    [Senate Hearing 111-701, Part 6]
    [From the U.S. Government Publishing Office]

                                                       S. Hrg. 111-701 Pt. 6

    DEPARTMENT OF DEFENSE AUTHORIZATION FOR APPROPRIATIONS FOR FISCAL YEAR
                                      2011

    =======================================================================

                                    HEARINGS

                                   before the

                          COMMITTEE ON ARMED SERVICES
                              UNITED STATES SENATE

                         ONE HUNDRED ELEVENTH CONGRESS

                                 SECOND SESSION

                                       ON

                                    S. 3454

         TO AUTHORIZE APPROPRIATIONS FOR FISCAL YEAR 2011 FOR MILITARY
    ACTIVITIES OF THE DEPARTMENT OF DEFENSE, FOR MILITARY CONSTRUCTION, AND
       FOR DEFENSE ACTIVITIES OF THE DEPARTMENT OF ENERGY, TO PRESCRIBE
        PERSONNEL STRENGTHS FOR SUCH FISCAL YEAR, AND FOR OTHER PURPOSES

                                   __________

                                     PART 6

                                   PERSONNEL

                                   __________

                      MARCH 10, 24; APRIL 28; MAY 12, 2010

                                   __________

             Printed for the use of the Committee on Armed Services

            Available via the World Wide Web: http://www.fdsys.gov/

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                          COMMITTEE ON ARMED SERVICES

                         CARL LEVIN, Michigan, Chairman

    ROBERT C. BYRD, West Virginia        JOHN McCAIN, Arizona
    JOSEPH I. LIEBERMAN, Connecticut     JAMES M. INHOFE, Oklahoma
    JACK REED, Rhode Island              JEFF SESSIONS, Alabama
    DANIEL K. AKAKA, Hawaii              SAXBY CHAMBLISS, Georgia
    BILL NELSON, Florida                 LINDSEY GRAHAM, South Carolina
    E. BENJAMIN NELSON, Nebraska         JOHN THUNE, South Dakota
    EVAN BAYH, Indiana                   ROGER F. WICKER, Mississippi
    JIM WEBB, Virginia                   GEORGE S. LeMIEUX, Florida
    CLAIRE McCASKILL, Missouri           SCOTT P. BROWN, Massachusetts
    MARK UDALL, Colorado                 RICHARD BURR, North Carolina
    KAY R. HAGAN, North Carolina         DAVID VITTER, Louisiana
    MARK BEGICH, Alaska                  SUSAN M. COLLINS, Maine
    ROLAND W. BURRIS, Illinois
    JEFF BINGAMAN, New Mexico
    EDWARD E. KAUFMAN, Delaware

                       Richard D. DeBobes, Staff Director

                   Joseph W. Bowab, Republican Staff Director

                                     ______

                           Subcommittee on Personnel

                          JIM WEBB, Virginia, Chairman

    JOSEPH I. LIEBERMAN, Connecticut     LINDSEY GRAHAM, South Carolina
    DANIEL K. AKAKA, Hawaii              SAXBY CHAMBLISS, Georgia
    E. BENJAMIN NELSON, Nebraska         JOHN THUNE, South Dakota
    CLAIRE McCASKILL, Missouri           ROGER F. WICKER, Mississippi
    KAY R. HAGAN, North Carolina         GEORGE S. LeMIEUX, Florida
    MARK BEGICH, Alaska                  DAVID VITTER, Louisiana
    ROLAND W. BURRIS, Illinois           SUSAN M. COLLINS, Maine
    JEFF BINGAMAN, New Mexico

                                      (ii)

                                C O N T E N T S

                                  ----------

                        CHRONOLOGICAL LIST OF WITNESSES
            Active, Guard, Reserve, and Civilian Personnel Programs
                                 march 10, 2010

                                                                       Page

    Stanley, Hon. Clifford L., Under Secretary of Defense for
      Personnel and Readiness........................................     6
    Lamont, Hon. Thomas R., Assistant Secretary of the Army for
      Manpower and Reserve Affairs...................................    30
    Garcia, Hon. Juan M., III, Assistant Secretary of the Navy for
      Manpower and Reserve Affairs...................................    38
    Ginsberg, Hon. Daniel B., Assistant Secretary of the Air Force
      for Manpower and Reserve Affairs...............................    42
    Barnes, Master Chief Joseph L., USN (Ret.), National Executive
      Director, Fleet Reservse Association...........................    71
    Moakler, Kathleen B., Government Relations Director, National
      Military Family Association....................................    77
    Cline, Master Sergeant Michael, USA (Ret.), Executive Director,
      Enlisted Association of the National Guard of the United States    96
    Holleman, Deirdre Parke, Executive Director, The Retired Enlisted
      Association....................................................    98
    Strobridge, Steven P., USAF (Ret.), Director of Government
      Relations, Military Officers Association of America............   100

           Military Health System Programs, Policies, and Initiatives
                                 march 24, 2010

    Cardin, Hon. Benjamin L., U.S. Senator from the State of Maryland   181
    Rice, Charles L., M.D., Performing the Duties of the Assistant
      Secretary of Defense for Health Affairs, and Acting Director,
      Tricare Management Activity....................................   185
    Hunter, RADM Christine S., USN, Deputy Director, Tricare
      Management Activity............................................   192
    Schoomaker, LTG Eric B., USA, Surgeon General of the U.S. Army,
      and Commander, U.S. Army Medical Command.......................   194
    Robinson, VADM Adam M., Jr., USN, Surgeon General of the U.S.
      Navy, and Chief, Navy Bureau of Medicine and Surgery...........   218
    Green, Lt. Gen. Charles B., USAF, Surgeon General of the U.S. Air
      Force..........................................................   227
    Jeffries, RADM Richard R., USN, Medical Officer of the U.S.
      Marine Corps...................................................   235

      Military Compensation and Benefits, Including Special and Incentive
                                      Pays
                                 april 28, 2010

    Carr, William J., Deputy Under Secretary of Defense for Military
      Personnel Policy...............................................   313
    Farrell, Brenda S., Director, Defense Capabilities and
      Management, Government Accountability Office...................   317

                                     (iii)

    Murray, Carla Tighe, Senior Analyst, National Security Division,
      Congressional Budget Office....................................   323
    Hosek, James R., Director, Forces and Resources Policy Center,
      RAND National Security Research Division.......................   330

                           Reserve Component Programs
                                  may 12, 2010

    McCarthy, Hon. Dennis M., Assistant Secretary of Defense for
      Reserve Affairs................................................   369
    McKinley, Gen. Craig R., USAF, Chief, National Guard Bureau......   378
    Wyatt, Lt. Gen. Harry M., III, USAF, Director, Air National Guard   379
    Carpenter, MG Raymond W., ARNG, Acting Director, Army National
      Guard..........................................................   380
    Stultz, LTG Jack C., USAR, Chief of Army Reserve; and Commanding
      General, U.S. Army Reserve Command.............................   396
    Debbink, VADM Dirk J., USN, Chief of Navy Reserve; and Commander,
      Navy Reserve Force.............................................   401
    Kelly, Lt. Gen. John F., USMC, Commander, Marine Forces Reserve;
      and Commander, Marine Forces North.............................   409
    Stenner, Lt. Gen. Charles E., Jr., USAF, Chief of Air Force
      Reserve; and Commander, Air Force Reserve Command..............   419
    Stosz, RADM Sandra L., USCG, Acting Director of Reserve and
      Training, U.S. Coast Guard.....................................   428

    DEPARTMENT OF DEFENSE AUTHORIZATION FOR APPROPRIATIONS FOR FISCAL YEAR
                                      2011

                                  ----------

                           WEDNESDAY, MARCH 10, 2010

                                   U.S. Senate,
                             Subcommittee on Personnel,
                                   Committee on Armed Services,
                                                        Washington, DC.

            ACTIVE, GUARD, RESERVE, AND CIVILIAN PERSONNEL PROGRAMS

        The subcommittee met, pursuant to notice, at 10:33 a.m. in
    room SR-232A, Russell Senate Office Building, Senator Jim Webb
    (chairman of the subcommittee) presiding.
        Committee members present: Senators Webb, Hagan, Begich,
    Graham, and Chambliss.
        Majority staff members present: Jonathan D. Clark, counsel;
    Gabriella Eisen, counsel; and Gerald J. Leeling, counsel.
        Minority staff members present: Diana G. Tabler,
    professional staff member; and Richard F. Walsh, minority
    counsel.
        Staff assistants present: Jennifer R. Knowles and Brian F.
    Sebold.
        Committee members' assistants present: Juliet Beyler and
    Gordon Peterson, assistants to Senator Webb, Lindsay Kavanaugh,
    assistant to Senator Begich; Clyde Taylor IV, assistant to
    Senator Chambliss; and Adam Brake, assistant to Senator Graham.

            OPENING STATEMENT OF SENATOR JIM WEBB, CHAIRMAN

        Senator Webb. Good morning. The subcommittee will come to
    order.
        The subcommittee meets today to receive testimony on the
    Active, Guard, Reserve, and civilian personnel programs in
    review of the National Defense Authorization Request for Fiscal
    Year 2011 and the Future Years Defense Program.
        We will have two panels today. The first panel's witnesses
    are the senior civilian officials in the Department of Defense
    (DOD) and the military departments who are responsible for
    personnel matters. I welcome The Honorable Clifford Stanley,
    Under Secretary of Defense for Personnel and Readiness; The
    Honorable Thomas Lamont, Assistant Secretary of the Army for
    Manpower and Reserve Affairs; The Honorable Juan Garcia,
    Assistant Secretary of the Navy for Manpower and Reserve
    Affairs; and The Honorable Daniel Ginsberg, Assistant Secretary
    of the Air Force for Manpower and Reserve Affairs.
        Nobody wants to sit in this center seat, here? [Laughter.]
        Dr. Stanley, feel free to be the major focal point of the
    room. [Laughter.]
        Our second panel will include witnesses drawn from
    associations that represent and advance the interests of Active
    Duty, Reserve, and retired servicemembers and their families.
    I'll introduce our second panel when it convenes, but I wish to
    express my appreciation to all our witnesses for joining us
    this morning.
        This is my first hearing as chairman of this subcommittee.
    The subcommittee's jurisdiction extends to virtually all
    matters of personnel policy--compensation, military healthcare,
    military nominations, civilian personnel. I'd like to say, at
    this point, that I intend for this subcommittee to exercise
    continuous and active oversight of all our military personnel
    matters, through hearings, through consideration of the
    Department's budget and legislative proposals, and also through
    day-to-day interaction with you and people who work with you,
    and with our committee staff, as well. This hearing is one
    part, and one part only, of that process.
        There's no greater responsibility for Congress and military
    leaders, as our witnesses all know, than to care and provide
    for our servicemembers and for their families. This is a
    concept of stewardship that I, and I think all of my
    compatriots up here, feel about very strongly.
        I grew up in the military, as many of you know. I know what
    it's like to have a parent deployed. I also know what that
    means, in terms of the responsibilities and the challenges of
    family members. I can remember, at one point, when--my father
    was career Air Force--I went to a different school in the fifth
    grade, sixth grade, seventh grade, three different schools in
    the eighth grade, the ninth grade, two different schools in the
    tenth grade, from England to Missouri to Texas to Alabama to
    California to Nebraska, and I know how that stresses the
    families, and I know how important it is for us to always keep
    that in mind.
        I had the honor of serving with the Marine Corps infantry
    in Vietnam. I understand a lot of the stresses of what it means
    to be deployed in combat. I'm a father of a Marine NCO who had
    some hard time in Iraq, and also the father-in-law of a Marine
    infantry sergeant, who is now, at the age of 24, looking to be
    deployed for the fourth time, coming this July.
        That, coupled with the experience that I was able to gain
    through 5 years in the Pentagon--one as a Marine officer, three
    having responsibility for our Guard and Reserve programs, about
    which I feel very strongly, and the other as Secretary of the
    Navy--we got a very good look, in the 1980s, at the evolution
    of the total-force concept, where the manpower challenges came
    from, force-structure issues, and those sorts of things, and
    they will come to play here, in this subcommittee, as we move
    forward.
        We're very cognizant of the fact DOD, supported by this
    committee, has instituted many innovative programs over the
    past several years in order to deal with the challenges that
    have occurred since September 11, 2001.
        I would mention, briefly, since this is my first hearing as
    chairman of this subcommittee, that the Commonwealth of
    Virginia has a long history, in terms of taking care of, and
    being host to, one of the largest Active Duty and retired
    military populations in our country, and I'm honored to serve
    in the tradition of John Warner, who is no longer in the
    Senate, but gave tremendous service to this committee and also
    to the people of Virginia, in this area.
        Our military is now engaged in its 9th year of combat
    operations since September 11. Our Guard and Reserve components
    have played critical roles during this period, in ways that
    were not envisioned at the inception of the All-Volunteer Force
    and, quite frankly, were not envisioned when I was Assistant
    Secretary of Defense for Reserve Affairs.
        It's also important for us to remember that the All-
    Volunteer Force is not an all-career force. Sometimes we lose
    that focus when we have people from the Pentagon coming over
    here talking to us about programs. The Services do a very fine
    job of attending to the needs of its career force, but we
    should always keep in mind our stewardship to those who feel,
    in the citizen-soldier tradition of this country, that they
    should come in and obligate themselves for one enlistment, and
    return to their communities.
        The data that we received when we were formulating the GI
    Bill was that 75 percent of the Army enlisted folks, and 70
    percent of the Marine Corps, and roughly half of the other two
    Services, leave the military on or before the end of their
    first enlistment. Those numbers may have varied a bit with the
    economic conditions right now, but those are the people that we
    should never forget when we come up--in talking about these
    other programs.
        I'm look forward, greatly, to serving with our
    subcommittee's ranking member, Senator Graham, in addressing
    these challenges, and to ensure the long-term viability of the
    All-Volunteer Force, not simply in numbers, but also in
    quality. Everyone in this room is very familiar with Senator
    Graham's service, not only on this committee, but also to our
    country, continuing to serve as a colonel in the Air Force
    Reserve. He brings valuable perspective, I think, as everyone
    has seen, as we've attempted to work through the issues of the
    Guantanamo Bay detainees and many other areas. He's served
    regularly on Active Duty, and his duties have allowed him to
    keep his finger on the pulse of the men and women in our
    military today. He and I have collaborated on a number of
    important issues over the past 3 years, and I welcome this
    opportunity to work with him even more closely during the
    months and years ahead.
        The All-Volunteer Force is stressed by the past 9 years of
    conflict. Having experienced multiple deployments, extended
    deployments to Afghanistan, Iraq, this is especially true of
    our ground forces. We're entering uncharted territory, in terms
    of the long-term consequences of past rotation cycles and an
    unsatisfactory deployment-to-dwell ratio that is only now
    beginning to be corrected. Despite authorizing more than 55,000
    additional Active-Duty servicemembers in the last year, today's
    dwell times are still inadequate to ensuring the vital
    recuperation, revitalization, and reset of the force and their
    families. I'm concerned about that impact on the resilience of
    the force, and we'll have some questions, during your
    testimony, with respect to those issues.
        This subcommittee faces a very clear and immediate
    challenge, and that is in addressing the rising costs of
    personnel. The combination of rising end strengths and an
    increasing compensation package continues to send personnel-
    related costs soaring. As Secretary Gates recently said, ``The
    costs of healthcare are eating the Department alive.'' The
    total personnel-related budget in the Department's fiscal year
    2011 request, including the cost of providing healthcare to
    servicemembers, their families, and retirees, amounts to $178
    billion, or 32 percent of the overall DOD base budget. By
    contrast, when I was Secretary of the Navy in 1987, I think the
    entire Navy budget was right about $100 billion. Compare that
    with the fiscal year 2003 total personnel-related spending,
    including healthcare, amounted to $114 billion. That's an
    increase of 56 percent from fiscal year 2003 to fiscal year
    2011. By all accounts, that growth is going to continue.
        Though these challenges are steep, we should also be
    thankful for the successes that the Department and our Services
    have enjoyed. The combination of patriotism, a stagnant
    economy, a robust compensation package, including retirement,
    healthcare, and education benefits, have allowed the Services
    to achieve historic highs in recruiting and retention.
        The quality of our people has also been sustained. Waivers
    are down across the Services, test scores are up, and the vast
    majority of new recruits are high school graduates, a higher
    percentage than just a couple of years ago. These are all
    strong indicators of the quality of character and service that
    our people in uniform exhibit, across the board, day after day.
        I look forward to hearing from both panels this morning. I
    would encourage you to express your views candidly and, in
    addition relating to what you see going well, to address your
    concerns in those issues that you believe this subcommittee
    needs to pay attention to. I, along with Senator Graham and our
    colleagues, are dedicated to the prospect of ensuring that our
    military remains the very best in the world.
        Senator Graham.

                  STATEMENT OF SENATOR LINDSEY GRAHAM

        Senator Graham. Thank you, Mr. Chairman.
        As I listened to your opening statement, it really struck
    me that, of all of the people in the Senate, you're clearly, I
    think, the most qualified person to lead this subcommittee
    right now, in the sense of your understanding the personnel
    issues and just your personal history.
        I want to also acknowledge that Senator Nelson was a
    complete joy to work with, and he's gone to another
    subcommittee. But, Mr. Chairman, I promise, when it comes to
    the troops, we'll be as bipartisan as possible. I think we've
    proven, between the two of us, that we can disagree, but also
    find common ground on things that really do matter.
        I was on a plane not long ago, and on that one plane I had
    a young man come up to me who had just gotten out of the
    military, he's going to Harvard, and he mentioned the GI bill
    that you authored and we worked together to pass. It really is
    working. There's a lot of implementation problems, but the fact
    that this young man is able to get most of his college
    education paid for, if not all, for serving 4 years, going to
    Harvard, I think, is a testament to that bill. The guy sitting
    right by me was a 28-year service Air Force colonel who is
    going to transfer his benefits to his youngest daughter going
    to college, and he was just telling me how much that meant to
    his family. So, what we're able to accomplish there, with your
    leadership, is really helping people.
        The one thing I would suggest is, the President's budget--
    I'm going to try to support as much as possible. The 1.4-
    percent pay raise is the least we can do. We all wish it would
    be more, but we do have budget problems up here. The
    sustainability of healthcare is the issue, I think, for us on
    this committee, and maybe the Congress as a whole, because, as
    you talked about your time with the Navy, the budgets have
    grown, the obligations are great, so few people are doing so
    much for so long. Here we are, 9 years almost into this war,
    and we're growing the military. I think that's a wise thing to
    do. Personnel costs are 30-something percent of the budget, but
    the healthcare component is 8 percent of the budget, growing,
    it's going to be hard to sustain that. We haven't had a premium
    increase in TRICARE since 1995. I want to do everything I can
    to help the families and retirees and military members, but
    eventually we're going to have to deal with that problem: How
    do you sustain the growth of TRICARE and other medical benefits
    within the budget before you start taking away from the
    warfighter? That means some hard decisions are to come.
        When it comes to ``Don't Ask, Don't Tell,'' I think we all
    are waiting to see what this survey shows, and try to make an
    intelligent decision based on input from the military, and I
    would just urge my colleagues to let that run its course.
        With that, Mr. Chairman, I will listen to the witnesses and
    look forward to working with you. Again, I think, between the
    two of us and the members of this committee, we can do some
    good things for our men and women in uniform.
        One last thought. Senator Chambliss has a bill that I've
    been working with to lower retirement age for Guard and Reserve
    members who have served on Active Duty since September 11,
    2001. For every year they would serve, or 90 days they would
    serve, they could retire a bit earlier, all the way down to 55.
    That has a cost associated with it, but I think it's an idea
    whose time has come, and I look forward to working with you to
    see if we can make that possible.
        Mr. Chairman, I look forward to being your ally and
    colleague on this. Now is the time for me to shut up and let
    the people who are in charge talk.
        Senator Webb. Let me say that I can't think of a better
    person to be working with than Senator Graham on these issues,
    as well.
        Senator Graham. Thank you.
        Senator Webb. We've received statements for the record from
    the Fleet Reserve Association, the Reserve Officer Association,
    and, without objection they will be included in the record at
    this point.
        We've also received a statement for the record from Senator
    Bill Nelson, who could not be here, and, without objection,
    that will be included in the record after the principal
    statements of our witnesses.
        [The prepared statement of Senator Bill Nelson follows:]
                   Prepared Statement by Senator Bill Nelson
        Mr. Chairman, thank you for allowing me to speak about one of the
    last injustices plaguing the veterans' benefits system. I am talking
    about the offset between the Department of Defense (DOD) Survivor
    Benefit Plan (SBP) annuity and the Department of Veterans Affairs (VA)
    Dependency and Indemnity Compensation (DIC) benefit.
        SBP is an annuity paid by the DOD to survivors when either a
    military retiree pays a premium as income insurance for their survivors
    or when a servicemember dies on active duty. DIC is a survivor benefit
    paid by the Veterans Administration. Survivors receive DIC when
    military service caused the servicemember's death.
        There is a longstanding problem in our military survivor benefits
    system, the requirement for a dollar-for-dollar reduction of survivor
    benefits from the SBP paid by DOD by the amount of DIC received from
    the VA. I have fought for 9 years to eliminate the offset for SBP
    beneficiaries whose loved ones purchased or earned this annuity.
        Following the bloodiest of America's wars, President Abraham
    Lincoln, in his second inaugural address, said that one of the greatest
    obligations in war is to ``finish the work we are in; to bind up the
    Nation's wounds; to care for him who shall have borne the battle, and
    for his widow, and his orphan.''
        To truly honor our servicemembers, we all agree that the U.S.
    Government must take care of our veterans, their widows and orphans. In
    keeping with that moral principle, we must repeal the unjust offset
    that denies widows and orphans the annuity their deceased loved ones
    have earned on active duty or purchased for them.
        In the 2008 National Defense Authorization Act, we cracked the door
    to eliminating the offset. In conference negotiations with the House,
    we made some progress when we got a ``special payment'' of $50 per
    month, which will increase to $310 per month by 2017 because of money
    savings found in Tobacco Legislation passed last year.
        Our efforts have been important steps in the right direction, but
    they are not enough. We must meet our obligation to the widow and
    orphan with the same sense of honor as was the service their loved one
    had rendered. We must completely eliminate the SBP-DIC offset.
        I commend many of the organizations represented by the witnesses
    today for the support they have shown and hard work put in for full
    repeal of the offset. I ask DOD to work with Congress to honor the
    retirees, the fallen, and their families, and budget for full repeal of
    the SBP-DIC offset.
        Thank you, Mr. Chairman.

        Senator Webb. With that, we would begin with Dr. Stanley,
    and then move to Mr. Lamont, Mr. Garcia, and Mr. Ginsberg, in
    that order.
        Dr. Stanley, welcome.

       STATEMENT OF HON. CLIFFORD L. STANLEY, UNDER SECRETARY OF
                  DEFENSE FOR PERSONNEL AND READINESS

        Dr. Stanley. Good morning, Senator Webb and Senator Graham
    and other distinguished members of the subcommittee.
        First of all, let me just say I'm honored to be here, and
    particularly with colleagues and, in some cases, just meeting
    today.
        As I speak to you concerning DOD's personnel programs and
    readiness, for the past 3 weeks, as the Under Secretary of
    Defense, I've had the honor of working and interacting with
    some of the greatest men and women in uniform, DOD civilians,
    contractors, and their great families. It is truly a privilege
    to serve them in this position.
        I first want to thank you for your support of these men and
    women over the years. They have fought our wars, protected our
    interests and our allies around the globe. I look forward to
    working closely with this committee to improve support for
    those in uniform, the civilian employees of the Department, and
    their families.
        Just a few short months ago, I appeared before you as
    President Obama's nominee to be the Under Secretary of Defense
    for Personnel and Readiness. At that time, I emphasized several
    top priorities: the All-Volunteer Force, support to wounded
    warriors, personnel readiness, family programs, and the stress
    that is affecting our military today.
        In terms of military personnel, the Services are
    experiencing historic success in recruiting and retention. It
    is a tribute to both the dedication of our military personnel
    and to the patriotism of our Nation's citizens that we continue
    to maintain an All-Volunteer Force of unprecedented quality
    after more than 8 years in active combat operations.
        I am happy to report that in fiscal year 2009, the Services
    have had the most successful recruiting year of all the All-
    Volunteer Force era. All four Active Services and all six
    elements of the Reserve component achieved both numerical and
    recruit quality targets for the first time, which is a banner
    year. To continue to secure sufficient personnel for the Armed
    Forces, the Department must provide a compensation package
    comparable and competitive to the private sector at the same
    time we balance the demands of an All-Volunteer Force in the
    context of growing equipment and operational costs.
        The Department continues this commitment through the
    President's request for a 1.4-percent increase in military pay
    for all servicemembers in the fiscal year 2011 budget, an
    amount that equals earning increases in the private sector, as
    measured by the Employment Cost Index. Of note, from the
    January 1, 2002, through the January 1, 2010, pay raises,
    military pay rose about 42 percent, and the housing allowance
    rose by 83 percent. During the same period, private-sector
    wages and salaries rose only 32 percent.
        While there is little question that those increases were
    necessary in the past, rising personnel costs could
    dramatically affect the readiness of the Department. We are at
    a point where discretionary spending offers the best ability to
    target specific skills, and the quality and quantity of those
    filling such positions. I believe the Services still require
    the use of special pay and bonuses to ensure sufficient
    operational readiness and our mission.
        Our military forces maintain an exceptionally high level of
    readiness, but multiple deployments to Iraq and Afghanistan
    have certainly increased the stress on our servicemembers and
    their families. We have a number of initiatives underway to
    address this stress, and have set clear limits and goals for
    the deployment lengths and the amount of time, or ``dwell,''
    between deployments.
        To that end, we have limited our unit deployments to 1 year
    in theater, a minimum of 1 year between deployments for our
    Active component. Our goal is to increase the time between
    deployments to 2 years for every year deployed, commonly called
    a 1-to-2 dwell ratio. For the Reserve component, we have
    limited the mobilization period to 1 year, and we strive to
    have a minimum 3-year break between mobilizations. The goal of
    the Reserve component dwell ratio is 1 year mobilized, with a
    5-year break between mobilizations, or a 1-to-5 dwell ratio.
    Although we are not there yet, we are making progress toward
    those goals.
        The Department is focused on care for our wounded, ill, and
    injured military members. As Secretary Gates stated last month,
    aside from winning the wars themselves, this is the
    Department's highest priority. Initiatives are currently
    underway to achieve a seamless transition from Active Duty to
    veteran status, and to increase cooperation between DOD and the
    Department of Veterans Affairs (VA). In addition, efforts to
    create a Disability Evaluation System that is simpler, faster,
    fairer, and more consistent are underway.
        Finally, in support of President Obama's commitment, the
    Department is partnering with the VA to establish Virtual
    Lifetime Electronic Records that will improve veteran care and
    services through increased availability and administrative and
    health information.
        We are also committed to further improving support to our
    military families. For fiscal year 2011, we have requested for
    a 41-percent increase in family assistance baseline funding
    across the Department to ensure that we are on target, in the
    sense of investing in programs that are needed by
    servicemembers and their families. We have initiated an
    extensive strategic planning process to address the current
    issues facing family readiness programs. This begins with a
    thorough assessment of existing needs, programs, and related
    issues.
        Unfortunately, we have had stumbles in this area. As I'm
    sure you're aware, we announced a temporary pause to the My
    Career Advancement Account (MyCAA) program on February 16,
    2010. Due to unforeseen, unprecedented, but welcome, demand in
    enrollments that overwhelmed the infrastructure, we nearly
    reached the budget threshold. While it was necessary to pause
    the program immediately, we failed to communicate properly the
    reasons for the pause. Over the past few weeks, DOD has worked
    tirelessly on mapping out solutions, for both the short and
    long term, that honors our commitment to our military spouses
    while accounting for fiscal realities.
        Our proposals are in the final stage of approval and we
    hope to restart the program very soon. We know we must make a
    concerted effort to restore our credibility and confidence with
    our military spouses, servicemembers, and the American public.
        Our military has proven its resilience during the most
    challenging of times, but the stress on the force is obvious.
    The Department's civilian and military leadership remain
    focused on employing numerous strategies to reduce the
    incidence of suicide in the Armed Forces. In calendar year
    2009, there were a total of 312 suicides, 285 Active component
    and 26 in the Reserve component, marking an increase, up from
    268 in 2008. I know this committee shares our belief that even
    one suicide is too many.
        There are many other critical issues facing the Department
    and this Nation, and I am exceedingly grateful to this Congress
    and this committee for their continuous commitment to
    supporting our men and women in DOD.
        I look forward to your questions and thank you for your
    time.
        [The prepared statement of Dr. Stanley follows:]
                 Prepared Statement by Hon. Clifford L. Stanley
        Mr. Chairman and members of this distinguished subcommittee, thank
    you for inviting us to testify before you.
        As I humbly assume my role as the new Under Secretary of Defense
    for Personnel and Readiness, I am resolute in my determination to
    honor, protect and improve the lives of U.S. airmen, soldiers, sailors,
    and marines. I am here today to describe our mission as I see it and
    share my thoughts on how compassion, excellence and heightened sense of
    urgency will help me and my organization fulfill our duty.
        I am mindful we are at war and we must prevail. We win when we help
    our troops succeed in combat, and be healthy and happy with their
    families when at ease. We win when our troops can be confident their
    families have easy access to the resources and support they need while
    their loved ones are deployed. Maintaining our incredible All-Volunteer
    Force is our highest priority as we strive to recruit, attract, retain,
    and reward American's best and brightest, and their families.
                                  active duty
    Recruiting
        After more than 5 years of the most challenging recruiting
    environment since the inception of the All-Volunteer Force (AVF) in
    1973, the Services emerged in fiscal year 2009 with the most successful
    recruiting year of the AVF era--all four Active Services and all six
    Reserve components achieved both numerical and recruit quality targets
    for the first time, a banner year. Previous years were marked by a
    growing economy, low unemployment, reluctance of influencers of youth
    to recommend military service, propensity among youth themselves at an
    all-time low, and recruiting goals of the Army and Marine Corps
    increasing. Yet since 2005, the Services met or exceeded recruiting
    goals--the AVF concept has proven itself amidst some of the greatest
    stressors it could face.
        The recruiting environment has now changed. Unemployment has risen
    considerably. Generally, times like this make recruiting less
    challenging, and a regrettable trend in national unemployment operates
    to the advantage of those who are hiring, including the U.S. military.
    In addition, interest in the military among young people has increased.
        On the other hand, challenges remain--the lower likelihood of
    influencers of youth (e.g., parents and teachers) to recommend service,
    a large and growing proportion of youth population who are ineligible
    to serve in the military principally as a consequence of rising
    obesity, high numbers of youth going to college directly from high
    school, and the continuing concerns about overseas contingency
    operations with its concomitant high operations tempo, particularly the
    announced increases in force levels in Afghanistan. Therefore, we are
    in uncharted waters--with significant factors, both negative and
    positive, directly affecting military recruiting efforts.
        As a result, we continually review our recruiting programs to align
    funding and policies with current realities, recognizing that stable
    and adequate investments in recruiting resources are necessary to
    maintain success, especially in the long term. These reviews have
    allowed the Services to reduce recruiting resources in fiscal year 2010
    and 2011. While this results in a decreasing reliance on bonus
    incentives to meet recruiting goals, each Service knows it must be
    judicious in its cuts--reducing budgets gradually, and in the right
    places--using those targeted incentives to ensure we attract high
    quality youth into our most critical skills. We are mindful of the
    past, when fluctuating resources--up in tough recruiting environments,
    down in favorable ones--jeopardized recruiting missions, often
    resulting in sporadic failures.
        The recruiting environment is less challenging today, but we know
    that a tough recruiting environment will return. If we enter those
    difficult recruiting periods with insufficient resources and
    inexperienced recruiters, it will only exacerbate the problem and
    contribute to the ``boom and bust'' recruiting cycle which has
    characterized the past. Such a cyclical resourcing strategy also
    ignores the ongoing and significant role recruiting resources--
    particularly advertising--have on both youth and influencer awareness,
    attitudes, and propensity. Therefore, it is imperative that we
    stabilize necessary recruiting resources. We appreciate this
    committee's untiring support of our recruiting programs and look
    forward to working together to ensure future success.
        As previously stated, fiscal year 2009 was a banner year for active
    duty recruiting. Altogether, the Services exceeded their goal of
    163,880 accessions by 5,088, accessing 159,374 first-term enlistees and
    an additional 9,594 individuals with previous military service.
        Fiscal year 2010 active duty recruiting efforts, to date, are even
    better. Through December, all Services met or exceeded both quantity
    and recruit quality objectives for the active force, with the Army
    achieving 13,977 of its 13,716 recruiting goal, for a 102 percent year-
    to-date accomplishment (Table 1). Especially notable is the fact that
    for the second year in a row, after 4 years of falling below the 90
    percent DOD Benchmark for High School Diploma Graduates, the Army is
    now exceeding that measure, with an impressive 99.9 percent of new
    recruits holding that credential.

        We should not lose sight of the fact that, although the overall
    youth population is large, only a relatively small proportion of
    American youth is qualified to enlist. It is an unfortunate fact that
    much of the contemporary youth population is currently ineligible to
    serve. Medical disqualification, with obesity a large contributing
    factor, removes 35 percent, drug or alcohol abuse removes 18 percent,
    and another 23 percent do not meet our standards for reasons such as
    criminal misbehavior, have more dependents than can reliably be
    accommodated in the early career, or low aptitude scores. Another
    estimated 10 percent are qualified, but are attending college.
        To expand the recruiting pool and assist the Services in meeting a
    special category of critical readiness needs, the Department initiated
    a 1-year pilot program, Military Accessions Vital to National Interest
    (MAVNI), allowing the enlistment of up to 1,000 of a select group of
    non-U.S. citizens who had been in the United States for at least 2
    years. Enlistments under this pilot are open only to health care
    professionals in critically short specialties and individuals with
    language skills and cultural backgrounds in a limited list of
    languages. We are currently reviewing results of this pilot program.
        But, given the overall limited pool of eligible youth, our
    continuing recruiting success does not come easily. It remains the
    result of long hours and hard work by the 15,100 dedicated and
    professional, active-duty military recruiters. These recruiters often
    are the sole representative of our military forces in local
    communities, and they have both my and the Department's most sincere
    respect and gratitude.
        This past August, we implemented the post-September 11 GI Bill--the
    most extensive restructuring of post-service education benefits since
    the introduction of the original World War II GI Bill. As I am sure you
    are aware, the Montgomery GI Bill (MGIB) has been a cornerstone of our
    active-duty military recruiting efforts since 1985. There is little
    doubt that the MGIB has met or even exceeded the expectations of its
    sponsors when it was enacted, and has been a major contributor to the
    success of the All-Volunteer Force.
        This new post-September 11 GI Bill should enhance our recruiting
    efforts even more. However, we remain cautious about the impact of such
    a major, new benefit on retention, particularly first-term retention.
    We hope that the provision in the new program that allows career
    servicemembers to share or transfer their GI Bill with immediate family
    members, long requested by both members and their families, will
    mitigate negative retention impacts. Early results look favorable, with
    over 100,000 career servicemembers already requesting authority to
    share their earned educational benefits with their family members. We
    are monitoring the effects of this implementation very closely.
    Military Decorations and Awards
        The Department continues to work in concert with the Services to
    appropriately recognize and laud the accomplishments, both valorous and
    non-valorous, of our soldiers, sailors, marines, and airmen. In the
    AVF, appropriately recognizing the accomplishments of our
    servicemembers is fundamental to maintaining esprit-de-corps and a
    motivated force. It is most important that the Services recognize the
    significant acts and achievements of our servicemembers while
    simultaneously maintaining the time-honored prestige of our most
    revered military decorations such as the Medal of Honor, Distinguished
    Service Cross, Navy Cross, Air Force Cross, and Silver Star. I am aware
    of the concern from some Members of Congress in regard to the award of
    valor decorations and will closely examine the results of the ongoing
    review and report on the Medal of Honor awards process as requested in
    the House Armed Services Committee report language that accompanied the
    National Defense Authorization Act of Fiscal Year 2010.
    Leave and Liberty Enhancements
        Given the ongoing operations tempo associated with Operations Iraqi
    Freedom and Enduring Freedom, the Department is acutely aware of the
    need to provide all soldiers, sailors, marines, and airmen with
    adequate leave and liberty opportunities, especially during and after
    deployments, for respite and reintegration, respectively.
    servicemembers serving in Iraq and Afghanistan are provided a much
    needed break from combat through the Rest and Recuperation (R&R) leave
    program. This vital program provides servicemembers, who are on long
    deployments, government funded transportation to the airport closest to
    their leave destination, and allows them to take 15 days of respite
    leave in an area of their choosing. For those servicemembers serving in
    the most dangerous and arduous areas of the combat zone, the R&R leave
    is not chargeable which not only recognizes their stressful duty but
    also provides more accrued leave to utilize upon redeployment for
    reintegration into their family and community. Additionally, the Post
    Deployment/Mobilization Respite Absence (PDMRA) program provides Active
    and Reserve component members who are deployed or mobilized above and
    beyond the Secretary of Defense's established deployment--dwell time
    ratios with respite nonchargeable administrative absence upon return
    from deployment or mobilization.
        I thank Congress for passing legislation, through the NDAA for
    Fiscal Year 2010, which allows our servicemembers to temporarily
    increase, from 60 to 75, the number of leave days authorized for carry
    over from 1 fiscal year to the next. This provision will reduce the
    frequency of lost leave for those servicemembers who have fewer
    opportunities to take longer leaves due to the persistent operational
    demands. The Department continues to monitor leave balances and lost
    leave to preclude avoidable loss of the benefit.
    Retention
        For fiscal year 2009, the Department was very successful in
    attaining enlisted retention goals. All Active components met or
    exceeded their respective retention goals in every measurable category.
    The Services and the Department anticipate continued success in the
    upcoming year and are already meeting or exceeding the monthly goals
    for early fiscal year 2010.
        Despite the overall strength of enlisted retention over the last
    few years, there remain critical shortages in many low density/high
    demand skills and other ``hard-to-retain'' skills, such as explosive
    ordnance disposal specialists, linguists, intelligence and
    counterintelligence analysts, and pararescue operators, that justify
    the continuation and application of the statutory bonus authorities.
    The Selective Reenlistment Bonus (SRB) and the Critical Skills
    Retention Bonus (CSRB) are among the most effective and are authorized
    by 37 U.S.C. 308 and 37 U.S.C. 355, respectively, as incentives to
    attract/retain qualified personnel in critical military specialties.
        The Department's process to manage bonuses is very well defined. A
    skill is critical if it meets one or more of the following: (a)
    technical skills requiring high training and/or replacement costs; (b)
    skills in high demand in the civilian sector; (c) challenging to
    recruit into; (d) crucial to combat readiness or capabilities; and (e)
    low density/high demand (those skills that are in high demand for
    current operations yet are low density due to less requirements during
    peacetime). All requests from the Services must have a rigorous
    business case that clearly outlines the need for the bonus for that
    skill, payment amount and method, and expected retention results.
    Designations do not exceed 3 years, subject to congressional extension
    of the statutory bonus authority. The complementary authority of the
    CSRB is the Selective Reenlistment Bonus (SRB). The SRB is under the
    authority of the Service Secretaries and is not centrally managed by
    the Department. However, applications of the bonus authorities are
    reviewed at the Department and sent as an annual report to Congress.
    Stop Loss
        The Army is the only Service with members currently extended under
    the Stop Loss authority. From a peak of 15,758 in 2005, the Army
    reduced the number of soldiers affected by Stop Loss to approximately
    8,000 at the end of December 2009. The Department is progressing as
    planned to completely end the use of the Stop Loss authority. Army
    units deploying after January 1, 2010, are no longer using the Stop
    Loss authority. The Department further expects to reduce the number of
    servicemembers on Stop Loss to less than 6,600 by June 2010. This is a
    50 percent reduction from February 2009 (date that the Secretary of
    Defense announced the milestones to end Stop Loss). All use of the Stop
    Loss authority will end by March 2011.
        Two Stop Loss Special Pays have been enacted which allow a payment
    of up to $500 per month for members whose active duty (retroactive to
    September 11, 2001) is or was extended by use of the Stop Loss
    authority. These pays were appropriated and authorized by the Congress,
    with the Department's support, to mitigate the impact and disruption
    that extensive use of Stop Loss had and has on the lives of
    servicemembers and their families. The Department implemented both
    pays, active and retroactive, and appreciates the support of Congress
    to compensate members for the unique circumstances presented by the use
    of this policy, while still preserving our ability to react with
    discretionary authority as dictated by future circumstances.
    Separation Policy
        The Department continues to improve military discharge policies in
    response to conditions of the current war and its effects on those who
    serve. As we reported to Congress earlier, one such improvement is the
    addition of increased rigor when using a personality disorder as the
    basis for administratively separating servicemembers who had deployed
    to imminent danger areas. This more rigorous process now includes a
    review by the Surgeon General of the Military Department concerned,
    yielding greater confidence that servicemembers who should be separated
    due to post-traumatic stress disorder (PTSD) or traumatic brain injury
    (TBI) are appropriately processed for disability separation as opposed
    to personality disorder. The immediate evidence of the positive effect
    of the increased rigor is that the number of personality discharges has
    decreased from 81 at the policy's promulgation in September 2008 to an
    average of 16 per month in 2009. Also, in response to section 512 of
    the NDAA for Fiscal Year 2010, the Department is prescribing policy
    regarding a more in-depth medical examination to assess whether the
    effects of PTSD or TBI relate to the basis for an administrative
    separation for those servicemembers who are pending discharge or who
    were discharged under conditions other than honorable.
    End Strength Management
        Meeting end strength is a priority of the Department. The table
    below depicts the fiscal year 2009 Active Duty authorizations
    (prescribed and actual) and fiscal year 2010 authorized levels which
    the Department intends to achieve. The Secretary of Defense has
    authority granted under the terms of the President's national emergency
    declaration to increase statutory strength levels prescribed by the
    National Defense Authorization Act if needed. The Services have
    implemented recruiting, retention, and force shaping policies and
    programs to achieve end strengths for fiscal year 2010. The Department
    appreciates the congressional support of the fiscal year 2010 end
    strength levels. These end strengths will provide the ground forces to
    meet strategic demands, eliminate the need for the use of Stop Loss,
    and mitigate persistent capability shortfalls which will reduce stress
    and demands on servicemembers and families by increasing dwell time.

    Force Development
        The Department continues to emphasize joint officer development and
    has made great strides in implementing the extraordinary authorities
    authorized in the 2007 NDAA. Active and Reserve component participation
    continues to grow, and the adjudication of over 3,200 joint experiences
    from nontraditional joint duty assignments attests to the Department's
    ability to recognize joint experiences whenever and wherever they
    occur.
        Joint officer management is not the only area of significant
    improvement for the officer corps. We appreciate the authorities
    provided by Congress in the fiscal year 2009 and 2010 NDAAs that allow
    the development of general and flag officers with the joint knowledge
    and skills necessary to lead and counter emerging threats. This
    landmark general and flag officer management legislation apportioned
    general and flag officer authorizations between internal and external
    Military Service requirements, ensuring the statutory responsibilities
    of the military departments and the joint warfighter can be met.
        The enactment of conforming legislation from the Department's 2010
    legislative package is also serving to dramatically accelerate the
    development of joint experience in the Reserve components. The
    legislation expanded on the previously enacted statutory framework
    affording the Military Departments the opportunities to purposefully
    develop officers from the Reserve components for senior posts in joint
    warfighting organizations. This delivered on the promise of the charter
    Goldwater-Nichols legislation by institutionalizing joint officer
    development through the senior officer grades regardless of component.
    Compensation
        The Department and Congress continue their strong commitment to
    provide a secure standard of living and quality of life to those who
    serve in uniform. Today, we find ourselves empowered with a never
    before seen set of flexible and targetable pay authorities which enable
    the Department to dynamically address recruiting and retention and
    achieve specific and desirable effects. We also find ourselves with
    large fixed costs encompassed in our entitlements, and the prospect of
    continued growth in that area. To secure sufficient personnel for the
    Armed Forces, the Department must provide a compensation package
    comparable and competitive in the private sector while at the same time
    balancing the demands of an All-Volunteer Force in the context of
    growing equipment and operations costs.
        The Department continues this commitment through the President's
    request for a 1.4 percent increase in military pay for all
    servicemembers in the fiscal year 2011 budget--an amount that equals
    earnings increases in the private sector as measured by the Employment
    Cost Index. Of note, since January 1, 2002 through the January 1, 2010
    pay raise, military pay has risen by 42 percent, the housing allowance
    has risen by 83 percent, and the subsistence allowance has risen by 40
    percent. During this same period, private sector wages and salaries
    have only risen by 32 percent. Government Accountability Office (GAO)
    is currently auditing the overall adequacy of military pay, as well as
    the appropriateness of the benchmarks used to measure any gaps relative
    to the private sector and its report is due April 2010. We are
    confident regular military compensation will compare favorably with pay
    in the private sector. While there is little question that those levels
    of increase were necessary in the past, the Department now finds itself
    at a point where discretionary spending offers the best ability to
    target specific skills, and the quantity and quality of those filling
    such positions.
        Collateral to the GAO review, the President recently commissioned
    the eleventh Quadrennial Review of Military Compensation. The four
    themes he has asked the panel to focus on continue the thesis of
    tailoring pays beyond entitlements to target groups and behaviors. This
    review, in general terms, will be looking at the compensation package
    for service performed in combat of hostile areas; compensation for our
    Reserve components in light of current and planned utilization;
    compensation benefits available to our wounded, those who care for them
    and the survivors of those fallen; and the pay and incentives for some
    of our most critical fields, including mental health professionals,
    special operators, operators of remote systems and those with
    specialized linguistic skills. With the recently consolidated pay
    authorities, I am confident in saying Congress has given us the tools
    we need to address each of these areas; what remains is identifying the
    best combination of the pays to achieve the ideal combination of outlay
    to impact. The Department, as always, welcomes the continuance of these
    authorities, but would be generally opposed to continued entitlement
    growth beyond indexed levels in the absence of specific goals and
    outcomes supported by studies such as those just discussed.
        Similar to our efforts to target and define the impacts of each pay
    with our active personnel, we must continue to ensure we support those
    who have already served, but again, we must do so in an equitable
    manner and one that is consistent with the overall demands of the
    Department. As an example, the Department continues to oppose efforts
    to eliminate the offset between the Survivor Benefit Plan (SBP) and
    Dependency Indemnity Compensation (DIC) programs. Allowing concurrent
    receipt of SBP and DIC without offset would create an inequity with one
    select group receiving two survivor annuities, while survivors of most
    military retirees and survivors of veterans who died of service
    connected cause, but were not retired, would receive only one or the
    other. At the same time, in seeking that broader equity and Department-
    wide impact, we see a win-win opportunity in expanding the concurrent
    receipt program to include military disability retirees with less than
    20 years of service regardless of disability rating. This expansion
    would cover our most challenged retirees by allowing them to receive
    retired pay for their years of service performed and VA disability
    compensation for their future reduced earning capability.
        Overall, the state of military compensation is healthy. We have
    improved our overall entitlements to the point that all of our
    personnel are paid at or above the 70th percentile of their civilian
    counterparts. We have eliminated out-of-pocket expenses for housing to
    fully cover, on average, the costs of comparable civilian housing.. We
    have gained a new and dynamic set of authorities which we are in the
    midst of implementing. For the first time, we truly have the ability to
    target pay with pinpoint accuracy to achieve desired aims and maximize
    effects of dollars spent. Our challenge today is to maintain this
    position without imposing greater long term bills, while using our
    targetable tools to shape and manage our force.
    Legislative Fellowship Program:
        The Legislative fellowship program is a unique and excellent
    opportunity for members with great potential to serve to learn the day-
    to-day functions of the Legislative Branch of Government and is a
    valuable experience in the professional development of career military
    members or civilian employees in the Department. The Services and
    Components assign their Legislative Fellows to appropriate follow-on
    tours, which the Department monitors for each Fellowship cycle. Typical
    of the follow-on assignments are positions in: the House and Senate
    Liaison Divisions of the Services; the Office of the Secretary of
    Defense (Legislative Affairs); the Combatant Command Headquarters with
    duties associated with interacting with Congress; Service primary
    staffs responsible for legislation development and interaction with
    Congress; and the Staffs of senior leaders. The Secretary of Defense
    established the maximum number of Legislative Fellows at 100. The 100
    Legislative Fellowships are broken out in calendar year 2011 as
    follows:

        Legislative Fellows serve no more than 12 months in the House or
    Senate. The Legislative Fellowship Program is the only program that
    authorizes Department of Defense personnel to work in Congress on a
    more than temporary basis and the program and policies are clearly
    promulgated in a DOD Instruction. Legislative Fellows are selected
    under Service competitive selection process and approved by the OUSD
    (P&R).
                               reserve component
        Achieving the defense strategy articulated in the Quadrennial
    Defense Review (QDR) requires a vibrant National Guard and Reserve
    seamlessly integrated into the Total Force. National Guard and Reserve
    units and individual members are heavily utilized across the full
    spectrum of current military operations, ranging from combat missions
    in support of the global war on terror to homeland emergencies. The
    Guard and Reserve have demonstrated their readiness and ability to make
    sustained contributions, and to prevail in today's wars, the Reserve
    components must serve in an operational capacity--available, trained,
    and equipped for predictable routine deployment--as well as a strategic
    capacity. Preventing and deterring conflict will likely necessitate the
    continued use of some elements of the Reserve Component (RC) in an
    operational capacity well into the future, especially in high-demand
    skill sets. Accordingly, the Department will use the Guard and Reserve
    where needed as an operational Reserve, rather than the ``force of last
    resort,'' to fulfill requirements for which they are well suited in the
    United States and overseas. Today's Citizen Warriors have made a
    conscious decision to serve, with full knowledge that their decision
    means periodic recalls to active duty under arduous and hazardous
    conditions.
        Consistently averaging about 140,000 National Guard and Reserve
    members mobilized to support ongoing operations on a daily basis, the
    Reserve components continue to make significant contributions to the
    national defense. The fiscal year 2011 budget provides about $50
    billion for pay, training, equipping, and facilities to support the
    Reserve components of the Army, Navy, and Air Force in their respective
    Reserve components as operational Reserve Forces. The budget includes
    an across-the-board pay raise of 1.4 percent, along with pay and
    allowances for over 1 million personnel. Operating funds support
    necessary training requirements to ensure deploying personnel are fully
    mission-ready.
        The fiscal year 2011 budget request supports the Department's Ready
    Reserve totaling about 1.1 million members contributing about 43
    percent of the total military end strength at a cost of about 9 percent
    of the total base budget. The Ready Reserve consists of the Selected
    Reserve (about 838,300), the Individual Ready Reserve (IRR) about
    (250,000), and the Inactive National Guard (ING) (about 2,000). This
    budget request includes about $53.3 billion to fund pay and allowances
    and costs of Reserve component training, incentives, equipment
    operation and maintenance costs, and readiness training costs for
    eligible military personnel. This amount includes $5.5 billion for
    Reserve component equipment procurement, which is funded by the
    military departments as a subset of their Active component procurement
    budget.
        Managed as strategic and operational forces, the total Reserve
    component structure operates across the continuum of military missions
    performing both strategic and operational roles in peacetime, wartime,
    contingency, domestic emergencies and homeland defense operations. As
    such, the Services organize, resource, equip, train, and utilize their
    Guard and Reserve components to support mission requirements to the
    same standards as their Active components. The budget supports
    preparation of both units and individuals to participate in missions,
    across the full spectrum of military operations, in a cyclic or
    periodic manner that provides predictability for the combatant
    commands, the Services, servicemembers, their families, and civilian
    employers, while potentially increasing the Department's overall
    capacity and reducing costs.
        To help reduce Active component ``dwell to deployment'' ratio, all
    Reserve components are moving towards a more rotational process,
    characterized by a period of active service thereby relieving active
    force burden, and then followed by an extended period at home. The
    current mobilization policy issued in January 2007 by the Secretary of
    Defense mandated involuntary mobilizations be limited to no more than
    12 months, which does not include individual skill training days
    required for mobilization or deployment or terminal leave. The
    Secretary of Defense also set a goal of not more than 1 year mobilized
    in any 6 year period for the Reserve components. The Services are
    moving toward this goal as quickly as possible given current
    operational requirements. Unlike before, when the RCs were usually
    funded at less than full readiness because they were not first to
    fight, specific units now must be fully resourced in any given year.
    This new train-mobilize-deploy construct means that the RCs must be
    ready, manned, trained, medically and dentally prepared, and equipped
    when their scheduled availability comes up, and they must be funded
    accordingly.
    Resourcing Operational Reserve Forces
        Managing the Reserve components as operational forces affects
    training schedules and funding requirements, including medical
    readiness. In the past, normal training profiles meant training about 2
    days per month plus 14 to 15 days of active duty for training annually,
    during which time Reserve component personnel were required to train to
    the same standards as their Active counterparts. While that training
    profile remains for some units, current Department policy states that
    for those with planned deployments, training days prior to mobilization
    must increase. This training profile, with more training pre-deployment
    and less post-deployment, minimizes mobilized time away from families
    and civilian jobs and will require a different resourcing approach. In
    general, the land based (Army and Marine Corps) Reserve components
    train according to this new profile, meaning that funds which had been
    consumed after mobilization from the active accounts are now required
    and expended prior to mobilization from the Reserve accounts. This
    change in training profiles means a simple comparison to prior year
    execution funding models can be misleading. For fiscal year 2011,
    Congress has authorized Reserve component military personnel budgets to
    be consolidated into a single budget activity, allowing much improved
    management of Reserve component assets and more agile fund allocation.
    This flexibility is especially crucial for managing funds for the new
    operational Reserve, and the Department greatly appreciates this
    Congressional approval.
    Equipping and Basing Operational Reserve Forces
        The fiscal year 2011 budget requests $5.5 billion for Reserve
    component equipment, and provides greater transparency and more robust
    funding for vital equipment needs as the Department continues to ensure
    that deployed and next-to-deploy units, whether in the active or
    Reserve component, receive the highest equipping priority. Effective
    and realistic readiness training at home requires that the National
    Guard and Reserve have access to equipment compatible with the active
    components and used in the assigned operational environment.
    Modernization, mission transformation, equipment replacement due to the
    war losses, and homeland defense are all catalysts for a new approach
    to equip the Reserve components.
        In the past, the Reserve components often relied on cascaded or
    ``hand-me-down'' equipment from the Active components and they often
    were short in their equipment inventories. The fiscal year 2011 budget
    contains funds needed for Reserve component equipment procurement to
    continue that transition, repair and replace war-damaged equipment, and
    to correct longstanding deficiencies. The budget request includes funds
    for equipment that will not only improve combat readiness but will also
    allow the National Guard to further improve its ability to respond to
    local domestic emergencies.
        Additionally, the Guard and Reserves previously have been a low
    priority for receiving new equipment. But today that standard has
    changed and these Forces receive the same equipment as their Active
    counterparts. We have achieved major progress in programming funds and
    equipping our Reserve components for an operational role. With this
    operational role comes the requirement for equipment transparency in
    form of increased visibility and accountability for the National Guard
    and Reserve in the programming and budgeting process.
    Institutionalizing this process will ensure an adequate mission
    capability for foreign and domestics responses and we are proceeding in
    that direction.
        The Reserve components request $1.4 billion for military
    construction (MILCON) projects. These projects will meet both current
    and new mission requirements for RC operations, readiness, and training
    facilities.
                             readiness and training
    Deployment and Dwell
        Multiple deployments to Iraq and Afghanistan have certainly
    increased the stress on our servicemembers and their families. We have
    a number of initiatives underway to address this stress, and have set
    clear limits and goals for deployment lengths and the amount of time or
    ``dwell'' between deployments.
        To that end, we have limited unit deployments to 1 year in theater,
    with a minimum of 1 year between deployments for our Active component.
    Our goal is to increase the time between deployments to 2 years for
    every year deployed, commonly called a 1:2 ``dwell'' ratio. For the
    Reserve component, we have limited the mobilization period to 1 year,
    and strive to have a minimum 3 year break between mobilizations. The
    goal for Reserve component dwell ratio is 1 year mobilized with a 5
    year break between mobilizations, or a 1:5 dwell ratio.
        Dwell time is driven by the number of forces deployed for missions
    around the world against the supply of available forces. We have
    increased the supply of forces by increasing the end strength for the
    Army, the Marine Corps, and Special Operations Forces. We also expect
    to make progress toward meeting the dwell goals as we drawdown forces
    in Iraq.
    Defense Mishap Reduction Initiative.
        As Chair of the Defense Safety Oversight Council (DSOC), I have
    been chartered to ensure that the Department is making steady progress
    toward the Secretary's goal of a 75 percent reduction in all accidents.
    The Department has made considerable progress to date due to the
    tremendous effort of our military and civilian leaders. From our 2002
    baseline, we have reduced our civilian lost workday rate 41 percent,
    are down 31 percent in our private motor vehicle fatality rate, and
    dropped our Class A aviation accident rate 56 percent.
        The DSOC is supporting the Military Departments' pursuit of the
    Occupational Safety and Health Administration's (OSHA) Voluntary
    Protection Program (VPP) at more than 200 DOD installations and sites.
    We have 30 sites that have already attained OSHA's Star recognition and
    we expect 17 more sites by the end of 2010. Their OSHA Star status
    designates them as exemplary worksites with comprehensive, successful
    safety and health management systems, and improved labor/management
    relations.
        We recently completed a comprehensive, data driven assessment to
    further prevent aircraft crashes, save military lives, and reduce the
    need for replacement aircraft. The task force, consisting of a variety
    of experts from across the Department, recommended that the military
    aviation communities acquire technologies for collision awareness,
    crash survivability, and risk management. As a result of this important
    work, the military departments are making further investments in
    hardware and software that will avert aircraft crashes. With your
    continued support, we can make further progress in preventing injuries,
    fatalities, and aircraft crashes; and be well on our way towards
    attaining the Secretary's accident reduction goal.
                             military health system
    Health Budgets and Financial Policy
        The fiscal year 2011 budget reflects several areas of continued
    emphasis, including the modernization of our medical infrastructure and
    full funding and support of our Wounded, Ill and Injured programs. The
    Unified Medical Budget, the Department's total request for health care
    in fiscal year 2011, is $50.7 billion. This includes the Defense Health
    Program, Military Personnel, Military Construction, and Medicare-
    Eligible Retiree Healthcare. Major increases in the budget request
    include $0.8 billion for medical and general inflation; $1.2 billion
    for private sector care costs due to an increase in users of TRICARE
    and an increase in utilization of the TRICARE benefit; $0.6 billion for
    enhancements for the Direct Care system; and $0.3 billion for
    modernizing the Department's electronic health record to enable data
    compatibility for the Virtual Lifetime Electronic Record, and
    correcting critical system problems, increasing user satisfaction, and
    improving system reliability and availability.
        Our primary and enduring responsibility is to provide the highest
    quality care to our beneficiaries, using the most current medical
    evidence to drive our clinical decisionmaking; and one of our
    fundamental tenets is that quality of care is also cost-effective. In
    addition, there are a number of actions we have undertaken and will
    continue in fiscal year 2011 to continue to provide value to the
    Department and the taxpayer. The ways we are addressing cost
    effectiveness in fiscal year 2011 include:

             continued implementation of Federal Ceiling Pricing of
            retail pharmaceuticals ($842 million savings);
             continued implementation of the Outpatient Prospective
            Payment System, which reduces the reimbursement paid for
            outpatient care at inpatient private sector care facilities
            ($366 million savings)
             standardization of medical supply chain management
            across the full range of military health care operations ($27
            million savings);
             increasing efforts to identify and detect fraud,
            waste, abuse, and overpayments to civilian medical providers
            ($68 million savings); and
             additional VA and DOD facilities sharing--most notably
            the first fully integrated Joint DOD/DVA healthcare
            collaboration consisting of the North Chicago Veterans Affairs
            Medical Center and the Navy Ambulatory Care Center, Great
            Lakes, IL.
    Health Affairs/TRICARE Management Activity Strategic Direction
        In 2002, the assistant Secretary of Defense for Health Affairs
    (ASD/HA) aligned policy and program execution strategies under Health
    Affairs/TRICARE Management Activity (HA/TMA). In HA/TMA, as in most
    organizations, the bridge from strategy to execution was challenging,
    and the organizational alignment, still in effect today, was intended
    to streamline processes for faster and more effective execution of
    policies and programs. Under this arrangement, HA is setting clear
    strategic direction for the Military Health System (MHS) in partnership
    with the Services.
        For the past 12 months, HA/TMA has worked closely with the Service
    Surgeons General on initiatives that have coalesced around a strategic
    initiative known as the ``Quadruple Aim.'' Borrowing liberally (and
    with permission) from the nonprofit Institute for Healthcare
    Improvement's (IHI) ``Triple Aim,'' the Department is focusing on four
    strategic imperatives:

             Readiness - Ensuring that the total military force is
            medically ready to deploy and that the medical force is ready
            to deliver health care anytime, anywhere in support of the full
            range of military operations, including humanitarian missions.
             Population Health - Improving the health of a
            population by encouraging healthy behaviors and reducing the
            likelihood of illness through focused prevention and the
            development of increased resilience.
             Experience of Care - Providing a care experience that
            is patient and family centered, compassionate, convenient,
            equitable, safe, and always of the highest quality.
             Responsibly managing the total health care costs -
            Creating value by focusing on measuring and enhancing quality
            healthcare; eliminating inefficiencies; reducing unwarranted
            variation; and emphasizing investments in health that reduce
            the burden and associated cost of preventable disease in the
            long term.

        There are many important initiatives that will emerge from this
    strategic direction. One of the most vital, because it will have
    effects across all four components of the Quadruple Aim, is the
    ``medical home'' concept being piloted by all three Services. This
    approach takes the existing construct of a primary care manager and
    enhances it through improved access to care. Features will include 24/7
    access to a provider through multiple avenues--that will include
    leveraging technology to avoid unnecessary visits or emergency room
    visits. More importantly, it will enhance continuity of care and
    greatly improve satisfaction with service. The early results from pilot
    sites are very encouraging, and we are applying lessons learned from
    these sites to improve the program as we proliferate it across the
    Department.
        With the shared vision of the Quadruple Aim and a revised decision-
    making process, the MHS is laying the groundwork for a smooth
    transition under the BRAC-directed co-located medical headquarters in
    the National Capital Area (affecting HA/TMA and the Services' Surgeons
    General staffs). The co-location initiative offers significant
    opportunities to achieve even greater unity of effort.
    Mental Health Professionals
        Significant effort has been made to recruit additional mental
    health personnel in order to meet the growing demand for behavioral
    health services in the Department. Since 2007, the number of active-
    duty mental health providers has remained relatively constant, yet we
    expect the Consolidation of Special Pay language (10 U.S.C. Sec. 335)
    recently implemented will have a significant effect on retention of
    psychologists and social workers.
        Our work to recruit civilian mental health providers has been very
    effective. Table 3 shows the Services total mental health needs/
    requirements as compared to the number of providers on-hand as of the
    third quarter of fiscal year 2009. The Navy and the Air Force compare
    assigned personnel versus requirements. The Army's growing needs are
    not completely reflected by official requirement documents yet, and
    thus they are identified as ``needs.'' Table 4 shows the significant
    improvements in total Mental Health personnel that have been made since
    2007, including in the TRICARE Network.

    Suicide Prevention
        The Department's civilian and military leadership remain focused on
    employing numerous strategies to reduce the incidence of suicide in the
    Armed Forces. In calendar year 2009, there were a total of 312
    suicides--285 in regular components and 26 in Reserve Components--
    marking an increase from 268 in calendar year 2008. Suicides within the
    Regular Components increased from 235 in calendar year 2008 to 285 in
    calendar year 2009. Demographic risk factors are: male, Caucasian, E-1
    to E-2, younger than 25 years old, GED/less than high school education,
    divorced, and in the Active Duty component. Other factors associated
    with suicide, which are consistent with data from the civilian
    population, are: substance abuse, relationship problems, legal,
    administrative (article 15), and financial problems. Although the
    impact of role of deployment on suicide risk is still under
    investigation, a majority of suicides do not occur in the theaters of
    operation.

        When a servicemember has a problem, he or she can, in most cases,
    receive confidential help from military and other mental health
    providers. However, if the individual is unable to perform his/her
    duties, is homicidal or suicidal, or is in a sensitive duty, the
    commander will be notified for safety reasons. Resources available to
    servicemembers and their families include: confidential problemsolving
    counseling through Military OneSource, online information and tools at
    militarymentalhealth.org and afterdeployment.org, confidential pastoral
    counseling with chaplains, Military Family Life Consultants (active
    duty and families), military mental health providers, Service-level
    counseling centers, and access to information and referral to mental
    health professionals through the Defense Centers of Excellence for
    Psychological Health and Traumatic Brain Injury (DCoE) Outreach Center.
        The Department and Services recognize suicide prevention begins
    long before an individual exhibits suicidal ideation. Comprehensive
    programs focus on enhancing resilience and early identification
    designed to reduce psychological health issues or disorders that may
    contribute to suicide risk. Leadership at every level receives training
    on warning signs, resources, healthy lifestyle choices, and actions to
    take if an intervention is deemed necessary. The Suicide Prevention and
    Risk Reduction Committee (SPARRC) is a forum for developing/expanding
    partnerships among the Services, VA, Federal and civilian partners. The
    SPARRC's goal is to improve policies, programs and systems across the
    Department while providing support for medical, line, and community
    leaders. Chaired by DCoE, the SPARRC includes representatives from all
    Services, VA, SAMHSA, Center for Disease Control, Medical Examiners,
    Chaplains, Telehealth/Technology and National Guard/Reserves.
        The Department also collaborates with VA and the Substance Abuse
    and Mental Health Services Administration (SAMHSA) on suicide
    prevention efforts. This includes an annual joint DOD/VA conference on
    reducing the rate of suicides in the Active Duty components, Reserve
    components, and veteran populations. The January 2010 DOD/VA Suicide
    Prevention Conference, ``Building Strong and Resilient Communities,''
    brought together over 900 servicemembers, family members, and mental
    health professionals throughout DOD, VA, and other Federal agencies.
    The conference highlighted practical tools, personal stories, and
    ongoing efforts in supporting the community.
        The Department's mental health initiatives dovetail with both the
    Readiness and Population Health components of the Quadruple Aim. We
    have developed metrics that we closely monitor to determine if our
    programs are effective and if our policies are being effectively
    implemented. We are also broadening our view of readiness, to include
    perspective on the ``readiness'' of an entire family for a
    servicemember's deployment. In 2010, we will expand our measures to
    include this more expansive view of readiness--and consequently, better
    manage pre-deployment, deployment, and post-deployment activities for
    the Total Force.
        We recognize the number of suicides continues to increase and
    suicide has a multitude of causes, and no simple solution. There are
    many potential areas for intervention, and it is difficult to pinpoint
    the best approach because each suicide is unique. Recognizing this, DOD
    is tackling the challenge using a multi-pronged strategy involving
    comprehensive prevention education, research, and outreach. We believe
    in fostering a holistic approach to treatment, leveraging primary care
    for early recognition and intervention, and when needed, providing
    innovative specialty care. The areas of focus to reduce risk include:
    (1) conducting data collection and analysis to detect contributing risk
    factors; (2) facilitating partnerships across DOD, Federal, and
    civilian organizations to increase collaboration and communication; (3)
    reducing stigma and increasing access to resources to provide needed
    care; and (4) using research to close gaps and identify best practices.
    Health Informatics
        The DOD's Electronic Health Record (EHR) continues to be a key
    enabler of military medical readiness; giving healthcare providers
    secure, 24/7, worldwide access to medical records of our highly mobile
    patient population. Across the enterprise, the EHR supports uniform,
    high-quality health promotion and healthcare to more than 9.5 million
    MHS beneficiaries. Using the EHR, our healthcare providers access the
    electronic medical records of MHS beneficiaries from any point of care
    throughout the direct care system.
        The MHS Information Management/Information Technology Strategic
    Plan for 2010--2015 provides the roadmap for improving the EHR, and
    lists EHR improvement as a top IM/IT priority. Using this roadmap, MHS
    will effectively execute its action plan to stabilize the current
    system while transitioning to a suite of EHR applications and
    supporting infrastructure that will improve reliability, speed, user
    interface and data integrity, and achieve higher satisfaction from all
    users. These improvements will enhance IT interoperability within the
    MHS and support planned improvements in electronic health data sharing
    with VA and our private sector care partners.
        For future years, ICIB will prioritize additional health related
    sharing capabilities or usability enhancements to continue the
    advancement of DOD/VA interoperability in a manner that supports
    clinicians in healthcare delivery. The Departments will continue to
    work together to improve and expand upon the interoperability of
    appropriate healthcare data as appropriate and necessary.
    Virtual Lifetime Electronic Record (VLER)
        On April 9, 2009, President Obama announced that DOD and VA would
    work together to create of a ``virtual lifetime electronic record''
    (VLER) for servicemembers and veterans. While the Department and VA
    already share an unprecedented amount of health care information
    between the two systems, a very large portion of health care to our
    beneficiaries comes from private sector contract providers. The DOD,
    VA, and the Department of Health and Human Services are working
    together to promote access of electronic health care information for
    care provided in DOD, VA, and private sector facilities while DOD and
    VA continue to leverage work already done to improve our capabilities
    for sharing information.
        VLER will rely on the Nationwide Health Information Network (NHIN)
    as the mechanism to share standards-based health data between DOD, VA,
    and private sector partners. Well-defined standards are the essential
    foundation for interoperability among systems. These standards will be
    guided by the Department of Health and Human Services (HHS) and will be
    consistent with the NHIN model based on the Federal Health
    Architecture.
        DOD and VA have been active participants and among the leaders in
    the development of the NHIN working with the HHS Office of the National
    Coordinator for Health Information Technology. The NHIN will tie
    together health information exchanges, integrated delivery networks,
    pharmacies, government health facilities and payers, diagnostic
    laboratories, providers, private payers, and other stakeholders into a
    ``network of networks.'' The NHIN provides a national standards-based
    mechanism for previously unconnected electronic health records and
    other sources of healthcare information to share information securely
    while respecting and enforcing mandates for guarding patient privacy.
        Working together with HHS and private health care providers, DOD
    and VA are creating a capability that will take a huge step towards
    modernizing the way health care is delivered and services are
    administered for our Nation. VLER will allow health care providers
    access to servicemembers' and veterans' military medical records,
    providing the information needed to deliver high-quality care. VLER
    will do all of this with the strictest and most rigorous standards of
    privacy and security, so that our servicemembers and veterans can have
    confidence that their medical records can only be shared at their
    direction.
        VLER is not a large acquisition program nor will VLER result in one
    single DOD/VA Information Technology (IT) system. Rather, VLER builds
    on the electronic health care systems already in place in DOD, VA and
    the private sector. Even if DOD and VA were to embark on a huge
    acquisition program to implement a single system, they would still not
    be able to access the critical information captured by the private
    sector. The VLER solution is viable for the entire health care
    community and enables each individual entity to develop and maintain
    their own internal systems. It creates an opportunity for competition
    since it uses well-documented standards that can be implemented through
    a variety of electronic health initiatives that can be linked to the
    NHIN.
                military family support and wounded warrior care
        This past year, due to the high level interest in supporting
    military families, resources were increased to institutionalize
    servicemember and family support programs across the Department. A 41
    percent increase in the Defense-wide family assistance baseline funding
    in fiscal year 2011 from fiscal year 2010 will provide lifelines of
    support for servicemembers and their families through outreach to Guard
    and Reserve members and families, Military OneSource 24/7 accessible
    family support assistance, referrals for counseling, financial
    education and training, and access to education, training certification
    opportunities leading to a portable career for spouses.
        To ensure we are on-target in investing in programs needed by
    servicemembers and their families, we initiated an extensive strategic
    planning process to address the current issues facing family readiness
    programs, beginning with a thorough assessment of existing needs,
    programs, and related issues. A variety of methods were used to gain
    input from key players across the system, including family members,
    support professionals, non-governmental organizations, land-grant
    universities, and senior DOD leadership.
    Child Care
        Access to child care remains a top priority for the Department.
    Efforts are ongoing to meet the needs of our deployed families,
    including National Guard and Reserve families. We have expanded respite
    child care options through the YMCA program, offering opportunities for
    geographically isolated families to help mitigate the stress
    experienced by the parent at home. These efforts augment the respite
    child care provided by the Military Services.
        We continue to reduce the unmet need for child care, yet are
    cognizant of the ongoing need to recapitalize our aging child and youth
    facilities. We need to eliminate barriers to hiring practices key to
    expanding our partnerships with community child care providers. The
    temporary program to use minor military construction authority for the
    construction of child development centers provided a means to increase
    the availability of quality, affordable child care for servicemembers
    and their families. This authority expired at the end of fiscal year
    2009, and we have proposed legislation to reinstate the authority. The
    legislation would also expand age limit requirements from 5 years old
    to 12 years old to include children in school age care programs,
    broaden the authority to include other family support initiatives
    (e.g., family center, fitness facilities, etc.), and increase the
    funding authority to $15 million for all projects.
    Youth Programs
        We are also deeply committed to addressing the needs of our
    military youth. More than 350 dynamic, innovative and successful youth
    programs serve more than 500,000 military connected children and youth
    between the age of 6-18 worldwide. Programs promote positive youth
    development and prepare pre-teens and teenagers to meet the challenges
    of military life, adolescence, and adulthood. Partnerships with other
    youth-serving organizations enable the Department to offer resources in
    a variety of domains, including physical fitness and sports; arts and
    recreation; training in leadership; life skills; career/volunteer
    opportunities; mentoring; intervention; and support services.
    Programming supports character and leadership development, sound
    education choices, healthy life skills, the arts, and sports and
    recreation. Many programs offer summer day camp and youth employment
    opportunities. Twenty-two youth facilities were funded in 2008 and
    2009, totaling $145.6 million in non-appropriated funds; this support
    constitutes a critical aspect of family support. Six youth facilities
    are funded for fiscal year 2010 and fiscal year 2011, totaling $49.7
    million.
    Family Advocacy Programs
        The DOD Family Advocacy Program (FAP) plays a key role in
    addressing familial physical, sexual, and emotional abuse and neglect
    involving military personnel in the active component as victims and
    abusers. On each military installation with command-sponsored families,
    there is a FAP that provides services in prevention, identification,
    intervention and treatment of child abuse and neglect and domestic
    abuse. Two key programs, the New Parent Support Program and treatment
    programs for substantiated spouse abusers have been tied to outcomes
    for prevention.
    Casualty and Mortuary Affairs Programs
        The Department remains committed to providing the highest quality
    of compassionate and caring assistance to families of fallen
    servicemembers for as long as they determine assistance is needed.
    After which, additional assistance can be obtained by a simple phone
    call or letter written to the appropriate Service Casualty Office.
    Since early 2006, the Department has worked extensively with the
    Military Services; the Department of Veterans Affairs; the Social
    Security Administration; family support organizations; nonprofits
    groups, and more importantly, survivors, to ensure our policies and
    procedures are standardized to the maximum extent possible, more
    customer focused, and flexible enough to address unique situations.
        While the Department has made many enhancements to the Casualty
    Assistance Program, we recognize there is always room for improvement
    and therefore we strive every day to make it better, simpler, more
    respectful, and more compassionate. As the Secretary stated, ``When
    young Americans step forward of their own free will to serve, they do
    so with the expectation that they and their families will be properly
    taken care of should anything happen to them.'' We listen to those we
    serve and to those organizations who have dedicated their existence to
    providing valuable support and services to survivors of the fallen.
    Together, our collaborative efforts will ensure our program will
    continue to be enhanced and our families provided the very best
    assistance possible.
    Military OneSource
        Military OneSource (MOS) continues to have a positive impact on
    servicemembers and their families. OneSource offers a 24-hour/365-day
    centralized assistance program to provide diverse information and
    referral services by credentialed counselors to Active Duty, Guard,
    Reserves and their family members, regardless of physical location or
    activation status. Assistance can be provided in many languages. Since
    inception, Military OneSource has experienced exponential expansion.
    Over 739,000 telephone calls were received in fiscal year 2009, more
    than doubling the number of calls received in fiscal year 2008. The
    website received over 4 million visits, almost doubling the number of
    visits received during the prior year. Nearly one in three
    servicemembers uses Military OneSource.
        In general, the most common reasons for which a person sought MOS
    counseling were marital and intimate relationships, stress management,
    family relationships, and anger management. In addition, MOS financial
    counseling support is offered in-person and telephonically. In fiscal
    year 2009, MOS conducted 4,501 financial counseling sessions. The most
    common reasons for which a person sought financial counseling support
    from MOS were budgeting and money management, overextension with bills,
    credit management, loans and consolidating loans, and mortgages and
    refinancing. In fiscal year 2009, OneSource assisted members and
    families with almost 600,000 tax filings at no cost to the family.
        The Wounded Warrior Resource Center (WWRC), accessed via Military
    OneSource, provides immediate assistance to the wounded and their
    families with issues related to health care, facilities, or benefits.
    The WWRC works collaboratively with the Military Services' wounded
    warrior programs and the Department of Veterans Affairs to ensure
    callers are promptly connected to the resources that can help address
    their needs. In fiscal year 2009, 1,200 cases for wounded warriors were
    handled.
    Dependents' Education Programs
        A key quality of life issue is the education of military children.
    Servicemembers often make decisions about assignments based on the
    availability of quality educational opportunities for their children.
    The Department of Defense Education Activity (DODEA) provides quality
    pre-kindergarten through 12th grade educational opportunities and
    services to eligible military dependents around the globe where DODEA
    schools are located. Of the approximately 1.2 million military
    dependent children, DODEA educates nearly 85,000 in 192 schools in 12
    foreign countries, 7 States, Guam, and Puerto Rico with 8,700
    educators. DODEA also assists eligible military dependent students
    through a tuition reimbursement program for military assigned to
    overseas locations without a DODEA school.
        The ongoing relocation of military dependent students through force
    structure changes created a need to enrich and expand partnerships with
    military-connected communities to ensure the best possible educational
    opportunities for military dependent children. Through its Educational
    Partnership Initiative, DODEA was given expanded authority to assist
    local education agencies (LEA's) who educate military dependent
    students through efforts focused on highest student achievement. DODEA
    works collaboratively with the Department of Education to ease the
    transition of military students by sharing experience and expertise
    with LEAs who educate larger populations of military dependent
    students.
        Data from the Department of Education reports that there are 300
    LEAs with a military child enrollment of 5 percent or more. Of the 300
    LEAs with 5 percent military child enrollment, 153 of the LEAs are not
    meeting the State academic standards in reading/language arts and/or
    math using annual tests aligned to academic indicators. In addition,
    there is significant research surrounding the psychosocial effects of
    multiple deployments on school performance and student behavior. In
    fiscal year 2009, DODEA extended support through grants focusing on
    enhancing student learning opportunities to 44 school districts serving
    approximately 77,000 military children in over 284 schools.
        Through new technologies, DODEA is developing additional academic
    opportunities for its students. The focused efforts are to expand
    access to education and provide curricular options to eligible students
    within DODEA through the expanded use of distance learning. DODEA plans
    to transition its distance learning program into a virtual school
    program beginning with the implementation of fully accredited virtual
    high school in School Year in 2010-2011. These tools include real-time
    audio and video, document sharing, screen sharing and web collaboration
    to stimulate active teacher-student, student-student and student-
    content interaction. A ``virtual hub'' model has been put into place
    that puts the teachers in locations closer to the students to
    facilitate interaction that simulate traditional classroom discussion
    and one-on-one tutoring.
        Beginning in 2008, DODEA implemented a new process for advising
    decision-making that focuses on highest student achievement and a
    thorough review of data, implementation, and effectiveness of programs.
    Part of the advisory process includes educator-led task groups which
    review and analyze data. DODEA task groups are convened for various
    reasons such as instructional and curricular topics, issues of interest
    from the field, or management needs. All task groups spend considerable
    time reviewing and analyzing information and data on a specific issue
    and then, through consensus, developing systemic recommendations sent
    to the Director to guide future educational actions. Currently, DODEA
    has seven on-going task groups.
    Korea Tour Normalization
        United States Forces Korea (USFK), through the Tour Normalization
    Program, is aggressively increasing command-sponsored military families
    on the Korean peninsula for the primary purpose of establishing a
    higher quality of life for military families. In addition to the
    housing needs, this impacts educational needs. DODEA anticipates adding
    25 schools in Korea over the next 10 years, providing an end state
    program by 2020 of 31 DODEA schools in Korea. Student growth is
    expected to grow from 4,422 DODEA students currently in the Republic of
    Korea to 21,758 at the end state. This is approximately a 500 percent
    increase in the student population. DODEA is actively working
    programmatic details with USFK and local Military Service communities
    to support this effort.
    MWR Support to Troops in Combat
        The ability to communicate with family and friends is the number
    one factor in being able to cope with longer and more frequent
    deployments. We continue to balance the most effective use of available
    bandwidth between mission and personal requirements, including wireless
    access. Currently, servicemembers have free access to the non-secure
    military Internet by using their military e-mail address, including
    aboard ships. They also have free Internet access at over 1,008 MWR
    Internet Cafes in Iraq and Afghanistan with 9,241 computers and 4,101
    Voice Over IP phones (with call rates of less than 4 cents a minute).
    Another 197 cafes, 2,191 computers and 1,154 phones have been funded
    for fiscal year 2010 for use in Afghanistan. To enhance MWR provided
    services, the Exchanges provide personal information services for a
    usage fee for this customer convenience. Back home, computers and
    Internet service located in our family support centers, recreation
    centers, libraries, and youth centers help ensure families can connect.
    DOD-State Initiatives
        The Department continues to work with State governments to educate
    their policymakers on the life-challenges faced by servicemembers and
    their families and to ensure that state-level policies do not
    disadvantage military families' transient life style. States have
    addressed several key quality of life issues, to include the impact of
    frequent school transitions experienced by military children, the loss
    income by military spouses as a result of military moves, and the
    enforcement of the congressionally-mandated DOD predatory lending
    regulation. The response from states has affirmed their commitment to
    supporting the well-being of the Nation's fighting force. For example,
    27 States have joined the Interstate Compact on Educational Opportunity
    for Military Children, 36 States now provide eligibility for
    unemployment compensation to military spouses, and 30 States enforce
    the DOD predatory lending regulation. The Department is continuing this
    effort in the 2010 session and has added child custody to the slate of
    issues. In this regard, the Department is asking States to
    appropriately balance the interests of servicemembers who are absent
    due to military service with the best interests of the child by
    ensuring absences caused by military deployments are not the sole basis
    for permanent custody decisions and addressing delegation of visitation
    rights while the servicemember is deployed.
    Special Needs
        The establishment of the Office of Community Support for Military
    Families with Special Needs was mandated by NDAA 2010. The purpose of
    the Office is to enhance and support Department of Defense support for
    military families with special needs to ensure parity across the
    Services. The Office will be headed by a member of the Senior Executive
    Services. It will be staffed with personnel in the fields of medicine,
    education, early intervention, social work, personnel and information
    technology, as well as members of the armed services to ensure
    appropriate representation by the military departments. Currently,
    plans are underway to identify the specific mix of staff and to create
    an umbrella Office of Community and Family Support with an emphasis on
    special needs, which will synchronize all family support needs with
    those of families with special needs.
    Disability Evaluation System
        The Disability Evaluation System (DES) Pilot simplifies and
    restructures how servicemembers are evaluated for continued service and
    compensation as a result of a wound, injury, or illness. Based on the
    recommendations of several commissions and task forces, DOD and VA
    implemented the DES Pilot on November 26, 2007, at three National
    Capital Region (NCR) locations (Walter Reed, Bethesda, and Malcolm
    Grow). Since November 2007, this program has been administered jointly
    by the DOD and VA. The Pilot eliminates duplicate disability
    examinations and disability ratings by the Departments. The DOD
    determines fitness for duty; the VA examines and rates for disability.
    The rating is used by DOD for unfitting conditions and by VA for all
    service-connected or aggravated conditions. After March 2010, the DES
    Pilot will operate at 27 locations across the continental United States
    and Alaska and encompass 47 percent of all potential servicemembers'
    cases. Compared to the legacy system, case processing time has been
    nearly cut in half (46 percent decrease) for Active and Reserve
    component servicemembers. The Pilot will be expanded to encompass 100
    percent of the DES by December 2012. The DES Pilot Final Report which
    includes the results and recommendations for the DES Pilot-model
    worldwide implementation will be forwarded to Congress by May 31, 2010.
    Transition Initiatives
        The Department has several initiatives relating to the Department
    of Defense (DOD) Transition Assistance Program (TAP). We began this
    fiscal year by convening the first Joint Interagency Strategic Working
    Group on the Transition Assistance Program in November 2009. We are
    also working on several employment initiatives with our partners at the
    Department of Labor. As an ex-officio member of the Secretary of
    Labor's Advisory Committee on Veterans Employment, Training and
    Employer Outreach (ACVETEO), the Department is looking at more
    efficient ways to connect employers with transitioning Services
    members, veterans and their spouses. We are also looking at revamping
    the Department of Labor (DOL) TAP Employer Workshop to make it more
    dynamic and ensure it is meeting the needs of our warriors. Finally, we
    continue to collaborate with DOL on how to ensure our wounded, ill and
    injured are being prepared for and get meaningful jobs.
        In addition to our work with DOL, this office assisted with the
    Office of Personnel Management (OPM) strategic plan as well as an
    executive order signed by the President in November 2009, which
    directed all Executive Branch Federal Agencies to increase the hiring
    of veterans. We are pursuing other initiatives like our work with the
    U.S. Interagency Council on Homelessness. The Department is assisting
    the council in developing a Federal Strategic Plan on Homeless. The
    plan will address ideas and ways to end homeless for our veterans,
    families, and youth.
        One of our most exciting initiatives was joining the social network
    community with the launching of the DOD TAP Facebook. We are taking
    advantage of the popularity of social media as another communication
    resource to promote transition services and benefits to military
    personnel and their families.
        Finally, we are working to improve outreach and education to all
    servicemembers to increase their participation in the Benefits Delivery
    at Discharge and Quick Start Programs. These programs allow eligible
    servicemembers to submit their application for disability compensation
    prior to separation or retirement.
                               civilian personnel
    National Security Personnel System Transition
        The National Defense Authorization Act for Fiscal Year 2010 (NDAA
    2010) repealed the authority for the National Security Personnel System
    (NSPS) and requires the Department to transition out all employees and
    positions from NSPS to the appropriate non-NSPS personnel and pay
    system no later than January 1, 2012. The law provides no employee will
    suffer any loss of or decrease in pay upon conversion from NSPS.
        Planning for terminating NSPS is well under way with the goal of
    transitioning employees and organizations from NSPS back into their
    pre-NSPS personnel and pay system during fiscal year 2010. The rules of
    the gaining pay and personnel system will be followed in determining
    placement of NSPS employees. Since the majority of the 226,000
    employees covered by NSPS will transition to the General Schedule
    system, government-wide rules issued by the Office of Personnel
    Management (consistent with title 5, U.S.C.) are applicable. Until the
    transition takes place, organizations and employees currently covered
    by NSPS will continue to follow NSPS regulations, policies, and
    procedures. While the Department did not transition any bargaining unit
    employees into NSPS, approximately 900 employees organized after their
    organizations moved into the system. The Department plans to meet with
    representatives of national unions representing these NSPS bargaining
    unit employees to discuss transition issues and will ensure that local
    collective bargaining obligations are fully satisfied as these
    employees transition from NSPS back to the General Schedule. Transition
    timelines are being determined based on organizational readiness as
    evidenced by avoidance of undue interruption to mission and hardship to
    employees; established processes to classify NSPS positions into the
    appropriate non-NSPS personnel system; existence of an appropriate
    performance management system; and information technology capability.
    Prior to their transition out of NSPS, employees will be informed of
    their position classification under the non-NSPS personnel system. With
    limited, approved exceptions, no new appointments to NSPS will be made
    after March 1, 2010. The Department is tracking transition costs as it
    did with NSPS implementation costs. The organization that is guiding
    and directing transition planning and execution is the National
    Security Personnel System Transition Office (NSPSTO). The Director,
    NSPSTO is responsible for the development, coordination, and
    dissemination of supporting procedures, policies, and tools; and for
    developing training products and services for use by the Components in
    training employees and supervisors on all aspects of the transition. In
    addition, the Department is committed to providing open and frequent
    communications during the transition. The NSPSTO has redesigned its Web
    site to publicize up-to-date information on the transition, including
    transition toolkits that contain a variety of products such as
    conversion guides, fact sheets, brochures, articles, frequently asked
    questions, performance management guidance, timelines, and town hall
    briefings on the transition. The website and communications will be
    updated periodically as new information becomes available and new
    products are developed. In addition, the Department will deliver a
    report to Congress at the end of April 2010, as required by NDAA 2010,
    that covers the steps taken for the reclassification of NSPS positions
    and the initial plan for transitioning employees and organizations from
    NSPS; semiannual reports that cover transition progress will also be
    provided until all organizations and employees are out of NSPS.
    Civilian Strategic Human Capital Planning and Forecasting
        With over 760,000 civilian employees, in over 600 occupations,
    supporting a myriad of critical missions, it is essential the
    Department have a structured plan to ensure civilian talent is in place
    to meet current and future mission requirements. To meet this demand,
    the Department is leading an enterprise-wide effort to establish a more
    structured, standard approach to Strategic Human Capital Management
    (SHCM), based on a combined effort of competency assessment and
    workforce analysis trending. The Department recognizes the need for a
    civilian workforce with the attributes and capabilities to perform
    seamlessly in an environment of uncertainty and surprise, execute with
    a wartime sense of urgency, and create tailored solutions to multiple
    complex challenges. We are institutionalizing an updated, integrated
    human capital strategy for the development of talent, that is
    consistent with 21st century workforce demands and a new generation of
    workers, and that is competency-focused, performance-based, agile,
    responsive to mission impacts, and focused on employee engagement and
    respect.
    Civilian Expeditionary Workforce
        The Department is working to better employ the talents of our
    civilian workforce to meet expeditionary mission challenges, especially
    those not directly related to warfighting. Global security challenges
    require adequate civilian capacity to conduct complex operations,
    including those missions that require close military-civilian planning
    and cooperation in theater. Since 2001, more than 43,000 Department
    civilians have been involved in contingency operations around the
    globe. Currently, approximately 5,100 civilian employees are serving in
    theater. In response to these imperatives, the Department
    institutionalized the Civilian Expeditionary Workforce (CEW) to provide
    deployable civilian experts to support military operations,
    contingencies, emergency operations, humanitarian missions, disaster
    relief, and stabilization and reconstruction operations. The CEW is
    designed to enhance the Department's ability to work alongside and help
    build the capacity of partner defense ministries and provide surge
    support where needed. The CEW encompasses a pre-identified subset of
    the Department's emergency essential and volunteer civilian workforce
    by skill sets and capabilities, who are trained, ready, cleared, and
    equipped for rapid response and quick assimilation into new
    environments.
        Civilians deployed under the CEW receive general and theatre-
    specific, urban training, and are eligible for the same health care
    benefits as deployed military personnel, including medical evacuation
    and access to hospital services in-theatre. With the support of
    Congress, the Department has obtained important incentives and benefits
    to help compensate for the inherent risks of deployment. The Department
    continues to identify pertinent issues and propose fully integrated
    solutions to ensure force health protection, surveillance, deployment
    benefits, and medical care for civilians who have been injured,
    wounded, or have contracted diseases while deployed in support of
    contingency operations. We have worked in partnership with the Office
    of Personnel Management, the Department of State, and the Department of
    Labor to ensure all similarly-situated Federal civilians receive
    consistent and equitable benefits commensurate with the risks of
    deployment.
    Civilian Leadership Development
        The Department is currently working on the recruitment and
    development of entry-level leaders in conjunction with Section 1112 of
    the NDAA for Fiscal Year 2010, which requires the establishment of a
    DOD Civilian Leadership Program. The Department recognizes the need for
    an improved model to attract, retain, and deliberately develop civilian
    leaders to support pipeline readiness and enhance bench strength. In
    fiscal year 2010, the Department will fully develop the entry-level
    program to grow emerging leaders. We will launch an initial program
    pilot in fiscal year 2011 and expand the pilot and implementation in
    fiscal year 2012. Our communities of initial focus for this effort
    include acquisition and finance specialists to meet the Department's
    needs.
    Recruitment for Critical Positions and Competencies
        The Department has an aggressive approach for identifying mission
    critical recruitment requirements, to include health, acquisition,
    linguists and emerging mission-essentials such as IT specialists in
    cyber warfare. We have a plan in place and a robust forecasting model
    that indicates those areas where recruitment surges may be needed.
    Where such surges are indentified, we craft staffing strategies, such
    as expedited hiring authority and scholarship programs, to meet those
    needs. Our integrated approach to Strategic Human Capital Management
    (SHCM) will prove to enhance our ability to analyze demographic trends,
    forecast requirements, assess gaps, and further define recruitment and
    hiring strategies.
    Increasing Veterans Opportunities
        The Department values the experience and commitment of our
    servicemembers and places special emphasis on supporting transitioning
    servicemembers, wounded warriors, and veterans in their search for
    employment. We continue our efforts to actively reach out to our
    veterans to assist them in their civilian employment search with
    aggressive outreach programs, transition assistance programs, career
    and job fairs, and benefits counseling and assistance.
        The Department continues this tradition in support of Executive
    Order 13518, the Veterans Employment Initiative. In January 2010, the
    Department stood up the DOD Veterans Employment Program Office to
    promote veterans recruitment, training and development throughout the
    Department. We are promoting the Veterans Initiative through DOD's
    Hiring Heroes Program, through which we conduct eight to ten Hiring
    Heroes Career Fairs throughout the U.S. for wounded, ill and injured
    servicemembers, transitioning military, veterans, and their families.
    In-sourcing
        The Department is on track to reduce the level of contracted
    support service from the current 39 percent of our workforce to the
    pre-2001 level of 26 percent, and perform those services with full-time
    government employees. Over the next 5 years, DOD expects to hire up to
    33,400 new civil servants to fill positions established as a result of
    insourcing contracted services. This includes 5,000 acquisition
    personnel over fiscal year 2010/2011 and 10,000 through fiscal year
    2014. On January 4, 2010, the Department submitted to Congress a report
    on ``fiscal year 2010 Insourcing Initiative and Plans.'' DOD Components
    estimated they would establish nearly 17,000 new civilian
    authorizations in fiscal year 2010 to perform currently contracted
    work.
        There are no artificial limits placed on DOD Components'
    identification of in-sourcing candidates (i.e., contracted services
    that would more appropriately be performed by government employees).
    The Department considers insourcing as a well-reasoned part of Total
    Force management that:

             Rebalances the workforce and rebuilds organic
            capabilities.
             Ensures that inherently governmental functions that
            support the readiness/management needs of the Department are
            performed by government employees.
             Implements Congressional direction on in-sourcing
            (NDAA for Fiscal Year 2008).

        Contractors remain a vital part of the Department's Total Force.
    The Department is not ``replacing'' or ``converting'' contractors but
    rather in-sourcing contracted services--contractors remain a vital
    source of expertise to the Department and are an integral part of our
    Total Force.
                            other personnel concerns
    Foreign Language, Regional, and Cultural Capabilities
        The Department is continuing its work to ensure our commissioned
    and noncommissioned officers are prepared for a full range of varying
    and complex missions that our current and future security environment
    requires which includes building expertise in foreign languages,
    regional and cultural skills. The fiscal year 2011 budget focuses on
    sustaining gains achieved in previous years and continuing to build a
    solid infrastructure in which to meet future demands. Baseline funding
    of $793 million in fiscal year 2011 supports redirected language and
    culture instruction to achieve higher proficiencies for the Total Force
    in these skills. During the most recent programming cycle, the
    Department committed an additional $29 million in fiscal year 2011 to
    establish Language Training Detachments to provide and sustain
    commanders' needs, support the Afghanistan/Pakistan Hands program, and
    expand the role of English language training for partner nation
    personnel. The Department's continuing efforts feature the following
    significant initiatives and accomplishments.
    Military Leadership Diversity Commission
        As mandated by NDAA 2009, the Department established the Military
    Leadership Diversity Commission (MLDC) to conduct an independent review
    and comprehensive evaluation and assessment of policies that provide
    opportunities for the promotion and advancement of minority members of
    the Armed Forces, including minority members who are senior officers.
    Led by General Lester Lyles (ret.), the Commission consists of 26
    appointed members to include retired and active duty officers,
    enlisted, and civilian representation from all the Service components
    and the Coast Guard. The Commission will expand to 32 members.
        The Commission conducted its first meeting in Washington, DC in
    September 2009. Several monthly meetings are planned throughout the
    country during the independent review, culminating with a written
    report to the President and Congress no later than September 2010. The
    report shall include the Commission's findings and conclusions,
    recommendations for improving diversity within the Armed Forces, and
    other relevant information and proposals considered appropriate.
    Sexual Assault Prevention and Response
        The Department's position on sexual assault is a simple one: Sexual
    assault is a crime that is incompatible with service in the U.S. Armed
    Forces. It undermines core values, degrades military readiness,
    subverts strategic goodwill, and forever changes the lives of victims
    and their families. To address this crime, the Department has put
    numerous broad-based programs in place to achieve our vision of
    enhancing military readiness by establishing a culture free from sexual
    violence.
        The Department's goal is to prevent sexual assault through
    institutionalized prevention efforts that influence the knowledge,
    skills, and behaviors of servicemembers to stop a sexual assault before
    it occurs. We have developed a comprehensive prevention strategy built
    around the concept of bystander intervention. Throughout the
    Department--from the newest recruits to the most senior leaders--
    servicemembers are getting educated on the role they can play as
    individuals in preventing this crime.
        In conjunction with prevention, we are working to increase
    awareness so when a crime does occur, it is reported. We want any
    victims within the military to come forward, first and foremost, to get
    treatment, and if so desired, provide details of the crime so the
    perpetrator can be held accountable.
        The Department is committed to ensuring the sexual assault
    prevention and response program works as intended. This ``system
    accountability'' is achieved through data collection, analysis, and
    reporting of case outcomes. In order to improve data collection,
    analysis, and case management, the Department initiated the development
    of the Defense Sexual Assault Incident Database (DSAID). In January
    2010, a Request for Proposal was issued to identify a vendor for the
    database, with selection expected by the fall.
        The Department has participated in several external reviews in
    recent years, most recently by the Government Accountability Office
    (GAO) and the Defense Task Force on Sexual Assault in the Military
    Services (DTF-SAMS). DTF-SAMS released their report in December 2009
    and GAO released their report in February 2010. We are currently
    reviewing and responding to their recommendations.
    Child Custody
        The Department believes the States are in the best position to
    balance the competing interests within the context of their own
    domestic relations laws. Approximately 30 States have passed
    legislation that addresses the special circumstances facing military
    parents who have custody of children but who are not married to the
    other parent.
        The American Bar Association, National Military Family Association,
    and the Senate support the Department's position. Although the Senate
    has continued to reject Federal child custody legislation, it did
    include language in the NDAA for Fiscal Year 2010 that requires a
    report to Congress on military child custody issues by March 31, 2010.
    Senate Armed Services Committee staff indicate this report will form
    the basis for hearings anticipated in April 2010.
        The Department has committed to several efforts to address the
    unique challenges facing military members who have custody of a child
    but are not married to the other parent. The Department is working with
    its State liaisons to encourage those 20 States who have not addressed
    military child custody issues in their domestic relations laws to do
    so. The Department is also looking for opportunities to increase
    participation in and support of the American Bar Association's Military
    Pro Bono project, which provides free in-court representation to
    military members for domestic relations cases (and other cases).
    Finally, the Department is updating and reissuing its Family Care Plan
    instruction, which can, if used properly, significantly reduce custody
    problems without the detrimental effects of the proposed Federal law.
    Federal Voting
        The Department vigorously assists our men and women in uniform,
    their voting-age dependents and U.S. citizens residing overseas to
    successfully participate in the 2010 primary and general elections.
    Initial indications are that the Department's programs are having a
    significant impact: for the 2008 general election, the active duty
    military voter registration rate exceeded that of the general
    population's: 77 percent for the military as compared to 71 percent for
    the general population.
        Unfortunately, while more than 91 percent of absentee ballots were
    successfully returned by general electorate voters in the 2008 general
    election, only 67 percent of uniformed services and overseas voter
    absentee ballots were successfully returned. Unsuccessful return of
    ballots represents the single greatest point of failure for military
    and overseas voters, and is largely due to absentee ballots being sent
    out too close to the election, with insufficient time for the voter to
    successfully receive, vote and return the ballot by the States'
    mandated deadlines. In fact, more than 81 percent of all the voting
    failure suffered by military and overseas voters was because of ballots
    transmitted to them, but never returned.
        The Department is focusing its voting assistance programs to
    address the overwhelming point of failure by focusing on those programs
    that will expedite both the delivery and return of ballots from
    military and overseas voters. First, the Federal Voting Assistance
    Program is developing an online wizard that will allow military and
    overseas voters to receive and mark their complete Federal, State, and
    local ballot online, and then print it out for voter verification,
    signature of the voter's oath, and postal mail return of the paper
    ballot. Second, the Military Postal System is also preparing an
    expedited ballot return system which will return ballots by Express
    Mail, as well as provide the voter with an online tracking system all
    the way to delivery to the local election official. The Military Postal
    System's desired delivery time is no more than 7 days from receipt of
    the ballot from the voter to delivery to the local election official.
        The Department is also taking full advantage of the authority
    granted it under the Military and Overseas Voter Empowerment (MOVE) Act
    of 2009 to designate all military installation voting assistance
    offices as National Voter Registration Act voter registration agencies.
    This will allow the Department to also collect from and mail in for
    those voters (who desire the assistance), the FPCAs or other
    registration forms completed by those voters.
        The Department has been working closely with States to identify
    those changes in State law necessary to achieve the requirements of the
    MOVE Act, and to provide sufficient opportunity for military and
    overseas voters to successfully complete the absentee voting process.
                                   conclusion
        We face two fundamental, and related, challenges. First, we must
    continue to attract and retain high quality, motivated individuals for
    Active and Reserve military service and we must maintain an
    enthusiastic and skilled civilian workforce. Second, we must weigh
    sufficiency against the risks of an uncertain future. As we invest in
    our human capital, we must do so judiciously. While our future
    challenges may often seem without bounds, our resources are not. We
    must make hard choices, as a Department and as a Nation, of allocating
    our resources the best we can to win the war at hand while taking care
    of our most valuable asset--our men and women in uniform. I look
    forward to working with this Congress in this effort.

        Senator Webb. Thank you very much, Secretary Stanley.
        Secretary Lamont.

    STATEMENT OF HON. THOMAS R. LAMONT, ASSISTANT SECRETARY OF THE
                 ARMY FOR MANPOWER AND RESERVE AFFAIRS

        Mr. Lamont. Chairman Webb, Senator Graham, distinguished
    members of the committee, thank you for the opportunity to
    appear before you today.
        I appear before you on behalf of 1.1 million men and women
    serving here and abroad in peaceful, as well as hostile,
    environments. This combat-seasoned force is resilient and
    professional, yet strained and out of balance. More than 1
    million of this Nation's finest citizens have deployed, over
    the past 8 years, into harm's way. We realize, very well, that
    there are costs associated with this conflict, both visible and
    invisible.
        Our current programs to relieve stress on the force are
    critical to maintaining a healthy, balanced, and prepared
    force. These programs help us defend our country against some
    of the most persistent and wide-ranging threats in our Nation's
    history. The success of these programs is due, in large part,
    to the support Congress has given us since this Army went to
    war in 2001.
        First and foremost, you have enabled us, through
    appropriate resources, to meet a temporary end-strength
    increase for our agile Army. As a result, this will, in part,
    alleviate the stress and strain on the total Army. This is a
    step in the right direction to get our personnel structure back
    in balance.
        Congress has also given us the means to improve the quality
    of life for our soldiers and their families. Soldiers remain in
    the Army based on the established incentive programs, such as
    an excellent healthcare system, educational opportunities,
    financial stability with sufficient bonuses, general vacation
    time, soldier and family services, and frankly, out of a true
    sense of duty to our country. This Congress has embraced our
    needs, and for that, we are very grateful.
        The Army continues to face challenges, which we will
    encounter today and well into the future. Armed with lessons
    learned, it is our intent to stay in front of those challenges,
    anticipate them, develop strategies and programs to address
    them, and hopefully, keep them from becoming problems in the
    future.
        Specifically, one of the challenges that we are addressing
    is the concept of the Operational Reserve. The Army's Reserve
    component continues to transition from a strategic Reserve to
    an operational force. The Army will require recurrent, assured,
    and predictable access to the Reserve component to meet
    operational requirements. This transformation of the Reserve
    component into an operational force will provide an opportunity
    for the Army to provide the most cost-effective total force by
    investing resources in the most cost-efficient portion of the
    Army's total force.
        Our focus this year centers on restoring the balance,
    resilience, and sustainment of the force, growth in talent, and
    our ability to meet the Nation's needs with the highest-quality
    force available. The Army will continue to work hard to attract
    and retain the best, but we need your help in taking on this
    larger problem. The challenging environments that our soldier's
    serve in demand that we maintain the standards as set, and we
    must remain ever-vigilant that our force is manned with both
    physically and mentally qualified soldiers, as it is today.
        As you are well aware, we have some tough challenges ahead
    of us. I'm confident, however, that with the operational and
    institutional agility this Army has developed over the past 9
    years, we will meet all the challenges that will come our way.
    It is always easy to commit to a plan of action when we know
    that Congress supports us. Your leadership and your support
    have been unwavering.
        I appreciate this opportunity to come before the committee,
    both now and in the future, and I look forward to your
    questions.
        Senator Webb. Thank you very much, Secretary Lamont.
        [The prepared statement of Mr. Lamont follows:]
                  Prepared Statement by Hon. Thomas R. Lamont
                                  introduction
        Chairman Webb, Senator Graham, distinguished members of this
    subcommittee, thank you for the opportunity to appear before you on
    behalf of America's Army. Our greatest heroes are America's most
    precious resource--our soldiers. These soldiers and their families,
    backed by our civilian workforce, represent the very best of America's
    values and ideals and faithfully shoulder the load that our Nation asks
    of them. This fighting force of 1.1 million soldiers is continually
    tested at home and abroad. Repeatedly our Nation's men and women step
    forward and pledge to serve. They recognize the challenges facing our
    Nation, answer the call, and become part of something larger than
    themselves. Their dedicated service and sacrifice are deserving of the
    very best services, programs, equipment, training, benefits, lifestyle,
    and leadership available. Our focus this year centers on restoring the
    balance, resilience, and sustainment of the force, growth in talent,
    our ability to meet the national challenges, and the importance of
    maintaining this strength to meet the demands now and for the future.
    Thank you for your steadfast commitment to ensuring our soldiers, their
    families, and our civilian workforce by supporting our personnel
    initiatives to ensure growth, sustainment and well being of our All-
    Volunteer Force.
                               strategic overview
        America's Army, strained by over 8 years of persistent conflict,
    remains a resilient force. Our Army, however, is also stretched and out
    of balance while demand has continued to grow. The Army has added
    nearly 100,000 more soldiers since 2004. More than one million of our
    country's finest men and women have deployed to combat, with over 5,000
    lives sacrificed in the line of duty. The Army appreciates your recent
    support in providing the Army with temporary end strength increase of
    22,000 to provide some relief to our stressed force. We will complete
    the initial ramp of 15,000 by the end of fiscal year 2010 and will
    evaluate the need to complete the remaining amount later this year.
    Even with this temporary increase, we face many challenges ahead, but
    must remain vigilant and supportive to the needs of our people. We must
    continue to address these needs and find a way to get our Army back to
    a balanced force.
                                  end strength
        To alleviate the stress and strain on the force, the Department of
    Defense authorized the Army a Temporary End Strength Increase (TESI) of
    up to 22,000 Active Duty soldiers. Currently the plan is to use 15,000
    of the 22,000 with a decision on the remaining 7,000 expected at the
    end of the second quarter, fiscal year 2010. This temporary increase
    provides additional, primarily skill level one, soldiers within highly
    deployed Military Occupational Specialties (MOSs) to combatant
    commanders. TESI has already increased unit readiness and will provide
    increased manning and readiness until fiscal year 2013 when the Army
    returns to its base end strength level of 547,400 in the Active
    component. While the majority of these additional soldiers are
    enlisted, the officer ranks will also experience a slight increase.
        Another advantage of TESI is a reduction in the use of Stop Loss.
    The Army expects to achieve a 50 percent reduction in the number of
    soldiers affected by Stop Loss by June 2010. As of January 2010, 7,861
    soldiers were affected by Stop Loss, a 41 percent reduction from the
    January 2009 baseline of 13,217. By January 2011, the Army will have no
    soldiers deployed under Stop Loss. However, soldiers in post-deployment
    reintegration or demobilization may still be in Stop Loss until early
    spring 2011. TESI and the implementation of voluntary stabilization
    programs for each component have made significant contributions to the
    Army's ability to eliminate Stop Loss, while minimizing the potentially
    detrimental impact to unit readiness.
        We continue to make significant progress in our efforts to restore
    balance. Increasing time between deployments for our soldiers and
    building greater predictability for soldiers and families continues to
    be one of our key concerns. Despite the short term impact of the recent
    surge of troops to Afghanistan, we expect the ratio of Boots on Ground
    (BOG) time to dwell time at 1:2 for the Active Force and 1:4 for the
    Reserve component to improve as demand decreases. Eventually, increased
    dwell time will be achieved by lowering the demand on our forces while
    increasing the size of the active Army. This will ease the constant
    pressures on our forces as we move into the rotational cycle of the
    Army Forces Generation (ARFORGEN) model. The Army Senior Leadership
    remains committed to meet these deployment goals while eliminating Stop
    Loss, and without any increase in tour length for our soldiers.
                recruiting and retention (officer and enlisted)
        Our soldiers are the Army's most important resources, and our
    ability to meet the challenges of the current and future operational
    environments depends on our ability to sustain the All-Volunteer Force.
    The pace and demand of the operational environment over the last
    several years has caused us to dedicate our focus to reaching a high
    volume of recruits. The shift in the economy, however, has allowed us
    to demand even higher quality recruits. Despite the challenges of an
    Army engaged in two protracted conflicts, the Army exceeded its
    enlisted recruiting and retention missions for fiscal year 2009 and is
    confident it will meet its goals for fiscal year 2010. The Army met 104
    percent of its recruiting goals for fiscal year 2009, while at the same
    time, meeting its quality benchmarks for new recruits. Successfully
    meeting these critical benchmarks moves us closer to restoring balance.
    As we dedicate ourselves to the fiscal year 2010 recruiting mission, we
    will continue to monitor trends and make adjustments as required.
        In fiscal year 2009, with congressional support, the total Army
    spent $4.9 billion on recruiting and retention. In fiscal year 2010,
    these programs received $4.4 billion due to a more favorable recruiting
    and retention environment. Our $4.6 billion, fiscal year 2011 request
    is based on the need to continue funding for contracts written between
    fiscal year 2006 and fiscal year 2009 and to ensure the success of the
    total Army's recruiting and retention missions. The amount budgeted for
    contractual payments is anticipated to decrease in fiscal year 2012 and
    subsequent years.
        Because of this funding, the Army is now a higher quality All-
    Volunteer Force. For example, the Army's percentage of ``high quality''
    enlisted soldiers with a high school diploma have increased by 2.1
    percent since the end of fiscal year 2009. Additionally, recruits
    scoring in the upper range (50-99 percent) on the Armed Forces
    Qualification Test (AFQT) increased 2.0 percent; and recruits who
    scored poorly (30 percent and below) on the AFQT decreased 0.4 percent.
    The Army was able to decrease the amount of ineligibility waivers
    previously provided for enlistments and appointments. Also, the Army
    was able to repair mid-grade officer shortages in the Regular Army,
    which provided the opportunity to aggressively target mid-grade
    shortages in the Reserve components.
        Overall, the Army's programs are effective in recruiting and
    retaining both officers and enlisted soldiers with critical skills. For
    enlisted soldiers, the Enlistment Bonus (EB), the Selective
    Reenlistment Bonus (SRB), Critical Skills Retention Bonus (CSRB), Army
    College Fund (ACF), and the Student Loan Repayment Program (SLRP)
    remain as proven and effective tools for filling critical skills. The
    ACF and SLRP are especially effective in attracting quality recruits
    who have some college experience or plan to attend college after the
    Army.
        To assist in recruiting critical skills, the Army launched the
    ``Military Accessions Vital to the National Interest'' (MAVNI) Pilot
    Program which the Secretary of Defense authorized on November 25, 2008
    and Army launched on February 23, 2009. The purpose was to attract high
    quality individuals with exceptional skills in health care professions
    or native speaking skills in at least 1 of 35 critical foreign
    languages. MAVNI recruits are non-U.S. citizens who have been legally
    present in the United States for 2 or more years and speak a critically
    needed foreign language or are U.S. licensed health care professionals
    who meet or exceed all requirements for military service but for U.S.
    citizenship. They do not have permanent residency (i.e. Green Cards).
    We recruited 788 MAVNI with language skills and 143 health care
    professionals during the 12 months since the program launched. Without
    spending a single dollar on marketing or advertising, Army received
    over 12,000 leads for the MAVNI program and positive media coverage. Of
    the foreign language speakers recruited, 66 percent have a bachelor's
    degree or higher, and 30 percent have at least a master's degree. Half
    the MAVNI recruits speak and comprehend the foreign language for which
    they were recruited at the 3/3 level or higher which is akin to a
    college graduate. Their loss from the Delayed Entry Program (DEP) is
    one-third that of non-MAVNI recruits and their attrition rate once in
    the Service is virtually nil. We reached the cap for this program
    established by the Secretary of Defense so until the program is
    extended we are unable to recruit the many applicants waiting to be
    processed.
        Through a separate program, the Army has recruited more than 1,600
    soldiers as military interpreters and translators under the MOS O9L
    Program. This MOS enlists native speakers of Arabic, Pashtu, Dari,
    Farsi, and Kurdish into all components of the Army to serve as
    interpreters in uniform. Combatant Commanders have found them to be
    force multipliers as they bring high levels of proficiency in these
    languages as well as firsthand cultural knowledge.
        In fiscal year 2009, all components exceeded the annual retention
    goal. The Active Army achieved 124 percent of the annual goal, the Army
    Reserve achieved 105 percent, of the annual goal, and the Army National
    Guard achieved 106 percent of the annual goal. During fiscal year 2009,
    retention bonuses were carefully monitored and adjusted to achieve the
    maximum result, ensuring the Army met its retention goals while
    remaining fiscally responsible. The economic environment allowed the
    Army to reduce incentive levels as well as the number of occupations
    offering bonuses, while focusing on our most critical skills. In
    addition, use of the Army's Critical Skills Retention Bonus greatly
    assisted in retaining very experienced senior enlisted soldiers with
    invaluable leadership and combat experience. Retention of combat
    experienced veterans remains critical to current and future readiness.
    In fact, 39 percent of all reenlistments occurred while soldiers were
    deployed. The Active Army also continued to support and encourage
    Active Duty soldiers who elected not to reenlist to transfer to the
    Reserve component upon completion of their Active Duty tour.
        The Army retention mission is also on track to meet the goals set
    for fiscal year 2010. The Active Army has reenlisted 41,262 soldiers
    for 68 percent of the annual goal, the Army Reserve has reenlisted
    4,291 for 42 percent of the annual goal, and the Army National Guard
    has reenlisted 10,771 soldiers for 35 percent of the annual goal. In
    all components, the Army expects to finish successfully in every
    category.
        The Post-September 11 GI Bill, which took effect August 1, 2009,
    provides a significantly enhanced level of educational benefits for
    Active Duty servicemembers. Additionally, it serves as a valuable
    incentive to attract and retain quality soldiers of all ranks. The Army
    expects the Post-September 11 GI Bill to serve as an inducement for
    college oriented teens to join the Army, while transferability should
    increase retention within our mid-career (6-10 years of service),
    category of soldiers. Although it is too early to fully determine the
    impact of the Post-September 11 GI Bill on both recruiting and
    retention, initial signs are positive. In particular, we've kept a
    watchful eye on the retention of our initial term soldiers who some
    feared might separate under expiration of their term of service in
    order to use their educational benefits. However, the Army exceeded its
    retention goals for first-term soldiers in fiscal year 2009 and
    continues to do so in fiscal year 2010.
        Shortages remain within our officer corps due to overall structural
    growth of the Army. To correct this, the Army initiated the Captains'
    Retention Incentive Menu in September 2007. The Army spent $443.6
    million from fiscal year 2007 to present on this incentive program. The
    goal of the program was to recruit, retain, and manage critical skills
    to increase the retention of lieutenants and captains for 3 years. The
    Captains' Retention Incentives Menu program included a cash option
    based on the officer's branch, resident graduate school attendance for
    up to 18 months, or attendance at the Defense Language Institute for 1
    year. As a result, the Army's retention rate for Captains increased in
    fiscal year 2008 to 89.1 percent and again in fiscal year 2009 to 89.9
    percent over the 10-year average of 88 percent. The program guaranteed
    retention through fiscal year 2011 for over 16,000 of the 23,000
    captains who were eligible to participate. The timing of our Captains'
    Retention Incentives Menu program, concurrent with the dramatic
    downturn of the economy and job market, helped support our retention
    goals. The cash and Defense Language Institute options ended in
    November 2008. The remaining retention incentive, the Expanded Graduate
    School Program, has been funded at $7.5 million in fiscal year 2010.
    Overall, the single most effective retention incentive for junior
    officers was the cash bonus. Over 94 percent of the more than 16,000
    officers who took incentives in fiscal year 2008 elected to take the
    cash bonus. Department of Defense survey data analysis showed that most
    officers who intended to separate or were undecided, took the incentive
    and committed to further obligated Army service.
        The U.S. Military Academy (USMA) and ROTC both continue to offer
    pre-commissioning incentives. These consist of offering new officers
    their Post or Branch of Choice or Graduate Schooling. In fiscal year
    2006 through fiscal year 2009 there were approximately 6,000
    participants. These incentives have increased longevity by 40 percent
    for newly-commissioned, high-performing USMA and ROTC officers.
        In spite of a dramatically changed recruiting climate, based on the
    economy, our message to our soldiers and their families must resound
    with assurance that they will be cared for in a manner commensurate
    with their service and sacrifice. Incentives, bonuses, and pay are only
    part of the equation in creating balance in our soldiers and families
    lives. In the event of a life changing injury or the loss of life, our
    soldiers are assured that their families will receive financial and
    programmatic support for their loss and sacrifice. This support
    includes full-earned benefits and disability compensation. The Army is
    working closely and aggressively with soldiers and their families to
    streamline access to assistance from other Federal agencies, such as
    the Social Security Administration, Department of Labor, and Department
    of Veterans Affairs.
        In direct support of President Obama's Veteran's Day Executive
    Order on employment of veterans in the Federal Government, we have
    begun a Veterans Employment Transition Initiative to streamline,
    synchronize, and integrate existing policies, programs, and initiatives
    to assist soldiers and their families as they transition out of the
    military. The intent is to ensure that they have timely visibility of
    every opportunity available to them as they transition to civilian
    life, whether as Federal workers or as contributing members of the
    private sector.
        The Army carefully manages its resources, reviewing and adjusting
    incentives at least quarterly to ensure we attract and retain quality
    individuals in needed occupations, while remaining fiscally responsible
    to avoid excessive payments. The economic environment has allowed us to
    reduce incentive amounts and the number of occupations offered bonuses
    or education incentives. Enlistment Bonuses are at the lowest levels
    since the 1990s drawdown. However, we must retain the flexibility to
    apply incentives as necessary to retain soldiers with critical or
    specialized skills. The continued authorities and funding of these
    programs by Congress remain critical to the sustainment of the Army.
                     individual ready reserve mobilization
        The Individual Ready Reserve (IRR) is a category of the Ready
    Reserve, and is composed of those members of the Ready Reserve who are
    not serving in Selected Reserve units or assignments, or in the
    Inactive National Guard. The availability of IRR soldiers is critical
    to the Army's mission of providing properly trained and equipped units
    of sufficient strength to meet contingency operation or mobilization
    requirements. As of February 28, 2010, there are 59,413 soldiers in the
    IRR. Since September 11, 2001, a total of 29,997 soldiers received
    mobilization orders and a total of 12,018 soldiers deployed to the
    CENTCOM Area of Responsibility. The Army applies specific screening
    criteria and a tiered systemic approach regarding involuntary
    mobilization of the IRR. These actions align with the January 2007 DOD
    policy on Utilization of the Total Force and take into account a
    soldier's dwell time, Military Service Obligation (MSO), and previous
    deployments in support of OCONUS Contingency Operations (OCO).
        An effective IRR program is based on several factors, including the
    soldiers' understanding of their obligations, access to benefits and
    support, and time to adjust personal affairs prior to mobilizations. In
    an ongoing effort to validate the readiness of the IRR, the Army
    continues to implement the IRR Muster program. Approximately 5 months
    after entering the IRR program, soldiers will be ordered to muster
    duty. Afterward, soldiers are required to muster each year they remain
    in the IRR. Through the muster program, the Army established a
    partnership with the Department of Veterans Affairs to use VA medical
    centers as muster sites for the added opportunity of connecting
    soldiers to VA services. During fiscal year 2009, the Army spent
    approximately $3.6 million to muster 13,500 soldiers, contributing to
    3,300 soldiers returning to Army Reserve formations. The Army plans to
    muster 14,000 IRR soldiers at an estimated cost of $4.2 million in
    fiscal year 2010 and expect to impact 3,500 soldiers returning to Army
    Reserve Formations.
                              operational reserve
        As the Army continues to institutionalize the Operational Reserve,
    our first and greatest challenge is to effectively and efficiently
    deliver ready and trained soldiers. Transforming the Reserve components
    (RC) into an operational force in the near-term (fiscal year 2012-2014)
    will provide a means for RC forces to provide proportional support to
    the Army's Force Supply model of a Corps Headquarters, 5 division
    headquarters (4 Active component (AC), 1 RC), 20 Brigade Combat Teams
    (15 AC, 5 RC), and 90,000 enablers (41,000 AC, 49,000 RC) to support
    combatant command requirements through 2014 time period. It is
    important to note that programming decisions are required in the near
    term to ensure RC forces are sufficiently ready to support the Army's
    force generation plans. Without sufficient resources in unit
    management, collective training and medical/dental readiness, the RC
    will not be ready to support the planned 1/5/20/90 force supply
    construct.
        The Army will require recurrent, assured and predictable access to
    the RC to meet operational requirements as requirements increase for
    Army forces to conduct overseas engagement activities over the
    remaining years of the program period (fiscal year 2015-2017). During
    this period, RC forces will be mobilized and employed in full spectrum
    operations at rates proportional to AC forces within force utilization
    goals of 1:3 (AC) and 1:5 (RC). Continued investments in RC unit
    management, collective training and medical/dental readiness are
    required to achieve required readiness levels in accordance with these
    ARFORGEN goals. Moreover, these investments are required within the
    base funding to ensure the RC achieves a level of institutional
    transformation that cannot be achieved through the year-by-year
    allocation of resources from overseas contingency operations funds.
        Finally, transforming the RC into an operational force provides an
    opportunity for the Army to provide the most cost-effective Total Force
    and mitigate any decline in resources by investing now in the most
    cost-efficient portion of the Army's Total Force. The Army National
    Guard (ARNG) and the U.S. Army Reserve account for 51 percent of the
    Army's military end strength for 16 percent of the base budget. When
    comparing the cost per soldier, the relative value of the RC is even
    greater. A 2008 comparison of AC/RC manpower by HQDA G-8 identified the
    approximate total costs per Regular Army soldier in manpower, training,
    equipping, organization costs and operating costs as $135,000, compared
    to $36,000 for ARNG soldiers and $35,000 for Army Reserve soldiers.
    Given the relative value is a reasoned investment for the Army's Total
    Force, this will make targeted investments improve RC readiness.
    Moreover, such investments in the near-term (POM 2012-2017) will
    position the Army to better manage the risks of declining resources for
    the Army, should such a reduction be required in the next 2 to 5 years.
    However, delays in these investment decisions reduce the Army's
    flexibility to consider strategic alternatives to a larger Active Force
    structure model in the long-term.
                                quality of life
        Recognizing that the strength of our Army comes from the strength
    of our Army families, the Secretary of the Army and Chief of Staff of
    the Army initiated the Army Family Covenant in October 2007 and
    reaffirmed this commitment by resigning the Covenant this past October.
    The Covenant institutionalizes the Army's commitment to provide
    soldiers and families a quality of life commensurate with the quality
    of service they provide our Nation. The Army Family Covenant
    incorporates programs designed to build strength and resilience in our
    families. These improved services and programs help to mitigate the
    stress from mutiple deployments and frequent military moves.
        The Covenant focuses on the following: standardizing soldier and
    family programs; increasing access and quality of health care;
    improving soldier and family housing; ensuring excellence in our
    schools, youth and child care services; expanding the education and
    employment opportunities for family members; improving soldier quality
    of life in recreation, travel, and the Better Opportunities for Single
    Soldiers program; and improving relationships with local communities
    and marketplaces.
        From fiscal year 2007 to fiscal year 2010, the Army more than
    doubled its investment in family programs. To ensure they remain
    enduring, these increases have been included in the fiscal year 2010
    base budget. Furthermore, this funding will increase from $1.7 billion
    in fiscal year 2010 to $1.9 billion in fiscal year 2015.
        We must never forget that we are one Army made up of Active Duty,
    National Guard, and Army Reserve components and must often reach
    ``beyond the gates of the garrison'' to ensure we support our
    geographically dispersed families. We are thankful for all the citizens
    and community based organizations that have stepped up to support our
    soldiers and their families, regardless of their location.
                  civilian personnel and workforce development
        Department of the Army civilian employees provide vital support to
    soldiers and families in this era of persistent conflict. They share
    responsibility for mission accomplishment by delivering combat support
    and combat service support--at home and abroad. More than ever, Army
    civilians are an absolutely essential component of readiness and a key
    element in restoring balance. Today, the Army Civilian Corps has nearly
    300,000 employees with 3,832 currently serving in harm's way in the
    U.S. Central Command area of operations.
        Since September 11, 2001, we increased the civilian workforce from
    222,000 to 263,169 (plus 24,357 Civil Works) due to overseas
    contingency operations, Defense Health Program increases, Family and
    Soldier Support initiatives, acquisition workforce growth, in-sourcing
    contracts associated with inherently governmental functions, military
    technician increases, and military-to-civilian conversions. Future
    Civilian employee growth is critical to supporting current plans to
    rebalance the Army to 73 brigade combat teams and associated combat
    support/combat service support units by fiscal year 2011.
        In fiscal year 2009, the Army saved significant resources by in-
    souring more than 900 core governmental functions to Army civilians. We
    plan to in-source 7,162 positions in fiscal year 2010, and are
    programmed to in-source 11,084 positions during fiscal year 2011-2015,
    of which 3,988 are acquisition positions. These positions were
    identified in the Army's on-going contractor inventory review process.
        Current workforce development programs, such as the Army Intern
    Program; the Army Fellows Program; the Presidential Management Fellows
    Program; the Senior Fellows Program, and the Army Senior Leader
    Development Program, to name a few, are helping the Army to ``build a
    bench'', of future Army leaders. In an era of persistent conflict,
    however, the operational and budgetary realities of fighting terrorism
    on multiple fronts have simultaneously increased the requirements for
    development and decreased the available funding. Simply put, the Army's
    resources to develop our Civilians have not kept pace with the need.
    While current training and development programs provide highly
    competitive growth opportunities, better incentives for self-
    development and professional development are needed to ensure the
    Civilian cohort is as prepared to meet future missions as their
    military counterparts. The Department of the Army also has several
    initiatives to focus and invigorate development of the civilian
    workforce, which complement the strategic workforce plan requirements
    outlined in the National Defense Authorization Act for Fiscal Year
    2010.
        The Army is developing a Civilian Human Capital Strategy to better
    focus on the full life-cycle needs of Civilian Workforce, from
    recruitment to replacement. Because of the increasing complexity of
    today's operational environment, the Army must invest more resources
    into recruiting, sustaining, and developing its Civilian workforce. The
    Initial emphasis of our Civilian Human Capital Strategy will be on
    identification of the competencies needed by employees in mission
    critical occupations, assessment of the current competency levels of
    the workforce, and strategies for closing the gaps. This focus will
    enable the Army to develop competency-based civilian recruiting and
    hiring strategies as well. This approach will help ease the transition
    from one generation to the next as we implement Base Realignment and
    Closure and begin to experience the next wave of baby boomer
    retirements.
                         army equal opportunity policy
        The Army leads the Nation in Equal Opportunity (EO) policy and
    practice. Commanders at all levels are responsible for sustaining
    positive EO climates within their organizations to enhance Army
    Readiness. Remaining applicable and relevant within the ever-changing
    environment in which we operate, the Army is transforming EO policy/
    program by integrating and institutionalizing equal opportunity and
    diversity goals, objectives and training practices. This effort will
    strengthen the foundation of the Army's Human Capital Strategy. Since
    fiscal year 2008, the Army has invested $3.4 million and expects to
    invest another $0.9 million in fiscal year 2010 for EO personnel and
    services support, database and survey systems, outreach support, and
    training contracts.
                    sexual assault and harassment prevention
        The Army's goal is to eliminate sexual assault and harassment by
    creating a climate that respects the dignity of every member of the
    esteemed band of brothers and sisters. The Secretary of the Army
    (SECARMY) and the Chief of Staff (CSA) remain personally involved in
    reinforcing to all soldiers and leaders the importance of preventing
    sexual assault and harassment. Under their guidance and leadership, the
    Army launched a comprehensive sexual assault prevention strategy that
    requires leaders to establish a positive command climate where sexual
    assault is clearly not acceptable. The strategy further encourages
    soldiers to execute peer-to-peer intervention personally, and to not
    tolerate behavior that could lead to sexual assault.
        The cornerstone of the Army's prevention strategy is the ``I. A.M.
    Strong'' campaign, where the letters I, A, and M stand for Intervene--
    Act--Motivate. The ``I. A.M. Strong'' campaign features soldiers as
    influential role models and provides peer-to-peer messages outlining
    the Army's intent for all its members to personally take action in the
    effort to protect our communities. Leaders have embraced ``I. A.M.
    Strong'' initiatives and are motivating soldiers to engage proactively
    and prevent sexual assault.
        The Army's sexual assault prevention strategy consists of four
    integrated phases and extends through calendar year 2014 as we work to
    be the Nation's leader in sexual harassment and sexual assault
    prevention.
        The SECARMY introduced the ``I. A.M. Strong'' campaign at the
    Sexual Assault Prevention Summit in September 2008. The Summit served
    as a platform to launch Phase I (Committed Army Leadership) by
    providing training on best practices and allowing commands the
    opportunity to develop prevention plans to support the Army strategy.
        Phase II of the prevention strategy (Army-wide Conviction) includes
    educating soldiers to understand their moral responsibility to
    intervene and stop sexual assault and harassment. Phase II began at the
    2009 Sexual Assault Prevention Summit (6-10 Apr 09) during which the
    SECARMY, CSA, and Sergeant Major of the Army addressed attendees, which
    included over 100 sergeants major and 50 general officers.
        Phase III culminates the dedicated effort of leaders and soldiers
    under Phase I and Phase II by ``Achieving Cultural Change'' that truly
    reflects Army values and fosters an environment free from sexual
    harassment and sexual assault.
        The final phase is ``Sustainment, Refinement, and Sharing,'' during
    which the prevention program continues to grow while motivating
    national partners to support our efforts to change generally accepted
    negative social behaviors; thus eliminating the crime of sexual
    assault.
        With the implementation of the strategy, a likely near-term
    consequence will be an increase in the number of reported cases as
    soldiers' and other victims' propensity to report increases. This
    increase in cases will require more sexual assault responder support,
    specifically: victim advocates, healthcare personnel, investigators,
    and prosecutors.
                           suicide prevention program
        The loss of any soldier is a tragedy, particularly when it could
    have been prevented. There were 160 suicides by active-duty soldiers
    during 2009, continuing the 5-year trend of increased suicides within
    the Army. As a result, we have instituted a multi-level, holistic
    approach to health promotion, risk reduction and suicide prevention.
    Although the total number and rate of suicides in the Army remains of
    deep concern, we should remember each of these suicides represents an
    individual and a family that has suffered an irreparable loss---and, as
    a result, our suicide prevention efforts are focused on directly
    assisting soldiers, their families, and our Army civilians.
        On 16 April 2009, the Vice Chief of Staff of the Army (VCSA) signed
    the Army Campaign Plan for Health Promotion, Risk Reduction, and
    Suicide Prevention, a comprehensive plan setting in motion
    unprecedented changes in Army doctrine, policy, and resource
    allocation, as well as immediate guidance to commanders, in order to
    address the problem of suicides in the overall context of risk
    reduction and health promotion.
        The Army Suicide Prevention Task Force has addressed more than 240
    different tasks related to suicide prevention doctrine, organization,
    training, materiel, leadership, personnel, and facilities. Over 90
    percent of these tasks have been implemented.
        To build on the Army Campaign Plan's accomplishments during
    calendar year 2009, the Army Suicide Prevention Task Force is leading
    an effort to review and assess the effectiveness of Army Health
    Promotion, Risk Reduction and Suicide Prevention programs at all
    levels. Army has partnered with National Institute of Mental Health to
    conduct a long-term study (Army Study to Assess Risk and Resilience on
    Servicemembers) of risk and protective factors to inform health
    promotion and suicide prevention efforts. The VCSA Task Force is also
    reviewing all Army programs at all levels that are related to health
    promotion, risk reduction, suicide prevention, or were implemented to
    address soldier, family, or DA civilian stressors to ensure that the
    programs provide appropriate levels of support and address current
    problems, risk factors, and are relevant to today's soldiers' families'
    and DA civilians needs.
                     comprehensive soldier fitness program
        The Army's Comprehensive Soldier Fitness (CSF) program is a
    structured, long-term assessment and development program designed to
    build the resilience and enhance the performance of the Army's
    soldiers, families, and civilian personnel. The CSF program uses
    individual assessments, tailored virtual training, classroom training
    and embedded resilience experts to provide soldiers with the critical
    skills needed to take care of themselves, their families and their
    teammates in this era of persistent conflict. By developing the five
    dimensions of strength--physical, emotional, social, spiritual, and
    family--CSF equips soldiers with the skills to become more self-aware,
    fit, balanced, confident, and competent, and ultimately better prepared
    to face the physical and psychological challenges of sustained
    operations.
                          army substance abuse program
        The Nation's persistent conflict has created symptoms of stress for
    our soldiers, including an increase in alcohol and drug abuse. This
    commander's program uses prevention, education, deterrence, detection,
    and rehabilitation, to reduce and eliminate alcohol and drug abuse. It
    is based on the expectations of readiness and personal responsibility.
        A team recently returned from deployment to U.S. Army Forces, U.S.
    Central Command. To support our commanders, clear and effective
    procedures for random drug testing in theater are under development,
    such as the implementation of online tools to train unit prevention
    leaders and to quickly inform commanders of test results. Another area
    under development is the review of portable prevention education
    packages for deployed soldiers, soldiers at home, and soldiers in the
    RC. Additionally, the Army is conducting a pilot program that provides
    confidential education and treatment to soldiers who self-refer to the
    Army substance abuse program for assistance with alcohol issues. In
    addition to the pilot program, we are conducting a broader, more
    detailed study to determine the exact nature and extent of any stigma
    in the Army associated with substance abuse treatment. This study will
    run concurrently with the pilot program. The pilot program and detailed
    study were concluded on March 1, 2010 and we expect to report to
    Congress in April 2010. We want to ensure that all soldiers who may
    need assistance can get assistance without the barrier of stigma.
                            congressional assistance
        Recruiting, retention, and providing for the well-being of the best
    Army in the world requires a significant commitment by the American
    people. The Army is grateful for the continued support of Congress for
    competitive military benefits and compensation, along with incentives
    and bonuses for soldiers and their families and for the civilian
    workforce. These are critical in helping the Army be the employer of
    choice.
                                   conclusion
        We must maintain an appropriate level of investment to ensure a
    robust and high-quality force. The well-being and balance of our force
    are absolutely dependent upon your tremendous support. The Army is
    growing and transforming in a period of persistent conflict. We will do
    so with men and women of the highest caliber whose willingness to
    serve, is a credit to this great Nation.

        Senator Webb. Secretary Garcia.

     STATEMENT OF HON. JUAN M. GARCIA III, ASSISTANT SECRETARY OF
               THE NAVY FOR MANPOWER AND RESERVE AFFAIRS

        Mr. Garcia. Chairman Webb, Senator Graham, distinguished
    members of the committee, it's my pleasure to be here today to
    testify on behalf of our Navy and Marine Corps personnel.
        For the past 5 months as an Assistant Secretary of the
    Navy, I've had the honor of representing and advocating for the
    nearly 650,000 sailors and marines, both Active Duty and
    Reserve, and 180,000 civilian employees who, together, are
    globally engaged across a spectrum of operations ranging from
    major combat to humanitarian assistance.
        Across the Department of the Navy, we are asking our
    sailors, marines, and civilians to take on extraordinary tasks
    ranging from combat operations in Afghanistan to unplanned
    disaster relief in Haiti. The men and women who comprise the
    Navy and Marine Corps have invariably risen to meet the
    challenge presented.
        Our leadership team--Secretary Mabus, Under Secretary Work,
    Admiral Roughead, and General Conway--have set a course for the
    Department of the Navy that drives our human capital strategy,
    focusing on our greatest asset: our people. In order to achieve
    our best, we promote an environment in which every person can
    excel, where each person is treated with dignity and respect,
    and where all are recognized for the contributions they make.
        Both the Navy and Marine Corps are experiencing historic
    success in recruiting and retention of Active Duty
    servicemembers. I assess that both Services will continue
    meeting their recruiting and end-strength goals for the
    foreseeable future. It's a tribute to both the dedication of
    our military personnel communities and to the patriotism of our
    Nation's young men and women that we are able to maintain an
    All-Volunteer Force of unprecedented quality through more than
    8 years of active combat operations.
        Recruiting and retention in certain fields--healthcare,
    Special Forces, nuclear power--continue to pose challenges and
    will require the use of special pays and bonuses to ensure
    adequate numbers of qualified personnel are available in those
    critical specialties.
        Despite its high operational tempo, the Marine Corps was
    able to grow to 202,000 Active Duty end strength 2 years ahead
    of schedule. This focus on Active Duty recruiting and retention
    resulted in a slight shortfall of the Marine Reserve component
    end strength for 2009. For this same reason, 2010 Reserve
    strength may also be slightly below target.
        The health of the Reserve components is of particular
    concern because of our dependence on them to meet our global
    obligations. Since September 11, more than 142,000 mobilization
    requirements have been met by members of the Navy and Marine
    Corps Reserve.
        A high tempo, high stress environment appears to be the new
    normal for the Department of the Navy. One of the lessons to be
    learned from recent years is that our people step up and
    perform superbly in times of greatest need. But, the reality of
    continuing operations in Afghanistan, combined with our other
    deployment commitments, undeniably places great stress on our
    forces. The Department of the Navy is employing every measure
    available to help identify consequent risks, and we continue to
    assess and reevaluate these programs daily.
        As Secretary Gates has said, apart from the war itself, we
    have no higher priority than taking care of the wounded, ill,
    and injured. Through the Marine Corps Wounded Warrior Regiment
    and the Navy Safe Harbor Program, the sea Services strive to
    provide the best possible support for our personnel struck
    down, to include reintegration into society and a new emphasis
    on post-service employment.
        I'd like to thank the committee members for their
    continuous commitment to the support of our expeditionary
    fighting men and women, especially to those who have returned
    from the front line of battle with broken bodies but unbroken
    spirits, our wounded warriors.
        I look forward to your questions.
        [The prepared statement of Mr. Garcia follows:]
                   Prepared Statement by Hon. Juan M. Garcia
        Chairman Webb, Senator Graham, and distinguished members of the
    subcommittee, it is my pleasure to be here today to testify on behalf
    of our Navy and Marine Corps personnel. For the past 5 months as an
    Assistant Secretary of the Navy, I have had the honor of representing
    and advocating for the nearly 650,000 sailors and marines, both Active
    Duty and Reserve, and 180,000 civilian employees who, together, are
    globally engaged across a spectrum of operations ranging from major
    combat to humanitarian assistance. Across the Department of the Navy,
    we are asking our sailors, marines, and civilians to take on
    extraordinary tasks ranging from combat operations in Afghanistan to
    unplanned disaster relief in Haiti. The men and women who comprise the
    Navy and Marine Corps have invariably risen to meet the challenges
    presented.
        Our leadership team, Secretary Mabus, Under Secretary Work, Admiral
    Roughead, and General Conway, have set a course for the Department of
    the Navy that drives our Human Capital Strategy--focusing on our
    greatest asset--our people. In order to achieve our best, we promote an
    environment in which every person can excel, where each person is
    treated with dignity and respect, and where all are recognized for the
    contributions they make.
        Let me address some particular areas of interest and concern
    related to the Department's manpower and personnel.
        In terms of military personnel, both the Navy and Marine Corps are
    experiencing historic success in recruiting and retention of active
    duty servicemembers. I assess that both Services will continue meeting
    their recruiting and end-strength goals for the foreseeable future. It
    is a tribute to both the dedication of our military personnel
    communities and to the patriotism of our Nation's young men and women
    that we are able to maintain an All-Volunteer Force, of unprecedented
    quality, through more than 8 years of active combat operations.
        Recruiting and retention in certain fields--including health care,
    Special Forces, and nuclear power--continue to pose challenges, and we
    still require the use of special pays and bonuses to ensure adequate
    numbers of qualified personnel are available in critical specialties
    such as these.
        The Navy expects to continue to need an additional 4,400 end-
    strength for Overseas Contingency Operations. In considering that
    requirement, it is important to remember that the number of active duty
    sailors has been in gradual decline since the Vietnam war. As recently
    as 1993 the Navy had half-again as many sailors on active duty, and
    available for assignments, as it does today.
        Despite its high operational tempo, the Marine Corps was able to
    grow to 202,000 active duty end strength 2 years ahead of schedule.
    This focus on active duty recruiting and retention resulted in a slight
    shortfall of the Marine Reserve component end strength for 2009. For
    this same reason, 2010 Reserve strength may also be slightly below
    target. The health of the Reserve components is of particular concern
    because of our dependence on them to meet our global obligations. Since
    September 11, more than 142,000 mobilization requirements have been met
    by members of the Navy and Marine Corps Reserve.
        Another topic of particular interest is the introduction of female
    personnel on submarines. On February 19, 2010, the Secretary of Defense
    notified Congress of our intent to change the policy prohibiting the
    service of women in submarines. After the requisite notification period
    has expired, it is the Navy's intent to have the first cadre of female
    officers commence training on nuclear prototypes and begin a pipeline
    that will ultimately lead them to qualification as Naval Submariners,
    removing one of the last gender barriers in the U.S. Navy, and helping
    to insulate us from the anticipated surge in hiring by the civilian
    nuclear power industry in the decades to come. Because of the critical
    mission and demanding environment of the submarine force, we envision a
    gradual, and measured approach to this integration. Our initial efforts
    will focus on officers only and will concentrate on our large boats
    (SSGNs and SSBNs), where the existing infrastructure will accommodate
    these changes without material alteration. As a measure of extra
    caution, the Navy will not reduce the number of male officers trained
    and qualified for submarine duty until we have experience with
    successfully placing female officers in those roles.
        Some might argue that such initiatives should not be undertaken
    during a period of high operating tempo and stress on the force. But a
    high tempo, high stress environment appears to be the new normal for
    the Department of the Navy. One of the lessons to be learned from
    recent years is that our people step up and perform superbly in times
    of greatest need. Yet the reality of continuing operations in
    Afghanistan combined with our other deployment commitments undeniably
    places great stress on our forces.
        Stress on the force has many causes and manifests in many forms.
    The Secretary of Defense asked former Secretary West and Retired
    Admiral Clark to lead an independent review of the tragic events at
    Fort Hood. Their review produced 86 recommendations for changes in, or
    reviews of, procedures and policies. Currently, the Department of the
    Navy is working with the other Services and the Office of the Secretary
    of Defense to evaluate those recommendations and implement those that
    seem appropriate. Well before the shootings at Fort Hood, the
    Department of the Navy had in place its Caregiver Occupational Stress
    Control Program, which is designed to enhance the resilience of
    caregivers, including mental health professionals, chaplains, corpsmen,
    and other counselors and advisers. Additionally, for reservists and
    individual augmentees returning from mobilization, the Department
    created the Returning Warrior Workshops (which are a part of the Yellow
    Ribbon Reintegration Program) to help with the adjustment to life back
    home.
        Stress on our personnel has likely played a role in the
    heartbreaking increase in suicide rates among the active duty in recent
    years. The Department of the Navy has employed every measure available
    to help identify those at risk, encourage them to seek help, and
    prevent these tragedies. We continue to assess and re-evaluate our
    programs daily, and will not stop, believing that even a single suicide
    by those wearing our Nation's cloth is one too many.
        As Secretary Gates has said, apart from the war itself, we have no
    higher priority than taking care of the wounded, ill, and injured.
    Through the Marine Corps's Wounded Warrior Regiment and the Navy's Safe
    Harbor Program, the sea services strive to provide the best possible
    support for our personnel struck down, to include reintegration into
    society, and a new emphasis on post-Service employment.
        Thanks to advances in military medicine, many of our most seriously
    wounded, who even a few years of ago would have died of injuries, are
    recovering and, in many cases, able to resume their military jobs.
    Others will require special accommodations and support for the rest of
    their lives. We are working in close partnership with the Department of
    Veterans' Affairs to ensure the best and most dignified treatment
    possible for those sailors and marines.
        Members of our civilian workforce continue their crucial
    contributions to our mission while coping with two significant
    transitions of their own.
        Consistent with your direction in the National Defense
    Authorization Act for Fiscal Year 2010, we are currently in the process
    of moving all of our civilian employees out of the National Security
    Personnel System. Those who are returning to the General Schedule will
    be converted no later than the end of the fiscal year. Those who will
    move to one of the various alternative pay systems will be transitioned
    during 2011.
        While this is occurring, the DOD is also engaged in a significant
    in-sourcing initiative, expected to add more than 33,000 civilian
    positions over the next 5 years to perform currently contracted
    services--the Department of Navy expects to establish 10,000 new
    civilian positions as part of this effort. This initiative will
    rebalance our workforce; rebuild organic capabilities; reduce
    operational risk by ensuring that inherently governmental and functions
    that support the readiness/management needs of the Department are
    performed by government employees; and that services are delivered in
    the most cost effective manner. Nearly a third of these new positions
    are expected to be part of the crucial acquisition workforce. These
    insourcing initiatives are consistent with DOD's High Priority
    Performance Goals in the President's fiscal year 2011 Budget's Analytic
    Perspectives volume.
        Finally, I would like to thank the committee members for their
    continuous commitment to the support of our expeditionary fighting men
    and women, especially to those who have returned from the front line of
    battle with broken bodies but unbroken spirits--Our Wounded Warriors.
        I look forward to your questions.

        Senator Webb. Thank you, Secretary Garcia.
        Secretary Ginsberg.

     STATEMENT OF HON. DANIEL B. GINSBERG, ASSISTANT SECRETARY OF
             THE AIR FORCE FOR MANPOWER AND RESERVE AFFAIRS

        Mr. Ginsberg. Thank you, Chairman Webb, Ranking Member
    Graham, and members of the subcommittee.
        It is my honor to testify before you today about our
    airmen. They are doing incredible work every day to serve our
    Nation and accomplish the missions that our Nation has asked of
    them. Our Air Force has been engaged in continuous operations
    for over 19 years. We have never been more engaged than today.
    We have over 38,000 airmen deployed around the world, and
    thousands more airmen providing direct support to the
    warfighter through our space systems, global mobility
    operations, and remotely-piloted operations, to name just a few
    of the critical capabilities that we provide.
        Overall, our force structure is healthy. We are working
    internal challenges to ensure we meet the increased demand for
    new and emerging missions, such as our remotely piloted
    aircraft, cyberoperations, and irregular warfare. We are
    meeting our total-force recruiting goals, except for a few
    hard-to-fill specialties in our officer medical specialties.
        To address this, we are aggressively pursuing a three-
    pronged approach to, first, grow our own through expanded
    scholarship opportunities and commissioning opportunities for
    our enlisted force; second, increase compensation through
    special and incentive pays; and third, to improve quality of
    life.
        Although the Air National Guard will meet end strength, we
    are having challenges recruiting enough officers. That may be
    related to our high retention rates we are currently
    experiencing with our Active component. Historically, the Guard
    and Reserve rely heavily on recruiting prior-service trained
    airmen who separate from the Active side.
        An efficient and smooth transfer between each component and
    Civil Service allows the Air Force to access and retain
    important skill sets and balance our mission needs over time.
    To make this process work even better, we are focusing on our
    Continuum of Service Program. Through Continuum of Service, we
    are reviewing all Air Force, Office of the Secretary of Defense
    (OSD), and statutory requirements to identify areas where we
    can streamline the transfer between components. When statutory
    issues are identified, we will work with OSD and our
    counterparts in other Services to identify and support
    legislative proposals to you.
        Taking care of our airmen and their families is a top Air
    Force priority. In the spring of 2009, the Air Force renewed
    its longstanding commitment to our airmen and families by
    designating July 2009 through July 2010 as ``The Year of the
    Air Force Family.'' The observance serves two primary purposes.
    First, we examined our family support services and policies
    across the Air Force in order to expand or refine them as
    required to meet the emerging needs and expectations of our
    airmen, their families, and the larger Air Force family.
        Second, we set aside specific time to recognize the
    sacrifices and contributions of the members of our entire Air
    Force family--our Active, Guard, Reserve, civilian, spouses,
    and family members. We have focused our efforts to ensure we
    provide robust programs to meet the unique needs of our Guard
    and Reserve members and their families.
        In conjunction with the Year of the Air Force Family, we
    are also focused on reducing the stressors and mission
    detractors that impact our airmen and their families. We have
    taken a holistic approach to addressing airmen resiliency. We
    are strengthening our Exceptional Family Member Program to
    ensure we better meet their unique needs. We are dedicated to
    reducing incidence of sexual assault and suicide among our
    force. One is too many.
        Diversity is an integral part of our mission accomplishment
    and success in today's Air Force, and will remain in the
    forefront of that area, as we continue to exclusively attract,
    develop, and retain highly qualified professionals for the
    betterment of the total force.
        Across all of our programs, we continually strive to
    improve as we accomplish the Air Force's and the Nation's
    priorities. I am committed to ensuring we provide the best
    possible programs that increase our combat capability and take
    care of our most important asset: our airmen.
        I look forward to working with this committee, which has
    helped shape DOD into the world's premier defense organization.
    I thank you for the opportunity to appear before you today.
        [The prepared statement of Mr. Ginsberg follows:]
                 Prepared Statement by Hon, Daniel B. Ginsberg
                                  introduction
        Mr. Chairman, members of the subcommittee, thank you for this
    opportunity to discuss the Air Force's most important resource--our
    airmen. This diverse group of highly-skilled and dedicated men and
    women ensure our Air Force remains the most powerful in the world. Our
    airmen have been continuously deployed and globally engaged in combat
    missions for over 19 straight years. Approximately 38,800 airmen are
    currently deployed in support of joint operations across the globe. Of
    these, over 4,000 airmen are filling Joint Expeditionary Taskings in
    non-traditional roles in Iraq, Afghanistan and elsewhere. Thousands
    more are providing critical direct support to our combatant commanders
    from their home station. These critical capabilities include space
    systems such as GPS, rapid global mobility of people and supplies, as
    well as intelligence, surveillance, and reconnaissance from space and
    remotely piloted aircraft. Our airmen are committed to winning today's
    fight and prepared for tomorrow's challenges.
        As the Air Force's assistant Secretary for Manpower and Reserve
    Affairs, I am focused on accomplishing the Air Force's priorities by
    developing and implementing programs and policies to best leverage our
    total force--Active, Guard, Reserve, and civilians--to maximize our
    combat capability for the joint commanders. To that end, I have made
    Continuum of Service (CoS), which will allow for smooth transfer of
    skilled airmen between components, and increasing the diversity of our
    force high priorities. I am also attuned to the overall health of our
    force. We are working essential programs that support our wounded
    warriors, help airmen reintegrate after deployments, provide families
    with the support they need and minimize the incidents of sexual assault
    and suicide to name just a few.
                       end strength and force management
        With the National Defense Authorization Act for Fiscal Year 2010,
    our current approved total force end strength is 686,944. This includes
    331,700 Active component; 179,044 civilians; 69,500 Reserve; and
    106,700 Air National Guard. In the fiscal year 2011 budget request, our
    programmed total force end strength is 702,669. This includes 332,200
    Active component, 192,569 civilians, 71,200 Reserve, and Air National
    Guard end strength remaining at 106,700.
        The Air Force's fiscal year 2011 budget request preserved end
    strength in the face of fiscal constraints, realigned Active component
    and Reserve manpower within existing resources, and grew civilian end
    strength to meet Air Force priorities. Major manpower drivers include
    initial investment toward remotely piloted aircraft fleet operational
    capability to 65 combat air patrols; enhancing cyberspace/irregular
    warfare/command and control capabilities; and resourcing required Air
    Force priorities to include Acquisition Excellence, further
    enhancements to Nuclear Enterprise, and developing and caring for our
    airmen and their families while rebalancing our total force mix for
    agile combat support.
        Maintaining the optimum overall force size as well as balancing
    critical skill-sets is a routine part of the Air Force's force
    management efforts. The current downturn in the economy has had a
    direct impact on the Air Force's lower attrition rates projected in
    fiscal year 2010. As a result, the Air Force is expected to exceed end
    strength by about 3,700 airmen (2,100 officers and 1,600 enlisted) in
    fiscal year 2010. Although this increase would fall under the Secretary
    of the Air Force's purview of 2 percent over authorized end strength,
    the Air Force implemented a force management plan to bring this back in
    alignment. In fiscal year 2010, we made small adjustments in several
    areas including limited reductions of officer and enlisted accessions,
    increased service commitment waivers, waived enlisted time-in-grade
    requirements for retirement, and we are implementing an additional
    enlisted date-of-separation rollback. We are continually monitoring
    results from these actions and to date we have achieved about 50
    percent of our fiscal year 2010 force management goal. Even with these
    efforts, we do not expect these actions to fully achieve the reductions
    targeted for fiscal year 2010. As a result, we will likely continue
    many of these actions and consider other force management options for
    the remainder of fiscal year 2010 and in fiscal year 2011 as needed.
    Utilizing force management tools is a necessary and routine leadership
    obligation to ensure the Air Force remains within authorized strength
    levels and get the right balance of grades and skills to meet our
    evolving mission requirements. However, we strive to use these force
    management tools in a deliberate manner with the least disruption to
    the cohesion of the force.
                                   recruiting
        Even in a time of higher retention and a struggling economy,
    recruiting the highest quality airmen is as important as ever. Our
    recruiting force continues to achieve the enlisted accession mission
    with integrity and excellence. In fiscal year 2009, we met mission
    requirements for enlisted recruiting in all components (Active, Guard,
    and Reserve). To date in fiscal year 2010 we have achieved 100 percent
    of our active-duty accession goals and 100 percent and 112 percent of
    our Reserve and Guard accession goals, respectively.
        Although we have achieved mission goals in our line officer
    accession programs, we continue to struggle with health professions
    officer recruitment and retention. In fiscal year 2009, we recruited
    approximately 70 percent of officer health professions requirements
    exceeding the fiscal year 2008 production of 62 percent. The ongoing
    high-demand for medical professionals in the lucrative civilian market
    makes it difficult for the Air Force to attract and retain fully
    qualified individuals. As a result, in 2006 the Air Force implemented a
    long-term ``grow our own'' strategy by offering more medical school
    scholarships in student-based markets. In fiscal year 2008, we filled
    431 of 437 available scholarships (98.6 percent) and for fiscal year
    2009, we accessed 376 of 371 scholarships (101 percent). In fiscal year
    2010, we are on track to achieve a 100 percent scholarship fill rate.
    Our main shortfall in recruiting is attracting fully-qualified medical
    professionals to come straight into the service particularly in the
    Biomedical Science Corps. Psychology, Pharmacy, Optometry and Public
    Health Officers continue to be challenging to recruit. Our continued
    challenges in the health professions are why we have submitted $85.7
    million in this year's budget request for officer bonuses to attract
    and retain more medical professionals on active duty. We are
    appreciative of and ask for your continued support in this area.
        Although recruitment is also strong in the Reserve and Air National
    Guard, they face challenges with fewer prior-servicemembers due to
    lower Active component attrition rates and increased requirements for
    new and emerging mission specialties. As a result, both the Air
    National Guard and the Air Force Reserve have had to increase their
    non-prior service recruitment efforts. In fact, the Reserve non-prior
    service recruiting requirement has nearly doubled since the end of
    fiscal year 2007. Increased recruitment of non-prior servicemembers for
    both Air National Guard and the Air Force Reserve has directly resulted
    in increased recruitment costs as well as increased training costs over
    that of already trained prior-servicemembers. The continued support of
    the Air Force, Department of Defense and Congress will undoubtedly
    shape the foundation of their success.
                                   retention
        Although overall officer retention has remained strong, we have had
    challenges with retention of rated officers, some critical skills and
    some health profession specialties. To address our rated officer
    shortages, we implemented a rated recall program to bring back 500
    trained pilots to help fill our rated staff positions allowing more
    current pilots to return to the cockpit. The Air Force prudently
    employs Special and Incentive (S&I) pays to compensate for and
    incentivize the performance of hazardous and arduous duties, the
    acceptance of duty in hostile or remote and isolated locations, and the
    recruiting and retention of personnel with specific skills or in
    specific career fields. Fiscal year 2010 Active component recruiting
    and retention S&I pays total $465.9 million. For fiscal year 2011, we
    have requested this be increased to $480.1 million. This increase is
    due to changing eligible populations, anniversary payments, and the
    addition of retention bonuses for five stressed officer career fields.
    Our S&I pays are critical as we shape the force to meet new and
    emerging missions and support the combatant commanders in today's
    fight.
        The quality of Air National Guard recruits has not declined and
    their retention rate remains strong at 96.9 percent. The Air National
    Guard saves on average $62,000 in training costs for every qualified
    member retained or recruited. Our focus in this area allows us to
    retain critical skills lost from the Active component and save valuable
    training dollars. In 2009, through the use of our 14 In-Service Air
    National Guard recruiters strategically placed at active duty bases,
    the Air National Guard garnered approximately 896 confirmed accessions
    of a total of 5,309 accessions. The bonuses and incentive programs are
    a key component to that success.
        Retention for the Air Force Reserve remains solid with first-term
    airmen retention being the highest in recent history. Likewise, second-
    term and career airmen retention has rebounded following a drop in
    recent years due in-part to force structure changes. Although we have
    not formally studied the causes, we attribute this increase in
    retention rates primarily to the recent legislative authorizations
    congress has approved that enhance incentives to remain in the service
    like inactive duty training (IDT) travel pay, streamlining of TRICARE
    Reserve Select premiums, enhanced bonuses and the Post-September 11 GI
    Bill. We anticipate this positive trend in retention will continue for
    the foreseeable future.
                               civilian personnel
        Management of the civilian workforce will continue to be a priority
    for the Air Force. We are working collaboratively with the Deputy Under
    Secretary of Defense for Civilian Personnel Policy on Strategic Human
    Capital Planning efforts, in particular, to address the provisions in
    NDAA for Fiscal Year 2010 which require reporting by the Military
    Departments. We support this effort that will result in the Air Force
    and the Department of Defense (DOD) having the skills and competencies
    necessary to meet our current and future mission requirements.
        In October, 2009, the President signed into law the NDAA 2010 that
    repeals the authority for NSPS and requires DOD to transition civilian
    employees from NSPS to the appropriate statutory non-NSPS personnel and
    pay system not later than January 1, 2012. The Air Force has
    approximately 44,000 employees in NSPS. We are aggressively planning
    and preparing to transition these Air Force employees in an orderly and
    timely manner. We have begun the process of reclassification of
    positions, where necessary. We will soon issue a conversion plan that
    will inform and assist our human resource practitioners, supervisors,
    managers and employees to understand the transition process and to
    facilitate the transition. The NDAA also provided additional personnel
    flexibilities which we will be pursuing in conjunction with DOD and the
    Office of Personnel Management.
                                   diversity
        Diversity is an integral part of mission accomplishment and success
    in today's Air Force and will remain in the forefront as we continue to
    inclusively attract, develop, and retain highly qualified professionals
    for the betterment of the Total Force. The capacity to educate, manage,
    lead, and train a diverse force is a core competency of Air Force
    leadership. Currently, we are pursuing collaborative diversity outreach
    initiatives with Air University, Civil Air Patrol, Junior and Senior
    Reserve Officer Training Corps, Officer Training School and the United
    States Air Force Academy. Additionally, strategic plans are being
    formalized to utilize the Air Force Diversity Champions to promulgate
    the aims of diversity within the Air Force and the community. Areas of
    interests and emphasis to cultivate and develop future leaders of the
    Total Force will include reaching out to students enrolled in science,
    technology, engineering and mathematics programs in high schools,
    colleges and universities across the Nation.
        As the demographics of the Nation continue to change, the Air Force
    must position itself to optimize the true benefits of a diverse force
    and respectfully request appropriate Congressional funding for the
    sustainment of the aforementioned outreach initiatives. By
    incorporating diversity management leadership principles and strategies
    to leverage the unique qualities and talents of all citizens, the Air
    Force will achieve mission excellence and sustain dominance in air,
    space, and cyberspace.
                              continuum of service
        An important aspect of retention is our ability as a Service to
    allow skilled airmen to easily transfer from one component to another
    providing the Air Force flexibility while retaining valuable skills.
    CoS transforms the operating culture and paradigms to shape the future
    of personnel and manpower delivery throughout the Air Force to meet
    global mission requirements.
        CoS efforts have already positively impacted our Air Force members
    through a number of initiatives. Through our on-line CoS Tracking Tool
    (CoSTT), any airman can submit a proposal for a CoS initiative. Our
    tool was modified for use by the Army and is now being adapted for use
    throughout the Department of Defense. CoS initiatives have already
    improved our joint-spouse PCS process, interservice transfer of rated
    officers and helped facilitate the establishment of the Religious
    Professional Scholarship Program (RPSP) allowing members to attend
    seminary and later return to active duty. The RPSP is designed to help
    fill manning shortfalls within the chaplaincy for underrepresented
    faiths within the Air Force. This program is now being considered for
    utilization by my Navy and Army counterparts. In addition, CoS helped
    modify the chaplain accession age ceiling from 42 to 47.
        Some current Air Force CoS initiatives include: (1) aligning the
    Air Reserve Component pregnancy policy with that of the Army and Marine
    Corps to allow pregnant women to work until her orders expire; (2)
    changing Air Force policy on ``Lawful Permanent Resident'' accessions
    for critical specialties by utilizing current laws permitting the
    appointment of a Reserve Component officer who has been lawfully
    admitted to the United States; (3) evaluating the authority provided in
    the NDAA for Fiscal Year 2009 by considering a ``Career Intermission
    Pilot Program'' to determine whether a more flexible career path will
    prove to be an effective retention tool; and (4) examining the effects
    of changes to Air Force policy that would bring fully qualified
    personnel into stressed career fields faster than traditional methods
    by recognizing the value of nongovernmental experience.
        The Air Force CoS program is an important force multiplier as it
    not only helps our airmen transition between components, but also
    balances people and mission to ensure the right airman is in the fight.
    We greatly appreciate the outstanding support of the Senate Armed
    Services Committee Personnel Subcommittee on many of our CoS
    initiatives.
                               suicide prevention
        Preventing suicide among our airmen is extremely important to the
    well-being of our force. The Air Force developed the basis for its
    suicide prevention program in 1993 and it is one of ten suicide
    prevention programs listed on the Substance Abuse and Mental Health
    Services Administration's National Registry of Evidence-Based Programs
    and Practices. Although this program resulted in a reduction in the
    number of suicides among airmen, within the Air Force we have
    recognized the importance of a multi-faceted approach to meet the
    varied needs of our people. Since the initial program began, we have
    placed a strong emphasis on leadership involvement in preventing
    suicides. Training has been implemented in various professional
    military education curricula to create awareness among Air Force
    leaders and frontline supervisors of behaviors that may lead to suicide
    and to inform leadership of actions they can take to prevent suicide.
    We have identified specific career fields in which the requirements of
    the job place enormous stress on airmen and we are developing targeted
    programs to improve resiliency and encourage airmen to seek help early.
    To facilitate the seeking of mental health services, we have placed
    behavioral health specialists in our primary care clinics.
        Additionally, we emphasize community involvement in suicide
    prevention, combining the efforts of chaplains, family counselors, and
    other non-medical counselors to meet the psychological health needs of
    airmen. Finally, we collaborate with our sister Services, with the
    Defense Center of Excellence for Traumatic Brain Injury and
    Psychological Health, and with the Department of Veterans Affairs to
    identify best practices and continuously improve our existing suicide
    prevention program. Recently, the Air Force Surgeon General took the
    lead in implementing a two-tiered program to create and enhance
    psychological resiliency in deploying and returning airmen. This
    program includes a 2-day decompression program when the airmen return
    from theater. We believe one suicide is one too many and are strongly
    committed to preventing suicides and caring for our airmen.
                     sexual assault prevention and response
        Preventing sexual assault is also a top Air Force priority. Since
    program implementation in 2005, the Air Force has maintained a multi-
    disciplinary approach to addressing sexual assault that supports home-
    stationed and deployed airmen. A robust Air Force response to victims
    includes dedicated full-time civilian and military Sexual Assault
    Response Coordinators (SARCs) and more than 2,600 volunteer victim
    advocates who provide 24/7/365 support. Our robust Air Force Sexual
    Assault Prevention and Response program budget funds 80 civilian and 29
    military officer SARCs at the installation level, who work directly for
    the Vice Wing Commander. Our military SARCs provide a full-time
    deployed capability at seven primary deployment locations. The
    Secretary of the Air Force recently approved the addition of 24 Air
    Force Office of Special Investigations agents trained and dedicated to
    investigate sexual assault. Caring and professional response to victims
    has been a focus of the Air Force program but equally important is our
    focus to prevent the crime before it occurs.
        The primary challenge of addressing sexual assault in the military
    and society at large is to confront a culture where sexual assault is
    allowed to exist. It requires a positive, ongoing effort to educate our
    airmen and others, about the realities of sexual assault, debunking
    myths that continue to be propagated by media and entertainment, and
    maintained by peer pressure or other societal convention. The Air Force
    has developed a prevention-based approach that directly focuses on
    fostering positive behavior that is in concert with our core values.
    The approach includes leadership focus from the top down, risk
    reduction, and bystander intervention training. The later is a strategy
    that motivates and mobilizes people who may see, hear, or recognize
    signs of an inappropriate or unsafe situation, to act.
        We will be working with Dr. Stanley, OSD (P&R), and our sister
    Services, to address the recommendations in the report of the Defense
    Task Force on Sexual Assault in the Military Services. Sexual assault
    is a crime. The Air Force is dedicated to the elimination of this crime
    and we recognize the challenges dealing with this very complex issue.
                          year of the air force family
        In the spring of 2009, the Air Force renewed its longstanding
    commitment to taking care of our airmen and families by designating
    July 2009 through July 2010 as ``Year of the Air Force Family.'' The
    observance serves two primary purposes. Across the Air Force, we
    examined our support services and policies in order to expand or refine
    them as required to meet the emerging needs and expectations of our
    airmen, their families, and the larger Air Force Family. Second, we set
    aside specific time to recognize the sacrifices and contributions of
    all of the members of our Air Force family--our Active, Reserve, and
    Guard--civilians, spouses, and family members.
        We have focused our efforts to ensure we provide robust programs to
    meet the unique needs of our Guard and Reserve members and their
    families. The Yellow Ribbon Reintegration Program is one important way
    we are accomplishing this. The Air Force is working alongside other
    services in this DOD-wide effort to ensure the Air National Guard and
    Air Force Reserve airmen and their families are connected with all of
    the appropriate resources before, during and after deployments. We
    continue to focus on the reintegration phase after returning home and
    ensure that commanders are involved and aware throughout. We continue
    to improve our effectiveness and relationships with other associations
    such as the Department of Veterans Affairs and the Department of Labor
    in providing current and relevant information to members. The Air Force
    remains focused on airmen and their families and will ensure the
    oversight and success of the Yellow Ribbon Reintegration Program.
        Additionally, we are ensuring the Year of the Air Force Family does
    not overlook our ``extended Family'' our retirees, parents and the
    nongovernmental and community partners that support Air Force people
    every day across the Nation. We are using this year long period to
    launch our sharper focus on improving support to airmen and families.
    Under Secretary Donley's leadership, our concerted attention on
    providing the support that results in stronger, more resilient airmen
    and families will remain a priority in the years to come.
        In April 2010, we will hold a Caring for People Forum that will
    bring together helping professionals, airmen, and family members to
    develop an action plan to address the pressing and longer term concerns
    of airmen and families which will be briefed to senior leadership at
    the end of the forum.
        We are working to strengthen all of the partnerships that
    contribute to the quality of life for our members. These will include
    close rapport with local school districts (to enhance quality education
    and garner on-site support for children impacted by repeated
    deployments), housing privatization projects and agreements between our
    bases and city or county services.
                       wounded warrior and survivor care
        The Air Force Wounded Warrior program focuses on the needs of
    recovering airmen and their families, as well as families of the
    fallen. We now have 17 Recovery Care Coordinators (RCC) in 15
    locations, with an additional 10 RCCs being hired this year. Our RCCs
    are the primary point of contact for our wounded, ill, and injured
    airmen and ensure the health care, financial, informational, and
    personal needs of airmen and their families are available in a timely
    manner. Because of the range of questions airmen and families have
    after an injury or illness has incurred, it is critical to the healing
    process to have relevant and accurate information available to our
    airmen. Recovery Care Coordinators are in place to ensure those
    knowledgeable in medical and other areas of expertise are available to
    provide the requested information. This assistance is provided for as
    long as the airmen and families want assistance during recovery,
    rehabilitation, and reintegration. The Air Force also continues to work
    closely with the Office of Wounded Warrior Care and Transition Policy
    in the Office of the Secretary of Defense to ensure our programs
    continue to support all wounded, ill, and injured servicemembers. It is
    our solemn duty that these airmen receive the utmost support and care.
                                   conclusion
        I am continually impressed, but not surprised, by the tremendous
    hard work and focus our airmen display daily as they accomplish their
    missions. I am dedicated to providing them the best programs and
    support, removing any policy barriers and pursuing innovative ways to
    streamline our processes to allow them to be even more effective. Our
    Air Force is a critical component to our Nation's defense as we are
    faced with uncertain and ever changing threats.
        We appreciate your unfailing support to the men and women of our
    Air Force, and I look forward to your questions.

