010 have
not yet been approved by the Chief of Naval Personnel.
Question. Why did the Army increase the number of medical
scholarships in fiscal year 2008 from approximately 300 in previous
years to 360?
Answer. The Army increased the number of medical scholarships in
fiscal year 2008 from approximately 300 in the previous year to 360 in
fiscal year 2008 in order to make up for shortfalls resulting from
missed missions for medical scholarships for the previous 3 years
(2005-2007).
Question. How many medical scholarships is the Army awarding in
2009 and how many are proposed in the fiscal year 2010 budget?
Answer. We are projecting to fill 100% (365) of scholarships for
2009 and we have provided United States Army Recruiting Command with a
mission to recruit for 300 scholarships in fiscal year 2010.
Question. Are the Services having any problems meeting the
Department's medical manning requirements?
Answer. The most recent Health Manpower Personnel Data System
Report shows:

CLOSE-OUT DATA BY CORPS--FISCAL YEAR 2008
------------------------------------------------------------------------
Corps Auth Fills % Filled Diff
------------------------------------------------------------------------
Medical...................... 11,487 11,530 100.37 43
Dental....................... 3,109 2,851 91.70 -258
Nurse........................ 9,732 9,438 96.98 -294
Med Svc...................... 7,870 7,730 98.22 -140
Army Spec.................... 1,177 1,299 110.37 122
Bio Science.................. 2,345 2,182 93.05 -163
Vet.......................... 427 445 104.22 18
------------------------------------------
Total.................... 36,147 35,475 98.14 -672
------------------------------------------------------------------------

SHORTAGES
------------------------------------------------------------------------
Corps and Specialty Auth Fills % Filled Diff
------------------------------------------------------------------------
Medical:
CardioThoracic.............. 45 37 82.22 -8
Family Med.................. 1,217 1,159 95.23 -58
Gastro...................... 70 60 85.71 -10
Gen Surgeon................. 412 403 97.82 -9
Neurosurgeon................ 40 35 87.50 -5
Psychiatry.................. 319 308 96.55 -11
Urology..................... 87 86 98.85 -1
Dental:
Comprehensive............... 551 532 96.55 -19
Endodontics................. 113 111 98.23 -2
General Dentistry........... 1,343 1,106 82.35 -237
Orthodontics................ 72 69 95.83 -3
Nurse:
Critical Care............... 1,182 1,052 89.00 -130
Family Nurse Practitioner... 194 152 78.35 -42
General Nursing............. 1,283 591 46.06 -692
Mental Health............... 47 45 95.74 -2
Neonatal ICU................ 95 72 75.79 -23
CRN Anesthesia.............. 624 514 82.37 -110
Nurse Mid-Wife.............. 84 81 96.43 -3
Operating Room.............. 63 59 93.65 -4
Pediatric Nurse Practitioner 63 59 93.65 -4
Other:
Pharmacist.................. 526 472 89.73 -54
Physician's Assistant....... 1,276 1,248 97.81 -28
Psychologist................ 630 548 86.98 -82
Podiatrist.................. 65 58 89.23 -7
------------------------------------------------------------------------

Lung Cancer Research

Question. The Committee directed the Army to provide a plan on the
uses of these funds 120 days after enactment and to include Walter Reed
in the formulation of this plan.
Please provide a detailed description of the Department of
Defense's (DoD's) plans to obligate this funding in compliance with
congressional direction.
Answer. The Congressionally Directed Medical Research Program
(CDMRP) uses a flexible execution and management cycle from receipt of
appropriations through oversight of research grants. The first major
milestone of the Peer-Reviewed Lung Cancer Research Program (LCRP) was
the stakeholders meeting on February 22-23, 2009. Renowned scientists
and clinicians from academia, Walter Reed Army Medical Center, and the
United States Military Cancer Institute, as well as six lung cancer
survivors and advocates participated to discuss issues and gaps
critical to the identification, treatment, and management of early lung
cancer and the establishment of a tissue bank. Participants identified
nine gaps and five advancement opportunities for establishing a tissue
bank, 19 gaps and six advancement opportunities for early
identification of early lung cancer, and 10 gaps and 15 advancement
opportunities for treatment and management of early lung cancer, all of
which aligned with the congressional direction.
Utilizing the recommendations from the stakeholders, an Integration
Panel of 11 experts in the lung cancer field from academia, DoD, and
five disease survivors and advocates determined the program priorities
and an investment strategy for the Fiscal Year (FY) 2009 LCRP. The
following seven areas of emphasis were developed, and research
submitted to the FY 2009 LCRP must address at least one of the areas:
1. Identification or development of non-invasive or minimally
invasive tools to improve the detection of the initial stages of lung
cancer.
2. Identification and development of tools for screening or early
detection of lung cancer.
3. Understanding the molecular mechanisms that lead to clinically
significant lung cancer.
4. Identification of the mechanisms that lead to the development of
the various types of lung cancer.
5. Identification of innovative strategies for prevention and
treatment.
6. Understanding predictive and prognostic markers to identify
responders and non-responders for early lung cancer.
7. Understanding acquired resistance to treatment.
Five award mechanisms for funding competitive research and the
establishment of a tissue bank were identified:
1. Lung Cancer Bio-specimen Resource Network Award provides support
for the development of a lung cancer bio-repository resource
consortium.
2. Collaborative Translational Research Award supports multi-
institutional, multidisciplinary collaborations among clinicians and
laboratory scientists.
3. Concept Award--supports the exploration of a highly innovative
new concept or untested theory that addresses at least one of the FY
2009 areas of emphasis.
4. Lung Cancer Promising Clinician Research Award supports a
research project performed by promising physician-researchers.
5. LCRP Clinical Fellow Research Award supports a research project
performed by clinical fellows under the guidance of a mentored
designated mentor with an established lung cancer research program.
Question. Why hasn't the committee received a copy of this plan
since it has been almost eight months since enactment of the Fiscal
Year 2009 bill?
Answer. Unfortunately, in an effort to ensure coordination with all
interested parties, the process took far longer than anticipated. The
United States Army Medical Research and Materiel Command prepared the
required plan and report near the beginning of the calendar year and we
began the coordination process on January 22, 2009. At this time, the
coordination and revisions requested by the coordinating office are
nearly complete, and the report will be signed out within two weeks.
Question. Will the report include an early detection and screening
pilot program for our high risk military population?
Answer. Currently, the Fiscal Year (FY) 2009 Lung Cancer Research
Program does not have a specific award mechanism for a detection and
screening pilot program for a high risk military population. However,
each of the five award mechanisms for FY 2009 requires that the
research address one or more of the areas of emphasis, which include:
1. Identification or development of non-invasive or minimally
invasive tools to improve the detection of the initial stages of lung
cancer;
2. Identification and development of tools for screening or early
detection of lung cancer. Screening may include, but is not limited to,
computed tomography scans, radiographs, other imaging, biomarkers,
genetics/genomics/proteomics, and assessment of risk factors;
3. Understanding the molecular mechanisms that lead to clinically
significant lung cancer;
4. Identification of the mechanisms that lead to the development of
the various types of lung cancer;
5. Identification of innovative strategies for prevention and
treatment;
6. Understanding predictive and prognostic markers to identify
responders and non-responders for early lung cancer; and,
7. Understanding acquired resistance to treatment.
These areas of emphasis are aligned with the Congressional language
from the September 28, 2009 report which states, ``The bill includes
$20,000,000 for lung cancer research. Lung Cancer is the most lethal of
all cancers taking more lives each year than all the other major
cancers combined. Furthermore, the five-year survival rate for lung
cancer remains at 15 percent, and a major challenge is that 70 percent
of the diagnoses are late stage. Military personnel have heightened
exposure to lung cancer carcinogens. These funds shall be for
competitive research and the establishment of a tissue bank. Priority
shall be given to the development of the integrated components to
identify, treat, and manage early curable lung cancer. The Army is
expected to provide a plan for these funds and to include Walter Reed
Army Medical Center in the formulation of this plan. The plan shall be
submitted to the congressional defense committees 120 days after
enactment of this Act.''
This language does not specify funding an early detection and
screening pilot program for our high risk military population; however,
the areas of emphasis in our award mechanisms encourage the submission
of such an early detection and screening pilot program for our high
risk military population.
Question. If not, why not?
Answer. The Congressional language from the September 28, 2009
report does not specify funding an early detection and screening pilot
program for our high risk military population; however, the areas of
emphasis in our award mechanisms encourage the submission of an early
detection and screening pilot program for our high risk military
population.

Military HealthCare Facilities

Question. As you assess the military medical programs and services
and adapt to the changing needs of military members and their families:
What are your impressions of the quality of DoD medical facilities
and the TRICARE services provided in those facilities?
Answer. The geographic range of JTF CAPMED's Joint Operation Area
(JOA) stretches as far north as New Jersey, skirts West Virginia and
extends south into Virginia. It includes 37 medical treatment faculties
(MTFs), including the new Walter Reed Military Medical Center (WRNMMC)
and Fort Belvoir Community Hospital (FBCH).
Although a formal comprehensive assessment of the medical
facilities in the JOA has not been undertaken, MTF physical condition
appears to range from ``fair'' to ``excellent''. Each Service currently
manages the repair, maintenance and operations of their facilities
separately. Although the model for providing sustainment, restoration
and modernization (SRM) funding is the same across the MHS, how it is
applied varies somewhat between the Services, yielding varied condition
levels. SRM funding models adopted by DoD in the last decade are based
upon continued maintenance of facilities beginning in ``like new''
condition. Historic underfunding of facility repair and maintenance
before the new models were adopted resulted in accelerated
deterioration of many building systems. Although it will take time to
accomplish, a goal of JTF CAPMED is to assure proper resourcing in
facilities accounts to result in consistency in quality, safety, access
and appearance in all of the facilities in the JOA.
For the most part these MTFs lay outside the TRICARE access
standards for referral care (60 miles or 60 minutes drive time).
Generally patients from these MTFs are not referred to the larger MTFs
in or near the DC beltway. The Army and Navy manage these MTFs and
their scopes of practice and the services offered are determined by
them. The scope of care and services offered are limited to primary &
acute care in support of active duty and their family members and
occupational health services as required for the civilian work force.
The TRICARE Management Activity and the TRICARE Regional Office, North
together with the TRICARE managed care support contractor, Health Net,
provide a good network of civilian providers for the military
beneficiaries in these areas more removed from Washington, DC, when
they need specialty care services beyond the capabilities of these
MTFs.
Question. In your written statement you reference the important
activities that are underway at all facilities affected by BRAC. Can
you touch upon the activities currently going on in the National
Capitol Area?
Answer. There are a multitude of important activities currently
underway at the medical treatment facilities (MTFs) affected by BRAC in
the National Capital Region (NCR). Notwithstanding construction and
renovation, the Department's primary effort has been focused on
integrating military healthcare delivery in the NCR. To this end, JTF
CAPMED has been coordinating with the NCR medical components of the
Army, Navy, and Air Force to integrate processes and ensure the best
utilization of resources available which will eliminate redundancies,
enhance clinical care, promote health professions education and joint
training, and enhance military medical research opportunities. Some
examples include developing a joint manning document for the new Walter
Reed National Military Medical Center (WRNMMC) and Fort Belvoir
Community Hospital (FBCH), designing warrior transition services for
wounded warriors while maintaining the command and control equities
that the Services see as essential, and standardizing surgical care
operations so that surgeons and patients can more easily receive care
closer to home in any of the MTFs with operating rooms.
Question. What investments has the Department made in the
infrastructure of the military health system?
Answer. The BRAC recommendation to realign Walter Reed Army Medical
Center (WRAMC), coupled with warrior care enhancements directed by the
Department, will fundamentally change the landscape of health care in
the National Capital Region. The Department is expanding and renovating
the National Naval Medical Center (NNMC) to create the Walter Reed
National Military Medical Center (WRNMMC), and replacing the DeWitt
Army Community Hospital (DACH) at Fort Belvoir, VA, with Fort Belvoir
Community Hospital (FBCH). This $2.4B total investment represents the
single largest integrated investment in resources into medical
facilities in the history of the Military Health System. However, even
while the construction projects funded by this program are underway,
Operation & Maintenance funding continues to be leveraged at all three
locations, to ensure continued safe operations, until all construction
is completed and the legacy facilities have closed and gone through the
disposition process.
Question. What investments are currently needed?
Answer. Successful culmination of the National Capital Region (NCR)
Medical BRAC effort will not represent the end of capital investment in
medical infrastructure at the new Walter Reed National Military Medical
Center (WRNMMC) and Fort Bevloir Community Hospital (FBCH). BRAC
funding added healthcare capability to accommodate the redistribution
of the Walter Reed Army Medical Center (WRAMC) workload and
capabilities through new construction, additions, and renovations, in
order to meet the mandates of BRAC recommendations. However, portions
of the medical infrastructure and the supporting installations at
Bethesda and Fort Belvoir still require funding to upgrade and repair.
Both Services maintain project requirements listings, and JTF CAPMED is
working with both the Army and Navy to prioritize such projects for
funding. Additionally, in order to properly guide future investments in
these facilities to support the strategic mission of the WRNMMC, the
FBCH and the entire JTF CAPMED inventory, JTF CAPMED has begun the
development of long range strategic and capital investment master
plans.

Joint Task Force-National Capital Region

Question. On 12 September 2007 the Deputy Secretary of Defense
issued a memorandum establishing the Joint Task Force-National Capital
Region (JTF CapMed). The purpose of the organization was to ensure the
effective and efficient delivery of world-class military health care
within the National Capital Region Tricare Sub-region by utilizing all
military health care resources. The memorandum tasked you to report to
the Under Secretary of Personnel and Readiness, David Chu.
Given that Mr. Chu is no longer at the Defense Department, who do
you report to now and is this memorandum still in effect?
Answer. While the Under Secretary of Defense for Personnel and
Readiness (USD(P&R)) and the Vice Chairman, Joint Staff were directed
to oversee the initial establishment efforts of JTF CAPMED, JTF
CAPMED's establishment charter explicitly defines a direct reporting
relationship to the SECDEF through DEPSECDEF. JTF CAPMED is currently
working with the Department to formulate an ultimate governance
alignment that will recognize both the joint command and control
equities and the policy formulation and fund flow equities of the
Assistant Secretary of Defense for Health Affairs (ASD(HA)).
Commander, JTF CAPMED also coordinates key decisions and issue
status through an Overarching Integrated Process Team for the
Transition of Medical Activities in the National Capital Region (NCR
OIPT) as necessary. The NCR OIPT is co-chaired by ASD(HA) and Deputy
Under Secretary of Defense for Installations and Environment
(DUSD(I&E)). In addition, each Service's Vice Chiefs of Staff sit on
the NCR OIPT as do the Assistant Secretaries for Installations and
Manpower and Reserve Affairs.
Question. Why didn't the reporting chain have you reporting to the
Assistant Secretary of Defense, Health Affairs, isn't this unusual?
Answer. It would be unusual for JTF CAPMED to report to the
Assistant Secretary of Defense, Health Affairs (ASD(HA)), as JTF CAPMED
has been chartered with command authority. If the Department had
established a formal reporting relationship between JTF CAPMED and the
ASD(HA) it would have been structured with the control, direction and
authority typical of an agency or activity, not that of an entity with
command and control authority. The ASD(HA) retains the same policy,
oversight and funding authorities that are typically exercised in
relation to the Service Medical Departments.
Question. Exactly what is the relationship between the Service
Surgeons General and your organization?
Answer. JTF CAPMED maintains a collaborative relationship with the
three Service Surgeons General (SGs), but primarily works though each
Service's medical component commander (via tactical control
relationships) for the National Capital Region (NCR) Joint Operating
Area (JOA) to carry out its mission. JTF CAPMED also participates in
the Assistant Secretary of Defense for Health Affairs Senior Military
Medical Advisory Council, which includes the 3 SGs.
JTF CAPMED has tactical control over Service medical treatment
facilities and personnel in the NCR JOA, while Services retain
operational control. However, not later than 15 September 2011, the
Department has directed that JTF CAPMED take operational control of the
new Walter Reed National Military Medical Center (WRNMMC) and Fort
Belvoir Community Hospital (FBCH).
Question. The Army has a Major General at Walter Reed Army Medical
Center assigned as the Commander, North Atlantic Medical Region (NAMR).
Isn't she responsible for all TRICARE activities in the National
Capital Region (NCR) as well as the operations of Walter Reed Army
Medical Center and the Fort Belvoir community hospital?
Answer. TRICARE Regional Office--North (TRO-N), which covers the
National Capital Region (NCR), is one of three regional offices that
manages regional contract support to military healthcare providers in
the U.S.-based TRICARE regions. Each TRO is responsible for, among
other things, management of the TRICARE contracts for all eligible
Military Health System (MHS) beneficiaries in the region, the provision
of support to the military medical treatment facility (MTF) Commanders
in their delivery of health care services for MTF-enrolled
beneficiaries and funding of regional initiatives to optimize and
improve the delivery of health care.
The commander of Army North Atlantic Regional Medical Command
(NARMC) is responsible for all Army medical units and their activities
in the NCR, as well as some outside of the NCR. Commander NARMC acts as
the component commander within JTF CAPMED only for Army medical forces
within the NCR.
Currently, the Commander of NARMC is responsible for the operations
of Walter Reed Army Medical Center (WRAMC) and DeWitt Army Community
Hospital (DACH) at Fort Belvoir and will maintain responsibility until
those organizations are deactivated. The Commander of NARMC will not be
responsible for the two new joint medical facilities, Walter Reed
National Military Medical Center (WRNMMC) and Fort Belvoir Community
Hospital (FBCH), when they are established before 15 September 2011.
Question. Does Commander, NAMR work for you?
Answer. The Commander of JTF CAPMED exercises tactical control
(TACON) over the Commander of Army North Atlantic Regional Medical
Command (NARMC) and Army forces assigned to the Commander of NARMC in
the National Capital Region (NCR) Joint Operating Area (JOA). The
Commander of NARMC exercises Army operational control authorities over
all assigned forces.
JTF CAPMED exercises this same TACON relationship with the Navy and
Air Force medical component commanders in the NCR JOA.
Question. If not, what is her role and what is the command
relationship with your organization?
Answer. The Commander of Army North Atlantic Regional Medical
Command (NARMC) is the Army Component Commander for the Commander of
JTF CAPMED in the National Capital Region (NCR) Joint Operating Area
(JOA). Commander, JTF CAPMED exercises tactical control over Army NCR
JOA medical forces through the Commander of NARMC.

Armed Forces Institute of Pathology

Question. In Fiscal Year (FY) 2008, the Congress established a
Joint Pathology Center (JPC) as a successor to the Armed Forces
Institute of Pathology (AFIP).
What actions have been taken by the Department to preserve AFIP's
capabilities until the new Joint Pathology Center is fully operational?
Answer. The AFIP capabilities have been maintained in accordance
with the mission and requirements outlined in the National Defense
Authorization Act (NDAA) for Fiscal Year (FY) 2008 to perform this
mission for the Military Services and other Federal agencies. The JPC
will provide the same pathology consultation services as AFIP does
today to Federal agencies, as provided by the JPC authority in the NDAA
for FY 2008. Consistent with the Base Realignment and Closure
Commission's final recommendations, the previous program of providing
diagnostic consultation services to the civilian community is being
discontinued. The implementation of a JPC will be coordinated with the
closure of AFIP to optimize utilization of AFIP personnel, equipment,
and supplies, consistent with JPC mission requirements.
Question. What actions have been taken by the Department to
establish a Joint Pathology Center (JPC)?
Answer. In April 2008, the Assistant Secretary of Defense for
Health Affairs (ASD(HA)) chartered a JPC workgroup that included the
senior leadership from the Armed Forces Institute of Pathology (AFIP),
Uniformed Services University of the Health Sciences, the Services,
Department of Defense (DoD), Department of Veterans Affairs, and
Department of Health and Human Services to develop options for a JPC
within DoD. Based on these recommendations, the ASD(HA) chose to
establish the JPC as part of the new Walter Reed National Military
Medical Center, under the Joint Task Force National Capital Region
Medical (JTF CapMed). The JTF CapMed, with AFIP assistance, developed a
concept of operations for a JPC that was presented to the Defense
Health Board and the AFIP Board of Governors. Based on feedback from
these boards, and the Department's Senior Military Medical Advisory
Council, JTF CapMed is finalizing an implementation plan for a JPC
under their governance. Once approved, JTF CapMed and the AFIP will
begin coordinating the closure of AFIP with the implementation of the
JPC. Initial operating capability is targeted for July 2010 and full
operating capability is planned by mid-September 2011. The JPC will
provide the functions required by the National Defense Authorization
Act for Fiscal Year 2008: provide diagnostic consultations for the
Military and other Federal agencies, establish a Program Management
Office to manage consultations (required by Base Realignment and
Closure), provide pathology education and research, and maintain and
modernize the tissue repository.
Question. Where will the Center be located and when will it be
fully operational?
Answer. The Center will be located on the Bethesda campus, with the
new Walter Reed National Military Medical Center, the Joint Task Force
National Capital Region (JTF CapMed), and, due to space and funding
constraints, the Forest Glen Campus where the Tissue Repository will be
located. The Center locations will be consolidated when funds and
facilities become available. The implementation plan is being finalized
by the JTF CapMed, with assistance from the Armed Forces Institute of
Pathology, and will include a milestone for initial operational
capability in July 2010 and full operational capability in mid-
September 2011 when Base Realignment and Closure requires the Walter
Reed Army Medical Center campus to be vacated.

Reporting Requirements on the New Walter Reed National Medical Center

Question. This report was due 45 days after enactment and a similar
report on the transition plan was required by the appropriations
committees 120 days after enactment of the fiscal year 2009
appropriations bill.
What is the status of the reports required under these provisions?
Answer. In response to Section 2721(d) of the Fiscal Year (FY) 2009
National Defense Authorization Act (NDAA), the Department delivered an
interim submission to Congress on 13 March 2009 and approved its final
report on 14 May 2009. The Department's understanding from this
committee was that the 14 May 2009 submission that was delivered to
Congress satisfied both the requirements from section 2721(d) of the FY
2009 NDAA and the FY 2009 Defense Appropriations Conference Report.
In addition, the Department plans to submit the report required by
Section 1674(a) of FY 2008 NDAA by late Summer 2009, which will include
more detailed plans about the Walter Reed Army Medical Center
transition and a Master Transition Plan.
Question. It has been four years since the Department submitted its
Base Closure recommendations, why is it taking so long to provide this
information to the Congress?
Answer. The 2005 Walter Reed Army Medical Center (WRAMC) BRAC
recommendation only marked the first step in the military medical
realignment currently under way in the National Capital Region (NCR).
Since then, the Department has greatly expanded the scope of the
medical transformation in the NCR in ways such as identifying
additional wounded warrior transition requirements in the region,
directing the integration of military healthcare delivery in the NCR
Joint Operating Area (JOA), establishing the new Walter Reed National
Military Medical Center (WRNMMC) and Fort Belvoir Community Hospital
(FBCH) as the military's first jointly staffed and governed medical
treatment facilities (MTFs) and converting a significant number of
government civilians at the NCR Service facilities to become a DoD
civilian workforce--thereby significantly enhancing their career
development potential.
The Department has provided information to Congress throughout this
significant evolution through the President's Budget, congressional
briefings and site visits and report/interim submissions. In addition,
it chartered NCR Medical Joint Task Force (JTF CAPMED) with the mission
of overseeing the primary components of this complex transition. JTF
CAPMED reached full operating capability on 30 September 2008 and since
then has moved quickly and efficiently to create a milestone schedule
for the transition, which has been delivered to Congress. JTF CAPMED is
also nearing completion of a Master Transition Plan (MTP), which will
be an adaptive planning document that describes in greater detail the
individual actions required to transition current hospitals to the
regional end state. The initial version of the MTP is anticipated to be
completed in late Summer 2009.
Question. When can the Congress expect to receive a final copy of
responses to these provisions?
Answer. Section 2721 of the Fiscal Year 2009 National Defense
Authorization Act required the Secretary of Defense to: (b) establish a
design review panel to determine whether design/plans for Walter Reed
National Military Medical Center (WRNNMC) are ``world-class''; (c)
submit a cost estimate for closing Walter Reed Army Medical Center
(WRAMC) and relocating operations to WRNMMC and Fort Belvoir Community
Hospital (FBCH); (d) submit a milestone schedule for transition/
relocation of operations from WRAMC to WRNMMC and FBCH.
The Department noted its cost estimate for the project as the
President's Budget in the cover letter accompanying an interim report
delivered to Congress on 13 March 2009. In addition, in response to
section 2721(d) of the NDAA for FY 2009, a milestone schedule was
approved by the Department on 14 May 2009. The Department's
understanding from this committee was that the 14 May 2009 submission
that was delivered to Congress satisfied both the requirements from
section 2721(d) of the FY 2009 NDAA and the FY 2009 Defense
Appropriations Conference Report.
As for section 2721(b) of the NDAA for FY 2009, the Department
directed the Defense Health Board (DHB), National Capital Region (NCR)
BRAC Subcommittee to review the design plans for the WRNMMC and FBCH
and advise the Secretary of Defense regarding whether the design, in
the view of the panel, will achieve the goal of providing world-class
medical facilities. The DHB has not yet delivered to the Secretary of
Defense its recommendations regarding the design. Since the DHB is an
independent body the Department does not exercise control over when the
DHB will submit its report to the Secretary of Defense, but has
communicated the deadline set by Congress. The report is near
completion and once it is delivered to the Secretary of Defense the
Department will provide the DHB's report and its assessment of the
board's recommendation to Congress in a timely manner.

Collaborative Design

Question. Did the Department appoint an independent body to review
the design plans to ensure the new facility is truly world class?
Answer. As per section 2721(b) of the National Defense
Authorization Act (NDAA) for Fiscal Year (FY) 2009, the Department
directed the Defense Health Board, National Capital Region BRAC
Subcommittee to review the design plans for the Walter Reed National
Military Medical Center (WRNMMC) and the new military hospital at Fort
Belvoir (FBCH) and advise the Secretary of Defense regarding whether
the design, in the view of the panel, will achieve the goal of
providing world-class medical facilities.
Question. Do we now have a world class design for the new WRNMMC?
Answer. The design efforts to meet BRAC requirements at Walter Reed
National Military Medical Center (WRNMMC) and Fort Belvoir Community
Hospital (FBCH) have employed industry best practices by some of the
country's leading architectural firms. The highly progressive FBCH
design includes numerous Evidence Based Design and ``green'' practices.
The design and construction efforts at WRNMMC are similarly progressive
but did not include all elements of the medical campus or the full
renewal of all renovated areas.
The Defense Health Board National Capital Region BRAC Subcommittee
is formulating its report on this issue, as required by section 2721(b)
of the National Defense Authorization Act (NDAA) for Fiscal Year (FY)
2009.
Question. When was this design completed?
Answer. Design for the construction and partial renovation at the
Walter Reed National Military Medical Center (WRNMMC) for the new
inpatient and outpatient additions were completed in April 2009 and the
designs for the warrior transition services and renovations are
scheduled to be completed by December 2009.
Question. Who was appointed to this panel and what were their
credentials?
Answer. The Defense Health Board, National Capital Region BRAC
Subcommittee members include:
--Dr. Kenneth W. Kizer (Chair)--Medsphere Systems
--Col (Ret) Richard J. Andrassy, MD--University of Texas Houston
Health Science Center
--Lt Gen (Ret) Paul K. Carlton, Jr., MD--Texas A&M University
System Health Science Center
--Mr. Raymond F. DuBois--Center for Strategic and International
Studies (CSIS)
--BG (Ret) James J. James, MD--Center for Public Health
Preparedness and Disaster
--Dennis S. O'Leary, MD--President Emeritus, The Joint Commission
--Mr. Phillip E. Tobey--Smith Group
--Ms. Cheryl L. Herbert--Dublin Methodist Hospital
The Defense Health Board, National Capital Region BRAC Subcommittee
supporting subject matter experts include:
--Ms. Tammy Duckworth--Department of Veterans Affairs
--Mr. Andrew Mazurek--Navigant Consulting
--Mr. Charles M. Olson--Mayo Clinic Rochester
--Mr. John Pangrazio--NBBJ Architecture, Planning and Design
--Dr. A. Ray Pentecost III--Clark Nexsen
--Mr. Orlando Portale--Polomar Pomerado Health
--Mr. Stephen C. Schimpff--University of Maryland
The Department can provide individual biographies upon request.
Question. How many times did this panel meet?
Answer. The Defense Health Board, National Capital Region BRAC
Subcommittee held meetings on September 29, 2008, November 17-18, 2008,
and January 15-16, 2009 and held two telephone conferences on September
22, 2008 and December 12, 2008.
Question. What were the findings of the panel?
Answer. The Defense Health Board has not yet delivered its
recommendations regarding the design plans for the Walter Reed National
Military Medical Center and the new military hospital at Fort Belvoir
(FBCH) to the Secretary of Defense, as required by section 2721(b) of
the National Defense Authorization Act (NDAA) for Fiscal Year (FY)
2009.
Question. Have the results of their review been provided to the
Congress?
Answer. No, the Defense Health Board has not yet delivered to the
Secretary of Defense its recommendations regarding the design plans for
the National Military Medical Center and the new military hospital at
Fort Belvoir, as required by section 2721(b) of the National Defense
Authorization Act (NDAA) for Fiscal Year (FY) 2009.
Question. If not when will they be provided?
Answer. Since the Defense Health Board is an independent body the
Department does not exercise control over when the DHB will submit its
report to the Secretary of Defense, but has communicated the deadline
set by Congress. The report is near completion and once it is delivered
to the Secretary of Defense the Department will provide the DHB's
report and its assessment of the board's recommendation to Congress in
a timely manner.

Independent Cost Estimate

Question. What is the total cost to implement the BRAC 2005
proposals for medical care in the National Capital Region? Provide all
costs not just construction costs.
Answer. The current estimated total cost from FY 2006 to FY 2011
for the expansion and renovation of the National Naval Medical Center
(NNMC) and associated projects to create the Walter Reed National
Military Medical Center (WRNMMC), and replacement of the DeWitt Army
Community Hospital at Fort Belvoir, VA, with Fort Belvoir Community
Hospital (FBCH) is $2.4 billion. This total includes: the design,
construction, equipment, outfitting, and transition activities
associated with the creation of new health care capabilities at the
WRNMMC and FBCH. It also includes additional parking at both locations,
the construction of new Wounded Warrior transition services, and other
administrative and support functions at Bethesda required to
accommodate related functions relocating from the Walter Reed Army
Medical Center campus. However, it does not include final property
disposal and environmental cleanup costs for the closure of Walter Reed
Army Medical Center.
Question. Have these costs been verified by an Independent Cost
Estimate?
Answer. Section 2721(c) of the National Defense authorization Act
(NDAA) for Fiscal Year (FY) 2009 required a cost estimate which was
provided in the cover letter accompanying the Department's Section 2721
interim submission dated 13 March 2009. There was not a requirement to
do an independent estimate, but the DoD budget process and the bid
process provide opportunities to vet the construction agent estimates.
In addition, the Government Accountability Office reviews the BRAC
costs annually. The combination of these processes provides sufficient
review of the costs.
Question. What was the original cost estimate when BRAC 2005 was
submitted?
Answer. The 2005 original estimate for transitioning operations at
Walter Reed Army Medical Center (WRAMC) to Bethesda, MD and Fort
Belvoir, VA was $853M. These costs did not include the costs of the
non-medical treatment aspects of the WRAMC recommendation, which also
include moving various research and support functions from WRAMC to
other locations.
Question. Why have the costs increased by so much?
Answer. Cost growth for the new Walter Reed National Military
Medical Center (WRNMMC) at Bethesda and the Fort Belvoir Community
Hospital (FBCH) between May 2005 and the present is due to several
factors.
The 2005 original estimate for transitioning operations at Walter
Reed Army Medical Center (WRAMC) to Bethesda, MD and Fort Belvoir, VA
was $853M. These costs did not include the costs of the non-medical
treatment aspects of the WRAMC recommendation, which also include
moving various research and support functions from WRAMC to other
locations.
Between May 2005 and September 2006, DoD performed detailed
requirements and cost analysis for the healthcare requirements
associated with the Walter Reed Army Medical Center (WRAMC) BRAC
actions in the National Capital Region (NCR). These refinements
resulted in almost doubling the required floor space and a $473M
increase in MILCON costs above the original BRAC estimates.
The remaining approximately $1.1B cost increase comes in two main
parts: $679M in MILCON cost growth at both WRNMMC and FBCH resulting
from decisions to primarily enhance and also accelerate construction in
support of wounded warriors and $392.4M for additional construction
projects and outfitting costs for both hospitals. The latter portion
was added during the FY10-15 Program Objective Memorandum (POM)
process. Details are as follows.
$679M increase:
Inflation ($83M): The original construction budgets for
BRAC were based on FY04 pricing guides, whereas the new budgets reflect
the DoD's FY07 pricing guide.
Construction Schedule Acceleration ($123M): DoD responded
to requests from the Congress to accelerate the construction schedule
for the projects related to WRAMC BRAC including both WRNMMC and FBCH.
Warrior Care Enhancements ($473M): Several elements were
added to the expanded medical center and supporting facilities at
Bethesda to better respond to the expected influx of Warriors in
Transition and their families. They include enhancing 30 outdated
Intensive Care Unit beds, 66 new private medical surgical hospital bed
rooms, increased non-clinical medical center support facilities, space
for a primary care clinic dedicated to treatment of Warriors in
Transition (WIT), a WIT unit headquarters, accessible housing for
junior enlisted staff and WITs, dining facility expansion for WITs, a
fitness center capable of servicing WITs and sized for the new Bethesda
staff and parking sufficient for the additional patients, family and
staff.
$392.4M Increase:
MILCON ($146M):
$59.9M for Ft. Belvoir in support of the construction for the new
facility and expanded parking
$46.0M for Bethesda traffic mitigation measures
$28.0M in additional parking at Bethesda
$5.6M in re-pricing of the dental clinic at Fort Belvoir
$6.5M to address base infrastructure updates to support the
National Intrepid Center of Excellence (NICoE)
O&M ($246.4M):
$243.0M for Bethesda and Belvoir in additional Initial Outfitting
& Transition (IO&T) funding to address requirements developed from
detailed reviews of the requirements from the market
$3.4M in re-pricing for the dental clinic IO&T requirement
Question. Are additional cost increases expected?
Answer. There are some components of the overall project that do
not yet have final pricing. The combination of the final pricing and
any other issues uncovered as renovation proceeds may lead to cost
changes. Any cost increases will be addressed in the Fiscal Year (FY)
2011 president's budget (PB) submission or if necessary in FY 2010 PB
and FY 2009 Overseas Contingency Operations (OCO) funding execution
(with concomitant reprogramming notifications).
Question. What were the original annual savings and payback period
when the BRAC 2005 was enacted?
Answer. As stated in the BRAC commission report, the annual savings
was estimated to be $145M with a six year payback.
Question. What is the current annual estimated savings and payback
period?
Answer. The current estimate is that the recommendation will
generate $170M in annual savings for the entire recommendation. Payback
is around 16 years.
Question. With what you know now, does this project make fiscal
sense?
Answer. Yes. Savings estimates and payback do not include the
substantial costs that will be avoided to recapitalize the existing
Walter Reed Army Medical Center nor did it account for the enhanced
wounded warrior mission. BRAC afforded the Department the opportunity
to consolidate infrastructure in the National Capital Region and
provide care via an integrated regional delivery network. The focus on
BRAC was not only savings, but transformation of the infrastructure.
Question. If so, please explain why?
Answer. Significant investments in health care infrastructure were
required prior to BRAC, and the comprehensive strategy represented by
BRAC is more effective than a series of independent, Service specific
investments. Prior to the BRAC decision, military health care in the
National Capital Region (NCR) was unintegrated and operated with
outdated infrastructure. Delivery of specialty care was redundant
across three geographically separate medical centers, and although
significant strides had been made to integrate care, the fiscal
inefficiencies of operating separate facilities, and two distinct
medical installations within a 5 mile radius could not have been
overcome.
Community hospital and outpatient care was similarly not integrated
across Service lines, and not focused on providing the appropriate
level of care conveniently located to the patient population. The DoD
hospital and medical center infrastructure in the NCR was aging, and
more than 4 million square feet of existing facility infrastructure for
the three Services required recapitalization in the next decade. Walter
Reed Army Medical Center (WRAMC) and National Naval Medical Center
(NNMC) were both designed in the early 1970s based upon dated
healthcare delivery models and technology and as a result were in need
of update.
In 2002, it was estimated that an investment of almost $750M for
WRAMC alone would be required to update the building infrastructure and
convert it to a configuration optimal for current models of care. Such
a sizeable investment in the current location, of course, would still
not have resolved the operational challenges. Additionally, Service
funding processes challenged proper facility investment and operational
planning in the NCR. For example, in spite of a growing multi-service
demand in the Virginia portion of the market, the original replacement
project for the 1957 vintage Ft. Belvoir Community Hospital was only
sized to meet the Army demand model. Without the BRAC decision to
optimize health care delivery by making this investment in an
integrated solution, sizeable, Service-based investments in
infrastructure would not have resulted in an integrated delivery system
and would have perpetuated operational inefficiencies and redundancies
for decades to come.

Medical Care in the National Capitol Region-Transition Planning

Question. In addition, the fixed year 2009 DOD Appropriations bill
expressed concerns over challenges with the transition of over
1,500,000 patients from the three hospitals to two new facilities. We
directed you to submit a thorough and detailed milestone schedule which
outlines prove out of the facilities, transition of staff personnel as
well as care of service members and their families.
Has that detailed report been completed?
Answer. Yes. In response to Section 2721(d) of the Fiscal Year (FY)
2009 National Defense Authorization Act (NDAA), the Department
delivered an interim submission to Congress on 13 March 2009 and
approved its final report on 14 May 2009. The Department's
understanding from this committee was that the 14 May 2009 submission
that was delivered to Congress satisfied both the requirements from
section 2721(d) of the FY 2009 NDAA and the FY 2009 Defense
Appropriations Conference Report.
In addition, the Department plans to submit the report required by
Section 1674(a) of FY 2008 NDAA in late Summer 2009, which will include
more detailed plans about the Walter Reed Army Medical Center
transition and a Master Transition Plan.
Question. Has the problem of ingress and egress been solved?
Answer. The staff of the National Naval Medical Center (NNMC) has
worked closely with local and state officials to resolve issues related
to traffic congestion in the vicinity of NNMC and improve access to and
egress from the NNMC Campus. Traffic mitigation measures will occur
both on the Bethesda Campus and outside the Campus gates.
On Campus. Improvements to access roads, gate houses, and anti-
terrorism/force protection measures as well as construction of a truck
inspection station and small visitor's center will result in improved
access to and egress from the Campus and also provide improved security
measures. At present, funding for the on-Campus improvements is
budgeted at $26 million apportioned across FY 2010 ($18.4 million) and
FY 2011 ($7.6 million).
Off Campus. The NNMC staff members have worked closely with
Montgomery County and Maryland State Highway Administration to design
improvements which will facilitate greater access to the Campus from
public transportation and major thoroughfares. DoD has committed $1
million of the budgeted $26 million to improve a turn lane at the
Campus North Gate which will facilitate safer access to and egress from
the Campus for cross traffic on Rockville Pike/Hwy 355. Consistent with
the results of our Environmental Impact Statement (EIS), the Department
has submitted a needs report to the Defense Access Road (DAR) Program
requesting examination and certification of options that will help ease
pedestrian traffic crossing Rockville Pike/Hwy 355 to the NNMC Campus.
At present, $20M has been allocated in FY 2011 for this project. As is
the case with all future budgets, the funding for these projects is
subject to change as the FY 2011 budget is reviewed and finalized
within DoD.
Question. What is the plan to solve ingress and egress?
Answer. Projects are designed and programmed for funding for
improvements at all five gates, to include enhancing METRO access, as
previously stated. Considerable efforts are also being made by the
Bethesda Installation to enhance the use of alternative transportation.
National Naval Medical Center (NNMC) is working closely with local
transportation authorities to improve scheduling, actively encouraging
carpooling and the use of public transit subsidies and improving bus
stops proximate to the base and bicycle paths.
Additionally, analysis is underway to determine if the volume of
outpatient traffic coming to Walter Reed National Military Medical
Center (WRNMMC) can be effectively mitigated by increasing distributed
primary care services (including pharmacy) off of the WRNMMC campus and
by leveraging programs such as mail order and mail refill pharmacy.
Question. When do you plan on the completion of construction for
each of the two facilities?
Answer. Construction of the new Fort Belvoir Community Hospital is
scheduled for full completion by April 2011, and the construction of
facilities and renovations at Bethesda will continue through August
2011. At both locations, various building components will come on line
in sequence such that equipping, outfitting, commissioning, and
training activities can be coordinated over an extended period prior to
the final movement of patient care.
Question. Approximately 1,900 of the personnel at WRAMC are
supposed to move to the new Walter Reed and 2000 are supposed to move
to the new Fort Belvoir community hospital. Have those individuals been
notified of where they will be moving?
Answer. Not at this time. Individual notifications will be made as
soon as possible after the new joint manning documents for the Walter
Reed National Military Medical Center (WRNMMC), Fort Belvoir Community
Hospital (FBCH) and Andrew's Air Force Base (AAFB) which are currently
being vetted by the Services and approved for release.
Since the manning documents for the two new joint hospitals (WRNMMC
and FBCH) include new organizational structures, they must be
thoroughly reviewed to determine the most appropriate placements for
current civilian employees at Walter Reed Army Medical Center (WRAMC)
and National Naval Medical Center (NNMC). NCR Medical Joint Task
Force's goal, which we believe will be achievable for the vast majority
of individuals at WRAMC, is to place employees where they want to be
located doing the work they want to do. For military members, the Army,
Navy and Air Force will assign forces to joint billets at WRNMMC, AAFB
and FBCH.
Question. When can the medical staff at Walter Reed expect to be
notified of their future employment?
Answer. Based on the anticipated release of the joint manning
documents in September 2009, NCR Medical Joint Task Force expects to
begin to notify civilian employees of their future position and duty
stations by Spring 2010. The Army will determine how they will fill the
Army billet requirements at the two new joint hospitals, Walter Reed
National Military Medical Center (WRNMMC) and Fort Belvoir Community
Hospital (FBCH), and at Andrews Air Force Base (AAFB). Army personnel
currently at Walter Reed Army Medical Center (WRAMC) will be notified
by the Army based on its specific selection and notification processes.
Question. Do you find it troubling that there is no final personnel
plan?
Answer. There is and has been a plan to transition healthcare and
support staff currently employed in the National Capital Region (NCR)
to the regional end state. It began with the development of the Program
for Design (PFD), which gave the initial estimates of personnel in each
facility. It then took the form of establishing the Directors of
Integration (DCIs) at both Walter Reed Army Medical Center (WRAMC) and
National Naval Medical Center (NNMC). The DCI's are cross-service
personnel whose task is to prepare the WRAMC and NNMC staffs for the
eventual integration. The DCIs have been an integral part of shaping
the future workforce for the two new joint facilities--Walter Reed
National Military Medical Center (WRNMMC) and Fort Belvoir Community
Hospital (FBCH). Similar efforts are underway to prepare staff at
Dewitt Army Community Hospital (DACH) and Andrews Air Force Base
(AAFB).
The overall personnel plan has further evolved with the development
of joint manning documents which describe the Service mix within each
facility. These documents are currently under review by the Services
and Joint Staff and are expected to be released by September 2009. The
Civilian personnel plan has been guided by a Civilian Human Resources
Council (CHRC) that includes multi-Service stakeholders. The CHRC has
been and will continue to oversee the transition and integration of the
civilian employees at WRAMC, NNMC DACH and AAFB into a regional force
of DoD Military Health System civilians.
The elements of the personnel plan will be laid out in the Master
Transition Plan (MTP). The MTP is an adaptive planning document that
describes in greater detail the individual actions required to
transition the current hospitals to the regional endstate. The initial
version of the MTP is anticipated to be completed by late Summer 2009.
Question. How much of the major equipment at Walter Reed will be
utilized at the new WRNMMC or Fort Belvoir?
Answer. The DoD Joint Technology Assessment and Requirements
Analysis (JTARA) assessment reviewed the current condition and life
expectancy of all major equipment items valued at over $100,000, such
as radiology systems, to determine viability for reuse. Thirty five
percent of these equipment items are programmed for reuse at the new
facilities. Additionally, a review of almost 11,000 items of equipment
with a value under $100,000 was undertaken by the staff and it was
determined that approximately 20% of these items will be programmed for
reuse.
Approximately $19.9M worth of equipment will be reused at the new
Walter Reed National Military Medical Center (WRNMMC) and $26.8M worth
at Fort Belvoir Community Hospital (FBCH). The objective to reuse
equipment must be carefully balanced with the requirement to continue
safe and effective care without degradation. As a result, these
quantities and values will continuously fluctuate. As movement plans
continue to be fine tuned, these items will continue to be evaluated
for feasibility and practicality of their reuse.
Question. Please provide a detailed list of all equipment which
will be reutilized and to which location it will be sent?
Answer. Target lists for reuse of equipment valued over $100,000
are included below. Targets lists for reuse of equipment valued less
than $100,000 comprise nearly 40 pages at this time and that list can
be provided to the committee upon request.
Analysis is still ongoing to determine whether each of these items
can actually be reused without degradation of service or incurrence of
excessive expense for temporary provisions. The attached spreadsheets
indicate the equipment origin and destination locations for items going
to the new Walter Reed Army Medical Center (WRNMMC). The Architect/
Engineer for WRNMMC has been provided the cut-sheets for the reuse
equipment and is evaluating the list against the building design to
determine if the building design is suitable for reuse of the selected
reuse items.
The location information for the reuse items tentatively identified
for Fort Belvoir Community Hospital (FBCH) is not yet finalized. FBCH
only recently completed user reviews for their equipment requirements
and are in the process of assessing the Joint Technology Assessment and
Requirements Analysis (JTARA) and non-JTARA reuse items against these
requirements. They will perform a similar review of the building design
to determine whether it will support the reuse of the equipment
identified. Other evaluation criteria that is considered is whether the
reuse items meet the objectives for standardization and whether the
items from Walter Reed Army Medical Center (WRAMC) will be available
when the items are required onsite at FBCH for outfitting.
These lists are updated daily and are likely to change as the
region approaches transition to the new facilities depending on the
clinical analysis and possibility of interruption of healthcare.
[GRAPHIC] [TIFF OMITTED] T6286A.094

[GRAPHIC] [TIFF OMITTED] T6286A.095

Question. How much additional equipment will need to be procured
for both WRNMMC and Fort Belvoir and how much has been budgeted in
previous years and how much is in the fiscal year 2010 President's
Budget?
Answer. The Initial Outfitting and Transition budget of
approximately $550M will provide the equipment and transition services
for both Walter Reed National Military Medical Center (WRNMMC) and Fort
Belvoir Community Hospital (FBCH) after placement of all reusable
equipment from Walter Reed Army Medical Center (WRAMC).
The table below provides the amount executed in fiscal year 2007,
2008 and 2009 for National Naval Medical Center (NNMC) and DeWitt Army
Community Hospital (DACH). For the purpose of this response equipment
is defined as medical equipment with a value greater than $100,000.

------------------------------------------------------------------------
Bethesda Fort Belvoir
------------------------------------------------------------------------
FY07 Executed..................... $15,059,632.40 $942,382
FY08 Executed..................... $18,190,520.18 $1,034,661
FY09 Executed..................... $8,073,051.71 $318,433
* FY10 Planned.................... $7,262,659.41
------------------------------------------------------------------------
* The table includes the NNMC requirements planned for fiscal year 2010.
However, the Army Medical Department centrally budgets for medical
equipment greater than $100,000 and Medical Treatment Facility
requirements are prioritized and funded in the year of execution. This
makes it unfeasible to provide an accurate amount for the fiscal year
2010 President's Budget for Fort Belvoir.

Question. What do you consider the pacing items for the transition
from the old to the new facilities?
Answer. National Capitol Region Medical Joint Task Force (JTF
CAPMED) sponsored a Clinical Transition Wargaming Exercise in February
2009 to address this question. A copy of that report has been made
available to Congress. The exercise determined that patient safety and
satisfaction is best maintained by retaining virtually all services at
Walter Reed Army Medical Center (WRAMC) until a short transition period
in the late Summer of 2011. Of critical concern is making certain that
all the conditions are established for the continuity of care and
services supporting the wounded warrior population.
The key pacing, or ``trigger'' milestones for transition are below:
June 2009--Establish Central Program Management Office and
approve initiate contract for Joint Transition/Integration Teams.
October 2009--Fully staff Joint Transition/Integration
Teams and focused Transition Cells at Walter Reed, Bethesda, and
Belvoir.
\January 2010--Commence comprehensive turnkey equipment
procurement and transition services (move and activation) contract.
October 2010--Establish Joint Command structure to ensure
unity of effort of physical transition.
March 2011--Complete NNMC occupancy of new outpatient and
inpatient buildings at Bethesda.
June 2011--Complete transition of all Dewitt operations to
the new Fort Belvoir Community Hospital.
Late Summer 2011--Transition all operations from Walter
Reed to Bethesda and Belvoir.
Other significant items that are scheduled to be completed in the
third and fourth quarter of FY 2011 include delivery of wounded warrior
facilities, administrative buildings, parking garages and entrance gate
improvements on the Bethesda campus. All of these items are scheduled
to be completed in the third and fourth quarter of FY 2011.
For further detail please refer to the Department's milestone
schedule submission, as required by section 2721(d) of the FY 2009
National Defense Authorization Act (NDAA), which was approved on 14 May
2009 and delivered to Congress.
Question. Are you concerned with the transition and how long do you
estimate you will have from the completion of construction to September
15, 2011 when the move must be completed?
Answer. Completing the construction and Initial Outfitting &
Transition (I&OT) timelines for Bethesda and Fort Belvoir is the
largest transition program that the Military Health System has carried
out. While such transition challenges are not foreign to the private
sector, this project presents the unique challenge at Bethesda of
adding to a hospital while continuing to operate that hospital.
Ensuring a safe and effective transition is the JTF CAPMED's first
priority.
Completion of several key facilities on the Bethesda campus will
not be achieved until late Summer 2011. An analysis of industry
healthcare relocations found that it is common and prudent practice to
relocate major operations over a short period of time, or all at once.
By concentrating the actual move process to a compressed timeframe,
this strategy minimizes the disruption to patient care and confusion
for patients, and is safer than trying to extend operations across two
separate locations. This is accomplished following several months of
preparatory activities to ensure that the new spaces are fully
outfitted, equipped, and commissioned and staff and patients are
trained and oriented in advance of the move. Patient scheduling and
admitting will be managed to ensure continuity of care over this move
period.
For further detail please refer to the Department's milestone
schedule submission, as required by section 2721(d) of the FY 2009
National Defense Authorization Act (NDAA) that was dated 14 May 2009
and delivered to Congress.
Question. What actions are you taking to mitigate these concerns?
Answer. The Department is implementing the milestone schedule, as
required by section 2721(d) of the FY 2009 National Defense
Authorization Act (NDAA) that was approved on 14 May 2009 and delivered
to Congress.
Question. What is the planned disposition for the existing Walter
Reed Army Medical Center?
Answer. The Army is responsible for the disposition of the existing
Walter Reed Army Medical Center (WRAMC). Current plans call for a
Federal to Federal transfer of the 113 acres of WRAMC main post. The
General Services Administration (GSA) has requested 34 acres and the
Department of State the remaining 79 acres. The Department of State has
recently amended their request asking for only 18 acres. The Deputy
Assistant Secretary of the Army for Installations and Housing is
working with GSA to see if GSA is interested in amending their request
for the now remaining 61 acres. If no interest is found, the 61 acres
will be declared surplus.
Question. How much is estimated to clean up and dispose of the
facility?
Answer. The Army is responsible for the cleanup and disposal of the
Walter Reed Army Medical Center (WRAMC) facility. The extent of cleanup
is partially dependent on the future use of the facility (e.g., Federal
tenants vice non-Federal tenants). However, regardless of who the
future owners will be, DoD must terminate its Nuclear Regulatory
Commission (NRC) license. The current estimate is approximately $14M to
decommission all locations where radiological substances have been used
and terminate the NRC license in order to release all buildings for
unrestricted use. Estimates were based on the NRC-required
Decommissioning Funding Plan of 2005.