        Senator Webb. Thank you very much.
        I thank all of you for your testimony.
        I think what I would like to do is--since I took a good bit
    of time in my opening statement, I think I would like to just
    start with an 8-minute round, and Senator Graham could begin,
    and then we could go to Senator Hagan and Senator Begich, and
    then I'll follow on after you.
        Senator Graham. Well, thank you, Mr. Chairman.
        Secretary Stanley, when it comes to the personnel part of
    the budget, we're going to grow the Army and Marine Corps. I
    think we need to. The healthcare component--how do we get a
    grip on this? What are some ideas that you all are talking
    about there?
        Dr. Stanley. Well, Senator, in my 3 weeks, we haven't
    really talked a lot about details on----
        Senator Graham. You mean, you haven't fixed this in 3
    weeks? [Laughter.]
        Dr. Stanley. What we have done--in fact, the very first
    thing I did--and I think we would--working with Congress even
    then--was to bring someone over with the skills and qualities
    to at least fill the position temporarily while we wait on the
    person, who is to be confirmed at some point in the future, to
    work with. And so, this has been an actual priority from day
    one, actually, because we recognize the healthcare costs.
        Senator Graham. Okay, well, that's fair--and
    congratulations, to all of you, by the way, for having your
    job. This time last year we were looking for people like you,
    and now we have them.
        The idea of the Guard and Reserve recruitment and
    retention--with the economy like it is, it's a good time for
    the military, but I think the economy's going to get better--I
    hope it will, and I'm sure it will eventually--TRICARE benefits
    for the Guard and Reserve--I'd just like to get your impression
    about how that program has worked, from each of the Services.
    Secretary Stanley, how is it being received by our Guard and
    Reserve Force, that they are now eligible for TRICARE? They
    have to pay a premium.
        The second issue, what effect do you believe it would have
    if we allowed people to retire at 55 if they would do more
    Active Duty service--earn their way from 60 to 55?
        Starting with Secretary Stanley.
        Dr. Stanley. Well, Senator, I know that, the TRICARE
    programs, all of those programs are under review right now
    because it's all a part of the gestalt of looking at all of
    healthcare. I don't have answers for you today.
        Senator Graham. Okay.
        Dr. Stanley. But, we look forward to working with Congress
    on that.
        Senator Graham. From the Services' point of view, what are
    you hearing from the Army, the Marines, and the Air Force?
        Mr. Lamont. From the Army's perspective, TRICARE Reserve
    has gone over very well. But, we're finding, among particularly
    our Reserve component, they don't fully appreciate or are
    educated enough to understand its availability to them. We
    think it's incumbent upon this to broaden that perspective so
    they avail themselves of what's out there.
        It's an excellent program, and it's a wonderful incentive.
    On the Reserve side, we may also, at some point in time, need
    to look at some potential other incentives, from the healthcare
    side, as we continue operationalizing the Reserve. But, it's a
    resource issue, of course, as well, for all of us.
        Senator Graham. Okay.
        Secretary Garcia?
        Mr. Garcia. Senator, I have the opportunity and the honor
    to continue to serve in the Reserves, and had a Reserve
    squadron, until coming to take this appointment. I will tell
    you the--among those circles, the program is--there's a lot of
    awareness of it, and it's very popular.
        The piece that many members have read about, and are very
    interested in, is what's been called the ``gray area'' piece;
    that is, for retired reservists, not yet 60, being able to
    access TRICARE Select and some of those programs before their
    retirement.
        As Secretary Lamont said, there's a price tag that comes
    with that. I look forward to wrestling with that, with you.
    But, I can tell you that, among my circles, on the Navy and
    Marine side, it's very popular and well thought of.
        Mr. Ginsberg. Senator, TRICARE Reserve Select is a very
    well-liked program. We have good participation rates, as I
    understand it, within the Air Guard and Air Reserve. It's not
    just a benefit, it provides a tool to our airmen to make sure
    that they're medically ready for deployment.
        One of the challenges we need to look at this
    systematically--is whether--the health of the provider network,
    and whether maybe a stand-alone Air Guard base, whether we have
    a sufficient network in place, or we're taking imbursements.
    It's something we want to look at to ensure that this program
    is moving along helpfully.
        Senator Graham. Well, one last question. The sexual
    harassment, sexual assault problem is being better identified,
    and the number of reported cases is growing, which I think is
    probably an indication, not that there are more activity, it's
    just getting easier to report it, and people feel more
    confident about reporting it. But, we're not nearly where we
    need to be.
        Just very quickly, from each Service's perspective, what
    are you doing in that regard to enhance the ability of a
    servicemember to report sexual harassment or assaults in a way
    they feel will not be detrimental to their career?
        Mr. Lamont. From the Army perspective, we're looking at it
    from a couple of different directions. First, we want to make
    it easier for them to report. We have initiated programs that
    allow for the confidentiality of the report. Plus, we're also,
    as I think we----
        Senator Graham. In that regard, do we need to look at
    changing our laws? Because there's a lot of privileges
    available maybe in the civilian side, not available to military
    members. I know you have a priest-penitent privilege and
    limited medical privilege, but just look at that and see if
    there are some changes we need to make on the Personnel
    Subcommittee to expand privileges to healthcare providers. I'd
    just----
        Mr. Lamont. All right.
        Senator Graham. Okay.
        Mr. Lamont. Otherwise, as we try to build resilience within
    the force, particularly on our Sexual Harassment/Assault
    Response Prevention situation, we have initiated a program
    called ``I. A.M. Strong''--``I'' being ``Intervene,'' ``A''
    being ``Act,'' ``M'' being ``Motivate.'' Though it's a command-
    oriented climate that we're trying to address, that would
    respect the dignity of all of our soldiers, we've looked for
    this ``I. A.M. Strong'' program to educate and train our
    soldiers, on a peer-to-peer basis, to remove any stigma of
    going forward to make those reports.
        We believe it's working, at least as we've seen the number
    of reports increase. We still believe, unfortunately, that only
    roughly a third of sexual assaults are being reported.
        Senator Graham. Thank you.
        Mr. Garcia. Senator, Secretary Mabus has stood up the
    Sexual Assault Prevention Response Office. The dedicated
    officer--civilian SES--reports directly to him for the first
    time and a network of Sexual Assault Response Coordinators
    (SARCs) implemented in each unit across the fleet. As you
    indicated, we are seeing a rise in reported incidents. The
    challenge is to discern whether that's availability to
    reporting or whether it's a true spike in incidents. It's
    something we wrestle with every day.
        Mr. Ginsberg. Senator, I think from the Air Force
    perspective, this is an issue of leadership, it's an issue of
    investment, and it's just a leader--an issue of communication.
    Leadershipwise, it's about showing from the highest levels on
    down, that sexual assault absolutely won't be tolerated and
    that from our perspective, goes against everything--all of
    those core values that we hold dear.
        It's about putting in money for a strong, baseline program,
    a good, strong, healthy organization, along with funding for
    investigations, and very active and aggressive investigations.
    It's also a matter of just making sure that those who are
    victims know that their resources and reporting channels are
    available to them. We have an ability for somebody who is a
    victim to come forward and provide limited information about
    what happened so they'll come forward. It's called restricted
    reporting, and that's provided a useful channel for victims.
        Senator Graham. Thank you, all, for your service. I'm going
    to have to run to another hearing, but I shall return.
        Senator Webb. Thank you very much, Senator Graham.
        Senator Hagan.
        Senator Hagan. Thank you very much, Mr. Chairman.
        I do, too, want to thank all of you for your service to our
    country. I really do appreciate it.
        Secretary Stanley, you mentioned, in your opening remarks,
    about the Military Spouse Career Advancement Account--as it's
    being referred to MyCAA--and about the stop in the
    implementation of it. I have a serious concern with that,
    because, one, neither Congress nor the people who were
    beneficiaries of this program were given any sort of upfront
    notification about any of the problems that were being seen in
    the program. This pause has certainly caused a lot of concern
    to many people in my State, in North Carolina, because it's an
    excellent program and a lot of people are taking advantage of
    it. I think the uncertainty that's been put forth right now has
    resulted in the Department's decision--has certainly negatively
    impacted and affected the morale of our servicemembers and
    their families. It certainly has had, I think, an adverse
    impact on family readiness.
        But, one of the questions I have in the President's fiscal
    year 2011 budget, which reflects increased funding for this
    enhanced career and educational opportunities, does it address
    the longer-term needs of the program?
        Dr. Stanley. First of all, we are addressing the concerns,
    short-term and long-term. The Secretary is now, at this time,
    making a decision, looking at options that have been presented
    to him. But I will say that there are still some unanswered
    questions on long-term, but I feel confident that they're going
    to be addressed. I certainly share your concern about what's
    happened, in terms of the program being stopped. I understand
    that.
        Senator Hagan. Well, the lack of notification was certainly
    alarming too, I think, Members of Congress and the people who
    were the beneficiaries.
        As far as improving the implementation of the program, do
    you need more specialists on staff to help with that? Or is
    that some of the things you're looking into?
        Dr. Stanley. Actually, in my arrival--just to be very
    blunt.
        Senator Hagan. Okay.
        Dr. Stanley. I was sworn in on the 16th, and I learned
    about it on the 16th.
        Senator Hagan. Wow.
        Dr. Stanley. So----
        Voice. Welcome aboard. [Laughter.]
        Dr. Stanley.--I'm going to----
        Senator Hagan. Wow.
        Dr. Stanley. So, we're addressing the issues dealing with
    MyCAA----
        Senator Hagan. Okay.
        Dr. Stanley.--as we move forward. I'm very optimistic about
    it working out okay.
        Senator Hagan. Okay.
        Another question, concerning the Census. I'm concerned that
    servicemembers that are deployed during the conduct of the 2010
    Census will be counted in a negative way that impacts the
    communities that host military installations. For the 1990 and
    2000 Census, the decision was made to count deployed
    servicemembers as overseas.
        North Carolina currently has approximately 41,200
    servicemembers deployed as a part of the overseas
    contingencies, and in the event that they are counted as
    prescribed by the Census Bureau, areas with large
    concentrations of military personnel, I believe, will be
    significantly undercounted and underfunded for the next 10
    years.
        What's preventing the Defense Manpower Data Center from
    providing the Census Bureau with information regarding the base
    of last assignment or permanent U.S. duty station as the
    primary response for our deployed servicemembers that are
    currently engaged in overseas contingencies?
        Dr. Stanley. Senator, I'm going to ask to take that
    question for the record.
        Senator Hagan. Okay. That's fair.
        Dr. Stanley. Because I'd like to get back to you with a
    very specific----
        Senator Hagan. Okay.
        Dr. Stanley.--and correct answer.
        [The information referred to follows:]

        This issue falls under the purview of the Census Bureau, and we
    must follow its guidance on how to count our personnel. The Census
    Bureau, in turn, is following what it perceives to be existing
    Congressional guidance.
        We are aware of no law specifying how to count military members
    deployed overseas. The Census Bureau is using a bill passed in the
    House in 1990, H.R. 4903, as the methodology for counting overseas
    servicemembers and their accompanying dependents. This current
    methodology, used in 1990 and 2000, counts overseas military personnel
    in this order (where the data is available): State home of record,
    State of legal residence, and State of last duty station (i.e., base of
    last assignment).
        The Department recognizes the decision to use the current
    methodology will result in overseas military personnel being assigned
    to a home State without counting them toward the populations of towns
    or counties. We also understand counting ``last duty station'' first
    would have a beneficial effect on States with a large military
    population. We have discussed with the Census Bureau methodologies
    other than using ``home of record'' first, and these methodologies
    might provide a more accurate snapshot of the current residence of the
    military personnel and also the desired town and county specificity.
    However, the current methodology does have the benefit of consistency
    over time.
        The Department stands ready to discuss all possible methodologies
    with the Census Bureau. We also look forward to continuing to work with
    Congress on this important matter.

        Senator Hagan. Well, let me go to one other one. We were
    talking about suicide. One of you referred to that. So,
    Secretaries Lamont, Garcia, and Ginsberg, I think we have
    witnessed an unacceptable number of suicides within our
    military population, and some of these losses, hopefully, could
    have been prevented if servicemembers had the ability to access
    professional care during the early stages of emotional
    distress. I'm sure we all agree that we have to reduce those
    numbers. What measures are being taken within the Services to
    ensure that our military men and women receive and gain easier
    access to mental healthcare without being stigmatized--that's,
    obviously, sometimes associated with that--and with going
    through the chain of command?
        Secretary Lamont?
        Mr. Lamont. First, you're absolutely right, we take the
    loss of any soldier, through any means, very, very seriously.
    It truly is one of the very highest priorities that we have. We
    look at it from early identification of risk factors, as well
    as early intervention when we recognize those risk factors, to
    move in and encourage, as best we can, to have those
    individuals who may exhibit those risk factors to seek out
    help.
        We have instituted a program designed to reduce the stigma
    of reaching out for mental health care. Actually, what we're
    finding out with some of our younger soldiers, who, for
    whatever reasons, do not wish to meet personally with a
    healthcare provider, for instance--we have a software program,
    that they go online and they self-address----
        Senator Hagan. Right.
        Mr. Lamont.--their issues. It's become a very valuable tool
    for us. But, it's going to take a lot of effort.
        Also, we clearly have to address the resiliency side, and
    we're making our effort to do that through a program called
    Comprehensive Soldier Fitness, where we explore, not only just
    the physical health, but the mental, the emotional and the
    spiritual well-being of the soldier, as well, to build that
    mental health resiliency as best we can to address the issues
    going on in his or her life.
        Senator Hagan. Thank you.
        Mr. Garcia. Senator, I appreciate your question. For the
    first time, last year, our Marine rate approached that of the
    national rate; we normed for age and gender. It's an issue we
    brief daily and constantly look for a correlation that we can
    zero in on.
        We focused much of our training at the NCO level. We feel
    that they have the most insight and perspective to what our
    young sailors and marines are wrestling with, those issues. But
    every marine, every sailor receives training and is made aware
    that they have access to master's-level counseling. It is
    confidential unless, in the aftermath of that training, the
    counselor feels that the individual is suicidal, homicidal, or
    is unfit for duty. But, everyone is aware of it from boot-camp
    level on.
        Senator Hagan. Do you think these things are making a
    difference in the attitude and the health of our men and women?
        Mr. Garcia. I think there is a----
        Senator Hagan. Great.
        Mr. Garcia.--undeniably, a new level of awareness from E-1
    to O-10. I've seen the training that takes place at Marine Boot
    Camp, at Marine Corps Recruit Depot. It's the first time where
    a Marine drill instructor to--a new boot camp marine sees that
    drill instructor take his cover off and address him personally,
    in a way that he has not, yet. It speaks to the importance and
    the significance, I think, that the Corps and the Department
    are placing on this.
        Senator Hagan. Okay.
        Mr. Ginsberg. Well, Senator, obviously it's a tremendous
    tragedy even when one servicemember takes their life. We pride
    ourselves, in the Air Force, being a family, and when one feels
    so alienated that it becomes a major problem at the highest
    reaches.
        This is a matter--this goes to our staffing--our capacity
    levels, in terms of having enough psychiatrists and trained
    psychologists. We, in the Air Force, are doing well, but
    obviously there's tremendous competition with the private
    sector for trained psychiatrists and trained psychologists. The
    bonuses that you provide us are absolutely essential for us to
    grow our force and to bring in psychiatrists and trained
    psychologists.
        I'd also say that this is--and to address the stigma, one
    of the things that we're doing in the Air Force is to locate
    our mental health clinics within military treatment facilities,
    within regular divisions within the hospital, basically, where
    somebody who's going in to get treatment is not seen as going
    to some special clinic, but is just part of--accessing regular
    care. We want to normalize care.
        Senator Hagan. That's good.
        All right, thank you, Mr. Chairman.
        Senator Webb. Thank you, Senator Hagan.
        Just to follow on for a moment on that line of questioning,
    I believe you could show--and, in fact, the Chief of Staff of
    the Army recently brought me a chart to this effect--that there
    is a direct correlation between dwell time--the amount of time
    that people have between deployments--and the percentage of
    emotional difficulties that are in these units. That's why I
    introduced this dwell-time amendment in 2007. When the Chief of
    Staff of the Army called me and said they were going to 15-
    month deployments, with only 12 months dwell time back in the
    United States before they redeployed--having spent 4 years as a
    committee counsel over in the House Veterans' Affairs
    Committee, when we first started examining the difficulties of
    people who had served in Vietnam, first of all, I said, ``I
    can't believe you're going to do that. I don't think there's
    any operational requirement that should cause you, at this
    point in our history, to put that kind of pressure on our
    people. You're going to have challenges on the other end of
    doing this.'' Quite frankly, we're seeing that.
        All of your responses basically go to the means--and I
    salute these means--of addressing the situation once it occurs,
    but I don't think there's anything more valuable than putting
    the right kind of dwell time on our units. Particularly, when
    you look at the young age of the people who are doing these
    multiple deployments, and where they are in terms of addressing
    issues of adulthood.
        Mr. Lamont. If I may----
        Senator Webb. Mr. Lamont, do you want to----
        Mr. Lamont.--just add a comment to that. We have any number
    of programs that are well intentioned, well resourced, it
    doesn't matter. There is nothing more important than exactly
    what you say--is the dwell time of our soldiers, with their
    families and others, that will help them decompress and serve
    them so much better in this kind of situation. It is dwell
    time.
        Senator Webb. I totally agree. Thank you for saying that.
        Senator Begich.
        Senator Begich. Thank you very much, Mr. Chairman.
        I want to talk about TRICARE for a second, but then I
    actually want to get back to the SARC. In Anchorage, in
    municipal government, we call it SART, a very similar program,
    I think, but I want--that's what I want to ask you.
        But, Secretary Stanley, let me--I represent Alaska. It's
    very unique when it comes to TRICARE. It's the one that is not
    managed by a contractor, out of the whole system. We have some
    very unique situations. Alaska's population, in total, is--
    about two-thirds has Federal healthcare in some form or
    another: Medicaid, Medicare, Indian Health Services, VA,
    Federal employed. So, it's probably the highest percentage, I
    would bet, or per capita, in the country. So, it has some
    unique challenges. Then, geographically, the geography of
    Alaska is very vast, and so we have some great challenges.
        I have introduced a piece of legislation to set up a task
    force for Alaska to bring all the different agencies that deal
    with healthcare and TRICARE as part of that--and DOD would be
    at that table--to try to figure out what's the best way to
    deliver services. I don't know if you've had any chance to see
    that legislation, have any comment on it. If you haven't seen
    it yet, I'd be anxious to get your comment for the record, at
    some point, if you think the task force will be of help for
    something very unique, I think, in Alaska. I don't know if you
    have any comment on that.
        Dr. Stanley. Yes, Senator. I haven't seen the legislation,
    but I've seen what I can best describe now are anecdotal pieces
    of information that tell me, in Alaska, we have some unique
    issues that deal with healthcare, as you've already described.
    So, I look forward to not only looking at the legislation, but
    working very closely with you to address some very significant
    issues.
        Senator Begich. Great, I would love to get your response
    for the record, I appreciate that.
        [The information referred to follows:]

        Since two-thirds of Alaskans use a Federal health care program,
    creating an interagency task force \1\ would be helpful in working
    together to assess and plan improvements to health care access for our
    Alaskan beneficiaries in a coordinated manner. TRICARE has tested
    alternate means of reimbursement and other Alaska-unique initiatives to
    improve access to care, and we are happy to discuss our findings with
    the task force and learn the successes other Federal agencies have
    experienced as they face the unique challenges Alaska presents.
    ---------------------------------------------------------------------------
        \1\ Note: The creation of the Interagency Access to Health Care in
    Alaska Task Force was mandated by section 5104 of H.R. 3590, the
    Patient Protection and Affordable Care Act (P.L. 111-148 (124 Stat.
    119)).
    ---------------------------------------------------------------------------
        Our TRICARE Regional Office-West team has already begun engaging
    other Federal partners in Alaska in anticipation of establishment of
    the interagency task force. We look forward to discussing a potential
    rate schedule that recognizes the uniqueness of the health care system
    in Alaska.

        Senator Begich. The other thing I want to say--and the
    folks from the Federal Government that have been working on the
    TRICARE, that have been managing it for us, have done a great
    job. But, I'm also very pleased to see that there is kind of a
    reexamination. How would a contractor work? Would there be a
    benefit? Is there some advantage, or maybe not advantage,
    depending on how it's all looked at? So, I am pleased with
    that, and that perspective, and I want you to know that. But,
    do you have, from your view, working with TRICARE contractors,
    what would you consider some of the advantages that you have
    seen in the value of delivering that healthcare? From a
    contractor delivering it, versus the way it's done in Alaska?
        Dr. Stanley. I'm afraid my answer would probably be
    personal, only because----
        Senator Begich. Personal is sometimes better.
        Dr. Stanley.--I'm a recipient----
        Senator Begich. Very good.
        Dr. Stanley.--of TRICARE benefits and the contractor, and
    from what I've benefited from. It's been pretty transparent to
    me, in being able to use a system that works very well. But, I
    don't think that's going to address some of the macro issues
    we're talking about. I'm also aware of the fact that there are
    some, already, challenges that exist with the TRICARE system as
    it's presently presented, with our contractors as we address
    contracting issues. So, I'm looking into those issues now, but
    I will tell you that there are some pluses--some significant
    pluses--but, there are also some--probably some negatives
    that--as we look at that. But, I don't know what all of those
    are right now.
        Senator Begich. As you develop that, will you share it with
    the committee?
        Dr. Stanley. Absolutely.
        [The information referred to follows:]

        TRICARE-eligible beneficiaries make up almost 14 percent of the
    overall population in Alaska. In recognition of the challenges placed
    on military treatment facilities, we are working with TriWest, the
    TRICARE West Regional Contractor, to develop a preferred provider
    listing which would aid in providing more access to civilian providers.
    Our regional contractors are experienced in the identification and
    credentialing of qualified providers who are willing to provide care to
    our beneficiaries. In the future, we plan to identify primary care
    managers in the civilian community in the Fairbanks area to support
    beneficiaries assigned to Fort Wainwright and Eielson Air Force Base.

        Senator Begich. At least my side would be very interested
    in that.
        Dr. Stanley. I'll look forward to it.
        Senator Begich. Then, again, as we examine the role of
    TRICARE, the contractor who delivers TRICARE, as a potential
    option or augmentation to what we do in Alaska, I'm going to be
    very interested as we move through this over the next several
    months.
        Two other things. One more on TRICARE, and that is, one of
    the situations--and I use Alaska, obviously, because I
    represent Alaska--one of the things we do, if you take
    Medicare, Medicaid, TRICARE, Indian Health Services, VA, we're
    always chasing the highest rate, the reimbursement rate. Now,
    the problem we have in Alaska is, we have very high rates, no
    matter what. I mean, it's just delivery of care, that cost of
    care. We don't have a teaching hospital, for example. We lack a
    lot of things that other communities can tap into and,
    therefore, keep their costs more competitive. Ours, we've been
    very high-cost in. But, we've also been very fortunate,
    because, under the rules, you've been able to--DOD and--or, the
    Federal Government has been able to utilize, under a
    demonstration ability, to have a higher-rate reimbursement in
    Alaska. It's only been in a demonstration capacity they've been
    able to do it. Obviously, we're very interested. I know there's
    a study going on, or at least a potential study, that will talk
    about how those rates are different; and if they are, how do we
    make them more permanent? Because, obviously, doctors--and I
    think some of the comments made here is getting those doctors
    to perform those services under TRICARE. The reimbursement rate
    is critical.
        In Anchorage, for example, which is the largest provider,
    or largest city--about 43 percent of the State's population--I
    think we're down to--on Medicare, for new Medicare patients, I
    think we're down to less than three or four docs that will
    accept them. That's it. So, we are the tip of the iceberg of
    what's going to happen in this country, very rapidly, because
    our cost differential is now getting to a point where primary-
    care doctors can't afford to do it; and second, there are less
    and less of them being produced, in the sense of the system.
        So, I would like, if you have any comment on, one, the
    demonstration project. Again, if you're not familiar, I'd be
    very interested. Then, how we go about getting some permanency
    to this, because when docs see a pointer that's not permanent,
    then they just say, ``We're just done waiting, we have to move
    on to others,'' honestly, business has to continue for what
    they do. So, do you have any comment on that? The demonstration
    project, how do we move it to permanency, and is that a
    realistic viewpoint?
        Dr. Stanley. Well, thank you, Senator.
        Let me just say that I've been briefed on the project, in
    general.
        Senator Begich. Good.
        Dr. Stanley. My commitment is to work closely with you, not
    to study the problem to death----
        Senator Begich. Now you're talking. [Laughter.]
        Dr. Stanley.--but to move forward with a solution.
        Senator Begich. Good.
        Dr. Stanley. So, I'm aware of it. Now the issue is, okay,
    addressing this on the degree of permanency, which is why I put
    in place someone to help--with expertise, immediately--that's a
    physician--until we get somebody confirmed. I can't wait that
    long.
        Senator Begich. Right.
        Dr. Stanley. Which is the reason we're moving, kind of,
    like at flank speed, for lack of a better word----
        Senator Begich. Good.
        Dr. Stanley.--to put things in place and address these
    issues. There are other issues, too.
        Senator Begich. Absolutely. We would love to see
    confirmations happen very rapidly, but don't wait for that.
    Move forward on progress, and I appreciate your comments.
        I will end, Mr. Chairman, just on one--and this is more of
    a comment to the--as a former mayor, we worked on a project
    called SART, which is Sexual Assault Response Team, which is a
    combination public service, police--and they all are
    centralized into one location. They work with the community
    hospitals. It's good for investigation purposes. It has a kids'
    unit. It has a variety of things that--one of the pieces to
    this equation--and I haven't asked the--and I'm not asking for
    a response, at this point. I just want you to become aware, if
    you can, with what we're doing in Anchorage, which is the SART
    team.
        Why I say that, there's a very important component of how
    the person who has been the victim works through the process,
    and how that's handled, which is critical to your
    investigations, conviction rates, as well as to the care that's
    necessary. Then, if there are family members engaged in this,
    in the sense of a child who's also been assaulted, there's a
    whole process that is much different than the adult process.
        The SART program has been recognized around the Nation as a
    very cohesive and--like you, we saw rates go up, in the sense
    of reporting, but we also saw conviction rates go up, education
    capacity increasing--and young people, children especially,
    which is probably the hardest to deal with, with sexual assault
    or violence in a household or in a home.
        I'd just ask you--and we'd be happy to supply you some
    information--it's very unique and has been very, very
    successful. In Anchorage, we have two large military bases,
    literally as far as that door is from our facilities and our
    population. We have a great relationship with the military
    that--we know this program has had some impact.
        So, I'd just encourage you, as you work through this very
    troubling issue, to be very frank with you, but one we have to
    deal with, not only from a sexual assault on the officer, but
    also so many families are now part of the military family that,
    30 years ago, was not the case, but today, it's 70 or 75
    percent of the families. So the kids of this population, also,
    we need to make sure they're getting the services they need,
    and education they need. So, I would just encourage you to----
        Dr. Stanley. Will do, sir.
        Senator Begich. Okay, and we'll get you some information
    from staff.
        Dr. Stanley. Great. Thank you.
        Senator Webb. Thank you very much, Senator Begich.
        Senator Chambliss.
        Senator Chambliss. Thank you very much, Mr. Chairman.
        Gentlemen, first of all, let me just say that I want to
    thank all of you for what you do. You're charged with managing
    the most important aspect of our military, and that's the
    people and the programs that support them.
        I know much of what you do deals with numbers, but I also
    know you have an appreciation for what those numbers represent,
    in terms of the individual and his or her family, and what it
    means to our Nation.
        You all, along with our second panel, will help give us a
    sense of how we're doing, and how we can best continue to
    support the men and women of the Armed Forces and their
    families. So, I thank you for being here.
        Secretary Ginsberg, it's always great to see a Georgian on
    a panel like this--
        Mr. Ginsberg. It's my honor to be here. Thank you, Senator.
        Senator Chambliss.--so thanks for your service.
        Secretary Stanley, let me just ask you if you are familiar
    with the situation of the commissary at Dobbins and the one
    that we're transferring from Gillem to Dobbins. Does that ring
    a bell at all with you?
        Dr. Stanley. Vaguely. If you keep talking, Senator, I think
    I might pull something up, here. [Laughter.]
        Senator Chambliss. I'm not surprised that you don't, but--
        Dr. Stanley. Okay.
        Senator Chambliss.--basically, a BRAC decision was made to
    close Fort Gillem, in Atlanta, and that's the commissary that
    has served our retired population for decades. A decision was
    made, by your predecessor, to construct a new commissary at
    Dobbins that obviously will continue to operate, and it's going
    to serve our retired population. And it's in the hands of DeCA
    right now. That's why I'm not surprised you're not familiar
    with it. But, I wish you would familiarize yourself with it. At
    some point, you're going to have some significant input into
    it, and it may just be an issue of DeCA trying to find the
    funding for it. But, in any event, it is obviously a critical
    issue for the retired population, as well as for our active
    duty folks in the area.
        Dr. Stanley. Yes, sir.
        Senator Chambliss. Secretary Lamont, in light of the Fort
    Hood incident last November, can you elaborate on specific
    steps that the Army is taking to better recognize the presence
    of soldiers who may have become radicalized, as Major Hasan
    was?
        Mr. Lamont. I can tell you this. We are going through a
    very extensive internal review to look at all components of
    extremism that may have crept into society and, of course, may
    touch more and more into our Military Services, and what we can
    do to address those. We're aware of some apparent shortcomings
    in our officer evaluation forms and in our enlisted
    evaluations, and how some of the right questions may just not
    get asked. Some of the identifying risk factors may not just be
    exposed, as well.
        There is a Defense-wide Fort Hood review in progress right
    now. As I understand it--and perhaps Dr. Stanley knows more
    than I--that perhaps sometime this summer there will be a full
    report, as all of the Services, I believe, are involved in that
    report. But, certainly the Army is drilling down very deeply to
    see, what in the world did we miss here?
        Senator Chambliss. Let me just mention to all of you--I
    think Senator Graham may have mentioned this in his opening
    comments--the Guard and Reserve retirement initiative, early
    retirement initiative, that we have been successful at having
    put in place, that we're now looking to extend the retirement
    date back to service beginning on September 11, 2001. If there
    are any stumbling blocks out there, I would appreciate hearing
    from you now, if you're aware of anything. Obviously, funding
    is an issue. We're going to continue to work that until we,
    ultimately, have that retirement date, or that service date to
    qualify for retirement, go back to September 11, 2001, when so
    many of our men and women began being called up. Any comments
    any of you have, relative to any issues that are outstanding,
    that might be in our way on that issue?
        Dr. Stanley. Senator, I hadn't heard anything, I'm not sure
    if my colleagues have.
        Mr. Lamont. I've heard very little.
        Senator Chambliss. Okay.
        Mr. Lamont. But, as you say, the number one thing that we
    always look on something like that, of course, is the resource
    concerns----
        Senator Chambliss. Yes.
        Mr. Lamont.--as you are well aware.
        Senator Chambliss. Yes. Well, we'll continue to work that
    from our end.
        One other question. Secretary Lamont, I understand that the
    Vice Chief of Staff of the Army is currently hosting an online
    virtual conference regarding the future of the U.S. Army
    Officer Corps. The central premise behind this virtual
    conference is the recruitment and employment of talent within
    the Army. This sounds like a great idea, and a great way to
    look at the caliber of the young men and women who are--who
    make up our officer corps, from flag officers on down--could
    you give us any comment on that? Are any of the other Services
    doing something similar to this, or have plans for it?
        Mr. Lamont. Well, I understand the goal of what the Vice
    Chief is after, here. Our officer structure is not where we
    need it to be, given some of the demands that we've had over
    the past 8 or 9 years, and as we've moved to our modular
    rotational model in ARFORGEN, it has caused some fairly serious
    changes in how our officer structure is handled.
        I think there is an effort out there, particularly in the
    grades of major, for instance, or that--there are serious
    shortcomings there, in the numbers that we have available. I
    think these--through--what he is trying to do is look for any
    acceptable options and alternatives to how we identify our
    officer corps, and where we can move them within the structure
    that's available now, our other grade challenges, grade-plate
    challenges, that we have.
        Mr. Ginsberg. I'm not familiar with the program, but we
    work very closely with the Army. I'd love to reach out with my
    colleague, here, and learn more about it. Certainly provide
    some formal views to you.
        Senator Chambliss. Okay.
        Secretary Garcia, Secretary Stanley, anything going on in
    your branch, similar to this?
        Dr. Stanley. I'm not familiar with the program. I'm, in
    fact, learning about it as he's talking, Senator.
        Senator Chambliss. Yeah. Well, it does sound like a good
    idea, because everybody has the same issues, relative to the
    makeup of our officer corps. The Army and the Marine Corps, I
    guess, have a little bit different situation, just because
    you've been taxed more than anybody else, but it is an issue
    that sounds to me like it has a lot of merit to it, and I would
    encourage every branch to follow suit, there.
        Thank you, Mr. Chairman.
        Senator Webb. Thank you, Senator Chambliss.
        I'm going to ask a couple of service-specific questions,
    and then, Secretary Stanley, I'd like to ask you a series of
    questions.
        Let me say, I was a boxer for 8 years. You've been bobbing
    and weaving for an hour and 15 minutes, here. [Laughter.]
        So, I'm going to ask you a series of questions to sort of
    get us all looking forward, since you just came to this job and
    I just assumed the chairmanship. But, first, I want to put
    something in front of the Service Assistant Secretaries.
        There was an article in Military Times last week on
    prescription drug use in the military. I don't know if you all
    saw that article, or not. But, it pointed out that one in six
    servicemembers is on some form of psychiatric drug; 17 percent
    of the Active-Duty Force, and as much as 6 percent of the
    deployed troops are on antidepressants; and the use of
    psychiatric medications has increased about 76 percent since
    the start of these current wars.
        First, I would like to express my appreciation to Senator
    Cardin for having brought this issue to the attention of people
    here in the Senate. But, these statistics, quite frankly, are
    astounding to me. I'd like to know if--how familiar the three
    Assistant Secretaries are with this issue inside your
    departments, and what your thoughts are. Is this an indication
    of the overall fatigue of the force, with these constant
    deployments, or is it an indication of a different approach to
    medical treatment? Are we on top of this?
        I know that last year there was a provision in the Defense
    bill to require the Department to report on the administration
    and prescription of these drugs.
        But, Secretary Lamont, let me start with you. What are your
    thoughts on this?
        Mr. Lamont. Well, I'm not specifically aware of the article
    you're speaking about. I was TDY last week. However, I am well
    aware of the concerns we have with our pain management program.
    Those are the prescription drugs that we have found to have
    really crept into our system in much wider usage than we were
    ever aware of before.
        I'll also suggest to you, drugs like Oxycontin, I
    understand is used both in pain management and as an
    antidepressant. That's caused a number of concerns, because--
    the fear that they may be prescribed by separate healthcare
    providers.
        What we have done to try to address the pain management
    side, what we found was, depending on where you went for
    treatment, there could be an entirely different model, if you
    would, of how pain is treated and how pain drugs are
    prescribed. There was no consistency there. So, with the
    various Services, we began a joint task force, this last fall,
    which is due to report, at any date now, on how we can come
    together with some kind of consistency in how we handle our
    pain management problem--pain management equals the drugs--and
    how we administer the proliferation of drugs in our military
    system.
        Our soldiers are coming back wounded, sore, injured, in
    need of rehab, and that's--perhaps the easy answer, early on,
    was pain-managed prescription. But, there are other means. We
    hope this joint task force report will come to grips with how
    we can provide some consistency, not just throughout the Army--
    I mean, we found that every Army Medical Center was dealing
    with pain in altogether different ways, all individual to their
    situation. But, not an Army-wide program at all. I think, with
    this task force, we'll have the Services all together, and
    hopefully all in sync, of how we can address this growing
    problem.
        [Additional information supplied by Secretary Lamont
    follows:]

        Pain management has a significant behavioral health component, and
    drugs like Oxycontin and antidepressants may be simultaneously
    prescribed by different health care providers for better symptom
    management. While drugs like Oxycontin are used for pain management,
    what we have found is that pain has a strong behavioral health
    component requiring the addition of drugs like antidepressants for
    better symptom management. These prescription combinations are often
    managed by different health care providers. The issue of multiple-
    prescribers exists in our health system and others. It concerns me that
    patients can receive different agents like narcotics and psychiatric
    drugs from different sources.

        Senator Webb. Secretary Garcia?
        Mr. Garcia. Senator, I'm familiar with the piece, and, as I
    understood it, it also posited, or suggested, that there were--
    elicit drug use, to include in theater. We continue to drug
    test randomly across the fleet, forward-deployed and at home.
        On the prescription side, our Special Assistant for Health
    Affairs has initiated a working group, generated by the piece,
    to research this apparent spike, especially on the Marine side.
    That's where we are. All I can do is continue to keep you
    posted on the results.
        Senator Webb. Secretary Ginsberg.
        Mr. Ginsberg. Senator, I'm not familiar with the article,
    but I think you raise, obviously, a very important question
    about the extent of prescription drug use and whether this is
    an indicator of stress, or is this a new push to medicine? I'd
    very much like to get some concrete data from our surgeon-
    general community, and would be more than happy to provide that
    to you.
        [The information referred to follows:]

        Thank you for the opportunity to address this concern regarding the
    health and well-being of our Air Force members and their use of
    psychotropic medications. Based upon this inquiry we made two distinct
    efforts to review psychopharmacology utilization data for our active
    duty servicemembers. The first data set we reviewed was provided by
    LCDR Joseph B. Lawrence, USN, MSC as the Deputy Director, Department of
    Defense (DOD) Pharmacoeconomic Center COR, DOD Pharmacy Operation
    Center. LCDR Lawrence's data pull from the Military Health System (MHS)
    Pharmacy Data Transaction Service (PDTS) demonstrated that in the U.S.
    Air Force active duty psychotropic drug prescriptions increased from
    58,102 annually in 2005 to 113,010 annually in 2009. The most notable
    increases related to use of stimulant and sleep medications. Stimulants
    prescriptions increased from 6,886 in 2005 to 11,522 in 2009. The
    number of prescriptions for sleep medication went from 33,175 in 2005
    to 64,166 in 2009. These two classes of psychotropic medications
    accounted for approximately 65 percent of the total prescription
    increase over this time period. While prescription sleep medications do
    carry a low risk of abuse, they are also highly effective and
    beneficial when used appropriately for short-term use to address the
    maintenance of health sleep patterns with international travel and
    fluctuating operational work schedules.
        The second data pull was provided by Air Force Medical Operations
    Agency, Michael Squires. Mr. Squires extracted data from the PDTS table
    in the M2 which resulted in all Air Force active duty servicemembers
    who had received a psychotropic prescription (including
    antidepressants) between October 2009 and March 2010. The number of
    unique Air Force servicemembers who had one or more prescriptions for
    any psychotropic medication, including controlled prescription pain
    medications during this 6 month period was 81,253 or 22 percent of the
    Active Force. When controlled prescription pain medications are
    removed, the number of unique servicemembers on a psychotropic
    medication changes to 48, 233. This reflects a calculated user
    prevalence rate during a 6 month period of 1 in 8, or 13 percent , of
    the Active-Duty Force for psychotropic medications. This figure is a 6-
    month period prevalence; point prevalence on a specific day would be
    lower. Additionally, this data pull illustrated a utilization rate over
    a 6 month period of controlled pain medications as 51 for every 400
    servicemembers (12.75 percent), an antidepressant utilization rate of
    23 for every 500 servicemembers (4.6 percent), a sleep medication
    utilization rate of approximately 19 of every 421 servicemembers (4.4
    percent), a stimulant utilization rate of approximately 4 out of every
    425 servicemembers (0.94 percent), and an antipsychotic utilization
    rate of approximately 2 for every 1,000 servicemembers (0.2 percent).

        Senator Webb. I'd just say as an observation, one, we do
    have a really stressed, young force, because of these
    deployments. This is an indicator I think we really should be
    tracking very closely, with repeated deployments and these
    sorts of things.
        The other is, just purely as an observation, from looking
    at where they are deployed and the restriction of the use of
    alcohol, I would say it's--having been a journalist in
    Afghanistan before I started doing this, it is always rather
    ironic to me that, for reasons of comity with these other
    countries, we didn't allow our troops to use alcohol, but, I'll
    tell you, I was in a lot of villages in Afghanistan where
    everybody had their marijuana patch and their opium patch.
        The relief of stress on individuals is handled differently
    in different cultures, and that may be something you want to
    look into. It's a very troubling statistic, to me. I hope we
    can look at it, not simply medically, but in these other ways,
    as well.
        Secretary Ginsberg, can you give this subcommittee, some
    insight on this decision to provide aviation pay to nonrated
    pilots in the Remotely-Piloted Aircraft Program, what the
    justification is and--how does that fit into traditional
    definitions of flight pay, and those sorts of things?
        Mr. Ginsberg. Absolutely. Senator, the Air Force is meeting
    a very high demand to provide remotely-piloted aircraft--combat
    air patrols (CAPs) to our combatant command commander in
    Afghanistan and Iraq. We are currently providing 41 CAPs to the
    theater. We're working, by the end of fiscal year 2013, to
    provide 65 CAPs. What we're trying to do is develop a career
    field, where our airmen, who are providing this critical
    support to our forces on the ground, our brothers in the Marine
    Corps and the Army, as well as many are Air Force officers and
    enlisted on the ground, providing them this direct support. We
    want to make sure they can grow and develop.
        The incentive pays are a critical part of maintaining a
    robust pipeline of airmen who are operating these systems.
        Senator Webb. Under what category are they paid now?
        Mr. Ginsberg. I'm sorry?
        Senator Webb. Under what category are they being paid?
        Mr. Ginsberg. Well, this is an OSD-approved--under a--of
    course, the broad authority that Congress provides, under the--
    it's the--it's aviation continuation-paylike pay, and it----
        Senator Webb. It's not called ``flight pay''?
        Mr. Ginsberg. It's not called ``flight pay,'' but it's a--
    it's a different authority that we're providing under. This
    about just making--this--these officers and enlisted members
    are providing absolutely critical direct support to our forces
    on the ground, and we are putting tremendous stresses on them.
    Our crew ratios are not sufficient, at this point. They have a
    hard time getting leave, regular leave. We need to provide
    them--we're not giving them the opportunity to move to new
    assignments as flexibly as other career areas. We need to
    provide them pay and bonuses that will help make sure that this
    career field remains attractive.
        I went to Creech early in my tenure, to Creech Airfield,
    where we have a lot of our operators. It is absolutely
    astounding, what those airmen are doing to provide day-in and
    day-out support, truly lifesaving work.
        Senator Webb. Okay, thank you.
        Mr. Ginsberg. So, again, it's about making sure that they
    get the right pay--
        Senator Webb. I think that----
        Mr. Ginsberg.--and benefits that they deserve.
        Senator Webb. Secretary Stanley, I believe that this is a
    good time, with your coming in, to get a strong analytical look
    at how all of the special incentive pays, bonus pays,
    reenlistment pays, enlistment--how all of these fit together in
    a way that is beneficial to the people who are serving, and
    also to the efficiency of our programs.
        What I would like to do in a--rather than taking a great
    deal of time this morning, what I would like to do is to work
    with you and your staff to develop a matrix, so that we can
    fully understand what we're doing in these programs. I believe
    that the best way to address issues is, first, to assemble,
    clearly, the facts. So we are going to come to you with some
    questions about the incentive pays, the special pays, the
    reenlistment bonuses, the whole panorama, to get an
    understanding of how they are used, how many people are used,
    what the criteria are, how many of these are directed by
    Congress, how many of them are subject to the discretion of the
    implementers--your staff and the other----
        Dr. Stanley. Yes.
        Senator Webb.--Service departments--so that we can have a
    clear picture, as we move forward in these programs. I'm not
    sure of the last time that that's been done. I don't want to go
    through every one of these and ask for your justifications, but
    we're going to be having some questions. I don't want these to
    be considered questions for the record that are going to be
    answered----
        Dr. Stanley. Yes, sir.
        Senator Webb.--a month or 2 months. I really want to work
    on this so we can aggressively address it.
        There's a couple of other areas that I would like to get
    some feedback from you on. One of them, I'm sure you're
    familiar with, this mentor program that there were numerous
    articles, particularly USA Today, about where retired flag
    officers are getting up to $2,600 a day to come in and
    basically give advice. You know the situation, you're a retired
    flag. A retired four-star can be making in excess of $200,000 a
    year and then be working for a defense company, and then come
    in and be getting this sort of pay to give advice that, quite
    frankly, traditionally, has been a part of having worn the
    uniform, a sort of a continuing stewardship.
        So, there's a lot of questions, here in Congress, about how
    that reflects upon the dignity of Service, quite frankly. We
    want to get to the bottom of how that program is run.
        Then there's another area which relates to military
    fellowships, to think tanks. I would like to get some data on
    this with respect to the numbers of people who are involved in
    this and how taxpayer dollars are being spent, beyond regular
    military compensation, on areas that are called ``tuition'' for
    Active Duty military officers to go over and work on a think
    tank and not only be paid by the taxpayers for their regular
    military compensation, but actually being paid tens of
    thousands of dollars into these think tanks for this office
    space, et cetera. I don't think I have a full understanding of
    how this works, and we'd like to get specific data from you.
    Each Service may be doing it differently, but we'd like to
    assemble that data.
        With that, I thank all of you for your testimony, and look
    forward to working with you on a very close basis. Our door is
    open for any issues that you want to bring to the subcommittee,
    or to my office, personally.
        Thank you very much.
        Dr. Stanley. I appreciate that.
        Mr. Lamont. Thank you.
        Mr. Garcia. Thank you very much. [Pause.]
        Senator Webb. Our second panel will have members of the
    military coalition, a consortium of nationally prominent
    uniformed service and veteran organizations: Master Chief
    (Retired) Joseph Barnes, National Executive Director of the
    Fleet Reserve Association; Ms. Kathleen Moakler is the
    Government Relations Director of the National Military Family
    Association; Master Sergeant Michael Cline (Retired) is the
    Executive Director of the Enlisted Association of the National
    Guard of the United States; Ms. Deirdre Parke Holleman is the
    Executive Director of The Retired Enlisted Association; and
    Colonel Steven Strobridge (Retired) is the Director of
    Government Relations for the Military Officers Association of
    America.
        I mentioned earlier that we had two statements that would
    be put in the record. Probably more appropriate, they would be
    put in at this point rather than at the beginning of the
    hearing.
        [The joint prepared statement of the Reserve Officers
    Association and Reserve Enlisted Association follows:]
      Joint Prepared Statement by the Reserve Officers Association of the
                   United States Reserve Enlisted Association
                                  introduction
        On behalf of our members, the Reserve Officers Association (ROA)
    and the Reserve Enlisted Association (REA) thank the committee for the
    opportunity to submit testimony on military personnel issues. ROA and
    REA applaud the ongoing efforts by Congress to address readiness,
    recruiting and retention as evidenced by incentives in several
    provisions included in the National Defense Authorization Act (NDAA)
    for Fiscal Year 2010.
                               executive summary
        The Reserve Officers Association Calendar Year 2010 Legislative
    Priorities are:

             Reset the whole force to include fully funding
            equipment and training for the National Guard and Reserves.
             Assure that the Reserve and National Guard continue in
            a key national defense role, both at home and abroad. Support
            citizen warriors, families and survivors.
             Provide adequate resources and authorities to support
            the current recruiting and retention requirements of the
            Reserves and National Guard.
             Support warriors, families, and survivors.

        Issues supported by the Reserve Officers and Reserve Enlisted
    Associations are to:
    Changes to retention policies:
             Permit service beyond the current Reserve Officers
            Personnel Management Act (ROPMA) limitations.
             Support incentives for affiliation, reenlistment
            retention and continuation in the Reserve component.
    Education:
             Increase MGIB-Selected Reserve (MGIB-SR) to 47 percent
            of MGIB-Active.
             Include 4-year reenlistment contracts to qualify for
            MGIB-SR.
    Mobilization:
             Provide differential pay for deployed Federal
            employees permanently.
             Permit reservists the option of accumulating leave
            between active duty orders, as well as selling it back.
    Pay and Compensation:
             Reimburse a Reserve component member for expenses
            incurred in connection with round-trip travel in excess of 100
            miles to an inactive training location, including mileage
            traveled, lodging and subsistence.
             Obtain professional pay for Reserve component medical
            professionals, consistent with the Active component.
             Eliminate the 1l/30th rule for Aviation Career
            Incentive Pay. Career Enlisted Flyers Incentive Pay. Diving
            Special Duty Pay. and Hazardous Duty Incentive Pay.
             Simplify the Reserve duty order system without
            compromising drill compensation.
    Spouse Support:
             Expand eligibility of surviving spouses to receive
            Survivor Benefit Plan (SBP)-Dependency Indemnity Clause (DIC)
            payments with no offset.
    Health Care:
             Improve continuity of health care for all drilling
            reservists and their families by:

                     Monitoring the implementation of the
                    Department of Defense (DOD) paying a stipend toward
                    employers health care for dependents.
                     Allowing gray-area retirees to buy-in to
                    TRICARE by mid-2010.
                     Providing Continuing Health Benefit Plan to
                    traditional drilling reservists who are beneficiaries
                    of TRICARE Reserve Select but are separated from the
                    Selected Reserve to provide COBRA protections,
                     Permitting active members in the Individual
                    Ready Reserve (IRR) who qualify for a 20-year
                    retirement to buy-into TRICARE.
                     Allowing demobilized retirees and reservists
                    involuntarily returning to IRR to qualify for
                    subsidized TRS coverage,
                     Providing TRS coverage to mobilization ready
                    IRR members; levels of subsidy would vary for different
                    levels of readiness.
                     Improve post-deployment medical and mental
                    health evaluations of returning Reserve component
                    members.

             Fund restorative dental care prior to mobilization.
             Extend military coverage for restorative dental care
            following deployment to 90 days.
             Evaluate the Post-Deployment Medical Evaluation
            process.
             Encourage a discussion on health care costs between
            Congress, DOD, and nonprofits.
             Protect military and veteran's health care from
            inclusion in national health legislation.
    Voting:
             Ensure that every deployed servicemember has an
            opportunity to vote by:

                     Working with the Federal Voting Assistance
                    Program
                     Supporting electronic voting

             Ensure that every military absentee ballot is counted.

        Only issues needing additional explanation are included below.
    Self-explanatory or issues covered by other testimony will not be
    elaborated upon, but ROA and REA can provide further information if
    requested.
                              readiness discussion
    Operational versus strategic missions for the Reserve component:
        The Reserve Forces are no longer just a part-time strategic force
    but are an integral contributor to our Nation's operational ability to
    defend our soil, assist other countries in maintaining global peace,
    and fight in overseas contingency operations.
        National security demands both a Strategic and an Operational
    Reserve. The Operational Reserve requires a more significant investment
    of training and equipment resources, and places greater demands on its
    personnel as compared to the Strategic Reserve. Those serving in
    Operational Reserve units must be fully aware of the commitment
    required to maintain the expected level of readiness. A similar
    awareness and commitment is necessary for those responsible for
    providing resources to the Operational Reserve.
        Planners also must recognize that few individuals can remain in the
    operational Reserve for an entire career. There will be times when
    family, education, civilian career, and the other demands competing for
    their time and talents take priority. Such an approach requires the
    ability to move freely and without penalty between the operational and
    strategic elements of the Reserve component as a continuum of service.
        Each Service has its own force generation models and the Services
    organize, train, and equip their Reserve components to a prescribed
    level of readiness prior to mobilization to limit post-mobilization
    training and to maximize operational deployment time. ROA and REA urge
    Congress to continue to support and fund each Service's authority to
    manage the readiness of its own Reserve Forces as one model does not
    fit all.
        Congress can play an important role by requiring reports from
    Service leaders to ensure they have a plan for systematic augmentation,
    that the plan is adequately resourced, and that Reserve training and
    equipment will permit interoperability with the units they augment and
    reinforce. In an era of constrained budgets, a capable and sustainable
    Reserve and National Guard is a cost-effective element of national
    security.
    Junior Officer and Enlisted Drain:
        As an initial obligated period draws to the end, many junior
    officers and enlisted choose to leave, creating a critical shortage of
    young people in the leadership conduit. This challenge has yet to be
    solved. ROA and the National Guard Education Foundation published a
    report suggesting solutions to the problem. Copies can be provided to
    the committee, or be found at http://www.roa.org/JO-shortage.
    End Strength and Preparedness:
        It is noted that the only active service component to suffer cuts
    in the fiscal year 2011 proposed budget was the Coast Guard which will
    have a reduction of 1,100 personnel.
        The other Active components appear to maintain their end strengths
    with inclusion of temporary increases for the Army and the Navy. It
    should be remembered that individuals cannot be brought quickly on to
    active duly on a temporary basis, but it is an accumulation of
    experience and training that is acquired over years that becomes an
    asset for the military. Before cuts to the U.S. Coast Guard are made,
    ROA and REA hope that Congress requests a report from the U.S. Coast
    Guard, Department of Homeland Security, on the effect in the short and
    long term.
        Traditionally, it has been the Reserve component that has provided
    the temporary surge to fill-in the active duty numbers. The end
    strengths included in the President's budget appear to maintain current
    numbers. ROA and REA are concerned that the ongoing cuts to the Navy's
    Reserve will continue and this is a trend that needs to be reversed. A
    new manpower study needs to be done and published by the Navy Reserve
    to calculate the actual manning level: this study should be driven by
    readiness and not budgetary requirements.
        With pending withdrawals from Iraq and Afghanistan, there is
    already talk within the beltway about future cuts to military end
    strength to help offset rising deficits. Many blame the global war on
    terrorism for our current national debt, but part of high cost of the
    military is unpreparedness, and the bills borne by trying to create a
    force to match the need.
        Following World War I, Lieutenant General James Guthrie Harbord,
    USA, General John J. Pershing's chief of staff, was quoted in a 1922
    New York Times as saying. ``The size of our debt, incurred through
    unpreparedness, brings a demand for economy, and we continue
    unprepared. Thus unpreparedness brings the debt, and the debt continues
    unpreparedness.''
        Without external threats, the USA has traditionally reduced the
    size of its Armed Forces. But since the 1990s the Pentagon has
    recommended proportional cuts be taken in the Reserve component when
    taken in the Active Force. This reasoning fails in many ways. It
    results in a hollowing out of the force and preparedness, undermines
    morale, and undercuts retention. national security is put at risk.
    There is a need to maintain a national position of readiness, and the
    Reserve component is a cost-effective solution of being prepared.
    Should cuts be taken in the Active component, the Reserve component
    should grow in size to allow a place for readiness capability.
                              proposed legislation
    Retirement
        ROA and REA again thank the committee for passing the early
    retirement benefit in the National Defense Authorization Act for Fiscal
    Year 2008, as a good first step toward changing the retirement
    compensation for serving Guard and Reserve members, but. . .
        Guard and Reserve members feel that with the change in the roles
    and missions of the Reserve component, their contracts have changed.
    Informal surveys keep indicating that earlier retirement remains a top
    issue asked for by guardsmen and reservists. They ask why so many Guard
    and Reserve members who have served in the global war on terrorism were
    excluded from the new benefit; they also ask why even earlier duty is
    not included: and if faced with the same risks as active duty, why
    there is a 20 year difference in access to retirement pay?
        1. ``ROA and REA'' endorse S.831. National Guard and Reserve
    Retired Pay Equity Act of 2009, which is a corrective measure to the
    National Defense Authorization Act for Fiscal Year 2008 including those
    Guard and Reserve members who have been mobilized since September 11,
    2001. Over 600,000 were unfairly excluded. We realize the expense of
    this corrective measure scored by CBO is $2.1 billion over 10 years,
    but hope that offset dollars can be found.
        2. ROA and REA don't view this congressional solution as the final
    retirement plan. The Commission on the National Guard and Reserve
    recommends that Congress should amend laws to place the Active and
    Reserve components into the same retirement system. Secretary of
    Defense Robert Gates refers to the Tenth Quadrennial Review of Military
    Compensation's comprehensive review of the military retirement systems
    for suggested reform. The latter report suggests a retirement pay equal
    to 2.5 percent of basic pay multiplied by the number of years of
    service.
        ROA and REA agree that a retirement plan, at least for the Reserve
    component, should be based on accruement of active and inactive duty.
    Early retirement should not be based on the type of service, but on the
    aggregate of duty. It shouldn't matter if a member's contributions were
    paid or non-paid; inactive duty, active duty for training, special
    works or for mobilization. Under a continuum of service, this approach
    would provide both the Active or Reserve component members with an
    element of personal control to determine when they retire and will
    encourage increased frequency of service beyond 20 years within the
    Reserve.
        3. An additional problem arises for O-4 officers who, after a break
    in service, have returned to the Reserve component. After being
    encouraged to return a number of officers find they are not eligible
    for nonregular retirement. When reaching 20 years of commissioned
    service they find they may have only 15 good Federal years. Current
    policy allows these individuals to have only 24 years of commissioned
    time to earn 20 good Federal years.
        4. With an ongoing shortage of mid-grade officers (O-2 to O-3),
    Congress should reexamine the DOPMA and ROPMA laws to permit O-3s
    without prior enlisted service to be able to retire at 20 years of
    service. Many of badly needed skills that the Services would like to
    retain, yet must be discharged if passed over for promotion to often.
        ROA urges Congress to make changes in U.S. Code to allow O-3s and
    O-4s with 14 to 15 good Federal years to remain on Active Duty or in
    the Reserve until they qualify for regular or non-regular retirement.
    Education
        1. Montgomery ``GI'' Bill-Selected Reserve (MGJB-SR): To assist in
    recruiting efforts for the Marine Corps Reserve and the other uniformed
    services, ROA and REA urge Congress to reduce the obligation period to
    qualify for MGJB-SR (Section 1606) from 6 years in the Selected Reserve
    to 4 years in the Selected Reserve plus 4 years in the Individual Ready
    Reserve, thereby remaining a mobilization asset for 8 years.
        2. Extending MGIB-SR eligibility beyond Selected Reserve Status:
    Because of funding constraints, no Reserve component member will be
    guaranteed a full career without some period in a non-pay status. BRAC
    realignments are also restructuring the RC force and reducing available
    paid billets. Whether attached to a volunteer unit or as an individual
    mobilization augmentee, this status represents periods of drilling
    without pay. MGIB-SR eligibility should extend for 10 years beyond
    separation or transfer from a paid billet.
    Leadership
        Both the Army and Air Force Reserve Chiefs may only be selected
    from general officers from that component's reserve, yet the Navy and
    the Marine Corps can select its Reserve leadership from either Active
    or Reserve flag officers. (U.S.C., title 10. section 3038 states that
    ``The President, by and with the advice and consent of the Senate,
    shall appoint the Chief of Army Reserve from general officers of the
    Army Reserve . . .'' and section 8038 uses similar language for the
    appointment of the Chief of the Air Force Reserve, while U.S.C., title
    10, section 5143, only requires the President to appoint the Chief of
    Navy Reserve from flag officers of the Navy, and section 5144 only
    requires the President to appoint the Commander. Marine Forces Reserve,
    from general officers of the Marine Corps.) The Reserve Chief of a
    Service's Reserve should have an understanding of both the citizen
    warriors who are reporting to him or her, and the system through which
    the report. ROA urges Congress to change sections 5143 and 5144 of
    U.S.C., title 10 to only permit appointments from the Service's Reserve
    component.
    Military Voting
        ROA thanks Congress for the improvements made to absentee voting in
    the fiscal year 2010 Defense Authorization. Military personnel,
    overseas citizens, and their families residing outside their election
    districts deserve every reasonable opportunity to participate in the
    electoral process. Yet, studies by Congressional Research Service show
    that 25 percent of military member and family votes were not counted in
    the 2008 election.
        ROA and REA urge Congress to direct the Government Accountability
    Office to report further on the effectiveness of absentee voting
    assistance to Military and Overseas Citizens for the 2010 General
    Election and determine how Federal Voting Assistance Program's efforts
    to facilitate absentee voting by military personnel and overseas
    citizens differed between the 2008 and 2010 national elections. ROA and
    REA also hopes Congress encourages the Secretary of Defense, in
    conjunction with States and local jurisdictions, to gather and publish
    national data about the 2010 election by voting jurisdiction on
    disqualified military and overseas absentee ballots and reasons for
    disqualification.
                             health care discussion
        1. ROA and REA hold concerns over the implementation of TRICARE for
    gray area retirees. Rear Admiral Christine S. Hunter has shared that
    enrollment could be as early as July or as late as November 2010, and
    that it might be regionally rolled out. DOD wants to treat Reserve gray
    area retirees as a separate health care risk group which will likely
    drive up the cost of health care premiums as well. ROA and REA hope
    that the committee will ask hard questions at a future hearing about
    the process, as individuals in the health care industry question the
    length of time and the approach being taken.
        2. Sustaining Reserve Health care. ROA and REA was disappointed to
    learn that Continued Health Care Benefit Plan is only allowed to
    members of the Selected Reserve if they have had a tour of active duty
    within the previous 18 months by DOD. This is denying COBRA protections
    for traditional reservists who haven't been activated, and even
    overlooks the Secretary of Defense's directive to mobilize National
    Guard and Reserve members 1 year out of 6, which would be a dwell time
    of 60 months between call-ups. There is little cost as the beneficiary
    pays a premium of 102 percent of TRICARE Cost.
        A continuity of health care is needed if a continuum of service is
    to be seriously considered. Just as an Active Force needs to be
    provided military health, the Reserve component needs to have a
    seamless health protection during different duty statuses. As even
    discharged active servicemembers have the benefit of the Continuing
    Health Care Benefit Plan, those Guard and Reserve members who have
    signed up for TRICARE Reserve Select need to have protections when they
    leave the Selected Reserve.
        ROA and REA encourage Congress to work with the Pentagon to open up
    Reserve component member access to the Continued Health Care Benefit
    Plan to any TRICARE Reserve Select beneficiary separating from the
    Selected Reserve under conditions that are not punitive in nature.
        3. Employer health care option: The ROA and REA continues to
    support an option for individual reservists where DOD pays a stipend to
    employers of deployed Guard and Reserve members to continue employer
    health care during deployment. Because TRICARE Prime or Standard is not
    available in all regions that are some distance from military bases it
    is an advantage to provide a continuity of health care by continuing an
    employer's health plan for the family members. This stipend would be
    equal to DOD's contribution to Active Duty TRICARE.
        4. Dental Readiness. Currently, dental readiness has one of the
    largest impacts on mobilization. The action by Congress in the NDAA for
    Fiscal Year 2010 was a good step forward, but still more needs to be
    done.
        In the first quarter of fiscal year 2009, the Army Reserve was 48.8
    percent dental class 1 or 2 Navy Reserve was 92.8 percent, Air Force
    Reserve 86.6 percent, Marine Corps Reserve 77 percent. Air Guard 91
    percent Army Guard 48.2 percent, and Coast Guard Reserve 83.2 percent.
        While there has been slight improvement since fiscal year 2007, the
    Army Reserve and Marine Corps Reserve have actually decreased their
    dental readiness which is due to large numbers of Class 4
    servicemembers. Regardless none of the Services have met the 95 percent
    dental readiness goal.
        The Services require a minimum of Class 2 (where treatment is
    needed, however no dental emergency is likely within 6 months) for
    deployment. Current policy relies on voluntary dental care by the Guard
    or Reserve member. Once alerted, dental treatment can be done by the
    military, but often times there isn't adequate time for proper
    restorative remedy.
        ROA and REA continues to suggest that the Services are responsible
    to restore a demobilized Guard or Reserve member to a Class 2 status to
    ensure the member maintains deployment eligibility.
        Because there are inadequate dental assets at Military Treatment
    Facilities for active members, active families, and reservists, ROA and
    REA further recommend that dental restoration be included as part of
    the 6 months Transitional Assistance Management Program (TAMP) period
    following demobilization. DOD should cover full costs for restoration,
    but it could be tied into the TRICARE Dental program for cost and
    quality assurance.
        5. TRICARE Health costs: ROA and REA applaud the efforts by
    Congress to address the issue of increasing Department of Defense
    health care costs and its interest to initiate dialogue and work with
    both the Pentagon and the beneficiary associations to find the best
    solution. The time has come to examine the cost of TRICARE and the
    level of beneficiary contribution.
        ROA and REA are committed to our membership to sustain this health
    care benefit. We fear that we will be unable to continue to sustain
    prohibitions on health care fees into the future. We need to work
    together to find a fair and equitable solution that protects our
    beneficiaries and ensures the financial viability of the military
    health care system for the future. Some associations seek to continue
    to a freeze on premium fees permanently; others are joining ROA and REA
    by admitting that some increases are necessary.
        ROA and REA endorse a tiered enrollment fee and congratulate the
    Task Force for developing one based on annual income. As most Guard and
    Reserve members retire at 25 to 30 percent of active duty retirement
    pay, it makes sense that G-R enrollment fees should be lower. ROA and
    REA do suggest that if enrollment fees are based on income that it be
    based just on military retirement income of Active and Reserve
    retirees.
        The ROA and REA do not endorse annual enrollment fees for
    individuals who don't use the TRICARE Standard plan. Eligibility should
    remain universal; a one-time administrative enrollment fee might be
    implemented with first use of the program.
        If TRICARE Standard enrollment fees are increased, Congress needs
    to review the recommended deductibles and current copayment levels.
    While TRICARE Prime is in the top 90 percent for cost generosity.
    TRICARE Standard is at a lower level of the spectrum of plan
    generosity.
        6. National Health Care Plan. ROA and REA are concerned that the
    national health care legislation does not include specific language
    that preserves military and veteran health care programs under separate
    authorities. While there have been verbal guarantees from congressional
    members and the President, getting the pledge in writing would curtail
    concerns.
                                   conclusion
        ROA and REA reiterate our profound gratitude for the progress
    achieved by this committee by providing parity on pay and compensation
    between the Active and Reserve components, with the subcommittee also
    understanding the difference in service between the two components.
        ROA and REA look forward to working with the personnel subcommittee
    where we can present solutions to these and other issues, and offers
    our support in anyway.

        Senator Webb. Welcome, to all of you.
        I suppose we can start with Mr. Barnes and move to Mr.
    Strobridge.
        Welcome, sir.

        STATEMENT OF MASTER CHIEF JOSEPH L. BARNES, USN (RET.),
        NATIONAL EXECUTIVE DIRECTOR, FLEET RESERVSE ASSOCIATION

        Mr. Barnes. Good morning, Mr. Chairman, Senator Graham,
    distinguished members of the subcommittee. Thank you for the
    opportunity to appear before you today.
        The Military Coalition's statement reflects the consensus
    of coalition organizations on a broad range of important
    personnel issues and extensive work by eight legislative
    committees, each comprised of representatives from the
    coalition's 34 military and veterans organizations.
        The five of us will address key issues important to the
    Active, Guard, and Reserve, retiree, and survivor communities,
    and military families, and will conclude healthcare concerns
    which impact everyone within these groups, including our
    magnificent wounded warriors.
        Before proceeding, I wish to thank you and the entire
    subcommittee and your outstanding staff for effective
    leadership and strong support of essential pay and benefit
    program enhancements, and particularly for programs to
    adequately care for our wounded warriors and their families.
        Adequate service end strengths are absolutely essential to
    success in Iraq and Afghanistan, and to sustaining other
    operations vital to our national security. The coalition
    strongly supports proposed Army and Navy end strength levels in
    2011. A recent Navy Times story titled ``Sailor Shortage''
    cites too much work to do in the Navy and not enough people to
    do it, and lists the associated effects, which include little
    time for rest, fewer people to maintain and repair shipboard
    equipment, crew members with valuable skills being pulled for
    other jobs and not replaced, and lower material ship readiness.
        As referenced by the first panel, the strain of repeated
    deployments continues, and is also related to the adequacy of
    end strengths. Now we're tracking disturbing indicators of the
    effects, which include increasing drug and alcohol use, more
    mental healthcare appointments, alarming suicide rates, plus
    more military divorces. The unrelenting stress on
    servicemembers and their families is a serious and continuing
    concern that can lead to very serious morale, readiness, and
    retention challenges.
        Pay comparability remains a top priority, and the Coalition
    strongly supports the authorization of a 1.9-percent 2011
    Active Duty pay hike. We appreciate your past support for
    higher-than-ECI pay increases, which have collectively reduced
    the pay gap to 2.4 percent.
        Adequate funding for military recruiting efforts is
    important. During high retention periods, it's natural to look
    at reducing these accounts. However, sufficient resources are
    essential to ensuring continuing recruiting success. It's
    noteworthy that nearly three-quarters of the optimum
    recruiting-aged young people do not qualify for Military
    Service, and the Services must maximize efforts through our
    military recruiters to recruit optimum-quality personnel across
    the Armed Services.
        The coalition strongly supports the authorization to ship
    two personal vehicles in conjunction with PCS moves, along with
    long overdue increases in PCS mileage rates. We appreciate the
    distinguished Chairman's leadership on the enactment and
    implementation of the post-September 11 GI Bill and DOD
    policies on transferability options for personnel nearing
    retirement. However, technical corrections are still needed to
    ensure eligibility for members of the U.S. Public Health
    Service and NOAA Corps.
        Adequate programs, facilities, and support services for
    personnel impacted by BRAC actions, rebasing, and global
    repositioning is very important, particularly during wartime,
    which alone, results in significant stress on servicemembers
    and their families. The coalition notes with concern the 19-
    plus-percent reductions in military construction and family
    housing accounts in the proposed 2011 budget request.
        Finally, the coalition remains committed to adequate
    funding to ensure access to the commissary benefit for all
    beneficiaries. This is an essential benefit, and the Defense
    Commissary Agency is to be commended for highly cost-effective
    management of 255 stores in 13 countries.
        Thank you again for the opportunity to present our
    recommendations.
        [The prepared statement of Mr. Barnes follows:]
        Prepared Statement by Master Chief Joseph L. Barnes, USN (Ret.)
                         the fleet reserve association
        The Fleet Reserve Association (FRA) is the oldest and largest
    enlisted organization serving active duty, Reserves, retired and
    veterans of the Navy, Marine Corps, and Coast Guard. It is
    Congressionally Chartered, recognized by the Department of Veterans
    Affairs (VA) as an accrediting Veteran Service Organization for claim
    representation and entrusted to serve all veterans who seek its help.
    In 2007, FRA was selected for full membership on the National Veterans'
    Day Committee.
        FRA was established in 1924 and its name is derived from the Navy's
    program for personnel transferring to the Fleet Reserve or Fleet Marine
    Corps Reserve after 20 or more years of active duty, but less than 30
    years for retirement purposes. During the required period of service in
    the Fleet Reserve, assigned personnel earn retainer pay and are subject
    to recall by the Secretary of the Navy.
        FRA's mission is to act as the premier ``watch dog'' organization
    in maintaining and improving the quality of life for Sea Service
    personnel and their families. FRA is a leading advocate on Capitol Hill
    for enlisted Active Duty, Reserve, retired and veterans of the Sea
    Services. The Association also sponsors a National Americanism Essay
    Program and other recognition and relief programs. In addition, the
    newly established FRA Education Foundation oversees the Association's
    scholarship program that presents awards totaling nearly $100,000 to
    deserving students each year.
        The Association is also a founding member of The Military Coalition
    (TMC), a 34-member consortium of military and veteran's organizations.
    FRA hosts most TMC meetings and members of its staff serve in a number
    of TMC leadership roles.
        FRA celebrated 85 years of service in November 2009. For over eight
    decades, dedication to its members has resulted in legislation
    enhancing quality of life programs for Sea Services personnel, other
    members of the uniformed services plus their families and survivors,
    while protecting their rights and privileges. CHAMPUS, now TRICARE, was
    an initiative of FRA, as was the Uniformed Services Survivor Benefit
    Plan. More recently, FRA led the way in reforming the REDUX Retirement
    Plan, obtaining targeted pay increases for mid-level enlisted
    personnel, and sea pay for junior enlisted sailors. FRA also played a
    leading role in advocating recently enacted predatory lending
    protections and absentee voting reform for servicemembers and their
    dependents.
        FRA's motto is: ``Loyalty, Protection, and Service.''
                 certification of non-receipt of federal funds
        Pursuant to the requirements of House Rule XI, the FRA has not
    received any Federal grant or contract during the current fiscal year
    or either of the 2 previous fiscal years.
                                    synopsis
        The FRA is an active participant and leading organization in The
    Military Coalition (TMC) and strongly supports the recommendations
    addressed in the more extensive TMC testimony prepared for this
    hearing. The intent of this statement is to address other issues of
    particular importance to FRA's membership and the Sea Services enlisted
    communities.
                                  introduction
        Mr. Chairman, the FRA salutes you, members of the subcommittee, and
    your staff for the strong and unwavering support of programs essential
    to Active Duty, Reserve component, and retired members of the uniformed
    services, their families, and survivors. The subcommittee's work has
    greatly enhanced care and support for our wounded warriors and
    significantly improved military pay, and other benefits and enhanced
    other personnel, retirement and survivor programs. This support is
    critical in maintaining readiness and is invaluable to our uniformed
    services engaged throughout the world fighting the global war on
    terror, sustaining other operational commitments and fulfilling
    commitments to those who've served in the past.
                                  health care
        Health care is exceptionally significant to all FRA shipmates
    regardless of their status and protecting and/or enhancing this benefit
    is the Association's top legislative priority. A recently released FRA
    survey indicates that nearly 90 percent of all Active Duty, Reserve,
    retired, and veteran respondents cited health care access as a
    critically important quality-of-life benefit associated with their
    military service. From 2006-2008 retirees under age 65 were targeted by
    DOD to pay significantly higher health care fees. Many of these
    retirees served before the recent pay and benefit enhancements were
    enacted and receive significantly less retired pay than those serving
    and retiring in the same pay grade with the same years of service
    today. Promises were made to them about health care for life in return
    for a career in the military with low pay and challenging duty
    assignments and many believe they are entitled to free health care for
    life.
        Efforts to enact a national health care reform coupled with
    inaccurate and widespread information on the associated impact on
    retiree health care benefits has created unease and a sense of
    uncertainty for our members. FRA opposes any effort to integrate
    TRICARE and VA health care into any national health care program and
    appreciates the exclusion of TRICARE and VA health care in the House
    version of the national health care proposal. Military and VA health
    care services are fundamental to military readiness and serve the
    unique needs of current and former servicemembers, their families and
    survivors. Merging these programs into a colossal bureaucracy designed
    to provide health care to all Americans would broaden their focus and
    reduce their effectiveness. That said, the Association is concerned
    about proposed Medicare spending cuts associated with reform
    initiatives which may negatively impact physician reimbursement rates
    and access to care for Medicare and TRICARE beneficiaries.
        FRA strongly supports Representatives Chet Edwards (TX) and Walter
    Jones (NC) legislation, ``The Military Retirees' Health Care Protection
    Act'' (H.R. 816) that would prohibit DOD from increasing TRICARE fees,
    specifying that the authority to increase TRICARE fees exists only in
    Congress.
        FRA thanks this subcommittee for resisting past efforts to shift
    increasing health care cost to beneficiaries and ensuring adequate
    funding for the Defense Health Program in order to meet readiness
    needs, fully fund TRICARE, and improve access for all beneficiaries
    regardless of age, status or location. Adequately funding health care
    benefits for all beneficiaries is part of the cost of defending our
    Nation.
                               concurrent receipt
        The Association appreciates President Obama's support for
    authorizing Chapter 61 retirees to receive their full military retired
    pay and veterans disability compensation and continues to seek timely
    and comprehensive implementation of legislation that authorizes the
    full concurrent receipt for all disabled retirees. The above referenced
    FRA survey indicates that more than 70 percent of military retirees
    cite concurrent receipt among their top priorities. The Association
    strongly supports the fiscal year 2011 budget request of $408 million
    to cover the first phase of the 5-year cost for concurrent receipt for
    Chapter 61 beneficiaries that are 90 percent or more disabled.
                                wounded warriors
        FRA appreciates the substantial Wounded Warriors legislation in the
    National Defense Authorization Act (NDAA) for Fiscal Year 2008. Despite
    jurisdictional challenges, considerable progress has been made in this
    area. However, the enactment of legislation is only the first step in
    helping wounded warriors. Effective oversight and sustained funding are
    also critical for successful implementation and FRA supports the
    following substantive changes:

             Establish a permanent and independent office for the
            DOD/VA Interagency program and expand it's authority to include
            oversight of all components of achieving a true seamless
            transition;
             Authorizing full active duty TRICARE benefits,
            regardless of accessibility of VA care, for 3 years after
            medical retirement to help ease transition from DOD to VA;
             Extend and make permanent the charter of the ``Special
            Oversight Committee'' to ensure improved coordination with DOD
            and VA initiatives to help wounded warriors;
             Exempt severely wounded medically retired Medicare
            part B premiums until age 65;
             Providing up to 1 year of continuous habitation in
            onbase housing facilities for medically retired, severely
            wounded and their families;
             Eliminate the servicemember's premium for the
            Traumatic Servicemember Group Life Insurance;
             Ensure the creation and full implementation of a joint
            electronic health record that will help ensure a seamless
            transition from DOD to VA for wounded warriors; and
             Establishment of the Wounded Warriors Resource Center
            as a single point of contact for servicemembers, their family
            members, and primary care givers.

        Achieving an effective delivery system between DOD and VA to
    guarantee seamless transition and quality services for wounded
    personnel, particularly those suffering from Post Traumatic Stress
    Disorder and Traumatic Brain Injuries is very important to our
    membership. DOD should also make every effort to destigmatize mental
    health conditions that should include outreach, counseling, and mental
    health assessment for all servicemembers returning from the combat
    zone. Family support is also critical for success, and should include
    compensation, training, and certification, and respite care for family
    members functioning as full-time caregivers for wounded warriors. FRA
    supports ``The Caregivers and Veterans Omnibus Health Services Act''(S.
    1963), and parallel legislation to improve compensation, training and
    assistance for caregivers of severally disabled active-duty
    servicemembers.
                                 suicide rates
        FRA is deeply concerned that more servicemembers have taken their
    own lives by November 2009 than have been killed in either the
    Afghanistan or Iraq wars. Congressional Quarterly reports that as of
    November 24, 334 servicemembers have committed suicide in 2009,
    compared with 297 killed in Afghanistan and 144 who died in Iraq. In
    response to this, Congress has significantly increased funding for
    mental health in the DOD and VA budgets that established a suicide
    hotline. DOD and VA also sponsor annual conferences on this issue.
    Jurisdictional challenges notwithstanding, it is critically important
    that Congress further respond and enhanced coordination between the
    Veterans Affairs and Armed Services Committees is key to addressing
    this. As of the above date the Army has had 211 of the 334 suicides,
    while the Navy had 47, the Air Force had 34 and the Marine Corps
    (active duty only) had 42. Increases in the number of suicides are not
    limited to active duty members only, the Department of Veterans Affairs
    (VA) has indicated that veterans suicides have also been increasing at
    an alarming rate.
             uniform services former spouses protection act reform
        The Association believes that the increasing divorce rates among
    active duty personnel and reservists is related to stress caused by
    repeated deployments in conjunction with 8 years of fighting a two-
    front war. According to the Los Angeles Times, ``The 3.6 percent rate
    is a full percentage point above the 2.6 percent reported in late 2001,
    when the U.S. began sending troops to Afghanistan in response to the
    terrorist attacks. As in previous years, women in uniform suffered much
    higher divorce rates than their male counterparts--7.7 percent in 2009.
    An Army 2009 battlefield survey indicated that 22 percent of married
    soldiers were considering divorce, compared to 12.4 percent in 2003.''
    \1\ The divorce rate for women in uniform is especially troubling, and
    these numbers do not take into account divorce rates for veterans. The
    FRA has long advocated introduction of legislation addressing the
    inequities of the Uniform Services Former Spouses Protection Act
    (USFSPA) and associated hearings on this issue. The Association
    believes that this law should be more balanced in its protection for
    both the servicemember and the former spouse.
    ---------------------------------------------------------------------------
        \1\ Associated Press, November 28, 2009, Divorce Rate Rises in
    Military, Los Angeles Times.
    ---------------------------------------------------------------------------
        The recommendations in the Department of Defense's (DOD) September
    2001 report, which assessed USFSPA inequities and offered
    recommendations for improvement is a good starting point for
    considering badly needed reform of this onerous law.
        Few provisions of the USFSPA protect the rights of the
    servicemember and none are enforceable by the Department of Justice or
    DOD. If a State court violates the right of the servicemember under the
    provisions of USFSPA, the Solicitor General will make no move to
    reverse the error. Why? Because the act fails to have the enforceable
    language required for Justice or the Defense Department to react. The
    only recourse is for the servicemember to appeal to the court, which in
    many cases gives that court jurisdiction over the member. Another
    infraction is committed by some State courts awarding a percentage of
    veterans' compensation to ex-spouses, a clear violation of U.S. law;
    yet, the Federal Government does nothing to stop this transgression.
        FRA believes Congress needs to take a hard look at the USFSPA with
    the intent to amend it so that the Federal Government is required to
    protect its servicemembers against State courts that ignore provisions
    of the act. Other provisions also weigh heavily in favor of former
    spouses. For example, when a divorce is granted and the former spouse
    is awarded a percentage of the servicemember's retired pay, this should
    be based on the member's pay grade at the time of the divorce and not
    at a higher grade that may be held upon retirement. The former spouse
    has done nothing to assist or enhance the member's advancements
    subsequent to the divorce; therefore, the former spouse should not be
    entitled to a percentage of the retirement pay earned as a result of
    service after the decree is awarded. Additionally, Congress should
    review other provisions considered inequitable or inconsistent.
                        adequate personnel end strength
        Insufficient end strength levels and the rigors of supporting
    Operations Iraqi Freedom and Enduring Freedom are having a negative
    impact on the quality of life of servicemembers which will ultimately
    lead to retention and recruitment challenges. FRA urges this
    distinguished subcommittee to ensure funding for adequate end strengths
    and people programs consistent with the Association's DOD funding goal
    of at least 5 percent of the gross domestic product for fiscal year
    2011.
                          active duty pay improvements
        Our Nation is at war and there is no more critical morale issue for
    active duty warriors than adequate pay. This is reflected in the more
    than 96 percent of active duty respondents to FRA's recent survey
    indicating that pay is ``very important.'' The Employment Cost Index
    (ECI) for fiscal year 2011 is 1.4 percent and based on statistics from
    15 months before the effective date of the proposed active duty pay
    increase. The Association appreciates the strong support from this
    distinguished subcommittee in reducing the 13.5 percent pay gap to the
    current level during the past decade. In addition, FRA notes that even
    with a fiscal year 2011 pay increase that is 0.5 percent above the ECI,
    the result will be the smallest pay hike since 1958. FRA urges the
    subcommittee to continue the increases at least 0.5 percent above the
    ECI until the remaining 2.4 percent pay gap is eliminated.
                            reserve early retirement
        The effective date of a key provision in the NDAA for Fiscal Year
    2008, the Reserve retirement age provision that reduces the age
    requirement by 3 months for each cumulative 90-days ordered to active
    duty is effective upon the enactment of the legislation and NOT
    retroactive to October 7, 2001. Accordingly the Association supports
    ``The National Guardsmen and Reservists Parity for Patriots Act'' (H.R.
    208) sponsored by the subcommittee's ranking member Representative Joe
    Wilson (SC), to authorize reservists mobilized since October 7, 2001,
    to receive credit in determining eligibility for receipt of early
    retired pay. Since September 11, 2001 the Reserve component has changed
    from a Strategic Reserve to an Operational Reserve that now plays a
    vital role in prosecuting the war efforts and other operational
    commitments. This has resulted in more frequent and longer deployments
    impacting individual reservist's careers. Changing the effective date
    of the Reserve early retirement would help partially offset lost salary
    increases, lost promotions, lost 401K and other benefit contributions.
    The Association urges the subcommittee to support this important
    legislation.
                       paid-up survivor benefit annuities
        Under current law, retirees are no longer required to pay survivor
    benefit annuities (SBP) premiums after they have paid for 30 years and
    reach age 70. This is an inequity for those who may have entered the
    service at age 17 or 18 and will be required to pay for 33 or 32 years
    respectively until attaining paid-up SBP status. Therefore, FRA
    supports changing the minimum age for paid-up SBP from age 70 to age 67
    to ensure that those who joined the military at age 17, 18, or 19 and
    serve 20 years will only have to pay SBP premiums for 30 years.
                  retention of final full month's retired pay
        FRA urges the subcommittee to authorize the retention of the full
    final month's retired pay by the surviving spouse (or other designated
    survivor) of a military retiree for the month in which the member was
    alive for at least 24 hours. FRA strongly supports ``The Military
    Retiree Survivor Comfort Act'' (H.R. 613), introduced by Rep. Walter
    Jones (NC) which addresses this issue.
        Current regulations require survivors of deceased military retirees
    to return any retirement payment received in the month the retiree
    passes away or any subsequent month thereafter if there is a processing
    delay. Upon the demise of a retiree, the surviving spouse is required
    to notify the Defense Finance and Accounting Service (DFAS) of the
    death. DFAS then stops payment on the retirement account, recalculates
    the final payment to cover only the days in the month the retiree was
    alive, forwards a check for those days to the surviving spouse or
    beneficiary. If not reported in a timely manner, DFAS recoups any
    payment(s) made covering periods subsequent to the retiree's death.
        The measure is related to a similar Department of Veterans Affairs
    policy. Congress passed a law in 1996 that allows a surviving spouse to
    retain the veteran's disability and VA pension payments issued for the
    month of the veteran's death. FRA believes military retired pay should
    be no different. This proposal is also in response to complaints from
    surviving spouses who were unaware of the notification requirement and
    those with joint bank accounts, in which retirement payments were made
    electronically, who gave little if any thought that DFAS could access
    the joint account and recoup overpayments of retirement pay. This
    action could easily clear the account of any funds remaining whether
    they were retirement payments or money from other sources.
        To offset some of the costs, if the spouse is entitled to SBP on
    the retiree's death, there will be no payment of the annuity for the
    month the retirement payment is provided the surviving spouse.
                       mandate travel cost reimbursement
        FRA appreciates the NDAA for Fiscal Year 2008 provision (section
    631) that permits travel reimbursement for reservist's weekend drills,
    not to exceed $300, if the commute is outside the normal commuting
    distance. The Association urges the subcommittee to make this a
    mandatory provision. This is a priority issue with many enlisted
    reservists who are forced to travel lengthy distances to participate in
    weekend drills without reimbursement for travel costs. Providing this
    travel reimbursement would assist with retention and recruitment for
    the Reserves--something particularly important to increased reliance on
    these personnel in order to sustain our war and other operational
    commitments.
                                family readiness
        Military deployments create unique stresses on families due to
    separation, uncertainties of each assignment and associated dangers of
    injury or death for the deployed servicemember. Further, adapting to
    new living arrangements and routines adds to the stress, particularly
    for children.
        Fortunately men and women in uniform continue to answer the calls
    to support repeated deployments--but only at a cost of ever-greater
    sacrifices for them and their families. Now more than ever before the
    support of their families is essential to enduring the mounting
    stresses of the war effort and other operational commitments. This
    stress has resulted in doubling the number of outpatient mental health
    visits (1 million in 2003 to 2 million in 2008) for children with an
    active duty parent.\2\ It's most important that DOD and the military
    services concentrate on providing programs for the families of our
    servicemembers. DOD should improve programs to assist military families
    with deployment readiness, responsiveness, and reintegration. There are
    a number of existing spousal and family programs that have been fine
    tuned and are successfully contributing to the well-being of this
    community. The Navy's Fleet and Family Centers and the Marines' Marine
    Corps Community Services and Family Services programs are providing
    comprehensive, 24/7 information and referral services to the
    servicemember and family through its OneSource links. OneSource is
    particularly beneficial to mobilized reservists and families who are
    unfamiliar with varied benefits and services available to them.
    ---------------------------------------------------------------------------
        \2\ Military.Com More Troops' Kids Seeking Counseling Associated
    Press, July 8, 2009
    ---------------------------------------------------------------------------
        It's true that ``the servicemember enlists in the military
    service--but it's the family that reenlists.'' To ensure the family
    opts for a uniformed career, the family must be satisfied with life in
    the military.
                                   conclusion
        FRA is grateful for the opportunity to present these
    recommendations to this distinguished subcommittee. The Association
    reiterates its profound gratitude for the extraordinary progress this
    subcommittee has made in advancing a wide range of military personnel
    and retiree benefits and quality-of-life programs for all uniformed
    services personnel and their families and survivors. Thank you again
    for the opportunity to present the FRA's views on these critically
    important topics.

        Senator Webb. Thank you very much, Mr. Barnes.
        Ms. Moakler, welcome.

        STATEMENT OF KATHLEEN B. MOAKLER, GOVERNMENT RELATIONS
             DIRECTOR, NATIONAL MILITARY FAMILY ASSOCIATION

        Ms. Moakler. Thank you. Chairman Webb, Senator Graham,
    thank you for the opportunity to speak today on behalf of
    military families, our Nation's military families.
        Many families are facing their ninth year of deployment,
    many have dealt with multiple deployments. We have second-
    graders who have only known a lifestyle with a parent absent
    from their lives for months at a time, over and over again. We
    appreciate the many initiatives and programs supported by this
    subcommittee in the past. Military OneSource, increased
    benefits and support for surviving families, and the Yellow
    Ribbon Program are just a few. We have expanded access to
    mental health counseling across components, although the need
    continues to grow.
        Now military families expect these programs. They have
    become part of the overall fabric of family readiness. The
    challenge that now faces us is making sure that our family
    readiness programs receive sustained funding and continue to be
    included in the annual budget process. As the war has
    progressed, family readiness requirements have evolved. Some
    new programs have been initiated without evaluating already
    existing programs to see how they might have been adapted.
        The congressionally-mandated Military Family Readiness
    Council has begun an evaluation process. We endorse this
    process and hope that it will result in the elimination of
    repetitive or redundant programs. Existing programs can be
    improved, such as adding provisions for travel for family
    members participating in the Reserve-component Yellow Ribbon
    Program.
        With budget cuts and shortfalls looming, we should not
    randomly reduce funding to family programs, across the board.
    As redundant programs are identified, their elimination can add
    to efficiencies. Servicemembers and their families cite MWR
    programs, like gyms, libraries, and other installation-provided
    services, as important to their well-being during deployments.
    Substantial cuts to these programs make them wonder why
    Services talk about support, yet often cut or reduce the same
    programs that are identified as the most important by our
    families.
        One of the ways to evaluate the efficacy of programs is
    research. Our Association has spoken, for several years,
    concerning research into the effects of continuing deployments
    on our most vulnerable population: our military children. We
    appreciate the inclusion of a provision calling for a study in
    last year's NDAA. In May 2008, we commissioned the RAND
    Corporation to do a longitudinal study on the experience of
    1,500 families. Over the course of a year, RAND interviewed
    both the nondeployed caregiver parent and one child per family
    between the ages of 11 and 17. We addressed two key questions:
    How are school-aged children faring? What types of issues do
    military children face, related to deployment?
        The baseline findings were published in the January issue
    of the Journal of Pediatrics. The study found, as the months of
    parental deployment increased, so did the child's challenges.
    The total number of months away mattered more than the number
    of deployments. Older children experienced more difficulties
    during deployment, and there is a direct correlation between
    the mental health of the caregiver and the well-being of the
    child. It was interesting to note that in the initial findings,
    there were no differences in results between Service or
    components.
        What are the implications? Families facing longer
    deployments need targeted support, especially for older teens
    and girls. Supports need to be in place across the entire
    deployment cycle, including reintegration, and some nondeployed
    parents may need targeted mental health support.
        We still hear about needs for childcare. While most
    traditional childcare needs are being met, innovative
    strategies for after-hours care and respite care should be
    explored. These strategies need to be implemented across the
    Services, as well. Drop-in care for medical appointments,
    either at the Center for Disease Control or at the military
    treatment facility itself, can go a long way in improving
    access to care and eliminating missed appointments.
        I, too, must bring up the MyCAA Program, with an underline
    and an exclamation point. Several years ago, Congress mandated
    DOD create a program to promote portable careers for military
    spouses. The result was a very popular MyCAA program. Recent
    numbers indicate that 98,000 spouses already are enrolled in
    the program, an additional 38,000 have applied but have not yet
    completed the process. Unfortunately, DOD, as we have heard
    today, has recently had to suspend the program. We have heard,
    from many concerned military spouses using the MyCAA program,
    about the loss of funding for courses in which they were
    enrolled, and how they are scrambling to come up with the funds
    to continue, be it for an individual course that they are
    taking online or a semester.
        But, I think what bothered them the most was the way the
    notification was handled. There was no advance notification,
    information was sent via a press release. This, when the
    program was in possession of everyone's email address. Many
    view this as one more frustration in 8 long years of
    frustrations.
        The program may be a victim of its own success. We are
    unsure as to whether it was the lack of funds or an application
    overload, or both, that caused the suspension. We ask that the
    program be resumed as soon as possible, and that it be properly
    funded.
        We thank you for your support of our servicemembers and
    their families. We urge you to remember their service as you
    work to resolve the many issues facing our country. Working
    together, we can improve the quality of life for all these
    families.
        Thank you, and I await your questions.
        [The prepared statement of Ms. Moakler follows:]
                   Prepared Statement by Kathleen B. Moakler
        Chairman Webb and distinguished members of the subcommittee, the
    National Military Family Association would like to thank you for the
    opportunity to present testimony on the quality of life of military
    families--the Nation's families. As the war has continued, the quality
    of life of our servicemembers and their families has been severely
    impacted. Your recognition of the sacrifices of these families and your
    response through legislation to the increased need for support have
    resulted in programs and policies that have helped sustain our families
    through these difficult times.
        We endorse the recommendations contained in the statement submitted
    by The Military Coalition. In this statement, our Association will
    expand on several issues of importance to military families:

              I. Family Readiness
              II. Family Health
              III. Family Transitions
                              i. family readiness
        The National Military Family Association believes policies and
    programs should provide a firm foundation for families buffeted by the
    uncertainties of deployment and transformation. It is imperative full
    funding for these programs be included in the regular budget process
    and not merely added on as part of supplemental funding. We promote
    programs that expand and grow to adapt to the changing needs of
    servicemembers and families as they cope with multiple deployments and
    react to separations, reintegration, and the situation of those
    returning with both visible and invisible wounds. Standardization in
    delivery, accessibility, and funding are essential. Programs should
    provide for families in all stages of deployment and reach out to them
    in all geographic locations. Families should be given the tools to take
    greater responsibility for their own readiness.
        We appreciate provisions in the National Defense Authorization Acts
    and Appropriations legislation in the past several years that
    recognized many of these important issues. Excellent programs exist
    across the Department of Defense (DOD) and the Services to support our
    military families. There are redundancies in some areas, and times when
    a new program was initiated before looking to see if an existing
    program could be adapted to answer an evolving need. Servicemembers and
    their families are continuously in the deployment cycle, anticipating
    the next separation, in the throes of deployment, or trying to
    reintegrate after the servicemember returns. Dwell times seem shorter
    and shorter as training, schools, and relocation impede on time that is
    spent in the family setting.
        ``My husband will have 3 months at home with us between deployment
    and being sent to school in January for 2 months and we will be PCSing
    soon afterwards. . . . This does not leave much time for reintegration
    and reconnection.''--Army Spouse
        We feel that now is the time to look at best practices and at those
    programs that are truly meeting the needs of families. In this section
    we will talk about existing programs, highlight best practices, and
    identify needs.
    Child Care
        At every military family conference we attended last year, child
    care was in the top five issues affecting families--drop-in care being
    the most requested need. Some installations are responding to these
    needs in innovative ways. For instance, in a recent visit to Kodiak,
    Alaska, we noted the gym facility provided watch care for its patrons.
    Mom worked out on the treadmill or elliptical while her child played in
    a safe carpeted and fenced-in area right across from her. Another area
    of the gym, previously an aerobics room, had been transformed into a
    large play area for ``Mom and me'' groups to play in the frequently
    inclement weather. These solutions aren't expensive but do require
    thinking outside the box.
        Innovative strategies are needed to address the non-availability of
    after-hours child care (before 6 a.m. and after 6 p.m.) and respite
    care. We applaud the partnership between the Services and the National
    Association of Child Care Resource and Referral Agencies that provides
    subsidized child care to families who cannot access installation based
    child development centers. We also appreciate the new SitterCity.com
    contract that will help military families find caregivers and military
    subsidized child care providers.
        Still, families often find it difficult to obtain affordable,
    quality care especially during hard-to-fill hours and on weekends. Both
    the Navy and the Air Force have programs that provide 24/7 care. These
    innovative programs must be expanded to provide care to more families
    at the same high standard as the Services' traditional child
    development programs. The Army, as part of the funding attached to its
    Army Family Covenant, has rolled out more space for respite care for
    families of deployed soldiers. Respite care is needed across the board
    for the families of the deployed and the wounded, ill, and injured. We
    are pleased the Services have rolled out more respite care for special
    needs families, but since the programs are new we are unsure of the
    impact it will have on families. We are concerned, however, when we
    hear of some installations already experiencing shortfalls of funding
    for respite care early in the year.
        At our Operation Purple* Healing Adventures camp for families of
    the wounded, ill, and injured, families told us there is a tremendous
    need for access to adequate child care on or near military treatment
    facilities. Families need the availability of child care in order to
    attend medical appointments, especially mental health appointments. Our
    Association encourages the creation of drop-in child care for medical
    appointments on the DOD or VA premises or partnerships with other
    organizations to provide this valuable service.
        We appreciate the requirement in the National Defense Authorization
    Act for Fiscal Year 2010 calling for a report on financial assistance
    provided for child care costs across the Services and components to
    support the families of those servicemembers deployed in support of a
    contingency operation and we look forward to the results.
        Our Association urges Congress to ensure resources are available to
    meet the child care needs of military families to include hourly, drop-
    in, and increased respite care across all Services for families of
    deployed servicemembers and the wounded, ill, and injured, as well as
    those with special needs family members.
    Working with Youth
        Older children and teens must not be overlooked. School personnel
    need to be educated on issues affecting military students and must be
    sensitive to their needs. To achieve this goal, schools need tools.
    Parents need tools, too. Military parents constantly seek more
    resources to assist their children in coping with military life,
    especially the challenges and stress of frequent deployments. Parents
    tell us repeatedly they want resources to ``help them help their
    children.'' Support for parents in their efforts to help children of
    all ages is increasing, but continues to be fragmented. New Federal,
    public-private initiatives, increased awareness, and support by DOD and
    civilian schools educating military children have been developed.
    However, many military parents are either not aware such programs exist
    or find the programs do not always meet their needs.
        Our Association is working to meet this pressing need through our
    Operation Purple* Summer Camps. Unique in its ability to reach out and
    gather military children of different age groups, Services, and
    components, our Operation Purple program provides a safe and fun
    environment in which military children feel immediately supported and
    understood. Now in our seventh year, we have sent more than 30,000
    children to camp for free with the support of private donors. This
    year, we expect to send another 10,000 children to camp at 67 locations
    in 34 States and Guam, and Germany. We also provided the camp
    experience to families of the wounded. In 2009, we introduced a new
    program under our Operation Purple umbrella, offering family
    reintegration retreats in the national parks. They have been well
    received by our families and more apply than can attend. We are
    offering 10 retreats this year.
        Through our Operation Purple camps, our Association has begun to
    identify the cumulative effects multiple deployments are having on the
    emotional growth and well being of military children and the challenges
    posed to the relationship between deployed parent, caregiver, and
    children in this stressful environment. Understanding a need for
    qualitative analysis of this information, we commissioned the RAND
    Corporation to conduct a pilot study in 2007 aimed at the current
    functioning and wellness of military children attending Operation
    Purple camps and assessing the potential benefits of the Operation
    Purple program in this environment of multiple and extended
    deployments.
        In May 2008, we embarked on phase two of the project--a
    longitudinal study on the experience of 1,507 families, which is a much
    larger and more diverse sample than included in our pilot study. RAND
    followed these families for 1 year, and interviewed the nondeployed
    caregiver/parent and one child per family between 11 and 17 years of
    age at three time points over the year. Recruitment of participants was
    extremely successful because families were eager to share their
    experiences. The research addressed two key questions:

              How are school-age military children faring?
              What types of issues do military children face related to
            deployment?

        In December, the baseline findings of the research were published
    in the journal Pediatrics. Findings showed:

             As the months of parental deployment increased, so did
            the child's challenges.
             The total number of months away mattered more than the
            number of deployments.
             Older children experienced more difficulties during
            deployment.
             There is a direct correlation between the mental
            health of the caregiver and the well-being of the child.
             Girls experienced more difficulty during
            reintegration, the period of months readjusting after the
            servicemember's homecoming.
             About one-third of the children reported symptoms of
            anxiety, which is somewhat higher than the percentage reported
            in other national studies of children.
             In these initial findings, there were no differences
            in results between Services or components.

        What are the implications? Families facing longer deployments need
    targeted support--especially for older teens and girls. Supports need
    to be in place across the entire deployment cycle, including
    reintegration, and some nondeployed parents may need targeted mental
    health support. One way to address these needs would be to create a
    safe, supportive environment for older youth and teens. Dedicated Youth
    Centers with activities for our older youth would go a long way to help
    with this. Our Association, as an outgrowth of the study results, will
    be holding a summit in early May, where we will be engaging with
    experts to isolate action items that address the issues surfaced in the
    study. We will be happy to share these action items with you.
        Our Association feels that more dedicated resources, such as youth
    or teen centers, would be a first step toward addressing the needs of
    our older youth and teens during deployment.
    Families Overseas
        Families stationed overseas face increased challenges when their
    servicemember is deployed into theater. One such challenge we have
    heard from families stationed in EUCOM concerns care for a family
    member, usually the spouse, who may be injured or confined to bed for
    an extended illness during deployment. Instead of pulling the
    servicemember back from theater, why not provide transportation for an
    extended family member or friend to come from the States to care for
    the injured or ill family member? This was a recommendation from the
    EUCOM Quality of Life conference for several years.
        Our Association asks that transportation be provided for a
    designated caregiver to an overseas duty station to care for an
    incapacitated spouse when a servicemember is deployed.
    Military Housing
        In the recent RAND study of military children on the home front
    commissioned by our Association, researchers found that living in
    military housing was related to fewer caregiver reported deployment-
    related challenges. For instance, fewer caregivers who lived in
    military housing reported that their children had difficulties
    adjusting to parent absence (e.g., missing school activities, feeling
    sad, not having peers who understand what their life is like) as
    compared to caregivers who needed to rent their homes. In a subsequent
    survey, the study team explored the factors that determine a military
    family's housing situation in more detail. Among the list of potential
    reasons provided for the question, ``Why did you choose to rent?''
    researchers found that the top three reasons parents/caregivers cited
    for renting included: military housing was not available (31 percent);
    renting was most affordable (28 percent), and preference to not invest
    in the purchase of a home (26 percent).
        Privatized housing expands the opportunity for families to live on
    the installation and is a welcome change for military families. We are
    pleased with the annual report that addresses the best practices for
    executing privatized housing contracts. As privatized housing evolves
    the Services are responsible for executing contracts and overseeing the
    contractors on their installations. With more joint basing, more than
    one Service often occupies an installation. The Services must work
    together to create consistent policies not only within their Service
    but across the Services as well. Pet policies, deposit requirements,
    and utility polices are some examples of differences across
    installations and across Services. How will Commanders address these
    variances as we move to joint basing? Our families face many
    transitions when they move, and navigating the various policies and
    requirements of each contractor is frustrating and confusing. It's time
    for the Services to increase their oversight and work on creating
    seamless transitions by creating consistent policies across the
    Services.
        We are pleased the NDAA for Fiscal Year 2010 calls for a report on
    housing standards and housing surveys used to determine the Basic
    Allowance for Housing (BAH) and hope Congress will work to address BAH
    inequities.
        Privatized housing is working! We ask Congress to consider the
    importance of family well-being as a reason for expanding the amount of
    privatized housing for our military families.
    Commissaries and Exchanges
        The commissary is a vital part of the compensation package for
    servicemembers and retirees, and is valued by them, their families, and
    survivors. Our surveys indicate that military families consider the
    commissary one of their most important benefits. In addition to
    providing average savings of more than 30 percent over local
    supermarkets, commissaries provide a sense of community. Commissary
    shoppers gain an opportunity to connect with other military families,
    and are provided with information on installation programs and
    activities through bulletin boards and publications. Commissary
    shoppers also receive nutritional information through commissary
    promotions and campaigns, as well as the opportunity for educational
    scholarships.
        Our Reserve component families have benefited greatly from the
    addition of case lot sales. We thank Congress again for the provision
    allowing the use of proceeds from surcharges collected at these sales
    to help defray their costs. Not only have these case lot sales been
    extremely well received and attended by family members not located near
    an installation, they have extended this important benefit to our
    entire military community.
        Our Association continues to be concerned that there will not be
    enough commissaries to serve areas experiencing substantial growth,
    including those locations with servicemembers and families relocated by
    BRAC. The surcharge was never intended to pay for DOD and Service
    transformation. Additional funding is needed to ensure commissaries are
    built or expanded in areas that are gaining personnel as a result of
    these programs.
        Our Association believes that additional funding is needed to
    ensure commissaries are built or expanded in areas that are gaining
    personnel due to BRAC and transformation.
        The military exchange system, like the commissary, provides
    valuable cost savings to members of the military community, while
    reinvesting their profits in essential Morale, Welfare and Recreation
    (MWR) programs. Our Association strongly believes that every effort
    must be made to ensure that this important benefit and the MWR revenue
    is preserved, especially as facilities are down-sized or closed
    overseas. In addition, exchanges must continue to be responsive to the
    needs of deployed servicemembers in combat zones and have the right mix
    of goods at the right prices for the full range of beneficiaries.
        As a member of the Defense Commissary Patron Council and a strong
    proponent of the military exchange system, our Association remains
    committed to protecting commissary and exchange benefits which are
    essential to the quality of life of our servicemembers, retirees,
    families and survivors.
    Flexible Spending Accounts
        We would like to thank Members of Congress for the Sense of
    Congress on the establishment of Flexible Spending Accounts for
    uniformed servicemembers. We hope this subcommittee will press each of
    the seven Service Secretaries to establish these important pre-tax
    savings accounts in a consistent manner. Flexible Spending Accounts
    would be especially helpful for families with out-of-pocket dependent
    care and health care expenses. We ask that the flexibility of a
    rollover or transfer of funds to the next year be considered.
    Financial Readiness
        Financial readiness is a critical component of family readiness.
    Our Association applauds DOD for tackling financial literacy head-on
    with their Financial Readiness Campaign. Financial literacy and
    education must continue to be on the forefront. We are strong
    supporters of the Military Lending Act (MLA) and hope Congress will
    press States to enforce MLA regulations within their State borders.
    With the depressed economy, many families may turn to payday lenders.
    DOD must continue to monitor the MLA and its effectiveness of derailing
    payday lenders.
        Military families are not immune from the housing crisis. We
    applaud Congress for expanding the Homeowners' Assistance Program to
    wounded, ill, and injured servicemembers, survivors, and servicemembers
    with Permanent Change of Station orders meeting certain parameters. We
    have heard countless stories from families across the Nation who have
    orders to move and cannot sell their home. Due to the mobility of
    military life, military homeowners must be prepared to be a landlord.
    We encourage DOD to continue to provide financial education to military
    servicemembers and their families to help families make sound financial
    decisions. We also encourage DOD to continue to track the impact of the
    housing crisis on our military families.
        We appreciate the increase to the Family Separation Allowance (FSA)
    that was made at the beginning of the war. In more than 8 years,
    however, there has not been another increase. We ask that the FSA be
    indexed to the Cost of Living Allowance (COLA) to better reflect rising
    costs for services.
        Increase the Family Separation Allowance by indexing it to COLA.
                               ii. family health
        Family readiness calls for access to quality health care and mental
    health services. Families need to know the various elements of their
    military health system are coordinated and working as a synergistic
    system. Our Association is concerned the DOD military health care
    system may not have all the resources it needs to meet both the
    military medical readiness mission and provide access to health care
    for all beneficiaries. It must be funded sufficiently, so the direct
    care system of Military Treatment Facilities (MTFs) and the purchased
    care segment of civilian providers can work in tandem to meet the
    responsibilities given under the TRICARE contracts, meet readiness
    needs, and ensure access for all military beneficiaries.
    Military Health System
        Improving Access to Care
        In the question and answer period during a hearing of this
    subcommittee on June 3, 2009, Senator Lindsey Graham (R-SC) asked panel
    members to ``give a grade to TRICARE.'' Panel members rated TRICARE a
    ``B'' or a ``C minus.'' Our Association's Director of Government
    Relations stated it was a two-part question and assigned a grade of
    ``B'' for quality of care and ``C-'' for access to care. We welcomed
    this discussion focused on access issues in the direct care system--our
    military hospitals and clinics--reinforcing what our Association has
    observed for years. We have consistently heard from families that their
    greatest health care challenge has been getting timely care from their
    local military hospital or clinic.
        Our Association continues to examine military families' experiences
    with accessing the Military Health System (MHS). Families' main issues
    are: access to their Primary Care Managers (PCM); getting someone to
    answer the phone at central appointments; having appointments available
    when they finally got through to central appointments; after hours
    care; getting a referral for specialty care; being able to see the same
    provider or PCM; and having appointments available 60, 90, and 120 days
    out in our MTFs for follow-ups recommended by their providers. Families
    familiar with how the MHS referral system works seem better able to
    navigate the system. Those families who are unfamiliar report delays in
    receiving treatment or sometimes decide to give up on the referral
    process and never obtain a specialty appointment. Continuity of care is
    important to maintain quality of care. The MTFs are stressed from 8
    years of provider deployments, directly affecting the quality of care
    and contributing to increased costs. Our Association thanks Congress
    for requiring, in the NDAA for Fiscal Year 2009, a report on access to
    care and we look forward to the findings. This report must distinguish
    between access issues in the MTFs, as opposed to access in the civilian
    TRICARE networks.
        Our most seriously wounded, ill, and injured servicemembers,
    veterans, and their families are assigned case managers. In fact, there
    are many different case managers: Federal Recovery Coordinators (FRC),
    Recovery Care Coordinators, coordinators from each branch of Service,
    TBI care coordinators, VA liaisons, et cetera. The goal is for a
    seamless transition of care between and within the two governmental
    agencies, DOD and the VA. However, with so many coordinators to choose
    from, families often wonder which one is the ``right'' case manager. We
    often hear from families, some whose servicemember has long been
    medically retired with a 100 percent disability rating or others with
    less than 1 year from date-of-injury, who have not yet been assigned a
    FRC. We need to look at whether the multiple, layered case managers
    have streamlined the process, or have only aggravated it. Our
    Association still finds families trying to navigate alone a variety of
    complex health care systems, trying to find the right combination of
    care. Individual Service wounded, ill, and injured program directors
    and case managers are often reluctant to inform families that FRCs
    exist or that the family qualifies for one. Many qualify for and use
    Medicare, VA, DOD's TRICARE direct and purchased care, private health
    insurance, and State agencies. Why can't the process be streamlined?
        Support for Special Needs Families
        Case management for military beneficiaries with special needs is
    not consistent because the coordination of the military family's care
    is being done by a non-synergistic health care system. Beneficiaries
    try to obtain an appointment and then find themselves getting partial
    health care within the MTF, while other health care is referred out
    into the purchased care network. Thus, military families end up
    managing their own care. Incongruence in the case management process
    becomes more apparent when military family members transfer from one
    TRICARE region to another and is further exacerbated when a special
    needs family member is involved. Families need a seamless transition
    and a warm handoff between TRICARE regions and a universal case
    management process across the MHS. Each TRICARE Managed Care Contractor
    has created different case management processes. The current case
    management system is under review by DOD and the TRICARE Management
    Activity.
        We applaud Congress and DOD's desire to create robust health care,
    educational, and family support services for special needs children.
    But, these robust services do not follow them when they retire. We
    encourage the Services to allow these military families the opportunity
    to have their final duty station be in an area of their choice. We
    suggest the Extended Care Health Option (ECHO) be extended for 1 year
    after retirement for those already enrolled in ECHO prior to
    retirement. If the ECHO program is extended, it must be for all who are
    eligible for the program. We should not create a different benefit
    simply based on diagnosis.
        There has been discussion over the past years by Congress and
    military families regarding the ECHO program. The NDAA for Fiscal Year
    2009 included a provision to increase the cap on certain benefits under
    the ECHO program and the NDAA for Fiscal Year 201O established the
    Office of Community Support for Military Families with Special Needs.
    The ECHO program was originally designed to allow military families
    with special needs to receive additional services to offset their lack
    of eligibility for State or federally provided services impacted by
    frequent moves. We suggest that before making any more adjustments to
    the ECHO program, Congress should direct DOD to certify if the ECHO
    program is working as it was originally designed and if it has been
    effective in addressing the needs of this population. We need to make
    the right fixes so we can be assured we apply the correct solutions.
    This new office will go a long way in identifying and addressing
    special needs. However, we must remember that our special needs
    families often require medical, educational and family support
    resources. This new office must address all these various needs in
    order to effectively implement change.
        National Guard and Reserve Member Family Health Care
        National Guard and Reserve families need increased education about
    their health care benefits. We also believe that paying a stipend to a
    mobilized National Guard or Reserve member for their family's coverage
    under their employer-sponsored insurance plan while the servicemember
    is deployed may work out better for many families in areas where the
    TRICARE network may not be robust.
        Grey Area Reservists
        Our Association would like to thank Congress for the new TRICARE
    benefit for Grey Area Reservists. We want to make sure this benefit is
    quickly implemented and they have access to a robust network.
        TRICARE Reimbursement
        Our Association is concerned that continuing pressure to lower
    Medicare reimbursement rates will create a hollow benefit for TRICARE
    beneficiaries. As the 111th Congress takes up Medicare legislation, we
    request consideration of how this legislation will impact military
    families' health care, especially our most vulnerable service, access
    to mental health.
        National provider shortages in the mental health field, especially
    in child and adolescent psychology, are exacerbated in many cases by
    low TRICARE reimbursement rates, TRICARE rules, or military-unique
    geographic challenges--for example large populations in rural or
    traditionally underserved areas. Many mental health providers are
    willing to see military beneficiaries on a voluntary status. However,
    these providers often tell us they will not participate in TRICARE
    because of what they believe are time-consuming requirements and low
    reimbursement rates. More must be done to persuade these providers to
    participate in TRICARE and become a resource for the entire system,
    even if that means DOD must raise reimbursement rates.
        Pharmacy
        We caution DOD about generalizing findings of certain beneficiary
    pharmacy behaviors and automatically applying them to our Nation's
    unique military population. We encourage Congress to require DOD to
    utilize peer-reviewed research involving beneficiaries and prescription
    drug benefit options, along with performing additional research
    involving military beneficiaries, before making any recommendations on
    prescription drug benefit changes, such as co-payment and tier
    structure changes for military servicemembers, retirees, their
    families, and survivors.
        We appreciate the inclusion of Federal pricing for the TRICARE
    retail pharmacies in the NDAA for Fiscal Year 2008. However, we still
    need to examine its effect on the cost of medications for both
    beneficiaries and DOD. Also, we will need to see how this potentially
    impacts Medicare, civilian private insurance, and the National Health
    Care Reform affecting drug pricing negotiations.
        We believe it is imperative that all medications available through
    TRICARE Retail Pharmacy (TRRx) should also be available through TRICARE
    Mail Order Pharmacy (TMOP). Medications treating chronic conditions,
    such as asthma, diabetes, and hypertension should be made available at
    the lowest level of co-payment regardless of brand or generic status.
    We agree with the recommendations of the Task Force on the Future of
    Military Health Care that over-the-counter (OTC) drugs be a covered
    pharmacy benefit and there be a zero co-pay for TMOP Tier 1
    medications.
        The new T3 TRICARE contract will provide TRICARE Managed Care
    Contractors and Express-Scripts, Inc. the ability to link pharmacy data
    with disease management. This will allow for better case management,
    increase compliance, and decrease cost, especially for our chronically
    ill beneficiaries. However, this valuable tool is currently unavailable
    because the T3 contract is still under protest and has not yet been
    awarded.
        National Health Care Proposal
        Our Association is cautious about current rhetoric by the
    administration and Congress regarding National Health Care Reform. We
    request consideration of how this legislation will also impact TRICARE.
        The perfect storm is brewing. TMA will hopefully be instituting the
    new T3 contract in 2011. Currently, there is the possibility that two
    out of three TRICARE Managed Care Contractors could change. This means
    that the contracts of 66 percent of our TRICARE providers would need to
    be renegotiated. Add the demands and uncertainties to providers in
    regards to health care reform and Medicare reimbursement rate changes.
    This leads to our concern regarding the impact on providers'
    willingness to remain in the TRICARE network and the recruitment of new
    providers. The unintended consequences maybe a decrease in access to
    care due the lack of available health care providers.
        DOD Must Look for Savings
        We ask Congress to establish better oversight for DOD's
    accountability in becoming more cost-efficient. We recommend:

             Requiring the Comptroller General to audit MTFs on a
            random basis until all have been examined for their ability to
            provide quality health care in a cost-effective manner;
             Creating an oversight committee, similar in nature to
            the Medicare Payment Advisor Commission, which provides
            oversight to the Medicare program and makes annual
            recommendations to Congress. The Task Force on the Future of
            Military Health Care often stated it was unable to address
            certain issues not within their charter or the timeframe in
            which they were commissioned to examine the issues. This
            Commission would have the time to examine every issue in an
            unbiased manner.
             Establishing a Unified ``Joint'' Medical Command
            structure, which was recommended by the Defense Health Board in
            2006 and 2009.

        Our Association believes optimizing the capabilities of the
    facilities of the direct care system through timely replacement of
    facilities, increased funding allocations, and innovative staffing
    would allow more beneficiaries to be cared for in the MTFs, which DOD
    asserts is the most cost effective. The Task Force made recommendations
    to make the DOD MHS more cost-efficient which we support. They conclude
    the MHS must be appropriately sized, resourced, and stabilized; and
    make changes in its business and health care practices.
        We suggest additional funding and flexibility in hiring practices
    to address MTF provider deployments.
        Our Association recommends a 1 year transitional active duty ECHO
    benefit for all eligible family members of servicemembers who retire.
        We believe that Reserve component families should be given the
    choice of a stipend to continue their employer provided care during
    deployment.
    Behavioral Health Care
        Our Nation must help returning servicemembers and their families
    cope with the aftermath of war. DOD, VA, and State agencies must
    partner in order to address behavioral health issues early in the
    process and provide transitional mental health programs. Partnering
    will also capture the National Guard and Reserve member population, who
    often straddle these agencies' health care systems.
        Full Spectrum of Care
        As the war continues, families' need for a full spectrum of
    behavioral health services--from preventative care and stress reduction
    techniques, to counseling and medical mental health services--continues
    to grow. The military offers a variety of psychological health
    services, both preventative and treatment, across many agencies and
    programs. However, as servicemembers and families experience numerous
    lengthy and dangerous deployments, we believe the need for
    confidential, preventative psychological health services will continue
    to rise. It will remain high, even after military operations scale
    down. Our study on the impact of the war on caregivers and children
    found the mental health of the caregiver directly affects the overall
    well-being of the children. Therefore, we need to treat the family as a
    unit rather than as individuals because the caregiver's health
    determines the quality of life for the children.
        Access to Behavioral Health Care
        Our Association is concerned about the overall shortage of mental
    health providers in TRICARE's direct and purchased care network. DOD's
    Task Force on Mental Health stated timely access to the proper
    psychological health provider remains one of the greatest barriers to
    quality mental health services for servicemembers and their families.
    The Army Family Action Plan (AFAP) identified mental health issues as
    their number three issue for 2010. While families are pleased more
    mental health providers are available in theater to assist their
    servicemembers, they are disappointed with the resulting limited access
    to providers at home. Families are reporting increased difficulty in
    obtaining appointments with social workers, psychologists, and
    psychiatrists at their MTFs and clinics. The military fuels the
    shortage by deploying some of its child and adolescent psychology
    providers to combat zones. Providers remaining at home report they are
    overwhelmed by treating active duty members and are unable to fit
    family members into their schedules. This can lead to provider
    compassion fatigue, creating burnout and exacerbating the provider
    shortage problem.
        We have seen an increase in the number of mental health providers
    joining the purchased care side of the TRICARE network. However, the
    access standard is 7 days. We hear from military families after
    accessing the mental health provider lists on the contractors' web
    sites that the provider is full and no longer taking TRICARE patients.
    The list must be up-to-date in order to handle real time demands by
    families. We need to continue to recruit more mental health providers
    to join the TRICARE network and we need to make sure we specifically
    add those in specialty behavioral health care areas, such as child and
    adolescence psychology and psychiatrists.
        Families must be included in mental health counseling and treatment
    programs for servicemembers. Family members are a key component to a
    servicemember's psychological well-being. Families want to be able to
    access care with a mental health provider who understands or is
    sympathetic to the issues they face. We recommend an extended outreach
    program to servicemembers, veterans, and their families of available
    mental health resources, such as DOD, VA, and State agencies. We
    appreciate the VA piloting programs that incorporate active duty
    servicemembers and their families into their newly established OIF/OEF
    health care clinics. The family is accessed as a ``unit'' and educated
    about the VA's benefits and services. These initiatives need to be
    expanded throughout the VA and fully funded.
        Frequent and lengthy deployments create a sharp need in mental
    health services by family members and servicemembers as they get ready
    to deploy and after their return. There is also an increase in demand
    in the wake of natural disasters, such as hurricanes and fires. We need
    to maintain a flexible pool of mental health providers who can increase
    or decrease rapidly in numbers depending on demand on the MHS side.
    Currently, Military Family Life Consultants and Military OneSource
    counseling are providing this type of service for military families on
    the family support side. The recently introduced web-based TRICARE
    Assistance Program (TRIAP) offers another vehicle for nonmedical
    counseling, especially for those who live far from counselors. We need
    to make the Services, along with military family members, more aware of
    resources along the continuum. We need the flexibility of support in
    both the MHS and family support arenas, as well as coordination of
    support between these two entities. We must educate civilian network
    providers about our culture. Communities along with nongovernment
    organizations are beginning to fulfill this role, but more needs to be
    done.
        Availability of Treatment
        Do DOD, VA, and State agencies have adequate mental health
    providers, programs, outreach, and funding? Better yet, where will the
    veteran's spouse and children go for help? Many will be left alone to
    care for their loved one's invisible wounds resulting from frequent and
    long combat deployments. Who will care for them when they are no longer
    part of the DOD health care system?
        The Army's Mental Health Advisory Team (MHAT) IV report links
    reducing family issues to reducing stress on deployed servicemembers.
    The team found the top noncombat stressors were deployment length and
    family separation. They noted soldiers serving a repeat deployment
    reported higher acute stress than those on their first deployment and
    the level of combat was the major contribution for their psychological
    health status upon return. Our study on the impact of deployment on
    caregivers and children found it was the cumulative time deployed that
    caused increased stress. These reports demonstrate the amount of stress
    being placed on our troops and their families.
        Our Association is especially concerned with the scarcity of
    services available to the families as they leave the military following
    the end of their activation or enlistment. Due to the servicemember's
    separation, the families find themselves ineligible for TRICARE,
    Military OneSource, and are very rarely eligible for health care
    through the VA. Many will choose to locate in rural areas lacking
    available mental health providers. We need to address the distance
    issues families face in finding mental health resources and obtaining
    appropriate care. Isolated servicemembers, veterans, and their families
    do not have the benefit of the safety net of services and programs
    provided by MTFs, VA facilities, Community-Based Outpatient Centers and
    Vet Centers. We recommend:

             using alternative treatment methods, such as
            telemental health;
             modifying licensing requirements in order to remove
            geographic practice barriers that prevent psychological health
            providers from participating in telemental health services
            outside of a VA facility;
             educating civilian network psychological health
            providers about our military culture as the VA incorporates
            Project Hero; and
             encouraging DOD and VA to work together to provide a
            seamless ``warm hand-off'' for families, as well as
            servicemembers transitioning from active duty to veteran status
            and funding additional transitional support programs if
            necessary.
        National Guard and Reserve Members
        The National Military Family Association is especially concerned
    about fewer mental health care services available for the families of
    returning National Guard and Reserve members. Some are eligible for
    TRICARE Reserve Select but, as we know, National Guard and Reserve
    members are often located in rural areas where there may be fewer
    mental health providers available. Policymakers need to address the
    distance issues that families face in linking with military mental
    health resources and obtaining appropriate care. Isolated National
    Guard and Reserve families do not have the benefit of the safety net of
    services provided by MTFs and installation family support programs.
    Families want to be able to access care with a provider who understands
    or is sympathetic to the issues they face. We recommend the use of
    alternative treatment methods, such as telemental health; increasing
    mental health reimbursement rates for rural areas; modifying licensing
    requirements in order to remove geographic practice barriers that
    prevent mental health providers from participating in telemental health
    services; and educating civilian network mental health providers about
    our military culture. We urge DOD to expand information outreach about
    the new TRIAP program, which provides access to non-medical counseling
    via phone and web through the TRICARE managed care support contractors.
    We hear the National Guard Bureau's Psychological Health Services (PHs)
    is not working as designed to address members' mental health issues.
    This program needs to be evaluated to determine its effectiveness.
        Children
        Our Association is concerned about the impact deployment and/or the
    injury of the servicemember is having on our most vulnerable
    population, children of our military servicemember and veterans. Our
    study on the impact of the war on caregivers and children found
    deployments are creating layers of stressors, which families are
    experiencing at different stages. Teens especially carry a burden of
    care they are reluctant to share with the non-deployed parent in order
    to not ``rock the boat.'' They are often encumbered by the feeling of
    trying to keep the family going, along with anger over changes in their
    schedules, increased responsibility, and fear for their deployed
    parent. Children of the National Guard and Reserve members face unique
    challenges since there are no military installations for them to
    utilize. They find themselves ``suddenly military'' without resources
    to support them. School systems are generally unaware of this change in
    focus within these family units and are ill prepared to lookout for
    potential problems caused by these deployments or when an injury
    occurs. Also vulnerable are children who have disabilities that are
    further complicated by deployment and subsequent injury of the
    servicemembers. Their families find stress can be overwhelming, but are
    afraid to reach out for assistance for fear of retribution to the
    servicemember's career. They often choose not to seek care for
    themselves or their families. We appreciate the inclusion of a study on
    the mental health needs of our children in the NDAA for Fiscal Year
    201O.
        The impact of the wounded, ill, and injured on children is often
    overlooked and underestimated. Military children experience a
    metaphorical death of the parent they once knew and must make many
    adjustments as their parent recovers. Many families relocate to be near
    the treating MTF or the VA Polytrauma Center in order to make the
    rehabilitation process more successful. As the spouse focuses on the
    rehabilitation and recovery, older children take on new roles. They may
    become the caregivers for other siblings, as well as for the wounded
    parent. Many spouses send their children to stay with neighbors or
    extended family members, as they tend to their wounded, ill, and
    injured spouse. Children get shuffled from place to place until they
    can be reunited with their parents. Once reunited, they must adapt to
    the parent's new injury and living with the ``new normal.'' We
    appreciate the inclusion of a study to assess the impact on children of
    the severely wounded in the NDAA for Fiscal Year 2010.
        We encourage partnerships between government agencies, DOD, VA, and
    State agencies and recommend they reach out to those private and
    nongovernmental organizations who are experts on children and
    adolescents. They could identify and incorporate best practices in the
    prevention and treatment of mental health issues affecting our military
    children. We must remember to focus on preventative care upstream,
    while still in the active duty phase, in order to have a solid family
    unit as they head into the veteran phase of their lives. School systems
    must become more involved in establishing and providing supportive
    services for our Nation's children.
        Caregiver Burnout
        In the eighth year of war, care for the caregivers must become a
    priority. There are several levels of caregivers. Our Association hears
    from the senior officer and enlisted spouses who are so often called
    upon to be the strength for others. We hear from the health care
    providers, educators, rear detachment staff, chaplains, and counselors
    who are working long hours to assist servicemembers and their families.
    They tell us they are overburdened, burnt out, and need time to
    recharge so they can continue to serve these families. These caregivers
    must be afforded respite care, given emotional support through their
    command structure, and be provided effective family programs.
        Education
        The DOD, VA, and State agencies must educate their health care and
    mental health professionals of the effects of mild Traumatic Brain
    Injury (mTBI) in order to help accurately diagnose and treat the
    servicemember's condition. They must be able to deal with polytrauma-
    Post-Traumatic Stress Disorder (PTSD) in combination with multiple
    physical injuries. We need more education for civilian health care
    providers on how to identify signs and symptoms of mild TBI and PTSD.
        The families of servicemembers and veterans must be educated about
    the effects of TBI, PTSD, and suicide in order to help accurately
    diagnose and treat the servicemember/veteran's condition. These
    families are on the ``sharp end of the spear'' and are more likely to
    pick up on changes attributed to either condition and relay this
    information to their health care providers. Programs are being
    developed by each Service. However, they are narrow in focus targeting
    line leaders and health care providers, but not broad enough to capture
    our military family members and the communities they live in. As
    Services roll out suicide prevention programs, we need to include our
    families, communities, and support personnel.
        Reintegration Programs
        Reintegration programs become a key ingredient in the family's
    success. Our Association believes we need to focus on treating the
    whole family with programs offering readjustment information; education
    on identifying mental health, substance abuse, suicide, and traumatic
    brain injury; and encouraging them to seek assistance when having
    financial, relationship, legal, and occupational difficulties. We
    appreciate the inclusion in the NDAA for Fiscal Year 2010 for education
    programs targeting pain management and substance abuse for our
    families.
        Successful return and reunion programs will require attention over
    the long term, as well as a strong partnership at all levels between
    the various mental health arms of DOD, VA, and State agencies. DOD and
    VA need to provide family and individual counseling to address these
    unique issues. Opportunities for the entire family and for the couple
    to reconnect and bond must also be provided. Our Association has
    recognized this need and successfully piloted family retreats in the
    national parks promoting family reintegration following deployment.
        We recommend an extended outreach program to servicemembers,
    veterans, and their families of available psychological health
    resources, such as DOD, VA, and State agencies.
        We encourage Congress to request DOD to include families in its
    Psychological Health Support survey; perform a pre- and post-deployment
    mental health screening on family members (similar to the PDHA and
    PDHRA currently being done for servicemembers).
        We recommend the use of alternative treatment methods, such as
    telemental health; increasing mental health reimbursement rates for
    rural areas; modifying licensing requirements in order to remove
    geographic practice barriers that prevent mental health providers from
    participating in telemental health services; and educating civilian
    network mental health providers about our military culture.
        Caregivers must be afforded respite care; given emotional support
    through their command structure; and, be provided effective family
    programs.
    Wounded Servicemembers Have Wounded Families
        Our Association asserts that behind every wounded servicemember and
    veteran is a wounded family. It is our belief the government,
    especially the DOD and VA, must take a more inclusive view of military
    and veterans' families. Those who have the responsibility to care for
    the wounded, ill, and injured servicemember must also consider the
    needs of the spouse, children, parents of single servicemembers and
    their siblings, and the caregivers. DOD and VA need to think
    proactively as a team and one system, rather than separately; and
    addressing problems and implementing initiatives upstream while the
    servicemember is still on active duty status.
        Reintegration programs become a key ingredient in the family's
    success. For the past 2 years, we have piloted our Operation
    Purple"'HealingAdventures camp to help wounded servicemembers and their
    families learn to play again as a family. We hear from the families who
    participate in this camp, as well as others dealing with the recovery
    of their wounded servicemembers that, even with Congressional
    intervention and implementation of the Services' programs, many issues
    still create difficulties for them well into the recovery period.
    Families find themselves having to redefine their roles following the
    injury of the servicemember. They must learn how to parent and become a
    spouse/lover with an injury. Each member needs to understand the unique
    aspects the injury brings to the family unit. Parenting from a
    wheelchair brings a whole new challenge, especially when dealing with
    teenagers. Parents need opportunities to get together with other
    parents who are in similar situations and share their experiences and
    successful coping methods. Our Association believes we need to focus on
    treating the whole family with DOD and VA programs offering skill based
    training for coping, intervention, resiliency, and overcoming
    adversities. Injury interrupts the normal cycle of deployment and the
    reintegration process. We must provide opportunities for the entire
    family and for the couple to reconnect and bond, especially during the
    rehabilitation and recovery phases.
        Brooke Army Medical Center (BAMC) has recognized a need to support
    these families by expanding in terms of guesthouses colocated within
    the hospital grounds and a family reintegration program for their
    Warrior Transition Unit. The on-base school system is also sensitive to
    issues surrounding these children. A warm, welcoming family support
    center located in guest housing serves as a sanctuary for family
    members. The DOD and VA could benefit from looking at successful
    programs like BAMCs, which has found a way to embrace the family unit
    during this difficult time.
        The Vet Centers are an available resource for veterans' families
    providing adjustment, vocational, and family and marriage counseling.
    The VA health care facilities and the community-based outpatient
    clinics (CBOCs) have a ready supply of mental health providers, yet
    regulations have restricted their ability to provide mental health care
    to veterans' families unless they meet strict standards. Unfortunately,
    this provision hits the veteran's caregiver the hardest, especially if
    they are the parents. We recommend DOD partner with the VA to allow
    military families access to mental health services. We also believe
    Congress should require the VA, through its Vet Centers and health care
    facilities to develop a holistic approach to care by including families
    when providing mental health counseling and programs to the wounded,
    ill, and injured servicemember or veteran.
        The Defense Health Board has recommended DOD include military
    families in its mental health studies. We agree. We encourage Congress
    to direct DOD to include families in its Psychological Health Support
    survey; perform a pre- and post-deployment mental health screening on
    family members (similar to the PDHA and PDHRA currently being done for
    servicemembers). We appreciate the NDAA for Fiscal Year 2010 report on
    the impact of the war on families and the DOD's Millennium Cohort Study
    including families. Both will help us gain a better understanding of
    the long-term effects of war on our military families.
        Transitioning for the Wounded and Their Families
        Transitions can be especially problematic for wounded, ill, and
    injured servicemembers, veterans, and their families. The DOD and the
    VA health care systems, along with State agency involvement, should
    alleviate, not heighten these concerns. They should provide for
    coordination of care, starting when the family is notified that the
    servicemember has been wounded and ending with the DOD, VA, and State
    agencies working together, creating a seamless transition, as the
    wounded servicemember transfers between the two agencies' health care
    systems and, eventually, from active duty status to veteran status.
        Transition of health care coverage for our wounded, ill, and
    injured and their family members is a concern of our Association. These
    servicemembers and families desperately need a health care bridge as
    they deal with the after effects of the injury and possible reduction
    in their family income. We have created two proposals. servicemembers
    who are medically retired and their families should be treated as
    active duty for TRICARE fee and eligibility purposes for 3 years
    following medical retirement. This proposal will allow the family not
    to pay premiums and be eligible for greater access to care at certain
    MTFs and for certain benefits offered to active duty families for 3
    years. Following that period, they would pay TRICARE premiums at the
    rate for retirees. servicemembers medically discharged from service and
    their family members should be allowed to continue for 1 year as active
    duty for TRICARE benefits and then move into the Continued Health Care
    Benefit Program (CHCBP) if needed.
        Caregivers
        Caregivers need to be recognized for the important role they play
    in the care of their loved one. Without them, the quality of life of
    the wounded servicemembers and veterans, such as physical, psycho-
    social, and mental health, would be significantly compromised. They are
    viewed as an invaluable resource to DOD and VA health care providers
    because they tend to the needs of the servicemembers and the veterans
    on a regular basis. Their daily involvement saves DOD, VA, and State
    agency health care dollars in the long run. Their long-term
    psychological care needs must be addressed. Caregivers of the severely
    wounded, ill, and injured servicemembers who are now veterans have a
    long road ahead of them. In order to perform their job well, they will
    require access to mental health services.
        The VA has made a strong effort in supporting veterans' caregivers.
    The DOD should follow suit and expand their definition. We appreciate
    the inclusion in NDAA for Fiscal Year 2010 of compensation for
    servicemembers with assistance in everyday living. However, our
    Association believes this provision does not go far enough. In order to
    perform their job well, caregivers must be taught the skills to be
    successful.
        Compensation of caregivers should be a priority for DOD and the
    Secretary of Homeland Security. Caregivers must be recognized for their
    sacrifices and the important role they play in maintaining the quality
    of life of our wounded servicemembers and veterans. Financial
    compensation must be established for caregivers of injured
    servicemembers and veterans that begin while the hospitalized
    servicemember is still on active duty and transitions seamlessly to a
    VA benefit. Current law creates a potential gap in compensation during
    transition from active duty to veteran status. Our Association proposes
    that compensation should reflect the types of medical and non-medical
    care services provided by the caregiver. The caregiver should be paid
    directly for their services. Non-medical care should be factored into a
    monthly stipend tied to severity of injury--cognitive and physical
    injury and illness-and care provided. In order to perform their job
    well, caregivers must be taught the skills to be successful. This will
    require the caregiver to be trained through a standardized, certified
    program. Compensation for medical care should be an hourly wage linked
    to training and certification of the caregiver paid for by the VA and
    transferrable to employment in the civilian sector if the care is no
    longer needed by the servicemember or veteran.
        Consideration should also be given to creating innovative ways to
    meet the health care and insurance needs of the caregiver, with an
    option to include their family. Current proposed legislation does not
    include a ``family'' option. Additional services caregivers need are:
    respite care, such as 24 hour in-home care, mental health services, and
    travel and lodging expenses when accompanying servicemembers and
    veterans for medical care.
        There must be a provision for transition benefits for the caregiver
    if the caregiver's services are no longer needed, chooses to no longer
    participate, or is asked by the veteran to no longer provide services.
    The caregiver should still be able to maintain health care coverage for
    1 year. Compensation would discontinue following the end of services/
    care provided by the caregiver. Our Association looks forward to
    discussing details of implementing such a plan with members of this
    subcommittee.
        The VA currently has eight caregiver assistance pilot programs to
    expand and improve health care education and provide needed training
    and resources for caregivers who assist disabled and aging veterans in
    their homes. DOD should evaluate these pilot programs to determine
    whether to adopt them for caregivers of servicemembers still on active
    duty. Caregivers' responsibilities start while the servicemember is
    still on active duty.
        Relocation Allowance and Housing
        Active duty servicemembers and their spouses qualify through the
    DOD for military orders to move their household goods when they leave
    the military service. Medically retired servicemembers are given a
    final PCS move. Medically retired married servicemembers are allowed to
    move their family; however, medically retired single servicemembers
    only qualify for moving their own personal goods.
        Our Association suggests that legislation be passed to allow
    medically retired single servicemembers the opportunity to have their
    caregiver's household goods moved as a part of the medical retired
    single servicemember's PCS move. This should be allowed for the
    qualified caregiver of the wounded servicemember and the caregiver's
    family (if warranted), such as a sibling who is married with children
    or mom and dad. This would allow for the entire caregiver's family to
    move, not just the caregiver. The reason for the move is to allow the
    medically retired single servicemember the opportunity to relocate with
    their caregiver to an area offering the best medical care, rather than
    the current option that only allows for the medically retired single
    servicemember to move their belongings to where the caregiver currently
    resides. The current option may not be ideal because the area in which
    the caregiver lives may not be able to provide all the health care
    services required for treating and caring for the medically retired
    servicemember. Instead of trying to create the services in the area, a
    better solution may be to allow the medically retired servicemember,
    their caregiver, and the caregiver's family to relocate to an area
    where services already exist.
        The decision on where to relocate for optimum care should be made
    with the Federal Recovery Coordinator (case manager), the
    servicemember's medical physician, the servicemember, and the
    caregiver. All aspects of care for the medically retired servicemember
    and their caregiver shall be considered. These include a holistic
    examination of the medically retired servicemember, the caregiver, and
    the caregiver's family for, but not limited to, their needs and
    opportunities for health care, employment, transportation, and
    education. The priority for the relocation should be where the best
    quality of services is readily available for the medically retired
    servicemember and higher caregiver.
        The consideration for a temporary partial shipment of caregiver's
    household goods may also be allowed, if deemed necessary by the case
    management team.
        Medical Power of Attorney
        We have heard from caregivers of the difficult decisions they have
    to make over their loved one's bedside following an injury. We support
    the Traumatic Brain Injury Task Force recommendation for DOD to require
    each deploying servicemember to execute a Medical Power of Attorney and
    a Living Will.
        Provide medically-retired wounded, ill, and injured servicemembers
    and their families a bridge of extended active duty TRICARE e1igibility
    for 3 years, comparable to the benefit for surviving spouses.
        Servicemembers medically discharged from Service and their family
    members should be allowed to continue for 1 year as active duty for
    TRICARE and then start the Continued Health Care Benefit Program
    (CHCBP) if needed.
        Caregivers of the wounded, ill, and injured must be provided with
    opportunities for training, compensation and other support programs
    because of the important role they play in the successful
    rehabilitation and care of the servicemember.
        The National Military Family Association is requesting the ability
    for medically retired single servicemembers to be allowed the
    opportunity to have their caregiver's household goods moved as a part
    of the medically retired single servicemember's PCS move.
        DOD should require each deploying servicemember to execute a
    Medical Power of Attorney and a Living Will.
        Senior Oversiqht Committee
        Our Association is appreciative of the provision in the NDAA for
    Fiscal Year 2010 establishing a DOD Task Force on the Care, Management,
    and Transition of Recovery, Wounded, Ill, and Injured Members of the
    Armed Forces to access policies and programs. We understand the Office
    of Wounded Warrior Care and Transition Policy (WWCTP), a permanent
    structure for the Senior Oversight Committee, is in the process of
    being established and manned. This Task Force will be independent and
    in a position to monitor DOD and VA's partnership initiatives for our
    wounded, ill, and injured servicemembers and their families, while this
    organization is being created.
        The National Military Family Association encourages all committees
    with jurisdiction over military personnel and veterans matters to talk
    on these important issues. We can no longer continue to create policies
    in a vacuum and be content on focusing on each agency separately
    because this population moves too frequently between the two agencies,
    especially our wounded, ill, and injured servicemembers and their
    families.
        We would like to thank you again for the opportunity to provide
    information on the health care needs for the servicemembers, veterans,
    and their families. Military families support the Nation's military
    missions. The least their country can do is make sure servicemembers,
    veterans, and their families have consistent access to high quality
    mental health care in the DOD, VA, and within network civilian health
    care systems. Wounded servicemembers and veterans have wounded
    families. The caregiver must be supported by providing access to
    quality health care and mental health services, and assistance in
    navigating the health care systems. The system should provide
    coordination of care with DOD, VA, and State agencies working together
    to create a seamless transition. We ask Congress to assist in meeting
    that responsibility.
                            iii. family transitions
    Survivors
        In the past year, the Services have increased their outreach to
    surviving families. In particular, the Army's Survivor Outreach
    Services (SOS) program makes an effort to remind these families that
    they are not forgotten. DOD and the VA must work together to ensure
    surviving spouses and their children can receive the mental health
    services they need, through all of VA's venues. New legislative
    language governing the TRICARE behavioral health benefit may also be
    needed to allow TRICARE coverage of bereavement or grief counseling.
    The goal is the right care at the right time for optimum treatment
    effect. DOD and the VA need to better coordinate their mental health
    services for survivors and their children.
        We thank Congress for extending the TRICARE active duty family
    dental insurance benefit to surviving children. The current TRICARE
    Management Activity policy directive allows for the surviving children
    of Reserve component servicemembers who had not previously been
    enrolled to be eligible for the expanded benefit. We ask that
    eligibility be expanded to those active duty family members who had not
    been enrolled in the active duty TRICARE dental insurance program prior
    to the servicemember's death.
        Our Association recommends that eligibility be expanded to active
    duty survivors who had not been enrolled in the TRICARE Dental Program
    prior to the servicemember's death. We also recommend that grief
    counseling be more readily available to survivors.
        Our Association still believes the benefit change that will provide
    the most significant long-term advantage to the financial security of
    all surviving families would be to end the Dependency and Indemnity
    Compensation (DIC) offset to the Survivor Benefit Plan (SBP). Ending
    this offset would correct an inequity that has existed for many years.
    Each payment serves a different purpose. The DIC is a special indemnity
    (compensation or insurance) payment paid by the VA to the survivor when
    the servicemember's service causes his or her death. The SBP annuity,
    paid by DOD, reflects the longevity of the service of the military
    member. It is ordinarily calculated at 55 percent of retired pay.
    Military retirees who elect SBP pay a portion of their retired pay to
    ensure that their family has a guaranteed income should the retiree
    die. If that retiree dies due to a service-connected disability, their
    survivor becomes eligible for DIC.
        Surviving active duty spouses can make several choices, dependent
    upon their circumstances and the ages of their children. Because SBP is
    offset by the DIC payment, the spouse may choose to waive this benefit
    and select the ``child only'' option. In this scenario, the spouse
    would receive the DIC payment and the children would receive the full
    SBP amount until each child turns 18 (23 if in college), as well as the
    individual child DIC until each child turns 18 (23 if in college). Once
    the children have left the house, this choice currently leaves the
    spouse with an annual income of $13,848, a significant drop in income
    from what the family had been earning while the servicemember was alive
    and on active duty. The percentage of loss is even greater for
    survivors whose servicemembers served longer. Those who give their
    lives for their country deserve more fair compensation for their
    surviving spouses.
        We believe several other adjustments could be made to the SBP.
    Allowing payment of the SBP benefits into a Special Needs Trust in
    cases of disabled beneficiaries will preserve their eligibility for
    income based support programs. The government should be able to switch
    SBP payments to children if a surviving spouse is convicted of
    complicity in the member's death.
        We believe there needs to be DIC equity with other Federal survivor
    benefits. Currently, DIC is set at $1,154 monthly (43 percent of the
    Disabled Retirees Compensation). Survivors of Federal workers have
    their annuity set at 55 percent of their Disabled Retirees
    Compensation. Military survivors should receive 55 percent of VA
    Disability Compensation. We are pleased that the requirement for a
    report to assess the adequacy of DIC payments was included in the NDAA
    for Fiscal Year 2009. We are awaiting the overdue report. We support
    raising DIC payments to 55 percent of VA Disability Compensation. When
    changes are made, ensure that DIC eligibles under the old system
    receive an equivalent increase.
        We ask the DIC offset to SBP be eliminated to recognize the length
    of commitment and service of the career servicemember and spouse. We
    also request that SBP benefits may be paid to a Special Needs Trust in
    cases of disabled family members.
        We ask that DIC be increased to 55 percent of VA Disability
    Compensation.
    Education of Military Children
        The National Military Family Association would like to thank
    Congress for including a ``Sense of Congress'' in regards to the
    Interstate Compact on Educational Opportunity for Military Children in
    last year's National Defense Authorization Act. The Compact has now
    been adopted in 27 States and covers over 80 percent of our military
    children. The Interstate Commission, the governing body of the Compact,
    is working to educate military families, educators, and States on the
    appropriate usage of the Compact. The adoption of the Compact is a
    tremendous victory for military families who place a high value on
    education.
        However, military families define the quality of that education
    differently than most States or districts that look only at issues
    within their boundaries. For military families, it is not enough for
    children to be doing well in their current schools, they must also be
    prepared for the next location. The same is true for children in under
    performing school systems. Families are concerned that they will lag
    behind students in the next location. With many States cutting
    educational programs due to the economic downturn, this concern is
    growing. A prime example is Hawaii, which opted to furlough teachers on
    Fridays, cutting 17 days from the school calendar. With elementary
    schools already on a shortened schedule for Wednesday, these students
    are only getting 3\1/2\ days of instruction a week. In addition, the
    recent cuts have made it increasingly hard for schools to meet IEP
    requirements for special needs students. Furthermore, Hawaii is
    requiring parents to pay more for busing, and the cost of school meals
    have gone up 76 percent. Our Association believes that Hawaii's cuts
    are just the ``tip of the iceberg'' as we are beginning to see other
    States make tough choices as well. Although Hawaii's educational system
    has long been a concern for military families, many of whom opt for
    expensive private education, Hawaii is not the only place where parents
    have concerns. The National Military Family Association believes that
    our military children deserve to have a good quality education wherever
    they may live. However, our Association recognizes that how we provide
    that quality education may differ in each location.
        We urge Congress to encourage solutions for the current educational
    situation in Hawaii and recognize that servicemembers' lack of
    confidence that their children may receive a quality education in an
    assignment location can affect the readiness of the force in that
    location.
        While our Association remains appreciative for the additional
    funding Congress provides to civilian school districts educating
    military children, Impact Aid continues to be underfunded. We urge
    Congress to provide appropriate and timely funding of Impact Aid
    through the Department of Education. In addition, we urge Congress to
    increase DOD Impact Aid funding for schools educating large numbers of
    military children to $60 million for fiscal year 2011. We also ask
    Congress to include an additional $5 million in funding for special
    needs children. The DOD supplement to Impact Aid is critically
    important to ensure school districts provide quality education for our
    military children.
        As increased numbers of military families move into new communities
    due to Global Rebasing and BRAC, their housing needs are being met
    further and further away from the installation. Thus, military children
    may be attending school in districts whose familiarity with the
    military lifestyle may be limited. Educating large numbers of military
    children will put an added burden on schools already hard-pressed to
    meet the needs of their current populations. We urge Congress to
    authorize an increase in this level of funding until BRAC and Global
    Rebasing moves are completed.
        Once again, we thank Congress for passing the Higher Education
    Opportunity Act of 2008, which contained many new provisions affecting
    military families. Chief among them was a provision to expand in-State
    tuition eligibility for military servicemembers and their families, and
    provide continuity of in-State rates if the servicemember receives
    Permanent Change of Station (PCS) orders out of State. However, family
    members have to be currently enrolled in order to be eligible for
    continuity of in-State tuition. Our Association is concerned that this
    would preclude a senior in high school from receiving in-State tuition
    rates if his or her family PCS's prior to matriculation. We urge
    Congress to amend this provision.
        We ask Congress to increase the DOD supplement to Impact Aid to $60
    million to help districts better meet the additional demands caused by
    large numbers of military children, deployment-related issues, and the
    effects of military programs and policies. We also ask Congress provide
    $5 million for school districts with Special Needs children.
    Support for Military Voters
        The National Military Family Association would like to thank
    Congress for passing the Military and Overseas Voter Empowerment (MOVE)
    Act which was included in the National Defense Authorization Act for
    Fiscal Year 2010. As a member of the Alliance for Military and Overseas
    Voting Rights (AMOVR), our Association worked hard to pass this
    important legislation which resolves many of the absentee voting issues
    for our military servicemembers and their families. The passage of the
    MOVE ACT was a tremendous victory for our military community whose very
    service helps protect the right to vote.
    Spouse Education and Employment
        Our Association wishes to thank Congress for recent enhancement to
    spouse education opportunities. In-State tuition, Post-September 11
    G.I. bill transferability to spouses and children, and other
    initiatives have provided spouses with more educational opportunities
    than previous years.
        Since 2004, our Association has been fortunate to sponsor our
    Joanne Holbrook Patton Military Spouse Scholarship Program, with the
    generosity of donors who wish to help military families. Our 2010
    application period closed on January 31, 2010. We saw a 33 percent
    increase in applications from previous years with more than 8,000
    military spouses applying to our program. Military spouses remain
    committed to their education and need assistance from Congress to
    fulfill their educational pursuits.
        We have heard from many military spouses who are pleased with the
    expansion of the Military Spouse Career Advancement Accounts, now
    called MyCAA. Unfortunately the abrupt halt of the program on February
    16, 2010 has created a financial burden and undue stress for military
    spouses. Spouses who have established accounts and those who planned to
    set-up accounts in the future have been barred for accessing funds. The
    MyCAA system only permitted users to request financial assistance 30
    days prior to a class start date. Many, who had planned on the funding,
    will not receive it, if they didn't have a start date entered into the
    system by February 16. We ask Congress to push DOD to restart this
    critical program and find a way to assist spouses who have been
    abruptly cut-off from receiving funding. We also ask Congress to fully
    fund the MyCAA program, which is providing essential educational and
    career support to military spouses. The MyCAA program is not available
    to all military spouses. We ask Congress to work with the appropriate
    Service Secretary to expand this funding to the spouses of Coast Guard,
    the Commissioned Corps of NOAA and U.S. Public Health Service.
        Our Association thanks you for establishing a pilot program to
    secure internships for military spouses with Federal agencies. Military
    spouse are anxious for the program to launch and look forward to
    enhanced career opportunities through the pilot program. We hope
    Congress will monitor the implementation of the program to ensure
    spouses are able to access the program and eligible spouses are able to
    find Federal employment after successful completion of the internship
    program.
        To further spouse employment opportunities, we recommend an
    expansion to the Workforce Opportunity Tax Credit for employers who
    hire spouses of active duty and Reserve component servicemembers, and
    to provide tax credits to military spouses to offset the expense in
    obtaining career licenses and certifications when servicemembers are
    relocated to a new duty station within a different State.
        The Services are experiencing a shortage of medical, mental health
    and child care providers. Many of our spouses are trained in these
    professions or would like to seek training in these professions. We
    think the Services have an opportunity to create portable career
    opportunities for spouses seeking in-demand professions. In addition to
    the MyCAA funding, what can the Services do to encourage spouse
    employment and solve provider shortages? We would like to see the
    Services reach out to military spouses and offer affordable, flexible
    training programs in high demand professions to help alleviate provider
    shortages.
        Our Association urges Congress to recognize the value of military
    spouses by fully funding the MyCAA program, and by creating training
    programs and employment opportunities for military spouses in high
    demand professions to help fill our provider shortages.
    Military Families--Our Nation's Families
        We thank you for your support of our servicemembers and their
    families and we urge you to remember their service as you work to
    resolve the many issues facing our country. Military families are our
    Nation's families. They serve with pride, honor, and quiet dedication.
    Since the beginning of the war, government agencies, concerned citizens
    and private organizations have stepped in to help. This increased
    support has made a difference for many servicemembers and families,
    yet, some of these efforts overlap while others are ineffective. In our
    testimony, we believe we have identified improvements and additions
    that can be made to already successful programs while introducing
    policy or legislative changes that address the ever-changing needs of
    our military families. Working together, we can improve the quality of
    life for all these families.

        Senator Webb. Thank you very much.
        Mr. Cline.

        STATEMENT OF MASTER SERGEANT MICHAEL CLINE, USA (RET.),
    EXECUTIVE DIRECTOR, ENLISTED ASSOCIATION OF THE NATIONAL GUARD
                          OF THE UNITED STATES

        Mr. Cline. Mr. Chairman, we thank you, on behalf of the
    Enlisted Association of the National Guard of the United States
    and the Military Coalition, for holding these hearings.
        Mr. Chairman, over 142,000 National Guard and Reserve
    servicemembers are serving on Active Duty. Since September 11,
    2001, more than 752,000 of our citizens, soldiers, airmen,
    sailors, marines, Guard and Reserve servicemembers, have been
    called up, including well over 200,000 who have served multiple
    tours.
        With your permission, Mr. Chairman, I'd like to cut out the
    fluff and just get to the point of the needs of our Guard and
    Reserve people and their families.
        The next step in modernizing the Reserve retirement system
    is to provide equal retirement age reduction credit for all
    activated service rendered since September 11, 2001. The
    current law that credits only active service since January 28,
    2008, disenfranchises and devalues the service of hundreds of
    thousands of Guard and Reserve members who have served combat
    tours, many with multiple combat tours, between 2001 and 2008.
        The statute also must be amended to eliminate the inequity
    inherent in the current fiscal year retirement calculation,
    which only credits 90 days of active service for early
    retirement purposes if it occurs within the same fiscal year.
    The current rule significantly penalizes members who deploy in
    July or August, versus those deploying earlier in the fiscal
    year. It is potently unfair, as the current law requires giving
    3 months retirement-age credit for 90-day tours served from
    January through March, but only half credit for 120-day tours
    served from August through November, because the latter covers
    60 days in each of the 2 fiscal years.
        Mr. Chairman, we fully understand the budgetary problems
    facing our country, but we're also aware that more than $700
    billion was given to banks, financial institutions, automakers;
    $3 billion for Cash for Clunkers was spent, in 3 weeks, that
    did nothing more than reduce the inventory of autodealers; the
    American people, many of which are the very veterans who have
    been passed by, are looking at a trillion-dollar healthcare
    bill. If CBO figures are accurate, it will cost $2.1 billion
    over 10 years, or just about $21 million a year, to provide
    retroactivity for early retirement for those who have protected
    our freedom. It's the right thing to do to honor the unselfish
    heroes and their families who have given up so much to protect
    us and our way of life.
        For the near term, we place particular priority on
    authorizing early retirement credit for all qualifying post-
    September 11 Active Duty service performed by Guard and Reserve
    members, and eliminating the fiscal-year-specific accumulator
    that bars equal credit for members deploying for equal periods
    during different months of the year. Ultimately, we believe we
    must move forward to provide a reduced-age entitlement for
    retired pay and health coverage for all Reserve component
    members that is an age-service formula or outright eligibility,
    if otherwise qualified, at age 55.
        Further, we urge repeal of the annual cap of 130 days of
    inactive duty points that may be credited towards a Reserve
    retirement.
        Yellow Ribbon. We urge the subcommittee to hold oversight
    hearings and to direct additional improvements in coordination
    and collaboration and consistency of Yellow Ribbon services.
    DOD must ensure that State-level best practices, such as those
    in Maryland, Minnesota, and New Hampshire, are applied for all
    operational Reserve Force members and their families, and that
    Federal Reserve veterans have equal access to services and
    support available to National Guard veterans. Community groups,
    employers, and Service organizations' efforts need to be
    encouraged and better coordinated to supplement unit,
    component, Service, and VA outreach and service.
        We are grateful to you, in Congress, for inclusion of a
    critical ``earn as you serve'' principle, in the post-September
    11 GI Bill, which allows operational reservists to accumulate
    additional benefits for each aggregate call-up of 90 days or
    more on Active Duty. However, Active Duty members of the
    National Guard serving under Title 32 orders were not included
    in the new program, despite their critical role in homeland
    defense, counterdrug, border control, and other missions. We
    urge this subcommittee to work with the Veterans Affairs
    Committee to include Title 32 AGRs in the post-September 11
    statute.
        The Military Coalition's longstanding recommendation of
    coordinating and integrating various educational benefit
    programs has been made more challenging with the post-September
    11 GI Bill. For example, benefits for initially joining the
    Guard and Reserve, as authorized under Chapter 1606 of title
    10, continue to decline in proportion to the Active Duty
    Montgomery GI Bill, Chapter 30, title 38, in the new post-
    September 11 GI Bill. Reserve MGIB benefit levels have slipped
    to 24 percent of the Active Duty MGIB benefit, compared to 47
    to 50 percent during the first 15 years of the program.
    Restoration of the original ratio would raise basic Reserve
    rates from the current $333 a month to $643 to $684 a month for
    full-time duty. TMC maintains that restoring the ratio is not
    only a matter of equity, but essential to long-time success of
    the Guard and Reserve recruiting program.
        Continuing healthcare insurance options for the Guard and
    Reserve. The Coalition is very grateful for the passage of
    TRICARE for gray-area retirees; however, we're very
    disappointed that it's going to take DOD 18 months to implement
    the new program. As we have sent letters to you, we ask that
    you intervene with DOD to speed this program up. It's a
    benefit----
        Senator Graham. Absolutely.
        Mr. Cline.--that is needed.
        Senator Graham. Absolutely.
        Mr. Cline. When we look at the TRICARE Reserve Select
    Program, a disturbing fact is that only 6 to 7 percent of our
    eligible beneficiaries are taking advantage of the TRICARE
    Reserve Select Program. DOD and the Services and the Reserve
    components must do more to advertise the TRS program.
        The Coalition also believes that Congress is missing an
    opportunity to reduce long-term healthcare costs and increase
    beneficiary satisfaction by authorizing eligible members the
    option of electing a DOD subsidy of their civilian insurance
    during periods of activation. Current law already authorizes
    payment of up to 24 months of FEHBP premiums for activated
    members who are civilian employees of the Defense Department.
    Over the long term, the Guard and Reserve activations can be
    expected at a reduced pace. This option would offer
    considerable savings opportunities, relative to DOD permanent,
    year-round TRICARE.
        We recommend to the subcommittee--require a GAO review of
    DOD's methodology for determining TRS costs for premium
    adjustment purposes to assess whether it includes any costs of
    maintaining readiness or ``costs of doing business'' for DOD
    that don't contribute to beneficiary benefit values, and thus
    excluded from cost premium calculations.
        Mr. Chairman, I look forward to any questions that you or
    Senator Graham may have.
        Senator Webb. Thank you very much.
        Ms. Holleman.

     STATEMENT OF DEIRDRE PARKE HOLLEMAN, EXECUTIVE DIRECTOR, THE
                      RETIRED ENLISTED ASSOCIATION

        Ms. Holleman. Good morning. Mr. Chairman----
        Senator Webb. Good afternoon, actually. [Laughter.]
        Ms. Holleman. Good afternoon.
        Senator Graham. My stomach says it's afternoon.
        Ms. Holleman. Life goes quickly, right?
        It is an honor to speak to you today about the Military
    Coalition's legislative goals concerning military retirees and
    military survivors. I know you will not be surprised that TMC
    is urging you to, once and for all, end the unfair offset of
    military retired pay by VA disability pay.
        We are grateful for the great strides that have been made
    in ending this practice, which we all now acknowledge is
    terribly unfair. But, there are two groups of valiant retirees
    who are not getting the relief that you ordered for the others.
    One group is those longevity retirees with VA disabilities of
    10 to 40 percent. The other group is those servicemembers who
    were forced to medically retire with less than 20 years, due to
    an injury or medical condition that is not deemed combat-
    related under the Combat Related Special Compensation program.
    Even in these tough economic times, simple fairness should call
    for the end of the offset for all. But, even more dramatically,
    the President, for the second year, has proposed, in his
    budget, to end the offset for medical retirees. To have the
    administration propose a change that, in the past, was the goal
    of only you, in Congress, is a historic opportunity. We
    strongly urge you to join the President in this laudable goal
    and end the offset for medical retirees now.
        It is also clearly time to finally end the Survivor Benefit
    Plan (SBP)/Dependency and Indemnity Compensation (DIC) offset.
    SBP is an employee benefit, while DIC is an indemnity program
    for survivors of those who died because of their service in the
    military. The present practice of taking a dollar from a
    survivor's SBP payment for every dollar paid by the VA's DIC
    program is unfair and illogical. Legislation to end this offset
    is pending in both Houses of Congress. Now that Senator Bill
    Nelson's S. 535 has 55 cosponsors, and Representative Ortiz's
    H.R. 811 has 319 cosponsors, it is clear that a majority of the
    Members of Congress agree that this offset should end. It
    should end now, while our servicemembers are fighting in two
    wars and at risk throughout the world.
        While these two issues are of great and continuing concern
    to all of the members of the Coalition, there are several
    additional matters that we believe are critically important. We
    urge you to support Senator Blanche Lincoln's soon-to-be-
    introduced legislation that will be a companion bill to
    Representative Walter Jones's H.R. 613. Their Military Retirees
    Survivor Comfort Acts would authorize the retention of the full
    month's retired pay of the last month of a retiree's life by
    his or her surviving spouse. Presently, DFAS removed the
    month's retired pay from the retiree account, calculates how
    much is owed by how many days the retiree lived in the month
    that he or she died in, and then returns the prorated share to
    the survivor. This method can cause confusion and even bounce
    checks during a tremendously tense and sorrowful time. Senator
    Lincoln's bill would stop this, and treat military retiree
    survivors the same way as disabled veteran survivors are
    treated concerning the disability payments.
        The Uniformed Services Former Spouse Protection Act
    desperately needs improvement. While some organizations want
    dramatic fundamental changes, and other groups adamantly do
    not, it truly is time that we had a hearing on this rather
    explosive issue. There are already several improvements that
    DOD has supported, for years, that could be made during this
    session. These changes include basing the amount awarded in a
    divorce on the grade and years of service at the time of the
    divorce, rather than at the time of retirement, and prohibiting
    the inclusion of imputed income in a divorce property award,
    which often forces Active Duty members into retirement. A full
    list of our suggestions can be found in our written testimony.
        Finally, we urge that DFAS be allowed to make SBP payments
    into a Special Needs Trust. Presently, they may only pay SBP to
    a person. This means that a permanently disabled survivor
    cannot make use of this State-created legal device that allows
    a disabled person to protect their eligibility for SSI,
    Medicaid, and State means-tested programs. With the help of
    supporters like you, Chairman Webb, we hope that this change
    will be made. It would only affect a few people, but for those
    survivors, this small change would be an enormous help.
        Thank you for your time, and may I have the honor to
    introduce Colonel Strobridge.
        Senator Webb. Thank you very much for your testimony.
        Colonel Strobridge.

      STATEMENT OF STEVEN P. STROBRIDGE, USAF (RET.), DIRECTOR OF
     GOVERNMENT RELATIONS, MILITARY OFFICERS ASSOCIATION OF AMERICA

        Colonel Strobridge. Mr. Chairman, Senator Graham, my
    testimony is going to focus on healthcare and Wounded Warrior
    issues.
        The primary issue for all beneficiaries is access. The
    primary threat to access continues to be the perpetual threat
    of major cuts in Medicare and TRICARE payments to doctors. We
    fully realize that's beyond the authority of this subcommittee,
    but it is the number-one healthcare issue among our
    beneficiaries.
        On national healthcare reform, the principal issues for our
    members in the coalition are ensuring protection of military-
    unique health benefits, including TRICARE For Life, and
    protection of uniformed services beneficiaries from taxation on
    the value of those benefits.
        On TRICARE fees, we're grateful that the administration has
    not proposed any increases for fiscal year 2011, however,
    without congressional action, the TRICARE standard outpatient
    deductible will be increased administratively by more than $110
    per day as of October 1. Last October, the subcommittee acted,
    during conference action on the National Defense Authorization
    Act, to stop that change. We urge you to put a provision in
    law, capping the outpatient deductible at the current $535 per
    day, which the coalition believes is plenty high enough and
    should not be increased for the foreseeable future.
        We also ask you to put a ``Sense of Congress'' provision in
    the National Defense Authorization Act, as the Senate approved
    last year, highlighting the importance of military health
    benefits in offsetting the adverse conditions of service and
    recognizing that military people pay large upfront premiums
    through decades of service and sacrifice, over and above their
    cash fees.
        On Wounded Warriors, we're concerned that the change of the
    administration has left many senior positions vacant for more
    than a year, and that close joint oversight previously provided
    by top leaders has been delegated and diffused back along
    agency-centric lines. The coalition is particularly concerned
    that the diminution of the Senior Oversight Committee, or SOC,
    has weakened day-to-day oversight of, and priority on, joint
    agency operations and management. We urge revitalization of the
    SOC, or a similar joint agency staffed with senior officials
    with full-time primary oversight responsibility for seamless
    transition initiatives.
        Similarly, the transition from Active Duty to retiree care
    or to VA coverage still catches many wounded warriors and their
    families unaware. They need the same protections that we
    provide when someone dies on Active Duty: 3 years of continued
    Active Duty-level coverage to ensure a smooth transition to the
    next phase of their life.
        We appreciate the subcommittee's efforts last year to
    provide caregiver benefits on a par with what's provided by the
    VA. The Veterans Affairs Committees are now finalizing
    significant upgrades for caregivers, and we hope you'll act to
    reestablish comparability of DOD programs once that happens.
        Regarding psychological health, PTSD, and TBI, we know the
    subcommittee and DOD and the Services are pursuing a wide range
    of initiatives to enhance access to care and counseling, and to
    remove the stigma from seeking care. Unfortunately, some facets
    of the military environment continue to undermine those
    efforts. In that regard, many who suffer after-effects of
    combat continue being barred from reenlistment, or separated
    for other reasons, because service disciplinary and
    administrative systems are much less flexible and resilient
    than we're asking military people to be. We hope the
    subcommittee will continue its efforts to protect returnees
    from these lower profile, but still devastating, secondary
    effects of war.
        Mr. Chairman, that concludes my remarks.
        [The prepared statement of The Military Coalition follows:]
                  Prepared Statement by The Military Coalition
        Mr. Chairman and distinguished members of the subcommittee. On
    behalf of The Military Coalition (TMC), a consortium of nationally
    prominent uniformed services and veterans' organizations, we are
    grateful to the committee for this opportunity to express our views
    concerning issues affecting the uniformed services community. This
    testimony provides the collective views of the following military and
    veterans' organizations, which represent approximately 5.5 million
    current and former members of the 7 uniformed services, plus their
    families and survivors.

              Air Force Association
              Air Force Sergeants Association
              Air Force Women Officers Associated
              American Logistics Association
              AMVETS (American Veterans)
              Army Aviation Association of America
              Association of Military Surgeons of the United States
              Association of the United States Army
              Association of the United States Navy
              Chief Warrant Officer and Warrant Officer Association, U.S.
            Coast Guard
              Commissioned Officers Association of the U.S. Public Health
            Service, Inc.
              Enlisted Association of the National Guard of the United
            States
              Fleet Reserve Association
              Gold Star Wives of America, Inc.
              Iraq and Afghanistan Veterans of America
              Jewish War Veterans of the United States of America
              Marine Corps League
              Marine Corps Reserve Association
              Military Chaplains Association of the United States of
            America
              Military Officers Association of America
              Military Order of the Purple Heart
              National Association for Uniformed Services
              National Guard Association of the United States
              National Military Family Association
              National Order of Battlefield Commissions
              Naval Enlisted Reserve Association
              Noncommissioned Officers Association
              Reserve Enlisted Association
              Reserve Officers Association
              Society of Medical Consultants to the Armed Forces
              The Retired Enlisted Association
              United States Army Warrant Officers Association
              United States Coast Guard Chief Petty Officers Association
              Veterans of Foreign Wars of the United States

        The Military Coalition, Inc., does not receive any grants or
    contracts from the Federal Government.
                               executive summary
    Wounded Warrior Care
        Institutional Oversight
        The Coalition believes there's no substitute for a permanent
    Department of Defense (DOD)-Department of Veterans Affairs (VA) Senior
    Oversight Committee or other Joint Seamless Transition Office, staffed
    with senior officials working together full-time and charged with
    innovation and daily oversight of initiatives to institutionalize and
    sustain a culture of cross-department seamless transition.
        Continuity of Health Care
        The Coalition recommends:

             Authorizing active-duty level TRICARE benefits,
            independent of availability of VA care, for 3 years after
            medical retirement to help ease transition from DOD to VA;
             Authorizing blanket waiver authority for VA physicians
            treating active duty patients with multiple medical trauma
            conditions for all aspects of the member's treatment, including
            referral outside the VA/TRICARE system if needed; and
             Either exempting severely wounded, ill, or injured
            members who must be medically retired from paying Medicare Part
            B premiums until age 65 or authorizing a special DOD allowance
            to help offset the cost of such premiums until age 65.
        Mental/Behavioral Health Issues
        TMC recommends:

             Increased efforts to promote the destigmatization on
            all levels in service/unit administrative and strict
            accountability programs with outlined and enforced consequences
            to non-compliancy to ensure unit actions are consistent with
            leadership pronouncements;
             Continuing priority efforts to deliver information and
            assistance on-line, confidential options for counseling and
            uniformed access and availability to telemedicine services;
             Substantial increases in outreach efforts to provide
            such services and resources to Guard and Reserve members, rural
            populations and all families who don't live near military or VA
            facilities;
             Priority efforts to educate private sector providers
            on the unique needs of military and veteran patients and family
            members, and deliver needed information via on-line services,
            including contact points for discussion/consultation with
            military and VA providers;
             Consistent implementation of pre- and post-deployment
            evaluations and follow-up programs, particularly for Guard and
            Reserve members who may be leaving active duty;
             Establishing common DOD and VA protocols for
            diagnosis, treatment, and rehabilitation for Traumatic Brain
            Injury (TBI) conditions, as well as an electronic system to
            share and exchange a patient's medical history and other key
            medical information;
             Expanding Traumatic Servicemember Group Life Insurance
            (TSGLI) criteria to include moderate and severe TBI, without
            onerous ``functions of daily living'' standards that aren't
            required for other (and often much more functional) TSGLI-
            eligibles;
             Increasing availability and outreach on substance
            abuse counseling options;
             Pursuing aggressive medication reconciliation and
            management programs to protect against inadvertent over
            medication and adverse reactions and or accidental or
            intentional overdose;
             Requiring TBI and psychological health assessments for
            members who have been deployed to a combat zone as part of the
            disciplinary process prior to a decision concerning nonmedical
            separation; and
             Implementing recommendations from the 2008 RAND report
            (``Invisible Wounds of War Psychological and Cognitive
            Injuries, Their Consequences, and Services to Assist
            Recovery'').
        DOD-VA Disability Evaluation Systems (DES)
        TMC recommends:

             Barring ``fit, but unsuitable'' separations when a
            member's medical condition prevents continued service;
             Authorizing automatic enrollment in the VA health care
            system for any medically separated or medically retired
            servicemember (Chapter 61);
             Ending distinctions between disabilities incurred in
            combat vice non-combat;
             Monitoring the effectiveness of recent DOD
            compensation for catastrophically injured or ill servicemembers
            requiring assistance with activities of daily living authorized
            in the 2010 NDAA;
             Ensuring benefits afforded members wounded, ill, or
            disabled in the line of duty are applied equally for all
            uniformed services;
             Ensuring that the VA is the single authority for
            rating service-connected disabilities for military disability
            retirements and separations;
             Preserving the statutory 30 percent disability
            threshold for medical retirement and lifetime TRICARE coverage
            for members injured while on active duty;
             Continued monitoring of Service/DOD Medical-Physical
            Evaluation Boards, DOD DES Pilot Project, and the Physical
            Disability Board of Review, to assess needed DES changes;
             Eliminating member premiums for TSGLI;
             Barring ``pre-existing condition'' determinations for
            any member who deploys to a combat zone;
             Ensuring that any adjustment to the disability
            retirement system does not result in a member receiving less
            disability retired pay than he or she would receive under the
            current system; and
             Ensuring that members electing accelerated disability
            retirement/separation are fully counseled on any possible
            negative changes in compensation, health care and other
            benefits, with consideration to allowing a limited time to
            reverse a regrettable decision.
        Caregiver/Family Support Services
        The Coalition recommends:

             Upgraded compensation and assistance for caregivers of
            severely disabled active duty members, consistent with pending
            legislative action to improve compensation/assistance for
            caregivers of veterans; and
             Authorizing up to 1 year of continued residence in on-
            base housing facilities for medically retired, severely wounded
            servicemembers and their families.
    Active Forces and Their Families
        Military End Strength
        The Coalition urges the subcommittee to:

             Continue end strength growth as needed to sustain the
            war and other operational commitments while materially
            increasing dwell time for servicemembers and families;
             Sustain adequate recruiting and retention resources to
            enable the uniformed services to achieve required optimum-
            quality personnel strength; and
             Seek a 2011 defense budget of at least 5 percent of
            Gross Domestic Product that funds both people and weapons
            needs.
        Military Pay Comparability
        The Coalition believes a basic pay raise of at least 1.9
    percent--.5 percent above the Employment Cost Index (ECI) standard--is
    the bare minimum the Nation should do to sustain its military pay
    comparability commitment for 2011.
        Family Readiness and Support
        The Coalition recommends that the subcommittee:

             Press DOD to assess the effectiveness of programs and
            support mechanisms to assist military families with deployment
            readiness, responsiveness, and reintegration;
             Ensure that effective programs--including the Family
            Readiness Council--are fully funded and their costs are
            included in the annual budget process;
             Provide authorization and funding to accelerate
            increases in availability of child care to meet both Active and
            Reserve component requirements;
             Insist DOD implement flexible spending accounts to let
            active duty and Selected Reserve families pay out-of-pocket
            dependent and health care expenses with pre-tax dollars;
             Monitor and continue to expand family access to mental
            health counseling;
             Promote expansion of military spouse opportunities to
            further educational and career goals;
             Ensure additional and timely funding of Impact Aid
            plus continued DOD supplemental funding for highly-impacted
            military schools; and
             Mitigate the impact of Service transformation,
            overseas rebasing initiatives, housing privatization and base
            realignment on school facility needs and educational programs
            affecting military children.
        Permanent Change of Station (PCS) Allowances
        The Coalition urges the subcommittee to continue its efforts to
    upgrade permanent change-of-station allowances to better reflect
    expenses imposed on servicemembers, with priority on:

             Shipping a second vehicle on overseas accompanied
            assignments;
             Authorizing at least some reimbursement for house-
            hunting trip expenses; and
             Increasing PCS mileage rates to more accurately
            reflect members' actual transportation costs.
        Education Enhancements
        The Coalition urges the subcommittee to support amending the
    statute to authorize all otherwise-qualifying members of the
    ``uniformed services'' to transfer Post-September 11 GI Bill benefits
    to family members.
        Morale, Welfare, and Recreation (MWR) and Quality of Life (QoL)
            Programs
        TMC urges the subcommittee to:

             Protect funding for critical family support and QoL
            programs and services to meet the emerging needs of
            beneficiaries and the timelines of the Services' transformation
            plans;
             Oppose any initiative to withhold or reduce
            appropriated support for family support and QoL programs to
            include: recreation facilities, child care, exchanges and
            commissaries, housing, health care, education, family centers,
            and other traditional and innovative support services;
             Prevent any attempts to consolidate or civilianize
            military service exchange and commissary programs; and
             Sustain funding for support services and
            infrastructure at both closing and gaining installations
            throughout the entire transformation process, including
            exchange, commissary, and TRICARE programs.
    National Guard and Reserve
        Operational Reserve Sustainment and Reserve Retirement
        For the near term, the Military Coalition places particular
    priority on authorizing early retirement credit for all qualifying
    post-September 11 active duty service performed by Guard/Reserve
    servicemembers and eliminating the fiscal-year-specific accumulator
    that bars equal credit for members deploying for equal periods during
    different months of the year.
        Ultimately, TMC believes we must move forward to provide a reduced
    age entitlement for retired pay and health coverage for all Reserve
    component members--that is, an age/service formula or outright
    eligibility, if otherwise qualified, at age 55.
        Further, TMC urges repeal of the annual cap of 130 days of inactive
    duty training points that may be credited towards a reserve retirement.
        Guard and Reserve Yellow Ribbon Readjustment
        TMC urges the subcommittee to hold oversight hearings and to direct
    additional improvements in coordination, collaboration, and consistency
    of Yellow Ribbon services. DOD must ensure that State-level best
    practices--such as those in Maryland, Minnesota, and New Hampshire--are
    applied for all Operational Reserve Force members and their families,
    and that Federal Reserve veterans have equal access to services and
    support available to National Guard veterans. Community groups,
    employers and service organization efforts need to be encouraged and
    better coordinated to supplement unit, component, Service and VA
    outreach and services.
        Guard/Reserve GI Bill
        TMC urges the subcommittee to work with the Veterans Affairs
    Committee to include Title 32 AGRs in the Post-September 11 statute.
        Based on the DOD/Services' 10-year record of indifference to the
    basic Selected Reserve GI Bill under Chapter 1606, 10 U.S.C., TMC
    recommends either: restoring Reserve benefits to 47-50 percent of
    active duty benefits or transferring the chapter 1606 statute from
    title 10 to title 38 so that it can be coordinated with other
    educational benefits programs in a 21st century GI Bill architecture.
    TMC also supports assured academic reinstatement, including guaranteed
    re-enrollment, for returning operational reservists.
        Special and Incentive Pays
        The Coalition urges the subcommittee to ensure equitable treatment
    of Guard and Reserve vs. active duty members for the full range of
    special and incentive pays.
    Retiree Issues
        Concurrent Receipt
        The Coalition's continuing goal is to fully eliminate the deduction
    of VA disability compensation from earned military retired pay for all
    disabled retirees. In pursuit of that goal, the Coalition's immediate
    priorities include:

             Phasing out the disability offset for all Chapter 61
            (medical) retirees; and
             Correcting the Combat-Related Special Compensation
            (CRSC) formula to ensure the intended compensation is
            delivered.
        Proposed Military Retirement Changes
        TMC urges the subcommittee to:

             Reject any initiatives to ``civilianize'' the military
            system without adequate consideration of the unique and
            extraordinary demands and sacrifices inherent in a military vs.
            a civilian career; and
             Eliminate the Career Status Bonus for servicemembers
            as it significantly devalues their retirement over time. In the
            short term, the Services should be required to better educate
            eligible members on the severe long-term financial penalty
            inherent in accepting the REDUX option.
        Disability Severance Pay
        The Coalition urges the subcommittee to amend the eligibility rules
    for disability severance pay to include all combat--or operations--
    related injuries, using same definition as CRSC. For the longer term,
    the Coalition believes the offset should be ended for all members
    separated for service-caused disabilities.
        Former Spouse Issues
        The Coalition requests a hearing to address Uniformed Services
    Former Spouse Protection Act (USFSPA) inequities. In addition, we
    recommend legislation to include all of the following:

             Base the award amount to the former spouse on the
            grade and years of service of the member at time of divorce
            (and not retirement);
             Prohibit the award of imputed income, which
            effectively forces active duty members into retirement;
             Extend 20/20/20 benefits to 20/20/15 former spouses;
             Permit the designation of multiple Survivor Benefit
            Plan (SBP) beneficiaries with the presumption that SBP benefits
            must be proportionate to the allocation of retired pay;
             Eliminate the ``10-year Rule'' for the direct payment
            of retired pay allocations by the Defense Finance and
            Accounting Service (DFAS);
             Permit SBP premiums to be withheld from the former
            spouse's share of retired pay if directed by court order;
             Permit a former spouse to waive SBP coverage;
             Repeal the 1-year deemed election requirement for SBP;
            and
             Assist DOD and Services with greater outreach and
            expanded awareness to members and former spouses of their
            rights, responsibilities, and benefits upon divorce.
    Survivor Issues
        SBP-DIC Offset
        The Coalition urges repeal of the SBP-DIC offset. TMC further
    recommends:

             Authorizing payment of SBP annuities for disabled
            survivors into a Special Needs Trust;
             Allowing SBP eligibility to switch to children if a
            surviving spouse is convicted of complicity in the member's
            death; and
             Reinstating SBP for survivors who previously
            transferred payments to their children at such time as the
            youngest child attains majority, or upon termination of a
            second or subsequent marriage.
        Final Retired Paycheck
        TMC urges the subcommittee to authorize survivors of retired
    members to retain the final month's retired pay for the month in which
    the retiree dies.
    Health Care Issues
        Defense Health Program Cost Requirements
        The Coalition urges the subcommittee to take all possible steps to
    ensure continued full funding for Defense Health Program needs.
        National Health Reform
        TMC urges that any national health reform legislation must:

             Protect the unique TRICARE, TRICARE For Life (TFL),
            and VA health care benefits from unintended consequences such
            as reduced access to care;
             Bar any form of taxation of TRICARE, TFL, or VA health
            care benefits, including those provided in nongovernmental
            venues; and
             Preserve military and VA beneficiaries' choices.
        TRICARE Fees
        Establish a ``Sense of Congress'' which recognizes that military
    retiree health benefits are an essential offset to arduous service
    conditions which have been paid for upfront.
        Military vs. Civilian Cost-Sharing Measurement
        The Coalition believes that military beneficiaries from whom
    America has demanded decades of extraordinary service and sacrifice
    have earned coverage that is the best America has to offer.
        Large Retiree Fee Increases Can Only Hurt Retention
        Reducing military retirement benefits would be particularly ill-
    advised when an overstressed force already is at increasing retention
    risk despite the current downturn of the economy and current recruiting
    successes.
        Pharmacy
        The Coalition urges the subcommittee to ensure continued
    availability of a broad range of medications, including the most-
    prescribed medications, in the TRICARE pharmacy system, and to ensure
    that the first focus on cost containment should be on initiatives that
    encourage beneficiaries to take needed medications and reduce program
    costs without shifting costs to beneficiaries.
        Alternative Options to Make TRICARE More Cost-Efficient
        The Coalition has offered a long list of alternative cost-saving
    possibilities, including:

             Positive incentives to encourage beneficiaries to seek
            care in the most appropriate and cost effective venue;
             Encouraging improved collaboration between the direct
            and purchased care systems and implementing best business
            practices and effective quality clinical models;
             Focusing the military health system, health care
            providers, and beneficiaries on quality measured outcomes;
             Improving MHS financial controls and avoiding overseas
            fraud by establishing TRICARE networks in areas fraught with
            fraud;
             Establishing TRICARE networks in areas of high TRICARE
            Standard utilization to take full advantage of network
            discounts;
             Promoting retention of other health insurance by
            making TRICARE a true second-payer to other insurance (far
            cheaper to pay another insurance's co-pay than have the
            beneficiary migrate to TRICARE);
             Encouraging DOD to effectively utilize their data from
            their electronic health record to better monitor beneficiary
            utilization patterns to design programs which truly match
            beneficiaries needs;
             Sizing and staffing military treatment facilities to
            reduce reliance on network providers and develop effective
            staffing models which support enrolled capacities;
             Reducing long-term TRICARE Reserve Select (TRS) costs
            by allowing servicemembers the option of a government subsidy
            of civilian employer premiums during periods of mobilization;
             Doing far more to promote use of mail-order pharmacy
            system and formulary medications via mailings to users of
            maintenance medications, highlighting the convenience and
            individual expected cost savings; and
             Encouraging retirees to use lowest-cost-venue military
            pharmacies at no charge, rather than discouraging such use by
            limiting formularies, curtailing courier initiatives, etc.
        TMC Healthcare Cost Principles
        The Coalition strongly recommends that Congress establish statutory
    findings, a sense of Congress on the purpose and principles of military
    health care benefits earned by a career of uniformed service that
    states:

             Active duty members and families should be charged no
            fees except retail pharmacy co-payments, except to the extent
            they make the choice to participate in TRICARE Standard or use
            out-of-network providers under TRICARE Prime;
             The TRICARE Standard inpatient copay should not be
            increased further for the foreseeable future. At $535 per day,
            it already far exceeds inpatient copays for virtually any
            private sector health plan;
             There should be no enrollment fee for TRICARE Standard
            or TFL, since neither offers assured access to TRICARE-
            participating providers. An enrollment fee implies enrollees
            will receive additional services, as Prime enrollees are
            guaranteed access to participating providers in return for
            their fee. Congress already has required TFL beneficiaries to
            pay substantial Medicare Part B fees to gain TFL coverage;
             All retired servicemembers earned equal health care
            coverage by virtue of their service; and
             DOD should make all efforts to provide the most
            efficient use of allocated resources and cut waste prior to
            proposing additional or increased fees on eligible
            beneficiaries.
        TRICARE Prime
        The Military Coalition urges the subcommittee to require reports
    from DOD and from the managed care support contractors, on actions
    being taken to improve Prime patient satisfaction provide assured
    appointments within Prime access standards, reduce delays in
    preauthorization and referral appointments, and provide quality
    information to assist beneficiaries in making informed decisions.
    TRICARE Standard
        TRICARE Standard Provider Participation
        The Coalition urges the subcommittee to insist on immediate
    delivery of an adequacy threshold for provider participation, below
    which additional action is required to improve such participation. The
    Coalition also recommends requiring a specific report on participation
    adequacy in the localities where Prime Service Areas will be
    discontinued under the new TRICARE contracts.
        TRICARE Reimbursement Rates
        The Coalition places primary importance on securing a permanent fix
    to the flawed statutory formula for setting Medicare and TRICARE
    payments to doctors.
        To the extent a Medicare rate freeze continues, we urge the
    subcommittee to encourage DOD to use its reimbursement rate adjustment
    authority as needed to sustain provider acceptance.
        The Coalition urges the subcommittee to require a Comptroller
    General report on the relative propensity of physicians to participate
    in Medicare vs. TRICARE, and the likely effect on such relative
    participation of a further freeze in Medicare/TRICARE physician
    payments along with the effect of an absence of bonus payments.
    Dental Care
        Active Duty Dependent Dental Plan
        The Coalition recommends increasing the DOD subsidy for the Active
    Duty Dependent Dental Plan to 72 percent and increasing the cap on
    orthodontia payments to $2,000.
    Guard and Reserve Healthcare
        Continuum of Health Care Insurance Options for The Guard and
            Reserve
        The Coalition recommends the subcommittee:

             Require a GAO review of DOD's methodology for
            determining TRS costs for premium adjustment purposes to assess
            whether it includes any costs of maintaining readiness or
            ``costs of doing business'' for the Defense Department that
            don't contribute to beneficiary benefit value and thus should
            be excluded from cost/premium calculations;
             Authorize development of a cost-effective option to
            have DOD subsidize premiums for continuation of a Reserve
            employer's private family health insurance during periods of
            deployment as an alternative to ongoing TRS coverage;
             Allow eligibility in Continued Health Care Benefits
            Program (CHCBP) for Selected reservists who are voluntarily
            separating and subject to disenrollment from TRS;
             Authorize members of the IRR who qualify for a Reserve
            retirement at age 60 to participate in TRICARE Retired Reserve
            (TRR) as an incentive for continued service (and higher
            liability for recall to active duty);
             Monitor implementation of the new TRR authority to
            ensure timely action and that premiums do not exceed 100
            percent of the TRS premium; and
             Allow FEHB plan beneficiaries who are selected
            reservists the option of participating in TRS.
        Guard and Reserve Mental Health
        TMC believes that Guard and Reserve members and their families
    should have access to evidence-based treatment for PTSD, TBI,
    depression, and other combat-related stress conditions. Further, Post
    Deployment Health examinations should be offered at the member's home
    station, with the member retained on active duty orders until
    completion of the exam.
        Guard and Reserve Health Information
        The Coalition believes there should be an effort to improve the
    electronic capture of non-military health information into the
    servicemember's medical record.
        TRICARE For Life
        Coalition priorities for TFL-eligibles include:

             Securing a permanent fix to the flawed formula for
            setting Medicare/TRICARE payments to providers;
             Resisting any effort to establish an enrollment fee
            for TFL, given that many beneficiaries already experience
            difficulties finding providers who will accept Medicare
            patients; and
             Including TFL beneficiaries in DOD programs to
            incentivize compliance with preventive care and healthy
            lifestyles.
        Restoration of Survivors' TRICARE Coverage
        The Coalition recommends restoration of TRICARE benefits to
    previously eligible survivors whose second or subsequent marriage ends
    in death or divorce.
        Base Realignment and Closure (BRAC) and Rebasing
        The Coalition recommends requiring an annual DOD report on the
    adequacy of health resources, funding, services, quality and access to
    care for beneficiaries affected by BRAC/rebasing.
                                    overview
        Mr. Chairman, The Military Coalition extends our thanks to you and
    the entire subcommittee for your steadfast support of our Active Duty,
    Guard, Reserve, retired members, and veterans of the uniformed services
    and their families and survivors. Your efforts have had a dramatic,
    positive impact in the lives of the entire uniformed services
    community.
        Last year was an extremely tumultuous, difficult year. As our
    servicemembers continued to fight terror on two separate fronts, our
    Nation slowly started to recover from an economic crisis, the worst
    seen since the great depression. Congress and the administration had
    difficult choices to make as they attempted to ``jump start'' the
    economy while faced with a record budget deficit.
        We are grateful that both the Defense Department and Congress put
    top priority on personnel issues last year. As we enter the ninth year
    of extremely stressful wartime conditions, the Coalition believes that
    this prioritization should continue for fiscal year 2011.
        Despite ever-increasing pressures on them at home and abroad, men
    and women in uniform are still answering the call--thanks in no small
    measure to the subcommittee's strong and consistent support--but only
    at the cost of ever-greater sacrifices.
        Troubling indicators such as dramatic increases in suicide and
    divorce rates may reflect the effects of the long-term consequences we
    know are coming as we require the same people to return to combat again
    and again and yet again.
        In these times of growing political and economic pressures, the
    Coalition relies on the continued good judgment of the Armed Services
    Committees to ensure the Nation allocates the required resources to
    sustain a strong national defense, and in particular, to properly meet
    the pressing needs of the less than 1 percent of the American
    population--servicemembers and their families--who protect the freedoms
    of the remaining 99 percent.
        In this testimony, The Coalition offers our collective
    recommendations on what needs to be done to meet these essential needs.
                              wounded warrior care
        Much has been done in the last 3 years to address the grievous and
    negligent conditions that were brought to light since the tragic
    incident at Walter Reed Army Medical Center, where wounded and disabled
    troops and their families had fallen through the cracks as they
    transitioned from the military to VA health care and benefits systems.
        Subsequently, the subcommittee has worked hard to address these
    difficulties, and significant progress has been made on that score.
        But the extent and complexity of the challenges remain daunting,
    requiring continuing coordination of effort between the military
    services; the Department of Defense (DOD); the Department of Veterans
    Affairs (VA); several Centers of Excellence; a multitude of civilian
    contractors and nongovernmental agencies; and the two Armed Services,
    two Veterans Affairs, and two Appropriations Committees.
        The Coalition looks forward to working with the subcommittee this
    year in its ongoing efforts to identify and ease significant remaining
    problems.
    DOD-VA Seamless Transition
        Institutional Oversight
        While many legislative and fiscal changes have improved the care
    and support of our wounded and disabled members, the Coalition is
    concerned that the recent dissolution of the Senior Oversight Committee
    (SOC) poses significant risks for effective day-to-day leadership and
    coordination of DOD and VA seamless transition efforts.
        Last year, the Coalition expressed concern that the change of
    administration would pose a significant challenge to the two
    departments' continuity of joint effort, as senior leaders whose
    personal involvement had put interdepartmental efforts back on track
    left their positions and were replaced by new appointees who had no
    experience with past problems and no personal stake in ongoing
    initiatives.
        Unfortunately, those concerns are being realized, as many
    appointive positions in both departments have gone unfilled for a year,
    responsibilities have been reorganized, and oversight duties previously
    assumed by senior officials have been divested to lower-level
    administrators who are less regularly engaged with their cross-
    department counterparts.
        The result has been more uncertainty and degradation of
    cooperation, communication, and collaboration between the two
    departments over the last year.
        The Coalition is concerned that, having exerted major efforts to
    address the most egregious problems, there is a significant potential
    to fall victim to a ``business as usual'' operating mode, even though
    the difficult journey to true seamless transition between the
    departments has just begun.
        While many well-meaning and hard working military and civilians are
    doing their best to keep pushing progress forward, transitions in
    leadership and mission changes clearly are challenging and require
    formal and more standardized structures, policies, and programs that
    won't be as subject to disruption by one participant's unilateral
    organizational changes.
        It sends a message about departmental priorities when these
    responsibilities are pushed to lower-level officials.
        The Coalition believes there's no substitute for a permanent DOD-VA
    Senior Oversight Committee or other Joint Seamless Transition Office,
    staffed with senior officials working together full-time and charged
    with innovation and daily oversight of initiatives to institutionalize
    and sustain a culture of cross-department seamless transition.
        Continuity of Health Care
        Transitioning between DOD and VA health care systems remains
    challenging, confusing, and overwhelming to those trying to navigate
    and use these systems. Systemic, cultural, and bureaucratic barriers
    often prevent the servicemember or veteran from receiving the necessary
    continuity of care they need to heal and have productive and a high
    level of quality of life they so desperately need and desire.
        While servicemembers and their families tell us that DOD has done
    much to address trauma care, acute rehabilitation, and basic short-term
    rehabilitation, they are less satisfied with their transition from the
    military health care systems to longer-term care and support in
    military and veterans medical systems.
        We hear regularly from members who experienced significant
    disruptions of care upon separation or medical retirement from service.
        One is in the area of cognitive therapy, which is available to
    retired members under TRICARE only if it is not available through the
    VA. Unfortunately, members are caught in the middle because of
    differences between DOD and VA authorities on what constitutes
    cognitive therapy and the degree to which effective, evidenced-based
    therapy is available.
        The NDAA for Fiscal Year 2010 requires a report on such issues, but
    action is needed to protect the wounded and disabled. The subcommittee
    has acted previously to authorize 3 years of active-duty-level TRICARE
    coverage for the family members of those who die on active duty. The
    Coalition believes we owe equal transition care continuity to those
    whose service-caused illnesses or injuries force their retirement from
    service.
        Another significant issue faced by many members forced from active
    duty by severe service-caused disabilities is that the severity of
    their disability qualifies them for Medicare. In such cases, TRICARE is
    second-payer to Medicare.
        Under laws that were designed for elderly retirees but apply
    equally to all Medicare-eligible military beneficiaries, these younger
    disabled warriors must pay Medicare Part B premiums ($110 per month in
    2010) to retain any coverage under TRICARE.
        The Coalition believes it's wrong that members whose service caused
    them to become severely wounded, ill or injured should have to pay more
    for their care than they would if not injured by service, and believes
    they should either be exempt from paying the Part B premium until age
    65 or DOD should help them offset the cost of such payments.
        Finally, doctors at VA polytrauma centers indicate that one of
    their biggest problems is the requirement to get multiple
    authorizations from DOD to provide a variety of specialty care for
    active duty members with multiple medical problems.
        When an active duty member is referred to VA facility for care, DOD
    should grant an automatic waiver of preauthorization/referral
    requirements to allow the VA providers to deliver needed care without
    bureaucratic delays.
        The Coalition recommends:

             Authorizing active-duty-level TRICARE benefits,
            independent of availability of VA care, for 3 years after
            medical retirement to help ease transition from DOD to VA;
             Authorizing blanket waiver authority for VA physicians
            treating active duty patients with multiple medical trauma
            conditions for all aspects of the member's treatment, including
            referral outside the VA/TRICARE system if needed; and
             Either exempting severely wounded, ill, or injured
            members who must be medically retired from paying Medicare Part
            B premiums until age 65 or authorizing a special DOD allowance
            to help offset the cost of such premiums until age 65.
        Mental/Behavioral Health Issues
        The military community is experiencing a crisis of demand for
    mental/behavior health care, both for servicemembers and their spouses
    and children.
        The subcommittee included several initiatives in the NDAA for
    Fiscal Year 2010 aimed at increasing the number of military providers
    in this field and improving access for members and families.
        While the Coalition is very grateful for these initiatives, we
    respectfully request that the subcommittee continue, and more
    importantly expand, its efforts in addressing the growing epidemic of
    difficulties regarding post-traumatic stress disorder (PTSD), traumatic
    brain injuries (TBI), depression, and other mental/behavioral health
    issues disproportionally plaguing our military and veteran communities.
        Today our servicemembers, their spouses and children are facing
    immense stresses and uncertainties associated with repeated deployments
    and protracted separations. Our country is at war on multiple fronts
    and we must take all the necessary actions to ensure the mental well
    being of all those involved, at home and those on the frontlines.
        One of the most prevalent obstacles in successfully identifying and
    treating mental/behavioral health conditions is the stigma which the
    military's warrior culture continues to associate with such conditions
    and the threat or fear that admission of experiencing them may affect
    one's peer standing, security clearance, promotions, or ability to
    remain in service.
        Despite the continued efforts by senior leaders to reduce the
    stigmas associated with mental health issues, the unit-level reality is
    far different. The reality is that many officers, NCOs, and peers
    continue to view these conditions as signs of weakness or inability to
    coup.
        Furthermore, many servicemembers are deterred from seeking care by
    cases of friends who have been disciplined or separated as a result of
    using the available support systems the military has implemented.
        As a direct result, the suicide and divorce rates, as well as
    childhood depression diagnosis' continue to climb within the military
    and veteran communities. DOD openly acknowledges that stigmas remain
    within the ranks, despite their efforts of significantly ramping up
    efforts and outreach programs composed of anti-stigma campaigns, upper-
    level training programs, and easier access to mental health providers.
        The Coalition stresses our grave concerns to the subcommittee
    regarding the current state of DOD's inability to effectively handle
    the increasing demands/need for mental health services and outreach to
    all demographics of today's military forces. While our forces and their
    families display extraordinary strengths, resiliency and undaunted
    tenacity in the face of all stresses associated with service; it is
    vital that we never forget that these same stressors of service to this
    country are in all likelihood, leading to untreated mental and physical
    health conditions.
        The Coalition believes that due to the numerous unrealistic
    standards and high expectations of resiliency and coping abilities we
    have somehow come to expect from our servicemembers and their families,
    that the current military administrative and disciplinary systems being
    used are not effectively meeting the mental health needs, whether
    proactive or reactive, of the same people to whom we expect so much.
    DOD and VA have an obligation to provide the best care available to any
    servicemember who sustains an injury as a result of their service.
        Unfortunately, many of today's servicemembers have mental wounds
    that are undiagnosed and thus untreated. This lack of care or treatment
    for PTSD, TBI, or any one of the numerous stressors associated with
    service, is leading to an increased number of early separations or even
    more alarming, being barred from reenlisting due to a charge of
    misconduct, such as a driving under the influence (DUI) or other such
    incident, by a servicemember who has never previously displayed any
    such behaviors. These uncharacteristic behaviors are only one of the
    symptoms associated with untreated mental/behavioral health conditions.
    Ironically, some civil authorities often are more tolerant and offer
    more assistance in dealing with such cases involving combat veterans
    than military authorities.
        As a result of such circumstances, thousands, if not countless, of
    affected servicemembers, veterans and their family members have gone
    unidentified, untreated, or deterred from being given the opportunity
    to seek the care they deserve. Moreover, many have difficulty accessing
    and utilizing programs that are in place.
        In addition to expanding the availability of providers, the
    Coalition believes that two key elements will be in expanding the
    opportunities for confidential access to counseling or treatments and
    achieving more consistency between leadership campaigns for
    destigmatization/individual resiliency and the practical demonstration
    of greater resiliency and rehabilitation initiatives at the unit/
    administrative level.
        TMC recommends:

             Increased efforts to promote the de-stigmatization on
            all levels in service/unit administrative and strict
            accountability programs with outlined and enforced consequences
            to non-compliancy to ensure unit actions are consistent with
            leadership pronouncements;
             Continuing priority efforts to deliver information and
            assistance on-line, confidential options for counseling and
            uniformed access and availability to telemedicine services;
             Substantial increases in outreach efforts to provide
            such services and resources to Guard and Reserve members, rural
            populations and all families who don't live near military or VA
            facilities;
             Priority efforts to educate private sector providers
            on the unique needs of military and veteran patients and family
            members, and deliver needed information via on-line services,
            including contact points for discussion/consultation with
            military and VA providers;
             Consistent implementation of pre-and post-deployment
            evaluations and follow-up programs, particularly for Guard and
            Reserve members who may be leaving active duty;
             Establishing common DOD and VA protocols for
            diagnosis, treatment, and rehabilitation for TBI conditions, as
            well as an electronic system to share and exchange a patient's
            medical history and other key medical information;
             Expanding Traumatic Servicemember Group Life Insurance
            (TSGLI) criteria to include moderate and severe TBI, without
            onerous ``functions of daily living'' standards that aren't
            required for other (and often much more functional) TSGLI-
            eligibles;
             Increasing availability and outreach on substance
            abuse counseling options;
             Pursuing aggressive medication reconciliation and
            management programs to protect against inadvertent over
            medication and adverse reactions and/or accidental or
            intentional overdose;
             Requiring TBI and psychological health assessments for
            members who have been deployed to a combat zone as part of the
            disciplinary process prior to a decision concerning non-medical
            separation; and
             Implementing recommendations from the 2008 RAND report
            (``Invisible Wounds of War, Psychological and Cognitive
            Injuries, Their Consequences, and Services to Assist
            Recovery'').
        DOD-VA Disability Evaluation Systems (DES)
        Several recommendations made by various commissions, task forces
    and committees were addressed in the National Defense Authorization
    Acts for Fiscal Year 2008, 2009, and 2010; however, more needs to be
    done.
        One of the most emotional issues that emerged from the Walter Reed
    scandal was the finding that Services were ``low-balling'' disabled
    servicemembers' disability ratings, with the result that many
    significantly disabled members were being separated and turned over to
    the VA rather than being medically retired (which requires a 30 percent
    or higher disability rating).
        Encouraging rhetoric was heard from leadership in both the DOD and
    VA that this would be addressed by having DOD accept the (usually
    higher) disability ratings awarded by the VA.
        Congress has taken positive steps to correct previous ``low-ball''
    ratings and streamline the DES. Congress created the Physical
    Disability Board of Review (PDBR) to give previously separated
    servicemembers an opportunity to appeal their ``low-balled'' disability
    rating.
        They also authorized a jointly executed DOD-VA DES pilot in the
    2008 NDAA, and feedback from members and families who participated in
    the pilot program is that it has simplified the process and provided a
    more standardized disability rating outcome.
        TMC was further encouraged that wounded, ill, and injured members
    would benefit from the 19 Dec 07 Under Secretary of Defense (Personnel
    and Readiness) Directive Type Memorandum (DTM) which added
    ``deployability'' as a consideration in the DES decision process--
    permitting medical separation/retirement based on a medical condition
    that renders a member nondeployable.
        Unfortunately, several cases have surfaced indicating the Services
    have failed to incorporate the DTM in their DES process.
        In this regard, the services continue to issue findings that a
    member is ``fit, but unsuitable'' for service. Under this system, a
    member found ``fit'' by the PEB, is deemed by the service to be
    ``unsuitable'' for continued service--and administratively separated--
    because the member's medical condition prevents them from being able to
    deploy or maintain their current occupational skill.
        The Coalition believes strongly that medical conditions which
    preclude servicemembers from continuing to serve should be deemed
    ``unfitting''--not ``unsuitable.''
        In addition, we remain concerned about language used by some
    indicating a wish to remove DOD from the DES process (i.e., DOD
    determines fitness and VA determines disability). This simplified
    process could result in neglect of DOD's employer responsibilities,
    such as TRICARE eligibility for disabled members and their families.
        The Coalition believes strongly that members determined by parent
    service to be 30 percent or more disabled should continue to be
    eligible for a military disability retirement with all attendant
    benefits, including lifetime TRICARE eligibility for the member and
    his/her family. We do not support efforts to disconnect health care
    eligibility from disability retired pay eligibility. The Coalition also
    agrees with the opinion expressed by Secretary Gates that a member
    forced from service for wartime injuries should not be separated, but
    should be awarded a high enough rating to be retired for disability.
        TMC recommends:

             Barring ``fit, but unsuitable'' separations when a
            member's medical condition prevents continued service;
             Authorizing automatic enrollment in the VA health care
            system for any medically separated or medically retired
            servicemember (Chapter 61);
             Ending distinctions between disabilities incurred in
            combat vice non-combat;
             Monitoring the effectiveness of recent DOD
            compensation for catastrophically injured or ill servicemembers
            requiring assistance with activities of daily living authorized
            in the 2010 NDAA;
             Ensuring benefits afforded members wounded, ill, or
            disabled in the line of duty are applied equally for all
            uniformed services;
             Ensuring that the VA is the single authority for
            rating service-connected disabilities for military disability
            retirements and separations;
             Preserving the statutory 30 percent disability
            threshold for medical retirement and lifetime TRICARE coverage
            for members injured while on active duty;
             Continued monitoring of Service/DOD Medical-Physical
            Evaluation Boards, DOD DES Pilot Project, and the Physical
            Disability Board of Review, to assess needed DES changes;
             Eliminating member premiums for Traumatic
            Servicemember Group Life Insurance (TSGLI);
             Barring ``pre-existing condition'' determinations for
            any member who deploys to a combat zone;
             Ensuring that any adjustment to the disability
            retirement system does not result in a member receiving less
            disability retired pay than he or she would receive under the
            current system; and
             Ensuring that members electing accelerated disability
            retirement/separation are fully counseled on any possible
            negative changes in compensation, health care and other
            benefits, with consideration to allowing a limited time to
            reverse a regrettable decision.
        Caregiver/Family Support Services
        The sad reality is that, for the most severely injured
    servicemembers, family members or other loved ones are often required
    to become full-time caregivers. Many have lost their jobs, homes, and
    savings in order to meet caregiver needs of a servicemember who has
    become incapacitated due to service-caused wounds, injuries or illness.
        The Coalition believes the government has an obligation to provide
    reasonable compensation and training for such caregivers, who ever
    dreamed that their own well-being, careers, and futures would be
    devastated by military-caused injuries to their servicemembers.
        Last year, the subcommittee authorized a special payment to an
    active duty servicemember to allow compensation of a family member or
    professional caregiver. The authorized payment was in the same amount
    authorized by the VA for veterans' aid-and-attendance needs, reflecting
    the subcommittee's thinking that caregiver compensation should be
    seamless when the member transitions from active duty to VA care, as
    long as the caregiver requirements remain the same.
        The Coalition supported this initiative, but recognizes that both
    chambers have since approved legislation to authorize more significant
    VA assistance and compensation for caregivers.
        Once the House and Senate versions of the VA caregiver legislation
    have been reconciled in conference, the Coalition hopes the
    subcommittee will propose similar upgrades for caregivers of members
    while on active duty, consistent with the ``seamless transition''
    philosophy adopted last year.
        In a similar vein, many wounded or otherwise-disabled members
    experience significant difficulty transitioning to medical retirement
    status. To assist in this process, consideration should be given to
    authorizing medically retired members and their families to remain in
    on-base housing for up to 1 year after retirement, in the same way that
    families are allowed to do so when a member dies on active duty.
        The Coalition recommends:

             Upgraded compensation and assistance for caregivers of
            severely disabled active duty members, consistent with pending
            legislative action to improve compensation/assistance for
            caregivers of veterans; and
             Authorizing up to 1 year of continued residence in on-
            base housing facilities for medically retired, severely wounded
            servicemembers and their families.
                        active forces and their families
        In our overview, the Coalition expressed our collective concern
    over the stressors our servicemembers and their families are
    experiencing due to the long, repeated deployments and unrelenting
    operations tempo. In order to sustain a sufficient, highly trained and
    highly capable Active Force, the continuing overriding requirement is
    to find additional ways to ease the terrible burden of stress on
    servicemembers and their families.
    Military End Strength
        Increased end strength is the only effective way to reduce stress
    on forces and families as long as deployment requirements not only
    continue, but actually increase.
        The creators of the All-Volunteer Force never envisioned that the
    force would be deployed into combat 1 year out of 3--let alone every
    other year, as has been the case with many ground units.
        Regrettably, the scenario faced by today's forces is not unlike the
    World War II ``Catch-22'' situation described by Joseph Heller, in
    which aircrews braving horrendous enemy flak had their wartime mission
    requirements increased again and again, until they perceived that the
    terrible sacrifices being demanded of them would never end.
        Unfortunately, many in government and among the public seem to have
    become desensitized to the truly terrible sacrifices that the current
    mismatch between missions and force levels has already imposed on those
    in uniform. They acknowledge the problem, but most assume that
    servicemembers and families will simply continue to accept these--or
    even greater--levels of sacrifice indefinitely.
        Many point to the achievement of service recruiting and retention
    goals as indicators that all is well.
        Such perceptions grossly underestimate the current stresses on the
    force and the risk that poses for readiness and national security. The
    Coalition believes any complacency about retention is sadly misplaced,
    and that the status of the current force should be viewed in the
    context of a rubber band that has been stretched to its limit. The fact
    that it has not yet broken is of little comfort.
        Well-respected studies have shown that 20 to 30 percent of combat
    returnees have experienced PTSD, TBI, or depression, and that the
    likelihood of a servicemember returning as a changed person rises with
    each subsequent deployment. Other studies have shown that rising
    cumulative family separations are having significant negative effects
    on servicemembers' children.
        These are not mere academic exercises. They are well-known facts of
    life to those who are alone in actually experiencing them.
        A far truer, and truly tragic, indicator of these extremely
    troubling circumstances has been the significant rise in
    servicemembers' suicide and divorce rates.
        So the Coalition is very grateful for the subcommittee's support
    for end strength increases for all Services in the National Defense
    Authorization Act for Fiscal Year 2010, and for fending off the efforts
    of those who proposed cutting force levels to fund hardware needs.
        But we must not understate the reality that the increases approved
    to date will not significantly improve dwell time for military families
    anytime in the near future, given increasing operational requirements
    in Afghanistan.
        New requirements for massive humanitarian aid in Haiti and
    elsewhere only exacerbate the already grievous situation.
        The Coalition is relieved that the administration is requesting an
    increase to the overall defense budget by $100 billion over the next 5
    years--we just hope it's enough.
        The Coalition urges the subcommittee to:

             Continue end strength growth as needed to sustain the
            war and other operational commitments while materially
            increasing dwell time for servicemembers and families;
             Sustain adequate recruiting and retention resources to
            enable the uniformed services to achieve required optimum-
            quality personnel strength; and
             Seek a 2011 defense budget of at least 5 percent of
            Gross Domestic Product that funds both people and weapons
            needs.
        Military Pay Raise
        The Coalition thanks the subcommittee for its sustained commitment
    to restoring full military pay comparability--a fundamental
    underpinning of the All-Volunteer Force.
        To that end, we are grateful for the committee's leadership in
    approving a 3.4 percent military pay raise for 2010--vs. the 2.9
    percent proposed in the defense budget submission.
        Throughout the 1980s and 1990s, military pay raises consistently
    were capped below private sector pay growth, causing a ``pay
    comparability gap'' that reached 13.5 percent in 1998-1999, and
    contributed significantly to serious retention problems.
        Every year since then, the subcommittee has acted to pare the gap
    by approving military raises that have been at least .5 percent above
    private sector pay growth.
        Now that significant progress has been made and the ``erosion of
    pay and benefits'' retention-related problems have abated, some have
    renewed calls to cut back on military raises, create a new
    comparability standard, or substitute more bonuses for pay raises in
    the interests of ``efficiency.''
        The Defense Department has proposed a new comparability standard
    under which each pay and longevity cell would represent the 70th
    percentile of compensation for similarly-educated civilians. A recent
    Congressional Budget Office report asserted that, considering
    adjustments in housing allowances, military people actually are paid 10
    percent more than their civilian counterparts in terms of Regular
    Military Compensation (RMC), composed of basic pay, food and housing
    allowances, and the tax advantage that accrues because the allowances
    are tax-free.
        The Coalition believes such assertions are fundamentally flawed.
        First, the RMC concept was developed in the 1960s, when all
    servicemembers received the same allowances, regardless of location,
    and the allowances were arbitrary figures that weren't actually based
    on anything. In the interim, Congress has transformed the allowances
    into reimbursements for actual food costs and median locality-based
    housing costs.
        If one were to use the RMC comparability methodology in this
    scenario, basic pay--the largest element of military pay and the one
    that drives retired pay--would become ``flex'' compensation element.
    With tax rates and allowances figures set independently, a year in
    which average housing allowances rose (e.g., based on growth in high-
    cost areas) and taxes increased could actually yield a requirement to
    cut basic pay (and future retirement value) to restore
    ``comparability.''
        Second, the Coalition is not convinced that the civilian comparison
    cohort or percentile comparison point proposed by DOD are the proper
    ones, given that the military:

             Recruits from the top half of the civilian aptitude
            population;
             Finds that only about 25 percent of America's youth
            qualify for entry;
             Requires career-long education and training
            advancement;
             Enforces a competitive ``up-or-out'' promotion system;
            and
             Imposes severe limits on personal freedoms (e.g., not
            being able to quit when you want; risking a felony conviction
            for refusing an order).

        A fundamental requirement for any pay comparability standard is
    that it should be transparent and understandable. The Coalition has
    asked for, but has never been provided by DOD, any data on what
    civilian comparison cohort was selected and why, and what rationale was
    used to establish a specific percentile comparison point.
        Third, the Coalition believes it is essential to recognize that
    compensation is not simply the amount one is paid. It is pay divided by
    what's required of the recipient to earn that pay. If we increase pay
    25 percent but require 100 percent more sacrifice to earn it, that's
    not a pay raise.
        In that context, today's conditions of service are far more arduous
    than anything envisioned 40 years ago by the creators of the All-
    Volunteer Force, who believed a protracted war would require
    reinstitution of the draft.
        Finally, private sector pay growth between 2008 and 2009 would set
    the military pay raise for 2011 at 1.4 percent--the smallest military
    pay raise in almost 50 years, even while servicemembers are being asked
    to endure the most arduous service conditions in more than 60 years.
    Further, the Coalition observes that there is a lag of more than a year
    between the time the civilian pay growth is measured and the time it is
    applied to the military.
        The Coalition agrees with the approach the subcommittee has taken
    consistently -that the best comparability measure is a comparison of
    the military basic pay raise percentage with the percentage growth in
    the ECI.
        The government uses the ECI for every other measure of private pay
    growth, and it's very transparent to government leaders and
    servicemembers alike. As of 2010, cumulative military basic pay
    increases lag cumulative private sector pay growth by 2.4 percent since
    1982--the last time it was generally agreed that a state of
    comparability existed.
        Given the historic low raise produced by the ECI for 2011, the
    historic sacrifices being asked of servicemembers in this time of
    protracted war, and the dubious rationale for alternative pay raise
    proposals, any assertion that military people are overpaid is grossly
    off the mark.
        The Coalition believes a basic pay raise of at least 1.9
    percent--.5 percent above the ECI standard--is the bare minimum the
    Nation should do to sustain its military pay comparability commitment
    for 2011.
        Family Readiness and Support
        A fully funded, robust family readiness program continues to be
    crucial to overall readiness of our military, especially with the
    demands of frequent and extended deployments.
        Resource issues continue to plague basic installation support
    programs. At a time when families are dealing with increased
    deployments, they often are being asked to do without in other
    important areas. We are grateful that the subcommittee included a
    provision in last year's defense bill that will help improve family
    readiness and support though greater outreach. The Department's
    establishment of a comprehensive benefits web site for servicemembers
    and their families will help provide virtual assistance regardless of
    their physical proximity to installation-supported networks.
        Additionally, we could not agree more with last year's ``Sense of
    Congress'' regarding the establishment of flexible spending accounts
    (FSAs) for members of the uniformed services. We urge the subcommittee
    to continue to press the Defense Department until servicemembers are
    provided the same eligibility to participate in FSAs that all other
    Federal employees enjoy.
        Quality education is a top priority to military families.
    Servicemembers are assigned all across the United States and the world.
    Providing appropriate and timely funding of Impact Aid through the
    Department of Education is critical to ensuring quality education
    military children deserve, regardless of where they live.
        The Coalition believes that several initiatives could have
    unintended negative consequences on school facility needs and
    educational programs affecting military children. Service
    transformation, overseas rebasing initiatives, housing privatization,
    base realignment and closure actions all have the potential to affect
    the military family and their access to quality education programs.
        The Coalition recommends that the subcommittee:

             Press DOD to assess the effectiveness of programs and
            support mechanisms to assist military families with deployment
            readiness, responsiveness, and reintegration;
             Ensure that effective programs--including the Family
            Readiness Council--are fully funded and their costs are
            included in the annual budget process;
             Provide authorization and funding to accelerate
            increases in availability of child care to meet both Active and
            Reserve component requirements;
             Insist DOD implement flexible spending accounts to let
            active duty and Selected Reserve families pay out-of-pocket
            dependent and health care expenses with pre-tax dollars;
             Monitor and continue to expand family access to mental
            health counseling;
             Promote expansion of military spouse opportunities to
            further educational and career goals;
             Ensure additional and timely funding of Impact Aid
            plus continued DOD supplemental funding for highly-impacted
            military schools; and
             Mitigate the impact of Service transformation,
            overseas rebasing initiatives, housing privatization and base
            realignment on school facility needs and educational programs
            affecting military children.
        Permanent Change of Station (PCS) Allowances
        It's an unfortunate fact that members and their families are forced
    to incur significant out-of-pocket expenses when complying with
    government-directed moves.
        For example, the current Monetary Allowance in Lieu of
    Transportation (MALT) rate used for PCS moves still fall significantly
    short of meeting members' actual travel costs. The current rate of 24
    cents per mile is less than half of the 50 cents per mile authorized
    for temporary duty travel. Also, military members must make any advance
    house-hunting trips at personal expense, without any government
    reimbursements such as Federal civilians receive.
        DOD states that the MALT rate was not intended to reimburse
    servicemembers for travel by automobile, but simply a payment in lieu
    of providing transportation in-kind.
        The Coalition believes strongly that the MALT concept is an
    outdated one, having been designed for a conscripted, single, non-
    mobile force.
        Travel reimbursements should be adjusted to reflect the reality
    that today's all-volunteer servicemembers do, in fact, own cars and
    that it is unreasonable not to reimburse them for the cost of driving
    to their next duty stations in conjunction with PCS orders.
        Simply put, PCS travel is no less government-ordered than is TDY
    travel, and there is simply no justification for paying less than half
    the TDY travel rate when personal vehicle use is virtually essential.
        Additionally, the government should acknowledge that reassigning
    married servicemembers within the United States (including overseas
    locations) usually requires relocation of two personal vehicles. In
    that regard, the overwhelming majority of service families consist of
    two working spouses, making two privately owned vehicles a necessity.
    Yet the military pays for shipment of only one vehicle on overseas
    moves, including moves to Hawaii and Alaska, which forces relocating
    families into large out-of-pocket expenses, either by shipping a second
    vehicle at their own expense or selling one car before leaving the
    States and buying another upon arrival.
        At a minimum, the Coalition believes military families being
    relocated to Alaska, Hawaii, and U.S. territories should be authorized
    to ship a second personal vehicle, as the subcommittee has rightly
    supported in the past.
        The Coalition urges the subcommittee to continue its efforts to
    upgrade permanent change-of-station allowances to better reflect
    expenses imposed on servicemembers, with priority on:

             Shipping a second vehicle on overseas accompanied
            assignments;
             Authorizing at least some reimbursement for house-
            hunting trip expenses; and
             Increasing PCS mileage rates to more accurately
            reflect members' actual transportation costs.
        Education Enhancements
        The Post-September 11 GI Bill was a truly historic achievement that
    will provide major long-term benefits for military people and for
    America; however, the Coalition remains sensitive that transferability
    of the benefit to family members was restricted to members of the
    ``Armed Forces.''
        The Coalition believes all members of the uniformed services,
    including commissioned officers of the U.S. Public Health Service and
    NOAA Corps, should be able to transfer their benefit to family members.
    All previous GI Bill provisions have applied equally to all uniformed
    services, and the Post-September 11 GI Bill should not be an exception.
        The Coalition urges the subcommittee to support amending the
    statute to authorize all otherwise-qualifying members of the
    ``uniformed services'' to transfer Post-September 11 GI Bill benefits
    to family members.
    Morale, Welfare, and Recreation (MWR) and Quality of Life (QoL)
            Programs
        MWR activities and QoL programs have become ever more critical in
    helping servicemembers and their families cope with the extended
    deployments and constant changes going on in the force.
        The availability of appropriated funds to support MWR activities is
    an area of continuing concern for the Coalition. We are especially
    apprehensive that additional reductions in funding or support services
    may occur due to slow economic recovery and record budget deficits.
        BRAC actions pose an additional concern as DOD is struggling to
    meet the 2011 deadline at many BRAC locations. Two reports issued by
    the Government Accountability Office indicate significant challenges
    remain in areas of funding, facilities, and overall management.
        The Coalition is very concerned whether needed infrastructure and
    support programs will be in place in time to meet families' needs.
        TMC urges the subcommittee to:

             Protect funding for critical family support and QoL
            programs and services to meet the emerging needs of
            beneficiaries and the timelines of the Services' transformation
            plans;
             Oppose any initiative to withhold or reduce
            appropriated support for family support and QoL programs to
            include: recreation facilities, child care, exchanges and
            commissaries, housing, health care, education, family centers,
            and other traditional and innovative support services;
             Prevent any attempts to consolidate or civilianize
            military service exchange and commissary programs; and
             Sustain funding for support services and
            infrastructure at both closing and gaining installations
            throughout the entire transformation process, including
            exchange, commissary and TRICARE programs.
                           national guard and reserve
        Over 142,000 Guard and Reserve service men and women members are
    serving on active duty.
        Since September 11, 2001, more than 752,000 Guard and Reserve
    service men and women have been called up, including well over 200,000
    who have served multiple tours. There is no precedent in American
    history for this sustained reliance on citizen-soldiers and their
    families. To their credit, Guard and Reserve combat veterans continue
    to reenlist, but the current pace of routine, recurring deployments
    cannot be sustained indefinitely.
        Guard and Reserve members and families face unique challenges in
    their readjustment following active duty service. Unlike active duty
    personnel, many Guard and Reserve members return to employers who
    question their contributions in the civilian workplace, especially as
    multiple deployments have become the norm. Many Guard-Reserve troops
    return with varying degrees of combat-related injuries and stress
    disorders, and encounter additional difficulties after they return that
    can cost them their jobs, careers and families.
        Despite the continuing efforts of the Services and Congress, most
    Guard and Reserve families do not have access to the same level of
    counseling and support that active duty members have. In short, the
    Reserve components face increasing challenges virtually across the
    board, including major equipment shortages, end-strength requirements,
    wounded-warrior health care, and pre- and post-deployment assistance
    and counseling.
    Operational Reserve Retention and Retirement Reform
        Congress took the first step in modernizing the Reserve
    compensation system with enactment of early retirement eligibility for
    certain reservists activated for at least 90 continuous days served
    since January 28, 2008. This change validates the principle that
    compensation should keep pace with service expectations and work as an
    inducement to retention and sustainment of the Operational Reserve
    Force.
        Guard/Reserve mission increases and a smaller Active-Duty Force
    mean Guard/Reserve members must devote a much more substantial portion
    of their working lives to military service than ever envisioned when
    the current retirement system was developed in 1948.
        Repeated, extended activations make it more difficult to sustain a
    full civilian career and impede reservists' ability to build a full
    civilian retirement, 401(k), etc. Regardless of statutory protections,
    periodic long-term absences from the civilian workplace can only limit
    Guard/Reserve members' upward mobility, employability and financial
    security. Further, strengthening the Reserve retirement system will
    serve as an incentive to retaining critical mid-career officers and
    NCOs for continued service and thereby enhance readiness.
        As a minimum, the next step in modernizing the Reserve retirement
    system is to provide equal retirement-age-reduction credit for all
    activated service rendered since September 11, 2001. The current law
    that credits only active service since January 28, 2008 disenfranchises
    and devalues the service of hundreds of thousands of Guard/Reserve
    members who served combat tours (multiple tours, in thousands of cases)
    between 2001 and 2008.
        The statute also must be amended to eliminate the inequity inherent
    in the current fiscal year retirement calculation, which only credits
    90 days of active service for early retirement purposes if it occurs
    within the same fiscal year. The current rule significantly penalizes
    members who deploy in July or August vs. those deploying earlier in the
    fiscal year.
        It is patently unfair, as the current law requires, to give 3
    months retirement age credit for a 90-day tour served from January
    through March, but only half credit for a 120-day tour served from
    August through November (because the latter covers 60 days in each of 2
    fiscal years).
        For the near term, the Military Coalition places particular
    priority on authorizing early retirement credit for all qualifying
    post-September 11 active duty service performed by Guard/Reserve
    servicemembers and eliminating the fiscal-year-specific accumulator
    that bars equal credit for members deploying for equal periods during
    different months of the year.
        Ultimately, TMC believes we must move forward to provide a reduced
    age entitlement for retired pay and health coverage for all Reserve
    component members--that is, an age/service formula or outright
    eligibility, if otherwise qualified, at age 55.
        Further, TMC urges repeal of the annual cap of 130 days of inactive
    duty training points that may be credited towards a Reserve retirement.
    Guard and Reserve Yellow Ribbon Readjustment
        Congress has provided increased resources to support the transition
    of warrior-citizens back into the community. But program execution
    remains spotty from State to State and falls short for returning
    Federal Reserve warriors in widely dispersed regional commands.
    Military and civilian leaders at all levels must improve the
    coordination and delivery of services for the entire Operational
    Reserve Force. Many communities are eager to support and many do that
    well. But, yellow ribbon efforts in a number of locations amount to
    little more than PowerPoint slides and little or no actual
    implementation.
        TMC is grateful for the subcommittee's attention to this issue and
    for including reporting requirements on progress in the National
    Defense Authorization Act for Fiscal Year 2010.
        Making Yellow Ribbon work effectively is a major Coalition
    priority, and our hope is that the NDAA-required reports will point the
    way for further subcommittee action in this important area.
        TMC urges the subcommittee to hold oversight hearings and to direct
    additional improvements in coordination, collaboration, and consistency
    of Yellow Ribbon services. DOD must ensure that State-level best
    practices--such as those in Maryland, Minnesota and New Hampshire--are
    applied for all Operational Reserve Force members and their families,
    and that Federal Reserve veterans have equal access to services and
    support available to National Guard veterans. Community groups,
    employers, and service organization efforts need to be encouraged and
    better coordinated to supplement unit, component, Service and VA
    outreach and services.
    Guard/Reserve GI Bill
        TMC is grateful to Congress for inclusion of a critical ``earn as
    you serve'' principle in the new Post-September 11 GI Bill, which
    allows operational reservists to accrue educational benefits for each
    aggregate call-up of 90 days or more active duty. Inexplicably,
    however, active duty members of the National Guard serving under Title
    32 orders were not included in the new program despite their critical
    role in homeland defense, counter-drug, border control, and other
    missions.
        TMC urges the subcommittee to work with the Veterans Affairs
    Committee to include Title 32 AGRs in the Post-September 11 statute.
        TMC's longstanding recommendation of coordinating and integrating
    various educational benefit programs has been made more challenging
    with the Post-September 11 GI Bill.
        For example, benefits for initially joining the Guard or Reserve as
    authorized in Chapter 1606, 10 U.S.C. continue to decline in proportion
    to the active duty Montgomery GI Bill (Chap. 30, 38 U.S.C.) and the new
    Post-September 11 GI Bill. Reserve MGIB benefit levels have slid to 24
    percent of the active duty MGIB benefit, compared to 47-50 percent
    during the first 15 years of the program. Restoration of the original
    ratio would raise basic Reserve rates from the current $333 per month
    to $643-$684 per month for full-time study.
        TMC maintains that restoring the ratio is not only a matter of
    equity, but essential to long-term success of Guard and Reserve
    recruiting programs.
        Based on the DOD/Services' 10-year record of indifference to the
    basic Selected Reserve GI Bill under Chapter 1606, 10 U.S.C., TMC
    recommends either: restoring Reserve benefits to 47-50 percent of
    active duty benefits or transferring the Chapter 1606 statute from
    title 10 to title 38 so that it can be coordinated with other
    educational benefits programs in a 21st century GI Bill architecture.
    TMC also supports assured academic reinstatement, including guaranteed
    re-enrollment, for returning operational reservists.
    Special and Incentive Pays
        Increased reliance on Guard and Reserve Forces to perform active
    duty missions has highlighted differentials and inconsistencies between
    treatment of active duty vs. Guard and Reserve members on a range of
    special and incentive pays. Congress has acted to address some of these
    disparities, but more work is needed.
        The Coalition urges the subcommittee to ensure equitable treatment
    of Guard and Reserve vs. Active Duty members for the full range of
    special and incentive pays.
                                 retiree issues
        The Military Coalition remains grateful to the subcommittee for its
    support of maintaining a strong military retirement system to help
    offset the extraordinary demands and sacrifices inherent in a career of
    uniformed service.
    Concurrent Receipt
        In the NDAA for Fiscal Year 2003 and Fiscal Year 2004, Congress
    acknowledged the inequity of the disability offset to earned retired
    pay and established a process to end or phase out the offset for many
    disabled retirees. The Coalition is extremely grateful with the
    subcommittee's efforts to continue progress in easing the adverse
    effects of the offset.
        Last year we were very optimistic that another very deserving group
    of disabled retirees would become eligible for concurrent receipt when
    the White House included a concurrent receipt proposal in the Budget
    Resolution--the first time in history any administration had ever
    proposed such a fix.
        The administration's proposal, again submitted in this year's
    budget, would expand concurrent receipt eligibility over a 5 year
    period to all those forced to retire early from Service due to a
    disability, injury, or illness that was service-connected (chapter 61
    retirees).
        Thanks to the strong support of Armed Services Committee leaders,
    the proposal was included in the House version of the NDAA for Fiscal
    Year 2010. The Coalition was dismayed that, despite your leadership
    efforts and White House support, the provision failed to survive
    conference--an extremely disappointing outcome for a most deserving
    group of disabled retirees.
        Our fervent hope is that the subcommittee will redouble its efforts
    to authorize this initiative for fiscal year 2011.
        Additionally, the Coalition is concerned that an inadvertent
    problem exists in the statutory Combat-Related Special Compensation
    (CRSC) computation formula causes many seriously disabled and clearly
    eligible members to receive little or nothing in the way of CRSC. The
    Defense Department has acknowledged the problem in discussions with the
    subcommittee staff, and the Coalition urges the subcommittee to correct
    this technical problem.
        The Coalition believes strongly in the principle that career
    military members earn their retired pay by service alone, and that
    those unfortunate enough to suffer a service-caused disability in the
    process should have any VA disability compensation from the VA added
    to, not subtracted from their service-earned military retired pay and
    this remains a key goal in 2010--regardless of years of service or
    severity of their disability rating.
        The Coalition's continuing goal is to fully eliminate the deduction
    of VA disability compensation from earned military retired pay for all
    disabled retirees. In pursuit of that goal, the Coalition's immediate
    priorities include:

             Phasing out the disability offset for all Chapter 61
            (medical) retirees; and
             Correcting the CRSC formula to ensure the intended
            compensation is delivered.
    Proposed Military Retirement Changes
        The Coalition remains concerned that as budgets get tighter and
    calls to establish a new entitlement or debt-reduction commission grow
    louder, the military retirement system may come under greater scrutiny
    to seek savings or ``efficiencies.''
        Our concern is based on past experience that seeking to wring
    savings from military retirement programs poses a significant threat to
    long-term retention and readiness by decreasing the attractiveness of
    serving for 2 or 3 decades in uniform, with all of the extraordinary
    demands and sacrifice inherent in such extended career service.
        For example, the Coalition is very concerned that proposals to
    ``civilianize'' military retirement benefits, such as the changes
    recommended by the 10th Quadrennial Review of Military Compensation
    (QRMC) fail utterly to recognize the fundamental purpose of the
    military retirement system in offsetting service conditions that are
    radically more severe than those experienced by the civilian workforce.
        The QRMC proposed converting the military retirement system to a
    civilian-style plan under which full retired pay wouldn't be paid until
    age 57-60; vesting retirement benefits after 10 years of service; and
    using flexible ``gate pays'' and separation pay at certain points of
    service to encourage continued service in certain age groups or skills
    and encourage others to leave, depending on service needs for certain
    kinds of people at the time.
        Reduced to its essence, this admittedly cost-neutral plan would
    take money from people who stay for a career in order to pay additional
    benefits to those who leave the military short of a career.
        If this system were in place today, a 10-year infantryman facing
    his or her fourth combat tour would be offered a choice between: (a)
    allowing immediate departure with a vested retirement; vs. (b)
    continuing under current service conditions for another 10-20 years and
    having to wait until age 58 for immediate retired pay.
        The Coalition believes strongly that, if such a system existed for
    today's force under today's service conditions, the military services
    would already be mired in a deep and traumatic retention crisis.
        Further, the QRMC proposal is so complicated that people evaluating
    career decisions at the 4- to 10-year point would have no way to
    project their future military retirement benefits. Gate pays available
    at the beginning of a career could be cut back radically if the force
    happened to be undergoing a strength reduction later in a member's
    career.
        In contrast, the current military retirement system makes it very
    clear from the pay table what level of retired pay would be payable,
    depending how long one served and how well one progressed in grade.
        The sustained drawing power of the 20-year retirement system
    provides an essential long-term moderating influence that keeps force
    managers from over-reacting to short-term circumstances. Had force
    planners had such a system in effect during the drawdown-oriented
    1990s, the Services would have been far less prepared for the post-
    September 11 wartime environment.
        Many such proposals have been offered in the past, and have been
    discarded for good reasons. The only initiative to substantially
    curtail/delay military retired pay that was enacted--the 1986 REDUX
    plan--and only a remnant remain as the mandatory REDUX was scrapped 13
    years later after it began inhibiting retention.
        The only remnant that remains--and has been in place unchanged
    since 1999--is a voluntary program known as the Career Status Bonus--a
    $30,000 ``bonus'' bait and switch--where the servicemember can receive
    $30,000 at their 15 year point as long as they accept REDUX.
        That ``bonus'' was a bad deal at the time and it gets worse with
    every passing year as pay (and retired pay) increases.
        After taxes, the so-called bonus is more like $22,000 or $23,000.
    To get that, the typical NCO who retires with 20 years of service must
    agree to sacrifice more than $300,000 in future retired pay (those who
    live longer than average sacrifice far more). That's how much less
    REDUX is worth compared to the normal system.
        TMC urges the subcommittee to:

             Reject any initiatives to ``civilianize'' the military
            system without adequate consideration of the unique and
            extraordinary demands and sacrifices inherent in a military vs.
            a civilian career; and
             Eliminate the Career Status Bonus for servicemembers
            as it significantly devalues their retirement over time. In the
            short term, the Services should be required to better educate
            eligible members on the severe long-term financial penalty
            inherent in accepting the REDUX option.
    Disability Severance Pay
        The Coalition is grateful for the subcommittee's inclusion of a
    provision in the NDAA for Fiscal Year 2008 that ended the VA
    compensation offset of a servicemember's disability severance for
    people injured in the combat zone.
        However, we are concerned that the language of this provision
    imposes much stricter eligibility than that used for Combat-Related
    Special Compensation.
        The Coalition urges the subcommittee to amend the eligibility rules
    for disability severance pay to include all combat--or operations--
    related injuries, using same definition as CRSC. For the longer term,
    the Coalition believes the offset should be ended for all members
    separated for service-caused disabilities.
        Former Spouse Issues
        For nearly a decade the recommendations of the Defense Department's
    September 2001 report to Congress on the Uniformed Services Former
    Spouse Protection Act (USFSPA) have gone nowhere. For several years,
    DOD submitted many of the report's recommendations annually to Congress
    only to have one or two supported by the subcommittee while many others
    were dropped.
        The USFSPA is a very emotional topic with two distinct sides to the
    issue--just as any divorce has two distinct parties affected. The
    Coalition believes strongly that there are several inequities in the
    act that need to be addressed and corrected that could benefit both
    affected parties--the servicemember and the former spouse.
        But in order to make progress, we believe Congress cannot piecemeal
    DOD's recommendations. We support a collective grouping of legislation
    that would provide benefit to both affected parties. Absent this
    approach, the legislation will be perceived as supporting one party
    over the other and go nowhere.
        To fairly address the problems with the act, all affected parties
    need to be heard--and the Coalition would greatly appreciate the
    opportunity to address the inequities in a hearing before the
    subcommittee.
        The Coalition requests a hearing to address USFSPA inequities. In
    addition, we recommend legislation to include all of the following:

             Base the award amount to the former spouse on the
            grade and years of service of the member at time of divorce
            (and not retirement);
             Prohibit the award of imputed income, which
            effectively forces active duty members into retirement;
             Extend 20/20/20 benefits to 20/20/15 former spouses;
             Permit the designation of multiple Survivor Benefit
            Plan (SBP) beneficiaries with the presumption that SBP benefits
            must be proportionate to the allocation of retired pay;
             Eliminate the ``10-year Rule'' for the direct payment
            of retired pay allocations by the Defense Finance and
            Accounting Service (DFAS);
             Permit SBP premiums to be withheld from the former
            spouse's share of retired pay if directed by court order;
             Permit a former spouse to waive SBP coverage;
             Repeal the 1-year deemed election requirement for SBP;
            and
             Assist the DOD and Services with greater outreach and
            expanded awareness to members and former spouses of their
            rights, responsibilities, and benefits upon divorce.
                                survivor issues
        The Coalition is grateful to the subcommittee for its significant
    efforts in recent years to improve the Survivor Benefit Plan (SBP),
    especially its major achievement in eliminating the significant benefit
    reduction previously experienced by SBP survivors upon attaining age
    62.
    SBP-DIC Offset
        The Coalition believes strongly that current law is unfair in
    reducing military SBP annuities by the amount of any survivor benefits
    payable from the DIC program.
        If the surviving spouse of a retiree who dies of a service-
    connected cause is entitled to DIC from the Department of Veterans
    Affairs and if the retiree was also enrolled in SBP, the surviving
    spouse's SBP annuity is reduced by the amount of DIC. A pro-rata share
    of the SBP premiums is refunded to the widow upon the member's death in
    a lump sum, but with no interest. This offset also affects all
    survivors of members who are killed on active duty.
        The Coalition believes SBP and DIC payments are paid for different
    reasons. SBP is insurance purchased by the retiree and is intended to
    provide a portion of retired pay to the survivor. DIC is a special
    indemnity compensation paid to the survivor when a member's service
    causes his or her premature death. In such cases, the VA indemnity
    compensation should be added to the SBP annuity the retiree paid for,
    not substituted for it.
        It should be noted as a matter of equity that surviving spouses of
    Federal civilian retirees who are disabled veterans and die of
    military-service-connected causes can receive DIC without losing any of
    their Federal civilian SBP benefits.
        The reality is that, in every SBP-DIC case, active duty or retired,
    the true premium extracted by the Service from both the member and the
    survivor was the ultimate one--the very life of the member. This
    reality was underscored by the August 2009 Federal Court of Appeals
    ruling in Sharp v. U.S. which found ``After all the servicemember paid
    for both benefits: SBP with premiums; DIC with his life.''
        The Veterans Disability Benefits Commission (VDBC) was tasked to
    review the SBP-DIC issue, among other DOD/VA benefit topics. The VDBC's
    final report to Congress agreed with the Coalition in finding that the
    offset is inappropriate and should be eliminated.
        In 2005, Speaker Pelosi and all House leaders made repeal of the
    SBP-DIC offset a centerpiece of their GI Bill of Rights for the 21st
    Century. Leadership has made great progress in delivering on other
    elements of that plan, but the only progress to date on the SBP-DIC
    offset has been the enactment a small monthly Special Survivor
    Indemnity Allowance (SSIA).
        The Coalition recognizes that the subcommittee's initiative in the
    fiscal year 2008 defense bill to establish a special survivor indemnity
    allowance (SSIA) was intended as a first, admittedly very modest, step
    in a longer-term effort to phase out the Dependency and Indemnity
    Compensation (DIC) offset to SBP.
        We appreciate the subcommittee's subsequent work to extend the SSIA
    to survivors of members who died while on active duty in the NDAA for
    Fiscal Year 2009, as well as its good-faith effort to provide a
    substantial increase in SSIA payments as part of the Family Smoking
    Prevention and Tobacco Control Act.
        The Coalition was extremely disappointed that the final version of
    that legislation greatly diluted the House-passed provision and
    authorized only very modest increases several years in the future.
        While fully acknowledging the subcommittee's and full committee's
    good-faith efforts to win more substantive progress, the Coalition
    shares the extreme disappointment and sense of abandonment of the SBP-
    DIC widows who are being forced to sacrifice up to $1,110 each month
    and being asked to be satisfied with a $60 monthly rebate.
        For years, legislative leaders touted elimination of this ``widow's
    tax'' as a top priority. The Coalition understands the mandatory-
    spending constraints the subcommittee has faced in seeking redress, but
    also points out that those constraints have been waived for many, many
    far more expensive initiatives. The Coalition believes widows whose
    sponsors' deaths were caused by military service should not be last in
    line for redress.
        The Coalition urges repeal of the SBP-DIC offset. TMC further
    recommends:

             Authorizing payment of SBP annuities for disabled
            survivors into a Special Needs Trust; (Certain permanently
            disabled survivors can lose eligibility for Supplemental
            Security Income (SSI) and Medicaid and access to means-tested
            State programs because of receipt of SBP. This initiative is
            essential to put disabled SBP annuitants on an equal footing
            with other SSI/Medicaid-eligibles who have use of special needs
            trusts to protect disabled survivors.)
             Allowing SBP eligibility to switch to children if a
            surviving spouse is convicted of complicity in the member's
            death; and
             Reinstating SBP for survivors who previously
            transferred payments to their children at such time as the
            youngest child attains majority, or upon termination of a
            second or subsequent marriage.
    Final Retired Pay Check
        Under current law, DFAS recoups from military widows' bank accounts
    all retired pay for the month in which a retiree dies. Subsequently,
    DFAS pays the survivor a pro-rated amount for the number of days of
    that month in which the retiree was alive. This often creates hardships
    for survivors who have already spent that pay on rent, food, etc., and
    who routinely are required to wait several months for DFAS to start
    paying SBP benefits.
        The Coalition believes this is an extremely insensitive policy
    imposed by the government at the most traumatic time for a deceased
    member's next of kin. Unlike his or her active duty counterpart, a
    retiree's survivor receives no death gratuity. Many older retirees do
    not have adequate insurance to provide even a moderate financial
    cushion for surviving spouses.
        The VA is required by law to make full payment of the final month's
    VA disability compensation to the survivor of a disabled veteran. The
    disparity between DOD and VA policy on this matter is simply
    indefensible. Congress should do for retirees' widows the same thing it
    did 10 years ago to protect veterans' widows.
        TMC urges the subcommittee to authorize survivors of retired
    members to retain the final month's retired pay for the month in which
    the retiree dies.
                               health care issues
        The Coalition appreciates the subcommittee's strong and continuing
    interest in keeping health care commitments to military beneficiaries.
    We are particularly grateful for your support for the last few years in
    refusing to allow the Department of Defense to implement
    disproportional beneficiary health care fee increases.
        The Coalition is encouraged that the current administration so far
    has declined to pursue such increases, but has worked to reestablish a
    mutually constructive dialogue with beneficiary representatives.
        The unique package of military retirement benefits--of which a key
    component is a top-of-the-line health care benefit--is the primary
    offset afforded uniformed servicemembers for enduring a career of
    unique and extraordinary sacrifices that few Americans are willing to
    accept for 1 year, let alone 20 or 30. It is an unusual, and essential,
    compensation package that a grateful Nation provides for a relatively
    small fraction of the U.S. population who agree to subordinate their
    personal and family lives to protecting our national interests for so
    many years. This sacrifice, in a very real sense, constitutes a pre
    paid premium for their future healthcare.
    Defense Health Program Cost Requirements
        The Coalition is grateful for the subcommittee's support for
    maintaining--and expanding where needed--the healthcare benefit for all
    military beneficiaries and especially for the Guard, Reserve, and
    military children, consistent with the demands imposed upon them.
        It's true that many private sector employers are choosing to shift
    an ever-greater share of health care costs to their employees and
    retirees, and that's causing many still-working military retirees to
    fall back on their service-earned TRICARE coverage. Fallout from the
    recent economic recession is likely to reinforce this trend.
        In the bottom-line-oriented corporate world, many firms see their
    employees as another form of capital, from which maximum utility is to
    be extracted at minimum cost, and those who quit are replaceable by
    similarly experienced new hires. But that can't be the culture in the
    military's closed, all-volunteer personnel system, whose long-term
    effectiveness is dependent on establishing a sense of mutual, long-term
    commitment between the servicemember and his/her country.
        The Coalition believes it's essential to bear other considerations
    in mind when considering the extent to which military beneficiaries
    should share in military health care costs.
        First and foremost, the military health system is not built for the
    beneficiary, but to sustain military readiness. Each Service maintains
    its unique facilities and systems to meet its unique needs, and its
    primary mission is to sustain readiness by keeping a healthy force and
    to be able to treat casualties from military actions. That model is
    built neither for cost efficiency nor beneficiary welfare. It's built
    for military readiness requirements.
        When military forces deploy, the military medical force goes with
    them, and that forces families, retirees and survivors to use the more
    expensive civilian health care system in the absence of so many
    uniformed health care providers.
        These military-unique requirements have significantly increased
    readiness costs. But those added costs were incurred for the
    convenience of the military, not for any beneficiary consideration, and
    beneficiaries should not be expected to bear any share of that cost -
    particularly in wartime.
        The Coalition urges the subcommittee to take all possible steps to
    ensure continued full funding for Defense Health Program needs.
    National Health Reform
        The Coalition opposes any effort to integrate TRICARE and VA health
    care systems in any proposal that Congress may develop as part of
    national health care reform. These two programs are integral to
    military readiness and are designed expressly to meet the unique needs
    of servicemembers, military retirees, veterans, wounded servicemembers,
    guardsmen and reservists, their families, and survivors.
        TMC urges that any national health reform legislation must:

             Protect the unique TRICARE, TRICARE For Life, and VA
            health care benefits from unintended consequences such as
            reduced access to care;
             Bar any form of taxation of TRICARE, TRICARE For Life,
            or VA health care benefits, including those provided in
            nongovernmental venues; and
             Preserve military and VA beneficiaries' choices.
    Military vs. Civilian Cost-Sharing Measurement
        Defense leaders have in the past, and may in the future, assert
    that substantial military fee increases are needed to bring military
    beneficiary health care costs more in line with civilian practices. But
    merely contrasting military vs. civilian cash cost-shares is a grossly
    misleading, ``apple-to-orange'' comparison.
        For all practical purposes, those who wear the uniform of their
    country are enrolled in a 20- to 30-year prepayment plan that they must
    complete to earn lifetime health coverage. In this regard, military
    retirees and their families paid enormous ``upfront'' premiums for that
    coverage through their decades of service and sacrifice. Once that
    prepayment is already rendered, the government cannot simply pretend it
    was never paid, and focus only on post-service cash payments.
        DOD and the Nation--as good-faith employers of the trusting members
    from whom they demand such extraordinary commitment and sacrifice--have
    a reciprocal health care obligation to retired servicemembers and their
    families and survivors that far exceeds any civilian employer's to its
    workers and retirees.
        The Coalition believes that military beneficiaries from whom
    America has demanded decades of extraordinary service and sacrifice
    have earned coverage that is the best America has to offer.
    Large Retiree Fee Increases Can Only Hurt Retention
        The reciprocal obligation of the government to maintain an
    extraordinary benefit package to offset the extraordinary sacrifices of
    career military servicemembers is a practical as well as moral
    obligation. Mid-career military losses can't be replaced like civilians
    can.
        Eroding benefits for career service can only undermine long-term
    retention/readiness. Today's servicemembers are very conscious of
    Congress' actions toward those who preceded them in service. One reason
    Congress enacted TRICARE For Life in 2000 is because the Joint Chiefs
    of Staff at that time said inadequate retiree health care was affecting
    attitudes among active duty servicemembers.
        That's more than backed up by two independent Coalition surveys. A
    2006 Military Officers Association of America survey drew 40,000
    responses, including more than 6,500 from active duty servicemembers.
    Over 92 percent in all categories of respondents opposed the DOD-
    proposed fee hikes. There was virtually no difference between the
    responses of active duty servicemembers (96 percent opposed) and
    retirees under 65 (97 percent opposed). A Fleet Reserve Association
    survey showed similar results.
        Reducing military retirement benefits would be particularly ill-
    advised when an overstressed force already is at increasing retention
    risk despite the current downturn of the economy and current recruiting
    successes.
    Pharmacy
        The Coalition supports a strong TRICARE pharmacy benefit which is
    affordable and continues to meet the pharmaceutical needs of millions
    of eligible beneficiaries through proper education and trust. The TMC
    will oppose any degradation of current pharmacy benefits, including any
    effort to charge fees or copayments for use of military treatment
    facilities.
        The Coalition would oppose the need for pharmacy co-pay increases
    now that Congress has approved Federal pricing for the TRICARE retail
    pharmacy system. The Coalition notes that due to continued legal
    maneuvering, Federal pricing still has not been implemented by the
    executive branch, and this failure is costing DOD tens of millions of
    dollars with every passing month. This is an excellent example of why
    the Coalition objects to basing beneficiary fees on a percentage of DOD
    costs--because DOD all-too-frequently does not act, or is not allowed
    to act, in a prudent way to hold costs down.
        The Coalition has volunteered to conduct a joint campaign with DOD
    to promote beneficiary use of lower-cost medications and distribution
    venues--a ``win-win'' opportunity that will reduce costs for
    beneficiaries and the government alike.
        The Coalition also believes that positive incentives are the best
    way to encourage beneficiaries to continue medication regimens that are
    proven to hold down long-term health costs. In this regard, TMC
    believes eliminating copays for medications to control chronic
    conditions (e.g., diabetes, asthma, high blood pressure, and
    cholesterol) are more effective than negative ones such as copayment
    increases.
        The Coalition urges the subcommittee to ensure continued
    availability of a broad range of medications, including the most-
    prescribed medications, in the TRICARE pharmacy system, and to ensure
    that the first focus on cost containment should be on initiatives that
    encourage beneficiaries to take needed medications and reduce program
    costs without shifting costs to beneficiaries.
    Alternative Options to Make TRICARE More Cost-Efficient
        TMC continues to believe strongly that DOD has not sufficiently
    investigated options to make TRICARE more cost-efficient without
    shifting costs to beneficiaries. The Coalition has offered a long list
    of alternative cost-saving possibilities, including:

             Positive incentives to encourage beneficiaries to seek
            care in the most appropriate and cost effective venue;
             Encouraging improved collaboration between the direct
            and purchased care systems and implementing best business
            practices and effective quality clinical models;
             Focusing the military health system, health care
            providers, and beneficiaries on quality measured outcomes;
             Improving MHS financial controls and avoiding overseas
            fraud by establishing TRICARE networks in areas fraught with
            fraud;
             Establishing TRICARE networks in areas of high TRICARE
            Standard utilization to take full advantage of network
            discounts;
             Promoting retention of other health insurance by
            making TRICARE a true second-payer to other insurance (far
            cheaper to pay another insurance's co-pay than have the
            beneficiary migrate to TRICARE);
             Encouraging DOD to effectively utilize their data from
            their electronic health record to better monitor beneficiary
            utilization patterns to design programs which truly match
            beneficiaries needs;
             Sizing and staffing military treatment facilities to
            reduce reliance on network providers and develop effective
            staffing models which support enrolled capacities;
             Reducing long-term TRICARE Reserve Select (TRS) costs
            by allowing servicemembers the option of a government subsidy
            of civilian employer premiums during periods of mobilization;
             Doing far more to promote use of mail-order pharmacy
            system and formulary medications via mailings to users of
            maintenance medications, highlighting the convenience and
            individual expected cost savings; and
             Encouraging retirees to use lowest-cost-venue military
            pharmacies at no charge, rather than discouraging such use by
            limiting formularies, curtailing courier initiatives, etc.

        The Coalition is pleased that DOD has begun to implement some of
    our suggestions, and stands ready to partner with DOD to investigate
    and jointly pursue these and other options that offer potential for
    reducing costs.
    TMC Healthcare Cost Principles
        The Military Coalition believes strongly that the recent fee
    controversy is caused in part by the lack of any statutory record of
    the purpose of military health care benefits and the specific benefit
    levels earned by a career of service in uniform. Under current law, the
    Secretary of Defense has broad latitude to make administrative
    adjustments to fees for TRICARE Prime and the pharmacy systems. Absent
    congressional intervention, the Secretary can choose not to increase
    fees for years at a time or can choose to quadruple fees in 1 year.
        Until a few years ago, this was not a particular matter of concern,
    as no Secretary had previously proposed dramatic fee increases. Given
    recent years' unsettling experience, the Coalition believes strongly
    that the subcommittee needs to establish more specific and permanent
    principles, guidelines, and prohibitions to protect against dramatic
    budget-driven fluctuations in this most vital element of
    servicemembers' career compensation incentive package.
        The Coalition strongly recommends that Congress establish statutory
    findings, a sense of Congress on the purpose and principles of military
    health care benefits earned by a career of uniformed service that
    states:

             Active duty members and families should be charged no
            fees except retail pharmacy co-payments, except to the extent
            they make the choice to participate in TRICARE Standard or use
            out-of-network providers under TRICARE Prime;
             The TRICARE Standard inpatient copay should not be
            increased further for the foreseeable future. At $535 per day,
            it already far exceeds inpatient copays for virtually any
            private sector health plan;
             There should be no enrollment fee for TRICARE Standard
            or TRICARE For Life (TFL), since neither offers assured access
            to TRICARE-participating providers. An enrollment fee implies
            enrollees will receive additional services, as Prime enrollees
            are guaranteed access to participating providers in return for
            their fee. Congress already has required TFL beneficiaries to
            pay substantial Medicare Part B fees to gain TFL coverage;
             All retired servicemembers earned equal health care
            coverage by virtue of their service; and
             DOD should make all efforts to provide the most
            efficient use of allocated resources and cut waste prior to
            proposing additional or increased fees on eligible
            beneficiaries.
    TRICARE Prime
        The Coalition is very concerned about growing dissatisfaction among
    TRICARE Prime enrollees--which is actually higher among active duty
    families than among retired families. The dissatisfaction arises from
    increasing difficulties experienced by beneficiaries in getting
    appointments, referrals to specialists, and sustaining continuity of
    care from specific providers.
        Increasingly, beneficiaries with a primary care manager in a
    military treatment facility find they are unable to get appointments
    because so many providers have deployed, PCSed, or are otherwise
    understaffed/unavailable.
        The Coalition supports the implementation of a pilot study by TMA
    in each of the three TRICARE Regions to study the efficacy of
    revitalizing the resource sharing program used prior to the
    implementation of the TRICARE-The Next Generation (T-NEX) contracts
    under the current Managed Care Support contract program.
        The Coalition supports adoption of the ``Medical Home'' patient-
    centered model to help ease such problems.
        But the new TRICARE contracts and the attendant reduction of Prime
    service areas outside the vicinity of military installations will
    exacerbate anxieties by forcing disenrollment of many thousands of
    current Prime beneficiaries.
        The Coalition strongly advocates the transparency of healthcare
    information via the patient electronic record between both the MTF
    provider and network providers. Additionally, institutional and
    provider healthcare quality information should be available to all
    beneficiaries so that they can make better informed decisions.
        The Military Coalition urges the subcommittee to require reports
    from DOD and from the managed care support contractors, on actions
    being taken to improve Prime patient satisfaction, provide assured
    appointments within Prime access standards, reduce delays in
    preauthorization and referral appointments, and provide quality
    information to assist beneficiaries in making informed decisions.
                                tricare standard
    TRICARE Standard Provider Participation
        The Coalition appreciates the subcommittee's continuing interest in
    the specific problems unique to TRICARE Standard beneficiaries. TRICARE
    Standard beneficiaries need assistance in finding participating
    providers within a reasonable time and distance from their home. This
    is particularly important with the expansion of TRICARE Reserve Select
    and the upcoming change in the Prime Service Areas, which will place
    thousands more beneficiaries into TRICARE Standard.
        The Coalition is concerned that DOD has not yet established any
    standard for adequacy of provider participation, as required by section
    711(a)(2) of the NDAA for Fiscal Year 2008. Participation by half of
    the providers in a locality may suffice if there is not a large
    Standard beneficiary population. The Coalition hopes to see an
    objective participation standard (perhaps number of beneficiaries per
    provider) that would help shed more light on which locations have
    participation shortfalls of Primary Care Managers and Specialists that
    require positive action.
        The Coalition urges the subcommittee to insist on immediate
    delivery of an adequacy threshold for provider participation, below
    which additional action is required to improve such participation. The
    Coalition also recommends requiring a specific report on participation
    adequacy in the localities where Prime Service Areas will be
    discontinued under the new TRICARE contracts.
    TRICARE Reimbursement Rates
        Physicians consistently report that TRICARE is virtually the
    lowest-paying insurance plan in America. Other national plans typically
    pay providers 25-33 percent more. In some cases the difference is even
    higher.
        While TRICARE rates are tied to Medicare rates, TRICARE Managed
    Care Support Contractors make concerted efforts to persuade providers
    to participate in TRICARE Prime networks at a further discounted rate.
    Since this is the only information providers receive about TRICARE,
    they see TRICARE as lower-paying than Medicare.
        This is exacerbated by annual threats of further reductions in
    TRICARE rates due to the statutory Medicare rate-setting formula.
    Physicians may not be able to afford turning away Medicare patients,
    but many are willing to turn away a small number of patients who have
    low-paying, high-administrative-hassle TRICARE coverage.
        The TRICARE Management Activity has the authority to increase the
    reimbursement rates when there is a provider shortage or extremely low
    reimbursement rate for a specialty in a certain area and providers are
    not willing to accept the low rates. In some cases, a State Medicaid
    reimbursement for a similar service is higher than that of TRICARE. But
    the Department has been reluctant to establish a standard for adequacy
    of participation to trigger higher payments.
        The Coalition places primary importance on securing a permanent fix
    to the flawed statutory formula for setting Medicare and TRICARE
    payments to doctors.
        To the extent a Medicare rate freeze continues, we urge the
    subcommittee to encourage DOD to use its reimbursement rate adjustment
    authority as needed to sustain provider acceptance.
        The Coalition urges the subcommittee to require a Comptroller
    General report on the relative propensity of physicians to participate
    in Medicare vs. TRICARE, and the likely effect on such relative
    participation of a further freeze in Medicare/TRICARE physician
    payments along with the effect of an absence of bonus payments.
    Dental Care
        The Coalition appreciates the subcommittee's action in continuing
    active duty-level dental coverage for dependent survivors and allowing
    transitional dental care for Reserve members who separate after
    supporting contingency missions.
        Active Duty Dependent Dental Plan
        TMC is sensitive to beneficiary concerns that Active Duty Dental
    Plan coverage for orthodontia has been eroded by inflation over a
    number of years.
        The current orthodontia payment cap is $1,500, which has not been
    changed since 2001. In the intervening years, the orthodontia cost has
    risen from an average of $4,000 to more than $5,000.
        The Coalition understands that, under current law, increasing this
    benefit could require a reduction in some other portion of the benefit,
    which we do not support.
        The Coalition notes that current law assumes a 60 percent DOD
    subsidy for the active duty dental plan, whereas other Federal health
    programs (e.g., FEHB Plan and TRS) are subsidized at 72 percent.
        The Coalition recommends increasing the DOD subsidy for the Active
    Duty Dependent Dental Plan to 72 percent and increasing the cap on
    orthodontia payments to $2,000.
    Guard and Reserve Healthcare
        Continuum of Health Care Insurance Options for The Guard and
            Reserve
        The Coalition is very grateful for passage of TRICARE Retired
    Reserve (TRR) coverage for ``gray area'' reservists in the NDAA for
    Fiscal Year 2010.
        The Coalition notes that DOD complied with direction from Congress
    to reduce TRICARE Reserve Select (TRS) premiums to the actual cost of
    coverage. For 2009, monthly TRS premiums were reduced to $47.51 (vs.
    $81) for member-only coverage and to $180.17 (vs. $253) for family
    coverage.
        TMC believes a review of the current statutory methodology for
    adjusting premiums based on program costs should be conducted to assess
    whether any of the costs currently included are, in fact, costs of
    maintaining readiness or ``costs of doing business'' for the Defense
    Department that don't contribute to delivering benefit value to
    beneficiaries (and therefore should be excluded, with the expected
    result that premiums would go down). In principle, TMC believes
    Congress should establish a moratorium on TRS premium increases and
    direct DOD to make a determined effort for the most efficient use of
    resources allocated and to cut waste prior to the consideration of any
    adjustment in such premiums.
        Moreover, TMC believes that holding the line on TRS premiums will
    encourage more families to enroll. DOD, the Services, and the Reserve
    components must do much more to advertise the TRS program which stands
    at only 6-7 percent of eligible beneficiaries.
        The Coalition also believes Congress is missing an opportunity to
    reduce long-term health care costs and increase beneficiary
    satisfaction by authorizing eligible members the option of electing a
    DOD subsidy of their civilian insurance premiums during periods of
    activation.
        Current law already authorizes payment of up to 24 months of FEHBP
    premiums for activated members who are civilian employees of the
    Defense Department. The Coalition believes all members of the Selected
    Reserve should have a similar option to have continuity of their
    civilian family coverage.
        Over the long term, when Guard and Reserve activations can be
    expected at a reduced pace, this option would offer considerable
    savings opportunity relative to funding permanent, year-round TRICARE
    coverage.
        DOD could calculate a maximum monthly subsidy level that would
    represent a cost savings to the government, so that each member who
    elected that option would reduce TRICARE costs.
        The Coalition recommends the subcommittee:

             Require a GAO review of DOD's methodology for
            determining TRS costs for premium adjustment purposes to assess
            whether it includes any costs of maintaining readiness or
            ``costs of doing business'' for the Defense Department that
            don't contribute to beneficiary benefit value and thus should
            be excluded from cost/premium calculations;
             Authorize development of a cost-effective option to
            have DOD subsidize premiums for continuation of a Reserve
            employer's private family health insurance during periods of
            deployment as an alternative to ongoing TRS coverage;
             Allow eligibility in Continued Health Care Benefits
            Program (CHCBP) for Selected reservists who are voluntarily
            separating and subject to disenrollment from TRS;
             Authorize members of the IRR who qualify for a Reserve
            retirement at age 60 to participate in TRR as an incentive for
            continued service (and higher liability for recall to active
            duty);
             Monitor implementation of the new TRR authority to
            ensure timely action and that premiums do not exceed 100
            percent of the TRS premium; and
             Allow FEHB plan beneficiaries who are Selected
            reservists the option of participating in TRS.
        Guard and Reserve Mental Health
        The Coalition is concerned that Guard and Reserve members and their
    families are at particular risk for undetected effects of the unseen
    injuries of war. The risk is compounded by Reserve component members'
    anxiety to return to their families as soon as possible, which
    typically entails expedited departure from active duty and return to a
    community where military health care and other support systems are
    limited.
        Unfortunately, most such members view the current post deployment
    health self-assessment program at demobilization sites as an impediment
    to prompt return to their families. Under this scenario, strong
    disincentives for self-reporting exacerbate an already wide variation
    in the diagnosis and treatment of post-traumatic stress disorder
    (PTSD), traumatic brain injury (TBI), depression, and other combat-
    related stress conditions.
        The Coalition believes redeploying Reserve component members should
    be allowed to proceed to their home station and retained on active duty
    orders to complete post-deployment examination requirements at the home
    station. This change is important to improve proper diagnosis,
    reporting and treatment of physical and mental injuries; to help
    perfect potential service connected disability claims with the VA; and
    to help correct the non-reporting of injuries at the demobilization
    site.
        The Coalition believes that Guard and Reserve members and their
    families should have access to evidence-based treatment for PTSD, TBI,
    depression, and other combat-related stress conditions. Further, post-
    deployment health examinations should be offered at the member's home
    station, with the member retained on active duty orders until
    completion of the exam.
        Guard and Reserve Health Information
        The Coalition is concerned that the current health records for many
    Guard and Reserve members do not contain treatment information that
    could be vital for diagnosis and treatment of a condition while on
    active duty. The capture of nonmilitary treatment is an integral part
    of the member's overall health status.
        The Coalition believes there should be an effort to improve the
    electronic capture of nonmilitary health information into the
    servicemember's medical record.
    TRICARE For Life (TFL)
        When Congress enacted TFL in 2000, it explicitly recognized that
    this coverage was fully earned by career servicemembers' decades of
    sacrifice, and that the Medicare Part B premium would serve as the cash
    portion of the beneficiary premium payment. The Coalition believes that
    this remains true today and will oppose any new additional fees.
    Additionally, the Coalition believes that means-testing has no place in
    setting military health fees.
        The Coalition is aware of the challenges imposed by Congress'
    mandatory spending rules, and appreciates the subcommittee's efforts to
    include TFL-eligibles in the preventive care pilot programs included in
    the NDAA for Fiscal Year 2009. We believe their inclusion would, in
    fact, save the government money and hope the subcommittee will be able
    to find a more certain way to include them than the current
    discretionary authority, which DOD has declined to implement.
        The Coalition also hopes the subcommittee can find a way to resolve
    the discrepancy between Medicare and TRICARE treatment of medications
    such as the shingles vaccine, which Medicare covers under pharmacy
    benefits and TRICARE covers under doctor visits. This mismatch, which
    requires TFL patients to absorb the cost in a TRICARE deductible or
    purchase duplicative Part D coverage, deters beneficiaries from seeking
    this preventive medication.
        Coalition priorities for TFL-eligibles include:

             Securing a permanent fix to the flawed formula for
            setting Medicare/TRICARE payments to providers;
             Resisting any effort to establish an enrollment fee
            for TFL, given that many beneficiaries already experience
            difficulties finding providers who will accept Medicare
            patients; and
             Including TFL beneficiaries in DOD programs to
            incentivize compliance with preventive care and healthy
            lifestyles.
    Restoration of Survivors' TRICARE Coverage
        When a TRICARE-eligible widow/widower remarries, he/she loses
    TRICARE benefits. When that individual's second marriage ends in death
    or divorce, the individual has eligibility restored for military ID
    card benefits, including SBP coverage, commissary/exchange privileges,
    etc.--with the sole exception that TRICARE eligibility is not restored.
        This is out of line with other Federal health program practices,
    such as the restoration of CHAMPVA eligibility for survivors of
    veterans who died of service-connected causes. In those cases, VA
    survivor benefits and health care are restored upon termination of the
    remarriage. Remarried surviving spouses deserve equal treatment.
        The Coalition recommends restoration of TRICARE benefits to
    previously eligible survivors whose second or subsequent marriage ends
    in death or divorce.
    Base Realignment and Closure (BRAC) and Rebasing
        Military transformation and BRAC become more pressing issues as the
    Pentagon approaches the BRAC deadline set for September 15, 2011. The
    impact on the MHP is significant and concern about the impact on
    beneficiaries is of high priority to TMC. Specific areas of interest to
    the TMC include:

             Supporting a Health Facilities Program that uses
            evidenced-based design to update or replace Military Treatment
            Facilities (MTFs) to maintain world-class health care delivery
            capability in support of all eligible beneficiaries;
             Protecting full access, availability and services to
            beneficiaries and their families during the entire military
            transformation (BRAC and global rebasing) process, with added
            focus on Walter Reed Army Medical Center, Bethesda National
            Naval Medical Center, DeWitt Healthcare Network, and San
            Antonio Army Medical Center, while seeking full and timely
            funding for these world-class projects;
             Encouraging DOD to establish and sustain provider
            networks and capacity at both closing and gaining installations
            and units impacted by transformation;
             Promoting the coordination of efforts between Managed
            Care Support Contractors to ensure smooth beneficiary
            transition from one geographic area to another;
             Codifying the requirement to continue Prime benefits
            and assistance in localities affected by realignment and
            closure actions; and
             Monitoring the National Capitol Region Medical Joint
            Task Force activities to ensure the most effective use of
            resources to improve access and quality.

        The Coalition recommends requiring an annual DOD report on the
    adequacy of health resources, funding, services, quality and access to
    care for beneficiaries affected by BRAC/rebasing.

        Senator Webb. Thank you very much.
        I want to thank all of you for your testimony. The feedback
    is important to us. It's useful. It's not only useful, it's
    valuable. It will be taken into full consideration.
        There are a dozen really important points that were raised,
    from my perspective, listening to your testimony.
        TRICARE will not be affected, as long as I have anything to
    do with it. I know Senator Graham feels the same way. I've seen
    the benefits in my own family, I've seen it with my mother
    right now.
        When you mention the SBP situation, my father paid into SBP
    for 28 years. When he died in 1997, they took it out of my
    mother's Social Security. Luckily, we had that situation fixed,
    but we will give the situation you mentioned a hard look. I'm
    on Senator Bill Nelson's bill.
        With respect to commissary benefits, I grew up in the
    military. I used to work in a commissary, actually; I was a
    bagboy for 2\1/2\ years when I was in high school. [Laughter.]
        But, I've always looked at commissary benefits in the same
    way that we articulate the healthcare benefits to people.
    It's--the idea of being able to go to the commissary after you
    retire is something that people count on while they're in the
    military. That's something we don't think about, I think, as
    much as we need to up here.
        Your comment, Ms. Moakler, about family difficulties and
    the need to get on top of that, there was a period in my life
    when my dad was either deployed or stationed where there was no
    family housing, for 3\1/2\ years. We had no structure in--at
    that period. We were--this idea of the family as a part of the
    operational military was not even in its infancy at the time.
        I also recall when I was in the Marine Corps and I got back
    from Vietnam, in Quantico--they did a study of the Quantico
    school system, and I think the statistic at the time was that
    the kids in the Quantico school system--the high school--had
    three times the level of emotional difficulties as the national
    level at the time, because of the intensity of the Vietnam war.
    About 100,000 killed or wounded in the U.S. Marine Corps.
    People forget that. We had more total killed or wounded in
    Vietnam than we did in World War II, in the Marine Corps. The
    stress of these 13-month deployments on the marines, and
    wondering what your dad was doing, and, at that time, he could
    be dead. Enormous impact.
        I really salute you for bringing the issue to us the way
    that you did today.
        I had one question, quickly. I know we're way behind
    schedule here, and I know Senator Graham wants to also
    participate here. But, there's a lot of experience in this
    panel--military experience. I am really puzzled when I keep
    hearing the statistic that two-thirds of the--your phraseology
    was ``optimally-aged potential enlistees'' are not qualifying,
    and that defies historical trends. If you go back, for
    instance, to the Vietnam era, which I've done a lot of study
    on, obviously, over my life--one-third of the entire age group
    served--9 million out of 27 million actually served. We're now
    saying that only one-third of an age group could even qualify
    to serve. What are your thoughts on that? Are the standards not
    fitting the potential? Or are the physical and mental
    capabilities different? Where do we get this--and what could we
    do about it?
        Mr. Barnes. Mr. Chairman, I'll speak to that first. Those
    statistics are from recruiting--Navy Recruiting Command----
        Senator Webb. Yes, I've actually heard them in other
    hearings, so----
        Mr. Barnes. Exactly. I think there are a number of facets
    associated with that. Number one, it's the All-Volunteer Force,
    which has obviously been up and functioning since the early
    1970s. The service requirements across the Services as to what
    the expectations are with regard to them; social issues, with
    practices and whatever, that are not conducive or not
    compatible with the requirements; perhaps drug use or other
    things that are happening.
        So, it's a multifaceted issue. It's very troubling to our
    Association. We have a number of recognition programs, work
    very closely with Navy, Marine Corps, and Coast Guard
    recruiting communities, I share your concern about that. It's
    kind of a staggering statistic, but it's held consistent for
    several years, now.
        Senator Webb. Does anyone else have any thoughts on that?
        Colonel Strobridge. Yes, sir. I attended a briefing by Dr.
    Curt Gilroy recently, the DOD Director of Accession Policy. I
    think one of the things he emphasized is--and, as a matter of
    fact, he--the number he gave was, only 25 percent qualify. One
    of the changes, I think, is obesity. We have a significantly
    larger number of people who are overweight today than we did in
    the past. Another thing is, kind of, the incongruity, perhaps,
    in some of the drug issues. If you report to Basic Training and
    say you experimented once with marijuana, they'll let you stay,
    but if you had a conviction for possession of a marijuana
    cigarette when you were 18, you can't come in. So, there is a
    variety of things like that, I think.
        Ms. Moakler. I think we also need to look at the converse
    of that. You have an example of this, Chairman Webb, as do I.
    I'm the mother of two soldiers. It behooves us to keep our
    promises to our families so that our children see that the
    military lifestyle is a rewarding one. We're already teaching
    them self-sacrifice. So many of our children are eligible,
    because they see that physical fitness is an important part of
    everyday life, because they are discouraged from using drugs,
    and because they seek that life of selfless service. So, that's
    just another aspect to look on it, as well.
        Mr. Cline. Mr. Chairman, we have similar problems in the
    Guard and Reserve. Standards today in the Guard and Reserve are
    much higher--back in the day when I joined. The education
    requirements, the drug problems are just higher today than they
    are.
        We're living in a day of fast food, as Colonel Strobridge
    mentioned. Overweight problems. We're constantly weeding out
    people who cannot meet the physical fitness requirements.
        Senator Webb. I know Senator Graham has to go, and he
    wanted to----
        Senator Graham. Well, one, we've been doing this together
    for several years now, and you all really do a good job of
    making the case for benefit increases and inequities. That's
    what your job is, and our job is to listen and try to meet as
    many needs as we can, understanding we can't be everything for
    everybody all the time because of budget problems.
        The thing about TRICARE--I want to just let Senator Webb
    know that, working with Senator Clinton and others, we're able
    to make the Guard and Reserve Force eligible for TRICARE year
    round. The belief is that 25 percent did not have healthcare in
    the private sector; it gives them a healthcare home. It will
    allow them to have healthcare throughout their military
    service, which is an incentive to stay in.
        I'm very disheartened by the numbers you gave me. We're
    going to do everything we can on this subcommittee to let
    people know, this benefit is there, you've earned it; it's a
    good deal, compared to the private sector; and try to get
    people to take more advantage of it. So, I promise you--18
    months is too long, so we're going to start--about the other
    problem you mentioned, about 18 months to implement the GI
    stuff, benefits.
        So, this really helps us understand how these programs
    actually work. Because when I go around talking about them, I'm
    very proud of it, but only 6 or 7 percent of the force is
    joining up, there's a disconnect. You all are really fair
    arbitrators of that.
        One thing I would suggest, Mr. Chairman, is that this
    country has to come to grips with Medicare and Social Security
    and entitlement programs that have no end in sight and
    beginning to eat up the budgets of everything else we do. The
    same is true for military healthcare. We haven't had a premium
    increase since 1995. I understand that what the past
    administration tried to do was just too much, too quick. I
    mean, it's just--couple hundred percent. Lowering the
    deductible from 500, or whatever it is, to 100 is just kind of
    a--just pretty rapid change that hits the wallet pretty hard.
        But, I would suggest that we try to work with these groups.
    You all have done a--remember when we had that big meeting a
    couple years ago? How could you lower the cost of military
    healthcare? How could you improve access and quality? What
    things could we put on the table, that are preventive, that
    would allow the military member and their family to get better
    treatment, but actually lower cost?
        I think it would be--probably behoove us to look at that
    again, before we ask for more money; to really go into this
    system and see, is it serving, an optimal level, the
    beneficiaries? Are we doing preventive medicine things that
    will lower costs and improve quality of life? But also
    understand one word: sustainability. None of these programs are
    going to be sustainable if we don't do something about that.
    That's what I would like to have this subcommittee look at, if
    we could, a way to get sustainable medical healthcare benefits
    for the retired force, the active and Guard force, and their
    families, so you can recruit and retain, but not have the
    dilemma of taking money away from a budget where you also are
    going to need to fight the war and buy equipment.
        That's the challenge of our lifetime, quite frankly, and
    you and your organization that you represent can really be
    helpful here.
        Mr. Chairman, thank you. You--obviously----
        Senator Webb. Well said.
        Senator Graham. Just listening to you--I mean, you have so
    many experiences. I don't know how you got through school.
    [Laughter.]
        I mean, changing schools that many times. Can you imagine
    the stress on that? I didn't know that. I didn't know that more
    Marines were killed in Vietnam, and wounded, than World War II.
        Senator Webb. More total casualties----
        Senator Graham. I did not know that, so----
        Senator Webb.--killed in World War II, more total
    casualties.
        Senator Graham. You have lived the life that these people
    are talking about, from personal and from your parents' point
    of view, and let's take that knowledge and put it to good use.
        Senator Webb. It's a pleasure to be working with you,
    Senator Graham, and I take all your points on track.
        I want to make one 30-second point here, just to wrap up
    this question I had about percentage of people who might be
    able to come in.
        I think we undervalue what we can get out of people who
    haven't yet finished high school, who fall out of the system,
    who can come into the military. I've seen too many success
    stories from the Marine Corps with--we have about the same
    percentage of people now who aren't finishing high school as
    did when I was in the Marine Corps. We took them, some of my
    best friends, some of my close friends in my life, people like
    Carlton Sherwood, high school dropout, three Purple Hearts in
    Vietnam, became a Pulitzer Prize-winning investigative
    reporter. Walter Anderson, Chief Executive Officer of Parade
    Magazine, Parade Enterprises, high school dropout, went in the
    Marine Corps, came back, and was valedictorian of his college
    class.
        I mean, there's a pool of people out there who, with the--
    if you take their mental scores, the capability they have, who
    are looking for structure in their life, and can come in and
    really add value to our society. Maybe we ought to take that
    piece and look at it and talk to DOD about it, if we want to
    increase this pool.
        It's been a great discussion; and Senator Graham, it's a
    pleasure working with you.
        The hearing is adjourned. Thank you all.
        [Questions for the record with answers supplied follow:]
                 Question Submitted by Senator Daniel K. Akaka
                        catastrophic injuries assistance
        1. Senator Akaka. Dr. Stanley, Mr. Lamont, Mr. Garcia, and Mr.
    Ginsberg, the 2010 National Defense Authorization Act includes a
    provision concerning the special compensation for members of the
    uniformed services with catastrophic injuries or illnesses requiring
    assistance in everyday living. (Subtitle A, Sec. 603 of the Conf Report
    to accompany H.R. 2647) Please provide an update on the Department of
    Defense's (DOD) actions concerning this provision.
        Dr. Stanley. The program was briefed at the March 18, 2010 Senior
    Oversight Committee (SOC) meeting, co-chaired by the Deputy Secretary
    of Defense, and the SOC decided the level to set monthly payments. We
    anticipate a decision establishing eligibility for this program will be
    made this month. The Services support providing compensation to
    catastrophically wounded, ill, and injured servicemembers for the
    assistance provided by designated caregivers. We anticipate completing
    formal coordination and signing a DOD-level Directive Type Memorandum
    by the end of May to implement this program.
        Mr. Lamont. The DOD Wounded Warrior Care and Transition Program
    Office (WWCTP) began developing a Directive-Type Memorandum (DTM) in
    December 2009 to provide guidance to the Services for the
    implementation of the provisions of Section 603 of Public Law 111-84,
    the National Defense Authorization Act for Fiscal Year 2010. To
    accomplish this task, the WWCTP established a work group consisting of
    representatives from all Services, the TRICARE Management Agency, the
    Defense Finance and Accounting Service, and other key stakeholders in
    the implementation of the special compensation program. The DTM is
    nearing completion.
        Mr. Garcia. The Office of the Secretary of Defense (OSD) is in the
    final stages of developing draft policy for coordination with the
    Services prior to implementing in April.
        Mr. Ginsberg. The Air Force is working with Army, Navy, and the OSD
    to implement this program in April 2010. OSD is finalizing a DTM for
    the Services to review and coordinate. Because we have been working on
    this together for several weeks, it is anticipated that the review will
    be finalized very quickly by the Services and signed by the Under
    Secretary of Defense (Personnel & Readiness) in the next few weeks. It
    is our desire to implement this special monthly compensation as quickly
    as possible to offer the financial assistance caregivers of our
    catastrophically wounded, ill, and injured servicemembers deserve when
    dedicating their time to assisting these servicemembers with daily
    living activities.
                                     ______

                  Questions Submitted by Senator Kay R. Hagan
              census bureau tabulation of deployed servicemembers
        2. Senator Hagan. Dr. Stanley, I am very concerned that
    servicemembers that are deployed during the conduct of the 2010 Census
    will be counted in a way that negatively impacts communities that host
    military installations. North Carolina currently has approximately
    41,200 servicemembers deployed as a part of the overseas contingencies,
    and in the event that they are counted as prescribed by the U.S. Census
    Bureau, areas with large concentrations of military personnel will be
    significantly undercounted, and underfunded for the next 10 years. What
    is preventing the Defense Manpower Data Center from providing the U.S.
    Census Bureau with information regarding the base of last assignment or
    permanent U.S. duty station as the primary response for deployed
    servicemembers currently engaged in overseas contingencies?
        Dr. Stanley. While there is no law specifying how to count
    servicemembers deployed overseas, for the 2010 census the Census Bureau
    has directed use of the same procedures used in the 1990 and 2000
    Censuses. These procedures were developed based on a bill that passed
    the House of Representatives in 1990 (H.R. 4903) and recognition of
    strong bipartisan congressional support for including overseas military
    personnel in the census.
        The decision for specific methodology used falls under the purview
    of the Census Bureau, and the Department follows its guidance for this
    accounting. The Census Bureau believes that the current methodology
    provides the benefit of consistency over time.
        The directed methodology counts overseas military personnel, both
    stationed and deployed (including the National Guard), as part of the
    U.S. overseas population. The Department uses the following hierarchy
    (based on data availability): State home of record, State of legal
    residence, and State of last duty station (i.e., base of last
    assignment). While servicemembers deployed overseas at the time of the
    census will be included in the federally affiliated overseas count for
    apportionment purposes, their families residing in the U.S. will be
    counted through the standard census questionnaire.
        The Department understands the potentially beneficial effects
    counting by ``last duty station'' first could have on States with a
    large military population and has discussed this and other
    methodologies with the Census Bureau. Clear legislation would resolve
    questions and codify the methodology to count deployed servicemembers.
    The Department stands ready to discuss all possible methodologies with
    the Census Bureau and Congress.

                           post-september 11 gi bill
        3. Senator Hagan. Dr. Stanley, due to the Post-September 11 GI
    Bill, servicemember benefits were increased to rates that are 100
    percent of in-State public university tuition rates. Eligible veterans
    are also provided with a housing allowance in order to offset living
    expenses. These benefits have been extended to officers that had their
    bachelor degrees funded through attendance at the service academies or
    through ROTC programs. However, servicemembers that served in the
    Reserves prior to commissioning and received benefits under Chapter
    1606 while funding their own educational expenses, are not similarly
    included under the Post-September 11 GI Bill. Additionally, several
    programs that were included under the GI Bill, such as vocational
    programs, are not included under the Post-September 11 GI Bill. Now
    that the Post-September 11 GI Bill has been fully implemented, do you
    feel that technical correction legislation would be appropriate in
    order to reconcile some of the program inequities that have been
    identified?
        Dr. Stanley. DOD does not believe technical changes are necessary
    to the Post-September 11 GI Bill at this time. The Department supports
    the widest possible usage of benefits for our former Active and Reserve
    servicemembers, who served on active duty since September 11, 2001.

        4. Senator Hagan. Mr. Lamont, Mr. Garcia, and Mr Ginsberg, at a
    time when the Nation is relying more and more on its Reserve Forces,
    there now appears to be the largest historical gap in the relative
    value of education benefits provided under Chapter 1606 when compared
    to those under Chapters 30 or 33 of the GI Bill. Do you anticipate that
    the disparity in educational benefits will have a negative impact on
    Reserve recruiting?
        Mr. Lamont. The Army Reserve and Army National Guard components
    exceeded its accession goal last year. There are no indicators at this
    time that enactment of the Post-September 11 GI Bill has had a negative
    influence among potential candidates for either Active or Reserve
    components.
        Mr. Garcia. Both Navy and Marine Corps reservists are poised to
    take advantage of Post-September 11 GI Bill benefits (Chapter 33) as
    well as other VA education programs to include Chapter 30, Chapter 1607
    (REAP), and Chapter 1606 (MGIB-SR). It is because our reservists are
    answering the call to service that their education benefits continue to
    expand and grow. RC members continue to have the opportunity to choose
    which VA education benefits they would like to use based on their
    eligibility. These benefits will continue to have a strong positive
    impact on recruiting and on retention in the RC well into the future.
        Mr. Ginsberg. The disparity in Chapters 1606, 30 and 33 educational
    benefits has proven not to have a negative impact on recruiting. The
    Air Force Reserve (AFR) continues to exceed recruiting goals despite
    the disparity. Although Reserve and active duty component recruiters
    compete in the same marketplace, our products are distinctly
    different--specifically, part-time versus full time employment.
    Accordingly, there will be a continual ``full-time/part time'' benefit
    disparity among MGIB programs. (The disparity between Chapters 1606 and
    30 has increased and is currently at 26 percent). In addition, Chapter
    30 was created as a reward for service whereas Chapter 33 is primarily
    a retention tool--increasing monetary benefits and allowing members to
    commit to additional service in exchange for transferring educational
    benefits to dependents.

              unemployment rate among returning military personnel
        5. Senator Hagan. Mr. Lamont, Mr. Garcia, and Mr. Ginsberg, the
    current economic climate has been difficult for all of America's
    families; statistics show it has been especially difficult for
    returning military personnel serving in the National Guard and
    Reserves. For combat veterans returning home, it is especially
    challenging as they make the transition back to being a citizen
    soldier, while at the same time, having to deal with symptoms commonly
    associated with Post Traumatic Stress Disorder (PTSD). With an all-
    volunteer military that relies upon the National Guard and Reserves as
    essential components of the total force structure, what steps are being
    taken in order to provide more comprehensive transitional assistance
    for servicemembers returning home, and what are the significant gaps
    that remain?
        Mr. Lamont. We are doing whatever is necessary to help Reserve
    soldiers transition back to everyday life. Reserve soldiers are briefed
    at the demobilization station on the Transitional Assistance Management
    Program (180 days of TRICARE coverage post mobilization), Veteran's
    Healthcare Benefits, Yellow Ribbon, Military OneSource (counseling
    services at no cost to our soldiers), Joint Family Assistance Program
    (augments existing family programs to provide a continuum of support
    and services), Strong Bonds Program (relationship training to Singles,
    Couples and Families) and Recovery Care Coordinators (facilitators
    assigned to work with recovering Army Reserve soldiers to include those
    with psychological health conditions and/or Traumatic Brain Injury
    (TBI)).
        The Army Reserve has partnered with the Department of Labor and is
    implementing an Employer Awareness Campaign which will provide
    employers with access to education and informational tools regarding
    psychological health and TBI, as well as a variety of other topics
    located at America's Heroes at Work website.
        A significant gap is the transition assistance programs are of
    limited duration and are temporary programs (tied to contingency
    operations); continued support to ensure the programs are properly
    resourced is essential. Another gap is when an Army Reserve soldier is
    released from active duty; the soldier is no longer eligible for
    support. For example, the Army Emergency Relief only offers financial
    assistance to soldiers and their Family members when the soldier is in
    an active duty status. Providing transitioning Army Reserve soldiers
    access to all Services afforded Active component soldiers will bridge
    some current gaps.
        The National Guard soldiers and airman go through a number of steps
    in their transition phase, from an active duty status back to a Reserve
    status. The first step begins with a demobilization process with the
    active component. During this step they process through various
    stations to address issues such as financial, personnel, logistics,
    medical and dental services, and benefits.
        In the medical station both physical and behavioral areas, such as
    PTSD, are assessed. In the benefits station a Veterans Administration
    representative reviews the services provided through the Veterans
    Health Administration and can enroll the Guard member for care at a
    Veterans Affairs hospital in their local area when they return home.
        The next step occurs when the National Guard soldier is at home.
    Through the Yellow Ribbon Program there are a series of events at 30-,
    60-, and 90-day intervals. Each of these events revisits the various
    processes they went through at the demobilization station. These
    meetings remind Guard soldiers and their families of the services and
    benefits as well as an introduction to the various local community
    resources that are available. These resources include our own internal
    Warrior Support team consisting of an Employer Support of the Guard/
    Reserve, Psychological Health, and Family Program representatives, and
    a Transition Assistance Advisor.
        Working in concert with the National Guard Yellow Ribbon
    Reintegration Program, Employer Support, and Warrior Support offices
    participate in Yellow Ribbon Reintegration events and activities to
    ensure that all returning servicemembers are made aware of their
    employment rights under law as well as employment opportunities within
    the States and Territories to include the District of Columbia.
    Additionally, the National Guard is working with the DOD Transition
    Assistance Task Force to recommend change to the current Transition
    Assistance Program legislation to reflect the specific needs of the
    Guard and Reserve in relation to transition assistance.
        Mr. Garcia. Both the Navy and Marine Corps offer Transition
    Assistance Programs to separating and retiring servicemembers. Program
    outcomes are intended to provide participants with the skills they need
    to obtain appropriate post-service employment and make the transition
    back to being a citizen soldier. These services are provided at Navy
    and Marine Corps installations worldwide.
        In accordance with title 10 U.S.C., section 1142 and 1143,
    Transitional Assistance Management Program (TAMP) services are provided
    to all servicemembers who are released from active duty/separated/
    retired who serve 180 continuous days or longer on active duty.
    Although existing transition programs were originally designed for the
    active component, the program supports reservists, as members of the
    total force, provided eligibility requirements are met (i.e., served
    180 continuous days or longer on active duty, and are within 12-months
    from separation, or are within 24-months from retirement).
        Reserve servicemembers are provided information on their rights
    under the Uniformed Services Employment and Reemployment Rights Act
    (USERRA) which is intended to minimize the disadvantages to an
    individual that can occur when a person needs to be absent from his or
    her civilian employment in order to serve in the uniformed services.
        In addition to providing assistance with career, employment,
    education and training benefits, Pre-separation Counseling, which is
    required by title 10 U.S.C., section 1142, includes information on how
    to maximize the use of benefits earned through their service such as
    determining health and life insurance requirements, financial planning,
    and Veteran's benefits and entitlements.
        The Yellow Ribbon Reintegration Program (YRRP), which was created
    by P.L. 110-181 (NDAA for Fiscal Year 2008), provides access to
    programs, resources, and services to minimize stresses on National
    Guard and Reserve members and their families before, during, and after
    deployments of 90 days or more.
        The Warrior Transition Program was established in Kuwait and
    provides a place and time for sailors to decompress and transition from
    the war zone to life back home. Through small group discussions
    facilitated by chaplains and medical personnel, Warrior Transition
    Workshops prepare sailors for resumption of family and social
    obligations, return to civilian employment, and reintegration with the
    community.
        The Returning Warrior Workshop (RWW) is another important step in
    the demobilization and reintegration process for the Total Force and
    their families. The RWW is designed to remove stigma and direct family
    members to appropriate support programs. Originally developed by and
    for the Navy Reserve, the RWW has expanded to include Navy active and
    Marine Corps Reserve members and their families.
        The Navy's Operational Stress Control (OSC) and Marine Corps'
    Combat and Operational Stress Control (COSC) programs are a set of
    policies, programs, training and tools to enable leaders, marines,
    sailors, family members, and caregivers to deal effectively with the
    stress of operational deployment and training.
        The Marine Corps also developed a specific ``Demobilization Tool
    Kit'' and Career Guide CD which supplement our existing transition
    program. These Kits were designed to meet the unique needs and concerns
    of demobilizing Reserve marines and family members as they return to
    civilian life and workforce. Toolkits were not re-distributed in fiscal
    year 2010 since the OSD Office of Wounded Warrior Care and Transition
    Policy is in the process of creating a toolkit that will serve both the
    transitioning Active Duty and Reserve community.
        The Deputy Under Secretary of Defense, Office of Wounded Warrior
    Care and Transition Policy is leading an effort to expand transition
    support to the National Guard and Reserves through an amendment to the
    current law as well as revision of the DODD 1332.35 and DODD 1332.36.
    The Marine Corps is also convening an Operational Planning Team (OPT)
    to look at program improvements, such as starting the transition
    process 2 years earlier (recognizing that over 65 percent leave the
    Marine Corps after the first term) and offering tiered delivery of
    services, such as Education, Training, and Employment Job Placement.
        Mr. Ginsberg. The AFR and Air National Guard (ANG) enlist the
    resources of a variety of programs to ease the transition of its
    members back to civilian status. The YRRP is the comprehensive DOD
    program used by all components to provide assistance to members and
    families. In addition, because health care and employment issues are
    particularly important to returning veterans, the AFR and ANG have
    programs and resources that place particular emphasis on these areas.
    Yellow Ribbon
        The AFR and ANG employ the Yellow Ribbon Program as a key component
    to effectively address the transition back to civilian life. Experts
    who participate regularly in Yellow Ribbon events--pre-deployment,
    during deployment, and post-deployment--include the DOD contracted
    Military Family Life Consultants (MFLCs), Military OneSource, and
    Personal Financial Readiness. Since the standup of the Yellow Ribbon
    Program by the AFR Command in August 2008, comprehensive support to
    airman, families, and employers throughout the deployment cycle
    minimizes the stress of deployment and family separation. During the
    period from August 2008 through 1 March 2010, the Yellow Ribbon Program
    held 156 total events across 39 Wings/Groups with 5,668 Reserve members
    and 5,288 family members participating.
        National Guard soldiers and airman go through a number of steps in
    their transition from an active duty status back to a Reserve status.
    The first step begins with their participation in a demobilization
    process along with the active component. During this step they go
    through various stations with subject matter experts to address issues
    such as financial, personnel, logistics, medical, dental, services, and
    benefits. In the medical station both physical and behavioral areas,
    such as PTSD, are assessed. In the benefits station a Veterans
    Administration representative reviews the services provided through the
    Veterans Health Administration and can enroll the Guard member for care
    at a VA hospital in their local area when they return home.
        The next step occurs when the National Guardsman is at home. The
    Yellow Ribbon program conducts a series of events at 30-, 60-, and 90-
    day intervals. Each of these events reassembles the various experts
    that were available at the demobilization station. These events remind
    Guardsmen and their Families of the services and benefits as well as
    introduce them to the available local community resources. These
    resources include an internal Warrior Support team consisting of an
    Employer Support of the Guard/Reserve Specialist, Psychological Health,
    Family Program representatives, and a Transition Assistance Advisor.
    The Warrior Support team members are available via phone, email and
    personal meetings for the Guard member or their family at any time and
    serve as a resource and referral advocate for them. In addition, the
    creation of the Joint Services Support portal covers all transitional
    assistance programs and initiatives to enable all Guardsmen and their
    families to access information about support and services available in
    their local areas.
    Health Care
        Both the AFR and ANG have placed particular emphasis on mental
    health. The AFR employs Psychological Health Advocates (PHAs),
    reservists who are mental health or clinical nurses and enlisted
    personnel, and are qualified to provide assessment and referrals for
    mental health services. The PHAs and MFLCs work in concert with one
    another to ensure comprehensive services are available to reservists
    and their families. The ANG has placed Directors of Psychological
    Health in each State and territory to perform as an assessment and
    referral resource and act as the subject matter expert to the State/
    territory with regards to psychological health matters. In its
    inaugural year (fiscal year 2009) they intervened in 255 critical cases
    that were deemed high risk suicide/homicide situations.
        Air Force Reserve Command (AFRC) is also working cooperatively with
    Department of Veterans Affairs Veterans Health Administration to ensure
    implementation of the Combat Veteran Heath Care Benefits and Co-Pay
    Exemption Post-Discharge from Military Service. Reserve personnel
    returning from any theater of combat operations are briefed by VHA
    representatives and given the opportunity to apply for Veterans Health
    care. This allows reservists to receive medical care, to include
    treatment for post-traumatic stress disorder (PTSD) at VA health
    facilities with no co-pay. In addition, those who serve in combat
    theater for not less than 90-days are informed of their eligibility for
    one-time correction of dental conditions if they had not had dental
    care while deployed.
    Employment Assistance
        In addition to providing assistance with benefits and entitlements
    associated with active service, Air Force Reserve Airman and Family
    Readiness Centers provide employment assistance. Unemployment in the
    civilian sector is a growing concern for the AFR, but not a ubiquitous
    problem. Much of the unemployment seems to be associated with the
    economic situation where a reservist resides. Several locations, with
    one full-time Airman and Family Readiness staff member, offer
    employment-related classes similar to those offered during a Transition
    Assistance Program (TAP) seminar including resume writing,
    interviewing, job search skills, how to dress for career fairs and job
    interviews. The employment focus of TAP is to make the reservist more
    marketable in an environment where there are few or no jobs. reservists
    are often tied to communities where their spouses have employment so
    relocation for job opportunites may create another problem. This is not
    unlike situations active duty spouses find themselves in the job
    market.
        For the ANG, Employer Support, and Warrior Support offices
    participate in Yellow Ribbon Reintegration events and activities to
    ensure that all returning servicemembers are made aware of their
    employment rights under law as well as employment opportunities within
    the States and Territories (to include the District of Columbia). The
    National Guard is working with the DOD Transition Assistance Task Force
    to change the current Transition Assistance Program legislation to
    reflect the specific needs of the Guard and Reserve in relation to
    transition assistance. Finally, the National Guard Employer Support
    Program Support Specialist located in each Joint Force Headquarters
    State is responsible to connect returning Guardsman with Federal,
    State, local, and private agencies to obtain employment referrals. In
    many cases these referrals may involve additional training and
    education to compete for areas of future employment. Additionally, the
    National Guard Program Support Specialist advise returning Guardsman of
    specific unemployment trends and retraining benefits in their local
    area.
                                     ______

                Questions Submitted by Senator Roland W. Burris
               defense integrated military human resources system
        6. Senator Burris. Dr. Stanley, now that the Defense Integrated
    Military Human Resources System (DIMHRS) is being canceled by the
    Secretary of Defense, what is the plan to look at other options to
    manage personnel and pay under a single system for the DOD?
        Dr. Stanley. When the Department determined to terminate the DIMHRS
    program, the decision also included direction for a way forward. There
    are no plans to review options for a single DOD system to manage
    military personnel and pay; rather each of the Services will implement
    enterprise standards in their own systems.
        The software configured to support the original DIMHRS effort has
    been provided to each Service for their individual development efforts
    called Service Integrated Personnel and Pay Systems (SIPPS). SIPPS-Army
    is currently the most mature effort and expects to begin deployment in
    fiscal year 2013. A governance structure is also in place to manage
    development of the individual Service systems that includes the DIMHRS
    Transition Council, mandated by Congress in the National Defense
    Authorization Act for Fiscal Year 2010. A Joint Enterprise Change
    Management Board was put in place to ensure changes to the Service
    systems do not adversely impact the Enterprise Standards compliance.
    This body is co-chaired by the OUSD (P&R) Director, Information
    Management and the Director, Defense Finance and Accounting Service,
    Financial Management Center of Excellence.
        I am confident this governance structure ensures the individual
    Service development programs support and execute military personnel and
    pay policies accurately, equitably, and in a timely manner for our
    servicemembers.

                                   minorities
        7. Senator Burris. Dr. Stanley, what are the percentages of
    minorities by category and women in the Senior Executive Service (SES)
    General and Flag Officer ranks of the Armed Services, and DOD
    headquarters?
        Dr. Stanley. For the General and Flag officer population, gender
    composition is 93.6 percent males and 6.4 percent females. The race/
    ethnic composition is 89.8 percent White, 6.0 percent Black, 1.6
    percent Hispanic, 1.3 percent Asian/Pacific, .2 percent American
    Indian/Alaskan Native and 1.1 percent Other. These data are current as
    of March 2010
        For the SES population, gender composition is 76.3 percent males
    and 23.7 percent females. The race composition is 90.53 percent White,
    4.48 percent Black/African American, 1.6 percent Hispanic, 2.10 percent
    Asian, 0.14 percent Native Hawaiian/Pacific Islander, 0.87 percent
    Multiracial; 0.14 percent ID Pending; and 1.3 percent Unspecified. The
    Unspecified group primarily consists of individuals designated as
    Hispanic but who do not have a race specification. The percentage of
    SES population identified as Hispanic ethnicity is 1.73 percent. These
    data are current as of January 2010.

                               civilian employees
        8. Senator Burris. Dr. Stanley, civilian employees that participate
    in the Thrift Savings Plan (TSP) are entitled to receive matching
    agency contributions to their TSP account, yet military members do not.
    When will this disparity be addressed for our military personnel?
        Dr. Stanley. To address the appropriateness of providing agency
    matching contributions to military members, it is important to consider
    and compare the role of the TSP in the civilian and military
    compensation systems.
        For a civilian employee under the Federal Employee Retirement
    System (FERS), the funds provided by the government in the form of
    matching contributions are one of the key components of retirement.
    Under FERS, in addition to receiving matching contributions, the
    employee contributes to a defined benefit plan and receives an annuity
    upon retirement after reaching a specified age and years of service.
        For a military member, the government provides a defined benefit
    retirement plan more generous than FERS and fully funded by the
    government. Unlike the civilian employee under FERS, the military
    member does not contribute to the defined benefit plan and receives
    monthly retired pay immediately upon retirement, but at an earlier age
    with many working years ahead.
        The military member is also allowed to contribute to the TSP.
    However, the ability to participate in the TSP was not designed as a
    key component of the military member's retirement. For the military
    member, participation in the TSP is a valuable, additional benefit, one
    that facilitates long-term saving. Although participation in the TSP
    may be a common element across both military retirement and FERS, the
    roles of the TSP and the need for and purpose of providing agency
    matching contributions are different.
        In the past, the Department has investigated the impact on
    recruiting and retention and the cost effectiveness of providing
    military members with agency matching contributions. Based on data of
    members currently contributing to TSP, the cost of providing agency
    matching contributions is estimated to be between $840 million and $2.8
    billion annually, depending upon the level of participation.
        RAND and the Center for Naval Analyses (CNA) have both investigated
    the issue of providing agency matching contributions. RAND reviewed an
    Army pilot program which offered agency matching contributions from
    2006 through 2008 to new enlistees who selected longer enlistments and
    enlisted in hard-to-fill specialties. RAND found no appreciable
    increase as a result of providing agency matching contributions. CNA
    also studied the issue of providing agency matching contributions and
    determined providing agency matching contributions would have minimal
    impact on retention.

                             don't ask, don't tell
        9. Senator Burris. Dr. Stanley, how will a moratorium on Don't Ask,
    Don't Tell (DADT) affect the pending cases of servicemembers facing
    discharge?
        Dr. Stanley. The Secretary of Defense has appointed a high-level
    Working Group to review how to implement repeal of 10 U.S.C. Sec. 654.
    As the Secretary has said, he does not support a moratorium while this
    Working Group is undertaking its review. In general, a moratorium would
    prohibit the separation of servicemembers on the basis of homosexual
    conduct until the moratorium ends. This would presumably have the
    effect of allowing openly gay and lesbian servicemembers to continue
    serving on active duty for the duration of the moratorium and would, in
    that respect, have an effect very similar to repeal of section 654.

                                  end strength
        10. Senator Burris. Mr. Lamont, given the operational tempo placed
    on the forces, particularly as it relates to the Army Reserve
    components, do you feel there is a need for the end strength of the
    Army Reserve and Army National Guard to increase?
        Mr. Lamont. Yes. The Army is considering if additional funded end
    strength is needed for the Reserve components in order to optimize Army
    National Guard and Army Reserve Trainees, Transients, Holdees, and
    Student (TTHS) accounts. Each of the Army's components requires a TTHS
    account to allow them to optimize the management of their force. The
    Active component is authorized approximately 71,000 soldiers (13
    percent of Active component end-strength) within a TTHS account,
    allowing the Active component to segregate nondeployable personnel
    (e.g. non-trained or soldiers in resident training) from units. In
    contrast, the relative small size of the Army National Guard (2.5
    percent) and Army Reserve (2 percent) TTHS accounts are insufficient to
    make full use of a TTHS mechanism and its positive effects on
    readiness.

        11. Senator Burris. Mr. Lamont, the Army has asked for a temporary
    end strength increase, due in part to deployments and now with perhaps
    a bigger burden on the forces given the requirements brought forth from
    the Quadrennial Defense Review, don't you think the Reserve component
    needs additional forces as well?
        Mr. Lamont. The Army is doing an ongoing RAND Study to determine if
    increasing the end strength of the Reserve components (RC) is
    necessary. Should the study show additional end strength is required to
    optimize the RC, we will include additional cost in the next Army
    budget request.

                                    reserve
        12. Senator Burris. Mr. Lamont, the Army Reserve has the lowest
    percentage of full time support comparing it with the size of the
    Reserve component forces, followed by, I believe, the Army National
    Guard. Yet, their participation in Overseas Contingency Operations
    (OCO) is more significant than the other Reserve components. How can
    you explain that?
        Mr. Lamont. Adequate full-time support is essential for Reserve
    component (RC) unit readiness, training, administration, logistics,
    family assistance and maintenance. The Commission on the National Guard
    and Reserve found that effective performance of such functions
    correlates directly to a RC unit's readiness to deploy. The Army with
    the largest Reserve operational force has 12.89 percent of its RC end
    strength as full-time support; the Air Force has 25.29 percent of its
    Reserve components as full-time manning. The current full-time support
    levels of the Army's Reserve Components are based, in part, on a 1999
    RAND Study that was revalidated in 2005. The manpower authorization
    levels established by RAND are currently funded at 72 percent of
    validated requirements, which was sufficient for a Strategic Reserve
    Force. Since 2001 the RC's have used personnel on Active Duty
    Operational Support-Reserve Components (ADOS-RC) orders and other full-
    time equivalent (FTE) manpower to meet the full-time support
    requirements generated by contingency operations. The Army is
    considering what full-time support for the Guard and Reserve is needed
    to ensure adequate manning for various support functions (organizing,
    manning, training and equipping) required for managing the Reserve
    components as an operational force.

                                   recruiting
        13. Senator Burris. Mr. Lamont, is there an initiative to
    consolidate the recruiting programs of the three Army components (Army,
    Army Reserve, and National Guard)?
        Mr. Lamont. While there have been informal discussions about having
    a single Army recruiting command that serves the needs of the total
    force--Regular Army, Army Reserve (USAR) and Army National Guard
    (ARNG)--there are no initiatives to further consolidate recruiting at
    this time.
                                     ______

                 Questions Submitted by Senator Lindsey Graham
                      recruiting health care professionals
        14. Senator Graham. Mr. Lamont, Mr. Garcia, and Mr. Ginsberg, you
    indicated in your written statements that achieving Service recruiting
    goals for doctors, psychologists, nurses, dentists, and other health
    care professionals, in both the active and Reserve components, presents
    significant challenges. Please discuss the challenge of recruiting
    health professionals in this wartime environment in your Service, and
    how you plan to meet this challenge.
        Mr. Lamont. Hiring difficulties continue to stem from remote
    locations, compensation limitations inherent to government employment,
    and a national shortage of qualified providers. The Army is using
    numerous traditional mechanisms to recruit and retain both civilian and
    uniformed providers including Retention Bonuses; Student Loan Repayment
    Program; Special Pay for Certified Nurses; Medical Special Pays for
    Psychiatrists, and a Social Work Program in partnership with
    Fayetteville State University. A non-traditional recruiting approach
    has been the Military Accessions Vital to the National Interest (MAVNI)
    Pilot Program. MAVNI was launched in 2009 to attract high quality
    individuals with exceptional skills in health care professions or
    special language and cultural backgrounds. MAVNI recruits are non-U.S.
    citizens who have been legally present in the United States for 2 or
    more years and are licensed health care professionals or possess
    specific language and cultural capabilities in a language critical to
    the DOD, but who do not have permanent residency.
        Mr. Garcia. Navy has a comprehensive medical recruiting focus,
    which enabled us to exceed our overall medical recruiting goals in
    fiscal years 2008 and 2009. We are on track to meet our overall goal in
    the Active component (AC) in 2010, but are experiencing challenges in
    meeting the Reserve component (RC) goal, which increased by 121
    accessions this year, an increase of 43 percent.
        Increased 2010 recruiting goals notwithstanding, our analysis
    indicates medical professionals do not often consider military service
    a primary career option. Reasons for this include:

             Civilian salaries are more lucrative than military pay
            and continue to outpace financial incentives we offer to our
            target market.
             Excessive debt is a major concern for medical
            professionals, who are able to find low-interest loans outside
            of the military.
             Percentage of females attending medical school has
            risen over the past 10 years yet females are less inclined to
            serve in the military than males.
             Concerns over multiple deployments.
             Potential Reserve medical providers fear a loss of
            their private practice.

        It should also be noted that we remain in keen competition with the
    private sector, the Department of Veterans Affairs, as well as with the
    other military departments, for the same finite talent pool.
        We are continuing best practices learned during the past 2 years
    and are implementing several new initiatives that we expect will bear
    fruit in our shortfall areas including:

             Adjusting bonuses and incentives for fully trained
            medical professionals.
             Participating in the Military Accessions Vital to the
            National Interest (MAVNI) pilot program to access qualified,
            legal non-citizen medical doctors.
             Initiating an accession process for legal permanent
            residents who are qualified physicians or medical students.
             Offering loan repayment opportunities for critical
            medical specialties.
             Expanding use of medical officers to inform
            undergraduate and professional medical students across the
            Nation of opportunities in Navy medicine.
             Adding more full time recruiters to recruiting medical
            professionals.
             Expanding the Health Service Collegiate Program to
            include Permanent Residents (green card) in critical student
            specialties.
             Offering bonuses for clinical psychologists,
            physician's assistants, and social workers.
             Continuing the Critical Wartime Skills Accession Bonus
            to target physicians (up to $400,000) and dentists (up to
            $300,000).

        Mr. Ginsberg. Accessing fully qualified professionals is our
    greatest challenge. Air Force recruiting is challenged by the same
    factors our Nation faces in having sufficient health care professions
    such as: nursing, general surgery, family practice, psychology, and
    oral maxillofacial surgery. The Air Force faces keen competition for
    fully qualified specialists from the private sector and other Federal
    agencies, such as the Department of Veterans Affairs and the Public
    Health Service, where multiple deployments are not an issue. Also,
    there are significant pay disparities between the military and private
    sector employers, especially those surgical specialties crucial for
    wartime support. The changing demographics of health professions, with
    increased numbers of women entering the profession who may be less
    inclined to choose military service, also provide a challenging
    environment for our recruiters. Current data suggests less than 7
    percent of eligible graduates consider entering military service.
        Using feedback from exit interviews and informal counseling, the
    Air Force confronts the above challenges in a three-pronged approach:
    (1) education, (2) compensation, and (3) quality of life.

              (1) Education: Due to historical problems in recruiting fully
            qualified and trained specialists, the Air Force deliberately
            places increased emphasis and funding into educational
            scholarship opportunities. We have found great success in
            ``growing our own,'' either through the scholarship programs or
            through training in the Uniformed Services University of Health
            Sciences (USUHS). The highest retention occurs when we control
            the educational environment. The Health Professions Scholarship
            Program (HPSP) is a resounding success with 1,466 students
            currently enrolled. As reflected in the DOD budget for fiscal
            year 2013, the Air Force has a programmed budget to support a
            gradual increase to 1,666 students. We have also optimized our
            enlisted commissioning programs, such as the InterService
            Physician assistant Program (37 graduates per year), the Nurse
            Enlisted Commissioning Program (50 graduates per year), or
            guidance and statutory limitations in Section 2124 of Title 10,
            capping the total students enrolled DOD-wide in HPSP at 6,000.
            USUHS programs have physical constraints with the facility and
            academic accreditation constraints of oversight committees.
            Enlisted commissioning programs are constrained by the number
            of training-years programmed and funding against all enlisted
            training. Even with limitations, education has proven the most
            successful avenue of accession for the health professions.
              (2) Other ways we entice fully qualified specialists into the
            Air Force is through compensation, using accession bonuses and
            incentives. Under the auspices of Health Affairs, the Air Force
            has funded accession bonuses and incentive pays to entice
            selected fully qualified specialists. For fiscal year 2011, the
            Air Force has sufficiently budgeted $16.4 million of this
            towards accession bonuses for personnel in fully qualified
            critical specialties based on historical rates of accession.
            Historically, as outlined in the first paragraph and under
            section (1), above, our accession bonuses have been of limited
            success due in part to bonus structures, as section 301d and
            301e of Title 37 are mutually exclusive of section 302k and
            302l of Title 37. Because these accession bonuses cannot be
            taken with a multi-year special pay, we have had limited
            effectiveness from its use. In fiscal year 2009, 12 of 118
            fully qualified physicians accessed were eligible for an
            accession bonus; only 2 actually accepted the bonus. Our
            greatest success is within the Dental Corps, where 14 of 17
            billets were filled for fiscal year 2009. Our other programs
            have limited success with nurse specialties at 120 of 155
            qualified nurse billets filled. The various specialties of the
            Biomedical Sciences Corps having only 129 of 321 requested
            specialty positions filled for fiscal year 2009. As we migrate
            our compensation portfolio under the new pay authority of
            section 335 of Title 37, we will be able to initiate specialty
            pays for the mental health care providers and other critical
            wartime or shortage specialties that previously were excluded
            from accession and incentive pays. We feel this will be of
            great benefit to the Air Force and military health care in
            general, allowing targeted accession bonuses, incentive pays,
            and retention bonuses to address the manning shortages in the
            health professions. Due to the complexity of medical specialty
            and incentive pays and entitlements, scheduled migration of
            these contractual agreements under ASD(HA) will take time to
            fully implement. In general, recruiting many of the fully
            qualified specialists without bonuses is extremely limited.
            Level of compensation is an important consideration, but does
            not entirely ease the burden of multiple deployments.
              (3) Lastly, no recruit enters without discussing quality of
            life issues, whether this is family services, medical practice,
            educational or leadership opportunities, or frequency of moves
            and deployments. We address many of these issues amongst the
            Air Force agencies. Ongoing projects include the Family Health
            Initiative, which is a medical model that better leverages our
            personnel. We are building force sustainment models, analyzing
            promotion opportunities, and developing a more proactive
            approach to provide more opportunities for advancement. In
            specialties with increasing wartime deployments, we are better
            able to spread the deployment load more evenly among our
            members. Restructuring of our medical groups allow increased
            opportunities for all health professions to become leaders in
            the Air Force.

        We remain committed to obtaining the best in health care for our
    Nation' s military and their familiy members through enhanced
    recruiting efforts maximizing the tools provided for education,
    compensation, and creative quality of life efforts of new health
    professionals.

        15. Senator Graham. Mr. Lamont, Mr. Garcia, and Mr. Ginsberg, what
    about retention of health care professionals; how much visibility do
    you have and oversight do you exercise into how well your medical
    community leaders and personnel chiefs are doing in effectively
    retaining mid-career personnel?
        Mr. Lamont. The Army Medical Department continuously monitors the
    need for behavioral health care providers based on the reliant
    populations' ongoing and changing demand. MEDCOM has increased funding
    for scholarships and bonuses to support expansion of our provider
    inventory. The Army expanded the use of the active Duty Health
    Professions Loan Repayment Program and offers a $20K accessions bonus
    for Medical and Dental Corps health professions scholarship applicants.
    MEDCOM increased the number of Health Professions Scholarship
    Allocations dedicated to Clinical Psychology and the number of seats
    available in the Clinical Psychology Internship Program (CPIP). In
    partnership with Fayetteville State University, MEDCOM developed a
    Masters of Social Work program which graduated 19 in the first class in
    2009. The program has a current capacity of 30 candidates.
        Mr. Garcia. Recruiting and retention rates of health care
    professionals are tracked very closely. I receive updates monthly from
    the Chief of Naval Personnel and the Surgeon General of the Navy, with
    particular emphasis on retention of mid-career medical personnel.
    Additionally, I receive a quarterly update, which is also presented to
    the Chief of Naval Operations. My staff coordinates with the staffs of
    the Bureau of Naval Personnel and Bureau of Medicine and Surgery to
    address any shortfalls, leveraging current policies and legislative
    authorities, consistent with the President's budget to recruit and
    retain these highly skilled professionals along the entire career
    continuum
        Mr. Ginsberg. Within the Air Force I have visibility on a quarterly
    basis into the special pays and retention bonuses offered to the
    Medical Corps, Dental Corps, Biomedical Science Corps, Nurse Corps, and
    Medical Service Corps. My office monitors the amounts offered, the
    number of personnel eligible to elect the special pays, and the
    acceptance rate among our health care professionals, especially those
    in the critical wartime specialties, as well as among the mental health
    professionals. I firmly believe the Air Force medical community is
    sensitive to the health care needs of the population we serve and does
    an exceptional job ensuring the requisite health care professionals are
    retained. My office continues to work closely with the Air Force
    Surgeon General in anticipating requirements and using all available
    authorities to retain trained and experienced health care providers.

        16. Senator Graham. Mr. Lamont, Mr. Garcia, and Mr. Ginsberg,
    please provide a snapshot effective March 1, 2010, of the current
    status of each of your Service's health care professional recruiting
    and retention, clearly indicating where shortfalls exist and also
    indicating by specific officer grade (e.g., O3, O4 , O5).
        Mr. Lamont. As of 22 March 2010, the United States Army Recruiting
    Command (USAREC) Medical Recruiting Brigade (MRB) has achieved 51
    percent (457 of 905) of the fiscal year 2010 Active Duty recruiting
    mission and 46 percent (425 of 926) of the fiscal year 2010 U.S. Army
    Reserve mission. Mission achievement is most problematic in recruiting
    fully qualified military physicians, where only 18 percent (11 of 60)
    of mission is currently achieved, even given the availability of the
    Critical Wartime Skills Accession Bonus, which ranges from $180,000 to
    $400,000 depending on the specialty. The Army Medical Department
    (AMEDD) is currently short at the grade of Major (O4) across the board.
    This is a function of several phenomena; the most notable being the
    loss of officers in the grade of Captain (O3) who had completed their
    obligation prior to implementation of current retention initiatives,
    thus decreasing the number of officers available to promote to the
    grade of O4. While this grade imbalance is true, each Corps also has
    specific specialty shortages at differing grades, signifying a
    potential capability gap. Resolution of specific shortages is being
    addressed through precision recruiting, training and retention
    initiatives. Recent recruiting success has increased the company grade
    inventory that will increase the inventory at the rank of Major if
    these junior officers are retained, select specialty training and are
    promoted. Current projections for the end of fiscal year 2010 suggest
    that all but the Medical and Dental Corps will exceed the aggregate
    Budgeted End Strength. In fiscal year 2011, the Army G-1 will direct
    the recruiting force to emphasize specific qualifications.
        Mr. Garcia. Navy recruiting for health care professionals in the
    active Component is on track to meet program fiscal year 2010 goals,
    while we continue to experience challenges in recruiting health care
    professionals into the Reserve Component.
    Active Component (AC):
        We have reached 57 percent of overall AC health professions officer
    accession goals as of March 1, 2010. Student programs are out-
    performing the direct accession programs, continuing last year's strong
    student recruiting:

             Dental Corps: 51.6 percent of goal (77 of 149)
             Medical Corps: 44.5 percent of goal (143 of 321)
             Medical Service Corps: 64.1 percent of goal (143 of
            223)
             Nurse Corps: 75.5 percent of goal (136 of 180)
    Reserve Component (RC):
        We have reached 24 percent of overall RC health professions officer
    accession goals as of March 1, 2010. This remains our most significant
    challenge. We are encouraged by recent authorization to establish a
    bonus for RC Nurse Corps officers, the health professions community
    which has the highest accession goal but the lowest attainment to date.
    We anticipate that implementation of this new incentive will favorably
    impact production.

             Medical Corps: 23.6 percent of goal (140)
             Dental Corps: 24 percent of goal (50)
             Medical Service Corps: 40 percent of goal (45)
             Nurse Corps: 19.4 percent of goal (165)

        As of January 1, 2010, retention rate among Navy health profession
    officers is 93.5 percent AC and 85.3 percent RC. Fiscal year 2010
    brings significant changes to Navy Medical Department's manning, such
    as the military to civilian buyback. Individual Corps status is
    summarized below:

             Medical Corps. AC manning is 97.3 percent and RC
            manning is 70.5 percent.

                     Shortfalls exist in the following critical
                    wartime specialties: General and Orthopedic Surgery,
                    Family Practice and Psychiatry.

             Dental Corps. AC manning is 89.9 percent and RC
            manning is 102.0 percent.

                     Shortfalls exist among O3-04 officers and in
                    certain subspecialties: Oral Surgeons, Prosthodontists,
                    General Dentists and Endodontists.

             Medical Service Corps. AC manning is 92.0 percent and
            RC manning is 93.8 percent.

                     Shortfalls exist in Podiatry and the following
                    critical wartime specialties: Clinical Psychology,
                    Physician's assistant and Social Work.
                     Navy is increasing the number of mental health
                    providers to meet operational demand over the next few
                    years, and the focus remains on filling and retaining
                    critical wartime specialties.
                     USD (P&R) authorized establishment of a Health
                    Professions Officer Special Pay to support accession
                    bonuses for Clinical Psychology, Social Work and
                    Physician's assistant, and retention bonuses for
                    Clinical Psychology and Physician's assistant. This
                    special pay package will be critical to meeting
                    accession and retention goals in these specialties.

             Nurse Corps. AC manning is 90.7 percent and RC manning
            is 83.7 percent. We continue to see improved retention due to
            new special pays for critical and undermanned specialties.

        It must be noted that we remain in keen competition with the
    private sector, the Department of Veterans Affairs, as well as with the
    other military departments, for the same finite talent pool.
        Mr. Ginsberg. The snapshot requested is best answered by discussing
    the Air Force Medical Service (AFMS) in general, with focus on specific
    specialties as targeted examples. Of the 189 specialties in the AFMS,
    manning by specialty varies.
        AFMS: Current officer manning as of March 1, 2010 shows officer
    manning at 91.2 percent, which includes medical residents but does not
    include other student categories. The Health Professions Scholarship
    Program (HPSP) continues to remain our primary vehicle for the
    recruitment of entry-level medical and dental officers with 82 percent
    of their fiscal year 2010 scholarships awarded. The Nurse Corps (NC)
    and Biomedical Sciences Corps (BSC) also utilize HPSP as an entry into
    these critical specialties, and 76 percent of these Corps' fiscal year
    2010 scholarships are awarded. It is expected the remaining
    scholarships will be filled at the next selection board. The Medical
    Service Corps (MSC) does not participate in this program.
        Accession of fully qualified (FQ) and experienced health
    professions officers remains problematic. It is much easier to access
    new graduates than residency-trained or specialized health care
    professionals. To date, Air Force Recruiting Service has successfully
    accessed only 35 percent of fiscal year 2010 requirements for FQ health
    professions.
        Retention of health care professionals once their initial
    educational obligation is completed is also very problematic, and
    varies by Corps and by specialties within the Corps. Dental Corps (DC)
    retention after completion of educational obligations is 42 percent, an
    increase of 10 percent since 2004. As a Corps, dental officers show a
    small shortfall at the O-5 ranks, which corresponds to a ripple effect
    from retention problems in past years. This is most pronounced in our
    critically manned Oral Maxillofacial Surgeons with has large defects in
    manning within the O-5 rank for those officers with 14 to 19 years of
    commissioned service.
        The Medical Corps has not shown a significant improvement in
    physician retainability even with the sluggish economy. Retention after
    completion of initial education obligation has not risen. There are
    several critical areas of concern with the MC. Foremost are our general
    and trauma surgeons, where we have limited personnel in the skilled O-5
    rank. As surgical training and educational obligation encompasses the
    O-3 and O-4 rank, we find they leave at their earliest opportunity at
    completion of their military obligation in the O-4 and O-5 rank.
    Another concern is psychiatry with decreased retention at the O-4 rank,
    which produces a ripple shortfall to the O-5 rank. Critically important
    are our family practice and internal medicine specialists where we tend
    to lose the O-4 and O-5 experienced specialists, producing a shortage
    of senior skilled physicians in higher ranks.
        Retention of Nurse Corps specialists is improving with the
    selective use of incentive pays with multi-year contracts. For the
    Nurse Corps in general, we have historically noticed a loss of O-3
    officers. This trend is reflected throughout our clinical nurse
    specialties, but is magnified in our Surgical Nurse specialty where we
    have a loss of O-3 ranks and again at the O-4 rank. The implementation
    of our multi-year incentive contract has just passed its first year and
    we note retention has risen 13 percent since 2008, and now stands at 80
    percent at the 4-year point for the Nurse Corps as a whole.
        Our Biomedical Sciences Corps is the most diverse Corps and
    represents 19 specific specialties. Retention appears to have improved
    for some of these professions, although as a whole, the BSC has
    significant losses in the O3 rank and O4 rank. Early indicators show
    use of the special and incentive pays under the Consolidation of Pays
    authority released in July 2009 are showing increased retention for the
    physician assistant field as attritions in this field have decreased.
    The clinical psychologist specialty has gross losses after their
    initial completion of their initial obligation in the O3 rank, with
    ripple effects throughout the specialty. The public health career field
    also has similar deficits at the O3 rank and struggles to maintain
    adequate retention to meet mission requirements. Many other biomedical
    science career fields are not authorized or funded for special and
    incentive pays, although recruitment and retention of these fields is a
    challenge.
        Retention of the Medical Service Corps is generally not an issue,
    but recently we have noticed a loss trend in O-4 and O-5 rank as
    increasing numbers of personnel with long prior service become eligible
    for retirement with only 10 years of commissioned service. Recent
    changes to the selection process should provide more stability in this
    field.
        In summary, improved recruitment and retention incentives are
    projected to stabilize the chronic manning shortfall of several
    critical health professions specialties. Educational incentives (HPSP,
    FAP, USUHS) are especially successful to fulfill out-year requirements,
    however recruiting FQ health professionals continues to be a challenge.

        17. Senator Graham. Mr. Lamont, Mr. Garcia, and Mr. Ginsberg, what
    is your Service's plan for accomplishing the difficult task of
    recruiting and retaining highly qualified and motivated health care
    professionals?
        Mr. Lamont. The Army will continue to use monetary and nonmonetary
    incentives to recruit and retain sufficient quantity of military and
    civil service behavioral health providers.
        Mr. Garcia. Navy met overall health professions recruiting goals in
    fiscal years 2008 and 2009 and is on track to meet overall Active
    medical goals in 2010. With a 43 percent increase in Reserve Component
    (RC) medical goal in 2010, an increased accession requirement of 121
    providers, we continue to experience challenges in all four RC health
    profession corps.
        We are continuing best practices learned during the past 2 years
    and are implementing several new initiatives that we expect will bear
    fruit in our shortfall areas including:

             Adjusting bonuses and incentives for fully trained
            medical professionals.
             Participating in the Military Accessions Vital to the
            National Interest (MAVNI) pilot program to access qualified,
            legal non-citizen medical doctors.
             Initiating an accession process for legal permanent
            residents who are qualified physicians or medical students.
             Offering loan repayment opportunities for critical
            medical specialties.
             Expanding use of medical officers to inform
            undergraduate and professional medical students across the
            Nation of opportunities in Navy medicine.
             Adding more full time recruiters to recruiting medical
            professionals.
             Expanding the Health Service Collegiate Program to
            include Permanent Residents (green card) in critical student
            specialties.
             Offering bonuses for clinical psychologists,
            physician's assistants, and social workers.
             Continuing the Critical Wartime Skills Accession Bonus
            to target physicians (up to $400,000) and dentists (up to
            $300,000).

        Navy's most effective tools for retaining health care are special
    and incentive pays. Each of the four Corps (Medical, Dental, Medical
    Service and Nurse) has unique special pays designed to enhance
    retention among their respective health professionals. Other tools
    include training opportunities, age waivers and selective use of
    retired retained officers.

             Medical Corps. The retention challenge for the Medical
            Corps is maintaining the needed inventory with the proper
            specialty mix to meet requirements. We are addressing this
            challenge through targeted use of direct accessions, age
            waivers, and selective use of retaining retired officers for
            undermanned critical medical specialties. Multi-year Special
            Pay (MSP), Additional Special Pay and Board Certified Pay are
            all critical retention tools the Navy uses to maintain its
            inventory. Of these, MSP offers the greatest leverage with a 2-
            to 4-year obligation that enables achievement of proper
            specialty mix.
             Dental Corps. The Dental Corps is falling short of
            meeting retention goals. Junior officers are especially
            difficult to retain. Just as with the Medical Corps, special
            pays are critical to Dental Corps retention efforts. The Dental
            Corps has a Critical Skills Retention Bonus for junior
            officers, which was recently renewed for another 3 years and a
            multi-year retention bonus targeted at junior officer dentists.
            Additionally, a Critical Wartime Skills Accession Bonus was
            approved fiscal year 2010.
             Medical Service Corps (MSC). Fiscal year 2009 gains in
            MSC exceeded losses for first time since 2002. The overall loss
            rates are starting to stabilize at 9 percent, but still fall
            short of meeting the 5-year retention goals. Another retention
            challenge is retaining the proper specialty mix. MSC retention
            bonuses were recently approved for clinical psychology and
            physician's assistants, along with the retention special pay
            that exists for pharmacists and optometrists. Navy is
            addressing the retention of mental health and wartime
            specialties through the Health Professions Loan Repayment
            program and other special/retention pays.
             Nurse Corps. Retention of Nurse Corps junior officers
            has been difficult due to issues around work/life balance and
            long deployments. Navy is working to improve retention through
            application of new special pays for critically manned and
            undermanned specialties. Additionally, the Nurse Corps is
            allowing junior officers to apply for funded training earlier
            in their career and using the Health Profession Loan repayment
            program to encourage retention of junior officers.

        Mr. Ginsberg. The specific recruiting challenges faced by the Air
    Force and our plan to overcome those challenges were described in the
    response to Senator Graham's question on the challenge of recruiting
    health professionals in the wartime environment and how we plan to meet
    this challenge. Our future members have many of the same concerns as
    our current members. Retention presents many of the same challenges as
    recruiting. As we attempt to retain our skilled health care
    professionals, the private sector and other Federal agencies, such as
    Department of Veterans Affairs (VA) and Public Health Service, are our
    strongest competitors. Private sector pays, sign-on bonuses, annual
    compensation, and retirement packages are increasing due to the growing
    demand for these skilled professionals. Once the education of our
    health care professionals is completed, the value of these individuals
    is enhanced, leading to significant pay disparities between our members
    and their private sector counterparts. This is especially true for
    those surgical specialties crucial for wartime support. Limited
    compensation packages, limited educational and leadership
    opportunities, limited family and quality of life benefits are all
    areas we hear as reasons for our health professionals leaving the Air
    Force. Similar to the approach we have for recruiting, the Air Force is
    confronting retention challenges with an aggressive three-pronged
    approach to enhance: (1) education, (2) compensation, and (3) quality
    of life.

              (1) Education: Education is an invaluable tool. We continue
            to find great success in ``growing our own'' through civilian
            or military-sponsored residency and subspecialty programs, with
            over 13 percent of the Air Force Medical Service (AFMS)
            commissioned officers in formal training programs. ``Growing
            our own'' encompasses the spectrum from accessing new recruits,
            developing their skills and specialties, to maintaining and
            expanding on those capabilities for use in both state-of-the-
            art medical centers and in the deployed and austere
            environments of wartime and humanitarian missions. Our highest
            retention occurs when we control both the educational
            environment and the service obligations associated with
            advanced training programs. Our educational opportunities
            include aggressive use of subspecialty training and post-
            baccalaureate degree programs for our Nurse Corps, Biomedical
            Sciences Corps, and Medical Service Corps. Our surgical
            optimization project partners with VA hospitals and other non-
            Federal facilities. The continuing education of our health care
            professionals enhances the retention and value of these
            military members through continuing commitments and service
            obligations.
              (2) Direct compensation through contractual agreements is
            another way we retain members, using all available pay
            authorities equitably amongst the other Services and under the
            auspices of Health Affairs. By fully funding multi-year
            contract retention programs with our incentive pay programs,
            the Air Force affirms its commitment to retaining long-term the
            best skilled health care professionals. With the exception of
            our wartime and critical surgical specialties, the total
            enhanced pay compensation programs are helping to retain mid-
            and senior-level physician specialists. The Air Force
            investment in health professions special incentive pays totaled
            $194 million in fiscal year 2008 and $259 million in fiscal
            year 2009, and $271 million for fiscal year 2010. These
            increases are having a positive effect on retention. Retention
            of our Dental Corps specialists has greatly improved over the
            last 2 years; we look forward to maintaining nearly 100 percent
            in the near future. Our best successes are with our Nurse
            Corps, where we appear to be stabilizing after precipitous
            losses of 11.4 percent annually from fiscal year 2005 to fiscal
            year 2008. With increased incentives, we lost only 9.5 percent
            of the Nurse Corps inventory in fiscal year 2009. Various
            specialties of the Biomedical Sciences Corps, including
            clinical psychologists and clinical social workers, have
            recently been funded for incentive pays. Early results indicate
            these programs are stabilizing also. Incentive packages help
            offset some of the pay disparities between the military and
            private sector compensation packages. Although it does not
            reach parity, it does help ease the burden of multiple
            deployments. Multi-year contracts under Title 37 allow some
            stability in the health care professions, especially those with
            high separation rates. As the incentive pay programs come
            closer to meeting private sector compensations, we see
            increased retention of our stressed career fields. At this
            point, we are close to maximizing the pay authorities of Title
            37 for many of our most critical wartime specialties, leading
            us to utilize more of section 335 of Title 37. As we migrate
            our compensation packages under the new pay authority of
            section 335 of Title 37, we will finally be able to include
            other critical specialties previously excluded from incentive
            and retention pays. We will still be at the threshold ceiling
            for many critical specialties for the retention bonuses and
            board certification pay areas. We feel the eventual migration
            of all our pay programs under section 335 of Title 37 over the
            next several years will be of great benefit to the Air Force,
            but we will be unable to compete with private sector
            compensation packages for many of the critical surgical
            specialties.
              (3) As our members grapple with decisions to remain in the
            service, we understand the family is greatly involved. Quality
            of life issues of family services, availability of schools,
            frequency of moves and deployments, general base services, and
            future opportunities are at the forefront of any discussion. We
            have addressed many of these issues both for the new member,
            the 20-plus year veteran, or the civil service employee. For
            those specialties with increasing wartime deployments, we are
            able to spread the deployment load more evenly among our bases
            and members. By maintaining our deployments to 6-months in
            duration, we can stabilize our force and retain more of our
            skilled assets. Other ongoing projects include the Family
            Health Initiative, posturing our personnel for our future
            medical model. We are partnering among intra-AF agencies to
            build force sustainment models, increase promotions, and
            develop a proactive approach to retaining the numbers of
            professionals in each specialty, providing the Air Force a
            valued tool to reflect our future force.

        While retention of the health professions remains a challenge, we
    remain committed to exercise all available authorities in concert with
    the other Services under Health Affairs to obtain the best value in
    health care for our Nation's military and their family members.

                                   pay raise
        18. Senator Graham. Dr. Stanley, the proposed pay raise for fiscal
    year 2011 is only 1.4 percent, but as you point out, matches the rise
    in the Employment Cost Index. What would be the impact on the DOD
    budget, and on the personnel accounts of each of the Services, if
    Congress directed an increase in the pay raise by 1 percent, or even a
    half percent, and did not provide a top-line increase or offsetting
    funding?
        Dr. Stanley. While the Department must and will continue to offer a
    competitive compensation package that recognizes the sacrifice of
    military members and their families, the Department must work closely
    with OMB and Congress to ensure the additional cost hinder
    recapitalization or put additional burden on the American taxpayer.
        Each time the annual pay raise is increased by an additional \1/2\
    percent, military personnel costs are increased by roughly $0.5 billion
    in the current year and every year thereafter. Without a top-line
    increase, the Department would be forced to sacrifice other programs to
    fund the pay raise.
        The Department supports an increase in the military basic pay of
    1.4 percent, corresponding to the increase in the Employment Cost Index
    but is opposed to an increase in excess of this amount. The pay gap
    between military and private sector compensation has been closed as a
    result of congressionally mandated military basic pay increases of \1/
    2\ percent above the ECI over the past decade. Currently, the
    Department believes the full compensation package provided to military
    members compares favorably with counterparts in the private sector.

                           incentives for uav pilots
        19. Senator Graham. Mr. Lamont, Mr. Garcia, and Mr. Ginsberg, the
    importance of improving our surveillance capabilities through unmanned
    aircraft is well understood. Each Service, however, seems to approach
    the issue of who controls--or pilots--such aircraft, and the
    compensation they receive--differently. Please explain how your Service
    handles this issue, and how you are doing in making this an attractive
    career path or skill.
        Mr. Lamont. All Army Unmanned Aircraft Systems (UAS) are operated
    by enlisted personnel in the Military Occupational Specialty (MOS) 15W,
    UAS Operator. MOS 15W is one of the most popular MOSs, and the Army is
    not experiencing problems filling or maintaining its ranks. The
    majority of UAS operators are assigned to maneuver Brigade Combat Teams
    (BCTs), operating the RQ-7 Shadow UAS. These personnel directly support
    ground maneuver commanders, providing intelligence, surveillance,
    reconnaissance, and target acquisition capability. Although the UAS
    community has a small population of Warrant Officers who were prior UAS
    operators, they serve as the tactical and technical UAV systems
    integrators who interface with the ground commanders, and no longer
    function as operators.
        As the Army continues to grow the UAS operator population, the
    capability of the Army to fill and maintain these positions has grown
    along with it. This is a specialty in which the Army has enjoyed
    tremendous success with its enlisted operator community. Given this
    success, there are no plans at this time to request any special or
    incentive pay for UAS operators.
        Mr. Garcia. Marine Corps Unmanned Aerial Vehicle (UAV) Operators
    are enlisted Marines, E1 through E9, assigned Primary MOS 7314. The
    Marine Corps currently reports PMOS 7314 as ``critical'' to OSD due to
    inventory shortages. While there is no Enlistment Bonus to become a UAV
    operator (the Marine Corps does not pay enlistment bonuses for specific
    MOSs), the Marine Corps currently pays high Selective Reenlistment
    Bonuses (SRB) to retain Marines with these skills. Additionally, in the
    fiscal year 2010 Retention Plan, the Marine Corps has opened up 7314
    for qualified Marines from other PMOSs to lateral move into upon
    reenlistment.

                                                                                       Fiscal Year 2010 SRB Rates
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
                                        Zone A (E3 and                          Zone A (E5 and      Zone B (E5 and      Zone B (E6 and                                              Zone C (E7 and
                  PMOS                      Below)            Zone A (E4)           Above)              Below)              Above)            Zone C (E5)         Zone C (E6)           Above)
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
    7314............................  $46,500...........  $53,000...........  $58,500...........  $36,000...........  $40,000...........  $38,000...........  $43,500...........  $48,000
    ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

        The decision on who will pilot Navy's UAVs has not been determined
    as the program is still in its early development phase.
        Mr. Ginsberg. Today's operational requirements for both unmanned
    and manned aircraft demand high level of aviation professionalism from
    both the rated and career enlisted aviator communities. Current
    resourcing methods of manning remotely piloted aircraft (RPA)
    authorizations with traditional undergraduate pilot trained (UPT)
    pilots from other manned weapon systems are unsustainable. As the AF
    continues to grow to 65 RPA Combat Air Patrols (CAPs) by 2013, the
    demand on a stressed inventory of undergraduate pilot trained (UPT)
    pilots competing to fill both manned and unmanned weapon systems
    requirements is falling short. As a result, the Air Force created a new
    rated officer Air Force Specialty Code (AFSC) to categorize RPA pilots
    in a distinct career field and created a unique RPA training pipeline,
    currently being refined through ``BETA Test'' classes. The RPA ``BETA
    Test'' is a potential future alternative to the current UPT method. In
    addition, the Air Force also created a new AFSC to categorize enlisted
    RPA sensor operators in a distinct career field.
        As with other aviation career fields, having the ability to attract
    and retain airmen to these new RPA career fields for a military
    aviation career is instrumental. Due to legislative language in the
    monthly Aviation Career Incentive Pay (ACIP) and Career Enlisted Flyer
    Incentive Pay (CEFIP) authorities, the Air Force is unable to pay new
    RPA pilots and sensor operators ACIP or CEFIP. As a result, by
    memorandum, I authorized implementation of the Air Force's RPA Pilot
    Incentive Pay Program effective 30 November 2009 and the RPA Sensor
    Operator Incentive Pay Program effective 29 January 2010, both
    consistent with approval provided by DUSD (P&R). RPA pilot and sensor
    operator incentive pay is paid monthly under the assignment incentive
    pay (AIP) legislative authority, 10 U.S.C., 307a, and mirrors the
    policy and dollar amounts outlined for paying and receiving ACIP or
    CEFIP. As far as annual bonuses, BETA-trained RPA pilots will not be
    eligible for a retention bonus until the expiration of their 6-year
    training ADSC in 2015. However, to initially grow the enlisted RPA
    sensor operator career field, use of the selective re-enlistment bonus
    (SRB) was deemed necessary to garner volunteers from both the enlisted
    Intelligence and Career Enlisted Aviators (CEAs) career fields.
        The Air Force will continue to evaluate monthly incentive pays and
    annual bonuses as both of the RPA career fields mature.

                                   recruiting
        20. Senator Graham. Dr. Stanley and Mr. Lamont, you pointed out in
    your written statement that the Services achieved remarkable success in
    recruiting high school graduates in fiscal year 2009. You also note,
    however, that economic conditions will change and that the Services
    have to be ready to recruit the highest caliber men and women in good
    economic times or bad. The Army looked very hard a few years ago at the
    merits of individuals who wished to enlist, but did not finish high
    school. Similarly, waivers for drug use, minor--and not so minor--
    civilian criminal activities and so on, were carefully administered,
    but in much greater numbers than today. What is your assessment of the
    Services' ability to identify individuals with potential for
    outstanding service despite blemishes on their records?
        Dr. Stanley. We are confident processes the Services have in place
    to screen potential recruits are sound. Each Service realizes that
    youthful indiscretions not indicative of moral turpitude are not sound
    predictors of successful service.
        The waiver process used by the Services revolves around the ``whole
    person'' concept and includes extensive screening which takes into
    account many factors, such as the time since the infraction, the actual
    events leading to the infraction, recommendations from members of the
    community (teachers, members of the clergy, neighbors, etc), and face-
    to-face interviews with senior leaders. Studies have shown that
    individuals granted enlistment waivers generally perform equally or
    better than their non-waivered counter parts.
        In 2008, the Department issued policy directives that standardize
    the waiver processes and data collection procedures across the
    Services. These changes were designed to improve the process and
    provide the Department with more reliable data for analysis. We have
    recently contracted with the Center for Naval Analyses to study this
    issue further and to provide us with a more current assessment. The
    analysis will be concluded this fall.
        Mr. Lamont. The Army has an excellent process to identify
    individuals who display potential for military service despite
    blemishes on their records. Statistics clearly show there is very
    little risk involved in recruiting individuals with blemishes on their
    records.

        21. Senator Graham. Dr. Stanley and Mr. Lamont, if supply and
    demand dictates varying standards for recruitment, should we not be
    looking continually and over the long run at the metrics that will
    ensure successful recruiting of quality individuals over the long run?
        Dr. Stanley. DOD has proven, long-established Recruit Quality
    Benchmarks, developed under the guidance of the National Academy of
    Sciences. The key metrics for each fiscal year enlistment cohort are:
    90 percent high school diploma graduates (because they have lower
    attrition rates in the first 36-months of Service than other credential
    holders or dropouts); and 60 percent average or above cognitive ability
    (as measured by the Armed Forces Qualification Test because higher
    scoring recruits perform better in training and on the job than lower
    scoring recruits). That said, the Department recognizes the potential
    value of other metrics--such as temperament (personality)
    characteristics of applicants and has been encouraging Service efforts
    to explore such non-cognitive attributes that may be reliably measured
    and predictive of military performance.
        Mr. Lamont. We are experiencing a marked increase in fiscal year
    2008, 2009, and 2010 recruit quality. Part of that increase is based on
    screening metrics. The Army's attempts to screen recruits to predict
    high performance and retention continued last year as we employed the
    Tailored Adaptive Personality Assessment System, a non-cognitive test
    which can be used to predict first term attrition and other
    motivational performance aspects of applicants. Additionally, a recent
    Tier II Attrition Screen (TTAS) report completed by the United States
    Army Accessions Command indicated the TTAS screen could significantly
    reduce the Tier II (Non-High School Diploma Graduate/Alternate
    Credential Holder) 36-month attrition rate. These are two applications
    employed in an effort to sustain the Army's tremendous momentum of
    recruiting high quality individuals. We also commissioned a RAND study
    this year to develop a holistic strategy for the optimal levels and
    balance of recruiting resources that both accounts for the near-term
    recruiting environment and postures the Army for continued longer-term
    quality recruiting success as the environment changes. The results
    should assist the Army with manning the recruiting force and optimally
    employing incentives and deploying resources based on the recruiting
    mission and environment.

                educational opportunities for military children
        22. Senator Graham. Dr. Stanley, last year we received testimony
    from military spouses who were concerned about access to high quality
    education for their children, and in particular, the problem that
    military families experience in moves to remote areas or communities
    where there are few educational options. In your statement you report
    that more than half of the schools serving communities with significant
    military populations do not meet State academic standards in reading
    and math. The National Defense Authorization Act for Fiscal Year 2010
    required DOD to do a study on options to improve educational
    opportunities for military children, including the option of charter
    schools. A report on that study is due to the subcommittee on March 31,
    2010. Are we on track for that?
        Dr. Stanley. The quality of education for the children of our
    servicemembers is extremely important to the Department. I share your
    concern that some families, based on their assignment, may have fewer
    educational choices.
        To address the important question posed within the National Defense
    Authorization Act (NDAA) for Fiscal Year 2010, we are conducting a
    competitive procurement to obtain a reputable and experienced
    contractor in education and military student research. This method of
    conducting the study will provide an unbiased view and expert analysis
    to inform Congress of the Department's progress in this area.
        The procurement process for developing a solicitation which
    includes free and open competition takes approximately 4 months. This
    process began in November, and included collaboration with the U.S.
    Department of Education as the reporting requirement in the NDAA
    required. The solicitation was put out for bidding on March 26. We
    expect to have a contract awarded in May and a report to you by
    December 31, 2010.
        An interim response giving detailed accounts of the Department's
    progress is currently being reviewed and will be delivered to Congress
    in the near future.

        23. Senator Graham. Dr. Stanley, what is your opinion on the option
    of charter schools?
        Dr. Stanley. DOD welcomes parental and community efforts to develop
    and enhance the educational opportunities for all children, especially
    military connected children. These opportunities can include
    traditional public schools, private schools, home school, and charter
    schools.
        DOD supports charter school options on military installations as
    one approach to improving the public schooling of military children.
        Specific examples of DOD's support of charter schools are the three
    Charter Schools currently on military installations, Joint Reserve Base
    New Orleans, Davis Monthan Air Force Base, and Vandenberg Air Force
    Base.

        24. Senator Graham. Dr. Stanley, what would be the advantages of
    DOD looking at this type of public option on military installations?
        Dr. Stanley. An advantage of charter schools on military
    installations is to provide our families with another viable public
    school option when considering where to educate their children.
    Additionally, starting a charter school takes community investment and
    involvement, we encourage our families and leadership to be involved in
    their children's education.
        DOD does not have the authority to establish charter schools. There
    are, however 158 public schools on 68 military installations which are
    not DOD schools. The establishment of charter schools could be another
    alternative.

        25. Senator Graham. Dr. Stanley, can you envision a circumstance in
    which an opportunity scholarship program could address the concerns of
    military families regarding expanded educational options?
        Dr. Stanley. Yes, I can envision a circumstance in which
    opportunity scholarship programs could address military families'
    concerns for expanded educational options. I consider education
    opportunities for military families an important Departmental goal.

        26. Senator Graham. Mr. Ginsberg, I understand that the Air Force
    hosts two charter schools, one at Davis-Monthan in Arizona and one at
    Vandenberg Air Force Base in California. What have you learned in this
    experience; some of the best practices that could be shared, especially
    in terms of funding for facilities and capital expenses, drafting of a
    school's charter or contract, staffing, etc? What unique challenges
    does the Air Force face in establishing carter schools on military
    installations?
        Mr. Ginsberg. The initiatives at Davis-Monthan AFB and Vandenberg
    AFB have worked for those two bases. Davis-Monthan used results from a
    survey of 200 parents to identify interest in, and a need for, an on-
    base middle school. The school liaison officer coordinated with base
    leadership including the Plans Office, Civil Engineering, the Legal
    Office, Contracting, and Security Forces to ensure smooth
    implementation of the charter school. The school on Davis-Monthan now
    has 114 students (5 are non-military connected) and is requesting
    future expansion (over 4 years) from grades 6-8 to grades 6-12. The
    school is housed in an existing facility that was previously leased to
    the local school district. The charter school company signed a no-fee
    lease and cares for the property and provides building maintenance.
        Davis-Monthan reports challenges do still exist, especially
    ensuring installation security procedures are communicated to and
    followed by all school personnel, students and parents. Included in
    maintaining these essential procedures is the proper coordination for
    the entrance of non-DOD personnel and school subcontractors onto the
    installation. In addition faculty members who are foreign national
    sometimes required an extended period of time for background checks.
        At Vandenberg AFB, the charter school, located on the base,
    operates as a public school with open enrollment. The base leases the
    school to the local education agency which, in turn, leases the
    building site to Manzanita Charter School. All facility maintenance,
    utilities, etc are paid by the charter school. The base does have
    jurisdiction for law enforcement and contingencies. Manzanita officials
    are very vocal about their continued desire to remain on base due to
    the outstanding relationship built with the military community.
    Military students account for approximately 100 of the 280 children
    enrolled. Parents of the military students are grateful to have the
    choice of attending a Lompoc Unified school District school or the
    Manzanita pubic charter school. Each entity operates off a different
    educational model, enabling parents to choose the best option for their
    child.
        Headquarters Air Force Services recently issued a memo to address
    the establishment of charter schools on or near Air Force
    installations. In an effort to provide standard procedures for Air
    Force base leadership in working with charter school initiatives in
    their communities, installation commanders now contact the Headquarters
    Air Force office with functional responsibility for military-connected
    student programs.