Missions of Joint Task Force--National Capital Region (JTF CAPMED)

Question. Does JTF CAPMED have missions that go beyond NCR BRAC
coordination?
Answer. In September of 2007, the Department established JTF CAPMED
as a fully functional standing JTF located on the National Naval
Medical Center (NNMC) campus and reporting directly to the Secretary of
Defense through the Deputy Secretary of Defense.
JTF CAPMED was chartered to lead the way for the effective and
efficient consolidation and realignment of military healthcare delivery
in the National Capital Region (NCR) Joint Operation Area (JOA). To
accomplish this mission, JTF CAPMED is coordinating with the NCR
medical components of the Army, Navy, and Air Force to integrate
processes and ensure the best utilization of resources available which
will eliminate redundancies, enhance clinical care, promote health
professions education and joint training, and enhance military medical
research opportunities. In addition, JTF CAPMED has been tasked to
oversee implementation of the 2005 BRAC recommendation that directed
the realignment of functions at Walter Reed Army Medical Center (WRAMC)
in Washington, DC to Bethesda, MD, establishing the Walter Reed
National Military Medical Center (WRNMMC), and a community hospital at
Fort Belvoir, VA (FBCH).
The NCR's JOA stretches as far north as New Jersey, skirts West
Virginia and extends south to Bowling Green, VA. It includes 37 Medical
Treatment Facilities (MTFs), including WRNMMC and FBCH, and 12K
military and civilian employees. The region comprises over 545K
eligible beneficiaries and 282K MTF enrollees.
Not later than the BRAC deadline of 9/15/11, the new WRNMMC in
Bethesda, MD and FBCH in Fort Belvoir, VA will be aligned as joint
commands subordinate to JTF CAPMED. In addition, to allow for greater
interoperability throughout the region, JTF CAPMED will have tactical
control of the other JOA MTFs (outpatient) while the Service Medical
Departments retain operational control. JTF CAPMED will be the
allotment administrator for $1.3B supporting all assigned MTFs.
JTF CAPMED has become the functional provider of Health Service
Support (HSS) to the DoD, U.S. NORTHCOM, Joint Force Headquarters
National Capital Region (JFHQ-NCR), and multiple interagency partners
within the National Capital Region for training exercises; National
Security Special Events (NSSEs) and Defense Support of Civil Authority
(DSCA) support missions; and contingency planning. Since activation,
JTF CAPMED has deployed 130 medical support teams within the NCR in
order to provide advanced trauma/cardiac life support, emergency
medical services, basic life support, ground evacuation support,
vaccinations and liaison support on such events as the 56th U.S.
Presidential Inaugural; State of the Union Addresses; the Papal Visit;
Joint Sessions of Congress involving the Irish and U.K. Prime
Ministers; the Joint Service Open House; State Funeral exercises; and
multiple national observance ceremonies throughout the District of
Columbia.
Question. The specified missions for JTF CAPMED include healthcare
delivery. Do you have any disaster or contingency roles?
Answer. JTF CAPMED has an active contingency/disaster role within
the National Capital Region (NCR) Joint Operating Area (JOA). When
directed by the Secretary of Defense, JTF CAPMED conducts and provides
integrated Health Service Support (HSS) within the framework of Defense
Support to Civil Authorities (DSCA) in accordance with the National
Response Framework (NRF) pursuant to the Requests for Assistance (RFA)
from civil authorities. JTF CAPMED maintains its command relationship
with Secretary of Defense while maintaining a general support (HSS)
relationship with USNORTHCOM and a direct support (HHS) relationship
with Joint Task Force National Capital Region (JTF-NCR). This Health
Service Support is provided within the authorities of 11 different
USNORTHCOM Conceptual Operations (CONOPs) Plans and six JTF-NCR CONOPS
Plans.
Recently, JTF CAPMED took the lead DoD medical role for novel
swine-origin influenza A/H1N1 support within NCR JOA. Moreover, JTF
CAPMED provides medical forces and consequence management within the
NCR JOA in support of National Security Special Events and as needed to
Office of the Attending Physician, U.S. Congress. The creation of JTF
CAPMED has streamlined and created efficiencies for providing unified
and integrated medical support in response to disasters/contingencies.
Question. Will medical personnel in the new hospitals still deploy
to Iraq and Afghanistan?
Answer. Yes. Depending upon the mission, all military personnel
assigned to JTF CAPMED may be required to fill Combatant Commander
requests for forces, as determined by the Services.
Question. Why does it make sense to regionalize healthcare delivery
in the NCR?
Answer. Effective and efficient healthcare delivery within the
National Capital Region (NCR) Joint Operating Area (JOA) is achieved by
alignment to one Joint commander integrating care to provide an
integrated delivery system. This allows for the integration of
processes and ensures the best utilization of resources available which
will eliminate redundancies, enhance clinical care, promote health
professions education and joint training, and enhance military medical
research opportunities.
Each Branch of Service otherwise has little incentive in
overlapping catchment areas to plan for the care of the entire
beneficiary population. This leads to cost and workload shifts causing
inefficiencies and increasing costs to the Department. Moreover, lack
of integration of care provides a structure for intra-Medical Treatment
Facility referrals impacting beneficiaries and their family members. A
Joint Commander gives other DoD, Federal, State, academic and local
government agencies a single point of contact simplifying contingency
planning and speeding response in a crisis as well.
Question. Are all capabilities being planned for the new Walter
Reed National Military Medical Center installation NCR BRAC related?
Answer. Although all capabilities being planned for the Walter Reed
National Military Medical Center (WRNMMC) installation support the
future operations of the WRNMMC directed by BRAC, the establishment of
the Defense Center of Excellence for TBI/PTSD research and additional
Fisher Houses are being funded privately. Additionally, many other
projects, such as the establishment of the Vision Center of Excellence
and the Joint Pathology Center on the installation are also non-BRAC
projects, but enhance the overall mission of WRNMMC.
Question. Will the significant realignment of resources to Fort
Belvoir support your healthcare delivery mission?
Answer. Yes. The Multi-Service Market Office, the Joint Cross
Service Working Group and the BRAC Commission confirmed findings that
over the last several decades commands, patients and families have
located in the southern part of the National Capital Region. Fort
Belvoir Community Hospital (FBCH) will be closer to more patients than
Walter Reed National Military Medical Center (WRNMMC). A robust
community hospital and outpatient clinic system at Fort Belvoir will
significantly improve access to care and reduce drive times for active
duty service members and other beneficiaries.
Question. Will the NCR BRAC process affect your ability to provide
casualty care in the NCR?
Answer. No. As America's primary casualty reception site for
returning warriors from Iraq, Afghanistan and other areas where
Americans remain in harm's way, JTF CAPMED's number one priority
remains casualty care. Our ability to provide high-quality casualty
care during the National Capital Region (NCR) BRAC process will in no
way be affected; in fact, the ultimate transition to the new facilities
will greatly enhance the NCR's capabilities for wounded warrior care.
Question. Please talk about what you have accomplished since your
inception.
Answer. JTF CAPMED reached Initial Operational Capability on 1
October 2007 and reached Full Operational Capability (FOC) on 30
September 2008. Since reaching FOC, JTF CAPMED has realized numerous
accomplishments. Among them are the following:
The Department approved a DoD Civilian Manning Model for
National Capital Region (NCR) Joint Operating Area (JOA) 20 Oct 2008.
Phased implementation will start with Walter Reed National Military
Medical Center (WRMMC) & Fort Belvoir Community Hospital (FBCH).
The Department approved a Military Personnel Staffing
Model 15 Jan 09. Continues JTF CAPMED as a joint military command,
establishing WRNMMC and FBCH as subordinate joint commands.
JTF CAPMED is coordinating a joint manning document for
civilians and military at the new WRNMMC, FBCH and Andrews Air Force
Base.
JTF CAPMED helped establish Directors of Integration (DCI)
at both Walter Reed Army Medical Center (WRAMC) and National Naval
Medical Center (NNMC). The DCI's are cross-service personnel whose task
is to prepare the WRAMC and NNMC staffs for the eventual integration.
JTF CAPMED prepared, and the Department approved, a
milestone schedule for transition of operations from WRAMC to WRNMMC
and FBCH, as required by Section 2721(d) of the Fiscal Year 2009
National Defense Authorization Act.
JTF CAPMED is coordinating BRAC NCR Master Transition Plan
(MTP) to direct execution of BRAC and maintenance of critical medical
capabilities during the transition process.
JTF CAPMED has successfully started integration of
healthcare delivery in the NCR JOA.
Completed 160+ Clinical and administrative/logistic Concept
of Operations Plans and will provide the foundation document guiding
the provision of healthcare across the Joint Operation Area (JOA).
Air Force Referral Management System Tracking Tool now used
by all referral management staff in JOA, allowing for consistent
application of business rules. Standard practices also implemented in
patient appointing and monitoring key performance measures.
Implementation of the first-ever JOA-wide synchronized
influenza immunization program, resulting in the synchronized ordering,
delivery, and administration of vaccine, so all Medical Treatment
Facilities (MTFs) in the JOA start their programs at the same time and
prevent beneficiaries from ``chasing'' vaccine from one facility to
another.
Production of a strategic plan for credentials and
privileging that utilizes a regional concept of operation for bylaws
reconciliation and adverse privileging actions.
Inclusion of all JOA facilities into a benchmark Surgical
Optimization and Standardization initiative.
Roll out of an AHLTA Clinical Enhancement project throughout
the region.
Decision to use national standards for our ambulances when
Advanced Cardiac Life Support or Basic Life Support ambulance is
requested for a National Special Security Event.
For the Presidential inauguration, standardized the equipment
for the roving medics and the aid stations; established a MTF JOA bed
status/sit-rep for situational awareness and planning in the event of a
Mass Casualty Incident.
Established the Trauma Service at WRAMC.
JTF CAPMED has assumed the role as National Capital Region
(NCR) Medical Force Provider to Joint Forces Headquarters NCR.
JTF CAPMED has successfully provided support to the
following Health Service Support missions to the Department of Defense:
White House Communication Agency Medical Readiness Support
National Memorial Day Observance
Joint Service Open House
JFHQ-NCR Joint State Funeral Training Exercise
National Veterans Day Observance Support
Support to White House Communication Agency (WHCA) Service
Member Readiness Processing
Support of the Groundbreaking Ceremony for the Walter Reed
National Military Medical Center (WRNMMC)
Support of National Memorial Day Observance 2008
Support of National Peace Officers' Memorial Service
JTF CAPMED has successfully provided support to the
following Defense Support to Civil Authorities missions:
Annual National Peace Officer's Memorial Service
Joint Session of Congress (Prime Minister Brown)
Presidential Address to the Joint Session of Congress
56th Presidential Inaugural
G-20 Summit
Pentagon 9-11 Memorial Dedication
Prime Minister of Ireland address to Congress
Papal Visit to the National Capital Region (NCR)
State of the Union Address
Question. With each Service Medical Component employing different
concepts of care delivery and processes, how will you develop common
practices within the NCR that will be suitable for a multi-Service pool
of beneficiaries?
Answer. Working closely with the Assistant Secretary of Defense for
Health Affairs (ASD (HA)) and the Service Surgeons General, JTF CAPMED
is prioritizing the operations of care necessary to meet the
expectation of world-class integrated healthcare delivery. The focus is
to blend the best of each Service and then shape those processes for
what is best for the patient.
ASD(HA) is supporting JTF CAPMED's mission by using the National
Capital Region (NCR) as a test bed for Military Health System
initiatives such as surgical optimization and AHLTA enhancement. As the
annual planning cycle begins again, JTF CAPMED will take the next steps
to implement common standards for the patient care supporting business
processes that improve access to care and patient satisfaction.

[Clerk's note.--End of questions submitted by Mr. Murtha.]

Wednesday, June 3, 2009.

FISCAL YEAR 2010 AIR FORCE POSTURE

WITNESSES

HON. MICHAEL B. DONLEY, SECRETARY OF THE AIR FORCE
GENERAL NORTON A. SCHWARTZ, CHIEF OF STAFF, UNITED STATES AIR FORCE

Introduction

Mr. Dicks. This morning the committee will hold an open
hearing concerning the Air Force fiscal year 2010 budget
request. We are pleased to welcome two distinguished witnesses,
Mr. Michael B. Donley, Secretary of the Air Force, General
Norton A. Schwartz, Chief of Staff of the Air Force. They are
very well qualified to discuss these areas and to answer the
questions of the committee.
Secretary Donley, General Schwartz, thank you all for being
here this morning. This committee is very interested in hearing
what you have to say about the Air Force's fiscal year 2010
budget. Specifically as you are well aware, some of us on the
committee are anxious to hear the status of the KC-X
competition and particularly how you will address the issues
that led the General Accountability Office to overturn last
year's competition.
In addition, the Air Force budget includes the retirement
of over 250 fighter aircraft yet to date. The Air Force has
been unable to provide a schedule for retirement of the
aircraft or a plan for reassignment of personnel. We look
forward to your testimony and to a spirited and informative
question and answer session.
Before we hear you I would like to call on our Ranking
Member this morning, Kate Granger of Texas, for any comments
you would like to make.
Ms. Granger. Thank you, Mr. Chairman. I have no comments.
Mr. Dicks. Okay. Secretary Donley, we understand that you
and General Schwartz will each make an opening statement. You
may proceed with your summarized statement. Your entire
statement will be placed in the record and you may proceed as
you wish.

Summary Statement of Secretary Donley

Mr. Donley. Thank you, Mr. Chairman and members of the
committee. I appreciate the opportunity to appear before you
today to discuss the Air Force's fiscal year 2010 budget.
It has been almost a year since General Schwartz and I took
on these roles as Chief and Secretary. And I must tell you I
could not have had a better partner in this work than General
Schwartz. In recent months, Secretary Gates and Admiral Mullen
led a constructive dialogue about necessary changes in our
national defense priorities and areas of emphasis. Our
discussions emphasized taking care of our most important asset,
which is our people; rebalancing our capabilities to fight and
win the current and most likely conflicts in front of us, while
also hedging against other risks and contingencies; and
reforming how and what we buy.
We have contributed our analysis and judgment throughout
this process. With OSD, our sister Services and interagency
partners, we have undertaken several strategic reviews in the
Air Force over the last year. Last fall we refined the Air
Force's mission statement. We articulated our five strategic
priorities and refined our core functions to more clearly
articulate the Air Force's role in national security.
We also made progress in areas that required some focused
attention up front, such as strengthening the Air Force's
nuclear enterprise, preparing to stand up our cyber-numbered
Air Force, articulating our strategy for irregular warfare and
counterinsurgency operations, consolidating our approach in the
Air Force for global partnerships, and advancing stewardship of
the Air Force's energy program.
Our reviews were guided by the concept of strategic
balance, which has several meanings for us. As Secretary Gates
and Admiral Mullen have described, balance means prevailing in
today's fight while also being able to respond across the
spectrum of conflict to emerging hybrid threats. Balance also
means allocating investment across our 12 diverse but
complementary core functions. And balance also means
organizing, training and equipping ourselves as an Air Force
across our Active and Reserve components.
Our budget proposal recognizes that people are the heart
and soul of America's Air Force. Without them our organizations
and equipment would grind to a halt. In fiscal year 2010, we
are reversing the previously planned reductions in Air Force
Active Duty end strength with commensurate adjustments in
Reserve components. We will also grow our civilian cadre,
especially the acquisition workforce. At the same time, we will
continue to reshape our skill sets with particular emphasis on
stressed career fields and missions that need our attention
now, such as intelligence, surveillance and reconnaissance,
acquisition, maintenance, cyber operations and nuclear matters.
In fiscal year 2010 we are also driving more balance into
our force structure. In theater, the demand for intelligence,
surveillance, and reconnaissance (ISR) and special operations
capabilities continues to increase. So we will increase
unmanned combat air patrols (CAPS) from 34 today to 43 by the
end of fiscal year 2010, as well as increase special operations
forces (SOF) end strength by about 550 personnel.
We also took a broader strategic look at the total combat
Air Force capabilities. And there is a general view in the
Department's leadership that the United States has enough
tactical air capability. With that in mind, we judge this as a
prudent opportunity to accelerate the retirement--the planned
retirement--of older aircraft, as we have done in this budget.
As a result, we will reshape the portfolio of the fighter
force by retiring about 250 of our oldest tactical fighters,
completing production of the F-22 program at 187 aircraft and
committing to planned F-22 upgrades, and readying the fifth
generation F-35 Joint Strike Fighter program to become the
workhorse of our new fighter fleet going forward.
We will also ensure balance for joint airlift needs by
completing the C-17 production, continuing to modernize our C-
5s, reinitiating the C-130J production line and transitioning
the C-27J program from the Army to the Air Force. In
particular, the Department made a judgment that about 316
strategic airlift tails in the program of record is adequate to
meet our needs. We also conducted a business case analysis that
identified alternatives to improve our current strategic
airlift capability at less cost than simply buying more C-17s.
We will enhance stability and remove risk in our military
Satellite Communications (SATCOM) programs by extending our
Advanced Extremely High Frequency (AEHF) and Wideband Global
SATCOM (WGS) inventories and continuing partnerships with
commercial providers. While AEHF does not give us all the
capabilities of the projected Transformational Satellite (TSAT)
program, adding additional AEHF and WGS satellites does provide
additional MILSATCOM capability until we can gain confidence
about the affordability and requirements for TSAT-like
capabilities in the future.
We also placed additional emphasis on Air Force
acquisition. We recently published our acquisition improvement
plan to focus our efforts on several key areas. First, to
revitalize the Air Force's acquisition workforce. Second,
improving the requirements generation process. Third,
instilling budget and financial discipline into our programs.
Fourth, improving the Air Force's major systems source
selection process. And fifth, establishing clear lines of
authority and accountability within acquisition organizations.
I look forward to working with this committee in the future
and with our OSD leadership as we address Defense acquisition
improvements going forward. Over the coming months the Air
Force will, with the other Services, participate in several
major reviews, including the Quadrennial Defense Review,
Nuclear Posture and Space Posture Reviews. And from these
analyses we will better understand the needs, requirements and
available technologies for long-range strike, as well as our
requirements and potential joint solutions for personnel
recovery.
Stewardship of the United States Air Force, Mr. Chairman,
is a responsibility that General Schwartz and I take very
seriously. We are grateful for the support that we get from
this Committee and we do look forward to working with you in
the months ahead.
Mr. Dicks. Thank you Mr. Secretary.
General Schwartz.

Summary Statement of General Schwartz

General Schwartz. Mr. Chairman, Congresswoman Granger and
other members of the committee, I am proud to be here with
Secretary Donley representing your Air Force.
The United States Air Force is fully committed to effective
stewardship of the resources that the American people place in
our trust, a commitment founded on our core values of integrity
first, service before self, and excellence in all we do. Guided
by these core values, American airmen are all working
courageously every day with precision and reliability.
I recently had a chance to take a trip to visit with some
of our airmen who are serving in various locations around the
world and they are providing game-changing capabilities to the
combatant commanders in the air and on the ground. Last year
American airmen conducted 61,000 sorties in Operation Iraqi
Freedom, some 37,000 sorties in Operation Enduring Freedom.
That is 265 sorties each and every day.
Airmen also serve on convoys and in coalition operation
centers and delivered 2 million passengers and some 700,000
tons of cargo in the United States Central Command area of
responsibility last year. Dedicated airmen directly support
CENTCOM operations from right here in the United States by
providing command and control of unmanned aerial vehicles,
while our nuclear operations professionals support the umbrella
of deterrence for the Nation and its allies across the globe.
As well, our space professionals are providing truly
amazing capabilities ranging from early warning to precise
global positioning, navigation and timing.
Through Secretary Donley's guidance and leadership, we have
set a course to provide even greater capabilities for the
Nation and to balance our priorities to meet a spectrum of
challenges.
The top priority is to reinvigorate our Air Force nuclear
enterprise as outlined in a nuclear roadmap. We are also
fueling capabilities that allow us to innovate partnerships
with joint and coalition teammates to win today's fight by
expanding intelligence, surveillance and reconnaissance with
the procurement of 24 MQ-9 Reaper unmanned aerial systems.
At the same time we will continue support for our most
precious asset: our people. We are focused on providing
programs that develop and care for our airmen and their
families with world-class quality of service and honor our
commitments that we have made, the lasting commitments that we
have made, to our wounded warriors.
Part of ensuring support for airmen means providing them
with the tools they need to do their jobs effectively.
Therefore, we are modernizing our air and space inventories,
organizations and training with the right, yet difficult,
choices.
In addition to programs that Secretary Donley just
mentioned, we are committed to providing robust air refueling
capability. We also intend to increase efficiency by retiring
aging aircraft and we will complete the production of the F-22
at 187 aircraft and the C-17 at 205 aircraft, subject to
congressional approval.
In recent testimony Admiral Mullen stated we are what we
buy. Following his lead, we intend to maintain stewardship of
America's resources for our war fighters in the field as well
as taxpayers at home by recapturing acquisition excellence and
fielding the right capabilities for the Nation, on time and
within budget.
Mr. Chairman, with our core values guiding us, the Air
Force will continue to provide our best military advice and
stewardship, delivering global reach, vigilance and power for
America.
Thank you for your continuing support of the United States
Air Force and particularly for our Airmen and their families.
Sir, I look forward to your questions.
[The joint statement of Secretary Donley and General
Schwartz follows.]

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AIR FORCE ACQUISITION WORKFORCE

Mr. Dicks. Thank you both for your statements. Secretary
Donley, on May 4 you and General Schwartz signed a plan to
improve Air Force acquisition. Included in the plan are five
goals and 33 actions that ensure rigor, reliability and
transparency across the Air Force acquisition enterprise.
Your first goal is to revitalize the Air Force acquisition
workforce. Will you hire new personnel or retask current
employees, or both?
Mr. Donley. Our intent is to strengthen the acquisition
workforce through both internal retraining and enhanced
training in critical skill sets, and also to bring in new
personnel as well.
As you are probably aware, the broader intent in the
Department is to make changes in civilian personnel which will
bring more work now performed by contractors back into the
government. That pendulum of contracting out some of our
important functions is swinging back toward a definite bias
among the current leadership to get more of this capability
back into our organic workforce. So our goal----
Mr. Dicks. Were we using contractors to actually do the
acquisition work?
Mr. Donley. Contractors are definitely supporting our
acquisition work. I am not sure that they were--they were not
in charge of our acquisition decision process. But no question
that contractors have been part of that.
As we go forward, our target for contractor-to-civilian
conversions is about 4,000 in fiscal year 2010, of which about
half are focused on our acquisition workforce. So we anticipate
beefing up our acquisition workforce by about 2,000.
Mr. Dicks. What was the number again, 10,000?
Mr. Donley. Two thousand. And this is across a number of
skill sets: systems engineering, contracts, cost estimators,
all the different functions and supporting expertise that
supports the acquisition process.
Mr. Dicks. Will they mainly be civilians or will they be
civilians and military?
Mr. Donley. Mostly civilians.
Mr. Dicks. How will you improve the requirements generation
process? I mean, one of the things we have talked about over
the years is the fact that we have this requirements creep that
drives up the cost. How are we going to try to get that under
control?
Mr. Donley. Our focus in the Air Force on this subject is
getting better visibility on requirements in the acquisition
process and getting better understanding of the acquisition
process in the requirements process up front. So we are
undertaking procedures internally which require the
requirements being developed by the warfighter to be reviewed
by the acquisition process so we know those requirements can be
translated into deliverables, contract deliverables, that we
know can be accomplished; and to get acquisition professionals
to sign off on those requirements so that they are written in
such a way that they can be translated into contracts. And
then, as the requirements move into the acquisition process,
that as we write the contracts and as we translate those
requirements into acquisition activities, that the warfighter
who set the requirements signs off on those. So it is really
cross-checking between requirements and acquisition.

KC-X PROCUREMENT PROGRAM

Mr. Dicks. Secretary Donley, what is the status of the KC-X
procurement program and when will you release the latest RFP?
Mr. Donley. As you know, Mr. Chairman, I have been in
dialogue with the new Under Secretary for Acquisition, Dr.
Carter, and the Deputy Secretary of Defense and our acquisition
officials on a regular basis over the last couple of months. We
hope to take the work that we have developed thus far to the
Secretary very soon and to have him give us his direction on
how to proceed. We are hopeful that that new request for
proposal will be out on the street this summer.
Mr. Dicks. How much funding is requested for the KC-X in
the 2010 budget?
Mr. Donley. I would have to check, sir. I believe it is in
the neighborhood of $600 to $800 million. I would have to
double-check.
Mr. Dicks. I think we have the number. We think it is 439.
Mr. Donley. 439, right.
Mr. Dicks. But this year is going to be mainly the
competition, and we hope it will be a fair and open transparent
competition, which Secretary Gates has promised. And also I
want to--and I want to say this on the record--encourage
dialogue between the two competing sides. I think that is very
important and was one of the issues, by the way, in the GAO
report was that there was unfairness toward one side in the
previous competition.
So transparency, openness and, I would hope, trying to keep
both sides on the political side to let you guys--let the
professionals make this decision without political
interference, which I am afraid did mar this somewhat in the
previous competition.
And then we understand also that the KC-X requirement was
briefed at the Joint Requirements Oversight Council. And what
was the outcome of that, do you know?
Mr. Donley. The general work done earlier this year was to
revalidate that the requirements for the KC-X are and remain as
they had been approved previously. So they were revalidated
this year.
Mr. Dicks. We also understand that there has been a
significant reduction in the 800 previous requests for
proposals and the requirements in the previous request. Is that
accurate as well?
Mr. Donley. We have been working to reduce, to streamline,
to consolidate requirements, to write them as clearly as we can
going forward; so that that has been part of our process this
winter.
Mr. Dicks. One final question, and I am going to yield to
Ms. Granger. The last competition was based on the best value,
yet we understand that the Air Force may be considering low
cost in the next competition. How do you differentiate these
two concepts, best value and low cost?
Mr. Donley. Well, performance and cost are always part of
our trade space in contract--in source selections. And I
believe they will be part of our trade space going forward. I
can't describe for you here yet exactly how that will be
balanced out as we finalize the Request for Proposal (RFP). But
I think in some cases there is a tendency to polarize these
concepts, whereas they are always part of our mix.
Mr. Dicks. The source selection authority has not yet been
decided, is that correct, between the Air Force and DOD?
Mr. Donley. That is correct.
Mr. Dicks. Thank you. Ms. Granger.

JOINT STRIKE FIGHTER

Ms. Granger. Thank you. Thank you both for being here and
thank you for your service.
I had a question for the General having to do with the
Joint Strike Fighter, not surprisingly. I would like to know
what impact there would be on reducing the procurement of the
Joint Strike Fighter on your modernization plans. We have heard
year after year how important reform and modernization is. And
so my first question would be, what effect would it have? And
given that, are there any plans to increase your buy from 80 to
110 per year, since that was the original plan?
General Schwartz. Ma'am, clearly--and this not just for the
Air Force; certainly the United States Navy, the United States
Marine Corps and a number of international partners are highly
dependent on delivery of the F-35, and that is certainly true
for your Air Force.
We need to have very substantial rates of production for
the F-35 to accomplish a couple of things for us. The most
pressing has to do with the fact that much of our inventory is
aging. I mean all of it is. But many of the machines that were
bought during the Reagan buildup in the eighties are
approaching the end of their service life, some of which we are
going to retire early in order to get us on the ramp that we
need to be on for high rates of production for the F-35.
And if we have those high rates of production, not less
than 80 a year, and hopefully more as you indicated, we will be
able to manage the retirements of remaining aircraft in our
fleet, upgrade those that will last a bit longer time and,
again, provide the overall tactical air capability that the
Department requires of us. So in short as I see it, 80 is the
minimum, it is the floor, it is not the ceiling, and that it is
very important that this program deliver on time and on cost.
Ms. Granger. Thank you. I want to follow up on that to both
of you. Given the fact that your requirement for 1,763 Joint
Strike Fighters was predicated on the F-22 force of 381
aircraft, will there be an effort on your part in the
Quadrennial Defense Review to make a case for the F-35 force
structure to compensate for not having 381 F-22s?
General Schwartz. Ma'am, it depends, frankly, on what the
analysis that is currently underway with the Quadrennial
Defense Review, what it comes up with. All of this is highly
dependent on the scenarios we use to conduct the analysis with
one warfight, two warfights, how close those warfights might be
in terms of simultaneity. All of this affects both the size of
the force and the mix of the force. And more broadly it is the
joint team, but in the fighter area, as you indicated for us,
the F-35, F-22 and some number of legacy platforms. I think it
is not yet clear what the top line will be for the Department.
For us it has been 2,250 fighter strike-type aircraft for some
number of years. It could end up being less. And if that is the
case, we will still have a predominantly F-35-populated force.
We will have the 187 F-22s, we will have well over 1,500 F-35s,
and then some number of legacy airplanes. That will be the mix.
It remains to be seen what the top line is, however, based on
the analysis.
Ms. Granger. Mr. Secretary.
Mr. Donley. Ma'am, I would add one other item in addition
to what the General has mentioned, and that is that as the
Department looks at its tactical fighter and its air-to-ground
capabilities in particular, the Reaper and armed Predator
capabilities that the Department has been building the past
several years to support the warfighter are coming into view as
substantial assets for the Department in terms of air-to-ground
capability.
So as we think about total tactical fighter strike
inventories, we are starting to include these armed unmanned
aerial system (UAS) capabilities in that mix as well. They are
certainly not--they don't have air-to-air fighter capability,
but they are certainly providing air-to-ground strike. And it
is making that tactical Air Force more effective at the low end
of the conflict spectrum.
Ms. Granger. Thank you very much. Thank you, Mr. Chairman.
Mr. Dicks. Mr. Boyd.

AIR FORCE COMBAT STRUCTURE

Mr. Boyd. Thank you, Mr. Chairman.
Secretary Donley, General Schwartz, welcome, and thank both
of you for the time you have given me to work through some of
the issues that we have a common interest in. And also I look
forward to your visit to Tyndall Air Force Base on June 22nd,
and I thank you for that commitment to come.
Secretary Donley, General Schwartz, last year the Air Force
briefed this committee and other committees of Congress on
combat Air Force structure. And basically that briefing
concluded that we were in a real deficit in terms of air
structure, tactical Air Force structure.
On May 9th of this year, you briefed this committee staff
on the combat Air Force's restructure that is proposed in the
fiscal year 2010 budget. And that includes retiring
approximately 250 F-15s, F-16s, and A-10s in 2010. So it is a
very radical fast-forwarding of what was in the BRAC documents
that were put in place a couple of years ago.
Can you explain to the committee what, in your mind, has
changed in the last 12 months that has gotten us to this point?
General Schwartz. Sir, I think it is a couple of things.
Clearly there are budgetary pressures that we are dealing with.
That is one aspect.
A significant aspect has to do with the demands that are
being placed on us by our joint commanders, which is to expand,
amplify, certain aspects of the force; in other words,
intelligence, surveillance and reconnaissance, reinvestment in
the nuclear mission.
There are a number of areas where we had to expand or do
more. And the issue for us was how do we bridge ourselves from
the current position that we are with the legacy fighter force
to the one that we know we need to have, which will be a
predominantly generation five kind of force. And it was our
judgment, looking at this fresh this year, that it was not
without risk, but that it was an opportunity to retire some of
the legacy force structure sooner, several years sooner than
they would otherwise have retired, take those resources, both
dollars and manpower, in order to address some of those needs
that we spoke to--invest in the remaining fourth-generation
fighter fleet, radars, infrared search-and-track capability and
so on, and then have the resources to leap to the high
production rates of F-35 that we know we have to have. It is a
difficult choice but one we think is needed, sir.

REASSIGNMENT OF MANPOWER POSITIONS

Mr. Boyd. Obviously this is a long thought-out process
action and one that, as you know, became public in the Tyndall
Air Force Base area and around the Air Force community much
before you--or weeks before you intended it to. But the May 9th
briefing was about 4 weeks ago. And to this point, there has
been no plan for reassigning personnel, there has been no plan
for the retirement, particular retirement dates of the
aircraft. We can't really seem to get any meat on the bones
here. And obviously from an operational standpoint and from a
parochial standpoint for the communities we represent, that is
a very--you know, that is a very serious subject.
So can you help me a little bit here about the reassignment
of 4,000 manpower positions, civilian and military, where will
they be reassigned, what about all your 2,500 Air National
Guard folks? You have got two schoolhouses for F-15s in the
country, I understand; you have got Klamath Falls and you got
Tyndall Air Force Base, and you are going to transfer all of
those to Klamath Falls under your plan.
Why would you do that? What about the military construction
requirements? I haven't been to Klamath Falls, but I have spent
a lot of time around Tyndall Air Force Base. You need to talk
to us a little bit about those things.
General Schwartz. Sir, this an example of thinning out the
fighter fleet. Whether we need to have two schoolhouses in
order to sustain the long-term F-15 population----
Mr. Boyd. Okay, granted you go to one schoolhouse.
General Schwartz. Right.
Mr. Boyd. Talk to me about the choice.
General Schwartz. This is a mission which is well-suited to
the Air National Guard, and one which has performed not just in
the F-15 community but the F-16 community in Tucson as well.
The bottom line is those remaining F-15 units will be
operational combat-coded kinds of units. And the training will
occur by our partners who are full-up round in the Air National
Guard, and have no reservations about that, sir, at all.
With regard to the reallocation of manpower, some of these
folks no doubt will be reassigned in their current disciplines.
Perhaps an F-15 crew chief from Tyndall Air Force Base might
become an F-16 crew chief at Hill Air Force Base. But
fundamentally folks will be reassigned, to a great degree, in
their current disciplines.
Some of these folks, however, will be retrained into these
growth areas, one of which the Secretary mentions, which is
unmanned aerial vehicles. We are putting roughly 4,000 spaces
overall--not just out of the combat air patrol (CAP)
adjustment, but also out of the growth of our head space--into
intelligence surveillance and reconnaissance. While we call
them unmanned vehicles, sir, they are hardly unmanned. The
truth is that there are a lot of folks that operate them and
also digest the data that comes from the platforms and turn it
into actionable intelligence.
Mr. Boyd. Mr. Chairman, I have got many other questions, so
I would like to go maybe to the second round and hold those
questions. But I would ask one final point, is that when can
you give us a timetable or a schedule for retirement of
particular aircraft and reassignment and when will we have a
little meat on the bones here with this?
General Schwartz. Sir, you will have insight into that
before the end of the month.
Mr. Boyd. Okay. And I would hold, Mr. Chairman, my other
questions to the second round.
Mr. Dicks. We appreciate your questions and we will have a
second round. Mr. Bishop.

PERSONNEL TEMPO

Mr. Bishop. Thank you very much. I would like to welcome
you gentlemen, but I want to focus on personnel tempo, if you
will. The increase in deployments over the past few years for
domestic disasters, contingency operations, military operations
other than war, has stressed military personnel and their
families.
What is the average time that airmen are away from home
doing your training exercises and deployments, other than Iraq
and Afghanistan? And Secretary Donley, would you talk to us
about how the Air Force manages the personnel tempo so that it
doesn't have an adverse impact on individual unit readiness and
training, and what systems you have in place to track that
personnel tempo information?
Mr. Donley. Sir, I can give you a partial answer and let
the Chief follow up a little bit. In the last year we have
begun to band our Air Expeditionary Forces (AEFs), our AEF
deployments, into various bands of activity. So personnel
assigned to various functions and jobs understand what kind of
a rotation they will be in, depending on which band they are
in.
The Air Force has a broad range of deployment lengths of
tours for its personnel, and this is a way in which we have
spread the load across our Air Force. So if you are--you can be
a medical professional in Yokota Air Base, Japan, and know that
you are going to deploy to Iraq or Afghanistan on sort of a
regular basis. But the medical community has its own--for
example, the medical community has its own deployment----
Mr. Bishop. Search and rescue, for example.
General Schwartz. Sir, just to give you broad numbers,
about half of our deployments are 179-day, 6-month tours. About
a third are less than that, up to 120 days. And maybe 10
percent or so are 1-year duration deployments. In the case of,
search and rescue, those are typically 120 to 179 days. A case
in point is we have 12 combat search-and-rescue helicopters
serving in Afghanistan now doing both the search-and-rescue
mission, combat search-and-rescue mission and the aeromedical
evacuation.
Mr. Bishop. Are there certain units or mission skills that
are being continually stressed with either the normal
deployments for training exercises or contingency operations;
and if so, which of those skill sets or units are being
stretched thin?
General Schwartz. Sir, there are several. Certainly the
intelligence field is stressed, the security forces career
field is stressed, contracting is another high-demand career
field. They are essentially on a 1-to-1 deployment to at-home
ratio.
Mr. Bishop. And these are Air Force contract----
General Schwartz. Air Force contracting personnel who are
supporting the joint fight, who are in joint assignments.
Mr. Bishop. Because I understand that you have reduced your
contracting significantly.
General Schwartz. That is another area, as the Secretary
mentioned, that we will robust over time. In addition, as you
are aware I am sure, we have also included incentives for these
personnel who are in high-demand career fields in order to help
compensate in some way for the demands on themselves and their
families.
Mr. Bishop. Has that been effective? How much of the budget
for 2010 is being allocated for the retention in these high-
stress skill sets, and has that been successful? Because I
think there are some areas where you have met your goals, but
other areas where you have not.
General Schwartz. Yes, sir. I am sure the Secretary will
want to lean into this. But, in short, I think the number
overall for incentives and bonuses and so on is in the
neighborhood of $700 million. It is substantial money, which is
largely targeted to the high-stress career fields. We have seen
adequate results.
We still--you know, we are on the bubble in a couple of the
career fields like contracting, for example. And another one
that is very interesting is the medical career field. We have
had some difficulty in meeting our goals both on recruiting and
retention in the medical disciplines. But interestingly, this
is not just an issue for the Air Force; it is an issue for the
other Services and in the civilian posture as well.

RESERVE COMPONENT PERSONNEL ON ACTIVE DUTY

Mr. Bishop. One final question Secretary Donley. According
to the Office of Assistant Secretary of Defense for Reserve
Affairs, reservists contributed about a million man days per
year to their respective services between fiscal years 1986 and
1989. In fiscal year 2007, reservists contributed 45.8 million
days.
What is the number of Air National Guard and Air Force
Reserve personnel that are currently on active duty in support
of ongoing operations, and what is the Air Force's current
mobilization cap?
Mr. Donley. Sir, I will have to get back to you on the
record for that to get those numbers.
Mr. Bishop. Okay.
Mr. Dicks. General, do you have any idea?
General Schwartz. Sir, we have roughly 38,000 people
deployed, about 8,000 of which, if I recall correctly, are
Guard and Reserve.
[The information follows:]

The Air National Guard and the Air Force Reserve have 6,745 and
2,141 personnel, respectively, currently on active duty supporting
ongoing contingency operations. The Air Force's current mobilization
cap is 72,607.

Mr. Dicks. Ms. Kilpatrick.

EDUCATION PROGRAMS

Ms. Kilpatrick. Thank you, Mr. Chairman, General,
Secretary--I should say it the other way around. Secretary and
General, thank you for your service. Along that same lines kind
of--first of all, congratulations on a successful graduation
from the Academy. I understand the numbers--was it the highest
ever, and what was that number?
General Schwartz. It was 1,046, ma'am. It was a very large
class, and we shook quite a number of hands that day.
Ms. Kilpatrick. Okay. Thank you very much for that, and for
the young men and women who serve in the Air Force and the
service, who are children who commit their lives. I believe
that we in this committee, and certainly our Chairman, is
totally committed to the force and people who serve.
Along that same line, education is where I want to go. I
know that your Air Reserves, as well as your Active Duty Air
Guard numbers are up. And in the retention of the Air Force,
the numbers are down just a bit. I read somewhere you expect
with the economy that those may increase as well.
What kind of programs do you have, in K-12 particularly and
others, that would help increase those numbers and lead people,
young people, into the fields of military? Are there currently
those education programs; do you partner with anyone; are we
looking for certain types of students? I know you have
recruiters all over the country. Can you talk a little bit
about it?
General Schwartz. There are a number of programs that help,
I think, to grow good citizens. I think that is fundamentally
what they are about. And they have the side benefit of perhaps
increasing the propensity of the young to serve in the Armed
Forces or elsewhere in public service.
Civil Air Patrol is one, junior ROTC at the high schools is
another, both of which are excellent programs, I think, that
focus on citizenship but increase the propensity to serve.
Naturally, it is a competitive arena out there. And while the
economy is suffering, and that has improved our recruiting
performance of late, we know that we have to keep at it. This
is a constant effort. And one thing I would just say, ma'am, is
that it is very important that the influencers, like you, like
the other members of this committee, certainly parents and
other influential folks, remind our youth that public service
is a worthy undertaking. And that would certainly be helpful.
Ms. Kilpatrick. I do participate in our own Civil Air
Patrol, as well as ROTC. I think those are good feeders as we
move to the military. It is important to me that young people
have that kind of discipline and responsibility even as they
move forward, whatever career that they choose.
Mr. Donley. Can I just add one other aspect that is
important to our Air Force? And that is continuing to encourage
our partnerships with academia and various schools and
organizations on science, technology, engineering and math,
what we call STEM education. Very important to the future of
our Nation, regardless of whether young people come into the
United States Air Force. And we have partnered--I just
partnered with the Aerospace Industries Association a few weeks
ago, and the American Rocketry Club, which sponsors events for
young people around the country to get them interested in this
important work.
Ms. Kilpatrick. Funny you should mention that. Former
Congressman Lou Stokes brought together a program partnering
with NASA, STEM-related, and we put together one at Wayne State
University and they are phenomenal. Our team, and it is called
SEMAA--Science, Engineering, Mathematics Aerospace Academy. Our
team from Michigan competed around the world--excuse me, around
the country--in rocketry and came here to D.C. to compete and
placed kind of high. So we know that STEM is the future. I
would like to work with you on that because that is very
important.

SHIFT OF EMPHASIS FROM IRAQ TO AFGHANISTAN

And finally I will wait for the second round. Afghanistan,
Iraq moving, I guess shifting up in the other. What are some of
your concerns and are you ready for that challenge?
Mr. Donley. Well, the Air Force has been working with the
joint community for many months on the shift of emphasis from
Iraq to Afghanistan. I will let the Chief go into some of the
operational details, but I will just mention a couple.
One is that certainly our mobility community, led by the
United States Transportation Command and the Air Mobility
Command, have been working very hard on logistical support to
Afghanistan, developing alternative routes for supplies and
transportation to support this shift and to support a higher
tempo of operations in that part of the world. That has been a
great focus. And also our construction and engineering units
and organizations have been deeply involved.
Congress has been very supportive in supporting our
military construction (MILCON) requirements down range. As you
appreciate, Afghanistan has much less infrastructure in that
country and needs much more development of air bases and other
infrastructure as we build up our capability, so we have been
working very hard on that for many months.
Ms. Kilpatrick. Thank you, Secretary.
General Schwartz. I would only amplify by saying that we
currently have 5,000 Air Force personnel in Afghanistan
supporting the joint team, part of the joint team. It will
increase, probably, to in the neighborhood of 6,500 or so by
the time all the additional troops have been authorized by the
President or arrive there to assume their new missions.
Ms. Kilpatrick. Thank you, General. Thank you, Mr.
Chairman.

NEXT GENERATION BOMBER

Mr. Dicks. Mr. Secretary, General Schwartz, over the last
couple of years many of us have been briefed on the Next
Generation Bomber. And one of Mr. Secretary Gates' decisions
was to terminate this program. You know, at some point we only
have 20 stealthy B-2 bombers. And that is 1980s, 1970s,
actually, technology--1970s and 1980s technology, which we have
modernized.
Can you give us kind of the status where we are on the Next
Generation Bomber? And I understand that there in your unfunded
list, there is a request for $140 million to keep some level of
effort going, which I personally would support. But can you
fill us in on this?
Mr. Donley. Well, sir, I think the short story on Next
Generation Bomber is that our plans in that area were probably
running out ahead of the political consensus inside the
Department of Defense on what was needed for that capability
going forward. Well, we had significant resources put against
this. We had not yet worked through the basic parameters of the
program. I will let the Chief address those in a moment. But in
addition to the programmatic detail, I take your point that we
do need to be attentive to the kinds of technology integration
support in this very sensitive area where we are combining many
different technologies. And we do think it is important as we
go forward to look at this more closely in the QDR and develop
a new way ahead, that we do bridge this period of time where we
do not have the Next Generation Bomber (NGB). That program is
being canceled.
Mr. Dicks. General, before you start, I want to read to you
a statement that was made before a committee in the other body.
Barry Watts of the Center for Strategic and Budgetary
Assessment replied to a question on Next Generation Bomber
requirements. We have studied the NGB issue to death. The need,
the requirement and the technology are in hand and reasonably
well understood. Would you address that as you address your
answer?
General Schwartz. Yes, sir. The bottom line was that I
don't think that our Secretary of Defense was comfortable with
how the Air Force had defined the parameters of this platform.
I do not believe that he has misgivings about the fundamental
mission of long-range strike. This was a question about whether
we had this thing right. Did we have the right range, did we
have the right payload, did we know whether this should be
supersonic or subsonic, should it be low observable or very low
observable, should it be nuclear or nonnuclear capable, should
it be manned or unmanned?
These were questions that we did not have the Secretary of
Defense in his comfort zone. And this is what we will do over
the next cycle, is to make sure that he in fact is comfortable.
Mr. Dicks. Wasn't that exactly what the Next Generation
Bomber program was doing, was analyzing all of those issues so
that the decision--it sounds to me we know what the options
are. It is just a failure of decision-making here. We couldn't
make a decision, we couldn't decide let's go do it, and we are
going to go one way or the other.
General Schwartz. Mr. Chairman, I think the bottom line was
that what he wanted to make sure was that he did not get son-
of-NGB as the answer to this near-term process that we have
underway. He wanted this to be a thorough, no holds barred
review of parameters and that he would get a truly fresh look.
That is what I believe was behind the programmatics which came
out that we have discussed.
The key thing about this is that, in my view, Barry Watts
certainly respects him, numerous studies have been done, but
you have to get the decision-maker comfortable with your
proposal and your program. That is something we have not done
effectively, but we will do that.
Mr. Donley. If I could add one more item to that, Mr.
Chairman. This is a very significant program for the Air Force
and potentially a very large and highly complex program. We
need to make sure that as we go forward we can make this a
successful acquisition program for the Air Force.
And I will tell you that I am concerned about how we do
that. We do not have a good track record in our last two
bombers in terms of developing a program, a program of record,
which we are able to sustain financially over time to get done
what we say initially we think needs to be done. We planned on
buying a few hundred B-1 bombers. We ended up with----
Mr. Dicks. You mean B-2s.
Mr. Donley. B-1s, a few hundred.
Mr. Dicks. We got 100.
Mr. Donley. And we got 100.
Mr. Dicks. And B-2s were way up there, too.
Mr. Donley. It is 175, I think.
Mr. Dicks. And we got 20.
Mr. Donley. We got 20. That makes those airplanes very
expensive. And I do not want to repeat that process going
forward.

C-5A RETIREMENTS

Mr. Dicks. I understand that. I can understand the
budgetary implication. But I still think--and I am glad to see
you got some money in the unfunded--that we have got to have an
office and keep this thing going. The Secretary isn't going to
learn anything if we don't have any work being done on this
issue anywhere in the government. So it seems to me that we
have to correct this flaw.
Now, the other thing, quickly. On the C-5A retirements,
where do we stand on this? As far as I am concerned, I have
supported you every step of the way. I think we are trying to
do something in the supplemental, I am told, on this issue. I
mean, can't we save a lot of money by retiring these older
airplanes; and when we are so stressed, you know, so short of
money to do all these important things, isn't it imperative
that we deal with this issue?
General Schwartz. Sir, here is the bottom line. Sometimes
too much aluminum is as bad as not enough. And too many
airplanes, excess capacity, if you will, as you suggest,
competes with other needs. And our view is if it is the
Congress' determination to continue to acquire C-17 platforms
beyond the 205 that we have indicated we think is the proper
force size, then we need to make adjustments elsewhere in the
fleet mix, and that means C-5A retirements.
Now, there is a debate about what the floor should be on
that. And from a former mobility capability study, circa 2005,
that floor was at 292. There has been more recent legislation
over the years that established the floor at 299. We currently
are at 316. That is slightly above what we believe is the
minimum requirement that was certified during the Nunn-McCurdy
action related to the C-5 re-engining. That was 33.95 million
ton miles per day. So there is some space to reduce.
And my recommendation, my best military advice to the
Secretary, is if there are X number of C-17s either in the
supplemental or the authorization going forward, that we should
retire C-5As in like number on a one-for-one basis. That would
be my best military advice.

NEW MILITARY MOBILITY REQUIREMENT STUDY

Mr. Dicks. Mr. Secretary, do you have anything to add on
that, or do you just want to stand with that?
Mr. Donley. Well, I do think, as you know, Mr. Chairman, we
do have a new military mobility requirement study going on now
that delivers toward the end of this year. My hope is that we
will get that in sync with the QDR conclusion so that we can
provide the Congress, again, sort of the next best, the best
benchmark for what the strategic airlift requirements are.
Mr. Dicks. And I am with you on that. It also says to me,
do we really want to shut down the C-17 line until we get the
study? I mean, wouldn't it be a good idea to get the study in
to see if in fact the assumptions we are making now are
validated by the study?
Mr. Donley. We understand that perspective, but we think
there is enough flex in the 316 that the General referred to,
to add some marginal capability within the existing fleet by
making other changes. We still have opportunities to do more
re-engining and modernization of the C-5Bs. That program had
been truncated during the Nunn-McCurdy decisions, but we can do
that.

CIVIL RESERVE AIRLIFT FLEET

We have other options that have not been pursued. We have
two or three things we can do that are cheaper than buying new
C-17s, as good an airplane as that is.
Mr. Dicks. Ms. Granger.

UNMANNED AERIAL SYSTEMS

Ms. Granger. I want to turn briefly to the unmanned aerial
systems. Give us a little more detail about your vision for the
future in unmanned aerial systems in counterinsurgency; and in
particular, are we short of those in places like Iraq,
Afghanistan, Korea, our hot spots?
General Schwartz. Ma'am, the way--we will grow to 50 orbits
of unmanned systems by 2011. We are currently at 34, 31 of
which are the smaller Predator, three of which are the larger
Reaper, and then the yet larger, more strategic platform of
Global Hawk more in orbit. We have approximately 120 Predators
in the inventory, about 30 Reapers and about 15 of the Global
Hawks. This is a trend which will continue, ma'am.
It is clear that we will become over time a more unmanned
force. These are very useful assets, particularly in those
cases where you need persistence, where 24/7 coverage is what
is required to get the mission done. And there are very
efficient ways to perform that kind of mission: particularly
intelligence, surveillance and reconnaissance, some quick
reaction strike and so on. This will be a significant portion
of our portfolio going forward.
And the 24 Reapers that are in this fiscal year's budget
request are a manifestation of that. I don't think that we will
ever end up being a completely unmanned force. There are some
missions in my view that require a man in the cockpit, or a
woman in the cockpit.
For example, a nuclear bomber like the B-2. I am not sure
that I would be comfortable making that an unmanned platform.
Nonetheless, the plan will be to expand the population of
unmanned vehicles certainly to the 50-orbit level. That is our
current target. And we will see what the demand signal looks
like out of QDR and so on.
The last thing I would like to mention to you, ma'am, is
that it is important to recognize that UASs are not any time/
any place machines. They have a wonderful application but they
need to be utilized largely in benign airspace. In other words,
if it is denied airspace, they cannot protect themselves, they
do not have the natural capacities to avoid attack. And they
are vulnerable.
In fact, as you may recall in the news, we shot down an
Iranian UAV in Iraq some months back. So we need, again, to
think about this in terms of the whole concept of operations,
where do they apply, where are they less applicable. Maybe they
don't go in right away, but they follow the F-35s and the F-
22s, that sort of thing. This is a package, and that is really
the genius of this, being able to package this in a good way.
Mr. Dicks. What about the Special Forces? Are you talking
about--when you talk about these various orbits and how many of
these you have, are you also including the fact that you are
doing this for SOCOM as well?
General Schwartz. Mr. Chairman, yes, indeed. Of those 34
orbits that are currently performing, I would say probably half
of those are dedicated to Special Operations teams on the
ground and half to more conventional forces.
Mr. Dicks. All right. Do you have a third question?
Ms. Granger. No, I don't. Thank you.
Mr. Dicks. Mr. Boyd.
Mr. Boyd. Thank you, Mr. Chairman.