        27. Senator Graham. Dr. Stanley, Mr. Lamont, Mr. Garcia, and Mr.
    Ginsberg, how would you characterize the concerns of military families
    about the quality of education for their children?
        Dr. Stanley. The quality of K-12 education is an important factor
    for military families as they make career decisions on assignments and
    is linked to retention in the military services.
        A significant element of family readiness is an educational system
    which provides not only a quality education but recognizes and responds
    to the unique needs of children of military families.
        Children of military families face distinctive challenges
    unparalleled in the general student population. The most glaring of
    these challenges is the number of transitions military children undergo
    during their school years. Military children move on average six to
    nine times during their K-12 school years. Among the common stresses
    involved in children relocating to a new school are the differences in
    achievement standards, school protocol, course offerings,
    extracurricular activities, and academic requirements.
        These school-based transitions are exacerbated by the challenges of
    leaving a cadre of friends, educators, and caregivers the military
    child has spent months or years establishing. Additionally, one of the
    greatest difficulties military children will face, regardless of
    additional stresses of relocation and school transition, is the effect
    of being apart from one or both parents who may be deployed. All of
    these factors can result in military children suffering in areas of
    school performance and educational attainment.
        The Department offers a variety of support programs and educational
    opportunities to address these concerns.
        Mr. Lamont. Army parents care deeply that their children have
    access to quality educational opportunities despite the frequent moves
    and deployments. Recognizing this importance, one of the five tenets of
    the Army Family Covenant is our commitment to ensure excellence in
    schools. As our children move from State to State, school district to
    district, they encounter different achievement standards, school
    protocols, course offerings, extracurricular activities, and academic
    requirements that may jeopardize their educational progress to include
    high school graduation. These school-based transitions are further
    exacerbated by the challenges of leaving friends, educators, and
    caregivers that the military child has spent months or years
    establishing. Additionally, one of the greatest difficulties military
    children will face, regardless of additional stresses of relocation and
    school transition, is the effect of being apart from one or both
    parents who have been deployed. All of these factors can result in
    military children suffering in areas of school performance and
    educational attainment.
        Army has implemented several programs and initiatives to mitigate
    the effects of deployments and to help ensure smooth educational
    transitions as our children move from one installation to another. Army
    School Liaison Officers serves as advocates for military-connected
    students and assist them through school transitions and with school-
    related issues. Academic support services help students compensate for
    parental absences with on-post homework centers, and 24/7 online
    tutoring support for students regardless, of where they live. The Army
    provides specialized training for school personnel to ensure they are
    prepared for the challenges our military students face when their
    parents are deployed. In addition, Military Family Life Consultants,
    licensed mental health clinicians, have been placed in many of the
    public schools that serve large populations of military children, to
    assist students to effectively handle the stress of parental
    deployment.
        Mr. Garcia. Marine Corps and Navy parents rank quality K-12
    education very high on their priorities when making decisions that
    impact their families. It also gets high consideration on their career
    decisions, on assignments, and is linked to retention. One of the first
    areas many of our families explore when notified of a Permanent Change
    of Station (PCS) is the quality of the schools near their new
    installation. A significant element of family readiness is an
    educational system that provides not only a quality education, but also
    one that recognizes and responds to the unique needs of children of
    military families.
        Military children move several times during their K-12 school
    years. Continuous transitions equate to increased difficulties
    integrating into new schools which are usually in different States;
    adjusting to differences in achievement standards, enrollment criteria,
    school policies, and course offerings; access to or eligibility for
    extracurricular activities; and academic requirements for graduation.
    The Interstate Compact for Educational Opportunity for Military
    Children, now signed by 28 States, focuses on leveling the field for
    those issues. The DoN is engaged with the DOD in supporting that
    Compact.
        Mr. Ginsberg. Air Force families across the world include 175,000
    children ages 5-18 and these children generally move more than six to
    nine times during their K-12 school years, often making multiple moves
    in high school years alone. Academic standards, promotion/graduation
    requirements, services for children with special needs, eligibility for
    sports and extracurricular activities, and transfer and acceptance for
    records vary greatly from State to State and even district to district.
    While these are not new issues, national emphasis on quality education
    (as exemplified by strong interest in the re-authorization of the
    Elementary and Secondary Education Act), and higher standards for
    admission to many post high school education and training institutions
    increase the stakes like never before. In addition, the added stress of
    family separation due to deployments (recent study indicates 37 percent
    of children worry about safety of the deployed parent) has combined
    with transition issues to increase the need for providing information
    and support to military families dealing with military child education
    issues.
        Air Force families are no different than civilian families in that
    concern for the general well-being of their children is a primary
    driver in their lives. A major part of this sense of well-being is
    availability of quality education opportunities. Most of our families
    are fortunate to be located in areas where the local school districts
    (and overseas, the DODDS schools) provide a positive educational
    experience. In areas where that is not the case, our families have
    proven very proactive and resourceful in working with school liaison
    officers, installation leadership, local education agencies and others
    to find suitable educational augments or options.

        28. Senator Graham. Dr. Stanley, Mr. Lamont, Mr Garcia, and Mr.
    Ginsberg, what thoughts do you have on ideas that could lead to better
    options, including establishing charter schools or offering opportunity
    scholarships on military installations?
        Dr. Stanley. My ideas for better educational options include
    support for charter schools, DOD partnership with Department of
    Education, and an interagency collaboration.
        DOD supports charter school options on military installations as
    one approach to improving the public schooling of military kids. Like
    all parents, military parents want quality education for their
    children. A significant element of family readiness is an educational
    system that provides not only a quality education but one that
    recognizes and responds to the unique needs of children of military
    families.
        The Department is working on a collaborative Educational
    Partnership Initiative with the Department of Education in efforts to
    ease the transition of military students and to provide resources to
    local education agencies (LEA) who educate military children. DOD
    expanded mission is a proactive approach to addressing the issue of the
    availability of quality educational opportunities for military
    children.
        The Department is represented on the National Security Council
    Military Family Interagency Policy Committee (IPC) that has been
    established as part of the President's commitment to military families.
    This administration-wide effort is essential to focus the strengths of
    the various departments and agencies toward supporting and enriching
    the lives of our military families, including transition, achievement,
    and expanding educational options for military children.
        Mr. Lamont. While Army has no authority or expertise to establish
    charter schools, we fully support charter school options on military
    installations as one avenue to improve the educational achievement of
    military students and meet their unique needs. Using another approach,
    Army is an active participant in DOD's formal partnership with the
    Department of Education in an effort to ease the transition of military
    students and provide resources to local education agencies who educate
    military children. In June 2008, the Deputy Secretaries of Defense and
    Education signed a Memorandum of Understanding (MOU) to create a formal
    partnership between the two departments to support the education of
    military students. The MOU provides a comprehensive and cohesive
    structure for collaboration between the two Federal agencies as well as
    with local, State, and other relevant entities. Through the MOU, the
    agencies can now leverage their coordinated strengths to improve the
    educational opportunities of military connected students.
        Mr. Garcia. Navy and Marine Corps parents' desire for access to a
    quality K12 education is no different than most other parents. With our
    sailors and marines already experiencing a high state of readiness,
    regular relocations, and multiple/extended deployments, it is
    particularly important that Services do all they can to support access
    to quality education for their children. It is essential that we
    explore alternatives. However, the DoN does not have the authority, nor
    the required resources, to establish charter schools.
        Through recent improvements in the provision of civilian School
    Liaison Officers (SLO) at installations, an emphasis on Exceptional
    Family Member services, better collaboration with Local Educational
    Authorities (LEAs) through the Educational Partnership Initiative, and
    connections to the military liaisons working with States on the
    Interstate Compact, we've made great strides toward smoothing
    transitions for our students. A number of parents have opted to home
    school their children. While a viable option, it adds additional
    stressors to parents who are already experiencing difficulties and can
    even add to the economic burden of the family when a spouse must leave
    paid employment to educate their children. Our SLOs are helping by
    providing home school parents with linkages to networks and resources.
        The DoN supported the 2008 Memorandum of Understanding between DOD
    and the Department of Education which created a formal partnership to
    support the needs of military children. The DoN continues to work
    closely with DOD and the Department of Defense Education Activity
    (DODEA) on collaboration between local, State, and other agencies to
    support the educational opportunities of military children.
        Both the Navy and the Marine Corps will continue to place a high
    emphasis on collaborative relationships between military families and
    their LEAs and seek to find resolutions at the local level.
        Mr. Ginsberg. Installation commanders are encouraged to support
    parental and community efforts to develop/enhance learning
    opportunities for all children and especially military connected
    students. These opportunities can include traditional public schools,
    private schools, virtual schools, home schools, and charter schools.
        Headquarters Air Force Services recently issued a memo to address
    the establishment of charter schools on or near Air Force
    installations. In an effort to provide standard procedures for Air
    Force base leadership in working with charter school initiatives in
    their communities, installation commanders now contact the Headquarters
    Air Force office with functional responsibility for military connected
    student programs. This office provides procedural guidance and
    coordinates with other headquarters offices on related issues such as
    use/lease of Air Force facilities. This policy insures a positive,
    standardized approach to support of charter schools and other
    educational options for military-connected students.
        Air Force also works closely with the DODEA Educational Partnership
    Initiative, providing input and advocating for grants and other support
    to school districts that educate military-connected students. We
    believe this proactive approach will strengthen educational options
    within local education agencies for not just Air Force children but all
    students within these districts.

                                  legislation
        29. Senator Graham. Dr. Stanley, Mr. Lamont, Mr. Garcia, and Mr.
    Ginsberg, do you need any additional legislation in order for the DOD
    to move forward?
        Dr. Stanley. No, other than the fiscal year 2011 Omnibus
    legislative proposals submitted to Congress no further legislative
    adjustments for my organization, the Office of the Under Secretary of
    Defense (Personnel and Readiness), are needed at this time. If
    additional authority is required, the Department will follow the formal
    channels to work with Congress.
        Mr. Lamont. The Department is continually assessing the need for
    additional legislation. As we reach consensus as to what legislative
    changes will help DOD move forward, we will certainly communicate those
    recommendations to Congress.
        Mr. Garcia. The Department of Navy is not currently seeking new
    legislative authorities. If new legislative requirements are
    identified, we will propose their inclusion in the Defense Legislative
    Program.
        Mr. Ginsberg. Yes. Compressed Orderly Rapid Equitable Replacement
        DOD has transmitted a proposal to authorize the Secretary of
    Defense and the Air Force specifically to conduct an alternate,
    streamlined Equal Opportunity complaint processing system similar to a
    highly successful pilot program the Air Force conducted from 2005-2007
    pursuant to a congressional mandate. This system is completely optional
    for the complainant, stresses early dispute resolution, consolidates
    processes in the administrative stage and preserves the complainant's
    full right to appeal to the Equal Employment Opportunity Commission and
    to bring suit in Federal court. According to a June 2008 DOD report to
    the Government Accountability Office report, the previous pilot cut
    processing times for cases that used this alternate system by
    approximately 50 percent (from 216 calendar days to 109). We
    found this to be an effective tool in addressing the chronic problem of
    excessive time to process these complaints. It saves resources and
    leads to a quicker resolution of the complainant allowing complainants,
    coworkers and managers involved to return their full focus to the
    mission. We would ask that this legislation be favorably considered.

        [Whereupon, at 12:41 p.m., the subcommittee adjourned.]

    DEPARTMENT OF DEFENSE AUTHORIZATION FOR APPROPRIATIONS FOR FISCAL YEAR
                                      2011

                                  ----------

                           WEDNESDAY, MARCH 24, 2010

                                   U.S. Senate,
                             Subcommittee on Personnel,
                                   Committee on Armed Services,
                                                        Washington, DC.

           MILITARY HEALTH SYSTEM PROGRAMS, POLICIES, AND INITIATIVES

        The subcommittee met, pursuant to notice, at 10:02 a.m. in
    room SR-232A, Russell Senate Office Building, Senator Jim Webb
    (chairman of the subcommittee) presiding.
        Committee members present: Senators Webb, McCaskill,
    Begich, Graham, and Thune.
        Also present: Senator Cardin.
        Majority staff members present: Jonathan D. Clark, counsel;
    Gabriella Eisen, counsel; and Gerald J. Leeling, counsel.
        Minority staff members present: Diana G. Tabler,
    professional staff member; and Richard F. Walsh, minority
    counsel.
        Staff assistants present: Paul J. Hubbard and Jennifer R.
    Knowles.
        Committee members' assistants present: Nick Ikeda,
    assistant to Senator Akaka; Gordon I. Peterson, assistant to
    Senator Webb; Tressa Guenov, assistant to Senator McCaskill;
    Lindsay Kavanaugh, assistant to Senator Begich; and Walt Kuhn,
    assistant to Senator Graham.

            OPENING STATEMENT OF SENATOR JIM WEBB, CHAIRMAN

        Senator Webb. Good morning. The subcommittee meets today to
    receive testimony on Military Health System programs, policies,
    and initiatives in review of the National Defense Authorization
    Request for Fiscal Year 2011 and the Future Years Defense
    Program.
        The Military Health System serves a population of more than
    9.5 million eligible beneficiaries, both in military treatment
    facilities and through contracted private-sector care.
        The primary mission of the Military Health System is to
    maintain the health and readiness of our Active Duty military
    personnel, both at home and on the battlefield. The system also
    provides medical care for millions of dependents of Active Duty
    personnel, military retirees and their dependents, certain
    Guard and Reserve members and their families, and others.
        As one who's spent most of his life in and around the
    military, I note the presence of the ranking Republican.
        Senator Graham. Thanks for starting on time.
        Senator Webb. Yes.
        I care deeply about our special obligation to provide our
    military servicemembers, their families, retirees, and our
    veterans with the finest healthcare treatment available.
        For this reason, I introduced a companion bill in the
    Senate on Monday, when it was recognized that legislation was
    needed to explicitly state in the law that TRICARE and
    Department of Defense (DOD) nonappropriated-fund health plans
    meet the minimum essential coverage for individual healthcare
    insurance required by the healthcare reform bill. My bill was
    based on one introduced in the House of Representatives last
    Friday by Congressman Skelton.
        I appreciate the support demonstrated by Senator Graham and
    other members of this subcommittee for this bipartisan
    legislation. The measure was hotlined last night. I'm hopeful
    that our members will agree to pass it soon so that we can take
    this issue off the table as a matter of concern for our
    servicemembers, their families, and other beneficiaries.
        Nine years of conflict have stressed our military in ways
    that were not contemplated at the inception of the All-
    Volunteer Force. As I noted 3 years ago, and again 2 weeks ago,
    during this subcommittee's initial hearing in this session, we
    are in uncharted territory as a result of past rotation cycles,
    multiple combat deployments, and an unsatisfactory deployment-
    to-dwell ratio.
        Many of you will remember that I introduced what was called
    dwell time legislation 3 years ago, trying to put a safety net
    underneath our military members being deployed when the
    rotational cycles went below 1 to 1, although traditionally
    they were supposed to be, and have been, around 2 to 1--2 years
    home for every year deployed, 1 year home for every 6 months
    deployed.
        A lot of people at that time, I think, interpreted this
    legislation as politically motivated. I can say again, and
    reaffirm today, that it was not, that the well-being and proper
    leadership of our men and women in uniform is not the sole
    prerogative or the sole responsibility of our military
    commanders. The circumstances under which they serve, where,
    for how long, and under what conditions is very much the
    subject of the stewardship of Congress.
        My perspective on this issue is also shaped by 4 years
    spent as a counsel to the House Committee on Veterans' Affairs,
    when we did pioneering work in the areas of post-traumatic
    stress disorder (PTSD) and other issues posing long-term
    consequences for veterans of the Vietnam war.
        During the past 3 years, we've seen a marked improvement in
    areas such as the treatment of traumatic brain injury (TBI) and
    wounded warrior care management, but the Military Health System
    is still a work in progress. It's not enough simply to provide
    healthcare. It must also be the most appropriate and effective
    professional care given in a timely way. In this regard, I
    believe it's always important to point out our appreciation to
    the healthcare providers in each branch of the Armed Forces who
    treat and stabilize servicemembers wounded in battle. Our
    dedicated medical teams bring wounded warriors from the
    battlefield to the operating room within what is called the
    ``golden hour,'' enabling our medical professionals to achieve
    the best wartime survival rates, by far, in our Nation's
    history.
        The budget request for fiscal year 2011 includes more than
    a billion dollars for research into TBI and PTSD. Last year,
    the Army established a Warrior Transition Command to oversee
    the care and management of wounded, ill, and injured soldiers.
    The Navy and Marine Corps created programs, such as the Marine
    Corps Wounded Warrior Regiments and the Navy's Safe Harbor, to
    support a full-spectrum recovery process for sailors, marines,
    and their families.
        Our most pressing concern is the health of our
    servicemembers who are deployed, and who have been deployed
    repeatedly. Despite shortages of healthcare professionals, we
    must adequately assess the medical condition of our
    servicemembers, before and after they deploy, to include
    effective mental health screenings.
        We've seen recent reports of increased prescription drug
    use that are deeply troubling. In fact, the data is stunning,
    when you look at it. According to an article published this
    month by the Military Times, at least one in six servicemembers
    is on some form of psychiatric-related drug. The newspaper
    reported that the use of such medications is estimated to have
    increased by 76 percent since combat operations began in
    Afghanistan and Iraq, with antipsychotic prescriptions more
    than tripling from 2001 to 2009. Whether these drugs are
    antidepressants, pain medications, muscle relaxants, or
    antianxiety drugs, we really do need to understand the dynamic
    of this problem. We look to today's witnesses to help us
    understand the scope of these alarming trends and to describe
    what is being done to address them.
        I would say that there is a larger issue in play here that
    I have a great deal of concern about, and that is the
    transparency of what is actually happening to our Active Duty
    military when they are deployed, whether it is in the context
    of the combat operations that they are in, the living
    circumstances that they have in these deployed areas, or issues
    such as this.
        This subcommittee is also hearing reports of increased
    substance abuse, growing numbers of servicemembers with
    emotional difficulties across the Services, and a lack of
    access to mental healthcare. It's not enough to address these
    issues piecemeal, we must approach them holistically, because
    their effects, clearly, tend to overlap.
        At a hearing held by the Personnel Subcommittee last year,
    we were told by a number of military spouses that access to
    healthcare, including access to mental healthcare and specialty
    care, was a top concern. Clearly, our servicemembers must be
    secure in the knowledge that their family members are receiving
    the medical care that they need.
        We must also be mindful of the cost of providing this care.
    Secretary Gates said last year that ``healthcare is eating the
    Department alive.'' This year, he stated his desire to ``work
    with Congress, in figuring out a way to bring some modest
    control to this program.''
        We welcome any suggestions the Department and the Services
    may have to address the steadily increasing costs of providing
    healthcare under the Military Health System.
        Our military men and women in uniform and their families
    have given much to this country. We must do everything we can
    to ensure that they continue to receive the finest healthcare
    available. We cannot achieve that goal without open
    communication with DOD and with the Services. If we are not
    aware of a problem, we cannot be a part of a solution.
        I'd like now to recognize our ranking member, Senator
    Graham, if he has any opening statement.
        Senator Graham.
        Senator Graham. Thank you, Mr. Chairman, for holding this
    hearing.
        I'll tell you what, I'll just work my comments in with the
    witnesses. I know Senator Cardin is a busy man. I look forward
    to hearing what he has to say.
        Senator Webb. Without objection, all witness written
    testimony submitted for today's hearing will be included in the
    record.
        In addition, the National Military Family Association and
    Georgetown University Medical Center's Palliative Care Program
    have submitted testimony, and, without objection, this will
    also be included in the record.
        [The information referred to follows:]

        Senator Webb. I'm very pleased to introduce our colleague,
    Senator Ben Cardin, who is the lone witness on our first panel.
    Senator Cardin shares with me a great concern about the
    dramatic increase in the use of prescription drugs by
    servicemembers. I would like to express my appreciation to
    Senator Cardin, for having really gotten out in front of this
    issue and helped make all of us aware of the data that ended up
    being reported in USA Today. I invited him. I sought his
    testimony today. I would like to welcome you, this morning.
        Senator Cardin.

      STATEMENT OF HON. BENJAMIN L. CARDIN, U.S. SENATOR FROM THE
                           STATE OF MARYLAND

        Senator Cardin. Chairman Webb, first of all, thank you very
    much for holding this hearing and for your interest in this
    subject.
        Senator Graham, thank you for your continued interest in
    fighting for our soldiers in so many different ways. I'm
    honored to be before your committee, and I bring to your
    attention a serious issue concerning the health of our combat
    troops and how the military is dealing with the stress of
    combat and repeated deployments.
        There are some very disturbing statistics that the chairman
    mentioned in his opening statement. Let me try to just fill in
    a few more of the details. In 2009, there were 160 Active Duty
    Army suicides. That's a 15 percent increase from the previous
    year. We have an alarming use in the increase of
    antidepressants. In 2005, there were a little over 4,000 combat
    troops using antidepressants. That's about 1 percent. By 2007,
    it grew to over 19,000, or 5 percent, of our troops on
    antidepressants. That's a huge increase in the use of
    antidepressants, and that number remained pretty constant for
    2008.
        We do know that there is information that's been made
    available to us. I can cite just one source. The Army's Fifth
    Mental Health Advisory Team tells us that the use of
    antidepressants and sleeping pills of our combat troops in Iraq
    is 12 percent, and our combat troops in Afghanistan is 17
    percent. Mr. Chairman, as you said, one out of every six. We
    know that there's a huge number of those that are using these
    types of medications.
        There's a real question as to whether they're receiving the
    proper medical supervision, the proper monitoring. This is
    particularly true during the first 6 weeks, when medications
    are taken and when your body adjusts to the medicines that
    you're taking, so that the adverse reactions are less likely.
        In combat, the antidepressant that's most likely used is
    selective serotonin reuptake inhibitors (SSRI). Since 2004, the
    Food and Drug Administration (FDA) has required a warning on
    the use of these types of antidepressants by the increased risk
    of suicidal thoughts. The vulnerable age that the FDA tells us
    is 18 to 24. Forty-one percent of those deployed in Iraq and
    Afghanistan fall within that age group, which should have all
    of us concerned.
        I want to say, I think DOD has made some strides in the
    right direction. As part of the National Defense Authorization
    Act for Fiscal Year 2010, I offered an amendment that requested
    information to be made available to our congressional
    committees on the numbers taking these drugs over the next 5-
    year period. It was included in the Senate version. It was not
    included in the conference version. I did send a letter to
    Secretary Gates, and I want to compliment Secretary Gates. He
    supplied the information to my office. I have had a chance to
    talk to him personally. I think he understands the seriousness
    of this matter.
        There's been significant improvements in the predeployment
    screening for healthcare issues for our soldiers before they go
    to combat. There's been post-deployment healthcare assessment
    and treatment. I acknowledge that. But, I still think we need
    DOD's help in trying to understand what is happening, as far as
    the use of these prescribed drugs.
        We have a lot of dots, but we haven't connected the dots. I
    really do ask this committee, and I'll be asking my colleagues
    in the Senate, to help in trying to understand what is
    happening here. Why has there been such a large increase in the
    use of antidepressants? I think we need to have the answers to
    the questions. We need to know whether there is proper medical
    supervision for those who are taking prescribed
    antidepressants. We need to know what the policy is for those
    soldiers that are in combat. If they start on antidepressants,
    what is the policy of the military during those first 6 weeks?
    Are they to be sent into combat itself, again, there is a
    particular vulnerability during that 6-week period. I'm not
    aware if there is a policy, and I think this committee needs to
    know, and the U.S. Senate needs to know.
        I think we need to have a better understanding of the
    relationship between the use of antidepressants and suicide
    within the military. I would urge us to make the resources
    available for a scientific study, with peer review, so that we
    can try to connect the dots. I think we need to know whether
    there are other treatment options, rather than the use of
    prescribed medicines. I certainly would urge us to request
    relevant data be made available to Congress on the use of
    antidepressants, so that we can be part of the oversight
    responsibilities that we have as Members of the U.S. Senate.
        I look forward to working with the committee. I look
    forward to working with my two colleagues. I think this is an
    important issue, and I thank you for giving it attention.
        [The prepared statement of Senator Cardin follows:]
                Prepared Statement by Senator Benjamin L. Cardin
        Chairman Webb, Ranking Member Graham and distinguished members of
    the subcommittee: thank you for your invitation to appear before you
    this morning.
        I am pleased to have this opportunity to discuss with you the issue
    of the deteriorating mental health of so many of our combat troops. On
    behalf of the American families whose loved ones have gone into harms
    way I come before you today to discuss the strains that have been
    placed upon our All-Volunteer Force.
        In 2009, an unprecedented 160 Active-Duty Army suicides were
    reported, representing a 15 percent increase over the previous year. In
    response to this growing concern I proposed an amendment (#1475) to the
    2010 National Defense Authorization Act (NDAA) which would have
    required the Department of Defense to report to Congress annually, for
    the next 5 years, the number and percentage of servicemembers who were
    prescribed antidepressant medications while serving in Iraq and
    Afghanistan. It would have also required that a study be initiated to
    investigate the relationship between the increased number of suicides
    and attempted suicides by members of the Armed Forces and the increased
    number of antidepressants and other behavior modifying prescriptions
    being used to treat anxiety for our combat troops.
        This amendment was successfully accepted into the Senate's version
    of the NDAA, but was unfortunately removed during the conference
    process.
        As a follow-up to my amendment, I also sent a letter to Defense
    Secretary Gates last November, asking him to provide details on the
    number of troops being prescribed antidepressant medications while
    serving in Iraq and Afghanistan. The intent of this letter was to get a
    preliminary assessment of the number of troops being affected by the
    Department of Defense's (DOD) policies on mental health care in
    theater. This information, when coupled with the committee's
    requirement for the DOD to demonstrate their policies on how they
    manage patients prescribed antidepressants in-theater, would begin to
    provide insight into how the DOD was addressing this significant issue.
        As background to this discussion, I would like to first invite your
    attention to the following information. In October 2004, the Food and
    Drug Administration (FDA) directed manufacturers of a certain class of
    anti-depressants known as Selective Serotonin Reuptake Inhibitors--
    commonly referred to as SSRIs--to add a black box warning that alerted
    the public to the increased risk of suicidal thoughts by children and
    adolescents. By May 2007, the FDA further directed that the warning be
    extended to include young adults from ages 18 to 24, with an emphasis
    towards the first 6 weeks of initiating treatment.
        The FDA's decision to extend the black box warning was the result
    of scientific findings that children with major depressive disorders
    showed significant increases in the risk of ``possible suicidal
    ideation and suicidal behavior.'' An additional analysis indicated a
    one-and-a-half fold increase in the potential for suicide in the 18-24
    year old age group. For the purpose of today's hearing, it is
    critically important to understand that this same age group--18-24 year
    olds--comprises about 41 percent of our young men and women currently
    deployed to Iraq and Afghanistan.
        Now, during the 2005 to 2008 time period (the last year full data
    were provided by the DOD) there was a 400 percent increase in the
    prescription of antidepressants and other drugs used to treat anxiety--
    a disproportionate number of which are the SSRIs I just described. Of
    the 18,155 troops taking antidepressants while on deployment in 2008,
    98.5 percent of them initiated the use of the drug while on deployment.
        Data contained in the Army's Fifth Mental Health Advisory Team
    Report indicate that roughly 12 percent of combat troops in Iraq and 17
    percent of those in Afghanistan were taking prescription
    antidepressants or sleeping pills to help them cope with the stress of
    their deployments. While the sixth report--released in late 2009 from
    this same group of mental health professionals--shows that the suicide
    rate in Iraq had since stabilized, it more tellingly indicates that the
    suicide rate in Afghanistan doubled during the same timeframe.
        It bears repeating that military personnel, who are being called
    upon to serve in a forward deployed combat area, often for up to a
    year-long deployment, are being prescribed medications with a warning
    that indicates potential side effects which include an increased risk
    of suicide as well as aggressive, angry, or violent behavior.
        This deeply concerns me, and it should equally concern those who
    are responsible for the long-term mental health of our servicemembers.
        I submit, for your consideration, the following questions that I
    hope you will agree merit a response from those charged with caring for
    these young men and women:

             If the DOD is medicating personnel in forward deployed
            combat areas, how are they maintaining the necessary oversight
            of these soldiers, sailors, and marines, especially during the
            initial 6-week window when the increased risk of suicidal
            thoughts is said to occur?
             Are these personnel removed from combat status? (At
            least during the first 6 weeks of medication).
             Who makes the determination of whether a servicemember
            undergoing mental health treatment in-theatre is deemed fit-
            for-duty? Is it the physician or mental health professional, or
            is it the servicemember's operational commander, and if so, is
            this the right person to make that decision? Why?

        Let me in closing recognize that the DOD has made significant
    strides in addressing both its pre-deployment health care screenings
    and its post-deployment health care follow-ups and treatment when
    necessary. It has also achieved many positive steps towards
    destigmatizing the process of seeking and obtaining mental health care
    for our troops.
        In light of this, I recognize that to move forward with a review of
    DOD's procedures, great caution must be exercised so as to avoid
    undoing the progress that has been made. Due diligence, however,
    dictates that Congress utilize its oversight authority in this matter
    and investigate whether the DOD's current policies regarding the use of
    prescription antidepressant drugs--most notably those known adverse
    side effects--pose an unacceptably high risk to our troops--especially
    while they are serving in forward operating areas.
        Since the beginning of the current conflicts there has been a
    steady increase in the number of suicides and suicide attempts by
    current and past members of our Armed Forces. We have been told that
    there is no one reason for this increase, but rather a combination of
    causes and stressors. However, we cannot ignore that this has occurred
    at the same time as we have witnessed a four-fold increase in the
    number of psychiatric medications being prescribed to our men and women
    serving in combat areas.
        Admittedly, much debate continues within the scientific and mental
    healthcare communities over the potential relationship and extent
    between the use of psychiatric medication and suicide.
        Mr. Chairman, we owe it to our servicemembers--past, present, and
    future--and to their families, to do everything in our power to ensure
    that the mental healthcare they receive is the best our Nation can
    offer. For this reason, I ask that you and the rest of my Senate
    colleagues will again consider requiring the implementation of an
    annual reporting mechanism for DOD to come before Congress and disclose
    the extent to which it is employing antidepressant medications to treat
    the wartime stress and overall mental health of our service men and
    women. I would also ask that the DOD be directed and sufficiently
    funded to contract for a scientific, peer-reviewable study of the
    potential relationship between this increased use of antidepressant
    medications and the increased number of military suicides.
        I thank you again Mr. Chairman, Ranking Member Graham, and the
    distinguished members of this subcommittee. I hope that my testimony
    before you today has been truly enlightening, and will serve as a call
    to action on this important issue.

        Senator Webb. Senator Cardin, thank you very much for
    having worked so hard to bring this matter to the attention of
    the Senate and of Congress. You have our commitment that we
    will be working on it. We will actually be seeking observations
    of the witnesses that follow you today.
        Thank you for being with us.
        Senator Cardin. Thank you.
        Senator Graham. Thank you, Senator. What you're pointing
    out is very important to the country, and I appreciate your
    interest, and we'll get some answers to these real legitimate
    questions.
        Senator Cardin. Appreciate it.
        Senator Webb. I'm pleased now to welcome and introduce the
    witnesses for our second panel. They are Dr. Charles L. Rice,
    who is performing the duties of the Assistant Secretary of
    Defense for Health Affairs and Acting Director of TRICARE
    Management Activity--you could join us as we announce your
    names--Rear Admiral Christine Hunter, U.S. Navy, Deputy
    Director of TRICARE Management Activity; Lieutenant General
    Eric B. Schoomaker, U.S. Army, Surgeon General of the Army and
    Commander of U.S. Army Medical Command; Vice Admiral Adam
    Robinson, Jr., U.S. Navy, Surgeon General of the Navy, and
    Chief of the Navy Bureau of Medicine and Surgery; Lieutenant
    General Charles B. Green, U.S. Air Force, Surgeon General of
    the Air Force; and Rear Admiral Richard R. Jeffries, U.S. Navy,
    who is the Medical Officer of the U.S. Marine Corps.
        I'd like to thank all of you for joining us today to
    discuss the vital issues associated with military healthcare. I
    would like to ask Dr. Rice to begin the panel's opening
    statements. Unless there's some special protocol, maybe we
    could just work across the table.
        Senator Graham. Sounds good to me.
        Senator Webb. Welcome to you all.
        Dr. Rice, the floor is yours.

     STATEMENT OF CHARLES L. RICE, M.D., PERFORMING THE DUTIES OF
      THE ASSISTANT SECRETARY OF DEFENSE FOR HEALTH AFFAIRS, AND
              ACTING DIRECTOR, TRICARE MANAGEMENT ACTIVITY

        Dr. Rice. Thank you, Mr. Chairman, Senator Graham, for the
    opportunity to come before you today.
        Late February, I was asked by Dr. Stanley, the Under
    Secretary of Defense for Personnel and Readiness, to perform
    the duties of the Assistant Secretary of Defense for Health
    Affairs, stepping away from my permanent position as the
    President of the Uniformed Services University until President
    Obama's choice for this job is confirmed by the Senate and
    sworn in, whereupon I will happily return to Uniformed Services
    University.
        I'm honored to be here and to be able to represent the men
    and women who serve in our Military Health System and deeply
    appreciative of the support you have always provided military
    medicine and for your unwavering support to the University.
        I have submitted my written comments to the committee, and
    with your indulgence, I'd like to make just some very brief
    opening remarks.
        I approach my role as the senior medical advisor to
    Secretary Gates and Secretary Stanley with advantages of
    multiple perspectives. As a trauma surgeon, as an educator, as
    a retired Navy medical officer, and, like you, Mr. Chairman, as
    the father of an Active Duty servicemember, this issue is
    personal to me.
        There is much to be proud of in the Military Healthcare
    System. The performance of our military medics in combat
    remains nothing short of remarkable. In addition to the
    lifesaving care on the battlefield, we're continuously
    improving the medical readiness of the total force.
        We monitor and record the health of servicemembers in the
    most comprehensive manner ever witnessed throughout the cycle
    of deployment, before, during, and after their service in
    combat theaters. Despite the breakneck pace of combat, our
    medical personnel have responded heroically to natural
    disasters in Haiti and Chile.
        I know that you share this pride in the people who serve
    our Nation, and so, today I want to focus on those areas where
    greater attention is required from me, so that you will
    understand where I focus my energies.
        First, our deepest obligations are reserved for the
    casualties returning to the United States and to their families
    and the caregivers who support them. Substantial progress has
    been made since problems with wounded warrior support first
    came to light in 2007. This committee has played an important
    role for driving change, standing up new programs, and ensuring
    substantial new resources to address any shortcomings. We are
    grateful for that.
        More needs to happen on our end to ensure that the
    programs, services, health information, and communication are
    knitted together more tightly so that we can provide more clear
    and cohesive services to those families who continue to
    sacrifice so much.
        Second, I am intently focused on the performance and the
    perception of our electronic health record, AHLTA. My intent is
    not to micromanage the many technological issues, but to
    determine whether our proposed solutions will result in better
    capability for our providers--nurses, physicians, pharmacists--
    all the key members of the healthcare team, and to deliver
    value for patients. The key test for a successful electronic
    health record is whether it leads to better quality care. If
    our current effort fails that test, we will find one that can
    deliver on that crucial expectation.
        Third, the Department continues to implement the broad
    changes required by the 2005 Base Realignment and Closure
    Commission. Our approach to the right organizational construct
    and how we build medical facilities design must result in
    better service, better quality, and better access for our
    patients. Investments in evidence-based design concepts for our
    new facilities are critically important. They offer a better
    healing environment for patients and for their families.
        The hospital at Fort Belvoir will be a showcase for this
    new approach. I was there last week with General Schoomaker and
    was truly dazzled by the design concepts that have been
    incorporated to create an unmatched healing environment. If you
    haven't been down to see it, I urge you to try to work a visit
    in to your busy schedules.
        In addition to design, we need to better integrate service
    delivery across the military branches, an effort that will
    require sustained effort in decisions in the months ahead to
    better serve our patients.
        Fourth, we're working to resolve the serious matters
    identified in the protests upheld by the Government
    Accountability Office (GAO) regarding the TRICARE system
    contract awards. While the issues that we must address are
    serious, I am reassured, and want to reassure you, that the
    internal issues affecting these awards have not affected the
    day-to-day service for our beneficiaries. Nonetheless, our
    efforts to control TRICARE cost growth are closely linked to
    the effective implementation of new contracts. It is in the
    best interests of the government and of the organizations who
    are involved in these contract decisions to move toward a
    definitive conclusion. I'm grateful to Admiral Hunter for her
    leadership in this area.
        Finally, I'd like to briefly comment on the larger issue of
    national healthcare reform that you alluded to, Mr. Chairman.
    It has been the focus of much attention this week. Although the
    Military Health System is in many ways a unique system of care,
    we do not function apart from the civilian healthcare system
    used by the American people. In fact, almost 70 percent of the
    care our beneficiaries receive is delivered by our civilian
    colleagues.
        TRICARE benefits will not be affected at all by the passage
    of reform. We know that the DOD medical benefit is,
    appropriately, one of the most comprehensive medical benefits
    of any employer. One visit to Walter Reed or Bethesda
    demonstrates why this should be so more than any words I can
    offer here.
        Yet, there are other potential benefits that will accrue to
    the Department when more Americans are covered by insurance.
    This includes a more medically fit recruiting pool, greater
    investments in comparative effectiveness research that will
    help all practitioners of care with delivering scientifically
    valid approaches to medicine, and a more secure transition for
    those members of our Armed Forces who decide to separate prior
    to full retirement.
        I will be working with my healthcare colleagues at the
    Department of Health and Human Services and elsewhere to ensure
    that we're appropriately involved in the implementation of
    healthcare reform initiatives that both reassure our
    beneficiaries and promote the goals of reform.
        Mr. Chairman, I want to thank you again for your steadfast
    support of the Military Health System. I look forward to your
    questions.
        [The joint prepared statement of Dr. Rice and Rear Admiral
    Hunter follows:]
     Joint Prepared Statement by Charles L. Rice, M.D., and RADM Christine
                                 S. Hunter, USN
        Mr. Chairman, members of the committee, thank you for the
    opportunity to discuss the Military Health System's (MHS) priorities
    and budget for fiscal year 2011.
        We have enduring obligations to the men and women of our Armed
    Forces, and to their families who serve with them, and to the millions
    of retired military personnel who have served us in the past.
        This obligation begins the moment a recruit walks through our
    doors. In our budget for the coming year, we acknowledge that lifetime
    commitment we have to those who serve today or have served in the past,
    and to their families.
        For those servicemembers who honorably conclude their service
    before reaching military retirement, we have an obligation to ensure
    their medical experience is fully captured and easily shared with the
    Department of Veterans Affairs (VA) or with their own private
    physician. For those who retire from military service, our obligation
    to them and their families often extends for a lifetime.
        For those who have borne the greatest burden, through injury or
    disease suffered in our Nation's conflicts, we have an even higher
    obligation to the wounded and their families. As Secretary Gates stated
    with the introduction of the Defense budget, ``Recognizing the strain
    that post-September 11 wars have put on so many troops and their
    families, the department will spend more than $2 billion for wounded
    warrior initiatives, with a special focus on the signature ailments of
    current conflict, such as post-traumatic stress disorder (PTSD) and
    traumatic brain injury. We will sustain health benefits and enlarge the
    pool of medical professionals. We will broaden electronic information-
    sharing between the Department of Defense (DOD) and VA for wounded
    warriors making the transition out of military service.''
        The budget we are putting forward reflects our commitment to the
    broad range of responsibilities of the MHS--the medical readiness
    requirements needed for success on today's battlefield; the medical
    research and development necessary for success on tomorrow's; the
    patient-centered approach to care that is being woven through the
    fabric of the MHS; the transformative focus we are placing on the
    health of our population; the public health role we play in our
    military community and in the broader American community; the reliance
    we have on our private sector health care partners who provide
    indispensable service to our servicemembers and families; and our
    responsibility to deliver all of these services with extraordinary
    quality and service.
        As our military forces in Afghanistan are engaged in combat
    operations to expand the security, governance, and development
    environment for the people of Afghanistan; as we continue with the
    careful hand-off of responsibilities to the elected leaders of Iraq;
    and, as marines provide security and the joint medical team provides
    care for the people of Haiti, we are mindful of the trust and
    investment that the American people have made in military medicine. We
    will continue to honor that trust.
                         mhs mission and strategic plan
        The MHS overarching mission remains as in years past: to provide
    optimal health services in support of our Nation's military mission--
    anytime, anywhere.
        Over the last 12 months, the Office of the Assistant Secretary of
    Defense for Health Affairs has worked with our Service Surgeons General
    and the entire Joint MHS leadership team to update and refine the MHS
    Strategic Plan.
        In the process, we sought the expertise and advice from leaders
    both within our system and external to the MHS, to include renowned
    experts at the Mayo Clinic, Kaiser Permanente, Geisinger Health System,
    the Cleveland Clinic, Intermountain Health, and the Institute for
    Healthcare Improvement.
        This effort resulted in unanimous support for adopting ``The
    Quadruple Aim'' as the foundation for our strategic plan in the coming
    years.
        The Quadruple Aim borrows liberally (and with permission) from the
    Institute for Healthcare Improvement's ``Triple Aim,'' and is further
    tailored to the unique mission of the MHS. The four core components of
    the Quadruple Aim are:

             Readiness--Ensuring that the total military force is
            medically ready to deploy and that the medical force is ready
            to deliver health care anytime, anywhere in support of the full
            range of military operations, including combat support, defense
            support to civil authorities, and humanitarian assistance/
            disaster relief missions as we witnessed most recently in
            Haiti.
             Population Health--Improving the health of our
            population by encouraging healthy behaviors and reducing the
            likelihood of illness through focused prevention and the
            development of increased resilience.
             Experience of Care--Providing a care experience that
            is patient and family centered, compassionate, convenient,
            equitable, safe, evidence-based, and always of the highest
            quality.
             Cost--Creating value by focusing on measuring and
            enhancing quality healthcare; eliminating inefficiencies;
            reducing unwarranted variation; and emphasizing investments in
            health that reduce the burden and associated cost of
            preventable disease in the long term.

        The outcome of this strategic planning effort is more than the plan
    itself. The values and strategies we have articulated in our plan are
    reflected in our proposed budget.
        Whereas we take great pride in the past accomplishments of the
    joint MHS team, the overview we provide in the following pages for our
    fiscal year 2011 strategic priorities is forward-looking, not merely a
    reflection of past accomplishments. By aligning this testimony with our
    strategic plan, we link our budget proposal and priorities to our
    strategic focus inherent in the four core components of the Quadruple
    Aim.
                                   readiness
        A fit, healthy, and protected force is the starting point in
    ensuring a medically ready force. We have a core set of individual
    medical readiness (IMR) measures that inform both our line commanders
    and our medical teams about the individual preparedness of a
    servicemember to deploy.
        We will continue to use our monitoring systems so that we reduce
    the rate of deployment limiting conditions. We will also focus on
    disparities between the active and Reserve Components in terms of IMR,
    and improve the medical readiness of the Total Force.
        A critical companion strategic matter for the Department is the
    psychological health of our people. Between 20-30 percent of our
    servicemembers who have deployed to Operation Iraqi Freedom or
    Operation Enduring Freedom (OIF/OEF) have reported some form of
    psychological distress. As has been widely noted, suicide rates in the
    Armed Forces have also been rising. DOD and the individual Services are
    studying every suicide or suicide attempt closely, and we have
    collectively introduced a number of new programs and initiatives to
    reduce the occurrence of suicide. We are engaging commanders, the
    medical research community and fellow servicemembers in a multi-tiered
    effort to understand and implement effective strategies to deter
    suicide; to reduce the stigma of seeking professional help and
    counseling; and to ensure there are adequate personnel resources to
    meet a clear and growing demand for mental health services.
        We remain focused on accelerating our research into and the
    adoption of evidence-based care treatments for personnel with PTSD and
    traumatic brain injury. Secretary Gates continues to be personally
    interested in seeing us move information from the research realm to the
    field in a much more rapid manner.
        We are proposing another $669 million to support our requirements
    in meeting these critical needs in support of psychological health.
    Significant funds are also directed to other critical battlefield
    medical research and development needs.
        In addition, our investments in Defense Centers of Excellence and
    the Defense and Veterans Brain Injury Center are funded and poised for
    delivering world-class care and service to our military and veteran
    populations.
        Finally, in fiscal year 2010 and fiscal year 2011, we will be
    undertaking actions to expand our measures of ``readiness.''
    Specifically, we will be assessing how to better measure ``family
    readiness.'' There is no question that the health and resiliency of the
    entire family is tied to the readiness of the individual soldier,
    sailor, airman, and marine. Our efforts will be directed toward
    measures that help us proactively identify and address health risks
    within a family prior to deployment.
                               population health
        There are few organizations in the world that compare to the DOD in
    having the right incentives to truly invest in population health
    efforts. A significant number of military personnel and their families
    will have their health care managed by DOD or other Federal and private
    sector partners for their lifetimes. Accordingly, we will continue to
    develop and employ the best tools and programs to transform our culture
    to one focused not just on expertly treating disease and injury, but to
    one focused on sustaining the health and well-being of our population.
        There are a number of tools and programs at our disposal to improve
    overall population health. The Department will continue to invest
    deeply in our preventive service programs. We will improve our provider
    support tools so that opportunities for education or preventive
    treatment can be engaged at all patient-provider opportunities.
        We will closely track our performance in delivering preventive
    services using the Health Employer Data Information System (HEDIS)
    measures. HEDIS allows us the opportunity to compare ourselves among
    each Service or MTF, but equally importantly, to compare ourselves
    against our private sector counterparts. In 2009, we witnessed
    impressive gains in preventive service delivery as compared to both
    national norms and national benchmarks, particularly in the Army and
    Navy, after introducing pay for performance incentive programs.
        We recognize, however, that not all measures are moving in the
    right direction. For example, we are seeing continued high levels of
    tobacco usage among our youngest servicemembers. We are also seeing
    rising rates of obesity in our non-active duty population (along with
    the related morbidities, particularly diabetes).
        As an aspect of our strategic imperatives, we are seeking to more
    directly and more personally engage patients to take a more active role
    in managing their health. We will seek to influence behaviors through
    increased positive actions (better nutrition and increased physical
    activity) and reduced negative habits (tobacco use and excessive
    alcohol intake).
        Our efforts to improve the overall health status of our population
    do not operate in a vacuum. Improvements are made one patient at a
    time; one patient visit at a time. In this regard, our efforts in this
    strategic arena are directly tied to our efforts at the individual
    level with their experience with the care received--and the topic of
    the next section.
                               experience of care
        One of our foremost and sustained priorities is to improve the
    experience of care for those who are most intimately interacting with
    our MHS every day--the wounded, ill, and injured from our current
    conflicts who are moving through the joint patient evacuation system,
    from point of injury in the theater of operations, to the point of
    definitive care in the United States, where many are recovering at our
    flagship military medical centers in the National Capital Area and
    other medical centers around the country.
        We remain grateful for the support of Congress, and especially this
    committee, to ensure we have the resources to provide the very best
    health care for our forces and their families, and in particular for
    the wounded, ill, and injured.
        We propose a budget of more than $670 million to support the
    spectrum of services for the wounded, ill, and injured--services which
    include enhanced case management, improvements to our Disability
    Evaluation System, and greater data sharing with the VA and other
    private sector medical organizations.
        Central to our efforts is the obligation to expedite the
    administrative elements of our disability cases, and work to get our
    Wounded Warriors to the best possible location to facilitate their
    recovery. We are expediting our Medical Evaluation Board (MEB) process
    toward a goal of completing all MEBs within 30 days.
        We have also successfully piloted efforts with the VA to have both
    Departments' medical examination requirements completed in a single
    exam--which increases the timeliness of processing and increases
    satisfaction with the entire experience for the servicemember.
        Enhancing the care experience is not limited, however, to our
    wounded warriors. It is imperative that we offer solutions and
    improvements for our entire beneficiary population we serve.
        The overriding issue in our system has historically been and
    continues to be ``access to care.'' Simply put, access is about getting
    the right care for the right patient at the right time.
        Our efforts to improve access in the coming year will be focused on
    expanding our ``Medical Home'' initiatives. The Patient Centered
    Medical Home provides patients with a known provider or small team of
    providers, who will get to know that patient and her or his medical
    problems. The continuity of care offered by this model, when coupled
    with enhanced access to the provider through telephone messaging or
    secure electronic communication and timely appointing, will enhance the
    quality and safety of care and improve the patient experience. This
    model has been endorsed by professional medical societies (the American
    Academy of Pediatrics and the American Academy of Family Physicians,
    American College of Physicians, and American Osteopathic Association),
    several large third party payers, employers, and health plans. Its
    adoption in the MHS reflects the continuation of a journey toward
    improving patient access and satisfaction.
        We will be providing our enrolled population with clear
    communications about how to access the appropriate level of medical
    care to meet their needs at any time, 24 hours a day, 7 days a week. We
    will offer our patients with multiple modes of accessing care, to
    include expansion of telephone access, and secure, web-based patient-
    provider messaging service.
                            per capita cost control
        We are proposing a fully funded budget for fiscal year 2011. The
    MHS serves 9.5 million beneficiaries, to include active duty members
    and their families, members of the Reserve Component and their
    families, and retired military personnel and their families. It is
    important to note that this number that has grown with the increased
    active duty end strength as well as the expansion of health benefits to
    members of the Reserve Component. Thus, while real cost growth will
    continue to rise, we, nonetheless, will be focused on controlling per
    capita costs within our system.
        Our primary and most strategically important bulwark against
    unmanaged cost growth for the coming year is quality. Our efforts to
    develop, proliferate and adhere to evidence-based guidelines will have
    the most dramatic effect on our costs. In this instance, we will again
    compare ourselves against each other and against private sector data
    using the Dartmouth Atlas as our guide. Our goal is to reduce
    inappropriate variation in the utilization of services.
        The urgency of addressing costs in fiscal year 2011 is clear from
    our budget request. A major increase in the budget request includes
    $1.2 billion for private sector care costs due to an increase in users
    of TRICARE and an increase in utilization of the TRICARE benefit.
        We recognize that this focus on quality and utilization does not
    diminish the need for wise and informed management actions to also
    control costs. In fiscal year 2011, we will also:

             continue implementation of Federal Ceiling Pricing of
            retail pharmaceuticals;
             continue implementation of the Outpatient Prospective
            Payment System, which reduces the reimbursement paid for
            outpatient care at inpatient private sector care facilities;
             standardize medical supply chain management across the
            full range of military health care operations;
             increase efforts to identify and detect fraud, waste,
            abuse, and overpayments to civilian medical providers; and
             pursue the first fully integrated Joint DOD/VA
            healthcare collaboration consisting of the North Chicago
            Veterans Affairs Medical Center and the Navy Health Clinic,
            Great Lakes, IL.

        Through improved access to care from the medical home initiative
    and adherence to evidence-based care guidelines, we are hoping to
    reduce the need for referrals to private sector sources wherever
    possible, and to decrease utilization of emergency room services (when
    used as a source for non-emergent primary care).
        We recognize that the MHS is not immune from the cost growth
    challenges faced by our private sector peers. The ever-increasing value
    of the TRICARE benefit against private sector plans and premiums will
    likely place additional pressure on the MHS budget. Yet, along with the
    civilian and military leadership of the Department, we are mindful of
    the trade-offs being made every day to sustain this system of care.
                              learning and growth
        Fiscal year 2011 promises to be both exciting and challenging, as
    many of the Department's most significant health efforts will be
    advanced in bold and meaningful ways. The 2005 Base Realignment and
    Closure actions, which impact medical facilities in multiple joint
    medical markets, the joint Medical Education and Training Campus, and
    co-location of medical headquarters, will come to fruition in September
    2011. Additionally, work on the Electronic Health Record (EHR) will
    continue on the trajectory toward improved system effectiveness and
    interoperability. The Department will continue to address and resolve
    governance issues related to emerging requirements to organize,
    execute, and oversee joint peacetime health care activities.
        In this dynamic environment, supporting the Quadruple Aim is an
    objective that must continue to grow and support the people who serve
    the MHS. Our major initiatives for this year center on: (1) furthering
    the MHS, contribution to medical science; (2) delivering information to
    enable better healthcare decisions; and (3) ensuring a fully capable
    workforce most prepared to support our strategic initiatives.
        Our medical research program continues to grow, with the leadership
    of Secretary Gates and the ongoing support of Congress. Significant
    funding has been dedicated to TBI and psychological health; battlefield
    medicine; threats from the full range of chemical, biological,
    radiobiological and nuclear threats. Our EHR continues to serve a vital
    function in support of our clinicians and patients. The incredibly rich
    clinical data repository is capturing care delivered throughout our
    system, to include outpatient services in the combat theaters. In each
    successive year, we are able to transfer more health information more
    easily with our counterparts in the VA.
        Yet, our EHR has not been without its technical challenges. For
    fiscal year 2011, we are proposing a total of $875 million for
    modernization efforts and to enable data interoperability with the
    Virtual Lifetime Electronic Record (VLER), being jointly led by DOD and
    the VA. VLER is an ambitious and needed undertaking to integrate
    medical, personnel benefits, and financial information in a single
    virtual record for veterans.
        Finally, vital to our ability to deliver a high quality, accessible
    and cost-effective health system is a workforce that is trained and
    ready to operate in a fast-paced environment. We are investing in
    recruitment and retention programs to sustain our system. We have
    proposed legislation that will allow us to offer post-graduate
    scholarships for MHS civilians. We are partnering with universities,
    marketing our job opportunities to their graduates. Outreach activities
    include attending job fairs, speaking at professional conferences, and
    marketing through our MHS website. Partnering with the VA has allowed
    us to share recruiting opportunities, improving our mutual ability to
    recruit scarce medical professionals. In all, our MHS human capital
    programs will continue to allow us to extol the benefits of public
    service while supporting our strategic initiatives.
        We are proud to serve with the talented, dedicated and resourceful
    team of public servants and military volunteers who comprise the MHS.
    We are committed to enhancing their professional experience in service
    to the country.
              unified medical budget request for fiscal year 2011
        The Defense Health Program (DHP), the appropriation that supports
    the MHS, is under mounting financial pressure. The DHP has more than
    doubled since 2001--from $19 billion to $50.7 billion in fiscal year
    2010.
        The majority of DOD health spending supports health care benefits
    for military retirees and their dependents, not the active force. We
    project that up to 65 percent of DOD healthcare spending will be going
    toward retirees in fiscal year 2011--up from 45 percent in fiscal year
    2001. As civilian employers' health costs are shifted to their military
    retiree employees, TRICARE is seen as a better, less costly option and
    they are likely to drop their employer's insurance. These costs are
    expected to grow from 6 percent of the Department's total budget in
    fiscal year 2001 to more than 10 percent in fiscal year 2015.
        Despite these fiscal challenges, the fiscal year 2011 budget
    request provides realistic funding for projected health care
    requirements.
        The Unified Medical Budget, the Department's total request for
    healthcare in fiscal year 2011, is $50.7 billion. This includes the DHP
    appropriation, including Wounded, Ill and Injured Care and
    Rehabilitation; Military Personnel, Military Construction, and normal
    cost contributions for the Medicare-Eligible Retiree Healthcare.
        89Defense Health Program
        The largest portion of the request, or $30.9 billion, will be used
    to fund the DHP, which is comprised of Operation & Maintenance (O&M),
    Procurement and Research, Development, Test & Evaluation (RDT&E). A
    little over $29.9 billion is for O&M, which funds most day-to-day
    operational costs of healthcare activities;
                      military personnel and construction
        For Military Personnel, the Unified Medical Budget includes $7.9
    billion to support the more than 84,000 military personnel who provide
    healthcare services in military theaters of operations and fixed health
    care facilities around the world. These services include medical and
    dental care, global aeromedical evacuation, shipboard, and undersea
    medicine, and global humanitarian assistance and response.
        Funding for medical Military Construction (MILCON) includes $1.0
    billion to improve our medical infrastructure. We are committed to
    building new hospitals using the principles of Evidence-Based Design
    (EBD). We are excited to be able to open a national showcase in EBD,
    the new Fort Belvoir Hospital, in 2011.
        MILCON funding will also be directed toward infrastructure
    enhancements at the National Interagency Biodefense Campus at Fort
    Detrick, MD--a vital resource for the Nation.
                 dod medicare-eligible retiree health care fund
        The estimated normal cost of the Medicare-Eligible Retiree Health
    Care Fund in fiscal year 2010 is $10.9 billion. This funding includes
    payments for care in MTFs, to private health care providers, and to
    reimburse the Services for military labor used in the provision of
    healthcare services.
                                   conclusion
        Mr. Chairman, the Military Health System continues to provide
    world-class medical care for a population that demands and deserves the
    best care anywhere. We are proud to represent the men and women who
    comprise the MHS. We are proud to submit to you and your committee
    members a budget that is fully funded and that we can successfully
    execute in the coming year.
        We are pleased that we are able to provide you a budget with a
    direct and specific link to our strategic planning efforts of the last
    year.
        Thank you again, Mr. Chairman, for the opportunity to be with you
    today. We look forward to your questions.

        Senator Webb. Thank you very much, Dr. Rice.
        Admiral Hunter, welcome.

     STATEMENT OF RADM CHRISTINE S. HUNTER, USN, DEPUTY DIRECTOR,
                      TRICARE MANAGEMENT ACTIVITY

        Admiral Hunter. Thank you, Mr. Chairman, Senator Graham.
    I'm really honored to be able to appear before you today.
        Together with Dr. Rice, I have the responsibility for
    operating the TRICARE Management Activity (TMA) and
    administering the TRICARE benefit.
        As you said, 9.6 million Americans rely on us to ensure
    they receive high-quality healthcare whenever they need it and
    wherever they are in the world. Along with the growth in the
    Army and Marine Corps, our program has grown by over 370,000
    servicemembers, families, and retirees since 2008.
        Since assuming my responsibilities 10 months ago, I've been
    fortunate to work closely on many critical initiatives with DOD
    leaders, the Service Surgeons General, and key stakeholders who
    represent our beneficiaries.
        Initially, we focused our efforts on the care of wounded
    warriors, access to care, particularly behavioral healthcare,
    and services for families whose children have special needs.
        More recently, we introduced the construct of the Quadruple
    Aim and carefully examined how we're performing in each domain.
    The Quadruple Aim builds on the Institute for Healthcare
    Improvements Triple Aim for Health Systems, which advocates
    that we achieve excellence in population health, the patient
    experience, and responsibly manage the costs.
        In the Military Health System, our Quadruple Aim adds the
    fourth aim, a specific emphasis on our core mission of
    readiness. I'm pleased to report that we're making progress. To
    support readiness, certainly the Surgeons General will share
    many of their observations. But, at TMA we have concentrated on
    our Reserve and Guard populations, as well as behavioral
    health.
        Participation in our TRICARE Reserve Select product is
    growing, ensuring that reservists and guardsmen have coverage
    to maintain their health between mobilizations. We've also made
    it easier for physicians around the country to participate in
    this plan and receive timely payment.
        Our efforts to reduce the stigma associated with seeking
    mental healthcare have been accompanied by an increase in
    providers to meet the growing demand. Together with the
    Surgeons General and our TRICARE contractors, we've added over
    1,900 providers to the military hospitals and clinics, and more
    than 10,000 added to the networks. Visits have increased
    dramatically, with 112,000 behavioral health outpatients now
    seen every week. In addition, servicemembers and their families
    can access the TRICARE Assistance Program for supportive
    counseling via Web cam from their homes, 24 hours a day.
        To improve health overall, we're putting a priority on
    prevention, eliminating copays for preventive services under
    TRICARE standard, recently adding immunizations like flu
    vaccine to our retail pharmacy program, and tracking our
    performance. Since 2007, we can demonstrate significant
    improvement in the number of patients who receive cancer
    screening that's appropriate to their age, immunizations, and
    medications to control diabetes, asthma, and cholesterol.
        Patients are beginning to notice the difference. On
    surveys, they're telling us that they receive timely care,
    needed care, and see their assigned primary care manager more
    often. We certainly still have room to improve, but this is a
    very encouraging beginning trend.
        To address the costs of care, we're focused on ensuring
    that patients with acute minor conditions visit their primary
    care site or an urgent care clinic, rather than the emergency
    room, and choose the convenience and lower out-of-pocket cost,
    as well as lower government cost, of our mail-order pharmacy,
    rather than the retail pharmacy, whenever that's possible.
        Our partnerships at the interface between the direct care
    and private-sector care are thriving. On a regular basis,
    TRICARE regional directors engage with Army MTF commanders in
    rehearsal of capability drills. We work together to develop the
    medical capacity that's needed as the Army grows and shifts its
    population concentrations.
        When Navy medical personnel ably responded to the disaster
    in Haiti, we staffed a fusion cell to make daily adjustments to
    network referrals and assist with interservice crossleveling,
    to ensure that all patients continue to receive timely care.
        The Air Force has led the other Services to articulate the
    challenges with access to care in Alaska, and we've been able
    to stabilize reimbursement to encourage more providers to
    participate.
        We appreciate the Senate's leadership in this area, and
    we're engaged with the Veterans' Affairs (VA) Department and
    other Federal partners to develop comprehensive solutions.
        In the months ahead, we'll work diligently to address all
    concerns cited by the GAO and move forward to delivery of
    healthcare under the TRICARE third-generation contracts.
        We proudly anticipate the introduction of our TRICARE
    Reserve Retiree Program for those gray-area reservists who have
    served our Nation so honorably, and are excited by pending
    improvements to our overseas and dental programs.
        There's certainly much more to do, but my staff and I come
    to work every day mindful of all those that we serve and
    striving to make a positive difference.
        Thank you again, Mr. Chairman, for your advocacy on behalf
    of our servicemembers, and I look forward to your questions.
        Senator Webb. Thank you, Admiral Hunter.
        General Schoomaker.

     STATEMENT OF LTG ERIC B. SCHOOMAKER, USA, SURGEON GENERAL OF
        THE U.S. ARMY, AND COMMANDER, U.S. ARMY MEDICAL COMMAND

        General Schoomaker. Chairman Webb, Senator Graham, and
    distinguished members of the Personnel Subcommittee, thank you
    for inviting us to discuss the Defense Health Program and our
    respective Service medical programs.
        Now in my third congressional hearing cycle as the Army
    Surgeon General and Commanding General of the U.S. Army Medical
    Command, I can tell you that these hearings are valuable
    opportunities for me to talk about the accomplishments and
    challenges of Army Medicine, and to hear your collective
    perspectives regarding military health promotion and
    healthcare.
        I'm pleased to tell you that the President's budget
    submission for fiscal year 2011 fully funds the Army Medical
    Department's needs. Your support of the proposed President's
    budget is greatly appreciated.
        I know, in your recent hearing with the Under Secretary of
    Defense for Personnel and Readiness and the Assistant
    Secretaries for Manpower and Reserve Affairs, that much concern
    was expressed regarding the increasing size of the defense
    health budget within the overall defense budget. I'd like to
    share with you some of the efforts that we are making in Army
    Medicine that complement what Admiral Hunter just discussed, to
    maximize the value in health services that we deliver, of our
    Army Medicine's five strategic themes.
        This theme is built on a belief that providing high-quality
    evidence-based services is not only right for soldiers and
    families, it results in the most efficient use of resources
    within the healthcare system, thus delivering value not only
    for our patients, but indeed for the Nation as a whole. In
    fact, what we really want to do is move from a healthcare
    system, one that is focused on delivering care, simply, to one
    that is a system of health and a system for health, which
    optimizes health and well-being through enhanced prevention and
    in a holistic approach.
        We've resisted simply inventing new processes and inserting
    new diagnostic tests or therapeutic options, although we are
    keeping abreast of all of the cutting-edge changes in the
    American healthcare and international healthcare terrain. Or
    we've resisted adding just more layers of bureaucracy, but
    we're really, truly adding value to the products we deliver,
    the care we provide, and the training of our people.
        This requires focusing on the clinical outcome for the
    patient and the community, and maintaining or even reducing the
    overall resource expenditure that's needed to achieve this
    objective. My own wife reminds me, she's not interested in
    sitting in waiting rooms or going through the turnstile of
    medicine, she wants to know, at the end of the day, is she
    better for what she came to seek care for? I think we can tell
    here unequivocally, and all of our patients and soldiers and
    families, that we are.
        This has occurred, for us, through adoption of evidence-
    based practices, that you heard both of my colleagues here talk
    about, and reducing unwarranted variation in our practices,
    even unwarranted administrative practice variation for all the
    transactional processes that go on in our work.
        One example of this in Army Medicine is that, we are
    expanding upon a performance-based budget model that links
    resources to clinical and quality outputs. Since 2007, we've
    been providing financial incentives to our hospitals, our
    clinics, our clinical commanders, and our clinicians for
    superior compliance in key preventive measures and other
    measures of evidence-based practices.
        Currently, we track nine measures and compare our
    performance to a national benchmark. Our performance has
    improved on every measure, in one case by 63 percent. We've
    demonstrated that these incentives work to change
    organizational behavior to achieve desired outcomes in our
    health system.
        Put quite simply, our beneficiaries, our patients, and our
    communities are receiving not only better access to care, but
    for better care once they get that access, that we can
    objectively measure.
        We've undertaken major initiatives to improve both access
    and continuity of care. This is one of the Army Chief of
    Staff's and my top priorities, and it's reflected in what
    you've heard Admiral Hunter talk about. After conducting
    thorough business-case analyses, Army Medicine is expanding
    healthcare product lines in some communities, and we're
    expanding clinical space in others. In 14 locations across the
    country, we're establishing community-based primary care
    clinics by leasing and operating clinics located in off-post
    communities that are close to where our Active Duty families
    live and work and go to school. These clinics will provide a
    Patient-Centered Medical Home for families, an effort which is
    warmly embraced and resourced by all three of the medical
    services in the Military Health System and will provide a range
    of benefits, to include improved readiness for our Army and our
    Army family, improved access to and continuity of care, reduced
    emergency room visits, and improved patient satisfaction, which
    is growing.
        Both our community-based Primary Care Clinic Initiative and
    the three medical services Patient-Centered Medical Home
    implementation have been well-supported by Rear Admiral Hunter
    and the TRICARE Management Agency and the Assistant Secretary
    of Defense for Health Affairs. We are very appreciative and are
    working closely on these efforts.
        I look for 2010 to be the year that Army Medicine achieves
    what we set out to improve 2 years ago in access and
    continuity, key elements of our covenant with the Army family,
    led by our Chief of Staff and by the Secretary of the Army.
        Army leadership is also engaged in an all-out effort to
    change DOD culture regarding TBI, or mild TBI, as it's called,
    especially the milder form, or what we call concussion TBI,
    which has a very wide spectrum, from concussive injury to much
    more unusual penetrating injuries or moderate crush injuries,
    of those, we are really focusing very, very closely on
    concussive injury, the most common injury. Our goal is nothing
    less than a cultural change in the management of soldiers after
    potential concussive events in combat or, frankly, on the
    football fields or sports fields or in motor vehicle accidents.
        Every warrior requires appropriate treatment to minimize
    concussive injury and maximize recovery. To achieve this goal,
    we're educating the force so as to have a trained and prepared
    soldier, a leader, and our medical professional and personnel
    to provide early recognition, treatment, and tracking of these
    concussive injuries, ultimately designed to protect warrior
    health.
        The Army is issuing very direct standards and protocols to
    commanders and healthcare providers, similar to aviation
    incident actions. There's an automatic grounding and medical
    assessment which is required for any soldier that meets
    specified criteria. The end state of these efforts is that
    every servicemember sustaining a possible concussion will
    receive early detection, state-of-the-art treatment, and
    return-to-duty evaluations, with long-term digital health-
    record tracking of their management.
        We're combining our efforts to identify and manage
    concussive brain injury as close as possible, both in time and
    geographic proximity, to the actual blast event, with more
    aggressive battlefield management of post-traumatic stress
    symptoms. Our experts tell us that the closer we can manage
    those symptoms as they emerge in combat, the more likely we are
    to reduce long-term PTSD problems.
        Treatment of concussive injuries is an emerging science.
    The Army is leading the way in implementing these new treatment
    protocols for DOD, and the DOD is leading the Nation.
        I brought with me today our Brain Injury Awareness Toolkit.
    I'd like to share this with you and your staff. If you don't
    have any other time, I'd really urge you to look at the DVD
    that we've put together with our senior leadership, because
    this is really a commanders-led program--the Chief of Staff,
    George Casey; the Vice Chief of Staff, Pete Chiarelli; and our
    Sergeant Major of the Army are very actively involved in. They
    contain patient information materials, as well as this DVD,
    which we're using to educate soldiers before they deploy
    overseas. We're training them as to what they should do, should
    they have a concussion.
        [The information referred to follows:]

        General Schoomaker. I truly believe that this evidence-
    based directive approach to concussive management will change
    the military culture regarding head injuries and significantly
    impact the well-being of our force.
        In closing, I'm very optimistic about the next 2 years. I
    feel very privileged to serve with the men and women of Army
    Medicine, as soldiers, as Americans, and as global citizens.
        Thank you for holding this hearing and your unwavering
    support of the Military Health System and Army Medicine.
        I look forward to answering questions. In particular, I'd
    be happy to discuss the Army's approach to pain management, to
    the treatment of post-traumatic stress, and the use of
    medications across the force, those other concerns that were
    raised by Senator Cardin.
        Thank you.
        [The prepared statement of General Schoomaker follows:]
               Prepared Statement by LTG Eric B. Schoomaker, USA
        Chairman Webb, Senator Graham, and distinguished members of the
    Personnel Subcommittee, thank you for inviting us to discuss military
    medicine and our respective Service medical programs. Now in my third
    Congressional hearing cycle as the Army Surgeon General and Commanding
    General, U.S. Army Medical Command (MEDCOM), I can tell you that these
    hearings are valuable opportunities for me to talk about the
    accomplishments and challenges of Army Medicine and to hear your
    collective perspectives regarding military healthcare. You and your
    staff members ask some difficult questions, but these questions help
    keep us focused on those we serve--the soldiers, sailors, marines,
    airmen, coastguardsmen, family members, and retirees as well as the
    American public. I hope you also find these hearings beneficial as you
    review the President's budget submission, which this year fully funds
    the Army Medical Department's needs, and determine priorities and
    funding levels for the next fiscal year.
        The U.S. Army Medical Department is a complex, globally-deployed,
    and world class team. My command element alone, the MEDCOM, is an $11
    billion international health improvement, health protection, emergency
    response and health services organization staffed by 70,000 dedicated
    Soldiers, civilians, and contractors. I am in awe at what these
    selfless servants have done over the past years--their accomplishments
    have been quietly, effectively, powerfully successful. While we have
    experienced our share of crises and even tragedies, despite 8 years of
    continuous armed conflict for which Army medicine bears a heavy load,
    every day our soldiers and their families are kept from injuries,
    illnesses, and combat wounds through our health promotion and
    prevention efforts; are treated in cutting-edge fashion when prevention
    fails; and are supported by an extraordinarily talented medical force
    to include those who serve at the side of the Warrior on the
    battlefield. We mourn the loss of 26 teammates in the Fort Hood
    shootings--6 dead and 20 wounded--but are inspired by the resolve shown
    by their units to continue their missions and the exemplary performance
    of the 467th and 1908th Medical Detachments serving in Afghanistan
    today.
        One area of special interest to Congress is our comprehensive
    effort to improve warrior care from point of injury through evacuation
    and inpatient treatment to rehabilitation and return to duty. I am
    convinced the Army has made some lasting improvements, and I was
    recently heartened to read the comments of a transitioning warrior that
    reinforced these perceptions. She commented:

              As I look back in the past I am able to see with a reflective
            eye . . . the people that have helped me fight this battle,
            mostly my chain of command, who have always stood beside me
            instead of in front of me. They have gone out of their way to
            do what was best for me and I cannot say I would be here still
            if I hadn't had such wonderful support. . . . This is my story
            at the WTB and all in all, I just had to make aware to everyone
            that has helped that I am very grateful and I truly appreciate
            all of the work you have done for me.

        There is nothing more gratifying than to care for these wounded,
    ill, and injured heroes. We in Army medicine continue to focus our
    efforts on our warriors in Transition and I want to thank Congress for
    its unwavering support. The support of this committee has allowed us to
    hire additional providers, staff our warrior transition units, conduct
    relevant medical research, and build healing campuses. In the remainder
    of my testimony today, I will discuss how we are providing optimal
    stewardship of the investment the American public and this Committee
    has made in Army medicine.
        We lead and manage Army medicine through the Kaplan & Norton
    Balanced Scorecard performance improvement framework that I introduced
    to you in last year's testimony. The Scorecard balances missions and
    resources across a broad array, while ensuring that near-term measures
    of success are aligned with longer-term, more strategic results. This
    balancing is depicted on the Scorecard's Strategy Map, which shows how
    we marshal our resources, train and develop our people, and focus our
    internal processes and efforts so as to balance competing goals.
    Ultimately our means, ways, and ends contribute toward accomplishing
    our mission and achieving our strategic vision. The five strategic
    themes that guide our daily efforts are:

             Maximize Value in Health Services
             Provide Global Operational Forces
             Build the Team
             Balance Innovation with Standardization
             Optimize Communication and Knowledge Management

        Although distinct themes, they inevitably overlap and weave
    themselves through everything we do in Army medicine.
        The first strategic theme--Maximize Value in Health Services--is
    built on the belief that providing high quality, evidence-based
    services is not only the right for our soldiers and families; it
    results in the most efficient use of resources within the healthcare
    system, thus delivering value to not only our patients, but indeed, the
    Nation. In fact, what we really want to do is move from a healthcare
    system to a system for health.
        We have resisted simply inventing a new process, inserting a new
    diagnostic test or therapeutic option in vacuo or adding more layers of
    bureaucracy but are truly adding value to the products we deliver, the
    care we provide, and the training of our people. This requires focusing
    on the clinical outcome for the patient and the community and
    maintaining or even reducing the overall resource expenditure needed to
    achieve this objective. It has occurred through adoption of evidence-
    based practices and reducing unwarranted practice variation--even
    ``unwarranted administrative practice variation'' for the transactional
    processes in our work. As one example of this, Army Medicine is
    expanding upon our Performance Based Budget model to link resources to
    clinical and quality outputs. The Healthcare Effectiveness and Data
    Information Set (HEDISR) is a tool used by more than 90 percent of
    America's health plans (> 400 plans) to measure performance on
    important dimensions of care, namely, the prevention of disease and
    evidence-based treatments for some of the most common and onerous
    chronic illnesses. The measures are very specifically defined, thus
    permitting comparison across health plans. Since 2007, we have been
    providing financial incentives to our hospitals, clinics and clinicians
    for superior compliance in key HEDIS measures. Currently, we track nine
    measures and compare our performance to national benchmarks. Our
    performance has improved on each measure, in one case by 63 percent. We
    have demonstrated that these incentives work to change organizational
    behavior to achieve desired outcomes in our health system. Put quite
    simply, our beneficiaries, patients and communities are receiving not
    only better access to care but better care--objectively measured.
        As the DOD budget and health-/healthcare-related costs come under
    increasing scrutiny, this element of our strategy will be even more
    critical for us. As the United States struggles to address improvements
    in health and healthcare outcomes while stabilizing or reducing costs
    of our national system of care, we in Army Medicine and the Military
    Health System will surely keep the goal of maximizing value in our
    cross-hairs . . . or we will find our budgets tightening without a way
    to measure the effects on our patients' and our communities' health and
    well-being.
        All of these remarkable achievements would be without meaning or
    importance to our soldiers, their families, and our patients if we do
    not provide access and continuity of care, especially within the direct
    care system of our medical centers, community hospitals, health
    centers, and clinics. I am looking carefully at my commanders'
    leadership and success in ensuring that their medical and dental
    treatment facilities provide timely access and optimize continuity of
    care. We have undertaken major initiatives to improve both access and
    continuity--this is one of the Army Chief of Staff's and my top
    priorities. After conducting thorough business case analyses, Army
    Medicine is expanding product lines in some markets and expanding
    clinical space in others. At 14 locations, we are establishing
    Community-Based Primary Care Clinics by leasing and operating clinics
    located in off-post communities that are close to where active duty
    families live, work, and go to school. These clinics will provide a
    patient-centered medical home for Families and will provide a range of
    benefits:

             Improve the readiness of our Army and our Army Family
             Improve access to and continuity of care
             Reduce emergency room visits
             Improve patient satisfaction
             Implement Best Practices and standardization of
            services
             Increase physical space available in military
            treatment facilities (MTFs)
             Improve physical and psychological health promotion
            and prevention

        Along with the rest of the Military Health System, Army Medicine is
    embracing the Patient-Centered Medical Home concept, which is a
    recommended practice of the National Committee for Quality Assurance
    and is endorsed by a number of medical associations, several large
    third-party payers, and many employers and health plans. The Patient-
    Centered Medical Home improves patient satisfaction through its
    emphasis on appropriate access, continuity and quality, and effective
    communication. The goal is simple: consult with one consistent primary
    care provider-nurse team for all your medical needs. The seven core
    features of the Medical Home are:

             Personal Primary Care Provider (primary care manager/
            team)
             Primary Care Provider Directed Medical Practice (the
            primary care manager is team leader)
             Whole Person Orientation (patient centered, not
            disease or provider centered)
             Care is Coordinated and/or Integrated (across all
            levels of care)
             Quality and Safety (evidenced-based, safe medical
            care)
             Enhanced Access (meets access standards from the
            patient perspective)
             Payment Reform (incentivizes the development and
            maintenance of the medical home)

        I look for 2010 to be the year Army medicine achieves what we set
    out to improve 2 years ago in access and continuity, key elements of
    our covenant with the Army Family, led by our Chief of Staff and
    Secretary of the Army.
        Unlike civilian healthcare systems that can focus all of their
    energy and resources on providing access and continuity of care, the
    Military Health System has the equally important mission to Provide
    Global Operational Forces.
        The partnership between and among the medical and line leadership
    of Operations Iraqi Freedom and Enduring Freedom, Central Command, Army
    Forces Command, U.S. Army Reserve Command, National Guard Bureau, Army
    Medical Department Center & School, Medical Research and Materiel
    Command, Army G3/5/7, and others has resulted in a dynamic
    reconfiguration of the medical formations and tactics, techniques, and
    procedures required to support the deployed Army, joint and coalition
    force. Army Medicine has never missed movement and we continue to
    achieve the highest survivability rate in the history of warfare. Army
    medicine leaders have never lost sight of the need to first and
    foremost make a difference on the battlefield.
        This will not change--it will even intensify in 2010 as the
    complexity of the missions in Afghanistan increases. This is occurring
    even while the need to sustain an Army and joint force which is
    responsibly withdrawing from Iraq puts more pressure on those medics
    continuing to provide force health protection and care in Operation
    Iraqi Freedom. This pressure on our All-Volunteer Army is
    unprecedented. Healthcare providers, in particular, are subject to
    unique strains and stressors while serving in garrison as well as in
    deployed settings. The MEDCOM has initiated a defined program to
    address provider fatigue with current efforts focused on sustaining the
    healthy force and identifying and supporting higher risk groups. MEDCOM
    has a healthy healthcare workforce as demonstrated by statistically
    significant lower provider fatigue and burnout than: The Professional
    Quality of Life Scale (ProQol) norming sample of 1187 respondents; and
    Sprang, Clark and White-Woosley's study of 222 civilian behavioral
    health (BH) providers. But as our Chief of Staff of the Army has told
    us: this is not an area where we just want to be a little better than
    the other guy--we want the healthiest and most resilient healthcare
    provider workforce possible.
        The Provider Resiliency Training (PRT) Program was originally
    designed in 2006, based on Mental Health Advisory Team findings. The
    U.S. Army Medical Department Center and School (AMEDDC&S) developed a
    military-specific model identifying ``provider fatigue'' as the
    military equivalent of compassion fatigue. In June 2008, MEDCOM
    implemented a mandated PRT program to educate and train all MTF
    personnel to include support staff on the prevention and treatment of
    signs and symptoms of provider fatigue. The stated goal of PRT is to
    mitigate the negative effects of exposure to combat, to deployment, to
    secondary trauma from caring for the casualties of war as well as the
    unremitting demand for healthcare services and from burnout. All will
    ultimately improve organizational effectiveness. The AMEDDC&S currently
    offers three courses in support of the MEDCOM PRT: the Train the
    Trainer Course; the Professional Resiliency Resident Course; and the
    PRT Mobile Training.
        None of our goals and themes would be achievable without the right
    mix of talented professionals within Army Medicine and working with
    Army Medicine; what our Balanced Scorecard refers to as Build The Team:
    a larger, more inclusive joint medical team; an adaptive and responsive
    interagency team (VA, DHS, DHHS/NIH/NIAID, CDC, USDA, etc.); an
    effective coalition team; and a military-civilian/academic-operational
    team. The teams we build must be aligned with the Army, Defense, and
    National Military Strategy and long-term goals, not based solely on
    personalities and the arcane interests of a few. My Deputy Surgeon
    General, subordinate leaders, and others have been increasingly more
    deliberate and disciplined in how we form and sustain these critical
    partnerships.
        Effective joint, interagency and coalition team-building has been a
    serious challenge for some time now. I see the emphasis on our ability
    to craft these teams grow in 2010. The arrival of September 15, 2011--
    the deadline for the 2005 BRAC--will be one of the key milestones and
    tests of this skill. My regional commanding generals in San Antonio and
    Washington, DC have taken lead roles in this endeavor. Let there be no
    question among those who underestimate our collective commitment to
    working as a team and our shared vision to serve the Nation and protect
    and care for the warriors and his or her family--we are one team!
        In addition to building external teams, we need to have the right
    mix and quality of personnel internal to Army medicine. In fiscal year
    2010 and continuing into fiscal year 2011 the Army requested funding
    for programs to improve our ability to attract and retain the
    professional workforce necessary to care for our Army. Our use of
    civilian hiring incentives (Recruiting, Retention, and Relocation)
    increased in fiscal year 2010 by $90 million and should increase by an
    additional $30 million in fiscal year 2011. In fiscal year 2011,
    civilian hiring incentives will equate to 4.8 percent of total civilian
    pay. We have instituted and funded civilian recruiting programs at the
    MEDCOM, regional, and some local levels to seek qualified healthcare
    professionals. For our military workforce, we are continuing our
    successful special salary rates, civilian nurse loan repayment
    programs, and civilian education training programs. Additionally, our
    Health Professional Scholarship Program and loan repayments will
    increase in fiscal year 2010 by $26 million and continue into fiscal
    year 2011. This program supports 1,890 scholarships and 600
    participants in loan repayments--it is as healthy a program as it has
    ever been. Let me point out that our ability to educate and train from
    within the force--through physician, nursing, administrative, medic,
    and other programs in professional education--is a vital capability
    which we cannot permit to be degraded or lost altogether. In addition
    to providing essential enculturation for a military healthcare
    provider, administrator and leader, these programs have proven to be
    critical for our retention of these professionals who are willing to
    remain in uniform, to deploy in harm's way and to assume many onerous
    duties and assignments in exchange for education in some of the
    Nation's best programs. Army and Military Graduate Medical, Dental,
    Nursing, and other professional education has undoubtedly played a
    major role in our remaining a viable force this far into these
    difficult conflicts.
        The theme of evidence-based practice runs through everything we do
    in Army Medicine and is highlighted throughout our Balanced Scorecard.
    Evidence-based practices mean integrating individual clinical expertise
    with the best available external clinical evidence from systematic
    research. Typical examples of evidence-based practices include
    implementation of clinical practice guidelines and dissemination of
    best practices. I encourage my commanders and subordinate leaders to be
    innovative, but across Army medicine we Balance Innovation with
    Standardization so that all of our patients are receiving the best care
    and treatment available. Standardization efforts include:

             The MEDCOM Armed Forces Health Longitudinal Technology
            Application (AHLTA) Provider Satisfaction (MAPS) initiative
             Care of combat casualties through the Joint Theater
            Trauma System (JTTS), enabled by the use of a Joint Theater
            Trauma Registry (JTTR)--both of which I will discuss further
            below--which examines every casualty's care and outcome of that
            care, including en route care during medical evacuation
            (MEDEVAC) with an eye toward standardizing care around the best
            practices
             The Virtual Behavioral Health Pilot (aka Comprehensive
            Behavioral Health Integration) being conducted at Schofield
            Barracks and Ft. Richardson
             Our initiative to reduce Ventilator Associated
            Pneumonia events in our ICUs by adopting not only industry best
            practices, but sending out an expert team of MEDCOM
            professionals to evaluate our own best practices and barriers
            to success
             Our standardized events-driven identification and
            management of mild TBI/concussion on the battlefield coupled
            with early diagnosis and treatment of Post-Traumatic Stress
            Reactions/Acute Stress Reactions as close in time and space to
            the events which lead to these reactions

        Programs which are in the process of maturing into best practices
    for more widespread dissemination are:

             The Confidential Alcohol Treatment and Education Pilot
             The standardized and now automated Comprehensive
            Transition Plan for Warriors In Transition in our WTUs and
            CBWTUs
             A standardized program to ``build trust in Army
            Medicine'' through hospitality and patient/client/customer
            service in our medical, dental, and veterinary treatment
            facilities and throughout the MEDCOM
             Standardized support of our Active, National Guard,
            and Reserve Forces engaged in the reiterative, cyclic process
            of the Army Force Generation Model including but not restricted
            to preparation for combat medics and medical units, Soldier
            Readiness Processing of deploying units, ensuring full medical
            readiness of the force, restoration of dental and behavioral
            health upon redeployment, support of the total Army Family
            while soldiers are deployed, and provision of healthcare for
            mobilized and demobilizing Reserve component soldiers and their
            families.

        These and many other standardized efforts reflect a change in how
    we do the business of Army medicine. We can no longer pride ourselves
    on engaging in a multiplicity of local ``science projects'' being
    conducted in a seemingly random manner by well-meaning and creative
    people but without a focus on added value, standard measures of
    improved outcomes, and sustainability of the product or process. Even
    the remarkably agile response to the behavioral health needs-assessment
    and ongoing requirements at Fort Hood following the tragic shooting
    were conducted in a very deliberate and effective fashion which
    emphasized unity of command and control, alignment of all efforts and
    marshalling of resources to meet a well-crafted and even exportable
    community behavioral health plan.
        The emphasis which Army Medicine leaders have placed on
    disciplining these innovative measures so as to harvest best practices,
    subject them to validation at other sites, and rapidly proliferate them
    across the MEDCOM and Army in a standard fashion has been remarkable.
    It is the essence of Optimizing Communication and Knowledge Management.
        Many of our goals, internal processes and enablers, and resource
    investments are focused on the knowledge hierarchy: collecting data;
    coalescing it into information over time and space; giving it context
    to transform it into knowledge; and applying that knowledge with
    careful outcome measures to achieve wisdom. This phenomenon of guiding
    clinical management by the emergence of new knowledge is perhaps best
    represented by Dr. Denis Cortese, former President and Chief Executive
    Officer of the Mayo Clinic. He laid out this schematic earlier this
    year after participating in a set of workshops which centered on
    healthcare reform. We participated to explore how the Federal system of
    care might contribute to these changes in health improvement and
    healthcare delivery.
        What Dr. Cortese depicted is a three-domain ideal representation of
    healthcare delivery and its drivers. We share this vision of how an
    ideal system should operate. His notion is that this system of care
    should focus on optimizing individual health and healthcare needs,
    leveraging the knowledge domain to drive optimal clinical practices.
    This transition from the knowledge domain to the care delivery domain
    now takes 17 years. The clinical practice domain then informs and
    drives the payer domain to remunerate for effective clinical outcomes.
    What occurs too often today is what I call ``widget-building'' or
    ``turnstile'' medical care which chases remuneration for these
    encounters--too often independent of whether it is the best treatment
    aimed at the optimal outcome. To transform from a healthcare system to
    a system for health, we need to change the social contract. No longer
    should we be paid for building widgets (number of clinic visits or
    procedures), rather, we should be paid for preventing illness and
    promoting healthy lifestyles. When bad things happen to good people--
    which severe illness and injury and war continuously challenge us
    with--we should care for these illnesses, injuries and wounds by the
    most advanced evidence-based practices available, reducing unwarranted
    variation in practice whenever possible.
        Our Military Health System is subtly different in that we have two
    practice domains--garrison and battlefield. Increasingly, we leverage
    the clinical domain to provide feedback into the knowledge domain--with
    the help of the electronic health record--AHLTA--and specialized
    databases. We do this in real time and all under the umbrella of the
    regulatory domain which sets and enforces standards.
        The reengineering of combat trauma care borne of rapid turnaround
    of new-found, data-driven knowledge to new materiel and doctrinal
    solutions is one of the premier examples of this concept. The simplest
    example is our continuous re-evaluation of materials and devices
    available to soldiers, combat life savers, combat medics and the trauma
    team at the point of injury and in initial trauma management and the
    intellectual framework for their application to rapidly improve
    outcomes from combat-injured warriors.
        After making the first major change in 40 years to the field
    medical kit--the Improved First Aid Kit--we have modified the contents
    of the kit at least three times since May 2005 based upon ongoing
    reviews of the effectiveness of the materials and head-to-head
    comparisons to competing devices or protocols. In like fashion, we have
    modified protocols for trauma management through active in-theater and
    total systemic analyses of the clinical outcomes deriving from the use
    of materials and protocols.
        The specialized system in this endeavor is a joint and interagency
    trauma system which creates the equivalent of a trauma network
    available for a major metropolitan area or geographic region in the
    U.S. but spread across three continents, 8,000 miles end-to-end--the
    JTTS. Staffed and led by members of the Army, Navy, Marine Corps, and
    Air Force, it is truly a joint process. It is centered on the U.S. Army
    Institute of Surgical Research in San Antonio, TX. The specialized
    database in this effort and an essential element of the JTTS is the
    JTTR--a near-comprehensive standardized database which has been
    developed for each casualty as soon as possible in the treatment
    evacuation chain--usually at level II or III healthcare in theater. One
    of the most important critical applications of the JTTS and JTTR at
    present is the ongoing analysis of MEDEVAC times and the casualties
    being managed during evacuation. This is our effort to minimize the
    evacuation time for casualty in a highly dispersed force which is
    subjected in Afghanistan to the ``tyranny of terrain and weather.''
        The decisions about where and how many trauma teams should be
    placed around the theater of operation as well as where to place
    MEDEVAC crews and aircraft is a delicate balancing act--one which
    balances the risk of putting care providers and MEDEVAC crews and
    helicopters at risk to the enemy and the elements with the risk of loss
    of life and limb to Warriors whose evacuation may be excessively
    prolonged. The only way to fully understand these competing risks is to
    know the outcomes of care and evacuation by injury type across a wide
    range of MEDEVAC missions. This analysis will help us understand if we
    still require a ``Golden Hour'' for every casualty between initial
    management at the point of injury and arrival at a trauma treatment
    site (like an Army Forward Surgical Team, the Marine Forward
    Resuscitative Surgical System or a Combat Support Hospital) or whether
    we now have a ``Platinum 15 Minutes'' at the point of injury which
    extends the Golden Hour.
        This methodology and these casualty data are being applied to the
    next higher level of inquiry: how do we prevent injury and death of our
    combatants from wounds and accidents at the point of potential injury?
    Can we design improved helmets, goggles, body armor, vehicles and
    aircraft to prevent serious injuries? These questions are answered not
    only through the analysis of wound data, both survivable and
    nonsurvivable, through the JTTS and data from the virtual autopsy
    program of the Office of the Armed Forces Medical Examiner, but also by
    integrating these data with information from the joint operational,
    intelligence, and materiel communities to enable the development of
    improved tactics, techniques, and procedures and materiel improvements
    to protective equipment worn by the Warriors or built into the vehicles
    or aircraft in which they were riding. This work is performed by the
    Joint Trauma Analysis and Prevention of Injury in Combat program, a
    component of the DOD Blast Injury Research Program directed by the
    National Defense Authorization Act for 2006. To date it has been an
    effective means of improving the protection of warriors and preventing
    serious injury and death even as the enemy devises more lethal and
    adaptive weapons and battlefield tactics, techniques, and procedures.
        We in Army Medicine are applying these knowledge management tools
    and approaches to the improvement of health and the delivery of
    healthcare back home as well. We are coupling these knowledge
    management processes with a funding strategy which incentivizes our
    commanders and clinicians to balance productivity--providing episodes
    of care--with optimal outcome: the right kind of prevention and care.
        Among our greatest team achievements in 2009 was our effort to
    better understand how we communicate effectively with our internal and
    external stakeholders, patients, clients and customers. We adopted a
    formal plan to align our messages--ultimately all tied to Army goals
    and those on our Balanced Scorecard. Our creation of a Strategic
    Communications Directorate to ensure alignment of our key messages, to
    better understand and use social media, to expedite cross-talk and
    learning among such diverse groups as the Office of Congressional
    Liaison, Public Affairs, Protocol, Medical History, the Borden
    Institute, the AMEDD Regiment and others speaks directly to these
    efforts.
        While we are still in the ``advanced crawl/early walk'' phase of
    knowledge management, we know from examples such as the JTTS and the
    Performance Based Budget Model that we can move best practices and
    newly found evidence-based approaches into common or widespread use if
    we aggressively coordinate and manage our efforts and promote
    transparency of data and information and the knowledge which derives
    from it. We have begun a formal process under the Strategy and
    Innovation Directorate to move the best ideas in both clinical and
    transactional processes into standard practices across the MEDCOM in a
    timely way. This will be achieved through a process to identify,
    validate, and transfer best practices. We endeavor to be more agile and
    adaptive in response to a rapidly changing terrain of U.S. and Federal
    healthcare and operational requirements for a Nation at war.
        In closing, I am very optimistic about the next 2 years. We have
    weathered some serious challenges to trust in Army Medicine. Logic
    would not predict that we would be doing as well as we are in
    attracting, retaining and career developing such a talented team of
    uniformed and civilian medical professionals. However, we continue to
    do so year after year--a tribute to all our Officer Corps, the
    leadership of our noncommissioned officers, and our military and
    civilian workforce. The results of our latest Medical Corps Graduate
    Medical Education Selection Board and the Human Capital Distribution
    Plan show continued strength and even improvements over past years. The
    continued leadership and dedicated service of officers, noncommissioned
    officers, and civilian employees are essential for Army Medicine to
    remain strong, for the Army to remain healthy and strong, and for the
    Nation to endure. I feel very privileged to serve with the men and
    women of Army medicine during this historic period as Army medics, as
    soldiers, as Americans and as global citizens.
        Thank you for holding this hearing and your unwavering support of
    the Military Health System and Army Medicine. I look forward to working
    with you and your staff and addressing any of your concerns or
    questions.

        Senator Webb. Thank you, General Schoomaker.
        Let me just very quickly thank you for those comments about
    TBI and concussive injuries. This really is a different
    phenomenon from, I think, anything we've ever seen, because of
    the echo effect of so many of these actually occurring inside
    vehicles. It's almost like shaped charge. So, you can't even
    directly compare this with football injuries----
        General Schoomaker. No, sir.
        Senator Webb.--or any of these others.
        We have a great program down at Virginia Tech that's
    examining this concept, and I thank you for that detailed
    analysis.
        General Schoomaker. This has been a great collaborative
    effort with my colleagues here, too, sir.
        Thank you.
        Senator Webb. Admiral Robinson, welcome.

     STATEMENT OF VADM ADAM M. ROBINSON, JR., USN, SURGEON GENERAL
       OF THE U.S. NAVY, AND CHIEF, NAVY BUREAU OF MEDICINE AND
                                SURGERY

        Admiral Robinson. Good morning, Chairman Webb, Senator
    Graham, distinguished members of the subcommittee.
        I want to thank you for your unwavering support of Navy
    Medicine, particularly as we continue to care for those who go
    into harm's way, our Marine Corps, our Navy, their families,
    and all beneficiaries.
        I am honored to be with you today to provide an update of
    the state of Navy Medicine, including some of our
    accomplishments, our challenges, and strategic priorities.
        Navy Medicine: World-Class Care, Anytime, Anywhere. This
    poignant phrase is arguably the most telling description of
    Navy Medicine's accomplishments in 2009 and continues to drive
    our operational tempo and priorities for the coming year and
    beyond.
        Throughout the last year, we saw challenges and
    opportunities. Moving forward, I anticipate the pace of
    operations and demands will continue to increase. We have been
    stretched in our ability to meet our increasing operational and
    humanitarian assistance requirements, as well as maintain our
    commitment to provide care to a growing number of
    beneficiaries. However, I am proud to say that we are
    responding to this demand with more flexibility and agility
    than ever before.
        The foundation of Navy Medicine is force-health protection;
    it's what we do and why we exist. Nowhere is our commitment
    more evident than in Iraq and Afghanistan. During my October
    2009 trip to theater, I again saw the outstanding work of our
    medical personnel. The Navy Medicine team is working side-by-
    side with Army and Air Force medical personnel and coalition
    forces to deliver outstanding healthcare to our troops and
    civilians alike.
        As our wounded warriors return from combat and begin the
    healing process, they deserve a seamless and comprehensive
    approach to their recovery. We want them to mend in body, mind,
    and spirit. Our patient- and family-centered approach brings
    together medical treatment providers, social workers, care
    managers, behavioral health providers, and chaplains. We are
    working closely with our line counterparts in the Marine Corps
    Wounded Warrior Regiments, and the Navy's Safe Harbor, to
    support the full-spectrum recovery process for sailors,
    marines, and for their families.
        We must act with a sense of urgency to continue to help
    build resiliency among our sailors and marines, as well as the
    caregivers who support them. We are aggressively working to
    reduce the stigma surrounding psychological health and
    operational stress concerns, which can be a significant barrier
    to seeking mental health services.
        Programs such as Navy Operational Stress Control, Marine
    Corps Combat Operational Stress Control, Families OverComing
    Under Stress (FOCUS)--Caregiver Occupational Stress Control,
    and our Suicide Prevention Program are in place and maturing to
    provide support to personnel and to their families.
        An important focus for all of us continues to be caring for
    our warriors suffering from TBIs. We are expanding TBI training
    to healthcare providers throughout the fleet and the Marine
    Corps. We are also implementing a new in-theater TBI
    surveillance system and conducting important research. This is
    in collaboration with our sister Services and medical
    colleagues.
        We are also employing a strategy that is both collaborative
    and integrative by actively partnering with other Services, the
    Defense Centers of Excellence for Psychological Health and
    Traumatic Brain Injury, the Department of Veterans Affairs, and
    leading academic, medical, and research centers, to make the
    best care available to our warriors.
        We must continue to recognize the occupational stress on
    our caregivers. They are subject to the psychological demands
    of exposure to trauma, loss, fatigue, and inner conflict. This
    is why our Caregiver Occupational Stress Control programs are
    so important to building and sustaining the resiliency of our
    providers. Mental health specialists are being placed in
    operational environments and forward deployed to provide
    services where and when they are needed. The Marine Corps is
    sending more mental health teams to the front lines, with the
    goal of better treating an emotionally strained force.
    Operational Stress Control and Readiness teams known as OSCAR
    will soon be expanded to include the battalion level. This will
    put mental health support services much closer to combat
    troops. A mobile care team of Navy Medicine mental health
    professionals is currently deployed to Afghanistan, conducting
    mental health surveillance, command leadership consultation,
    and coordinate mental health care for sailors throughout the
    AOR.
        An integral part of the Navy's Maritime Strategy is
    humanitarian assistance and disaster relief. In support of
    Operation Unified Response Haiti, Navy Medicine answered the
    call. We deployed the Hospital Ship Comfort from her homeport
    in Baltimore within 77 hours of the order and ahead of
    schedule.
        Senator Webb. Admiral?
        Admiral Robinson. Yes, sir?
        Senator Webb. Just making an announcement, here.
        Apparently, the Republicans are objecting to all hearings
    after 11:00 this morning, except for one. Senator Graham is
    going to try to see----
        Senator Graham. Yes, I would like to----
        Senator Webb.--if we can't get ours also excluded, but----
        Senator Graham. Yes, I want to hear what you have to say,
    if I can.
        Senator Webb. How do we do this, Senator?
        Senator Graham. They're checking on it, now. Let's just
    keep going, and we'll figure out what the rules are.
        Senator Begich. Mr. Chairman?
        Senator Webb. Yes?
        Senator Begich. With or without it, can we just continue on
    and just have it as a non-hearing hearing?
        Make the rules as we go, is my rule. [Laughter.]
        Why not?
        I mean these guys have come----
        Senator Webb. I suppose we could go into informal
    conversation, if they cancel the hearing at 11 a.m. I don't
    know what that would do to the official transcript of the
    hearing, or that sort of thing. But, I----
        Senator Begich. I think this is an important issue.
        Senator Graham. I want to hear what they have to say.
        Senator Webb. Okay.
        Senator Graham.--we'll figure out----
        Senator Webb. Let's proceed.
        Senator Begich. I don't think you have support, bipartisan,
    for this effort, Mr. Chairman. [Laughter.]
        Admiral Robinson. Thank you very much, sir.
        An integral part of Navy's Maritime Strategy is
    humanitarian assistance and disaster response. In support of
    Operation Unified Response Haiti, Navy Medicine answered the
    call. We deployed Naval Hospital Ship Comfort within 77 hours
    of the order and ahead of schedule. She was on station in Port-
    au-Prince 5 days later. From the beginning, the operational
    tempo on board Comfort was high and our personnel were
    challenged, both professionally and personally. For many, this
    was a career-defining experience, and I was proud to welcome
    the crew home last week and congratulate them for their
    outstanding performance. The men and women of Comfort and all
    involved in this mission saved lives, alleviated suffering, and
    brought hope in the midst of devastation.
        I'm also encouraged with our recruiting efforts within Navy
    Medicine, and we are starting to see the results of new
    incentive programs. But, while overall manning levels for both
    officer and enlisted personnel are relatively high, ensuring we
    have the proper specialty mix continues to be a challenge in
    both the Active and Reserve components. Several wartime
    critical specialties, as well as advanced practice nursing and
    physicians' assistants are undermanned. We are also facing
    shortfall for general dentists, oral maxilla facial surgeons,
    and many of our mental health specialists, including clinical
    psychologists and social workers. We continue to work hard to
    meet this demand, but fulfilling the requirements among these
    specialties is expected to present a continuing challenge.
        Research and development is critical to Navy Medicine's
    success and our ability to remain agile to meet the evolving
    needs of our warfighters. It is where we find solutions to our
    most challenging problems and, at the same time, provide some
    of medicine's most significant innovations and discoveries.
    Research efforts targeted at wound management, including
    enhanced wound repair and reconstruction, as well as extremity
    and internal hemorrhage control and phantom limb pain in
    amputees, present definitive benefits. These efforts support
    our emerging expeditionary medical operations and aid in
    support of our wounded warriors.
        Clearly, one of the most important priorities for
    leadership of all the Services is the successful transition to
    the Walter Reed National Military Medical Center on board the
    campus of the National Naval Medical Center in Bethesda. We are
    working diligently with the lead DOD organization, Joint Task
    Force National Capital Region Medical, to ensure that this
    significant and ambitious project is executed properly and
    without disruption of services to our wounded warrior, our
    sailors, marines, and their families, and all other
    beneficiaries that we are privileged to serve.
        In summary, I believe we are at an important crossroads for
    military medicine. How we respond to challenges facing us today
    will likely set the stage for decades to come. Commitment to
    our wounded warriors and their families must never waver, and
    our programs of support and hope must be built and sustained
    for the long haul. The long haul is the rest of the century,
    when the young wounded warriors of today mature into aging
    heroes in the years to come. They will need our care and
    support, as will their families, for a lifetime.
        On behalf of the men and women of Navy Medicine, I want to
    thank the committee for your tremendous support, your
    confidence, and your leadership. It has been my pleasure to
    speak before you today, and I look forward to your questions.
        [The prepared statement of Admiral Robinson follows:]
           Prepared Statement by VADM Adam M. Robinson, Jr., MC, USN
                                  introduction
        Chairman Webb, Senator Graham, distinguished members of the
    subcommittee, I am honored to be with you today to provide an update on
    the state of Navy Medicine, including some of our accomplishments,
    challenges and strategic priorities. I want to thank the committee
    members for your unwavering support of Navy Medicine, particularly as
    we continue to care for those who go in harm's way, their families and
    all beneficiaries.
        Navy Medicine-World Class Care . . . Anytime, Anywhere. This
    poignant phrase is arguably the most telling description of Navy
    Medicine's accomplishments in 2009 and continues to drive our
    operational tempo and priorities for the coming year and beyond.
    Throughout the last year we saw challenges and opportunities; and
    moving forward, I anticipate the pace of operations and demands placed
    upon us will continue to increase. Make no mistake: We have been
    stretched in our ability to meet our increasing operational and
    humanitarian assistance requirements, as well as maintain our
    commitment to provide Patient and Family-Centered care to a growing
    number of beneficiaries. However, I am proud to say to that we are
    responding to this demand with more flexibility and agility than ever
    before. We are a vibrant, world-wide health care system fully engaged
    and integrated in carrying out the core capabilities of the Maritime
    Strategy around the globe. Regardless of the challenges ahead, I am
    confident that we are well-positioned for the future.
        Since becoming the Navy Surgeon General in 2007, I have invested
    heavily in our strategic planning process. How we accomplish our
    mission is rooted in sound planning, sharp execution and constructive
    self-assessment at all levels of our organization. I challenged our
    leadership to create momentum and establish a solid foundation of
    measurable progress. It's paying dividends. We are seeing improved and
    sustained performance in our strategic objectives. Just as importantly,
    our planning process supports alignment with the Department of Navy's
    Strategic Plan and Operations Guidance.
        Navy Medicine's commitment to Patient and Family-Centered Care is
    also reflected in our resourcing processes. An integral component of
    our Strategic Plan is providing performance incentives that promote
    quality and directly link back to workload and resources. We are
    evolving from a fiscal planning and execution process rooted in
    historical data, to a system which links requirements, resources and
    performance goals. This transformation to Performance Based Budgeting
    properly aligns authority, accountability, and financial responsibility
    with the delivery of quality, cost-effective health care.
        The President's budget for fiscal year 2011 adequately funds Navy
    Medicine to meet its medical mission for the Navy and Marine Corps. The
    budget also provides for the maintenance of our facilities. We
    appreciate the committee's strong support of our resource requirements.
                            force health protection
        The foundation of Navy Medicine is Force Health Protection. It's
    what we do and why we exist. In executing our Force Health Protection
    mission, the men and women of Navy Medicine are engaged in all aspects
    of expeditionary medical operations in support of our warfighters. The
    continuum of care we provide includes all dimensions of physical and
    psychological well-being. This is our center of gravity and we have and
    will continue to ensure our sailors and marines are medically and
    mentally prepared to meet their world-wide missions.
        Nowhere is our commitment to Force Health Protection more evident
    than in our active engagement in military operations in Iraq and
    Afghanistan. As these overseas contingency operations evolve, and in
    many respects become increasingly more dangerous, we are seeing
    burgeoning demand for expeditionary combat casualty care in support of
    joint operations. I recently returned from a trip to Afghanistan and I
    again saw the outstanding work of our medical personnel. The Navy
    Medicine team is working side-by-side with Army and Air Force medical
    personnel and coalition forces to deliver outstanding health care to
    our troops and civilians alike.
        We must continue to be innovative and responsive at the deckplates
    and on the battlefield. Since the start of Operation Enduring Freedom
    and Operation Iraqi Freedom, the Marine Corps has fielded new combat
    casualty care capabilities which include: updated individual first aid
    kits with combat gauze, advanced tourniquets, use of Tactical Combat
    Casualty Care principles, troop training in Combat Lifesaver, and the
    use of Factor VII--a blood clotting agent used in trauma settings. In
    addition, Navy Fleet Hospital transformation has redesigned
    expeditionary medical facilities that are lighter, modular, more
    mobile, and interoperable with other Services' facilities.
        Our progress is also evident in the innovative work undertaken by a
    Shock Trauma Platoon 2 years ago in Afghanistan. This team, comprised
    of 2 physicians, 2 nurses, 1 physician assistant, and 14 corpsmen,
    essentially created a mobile emergency room--a 7-ton truck with a Conex
    container and welded steel plates--that went into combat to administer
    more expedient and effective care in austere settings. This prototype
    led to the creation of the Mobile Trauma Bay (MTB), a capability that
    both Marine Corps and Navy Medicine leadership immediately recognized
    as vital to the warfighter and an unquestionable lifesaver on the
    battlefield. MTB use has already been incorporated into our Afghanistan
    shock trauma platoon operations, and they are already positively
    impacting forward resuscitative and stabilization care. We understand
    that the Marine Corps has fully embraced the MTB concept and is
    planning to add additional units in future POM submissions.
    Humanitarian Assistance and Disaster Response
        An integral part of the Navy's Maritime Strategy is humanitarian
    assistance and disaster response. In the wake of the devastating
    earthquake in Haiti earlier this year, our Nation moved forward with
    one of the largest relief efforts in our history to save lives, deliver
    critically needed supplies and provide much-needed hope. The response
    was rapid, as Navy deployed ships and expeditionary forces, comprised
    of more than 10,000 personnel, to provide immediate relief and support
    for the Haitian people. In support of Operation Unified Response, Navy
    Medicine answered the call. We deployed USNS Comfort (T-AH 20) from her
    homeport in Baltimore within 77 hours and ahead of schedule--going from
    an industrial shipboard site to a ready afloat naval hospital, fully
    staffed and equipped. She was on station in Port-au-Prince 5 days later
    and treating patients right away. From the beginning, the operational
    tempo onboard USNS Comfort has been high with a significant trauma and
    surgical caseload. Medical teams from the ship are also ashore to help
    in casualty evaluation, triage crush wounds, burn injuries and other
    health issues. Providing care around the clock, our personnel were
    challenged both professionally and personally. For many, this was a
    career-defining experience and certainly reflects the Navy's commitment
    as a ``Global Force for Good.'' I spoke to the crew as they were
    preparing to get underway, and personally related just how important
    this mission is and why it is a vital part of the Navy's Maritime
    Strategy.
        Navy Medicine provided additional support that included the
    deployment of a Forward Deployed Preventive Medicine Unit and augmented
    Casualty Receiving and Treatment Ship medical staff capabilities
    onboard USS Bataan (LHD 5). We also recognized the potential
    psychological health impact on our medical personnel involved in this
    humanitarian assistance mission and ensured we had trained Caregiver
    Occupational Stress Control (CgOSC) staff onboard.
        The ship departed Haiti on 10 March 2010. Prior to getting
    underway, the crew gathered for a memorial ceremony in honor of the
    people of Haiti. The men and women of USNS Comfort, and all involved in
    this mission, saved lives, alleviated suffering, and brought hope in
    the midst of devastation. Their performance and spirit of caring was
    exemplary.
        Navy Medicine is inherently flexible and capable of meeting the
    call to support multiple missions. I am proud of the manner in which
    the men and women of Navy Medicine leaned forward in response to the
    call for help. In support of coordination efforts led by the Department
    of State and the U.S. Agency for International Development, and in
    collaboration with nongovernmental organizations, both domestic and
    international, our response demonstrated how the expeditionary
    character of our Naval and Marine forces is uniquely suited to provide
    assistance during interagency and multinational efforts.
                                concept of care
        Navy Medicine's Concept of Care is Patient and Family-Centered
    Care. It is at the epicenter of everything we do. This concept is
    elegant in its simplicity yet extraordinarily powerful. It identifies
    each patient as a participant in his or her own health care and
    recognizes the vital importance of the family, military culture and the
    military chain of command in supporting our patients. My goal is for
    this Concept of Care--this commitment to our patients and their
    families--to resonate throughout our system and guide all our actions.
    It is enabled by our primary mission to deliver force health protection
    and a fully ready force; mutually supported by the force multipliers of
    world class research and development, and medical education. It also
    leverages our emphasis on the health and wellness of our patients
    through an active focus on population health.
                             caring for our heroes
        When our Warriors go into harm's way, we in Navy Medicine go with
    them. At sea or on the ground, sailors and marines know that the men
    and women of Navy Medicine are by their side ready to care for them.
    There is a bond of trust that has been earned over years of service
    together, and make no mistake, today that bond is stronger than ever.
    Our mission is to care for our wounded, ill, and injured, as well as
    their families. That's our job and it is our honor to have this
    opportunity.
        As our Wounded Warriors return from combat and begin the healing
    process, they deserve a seamless and comprehensive approach to their
    recovery. We want them to mend in body, mind and spirit. Our focus is
    multidisciplinary-based care, bringing together medical treatment
    providers, social workers, case managers, behavioral health providers
    and chaplains. We are working closely with our line counterparts with
    programs like the Marine Corps' Wounded Warrior Regiments and the
    Navy's Safe Harbor to support the full-spectrum recovery process for
    sailors, marines, and their families.
        Based on the types of injuries that we see returning from war, Navy
    Medicine continues to adapt our capabilities to best treat these
    conditions. When we saw a need on the west coast to provide expanded
    care for returning Wounded Warriors with amputations, we established
    the Comprehensive Combat and Complex Casualty Care (C5) Program at
    Naval Medical Center, San Diego, in 2007. C5 manages severely injured
    or ill patients from medical evacuation through inpatient care,
    outpatient rehabilitation, and their eventual return to active duty or
    transition from the military. We are now working to expand utilization
    of Project C.A.R.E - Comprehensive Aesthetic Recovery Effort. This
    initiative follows the C5 model by ensuring a multidisciplinary
    approach to care, yet focuses on providing state-of-the-art plastic and
    reconstructive surgery for our Wounded Warriors at both Naval Medical
    Center San Diego and Naval Medical Center Portsmouth, with potential
    future opportunities at other treatment facilities.
        We have also significantly refocused our efforts in the important
    area of clinical case management at our military treatment facilities
    and major clinics serving Wounded Warriors to ensure appropriate case
    management services are available to all who need them. The Clinical
    Case Management Program assists patients and families with clinical and
    non-clinical needs, facilitating communication between patient, family
    and multi-disciplinary care team. Our clinical case managers
    collaborate with Navy and Marine Corps Recovery Care Coordinators,
    Federal Recovery Coordinators, Non-Medical Care Managers and other
    stakeholders to address sailor and marine issues in developing Recovery
    Care Plans. As of January 2010, 192 Clinical Case Managers are assigned
    to Military Treatment Facilities and ambulatory care clinics caring for
    over 2,900 sailors, marines, and coastguardsmen.
                 psychological health and post-traumatic stress
        We must act with a sense of urgency to help build resiliency among
    our sailors and marines, as well as the caregivers who support them. We
    recognize that operational tempo, including the number and length of
    deployments, has the potential to impact the psychological health of
    servicemembers and their family members. We are aggressively working to
    reduce the stigma surrounding psychological health and operational
    stress concerns which can be a significant barrier to seeking mental
    health services for both military personnel and civilians. Programs
    such as Navy Operational Stress Control, Marine Corps Combat
    Operational Stress Control, Families Overcoming Under Stress (FOCUS),
    CgOSC, and our suicide prevention programs (A-C-T Ask-Treat-Care) are
    in place and maturing to provide support to personnel and their
    families.
        The Navy Operational Stress Control program and Marine Corps Combat
    Operational Stress Control program are the cornerstones of the
    Department of the Navy's approach to early detection of stress injuries
    in sailors and marines and are comprised of:

             Line led programs which focus on leadership's role in
            monitoring the health of their people.
             Tools leaders may employ when sailors and marines are
            experiencing mild to moderate symptoms.
             Multidisciplinary expertise (medical, chaplains, and
            other support services) for more affected members.

        Decreasing the stigma associated with seeking psychological health
    care requires a culture change throughout the Navy and Marine Corps.
    Confronting an ingrained culture will take time and active leadership
    support. Stigma reducing interventions span three major fronts: (1)
    education and training for individual sailors and marines that
    normalizes mental health care; (2) leadership training to improve
    command climate support for seeking mental health care; and (3)
    encouragement of care outreach to individual sailors, marines, and
    their commands. This past year saw wide-spread dissemination of
    Operational Stress Control (OSC) doctrine as well as a Navy-wide
    education and training program that includes mandatory Navy Knowledge
    Online courses, instructor led and web-based training.
        Navy Medicine ensures a continuum of psychological health care is
    available to servicemembers throughout the deployment cycle--pre-
    deployment, during deployment, and post-deployment. We are working to
    improve screening and surveillance using instruments such as the
    Behavior Health Needs Assessment Survey (BHNAS) and Post-Deployment
    Health Assessment (PDHA) and Post-Deployment Health Reassessment
    (PDHRA).
        Our mental health specialists are being placed in operational
    environments and forward deployed to provide services where and when
    they are needed. The Marine Corps is sending more mental health teams
    to the front lines with the goal of better treating an emotionally
    strained force. Operational Stress Control and Readiness (OSCAR) teams
    will soon be expanded to include the battalion level, putting mental
    health support services much closer to combat troops. A Mobile Care
    Team (MCT) of Navy Medicine mental health professionals is currently
    deployed to Afghanistan to conduct mental health surveillance, command
    leadership consultation, and coordinate mental health care for sailors
    throughout the AOR. In addition to collecting important near real-time
    surveillance data, the MCT is furthering our efforts to decrease stigma
    and build resilience.
        We are also making mental health services available to family
    members who may be affected by the psychological consequences of combat
    and deployment through our efforts with Project FOCUS, our military
    treatment facilities and our TRICARE network partners. Project FOCUS
    continues to be successful and we are encouraged that both the Army and
    Air Force are considering implementing this program. We also recognize
    the importance of the counseling and support services provided through
    the Fleet and Family Support Centers and Marine Corps Community
    Services.
        Beginning in 2007, Navy Medicine established Deployment Health
    Centers (DHCs) as non-stigmatizing portals of care for servicemembers
    staffed with primary care and psychological health providers. We now
    have 17 DHCs operational. Our health care delivery model supports early
    recognition and treatment of deployment-related psychological health
    issues within the primary care setting. Psychological health services
    account for approximately 30 percent of all DHC encounters. We have
    also increased mental health training in primary care, and have
    actively partnered with Line leaders and the Chaplain Corps to develop
    combat and operational stress control training resources. Awareness and
    training are keys to our surveillance efforts. Over 4,000 Navy Medicine
    providers, mental health professionals, chaplains and support personnel
    have been trained to detect, screen, and refer personnel who may be
    struggling with mental health issues.
        We must continue to recognize the occupational stress on our
    caregivers. They are subject to the psychological demands of exposure
    to trauma, loss, fatigue, and inner conflict. This is why our Caregiver
    Occupational Stress Control programs are so important to building and
    sustaining the resiliency of our providers. We cannot overlook the
    impact on these professionals and I have directed Navy Medicine
    leadership to be particularly attuned to this issue within their
    commands.
                             traumatic brain injury
        While there are many significant injury patterns in theatre, an
    important focus area for all of us remains Traumatic Brain Injury
    (TBI). Blast is the signature injury of OEF and OIF--and from blast
    injury comes TBI. The majority of TBI injuries are categorized as mild,
    or in other words, a concussion. Yet, there is much we do not yet know
    about these injuries and their long-term impacts on the lives of our
    servicemembers.
        The relative lack of knowledge about mild TBI amongst
    servicemembers and health care personnel represents an important gap
    that Navy Medicine is seriously addressing. We are providing TBI
    training to health care providers from multiple disciplines throughout
    the fleet and the Marine Corps. This training is designed to educate
    personnel about TBI, introduce the Military Acute Concussion Exam
    (MACE) as a screening tool for mild TBI, inform providers about the
    Automated Neurocognitive Assessment Metric (ANAM) test, and identify a
    follow-up for assessment including use of a repeatable test battery for
    identification of cognitive status. We have recently established and
    are now expanding our TBI program office to manage the implementation
    of the ANAM as a pre-deployment test for servicemembers in accordance
    with DOD policy. This office will further develop models of assessment
    and care as well as support research and evaluation programs.
        All the Services expect to begin implementation of a new in-theater
    TBI surveillance system which will be based upon incident event
    tracking. Promulgated guidelines will mandate medical evaluation for
    all servicemembers exposed within a set radius of an explosive blast,
    with the goal to identify any servicemember with subtle cognitive
    deficits who may not be able to return to duty immediately.
        Navy Medicine has begun implementing the ANAM assessment at the
    DHCs and within deploying units as part of an assistant Secretary of
    Defense (Health Affairs) mandate. We have also partnered with line
    leadership, or operational commanders, to identify populations at risk
    for brain injury (e.g., front-line units, SEAL units, and Navy
    Explosive Ordinance Disposal units). In addition, an in-theater
    clinical trial for the treatment of vestibular symptoms of blast-
    exposure/TBI was completed at the USMC mTBI Center in Al Taqqadum,
    Iraq.
        Both our Naval Health Research Center and Navy-Marine Corps Public
    Health Center are engaged with tracking TBI data through ongoing
    epidemiology programs. Goals this year include the establishment of a
    restoration center in-theatre to allow injured sailors and marines a
    chance to recover near their units and return to the fight.
        Additionally, the National Naval Medical Center's Traumatic Stress
    and Brain Injury Program provides care to all blast-exposed or head-
    injured casualties returning from theatre to include patients with an
    actual brain injury and traumatic stress. Navy Medicine currently has
    TBI clinics at San Diego, Portsmouth, Camp Pendleton, and Camp Lejeune
    with plans for further expansion reflecting our commitment to the
    treatment of this increasingly prevalent injury.
        We are employing a strategy that is both collaborative and
    integrative by actively partnering with the other Services, Defense
    Center of Excellence for Psychological Health and Traumatic Brain
    Injury, the Veterans Administration, and leading academic medical and
    research centers to make the best care available to our Warriors
    afflicted with TBI.
                     excellence in research and development
        Research and development is critical to Navy Medicine's success and
    our ability to remain agile to meet the evolving needs of our
    warfighters. It is where we find solutions to our most challenging
    problems and, at the same time, provide some of medicine's most
    significant innovations and discoveries. Our research and development
    programs are truly force-multipliers and enable us to provide world-
    class health care to our beneficiaries.
        The approach at our research centers and laboratories around the
    world is straightforward: Conduct health and medical research,
    development, testing, evaluation and surveillance to enhance deployment
    readiness. Each year, we see more accomplishments which have a direct
    impact on improving force health protection. The contributions are many
    and varied, ranging from our confirmatory work in the early stages of
    the H1N1 pandemic, to the exciting progress in the development of a
    malaria vaccine. Research efforts targeted at wound management,
    including enhanced wound repair and reconstruction as well as extremity
    and internal hemorrhage control, and phantom limb pain in amputees,
    present definitive benefits. These efforts also support our emerging
    expeditionary medical operations and aid in support to our Wounded
    Warriors.
                             the navy medicine team
        Navy Medicine is comprised of compassionate and talented
    professionals who continue to make significant contributions and
    personal sacrifices to our global community. Our team includes our
    officers, enlisted personnel, government civilian employees, contract
    workers and volunteers working together in a vibrant health care
    community. All have a vital role in the success of our enterprise. Our
    priority is to maintain the right workforce to deliver the required
    medical capabilities across the enterprise, while using the appropriate
    mix of accession, retention, education and training incentives.
        Overall, I am encouraged with our recruiting efforts within Navy
    Medicine and we are starting to see the results of new incentive
    programs. But while overall manning levels for both officer and
    enlisted personnel are relatively high, ensuring we have the proper
    specialty mix continues to be a challenge. Several wartime critical
    specialties including psychiatry, family medicine, general surgery,
    emergency medicine, critical care and perioperative nursing, as well as
    advanced practice nursing and physician assistants, are undermanned. We
    are also facing shortfalls for general dentists, oral maxillofacial
    surgeons, and many of our mental health specialists including clinical
    psychologists and social workers. We have increasing requirements for
    mental health professionals as well as for Reserve Component Medical
    Corps, Dental Corps, Medical Service Corps, and Nurse Corps officers.
    We continue to work hard to meet this demand, but fulfilling the
    requirements among these specialties is expected to present a
    continuing challenge.
        I want to also reemphasize the priority we place on diversity. We
    are setting the standard for building a diverse, robust, innovative
    health care workforce, but we can do more in this important area. Navy
    Medicine is stronger and more effective as a result of our diversity at
    all levels. Our people are our most important resource, and their
    dignity and worth are maintained through an atmosphere of service,
    professionalism, trust and respect.
                         partnerships and collaboration
        Navy Medicine continues to focus on improving interoperability with
    the Army, Air Force, Veterans Administration (VA), as well other
    Federal and civilian partners to bring operational efficiencies,
    optimal technology and training together in support of our patients and
    their families, our missions, and the national interests. Never has
    this collaborative approach been more important, particularly as we
    improve our approaches to ensuring seamless transitions for our
    veterans.
        We remain committed to resource sharing agreements with the VA and
    our joint efforts in support of improving the Disability Evaluation
    System (DES) through the ongoing pilot program at several MTFs. The
    goal of this pilot is to improve the disability evaluation process for
    servicemembers and help simplify their transitions. Together with the
    VA and the other Services, we are examining opportunities to expand
    this pilot to additional military treatment facilities. Additionally,
    in partnership with the VA, we will be opening the James A. Lovell
    Federal Health Care Center in Great Lakes, IL--a uniquely integrated
    Navy/VA medical facility.
        We also look forward to leveraging our inter-service education and
    training capabilities with the opening of the Medical Education and
    Training Campus in San Antonio in 2010. This new tri-service command
    will oversee the largest consolidation of service training in DOD
    history. I am committed to an inter-service education and training
    system that optimizes the assets and capabilities of all DOD health
    care practitioners yet maintains the unique skills and capabilities
    that our hospital corpsmen bring to the Navy and Marine Corps--in
    hospitals, clinics at sea and on the battlefield.
        Clearly one of the most important priorities for the leadership of
    all the Services is the successful transition to the Walter Reed
    National Military Medical Center onboard the campus of the National
    Naval Medical Center, Bethesda. We are working diligently with the lead
    DOD organization, Joint Task Force--National Capital Region Medical, to
    ensure that this significant and ambitious project is executed properly
    and without any disruption of services to our sailors, marines, their
    families, and all our beneficiaries for whom we are privileged to
    serve.
                                the way forward
        I believe we are at an important crossroads for military medicine.
    How we respond to the challenges facing us today will likely set the
    stage for decades to come. Commitment to our Wounded Warriors and their
    families must never waver and our programs of support and hope must be
    built and sustained for the long-haul--and the long-haul is the rest of
    this century when the young Wounded Warriors of today mature into our
    aging heroes in the years to come. They will need our care and support
    as will their families for a lifetime. Likewise, our missions of
    cooperative engagement, through humanitarian assistance and disaster
    response, bring opportunities for us, our military, and the Nation. It
    is indeed a critical time in which to demonstrate that the U.S. Navy is
    truly a ``Global Force for Good.''
        Navy Medicine is a vibrant, world-wide health care system comprised
    of compassionate and talented professionals who are willing to make
    contributions and personal sacrifices. This team--our team--including
    officer, enlisted, civilians, contractors, and volunteers work together
    as a dynamic health care family. We are all essential to success.
        Navy Medicine will continue to meet the challenges ahead and
    perform our missions with outstanding skill and commitment. On behalf
    of the men and women of Navy Medicine, I want to thank the committee
    for your tremendous support, confidence, and leadership. It has been my
    pleasure to testify before you today and I look forward to your
    questions.

        Senator Webb. Thank you very much, Admiral Robinson.
        General Green, welcome.

     STATEMENT OF LT. GEN. CHARLES B. GREEN, USAF, SURGEON GENERAL
                         OF THE U.S. AIR FORCE

        General Green. Thank you, sir.
        Chairman Webb, Senator Graham, and distinguished members of
    the committee, it's an honor and a privilege to appear before
    you, representing the Air Force Medical Service.
        I look forward to working with you and pledge to do all in
    my power to support the men and women or our Armed Forces and
    this great country. Thank you for your immeasurable
    contributions to the success of our mission.
        ``Trusted Care Anywhere'' is our vision for 2010 and
    beyond. Our nearly 60,000 total-force medics contribute world-
    class medical capabilities to Air Force, joint, and coalition
    teams around the world. Seventeen hundred Air Force medics are
    currently deployed to 40 locations in 20 countries, delivering
    state-of-the-art preventive medicine, rapid lifesaving care,
    and critical air evacuation. Since November 2001, we've air-
    evac'd over 70,000 patients from Afghanistan and Iraq, and have
    lost only 4 patients during evacuation.
        Air Force medics are responding globally in humanitarian
    missions, as well as on the battlefield, and in just the last 6
    months, we contributed significant support to Indonesia, Haiti,
    and the Chilean earthquake victims.
        This is a year of firsts. The first known successful air
    evacuation of a patient with traumatic lung removal was done
    last July. The patient is doing well in Birmingham, England,
    today.
        In January 2010, a U.S. marine sustained dislocation of
    both knees, with loss of blood flow to his lower legs,
    following an IED attack in the Helmand Province. Air Force
    surgeons performed definitive vascular reconstruction within
    hours of the injury, and the marine is now recovering in the
    National Naval Medical Center in Bethesda, and is expected to
    have fully functional limbs.
        An airman shot three times in the back will not be a
    diabetic, despite the absence of his pancreas, because surgeons
    across three continents harvested and grew his pancreatic cells
    then implanted the cells into his liver at Walter Reed.
        These success stories are possible only because of tireless
    efforts of Air Force, Army, Navy, and coalition medics to
    continuously improve our care.
        At home, our healthcare teams provide patient-centered
    full-spectrum healthcare to our beneficiaries. We're improving
    patient and provider satisfaction through our Patient-Centered
    Medical Home by building strong partnerships between patients
    and their healthcare teams. Our Family Health Initiative and
    Surgical Care Optimization Initiatives are improving healthcare
    continuity, quality, access, and patient satisfaction.
        Our Air Force Suicide Prevention Program, implemented in
    1997, continues to be effective, but we have noted a slowly
    increasing rate of suicides since 2007. We are enhancing our
    prevention programs to further decrease suicides by targeting
    the most stressed by our high operations tempo. We now target
    more indepth interventions and training to Air Force security
    forces and intelligence career fields, whom we have identified
    as having double the incidence of suicide, compared to the rest
    of the Air Force.
        We continue training the entire force on suicide prevention
    and coping skills, to improve both airmen and family
    resilience. We adapted new concepts rapidly, such as ``Ask,
    Care, and Escort'' and collaborative care, wherein mental
    health providers are now embedded in the majority of our family
    health clinics.
        We have also studied and targeted interventions for our
    civilian workforce identified at high risk. Collaborative care,
    online help, mandatory post-deployment surveys, and family-life
    counselors at our Airman and Family Readiness centers, have
    decreased stigma and allowed those in need to get help earlier.
        We're encouraged by the continued low indicators for stress
    in the Air Force. Alcohol abuse remains low and stable, as does
    illegal and prescription drug abuse. We target programs to
    further reduce underage drinking and enhance safety. Our
    numbers in domestic violence are trending downward. We continue
    to monitor these indicators carefully to target effective
    interventions.
        To achieve our vision of ``Trusted Care Anywhere,'' we
    require highly-trained, current, and qualified providers, and
    we're extremely grateful to this committee for your many
    efforts to strengthen our recruiting and retention programs.
        The Air Force Medical Service is committed to the health
    and wellness of all entrusted to our care. We are, indeed, all
    in to meet our Nation's call, and will achieve our vision
    through determined, continuous improvement. We could not
    achieve our goals of better readiness, better health, better
    care, and best value for our heroes and their families without
    your support, and we thank you.
        I stand ready for your questions, sir.
        [The prepared statement of General Green follows:]
          Prepared Statement by Lt. Gen. (Dr.) Charles B. Green, USAF
        Chairman Webb, Senator Graham, and distinguished members of the
    subcommittee, it is an honor and a privilege to appear before you
    representing the Air Force Medical Service and our 60,000 Total Force
    medics. I'm looking forward to working with you during my tenure as Air
    Force Surgeon General. I pledge to do all in my power to support the
    men and women of the Armed Forces and this great country. Thank you for
    your immeasurable contributions to the success of our mission.
        ``Trusted Care Anywhere'' is the Air Force Medical Service's vision
    for 2010 and beyond. In the domain of Air, Space and Cyberspace, our
    medics contribute to the Air Force, Joint, and coalition team with
    world class medical capabilities. Our 60,000 high performing Total
    Force medics around the globe are trained and ready for mission
    success. Over 1,600 Air Force medics are now deployed to 40 locations
    in 20 countries, building partnership capability and delivering state
    of the art preventive medicine, rapid lifesaving care, and critical air
    evacuation. In all cases, these efforts are conducted with joint and
    coalition partners. At home, our health care teams assure patient-
    centered care to produce healthy and resilient airmen, and provide our
    families and retirees with full spectrum health care.
        Today's focus is on world-class health care delivery systems across
    the full spectrum of our operations. From theater hospitals in Balad
    and Bagram, to the efforts of humanitarian assistance response teams,
    to the care of our families at home, we put patients first. We are
    transforming deployable capabilities, building patient-centered care
    platforms, and investing in our people, the foundation of our success.
    We are expanding collaboration with joint and coalition partners to
    collectively strengthen rapid response capabilities. Globally, Air
    Force medics are diligently working to balance the complex demands of
    multiple missions in current and expanding areas of operations.
        We are committed to advancing capabilities through education and
    training, research, and infrastructure recapitalization. Recent efforts
    in these areas have paid huge dividends, establishing new standards in
    virtually every major category of full spectrum care including
    humanitarian assistance. The strategic investments assure a trained,
    current, and deployable medical force today and tomorrow. They
    reinforce a culture of learning to quickly adapt medical systems and
    implement agile organizations to produce healthier outcomes in diverse
    mission areas.
        While we've earned our Nation's trust with our unique capabilities
    and the expertise of our people, we constantly seek to do better! I
    would like to highlight our areas of strategic focus and share some
    captivating examples of Air Force medics in action.
        transforming expeditionary medicine and aeromedical evacuation
                                  capabilities
        Our success on the battlefield underscores our ability to provide
    ``Trusted Care, Anywhere.'' The joint and coalition medical teams bring
    wounded warriors from the battlefield to an operating room within an
    unprecedented 20 to 40 minutes! This rapid transfer rate enables medics
    to achieve a less than 10 percent died-of-wounds rate, the best
    survival rate ever seen in war.
        In late July, a British soldier sustained multiple gunshot wounds
    in Afghanistan. After being stabilized by medical teams on the ground,
    who replaced his blood supply more than 10 times, doctors determined
    the patient had to be moved to higher levels of care in Germany. It
    took two airplanes to get the medical team and equipment in place,
    another aircraft to fly the patient to Germany, three aircrews and many
    more personnel coordinating on the ground to get this patient to the
    next level of care. Every member of the joint casualty care and
    aeromedical evacuation teams selflessly gave their all to ensure this
    soldier received the compassionate care he deserved. After landing
    safely at Ramstein Air Base in Germany, the soldier was flown to
    further medical care at a university hospital by helicopter. This case
    highlights the dedication and compassion our personnel deliver in the
    complex but seamless care continuum. This tremendous effort contributes
    to our unprecedented survival rate.
        As evidenced in this story, our aeromedical evacuation system (AE)
    and critical care air transport teams are world-class. We mobilize
    specially trained flight crews and medical teams on a moment's notice
    to transport the most critical patients across oceans. Since November
    2001, we have transported more than 70,000 patients from Afghanistan
    and Iraq.
        We are proud of our accomplishments to date, but strive for further
    innovation. As a result of battlefield lessons learned, we have
    recently implemented a device to improve spinal immobilization for AE
    patients that maximizes patient comfort and reduces skin pressure. We
    are working toward an improved detection mechanism for compartment
    syndrome in trauma patients. The early detection and prevention of
    excess compartment pressure could eliminate irreversible tissue damage
    for patients. In February 2010, a joint Air Force and Army team will
    begin testing equipment packages designed to improve ventilation,
    oxygen, fluid resuscitation, physiological monitoring, hemodynamic
    monitoring and intervention in critical care air transport.
                 information management/information technology
        Our Theater Medical Information Program Air Force (TMIP AF) is a
    software suite that automates and integrates clinical care
    documentation, medical supplies, equipment, and patient movement. It
    provides the unique capabilities for in-transit visibility and
    consolidated medical information to improve command and control and
    allow better preventive surveillance at all Air Force deployed
    locations. This is a historic first for the TMIP AF program.
        Critical information is gathered on every patient, then entered
    into the Air Force Medical Service (AFMS) deployed system. Within 24
    hours, records are moved and safely stored at secure consolidated
    databases in the United States. During the first part of 2010, TMIP AF
    will be utilized in Aeromedical Evacuation and Air Force Special
    Operations areas.
               expeditionary medicine and humanitarian assistance
        We have also creatively developed our Humanitarian Assistance Rapid
    Response Team (HARRT), a Pacific Command (PACOM) initiative, to
    integrate expeditionary medical systems and support functions. The
    HARRT provides the PACOM Commander with a rapid response package that
    can deploy in less than 24 hours, requires only two C-17s for transport
    and can be fully operational within hours of arrival at the disaster
    site. This unique capability augments host nation efforts during the
    initial stages of rescue/recovery, thus saving lives, reducing
    suffering, and preventing the spread of disease. So far, HARRT
    successfully deployed on two occasions in the Pacific. Efforts are
    underway to incorporate this humanitarian assistance and disaster
    relief response capability into all AFMS Expeditionary Medical System
    (EMEDS) assets.
        Air Force medics contribute significant support to the treatment
    and evacuation of Haiti earthquake victims. The Air Force Special
    Operations Command sent 47 medics to support Air Force Special
    Operations Command troops on the ground within 12 hours following the
    disaster to perform site assessments, establish preventive public
    health measures, and deliver lifesaving trauma care to include surgical
    and critical care support. This team was also instrumental in working
    with Southern Command and Transportation Command to establish a patient
    movement bridge evacuating individuals from Haiti via air transport.
        As part of the U.S. Air Force's total force effort, we sent our
    EMEDS platform into Haiti and rapidly established a 10-bed hospital to
    link the hospital ship to ground operations. The new EMEDS includes
    capabilities for pediatrics, OB/GYN and mental health. Personnel from
    five Air Force medical treatment facilities are supporting Operation
    Unified Response, as well as volunteers from the Air Reserve Forces.
     build patient-centered care and focus on prevention to optimize health
        We are committed to achieving the same high level of trust with our
    patients at home through our medical home concept. Medical home
    includes initiatives to personalize care, and to improve health and
    resilience. We are also working hard to optimize our operations, reduce
    costs and improve patient access. We partner with our Federal and
    civilian colleagues to continuously improve care to all our
    beneficiaries.
    Family Health Initiative
        To achieve better health outcomes for our patients, we implemented
    the Family Health Initiative (FHI). FHI mirrors the American Academy of
    Family Physicians' ``Patient Centered Medical Home'' concept and is
    built on the team-approach for effective care delivery. The partnership
    between our patients and their health care teams is critical to create
    better health and better care via improved continuity, and reduce per
    capita cost.
        Our providers are given full clinical oversight of their care teams
    and are expected to practice to the full scope of their training. We
    believe the results will be high quality care and improved professional
    satisfaction. Two of our pilot sites, Edwards Air Force Base (AFB), CA,
    and Ellsworth AFB, SD, have dramatically improved their national
    standings in continuity, quality, access to care, and patient
    satisfaction. Eleven other bases are implementing Medical Home, with an
    additional 20 bases scheduled to come on-line in 2010.
        We are particularly encouraged by the results of our patient
    continuity data in Medical Home. Previous metrics showed our patients
    only saw their assigned provider approximately 50 percent of the time.
    At Edwards and Ellsworth AFBs, provider continuity is now in the 80-90
    percent range.
        We still have work to do, such as developing improved decision
    support tools, case management support, and improved training.
    Implementing change of this size and scope requires broad commitment.
    The Air Force Medical Service has the commitment and is confident that
    by focusing on patient-centered care through Medical Home, we will
    deliver exceptional care in the years ahead.
        The Military Health System's Quadruple Aim of medical readiness,
    population health, experience of care and per capita cost serves us
    well. Patient safety remains central to everything we do. By focusing
    on lessons learned and sharing information, we continually strive to
    enhance the safety and quality of our care. We share our clinical
    lessons learned with the Department of Defense (DOD) Patient Safety
    Center and sister Services. We integrate clinical scenarios and lessons
    learned into our simulation training. We securely share de-identified
    patient safety information across the Services through DOD's web-based
    Patient Safety Learning Center to continuously improve safety.
    Improving Resilience and Safeguarding the Mental Health of Our Airmen
        Trusted care for our beneficiaries includes improving resilience
    and safeguarding their mental health and well-being. We are engaged in
    several initiatives to optimize mental health access and support.
        Air Force post-deployment health assessment and post-deployment
    health re-assessment data indicates a relatively low level of self-
    reported stress. However, about 20-30 percent of servicemembers
    returning from Operation Iraqi Freedom/Operation Enduring Freedom
    deployments report some form of psychological distress. The number of
    personnel referred for further evaluation or treatment has increased
    from 25 percent to 50 percent over the past 4 years, possibly
    reflecting success in reducing stigma of seeking mental health support.
    We have identified our high-risk groups and can now provide targeted
    intervention and training.
        We recently unveiled ``Defenders Edge,'' which is tailored to
    security forces airmen who are deploying to the most hostile
    environments. This training is intended to improve airmen mental
    resiliency to combat-related stressors. Unlike conventional techniques,
    which adopt a one-on-one approach focusing on emotional vulnerability,
    ``DEFED'' brings the mental health professional into the group
    environment, assimilating them into the security forces culture as
    skills are taught.
        Airmen who are at higher risk for post traumatic stress are closely
    screened and monitored for psychological concerns post-deployment. If
    treatment is required, these individuals receive referrals to the
    appropriate providers. In addition to standard treatment protocols for
    post-traumatic stress disorder (PTSD), Air Force mental health
    professionals are capitalizing on state-of-the-art treatment options
    using Virtual Reality. The use of a computer-generated virtual Iraq in
    combination with goggles, headphones, and a scent machine allow
    servicemembers to receive enhanced prolonged exposure therapy in a safe
    setting. In January 2009, 32 Air Force Medical Service therapists
    received Tri-Service training in collaboration with the Defense Center
    of Excellence at Madigan Army Medical Center. The system was deployed
    to eight Air Force sites in February 2009 and is assisting
    servicemembers in the treatment of PTSD.
        Future applications of technology employing avatars and virtual
    worlds may have multiple applications. Servicemember and family
    resiliency will be enhanced by providing pre- and post-deployment
    education; new parent support programs may offer virtual parent
    training; and family advocacy and addiction treatment programs may
    provide anger management, social skills training, and emotional and
    behavioral regulation.
    Rebuilding Our Capabilities by Recapturing Care and Reducing Costs
        Our patients appropriately expect AFMS facilities and equipment
    will be state-of-the art and our medical teams clinically current. They
    trust we will give them the best care possible. We are upgrading our
    medical facilities and rebuilding our capabilities to give patients
    more choice and increase provider satisfaction with a more complex case
    load. In our larger facilities, we launched the Surgical Optimization
    Initiative, which includes process improvement evaluations to improve
    operating room efficiency, enhance surgical teamwork, and eliminate
    waste and redundancy. This initiative resulted in a 30 percent increase
    in operative cases at Elmendorf AFB, AK, and 118 percent increase in
    neurosurgery at Travis AFB, CA.
        We are engaged in an extensive modernization of Wright-Patterson
    Air Force Base Medical Center in Ohio with particular focus on surgical
    care and mental health services. We are continuing investment in a
    state-of-the-art new medical campus for SAMMC at Lackland AFB, TX. Our
    ambulatory care center at Andrews AFB, MD, will provide a key
    capability for the delivery of world-class health care in the National
    Capital Region's multi-service market.
        By increasing volume, complexity and diversity of care provided in
    Air Force hospitals, we make more care available to our patients; and
    we provide our clinicians with a robust clinical practice to ensure
    they are prepared for deployed operations, humanitarian assistance, and
    disaster response.
    Partnering With Our Private Sector and Federal Partners
        Now more than ever, collaboration and cooperation with our private
    sector and Federal partners is key to maximizing resources, leveraging
    capabilities and sustaining clinical currency. Initiatives to build
    strong academic partnerships with St. Louis University, Wright State
    University (Ohio); University of Maryland; University of Mississippi;
    University of Nebraska-Lincoln; University of California-Davis and
    University of Texas-San Antonio, among others, bolster research and
    training platforms and ultimately, ensures a pipeline of current,
    deployable medics to sustain Air Force medicine.
        Our long history of collaborating with the Veterans Administration
    (VA) also enhances clinical currency for our providers, saves valuable
    resources, and provides a more seamless transition for our airmen as
    they move from active duty to veteran status. The Air Force currently
    has five joint ventures with the VA, including the most recent at
    Keesler AFB, MS. Additional efforts are underway for Buckley AFB, CO,
    to share space with the Denver VA Medical Center, which is now under
    construction.
        The new joint Department of Defense-Veterans Affairs disability
    evaluation system pilot started at Malcolm Grow Medical Center at
    Andrews AFB, MD in November 2007. It was expanded to include Elmendorf
    AFB, AK; Travis AFB, CA and Vance AFB, OK; and MacDill AFB, FL, in May
    2009. Lessons learned are streamlining and expediting disability
    recovery and processing, and creating improved treatment, evaluation
    and delivery of compensation and benefits. The introduction of a single
    comprehensive medical examination and single-sourced disability rating
    was instrumental to improving the process and increasing the
    transparency. Services now allow members to see proposed VA disability
    ratings before separation.
        We continue to work toward advances in the interoperability of the
    electronic health record. Recent updates allow near real-time data
    sharing between DOD and Veterans Affairs providers. Malcolm Grow
    Medical Center, Wright-Patterson Medical Center, and David Grant
    Medical Center are now using this technology, with 12 additional Air
    Force military treatment facilities slated to come online. New system
    updates will enhance capabilities to share images, assessment reports,
    and data. All updates are geared toward producing a virtual lifetime
    electronic record and a nationwide health information network.
                          year of the air force family
        This is the ``Year of the Air Force Family,'' and we are working
    hand in hand with Air Force personnel and force management to ensure
    our Exceptional Family Member Program beneficiaries receive the
    assistance they need.
        In September 2009, the Air Force sponsored an Autism Summit where
    educational, medical, and community support personnel discussed
    challenges and best practices. In December 2009, the Air Force Medical
    Service provided all Air Force treatment facilities with an autism tool
    kit. The kit provided educational information to providers on diagnosis
    and treatment. Also, Wright-Patterson AFB, OH is partnering with
    Children's Hospital of Ohio in a research project to develop a
    comprehensive registry for autism spectrum disorders, behavioral
    therapies, and gene mapping.
        The Air Force actively collaborates with sister Services and the
    Defense Center of Excellence for Psychological Health and Traumatic
    Brain injury to offer a variety of programs and services to meet the
    needs of children of wounded warriors. One recent initiative was the
    ``Family Connections'' website with Sesame Street-themed resources to
    help children cope with deployments and injured parents. In addition,
    DOD-funded websites, such as afterdeployment.org, providing specific
    information and guidance for parents/caregivers to understand and help
    kids deal with issues related to deployment and its aftermath.
        Parents and caregivers also consult with their child's primary care
    manager, who can help identify issues and refer the child for care when
    necessary. Other resources available to families include counseling
    through Military OneSource, Airman and Family Readiness Centers,
    Chaplains, and Military Family Life Consultants--all of whom may refer
    the family to seek more formal mental health treatment through
    consultation with their primary care manager or by contacting a TRICARE
    mental health provider directly.
           investing in our people: education, training, and research
    Increased Focus on Recruiting and Retention Initiatives
        To gain and hold the trust of our patients, we must have highly
    trained, current, and qualified providers. To attract those high
    quality providers in the future, we have numerous efforts underway to
    improve recruiting and retention.
        We've changed our marketing efforts to better target recruits, such
    as providing Corps-specific DVDs to recruiters. The Health Profession
    Scholarship Program remains vital to attracting doctors and dentists,
    accounting for 75 percent of these two Corps' accessions. The Air Force
    International Health Specialist program is another successful program,
    providing Air Force Medical Service personnel with opportunities to
    leverage their foreign language and cultural knowledge to effectively
    execute and lead global health engagements, each designed to build
    international partnerships and sustainable capacity.
        The Nursing Enlisted Commissioning Program (NECP) is a terrific
    opportunity for airmen. Several airmen have been accepted to the NECP,
    completed degrees, and have been commissioned as Second Lieutenant
    within a year. To quote a recent graduate, 2nd Lt. April C. Barr, ``The
    NECP was an excellent way for me to finish my degree and gave me an
    opportunity to fulfill a goal I set as a young airman . . . to be
    commissioned as an Air Force nurse.''
        For our enlisted personnel, targeted Selective Reenlistment
    Bonuses, combined with continued emphasis on quality of life, generous
    benefits, and job satisfaction have positively impacted enlisted
    recruiting and retention efforts.
    Increasing Synergy to Strengthen GME and Officer/Enlisted Training
        We foster excellence in clinical, operational, joint and coalition
    partner roles for all Air Force Medical Service personnel. We are
    increasing opportunities for advanced education in general dentistry
    and establishing more formalized, tiered approaches to Medical Corps
    faculty development. Senior officer and enlisted efforts in the
    National Capital Region and the San Antonio Military Medical Center are
    fostering Tri-Service collaboration, enlightening the Services to each
    others' capabilities and qualifications, and establishing opportunities
    to develop and hone readiness skills.
        The Medical Education and Training Campus (METC) at Fort Sam
    Houston, TX, will have a monumental impact on the Department of Defense
    and all Military Services. We anticipate a smooth transition with our
    moves completed by summer 2011. METC will train future enlisted medics
    to take care of our servicemembers and their families and will
    establish San Antonio as a medical training center of excellence.
        Our Centers for the Sustainment of Trauma and Readiness Skills at
    St. Louis University, University of Maryland-Baltimore Shock Trauma and
    University of Cincinnati College of Medicine remain important and
    evolving training platforms for our doctors, nurses and medical
    technicians preparing to deploy. We recently expanded our St. Louis
    University training program to include pediatric trauma. Tragically,
    this training became necessary, as our deployed medics treat hundreds
    of children due to war-related violence.
        Partnerships with the University Hospital Cincinnati and
    Scottsdale, AZ, trauma hospitals allow the Air Force's nurse transition
    programs to provide newly graduated registered nurses 11 weeks of
    rotations in emergency care, cardiovascular intensive care, burn unit,
    endoscopy, same-day surgery, and respiratory therapy. These advanced
    clinical and deployment readiness skills prepare them for success in
    Air Force hospitals and deployed medical facilities, vital to the care
    of our patients and joint warfighters.
    Setting Clear Research Requirements and Integrating Technology
        Trusted care is not static. To sustain this trust, we must remain
    agile and adaptive, seeking innovative solutions to shape our future.
    Our ongoing research in procedures, technology, and equipment will
    ensure our patients and warfighters always benefit from the latest
    medical technologies and clinical advancements.
        Air Force Medical Service vascular surgeons, Lieutenant Colonels
    Todd Rasmussen and William ``Darrin'' Clouse, have completed 17
    research papers since 2005 and edited the vascular surgery handbook. On
    January 10, 2009 a U.S. Marine sustained bilateral posterior knee
    dislocations with subsequent loss of blood flow to his lower legs
    following an improvised explosive device attack in the Helmand
    Province. Casualty evacuation delivered the marine to our British
    partners at Camp Bastion, a level II surgical unit within an hour. At
    Bastion, British surgeons applied knowledge gained from combat casualty
    care research and restored blood flow to both legs using temporary
    vascular shunts. Medical evacuation then delivered the casualty to the
    455th Expeditionary Medical Group at Bagram. Upon arrival, our surgeons
    at Bagram performed definitive vascular reconstruction and protected
    the fragile soft tissue with negative pressure wound therapy. The
    Marine is currently recovering at the National Military Medical Center
    in Bethesda and is expected to have functional limbs.
        In another example, a 21-year-old airman underwent a rare
    pancreatic autotransplantation surgery at Walter Reed Army Medical
    Center (WRAMC) to salvage his body's ability to produce insulin. The
    airman was shot in the back three times by an insurgent at a remote
    outpost in Afghanistan. The patient underwent two procedures in
    Afghanistan to stop the bleeding, was flown to Germany, then to WRAMC.
    Army surgeons consulted with University of Miami's Miller School of
    Medicine researchers on transplantation experiments. The surgeons
    decided to attempt a rare autotransplantation surgery to save the
    remaining pancreas cells. WRAMC Surgeons removed his remaining pancreas
    cells and flew them over 1,000 miles to the University of Miami Miller
    School of Medicine. The University of Miami team worked through the
    night to isolate and preserve the islet cells. The cells were flown
    back to WRAMC the next day and successfully implanted in the patient.
    The surgery was a miraculous success, as the cells are producing
    insulin.
        These two cases best illustrate the outcome of our collaborations,
    culture of research, international teamwork, innovation, and
    excellence.
    Shaping the Future Today Through Partnerships and Training
        Under a new partnership with the University of Illinois at Chicago,
    we are researching directed energy force protection, which focuses on
    detection, diagnosis and treatment of directed energy devices. We are
    exploring the discovery of biomarkers related to laser eye injuries,
    development of films for laser eye protection and the development of a
    ``tricorder'' prototype capable of laser detection and biomarker
    assessment. Additional efforts focus on the use and safety of laser
    scalpels and the development of a hand-held battery operated laser tool
    to treat wounds on the battlefield.
        We continue our 7-year partnership with the University of
    Pittsburgh Medical Center to develop Type II diabetes prevention and
    treatment programs for rural and Air Force communities. Successful
    program efforts in the San Antonio area include the establishment of a
    Diabetes Center of Excellence, ``Diabetes Day'' outreach specialty
    care, and efforts to establish a National Diabetes Model for diabetic
    care.
        Another partnership, with the University of Maryland Medical Center
    and the Center for the Sustainment of Trauma and Readiness Skills (C-
    STARS) in Baltimore is developing advanced training for Air Force
    trauma teams. The project goal is to develop a multi-patient trauma
    simulation capability using high fidelity trauma simulators to
    challenge trauma teams in rapid assessment, task management, and
    critical skills necessary for the survival of our wounded warriors. A
    debriefing model is being developed to assist with after action reviews
    for trauma team members.
        Radiofrequency technology is contributing to medical process
    improvements at Keesler AFB, MS. Currently, Keesler AFB is analyzing
    the use of automatic identification and data capture (AIDC) in AFMS
    business processes. The AIDC evaluation focuses on four main areas:
    patient tracking, medication administration, specimen tracking, and
    asset management. Further system evaluation and data collection is
    ongoing in 2010 with an expansion of AIDC use in tracking automated
    data processing equipment.
                                   conclusion
        As a unique health system, we are committed to success across the
    spectrum of military operations through rapid deployability and
    patient-centered care. We are partnering for better outcomes and
    increasing clinical capacity. We are strengthening our education and
    training platforms through partnerships and scanning the environment
    for new research and development opportunities to keep Air Force
    medicine on the cutting edge.
        We will enhance our facilities and the quality of health care to
    ensure health and wellness of all entrusted to our care. We do all this
    with a focus on patient safety and sound fiscal stewardship. We could
    not achieve our goals of better readiness, better health, better care
    and reduced cost without your support, and so again, I thank you.
        In closing, I share a quote from our Air Force Chief of Staff, Gen.
    Norton A. Schwartz, who said, ``I see evidence every day the Medical
    Service is ``All In,'' faithfully executing its mission in the heat of
    the fight, in direct support of the warfighter, and of families back
    home as well.'' I know you would agree that ``All in'' is the right
    place to be.

        Senator Webb. Thank you, General Green.
        Admiral Jeffries, welcome.

    STATEMENT OF RADM RICHARD R. JEFFRIES, USN, MEDICAL OFFICER OF
                         THE U.S. MARINE CORPS

        Admiral Jeffries. Chairman Webb, Senator Graham,
    distinguished members of the subcommittee, good morning.
        I'm honored to be with you, the Senate Armed Services
    Personnel Subcommittee, today to discuss the state of Navy
    Medicine as it pertains to the health services support to the
    U.S. Marine Corps.
        I want to thank the committee members for your unwavering
    support of Navy Medicine and the U.S. Marine Corps,
    particularly as it relates to our healthcare advances and
    continuum of quality care for marines and sailors. Our warriors
    who go into harm's way for this great Nation, their families,
    and those who have gone before in service to our country
    deserve the very best in care and support that we can provide.
        Marine Medicine is all about a special bond--the one of
    complete trust between a marine and a doctor. They know that
    all will be given, each for the other, when the Nation's
    mission calls for their total commitment and potential
    sacrifice to the defense of our country. Corpsmen up with
    lifesaving skills, and yet, the potential risk of injury or
    death is just as real today as it was over 50 years ago.
        Navy Medicine is a dedicated, fully integrated worldwide
    healthcare system meeting the needs of our marines and sailors,
    their families, retirees, and, at times, those whose fortunes
    are beset with a disaster. We specialize in health, prevention,
    and readiness, and, when called upon, casualty and humanitarian
    lifesaving care to all we touch.
        Marine Medicine lives first and foremost at the point of
    injury, but is founded in primary care, prevention, wellness,
    and resilience, skills that are the hallmark of readiness. When
    called upon to deploy, they are ready to provide the best in
    damage control, resuscitation, and stabilization, with
    evacuation to a higher level of care anywhere, anytime.
        The numbers speak for themselves, even now, in Afghanistan.
    In the toughest battle, with single-digit percentages in
    ultimate sacrifices, astonishing mass transfusion, lives saved,
    and the lowest disease/nonbattle injury levels in history.
        Yes, we continue to research and advance the latest in tip-
    of-the-spear advances in healthcare. We focus on equipment,
    like tourniquets and blood-clotting combat gauze, techniques in
    traumatic combat casualty care, and forward-resuscitate
    surgical and nonsurgical care, and the skills of embedded
    resilient and post-traumatic stress teams, plus early treatment
    protocols for mild TBI.
        Last year, the Commandant of the Marine Corps directed
    immediate development and fielding of the Mobile Trauma Bay,
    mini emergency rooms in protected vehicles from lessons learned
    in the field, and by the end of the year, several prototypes
    were already deployed to Afghanistan, where they're saving
    lives and mitigating injuries at the tip-of-the-spear today.
        We continue to push for solutions to some of medicine's
    toughest challenges. We are fully engaged partners with our
    ``sister scissors,'' the VA, and civilian experts, to advance
    research rapidly and PTSD treatment, casualty care, recovery,
    and rehabilitation for the return of our wounded warriors.
        Collaboration with new innovative research consortia, like
    under the Armed Forces Institute for Regenerative Medicine,
    AFIRM, and early transitional enablers, like the DOD's Office
    for Technological Transition, that can quickly navigate through
    our complex bureaucratic systems and policies, can and are
    making a difference to those in the front lines, getting the
    latest advancements in medicine quickly to our providers and
    casualties.
        As we all know now, today's irregular warfare in this
    complex, protracted war is adversely affecting our forces in
    many devastating ways. Most blast injuries and horrors
    witnessed on the battlefield are putting astonishing stresses
    on our warriors--mentally, emotionally, physically, and
    spiritually. We are seeing severe amputations, burns, traumatic
    stresses, and brain injuries on an unbelievable scale.
        Our greatness in saving lives has a significant cost in the
    degree of injury and loss our warriors have suffered. Navy/
    Marine Corps Medicine has been a leader in changing the way our
    military engages the mental health challenges of this war with
    providers embedded in front-line units under the Marine Corps
    Operational Stress Control and Readiness Program begun at the
    beginning of the war. The three Marine Expeditionary Force
    commanders demanded a Total Force Combat Operational Stress
    Control Program to combat stigma, mitigate suicides, and
    properly address stress. A Total Marine Corps Family Response
    has been initiated. Last year, Total Force trained suicide
    prevention with video vignettes, group discussions,
    identification and referral tools, took place in a new Marine
    Corps program involving a total team engaged leadership concept
    with OSCAR Extenders is being instituted.
        The 1st Marine Expeditionary Force (1MEF) ground combat
    units going to Afghanistan with this current surge will have
    trained OSCAR Extender peer and senior mentors, besides primary
    care mental health embed specialists. With this patient-
    centered Marine and Navy Medicine team effort, stigma will be
    further challenged, and seeking and receiving help will become
    a normal part of the ever-improving Marine culture. For TBI,
    the Assistant Commandant of the Marine Corps and the current
    Marine Expeditionary Brigade commander in Afghanistan have led
    the advancement of a revolutionary concept in prevention and
    care. They have a ``three strikes and you're out'' policy. You
    will stay inside the wire if you've had three major concussions
    until you get a comprehensive health evaluation.
        Plans have been developed for an event-driven reporting,
    all-involved identification, medical evaluation and recovery
    timeout program to enhance early identification care of TBI,
    protecting our warriors with care of TBI, protecting our
    warriors at the front, and decreasing long-term sequelae.
        1MEF Forward will also be piloting a new restoration center
    concept for earlier recovery, rehabilitation, and care at the
    forward operating bases later this year.
        Many challenges remain. One concern has been the high
    demand on many of our healthcare provider areas. The Surgeons
    General have identified shortfalls in key specialties and
    supporters that could adversely affect our abilities to care
    and support our forces. More demands will come as we improve
    TBI restorative care, enhance en route casualty care, expand
    OSCAR Extender, add Medical Home Patient-Centered Care
    initiatives, and initiate other discovered advances in
    healthcare.
        Marine Corps is working closely with Navy Medicine and
    Health Affairs to address current and future needs. In the end,
    that special bond between marine and doctors propels us to do
    our very best for our warriors.
        On behalf of the men and women of Navy Medicine working
    inside the U.S. Marine Corps, I want to thank the committee for
    your exceptional leadership, help, and support. We appreciate
    your continuing confidence in our abilities to meet mission and
    to show you how we continue to address and succeed in meeting
    the healthcare needs of our marines and sailors.
        I look forward to your questions, sir.
        Senator Webb. Thank you very much, Admiral.
        I appreciate all of the testimony this morning.
        I assume we're going to continue.
        Senator Graham. Yes, Mr. Chairman. I'll take responsibility
    for not informing our leadership about this hearing.
    [Laughter.]
        So, they obviously are letting a TSA nomination go forward,
    and I'm sure every member of the Senate would like to continue
    this hearing. If I need to--because the rules do matter--I'll
    be glad to go over to the floor, take 5 minutes, and make a
    unanimous consent request to continue the hearing, if that's
    necessary. But, I'm very much committed to allowing you to stay
    here to answer questions because there are a lot of things
    hanging in the air----
        Senator Webb. I appreciate that very much.
        Senator Graham.--and I want to know the outcome of where
    are folks at? What do we need to do here?
        Senator Webb. We'll assume we're fine, unless told
    otherwise.
        Senator Graham. Sure.
        Senator Webb. I will start with a question, and then, I
    suppose, among the three of us, we can rotate through
    questions.
        Senator Graham. Sure.
        Senator Webb. I would like to get into this data that I
    mentioned in my opening statement, with respect to prescription
    drug use. Let me review what I said in my statement.
        From a recent Military Times article, ``One-in-six
    servicemembers is on some form of psychiatric drug.'' That's a
    quote, ``17 percent of the Active-Duty Force, and as much as 6
    percent of deployed troops, are on antidepressants.'' That's a
    quote. ``The use of psychiatric medications has increased about
    76 percent overall since the start of the current wars.''
        Now, I have some other data here. I'm going to ask
    unanimous consent to put this chart into the record at this
    point, as well.
        [The information referred to follows:]

        Senator Webb. I have data here from DOD that goes from 2001
    to 2009, in terms of a breakdown of different prescription drug
    uses. I'm going to start with 2002, just to put this in front
    of the panel.
        I want to lay this out, because we all know that we have to
    be careful with statistics. I'm not going to make a judgment
    based simply on these statistics. There are a number of
    potential answers to this. I don't want to answer them. I want
    to hear the answers of the panel. One is, in terms of these
    numbers in the charts, maybe there is a larger pool of people
    who are receiving prescriptions. I don't know. Maybe there is a
    different approach that's being used in medicine over the last
    8 years, in terms of people with difficulties, or maybe this is
    the stress of the force. But, if you go from 2002 to 2009,
    barbituate usage--or prescriptions increased from 7,600 to
    almost 27,000; that's three and a half times. Muscle relaxers
    increased from 139,000 to 312,000; that's two and a half times.
    Pain relievers, from 2 million to 3.8 million, that's almost
    twice. Tranquilizers, from 131,000 to 517,000, which is about
    four times. On its face, it's pretty astounding and also very
    troubling.
        Dr. Rice, I would like your thoughts on what this means.
        Dr. Rice. Yes, sir. Thank you, Mr. Chairman.
        First, let me echo your concern about the statistics. Most
    of the data here come from the Pharmacy Data Transaction
    Service (PDTS) that the TMA runs. This is a claims tracking
    system. Up until April 2007, the PDTS, the tracking system, did
    not lock the beneficiary's status in time. So, the last time a
    transaction was recorded reflected whatever the servicemember's
    status was at that time. So, you could have somebody who was
    taking an antidepressant in 2005, got another one in 2007. In
    2005, we would not have known that he was Active Duty. So, the
    underlying denominator here that leads to the substantial
    increase that you talked about results from a problem that we
    had with the way we were tracking the data and not locking it
    down.
        The second point I would make is, I think it's important to
    keep in mind that the men and women of our military are drawn
    from the population of the United States, and the use of
    psychotropic medications in the Nation as a whole has
    increased. It's difficult to turn on the television without
    becoming convinced that you're bipolar or have some other
    problem for which there is a drug ready made for you.
        With respect to pain medications, we have placed great
    emphasis on dealing with pain. The Joint Commission for the
    Accreditation of Healthcare Organizations has had a substantial
    effort, in the last several years, to make sure that we
    recognize pain among our patients, and that we treat it
    appropriately.
        I think there are a number of factors that enter into this
    apparent increase in usage that we're seeing.
        But, I would defer to my colleagues for their particular
    perspectives on this issue, as well.
        Senator Webb. When you say ``apparent,'' you mean apparent
    from the data or that the data really isn't speaking correctly
    to reality?
        Dr. Rice. No, there's no question that there is substantial
    usage. What I'm referring to is that we don't know how many of
    the people who were getting the drug in 2005 were actually on
    Active Duty. So, the denominator may be a problem, since we
    didn't lock down their status at that time, but used the last
    time they were in the system to reflect what their status was
    at any previous time.
        Senator Webb. Are these numbers reflective of Active Duty
    use in the later years? They are not?
        General, I see your shaking your head.
        General Schoomaker.
        General Schoomaker. No, sir. I think, as Dr. Rice was
    pointing out, until the last 2 years or so, the last entry that
    the soldier--in our case, soldier--would have been--say, a
    retiree--would have characterized everything we had in the
    database before that. So, it was artificially lower than the
    actual use in 2001.
        Senator Webb. Which was artificially lower?
        General Schoomaker. The use of drugs.
        Senator Webb. The use of drugs----
        General Schoomaker. If a soldier is on----
        Senator Webb.--among Active Duty----
        General Schoomaker. Yes, sir.
        Senator Webb.--in the data? That's what----
        General Schoomaker. If a soldier was on Active Duty----
        Senator Webb. Right.
        General Schoomaker.--in 2001, and was on ongoing sleep
    medicines or using a SSRI for depression or something, or for
    pain relief, and then retired in a retirement physical or
    retirement setting, in a clinical setting, got turned into a
    retiree, that was then used to characterize all of the record
    before then. So, everything attributed to his or her Active
    Duty time would have disappeared from the Active Duty roster.
    So, it appeared much lower in use in 2001, 2002, 2003 than
    actually was being used by the Active Duty.
        One of the things that you all have discussed here that is
    quite startling is the very marked increase from 2001 to 2009.
    Some of that, as Dr. Rice has explained----
        Senator Webb. What is the year that this adjustment was
    made?
        General Schoomaker. 2006, 2007.
        Dr. Rice. It was locked in April 2007.
        Senator Webb. April 2007?
        Dr. Rice. Yes, sir.
        General Schoomaker. So, we're looking at trends from 2007
    and beyond as being much more accurately reflecting the trends
    in use. There's no question, sir, as Dr. Rice has said, we're
    all concerned about the amount of use of drugs and the stress
    on the force that this reflects. But, the increase is not quite
    as marked as the data would suggest there.
        Senator Webb. Okay. We will come back to you on this to try
    to get what your view of accurate data is.
        What about the comment that ``1 in 6 servicemembers is on
    some form of psychiatric drug''?
        General Schoomaker. Sir, we have three intersecting sources
    of data--independent, somewhat--that all corroborate roughly
    the same number. The Mental Health Advisory Team 6, which I
    think you referred to, or Senator Cardin referred to, that was
    conducted in 2009--through direct surveys--scientifically
    credible surveys of the force deployed, found that, in Iraq and
    Afghanistan, so between 3 and 6 percent of soldiers were on a
    drug for mental health or stress-related, so between 3 and 6
    percent. At about the same time, or in the last year, we've had
    the release of the DOD Health-Related Behaviors Among Active
    Duty Military Personnel. As I recall, that's a triannual event
    that the Research Triangle Institute conducts for us. That's
    confidential and anonymous, so you get a much better, probably
    confidential, report on all of the Services. They report 8.6
    percent being treated for depression, anxiety, or sleep. So,
    that's a combined----
        Senator Webb. Of the deployed.
        General Schoomaker. No, sir. The total force deployed and
    nondeployed.
        We're looking at 3 to 6 percent of the deployed force.
    Roughly 8 percent of the total force.
        Then, the last thing is this PDTS snapshot of the Army. We
    have, in February of this year--last month--done a snapshot of
    550,000 Active Duty soldiers, deployed and nondeployed, and we
    find there a similar number of about 6 percent.
        I'm looking at the range of between 3 and 6 percent--at
    most, 8 percent--of being on some sort of medication related to
    mental health or stress.
        Now, admittedly, sleep medicines are being used in a
    variety of settings as an adjunct. Sleep medicines, short-term,
    are frequently used for problems of sleep in combat, problems--
    --
        Senator Webb. The----
        General Schoomaker.--of sleep at home.
        Senator Webb. Excuse me. The data you're talking about is
    Army data?
        General Schoomaker. Yes, sir. It's Army data. The Mental
    Health Advisory Team 6--the second study I mentioned, the DOD
    Health Related Behaviors Among Active Duty, actually----
        Senator Webb. Right.
        General Schoomaker.--is all Services. The last----
        Senator Webb. The data from Military Times article, again,
    is 1 in 6 servicemembers. They did say 6 percent of those
    deployed.
        General Schoomaker. Yes, sir.
        Senator Webb. That number fairly well comports----
        General Schoomaker. Yes, sir.
        Senator Webb.--with what you're saying. The other number
    seems higher.
        General Schoomaker. I said, for sleep, I think that there's
    a broader group of people using sleep medications. Some of them
    are also on active drugs for stress or mental health. Frankly,
    sir, I probably, myself, appeared in that database, because
    every time I go overseas, I take a prescription for Ambien.
        Senator Webb. Right.
        General Schoomaker. I think many of us do that. It's a
    sleeper that we use transiently, and it's a prescription drug.
        That's a little broader, but I think the implication that
    we have 1 in 6 with a serious mental disorder, I think, is a
    reach.
        Senator Webb. I would like to express my appreciation to
    Senator Graham. The cloakroom is now advised that we are legal
    again in our hearing. [Laughter.]
        We have permission to meet.
        Admiral, you wanted to say something?
        Admiral Robinson. There's one more data source, and that's
    BHNAS, which is the Behavioral Health Needs Assessment Survey,
    which is very similar to the MHAT, which is Army, but the BHNAS
    is done by Navy Medicine. The numbers that General Schoomaker
    gives are approximately correct, we were looking at 2010--we're
    talking about men and women in theater--so, this is in the
    combat zone--with a 3.2 percent mental health psychotropic
    medication usage, and probably about a 20 percent--22 percent,
    actually--of sleeping medication. I think that corroborates, at
    different points, to be about that. That's all that I wanted to
    add.
        Senator Webb. Okay. We will work with you to see if we
    can't scrub this data. I think it's an extremely troubling
    piece of information here.
        Admiral Robinson. The other point, which is off the data,
    but it's to the point, I think. It's not about the data. In the
    attempt, at least in the last 3 years, as my tenure as Surgeon
    General of the Navy, to decrease stigma--we've made a huge
    drive throughout the military--Navy, Army, Marine Corps--we've
    done it independently, but we've been together. We've tried to
    increase, in the Navy, Marine Corps, as an example--and I think
    the Army has done this, too, to a degree--to increase mental
    health professionals forward deployed--and the Air Force has
    done this, also--but, we're trying to--forward-deployed mental
    health experts--psychologists, psychiatrists, social workers,
    psychiatric nurses--those people and also our medics and
    corpsmen, and our primary care providers--who can, in fact,
    intervene in mental illnesses and emotional distress amongst
    our troops, no matter where they may be.
        In concert with that is also the utilization of
    psychotropic medication. But, my point is simply that we're
    really making a huge desire and a huge effort to destigmatize
    mental health issues and their treatment and stop--and taking
    it out of the closet or suppressing it so that it's not coming
    to light, and bringing it to light, so that we can get
    effective treatments.
        Senator Webb. Well said. In that respect, it probably goes
    back to one of the possibilities that I was raising here, and
    that is that this is an indicator of the long-term stress of
    the force and also different medical practices, or more open
    medical practices.
        Admiral Robinson. I think that there is stress on the
    force. But, I also think that there is an acknowledgment by
    medical professionals--by medicine and the Services that mental
    illnesses exist and have to be treated. We have, for a long
    time, as a society----
        Senator Webb. I agree. That's the second point that I was
    making, in terms of medical practice. So, I don't want to
    dominate all the time here.
        Admiral Robinson. Yes, sir.
        Senator Webb. I appreciate your answers.
        Senator Graham, do you want to----
        Senator Graham. Thank you, Mr. Chairman.
        I think the numbers you brought up are very important,
    because I think most Americans want to make sure that our men
    and women are functioning as well as possible and getting the
    help they need. I know we have a shortage of mental health
    professionals in the military, and we're trying to address
    that.
        But, it goes back to this--being away from your home in a
    combat arena is a stressful environment that--if you're not
    depressed at some times, you're not normal. It's just a
    depressing situation to have to be away from your home.
        What Senator Webb indicates is very important. We want to
    make sure that we're tracking the health of the force. So, if
    each Service could provide us a breakdown of the percentage of
    the force, in theater and outside the theater, that's on
    psychotropic drugs, and break that out, versus sleep aids,
    because--I'm supposed to do my Reserve duty next week,
    overseas, and I've already ordered some Ambien. So, I feel
    guilty already. I'm spiking up the numbers. [Laughter.]
        Senator Webb. Messing up the database. [Laughter.]
        Senator Graham. Yes. The database.
        I just literally ordered it from the Navy physician.
        Senator Webb. Actually, if I may, if we're going to get a
    breakdown of this, perhaps you could clean up the timeline for
    us.
        Senator Graham. That's a great idea. What are the real
    numbers?--so we can judge apples to apples, and because this is
    anecdotal evidence, quite frankly, of what Senator Webb's been
    concerned about a long time. We have to make sure that we're
    not wearing these folks out beyond their ability to respond to
    the Nation's call. At the same time, you do have this counter-
    competing idea that we want to make sure that every member of
    the military gets the treatment they need. There's nothing
    wrong with going to the mental health professionals in your
    unit, or the doctor or the surgeon, and saying, ``Hey, Doc, you
    know, I need a little help here. I've had a bad experience.
    Help me through it.'' That is exactly what we want to have
    happen. So, having that concept validated, that it's okay to do
    this, but, at the same time, understand how widespread these
    problems are, I think, will help us make some intelligent
    decisions.
        If each Service could give us a breakdown in your Service,
    that would be much appreciated.
        Dr. Rice. Yes, sir.
        [The information referred to follows:]

        Utilization of automated systems to record medications dispensed at
    both inpatient and outpatient theater medical facilities was not
    broadly available until 2008. Prior to this period, data retrieval
    required extensive paper reviews.
        To provide a more complete picture, using current electronic
    systems, dispensed psychiatric and sleep aid medications were queried
    starting from 2008, to most current data received. This is not a
    standard report and requires an ad hoc query for the specific drugs.
    Approximately 5 million medical records were searched for these
    specific medications and computer processing was extensive.
        The attached table provides available theater psychotropic/hypnotic
    prescription drug data through June 8, 2010.

        Senator Graham. About sustainability, I know we don't have
    all the teams in place yet, but as we look at the budget over
    time, the healthcare portion of the DOD budget is growing
    exponentially. In 2007, I had a meeting with some associations
    representing the retired community in different branches of the
    Services, as well as people who manage TRICARE. We came up with
    a list of a dozen or more things that we could do to make the
    system more efficient. Is anybody aware of that meeting? Is
    there any effort to implement those ideas? Where do we stand
    with the concept, before we ask more money from retirees, in
    terms of premiums increases? What have we done to make the
    system more efficient?
        Dr. Rice. Sir, we constantly strive to find efficiencies in
    the system. The challenges are, as I mentioned, with respect to
    the use of psychotropic drugs, we exist in a system in the
    larger national healthcare context. I know you've been having
    some conversations about that issue recently, so you know
    what's happening on the national scene. I think it was a few
    years ago that Stewart Altman appeared before your committee
    and said that if present trends continued, healthcare costs as
    a fraction of the national economy would continue to grow, but
    he was pretty sure they could not exceed 100 percent of the
    gross domestic product.
        We have more people in the force, we have more
    beneficiaries, we have more people who have been added to the
    beneficiary list. Seventy percent of the costs are incurred
    outside the direct care system, where we have less direct
    ability to control----
        Senator Graham. We haven't had a premium increase in
    TRICARE since, what?
        Admiral Hunter. 1995.
        Dr. Rice. 1995. Right.
        Senator Graham. I want to be generous and fair to all those
    who serve, but there's a cost-containment problem within DOD's
    budget. Before we ask for premium increases, I think we need to
    try to make sure that we're telling the force, ``We've done
    everything we can within reason to make it more efficient and
    to lower the cost, through efficiency, best practices,
    preventive healthcare.''
        Mr. Chairman, I don't see how we can sustain this forever,
    where TRICARE is never subject to adjustment, in terms of the
    premiums to be paid. If we're going to do that, we're going to
    have to come up with a lot more money for DOD, because it's
    going to eat away at readiness and the other things you need to
    run the military.
        What's your view of that, Admiral Hunter and Dr. Rice? What
    do we do, long term?
        Dr. Rice. I think there are a number of efforts that we can
    take to try to reduce--General Schoomaker talked about unwanted
    variation, and that is seen to be a major driver of the
    increase in healthcare costs. I think we have to focus on that.
    We have to focus on improving the quality of care. There's no
    question that better quality care tends to be less expensive
    care. Focusing on things like patient safety, I think, is an
    important dimension.
        We think that the full deployment and wide utilization of
    the Electronic Health Record will be an important aid to us in
    developing that capability. A number of steps we can take.
        Your comment about the TRICARE premium is exactly right;
    there has not been an increase since 1995, while the cost of
    healthcare insurance in the rest of the world has continued to
    rise. I would be happy to work with you on that.
        Let me ask Admiral Hunter if she has anything to add to
    that.
        Admiral Hunter. Yes, Senator, let me add a little bit, in
    terms of what we're doing internally.
        I appreciate all the comments about variation. We've looked
    very carefully, for example, at technology variation and our
    use of technology throughout military medicine, both in direct
    care and private-sector care, so that it's appropriately
    applied. I talked earlier about preventive measures.
        I'd also like to talk a little bit about utilization of
    care. In the last several years, we've seen a dramatic rise in
    our patients using the emergency room or emergency department
    as a site of care. Initially, we were concerned that that meant
    that they didn't have access to care, that they couldn't reach
    their primary care provider or perhaps they didn't have one
    assigned. But, as we looked at the data more carefully, we see
    that the graph is going up in exactly the same way for people
    who are enrolled to private sector--have a stable primary care
    relationship, where the provider isn't deploying or those sorts
    of things, as it is in our direct care systems.
        To address that, we've looked at all of the different
    quadrants of our Quadruple Aim that I talked about. First of
    all, have we maximized the relationship between provider and
    patient? All of the surgeons talked about the Medical Home.
    Second of all, have we made resources available to patients so
    that they know where else they can go if it's after hours? Do
    we reach out? Do you have the right refrigerator magnet, or
    information that says, ``This is the urgent care''? How do we
    help them get to that relationship?
        Our contractors are working with us. Many have even added
    what we call ``convenience clinics,'' the types of clinics that
    are in drug stores and things like that, to some of their
    networks so that we are working to add more and more
    convenient, but lower-cost, after-hours settings of care that
    would be appropriate for the earache, the respiratory
    infection, the sore throat, the backache that really doesn't
    require an emergency room.
        Working with all our partners to get to that effective
    Medical Home, and then measuring and holding accountable for
    continuity on our side, is important.
        In our contracting area, if I may shift, working hard on
    the business processes. General Schoomaker also talked about
    administrative variation. The business processes that bring our
    processes of care--our back office--to be as efficient as it
    can: electronic funds transfer, not manual processes,
    automating payments and claims and all of those things to the
    greatest extent possible, so that the administrative dollars on
    the contracts are minimized. Bringing multiple contracts
    together into single ones. Overseas we've just combined six
    contracts into one, where we'll be getting streamlined
    services. That's better for our patients--they deal with one
    overseas contractor--and better for us, because we get a better
    deal.
        Then the last thing I'd point out is fraud prevention. We
    know that in all major programs we need to be vigilant for
    others that may take advantage of the system, and how that
    might happen. So, we have a program integrity group that works
    carefully with our contractors, with others in the Federal
    Government--Department of Justice, Centers for Medicare and
    Medicard Services--and also with private providers to look for
    trends in claims that may suggest behavior that we need to more
    fully investigate.
        In addition, our explanations of benefits that are mailed
    to patients each time they have a health encounter. We just
    started mailing them, even with pharmacy encounters. Patients
    are great policemen on behalf of the Services. They call us and
    say--just like a credit card bill--``There's something on my
    explanation of benefits''----
        Senator Graham. That's good. That's very good.
        Admiral Hunter.--``that I didn't get and can you look at
    it?''
        Senator Graham. Yes, I think that is a terrific idea,
    because all of us, now, are worried about the cost to the
    country and to--beyond ourselves, which is good, because we all
    bear these costs.
        Mr. Chairman, I don't have any more questions. I'll make
    one brief comment to the Surgeons General and those under your
    command.
        I think one of the unsung heroes of this war are the
    medical personnel on the front lines. As Senator Webb said,
    ``the golden hour.'' There are people surviving attacks in this
    war that would never have survived in any other war. I am just
    amazed and just astonished at what's been able to be done in
    theater and at Landstuhl and other places.
        There was a young man--who was a marine, who lost both
    legs. He's had 60-something surgeries. He is now at Harvard Law
    School. He just was medically discharged from the Marine Corps,
    I think, last year. He was a Congressional Fellow with me in my
    office. I think he's a testament of what people under your
    command have done for those who put themselves in harm's way. I
    just want to thank you all for your service.
        Senator Webb. Thank you very much, Senator Graham.
        Also, again, I appreciate your having gone to the floor to
    allow us to be able to continue our hearing.
        Senator Graham. It's very important.
        Senator Webb. Senator Begich.
        Senator Begich. Thank you very much, Mr. Chairman.
        I have a couple of followup comments and questions.
        First, with regards to painkillers and pain management and
    so forth, once a patient wants to try to get off of those
    painkillers, what are the services you have available for them?
    Because I do hear complaints that they don't think they're
    adequate, or where they have to go if they've become addicted
    to the painkillers. Could someone elaborate on that?
        General Schoomaker. Yes. Maybe I could take that one, if
    you don't mind.
        Senator Begich. Sure.
        General Schoomaker. Sir, I would say that to follow on a
    lot of what we've been saying up here--one of the nonstandard
    areas of care right now is in pain management.
        Senator Begich. Right.
        General Schoomaker. This is not a problem just for the
    military, it's a problem across the Nation.
        I stood up a task force last year, a Pain Management Task
    Force, to look at practices across the Army, and, frankly, the
    VA has been very active in helping with this. The other
    Services have joined, as well as support from TRICARE
    Management Agency on this. I got the latest in-progress review
    this week. It's going very well, and I expect the formal report
    to be out in the next 2 weeks.
        I'm trained as an internist and a hematologist, and I can
    tell you that caring for acute pain and chronic pain is a
    problem across the country, in terms of how we standardize it,
    how we transition from one phase to the other. We're looking at
    this in a very holistic way, so that we're employing all of the
    tools that we have available.
        Specifically within the Warrior Transition Units of the
    Army, we have a very good, comprehensive program which is
    increasingly more seamless between the inpatient to the
    outpatient and then to life beyond, even being within the
    medical system, and it addresses the issues that you're talking
    about.
        Senator Begich. If I can make sure I understand what you're
    saying, there. Not only is it the pain management program, but
    it's when they get addicted on these painkillers and they want
    to get clean. What do you do for them? I understand you're
    working through it. But, what are the services that are
    available that they can tap into to move from being addicted to
    the painkillers?
        General Schoomaker. All the Services have substance abuse
    programs for those who get addicted to addicting narcotics and
    the like. Quite honestly, sir, most of the problems with
    addictions to narcotics--and I'll go out on a limb on this--are
    attributed to social uses, rather than those associated with
    painkillers for surgical pain and the like.
        Senator Begich. We don't have to debate this much further--
    I would ask you to provide me, if you can at some point, some
    of the data that shows that, because what I'm starting to hear
    from are individuals who experienced an incident during their
    deployment, have then been prescribed painkillers and may they
    misuse them or excessive use, now are addicted to them. I just
    want to know--understand that, as you're trying to develop pain
    management, another step to this.
        General Schoomaker. Yes, sir.
        Senator Begich. The step is, some of these are very strong
    prescription drugs that turn into addictive drugs. I want to
    get a better understanding of how you come to that conclusion
    so we are not missing that boat. In other words, may they no
    longer be in the DOD system because they've exited out or
    whatever, but yet, they're addicted, that our relationship with
    them has to continue in some way to make sure we clean them.
    So, that's what I want to understand.
        General Schoomaker. Yes, sir. My comments, quite frankly,
    are driven by the fear that everybody who prescribes pain
    medicines, and every patient who receives them, especially for
    surgical pain----
        Senator Begich. Right.
        General Schoomaker.--and for short-term uses is concerned
    about addiction. We don't want to do anything that drives
    people into having pain and avoiding what's appropriate
    treatment.
        Senator Begich. Excellent.
        One thing I'll mention. I'm going to go to a very Alaskan
    item here. But, you were talking about the emergency room
    increases.
        Admiral Hunter. Yes, Senator.
        Senator Begich. Admiral, thank you--I wasn't here at the
    beginning, but I know you mentioned Alaska, and I appreciate
    that.
        There's a really interesting program that Indian Health
    Services does within Alaska called the ``Nuka model''--N-U-K-A.
    They saw the exact same thing that you were describing.
    Significant increases in emergency room care, even though they
    had clinics----
        Admiral Hunter. Yes.
        Senator Begich.--all around and available in the villages
    and so forth. But, they were seeing spikes in emergency care.
        They created a demonstration project under Indian Health
    Services, and it's managed by South Central Foundation. They
    have reduced their emergency care access by 68 percent in the
    last 2\1/2\ to 3 years, and many other things. They have
    developed a model that--when you were describing the situation
    you were laying out, it was very similar to what they had
    described about 5 to 10 years ago, that they were
    experiencing--and they couldn't understand why, when they were
    building these clinics in their facilities--but they went
    through a whole process, and they saw a huge decrease in the
    last 2 or 3 years, I'd say, at least, maybe longer, on
    emergency entries, which, of course, is a huge savings, when
    you don't have to deal with that process.
        General Schoomaker. Yes, sir, we're seeing this. As we
    stand up the Patient-Centered, Family-Centered Medical Home
    concept across the Services--all of my clinic and hospital
    commanders track emergency room use, and in those places, like
    Fort Benning, where these are standing up--Fort Polk--we see
    emergency room use drop.
        Senator Begich. That's great.
        General Schoomaker. It's a chaotic, episodic kind of care
    that people are tapped into.
        Senator Begich. Right. Emergency care is expensive and, the
    last thing you want.
        General Schoomaker. Yes, sir.
        Senator Begich. Doctor, did you have a comment?
        Dr. Rice. Yes, Senator. One of the things that I think we
    hold out a lot of hope for is--with our Electronic Health
    Record--is providing patients access to their own record
    online. The experience of several healthcare systems has been
    that, as patients are able to go online, find out for
    themselves particular aspects that might influence their care,
    or get answers to questions, their use of the emergency room
    and their seeking appointments with their physicians drops off
    dramatically.
        Senator Begich. Very good.
        Mr. Chairman, I just have two quick, final comments, one
    for Dr. Rice or Admiral Hunter. Again, thank you for mentioning
    Alaska. I know we've had a conversation about this.
        Admiral Hunter. Yes, Senator.
        Senator Begich. In the healthcare reform bill that the
    President signed yesterday, we have within there a task force,
    as we've already started the process of trying to deal with
    healthcare costs in Alaska. It now sets it up formally. I just
    want to see if you have any comment for the record, while we're
    here, on the idea of the task force and how you see that moving
    forward.
        Admiral Hunter. Thank you, Senator. We absolutely
    appreciate your leadership in this area and bringing all the
    parties together. Our TRICARE Regional West Director, Admiral
    Niemyer, was up in Alaska recently and visibly engaged and
    actively engaged all of the Federal health partners in coming
    together around trying to stabilize the rate schedule.
        In addition, we're working to improve what we call the
    ``back offices of care'' to make it easier for us to manage the
    relationships with providers and to bring providers on board
    for TRICARE. You will see some changes to the TRICARE manual
    soon that reflect that change. We appreciate the opportunity to
    work with you and your staff in that endeavor.
        Senator Begich. Excellent.
        Then, the last question. I appreciate--you actually
    mentioned it, and that was on the whole issue of the
    reimbursement rate. We have a differential up there because of
    some of the high costs and capacity for certain specialties and
    so forth. Do you have any additional further comment you want
    to make on that? I know we're anxious to make that more
    permanent. I know you're going through a process right now.
        Admiral Hunter. Yes.
        Senator Begich. Can you elaborate a bit on that, at this
    point?
        Admiral Hunter. Yes, Senator. But for the other members, we
    have a demonstration project in progress that allows us to pay
    a little bit more than the standard TRICARE rates up in Alaska,
    because of the difficulty in obtaining care. Primary care is
    obtained in the military medical treatment facilities, and
    specialty care goes out. For some specialties, there is truly a
    provider shortage, and it's difficult to get all the care that
    we need. Air Force has partnered with us, particularly Chief of
    Staff of the Air Force--an interest item for him--and Army--
    also Coast Guard--in looking at these issues for, what do we
    need and where do we need it? So, what we did for an interim,
    we extended the demonstration project, and then we put in what
    we call locality-based waivers for certain specialties, where
    we had to go even higher--orthopedics, ENT, rheumatology, where
    some of the specialties for which we have location-specific
    waivers.
        With the other Federal partners, we're looking long-term
    solution to move to a Federal rate schedule, so that we don't
    compete with one another. We hope to at least have some interim
    progress on that this summer, so that we don't have to--we see
    extending the demo as, perhaps, a concern that we aren't
    committed.
        Senator Begich. Right.
        Admiral Hunter. We want to move forward very deliberately
    in this area.
        Thank you.
        Senator Begich. Thank you very much.
        Mr. Chairman, thank you very much.
        Senator Webb. Thank you, Senator Begich.
        Senator McCaskill.
        Senator McCaskill. Thank you, Mr. Chairman.
        I had to rush down here, because the rumor all over the
    Hill is that Webb and Graham have gone rogue. [Laughter.]
        Senator Webb. We're getting it done.
        Senator Graham. We're getting it done, yes.
        Senator McCaskill. Getting it done.
        In fact, if I'd known that this could have happened--I had
    a hearing this afternoon on Afghanistan police training
    contracting in my Contracting Subcommittee--I would have asked
    you guys to come out with me at 2:30 so we could have gotten
    that hearing done.
        Senator Webb. Senator Graham has certain connections.
        Senator McCaskill. Yes. I don't get it. I would have loved
    to have that hearing this afternoon. I'm trying to figure out
    what the point is of not being able to have a hearing this
    afternoon.
        But, I admire you all for forging ahead, in spite of what
    the rules say. I think it's great we're talking about this. I
    think you all know that there are many things that I'm very
    concerned about in this particular portfolio.
        Let me start with stigma about getting help, and how that
    stigma is such a particular problem because of the training and
    the appropriate peer pressure that makes our military so
    successful.
        I know that we're doing a confidentiality study at Fort
    Leonard Wood, on the heels of a scandal there, where we had
    some problems with the substance abuse program. General
    Schoomaker, I'd like to know, do you have anything you can tell
    this committee today about the pilot program to look at a
    program where soldiers can come forward and say, ``I need
    help,'' without it getting reported up the chain of command?
        General Schoomaker. Yes, ma'am. We identified, some time
    ago, that the soldiers would tell us, confidentially, that they
    had problems, say, with alcohol, and yet, would not be formally
    referred, because there was an automatic notification of their
    commanders. So, we started a pilot program in Hawaii and
    Alaska, in Fort Lewis. I know, ma'am, that you're aware of this
    in Fort Leonard Wood. Many other camps, posting stations, have
    signed on to the desire to have the program generalized. We
    call this the Confidential Alcohol Treatment and Education
    Program and what we find is, a much larger group of soldiers is
    now coming forward and getting treatment at an earlier stage,
    before the misconduct has been performed, before there's family
    violence, before they have a DUI or some other problem. The
    other thing that's very, very encouraging is that we're getting
    a spectrum of older soldiers, noncommissioned officers (NCO),
    and officers that are coming forward.
        The interesting part of that is that--and we expected that
    this would happen--a part of any treatment of an alcohol or
    drug problem, but certainly alcohol, is that it's a chronic-
    disease model. You're going to have this as a problem for life.
    If you're really going to beat this, it's because you get your
    support system, to include your chain of command, involved in
    how to stay out of trouble. So that a large number of soldiers,
    even after they enter confidentially, come back later and
    inform their chain of command and say, ``Look, I've had the
    treatment. I've been informed. I've been counseled. I know that
    I'm going to have to get more people involved in keeping me
    sober.'' So far, it's been very successful. We have great
    support from the rest of the Army and the Army leadership to
    generalize this across the force.
        Senator McCaskill. I know that the report's due in
    September, and I'll be looking forward to seeing what's put on
    paper, because then I think it's a situation--we can look at
    all the branches----
        General Schoomaker. Yes, ma'am.
        Senator McCaskill.--and talk about confidentiality and
    stigma and how we can work around the culture of the military
    to get us to a point that folks can get help, because many,
    many times, if they feel like it's going to impact their
    career, they wait until it's too late, and it really impacts
    their career. I think those are men and women that we can't
    afford to lose in the service of our country.
        Let's talk a little bit about counselors. Does anybody have
    a number of how many counselors we're short right now, in terms
    of substance abuse counselors? I know--speaking of chronic--
    this is a chronic problem, having the right number of
    counselors available.
        General Schoomaker. We have the exact numbers. What we're
    trying to do is keep abreast of the demand. Programs like the
    KTAP program--the confidential--is generating more need. So,
    the attempt is to--we've reengineered the Alcohol and Substance
    Abuse Program so that it's horizontally integrated from the
    assessment, education----
        Senator McCaskill. That's good.
        General Schoomaker.--targeted at an early intervention to
    full treatment. In doing that, we're beginning to see what the
    bow wave is, and anticipate that. We're doing, centrally,
    hiring of counselors. But, I can tell you, ma'am, just as in
    behavioral health in general, across the Army, we remain with
    shortages, because it's very hard, in some locations, to find
    counsels. It's not a money issue. It's not a problem of
    bureaucracy. It's a problem, quite frankly, of finding, in a
    Nation which is already strained for having an appropriate
    number of trained counselors, it's finding people willing to go
    to some of our locations.
        Senator McCaskill. Has there been any thought given to some
    kind of pilot program to internalize this function without
    contractors, to have military people get the substance abuse
    training, so that it's peer-to-peer, as opposed to an outside
    contractor that you're going to and talking to about your
    substance abuse issues?
        General Schoomaker. Ma'am, I think part of the program of
    horizontal integration is to start employing peer-to-peer
    counselors and even groups like former NCOs who want to come in
    and participate in this, well before the need for formal
    counseling for treatment. If we can do targeted intervention
    and education early on, the intent is to obviate the need to
    have people fall off the cliff before they're approached.
        Senator McCaskill. Let me talk a little bit about a
    specific drug, OxyContin. This is a highly addictive drug. In
    fact, it is not uncommon in many places in the country right
    now. The street value of OxyContin exceeds heroine. Let me just
    say that again. The street value of OxyContin exceeds heroine.
    As high as $80 a pill, on the street. This has really become a
    drug of choice that is a huge problem in this Nation. I
    listened to some of the testimony before I got here, and I want
    to make sure that everyone is aware that this is a growth
    industry right now, in terms of pain meds. It is something
    that--in fact, too late--we're beginning to get a handle on the
    addictive nature of this drug.
        Can you tell me, General, or can any of you tell me--I know
    that there was some diminishing of the data because of sleeping
    pills, but I have to tell you, if you guys aren't on top of
    this----
        General Schoomaker. Yes, ma'am.
        Senator McCaskill.--I guarantee you, if you plot a graph of
    how much OxyContin is being prescribed, if you all had that
    number right now, I think it would scare the bejesus out of
    you.
        General Schoomaker. Yes, ma'am. We do track that pretty
    closely.
        Senator McCaskill. What is it, in the Army?
        General Schoomaker. I can give you--I can take it for the
    record and give you the numbers. But OxyContin's been with us
    for almost 100 years. It's a derivative of----
        Senator McCaskill. Morphine.
        General Schoomaker.--many of the drugs that are related to
    one another--morphine, codeine, heroin, methadone. These are
    all related to one another, cross-react with one another, have
    variations in their absorption or how they're administered and
    how long they last.
        OxyContin is a component of a long-acting--or is a long-
    acting form of Oxycodone that is mixed in other formulations
    with nonsteroidal anti-inflammatories, like acetaminophen or
    Motrin or Ibuprofen. So, we use the components of that in many,
    many different applications for pain management. But, as I said
    earlier, I think one of our problems here is that prescription
    drugs have become increasingly used in social environments for
    recreational use, and have resulted in addictions that are
    related to morphine and heroin addictions. We're tracking them
    very closely in the Army, especially in that population of
    wounded, ill, and injured soldiers for whom we know there's a
    very high use. We have sole provider programs. That is, a
    single provider prescribes all psychotropic and potentially
    addictive drugs, and watches and tracks those. Those go on in
    our hospitals and clinics for other nonwounded, ill, and
    injured soldiers, where there is high use of pain medicine.
        Frankly, ma'am, I go back to what I said earlier about our
    Pain Management Task Force. That's one of the reasons we stood
    it up, is we need a far more holistic and even nonpharmacologic
    approach to pain management.
        Senator McCaskill. Thank you very much.
        I know I'm out of time.
        I would like to put one question on the record, though,
    about a young man, Lance Corporal Lopez, from Missouri, who had
    a severe adverse reaction to a vaccine when he was deployed,
    and he was not allowed the one-time benefit on the Traumatic
    Servicemember Group Life Insurance policy, even though he was
    in a coma and, in a wheelchair for a while and has ongoing
    problems. For the record, I want to put it in and get your
    reaction as to whether or not that should be a loophole in that
    coverage.
        It seems to me that his injury has been as traumatic as any
    battlefield injury, and it doesn't seem fair to me that he's
    denied that benefit because it's an adverse reaction to a
    vaccine that he had to take for deployment, as opposed to an
    injury on the battlefield.
        General Schoomaker. This was a soldier?
        Senator McCaskill. No. It was a marine.
        Thanks.
        Senator Webb. Thank you, Senator McCaskill.
        I have two semi-technical questions, here, I want to ask.
        Then, Senator Begich, did you want another round?
        Senator Begich. No, I'm good.
        Senator Webb. Okay.
        First is--I've been trying to follow--and I think, Dr.
    Rice, I'd like to ask you to start on the answer--this ongoing
    evaluation of the disability evaluation system--the pilot
    program that's in place. I'm very familiar with the two
    different disability systems, having worked as counsel on the
    House Veterans Committee years ago, where traditionally DOD
    would be rating people based on whether they were fit for duty
    in a DOD environment, and then giving a percentage of
    disability as of the moment they left the military. VA was
    known as lifetime reevaluation. Whatever disability you
    incurred on Active Duty could be aggravated, and your VA
    percentage actually could go up over the rest of your life.
        They're basically two totally different concepts, and the
    compensation amounts pretty much reflected that. Now we have
    been exploring ways, since the Dole-Shalala Commission, to see
    if we can merge the process. Could you bring us up to date on
    how that's working?
        Dr. Rice. Senator, this issue has been a challenge. It's
    been a challenge since the early 1950s. It's been the subject
    of a number of panels and congressional hearings. The
    challenges that you mention are--that's exactly right, the--we
    have the Medical Evaluation Board, which determines whether or
    not somebody can continue on Active Duty, and then the VA has
    its own separate process.
        In all candor, it--from my vantage point at the Uniformed
    Services University, I didn't deal with that issue on a day-to-
    day basis, and I'm just beginning to get up to speed. Perhaps I
    can ask one of my colleagues----
        Senator Webb. Okay.
        Dr. Rice.--who could--General Schoomaker, I expect, is a
    lot more conversant with it than am I.
        Senator Webb. If there are others who would like to be in
    that, as well.
        General Schoomaker. I feel very strongly about this topic,
    because, of course, this surfaced with the problems that we had
    at Walter Reed, roughly 3 years ago this month.
        We have a highly adversarial, highly bureaucratized program
    in which two systems are trying to intersect with one another--
    the DOD system that determines fitness and then begins an
    adjudication process of disability and I focus on disability--
    physical disability--for the single unfitting--most unfitting
    condition, and then hands it off to the VA, who adjudicates,
    based upon a whole-person concept, what problems that soldier,
    sailor, airman, marine may have. The fact remains that there
    are major benefits derivative from certain thresholds, like 30
    percent, where you accrue, for yourself and family, TRICARE
    benefits. The system, in 3 years, in my view, although we've
    tried in every way we can to streamline the bureaucracy and to
    improve the handoff of the VA, continues to be problematic.
    We're tweaking the edges, and I think Admiral Robinson has used
    language to that effect. We're nibbling at the edges of a
    system and a process which is inherently and intrinsically
    antiquated and adversarial.
        I say to my soldiers, it's one of the tragedies that the
    very people who saved you on the battlefield, that evacuated
    you successfully back through two or three continents, across
    8,000 miles, toward the end of your processing, becomes your
    enemy. The same people that you looked to, to get you recovered
    and rehabilitated, now you look upon as not supporting your
    successful transition into private life. It needs to be
    fundamentally changed.
        We need to focus on ability. We need a system that focuses
    on ability, that's aspirational in its focus, much like our
    most successfully transitioning soldiers, soldiers who have--
    amputees, much as has already been discussed here, sir. Some of
    our most----
        Senator Webb. We also need to----
        General Schoomaker.--severely injured soldiers----
        Senator Webb.--to focus on properly compensating people who
    incur lifetime----
        General Schoomaker. Absolutely.
        Senator Webb.--difficulties, as a result of their military
    service. That's how the----
        General Schoomaker. Absolutely.
        Senator Webb.--the whole compensation system began. At one
    time in our history, if someone were to suffer an amputation on
    a battlefield, have to introduce a private bill in Congress in
    order to get relief from the government. Nobody could sue--
    either that or you would want to sue--you can't sue the
    government for your disability, so we put this system into
    place. The intention, I think, was to try to make people whole
    as--in as much as you can.
        General Schoomaker. To go back to what Dr. Rice said, this
    was a system that developed during an industrial economy, that
    focused on physical disability. In an information age economy,
    we need a far different and better system that allows the
    Services to adjudicate--or to decide upon unfitness, and an
    adjudication of disability and compensation, but also assesses
    ability and gives people the tools and the bridging support----
        Senator Webb. I've heard that argument. I heard it when the
    Dole-Shalala Commission came in, and from my perspective, it's
    more akin to compensation from a tort claim or an injury,
    rather than fitting someone to a particular profession in an
    industrialized economy, other than the military profession.
    Each Service has been very different over the years in terms of
    how they've evaluated people when they left.
        I used an example 3 years ago when you were testifying, of
    two brothers, both of whom are good friends of mine in the
    Marine Corps, both of whom were badly wounded and returned to
    Active Duty. One had his patella blown off and had a really bad
    back injury. Went back to Vietnam and did a tour. These are the
    famous McKay brothers, if anyone is looking for historical
    documentation. Jim McKay finished his enlistment and said,
    ``All right, I'm ready to get my disability and go on with my
    life.'' The Marine Corps said, ``No, you return to duty. Your
    disability is zero.'' He went across the street to the VA, and
    I think he got 60 percent.
        John McKay--a classmate of mine in the Naval Academy--got
    his eye shot out and broke a piece of the bone up here
    [indicating], so he couldn't even wear an artificial eye,
    stayed on Active Duty for 26 years, retired as a colonel, and
    the Marine Corps said, ``You're zero disability.'' He had the
    anatomical loss of an eye, busted sinus, busted jaw where the
    bullet went through, and they gave him a zero. I went and
    testified at his appeal hearing, saying it should have--the VA
    immediately gave him 90 percent, probably more. But, when you
    say ``an adversarial system,'' those are two pretty good
    examples of people who just wanted to give more and the
    injuries, the wounds that they suffered, even though they were
    able to do their job, related more to, I think, tort law--how
    we've formalized tort law through statute. That's really what
    the disability system is supposed to be.
        But, Admiral, I'd like to hear from you. We're going to
    wrap this up fairly soon here.
        Admiral Robinson. Just one addition, and I'm not sure it's
    going to be that helpful, but I think that what you and General
    Schoomaker are talking about is correct. I think, also, that
    there is--and, by the way, I'm not a lawyer, so the tort part,
    I'll have to ask exactly how you're working that.
        VA: systematic rehabilitative care, generally. DOD: acute
    care, generally. What's happened is, that's intermixing now.
    So, how we've done business in the past is not what we're doing
    today. Men and women who are injured today, who would normally
    never be kept in the Service, because you wouldn't stay in the
    Service with an amputation or with all sorts of different
    things, are being kept in the Service now. Men and women who
    are amputees, as an example, who would normally have moved to
    the VA system, but now we have, led by Army, a huge, major, and
    an excellent amputation program. But, again, that's a
    systematic rehab type of condition.
        So, you have DOD, and then you have the VA that's funded
    for the systematic rehab. We need to try to blend those two
    together. I think a great deal of what we're doing in the
    disability evaluation system is the two mammoth organizations
    that are coming to grips with: Who is going to fund this now?
    How is this going to get done? It has to be done, and it has to
    be done correctly, because the men and women who we're taking
    care of--I'm not thinking of 2010 and 2011, I'm thinking of
    2022 and 2025--need to know how they're going to continue that
    amputation care, whatever care that they need to have, and how
    they can actually get their lives back online.
        Senator Webb. I'm really concerned that this whole process
    is bogged down, and we have people waiting around. We have
    people waiting around to get evaluated as the pilot programs
    move forward. I've heard a number of stories from the Wounded
    Warrior Program down at Camp Lejeune, for instance, with
    marines getting frustrated because they're waiting to have
    their cases adjudicated, and then getting in trouble because
    they're going stir-crazy down there, et cetera. So, we need to
    somehow come to a conclusion on this.
        Senator Graham. Along those lines, you have two systems
    that have never been melded together before, and we need to do
    that, and you're well on your way to doing it. Again, you have
    competing interests. A lot of wounded warriors want to stay in.
    So, their first goal at that hearing is to convince the
    military, ``Hey, keep me on Active Duty.'' Sometimes that
    doesn't work out, and then you have to evaluate how much
    disability did the person have.
        The other problem we have is that, when people are
    discharged from DOD to the VA, we have to make that as seamless
    as possible, and that's what Senator Webb's talking about,
    having a joint board, where everybody sits at the same time and
    the same place to evaluate these disabilities without having
    redundancy, is great.
        But, here's just a problem. When you're discharged to rural
    South Carolina with a major injury, healthcare services are
    going to be limited. How we connect people in rural America to
    these services is a challenge for the country. I know your
    heart's right, but these are just logistical obstacles that
    have to be overcome, because when you go into a military
    treatment facility for amputation, like Walter Reed--I know
    you've been out there. It's amazing what you all are doing out
    there to get these folks back up and prosthetics and TBI. So,
    you get world-class care, then you may be sent to some rural
    place in South Carolina, where there's just not capacity. We're
    trying to connect people up to the best provider possible, with
    the least amount of logistical problems.
        Another problem that we've looked at, Mr. Chairman, is the
    spouse, their life changes dramatically. Their hopes and dreams
    basically take a back seat to this traumatic injury. Not just
    the spouse, but the entire family. So, I want to keep pushing
    to create a reimbursement system that we're honoring that
    spouse's service by having a reimbursement system to pay them,
    quite frankly, because they don't have the ability to go back
    to school, some amount of money that would otherwise go to some
    professional service to help that family, who are the primary
    care providers in the emotional front, particularly.
        So, I look forward to working with you, Mr. Chairman, to
    get this process moving. People are waiting way too long. But,
    the sad news is, there are just a lot of people affected by
    this war, and we were overwhelmed a few years ago; that's what
    happened at Walter Reed. We just didn't have the capacity
    built, and we're now building it out. I want to be your partner
    in building it out.
        As to this hearing, I'm glad we're able to conduct it. I
    called my leadership. It was an easy lift to allow the hearing
    to go forward.
        My views on healthcare will be known this afternoon. You're
    welcome to come listen. [Laughter.]
        Business as usual hasn't been done, in many ways, on both
    sides of the aisle, and I don't want to get into a healthcare
    debate, so I won't tell you my views on healthcare, but I'm
    glad we're able to conduct this hearing.
        I hope and pray the Senate, one day, can get back to doing
    business as usual. We're not there yet, but maybe we will be.
        So, thank you, Mr. Chairman.
        Senator Webb. I appreciate your saying that, Senator
    Graham. We do have people who are working on both sides of the
    aisle trying to solve problems, and you're one of them. I hope
    I'm one of them. I think Senator McCaskill is one of them.
        I would like to request all of you to give me your
    evaluation of something before I close this hearing--not at
    this hearing. But, I'd like you to look at--we've talked a lot
    about the electronic data management records and this sort of
    thing. I'm a little curious about your basic software programs
    that you use in your hospitals, whether you believe you have
    the best programs that are available. I say that from personal
    experience, having looked at a really fine software program at
    the Naval Hospital in Bethesda, which I've used for many, many
    years, about 6 or 7 years ago, in seeing that it was replaced
    by something it was less than good, according to the medical
    people that I was talking to. Just tell us whether you need
    better software systems in order to manage all your product,
    and we'd like to get your advice on that.
        [The information referred to follows:]

        Our Military Health System hospitals currently use AHLTA, the
    Department of Defense's (DOD) current electronic health record (EHR)
    capability, as part of a family of systems. AHLTA generates, maintains,
    stores, and provides secure online access to comprehensive patient
    records. The DOD EHR family of systems forms one of the largest
    ambulatory records systems in the world, with documentation of an
    average of 140,000 patient encounters each day. However, the current
    suite of applications and underlying infrastructure do not support the
    challenges of the rapid evolution of today's health care practices, the
    ever-increasing need to transact and share data across the continuum of
    care, and the timely fielding of new capabilities.
        The Military Health System is executing the multi-year plan
    developed in the fall of 2009 to redesign the EHR supporting
    infrastructure and incrementally deliver key functionality. At the
    threshold, the system must stabilize current record capabilities so
    that users may efficiently perform their duties in a timely manner,
    regardless of location, time of day, or network issues. It is
    imperative that DOD address known shortfalls and key challenges with
    functional applications and core infrastructure, including critical
    user concerns with system speed, operational availability, and the user
    interface. This will allow DOD to meet providers' near-term needs and
    better prepare for the transition of applications and supporting
    infrastructure. Further, stabilization efforts will mitigate potential
    risks prior to increasing reliance on these systems for achieving
    expanded interoperability through the virtual lifetime electronic
    record.

        Senator Webb. Any other questions for the record by anyone
    on this subcommittee will be welcome by close of business
    today, which is going to be very late.
        Senator McCaskill, you have anything?
        Senator McCaskill. I don't.
        Senator Webb. Okay.
        Again, I appreciate the incredible work that all of you are
    doing on behalf of the people who are serving, and who have
    served. I appreciate your coming today.
        This hearing is adjourned.
        [Questions for the record with answers supplied follow:]
                Questions Submitted by Senator Claire McCaskill
                  traumatic servicemember group life insurance
        1. Senator McCaskill. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, in September
    2006 Lance Corporal Josef Lopez took a Department of Defense (DOD)
    administered smallpox vaccination prior to a deployment to Iraq and
    then suffered a severe adverse reaction resulting in temporary
    paralysis, coma, bladder damage, severe leg spasms, memory loss, and
    other conditions that require daily medication and care. At the time of
    his injuries from the vaccine, Lance Corporal Lopez applied for the
    Traumatic Servicemember Group Life Insurance (TSGLI) benefit, which was
    enacted by Congress in 2005 to provide a one-time benefit of up to
    $100,000 to servicemembers who endured a traumatic injury, whether in a
    combat or non-combat environment. The benefit is intended to help
    servicemembers and their families with immediate expenses related to
    the servicemember's injury and convalescence period. Due to a loophole
    in title 38, section 1980A(b)(3), Lance Corporal Lopez was denied the
    TSGLI benefit by the Department of Veterans Affairs (VA), even though
    by all measures his injuries from the vaccine were traumatic enough to
    affect key activities of daily living, including incontinence and
    walking. Although his condition has improved to some degree, Lance
    Corporal Lopez had to be medically retired from the Marine Corps in
    June 2009 and now undergoes long-term care management through the VA.
    He cannot drive, hold a normal job, and must take extensive medication
    to prevent spasms in his legs. What is DOD's current policy in handling
    adverse reactions incurred by mandatory DOD-administered vaccines?
        Dr. Rice and Admiral Hunter. The Department's policy concerning
    reactions to vaccines is to follow best available medical practices to
    screen for potential adverse reactions and avoid unnecessary risks.
    Unfortunately, screening methods cannot prevent all adverse vaccine
    events.
        The Services administer specific vaccines based upon disease risk
    and where the servicemember will serve. If anyone receiving a vaccine
    has a negative reaction, providers monitor the patient and determine
    the severity of the reaction. DOD medical providers are required to
    report and file a Vaccine Adverse Event Reporting System (VAERS) Report
    with the Centers for Disease Control (CDC) and Food and Drug
    Administration (FDA).
        In addition, DOD has four vaccine health care centers to provide
    consultative support to providers, serve as patient advocates, support
    research to enhance vaccine safety, and provide long-term follow-up for
    patients.
        General Schoomaker. DOD is committed to providing our
    servicemembers the highest quality of health care and support. If a
    potential vaccine-related adverse event is suspected from a mandatory
    DOD-administered vaccine, the attending healthcare provider is required
    to file a VAERS report. VAERS is a national reporting and surveillance
    system to identify adverse events and promote vaccine safety, and is
    administered by the CDC and the FDA. Additionally, the attending
    healthcare provider will refer the patient to the DOD's Vaccine
    Healthcare Centers (VHC) network for further consultation, treatment,
    and follow-up. The VHC's role is to prevent, identify, and treat
    vaccine-related adverse events. It offers a 24-hour clinical call
    center and a web-based digital photo-sharing system that allows for
    easier diagnosis from remote sites. Following service discharge,
    ongoing medical care becomes the responsibility of the VA. However, the
    VHC will provide the healthcare providers at the VA clinical
    consultative follow-up care on our veterans being treated.
        Admiral Robinson. The Military Vaccine Agency (MILVAX) is the DOD
    lead agent for all vaccine-related issues. If a potential vaccine-
    related adverse event is suspected from a mandatory DOD-administered
    vaccine, the attending healthcare provider will file a VAERS report.
    VAERS is administered by the CDC and the FDA. Additionally, the
    attending healthcare provider would refer the patient to the DOD's VHC
    network for further consultation, treatment, and follow-up based upon
    the clinical diagnosis.
        General Green. TSGLI is not administered through the Air Force
    Surgeon General's office, but through the Air Force Office of the
    Deputy Chief of Staff for Manpower and Personnel (AF/A1).
        If a potential vaccine-related adverse event is suspected from a
    mandatory DOD-administered vaccine, the attending healthcare provider
    will file a VAERS report in accordance with Air Force Joint Instruction
    48-110, section 2-10. VAERS is administered jointly by the CDC and the
    FDA, with occasional assistance in the analysis by the Immunization
    Safety Office at the National Center for Immunization and Respiratory
    Diseases of the CDC. Any person--not just healthcare providers--may
    submit a VAERS report to the FDA.
        Admiral Jeffries. The MILVAX is the DOD lead agent for all vaccine-
    related issues. If a potential vaccine-related adverse event is
    suspected from a mandatory DOD-administered vaccine, the attending
    healthcare provider will file a VAERS report. VAERS is administered by
    the CDC and the FDA. Additionally, the attending healthcare provider
    would refer the patient to the DOD's VHC network for further
    consultation, treatment, and follow-up based upon the clinical
    diagnosis.

        2. Senator McCaskill. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, how many
    servicemembers have had adverse reactions to mandatory DOD-administered
    vaccines over the past 5 years?
        Dr. Rice and Admiral Hunter. The Department reports 3,798
    servicemembers have had adverse reactions to mandatory DOD-administered
    vaccines over the past 5 years.
        General Schoomaker. DOD requires the attending healthcare provider
    to submit a VAERS report if a potential adverse event is suspected.
    Additionally, anyone can submit a VAERS report if they feel that they
    have had an adverse reaction to a vaccine. From January 2005 to
    December 2009, DOD personnel filed 3,798 reports to VAERS.
        Admiral Robinson. According to the MILVAX, DOD requires the
    attending healthcare provider to submit a VAERS report if a potential
    adverse event is suspected. Additionally, anyone can submit a VAERS
    report if they feel that they have had an adverse reaction to a
    vaccine. From January 2005 through December 2009, there were 3,798
    reports filed by DOD personnel to VAERS.

    2005.......................................................        352
    2006.......................................................        525
    2007.......................................................        794
    2008.......................................................      1,080
    2009.......................................................      1,047
                                                                ------------
      Total:...................................................      3,798

        General Green. From January 2005 to December 2009, there were 3,798
    reports filed by DOD personnel to VAERS. As the VAERS form does not
    require the specification of the Service, it is not possible to
    determine how many of these reports were from or about Air Force
    members. DOD requires the attending healthcare provider to submit a
    VAERS report if a potential adverse event is suspected. Additionally,
    anyone may submit a VAERS report if they feel that they or a family
    member have had an adverse reaction to a vaccine.
        Admiral Jeffries. According to the MILVAX, DOD requires the
    attending healthcare provider to submit a VAERS report if a potential
    adverse event is suspected. Additionally, anyone can submit a VAERS
    report if they feel that they have had an adverse reaction to a
    vaccine. From January 2005 through December 2009, there were 3,798
    reports filed by DOD personnel to VAERS.

    2005.......................................................        352
    2006.......................................................        525
    2007.......................................................        794
    2008.......................................................      1,080
    2009.......................................................      1,047
                                                                ------------
      Total....................................................      3,798

        3. Senator McCaskill. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, how are these
    numbers tracked? Please provide specific numbers.
        Dr. Rice and Admiral Hunter. The number of adverse reactions to
    DOD-administered vaccines is tracked through the VAERS at the CDC and
    FDA.
        General Schoomaker. DOD uses the VAERS to report and track any
    suspected adverse events after vaccination. This system is also used by
    civilian vaccine manufacturers, healthcare professionals, and the
    public to report and track clinical events temporally associated with
    vaccination. From January 2005 to December 2009, there were a total of
    3,798 VAERS reports filed by DOD personnel. The number of VAERS reports
    filed by year is as follows:

    2005.......................................................        352
    2006.......................................................        525
    2007.......................................................        794
    2008.......................................................      1,080
    2009.......................................................      1,047
                                                                ------------
      Total:...................................................      3,798

        Admiral Robinson. According to the MILVAX, DOD uses the VAERS to
    report and track any suspected adverse events after vaccination. This
    system is also used by civilian vaccine manufacturers, healthcare
    professionals, and the public to report and track clinical events
    temporally associated with vaccination. From January 2005 to December
    2009, there were a total of 3,798 VAERS reports filed by DOD personnel.
    The number of VAERS reports filed by year is as follows:

    2005.......................................................        352
    2006.......................................................        525
    2007.......................................................        794
    2008.......................................................      1,080
    2009.......................................................      1,047
                                                                ------------
      Total....................................................      3,798

        General Green. DOD uses the VAERS to report and track any suspected
    adverse events after vaccination. This system is also used by civilian
    vaccine manufacturers, healthcare professionals, and the public to
    report and track clinical events temporally associated with
    vaccination. From January 2005 to December 2009, there were a total of
    3,798 VAERS reports filed by DOD personnel. The number of VAERS reports
    filed by year is as follows:

    2005.......................................................        352
    2006.......................................................        525
    2007.......................................................        794
    2008.......................................................      1,080
    2009.......................................................      1,047
                                                                ------------
      Total....................................................      3,798

        As the VAERS form does not require the specification of the
    Service, it is not possible to determine how many of these reports were
    from or about Air Force members.
        Admiral Jeffries. According to the MILVAX, DOD requires the
    attending healthcare provider to submit a VAERS report if a potential
    adverse event is suspected. Additionally, anyone can submit a VAERS
    report if they feel that they have had an adverse reaction to a
    vaccine. From January 2005 through December 2009, there were 3,798
    reports filed by DOD personnel to VAERS.

    2005.......................................................        352
    2006.......................................................        525
    2007.......................................................        794
    2008.......................................................      1,080
    2009.......................................................      1,047
                                                                ------------
      Total....................................................      3,798

        4. Senator McCaskill. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, have any adverse
    vaccine injuries resulted in TSGLI claims? If so, how many?
        Dr. Rice and Admiral Hunter. Yes, there have been reports of
    adverse vaccine injuries which resulted in TSGLI claims.
        The Army reported three claims for TGLSI benefits due to adverse
    reactions to vaccines. The Marine Corps reported three claims for TGLSI
    benefits due to adverse reactions to vaccines. The Navy and Air Force
    have reported no claims for TGLSI benefits due to adverse reactions to
    vaccines.
        General Schoomaker. The Army TSGLI program has received four TSGLI
    claims with losses thought to be a result of vaccine injuries. The
    claimed losses were primarily those of Activities of Daily Living
    Losses (ADL), caused by a neurological or muscular dysfunction. One
    claim stated that the claimant would require surgery based upon a
    reaction to the vaccine and his ADLs would be impacted post surgery
    during recovery.
        Admiral Robinson. Navy's TSGLI database is managed by the Bureau of
    Naval Personnel and tracks the medical condition or event associated
    with the claim, but not necessarily the underlying cause. As such, the
    database does not explicitly track claims stemming from an adverse
    vaccine reaction. However, an electronic keyword search of the database
    was conducted, using terms such as ``vaccine,'' ``injection,'' and
    ``allergic reaction.'' A follow-on manual search of claims in which the
    medical condition or event was not clearly identified in the electronic
    database was also conducted. These combined searches revealed that, as
    of 19 March 2010, no TSGLI claims filed by Navy personnel have resulted
    from an adverse vaccine reaction.
        General Green. The Air Force has not received any Active Duty, Air
    National Guard, or Air Force Reserve TSGLI claims identifying an
    adverse reaction to vaccine as a traumatic injury.
        Admiral Jeffries. The Marine Corps administration of the TSGLI plan
    is managed by the Manpower and Reserve Affairs (M&RA) division of
    Headquarters, Marine Corps and specifically the Wounded Warrior
    Regiment. The database maintained by the Wounded Warrior Regiment was
    queried and three claims related to a vaccine injury were discovered,
    one of which was that of Lance Corporal Lopez.

        5. Senator McCaskill. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, how many
    servicemembers have been denied TSGLI claims for conditions and
    injuries related to adverse vaccine reactions?
        Dr. Rice and Admiral Hunter. A total of six servicemembers have
    been denied TSGLI claims for condition and injuries related to adverse
    vaccine reactions.
        The Army reported three denials of TSGLI benefits claims made due
    to adverse vaccine reactions. The Marine Corps reported three denials
    of TSGLI benefits claims made due to adverse vaccine reactions. The
    Navy and Air Force reported no denials to TGSLI benefits claims made
    due to adverse reactions to vaccines.
        General Schoomaker. The Army TSGLI program has received four TSGLI
    claims with losses thought to be a result of vaccine injuries. Each
    claim was denied due to a lack of medical documentation establishing a
    direct link to the claimed losses and the administration of the
    vaccine. Claims were also denied as not being a result of a traumatic
    event per requirements of the TSGLI program.
        Admiral Robinson. Navy's TSGLI database is managed by the Bureau of
    Naval Personnel and tracks the medical condition or event associated
    with the claim, but not necessarily the underlying cause. As such, the
    database does not explicitly track claims stemming from an adverse
    vaccine reaction. However, an electronic key word search of the
    database was conducted, using terms such as ``vaccine,'' ``injection,''
    and ``allergic reaction.'' A follow-on manual search of claims in which
    the medical condition or event was not clearly identified in the
    electronic database was also conducted. These combined searches
    revealed that, as of 19 March 2010, no Navy personnel have been denied
    a TSGLI claim for conditions or injuries related to an adverse vaccine
    reaction.
        General Green. The Air Force has neither received nor denied any
    Active Duty, Air National Guard, or Air Force Reserve TSGLI claims
    identifying an adverse reaction to vaccine as a traumatic injury.
        Admiral Jeffries. The Marine Corps administration of the TSGLI plan
    is managed by the M&RA division of Headquarters, Marine Corps and
    specifically the Wounded Warrior Regiment. The database maintained by
    the Wounded Warrior Regiment was queried and three claims related to a
    vaccine injury were discovered, one of which was that of Lance Corporal
    Lopez.

        6. Senator McCaskill. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, given that TSGLI
    is meant to cover traumatic injuries of servicemembers, what is your
    interpretation of whether Lance Corporal Lopez qualifies for TSGLI
    given the nature of his injuries from the DOD-administered vaccine,
    which caused him permanent and lifelong disability?
        Dr. Rice and Admiral Hunter. DOD concluded, based on current statue
    and policy, that Lance Corporal Lopez does not qualify for TSGLI given
    the nature of his injuries from the administered vaccine.
        Upon discharge a veteran would be entitled to monetary benefits and
    lifetime medical care for disabilities caused by lingering effects from
    vaccine reactions through the VA. However, DOD does not believe the
    TSGLI program is the appropriate vehicle for providing benefits for
    members who experience adverse reactions to vaccines.
        TSGLI was designed by Congress to provide severely injured
    servicemembers, who suffer a loss as a direct result of a traumatic
    event, with short-term monetary assistance. The definition of a
    traumatic event, according to 38 CFR 9.20, is, `` . . . the application
    of external force, violence, chemical, biological, or radiological
    weapons, or accidental ingestion of a contaminated substance causing
    damage to a living being.'' The TSGLI benefit is intended to lessen the
    economic burden on the member and the member's family which often
    ensues during the often long and difficult treatment and rehabilitation
    periods.
        General Schoomaker. It is tragic that Lance Corporal Lopez and
    other servicemembers have had adverse reactions to predeployment
    vaccinations. Preserving the health and safety of our servicemembers is
    my top concern. I would not consider this event to be a traumatic
    injury as defined by current law. Under the current law, inoculations
    are specifically excluded from TSGLI payment.
        TSGLI provides for payment to servicemembers who are severely
    injured (on or off duty) as the result of a traumatic event and suffer
    a loss that qualifies for payment under TSGLI. The servicemember must
    suffer a qualified loss that is a direct result of a traumatic event to
    qualify for TSGLI payment.
        Lance Corporal Lopez was given a required predeployment vaccination
    (smallpox). He had a severe reaction to the vaccination. As a result,
    he suffered temporary paralysis, was in a coma, and continues to
    struggle to independently perform activities of daily life. However,
    these injuries were not caused by a traumatic event under the VA's
    regulations governing TSGLI. These regulations define a traumatic event
    as ``the application of external force, violence, chemical, biological,
    or radiological weapons, accidental ingestion of a contaminated
    substance, or exposure to the elements that causes damage to the
    body.'' Also, specifically excluded from TSGLI payment is a loss caused
    by ``[d]iagnostic procedures, preventive medical procedures such as
    inoculations . . . or any complications arising from such procedures or
    treatment.''
        Lance Corporal Lopez's loss was caused by a smallpox vaccination.
    Smallpox is a serious, highly contagious, and sometimes deadly
    infectious disease. A smallpox outbreak would significantly affect
    military readiness. Administering the vaccination now, before an
    outbreak, is the best way to protect our troops. Very rarely, the
    smallpox vaccine can cause serious side effects. We will continue to
    enhance vaccine safety through research and education. We will also
    continue to optimize our screening process to ensure those at increased
    risk will not receive the vaccination.
        Admiral Robinson. Both the Code of Federal Regulations (CFR) (38
    CFR Sec. 9.20(e)(3)(i)(C)) and the August 5, 2009, TSGLI procedural
    guide specifically address this issue by stating that preventive
    medical procedures such as inoculations, and any complications arising
    from such procedures or treatment, are excluded from TSGLI payment.
        The Disability Evaluation System (DES) is the Uniformed Services'
    program to consider servicemembers whose ability to continue their
    military career is called into question as a result of their health
    state. This system does not delineate servicemembers based upon the
    cause of their injury or illness, with the potential exception of self-
    inflicted cases, but rather the outcome and impact. The servicemember
    may be medically retired and compensated based on the level of
    disability associated with their injury or illness. Service-connected
    conditions and disabilities are also eligible for continuing care and
    potential compensation through the VA upon the servicemember's
    separation or retirement.
        General Green. TSGLI is not administered through the Surgeon
    General's office, but through the Air Force Office of the Deputy Chief
    of Staff for Manpower and Personnel. However, anthrax and smallpox
    vaccines are not covered under the TSGLI, but would be covered under a
    program administered by the Department of Health and Human Services
    under the Public Readiness and Emergency Preparedness Act of 2005 (42
    U.S.C. Secs. 247d-6d, 247d-6e). As the Air Force has not had the
    opportunity to review Marine Lance Corporal Lopez's medical record, we
    would not be able to comment further.
        Admiral Jeffries. Both the CFR (38 CFR Sec. 9.20(e)(3)(i)(C)) and
    the August 5, 2009, TSGLI procedural guide specifically address this
    issue by stating that preventive medical procedures such as
    inoculations, and any complications arising from such procedures or
    treatment, are excluded from TSGLI payment. Based upon this established
    guidance, TSGLI does not cover the injury and/or disability brought
    about by their adverse reaction to receipt of the small pox
    vaccination. Current policy focuses on the acquisition of the injury as
    the focus of coverage, rather than including the outcome and associated
    disability.

        7. Senator McCaskill. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, do you think
    that Lance Corporal Lopez and people with similar injuries should
    receive compensation under TSGLI?
        Dr. Rice and Admiral Hunter. While I do think Lance Corporal Lopez
    and members with similar injuries should receive compensation, I do not
    think they should received TGSLI benefits resulting from adverse
    reactions to vaccinations, surgical trauma, or medical procedures given
    current policy.
        While the Lance Corporal Lopez situation is unfortunate, the TSGLI
    program employs the same industry standards and practices regarding an
    insurable loss as employed across the United States with respect to
    anyone who make claims covered by accidental death and dismemberment
    insurance. DOD follows the laws and regulations that embody these
    standards when adjudicating TSGLI claims. Specifically, vaccinations do
    not meet the definition of traumatic event as contemplated in the TSGLI
    statutes and regulations. Servicemembers who suffer adverse reactions
    to vaccines (to the degree that Lance Corporal Lopez suffered) would be
    entitled to monetary benefits and lifetime medical care for these
    disabilities through the VA.
        General Schoomaker. Lance Corporal Lopez and other servicemembers
    who sustain this injury may be entitled to receive a combination of
    military, veterans, and Social Security health and disability benefits.
    However, receiving compensation under TSGLI for this injury would be
    inconsistent with the policy and purpose of the current law.
        Military insurance programs such as TRICARE, SGLI, and TSGLI are
    modeled after commercial insurance policies. Specifically, TSGLI is
    modeled after commercial accidental death and dismemberment insurance.
    Like commercial insurance, TSGLI is a limited benefit that provides
    compensation for specific losses caused by specific events. Also, both
    TSGLI and commercial insurance policies specifically exclude payment
    for losses caused by medical treatment and procedures.
        Vaccinations are preventive medical procedures provided as part of
    the Army's force health-protection program. Unfortunately, some
    servicemembers will experience side effects or adverse reactions from
    the smallpox vaccine. Although rare, there are some serious side
    effects possible from the vaccine. We try to reduce the risk of side
    effects by exempting servicemembers who should not receive this
    vaccine. Like commercial insurance, this injury is not covered by TSGLI
    because it is a direct result of medical treatment and not a traumatic
    event.
        TSGLI is not the sole benefit available to servicemembers who
    suffer serious adverse reactions to vaccinations. TSGLI is very
    specific coverage that provides limited protection. The underlying
    policy and purpose for the TSGLI program will be significantly changed
    if a loss caused by a non-traumatic event qualifies for payment.
        Admiral Robinson. Both the CFR (38 CFR Sec. 9.20(e)(3)(i)(C)) and
    the August 5, 2009, TSGLI procedural guide specifically address this
    issue by stating that preventive medical procedures such as
    inoculations, and any complications arising from such procedures or
    treatment, are excluded from TSGLI payment.
        The DES is the Uniformed Services' program to consider
    servicemembers whose ability to continue their military career is
    called into question as a result of their health state. This system
    does not delineate servicemembers based upon the cause of their injury
    or illness, with the potential exception of self-inflicted cases, but
    rather the outcome and impact. The servicemember may be medically
    retired and compensated based on the level of disability associated
    with their injury or illness. Service-connected conditions and
    disabilities are also eligible for continuing care and potential
    compensation through the VA upon the servicemember's separation or
    retirement.
        General Green. The answer requires more than a simple yes or no
    reply. My understanding is that Congress modeled TSGLI after commercial
    accidental death and dismemberment policies with some expansion of
    benefits to address the unique needs of military service. Commercial
    accidental death and dismemberment policies specifically exclude
    disease and illness, including mental health conditions such as PTSD as
    is the case with the current TSGLI program. The TSGLI program also does
    not currently cover claims resulting from the diagnosis of, or medical
    or surgical treatment for, an illness or disease, or any complications
    arising from such medical or surgical treatment, or preventive medical
    procedures such as inoculations. Congress also expressed their intent
    that the basic TSGLI premium go no higher than its current level of $1
    per month. Expanding TSGLI to include claims resulting from medical
    treatments, illnesses, or preventive inoculations would almost
    certainly result in higher TSGLI premiums.
        Currently, our servicemembers cannot decline TSGLI coverage unless
    they also decline SGLI coverage. They automatically have the monthly $1
    premium deducted from pay. If expanding coverage results in a TSGLI
    premium increase, our concern is that it could change how the program
    is administered. An increase in premium may require giving
    servicemembers an option on whether to elect TSGLI coverage. If that
    occurs, our junior servicemembers may decline TSGLI coverage resulting
    in fewer servicemembers receiving coverage and payment for future
    traumatic injuries. While we support a broad TSGLI program that
    maximizes coverage to the widest degree possible, we do not support
    expanding coverage to the point that it results in an increase of the
    current TSGLI premium and a change in the program that would allow
    servicemembers to opt out. Any expansion of coverage needs to consider
    this possibility as this program is too important to our junior
    servicemembers to allow that to occur.
        Admiral Jeffries. Both the CFR (38 CFR Sec. 9.20(e)(3)(i)(C)) and
    the August 5, 2009, TSGLI procedural guide specifically address this
    issue by stating that preventive medical procedures such as
    inoculations, and any complications arising from such procedures or
    treatment, are excluded from TSGLI payment.
        The DES is the Uniformed Services' program to consider
    servicemembers whose ability to continue their military career is
    called into question as a result of their health state. This system
    does not delineate servicemembers based upon the cause of their injury
    or illness, with the potential exception of self-inflicted cases, but
    rather the outcome and impact. The servicemember may be medically
    retired and compensated based on the level of disability associated
    with their injury or illness. Service-connected conditions and
    disabilities are also eligible for continuing care and potential
    compensation through the VA upon the servicemember's separation or
    retirement.
                                     ______

                   Questions Submitted by Senator Mark Begich
                               suicide prevention
        8. Senator Begich. General Schoomaker, I understand the Army has
    instituted a number of programs to address the increasing suicide rates
    among servicemembers. Can you provide an update on some of the
    programs?
        General Schoomaker. The Army has implemented several near-term
    projects to improve our understanding--such as the Army Campaign Plan
    for Health Promotion, Risk Reduction, and Suicide Prevention, and the
    Vice Chief of Staff's monthly suicide review meetings. The Army has
    also enlisted the help of the National Institute of Mental Health
    (NIMH) to conduct a long-term study on risk and resilience in the Army.
        The Army conducts extensive reviews of every suicide death, both
    Active Duty and non-Active Duty, to improve our understanding of why a
    soldier may choose to take his/her life. The Army Suicide Prevention
    Task Force has created a standardized 37 line report which units use to
    analyze the factors surrounding each soldier's death by suicide. This
    report is forwarded to the Pentagon within 30 days of the soldier's
    death, and a general officer conducts a back brief to the Vice Chief of
    Staff of the Army during his monthly suicide review meeting. This back
    brief is done via a world-wide video teleconference so that leaders
    across the Army can share lessons learned and improve early recognition
    of at-risk soldiers.
        The Army has created the Army Behavioral Health Integrated Data
    Environment database. This database will provide a standardized,
    enterprise-wide, capability to integrate information from dispersed
    legal, medical, and personnel databases into a comprehensive health
    surveillance database to support mental, behavioral, social health, and
    public health activities.
        NIMH has undertaken the Army Study to Assess Risk and Resilience in
    Servicemembers (Army STARRS), which is the largest study ever
    undertaken of suicide and mental health among military personnel. The
    purpose of Army STARRS is to identify, as rapidly and as scientifically
    as possible, modifiable risk and protective factors of suicidal
    behavior, to help inform the Army's ongoing efforts to prevent suicide
    and improve soldiers' overall psychological health and functioning.
        Army actions taken in 2009 to combat the increasing suicide rate
    follow:

        1.  Produced the interactive ``Beyond the Front'' training video.
        2.  Produced the ``Shoulder to Shoulder: No Soldier Stands Alone''
    training video.
        3.  Updated AR 600-63 (Army Health Promotion) and DA Pam 600-24
    (Health Promotion, Risk Reduction and Suicide Prevention).
        4.  Published Suicide Awareness Pocket Guide for all soldiers.
        5.  Increased access to behavioral health and substance abuse
    counseling.
        6.  Funded NIMH grant for the Army STARRS, $50 million/5-year
    study--Quarterly Updates to VCSA to Accelerate Lessons Learned.
        7.  Initiated a tele-behavioral health screening pilot project with
    the 25th Infantry Division, involving 100 percent screening through
    face-to-face or live video counseling.
        8.  Approved nationally-recognized best-practice suicide
    intervention skills training for Army use to assist in early
    recognition of at-risk individuals.

        Army actions for 2010 follow:

        1.  Developing interactive ``Home Front'' training video.
        2.  Developing sequel to ``shoulder to shoulder'' training video.
        3.  Developing an additional skill identifier for certified suicide
    intervention skills trainers.
        4.  Expanding tele-behavioral health pilot project, to become the
    Comprehensive Behavioral Health System of Care and implementing it into
    the ARFORGEN cycle so behavioral health care is targeted at critical
    points (predeployment, deployment, reintegration, reset, et cetera).
        5.  Developing program effectiveness measures.
        6.  Using the Suicide Specialized Augmentation Response Team/Staff
    Assistance Team to support commanders by assessing programs, policies,
    and resources, and identify gaps to improve local suicide prevention
    programs.

        9. Senator Begich. General Schoomaker, in your opinion, are we
    doing enough?
        General Schoomaker. I will not be satisfied until suicide rates in
    the Army are reduced below the suicide rate for the civilian
    population. Despite our inability to halt the increase in suicide, I am
    very impressed with the prevention efforts of leaders across the Army.
    The Army has implemented many changes to programs, policies, and
    procedures in an effort to improve our suicide prevention programs. We
    have hired more behavioral health professionals, we are improving our
    screening methods, and we are using technology to expand access to our
    behavior health providers. We are constantly looking for ways to
    improve and have eagerly sought the assistance of numerous outside
    experts.
        The Army has documented behavioral health authorizations for 2,340
    providers. As of the first quarter of fiscal year 2010, the Army had an
    on-hand behavioral health provider inventory of 3,714, this equates to
    a 159 percent fill rate. However, given current workload requirements
    and accounting for the increased demand for psychological health
    support for soldiers and families, we have calculated a current
    ``needs'' estimate of approximately 4,305 behavioral health providers.
    This represents an 86 percent fill rate when compared to the current
    on-hand inventory. We estimate that an additional 591 behavioral health
    providers are needed to meet current demand. The Army is actively
    engaged in the recruitment and accession of providers to meet the
    identified behavioral health requirements.
        Stigma remains a significant issue in America and Army culture.
    Army leaders are concerned that soldiers appear reluctant to seek
    behavioral healthcare due to stigma and/or fear of negative
    repercussions. As a result, programs have been developed to help
    decrease the stigma associated with soldiers seeking behavioral
    healthcare while also providing an increased layer of privacy.
        The Reengineering Systems of Primary Care Treatment in the military
    is a program designed to decrease the stigma associated with seeking
    behavioral health treatment by placing these services within primary
    care facilities. Through this program, any visit a soldier makes to
    his/her primary care physician for any reason is an opportunity to
    screen the soldier for symptoms that could indicate that he/she is
    struggling with symptoms associated with post-traumatic stress disorder
    (PTSD) or other behavioral health diagnoses. This program is also
    accessible via the web, where soldiers can self-refer. Services
    provided are confidential, unless it is determined that a soldier is at
    risk of harm to self or others.
        The Soldier Evaluation for Life Fitness program incorporates
    behavioral health as a routine component of the health readiness
    process for all soldiers returning to their home stations following
    deployment. Since every soldier receives a consultation on-site, no one
    is stigmatized when seen by a behavioral healthcare practitioner.
    Through the Soldier Evaluation for Life Fitness program, soldiers first
    complete a computer-based self-assessment. On-site clinicians review
    the results of the assessments immediately, allowing them to tailor
    their consultations to meet each soldier's unique needs. Soldiers can
    then be evaluated for individual health risks that may range from PTSD
    and other behavioral health diagnoses to physical health conditions.
        Military OneSource is a free information center and website where
    soldiers can seek assistance 24 hours/day, 7 days/week. Counseling is
    provided by phone or in person by Masters-level consultants on issues
    such as family support, emotional support, debt management, and legal
    issues for up to 12 sessions at no cost to the soldier. Military
    OneSource does not release information about users of the services,
    with the exception of issues of child abuse, elder abuse, spousal
    abuse, and/or risk of harm to self or others. Military OneSource can be
    accessed at www.militaryonesource.com or 1-800-342-9647. Soldiers may
    complete a free, voluntary online behavioral health self-assessment,
    and obtain referrals at www.MilitaryMentalHealth.org. This is an
    approach to assist soldiers and family members with identifying
    symptoms and getting assistance. It provides confidential and immediate
    feedback, as well as referrals to TRICARE, VA centers, and Military
    OneSource.
        Military and family life consultants are also available to assist
    soldiers who are experiencing difficulty coping with daily life
    concerns and issues. Military and family life consultants are Licensed
    Clinical Social Workers, Professional Counselors, Marriage and Family
    Therapists, and Psychologists. They provide six free informal and
    confidential counseling sessions. No records are kept and flexible
    appointment times and locations are offered. Soldiers may access
    military and family life consultants through the Army Community
    Services by self referral, without having to provide a reason for
    seeking these services, or via Military OneSource, who can assist them
    with the identification of a consultant in the soldier's local area.

                     comprehensive soldier fitness program
        10. Senator Begich. General Schoomaker, the Army's Comprehensive
    Soldier Fitness (CSF) program is a structured, long-term assessment and
    development program to build the resilience and enhance the performance
    of every soldier, family member, and Army civilian. Can you tell me
    more about this program, and the role of the Army Medical Department
    (AMEDD) in support of the program?
        General Schoomaker. The Army established the CSF program to
    increase the resilience of soldiers and families by developing their
    strengths in five important domains: physical, emotional, social,
    spiritual, and family. The CSF program will ensure that all soldiers
    undergo an assessment of their total fitness. The results of the
    assessment will direct individualized training, intervention, or
    treatment programs, as needed. This program will begin at accession,
    and, like physical fitness, will include reassessment at appropriate
    intervals. The CSF office applies accepted methodology and scientific
    rigor to ensure that all training, interventions, and treatments have
    demonstrated effectiveness.
        The AMEDD is a strong supporter of the CSF program. Although there
    is overlap with AMEDD goals, CSF is not a medical program. The AMEDD
    will implement CSF as will every other unit by taking the Global
    Assessment Tool (GAT), training Master Resilience Trainers (MRT), and
    implementing CSF training on our training calendar (as we would any
    other Warrior Task and Battle Drill). Additionally, the AMEDD supports
    the CSF physical dimension by providing medical/health-related data on
    the Soldiers Independent Operational Test to provide physical fitness
    metrics for the soldiers. Also, the AMEDD is instrumental in
    coordinating with CSF on state-of-the-art physical fitness training
    content and products for inclusion in the CSF online training modules,
    MRT training, and Warrior Task and Battle Drill training.

        11. Senator Begich. General Schoomaker, do you believe this program
    is properly funded?
        General Schoomaker. Yes, I am not aware of any requirements for CSF
    that have not been funded.

                            family health initiative
        12. Senator Begich. General Green, I understand the Air Force
    implemented the Family Health Initiative (FHI) which mirrors the
    American Academy of Family Physicians ``Patient Centered Medical Home''
    concept and is built on the team-approach for effective care delivery.
    I also understand you have two pilot programs at Edwards Air Force
    Base, CA, and Ellsworth Air Force Base, SD. Can you provide an update
    on the status of these pilots?
        General Green. We began implementation of the FHI at Edwards Air
    Force Base and Ellsworth Air Force Base in 2008. As our most mature
    sites, we have seen outstanding improvement in patient continuity
    leading to improved patient and staff satisfaction. Additionally, as we
    have forged greater relationships through continuity with our patients,
    health care outcomes have improved accordingly, especially for our most
    complex patients with diseases such as diabetes mellitus. We have taken
    the lessons learned from our initial two sites and used them to improve
    FHI implementation at 11 additional locations across the Air Force in
    2009: Andrews, Bolling, Elmendorf, FE Warren, Hill, Lakenheath,
    Laughlin, Misawa, Patrick, Scott, and Sheppard Air Force Bases. The
    lessons learned at all 13 of these locations are being applied as we
    implement FHI and the Patient Centered Medical Home at 20 additional
    Air Force military treatment facilities (MTF) in 2010, with a goal of
    Air Force-wide implementation by the end of 2012.

        13. Senator Begich. General Green, do you believe this program
    should be implemented across DOD and the other Services?
        General Green. The Air Force FHI is based on a concept known as the
    Medical Home that originated in U.S. professional medical societies for
    primary care specialties. The Medical Home has become a Military Health
    System (MHS) strategic priority. The Army and Navy have prototype
    programs based on the Medical Home concept. We are exchanging
    information, ideas, and experiences with the Army and Navy as we move
    forward and adapt the processes to the missions we support. An
    advantage of sharing this as a MHS priority is the pursuit of common
    requirements supporting the Medical Home concept, reflected in the
    electronic health record (EHR) and personal health record requirements
    in DOD. We are excited about providing benchmark-quality primary care
    services to our patients.

                              center of excellence
        14. Senator Begich. Dr. Rice, can you give an update/status of
    section 1623, ``Center of Excellence in Prevention, Diagnosis,
    Mitigation, Treatment, and Rehabilitation of Military Eye Injuries''
    that was in the National Defense Authorization Act for Fiscal Year
    2008? In general, this section stated that the ``Secretary of Defense
    shall establish within DOD a center of excellence in the prevention,
    diagnosis, mitigation, treatment, and rehabilitation of military eye
    injuries.''
        Dr. Rice. The Department has completed facility design of the
    Vision Center of Excellence (VCE). Contract award is pending, with a
    projected completion by third quarter of fiscal year 2011.
        The VCE is creating a staffing plan for Initial Operating
    Capability (IOC) and Full Operating Capability, to include functions,
    grades, classification, responsibilities, and mission of each
    subordinate division. We anticipate hiring IOC staff in the third
    quarter of fiscal year 2010.

                              specialist shortages
        15. Senator Begich. General Green, the 3rd Medical Corps at
    Elmendorf Air Force Base, headed by Colonel Paul Friedrichs, runs one
    of the best MTFs in the Air Force. However, specialty shortages at the
    MTF and in Alaska continue to plague the ability to treat patients. Is
    the Air Force looking at how to address those shortages by bringing in
    more specialists?
        General Green. I returned this week from my third visit to Alaska
    to learn more about how the Air Force Medical Service (AFMS) partners
    with our municipal, State, and Federal counterparts to improve access
    to care while sustaining the medical proficiency of our Air Force
    medics in Alaska. As part of this visit, I was able to travel with your
    Rural Director, Ms. Tiffany Zulkosky, to visit military medics bringing
    much-needed care to the residents of Kotzebue, Noorvik, and Selawik. As
    our military population has grown, the Air Force has added over 150 new
    medical authorizations at the third Medical Group to minimize the
    number of patients who must seek care downtown. We are actively
    pursuing sharing agreements with the VA and Alaska Native Medical
    Center to further expand the medical services we offer our patients.
        The AFMS programs medical resources based on population and mission
    requirements. The AFMS programmed an increase of specialty doctors and
    key medical enablers, such as nurses, medical technicians, and
    administrative support from fiscal years 2008 to 2011. As part of the
    fiscal years 2012 to 2017 Program Objective Memorandum planning, the
    AFMS is carefully reviewing the mix of services offered at each of our
    facilities including those at Eielson and Elmendorf Air Force Bases. We
    see continued opportunities to support State and local medical
    providers' efforts to build a trauma system for Anchorage, as well as
    to build robust Graduate Medical Education programs, and a seamless e-
    health network that will help improve access for all patients.
                                     ______

                   Questions Submitted by Senator John McCain
                            adara networks contract
        16. Senator McCain. Dr. Rice, what is the status of the DOD
    Inspector General's (IG) investigation into allegations of impropriety
    in the award of health information technology contracts to Adara
    Networks, Inc.?
        Dr. Rice. DOD policy does not permit comment on ongoing DOD IG
    investigations.

        17. Senator McCain. Dr. Rice, what were the findings and results of
    the internal investigation conducted by the Department into allegations
    of impropriety in the award of health information technology contracts
    to Adara Networks, Inc.?
        Dr. Rice. The preliminary review found the program did not fully
    adhere to the DOD Directive 5000 series, Federal Acquisition
    Regulations, Defense Federal Acquisition Regulations Supplement
    Acquisition Principles.
        There were errors in judgment and a lack of program and acquisition
    planning, transparency, and oversight. Software and documentation,
    intellectual property developed and owned by the MHS, was
    inappropriately provided to Adara Networks.

        18. Senator McCain. Dr. Rice, please identify the source and total
    amount of funds provided to Adara for work on the DOD EHR.
        Dr. Rice. The funding source was Operation and Maintenance--fiscal
    year 2007 and the total aount awarded was $9,944,792.53.

        19. Senator McCain. Dr. Rice, please identify and describe each
    product delivered to the government under the Adara contract, including
    reports, software, and/or electronic code.
        Dr. Rice. The following products were delivered to the government
    under the Adara contract:

             (1) Lot, Mesh Networking Technologies
             (1) Lot, Equipment, including software licenses,
            necessary for an eight node infrastructure. Standard support
            and maintenance--including 1 year of all minor releases, all
            maintenance patches, and support coverage is included with the
            software
             (8) Each, Multi Path Virtual Circuit Router
             (8) Each, Multi Path Dynamic Application Layer
             (8) Each, Multi Homed Application Layer (7) Object
             (8) Each, Multi Homed Application Layer (7) Host
             (8) Each, Multi Path Virtual Routers
             (8) Each, Multi Path Routing Software, Multi Path
            Routing Protocol and Daemon
             (8) Each, Multi Path QoS Router
             (8) Each, Multi Path SOA Content Based Router
             (10) Each, Secure Communication Gateways
             (1) Each, Central Management Systems

        20. Senator McCain. Dr. Rice, are those products being utilized in
    ongoing development of the EHR? If not, why not?
        Dr. Rice. No, those products are not being utilized in ongoing
    development of the EHR.
        An Analysis of Alternatives (AoA) is currently being developed,
    which will provide materiel solutions to the requirement to the EHR.
    Once that solution is chosen, an acquisition strategy will be
    formulated in accordance with DOD Directive 5000, the Defense
    Acquisition System.

        21. Senator McCain. Dr. Rice, according to press reports,
    electronic code for the MHS was provided to Adara Networks, Inc. What
    companies under contract to DOD are in possession of that code at this
    time?
        Dr. Rice. Only Adara Networks, Inc., was in possession of that
    code.

        22. Senator McCain. Dr. Rice, what assurances can you give Congress
    that sensitive medical information is not at risk?
        Dr. Rice. I am confident sensitive medical information is not at
    risk.
        On December 7, 2009, in consultation with the TRICARE Management
    Activity (TMA) Privacy Office and TMA Information Assurance, the
    Defense Health Information Management System (DHIMS) Program Office
    determined that the overall risk of penetration of DOD health records,
    accounts, or other privileged/secured access sites or databases was
    low. The Computer Network Defense would prohibit unauthorized access to
    the production system.

        23. Senator McCain. Dr. Rice, has the Department imposed any
    sanctions with respect to future contracts on Adara Networks, Inc.?
        Dr. Rice. No, the Department has not imposed any sanctions with
    respect to future contracts on Adara Networks, Inc.

                           electronic health records
        24. Senator McCain. Dr. Rice, what is the schedule for development
    and delivery of an EHR for DOD?
        Dr. Rice. Armed Forces Health Longitudinal Technology Application,
    the existing DOD EHR, has been deployed worldwide since 2006. A
    schedule of the way ahead for the EHR will be developed and released
    following completion of the AoA for EHR capability.

        25. Senator McCain. Dr. Rice, is the program fully funded in the
    fiscal year 2011 request and in the Future Years Defense Plan?
        Dr. Rice. DOD's EHR program is fully funded in the fiscal year 2011
    request and in the Future Years Defense Plan.
                                     ______

                 Questions Submitted by Senator Lindsey Graham
                               tricare contracts
        26. Senator Graham. Dr. Rice, last July, TRICARE Management
    Activity announced the selection of the contractors for the $55.5
    billion (over 5 years) TRICARE Third Generation (T-3) Managed Care
    Support Services Contracts. It is our understanding that as a result of
    protest filed by two of the incumbents, however, that transition work
    with the newly selected contractors was stopped pending the Government
    Accountability Office (GAO) protest review and decision. Current
    TRICARE managed care contracts remain in place until March 31, 2011,
    and health care delivery continues while options are being considered.
    I want to ensure that TRICARE beneficiaries continue to have timely
    access to high quality health care during the protest period and the
    critical transition period to the new contracts. What is the status
    regarding the evaluation of GAO's recommendations?
        Dr. Rice. We are concluding our evaluation of the GAO
    recommendations and will be announcing our approach to resolving the
    protest issues in the summer of 2010.

        27. Senator Graham. Dr. Rice, when will these contracts be awarded?
        Dr. Rice. We expect to take steps to resolve the remaining issues
    regarding these contracts in the summer of 2010.

        28. Senator Graham. Dr. Rice, since the 10-month transition
    deadline is approaching, does DOD expect to resume transition soon or
    will the current contracts be further extended?
        Dr. Rice. We believe transitions can be completed by April 2011,
    coinciding with the current contracts end date.

        29. Senator Graham. Dr. Rice, can you assure me that TRICARE's
    beneficiaries will not be harmed during this contract transition?
        Dr. Rice. I assure you TRICARE beneficiaries will not be harmed
    during this contract transition.
        The current regional health care contractors will continue to
    provide services to beneficiaries until March 31, 2011. Extensions to
    our current contracts will allow time for transition to the T-3
    contracts, while ensuring beneficiaries continue to receive high-
    quality care and outstanding customer service.

                            medicating the military
        30. Senator Graham. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, do you agree
    with the reporting in the Army Times on March 8, 2010, that: ``At least
    one in six servicemembers is on some form of psychiatric drug.'' If
    not, why not? What available data do you use to support your statement?
        Dr. Rice and Admiral Hunter. We do not agree with the Army Times
    reporting.
        In an analysis completed in February 2010, data from the Pharmacy
    Data Transaction Service (PDTS), reported less than 3 percent of all
    Active Duty members are on psychiatric drugs.
        The PDTS is a centralized data repository that allows us to build a
    common patient medication profile for all DOD beneficiaries. The data
    for this analysis was focused on two queries: (1) the number of unique
    Active Duty servicemembers who received any prescription, and (2) the
    number of Active Duty servicemembers that received any of the
    psychotropic medications as defined by the CENTCOM Pharmacy and
    Therapeutics Committee.
        General Schoomaker. I do not agree with the statistic used by the
    Army Times. The quote referred to data from the Mental Health Advisory
    Team (MHAT)-V Report from Afghanistan (2007), in which 17 percent of
    U.S. soldiers reported taking a medication for a mental health or sleep
    problem during their deployment. The MHAT-VI (2009) conducted a more
    systematic sampling of maneuver and support units across both the Iraq
    and Afghanistan theaters and separated medications for sleep and other
    mental health indications. Overall, in MHAT-VI, 3 to 6 percent of
    soldiers surveyed reported using a medication for a ``mental health or
    stress problem,'' and 8 to 14 percent reported using a medication for a
    sleep problem. (Note: These percentages cannot be added together,
    because some individuals were taking both categories. In-theater data
    were not available for sailors, marines, or Air Force personnel.)
        In a stratified random DOD-wide survey at CONUS and OCONUS
    installations involving Active Duty of all Services, 8.6 percent of
    servicemembers reported receiving a prescription for depression,
    anxiety, or sleep problems in the preceding 12 months (10.7 percent
    Army, 6.2 percent Navy, 7.9 percent Marines, 8.1 percent Air Force)
    (DOD Health Related Behaviors Among Active Duty Military Personnel
    2009).
        In January 2010, data from the PDTS which captures all
    prescriptions filled at MTFs, the TRICARE Mail Order Pharmacy, and
    civilian pharmacies (when paid for using the TRICARE benefit),
    indicated that 3.3 percent of Army Active Duty soldiers filled a
    prescription for an antidepressant in that month. Antidepressants
    include selective serotonin reuptake inhibitors (SSRIs), tricyclics,
    heterocyclics, and monoamine oxidase inhibitors (MAOIs). It should be
    noted, however, that this analysis does not include prescriptions
    filled in the deployed environment, and may not capture the full
    medication usage if soldiers received a prescription from outside the
    MHS, or a prescription prior to January that was for longer than a 1-
    month period.
        Thus, the best data available suggest that the rate of current (1
    month) use of antidepressants specifically in CONUS is approximately 3
    percent and the estimate for any use of antidepressants during
    deployment is 3 to 6 percent. The rate is considerably higher when
    sleep and antianxiety medications are included in addition to
    antidepressants.
        Admiral Robinson. The quoted statistic regarding one in six
    servicemembers on some form of psychotropic drug is apparently derived
    from the fifth MHAT survey done in 2007. This was a survey of deployed
    Army personnel and included a question about taking a medication for
    help with sleeping or any mental health or stress problem. The result
    was about 17 percent of respondents said that they had taken a
    medication for one of these reasons. A soldier would have answered yes
    to this question if they had been given a few sleep aids to help with
    changing 12 time zones in 2 days, which is accepted medical practice,
    or been on a several-month course of antidepressants. Clearly,
    combining these two very different answers together is not ideal.
        To address this shortcoming, the MHAT 6 survey, completed in 2009,
    broke out the questions: (1) about taking a medication for sleep; and
    (2) about taking a medication for a mental health or stress problem.
    This resulted in a rate of 3 to 6 percent of respondents indicating
    they had taken a medication for mental health or stress. MHAT 6 results
    are consistent with other data points concerning psychotropic use by
    military personnel, including the Navy Behavioral Health Needs
    Assessment Survey (BHNAS) data from this year that indicates that about
    22 percent of respondents used sleeping medication during their
    deployment and 3.2 percent used medication for mental health reasons.
    The estimate of usage for mental health reasons of the adult U.S.
    civilian population approximates 10 percent. The Navy BHNAS is an
    assessment tool utilizing similar questions to the U.S. Army's Mental
    Health Assessment Tool (MHAT). It provides real time, actionable, unit
    level psychological health surveillance and is being used to assess
    Navy members who are deployed as individual augmentees.
        General Green. Thank you for the opportunity to address this
    concern regarding the health and well-being of our Air Force members
    and their use of psychotropic medications. The prevalence rate of
    psychotropic medication use in the Air Force on a single day, March 1,
    2010, was 1 in 17, or 5.8 percent, of the Active-Duty Force. This
    figure is a point prevalence of one day. The number of unique Air Force
    servicemembers who had one or more prescriptions for any psychotropic
    medication, including controlled prescription pain medications, on this
    date was 22,003 or 5.8 percent of the Active Force. When controlled
    prescription pain medications are removed, the number of unique
    servicemembers on a psychotropic medication changes to 17,962 or 4.7
    percent of the force. Psychotropic medications are used to treat many
    medical conditions beyond psychiatric syndromes such as the use of
    tricyclic antidepressants for chronic pain, and other antidepressant
    classes are also used to treat migraine headaches and fibromyalgia. The
    data was extracted from the MHS PDTS table in the M2 on March 1, 2010.
        Admiral Jeffries. The quoted statistic regarding 1 in 6
    servicemembers on some form of psychotropic drug is apparently derived
    from the fifth MHAT survey done in 2007. This was a survey of deployed
    Army personnel and included a question about taking a medication for
    help with sleeping or any mental health or stress problem. The result
    was about 17 percent of respondents said that they had taken a
    medication for one of these reasons. A soldier would have answered yes
    to this question if they had been given a few sleep aids to help with
    changing 12 time zones in 2 days, which is accepted medical practice,
    or been on a several-month course of antidepressants. Clearly,
    combining these two very different answers together is not ideal. To
    address this shortcoming, the MHAT 6 survey, completed in 2009, broke
    out the questions: (1) about taking a medication for sleep; and (2)
    about taking a medication for a mental health or stress problem. This
    resulted in a rate of 3 to 6 percent of respondents indicating they had
    taken a medication for mental health or stress. MHAT 6 results are
    consistent with other data points concerning psychotropic use by
    military personnel, including the Navy BHNAS data from this year that
    indicates that about 22 percent of respondents used sleeping medication
    during their deployment and 3.2 percent used medication for mental
    health reasons.
        The most current data, based on actual prescriptions filled by
    marines, demonstrate that less than 7 percent of marines filled a
    prescription for an antidepressant, antianxiety medication, or
    stimulant during all of 2009. At any one time the percentage is
    obviously even smaller. Estimates for the adult civilian population of
    the United States are higher.

        31. Senator Graham. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, do you agree
    that many troops are taking more than one kind of psychiatric drug,
    ``mixing daily cocktails,'' and that this behavior can lead to suicide?
        Dr. Rice and Admiral Hunter. No, we do not agree. While we are
    aware of a small number of troops who may be taking more than one kind
    of psychiatric drug to treat multiple symptoms justified by their
    clinical condition, this is not a common occurrence and we would not
    categorize it as many troops.
        Suicide is caused by multiple factors. We have not seen evidence
    directly correlating an increase in suicides with servicemembers who
    are prescribed multiple psychiatric drugs justified by clinical
    condition under the supervision of physicians. Independent studies have
    found that the benefits of antidepressants outweigh the risks of
    suicide.
        General Schoomaker. The Army is concerned with the health and
    resilience of all servicemembers and extends great effort to reduce the
    risk of loss of a single servicemember to the tragedy of suicide.
        In our soldier population, we use pharmacy data to provide a very
    precise accounting of how many soldiers are on multiple medications. We
    define multiple medications as two or more of any combination of sleep,
    psychotropic, or narcotic medications. For our Warriors in Transition,
    who have a variety of medical and psychiatric diagnoses, 703 (7.7
    percent) Warriors are on multiple medications out of a total population
    of 9,095 warriors. In the overall Active Duty population, 1,075 (0.2
    percent) soldiers are on multiple medications out of a population of
    557,642 soldiers.
        Reviewing completed suicides from 2001 to 2008, we found slightly
    more than one-third of the suicides had a history of psychotropic
    prescriptions, with 14 percent current prescriptions at time of death,
    and 19 percent within 3 months. We do not have the level of detail in
    our database to assess how many were on multiple medications.
        The Army has funded a 5-year, $50 million study with the National
    Institute of Mental Health to help answer questions about the
    relationship between psychiatric medications and suicide. This is a
    multi-pronged and multi-site study, led by the Uniformed Services
    University of the Health Sciences (USUHS) and supported by Harvard
    University, Columbia University, and the University of Michigan.
        Admiral Robinson. I do not agree with this statement. Sailors and
    marines who are taking medications have been carefully diagnosed, and
    when indicated, prescribed medications. Individuals placed on
    medications are closely monitored to ensure they are stable on the
    medications without side effects that would impair their ability to
    function or place them at risk. In addition, every sailor is screened
    prior to deployment via the NAVMED 1300/4 which addresses all medical
    requirements and is reviewed by a licensed medical provider to ensure
    individuals are medically suitable for deployment. Every marine is
    screened in a similar manner by their battalion surgeon to ensure they
    are suitable for deployment. Periodic surveillance of the psychological
    health of deployed sailors and marines is also being conducted.
        General Green. The Air Force is concerned with the health and
    resilience of all servicemembers and extends great effort to reduce the
    risk of loss of a single servicemember to the tragedy of suicide. In
    reviewing Air Force suicides over the past nearly 2 years we have seen
    no indication of a trend toward polypharmacy, or use and/or abuse of
    multiple psychotropic medications, in our servicemembers lost during
    this time. Data pulled from M2 reflects one day point prevalence for
    Active Duty Air Force personnel taking more than one psychotropic
    medication at the same time, or polypharmacy in psychotropics, on March
    1, 2010, was 6,061 or 1.6 percent of the Active Force. We have
    demonstrated vigilance in our management of servicemembers with chronic
    pain and complex medical management through guidance sent to the Chiefs
    of Medical Staff in an effort to ensure safe, multidisciplinary team
    management of servicemembers with chronic controlled pain medication
    use.
        The Air Force Suicide Prevention Program is also engaged in a
    number of studies with researchers at the USUHS to examine case data on
    past suicides, including data collected through our Suicide Event
    Surveillance System, and the DOD Suicide Event Report and Personal
    Health Assessment data, to look for factors that may allow us to better
    identify those at risk for suicide. Recent efforts in this area have
    allowed us to identify career fields that appear to be at greater risk
    for suicide, allowing leadership to target additional prevention
    efforts at these groups.
        The Air Force has also been collecting data on new recruits
    entering the Air Force regarding their past behavioral history. This
    data collection appears to show promise in allowing us to identify,
    from a recruit's earliest days in the Air Force, those airmen who may
    be at higher risk for a variety of problems. The Air Force is now
    exploring ways to reach out to these airmen to improve their ability to
    cope with the rigors of military life and improve resiliency.
        Admiral Jeffries. I do not agree that many marines are taking more
    than one kind of psychiatric medication and ``mixing daily cocktails.''
    The most current data, based on actual prescriptions filled by marines,
    demonstrate that less than 7 percent of marines filled a prescription
    for an antidepressant, antianxiety medication or stimulant during all
    of 2009. At any one time the percentage is obviously even smaller.
    Servicemembers with more serious or complicated mental health
    conditions are more likely to be on multiple medications and these
    personnel are also more likely to attempt suicide. However, this is not
    a cause-and-effect relationship as much as a marker of a more serious
    condition.
        Internal Marine Corps suicide reviews have shown that regardless of
    duty station, deployment, or duty status, the primary stressors
    associated with marine suicides are problems in romantic relationships,
    physical health, work-related issues, such as poor performance and job
    dissatisfaction, and pending legal or administrative action. A fellow
    marine is the most likely person to notice a change in behavior that
    may be the first indication of an impending serious problem and the
    Marine Corps' strategy for dealing with the entire range of stress
    related issues starts with engaged leadership.

        32. Senator Graham. Dr. Rice, Admiral Hunter, and General Green,
    Brigadier General Loree Sutton, Director of the Center of Excellence
    for PTSD and TBI, recently testified to the House Veterans Affairs
    Committee that 17 percent of troops are currently on antidepressants.
    Is she correct?
        Dr. Rice and Admiral Hunter. Brigadier General Sutton's oral
    statement is correct that data from the 2007 MHAT-V Report from
    Afghanistan found 17 percent of U.S. Army soldiers reported taking
    medication for mental health or sleep problems while deployed. Those
    medications include, but are not limited to, antidepressants.
        General Green. Thank you for the opportunity to address this
    concern regarding the health and well-being of our Air Force members
    and their use of antidepressant medications. Antidepressant medications
    are used for more than psychiatric conditions alone. Antidepressants
    can be used in managing pain conditions, fibromyalgia, and migraine
    headaches, as examples. Thus the current use of antidepressant
    medications in the Air Force cannot be directly construed to imply
    prevalence of psychiatric conditions in our members.
        The Air Force has an antidepressant utilization rate of 1 in 63 or
    1.6 percent of the Active Force based upon data extracted from the MHS
    PDTS table in the M2 on March 1, 2010. This figure is a one-day point
    prevalence.

        33. Senator Graham. Admiral Hunter, has your office conducted any
    kind of study to examine the utilization of prescription medicines by
    Active Duty members? If so, what were the results?
        Admiral Hunter. The Utilization Management Division of the
    Pharmaceutical Operations Directorate, within the TRICARE Management
    Activity, conducts routine utilization studies based on various
    parameters. The results of these studies show use of prescription
    medication in the Active Duty population is well in line with trends we
    see in the non-Active Duty population.

        34. Senator Graham. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, is more research
    needed on the effect of psychiatric drugs on performance of military
    duties?
        Dr. Rice and Admiral Hunter. Further research on the effects of
    psychiatric medications and how they relate to performance of military
    duties is needed for continual assessment. It is DOD policy that health
    care providers must recommend to commanders whether servicemembers with
    psychiatric disorders or who are prescribed psychotropic medication
    should be deployed or are fit for military duties.
        General Schoomaker. Yes, more research is needed to assess the
    effect of psychiatric drugs and all medications on the performance of
    military duties. This is especially true in deployed environments that
    may require prolonged vigilance and sustained coordination skills to
    ensure safe and effective functioning of servicemembers.
        Admiral Robinson. Psychiatric medications can and do effectively
    treat symptoms and permit individuals to deploy and to function without
    compromising performance. When individuals are placed on medications,
    they are closely monitored by their healthcare provider to ensure they
    are not experiencing side effects that may compromise their ability to
    perform their duties. Research on medication effects is currently
    underway in many sectors and clinical evidence uncovered in research is
    used to advise the selection of medications.
        General Green. Yes, more research is needed to assess the effect of
    not only psychiatric drugs, but all medications, on the performance of
    military duties. This is especially true in deployed environments that
    may require prolonged vigilance and sustained coordination skills to
    ensure safe and effective functioning of servicemembers.
        Admiral Jeffries. Psychiatric medications can and do effectively
    treat symptoms and permit individuals to deploy and to function without
    compromising performance. When individuals are placed on medications,
    they are closely monitored by their healthcare provider to ensure they
    are not experiencing side effects that may compromise their ability to
    perform their duties. Research on medication effects is currently
    underway in many sectors and clinical evidence uncovered in research is
    used to advise the selection of medications.

        35. Senator Graham. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, can you comment
    on the reasons why various medicines, such as antidepressants, are
    prescribed and the potential benefits for servicemembers who are
    receiving them?
        Dr. Rice and Admiral Hunter. Antidepressants, often referred to as
    psychotropic or psychotherapeutic medications, are prescribed for a
    variety of reasons, including depression, recurrent headaches, pain,
    smoking cessation, and specific mental health disorders.
    Antidepressants, when used with proper medical supervision, in
    appropriate situations, and in conjunction with other treatments, are
    important and effective tools for supporting the mental health needs of
    our Armed Forces.
        These medications have changed the lives of servicemembers for the
    better. Each patient reacts differently to antidepressants, some
    require only short-term antidepressant treatment while others require
    long-term treatment for more resistant conditions.
        General Schoomaker. Antidepressants, when used with proper medical
    supervision, in appropriate situations, and usually in conjunction with
    other treatments, are an important and effective tool for supporting
    mental health needs, both in deployed settings and at home.
        Antidepressants are now prescribed for a variety of diagnoses. They
    are used for a variety of depressive disorders, and anxiety disorders
    including PTSD. Certain antidepressants are also used for headaches,
    pain, and sleep.
        There are many different types of antidepressants. The class known
    as selective serotonin re-uptake inhibitors is very safe, in general.
    Older agents, known as tricyclics, heterocyclics, and monoamine oxidase
    inhibitors have more side-effects and are used more rarely. Sometimes
    they are used for pain and headaches rather than depression. Finally,
    buproprion is also used as an anti-smoking aid.
        The degree of response to medication, ranging from little relief of
    symptoms to complete remission, depends on a variety of factors related
    to the individual and the particular disorder being treated. In
    general, antidepressants are effective for treating symptoms of
    depression, anxiety, and PTSD.
        Admiral Robinson. Medications such as antidepressants can be
    prescribed for a variety of reasons including depressive symptoms,
    anxiety, recurring headaches, pain, and smoking cessation. In addition,
    the use of medications can enable an otherwise nondeployable
    servicemember to effectively complete their mission in a deployed
    environment--greatly empowering the servicemember and significantly
    reducing the effects of mental health stigma.
        Stigma can be a significant factor in personnel not receiving
    treatment when treatment is needed. The use of medication in a deployed
    setting may suggest that servicemembers who need help are increasingly
    comfortable seeking help, which can significantly reduce the risk
    associated with untreated psychiatric problems, to include suicidal
    behavior associated with certain mental health conditions. A potential
    risk of suggesting that medication use is somehow a negative indicator
    or a problem is that it may increase stigma, thus inhibiting some from
    seeking critically important mental health treatment. Mental health
    medications, when used with proper medical supervision, in appropriate
    situations, and usually in conjunction with other treatments, can be a
    very appropriate and helpful part of personnel treatment, both in
    theater and at home and permit the servicemember to serve without the
    impairment that their untreated symptoms could impose.
        General Green. The prescription and management of medication, in
    all cases, must be done by a responsible physician working closely with
    their patient and sometimes the patient's family or other mental health
    professionals. This is the only way to ensure that the most effective
    use of medication is achieved with minimum risk of side effects or
    complications. Psychotropic medications have made dramatic changes in
    the treatment of mental disorders. Psychotropic medications also may
    make other kinds of treatment more effective by making it possible for
    the person to respond better to other therapy and treatment efforts.
        Like most drugs used in medicine, they correct or compensate for
    some malfunction in the body. Psychotherapeutic medications do not cure
    mental illness, but they do lessen its burden. The degree of response
    to medication, ranging from little relief of symptoms to complete
    remission, depends on a variety of factors related to the individual
    and the particular disorder being treated.
        Admiral Jeffries. Medications such as antidepressants can be
    prescribed for a variety of reasons including depressive symptoms,
    anxiety, recurring headaches, pain, and smoking cessation. In addition,
    the use of medications can enable an otherwise nondeployable
    servicemember to effectively complete their mission in a deployed
    environment--greatly empowering the servicemember and significantly
    reducing the effects of mental health stigma.
        Stigma can be a significant factor in personnel not receiving
    treatment when treatment is needed. The use of medication in a deployed
    setting may suggest that servicemembers who need help are increasingly
    comfortable seeking help, which can significantly reduce the risk
    associated with untreated psychiatric problems, to include suicidal
    behavior associated with certain mental health conditions.
        A potential risk of suggesting that medication use is somehow a
    negative indicator or a problem is that it may increase stigma, thus
    inhibiting some from seeking critically important mental health
    treatment. Mental health medications have solid medical evidence and
    research to support their use and when used with proper medical
    supervision, in appropriate situations, and usually in conjunction with
    other treatments, can be a very appropriate and helpful part of an
    individual's treatment. Appropriate use of these medications, both in
    theater and at home, along with leadership support, facilitate
    servicemembers continuing to serve without the impairment that their
    untreated symptoms could impose.

                          vision center of excellence
        36. Senator Graham. Admiral Hunter, one of the Senate Armed
    Services Committee's recommendations last year was to rapidly implement
    the programs and research mandated by Congress for the Vision Center of
    Excellence. How will the 2011 request support that Center?
        Admiral Hunter. The fiscal year 2011 budget request supports
    requirements for staffing towards full operational capability of the
    Vision Center of Excellence (VCE). This full operational capability
    will include civilian personnel and contract support, completion of
    Phase One and implementation of Phase Two of the Defense and Veterans
    Eye Injury and Vision Registry, establishment of the VCE Regional
    Clinical Centers of Excellence, Vision Support Cells and Vision
    Deployment Support Platforms, quarterly educational conferences and
    research symposia, and occupation of permanent facilities.

                       task force on wounded warrior care
        37. Senator Graham. Dr. Rice, last year Congress directed DOD to
    establish a task force to continuously examine care for wounded
    warriors. What is the status of that task force at this time?
        Dr. Rice. The task force is currently in the member nomination and
    establishment phase.
        The membership nomination slate is complete. The Department
    received input from the Services, Congress, White House Liaison Office,
    and private sector on the nominations. Currently, the recommended slate
    of 14 members is being reviewed within the Department and will be
    completed by April 30, 2010.
        The logistical support has been established by the Washington
    Headquarters Services for facilities, administrative support, and
    charter. Additionally, the initial support personnel for the task force
    have been identified along with a preliminary budget.
        Throughout this process, we are committed to working with Congress
    on this vital task force to examine care for wounded warriors.

                               health care reform
        38. Senator Graham. Dr. Rice, to the best of your knowledge, are
    there any primary negative effects of the newly enacted health reform
    legislation that will negatively impact health care benefits for
    military personnel, retirees, and their families?
        Dr. Rice. No, I do not believe the Patient Protection and
    Affordable Care Act will have any negative impacts on health care
    benefits for military personnel, retirees, and their families.

        39. Senator Graham. Dr. Rice, are there any secondary effects, such
    as cutting Medicare payments to physicians and hospitals, or expanding
    access to care, that could hurt military health care in the future?
        Dr. Rice. There may be secondary effects to TRICARE, but we will
    ensure these effects will not hurt military health care in the future.
        Because of this statutory connection between Medicare and TRICARE
    reimbursement rates, Medicare payment provisions of the Patient
    Protection and Affordable Care Act will affect TRICARE. We will monitor
    access to care and, when necessary, use available tools such as
    locality based waivers to increase payment levels for physicians to
    ensure adequate access to care for our beneficiaries.

                             health care workforce
        40. Senator Graham. Dr. Rice, do you agree that America and the
    military are facing a serious shortage of health care professionals
    that will only grow over time?
        Dr. Rice. Yes, I agree there is a shortage of health care
    professionals in the military and America. The military departments
    have a declining inventory of some wartime critical medical
    specialties. There is also a growing shortage of physicians and nurses
    in the United States. The pool of medical school applicants is
    shrinking and the population traditionally applying for the Health
    Professions Scholarship Program (HPSP) has been declining.

        41. Senator Graham. Dr. Rice, how will this shortage of health care
    professionals affect the military, and are we adequately preparing for
    it now?
        Dr. Rice. Currently, the military has a declining inventory of some
    wartime critical medical specialties which will affect the care of our
    servicemembers.
        To prepare for and counteract these shortages, the Department
    relies on Multiyear Special Pay and Incentive Special Pay as critical
    tools for managing the medical force. Also, DOD annually convenes the
    Health Professions Incentives Working Group, to make recommendations on
    incremental adjustments to the existing financial incentives for
    retention underneath the Federal cap.

        42. Senator Graham. General Schoomaker, Admiral Robinson, General
    Green, and Admiral Jeffries, you testified recently to the Senate
    Appropriations Subcommittee on Defense that you all face shortages in
    medical personnel. Where are your greatest shortages?
        General Schoomaker. The AMEDD is experiencing force-wide shortages
    in certain specific specialties and specialty shortages in certain
    locations. However, despite the persistent deployment tempo, the
    national shortage of many healthcare disciplines, and the compensation
    gap between military and civilian providers, the Army is doing well
    recruiting and retaining healthcare providers. Recruiting and retention
    authorities and bonuses are working, but we need to maintain constant
    vigilance.
        The most difficult skill sets to recruit and retain include: fully-
    qualified physicians with surgical or primary care specialties,
    dentists (general and specialty), behavioral health professionals, and
    nurse anesthetists. According to the U.S. Army Recruiting Command
    (USAREC), one of the greatest challenges in the recruitment of
    healthcare professionals is simply a lack of awareness of Army
    Medicine. USAREC is attempting to alleviate this challenge by adopting
    a strategy of increased marketing of the benefits of Army Medicine.
        Additionally, the AMEDD is currently short at the grade of major
    (O4) across all corps. This is a function of several phenomena; the
    most notable being the loss of officers in the grade of captain (O3)
    who had completed their obligation prior to implementation of current
    retention initiatives, thus decreasing the number of officers available
    to promote to the grade of O4. While this overall grade imbalance is
    true, each corps also has specific specialty shortages at differing
    grades, signifying a potential capability gap. Recent recruiting
    success has increased the company grade inventory that will increase
    the inventory at the rank of major if these junior officers are
    retained, select specialty training, and earn promotion.
        We are addressing resolution of specific specialty shortages
    through precision recruiting, training, and retention initiatives. We
    must continue to take full advantage of the recruiting and retention
    authorities and bonuses provided by Congress if we are to maintain the
    recent strong results. Our experience over the last decade has proven
    that incentives, bonuses, and special pays work.
        Admiral Robinson.

    ------------------------------------------------------------------------
                                         Percent
               Subspecialty               Manned    Current INV   Authorized
    ------------------------------------------------------------------------
    Medical Corps
      Surgery........................          84          176          210
      Family Medicine................          84          353          418
      Psychiatry.....................          83           93          112
      Preventive Medicine............          69           38           55

    Dental Corps
      General Dentist................          86          365          424
      Oral Surgeon...................          81           70           86
      Prosthodontist.................          80           44           55
      Endodontist....................          89           42           47

    Medical Service Corps
      Clinical Psychologist..........          84          106          126
      Physician assistant............          75          180          241
      Social Work....................          66           23           35
      Podiatry.......................          80           16           20

    Nrse Corps
      Critical Care Nursing..........          73          290          396
      Perioperative Nursing..........          81          240          295
      Mental Health Nurse                      55           11           20
       Practitioner..................
      Family Nurse Practitioner......          82           72           88
    ------------------------------------------------------------------------

        Medical Corps
             Recruiting and retaining general surgeons, preventive
            medicine physicians, family medicine physicians, and
            psychiatrists will remain a challenge over the next several
            years. Wartime demand, perceived inequities in pay compared
            with the civilian sector, and limited student pipelines are
            contributing factors.

        Dental Corps
             Dental Corps has difficulty directly accessing and
            retaining oral surgeons, prosthodontists, and general dentists
            because of the pay gap between military and civilian
            compensation. A general dentist pay package offering
            significant compensation increases is currently routing through
            DOD. Additionally the DOD Health Professions Incentive Working
            Group will be recommending a $20,000 per year increase in
            incentive special pay for oral surgeons in fiscal year 2011.

        Medical Service Corps
             Our greatest shortages are physician assistants,
            clinical psychologists, podiatrists, and social workers.
            Retention and recruiting has been affected due to high
            operational commitments.

        Nurse Corps
             High operational commitments are affecting recruiting
            and retention in all of Navy's nurse practitioner specialties.

        General Green. The top 10 medical fields not manned to
    requirements:

          Medical Corps (4):

          1.  Flight Surgery (RAM) 182/213* = 85.4 percent (high value,
    deployable specialty)
          2.  Trauma Surgery 11/19** = 57.9 percent (includes 45SXK AFS
    only; Health Manpower Personnel Data System (HMPDS) data included this
    sub-specialty within general surgery career field, hence sub-specialty
    not reported separately; high value, deployable specialty)
          3.  General Surgery 83/86** = 96.5 percent (includes 45S AFS
    only; HMPDS data shows 87/83* @ 104.8 percent; due to declining manning
    and increasing authorizations for fiscal year 2010, higher number
    reported under HMPDS; high value, deployable specialty--using Critical
    Skills Retention Bonus (CSRB) to maintain numbers)
          4.  Family Practice 495/551** = 89.8 percent (recent AFMS
    emphasis on FHI dramatically drove increased authorizations, while
    pipeline remains at flat rate due to demands of other specialties,
    rising authorizations in fiscal year 2010 over HMPDS data of 473/435 @
    108.7 percent significantly dropped percent manning for fiscal year
    2010)

          Nurse Corps (2):

          1.  Operating Room Nurse 219/237* = 92.4 percent (high value,
    deployable specialty)
          2.  Flight Nurse 100/190* = 52.6 percent (high value, deployable
    specialty/air transport wartime demand)

          Biomedical Sciences Corps (2):

          1.  Clinical Psychologists 215/255* = 84.3 percent (increasing
    wartime demand/limited pipeline)
          2.  Pharmacists 233/253* = 92.1 percent (high value, deployable
    specialty)

          Enlisted Medical Corps (2):

          1.  Independent Duty Medical Technician 415/625* = 66.4 percent
    (high value, deployable specialty)
          2.  Orthopedic Technician 98/151* = 64.9 percent (high value,
    deployable specialty)
    ---------------------------------------------------------------------------
        Data source: *Fiscal Year 2009 HMPDS, **9 Apr. 10 AFPC/DS data
    extrapolation by Lt Col Terry Mathews/SG1D

        Admiral Jeffries. I did not testify at the referenced hearing. This
    question is most appropriately answered by the Service Surgeons
    ---------------------------------------------------------------------------
    General.

        43. Senator Graham. General Schoomaker, Admiral Robinson, General
    Green, and Admiral Jeffries, does the budget request fully fund your
    requirements for scholarships, special pays, loan repayment, and
    accession and retention bonuses that you need to ensure the future
    readiness of the military medical components?
        General Schoomaker. The budget request does not fully fund all
    requirements for scholarships, special pays, loan repayment, and
    accession/retention bonuses across all components. For the Active
    component, the budget fully funds requirements for scholarship and loan
    repayment programs. Sweeping changes made to the DOD Health Professions
    Special Pay Program by Section 661 of National Defense Authorization
    Act for Fiscal Year 2008 expanded special pay opportunities to include
    psychologists, social workers, physician assistants, veterinarians,
    general dentists, and critical wartime specialty accessions. Army
    Medical Command is working closely with the Army staff to ensure
    special pays are supported to the maximum extent possible.
        For the Army Reserve, the budget request fully funds the Health
    Professions Scholarship Program and the Army Reserve Health Incentives
    Program. While the budget request does not fully fund the Army Reserve
    to achieve the health professions recruiting mission, it does account
    for increases in mission accomplishment. As these incentives are
    implemented, the Army Reserve will continue to analyze the return on
    investment in terms of recruiting and retention and update our models
    appropriately to ensure the incentives programs continue to be properly
    funded.
        For the Army National Guard, the budget request fully funds
    existing requirements. However, greater than 30 percent of the Army
    National Guard's current Medical, Dental, and Medical Specialists Corps
    personnel are within 1 year of their retirement eligibility date and
    are not eligible for incentives under current DOD regulations. The Army
    is reviewing proposals to ensure all available incentives are available
    to our critical skill personnel, regardless of the number of years'
    service they have within the Reserve components.
        Admiral Robinson. The President's budget for fiscal year 2011 fully
    funds incentive programs for recruitment and retention of Navy
    healthcare professionals. We continue to closely monitor these programs
    to identify any need for additional resources that may be required to
    meet emerging growth requirements and future readiness among healthcare
    professionals.
        General Green. For the current fiscal year 2010 budget and the
    fiscal year 2011 budget submission, the AFMS is provided sufficient
    money from the Line of the Air Force to cover our current projected
    cost of the Medical Special and Incentive Pays Program (special pays,
    accession bonuses, incentive pays, and retention bonuses). Any cuts to
    the fiscal year 2011 budget submission affecting Air Force Special and
    Incentive Pays program will have a drastic and lasting effect on
    accession and retention of our critical specialties. The money under
    the Medical Special and Incentive Pays Program covers all medical
    entitlements and contracted pays. Our incentive and retention pays are
    all contract linked and require military obligations for the fully-
    qualified member to receive. Our accession bonuses are currently
    covered for the projected increase in fully-qualified health
    professions officers recruiting requirements and also require a
    mandatory military obligation to be eligible. To avoid a possible
    revolving door program of accessions and separations, the AFMS will
    require an adjustment to the Line of the Air Force money provided to
    the AFMS for Medical Special and Incentive Pays Program, possibly as
    early as fiscal year 2014 or fiscal year 2015. As these newly accessed
    health professions officers complete their initial military obligations
    and become eligible to either separate or contract for enhanced
    compensation contracts under the new authorities of 37 U.S.C. 335, we
    must remain within 75 percent of comparable direct salary compensation
    to stay viable and competitive with the private sector health care
    employment market and retain these critical and experienced health care
    professionals.
        HPSP/Financial Assistance Program funding for fiscal year 2010 from
    the Air Force Reserves and Defense Health Program are fully funded.
    Current projected funds will support our steady state of 1,666
    participants starting in fiscal year 2011.
        Admiral Jeffries. The President's budget for fiscal year 2011 fully
    funds incentive programs for recruitment and retention of Navy
    healthcare professionals. We continue to closely monitor these programs
    to identify any need for additional resources that may be required to
    meet emerging growth requirements and future readiness among healthcare
    professionals.

                                 mental health
        44. Senator Graham. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, we recently
    received a report from DOD which concluded that: there is an increased
    need for civilian mental health care providers within DOD; that the
    supply in the civilian labor market may not meet the demand; and we
    should pilot a scholarship program for civilian mental health providers
    in exchange for a commitment to serve in areas where there are DOD
    beneficiaries. Do you agree that such a program could be beneficial?
        Dr. Rice and Admiral Hunter. We agree there is an increased need
    for mental health providers with DOD. We are working hard to ensure the
    MHS remains competitive to recruit from the civilian labor market and
    to answer the Deputy Secretary of Defense's challenge to ``grow our
    own'' mental health professionals.
        To those ends, we have proposed legislation for a scholarship
    program for health professionals, initially targeting mental health
    professionals. This legislation is entitled Health Professions
    Financial Assistance Program for Civilians. This program will give the
    Services authority to provide pay and allowances for civilians toward
    their education within the health professions focusing on mental health
    professions. This program will be given in exchange for a commitment to
    DOD service, ensuring additions to our inventory of critical
    specialties. We request congressional support for this important
    legislation.
        General Schoomaker. I have concerns about piloting a scholarship
    program for civilian mental health providers. Such a scholarship
    program may not work for all behavioral health specialties, as each
    specialty has unique educational requirements. Physicians who attend
    medical school would have to commit to a particular specialty (e.g.,
    psychiatry) when applying to medical school. Very few people enter
    medical school with a clear idea of what specialty to pursue and many
    change their mind several times during the 4 years of medical training.
    Therefore, requiring a person to commit to a particular specialty prior
    to entering medical school is not practical. In addition, there is no
    guarantee that the person will match to a residency training program in
    that specialty 4 years later.
        Similarly, a scholarship program for clinical psychologists could
    face significant difficulty. Clinical psychologists complete 3 to 4
    years of academic coursework plus a dissertation and a 1-year
    internship prior to award of the doctorate; they follow this with an
    additional year of post-doctoral supervision prior to licensure. There
    are many opportunities for students to be derailed from their training
    plans that make a scholarship program problematic. The Army has a tight
    process for selecting HPSP recipients for the military, but we still
    find almost 20 percent of students do not meet qualification standards
    by the time they reach the internship. Each student who does not
    complete their training is a loss of about $100,000.
        The Army already has an educational program for producing social
    workers. We are in the second year of the new Army Masters of Social
    Work (MSW) program. Originally only offered to servicemembers, the MSW
    program has expanded to include Federal service employees, and will
    further expand next year to include non-Federal civilians.
        The Army has expended great effort and has seen strong success
    recruiting civilian behavioral health providers over the last 5 years.
    Army records indicate an increase of 861 civilian behavioral health
    providers from March 2006 to March 2010, or 105 percent increase for a
    total on-board strength of 1,680 civilian behavioral health employees.
    Increases among these behavioral health occupations include: (1)
    Psychologists (an increase from 288 to 533 or an 85 percent increase);
    (2) Social Workers (an increase from 369 to 854 or a 131 percent
    increase); (3) Psychiatrists (an increase from 89 to 131 or a 47
    percent increase); and (4) Psychiatric Registered Nurses (an increase
    from 73 to 162 or a 122 percent increase). To achieve the 105 percent
    increase in civilian behavioral health providers, Army Medical Command
    (MEDCOM) has aggressively pursued several actions. For the past 3
    fiscal years, MEDCOM centrally funded $1.5 million annually for the
    student loan repayment program for registered nurses, including
    psychiatric registered nurses. MEDCOM also set aside monies for
    recruitment, relocation, and retention incentives for all healthcare
    occupations. A little more than $11 million was granted to civilian
    employees in the four behavioral health occupations during the last 18
    months through the end of March 2010.
        Admiral Robinson. Navy Medicine has been generally successful
    hiring civilian and contract mental health providers. The Services, as
    well as the VA, continue to pursue a limited pool of applicants which
    has become more challenging especially in remote locations. Careful
    cost-benefit analyses in support of initiatives such as a civilian
    scholarship program must be conducted and the potential impact on
    current military scholarship programs must be assessed. We would not
    support competing scholarship programs. We rely on our current military
    scholarship programs as the primary source for commissioning military
    health care providers.
        General Green. With respect to the idea of a civilian scholarship
    program, I feel that the establishment of such a program would compete
    with the recruitment of Active Duty mental health providers, which has
    been a significant challenge for the Air Force. This would be
    particularly true for our HPSP. While civilian employee mental health
    providers are a pivotal part of the military mental health care
    delivery system, we recommend continuing to emphasize the recruiting
    and retention of Active Duty providers who can fill certain roles only
    they can perform--most notably deployment.
        We already have existing, vacant civilian mental health provider
    positions and so the issue is how to better recruit and retain civilian
    providers, with a particular focus on those Air Force bases located in
    areas underserved by civilian mental health providers. To do this, we
    should seek to maximize a number of initiatives already in place that
    could have positive effect on this situation:

        1.  Existing DOD Direct Hire Authority for medical occupations is a
    valuable recruiting tool and has made a positive impact on medical
    occupation accessions.
        2.  Multiple tools are available for civilian employees for both
    accession and retention purposes:

               Recruitment bonuses for new accessions (up to 25
            percent of base salary)
               Retention allowances to sustain high caliber
            employees (up to 25 percent of base salary)
               Credit for non-Federal and Uniformed Service
            experience for annual leave accrual for new employees
               Student Loan Repayment for new accessions ($10,000
            per year with $60,000 max payment)

        3.  Superior Qualification Appointments (for GS employees only)
    provides an advance in-hire rate up to Step-10 of assigned grade.

        In addition, I would like to see incentives for those professionals
    willing to relocate and work on bases underserved by local civilian
    mental health professionals. Those areas generally provide very little
    in the way of a pool of candidates for positions on base.
        Lastly, I encourage Congress to consider reviewing TRICARE
    reimbursement rates and business rules to see if there may be
    opportunities to encourage community civilian providers to join and
    expand existing TRICARE networks. Family members in certain markets
    frequently report challenges accessing providers willing and able to
    accept network referrals.
        Admiral Jeffries. Navy Medicine has been generally successful
    hiring civilian and contract mental health providers that support the
    Marine Corps. The Services, as well as the VA, continue to pursue a
    limited pool of applicants which has become more challenging especially
    in remote locations. Careful cost-benefit analyses in support of
    initiatives such as a civilian scholarship program must be conducted
    and the potential impact on current military staffing and scholarship
    programs must be assessed prior to initiating such an effort. Current
    military scholarship programs are the primary source for commissioning
    military health care providers that support the Marine Corps and the
    development of a competing program may have undesirable consequences.

                              tricare for reserves
        45. Senator Graham. Admiral Hunter, I was gratified to learn that
    enrollment in TRICARE for Reserves has grown significantly since last
    year but there is still concern among the personnel chiefs of the
    Services that the word is not getting out to reservists. How can we
    improve the marketing of this program?
        Admiral Hunter. We are committed to improving the marketing of this
    program to reach every potential TRICARE Reserve Select (TRS)
    beneficiary.
        TRICARE Management Activity and OASD (Reserve Affairs) are
    collaborating to ensure each Reserve component member has the necessary
    information to make an educated decision regarding the purchase of TRS.
        Reserve Affairs issued a Policy Memorandum governing TRS. This
    requires each of the Reserve components to develop and execute a
    communications plan to all of their members. The Communications Plan
    for 2010 is designed to emphasize informing both Reserve members and
    family members, to enable the entire military family to make the health
    care decision together.

        46. Senator Graham. Admiral Hunter, I am not happy to hear that
    implementation of TRICARE for Gray Area reservists is taking so long.
    When will it be up and running?
        Admiral Hunter. We anticipate TRICARE for Gray Area reservists will
    be up and running and benefits in place no later than October 2010.

                     post deployment health re-assessments
        47. Senator Graham. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, many of you have
    indicated that the Post-Deployment Health Reassessment (PDHRA), is an
    effective program to identify health concerns that may emerge over time
    following deployment. In November 2009 the GAO reported that
    substantial numbers of records from Active and Reserve servicemembers
    who returned from Iraq or Afghanistan were missing from the DOD central
    database--in fact nearly 25 percent were missing. How can we and the
    Department have reasonable assurance that servicemembers are getting
    the care that they need when nearly one out of four of these records is
    missing?
        Dr. Rice and Admiral Hunter. The GAO findings led to a number of
    actions within DOD. I believe these actions convey reasonable assurance
    servicemembers are getting the care they need.
        The actions initiated include:

             A memorandum sent to the Services reemphasizing the
            need for all eligible servicemembers to be offered the PDHRA.
             The DOD central database at the Armed Forces Health
            Surveillance Center (AFHSC) established a mechanism with each
            Service to ensure PDHRAs sent by the Services are received at
            the AFHSC.
             We have obtained a list of ``missing'' servicemembers
            from the GAO and are having the Services examine the reasons
            for why the expected PDHRAs were not present.
             A working group was formed to both monitor the
            Services' efforts to increase the percentage of servicemembers
            taking advantage of the PDHRA and to exchange successful
            initiatives and lessons learned across Services.

        General Schoomaker. The number of soldiers who complete their PDHRA
    is significantly higher now than when the program was initiated Army-
    wide in 2006. To ensure these records reach the DOD central database,
    we now conduct a reconciliation of records (``handshake'') each month
    between the DOD database and the Army database. So far, this check is
    showing 100 percent record transfer between these two databases.
        To improve compliance, we increased communication outreach to
    support commanders by mailing reminder postcards and emails to soldiers
    who are eligible for the PDHRA. Soon, we will begin to send email
    reminders to soldiers in all three components when they become eligible
    for the PDHRA and will follow up with several more email reminders as
    needed.
        There are a variety of programs available to soldiers to self refer
    for care if needed such as the soldier hotline. The Reserve component
    uses the Yellow Ribbon Program for soldiers to complete the PDHRA and
    to provide many more services which includes family assistance, pre-
    and post-deployment services, education, and Veteran Affairs. The
    Reserve component audits the Regional PDHRA leadership to check
    compliance and also visits units to check compliance.
        Increasing soldier PDHRA completion along with proper record
    transfers will result in more records in the DOD central database. The
    combination of identifying care needs from the PDHRA and our current
    efforts to ensure appointments are kept will provide soldiers the care
    they need.
        Admiral Robinson. The GAO Report focused on servicemembers who
    returned from deployment between January 2007 and May 2008. Since that
    time, Navy has made significant progress in establishing policies and
    procedures to ensure timely and accurate completion of deployment
    health assessments. Coordinated efforts by the medical, line, and
    personnel communities have resulted in an effective implementation plan
    for meeting PDHRA program requirements. Key elements include: clear
    delineation of roles and responsibilities; line involvement in ensuring
    compliance; increased medical resources; improved information
    management systems and data transfer processes; and support from senior
    leadership. Navy currently reports a PDHRA compliance rate of 90
    percent and continues to work toward a goal of ensuring that all of our
    returning servicemembers receive the care they need.
        General Green. In a November 2009 audit report, the GAO identified
    PDHRA records were missing for 8,162 Air Force deployments,
    constituting 16 percent of the total number of Air Force PDHRA records
    expected at AFHSC. However, upon further investigation, the Air Force
    identified all but 3 percent of expected PDHRA records, attributing
    unidentified records to attrition, frequent deployments, and incorrect
    deployment data.
        To ensure PDHRA documentation for all eligible deployments, the Air
    Force has implemented a number of initiatives, including: (1)
    establishing deployment-health requirements, including the PDHRA, as
    required components of in- and out-processing checklists; (2)
    contacting servicemembers at multiple points (90, 120, and 150 days)
    after return from deployment if they have not yet completed the PDHRA;
    (3) developing a data-verification process with AFHSC to ensure all
    data sent by the Air Force is received by AFHSC; and (4) developing a
    data-use agreement with sister Services to prevent loss of PDHRA
    completion data for members completing the PDHRA in sister-Service
    applications.
        Admiral Jeffries. The Marine Corps is committed to the health and
    wellbeing of marines. The PDHRA is one tool that is used to discover
    marines who have concerning symptoms who for some reason may have not
    yet been identified. A recent audit revealed that 84 percent of marines
    had successfully completed their required PDHRA. While this rate offers
    more opportunities for improvement, it does show improving performance.
    One key element to improving the PDHRA rate is to ensure that leaders
    have the tools they need to know which marines under their command are
    required to complete a survey. The Marine Corps has developed a
    specific field in the Medical Readiness Reporting System (MRRS) on
    PDHRA completion that is anticipated to make tracking of marines who
    are required to complete a survey easier for leaders.
        The PDHRA is not the only opportunity to discover marines with
    ongoing health concerns. The annual Periodic Health Assessment provides
    each marine with a personal interaction with a health care professional
    who can address any concerns. Marines also have open-door access to
    Deployment Health Clinics that are staffed with medical professionals,
    including mental health professionals, who can be accessed in a non-
    stigmatizing environment.

        48. Senator Graham. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, I believe that
    DOD needs to include in its quality assurance program a reliable means
    of determining whether or not servicemembers referred for care
    following a deployment, actually receive it. Do you agree?
        Dr. Rice and Admiral Hunter. Yes, we agree that a reliable means of
    determining whether or not servicemembers referred for care following
    deployment actually receive it.
        To address this, the DOD Quality Assurance Program monitors,
    audits, and reports on the health care provided to Active Duty and
    Reserve components (while on Active Duty) culminating in quarterly
    reports to the Service Surgeons General, and an annual report to
    Congress.
        General Schoomaker. I agree that it is critically important to have
    a reliable means of determining whether servicemembers referred for
    care following a deployment actually receive care. To emphasize this
    importance, Army Medical Command tracks referral completion quarterly
    for the PDHRA on the organization's Balanced Scorecard and PDHA
    referral tracking is included as part of the command's Organizational
    Inspection Program.
        The Army PDHRA Implementation Plan, dated January 23, 2006,
    mandates that soldiers be case-managed to ensure they are able to
    access needed healthcare. The Army Medical Command policy also includes
    guidance to the Regional Medical Commands mandating tracking of
    referrals for the Active component to ensure care.
        Most recently, the Army developed an automated web-based tool to
    help track referrals from all health assessments. Enterprise-wide
    policy guidance will include direction on case management and reporting
    methods to ensure accountability. Army has released this tool for all
    components concurrently with the decision to change from a
    retrospective to a prospective tracking requirement.
        The Reserve component is working to acquire funds to allow soldiers
    to receive travel orders to attend follow-up appointments at VA
    facilities as a result of the PDHRA. In addition, the Reserve Component
    Recovery Care Coordinators will help ensure these soldiers get to their
    appointments and receive the care that they need.
        Admiral Robinson. Navy Medicine concurs that a reliable means of
    determining referral completion is important and a key component to
    ensuring that our sailors and marines receive the care they need. In
    addition to expanding best practices throughout the system, two Navy
    Medicine initiatives are underway to help address this issue. They
    include: (1) the development of a Referral Management Policy to ensure
    standardized tracking of referrals; and (2) exploration of a population
    health management demonstration program that is intended to coach
    patients through the referral process in order to facilitate the
    execution of referrals.
        General Green. In accordance with DOD policy, PDHRA quality
    assurance must ensure referrals and follow-up visits for deployment-
    related medical concerns and issues are accomplished. To comply with
    this mandate, Air Force policy directs medical treatment facilities
    (MTF) to review members' medical records for pending or incomplete
    referrals when members separate, retire or transition to new
    assignments. The review also must identify any outstanding deployment-
    health requirements.
        The Air Force will soon employ additional PDHRA quality assurance
    measures, and is developing a referral tracking function for the PDHRA
    web application. This functionality, which will be deployed Air Force-
    wide in August 2010, will expand the ability to ensure referral
    appointments occur as prescribed. Additionally, high-level oversight of
    PDHRA completion rates will include surveillance of PDHRA-referral
    completion metrics.
        Admiral Jeffries. Navy Medicine concurs that a reliable means of
    determining referral completion is important and a key component to
    ensuring that our sailors and marines receive the care they need. In
    addition to expanding best practices throughout the system, two Navy
    Medicine initiatives are well underway that further support the Marine
    Corps and will help address this issue. They include: (1) the
    development of a Referral Management Policy to ensure standardized
    tracking of referrals; and (2) exploration of a population health
    management demonstration program that is intended to coach patients
    through the referral process in order to facilitate the execution of
    referrals.

                               health care fraud
        49. Senator Graham. Dr. Rice, I have read that Medicare has a fraud
    rate of as high as 10 percent--the highest rate of any Federal program.
    What is your estimate of the potential fraud in DOD medical care?
        Dr. Rice. The National Health Care Anti-Fraud Association estimates
    the most generally accepted range from 3 to 7 percent. While no precise
    estimate can be made, TRICARE reasonably estimates fraud at the lower
    end of 3 percent of the Department's private sector health care
    expenditures. This estimate is based on the numerous pre- and post-pay
    controls in place.
        We are continuously enhancing TRICARE's antifraud program and
    looking for areas of vulnerability to decrease dollar losses and
    increase returns to the program.

        50. Senator Graham. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, do you have
    sufficient resources to prevent fraud and investigate physicians,
    hospitals, or laboratories who attempt to commit fraud in DOD health
    care?
        Dr. Rice and Admiral Hunter. We have sufficient resources to
    prevent fraud and investigate physicians, hospitals, or laboratories
    who attempt to commit fraud in DOD health care at this time.
        TRICARE Management Activity (TMA) has committed a host of resources
    to prevent, curtail, indentify, and investigate fraud, waste, and
    abuse. TMA continually reviews its fraud program and pursues enhanced
    fraud fighting tools. Recent enhancements include additional dedicated
    staff to combat fraud, award of the contract for pharmacy fraud
    detection data mining, and more rigorous requirements for Managed Care
    and Pharmacy Contractors.
        General Schoomaker. The Army Medical Command has sufficient
    resources to prevent fraud and investigate it if it does occur. We have
    a large staff of contract and fiscal law attorneys at the Command
    Headquarters and have increased the number of attorneys since 2008. Two
    of the attorneys specialize in procurement fraud prevention and advice.
    We do not have criminal investigators within the command, but we do
    have the resources of the U.S. Army Criminal Investigation Command
    (CID) available to us, and we receive excellent support from their
    agents. We provide ethics training throughout the command, particularly
    for those in the acquisition community, and I have directed that a
    video on unauthorized commitments (produced by our contract law
    attorneys) be shown at all ethics training this calendar year. We have
    a robust inspection program of our regional contracting offices, and
    the inspection team takes one of our contract law attorneys with them
    to provide additional specialized training and advice. I also place a
    good deal of emphasis on our command off-duty employment rules for
    providers, to ensure that Army providers do not engage in work
    arrangements that would conflict with the interests of DOD or our
    patients. I issued a new command regulation on this subject in 2008,
    and this is a topic regularly included in ethics training, particularly
    in ethics training for providers.
        Admiral Robinson. This question requests information regarding DOD
    resources in support of the detection of health care fraud. As such, it
    is most appropriately answered by the Assistant Secretary of Defense
    (Health Affairs)/Director, TRICARE Management Activity.
        General Green. The Air Force does have adequate resources to
    prevent and investigate fraud in Air Force Medical Service (AFMS)
    healthcare. We utilize a two-pronged approach to combating fraud in the
    AFMS.
        In working with our TMA partners to provide appropriate off-base
    specialty care to our beneficiaries, the TMA identifies and
    investigates fraud on both the provider and patient level. Much of the
    provider fraud relates to billing for services that were not performed,
    or knowingly overbilling for work done. Many of the patient fraud
    incidents that are identified relate to former beneficiaries who
    continue to seek and obtain care within the AFMS after their
    eligibility for such care has expired.
        The second, equally important aspect of our anti-fraud effort, is
    our annual statement of assurance/management internal control (SOA/MIC)
    program which assesses each Medical Treatment Facility (MTF) in several
    key fraud-susceptible areas.
        The SOA/MIC program includes the following assessable units:

             Review of medical services contracts
             Review of local anti-fraud programs at MTFs
             Quality Assurance/Risk Management program review
             Custody and control of medical records
             Information security controls
             Defense Enrollment Eligibility Reporting System
            identification card checks and confiscation of expired
            identification cards.

        Admiral Jeffries. This question requests information regarding DOD
    resources in support of the detection of health care fraud. As such, it
    is most appropriately answered by the Assistant Secretary of Defense
    (Health Affairs)/Director, TRICARE Management Activity.

                      medical support for the marine corps
        51. Senator Graham. Admiral Jeffries, General James T. Conway,
    USMC, testified last year that the military may be rethinking the so-
    called ``golden hour'' policy of evacuating wounded troops off the
    battlefield within 60 minutes. Can you comment on what the situation is
    on the battlefield today?
        Admiral Jeffries. Currently, average medical evacuation times
    continue to be measurably less than 60 minutes. For operational
    planning purposes, the target to complete medical evacuations in less
    than 1 hour is unchanged.
        The issue that General Conway referenced is that commanders and
    medical personnel working in close collaboration should not be beholden
    to a medical evacuation time of less than 60 minutes if operational and
    clinical considerations support a slightly longer time. Rather than
    focusing on a set timeframe from injury to arrival at an advanced
    treatment location, superb trauma care requires delivering high quality
    on-scene/first responder treatment and triage followed by expeditious
    and appropriate level 2 interventions or immediate transport to level 3
    care. With more advanced medical capabilities moved ever closer to the
    areas of military engagements and with the wide use of Tactical Combat
    Casualty Care principles some injured servicemembers receive care in
    the first few minutes following an injury that may make the decision to
    accept a slightly longer evacuation time to a more appropriate level of
    care the best course of action in some situations.

        52. Senator Graham. Admiral Jeffries, are there sufficient
    resources--surgeons and mental health providers--to save lives in
    Afghanistan as we did in Iraq?
        Admiral Jeffries. Absolutely yes. The Marine Corps continues to
    receive excellent support from Navy Medicine. The survival rates from
    the Afghanistan Area of Operations remain at historic highs even in the
    face of an aggressive and creative enemy. Psychological Health support
    to the operational Marine Corps forces remains Navy Medicine's top
    mental health imperative.

        53. Senator Graham. Admiral Jeffries, are there sufficient medical
    resources to support Marine Corps wounded warriors?
        Admiral Jeffries. Yes, there are sufficient resources. However, it
    takes much more than medical expertise to fully address the needs of
    wounded marines. Since activation in April 2007, the Wounded Warrior
    Regiment has provided a wide range of nonmedical care for the injured
    and ill. The Marine Corps now has wounded warrior battalions at Camp
    Pendleton and Camp Lejeune and detachments at other installations.
        The Marine Corps is investing $50 million from the 2009 Overseas
    Contingency Operations supplemental for the construction of resource
    and recovery centers at Camp Pendleton and Camp Lejeune. These recovery
    centers will provide spaces for counseling, physical therapy,
    employment support, financial management, and other training and
    outreach programs in support of our wounded.
        With a 24-hour call center for wounded marines and their families,
    the Wounded Warrior Regiment has contacted 99.4 percent of all marines
    (7,654 out of 7,703) who were wounded since the beginning of Operations
    Iraqi Freedom and Enduring Freedom, in order to determine their health
    status. The Marine Corps also maintains a toll-free number to the
    medical center in Landstuhl, Germany, for families to contact their
    loved ones who have been wounded.

                                  golden hour
        54. Senator Graham. General Schoomaker, could you please elaborate
    on your testimony regarding a ``platinum 15 minutes''?
        General Schoomaker. The golden hour is a term coined in the 1970s
    for trauma patients referring to the mortality of trauma patients
    rising steeply 1 hour after injury without definitive surgical care.
    The ``platinum 15 minutes'' refers to medical care that may improve
    survival rate and extend the golden hour time frame if certain life-
    saving interventions are performed within 15 minutes of injury. Some of
    these life-extending actions include haemostatic control, definitive
    airway management, and correction of tension pneumothorax. Our combat
    casualty care training and education programs emphasize these
    capabilities for our combat medics and first responders.

        55. Senator Graham. General Schoomaker, what are you trying to
    convey about the doctrine for combat casualty care?
        General Schoomaker. Seven years into the long war against terrorism
    with tens of thousands of battle casualties and over 4,000 combat
    deaths, the Army has learned many hard lessons of combat and combat
    casualty care. We continue to learn new lessons as the enemy's tactics
    and weapons evolve and our ability to counter them and to save the
    lives of soldiers both before and after injury evolves. The power to
    actively study its own performance and that of its enemy in near real
    time is the hallmark of a learning organization in the 21st century.
    Army Medicine, in concert with our U.S. and coalition partners,
    approaches the challenges of combat casualty care with the same
    systematic processes and analytical rigor as we do all of our core
    missions: we collect the data, we analyze it for lessons learned, we
    act on the information in one or more of the appropriate domains
    (Doctrine, Organization, Training, Materiel, Leadership, Personnel, and
    Facilities); and we verify that these actions have been done and
    measure their effects. With regard to the care of battle casualties,
    these processes have resulted in significant changes in many areas,
    especially the following:
        The concepts and principles of Tactical Combat Casualty Care (TCCC)
    dramatically changed care at the point of injury, blending tactical
    considerations with the epidemiology of the battlefield. TCCC focuses
    directly on the immediate care of battle casualties in those tactical
    situations where the threat, the specific injuries most frequently
    suffered by our soldiers, and the special skills and equipment needed
    to save those soldiers' lives all come together and where immediate
    medical actions during the platinum 15-minutes make the difference
    between life and death. TCCC divides point of injury care into three
    logical phases: Care Under Fire, during which the key actions are
    suppressing the enemy's fire, rescuing casualties from danger, and
    doing only those few life-saving interventions that must be performed
    within minutes of the injury; Tactical Field Care, during which
    additional interventions directed at the main causes of preventable
    mortality in combat are performed; and Tactical Evacuation Care in
    which those life-saving interventions are maintained and additional
    measures taken while the casualty is moved to a forward medical
    facility.
        The concept of Damage Control Resuscitation (DCR) is a marked
    change from previous methods of fluid resuscitation that concentrates
    on early and aggressive use of blood and blood products to correct or
    even prevent what is referred to as ``the lethal triad:'' hypothermia
    (low body temperature), acidosis (excessive acid in the circulation),
    and coagulopathy (failure of the blood clotting system). To further
    improve our ability to provide DCR, the development of new FDA-
    compliant blood products and new treatments to address trauma at the
    cellular or even molecular level are high priorities for our medical
    research and development efforts.
        Damage Control Surgery (DCS) calls for the performance of targeted
    surgical interventions at forward surgical facilities in order to
    control internal bleeding and reduce internal contamination so that the
    casualty can then be evacuated to more robust surgical facilities for
    definitive surgical repair and further care.
        The medical resources and processes of the entire theater (all U.S.
    Services and, in many instances, those of our coalition partners) are
    integrated and coordinated within the Joint Theater Trauma System
    (JTTS) to minimize mortality and morbidity and to optimize the ability
    to provide essential care, getting the right patient to the right place
    at the right time to receive the right care. The JTTS components
    include prevention, pre-hospital integration, education, leadership and
    communication, quality improvement/performance improvement, research,
    and information systems.
        The AMEDD today captures the best knowledge and most recent
    experiences of combat medics, surgeons, nurses, and the whole AMEDD
    team in both theaters and uses that knowledge to achieve the highest
    battle casualty survival rates in history. However, although what we do
    today reflects the current best practices, we are well aware that new
    technologies, new data, and new tactical and strategic challenges will
    make some of this information obsolete. The systematic and rigorous
    study of battlefield medical care will make today's AMEDD soldiers and
    their successors learning medics in a learning organization dedicated
    to conserving the fighting strength and saving lives in combat.

        56. Senator Graham. General Schoomaker, how does it differ from the
    successful practices in Iraq, and what results will it achieve?
        General Schoomaker. The critically wounded servicemen in both Iraq
    and Afghanistan are being delivered to surgical facilities consistently
    in less than 1 hour. We have increased our resources, changed our force
    structure, and invested in improvements to take care of the wounded in
    Afghanistan. The Army implemented several initiatives to achieve this
    standard, the greatest being the increase in assets deployed to the
    theater. In March 2009 there were 15 HH-60 MEDEVAC helicopters and 3
    Forward Surgical Teams (FST) deployed. Today the Army has deployed 42
    HH-60 MEDEVAC helicopters and 8 FSTs. Additionally, the Army's
    increased assets include Role III surgical augmentation and a medical
    brigade command and control headquarters. Other initiatives include
    changing doctrine for aeromedical evacuation to 1 hour for urgent and
    urgent surgical missions and streamlining launch procedures. The Army's
    force structure changes include a May 2009 decision to aggressively
    grow nine additional MEDEVAC companies in the Reserve component (two of
    which will be deployed this year). Additionally, in October 2009, the
    Army changed the force design of each of the 37 MEDEVAC companies,
    increasing from 12 aircraft and 12 crews to 15 aircraft and 20 crews
    (13 Active component, 21 ARNG, and 3 USAR). The first of these new
    designed companies deployed in March 2010. All of these efforts have
    brought MEDEVAC response times in Afghanistan below the 1-hour
    standard.

                          disability evaluation system
        57. Senator Graham. General Schoomaker, Admiral Robinson, General
    Green, and Admiral Jeffries, the DES within DOD and VA is still too
    long, and too complicated, do you agree?
        General Schoomaker. Yes. The DES within DOD and VA is still too
    long and complicated. Current military disability law fosters a DES
    that is complex and adversarial. Soldiers still undergo dual
    adjudication by the military and VA based on the laws, legal opinions,
    and policies specific to each, resulting in differing outcomes between
    the two agencies for the same type of determination. Soldiers receive a
    rating for unfitting conditions by the military, and a rating from the
    VA for all service-connected conditions. This leads to confusion and
    mistrust.
        DOD and VA launched a joint pilot model on November 26, 2007, as a
    way to improve the DES within the constraints of current law. The DES
    Pilot features a single medical examination based on VA disability
    examination templates and a single-sourced disability rating provided
    by VA rating officers. The Departments share the examinations and
    disability ratings, resulting in more consistent decisions and faster
    approval of disability benefits and compensation. Refinements made by
    the DES Pilot are an improvement, but are insufficient.
        The only way to significantly improve the process is to change the
    law. The Army has been advocating for eliminating dual adjudication
    from the current DES, and moving to a system where the military
    determines fitness for duty and the VA determines service-connection
    and disability rating as part of the soldier's transition. Under this
    kind of system, the military compensates for loss of career due to
    disability based on years of service, and VA compensates for disability
    and loss of earnings potential.
        Admiral Robinson. The DES Pilot provides significant improvement
    over the existing DES process, which is often time-consuming and
    complicated. The DES Pilot is a servicemember-centric initiative
    designed to eliminate the duplicative, time-consuming and often
    confusing elements of the two current disability processes of DOD and
    the VA. While there are instances where the time processing goals under
    the DES Pilot are not met, extended process delays typically result
    from the need to obtain additional medical information to ensure proper
    adjudication of the case. The majority of cases under the DES Pilot are
    completed within predicted time standards, and members receive
    considerable aid, counsel, and support along the way. Cumulative DES
    Pilot survey results for the period November 2007 through March 2010
    indicate sailors and marines are significantly more satisfied with the
    DES Pilot than with non-Pilot Medical Evaluation Board (MEB) and
    Physical Evaluation Board (PEB) processes.
        Historically, the DES has been considered complicated and difficult
    to understand. The DES Pilot is specifically designed to streamline and
    simplify the existing complex process and to enhance transparency for
    servicemembers. Under the Pilot, the VA performs one medical exam that
    meets the needs of the DOD in determining fitness for continued
    military service and also provides the basis for the VA to rate the
    servicemember's disabilities if he/she has been determined to be unfit
    by their Service PEB. The servicemember is not directly involved in
    certain complexities driven by law, regulation, or administrative
    circumstances. Aside from counseling and support interactions, the DES
    Pilot typically only involves direct servicemember interaction at the
    following milestones:

        1.  VA Claim Development
        2.  Compensation and Pension (C&P) physical examinations
        3.  Review of Medical Evaluation Board Package
        4.  Election of Options following the Informal PEB determination
        5.  Formal PEB (if applicable)
        6.  Notification of Formal PEB determination (if applicable)
        7.  Appeal process (if applicable)

        These steps ensure transparency and guarantee protection of due
    process rights. By enabling servicemembers to receive Title 10 and
    Title 38 disability benefits on the first day authorized by law
    following separation or retirement, the DES Pilot offers a much
    improved process for members who are evaluated for continued service,
    separation, or medical retirement.
        General Green. The DES Pilot has been successful in enabling our
    veterans to only have to undergo one physical exam process and receive
    one disability rating, greatly reducing the time involved, resources
    expended, and confusion incurred from the legacy system. Additionally,
    the DES Pilot has reduced the financial loss for the separated and
    retired veterans who previously would have had to wait the duration of
    the VA process before receiving compensation.
        According to information provided by the Wounded Warrior Care and
    Transition Policy office in their latest analysis of case processing
    time in the DES Pilot:

              ``The DES Pilot is ``faster, more efficient, effective, and
            transparent. Active component servicemembers who completed the
            DES Pilot averaged 277 days from Pilot entry to VA benefits
            decision, excluding pre-separation leave. Including pre-
            separation leave, Active component servicemembers completed the
            DES Pilot in an average of 293 days. This is 1 percent faster
            than the goal established for Active component servicemembers
            and is 46 percent faster than the current DES and VA claim
            process. Reserve component/National Guard servicemembers who
            completed the DES Pilot averaged 289 days from Pilot entry to
            issuance of the VA Benefits Letter, which is 5 percent faster
            than the projected 305 day timeline (DES Pilot Weekly Report
            with Outlier Analysis Appendix, March 22, 2010-March 28,
            2010).''

        Admiral Jeffries. The DES Pilot process is proving to be a
    significant improvement in the way our wounded, ill, and injured
    sailors and marines navigate the DES and attain their disability
    benefits. While there are incidents of process delays, these are
    typically due to obtaining information vital to the proper adjudication
    of that case. Most servicemembers move through the DES Pilot within
    predicted time standards and receive considerable aid, counsel and
    support along the way. The DES Pilot is helping to make a process
    frequently perceived as complex easier to understand and more
    transparent from the perspective of the servicemember. Servicemembers
    receive both their title 10 and title 38 disability benefits on the
    first day authorized by law following separation or retirement. Based
    upon the cumulative DES Pilot Survey Results for the period November
    2007 through 31 March 2010, sailors and marines are significantly more
    satisfied with DES Pilot than with non-Pilot MEB and PEB processing.
        The DES still can appear overly complex to people who interface
    with it infrequently, but most of these complexities do not directly
    involve the servicemember or require them to act. The DES Pilot has
    several critical steps that enhance transparency and ensure due process
    rights are upheld. Servicemembers are provided significant counseling
    and support during these critical steps that include:

        1.  VA Claim Development
        2.  Compensation and Pension (C&P) physical examinations
        3.  Review of their Medical Evaluation Board Package
        4.  Election of Options following the Informal PEB determination
        5.  Formal PEB (if applicable)
        6.  Notification of Formal PEB determination (if applicable)
        7.  Appeal process (if applicable)

        In addition, the Wounded Warrior Regiment and Battalions augments
    the services provided by MTF by offering additional counseling and
    guidance during the entire PEB process.

        58. Senator Graham. General Schoomaker, Admiral Robinson, General
    Green, and Admiral Jeffries, to what extent do the medical evaluations
    prolong this process, and how can that part of the process be improved?
        General Schoomaker. Medical evaluations are an inherent component
    of the Disability Evaluation Process. It is imperative that soldiers
    are provided access to the full spectrum of medical care to determine
    the complete range of their medical conditions. The Army has already
    targeted three elements of the medical evaluations process for
    continued improvements: (1) Closer coordination with the VA for
    specialty care evaluations; (2) Monitoring of process data collected
    via the Veterans Tracking Application to maximize efficiencies; and (3)
    Targeting access to Behavior Health assets to expedite the Medical
    Board Process.
        DOD and VA launched a joint pilot test of an improved DES on
    November 26, 2007, for disability cases originating at the three major
    MTFs in the National Capital Region. Today the DES Pilot model operates
    at 15 Army installations. The DES Pilot features a single medical
    examination based on VA disability examination templates and a single-
    sourced disability rating provided by VA rating officers. Survey
    results indicate our soldiers are more satisfied with the DES Pilot
    process, and receipt of VA ratings allows them to make better informed
    decisions reducing the number of appeals of PEB findings.
        Admiral Robinson. The DES Pilot takes longer from start to finish;
    however, the process actually decreases the amount of time between the
    initial referral for disability evaluation and the servicemember's
    receipt of VA benefits determination by 28 percent. On average, the
    length of time from case initiation to receipt of benefits is 295 days
    vice over 500 days if the servicemember could not submit a claim to the
    VA until after disability separation or disability retirement from the
    military, as in the legacy process. The claim development and medical
    examination phases in the DES Pilot account for 55 days--10 days for
    claim development with the VA, and 45 days for the VA to complete the
    examination. This accounts for less than 20 percent of the amount of
    time for an average DES Pilot case.
        Improved tracking of servicemembers' examination appointments
    reduced delays in the examination phase. Also, two Navy locations with
    larger volumes of DES cases--Naval Medical Center Portsmouth and Naval
    Hospital Camp Lejeune--actually brought VA examiners into the facility
    to improve access to the exams. Increased efficiencies in processing
    DES cases are being explored through various working groups and other
    activities coordinated by OSD's Wounded Warrior Care and Transition
    Policy office along with the Military Services and the VA. Proposed
    recommendations and options include using the VA Healthcare Network and
    their contracted exam services to perform exams at locations as close
    to the servicemembers as possible, and certifying military providers to
    perform exams.
        Feedback to date from servicemembers and Wounded Warrior programs
    indicate overall satisfaction with the process, largely due to the fact
    that VA benefits are delivered at the time of completion of the
    process.
        General Green. The medical evaluation process is being conducted in
    a timely manner. The VA is faced with the challenge of serving an ever
    increasing number of veterans along with the influx of new requirements
    under the DES Pilot program. We agree that when it comes to
    streamlining medical evaluations, working with the VA in the following
    areas of the process would be very beneficial: place more reliance on
    the contents of the servicemember's service treatment record; update
    the worksheets VA examiners use; establish improved automation for VA
    examiners; and establish more targeted exams, to fit the current
    population of servicemembers/veterans. Improving on these medical
    evaluation processes would be extremely helpful in making the overall
    process more efficient for the servicemember.
        Admiral Jeffries. The DES Pilot takes longer from start to finish;
    however, the process actually decreases the amount of time between the
    initial referral for disability evaluation and the servicemember's
    receipt of VA benefits determination by 28 percent. On average, the
    length of time from case initiation to receipt of benefits is 295 days
    vice over 500 days if the servicemember could not submit a claim to the
    VA until after disability separation or disability retirement from the
    military, as in the legacy process. The claim development and medical
    examination phases in the DES Pilot account for 55 days--10 days for
    claim development with the VA, and 45 days for the VA to complete the
    examination. This accounts for less than 20 percent of the amount of
    time for an average DES Pilot case.
        Improved tracking of servicemembers' examination appointments
    reduced delays in the examination phase. Also, two Navy locations with
    larger volumes of DES cases--Naval Medical Center Portsmouth and Naval
    Hospital Camp Lejeune--actually brought VA examiners into the facility
    to improve access to the exams. Increased efficiencies in processing
    DES cases are being explored through various working groups and other
    activities coordinated by OSD's Wounded Warrior Care and Transition
    Policy office along with the Military Services and the VA. Proposed
    recommendations and options include using the VA Healthcare Network and
    their contracted exam services to perform exams at locations as close
    to the servicemembers as possible, and certifying military providers to
    perform exams.
        Feedback to date from servicemembers and Wounded Warrior programs
    indicate overall satisfaction with the process, largely due to the fact
    that VA benefits are delivered at the time of completion of the
    process.

                             traumatic brain injury
        59. Senator Graham. General Schoomaker, Admiral Robinson, General
    Green, and Admiral Jeffries, we understand that DOD is working on new,
    stronger guidelines for dealing with TBI in the field; what are they?
        General Schoomaker. A Directive Type Memorandum titled, ``Policy
    Guidance for a Management of Concussion/Mild Traumatic Brain Injury in
    the Deployed Setting'' is currently under review within DOD. This
    guideline will work in accordance with the authority in DOD Directive
    5124.02, to establish policy, assign responsibilities, and provide
    procedures on the medical management of mild TBI, also known as a
    concussion, in the deployed setting. It is intended to standardize the
    terminology, procedures, leadership actions, and medical management to
    provide maximum protection for servicemembers.
        While awaiting DOD publication of the Directive Type Memorandum,
    the Army has begun executing a Campaign Plan for Warrior mild TBI. The
    Campaign Plan codifies incident driven protocols for concussion
    management. The mandatory events are: (1) any servicemember in a
    vehicle associated with a blast event, collision, or rollover; (2) any
    servicemember within 50 meters of a blast (inside or outside); (3) a
    direct blow to the head or witnessed loss of consciousness; and (4)
    command-directed. Leaders are required to assess all servicemembers
    involved in a mandatory event, including those without apparent
    injuries, as soon as possible using the Injury/Evaluation/Distance from
    Blast (I.E.D.) checklist. Exposure to a mandatory event or a `Yes'
    response during screening leads to a mandated referral for medical
    evaluation. The evaluation component of the I.E.D. leader checklist
    uses the mnemonic ``HEADS'': Headaches, Ears ringing, Altered
    consciousness/loss of consciousness, Double vision/dizziness, or
    Something not right. After the I.E.D. assessment is complete, the
    results shall be recorded for each individual involved in the event and
    submitted as part of the significant activities report required for
    blast-related events or the events outlined above.
        The Army has developed training programs for soldiers, leaders, and
    medical personnel. Training soldiers and leaders involves making them
    competent in recognizing signs and symptoms of mild TBI and the
    requirements of the Directive Type Memorandum; this is being
    accomplished using leadership briefings and educational videos.
    Training medical staff on the clinical assessment tools and algorithms
    is being accomplished by infusing the content into existing training
    programs and providing in-person and computer-based training.
        Admiral Robinson. The Defense Centers of Excellence for
    Psychological Health and Traumatic Brain Injury has been the lead for
    newer DOD In-Theater TBI evaluation guidelines. These new guidelines
    mandate clinical evaluations for servicemembers exposed to explosive
    blasts or who may have sustained a concussion and a minimum of 24 hours
    of rest prior to return to combat. In theater TBI treatment continues
    to be done using guidelines developed by the Defense and Veterans Brain
    Injury Center.
        A Directive Type Memorandum (DTM) 09-033, ``Policy Guidance for a
    Management of Concussion/Mild Traumatic Brian Injury in the Deployed
    Setting'' is currently under review. It standardizes the terminology,
    procedures, leadership actions, and medical management to provide
    maximum protection of servicemembers with regards to TBI. There are
    four revised medical Concussion Clinical Guideline Algorithms for
    providers to follow:

        1.  Combat Medic/Corpsman Concussion (mTBI) Triage (Pre-hospital,
    no medical officer in the immediate area);
        2.  Initial Provider Management of Concussion in the Deployed
    Setting;
        3.  Comprehensive Concussion Algorithm Referral from Level I or II
    or Polytrauma;
        4.  Recurrent Concussion (3 documented in 12-month span) Evaluation
    Algorithm.

        In addition, there is a list of mandatory events which necessitate
    command evaluations and reporting of exposure of all personnel
    involved. These events include, but are not limited to:

            a.  Any damage to a vehicle (e.g., blast, accident, rollover).
            b.  Exposure of dismounted personnel to a blast:

                    (1) All within 50 meters of the blast.
                    (2) All within a structure hit by an explosive device.

            c.  A direct blow to the head or witnessed loss of
            consciousness.
            d.  Command-directed, especially in a case with exposure to
            multiple blast events.

        Commanders or their representatives are required to assess all
    servicemembers involved in a mandatory event, including those without
    apparent injuries, as soon as possible using a checklist. Any `Yes'
    response in screening mandates a referral for medical evaluation. After
    the assessment is complete, the results shall be recorded for each
    individual involved in the event and submitted as part of the
    significant activities (SIGACT) report.
        General Green. Yes. Guidelines to assure commanders and medical
    providers take a uniform approach to mild Traumatic Brain Injury (mTBI)
    in deployed settings are being finalized.
        The Directive-Type Memorandum (DTM) 09-033, ``Policy Guidance for
    Management of Concussion/Mild Traumatic Brain Injury in the Deployed
    Setting'' is in the last stages of approval. A draft Fragmentary Order
    (FRAGO) ``Concussion/mTBI,'' is a supplement to the DTM and outlines
    specific tracking, training, and treatment for eligible personnel.
    Implementation of this FRAGO is underway and will follow the approval
    of the DTM.
        Tracking involves implementation of a dedicated database (CIDNE
    BECIR [Combined Information Data Network Exchange/Blast Exposure and
    Concussion Incident Report]). The events to be tracked include: (1) all
    mounted personnel in a damaged vehicle and/or personnel within 50
    meters of a vehicle damaged by a blast; (2) all dismounted personnel
    within 50 meters of a blast; (3) all personnel who suffer a direct blow
    to the head or loss of consciousness; and (4) those situations where a
    leader suspects an individual is suffering mTBI.
        Training requirements will include training both leaders and
    providers. Training leaders involves making leaders competent in
    recognizing signs and symptoms of mTBI. Providers (including corpsmen,
    medical technicians, and privileged medical providers) will learn to
    administer the MACE (military acute concussion evaluation) as well as
    proper management of the JTTS-CPG (joint theater trauma system clinical
    practice guidelines).
        Guidelines involve a medical evaluation for all personnel involved
    in a ``mandatory event.'' Mandatory events follow the mnemonic ``IED:''
    (1) Injury - yes/no; (2) Evaluation - using a mnemonic for the
    ``HEADS'' symptoms--Headaches, Ears ringing, Altered consciousness/loss
    of consciousness, Double vision/dizziness, or Something not being
    right; and (3) Distance - a blast within 50 meters of the individual.
        Admiral Jeffries. Service leadership, especially the Assistant
    Commandant of the Marine Corps and the Vice Chief of Staff of the Army,
    asked for enhanced guidelines for line commanders as well as medical
    personnel in the early diagnosis and treatment of TBIs that occur in
    the field environment. The Defense Centers of Excellence for
    Psychological Health and Traumatic Brain Injury was given the lead for
    developing these guidelines. These new guidelines mandate clinical
    evaluations for servicemembers exposed to explosive blasts or who may
    have sustained a concussion and a minimum of 24 hours of rest prior to
    return to combat. In theater TBI treatment continues to be done using
    guidelines developed by the Defense and Veterans Brain Injury Center.
        A draft policy in the form of a Directive Type Memorandum (DTM)
    ``Policy Guidance for a Management of Concussion/Mild Traumatic Brian
    Injury in the Deployed Setting'' is in final coordination. It
    standardizes the terminology, procedures, leadership actions, and
    medical management to provide maximum protection of servicemembers with
    regards to TBI. There are four revised medical Concussion Clinical
    Guideline Algorithms for providers to follow: 1. Combat Medic/Corpsman
    Concussion (mTBI) Triage (Pre-hospital, no medical officer in the
    immediate area); 2. Initial Provider Management of Concussion in the
    Deployed Setting; 3. Comprehensive Concussion Algorithm Referral from
    Level I or II or Polytrauma; 4. Recurrent Concussion (3 documented in
    12-month span) Evaluation Algorithm. In addition, there is a list of
    mandatory events which necessitate command evaluations and reporting of
    exposure of all personnel involved. These events include, but are not
    limited to:

        a.  Any damage to a vehicle (e.g., blast, accident, rollover).
        b.  Exposure of dismounted personnel to a blast:

                    (1) All within 50 meters of the blast.
                    (2) All within a structure hit by an explosive device.

        c.  A direct blow to the head or witnessed loss of consciousness.
        d.  Command-directed, especially in a case with exposure to
    multiple blast events. Commanders or their representatives are required
    to assess all servicemembers involved in a mandatory event, including
    those without apparent injuries, as soon as possible using a checklist.
    Any `Yes' response in screening mandates a referral for medical
    evaluation. After the assessment is complete, the results shall be
    recorded for each individual involved in the event and submitted as
    part of the significant activities report.

        60. Senator Graham. General Schoomaker, Admiral Robinson, General
    Green, and Admiral Jeffries, are there sufficient treatment and
    rehabilitation resources available when our servicemembers return home?
        General Schoomaker. Yes, there are sufficient treatment and
    rehabilitation resources available for returning soldiers. We have
    implemented TBI screening for all medically evacuated patients and all
    soldiers during post-deployment; positive screening leads to a
    confirmation evaluation by a provider and documentation in the
    electronic medical record. The Army TBI program has been conducting a
    multi-step validation of treatment facilities since 2008. Every Army
    medical treatment facility (MTF) is undergoing validation; 12 have
    achieved full validation and an additional 20 have achieved initial
    validation. The goal is full validation of all facilities by September
    30, 2010.
        Since 2008 the Army Medical Command has funded over 400 positions
    to treat and support patients with TBI and their families. These
    positions include a TBI Program Manager at each MTF and surge
    capability to ensure that TBI care is available at sites with limited
    organic TBI assets. We are emphasizing primary care and case management
    and using a family-centered approach. Specialty services are available,
    as needed. We have initiated 37 facility projects and purchased over
    $11 million of equipment to support the Army TBI programs.
        The Army partners with Defense Centers of Excellence for
    Psychological Health and Traumatic Brain Injury (DCoE) and Defense and
    Veterans Brain Injury Center (DVBIC) for care coordination, education,
    and clinical research for TBI. We have implemented tele-health
    initiatives for several aspects of TBI care. Multiple research projects
    are underway to further our knowledge and ability to care for TBI. In
    addition, current educational initiatives are geared toward a broad
    spectrum of audiences: soldiers, family members, commanders, leaders,
    providers, and medical staff.
        Admiral Robinson. Since 2008, Navy Medicine has funded positions
    dedicated to treat and support TBI patients. These personnel are funded
    through Wounded, Ill, and Injured and TBI programs. For fiscal year
    2008, 28 contract positions were hired. In fiscal year 2009, there were
    an additional 52 contract positions hired for a total of 80. For fiscal
    year 2010, we expect an increase of 2 additional contract positions. In
    January 2010, Navy Medicine convened a conference of medical providers
    to discuss standardization of TBI care across the Navy Medicine
    enterprise, based upon the primary care model. Not every servicemember
    who sustains a concussion will need to be seen by medical specialists,
    and initially all care is typically done by the primary care provider
    who then generates specialist referrals as appropriate and needed. Navy
    Medicine is committed to improving access to care and has dedicated
    resources to facilities anticipated to have increased numbers of TBI
    patients. Facility staffing can be flexibly augmented by temporary duty
    assignment of staff to support redeployment surges. Finally,
    telemedicine can be utilized to remind patients of appointments and to
    facilitate medical appointments with a provider available at a remote
    location interviewing patients by video teleconference.
        General Green. Yes, there are many treatment and rehabilitation
    resources available when our servicemembers return home. The Air Force
    has case managers to take care of wounded, ill, and injured (WII) at
    each MTF. A WII patient is assigned a case manager and a primary care
    manager who coordinate care and interact/support the servicemember and
    family. In addition to the case manager and primary care manager, there
    are numerous specialists ready to take care of our servicemembers.
        Other services available to our servicemembers include a Wounded
    and Survivor Care Division run by A1 (Manpower and Personnel). This
    program has four components: (a) Air Force Survivor Assistance Program;
    (b) Family Liaison Officer; (c) Air Force Wounded Warrior Program; and
    (d) Recovery Care Coordination Program.
        An example of the type of care available to our servicemembers is
    Wilford Hall Medical Center, which partners with Brooke Army Medical
    Center to ensure comprehensive integrative MTF (TBI) care to medically-
    evacuated Wounded Warriors. The joint Air Force/Army TBI Clinic at
    Elmendorf AFB treats TBI/PTSD in redeployed members so that returning
    Operation Iraqi Freedom/Operation Enduring Freedom servicemembers may
    remain with their loved ones while receiving care.
        Admiral Jeffries. Since 2008, Navy Medicine has funded positions
    dedicated to treat and support TBI patients. These personnel are funded
    through Wounded, Ill, and Injured and TBI programs. For fiscal year
    2008, 28 contract positions were hired. In fiscal year 2009, there were
    an additional 52 contract positions hired for a total of 80. For fiscal
    year 2010, we expect an increase of two additional contract positions.
    In January 2010, Navy Medicine convened a conference of medical
    providers to discuss standardization of TBI care across the Navy
    Medicine enterprise, based upon the primary care model. Not every
    servicemember who sustains a concussion will need to be seen by medical
    specialists, and initially all care is typically done by the primary
    care provider who then generates specialist referrals as appropriate
    and needed. Navy Medicine is committed to improving access to care and
    has dedicated resources to facilities anticipated to have increased
    numbers of TBI patients. Facility staffing can be flexibly augmented by
    temporary duty assignment of staff to support redeployment surges.
    Telemedicine can be utilized to remind patients of appointments and to
    facilitate medical appointments with a provider available at a remote
    location interviewing patients by video teleconference. Importantly,
    non-medical support and case management are provided to marines through
    the Wounded Warrior Regiment and Battalions which are critical to
    ensuring that marines successfully engage with available resources.

        61. Senator Graham. General Schoomaker, Admiral Robinson, General
    Green, and Admiral Jeffries, what have we learned about TBI in the last
    5 years that has lead to better prevention, treatment, and
    rehabilitation?
        General Schoomaker. Our knowledge of TBI continues to evolve. We
    have learned many things about TBI in the last 5 years, but most
    importantly we know early detection of injury is essential. Receiving
    prompt care, regardless of injury severity, is a key to returning to
    the highest functional level possible. Advancements in battlefield
    medicine have improved initial management, speed of evacuation, far
    forward medical and surgical assets, and survival rates of injured
    warriors.
        Identification of mild TBI, also known as concussion, is difficult
    because the injury is less obvious. Identifying soldiers who have
    sustained an injury and experienced an alteration of mental state could
    lead to diagnosis of mild TBI. The Military Acute Concussion Evaluation
    (MACE) tool has been used for initial evaluation since 2006. The MACE
    contains a rapid screening tool for cognitive dysfunction, a brief
    neurological screening, and a review of history and symptoms. It can be
    given by all medical personnel and was validated by the Institute of
    Medicine's ``Report on the Long-term Consequences of TBI'' in 2008. In
    addition, we have established and implemented protocols (the ``Mild TBI
    Clinical Practice Guideline in the Deployed Setting'' and ``Mild TBI
    Clinical Guidance'') to help ensure our soldiers are diagnosed quickly
    and accurately. These guidelines standardize the systems approach to
    treatment by incorporating state-of-the-art science, technology, and
    knowledge-based outcomes.
        Recognition of the importance of early detection led to the
    development of a DOD Directive Type Memorandum to codify incident-
    driven protocols for concussion management and publish revised clinical
    practice guidelines for the deployed setting. This accompanies our
    efforts to change the culture in fighter management after concussive
    events. Prevention and mitigation of concussion are everyone's concern
    beginning with command and leadership.
        Significant strides are being made to improve the Personal
    Protective Equipment (PPE) worn by our servicemembers. Currently under
    development are the state-of-the-art Enhanced Combat Helmet (ECH) and a
    future head borne system (HBS) designed to reduce the overall effects
    of battle field kinetics, IED blasts, and to mitigate blunt impact.
        Additionally, the Post Deployment Health Assessment and
    Reassessment contain TBI screening questions for all soldiers.
    Providers and staff at Landstuhl Regional Medical Center conduct a TBI
    screen for all medically evacuated soldiers. The VA also instituted a
    TBI Clinical Reminder. Our screening instruments are all based on the
    Brief TBI Screen (BTBIS), a tool validated by the Defense Health Board
    and the Institute of Medicine.
        Research shows that repeated concussions may lead to increased
    long-term effects on the brain and patient function. Transcranial
    doppler studies demonstrate that cerebral vasospasm is more common in
    blast injured patients than other trauma patients, and is therefore
    something that should be assessed. The Army has led a multi-service/
    agency effort to develop and implement medical staff training in order
    to improve care and management of patients with TBI. The coordination
    of the TBI continuum of care has increased significantly through the
    collaboration of the Services, the Defense and Veterans Brain Injury
    Center, the VA Polytrauma System, and community resources. This
    coordination is vital to ensure that the highest level of care is
    provided to our injured servicemembers throughout the care continuum.
        Admiral Robinson. Basic science and clinical advances in the last 5
    years have led to improvements in the prevention, treatment, and
    rehabilitation of TBI. Lessons learned include:

        1.  A clear definition of TBI did not exist. Collaboratively, the
    military has developed a single, academically-rigorous, operationally-
    sound definition for the case ascertainment of TBI (especially mild
    TBI) to facilitate accurate screening, evaluation, diagnosis,
    treatment, coding, and education.
        2.  Education of patients, caregivers, providers, and leadership
    was needed to ensure proper identification and treatment. Formalized
    TBI education is now provided to deploying providers and providers at
    MTFs with standardized education materials available for servicemembers
    and their families.
        3.  Identification of TBI, especially mild TBI, requires
    standardized screening. As a result, implementation of TBI screening
    and documentation policy for theater, Landstuhl Regional Medical Center
    (initial evacuation site), CONUS/OCONUS home bases, and the VA has been
    instituted. TBI screening questions have been added to the Deployment
    Health Assessments and Navy Medicine has developed tools and
    implemented post-deployment TBI screening. This process facilitates a
    formalized methodology for TBI surveillance. Additionally,
    servicemembers are required to have predeployment neurocognitive
    testing using Automated Neuropsychological Assessment Metrics (ANAM)
    and ANAM computers have been deployed to Operation Iraqi Freedom (OIF)/
    Operation Enduring Freedom (OEF) for use after a servicemember sustains
    a mTBI (concussion).
        4.  Best practices for evaluation and treatment have been
    developed. In conjunction with the other Services, we have identified
    and adopted best practices across the continuum of care for patients
    with all degrees of TBI, including acute in-theater management of mild
    TBI and establishment of multidisciplinary TBI clinics in high volume
    locations.
        5.  Ongoing support for continued research is needed to continue to
    learn and evolve the care provided for wounded warriors with TBI.