PROPOSED PLAN FOR AIRCRAFT RETIREMENTS

Secretary Donley, I want to go back to the proposed plan of
the retirement of the 15s, 16s and A-10s.
As you know, Mr. Secretary, the Air Force does not have a
particularly good track record when it comes to proposed cost
savings versus actual cost savings, and I think many of us on
this committee would be somewhat suspicious of proposed cost
savings until we saw some thorough analysis of what those would
be and how you would achieve that $3.5 billion over the next 5
years.
Can you speak to that and when we might see that analysis
and in what detail.
Mr. Donley. I am open to briefing that to the Committee.
There are some sensitivities with it with respect to outyear
funding. We have not yet--the Department has not yet provided a
5-year plan of detail to the Congress as is normally the case
by this time of year because the outyear work just hasn't been
done. But I think the main message, sir, is the one that the
Chief indicated earlier.
This was not just a budgetary and a savings drill. We
reinvested the resources elsewhere in the Air Force program,
and we have a good briefing and a good track record of where we
put the money. Back in 4th Generation modifications we put it
in air-to-ground munitions, air-to-air munitions and very
specific movements of dollars from one account to another; and
we have a very specific track on what we did with the people
which, as the Secretary mentioned, is just as important.
We needed additional personnel to be reinvested in higher
priority mission areas and to get that done as soon as
possible. So these were the factors behind the decision. I
think we have a good trail on the dollars and the people.
Mr. Boyd. I think we understand the intent, of course, to
reduce cost in one account and transfer it to another account.
But before you can transfer it, you have to reduce it in one
account, and I think that is where the track record hasn't been
very good. So we look forward to getting those briefings and
seeing that detailed analysis.
What would be the MILCON requirements for Klamath Falls in
this particular scenario?
General Schwartz. Sir, I don't know the answer to that. I
would like to take that for the record and get back to you.
Mr. Boyd. I assume there would be some.
General Schwartz. I am not certain that is the case. They
currently have a schoolhouse operation, and the resized force,
that may not be true, but I need to confirm that for you.
[The information follows:]

The Air Force has no military construction requirements at Klamath
Falls, Oregon through fiscal year 2013.

[GRAPHIC] [TIFF OMITTED] T6286A.110

Mr. Boyd. Okay. Thank you.

PERSONNEL AND FUNDING IMPACT TO TYNDALL A.F.B.

Can you speak to the specific personnel and funding impact
to Tyndall Air Force Base, General.
General Schwartz. Sir, as you are aware, the intent is to
draw down to an F-22-only--at the moment, F-22-only scenario.
So you will end up losing the F-15s that are currently there
and the folks that are associated with that mission; and again,
I will be happy to give you the precise numbers, and we will
certainly have that for you on the 22nd.
Mr. Boyd. Thank you, sir.
Now, in your report or when you briefed the committee
earlier, you said that this plan would free up nationwide some
266 full-time and 2,426 part-time Air National Guard personnel.
Can you talk to us about where those personnel will be? Will
they be reassigned?
General Schwartz. This is really an issue for the Air
National Guard and National Guard Bureau, and we will certainly
get that information to you as well. As you know, active duty
we can reassign to other missions in other locations. This is
not as easy to do with regard to the National Guard and we are
working those adjustments with the Air National Guard and
General McKinley at the National Guard Bureau.
Mr. Boyd. I think that was the point, and what I wanted to
hear you say is, you have got 2,700 Air National Guard, many of
them part-time.
It seems to me that--how do you reassign a part-time Air
National Guardsman from one community to another across the
Nation? I think that is a very difficult--you probably can't do
it. So all of these questions that we have talked about in the
two rounds that I have had, I know you have told me a lot, that
you will give us the reports, give us the briefings, and we
will have that before the end of the month.
General Schwartz. You bet.
Mr. Boyd. Okay.
Mr. Chairman.
Mr. Dicks. Good questions.
Mr. Boyd. Thank you.
Mr. Dicks. Mr. Tiahrt.

TANKER REPLACEMENT

Mr. Tiahrt. Thank you, Mr. Chairman.
Mr. Donley and General Schwartz, thanks for your service to
the country, and I appreciate your time here.
I just want to briefly go over the tanker replacement. We
have an RFP that was clearly to replace a medium-sized tanker
with a single platform; and there is no plan to change that
concept of a single platform in the Air Force's revision of the
RFP, is there?
Mr. Donley. Sir, our view is, we ought to go ahead with a
source selection for a single airplane.
Mr. Tiahrt. I thought the RFP was very clear last time
about that, but we had some significant political influence
where the RFP became modified so much that it resulted in a GAO
study. It seemed like the Joint Strike Fighter had Euro
participation so we tried to reciprocate by modifying the RFP
to accommodate a mega medium-sized tanker, and I hope that
doesn't occur this time, that the political influence is
excluded from the RFP.
As you know, the results of the GAO study brought to light
that some of these changes were just way beyond the pale, and
it resulted in a cancellation of the decision. So as we move
forward, I am hoping that we can keep the political influence
out of it, that we look at the actual cost, the long-term cost,
as well as the other significant requirements and come up with
a good decision this time that is not influenced by politics.

PROJECT LIBERTY (MC-12 PROGRAM)

There is another program called Project Liberty. It is an
ISR platform and it seems to be held up right now. Can you tell
me right now the status of the MC-12 program, Project Liberty?
General Schwartz. Sir, the first aircraft deployed for Iraq
on the 1st, and it will arrive Friday. So you know that we have
had training operation going on in Mississippi, the temporary
location, so that we can train the crews and man these, that we
are going to push the aircraft forward. There will only be
several training birds left in the States. Everything else will
go forward.
And this in a way also addresses Congresswoman Granger's
earlier question about ISR capacity, that the MC-12s are an
important part of that. They have much the same kind of
capability, at least in the video area, that the Predators and
the Reapers do, and they will provide support to the ground
forces that are required both in Iraq and ultimately in
Afghanistan.
So the program is slightly behind schedule based on efforts
by the prime contractor, L-3. We originally anticipated
deployments in April. We just got deployments this week, and we
will continue to press on that.
Mr. Tiahrt. Is it an integration problem or a hardware
problem-software problem?
Mr. Donley. Sir, I think this is just sort of
underestimating some of the engineering demands that have been
placed on this program. It was a very aggressive schedule to
begin with. As you may recall, the first--the plan was to buy
the first eight aircraft from commercial sales and the used
aircraft market. As we bought those airplanes, we ended up with
seven or eight different configured airplanes. So the
engineering integration had to be done differently seven times
for those initial airplanes. For the Block 2 aircraft, we have,
working with the Office of the Secretary of Defense, with
USCENTCOM and others, have been adding capabilities to these
aircraft to ensure that they have the ISR capabilities that the
combatant commander wants and needs in the theater. And as we
have done that, we have added engineering time again into that
process. So those I think are the reasons really for the delay.
The contractor is on it and they are working 24/7 to meet the
contract schedule.
General Schwartz. Congressman, I will only add that the
first delivery was seven months after contract award. So this
was not sort of business as usual on anybody's part.
Mr. Tiahrt. That is a pretty short stroke. When we spoke
last time, there was a problem with the AT-6C program and it
was an engine problem with the prop sleeve, and I think that
has been resolved.
But how are we doing to ensure that the Iraqis are fielding
them properly and are working them, as well as the trainers,
the trainer version of it.
General Schwartz. Sir, the trainers have not been delivered
to the Iraqi forces yet. That is still ahead of us. The prop
sleeve touchdown problem with the engine, we still have 64
airplanes that are grounded pending certification of the fix.
Certainly Pratt & Whitney believes they have the fix, and we
are in the midst of phase one test to confirm that before we
take the machines back airborne. Assuming that comes through as
advertised, we will be okay with regard to the schedule for
delivery to the Iraqi air force of the trainers.

IRAQI BUDGET

Mr. Tiahrt. Are you aware of the state of the Iraqi budget
as far as the funding? Are they in good shape?
Mr. Donley. The Iraqis have had a couple of ups and downs
in their budget planning, including national defense for them,
based on the price of oil. So their budgeting process is very
dependent on the price of oil. We understand the Minister of
Defense is being briefed this week by their Air Chief and they
are working through the various programs and priorities that
they have set for the new Iraqi air force and we have advisors
as part of that process continue to be directly involved with
their leadership in watching the schedules and the performance
of the programs that have been set in place to support the
buildup of that, but they are definitely under resource
constraints and remain heavily dependent on U.S. support.

B-52'S RE-ENGINING

Mr. Tiahrt. Mr. Dicks was talking about the next generation
bomber, which seems like it is some ways downstream and we have
a limited inventory of other bombers available today.
Is there a program office for re-engining the B-52s in
existence today and would you consider that?
General Schwartz. Congressman, we have looked at that a
number of times over the years. The TF-33 engine is sustainable
through the airframe life of the platform, so at the moment
there is no consideration of re-engining the B-52, sir.
Mr. Tiahrt. The current fuel costs, it always varies, but
it looks like it is going no place but up. Have you
recalculated based on current fuel costs and how they are
projected in the future? Because it seems like there is a
significant fuel savings with the re-engining program.
General Schwartz. We have looked at the business case, and
it has not risen to a level of priority which would suggest
that we would preempt something else in order to re-engine the
B-52.
For example, candidly we wouldn't interfere with F-35 or
KC-X procurement to re-engine the B-52. We think those two
other items and others are a higher priority.
Mr. Tiahrt. Thank you, Mr. Chairman.
Mr. Dicks. Mr. Bishop.

AIR FORCE MISSIONS AND REQUIREMENTS

Mr. Bishop. Thank you very much. I would like to turn my
attention to general Air Force missions and requirements.
Now the Air Force is really embracing a collaborative and
supportive role in the types of operations that have been
conducted in Iraq and Afghanistan and, in general, attempting
to change the service's culture to meet these new challenges.
Of course, the Air Force has always provided mission support in
the struggle against extremism, which you designated as in lieu
of, and now ``in lieu of'' has been defined as a standard force
and equipment that is supplied to execute missions and tasks
outside of your core competencies of core responsibilities.
Now, the Air Force views these responsibilities and refers
to them as Joint Expeditionary Tasking, JETs, but to support
that there are some realities that you have got to deal with--
increased deployment tempo and requirements--and they are done
at the expense of your traditional missions.
General Schwartz, I think you stated you want to change the
Air Force's culture. What types of changes can we expect to see
in the Air Force?
And Secretary Donley, will there be any overall policy
changes to reflect such a shift in the fiscal year 2010?
General Schwartz. Congressman, I think the way to start
this--and I know the Secretary will wrap--the Nation is at war,
and there are demands on the joint team, writ large, to be
successful in Iraq and Afghanistan. And if there is a need and
if the Air Force can fill a need, it was our view, the
leadership's view, that in a time of war we will do whatever is
necessary wherever it is needed for however long it is needed.
Now, our commitment to our youngsters is that they will be
trained to do what we ask them to do, and I think we have been
very rigorous in that regard. But, yes, we have some people who
are doing nontraditional things, but I think we should
celebrate that. It doesn't diminish us at all.
The truth is that--and I just met with 60 folks or so that
are doing convoy work at Camp Arifjan in Kuwait and sustaining
our forces in Iraq, including Air Force youngsters, and these
Airmen will be better Chief Master Sergeants when they grow up
as a result of this experience.
So, in short, sir, I do not apologize for our folks filling
legitimate combat requirements for the joint team. We just
simply need to recognize their contribution, honor their
contribution, make sure that they are properly trained and that
they are rewarded for their work.
Mr. Bishop. Is that going to result in a shortfall of the
traditional missions for training as well as execution if you
do that? And how many of those functions were performed by the
Army and Marine Corps?
General Schwartz. Sir, it means that the folks that remain
in those disciplines where we drew folks for nontraditional
tasks will work harder. It means the entire team works harder.
That is the reality.
But, again, I would put this in context. This is not
peacetime, and people are dying, and so we are not going to
stand by and argue about it is not our job. That is not what we
are about.
Mr. Donley. I would echo exactly what the Chief has said,
that we are all in. Whatever we are asked to do, we will do.
I think another aspect of our joint work together over the
last year has been to broaden the appreciation with both
outside and inside communities in our Air Force of the extent
to which we are all participating in this fight whether we are
deployed downrange or not. We have logisticians; we have
mobility forces that are back and forth from the theater on a
regular basis that are not necessarily deployed there; we have
all the UAS support work, the intelligence work that backs up
all that data collection that is done in other parts of the
world, not just in CONUS.
Some of it is done in Europe; some of it is done elsewhere.
Our Air Force is committed to these fights from--geographically
from, basically from all around the world and in all of our
different functions.
Mr. Bishop. How many of them in the Central Command area of
responsibility?
Mr. Donley. About 26,000 at any given time of our 37,000
deployed abroad are in the USCENTCOM AOR.
Mr. Bishop. Are you experiencing any difficulty filling
those deployment missions?
General Schwartz. It is interesting, sir. We--and I will
give you an example.
We just lost two people on a provincial reconstruction team
mission in Afghanistan last week, one officer and one young
Airman, both of whom were volunteers. And this is the reality.
The people understand the value of the work and they have
volunteered. Thus far, we are fulfilling the requirements that
have been levied on us.
Mr. Bishop. As I understand it, the Air Force is currently
playing a critical role in the mission that is expected to
continue expanding to match 50 unmanned combat air patrols.
Will this expanded role affect ISR manning requirements, and if
so, how does the 2010 budget request address those needs?
Mr. Donley. Sir, we have been very attentive to making sure
that as we add ISR collection assets, as the unmanned aerial
systems and other ISR assets increase, that we also back it up
with the necessary intelligence personnel to do that, sir. We
have done that in the 2010 budget.
We can get you more detail as you would like.

NUCLEAR MANNING REQUIREMENTS

Mr. Bishop. Finally, what are the nuclear manning
requirements and how does your 2010 budget address those needs?
And are you able to source all your requirements in the nuclear
field, and if not, what shortfalls do you have and how can we
help in that regard?
General Schwartz. We are on a glide path, Congressman, with
regard to reinvigorating the nuclear discipline in our Air
Force, so in some areas we don't have the numbers or the depth
of expertise we would like. That is part of our plan for
recapturing excellence in this area.
We are putting, for example, about 1,000 spaces back into
the nuclear enterprise in order to serve that mission well.
Some of that is in the new headquarters, the Global Strike
Command. Some of that is in the 4th B-52 Squadron that will be
moving to Minot Air Force Base in North Dakota, and it is in
the 2010 program.
Mr. Bishop. It is in the 2010 program.
Thank you, Mr. Chairman.
Mr. Dicks. Mr. Rogers.

NUCLEAR OVERSIGHT BOARD

Mr. Rogers. Thank you, Mr. Chairman.
Good morning, gentlemen. Thanks for your service to our
country to all of you in the room.
Let me quickly ask about the two high-profile nuclear
security incidents in the past few years, Minot and Taiwan. You
have taken severe--I guess is the word--steps to try to correct
those problems.
Are you satisfied, both of you, with what you have done,
that our nuclear capability is kept secure at all times?
General Schwartz. I can speak from the operational side.
I think we took the necessary actions, some of which
included disciplining officers and NCOs, some of which entailed
reorganizing the way we had responsibilities distributed around
the Air Force in a number of commands and concentrating that
operationally in one command and on a sustainment side in one
command, one accountable officer.
We likewise have given focus to the policy side of this,
which is not trivial, as well, and that activity, of course,
works for the Secretary.
My view is, we are on exactly the right path, the needed
path. In fact, this Saturday we will have what we call the
Nuclear Oversight Board. We meet periodically to address
progress along with our nuclear road map, those remedies that
we have put in place, and I am persuaded that we are on the
right path, sir.
Mr. Donley. Likewise, I think we have put together a strong
road map to get back the level of expertise and discipline that
we need in this very important area.
But I would tell you, this is a work in progress, that it
will not come back quickly and it needs continued attention in
the next several years as we build back the necessary
expertise.
We have had since October, I believe about 19 inspections
across our nuclear enterprise of which 17 resulted in
satisfactory or excellent ratings. Two were unsatisfactory and
had to be retested at a later date, which they passed. But this
continues to be a work in progress.
The Chief mentioned the Nuclear Oversight Board that we
have established. This will be our third meeting at the end of
this week.
Just this last weekend, we were back at Ogden Air Logistics
Center reviewing the progress made there over the past year in
the handling of nuclear-related materials. They have made
progress there, but there is more to do. We do not have in
place all the automated systems and such that we should have
that would help us with end-to-end accountability and get us
out of the paper environment. So we have a lot of work to do to
build back, but we have a good program and we are putting the
resources in place to do it.
So I am very pleased with the progress we have made over
the last year.
Mr. Rogers. Well, I need not remind us all it just takes
one simple mistake to do a lot of damage.
Well, on February 4, the Washington Times and other
agencies reported that Air Force nuclear units have failed two
surety inspections in the past 3 months. Are those the ones
that you mentioned a moment ago?
Mr. Donley. I believe they are, sir.
Mr. Rogers. Well, again, are you positive that we have
solved the problem, given those lapses that we have just
mentioned?
General Schwartz. Sir, in the end, you know, this is
discipline, it is compliance with procedures, and there will be
some human error; so that is why we do two-man or two-woman
kinds of processes to assure that we mitigate that risk.
But with respect to the inspections, I don't think that 100
percent pass on inspections is necessarily the thing we want to
see. We consciously turn the dial up on the inspection process
to make sure that it was rigorous, to make sure that it was
more invasive, to make sure that it actually told commanders
where they had problems.
And that was one of the dilemmas we had. Frankly, I think
the inspection process became too easy and so that has been
part of the corrective action. And if we see failures, I think
that is a reflection of rigor and not necessarily a situation
over which we should be alarmed, too alarmed in any event.
Mr. Rogers. All right. Thank you.
Mr. Dicks. Ms. Kilpatrick.

NUCLEAR REQUIREMENTS

Ms. Kilpatrick. Thank you, Mr. Chairman. Those were exactly
where I was going with regard to the nuclear.
But one thing as it relates to the 2010 budget--and I thank
you for all you said, and Senator Gates coming in and changing
the command, and the two of you assuming new positions and
carrying out what we just discussed in the last questioning.
Does the 2010 budget fully source all your requirements for the
field? Do you have what you need? And I think I asked you that
before. Are there any shortfalls we should look at at this
time?
General Schwartz. Trust me, ma'am. We made sure that all
the nuclear requirements were addressed at 100 percent.
Ms. Kilpatrick. So as this committee goes through its due
diligence after you have gone back to the base and all that,
you want to leave us with that point?
General Schwartz. Yes, ma'am. The key thing is, you won't
see any nuclear items on the unfunded list.

HEALTH CARE

Ms. Kilpatrick. Thank you very much.
Let's go to health care. We didn't talk about that very
much this morning.
General, you did mention that is one of your short staffing
falls. I don't know if you have the people that would require--
the needs that we have as we go forth to Afghanistan and really
the domestic and around the world needs. What kind of
assistance do you need? I am talking more positions and
dollars, enlisted or not.
I just left a hearing where Congresswoman Nita Lowey was
introducing a bill that the medical profession's nurses who
performed in World War II are not--they don't get pensions. Her
bill was trying to get them pensions and make them a part of
the military, which I strongly support, and those who now
commit their lives and follow the troops around and care for
them and keep them safe and healthy.
Talk a little bit about health care as it relates to the
mission in theater and the overall Air Force.
General Schwartz. Clearly, one of the great successes of
this period of conflict that we have been in is how the medical
community has performed. When I first came into the Armed
Forces, we were in the midst of the Vietnam conflict, and I
remember vividly how it took weeks to get wounded back from
Vietnam to hospitals in the States, maybe longer. Now it takes
hours, literally.
And as you are aware, ma'am, the survival rate of our
troops, our Airmen, Marines, Sailors, who are wounded on the
battlefield is well in excess of 95 percent, higher than it has
ever been because of the casualty evacuation capability, of the
field medical capability, and the strategic efforts that we
have to move folks from one theater to the next back to the
U.S. for definitive care. I think it is a wonderful example of
how the Armed Forces take care of their own.
This is not to say that there are not difficulties with
respect to certain specialties in the medical area. One of
the--the truth is, though, that we have had greater success in
recruiting surgeons of late than perhaps we did before. We
typically were a very healthy force in peacetime, so you only
did geriatric surgery, if you will. But this is the real deal
now, and certainly trauma surgeons know that the Armed Forces
are a place where their skills can be put to very good use.
So the bottom line is, we compete in the civil market for
talent. We need to have incentives that allow people to have a
fair standard of living along with the rewards that come with
military service.
Ms. Kilpatrick. When you talked about the shortage in
health care, were you talking about the surgeons specifically,
or the other professionals in that field?
General Schwartz. An area where we have had difficulty
because they are in short supply is mental health. And we
have--for example, we have hired 100 mental health
professionals in the Air Force, and this is a relatively small
number compared with what the Army has done; but there is keen
competition for mental health professionals.
Ms. Kilpatrick. In the domestic world----
General Schwartz. Exactly. And that is my point.
So this is a difficult area, and it is one where, after
folks return home, there are still mental health needs, and
that is an area where incentives and so on are certainly
required.
Mr. Donley. As the Chief mentioned earlier, we have put
about $645 million against incentives and bonuses for
recruiting and retention generally. Of that amount, about 88
million or so is targeted at health care professionals. So I
think we have--as the Chief suggested, I think we have
addressed the requirements issues and we have established where
we need additional personnel positions. I mean, we have done
that internally. The shortage is in the bodies and getting them
in and retaining them; that is a common problem across the
Armed Forces right now.
Ms. Kilpatrick. Finally, along that same line, the wounded
warriors who come home and their families, adequate health care
resources?
General Schwartz. For the Air Force, we do. We have had far
fewer numbers of casualties than have the other services. But
we have been focused on this and we are okay with regard to
assuring that our commitments to our wounded warriors are
fulfilled.
Ms. Kilpatrick. And their families?
General Schwartz. Certainly, and their families. Yes,
ma'am, forgive me for----
Ms. Kilpatrick. Thank you.
Mr. Dicks. Let me ask you, on the ILOs, are they all
volunteers?
General Schwartz. Probably not all, but a large proportion
certainly are, and we prefer it that way. For example, in the
contracting area where we have a lot of our folks involved,
they are on a one-to-one ratio as I indicated, somewhat like
the security forces or the engineers. And we have had to direct
people to serve and, of course, that is what we sign up to do
in the Air Force or in any of the Armed Forces. But we seek
volunteers first and then deal with the remainder as we need
to.

JOINT CARGO AIRCRAFT

Mr. Dicks. On the joint cargo aircraft, can you explain
what is going to happen here? First, this was an Army program,
then it was a joint program, and now we understand it is an Air
Force program. That is rather magical.
Recently the Secretary of Defense has stated that the C-130
aircraft could and should be used to carry out the mission. So
tell us where we are on this.
And the Army has got eight of those planes, as I understand
it. How are you going to get those back? What is the story
here? And we hope this is the final chapter.
General Schwartz. Sir, nothing happens instantaneously in
this, and it would be foolish to do so.
The Army program office will remain in the lead until well
into 2010. They will have--they currently have Air Force people
in the office, but there will be more folks assigned and
attached now that the transfer has been directed and that we
will migrate the program from Army supervision and management
to Air Force supervision and management over the next year.
A key factor in this is that there is a deployment of four
aircraft that are required to go to the U.S. Central Command
area of responsibility late in 2010. So that is the mark on the
wall. We will fulfill that commitment. And it may be with some
Army crews and some Air Force crews; it will probably be a mix.
We are getting the plan together now on how we will man this
and likewise how we will operate this mission downrange. Still
a lot of work to do.
I think that at the strategic level, Mr. Chairman, the
issue was, how many C-27s do we need? And I believe that the
Secretary was concerned that perhaps we were not getting as
much utilization out of our C-130 fleet as he thought
appropriate.
Just again as background, about two-thirds of our C-130
fleet is in either the Air National Guard or the Air Force
Reserve, and because of availability management issues related
to that, they are not quite as available for deployment as our
active duty, and this is the nature of things.
We need to get the Secretary settled on what the right mix
is, and clearly that will be an outcome of the Quadrennial
Defense Review. It might mean more than 38 JCAs. That is an
open question. I think 38 is the floor; it could be more. We
will have to satisfy his inquiry related to the applicability
of available C-130 capacity to do that mission.
Mr. Dicks. What I have a hard time understanding is, if the
Air Force is going to take this program over, why wouldn't it
be Air Force crews? Why would you do mixed crews? Why not deal
with this once and get it over with?
General Schwartz. I agree, sir. And that will be the end
game. But the problem is, we have a near-term deployment
requirement, and to get people trained and certified and so on
may require a mix before the total migration occurs.
And so this is something we are working out. We probably
won't have mixed crews, but it is conceivable that you would
have Army--a coherent Army crew, coherent Air Force crew that
would operate the aircraft using the same rules.
Mr. Donley. Just to follow up, Mr. Chairman, there are many
moving parts to this: the program management piece, the
training piece, the Guard, the basing issues, the deployment
commitments that have been made.
The Army and the Air Force and the National Guard Bureau
together are working this very hard. I think it is going to
take several months before we get a real firm handle on how all
the details of this will spin out. So there is a lot of work
here.
I think the strategic level decision that the Secretary
took is that the direct support mission can move, should move
from the Army to the Air Force. That was the strategic level
decision, not just the JCA program.
So there is a lot of work that needs to be done and--to the
concepts of operations and how Army needs to be supported and
making sure that the Air Force prepares itself to do that
correctly. So, many moving parts. The clutch here will operate
probably for a year or two as we make this transition; it is a
significant one.

KCX COMPETITION

Mr. Dicks. Going back to the KCX competition, one of the
things that really bothered me in this is the fact that the Air
Force leadership, as I understand it, by statute, is precluded
from being involved in the decisionmaking.
Is that accurate as it relates to the acquisition part of
this program, that the acquisition people do this, or is that
inaccurate?
Mr. Donley. Source selection decisions are closely held and
are limited to those individuals who have been assigned that
responsibility, so we do not share source selection information
outside of the select--source selection team.
Mr. Dicks. So we have people in the source selection group
who are going to take into account--who take into account the
industrial base issues?
Who takes into account key issues that affect the country
here in terms of industrial base and where this thing is going
to be built and the whole thing? I mean, those kinds of issues,
who takes those kinds of issues into account?
Mr. Donley. Well, the source selection authority is
responsible for ensuring that----
Mr. Dicks. That those things have been looked at.
Mr. Donley [continuing]. That those things have been looked
at, that the law has been fulfilled in every respect--
regulations, et cetera.
Mr. Dicks. There is a provision in Title 10 that says you
have to look at industrial base. We don't think that was done
on this program the last go-round, and we raised this with
Secretary Young before his departure.
So we would like you to look and make sure that we have
looked at--and that is supposed to be done to make sure we have
evaluated the effect on the industrial base. We can get you the
citation. It is in Title 10.
The other thing is, there were some changes made in the
model, the CMARP, that in order to allow the Airbus aircraft,
the EADS Airbus aircraft, Northrup Grumman, to be able to
compete. Now, when we start this process over again, are those
same changes in the CMARP going to be allowed or are they going
to be reevaluated, or do you know?
Mr. Donley. I can't speak to the specific issue you are
raising here. All I can assure you is that we are going through
this process with a fine tooth comb to make sure that we have
established all the requirements for the program in ways that
can be understood and written into a good proposal--clear
proposal, measurable requirements--and that we have good
oversight of this program going forward.
We have made internal changes to the Air Force to
strengthen that source selection process. We have increased the
seniority of the team. We have done sort of remedial training,
if you will. We have moved contracting responsibilities and
oversight to a higher level in the Air Force.
So we have taken a number of steps since last summer to
strengthen our preparedness to get back into this RFP this
summer and to go through a fair and open competition and to
make sure that we can withstand scrutiny that we know will
come, and should come, from the Congress and those overseeing
us.
Mr. Dicks. We have had this discussion, but I want to say
this on the record:
I would hope that they would go back and reevaluate the
changes that were made in the model, the CMARP, in order to
make certain that that was in the best interest of the Air
Force and the operation of the Air Force. I have doubts about
that myself, that those changes should have been made. They
were done so that one company would be able to compete because
they said they were going to withdraw from the competition if
changes weren't made.
The other thing is, in the GAO report there were two
requirements: Now they have to meet the requirements. Two of
the requirements were not met. One was on the organic--having
an organic maintenance site within 2 years and the other was
the ability to refuel all Air Force aircraft. Those were not
met, and I want to know whether in the next go-round if a
competitor doesn't meet the requirements, stated requirements,
that they will be disqualified, which they should have been
under the law.
And those are two things that I think are fundamental.
And the third thing is to do a valid cost comparison on
life-cycle costs. I mean, I think Congress is--we want to know
the difference in life-cycle costs between the planes that are
competing; and that was not, in my judgment and in the judgment
of many others, properly evaluated in the first go-round.
So those three things we would like an answer to, how you
are going to approach those things.
Mr. Tiahrt.
Mr. Tiahrt. Mr. Chairman, you are referring to Title 10,
U.S. Code. It is section 2440 just to be specific.
And if I might add, there are also some Defense Federal
Acquisition Regulations, DFARs, that waive regulations for some
of our allies, particularly the International Traffic in Arms
Regulations, the Foreign Corrupt Practices Act, along with
other cost accounting procedures that are demanded upon our
American contractors and not our European allies that I think
need to be reevaluated for a fair and level playing field.
I have an additional question if we have time.
Mr. Dicks. I yield to you.

INDEPENDENT COST REQUIREMENT

Mr. Tiahrt. Thank you, Mr. Chairman.
In the process of every major program, there is a
requirement for the Air Force to conduct an independent cost
estimate, and in that independent cost estimate--which is a
difficult task, by the way; whether you use parametrics or some
similar programs, it is always hard to estimate what new
technology is going to be and how you get there.
But once that has been established and there is some degree
of confidence, there has been a tendency within the Air Force
in the past to underbudget those programs. They are trying to
cram more program into the budget by number of aircraft by
lowering the independent cost estimate or adjusting it
downward. And the tendency is in doing that--the result, I
should say, in doing that is that we end up later on with
program overruns; and then we go through these machinations of
trying to catch up on the funding on very essential programs.
I assume you will have to keep continuing on the
independent cost estimates. But I think it is important that we
keep in mind that once you establish a dollar figure for a
program, that it is fully included in the budget because the
harder it goes, later on, by trying to cram 10 pounds of sand
into a 5-pound bag, eventually it is going to spill out; and
that spilling out is where we run into a lot of trouble with
our budgeting process, our funding process, as well as your
having to go through all of these hearings.
So I would encourage you in the future, when you get an
independent cost estimate, that is what your budgetary number
ought to be. Can I get some agreement on that?
Mr. Donley. The use of independent cost estimates is a very
important tool to the leadership, no question; inside the Air
Force and inside the DOD leadership, this carries weight with
us. As we look toward improving the acquisition workforce, we
are adding cost estimators. That is--part of our plan is to
beef up that part of our workforce that supports this aspect of
the acquisition process.
I would say, as the chairman and I were discussing earlier,
we have seen a lot of acquisition reform in our time here in
Washington, DC over 30 years. I would summarize it a little bit
as you did, perhaps a little bit more bluntly. Those who want
to add capability to programs usually underestimate the cost
and the impact on schedule. Those that want to take money from
programs usually underestimate the impact on capability and
schedule when they do that, and we have people in this town for
various programs--all of us are participating in this process
who want to add capability or who want to cut dollars from
programs; it just depends on the program.
So we put our program managers in a very difficult
situation. There are only certain aspects of programs that they
really have control over, because the leadership in the
Pentagon, the Air Force, the Office of Secretary of Defense,
many different competing pressures on programs, and also,
obviously, in Congress with multiple committees marking and
funding programs at different levels with different goals,
different objectives, different capabilities. We are all
working around the edges of these programs.
So maintaining stability both in content and in funding is
a very significant challenge for all of us and continues to be
going forward and requires a lot of discipline on our part to
know when to intervene and when to leave it alone.
Mr. Tiahrt. I know that some people are always a little bit
surprised that there are politics in Washington, D.C. And I
know it doesn't end at the Potomac; I know it occurs the across
the river as well. But I think in this process, if we can have
some stability in abiding by these independent cost estimates,
it will help us avoid some future overruns, which politically
are difficult to live through for both you and ourselves.
Thank you, Mr. Chairman.
Mr. Dicks. Mr. Bishop.

NEW MILITARY SATELLITE COMMUNICATION ARCHITECTURE

Mr. Bishop. Thank you very much.
As part of the fiscal year 2010 budget development,
Secretary Gates cancelled the Next Generation Military
Satellite Communications Program, TSAT. TSAT would have
provided anti-jam, high-data rate MILSAT communications and
Internet-like services to military users, such as the future
combat systems and the intelligence, surveillance, and
reconnaissance assets.
With the cancellation of TSAT, the restructure of FCS and
the addition of 50 Predator orbits, it is not clear whether or
not the current satellite communications architecture is
capable of supporting force projection assets. And, of course,
last week DOD issued the stop order on the TSAT program.
What are your plans, Secretary Donley, for the new military
satellite communication architecture, and when will you make
those plans available to Congress? And could you tell me
whether or not you are going to migrate the TSAT capabilities
onto the advanced, extremely high-frequency satellite system?
Would you address that for me?
Mr. Donley. As you indicated, the Secretary made a
strategic level decision to reduce the risk in our MILSATCOM
programs that was perceived to be associated with the TSAT
program. It had forecast significant increases in capability
across a broad range of functions and aspects for MILSATCOM. It
protected communications on the move, et cetera. These were
viewed as very desirable by the combatant commanders, but also
very high risk and potentially high cost.
The Secretary's decision was to take risk out of our
program by continuing to add MILSATCOM capability by extending
the Wide-Band Global System another two satellites, by
extending the AEHF system that you referred to by another two
satellites.
At the same time, the decision recognized that at some
point in the future we would want to continue the R&D work
necessary to develop the advance MILSATCOM capabilities that we
hope would be available in the future from a TSAT-like
capability and decide whether those capabilities ought to be
migrated into our MILSATCOM structure.
So we owe a plan to the Office of the Secretary of Defense
as part of the TSAT cancellation, that develops a plan--Air
Force working with combatant commanders and other users in the
system--to continue to evaluate the technology and to determine
when that technology is ready to be inserted into the
MILSATCOM--future MILSATCOM architecture.
So the details of that have not been worked, but it is
probably at AEH-6 or beyond.
Mr. Bishop. How are you trading off the commercial lease
satellite communications systems with the military satellite
communications systems in your future architecture analysis?
Mr. Donley. We are big users of commercial SATCOM today and
depend on our commercial partners to support ongoing operations
in the theater. They bear a significant part of our requirement
today.
I believe they will continue to be part of our MILSATCOM
architecture in the future. We will have further internal
debates on how much and what kind----
Mr. Bishop. I was going to ask you what the balance was
going to be.
Mr. Donley. Right. And we will continue to work that going
forward.
There is no question in my mind that it is recognized
within the space and MILSATCOM community that commercial
partners are a part of our MILSATCOM--part of our SATCOM
architecture going forward. They will be meeting part of our
needs going forward, no question.
Mr. Bishop. Thank you very much, gentlemen.
And thank you, Mr. Chairman. I would like to at the close
of the hearing have a moment with General Schwartz, if you
don't mind----
General Schwartz. Yes, sir.
Mr. Bishop [continuing]. Regarding a constituent matter.
Thank you, Mr. Chairman.

ALTERNATE ENGINE FOR JOINT STRIKE FIGHTER

Mr. Dicks. Can you give me kind of the newest update on the
alternate engine on the Joint Strike Fighter, what the
administration's position on this is?
Mr. Donley. Sir, the administration's position remains that
the second engine for the F-35 would not be in the best
interest of the F-35 program going forward. So there is--at the
moment, there is no change in the Administration's position on
that subject.
Mr. Dicks. We understand that the Congress has added $2.5
billion. A lot of this comes from the--I think it is the F-100
competition; and our analysis up here is that over the life
cycle that--even in the worst case, this would only cost $300
million. And that with competition there, it keeps both
competitors' prices down.
So, anyway, I just want to make that point because I am
pretty confident Congress is going to stay with their position
on this.
General Schwartz. Mr. Chairman, if I could, if you would
allow me just to say that I think we understand that argument.
I would only ask that if that is the case, if we are going to
proceed, that Congress directs that we proceed with the
alternate engine, that we all do our best not to have that
decision impact the production rate of our F-35 platforms.
If the trade is fewer airplanes for more engines, from an
operator's point of view, that is less than ideal.

COMBAT SEARCH AND RESCUE HELICOPTER PROGRAM

Mr. Dicks. That is a valid point and noted.
On April 6, Secretary Gates announced the termination of
the Air Force Combat Search and Rescue helicopter program due
to a concern over the acquisition history and questions whether
the mission can only be accomplished by yet another single-
service solution with a single-purpose aircraft.
Secretary Gates further stated that he would take a fresh
look at the requirement behind the program and develop a more
sustainable approach.
Later in the month, at Maxwell Air Force Base, he stated,
frankly, the notion of an unarmed helicopter going 250 miles by
itself to rescue somebody did not seem to be a realistic
operational concept.
What is in the budget to address this critical capability?
Anything?
General Schwartz. Sir, the decision to cancel the CSAR-X
solicitation did not remove all the dollars that were
associated with that effort. In fact, there is a fair amount of
money left in the personnel recovery search and rescue line;
and what we will end up doing, I think--the bottom line is I
think the Secretary's view was that we had over spec'd the
requirement and that there are less expensive capabilities that
can help satisfy this mission, and what we will end up doing is
procuring airplanes currently in production that are either
supporting the Army or the Special Operations Forces.
Mr. Bishop. These airplanes, are you talking about
helicopters?
General Schwartz. Yes, sir, helicopters.
Mr. Bishop. Rotary wing?
General Schwartz. Rotary wing, helicopters, yes. UH-60M
variance.
Mr. Dicks. What about the idea of purchasing two H2M
helicopters to be modified to a CSAR configuration?
General Schwartz. Sir, could you repeat that?
Mr. Dicks. What about the--there is one option of
purchasing two H-60M helicopters to be modified to a CSAR
configuration.
General Schwartz. Yes, that is the Department's position,
sir.
Mr. Dicks. That is what you are going to do.
Mr. Donley. I don't think that has been completely decided.
What I think you saw and have seen in the 2010 budget,
first of all, there are dollars--as the Chief indicated, there
are dollars left behind from the CSAR program cancelation that
we intend to put into a different capability going forward. But
at the same time that decision was made we also made what I
will call some clean-up decisions.
Since we knew we were not going to have CSAR procured in
the near future to do some loss replacement for helicopters, we
put in some dollars for MC-130 for additional tanking. We did
some additional modification dollars on H-60s as well, adding
clear capabilities and some other functions that would be
helpful in the CSAR in the personnel recovery missionary.
These were short-term, band-aid budget adjustments made to
compensate in the immediate near term for the CSAR cancelation.
We need to reconstitute a future program that needs to be
defined here in the QDR going forward.
Mr. Bishop. Will the gentleman yield?
Mr. Dicks. Yeah, I yield.
Mr. Bishop. The CSARs that you are talking about, will they
be armed so that when they go in on the missions that they have
some protection? And, if so, will that reduce the available
space for MediVac and the number of casualty victims that can
be extracted?
General Schwartz. They will be armed, as ours are today,
either with light machine guns or 50-caliber weapons is the
typical configuration. And, yes, there is a tradeoff between
payload in space with regard to what you put on to protect the
airplane, how much gas you carry, how far you can go versus how
many people you can pick up and return and so on.
But the bottom line is that these aircraft do have self-
protection capability, and the aircraft that we are talking
about procuring will likewise have that capability.
Mr. Dicks. Mr. Tiahrt.

TANKER

Mr. Tiahrt. Thank you, Mr. Chairman.
General Handy has been talking about a duel buy on the
tankers, and what is the plan on the KC-10 replacement? Is it
on the radar screen yet.
Mr. Donley. No.
Mr. Tiahrt. It is still long term out? He was talking about
the lower cost paragraph, if you replace them up front. But it
just seems they are not in the budget now.
Mr. Dicks. Would you yield on that?
As I understood what the Air Force's position was, we are
going to buy 179 in the first tranche of medium-size aircraft,
179 in the second tranche, and then a third tranche of 179,
which could be a larger airplane. That was the original plan;
and that would take a long, long time. I know Mr. Murtha feels
that whatever we do we should accelerate this to try to get the
unit cost down and get these tankers sooner, but is that not
still the plan?
Mr. Donley. You are exactly right, Mr. Chairman. The broad
intent is to do this in three increments. We have over 400
tankers involved, KC-135 replacements, if you will, to effect
over the next 15 to 20 to 25 years.
Mr. Dicks. This was over 45 years.
Mr. Donley. This is going to take time. This is going to
take time. And we had not looked at the exact content of all
that.
The main purpose behind these increments was to give us way
points, if you will, decision making points to understand where
the future technologies and what the future commercial air
frames might be 10 years or 15 years out so that we don't
commit to an air frame now that may be passed by technology
advancements or new commercial aircraft available 20 or 30
years from now.
Mr. Dicks. General, do you want to make a comment?
General Schwartz. I would just say that KC-10 was really
KCZ.
Mr. Dicks. That's right, XYZ.
General Schwartz. It was the third increment. And so
notionally, conceptually it is out there, but it is not
programmatic yet.
Mr. Dicks. But it is still the administration's position
that you are against a split buy, isn't that correct?
Mr. Donley. Yes.
Mr. Dicks. And can you give us some of the reasoning why
you are?
Mr. Donley. Well, the split buy would require us really to
fully develop two aircraft going forward. In addition to fully
developing those aircraft, we would end up with two logistics
and support trains that go with those aircraft. A third
consideration from our point of view is that the minimum buy to
support two production facilities, if you will, is probably a
minimum of about 12 each.
So our plan going forward assumed that the Air Force would
be buying about 15 airplanes a year into the future, and that
was roughly what we thought we could afford with our
procurement accounts going forward. If we end up with a split
buy, the minimum for each is 12. That means a buy of 24
airplanes a year.
There is goodness in that. From one point of view, it is
sort of a more robust industrial base kind of situation. You
get them faster. The KC-135s come out faster. However, we think
it is probably more expensive in the long run to support that;
and it requires that, instead of buying 15 per year, we would
buy 24 per year. So the impact on our budget is significant. We
end up spending a lot more on tankers, and that crowds out
other programs.
Mr. Dicks. And there is a very definite increase in the
development cost, as we understand it. I think Secretary Gates
has said, or somebody, at least $7 billion more in development
costs in the near term. So that also has an effect, would have
an adverse effect on the Air Force budget.
Mr. Tiahrt.

REQUIREMENTS FOR AIRLIFT CAPABILITY

Mr. Tiahrt. In your questioning, Mr. Chairman, you were
talking about a study of requirements for the airlift
capability.
Mr. Dicks. Right.
Mr. Tiahrt. And when we think of the current situation in
Afghanistan we are pretty easy to be landlocked. We have the
Russians trying to influence the northern side of it. We have
Iran to the west, Pakistan's uncertainty to the east and south.
And that really brings a high emphasis to the ability to get
equipment and supplies and personnel in and out of Afghanistan.
We have been using this link through Pakistan, and we have
had a lot of trouble with that. They have broken into some of
the containers. You can go down in the black market just
outside the air base in--was it Bagram--and buy the seals that
they put on the back of the cargo containers to show they
haven't been broken into. You can buy replacements for those.
And so they simply bust the seal, steal what they want, and put
the seal back on. And then the manifest doesn't match the
cargo. So there has been a lot of trouble with going through
Pakistan.
Will this be part of the plan? I mean, it seems like a
near-term problem when you are doing a long-term study. But
when it comes to handling cargo, we could have a huge demand
almost immediately with instability in that area.
General Schwartz. Congressman Tiahrt, we certainly have
contingency plans to deal with either limitations on access
through the southern routes, the Chaman or the Torkham gates,
as they are called, in the east of Afghanistan or from the
north through any number of the stans.
This really is in the U.S. Transportation Command lane. But
fundamentally what we have done is establish relationships with
a number of the governments.
For example, in Kyrgyzstan should have an agreement for
continued access to Manas. And that is an important location
because it allows us not only to do transload of personnel from
commercial to military to go in country, but it also allows us
to have tankers near or closer to Afghanistan to support day-
to-day missions.
If we had to fall back to other locations, we could do
that. We have a plan. We have a back-up. It is harder. It is
more expensive. It is more asset intensive. But we are not
without options with regard to maintaining support for the
folks that are on the ground there.

IRREGULAR WARFARE

Mr. Dicks. Let me ask you, Secretary Donley, has irregular
warfare DOD directive 3000-.07 been reflected in your 2010
budget request?
Mr. Donley. I believe it has. The work that the Air Force
has done over the last several months has really helped to
focus building partnership capacity in that our international
affairs work as a core function in the Air Force. So we have
stepped out to recognize the importance of this work.
As we have alluded to in a few different programs here
today, if you package them together we have looked carefully at
how to further develop Air Force force structure and capacity
for irregular warfare sort of at the lower end of the conflict
spectrum and to develop capabilities that not only are useful
to the United States in its work but can be translated over to
international partners who are not the same kinds of partners
that we deal with in, for example, in NATO context.
So building partnership capacity at the high end with NATO
partners means F-35s and high-end Rivet Joint kinds of
capacity, unmanned aerial vehicles. These are the kinds of
issues that we work with the British, with the Germans, and
with other partners.
At the lower end, we need to have capabilities that are at
the technological level, resource level, training level that
fits partners facing different kinds of resource challenges,
geographic challenges.
So building capabilities like the JCA, like the C-27
capability, building ISR capabilities in platforms like the MC-
12 and potentially developing training airplanes like the T-6
or the Super Tucano or other kinds of aircraft in that class of
airframe can help us, and it can help us teach and work with
partners to build up their indigenous capability. So we have
been working the IW and partnership issues very hard and
continue to do so. We have more work to do there.
Mr. Dicks. Is the Air Force doing anything, General, to
revise doctrine, organization, training, material leadership,
personnel, and facilities to reflect a sharpened focus on
irregular warfare?
General Schwartz. We are. In fact, this will be a major
topic for discussion in our four-star conference here this
weekend. And I think what you will see----
For example, we have what we call contingency response
groups in the overseas theaters. They originally were conceived
to be elements with lots of different disciplines, from
airfield management to engineers to services personnel support
kind of capabilities to open airfields. It is an important
function for us. If we are expeditionary, you need to have an
airfield opening capability.
But it turns out that these organizations also have,
because they are multi-disciplinary, the interesting capacity
to engage other air forces in interaction related to the
various disciplines, whether it is building a runway or whether
it is air traffic control, whether it is medical support.
And what we will probably do--and it is an example of
several initiatives--is to dual-role those organizations both
to do airfield opening, but when they are not opening airfields
to build partner capacity with our partners like the Afghan
Army Air Corps.
The truth is that we have capacity that may have been
overly focused on a particular mission set, that we can expand
their view, and I think with minimal expense and minimal growth
in manpower requirements actually serve the irregular warfare
mission very well. And that is where we will start, sir. There
will be some new stuff, as the Secretary suggested. But I think
our first effort will be to make better use of what we already
possess in that lower end of the spectrum.

AIR OPERATIONS

Mr. Dicks. Why is the air operations request for 2010 50
percent less than 2009?
General Schwartz. I am not sure, sir, what you mean with
regard to air operations.
Mr. Dicks. Basically, flying hours we are talking about.
How has the Air Force training curriculum for flying hours been
substantially updated since the Berlin Wall? When did it
occur--yeah, when did it occur on training hours, training
curriculum? Has the Air Force's training curriculum for flying
hours been substantially updated since the Berlin Wall came
down?
General Schwartz. Certainly it has. I mean, the most
graphic example of that, Mr. Chairman, is the capacity in
simulation. I mean, we now--and to network simulation. Our
simulators--and, of course, this is true in the commercial
sector as well. And as you well know, in the commercial
business, aviators are no longer qualified and actually flying
the airplanes. All that is done in high fidelity simulators.
The same thing is true for our aircrews.
Now, there is some things you have got to do in the air,
and we certainly do that. But we are making better use of high
fidelity simulation, of networking those simulators in a way
that allows F-15s, let's say, to gaggle with F-16s in a virtual
sense. And it isn't a complete substitute, but it has reduced
our need for flying in the air, sir.
Mr. Dicks. Our staff is concerned that this may be an
excuse to cut out some major programs, that we are moving to
irregular warfare, therefore, we need fewer F-22s, fewer C-17s.
We are shutting down a lot of programs, Next Generation Bomber.
I mean, it is--you know, and what are you switching to? What
does irregular warfare bring with it in terms of requests? Now,
we know there is going to be Predators, Reapers, ISR, things
that you have talked about. But you know----
General Schwartz. Some of this is human capital, Mr.
Chairman. The question is--I only speak one language, and that
is not a good thing. You know, in 15 or 20 years, the next
Chief of Staff you should expect to be conversing in more than
one language.
And that is one of those things that really is irregular
warfare. We need to make sure that our folks in our Air Force,
your Air Force, both can connect with other cultures, have the
sensitivity and the awareness to do that well, can communicate
and so on and so forth. So part of this is human capital.
Yes, we are growing in some areas that we have talked about
and shrinking in others. I think this is the reality that we
face. Because the truth of the matter is that our budgets are
limited, and we are going to have to make choices.
But I think what you hopefully will see is that at the
strategic level we have certain things that are single purpose.
For example, the missiles in North Dakota and Wyoming and so on
are single purpose. They serve the deterrent mission. They are
not really very applicable in the irregular warfare context.
Mr. Dicks. Right.
General Schwartz. You have some things on the other end
that are very mission specific that are not applicable as you
move up the warfare spectrum. But that general purpose force in
the middle we need to make more versatile. So we will have some
dedicated to this and some dedicated to that. But I think our
way ahead is to build versatility into our force so that we can
swing to the needs without doing these major fluctuations of
discontinuing some programs and starting new ones.