        General Green. We have learned many things about TBI in the last 5
    years but most importantly that TBI can be treated, and early detection
    of injury is the cornerstone of treatment. Diagnosis and treatment of
    moderate, severe, and penetrating TBI is typically not delayed due to
    the obvious and visible nature of the injury. Identification of mild
    TBI is more difficult because it is less obvious. The keys to detection
    of mild TBI is identifying servicemembers who may have sustained an
    injury, and performing initial evaluation with a clinician confirmation
    when needed. The systematic tool for this process is the MACE tool. The
    MACE is a rapid screening tool for cognitive dysfunction, brief
    neurological examination, and a symptoms checklist. It can be given by
    all medical personnel and was validated by the Institute of Medicine
    Report on the long-term consequences of TBI in 2008. In addition,
    established protocols, the ``Mild TBI Clinical Practice Guideline (CPG)
    in the Deployed Setting'' and ``Mild TBI Clinical Guidance'' are in
    place, which help ensure our servicemembers are diagnosed quickly and
    accurately. This guidance standardizes the systems approach to
    treatment by incorporating state-of-the-art science, technology and
    knowledge-based outcomes.
        All the Services have worked to enhance provider training that will
    greatly improve TBI patient management throughout DOD. The coordination
    of the TBI continuum of care between the DOD and the VA has increased
    significantly through the collaboration of the Defense and VA Brain
    Injury Center (DVBIC) TBI Care Coordination Network and the VA
    Polytrauma Federal Care Coordination System.
        Significant strides are being made to improve the PPE worn by our
    servicemembers. Currently under development are the state-of-the-art
    ECH and a future HBS designed to reduce the overall effects of battle
    field kinetics, and improvised explosive device blasts, and to mitigate
    blunt impact.
        Once we learned early detection was a key to TBI recovery, the DOD
    embarked on initiating a cultural change. The responsibility for force
    preservation lies with the leaders and servicemembers themselves.
    Operational events, such as exposure to a blast within a certain
    distance or the presence of vehicular damage, now mandate a medical
    evaluation.
        Although the MACE and CPG are great clinical tools for identifying
    acute injuries, identifying servicemembers post-deployment and more
    than a week after injury require a different methodology. The DOD began
    screening initiatives in 2008 with the intent of finding servicemembers
    who may have sustained a TBI while deployed and perhaps have symptoms
    that require further assessment and treatment. This TBI screening
    occurs at several points. All servicemembers evacuated from theater for
    battle or non-battle injuries are screened on arrival at Landstuhl
    Regional Medical Center. Three other screening tools are used at
    various other times such as the Post-Deployment Health Assessment
    (PDHA), PDHRA and VA TBI Clinical Reminder. All the questions used in
    the screening tools are an adaptation of an instrument called the Brief
    TBI Screen. This tool was validated by the Defense Health Board in
    2008.
        The Air Force has been involved in multiple joint training efforts
    to ensure its medics have the most up to date information to diagnose
    and treat our injured servicemembers. The Air Force also added TBI
    training to the Expeditionary Medical Support training which is
    attended by all Air Force medics before deployment.
        In addition, a nationwide care coordination network has been
    established by DVBIC for those diagnosed with TBI. A care coordinator
    contacts the servicemember diagnosed with TBI once they reach
    continental United States and again at 3, 6, 12, and 24 months
    following an injury. During these contacts, assessments are made to
    determine what resources may be needed in addition to follow up
    questions about substance use, relationships, readjustment after
    deployment and other areas shown to be important to follow up in a
    patient that has sustained a TBI.
        The Air Force is the lead agency in formulating responses to
    complex medical problems involved in air transport of acute care TBI
    patients. At the forefront of that effort is the Air Force Critical
    Care Air Transport Teams. This initiative has saved countless lives.
    The Air Force continuously improves this capability, reviewing
    information from databases such as the JTTS and incorporating lessons
    learned.
        What we have learned in the past 5 years about TBI has been key to
    providing the best care to our servicemembers. The future holds even
    more promise as research continues to provide better ways to protect,
    evaluate, and treat servicemembers with TBI.
        Admiral Jeffries. Basic science and clinical advances in the last 5
    years have led to improvements in the prevention, treatment, and
    rehabilitation of TBI. Lessons learned include:

        1.  A clear definition of TBI did not exist. Collaboratively, the
    military has developed a single, academically-rigorous, operationally-
    sound definition for the case ascertainment of TBI (especially mild
    TBI) to facilitate accurate screening, evaluation, diagnosis,
    treatment, coding, and education.
        2.  Education of patients, caregivers, providers, and leadership
    was needed to ensure proper identification and treatment. Formalized
    TBI education is now provided to deploying providers and providers at
    MTFs with standardized education materials available for servicemembers
    and their families.
        3.  Identification of TBI, especially mild TBI, requires
    standardized screening. As a result, implementation of TBI screening
    and documentation policy for theater, Landstuhl Regional Medical Center
    (initial evacuation site), CONUS/OCONUS home bases, and the VA has been
    instituted. TBI screening questions have been added to the Deployment
    Health Assessments and Navy Medicine has developed tools and
    implemented post-deployment TBI screening. This process facilitates a
    formalized methodology for TBI surveillance. Additionally,
    servicemembers are required to have pre-deployment neurocognitive
    testing using ANAM and ANAM computers have been deployed to OIF/OEF for
    use after a servicemember sustains a mild TBI (concussion).
        4.  Best practices for evaluation and treatment have been
    developed. In conjunction with the other Services, we have identified
    and adopted best practices across the continuum of care for patients
    with all degrees of TBI, including acute in-theater management of mild
    TBI and establishment of multidisciplinary TBI clinics in high volume
    locations.
        5.  Ongoing support for continued research is needed to continue to
    learn and evolve the care provided for wounded warriors with TBI.

                 tobacco and health care costs in the military
        62. Senator Graham. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, last summer the
    National Institute of Medicine published a report on tobacco use in the
    military that concluded: there has been an upturn in consumption in the
    last decade; that tobacco adversely affects military performance and
    results in high costs; and that tobacco cessation programs have
    received insufficient attention in the military. Does DOD still provide
    tobacco products at a discount to servicemembers?
        Dr. Rice and Admiral Hunter. Yes, under current policy, tobacco
    products are sold at a relative discount to servicemembers at
    exchanges.
        General Schoomaker. Yes, DOD Instruction 1330.9, dated 7 Dec 2005,
    provides guidance to the Army and Air Force Exchange Services (AAFES)
    and the Defense Commissary Agency (DeCA) regarding tobacco product
    sales, pricing, and restrictions. This Armed Services exchange policy
    states that military resale outlets will not charge more than the most
    competitive commercial retailer, and may charge up to 5 percent less.
    This means that, in effect, DOD is selling tobacco products at slightly
    lower cost than competing retailers. For example, if the most
    competitive commercial retailer sold a pack of cigarettes for $5.00,
    AAFES could sell the same pack for $4.75. DeCA sells tobacco products
    at the cost from AAFES for no profit. Additionally, AAFES and DeCA do
    not charge State or local sales taxes (approximately 6 percent
    savings).
        Admiral Robinson. Current DOD policy is that tobacco products sold
    in military resale outlets shall be no higher than the most competitive
    price in the local community and no lower than 5 percent below the most
    competitive commercial price in the local community.
        General Green. Yes, Air Force commissaries and base exchanges
    continue to sell tobacco products at discounted prices. The military
    medical community is very interested in examining this issue with our
    commissaries and exchanges in light of the Institute of Medicine's
    findings that increased tobacco prices is one of the most effective
    interventions for reducing tobacco consumption. The Air Force Medical
    Service participates in a working group to address this issue with the
    Defense Commissary Agency and the Army and Air Force Exchange Service.
        Admiral Jeffries. Current DOD policy is that tobacco products sold
    in military resale outlets shall be no higher than the most competitive
    price in the local community and no lower than 5 percent below the most
    competitive commercial price in the local community.

        63. Senator Graham. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, do you agree
    that prevention could reduce overall health care costs? If so, what
    more should be done?
        Dr. Rice and Admiral Hunter. We agree that prevention is a route to
    better health and longer life, and is generally cost saving with
    respect to the disease being targeted for prevention.
        TRICARE generally covers preventive services recommended by the
    U.S. Preventive Services Task Force.
        General Schoomaker. Yes, I agree that tobacco cessation can reduce
    overall healthcare costs. According to the American Journal of Health
    Promotion, DOD spends an estimated $564 million per year on medical
    care costs associated with tobacco use for TRICARE Prime Members alone.
    Tobacco usage is notorious for increasing the lifetime risk of
    acquiring serious chronic diseases and costs the DOD billions of
    dollars in medical care, diminished productivity, early attrition, and
    other adverse events. Since most tobacco-related diseases take years to
    develop, military personnel who use tobacco may eventually enter into
    the VA health system and consequently increase overall healthcare
    costs. In the short term, tobacco use impairs military readiness by
    reducing physical fitness and healing times for injuries, surgeries,
    lowering visual acuity, and contributing to hearing loss.
        The Army must address the perception that tobacco use is an
    accepted practice. Equally important is the development of a strategic
    workgroup to address tobacco issues in the Army. Senior leadership
    support and role-modeling by commanders can influence a positive
    tobacco-free culture change. Other strategies to consider:

        (1)  Tobacco use prohibition at basic/AIT, military schooling, and
    military conferences;
        (2)  Use of wellness centers to help combat tobacco;
        (3)  Tobacco cessation throughout all medical and installation
    healthcare systems;
        (4)  Tobacco-free Army military medical treatment facilities, child
    development centers and schools;
        (5)  Incentivizing tobacco-free lifestyle, i.e. promotion points to
    tobacco-free soldiers;
        (6)  Raising awareness of tobacco cessation resources such as
    ``UCANQUIT 2'';
        (7)  Continue with development of 24-hour quit lines; and
        (8)  Standardize best practices for tobacco cessation programs and
    pharmacotherapy.

        Admiral Robinson. The prevention of tobacco use in the military is
    one of necessity to increase mission readiness and to decrease the
    physical and financial burden of tobacco-related illness. Tobacco
    cessation interventions have been demonstrated to be one of the top
    preventive services to implement in terms of return on investment. Many
    interventions have been adopted by the Navy to decrease tobacco use
    with the potential to do more.
        Presently, initial recruit training is done in a tobacco-free
    environment. Efforts are ongoing to extend this practice to advanced
    training schools as well. In the Fleet, the Submarine Force has just
    ordered that all of their submarines will be smoke free. Extending this
    policy to other classes of afloat units would be beneficial as well.
    Widespread access and provision of tobacco use screening, tobacco
    cessation counseling, and nicotine replacement therapy are high Navy
    Medicine priorities to address this most important issue.
        General Green. Yes, there are several studies that illustrate the
    impact of tobacco use on health care costs, so if the Air Force can
    prevent military members from using tobacco, we can reduce health care
    costs. The Air Force currently bans tobacco use during basic training
    of new recruits and continues this ban for the first 36 days of
    technical training which is our follow-on, initial skills training.
    There is evidence to suggest that extending this ban would help prevent
    new recruits from initiating smoking or relapsing to smoking. A 2003
    study found that new Air Force recruits were in favor of the tobacco-
    free policy during basic training and felt that it would be relatively
    easy for them to continue to remain tobacco-free after completing basic
    training if a policy were in place that prohibited the use of tobacco.
    Additionally, the Department of Health and Human Services' Task Force
    on Community Preventive Services recommends the use of smoking bans and
    restrictions based on strong evidence of their effectiveness on
    reducing cigarette consumption and increasing smoking cessation rates.
        Admiral Jeffries. The prevention of tobacco use in the military is
    one of necessity to increase mission readiness and to decrease the
    physical and financial burden of tobacco-related illness. Tobacco
    cessation interventions have been demonstrated to be one of the top
    preventive services to implement in terms of return on investment. Many
    Service and Defense Department interventions have been adopted to
    decrease tobacco use with the potential to do more. Widespread access
    and provision of tobacco use screening, tobacco cessation counseling,
    and nicotine replacement therapy are military medicine priorities to
    address this important issue.

                         post-traumatic stress disorder
        64. Senator Graham. General Green, who is most at risk for PTSD in
    the Air Force?
        General Green. The Air Force has continued to monitor the well-
    being of all airmen through multiple measures. Among these measures are
    our Post-Deployment Health Assessments (PDHA) and Post-Deployment
    Health Reassessments (PDHRA) administered following a deployment. For
    Air Force servicemembers who have deployed the prevalence of self-
    reported post-traumatic stress (PTS) symptoms within 6 months post
    deployment is around 1.5 percent for men and 2.5 percent for women over
    the past 2\1/2\ years. The prevalence was varied for both self-reported
    symptoms and provider-diagnosed PTSD rates by demographic and
    deployment variables. The higher PTS(D) rates (self-reported or
    diagnosed) were consistently observed in the demographic sub-groups of
    `Female' and `Enlisted,' and the deployment sub-groups of `longer
    deployment duration' and `positive combat exposure.' Combat exposure
    remains the most significant predictor of both PTS and PTSD diagnoses
    for those who have deployed. Air Force leadership supported plans to
    provide targeted, tiered resiliency training for higher-risk career
    groups, such as our security forces, explosive ordnance disposal, and
    combat convoy driver personnel, including the formation of a Deployment
    Transition Center (DTC) in U.S. Air Forces in Europe (USAFE). The DTC
    is a 2-day resiliency training and decompression stop on a deploying
    airman's way home. The Air Force has developed a targeted approach to
    assisting those at greatest risk for exposure to potentially traumatic
    events through the DTC. Several DTCs have already been prototyped and
    the initial feedback from servicemembers participating has been
    positive. These airmen will continue to be tracked and followed to
    assess program effectiveness for their reintegration. We will continue
    the ongoing surveillance of PTS and PTSD refining and targeting
    intervention approaches. In addition to the DTC, plans are underway for
    enhanced pre- and post-deployment resiliency training for these groups
    and targeted interventions for high risk groups, with enhanced small
    group training.

        65. Senator Graham. General Green, are you designing strategies in
    behavioral health and suicide prevention tailored to those at highest
    risk?
        General Green. Yes. The Air Force is working diligently to identify
    those at greater risk for PTSD and suicide, and to target specific
    interventions to these groups. We have developed a tiered intervention
    approach to improve resilience of our entire force and to target and
    track those most at risk for additional interventions. In addition to
    foundational training for all airmen that serves to build strength and
    resilience, the Air Force addresses a variety of behavioral health risk
    factors through annual training, commanders' calls, exercises, and
    inspections. We have identified several career fields as being at
    greater risk for suicide and have initiated more intensive suicide
    prevention training for all members in those career fields, along with
    additional training for supervisors in the same career fields to
    improve their skills in intervening with at-risk airmen.
        We have also identified specific career fields and mission sets
    that are at greater risk for exposure to trauma while deployed. For
    these airmen, we have developed Deployment Transition Sites that
    provide a critical decompression and recovery period to facilitate
    their smooth return to in-garrison life. These airmen will be tracked
    to allow us to assess the effectiveness of this program and to
    intervene with any of these airmen who show signs of distress.

                                substance abuse
        66. Senator Graham. General Schoomaker, please tell me more about
    the Confidential Alcohol Treatment and Education Pilot program. What is
    it intended to demonstrate and what are the early results?
        General Schoomaker. The Army recognizes that substance abuse has
    been on the increase among soldiers over the past several years.
    Current data indicate that roughly 50 percent of soldiers with PTSD,
    depression, and mild TBI (concussion) have concurrent alcohol issues.
    The Army also recognizes that alcohol use is a significant risk factor
    for accidents, domestic violence, criminal behavior, and suicide. Since
    the 1970s, the Army Substance Abuse Program (ASAP) has helped soldiers
    with addictions problems, but the program requires strict soldier
    accountability, notifying all commanders of soldier enrollment, and
    leveraging soldier treatment compliance with consequences that may
    adversely affect the soldier's military career. In most cases, ASAP
    counselors see soldiers with addiction problems only after they have
    gotten into trouble and been formally referred to the clinic for help.
    Career-minded soldiers are more likely to avoid seeking help from the
    ASAP clinic because of concerns about the potential risk to their
    careers. Based on these findings, the Army explored alternatives to
    benefit soldiers with substance abuse problems. The Confidential
    Alcohol Treatment and Education Pilot program was designed to allow
    soldiers to present to the ASAP clinic on a self-referral basis for
    alcohol problems without automatically notifying or involving their
    commanders, and without leveraging potential consequences that may
    adversely impact one's military career, as long as they have not
    already had a bad outcome, an alcohol-related incident, or a drug
    problem. The intent of the Confidential Alcohol Treatment and Education
    Pilot is to reach more soldiers earlier in the course of their alcohol
    problem, before they get into trouble or have a bad outcome or
    incident. The Pilot has been implemented for more than 8 months at
    three Army installations. Initial findings from the Confidential
    Alcohol Treatment and Education Pilot indicate that more soldiers are
    coming forward to seek substance abuse treatment for an alcohol
    problem. This includes more career-minded soldiers, senior enlisted
    soldiers, and officers, three groups that normally would avoid
    accessing care. Under the provisions of the Pilot, medical providers
    are more willing to refer to the ASAP clinic, and soldiers are more
    willing to go as referrals. Senior Army leadership is currently
    evaluating the expansion of the Confidential Alcohol Treatment and
    Education Program across the Army so that all soldiers may benefit from
    this new approach.

                        patient and family-centered care
        67. Senator Graham. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, you have talked
    at length about patient and family-centered care. Do the families know
    about this?
        Dr. Rice and Admiral Hunter. Yes, patient and family-centered care
    was first publicized in 2006. There was an extensive media campaign
    that included kickoff meetings, posters, brochures, Web sites, and an
    intensive review of processes to better meet the needs of patients. We
    have continued to inform military families about these programs since
    their inception.
        The full implementation of the Patient Centered Medical Home is
    still under development and will include a media campaign as well as
    written guidance for providers.
        General Schoomaker. We are making coordinated efforts to inform our
    beneficiaries about patient and family-centered care as part of our
    implementation of the Medical Home concept. Marketing and beneficiary
    communications are key components of Medical Home implementation. Our
    communication plan focuses on three interrelated goals. The first is to
    change culture and close the gap between what our beneficiaries value
    and what we deliver through the Medical Home. For example, research
    findings demonstrate that continuity and the ability to identify one's
    physician are markers of high quality care. However, our beneficiaries,
    like their civilian counterparts, may not understand and appreciate
    this concept. Accordingly, we will focus on educating our beneficiaries
    on the value of continuity with their identified primary care clinician
    as we implement the business practices that maximize continuity. The
    second goal is to standardize our operations to a common patient
    experience as beneficiaries move between medical treatment facilities.
    Creating a common patient experience is the basis for the Army Medical
    Home brand and, by making our system easier to use, will increase both
    staff and patient satisfaction. The third goal is to build the tools
    and processes required to support both day-to-day patient
    communications and broader campaigns and community outreach. Culture
    change, branding, and communication will ensure that our families get
    the Medical Home message. While the overall communication effort is
    coordinated centrally, execution occurs at the individual MTF. This
    effort will accelerate as we prepare to open Community Based Primary
    Care Clinics and expand use of the Medical Home.
        Admiral Robinson. Achieving optimal patient and family-centered
    care within Navy Medicine is one of our top strategic goals. We
    communicate to our Navy and Marine Corps families on many levels to
    ensure that their care is patient and family-centered. Our concept of
    care is focused around patient/family empowerment and advocacy and
    patient satisfaction with the health care experience.
        Many Navy MTFs have healthcare consumer councils and other patient
    advisory groups that facilitate bidirectional feedback to Navy
    physicians and healthcare staff on how to improve healthcare services
    and access. Other MTFs host town hall meetings where patients can
    identify issues and topics for improvement at that activity. In
    addition, some MTFs also have access to information technology tools
    that allows patients to directly email their healthcare team, through a
    secure system, with questions and concerns. Finally, through our
    facilities' public websites, patients can access information on Navy
    Medicine healthcare services and educate themselves on patient and
    family-centered care.
        Navy Medicine continuously surveys patients to assess their
    satisfaction with access to healthcare, coordination of healthcare
    services, and patient safety. This outreach ensures ongoing feedback
    and communication between patients and their healthcare staff to tailor
    healthcare delivery to patients and their family's expectations.
        Finally, Navy Medicine is implementing a new model of healthcare
    delivery called Medical Home Port, which has proven successful in the
    civilian sector and at Navy Medicine's demonstration sites. The Medical
    Home Port model utilizes a dedicated team of medical providers and
    support staff designed to increase access to care, improve clinical
    quality, and improve patient satisfaction. Medical Home Port leverages
    technology and maximizes personnel to deliver services that improve
    continuity for beneficiaries with their provider, as well as patient
    outcomes.
        General Green. Yes, as part of our implementation strategy for our
    FHI, Air Force Medical Service has an implementation team that works
    with each of our facilities when setting up their Patient Centered
    Medical Home. As part of this assistance, teams work with the
    facilities on ways to educate their wing leadership and base populace
    regarding the new approach to care through venues such as base
    newspaper articles, pamphlets, and handouts for the patients, briefings
    at various functions across the wing, and any other locally unique ways
    to communicate with our beneficiaries. Patrick Air Force Base, for
    example, held an open house for patients and their families. In
    addition to sharing education materials, each person met their own
    provider and their personal team, establishing a solid foundation to
    their medical care.
        Admiral Jeffries. Achieving optimal patient and family-centered
    care within Navy Medicine is one of our top strategic goals. We
    communicate to our Navy and Marine Corps families on many levels to
    ensure that their care is patient and family-centered. Our concept of
    care is focused around patient/family empowerment and advocacy and
    patient satisfaction with the health care experience.
        Many Navy MTFs have healthcare consumer councils and other patient
    advisory groups that facilitate bidirectional feedback to Navy
    physicians and healthcare staff on how to improve healthcare services
    and access. Other MTFs host town hall meetings where patients can
    identify issues and topics for improvement at that activity. In
    addition, some MTFs also have access to information technology tools
    that allows patients to directly email their healthcare team, through a
    secure system, with questions and concerns. Finally, through our
    facilities' public websites, patients can access information on Navy
    Medicine healthcare services and educate themselves on patient and
    family-centered care.
        Navy Medicine continuously surveys patients to assess their
    satisfaction with access to healthcare, coordination of healthcare
    services, and patient safety. This outreach ensures ongoing feedback
    and communication between patients and their healthcare staff to tailor
    healthcare delivery to patients and their family's expectations.
        Finally, Navy Medicine is implementing a new model of healthcare
    delivery called Medical Home Port, which has proven successful in the
    civilian sector and at Navy Medicine's demonstration sites. The Medical
    Home Port model utilizes a dedicated team of medical providers and
    support staff designed to increase access to care, improve clinical
    quality, and improve patient satisfaction. Medical Home Port leverages
    technology and maximizes personnel to deliver services that improve
    continuity for beneficiaries with their provider, as well as patient
    outcomes.

        68. Senator Graham. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, last year in a
    hearing of this subcommittee, I asked family members to rate their
    health care system from A to F--I was surprised at the results, which
    were much lower than I expected. Families explained the difficulty in
    obtaining appointments. How will your family-centered care plans fix
    the access problems that family members are experiencing?
        Dr. Rice and Admiral Hunter. We are implementing several
    initiatives to address the access problems that some family members are
    experiencing.
        The Patient Centered Medical Home is designed for every Prime
    patient to be assigned to a primary care manager by name. Each primary
    care manager is part of a team practice to ensure continuity of care so
    patients have access to advice and their provider 24 hours a day/7 days
    a week.
        MTFs are utilizing innovative patient-centered and access-focused
    approaches. Several examples include open access scheduling, online
    appointment-making and online provider/patient communication, 24-hour
    nurse advice and triage phone lines, and provider/patient telephonic
    consults.
        General Schoomaker. Implementation of the Army Medical Home model
    is intended to improve access, increase quality of healthcare, and
    decrease the cost of care. The Army Medical Home model will improve
    access in several ways. First, the Medical Home expands the number of
    ways by which our beneficiaries can gain access to health care. In
    addition to the traditional, face-to-face encounter with a clinician,
    the Medical Home will offer improved telephone consultation services,
    secure e-mail communication between care providers and patients, group
    visits, and more face-to-face encounters with nurses and other members
    of the health care team. Second, the Medical Home uses an open access
    appointment-making system focused on providing same-day access for
    those beneficiaries who request it. Third, measures of Medical Home
    performance focus on access and incorporate these measures into
    individual performance plans so that every staff member is incentivized
    to focus on improving access. Finally, the Army Medical Home improves
    operating efficiencies that will improve the supply of both traditional
    and nontraditional appointments. These include increased numbers of
    exam rooms in new facilities, more effective administrative models that
    free clinicians to see patients, better information systems, updated
    business rules, enhanced marketing and communications, improved staff
    training, and standardized operating rules. Taken together, these
    features of the Army Medical Home will help fix the access problems
    that family members are experiencing.
        Admiral Robinson. Navy Medicine is implementing a new model of
    healthcare delivery called Medical Home Port. This evidence-based model
    has proven successful in enhancing patient access to care in both the
    civilian sector and at pilot sites in Navy Medicine. Due to this
    initial success, Navy Medicine is currently expanding implementation of
    this model to eight additional sites by June 2010 and all primary care
    clinics by the end of 2011.
        Medical Home Port enhances access through numerous means. The first
    method is through the use of open access scheduling. This scheduling
    model ensures that patients can book appointments based on their need
    and preference. Patients can be seen the same day of their requested
    appointment; or, if they prefer, at a later more convenient date.
        Additionally, patients enrolled to the Medical Home Port will have
    direct access to their healthcare team 24/7 through secure messaging,
    telephone, pager, or other communication format. This allows the
    healthcare team to ensure that continuous, comprehensive and holistic
    care is provided to their patients. The team will address as many of
    the patient's healthcare needs as possible through a single
    appointment--from behavioral health to patient education to chronic
    disease management.
        General Green. A major focus of our FHI is access to care. We
    require our providers to provide a minimum of 90 appointments per full
    week in clinic. We have subsequently seen improvement in patient
    satisfaction with access at locations that have implemented FHI.
    Additionally, as we are seeing more continuity between patients and
    their providers, a secondary effect has been decreased demand, improved
    coordination of care, and overall improvement in access.
        Admiral Jeffries. The Marine Corps is supportive of the Patient and
    Family-Centered Care and Medical Home initiatives. These initiatives
    hold the promise of improving access and care to marines and their
    families.
        Navy Medicine is implementing a new model of healthcare delivery
    called Medical Home Port. This evidence-based model has proven
    successful in enhancing patient access to care in both the civilian
    sector and at pilot sites in Navy Medicine. Due to this initial
    success, Navy Medicine is currently expanding implementation of this
    model to eight additional sites by June 2010 and all primary care
    clinics by the end of 2011. This roll out plan will result in nearly
    all Marine Corps personnel being included in Medical Home Port by the
    end of 2011.
        Medical Home Port enhances access through numerous means. The first
    method is through the use of open access scheduling. This scheduling
    model ensures that patients can book appointments based on their need
    and preference. Patients can be seen the same day of their requested
    appointment; or, if they prefer, at a later more convenient date.
        Additionally, patients enrolled to the Medical Home Port will have
    direct access to their healthcare team 24/7 through secure messaging,
    telephone, pager, or other communication format. This allows the
    healthcare team to ensure that continuous, comprehensive and holistic
    care is provided to their patients. The team will address as many of
    the patient's healthcare needs as possible through a single appointment
    including behavioral health, patient education, and chronic disease
    management.
        If the anticipated successes of this approach are achieved, a
    future next step might involve integrating the care delivered to
    marines in garrison by organic personnel, for example a regimental
    surgeon, with the care delivered to the marine's family in the Navy
    MTF.

                          growth in health care costs
        69. Senator Graham. Dr. Rice, your testimony indicates that health
    care costs are expected to grow from 6 percent to more than 10 percent
    of the 000 top line by fiscal year 2015. This is a change from previous
    statements that costs were expected to grow from 8 percent to 12
    percent of the budget by fiscal year 2015. Is this an indication that
    we are achieving efficiencies in the system, or that we've found a
    different way to do the math?
        Dr. Rice. The variation is neither an indication we are achieving
    efficiencies in the system, nor that we have found a different way to
    do the math. The Unified Medical Budget percentage of the DOD top line
    is never constant; it varies from year to year due to fluctuating cost
    assumptions.

    military performance at the uniformed services university of the health
                                    sciences
        70. Senator Graham. Dr. Rice, when you are not performing the
    duties of the Assistant Secretary of Defense for Health Affairs, you
    are the President of the USUHS and have been since 2005. The University
    is the military's medical school and has produced hundreds of
    outstanding doctors since its establishment over 35 years ago, many of
    whom stay in uniform for long careers. Oddly, the original statute
    required that students remain as second lieutenants or ensigns for
    their entire 4-year education. At your recommendation last year, we
    supported a legislative provision that would allow the promotion of
    medical students at USUHS after 2 years--like all other commissioned
    officers. Our intent was to place greater emphasis on the military
    responsibilities of medical officers, but our friends in the House of
    Representatives did not support this proposal. Please comment about
    this idea, with the benefit of your 5 years out at USUHS. Would
    permitting promotion after 2 years of medical school, in response to
    good performance, help improve the student body?
        Dr. Rice. Although I am consistently impressed with the dedication
    and commitment of USUHS medical students, I believe their development
    as future leaders could be enhanced by properly administered promotion
    consideration and selection. It is my view promotion ceremonies
    involving the Surgeons General and other Service officials at the 2-
    year mark would provide an important Service connection and motivator,
    as well as morale builder, for both officers and their families--
    recognizing their hard work and sacrifice. Further, providing promotion
    with contemporaries will assist in both recruitment--particularly in
    the recruitment of quality Academy and ROTC graduates and prior-service
    personnel--and long-term retention. I also believe such a promotion
    opportunity would enhance our students' understanding of being a
    military officer.
        I am more aware now than ever successful accomplishment of the DOD
    mission requires military health care providers see themselves as an
    integral part of their Service teams. Ensuring officers attending
    USUHS, which is the primary accessions source for career military
    health care providers, are treated as part of their Service teams from
    their first day of service is critical to this self view.

        71. Senator Graham. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, do you think it
    could help eliminate from the student body, students who are not
    motivated and who do not demonstrate the military bearing, loyalty, and
    leadership traits that all officers should have?
        Dr. Rice and Admiral Hunter. Yes, I believe 2-year promotion
    eligibility could help eliminate from the student body, students who
    are not motivated and who do not demonstrate the military bearing,
    loyalty, and leadership traits that all officers.
        Promotion consideration at the 2-year point would involve a
    critical additional assessment of officership by the chain of command
    at USUHS and the Services. Medical students who fail to measure up to
    officership standards (military bearing, loyalty, and leadership) at
    this point, will be clearly identified for separation, if appropriate,
    or at a minimum, for continued attention (mentoring and observation).
        General Schoomaker. No, promotion from second lieutenant to first
    lieutenant while at the USUHS would not help. Processes are already in
    place to regularly evaluate performance and determine advancement,
    deceleration, or termination for students at USUHS. I doubt that any
    additional value would be added to the current process by the addition
    of a promotion opportunity.
        Admiral Robinson. This question is specific to the USUHS. As such,
    it is most appropriately answered by President of USUHS.
        General Green. Since promotions are based on merit and the
    demonstrated ability to perform in a higher grade, allowing medical
    students (both USUHS and HPSP) to advance to the next grade (O-2)
    following their second year of medical school would serve as a positive
    incentive, one that could also enhance our ability to recruit and
    retain strong military medical leaders for the future.
        As military-medical officers, USUHS (and HPSP) students must adhere
    to the same standards of professional comportment as their line
    counterparts, so promoting those who demonstrate positive professional
    performance, while deferring promotion for those who fail to meet
    Service specific standards, would be yet another means of ensuring a
    truly quality force.
        Admiral Jeffries. This question is specific to the USUHS. As such,
    it is most appropriately answered by President of USUHS.

                        remedial actions after fort hood
        72. Senator Graham. General Schoomaker, there is disciplinary
    action pending against Major Nidal Hasan, but we need to know what
    steps you have taken to ensure that the performance of young doctors in
    the Army Medical Corps is being accurately reported on and effective
    corrective measures are being implemented when individual officers fail
    to perform to standards. What guidance have you given to ensure that
    officer efficiency reports are useful tools in evaluating the
    performance and assignment of medical officers?
        General Schoomaker. I have issued guidance to my subordinate
    commanders reinforcing the importance of honest, forthright
    evaluations. Army Regulation 623-3 (Evaluation Reporting System)
    Appendix E provides special instructions for evaluations pertaining to
    Army Medical Department (AMEDD) officers. The overarching priority for
    Appendix E is accurately reporting on an officer's performance while
    ensuring effective corrective measures are in place to produce a broad-
    based corps of leaders who possess the necessary values, attributes,
    skills, and actions to perform their duties and serve the Nation. These
    leaders must demonstrate confidence, integrity, critical judgment, and
    responsibility while operating in an environment of complexity,
    ambiguity, and rapid change.
        Furthermore, the AMEDD relies on a concerted, joint effort of
    subject matter experts to train, develop, and optimally assign its
    officers. The primary tool facilitating this process, especially to
    ensure that senior officers are assigned to clinical positions that
    maximize their utilization and experience, is the biannual Human
    Capital Distribution Process (HCDP). The HCDP is a business practice
    whereby the Army Medical Command collaboratively distributes its human
    capital in a manner that ensures the right mix of qualified providers
    are present at each AMEDD facility to ensure mission accomplishment.
        Additionally, Department of the Army Pamphlet 600-4 (Army Medical
    Department Officer Development and Career Management) is Army guidance
    that promotes the assignment of senior O6 officers into positions which
    foster mentorship for junior officers. AMEDD leaders are directed to
    continually conduct developmental counseling and mentor young Medical
    Corps officers to help them professionally develop, accomplish
    organizational goals, and achieve personal ambitions, while preparing
    them for increased responsibilities.

        73. Senator Graham. General Schoomaker, what measures have you
    instituted to ensure that medical officers, particularly those in the
    training pipeline, conform to physical standards and are appropriately
    evaluated and counseled for shortcomings?
        General Schoomaker. I am aware that maintaining physical standards
    is an issue across the Services while students attend the Uniformed
    Services University. However, within the Army, I have reinforced to my
    subordinate commanders and leaders the need to strictly comply with
    Army policy and regulation regarding physical standards. Army
    Regulation 350-1 (Army Training and Leader Development) provides
    policies, procedures and responsibilities for developing, managing, and
    conducting Army Training and Leader Development for all Army officers.
    All Army officers are also covered by Army Regulation 600-9 (Army
    Weight Control Program) which establishes policies and procedures for
    the implementation of the Army Weight Control Program. Individuals who
    are selected to enter Graduate Medical Education (GME) must sign a
    training agreement acknowledging that, as a condition of employment and
    for continuation in GME, they must comply with the Army physical
    fitness, appearance, and weight standards. Those entering Active Duty
    internships are given a diagnostic Army Physical Fitness Test (APFT)
    during their orientation to assess for those who will require
    additional physical training. Those selected for advanced GME training
    must be in compliance with APFT and height and weight requirements
    prior to beginning training; if not, the training opportunity may be
    withdrawn. Trainees who are out of compliance at any time are counseled
    by program directors as well as company commanders on the importance of
    meeting the standards and the negative impact of noncompliance on their
    training and career progression.

        74. Senator Graham. General Schoomaker, what steps have you taken,
    or have you recommended, ensuring that personnel who demonstrate
    reservations or doubts about active military service are identified and
    dealt with?
        General Schoomaker. I have reinforced with my commanders, with
    direction to disseminate to the rest of the force, the importance of
    leaders engaging with their subordinates in regular, routine counseling
    sessions. This is a fundamental precept of military leadership. Leaders
    should know what is happening in their soldiers' lives and provide
    support and intervention as necessary. An individual who demonstrates
    reservations or doubts about active military service may be referred to
    the chaplain, a counselor, or some other appropriate authority,
    depending on the circumstances of the case. At all times the chain-of-
    command should be made aware of these cases and exercise appropriate
    command oversight.
                                     ______

                   Questions Submitted by Senator John Thune
                   electronic medication management assistant
        75. Senator Thune. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, I understand
    that the Army Surgeon General's office piloted the use of a remote
    medication management device known as Electronic Medication Management
    Assistant (EMMA) on patients at the Warrior Transition Unit at Walter
    Reed Army Medical Center (WRAMC). Due to the success at Walter Reed,
    the pilot program was expanded to Fort Carson, Fort Lewis, and Fort
    Bragg.
        I also understand that the expanded pilots are confirming Walter
    Reed's results that EMMA controls the access to dangerous narcotics and
    controlled substances; improves outcomes by increasing prescription
    adherence from an estimated 65 percent to over 90 percent; and limits
    the abuse and misuse of medications. Furthermore, due to the results at
    the Warrior Transition Units, EMMA was made a TRICARE benefit.
        Since the EMMA pilots are showing that this device successfully
    mitigates the risk of medication misuse and improves patient safety,
    what is being done to expedite the expansion of this device to other
    Warrior Transition Units and to all high risk wounded warrior patients?
        Dr. Rice and Admiral Hunter. We are not currently developing plans
    to expedite the expansion of EMMA device use throughout the MHS.
        We have conducted a review of EMMA and in response to the review
    results, have cautiously restricted coverage for EMMA to cases where it
    is prescribed by a military physician to an Active Duty servicemember.
        General Schoomaker. The Army Medical Command directed an expanded
    pilot of EMMA after experiencing limited success at WRAMC. Once the
    expanded pilot has concluded and data have been analyzed, we will
    determine whether to continue with EMMA and, if so, who would benefit.
    Although WRAMC pharmacy did not conduct outcomes studies in the WRAMC
    portion of the pilot, they did find success in warriors with TBI who
    were having difficulty remembering to take their medications. The
    automatic alert on EMMA has been instrumental in helping the warriors
    take medications at appropriate times. The WRAMC staff noted that
    warriors with potential prescription abuse issues were not as
    successful with EMMA as they often found ways to work around the
    automated controls. The 6-month expanded pilot will be completed in May
    2010 with a planned briefing to Army leadership in July after
    appropriate evaluation of outcomes and satisfaction data. Since
    implementation at WRAMC, a total of 24 warriors have used EMMA; there
    are currently 18 warriors active. Each additional pilot site enrolled
    10 warriors.
        TRICARE reimbursement rules allow for paying for EMMA under the
    Supplemental Healthcare Program for Active Duty. While EMMA can be
    considered durable medical equipment in the TRICARE Manual Policy, it
    is not considered medically necessary based on a review of the
    supplier's literature by TMA's Medical Benefits and Reimbursement
    Branch. Therefore, TRICARE is not permitted to pay EMMA costs for non-
    Active Duty personnel.
        Admiral Robinson. The Navy Medicine Information System Support
    Activity (NAVMISSA), as the execution arm for deployment and
    maintenance of Navy Medicine IT Systems has been providing assistance
    to the contractor, INRange, since October 20, 2009, to develop the
    necessary documentation package for the Information Assurance
    Certification and Accreditation (C&A) of the EMMA. NAVMISSA's
    responsibility as the Navy medical network security manager is to
    ensure that all Information Assurance C&A packages are prepared,
    reviewed, and validated in accordance with Joint Task Force, Global
    Network Operations (JTFGNO) (security arm for DOD) requirements prior
    to submission to the Naval Network Warfare Command (NETWARCOM) for
    approval. EMMA must be formally certified and accredited by NETWARCOM
    prior to interface with the Navy Medicine IT network. All military
    Services are held to the same level of security certification. INRange
    has not provided the level of security required both in documentation
    and technical certification to prepare the total package required for
    review and submission by NAVMISSA to NETWARCOM for approval leading to
    certification and accreditation. It is the intent of the Bureau of
    Medicine and Surgery to expeditiously field this capability as soon as
    the contractor, INRange, provides the predefined security deliverables.
        General Green. This question addresses the Army's Warrior
    Transition Units and as such I defer to the Army Surgeon General for
    the response to this question for the use of EMMA in the Warrior
    Transition Units.
        Admiral Jeffries. The NAVMISSA, as the execution arm for deployment
    and maintenance of Navy Medicine IT systems, has been providing
    assistance to the contractor, INRange, since October 20, 2009 to
    develop the necessary documentation package for the Information
    Assurance Certification and Accreditation (C&A) of the EMMA. NAVMISSA's
    responsibility as the Navy medical network security manager is to
    ensure that all Information Assurance C&A packages are prepared,
    reviewed, and validated in accordance with JTFGNO (security arm for
    DOD) requirements prior to submission to the NETWARCOM for approval.
    EMMA must be formally certified and accredited by NETWARCOM prior to
    interface with the Navy Medicine IT network. All military Services are
    held to the same level of security certification. INRange has not
    provided the level of security required both in documentation and
    technical certification to prepare the total package required for
    review and submission by NAVMISSA to NETWARCOM for approval leading to
    certification and accreditation. It is the intent of the Bureau of
    Medicine and Surgery to expeditiously field this capability as soon as
    the contractor, INRange, provides the predefined security deliverables.

        76. Senator Thune. Dr. Rice, Admiral Hunter, General Schoomaker,
    Admiral Robinson, General Green, and Admiral Jeffries, I also
    understand that the marines at Camp Lejeune have been unable to obtain
    the EMMA TRICARE benefit for Wounded Warriors because the NAVMISSA has
    refused to do so based on information systems program management
    issues. What is being done to provide this device to the marines and
    why is NAVMISSA involved in a TRICARE benefit?
        Dr. Rice and Admiral Hunter. We have conducted a review of EMMA,
    one of the results of that review was concerns with ensuring secure
    data communications from a remote device in the patient's home to
    protect patient privacy.
        With these concerns, we have cautiously restricted coverage for
    EMMA to cases where it is prescribed by a military physician to an
    Active Duty servicemember.
        General Schoomaker. We respectfully defer to the Navy and the
    Marine Corps to address this question.
        Admiral Robinson. The NAVMISSA, as the execution arm for deployment
    and maintenance of Navy Medicine IT systems has been providing
    assistance to the contractor, INRange, since October 20, 2009, to
    develop the necessary documentation package for the Information
    Assurance C&A of the EMMA. NAVMISSA's responsibility as the Navy
    medical network security manager is to ensure that all Information
    Assurance C&A packages are prepared, reviewed, and validated in
    accordance with JTFGNO (security arm for DOD) requirements prior to
    submission to the NETWARCOM for approval. EMMA must be formally
    certified and accredited by NETWARCOM prior to interface with the Navy
    Medicine IT network. All military Services are held to the same level
    of security certification. INRange has not provided the level of
    security required both in documentation and technical certification to
    prepare the total package required for review and submission by
    NAVMISSA to NETWARCOM for approval leading to certification and
    accreditation. It is the intent of the Bureau of Medicine and Surgery
    to expeditiously field this capability as soon as the contractor,
    INRange, provides the predefined security deliverables.
        General Green. As this question relates to Navy issues, I defer the
    response on EMMA TRICARE benefit and NAVMISSA's involvement in a
    TRICARE benefit to the Navy Surgeon General for response.
        Admiral Jeffries. The NAVMISSA, as the execution arm for deployment
    and maintenance of Navy Medicine IT systems has been providing
    assistance to the contractor, INRange, since October 20, 2009, to
    develop the necessary documentation package for the Information
    Assurance C&A of the EMMA. NAVMISSA's responsibility as the Navy
    medical network security manager is to ensure that all Information
    Assurance C&A packages are prepared, reviewed, and validated in
    accordance with JTFGNO (security arm for DOD) requirements prior to
    submission to the NETWARCOM for approval. EMMA must be formally
    certified and accredited by NETWARCOM prior to interface with the Navy
    Medicine IT network. All military Services are held to the same level
    of security certification. INRange has not provided the level of
    security required both in documentation and technical certification to
    prepare the total package required for review and submission by
    NAVMISSA to NETWARCOM for approval leading to certification and
    accreditation. It is the intent of the Bureau of Medicine and Surgery
    to expeditiously field this capability as soon as the contractor,
    INRange, provides the predefined security deliverables.

        [Whereupon, at 12:05 p.m., the subcommittee adjourned.]

    DEPARTMENT OF DEFENSE AUTHORIZATION FOR APPROPRIATIONS FOR FISCAL YEAR
                                      2011

                                  ----------

                           WEDNESDAY, APRIL 28, 2010

                                   U.S. Senate,
                                Subcommittee Personnel,
                                   Committee on Armed Services,
                                                        Washington, DC.

      MILITARY COMPENSATION AND BENEFITS, INCLUDING SPECIAL AND INCENTIVE
                                      PAYS

        The subcommittee met, pursuant to notice, at 10:03 a.m. in
    room SR-222, Russell Senate Office Building, Senator Jim Webb
    (chairman of the subcommittee) presiding.
        Committee members present: Senators Webb, Begich, and
    Chambliss.
        Committee staff members present: Leah C. Brewer,
    nominations and hearings clerk; and Jennifer L. Stoker,
    security clerk.
        Majority staff members present: Jonathan D. Clark, counsel;
    Gabriella Eisen, counsel; and Gerald J. Leeling, counsel.
        Minority staff members present: Diana G. Tabler,
    professional staff member; and Richard F. Walsh, minority
    counsel.
        Staff assistants present: Jennifer R. Knowles and Breon N.
    Wells.
        Committee members' assistants present: Gordon I. Peterson,
    assistant to Senator Webb; Lindsay Kavanaugh, assistant to
    Senator Begich; and Jason Lawrence and Clyde A. Taylor IV,
    assistants to Senator Chambliss.

            OPENING STATEMENT OF SENATOR JIM WEBB, CHAIRMAN

        Senator Webb. The subcommittee will come to order.
        The subcommittee meets today to receive testimony on
    military pay and compensation programs.
        We welcome four witnesses this morning. William Carr is the
    Deputy Under Secretary of Defense for Military Personnel
    Policy; Brenda Farrell is the Director of Defense Capabilities
    and Management, Government Accountability Office (GAO); Dr.
    Carla Tighe Murray is the Congressional Budget Office (CBO)
    Senior Analyst for Military Compensation and Healthcare; and
    Dr. James R. Hosek is the Director of Forces and Resources
    Policy Center, RAND National Defense Research Institute. We
    welcome all four of the witnesses to this hearing.
        I'd like to say this is the first time that I have chaired
    a hearing in this room, and it's rather odd, because I spent
    many times down where you guys are when I was in the Department
    of Defense (DOD). It looks a little better from this end of the
    table, I have to say. [Laughter.]
        The cost of military personnel, including pay and
    compensation, noncash and deferred benefits, and healthcare
    continues to rise at disturbing rates. The Department's
    proposed base budget for fiscal year 2011 for military
    personnel and healthcare amounts to almost $170 billion, or
    more than 30 percent of the Department's total budget. By
    comparison, using 2010 constant dollars, the Department's total
    cost for military personnel and healthcare in 2001 was $109
    billion. This represents an increase of more than 57 percent.
    The defense health program base budget, including retiree
    healthcare costs, has increased from $16.6 billion in 2001,
    using constant dollars, to $41.7 billion in 2011, which
    represents an increase of more than 151 percent.
        Nevertheless, we face the realities posed by the ninth
    consecutive year of combat operations and the incredible stress
    this has placed on our servicemembers and their families.
        In order to carry out our national obligations, the
    Services must continue to recruit and retain highly qualified
    individuals in sufficient numbers. Unlike past wars, this
    Nation today is fighting with an All-Volunteer Force (AVF). If
    the Services are to sustain the quality of the AVF, they must
    be able to compete with the private sector, with the right
    numbers of talented young men and women.
        Beyond the basic requirement to compensate our
    servicemembers fairly for their unique conditions of service
    and sacrifice, a robust military compensation and benefit
    package is key to maintaining the military's competitive
    position.
        As a consequence, compensation and benefits have risen
    significantly over the past decade. In the 2010 National
    Defense Authorization Act (NDAA), Congress enacted a pay raise
    above the annual increase in the employment cost index (ECI)
    for the 12th consecutive year. For 10 of those years, the pay
    raise was across the board for all members of the uniformed
    Services, including uniformed members of the National Oceanic
    and Atmospheric Administration, the Public Health Service, and
    the Coast Guard.
        While the pay raises of the past decade were appropriate,
    and I supported them on this subcommittee over the past 3
    years, DOD officials remind us that additional pay raises above
    the ECI have a tailing cost that is often overlooked. Because
    of the increased basic pay above the rate of inflation, for
    example, future retired pay is increased for all members of
    uniformed Services, well beyond DOD projections.
        In addition to basic pay, the Department and the Services
    rely on bonuses and other special and incentive (S&I) pays to
    attract and retain highly qualified individuals who serve in
    critical occupational specialties and hard-to-fill billets.
    Such cash incentives, while sometimes causing sticker-shock to
    the media, the public, and even some Members of Congress, have
    the benefit of being targeted to essential people and necessary
    skills, when done properly.
        We, in government, have a particular responsibility to have
    a full understanding of how such funds are being used and if
    they are being used in a logical and efficient way. S&I pays
    are not reprogrammed from other accounts with specific
    congressional approval. However, unlike other DOD spending
    actions during a budget execution year, they can be dialed up
    or down, depending on circumstances and the needs of each
    branch of the Armed Forces. They also can be used to encourage
    an appropriately recognized Service, under the most arduous and
    demanding conditions.
        The Department's management and stewardship of S&I pays is
    not always transparent, either to the public or to Congress.
    During this subcommittee's personnel posture hearing last
    month, I asked Under Secretary Stanley to provide a
    consolidated accounting and an explanation of the Department's
    use and management of S&I pays, and how these pays ensure that
    they are being used efficiently and prudently.
        We are informed by DOD that S&I pays make up less than 4
    percent of the proposed 2011 military personnel budget. This,
    in fact, represents a decline from prior years. This level of
    funding, more than $5.5 billion, is still significant. In its
    response to my inquiry, the Department has urged the greater
    use of S&I pays as a more efficient and, ultimately, less
    costly use of funds, versus an additional across-the-board pay
    raise above ECI that affects all members of the uniformed
    Services equally.
        The GAO report on military compensation released this month
    seems to agree with this assessment, as does the 2007 CBO
    report on military compensation. I look forward to hearing from
    Ms. Farrell and Dr. Murray on their agencies' work in this
    area.
        This raises the question of what comprises the best mix of
    across-the-board pay raises versus cash incentives in order to
    attract and retain the highest quality AVF in sufficient
    numbers to reduce the stress on the force while compensating
    servicemembers adequately and fairly for the unique conditions
    of their Service.
        I believe this is the ultimate goal of an equitable
    military compensation system. In the final analysis, the
    relative success of recruiting and retention may be the most
    relevant indicator of our striking the right balance and
    adequately compensating our all-volunteer military.
        In the end, we must make sure that our compensation systems
    are as efficient and responsible as fairness allows so that we
    can afford the end strength that we need.
        I hope our witnesses today, especially Mr. Carr, can shed
    some light on the Department's needs and the process that it
    follows to ensure that S&I pays are used in a way that best
    serves the interests of our military and of the U.S. taxpayer.
        Similarly, I look forward to working with Under Secretary
    Stanley to ensure that Congress has the visibility it needs in
    order to effectively discharge its responsibilities to oversee
    the military and the military compensation system.
        I thank each of our witnesses for appearing to testify
    today. I hope you can shed some light on how we can be more
    efficient, at the same time being adequate and fair, in terms
    of compensating our servicemembers. I also hope to hear some
    ideas on what we can do to address the sharp growth in some of
    these costs. I'm looking forward to a dialogue on that during
    this hearing.
        Senator Graham is held up in a markup in another committee.
    We're very pleased to have Senator Chambliss here to represent
    the Republican side.
        Senator Chambliss, welcome.

                  STATEMENT OF SENATOR SAXBY CHAMBLISS

        Senator Chambliss. Thank you very much, Mr. Chairman, first
    of all, for holding this hearing, and for your leadership on
    this issue.
        I want to join you in welcoming our witnesses and thanking
    them for their public service. We appreciate the great work you
    do. It's never easy dealing with numbers, period. But, when
    you're having to deal with numbers in tough times, particularly
    on this particular issue, where the service to the United
    States is reflected by the men and women who continue to serve
    so valiantly, it's even more difficult, I know. So, we
    particularly thank you for your service to our country.
        In view of the sacrifices and service of the men and women
    of our Armed Forces, it is essential that we provide them and
    their families with compensation and a quality of life that
    reflects not only what is needed to successfully recruit and
    retain personnel, but also our appreciation and respect for
    their volunteer service.
        Monitoring and adjusting the levels of military pay is a
    shared responsibility of Congress and the Department which we
    all take very seriously. Mr. Chairman, it's helpful to step
    back, occasionally, and assess how we are doing.
        I appreciate the views expressed by our witnesses regarding
    military pay comparability with civilian counterparts. Since
    2000, our committee has supported robust pay increases, and
    there is no question that this has contributed to the superb
    caliber and readiness of the Armed Forces. To recruit the
    highest caliber young people and to retain them for careers,
    during good economic times and bad, it is absolutely critical
    that incentive pay, such as bonuses and special pays, be
    flexible enough to respond to changing manpower needs.
        The military has had to be able to compete successfully for
    the services of critically needed professionals, and retain
    leaders of proven ability for careers of service. Critically
    needed warfighters, such as Special Forces personnel, are high
    on this list. Healthcare professionals, nuclear-qualified
    individuals, EOD personnel, and many others come to mind, as
    well.
        Compensation for our Reserve component personnel is another
    area that requires careful examination. Reservists and
    guardsmen provide a great return on the investment, in terms of
    the capability they provide; but, an operationally-oriented
    Reserve and Guard is very different from the Strategic Reserve
    of the past. I'll be interested to hear how DOD is using pay as
    an incentive to retain reservists for long careers, and what
    changes we may see in that regard.
        The issue of pay and benefits is very important to our
    servicemembers, and one that this committee cares a great deal
    about. Each of your perspectives can help inform our
    recommendations in this area and help us, with DOD, shape a set
    of pay and benefit policies that serves to recruit and retain
    the people our Nation needs in the military, and does so in a
    way that is also fiscally responsible.
        I thank you for your appearance today, for your commitment
    to this issue, and, most of all, your commitment to our members
    of the military.
        Thank you very much, Mr. Chairman.
        Senator Webb. Thank you very much, Senator Chambliss.
        We're going to go to the witnesses. Mr. Carr will go first.
        But, before we do, I would like to raise a matter. Mr.
    Carr, I hope you will take this back to your boss. This relates
    to a question that I raised about military fellows. This is a
    very simple question requesting data on military fellows in all
    elements of their involvement outside of DOD. I asked this
    question on February 2, 2010, to Secretary Gates. I re-asked it
    again on March 10 to Secretary Stanley.
        I want to start off by saying, when I was a committee
    counsel over on the House side 30 years ago, DOD was famous for
    its responses. During a hearing where we were looking at the
    Carter discharge review program--we were trying to get a
    breakdown on who served during the Vietnam war, where the
    casualties were, et cetera--I once turned around to the DOD
    liaison and said, ``I need a breakdown of who served:
    ethnically, racially, by Service, by year; and what the
    casualties were, by Service, by race, by ethnicity, by year.''
    I had that information in 1 day; a very voluminous piece of
    information. DOD invented computer technology. It basically
    invented the Internet, with apologies to some other people who
    made contrary statements in the past. [Laughter.]
        This kind of information shouldn't take 3 months. I don't
    want to be put in a position where I'd have to put a hold on
    nominations or do any of these sorts of things that we have to
    do in order to get cooperation. We finally, this morning,
    received a reply, and it's really inadequate. It's basically, I
    think, minimal cooperation. So, we need to do a lot better on
    these kinds of things.
        Mr. Carr. Yes, sir.
        Senator Webb. So, just take that back to your boss, if you
    would.
        Mr. Carr. I will do that, sir.
        Senator Webb. Welcome.
        Mr. Carr, the floor is yours.

    STATEMENT OF WILLIAM J. CARR, DEPUTY UNDER SECRETARY OF DEFENSE
                     FOR MILITARY PERSONNEL POLICY

        Mr. Carr. Thank you, Mr. Chairman.
        Very correctly, the chair pointed out that today we fight
    the wars with an AVF. If we would have looked back a number of
    years ago and asked ourselves how a volunteer force could
    perform the protracted war, we would have viewed it as a risky
    proposition. It has not proven that. Our retention is stable.
    Our retention is good. Unit manning, as a consequence, is good.
    The skill distribution is good--far better than I would have
    projected years ago.
        The things that have happened because of this subcommittee
    and because of Congress--I'll mention, simply, one, because it
    goes to the chairman's point on pay as being an important
    component, in addition to S&I pays. We took the military pay
    table which is rank versus years of service, and when we looked
    at it, we realized noncomissioned officers (NCO) and junior
    officers were relatively underpaid; some pay compressions had
    occurred. It took a number of years to tweak the pay table and
    jack those up, and we did. But, we did something else. Congress
    moved it to a 40-year pay table, instead of 30. We had an
    extraordinary number of senior NCOs who were called upon
    repeatedly to go to the theater, because they were talented,
    sharp, and experienced. For that reason, they served beyond 30
    years. But, retirement pay would be capped at 75 percent. That
    was removed, coupled with a 40-year pay table enacted by
    Congress. Those are the kinds of things that adapt, that show
    the agility and, I think, specifically, are generating the kind
    of readiness we have.
        Today we focus on roughly 3 percent of the budget for
    military personnel that are, I believe, the best-leveraged
    dollars we invest. They allow the Nation to recognize special
    circumstances: the hazards of combat and special duties, such
    as explosive ordnance disposal, or unique private-sector
    opportunities, where a given segment of the force has an
    opportunity and a strong temptation for their families to move
    to a different line of work. Yet, they remain with us, in part,
    because of the S&I pays that we provide. Those pays are
    targeted. They produce a specific result on a limited
    population. They, therefore, tend to be some of the most
    efficient manpower dollars that we invest in the pursuit of
    readiness.
        But, that account is tight, and it's growing tighter. We
    believe it's sized right. We believe it's prioritized correctly
    in this budget. But, even so, those dollars, as the chairman
    pointed out, are tightening, and we're moving from 2009 levels,
    of about 4.4 percent of the military personnel account, being
    allocated to these very precious, targeted, leveraged,
    efficient pays, to about 3 percent. There are reasons we do
    that. We think the risk is reasonable, based on our forecasts
    of how the members and families are going to react.
        Now, we know that setting compensation at an appropriate
    level is critical to the sustainment of robust Guard and
    Reserve, as the chairman also correctly pointed out, as did
    Senator Chambliss. The 11th Quadrennial Review of Military
    Compensation (QRMC) has convened, and the President asked that
    they look specifically at this. These QRMCs are producing solid
    public policy options--bold, almost daring. The 10th QRMC
    certainly did in its reviews of options for military
    retirement, for example.
        With the people that we've chosen to lead that, I have
    little doubt that this QRMC is going to produce a systematic
    set of outcomes that will help improve the lot of the Reserves
    and the way that we integrate them in today's environment.
        In summary, Mr. Chairman, you have aggressively and
    attentively watched over those in the military. Every person in
    uniform owes you a debt, and the subcommittee a debt, for the
    things that you've done.
        I thank you for the opportunity to appear before you and
    look forward to participating today.
        [The prepared statement of Mr. Carr follows:]
                     Prepared Statement by William J. Carr
        Chairman Webb, Senator Graham and distinguished members of the
    subcommittee, thank you for the opportunity to come before you on
    behalf of the men and women who so ably serve in the uniforms of our
    Nation's Armed Forces.
        I am here today to speak to you about the state of compensation for
    our uniformed services. I am pleased to report that--thanks to your
    support--soldiers, sailors, airmen, and marines continue to express
    healthy satisfaction with the full pay and benefits the military
    services provide. This is understandable since military compensation
    competes very well with private sector wages.
        Over the past decade, the Department and Congress together have
    faced a host of challenges in ensuring military compensation is
    adequate to recruit and sustain America's All-Volunteer Force.
    Together, we have reshaped military compensation to make certain that
    military service remains an attractive option for today's youth as they
    enlist, and as they progress through critical points in their careers.
    The success of our combined efforts is manifest by sustained success in
    meeting or exceeding overall recruiting and retention goals in almost
    every year over the past decade, across the components.
        The Department is committed to carefully managing both the
    compensation tools and the resources provided by Congress. In the years
    ahead, the Department very likely will continue its focus on restrained
    growth of mandatory entitlements while leveraging cost-effective
    discretionary pays and bonuses.
        Military compensation consists of five monetary components. Common
    to every military member serving on active duty is basic pay, the Basic
    Allowance for Housing, and the Basic Allowance for Subsistence.
    Combined with the Federal tax advantage from the housing and
    subsistence allowances, the aggregate of these four components is
    defined as Regular Military Compensation (RMC). RMC is then used to
    benchmark against private sector wages. Based on the Ninth Quadrennial
    Review of Military Compensation in 2002, the Department evaluates the
    comparability of military compensation by comparing RMC to the 70th
    percentile of comparably educated civilians in the private sector.
        RMC is the foundation of military pay. It is the fundamental basis
    we use to recruit, retain, motivate, and separate our force. When the
    Department experiences broad-based recruiting and retention problems
    across occupations and services, it is usually because RMC lags
    private-sector compensation. To ensure this foundation remains sound,
    it must keep pace with growth in civilian wages as measured by the
    yearly change in the Employment Cost Index (ECI). This is why the
    Department supports an annual basic pay raise for 2011 of 1.4 percent--
    an ``ECI pay raise.'' Should we fail to keep pace with private-sector
    wages, the result could be a repeat of across-the-force recruiting and
    retention failures witnessed as recently as the late 1990s.
        In response to such failures in the late 1990s, Congress and the
    Department, together, swiftly improved military compensation. Between
    January 2002 and January 2010, military pay has risen by 42 percent,
    the housing allowance has gone up by 83 percent, and the subsistence
    allowance has grown by 40 percent. By contrast, private-sector wages
    and salaries rose by only 32 percent during the same period. This has
    been a signature accomplishment both of the administration and
    Congress.
        The final component of military compensation--and an area of
    special interest in today's hearing--is represented by the Special and
    Incentive (S&I) pays. It is with these S&I pays that the Department
    draws upon, as an increment to RMC, when needed to influence human
    behavior toward the achievement of high levels of manning and unit
    performance. These S&I pays are flexible and responsive in affording
    DOD an ability to respond to external labor market conditions.
        The Department provides guidance and exercises continuous oversight
    over all S&I pays, while delegating significant authority to each of
    the military departments and Services to implement and execute the
    pays. The S&I pays typically comprise less than 5 percent of the
    Department's personnel budgets, yet they provide critical flexibility
    in responding to private-sector market changes. For example, accession
    bonuses are used to attract America's youth into hard-to-fill
    specialties, while retention bonuses are used to keep them in those
    career fields. The Army recently identified an emerging shortage of
    Judge Advocate majors through fiscal year 2015. In response, the Army
    requested and was approved for a series of retention incentives
    targeting specific year groups to address and correct the projected
    shortfall. Additionally, S&I pays recognize wage differentials in
    occupations, such as dentistry, aviation, and nuclear specialties.
    Assignment Incentive Pay is used to fill arduous assignments around the
    world, and Hardship Duty Pay is used to recognize duty in a remote
    location.
        These pays are essential and the Department maintains its careful
    stewardship of these resources. For example, in 2009, S&I pays totaled
    $6.4 billion, or 4.4 percent of the personnel account. In our recent
    budget submission for 2011, S&I pays were $5.6 billion, or 3.6 percent
    of the personnel account. This decrease does not mean S&I pays are less
    important; rather, it reflects the Department's recognition that the
    slow recovery in the economy increases the attractiveness of military
    service, which in turn moderates our need to use bonuses in meeting
    recruiting and retention goals.
        The value of the S&I pay program lies in its ability to
    significantly, yet cost-effectively, influence behavior. A $340 million
    investment in the S&I pay program, for example, would allow the
    Department to offer more than 11,000 members with specialized skills or
    training a bonus of $30,000. That's a big amount to be sure, yet
    nonetheless efficient when it serves to retain someone who otherwise
    would walk away with enormously valuable training and experience that
    will take years to regenerate. Special Operations Forces are a great
    example of that, which explains our heavy investments in that vital
    segment of today's military.
        An alternative would be to apply that same $340 million to generate
    a bigger pay raise in the form of a half percent across-the-board hike.
    For a corporal at 4 years of service, this translates to about $11 per
    month before taxes. For an officer with 6 years of service, it means
    about $22 per month. This does not mean that overall pay raises are the
    wrong answer--simply that they are not the best answer when the general
    status of pay is healthy as it is today. With the great help of this
    Subcommittee, we have elevated military pay above the 70th percentile
    for similarly educated and experienced workers in the private sector--
    well into the top third of earners--and that shows up in the types of
    strong retention we have witnessed in recent years. For that reason, we
    feel strongly that, while we never can offer enough to offset
    sacrifices of the military and their families, we are in a generally
    solid position. But we are not in a solid position in certain hard to
    fill and hard to keep areas like Special Operations.
        Furthermore, the Services continue to face challenges in recruiting
    and retaining certain health professionals so vital to a nation in
    battle. Certain skill sets are very troublesome. For example, the
    nature of injuries in Afghanistan and Iraq has increased demand for
    mental health professionals, yet physicians holding that skill are in
    short supply nationwide. Here, again, we must and we do turn to S&I
    pays to preserve our military effectiveness. In 2009, the Department
    implemented the special bonus and incentive pay authorities for
    officers in health professions as provided in the 2008 National Defense
    Authorization Act. These incentives have improved staffing in
    behavioral health, social workers and psychologists. Additionally, in
    2009 the Health Professions Scholarship Program (HPSP) filled all
    medical and dental student positions by offering an Officer Critical
    Skills Accession Bonus. This will greatly assist in meeting future
    medical and dental recruiting goals. It will save lives.
        Remaining with the health area, the Services continue to witness
    shortages in general dentistry and nursing specialties. To attack and
    control that problem, we continually monitor, adjust and expand medical
    special pay plans and bonus structures. For example, to attract general
    dentists in 2010, the Army has an accession bonus of $75,000 for a 4-
    year active duty service obligation. Each Service also offers loan
    repayment programs to recruit and retain general dentists. As for
    nurses, the Services offer a 3- or 4-year accession bonus, a loan
    repayment option, or a combination of the two to attract nurses. An
    advanced nursing training program is another tool the Service to
    recruit nurses. Currently the Department offers an incentive special
    pay to several nursing specialty and a nurse anesthetists incentive pay
    for retention contracts of 1 to 4 years. Due to a continuing shortfall
    for nurse anesthetists, the incentive pay next year for a 4-year
    retention contract will increase to $50,000.
        Turning now from occupations to military components: We know that
    setting compensation at an appropriate level is critical to sustainment
    of a robust Guard and Reserve. We remain attentive to the need to treat
    Active and Reserve colleagues equitably. For example, while on active
    duty for more than 30 continuous days, Guard and Reserve members are
    paid the same as Active members. Congress and the Department have
    worked closely to ensure that reservists are not financially
    disadvantaged when involuntarily called to active duty. In 2006,
    Congress authorized the Reserve Income Replacement Program, enabling
    reservists to maintain the same or nearly the same monthly income. In
    2009, Congress created the reservist Differential Pay Program, an
    additional income replacement program to cover all Federal Government
    employees, further strengthening the Total Force. Congress has also
    recognized the sacrifices of mobilized Guard and Reserve members by
    reducing the retirement age for qualifying service in support of
    contingency operations. Furthermore, the 11th Quadrennial Review of
    Military Compensation has been tasked by President Obama to
    specifically review Guard and Reserve compensation.
        Let me now turn from money paid today to the many non-cash and
    deferred benefits. Non-cash benefits include medical, education,
    commissary, and Morale, Welfare, and Recreation benefits. These are
    critical to maintaining quality of life for members and families,
    directly influencing the family's impression of the military life, and
    more directly, the retention decision that emerges from that
    impression. Deferred compensation, namely the retirement program,
    provides a strong retention incentive, particularly for personnel with
    over 10 years of service. We recognize non-cash and deferred benefits
    are important components in the total compensation package.
        In summary, Mr. Chairman and members of this subcommittee--you who
    have so aggressively and attentively watched over our military--I
    underscore the Department's request for a basic pay increase of 1.4
    percent since it well maintains compensation levels competitive with
    the private sector. But for all the reasons just enumerated, we ask
    your special consideration this year in supporting our S&I pay program
    since that specific act will make sure the Department is able to
    channel resources where needed as the Nation's economy moves forward
    and pockets of critical--and often unexpected--shortages emerge. I
    thank you again for the opportunity to testify and for your continued
    support of our military members and their families. I look forward to
    your questions.

        Senator Webb. Thank you very much, Mr. Carr.
        Ms. Farrell, welcome.

    STATEMENT OF BRENDA S. FARRELL, DIRECTOR, DEFENSE CAPABILITIES
            AND MANAGEMENT, GOVERNMENT ACCOUNTABILITY OFFICE

        Ms. Farrell. Mr. Chairman, Senator Chambliss, thank you for
    the opportunity to be here today to discuss our most recent
    report on military compensation.
        The NDAA for Fiscal Year 2010 required that GAO conduct a
    study comparing the pay and benefits of military servicemembers
    with those of comparably situated private-sector employees to
    assess how the difference in pay and benefits affect recruiting
    and retention of military servicemembers. Our work focused on
    servicemembers' perspectives on compensation--that is, cash
    compensation and the value of benefits to the servicemembers--
    rather than the cost to the government of providing
    compensation.
        My written statement today summarizes the findings of our
    report, issued earlier this month, that you mentioned in your
    opening statement. Now I will briefly discuss my written
    statement that is presented in three parts.
        The first part of the written statement highlights that
    total military compensation for Active Duty members is broad
    and difficult to assess. DOD provides Active Duty
    servicemembers with a comprehensive package that includes cash,
    such as basic pay; noncash, such as healthcare; and deferred
    compensation, such as retirement pension.
        CBO, RAND, and CNA all have assessed military compensation
    using varying approaches. All of their studies include some
    components of compensation; for example, cash compensation
    beyond basic pay, which includes housing and subsistence
    allowances, the Federal income tax advantage, and, when
    possible, S&I pays. However, these studies did not assess all
    components of compensation offered to servicemembers. Thus, the
    results of the studies differ based on what is being assessed,
    the methodology used to conduct the assessment, and the
    components of compensation included in the calculation.
    Furthermore, the valuation rates of noncash and deferred
    benefits proved more difficult to determine than cash
    compensation, because servicemembers value these benefits
    differently and varying assumptions have to be made to assign
    value.
        The second part of my written statement addresses comparing
    private-sector compensation for civilians with those of
    military personnel. We found that military compensation
    generally compares favorably with civilian compensation in
    studies. But, these comparisons present limitations. While
    these studies and comparisons between military and civilian
    compensation, in general, provide policymakers with some
    insight into how well military compensation is keeping pace
    with overall civilian compensation, we believe such broad
    comparisons are not sufficient indicators for determining the
    appropriateness of military compensation levels. For example,
    the mix of skills, education, and experience can differ between
    the comparison groups, making direct comparisons of salary and
    earnings difficult.
        The third part of my statement addresses the 10th QRMC's
    recommendation to include not only regular military
    compensation, but also select benefits, when comparing. This
    recommendation appears reasonable to us, because it provides a
    complete measure of military compensation than considering only
    the cash compensation. Given the large portion of servicemember
    compensation that is comprised of noncash and deferred
    benefits, the 10th QRMC emphasized that taking these additional
    components of compensation into account shows that
    servicemember compensation is generous, relative to civilian
    compensation; more so than the traditional comparison of
    regular military compensation suggests. The 10th QRMC found
    that when some benefits were included, military compensation
    compared approximately with the 80th percentile of the
    comparable civilian compensation. That is, 80 percent of the
    comparable civilian population earn less than the military
    population in the comparison.
        In summary, I would like to emphasize that another key
    indicator of the appropriateness and adequacy of military
    compensation is DOD's ability to recruit and retain personnel.
    Since 1982, DOD has only missed its overall annual recruiting
    target three times: in 1998, 1999, and in 2005.
        Certain specialties, such as medical personnel, continue to
    experience recruiting and retention challenges. Permanent
    across-the-board pay increases may not be seen as the most
    efficient recruiting and retention mechanism. The use of
    targeted bonuses may be more appropriate for meeting DOD's
    requirements for selected specialties where DOD faces
    challenges in recruiting and retaining sufficient numbers of
    personnel.
        Mr. Chairman, that completes my opening remarks.
        [The prepared statement of Ms. Farrell follows:]
                    Prepared Statement by Brenda S. Farrell
        Mr. Chairman and members of the subcommittee:
        Thank you for providing me this opportunity to discuss our most
    recent report on military and civilian pay comparisons and the
    challenges associated with those types of comparisons.\1\ The
    Department of Defense's (DOD) military compensation package, which is a
    myriad of pays and benefits, is an important tool for attracting and
    retaining the number and quality of active duty servicemembers DOD
    needs to fulfill its mission. Since DOD transitioned to an All-
    Volunteer Force in 1973, the amount of pay and benefits that
    servicemembers receive has progressively increased.\2\ When it is
    competitive with civilian compensation, military compensation can be
    appropriate and adequate to attract and retain servicemembers. However,
    comparisons between the two involve both challenges and limitations.
    Specifically, as we have previously reported,\3\ no data exist that
    would allow an exact comparison between military and civilian personnel
    with the same levels of work experience. Also, nonmonetary
    considerations complicate such comparisons, because their value cannot
    be quantified. For example, military service is unique in that the
    working conditions for active duty service carry the risk of death and
    injury during wartime and the potential for frequent, long deployments,
    unlike most civilian jobs.
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        \1\ GAO, Military Personnel: Military and Civilian Pay Comparisons
    Present Challenges and Are One of Many Tools in Assessing Compensation,
    GAO-10-561R (Washington, DC: Apr. 1, 2010).
        \2\ Historically, ``basic pay'' has been the largest component of
    military compensation, and is paid to all servicemembers according to
    their respective rank and years of service. Congress has provided for
    and DOD has also implemented over the years a number of additional
    benefits--some of which may be deferred until after the completion of
    active duty service. An example is the Post-September 11 Veterans
    Educational Assistance Act, which expanded the education benefits
    available to qualified Active Duty and Reserve component members.
        \3\ GAO, Military Compensation: Comparisons With Civilian
    Compensation and Related Issues, NSIAD-86-131BR (Washington, DC: June
    5, 1986) and GAO-10-561R.
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        In addition, there is variability among past studies in how
    compensation is defined (for example, either pay or pay and benefits)
    and what is being compared. Most studies, including those done by the
    Congressional Budget Office (CBO) and RAND Corporation, have compared
    military and civilian compensation but limit such comparisons to cash
    compensation--using what DOD calls regular military compensation--and
    do not include benefits.\4\ DOD has also conducted studies comparing
    military and civilian compensation as part of its Quadrennial Review of
    Military Compensation (QRMC)--a review required by law, every 4 years,
    of the principles and concepts of the compensation system for members
    of the uniformed services.\5\ The 2008 QRMC (the 10th) focused on seven
    compensation-related areas, including the adequacy of compensation, and
    it recommended, among other things, the inclusion of both cash and some
    benefits--such as health care--when assessing military compensation.
    The 10th QRMC also found that, when some benefits were included,
    military compensation compared approximately with the 80th percentile
    of comparable civilian compensation--that is, that 80 percent of the
    comparable civilian population earned less than the military population
    in the comparison. Previously, the 2004 QRMC (the 9th) found that
    regular military compensation met the 70th percentile of comparable
    civilian cash compensation.
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        \4\ Regular military compensation is the sum of basic pay,
    allowances for housing and subsistence, and the Federal income tax
    advantage--which is the value a servicemember receives from not paying
    Federal income tax on allowances for housing and subsistence. It was
    initially constructed by the Gorham Commission in 1962 as a rough
    yardstick to be used to compare military and civilian-sector pay.
        \5\ 37 U.S.C. Sec. 1008.
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        The National Defense Authorization Act for Fiscal Year 2010
    required that we conduct a study comparing the pay and benefits
    provided by law to members of the Armed Forces with those of comparably
    situated private-sector employees, to assess how the differences in pay
    and benefits affect recruiting and retention of members of the Armed
    Forces.\6\ Earlier this month, we issued our report.\7\ My testimony
    today summarizes the findings of that report. Specifically, my
    statement will: (1) examine total military compensation for active duty
    officers and enlisted personnel; (2) compare private-sector pay and
    benefits for civilians with those of officers and enlisted personnel of
    the Armed Forces; and (3) assess the 10th QRMC's recommendation to
    include regular military compensation and select benefits when making
    such comparisons.
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        \6\ Pub. L. No. 111-84, Sec.  606 (2009).
        \7\ GAO-10-561R.
    ---------------------------------------------------------------------------
        We focused our work on active duty servicemembers' perspectives on
    compensation--that is, cash compensation and the value of benefits to
    servicemembers versus the costs to the government of providing
    compensation. To conduct our work, we identified and reviewed studies
    on compensation by such organizations as CNA Corporation (CNA), CBO,
    the Congressional Research Service, DOD, GAO, and RAND. We interviewed
    officials from DOD's Office of the Under Secretary of Defense for
    Personnel and Readiness, including the Deputy Under Secretary of
    Defense for Military Personnel Policy and officials within the
    Directorate of Compensation, as well as officials from CNA, CBO, the
    Defense Manpower Data Center, the Bureau of Labor Statistics, and the
    Military Officers Association of America. To assess total military
    compensation, we reviewed a 2008 DOD-commissioned report \8\--completed
    by CNA--and identified estimated values for the elements of military
    compensation (that is, regular military compensation, health care,
    retirement, and additional tax advantages). We also identified the
    employee benefits available to active duty servicemembers and used DOD
    survey data to identify the utilization rates of these benefits by
    servicemembers. To compare military compensation with private-sector
    pay and benefits of comparable civilians, we used CNA's report to
    identify estimated values for private-sector compensation--pay and
    benefits--for comparable civilians. In addition, we reviewed the
    methods CNA used to estimate values for several benefits--retirement,
    health care, and additional tax advantages.\9\ Finally, to assess the
    10th QRMC's recommendation to include regular military compensation and
    select benefits when comparing military and civilian compensation, we
    conducted a review of recent literature on compensation--including
    regular military compensation and select benefits--and interviewed DOD
    officials and other knowledgeable individuals in the fields of
    compensation and human capital management. We conducted our work in
    accordance with generally accepted government auditing standards. Those
    standards require that we plan and perform the audit to obtain
    sufficient, appropriate evidence to provide a reasonable basis for our
    findings and conclusions based on our audit objectives. We believe that
    the evidence obtained provides a reasonable basis for our findings and
    conclusions based on our audit objectives.
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        \8\ James E. Grefer, CNA Corporation, Comparing Military and
    Civilian Compensation Packages (Alexandria, VA: March 2008).
        \9\ For example, servicemembers do not pay Federal Insurance
    Contributions Act (FICA) tax and State tax on their housing and
    subsistence allowances.
    ---------------------------------------------------------------------------
       total military compensation for active duty officers and enlisted
                   personnel is broad and difficult to assess
        DOD provides active duty servicemembers with a comprehensive
    compensation package that includes a mix of cash, such as basic pay;
    noncash benefits, such as health care; and deferred compensation, such
    as retirement pension. The foundation of each servicemember's
    compensation is regular military compensation, which consists of basic
    pay, housing allowance, subsistence allowances, and Federal income tax
    advantage. The amount of cash compensation that a servicemember
    receives varies according to rank, tenure of service, and dependency
    status. For example, a hypothetical servicemember with 1 year of
    service at the rank of O-1 and no dependents would currently receive an
    annual regular military compensation of $54,663, whereas a hypothetical
    servicemember with 4 years of service at the rank of E-5 and one
    dependent would receive an annual regular military compensation of
    $52,589.\10\ In addition to cash compensation, DOD offers current and
    retired servicemembers a wide variety of noncash benefits. These range
    from family health care coverage and education assistance to
    installation-based services, such as child care, youth, and family
    programs.
    ---------------------------------------------------------------------------
        \10\ These estimates come from DOD's regular military compensation
    calculator, available at http://militarypay.defense.gov/mpcalcs/
    Calculators/RMC.aspx.
    ---------------------------------------------------------------------------
        While many studies of active duty military compensation have
    attempted to assess the value of the compensation package, most did not
    consider all of the components of compensation offered to
    servicemembers. CBO, RAND, and CNA have assessed military compensation
    using varying approaches. All of their studies include some components
    of compensation--for example, cash compensation beyond basic pay, which
    includes housing and subsistence allowances, the Federal income tax
    advantage, and, when possible, special and incentive pay. However,
    these studies did not assess all components of compensation offered to
    servicemembers. Thus, the results of these studies differ based on what
    is being assessed, the methodology used to conduct the assessment, and
    the components of compensation included in the calculations.
        The most recent study, a 2008 DOD-sponsored study performed by CNA,
    assessed military compensation using regular military compensation and
    some benefits (specifically, health care, the military tax advantage,
    and retirement benefits).\11\ In particular, the results of this study
    state that in 2006, average enlisted servicemembers' compensation
    ranged from approximately $40,000 at 1 year of service to approximately
    $80,000 at 20 years of service.\12\ Additionally, in 2006 the average
    officers' compensation ranged from approximately $50,000 at 1 year of
    service to approximately $140,000 at 20 years of service. Our analysis
    of CNA's 2008 study found that overall, CNA used a reasonable approach
    to assessing military compensation; however, we provided comments on
    two issues. In general, we agree that when assessing military
    compensation for the purpose of comparing it with civilian
    compensation, it is appropriate to include regular military
    compensation and benefits (as many as can be reasonably valued from the
    servicemembers' perspective). For example, in order to value health
    care, CNA estimated the difference in value between military and
    civilian health benefits, because servicemembers receive more
    comprehensive health care than most civilians.\13\
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        \11\ CNA was commissioned by the 10th QRMC to conduct a study
    comparing military and civilian compensation. The results of the study
    were used by the QRMC. Typically, discussions of the military tax
    advantage focus on the savings that arise because the allowances for
    housing and subsistence are not subject to Federal income tax. However,
    CNA's study also included an estimation of the expected annual tax
    advantage that servicemembers receive because they do not pay State and
    FICA taxes on their housing and subsistence allowances and can often
    avoid paying any State income taxes depending on their State home of
    record.
        \12\ We did not verify the calculations underlying CNA's reported
    estimates of the value of these select benefits.
        \13\ Specifically, active duty servicemembers are automatically
    enrolled in TRICARE Prime and do not pay premiums or out-of-pocket
    expenses for their healthcare whereas many civilians do not receive any
    health care benefits from their employers and even those who do usually
    pay some out-of-pocket expenses and part of the premium. By calculating
    the amount that the typical civilian worker pays for premiums and out-
    of-pockets expenses, CNA found the difference between what civilians
    and servicemembers pay. In other words, the benefit servicemembers
    receive is avoiding the costs civilians would have to pay to receive
    comparable health care.
    ---------------------------------------------------------------------------
        As mentioned previously, we identified two areas for comment with
    regard to CNA's approach. First, with regard to retirement, health
    care, and tax advantage, CNA's methodology makes various assumptions
    that allow the study to calculate approximate values for these
    benefits. While the assumptions are reasonable, we note that other,
    alternative assumptions could have been made, and thus, in some cases,
    could have generated substantially different values.\14\ Second, the
    CNA study omits the valuation of retiree health care, which is a
    significant benefit provided to servicemembers. Nevertheless, we note
    that CNA's study and other studies of military compensation illustrate
    that valuing total military compensation from a servicemember's
    perspective is challenging, given the variability across the large
    number of pays and benefits, the need to make certain assumptions to
    estimate the value of various benefits, and the utilization of benefits
    by servicemembers or their dependents, among other reasons.
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        \14\ For example, when applying discount rates to value retirement
    benefits, the rate assumed affects the value of the retirement. To
    illustrate, if a person is to receive $100 in 20 years, the present
    value of that money is $3.65 using 18 percent, $10.37 using 12 percent,
    or $31.18 using 6 percent.
    ---------------------------------------------------------------------------
       military compensation generally compares favorably with civilian
       compensation in studies, but these comparisons present limitations
        In comparing military and civilian compensation, CNA's study as
    well as a 2007 CBO study,\15\ found that military pay generally
    compares favorably with civilian pay. CNA found that in 2006, regular
    military compensation for enlisted personnel averaged $4,700 more
    annually than comparable civilian earnings. Similarly, CNA found that
    military officers received an average of about $11,500 more annually
    than comparable civilians. Further, CNA found that the inclusion of
    three military benefits--health care, retirement, and the additional
    tax advantage for military members--increased the differentials by an
    average of $8,660 annually for enlisted servicemembers and $13,370
    annually for officers. A 2007 CBO study similarly found that military
    compensation compares favorably with civilian compensation. For
    example, CBO's report suggested that DOD's goal to make regular
    military compensation comparable with the 70th percentile of civilian
    compensation has been achieved. We note that the major difference
    between the two studies lies in their definitions of compensation. CNA
    asserted, and we agree, that the inclusion of benefits allows for
    comparisons of actual levels of compensation and provides some useful
    comparison points for determining whether servicemembers are
    compensated at a level that is comparable to that of their civilian
    peers, although the caveats that we discuss below should be considered.
    CBO also noted, and we agree, that including benefits can add another
    level of complexity to such analytical studies.
    ---------------------------------------------------------------------------
        \15\ CBO, Evaluating Military Compensation (Washington, DC: June
    2007).
    ---------------------------------------------------------------------------
        However, while these studies and comparisons between military and
    civilian compensation in general provide policymakers with some insight
    into how well military compensation is keeping pace with overall
    civilian compensation, we believe that such broad comparisons are not
    sufficient indicators for determining the appropriateness of military
    compensation levels. For example, the mix of skills, education, and
    experience can differ between the comparison groups, making direct
    comparisons of salary and earnings difficult. While some efforts were
    made by CNA to control for age (as a proxy for years of experience) and
    broad education levels, CNA did not control for other factors, such as
    field of degree or demographics (other than age), that we feel would be
    needed to make an adequate comparison. As another example, one approach
    that is sometimes taken to illustrate a difference, or ``pay gap,''
    between rates of military and civilian pay is to compare over time
    changes in the rates of basic pay with changes in the Employment Cost
    Index.\16\ We do not believe that such comparisons demonstrate the
    existence of a pay gap or facilitate accurate comparisons between
    military and civilian compensation because they assume that military
    basic pay is the only component of compensation that should be compared
    to changes in civilian pay and exclude other important components of
    military compensation, such as the housing and subsistence allowances.
    We note that CBO also previously discussed three other shortcomings of
    making such comparisons in a 1999 report.\17\ Specifically, CBO noted
    that such comparisons: (1) select a starting point for the comparison
    without a sound analytic basis; yet the results of the pay gap
    calculation are very sensitive to changes in that starting point; (2)
    do not take into account differences in the demographic composition of
    the civilian and military labor forces; and (3) compare military pay
    growth over one time period with a measure of civilian pay growth over
    a somewhat different period.
    ---------------------------------------------------------------------------
        \16\ The Employment Cost Index is a nationally representative
    measure of labor cost for the civilian economy and measures changes in
    wages and employers' costs for employee benefits.
        \17\ CBO, What Does the Military ``Pay Gap'' Mean? (Washington, DC:
    June 1999).
    ---------------------------------------------------------------------------
    10th qrmc's recommendation to include regular military compensation and
       select benefits when comparing military and civilian compensation
                               appears reasonable
        The 10th QRMC's recommendation to include regular military
    compensation and select benefits when comparing military and civilian
    compensation appears reasonable to us because it provides a more
    complete measure of military compensation than considering only cash
    compensation.\18\ Given the large proportion of servicemember
    compensation that is comprised of in-kind and deferred benefits, the
    10th QRMC emphasized that taking these additional components of
    compensation into account shows that servicemember compensation is
    generous relative to civilian compensation--more so than traditional
    comparisons of regular military compensation suggest.\19\ The 10th QRMC
    also recommended that in order to maintain the standard established by
    the 9th QRMC's 70th percentile (which includes only regular military
    compensation), DOD adopt the 80th percentile as its goal for military
    compensation when regular military compensation and the value of some
    benefits, such as health care, are included in the analysis. In
    general, when comparing military and civilian compensation, a more
    complete or appropriate measure of compensation should include cash and
    benefits. When considering either a military or a civilian job, an
    individual is likely to consider the overall compensation--to include
    pay as well as the range and value of the benefits offered between the
    two options. The challenge with this approach, as mentioned previously,
    lies in determining how to ``value'' the benefits, and which benefits
    to include in the comparison.
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        \18\ According to senior officials in the Office of the Under
    Secretary of Defense for Personnel and Readiness' Directorate of
    Compensation, the department has not yet adopted the 10th QRMC's
    recommendation of including benefits in comparing military and civilian
    compensation, thus setting the department's overall compensation goal
    at the 80th percentile of comparable civilian employees.
        \19\ According to 2005 and 2007 GAO reports, about half of active
    duty compensation costs consist of benefits, as compared with about 18
    percent in the private sector and about 33 percent for Federal civilian
    employees. See GAO, Military Personnel: DOD Needs to Improve the
    Transparency and Reassess the Reasonableness, Appropriateness,
    Affordability, and Sustainability of Its Military Compensation System,
    GAO-05-798 (Washington, DC: July 19, 2005), and Military Personnel: DOD
    Needs to Establish a Strategy and Improve Transparency over Reserve and
    National Guard Compensation to Manage Significant Growth in Cost, GAO-
    07-828 (Washington, DC: June 20, 2007).
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        Prior to issuing our report earlier this month the Deputy Under
    Secretary of Defense for Military Personnel Policy provided us with
    oral comments on a draft of the report. The Deputy Under Secretary
    generally agreed with our findings, noting that numerous studies have
    attempted to estimate the value military members place on noncash and
    deferred benefits and that each study has found that identifying
    relevant assumptions, valuing these benefits, and finding appropriate
    benchmarks and comparisons are significant challenges. Noting the
    variation in the results of these studies, the Deputy Under Secretary
    stated that further study is necessary before DOD is willing to
    consider measuring and benchmarking military compensation using a
    measurement that incorporates benefits.
        While comparisons between military and civilian compensation are
    important management measures, they alone do not necessarily indicate
    the appropriateness or adequacy of compensation. Another measure is
    DOD's ability to recruit and retain personnel. We have reported in the
    past that compensation systems are tools used for recruiting and
    retention purposes.\20\ Similarly, in 2009, CBO stated that ultimately,
    the best barometer of the effectiveness of DOD's compensation system is
    how well the military attracts and retains high-quality, skilled
    personnel.\21\ Since 1982, DOD has only missed its overall annual
    recruiting target three times--in 1998 during a period of very low
    unemployment, in 1999, and most recently in 2005. Given that: (1) the
    ability to recruit and retain is a key indicator of the adequacy of
    compensation; and (2) DOD has generally met its overall recruiting and
    retention goals for the past several years, it appears that regular
    military compensation is adequate at the 70th percentile of comparable
    civilian pay as well as at the 80th percentile when additional benefits
    are included. We note that although the services have generally met
    their overall recruiting goals in recent years, certain specialties,
    such as medical personnel, continue to experience recruiting and
    retention challenges. As a result, permanent, across-the-board pay
    increases may not be seen as the most efficient recruiting and
    retention mechanism. In fact, our previous work has shown that use of
    targeted bonuses may be more appropriate for meeting DOD's requirements
    for selected specialties where DOD faces challenges in recruiting and
    retaining sufficient numbers of personnel.\22\
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        \20\ GAO, Military Personnel: Active Duty Benefits Reflect Changing
    Demographics, but Opportunities Exist to Improve, GAO-02-935
    (Washington, DC: Sept. 18, 2002).
        \21\ CBO, Statement of Matthew S. Goldberg: Long-Term Implications
    of the Department of Defense's fiscal year 2010 Budget Submission
    (Washington, DC: Nov. 18, 2009).
        \22\ GAO, Military Personnel: Observations Related to Reserve
    Compensation, Selective Reenlistment Bonuses, and Mail Delivery to
    Deployed Troops, GAO-04-582T (Washington, DC: Mar. 24, 2004); Military
    Personnel: DOD Needs More Effective Controls to Better Assess the
    Progress of the Selective Reenlistment Bonus Program, GAO-04-86
    (Washington, DC: Nov. 13, 2003); Military Personnel: DOD Needs More
    Data to Address Financial and Health Care Issues Affecting reservists,
    GAO-03-1004 (Washington, DC: Sept. 10, 2003); and Human Capital:
    Effective Use of Flexibilities Can Assist Agencies in Managing Their
    Workforces, GAO-03-2 (Washington, DC: Dec. 6, 2002).
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                            concluding observations
        In closing, we note that comparisons between military and civilian
    compensation are important management tools--or measures--for the
    department to use to assess the adequacy and appropriateness of its
    compensation. However, such comparisons present both limitations and
    challenges. For example, data limitations and difficulties valuing
    nonmonetary benefits prevent exact comparisons between military and
    civilian personnel. Moreover, these comparisons represent points in
    time and are affected by other factors, such as the health of the
    economy. To illustrate, it is not clear the degree to which changes in
    the provision of civilian health care or retirement benefits affect the
    outcome of comparing military and civilian compensation. In addition,
    valuing military service is complicated. While serving in the military
    offers personal and professional rewards, such service also requires
    many sacrifices--for example, frequent moves and jobs that are arduous
    and sometimes dangerous. Ultimately, DOD's ability to recruit and
    retain personnel is an important indicator of the adequacy--or
    effectiveness--of its compensation.
        Mr. Chairman, this concludes my prepared statement. I would be
    happy to respond to any questions that you or members of the
    subcommittee may have at this time.

        Senator Webb. Thank you very much, Ms. Farrell.
        Welcome, Dr. Murray.

       STATEMENT OF CARLA TIGHE MURRAY, SENIOR ANALYST, NATIONAL
             SECURITY DIVISION, CONGRESSIONAL BUDGET OFFICE

        Dr. Murray. Mr. Chairman, Senator Chambliss, I appreciate
    the opportunity to discuss CBO's analysis of compensation for
    members of the Armed Forces.
        I've provided a written statement for the record which
    gives more detail, and so, I'll simply outline my points here.
        To attract and retain the military personnel it needs, DOD
    must offer a competitive compensation package, one that
    adequately rewards servicemembers for their training and
    skills, as well as for the rigors of military life,
    particularly the prospect of wartime deployment.
        The best barometer of effectiveness of DOD's compensation
    system may be how well the military attracts and retains high
    quality personnel. However, the relationship between specific
    changes in pay and benefits, and the amount of recruiting and
    retention, may not be clear. A variety of factors, including
    economic conditions, may affect DOD's ability to attract and
    retain the force it needs. Therefore, it is difficult to
    determine the appropriate increase in pay solely on the basis
    of patterns of recruiting and retention.
        Another way to determine whether military compensation is
    competitive is to compare it with civilian compensation. This
    testimony will focus primarily on such comparisons, which can
    be useful, but not definitive, in part because of the
    significant differences in working conditions and benefits
    between military and civilian jobs.
        Today, I will address three questions. The first question
    is: how does military cash compensation compare with civilian
    wages and salaries? CBO's most recent analysis for calendar
    year 2006 found that average cash compensation for
    servicemembers, including the tax-free cash allowances for
    housing and subsistence, was greater than that of more than 75
    percent of civilians of comparable age and educational
    achievement. Since then, military pay raises have continued to
    exceed increases in civilian wages and salaries. So, that
    finding has not changed.
        Second, is there a gap between civilian and military pay
    raises over the past few decades? The answer depends on how
    narrowly military cash pay is defined. One frequent method
    compares the cumulative increases in military basic pay with
    civilian pay raises. Applying that method would indicate that
    military pay rose by about 2 percent less than civilian
    earnings since 1982. But, this method does not encompass the
    full scope of military cash compensation. Using a broader
    measure, one which includes housing and subsistence allowances,
    indicates that the cumulative increase in military compensation
    has exceeded the cumulative increase in civilian wages and
    salaries by 11 percent since 1982. That comparison does not
    include noncash and deferred compensation, which would probably
    add to the cumulative difference.
        Third, how would the costs of using bonuses to enhance
    recruiting and retention compare with the costs of adding more
    to basic pay? Changing the basic pay raise that would take
    effect on January 1, 2011, from the 1.4 percent requested by
    the President to 1.9 percent, for example, would increase DOD's
    costs by about $350 million in 2011, and by a total of about
    $2.4 billion through 2015. A larger pay raise would probably
    enhance enlistment and retention, although the effect would be
    small.
        One alternative would be to increase cash bonuses by enough
    to achieve the same retention effects as a higher across-the-
    board pay raise. That approach would have a smaller impact on
    DOD's costs, because bonuses can be targeted to servicemembers
    who possess the occupational skills the military needs most.
    Unlike pay raises, bonuses do not compound from year to year or
    affect retirement pay and other elements of compensation.
        Thank you, and I look forward to answering your questions.
        [The prepared statement of Dr. Murray follows:]
                  Prepared Statement by Dr. Carla Tighe Murray
        Mr. Chairman, Senator Graham, and members of the subcommittee, I
    appreciate the opportunity to discuss the Congressional Budget Office's
    (CBO) analysis of compensation for members of the armed forces. To
    attract and retain the military personnel it needs, the Department of
    Defense (DOD) must offer a competitive compensation package--one that
    adequately rewards servicemembers for their training and skills as well
    as for the rigors of military life, particularly the prospect of
    wartime deployment.
        The best barometer of the effectiveness of DOD's compensation
    system may be how well the military attracts and retains high-quality
    personnel. Between 2005 and 2008, the Services periodically had trouble
    recruiting or retaining all of the high-quality personnel they
    needed.\1\ To address those problems, Congress authorized increases in
    both cash compensation (such as pay raises and bonuses) and noncash
    compensation (such as expanded education benefits for veterans and
    their families). All of the Services met their recruiting and retention
    goals in 2009 and are continuing to do so in 2010. However, the
    relationship between specific changes in pay rates and benefits and the
    amount of recruiting and retention is not clear, and changes in
    recruiting and retention may be too gradual or too ambiguous to guide
    all decisions about compensation. In particular, a variety of factors--
    including economic conditions--may have significant effects on DOD's
    ability to recruit and retain personnel during a given period.
    Therefore, it is difficult to determine the appropriate increase in
    compensation solely on the basis of recent patterns of recruiting and
    retention.
    ---------------------------------------------------------------------------
        \1\ Congressional Budget Office, Recruiting, Retention, and Future
    Levels of Military Personnel (October 2006). Data for later years come
    from DOD's Directorate for Accession Policy and Directorate for Officer
    and Enlisted Personnel Management.
    ---------------------------------------------------------------------------
        Even when overall goals for recruiting and retention are met,
    shortages or surpluses may exist in specific occupations or among
    people with certain years of service or rank. In those cases, the
    military services have other tools at their disposal. For example, they
    can enhance their efforts to attract recruits and can fine-tune their
    bonus programs to retain existing personnel who possess particular
    occupational skills.
        Another way to determine whether military compensation is
    competitive is to compare it with civilian compensation. This testimony
    will focus primarily on such comparisons--which can be useful but not
    definitive, in part because of the significant differences in working
    conditions and benefits between military and civilian jobs.
        My remarks today will address three questions:

             How does military cash compensation compare with
            civilian wages and salaries?

        CBO's most recent analysis, for calendar year 2006, found that
    average cash compensation for servicemembers (including tax-free cash
    allowances for housing and food) exceeded the median compensation for
    civilians of comparable age and educational achievement. Since then,
    military pay raises have continued to exceed the increases of civilian
    wages and salaries, so that finding has not changed.

             Is there a ``gap'' between civilian and military pay
            raises over the past few decades?

        The answer depends on how narrowly military cash pay is defined.
    One common method of comparison is to calculate the cumulative
    difference between increases in military and civilian pay using
    military basic pay, a narrow measure of cash compensation that does not
    include, for example, tax-free allowances for housing and food.
    Applying that method would indicate that cumulatively, civilian pay
    rose by about 2 percent more than military pay between 1982 and the
    beginning of 2010. But that measure does not encompass the full scope
    of military cash compensation. Using a broader measure that includes
    cash allowances for housing and food indicates that the cumulative
    increase in military compensation has exceeded the cumulative increase
    in private-sector wages and salaries by 11 percent since 1982. That
    comparison excludes the value of noncash and deferred benefits, which
    would probably add to the cumulative difference, because benefits such
    as military health care have expanded more rapidly than corresponding
    benefits in the private sector.

             How would the costs of using bonuses to enhance
            recruiting and retention compare with the costs of adding more
            to basic pay?

        Traditionally, servicemembers receive an across-the-board increase
    in basic pay each calendar year, and proposals are frequently made to
    boost the rate of increase. Changing the basic-pay raise that will take
    effect on January 1, 2011, from the 1.4 percent requested by the
    President and DOD to 1.9 percent, for example, would increase DOD's
    costs by about $350 million in 2011 and by a total of about $2.4
    billion through 2015, CBO estimates. A larger pay raise would probably
    enhance recruiting and retention, although the effect would be small.
    One possible alternative would be to increase cash bonuses by enough to
    achieve the same recruiting and retention effects as a higher across-
    the-board pay raise. That approach would have a smaller impact on DOD's
    costs because bonuses can be awarded only to the types of
    servicemembers the military needs most. Bonuses can also be focused on
    current personnel or potential enlistees who are at the point of making
    career decisions. Unlike pay raises, bonuses do not compound from year
    to year (a higher pay raise in 1 year will cause the following year's
    raise to be applied to a higher base), and bonuses do not affect
    retirement pay and other elements of compensation.
                     the structure of military compensation
        Earnings can be measured in several different ways, but most
    studies begin with cash compensation. For the military, the narrowest
    measure of cash compensation is basic pay. All members of the armed
    services on active duty receive basic pay, which varies according to
    rank and years of service. A broader measure of cash compensation--
    called regular military compensation (RMC)--consists of basic pay plus
    servicemembers' basic allowances for housing and subsistence, as well
    as the tax advantage that arises because those allowances are not
    subject to Federal income taxes. All personnel are entitled to receive
    RMC, and DOD has used it as a fundamental measure of military pay since
    at least 1962.\2\
    ---------------------------------------------------------------------------
        \2\ Department of Defense, Under Secretary of Defense for Personnel
    and Readiness, Report of the 9th Quadrennial Review of Military
    Compensation, vol. 1 (March 2002), p. 29.
    ---------------------------------------------------------------------------
        While on active duty, servicemembers may also receive various types
    of special pay, incentive pay, bonuses, and allowances that are not
    counted in RMC. Those cash payments help compensate servicemembers for
    unique features of military life. They may be awarded to personnel who
    possess particular skills or undertake hazardous duty, including
    deployment and combat. Personnel may also earn bonus payments when they
    reenlist after completing their contracted term of service, especially
    if they have occupational skills that are in short supply. Because
    those special types of pay are earned irregularly or by a small number
    of specialists, they are generally excluded when comparing military and
    civilian compensation.
        The broadest measure of military compensation includes noncash or
    deferred benefits, such as retirement pay, health care, and veterans'
    benefits. In both the armed forces and civilian jobs, such benefits can
    be sizable and can influence people's decisions about employment,
    including whether to enlist or reenlist in the military. Non-cash
    benefits make up about half of total compensation for the average
    servicemember, CBO estimates--compared with about one-third for the
    average civilian worker. Thus, a measure of compensation that includes
    all noncash and deferred benefits gives a broader and clearer picture
    of the military's entire compensation package and provides a useful
    framework for analyzing servicemembers' cash compensation. However,
    such a comprehensive measure combines funds in different defense
    appropriation titles and in departments other than DOD; thus, it is
    more difficult to use than narrower measures of cash compensation to
    assess a particular department's budget.
                how does military pay compare with civilian pay?
        The results of pay comparisons differ depending on the definition
    of military compensation and the segment of the civilian population
    used in the comparison. Most enlisted personnel join the military soon
    after high school, but they generally receive some college-level
    education while on active duty. (The share of enlisted personnel with
    at least 1 year of college education grew from 32 percent in 1985 to 72
    percent in 2005, CBO estimates.) DOD has asserted that in order to keep
    experienced personnel in the force, military pay must compare favorably
    with the wages of college-educated civilians rather than high school
    graduates. Specifically, DOD's goal has been to make RMC comparable
    with the 70th percentile of earnings for civilians who have some
    college education.\3\
    ---------------------------------------------------------------------------
        \3\ Ibid. Two years ago, DOD's 10th Quadrennial Review of Military
    Compensation developed a new measure of compensation--called military
    annual compensation (MAC)--that would include selected noncash elements
    and deferred compensation. The review's authors recommended making MAC
    comparable to the 80th percentile of civilian earnings (including
    similar noncash elements). DOD has not adopted the new measure and
    continues to use RMC; see, for example, the statement of Clifford L.
    Stanley, Under Secretary of Defense for Personnel and Readiness, before
    the Subcommittee on Personnel, Senate Armed Services Committee, March
    10, 2010.
    ---------------------------------------------------------------------------
        CBO estimated that in calendar year 2006, average basic pay for
    enlisted personnel closely matched the 50th percentile of estimated
    earnings for civilians with some college education--in other words,
    roughly half of those civilians had earnings that were higher than
    average basic pay and half had earnings that were lower.\4\ CBO also
    estimated that average RMC (which includes cash allowances and
    associated tax advantages) exceeded the 75th percentile of earnings for
    civilians with some college education, surpassing DOD's goal. Lawmakers
    have continued to authorize military pay raises that exceed the average
    rise in civilian wages and salaries, so those measures of military
    compensation would probably match higher percentiles of civilian
    earnings today. CBO's study also concluded that servicemembers have
    access to a range of benefits not routinely offered in the private
    sector, including free or low-cost health care, housing, education
    assistance, and discount shopping. Other studies of cash and noncash
    compensation have reached similar conclusions.\5\
    ---------------------------------------------------------------------------
        \4\ Congressional Budget Office, Evaluating Military Compensation
    (June 2007).
        \5\ See Department of Defense, Under Secretary of Defense for
    Personnel and Readiness, Report of the 10th Quadrennial Review of
    Military Compensation, vol. 1 (February 2008); James E. Grefer,
    Comparing Military and Civilian Compensation Packages (Alexandria, VA:
    CNA, March 2008); Government Accountability Office, Military Personnel:
    DOD Needs to Improve the Transparency and Reassess the Reasonableness,
    Appropriateness, Affordability, and Sustainability of Its Military
    Compensation System, GAO-05-798 (July 2005); Beth J. Asch, James Hosek,
    and Craig Martin, A Look at Cash Compensation for Active-Duty Military
    Personnel, MR-1492-OSD (Santa Monica, CA: RAND Corporation, 2002); and
    Congressional Budget Office, Military Compensation: Balancing Cash and
    Noncash Benefits, Issue Brief (January 16, 2004).
    ---------------------------------------------------------------------------
        Comparisons of military and civilian pay have several important
    limitations. First, working conditions can differ markedly between
    military and civilian jobs. For example, military personnel are
    generally expected to change locations every few years--in addition to
    deploying for specific operations--whereas most civilians can choose to
    remain in the same area throughout their career. Military personnel may
    work longer hours or in more hazardous conditions than civilians do,
    even if their type of occupation is the same. At the same time,
    military life includes features that people may find more attractive
    than comparable civilian jobs. Some military personnel receive greater
    responsibility earlier in their career than civilians do. Job security
    and group solidarity can also be greater for military personnel than
    for civilians. Pay comparisons cannot easily incorporate those
    intangible job characteristics.
        Second, pay comparisons may ignore the value of training and
    education that are provided on the job. DOD generally tries to enlist
    capable young people with high school diplomas or some college
    education and then trains them for military life and for their
    occupational specialty. Civilian employers, by contrast, generally hire
    people who have already been trained, often at their own expense
    (although most large employers offer work-related education
    assistance). In addition, civilian employers are more likely to hire
    people who have more experience. Adding in the value of government-
    provided training and education would generally make the noncash share
    of total military compensation even greater relative to civilian
    compensation.
        Third, differences between military and civilian career patterns
    complicate pay comparisons. Because the military ``promotes from
    within,'' pay may need to be higher for new recruits than for civilians
    of similar ages and education levels as DOD tries to compete for the
    best pool of applicants from which to select the best career personnel.
    Also, data on average civilian compensation include the pay of people
    who are successful in their civilian career as well as the pay of
    people who are not. But in the military, the ``up-or-out'' promotion
    system means that the least successful personnel have generally left
    military service before reaching senior levels.
          is there a ``gap'' between military and civilian pay raises?
        Because basic pay makes up the majority of regular military
    compensation, one of the most common comparisons is between changes in
    military basic pay and changes in the employment cost index (ECI) for
    wages and salaries of private-sector workers. In 1981 and 1982,
    relatively large increases in basic pay were enacted to address
    shortfalls in recruiting and retention. For much of the following two
    decades, however, basic pay increased more slowly than the ECI did.
    Some observers have measured the percentage by which the cumulative
    increase in military basic pay since 1982 has fallen short of the
    cumulative increase in the ECI for private-sector wages and salaries,
    referring to that difference as a military ``pay gap.'' By 1998, the
    gap totaled nearly 14 percent (see Figure 1).
        Lawmakers enacted several measures that helped narrow the perceived
    gap. In November 2003, for example, they passed a provision stipulating
    that the increases in basic pay for 2004, 2005, and 2006 exceed the
    corresponding increases in the ECI by 0.5 percentage points.\6\ Each
    year since then, Congress has continued to set the basic-pay raise at
    0.5 percentage points above the increase in the ECI.\7\ As a result,
    the cumulative difference between increases in basic pay and the ECI
    since 1982 has shrunk to a little over 2 percent.
    ---------------------------------------------------------------------------
        \6\ Section 602 of the National Defense Authorization Act for
    Fiscal Year 2004 (117 Stat. 1498, 37 U.S.C. 1009).
        \7\  For example, the President requested a 2.9 percent increase in
    basic pay for 2010, which equaled the percentage increase in the ECI.
    Congress authorized a 3.4 percent pay raise in section 601 of the
    National Defense Authorization Act for Fiscal Year 2010 (123 Stat.
    2347, 37 U.S.C. 1009).
    ---------------------------------------------------------------------------
        As a basis for evaluating pay, however, the gap between military
    and civilian raises since 1982 has some significant limitations.\8\
    First, the ECI is based on a survey that includes a broad sample of
    civilian workers; on average, those workers are older than military
    personnel and more likely to have college degrees. Since 1980, the pay
    of college-educated workers has risen faster than that of high school
    graduates in the civilian sector. Also, the pay of older civilian
    workers has generally grown faster than that of younger workers.
    Because the military mainly recruits young high school graduates, pay
    raises that were smaller than increases in the ECI would not
    necessarily hamper DOD's efforts to attract new personnel.
    ---------------------------------------------------------------------------
        \8\ CBO produced a technical analysis of those limitations in 1999,
    and they continue to exist today. See Congressional Budget Office, What
    Does the Military ``Pay Gap'' Mean? (June 1999).
    ---------------------------------------------------------------------------

        Second, the pay-gap calculation focuses on one part of military
    compensation--basic pay--and ignores changes in other cash and noncash
    components. In 2000, besides raising basic pay, lawmakers authorized a
    restructuring of housing allowances that eliminated out-of-pocket
    expenses typically paid by servicemembers (which had averaged about 20
    percent of housing costs).\9\ Other changes included linking housing
    allowances more closely to increases in local housing prices and giving
    servicemembers ``rate protection'' from any declines in those prices.
    ---------------------------------------------------------------------------
        \9\ Those changes were enacted in section 605 of the National
    Defense Authorization Act for Fiscal Year 2001 (114 Stat. 1654A-147, 37
    U.S.C. 403).
    ---------------------------------------------------------------------------
        With RMC substituted for basic pay in the comparison, the total
    growth in military compensation since 1982 has exceeded the growth in
    the ECI for private-sector wages and salaries by about 11 percent (see
    Figure 1). Including the value of noncash and deferred benefits would
    probably add to that cumulative difference.
       what are the effects of changing basic pay versus awarding higher
                                    bonuses?
        Increasing basic pay in 2011 will affect DOD's budgetary
    requirements in future years. Pay raises compound from 1 year to the
    next, because a higher raise this year will cause next year's rate of
    increase to be applied to a higher base. Changes in basic pay also
    affect other components of compensation, such as retirement pay. CBO
    estimates that increasing the basic-pay raise that will take effect on
    January 1, 2011, from 1.4 percent, as requested by DOD and the
    President, to 1.9 percent would boost DOD's personnel costs by about
    $350 million in 2011 as well as by a total of about $2 billion over the
    following 4 years (see Table 1).
        A higher pay raise would most likely enhance recruiting and
    retention, but the effect would be small. The annual difference between
    a 1.4 percent increase and a 1.9 percent increase in basic pay for the
    average enlisted member is about $150. CBO estimates that roughly 1,000
    people who would not choose to enlist or reenlist in 2011 if basic pay
    rose by 1.4 percent would do so with the higher raise.
        Alternatively, the same result might be accomplished by increasing
    bonuses for enlistment and reenlistment or by stepping up recruiting
    efforts. A bonus program generally requires smaller increases in
    spending than a basic-pay raise does to achieve the same effect on
    recruiting and retention, for several reasons. Bonuses can be targeted
    toward those servicemembers (or potential recruits) whom the military
    needs most. Bonuses do not compound, as pay raises do, and they do not
    affect retirement pay and other elements of compensation. Bonuses also
    do not involve expending resources on servicemembers who do not have
    the option of leaving in a particular year; they can be focused on the
    years of service in which personnel make career decisions and can be
    curtailed if other factors (such as economic conditions or deployment
    requirements) change. In addition, larger bonuses could create more-
    meaningful differences in pay between occupations, which could be a
    cost-effective tool for improving military readiness.
        However, amplifying pay differences between occupations or between
    people at slightly different stages of their career could run counter
    to the longstanding principle of military compensation that personnel
    with similar amounts of responsibility should receive similar pay.
    Also, increasing bonuses rather than adding to basic pay would reduce
    retirement and other benefits for servicemembers relative to what they
    would receive if the extra money was part of basic pay throughout their
    career.

        How much it would cost to attract and retain the same number of
    personnel with bonuses rather than a larger increase in basic pay would
    depend on how the services structured their bonus programs. In any
    event, the lack of compounding means that in 2012 and beyond, virtually
    all servicemembers would have lower overall compensation than they
    would receive with a larger increase in basic pay. That outcome could
    also affect recruiting and retention in future years. If DOD wanted to
    attain the same levels of recruiting and retention as it would achieve
    with the higher basic pay, an augmented bonus program would need to
    continue in future years as well.

        Senator Webb. Thank you very much, Dr. Murray.
        Dr. Hosek, welcome.

      STATEMENT OF JAMES R. HOSEK, DIRECTOR, FORCES AND RESOURCES
        POLICY CENTER, RAND NATIONAL SECURITY RESEARCH DIVISION

        Dr. Hosek. I would like to thank the committee for the
    opportunity to testify.
        I will address my comments to the usefulness of incentive
    pays, such as bonuses, in influencing career decisions of
    servicemembers.
        To summarize my main points, research consistently finds
    that people are responsive to enlistment and reenlistment
    bonuses. Bonuses expand the recruiting market, channel
    enlistees into hard-to-fill occupations, reduce attrition, and
    increase reenlistment. Because bonuses and other incentive pays
    can be targeted and increased or decreased in value, they can
    be a flexible, cost-effective element of military compensation.
        The health of the AVF depends on maintaining an adequate
    foundation of compensation. The foundational pays of military
    compensation include basic pay, allowances, health benefits,
    educational benefits, and retirement benefits. These pays and
    benefits help to ensure that the Services can recruit, retain,
    and motivate the number and caliber of people they need to meet
    manpower requirements, as well as produce future leaders and
    shape the force. However, it is not cost-effective to pay
    servicemembers only through foundational pays, but through a
    combination of foundational pays and incentive pays.
        The relevance of this observation to policy action depends
    on the state of the economy. In 1999, when unemployment was low
    and jobs were plentiful, recruiting and retention were hampered
    by low military pay, and the basic pay increases enacted at
    that time were an effective response. Today, the economy is
    climbing out of a deep recession, the unemployment rate is
    high, and job opportunities are expected to improve only
    gradually during the coming year. These conditions have helped
    recruiting and retention, and weaken the case for a higher-
    than-usual increase in basic pay.
        Enlistment and reenlistment bonuses have been used
    extensively in recent years, and they have helped to stabilize
    recruiting and retention. In the case of enlistment bonuses,
    the average Army enlistment bonus increased from about $3,000
    to $12,000 from fiscal year 2004 to fiscal year 2008. In the
    absence of this increase, high quality enlistments would have
    been about 20 percent lower. If basic pay had been used instead
    of bonuses, the cost to the taxpayer would have been greater.
    Enlistment bonuses tended to decrease attrition, as well. I
    should add that other recruiting resources, such as the number
    of recruiters and advertising, have also contributed to
    recruiting success.
        Reenlistment bonuses have been equally valuable. Our
    analyses show that, by 2006, the growing burden of deployment
    was putting downward pressure on Army and Marine Corps
    reenlistment. Two-thirds of the soldiers and half of the
    marines up for first-term reenlistment had 12 or more months of
    deployment in the previous 3 years. We found that this
    cumulative amount of deployment tended to decrease
    reenlistment. The expanded use and increased generosity of
    reenlistment bonuses, starting in 2005, helped to offset this
    downward pressure and keep reenlistment rates on a fairly even
    course.
        The role of bonuses is not limited to the Active
    components. We are finding that enlistment bonuses are
    effective in increasing enlistment into the Reserve components
    by those who have served in an Active component and who,
    therefore, already have training and experience.
        In closing, I want to note an area where the use of bonuses
    might be improved. This has to do with bonus ceilings; that is,
    the upper limit on the size of the bonus. Some servicemembers
    may be at or near the bonus ceiling because they are at a high
    grade or in a specialty offering a high bonus. In these cases,
    an increase in the bonus means that the member can sign up for
    a shorter term without decreasing the amount of bonus he
    receives. Our empirical evidence confirms this behavior. A
    higher bonus ceiling would remove this undesired effect. More
    generally, there should be flexibility to allow a higher
    ceiling in cases where higher bonuses are needed to sustain
    retention.
        Thank you.
        [The prepared statement of Dr. Hosek follows:]
                  Prepared Statement by Dr. James R. Hosek \1\
    ---------------------------------------------------------------------------
        \1\ The opinions and conclusions expressed in this testimony are
    the author's alone and should not be interpreted as representing those
    of RAND or any of the sponsors of its research. This product is part of
    the RAND Corporation testimony series. RAND testimonies record
    testimony presented by RAND associates to Federal, State, or local
    legislative committees; government-appointed commissions and panels;
    and private review and oversight bodies. The RAND Corporation is a
    nonprofit research organization providing objective analysis and
    effective solutions that address the challenges facing the public and
    private sectors around the world. RAND's publications do not
    necessarily reflect the opinions of its research clients and sponsors.
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            the role of incentive pays in military compensation \2\
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        \2\ This testimony is available for free download at http://
    www.rand.org/pubs/testimonies/CT345/.
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        I would like to thank the committee for the opportunity to testify.
    I will address my comments to the utility of incentive pays in
    influencing career decisions of members of the U.S. military.
        The Armed Forces share a common foundation of military pay. The
    foundation includes basic pay, basic allowance for subsistence, basic
    allowance for housing (or housing in-kind), and a military health
    benefit for servicemembers and their families. Educational benefits
    could also be included, as could contributions toward retirement
    benefits. This foundation of pay performs several functions. It helps
    to ensure that the Services can recruit, retain, and motivate the
    number and caliber of people they need to meet manpower requirements,
    produce a flow of capable future leaders within the enlisted and
    officer ranks, and shape the force so that its experience and grade mix
    are appropriate to the desired force structure.
        The health of the volunteer force depends on maintaining an
    adequate foundation of pay. This seems like an obvious statement, but
    at times the Nation has inadvertently tested its validity. The
    combination of basic pay, basic allowance for subsistence, and basic
    allowance for housing were set high enough at the start of the
    volunteer force in 1973 to enable a successful launch. Yet lower than
    adequate pay increases in the following years led to a recruiting and
    retention crisis at the end of the 70s, and Congress faced the
    alternatives of returning to a draft or restoring military pay to
    competitive levels. Congress chose to restore pay, increasing it a
    total of 26 percent in fiscal years 1980 and 1981. A second test
    occurred as the economy boomed in the late 1990s. Again military pay
    did not keep up with pay in the private sector and strains developed in
    recruiting and retention, though not as severe as in the late 1970s.
    Congress responded in the National Defense Authorization Act (NDAA) of
    2000 with a 4.8 percent increase in basic pay, a restructuring of the
    pay table with higher increases for certain years of service and ranks,
    and a commitment to increase basic pay half a percentage point more
    than the Employment Cost Index in each fiscal year through 2006. The
    importance of this pay action was not that it had to be taken--
    ultimately, the volunteer concept cannot survive unless pay is kept at
    levels competitive with the private sector--but that the Nation had
    restored pay and stabilized recruiting and retention before the
    terrorist attack on September 11, 2001 and the ensuing military
    operations in Iraq and Afghanistan.
        An adequate foundation of military pay is necessary for the
    viability of the volunteer force, but it is not cost effective to pay
    servicemembers only though foundational pays. Because market wages
    differ by skill, education, aptitude, and work conditions, it would be
    extremely costly to increase the foundational pays so they were
    competitive for the highest wage individuals. Doing so would mean that
    military pay was higher than needed for everyone else. This point is
    true in general but its relevance to policy action depends on the state
    of the economy. In 1999 when unemployment was low and jobs were
    plentiful, recruiting and retention were hampered by low military pay
    and the increases enacted in NDAA 2000 were appropriate. Today the
    economy is climbing out of a deep recession, unemployment is high, and
    job opportunities are expected to improve only gradually during the
    coming year. These conditions have helped recruiting and retention and
    weaken the case for a higher than usual increase in basic pay.
        Incentive pays help the military compete in the labor market in a
    cost-effective way. Rather than increasing military pay for all,
    incentive pays increase military pay selectively. Incentive pays are a
    means of targeting higher pay to where and when it is most needed to
    ensure an adequate supply of manpower. Because incentive pays are
    targeted, they are less expensive than an across-the-board increase in
    military pay. Some incentive pays such as sea pay or aviation career
    incentive pay are highly stable additions to foundation pay. Other
    incentive pays such as enlistment and reenlistment bonuses can be
    turned on and off as needed, and this flexibility means that they offer
    a fast, well targeted, and temporary increase in pay. Similarly,
    deployment related pays such as hostile fire pay and the combat zone
    tax exclusion are viewed as a just recognition of special sacrifices
    and risk attached to deployment to a hostile area.
        Incentive pays are paid to those people on the brink of enlisting
    or reenlisting who wouldn't have enlisted or reenlisted without getting
    these pays. But they are also paid to those who would have enlisted or
    reenlisted even without the bonus. For instance, all servicemembers who
    reenlist in a specialty covered by a bonus will receive a bonus, though
    some would have reenlisted without a bonus. The fact that some
    individuals are paid more than they need to be paid to reenlist is not
    unique to military incentive pays but is a common feature of labor
    markets. The market-clearing wage is the wage needed to hire or keep
    the worker on the margin and is higher than needed for workers below
    the margin. But all workers receive the market wage because if they
    didn't they could seek work in a different market, and they have no
    incentive to reveal that they would accept less than the market-
    clearing wage.
        The fact that incentive pays (or market wages in general) pay some
    workers more than they would be willing to accept should not be seen as
    a flaw. Incentive pays are a way of making military pay competitive in
    a competitive labor market. Without them, losses at the margin would
    escalate and manning in specialized assignments would suffer. For
    example, overall manning in a military specialty such as logistics may
    be in good balance, but the subset of logisticians qualified to perform
    as recruiters or parachutists may be in very short supply. An incentive
    pay motivates logisticians to volunteer for specialized training and
    duty in these particularly challenging or risky duties, payable so long
    as they hold the specialized assignments.
        Enlistment and reenlistment bonuses have been extensively used in
    recent years. This may seem puzzling in view of the major adjustments
    to pay in NDAA 2000 and subsequent increases in basic pay and the basic
    allowance for housing. But despite these pay actions, our analyses
    suggest that the military operations in Iraq and Afghanistan had a
    downward effect on Army recruiting, and the extensive deployments
    supporting these operations had a downward effect on Army and Marine
    reenlistment. However, we also find that the expanded use and higher
    levels of enlistment bonuses helped to counteract the downward trend on
    Army enlistment and the expanded use and higher levels of reenlistment
    bonuses greatly helped to counteract the downward pressure on
    reenlistment of more extensive deployments.
        These analyses are described in a forthcoming RAND report, Cash
    Incentives and Military Enlistment, Attrition, and Reenlistment, MG-
    950. In the case of enlistment bonuses, we estimate that a 10 percent
    increase in enlistment bonuses expands the high-quality market for Army
    recruiting by 1.7 percent. While this may seem small, it is useful to
    put this result in perspective. Between the end of fiscal year 2004 and
    the end of fiscal year 2008, the average enlistment bonus in the Army
    increased from about $3,000 to about $12,000. Using our estimated
    model, we predict that in the absence of this increase in enlistment
    bonuses, high quality contracts in the Army would have been about 20
    percent lower, implying that the Army would have enlisted 1,670 fewer
    high-quality contracts per quarter. At the same time, we estimate that
    the Iraq war took a negative toll on Army recruiting, after controlling
    for other factors that were changing at the same time, and that the
    increase in enlistment bonuses expanded the market and helped offset
    this negative effect of the Iraq war on recruiting. We also estimate
    that enlistment bonuses achieved this market expansion at less cost
    than had basic pay been increased instead. That is, if basic pay had
    been increased to generate the additional 1,670 recruits per quarter,
    the cost to the taxpayer would have been greater.
        How effective are reenlistment bonuses? It is useful to think of
    the generosity of a bonus offer in terms of the bonus multiple, or
    step. The amount of the bonus for a 4-year reenlistment is equal to the
    product of monthly basic pay, years of reenlistment, and bonus step.
    Monthly basic pay depends on rank and years of service, the length of
    reenlistment is chosen by the servicemember, and the Service sets the
    bonus step. The fiscal year 2010 basic pay for a corporal (E-4) with 3
    to 4 years of service is $2,094, so the bonus for a 4-year hitch at
    step 1 is $8,376, for example. In the study mentioned above, we
    estimate that a one-step increase in the bonus increased first-term
    reenlistment by 2.5 percentage points in the Army, or from about 40
    percent to 42.5 percent. The estimates for the other services are 2.5
    percentage points for the Navy, 3.6 percentage points for the Marine
    Corps, and 1.6 percentage points for the Air Force. Estimates at
    second-term reenlistment tend to be somewhat smaller: Army, 2.5
    percentage points; Navy, 1 percentage point; Marine Corps, estimate not
    statistically different from zero; and Air Force, 1.5 percentage
    points. These estimates are in line with previous studies.
        To put these reenlistment bonus estimates in perspective, it is
    useful to compare them to the effects of deployment on reenlistment. We
    find that soldiers and marines with 12 or more months of deployment in
    the 3 years before their reenlistment point had lower reenlistment
    rates, as compared to those with no deployment, and by 2006 two-thirds
    of the soldiers and half of the marines at first-term reenlistment had
    12 or more months of deployment. The large portion of personnel with 12
    or more months of deployment coupled with the negative effect on
    reenlistment for those with 12-or-more months threatened to reduce
    reenlistment and imperil unit manning. However, reenlistment bonus
    usage and amounts increased a great deal from 2004 to 2005 and remained
    at higher levels in the following years. For instance, in 2004
    approximately 15 percent of first-term soldiers who reenlisted received
    a bonus, and its average step was about 1.3. In 2005 about 70 percent
    of first-termers who reenlisted received bonuses, and the average step
    was about 1.9, or roughly a 50 percent increase in bonus generosity.
    The percentage receiving a bonus and the average step increased a bit
    further in 2006 and 2007. We estimate that the expanded use and
    increased generosity of reenlistment bonuses was sufficient to offset
    the downward pressure coming from deployments, resulting in a steady
    overall reenlistment rate. (This is reported in How Have Deployments
    During the War on Terrorism Affected Reenlistment? MG-873.)
        Both enlistment and reenlistment bonuses today are paid half up
    front at the time the new term begins and half in annual installments
    over the term. This approach is a sensible compromise.
        Research shows that servicemembers prefer a bonus to be paid in
    full immediately rather than paid in installments, but by paying half
    of the bonus in installments the services create an ongoing incentive
    for the member to stay in service for the entire term. In the Cash
    Incentives report, we find evidence that bonuses induce members to stay
    in service, though the effect is rather modest. Specifically, we find
    that a 10 percent expansion in Army enlistment bonuses reduces first-
    term attrition from about 32 percent on average to about 31 percent.
        Bonuses can be used to fine-tune personnel management. For
    instance, the Army offers higher bonuses for certain locations, and is
    using bonuses to match the entry date of new recruits with the
    availability of training seats. Another important use of bonuses is to
    channel recruits into hard-to-fill specialties. The effectiveness of
    bonuses for skill channeling was demonstrated in an enlistment bonus
    experiment (The Enlistment Bonus Experiment, R-3353). That study found
    that holding the total number of enlistments constant, an increase in
    bonuses targeted to hard-to-fill occupations increased enlistments in
    those occupations by 43 percent.
        The role of bonuses is not limited to the Active components. In the
    Reserve components, two types of recruitment bonuses are used,
    enlistment bonuses and affiliation bonuses. The allowable size of these
    bonuses increased markedly in 2006, and in work underway at RAND we are
    finding that these bonuses have been effective in increasing prior
    service enlistment into the Reserve components. The study has not yet
    addressed non-prior service enlistment so we do not have estimates of
    bonus effects for this population.
        There is an area where the use of bonuses might be improved. This
    has to do with bonus ceilings, i.e., the upper limit on the size of a
    bonus. Generally speaking, a more generous bonus creates an incentive
    to sign up for a longer term, but a bonus ceiling can thwart this
    incentive. Some servicemembers may be at or near the bonus ceiling
    because they are in a high pay grade or a specialty offering a high
    bonus step. In these cases, an increase in the bonus step means that
    the member can sign up for a shorter term without decreasing the amount
    of bonus he receives. Our empirical evidence confirms this behavior. A
    higher bonus ceiling would remove this undesired effect. More
    generally, there should be some flexibility to allow a higher ceiling
    in cases where higher bonuses are needed to sustain retention.
        To summarize, research consistently finds that people are
    responsive to enlistment and reenlistment bonuses, and this finding is
    confirmed in our studies and those of others. Bonuses expand the
    recruitment market, are effective in inducing enlistees to select hard-
    to-fill occupations, and induce servicemembers to reenlist rather than
    leave for civilian opportunities. Furthermore, our analysis finds that
    bonuses have expanded the market and increased reenlistments in a
    costeffective manner, especially when compared to military pay. In
    other words, if Congress had instead opted to raise pay more to achieve
    the same increase in enlistments and reenlistments, the cost to the
    taxpayer would have been more. Finally, carefully targeted bonuses have
    been helpful in sustaining reenlistment in recent years when the
    burdens of deployment have threatened to decrease it.

        Senator Webb. Thank you very much.
        To all the witnesses, thanks for your testimony. We have a
    tremendous amount of experience at the table right now, from a
    number of different perspectives.
        As I mentioned at the outset, this is, I think, a good
    opportunity for all of us just to take a look at these
    programs. Sometimes we have to even re-explain them to the
    political process, because of the momentum with which they are
    dealt. We rarely break down and say, ``All right, what is this?
    What is this program? How does it help?'' In that spirit, I'd
    like to ask a number of questions, and get the panel's thoughts
    on them.
        The first occurred to me listening to Ms. Farrell and Dr.
    Murray both, talking about the civilian comparability on
    military compensation. Let me just start by saying, when I was
    growing up in the military, the differential truly was the
    other way around. You could compare, say, an O6 with a GS15,
    and, in terms of benefits and long-term benefits, the civil
    servant clearly had a better deal. I don't think that's true
    today. It's probably the other way around today, when you look
    at the protections that are in place.
        Even when my father finally made colonel--and I was long
    gone when that happened--I think he made $14,000. Even if you
    do all the multiples, it's not a whole lot of money. There
    weren't a lot of other incentive pays to go along with that.
        I was on Active Duty when we began the volunteer Army
    concept. I actually was on the Secretary of the Navy's staff in
    1971, when they first started talking about reconfiguring the
    overall pay structure. It was pretty much a bold leap forward.
    It was before they got into these add-ons. But, as all of you
    know, the premise in military compensation, until the creation
    of the volunteer system, was that the lower three enlisted
    ranks and the lower two officer pay levels were paid very
    little, the idea being that that was the citizen soldier, as a
    consequence of a country that had conscription. Then, the
    money, such as it was, went into the career force, to try to
    protect and properly compensate the career force. So, when they
    started the volunteer concept, the first step that they made
    was to dramatically increase the pay scale at the bottom, to
    incentivize people to come in on a voluntary basis.
        Then all these other programs that are now in place, fell
    in incrementally over the years. We saw a lot of it when I was
    in the Reagan administration, in the Pentagon, where it really
    started focusing in on different areas.
        This is still a work in progress, in terms of how we field
    the best military in the world, and how we take care of our
    people.
        The question that came to my mind when I was listening was,
    when we're talking about comparability with the private
    sector--for instance, when the comment was made if you include
    other benefits, there's about an 80th percentile for the
    typical military person--I would like to hear from all of you--
    first of all, which benefits are we including when we do that?
    Which benefits are we not? For instance, even on the medical
    side, do we factor in such things as not having to have
    malpractice insurance or to pay for an office? Do we count that
    as compensation when we're looking at comparing what the costs
    would be on the outside? What are we doing on these different
    areas? What are we putting in and what are we leaving out when
    we hit these kinds of numbers?
        Ms. Farrell, you might want to start on that.
        Ms. Farrell. Sure, Senator.
        As I noted, the studies differ in what they include. That's
    the reason you get different results; although at this time,
    the reports that we looked at from my colleagues here all came
    up with similar results showing that the military pay was very
    favorable. The 10th QRMC included select benefits: it was
    healthcare, retirement, and the tax advantage. We're talking
    about a very broad base approach. When you referred to
    malpractice insurance, maybe you're thinking more of a scenario
    that's comparing one occupation for a physician with a
    physician in the private sector. These studies are very
    broadbased, and that's the reason we say that they have
    limitations, because the populations can differ, for example,
    in terms of age and education--usually your private-sector
    population is older than what you have in the military
    workforce, and usually your private-sector population is
    already further ahead in education. Many of our young people
    join the military with the plans to go on and get that
    education. So, you have different populations, in terms of
    demographics that you're reviewing, that places some
    limitations on the methodology.
        But, with that said, we feel that the studies that
    reviewed, with CNA being the backup for the data, with the 10th
    QRMC that included the three select benefits, took a very
    reasonable approach. There could be--there were a couple
    comments that we made on the CNA study, regarding assumptions
    about healthcare and retirement, and some other organization
    could come up with different assumptions. We still think it's
    reasonable.
        One of the assumptions made, for example, about retirement
    involves the discount rate. If someone's going to retire in 20
    years and receive $100, to make if very simple, what is the
    discount rate that would be the present value today? The
    discount rate that CNA used could be a little bit on the high
    side, compared to if a different rate was used. So, there's
    differences in the assumptions that are used for these noncash
    benefits, such as the healthcare--trying to place the value on
    it--as well as the retirement.
        Does that help?
        Senator Webb. That helps.
        Mr. Carr. I should make a point, I think.
        Senator Webb. Mr. Carr.
        Mr. Carr. Military pay, if it's simple and it's
    understood--for example, paystub--we, for years, used regular
    military compensation, which is roughly synonymous with
    paystub. It considers my basic pay, my allowances, and--housing
    allowances, for example--because allowances are not taxable,
    the tax advantage--an enormous amount of time explaining that
    to the soldier, sailor, or marine, so that they can gain some
    cross-comparison. Whether it's true that--and I'll stipulate
    that we're 70 percent against that paystub measurement--or 80
    percent, if we included esoteric things that aren't reflected
    in the paystub. It simply is a means of communicating a
    baseline. Either one is producing the same effect--80 percent,
    if you use the esoteric; 70 percent, if you're not. But, the
    importance is consistency in use.
        So, if we are 70 percent today, and we've used that
    measurement for years and hope to use it into the future, then
    we are communicating about a point at which core retention
    patterns look okay to us. What was the pay level then? We'd
    say, ``The regular military compensation''--because we have to
    account for the tax break--``is at this level, and yes,
    retention was good, and unemployment was that.'' We can
    communicate in much simpler, cogent terms that I think the
    troops would subscribe to, first, because we've talked to them
    in those terms for so long, and, second, because it has to do
    with the paystub. They get that.
        Senator Webb. The question, though, is whether we have the
    right information to truly compare, because there are a number
    of concerns. We hear from the Military Officers Association, et
    cetera, saying that the pay differential for the same type of
    job in the military is less. We need an accurate number. If
    it's less, it's less. If you're factoring all of the different
    pieces in together, and it's good, we should say, ``It's
    good.''
        So, the question, again, becomes, what are we putting into
    this when we make the formula?
        Ms. Farrell, when I was talking about medical insurance, it
    was just one of the things that popped into my mind while you
    were giving your presentation, in that you can't sue a military
    doctor--Federal Tort Claims Act. There are a lot of doctors in
    civilian practice who spend tens, if not hundreds, of thousands
    of dollars in medical malpractice insurance in order to cover
    the possibility of a lawsuit. We, arguably, should factor that
    in when we look at compensation for medical folks.
        Just one of many questions that I would have in terms of
    how sophisticated are we in--should people be concerned about
    these pay levels as they are right now? Maybe they should,
    maybe they shouldn't. But, are we using the right formula?
        Ms. Farrell. Again, we think by going with the 10th QRMC's
    recommendation to include select benefits, that's an advantage
    to DOD, to show how good their package really is and that it
    could be used even as a recruiting or retention tool. We have
    reported in the past through our surveys with servicemembers--
    they lacked an understanding of how their pay compared to
    counterparts in the private sector. There are a lot of
    misperceptions out there.
        Granted, DOD has its hands full, because this is such a
    large workforce. They bring in about 180,000 every year.
    They're maintaining 1.2 million servicemembers; it's a vast
    array of occupations. But, when you're doing a broadbased
    comparison of how the military compares to the private sector,
    we firmly believe that the total package should be included.
    The regular military compensation that Mr. Carr mentioned,
    we're not saying, ``Don't look at that.'' Keep that measurement
    of how the cash does compare with the civilian, but also go
    with the recommendation to look at select benefits, to the
    extent possible, because it will give a fuller picture. It will
    help DOD to monitor what is going on so that they can keep pace
    and be competitive with the private sector. It's a good
    recruiting tool, as we said.
        Senator Webb. Dr. Hosek, what do you think about that?
        Dr. Hosek. Various things. The first thing to observe, I
    think, is that the basic elements--what, in the past, have been
    referred to as ``regular military compensation'' for officers
    or enlisted personnel--still constitutes the vast majority of
    their current compensation, even when one considers benefits
    and allowances. That is, it's on the order of 90 percent. What
    that means to me is that it's really important to make sure
    that, whatever we do, we keep track of that and watch it
    carefully.
        The second thing is that probably the most salient benefit
    to military families on Active Duty or Reserve today would be
    the health benefit. That comes not only because the military
    has pledged to care for military servicemembers and their
    families, and follow through with this health benefit--it's a
    fairly comprehensive benefit--but also because the cost of
    similar services in the private sector have risen
    dramatically--at times, upwards of a 40 to 50 percent a year
    increase in cost. Today, I believe, in the private sector, the
    cost of a relatively good healthcare benefit for a family of
    four is around $13,000; whereas at the beginning of the decade,
    it was probably half that. So, the value of the military
    benefit can be thought of in terms of what it would cost a
    military family to obtain comparable healthcare outside.
        I want to, certainly, recognize the fine work that's been
    done by CBO, GAO, and, in this area, but, let me with that
    comment, add that a few years ago before these studies we did a
    study at RAND, trying to place a value on the military
    healthcare benefit, by which we made use of information on
    private-sector claims data for providers, and skill sets, and
    the age and ethnic distribution similar to that in the
    military. To make the story short, we, too, came up with a
    number such that, when you put it in the full context, enlisted
    personnel had a benefit, including basic pays, allowances,
    tax--the nontaxability of the allowance--and the healthcare
    benefit, placing their compensation at around the 80th
    percentile. For officers, I believe it was at around the 90th
    percentile.
        I'll end there, with only an additional final comment,
    that, as you stressed at the beginning, as important as it is
    to look at the specific elements of pay and be clear about what
    we're including and how we're doing it, we always want to be
    able to relate those elements of pay to our recruiting and
    retention outcomes.
        Thank you.
        Senator Webb. Also, if I may, on an issue like healthcare,
    that's a moral contract. It's a moral contract that goes beyond
    benefits, and it goes to the life of an individual who spends a
    career in the military. I can't tell you how many people in my
    lifetime who are career military who point that out while
    they're on Active Duty and after they retire.
        Mr. Carr, how do you develop, for lack of a better term,
    the internal discipline on a lot of these special pays, when
    there's really no business model here? We're doing this if this
    were a business, you would say, ``This is the amount of money
    we have coming in. Unless we take out a loan, we can't get more
    money. This is where we're going to put this money, in order to
    make a productive business work.'' When we're doing DOD, we're
    not doing that. We look at what we need in order to keep the
    country secure; we make decisions. When it goes to a lot of
    these S&I pays--I'm going to ask some questions in a minute
    about some of them--what are the factors that you put in that
    could bring a discipline to the process?
        Mr. Carr. Sir, if we asked any of the Services, ``What are
    you trying to hit with your retention incentives?'', the answer
    is going to be, ``A grade and experience mix, such that I
    produce seasoned noncommissioned and petty officers.'' I say,
    ``Okay. Define that, mathematically.'' The answer would be,
    ``I'd like to have 50 percent of my enlisted force with fewer
    than 7 years of service, and 50 percent with more than that.''
    They draw, physically, as I'm sure the chairman has seen, a
    profile that says how many people they want to have in year of
    service 1, 2, 3, 4, 5. Do it for pilots. Do it for--you name
    the skill or the service aggregate.
        So, the question becomes, ``For my inventory, how much does
    that inventory deviate from that ideal line? Where does it
    deviate? How do I prop it up?'' There is a mathematical
    solution to that. It's imperfect, because human behavior cannot
    be perfectly predicted. But, we would know, for the given
    investment, what it seeks to accomplish. By drawing another
    picture--we know who's out there in the force--whether or not
    that gap is being closed.
        So, the empirical knowledge in this area is applied against
    that rigidly defined goal in a disciplined way, with a best
    estimate of what the cause and effect is on the money we're
    going to spend. If we guess wrong, we adjust, because it is,
    after all, a forecast. But, take that through any skill, and it
    pretty much proceeds the same way.
        There's a lot of pays, of course, that do not depend on
    retention--such as recognizing the hazardous exposure of
    service, and so forth. So, there's many others that do that.
    But, I think the chairman's question was, ``When we're trying
    to decide where to put a retention dollar and why we're going
    to put it on that occupation, for that zone, which is expressed
    as a range of years of service,'' the answer is, ``Because
    we're trying to close the gap between two explicit lines.''
        Senator Webb. Can you give us an understanding of
    continuation pay and how it fits into that formula that you
    just expressed? You have aviator career incentive pay (ACIP),
    nuclear officer continuation pay, judge advocate continuation
    pay, engineering and scientific career continuation pay,
    acquisition corps continuation pay, surface warfare officer
    continuation pay; just if you could explain for us the program
    and how it affects what you just said.
        Mr. Carr. I'll knock out surface warfare officer and
    aviator continuation pay pretty much the same way. The question
    is, ``what's your force profile?'' In the late 1980s, we
    overhauled aviation pays. I chaired the study that produced the
    legislation that revised ACIP and then reinvented aviator
    continuation pay (ACP). But, in every case, in every weapons
    system that we were trying to satisfy--and the Navy was the
    most disciplined in this--there was a reason that they wanted
    to move this year-of-service cohort, this experience group, to
    a higher level. It had to do with department-head requirements.
    So, they would say, my department heads on ship--the squadrons
    that are embarked--are weapon-system-specific. I, therefore,
    need X number of department heads who grew up in Prowlers. How
    many do I have in the pipeline? If my number is too short, then
    I pay ACP in whatever measure is required to close that gap.
    The Air Force is similar. It has greater fungibility across
    weapon systems. Whether it's a surface warfare officer or an
    aviator, simply, in those cases, count your department heads
    who are going to pop up at their certain years of service. How
    many people are in the pipeline, in that occupational
    discipline? Am I going to fill them, or am I going to be short?
    If I'm short, then I'm going to cause some people to change
    their behavior so that I can fill them all.
        So, again, it's empirically derived against a very
    specific, tight target.
        Senator Webb. But, the continuation pay goes to everyone
    who is qualified, under those occupational specialties? Would
    it not?
        Mr. Carr. An aviator is going to come in, as the chairman
    knows, having completed their major weapon system training.
    Then, with that is, say, a 9-year Active Duty service
    obligation. So, you're taking the person at that point--up
    until then, there's been no retention choice; the contract
    said, ``You must remain''--and we're focusing on that group of
    people, to stimulate their behavior to carry them from the end
    of the contract, which we all agreed to, incident to entering
    the training, and vault them out for another 6 years. It is
    system-specific, but it's not to all, because we're targeting
    the retention-sensitive years, so it is almost exclusively
    dedicated to those who are approaching their first quit option.
        Senator Webb. But, in that group, it's all.
        Mr. Carr. Yes, sir.
        Senator Webb. The same with how you do the judge advocate?
    As a lawyer here, I'm treading on sensitive ground.
        Mr. Carr. No, you're right, sir. If we were talking about
    an aviator, about pilots--is that they hold that rank of O4 for
    a reason, and they're promising. So, I'm ambivalent as to which
    ones I get, so long as I get so many. I could, however, set
    quality standards for department head and say, ``Only those
    that had these assignments may be considered in the pool I'm
    trying to vault up.'' As a general proposition, yes, sir,
    you're right. For a given experience cohort, take all comers
    within that, considering them to be of homogeneous quality.
        Senator Webb. Same with the Judge Advocate General Corps
    (JAG)?
        Mr. Carr. Same with JAG.
        Senator Webb. We have a problem recruiting JAGs?
        Mr. Carr. The JAGs demonstrated to us, convincingly, that
    there was a shortage in retaining JAGs against the force
    profile. Let me set it up this way.
        If Congress should enact a law that says, ``Pay money for
    this circumstance,'' typically, it says, under regulations
    established by the Secretary of Defense, ``We, in turn, will
    issue a directive that says, `If you think you meet these
    conditions, come see us and we'll discuss it and have a second
    review.' '' If you present evidence that you do have a shortage
    against authorized lawyer billets, and you're not keeping them,
    then, yes, we would be in, I'll call that ``readiness''--and
    say, ``We must keep that number of lawyers,'' and therefore, we
    would pay them in order to fill a specific set of billets that
    would have otherwise demonstrably go unfilled.
        Senator Webb. But, there is no continuation pay for
    infantry.
        Mr. Carr. There is not a continuation pay for infantry
    officers, and the Army did use an incentive to retain captains.
    There can be. I think the chairman's point may be, I suspect
    we're in a tight supply on infantry captains, if the selection
    to major is running as high as it is. Shouldn't we try and
    boost up the number of persons entering the zone for major?
        The Army, a few years ago, for example, said yes and
    offered a continuation bonus to combat arms in order to address
    that very specific shortage. The new battlefield required new
    organization, begat smaller organizations, which, necessarily,
    creates, proportionately, a richer grade structure, and, boom,
    we had a lot of major requirements that we didn't have before
    and some lean captain cohorts that we had to pay some
    incentives to in order to generate the requisite number.
        Senator Webb. As a former infantry rifle platoon and
    company commander, I think the question needed to be asked.
        That's one of the questions that, actually, was being asked
    a lot, back in the 1980s, when you were going to this targeted
    pay, as Dr. Hosek may remember, having been on so many of these
    boards--these quadrennial reports. In fact, I don't know, was
    it General Vessey, someone back there, who said, ``How much do
    you pay a point man in the infantry when things really get bad?
    What kind of a bonus should they get?'' So the perception, from
    the inside out, from people who've done a lot of the hard work,
    seeing some of these continuation pays is that I think that's
    still there, as a matter of fairness, inside the military.
        Mr. Carr. Point taken, sir.
        Senator Webb. Dr. Hosek, you have sat on three quadrennial
    reviews?
        Dr. Hosek. Yes.
        Senator Webb. When was the first?
        Dr. Hosek. I think it was 1992.
        Senator Webb. 1992? What would be your observations on this
    particular area, the specialty pays, as they've evolved from
    that period? Are we on the right track? Is there something else
    we need to be looking at?
        Dr. Hosek. I think, even going back to the 1970s and 1980s,
    and certainly since, there's been a recognition of how
    important special and incentive pays can be, for various
    reasons. I think the evolution, as you mentioned earlier, of
    the increase in these pays is notable. It's really a reflection
    of the fact that the pays have turned out to be a useful,
    flexible, and, I think, on the whole, cost-effective mechanism
    allowing the Services to tailor their compensation to secure
    the people needed for particular occupational areas and
    leadership positions, both enlisted and officer.
        I'm not dismayed in any way, I think, with the way things
    have evolved, in terms of the increase in the numbers of these
    pays. As I mentioned, I think that the foundational pays, that
    I noted in my testimony, still remain of vital importance to
    the health of the force. The suggestion on that has since been
    enacted under the 10th QRMC, to consolidate into, I believe,
    seven categories the proliferating number of special pays that
    had become confusing, is a good move, if only to do a better
    job of communicating what these pays are to our servicemembers,
    Active and Reserve. So, I look forward to that.
        Basically, I think these pays are quite good. I think that
    we do have to--the S&I pays are of different types and serve
    different purposes. For example, the ACIP that you mentioned
    and, for that matter, the pays for JAGs and so forth, I view as
    fairly permanent compensating differentials that reflect
    private market conditions for those skills. Same for
    physicians. It's important that the military be able to get
    physicians, lawyers, et cetera, in order to satisfy its
    requirements. In fact, I think I would emphasize, even more
    than that. To me, we have to go back and ask, ``What would an
    enlisted person or an officer think if they didn't have the
    full cadre of individuals needed to provide military
    capability, if we didn't have officers or enlisted?'' Even
    though they, individually, might not be the beneficiary of
    certain select--certain S&I pays, I think, somehow, that
    they're also willing to recognize and accept the importance of
    pay differentiation in order to ensure that we have a full
    complement of individuals for the purpose of military
    capability. I think that's really the role of these things.
        I've thought about this a fair amount, because, as you
    noted, the infantry point guy--if he comes under fire or is in
    really dangerous conditions, you wonder if we are paying that
    person enough at that time? What do we do to recognize that? We
    don't have spot bonuses to award that sort of thing, and I'm
    not sure we want them.
        Senator Webb. That's sort of where the civilian comparative
    model breaks down, because maybe that--well, actually, there
    are some areas where that skill is marketable on the outside,
    but there's not a lot of people on the outside who aren't doing
    it who would step in to do it. It's sort of an inverse model,
    in a way.
        Dr. Hosek. The bottom line is, we want to set pay so that,
    on net, when people come to making their decisions to stay or
    leave, and, for that matter, to really exert effort and take
    risks on behalf of their country, they're there, and they know
    that the country is providing the compensation, family support,
    healthcare, retirement benefits, and educational benefits that
    they want. The real test of that in our military over time,
    though not necessarily at a particular instant, is whether we
    have gotten, and can keep, the caliber of people we need.
        The market is a real taskmaster in that regard. Even in
    draft years, in the 1960s, and leading up to the advent of the
    AVF in 1973, we had, primarily, an AVF. What we also had was a
    partially drafted force. As you pointed out, absolutely
    correctly, the onset of the AVF involved serious exercise in
    trying to raise the entry-level pay to competitive levels.
        People have always served on a voluntary basis, for the
    most part. Certainly, all servicemembers do so today. That
    means, when they're thinking about entering or thinking about
    leaving the military, they're scouting around to consider their
    outside opportunities. That's the test; that's the source of
    feedback that tells us something about whether we're paying
    people the right amount.
        Thank you.
        Senator Webb. I couldn't agree with you more, and you raise
    an interesting point that people tend to forget. It has two
    different components to it, when you mention that, during the
    Vietnam era, most people were volunteers. Two-thirds of the
    people who served during the Vietnam era were volunteers, and
    73 percent of those who were killed in action were volunteers.
    There's an application in that thought pattern today, in the
    sense that, even though we are a volunteer military, we're not
    an all-career military.
        It's something that I had a number of challenges putting on
    the table when I first came to the Senate, becoming a member of
    this committee, the tendency of a lot of people coming over
    from the Pentagon would simply talk about retention, rather
    than assisting the large number of people, the majority of the
    people who enlist, actually, who leave on or before the end of
    their first enlistment. It took us about a year to get the
    numbers, but the numbers we had before this economic meltdown
    were that 75 percent of the people who enlist in the Army, and
    70 percent of those who enlist in the Marine Corps, leave the
    military on or before the end of their first enlistment. That's
    actually very healthy for the military. It's very healthy for
    the country. It preserves the citizen-soldier concept. It's one
    of the reasons I pushed so hard to get this GI Bill through,
    because the transition period is something that we haven't
    always looked at.
        It also goes to the notion that, aside from these S&I pays,
    we really want to make sure that people who aren't eligible for
    these S&I pays are adequately compensated while they are in the
    military, and properly cared for the rest of their lives.
        I thank you very much for your comment on that.
        Dr. Murray, you've been silent. Would you have any thoughts
    on what we've been talking about?
        Dr. Murray. I would just say that when you ask CBO for the
    cost of military personnel, including cash and noncash benefits
    is important. Sometimes it depends on the question being asked,
    and the context in which it's being framed. When you start to
    include noncash benefits, of course, they do cut across
    different departments, involving the Department of Veterans
    Affairs, et cetera.
        Also, the valuation aspect is very important in analyzing
    the role that compensation plays in peoples' decisions to join
    or stay in the military. So, when I offer cash compensation,
    the value is easily understood. I give you a dollar, you spend
    that dollar on goods and services, and the cost to the
    government is the value that's been received by the
    servicemember.
        I think for all researchers deciding the valuation of
    something that is less easily tangible--counted--things like
    noncash benefits, and the role that those different aspects
    play is much more dependent on how the analysis is done and
    what you choose to include, and so on and so forth.
        Senator Webb. I believe it was your written testimony that
    had the chart on the percentage of military medicine that was
    being provided to retirees. Was that yours? I believe it was
    your testimony, your pie chart.
        It had, I think it was 52 percent of medical care actually
    was going to--of the different programs--were going to retirees
    at this point--and their families, obviously.
        Dr. Murray. That was not in my written testimony.
        Senator Webb. Not in yours?
        Was it in yours, Ms. Farrell?
        Ms. Farrell. We didn't have a chart, but, in terms of
    retirement figures, we had 15 percent of the enlisted would go
    on and be eligible for retirement. Around 47 percent of
    officers would go on and be eligible for retirement.
        Senator Webb. I'll find the chart and get back to you.
    [Laughter.]
        Ms. Farrell. We'll get you a chart, if you want a chart.
    [Laughter.]
        Senator Webb. No, actually, it was in one of the pieces of
    the testimony that I read. I found it really interesting, that
    a majority of the healthcare was going to dependents, retirees,
    et cetera.
        Dr. Murray. That is correct, yes.
        Senator Webb. Senator Begich has arrived.
        Senator Begich. Thank you, sir.
        Senator Webb. Welcome, sir.
        Senator Begich. Thank you very much, Mr. Chairman.
        If I can, I just have just a couple quick questions. Is
    that okay?
        First, just a general question on compensation. If this was
    talked about, I apologize to repeat it. But, because of where
    the economy is today--unemployment--and if I remember the
    information I was reading here, the pay gap between military
    and civilian pay is about 2\1/2\ or so percent. Has there--have
    you had--I'm trying to think how to word this--for the
    increases or the pay that we're trying to make sure that we're
    competitive with, has that pay changed in the private sector
    because the economy has flattened, and therefore, their pay has
    come down? Or is there a real gap that we don't really realize
    yet, because as soon as the economy recovers then there'll be a
    bigger gap? Do you follow what I'm saying?
        Mr. Carr. I do, Senator.
        Senator Begich. Okay.
        Mr. Carr. The private sector wages have gone flat, for
    reasons you understand. Our objective is to parallel that. By
    law, we set a relationship between those two events by saying
    that the annual military pay raise would equal the change in
    the private sector in what's called the ``employment cost
    index''--how much does it cost me to pay all these people in
    these chairs?
        Senator Begich. Sure.
        Mr. Carr. I, each year, sample the same chairs, and I see
    what the change is. So, the military parallels it. Hence, the
    pay raise for this year, proposed in the President's budget, is
    probably on the order of half that is programmed for future
    years in the Defense budget, if all were to hold together.
        So, the economy is flat.
        Senator Begich. Right.
        Mr. Carr. We're, therefore, flat because we are, by law,
    tracking against that, but we're holding our own.
        Senator Begich. Do you think--my assumption is--and, again,
    we saw some good market indicators yesterday and the day before
    housing starts are up and housing loans are up. The consumer
    confidence, which to me is the ultimate measuring stick--all
    this other stuff--I know people say unemployment's important to
    measure, but if the confidence of the consumer is not up, the
    economy will not fully recover. That number has moved, the
    first time; and the number that it's at now is equal to where
    it was in September or so of 2008, which is good. That's a good
    signal.
        So, as the private sector recovers and the job rates or the
    pay rates will start moving up, will we fall into--because the
    way our system works here, it's not the fastest system, to say
    the least--will we be able to track that as fast as the private
    sector will be moving? Because I believe the private sector
    will move much faster than we could ever move. So, the question
    is, can we get there?
        Mr. Carr. I have to say that, in order to do it, yes,
    that's our duty. That's our objective in forecasting the funds.
    If we get it out of line before we would hemorrhage experience
    that we couldn't replace, then we would probably turn to
    reprogramming, because if we have gotten it wrong and we
    thought the economy was going to do this, but it heated up much
    faster, then our resources allocated to retention incentives
    won't be sufficient, because, again, it happened faster than,
    better than we thought. In that case, then we have to look at
    the defense budget in the execution year and find what we're
    going to do to prevent the hemorrhage.
        Senator Begich. Okay. You feel confident enough that, if
    that moment happens--it's nice to have a nice slide, rather--
    and a glide up, rather than a spike; but, if it's a spike
    potential, do you feel the system that you work within can deal
    with this in a rapid pace, versus us coming along and saying,
    ``Why the heck haven't you done it?'' Do you think--we might
    still do that----
        Mr. Carr. I believe that----
        Senator Begich.--the way we operate here. [Laughter.]
        Mr. Carr.--we can. The great insurance policy that Congress
    has--security blanket that you've placed over retention is the
    construction of our pay table. For military pay, from 1999,
    it's gone up 57 percent, compared to 42 percent in the private
    sector. That's insurance, and I think that's stabilized our
    retention.
        Senator Begich. Gave you the flexibility?
        Mr. Carr. Say again, sir?
        Senator Begich. Gives you the flexibility to sort of----
        Mr. Carr. It gives us a baseline stability, so that we
    don't have to chase the tweaks, and we're not trying
    everything.
        Senator Begich. Gotcha.
        Mr. Carr. So, that baseline stability keeps things settled
    so that where we do have to chase will be relatively few in
    number and we can do that better.
        Senator Begich. Let me ask you one last question. This is
    on base housing and allocations. When you do your studies--and
    I'll just be very parochial here--in Alaska--and when you've
    done your studies, the most recent one, you based part of the
    study, obviously, on vacancies. The timetable you did it was in
    the summer in Alaska, which has very low vacancies. What's left
    is--to be very frank with you, as someone who's been in the
    real estate business for almost 25 years now, it's low quality.
    So, it's not a real market condition.
        On top of that, through the winter here, our utility rates
    have gone significantly up, for a variety of reasons. We have a
    problem with gas supply in South Central. By 2015, we
    anticipate a shortage of gas which is a predominant utility for
    heating which also generates our electricity. So, that has
    spiked. There was a slight decrease, but overall, it's spiked
    in the winter, and probably will stay that way, as well as--
    other utility costs have gone up.
        You don't have to answer this right here, because it's very
    Alaskan perspective--I'm just trying to understand how we
    ensure that these soldiers aren't pulling money out of their
    pocket to survive in their housing when--because the formula we
    used was just the wrong timing. In other words, for us, summer
    was probably not the best time to do it. Then the winter set in
    some heavy rate increases.
        Mr. Carr. Whenever an artificiality is introduced that
    serves to the disadvantage, then we have to look to what change
    we're going to do to make that good.
        Senator Begich. Would you be willing to look at this for
    us?
        Mr. Carr. I will.
        Senator Begich. It might be other States having the same
    problem, but for us, just because the way our energy costs are
    there, the higher cost, but also the transient and summertime
    business, we do really fill our apartments up. Then what's
    left, really, is a very low quality. I'm sure I'm going to hear
    from my friends in the rental business that will say, ``Our
    property isn't low quality.'' But, I'm just telling you, after
    25 years in the business, I know.
        Mr. Carr. Sir, I'd be eager to do that.
        [The information referred to follows:]

        The Department contracts Runzheimer, International, an industry
    leader in cost-of-living data collection and analysis, to collect
    housing cost data used in the setting of Basic Allowance for Housing
    (BAH) rates. Runzheimer obtains rental cost data from properties
    selected by the local Military Housing Offices (MHOs), as well as
    properties found in local newspapers, apartment guides, and from local
    real estate professionals.
        The MHOs are directed to provide housing to be priced which is both
    adequate and in safe and secure areas. Unacceptable, low quality
    housing is not included for BAH rate-setting purposes. Rental data are
    collected for a variety of housing types, from April through August.
    Pricing during this period ensures that rents are collected and
    documented during the high demand seasons, when rents are highest.
        Runzheimer collects utility cost data from the American Community
    Survey over a 12-month period. Since the expenses are collected
    throughout the year, highs and lows in seasonal energy costs are
    captured. Housing cost data in the form of rent, utilities, and
    renter's insurance are collected in each military housing area for the
    50 States and the District of Columbia.
        However, if members rent above their median and/or above their
    housing profile, they will have out-of-pocket expenses as BAH is not
    intended to cover every member's total housing costs.

        Senator Begich. Okay. That'd be great.
        Mr. Chairman, I'll leave it at that.
        I really wanted to ask him one question, but I know they
    can't answer it, and that is--because I deal with personnel--
    it's been bugging me ever since I heard it--and that is the
    personnel pay system, which I won't bother you with, because I
    know it's out of your realm. But, how we spent half a billion
    dollars and got minimal utilization out of it. But that's
    another question for another day, unless you want to dive into
    that. I don't want to torture you with that issue. But, I think
    we have to figure out how, when we pay our personnel in the
    military, that the complaint levels go down. I know there was a
    great attempt by DOD to solve this problem. But, a huge amount
    of expenditure was laid out with minimal utilization. I know
    there'll be efforts to try to utilize all that information.
    But, it's half a billion-plus in expenditure.
        Someone who's been a former mayor, it can't be that
    complicated. We had police and fire. I'll tell you, that's
    complicated pay scales. For everything they do, from breathing
    to walking onto the soil of a crime scene, there's different
    pay levels you have to incorporate within that 2-week pay
    period. We were able to do it, and every local government does
    it. Why the military couldn't figure this out is beyond me.
    But, you don't have to answer. It's just a rant I just went on,
    and I apologize.
        Thank you, Mr. Chairman.
        Senator Webb. Well, sir, I'd be happy to have a further
    discussion with you about that. If you like, we can put
    together a question that could be sent over to Mr. Carr.
        Senator Begich. That'd be great.
        Senator Webb. Perhaps we could clarify where your concern
    is here.
        Senator Begich. I will do that. We'll work on it and give
    it to you, Mr. Chairman.
        I want to make sure when we spend that kind of money to
    revamp the personnel pay system, that we do it. I just got
    frustrated when I heard at a big committee meeting that it just
    was scrapped. It's hard to explain to taxpayers when you scrap
    a half-a-billion-dollar program.
        Senator Webb. Let's run down where the direction of the
    question would go, and I'll submit it.
        Senator Begich. Thank you, Mr. Chairman.
        Thank you all for being here. Thank you for letting me come
    in late here to give you my two bits.
        Thank you, sir.
        Senator Webb. Thank you, Senator Begich.
        Mr. Carr, I want to ask you a question that is not directly
    related to the hearing today, but you're a target of
    opportunity here, obviously, because it's within your
    jurisdiction and it is within the jurisdiction of the
    committee. I'm trying to get a better overall picture of how
    DOD has evolved over the years. This is a small area, but it's
    something I want to get a clear understanding of.
        When I was on Active Duty, there were 3 million people on
    Active Duty. When I was in the Pentagon, I think there were
    2.14 million. Today, there's about 1.4 million, with,
    obviously, the greatly expanded participation of the Guard and
    Reserve, which I was responsible as Assistant Secretary, for 3
    years, at one point.
        I would appreciate it if you could get me a--on that
    timeline--so, let's say, 1970, 1986, and today--how many
    generals and admirals, by Service and by rank, there were, and
    are, in the United States military. I would think the number--
    from what I'm looking at, the number is well more than it was
    when I was in the Pentagon in the 1980s. I would like to better
    educate myself as to what these responsibilities are--where
    these people are now being used in flag billets, with the
    smaller number of people on Active Duty, and also flag levels
    in the Guard and Reserve, in a separate category. I would hope
    that would be pretty easy to put together.
        Mr. Carr. It is, sir.
        [The information referred to follows:]

        I would like to submit for the record the requested General and
    Flag Officer (GFO) ratios for the Active component and the Reserve
    components. Please note that between 1970 and 2000, Active component
    end strength was reduced at a greater rate than the pace of GFOs (55
    percent versus 34 percent). Between 2000 and 2010, Active component end
    strength grew at a slower rate than the number of GFOs (3 percent
    versus 8 percent). This increase in GFOs was largely due to recent
    reforms (2009 and 2010 National Defense Authorization Acts) passed by
    Congress to address joint warfighting requirements. Only a handful of
    in-service authorizations were created during this period and the
    majority were specific to the acquisition community.
        The best methodology for confirming fidelity of the proper number
    of GFO has been the subject of numerous debates. Since World War II,
    there have been 10 documented special studies or reviews of GFO
    requirements. Each used a distinct methodology and ALL recommended
    increases beyond the statutory authority. The use of ratios does not
    offer sufficient fidelity in explaining changes in mission requirements
    of the institution. As a rudimentary example, the deployment of five
    Army brigades (led by a colonel) instead of eight brigades may well
    require the same number of general officers in the parent headquarters.
    This in turn produces a corresponding shift in GFO requirements.
        In 2006, the Department evaluated a number of different ratios to
    include: total Active Duty, officer only, senior leader (SES and GFO),
    capital assets, and joint participation. Each was ultimately considered
    inferior in determining the appropriate number of GFO authorizations.
    This information is detailed in a report to Congress titled, ``General
    and Flag Officer Strategic Review,'' which was the impetus for the
    statutory changes that led to the current structure and number of GFOs.
    On the opposite end of the spectrum is a methodology that involves a
    position-by-position review. The last external study of this type was
    completed in 2003, when the Department undertook a review of all
    general and flag officer billets. This study validated 1,039 Active
    Duty and 591 Reserve GFO requirements, which significantly exceeded the
    statutory limit at the time of 889 Active Duty and 422 Reserve GFO
    authorizations.
        A similar position-by-position internal review was conducted in
    2008, to inform the previously mentioned legislative reforms. This
    review was documented in the previously referenced report to Congress,
    ``General and Flag Officer Strategic Review.'' This report specifically
    addressed GFO requirements and the methodologies used to identify the
    appropriate number of GFOs authorized. The resulting legislation
    institutionalized joint GFO positions for the first time in the history
    of the Department, and resulted in joint restricted GFO authorizations.
    The in-service GFO authorizations were reduced by more than 25 percent
    to compensate for these authorizations. A nominal increase did occur
    which elevated the number of joint GFO positions filled from 231 to
    294, allowing the Department to meet joint warfighting demands. This,
    in turn, greatly reduces the need for use of the available emergency
    authorities.

        Senator Webb. Anecdotally, when I was doing a lot of work
    in NATO for Secretary Weinberger, when I was ASD, I came across
    the number--the British Army, in the 1980s, had 145,000 people
    on Active Duty. My recollection is, I think they had 321
    generals. I came back to Al Gray, who was the Commandant, and I
    said, ``We have 200,000 people in the Marine Corps, and we have
    67 generals. What's going on?'' Al Gray made a very famous
    comment. He said, ``Well, they have more bands.'' [Laughter.]
        Mr. Carr. That's not bad.
        Senator Webb. He may not want to have that comment recycled
    today. But, let's just--I'd just like to get an idea of what
    we're doing on the GFOs.
        Mr. Carr. We'll follow up with you, sir.
        Senator Webb. I appreciate all of your coming in to be with
    us today. I think it's really helped. This information will get
    recycled to other Members of Congress sent out for it to
    increase the understanding of these programs.
        I think there should be no doubt in anybody's mind that we
    are very committed to making sure that our military people are
    well compensated. We know how hard they work. We know what
    they're doing. We appreciate it. We will make sure that we
    retain the quality and the expertise of our military, to keep
    them the finest military in the world.
        Thank you very much.
        We are adjourned.
        [Questions for the record with answers supplied follow:]
                    Questions Submitted by Senator Jim Webb
       education of the value of the total military compensation package
        1. Senator Webb. Mr. Carr, in its report, the Government
    Accountability Office (GAO) discussed the importance of understanding
    the value of the servicemembers' total compensation package and how
    this understanding can be used as a recruiting and retention tool. GAO
    has recommended in the past that the Department of Defense (DOD)
    develop a comprehensive communication and education plan to inform
    servicemembers, recruits, and their families of the value of their pays
    and benefits. Meanwhile, in the 2010 National Defense Authorization Act
    (NDAA), Congress required DOD to establish a comprehensive Web site
    that would allow servicemembers and their families to learn the value
    of their benefits, including survivor and retirement benefits. What
    steps has DOD taken to provide comprehensive education on the value of
    pay and benefits to servicemembers and their families, including the
    value of such benefits as health care, commissary and exchange
    benefits, and child care benefits?
        Mr. Carr. DOD and the Military Services have substantive efforts
    underway, and continue to seek new and responsive mechanisms to educate
    their servicemembers and families on their earned benefits. Efforts
    include a variety of communication formats including: handbooks and
    guides such as the Wounded Warrior Pay and Entitlements Handbook, the
    Guard and Reserve Family Member Benefits Guide, the Mobilization
    Information and Resources Guide, and annual statements of military
    compensation. Furthermore, DOD and the Military Services continue
    providing numerous educational classes and facilitating online
    resources to help raise awareness of these benefits so that
    servicemembers can take full advantage of them. The portal,
    MilitaryOneSource.com, is a comprehensive Web site that provides
    servicemembers a wealth of information about many topics, including pay
    and benefits. This Web site is also linked to each of the Service Web
    sites that provide additional information. For example, My Army
    Benefits (http://myarmybenefits.us.army.mil), one of many resources
    offered by the Military Services about benefits, educates soldiers and
    their families about the wide variety of educational pay and
    compensation and other benefits available to them, even allowing them
    to calculate their pay while on deployment. The Navy's Pay and
    Compensation Calculator at the Stay Navy Web site (https://
    staynavytools.bol.navy.mil/PCC/?B3=Launch+Calculator) allows sailors to
    input their current pay and benefits to see how these compare to those
    in the civilian world, showing what a comparable salary would be
    outside the military to be able to enjoy the same benefits, services,
    and standard of living.

     use of employment cost index as benchmark index for military basic pay
        2. Senator Webb. Dr. Murray and Ms. Farrell, in Dr. Murray's
    prepared statement, she stated that using the Employment Cost Index
    (ECI) as the benchmark index for annual military pay raises had its
    limitations, since it measured a population that tended to be older and
    college-educated, a population whose pay has increased more rapidly
    over the past decade than younger high school graduates. Is the ECI an
    appropriate index to use to adjust military basic pay rates annually?
    If not, is there a benchmark that is more appropriate?
        Dr. Murray. Despite its limitations, the ECI provides lawmakers
    with a reasonable benchmark of the growth in civilian wages and
    salaries upon which to evaluate the basic pay raise in a particular
    year. Because of its limitations, however, the decision about the basic
    pay raise can be better informed by supplementing that benchmark with
    data regarding recent recruiting and retention trends, changes in
    noncash benefits, and assessments of how the housing and subsistence
    allowances may change.
        Ms. Farrell. In our April 1, 2010 report,\2\ we noted that using
    the ECI for the purpose of determining the amount of the annual basic
    pay raise for servicemember has both strengths and weaknesses, but is
    generally reasonable to use to adjust such pay annually. It should also
    be noted that basic pay is just one component of the total military
    compensation package. In addition to basic pay, servicemembers also
    receive allowances, tax advantages, as well as deferred and in-kind
    compensation.
    ---------------------------------------------------------------------------
        \2\ GAO, Military Personnel: Military and Civilian Pay Comparisons
    Present Challenges and Are One of Many Tools in Assessing Compensation,
    GAO-10-661R (Washington, DC: Apr. 1, 2010).
    ---------------------------------------------------------------------------
        The ECI is a measure of changes in wages and employer costs for
    employee benefits. Created in the mid-1970s, the ECI is published
    quarterly by the Bureau of Labor Statistics and is part of the bureau's
    National Compensation Survey program, which provides measures of
    occupational wages, employment cost trends, and benefit incidence and
    detailed plan provisions. Organizations use the ECI to inform their
    decisionmaking in a variety of ways--including adjusting their wage
    rates to keep pace with what their competitors pay or to adjust wage
    rates in collective bargaining agreements. In addition, the Federal
    Government uses the ECI to inform its decisionmaking. For example,
    Congress included a provision in the NDAA for Fiscal Year 2004 tying
    the annual basic pay raise for military personnel to the ECI.\3\ The
    law contains a provision allowing the President to propose alternative
    pay adjustments to Congress, in certain circumstances, if the President
    deems the standard increase required by the law to be inappropriate.
    ---------------------------------------------------------------------------
        \3\ Pub. L. No. 108-136, Sec. 602 (2003), codified at 37 U.S.C.
    Sec. 1009. Specifically, the law requires that all eligible
    servicemembers' monthly basic pay be increased annually by the annual
    percentage increase in the ECI, except for in fiscal years 2004, 2005,
    and 2006 when the law required that servicemembers' basic pay increase
    be equal to the annual percentage increase in the ECI, plus an
    additional one-half percentage point.
    ---------------------------------------------------------------------------
        As noted, our recent work \4\ has found that using the ECI to
    adjust military basic pay annually has both strengths and weaknesses.
    For example, its strengths include the following: the ECI is a
    nationally representative measure of labor costs for the civilian
    economy; it is also produced in a consistent fashion,\5\ using a
    transparent methodology; and it provides separate data series for
    different occupational groups, industries, and geographic areas. With
    regard to its weaknesses, the ECI is not tailored to the specific
    segments of the civilian economy most relevant to the DOD--for example,
    those occupations and industries that the Military Services primarily
    compete with for workers. Also, because the ECI is constructed from
    data collected from surveys of employers, it does not provide data
    about the demographics of the civilian workforce--such as workers'
    education and experience, both of which are important factors that are
    often taken into account when setting employee pay. Nevertheless, we,
    as well as the Congressional Budget Office (CBO),\6\ have previously
    reported \7\ on the challenges of creating more tailored indexes.
    Further, none of the experts with whom we consulted, nor any reports
    published by other organizations that we reviewed during the course of
    our review, suggested that any other existing indexes or data series
    would provide more useful data than those provided by the ECI.
    ---------------------------------------------------------------------------
        \4\ GAO-10-561R.
        \5\ We do note, however, that adjustments to the methodology have
    been made from time to time. For example, in 2006 the Bureau of Labor
    Statistics changed the way the ECI classified industries and
    occupations to reflect new industry and occupational classification
    systems and rebased the index, among other changes.
        \6\ Congressional Budget Office, Evaluating Military Compensation
    (Washington, DC: June 2007),
        \7\ GAO-10-561R; GAO, Poverty Measurement: Adjusting for Geographic
    Cost-of-Living Difference, GAO/GGD-95-64 (Washington, DC: March 9,
    1995); and GAO, Developing a Consumer Price Index for the Elderly, GAO/
    T-GGD-87-22 (Washington, DC: June 29, 1987).
    ---------------------------------------------------------------------------
                                     ______

                Questions Submitted by Senator Roland W. Burris
                              thrift savings plan
        3. Senator Burris. Mr. Carr and Dr. Hosek, one benefit that the
    military offers is the Thrift Savings Plan (TSP). However, the military
    does not match contributions to the TSP, even though they are
    authorized to. What is the reason for this and are there plans to
    implement this benefit in the future?
        Mr. Carr. The Department currently has no plans to provide military
    members with matching TSP contributions. There are two reasons for
    this. First, unlike the circumstance for Federal employees under the
    Federal Employee Retirement System (FERS), TSP for military members
    represents an added vehicle for long-term savings, it is not a
    fundamental component of their retirement plan. Thus, matching
    contributions do not fulfill the same purpose as they do for civilians.
    Second, independent studies by RAND and the Center for Naval Analyses
    (CNA) indicate that matching contributions are not effective recruiting
    and retention tools and have a sizable estimated annual cost--$840
    million to $2.8 billion.
        For a military member, the government provides a defined benefit
    retirement plan that is more generous than FERS and is fully funded by
    the government. Unlike the civilian employee under FERS, the military
    member does not contribute to the defined benefit plan and receives
    monthly retired pay immediately upon retirement, but at an earlier age
    with many prime working years ahead.
        Dr. Hosek. I do not know the reason the military does not match
    contributions to the TSP and do not know of plans, if any, regarding
    the implementation of TSP in the future. The NDAA 2000 extended TSP to
    the military and provided for service matching of individual
    contributions. Individual contributions can be 1 to 100 percent of
    basic pay, and 1 to 100 percent of any special or incentive pay
    provided that contributions are also made from basic pay. Total
    contributions must be no more than a stated maximum, e.g., $15,500 in
    2007. According to the Defense Finance and Accounting Service (http://
    www.dfas.mil/militarypay/thriftsavingsplantsp/contributionbasics.html),
    NDAA 2000 also allowed uniformed Services to designate critical
    specialties for matching contributions--although no Services have
    chosen to do so. The law stated that servicemembers in these
    specialties must agree to serve on Active Duty for 6 years as a
    condition of eligibility for matching. If eligible, the member may
    receive a Service match dollar-for-dollar on the first 3 percent of
    basic pay contributed and 50 cents per dollar of contribution on the
    next 2 percent of pay, per period. The military TSP is an offshoot of
    the TSP for Federal civilian workers established in 1986. According to
    the Social Security Administration (SSA) (http://www.ssa.gov/policy/
    docs/ssb/v63n1/v63n1p34.pdf), employees under the FERS may contribute
    up to 10 percent of their earnings, with Federal Government matching up
    to 5 percent. Also, the Federal Government makes a 1 percent
    contribution to TSP regardless of whether the employee contributes.
    Civil Service Retirement System (CSRS) participants may contribute up
    to 5 percent of their earnings and do not receive any matching. SSA
    reports the following participation rates in the 1990s in TSP by
    income: $10,000 to $19,999, 57 percent; $20,000 to $29,999, 78 percent;
    $30,000 to $39,999, 90 percent; $40,000 to $49,999, 90 percent; and
    $50,000 or more, 96 percent. (These participation rates exclude the
    automatic 1 percent contribution made by the Federal Government for
    employees under FERS.)
        Drawing together some of the above information, I speculate that
    the willingness of Services to match contributions is limited by the
    cost and resources required to administer the matching program for a
    target population of eligible servicemembers that is likely to be
    small. Small, because the members must be in a critical specialty and
    must agree to an Active Duty service obligation of 6 years. These
    eligibility requirements may also be relevant to speculation about the
    recruiting and retention effects of matching. From the perspective of a
    servicemember or a would-be recruit, both the chance of being in a
    specialty designated as critical and the willingness to sign up for 6
    years might be low.
        Obligations of 3 or 4 years are common, but 6-year obligations are
    much less common. Enlistment and reenlistment might not increase much
    in response to the Federal match. The value of the Federal match will
    depend on how much the individual contributes, and it is likely that
    lower income, younger servicemembers would choose not to participate in
    TSP--and hence put a zero value on possible Service match
    contributions--or would participate but contribute a small amount. To
    put this in perspective, a one-step increase in a reenlistment bonus is
    worth roughly $4,000 to a soldier at first-term reenlistment and, we
    estimate, would increase the reenlistment rate in the specialty
    offering the bonus by 2 to 3 percentage points. Suppose the soldier is
    willing to contribute 3 percent of basic pay plus bonus to TSP, for a
    contribution of about $1,000. The match on this would be $1,000 for a
    total contribution of $2,000, and this would produce an effect on
    reenlistment of perhaps 1 to 1.5 percentage points. The effect could be
    smaller because once the money is contributed there is a penalty for
    withdrawing it early (withdrawals are not tax sheltered), so the money
    is not as liquid as, say, money in a savings account. The individual
    might alternatively consider contributing to a Roth IRA, which does not
    entail a service obligation but has no matching.
        From a longer perspective, the expansion of TSP matching to all
    servicemembers rather than only those in designated specialties would
    be a way, if desired, to alter the nature of the military retirement
    system. It is currently a cliff-vested system with vesting at 20 years.
    Most enlistment members, about 85 percent, do not qualify for military
    retirement benefits and leave the military with no vested pension
    contributions apart from the Social Security contributions made on
    their behalf by DOD. About half of military officers do qualify for
    military retirement benefits. The cliff-vesting system creates a strong
    incentive to remain in the military after completing 10 or so years of
    service, and immediate eligibility to receive retirement benefits upon
    vesting creates an incentive to leave military service. As is well
    known, these incentives cause high retention in the 10 to 20 year of
    service range and a noticeable drop in retention around the 20-year
    point. Depending on how it was done, expanding TSP to make
    participation and matching universal could induce more servicemembers
    to stay in service longer on average than they do today and would
    provide all who complete some minimum number of years of service with
    vested TSP retirement benefits. However, this increase in mid-career
    retention might result in too many heading for 20 years under the
    current military retirement benefit system, and to control this
    increase there would probably have to be changes in the regular
    military retirement system to decrease its generosity or greater use of
    separation pay. Issues like these were considered by the 10th QRMC.

        4. Senator Burris. Mr. Carr and Dr. Hosek, in your opinion, would
    matching TSP contributions be an effective recruiting or retention
    tool?
        Mr. Carr. The Department is not convinced providing matching TSP
    contributions would be an effective recruiting or retention tool.
        RAND analyzed a recent Army pilot program offering new, non-prior
    service enlistees matching TSP contributions as an incentive to enlist
    for longer terms or into critical military occupational specialties
    (MOS).
        In the study, there was little evidence that the availability of
    TSP matching contributions increased the likelihood that a soldier
    would select an MOS eligible for the TSP matching contribution program
    as compared to an MOS not eligible for the program. There was some
    evidence that suggested the availability of TSP matching contributions
    may have resulted in longer-term enlistments, however, a number of
    other factors, such as larger enlistment bonuses easily could have
    accounted for this increase. Overall, the Army pilot program achieved
    minimal success, and the cost to provide matching contributions as an
    incentive did not achieve the desired results.
        The Center for Naval Analyses (CNA) also studied the impact on
    retention of providing matching TSP contributions, using discount rate
    analysis. The study identified that providing these matching TSP
    contributions would appeal most to members seeking short-term savings.
    A member who receives a poor performance report would be likely to save
    the maximum amount necessary to receive a full matching contribution in
    anticipation of leaving the military. The TSP matching contributions
    are an incentive to those more likely to leave the military rather than
    stay.
        Dr. Hosek. I would expect the effect of matching TSP contributions
    on recruiting and retention to be small if matching were limited to
    critical specialties and required a 6-year obligation. The effects
    could be much larger if TSP--with matching were universally available
    to servicemembers. Universal TSP with matching and with a required
    service obligation of 6 years--the current obligation--or perhaps
    longer, say 8 or 10 years, could be expected to increase the average
    number of years of service. The effect on recruiting might be small
    because many potential recruits would not be sure they wanted to be in
    the military long enough to vest their TSP match.

               post-deployment and mobilization respite allowance
        5. Senator Burris. Mr. Carr, the Army has a detailed plan for
    payment to all National Guard soldiers who are eligible for
    compensation under the Post Deployment and Mobilization Respite
    Allowance (PDMRA). The Army Deputy Chief of Staff, G-1, is responsible
    for this action and already has the Army National Guard's preliminary
    list of 6,865 eligible individuals. There is a projection of up to
    15,000 Reserve component personnel who may be eligible. The Army
    anticipates that the majority of claims will be paid by March 19, 2010.
    The Secretary of the Army has directed the immediate flow of certified
    portions of the eligible list to the Defense Finance Accounting System
    (DFAS) as soon as they are ready. How many of the projected 15,000
    Reserve component personnel have yet to receive their PDMRA?
        Mr. Carr. As of May 18, 2010, the Army has paid 7,655 soldiers a
    total of $30,717,800 for 153,092 PDMRA days. If the projected estimate
    of 15,000 is accurate, there are approximately 7,345 soldiers still
    eligible to be paid.

                                reserve affairs
        6. Senator Burris. Mr. Carr, in 2001, the Office of the DOD Office
    of Reserve Affairs, in a report for the 2001 Quadrennial Defense Review
    (QDR), outlined a new approach to military service as a continuum
    between full-time duty and service for only a few days a year. The
    report suggested ``a new availability and service paradigm--referred to
    here as a continuum of service--that provides individual servicemembers
    greater flexibility in becoming involved in and supporting the
    Department's mission. In turn, DOD would have greater flexibility in
    accessing the variety of skills required to meet its evolving
    requirements.'' How many Reserve component personnel are affected by
    this policy and what are the projected costs?
        Mr. Carr. The continuum of service concept applies to all military
    servicemembers in the Active component (1.4 million) and the Reserve
    components (851,000 Selected Reservists and 218,000 Individual Ready
    Reservists).
        A comprehensive cost analysis of this policy has not been
    completed. However, the real issue is access to servicemembers and
    reducing the barriers that impede the seamless movement of Total Force
    members between Active and Reserve components. The continuum of service
    capitalizes on the operational experience of the Active, Guard, and
    Reserve components and enhances a return on our training and education
    investment. It creates a system of Reserve component service that
    continues to effectively use each individual's abilities throughout
    their career. Making the best use of our military talent pool,
    particularly in an era of increasingly constrained resources,
    translates to a more capable force at a lower cost.

        7. Senator Burris. Mr. Carr, how does DOD plan to implement the
    continuum of service policy?
        Mr. Carr. The Joint Service Continuum of Service Working Group was
    established to identify and eliminate barriers to fielding capabilities
    by providing seamless transition between Total Force components (Active
    component, Reserve component, and civilians) to fill the Nation's
    requirements. Coordinated actions between Services result in retention
    of experienced and trained individuals and eliminate barriers that
    prevent transition between differing service commitments and between
    military and civilian service.
        The Working Group is addressing the reform of military personnel
    records information management, to include a review of the types of
    information (such as waivers and law enforcement infractions) that
    should be maintained throughout servicemembers' careers. It is also
    addressing the life-cycle management of medical records. The Working
    Group continues to work with the Services on improving the seamless
    transition between the Active and Reserve components.

        8. Senator Burris. Mr. Carr, how does policy support the plan to
    operationalize the Reserve component?
        Mr. Carr. The current policy, DOD Directive 1200.17, establishes
    the overarching set of principles and policies to promote and support
    the management of the Reserve components (RC) as an operational force.
    It outlines the major stakeholders' responsibilities and defines terms
    of reference necessary to accomplish those responsibilities. This
    policy also defines the duration and frequency for orders to Active
    Duty and implements the train-mobilize-deploy model that ensures our
    servicemembers are mission-ready yet able to balance the needs of their
    families, civilian careers, and periodic military service.
        The 2010 QDR also included several themes that support an
    Operational Reserve force. It stressed that RC forces will be required
    to serve in an operational capacity through predictable deployments in
    order to prevail in today's wars and also to fulfill requirements for
    which they are well-suited in the future. In the QDR, the Department
    committed to meeting expectations of National Guard and Reserve men and
    women to periodically serve on Active Duty, be judiciously used, given
    meaningful work to do and provided the right training and equipment to
    complete the mission. It also recognized that using the RC in this way
    will lower overall personnel and operating costs and contribute to the
    sustainability of the Active and Reserve components. Lastly, the QDR
    acknowledged the untapped capability and capacity of the RC and called
    for a comprehensive review of the future role of the RC, to include an
    examination of the balance between Active and Reserve Forces. We
    anticipate the findings from this review will generate recommendations
    for further law, policy, and doctrinal adjustments.
                                     ______

                 Questions Submitted by Senator Lindsey Graham
                   sufficiency of pay raise and the pay table
        9. Senator Graham. Mr. Carr, Ms. Farrell, Dr. Murray, and Dr.
    Hosek, the proposed pay raise for fiscal year 2011 is 1.4 percent, but
    this matches last year's rise in the ECI. Increasing this percentage
    would cost an additional $350 million in fiscal year 2011, and much
    more over time, as you have all noted in your testimony. Please explain
    what the impact on the DOD budget would be if Congress directed an
    increase in the pay raise by 1 percent, or half a percent without
    offsets.
        Mr. Carr. Increasing the military pay raise by an additional 1
    percent would cost approximately $680 million for the fiscal year 2011
    base budget and increase fiscal year 2011 Overseas Contingency
    Operation costs by another $60 million. If funding was provided without
    offsets, there would be no impact on DOD's fiscal year 2011 budget.
    However, there would be significant impact on the Defense budget in
    fiscal year 2012 and every year thereafter as the pay raise increase
    continues to compound and crowd out funding for other critical DOD
    programs within a fiscally constrained environment.
        For example, because the pay raise occurs on January 1st each year,
    the $680 million in fiscal year 2011 represents the cost for only 9
    months. Therefore in fiscal year 2012, the full 12-month impact of the
    1 percent increase is over $900 million.
        Ms. Farrell. Any increase in basic pay--whether it is equivalent to
    the ECI or some percentage above the ECI--results in additional near-
    term and long-term costs to compensate servicemembers. The NDAA for
    Fiscal Year 2004\8\ included a provision tying the annual basic pay
    raise to the annual percentage increase in the ECI and, for fiscal
    years 2004, 2005, and 2006, the law required that servicemembers' basic
    pay increase be equal to the annual percentage increase in the ECI plus
    an additional one-half percentage point. That law also contains a
    provision allowing the President to propose alternative pay adjustments
    to Congress, in certain circumstances, if the President deems the
    standard increase required by the law to be inappropriate. For fiscal
    year 2011, the President and DOD have requested a 1.4 percent increase,
    which is equivalent to the percentage increase in the ECI.
    ---------------------------------------------------------------------------
        \8\ Pub. L No 108-136, Sec. 602 (2003), codified at 37 U.S.C.
    Sec. 1009.
    ---------------------------------------------------------------------------
        In recent years, the additional one-half percentage point has been
    added in order to reduce a perceived gap between military and private-
    sector pay. However, as our recent work comparing military and civilian
    compensation asserts, we do not believe that comparing changes in the
    ECI with changes in the rates of basic pay shows there is a difference,
    or pay gap, between the two, or that such comparisons facilitates the
    assessment of how military pay rates compare with what civilian
    employers provide. In our view, and as officials at CBO noted,\9\ such
    a comparison does not reveal a pay gap because, among other reasons, it
    assumes that basic pay is the only component of military compensation
    that should be compared with changes in civilian pay. While basic pay
    represents the largest portion of military compensation, servicemembers
    may also receive allowances for housing and subsistence. By excluding
    these allowances, comparing changes in the ECI with changes in the
    rates of basic pay simply illustrates how a portion of military
    compensation--basic pay--has changed over time.
    ---------------------------------------------------------------------------
        \9\ Congressional Budget Office, Statement of Carla Tighe Murray:
    Evaluating Military Compensation, CBO (Washington, DC, Apr. 28, 2010);
    CBO, Evaluating Military Compensation (Washington, DC, June 2007); and
    CBO, What Does the Military ``Pay Gap'' Mean? (Washington, DC, June
    1999).
    ---------------------------------------------------------------------------
        Dr. Murray. CBO estimates that increasing the pay raise to 1.9
    percent, rather than the 1.4 percent requested by the President, would
    cost an additional $350 million in fiscal year 2011, assuming the pay
    raise took effect in January 1, 2011. In fiscal year 2012, DOD
    personnel costs would rise by $490 million, and by a total of about
    $2.4 billion between 2011-2015, CBO estimates. Increasing basic pay by
    2.4 percent would double the effect: it would raise DOD personnel costs
    (relative to a 1.4 percent pay raise) by about $700 million in fiscal
    year 2011 and by a total of about $4.7 billion between 2011-2015.
        Dr. Hosek. I defer to the others as they have developed models for
    such projections.

        10. Senator Graham. Mr. Carr, Ms. Farrell, Dr. Murray, and Dr.
    Hosek, is there a better metric than the ECI to gauge what an annual
    pay raise should be?
        Mr. Carr. The Department believes the ECI provided by the Bureau of
    Labor Statistics is the appropriate metric to gauge the annual
    adjustment to basic pay. This index measures the change in the cost of
    labor in the United States, free from the influence of employment
    shifts among occupations and industries. It is national in scope and,
    like the military, covers a full spectrum of occupations. While some
    variations exist in comparing the military population with the
    population surveyed for the ECI, the ECI provides a broad, reliable,
    and statistically sound measure upon which to base the annual pay
    raise.
        The 11th Quadrennial Review of Military Compensation intends to
    review the adequacy of military basic pay and to compare pay to the
    portion of the civilian population with similar characteristics.
    Currently, the Department uses the ECI for measuring wage growth in the
    private sector. It is possible the 11th QRMC could identify a more
    tailored metric to gauge military pay raise. The 11th QRMC's
    recommendations are expected in May 2011.
        Ms. Farrell. As we have reported \10\ and as noted above, using the
    ECI for the purpose of determining the amount of the annual basic pay
    raise for servicemembers has both strengths and weaknesses but is
    generally reasonable to use to adjust such pay annually. It should also
    be noted that basic pay is just one component of the total military
    compensation package. In addition to basic pay, servicemembers also
    receive allowances, tax advantages, as well as deferred and in-kind
    compensation.
    ---------------------------------------------------------------------------
        \10\ GAO-10-561R.
    ---------------------------------------------------------------------------
        The ECI is a nationally representative measure of labor costs for
    the civilian economy and is used by businesses and other organizations
    to, among other things, adjust wage rates to keep pace with
    competitors. In our view, using the ECI to determine the amount of the
    annual basic pay raise has both strengths and weaknesses, but it is
    generally reasonable to use it to adjust basic pay annually. As
    mentioned earlier, the strengths include the following: the ECI is a
    nationally representative measure of labor costs for the civilian
    economy; it is produced in a consistent fashion,\11\ using a
    transparent methodology; and it provides separate data series for
    different occupational groups, industries, and geographic areas.
    However, the ECI is not tailored to the specific segments of the
    civilian economy most relevant to DOD--for example, those occupations
    and industries that the Military Services primarily compete with for
    workers. Also, because the ECI is constructed from data collected from
    surveys of employers, it does not provide data about the demographics
    of the civilian workforce--such as workers' education and experience,
    both of which are important factors that are often taken into account
    when setting employee pay. Nevertheless, we, as well as CBO,\12\ have
    previously reported \13\ on the challenges of creating more tailored
    indexes. Further, none of the experts whom we consulted nor any reports
    published by other organizations that we reviewed during the course of
    our review suggested that any other existing indexes or data series
    would provide more useful data than those provided by the ECI.
    ---------------------------------------------------------------------------
        \11\ There are adjustments in the methodology from time to time.
    For example, in 2006 the Bureau of Labor Statistics changed the way the
    ECI classified industries and occupations to reflect new industry and
    occupational classification systems and rebased the index, among other
    changes.
        \12\ Congressional Budget Office, Statement of Carla Tighe Murray:
    Evaluating Military Compensation (Washington, DC, Apr. 28, 2010) and
    Evaluating Military Compensation (Washington, DC, June 2007).
        \13\ GAO-10-561R, GAO/GGD-95-64, and GAO/T-GGD-87-22.
    ---------------------------------------------------------------------------
        Dr. Murray. While the ECI does have some limitations, as discussed
    in the CBO testimony, it is a reasonable benchmark of the increase of
    civilian wages and salaries to use in evaluating the annual basic pay
    raise. Because it is only a benchmark, however, the decision of where
    to set the basic pay raise can also be informed by trends in recruiting
    and retention, recent changes in noncash benefits, and expected changes
    in housing and subsistence allowances.
        Dr. Hosek. The ECI is an objective, well-documented, frequently
    updated measure of employment cost growth in the U.S. economy. It is
    designed to be representative of nationwide employment. In earlier
    research (A Civilian Wage Index for Defense Manpower), my colleagues
    and I critiqued the ECI because it was not designed to be
    representative of the military population. This is important because
    wage trends for workers with age, education, race/ethnicity, gender,
    and occupations characteristics of enlisted and officer personnel are
    not the same as those of the general working population. The research
    proposed an index approach similar in character to that of the ECI but
    designed to be representative of the Active Duty military. The research
    found that over the 1982-1991 period military basic pay grew 11.8
    percent slower than the ECI but only 4.7 percent slower than our
    civilian wage index representative of the military. This is evidence
    that civilian wage trends do vary by worker age, education, et cetera,
    which implies that relying on a broad-gauge measure such as the ECI
    might give an inaccurate picture of whether military pay was keeping up
    with civilian pay. Further, the ECI is not always the best index to use
    in defining the military pay gap. A measure of military/civilian pay
    based on the ECI did a worse job of tracking recruiting and retention
    than one based on our representative index.
        No approach will be perfect. My sense in brief is: (a) continue to
    rely on the ECI, but (b) require that recruit quality and retention
    measures be reported and considered in tandem, and (c) conduct
    periodic--even annual--assessments of military pay using micro data to
    control for the factors mentioned above. The ECI is a convenient
    starting point for a discussion of annual pay raises but not the ending
    point. The fact that it is provided by the Bureau of Labor Statistics,
    an impeccable source that is independent of interest groups, is a
    genuine plus. However, discussions of military pay raises should
    include consideration of recruiting and retention as well as
    comparisons of military pay with the civilian wage distribution for
    workers with comparable characteristics to those of military members.
    CBO currently does such comparisons.

        11. Senator Graham. Mr. Carr, Ms. Farrell, Dr. Murray, and Dr.
    Hosek, several years ago, the Department proposed targeted changes to
    the pay in certain grades with certain longevity, which was designed to
    relieve pay compression, and provide greater incentives for promotion.
    Does the current pay table need adjustment?
        Mr. Carr. The Department believes the changes to the pay table over
    the past several years have achieved the objectives of relieving pay
    compression and providing greater compensation incentives for
    promotion. The current pay table does not need further adjustment in
    this regard.
        The 9th Quadrennial Review of Military Compensation (QRMC)
    evaluated military compensation and determined pay should be
    benchmarked against the 70th percentile of comparably educated
    civilians. In certain places within the basic pay table, basic pay fell
    below the 70th percentile. As a result, the 9th QRMC recommended and
    the Department implemented specific changes in the basic pay table to
    move those grades and years-of-service up to the 70th percentile. The
    9th QRMC recommendations also were designed to relieve pay compression
    and provide greater incentives for promotion.
        Since the review in 2006, we have reevaluated the basic pay table
    every 2 years and concluded military pay across-the-board continues to
    exceed the 70th percentile.
        Ms. Farrell. While we have not previously assessed whether the
    current pay table needs adjustment, we have for over 3 decades reported
    \14\ that the current military compensation package has been the result
    of piecemeal changes and adjustments over time and lacks overall
    guiding principles. Specifically, in 1979, we evaluated DOD's military
    compensation system and concluded that piecemeal adjustments and a lack
    of overall guiding principles of compensation were a problem in
    establishing a basis for evaluating changes to the total compensation
    system. More recently, in 2005, we noted that some of the same
    underlying problems that we identified in 1979--including a lack of
    explicit compensation principles and difficulty in making major changes
    to compensation--still existed.
    ---------------------------------------------------------------------------
        \14\ GAO, Military Personnel: DOD Needs to Improve the Transparency
    and Reassess the Reasonableness, Appropriateness, Affordability, and
    Sustainability of Its Military Compensation System, GAO-05-798
    (Washington, DC: July 19, 2005) and The Congress Should Act To
    Establish Military Compensation Principles, GAO/FPCD-79-11 (Washington,
    DC: May 9, 1979).
    ---------------------------------------------------------------------------
        In discussions with DOD, officials indicated that the Department
    previously adjusted the basic pay table in order to make pay at all
    ranks and years of service more in line with the 70th percentile--as
    recommended by the 9th QRMC 2004. That review recommended that regular
    military compensation be set to equal the 70th percentile of comparable
    civilian compensation. At that time, the Department found that for some
    ranks and years of service, compensation was close to the 70th
    percentile, but for other ranks and years of service it was not so
    close. As a result, according to DOD officials, the Department relied
    on targeted pay increases to raise the level of pay for certain ranks
    and years of service in the pay table from about the year 2000 through
    2005. However, according to one of these officials, 2005 was the first
    year in which pay for all ranks and years of service was increased in
    lockstep to bring pay more in line with the 70th percentile.
        Regarding targeted changes to pay, we have reported that across-
    the-board pay increases fail to target resources where they are most
    needed and they affect a variety of other costs--such as retired pay.
    Rather, the targeted use of compensation--such as special pays and
    bonuses for particular occupational skills--tends to maximize limited
    resources and help make recruiting and retention gains in needed areas.
    Our prior work \15\ recognizes DOD's ability to use the more than 60
    different special and incentive pays--including reenlistment bonuses
    and hazardous duty pay, as well as other pays for specific duties like
    aviation and medical, and incentives for servicemembers to take certain
    assignments, among others. Because most compensation is determined by
    factors such as tenure, rank, location, and dependent status, these
    special pays and allowances are the primary monetary incentives DOD has
    for servicemembers other than promotions and are used to influence
    certain behaviors, such as extending a service contract or filling
    critical shortage occupations.
    ---------------------------------------------------------------------------
        \15\ GAO-10-666T, GAO-10-561R, Military Personnel: DOD Needs to
    Establish a Strategy and Improve Transparency over Reserve and National
    Guard Compensation to Manage Significant Growth in Cost, GAO-07-828
    (Washington, DC: June 20, 2007), and GAO-05-798.
    ---------------------------------------------------------------------------
        Dr. Murray. CBO has not studied this issue in depth. However,
    recent trends in recruiting and retention suggest that the current pay
    table, supplemented by DOD with bonuses where needed, is adequately
    compensating the force for the hardships of military life.
        Dr. Hosek. Targeted increases were done in several years beginning
    with NDAA for Fiscal Year 2000. I do not know whether the pay table
    needs further adjustment. One of the motivations for targeting was to
    ensure adequate incentives and rewards for individuals who showed high
    performance in the military but who, because of their talent and
    expertise, might also have excellent job opportunities in the civilian
    world. Targeted pay raises and relieving pay compression were steps
    toward helping the military keep highly capable members and future
    leaders. Entry characteristics such as education and AFQT are valid
    predictors of early retention, successful completion of initial
    training, and proficiency in performing mission essential tasks, but
    our research at RAND indicates that much of the information about a
    member's fit with the military and performance in the military is
    revealed in service, not at entry. It is important for the military to
    have an incentive structure that works to retain these individuals who
    have distinguished themselves. To determine whether the pay table needs
    further adjustment, it might be useful to study whether the military is
    doing better today, or at least as well as before, in keeping high
    performers.

                            effects of cliff vesting
        12. Senator Graham. Mr. Carr, Ms. Farrell, Dr. Murray, and Dr.
    Hosek, various study groups in recent years have questioned the wisdom
    of the military's traditional 20-year requirement to earn retired pay,
    suggesting that vesting at an earlier milestone in a career--say 10
    years--would more effectively help to achieve DOD's personnel goals.
    However, assuring retention of mid-level personnel beyond their first
    or second terms of service--especially in wartime--would seem to
    justify reliance on this approach. What do you think the effect of
    reducing the requirement for entitlement to retired pay below 20 years
    would be on the ability to retain the personnel we need in leadership
    positions in the Armed Forces?
        Mr. Carr. Reducing the requirement for retired pay entitlement
    below 20 years will have a pronounced impact on retention patterns. The
    20-year vesting requirement creates a strong incentive for personnel
    who have reached 10 to 12 years of service. As a result, the 20-year
    vesting requirement results in significantly greater retention of mid-
    grade members than would otherwise occur. To increase retention and
    maintain the desired numbers of mid-grade personnel, the Department
    would need to provide substantial additional bonuses or incentive pays.
        The 20-year vesting also provides an equally strong incentive for
    those members who reach the 20-year threshold to leave. This has
    allowed the Department to minimize the use of involuntary separations
    and avoid the negative impact these separations would likely have on
    force morale. With significant portions of each 20-year cohort leaving
    every year, this ensures senior positions are available for rising
    junior personnel. Therefore, the Department does not support reducing
    the requirement for entitlement to retired pay below 20 years of
    service.
        Ms. Farrell. In the absence of any identified weaknesses in the
    overall recruiting and retention rates, it is difficult to determine if
    problems exist that would be best corrected through changes to the
    current retirement system. Further, our prior work \16\ has shown that
    benefits, especially deferred benefits like retirement, are a
    relatively inefficient way to influence recruiting and retention, as
    compared with cash pay. Efficiency, as defined by DOD, is the amount of
    military compensation--no higher or lower than necessary--that is
    required to fulfill the basic objective of attracting, retaining, and
    motivating the kinds and numbers of Active Duty servicemembers needed.
    However, the efficiency of some benefits is difficult to assess because
    the value that servicemembers place on them is different and highly
    individualized. Therefore, understanding the effect of reducing the
    vesting requirement below 20 years requires an understanding of how
    servicemembers value retirement benefits, in general. Because the
    current military retirement benefit is: (1) a defined benefit plan with
    a 20-year cliff vesting requirement; and (2) a promise of future
    retirement payments made over the remainder of the servicemember's
    lifetime, calculating the value today--the present value--is difficult.
    In calculating the present value of the retirement benefit, two factors
    are critically important: the probability of staying in the military
    until retirement and the discount rate used to calculate the present
    value of retirement.
    ---------------------------------------------------------------------------
        \16\ GAO-05-798.
    ---------------------------------------------------------------------------
        DOD's current retirement system is meant to create a strong
    incentive for military personnel who stay beyond 8 to 10 years to
    complete 20 years and leave soon thereafter. Specifically, under DOD's
    current retirement system, according to the Department's Office of the
    Actuary, only 15 percent of enlisted and 47 percent of officers become
    eligible to receive retirement under the current plan that requires 20
    years of service to vest.
        If a military career is viewed as a continuum, retention rates will
    typically rise just before the point at which servicemembers may vest,
    and will subsequently decline on the far side of that point. As noted,
    under the current retirement system, servicemembers vest after 20 years
    and may immediately retire. Thus, moving the vesting milestone from 20
    years to 10 years makes sense if the perceived challenge is getting
    people, who otherwise might have left after 5 years, to stay until 10
    years, and/or getting people to leave after 10 years. However, moving
    the vesting requirement would eliminate a major incentive for
    servicemembers with 10 years of service to stay on until 20 years.
    Therefore, retention rates of experienced servicemembers with 10 years
    of service or more may decline. Lastly, vesting servicemembers at 10
    years is likely to be less powerful in affecting behavior because the
    stakes are lower--specifically, a servicemember who leaves the Service
    at 9 years of service under 10-year vesting forfeits much less than
    someone who leaves after 19 years of service under 20-year vesting.
    However, these effects may differ based on the extent to which changes
    are made to the retirement system--for example, if changes are made
    solely to the vesting requirement but not to the number of years
    required to reach retirement eligibility. Another approach that would
    yield different results would maintain the immediate retirement
    standard at 20 years, but allow servicemembers to vest at an earlier
    point in their careers (e.g., 10 years) and make it a deferred vested
    benefit that servicemembers would receive at, for example, 65 years of
    age.
        It is important, however, to consider all potential effects \17\ of
    such a change. For example, reducing the requirement for vesting
    eligibility would potentially result in higher percentages of officers
    and enlisted servicemembers vesting and thus receiving a retirement
    pension, which could have significant cost implications for the
    Department in the future. Furthermore, the uniformed services are
    unlike nearly all other organizations in that: (1) they have closed
    personnel systems--that is, DOD relies almost exclusively on accession
    at the entry level (E-1 or 0-1), and on its higher-ranking members
    being retained and promoted from lower ranks; and (2) according to DOD,
    there is no private-sector labor market from which the military can
    hire for certain unique occupations--such as an infantry battalion
    commander. By contrast, most other organizations can and do hire from
    the outside at all levels. Thus, the failure to meet recruiting or
    retention goals at lower levels in a given year can have significant
    consequences for a Service's ability to produce experienced leaders for
    years to come.
    ---------------------------------------------------------------------------
        \17\ In 2005 and 2007, we provided Matters for Consideration that
    asked Congress to consider the long-term affordability and
    sustainability of any additional changes to pay and benefits for
    military personnel and veterans, including the long-term implications
    for the deficit and military readiness. Such a change to the current
    retirement system would most certainly have long-term implications for
    affordability and sustainability. See GAO-05-798 and GAO-07-828.
    ---------------------------------------------------------------------------
        Dr. Murray. Researchers generally agree that the relatively low
    value that young people place on deferred compensation, combined with
    the relatively low probability that a new recruit will stay for 20
    years, suggests that the recruiting and retention value of the current
    retirement system is lower than that of current cash compensation,
    particularly among those serving less than 10 years. However, the
    promise of retirement pay does encourage personnel who have already
    served for at least 10 years to remain for the full 20-year career; it
    also encourages them to leave soon after, even if they might have
    productively served DOD beyond that time. In addition, some researchers
    argue that DOD is reluctant to involuntarily separate those mid-
    careerists, and instead treats them as though they have an implicit
    contract to stay for 20 years. Thus, the current system encourages some
    members to leave too soon, and it encourages others to stay too long.
    Changing the retirement system would alter the force profile, but the
    nature of the change, and the career incentives it would create, would
    depend on the specifics of the proposal.
        Dr. Hosek. The current military retirement system contains strong
    incentives to stay in an Active component until 20 years of service if
    a member has completed 10 or so years of service. The system also has
    strong incentives to leave after 20 years of service. Advantages of the
    system are that the incentives operate automatically; are well known to
    the servicemember and stable over time; are equitable in the sense that
    servicemembers (probably) perceive fairness in having the amount of
    benefit based on years of service and rank, which are well understood
    outcomes in a system with broadly equal ex ante opportunity for
    enlisted personnel and, separately, for officer personnel; and are
    largely independent of the size of the force, meaning that the force
    can be scaled up or down without affecting the servicemember's expected
    benefit so long as promotion opportunities and up-or-out rules remain
    the same. I list these aspects of the current system because each is
    relevant to the question of whether reducing the requirement for
    vesting to below 20 years would affect the ability to retain personnel
    needed in leadership positions.
        Reducing vesting to say, 10 years of service, is not the same as
    reducing the time at which retirement benefits may be drawn. Keeping
    all other features of the retirement system as they are now but
    reducing vesting will increase the value of staying until 10 years.
    This is because today, with vesting at 20 years, a member who leaves at
    10 years has a zero value of retirement benefits, whereas under 10-year
    vesting the value would be positive. Vesting at 10 years therefore
    increases the incentive to stay to year 10 at least and so should
    increase retention to 10 years, and it also increases the incentive to
    enter service. However, because there is no longer a ``lock in'' effect
    to stay until 20 years of service, there is, by comparison, a greater
    incentive to leave after completing 10 years. This can be counteracted
    by introducing an incentive to stay, such as a completion bonus at year
    16. RAND explored complex changes to the compensation system such as
    these for the 10th QRMC, and drawing on the insights of our analysis I
    expect that a decrease in the year of vesting accompanied by a
    completion bonus of sufficient size could maintain the current
    retention profile of the force.
        Still, the question draws attention to wartime--if vested at 10
    years, would servicemembers in wartime be more likely to leave service
    than they would under the current system? I know of no research
    specifically addressing this question. Research on the effect of
    deployment for hostile duty on first- and second-term reenlistment, and
    on junior officer retention, finds that for the most part deployment
    has a positive effect on enlisted and officer retention. The exception
    to this occurs when a servicemember has extensive deployment, e.g., 12
    or more months of hostile deployment in the previous 36 months, in
    which case deployment can have a negative effect on retention. This
    finding takes into account deployment-related pays. As a specific
    example, a negative effect of deployment occurred in 2006 to 2007 in
    the Army, and it was largely offset by the expanded use of reenlistment
    bonuses and an increase in the average amount of the bonuses (How Have
    Deployments During the War on Terrorism Affected Reenlistment?).
    Summarizing, evidence indicates that for the most part the effect of
    hostile deployment on enlisted and officer retention has been positive,
    but extensive deployment can cause a negative. When this has occurred,
    bonuses have been effective in counteracting the negative effect.

               recruiting and retaining health care professionals
        13. Senator Graham. Mr. Carr, there are significant shortages among
    certain health care professionals, coupled with historic low rates of
    acceptance of fully paid health professions scholarships. We knew that
    these problems could not be fixed overnight, and the committee stepped
    in to increase the ceilings on scholarships and update several medical
    and recruiting incentives. How much visibility does your office have
    and what oversight do you exercise into how well the medical community
    and personnel chiefs are doing in effectively recruiting and retaining
    medical personnel?
        Mr. Carr. The Under Secretary of Defense for Personnel and
    Readiness has responsibility for the Department concerning all
    recruiting and retention matters. Many specific program authorities
    have been delegated to the Assistant Secretary of Defense for Health
    Affairs (ASD(HA)). For matters involving the health professions,
    ASD(HA) collaborates with Military Personnel Policy (MPP) to provide
    oversight and develop medical personnel policy guidance for the
    Military Department Secretaries regarding accessing and retaining
    personnel in health professions. The military departments program and
    budget for the necessary funds to recruit and retain their medical
    professionals.
        To ensure oversight, DOD annually convenes the Medical-Personnel
    Executive Steering Committee, made up of the Deputy Chiefs of Staff for
    Personnel and the Surgeons General from each Service. The Department
    and Services review the annual Health Manpower Statistics Report, which
    is published by the Defense Manpower Data Center to check the status of
    medical manning. On a monthly basis, the Health Professions Incentives
    Working Group meets to review medical personnel issues and make
    recommendations to leadership on incremental adjustments to the
    existing financial incentives.

        14. Senator Graham. Mr. Carr, please explain how the incentive pays
    for health care professionals are regulated to help the Services meet
    their recruiting and retention goals. How involved is your office (as
    opposed to the ASD(HA) in ensuring that personnel needs are met?
        Mr. Carr. Deputy Under Secretary of Defense for MPP works closely
    with the ASD(HA) on matters pertaining to military medical force
    management. We rely on bonuses and special pays as critical tools for
    managing the medical force. Each year, the DOD convenes the Health
    Professions Incentives Working Group to make recommendations to
    leadership on incremental adjustments to the existing financial
    incentives for retention under the legislative limits. The Military
    Departments and Public Health Service participate. The process takes
    into account DOD staffing, civilian pay, operational demand, and
    service-specific issues.
        The Office of the ASD(HA) develops the policy and establishes bonus
    and special pay amounts for health care professionals. In matters
    pertaining to recruiting and retention of medical military personnel,
    HA coordinates closely with the office of the Deputy Under Secretary of
    Defense for MPP. MPP is responsible for oversight and policy for
    recruiting and retention matters, with the exception of Reserve
    personnel and health professionals. Approval authority and reporting
    responsibility reside with the Principal Deputy Under Secretary of
    Defense for Personnel and Readiness. Annually, the Department provides
    Congress a report analyzing effects and future use of critical skills
    retention bonuses which includes bonuses for several health care
    professions.

        15. Senator Graham. Mr. Carr, what about retention of health care
    professionals? How much visibility do you have into how the Services'
    personnel chiefs are doing in effectively retaining mid-career
    personnel and what is your assessment of the Services' ability to
    recruit and retain doctors, dentists, nurses, et cetera?
        Mr. Carr. The Office of the Deputy Under Secretary of Defense for
    MPP continuously monitors the retention of mid-career medical personnel
    by using reports from the Services and the annual Health Manpower
    Statistics Report, published by the Defense Manpower Data Center
    (DMDC). This report is used to check the status of medical manning for
    the DOD and provides a fiscal year-end snapshot of the status of
    medical manning as well as historical trend information on medical
    manpower and personnel for managers within the DOD. The report is
    produced in coordination with the ASD(HA), the Assistant Secretary of
    Defense for Reserve Affairs, DMDC, and Service representatives.
        In assessing the data from the Health Manpower Statistics Report,
    the ASD(HA) and Services continually monitor and adjust and expand
    medical special pay plans and bonus structures where significant
    shortages exist for specific physician, dentist, nurse and other allied
    health specialties.
        The DOD uses a comprehensive package of special and incentive pays
    to attract and retain health professionals. Physicians and dentists are
    eligible to receive special and incentive pays consisting of a
    multiyear retention bonus, variable special pay, additional special
    pay, incentive special pay, board certification pay, critical skills
    retention bonuses, critically short wartime specialties, and critical
    skills accession bonuses. Nurses and other health care professionals
    are eligible for accession, board certification, incentive, and
    retention pays and bonuses depending on their specialties and skill.
    The Department recently implemented the special bonus and incentive pay
    authorities for officers in health professions. This authority provides
    DOD the flexibility to react quickly to shortfalls in health care
    profession specialties, and was recently used to provide special pay to
    licensed clinical psychologists and clinical social workers.

                         value of health care benefits
        16. Senator Graham. Dr. Murray and Dr. Hosek, there is widespread
    concern about the sustainability of military health care benefits.
    According to a Congressional Budget Office 2009 report, projections
    indicate that costs for medical care will rise more rapidly than
    overall resources for defense, and require an estimated 13 percent of
    total defense funding by 2026. What is your advice to Congress on how
    to strike an appropriate balance between the need to sustain military
    health care benefits in the future, and the obvious value of this
    benefit in recruiting and retaining needed military personnel?
        Dr. Murray. CBO estimates that under DOD's plans for fiscal year
    2010, the Department's medical funding will grow from $46 billion in
    2010 to $90 billion by 2028, nearly doubling over and above the effects
    of general inflation. More than half of health care spending goes to
    military retirees and their families. However, only about 15 percent of
    enlisted members and about half of officers will serve long enough to
    retire. Thus, most of the current force, including most of those
    serving in Iraq and Afghanistan, will not receive the retiree health
    care benefit.
        Most researchers agree that deferred benefits like retiree health
    care are not valued by younger personnel as highly as current cash
    compensation. Moreover, the military retirement system, in which
    members can receive retired pay only after serving 20 years or more,
    encourages those who have served 10 years or more to stay for a full
    career. In its budget request for 2009, DOD proposed increasing the
    copayments, enrollment fees, and deductibles paid by military retirees
    and their families to levels that reflect the growth seen in civilian
    health care spending. In analyzing the DOD proposal, CBO found that
    charging higher out-of-pocket costs could significantly reduce DOD's
    spending on health care for military retirees and their survivors and
    dependents. Most of the estimated savings would have come from a drop
    in enrollment in TRICARE--current users who would leave the program and
    prospective users who would choose not to enroll. Because some of those
    retired users would switch to other Federal programs, such as the
    services offered by the Veterans Health Administration, savings to DOD
    would be partially offset by increases in other Federal spending.
        Dr. Hosek. TRICARE provides military beneficiaries with
    comprehensive health benefits at no cost for most Active Duty
    beneficiaries and very low cost for retired beneficiaries. While costs
    have increased for all beneficiaries, consistent with the national
    pattern, the biggest share of the increase is attributable to retired
    beneficiaries. The benefit compares favorably with benefits offered by
    civilian employers and the Federal Employees Health Benefits Program,
    and the difference in out-of-pocket costs between TRICARE and employer
    insurance has continued to grow wider. Accordingly, military retirees
    have increasingly passed up the health benefits available to them
    through their employer in favor of TRICARE. The 2007 report of the Task
    Force on the Future of Military Health Care proposed a gradual increase
    in TRICARE's cost-sharing rates for military retirees and suggested
    piloting a new benefit that would augment benefits provided by civilian
    employers--e.g., by covering premium contributions. Careful redesign of
    the retiree benefit would maintain a high level of health coverage for
    these beneficiaries while controlling costs by encouraging use of the
    employer benefits to which they are eligible.
        For all beneficiaries, the cost sharing provisions should be
    carefully reviewed now and regularly in the future to ensure that they
    induce the most appropriate care-seeking behavior. Similarly, it is
    worth considering strengthening the incentives of TRICARE's military
    and civilian network providers to provide cost-effective care. That
    said, research on the demand for health care indicates that individuals
    and families have low sensitivity to the price they pay for health
    care; in more technical terms, the demand elasticity is low, at about
    0.2. This means that changes in cost sharing might have modest effect
    on care seeking behavior--but such changes deserve consideration
    because seemingly small changes might result in billions of dollars of
    savings.
        Another aspect of controlling cost without diminishing the value of
    the health care benefit to servicemembers and retirees is to ensure
    that providers are providing the appropriate amount of care, and the
    care is evidenced-based. The Department of Veterans Affairs (VA), for
    instance, has a reputation for providing high-quality care, and the
    military system may want to adopt the VA's innovative quality
    improvement system. There may be more room for inquiring into the
    efficiency of providers: are they providing too much care, too little
    care (which might result in repeat visits and undetected conditions
    that are very costly to treat in advanced stages), or care that is
    inefficient and therefore too costly?

        17. Senator Graham. Dr. Murray and Dr. Hosek, what do studies
    reveal about the relationship of the value of noncash benefits, such as
    health care, and successful recruiting and retention?
        Dr. Murray. Many researchers view noncash compensation as less
    economically efficient than cash compensation because it restricts the
    way in which people can choose to spend their earnings. For example, an
    economist might argue that on-base fitness centers are economically
    less efficient than a ``fitness allowance'' that can be spent in
    whatever way the employee chooses. To the extent that people value
    greater choice, the recruiting and retention effect of cash allowances
    should be greater than benefits provided in-kind. However, the
    popularity of noncash benefits--both in military and civilian life--may
    stem from the fact that many of them are not taxed (or the tax
    liability may be postponed for many years). Another reason that
    employers might offer noncash compensation is to provide a way of
    screening for or maintaining desirable employee characteristics (e.g.,
    physical fitness). In addition, some employers offer a noncash benefit
    if the benefit fosters goodwill or loyalty to the employer. Family-
    support benefits may provide that kind of gift effect, if deployed
    personnel value the feeling that their families are being cared for
    while they are away.
        Dr. Hosek. It is difficult to estimate this relationship because,
    over time, the benefit has been relatively stable and the effects of
    the notable benefit changes that have occurred (e.g., TRICARE and the
    2001 benefit changes) are difficult to isolate from other events. I
    know of no evidence about the effects of noncash benefits on recruiting
    and retention; however, I know that Dr. Murray has studied this topic
    and would defer to her knowledge.

                incentives for unmanned aircraft vehicle pilots
        18. Senator Graham. Mr. Carr, the importance of improving
    surveillance capabilities through unmanned aircraft is well-understood.
    Each Service, however, seems to approach the issue of who controls--or
    pilots--such aircraft, and the compensation they receive--differently.
    Please explain how the Office of the Secretary of Defense (OSD) is
    involved in determining what kinds of special pay and bonuses are
    appropriate for this occupational skill and career path?
        Mr. Carr. Secretaries of Military Departments who elect to pay some
    form of special or incentive pay and/or bonus to unmanned aerial
    vehicle (UAV) operators must submit a UAV recruiting and retention
    compensation plan. The plan is then reviewed by the Office of the Under
    Secretary of Defense (Personnel and Readiness) and approved or
    disapproved as appropriate. To date, the Air Force is the only Service
    that has requested UAV-operator incentive pay. After dialogue between
    the OSD and the Air Force, the rationale for the requested incentive
    pay, statutory authorities, levels of pay, et cetera, the OSD approved
    an incentive pay plan that will extend through December 2010. If the
    Air Force determines UAV operators should be paid an incentive pay
    after December 2010, a new recruiting and retention compensation plan,
    or an extension request, must be submitted for approval.
        The basis of approval or disapproval of a Service's UAV recruiting
    and retention compensation plan depends on a multitude of factors, such
    as UAVs flown (size, weight, complexity, et cetera), armed or unarmed
    status, altitude and airspace flown (FAA nationally controlled airspace
    versus restricted battlefield airspace), supply and demand of UAV
    pilots, as well as the technical difficulty of flying the particular
    UAV types and the associated rigor of the UAV training.
                                     ______

                  Questions Submitted by Senator Susan Collins
                              commissary benefits
        19. Senator Collins. Ms. Farrell, according to a Pentagon survey,
    90 percent of military personnel utilize commissary benefits. Last
    year, the Navy Exchange Service Command generated more than $45 million
    in dividends. These figures seem to indicate that commissary and
    exchange benefits are not especially costly to DOD and that
    servicemembers place a high value on these benefits. How can these
    figures inform the Department in maintaining a competitive cash and
    noncash compensation package for servicemembers and providing it in
    such a way that is affordable to the Department?
        Ms. Farrell. While these figures are informative in terms of
    servicemember use of the commissary and the cost of operating the
    commissary, in the absence of additional data and information on how
    servicemembers value the commissary, these figures cannot appropriately
    inform DOD on affordably maintaining a competitive cash and noncash
    compensation package for servicemembers. We have previously reported
    \18\ that military compensation includes a mix of cash, noncash
    benefits, and deferred compensation, and has been one of the primary
    tools used by DOD to recruit and retain servicemembers since the
    military transitioned to an All-Volunteer Force in 1973. The commissary
    benefit is just one of the noncash benefits available to
    servicemembers. In our recent report,\19\ we noted that 90 percent of
    military personnel responding to the 2007 Status of Forces Survey for
    Active Duty Personnel indicated that they utilize commissary benefits.
    However, while these survey results show that 90 percent--a large
    majority--of respondents reportedly used the commissary, the survey
    does not contain a question that asks about the value the individual
    places on the commissary benefit; therefore, the results of the survey
    could not take into account the value that an individual servicemember
    places on the commissary benefit.
    ---------------------------------------------------------------------------
        \18\ GAO-10-666T, GAO-10-561R, GAO-07-828, and GAO-05-798.
        \19\ GAO-10-561R.
    ---------------------------------------------------------------------------
        In addition, the Navy Exchange Service Command is meant to provide
    quality goods and services at a savings and to support quality-of-life
    programs by providing dividends to Navy Morale, Welfare, and Recreation
    (MWR). In 2008, the Navy Exchange Service Command had total annual
    sales of $2.52 billion and generated more than $45 million in dividends
    for MWR quality-of-life programs. While this figure gives an indication
    of the Command's profitability, it does not take into account the value
    that a servicemember places on the benefit. Further, as we reported in
    2005, servicemembers may not understand the full extent (i.e., the
    value) of their benefits--in this case, the commissary benefit.
        As noted previously, DOD's compensation package is a mix of cash
    and noncash benefits--the commissary benefit being one of the noncash
    benefits available to servicemembers. However, in 2005,\20\ we reported
    that DOD's mix of compensation (i.e., the ratio of cash to noncash to
    deferred benefits) was highly inefficient for meeting near-term
    recruiting and retention needs. We further reported that cash pay in
    the present is generally accepted as a far more efficient tool than
    future cash or benefits for recruiting and retention.
    ---------------------------------------------------------------------------
        \20\ GAO-05-798.

        20. Senator Collins. Mr. Carr, given the rising costs associated
    with salary and health care benefits, is it fair to say that one of
    your goals in developing an effective compensation package for our men
    and women in uniform would be to maximize availability of benefits that
    incur little cost to the Department, but that are also highly valued by
    the Active Duty and retiree community, such as commissary and exchange
    benefits?
        Mr. Carr. Yes. The first and foremost goal of an effective military
    compensation package is to attract, retain, motivate, distribute, and
    ultimately separate the force, both Active and Reserve, required to
    meet the Nation's needs. Within this compensation package, the
    Department strives to provide an appropriate mix of cash, noncash, and
    deferred benefits that meets the goals of the Department as well as the
    needs of military members. This overall package includes benefits such
    as healthcare, commissary, and exchanges.

        [Whereupon, at 11:25 a.m., the subcommittee adjourned.]

    DEPARTMENT OF DEFENSE AUTHORIZATION FOR APPROPRIATIONS FOR FISCAL YEAR
                                      2011

                                  ----------

                            WEDNESDAY, MAY 12, 2010

                                   U.S. Senate,
                             Subcommittee on Personnel,
                                   Committee on Armed Services,
                                                        Washington, DC.

                           RESERVE COMPONENT PROGRAMS

        The subcommittee met, pursuant to notice, at 10:02 a.m. in
    room SR-222, Russell Senate Office Building, Senator Jim Webb
    (chairman of the subcommittee) presiding.
        Committee members present: Senators Webb, Hagan, Chambliss,
    and Graham.
        Committee staff members present: Leah C. Brewer,
    nominations and hearings clerk; and Jennifer L. Stoker,
    security clerk.
        Majority staff members present: Jonathan D. Clark, counsel;
    Gabriella Eisen, counsel; and Gerald J. Leeling, counsel.
        Minority staff members present: Diana G. Tabler,
    professional staff member; and Richard F. Walsh, minority
    counsel.
        Staff assistants present: Jennifer R. Knowles, Hannah I.
    Lloyd, and Brian F. Sebold.
        Committee members' assistants present: Nick Ikeda,
    assistant to Senator Akaka; Roger Pena, assistant to Senator
    Hagan; Clyde A. Taylor IV, assistant to Senator Chambliss; and
    Walt Kuhn, assistant to Senator Graham.

            OPENING STATEMENT OF SENATOR JIM WEBB, CHAIRMAN

        Senator Webb. Good morning. The subcommittee will come to
    order.
        The subcommittee meets this morning to receive testimony on
    the Guard and Reserve programs of the Department of Defense
    (DOD).
        We'll have two panels this morning. The first panel, we'll
    welcome the Honorable Dennis McCarthy, Assistant Secretary of
    Defense for Reserve Affairs; General Craig McKinley, Chief of
    the National Guard Bureau; Lieutenant General Harry Wyatt III,
    Director of the Air National Guard; and Major General Raymond
    Carpenter, Acting Director of the Army National Guard.
        On the second panel, we'll have the Chiefs of the Reserve,
    and we'll introduce them when we bring in the second panel.
        I should point out that we are expecting three consecutive
    roll call votes to begin at any time, and we're going to do our
    best to keep the hearing going rather than having to suspend
    it. That sounds like a vote being called. If we reach the point
    where we can't do that, then we're just going to have to
    declare a recess. But, we'll do our best.
        The Guard and Reserve continue to transform from a Cold
    War-era strategic force to an operational force manned and
    equipped to face both the traditional and asymmetric threats of
    the 21st century. It's a transformation that started well more
    than 20 years ago, when the total force concept replaced the
    force structure that we had during conscription.
        I was a part of this transformation, as many of you know,
    during the Reagan administration. I was the first Assistant
    Secretary of Defense for Reserve Affairs. It was one of the
    great leadership experiences of my life, quite frankly, to have
    put that office online. When we inherited the upgrade, it was
    composed of 14 full-time staff, plus a lot of Individual
    Mobilization Augmentees and others that we were able to use
    from time to time, but we took great care, back in 1984, in
    designing the structure of the staff and trying to put it into
    those functions that were necessary, should we have to mobilize
    and go into a full-out wartime environment. I believe that the
    office has survived the test of time and adapted to the issues
    that we face.
        I used to say, during the first year, when you have all
    seven Guard and Reserve components, all four Active components,
    political appointees and career civilians on one staff, it was
    like trying to hold a meeting in Yugoslavia; there were so many
    different points of view at the table. I see some knowing nods,
    here. [Laughter.]
        But, it's been a great addition to DOD, and we welcome the
    current leadership in those roles, today.
        More than 2 years ago, the Commission on the National Guard
    and Reserve delivered its final report to Congress. One of its
    conclusions was that there is no reasonable alternative to the
    Nation's continued reliance on the Guard and Reserve for
    missions at home and abroad as a part of an operational force.
    The question this raises is whether this level of operational
    use is sustainable in the future. Will the Guard and Reserve
    still be able to recruit and retain the quality individuals
    they need, given their increased operational tempo? How will
    this evolution impact the military's relationship with civilian
    employers?
        The operationalization of the Guard and Reserve also raises
    questions about their capacity to respond to unforeseen events,
    such as Hurricane Katrina or the earthquake in Haiti, which
    require surge capacity and specialized skills that the Active
    components may not be able to provide.
        The use of the Guard and Reserve has increased, in large
    part, to ease the stress on the Active components, but we run
    the risk of overly stressing guardsmen and reservists, who, in
    addition to their military duties, hold down civilian careers.
        After 9 years of overseas commitments, the Guard and
    Reserve remain stressed, including dwell times closer to 1 to 3
    than the stated goal of 1 to 5, and we need to look at these
    issues and many others.
        I have a longer statement that I'm going to submit into the
    record at this point, but, in the interest of time--and also, I
    want to get into the views of our witnesses--I would like to
    just submit this into the record and call on a ranking
    Republican, Colonel Lindsey Graham to give his opening
    statement.
        [The prepared statement of Senator Webb follows:]
                     Prepared Statement by Senator Jim Webb
        The subcommittee meets this morning to receive testimony on the
    Guard and Reserve programs of the Department of Defense.
        We will have two panels this morning. On the first panel, we
    welcome the Honorable Dennis M. McCarthy, Assistant Secretary of
    Defense for Reserve Affairs; General Craig R. McKinley, Chief, National
    Guard Bureau; Lieutenant General Harry M. Wyatt III, Director, Air
    National Guard; and Major General Raymond W. Carpenter, Acting
    Director, Army National Guard.
        On our second panel, we will have the Chiefs of the Service
    Reserves, and I will introduce them when we convene the second panel.
        The Guard and Reserve continue to transform from a Cold War-era
    strategic force to an operational force manned and equipped to face
    both the traditional and asymmetric threats of the 21st century. It is
    a transformation that started more than 20 years ago during the Reagan
    administration, and I bring a definite perspective to the table having
    been privileged to serve for 3 years as the first Assistant Secretary
    of Defense for Reserve Affairs. At the height of the Cold War, my staff
    and I broke new ground in determining if our Guard and Reserve
    components were, in fact, ready and available to be mobilized and
    deployed in the event of major crisis or hostilities.
        More than 2 years ago, the Commission on the National Guard and
    Reserves delivered its final report to Congress. One of its conclusions
    was that there is no reasonable alternative to the Nation's continued
    reliance on the Guard and Reserve for missions at home and abroad as
    part of an operational force. The question this raises is whether this
    level of operational use is sustainable into the future. Will the Guard
    and Reserve still be able to recruit and retain the quality individuals
    they need given their increased operational tempo? How will this
    evolution impact the military's relationship with civilian employers?
        The operationalization of the Guard and Reserve also raises
    questions about their capacity to respond to unforeseen events, like
    Hurricane Katrina or the earthquake in Haiti, which require the surge
    capacity and specialized skills that the Active component may not be
    able to provide. The use of the Guard and Reserve has increased in
    large part to ease the stress on the Active components, but we run the
    risk of overly stressing guardsmen and reservists, who in addition to
    their military duties, hold down civilian careers. The Guard and
    Reserve must be ready and able to meet their missions while retaining
    the character and essence of the citizen soldier.
        After 9 years of continuous combat the Guard and Reserve remain
    stressed, including dwell times closer to 1 to 3 years than the stated
    goal of 1 to 5 years. We must increase the amount of time guardsmen and
    reservists receive between deployments. This is absolutely vital to the
    long-term health and sustainability of the Guard and Reserve. It
    ensures that our reservists and guardsmen remain trained and
    proficient, while providing predictability for their families and
    civilian employers. This predictability and transparency will help
    sustain the morale and mental health of our servicemembers, and allow
    them to plan both their military and civilian careers with a degree of
    surety and predictability that enhances retention. It is good for the
    servicemembers and their families, the military, the civilian sector,
    and for the Nation.
        This subcommittee has over the past several years sponsored or
    supported many initiatives to address the well-being of reservists,
    guardsmen, and their families. Few countries, for instance, offer
    retirement benefits for Reserve or non-regular military service, and of
    those who do, the United States appropriately offers some of the most
    generous, including a retirement pension at age 60 (or earlier under
    certain conditions), health care, survivor benefits, and the full range
    of veteran benefits.
        Over the past several years, Congress continued to enhance and
    expand benefits and programs for guardsmen, reservists, and their
    families. The committee authorized the Yellow Ribbon program, which has
    been a resounding success. In 2006, Congress authorized income
    replacement for members of the Guard and Reserve subject to extended
    and frequent active-duty service. In 2007, Congress extended TRICARE
    eligibility to members of the Selected Reserve. Last year, Congress
    extended TRICARE eligibility to gray-area retirees and increased the
    number of days prior to mobilization that guardsmen and reservists have
    access to health care. In 2008, Congress authorized travel allowances
    for certain members of the Selected Reserve Forced to travel long
    distances to drill. Finally, we enacted the Post-9/11 GI Bill, complete
    with transferability. In recognition of their exceptional service since
    September 11, many guardsmen and reservists are eligible for these
    benefits.
        Nevertheless, work remains to be done. Medical and dental readiness
    of guardsmen and reservists remains a challenge, despite legislation
    over the past two years to help improve it. Suicide rates in the Guard
    and Reserve continue to rise at disturbing rates. We must continue to
    work to integrate the Guard and Reserve with the active duty in a more
    seamless way. I look forward to hearing what challenges and obstacles
    exist that prevent a more seamless integration, what is being done to
    address them, and whether legislation is needed to help that effort.
        Finally, I want to note that we are still waiting for the
    Department's final assessment of the remaining recommendations from the
    final report of the Commission on the National Guard and Reserves that
    was due April 1, 2009. I understand that the Department is implementing
    those recommendations with which it agreed, but we have yet to learn of
    its views on the remainder. At this hearing last year, the acting
    Assistant Secretary of Defense for Reserve Affairs stated that the
    Department's assessment was in the final coordination stages, and that
    we could expect it within weeks. A full year has passed. The
    Department's final assessment of the Commission's recommendations is
    long overdue. Such delinquent reports limit the ability of this
    subcommittee to exercise its oversight functions properly. Absent a
    compelling reason, we cannot tolerate such inordinate delays.
        On our second panel we welcome Lieutenant General Jack C. Stultz,
    Chief of the Army Reserve; Vice Admiral Dirk J. Debbink, Chief of the
    Navy Reserve; Lieutenant General John F. Kelly, Commander, Marine
    Forces Reserve; Lieutenant General Charles E. Stenner, Chief of the Air
    Force Reserve; and Rear Admiral Sandra L. Stosz, Acting Director, U.S.
    Coast Guard Reserve.

        Senator Graham. I move I be promoted. [Laughter.]
        I think I'd lose, two to one. [Laughter.]
        Senator Webb. I think you're looking at the right people on
    the other end of the table for that.

                  STATEMENT OF SENATOR LINDSEY GRAHAM

        Senator Graham. Yes. Anyway, I know we have to go vote,
    here.
        The legal authorities that you would need to be able to
    activate the Reserves in a less bureaucratic manner, I want to
    hear about that. The Guard and Reserve, as Senator Webb said,
    is an indispensable part of this war effort. Civil affairs,
    military police, you name it, the Guard and Reserves are on the
    front lines of what we need in Iraq and Afghanistan. As you
    build out the 21st century threats, the Guard and Reserve are
    completely indispensable. The Cold War model has to be changed,
    because the Cold War--thank God, we won that; we need to win
    the war we're in now.
        Senator Chambliss has some proposals regarding earlier
    retirement. I couldn't support his idea more. We need to
    deliver for the troops here.
        Secretary Gates is a fine man. Don't even think about
    cutting military pay. That's on the Active Duty side. From the
    Guard and Reserves point of view, you're the best bang-for-the-
    buck for the American taxpayer, about 25 cents on the dollar,
    in terms of Active Duty cost, and you hit way above your
    weight. I want to talk to you about--when we have a chance
    here--deploying the National Guard along the border. Is that
    feasible? Do you think that would make a difference, and could
    you do it?
        With that, Mr. Chairman, I'd just end with saying that our
    Guard and Reserve members and their families--we're doing the
    best we can to take care of you. TRICARE has been a good
    addition to the benefit package available to Guard and Reserve
    members and their families.
        America should be very proud of the commitment of the
    citizen soldier. I know I am.
        Thank you.
        Senator Webb. Thank you very much, Senator Graham.
        Secretary McCarthy, welcome.

     STATEMENT OF HON. DENNIS M. McCARTHY, ASSISTANT SECRETARY OF
                      DEFENSE FOR RESERVE AFFAIRS

        Mr. McCarthy. Thank you, Mr. Chairman, Senator Graham,
    members of the subcommittee. I appreciate the opportunity to
    testify today and to engage with you about the direction and
    the future role of our Nation's Reserve components.
        I'm honored to be present with my colleagues in uniform,
    all seven of the Reserve Chiefs. It's a pleasure to serve with
    them. I know they'd all join me, or will all join me, in saying
    thank you to the subcommittee for everything that you have done
    for the men and women in uniform, both Active and Reserve, and
    DOD civilians.
        As we've all discussed many times, I think we're at a very
    significant point in the history of our Reserve components,
    and, frankly, at a point of great opportunity. I think there's
    three main themes that we ought to touch on, and I'll just
    summarize them.
        First of all, every man and woman serving in uniform today
    has either enlisted or reenlisted since September 11. They've
    made a conscious decision to serve, with full understanding of
    what service in today's environment means. They know it means
    service in combat, they know it means repeated deployments;
    and, for members of the Reserve component, they know that it
    means, not just stress on themselves and their families, but
    also on their employers. Yet, they have continued to make that
    decision to serve.
        Second of all, because we've had over 750,000 Reserve and
    Guard members mobilized since September 11, we have the most
    experienced, best-trained, best-equipped Reserve component
    we've had in anybody's recent memory. But, to sustain this
    force, we need to continue to support the families of those in
    uniform and their employers.
        Third, I think there is an emerging consensus that, even
    after the high demand for forces in Afghanistan and Iraq come
    down, it still makes sense to utilize our Reserve components on
    a rotational basis. We've made a significant investment in
    them. They've made a significant investment. We should continue
    to use that so that we get return on that investment.
        I would say that it's not just indispensable, which it is,
    but it's also a sensible use of this great Reserve component
    that we have. But, to do that, we're going to have to find some
    new ways to do things. As has been mentioned, finding a way to
    assure that we have access, and that those who plan for the use
    of Reserve component forces can make those plans confidently,
    knowing that they will be able to get access to the forces, is
    very important. We need to find a constitutionally sound method
    to authorize that access.
        We need to make progress on this thing that we've been
    talking about for years, the continuum of service, the ability
    of an individual to flow on and off of full-time duty without
    jeopardizing their pay or their medical care.
        We need to find ways to continue to support families and
    employers, and, in particular, support employers so that they
    will continue to support us, as they have so tremendously done
    up until now.
        Almost everything that is in that laundry list of things to
    do relates back to a recommendation that was made by the
    Commission on the National Guard and Reserve, and was approved
    by the Secretary of Defense. Quite frankly, we haven't made as
    much progress in implementing those recommendations as I would
    like, but I guarantee you, we are working hard on that.
        I turn to my colleagues in uniform for their comments, but
    I do look forward, Senators, to answering your questions.
        [The prepared statement of Mr. McCarthy follows:]
                 Prepared Statement by Hon. Dennis M. McCarthy
                                  introduction
        Chairman Webb, Ranking Member Graham, and members of the
    subcommittee; thank you for your invitation to present the capability
    of America's Reserve component (RC) forces to meet current and future
    operational requirements. This is my first appearance before this
    committee in my current role, and I would like to recap where we've
    been and where I think we need to go. The Senate Armed Services
    Committee has always been very supportive of our National Guard and
    Reserve Forces. On behalf of those men and women, our Citizen Warriors,
    their families and employers, I want to publicly thank you for all your
    help in providing for them as they have stepped up to answer the call
    to duty. We will do everything in our power to merit your continued
    support.
                                    preface
        The office I hold was specifically mandated by Congress because of
    recognition that sustaining the Reserve components was essential to the
    success of the All-Volunteer Force. The statutorily mandated mission of
    the Assistant Secretary of Defense for Reserve Affairs (ASD/RA) in
    title 10 section 138 is, `` . . . the overall supervision of Reserve
    component affairs of the Department of Defense.'' I take this
    responsibility very seriously because our Guard and Reserve perform
    vital national security functions and are closely interlocked with our
    States, cities, and communities. I have very specific guidance from the
    Under Secretary of Defense for Personnel and Readiness to focus on the
    readiness of our Reserve components, and to measure our success by our
    contribution to maintenance of the All-Volunteer Force. I know from
    first hand conversations with the men and women who comprise our
    National Guard and Reserve that this is a most welcome message. They
    too are focused on readiness and have every intention of being fully
    ready for whatever mission their country may assign them.
        I believe the goal for the Reserve components should be to become;
    a force that is sustainable, seamlessly integrated with the Active
    components, and complementary in its capabilities to our overall
    national security requirements. Achieving this goal will require a
    coordinated effort between the legislative and executive branches.
                                where we've been
        I try to consistently speak about a few central themes that I
    believe are particularly relevant as the Department actively plans for
    the next few years. But first, let me briefly recap where we've been.
    In recent years, we have seen an unprecedented reliance on the Reserve
    components--since September 11, over 761,000 Citizen Warrior
    mobilizations have occurred; of that number over 232,000 Selected
    Reserve members have been activated two or more times. Their service
    has been magnificent, fully accessible, participating across the full
    spectrum of missions, absolutely outstanding. I have visited the
    CENTCOM AOR several times and have witnessed first-hand the seamless
    integration of our forces in the field.
        During the Cold War, the Reserve components were basically a force
    held in Reserve. The typical RC member trained for approximately 38
    days a year and had little expectation of being mobilized. If he/she
    were called to duty, the expectation was that there would be plenty of
    time to mobilize, train, and deploy--an event that might happen perhaps
    once in a career. I think we can all safely say ``This is not your
    father's, mother's, or even your older brother's Reserve component
    anymore.'' Today's Citizen Warriors have made a conscious decision to
    serve, with full knowledge that their decision may involve periodic
    recalls to active duty under arduous and hazardous conditions. They
    know this is no longer a ``1 week-end a month'' organization, and they
    didn't join up just for the college tuition. Also, it is clear that we
    have left the old model of, ``maybe once in a lifetime mobilization''
    behind. In the nineties, the Active component (AC) and RC end strength
    drew down, but the world continued to be a dangerous place, so we
    increasingly relied on the National Guard and Reserves to support
    military mission requirements in the first Gulf War, Bosnia, Kosovo,
    Multinational Force and Observers (MFO) Sinai, air operations in and
    around Iraq, as well as daily operational support requirements. Even
    before September 11, we were evolving toward a total transformation in
    the way the Reserve component was being utilized.
        Recognizing this change, the Department set about transforming the
    Guard and Reserve from a purely strategic force to a sustainable
    Reserve Force with both operational and strategic roles. Effective
    management of the Guard and Reserve as an operational force required
    changes in numerous policies, including: mobilization, force structure
    rebalancing, personnel management, training, readiness, equipping, and
    family and employer support. These changes have been critical to our
    success during what is now the largest mobilization of the Guard and
    Reserve since the Korean War, in a war that has lasted longer than
    World War II. It is important to note that in addition to these
    expanded operational capabilities, the Reserve components still provide
    strategic depth to meet U.S. defense requirements across the full
    spectrum of conflict. Additionally, the indisputable fact of high
    enlistment and retention rates in all services and components clearly
    demonstrates this generation's commitment to service; they are
    convinced that their service is valuable, and that it is valued. The
    six DOD Reserve components combined achieved 104 percent of their
    recruiting goal for fiscal year 2009 and retention is high. As a
    result, end-strength expectations are being met.
                               where we're going
        Writing the next chapter in the history of our Nation's use of its
    Reserve components begins with the Quadrennial Defense Review (QDR) and
    other strategic planning processes, to include the findings and
    recommendations of the Commission on the National Guard and Reserves
    (CNGR). The Department continues to work the 53 CNGR recommendations
    the Secretary of Defense approved in his November 2008 memo. While much
    work still needs to be accomplished, there have been several high
    points. This includes improvements in the oversight of equipment
    readiness and transparency of Reserve component procurement funding and
    establishment of the Yellow Ribbon program. The fiscal year 2011 budget
    provides about $50 billion for pay, training, equipping and facilities
    to support the RCs. The funds provide about 43 percent of the total
    military end strength for 9 percent of the total base budget.
        The CNGR recommendations that the Secretary of Defense approved
    will continue to be a high priority for me until they are fully
    implemented. The implementation of those recommendations will enable
    the proper utilization of the National Guard and Reserve, reducing the
    burden on all forces--a Presidential priority. Effective utilization of
    the Guard and Reserve increases the strategic capacity of the Total
    Force. We have authored mobilization policies which institutionalized
    ``judicious use'' as the core principle of Reserve component
    participation, and are the foundation of predictability (1-year
    mobilization and 1:5 utilization goals) for the operational reserve.
    This principle is widely supported by military members, families, and
    employers alike.
        Another important concept emphasis in the CNGR is Continuum of
    Service (CoS). This phrase often appears in testimony and documents;
    however, there is little concrete description of what CoS actually is.
    CoS is an important aspect of retention that allows servicemembers to
    easily transfer from one component (Regular, Guard, Reserve, or
    civilian) to another. The CoS program provides greater flexibility and
    predictability for retaining valuable skills over a lifetime of service
    to the Nation. In the future, DOD will seek necessary legislative
    changes to assist in duty status reform.
        CoS initiatives have had a positive impact on our servicemembers.
    The Air Force initiated an on-line CoS Tracking Tool that provides a
    single comprehensive information source for capturing and monitoring
    Total Force CoS initiatives. This tool was incorporated by the Army and
    is now being adapted for use throughout the Department of Defense.
    Based on NDAA-authorization, the Navy initiated a Career Intermission
    Pilot Program allowing a break in service from active duty to the
    Nonparticipating Individual Ready Reserve for up to 3 years for
    personal or professional reasons. The Army and Air Force are now
    implementing this pilot program to retain valuable experience and
    training of our servicemembers who might otherwise be lost to permanent
    separation.
        For Reserve components, CoS is an important force multiplier for
    balancing people and mission to ensure the right member to the fight.
        I would note that the budget supports preparation of both units and
    individuals to participate in missions, across the full spectrum of
    military operations, in a cyclic or periodic manner that provides
    predictability for the combatant commands, the Services,
    servicemembers, their families, and civilian employers; potentially
    increasing the Department's overall capacity while reducing costs.
        We now have a policy of notifying members 180 days prior to
    mobilization whenever possible. The Services are also striving to
    provide alerts to units 1 year or more in advance. In addition, this
    subcommittee helped provide a change in statute which doubled from 90
    to 180 days the period prior to mobilization in which reservists are
    eligible for healthcare. I believe this change will have a positive
    impact on individual medical readiness. As the services perfect their
    rotational readiness models, it will be increasingly common to notify
    units of upcoming missions up to 2 years in advance. We have
    streamlined the mobilization and pre-deployment training processes, and
    these and other changes are sustaining the Reserve components during
    this extensive mobilization period. In addition we are implementing a
    ``train-mobilize-deploy'' construct, as opposed the old Cold War model
    of ``mobilize-train-deploy,'' this means that the RCs must be ready,
    manned, trained, medically prepared, and equipped when their scheduled
    availability comes up, and they must be funded accordingly.
        Clearly, your changes in compensation and benefits that recognized
    the increased operational role of the Guard and Reserve, as well as the
    pride they take in serving their country in these challenging times,
    are major factors in improving our abilities to recruit and retain a
    quality force.
        Over the past 8 years, we developed a rebalancing effort in the
    Active and Reserve components that initially transitioned 89,000
    billets in less-stressed career fields to more heavily used
    specialties. From 2003 until now, we have rebalanced over 180,000
    billets and working with the Services, have planned and programmed an
    additional 121,900 billets for rebalancing between fiscal year 2010 and
    2015. Although the amount and type of rebalancing varies by Service,
    key stressed capability areas include: Engineers, Civil Affairs,
    Intelligence, Special Operations, Military Police, Infantry, Aviation,
    Space and Combat Air Superiority. By 2015, we expect to have rebalanced
    over 302,000 billets. Rebalancing is a continuous and iterative
    process. The Department will continue to work closely with the Services
    as they review and refine their rebalancing plans to achieve the right
    mix of capabilities and alignment of force structure. For that reason,
    the QDR and the defense budget will continue the efforts the Secretary
    started, to rebalance the military's forces and programs to meet the
    current threats and to reform the way the Defense Department does
    business. The Under Secretary of Defense for Policy recently testified,
    ``If the QDR has a bumper sticker it would be `Rebalance and Reform'.''
    This will greatly help reduce stress and increase support to the Active
    and Reserve operational force by providing a deeper bench for those
    skills that are in high demand. However, easing the stress on the force
    is more than just rebalancing, judicious use and notification.
        ``Rebalance and Reform'' also means sustaining the readiness of our
    forces. One such program is the Innovative Readiness Training (IRT)
    Program. This program provides mission essential training opportunities
    for our National Guard and Reserve sustainment units while providing a
    critical link between the military and underserved civilian
    communities. The IRT program's focus is to provide a venue for Mission
    Essential Task List (METL) training requirements in engineering, health
    care, diving, and transportation. Each year new training opportunities
    are presented by Federal, State, or local government agencies or
    nonprofits. The IRT program's goal is to strive to ensure a varied and
    challenging menu of training opportunities that result in
    interoperability and ensure readiness training is available for our
    military personnel. Examples of IRT activities include, constructing
    rural roads and runways, small building and warehouse construction, and
    providing medical and dental care to Native Americans, Alaska Natives
    and other medically underserved communities. IRT continues to evolve to
    meet the challenges of DOD transformational priorities to strengthen
    joint warfighting capabilities while ensuring our Nation maintains a
    fully capable National Guard and Reserve.
                                how we get there
        We need a roadmap to list the waypoints, to foster dialog and
    change some widely held traditional beliefs. Extracting full value from
    our Reserve components will require a fundamental shift in the way many
    in DOD currently envision these forces. During the Cold War, military
    planning generally viewed the Guard and Reserve as essentially a
    ``force of last resort,'' to be used after all possible Active
    component solutions have been attempted. Going forward, I believe the
    Services should not hesitate to use National Guard and Reserve
    formations as the ``force of first choice'' for requirements for which
    they are well suited. This will require many minds to transition from
    ``what was,'' to ``what is,'' then ``what should be.''
        Predictability is perhaps one of the most important keys to tapping
    into the reservoir of Guard and Reserve capabilities. The process by
    which roles and missions are assigned to the Reserve and Guard should
    be characterized by a belief that these forces can, and frequently
    should be, the first choice for recurring or predictable missions
    within their capabilities, because they are and have been fully
    accessible. In this context, predictability encourages anticipatory
    planning--thinking ahead, not just in terms of the type of mission, but
    the timing and duration of the mission as well. Predictable missions
    create lead time for proper planning and training. That kind of
    anticipatory thinking can't be done when the Reserve components are
    used as the ``last option.'' The other important parts of this ``best
    advantage'' equation are the assignment of challenging and relevant
    missions to the National Guard and Reserves, and ensuring that
    resources are available in order to set the conditions for their
    success.
        Using the Reserve components on a rotational basis, especially
    where the cycle can be pointed toward a predictable mission, maintains
    their readiness and expands their availability and capability. The
    rotational availability models in use today--the Army Force Generation
    (ARFORGEN), or Air Force Expeditionary Force (AEF), etc.--are essential
    to ensuring that the Guard and Reserve are trained and ready when
    needed.
        We must also ensure that the visibility, transparency and
    accountability of National Guard and Reserve equipment, from planning,
    programming, and budgeting, through acquisition and fielding, occurs at
    all levels. In addition, resetting the force is absolutely essential
    because it integrates the transformation, reconstitution, rebalancing,
    modernization, and recapitalization into a common action with a focus
    on the contribution to the Services' roles and missions. The Commission
    on the National Guard and Reserves had two specific recommendations to
    address this challenge. The Deputy Secretary of Defense directed, and
    agreed to an implementation plan that we have been executing since
    August 2009. The Reserve component of each military department must be
    properly equipped not just to deploy, but to also sustain itself as a
    trained and ready force. The design of the Reserve component equipping
    strategy is envisioned to procure and distribute required equipment; to
    maintain a degree of readiness that is responsive to the combatant
    commanders' request; while sustaining capabilities to respond when
    called upon here at home. This strategy takes into account the
    Department's support to each State's Homeland Defense mission, while
    maximizing equipment availability throughout the force.
        Our ultimate goal is for the RC to be a ready force, equipped and
    supported with facilities, ranges, and simulators to succeed in
    fulfilling their domestic and overseas missions. Our efforts include
    the development of strategies and processes to ensure RC equipment
    readiness levels are not adversely affected by losses from ``stay-
    behind'' equipment, cross-leveling, and reset policies. We are striving
    to ensure the RCs have the right equipment, available in the right
    quantities, at the right time, and at the right place to support the
    ``Train-Mobilize-Deploy'' model for an operational reserve. We are
    expanding the use of simulators that increase proficiency while at the
    same time reducing equipment costs and range utilization. An effective
    ``Train-Mobilize-Deploy'' force must not encounter modern equipment for
    the first time after mobilization or after arriving in theater. We also
    support the RC in their Homeland Defense and civil support role. This
    is a Total Force responsibility, and one in which we are making
    considerable progress. Identifying and procuring critical dual use
    equipment (equipment that is used in both domestic and war fighting
    missions) is another effort that has realized tremendous dividends. As
    the Department embarks on a new RC equipment strategy, we are working
    hand-in-hand with the Services to improve the transparency of equipment
    from the appropriation of funding to the delivery of that equipment.
        There is a direct correlation between readiness and facilities,
    particularly in the RC. The move from a strategic reserve to an
    operational reserve doesn't change the fact that we owe our Guard and
    Reserve member's quality facilities in which to work and train. The
    fiscal year 2011 Military Construction (MILCON) program request for the
    Reserve components has increased, and will help alleviate some facility
    deficiencies. We continue to pursue joint construction opportunities as
    a way to combine the space and functional requirements of two or more
    Service components into one facility, thereby eliminating the need to
    build separate buildings. The benefits of doing this go far beyond cost
    savings by promoting cooperation, building trust, and providing
    opportunities for joint training.
        Record levels of Guard and Reserve mobilizations over the past 8
    years have highlighted a critical shortfall in facility requirements,
    re-emphasizing the need for meticulous analysis of funding and
    investment in order to fill the capability gap to support rotational
    readiness requirements, such as transient training facilities. The Army
    has developed an Operational Readiness Training Complex (ORTC) concept
    to provide permanent facilities in centralized locations that will
    improve unit cohesion, the efficient use of limited training time, and
    quality of life for members of the Guard and Reserves. The challenges
    in getting priority funding for these ORTCs have prompted us to engage
    with the Army in an analytical effort that documents current transient
    training facility status, assesses the current ORTC implementation
    plan, recommends changes/improvements in design, and develops a
    synchronized strategic communications plan in order to gain support for
    increased and accelerated ORTC funding in the Army budget formulation
    process.
        We can't accomplish any of the foregoing without the support of the
    families and employers of our men and women. That support is critical
    to any endeavor the Department attempts. We have seen that where
    assigned missions are anticipated, planned in advance, and matched with
    the right supportive resources, families and employers will step up to
    support their Citizen Warriors. We must continue to engage and support
    families and employers through well planned and well resourced efforts
    such as: unit family readiness programs, the Yellow Ribbon Re-
    integration process, and the National Committee for Employer Support of
    Guard and Reserve.
        The Yellow Ribbon Program (YRP) originates from the 2008 National
    Defense Authorization Act. It is a DOD-wide effort to help National
    Guard and Reserve servicemembers and their families connect with local
    resources before, during, and after deployments, especially during the
    reintegration phase that occurs months after they return home.
    Commanders and leaders play a critical role in assuring that Reserve
    servicemembers and their families attend Yellow Ribbon events where
    they can access information on health care, education/training
    opportunities, financial, and legal benefits. The DOD works in
    conjunction with Federal partners, including the Department of Veterans
    Affairs and the Department of Labor, to provide up-to-date and relevant
    information to servicemembers and their loved ones. This program has
    met with great success and continues to fill a definite need. In fiscal
    year 2009 the Yellow Ribbon Program conducted the following events:

    ----------------------------------------------------------------------------------------------------------------
                                                                  U.S. Marine                 U.S. Air
                                          National    U.S. Army      Corps      U.S. Navy      Force        Total
                                           Guard       Reserve      Reserve      Reserve      Reserve
    ----------------------------------------------------------------------------------------------------------------
    Number of Events..................          906          180          120          145           93        1,444
    Servicemembers served.............       54,472       11,701        2,500       18,313        4,115       91,101
    Family members served.............       72,316       11,631        3,037       12,757        3,280      103,021
    ----------------------------------------------------------------------------------------------------------------

        Employer Support of the Guard and Reserve (ESGR) engagement has
    grown significantly in recent years, ESGR's vision is, ``to develop and
    promote a culture in which all American employers support and value the
    military service of their employees with ESGR as the principal advocate
    within DOD.'' The ESGR mission is ``to develop and promote employer
    support for Guard and Reserve service by advocating relevant
    initiatives, recognizing outstanding support, increasing awareness of
    applicable laws, and resolving conflict between employers and
    servicemembers.'' ESGR has a footprint in all 50 States, U.S.
    Territories, and DC with over 4,600 volunteers assisting employers and
    servicemembers on a daily basis. In striving to enhance employer
    support, ESGR relies on recognition programs, including the
    servicemember-nominated Patriot Award and the Secretary of Defense
    Employer Support Freedom Award, where 15 employers are honored for
    their outstanding support of Guard and Reserve servicemembers annually.
    With current ongoing global operations, combat-related and
    humanitarian, the support of employers and families has never been more
    critical to our national defense. The data below shows the improving
    trend of the ESGR programs/activities over the last 3 fiscal years.

                                                   ESGR BY THE NUMBERS
    ----------------------------------------------------------------------------------------------------------------
                                    Employers   Servicemembers     USERRA       Cases Mediated     Average Mediated
             Fiscal Year             Briefed        Briefed       Inquiries        (Percent)            in Days
    ----------------------------------------------------------------------------------------------------------------
    2007........................       69,614        232,808         13,116          1,742=73.4                19.9
    2008........................      148,463        341,953         13,090          1,899=71.3                14.2
    2009........................      162,849        443,833         15,870          1,982=80.1                 6.7
    ----------------------------------------------------------------------------------------------------------------

        Despite all of the good work done by our National Committee for
    Employer Support and by the Defense Advisory Board for ESGR, I believe
    more must be done. Historically, our efforts in this area have been to
    sustain and maintain existing employment relationships. But in today's
    very tough job environment, some Citizen Warriors return from a
    deployment to find their jobs sharply curtailed or gone entirely. All
    of us involved in the ESGR effort are looking for ways to support job
    development. This will not only help our Citizen Warriors, it will help
    those American businesses that are looking for the kind of high-skill,
    high integrity people who serve in the Reserve and National Guard.
        We also have the unique opportunity to support the President's
    education agenda and manage two youth outreach programs in order to
    achieve our national security objectives. The President's Budget
    request continues to support the DOD STARBASE and National Guard Youth
    Challenge Programs. Both programs leverage the knowledge, experience,
    and skills of our DOD civilian and military members to help prepare our
    youth to become productive and contributing citizens of our society.
        The President has made the learning of science, technology,
    engineering, and math (STEM) a national priority. The DOD STARBASE
    Program supports this effort and provides elementary and middle school
    students with real-world applications of STEM through experiential
    learning, simulations, and experiments. The STARBASE Program utilizes
    instructional modules with high benchmarks linked to State standards.
    Teamwork and goal setting are also integrated into the curriculum. The
    fiscal year 2011 budget will support over 65,000 students participating
    in the program from approximately 1,250 schools and 350 school
    districts, which includes schools from Native American communities in
    Mississippi, Oklahoma, and South Dakota. Since the program's inception,
    over 560,000 youths have attended the program, pre and post testing
    showed a significant improvement in student's understanding and
    interest in STEM, and a desire to pursue further education. Currently,
    there are 60 DOD STARBASE Program sites on military facilities in 34
    states, the District of Columbia, and Puerto Rico.
        Many of you may also be aware of the President's 2020 education
    goal of being first in the world in college completion, and how an
    important piece of work is re-engaging high school dropouts. I am
    working with General McKinley, Chief of the National Guard Bureau, and
    the State Adjutants General to provide oversight, but more importantly
    to support the National Guard Youth Challenge Program so that every
    qualified high school dropout has an opportunity to attend a program.
    The National Guard Youth Challenge Program is currently operating at 32
    sites in 27 States and Puerto Rico, and is one of several ways the
    administration is approaching the dropout crisis. The goal of the
    Program is to improve the education, life skills, and employment
    potential of America's high school dropouts. This is accomplished by
    providing quasi-military based training, supervised work experience and
    advancing the program core components. The core components include
    assisting participants to obtain a high school diploma or equivalent,
    developing leadership qualities, promoting fellowship and service to
    community, developing citizenship, life-coping and job skills, and
    improving physical fitness, health, and hygiene. Since the program's
    inception over 90,000 students have successfully graduated from the
    program, with 80 percent earning their high school diploma or GED. The
    average cost per Challenge student is approximately $16,800. The fiscal
    year 2011 budget will support increasing annual enrollment and/or start
    up new programs in states that have the fiscal resources to match the
    cost-share funding requirements and to sustain the program's viability
    in states that have budget limitations. These two successful DOD youth
    outreach programs provide the Department an opportunity to connect with
    the American public and work with our Nation's most valued resource--
    our young people.
                            what constitutes success
        With appropriate advanced planning and proper support, Guard and
    Reserve Forces have the potential to greatly increase the Department's
    capacity both traditional and emerging mission areas. The long term,
    recurring, and predictable nature of many of the requirements we face
    in the contemporary strategic environment are ideally suited for the
    National Guard and Reserve. Such missions include post-hostility
    stabilization tasks, theater security cooperation requirements, and
    engagement activities that are essential to dissuade or deter potential
    foes and build partnership capacity.
        A major factor in shaping the 2010 Quadrennial Defense Review was
    the realization that the complexity of the current security environment
    and the uncertainty of future threats requires the Nation to have `` .
    . . a broad portfolio of military capabilities with maximum versatility
    across the widest possible spectrum of conflicts,'' as Defense
    Secretary Robert Gates testified on 2 February 2010.
        Achieving the defense strategy articulated in the QDR requires a
    vibrant National Guard and Reserve, seamlessly integrated within the
    Total Force. If the National Guard and Reserve are utilized in a
    deliberately planned way, and are seamlessly integrated as members of a
    true Total Force, the Nation will reap the benefits deserved. We must
    recognize:

             RC servicemembers volunteered to serve with the
            expectation that they would be judiciously used, and they do
            not want to return to being exclusively a ``strategic
            reserve.''
             The National Guard and Reserves are cost-effective.
            Using a force in its 1 year of ``rotational availability''
            permits a 5 year preparation with personnel costs that are only
            a fraction of a force on full time active duty, and without
            most of the support infrastructure and sustainment costs of
            active duty units.
             Using the National Guard and Reserve increases Active
            component dwell to deployment ratio, and helps to sustain that
            force for future use.
             Using the National Guard and Reserve allows us to take
            full advantage of unique skills and capabilities resident in
            our Reserve components. Guardsmen and reservists bring valuable
            professional, technical and managerial skills from the private
            sector that match well with many current and anticipated DOD
            requirements.
             Homeland Defense and Defense Support to Civil
            Authorities are Total Force responsibilities. Reserve
            components, particularly the National Guard, are the center of
            gravity for DOD Homeland Defense response operations. RC roles
            continue to evolve in this complex environment, but one thing
            is certain - the community basis of the Guard and Reserve have
            them already ``forward deployed'' in this critical AOR. They
            have the local knowledge necessary to succeed in times of
            greatest stress on local people and institutions.
             We can achieve higher utilization rates of expensive
            assets by increasing the use of equipment and facilities that
            are shared between Active and Reserve component units. In
            particular, increasing the Active and Reserve crew and
            maintainer ratios of our most modern and expensive aircraft
            seems to me to make good sense, and could be an immediate
            benefit.
             We must recruit and retain prior-service personnel--a
            proven capability of both the National Guard and Reserves--
            thereby preserving the expensive training costs invested in
            these personnel while they served on active duty. This is often
            an under-appreciated return on investment that must be taken
            into account when we calculate the cost and value of the
            Reserve components.
             When they are used correctly, there is a cumulative
            and positive readiness impact on Guard and Reserve Forces that
            will pay immediate dividends if they are called to respond to
            an unanticipated contingency and helps the Active components
            also.
             As a community-based force, the Reserve and National
            Guard provide a unique connection to the American people that
            facilitates an awareness and engagement on key national
            security issues. This connection is essential to maintaining
            the Nation's commitment to our armed forces.
             I ask your support of the legislative proposals that
            will enable the Department to accomplish many of the ideas
            promoted here:

                     The extension of bonuses and special pays
                     Authority to allow servicemembers to designate
                    the best person to travel to Yellow Ribbon events
                     Special assignment of dual status military
                    technicians
                     Revised structure and functions of the Reserve
                    Forces Policy Board

        We need your support of those proposals, particularly the increase
    in full-time support which forms an increasingly important part of the
    manning for the Reserve components. With more frequent unit
    mobilizations, the Guard and Reserves need more non-deploying full-time
    positions to perform those enduring ``home station'' administrative,
    maintenance, fiscal and support functions which otherwise are disrupted
    if performed by a military member who must be absent for a deployment.
    The 2010 QDR calls for a comprehensive review of the future role of the
    Reserve component, including an examination of the balance between
    Active and Reserve Forces. Effective use of the Reserve components will
    act as a force multiplier, increasing the capacity and expanding the
    range of available capabilities; thus enhancing and preserving the All-
    Volunteer Force. Force multiplication is generated through lower
    overall personnel and operating costs, a right mix and availability of
    equipment, a more efficient and effective use of defense assets, and an
    increased sustainability of both the Active and Reserve components. The
    National Guard and Reserves have capability and capacity to continue if
    properly funded and equipped.
                                   conclusion
        As we reinforce policies, implement strategies and continue to call
    upon our Reserve components, we must remember that judicious use is
    still the watchword. The National Guard and Reserve continue to be a
    mission-ready critical element of our National Security Strategy.
    Because our Reserve components will be asked to continue in their role
    as an operational force, we must ensure a Total Force Policy exists
    that supports employment of the Reserve components in both an
    operational and strategic role. Working together, we can ensure that
    the Reserve components are trained, ready, and continue to perform to
    the level of excellence that they have repeatedly demonstrated. Thank
    you very much for this opportunity to testify on behalf of our Guard
    and Reserve.

        Senator Graham [presiding]. Thank you, Mr. Secretary.
        I apologize, I think the best thing for us to do now is to
    recess, because time's about out. I'll go vote. We'll come
    back, and so we'll stand down for a few minutes.
        We'll be in recess. Thank you.
        [Recess.]
        Senator Webb [presiding]. The hearing will again come to
    order.
        I was informed by staff that, Secretary McCarthy, you were
    able to finish your statement and we've not yet begun with
    General McKinley.
        So, General, let me start by saying--I understand there's
    only one statement from the National Guard. Is that correct?
        General McKinley. Sir, I have brief remarks, and I was
    going to let the Directors of the Air and the Army just make
    very brief remarks also.
        Senator Webb. I would encourage them to do so. I was told
    by staff that we only got one written statement.
        General McKinley. I will introduce the two directors, and
    they represent the bulk of our portfolio.
        Senator Webb. So, is there a written statement from either
    of them?
        General McKinley. We have one written statement, and then
    we were going to make three verbal statements.
        Senator Webb. All right.
        General McKinley. Is that okay?
        Senator Webb. Proceed.
        General McKinley. Thanks, Senator.

      STATEMENT OF GEN. CRAIG R. McKINLEY, USAF, CHIEF, NATIONAL
                              GUARD BUREAU

        General McKinley. Chairman Webb, it's an honor and
    privilege to be here today to discuss the National Guard's
    personnel issues related to its ongoing role as an operational
    force.
        The evolution of today's threat environment has made it
    essential for the National Guard to strike the proper balance
    between operational force and strategic hedge. The asymmetry of
    our adversaries require us to have an adaptable force that is
    capable of efficiently engaging in the current fight while
    maintaining a cost-effective surge capability prepared for
    tomorrow's threat.
        Today, there are about 460,000 members of the Army and the
    Air National Guard. Our strength is good, and our retention is
    even better.
        With me today is Lieutenant General Bud Wyatt, the Director
    of the Air National Guard and a former adjutant general of
    Oklahoma. Also with me is Major General Ray Carpenter, the
    acting Director of the Army Guard from South Dakota, and Major
    General Mike Summeral, Director of our National Guard Joint
    Staff from Alabama, and a former adjutant general.
        As the U.S. Armed Forces continue to conduct operations in
    Iraq, Afghanistan, and elsewhere around the world, units of the
    Army and the Air National Guard are participating as total
    force partners in that effort. I'd like to personally thank
    General Casey and General Schwartz and the Secretaries of the
    Army and the Air Force for including the National Guard in
    their force as planning constructs and all they do for the
    National Guard.
        The National Guard has repeatedly, over the past decade,
    proven itself to be a ready, accessible, and, I would include,
    a reliable force. We have validated the total-force concept by
    showing that the men and women in our formations are ready to
    answer the call, to be mobilized, or, in the case of the Air
    National Guard, to be volunteered to deploy overseas, return
    home, and then become prepared to do it again and again.
        The citizen soldiers and airmen of your National Guard are
    adding value to America every day that they serve. The
    capabilities they bring to bear would not have been possible
    without the strong support of this committee, and we thank you
    all very much for that support, to include your support of
    Yellow Ribbon and other personnel programs that take care of
    soldiers and airmen and their families.
        The most critical part of the proven capability, however,
    is our National Guard men and women. Today's men and women
    volunteer to join or stay in the National Guard, fully
    expecting to be deployed. This shift in expectation is a
    central aspect of the National Guard and, I would argue, with
    my colleagues from the other Reserve components, shift to
    becoming a fully operational force, and no longer merely a
    strategic reserve. Indeed, the soldiers and airmen of your
    National Guard now serve with that expectation, and are proud
    of it. They want to remain central players in the Nation's
    defense, and would, indeed, be resistant to any move to return
    to a role limited to a strictly strategic reserve.
        Overall, we can say that the budget request for fiscal year
    2011 meets the critical needs of the Army and the Air National
    Guard in this era of persistent conflict overseas and the
    ongoing threats to American lives and property here in the
    Homeland.
        One of the longest-running joint programs in the National
    Guard, one which employs both Army and Air National Guard
    capabilities, is the National Guard Counterdrug Program. This
    unique program provides a mechanism under which National Guard
    military experience can be employed to assist civilian law
    enforcement agencies to fight the corrosive effect of illegal
    drugs in American society. Funding for our Counterdrug Program
    is included in the fiscal year 2011 budget request, and we
    would ask for your full support of that request. As we've seen
    with recent incidents along our southwest border, the scourge
    of drugs migrating across our borders constitutes a real
    threat. Consequently, our National Guard Counterdrug Program
    fills a very vital need.
        We are well aware that last year, as it has done in
    previous years, this committee supported significant additional
    funds for that Counterdrug Program to fund capability
    enhancements. Nearly a quarter of the capability of the
    National Guard Counterdrug Program exists today because of
    additional funding provided in the past by Congress.
        I would now like to turn to my colleagues from the Army and
    Air National Guard for their brief verbal comments. To my
    friend and flightmate, Bud Wyatt.

     STATEMENT OF LT. GEN. HARRY M. WYATT III, USAF, DIRECTOR, AIR
                             NATIONAL GUARD

        General Wyatt. Mr. Chairman and members of the committee,
    thank you very much for the opportunity to discuss issues of
    vital importance that impact----
        Senator Webb. General Wyatt, welcome. Let me just reiterate
    what I said a minute ago. It's my understanding this is the
    first time that there's not been separate written statements by
    all three witnesses from the National Guard.
        General Wyatt. Yes, sir. But, I would assure the chairman
    that my written inputs were included in those of General
    McKinley. I did have input.
        Senator Webb. It's traditional to receive separate written
    statements, and we would expect that. We'd certainly want to
    see that next year.
        General Wyatt. Yes, sir.
        Senator Webb. Thank you.
        General Wyatt. Mr. Chairman, Air National Guard airmen are
    volunteering at unprecedented rates and risking their lives
    daily because they believe strongly in what they're doing for
    their country and their communities.
        Since September 11, 146,000 Air National Guard members have
    deployed overseas, many of them on second and third rotations
    to the combat zones. In the past year alone, we have deployed
    18,366 servicemembers to 62 countries and every continent on
    the face of the Earth, including Antarctica.
        The Air National Guard continues to prove the availability
    and accessibility of the Guard to our Nation and to our
    communities. In the past year, Air Guard members helped their
    fellow citizens battle floods, mitigate the aftermath of ice
    storms, fight wildfires, and provide relief from the
    devastating effects of tsunamis.
        Early last year, Guard members from Kentucky, Arizona, and
    Missouri responded to debilitating ice storms, which resulted
    in the largest National Guard callup in Kentucky's history.
        Last spring, North Dakota, South Dakota, and Minnesota Air
    National Guard members provided rescue relief and manpower in
    response to midwest flooding. Similar efforts continue this
    year, with the recent flooding in Tennessee and surrounding
    areas.
        Last September, the Hawaii Air National Guard sent
    personnel from their Chemical, Biological, Radiological,
    Nuclear, and High-Yield Explosive Enhanced Response Force
    Package (CERFP), a command-and-control element, and a mortuary
    affairs team to American Samoa, in response to an 8.4-
    magnitude-earthquake-generated tsunami.
        These are just a few of the examples of how the Air
    National Guard provides exceptional expertise, experience, and
    capabilities to mitigate disasters and their consequences.
    Without the stewardship of your committee, our airmen would
    have an incredibly difficult time doing their jobs and taking
    care of their families. We're thankful for everything that you
    and the committee have done, and continue to do, to let our
    members know that America cares about them and is grateful for
    their service.
        In conclusion, with the continued support of Congress, the
    Air National Guard will continue to develop and field the most
    capable, cost-effective force that serves with pride and
    distinction at home and abroad. It's an honor and privilege to
    be here this morning. I look forward to answering any questions
    that you or the committee may have.
        Thank you, sir.
        Senator Webb. Thank you, General Wyatt.
        General Carpenter, welcome.

     STATEMENT OF MG RAYMOND W. CARPENTER, ARNG, ACTING DIRECTOR,
                          ARMY NATIONAL GUARD

        General Carpenter. Thank you, sir.
        Mr. Chairman, I am honored to represent more than 362,000
    citizen soldiers in the Army National Guard. As I speak, we
    have over 52,000 of our soldiers deployed, mobilized, and on
    point for this Nation. The sacrifice of those soldiers, their
    families, and their employers is something we must not only
    acknowledge, but certainly appreciate.
        The National Guard of today is a far cry from the one I
    joined. The last 8 years have seen the Guard transform to an
    operational force. The enablers for the Army National Guard
    have been provided and sustained by congressional initiatives,
    and we thank you for your continued support.
        Today, we would like to highlight our requested increase in
    non-dual status technicians. These civilian technicians have
    emerged as being more important, as the Army Guard has shifted
    from being a strategic reserve to being a frequently deployed
    operational force. The President's budget for fiscal year 2011
    requests an increase in Army National Guard non-dual status
    employees from 1,600 to 2,520. We ask the committee to provide
    this increase in its mark of the National Defense Authorization
    Act for Fiscal Year 2011.
        We also want to talk about accessibility today. We feel
    that our deployment numbers speak for themselves. In July 2009,
    mobilizations reached the highest point since 2005, of more
    than 65,000 soldiers. An additional 5,500 soldiers were
    mobilized for other contingency operations in Bosnia, Kosovo,
    Sinai, the Horn of Africa, and also for domestic operations.
    The National Guard has been there when called. We are
    accessible.
        Many have expressed concern about the Army Guard's ability
    to continue to deploy and meet future requirements. I believe
    our personnel numbers answer the question. We continue to
    exceed recruiting goals, and our retention rate averages 110
    percent. The men and women who serve in the Army National Guard
    today do so with full understanding that they are likely to be
    deployed overseas. Some of them join for that very reason. The
    shift in expectation is a central aspect of the National
    Guard's shift to being a fully operational force.
        Today's Army National Guard soldiers join and reenlist with
    the expectation of serving at home and abroad, and they are
    proud of it. I appreciate the opportunity to be here today and
    look forward to your questions.
        [The joint prepared statement of General McKinley, General
    Wyatt, and General Carpenter follows:]
      Joint Prepared Statement by Gen. Craig R. McKinley, USAF; Lt. Gen.
          Harry M. Wyatt III, USAF; and MG Raymond W. Carpenter, ARNG
                                opening remarks
        Chairman Webb, Ranking Member Graham, distinguished members of the
    subcommittee; I appreciate the opportunity to appear before you today
    to discuss the National Guard's personnel issues related to its ongoing
    role as an operational force. The evolution of today's threat
    environment has made it essential for the National Guard to strike the
    proper balance between operational force and strategic hedge. The
    diversity of our adversaries require us to have an adaptable force that
    is capable of efficiently engaging in the current fight while
    maintaining a cost-effective surge capability prepared for tomorrow's
    threat.
        Today there are about 460,000 members of the Army and the Air
    National Guard. Our strength is good and our retention is even better.
        As the U.S. Armed Forces continue to conduct operations in Iraq,
    Afghanistan and elsewhere around the world, units of the Army and Air
    National Guard are participating as total force partners in that
    effort.
        The National Guard has repeatedly proven itself to be a ready,
    accessible force. We have validated the total force concept by showing
    that the men and women in our formations are ready to answer the call,
    to be mobilized, to deploy overseas, return home, and then become
    prepared to do it again and again.
        The citizen soldiers and airmen of your National Guard are adding
    value to America every day that they serve. The capabilities they bring
    to bear would not have been possible without the strong support of this
    committee, and we thank you all very much for that support.
        The most critical part of that proven capability, however, is our
    National Guard men and women. Today's men and women volunteer to join
    or stay in the National Guard fully expecting to be deployed. This
    shift in expectation is a central aspect of the National Guard shift to
    being a fully operational force and no longer merely a strategic
    reserve.
        Indeed, the soldiers and airmen of your National Guard now serve
    with that expectation and are proud of it. They want to remain central
    players in the Nation's defense and would, indeed, be resistant to any
    move to return to a role limited to strictly strategic reserve.
        In addition, the Department of Defense is moving forward to
    identify a nominee for the position of Director of the Army National
    Guard. Once that occurs we would be most grateful for your support and
    that the Senate move quickly to confirmation.
        Overall, the budget request for fiscal year 2011 meets the critical
    needs of the Army and Air National Guard in this era of persistent
    conflict overseas and ongoing threats to American lives and property
    here in the homeland.
        One of the longest running joint programs in the National Guard,
    one which employs both Army and Air National Guard capabilities, is the
    National Guard Counterdrug Program. This unique program provides a
    mechanism under which National Guard military experience can be
    employed to assist civilian law enforcement agencies to fight the
    corrosive effect of illegal drugs in American society.
        Funding for our counterdrug program is included in the fiscal year
    2011 budget request, and it is important that the program is fully
    funded. The recent incidents along the southwest border and the scourge
    of drugs migrating across our borders constitutes a real threat.
    Consequently, our National Guard counter drug program fills a very
    vital need.
        Below you will find detailed information about personnel matters as
    they pertain to the Air and Army National Guard.
                               air national guard
    America's Exceptional Force, Home and Away
        The Air National Guard anchors the Total Air Force team, providing
    trained and equipped units and personnel to protect domestic life and
    property; preserving peace, order, and public safety; and providing
    interoperable capabilities required for Overseas Contingency
    Operations. The Air National Guard, therefore, is unique by virtue of
    serving as both a Reserve component of the Total Air Force and as the
    Air component of the National Guard.
        Upon founding in 1947, the Air Guard served primarily as a
    strategic reserve for the U.S. Air Force. Increasingly and
    dramatically, the Air National Guard has become more of an operational
    force, fulfilling U.S. Air Force routine and contingency commitments
    daily. Since September 11, over 146,000 Guard airmen have deployed
    overseas. A snapshot of U.S. forces at any time shows Air Guard members
    in all corners of the globe supporting joint and coalition forces in
    mission areas such as security; medical support; civil engineering; air
    refueling; strike; airlift; and intelligence, surveillance, and
    reconnaissance.
        By any measure, the Air National Guard is accessible and available
    to the combatant commanders, Air Force and our Nation's governors.
    Currently, the Nation has over 13,000 Air National Guard members
    deployed in Iraq, Afghanistan, and other overseas regions. At 16 alert
    sites, three air defense sectors, and Northern Command, 1,200 Guard
    airmen vigilantly stand watch over America's skies. Amazingly, 75
    percent of our deployed individuals are volunteers, and 60 percent are
    on their second or third rotations to combat zones. Percentages like
    these speak volumes about the quality and sense of duty of America's
    Air National Guard force!
        The Air National Guard supports State and local civil authorities
    with airlift, search and rescue, aerial firefighting, and aerial
    reconnaissance. In addition, we provide critical capabilities in
    medical triage and aerial evacuation, civil engineering, infrastructure
    protection, and hazardous materials response with our Civil Support
    Teams and our Chemical, Biological, Radiological, Nuclear, and high-
    yield Explosive Enhanced Response Force Packages (CERFPs).
        In the past year, Air Guard members helped their fellow citizens
    battle floods, mitigate the aftermath of ice storms, fight wild fires,
    and provide relief from the devastating effects of a tsunami. Early in
    the year, Guard members from Kentucky, Arizona, and Missouri responded
    to debilitating ice storms, which resulted in the largest National
    Guard call-up in Kentucky's history. Last spring, North Dakota, South
    Dakota, and Minnesota Air National Guard members provided rescue relief
    and manpower in response to Midwest flooding. In September, the Hawaii
    Air National Guard sent personnel from their CERFP, a command and
    control element, and a mortuary affairs team, to American Samoa in
    response to an 8.4 magnitude earthquake-generated tsunami. These are
    just a few examples of how the Air Guard provides exceptional
    expertise, experience, and capabilities to mitigate disasters and their
    consequences.
        Within the Total Force, the Air National Guard provides
    extraordinary value in terms of delivering the most immediately
    available capability for cost in meeting America's national defense
    needs. In its domestic role, the Air Guard provides capabilities to
    support local emergency responders with life and property saving
    capabilities and expertise in consequence management not usually found
    elsewhere in the Total Force.
        The changing nature of our force and our mission causes us to
    relook the rank structure of our full-time support personnel,
    particularly at the more senior mid-management levels. Specifically, we
    are examining whether we face a growing need for majors, lieutenant
    colonels and colonels as well as Senior Master Sergeants and Chief
    Master Sergeants. The number of airmen we are allowed to have in these
    grades is limited by law.
    Best Value for America
        The outstanding men and women of the Air National Guard continue to
    defend American interests around the world. Throughout 2009, the Air
    National Guard projected global presence in a variety of missions in
    regions ranging from the Balkans to Southwest Asia and from Eastern
    Europe to Latin America. We have provided much more than airpower,
    contributing our exceptional capabilities in security, medical,
    logistics, communications, civil support, and engineering, in order to
    support our Nation's national security.
        While the strategic environment has continually changed throughout
    history, the Air Guard has proven itself an adaptive force, able to
    meet any new challenges. One reason for this success is that Guard
    members normally live in the same communities in which they serve
    during times of natural disasters or when called upon to respond to
    national emergencies. Our Guard members know the folks they support
    very well, because they work together, their children attend the same
    schools, and they shop at the same business establishments. Our fellow
    citizens know the local Guard members and their contributions, and
    their appreciation has been illustrated through countless welcome home
    parades and outpouring of support over the years.
        Throughout history, many of the issues our forbearers faced are
    essentially the same issues we face today: aging capabilities and
    declining budgetary resources. The Air National Guard has consistently
    provided the answer in an efficient, cost-effective, community-based
    force that is ready and responsive to domestic and national security
    needs.
    Best Value in Personnel, Operations, and Infrastructure
        During the past year, the Air National Guard has deployed 18,366
    servicemembers to 62 countries and every continent, including
    Antarctica. The Air National Guard provides a trained, equipped, and
    ready force for a fraction of the cost. We provide a third of Total Air
    Force capabilities for less than 7 percent of the Total Force budget.
    In all three areas--personnel, operations, and facilities--the Air
    Guard provides the ``Best Value for America.''
        A key Air National Guard efficiency is the part-time/full-time
    force structure mix. The predominantly part-time (traditional) force
    can mobilize quickly when needed for State disaster response missions,
    homeland defense, or when we need to take the fight overseas.
        We have the ability to maintain a stable force with considerably
    fewer personnel moves than the Regular Air Force, which is a critical
    factor in our cost-effectiveness. Traditional National Guard members
    cost little, unless on paid duty status. Some Air National Guard
    efficiencies compared to regular military components include:

             Fewer ``paydays'' per year
             Lower medical costs
             Significantly lower training costs beyond initial
            qualification training
             Virtually no costs for moving families and household
            goods to new duty assignments every 3 or 4 years
             Fewer entitlements, such as basic allowances for
            housing
             Lower base support costs, in terms of services,
            facilities, including commissaries, base housing, base
            exchanges, child care facilities, etc.

        The Air National Guard is an operational reserve with surge
    potential, with 2,200 mobilized and 5,700 volunteering per day. If this
    force were full-time active duty, the military personnel budget would
    be $7.62 billion. Air National Guard military personnel pay in fiscal
    year 2009, including military technician pay, was $4.77 billion, for a
    yearly cost savings of $2.85 billion, or a daily cost savings of $7.8
    million.
        Whether compared to another major Air Force command, or even to the
    militaries of other countries, the Air National Guard is an
    extraordinary value. In direct comparison with the militaries of France
    and Italy, for example, our Air National Guard members cost only
    $76,961 per member, while the bills of those countries respectively run
    to $128,791 and $110,787 per member. Further, compared to the U.S. Air
    Force, cost per Air Guard member is less than a fifth of that of the
    Regular Air Force. Comparisons such as these illustrate well the cost
    savings realized with an operational reserve possessing surge
    potential.
        Operational savings are due to the Air National Guard's experienced
    force and lean operating methods. An examination of the Air National
    Guard's F-16 maintenance by Rand Corporation last year highlighted the
    ability of our maintenance personnel to generate double the amount of
    flying hours in a one-to-one comparison of full-time equivalents.
    Recruiting and Retention
        Air National Guard Recruiting and Retention programs play a
    critical role in supporting today's fight and how we posture our force
    for the future. The commitment of our field commanders and their
    exceptional recruiters are key factors in recruiting successes. Their
    partnership with the National Guard Bureau has enabled us to remove
    barriers that traditionally prevented the ability to meet end strength.
    The Air National Guard continues to build on that success and has
    focused its efforts to target critical needs.
        As of April 22, 2010, Air National Guard end strength is 108,420.
    The challenge as we move forward is to strike a delicate balance of
    remaining close to end strength while strengthening ``effective''
    recruiting. We show troubling signs in specific areas of officer
    recruiting (currently 1,500 short) and critically manned mission areas
    including Health Care Professionals, Chaplains, Engineers,
    Intelligence, and Mobility aviators. To compensate for lagging prior
    service numbers, the Air National Guard increased its emphasis on the
    non-prior service market. This required increases in advertising to the
    non-prior service market through radio, theatre, print media and web
    sites, as well as additional recruiters, community presence with store-
    front offices and additional advertising dollars. The continued support
    of the Air Force, Department of Defense, and Congress will undoubtedly
    shape the foundation of their success.
        The quality of Air National Guard recruits has not declined and
    their retention rate remains strong at 96.9 percent. The Air National
    Guard saves on average $62,000 in training cost for every qualified
    member retained or recruited. Our focus in this area allows us to
    retain critical skills lost from the Active component and save valuable
    training dollars.
        In 2009, through the use of our 14 In-Service Air National Guard
    recruiters strategically placed at active duty bases, the Air National
    Guard garnered approximately 896 confirmed accessions of a total of
    5,309 accessions. The bonuses and incentive programs are a key
    component to that success.
        Our Air National Guard incentive program is a critical component in
    our Recruiting and Retention efforts and serves to motivate and support
    manning requirements in units with skills that are severely or
    chronically undermanned. It is established to encourage the
    reenlistment of qualified and experienced personnel. Stable funding for
    the Air National Guard Recruiting and Retention program is critical to
    our success.
    Airman and Family Readiness Programs
        In focusing on our airmen we must also focus on the most important
    people in their lives--their families. The Air National Guard is a
    wing-centered organization. Our 92 Wing Family Program Coordinators
    around the Nation are at the center of our efforts to ensure our airmen
    and their families receive the support they need.
        In past year we were successful in having these coordinator
    positions upgraded from GS-9 to GS-11. Our coordinators are one-deep
    positions for us, so most of the effort is done through part-time
    support.
        This is one area where we differ dramatically from our Regular Air
    Force counterparts. The Air National Guard does not have Airman and
    Family Readiness Centers as they have on active duty bases. In a
    culture that does not believe in saying ``no,'' our program
    coordinators have more and more piled onto their plates, thereby
    threatening the overall quality of service, if the Air National Guard
    maintains its pace as an operational force.
        Programs like Operation Military Child Care have been very helpful.
    Also, military and community partners like Military OneSource, Military
    Family Life Consultants, and Operation Military Kids, just to name a
    few, are extremely beneficial in meeting the needs of the Guard airmen,
    especially while deployed. Youth Development Camps like Air Force Teen
    Aviation, Air Force Space Camp, and the Air Force Reserve/Air National
    Guard Leadership Summits are huge successes as well. Additionally, this
    year we are conducting training such as Community Healing and Response
    Training, which is part of the Yellow Ribbon Reintegration Program, and
    essential in our suicide prevention efforts.
        For the Air National Guard, we believe maintaining strong family
    support programs are critical to ensuring the overall health of our
    force and our Guard airmen.
    Employer Support for the Guard and Reserve
        We must recognize the importance of support for military service by
    families, military leadership and civilian employers. This is referred
    to as the ``Triad of Support.'' It is important to maintain an overall
    climate in which military service is honored and supported. The
    Department of Defense's organization that addresses civilian employer
    support is Employer Support for the Guard and Reserve. Their vision is
    to develop and promote a culture in which all American employers
    support and value the military service of their employees serving in
    the Guard and Reserve. Employer Support for the Guard and Reserve
    accomplishes this by gaining and maintaining employer support for Guard
    and Reserve service by recognizing outstanding support, increasing
    awareness of the law, and resolving conflict through mediation. A
    Statement of Support, a formal statement voluntarily signed by an
    employer, is one way to demonstrate support and acknowledge employer
    rights and responsibilities under the Uniformed Services Employment and
    Reemployment Rights Act. During fiscal year 2009, 54,965 employers
    signed Statements of Support for their employees serving in the Guard
    or Reserve. This is an increase from the 44,861 employers that signed
    Statements of Support in fiscal year 2008. Another indicator of the
    current employer support climate is the number of Uniformed Services
    Employment and Reemployment Rights Act cases requiring mediation. The
    average number of cases mediated has remained consistent over the last
    3 fiscal years: 2007 = 2,374, 2008 = 2,664 and 2009 = 2,475. These
    numbers indicate less than .01-percent of all Selective Reserve members
    who have opened a case to address employer issues. Based on these two
    indicators, it appears American employers are continuing to support
    their employees serving our Nation.
                              army national guard
        Today, 76,949 of our soldiers are mobilized, deployed, and on point
    for this Nation. The sacrifice of those soldiers, their families, and
    employers is something we must acknowledge and appreciate.
        The last 8 years have seen the Guard transform to an operational
    force. The enablers for the Army National Guard--one of the greatest
    forces for good-- have been provided and sustained by congressional
    initiatives. Thank you for your continued support.
        Today we would like to discuss the role of the Army National Guard
    as an operational force. We plan to describe our personnel challenges,
    significant accomplishments, and future operational requirements. Since
    September 11, 2001, the Army National Guard has transformed in several
    ways. The organization is no longer a strategic reserve; we are now and
    have been, for several years, an Operational Force.
    Budget Requested Increase in Full-time Non-Dual Status Technicians
        The President's budget for fiscal year 2011 requests an increase in
    funding for Army National Guard non-dual status technicians from 1,600
    to 2,520--an additional 920 positions. We ask the committee to provide
    this increase in its mark of the National Defense Authorization Act for
    2011.
        Non-dual status technicians work primarily in personnel
    administration, contract management, information technology and similar
    support functions with the Army National Guard's frequent
    mobilizations, we find that we need these non-deploying civilian
    technicians to fill critical positions in our generating force. Filling
    these positions with dual-status military members who deploy creates a
    disruption in workflow. Thanks to a special wartime exception, the Army
    National Guard has been able to hire some additional temporary non-dual
    status technicians, but these hires are only on a year-to-year basis.
    Reliance on ``temporary'' technicians, however, causes instability for
    the employees themselves and in the work produced. For this reason we
    are asking for a formal increase in the authorization level of Army
    National Guard non-dual status technicians in the National Defense
    Authorization Act for Fiscal Year 2011.
        Last year, the conference committee directed the Secretary of
    Defense to submit to the defense committees an extensive report on the
    duties of and requirements for National Guard non-dual status
    technicians. We at National Guard Bureau are completing our input to
    that Department of Defense report.
    Duties Performed by Non-Dual Status Technicians
        National Guard non-dual status technicians are employed in
    positions that do not have an associated deployable position. These
    positions are typically not inherently military in nature, are lower
    graded, and are not supervisory except when the supervision is over
    other non-mobilization positions. More than 88 percent of non-dual
    status technicians work in the areas of human resources, administrative
    services, financial services, and information technology. More than 95
    percent are in pay grades of GS-12 and below. Non-dual status
    technicians serve in positions that provide continuity of services in
    functional areas that continue to be required especially after large
    scale mobilizations within the State.
    Current Authority for Non-Dual Status Technicians
        Under section 10217 of title 10, the Air National Guard and Army
    National Guard are limited to a total of 1,950 non-dual status
    technicians across the two organizations. This limit of the current law
    has been in place unchanged since 1997. The National Defense
    Authorization Act has been annually prescribing the number of positions
    for the Army National Guard and Air National Guard at 1,600 and 350
    respectively.
        As the Army National Guard has transitioned from a strictly
    strategic reserve to more of a frequently and rotationally mobilized
    and deployed operational force both at home and abroad, it has become
    clear that more of the supporting positions at the State level need to
    transition from being held by deployable military members of the
    National Guard to being held by nondeployable civilian technicians. The
    Constitution Reserves to the States the authority of training the
    militia. Consequently it is necessary to provide the States with the
    type of staffing needed to achieve the goal of continuing to produce a
    ready operational force over the long term.
    Current and Near-Term Means of Addressing the Technician Shortfall
        The Office of Personnel Management has delegated emergency hire
    authority for temporary non-dual status technicians. Each emergency
    hire technician is not to exceed a 2-year employment period for that
    position. This process is consistent with the stipulations of the
    Extension of Declaration of National Emergency. Using temporary non-
    dual status technicians helps fill critical requirements left unfilled
    due to the 1,600 limit for the Army National Guard.
    Future Technician Requirements
        The National Guard Bureau is in the process of assessing the
    overall longer-term needs of the force, including both the Army and the
    Air National Guard, to determine whether legislative changes are needed
    regarding non-dual status technicians to manage and support the
    National Guard beyond fiscal year 2011. This effort continues to be
    actively deliberated through processes inside the Department of Defense
    and we will communicate any additional requirements or requests to the
    committee once final determinations are made concerning the long-term
    appropriate levels of non-dual status technicians in the National
    Guard.
    Full-Time Support and Active Duty Operational Support
        Adequate full-time support is essential for Reserve component unit
    readiness, training, administration, logistics, family assistance and
    maintenance, and a unit's readiness to deploy.
        Since September 11, 2001, the Army, the Army National Guard, and
    the Army Reserve have maintained a tremendous operational tempo
    (OPTEMPO). This high OPTEMPO has required an increased level of full-
    time manning in order to prepare individuals and units for deployment.
    The Army National Guard and the Army Reserve have been able to meet the
    operational needs of the Army through the use of Active Duty
    Operational Support (ADOS) soldiers and other full-time equivalent
    manning, such as temporarily hired military technicians, to bridge
    full-time manning shortfalls.
        As a result it is clear that a robust authorization for Active Duty
    Operational Support is critical to the ability of the ARNG to continue
    its success in meeting Army mission requirements as a fully operational
    force.
    Significant Achievements and Adequate Resources
        The intensive use of the Army National Guard over the last 8 years
    demonstrates the value-added role our citizen soldiers render in the
    defense and protection of our Nation at home and the support of the
    Nation's strategic missions abroad. In order to sustain the Army
    National Guard as an operational force and to provide consequence
    management response forces adequate resources are required. Our key
    goals in support of the transition to an operational force are:
    maintain end strength of at least 358,200; train the force to the
    desired levels of proficiency in accordance with the Army Force
    Generation Model (ARFORGEN). Our current manning level enables us to
    meet ARFORGEN readiness goals and provide the logistics train for
    maintaining and improving our infrastructure of buildings and
    equipment. In addition, the Army Equipping Strategy must ensure mission
    readiness, interoperability, and compatibility across all three Army
    organizations: Active Army, Army National Guard, and U.S. Army Reserve.
    As part of our domestic mission requirements, the Army National Guard
    must have a minimum of 80 percent of critical dual use equipment on-
    hand and available at all times.
        As stewards of a 373-year militia tradition, we are privileged to
    uphold the institutions and maintain the infrastructure of our national
    readiness. Over 1,400 of our readiness centers are 50 years old or
    older. The Army National Guard requests continued support from the Army
    to provide necessary improvements, including energy saving initiatives
    for our readiness centers and other facilities. Another goal is to care
    for the force by improving soldier medical, dental, and family
    readiness.
        In order to minimize force structure turbulence, we need to retain
    our current key force structure elements of 8 Divisions, 8 Combat
    Aviation Brigades (CABs), 28 Brigade Combat Teams (BCTs) and functional
    brigades while addressing key Homeland Defense and Homeland Security
    requirements.
        The Army National Guard has made significant progress modernizing
    and converting to an operational force. The Army has transformed from a
    division-centric force to a more flexible brigade-centric force and is
    restructuring to create units that are more stand-alone and alike while
    enhancing full-spectrum capabilities. The Army National Guard BCTs are
    structured and manned identically to those in the active Army and can
    be combined with other BCTs or elements of the joint force to
    facilitate integration, interoperability, and compatibility across all
    components. The Army National Guard has transformed more than 2,800
    operating force units to modular designs.
        In fiscal year 2009, 46,220 Army National Guard soldiers were
    mobilized in support of combat operations (Iraq, Afghanistan, and
    Kuwait). Overlapping with soldiers deployed in fiscal year 2008,
    mobilizations reached the highest point since 2005 of more than 65,000
    soldiers. An additional 5,500 soldiers were mobilized for other
    contingency operations in Bosnia, Kosovo, Sinai, and the Horn of Africa
    and also for domestic operations.
        As part of transformation to an operational force, the ARNG
    rebalanced its force by reducing overall Force Structure Allowance
    (FSA) to approximately 350,000 authorizations while Congress maintained
    End Strength at 358,200. The resulting variance between FSA and end
    strength of 8,000 provided the ARNG some flexibility to implement an
    8,000 soldier trainees, transients, holdees and students account within
    the authorized end strength of 358,200 starting in fiscal year 2011.
    The initial program will concentrate on the medically non-deployable
    within the ARNG.
    Recruiting
        We achieved our recruiting goals in fiscal year 2009 and we are on
    track to meet our fiscal year 2010 goal of maintaining our
    congressionally authorized end strength of 358,200 soldiers (actual
    strength is 361,904 as of March 31, 2010). We have shifted our focus
    from increasing the quantity of our assigned strength to improving the
    quality of our force. We applaud the leadership of Congress, Governors,
    adjutants general, and our communities for their incredible efforts and
    achievements in helping us build and maintain the Army National Guard
    as our Nation's largest community-based defense force. We are extremely
    proud of the overwhelming response of our patriotic communities and
    most grateful for congressional support to our citizen soldiers.
    Stabilize the Force to Build Readiness
        One of the enduring lessons learned from the overseas contingency
    operations is that we need to stabilize and sustain our forces
    mentally, physically, and spiritually. This includes having an
    outstanding full-time support team. Today's full-time personnel are
    major contributors across the full spectrum of Army National Guard
    operations. Meeting the needs of the persistent conflict underscores
    the vital role full-time support personnel have in preparing units for
    the multitude of missions at home and abroad. The ARNG program consists
    of both military technicians and Active Guard Reserve soldiers. full-
    time personnel sustain the day-to-day operations of the entire ARNG.
    The readiness levels of Army National Guard units are directly tied to
    the full-time support program. Congress has supported the ARNG full-
    time support (FTS) through increased authorization over the last
    several years. Those increases coupled with the soldiers we have put on
    ADOS have allowed the ARNG to increase its readiness and be able to
    continue fighting the overseas contingency operations and become an
    operational force.
        To provide the best support and transition assistance for wounded,
    injured, and ill soldiers, the Army National Guard continued to support
    the Army's warrior transition units and community-based warrior
    transition units. The transition units provide non-clinical support,
    complex case management, and transition assistance for soldiers of all
    components at medical treatment facilities on Active Army
    installations. The community-based warrior transition units provide
    high-quality health care, administrative processing, and transition
    assistance for recuperating Reserve component soldiers while allowing
    them to live at home and perform duties close to their homes and
    families. At the end of fiscal year 2009, the warrior transition units
    managed more than 1,500 Army National Guard soldiers and the community-
    based warrior transition units managed more than 900 ARNG soldiers
    throughout the United States.
        The Army National Guard remains committed to supporting the
    families of deployed soldiers throughout the deployment cycle. Every
    soldier needs a support structure and a network of protection that
    includes self readiness, within a circle of family support, within a
    band of unit and community brothers and sisters, and within the larger
    networks of State and national organizations.
        Army National Guard families were supported in numerous ways in
    fiscal year 2009. The National Guard Bureau's Family Program Office
    provided families with training via computer-based modules, centralized
    classes, and locally-provided lectures to help make families self-
    reliant throughout the deployment cycle process. The Army Well-Being
    Program established the Army Families Online website, an information
    portal for families of National Guard soldiers. The Department of
    Defense Military OneSource Program provided benefits which include
    counseling services, resources for parents, assistance with consumer
    credit, and online tax return preparation for military families.
        The Resiliency Training Center focuses on prevention through
    proactive marriage workshops and stress-relief training before, during,
    and after deployments. The main goal of the resiliency program is to
    create ``resilient'' servicemembers and families. The mission of the
    program is to provide a continuum of care, including a comprehensive
    range of education, training, and the tools necessary to cope with high
    levels of stress. This includes the skills to identify potential
    problems and the team effort of developing both individual and group
    techniques for surviving and prospering in times of great stress.
        The Resiliency Training Program rolled out several courses in
    fiscal year 2009 by collaborating on their course material with Army
    and Battlemind leaders, leading military personnel and mental health
    experts, and leading researchers in the stress management field. This
    included teaming with course developers from the American Association
    of Emergency Psychiatrists, the Walter Reed Institute for Research, the
    National Defense University, the Military Family Institute at Kansas
    State University, and partnering with the Tragedy Assistance Program
    for Survivors.
        The Resiliency Training Center plans to continue to use all
    available traditional and modern communication tools, including onland
    and online training, Podcasts, web sites, social networking,
    professional speakers and trainers, videos, and small group
    discussions. The Army National Guard has appointed suicide intervention
    officers to every ARNG company nationwide. Each State and territory has
    a trained suicide prevention program manager. Also, each State and
    territory has hired a Director of Psychological Health to provide case
    management and resourcing support for soldiers in crisis.
    Soldier and Family Support
        The Army National Guard strives to provide our soldiers and
    families with a continuum of care with a special emphasis on the
    Deployment Cycle Support process.
        Some of our family readiness efforts include Family Assistance
    Centers, the Yellow Ribbon Reintegration Program, the Freedom Salute
    Program, the Strong Bonds Program, and Suicide Prevention training. The
    Army National Guard operates 369 Family Assistance Centers across all
    54 States and Territories. The Family Assistance Centers service all
    components and are strategically placed in each State and Territory to
    overcome geographic dispersion.
        The National Guard Yellow Ribbon Reintegration program provides
    information services, referral, and proactive outreach opportunities
    for soldiers, families, employers, and youth throughout the entire
    deployment cycle: predeployment, deployment, post-deployment, and
    return to civilian life. The Yellow Ribbon program benefits
    servicemembers from all Reserve components.
        The Yellow Ribbon Reintegration program is a flexible soldier and
    family support system that meets the soldier and family readiness needs
    of geographically dispersed families. The Yellow Ribbon Reintegration
    program has hosted 40,421 soldiers and 34,513 family members at
    hometown events so far this fiscal year. In fiscal year 2009, the
    Yellow Ribbon program supported 54,472 soldiers and 72,316 family
    members.
        Fiscal year 2009 was a very active year for the Freedom Salute
    Campaign. As one of the largest Army National Guard recognition
    endeavors in history, the Freedom Salute Campaign publicly acknowledges
    Army National Guard soldiers and those who supported them during the
    President's call to duty.
        The Freedom Salute Campaign is an important tool in the recruiting
    and retention program. The way an organization treats its people is a
    direct reflection of organizational values. The entire Army community
    pays attention to how the ARNG treats returning soldiers. The Freedom
    Salute Campaign increases community awareness throughout the Nation of
    the good work being done by National Guard soldiers. In a recent
    survey, soldiers returning from Operation Iraqi Freedom indicated that
    recognition for their service and sacrifice was one of the most
    important contributing factors in their decision to continue to serve
    in the Guard.
        The Strong Bonds program is a commander's program that is unit-
    based and chaplain-led to help soldiers and their families build and
    rebuild strong relationships, especially when getting ready for or
    recovering from a deployment.
        The Army National Guard recently initiated the Job Connection
    Education Program (JCEP). This program improves National Guard force
    stability by advancing member skills at seeking, obtaining, and
    retaining civilian employment, much like the Army Career and Alumni
    Program, but at the local level. A key component of this jobs program
    is its proactive approach to connecting soldiers, and where applicable,
    potential employers, to new and existing Federal, State and Guard
    programs and resources, coordinating job expositions and fairs, and
    conducting seminars, webinars, and workshops. JCEP team members work
    closely with local employers to ensure they are aware of all the
    resources available to them in their effort to hire local Guard
    soldiers. Classroom activities and practical exercises result in
    improved employment and reemployment rates for laid-off, under-
    employed, and unemployed Guard soldiers. The JCEP introduces and
    connects soldiers to the evolving Employment Partnership Office efforts
    and the emerging formal relationships between Reserve component and
    private sector businesses with a focus at the local community level.
    The State of Texas is the pilot test site with the first location in
    the Dallas area. This program can be used by Army Reserve soldiers as
    well as National Guard soldiers.
        The Army National Guard is also partnering with the Army Reserve in
    the Employer Partnership Office. The Guard and Reserve soldiers rely on
    a demographic segment that balances two careers. Service in the Army
    National Guard and Army Reserve is vocational in nature and represents
    a motivation to serve in other than an active duty capacity. The Army
    National Guard and Army Reserve cannot exist without citizen-soldiers,
    the bulk of whose livelihoods are provided by civilian employers. Under
    the ARFORGEN concept, all Guard and Reserve servicemembers are
    virtually assured of at least 1 year-long mobilization over the course
    of their careers. This affects small businesses much more than larger
    firms, in addition to the known effects on the soldier and his or her
    family. We recognize that readiness has three dimensions: unit, family,
    and employer. The broad aims of this initiative are threefold: (1) to
    foster employer readiness for mobilization; (2) to make employing and
    retaining Reserve component servicemembers attractive to employers; and
    (3) to identify areas where the Reserve component and civilian
    employers can share costs for benefit programs.
        In order to provide assistance to the soldiers to improve their job
    skills the Army National Guard has started an initiative called--Guard
    Apprenticeship Program Initiative (GAPI). This initiative involves
    partnering with the Department of Labor and coordinating with the
    Department of Veterans Affairs while National Guard soldiers work in
    their civilian jobs and participate in the program. Apprenticeship is a
    training opportunity for ARNG soldiers to earn national certification
    and skills in a specific field while earning wages. In certain cases,
    eligible ARNG soldiers can receive their VA educational benefits while
    they pursue an apprenticeship program. Apprenticeship combines
    classroom studies with on-the-job training supervised by a trade
    professional or supervisor. Apprenticeship training takes 1 to 5 years
    to complete or 2,000 documented workhours to become fully qualified in
    the occupation or trade. Soldiers earn money while they learn on the
    job. This collaboration is essential to the sustainability of the ARNG
    and the vitality of the best-trained and dependable professionals our
    Nation has to offer, which are our volunteer soldiers. This is an
    opportunity to gain civilian employment and certification, while
    serving in the ARNG. This program can also be used by the Army Reserve.
        We must recognize the importance of support for military service by
    families, military leadership and civilian employers. This is referred
    to as the ``Triad of Support''. It is important to maintain an overall
    climate in which military service is honored and supported. DOD's
    organization that addresses civilian employer support is Employer
    Support the Guard and Reserve (ESGR). ESGR's vision is to develop and
    promote a culture in which all American employers support and value the
    military service of their employees serving in the Guard and Reserve.
    ESGR accomplishes this by gaining and maintaining employer support for
    Guard and Reserve service by recognizing outstanding support,
    increasing awareness of the law, and resolving conflict through
    mediation. A Statement of Support, a formal statement voluntarily
    signed by an employer, is one way to demonstrate support and
    acknowledge employer rights and responsibilities under the Uniformed
    Services Employment and Reemployment Rights Act (USERRA). During fiscal
    year 2009, 54,965 employers signed Statements of Support for their
    employees serving in the Guard or Reserve. This is an increase from the
    44,861 employers that signed Statements of Support in fiscal year 2008.
    Another indicator of the current employer support climate is the number
    of USERRA cases ESGR has mediated. The average number of cases ESGR
    mediated has remained consistent over the last 3 fiscal years: fiscal
    year 2007--2,374, fiscal year 2008--2,664, fiscal year 2009--2,475.
    These numbers indicate less than .01 percent of all SELRES have opened
    a case to address employer issues. Based on these two indicators, it
    appears American employers are continuing to support their employees
    serving our Nation.
    Reserve Retirement
        The current Reserve Retirement system was implemented in 1949 to
    enhance volunteerism, bolster recruiting, enable unit cohesion all
    while ensuring a ready force available for deployment based on lessons
    learned in World War I and II. Over these 61 years, the system has
    undergone few modifications. Congress recently made a critical shift in
    the retirement program paradigm of an operational reserve when they
    passed legislation authorizing Reduced Retirement Age Eligibility on 28
    January 2008. The Army National Guard will continue to be employed as a
    major operational element of the Army, and as such, citizen soldier
    benefits and entitlements should reflect their continued and often
    extended active duty service.
    Medical and Dental Readiness
        The Army National Guard has three primary medical readiness goals:
    deploying a healthy force; deploying the medical force-units; and
    facilitating warriors in transition and family care-beneficiaries.
        In fiscal year 2009, the ARNG Office of the Chief Surgeon received
    funding for the following programs: medical readiness, $126.5 million;
    overseas contingency operations, $9.5 million; and dental treatment,
    $21.2 million. These funds went toward period health assessments,
    immunizations, contracts in support of medical readiness, and
    deployment of 41,500 soldiers who met physical, dental, and mental
    health standards.
        Readiness increased from 35 percent fully-ready in fiscal year 2008
    to 46 percent in fiscal year 2009. This success resulted from increased
    targeted funding and a concerted effort by National Guard Bureau (NGB)
    staff to act as liaisons between NGB and Army medical commands to meet
    funding, manning, and equipment requirements.
        Dental readiness at mobilization stations continued to increase to
    over 90 percent in fiscal year 2009. Funding of $21.2 million and
    National Guard Bureau/State coordination were instrumental in providing
    a drop in dental releases from active duty and soldiers who were
    dentally disqualified. The First Term Dental Readiness Program moved
    forward to phase two with the goal of 95 percent in Dental Fitness
    Category 1 or 2 for soldiers completing advanced individual training.
    Demobilization Dental Reset was implemented by U.S. Army Dental Command
    with a goal of 95 percent in Dental Readiness Category 1 or 2 upon
    release from active duty. To date over 90 percent of ARNG soldiers
    processed by Dental Command facilities have been reset to a dental
    condition of Dental Readiness Category 1 or 2.
        The Army Selected Reserve Dental Readiness System enables dental
    treatment of soldiers throughout ARFORGEN. Program objective memorandum
    (POM) efforts to fund this initiative were successful for fiscal year
    2010 through fiscal year 2015, achieving $1.1 billion in critical
    requirements across the POM years.
    ARFORGEN Cycle
        Unit stability in the ARNG is a key enabler of the ARFORGEN model
    to work most effectively. The annual personnel turbulence rate in a
    typical BCT, prior to a Notice of Sourcing, is 15.6 percent. This
    includes gains, losses, transfers in, and transfers out.
        During the Sourcing period of the ARFORGEN cycle, between 6 and 12
    percent of soldiers assigned to units are untrained and cannot be
    deployed by law. These soldiers are new enlistments who have signed up
    for service, but who have not yet completed initial entry training. The
    Army National Guard and Training Doctrine Command (TRADOC) have worked
    hard to alleviate this problem by increasing the capacity for initial
    entry training at the key times that ARNG soldiers are available to
    attend (for example, during the summer months). The training pipeline
    has been reduced by more than 10,000 soldiers.
    Accelerated initial training
        Once a unit receives an Alert Order, additional training seats need
    to be made available in order to return Duty Military Occupational
    Skills Qualification (DMOSQ) soldiers that are assigned to that unit.
    On average, new recruits take 11 months to complete initial entry
    training. Our Recruit Sustainment Program (RSP) decreases training ship
    time, as well as pre-training and in-training losses. Since the ARNG
    initiated RSP, the rolling 12-month average number of soldiers lost
    during initial entry training has decreased by 3.6 percent resulting in
    positive control of DMOSQ drop. Training seat availability is directly
    linked to personnel readiness. Additionally, the Recruit Force Pool
    (RFP) reduces the period of time in which non-MOSQ soldiers are holding
    paragraph and line numbers in MTOE units and gives the ARNG the ability
    to target the available seats.
        Upon an Alert Order, units enter the pre-mobilization cycle with
    personnel shortages due to untrained and medically nondeployable
    soldiers occupying positions in the operational force, as well as
    normal attrition. Mobilizing BCTs must cross-level on average 37
    percent of their authorized strength in order to meet mobilization
    requirements. This depletes donor units and creates a cascade of
    unreadiness across the ARNG. The ARNG is working an initiative to
    anticipate so as to better manage this cross-leveling and minimize the
    impact to units preparing for deployment.
            increasing the stability of units prior to mobilization
        Retention incentives to minimize cross-leveling: The Deployment
    Extension Stabilization Pay (DESP) program stabilizes ARNG units from
    the period of sourcing through mobilization. This program has a
    positive impact on unit readiness by reducing cross-leveling and
    attrition well in advance of the unit's mobilization date. By fixing
    end strength at 358,200, each soldier retained by DESP reduces the loss
    rate and simultaneously reduces the requirement for an accession by one
    in addition to stabilizing the unit through the next subsequent
    mobilization. As retention increases, losses and accessions decrease.
    In other words, the ARNG `trades losses' between DESP takers and other
    ETS-eligible soldiers in order to meet programmed losses where end
    strength is fixed at 358,200.
    Access to the ARNG
        The Army has determined that it must rely on an operational reserve
    to meet the demands of the Army in today's environment and will need to
    continue to rely on an operational reserve to meet expected near-term
    demands of the Nation. The soldiers in the Army National Guard also
    want to be part of an Operational Force as well. We know this from the
    discussions we have had with our soldiers and their leaders; but more
    indicative are the recruiting and retention rates of Army National
    Guard soldiers. Everyone of our soldiers have had to make a decision to
    either enlist, stay or leave the Army National Guard during the current
    conflict, knowing they will more than likely deploy at least once in
    their initial period of service. As I have stated earlier, the Army
    National Guard continues to meet its authorized end strength of
    358,200. Our current reenlistment rate is 116 percent of our plan. As
    long as our soldiers are doing meaningful missions and provided the
    resources to accomplish those missions, Army National Guard soldiers
    want to continue to be an operational part of the Nation's defense
    solution.
        The Army National Guard is a fully accessible Reserve component of
    the U.S. Army. It has met every request for forces to date. The Reserve
    components provide significant capability to the Department of Defense
    at a very cost effective rate. A number of authorities exist that
    permit the executive branch to access the Reserve component. We are
    working with the Office of the Secretary of Defense and the Army to
    ensure there is a clear understanding of the authorities and the
    policies that allow the exercise of those authorities, particularly in
    light of the current and future operational and funding environment.
        The Army with Congressional support has invested a significant
    amount to bring up the readiness of the Army National Guard. It is
    important to maintain the capabilities of that investment. The
    alternative means a larger Active Force at a considerably higher cost.
    The Army National Guard is better equipped, trained and ready than it
    has ever been in its history. The 12 month mobilization policy enacted
    by the Secretary of Defense goes a long way in protecting the Reserve
    component soldiers and allowing more predictability for mobilizations.
    This is key to our soldiers.
        We need to continue to educate our senior leaders on the capability
    of the Army National Guard and advise them if we are getting over used;
    however, the Army National Guard is committed to the ARFORGEN model. In
    my view, it is able to provide about 55,000 soldiers every year based
    on the rotational rate of 1 year mobilized and 5 years at home.
        Our Nation was built as a militia nation and the Reserve components
    are the tie back to the communities we serve. The Army National Guard
    has provided over 300,000 soldiers to Operations Iraqi Freedom and
    Enduring Freedom. At the height of the Operation Iraqi Freedom surge
    when the Army National Guard had over 90,000 mobilized or deployed
    overseas, more than 50,000 others responded to the support Hurricane
    Katrina recovery efforts within 11 days. This proves that the militia
    concept remains strong in the face of 21st century challenges.
                                closing remarks
        The men and women of the National Guard greatly appreciate the
    cooperation and support you have provided in the past and look forward
    to working with you as we meet today's challenges.
        Thank you for the opportunity to be here today. I look forward to
    your questions.

        Senator Webb. Thank you very much, General Carpenter, and
    all of you, for your testimony.
        I note in the bios that General McKinley and General Wyatt
    both went to SMU. Is there something in the water down there?
        General McKinley. Coincidental, sir. [Laughter.]
        General Wyatt. Sir, I'm actually a couple of years ahead,
    but obviously he's a much faster burner than I am.
        General McKinley. Yes, thanks. [Laughter.]
        Senator Webb. I also notice that General Carpenter studied
    Vietnamese language before he deployed to Vietnam in the Navy.
        General Carpenter. Yes, Senator.
        Senator Webb. [Said something in Vietnamese.]
        General Carpenter. Sir, that was 30 years ago. [Laughter.]
        Senator Webb. We appreciate all of your service, and yours
    as well, Secretary McCarthy.
        General McKinley, it's been, I think, 2 years since your
    position was elevated to a four-star position. You're the first
    four-star to serve in this position. Would you like to tell
    this committee how these changes have affected your role, what
    difference they've made?
        General McKinley. Mr. Chairman, I think what I have sensed
    over the past 14, 15 months in the position is, the position
    has allowed me to enter discussions and forums that were not
    previously afforded my predecessor. To be very specific, I'm a
    member of the Defense Advisory Working Group, which Deputy
    Secretary Lynn chairs. Going through the Quadrennial Defense
    Review (QDR), that was a programmatic session where I was able
    to shape and influence for the 460,000 guardsmen those things
    which I felt were important for the QDR. I've also been
    included by the Chairman, Admiral Mullen, in all of the tank
    discussions. I'm not a voting member, but I'm certainly able to
    offer my best military advice to the Chairman and to the
    Secretary, through the Defense Senior Leadership Conferences
    that Secretary Gates holds to specifically address the needs of
    the National Guard force. That, coupled with the fact that
    Secretary McCarthy and I are working extremely closely
    together, and along with Secretary Stockton, the venues and the
    numbers of meetings, and the number of forums available to me
    now has grown exponentially. To take that into context in DOD,
    that has made a significant improvement in my quality of advice
    to the senior leaders of the Department.
        Senator Webb. Thank you.
        Secretary McCarthy, when I held the position that you have
    right now, I sat on what was then called the Defense Resources
    Board. I'm not sure the same board exists. But, do you sit on
    that board or on an equivalent?
        Mr. McCarthy. Short answer: No, sir. I don't think the
    Defense Resources Board exists. If it does, I'm not aware of
    it. I think that the Defense Advisory Working Group that
    General McKinley mentioned is perhaps a comparable forum today.
    I do not routinely sit on that. Quite frankly, I'm working
    closely with both Under Secretary Stanley, and occasionally
    with Secretary Gates, to figure out what the right level of my
    participation is.
        Senator Webb. The Defense Resources Board, at the time that
    I was in the Pentagon, had input on all budget recommendations
    of all Services at the level of $60 million or higher during
    the formation of the budget. It was very important when this
    position was created that someone overseeing the Guard and
    Reserve programs had that sort of direct input. Is there any
    similar forum where you can have direct input today?
        Mr. McCarthy. No, sir, there is not. Not today.
        Senator Webb. All right. I may have a followup question for
    you on that.
        I'd like to ask General Wyatt and General Carpenter,
    separately, a couple of questions, just datapoints--the
    percentage of the Air Guard and the Army Guard that are prior
    service, and the percentage that are over the age of 40.
        General Wyatt. Senator, we have about a 60 percent prior-
    service membership in the Air National Guard. I think that
    question, and the answer, points out the--one of the benefits
    of having an operational and robust National Guard. It is that
    it does allow for the active duty members who want to continue
    serving their country--it affords them the opportunity to do so
    when they, perhaps, make that choice not to serve in a full-
    time capacity.
        The second part of your question, sir?
        Senator Webb. The percentage of the Air Guard that is over
    the age of 40.
        General Wyatt. I can't get you the exact percentages, but
    we are an older force, with more experience than the Active
    component. But, if I could take that for the record, sir, I'll
    get you the exact percentages.
        Senator Webb. Actually, what I would request is--Secretary
    McCarthy, if you could get me a breakdown of the Guard and
    Reserve components, in terms of age.
        [The information referred to follows:]

        The average age of Reserve component officer servicemembers (all
    Services) is 40.2 years old (median age is 40.0), while the average
    enlisted age is 30.8 years old (median 28). The average and median ages
    for all Reserve component members (all Services) are 32.2 years old
    (median 30).

    ----------------------------------------------------------------------------------------------------------------
                           Age                           ARNG     USAR     USNR    USMCR     ANG     USAFR    USCGR
    ----------------------------------------------------------------------------------------------------------------
    Approx. Average Age..............................     30.6     32.1     35.1       26     35.1     36.3     34.7
    Percent over age 40..............................     23.6     29.5     38.4      0.9     38.0     43.0     34.0
    ----------------------------------------------------------------------------------------------------------------

        Senator Webb. When I had your position, it was one out of
    five was over the age of 40. It impacted a lot of policies,
    such as over-40 stress testing and that sort of thing. It's one
    that you would expect, particularly on the aviation side, to
    have a higher number of prior service and a higher age level.
    It's amortizing a very precious asset that you don't have to
    retrain over and over again. But, I'd like to be able to see
    the numbers.
        General Carpenter, do you have data on those two points?
        General Carpenter. Senator, a couple of specific comments
    on your questions.
        One is, we have seen the average age of the force in the
    Army National Guard become younger. That's a function of
    increased deployments and a change in the culture from where we
    were at before September 11. We were an average of over 30
    years old, in terms of our force, and we're now somewhere
    around 29 years of age, and so we've become younger, and it's a
    function of the OPTEMPO.
        The other datapoint that's probably of note here is the
    number of prior service. Before September 11, we recruited a
    lot of prior-service soldiers into our organization, and that
    was one of our mainstays. Frankly, after September 11, what's
    happened is that people leave the Army, and they want to leave
    the entire mobilization piece. They know that the National
    Guard is a mobilizing and deploying force, and so, we have had
    to turn more to the non-prior-service market, in terms of where
    we go to recruit and sustain our end strength.
        Senator Webb. How does that affect your ability to train up
    a ground soldier?
        General Carpenter. Sir, I think the offset of that is the
    mobilization and the deployments that we've seen inside the
    Guard. We have over 60 percent of our soldiers that are combat
    and deployed veterans inside of our formations. Now, we haven't
    seen that kind of a statistic since World War II. So, we have
    not necessarily gotten the experience level that you allude to
    from the Active component coming into our ranks. We've actually
    gotten firsthand experience, in terms of the deploying units.
        Senator Webb. All right.
        General McKinley, I know that Senator Graham is going to
    have some questions on this, but I would be interested in your
    thoughts on the border security and drug interdiction efforts
    that--the different areas where the Guard can participate in
    that.
        Secretary McCarthy, if you had thoughts on that, I'd like
    to hear them, as well.
        But, General McKinley, specifically with the Guard; and if
    Secretary McCarthy has something broader.
        General McKinley. Mr. Chairman, I'm sure you're well aware
    of Operation Jump Start, which my predecessor worked with the
    Department on to put up to 6,000 members of the National Guard
    on the border. It was originally planned for a 1-year event; it
    ended up being 2 years.
        The express mission assignment was to relieve the stress on
    the U.S. Customs and Border Protection Agency so that they
    could hire more agents. From all accounts, that was
    accomplished.
        I have had no personal discussions in the Department on any
    future mission along the southwest border. That doesn't mean
    that our Governors along the southwest border have not sent me
    copies of letters that they've sent to Secretary Gates. We know
    that many of the Governors along the southwest border are
    seeking some support.
        We have small footprints of National Guard forces serving
    today along the border, under the Governors' consent. Those are
    mainly counterdrug personnel assigned to that mission I
    referenced in my opening remarks.
        We have had preliminary planning sessions to discuss
    capabilities that we might afford. But, without specific
    tasking, I would offer my personal opinion that any future
    mission involving National Guard would be different; the
    circumstances are different, the complexities along the border
    have changed dramatically since Operation Jump Start. But,
    personally, I've not been involved in any discussions. I know
    that Secretary Napolitano, Secretary Gates, and their staffs,
    have had some discussions. But, until given official tasking, I
    think it would be premature for me to speculate on any specific
    missions that the National Guard can perform, other than to
    say, the Governors are interested in seeking that support.
        Senator Webb. Thank you.
        Secretary McCarthy?
        Mr. McCarthy. Senator, the most direct responsibility for
    this is really in the lane of Assistant Secretary Paul
    Stockton, Homeland Defense. But, he and I work extremely
    closely together, and one of the things that I believe is--best
    states current policy is that the requirements on the border,
    as we see them right now, are law enforcement rather than
    military. So, I don't believe that there is any plan--and I
    talked to Secretary Stockton as recently as Monday of this
    week--I don't think there's any current plan or inclination to
    change that assessment.
        Senator Webb. I have about 3 minutes before the second vote
    ends. What I'm going to do is--since Senator Graham isn't back,
    I'm going to have to interrupt the hearing again. When I come
    back, I think what we'll do is just get the second panel up,
    except, Secretary McCarthy, I'd like for you to stay so I can
    follow up on some of the DOD policy.
        Gentlemen, thank you very much for your testimony. We may
    have some followup written questions. But, we appreciate the
    data that we requested.
        Again, my best to all of the men and women who are serving
    under your jurisdiction.
        I'll be back after the second vote. [Recess.]
        Senator Graham [presiding]. Ladies and gentlemen, I want to
    apologize, but Senator Webb is voting. I just voted. I'm going
    to have to leave; he'll come back. But, we'll get this done.
        So, where were we?
        Voice. The first panel was dismissed. However, Secretary
    McCarthy was asked to stay.
        Senator Graham. Okay.
        Voice. So we're ready for opening statements.
        Senator Graham. Let's start with the next panel, starting
    with the Army and working our way downstream.

     STATEMENT OF LTG JACK C. STULTZ, USAR, CHIEF OF ARMY RESERVE;
           AND COMMANDING GENERAL, U.S. ARMY RESERVE COMMAND

        General Stultz. Yes, sir. In the interest of time, because
    I know that we are trying to be as concise as possible, we have
    submitted our written statement, and I would just say that, on
    behalf of the 208,000 soldiers that are in uniform for the Army
    Reserve today, first and foremost, thanks for the support that
    we're getting from Congress, in terms of our compensation, in
    terms of our medical, in terms of the other benefits, in terms
    of the ability to be trained and ready when the Nation needs.
        We do have, as I mentioned, 208,000 soldiers, which puts us
    in a situation today of being 3,000 over what our authorized
    end strength is. That is a reflection of the tremendous success
    we've had in recruiting, but also the tremendous success we've
    had in retention. Our retention goals right now are at 124
    percent.
        Senator Graham. How much do you think that's due to the job
    situation?
        General Stultz. Sir, I think there is a portion of that
    that is economically-related. But, I would submit to you, I
    think a lot of it is due, in fact, that the soldiers we have
    today in the Army Reserve feel good about what they're doing--
    --
        Senator Graham. Great.
        General Stultz.--serving their Nation. All they're asking
    me is, really, when I get around the world, traveling--and I've
    been in 11 countries since January, visiting Reserve soldiers
    that are on duty for this Nation, and they tell me two things.
    Number one, ``Give me some predictability because I do have a
    civilian job''----
        Senator Graham. Right.
        General Stultz.--``I do have a family.'' Number two,
    ``Don't waste my time. If you're going to use me, use me. If
    you're going to train me, train me.''
        Senator Graham. Fair enough.
        General Stultz. Yes, sir.
        [The prepared statement of General Stultz follows:]
                  Prepared Statement by LTG Jack Stultz, USAR
        Against the backdrop of the second longest war in our Nation's
    history and the longest ever fought by an All-Volunteer Force, the Army
    Reserve continues to be a positive return on investment for America.
    The fiscal year 2009 $8.2 billion Army Reserve appropriation
    represented only 4 percent of the total Army budget, yet we supply the
    Army seven to eight brigade-size elements. Since September 11, 2001,
    the Army Reserve mobilized 183,144 soldiers, and now has 29,000
    deployed in support of Army missions. We supply the Army with 87
    percent of its Civil Affairs capability, 65 percent of its
    Psychological Operations, and 59 percent of its Medical support--to
    highlight a few of our top contributing specialized functions. Compared
    to the cost of expanding the full-time force, the small investment in
    the Army Reserve provides security at home and fights terrorism abroad.
    We respond to domestic disasters and participate in security
    cooperation operations while protecting national interests around the
    globe. In support of contingency operations, we foster stability in
    underdeveloped nations where conditions are ripe for terrorists to gain
    a foothold.
        The events of September 11, 2001 forever changed the way in which
    the Army Reserve provides combat support and combat service support to
    the Army and to the Joint Forces. Operational demands for Army Reserve
    support have been heavy and enduring. The reality is, current
    operations are consuming Army Reserve readiness as fast as we can build
    it, but Congress' support for the Army Reserve in recent years has gone
    far toward both meeting current demands and reshaping the Army Reserve
    for future national security requirements.
        As sustained operational demands on the Army Reserve became heavier
    after September 11, it became ever apparent we could no longer function
    as a part-time strategic reserve. Based on the operational requirements
    outlined for the Army Reserve in the 2010 Quadrennial Defense Review,
    and while fighting two wars, we continue our efforts to fully
    transition from a strategic reserve to an operational force, based on
    current resourcing and mission requirements. An operational Army
    Reserve is a good return on investment for America because now we are
    in a stronger position to provide the Army with predictable, trained,
    equipped, and ready forces to meet global and contingency requirements.
    What remains is an ongoing effort to sustain an operational posture,
    with a fully functioning Army Force Generation model--that receives
    full funding.
        Thanks to Congress' leadership, we have made great progress in a
    number of initiatives required to complete Army Reserve transformation.
    We have re-organized operational commands to better support theater
    requirements, opened new training centers, and restructured training
    commands to support the total force. Through Base Realignment and
    Closure (BRAC), we have closed scattered facilities in favor of more
    efficient, multi-service Reserve centers. Through the Army Reserve
    Enterprise process, we are restructuring our strategic and operational
    efforts to maximize productivity, efficiency, and responsiveness in
    four Enterprise areas: Human Capital, Materiel, Readiness, and Services
    and Infrastructure.
        We have identified ``Five Imperatives'' to facilitate Army Reserve
    continued transformation to a stronger and more capable operational
    force. They are Shaping the Force, Operationalizing the Army Reserve,
    Building the Army Reserve Enterprise, Executing BRAC, and Sustaining
    the Force.
                               shaping the force
        As we look ahead, we know that building the right force is crucial
    for success. In 2010, we will leverage human capital management
    strategies to better shape the force into a more affordable and
    effective Army Reserve capable of supporting national security
    objectives and our combatant commanders' warfighting needs. We are
    developing a more precise human capital strategy to meet our Nation's
    future military needs by ensuring the right people, with the right
    skills, in the right units, are in place at the right time.
        In today's competitive recruitment environment, incentives matter
    because they allow the Army Reserve to sustain and shape the force. We
    achieved our fiscal year 2009 end strength due to the hard work and
    dedication of our recruiters and our soldiers. We also attribute this
    success to the recruiting and retention initiatives that support the
    Army Reserve's manning strategy. These include the Army Reserve
    Recruiter assistant Program that promotes strength from within by
    recognizing and rewarding those soldiers, family members, and
    Department of the Army civilians working for the Army Reserve who bring
    talent to the team. The second is enlistment bonuses, which help us
    recruit the critically short/high demand Military Occupational
    Specialties. In fiscal year 2009, our focused incentives increased Army
    Reserve End Strength. As we met the objective, it became evident that
    not all of our new soldiers possessed the skill sets needed to support
    the Army Reserve structure while also fulfilling our wartime
    requirements.
        Successful recruiting added an abundance of soldiers in the lowest
    three pay grades, but recruiting new soldiers as privates and second
    lieutenants cannot fill the thousands of mid-grade noncommissioned and
    commissioned officer vacancies that currently exist. Despite excellent
    retention results, these shortages continue.
        U.S. Army Reserve authorizations for Medical Corps, Dental Corps,
    and the Specialist Corps have not changed much materially for 2000-2009
    (2614 vs. 2572), but the inventory has decreased dramatically from 165
    percent of authorized end strength in 2000 to the current 89 percent in
    2009. This attrition has come predominately at the expense of its
    senior providers with more than 20 years of clinical experience in a
    military environment who now represent only 9 percent of Medical Corps
    inventory, 17 percent of Dental Corps inventory and 11 percent of the
    current Specialist Corps inventory. In the coming year, we must do more
    to retain these uniquely qualified medical providers and seek to build
    a system that incentivizes these most skilled clinicians.
        Our recruitment efforts will focus on more prior-service recruits
    who are slightly older and bring more experience than most first-term
    soldiers. These experienced soldiers can fill shortages among mid-level
    commissioned and noncommissioned officers. Targeted incentives have
    been crucial to rebuilding our end strength and addressing critical
    shortages in some grades and job specialties. Continuing these
    incentives allows the Army Reserve to shape the force to better meet
    the requirements of our National security strategy and to give
    soldiers, families, and employers stability and predictability.
        Ensuring a Continuum of Service (COS) is a human capital objective
    that seeks to inspire soldiers to a lifetime of service. Active (full-
    time) and Reserve (part-time) military service are two elements of
    valuable service to the Nation. Continuum of Service provides Active
    and Reserve components some of the means necessary to offer soldiers
    career options while maintaining capability for the Operational Force.
    COS also recognizes the tremendous cost of accessing and training each
    servicemember and seeks to avoid unnecessary replication of those
    costs. To reach our objective, it is our intention to work with Army to
    propose recommended changes t current statutes and policies that will
    ease restrictions on statutes limiting Reserve component soldiers from
    serving on active duty.
                       operationalizing the army reserve
        Our status as an Operational Force means that the Army Reserve is
    no longer a force in waiting--we are an Operational Force in being. We
    can continue providing that positive return on investment to the Nation
    when the Army Reserve is given the proper resources to succeed.
        The Army Reserve plays a vital operational role in overseas
    contingency operations and will for the foreseeable future. Since
    September 11, 185,660 Army Reserve soldiers have mobilized in support
    of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF);
    33,754 have mobilized more than once. In 2009, the Army Reserve
    mobilized 39,150 soldiers to support combatant commanders' requests for
    forces. We execute a readiness strategy to deploy highly ready units
    and soldiers to support OIF and OEF requirements. This readiness
    strategy synchronizes those strategic planning and resourcing actions
    necessary to generate sufficient manning, training, and equipping
    levels to meet combatant commander mission requirements. The Army Force
    Generation process allows for a structured progression of increased
    unit readiness over time, and provides the Army recurring access to
    Army Reserve trained, ready, and cohesive units, which translates to
    predictability for soldiers, their families, and employers. In effect,
    ARFORGEN drives the battle rhythm of the Army Reserve.
        ARFORGEN works for the Army Reserve. It has enduring qualities that
    have been apparent in providing support to emergencies such as
    Hurricane Katrina and the Haiti earthquake relief efforts, for training
    soldiers in Afghanistan, to supporting the African Contingency
    Operations Training and Assistance Program with training and equipment
    for selected militaries engaged in humanitarian or peace operations.
    The Army Reserve seeks continued support from Congress to be an
    effective responder to missions such as these.
        Within the transformation process, we realigned our force structure
    to meet the Army's global mission requirements in both the Operational
    and Generating Force categories. The Army Reserve is ready to take on
    additional missions as the Department of Defense and U.S. Army validate
    emerging requirements. Authorized growth in end strength will enable
    the Army Reserve to activate validated units to meet these emerging
    requirements and maintain the number of units we have in our ARFORGEN
    process. Plans reflect an increase of 1,000 to 205,000 spaces of
    Authorized End Strength (ESA) to provide the Army Reserve capability to
    meet emerging mission requirements within our ability to operate the
    force.
        Full-time support personnel comprise a select group of people who
    organize, administer, instruct, recruit, and train our people; and who
    maintain supplies, equipment, and aircraft. They also perform other
    functions required on a daily basis to maintain readiness in support of
    operational missions. Without these critical soldiers and civilians,
    the Army Reserve could not function as an Operational Force.
        Although resourced to the Department of the Army ``High Risk''
    funding methodology (meets minimal acceptable risk in support of a
    strategic reserve force), it is imperative that future planning ensure
    full-time support is fully resourced as an operational reserve.
    Adequate resourcing is critical in meeting the readiness requirements
    of the Army Force Generation (ARFORGEN) model.
        The current full-time support model remains a strategic reserve
    legacy. Key legislative and policy modifications are required to change
    personnel support processes. Manpower models and programming processes
    require review and modifications to provide flexibility and rapid
    response adjusting resources amid changing priorities across the
    ARFORGEN process.
        Our Active Guard Reserve (AGR) and Military Technician (MT)
    programs provide the bulk of full-time support at the unit level. They
    provide the day-to-day operational support needed to ensure Army
    Reserve units are trained and ready to mobilize within the ARFORGEN
    process. The AGR and MT programs are vital to the successful transition
    to--and sustainment of--an operational reserve. The Army Reserve
    requires added flexibility in its hiring practices to sustain its
    commitments to ARFORGEN. We must take action to create a new category
    of Non-Dual Status Technician, which allows retention and direct hire
    of personnel from outside the Selected Reserve. This new capability
    will allow us to support non-mobilizing/deploying organizations while
    authorizing Dual Status Military Technicians to meet conditions of
    employment with a military assignment anywhere within the Selected
    Reserve. We are working with Army to relax legacy full-time support
    policies in order to provide flexibility in the reallocation of
    resources within AFORGEN cycle.
        As an Operational Force, the Army Reserve must have the most
    effective and sustainable equipment for soldiers and units at the right
    place and at the right time. The Army Reserve supports the Army
    Equipping Strategy of Cyclical Readiness, which means all units are
    equipped based on their position in the ARFORGEN process and their
    mission--regardless of component. The Equipment Readiness levels
    increase as units move through the ARFORGEN process from the RESET to
    the Available Phase. Those units that are within the RESET phase will
    have a chance to reintegrate soldiers and families, then organize, man,
    equip, and train as a unit. As the units move to the Train/Ready phase,
    they will be resourced from 80 percent growing to 90 percent; and once
    the units enter the Available Phase, they are resourced to ensure 90
    percent plus equipment readiness. To maximize collective and individual
    training opportunities for our units in the ARFORGEN process on high
    demand/low density systems, the Army Reserve must address the challenge
    with small pools of current generation systems. Additionally, while the
    Army Reserve units in the Reset Phase should have minimal specific
    equipping expectations; the Army Reserve is identifying equipment
    requirements that a unit can properly maintain at a Reserve Unit Home
    Station while sustaining soldiers and training readiness. We are
    thankful to Congress for helping us meet this goal with National Guard
    and Reserve Equipment Appropriation (NGREA) funding. These funds
    greatly add toward operationalizing the Army Reserve by supporting Army
    Modularity, Homeland Defense/Homeland Security, and the Army Force
    Generation cycle with a fully modern and interoperable force. With
    continued NGREA funding, we will be able to train our soldiers on the
    latest combat equipment before they deploy into harm's way.
                              sustaining the force
        The Warrior-Citizens of the Army Reserve and their families embody
    a lasting commitment to serve America. The Army Reserve recognizes the
    strain of this era of persistent conflict on soldiers and families. We
    know family readiness is inextricably linked to mission readiness,
    recruitment, and retention. Operationalizing of the Army Reserve
    creates a requirement for an enduring level of support. As the Army
    Reserve transforms, so must family programs. Our way ahead includes
    realignment actions to: support the Army Reserve Enterprise management
    approach, sustain services to soldiers and families in the
    expeditionary force, standardize existing programs and services across
    the Army Reserve, and build partnerships with Army families and
    communities. Our end state is to optimize programs and services to
    connect soldiers and families to the right service at the right time.
        The cornerstone of our planning effort is to ensure the integration
    of Family Support services with the ARFORGEN process. By doing so, we
    ensure that our Warrior-Citizens and their families have solid programs
    that are ready for execution any time during the training and
    deployment cycle. Appropriate resourcing will allow us to assess
    structure requirements, staffing needs, and develop effective processes
    that ensure the consistent delivery of programs and services that meet
    the needs of ARFORGEN and especially for those of our geographically
    dispersed customers.
        The Army Reserve Family Programs Virtual Installation Program is an
    exciting new initiative that ensures the same services provided to
    Active component soldiers are available to all servicemembers and their
    families not living close to a military installation. Leveraging assets
    we have on hand is allowing us to test the program through a series of
    pilots located in selected communities. Funding for this priority will
    allow us to expand Virtual Installation within Army Strong Community
    Centers around the country and overseas.
        We must continue to increase the quantity and quality of support
    for Army Reserve children and youth. We can increase opportunities for
    youth to develop leadership skills and strategies for coping with
    separation. Teen panels provide forums for our youth to propose
    solutions for concerns that affect their lives during mobilization and
    deployment. Additional online teen deployment classes support youth
    living in the ``new normal'' of repetitive deployments. With additional
    resources, we will work with our community partners to expand childcare
    for geographically dispersed families and respite care for mobilized
    families.
        This year we provided new opportunities for children of Army
    Reserve families to attend camps. While the Department of Defense (DOD)
    ``Purple Camps'' were a great initiative, they distributed
    opportunities among all military communities in DOD. This resulted in
    fewer opportunities for Army Reserve children than needed.
    Additionally, Army Reserve children are usually unable to travel, and
    require activities located in areas near their homes. By operating our
    own camps, we increased these opportunities to Army Reserve families in
    their communities and tailored them to our communities. The goal of the
    program is to prepare Army Reserve soldiers and their family members
    for mobilization, sustain families during deployment, and reintegrate
    soldiers with their families, communities, and employers upon release
    from active duty. The Army Reserve Yellow Ribbon Reintegration Program
    (YRRP) provides information, services and support, referral, and
    proactive outreach to Army Reserve soldiers and their families through
    all phases of the deployment cycle. The program includes information on
    current benefits and resources available to help overcome the
    challenges encountered with Army Reserve mobilization and
    reintegration.
        The Army Reserve successfully launched its Yellow Ribbon
    Reintegration Program. We have coordinated with other military
    agencies, Federal/State/local government agencies, community
    organizations, and faith-based organizations to provide robust,
    preventive, proactive programs for soldiers and their families.
    Elements of the program include promoting preparedness through
    education, conducting effective family outreach, leveraging available
    resources, and supporting the All-Volunteer Force. During fiscal year
    2009, the Army Reserve executed more than 250 Yellow Ribbon events,
    serving some 12,000 redeploying soldiers and 12,000 family members. In
    interviews conducted by the Office of the Secretary of Defense,
    soldiers and family members reported positive experiences with the Army
    Reserve Yellow Ribbon Reintegration Program.
        The challenge to the Army Reserve remains to develop, improve, and
    sustain the mental, spiritual, and emotional health that fosters
    resilient soldiers and families.
        We are moving out aggressively to mitigate the effects of
    persistent conflict and build a strong, resilient force. Multi-symptom
    conditions including those signature wounds not visibly apparent (for
    example: Post-Traumatic Stress Disorder and Traumatic Brain Injury,
    exist for soldiers with military service in Southwest Asia. We will
    work with Health Affairs and the other Services to continue to provide
    the care necessary for the wounds from the current conflicts.
        We appreciate the resources that Congress has provided to date to
    further programs such as the new GI Bill and TRICARE. The benefit of
    TRICARE Reserve Select provides our soldiers and families peace of mind
    knowing that if a soldier decides to better him/herself career-wise
    with the skills gained while deployed, medical care will not be a worry
    if he or she decides to change careers.
        We are teaming with civilian industry to shape the Army Reserve
    into America's premier reservoir of shared military-civilian skills and
    capabilities through our Employer Partnerships programs. Through these
    mutually beneficial alliances with businesses that share our valuable
    human capital, we can strengthen soldier-employees, families,
    employers, and communities.
        We seek to identify locations where our soldiers can simultaneously
    add value to both the civilian workforce and the Army Reserve. This
    effort ties into our objective of achieving a continuum of service for
    soldiers who want the option to transition from Active and Reserve
    components, and vice versa, to provide soldiers flexibility with their
    career objectives, while allowing the Army Reserve to retain the best
    talent and critical skills capability.
                           enterprise transformation
        Using an enterprise approach to managing our internal processes, we
    add value to the Army by applying a holistic approach to managing our
    resources and shape the force into what is beneficial for the Army
    Reserve and supports the needs of the Army. By ``shape the force,'' I
    mean taking a fresh approach to how we recruit and retain the best and
    brightest, and positioning them in the right place, in the right job,
    and at the right time.
        The Army Reserve Enterprise consists of four core management areas:
    Human Capital, Readiness, Materiel, and Services & Infrastructure. To
    optimize the enterprise we must: Attract and retain the very best
    Warrior Citizens to serve our Nation (Human Capital), Prepare, train,
    and equip soldiers (Readiness); provide our soldiers with the latest
    mission ready modular force equipment, (Materiel); provide for the
    well-being of our soldiers, families, Army civilians, and employers
    while providing training and unit facilities and secure, redundant
    communications (Services and Infrastructure). Working together, these
    core management areas enable the Army Reserve enterprise to realize its
    ultimate goal: predictable, trained, and ready units--the essential
    components that define Capability.
                          base realignment and closure
        We have facility responsibilities at more than 1,100 Reserve
    Centers and the installations of Fort McCoy, Fort Buchanan, and Fort
    Hunter-Liggett installations. We also are responsible for significant
    training areas at Jolliet, Devens Reserve Forces Training Area, and
    Parks Reserve Forces Training Area. Moving toward completion of the
    current BRAC cycle of 2005, the Army Reserve military construction
    priority is to complete the remaining projects budgeted at $357 million
    for fiscal year 2010. In addition to BRAC, we will implement 26
    construction projects at a cost of $318 million supporting the
    transformation of the Army Reserve from a strategic reserve to an
    Operational Force. Our construction effort supports the realignment of
    the field command organizations into Operational Supporting Commands.
    In fiscal year 2011, the Regional Support Commands will invest $577
    million in base operations and $344 million in maintenance and repair
    of facilities that allows mission accomplishment for the Operational
    Commands.
        We are committed to minimizing turbulence to soldiers and their
    families while providing the most effective and efficient trained and
    ready units and forces to meet world-wide requirements. We must
    maintain current levels of predictability while making plans to
    increase it. The Army Force Generation process allows for a structured
    progression of increased unit readiness over time, and provides the
    Army recurring access to Army Reserve trained, ready, and cohesive
    units. While our commitment in Iraq may draw down, the requirement for
    forces to commit to other global missions will only increase. In 2010,
    we will work with Congress to ensure we obtain the necessary resources
    to sustain a viable Army Force Generation cycle that supports global
    commitments and new missions.
        Thank you.