IRREGULAR WARFARE

Mr. Dicks. Just to follow up on that, what would be kind of
the--in your vision of this with irregular warfare, what are
the kinds of things that the Air Force will need in order to
implement irregular--I mean, and equip itself with irregular
warfare? Have we missed anything here? I mean, are we talking
about helicopters? Are we talking about UAVs? Are we talking
about--what else?
General Schwartz. You are talking about mobility, you are
talking about reconnaissance, you are talking about light
strike, and you are talking about the management capacity to
orchestrate and sustain those resources. And one of the things
that your Air Force brings to the table here is to be able to
train others like the Afghan Army Air Corps how to maintain and
how to sustain these assets that they will have, largely non-
U.S. made. Some Italian air lifters, some Russian helicopters,
a mix.
But our kids need to be able to train others to use those
assets; and that is something which requires, again,
versatility. We build that into the force. We have people that
are qualified on various platforms and that can teach. That is
the way ahead, in my view.
Mr. Dicks. Mr. Secretary----
Mr. Donley. Just to add an additional couple of points, Mr.
Chairman.
As the Chief indicated, the Secretary is not swinging in
this budget, swinging a pendulum hard over to irregular
warfare. He is asking the Department to look more carefully at
how we can use those general purpose forces that we are
building.
We are still committed to JSF. For example, our program for
JSF is 1,763 airplanes, and that is going take a while, and we
are deeply invested in that, and we hope to execute that. But
the issue is, as we build and maintain force structure going
forward, making it as useful as possible across the spectrum of
conflict.
And the other thing that should be in our minds as we
continue to work the irregular warfare issue is that the
effectiveness of our Armed Forces jointly both in Iraq,
Afghanistan, across the board in any operation today is our
ability to network and work together. So it is the enabling
capabilities, much of which the Air Force brings to the table
in its space and ISR communications, these capabilities that
are useful across the spectrum of conflict and for which we are
able to scale up and scale down to support irregular warfare,
and support high intensity combat when necessary.
These enabling capabilities are critical to all the Armed
Forces. We bring a lot of that to the table, and I see growth
and demand in those areas. Cyber and space are the other key
domains that we are focused on. Those are growth areas for I
think the joint community going forward, and we have got to do
the work necessary to continue to build capacity in cyber and
in space.

CYBER ATTACKS

Mr. Dicks. Mentioning cyber, has the Air Force been a
victim of attacks by other countries?
Mr. Donley. Yes.
Mr. Dicks. And I know we can't go too far here, but has it
gone beyond unclassified systems into classified systems?
Mr. Donley. It has, and it is persistent. It is a regular
part of doing business today. This is a warfare domain.
Mr. Dicks. Any further questions?
All right. The committee will stand in adjournment. Thank
you very much, and we appreciate your testimony.
Also, Secretary Donley, I want to thank you personally for
meeting with a group of my constituents from Tacoma. They very
much enjoyed the meeting.
Mr. Donley. Happy to do that, Mr. Chairman.
[Clerk's note.--Questions submitted by Mr. Boyd and the
answers thereto follow:]

Tyndall Air Force Base

Question. What is the personnel and funding impact to Tyndall Air
Force Base with the removal of 48 aircraft due to the early retirement
of the F-15?
Answer. The combat air forces restructure reduces 48 primary
aircraft from Tyndall Air Force Base, Florida and the corresponding
personnel impact is a reduction of 594 total active duty authorizations
(550 enlisted, 40 officers and 4 civilians). This represents a
reduction of $19.7 million in personnel costs ($16.9 million for
enlisted, $2.6 million for officers and $.2 million for civilians).

Kingsley Field

Question. What are the infrastructure requirements for Kingsley
Field through FY 2013 that relate to F-15s, their maintenance and/or
training for F-15 pilots? What are the costs associated with that
military construction?
Answer. The Air National Guard operates an F-15 formal training
unit at Kingsley Field, Klamath Falls, Oregon to train F-15 aircrew
members. Presently, there are no military construction projects
programmed to recapitalize F-15 maintenance or training facilities for
F-15 pilots at this installation.
Question. What is the aircraft utilization rate (scheduled vs.
actual) at Kingsley Field?
Answer. Aircraft utilization rate statistics for Kingsley Field for
the current and prior fiscal year are indicated below.
For fiscal year 2009 (thru May): scheduled 23.2; actual 20.3 and
attrition 12.2 based on cancellations (maintenance, operations,
weather, etc.).
For fiscal year 2008: scheduled 20.8; actual 15.9 and attrition
23.2 based on cancellations (maintenance, operations, weather, etc.).
Question. What is the maintenance non-delivery rate at Kingsley
Field?
Answer. For fiscal year 2008 the maintenance non-delivery rate at
Kingsley Field was 2.1 percent. For fiscal year 2009 the rate is 1.3
percent (maintenance cancellations/sorties flown).
Question. How many classrooms are available at Kingsley Field?
Answer. There are 20 classrooms at Kingsley Field.
Question. Is ACMI range access available at Kingsley Field for F-15
training?
Answer. Yes. However, the air combat maneuvering instrumentation
(ACMI) pods used at Kingsley Field and other Air National Guard (ANG)
locations are not associated with the specific ANG facility. The ANG
centrally manages their ACMI capabilities at four combat readiness
training centers to minimize operations and maintenance costs. The only
ANG location that owns their pods is Montana, who acquired eighteen P5
pods through congressional action. But even in that case, the pods are
being maintained by the Savannah combat readiness training centers.
Through this centralized management construct, Kingsley Field has ACMI
capability on a full-time basis including full de-brief capability.

F-35s

Question. The number of F-35 aircraft requested in the fiscal year
2010 budget was reduced from what was projected for fiscal year 2010 in
last year's budget request. With the looming aircraft shortfall the Air
Force is facing, how do you rationalize the reduced procurement of F-35
aircraft?
Answer. The Air Force supports Secretary Gates' decision to reduce
the fiscal year 2010 Air Force procurement of F-35A aircraft from 12 to
10 as it allows the Marine Corps to correspondingly increase their
fiscal year 2010 procurement by two F-35B STOVL variants. This enables
the Marines to reach their planned initial operational capability in
fiscal year 2012. The reduction of two F-35s in fiscal year 2010 for
the Air Force does not impact our planned initial operational
capability date of fiscal year 2013.
Question. The platform that will provide the most relief for the
tactical fighter shortfall is the F-35 (Joint Strike Fighter). As with
the majority of complex, new weapon systems, this program has seen its
share of problems and is likely not out of the woods yet. In fact, the
Marine Corps variant has been delayed from its original schedule due to
engine problems.
Do you anticipate the Joint Strike Fighter becoming operational in
time to help with the shortfall or will continued delays make it worse?
Does the department have a contingency plan to mitigate the aircraft
shortfall should the Joint Strike Fighter continue to slip?
Answer. The Air Force's variant of the Joint Strike Fighter is
currently scheduled for initial operational capability in late 2013.
Beginning 2015, the Air Force is programmed to purchase 80 Joint Strike
Fighters each year alleviating the projected fighter shortfall. In
addition, the Air Force will maintain approximately 220 F-15Es and
approximately 350 A-10s until unspecified retirement dates after 2030
enabling the Air Force to maintain sufficient strike assets as the F-
35A comes on line. The Air Force is also taking additional steps to
further evaluate the sustainability and viability of its F-16 fleet, if
additional service life is required due to a significant delay in the
Joint Strike Fighter's initial operational capability.
Question. What maintenance reliability lessons from the F-22
program can be applied to the F-35?
Answer. One of the key strategic efforts during and post
Engineering and Manufacturing Development phase of the F-22 program has
been to proactively identify reliability issues very early based upon
detailed analysis of developmental/operational test data and to
programmatically fund for a Reliability and Maintainability Maturation
Program (RAMMP) to effect critical redesigns where needed. The RAMMP
effort has led to a six-fold improvement of measured reliability from
initial operational test to today. Due to this proactive approach the
F-22 program is well on track to meeting or exceeding the Mean Time
Between Maintenance Event Key Performance Parameter by the required
100,000 flying hour definition of maturity in the Operational
Requirements Document. In fact recent data shows at least one
operational base meeting and exceeding the mature requirement today,
over 1.5 years ahead of expected fleet maturity at 100,000 cumulative
flying hours sometime in late calendar year 2010. A key lesson from the
F-22 program, for the F-35 program, is that a RAMMP or RAMMP-like
program should be considered for the F-35. Additionally, the F-35 Joint
Program Office meets regularly with the F-22 System Program Office and
F-22 users to gain lessons learned on all F-22 and F-35 aircraft system
reliability issues. The F-35 Joint Program Office has an in-depth
integrated systems approach to testing F-35 components, and is flying a
highly modified Boeing 737 with a full suite of F-35 avionics to find,
fix, and prevent potential avionics integration problems.

F-22s

Question. The F-22 program is proposed to be completed at 187
aircraft in addition to the proposal to retire 250 Air Force fighters.
These actions create a gap in capability. How do you rationalize these
decisions?
Answer. To comply with the Secretary of Defense's Guidance for the
Development of the Force, the Air Force analyzed its fighter force
structure and determined we have a window of opportunity to take a
strategic pause and build a smaller, but more flexible, capable, and
lethal force as we bridge to the 5th Generation-enabled force. This
analysis determined that the Air Force is faced with aging fighter
aircraft during a period in history where we are not directly
threatened by a near-peer competitor, ultimately assessing the risk as
acceptable. Any remaining risk is mitigated in the short-term through a
combination of permanently based and rotational forces. It is part of a
global resource allocation process that makes strategic sense.
As we developed this combat air forces restructuring plan over the
last year, we were successful in balancing planned force reductions
across our active duty, Guard, and Reserve components, as well as in
the States and overseas locations. We carefully analyzed the missions
across our units in all the Air Force components to achieve the force
mix that made the most strategic sense. The changes in this plan were
closely coordinated with our Air National Guard and Air Force Reserve
partners, as well as our major commands and affected regional combatant
commanders.
Secretary Gates agreed with the Air Force's assessment and approved
the restructuring plan. The retirement of approximately 250 fighter
aircraft in fiscal year 2010 will not affect the potential fighter
shortfall identified last year. That shortfall referenced the year
2024, by which time all of the 250 aircraft would have previously
exceeded the end of their programmed service lives.
Question. Has F-22 system reliability improved?
Answer. The F-22 system reliability has dramatically improved over
six-fold from the completion of the Engineering and Manufacturing
Development phase to present. At the end of the Engineering and
Manufacturing Development, the measured reliability Mean Time Between
Maintenance event was approximately 0.5. One operational base is
currently measuring above the mature requirement (3.0) at 3.03 prior to
fleet maturity at 100,000 flying hours expected in late calendar year
2010. Additional planned changes will ensure the design at maturity
meets the Mean Time Between Maintenance key performance parameter of
3.0.
Question. What is the current performance in meeting the key
reliability requirement of 3-hour mean time between maintenance
actions?
Answer. The F-22 Operational Requirements Document key performance
parameter requires the 3.0 Mean Time Between Maintenance (MTBM) event
to be achieved by 100,000 cumulative flying hours. The current
operational fleet average between November 2008 and April 2009 is a 1.9
MTBM. One operational base demonstrated a 3.03 MTBM in April 2009.
Question. How well are the on-board maintenance diagnostics and
health management systems working?
Answer. The current F-22 operational fleet average performance
between November 2008 and April 2009 is as follows: the Fault Detection
percentage (FD %) metric is 68.3 percent and the Fault Isolation
percentage (FI %) metric is 94.1 percent. Planned diagnostic software
updates by the end of calendar year 2010 are expected to improve the
metrics as the operational fleet reaches system maturity at 100,000
cumulative flying hours.
Question. What efforts remain to fully demonstrate those
capabilities?
Answer. The final demonstration of the F-22 mature reliability
capabilities will occur during the follow-on Operational Test and
Evaluation III period scheduled for late calendar year 2010.
Question. Are they paying off in terms of reduced base-level
maintenance and earlier recognition of problem areas needing
inspection?
Answer. Yes. The F-22 standard (Systems Specification) Direct
Maintenance Man Hour/Flying Hour (DMMH/FH) requirement is to be less
than or equal to 12 at system maturity at 100,000 cumulative fleet
flying hours (expected by end of calendar year 2010). At the end of the
Engineering and Manufacturing Development phase in March 2004, the
DMMH/FH was initially measured at 13.4 DMMH/FH. The current operational
fleet DMMH/FH metric is measured at 10.48 DMMH/FH as of April 2009.
This is a result of the Reliability and Maintainability Maturation
Program identified improvements.

Test and Evaluation Support

Question. The President's Budget request cuts PE 0605807F almost
$50 million when compared to the FY 09 budget and first FY10 budget
request submitted in January. A portion of this cut is simply a cut.
The second element of the cut is based upon the assertion that there
will be savings realized when 750 contractor and civil service
positions are converted to civil service solutions.
What analysis has been done to identify what the workforce mix of
contractor and civil service should be? Please provide a copy of the
analysis?
Answer. The Service components received an Office of the Secretary
of Defense-directed contract to Department of Defense civilian
conversion targets starting in fiscal year 2010. The Air Force is in
the process of identifying specific in-sourcing candidates to comply
with this mandate.
Question. What is the hiring ramp-up schedule for achieving the
contractor to civil service conversions? What analysis has been done to
verify that OPM and AF offices can achieve the ramp-up schedule? Please
provide a copy of the analysis.
Answer. The Service components received an Office of the Secretary
of Defense-directed contract to Department of Defense civilian
conversion targets starting in fiscal year 2010. The Air Force is in
the process of identifying specific in-sourcing candidates to comply
with this mandate.
Question. What analysis has been done showing the savings that will
result from the conversion of contractor positions to civil service
positions? Did the analysis include fully burdened costs of civil
service positions similar to costs clearly visible for contractor
support (i.e., overhead, G&A, material & handling, etc.)?
Answer. The Service components received an Office of the Secretary
of Defense-directed contract to Department of Defense civilian
conversion targets starting in fiscal year 2010. The associated funding
reductions were based on Department of Defense's assumption of 40
percent savings. The Air Force is in the process of identifying
specific in-sourcing candidates to satisfy this mandate.

[Clerk's note.--End of questions submitted by Mr. Boyd.
Question submitted by Mr. Kingston and the answer thereto
follows:]

Operationally Responsive Space

Question. The Operationally Responsive Space (ORS) program was
initiated in 2007 by the Air Force to develop test and field satellites
for meeting military requirements particularly in forward deployed
areas. ORS continues to bring to maturity space-borne sensors and put
in the field tactical satellites targeted to specific theater needs. We
desire to fund cost-reducing programs and initiatives that modernize
space operations including ground support for satellites and spacecraft
development and construction.
How helpful would programs that provide rapid spacecraft
prototyping and mission performance and analysis be for the ORS
activity? How much collaboration is there between Air Force and
industry on developing relatively low cost prototyping for programs
such as ORS?
Answer. The vision for Operationally Responsive Space (ORS) is to
provide operational mission capability for combatant commanders quickly
and one aspect of that is the ability to rapidly analyze alternative
solutions. ORS is investigating and evaluating tools from industry that
can demonstrate these capabilities. These tools are a key enabler for
the rapid response space capability that ORS is developing. It's
uncertain at this time if there is a role for rapid prototyping in
developing operational ORS spacecraft on the timelines required for
responding to urgent military requirements.
[Clerk's note.--End of question submitted by Mr. Kingston.]
Wednesday, June 3, 2009.

NAVY AND MARINE CORPS POSTURE

WITNESSES

HON. RAY MABUS, SECRETARY OF THE NAVY
ADMIRAL GARY ROUGHEAD, CHIEF OF NAVAL OPERATIONS
GENERAL JAMES CONWAY, COMMANDANT OF THE MARINE CORPS

Opening Statement

Mr. Murtha. The committee will come to order.
I want to welcome these three distinguished gentlemen. I
want to say Bill we were talking about Jamie Whiten. Of course,
the Secretary is from Mississippi and he was Governor when
Jamie was the chairman. So he remembers him well. And he
reminded me, told me that Jamie and his uncle were in the 1932
convention and Mississippi went by one vote for Roosevelt.
Jamie used to tell me that story all the time.
But we welcome you gentlemen to the committee, and we
appreciate your distinguished careers and look forward to your
statements. If you will summarize them and then we will ask
some questions.
Mr. Young.
Mr. Young. Mr. Chairman, I just want to agree with what you
said. We appreciate the very distinguished careers of the
witnesses and their support teams. We are looking forward to
being supportive of the needs of our Sailors and our Marines.
Mr. Murtha. Bill, I want you to know that the Secretary,
and I said we wouldn't hold it against him, he graduated from
Harvard Law School. He said he couldn't get into the University
of Mississippi. That's what he said.
Mr. Secretary.

Summary Statement of Secretary Mabus

Mr. Mabus. Mr. Chairman, thank you very much, Congressman
Young, distinguished members of committee, it is an honor to be
here with Admiral Roughead and General Conway on behalf of our
Sailors, Marines, and their families.
Two weeks ago, I assumed the responsibility as the
Secretary of the Navy. In this very short period of time, it
has been my privilege to gain firsthand insight into our
Nation's exceptional Navy and Marine Corps. This naval force
serves today around the world providing a wide range of
missions in support of our Nation's interests. I am here today
to discuss with you the fiscal year 2010 budget, the various
missions of the Navy and Marine Corps, and some priorities of
our Department.
The Navy Department's fiscal year 2010 budget reflects a
commitment to our people, shaping our force, providing adequate
infrastructure, sustaining and developing the right
capabilities for the future. The ongoing Quadrennial Defense
Review will also aid in shaping the department's contribution
to the national effort in the future.
As I have taken on these new duties, my first priority is
to ensure we take care of our people: Sailors, Marines,
civilians, and their families. Thousands of brave Marines and
Sailors are currently engaged in Iraq and Afghanistan, and
thousands more are carrying out other hazardous duties around
the world. These inspirational Americans volunteered to serve,
and they are protecting us and our way of life with unwavering
commitment. We have to show them the same level of commitment
when providing for their health and welfare and that of their
families.
Last week I went to the National Naval Medical Center in
Bethesda and visited with our wounded. It was both a humbling
and inspirational experience, reinforcing the enduring
commitment we owe them in terms of treatment, transition, and
support. Programs like the Marine Corps Wounded Warrior
Regiment, the Navy's Safe Harbor Program, advances in treatment
and traumatic brain injuries, and programs that offer training
and support and stress control must continue to be our
priorities.
Today our Sailors and Marines are serving and responding to
a wide variety of missions from combat operations to
humanitarian assistance and maritime interdiction. The Navy has
13,000 Sailors ashore and 9,500 Sailors at sea in Central
Command's Area Of Responsibility (AOR). More than 25,000
Marines are deployed in Iraq and Afghanistan. Our civilian
force is also heavily engaged in supporting these operational
efforts. We have to ensure that the Department of the Navy will
continue to meet these missions while investing in capabilities
that provide the right naval force for future challenges.
Real acquisition reform too has to be a priority. The
Department of Navy has begun to implement the Weapons Systems
Acquisition Reform Act and is ready to use this Act and other
tools to try to ensure we get the right capabilities on time
and at an affordable cost. The Department of the Navy and I, in
particular, look forward to working together with you in our
shared commitment to our Nation, our Marines, our Sailors,
civilians, and their families. On behalf of all of them, and
very importantly, thank you and this committee for your
unwavering support, for your continued stance of providing
these Sailors, Marines, civilians, and their families with the
tools they need with the assistance they deserve. Thank you on
behalf of all of them.
I look forward to your questions.
[The statement of Secretary Mabus follows:]
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Summary Statement of Admiral Roughead

Mr. Murtha. Admiral Roughead.
Admiral Roughead. Chairman Murtha, Congressman Young,
distinguished members of the committee, on behalf of the
600,000 Sailors, Navy civilians, and families, I thank you for
your continued support and for the opportunity to represent our
Navy alongside the Secretary and General Conway.
Today we have 40,000 Sailors on station making a difference
around the world. We are more versatile and agile than we have
ever been with more than 13,000 Sailors serving on the ground
in the Central Command. The 2010 budget balances the needs of
these Sailors around the world, our current operations and
needs for future Fleet in accordance with our maritime
strategy. However, we are progressing at an adjusted pace. Our
risk is moderate today trending toward significant because of
challenges posed by our Fleet capacity, our operational
requirements, manpower, maintenance and infrastructure costs.
Our Navy is operating at its highest levels in recent years,
and while we remain ready and capable, we are stretched in our
ability to meet additional operational demands while balancing
our obligation to our people and to building the future Fleet.
We require additional capacity to meet Combatant Commander
demands and maintain our operational tempo. A Fleet of at least
313 ships is needed along with capabilities that include more
ballistic missile defense, irregular warfare, and open ocean
anti-submarine warfare (ASW) capabilities. These needs drove
the decision to truncate the DDG-1000 and restart the DDG-51
with its blue water ASW capability and integrated air and
missile defense capability, and also to procure in this budget
three littoral combat ships.
As I articulated last year, our Navy must have a stable
shipbuilding program that provides the right capability and
capacity while preserving our Nation's industrial base. The
balance among capability, capacity, affordability, and
executability in our procurement plans, however, is not
optimal. I continue to focus on the control of requirements,
integration of total ownership costs into our decision making,
maturing new ship designs before production and pursuing proven
designs.
The use of common hull forms and components and longer
production runs to control costs as we build the future Fleet
are most important. To best maintain the ships we have, we have
reinstituted an engineering-based approach to maintenance for
our surface ships through the surface ship lifecycle management
activity. Meanwhile, our board of inspection and survey teams
will continue to use INSURV processes to conduct rigorous self-
assessments on the condition of our ships and submarines. All
that we do is made possible by our dedicated Sailors and Navy
civilians.
I am committed to providing the necessary resources and
shaping our personnel policies to ensure our people and their
families are properly supported. We are stabilizing our force
this year by seeking authorization and funding for an end
strength of 328,800 Sailors, including overseas contingency
operation funding for 4,400 individual augmentees who are in
today's fight. We continue to provide a continuum of care that
covers all aspects of individual medical, physical,
psychological, and family readiness to our returning warriors
and Sailors. In 2008, we added 170 care managers to our
military treatment facilities and ambulatory care clinics for
our 1,800 wounded warriors and their families.
In addition, we continue to move mental health providers
closer to the battlefield and are actively working against the
stigma of post-traumatic stress disorder. Achieving the right
balance within and across my three priorities of the future
fleet, current operations, and people is critical today and for
the future, and I ask for your support for this 2010 budget.
Thank you for your continued support and commitment to our
Navy, for all you do to make the United States Navy a force for
good around the world today and tomorrow.
I look forward to your questions.
[The statement of Admiral Roughead follows:]

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Mr. Murtha. Before I acknowledge the Commandant, I want you
to know I had three brothers in the Marine Corps, and the
committee has heard this story before, but when I enlisted it
was 1952 in the Korean War. My mother cried all through my
enlistment. My second brother joined the Marine Corps. My third
brother joined the Marine Corps. I was going to go into the
Army. The reason I am reminded of this is when I see these
public relations guys in front of you guys, it makes me realize
why my mother was so upset when she thought I couldn't join the
Army because of all that information you send out to the
families to make sure they know how good a job we are doing in
the Marine Corps.
Commandant.

Summary Statement of General Conway

General Conway. Mr. Chairman, Congressman Young and
distinguished members of the committee, thank you for the
opportunity to report to you on the posture of your Marine
Corps. My pledge, as always, is to provide you with a candid
and honest assessment and it is in that spirit that I appear
before you today.
Our number one priority remains your Marines in combat.
Since testimony before your committee last year, progress in
the Al Anbar province in Iraq continues to be significant.
Indeed, our Marines are in the early phases of the most long
awaited phase of operations, redeployment of the force, and a
reset of our equipment. Having recently returned from a trip to
theater, I am pleased to report to you that the magnificent
performance of our Marines and Sailors in Anbar continues
across a whole spectrum of tasks and responsibilities.
In Afghanistan, we have substantially another story as thus
far in 2009 the Taliban have again increased their activity.
The 2nd Marine Expeditionary Brigade and Air Ground Task Force
numbering more than 10,000 Marines and Sailors has just assumed
responsibility for its battle space under Regional Command
South. They are operating primarily in the Helmand Province,
where 93 percent of the country's opium is harvested and where
the Taliban have been most active. We are maintaining an effort
to get every Marine to the fight and today more than 70 percent
of your Marine Corps has done so. Yet our force remains
resilient in spite of an average deployment to dwell that is
slightly better than one to one in most occupational
specialties. We believe retention is a great indicator of the
morale of the force and the support of our families. By the
halfway point of this fiscal year, we had already met our
retention goals for our first-term Marines and for our career
force.
Our growth in the active component by 27,000 additional
Marines has proceeded 2\1/2\ years ahead of schedule with no
change to our standards. We have reached the level of 202,100
Marines and have found it necessary to throttle back our
recruiting efforts. We attribute our accelerated growth to four
factors: quality recruiting, exceptional retention levels,
reduced attrition, and not least a great generation of young
Americans who wish to serve their country in wartime. Our Corps
is deeply committed to the care and welfare of the wounded and
their families. The Wounded Warrior Regiment reflects this
commitment. We seek through all phases of recovery to assist in
the rehabilitation and transition of our wounded, injured and
ill, and their families. I would also like to thank those of
you on the committee who have set aside your personal time to
visit with our wounded warriors.
Secretary Gates seeks to create a balanced U.S. Military
through the efforts of the Quadrennial Defense Review. We have
always believed that the Marine Corps has to be able to play
both ways, to be a two-fisted fighter. Our equipment and major
programs reflect our equipment to be flexible in the face of
uncertainty, that is to say 100 percent of USMC procurement can
be employed either in a hybrid conflict or in major combat. If
this Nation decides through the QDR that it still needs a
forcible entry capability, and we tend to think that it does,
then we believe based on the threat and risk to the ships of
the United States Navy that the requirement for a platform with
the capabilities of the expeditionary fighting vehicle is
absolutely essential. And it has my personal attention, sir.
The future posture of our Corps includes a realignment of
Marine forces in the Pacific. As part of the agreement between
Tokyo and Washington, we are planning the movement of 8,000
Marines off Okinawa to Guam. We support this move. However, we
believe the development of training areas and ranges on Guam
and the adjoining islands in the Marianas are key prerequisites
for the realignment of our forces. We are actively working
within the Department of Defense to align USMC requirements
with ongoing environmental assessments and political
agreements.
On behalf of your Marine Corps, I extend my gratitude for
the support that we have received to date. Our great young
patriots have performed magnificently and have written their
own page in history. They know as they go into harm's way that
their fellow Americans are behind them. On their behalf, I
thank you for your enduring support. We pledge to spend wisely
every dollar you generously provide in ways that contribute to
the defense of this great land.
Thank you once again for the opportunity to report to you
today, sir, and I look forward to your questions.
[The statement of General Conway follows:]

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Remarks of Mr. Murtha

Mr. Murtha. Well, one of the things, Mr. Secretary, that I
have harped on over and over again is the fact that we
constantly send out RFPs and those RFPs are unrealistically
low, either having too great a number that the Navy or Air
Force or one of the services asked for or they have an
underestimated price. I know I saw in your biography that you
ran a company out of bankruptcy in a short period of time. I
think it would be a little more difficult just because of the
size of the forces but we want to work with you in order to try
to get more realistic appraisals because we have done so much
research, the Secretary had to cancel a couple of programs
before the research was made, which is lost. We may disagree
with him about those and see if we can't salvage part of it,
but you are going to have a tough time making sure that the
services are realistic and then the companies don't underbid
this. So you are going to have a very tough job.
And for the Commandant, there is a list of questions in
here about your vehicle. We know we got the first report, but
if nobody asks the questions, I would hope you would look at
those questions and send me a personal answer to the questions
about the new vehicle.
Mr. Young.

LITTORAL COMBAT SHIP

Mr. Young. Mr. Chairman, first, I wanted to say to the
Secretary congratulations on your assignment. I think you have
a very unique opportunity to deal with some just outstanding
men and women in the United States Navy and the United States
Marine Corps. And I have known a lot of secretaries of the
Navy, and I can tell you they are all very, very proud of the
services that they represent. So I thank you for being willing
to accept that responsibility and I look forward to working
with you as we provide whatever it is that our Navy and Marine
Corps need.
On the issue of ships, and of course, that is a big issue
for the Navy and for the Marines, of course, because Marines
use ships to get there, the Sailors and the Marines have some
banter back and forth on who does what as far as the mission
that they are assigned to, and it is good natured and it is
probably morale producing in a positive way. But on ships, LCS,
littoral combat ships, have been a very big item for the Navy
now for some time. The program has run into some difficulty. My
understanding is that in order to keep on schedule, you need 55
LCS ships. We only had one delivered. One was delivered late
last year. When do you expect the other to be delivered, the
number two?
Mr. Mabus. Sir, the first one has just finished sea trials,
and it has gotten back in, and those sea trials while
preliminary results are back, indicate that they went very
well. The second one is still in the shipyard but has lit off
both engines, is doing the testing that it needs inside the
shipyard. The follow-on ships, numbers 3 and 4, are being
produced now and in the fiscal year 2010 budget, we are asking
for funds for three more of these LCSs. LCS, as Admiral
Roughead has said on many occasions, is very important to the
future of our Navy. He pointed out before the hearing that it
is a program that has brought from idea to implementation in
about half the time that Navy ships normally require.
As we move from the first ship of the line further into the
follow-on ships, we are seeing costs go down. We are looking at
common components. We are looking at ways to continue to drive
the costs down, but I think you will see the next ship, which
is the first of its class--as you know, there are two LCSs
right now--I think you will see it delivered in relatively
short order and the follow-on ships on schedule and with the
costs continuing to decline.
Mr. Young. Mr. Secretary, what difference do you expect to
see in LCS number 4 compared to what you have in the LCS 1?
Mr. Mabus. One of the ways that we are trying to lower the
cost is to stop the requirements creep, to make the
requirements standard, uniform, and not to continually change
requirements during construction. The main change from number 1
to number 4 is a reduction in cost and a speedup in schedule of
getting those ships. Number 1, as you know and number 4 are two
different hull types, and so I think you will see the unique
capabilities of both of those LCS ships.
Mr. Young. And what about the capability? Do you see
increased capability with each ship, or will you pretty much
have a common ship as when it comes to the capability of each
individual vessel?
Mr. Mabus. The two different LCSs, each offer unique
capabilities, both of which right now the Navy thinks is
important for the future of the fleet. One of the unique things
about LCS that gives it much greater flexibility in the future
in terms of capabilities is the modules that you can put on
there, the weapons systems and different modules that can be
placed on the ships so you have got the hull ready to go, you
have got the propulsion system, you have got the platform, and
you can put different weapons systems, and as you get new
technologies, you can incorporate it without building a whole
new platform.
Mr. Young. Mr. Secretary, thank you.
Mr. Chairman, because of good attendance here today, I am
going to put off my next series of questions, but I want to
talk about the F-18 and the Navy's approach to the F-18 as it
differs from the Marine Corps approach to the F-18, but I will
do that on a second round. So I will yield back at this time.
Mr. Murtha. Mr. Dicks.

DEPOT MAINTENANCE

Mr. Dicks. I want to welcome Admiral Roughead, Secretary
Mabus, and the Commandant. I appreciate all your good work and
service.
The Navy has budgeted nearly $5.3 billion for ship depot
maintenance in fiscal year 2010. Additionally, the Navy's
unfunded requirement list contains only two items, ship and
aircraft depot maintenance, requesting an additional $200
million for ships and I think $195 million for aviation depot
maintenance. This would be on the unfunded list. Is there a
risk here if we don't fund those two items?
Admiral Roughead. Yes, sir. That is the unfunded list that
I submitted. And we normally----
Mr. Dicks. Secretary Gates, I take it, approved your
unfunded list?
Admiral Roughead. We had a good discussion about our
unfunded requirements. And I would say that what we have done
over the years, Mr. Dicks, is we do not normally fund
maintenance up to 100 percent. As we work to balance and make
sure that we are covering all of our requirements it is not
uncommon for us to lay in the maintenance money about where we
did this year. When I was asked by the Congress to provide
unfunded requirements, it was in the area of maintenance that I
said if I had another dollar to spend, I would put it into
maintenance. So those numbers would bring us up to----
Mr. Murtha. What is the figure?
Mr. Dicks. $5.3 billion.
Mr. Murtha. Shortfall?
Admiral Roughead. No.
Mr. Dicks. $200 million.
Admiral Roughead. It is $200 million in maintenance. It is
funded to about 96 percent of what we considered the amount to
be.
Mr. Dicks. And aviation depot maintenance is at $195
million shortfall.
Admiral Roughead. Right. And that is at about 87 percent.
And that is consistent with where we have been over the years.
So when I had the opportunity to address the unfunded issues, I
put that in there because that would remove the maintenance
risk. But maintenance risk is important to us, Mr. Dicks, and
one of the things I think is important, as I mentioned in my
opening statement, is that several years ago, we walked away
from engineering approach to maintenance requirements in our
conventional surface ships and that was a mistake, and this
year we put that back in. I think it will be good for the Fleet
because they will be able to better assess what the maintenance
requirements are. I believe that it will be better for our
maintenance activities, both public and private yards, because
they will then be able to see what the requirements are going
to be out into the future, and it will all be based on an
engineering approach.
Mr. Dicks. Does the fiscal year 2010-based budget have
sufficient funding to cover the maintenance requirement for
repair of the USS NEW ORLEANS and the USS HARTFORD as well as
provide for your planned maintenance requirements in the
absence of additional funding? I mean, has this changed this at
all, these----
Admiral Roughead. The HARTFORD and the NEW ORLEANS and the
PORT ROYAL were accidents that occurred this year, and those
are adjustments that we are going to have to make as we work
our way through our maintenance accounts. But those were
unfortunate accidents that will cost us.
Mr. Visclosky. If the gentleman would yield for one second.
Mr. Dicks. Of course.
Mr. Visclosky. Talking about working through that, if you
have a shortfall of about $200 million for '10, my
understanding is given a supplemental request, you would still
be short $452 million in '09. So your shortfall on maintenance
is about 652. Where will you find that money?
Admiral Roughead. That is where we will go in and see how
we can balance our maintenance accounts. We have not cancelled
any maintenance availabilities this year. In some instances we
can adjust the scope of the maintenance, but that is the way
that we will work our way through the maintenance account, sir.

MISSION FUNDING

Mr. Dicks. If I can go back, even with mission funding,
because mission funding, we took a leap of faith, and I went
along with the Navy on this, when you change the way you do
your accounting and sometimes if you don't have a clear picture
of what it is, you are going to be short if you have mission
funding. That means that something isn't going to get done
unless Congress comes up with a supplemental appropriations
bill. So I just hope that if we have got a problem that before
the committee marks up for the fiscal year 2010 budget that we
would know about that so we could take some action. It is on
your unfunded list. I realize that.
Admiral Roughead. Yes, sir.

SUBMARINES

Mr. Dicks. Let me ask one further question. The President
has been very clear in his intention to reduce the number of
nuclear weapons in the U.S. inventory in the next four years.
The ongoing Nuclear Posture Review will help inform the risk
calculus in moving this Presidential initiative forward and
serve as a regulator on the pace of change in this area.
Now, if we were going to reduce the number of Trident
submarines, for example, would there be any consideration given
to converting them to SSGN since I believe the SSGN program has
been extraordinarily successful, or are these submarines now
too old to be converted and have a 20- or 30-year lifetime to
justify the conversion?
Admiral Roughead. Where we are right now is the Ballistic
Missile Submarine Force that we have is--even though we have
yet to go through the Nuclear Posture Review (NPR), it remains
the significant leg of our nuclear capabilities. So with regard
to the OHIO class, I believe we are going to see the OHIO class
submarines through their entire life. The four SSGNs that we
have we are now beginning to get some usage and some lessons
out of those ships. But also in this budget, which is very
critical, is the replacement--beginning with the replacement
costs for the follow on to the OHIO. Now is the time to start
that. We are about in the window where we were when we began
the design of the OHIO class. I believe the NPR will inform the
number of ships that will be in that class. I think that is an
important element of the NPR that will take place. But now is
the time and the money in this 2010 budget is key to the
replacement for the OHIO submarine, sir.
Mr. Dicks. So you think we will keep the remaining 14
Tridents, maybe we will do some other way of reducing the
number of warheads or----
Admiral Roughead. Sir, I think the number of launch
platforms and warheads are related, but they do not become so
interdependent until you drop to a certain number, and the
flexibility that the Nation gets from the current fleet of OHIO
submarines I believe will remain.
Mr. Dicks. Thank you.
Thank you, Mr. Chairman.
Mr. Murtha. Mr. Frelinghuysen.

SHORTFALLS

Mr. Frelinghuysen. Thank you, Mr. Chairman. Thank you
gentlemen for your service. I held my academy night on Monday
night. This is not where we interview young men and women, but
not surprisingly, perhaps due to the economy, but certainly
there is an element of patriotism there. We had some of the
highest numbers we have ever had of freshmen, sophomores, and
juniors, and many obviously want to go to the Naval Academy and
they want the Marine Corps option. They want to be Navy SEALs.
So I thought I would put a good plug in there. There are a lot
of young people that you represent and potentially represent
that are ready to stand up and serve.
I would sort of like to get to the question of some of the
Navy's shortfalls. I know there are shortfalls and there are
shortfalls, but there are some shortfalls on the domestic front
here that affected your ability, Admiral, for cruises to keep
our Sailors up to speed. Those who are trying to improve their
flying ability, they need more flying hours. Can you talk a
little bit about what is out there, why that has occurred, and
what you are doing to remedy it?
Admiral Roughead. Yes, sir. As we have moved into the
latter part of this fiscal year, we are, as I said, operating
the Navy at a pretty significant pace. The Navy is globally
deployed. It is not just in the Middle East, but in the Western
Pacific we are very busy. The pace of operations in the Central
Command is high. And on top of that we have experienced
extraordinary retention figures and lack of attrition in the
force, and so I have been driven for example in the manpower
account to where making payroll has become critical, and
without the overseas contingency operation funding, the most
prudent thing to do was to throttle back on some of the
activity that we had going on. I did not short any of the
operations that are taking place forward in the Middle East,
but I have cut back on the nondeployed operations while I wait
the overseas contingency operations.
Mr. Frelinghuysen. But the throttling back means obviously
the time that people will be flying, the time that people will
be cruising, honing their skills. It sort of begs the question
we often used to hear is that when those guys and gals are
ready to go, will they be ready in every way to go?
Admiral Roughead. Right. And what we----
Mr. Frelinghuysen. I gather you have discontinued retention
bonuses, I assume, because of this situation.
Admiral Roughead. I cut back on retention bonuses in those
areas where our retention did not demand that we needed to
incentivize that retention behavior. So we have cut back on
those. We have retained those in the areas where we believe we
still need the bonuses. But this was all a function of really
overexecuting on payroll because of the economic situation and
the desire that our Sailors have to serve, and I am managing to
my budget, as anyone who is a good steward of the public money
is expected to do. So by throttling back on that, we have had
to make some adjustments as we await the supplemental.
Mr. Frelinghuysen. Often when I have asked that questions
to others, people say, well, there are ways to simulate these
types of experiences. But obviously flying is flying, sea duty
is sea duty. And I would assume that these are all issues that
you are taking into consideration.
Admiral Roughead. Absolutely, sir. The readiness of the
force, maintaining that force in a ready status is key. We do
make good use of simulation, but there is nothing that compares
to going out and doing it on the ocean, in the air, and under
the ocean. And as we have monitored our readiness we have made
these adjustments. I am comfortable with where we are, but the
importance of getting the supplemental is key so that we can
get back into what I would call a less constrained mode of
operation.
Mr. Frelinghuysen. Okay.
Thank you, Mr. Chairman.
Mr. Murtha. Mr. Visclosky.

SHIPBUILDING

Mr. Visclosky. Thank you, Mr. Chairman.
Mr. Secretary, let me ask you about shipbuilding and the
outyears because it is my understanding we are still talking
about a 313-ship Navy.
Mr. Mabus. Yes, sir.
Mr. Visclosky. And I would acknowledge that given the
contracts signed that you will be constructing two submarines a
year and would also acknowledge your request for 2010 includes
eight ships. That is clearly an improvement. We are moving in
the right direction. But if you also look at the projections as
to when we are going to get to where we need to be, it is now
2019, and those outyears keep slipping. When do you anticipate
we are going to start meeting the need as far as that 313 mark
for ship construction? This is my annual question for the last
decade under several administrations for both parties, but I
ask it in all earnestness. It is a very serious issue.
Mr. Mabus. I think it is a good first step, the fiscal year
2010--or a good step, not the first step, a good step in the
fiscal year 2010 budget that we are requesting eight ships of
various kinds, as you pointed out. I also think that the
ongoing Quadrennial Defense Review that is happening right now
is going to inform us in terms of types of ships, in terms of
quantities that are needed for the future Navy. The CNO has
often said that he sees the 313-ship Navy as a floor and not a
ceiling, and I think that we have to work diligently toward
that. And in my opening statement and my answer to an earlier
question, I think one of the ways we get there is to work very
earnestly and hard in terms of bringing down costs of these
ships because as schedules keep pushing out, as costs keep
going up, as a very necessary result of that, numbers tend to
go down. And if we are going to reach that goal that we all
have, we are going to have to make sure that costs stay within
reason and that our schedules are not allowed to slip to the
extent that they have in the past.

LEASING OF FOREIGN-BUILT SHIPS

Mr. Visclosky. I appreciate hearing that because the
committee has had hearings simply on the costs of ship
building, change orders, and other problems that have been
faced. And to the extent you can reduce a unit cost, if you
would, obviously that would help us along and I think everyone
on the committee would to be helpful in that regard too.
If I could ask on the leasing of foreign-built ships, it is
my belief that the Navy is not within the spirit, if you would,
and the intent of the 1990 Budget Enforcement Act as far as
leasing, and I am just wondering what is the plan that's Navy
plans to reduce the number of foreign built ships that they
lease.
Mr. Mabus. I can ask on one specific thing and that is the
Joint High Speed Vessel that we are leasing ships now in that
class of ship. And we have one Joint High Speed Vessel in the
fiscal year 2010 budget and it is our plan on that class of
ship to ramp up production in the U.S. to build those ships and
to move the leased ships out and to move U.S. Government ships
in to replace those.
Admiral Roughead has a better idea in terms of other leased
ships than I do.
Admiral Roughead. Sir, if I recall, I believe right now we
have 14 foreign built ships under lease, and all of those ships
are compliant with the appropriate regulations. And it is my
understanding that in the solicitation, there were no U.S.
built ships that were offered up. So, I mean we do open the
competition and it is just a question of those that respond to
that solicitation, but we are very mindful of that and----
Mr. Visclosky. Why do you think that is?
Admiral Roughead. I would offer my personal opinion, and
that is that we simply do not have the U.S. built fleet that is
able to respond to these solicitations.
Mr. Visclosky. And that is my concern, and I am not
personally or professionally blaming you for it, but it is that
classic chicken and egg, that as the Navy has leased foreign
vessels and we look overseas and then shipyards close, suddenly
it is a self-fulfilling prophecy and now we have people not
bidding because they don't have the ability to build. And I
think we have some real responsibility to look at that
industrial base and our citizens having those jobs for our
national defense. I just think it is a very important
principle.
Admiral Roughead. I agree, sir. And I think that the notion
that we are a maritime nation is something that goes beyond the
Navy. I believe that we should not lose sight of the fact that
we are tied to the oceans and that we, as a maritime nation,
have to look at it holistically and do all we can to encourage
that level of interest that you described.
Mr. Visclosky. And I would encourage you. And, gentlemen,
thank you very much.
Thank you, Mr. Chairman.

THE ``JONES ACT''

Mr. Murtha. Chief, we put in $60 million last year for the
Jones Act, which helps commercial building. Does that help the
Navy also? Does that help shipbuilding in the United States? It
translates into big money, as I understand it.
Admiral Roughead. Yes, sir. I would like to take that
question for the record to make sure--if there is any financial
effect. But clearly it would seem to me that should there be
growth in application of that money in our shipyards, in our
Nation's shipyards, then that would mean that's overhead would
be coming down and----
Mr. Murtha. For example, San Diego gets those commercial
ships as well as Navy ships; right? So it's not a help in
situations like that.
Admiral Roughead. Right. But it also brings overhead down.
[The information follows:]

The Maritime Loan Guarantee Program was established pursuant to
Title XI of the Merchant Marine Act of 1936 (the ``Jones Act'') and
provides commercial shipbuilders a full faith and credit guarantee by
the U.S. Government of debt obligations on commercial bank loans.
Commercial shipbuilders may use this funding to help finance new ships
built in U.S. yards, or to finance capital improvements that modernize
and upgrade shipyard infrastructure.
There is no mandate that Jones Act funding be awarded for the
construction of ships with military utility. The U.S. Department of
Transportation's Maritime Administration (MARAD), which administers
Jones Act funding for the Department of Navy, allocates loan guarantees
solely on financial viability. It is possible that Navy could benefit
from Jones Act funding if commercial shipyards that also build Navy
ships reduce overhead costs and improve their infrastructure as a
result of receiving Jones Act funding.

Mr. Murtha. Mr. Kingston.

RIVERINE MISSION

Mr. Kingston. Thank you, Mr. Chairman.
Admiral Roughead, I wanted to ask you about the riverine
mission and what your vision is for expanded capacity, and
maybe just talk to the committee a little bit about how
important they are to irregular warfare that is----
Admiral Roughead. Yes, sir. And thank you for that
question. As you know, we established or reestablished a
riverine force a couple of years ago. We had a significant one
in Vietnam. We did away with it. And then we brought a riverine
capability back, and our Sailors who are in that riverine force
are doing extraordinary work in Iraq guarding some critical
infrastructure and should that infrastructure be attacked, it
would have devastating consequences. And I can't say enough
about the great work they are doing.
The other thing I have done with regard to riverine and
what we call our Navy Expeditionary Combat Command, which has
our SEABEES, our EOD, riverine, and other expeditionary types
of capabilities, is this years budget for the first time brings
that capability--a bigger part of it into the base budget. We
had been running that capability on supplemental money, which
was to me a huge mistake. So we brought that into the base.
I have also, in order to expand the knowledge base of the
riverine force, have reached out to some of my foreign
counterparts and we are working with getting the riverine force
into environments that are different than Iraq or different
than in the United States. When I went out and for the first
time we did a force structure analysis of that capability. We
went to every Combatant Commander so we could get their input
to give us a better idea of what we have to go grow in the
future. So I think we have made some very positive,
significant, substantive steps to better size, better resource,
and better shape that force for the future. But in the input
that we have received back from the Combatant Commanders, the
size of the riverine force that is being demanded right now is
what we have. That said, we are going to continue to look at
it. We are going to continue to explore other areas of
operations, and that will inform where we go in the future.
Mr. Kingston. What is the size right now?
Admiral Roughead. The size of the riverine force is we have
three squadrons. They are on a very tight deployment schedule
to Iraq but we are not getting the demands out of the other
Combatant Commanders yet. So the force is doing quite well and
I am very proud of the work that they do.
Mr. Kingston. Thank you.
Thank you, Mr. Chairman.
Mr. Murtha. Ms. Kaptur.

REMARKS OF MS. KAPTUR

Ms. Kaptur. Thank you, Mr. Chairman and thank you gentlemen
for your service to our country. Welcome, Secretary Mabus. Good
to have you here. General Conway, Admiral Roughead.
There is just so much to ask. I began my week this week
with a phone call with several other members, Governors and
Senators, from the head of General Motors informing us of the
number of plant closures that would be occurring in our country
and the tens of thousands of Americans that will become
unemployed. One of the--and I note the increasing number of
those you are able to recruit because of the fallout in the
commercial economy of this country. One of the issues we got
into in that phone call was the lack of certain technologies
that have caused our country to fall behind, certainly in the
area of energy production, and we got into the issue of
batteries. And General Conway, I am looking at you because of
the Expeditionary Fighting Vehicle and thinking about the
various investments that people of the United States make in
the Department of Defense in the national interest and
wondering about the lack of our ability to successfully
transfer to the commercial sector when it is obviously so
vitally needed.
Secretary Mabus, I was glad to see you mention briefly in
your testimony something about energy efficiency. I like the
term ``energy independence'' again for America. And I would
like to ask each of you gentlemen, the President campaigned on
this issue when Congress passed the recovery bill. Energy
independence was one of the three top priorities in addition to
broadband and health information systems that were laid out for
the Nation. As you look at your responsibilities, how do you
think about helping our Nation domestically become energy
independent again and transferring some of the knowledge that
is being developed under your watch to help our country when it
is so vitally needed? And you can talk about projects that may
be underway for power-train development for your various
systems, new types of energy production whether they be
cryogenic hydrogen, cellulosic ethanol, biofuels of different
kinds, advanced solar. I would be very interested to hear how
you think about this because I can tell you that this country
would be a much weaker Nation defense-wise if we do not have a
strong transportation infrastructure in this country.
General Conway. I will start now, ma'am, and say that we
have been doing experimentation for some time now with what we
call our supporting establishments, our bases and stations. And
in fact, we have an experiment underway at this point with two
bases that are attempting to be zero energy in terms of their
requirements outside the wire. Both in Southern California. One
with wind turbine, the other pretty much with solar power. And
thus far, the results have been fairly optimistic. We are
encouraged by what we see. How much that will, I will say,
transport to other bases and stations outside Southern
California (SOCAL), of course, remains to be seen.
But we ask ourselves as an expeditionary force, why can't
we transfer some of that to our operational forces? And being
green is a part of it, of course, but being lighter and more
expeditionary is the true objective here. We are holding a
conference here at Quantico in the next few weeks on this very
issue. Can we have some sort of alternative power to lighten
our load with batteries? Batteries are very heavy. Batteries
wear out and you need more batteries. The same with fuels, the
same with lighter weight ammunition components, those types of
things to be able to lighten our load and at the same time
conserve our resources.
Ms. Kaptur. Is there anyone that--obviously, we have the
Secretary of the Navy here. Is there someone within the
Department charged with thinking about this and linking across
this massive agency and the massive number of units and massive
number of research projects as you look at your own department?
Is there a reporting structure on energy independence within
DOD?
Mr. Mabus. I know that energy independence inside DOD is
one of the top priorities. And in my confirmation hearing I did
talk about energy independence for the Navy and the Marine
Corps in particular. To give you a very concise answer to your
particular question, I don't know.
Ms. Kaptur. That's honest.
Mr. Mabus. But I will find out and will be happy to let you
know what I do find out. In terms of the Navy and the Marine
Corps, some of the things that I have been thinking about in
talking with the CNO and the Commandant about, the Commandant
mentioned onshore continental U.S. bases. Right now the Navy
and Marine Corps are producing about 17 percent of the energy
that we need from alternative sources, which is good but can be
a lot better. The second thing is in noncombat operations, we
buy a lot of vehicles and we can certainly work to buy vehicles
that are alternate fuel vehicles, that are American vehicles,
that can hopefully help some of the jobs that you were talking
about. And, third, as the Commandant also said, in our deployed
forces, ships, airplanes, ground vehicles, we have got to look
at alternative energy sources both from an operational
standpoint, as the Commandant pointed out and as the CNO has
spoken of, but also to cut our dependence on sources of energy
that are doubtful or can be interrupted. And operationally, I
know that our ships that we are building and are building for
the future are taking more and more energy all the time to run.
And so just operationally being tied so closely to an oiler,
for example, gives you less flexibility. So that is one of the
areas that I hope during my tenure here that I can work on very
hard with the Congress very closely.
Ms. Kaptur. Mr. Secretary, I, along with many members of
this committee and Congress, support you in those efforts. And
I have seen some of the Marine vehicles coming off one of the
lines at General Dynamics that builds the Abrams tank near my
district. And I have looked at some of the new vehicles coming
off the line and I am thinking to myself you mean we can't take
this and make it better and more fuel efficient and more energy
independent and move the knowledge up into the commercial
sector 50 miles up the road? What is wrong with us? If we can
do the Abrams tank, which is an unbelievable vehicle, if we can
do all this and yet we can't beat the Japanese or the Chinese
in terms of fuel efficiency and fuel systems? And I would just
urge you, Mr. Secretary, to devote time to this. If you need
funds to place people at DOD or to transfer people who think
about this on a regular basis, my sense is for a very long time
it has been happenstance and it is not a real commitment,
although we spend enormous amounts on research. And it just
doesn't seem to--I think your statement is honest. The vehicles
that come out use more fuel. We become more vulnerable rather
than less vulnerable. Someone over there has got to be charged
with thinking about this a lot and filtering it down through
the Department, which is so huge. Thank you.
Thank you, Mr. Chairman.
[The information follows:]

Question. Is there anyone that--obviously, we have the Secretary of
the Navy here. Is there someone within the Department charged with
thinking about this and linking across this massive agency and the
massive number of units and massive number of research projects as you
look at your own department? Is there a reporting structure on energy
independence within DOD?
Answer. Representative Kaptur, I intend to make seeking smart
energy solutions, achieving greater energy dependence, and being good
stewards of the environment top priorities during my time as the
Secretary of the Navy. I have directed a review of all related
activities inside the Department and am now in the process of
formulating plans and objectives to guide our efforts to pursue both
expanded and new renewable energy solutions and to decrease
dramatically energy usage across the Department. As these plans have
not yet been fully developed, let me now tell you the current state of
the reporting structure inside the Department of the Navy (DON).
The Department of the Navy currently provides energy oversight
through the Navy Energy Policy Office under the Deputy Assistant
Secretary of the Navy (Installations and Facilities). The Office of
Naval Research (ONR) provides Science and Technology support for both
Navy and Marine Corps research and development. In December 2008, the
Chief of Naval Operations established Task Force Energy (TFE) and the
Navy Energy Coordination Office (NECO) to provide operational energy
plans and programs for Navy. As part of its responsibility, NECO works
with ONR and the major Navy systems commands (e.g. Naval Sea Systems
Command, Naval Air Systems Command, Naval Expeditionary Combatant
Command, and Naval Facilities Engineering Command) to oversee all
energy related research and development.
In concert with the Office of the Secretary of Defense and in
accordance with the National Defense Authorization Act (NDAA) of 2009,
the Navy Energy Policy Office will transition into the Naval Energy
Office (NEO) within the Office of the Secretary of the Navy to align
and consolidate these functions within DON and its components to
provide oversight of operational energy plans and programs (to include
research and development) for DON.
The Naval Energy Office will provide a consolidated and
comprehensive voice for the Navy Secretariat and its operational
components. The office will also speak to Navy and Marine Corps
facilities on energy infrastructure plans and programs and roadmaps
toward energy ``security''. Moreover, NEO will bring a broad, strategic
approach to establishing policy and for overseeing programs within Navy
and Marine Corps, as well as coordinating within Department of Defense
(DOD) and with other federal agencies on their respective energy
initiatives and investments. The Naval Energy strategic plan and
roadmap includes sections for energy R&D addressing mobility fuels and
electrical grid security.
There is also a reporting structure on energy within DOD. The
Principal Deputy, Director Defense Research and Engineering is
currently lead for the DOD Energy Security Task Force. DOD reporting
requirements for energy initiatives, such as those resourced through
the American Reinvestment and Recovery Act of 2009, are coordinated
through this office. In accordance with Section 902 of the National
Defense Authorization Act (NDAA) for Fiscal Year 2009, the Office of
the Secretary of Defense will establish a Director of Operational
Energy Plans and Programs (DOEP&P) as the principal advisor to the
Secretary of Defense regarding operational energy plans and programs
and the principal policy official within the senior management of DOD
regarding operational energy plans and programs.
Representative Kaptur, based on my ongoing review, I may make
further changes to the current energy oversight and reporting
structure. Under any circumstances, however, I look forward to working
with you and the Committee toward the goal of a ``green'' and energy
efficient Department of the Navy.

Mr. Murtha. Ms. Granger.

MV-22 OSPREY

Ms. Granger. Thank you.
Mr. Secretary, thank you for being with us and thank you
for the job you are doing. And to Admiral Roughead and General
Conway, thank you for your service and being here to answer
some questions.
To the Commandant I have a question. The MV-22 will be
going into Afghanistan in October. Tell me and tell this
committee what capabilities we brought with the Osprey and what
difference it will make in Afghanistan.
General Conway. Yes, ma'am. Well, we think it will make a
huge difference over and above our current medium lift
helicopter. We have had three now successful deployments to
Iraq where in every instance, the aircraft I think it is fair
to say exceeded our expectations. There is currently a squadron
aboard ship, aboard the Marine Expeditionary Unit, that will be
shortly headed into the theater, into CENTCOM, and the aircraft
will be available for use there when that (ARG/MEU) Amphibious
Readiness Group/Marine Expeditionary Unit arrives. The aircraft
basically, ma'am, gives you at least twice the capability of
our current medium-lift helicopter, the CH-46.
In fact, you will find very few CH-46s in Afghanistan today
because although the aircraft was created to carry as many as
18 combat-loaded Marines, elevations and temperatures in the
summer in particular put the lift at about five or six combat-
loaded Marines. So we have been forced to cycle CH-53s in to
serve, in many cases, what our medium helicopter ought to be
able to do. Three times the range, five times the payload,
twice the speed, cruises at 13,000 feet, comes out of a zone
like a rocket ship and can stop abruptly over a zone to come
back into place. Our challenge at this point is to stop
thinking about it as a helicopter and think about it as
something else in terms of its operational capacity, and that
is a pleasant problem to have.

JOINT STRIKE FIGHTER

Ms. Granger. It is. It took a long time coming, but it has
enormous capabilities and possibilities.
My other question is to the Commandant and to the Admiral.
Both of you have expressed strong concerns about the shortfall
in the Joint Strike Fighter. So what I would like to know is
how important that is that we keep on track with that to the
operations of the Navy and Marines and even accelerate that?
What difference is it going to make and what can we do to help
that?
Admiral Roughead. Well, in our budget, ma'am, we have the
four essentially test articles for the Navy variant. We, as a
service, are the last ones to get Joint Strike Fighter, and
Joint Strike Fighter is extraordinarily important to t our
future and naval aviation. The importance of getting on with
the program is key, and I am pleased that we have those
airplanes in this budget so that that we can move on toward
that. We need that airplane because as our Hornets are aging,
we have to make sure that we can provide the number of
airplanes on our carrier decks that we need and keeping Joint
Strike Fighter on track is absolutely key.
General Conway. Ma'am, we are the first to field the Joint
Strike Fighter of all the services in 2012. We bought our last
fixed wing attack aircraft in 1998. That is 14 years of waiting
for a fifth generation kind of capability that we think we will
desperately need in the future. Now we have ridden hard our F-
18s A through D. We are in the process of trying to get 10,000
hours now out of those aircraft to bridge that gap and mitigate
the risks that we see. Our venerable Harriers are doing great
work for us as well both in Iraq and in Afghanistan. But there
is some risk and we are emphatic with the vendor that we cannot
afford a delay past 2012. We want those aircraft on time and on
delivery.
Ms. Granger. Good. We will try to help you make that
happen. Thank you very much.
Thank you, Mr. Chairman.
Mr. Murtha. Mr. Moran.

IRREGULAR WARFARE

Mr. Moran. Thank you, Mr. Chairman.
It is nice to see you, Mr. Secretary. It is good to see
your colleagues in uniform, but I haven't seen Mr. Mabus for a
long time.
I want to ask about irregular warfare because this past
December the Deputy Secretary of Defense issued guidance that
was DOD Directive 3000.07 and it elevated the importance of
irregular warfare to be as strategically important as
traditional warfare. The policy requires that the department
integrate irregular warfare concepts and capabilities into
doctrine, organization, training, material, leadership,
personnel, and facilities. The Army and the Marine Corps have
de facto changed doctrine and training due to their prolonged
intense involvement in Iraq and Afghanistan, but the Navy's
planning and curricula have not changed.
So I want to ask how has their irregular warfare concept
been--because there was a directive--how is it reflected in the
2010 budget request? Is the Navy doing anything to revise
doctrine, organization, training, material, leadership,
personnel, and facilities to reflect a sharpened focus on
irregular warfare as the Secretary instructed and as the Army
and Marine Corps complied? So I was going to ask that of
Secretary Mabus, but if that is not fair, I will ask that of
the Admiral and the General.
Mr. Mabus. With your permission, sir, I will give that to
the----
Mr. Moran. I had a suspicion.
Admiral, do you want to go ahead with that? The Marine
Corps is fine; so there is no sense in putting General Conway
on the spot.
Admiral Roughead. I would be very pleased to do that. In
fact, I would say that this budget captures our contribution,
our commitment to irregular warfare quite well with three
littoral combat ships, and one Joint High Speed Vessel. Those
are new types of ships that will allow us to get into the type
of environments that I think are going to be very important.
For the first time, this budget represents taking our
expeditionary combat command, which is the Navy's core of
irregular warfare capability apart from our SEALs, and for the
first time we have pulled that into our base budget. I believe
that is a significant statement with regard to our contribution
to irregular warfare.
I would also say that our curricula at the Naval War
College has also been changed to reflect irregular warfare and
the type of environments in which we are going to operate. The
use that we have made of our amphibious ships as we go forward
and do theater security cooperation, much like we have just
finished in the Africa Partnership Station where for six months
we took one of our amphibious ships in a very different
application and worked with the nations on the west coast of
Africa on littoral maritime security issues and humanitarian
assistance.
The use of our hospital ships that has been ongoing now for
three years is also a dimension that gets into a different form
of the application of naval power. The fact that we have taken
our P-3 aircraft and used them over Iraq, as opposed to the
maritime patrol mission to which they are normally suited, is
key.
The fact that in the rescue of Captain Phillips from the
Maersk Alabama that there was an unmanned aerial vehicle
deployed from a guided missile destroyer that provided the
information, surveillance, and reconnaissance, I would say that
also is a significant statement.
The fact that for the first time in the history of the
United States Navy an unmanned autonomous vehicle took off and
landed at night from a ship is another statement. So I think we
have plenty of examples in the budget----

MRAPS

Mr. Moran. Well, you certainly do, Admiral, and you seem to
be well prepared for that. But I am informed that the training
has not been altered in the way it has with the Marine Corps
and the Army. You are fully prepared for that so we can pursue.
I do have one other question I wanted to ask, and that is
with regard to the MRAPs. The committee is proud that it
provided the funding for that because there have been far fewer
IED deaths. But it is too big for Iraqi city streets and many
bridges and adverse terrain. And now that we are moving forces
into Afghanistan, with the terrain even more problematic, a
lighter and smaller and more agile form of MRAP is needed, the
all-terrain vehicle.
I would like to get some response, probably from General
Conway, in terms of what you are doing with regard to that,
because the big MRAPs in Iraq are even less practical in
Afghanistan. So how are we applying the lessons of Iraq to
Afghanistan, and are the Soldiers and Marines, do they feel
equally secure in the ATV as they did in the bigger version of
the MRAP?
General Conway. Sir, we don't have the ATV variant yet. It
is under development and looks to be available in about an
18,000-pound variant by our best information at this point.
Your analysis is right on the MRAPs for the most part that we
bought in Iraq. They were not as off-road worthy, in some cases
were too big, and we actually found our commanders going back
to Humvees in order to make their convoys effective and
accomplish their mission.
What we are doing, sir, in the Marine Corps is taking a
look at how we enhance the off-road capability of our smallest
MRAP, the Cat 1's that weigh about 38,000 pounds, and we have
successfully moved the independent suspension of our 7-ton
trucks onto those MRAPs. It gives them a tremendous off-road
capability. The terrain we are operating in in the south is not
as nasty as it is in the north and the east where some Army
components are. We are not operating off the spine of a
mountain with those vehicles. It is high desert. And in fact it
is pretty well-suited.
In fact, my visit there, about six weeks ago now, showed me
that the most popular vehicle currently in Afghanistan is the
7-ton truck, is the MTVR. So we can rapidly transition those
vehicles. It gives us a promise for the rest of the fleet in
future use of MRAPs in the Marine Corps. We can do it sooner so
we can protect our Marines more rapidly. And we can do it much
cheaper than what we can with the MATV arriving. I think we
will still buy some MATVs. We see a need to replace some of our
Humvees, but not nearly at the scope and scale, I think, that
we originally envisioned.
Mr. Moran. My fuel conscious colleague has requested that I
ask what miles per gallon do you get on those.
General Conway. On the Cat 1 MRAPs?
Mr. Moran. Yes.
General Conway. It is not real good, sir. I can take it for
the record.
Mr. Moran. About a mile a gallon.
Ms. Kaptur. If my dear friend could yield, if you would,
just for a second. General, could you provide for the record
for the vehicles under your command what their fuel efficiency
is?
General Conway. Yes ma'am. I can get you a listing of each.
[The information follows:]

Answer. The fuel efficiency for vehicles in the Marine Corps
inventory is provided in the following attachment:

[GRAPHIC] [TIFF OMITTED] T6286B.059

[GRAPHIC] [TIFF OMITTED] T6286B.060

[GRAPHIC] [TIFF OMITTED] T6286B.061

[GRAPHIC] [TIFF OMITTED] T6286B.062

[GRAPHIC] [TIFF OMITTED] T6286B.063

IRREGULAR WARFARE

Mr. Dicks. Will the Chairman yield to me just for a second.
I would like to give Admiral Roughead a chance to answer the
question about training on irregular warfare. I think it was
unfair of my good friend and my Vice Chairman of Interior to
cut you off and not give you a chance to answer the question.
Mr. Moran. If the gentleman would yield momentarily. I
don't think Admiral Roughead gets his feelings hurt very
easily. But we would like to know, even if it is just for the
record, how the flying curricula has been altered to reflect
that irregular warfare directive.
Admiral Roughead. What I would say, sir, is that our
aviators have been involved in irregular campaigns for quite
some time. And it is the aircraft carrier that is in the Indian
Ocean that is providing about 46 percent; one aircraft carrier,
46 percent of the close air support supporting our troops on
the ground in Afghanistan. That same skill and competence was
demonstrated in Iraq and in so many other places. So our naval
air aviation capability coming off of our carriers, our
helicopter pilots who are flying medevac missions, who are in
support of our SEALs, are in the fight and they are doing
extraordinary work.
Mr. Dicks. But they are training to do this. They just
didn't think it up, right?
Admiral Roughead. That is part of what our curriculum is.
Mr. Murtha. So how far are these aircraft carriers from the
action.
Admiral Roughead. It is a long flight into the area of
operation.
Mr. Murtha. Refueling is a major issue not only for the Air
Force but for the Navy.
Admiral Roughead. Yes, sir. Gas, when you are flying an
airplane off an aircraft carrier, gas is the most important
thing that you think about. But I would also say with our E and
F we are able to tank the strike packages going in off of E and
F, which gives us great capability as we go into that
environment. But fixed-wing tanking is key to us.
Mr. Murtha. Mr. Boyd.
Mr. Boyd. Mr. Chairman, I will pass and come later.
Mr. Murtha. Mr. Bishop.

RESET OF EQUIPMENT

Mr. Bishop. Thank you very much. Gentlemen, welcome. And a
special welcome to you, Governor Mabus. We have some family
ties there that go back to my roots in Mississippi, so I
especially want to give you a warm welcome to the committee.
Let me just ask a question here. I understand that the war
effort in both Iraq and Afghanistan have placed an
unprecedented demand on the core ground and aviation equipment.
And thus far the committee has provided over $12 billion toward
resetting your equipment. Could you tell us what more is needed
to address the Marine Corps capacity to receive and to perform
the critical maintenance on returning equipment to Blount
Island and the Marine Corps depots, albeit Barstow?
General Conway. Sir, first of all let me thank this
committee and your Senate counterparts for the reset moneys
that have been provided to date. We have a running tally, of
course, with Afghanistan and Iraq continuing, and that bill is
about $20 billion. We received about $12 billion of that
already and we continue to receive more. Blount Island is in
fact on our unfunded priority list of things we see that we
need, because Blount Island is the focal point for arrival back
in the States on that equipment where triage essentially takes
place. And either the piece of equipment is deemed not suitable
for replacement or repair and it is junked, or we repair it at
our depots at Albany and Barstow; or, in some cases, we buy the
next-generation equipment, depending upon just the nature of
the end item.
Blount Island has more capacity at this point for
throughput than we have space for. So our unfunded priority is
associated with just enhancing the facility down there so that
our throughput can stay abreast and even be better than what we
see coming back from theater.
Mr. Murtha. Gentlemen, what is the figure we are talking
about at Blount Island?
General Conway. Sir, as I recall, our total unfunded was
$155 million to make it into what we know it needs to be.
Mr. Murtha. And how would you use that money?
General Conway. Sir, we would use it to just create space,
create a hard stand, create vehicle racks, enhance the
throughput if you will.
Mr. Murtha. This is O&M money, this is not military
construction?
General Conway. No, sir. This is military construction
money.
Mr. Murtha. Mr. Bishop.
Mr. Bishop. Continue, sir.
General Conway. That is the essence of the message,
Congressman Bishop. Thank you.
Mr. Bishop. So all of that would be done at Blount Island.
You don't need to do that at Albany or Barstow?
General Conway. Sir, Albany would be where we actually do
the repair. But Blount Island, again, is that point where the
equipment arrives and we do the analysis there. I might add we
are in the process right now of rehabilitating our Third MPS
Fleet. We have been on cycle now since about 2007. We have
rehabbed two of the three, and that third one is currently at
Blount Island undergoing that kind of evaluation and reset.
Mr. Bishop. Thank you, sir. I appreciate that very much. I,
as you probably know, represent the Albany depot.
General Conway. I was aware of that, sir.

EXPEDITIONARY FIGHTING VEHICLE (EFV) PROGRAM

Mr. Bishop. Let me talk about another perhaps sore topic,
and that is the Expeditionary Fighting Vehicle (EFV) program
and the requirements. With the initial operational capability
now projected at 2015 and full operational capability projected
at 2025, isn't that an excessive development cycle for a
program of that magnitude, and are there scenarios that will
justify the program? But the fact that we have not had a beach
assault landing in 59 years, is it possible that the EFV is no
longer necessary? And it has been suggested that the fleet
might need to operate at least 100 miles away from shore which
is, again, beyond the range of the EFV.
Have we reached a point in the debate where we should
really take a hard look at whether or not the program should
continue to go forward with the large sums of money that have
already been invested with not very much input?
General Conway. Sir, two points I would make to answer your
question. One, that precise set of questions is under review in
the Quadrennial Defense Review. And the question that has to be
asked of that review and I think of the Department of the Navy,
and ultimately of the Congress, is does this country need a
forceable entry capability. If the answer is no, then we don't
need the vehicle. If the answer is yes, then we most assuredly
need the vehicle.
With the anti-access systems that exist today really across
the globe--I mean, we saw Hezbollah, political party, knocking
down ships at 12 miles. With the anti-access systems that exist
our Navy should not go closer than about 25 miles to a
coastline with Admiral Roughead, Sailors, my Marines and his
ships.
So we have to make that determination first of all as to
whether or not there is a need for a forcible entry capability.
If the answer is yes, then we assuredly need that vehicle.
Now, in terms of the development cycle, I will tell you,
sir, we are at risk right now because right now those ships are
going closer than 25 miles. If you witness, say, the Korean
scenario that we all watch the papers for daily, there would be
a need there for Marines and ships and amphibious capability.
And we are concerned about our ability to execute those type of
things with the vehicles that we currently own. By the way, the
Chinese are building 1,500 like-vehicles to give them that
hydroplane kind of capability to close on other nations ashore.
Mr. Bishop. The design on the EFV is flat-bottom aluminum.
And of course once it hits the ground you have designed, I
think in response to some of the concerns that were raised by
the committee, an armor capacity. At what point is somebody
going to have to get out of the vehicle and strap on--bolt on
that armor while they are potentially under fire? Is that
realistic or is that going to subject our folks to more risk?
General Conway. That is a point that needs clarification.
We would not go onto a beach that has that kind of defensive
capability associated with it. We would bypass those things
with our speed and mobility presented by the EFV and the Osprey
that would be working in conjunction with such an effort. It
would be dependent upon the threats that start to appear. My
guess is it would be days or weeks, maybe hundreds of miles
inland, before we would be stationery enough for an enemy to
plot our movement and be able to use those kinds of weapon
systems against us. When that time comes, it would be about a
four to six hour evolution to strap this armor onto those
vehicles. That puts the protection on these vehicles somewhere
below an M2 Abrams tank and just above a Bradley. So we are
comfortable that we have the necessary protection.
Mr. Bishop. In the case of a Korea or any other beachhead
landing, particularly if it would be anticipated by the enemy
that there would be such, wouldn't they plant those IEDs there
well ahead of time?
General Conway. Sir, we have engineers that--we call it a
mine threat--and we have engineers that deal with that. We have
means available on a routine basis to breach minefields and
move on, again incorporating the mobility that the vehicle
gives us.
Mr. Murtha. I don't know how extensive the questions on the
record are, but we still need you to look at those because the
committee really has some questions about this particular
vehicle. Mr. Boyd.

TACTICAL AIRCRAFT

Mr. Boyd. Thank you, Mr. Chairman. I have a couple of
questions for you, Mr. Secretary. In the F-18, the 2010 budget
reduced--I have problems with this technology, Mr. Chairman. I
did earlier today.
Mr. Murtha. High-tech.
Mr. Boyd. The 2010 budget reduced the number of F-18
aircraft requested by half of what was presumed in the 2009
budget, from 18 to 9; is that correct?
Mr. Mabus. Yes, sir.
Mr. Boyd. With the looming tactical aircraft shortfall the
Navy is facing, how do you rationalize this reduced
procurement?
Mr. Mabus. Well first, as Admiral Roughead said, the Joint
Strike Fighter is crucial to the future tactical aircraft in
the Navy and Marine Corps. In terms of the Fa-18E/F, it has
been reduced. But the 31 aircraft that are requested in this
budget, which nine are the E and F and the remainder are the
Growler electronic version of the aircraft, are more than
enough to keep that line, that F-18 line going at a stable
rate. And so as the Quadrennial Defense Review looks at the
need for tactical air across the services they can make
decisions based on a capacity both for the Joint Strike
Fighter, but also a line for the F-18 that is hot, so to speak,
that has more than enough airplanes going through it to
maintain that line.
Mr. Murtha. If I can interrupt, I think what we have to
look at, Mr. Boyd, is a multiyear for the F-18. I thought we
could get there with speeding up the JSF. But they told me
prior to our hearing that the research is still going on with
the JSF and we are just not going to get there. So we are going
to have a shortfall unless we put X number, I don't know what
the figure is, but you have got to work with us, giving us a
figure so we don't have the shortfall down the road, and look
back and say, I wish we had put more in there.
Mr. Boyd. Well, Mr. Chairman I think that was the point.
You know, a year later, when the only additional information we
have is that the JSF is not coming along like we expected it
to, so we can't expect those replacements as quickly. So is it
all cost-related, budget-related, deficit-related issues? Are
those really--I mean you didn't mention that, but I assume that
that is part of the equation here.
Mr. Mabus. It is part of the equation, but it is more
related to a total look at what tactical air requirements there
are in the QDR that is going on right now. And the other part
of this is the Navy/Marine Corps Air is looking at extending
the life of our current F-18 fleet to carry some of those to
10,000 hours. And it appears that about half of the F-18s that
we have now can be extended and the cost of that extension is
being looked at right now.
Mr. Boyd. To the Chairman's point, do you consider it to be
a viable option to extend the scheduled completion of the F-18
beyond 2012?
Mr. Mabus. Sir, I think that I need to defer my answer on
that to whatever the Quadrennial Defense Review comes out with
in terms of overall TACAIR.
Mr. Boyd. Thank you, Mr. Chairman.
Mr. Murtha. Mr. Hinchey.

VH-71 HELICOPTER

Mr. Hinchey. Thank you, Mr. Chairman. Gentlemen, thank you
very much. It is a pleasure to be with you and I very much
appreciate the work that you do; and it was very interesting to
listen to your statements and the answers that you give to
these questions.
I wanted to ask a question myself with regard to one of the
most controversial and, interestingly enough, increasingly
criticized aspects of this budget recommendation, and that is
the VH-71 helicopter. This helicopter is getting a lot of
attention for a number of reasons.
First of all, the number of jobs that are lost, about 2,000
across the country--maybe more than that--and the amount of
money that is apparently being just swept aside or wasted if
this vehicle is actually abolished. And that would be more than
$4 billion which would have been wasted. And the need for a
helicopter is very, very apparent because the one that is being
used for all of the purposes that this one would be used for
was designed back in the 1950s and not put together until the
1970s. So the ones that are being used are, most of them, much
more than 30 years old. So that situation is causing a great
deal of concern.
We need to have a vehicle like this. We need to have one
that is going to work effectively. And if we don't move forward
with this one, which is solid and secure, there doesn't seem to
be any serious question about its ability to function and
function very well, then we are going to need something else at
some point in the near future, and that will mean the
expenditure of huge amounts of additional money. So none of
this seems to make any sense. And, as I mentioned, it is
increasingly criticized.
There were a number of issues that came out within the last
several days in some of the prominent newspapers and some of
the news articles that functioned specifically on the military.
So I am wondering what we really need to do. I can't understand
the motivation for moving this way with regard to this vehicle.
It doesn't seem to make any rational sense. So I wonder what
you think we might do and why this program is being dealt with
in the way it apparently has, for very little real reasons. And
just, you know, like that.
Mr. Mabus. Well, I can tell you what we are asking for in
the fiscal year 2010 budget on this. Based on Secretary Gates'
decision, the Navy has, as you know, cancelled the contract on
this a couple of days ago.
Mr. Hinchey. A couple of days ago.
Mr. Mabus. Yes, sir. And we are asking for money for two
things in the budget for fiscal year 2010. One is to extend the
life of the current fleet of helicopters that are now flying.
And my information is that extension can be done within very
good safety and operational requirements. And, secondly, is
money to restart the competition for the next generation of
helicopter. I am sure you know both of these things. And I am,
as I said, I am not giving you any news here, but simply what
we are requesting in the 2010 budget.
Mr. Hinchey. I appreciate that, and I appreciate the sense
of humor that you have with regard to this issue and the way it
is being handled.
Mr. Dicks. Will the gentleman yield?
Mr. Hinchey. Yes.
Mr. Dicks. Can you tell us what the numbers are, what
amount of money? You said for extension--how much is in there
for that and how much is in there to restart the competition?
Admiral Roughead. The numbers that I have, Mr. Dicks, are
that we have $85 million in the budget for termination, and
then also for the beginning process of the way ahead. And with
regard to the maintenance of the existing fleet, I don't have
that number.
Mr. Dicks. Could we get it for the record? Thank you. Thank
you for yielding.
[The information follows:]

Navy's FY10 budget requests $42.5M in aircraft procurement
modification funds to sustain the existing VH-3D and VH-60N Fleet of
helicopters. The $85M requested in FY10 provides $55M to contribute to
the balance of the estimated VH-71 termination costs and $30M to start
work on a VH-71 replacement program.

Mr. Hinchey. I just want to mention something about that.
Mr. Murtha. Mr. Hinchey, let me make a couple points here.
The staff tells me it would cost $4.4 billion to extend the
present helicopter.
Mr. Mabus. Sir, my information for the next year is that we
are requesting substantially less than that.
Mr. Murtha. The staff is usually pretty right on this
stuff. They have been around a long time and they dig into
this. And so they say $4.4 billion to extend the life of the
present helicopters that fly the President around.
Now, we have already spent $3.2 billion in research on this
airplane. I had 14 people in here the other day, and I don't
blame the service in this case, this is the White House. And I
had the guy that is in charge of the White House, I had all
these different people and I asked them--and this is before the
new administration came in--what do you do with this airplane,
why do we need an airplane with such extensive capabilities?
Well, they told me they wanted to get the President out of town
in a hurry and so forth and so on, they had to have all these
communications because of this, that and the other.
I said, what about the rest of us? Dead silence. I mean,
the President is going to be out there by himself if this plan
would come to fruition. So I said, well, let's relook at this.
They said, well, we will put it off until the next
administration, and that is what they have done.
But we are still looking at this. I mean we are still
trying to figure out if there is not a way that we can use some
of this money that we have already spent on research and get
some benefit out of this research. I mean, this is unacceptable
that we would spend so much money and get nothing out of it. I
know this decision was made by the Defense Department.
Mr. Dicks. Mr. Chairman, on this point, weren't a number of
these helicopters already built that are Phase I that are going
to be upgraded? Wasn't there like nine of them, or some
number--five, nine?
General Conway. Five, sir.
Mr. Dicks. Five that are already there.
Mr. Murtha. You are flying those now? Are they flying? We
have five flying now?
General Conway. Yes, sir, five that have been produced. I
assume they are flying.
Mr. Murtha. Is the Marine Corps flying them?
General Conway. They are flown by Marine Corps pilots.
Mr. Murtha. And this idea you only get 5 years out of them,
I can't believe. I mean, that is some of the figures that I
have heard.
General Conway. I can't speak to that, sir. What I can
say--and I will put a mark on the wall and get back to you if
it is different--but my staff briefed me that it was about $47
million to enhance the aircraft that we are flying right now to
give them a service life extension.
[The information follows:]

Of the five VH-71 aircraft procured, the current service life of
each aircraft is 1500 hours.

Mr. Murtha. Believe me, if the staff tells me it will be
$4.4 billion over the lifetime of the system, it will be $4.4
billion or more. They know that I will remember what they told
me. Mr. Hinchey.
Mr. Hinchey. Thank you very much, Mr. Chairman. I just
wanted to mention that the flight test areas are pretty high
for this vehicle. I think it is something like 800 flight test
hours, something like that, which just indicates how effective
this vehicle really is. And all of the association it has with
others indicate that it will be very, very capable--I am
talking about the VH-71--very, very capable for at least 30
years, in spite of the fact that there has been some discussion
which is contrary to that.
And with regard to the $55 million for termination fees, my
information is that the Navy has estimated that the termination
fees would be about $555 million, 555, while industry estimates
that could be significantly higher or would be significantly
higher.
So I think that this is something I know you understand and
I know you understand it thoroughly and I know that you have
focused attention on it and you are deeply concerned about it.
And I just hope we can work this out in some way that is going
to provide the President with a helicopter that is going to be
strong, effective, efficient and do the job that is needed to
be done--which is a great improvement over what is being done
now--and do it without wasting money, without wasting tens of
billions of dollars over what has already been spent.
Mr. Murtha. The time of the gentleman has expired. We have
four votes so we are going to try to complete this hearing. Ms.
Kilpatrick.

MRAP LIGHTS

Ms. Kilpatrick. Thank you, Mr. Chairman, and thank you
gentlemen, Admiral, Secretary, as well as the General for all
that you do, and expert testimony this afternoon. My father is
a World War II Navy veteran so he would be delighted to hear
you today.
I want to go back to General Conway in terms of the M-Light
up-armored--Humvees is what we call them now. I want you to go
back to what you said. I think you said you are finding that
you won't need as many MRAP Lights and you are finding that the
Humvees will be suitable for you in Afghanistan. Did I hear
that correctly?
General Conway. Not entirely ma'am. We are undergoing a
series of tests this month now, about the middle of the month,
to make sure our initial survey of what we call this ISS
vehicle, the vehicle that is our Cat 1 MRAP, with the new
suspension, is as functional as we think it is going to be. The
transition time for these vehicles is pretty quick. So pending
successful tests this month, we think we can have as many as 40
into theater beginning late July.
Ms. Kilpatrick. Of which one?
General Conway. Of the MRAP with a 7-ton suspension on it.
Ms. Kilpatrick. And that is the weapon of choice? Is that
the vehicle of choice?
General Conway. Yes ma'am, for a number of reasons. We
don't normally like weight in the Marine Corps. But in dealing
with a blast, weight has a quality all its own. This is a
38,000-pound vehicle. And where we can run it off road we think
there is value in doing so for the protection it is going to
give our Marines and Sailors.
Now, we still have up-armored Humvees and they are still
running in both Iraq and Afghanistan. Our interest in the MRAP
MATV, the new variant when it is produced some months from now,
will be to replace those up-armored Humvees as required, based
upon requests from the field.
Ms. Kilpatrick. And that is what I wasn't clear on. You
still have a use for the Light, MRAP Light, but you want to
make sure that you have what you need now--and they are in
production, you don't have them in theater yet--so the up-
armored Humvees will suffice for what you need.
General Conway. Yes ma'am.
Ms. Kilpatrick. Then I notice in 2008 the appropriation was
$352 million for those Humvees, 981, and now back in 2010 to
$205 million. So are you asking for more production of the up-
armored Humvees as well?
General Conway. No ma'am. I think what you are referencing
is the total buy for Army and Marine Corps.
Ms. Kilpatrick. Right.
General Conway. We have a sustained buy for up-armored
Humvees, but it is much less than that. I will get back to you
with our exact figure.
[The information follows:]

The Expanded Capacity Vehicle (ECV) Program is currently
significantly short of its Approved Acquisition Objective of 29,942.
The current shortfall is 13,078 vehicles. The recent Overseas
Contingency Operations (FY09) funding will procure approximately 644
ECVs toward the current shortfall. We cannot provide details of funding
and quantity beyond the FY10 request for $10 million, but the funding
and quantities are anticipated to increase above that level in
subsequent budget submissions.

JOINT LIGHT TACTICAL VEHICLE

Ms. Kilpatrick. I guess I am getting at do you want more
up-armored Humvees for Afghanistan?
General Conway. Ma'am it gets complicated. To the degree
there is another vehicle out there called a Joint Light
Tactical Vehicle----
Ms. Kilpatrick. Right.
General Conway [continuing]. It is a replacement,
ostensibly the replacement for the up-armored Humvee. Right now
the Joint Light Tactical Vehicle is weighing about 18,000
pounds too, which is way too heavy for Marine Corps use. If we
don't take some weight off that vehicle, we are going to be
forced to look at our existing fleet of Humvees and say how do
we modify these things for the future until we get a lighter
vehicle that gives us the same level of protection.
Ms. Kilpatrick. So it is almost like a project in process,
as we are in theater in Afghanistan; and, unfortunately, upping
our numbers there as we go forward, we are kind of testing and
seeing which one fits best. Are my Marines safe? There is no
water for the Navy that is right up there, and drop off the
Marines.
General Conway. Ma'am, you hit it on a key. It is a science
project, and there are a lot of variables in this whole
evolution. But number one with us is giving the Marines a
vehicle that makes them safe and allows them to accomplish
their mission. That is the value we see in this creation that
we have now, bringing two vehicles together.
Ms. Kilpatrick. And then the unmanned vehicle, will you use
it and will you lighten the load of the field?
General Conway. We are experimenting right now with an
unmanned logistics vehicle that will lift, through man control
on the ground, as much as several kilometers. We are guardedly
optimistic that it may work. And if that happens it will
relieve the pressure on our helicopters and some of our route
convoys. So we are avidly following the development of that
capacity.
Ms. Kilpatrick. And you will let this committee know what
you need actually.
General Conway. Absolutely.
Ms. Kilpatrick. Thank you very much. Thanks, Mr. Chairman.
Mr. Murtha. Mr. Young.

DDG-51

Mr. Young. Mr. Chairman, I have just one quick question.
The F-18 issue was already discussed by General Conway. But,
Admiral Roughead, in your opening comments you mentioned about
DDG-1000 and moving the emphasis to DDG-51. But DDG-1000 was
supposedly a step toward DDX.
Am I reading this correct when I think that DDX----
Admiral Roughead. CGX.
Mr. Young [continuing]. May be out of the system and that
we are going to move eventually into CGX, bypassing DDX?
Admiral Roughead. Yes, sir. The DDG-1000 has a long history
that starts in 1992. But the DDG-1000 would eventually bridge
us to a CGX cruiser of the future. And when I became CNO, I
looked at our shipbuilding programs and specifically at the
DDG-1000. And looking at the trends that were taking place in
the world, the proliferation of ballistic missiles, the
proliferation of sophisticated anti-ship missiles that were
already mentioned by the Commandant--and that is the capability
that Combatant Commanders are asking for, the ability to
conduct integrated air and missile defense. We have in the DDG-
51 the best combatant in the world today. It has those
attributes, the DDG-1000 does not. But in truncating the DDG-
1000, where we build a couple of those, we can take the
technologies from that, we are advancing the integrated air and
missile defense capability of the DDG-51. And those two things
will give us a better sense of where we have to go with the new
cruiser.
Mr. Young. Do you have any kind of an estimated time line
for moving into the CGX?
Admiral Roughead. No, sir. We continue to look at that. And
the reason why there needs to be some more work done is that
the CGX will be an advanced air and missile defense capability.
But I believe we have to define the rest of the components of
the architecture that the Nation will use and that the military
will use. Until that is defined, I am not sure we know what the
design is for our piece of that.
And so by doing what we have done with the DDG-51 and the
DDG-1000 I believe we best position ourselves to let these
things sort out and then we can move on.
Mr. Young. Okay, sir, thank you very much for that. Mr.
Chairman, thank you.
Mr. Murtha. You mean what you recommend that we do.
Admiral Roughead. I am sorry, sir?
Mr. Murtha. You mean what you recommend that we do. We pay
for it.
Admiral Roughead. Yes, sir.
Mr. Murtha. Thank you very much. The committee is now
adjourned.
[Clerk's note.--Questions submitted by Mr. Frelinghuysen
and the answers thereto follow:]

W76 Life Extension Program

Question. Admiral Roughead, you receive your nuclear warheads from
the Department of Energy's National Nuclear Security Administration
(NNSA). A story last weekend in the Los Angeles Times seemed to
question the NNSA's ability to fulfill its mission to support your
needs in the Navy. At issue is the W76 warhead, and the NNSA's claims
that its life extension program was a success.
Now I'm well aware of the unexpected problems that the department
has faced in maintaining this weapon. But as far as I'm concerned,
until the government decides we no longer need this weapon, it's the
responsibility of NNSA to make sure your needs are met.
The NNSA requested $209 million for fiscal year 2010. Could you
tell us if this is enough to keep you on schedule? How much more will
they need?
Answer. The Fiscal Year 2010 NNSA request for $209 million will
delay the Navy's planned production rate for Fiscal Year's 2010-2011;
however, the delay can be accommodated provided the shortfall is
recovered by Fiscal Year 2014.
Question. My information is that the NNSA's budget request is $24
million short to meet your needs. Did they consult with you before they
submitted this inadequate request to Congress?
Answer: Yes, and NNSA and Navy have maintained a dialogue to
coordinate a sufficient Fiscal Year 2010 production rate needed to
support Navy requirements.

OHIO Class Reactor Funding

Question. Admiral Roughead, your Naval Reactor program is split
between the Navy and the Department of Energy. The Energy Department is
requesting $59M to begin design work on the new reactor for a new
generation of ballistic missile submarines to replace the OHIO class.
How much money is the Navy requesting for the potential new
reactor?
Answer. The Navy's FY10 President's Budget includes a request for
$107.9M.

Future of the Ballistic Submarine Program

Question. We don't know what the Nuclear Posture Review or the
Quadrennial Defense Review will say or what decisions your
Administration will make. Please explain why we should embark on this
new reactor program when we don't know for sure the future of the
ballistic submarine program?
Answer. The President has reaffirmed the need to maintain a strong
strategic deterrent for the foreseeable future. We are able to start
design of the replacement submarine before the Quadrennial Defense
Review and Nuclear Posture Review (NPR) conclude because the focus of
the NPR will be on the number of weapons and warheads required, rather
than on the design of our nuclear submarines which we know must be
recapitalized.
To ensure there is no gap in strategic coverage when the OHIO Class
SSBNs begin to retire in 2027, we should start concept and system
definition for the OHIO Class Replacement in Fiscal Year 2010. Starting
this work now is consistent with the 20-year timeline used to develop,
build, and test the existing OHIO Class submarines.
Key technical and schedule drivers require the Fiscal Year 2010
start so design and technology can mature to support a Fiscal Year 2019
ship construction schedule. For example, reactor plant components are
typically procured at least two years in advance of the submarine
construction, and the OHIO Class Replacement submarine's propulsion
plant will require new materials and advanced technologies beyond our
previous designs to support the energy requirements for a ballistic
missile submarine.

Effect on Submarine Strategy

Question. Would there be any effect on your submarine strategy and
outfitting if we do not approve the funding request for the new reactor
design this year?
Answer. The Fiscal Year 2010 funding is critical to ensure the
proper level of design maturity for timely fabrication and construction
of the replacement SSBN.
The Navy has seven years (Fiscal Years 2010-2017) to complete the
reactor design for the OHIO Class Replacement submarine to a level of
maturity sufficient to support advance procurement in 2017 and ship
construction in 2019. This seven-year design timeframe is consistent
with the amount of time it took to design other Navy submarines. For
comparison, the VIRGINIA Class submarine, while representing only a
nominal change from previous development work, required approximately
six years to reach the level of design maturity to initiate advance
procurement. The OHIO Class Replacement represents a major step change
in technology and capability (e.g., power rating, reactor life,
acoustics, etc.); therefore, we will need to accomplish more design
work in a similar amount of time.

[Clerk's note.--End of questions submitted by Mr.
Frelinghuysen.]
Tuesday, June 9, 2009.

ARMY POSTURE

WITNESSES

HON. PETE GEREN, SECRETARY OF THE ARMY
GENERAL GEORGE W. CASEY, JR., CHIEF OF STAFF, UNITED STATES ARMY

Introduction

Mr. Murtha. We want to try to finish this by 10:30 because
we have a Full Committee meeting. We want to finish by 10:30
because we have a Full Committee meeting. I want to welcome the
Secretary, who is leaving, and wish him well. He has done an
outstanding job. And I know that Secretary Gates speaks very
highly of your work, as we do. We appreciate the difficulties
the Army has gone through, and you have just done a marvelous
job with that. And we appreciate that.
Welcome, General Casey, who has started to work things out
here. So this team has been a good team, and we are going to
miss you, Mr. Secretary.
Mr. Geren. Thank you.
Mr. Murtha. Mr. Young.

Remarks of Mr. Young

Mr. Young. Mr. Chairman, I just want to welcome the leaders
of the world's best Army, and look forward to their testimony.
I have a written statement that I would submit for the record.
Mr. Murtha. If you would give us a summary of your
statements, we will put your statements in the record and then
get right to questions.

Summary Statement of Secretary Geren

Mr. Geren. All right. Thank you, Mr. Chairman and
Congressman Young and members of the committee, thank you for
the opportunity to appear before you. Mr. Chairman, thank you
very much for your kind words; Mr. Young as well. Thank you as
always. It has really been a privilege to work with you.
I do have a statement I would like to put in the record,
but before I do that we have got a few soldiers I would like to
introduce to you. Mr. Chairman, 2009 is the year of the
noncommissioned officer, and we are recognizing the
noncommissioned officers and the extraordinary work that they
do, the glue that holds our Army together.
We have also recognized the Members of Congress who served
as noncommissioned officers that served in our military. And
two of them are on your committee: Mr. Young and Mr. Rogers. I
want to thank them for their service.

Introduction of Soldiers

But I would like to also introduce some soldiers I have
with us today, two noncommissioned officers and a specialist.
We have Sergeant Shane Payne of Sunset, Louisiana. He is a
heavy equipment operator who served in Afghanistan in 2006 and
2007. He received a Purple Heart for wounds received in action.
And I appreciate his being here and thank him for his service.
Thank you, Sergeant.
And Sergeant Joel Dulashanti. Sergeant Dulashanti is a
Wounded Warrior from Cincinnati, Ohio. He was in the 82nd
Airborne Division. He was assigned to their sniper platoon. He
graduated the top of his class from AIT and from sniper school.
He was deployed to Afghanistan with the 82nd on the Pakistani
border, where he was seriously injured. He was caught in an
ambush, shot in his knee and his stomach. He is a distinguished
soldier, received a Purple Heart, Army Commendation Medal with
a V Device and Combat Infantry Badge. He has gone to all of the
posture hearings this year and has found it so interesting that
he volunteered to be part of legislative liaison. So he is now
working in legislative liaison with us.
Mr. Murtha. He thinks Afghanistan was a challenge?
Mr. Geren. Yes, sir. He figured he has been shot at in
Afghanistan, he is ready to tackle the Hill.
We are also joined today by a future NCO, Specialist James
Fay of Spring Harbor, Michigan. Specialist Fay is a combat
engineer deployed to Afghanistan with the 173rd Airborne
Brigade. Conducted route clearance for the brigade. And I want
to thank these three outstanding soldiers as representatives of
the soldiers that stand with them, and appreciate you giving me
the opportunity to introduce them.

ARMY BUDGET OVERVIEW

Let me say very briefly about our budget request, it is
$142 billion, and it is mostly about people and operations and
maintenance to support them. Our personnel and O&M accounts
make up fully two-thirds of our budget, demonstrating the axiom
that we heard from General Abrams over and over: People are not
in the Army, people are the Army. And this budget makes an
investment in those people.
I want to thank this Committee for your tremendous support
over these 7-plus years of war. You all have stood with the
soldiers and with the families, and in many ways have led the
government and made investments that we had not been able to
ask you for on behalf of the Army. In so many of the mental
health areas, soldier support areas, child development centers,
this Committee really has led the way for our government. And I
just want to thank you very much for your extraordinary support
to soldiers and families during this time. And I will submit
the rest of my statement for the record.
[Clerk's note.--The Fiscal Year 2010 Army Posture Statement
is printed at the end of this hearing.]
Mr. Murtha. General Casey.

Summary Statement of General Casey

General Casey. Thank you, Chairman, members of the
committee. I would like to just give you a quick progress
report here on what we have done over the last year, because I
think it is important that you have a sense of where we are on
our efforts to put ourselves back in balance. And you will
recall in 2007 I said that the Army was out of balance, that we
were so weighed down by our current commitments that we could
not do the things we knew we needed to do to preserve the
volunteer force and to prepare ourselves to do other things.
I would tell you my broad assessment is we have made
progress toward getting ourselves back in balance, but we are
not out of the woods yet. The next 12 to 18 months, until we
start feeling the impacts of the Iraq drawdown, will be tough
for us. We get past that, I think we will be in fairly good
shape.

FOUR IMPERATIVES FOR ACHIEVING BALANCE

To put ourselves back in balance, we said we needed to make
progress on four imperatives: sustain the soldiers and
families; continue to prepare ourselves for success in the
current conflict; reset our forces effectively when they
return; and then continue to transform for an uncertain future.

GROWTH IN END STRENGTH

Now, let me just give you a couple of nuggets here on where
we are on our objectives to get back in balance. Our first
objective was to finish our growth. You will recall in 2007 the
President said increase the size of the Army by 74,000, most of
that is in the Active force, but some in the Guard and Reserve.
As of last month, all components, Active, Guard and Reserve,
have met their end strength targets. And that is a good thing
for us. Originally, we were not supposed to be finished with
that until 2012. With the Secretary of Defense's help, we had
advanced that to 2010, and we basically got done a year ahead
of that.

FINISH GROWTH AND END STOP LOSS

Now, we still have to build the units, match those people
up with the equipment and the training to build the units. That
will take us a couple more years. It is important for a number
of reasons. One, it allows us to begin coming off of stop loss.
I know you have been very concerned about stop loss. And we
will begin this August with the Army Reserve deploying units
without stop loss, September for the Guard, and then the first
of January 2010 for the Active force. And as those units that
deployed before that finish up their deployments, by the end of
2011 we should be off of stop loss. That has been our objective
all along. As we modernize the Army, it has been our objective
to deploy our forces without stop loss.

TIME AT HOME STATION

The second reason it is important is the increased strength
allows us to increase the time our soldiers spend at home. And
I have come to believe that the single most important element
of putting ourselves back in balance is increasing the time the
soldiers spend at home. Now, several reasons: one, it allows
them to recover effectively; two, it allows them to have a more
stable preparation period for the next mission; and third, it
allows them to begin preparing to do other things.

CHANGING COLD WAR FORMATIONS TO MODULAR STRUCTURE

The third element of getting ourselves back in balance is
getting away from our Cold War formations. And we have been
working on this and building modular organizations that are far
more relevant to the current conflict than we were in the past.
We are 85 percent done converting all the brigades in the Army
to these new organizations. We are also about two-thirds of the
way through rebalancing the Army, moving soldiers away from
Cold War skills into skills more relevant in the 21st century.
We are two-thirds of the way through that.
I will tell you, just by way of example, what that means is
we have taken about 200 tank companies, artillery batteries,
and air defense batteries, and converted those soldiers into
military police, civil affairs, engineers, Special Forces. That
is the scope of what is going on there. Together, those two
things--modular conversions and rebalancing--is the largest
organizational transformation of the Army since World War II.
And we have done it while we are deploying 150,000 over and
back every year.

ESTABLISHING ARMY ROTATIONAL MODEL

The fourth element, we are putting the whole Army on a
rotational model much like the Navy and the Marine Corps has
been on for years. And that is the only way that we can sustain
commitments and preserve the volunteer force. We have to be
able to give our soldiers and families a sustainable deployment
tempo.

REBASING

Fifth, we are halfway through our rebasing effort. And you
know the scope of the BRAC effort. And when you add to that the
increased growth and the return of forces from Europe, we are
affecting 380,000 soldiers and families, moving around the Army
here in the next several years. We are on track to complete
BRAC.
And lastly, Mr. Chairman, as we complete all these, balance
entails having the strategic flexibility to do other things
quickly. And as we increase the dwell and the soldiers get to
18 months or more time at home, which I expect to see start
happening early part of next year, they will have more time to
train, to do some of the things they have not had time to train
for.
Now, so that is where we are. I would tell you to sum it
up: progress. Next 12 to 18 months tough, not quite out of the
woods yet.

STRYKER SERGEANT STORY

Let me just close, if I could, Mr. Chairman, with a story
about a great noncommissioned officer to give you some sense of
the quality of the men and women that we have in our Army and
that you see sitting behind me here. But in April 2007, Staff
Sergeant Christopher Waiters was on a patrol in Baghdad. He was
in a Stryker. He was following a Bradley. The Bradley hit an
IED in an ambush. It burst into flames. He rushed across 100
yards, got into the Bradley, drug two soldiers out of the
burning vehicle, dragged them back to his vehicle, was giving
them first aid when they told him there was still another
soldier in the Bradley. He went back across the hundred yards
of open ground, got into the vehicle, realized that the soldier
in there was already dead, and the ammunition there was
starting to cook off. He went back to the Bradley, got a body
bag, returned, pulled the soldier out. For that he was awarded
the Distinguished Service Cross, our second highest award for
valor. And that is the type of men and women you have not only
in the Army, but in all our Armed Forces. So I look forward to
answering your questions here.

CONTRACTING

Mr. Murtha. One thing you did not mention is contracting.
Where are we with contracting?
Mr. Geren. The issue of contracting has been one that we
have really wrestled with, worked with over the course of this
war. As you know, over the nineties when we shrunk the Army, we
also shrunk and outsourced many of the responsibilities that
had previously been done by soldiers: the personnel support,
feed, housing, fuel, transportation, recreation. And when the
war started, we had this model that would rely heavily on
outsourcing. And it has grown to a level we have not seen
previously.
When soldiers deploy now, it is roughly one to one, one
soldier deployed for one contractor. We are working on building
up both the civilian and military side to reverse that trend.
We have added thousands of people, both civilian and military,
in the contracting billets. With the Congress' support, we have
created five new contracting general officer positions. We are
now instructing our promotion boards to promote contractors.
And we are working hard to provide the oversight and also
shrink the number of contractors.
The Gansler Commission a couple years ago, gave us a
blueprint to move forward. We acted on it immediately, and we
are making headway in that regard. And this administration also
has instructed us to continue this effort. And we plan over the
course of this year to add additional--in-source jobs. We are
moving in the direction away from contracting. But where we
have contracting, we are also beefing up the oversight over
what we have had in the past.

COST OF CONTRACTOR V. SOLDIER

Mr. Murtha. Well, I know I asked Mr. Holt, who was in Iraq
over the weekend, to talk to General Abizaid. He said you are
down 16 percent, down to 132,000, and maybe somewhere in
between that. But the point is everybody understands the
importance because it costs $44,000, on average, more. And it
looks like you are going the right direction. We applaud that.
Last year we put in a billion dollars for direct hire and $5
billion out of the contracting. But you know, in conference we
changed that. We recognize that is the direction to go. So we
applaud that effort.
Mr. Geren. We are moving in that direction.
Mr. Murtha. Mr. Young.
Mr. Young. Mr. Chairman, on the issue of contracting, Mr.
Secretary, if you have for every soldier one contractor and you
do away with the contractors, who does the job that the
contractor did for the soldier?

RELIANCE ON CONTRACTORS

Mr. Geren. We are adding more billets, both military and
civilian, to take some of those responsibilities. We are moving
more people from other areas within the Army into these
contracting billets. But we definitely are not ever going to
find ourselves in a position where we do not have a significant
reliance on contractors.
There are limits, when you consider the stresses on the
rest of the force, how much of that we are going to be in-
sourcing. But we are in-sourcing more. We are providing greater
oversight. So where we continue to have a high percentage of
contractors, we are going to be providing better oversight.
But when it comes to food service, so much of just the
maintenance and support of deployed soldiers, that will
continue to be heavily reliant on contractors. The food
services, many of those are nationals from both Afghanistan and
Iraq. That will not go away. We are going to provide better
oversight, but we are shrinking them at the same time. We are
moving more civilians, Army civilians and uniformed military
into those positions.
Mr. Young. So the tasks that are performed by the
contractors now would not just go away, somebody would still do
them?
Mr. Geren. Yes. Yes, sir.
General Casey. But I think as the troop levels in Iraq and
Afghanistan--or Iraq particularly--come down, you will need
less contractors.

OFFICER SHORTAGES

Mr. Young. That is a legitimate response. But now talk
about the military personnel. And our Army should be commended
and you all should be commended for having achieved your end
strength goals even ahead of schedule. But I understand that
you are still short in the officer corps. You are short about
2,000 captains, short about 3,000 majors. And I know the NCOs
do a tremendous and dynamic job, but they still need some
officers in the chain of command.
What are you doing to make up for--well, number one, are
those figures accurate? And number two, what are you doing to
close the gap?
General Casey. The numbers are generally accurate. And the
officer shortages come from the fact that as we built these
modular organizations, the ones I talked about that are much
more relevant to this environment, they needed more captains
and majors to do the tasks that they need to do. And so we
significantly increased the numbers of captains and majors that
we required. And for several years we have been increasing the
numbers of officers that we bring into the Army to meet that
goal.
Unfortunately, a lot of those--not unfortunately, but just
the fact is a lot of those folks come in through ROTC, 4 years
of college, you do not get them quite as quickly as you need.
So it is going to take us some time to do that. We are at our
highest levels in a while in ROTC graduates. That is a good
thing. So we will overcome that. I think in about the next 2 or
3 years we will get back to a position where we are meeting our
own demands.

INCENTIVES FOR OFFICER RETENTION

Mr. Geren. We also have some incentive programs in place to
encourage retention in those areas. We have our officers, our
second lieutenants coming out of West Point. We are giving them
an opportunity there to agree to extend their commitment in
return for a commitment to be able to go to graduate school,
branch of choice, station of choice, giving them an opportunity
to make a commitment now in return for a commitment to them--
instead of 5 years go to 8 years.
We also did last year and the year before this captains'
retention bonus, and also provided them similar types of
opportunities in return for continuing in their service. And
that was well received. So in the short term we are working to
encourage, incentivize the captains to stay on and continue
their career. And that has had a positive contribution.
General Casey. If I could just piggyback on this for a
second, because there is a misperception that the reason we
have officer shortages is because officers are leaving at
higher-than-normal rates. And the fact of the matter is we are
actually retaining officers, and captains in particular, at a
slightly better rate than has been the historic average over
the last decade. So as I said, it is a shortage that has come
from changing and adapting our organizations to be better in
the environment that we will be operating in.

COMMENDING SECRETARY GEREN

Mr. Young. Mr. Chairman, Secretary Geren was a very
respected Member of Congress. Went to the Pentagon and became
Secretary of the Army at a rather awkward time and a rather
awkward situation. And he has performed admirably. I believe
that this will be his last hearing before the Congress as
Secretary of the Army. And I just want to take just a minute to
say, Secretary, thank you very much for the service that you
have given to the country. You have a right to be proud of what
you have contributed to our national security.
Mr. Geren. Thank you very much. I appreciate your kind
words.
Mr. Murtha. Mr. Dicks.

FUTURE COMBAT SYSTEMS

Mr. Dicks. Mr. Secretary, General Casey, in restructuring
the Future Combat System program, please describe the strategy
behind the decisions on which FCS systems were retained and
which systems were deleted. I understand the Secretary of
Defense played a major role in this. But this was somewhat
surprising. I thought, you know, especially you, General Casey,
had worked so hard on educating the members on this whole
program. What happened?
General Casey. We had a very significant discussion about
the future and about the future in the 2010 budget. I worked,
the Secretary and I both worked very closely with the Secretary
of Defense on the Future Combat System program. We went back to
him three times on its importance and its necessity. And it all
came down to the fact that I could not convince the Secretary
that we had incorporated enough of the lessons learned from the
current conflict into the design of the manned ground vehicle.
And it is the manned ground vehicle program that will be
halted. And the rest of the program, the network and the other
devices that are part of it, will be continued.
And I think you have heard the Secretary of Defense himself
say that he very much supports the network and very much
supports the spin-outs as they are called.
And so what we have done--and we are working with the
Department to publish an acquisition decision memorandum. The
Department publishes that. I would expect that to be on the
street in the next week or so. I have seen what is purported to
be the final version of that. And it looks like it is ready to
go. We will then move to restructure the program into different
elements--the network, the spin-outs, the other systems, and
then a ground combat vehicle. And we are----

IMPROVEMENTS NEEDED IN FUTURE COMBAT SYSTEMS

Mr. Dicks. What is it that the Secretary wants in the
ground vehicle that was not part of the FCS?
General Casey. I think, Senator, the program suffered from
a perception that it was a Cold War program. I mean I wrestled
with that, talking within the building and with Members of
Congress. And the fact of the matter is when we started this
program it was designed to fight conventional war as we thought
conventional war would look like in the 21st century. We have
to be up front with that.
So there was a perception this was a Cold War system that
was not relevant in the environments we are operating in today.
And I believe what the Secretary wants and what I want is a
vehicle that is capable across the spectrum of conflict,
because that is what we think we need. And I believe we can
build that. We know where vehicular technology is. We know
where protection technology is, because we pushed it there with
this program. And people should not think that we have got
nothing out of our investment here. We know the state of
technology to build ground vehicles. And we hope to bring that
and combine that with the lessons that we have learned here and
produce a vehicle in 5 to 7 years. And I think we can do that,
and we have the full support of the Secretary of Defense to do
that.

GROUND SOLDIER ENSEMBLE

Mr. Dicks. I had one other question, Mr. Chairman. The Land
Warrior program was terminated, but it was resurrected as the
Ground Soldier Ensemble. Budget justification materials
describe Ground Soldier Ensemble as a system which connects the
ground soldier to the network and provides protection,
mobility, sustainability, and embedded training. Now, as I
understand it, Land Warrior was used by several brigades, some
of which came out of Fort Lewis, and was very successful. And
the soldiers and the leadership of these brigades thought this
was a very important system. Can you tell us more about it and
kind of what you think the future has for this?
General Casey. Again, Congressman, in fact listening to you
say those words, ``Ground Soldier Ensemble,'' I said to myself
we have got to find another name.
Mr. Dicks. Sounds like some violinists.
General Casey. Does not sound very military. Anyway, I am
quite familiar with the Land Warrior.
Mr. Dicks. I like that a lot better, frankly. It could be
Land Warrior II.
General Casey. I visited the unit in Iraq. This system
basically brings the network down to the sergeant, the team
leader. And it has an eye piece and it has really a BlackBerry,
almost, that is portable. And he can look in his eye piece and
he can see where soldiers are. We are connecting it to unmanned
aerial vehicles, where he can see what is on top of the roof in
front of him. It is a wonderful system.
The soldiers told me, and I am sure they were exaggerating,
but they said they would rather go off base without their
weapons than they would without this system. And as we studied
the output of this, it significantly increased their
performance. There were like double the number of targets they
were able to engage compared to other like units.
Mr. Dicks. So why did we terminate it, then?
General Casey. It was terminated, frankly, before I got
here. The Ground Soldier Ensemble was always part of the Future
Combat Systems program. And so we are just basically moving
that into the Ground Soldier Ensemble. But we have to connect
the soldier to the network. The soldier needs to benefit from
the knowledge and the awareness that he gets from the network.
And so that is a part of the whole Future Combat System
program. It is one of the elements that will be continued as we
go forward.
Mr. Geren. If I could?
Mr. Dicks. Mr. Secretary.
Mr. Geren. Congressman, I would just like to add on your
question about the Future Combat Systems, the Secretary did
terminate the manned ground vehicle, but he strongly endorsed
the spin-outs, the unmanned ground vehicles, unmanned aerial
vehicles, the unattended sensors, and the non-line-of-sight
missiles. And we have expanded--instead of just 15 brigades
getting all those spin-outs, all 73 brigades would be getting
those spin-outs. And this budget continues to push that
forward.

FUNDING FOR FUTURE COMBAT SYSTEMS

There are some that have raised some questions about the
money we have in the 2010 budget. In fact, there is an effort
by some, in some of the other committees in the House, to try
to take a good bit of money out of the research in that area.
And we asked that the Committee fully support that funding,
because it is critically important to keep those spin-outs on
track and deliver those technologies to the soldiers.
We are greatly enhancing the situational awareness of
soldiers with these, expanding them, giving them capabilities
to leverage their capabilities on the ground. And we ask the
committee's strong support for the budget as written. We have
taken a hit on Future Combat Systems, but this has considerable
investments to allow us to keep on track. And we ask your
support for that budget, the number that is in the 2010 budget.
Mr. Dicks. Thank you for that clarification. Thank you, Mr.
Chairman.
Mr. Murtha. When we got into FCS, you were only putting $2
billion into the budget, and you had $160 billion total. So it
did not add up at all. So I am glad to see this thing has been
rewired to be more realistic. And I assume you asked for more
money for this year. What was the request for this year for
FCS?
General Casey. About $2.9 billion.
Mr. Murtha. It is down from last year. Last year it was 4.
Mr. Geren. Manned ground vehicle is out of this. We are
working on an alternative to the manned ground vehicle. And we
will have money in the 2011 budget request. We are going to be
delivering a proposal to the Secretary right after Labor Day
that will be a restart for the manned ground vehicle. But this
is for the research, this is for more spin-outs. This is to
advance the spin-outs and the technology support for the
individual soldiers.
Mr. Murtha. Mr. Frelinghuysen.
Mr. Frelinghuysen. Thank you, Mr. Chairman. Let me
piggyback on that. I think it is pretty devastating that we are
going to sort of start over on the ground vehicles. I mean,
that worries me a lot. We just have to sort of start from
scratch here. Maybe the MRAP model is the one you are going to
be going with. But a hell of a lot of research, a lot of money
has gone into this Future Combat Systems, and a lot of the
vehicles we are talking about here--Abrams and Bradleys, I
mean, hell, they have been around for a hell of a long time. We
have got to get something to replace them.

PROCUREMENT FUNDING

On procurement, those of us who were here a few years ago
were treated to General Schoomaker's famous holes in the yard
presentation. You may remember that, General Casey. His
contention was that the Army arrived in the post-11 era with a
$56 billion procurement shortfall, which had obviously an
effect as to what we were doing in Afghanistan and Iraq. As I
look at your budget request, your request for fiscal year 2010
totals just $30 billion. Back in 2008, not including the Joint
IED Task Force, the procurement budget was $61 billion. The
procurement budget for fiscal year 2009 was $37 billion. We are
headed in the wrong direction here.
Can you comment about what that effect is going to have on
the ability of the Army to do whatever we need to do? I mean,
hell, we are moving big time into Afghanistan. We are not out
of Iraq.
General Casey. No, I understand. And I think what you are
seeing----
Mr. Frelinghuysen. We are headed in the wrong direction.
General Casey. We are; but what we are benefiting from in
the years that you mentioned was a significant spike to make up
for the $56 billion worth of holes in the yard. And so now I
think we are coming down to a more sustainable level. The other
element is that--and I think you are including the OCO
procurement numbers in your $30 billion number. That is a
sustainable level of investment for us at this time. And we
will continue to work our modernization efforts. And if it
looks like we need to ask for more, well, then we will ask for
more.

SUPPLEMENTAL FUNDING

Mr. Frelinghuysen. How are you going to ask for more if we
are, quote, doing away with traditional supplementals, which
has actually been your way of sort of funding a lot of what you
are doing here? We call them overseas contingent funds, but
that is not an option you are going to be able to have
available. And as the Chairman has repeatedly said in sort of
forewarning, the day has come here. You cannot rely on the
supplemental process.
How are you going to meet the demands of today's Army? The
Army has always been on the short end of the stick anyway when
it comes to sort of service allocations. Now you have a
procurement situation which is substantially less than you did
a year ago.

PROCUREMENT FUNDING

General Casey. Again, it is; but we have benefited
significantly from a spike in procurement to fill those holes
in the yard. And I think we are stabilizing at a level that
will be sustainable for us. But again, we are looking, as a
result of this Future Combat Systems restructuring, we are
going back and relooking at our whole modernization effort. And
if we need more procurement as a result of that effort----
Mr. Frelinghuysen. That is all fine and good. A lot of what
you have in the way of equipment is so beat up to begin with.
General Casey. We have----
Mr. Frelinghuysen. You have replaced a lot.
General Casey. We have benefited an awful lot. And the
money that you put in for reset is going an awful long way in
keeping that equipment moving and operational. So it is a
combination both of procurement and of the reset money. And
there is $11 billion in this budget for reset. And we still
need that.
Mr. Frelinghuysen. I am disturbed about your trends.
General Casey. Thank you.
Mr. Frelinghuysen. The procurement account is pretty
important.
General Casey. Right.
Mr. Frelinghuysen. If we increase the size of the Army, you
know, the procurement account ought to reflect, obviously, what
is going to be I think apparently greater obligations,
continued obligations in Iraq that are not inexpensive. And now
we are going to have greater obligations in Afghanistan. North
Korea is rattling their saber. And Iran is out there. God only
knows if we had to do another contingency operation, which we
would not certainly encourage, but----
General Casey. I appreciate your concerns, Congressman.
Thank you.
Mr. Frelinghuysen. Thank you, Mr. Chairman.
Mr. Murtha. Mr. Visclosky.

JOINT TACTICAL RADIO SYSTEM

Mr. Visclosky. Thank you, Mr. Chairman.
Secretary, General, I am very interested in the radio
program and the Joint Tactical Radio System you are developing
as well as SINCGARS. And the first question I would have is, it
would appear that you have about $650 million appropriated for
SINCGARS that have not yet been obligated. What is the plan to
obligate those funds?

SINGLE CHANNEL GROUND AND AIRBORNE RADIO SYSTEM

Mr. Geren. We are finishing out the SINCGARS buy. We have
56,000 additional radios to buy, and it is a little over $600
million, the $600 million you referred to. We have recently had
a competition, and we have decided on the winner of that
competition. It is a partnership between ITT and--I have always
mispronounced the other partner's name--T-h-a-l-e-s, Thales or
Thales. I am not sure of the proper pronunciation. The award
was made several days ago, and it is still in the post-contract
review period. It will be final over sometime in the next
couple of weeks.
Mr. Visclosky. Would that be for the Joint Tactical Radio
System?
Mr. Geren. That is for the SINCGARS. The contract I was
just talking about was the SINCGARS purchase of 56,000 SINCGARS
radios, which is the ITT-Thales contract. The JTRS radio, the
Joint Tactical Radio----
Mr. Visclosky. Can I get back to the $650 million? Is that
what you are----
Mr. Geren. Yes, that is for the SINCGARS.
Mr. Visclosky. So that is now going to be expended?
Mr. Geren. It is, yes.
Mr. Murtha. Let me clarify for the gentleman. Since we took
out a hundred million for SINCGARS, they decided they would
spend some of that $650 million. And a day or so later they put
in--they spent $400 million. So there is now only $200 million
in that. So in the supplemental we have agreed that $50 million
rather than a hundred million cut, because of the gentleman's
interest in this program.
Mr. Visclosky. I appreciate the Chairman's clarification.
If I could then ask, funding of $128 million was requested for
overseas contingency operation; $71 million went to purchase
replacement radios; $57 million was paid for management, other
hardware, and total package fielding.
Why in that portion of the package--and I assume that is
separate from the $650 million--are the administrative and
fielding costs so high?
Mr. Geren. I will have to get back to you for the record on
that. The $600 million-plus is for that 56,000 radios finishing
up the SINCGARS buy. The JTRS plan that will transition in will
phase out the old first-generation SINCGARS radios. And that
will begin in 2015, assuming the JTRS is in position at that
point. But as far as the application of those individual
tranches of funds that you asked about, I will need to get back
to you for the record.
[The information follows:]

The administrative costs are not included in the $128M Overseas
Contingency Operations (OCO) request. The OCO request includes $71M to
procure the Radio/Transmitters (SINCGARS radios) and the other $57
million covers Other Hardware Costs and Total Package Fielding Costs to
procure hardware items and to support fielding the radios. These costs
break down as follows: Other Hardware Costs of $9.539 million to
procure hardware updates to the test set to support the new SINCGARS
RT-1523G model and address obsolescence sustainment issues, Embedded
Global Positioning System (GPS) Receiver (EGR) enhancements, and
installation kits for the 6,409 radios to support increased vehicle
density per Department of the Army direction. The other $48.05 million
in OCO is required for Total Package Fielding (TPF) costs that are used
primarily to cover the costs of 220 Field Installers through FY12.
The Administrative costs of $4.9M are covered in the Base Budget
and not the OCO budget request. The $4.9M is for engineering and
programmatic support, coordination of Engineering Change Proposals
(ECPs), technical manual updates, safety assessments, software and
hardware enhancements and program support.

JOINT TACTICAL RADIO SYSTEM

Mr. Visclosky. And the Joint Tactical Radio System would be
fielded in 2015, did you say?
Mr. Geren. 2015. That is the current plan.
Mr. Visclosky. And there is still a competition ongoing for
that as you work through?
Mr. Geren. That is still in the development phases.
Mr. Visclosky. Thank you very much. Thank you, Mr.
Chairman.
Mr. Murtha. Mr. Kingston.

FORT STEWART, GEORGIA

Mr. Kingston. Thank you, Mr. Chairman. General, Mr.
Secretary.
Mr. Secretary, I wanted to talk to you about something a
little more provincial, but you and I have had several
conversations about Fort Stewart. And I wanted to go through
that, because I do think that we have done a terrible injustice
to the community in Hinesville, Georgia, where Fort Stewart is
located. And I want to walk you through some of these things.
But basically, as you know, the announcement was made from BRAC
that there would be two new brigades coming to Fort Stewart,
Fort Carson, and Fort Bliss, and that the community needed to
get ready for it.
And just to underscore that that was not a whim--and I know
you know that--but for the record, December 19th, 2007, the
Vice Chief of Staff of the Army, General Dick Cody, said two
infantry brigade combat teams will go to Fort Stewart. On
December 19th, 2007, my office, along with Senators Isakson and
Chambliss and Congressman Barrow made the announcement as well.
January 2nd, 2008, the AUSA News said that Fort Stewart would
be getting two new brigades. April 3rd, 2008, in Army.com,
23,000 soldiers would be coming there in 2011; 27,000 by the
end of that year. November 14th, 2008, General Cucolo said a
brigade will be on its way to Fort Stewart. January 25th, 2009,
General Cucolo to the Hinesville, Liberty County Chamber of
Commerce: Get ready, be prepared, because they are coming.
January 26th, 2009, General Cucolo said the brigade will bring
service jobs and--well, excuse me, bring service, and jobs are
on the way. Where we need help, ``we'' being the Army, we need
help in family housing. We need family housing for all ranks.
February 15th, 2009, Colonel Todd Buchs: We are getting ready.
We have $400 million in projects coming.
These announcements were not casual announcements. They
were not infrequent. They were very frequent. And they were
done by people in authority, not by somebody, you know, not by
politicians just trying to sound good to the people back home.

COMMUNITY INVESTMENT FOR FORT STEWART

As a result, this committee put in $154 million in MILCON
for Fort Stewart in 2008 and $372 million in 2009. And in fact,
without the new brigade we will have an excess capacity of 800
rooms down there, 800 rooms and barracks. The local city, the
municipality, has put in about--and I am counting about $38 to
$39 million in public works for schools and roads, and
similarly, the private contractors have put in about $74
million in excess houses.
Now, actually, the real numbers are a lot bigger than this.
But what I asked them to do is tell me where you are really out
there. If you were expecting 10 people for dinner and only 8
showed up, I only want to figure out where are the two extra
plates. So do not tell me about the whole thing, because some
of this is going to be absorbed because of normal growth. And
Fort Stewart has grown.
I have really tried to focus on what did you do that you
would not have done. But to give you an example, I think this
statistic really says a lot: 2008, when housing was flat in
Georgia as around the country, this city, this small community
of 60,000 people, issued 634 housing permits. Nobody was doing
that. Banks made loans and developers invested in property, and
they all did it because we instructed them to do it.

ADDITIONAL UNITS AND MISSIONS FOR FORT STEWART

So I have a number of questions here. You know, I guess the
first thing is, is there anything that we can do to compensate
these folks? Another question is, are there other missions that
we can bring there? And how seriously is the Army considering
putting in some other missions? And keep in mind, the Army will
have excess capacity here. It is not just, oh, we feel bad for
the community, but we have overbuilt. And should the community
be expecting it?
And perhaps the central question is to our constituents
back there: Are they dangling on a limb right now, hoping that
something is going to happen, or are they actually in a free
fall and we need to go ahead and tell them they are in this
free fall and they need to go ahead and decide that they need
to declare bankruptcy if they are a developer, or that these
loans are going to go bad if they are a banker? Are we giving
them additional disservice and false hopes thinking that
something can happen that we are scrambling around?
So you and I have had many conversations. You have been
very sensitive to this. You have visited it yourself. The
Chairman has been down there. He knows how patriotic the
community is. But it is not just Hinesville, because I know
Fort Drum actually had this situation several years ago, and I
was told they did not get prepared because they did not believe
the Army, and then they did get additional troops. I am not
that familiar with Fort Drum, but that is one of the things I
have heard. But all communities are going to be watching this,
not just Carson and Bliss and Stewart. You know, if a town
overbuilds and the Army does not deliver, why would you take
the Army for its word next time?
Mr. Geren. Well, you and I have had many conversations
about this, and I appreciate the opportunity to discuss it
again. Nobody could have been a more forceful advocate for the
community of Hinesville than you have been. And I respect that,
and I appreciate that. The community has gone out on a limb.
The people of Hinesville, they love the military. We did
encourage them to step up, because we wanted every installation
that was going to grow to be ready to accommodate the families
and have schools for the children. And what you read is an
accurate depiction of what happened. We strongly encouraged,
and Hinesville stepped up. And it is not a big community; as
you noted, 60,000 people. That is a huge investment for a
community the size of 60,000 people. And we want to look at
ways to mitigate that impact.
I cannot tell you right now how we will do that. You know,
over the time ahead there are decisions that are made that move
resources around, move people around. The end strength of the
Army is not going to shrink. The end strength of the Active
Duty is going to stay at the same levels that we had before the
decision regarding those brigades.

REDUCTION IN NUMBER OF ARMY BRIGADES

We were all surprised by that decision to cut the number of
brigades from 48 to 45 in the Active component. And we want to
work with you and figure out ways to mitigate it. I cannot lay
out a game plan for you right now. But I look forward to
continuing to work with you. And again, you have forcefully
advocated for your community in this regard. The community did
lean very far forward to accommodate soldiers and families, and
we appreciate that. And we want to do what we can to mitigate
the negative impact. In fact, I had a conversation with the
Chairman about this matter as well.
Mr. Murtha. Mr. Bishop has a question.
Mr. Bishop. Would the gentleman yield?
Mr. Kingston. Yes. And I wanted to also say, Mr. Secretary,
Mr. Bishop and I have worked closely on this, as has
Congressman Marshall and Barrow and our Senators. So this has
been a Georgia delegation issue. But I know in the other States
they are doing the same thing. And so this has got a high level
of emotion right now and involvement.
Mr. Bishop. A very high level, particularly since BRAC and
the Army's plans are going to impact Fort Benning, which also
is connected with the 3rd I.D. But I wanted to ask whether or
not this decision, if you know, was budget-driven.

DECISION TO REDUCE THE NUMBER OF ARMY BRIGADES

Mr. Geren. No, it was not. Secretary Gates made the
decision to go from 48 to 45. In fact, the immediate budget
impact is not significant. The Secretary made his decision in
order to increase the number of personnel that would be
available to fill the 45 brigades that are remaining. It was
his decision. The term he used was ``thicken.'' He wanted to
thicken the supply of personnel that would be available for
those.
Mr. Bishop. This is the dwell time and training in existing
brigades as opposed to establishing some new ones.
Mr. Geren. That is right.
Mr. Bishop. It was not budget-driven?
Mr. Geren. It was a policy decision on the part of the
Secretary. He talked with us, with the chief and me, at length
about the issue.
Mr. Bishop. What is the fiscal impact going to be? How much
money will be saved?

ASSISTANCE FOR FORT STEWART COMMUNITY

Mr. Murtha. The time of the gentleman has expired. Let me
say this to both you gentlemen, and Mr. Barrow and Mr.
Marshall. We are going to work this out. What you laid out
happens occasionally throughout the country. Working with the
Army, we are going to find out exactly what was spent, we are
going to find out exactly if they can put more troops in there
and mitigate it that way. If they do not, then we are going to
find a way to reimburse the community for what they did at the
urging of the military. I mean, this is unacceptable to us. And
we do it all the time.
So I would like to have done it in the supplemental, but we
just do not have enough information this soon. The trouble is
our bill is not going to be passed probably until October 1st,
and your folks will have to hang on. Now, the Army will make a
decision here shortly about some of these other things. But we
are going to work with you and with them. And we are going to
work this out, no question about it. You can assure the folks
down there that legitimate expenses are going to be taken care
of, because it was not their fault; it is because the Army
urged them to make these expenditures, and we are going to take
care of it.
Mr. Kingston. Thank you, Mr. Chairman. Mr. Secretary.
Mr. Murtha. Mr. Moran.

BASE REALIGNMENT AND CLOSURE

Mr. Moran. Thanks, Mr. Chairman. And I think both witnesses
know the high regard we have for them. And it is great to see
you, General Casey, and Pete. We are sorry to see you leave,
really.
I do have a problem, though, with an issue that I just
cannot justify in my mind, or fiscally, or anything else. And
that has to do with the BRAC decision. And what I would like is
a candid response. You know, nothing diplomatic, just
straightforward. And I know you are both capable of doing that.
But the problem is that the costs to implement BRAC have
increased to $32 billion. It is a 50 percent increase over what
we were told would be the cost. The savings are less than half
of the savings we were told would be achieved. And in fact,
there are 230 locations around the country that are scheduled
to be completed only within the last 2 weeks of the statutory
deadline. So 230 relocations and they are going right up to
2011. I think we know it is impossible for them to truly meet
those deadlines.
Now, we have a particular problem in the back yard of the
Pentagon. We had 20,000 workers, some of them within walking
distance of the Pentagon, but all of them at Metro stations,
public transit stations. Many of them lived in those high-rises
near the Pentagon. They worked in offices that they could go
across the street to. They were right at a public transit
station; 20,000 of them are being moved to a place where there
is no public transit, primarily to Fort Belvoir. And your Army
Corps of Engineers has said that this move is going to cause a
3- to 4-hour back-up each morning and each evening.
Now, that does not make sense to me, and I would like to
get a candid response from you as to why we continue to go down
this path. And it is right in the back yard of the Pentagon.
Mr. Geren. The reason we continue to go down this path is
the BRAC law. And we are committed to getting these projects
completed by the fall of 2011. And it is going to be a
challenge. We feel like we are on track, but it is going to be
just barely making it under the wire. And the funding that we
have this year, it absolutely has to be received on time. We do
not have any margin for error now.
Mr. Murtha. Mr. Secretary, where did they get the cost
estimates? For instance, when they said they were going to move
Walter Reed, they said $200 million, $300 million. It is now
well over $2 billion. Where did the cost estimates come for
BRAC? Didn't they come from you folks?
Mr. Geren. The cost estimates were generated by all the
services. They were generated back in, I guess, 2003, 2004, as
they prepared for the BRAC. They were internally generated.
Mr. Moran. Pete, do you think it makes sense to take 20,000
people away from public transit and stick them down someplace
where it is going to cause a 3- to 4-hour congestion, where on
the very roads that every Federal--most Federal employees have
to travel every single morning? It is going to delay everybody
3- to 4 hours every single day of every workday.

TRANSPORTATION PROBLEMS AT FORT STEWART

Mr. Geren. I was not around when the decision was made. I
never understood the decision to move so many people from this
urban center down to Fort Belvoir. And as you have been
personally very involved in trying to address the
transportation concerns, we have worked to try to mitigate it
somewhat by moving some of them in other locations by expanding
the definition of Belvoir. But there is no doubt the
transportation network is not sufficient to support the size of
this relocation down there. It is going to be a very
significant traffic problem for a long period of time.
Mr. Moran. But yet we continue down this path. And what the
Army did do to relocate on Interstate Highway 395 without any
exit ramp is going to further complicate the problem. And the
Army will not build the roads because it says, rightfully, that
it is not just the Army being served by these roads, it is
other agencies, intelligence agencies, and so on. So the Army
will not take responsibility for fixing the transportation
problem.
Mr. Geren. No. We have been in extended discussions with
the county and with the State, as you know. And you have been
involved in that. And at the present time the infrastructure
will not support this additional growth without significant
impact on the travel times for people in that entire region. It
is going to be a very significant transportation challenge for
a long time.
Mr. Moran. The Corps of Engineers is going to tell us, we
told you so. We told you it could be 8 hours every day of back-
up. And we are going to say you told us that; then why didn't
we listen? I mean I know I am getting tedious on this, but you
can see it coming, and there is no way to avoid it, and yet we
continue down this path. I probably used up my time.
Mr. Murtha. The time of the gentleman has expired. We want
to be done before we have an 11 o'clock Full Committee. Without
objection, Mr. Hinchey has one question before he has to leave.

OUTSOURCING

Mr. Hinchey. Thank you very much, Mr. Chairman. Mr. Casey,
Mr. Geren, thank you very much. I appreciate it.
I wanted to ask you a question about the outsourcing
situation. This is a very, very questionable situation that was
initiated for reasons that were in themselves very
questionable. But on March 23rd, this Committee sent a letter
saying that the outsourcing was not working, that it was
costing more than it was saving, and that it should be stopped.
I also sent you a letter asking for the same kind of review.

OUTSOURCING AT WEST POINT

We have a situation now, a number of places, but including
in West Point, resulted in a decision to let 400 public
employees lose their jobs, while bringing in a private
corporation from someplace else out of State.
Mr. Geren. Georgia, I believe.
Mr. Hinchey. So you have two Government Accountability
reports issued last year. It is not a matter of where the State
is. The question is: Is it right to do it? That is the point.
Not what State the private company is coming from. The question
is: Is this wrong? And all the indications, all the evidence
shows clearly that it is wrong. It does not make any sense. And
this committee has asked that you stop it because it does not
make any sense.
So I am asking you now, are you going to continue to engage
in this and eliminate 400 jobs out of West Point? I am not
saying that because that is in my district. It is not. But I am
just concerned about the situation and the way it has been
carried out. You have been asked to stop it, OMB has shown that
it does not make any sense, it costs more money than it saves,
it has been dragged out year after year, and you have been
asked over and over again to stop it. Are you going to stop it
with regard to West Point?
Mr. Geren. Yeah, I am not in regard to West Point.
Mr. Hinchey. Pardon me?
Mr. Geren. No, I am not in regard to West Point.
Mr. Hinchey. You are not going to stop it with regard to
West Point?
Mr. Geren. No, sir, I am not.
Mr. Hinchey. You are going to eliminate 400 jobs at West
Point?
Mr. Geren. We began the A-76--let me put it in context. We
are not starting any new A-76 programs anywhere. We have four
underway right now, West Point being one of the four. I have
looked very carefully at the West Point A-76 effort. Based on
our examination of it, it was conducted in accordance with the
FAR and with the OMB guidelines. Right now, both of the
contract awards are under protest. There were two contracts
that were under consideration: the public works, which the
award was to a private contractor. The custodial services, the
government won the award. Both of them are under protest right
now, so neither of those decisions have been made. But I have
looked at it very carefully. And I have found no justification
for terminating it. It has been conducted in accordance with
the FAR. I can assure you----
Mr. Hinchey. Allow me to interrupt you. You found no
justification for stopping something which has been shown over
and over again to make no sense? It makes no sense for the
people employed, it makes no sense for the operation where they
are employed, because the effectiveness and the inefficiency
drops. And it makes no sense in terms of anything that is
supposed to be achieved here. The whole thing is seen as a
failure. And the budget that was passed by this Committee
eliminates the A-76 program.
But you are telling me in spite of that, you are going to
continue to do this because it was set up in a way that--for
reasons that I do not want to go into detail about, those
reasons why it was set up, but it makes absolutely no sense.
But you are telling me that you are going to continue it
anyway, in spite of the fact that it makes no sense in all of
those ways?
Mr. Murtha. Let us stop on that at this point and let the
Committee take a look at this. This is the first I have heard
of this, and let's see exactly what we are talking about. One
of our staffers has been involved in this. I don't personally
know about it, but we will take a look at it.
Mr. Geren. One thing, the Committee did instruct us to not
start any new A-76 programs, and we have abided by the
directive of the Committee. So we are fully in conformity with
the requirements of the Committee.
This A-76 started well before that direction came from the
Committee. And across all of the services----
Mr. Murtha. Mr. Secretary, I appreciate what you are
saying. Sometimes our Members living in a community have much
better advice. And you, as a Member of Congress at one time,
know what I am talking about. Let us look into it and see if we
can work something out here.
Ms. Granger.
Ms. Granger. Thank you, General Casey, Mr. Secretary, for
your service and for being here.
And, Mr. Secretary, I want to add my words to what Bill
Young said for the wonderful service you have given.
I am going to tell you that our folks back home, yours and
mine, send their best regards. They send their respect and
appreciation, and that happens every time I am home.
Mr. Geren. Thank you very much.

SUICIDE AND MENTAL HEALTH

Ms. Granger. We all appreciate what you did as a Member of
Congress, some of which I take credit for now, and what you
have done as Secretary of the Army.
One of the issues you came in to deal with was the health
care of our service members. And you and I have talked about
that. I know that you have undertaken a large and broad study
of suicide and mental health about what is happening. I want to
ask you, particularly now, do we have the resources? Do we have
the authority to deal with the problem of suicide and to help
with prevention? And then, also, what did you find out about
causes, deployment versus dwell time? What are some of the
results of the study?
Mr. Geren. Well, just to begin with your last question
first, we found that, when you look at those soldiers who have
committed suicide, roughly a third take place while they are
deployed; a third of the soldiers have deployed; and a third of
the soldiers who have committed suicide have never deployed.
When we examine the individual cases, the typical suicide
victim is young, 19 to 25. They are male. Often there is some
sort of drug or alcohol involved, and the majority of them use
their weapon to commit suicide.
The factors that are the precipitating events are the same
inside the service as outside the service. It is relationship
issues, financial problems, some sort of workplace humiliation.
But we have to assume that the stress that they are all under,
the ones who have deployed and haven't deployed, the separation
from family, the extraordinary stress of an institution like
the Army after 7-plus years of war, those exacerbate every one
of those issues.
If you have a relationship problem, it makes it harder. If
you have some mental health issues, it makes it harder to get
help, and it makes a tough situation worse.
We are working hard to encourage our soldiers to seek help.
Stigma is a big issue. Stigma is an issue on the outside, and
it is certainly an issue in the Army. There is a high premium
on self-reliance. We are working hard to try to break down that
stigma and get people past that barrier and seek care.
We are directing much of our suicide-prevention efforts all
of the way down to the grassroots level, trying to enlist all
1.1 million soldiers in suicide prevention. We have the
advantage of being able to force people to take training. We
are making literally every single soldier in the Army
participate in suicide-prevention training, not only so he or
she can see the issues in himself, but to see it in their
buddies with an imperative to intervene on behalf of your
fellow soldiers.
We know there is much that we don't know. There are many
mysteries still locked inside this issue. With the support of
this committee, we have a partnership with the National
Institute of Mental Health. It is a 5-year program. We hope
this is a groundbreaking research effort. It is a huge one. It
is the biggest suicide investigation research project
undertaken by anybody anywhere. It is a $50 million program
over 5 years. They are going to spin out the information as
they go and help us better understand it.
General Chiarelli, vice chief of staff of the Army, is in
charge of the program across the entire Army, and we are
working to not just focus on that narrow aspect of mental
health issues, but build overall resiliency of our soldiers.
Resiliency training. It is a multifaceted effort. I can assure
you every senior leader in this department considers it a very
high priority and thinks about it and works on it every single
day.

SHORTAGE OF MENTAL HEALTH PROFESSIONALS

Right now, it is not a question of resources so much as
just sustaining this effort. It is hard to hire mental health
professionals; they are short, particularly in rural areas
where many of our installations exist. We are using special
pays and different types of incentives to bring mental health
professionals into the Army and looking at innovative ways to
do that.

MENTAL FITNESS

General Casey. If I can just add, the other thing that we
are looking at is trying to build resilience into soldiers. We
have been working for about the last year on a program we call
the comprehensive soldier fitness program. It is designed to
bring mental fitness up to the same level that we give to
physical fitness because you can build mental resilience;
people can build mental resilience much like you can build
muscle mass.
About 3 weeks ago I was up at the University of
Pennsylvania where they are running a program to train our
sergeants to be resilience trainers, master resilience
trainers. And it was a remarkable program. There were about 50
people there, and I said, send me an e-mail; will this work in
the Army, or is it too touchy feely?
Almost to a person they came back and said, you have to
tweak it a bit because this is pretty much designed for
civilians, but this is exactly what my soldiers need.
People think that anyone who goes to combat gets post-
traumatic stress. But the fact of the matter is that the
majority of people who go to combat have a growth experience
because they are exposed to something very, very difficult, and
they succeed. Our objective is to give more and more soldiers
the skills to have a growth experience.
We will be starting this in July, and I think it will be
something that will benefit us over the long haul.
Ms. Granger. Thank you both for that response.
Mr. Murtha. Ms. Kaptur.
Ms. Kaptur. I wanted to follow-on on what Ms. Granger was
questioning about, and thank you, Secretary Geren and General
Casey, for your work, particularly in this area of neurological
and psychiatric care, and to urge you on.
I would like very much, Secretary Geren, for any member of
this Committee who is interested to have a briefing from the
Department of Defense on how you have organized this
department-wide. In other words, I know Ohio fits somewhere in
this because we have major consortium studies going on with
Case Western Reserve and with our Ohio Army Guard and Air
Guard, and the University of Michigan is involved. That is just
one little part of the country.
I am interested in how this is organized on a departmental
level. Can you help provide a briefing? There are so many
interested Members. Senator Boxer in the Senate had a proposal
for California. One of their doctors came in here a couple of
years ago and gave some testimony. But I can't honestly say
that I understand how you as a department or DOD is looking at
this whole neuro-psychiatric area. Could you provide that kind
of briefing?
Mr. Geren. We would be glad to do that.
Ms. Kaptur. So we have a comfort level how you have
designed this within the department.
Mr. Geren. All of the services are working it, as well as
OSD. This is a priority across the entire Department of
Defense.

ARMY COMMITMENTS FOR SECURITY AND ASSISTANCE

Ms. Kaptur. I thank you very much. I don't know if Ms.
Granger would want to join me for that, but thank you.
This is excellent. Whoever did this, congratulations to
you. It is sobering.
I worry about many things. One of them is this:
``Indigenous governments and forces frequently lack the
capability to resolve or prevent conflicts. Therefore, our Army
must be able to work with these governments,'' these
governments that are incapable, and many times undemocratic,
``to create favorable conditions for security and assist them
in building their own military and civil capacity.''
I have some serious doubts about where we are headed, but
let me ask you this. In the Afghan and Pakistani situations,
now you have got the number of Army commitments globally, and
you have over 100,000 listed for Iraq, today, can you provide
now or for the record, in both Afghanistan, Iraq and whatever
we are going to be doing in Pakistan, what other countries are
involved with us directly, and how many personnel they are
providing, and how much money they are providing? Is that
possible?
General Casey. Sure. Not right now. You are talking about
the allied countries that are operating with us, what are they
providing in terms of troop and financial support?

INTERNATIONAL PARTICIPATION IN IRAQ AND AFGHANISTAN

Ms. Kaptur. Absolutely. Troops, any kind of logistically
support, whatever it is, and money; what are we getting from
them?
I have a sense, am I wrong, that we are pretty much out
there alone for the tough duty, for the training of security
forces, for most of the money?
General Casey. In Afghanistan, not so much.
In Iraq, more so.
Ms. Kaptur. But as we ratchet up in Afghanistan, are others
joining us?
General Casey. Certainly not at the level that--I mean, the
people that are there will stay. They are not ratcheting up at
the level that we are ratcheting up.
Ms. Kaptur. I am very interested in those statistics.
I want to ask you two different questions.
General Casey, Secretary Gates talks about, we are changing
from a counterterrorism to counterinsurgency mode. What does
that mean for Army as you view it?
And, number two, Secretary Geren, who within Army is
responsible for energy independence within the department? Who
thinks about new energy systems, the types of fuels and
propulsion systems used by the vehicle fleets under your
control? Who reports? Who is the person within Army? What is
the structure within Army on the research side? So my questions
are dealing with counterinsurgency versus counterterrorism, and
on energy independence, who thinks about that on a daily basis?

COUNTERTERRORISM AND COUNTERINSURGENCY

General Casey. I will give you a short answer, but it is
not a question that lends itself to a short answer.
We adopted, in February 2008, a doctrine called Full
Spectrum Operations, that wherever the Army forces operate
across the spectrum, we will apply offense, defense, and
stability operations to seize and retain the initiative and
achieve our results. And so that is how we are dealing with
that effort to be relevant to the conflicts that we will be
dealing with in the 21st century.
Ms. Kaptur. Say that again for me.
General Casey. We will apply offense, defense, and
stability operations. So we have raised stability operations,
which include training indigenous forces, reconstruction, those
kinds of things, to the level of offense and defense because
that is the type of hybrid warfare that we are going to be
confronting here in the 21st century.

SENIOR ENERGY COUNCIL

Mr. Geren. Quickly on the energy front, I have set up a
senior energy council in the Army and appointed a senior energy
executive. Our goal is to lead the department when it comes to
advances on the proper use of energy.
We have made some starts over the last couple of years. We
are buying 4,000 electric vehicles to use on our installations.
We have four up the hill at Fort Myer. Those 4,000 vehicles
will save around 12 million gallons of gas over the 6 years of
their life.
We are working on developing energy alternatives on our
installations. We now have about 19,000 kilowatts of energy
that are generated on our installations out of nonfossil-fuel
sources; solar, geothermal, heat pumps.
We have got a plan underway to build, at least compared to
what is in existence today, the biggest solar panel farm any
place in the country at Fort Irwin. So we are exploring options
across the country.
Up at Hawthorne, we are doing a geothermal partnership with
the Navy.
We are building all of our new buildings according to the
LEEDs standards, silver LEEDs standards.
Mr. Murtha. Why don't you send the rest of your answer for
the record? We are very short on time.
Mr. Geren. We have got a lot of work in that area. And I
would like to brief you on it.

The Army is improving its energy security posture and assuring
access to critical power to a full spectrum of Army missions. Army
Directive 2008-04 established the term Army Energy Enterprise and the
Senior Energy Council (SEC) charter was signed by the Secretary of the
Army and the Chief of Staff of the Army giving responsibility for a
strategic plan for the Army Energy Enterprise. This plan is the Army
Energy Security Implementation Strategy (AESIS), which was approved on
January 13, 2009.
The Army Senior Energy Executive is responsible for monitoring the
Army's progress in meeting the goals and objectives of the AESIS and
reporting such progress to the Army Senior Energy Council (SEC). The
AESIS encompasses all aspects of Army energy consumption and
utilization, to include weapon systems. The ASA (ALT) is a member of
the SEC, along with the G-8 and G-3. The SEC, through the 2-star
general officer-level advisory board and colonel-level working group,
links up directly with the offices of primary responsibility throughout
the Army for the implementation of the AESIS, which includes research
and development.
The SEC oversees the Army's energy enterprise that encompasses all
aspects of energy consumption and utilization to include installations
and facilities, weapon systems, and contingency operations base camps.
The Army is making significant investments in energy security and
through the American Recovery and Reinvestment Act is applying $469M
toward energy security initiatives.
Many of our installations have significant renewable energy
opportunities to include renewable and alternative energy programs,
smart grid technology, Energy Savings Performance Contract, Waste-to-
Energy, and Waste-to-Fuel demonstrations.
Addressing energy concerns is also a key to increasing our tactical
advantage in contingency operations, in particular by reducing our fuel
requirements. Our investment in the insulation of temporary structures
and the deployment of smart micro-grid technology will help reduce fuel
requirements even further, potentially saving Soldier lives.

Ms. Kaptur. Thank you for your service, Secretary Geren. We
will miss you.

UNMANNED AERIAL SYSTEMS

Mr. Rogers. Thank you, Mr. Chairman.
Welcome, gentlemen.
Let me ask you, General Casey, about your vision of where
we are and where we are going with unmanned aerial systems,
both in counterinsurgency and in force-to-force situations.
General Casey. As I mentioned earlier, we are talking about
being able to operate across the spectrum of conflict, from
peacetime engagement to major conventional operations, and any
place in between.
One of the elements in any place on the spectrum is being
able to see your enemy with sufficient clarity to target them.
And unmanned systems, particularly aerial systems, give us that
capability to a far greater degree than most other systems. So
they will be a part of our inventory and I think will probably
increase in sophistication for the foreseeable future.

COMMAND AND CONTROL OF UNMANNED AERIAL VEHICLES

Mr. Rogers. Have you resolved the command and control
aspects with the Air Force?
General Casey. We are close to doing that. I met with the
chief of staff of the Air Force probably now a year ago, and we
agreed that the strategic level belonged to the Air Force and
that the tactical level belonged to the Army. And it was really
at the theater level where we had friction. And we asked two of
our majors at subordinate commands to get together and work out
an operational concept. They have completed that, and they are
bringing that to the chief of staff of the Air Force and I. I
am hopeful here. I know that we have made good progress. I am
hopeful that we have resolved it.
Mr. Rogers. It is an on-the-ground situation today, is it
not, both in Iraq and Afghanistan?
General Casey. It is. And the deconfliction issues in
theater now are well-established. My whole time there, I cannot
recall an issue where we had a problem that caused us to miss a
target, for example. So the actual practical application in
theater is taking place effectively. The doctrinal level is
what needs to be resolved.

FIRE SCOUT

Mr. Rogers. I see. What about the vertical UAVs like the
Fire Scout, what is your vision for those?
General Casey. The UAVs that can stand and hover give you a
slightly different capability than ones that constantly orbit.
And so there is relevance and need to have a mix of both.
You'll recall we have a small one that is designed for the
platoon and company level that looks like a beer keg, but it is
a vertical hover. I think we will wind up with a mix of hover-
capable systems and orbit systems.
Mr. Rogers. So you are happy with the Fire Scout?
General Casey. So far.
Mr. Geren. And we are developing prototypes for the Fire
Scout right now. It is in the critical design review this year,
and the first flight is planned for 2011. But it is certainly
an area of active work.
Mr. Rogers. Do you have adequate numbers of UAVs in
theater?
General Casey. I believe we do, and the number is
increasing over time.
Mr. Rogers. All right. Thank you.
Mr. Murtha. Mr. Boyd.
Mr. Boyd. Mr. Chairman, I will be very brief. I don't have
a question, but I just wanted to say to both of these
gentlemen, as an old--as a former Army infantry officer, I am
delighted, and I just wanted to commend both of you for your
service to this country, General Casey.
And to my long time acquaintance and friend, Pete Geren,
thank you for your service to this country.
Mr. Murtha. Mr. Bishop.

SUICIDE

Mr. Bishop. Let me join Mr. Boyd in thanking you for your
service, both of you.
I am particularly concerned with the suicides and what is
happening with our force. As I understand it, 46 percent of the
Army's enlisted ranks are between the ages of 17 and 25, which
places them in the adolescent category medically. Ms. Granger
asked whether or not you have what you need in terms of medical
providers to treat mental health with regard to this age group.
Could you provide the Committee with specific information of
how many of your providers are trained in adolescent
psychology, which is this particular age group? Provide that
for the record, please.

POST TRAUMATIC STRESS DISORDER

The other thing has to do with, General Schoomaker
testified several weeks ago before this subcommittee, and it
was emphasized I think to some extent in what you said,
Secretary Geren, that fractured relationships and not PTSD
account for the majority of the numerous suicides in the Army.
I find that very hard to believe. To me, that is almost
like saying, when an individual is killed by a gun shot or a
stab wound, that the cause of death is heart failure, which is
obvious. It seems to me that there ought to have been, and I
think that there must be some ongoing studies that relate PTSD,
the impact that PTSD has on relationships, to families. I think
we asked General Schoomaker to provide us with that
information, and I don't think the Committee has received it
yet, of the relationship between PTSD and the fractured
relationships in families.
The other thing that I am concerned about is the Army,
according to General Schoomaker, does not teach or give
soldiers an opportunity to measure post-traumatic growth or
lack of growth, so how is it that you have a basis for saying
that the relationship between PTSD is not directly or
indirectly related to suicides, and that is essentially what
General Schoomaker said?
That is very disturbing to me, and I would like to get some
more specific information on that because our troops, 46
percent of them being in the adolescent category, have got to
be impacted. The medical professionals who have testified
before our committees from all of the branches, General Casey,
have indicated, and the researchers, that any soldier who is in
combat or in that theater for 2 to 3 weeks has been impacted
and is very likely to have some form of PTSD. That is what the
medical professionals have said in this Committee.
General Casey. There is no question that everybody that
goes to combat gets stressed.
Mr. Bishop. I am asking about PTSD, not just stressed.
I get stressed when I drive down the interstate that Mr.
Moran is talking about.
I am talking about PTSD specifically.
General Casey. What I would tell you is that, as part of
this comprehensive soldier fitness program, one of the key
elements is an assessment tool that every individual will take
online, and it will give them direct feedback to themselves
about how they are doing in different areas.
And then it will connect them to self-help modules that
will allow them to work on building resilience in the other
areas. So we do not currently have a tool to assess, but we
have built one, and it is being tested right now. And by the
end of this summer, it will be in use across the Army. I think
that is a very positive step.

SELF-ADMINISTERED MENTAL HEALTH TOOL

Mr. Bishop. Let me interrupt you because I have some
serious problems about that because this subcommittee has put
in several appropriations bills requirements for the pre- and
post-deployment tests that we require by statute, and that was
fulfilled by the department by a self-administered assessment
also, and that was for medical problems. Now do you really
realistically expect that a self-administered tool online for
mental illness would be as effective or even more effective
than one for physical, which we found that to be inadequate?

POST DEPLOYMENT MENTAL HEALTH ASSESSMENT

Mr. Geren. When a soldier comes home from a deployment,
they have a face-to-face interview with a primary care provider
as well as a post-deployment mental health assessment.
Mr. Bishop. We know that statutorily they are supposed to,
but we have been getting information that that does not take
place unless they fill out this form and then some clinician
reviews their files and determines that they answered
affirmatively to certain specific questions; only then will
they get that face to face contact. That is what we have been
told.
Mr. Geren. They don't necessarily have a face-to-face with
a mental health professional. They have a face-to-face with a
primary care provider, and they would only have the mental
health professional if circumstances warranted. And then we
have another reassessment at 90 to 180 days, and we provide
them continuing care.
We are not where we need to be in that regard. I don't want
to tell you that the solution has been found and the problem is
solved. We have soldiers that come back with unmet
psychological needs, and we continue to work to develop
appropriate responses.
And your point at the beginning of your comments that PTSD
unquestionably contributes to strained personal relationships;
there is no doubt about that.
[The information follows:]

Psychiatrists, child psychiatrists, psychologists, social workers,
and psychiatric nurses provide behavioral health care to our Soldiers.
All of these providers receive training in child and adolescent
psychology during their formal education. The Army also provides
specialized training in the form of child and adolescent fellowships
for psychiatrists, psychologists, and social workers. Although these
providers are very highly specialized, most are treating the active
duty population, rather than military dependents. The Army has
approximately 47 uniformed child psychiatrists with specialized
fellowship training in child and adolescent psychiatry, with another 10
child psychiatrists in training, at any given time. The vast majority
of the child and adolescent trained psychiatrists are trained in one of
our two child and adolescent psychiatry training fellowships, either at
Walter Reed Army Medical Center or Tripler Army Medical Center. The
Army graduates, on average, five newly trained child and adolescent
psychiatrists each year. It is important to understand that all adult
psychiatrists are specifically and formally trained to treat the unique
18-25 year old age group. The Army has 61 uniformed adult psychiatrists
and 70 civil service or contractor providers in this specialty area.
Furthermore, the Army currently has eight uniformed psychologists
who have completed a two year post-doctoral fellowship in child
psychology. These fellowships in child psychology are located at
Tripler and Madigan Army Medical Centers. In addition, the Army manages
a child psychology fellowship at Brooke Army Medical Center that trains
civil service psychologists.
Walter Reed Army Medical Center has a child and family social work
fellowship, which graduates one or two providers per year. The Army
currently has 13 military and two civil service child-trained social
workers.
Even with a focus on active duty Soldiers, there are insufficient
uniformed and civilian adult psychiatrists to support the 18-25 year
old age population. The Army is attempting to attract and retain
civilian psychiatrists and psychologists to help meet the increasing
demand for psychological health services. Unfortunately, OPM's hiring
policies limit the ability for Army hospitals to compete for these
specialists. The salary caps and salary restrictions for hiring
graduating medical professionals limit the Army's ability to
effectively recruit and retain qualified professionals. These rules
should be reviewed and updated to allow the DoD to compete in the
medical professional labor market.

Mr. Murtha. The gentleman's time has expired.
Ms. Kilpatrick.
Ms. Kilpatrick. Thank you, Mr. Chairman.
Mr. Secretary and General, thank you for your service and
your understanding.
Please don't underestimate the stress, and I know you
don't, and I know you come to this Committee and say, you will
take care of the soldiers, and thank you for doing that. It is
going to be a problem.
My father is a World War II veteran who survived it with
his mind.
And I had an uncle who lost his mind. Didn't know until--he
came home looking well, and 60 days later, he spent the next 30
years in military hospitals because of stress.
So we are here to help you on that. I don't want to sweep
it; I want to be there for them in the theater and when they
leave with this committee and chairman and ranking member. We
support that effort. Just know that.

STRYKER

I want to talk about the Stryker just a bit. This committee
and the Congress has given you well, and it has performed well.
There were additional Strykers in the supplemental as well as
in the 2010 budget some upgrades for safety and security.
What is the way forward for the Stryker program? How will
it fit as we go to Afghanistan? The MRAP light is going to be
part of some of that. The terrain is different. I know we are
rushed for time. I would like to see how it fits and how we are
going to prepare ourselves for Afghanistan?
General Casey. With respect to Afghanistan, the first
Strykers have actually arrived in Afghanistan, and so they are
moving there right now.
As we look to the future, one of the things that strikes
us, and I think we all intuitively know it, the thing about the
future is we never get it quite right. No matter how hard we
try, we never get it exactly right. So we need to build a
versatile mix of forces. And we think we need a mix of heavy
forces, Strykers and infantry forces, infantry forces probably
mounted on things like MRAP ATVs. So between those three kinds
of systems, we think that we can give the Nation a very
versatile Army that can respond any place on the continuum.
Now, as we are looking through the Quadrennial Defense
Review, we are looking hard at whether we need to increase the
number of Stryker brigade combat teams that we have in the
Army. My inclination is that we do. It is a very capable
system. And again, it fills a middle weight place on the
spectrum of forces that we have. So we are looking at it hard,
and we haven't made any decisions, but that is the direction we
are leaning.
Ms. Kilpatrick. Is the Stryker a candidate for the man-down
vehicle?
General Casey. Probably not because it is not a fighting
vehicle. It is a troop carrier. It is a networked troop
carrier, and that is a good thing, but it is not a vehicle that
you can fight your way down the main part of Baghdad.

MEDICAL EVACUATION IN AFGHANISTAN

Ms. Kilpatrick. When the Secretary came, he talked about
evacuation. From Iraq, it is an hour with the capability of
lifting out and getting to a hospital before bringing them to
some of the more secure facilities. Afghanistan, it is a couple
of hours. Why the difference, and can we improve it and save
more lives?
Mr. Geren. We are working to improve it. The Army has been
working with the Secretary over the last few months. Dr. Gates
has given a very clear directive to the theaters that there
should be parity between the two theaters. We are moving
helicopter assets into Afghanistan to get the numbers
comparable. It is trained personnel. It is helicopters, and it
is also battlefield geometry. You have certain challenges that
come with the terrain and the altitude in Afghanistan. But our
commitment is to have the same standard both places, and that
is 60 minutes. That is our commitment, and we are working to
achieve that. We feel very strongly about it, and we are doing
everything possible to get there.
Ms. Kilpatrick. Do you have the resources to get that done?
Mr. Geren. We do. The resources are moving into theater
right now. We have some bridge resources. We have worked with
all of the services; Navy as well as the Air Force, have
provided some bridge resources to support it. 82nd CAB is there
now. We have everything underway to achieve that.
Our commitment is that it doesn't matter which theater you
are in, you are going to receive the same type of support when
it comes to medical evacuation.
Mr. Murtha. Mr. Dicks.

ONLINE MENTAL HEALTH ASSISTANCE

Mr. Dicks. I just wanted to say that I very much strongly
support what General Chiarelli is doing with this online
operation. I think this is something worth examining. I think
especially for people in rural areas, the Guard and Reserve,
when they come back, I can even see a situation where people
could use it in the country and go online if they are having
problems. Maybe this will help overcome the stigma issue. I
think this is worth examining. We have been strongly supporting
it.
Mr. Geren. Thank you.
Mr. Murtha. The Committee is now adjourned.
[Clerk's note.--Questions submitted by Mr. Rothman and the
answers thereto follow:]

Warfighter Information Network-Tactical (WIN-T)

Question. Secretary Geren and General Casey, in the FY 2010 Defense
Budget, the Office of the Secretary of Defense directed a $193 million
funding reduction, and a two and a half year delay, to the Warfighter
Information Network-Tactical (WIN-T) Research and Development program,
yet on April 16, 2009, in a speech at the Army War College, Secretary
Gates stated, ``the connectivity of the WIN-T will dramatically
increase the agility and situational awareness of the Army's combat
formations. And we will accelerate its development and field it, along
with proven FCS spin-off capabilities, across the Army.'' Can you
explain the apparent discrepancy in Secretary Gates' statement and the
budget request?
Answer. The Army cannot provide any insight into the apparent
discrepancy. WIN-T capability is important to the Army, and we
routinely engage OSD and Congress to provide information regarding the
progress of the program and funding requirements.

Single Channel Ground and Airborne Radio System (SINCGARS)

Question. Secretary Geren, I suspect we'll hear more about the
Joint Tactical Radio System (JTRS) in the coming months as programs
begin to deliver capabilities for test and evaluation. In the meantime,
what's the status of the last major Single Channel Ground and Airborne
Radio System (SINCGARS) acquisition?
Answer. The government awarded the SINCGARS contract to ITT
Communications Systems (teaming with Thales Corporation Inc.) on June
4, 2009. The procurement includes the purchase of 56,525 receiver-
transmitters required to satisfy the Army Acquisition Objective of
581,000. The procurement includes 44,496 ``F'' model SINCGARS (fixed
COMSEC devices) and 12,029 ``G'' model SINCGARS (offering programmable
COMSEC and Software Communications Architecture (SCA) compliance).
Deliveries of the ``F'' model will begin in December 2009 and deliver
at a rate of 3,625 receiver-transmitters per month through January
2011. The ``G'' model deliveries will begin in January 2011 and
continue through April 2011. This schedule allows necessary lead-time
to fully qualify the ``G'' model radio to Army specified requirements,
satisfy the Army Campaign Plan, and prevent production breaks.

[Clerk's note.--End of questions submitted by Mr. Rothman.
Questions submitted by Mr. Tiahrt and the answers thereto
follow:]

Aerial Common Sensor (ACS)

Question. The Army is now briefing a new acquisition strategy for
the Aerial Common Sensor (ACS) program, which focused on bringing near-
term, affordable solutions quickly to the battlefield. Can you describe
for the committee your plans to acquire and field the ACS system? Why
is a turbo-prop the right solution for the Army? When do you expect to
have a Request for Proposal and contract award?
Answer. The decision to restructure the ACS program to a turboprop
solution is based on Secretary of Defense guidance, lessons learned
from current overseas operations, and Army budgetary guidance. The
primary ACS mission is now supporting Irregular Warfare (IW) and direct
support to Brigade Combat Teams.
The Program Manager, ACS will award two Technology Development (TD)
contracts to competing industry partners. Engineering activities
throughout this phase will culminate in the execution of a Preliminary
Design Review and the development of flying system prototypes. The Army
will own the system prototypes by fiscal year (FY) 2012 and may conduct
a field operational assessment. The program released a draft Request
for Proposal (RFP) for the TD phase activities on July 1, 2009 and is
preparing for a Materiel Development Decision and final RFP release in
early FY10. Contract awards are planned for the Second Quarter FY10.
After completion of the TD phase, a single contract will be awarded for
the execution of the Engineering and Manufacturing Development (EMD)
phase. Three EMD systems will be developed and operationally tested by
FY15, followed by a Milestone C, Low Rate initial Production decision
in FY16. Fully production compliant and tested ACS systems will begin
fielding in FY17.
The aircraft performance required to support IW missions differs
from the performance needed in the original ACS effort. As a result,
the aircraft's range, altitude and endurance are reduced. This new
flight profile allows for a turboprop solution; a less expensive
platform. Additionally, the turboprop flight characteristics will
better enable on board sensors to support IW. The primary sensors
optimized to support IW missions include: communications intelligence
collection and location of modern signals; ground moving target
indicator sensor detection and location of vehicles and dismounted
targets; and electro-optical/infrared imagery.

Warfighter Information Network--Tactical (WIN-T)

Question. There appears to be a lack of funding in the Army budget
for the Warfighter Information Network--Tactical (WIN-T). As you know,
WIN-T is the Army's broadband wide area mobile network serving tactical
command posts from Theater down through Company level. I am told that
the lack of this funding will result in a three-year delay in the
program. In a speech at the Army War College in April, however,
Secretary Gates called for the acceleration of WIN-T. Can you reconcile
the budget request and Secretary Gates' statements?
Answer. The Army cannot provide any insight into the apparent
discrepancy. WIN-T capability is important to the Army, and we
routinely engage OSD and Congress to provide information regarding the
progress of the program and funding requirements.

[Clerk's note.--End of questions submitted by Mr Tiahrt.
Questions submitted by Mr. Kingston and the answers thereto
follows:]

BCT Stationing Decision

Question. The Hinesville community did not ask for an additional
brigade; however, community leaders responded to the Army's insistence
to aggressively build in time to accommodate the additional troops.
This decision will undoubtedly lead to overinvestment in Liberty
County. This rural community of 60,000 has overextended itself and
overbuilt. To that end, we would like to ask the following questions:
As part of the Army's transformation and growth, additional combat
support units are being stood up. Did the Army consider stationing
additional support units at Fort Stewart when it decided not to
establish the 46th brigade at Fort Stewart? What types of units were
considered?
Answer. The Army did not consider stationing additional support
units at Forts Stewart, Carson, or Bliss when the decision was made to
stop at 45 brigades. The Army was already at its authorized end
strength, currently 547,400, and had stationed those units as part of
the Grow the Army Stationing Plan in December 2007.
Question. On June 2nd the Army announced White Sands Missile Range,
New Mexico was also identified to no longer receive a Brigade Combat
Team (BCT). The brigade planned for White Sands was coming from Germany
in 2013. What is the current stationing plan for that brigade?
Answer. The restationing of two Heavy BCTs scheduled to return from
Europe in FY12 and FY13 is being examined as part of the ongoing
Quadrennial Defense Review, which will reassess the global force
structure end state for all the Services.
Question. If the brigade growth is stopped at 45, will those
brigades be better manned? What permanent increase in soldier strength
should the brigades currently stationed at Fort Stewart expect to see?
Answer. The decision to stop the growth of the Army at 45 brigade
combat teams (BCTs) was to ensure that the Army has fully-manned, ready
to deploy units. The Army has more documented and undocumented
requirements (jobs) for Soldiers than the Active Component 547,400-
Soldier Army can currently fill. By removing three Brigade Combat Teams
from the program in fiscal year (FY) 2011, the Army is estimating the
removal of approximately 10,300 requirements, allowing those associated
Soldiers to be used to offset requirements existing elsewhere in the
Force. In FY11, this will allow the Army to improve manning levels of
next-to-deploy units regardless of their location, much sooner than we
are currently able.
The population growth at Fort Stewart published in the June 2, 2009
Army press release reflected the combined growth of both Fort Stewart
and Hunter Army Air Field (HAAF). The published fiscal year (FY) 2013
population of 24,970 was based on the Fort Stewart/HAAF growth reported
in the December 17, 2007 Grow the Army report (28,470) minus a typical
Infantry Brigade Combat Team (BCT) of 3,500 military. This growth only
included Army military, Army students, and Army civilians--not all
population increases (i.e., other military, transient military, other
civilians, contractors). The April 30, 2009, Army Stationing and
Installation Plan shows the FY13 growth at Fort Stewart at 22,592 and
HAAF at 5,923, for a total of 28,515 for Army military, Army students,
and Army civilians. Adjusting this number to reflect the de-activation
of the BCT in question (3,443) reduces the population to 19,149 at Fort
Stewart, and no change at HAAF, for a total growth of 25,072.
Installation population projections will continue to fluctuate based on
operational needs and force management decisions.
Question. The lack of dwell time at home between deployments for
Soldiers has been a continuing serious concern. Since the Army employs
the force by rotating organizations, primarily combat brigades, what
impact will having only 45 brigades have on the Army's efforts to
increase soldiers' dwell time at home?
Answer: Secretary Gates announced in April 2009 that the active
Army will grow to 45 BCTs instead of the 48 BCTs as reported in the
December 2007 Grow the Army plan to Congress. The decision to stop the
Army's growth at 45 BCTs versus 48 was made to raise the readiness and
percentage fill of deploying units. This ensures that we retain our
ability to support future requirements to include rotations to Iraq,
Afghanistan, and other contingencies. This decision also contributes to
helping to put an end to the routine use of stop-loss to increase
deploying units' manning. The Secretary of Defense, in July 2009,
temporarily increased the Army end strength from its current 547,400 to
562,400 in 2010 and the authority to increase to 569,000 in 2012. With
this additional increase we will be better postured to rebalance our
enabling forces which perform key functions on the battlefield in
support of our BCTs.
The decision to stop at 45 BCTs will not have an immediate impact
on improving BOG-to-Dwell ratios. The end strength growth these three
BCTs represent will increase individual dwell for those Soldiers who
would have had to fill the ranks of those units identified for
deployment.
Question. It is well understood that one of the great stressors on
soldiers and families is the short time the soldiers are home between
deployments or short dwell time. How will the Army increase dwell time
in the near term? It seems the only two ways to do that is to reduce
the number of deployments or increase the size of the Army in terms of
soldiers and brigades that can deploy. This seems to be a problem that
has not been resolved since 2003. As we expand our commitment to
Afghanistan shouldn't we reasonably increase the size of the Army and
be ready for the demand with well-rested and well-trained soldiers?
Answer. The Army's size and force structure given current and
project demands, which includes the transitions in OIF and OEF and
other global commitments, are being examined as part of the Department
of Defense's Quadrennial Defense Review. In July 2009, the SECDEF
temporarily increased the Army end strength from its current 547,400 to
562,400 in 2010 and the authority to increase to 569,000 in 2012. These
additional forces will be used to ensure deploying units can increase
dwell time and are properly manned and trained. They will not be used
to create new combat formations.
Question. Additionally, we question the Army's press release which
stated that Fort Stewart would grow from 20,512 soldiers to 24,970 by
2013. Does this number include personnel assigned to Hunter Army
Airfield as well? We understand that a significant percentage or that
growth is projected for Hunter Army Airfield (HAAF) located in
Savannah, Georgia and not Hinesville. Can you please explain?
Answer. The population growth at Fort Stewart published in the June
2, 2009 Army press release reflected the combined growth of both Fort
Stewart and Hunter Army Air Field (HAAF). The published fiscal year
(FY) 2013 population of 24,970 was based on the Fort Stewart/HAAF
growth reported in the December 17, 2007 Grow the Army report (28,470)
minus a typical Infantry Brigade Combat Team (BCT) of 3,500 military.
This growth only included Army military, Army students, and Army
civilians--not all population increases (i.e., other military,
transient military, other civilians, contractors). The April 30, 2009,
Army Stationing and Installation Plan shows the FY13 growth at Fort
Stewart at 22,592 and HAAF at 5,923, for a total of 28,515 for Army
military, Army students, and Army civilians. Adjusting this number to
reflect the de-activation of the BCT in question (3,443) reduces the
population to 19,149 at Fort Stewart, and no change at HAAF, for a
total growth of 25,072. Installation population projections will
continue to fluctuate based on operational needs and force management
decisions.
Question. Secretary Gates reasoned that by continuing to increase
the Army's strength to 547,000 soldiers while stopping the growth of
combat brigades at 45 that this would allow the existing brigades to be
better manned. This would also minimize or eliminate the use of
initiatives like stop-loss. With an end-strength of 547,000 would a 48
brigade Army be undermanned and cause the continued use of stop loss?
Answer. Regardless of the number of brigade combat teams, the Army
is committed to phasing out stop loss beginning in January 2010, and
completely eliminating stop loss by March 2011.
Question. Fort Stewart has the largest training area east of the
Mississippi River and no other Army post has the transportation
infrastructure like Fort Stewart which has nearby a major port and a
major airfield with railways connecting all critical points. Would you
characterize Fort Stewart as the Army's most capable and well-equipped
power projection platform in the continental US? How would you rate
Fort Stewart in terms of being ready for more missions and ready for
more forces to be assigned?
Answer. Fort Stewart has 251,000 acres of maneuver training land
and over 18,000 acres of impact area with 51 live-fire ranges. Relative
to the missions that are being placed on Army commanders and the
distances that our new systems are able to cover, Fort Stewart is
somewhat limited in the training that can be realistically provided
because of the size and characteristics of its training land. Although
the training land is limited, the level of live-fire training
capability at Fort Stewart still establishes it as one of the Army's
most important training complexes. The Army remains committed to the
development and sustainment of Fort Stewart as a major training asset
and the recent changes in the Army growth posture does not
significantly reduce the overall training support capability that is
planned at Fort Stewart. In 2007, we analyzed installations that would
be capable of activating one of the six Grow the Army Infantry Brigade
Combat Teams (IBCTs) and Fort Stewart ranked high due to its growth
capacity, power projection, training, and Well-being for Soldier and
Families capabilities. It was the combination of all these criteria
that enabled it to be considered and selected as an installation to
receive an IBCT. The Army has several power projection platforms within
the United States that are fully capable and all have different
qualities.
Question. Over the past two years, when the Army was pressed to
mobilize, train and deploy National Guard Brigade Combat Teams from
Indiana, Texas and Oregon, few posts inside the United States were
better equipped to prepare these citizen soldiers for the rigors of
combat. Although the Army may desire to avoid mobilizing National Guard
units from Army installations, Fort Stewart's great training and
billeting facilities make it an ideal site (perhaps even preferred
site) for power projection. The community and the post consistently
step up to support these efforts. Recently the staff from the Oregon
delegation visited Fort Stewart and gave rave reviews for the post.
What could the community do to accommodate these visiting units and
continue to provide strong support for the Army?
Answer. Communities may continue to support the Army's mobilization
mission. Strong partnerships between local communities and neighboring
Army installations provide a solid foundation to support Soldier and
Family quality of life and mission preparedness. Additionally,
community investments increase military value to better posture the
installation for consideration for future Army stationing actions.
Question. The 3rd Infantry Division has a modular brigade located
across the state of Georgia at Fort Benning in Columbus. Where is the
ideal location for the Heavy Infantry Brigade Combat Team to train?
Will the joining of the Armor Center with the Infantry Center have any
effect on this BCT? Would the BCT have to compete for access to land
and ranges? Could the effects of any current environmental impact
issues be relieved by relocating the BCT to Fort Stewart until these
get resolved? Wouldn't it make more sense to re-locate that Heavy BCT
to Fort Stewart where it can train on the largest training area in the
eastern U.S. and be next door to an exceptionally capable airfield and
seaport? Once the environmental impact issues are fully addressed,
could a BCT from Germany be relocated to Fort Benning?
Answer. The ideal location for a Brigade Combat Team (BCT) to train
is at an installation that has growth capacity, power projection
capabilities, training opportunities, and provides for the well being
of Soldiers and their Families; the Army has several installations with
these qualities. Merging the Armor Center and Infantry Center into the
Maneuver Center of Excellence is mandated by the Base Realignment and
Closure Commission 2005, and the recommendation was based on their in-
depth analysis of installations within the United States. The training
land and range capability at Fort Benning will be able to support the
3rd Infantry Division brigade as well as the Armor Center and the
Infantry Center once all of the BRAC-related range construction is
complete. The Army is working with the United States Fish and Wildlife
Service to mitigate environmental issues at Fort Benning, and analysis
has concluded that relocating a Heavy BCT out of Fort Benning would
have minimal impact for mitigating the current environmental issues.
Whether it would make more sense to relocate the Heavy BCT to Fort
Stewart would require further analysis. The Quadrennial Defense Review
has agreed to review the status of the two heavy brigades in Germany.
One heavy brigade is returning to Fort Bliss in 2012, while the other
heavy brigade will return in 2013--that is, if the QDR agrees with that
recommendation. Until a decision from the QDR is made and until the
environmental impact issues are fully addressed, we do not have a
projection on whether a BCT could be relocated to Fort Benning.
Question. What does this say for the next community? What precedent
are we setting by making these policy decisions?
Answer. We supported Secretary of Defense Gates' decision to stop
the growth of Army BCTs at 45. We analyzed criteria that would maximize
FY09 and FY10 investments, minimize disruption to the current plan,
minimize community impact if at all possible, and maintain flexibility
for future force mix decisions. Our final stationing decisions reflect
the results of analysis and best military judgment. We understand that
communities have made significant investments which impact the
community. As partners with the community, we are committed to
providing critical information as quickly as possible--especially when
the community may perceive it as bad news. This allows maximum time for
communities and investors to reassess their investments and make
necessary adjustments in order to minimize negative impacts.

[Clerk's note.--End of questions submitted by Mr. Kingston.
Questions submitted by Ms. Granger and the answers thereto
follow:]

Residential Communities Initiative (RCI) Program

Question. Given the complexities inherent in the Residential
Communities Initiative (RCI) program and uncertainties in the financial
markets, shouldn't the Army be focused on getting the best value in its
service contracts so these technically demanding financial and real
estate transactions can be completed in a timely and efficient manner?
Answer. The Army is always interested in obtaining the best value
for its service contracts; however, best value is a difficult metric in
the service environment. The Military Housing Privatization Initiative
(MHPI) program was enacted in 1996, and the associated business
protocols have matured significantly over the life of the program
making a deliverables-based, Low-Price, Technically Acceptable (LPTA)
contract a cost effective vehicle to acquire technical financial
consulting services. This is based upon several factors to include the
fact that several consultants have gained significant experience in
advising the Office of the Secretary of Defense and the Military
Departments in executing successful privatization programs resulting in
a pool of well-qualified firms that can perform this mission. To ensure
that only qualified firms are eligible for award, the Army will require
all offerors to meet minimum experience qualifications before
submitting a price proposal. Competition between such top-notch
experienced companies will be healthy and produce an advisor who is
qualified to perform the required tasks at the lowest price, thus
allowing the Army to use any potential savings for other high-priority
missions. The Army will work to develop a scope of work that will
provide both a low price and best value in its service contracts.
Additionally, due to the maturity of the MHPI program and the
knowledge base of the government workforce, the Army is now able to
prudently re-balance the tasks performed by its employees and private
consultants. This ``re-balancing'' of the workforce between the
contractor community and government personnel has been an emphasis of
the Congress for some time now.
** Since the 9 June HAC-D hearing, and based on further
coordination with Army Corps of Engineers Contracting Officer, Army
leadership now recognizes that a ``best value solicitation process'' to
obtain service contracts in support of RCI is the Army's preferred
approach. The solicitation process is ongoing, with plans to issue a
``best value'' solicitation no later than January, 2010.
Question. Experience within the Department of Defense has shown an
increased risk inherent with selecting financial advisors based on
lowest bid. Given this, why is the Army considering deviating from a
``best value'' model?
Answer. The Army will not be selecting its financial advisor solely
on lowest bid. The Army intends to use a Low Price, Technically
Acceptable procurement strategy as part of the implementation of new
business processes regarding the use of consultant support. The
Military Housing Privatization Initiative program has matured
significantly since its implementation over 10 years ago, and the
government workforce has become more experienced and better qualified
to execute these private sector projects. Government program managers
are more technically capable and accountable for the level of
contractual support required to execute their duties.
The Army is now able to prudently re-balance the tasks performed by
its employees and private consultants and will focus consultant use on
provision of the real estate financial expertise which is not inherent
in the Army workforce. By requiring both the public and private sector
alike to be more diligent about eliminating redundancy, evaluating
value added, and improving the efficiency of the transactions that we
manage, the Army will continue to make significant strides in our
ongoing requirement to be good stewards of the taxpayers' money.

[Clerk's note.--End of questions submitted by Ms. Granger.
Questions submitted by Mr. Murtha and the answers thereto
follow:]

Army Suicides

Question. Yearly increases in suicides have been recorded since
2004 and on January 29, 2009, the Army released its 2008 data showing
suicides among Army troops have increased from 2007 to an all time
high. At least 128 soldiers killed themselves in 2008; the final count
likely could be higher because more than a dozen suspicious deaths are
still being investigated and could turn out to be self-inflicted. The
new figure of more than 128 compares to 115 in 2007 and 102 in 2006--
and is the highest since recordkeeping began in 1980. The Army's report
calculates at a rate of 20.2 per 100,000 soldiers--which is higher than
the adjusted civilian rate for the first time since the Vietnam War. In
response to the rise in suicides the Army mandated that between
February 15 and March 15, 2009 all Army personnel received training for
peer-level recognition of behaviors that may lead to suicidal behavior,
and intervention at the buddy level.
However, so far this year the Army has experienced 64 suicides and
Army officials are also investigating other deaths as possible
suicides. Specifically, at Fort Campbell, Kentucky there have been at
least 11 confirmed suicides this year. In response to this the Base was
closed for three days beginning May 27th to allow commanders to
identify at-risk soldiers and help them with their mental health
issues.
General Casey, Fort Campbell currently leads Army installations in
the number of suicides this year, with 11 confirmed incidents since
January, please discuss the situation at Fort Campbell. How many times
have units at Fort Campbell been deployed to Iraq or Afghanistan and do
you think that repeated lengthy combat tours combined with limited
dwell time at home station are major factors contributing to the
increase in the rate of suicides?
Answer. Over the past year, the Army has engaged in a sustained
effort to reduce the rate of suicide within its ranks. This effort has
included an Army-wide suicide prevention stand-down and chain teach for
every Soldier; the implementation of the Army Campaign Plan for Health
Promotion, Risk Reduction and Suicide Prevention; the establishment of
both a Suicide Prevention Task Force and Suicide Prevention Council; a
long-term partnership with the National Institute of Mental Health
(NIMH) to carry out the largest ever study of suicide and behavioral
health among military personnel; and more than 160 specific
improvements to Army suicide prevention policies, doctrine, training
and resources.
The 101st Airborne Division, Headquarters has deployed three times;
1st Brigade, three times; 2nd Brigade, three times; 3rd Brigade, four
times; and 4th Brigade, two times. The 101st and 159th Combat Aviation
Brigades have each deployed three times. The 101st Sustainment Brigade
has deployed three times. The 5th Special Forces Group has deployed (in
six-month rotations) seven times.
Although I believe that repeated combat tours combined with limited
dwell time are stressful, and that they may be factors contributing to
the increase in suicides, that is not entirely clear. Nonetheless, I am
working to improve unit dwell time to 1 year deployed and 2 years at
home station for active duty units and 1:4 dwell time for Reserve
Component units. In October 2008, the Army and the NIMH entered into a
memorandum of agreement for NIMH to conduct a longitudinal study to
ascertain, if possible, the causes and risk factors for suicides within
the Army's ranks.
Question. General Casey, what resources are included in the FY 2010
budget request to deal with this dilemma and how will they be used?
Does the Army need any additional funding to help prevent suicides?
Answer. The Army Suicide Prevention Program expands access to care
(behavioral, primary, and substance abuse) through various means: the
3R's (recruit, relocate, retain) incentives to retain substance abuse
personnel, increased staff in the Office of The Surgeon General
(primary care doctors, behavioral health doctors and support staff),
and expanded operating hours for hospitals and clinics with additional
clinical substance abuse doctors. The Army is funding new initiatives
such as Comprehensive Soldier Fitness (CSF) Action Plan to support
Soldiers, Families, and Army Civilians in an era of high operational
tempo and persistent conflict. The Army is increasing dwell time to 1:2
Active and 1:4 Reserve to allow Soldiers more time at home and to
train. In addition, the Army is funding the Strong Bonds Program,
investing in research and training (National Institute of Mental Health
(NIMH), Tele-behavioral Health, Point of Injury Registry, training
products), suicide prevention program managers to integrate health
promotion and provide installation suicide prevention, and an
Integrated Net-Centric comprehensive database.
The Army base requirements for FY10 Suicide Prevention Programs
total $29.8 million and the Defense Health Program requirements are
$45.8 million. The Army continues to review requirements for suicide
prevention programs but is not requesting additional funding at this
time.
Question. Secretary Geren, is this an active duty Army problem or
are you seeing this in the Army National Guard and Army Reserve as
well?
Answer. Suicides occur in all three components of the Army, but the
Active duty is overrepresented by suicides. That is, to date for
calendar year 2009, the Active component has comprised 49 percent of
the Total Army, but represents 60 percent of the Army's suicides. The
Army Reserve is under-represented for the same period; it has comprised
18 percent of the Total Army but represents only 11 percent of the
Army's suicides. The National Guard is within expected parameters; it
has comprised 33 percent of the Total Army, and represents 29 percent
of the Army's suicides for calendar year 2009.
Question. Gentlemen, of the 64 suicides this year, how many of
these occurred while in theater and how many occurred at home
installations?
Answer. We are now at 90 suicides Army-wide for calendar year 2009,
including the Army National Guard, U.S. Army Reserve, and one cadet. Of
those, 67 occurred in the United States; 12 occurred in Iraq or
Afghanistan; and 11 occurred in other areas (including five in Germany
and three in South Korea).
Question. The Army's BATTLEMIND training helps prepare Soldiers and
their Families for the stresses of war, and also assists with the
detection of possible mental health issues before and after deployment.
Please explain what services are available to Soldiers in Theater?
Answer. Combat and Operational Stress Control (COSC) is the Army
program that provides behavioral healthcare to service members in a
deployed/operational environment. There has been a robust COSC presence
in theater since the beginning of combat operations, with over 200
deployed behavioral health providers in Iraq, and an additional 30
providers in Afghanistan. Behavioral healthcare assets are deployed in
support of overseas contingency operations with the following
organizations: COSC Medical Detachments, Combat Support Hospitals,
Medical Companies Area Support, and Behavioral Health Sections of
Brigade Combat Teams.
COSC units provides full spectrum behavioral healthcare in theater.
This includes prevention and consultation services, traumatic event
management, behavioral healthcare and treatment, and stabilization and
restoration of both Soldiers and units. The restoration units operate
much like an intensive outpatient program. Mental Health Advisory Team
reports have demonstrated the necessity of these front line behavioral
health efforts.
In addition, Battlemind provides a range of resiliency training
modules throughout the deployment cycle. Specific tactical tools
include the Battlemind event driven and time driven psychological
debriefings. Finally, all deploying behavioral health providers are
required to attend a one week COSC Course. This course helps to ensure
that all deploying behavioral health providers receive specialized
training in battlefield behavioral healthcare.
Question. The Army and National Institute of Mental Health signed
an agreement in October 2008 to conduct long-term research to identify
factors impacting the mental and behavioral health of Soldiers and to
share intervention and mitigation strategies that will help decrease
suicides. During this study, which is expected to last five years, what
aspects of soldier life will be examined?
Answer. The Army-National Institute of Mental Health Suicide Study
is a multi-year study that will assess a broad range of aspects of
Soldier life. Personal factors such as history of suicidal behavior and
mental disorders, adverse childhood experiences, psychological traits,
cognitive function, stressful life events, social supports and mental
health treatment will be assessed via Soldier self-reports. This
information will be augmented with information gathered from Army
administrative data sources, and from Soldiers' buddies, supervisors,
and family members about the Soldier and his/her perceived work
environment, including unit-level information such as cohesion, morale,
and leadership, as well as operational tempo measures related to
deployment and combat. The study will also collect biological specimens
to examine the relationship between certain biomarkers and the risk
for, or development of, adverse outcomes such as suicidal behavior or
mental illness. All data collection will be subject to appropriate
consent and confidentiality protections.
A key objective of the study is to identify modifiable risk and
protective factors associated with suicide, mental disorders, and
psychological resilience, so that evidence-based recommendations for
intervention targets can be provided to the Army.

Grow-the-Army Brigades

Question. For the past several years, the Army has been adding end-
strength and equipment in order to form six new infantry brigades,
bringing the total number of combat brigades to 48. However Secretary
Gates recently announced a decision to stop increasing the number of
Army combat brigades at 45.
What is the impact on the Army, including Army force generation, of
Secretary Gates' decision to hold active Army brigades at 45, rather
than growing to 48?
Answer: Due to wartime operational demands, the Army has more
requirements for Soldiers than it can fill in the Active Component (AC)
end strength of 547.4K. By removing three Brigade Combat Teams (BCTs)
from the program in fiscal year (FY) 2011, the Army is estimating the
removal of approximately 10,300 requirements allowing those associated
Soldiers to be used to offset requirements existing elsewhere in the
force. This reduction should improve individual operational tempo and
stabilization. The reduction of three BCTs will generally reduce the
Army's capacity to source BCTs by one BCT per Army force generation
cycle. In FY11, this will allow the Army to improve manning levels of
next-to-deploy units much sooner than it is currently able.
Question. To what extent has DoD and the Army encouraged local
investment to support a greater military population at the bases that
were to have received the 46th, 47th, and 48th brigades but now will
not see additional brigades? To what extent does DoD and the Army
intend to compensate these communities for these investments?
Answer. The Army has and will continue to provide the communities
with the most current information available regarding stationing
decisions. There is no plan to compensate communities, per se; however,
their investments increase military value to better posture local
installations for consideration for future Army stationing actions. The
Army will still grow to 547,400 as planned and is currently analyzing
where these Soldiers will be stationed to fill existing unit
shortfalls.
Question. What is the status of manning, equipping, and training
the Grow-the-Army brigades? When will the Grow-the-Army brigades be
available for combat deployment?
Answer. Grow the Army brigade (GTA) #1, the 4/4 Infantry Division
(ID) Infantry Brigade Combat Team (IBCT) became available in FY08;
GTA#2, the 4/3 ID IBCT began its one year conversion process in March
2009; and GTA#3, the 3/1 Armor Division (AD) IBCT will begin its one
year activation process in September 2009.
The 4/4 ID IBCT (GTA#1) is currently manned at approximately 92%;
4/3 ID IBCT (GTA#2) is manned at approximately 91%; and 3/1 AD IBCT
(GTA#3), having not yet activated, is not yet manned.
The 4/4ID IBCT (GTA#1) has 92% of its equipment on hand; the 4/3 ID
IBCT (GTA#2) has 95% of its equipment on hand; and the 3/1 AD IBCT
(GTA#3) is not yet equipped.
The 4/4 ID (GTA#1) just deployed having completed all necessary
individual/crew/squad, company, battalion, and brigade level training
prior to their culminating training event. The 4/3 ID (GTA#2) recently
redeployed and continues to focus on individual/crew/squad level
training under the IBCT design, individual professional development,
and new equipment training. The unit will begin conducting collective
training in September 2009 with their culminating training event at the
Joint Readiness Training Center in the summer of 2010; they will deploy
in 1st Quarter FY10.
The 4/4 ID IBCT (GTA#1) is currently employed in OEF; the 4/3 ID
IBCT (GTA#2) is in a reset status, currently focused on individual
training, and the unit will begin collective training to reenter the
available pool in the 1st Quarter, FY10; and 3/1 AD IBCT (GTA#3), once
manned, equipped, and trained, should enter the available pool in 4th
Quarter, FY10.
Question. For the past several years, the Army has been adding end-
strength and equipment in order to form six new infantry brigades,
bringing the total number of combat brigades to 48. However Secretary
Gates recently announced a decision to stop increasing the number of
Army combat brigades at 45. Is the necessary equipment for the Grow-
the-Army brigades fully funded?
Answer. The reduction of Grow the Army by three Infantry Brigade
Combat Teams was accompanied by funding adjustments to account for the
reduced equipment requirements. Given continued support of Base and
Supplemental funding (i.e., continued support of reset for two years
beyond Operation Iraqi Freedom and Operation Enduring Freedom
deployments) the Army is on track to provide equipment to the remaining
Grow the Army force structure.

Stop Loss

Question. There are currently over 12,000 soldiers in the Army,
Army Reserve and Army National Guard who remain on active duty beyond
their scheduled separation date as a result of stop loss. To help ease
the burden of those affected by stop loss, the FY2009 Defense
Appropriations Act established and funded a new special pay of $500 per
month for all servicemembers extended by stop loss during FY2009.
Secretary Geren, Secretary Gates has been quoted several times stating
that he would like to end stop loss completely. What policy steps are
being taken to meet this goal?
Answer. Each Army component has a comprehensive plan to achieve the
goal of ending the use of Stop Loss, taking into consideration the
circumstances unique to each component. The intent is to cut the number
of Stop Lossed Soldiers in half by June 2010, and to discontinue the
use of Stop Loss by March 2011. The Active Component will begin
deploying units without Stop Loss in January 2010. Deployment policies
will be adjusted to permit certain Soldiers to deploy for portions of
the unit deployment. The U.S. Army Human Resources Command (HRC) will
provide replacements prior to deployment for Soldiers who will not
deploy due to insufficient time remaining in service and in-theater
replacements for losses, dependent on unit strengths, available
inventory, and projected redeployment dates. Additionally, each
component has developed and implemented an incentive program to
encourage Soldiers to extend to complete the deployment. The Active
Component is using the Deployment Extension Incentive Program, the Army
National Guard is using the Deployment Extension Stabilization Program,
and the Army Reserve is using the Designated Unit Stabilization
Program. The Army Reserve will begin mobilizing deploying units without
Stop Loss in August 2009. The Army Reserve will implement special pay
for mobilizing units to assist in stabilizing units for deployment.
Soldiers in units identified for mobilization who have insufficient
time to complete the deployment will be encouraged to extend. Soldiers
who do not commit to complete the mobilization will be transferred to
another unit until separation, and the Army Reserve will seek
volunteers in other units to replace these Soldiers. The Army National
Guard will begin mobilizing deploying units without Stop Loss in
September 2009. The Army National Guard will adjust mobilization and
deployment policies, utilize voluntary cross-leveling, and implement an
incentive program to encourage Soldiers to extend to complete the
deployment. For those Soldiers who are not extending and their
projected demobilization date is after their Expiration of Term of
Service (ETS), they will not be mobilized. Soldiers with an ETS after
demobilization but prior to the post-mobilization stabilization period
(90 days post-mobilization) will be mobilized and deployed, but will be
returned to home station 90 days prior to separation for transition.
Question. While keeping these Soldiers maintains unit integrity,
aren't you concerned that this undermines morale?
Answer. Clearly Stop Loss is an issue with Soldiers and Families
who are affected. But it appears that the great majority of Soldiers
understand the need to maintain cohesion and ensure that a fighting
force that has trained together remains together in combat. Our
deployed forces reenlist at a higher rate than our non-deployed forces,
and we have not seen indications that Stop Loss has been a significant
detriment to morale. However, we recognize that Stop Loss causes a
hardship for those Soldiers affected, and in March 2009 the Army
announced the implementation of Stop Loss Special Pay. Stop Loss
Special Pay provides $500.00 for each month or portion of a month a
Soldier is held in the Army under Stop Loss authority. The Army's
intent has always been to end the program as soon as operationally
feasible to maintain unit cohesion and stabilization without the use of
Stop Loss. The Army Reserve began deploying units without Stop-Lossed
Soldiers in August 2009, the Army National Guard in September 2009, and
the Active Army will begin in January 2010.

Quality of Today's Soldier

Question. The Army admitted recruits in 2005 through 2007 that were
below standard. Interviews with Non-Commissioned Officers (NCOs)
revealed that they believe sub-standard Soldiers end up in units and
cannot be utilized, making it harder on that unit to accomplish its
mission. In addition, the NCOs indicated that some new recruits are
unable to pass a physical readiness test. The NCOs feel that the basic
training course needs to be updated to provide the recruits with the
skills they will need upon deployment to theater. Essentially, the NCOs
believe the Army needs to get ``harder'' as new recruits lack
discipline. In addition, the NCOs feel that their influence to train
and shape recruits has eroded. Data supports the NCOs assessment of
overall quality. In June 2003 initial entry training (IET) attrition
rates were 14.78%. In December 2007 the attrition rate for IET was
8.49%. General Casey, given the state of the economy and people more
willing to enlist, will the Army be able to raise its standards back to
the original levels? Gentlemen, please explain the effect of the poor
economy on recruit quality.
Answer. The Army has not lowered its recruiting standards and
remains committed to ensuring we recruit the best from the available
pool of qualified volunteers who desire to serve our Nation as
Soldiers. Every Soldier enlisting and volunteering in the Army is fully
qualified for the military occupational specialty selected. The affects
of a poor economy may have a positive impact on quality mark
improvement.
Question. General Casey, even though the Marine Corps is growing
its forces like the Army, the Marine Corps seems to always meet DoD
quality benchmarks. Why does the Army continue to struggle with this
issue?
Answer. The Army's annual recruiting mission is almost three times
the size of the Marine Corps' mission. The Army's substantial manpower
demands and recruiting environment--which in previous years yielded
recruiting cohorts that significantly exceeded the Army's and the DoD's
recruiting quality standards--have impacted our ability to meet DoD
quality mark goals for the past five years. However despite these
shortfalls, we are now experiencing a return to favorable conditions
and the result is a marked increase in fiscal year 2008 and 2009
recruit quality. The Army's percentage of new enlisted Soldiers
considered ``high quality'' with a Tier 1 education (high school
diploma) increased by 2.1% in 2008. Additionally, recruits who scored
highly (50-99%) on the Armed Forces Qualification Test (AFQT) increased
1.6%; and recruits who scored poorly (30% and below) on the AFQT
decreased 1.2%. The Army is expected to exceed every DoD quality mark
goal in all components for FY09.
Question. What is the current percentage of Army recruits with high
school diplomas?
a. How many waivers were granted to recruits and what is the most
common waiver granted?
b. What is the attrition rate for recruits without high school
diplomas?
c. Has the Army performed any analysis on the conduct of these
recruits? Are discipline issues more frequent in this group?
Answer. In FY08 the percentage of Regular Army Non-Prior Service
recruits with Tier I (High School Diploma Graduate) credentials was
82.8%. As of end of month May 09 Non-Prior Service recruits with Tier I
(High School Diploma Graduate) credentials was 94.5%.
In FY08, the Army granted 19,202 regular Army non-prior service
waivers; the most common granted was for conduct (9,229). Most waivers
stem from when applicants were young and immature. In considering
waivers, we look at the applicant's recent history and behavior, such
as employment, schooling, and references from teachers, coaches,
clergy, or others who know the person well. We also look for signs of
remorse and changed behavior. The Army has always had waivers to enable
otherwise qualified applicants to serve their country. Young people who
made mistakes earlier in life can change. A one-time incident may not
accurately reflect an enlistee's character or potential.
A recent Tier II Attrition Screen (TTAS) report completed by the
United States Army Accessions Command indicated the Tier II (Non-High
School Diploma Graduate/Alternate Credential Holder) 36-month attrition
rate was 33.5% and the Tier I 36-month attrition rate was 20.1% for the
FY05 cohort.
The Army is conducting a longitudinal study on recruits who were
granted waivers for conduct. In general, recruits granted waivers are
high quality and perform well. Their education and aptitude are higher
on average. Soldiers who enlisted with a conduct waiver in recent years
train and perform better than those without waivers initially.
Indiscipline rates and first term attrition are slightly higher for
recruits with conduct waivers.

Recruiting and Retention

Question. A key principle of the U.S. Armed Forces is to attract
and retain competent personal to assure readiness and operational
effectiveness. The Army has generally met its aggregate recruiting and
retention goals. In some cases, the Army has lowered recruiting
standards and increased the amount of enlistment and reenlistment
bonuses. However, with the deteriorating economy many troops are
electing to stay in the Army and more civilians are considering
enlisting in the Army. Recruiting always remains a challenge, but a
tighter job market provides more opportunities for the Army to appeal
to young men and women. Many factors other than bonuses are appealing
to Soldiers and recruits such as: a 32 percent increase in military pay
since 2001, compared to 24 percent for the general population; the new
GI bill; and job security. This appears to be a good time to reduce
enlistment and reenlistment bonuses as well as return standards back to
higher levels. Gentleman, how have the current economic conditions
affected recruiting and retention?
Answer. Recruiting. The economic downturn has had a positive impact
on Army recruiting in FY09; as a result of the current demand for
military enlistment, we are now experiencing a return to favorable
conditions and a marked increase in fiscal years 2008 and 2009 recruit
quality marks. Additionally, the current environment has allowed us to
reduce our incentive amounts and the number of occupations that receive
bonuses. However, we need to retain the flexibility to offer bonuses as
necessary to attract and retain talent in shortage military
occupational specialties (MOSs) or to channel applicants into less
desirable MOSs. We will continue to monitor the trends and make
adjustments as required.
Retention. The affects of a tightening U.S. job market have had a
positive impact on Soldier's retention decisions; the Army easily
achieved the FY09 mission and has reduced bonuses this year. Challenges
will remain as the Army continues to attain its end-strength goals.
Question. General Casey, the Committee remains concerned regarding
the recruitment and retention for mission-critical occupational
specialties. Has the Grow-the Army recruitment helped fill the critical
specialties? If not, what steps are being taken to fill the specialty
occupations?
Answer. The Grow-the-Army initiative has had a minimal impact on
filling critical specialties. The Army is using targeted incentives to
fill critical specialties. Incentives help the Army channel quality
recruits to required critical MOSs by offering seasonal and targeted
bonuses to fill training seats at the right time. The Army also
recently launched a Military Accessions Vital to the National Interest
(MAVNI) recruitment pilot which could prove crucial in filling critical
health care professional shortages.
Question. General Casey, has the Army analyzed why these
occupational specialties have consistently been under-filled? What is
the operational impact of these shortages? Does the FY 2010 budget
provide the resources that are needed to fill these positions?
Answer. Yes, the protracted conflict has been a major factor
impacting our ability to fill critical occupational specialties. These
shortages have impacted our ability to offer increased dwell time to
our troops. We believe the FY10 budget provides the necessary resources
to properly incentivize Recruiting and Retention to increase the fill
of critical occupational specialties for the Army.

Enlistment and Retention Bonuses

Question. The military services offer a variety of enlistment and
re-enlistment bonuses to attract new recruits into military specialties
that are considered ``hard to fill,'' as well as to encourage
experienced military members in ``shortage jobs'' to stay in past their
first enlistment period. The Army has more enlistment incentives than
any of the other military services. Programs include Enlistment,
Overseas Extension, and Reenlistment bonuses. Bonus levels are in
constant flux. Secretary Geren, what was the total funding for Army
recruiting and retention bonuses for FY 2009 and what is the total for
FY 2010?
Answer. The total cash bonus funding for the Army recruiting and
retention bonuses for FY09 are below. Also listed below you will find
the FY10 bonus funding request.

FY09 Recruiting funding--$544.2M
FY10 Recruiting funding requested--$450.3M

FY09 Retention funding--$486.1M
FY10 Retention funding requested--$444.4M

*FY09 retention bonus total includes a $140M conference mark
reduction for recruiting and retention. The total retention bonus
request was $626.1M prior to the mark.
Question. Secretary Geren, what is the range of individual bonuses
for recruiting? For retention? Please indicate why there are
differences.
Answer. Recruiting. Recruiting bonuses range from as low as $2,000
up to the statutory limit of $40,000. Bonuses for skills vary greatly
depending on shortages in the particular skill and mission
requirements. As of March 1, 2009, 45 of 149 skills receive a cash
incentive.
Retention. The Army uses monetary incentives to retain quality
Soldiers in critical and hard-to-fill skills as a means to manage and
shape the force. Bonus amounts are adjusted based on the criticality of
a specialty. The Army currently uses the following bonuses as part of
the Army's Retention Program:
Selective Reenlistment Bonus (SRB). Currently the SRB is used for
skills identified as critical Army-wide. The program offers from $1K to
$12K for Soldiers in select skills, while Soldiers in special critical
skills can receive up to $27K.
SRB-Deployed. The SRB-Deployed program offers Soldiers deployed to
Afghanistan, Iraq, and Kuwait up to a maximum of $9.5K.
Critical Skills Retention Bonus (CSRB). The CSRB currently targets
seasoned, combat veterans to stay in the ranks beyond retirement
eligibility offering a lump sum bonus based on the Soldier's length of
commitment to serve. The program is currently paying Soldiers in
Special Operations Forces skills a maximum payment of $150K for a six-
year commitment. Six additional skills can receive a maximum payment of
$50K to $100K for a six-year commitment (the total number of CSRBs
averages less than 700 per year).
Question. Gentlemen, have you found any imbalances or inequities in
your recruiting and retention bonus structure that have been improved
for FY 2010?
Answer. The Army has not identified any inequities or imbalances in
our recruiting and retention bonus structure. The recruiting and
retention incentives structure is reviewed quarterly to determine if
imbalances or inequities exist and to correct any problems found. The
Army makes a concerted effort to target high quality recruits and to
insure marketing efforts are targeted to diverse populations of
potential applicants in urban, suburban and rural areas.
The Army continually measures the effectiveness of retention
incentives offered and makes adjustments as necessary.
Question. Gentlemen, since the Army has reached the Grow-the-Army
end strength goal and more people seem to be willing to join the Army
because of the state of the economy, does the FY 2010 Army budget
reflect the current environment?
Answer. Yes. Recruiting. Through refinement of the Active Army
enlistment bonus payment schedule, bonuses for specialties that had
received bonuses during fiscal years 2005-2007 were reduced
approximately 20% for fiscal year 2009 and 2010. The savings resulting
from bonus management will be approximately $65M per year through
fiscal year 2011. Reliance on seasonal bonuses which were required to
fill short term training seats has been curtailed in favor of building
a long term Delayed Entry pool. Seasonal bonuses, which previously
ranged up to $20,000 per new recruit have been cut nearly in half and
will be used less frequently. These changes will result in nearly $35M
per year in expected bonus savings in fiscal year 2010 and beyond.
Retention: The Army continues to measure the effectiveness of
retention incentives offered. While the economy plays a part in a
Soldiers decision to reenlist it is not the only reason. The
reenlistment bonus not only incentivizes Soldiers in shortage critical
skills MOSs to reenlist; it also encourages them to reenlist earlier
and for longer periods of service. Accordingly, the Army has steadily
decreased the SRB amounts paid per Soldier for the past year as
reenlistments increased. The Army has reduced maximum SRB payments from
a high of $40,000 to $27,000. The average SRB payment has been reduced
from $12,900 to $10,387. The Army's newest SRB message reduces bonus
amounts by 23% across all bonus zones and removes an additional 15
skills form the bonus list.
Question. Secretary Geren, at a time when the Army is having
unprecedented success at retaining its soldiers, especially in view of
the new, flexible GI Bill and the job security that military service
holds, has the Army reviewed its recruiting and retention bonus
program?
Answer. Yes. Recruiting. The Army, with the assistance of
researchers from the Research and Development Corporation and the Army
Research Institute, is working to refine and integrate bonus prediction
models that will enhance current bonus payment procedures. The goal is
precision recruiting in key critical skills and demographic areas
needed to effectively man the force. Existing internal models are also
undergoing revision to provide more precise and cost savings
methodology in filling critical training seats and to attract prospects
in higher mental and educational categories. The Army expects to
implement the new and refined methodology in late fiscal year 2009 for
fielding during fiscal year 2010 and beyond. Additionally, the Army
reviews and adjusts enlistment incentives on a quarterly basis to
ensure that the appropriate critical military occupational specialties
are targeted with an appropriate incentive.
Retention. Reenlistment options and bonuses are used as incentives
to shape the force. Current incentives are achieving mission success in
every category. Additionally, the Army reviews and adjusts reenlistment
incentives on a quarterly basis to ensure that the appropriate critical
MOSs are targeted with an appropriate incentive. The Army will continue
to make monetary adjustments to various specialties based on evolving
requirements.
Question. Secretary Geren, is the Army going to promote non-
monetary bonuses such as tuition assistance and the new GI Bill?
Answer. Yes, the Army will promote the new GI Bill, tuition
assistance, and other non-monetary incentives to the maximum extent
feasible.

Future Combat Systems

Question. The Army's Future Combat Systems began in 2003 and the
first FCS equipped brigade was scheduled to be fielded between 2015 and
2017. The FCS program originally included 18 subsystems. Over time,
four subsystems were deferred. During the appropriations process for
fiscal year 2009 the Army decided to shift the focus of technology spin
outs from heavy brigades to light brigades. Total program cost
according to the Army estimate is $160 billion. The GAO estimates the
program cost could be $203 to $234 billion. In the fiscal year 2010
budget request the FCS program has been restructured, deleting the
eight variants of manned ground vehicles, and accelerating the fielding
to all 73 brigade combat teams, of the remaining FCS systems, such as
UAVs, unattended sensors, unmanned ground vehicles, and the network.
The Committee understands that despite stripping the manned ground
vehicles from the FCS program that the Army still intends to field a
fleet of new combat vehicles within seven years. Please describe the
process the Army is going through to review the requirement and restart
the manned ground vehicle effort. What improvements over the current
FCS manned ground vehicles are needed?
Answer. The Army seized upon opportunities in re-examining the
operational requirements, technology readiness, and acquisition
approach for a new manned vehicle. We formed a special task that
conducted in-depth analysis of capability gaps and the operational
environment. The ground combat vehicle (GCV) requirements development
process considered the full spectrum of operations. We also conducted a
comprehensive review of lessons learned from seven plus years of war
including insights from the Marine Corps and key allies. These
assessments underpinned our revision of the Army capstone operational
concept as well as requirements definition for a modern GCV. The shift
from the FCS manned vehicle program included retaining elements that
were operationally and technologically sound while addressing needed
improvements. GCV operational design principles include improvements in
versatility, force protection, and mobility to address the limitations
of current platforms as well as shortfalls from the FCS manned ground
vehicle program. The GVC modular design, particularly for armor and
armaments, provides commanders with configuration and employment
options, and complements the Army's versatile mix of forces. The GCV
provides improved force protection to our Soldiers. The first GCV
increment provides all occupants explosive blast protection equivalent
to MRAP as well as the ability to observe 360 degrees from inside the
vehicle. House
The GCV provides full tactical mobility, able to negotiate the
confined spaces presented in complex urban terrain, with cross country
mobility to preclude being restricted to existing road networks.
Additionally, we included growth potential as an operational
requirement to facilitate upgrades and adapt the vehicles as new
technologies become available. This growth potential was lacking for
some parts of the FCS manned ground vehicle. The Army's GCV plan
includes the assessment of all combat vehicles (e.g. MRAP, M1 Abrams,
etc). We will upgrade, reset, divest, and build new combat vehicles as
part of a holistic vehicle modernization effort that leverages
investments to date.
Question. Does the Army's recent experience in Iraq and Afghanistan
suggest that wheeled vehicles, such as Stryker and MRAP All Terrain
Vehicles, could be the best solution for an expeditionary force Army?
Answer. We see Stryker and MRAP vehicles as part of the Army's
wheeled vehicle fleet for a long time to come. These wheeled vehicles
provide protected mobility for Soldiers and we have added selected
technologies where feasible to improve them. However, the size, weight,
and power limitations for these vehicles makes them only a part of the
solution, but not the ``best solution.'' Given the volatility,
uncertainty, complexity and ambiguity of current and future strategic
demands, versatility is the defining quality that must inform every
dimension of our Army. This versatility applies at the platform level
where protection, survivability, mobility, lethality, and sustainment
all come into play. We are currently working on the operational
requirements for the new ground combat vehicles to determine the ``best
solution'' for Army forces. The limitations of current wheeled and
tracked vehicles are all part of our ongoing assessment. While trades
will be made as the designs for future vehicle finalize, our goal is to
modernize the force with vehicles capable of full spectrum operations
across the entire continuum of conflict.
Question. The Secretary of Defense has criticized the fee structure
for the FCS contract for front loading the payment of fee to the
contractor and for failing to adequately tie contractors' pay to
performance. How does this budget with the associated restructure of
the FCS program address those concerns?
Answer. The Army views the impact of the FCS FY10 budget and the
direction to restructure the FCS program as an opportunity to enter
into negotiations to align a fee structure that is in the best interest
of the taxpayer and eliminates the Secretary of Defense's concerns. We
will use this new incentive arrangement to drive behavior, to drive
performance, and reduce risk. We have had high level discussions with
Boeing, who understands that as the program is restructured, the fee
arrangement will undergo significant changes.
Question. With the significantly revised and downsized Future
Combat Systems program, will the Army continue to use a contractor as
the Lead Systems Integrator (LSI), or will Army Acquisition
Professionals assume that role?
Answer. There is no longer a role for a LSI. The Program Manager
(PM) has taken contractual actions transitioning Boeing from the role
of LSI to that of a Prime Contractor. The PM has modified the existing
contract to implement Acquisition Decision Memorandum direction and
align with the Army modernization strategy in which the Boeing Company
will have a diminished role. Boeing will retain network development
reduced to support only Increment 1 (formally known as Spin Out Early-
Infantry Brigade Combat Team) and the follow-on increment. The
government will increase technical and program management staff to
assume a greater responsibly for work under the revised prime contract
arrangement.

War Demand for Aviation Assets

Question. Discussions of combat units needed for the wars in
Afghanistan and Iraq usually focus on the brigades that conduct combat
patrols mounted in HMMWVs, MRAPs, or on foot. However, the Committee is
aware that the demand for combat aviation brigades has remained high
and has tested the ability of the Army to meet the demands of the
combatant commanders. How many aviation brigades does the Army have,
and how many are required in Afghanistan and Iraq?
Answer. The Army has 11 Combat Aviation Brigades (CABs) in the
Active Component (AC) and 8 in the Reserve Component (RC). Two CABs are
required in Afghanistan and four CABs are required in Iraq.
Question. What is the combat tour duration for Army aviation
brigades, end how much home station dwell time is provided between
combat tours?
Answer. The combat tour duration, Boots on Ground, for Army
aviation brigades is 12 months for Active Component Aviation Brigades
and approximately 9 months for Reserve Component Aviation Brigades.
Active Component Aviation Brigades average approximately 16 months of
dwell while Reserve Component Aviation Brigades average 36 months of
dwell.
Question. What types and numbers of aviation assets are provided by
our allies?
Answer. In Iraq there are no coalition rotary wing aircraft besides
the Iraqi organic assets. In Afghanistan, our allies provide 79 rotary
wing aviation assets. These assets are divided into the following
numbers by types:

20 CH-47s,
6 A-129s,
3 AB-212s,
13 AH-64s,
5 SH-3s,
5 AS-532s,
2 AS-332s,
2 EC-725s,
8 CH-146s,
7 CH-53s,
3 Bell 412s, and
5 Lynxes.
Question. How does the fiscal year 2010 budget request address the
need for more Army aviation assets?
Answer. In its 2010 Aircraft Procurement budget submission, the
Army is requesting almost $7 billion to address its critical aviation
requirements. Approximately $5.3 billion is contained with the base
request with an additional $1.6 billion contained in the Overseas
Contingency Operations portion of the budget. This combined budget
request would provide the Army with 83 UH-60M Black Hawk, 39 CH-47F
Chinook, 54 UH-72A Lakota, and eight AH-64D Apache helicopters. The
budget submission also includes 36 MQ-1 Sky Warrior and 1,392 Raven
Unmanned Aerial Aircraft, and six C-12 fixed wing aircraft. Finally,
the budget requests funds to modify a number of aviation systems to
include CH-47 Chinook, OH-58D Kiowa Warrior, and AH-64 Apache
helicopters, the RQ-7 Shadow UAS, the Guardrail Common Sensor fixed
wing platform, and procurement of aircraft survivability equipment.

Requesting and Equipping U.S. Forces

Question. A U.S. Combatant Commander is responsible for a
particular geographic region, but the combatant commander does not
raise, equip, and train forces, rather he receives trained and ready
units from the Army, Navy, Marine Corps, and Air Force after requesting
them, by type, through the Joint Staff. General Casey please describe
for the Committee how the potential war fighting requirements of the
combatant commanders help shape the budget request that you submit to
support your efforts in recruiting, equipping, and training Army units.
Answer. The Combatant Commanders (COCOMs) conduct extensive annual
reviews with the supporting component commanders (Capability review/
integrated priority list. For example--U.S. Air Forces in Europe, U.S.
Army Europe, Naval Forces Europe, etc., for European Command). Based on
the outcome of this review, the COCOMs submit their shortfalls during
the Program Budget Review to OSD and the Joint Staff, which then works
with the Services to meet requirements. The Army considers the COCOM
requirements within the scope of the Army priorities, alongside lessons
learned from continuous operations. The FY10 budget reflects Army
decisions that incorporate this input and fields adaptive, trained
forces to meet the Nation's missions.
Question. Please elaborate on the process you go through to ensure
that the right type forces, in the right numbers, are available,
properly equipped, and well trained. Is the process responsive?
Answer. The Army continuously strives to design and field the most
effective force possible across all three components within our
authorized end strength. We continuously analyze current and
anticipated requirements for the Army capabilities combatant commanders
deem necessary to support ongoing operations and successfully
accomplish the National Security Strategy. Based on this analysis we
seek to build a sufficient number of organizations of each required
capability to not only meet but also to sustain employment of those
capabilities over time in a way that enables the Army to sustain it's
all volunteer soldiers and professional leaders.
Total Army Analysis (TAA) is a robust, systematic, cyclical process
by which we routinely relook at force structure to validate Army
emerging requirements prioritization and resourcing strategy across all
three components. While the Army has been progressively adapting since
the end of the Cold War, it is through TAA that we are able to take
advantage of what we continue to learn in our current operations,
leverage emerging technology and continuously adapt to build a balanced
Army to meet the demands of 21st Century conflict.
The requirement to generate rotational forces for combatant
commanders, defend the homeland, and provide Defense Support of Civil
Authorities (DSCA) led to the 2005 Army decision to shift from a
tiered-readiness system to a cyclic readiness process, called Army
Force Generation (ARFORGEN). The Army continues to implement the
ARFORGEN process to meet the strategic requirements for a campaign-
quality, expeditionary Army, and to preserve the All-Volunteer Force in
an era of persistent conflict.
The overarching purpose of ARFORGEN is to provide combatant
commanders and civil authorities with a steady supply of trained and
ready units that are task organized in modular expeditionary packages
and tailored to joint requirements for each specific mission. ARFORGEN
is inherently more responsive than the tiered readiness because
operational requirements drive the prioritization and synchronization
of institutional functions to recruit, organize, man, equip, train,
sustain, mobilize and deploy units on a cyclic basis. ARFORGEN is
scalable and can be accelerated based on demand to provide additional
forces for short periods of time.
The Army continues to improve the ARFORGEN process to ensure
Soldiers and units remain prepared to meet the strategic land-power
requirements of the Nation.
Question. The Committee understands that in some cases, military
personnel are assigned to work in mission areas that are not ordinarily
associated with the usual unit mission. For example you might have an
artillery unit performing an infantry mission or provincial
reconstruction mission. Please explain how such manning decisions are
made and how that information is transmitted to units as they prepare
for deployment.
Answer. In-lieu-of manning decisions are made in coordination with
Combatant Commands, the Joint Staff, Joint Forces Command and U.S.
Forces Command (Army's force provider) when specific type units are not
readily available and the in-lieu-of sourcing solution is capable of
performing the mission. Units selected are manned, equipped and trained
to execute the missions and tasks outside their core competencies.
Units selected for in-lieu-of sourcing solutions are notified by the
Army's force provider via deployment orders. All in-lieu-of units are
provided the time to be fielded the necessary equipment and to become
proficient with new equipment training and mission-specific training in
accordance with the Secretary of Defense approved Latest Arrival Date
for the specified mission.
Question. Army units have little time to prepare for operations
other than counter insurgency. What are your concerns regarding overall
readiness to respond to potential threats across the full spectrum of
warfare?
Answer. As a key component of a very capable joint force, the Army
remains focused on Counterinsurgency (COIN) operations, but trains for
full spectrum operations (FSO). Our current operational commitments
have produced a combat experienced force and our units are also
beginning to benefit from marginal increases in dwell time at home
station, thus providing greater training opportunities and we see this
trend continuing. The Army remains committed to achieving a balanced
force capable of executing across the full spectrum of conflict and in
environments including peace operations, peacetime military
engagements, limited intervention, and irregular warfare all the way up
to major combat operations.
Due to the demand from combatant commanders for combat, combat
support, and combat service support (all Army functions), the Army
finds itself strategically fixed on operations in OIF or OEF--that is--
our forces are manned, trained, and equipped for those two unique
operational environments. This limits the Army's strategic flexibility
and contributes significantly to the overall risk to the National
Security Strategy. The Army consumes its readiness as quickly as it is
built and challenges the Army to achieve a 1:2 (Active) and 1:4
(Reserve) dwell rate by the end of 2011.

Armed Reconnaissance Helicopter (ARH)

Question. One of the Army's key acquisition programs had been the
Armed Reconnaissance Helicopter. The program was designed to produce a
replacement and capability upgrade for the Vietnam era OH-58 series
helicopter. The ARH program had advanced to the production phase in
2008 and 2009. The Army had planned to procure 512 aircraft with a
total program cost of $5.9 billion. Funding appropriated for Aircraft
Procurement, Army for fiscal year 2009 included $242 million for
aircraft production. However, in October 2008 following a Nunn-McCurdy
review of cost and schedule breaches, the program was terminated. The
ARH was to be a simple, inexpensive, modified off-the-shelf aircraft.
What caused the schedule slip and cost growth?
Answer. The scheduled slip was initially caused by a slow start
within the program management at Bell Helicopter. Beyond managerial
issues, integration of key elements of the mission equipment and
availability of parts for manufacturing the prototype aircraft
contributed to schedule slips in the program.
The decision to cancel the production contract with Bell was based
on growth in both the development and unit procurement costs of the
ARH. Significant increases in manufacturing labor rates, manufacturing
labor hours and materiel costs in the production phase of the program
were the primary contributing factors to the cost growth.
Question. The Army Audit Agency conducted a review of the Armed
Reconnaissance Helicopter program termination and concluded that the
decision to limit the initial production cost to $5.2 million stifled
competition and was based on faulty assumptions. General Casey, please
explain how this cost cutting strategy was supposed to work and how it
failed in the end?
Answer. The $5.2M initial production cost, for the first 36 Low
Rate Initial Production aircraft, was established to steer industry to
provide existing platforms, to minimize development/modifications, and
to use technologically mature mission equipment already in the Army/DoD
inventory. Theoretically, this strategy would aggressively and rapidly
field the ARH--replacing the aging OH-58 series helicopter. The
strategy failed when selected mission equipment which was required to
meet the strict cost and schedule criteria was less technically mature
than anticipated. This resulted in development cost and schedule
growth.
Question. Does the Army still have a valid requirement for a new,
modern armed reconnaissance helicopter?
Answer. Yes, the Army has an enduring Joint Requirements Oversight
Council (JROC) approved requirement for a light, armed reconnaissance
capability. The termination of the ARH program as a result of the Nunn-
McCurdy process did not decrease the Army's continuing need for an
armed scout capability. The Army is initiating an analysis of
alternatives to determine the best way to meet the armed scout
requirement including a detailed analysis of manned-unmanned teaming.
Question. What is the current status and way ahead for the ARH
program?
Answer. On April 14, 2009, the Secretary of the Army approved a
revised Armed Scout Helicopter Strategy. The new strategy will reinvest
in the OH-58D to provide sustainment until a viable replacement is
procured, modernize the four remaining National Guard AH-64A battalions
to AH-64D battalions, review and revise requirements, and conduct a
comprehensive Analysis of Alternatives (AoA) to determine the best way
to meet the Army's enduring Armed Scout Helicopter requirement.
Currently, the Army is seeking a Material Development Decision from the
Defense Acquisition Executive to initiate the AoA. The AoA will take a
holistic look at the still valid requirements for the armed scout
capability to include manned systems, unmanned systems, and the
possibility of a manned-unmanned team. The AoA is expected to take 12
months to complete with a final report in September 2010.
Question. The Committee understands that the Army has lost 45 OH-
58D Kiowa Warriors in combat operations. What is the status of the
current fleet of OH-58D Kiowa Warrior armed reconnaissance aircraft?
Answer. The current Kiowa Warrior fleet is down to 338 aircraft. Of
those, 249 are assigned to MTOE units (51 short of required) while the
others are for training (36 aircraft) or in test/maintenance status to
include the Safety Enhancement Program.
Due to these shortages, it is increasingly difficult to provide 24
aircraft for units in garrison while ensuring that deployed units
remain at required quantities (30 each).
Cabins from divested OH-58A models will be retained and converted
into D model cabins to provide OH-58D Wartime Replacement Aircraft
(WRA). This WRA effort is dependent on congressional support for OCO
Supplemental funding. Even with OCO funding, the Army will continue to
experience shortages until FY13.
Life Support 2020 is the program that will sustain the OH-58D for
the near future by addressing performance enhancement through weight
reduction, improved sensor, and survivability. Initial production for
this effort will begin in FY13 and full rate production will likely
start eight months later. This program is funded almost entirely in the
POM FY10-15 with a projected completion date of FY17.
Question. How well suited is the OH-58D for operations in
Afghanistan?
Answer. There are currently two squadrons of OH-58D Kiowas deployed
to OEF (60 aircraft). Although the Kiowa Warrior is limited in power
and incapable of performing in some of the high/hot areas of
Afghanistan, the scout helicopter crews flying the OH-58D are
significantly contributing to the warfight through the expert
performance of reconnaissance, security and close combat attack
missions in support of our Soldiers on the ground.

Joint Cargo Aircraft (JCA)

Question. The Joint Cargo Aircraft (or C-27J) is a medium sized,
multi-purpose cargo aircraft that supports a full range of sustainment
missions. The JCA program was initiated by the Army to relieve pressure
on rotor craft for near-front-line logistics. The program eventually
was made a joint Army and Air Force effort. However, the fiscal year
2010 budget request proposes to make the program entirely an Air Force
program, and to cut the number of aircraft to be fielded from 78 to 38.
The Army had planned on replacing a number of older, small fixed wing
utility aircraft with the JCA. Given the decision to transfer the
entire program to the Air Force, what is the Army's plan for replacing
its fleet of small utility fixed wing aircraft?
Answer. The Army is conducting an assessment of the remaining
useful life of its current small fixed wing utility fleet of C-12, C-
26, and UC-35 aircraft to determine a required replacement timeframe.
Given the transfer of the C-27J program, the Army will conduct an
analysis to re-assess the required composition and quantity of its
small fixed wing utility aircraft fleet.
Question. Please explain the command and control of JCA aircraft
that are operated by the Air Force but have the mission of performing
front line resupply for Army Units.
Answer. Air Force C-27J aircraft that are providing direct support
to the Army will be co-located and under the tactical control (TACON)
of the senior Army Aviation unit commander. Direct support missions
will be assigned by the senior Army aviation unit commander in
accordance with priorities set by the ground component commander.
Question. How many JCA have been delivered to the Army, and where
are they based? Have JCA been deployed to Iraq or Afghanistan?
Answer. Two JCA have been delivered to the Army and they are based
at Robins AFB, Georgia. These aircraft are currently supporting
required test and training activities. The initial US forces deployment
of the C-27J is planned for the fall of 2010 to Afghanistan.
Question. Where are the JCA assembled and where does integration of
military hardware take place? When is the final assembly operation
scheduled to move from Italy to the United States? Will production move
to the United States if only a small number are ordered or will they
all be made in Italy?
Answer. JCA are assembled in Caselle, Italy, and the integration of
U.S. military hardware is done in Waco, Texas. The final assembly
operation move from Italy to the United States is on hold. This was a
business decision made by Alenia after the U.S. reduced the JCA
procurement quantity from 78 to 38.
Question. Many of the JCA that had been planned for the Army were
to be assigned to Army National Guard units. Without JCA, will these
units be without aircraft and without a mission?
Answer. The Army, in close coordination with the National Guard
Bureau, will make a determination whether to stand down the C-23
equipped aviation units or transform them into other type aviation
units.

M113 Armored Personnel Carrier

Question. The M113 Armored Personnel Carrier, or APC, is a lightly
armored, flat bottomed vehicle that is prolific in mechanized unit
formations. In various configurations, it has been used as a troop
carrier, ambulance, mortar carrier, engineer squad vehicle, command
post vehicle and for other purposes. The Committee understands that in
the current conflicts in Iraq and Afghanistan the M113 vehicles are not
used for patrols, or other missions, off of the operating bases.
General Casey, if the M113 is not suitable to participate in missions
in Iraq and Afghanistan, what substitute vehicles are used?
Answer. Currently, Mine Resistant Ambush Protected (MRAP)
ambulances replace M113 ambulances for units deployed in Theater.
M1064A3 120mm Mortar Carrier Vehicles and M1068A3 Command Post Vehicles
continue to be utilized in Iraq on bases. M113 Family of Vehicles (FOV)
is not fielded to Stryker Brigade Combat Teams and Infantry Brigade
Combat Teams. M113s are authorized by Modified Table of Equipment to
equip Heavy Brigade Combat Teams (HBCT) only. There are no deployed
HBCTs in Afghanistan.
Question. Does the Army have a requirement to replace all M113s
throughout the Army?
Answer. The Quadrennial Defense Review (QDR) will assess force
structure and force mix which may result in future adjustments for Army
combat vehicle requirements.
Question. Will M113 replacement vehicles be wheeled vehicles or
tracked vehicles? Will they be based on a variant of an existing
vehicle such as a Bradley Fighting Vehicle or Stryker?
Answer. The design configuration of the replacement vehicle(s) for
the M113 FOV has not yet been determined. M113 replacement will be
informed by the results of the QDR.

M109 Paladin

Question. The Army's current self-propelled howitzer, the M109
Paladin, dates back to the 1960s. The M109 lacks the mobility, speed
and agility of the Abrams tanks and Bradley Fighting vehicles which it
accompanies in heavy brigade combat teams. The Paladin was to be
replaced by the Crusader 155mm self-propelled Howitzer; however, the
Department of Defense canceled the Crusader program in May 2002.
Technologies developed for the Crusader were to be used to produce a
lighter and more deployable cannon, the Non-Line-of-Sight Cannon, a
system within the Army's Future Combat Systems (FCS). The Non-Line-of-
Sight Cannon is the most advanced of the FCS manned ground vehicles,
and the program had produced several operational pre-production
prototypes. However on April 6, 2009, Secretary of Defense Gates
announced termination of the FCS manned ground vehicles, including the
Non-Line-of-Sight Cannon. General Casey, what is the status of the
Army's modernization effort for the M109 series 155mm self-propelled
howitzer?
Answer. The Army will modernize the M109 series 155mm self-
propelled Howitzer through the Paladin Integrated Management (PIM)
program. The PIM program will insert new technologies to address
obsolescence and sustainment issues to ensure the long-term sustainment
of the platform and provide a viable life cycle solution through 2050.
The Paladin PIM program delivers a ready, relevant, and sustainable
platform. The Army is investing over $169 million in the development of
the PIM program between fiscal years (FY) 2008 through FY10. Starting
in FY10, the first 13 Paladin PIM and Field Artillery Ammunition
Support Vehicle (FAASV) sets will be produced. The current program
continues through FY21 totaling 600 Paladin PIM and FAASV sets.
Question. General Casey, the fiscal year 2010 budget request
includes $96 million for M109 modernization. What sort of modernization
does the funding buy? What is the Paladin Integrated Management
Program?
Answer. The $96 million requested in the budget will procure and
field 13 Paladin Integrated Management (PIM) vehicle sets (Paladin and
Field Artillery Ammunition Support Vehicle (FAASV)) as part of Low Rate
Initial Production. Technology insertion and system improvements to PIM
consist of:
--Improved commonality and reliability through integration of
Bradley common components (engine, transmission and suspension),
--Leveraging FCS NLOS--Cannon (NLOS-C) Azimuth and Elevation
Electric Drives and Rammer Design,
--Common Modular Power Supply (CMPS),
--Vehicle Health Management System (VHMS),
--Improved Survivability (new chassis structure, Growth to
accommodate Add on Armor (side and belly)).
The PIM program is a sustainment program to address obsolescence,
increase sustainability, and reduce operation and support costs of the
Paladin and FASSV fleet. The PIM program utilizes the existing M109A6
main armament and cab while integrating more sustainable and reliable
Bradley common components (engine, transmission and suspension) into a
new more survivable chassis. PIM also integrates selected technologies
from the NLOS-C (modified electric projectile rammer and electric-gun
azimuth and elevation drives) to replace the current hydraulically
operated elevation and azimuth controls. The program also leverages the
PEO Ground Combat Systems 600 volt Common Modular Power System and
Vehicle Health Management System (VHMS) to improve vehicle power
management and provide on-board vehicle diagnostics/prognostics.
Execution of the PIM program will ensure that the Paladin/FAASV systems
continue to meet the needs of the Army's Heavy BCT maneuver commander.
Question. What is the impact on the overall Army artillery program
of the termination of the Future Combat Systems (FCS) Non-Line-of-Sight
Cannon (NLOS-C)?
Answer. The Army's original plan was to replace the M109 Paladin
with the FCS NLOS-C in 15 Heavy Brigade Combat Teams. With the
termination of the NLOS-C program, we will upgrade the 15 Paladin
battalions through the Paladin Integrated Management (PIM) program. The
PIM program will insert new technologies to address obsolescence and
sustainment issues to ensure the long-term viability of the platform
and provide an efficient life cycle solution through 2050.

Stryker

Question. The Army received $951 million in fiscal year 2009
appropriations for procurement of 119 Stryker vehicles, including 40
Nuclear, Biological and Chemical Reconnaissance vehicles, and 79 Mobile
Gun Systems. The request for fiscal year 2009 Supplemental
Appropriations for Overseas Contingency Operations proposed $112.7
million for six Stryker Mobile Gun Systems plus survivability
enhancements on existing Strykers. The House bill added $338.4 million
to procure additional Stryker vehicles. The final amount will be
settled in conference with the Senate. The additional funding also
would keep the Stryker industrial base warm while the Army establishes
the way ahead for Stryker. The fiscal year 2010 budget request of
$388.6 million provides for safety and survivability upgrades but no
additional production of vehicles. General Casey, what is the way ahead
for the Stryker program?
Answer. The Quadrennial Defense Review will assess force structure
and force mix. This may result in future adjustments to Army Stryker
requirements. Until then, the fiscal year (FY) 2009 and anticipated
FY10 funding is sufficient to keep the Stryker industrial base viable
while the Army establishes the way ahead for Stryker.
Question. Will the Army replace certain M113 variants, such as the
ambulance, with Strykers?
Answer. The Quadrennial Defense Review will assess force structure
and force mix which may result in future adjustments for Army Stryker
requirements. Currently, Mine Resistant Ambush Protected (MRAP)
ambulances replace M113 ambulances for units deployed in Theater.
Question. Will the Army create additional Stryker brigades?
Answer. The Army continuously evaluates and adapts to a versatile
mix of tailorable and networked organizations, operating on a
rotational cycle, to provide a sustained flow of trained and ready
forces for Full Spectrum Operations and to hedge against unexpected
contingencies at a tempo that is predictable and sustainable for our
all-volunteer force. The Army's strategic estimate, based on the
premise of the unforeseeable future, is we will need a robust multi-
weight force, composed of Infantry Brigade Combat Teams augmented with
the protection and versatility of the Stryker Brigade Combat Teams and
Heavy Brigade Combat Teams.
Question. Is a Stryker type of vehicle a likely candidate for the
manned ground vehicle replacement program as part of the Brigade Combat
Team Modernization?
Answer. All current vehicle systems are potential candidates for
the manned ground vehicle replacement program. The Army will use the
requirements identified from current operations and other assessed
requirements to determine the capabilities the ground combat vehicle
must meet. The analysis of alternatives will assess the current
platforms' ability to meet these capability requirements.

Mine Resistant Ambush Protected Vehicles (MRAPs)

Question. The Army has had a goal of procuring approximately 12,000
MRAPs and DoD acquisition reports indicate that just over 11,000 have
been received by the Army with 8,344 in Iraq and 1,020 in Afghanistan.
In addition, the MRAP Joint Program Office is in the process of
procuring 1,080 new MRAP-All Terrain Vehicles (or M-ATV), which are
lighter and more maneuverable off-road, but still offer MRAP level of
protection. General Casey, the Army now owns and operates a fleet of
over 11,000 Mine Resistant Ambush Protected (MRAP) vehicles and will
soon receive approximately 1,000 MRAP All Terrain Vehicles which are
lighter and more maneuverable. Please describe the Army's strategy for
incorporating MRAPs in various units throughout the Army, beyond
Afghanistan and Iraq.
Answer. The Army has been working on this for a while. We know they
will be needed for training for the foreseeable future and started
flowing vehicles to training sets several months ago. Additionally, we
have identified a requirement for over 1,400 Medium Mine Protected
vehicles in our Explosive Ordnance and Route Clearance formations. We
will harvest approximately 1,000 of our MRAPs to fill this requirement
when they are no longer needed for ongoing operations. In an effort to
determine the best uses for the remaining MRAPs, we have engaged
multiple agencies to study different aspects of the vehicles ranging
from operational capabilities, mobility, and survivability to
maintainability to determine how many of each variant to place in the
force and where to place them. We anticipate seeing the recommendations
from these efforts at the end of the year and then we will begin
finalizing plans to place MRAPs in the force structure.
Question. What functions that were to be performed by Future Combat
Systems maimed ground vehicles can be performed by MRAPs?
Answer. The plan for Future Combat Systems manned ground vehicles
included eight separate vehicles with different mission roles. These
included: Infantry Fighting Vehicle; Mounted Combat System;
Reconnaissance; Cannon; Mortar; Command and Control; Maintenance and
Recovery; and Medical Treatment and Evacuation. Today's MRAP vehicles
perform several roles for combat with the primary one being the
transport of Soldiers to protect against IED blasts. However, MRAPs are
not fighting vehicles designed for assaulting objectives against
multiple threats and rapid transitions from mounted to dismounted
operations in close combat, tasks essential to dealing with today's and
tomorrow's hybrid threats. Additionally, MRAP vehicles are not
generally well suited for use as recovery vehicles for other platforms
due to center of gravity and chassis designs. However, we are assessing
the current use of MRAP vehicles for medical evacuation for future
applications. MRAP vehicles are part of the Army's vehicle fleet for a
long time to come. The key for Army formations is a variety of vehicle
options from which the commander can choose to meet specific mission
requirements against adaptive enemies.
Question. In order to more rapidly field MRAPs, the Joint Program
Office contracted with several producers for each of them to produce
their version of the MRAP as quickly as possible. What have been the
maintenance challenges in maintaining and repairing a fleet of vehicles
consisting of several different models built by several different
companies?
Answer. The DoD's strategy was to procure and field MRAP vehicles
as rapidly as possible, and in order to do that it was necessary to
procure MRAPs from multiple manufacturers. This is of course not
optimal from a supportability standpoint; however, it was the right
thing to do--and by getting MRAPs into the field quickly, we have saved
lives and reduced casualties. There is no question that the fielding of
several different MRAP variants has created maintenance and sustainment
challenges, particularly in our most forward maintenance activities,
not the least of which is a lack of commonality of repair parts across
these multiple variants, which has caused our tactical supply support
activities to have to stock around 40% more parts than would have been
required if there was commonality. The problem with repair parts is
further compounded by the necessity for frequent modifications to each
of the variants, many of which would not have been required if there
had been time to do more deliberate testing, where many of these needs
for modification would have been identified and addressed before
fielding. Despite the maintenance challenges, the operational readiness
rate for the Army's MRAP fleet remained at 90 percent or higher for the
last several months. The Army is responding to repair parts challenges
by making the most frequently demanded vehicle components for all
variants, such as engines, transmissions, starters, alternators, and
generators available through the standard Army supply system, and
positioning them well forward in Iraq and Afghanistan; additionally,
the Joint Program Office has an extensive contractor logistics support
network in both Iraq and Afghanistan, to assist with maintenance,
especially the more difficult to repair battle-damaged MRAPs.
Question. The Army has had a goal of procuring approximately 12,000
MRAPs and DoD acquisition reports indicate that just over 11,000 have
been received by the Army with 8,344 in Iraq and 1,020 in Afghanistan.
In addition, the MRAP Joint Program Office is in the process of
procuring 1,080 new MRAP-All Terrain Vehicles (or M-ATV) which are
lighter and more maneuverable off-road, but still offer MRAP level of
protection. When will MRAP-ATVs be fielded in Afghanistan? Will the
MRAP-ATV satisfy the requirements for the Joint Light Tactical Vehicle?
Answer. On June 30, 2009, the government awarded an initial
production delivery contract to Oshkosh Corporation for the M-ATV.
Initial fielding to Army units in Afghanistan is scheduled to begin in
December 2009.
The M-ATV will not satisfy all of the requirements of the Joint
Light Tactical Vehicle (JLTV). Two key areas in which the M-ATV will
not meet required capabilities are transportability and payload. The M-
ATV is too heavy to be transported by rotary-wing aircraft. This is a
critical requirement for the JLTV. In addition, the M-ATV is too heavy
to carry the projected payload of the JLTV. The Army intends to apply
lessons learned in development and testing of the M-ATV to the JLTV
program.

Outsourcing

Question. A March 23, 2009 Defense Subcommittee letter to Secretary
Gates called attention to the need to revise the Department's policy on
outsourcing. Over the past eight years OMB Budget Circular A-76, the
policy which governs public private competitions, has been misused and
has become a mandate for pushing more and more work into the private
sector. The letter advised that, in light of the Omnibus Appropriations
Act, the Secretary should cease to initiate or announce new A-76
studies. The letter also suggested the Secretary halt A-76 studies
pending OMB review of the A-76 program. On April 15, then
Undersecretary for Acquisition, Technology and Logistics responded ``.
. . the Department is reviewing the current program and will look at
the status of ongoing competitions.'' However, the Department continues
to proceed with A-76. Plans are now in process to outsource functions
at West Point in June. Secretary Geren, why have you not halted A-76
outsourcing, particularly given:
Your insourcing efforts in fiscal year 2009 (which are
commendable),
The further insourcing reflected in year 2010 budget
request, and
The GAO's findings that an error in the A-76 calculation
of ``overhead'' wrongly and unfairly has resulted in work performed by
federal employees being contracted out?
Answer. Although the Fiscal Year 2009 Omnibus Appropriation Bill
prohibits the start of any ``new'' public-private competitions pursuant
to the OMB Circular A-76 for the remainder of the fiscal year, it did
not stop on-going A-76 competitions. Significant time, money, and
resources have been invested on these competitions, and the Army
anticipates a savings of 20-25% over the next five years as a result of
implementation. The A-76 competitive process includes provisions for
resolving any protests submitted by interested parties. Stopping the
competitive process after a decision has been rendered would not be
prudent in that such action will have significant financial impact and
may lead to legal action. Continuing on-going competitions meets the
requirements placed on the service pursuant to the OMB circular and is
in the best interests of providing efficient service at the lowest cost
and minimizes further adverse impact on the workforce.
Question. Will you proceed with the plan to outsource jobs at West
Point?
Answer. The Fiscal Year 2009 Omnibus Appropriation Bill prohibits
the start of any ``new'' public-private competitions pursuant to the
OMB Circular A-76 for the remainder of the fiscal year, it did not stop
on-going A-76 competitions such as those conducted at West Point.
Significant time, money, and resources have been invested on these
competitions, and the Army anticipates a savings of 20-25% over the
next five years as a result of implementation. The A-76 competitive
process includes provisions for resolving any protests submitted by
interested parties. Stopping the competitive process after a decision
has been rendered would not be prudent in that such action will have
significant financial impact and may lead to legal action. Implementing
the decisions at West Point is the best course of action for the
Department of Defense. The Army will make every effort to minimize
adverse impact on the workforce.
Question. On December 1, 2008, the Deputy Secretary of Defense
issued guidance elevating the importance of ``irregular warfare'',\1\
to be as strategically important as ``traditional warfare'', and \2\
the policy requires that the Department integrate irregular warfare
concepts and capabilities into doctrine, organization, training,
material, leadership, personnel and facilities. The Army and the Marine
Corps have de facto changed doctrine and training due to their
prolonged intense involvement in Iraq and Afghanistan, but the planning
and curricula has not changed. The irregular warfare policy is intended
to substantially change the way the DoD plans and prepares for future
conflict. Secretary Geren, has irregular warfare doctrine (DoD
Directive 3000.07) been reflected in your 2010 budget request?
---------------------------------------------------------------------------
\1\ DoD defines ``Irregular Warfare'' as a violent struggle among
state and non-state actors for legitimacy and influence over the
relevant population. Irregular warfare favors indirect and asymmetric
approaches, though it may employ the full range of military and other
capacities, in order 10 erode an adversary's power, influence and will.
\2\ DoD defines ``traditional warfare'' as combat operations
between regulated states in which the objective to defeat the
adversary's armed forces, destroy an adversary's war-making capacity,
or control territory to change an adversary's government.
---------------------------------------------------------------------------
Answer. Yes, the Army is meeting and exceeding DoDD 3000.07
guidance with revised doctrine and the operational concept of ``Full
Spectrum Operations'' as outlined in the recently published Army Field
Manual, 3-05 Unconventional Warfare. The Army has redefined itself
along each of the capability functions to institutionalize a shift in
focus from Major Conventional Operations toward Irregular Warfare (IW).
The Army has taken measureable steps to include IW in the FY10
budget request. This includes the issuance of the Army Training and
Leader Development Guidance/Strategy and a change in Professional
Military Education shifting emphasis toward IW. There has been
investment in new equipment and technology to enhance survivability,
lethality, mobility, and situational awareness for units and individual
Soldiers operating in IW environments. The Army has created modular
units to increase options available to Combatant Commanders shifting
from division/corps-centric forces required for major conventional
operations to brigade-centric forces required for distributed
operations in an IW environment. The Army has also instituted an Army
Force Generation model to provide sustainable, predictable, adaptable,
and appropriately trained supply of forces for operations, as required,
anywhere on the spectrum of conflict or in any phase of the campaign.

Irregular Warfare

Question. Is the Army doing anything to revise doctrine,
organization, training, material, leadership, personnel and facilities
to reflect a sharpened focus on irregular warfare (IW)?
Answer. The Army recognizes that IW is an important aspect of
today's conflicts. Of the four roles of land forces in the 21st
century, three address IW. First, the Army must prevail in protracted
counterinsurgency (COIN) campaigns, both in current and future
operations. Second, the Army must engage to help other nations build
capacity and to assure friends and allies and prevent future conflicts
by increasing the capacity of other nations' security forces--both
military and police. Third, the Army must deter and defeat hybrid
threats and hostile state actors. With these complex and dynamic
demands of 21st century warfare in mind, the Army has institutionalized
significant IW-related changes since 2001. Doctrinally, the Army has
revised several Field Manuals, including the Army capstone doctrine, FM
3-0, Operations to account for IW-related operations and published over
500 IW-related handbooks with lessons learned. Organizationally, the
Army has developed and fielded new organizations to provide commanders
a more holistic perspective on operations conducted among the
population; established new organizations to provide Army-wide
solutions for complex asymmetric threats, weapons of strategic
influence, and other challenges; and embedded Information Operations,
Public Affairs, Civil Affairs, Psychological Operations (PSYOP),
Explosive Ordnance Disposal, Electronic Warfare, and Human Terrain
Teams into Brigade Combat Teams (BCT). Today in Iraq, in addition to
Special Operations Forces, Army General Purpose Force (GPF) Advise and
Assist Brigades (AAB), like the 4th Brigade, 82nd Airborne Division,
are task organized and augmented with additional senior level mentors
to deliver SFA. With regard to training, the Army has adopted the
contemporary operating environment at the Combat Training Centers,
created COIN academies in Iraq and Afghanistan, supported COIN Centers
of Excellence in Iraq and Afghanistan, and established a permanent and
enduring training formation--162nd Training Brigade at Fort Polk--as
the center for institutional development for the delivery of SFA.
Regarding leader development and education, the Army has updated
Professional Military Education curricula at all levels to address IW.
In terms of materiel, the Army has created the Rapid Equipping Force
and the Army Requirements and Resourcing Board to accelerate fielding
of material solutions to meet emerging war fighter needs, adjusted FCS
and complementary programs fielding to provide needed IW-relevant
capabilities to infantry units first because they are at the highest
risk, and equipped Soldiers with advanced situational awareness systems
required to defeat irregular threats. In terms of personnel, the All
Volunteer Force remains the center of gravity for the United States
Army. People are what matter most and operations in complex
environments against irregular and hybrid threats require motivated,
highly trained, and experienced professionals. The Army continuously
evaluates recruitment, retention, promotion, and separation programs
and policies to ensure the quality of the All Volunteer Force remains
capable of conducting full spectrum operations. To this end, the Army
has improved balance across all components to provide more capacity of
high demand/low density capabilities essential for conducting IW.
Increases include Infantry and Stryker BCTs, Engineer Construction
Companies, Military Police, Contracting Support Teams, Civil Affairs
Companies and Tactical PSYOP detachments. Additionally, Army SOF will
increase by one third through 2013. With regard to facilities, the Army
constructed new, enhanced, and more realistic Urban Operations Training
facilities at Fort Knox, Fort Benning, and the Combat Training Centers.
Since 2001, the Army has made dramatic changes in its capability to
perform IW and will continue to do so in the future in order to best
posture the Army to win in the current conflicts and prepare for future
Full Spectrum Operations.
Question. How has the Army's training curriculum for tank miles and
flying hours been substantially updated since the Berlin wall came
down? When did it occur? When will the training curricula be updated to
reflect the new and different skills needed to sharpen the focus on
irregular warfare while remaining capable to dominate and prevail in
major combat operations?
Answer. The Army continuously updates the training strategies and
training scenarios used to prepare units for deployment/employment,
based on lessons learned during operations, changes in Army doctrine,
transformation of Army force structure and organizational design,
advances in training technology, and changes in other factors over
time. For example, the Army recently adjusted training strategies to
reflect adoption of the doctrinal imperative to always conduct some
level of stability operations along with offense and defense
operations--full spectrum operations--regardless of where the unit
operates along continuum of operations. As a consequence, Army current
training strategies/requirements provide flexibility that adequately
enables units to prepare for irregular warfare, for major combat
operations, or for any assigned mission.
Over the preceding two decades, the Army has adjusted doctrinal
training strategies principally for the contribution of virtual
training (primarily in FY01, FY02, and FY04), for unit stabilization
achieved with life cycle management of units (primarily in FY04-05),
for transition to a modular force and the adoption of Army Force
Generation construct (during FY06-07), and for adoption of stability
operations doctrine (primarily in FY08).
The Army is currently conducting a review of the way we determine
training requirements to ensure we best represent training required to
prepare forces to conduct operations including irregular warfare or
major combat operations.
Question. With no outyear data available, how can the Congress be
assured that ``rebalancing'' has been reflected in the budget?
Answer. A journey rather than a destination, the rebalancing of
Army structure is a continuous effort requiring frequent review and
adjustment to meet projected operational demand within authorized
resources. Moreover, execution of force structure change is not
immediate, it requires time and resources. These changes are, and will
continue to be, reflected in Army budgets. Some examples of programmed
growth from FY06 to FY15 include 47 military police combat support
companies, 9 air ambulance companies, 12 explosive ordnance disposal
companies, 117 civil affairs companies, and 107 psychological
operations detachments.
The President's Budget Request for FY10 adds additional Army force
structure for Echelons above Brigade, with over 100 new Army units of
various sizes (detachments to full size battalions). These new units
are part of the phased implementation of Grow the Army and other force
structure initiatives. They provide the Army with operational depth
needed to sustain enduring levels of force deployment to meet global
commitments. Included are many high demand engineer, military police,
signal, intelligence, air defense, and transportation units. This
growth will help reduce the stress for these high demand units. In
addition, this budget provides increased home station training funding
to support the modular force design which will bring the Army closer to
a balanced training program for the entire force.
Question. With no outyear data and no movement to change doctrine
and training curricula significantly, how can the Congress be assured
that ``irregular warfare'' isn't just a convenient excuse to cut
programs that have a big impact on local economies?
Answer. The Army has been and continues to be committed to
updating, developing, and refining Irregular Warfare (IW) related
training and doctrine in light of the current operating environment. At
the center of this effort is the Army's Training and Doctrine Command,
which is focused on preparing versatile leaders and units through
integrating IW-related capabilities, concepts, and doctrine. Current
Army doctrine emphasizes full-spectrum operations, which includes IW.
New and updated principle field manuals include FM 3-0, Operations; FM
3-07, Stability Operations; FM 7-0, Training; FM 3-24,
Counterinsurgency and FM 3-07.1, Security Force Assistance. Additional
manuals with IW focus include FM 2-91.6, Soldier Surveillance and
Reconnaissance: Fundamentals of Tactical Information Sharing, FM 2-
91.4, Intelligence Support to Urban Operations, FM 3-36, Electronic
Warfare in Operations, and FM 3-90.119, Combined Arms Improvised
Explosive Device Defeat Operations. The Army has created
Counterinsurgency (COIN) Academies and Centers of Excellence in Iraq
and Afghanistan and a permanent and enduring training institution at
162nd Training Brigade to train the Joint Force with skills crucial for
advisors and mentors. Advisor Core Competencies trained at 162nd
Training Brigade--the central training location for Brigade Combat
Teams (BCTs) assigned the SFA mission--include Counterinsurgency (COIN)
fundamentals, application, and Political, Military, Economic, Social,
Infrastructure, and Information (PMESII). Typical training for BCTs
training for Iraq deployment when they cycle through 162nd Training
Brigade includes Iraqi Culture, History, and Islam; Security Overview
and Host Nation Security Forces Overview; Implications of Rapport,
Influence, and Negotiations; Interpreter Management; Border/Point Of
Entry Overview; Operational Framework and COIN/Stability Operations
(SO) Overview; and Role of Advisors and Team Dynamics. Mission
Essential Task Lists used in training at 162nd Training Brigade and
home station training focus upon training the key skills required when
operating in an IW environment, including language training, cultural
awareness, and advising. The tasks associated with IW, including SO and
SFA tasks, include Establish Civil Security, Establish Civil Control,
Support to Economic and Infrastructure Development, Develop and enable
the ISF, Restore Essential Services, and Support Governance. All of
these tasks are trained as part of a BCT train-up for full spectrum
operations deployment, to include IW-related deployments. With 1,000
train-the-trainers at 162nd Training Brigade and the capacity to train
IW-related tasks at Fort Polk, the BCT home station, or in theater,
each BCT, and the 3,500 Soldiers assigned to the BCT as well as
augmentees, receive IW-related training prior to deployment.
Additionally, the Army has institutionalized an IED-Defeat Strategy,
funding initiatives and developing them into a core capability. Current
Mission Readiness Exercises at the Army's Combat Training Centers at
Fort Polk, Fort Irwin, and in Germany replicate the operational
environment with IW-focused scenarios and include language- and
culture-proficient civilians, host nation security forces, other
government agencies, and non-governmental organizations to create
realistic and complex situational training. The Army has updated
training curriculum at all levels to address IW and has incorporated
training capabilities and cultural aspects into individual and unit
training through various ranges, training lanes, simulators, computer
exercises, seminars, workshops, computer software, and tactics,
techniques and procedures. The Army's IW enhancements are likely to
impact local economies in a positive manner with the additional
employment of civilian role-players and associated net growth to local
community jobs.

Contract Services

Question. The cost of the contracted workforce compared to the
military and federal civilian workforce has grown extraordinarily,
fueled in part by OMB's ``competitive sourcing'' direction. In 1997,
DoD spending on contract services and supplies was less than half, and
now it is greater than half, of the DoD budget. Further, spending on
government payroll fell from a third to just over a quarter of the DoD
total spending. President Obama's 2010 defense budget request may begin
to reverse this trend. On March 4th, President Obama stated ``. . . we
will stop outsourcing services that should be performed by the
Government. . . .'' Then on April 6th, Secretary Gates stated that the
2010 budget request will reduce. . . . the number of support service
contractors from the current 39 percent of the workforce to the pre-
2001 level of 26 percent and replace them with full-time government
employees. Our goal is to hire as many as 13,000 new civil servants in
FY10 to replace contractors with up to 30,000 new civil servants in
place of contractors over the next five years.'' Are you aware of GAO's
and DODIG findings that an error in the A-76 calculation of
``overhead'' wrongly and unfairly has resulted in work performed by
federal employees being contracted out?
Answer. Yes, we are aware that there are some GAO and DODIG
findings that have challenged the overhead calculation methodology in
some DOD competitions. In response, the Director, Housing and
Competitive Sourcing, Office of the Deputy Under Secretary of Defense
(Installations and Environment) modified cost estimating software to
flag the proper use of economic price adjustments in estimating the
government cost estimate to prevent erroneous data entry in the future.
DoD continues to use the standard cost factor for overheard required by
OMB Circular A-76, which continues to be an acceptable method for
capturing federal agency overhead costs. After competing over 32,000
positions over the last several years, the Army has reduced DoD's cost
of operating the services they perform by 40% compared to the costs
before competition. Annual recurring savings are over $660 million.
Question. Why are you converting federal jobs to contractors at
West Point in June 2009, rather than just holding pat until OMB
finishes its review of A-76?
Answer. The two West Point public-private competitions were
conducted in accordance with OMB Circular A-76, the Federal Acquisition
Regulation, and related statutes. Both competition decisions were
protested, and the Army is not implementing the competition decision in
order to comply with the GAO decisions made in response to the GAO
protests.

[Clerk's note. End of questions submitted by Mr. Murtha.
The Fiscal Year 2009 Army Posture Statement follows:]

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W I T N E S S E S

__________
Page
Alexander, Jay................................................... 457
Bye, Dr. Raymond, Jr............................................. 449
Casey, General G. W., Jr......................................... 355
Conway, General James............................................ 259
Donley, M. B..................................................... 199
Embrey, Ellen.................................................... 1
Finney, Sally.................................................... 467
Geren, Pete...................................................... 355
Mabus, Ray....................................................... 259
Mateczun, Vice Admiral J. M...................................... 1
Peluso, Karen.................................................... 443
Robinson, Vice Admiral A. M...................................... 1
Roudebush, Lieutenant General J. G............................... 1
Roughead, Admiral Gary........................................... 259
Rowles, J. S..................................................... 461
Schoomaker, Lieutenant General Eric.............................. 1
Schwartz, General N. A........................................... 199
Tenenbaum, Cara.................................................. 453
Visco, Fran...................................................... 436
Volpe, Brigadier General Philip.................................. 1