        Senator Graham. Admiral Debbink.

    STATEMENT OF VADM DIRK J. DEBBINK, USN, CHIEF OF NAVY RESERVE;
                   AND COMMANDER, NAVY RESERVE FORCE

        Admiral Debbink. Senator Graham, thank you for the
    opportunity to appear before you this morning.
        I definitely want to start out by expressing my
    appreciation for the support of this Congress for the 65,671
    members of the Navy Reserve sailors and their families.
        Of course, my written testimony will go into great length
    describing the programs that we utilize to ensure the Navy
    Reserve is a ready and capable force, responsive to the needs
    of the Navy/Marine Corps team and joint forces for both
    strategic depth and operational capabilities, while providing
    the necessary support to our sailors and their families, and
    also showing our appreciation for our sailors' employers'
    support.
        As the Chief of Naval Operations, Admiral Gary Roughead,
    has said: ``We are one Navy with an Active component and a
    Reserve component.'' As I testify this morning, Navy Reserve
    sailors are operating in every corner of the world, shoulder to
    shoulder with Active Duty sailors, as well as airmen,
    coastguardsmen, marines, soldiers, and, I think, importantly,
    interagency personnel.
        On any given day, more than 30 percent of your Navy Reserve
    is providing support to DOD operations. The Navy Reserve is
    ready now, anytime, anywhere, as our motto and our sailors
    proudly claim.
        [The prepared statement of Admiral Debbink follows:]
                Prepared Statement by VADM Dirk J. Debbink, USN
                                i. introduction
        Chairman Webb, Senator Graham, and distinguished members of the
    Personnel Subcommittee, thank you for the opportunity to speak with you
    today about the capabilities, capacity, and readiness of the dedicated
    men and women who serve in our Navy's Reserve component (RC). I offer
    my heartfelt thanks for all of the support you have provided these
    great sailors.
        I have now had the honor of serving as the Chief of Navy Reserve
    for 22 months. In that capacity, I am privileged to work for more than
    65,671 sailors in our Navy's RC, an elite fighting force which recently
    celebrated its 95th birthday. I am continuously amazed and humbled by
    the daily sacrifices our Reserve sailors are making for our Nation and
    our Navy. Witnessing such great deeds helps me to focus on the services
    that I can provide to each of them: to ensure they are given real and
    meaningful work every day they are on duty; to ensure that they receive
    every practical material and organizational advantage to support them
    in their work; and to provide their families and employers with the
    proper support to honor and ease their sacrifices.
        Our Navy needs, and our sailors deserve, the best Navy Reserve
    possible, and today's Navy Reserve is as strong and as relevant as it
    has ever been. Our success is a direct result of the dedication and
    professionalism of our sailors, which is a reflection of the tremendous
    support those sailors receive from their families and civilian
    employers.
        Last year, the Navy Reserve adopted an official Force Motto:
    ``Ready Now. Anytime, Anywhere.'' This motto is our pledge to our
    shipmates, our Navy, and our Nation and serves as the guiding principle
    of the Navy Reserve Strategic Plan. In that Plan, the mission of the
    Navy Reserve is defined: ``to provide strategic depth and deliver
    operational capabilities to our Navy and Marine Corps team, and joint
    forces, from peace to war.'' As Chief of Navy Reserve, I can report
    without reservation that our Navy Reserve sailors accomplish this
    mission every day.
        The Navy Total Force is aligned with and supports the six core
    capabilities articulated in the Maritime Strategy and is managed by
    Navy leadership to enable the Chief of Naval Operation's priorities:
    (1) build tomorrow's Navy; (2) remain ready to fight today; and (3)
    develop and support our sailors, Navy civilians, and their families.
    The Navy Reserve is integral to the Navy Total Force--we stand
    shoulder-to-shoulder with our Active Duty component executing full
    spectrum operations that represent every facet of our Navy's Global
    Maritime Strategy. Within this Total Force framework, I would like to
    take this opportunity to update you on the programs that support the
    Chief of Naval Operations' focus areas, while also highlighting some
    key contributions from Navy reservists in 2009.
                         ii. care for our warrior force
        This country owes a great debt to the men and women who have gone
    in harm's way in support of contingency operations around the globe and
    it is our obligation to provide them not just with every opportunity to
    succeed while deployed, but also with the means to reintegrate once
    they return from overseas.
        Secretary of Defense Robert Gates has stated, ``apart from the wars
    in Afghanistan and Iraq, my highest priority as Secretary of Defense is
    improving the outpatient care and transition experience for troops that
    have been wounded in combat.'' The Navy Reserve takes this commitment
    to heart and is setting a higher standard every day for the care and
    well-being of our Wounded Warriors. In 2009, we completed implementing
    programs recommended in the Naval Inspector General's Navy Reserve
    Wounded Warrior Care report, highlighted by the functional stand-up of
    the Reserve Policy and Integration organization (M-10) within the
    Bureau of Medicine and Surgery (BUMED). This organization provides
    BUMED with a Reserve perspective related to medical policies and issues
    impacting the Total Force. We continue to provide exceptional service
    to sailors assigned to the Navy's Medical Hold (MEDHOLD) units. These
    units provide necessary medical and non-medical case management to the
    Navy's RC Wounded, Ill, and Injured (WII) population. For those sailors
    and Coast Guardsmen who are seriously wounded, ill, or injured, the
    Navy Safe Harbor program is the Navy's lead organization for
    coordinating non-medical care for the warrior and their family members.
    Through proactive leadership, MEDHOLD helps RC WII members return to
    service and their communities, and Safe Harbor provides individually
    tailored assistance designed to optimize the successful recovery,
    rehabilitation, and reintegration of our shipmates.
        Superior care is not reserved for injured sailors alone. Medical
    research indicates that health concerns, particularly those involving
    psychological health, are frequently identified during the months
    leading up to and following return from an operational deployment.
    Current Navy programs, such as Operational Stress Control Training, the
    Psychological Health Outreach Program, and BUMED's Wounded, Ill, and
    Injured Warrior Support, are designed to align with critical stages of
    the deployment cycle.
        An integral component of Force Health Protection calls for ensuring
    all servicemembers are fit to deploy, and Navy has improved the
    screening procedures for mobilizing sailors to ensure they are
    medically able to meet theater requirements. For example, the Medical
    Readiness Reporting System (MRRS) has improved tracking of each
    sailor's suitability for Area of Responsibility-specific expeditionary
    assignments. In addition, annual Physical Health Assessments (PHA),
    coupled with the new, standardized consolidated pre-deployment
    screening and local line support will streamline screening requirements
    while maintaining fidelity on issues which impact medical readiness.
    Early screening and associated fitness determinations help alleviate
    unnecessary stress on our sailors and provides supported commands with
    a steady stream of well-prepared and able workforce. We are also
    actively engaged in implementing the new legislation that makes
    reservists eligible for Tricare coverage up to 180 days before a
    mobilization event. We are thankful to Congress for their work in
    providing this benefit to our mobilizing servicemembers.
        Sailors returning from overseas mobilizations are encouraged to
    attend a Returning Warrior Workshop (RWW), which is the Navy's
    ``signature event'' within the Department of Defense (DOD) Yellow
    Ribbon Reintegration Program (YRRP). In the 8 years since September 11,
    the overwhelming majority of Reserve sailors mobilized to active duty
    have deployed as Individual Augmentees (IAs). Deployed apart from their
    parent unit and often assigned duties which differ greatly from their
    primary specialty, these combat zone deployments can be uniquely
    stressful. The RWW is a dedicated weekend for sailors to reconnect with
    spouses, significant others, and each other following an IA deployment.
    Staged at a high-quality location at no cost to the participants, the
    RWW employs trained facilitators to lead Warriors and their families/
    guests through a series of presentations and tailored break-out group
    discussions that address post-combat stress and the challenges of
    transitioning back to civilian life. Additionally, my goal is to have a
    Navy Flag Officer in attendance at every RWW to make a visible
    statement of Department of the Navy support for this valuable program.
    A total of 47 RWWs have been held as of 1 May 2010, attended by 3,376
    military personnel and 2,617 guests/family members. The fiscal year
    2011 budget supports up to another 25 events. Pioneered by the Navy
    Reserve, these workshops are now available for all Navy IAs. RWWs are a
    true success story in honoring our sailors and their families. It is
    one of my top priorities to ensure this program continues to have both
    the full support of Navy leadership and the widest possible
    participation by all returning sailors.
        RWWs serve as a key component of the Navy Reserve Psychological
    Health Outreach Program. Outreach teams assigned to each Navy Region
    Reserve Component Command facilitate the RWWs and engage in other
    critical aspects of the Deployment Health Assessment (DHA) process.
    DHAs are regularly scheduled encounters used to screen servicemembers
    prior to and after deployment and to facilitate appropriate
    psychological care. The DHA process supports the DOD health protection
    strategy to deploy healthy, fit, and medically-ready forces; to
    minimize illnesses and injuries during deployments; and to evaluate and
    treat physical, psychological, and deployment-related health concerns.
    The process is designed to identify stress injuries and other health
    concerns requiring further assessment or treatment as appropriate. The
    Navy Reserve now has dedicated mental health professionals and
    associated assets available to provide psychological health services
    for the Navy and Marine Corps Reserve communities. Providing
    psychological health assessment services for deploying reservists will
    assist in identifying potential stress disorders and facilitate early
    intervention before these disorders accelerate to a more critical
    ``injured or ill'' stage, keeping Navy and Marine Corps reservists
    psychologically healthy for continued retention in the Reserves and for
    future overseas and CONUS mobilizations. Also recently established as
    part of the YRRP, the Pre-Deployment Family Readiness Conference
    (PDFRC) utilizes Psychological Health outreach teams to provide
    education and information to ensure that sailors and their families are
    ready for the rigors of deployment and the challenges of family
    separation.
        Additionally, Navy's formalization and emphasis of the Operational
    Stress Control (OSC) Program is working to de-stigmatize psychological
    health issues, which can improve sailors' participation in valuable
    psychological health programs for those in need. The Navy Reserve team
    is a charter member of the OSC Governance Board. The Psychological
    Health Outreach teams provide the OSC Awareness brief during periodic
    visits to Navy Operational Support Centers (NOSCs) across the country.
    As of 1 April 2010, the psychological health outreach team members have
    made 225 visits to NOSCs, providing the Operational Stress Control
    Awareness brief to over 23,400 reservists and staff personnel.
        Finally, and although not solely related to mobilized sailors, the
    Navy Reserve has aligned closely with the Chief of Naval Personnel on
    programs that detect and help individuals who are at risk of suicide.
    Families, often the first people to notice a desperate change in a
    sailor, are included in programs such as the PDFRC and the RWW. A
    Suicide Event Report (SER) is completed on all actual or attempted
    suicides, regardless of duty status, which has provided a more complete
    picture of the problems afflicting all Navy sailors. In every instance
    where the chain of command knows of a Navy reservist who has attempted
    suicide, either in a duty or non-duty status, the reservist is referred
    to the Navy Reserve Psychological Health Coordinators for follow-up and
    referral to the appropriate mental health care services. The
    aforementioned OSC Awareness briefs provided by the Psychological
    Health Outreach teams also include Suicide Prevention briefs.
                    iii. progress in programs for our people
        The Navy Reserve Strategic Plan defines the vision for the Navy
    Reserve as follows: ``Our vision for the Navy Reserve is to be a
    provider of choice for essential naval warfighting capabilities and
    expertise, strategically aligned with mission requirements and valued
    for our readiness, innovation, and agility to respond to any
    situation.'' During the last 8 years, the Navy Reserve has demonstrated
    the ability to continue sustained and valuable contributions to the
    Total Force, in the full spectrum of missions, at home and abroad, and
    as both an operational and strategic force. We continue to forge ahead
    with ideas and programs that will allow us to continuously contribute
    to the strategic aims of the Navy and the Joint Force.
        As defined in the Strategic Plan, one of the three Focus Areas for
    the Navy Reserve is to enable the Continuum of Service (CoS). CoS
    reflects the reality of our Navy. As our Chief of Naval Operations,
    Admiral Gary Roughhead, states, ``we are one force today. One Navy,
    with an Active component and a Reserve component.'' CoS initiatives
    provide for seamless movement between the Active component (AC), RC,
    and civilian service, while delivering operational flexibility and
    strategic depth at the best value for the Navy. Responding to the CoS
    philosophy, we recruit sailors once and retain them for life through
    variable and flexible service options that provide a career continuum
    of meaningful and valued work.
        Not long ago, we spoke of creating active duty ``on ramps'' and
    ``off ramps.'' Today, a better analogy is that we're all on the same
    career highway, and during our career we may wish to change lanes
    several times, moving from Active to Reserve and back. Our commitment
    to our sailors is to make these lane changes easier and faster.
        CoS is forcing us to think differently and make big changes in the
    way we do business. Changing our culture might be the hardest part. Too
    often we think the only way to have a Navy career is by serving on
    active duty alone. Our Navy Reserve gives Navy sailors many other
    possible ways to have a full Navy career
        There were many important accomplishments associated with our CoS
    efforts in fiscal year 2009. Beginning last year, the Career Management
    System-Interactive Detailing (CMS/ID) allowed our AC career counselors
    to assist sailors transitioning from active duty to consider Reserve
    units in the location where they planned to live. This is a good
    example of how an effective career development program can be a
    fantastic opportunity for Sailors to Stay Navy for Life. Additionally,
    sailors in selected ratings and designators are informed about their
    eligibility for bonuses of up to $20,000 for affiliating with the Navy
    Reserve in the specialties we need most.
        Our Perform to Serve (PTS) program has given AC sailors avenues for
    continued service in the AC Navy, primarily through transitions from
    overmanned rates into undermanned rates. Last fall, Navy expanded this
    program to allow AC sailors the option to affiliate with the RC in
    their current rate to continue their Navy career. Integrating Reserve
    opportunities early into the sailor's transition process demonstrates
    the AC's commitment to CoS initiatives.
        One of the most exciting developments supporting CoS is the new
    Career Transition Office (CTO) within Navy Personnel Command. The goal
    of the CTO is to counsel sailors before they leave active duty and
    through the transition process in order to help them to take full
    advantage of the opportunities in the Navy Reserve. By engaging our
    fully qualified, world-wide assignable personnel before they leave
    active duty, we can turn a personnel loss into a retention transaction
    without the need to involve a Navy recruiter. We started with officers
    transitioning from AC to RC, and immediately reaped success by nearly
    doubling Navy Veteran officer affiliation rates from 28 percent to 55
    percent. We have recently expanded the program to include enlisted
    sailors who elected the Selected Reserve (SELRES) option in PTS. In the
    future, the CTO will handle all officer and enlisted transitions from
    AC-to-RC and RC-to-AC, except mobilizations.
        Expanding our CoS efforts is one of my top priorities for fiscal
    year 2010. In the upcoming year, we will further our participation in
    the World Class Modeling initiative sponsored by the Chief of Naval
    Personnel to anticipate Navy warfighting needs, identify associated
    personnel capabilities, and recruit, develop, manage, and deploy those
    capabilities in an agile, cost-effective manner. Additionally, we will
    place Reserve information in the Navy Retention Monitoring System to
    provide enhanced reporting and analysis capabilities for retention
    metrics.
        With regard to educating a ready and accessible force, we thank
    Congress for its support of the Post-September 11 GI Bill. The
    opportunity to transfer post-secondary education funds to a spouse or
    child is a significant benefit for our sailors and their families.
    Since implementation on 1 August 2009, over 3,899 Reserve members have
    been approved for transferability. We will continue to assess the
    impact of transferability on enlisted and officer retention.
        Another focus area for the Navy Reserve is to deliver a ready and
    accessible force. Reserve support for contingency operations in the
    Central Command Area of Responsibility (AOR) is one of the most
    critical elements in the success our forces have experienced throughout
    Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF). In
    fiscal year 2009, Navy Mobilization Processing Sites (NMPS) processed
    more than 7,400 sailors for long-term active duty service. Of those
    sailors, over 6,100 were mobilized to support Operation Iraqi Freedom
    and Operation Enduring Freedom in combat, combat support, and combat
    service support missions; the remaining 1,300 were on Active Duty for
    special work orders providing valued support throughout the Fleet.
        In fiscal year 2010, Navy will continue to improve advance
    notification of personnel for upcoming mobilizations, with a goal of
    consistently providing at least 180 days prior notification for all
    recurrent and rotational mobilization assignments. Further, the Navy
    Reserve will continue to leverage the already robust Total Force
    Command IA Coordinator (CIAC) program at all NOSCs in order to optimize
    the frequency, quality, and depth of communications with mobilized
    reservists and their families throughout the deployment cycle. The CIAC
    program, complemented by the extraordinary efforts of our command and
    unit leadership teams, is significantly increasing quality of life for
    our deployed warriors and their families. Also, full-time, long-term
    support of Navy and Joint Flag Officer requirements by reservists will
    help expand the expertise and knowledge of the Navy, and I thank you
    for the increased ability for Reserve participation in those
    assignments due to the legislation passed as part of last year's
    National Defense Authorization Act (NDAA).
        The Navy Reserve executed the Navy Reserve Personnel (RPN) and
    Operations and Maintenance (OMNR) accounts, valued at $3.2 billion, at
    99.9 percent in fiscal year 2009. The force executed nearly $150
    million in discretionary Reserve Personnel funding in support of
    missions world-wide, including $98 million in Active Duty for Training
    (ADT) funding--a 32 percent increase over fiscal year 2008--
    contributing 311,345 man-days of on-demand expertise to our Navy and
    Marine Corps team and Joint Forces. This operational support is a
    critical enabler to the Navy as Navy reservists provide full-time
    excellence through part-time and full-time service. In fiscal year
    2011, the budget requests $1.94 billion in baseline RPN, to include
    $190 million in discretionary RPN, and $1.37 billion in baseline OMNR
    appropriations.
        In addition to personnel support, Navy Reserve units and hardware
    contribute to Navy's warfighting effort across multiple mediums, in
    missions ranging from combat operations or combat support operations,
    to logistics support around the globe, to training and readiness
    facilitation for soon-to-be-deploying units. The wide spectrum of
    missions that can be completed with Reserve units is in keeping with
    the third of our focus areas: Provide Valued Capabilities. Even when a
    Reserve unit itself is not mobilizing, our focus is centered on
    guaranteeing that sailors are ready to provide necessary capabilities
    to the supported combatant commander.
        In fiscal year 2010, it is one of my top priorities to ensure the
    use of long-term budgeting processes to ensure sufficient Operational
    Support funding to meet Navy and Joint Force requirements. Demand for
    the services of our talented sailors has never been greater, and we
    must solidify our access to the ADT dollars used to fund this on-demand
    expertise. Navy Reserve sailors can be incredibly cost-effective, but
    there is a cost, and that cost must be incorporated in any long-term
    plan. This means planning and budgeting for the Navy Reserve to do the
    part-time work of the Navy.
        Some of the Navy's work is ideally suited for the RC. For example,
    billets that require specialized skill sets on a periodic and
    predictable basis are the billets where the Navy Reserve can deliver
    great value on an ongoing basis while at the same time providing
    critical strategic depth in case of emergency. By working closely with
    the Navy to identify and quantify the work for the Navy Reserve, we can
    ensure the Fleet receives the support it requires and our sailors will
    have real and meaningful work, delivering full-time excellence through
    part-time and full-time service.
        The Office of the Secretary of Defense (OSD) designated the Navy
    Reserve as the lead agency for managing the RC Foreign Language/Culture
    Pilot Program. This exciting new program encourages our Reserve sailors
    to take classes at institutions of higher learning to expand their
    awareness of critical foreign language and cultures. Incentivizing our
    sailors' natural desire to learn will foster understanding across
    cultural lines which will shape our force for the better. Bonuses are
    awarded based on performance which can add up to $5,000 for strategic
    languages and cultural areas studied which are in high demand within
    DOD.
        The Navy continues to strive for ``Top 50 Employer'' recognition
    and the Navy Reserve is in lock-step with those efforts. Top 50
    organizations encourage innovation and focus on performance while
    taking care of their people through programs and policies that support
    a culture of trust, respect, communication, and collaboration.
    Maintaining a work environment that is conducive to quality work and
    leads to equal treatment of all personnel is paramount to the success
    of any organization. Sexual assault is a detractor from a healthy work
    environment, and it will not be tolerated in the Navy. The Navy Reserve
    participates in the Navy's Sexual Assault Prevention and Response
    (SAPR) Cross Functional Team to ensure compliance with the Navy's Total
    Force SAPR program instructions, policies, and procedures. Navy
    leadership continually communicates a ``Not in my Navy'' stance towards
    Sexual Assault through the ranks.
        The policies focused on enhancing the quality of life in the Navy
    have paid dividends for the Force. fiscal year 2009 marked the second
    consecutive year Navy attained enlisted and officer recruiting goals in
    both Active and Reserve components. In the Reserve, enlisted recruiting
    was at 100.6 percent of goal; officer recruiting finished at 107.7
    percent of goal. Not only did Navy find the quantity of recruits
    necessary to meet requirements, but the measured educational
    achievement of our recruits was at the highest level in years. SELRES
    retention numbers were equally strong, with attrition rates
    approximately 20 percent improved from fiscal year 2008 totals. There
    is still room for improvement in SELRES Officer strength, and numerous
    initiatives are underway to get SELRES Officer communities ``healthy''
    by 2014, including targeted Officer affiliation and future retention
    bonuses, the increase of accession goals, refinements in the CTO
    process, and development of retention measurements and benchmarks. The
    value of recruiting incentives and special pays has been critical to
    every success the Force has enjoyed in this arena, and I thank you for
    providing us with the tools necessary to populate the Navy Reserve in
    the right manner while working towards the fiscal year 2011 budgeted
    end strength of 65,500. Bonuses have helped shape the ``Fit versus
    Fill'' successes of recent years; however, for certain enlisted wartime
    skills sets and in the officer inventory in general, the Navy Reserve
    requires the help bonuses provide to continue to meet recruiting and
    retention goals.
                                 iv. way ahead
        In addition to the continuing attention to the programs and
    policies listed above, there are several other topics that have
    priority status this fiscal year to enhance our force-wide
    effectiveness, make it easier for each of us to serve, and to fully
    support our deploying members and their families.
        Foremost among my list of priorities is to achieve resolution on a
    path to fielding a Total Force Future Pay and Personnel System (FPPS).
    The Navy and Navy Reserve currently have separate pay and personnel
    systems, designed and built in an era when sailors rarely mobilized or
    transitioned between components. With the present system, it can take
    weeks to properly transition a sailor from one pay and personnel system
    to another. This creates a barrier to realizing our CoS goals.
        FPPS would enable sailors to transition quickly and seamlessly on
    and off active duty without the commensurate delays and confusion
    regarding pay and benefits. The Navy Total Force goal is to transition
    a sailor from one component to another within 72 hours. Navy leadership
    understands the urgency of resolving this issue, which impacts every
    sailor. I am confident that in fiscal year 2010, we will make
    considerable progress towards this goal.
        Another top priority this year is to ensure Navy has the funding
    allowing the RC to perform directed missions. In addition to working
    through the long-term budgeting process needed to pay for our sailors,
    we are fully engaged in the development of Naval Aviation Plan 2030 to
    ensure that the valued capabilities delivered by the Navy Reserve are
    properly resourced.
        Navy Reserve aviation trains the Fleet, moves the Fleet, and when
    needed, surges to the fight. Twenty-eight squadrons, 8 Fleet
    Replacement Squadron Augment Units (SAUs), and 17 Chief of Naval
    Aviation and Training SAUs provided more than 70,000 flight hours in
    fiscal year 2009, including 80 percent of the Navy's direct and
    indirect Fleet operational support. Our four adversary squadrons
    provided 76 percent of Navy capacity, and the Fleet Logistics Support
    Wing provided 100 percent of the shore-based Navy Unique Fleet
    Essential Airlift with an average weekly cost avoidance of $655,000.
    These assets provide strategic surge capacity and maintain warfighting
    readiness at a lower cost, both in terms of payroll and airframe life,
    than AC squadrons. Navy Reserve's lower Fatigue Life Expenditure has
    provided Navy inventory managers increased options that have been a
    valuable part of Naval Aviation's recapitalization plan generally, and
    of P-3Cs and F/A-18s in particular.
        Historically, Reserve aircraft have been procured via a combination
    of routine procurement processes, the use of National Guard and Reserve
    Equipment Appropriations (NGREA), Congressional buys, and the transfer
    of aircraft from the AC to the RC as new production aircraft enter the
    Total Force inventory.
        Current aviation procurement trends will challenge RC aviation
    capabilities as the Navy Reserve continues to recapitalize assets.
    Priorities include completing the C-40A (airlift) procurement and
    recapitalizing the electronic attack capability that is fully
    integrated into the Airborne Electronic Attack (AEA) deployment plan
    that has provided 12 years of combat deployments in support of COCOM
    requirements. I am very appreciative of Congress' support for the
    purchase of three C-40A aircraft in the last two budgets. The C-40A
    provides twice the range, twice the cargo load, and twice the Ready for
    Tasking (RFT) days of the C-9B it replaces. The overall burdened hourly
    operating cost of the C-9B is $8,147/flight hour versus the C-40A cost
    of $6,141/flight hour. As a result, a $42 million per year cost
    avoidance will be realized by completing C-40A procurement and retiring
    the 15 remaining C-9Bs.
        The fiscal year 2011 budget also supports the creation of a fourth
    Riverine Squadron for the Navy Expeditionary Combat Command (NECC).
    This additional unit was expressly addressed in the most recent
    Quadrennial Defense Review, and recognizes the unique skills and
    capabilities that the joint forces desire for current operations. NECC
    is manned equally by AC and RC personnel.
        We will continue to utilize NGREA as available to meet the needs of
    the Navy. NGREA has been a high impact capital infusion for the Navy
    Reserve since its inception in 1981, but has taken on added importance
    in recent years. While the Navy Reserve's NGREA service allocation has
    decreased from 11.3 percent in 2004 to 5.0 percent in 2009, the
    appropriation has been instrumental in resourcing the capability of the
    NECC and has bolstered the recapitalization of critical RC equipment in
    both Naval Aviation and the Surface Navy. In fiscal year 2009, the Navy
    Reserve executed NGREA funding to equip the Maritime Expeditionary
    Support Force, Explosive Ordnance Disposal, Naval Construction Force,
    Naval Expeditionary Logistics Support Group, Naval Aviation and Surface
    Warfare units with: tactical and armored vehicles; Civil Engineering
    Support Equipment; communications equipment; Table of Allowance
    equipment; aviation modernization upgrades; and Rigid Hull Inflatable
    Boats. I am thankful for the $55 million NGREA allocated to the Navy
    Reserve for fiscal year 2010.
        Secretary of the Navy Ray Mabus has committed the Navy and Marine
    Corps to meet bold, ambitious goals to advance Navy's energy strategy.
    The Navy Reserve, in cooperation with the Naval Installations Command,
    is committed to providing the Secretary an innovative and agile RC that
    can and will be a significant force multiplier in the pursuit of these
    goals.
        Navy Reserve Military Construction and Facilities Sustainment,
    Restoration and Modernization (FSRM) projects will be stringently
    evaluated for efficient use of energy and water, use of new and
    emerging energy technologies, employment of innovative strategies and
    best practices, use of renewable energy sources, and energy-efficient
    mobility. Large-scale, comprehensive organizational efforts will be
    made in the use of energy efficiency and management tools. All Navy
    Reserve Military Construction and FSRM projects will incorporate
    conservation measures and environmental stewardship practices into
    their design and execution. The focus will be to reduce the cost and
    environmental impact of Navy Reserve construction projects by advancing
    energy efficiency and water conservation, promoting the use of
    distributed and renewable energy, and improving utility management
    decisions at all Reserve facilities.
        Additionally, these energy goals can be helpful in facilitating
    transformation of the force; for example, completion of C-40A fleet
    logistics squadron recapitalization will offer a 13.2 percent fuel
    consumption reduction over the aging C-9B. Fuel savings in excess of
    43,300 barrels per year will be realized when the C-9s are finally
    retired.
        The Navy Reserve is an agile, innovative force, and in no arena is
    that description more apt than in the realm of Information Dominance.
    Navy Reserve has engaged in a directed, efficient transition from
    legacy systems and has successfully piloted state of the art solutions
    that are currently in use and will be used by the Fleet of the future.
    Continued use of this responsive Force as the Navy's' test platform is
    critical in successfully deploying the latest technology in the most
    timely and cost effective manner possible.
        The threat posed to the government from aggressive actors in the
    cyber arena grows every day, and the Navy is engaged in actions to keep
    our country's systems protected. Key to the Cyber Manpower Strategy is
    the development of an RC Surge capability. The vision is to transition
    current Cyber manpower into Reserve Cyber Units that would serve in
    this capacity. Also, an enhanced direct-commission program would allow
    for increased accession of Cyber specialists. Finally, the Navy is
    considering a Civilian Cyber Augment Force: an ``on call'' team of
    experts that can provide strategic relevance and depth to the Navy as
    the cyber environment changes and technical progress is made. Civilian
    experts and consultants can be rapidly hired under existing authorities
    to meet the emerging critical requirements of Fleet Cyber Command/
    Commander 10th Fleet. We feel this effort can open unexplored areas of
    expertise in support of Navy's Cyber vision and mission execution.
                                 v. conclusion
        Since September 11, more than 63,000 mobilization requirements have
    been filled by SELRES personnel, along with an additional 4,600
    deployments by FTS sailors in support of the ongoing conflicts in Iraq,
    Afghanistan, and the Horn of Africa. On any given day, more than 20,000
    Navy reservists, or about 30 percent of the Force, are on some type of
    orders providing support to global operational requirements of Fleet
    Commanders and COCOM global operational requirements. Our Navy Reserve
    Force--65,671 sailors--are forward deployed in support of coalition
    forces, at their supported commands around the world, or in strategic
    reserve and ready to surge 24/7 if and when additional Navy Total Force
    requirements arise.
        I am proud to be a Navy reservist, and I am humbled by the
    commitment of the men and women of our Navy Reserve. It is very
    rewarding and fulfilling to stand shoulder to shoulder with the Navy's
    AC as we meet our Nation's call to duty. I am honored to receive the
    support of Congress on key initiatives, such as providing TRICARE
    eligibility to ``gray area'' retirees. Although I readily admit my
    bias, there has never been a better time to be part of the Navy-Marine
    Corps team, and our Navy Reserve is clearly an integral part of the
    this hard-working, high-spirited, and amazingly capable force.
        The Navy's ability to be present in support of any operation, in
    war and peace, without permanent infrastructure in the area of
    operations, is a key advantage that will become even more important in
    the future. Our Navy remains the preeminent maritime power, providing
    our Nation with a global naval expeditionary force that is committed to
    global security, while defending our homeland as well as our vital
    interests globally. The Navy Reserve's flexibility, responsiveness, and
    ability to serve across a wide spectrum of operations clearly enhances
    the Navy Total Force, acts as a true force multiplier, and provides
    unique skill sets towards fulfilling Navy's requirements in an
    increasingly uncertain world.
        On behalf of the sailors, civilians, and contract personnel of our
    Navy Reserve, we thank you for the continued support within Congress
    and your commitment to the Navy Reserve and our Navy's Total Force.

        Senator Graham. What's your biggest challenge, as a head of
    the Navy Reserve?
        Admiral Debbink. Our biggest challenge right now, today, is
    our pay and personnel system and our travel claim system, sir.
    We're working hard to develop an integrated pay and personnel
    system, the Future Pay and Personnel System, as it's called. We
    appreciate the opportunity to move off of the DIMHRS.
        Senator Graham. Are you going to get us some ideas about
    how to fix that?
        Admiral Debbink. Yes, sir. We're working right now on a
    number of alternatives, analysis of alternatives. We think we
    have a couple of solutions that we're very close to being able
    to implement.
        Senator Graham. Okay.
        Admiral Debbink. We believe it'll take probably until at
    least 2012 for initial operating capability.
        Senator Graham. Will you need legislative action to change
    it, or can you do it internally?
        Admiral Debbink. We can do it internally, sir.
        Senator Graham. Okay.
        Admiral Debbink. We simply need the funding to be able to
    do it, of course.
        Senator Graham. From the recruiting/retention point of
    view, are you similar to where the Army's at?
        Admiral Debbink. Yes, sir, we're doing very well, overall,
    with our recruiting and our retention. The challenges we have
    right now are in our medical programs--specialty medical
    officers and Nurse Corps. Two challenges there are, we have
    very few coming off Active Duty, which is a primary source of
    recruiting for us, as well as, I think all of us have
    experienced the same problems with medical. Otherwise, we're
    doing very well.
        Senator Graham. Thank you.
        General Kelly.

     STATEMENT OF LT. GEN. JOHN F. KELLY, USMC, COMMANDER, MARINE
           FORCES RESERVE; AND COMMANDER, MARINE FORCES NORTH

        General Kelly. Sir, good morning. It's certainly an honor
    to be here this morning and to appear----
        Senator Graham. Congratulations, by the way.
        General Kelly. Thank you, sir.
        A couple of details, sir. I command 39,600 drilling
    reservists, and an additional 55,000 Individual Ready Reserve
    (IRR) reservists, in 83 locations around the country. In the 6
    months I've been in command, my sense is, the strength of the
    Marine Corps Reserve is that it has a relatively large number
    of prior-service marines that serve.
        Senator Graham. How much do you depend on the Active Duty
    going to the Reserve for your recruiting? How big a part of
    that?
        General Kelly. On the officer side, it's almost 100
    percent. We've had some shortfalls, recently, that we're making
    up with a couple of small programs----
        Senator Graham. So, 100 percent of the Marine Corps Reserve
    officers are former Active Duty people.
        General Kelly. Have had some length of--at least 4 years
    Active Duty.
        Senator Graham. So, with a downturn economy, General Kelly,
    does that present problems? People are less likely to get off
    Active Duty?
        General Kelly. No, sir. In fact, the problem we had, in
    terms of maintaining officer numbers, is that when the Marine
    Corps was growing--and it's just completed that--up to
    202,000----
        Senator Graham. Right.
        General Kelly.--the encouragement was to stay in the Marine
    Corps. So, the pool of individuals getting off Active Duty just
    wasn't there; they were staying in the Marine Corps. In fact,
    we were going into the Reserve, encouraging reservists to also
    go back on Active Duty.
        Senator Graham. Okay. So, you really don't have a problem
    with that. You have the opposite problem.
        General Kelly. Right. Exactly right.
        Senator Graham. Okay.
        General Kelly. To just finish up, I've experienced a total
    force Marine Corps, we don't think in terms of reservists and
    Active Duty. I know all of the other Services do that, as well.
    I would just end with--because I know time is of the essence--
    that the recruiting is good, troops are good and happy, and so
    are the families.
        I stand by to answer your questions, sir.
        [The prepared statement of General Kelly follows:]
               Prepared Statement by Lt. Gen. John F. Kelly, USMC
        Chairman Webb, Ranking Member Graham, and distinguished members of
    the subcommittee, it is my honor to report to you on the state of the
    Nation's Marine Corps Reserve.
        I assumed command of Marine Forces Reserve (MFR) and Marine Forces
    North (MFN) in October of last year; however, these past months have by
    no means been my first experience with the Reserve component (RC). Over
    my many years as a Marine, but particularly over the course of three
    tours totaling nearly 3 years in Iraq, I have served with and fought
    alongside Marine reservists and know first hand the mettle of these men
    and women. My appearance here today represents my first opportunity to
    share with you my assessment of these tremendous marines, and to
    outline my priorities for the Force going forward and as we work toward
    a better, more complete understanding of what the operational reserve
    means for the defense of the Nation and in the support of our
    international partners.
        First and foremost Marine Forces Reserve continues to be an
    integral element of the Marine Corps' ``Total Force.'' We share the
    culture of deployment and expeditionary mindset that has dominated
    Marine Corps culture, ethos and thinking since our beginning more than
    2 centuries ago. All marines stand eternally ready to answer the
    Nation's 911 call and as our charter requires, is to ``be most ready
    when the Nation is least ready.'' The Reserve component is trained,
    organized and equipped in the same way the Active Forces are, and
    consequently we are interchangeable and forever leaning forward to
    deploy as the Nation requires. The Commandant of the Marine Corps
    recently stated that Marine Forces Reserve can be ``whatever the Nation
    needs it to be,'' an operational or a strategic reserve. Sustained
    combat operations and worldwide theater security cooperation and
    training commitments over the last 9 years more than suggest the
    essential need for the Reserves to continue focusing at the operational
    vice strategic end of the continuum. Indeed, in the just-published U.S.
    Marine Corps Service Campaign Plan 2009-2015, Marine Forces Reserve is
    tasked no less than five times to train, organize and equip for
    participation as an ``operational reserve'' within the Corps' Total
    Force. The marines themselves, most of whom came to the Nation's colors
    after September 11 and have deployed deep into harms way, prefer this
    model and do not desire to assume lives as so called ``weekend
    warriors.'' This high level of flexibility, responsiveness and elan is
    only possible by the ever deepening bench of combat tested and uniquely
    qualified citizen ``Soldiers of the Sea.'' I am humbled daily by my
    interactions with these magnificent young Americans. Like their active
    duty brothers and sisters they sacrifice so much of their time, and so
    much of themselves, to protect and serve this Nation. The way they
    balance their family responsibilities, and civilian lives and
    occupations--and still stay Marine--amazes me. They do it with
    humility, without fanfare, and with a sense of pride and dedication
    that is consistent with the great sacrifices of marines of every
    generation. They continue to affirm the Commandant's conviction that
    today's marines are cut from the same cloth as those who fought
    conspicuously upon the battlefields of our Corps' long history.
                        i. today's marine corps reserve
        The Commandant has said the Marine Corps Reserve will be whatever
    the Nation needs it to be. In the last decade, the Nation has needed
    its Marine Reserves to be continuously engaged in combat operations in
    Iraq and Afghanistan and in regional security cooperation and crisis
    prevention activities. This tempo has built a momentum among our
    warfighters and a depth of experience throughout the ranks that is
    unprecedented in generations. The Marine Corps Service Campaign Plan
    calls for the employment of an operational reserve no less than 5
    times. Understanding that we are fighting a transnational enemy and
    that partner nations will continue to seek our training and mentoring
    capabilities, I expect our Marine reservists to be in great demand
    during the coming years in a sustained manner. We are prepared to
    provide that persistent capacity. Our Commandant has further stated
    that marines, Active or Reserve component, join the Marine Corps to do
    the things they are now doing--deploying and winning our Nation's
    battles. The nature of the fight in Afghanistan for instance, is
    particularly suited to our Marine Reserves. It is a thinking man's
    fight that requires solutions at the grassroots level, where our
    marines operate best, among the population, as evidenced by our combat
    prowess in Iraq and humanitarian assistance today in Haiti. Our
    successes in Iraq were hastened by the types of individuals we have in
    our ranks, who were utilizing civilian skills in ways not necessarily
    anticipated, but ultimately pivotal to the success in Al Anbar. That
    maturity, creativity and confidence is what an operational reserve
    brings to the fight. Your Marine Corps Reserve is more highly-trained,
    capable, and battle-tested than at any time since the Korean War. As an
    integral part of the Total Force Marine Corps, it blends seamlessly
    into the gaining force regardless of whether marines come as individual
    augments, detachments, or as operational units.
        As of January 31, 2010, more than 54,000 Reserve marines have
    executed over seventy thousand mobilizations in support of Overseas
    Contingency Operations (OCO) since September 11, 2001. The vast
    majority of these marines deployed to the U.S. Central Command area of
    responsibility. One-hundred percent of Marine Corps Reserve units at
    the battalion and squadron level have either been activated in their
    entirety or activated task-organized detachments. Again, the vast
    majority deployed to the U.S. Central Command area of responsibility.
    Without going into too many specifics, 4,000 marines and sailors--
    citizens from Texas, California, Missouri, Nevada, Utah, Maryland, and
    Virginia--from the 4th Marine Division deployed to both war zones and
    went a long way to achieving success in al Anbar Province, Iraq and
    training security forces in Afghanistan. Thousands of other division
    marines also deployed in support of Combatant Commander Theater
    Security Cooperation initiatives to South America, Eastern Europe,
    Asia, Africa, Australia, and various Pacific island nations. This year
    will be no different with exercises planned for Norway, Peru, Belize,
    Uganda, Estonia and Morocco, and again in various nations in Asia and
    the Pacific islands.
        Our Reserve aviators of the 4th Marine Aircraft Wing are no less
    busy supporting Marine and joint training requirements here in the
    United States, as well as deploying fighter and helicopter squadrons to
    the war zones and Horn of Africa, and supporting Combatant Commander
    initiatives across the globe as well. Of particular note the Total
    Force Marine Corps has had to rely heavily on the 4th Marine Aircraft
    Wing in support of the Marine Corps Aviation Transition Strategy.
    Modernizing from, in some cases, 40 plus year-old legacy aviation
    systems, to the leap ahead capabilities inherent in the V-22 ``Osprey''
    and the Joint Strike Fighter, we have had to temporarily transfer
    manpower, airframe, and support structure to the Active component.
    Beginning in 2014, Marine Forces Reserve will commence the process of
    transitioning to the new systems and capabilities, but in the mean time
    is in total support of the overall Total Force modernization efforts.
        The third Major Subordinate Command of the Reserve component is 4th
    Marine Logistics Group. Anyone who understands the Marine Air Ground
    Task Force (MAGTF) concept knows full well the ground fighters of the
    division, and aviators of the wing, go nowhere without the logistics
    professionals in the Group. In addition to service in both wars, and
    every 1 of the 57 events--large and small--that have contributed so
    mightily to all the combatant commanders' efforts across the globe,
    there were 2 special endeavors I want to highlight. The first was the
    command element's service as operational logistic providers in the
    Korean Theater last April during exercise Key Resolve, made necessary
    by a dearth of joint logistics capability due to the demands of Iraq
    and Afghanistan, and particularly the additional expeditionary demands
    of transitioning Marine forces in large numbers out of Iraq and into
    Afghanistan. The second is the increased support provided to various
    Maritime Prepositioning Exercises, again made necessary by wartime
    demands experienced by the Total Force.
        Unique inside the Marine Corps is the Mobilization Command
    (MOBCOM), of Marine Forces Reserve. As the increased use of the
    Individual Ready Reserve (IRR) has grown over the last several years,
    so too has the workload of Mobilization Command. During the last fiscal
    year, more than 900 sets of mobilization orders were issued with a
    total of 653 IRR marines reporting for activation. MOBCOM also
    processed more than 9,400 sets of shorter duration orders. Mobilization
    Command developed and participated in family readiness programs that
    are particularly difficult within the IRR construct. Initiatives like
    the congressionally-mandated ``Yellow Ribbon Programs'' seek to provide
    support to families from initial call up through return and
    demobilization. Additionally, Mobilization Command conducted regional
    IRR musters, often partnering with other government agencies like the
    Department of Veterans Affairs, to maintain required annual contact
    with marines once they have left active service but still ``owe'' the
    Nation Reserve time.
        Let me touch again on one of the important planning mechanisms for
    an operational reserve. Our Force Generation Model, developed and
    implemented in October 2006, continues to provide long-term and
    essential predictability of future activations and deployments. The
    Model provides my marines, their families, and just as importantly
    their employers, the capability to plan their lives 5 or more years
    out. It enables them to strike the critical balance between family,
    civilian career, and service to the Nation, while allowing employers
    time to manage the loss of valued employees. The Force Generation Model
    also assists service and joint force planners in maintaining a
    consistent and predictable flow of fully capable Marine Corps Reserve
    units. Internal to the Marine Corps this flow of fully trained and
    capable Reserve units has proven essential in reaching the Secretary of
    Defense established target of a 1:2 dwell for our Active component. The
    Model is a relatively simple management tool based on 1-year
    activations, to 4-plus years in a non-activated status. This makes
    continued programmed utilization of the Reserve component sustainable
    at 1:5 over the long term and supports the momentum about which I spoke
    in my introduction.
        Predictable activation dates, mission assignments and geographical
    destination years out now permits me to orient training on core mission
    requirements early in the dwell period, then transitioning training
    focus to specific mission tasks once the unit is 12-18 months from
    activation.
        In each of the past 3 years, between the wars in the Middle East
    and South Asia, and theater security cooperation activities to include
    mobile training teams conducting ``Phase Zero'' operations, nearly one-
    third of our 39,600 marines have deployed outside the continental
    United States both in an activated and non-activated status. In fiscal
    year 2009 alone, 7,500 marines were activated and deployed in support
    of the war in Iraq and Afghanistan, and an additional 5,800 were sent
    overseas to many locations on several continents in support of joint
    and combined theater security cooperation exercises.
        For the second year in a row Marine Forces Reserve stateside will
    sponsor exercise ``Javelin Thrust'' in June focusing on Marine Air-
    Ground Task Force (MAGTF) core competency training. The scenario of
    this year's event is tailored to the current operating environment, and
    participating units have been identified consistent with their future
    deployment schedule as defined by the Force Generation Model. The end
    state of the exercise (Javelin Thrust) is that the headquarters staffs
    of the participating organizations (regiments, aircraft groups,
    battalions, and squadrons) are prepared for activation and are provided
    an in-depth roadmap to guide future pre-activation training.
    Additionally, individuals serving on those staffs will receive training
    allowing them to take their place as individual augments on a MAGTF or
    joint staff overseas, while other individuals in those units will be
    prepared for activation and the conduct of pre-deployment training.
    Last year's Javelin Thrust was the first large scale MAGTF exercise
    involving all three Major Subordinate Commands (Division, Wing and
    Marine Logistics Group) in 6 years. The 2009 distributed operations
    Afghan scenario also allowed other Department of Defense (DOD) agencies
    to participate and to test advanced technologies and transformational
    concepts. This year's exercise will also be conducted aboard
    installations throughout the Western United States with both virtual
    and real world aspects to the exercise.
                                 ii. personnel
        The Selected Marine Corps Reserve is comprised of marines in
    Reserve units, those in Active Reserve status, Individual Mobilization
    Augmentees, and those in initial training. When taken together, these
    various categories of marines form the inventory of the 39,600
    authorized end strength in the Selected Marine Corps Reserve.
        Although we continue to enjoy strong volunteerism there has
    recently been some slight degradation in our ability to maintain
    authorized end strength. We were above 100 percent of our authorized
    end strength during fiscal years 2002-2005. There was a very slight
    drop to 99.71 percent in fiscal year 2006. In fiscal years 2007 and
    2008 percentages of authorized end strength dropped to 97.36 and 94.76
    percent--shortfalls of 1,044 and 2,077 individuals--respectively. This
    past fiscal year (2009), end strength improved to 97.25 percent. This
    is within the mandated 3 percent of authorization. When the 138 marines
    who had served on active duty for more than 3 of the last 4 years were
    taken into account, our shortfall increased to 3.1 percent (1,228). The
    dip below authorized strength experienced in 2007 and 2008 was
    predicted at the time due in large measure to the pressure put on the
    recruiting and retention of individuals to serve in the Active Force as
    the Marine Corps built to 202,000 active duty marines. Now that the
    202,000 goal has been met and surpassed well ahead of schedule, we are
    now institutionally focusing on Reserve recruiting and retention
    efforts to maintain required Reserve component end strength. For fiscal
    year 2010, we project an end strength of 39,266, a shortfall of less
    than 1 percent (prior to accounting for marines who have served on
    active duty for more than 3 of the last 4 years). The bonus and
    incentive programs that you provide for recruiting and retention will
    remain essential tools to continue achieving this goal.
        The Total Force Marine Corps will undoubtedly continue to rely
    heavily upon augmentation and reinforcement provided by Marine Forces
    Reserve. I believe our authorized end strength of 39,600 is still an
    appropriate number and will consequently drive recruiting and
    retention. This number provides us with the marines we require to
    support the Force, and achieve the Commandant's goal of a 1:5
    deployment-to-dwell ratio in the Selected Marine Corps Reserve.
        The Marine Corps - Navy Reserve Team is as strong as ever. In the
    past year the Navy ensured Marine Reserve units were fully manned and
    supported with Program 9 (U.S. Navy personnel in support of Marine
    Forces) and HSAP (Health Service Augmentation Program) personnel during
    all phases of the deployment (pre, operational, post). More 500 Navy
    personnel were sourced to staff Marine Forces Reserve units deploying
    to Iraq and Afghanistan, as well as numerous joint/combined exercises.
    These individuals focused almost entirely on providing medical, dental
    and religious services. The Navy Mobilization Office works with my
    headquarters, as well as with the four major subordinate commands,
    sourcing 100 percent of all requirements. As the demand increases
    throughout the forces, Program 9/HSAP support commands a high level of
    attention to fulfill not only Marine Corps missions, but Army and Navy
    missions as well. I am confident this process will continue ensuring
    Marine Forces Reserve units are supported with qualified Program 9 and
    HSAP personnel to accomplish the mission.
        The Marine Corps is unique in that all recruiting efforts--officer,
    enlisted, Active and Reserve component, and prior-service--fall under
    the direction of the Commanding General, Marine Corps Recruiting
    Command. This approach provides tremendous flexibility and unity of
    command in annually achieving Total Force recruiting objectives. Like
    the Active component, Marine Corps Reserve units rely primarily upon a
    first-term enlisted force. Recruiting Command achieved 100 percent of
    its recruiting goal for non-prior service recruiting (4,235) and prior
    service recruiting (4,501) in fiscal year 2008. It also exceeded its
    recruiting goal for non-prior service recruiting (5,296) and exceeded
    100 percent of its goal for enlisted prior service recruiting (3,862)
    during fiscal year 2009. As of January 31, 2010, 2,359 non-prior
    service and 1,397 enlisted prior service marines have been accessed,
    reflecting 46 percent of the annual enlisted recruiting mission for the
    Selected Marine Corps Reserve. We fully expect to meet our Selected
    Marine Corps Reserve recruiting goals again this year.
        The Selected Marine Corps Reserve Affiliation Involuntary
    Activation Deferment Policy was implemented during June 2006. The
    policy allows a Marine who has recently completed a deployment with an
    active unit an option for a 2-year deferment from involuntary
    activation if they join a Selected Marine Corps Reserve once they leave
    active duty. The intent of the 2-year involuntary deferment is to allow
    transitioning marines the opportunity to participate in the Selected
    Marine Corps Reserve, while at the same time giving them a break and an
    opportunity to start the process of building their new civilian career.
        Officer recruiting remains our most challenging area. Historically,
    the Active component has been the exclusive source of lieutenants and
    captains for the Reserves. This arrangement has paid tremendous
    dividends. Responding to the critical challenge of manning the Reserves
    with quality company grade officers, we have implemented three
    commissioning initiatives that focus exclusively on officer accessions
    for the Reserve component: Reserve Enlisted Commissioning Program
    (expanded to qualified active duty enlisted marines as well);
    Meritorious Commissioning Program-Reserve (open to individuals of
    either component holding an Associates Degree or equivalent in semester
    hours); Officer Candidate Course-Reserve (OCC-R). Since 2004 these 3
    programs have produced a total of 190 lieutenants for the Reserves with
    OCC-R being the most successful of the 3, producing 161 officers. The
    program focuses on ground billets with an emphasis on ground combat and
    combat service support and within specific Reserve units that are
    scheduled for mobilization. The priority to man units with these
    officers is once again tied to the Force Generation Model.
        All commanders and senior enlisted leaders across the force are
    tasked to retain quality marines through example, information and
    retention programs, and mentoring. This takes place across the Marine
    experience and not just in the final days of a marine's contract. For
    those approaching the end of their current contracts--Active or Reserve
    component--they receive more focused counseling on the tangible and
    intangible aspects of remaining associated with, or joining, the
    Selected Marine Corps Reserve.
        With Congress' help, affiliation bonuses, officer loan repayment
    and other initiatives have effectively supported our efforts to gain
    and retain the very best. The Commandant and certainly all of us in
    Marine Forces Reserve, greatly appreciate the continuance of all of the
    many programs that help us recruit and retain the best young men and
    women this Nation produces.
                                 iii. equipment
        As mentioned previously we are as good today as we have been since
    at least the Korean War, if not World War II. This level of proficiency
    as warfighters is due, in large part, to the amount and frequency of
    combat the Reserve Forces have accumulated over the past 9 years while
    serving as an operational reserve. In addition, the quality of our
    equipment is on par with that of the active duty. Therefore, it is
    imperative we spend the relatively small amount required to maintain
    our operational reserve and provide a reasonable return on that
    investment. The end result is a better trained and more capable force
    than ever operating alongside our active duty brethren on the ground,
    in the air, and at sea. To achieve and maintain this high level of
    readiness and proficiency we have like all of DOD relied heavily on
    supplemental funding in the Overseas Contingency Operational account.
    As we move forward it is in the best interests of the Nation to not
    lose these historically high levels of proficiency. The current strong
    and operationally competent Reserve component has cost us much in lives
    and budgetary treasure to achieve over the last 9 years.
        As part of the Total Force, Marine Forces Reserve has two primary
    equipping priorities. The priority is to equip units and individuals
    set to deploy, and the second is to ensure units that are accomplishing
    normal training within the first 2-3 years of their dwell cycle have
    what they need in training allowance. We will always continue to
    provide those next into the fight all that they need in the latest
    generation of individual combat and protective equipment, and unit
    suites, to fight, accomplish the mission, and come home with the fewest
    number of casualties possible. Those not as close to deploying overseas
    to combat will also continue to be equipped with the best of everything
    and tailored specifically to whatever is next in their lives as defined
    by the Force Generation Model.
        The Marine Corps approaches equipment procurement and fielding from
    a Total Force perspective with the Reserve component treated in exactly
    the way as the three active Operational Marine Forces organizations. In
    many cases we have achieved lateral fielding when Active and Reserve
    component organizations are receiving equipment sets simultaneously.
    Again, fielding is prioritized by who is next to the fight. If they
    need it to train with post-deployment, they have it, otherwise in some
    cases they will pick it up in theater in the normal transfer of
    equipment that has marked the way the Marine Corps has done business
    since 2003.
        The National Guard and Reserve Equipment Appropriation (NGREA)
    allows me to mitigate any equipment deficiencies here in CONUS. For
    fiscal year 2009, Marine Forces Reserve received two sources of NGREA
    funding totaling $62.4 million. By providing the flexibility to
    purchase or accelerate the fielding of mission essential equipment, our
    units are better trained during pre-deployment and integrate
    effectively once they get in theater.
        As the Commandant consistently states, our number one focus will be
    the individual Marine and Sailor in combat. Ongoing efforts to equip
    and train this most valued resource have resulted in obtaining the
    latest generation individual combat and protective equipment: M16A4
    service rifles, M4 carbines, Rifle Combat Optic scopes, Lightweight
    Helmets, enhanced Small Arms Protective Insert plates, Modular Tactical
    Vests, and the latest generation Flame Resistant Organizational Gear
    (FROG.) Every member of Marine Forces Reserve has deployed fully
    equipped with the most current authorized Individual Combat Clothing
    and Equipment to include Personal Protective Equipment. The decisions
    regarding what they deploy with are made by commanders with a great
    deal of combat experience, and nothing is left to chance. However, as
    personal protective equipment has evolved over the years of this
    conflict there is now so much equipment and it is so heavy that the way
    we fight is adversely impacted. In particular the infantrymen are so
    heavy, in some cases carrying more than 100 pounds of equipment; they
    are more beasts of burden than they are agile hunters. It is not simply
    a matter of reducing the weight of individual items as these only add
    up to marginal weight savings, but hard decisions about what they carry
    and how much they carry are essential.
        The Commandant's unit equipping priority for Marine Corps Reserve
    units inside their dwell periods is to provide sufficient equipment to
    train with, but not burden the organizations with so much gear that
    they use all of their training time or unit funds maintaining it. We
    call this a Reserve unit's Training Allowance (TA.) This TA is the
    amount of equipment required by each unit to conduct home station
    training. Our goal is to ensure that the Reserve TA contains the same
    equipment utilized by the Active component. It is imperative that our
    units train with the same equipment they will utilize while deployed.
    The Marine Corps Reserve maintains a training allowance at each of its
    Reserve centers. As a whole, we are adequately equipped to effectively
    conduct training.
        NGREA funding from 2009 continues to be used to purchase much
    needed Light Armored Vehicles, ruggedized command and control laptops,
    aircraft systems and survivability upgrades and continued procurement
    of the Logistics Vehicle Replacement System Cargo variant.
        Marines are exceptionally good stewards of American taxpayer
    dollars, and the public property procured by those monies. In order to
    sustain an inventory of current equipment necessary to conduct home
    station training several resources and programs are utilized. The first
    is the routine preventive and corrective maintenance performed locally
    by user and organic maintenance personnel. Second, we have expanded
    ground equipment maintenance efforts, which rely largely on contracted
    services and depot-level capabilities. Third is our reliance on Marine
    Corps Logistics Command mobile maintenance teams providing preventive
    and corrective maintenance support to all 183 Marine Reserve sites
    across the Nation. This partnership provides a uniquely tailored Repair
    and Return Program. Fourth, we are intimately involved in the Marine
    Corps Enterprise Lifecycle Maintenance Program rebuilding and modifying
    an array of principal end items as required. Finally, we field the
    Corrosion Prevention and Control Program. Cumulatively all of these
    initiatives have resulted in a Marine Forces Reserve ground equipment
    readiness rate of 97 percent. Our 4th Marine Aircraft Wing ``mission
    capable'' rate in 2009 was 73 percent which is consistent with recent
    year rates and with the Active component rate of 71 through November
    2009.
                                  iv. training
        The reality today is that the Reserve component has transitioned
    from what was considered a strategic reserve, to what is today the
    ``operational reserve.'' Forever gone are the days when Reserve marines
    were considered mere ``weekend warriors'' and held in Reserve to
    reinforce the Active Force when it experienced catastrophic casualties
    from a World War III scenario against the former Soviet Union. For the
    last 9 years our Reserves have been a fully integrated force, routinely
    deployed to fight in Iraq and Afghanistan, and to execute theater
    cooperation engagement operations around the world at the behest of the
    combatant commanders. From all of these experiences we have captured
    important lessons that we have put to immediate use in improving every
    facet of our training. In this regard, one of the most exciting areas
    where we are continuing to transform the depth and scope of our
    training remains the cutting-edge arena of Modeling and Simulations
    Technology.
        Marine Forces Reserve is fielding several immersive complex digital
    video-based training systems, complete with the sights, sounds and
    chaos of today's battlefield environments. These systems are
    particularly important considering the limited training time and
    facilities available to our commanders. Last year we completed the
    fielding and upgrading of the Indoor Simulated Marksmanship Trainer-XP
    (ISMT). These simulators make it possible for the marines to ``employ''
    a variety of infantry weapons (pistols through heavy machineguns) in
    rifle squad scenarios. These simulators now serve as regional training
    centers and more are planned. The Virtual Combat Convoy Trainer-
    Reconfigurable Vehicle System provides invaluable pre-deployment
    training for the drivers or all makes and models of tactical vehicles.
    The conditions of terrain, road, weather, visibility and vehicle
    condition can all be varied, as can the combat scenario (routine
    movement, ambush, IED, etc.) The simulator is a mobile, trailer-
    configured platform that utilizes a HMMWV mock-up, small arms, crew-
    served weapons, 360-degree visual display with after-action review/
    instant replay capability. We are now preparing to accept the fourth
    generation of this system, with student throughput doubling.
        Another simulation technology being fielded is the Deployable
    Virtual Training Environment (DVTE.) The DVTE also provides small-unit
    echelons with the opportunity to continuously review and rehearse
    command and control procedures and battlefield concepts in a virtual
    environment. All of this provides individual, fire team, squad and
    platoon-level training associated with patrolling, ambushes and convoy
    operations. Additional features include supporting arms upgrades (for
    virtual combined arms indirect fire and forward air control training),
    combat engineer training, small-unit tactics training, tactical foreign
    language training and event-driven, ethics-based, decision-making
    training. It is important to recognize the key role Congress has played
    in the fielding these advanced training systems, all of which have been
    rapidly acquired and fielded with supplemental and NGREA funding.
                                 v. facilities
        Marine Forces Reserve is comprised of 183 sites in 48 States, the
    District of Columbia, and Puerto Rico. These facilities consist of 32
    owned sites, 151 tenant locations, 3 family housing sites, and a Marine
    barracks. In contrast to Active Duty installations that are normally
    closed to the general public, our Reserve sites are openly located
    within civilian communities. This arrangement requires close partnering
    with state and local entities nationwide. Thus, the condition and
    appearance of our facilities may directly influence the American
    people's perception of the Marine Corps and the Armed Forces.
        DOD policy and the use of standardized models for Marine Forces
    Reserve Facilities Sustainment, Restoration, and Modernization (FSRM)
    dollars have greatly improved funding profiles for our Reserve
    Facilities over the last several years. We are experiencing some of the
    best levels of facility readiness due to increased funding in the last
    three years, complemented by the addition of $39.9 million in stimulus
    dollars from the American Recovery and Reinvestment Act of 2009.
        We have repaired and upgraded sites across the country with
    projects continuing to completion in 2011. Between the BRAC 2005 and
    our normal Military Construction of Naval Reserve (MCNR) Program, we
    will have replaced over 35 of our 183 Reserve Centers in the next 2
    years. This represents the largest movement and upgrade in memory for
    the Marine Corps Reserve.
        MARFORRES research and investment for the last 2 years in energy
    efficiency, sustainability, and renewable energy is coming to fruition
    this fiscal year. Every new FSRM renovation project or MILCON is
    targeted for energy efficiency and sustainability aspects in accordance
    with policy and Leadership in Energy and Environmental Design (LEED)
    guidelines. We recently commissioned our first LEED Silver building at
    Camp Lejeune (the first in the Marine Corps) and are anticipating
    completion this year of our first LEED Silver rehabilitation project
    for 4th Combat Engineer Battalion in Baltimore, MD (a potential first
    for the Marine Corps as well). All of our MILCON projects from fiscal
    year 2009 on will comply with directives to achieve LEED silver or
    higher as funding profiles allow. We will be conducting energy
    assessments of all our 32 owned sites this fiscal year along with
    preparation of smart metering technology for each to enhance
    conservation and management. The MARFORRES approach combines
    efficiency, conservation, and renewable aspects to achieve optimal
    return on investment. We have six active solar projects underway this
    year with all coming on line within the next 12 months. Our six wind
    turbine projects are under suitability and environmental evaluations.
    If findings support, they will start coming on line within 18 months at
    an anticipated payback of as little as 8 years. Marine Forces Reserve
    is working with the National Renewable Energy Lab to produce a sound
    renewable energy plan for all Marine Forces Reserve locations. Our
    investment and implementation of these technologies provides energy
    security, efficiency, and cost avoidance for our dispersed sites. The
    visibility of our projects in heartland of America and cities across
    the Nation provides tangible evidence of our commitment to the future.
        Marine Forces Reserve Facilities Sustainment, Restoration, and
    Modernization (FSRM) program funding levels continue to address
    immediate maintenance requirements and longer-term improvements to our
    older facilities. Sustainment funding has allowed us to maintain our
    current level of facility readiness without further facility
    degradation. Your continued support for both the MCNR program and a
    strong FSRM program are essential to addressing the aging
    infrastructure of the Marine Corps Reserve. The MCNR program for
    exclusive Marine Corps construction must effectively target limited
    funding to address at least $132 million in deferred construction
    projects of our aging infrastructure. Increases in our baseline funding
    over the last 6 years have helped to address these deferred projects
    substantially. Over 27 percent of the Reserve centers our marines train
    in are more than 30 years old and of these, 55 percent are more than 50
    years old. Past authorizations have improved the status of facilities
    in the 30 to 50 year range and continued investment will allow for
    further modernization. The $35 million in additional MCNR funding this
    fiscal year has allowed MARFORRES to commence several additional
    projects.
        The Base Realignment and Closure (BRAC) 2005 continues to move
    forward and the Marine Corps Reserve will relocate 12 units to
    consolidated Reserve centers this fiscal year. Marine Forces Reserve is
    executing 25 of the Marines Corps' 47 BRAC directed projects to include
    the only closure; Mobilization Command in Kansas City, MO, is moving to
    New Orleans, LA. Of these 25 BRAC actions, 21 are linked to Army and
    Navy military construction projects. Our BRAC plans are tightly linked
    to those of other Services and government agencies as we develop
    cooperative plans to share Reserve centers and coexist in emergent
    joint bases such as Joint Base Maguire-Dix-Lakehurst. All remaining
    Marine Corps Reserve BRAC projects are on track for successful
    completion with the directed timelines for closure.
        Of special note is the movement of Headquarters, Marine Forces
    Reserve and consolidation of its major subordinate commands in New
    Orleans. This unique BRAC project, integrating State, local, and
    Federal efforts, is now well underway for the new headquarters compound
    and tracking for on time completion. The State of Louisiana is
    providing construction dollars for the new headquarters facility and
    saving the Federal Government more than $130 million. The Department of
    the Navy is providing the interior finishings and security
    infrastructure in accordance with the lease agreement. This building
    will incorporate multiple energy and environmentally friendly processes
    to meet LEED certifiable standards. Marine Forces Reserve is working
    with the Department of Energy's Federal Energy Management Program to
    maximize the sustainability and energy efficiencies of the buildings
    and compound. Upon completion and certification, this building and its
    surrounding acreage will become the newest Marine Corps Installation:
    Marine Corps Support Facility, New Orleans.
        Our Marine Forces Reserve Environmental Program employs the
    Environmental Management System (EMS), which uses a systematic approach
    to ensure that environmental activities are well managed and
    continuously improving. Additionally, Marine Forces Reserve has
    initiated a nationwide program to reduce hazardous waste production and
    ensure proper disposal at our centers. Our Green Box Battery Program
    was responsible in fiscal year 2009 for recycling over 2 tons of
    various types of batteries alone. MARFORRES Environmental undertook
    steps to replace the recycling equipment with completely operable,
    fully recycling systems. Through fiscal year 2009, wash rack recycling
    systems at 16 Reserve center sites have been replaced. This project has
    saved over 650,000 gallons of water and cost savings of $500,000, not
    to mention the enhanced risk avoidance to our national water
    infrastructure. Marine Forces Reserve is updating all environment
    baseline surveys of our owned sites to ensure we are current in all
    aspects of caring for our Nation's resources.
                              vi. health services
        The most important part of any Marine organization is of course the
    marines, sailors, civilian marines, and families who shoulder the
    burden of defending our country every day. Taking care of them is a
    sacred trust. This begins with arduous training for combat, and
    equipping them with the best equipment in the world to do the job once
    deployed to the fight. It then extends to providing the best health
    care possible to them and their loved ones. Our routine health services
    priority is to attain and maintain Individual Medical and Dental
    Readiness goals as set by DOD. In 2009, individual medical and dental
    readiness for our marines and sailors was 68 percent and 77 percent
    respectively. This represents a 5 percent improvement over the previous
    year.
        The Reserve Health Readiness Program (RHRP) is the cornerstone for
    individual medical readiness. This program funds contracted medical and
    dental specialists to provide health care services to units
    specifically to increase individual medical and dental readiness. In
    the near term Navy medicine supports through various independent
    contracted programs such as the Post Deployment Health Reassessment
    (PDHRA), and the Psychological Health Outreach Program. The first
    identifies health issues with specific emphasis on mental health
    concerns which may have emerged since returning from deployment, while
    the Psychological Health Outreach Program addresses post deployment
    behavioral health concerns through a referral and tracking process.
    Worthy of mention in the area of mental health is our full
    participation in a very recent initiative designed and ruthlessly
    monitored by our Commandant and assistant Commandant, in an effort to
    get at the tragedy of suicide. Our Warrior Preservation Program, run by
    senior staff officers and noncommissioned officers has trained 239
    instructors who will return to their home units and reinforce the
    important lessons they received. We conducted training for all of our
    personnel at each of our units and I have as the Commander, filmed my
    own message on this topic and prominently displayed it on our public
    website.
        TRICARE remains a key piece of our medical support programs,
    providing medical, dental and behavioral health services. Members of
    the Selected Reserve qualify for and may enroll in TRICARE Reserve
    Select, which provides TRICARE Standard coverage until the member is
    activated. While on military duty for 30 days or less a reservist who
    does not choose TRICARE Reserve Select coverage is covered under Line
    of Duty care. Upon activation, and during any applicable early
    identification period, the reservist is covered by TRICARE Prime and
    may choose to enroll eligible family members in TRICARE Prime, Prime
    Remote or Standard. When deactivated, a reservist who mobilized in
    support of overseas contingency operations is eligible for 180 days of
    TRICARE transitional health plan options. With your support these DOD
    programs will continue to provide reservists and their family members'
    important medical benefits as they transition on and off active duty
    status
                              vii. quality of life
        Our Commandant has affirmed that our Corps' commitment to marines
    and sailors in harm's way extends to their families at home. As part of
    Marine Corps reforms to enhance family support, we are placing full-
    time Family Readiness Officers (FROs), staffed by either civilians or
    Active Duty marines, at the battalion/squadron level and above to
    support the Commandant's family readiness mission. As you might imagine
    an organization spread across the Nation and overseas has unique
    challenges, but communication technologies, improved procedures and
    processes have worked to more effectively inform and empower family
    members including spouses, children and parents who often have little
    routine contact with the Marine Corps and live far from large military
    support facilities. The installation of full-time Family Readiness
    Officers at the battalions and squadrons bridges many gaps and
    overcomes many challenges unique to the Reserve component. It is a low
    cost solution with a significant return on investment and I urge the
    continued support of this critical program.
        We fully recognize the strategic role our families have in mission
    readiness, particularly with mobilization preparedness. We prepare our
    families for day-to-day military life and the deployment cycle by
    providing education at unit family days, pre-deployment briefs, return
    and reunion briefs, and post-deployment briefs. To better prepare our
    marines and their families for activation, Marine Forces Reserve is
    fully engaged with OSD to implement the Yellow Ribbon Reintegration
    Program, much of which we have had in place for quite some time. We are
    particularly supportive of Military OneSource, which provides our
    reservists and their families with an around-the-clock information and
    referral service via toll-free telephone and internet access on
    subjects such as parenting, childcare, education, finances, legal
    issues, deployment, crisis support, and relocation.
        Through the DOD contract with the Armed Services YMCA, the families
    of our deployed Reserve marines are enjoying complimentary fitness
    memberships at participating YMCA's throughout the United States and
    Puerto Rico. Our Active Duty marines and their families located at
    Independent Duty Stations have access to these services as well.
        The Marine Forces Reserve Lifelong Learning Program continues to
    provide educational information to servicemembers, families, retirees,
    and civilian employees. More than 1,100 Marine Forces Reserve personnel
    (Active and Reserve) enjoyed the benefit of Tuition Assistance,
    utilizing more than $3 million that funded more than 3,900 courses
    during fiscal year 2009. The Marine Corps' partnership with the Boys
    and Girls Clubs of America and the National Association for Child Care
    Resources and Referral Agencies continues to provide a great resource
    for servicemembers and their families in accessing affordable child
    care, before, during, and after a deployment in support of overseas
    contingency operations. We also partnered with the Early Head Start
    National Resource Center Zero to Three to expand services for family
    members of our reservists who reside in isolated and geographically-
    separated areas.
        Managed Health Network is an OSD-contracted support resource that
    provides surge augmentation counselors for our base counseling centers
    and primary support at sites around the country to address catastrophic
    requirements. The Peacetime/Wartime Support Team and the support
    structure within the Inspector-Instructor staffs at our Reserve sites
    provide families of activated and deployed marines with assistance in a
    number of support areas. Family readiness directly impacts mission
    readiness and your continued support of these initiatives is deeply
    appreciated.
             viii. casualty assistance and military funeral honors
        Casualty assistance remains a significant responsibility of Active
    component marines assigned to our Inspector--Instructor and Site
    Support staffs. Continued operational efforts in Afghanistan and Iraq
    have required that these marines remain ready at all times to support
    the families of our marines fallen in combat abroad or in unforeseen
    circumstances at home. By virtue of our geographic dispersion, Marine
    Forces Reserve personnel are best positioned to accomplish the vast
    majority of all Marine Corps casualty assistance calls and are trained
    to provide assistance to the family. Historically, Marine Forces
    Reserve personnel have been involved in approximately 90 percent of all
    Marine Corps casualty notifications and follow-on assistance calls to
    the next of kin. There is no duty to our families that we treat with
    more importance, and the responsibilities of our Casualty Assistance
    Calls Officers (CACOs) continue well beyond notification. We ensure
    that our CACOs are adequately trained, equipped, and supported by all
    levels of command. Once a CACO is designated, he or she assists the
    family members in every possible way, from planning the return of
    remains and the final rest of their marine to advice and counsel
    regarding benefits and entitlements. In many cases, our CACOs provide a
    permanent bridge between the Marine Corps and the family, and assist
    greatly in the process of grieving. The CACO is the family's central
    point of contact and support, and is charged to serve as a
    representative or liaison to the media, funeral home, government
    agencies, or any other agency that may become involved.
        Additionally, Marine Forces Reserve units provide significant
    support for military funeral honors for our veterans. The active duty
    site support staff members, with augmentation from their Reserve
    marines, performed more than 12,700 military funeral honors in 2009 (91
    percent of the Marine Corps total.) We anticipate providing funeral
    honors to more than 13,000 Marine veterans in 2010, even as projected
    veteran deaths slowly decline. Specific authorizations to fund Reserve
    marines in the performance of military funeral honors have greatly
    assisted us at sites such as Bridgeton, MO; Chicago, IL; and Fort
    Devens, MA, where more than 10 funerals are consistently supported each
    week. As with Casualty Assistance, we place enormous emphasis on
    providing timely and professionally executed military funeral honor
    support.
                                 ix.conclusion
        Your Marine Corps Reserve is operational and fully committed to
    train and execute the Commandant's vision for the Total Force. The
    momentum gained over the past 9 years, in Iraq, Afghanistan and in
    support of theater engagements around the globe remains sustainable
    through coordinated focus, processes, and planning.
        In everything we do, we remain focused on the individual marine and
    sailor in combat. Supporting that individual requires realistic
    training, proper equipment, the full range of support services and
    professional opportunities for education, advancement and retention.
    That is our charge. You should know that the patriots who fill our
    ranks do so for the myriad reasons familiar to those who wear this
    uniform and those who sustain us. Yet reservists serve while balancing
    civilian careers and outside responsibilities, often at significant
    personal cost. Your continued unwavering support of the Marine Corps
    Reserve and associated programs is greatly appreciated. Semper Fidelis.

        Senator Graham. Okay. Thank you.
        General Stenner.

     STATEMENT OF LT. GEN. CHARLES E. STENNER, JR., USAF, CHIEF OF
      AIR FORCE RESERVE; AND COMMANDER, AIR FORCE RESERVE COMMAND

        General Stenner. Senator Graham, I am pleased to be here
    today on behalf of the 70,000 reservists. We are, in fact, I
    believe, a very strong strategic reserve that we leverage on a
    daily basis to provide the operational force around the world.
        Senator Graham. What percentage of aircrews in the air
    right now are reservist?
        General Stenner. Percentage of aircrews in the----
        Senator Graham. The nonfighter force--in transportation,
    airlift, and refueling.
        General Stenner. Yes, sir. I'll get you exact percentages--
    --
        [The information referred to follows:]

        The percentage of aircrews in the air right now that are reservists
    in the nonfighter force (transportation, airlift, and refueling) is 22
    percent.

        General Stenner.--but, we have roughly--between the Guard
    and Reserve, depending on the actual airframe, whether it's
    130s or KC-135s, anywhere from 40 to 60 percent of that
    capability.
        Senator Graham. I hope people understand what you just
    said. Between 40 and 60 percent of the people flying KC-135s
    are reservists or Guard members. Is that correct?
        General Stenner. I'll get you the exact numbers, sir, but
    it's a fairly significant----
        Senator Graham. Same for the 130 force?
        General Stenner. Yes, sir. Actually a little larger in the
    130 force.
        Senator Graham. Okay. What about the transport side, the C-
    17s?
        General Stenner. Same thing, sir. Part of the Air Force
    Reserve--we have 43,000 of our 70,000 folks that are associated
    with the air mobility piece of the house.
        Senator Graham. What percentage of the Reserve flying
    component has reached their 2-year activation limit, but still
    continue to serve voluntarily? Do you know?
        [The information referred to follows:]

        11 percent of the officers in the Reserve flying component have
    reached their 2-year activation limit. Of that number, 95 percent
    continue to serve voluntarily after demobilization.
        17 percent of enlisted aircrew members in the Reserve flying
    component have reached their 2-year activation limit. Of that number,
    95 percent continue to serve voluntarily after demobilization.

        General Stenner. Sir, I will get you the exact numbers that
    have reached the limit, but we are 80 percent volunteers right
    now. We have 20 percent that we----
        Senator Graham. The point I'm trying to make is that we
    have statutory limitations on how often you can be called up. I
    think--is that 2 years? Is that right? No?
        General Stenner. On a specific mobilization authority, 2
    years is the limit.
        Senator Graham. Okay. So, at the end of the day, a lot of
    these people could hold their head up high and walk away,
    basically say, ``I've done my time.'' They continue to serve
    voluntarily. Is that correct?
        General Stenner. That is absolutely true. We have higher
    retention on those that have served than we have on those that
    have not had an opportunity to----
        Senator Graham. I just want us to understand, structurally,
    as a nation, that we have statutes that we've blown by the cap,
    and people continue to serve, which is a testament to them, but
    we need to figure out how to address this problem. Okay?
        General Stenner. Yes, sir.
        Senator Graham. Anything else from the Air Force's point of
    view, in terms of retention?
        General Stenner. Retention is very good, sir; and
    recruiting is very good. We're growing. We are an Air Force
    Reserve that's growing in all new mission sets, so we have
    added a few recruiters, but we have no problem bringing the
    folks in. They want to serve.
        Senator Graham. Are most of your reservists people coming
    from Active Duty?
        General Stenner. No, sir. We're getting--60 percent of our
    folks are prior service, 40 percent are nonpriors.
        Senator Graham. Okay, great.
        [The prepared statement of General Stenner follows:]
          Prepared Statement by Lt. Gen. Charles E. Stenner, Jr., USAF
        Mr. Chairman and distinguished members of the committee, I
    appreciate the opportunity to appear before you today and discuss the
    state of the Air Force Reserve.
        The 21st century security environment requires military services
    that are flexible--capable of surging, refocusing, and continuously
    engaging without exhausting their resources and people. Moreover, the
    21st century fiscal environment is becoming ever-more constrained as
    threats by rising nations and pressing national interests compete for
    limited resources.
        In this challenging environment, the Air Force Reserve has never
    been more relevant. Reserve airmen continue to support our Nation's
    needs, providing superb operational capability around the globe. We
    have sustained this operational capability for nearly 20 years--at high
    operations tempo for the past 9 years. The Air Force Reserve is
    accomplishing this while still providing a cost-effective Tier 1 ready
    force to the Nation available for strategic surge or ongoing
    operations.
        Speaking of ongoing operations, U.S. Air Force C-130 aircrews were
    among the first U.S. military to respond to the earthquake disaster in
    Haiti, on the ground in Port Au Prince within 24 hours of the
    earthquake. This quick response was not simply fortuitous, but the
    result of planning, preparedness, and readiness. This rapid-response
    capability is available 24/7, 365 days a year through Operation Coronet
    Oak.\1\
    ---------------------------------------------------------------------------
        \1\ In addition to Haitian relief support through Operation Coronet
    Oak, Air Force Reserve ISR personnel provided exploitation support to
    assess the damage and focus relief while Air Force Reserve airlift crew
    saved lives with much needed medical, water, and food supplies flown
    into Haiti. Air Force Reserve members in fact planned, commanded and
    exploited Global Hawk derived exploitation missions in order to provide
    situational awareness on infrastructure status and guide relief efforts
    during one of the worst earthquakes to hit Haiti on over 200 years. The
    professional expertise and capabilities of these seasoned citizen
    airmen demonstrates the flexibility and service inherit in the men and
    women of the Air Force Reserve as they shifted from supporting combat
    operations to humanitarian relief.
    ---------------------------------------------------------------------------
        Since 1977, the Operation Coronet Oak mission has been manned
    primarily by Air Force Reserve and Air National Guard crews who rotate
    every 2 weeks, year-round. Crews from the Regular Air Force now perform
    about one-third of the mission. These Operation Coronet Oak crews are
    postured to respond within 3 hours of notification to any crises
    requiring airlift support within the U.S. Southern Command area of
    responsibility.
        This predictable-rotational mission allows reservists to perform
    real-world operational missions and still meet their obligations to
    their full-time civilian employers. Like Air Expeditionary Force (AEF)
    rotations, this operation leverages the Tier 1 readiness of Air Force
    Reserve airmen in a way that works for the combatant commander, and the
    reservist. Equally important, when Air Force Reserve airmen are not
    training or performing an operational mission--they are not being paid;
    yet they remain ready to respond to any crisis within 72 hours should
    they be called upon. In this resource-constrained environment in which
    manpower costs are placing downward pressure on our budgets, I believe
    this full-time readiness/part-time cost is a great use of taxpayer
    dollars.
        This next year brings new challenges and opportunities. Air Force
    Reserve airmen are being integrated into a wider variety of missions
    across the full spectrum of Air Force operations. Indeed, the
    Department of Defense (DOD) is considering using reservists from all
    Services to perform missions utilizing their unique civilian skill
    sets.
        The challenges we face are not unique to the Air Force Reserve or
    the Air Force as a whole. Each of the Military Services is being asked
    to shift capability and capacity across the spectrum of conflict--
    including irregular warfare--and to resource accordingly. Each has been
    asked to shift focus away from major weapon systems acquisitions and to
    the current fight.\2\
    ---------------------------------------------------------------------------
        \2\ In Operations Enduring and Iraqi Freedom, Reserve C-130 crews
    flew over 9,800 hours in fiscal year 2009; Reserve F-16 and A-10 crews
    flew over 5,400 hours. The Air Force Reserve provides 24 crews and 12
    fighter aircraft to USCENTCOM in their regularly scheduled rotations
    for the close air support mission.
    ---------------------------------------------------------------------------
        To do so, all three components of the Air Force must continually
    strive to improve the capability provided to the warfighter. Each
    service component must examine its existing business practices and
    explore new processes to make optimal use of personnel, platforms, and
    monetary resources. The Air Force Reserve is helping lead the way in
    improving Air Force capability as we approach fiscal year 2011 and
    beyond.
        As the Nation looks for ways to strengthen its organizations and
    integrate all of the untapped resources it will need in facing the
    challenges of the 21st century, we submit that a model by which
    ordinary people, dedicated to serving their country in ways that meet
    both their needs and the needs of the Nation, is already manifest in
    the U.S. Air Force every day--in the extraordinary Americans of the Air
    Force Reserve.
        I'm proud to serve alongside these great airmen and as Chief and
    Commander of the Air Force Reserve, I have made a promise to them that
    I will advocate on their behalf for resources and legislation that will
    allow them to serve more flexibly in peace and war with minimum impact
    to their civilian careers, their families and their employers. I will
    work to eliminate barriers to service, so that they can more easily
    serve in the status that meets their needs and those of the Air Force.
    I will work to efficiently and effectively manage our Air Force Reserve
    to meet the requirements of the joint warfighter and the Nation.
                            recruiting and retention
        Over the last 9 years, the Air Force Reserve has exceeded its
    recruiting goals and is on track to meet fiscal year 2010 recruiting
    and end-strength goals. Our success in great part has been due to the
    accessions of experienced Active component members upon completion of
    their active duty commitments. Indeed, recruiting highly-trained
    individuals is essential to lowering the training costs for the Air
    Force Reserve. For some of our most critical specialties, affiliation,
    and retention bonuses have provided a greater return on investment
    versus recruiting non-prior service airmen. However, due to lower
    regular Air Force attrition rates, we no longer have the luxury of
    large numbers of experienced airmen leaving Active service.
        As the Air Force Reserve builds end strength to meet the needs of
    new and emerging missions, we are facing significant recruiting
    challenges. Not only will the Air Force Reserve have access to fewer
    prior-service airmen; but, we will be competing with all other Services
    for non-prior service (NPS) recruits. In fact, our non-prior service
    recruiting requirement has nearly doubled since the end of fiscal year
    2007. To improve our chances of success, we have increased the number
    of recruiters over the next 2 years.
        Air Force Reserve retention is solid with positive gains in all
    categories in fiscal year 2009, after rebounding from a slight annual
    drop from fiscal year 2006-fiscal year 2008. Both officer and enlisted
    retention are up; enlisted retention has returned to the fiscal year
    2006 rate. Career airman retention is at its highest level in the last
    5 years.
        Some of this success can be attributed to implementing several
    retention-focused initiatives such as developing a wing retention
    report card tool and General Officer emphasis on retention during base
    visits. With Air Force Reserve retention at its best for the last 3
    years, this renewed focus on retention is expected to ensure that rates
    continue on a positive trend.
        We can't take all the credit for this success. Congress has
    generously responded to our requests for assistance with improved
    benefits such as the Post-9/11 GI Bill, inactive duty training (IDT)
    travel pay, and affordable TRICARE for members of the Selected Reserve.
        To date, under the conditions of the Post-9/11 GI Bill benefit, the
    Air Force Reserve has processed over 4,400 transferability requests
    impacting nearly 7,000 dependents. Under the Individual Duty Training
    travel pay benefit, more than 5,100 Air Force reservists have received
    this benefit. This has helped us address those critical duty areas
    where we have staffing shortages.
        Since October 2007 when the three-tier TRICARE plan was eliminated,
    the Air Force Reserve has seen an increase in covered lives from 4,541
    to 14,982 through January 31, 2010, equaling a 330 percent increase in
    program usage. The current coverage plan has made TRICARE more
    accessible and affordable for members of the Selected Reserve at a
    critical time when healthcare costs are rising. In addition to these
    new benefits, the Air Force Reserve has taken advantage of the many
    tools that you have provided us including the bonus program, the Yellow
    Ribbon Program, and our Seasoning Training program.
        The Bonus program has been pivotal to recruiting and retaining the
    right people with the right skills to meet combatant commander
    warfighting requirements. The Air Force Reserve uses the Bonus Program
    to fill requirements on our ``Critical Skills List.'' Those skills are
    deemed vital to Air Force Reserve mission capability. Development of
    these skills usually requires long training courses and members who
    have these skills are in high demand within the private sector. We are
    able to offer a wide menu of bonuses for enlistment, reenlistment,
    affiliation, and health professionals.
        Our Yellow Ribbon Reintegration Office is up and running and fully
    implementing DOD directives. Our program strives to provide guidance
    and support to the military members and their families at a time when
    they need it the most, to ease the stress and strain of deployments and
    reintegration back to family life. Since the standup of our program
    from August 2008 to December 2009, we have hosted 113 total events
    across 39 Wings and Groups. 4,515 reservists and 3,735 family members
    attended these events reflecting a 67 percent program usage rate for
    members deployed during this timeframe. From event exit surveys and
    through both formal and informal feedback, attendees indicated positive
    impressions, expressing comments about feeling ``better prepared, (and)
    confident following events.''
        Designed to build a ``ready force,'' our Seasoning Training Program
    allows recent graduates of initial and intermediate level specialty
    training to voluntarily remain on active duty to complete upgrade
    training. The results have been a larger pool of deployable reservists
    at an accelerated rate through this program. As a force multiplier,
    seasoning training is ensuring the Air Force Reserve maintains its
    reputation for providing combat-ready airmen for today's joint fight.
    The Seasoning Training Program is also proving beneficial for
    recruiting, training, and retaining members in the Air Force Reserve.
    This program is a success story and one that we will build on in the
    next year.
        The Air Force Reserve is working hard to increase reservists'
    awareness of benefits and incentives associated with their service.
    reservists are taking advantage of these programs because they are
    having their intended effect. These programs are helping to create the
    sustainable and predictable lifestyle that our members need to continue
    to serve in the Air Force Reserve.
        I am confident that as we act on not only our Air Force Reserve
    priorities, but also on those of the Air Force and DOD with the
    continued support of this committee and Congress, we will be able to
    continue to meet the needs of combatant commanders and the Nation with
    a viable operational and strategic Air Force Reserve.
     maintain a strategic reserve while providing an operational, mission
                                  ready force
        The Air Force Reserve is first and foremost a strategic reserve
    leveraged to provide an operational, mission ready force in all mission
    areas.\3\ Air Force Reserve airmen accomplish this by training to the
    same standards and currencies as their Regular Air Force counterparts.
    As indicated at the outset, Air Force Reserve airmen continue to
    volunteer at high levels and provide superb operational capability
    around the globe, serving side by side with the joint team. These
    airmen provide the insurance policy the Air Force and the Nation need:
    a surge capability in times of national crises. In fact, the Air Force
    Reserve is currently mobilizing our strategic airlift resources and
    expeditionary support to assist surge requirements in Afghanistan.\4\
    ---------------------------------------------------------------------------
        \3\ Airmen of the Selected Reserve are mission-ready, capable of
    performing ongoing operations. Collectively, they have met the
    operational needs of the Air Force for decades--largely through
    volunteerism, but also through full-time mobilization. Between 1991 and
    2003, reservists supported the no-fly areas of Operations Northern and
    Southern Watch. Since the attacks on 11 Sept 2001, 54,000 reservists
    have been mobilized to participate in Operations Enduring Freedom,
    Noble Eagle, and Operation Iraqi Freedom--6,000 remain on active duty
    status today. It is a fact that the Air Force now, more than any other
    time, relies on members of the Reserve and Guard to meet its
    operational requirements around the globe.
        The Air Force Reserve maintains 60 percent of the Air Force's total
    Aeromedical Evacuation (AE) capability. Reserve AE crews and operations
    teams provide a critical lifeline home for our injured warfighters. Our
    highly trained AE personnel fill 43 percent of each AEF rotation and
    augment existing USEUCOM and USPACOM AE forces in conducting 12 Tanker
    Airlift Control Center tasked AE channel missions each quarter--all on
    a volunteer basis.
        In 2009, the men and women of our Combat Search and Rescue (CSAR)
    forces have been heavily engaged in life saving operations at home and
    abroad. Since February, airmen of the 920th Rescue Wing at Patrick Air
    Force Base (AFB), FL, and their sister units in Arizona and Oregon,
    flew over 500 hours and saved more than 200 U.S. troops on HH-60
    helicopter missions in support of U.S. Army medical evacuation
    operations in Iraq and Afghanistan. While mobilized for 14 months in
    support of combat missions abroad, the 920th continued to provide
    humanitarian relief in response to natural disasters at home, as well
    as provide search and rescue support for NASA shuttle and rocket
    launches. In addition, the 39th Rescue Squadron (HC-130s), also at
    Patrick AFB, flew rescue missions in Africa and provided airborne CSAR
    support during the rescue of the Maersk Alabama's Captain from Somalian
    pirates.
        The Air Force Reserve provides 100 percent of the airborne weather
    reconnaissance (hurricane hunting) capability for DOD. Throughout the
    year, the Citizen Airmen of the Air Force Reserve's 53rd Weather
    Reconnaissance Squadron ``Hurricane Hunters'', a component of the 403rd
    Wing located at Keesler AFB in Biloxi, MS, fly over 1,500 operational
    storm hours. The Hurricane Hunters have 10 WC-130J Super Hercules
    aircraft that are equipped with palletized meteorological data-
    gathering instruments. They fly surveillance missions of tropical
    storms and hurricanes in the Atlantic Ocean, the Caribbean Sea, the
    Gulf of Mexico and the central Pacific Ocean for the National Hurricane
    Center in Miami. The unit also flies winter storm missions off both
    coasts of the United States and is also used to perform advanced
    weather research missions for the DOD and the National Oceanic and
    Atmospheric Administration (NOAA). The lifesaving data collected makes
    possible advance warning of hurricanes and increases the accuracy of
    hurricane predictions warnings by as much as 30 percent.
        In addition to our hurricane mission, the Air Force Reserve
    provides 100 percent of the aerial spray mission in support of the
    Federal Emergency Management Agency, the Centers for Disease Control,
    and state public health officials. Air Force Reserve aircrews and C-
    130s from the 910th Airlift Wing, Youngstown Air Reserve Station, OH,
    sprayed more than a million storm ravaged acres of land with pesticides
    to control the spread of disease.
        Our intelligence, surveillance and reconnaissance professionals are
    providing critical information as they answer the Nation's call to
    service. Since September 11, 2001, 1,079 intelligence personnel have
    deployed in support of world-wide contingency missions to include
    Afghanistan and Iraq. For the foreseeable future, Reserve intelligence
    professionals will continue to be deployed throughout the combatant
    command theaters, engaged in operations ranging from intelligence
    support to fighter, airlift, and tanker missions to ISR operations in
    Combined Air Operations Centers and Combined/Joint Task Forces as well
    as support to the National Command Authority, such as, Defense
    Intelligence Agency, National Security Agency, and National Geospatial-
    Intelligence Agency.
        These are but a few examples of the dedication and contributions
    our Air Force Reserve airmen have made and will continue to make around
    the clock, around the world, each and every day.
        \4\ Our Reserve community continues to answer our Nation's call to
    duty with large numbers of volunteer reservists providing essential
    support to combatant commanders. Forty-six percent of the Air Force's
    strategic airlift mission and 23 percent of its tanker mission
    capability are provided by Reserve airmen. We currently have over 450
    C-17, C-5, KC-135, and KC-10 personnel on active duty orders supporting
    the air refueling and airlift requirements.
    ---------------------------------------------------------------------------
        The Air Force Reserve is a repository of experience and expertise
    for the Air Force. Air Force Reserve airmen are among the most
    experienced airmen in the Air Force. Air Force Reserve officers average
    roughly 15 years of experience, and enlisted members average 14 years
    of experience, compared to 11 years and 9 years for Regular Air Force
    officers and enlisted, respectively. In fact, roughly 64 percent of Air
    Force Reserve airmen have prior military experience.
        Reserve airmen are a cost-effective force provider, comprising
    nearly 14 percent of the total Air Force authorized end strength at
    only 5.3 percent of the military personnel budget. Put differently, Air
    Force Reserve airmen cost per capita is 27.7 percent of that of Regular
    Air Force airmen, or roughly 3.5 Reserve airmen to 1 Regular airman.\5\
    ---------------------------------------------------------------------------
        \5\ Fiscal year 2008 budget, figures derived from Automated Budget
    Interactive Data Environment System (ABIDES), the budget system
    currently in use by the Air Force and recognized as the official Air
    Force position with respect to the Planning, Programming and Budget
    Execution (PPBE) system. Inflation data used for any constant dollar
    calculations were based on average ConsumerPrice Index for All Urban
    Consumers (CPI-U) rates for the past 10 years: roughly 2.6 percent
    average annual rate of inflation. Medicare Eligible Retirement Health
    Care (MERHC) is an accrual account used to pay for health care of
    Medicare-eligible retirees (age 65 and beyond). Cost per capita figures
    were derived dividing cost of Selected Reserve program by Selected
    Reserve end-strength. When MERHC figures are included, the cost of Air
    Force Reserve airmen to Regular Air Force airmen increases to 30.4
    percent.
    ---------------------------------------------------------------------------
        However, we cannot take for granted the high level of commitment
    our reservists have thus far demonstrated. We must do our best to
    ensure their continued service. Accordingly, we are undertaking
    enterprise-wide actions to make Air Force Reserve service more
    predictable.
        In the Air Force Reserve, we are revising our management structures
    and practices to eliminate redundancies associated with mobilizing and
    deploying reservists to meet combatant commanders' requirements. The
    intent is to create an integrated process that will be more responsive
    to the needs of reservists, provide them greater predictability, make
    participation levels more certain, and ultimately provide combatant
    commanders with a more sustainable operational capability. This is
    still a work in progress.
        At the Pentagon, the Air Force Reserve is examining its processes
    to improve Reserve interaction among the Air Force Headquarters staff
    to better support the Chief of Air Force Reserve, the Chief of Staff of
    the Air Force, and the Secretary of the Air Force in discharging their
    service responsibilities. Through the Air Reserve Personnel Center, the
    Air Force Reserve is also taking action to improve Reserve and Air
    National Guard personnel administrative and management capabilities.
    Collectively, these actions will contribute to the overall health of
    the strategic reserve and improve the sustainability of the Air Force
    Reserve and the Air Force operational capability required by the
    warfighters in this new century.
              preserve the care and viability of the reserve triad
        Reservists have relationships with three basic entities: family,
    civilian employer, and military employer--what I like to call ``The
    Reserve Triad.'' Helping our airmen preserve these relationships is
    critical to our sustainability. In this year of the Air Force family,
    our policies and our actions must support the viability of these
    relationships--especially the one reservists have with their families.
    Open communication about expectations, requirements, and opportunities
    will provide needed predictability and balance among all three
    commitments.
        To that end, we are now consistently and actively surveying Reserve
    and Regular airmen to better understand why they come to serve and why
    they stay. We are continually learning and gaining a better
    understanding of attitudes toward service and issues associated with
    employers and family. From their feedback, I can better advocate for
    benefits that help us recruit and retain airmen for the Air Force
    Reserve.
        Military Services must be flexible: capable of surging, refocusing,
    and continuously engaging without exhausting resources and people. That
    is sustainability. Approaching fiscal year 2011 and beyond, it is
    imperative that we preserve the health of our strategic reserve and
    improve our ability to sustain our operational capability. Going
    forward, we need to continuously balance capabilities and capacity
    against both near-term and long-term requirements.
        Clearly, in a time of constricted budgets and higher costs, in-
    depth analysis is required to effectively prioritize our needs. We must
    understand the role we play in supporting the warfighter and
    concentrate our resources in areas that will give us the most return on
    our investment. Optimizing the capability we present to the warfighter
    is a top priority, but we must simultaneously support our airmen,
    giving them the opportunity to have a predictable service schedule and
    not serve more than they can sustain.
                  broaden total force initiative opportunities
        As weapons systems become increasingly expensive and more capable,
    their numbers necessarily go down. Aging platforms are being retired
    and not replaced on a one-for-one basis. The Air Force is required to
    make the most of its smaller inventory. To this end, the Air Force
    Reserve, Air National Guard, and Regular Air Force are integrating
    across the force, exploring associations wherever practical. The Air
    Force is aggressively examining all Air Force core functions for
    integration opportunities.\6\
    ---------------------------------------------------------------------------
        \6\ The Air Force uses three types of associations to leverage the
    combined resources and experience levels of all three components:
    ``Classic Association,'' ``Active Association,'' and ``Air Reserve
    Component Association.''
        Under the ``Classic'' model, so-called because it is the first to
    be used, a Regular Air Force unit is the host unit and retains primary
    responsibility for the weapon system, and a Reserve or Guard unit is
    the tenant. This model has flourished in the Military Airlift and Air
    Mobility Commands for over 40 years. We are now beginning to use it in
    the Combat Air Forces (CAF): our first fighter aircraft ``Classic''
    association at Hill AFB, UT, attained Initial Operational Capability in
    June 2008. This association combined the Regular Air Force's 388th
    Fighter Wing, the Air Force's largest F-16 fleet, with the Air Force
    Reserve's 419th Fighter Wing, becoming the benchmark and lens through
    which the Air Force will look at every new mission. The 477th Fighter
    Group, an F-22 unit in Elmendorf, AK, continues to mature as the first
    AFR F-22A associate unit. This unit also achieved Initial Operating
    Capability in 2008 and will eventually grow into a two-squadron
    association with the Regular Air Force.
        The Air Force Reserve Command is establishing its first
    Intelligence, Surveillance and Reconnaissance Group Association at
    Langley AFB, VA, this year. This Group and assigned Intelligence
    Squadrons of Reserve airmen will partner with the Regular Air Force to
    provide operational command and control of units delivering real time,
    tailored intelligence to combat forces engaged in missions in Iraq and
    Afghanistan, with data derived from theater Predator/Reapers, Global
    Hawks and U-2s, in partnership with the Total Force team. The Air Force
    has also programmed additional associate intelligence squadrons for
    Beale and Langley AFBs for distributed support to global ISR operations
    to include EUCOM, and PACOM theaters. Once these units have reached
    full operational capability, Air Force Reserve exploitation and
    analysis surge capacity of Remotely Piloted Aircraft (RPAs) will be
    approximately 10 percent of the Air Force's capability based on 65
    orbits. Additional Command and Control Intelligence, Surveillance, and
    Reconnaissance capability is being stood up with an AFRC associate Air
    Force Forces Command unit at Beale AFB, CA, to support PACOM and one at
    Hurlburt AFB, FL, to support SOCOM global Special Operations Forces.
    These new capabilities create a strategic reserve force ready to
    respond to the call of our Nation, capable of being leveraged as
    operational crews ready and willing to support the Regular Air Force in
    everyday missions around the world. This model has proven itself and is
    the basis for the growth of associations over the last 5 years.
    ---------------------------------------------------------------------------
        Over the past 40 years, we have established a wide variety of
    associate units throughout the Air Force, combining the assets and
    manpower of all three components to establish units that capitalize on
    the strengths each component brings to the mix. We recently partnered
    with Air Mobility Command to create three more active associate flying
    squadrons in 2010 and beyond. About 500 regular airmen will associate
    with Air Force Reserve flying units at Keesler AFB, MS (C-130J); March
    Air Reserve Base, CA (KC-135); and Peterson AFB, CO (C-130H) by
    2012.\7\
    ---------------------------------------------------------------------------
        \7\ Under the ``Active'' model, the Air Force Reserve or Guard unit
    is host and has primary responsibility for the weapon system while the
    Regular Air Force provides additional aircrews to the unit. The 932nd
    Airlift Wing is the first ever Operational Support Airlift Wing in the
    Air Force Reserve with three C-9Cs and three C-40s. Additionally, the
    Air Force Reserve will take delivery of an additional C-40 in fiscal
    year 2011, appropriated in the fiscal year 2009 Consolidated Security,
    Disaster Assistance and Continuing Appropriations Act. This additional
    C-40 will help to replace the three C-9Cs, which are costly to maintain
    and fly. To better utilize the current fleet of C-40s at the 932nd, the
    Air Force created an Active Association. We also are benefitting from
    our first C-130 Active Association with the 440th AW at Pope AFB.
        Under the ``Air Reserve Component (ARC)'' model, now resident at
    Niagara Falls Air Reserve Station (ARS) in New York, the Air Force
    Reserve has primary responsibility for the equipment while the Guard
    shares in the operation of the equipment and works side by side with
    the Reserve to maintain the equipment. The Air National Guard has
    transitioned from the KC-135 air refueling tanker to the C-130,
    associating with the 914th Reserve Airlift Wing. The 914th added 4
    additional C-130s, resulting in 12 C-130s at Niagara ARS. This ARC
    Association model provides a strategic and operational force for the
    Regular Air Force while capitalizing on the strengths of the Air
    National Guard and Air Force Reserve. Additionally, in this case it
    provides the State of New York with the needed capability to respond to
    State emergencies.
        The Air Force Reserve has 9 host units and is the tenant at 53
    locations. There are currently more than 100 integration initiatives
    being undertaken by the Air Force and Air Reserve components.
    ---------------------------------------------------------------------------
        But associations are not simply about sharing equipment. The goal
    is to enhance combat capability and increase force-wide efficiency by
    leveraging the resources and strengths of the Regular Air Force, Air
    National Guard, and Air Force Reserve while respecting unique component
    cultures in the process. To better accommodate the Air Force-wide
    integration effort, the Air Force Reserve has been examining its 4
    decades of association experience. With Regular Air Force and Air
    National Guard assessment teams, we have developed analytical tools to
    determine the optimal mix of Reserve, Guard, and Regular forces in any
    given mission. These tools will give the Air Force a solid business
    case for associating as we go forward.
                           air force reserve manpower
        The Air Force is balancing Reserve Forces across the full spectrum
    of conflict. We are leveraging the experience of reservists to
    alleviate stressed career fields. We are improving our ability to
    retain experienced airmen by providing them a means to stay in the
    Service following any life-changing decisions they make regarding full-
    time participation. Over the next decade, the Air Force Reserve will
    grow into many new mission areas, including nuclear enterprise,
    intelligence, surveillance, reconnaissance, unmanned aerial systems,
    space, and cyberspace.
        However, rebalancing a force can take time, and the fight is now.
    To meet the more pressing needs of the Air Force, such as easing strain
    on stressed career fields and taking on new mission sets, the Air Force
    Reserve is growing by 2,100 airmen in fiscal year 2010. This will bring
    Air Force Reserve authorized end strength to 69,500. By fiscal year
    2013, Air Force Reserve end strength is planned to grow to 72,100.
        These manpower increases are placing a premium on recruiting
    highly-qualified and motivated airmen and providing them the necessary
    training. The Air Force Reserve recruiting goal for fiscal year 2010 is
    10,500. While we met our goal of 8,800 new airmen for fiscal year 2009
    in August, nearly 2 months before the end of the fiscal year, our
    forecast models indicate we will continue to face challenges in both
    recruiting and retention.
        Each of these measures--Total Force Integration (TFI), expanding
    into new mission areas, rebalancing of forces, and, where needed,
    increasing manpower--will help the Air Force more closely align force
    structure to current and future DOD requirements, as well as provide
    increased capability to the combatant commanders.
                        air force reserve modernization
        The Air Force Reserve is an organization of extraordinary working
    people, wedded to the fabric of our great Nation. Our Citizen airmen
    support all Air Force mission areas in air, space, and cyberspace. They
    are trained to the same standards and readiness as their Regular
    component peers and are among the most highly-experienced members of
    the U.S. Air Force.
        A number of trends continue to influence dependence on Air Force
    Reserve Forces to meet the strategic and operational demands of our
    Nation's defense: sustaining operations on five continents plus surge
    efforts in Iraq and Afghanistan and the resulting wear and tear on our
    aging equipment; increasing competition for defense budget resources;
    and increasing integration of the three Air Force components.
        The Air Force leverages the value of its Reserve components through
    association constructs in which units of the three components share
    equipment and facilities around a common mission. Increasing
    integration of all three Air Force components requires a holistic
    approach be taken when modernizing. To ensure our integrated units
    achieve maximum capability, the precision attack and defensive
    equipment the Air Force Reserve employs must be interoperable not only
    with the Guard and Regular component, but the joint force as well.
        As Chief of the Air Force Reserve, I am dedicated to ensuring that
    Air Force reservists have the training and equipment available to them
    required to provide for our Nation's defense. I appreciate the
    attention and resources provided to the Reserve thus far, and I ask for
    your continued support.
        The National Guard Reserve Equipment Account (NGREA) appropriation
    has resulted in an increase in readiness and combat capability for both
    the Reserve and the Guard. For fiscal year 2010, the Air Force Reserve
    Command received $55 million in NGREA appropriations. This resulted in
    the ability to purchase critical warfighting requirements for Reserve-
    owned equipment including critical upgrades to targeting pods, aircraft
    defense systems for C-5s and C-130s, and personnel protective equipment
    like security forces tactical weapons. These new capabilities are
    directly tied to better air support for our soldiers and marines in
    Iraq and Afghanistan. NGREA funding has helped the Air Force Reserve to
    remain relevant in today's fight as well as the ability to remain ready
    and capable in future conflicts. We truly appreciate and thank you for
    your support with this critical program.
             military construction and infrastructure modernization
        Along with challenges in modernizing our equipment, we face
    challenges modernizing our infrastructure. During the fiscal year 2011
    budget formulation, both the Regular Air Force and the Air Force
    Reserve took risk in military construction in order to fund higher
    priorities. Over time, this assumption of additional risk has resulted
    in a continuing backlog exceeding $1 billion for the Air Force Reserve.
    I would be remiss if I didn't take this opportunity to sincerely thank
    you for the $112 million that we received in last fiscal year's
    military construction appropriation. This allowed us to address some of
    the most dire needs that exist in our backlog.
        We will continue to work within the fiscal constraints and mitigate
    risk where possible to ensure our facilities are modernized to provide
    a safe and adequate working environment for all of our airmen.
                                   conclusion
        Mr. Chairman and members of this committee, I am excited to have
    these roles as Chief of the Air Force Reserve and Commander of the Air
    Force Reserve Command. I take pride in the fact that when our Nation
    calls on the Air Force Reserve, we are trained and ready to go to the
    fight. As a strategic reserve, over 68,500 strong, we are a mission-
    ready Reserve Force serving operationally throughout the world every
    day with little or no notice.
        As we approach fiscal year 2011 and beyond, it is clear the Air
    Force Reserve will play an increasingly vital role in meeting national
    security needs. The actions we initiated in 2009 and those we advance
    in 2010 will preserve the health of the Air Force Reserve but also help
    Congress address the more pressing issues we will face as a Nation in
    the years to come.
        I sincerely appreciate the support of this committee for the
    authorization and legislation it provides to our readiness and combat
    capability. I desire to continue working with each of you on the
    challenges facing the Air Force Reserve, the Air Force, and our Nation.
    Thank you.

        Senator Graham. Admiral Stosz.

      STATEMENT OF RADM SANDRA L. STOSZ, USCG, ACTING DIRECTOR OF
                 RESERVE AND TRAINING, U.S. COAST GUARD

        Admiral Stosz. Good morning, Senator Graham. On behalf of
    the 8,000 Coast Guard reservists, I am pleased to have this
    opportunity to appear before you today to discuss the Coast
    Guard Reserve, its contribution to national defense and
    homeland security, and the issues that face the men and women
    of our Reserve Force.
        Thank you for including the Coast Guard Reserve when
    considering armed service personnel issues, and for your
    continued support of our military men and women.
        Our Reserve component serves as a responsive and flexible
    force multiplier at home and abroad. In addition to our
    mobilization capability under title 10, the integration of our
    Active and Reserve components in the 1990s enables us to
    respond quickly when and where operational reserve Forces are
    needed, aided in part by the unique authority vested in the
    Secretary of Homeland Security under title 14.
        Recently, in response to the earthquake in Haiti, the USCGC
    Forward arrived on scene within 24 hours, while Coast Guard
    reservists prepared to mobilize, pending presidential recall
    authorization under Title 10. Port Security Unit (PSU) 307
    deployed just 48 hours after receiving that recall notification
    to provide port safety and security in Port-au-Prince and
    nearby Haitian ports. As a deployable surge capability, the
    Coast Guard Reserves PSU force package was vital to ensuring
    the safe passage of relief supplies and shipping commerce.
        Senator Graham. Admiral, we have your written statement. To
    all of you, Haiti was a major effort, and I couldn't be more
    proud of the Active and Reserve components helping the people
    of Haiti.
        Admiral, from your point of view, what's your biggest
    challenge to keep these 8,000 people retained, and recruit in
    the future?
        Admiral Stosz. Senator, I think our biggest challenge is to
    keep them well-trained and well-equipped. We use operational-
    unit training and equipping. Our Reserves augment----
        Senator Graham. Do you have ships in the Reserve units that
    are specific to Reserves?
        Admiral Stosz. No, we don't. Except for our PSU force
    packages, our Reserves are individual augmentees that go out
    and augment our operational Coast Guard stations. They use the
    equipment at those stations.
        The only problem we have is, Reserves stationed in the
    Great Lakes in the wintertime, we have to deploy them down
    somewhere warm to train on the boats that they need to keep
    their qualifications up. So probably our biggest challenge is
    keeping that training going with a geographically constrained
    workforce, when you also have the employment challenges of an
    employer, where you can't send them on temporary assigned duty
    for that long, to get the training somewhere else, outside that
    geographical area.
        Senator Graham. The equipment problems in the Coast Guard
    seem pretty serious to me. We have an aging fleet.
        Admiral Stosz. Yes, sir, our aging fleet. But, our small
    boats are much newer, so our capital cutters, the bigger ships
    that reservists don't serve in, are the aging assets, and our
    new smaller boats are the boats that our reservists man and
    deploy.
        Senator Graham. But, your recruiting and retention is okay
    right now?
        Admiral Stosz. Yes, sir. We have 87 percent enlisted and 93
    percent officer retention.
        Senator Graham. Okay.
        [The prepared statement of Admiral Stosz follows:]
                 Prepared Statement by RADM Sandra Stosz, USCG
        Good afternoon, Chairman Webb, Senator Graham and distinguished
    members of the Senate Armed Service Subcommittee. It is a pleasure to
    have this opportunity to appear before you today to discuss the Coast
    Guard Reserve; its contribution to national defense and homeland
    security; the issues that face the men and women of our Coast Guard
    Reserve; and the Coast Guard's ability to sustain our current high
    quality staffing.
        As one of the five Armed Forces of the United States, the Coast
    Guard has a long and distinguished history of service at home and
    abroad as a military, maritime, multi-mission service that is always
    ready for all threats and all hazards. Because of its mix of military
    and civil law enforcement authorities, the Coast Guard is uniquely
    positioned to serve as the lead Federal agency for maritime homeland
    security and response to natural and man-made disasters, while acting
    as a supporting agency for national defense.
        Founded in 1941, the Coast Guard Reserve is the force multiplier
    for the operational Coast Guard. During the last decade, we have
    completely integrated our Selected Reserve Force into Active component
    units. Over 80 percent of our 8,100-member Selected Reserve Force is
    directly assigned to Active Duty Coast Guard shore units, where
    reservists hone readiness skills through classroom instruction and on-
    the-job training side by side with their active duty counterparts. The
    remainder of our Selected Reserve Force is dedicated primarily to
    supporting defense operations, the majority of whom are assigned to our
    eight deployable Port Security Units (PSUs). The principal mission of
    the PSUs, which are staffed by both Active and Reserve duty personnel,
    is to support the combatant commanders in strategic ports of
    debarkation overseas. The remaining personnel are assigned to
    Department of Defense (DOD) units, such as the Maritime Expeditionary
    Security Squadrons and combatant commanders' staffs.
                           operation unified response
        Over the past 2 decades the Coast Guard has focused on an
    integrated workforce with deployable force packages. In support of the
    recent earthquake recovery efforts in Haiti, the Coast Guard Cutter
    Forward arrived on scene within 24 hours of the earthquake; PSU 307,
    augmented by individuals with select specialties from several other
    PSUs, deployed, for approximately 8 weeks, as a unified force to
    provide port safety and security in Port-Au-Prince and nearby Haitian
    ports. The Coast Guard Reserve's PSU force package was vital to
    ensuring the safe passage of relief supplies and shipping commerce in
    the port and surrounding waters of Haiti.
                                  integration
        The 8,100 operational reserve personnel act as a surge capability
    ready and able to respond to any national or domestic contingency. They
    responded magnificently to the attacks of September 11, 2001, and all
    contingency operations that have followed. Since 2001, there have been
    over 6,900 cumulative recalls of Coast Guard reservists under title 10
    of the United States Code. Reservists have served at home as part of
    the Coast Guard's Maritime Homeland Security mission--usually as part
    of PSUs--and overseas in direct support of the combatant commanders--in
    early 2003, at the height of Operation Iraqi Freedom, approximately
    half of Coast Guard personnel deployed overseas were reservists.
                               post-september 11
        Since September 2001, when we embarked on the largest mobilization
    of Coast Guard reservists since World War II, we have redoubled our
    efforts to ensure a Reserve Force with the right people, skills and
    training for the missions of the 21st century. We have examined our
    systems for recruiting, training, mobilizing and demobilizing
    reservists to identify and close readiness gaps. More significantly, we
    undertook a comprehensive review of the Coast Guard Reserve; upon
    completion, our Commandant, Admiral Thad Allen, issued a policy
    statement that embodies the three core strategic functions of the
    Reserve Force: maritime homeland security; domestic and expeditionary
    support to national defense; and domestic man-made or natural disaster
    response. The Reserve Employment and Analysis Working Group has further
    developed this policy statement into employment doctrine that will
    focus on training and augmentation.
                                    title 14
        None of this post-September 11 activity represents a radical change
    for the Coast Guard Reserve, but rather an affirmation of the vital
    role our reservists play as the Coast Guard's operational surge force.
    One key component of this ready surge force is availability and
    accessibility of individuals for mobilization. As with members of the
    other Reserve components, our men and women are subject to involuntary
    mobilization under Title 10 for national security contingencies.
    However, unlike members of the other Reserve components, Coast Guard
    reservists can also be involuntarily mobilized for up to 60 days at a
    time for domestic contingencies, including natural and manmade
    disasters and terrorist attacks. This unique authority provided under
    title 14 has been used over a dozen times since the 1970s to mobilize
    Coast Guard reservists for a wide range of emergencies ranging from the
    1980 Mariel Boat Lift to floods, hurricanes and other natural
    disasters.
        In 2005, this special authority was used by the Secretary of
    Homeland Security to allow the Coast Guard to mobilize approximately
    700 reservists for Hurricanes Katrina and Rita, providing a ready force
    for rescue and recovery operations in New Orleans and other stricken
    areas of the Gulf Coast. It was used again in 2008 for nearly 70
    members in response to Hurricanes Gustav and Ike. In all, members of
    the Coast Guard Reserve mobilized under Title 14 for Hurricanes Katrina
    and Rita performed nearly 20,000 person-days of duty in support of
    Coast Guard rescue and recovery operations. Most served alongside their
    active-duty counterparts as individual augmentees. For instance,
    several reservists assigned as Coast Guard Investigative Service
    special agents were mobilized to augment active-duty and civilian
    agents deployed to New Orleans, Baton Rouge, and Gulfport, where they
    provided armed security for senior officials and personnel disbursing
    cash to Coast Guard staff. In addition to individual augmentees, the
    Coast Guard also activated two PSUs to provide physical security in New
    Orleans and Gulfport and to aid in the distribution of relief supplies.
    These activities are a testament to the ability of our reservists to
    mobilize when and where needed to increase Coast Guard forces
    responding to an emergency.
        The Coast Guard and Maritime Transportation Act of 2006 expanded
    the Secretary of Homeland Security's Title 14 recall authority to
    permit mobilization of Coast Guard reservists ``to aid in prevention of
    an imminent serious natural or manmade disaster, accident, catastrophe,
    or act of terrorism.'' Other language included in the bill extended the
    limits on the period of recall to not more than 60 days in any 4-month
    period and to not more than 120 days in any 2-year period. This
    significantly enhanced our ability to mitigate major natural disasters
    and thwart terrorist attacks by enabling us to bring Coast Guard
    reservists on active duty even before disaster strikes.
                             organization structure
        A major component of the Coast Guard's success in responding to
    disasters is the Coast Guard's decentralized command and control
    structure. The authority and responsibility to move forces, including
    reservists, establish response readiness levels, and direct operations
    is vested in the regional District and Area Commanders. This provides
    the most direct oversight of operations at the field level and avoids
    delays in executing our missions. However, the most important factor
    contributing to the Coast Guard's effectiveness in disaster response is
    the fact that our forces are engaged in this type of mission on a daily
    basis. As the Nation's maritime first responder, Coast Guard men and
    women--Active, Reserve, civilian, and auxiliary--plan for, train, and
    execute missions every single day.
                                 an armed force
        The Coast Guard possesses several unique features that help to
    integrate its efforts with those of the DOD, other Federal agencies,
    the National Guard, and State and local authorities. As an Armed Force,
    our communications systems, planning processes, personnel training and
    even our command structures have much in common with the DOD Services.
    Coast Guard commanders can be either supported or supporting commanders
    for military operations, with extensive experience working in and with
    DOD Joint Task Force Headquarters. This capability allows for easy
    integration of forces and unity of effort when working together during
    major catastrophes. Today, we enjoy our closest relationship with DOD
    since World War II, with numerous active duty and Reserve personnel
    assigned at our combatant commands and various other DOD organizations.
                                  joint forces
        The Coast Guard maintains excellent working relationships with all
    of the Armed Forces, providing support and leveraging expertise through
    mutual agreements. At Marine Corps Base Camp Lejeune, NC, the Coast
    Guard has partnered with the Marine Corps to develop the Coast Guard
    Special Missions Training Center, which is tasked to provide training,
    doctrine, and testing/evaluation in support of mission requirements of
    the Coast Guard, Navy, and Marine Corps operational forces. The Special
    Missions Training Center offers specialized courses for Coast Guard
    Reserve deployable units, and inclusion of Coast Guard personnel in
    formal training conducted by the Navy and Marine Corps.
        In today's joint environment, the spirit of cooperation and common
    purpose is exceptionally high. The Coast Guard welcomed the opportunity
    in February 2010 to participate in Patriot Hook when PSU 312, working
    jointly with the 452nd Air Lift Control Flight, leveraged the
    opportunity to complete required underway live-fire, anti-swimmer
    grenade training, and personnel and equipment movement by land and air.
    During the 4-day exercise, held at San Clemente Island, CA, the U.S.
    Air Force transported over one-half million pounds of cargo from
    various airfields to San Clemente Island.
        As I report to you here today, 120 members of PSU 312 are deployed
    to Southwest Asia as an integral part of the Navy's Maritime
    Expeditionary Squadron, providing vital water and shore-side security
    for ports of strategic importance in Kuwait and Iraq.
                                  interagency
        In addition to our work with DOD, the Coast Guard works on a daily
    basis with other Federal, State, and local partners. The Coast Guard's
    port, waterway and coastal security mission requires the Coast Guard to
    interact daily with State and local law enforcement and emergency
    response organizations, exercising command structures and building the
    trust critical to effectively executing an emergency response. Coast
    Guard Captains of the Port provide a critical link through Local
    Emergency Planning Committees, Area Maritime Security Committees,
    Harbor Safety Committees, Area Planning Committees, Regional Response
    Teams and other venues that allow the Coast Guard to build close
    relationships with key partners in disaster response. Because of the
    integrated nature of the Coast Guard, individual reservists play a key
    role in these efforts. Their dual status as Coast Guard members and
    residents of their local communities frequently enables them to
    leverage organizational and personal relationships that yield
    immeasurable benefits during a crisis situation.
              commission on the national guard and reserve (cngr)
        The Coast Guard has participated from the start of the Commission
    on the National Guard and Reserve process, providing both a dedicated
    staff member as well as testimony to the Commission, participating in
    each of the factfinding sessions. Upon completion of the study, the
    Coast Guard worked with the Office of the Assistant Secretary of
    Defense, Reserve Affairs in evaluating the impact of the Commission's
    95 recommendations. The Coast Guard continues to participate in follow-
    on work groups with the other Reserve components as well as the Office
    of the Assistant Secretary of Defense, Reserve Affairs as the Services
    work to implement many of the Commission's recommendations.
                                   workforce
        The Coast Guard takes a unique approach to staffing a Reserve Force
    by performing both Reserve and Active Duty recruiting through a single
    Recruiting Command. The Coast Guard Reserve supplements recruiting
    offices with reservists on Active Duty (Temporary Active Reserve
    Recruiters) under the concept that reservists are best suited to
    recruit reservists. In addition to the Reserve recruiters, the
    Recruiting Command has found success in the use of In Service Transfer
    Teams to ensure that all Active Duty personnel being released from
    active duty are briefed on the benefits of the Coast Guard Reserve and
    offered an opportunity to affiliate with assignment.
                               improved benefits
        The Post-9/11 GI Bill, implemented in 2009, offers our reservists
    who have served extensively on active duty since September 11, 2001, an
    important benefit that will improve the education and professionalism
    of our already stellar workforce. This benefit has also contributed to
    current retention rates, which remain high and virtually unchanged from
    fiscal year 2009.
        The 2010 National Defense Authorization Act, along with changes to
    DOD and Coast Guard policy, provide continued improvements in benefits
    for members of the Coast Guard Reserve. Authority was extended to the
    service secretaries to provide our dedicated reservists with legal
    assistance for an extended period of time following their release from
    mobilization orders, which will assist them in resolving issues that
    may have occurred while they were deployed. Early TRICARE benefits
    increased from 90 days to 180 days, providing early access to TRICARE
    medical and dental care when members are notified of upcoming
    mobilizations, and thereby improving reservists' readiness. The new
    TRICARE Retired Reserve benefit will provide our retirees with health
    care options during the period where they do not yet qualify for
    TRICARE Reserve Select or TRICARE Standard at age 60.
        The Coast Guard Reserve often operates in a joint environment with
    its sister Service, the Navy. The two Services are working to implement
    joint instructions for the Yellow Ribbon Reintegration Program, which
    will ensure demobilized reservists are properly transitioned to
    civilian employment.
        The 2008 National Defense Authorization Act authorized early
    retirement benefits for eligible reservists who serve on active duty
    during a period of war or national emergency, including Active service
    under various sections of Title 10, and Title 32 in the case of
    National Guard reservists, for incidents or a National Special Security
    Event as designated by the Secretary of Homeland Security. Active
    service under Title 14 was inadvertently omitted as qualifying service
    supporting the same incidents where National Guard service would
    qualify.
                                   retention
        Retention in the Coast Guard Reserve is at 93 percent for officers
    and 87 percent for enlisted personnel in fiscal year 2010. These
    retention rates have held solid for a number of years, indicating that
    members see the Coast Guard Selected Reserve as an attractive option
    and, once they join, they want to continue serving.
                         employer support/job security
        The Coast Guard is actively engaged with Employer Support of the
    Guard and the Reserve (ESGR). Each year, the Coast Guard Reserve
    actively encourages reservists to nominate their employers for the
    Secretary of Defense Freedom Award. These concerted efforts have
    resulted in a substantial increase in nominees over previous years.
                                   next steps
        The Coast Guard has demonstrated its ability to prepare for and
    respond to a wide range of contingencies, including natural disasters
    and a terrorist attack, while executing more routine missions, such as
    maritime law enforcement and search and rescue. To continue to meet
    these challenges, the Coast Guard continuously examines best practices
    and takes steps to adapt. In 2008, the Coast Guard Reserve Program
    developed an initiative called the Reserve Force Readiness System,
    which is aimed at increasing readiness of Coast Guard Reserve Forces.
    Under the Reserve Force Readiness System, many billets have been
    realigned at the operational level providing improved oversight, day-
    to-day management, and readiness of our Reserve Forces. This new
    organizational construct also provides additional leadership
    opportunities for senior reservists (officer & enlisted), provides
    increased mentorship and training for junior personnel, and optimizes
    the placement of Full Time Support personnel.
        The Coast Guard is the Nation's premier maritime law enforcement
    agency with broad, multi-faceted jurisdictional authority. It is on
    behalf of the men and women of the Coast Guard that I thank you for
    your continued support of the Coast Guard and the Coast Guard Reserve.
        Thank you for the opportunity to testify today. I look forward to
    your questions.

        Senator Graham. I have just a few minutes until I have to
    vote and--we have your written statements. I don't mean to cut
    this short, but, at the end of the day, we have to find out
    what the real problems are, how are you doing, why are you
    doing so well, and what's likely to change.
        Mr. Secretary, tell me about the legal structure, in terms
    of accessing the Guard and Reserves. What does Congress need to
    do, with the administration, to change that dilemma? Am I right
    about the 2-year limit? You can be called up for 2 years----
        Mr. McCarthy. No, sir.
        Senator Graham.--involuntarily, right?
        Mr. McCarthy. No, sir, not exactly.
        Senator Graham. How does that work?
        Mr. McCarthy. There is a 2-year limitation, but it's
    interpreted to be 2 years of consecutive service. So, you can't
    involuntarily mobilize a member of the Guard or Reserve for
    more than 2 years, consecutively, but the interpretation that
    we are using is that there is no cumulative limit.
        But, you're absolutely right that----
        Senator Graham. I'm not so sure that's the intent. Maybe
    not. You could serve for 20 months, 10 times?
        Mr. McCarthy. I'm sorry, you can serve for----
        Senator Graham. Could you call----
        Mr. McCarthy.--20----
        Senator Graham.--could you call somebody up for 20 months
    and get 2 years--that doesn't count toward the 2 years, right?
        Mr. McCarthy. 20 months is not----
        Senator Graham. Not 24----
        Mr. McCarthy.--exceed the 2-year----
        Senator Graham.--yes.
        Mr. McCarthy. Not 24.
        Senator Graham. Yes.
        Mr. McCarthy. But, the interpretation that we've used since
    September 11 has been that the 2-year limit was consecutive
    rather than cumulative.
        Senator Graham. From the military point of view, here, most
    people understand that? Or do they care? From the Army's point
    of view.
        Admiral Debbink. Yes, sir. The Secretary of Defense came
    out with a policy on the 12-month mobilization, which I think
    did the most for us, in terms of putting some structure around
    the question you're asking, because the question was, is the 24
    months concurrent, consecutive, or cumulative? I think,
    Secretary Gates now has said the mobilization period will be 12
    months. Then, the goal is to get a 1 to--currently, a 1 to 4
    ratio, and eventually a 1 to 5 ratio, so that the soldier would
    know, 12 months every 4 to 5 years.
        Senator Webb [presiding]. I guess I came in in the middle
    of this discussion, so I'm not quite sure where it's going.
        Let me pick up on a couple of things that I was talking
    about before, just to begin my questions.
        First, Secretary McCarthy, the 2009 National Defense
    Authorization Act required the Secretary of Defense to submit
    to Congress a strategic plan to enhance the role of the
    National Guard and Reserves no later than April 1, 2009. This
    plan was to include an assessment of the findings of the
    Commission on the National Guard and Reserves (CNGR), as well
    as an assessment of certain legislative proposals, particularly
    the National Guard Empowerment and State National Defense
    Integration Act of 2008.
        On March 25, 2009, your predecessor testified: ``A detailed
    description of the actions being taken by the Department in
    response to the recommendations made by the Commission is
    contained in the report required by section 906 of the National
    Defense Authorization Act for Fiscal Year 2009, which will be
    submitted to Congress next month.''
        Despite numerous requests for this report, we still have
    not received it. This report is considered by many to be
    critical for Congress to carry out its oversight. Can you tell
    us where that report is?
        Mr. McCarthy. Yes, sir. First of all, with regard to the
    timeliness of the report, I'm absolutely defenseless. I know we
    are way late. I've signed out a new report, differently,
    entirely, from the one that was previously prepared, and it is
    being staffed in the Pentagon right now. I know that sounds
    exactly like what Tom Hall said a year ago. I will tell you,
    sir, that the CNGR report is, if not my highest priority, it's
    one of my highest priorities, in terms of implementing it, and
    implementing it effectively.
        When I looked at the state of our implementation plan, when
    I arrived in July, I realized that we had not made anywhere
    near the progress of substantive implementation. We had a lot
    of process, but we didn't have much substance. We have worked
    hard on that, and I think that you will see, when we do get
    this report to you, that there has been substantive progress on
    many issues, there's hard work on others, and that we are
    taking the CNGR report with 100 percent seriousness.
        Senator Webb. Do you know when we're going to receive it?
        Mr. McCarthy. Sir, I would hope that it will be to you
    within the month. It is a big, thick report. It's staffing
    around the Pentagon right now. I checked on it, right before I
    came over here, and I'm hopeful that we will have it to you
    within the month.
        Senator Webb. Thank you.
        For all of the Reserve component heads, the questions that
    I asked of the people in the Guard, I would like to reiterate,
    that we'd like to get some demographic data, as well, on the
    different Reserve components--prior service, percentage over
    the age of 40, and percentage of those who were in other-than-
    organizational billets. General Stultz, you and I had a
    discussion about that yesterday when you visited. Just to get
    the demographics of the Guard and Reserve down so that we can
    have a way to understand the population
        [The information referred to follows:]

        The average age of Reserve component officer servicemembers (all
    Services) is 40.2 years old (median age is 40.0), while the average
    enlisted age is 30.8 years old (median 28). The average and median ages
    for all Reserve component members (all Services) are 32.2 years old
    (median 30).

    ----------------------------------------------------------------------------------------------------------------
                           Age                           ARNG     USAR     USNR    USMCR     ANG     USAFR    USCGR
    ----------------------------------------------------------------------------------------------------------------
    Approx. Average Age..............................     30.6     32.1     35.1       26     35.1     36.3     34.7
    Percent over age 40..............................     23.6     29.5     38.4      0.9     38.0     43.0     34.0
    ----------------------------------------------------------------------------------------------------------------

        Senator Webb. General Stultz, what percentage of the Army
    Reserve has deployed?
        General Stultz. Sir, it's somewhat of a moving target, but
    right now approximately--if you use the latest figures we have,
    it's around 50 percent. Now, that sounds like we haven't used
    half the force, so there's this plethora of people out there.
    When we take the numbers and say, ``Okay, let's look at--of the
    ones that haven't deployed, where are they?'' First and
    foremost, there's about 14,000 to 15,000 that are in initial
    military training; those are the new recruits. There's another
    15,000 to 20,000 that are preparing to deploy; they just
    haven't gotten there yet. There's another percentage that are
    in some kind of status, on a medical hold or something else. It
    gets down to--there's around 52,000 soldiers that I have in my
    208,000 right now that are available and have not deployed.
        Furthermore, when you break that down--and I don't mean to
    get into too much detail, but we study this all the time,
    because the question comes up--of that 52,000, 86 percent are
    E-5 or below. It's a lot of our young soldiers that are new
    recruits, and they are dispersed throughout the force, so it's
    not as if I can assemble an MP company or a transportation
    company out of this 50,000. Our force is very seasoned and very
    used.
        What we have done is, we've arrayed the Army Reserve across
    a 5-year model to give our soldiers, number one,
    predictability, but, number two, to give the Army
    predictability about what kind of capacity and capability we
    can give you each year. The problem is, that's a supply-based
    system; we're reacting to demand right now, where the demand is
    higher than the supply.
        But, we keep very, very tight control over how many of
    those soldiers are out there that are available that we have
    not used.
        Senator Webb. Thank you.
        General Kelly, would you have a number on that for the
    Marine Corps?
        General Kelly. It's very, very high, sir. First of all, all
    of the battalions and squadrons have been overseas, 100
    percent. Considering turnover and whatnot--in each one of those
    units today, 70 percent of the marines have deployed overseas.
    The ones that haven't, simply because they've just joined the
    unit and they're just forming on the rotation. So, it's very,
    very, very high.
        Majors and above, virtually 100 percent have gone overseas
    at least once--many, multiple times--either as individual
    augments or parts of units. What we find is, when another
    unit--as we get ready to deploy someone, we have a great many
    volunteers that want to switch units, get into that unit to go
    back over again. So, it's a very, very high percentage.
    Frankly, we don't see any strain on the force, the way it's
    working.
        Senator Webb. Admiral Debbink?
        Admiral Debbink. Sir, we have approximately 65,671 in the
    Navy Reserve today. We've deployed over 66,000 mobilizations
    since September 11. That accounts for about 45,000 sailors.
    Some have done two, three, and four pumps.
        Having said that, with a flow through the force over the
    last 9 years, we have approximately 26,000 that are available
    today for mobilization.
        Senator Webb. So, of the total number in the Navy Reserve
    today, how many have deployed?
        Admiral Debbink. I'll get back to you on that.
        [The information referred to follows:]

        26,284 of 54,140 (48 percent) of the current members of the Navy
    Selected Reserve have deployed in support of the Overseas Contingency
    Operations.

        Senator Webb. A snapshot.
        Admiral Debbink. Yes, sir.
        Senator Webb. Okay.
        General Stenner?
        General Stenner. Sir, I will also get back with you on the
    exact numbers.
        [The information referred to follows:]

        The total number of Air Force Reserve members who have deployed is
    currently 39,351. Approximately 55 percent of our total current force
    has deployed.

        General Stenner. I would like to just put a little bit of a
    context on this one, as well.
        We have, on any given day, roughly 7,000 folks on orders;
    2,600 to 3,000 of those are deployed to the AOR. But, when you
    look at remotely piloted aircraft, when you look at the
    command-and-control--there's a lot of deployed in place, folks
    who are on orders, but they're right here in the CONUS. So,
    folks who have done their job are the folks who are staying
    with us, the retention piece; and I'll get you the demographics
    on how that works out.
        Senator Webb. Thank you.
        Admiral Stosz?
        Admiral Stosz. Senator, we have augmentees that augment
    Active Duty Coast Guard units. When they are recalled, they,
    generally speaking, become part of the total force. Eighty
    percent of our reservists serve as part of the total force when
    they're augmented. We do have our PSUs that deploy overseas to
    serve as part of the Maritime Expeditionary Security Squadron;
    and those units go one at a time, and there's about 120 people
    in each of those. I'll have to get you the exact figure, sir,
    on how many Reserves we've deployed overseas in recent years.
        [The information referred to follows:]

        31 percent of personnel assigned to the Coast Guard Selected
    Reserve are mobilized and deployed in support of domestic operations
    and Overseas Contingency Operations.

        Senator Webb. Recognizing at the outset that each one of
    these components has its own personality and its own way of
    conducting operations, it's a question that varies, just in
    terms of the way people are used, I fully recognize that, going
    in. But, I'd be curious to see the data on it.
        There's been a lot of discussion about the impact of these
    multiple deployments on employer relations. I know, General
    Stultz, you and I had a long discussion about some of the
    innovations that--putting in place in the Army Reserve. I'm
    curious to hear thoughts on where this issue is in the other
    components, and what might be done.
        General Kelly, I'll start with you.
        General Kelly. The first program, the Marine For Life
    Program, has proven effective, certainly since General Jones
    implemented it, some years ago. Other aspects of employer
    engagement have been very positive. In fact, we're all plugging
    into, now, Jack Stultz's program, in terms of reaching out to
    employers. So, within the Marine Corps Reserve right now, very
    little strain, in terms of jobs and employers and that kind of
    thing.
        The one thing that I've learned, that I wasn't aware of
    before and does concern me, is, as these men and women deploy
    overseas, the one thing we can't capture--and they don't
    complain about it, but--is the opportunity lost. They're
    overseas when an opening comes up that they would normally at
    least have the opportunity to bid on, that would raise them up
    in the company. The employers can't wait, in many cases, for
    them to come back, and they're exactly the kind of an employee
    they'd want to have advanced. I was not aware of that before. I
    don't think there's any way to get our arms around that, other
    than to just hope. I find this is the case, that the employers
    are doing the best they can to hold these positions open.
        Senator Webb. Very good.
        Admiral?
        Admiral Debbink. Sir, we believe that our employers remain
    very supportive of our Navy reservists. We know that over 85
    percent of those who deploy return back to their jobs. We hear,
    anecdotally, about issues and problems; but, every time we
    drill down into it--and I try to make employer visits in all of
    my travels--I hear nothing but strong support, provided that,
    when we employ our reservists, that we're validating the billet
    that we're sending them to, and that we're giving them real and
    meaningful work to do, so when they come back, they report back
    to their employer that, ``I was well utilized.''
        The other thing that we're trying very hard to do is to
    stay to a 1 to 5 dwell, because that's also our promise to the
    sailor, his or her family--and to the employers.
        Senator Webb. General?
        General Stenner. Sir, we have a very strong employer-
    relations/family-relations program that goes along with all of
    our units. We have ``Boss Lifts.'' We have a strong
    relationship with the Employer Support in Guard and Reserve
    (ESGR) Freedom Awards. The anecdotal evidence that we get is
    that the employers are doing a fantastic job, making up
    differences in pay, and, in some cases, full pay and allowances
    for folks who are on orders. It's part of the fabric of how
    we're doing this Nation's business.
        If I were to suggest anything, though, sir, I'd say that
    the Uniformed Services Employment and Reemployment Rights Act
    that was created many years ago wasn't necessarily written for
    the operational force that we have right now; it was written
    for that strategic reserve. Some of the numbers in there, and
    some of the nuances--it might be helpful if we could take a
    look at that and perhaps help our employers out in that
    respect--as well as our military members.
        Senator Webb. Admiral?
        Admiral Stosz. Mr. Chairman, when we recall our Reserves,
    oftentimes it's for shorter periods of time, as they're
    integrated in for hurricane relief, or Haiti, or, now, the
    Deepwater Horizon oil spill. So, it's not much of a time that
    they're gone from their jobs that--the ones that deploy
    overseas are a smaller percentage. We haven't had any problems
    with our employers that have come to my level. We, in fact, had
    15 of our reservists put in their employers for the Freedom
    Award last year. So, we do local outreach in our communities,
    and our reservists are probably spread far and abroad, more so
    than most of the other Services, to small towns. We do the
    small town local outreach, and it seems to be working.
        Senator Webb. General Stultz, I didn't mean to overlook
    you, since we had a long discussion yesterday. But, you've been
    something of a groundbreaker in this area.
        General Stultz. Yes, sir. The employer program--we started
    out--and, as I mentioned earlier, it's kind of snowballed on
    us, so now we have included all of the Reserve components as
    part of that--really has been a success story for us, because
    what we're finding, and what we have raised to the awareness of
    the business world, is, we have a treasure of talent, a
    treasure of talent in the Reserve components, that are drug-
    free, they're physically fit, they're morally fit, they've been
    given leadership, they've been given responsibility, they've
    been given self-confidence. It's a tremendous workforce out
    there, and, in a lot of cases, we've given them skill sets that
    apply in that civilian sector. So now the civilian business
    world is waking up to that and saying, ``Wow, we really haven't
    taken advantage of this workforce out there.''
        For us, in the military, we can translate those civilian
    skills back into the military, because, in a lot of cases, if
    that engineer is working in the civilian workforce, he's
    probably working state-of-the-art, probably levels higher than
    the Active Army engineer force is working, because they just
    don't have that same level of technology. Especially, we see
    that on the medical side.
        We're getting that embracing, now, from the civilian
    workforce of saying, ``Let us take advantage of your soldiers.
    Bring us your talent.'' We have the partnerships with over
    1,000 companies now across America who have said, ``We want to
    use the Reserve components as our force of choice for the
    workforce.''
        I am a little concerned that, as General Stenner said, what
    the employers tell me is, ``Okay, we want to partner with you,
    but we need some predictability to run a business.'' In today's
    environment, we have a lot of soldiers who are volunteering for
    duty. So, those employers say, ``You told me he was only
    calling him up once every 4 years, but he just came back, and
    now he's gone again. How can I run a business?'' So some of
    those situations, we have to take a look at. As General Kelly
    said, we're also seeing--I get resignations from officers every
    month who have completed their mandatory service obligation and
    have decided to get out. I read each one of those, the
    individual's statement as to why they're leaving the Service.
    In a lot of cases, it's family issues, it's other things like
    that, but, in some cases, they're saying, ``I don't think I'm
    going to have the opportunity to reach the level, in my
    civilian job, if I stay in the Reserve, because of the
    commitment. I'm going to be taken away and miss
    opportunities.'' So, there are still concerns in that--the
    employer world, of: Are we, in some cases, not maintaining
    faith with the employers, in terms of our predictability,
    because of our volunteer situation? Then, second, are we not
    maintaining faith with our soldiers, in terms of, ``They're not
    going to get, necessarily, all the opportunities in their
    civilian job''? So, it's not a perfect world.
        Senator Webb. Secretary McCarthy, would you have an
    overarching thought on that?
        Mr. McCarthy. I'd just second everything that people have
    said. I congratulate the Chiefs on this initiative; and General
    Kelly, in particular.
        But, I think that the world is changing. The idea of a
    rotationally available Reserve, whether there is a war on or
    not, or whether there's a hot war on or not, is going to change
    the way we relate to employers. Everything that we've done,
    historically, in ESGR has been about sustaining existing
    employment relationships. That's very, very important, and it
    has to continue.
        We have to broaden, though, what we do in the ESGR to think
    about creating employment relationships, as well as sustaining
    the existing ones. We're focused on that.
        As everybody has said, people come back, they have
    increased skills, they have increased capacity, they have
    increased confidence, and the job they left may not be the one
    they want to go back to. Many will come back and take advantage
    of the GI Bill, improve their education. Again, the job they
    left may not be the one that they want, because of their new
    education. We have to figure out a way to accommodate that.
        The only other thing I would say is, I think we also have
    to understand that, if you want to have a career in this new
    era of Reserve, that's going to have some influence on what
    kind of employment. In the days when it was 1 weekend a month
    and 2 weeks in the summer, that could be accommodated to just
    about any kind of employment. A rotationally available force
    may have to reshape the way they think about their own personal
    employment if they want to make a career in that sort of a
    force. That's going to be a transition force.
        Senator Graham. Is there anything--and I don't mean to
    interrupt, but that's a good thought.
        Senator Webb. No, it's your turn.
        Senator Graham. Is there anything, legally, we can do, in
    terms of if we're going to go to that model, which makes sense
    to me, quite frankly, given where we're at and the threats we
    face, then do we need to adjust our laws?
        Mr. McCarthy. Sir, there are a number of things that are
    working their way through the Department's legislative
    generation process. I won't get into details, but I do think
    that there is an area of opportunity for us, relative to health
    care.
        One of the things that, for many, many years, we've talked
    about, in terms of this continuum of service--on-again/off-
    again service--is maintaining the continuity of family health
    care. If we can figure out a way to combine what we're doing
    with TRICARE Reserve Select and employer needs with regard to
    furnishing health care, there may be an opportunity for us to
    help both employers and Reserve component members. But, the
    specifics of that are very complicated. There's a lot of people
    over there working on it. But, I think that, in the not-too-
    distant future, this may be something that the Department will
    want to talk to Congress about.
        Senator Webb. Thank you.
        Senator Hagan.
        Senator Hagan. Thank you, Mr. Chairman. Thank you for
    holding this hearing.
        Thanks, all of you.
        Under the current law, servicemembers that receive
    educational assistance in the form of an ROTC scholarship, or
    that graduate from one of our service academies, are still
    eligible for full educational benefits under the post-9/11 GI
    Bill. However, members of the Selected Reserve that received
    educational assistance under Chapter 1606 of the Montgomery GI
    Bill prior to receiving a commission and serving on Active Duty
    are not similarly entitled to 4 years of benefits under the
    post-9/11 GI Bill.
        My question for all of you is, are the Reserve components
    concerned that the significant disparity in benefits may
    dissuade college students who are interested in a commission
    from participating in the Selected Reserves while attending
    college?
        Mr. McCarthy. Senator Hagan, I'll just try to take----
        Senator Hagan. Okay.
        Mr. McCarthy.--just very, very generally, and then let the
    Chiefs hit the specifics.
        I think that we all recognize that, as we work into the
    post-9/11 GI Bill, there's probably some adjustments that need
    to be made. I know that a number of them are being looked at.
    I'm not familiar with the specific one that you've mentioned,
    but it sounds like something that we should be, and perhaps
    are, looking at.
        I think that, overall, everybody is tremendously pleased
    with the post-9/11 GI Bill, but we recognize that there are
    probably some adjustments that need to be made going forward.
        General Stultz. I'd just speak from the Army's perspective.
    I kind of echo what Secretary McCarthy said. I don't know the
    specific details of the situation you're explaining. I do know
    that the post-9/11 GI Bill has been a huge benefit. As we
    conduct townhall meetings, there are several things soldiers
    say: the retirement, they're concerned about that; the
    education benefits now, for their families, so they see this as
    enabling them to give something to their families; and the
    continuum of health care. Those are the three big issues that
    they say--if we can solve those--I think we can pay for a lot
    of those, because we will not have to pay the retention
    incentives and some of the other incentives, to the degree that
    we're paying now, because the incentive for being in the
    Reserve and staying in the Reserve is going to be education
    benefits, health care benefits, and retirement benefits.
        Senator Hagan. Anybody else, on that particular issue?
        I've actually talked to individuals, and I know that the
    post-9/11 GI Bill is generous to a vast majority of
    servicemembers; and I hear from people all the time how pleased
    they are with the funding that they're getting to go back to
    school. But, there are certain groups within the armed services
    that, based upon the programs that they entered through, are
    not fully served under the legislation as it's currently
    written, despite providing this--these individuals providing
    the same military service as their counterparts.
        I'm actually looking at introducing a bill on this pretty
    soon which aims to address, I think, just this act of disparity
    and this issue. So, hopefully we'll be hearing a little bit
    more about it.
        There's also a tremendous cost associated with recruiting
    and retaining--recruiting and training our servicemembers,
    which becomes even more pronounced when replacing midgrade
    noncommissioned and commissioned officers.
        General Stultz, I was wondering, are there statutory or
    policy changes that can be implemented, with respect to
    continuum of service, that would make it easier for Reserve
    component soldiers to voluntarily serve on Active Duty?
        General Stultz. I think most of it is policy, not statute.
    But, I think the--and General Debbink can--or, Admiral
    Debbink--I'm promoting him to the Army side----[Laughter.]
        Admiral Debbink and I were talking earlier about this, that
    the Navy, for instance, in the Navy Reserve and the Active
    naval component, have come much further than we have, in my
    opinion, on the Army side, in a continuum of service, where we
    have made it fairly easy for servicemembers to move from
    Reserve into the Active Force, but we have not made it as easy
    for the servicemember to move from the Active back into the
    Reserve Force.
        One of the things that we're working with Secretary
    McCarthy's office, and with the G-1, and other personnel in the
    leadership of the Army is, we truly have to get a continuum of
    service, where soldiers can flow from Active into the Reserve,
    to take a knee into the Individual Ready Reserve (IRR) to
    further take a knee, if they want to, and then be able to have
    the confidence to flow back into the Active Force, if the
    opportunity is there, because in some cases, there's not a
    need, and the Active Force simply says, ``I can't take any more
    of these.'' But, if the opportunity is there, to flow back and
    maintain that continuum of service.
        The other thing that we've discussed, and I know I've
    talked with Senator Graham about, is in the retirement. I would
    like to see a system where we reward soldiers who are eligible
    to retire in the Army Reserve--they have their 20 years of
    service--but we retain them past that 20 years of service by
    lowering, eventually, their retirement age, because, again,
    that is a retention tool that doesn't have an immediate cost.
    It has a long-term cost, but we retain that talent that we've
    invested so heavily in.
        Currently, with the operational tempo, a soldier gets his
    20 years of service, he may not be able to draw his retirement
    for another 25 years, and there's no incentive for him to stay,
    except that his love of his country and his love of the
    Service. But, he has to confront that spouse at home and say,
    ``Why are you re-upping when they're not going to give you
    anything except another deployment?'' Somehow, we have to put
    something out there.
        When I talk to soldiers about, ``What if we rewarded you
    for staying beyond 20 by lowering your retirement age?'' That
    rings home to them. Now, the caveat I've put on them is,
    selective retention that you may not get to stay as long as you
    want if you haven't served your country and done your education
    and physically fit and all the other requirements.
        Senator Hagan. Sure.
        General Stultz. So, the fact that we may be able to put a
    carrot at the end of the table here for you, you're going to
    have to earn it.
        Senator Hagan. Thank you. I look forward to continuing to
    work with you as your command is relocated to Fort Bragg.
        General Stultz. Yes, ma'am.
        Senator Webb. Thank you, Senator Hagan.
        Senator Hagan. Thank you.
        Senator Webb. Just let me, as the Chair, make a couple of
    comments.
        First, also, as the person who wrote the GI Bill, and then
    who worked hard with Senator Graham to put some of these other
    provisions in that, we know there's places where we need to
    refine it, there were two original intentions when it came to
    the Guard and Reserve components. First of all, was to include
    them for the first time in a GI Bill. It never happened before.
    We've done that, and then, there was a big discussion with
    respect to ROTC scholarship programs, service academy programs,
    where the initial period of service was actually a payback for
    having received an education. So, the question was, do you
    double count that first 5 years of Active service for a GI Bill
    when the education had already been the result of the Federal
    Treasury? So, that's an issue, it sounds to me, like you were
    asking a question about here, with the ROTC programs and the
    Reserve.
        Just as a matter of clarification, General Stultz, I've
    never heard the IRR termed the ``Inactive Ready Reserve.''
        General Stultz. Individual.
        Senator Webb. Individual Ready Reserve. I mean, it--I hear
    this a lot, and I think it's important----
        General Stultz. Yes, sir.
        Senator Webb.--to clarify it. That's basically a SELRES
    without it being in a unit. It led to a question that I wanted
    to ask both you and General Kelly, and that is, what percentage
    of today's IRR do you consider to be of the physical quality to
    be deployed?
        General Stultz. Yes, sir, we have come great strides, in
    terms of getting our hands around the IRR in the Army. As you
    may know, the IRR for the Army does not belong to the Army
    Reserve, it belongs to the Active Army; it's under Human
    Resources Command for the Army. We help administer the program.
        What we started--and it's part of the initiatives that you
    started, years ago, I think, when you were Secretary of the
    Navy--is, the muster formations. In the past 2 to 3 years----
        Senator Webb. Actually, when I was Assistant Secretary of
    Defense, we did----
        General Stultz. Yes, sir.
        Senator Webb.--the first call-up of the IRR--1-day call-
    ups, just to try to get the addresses down and get a physical
    and get people 1-day pay, travel, and proceed, find out where
    they are, see if they're actually a mobilizable asset.
        General Stultz. Yes, sir. We, in the past 2 to 3 years,
    have really gotten very active in the musters around the
    country. We've gotten very good results in the muster
    formations. We have improved our overall accountability and our
    overall readiness in the IRR, but we've also seen the numbers
    in the IRR decline significantly as people elected to get out
    of the IRR, didn't realize they were in the IRR, because they
    had not resigned their commissions, in some cases. So, the IRR
    numbers for the Army Reserve--or, for the Army right now, that
    we're overseeing, is about 68,000, where it used to be several
    hundred thousand.
        Senator Webb. Yes.
        General Stultz. So those numbers have gone down. But, the
    individuals that are there, we feel very confident that they're
    available for service, if needed.
        Senator Webb. General Kelly?
        General Kelly. Yes, sir. Senator, I have 55,000 in the
    Marine Corps IRR. They essentially belong to me; I manage them.
    My Mobilization Command is very aggressive in, as you've
    described, contacting them periodically, bringing them in for a
    day. Actually, for what we really need them to come in for, it
    takes about 20 minutes; and that is, to look at them and make
    sure they haven't grown their hair too long, they haven't grown
    a beard, and they haven't put on too much weight.
        We use the rest of the day, though, actually, to bring an
    awful lot of agencies in--the VA and people like that--where
    they weren't so interested in meeting with these folks of
    various agencies, they would just--when they decided to get out
    of the Marine Corps--they were just intent on getting out--as
    young men and women--just wanting to start something new. When
    we bring them in for these musters, they're very, very
    interested at that point. As I say, we bring in various job
    search agencies--the police, recruiters, everybody. We have a
    very, very high response, and those that come in--the people
    that do this to--with thousands of these IRR marines every
    year--as a general rule, they remain in pretty good shape. As I
    say, an awful lot of them do respond.
        During the war, we've involuntarily called up 3,800. I
    think, as of today, there's probably zero. There were a few
    residual that were getting off. All of them that we called up,
    in the period starting about 5 years ago, all came to the
    colors ready to go, and were in very good shape. Very, very few
    of them did we have to not bring on. They were all candidates
    to bring back on. Very few of them had any problems with the
    police or medical or whatever. So, it's a good program. Another
    part of the IRR, of course, is when people can't drill anymore,
    but want to stay associated, affiliated, they'll drop to the
    IRR; and then periodically we'll go looking for them, and
    they'll come out of the IRR and either become individual
    augmentees or start drilling again. So, it's kind of an in-and-
    out thing. Overall, very successful.
        Senator Webb. Good, thank you.
        Senator Graham, do you have any comments?
        Senator Graham. Yes. It's been a great hearing. Thank you,
    Mr. Chairman.
        One last thought and then I'm going to have to run. You all
    have been very informative.
        Mr. Secretary, this idea of mobilization and the way the
    law works, apparently the Coast Guard has a different system. I
    think we need to look long and hard at finding a way to call
    people in from the Reserves to Active Duty for limited periods
    of time without presidential consultation, because we're more
    in an operational mode than ever. I would just challenge the
    Department to sit down with us and find a way to adjust these
    laws to make it more flexible for our reservists to be able to
    be utilized, because, as General Stultz said, that they want to
    be used if they're going to be trained. I want to make sure
    they can be used in a logical way.
        So I look forward to getting your input as to how to change
    the law, because I think the law needs to be changed, quite
    frankly.
        Mr. McCarthy. We're anxious to work with you on that, sir,
    because getting access under this new paradigm of rotational
    availability is high on, I think, everybody's priority list.
        Senator Graham. Right. Thank you.
        Thank you, Mr. Chairman.
        Senator Webb. Good. Thank you, Senator Graham.
        I'd like to express my appreciation to all of you for your
    testimony today, and for the leadership that you are bringing
    to your different components.
        We will have follow-on questions. The hearing record will
    be kept open until close of business tomorrow, in case other
    Senators have questions for the record.
        I appreciate your testimony and also having had to wait for
    us today.
        We are adjourned.
        [Questions for the record with answers supplied follow:]
                     Question Submitted by Senator Jim Webb
                              reserve demographic
        1. Senator Webb. General McKinley, General Wyatt, General
    Carpenter, General Stultz, Admiral Debbink, General Kelly, General
    Stenner, and Admiral Stosz, please provide demographic data on the
    actual numbers of Guard and Reserve members in your Service that are
    prior service, the number that are more than 40 years of age, and the
    number of those who are assigned to an organizational billet. The
    numbers should include Individual Mobilization Augmentees (IMAs).
        General McKinley. Of the 363,357 soldiers in the Army National
    Guard, 154,287 (43 percent) came to us with prior service backgrounds.
    There are 77,213 (21 percent) soldiers over the age of 40. Currently,
    321,750 (89 percent) soldiers are assigned to MTOE units.
        Of the 108,386 airmen in the Air National Guard (ANG), 43,858 (40.5
    percent) came to us with prior service backgrounds. There are 70,419
    (65.0 percent) airmen over the age of 40. Currently 108,836 (100
    percent) airmen are assigned to an organizational billet.
        General Wyatt and General Stenner. The requested Air Force Reserve
    (AFR) demographic data is as follows: There are 41,827 Air Force
    reservists that are prior service. Included in this number are 7,041
    reservists who are IMAs. There are 27,846 Air Force reservists over 40
    years of age. Included in this number are 4,731 reservists who are
    IMAs. All Air Force reservists are assigned to an organizational
    billet.
        General Carpenter and General Stultz. All members in the Army
    Reserve (USAR) Selected Reserve (SELRES) are assigned against
    organizational billets. The USAR does not have an ``assigned not
    joined'' category, and does not command the Individual Ready Reserve.

    ----------------------------------------------------------------------------------------------------------------
                                                                          Assigned             Percent of Assigned
    ----------------------------------------------------------------------------------------------------------------
    Total SELRES................................................                  207,660
    Age 40 & Over...............................................                   56,013                        27
    Prior Service...............................................                   69,967                        34
    ----------------------------------------------------------------------------------------------------------------

        Of the 363,357 soldiers in the Army National Guard, 154,287 (43
    percent) came to us with prior service backgrounds. There are 77,213
    (21 percent) soldiers over the age of 40. Currently, 321,750 (89
    percent) soldiers are assigned to MTOE units.
        Of the 108,386 airmen in the ANG, 43,858 (40.5 percent) came to us
    with prior service backgrounds. There are 70,419 (65.0 percent) airmen
    over the age of 40. Currently 108,836 (100 percent) airmen are assigned
    to an organizational billet.
        Admiral Debbink.

          (a) 72 percent (46,964 of 65,671) of the Navy Reserve had prior
    service in the Armed Forces when they affiliated with the Reserves.
          (b) 27 percent (17,431 of 65,671) of the Navy Reserve is older
    than 40 years of age.
          (c) 82 percent (42,717 of 53,542) of Navy Selected reservists are
    assigned to an organizational billet.

        General Kelly. 3,186 officers and 6,704 enlisted SELRES members
    have previously served in the Active component.
        2,812 members are more than 40 years of age.
        33,298 members are assigned to an organizational (Selected Marine
    Corps Reserve unit or IMA) billet. An additional 2,282 are assigned to
    the AR program.
        Admiral Stosz. Currently, 31 percent of personnel assigned to the
    Coast Guard SELRES are mobilized and deployed in support of domestic
    operations and Overseas Contingency Operations (OCO).
                                     ______

                Questions Submitted by Senator Roland W. Burris
                                   diversity
        2. Senator Burris. General McKinley, the National Guard is the
    largest Reserve component force in our military, but its diversity has
    the worst actual numbers and percentages of minorities and women in the
    colonel and general officer ranks. Particularly the Army National Guard
    and the fills in the full-time positions are much worse. Explain to me
    why this situation exists?
        General McKinley. I share your concern in ensuring our military, in
    particular the National Guard, has representation in our senior ranks
    that reflects the diversity of the population we serve. The conflicts
    we are currently facing, as well as the environments that our men and
    women in uniform will face in the future, clearly indicate that
    diversity in thought, in perspective, and in experience is and will
    remain critical for success in conflict prevention and on the
    battlefield.
        In the past fiscal year, minority membership in the National Guard
    stood at over a quarter of our assigned strength. Seven percent of
    National Guard General Officers (GOs) are women, 5 percent are Black/
    African American, and 3 percent are Hispanic. In regards to colonels,
    nearly 10 percent of National Guard colonels are women, 5 percent are
    Black/African American, and 5 percent are Hispanic.
        The National Guard leadership is committed to increasing the
    diversity across our entire force, and will continue to focus efforts
    on recruiting, retaining, mentoring, and promoting up through the ranks
    a sufficiently diverse pool of officers from which to select our most
    senior leaders.

        3. Senator Burris. General McKinley, what are your plans to
    increase diversity within the senior ranks of the National Guard?
        General McKinley. The National Guard has taken several major steps
    to ensure that diversity is an active and critical component of the
    culture of the Guard. I have created the office of the Special
    Assistant for Diversity to provide oversight and guidance to National
    Guard leaders, at all levels, to aid in the creation and implementation
    of diversity strategies. In addition, I have formed the Joint Diversity
    Advisory Council (JDAC) made up of TAGs, ATAGs, Senior Enlisted, Junior
    Enlisted, both Army Guard and Air Guard. The National Guard Bureau's
    Joint Diversity Advisory Council's mission is to initiate and support
    those activities that increase diversity and promote cultural
    competency among all members of the National Guard by fostering a
    learning environment that accepts and bridges the gaps between persons
    of all cultures, genders, and religious differences in today's
    multicultural world.

                                joint qualified
        4. Senator Burris. General McKinley, General Stultz, Admiral
    Debbink, and General Kelly, there has been a lot of emphasis on joint
    operations, and the Reserve components are far behind the Active
    components in getting their officers joint qualified. Current
    statistics show that the Reserve components only have 1.1 percent of
    their eligible officers qualified in joint operations, whereas the
    Active components sit at almost 47 percent. This is largely due to the
    fact that the Reserve components only began participating in the Joint
    Qualification System in October 2007. However, some emphasis on getting
    officers joint qualified is clearly needed. Explain your plan for
    getting officers in your Service joint qualified.
        General McKinley. We agree with your assessment of the importance
    of getting National Guard Officer Joint qualified. There are several
    factors that impact joint qualification opportunities for National
    Guard officers. A significant factor is the limited number of joint
    positions available for assignment of National Guard officers in which
    to earn the joint credit. Presently, there are 124 Joint Duty
    Assignment List (JDAL) positions designated for National Guard
    officers. Other opportunities exist in the form of mobilization tours
    and perhaps limited Active Duty tours for our officers to be assigned
    against Active component positions.
        There is an additional piece of the equation for obtaining joint
    qualification, and that piece is education. In order to enhance our
    ability to attain joint qualification for our officers we need an
    increase in the availability of the Joint Professional Military
    Education II (JPME) awarding courses. With the completion of the JDAL
    assignment and JPME I and II, we can ostensibly produce 41 joint
    qualified officers per year though the Standard-JDAL Path.
        Once we have established Joint Force Headquarters (JFHQs) on the
    Joint Manning Documents a few Traditional/M-Day State positions may
    become JDAL billets. Incumbents of these positions would need to serve
    in these JDAL positions for a total of 6 years in order to earn the
    required points to become joint qualified. We are working with the
    Chairman of the Joint Chiefs of Staff and his staff to expand our
    opportunities for fully developing joint qualified officers. For
    example, the Reserve officer timeline is being reviewed to determine if
    there is a way to reduce the timeline without diminishing the integrity
    of ``joint qualification''. Furthermore, we're seeking increased
    educational opportunities in order for National Guard officers to
    participate in programs along side of our Active component
    counterparts.
        Through a combination of joint duty assignments, mobilizations, and
    utilization of limited existing educational opportunities, we have
    managed to improve our joint qualification status over the past 3
    years. Over 114 National Guard officers have been granted some
    experience points through the self-nomination process. Also 35 members
    have been granted Level II Joint Qualification and 25 members have been
    awarded the Joint Qualification Officer Designation. With the increase
    of additional JDAL positions and JPME II awarding school quotas, we can
    improve these numbers.
        General Stultz. Although much still needs to be completed to
    significantly increase the joint qualification rates for USAR officers,
    some important steps have been taken towards that goal.
        In March 2008, the Reserve Component Officer Joint Qualification
    Program Guidance was published. This established two paths for
    traditional Reserve officers to become qualified in joint operations.
    Through this program, Reserve officers can accumulate joint credit via
    a Standard Duty Assignment (S-JDA) path or the Experience Joint Duty
    Assignment (E-JDA) path. The S-JDA credit comes from assignments on the
    Joint Duty Assignment List (JDAL), while the E-JDA credit comes from
    joint experience gained while in positions not on the JDAL or from
    appropriate civilian experience. The E-JDA path is critical for
    traditional reservists, who typically gain joint experience from
    periodic or temporary joint assignments.
        The importance of joint qualification is being communicated by
    several methods. We have delivered several strategic communications to
    all USAR officers explaining the process to apply for joint credit, and
    promotion boards are being instructed to consider joint qualification
    in determining the best-qualified officers.
        One of the challenges to increasing joint qualification across the
    USAR is the current lack of Troop Program Unit (TPU) positions on the
    JDAL. Additionally, a final determination has not been made on the tour
    length requirement for TPU soldiers to receive S-JDA credit. Finally,
    the USAR is attempting to identify TPU positions eligible for E-JDA
    that are not associated with deployments.
        Joint qualification ensures that leadership has the critical
    thinking skills and experience to conceive and apply joint solutions to
    the 21st century battlefield. We will continue to take the necessary
    steps to increase the number of USAR officers qualified in joint
    operations.
        Admiral Debbink. JPME education is the foundation of the Joint
    Qualification System and Navy Reserve has funded 100 percent of our in-
    residence quotas (70 total for JPME I/II enrollment) in fiscal year
    2010. Additionally, we have funded distance learning courses (500
    personnel) for JPME phases I and II annually. Of note, we also seek out
    and regularly fill unfilled Active component quotas in the various JPME
    phase I and II courses. In fiscal year 2011, we requested and received
    10 additional in-residence quotas per year and will continue to offer
    these joint education opportunities and others to our sailors in the
    future.
        OCO over the past several years have given Reserve officers, both
    full-time support (FTS) and SELRES, more opportunities to become a
    Joint Qualified Officer (JQO) through experience tours. With the
    implementation of the Joint Qualification System Experience Review
    Process, Reserve officers have been able to gain parity with Active
    officers in receiving credit for their joint experiences while on
    Active Duty. Since October 2007, the approval ratings for joint credit
    submitted for panel review for Navy Active and Reserve officers is at
    85.7 percent and 85.2 percent, respectively. Of the total 39 Navy
    Active and Reserve officers who have attained JQO status via the
    Experience Review Process, 22 (56.4 percent) are from the Active
    component and 17 (43.6 percent) are from the Reserve.
        For SELRES, joint qualification is more challenging because of the
    present requirement to serve for 72 months in a Standard Joint Duty
    Assignment (S-JDA) position. The Navy Reserve is working with the
    Office of the Secretary of Defense (OSD), the Joint Staff and the other
    Services to develop policies that will enable SELRES officers to attain
    joint qualifications within the construct of their existing annual
    service requirements. One of the recommended policy changes is to
    decrease S-JDA tour lengths for drilling reservists to provide members
    with increased flexibility. However, this will require SELRES officers
    to serve in more than one joint assignment to meet JQO requirements.
        Today, most SELRES officers are achieving JQO through experience
    credit for qualifying joint experiences. However, as operational
    requirements change or are reduced, this will impact our members'
    ability to achieve the requirements of JQO Levels II, III, and IV
    through the experience track. Because of this, it is imperative more
    SELRES Joint Duty Assignment List (JDAL) billets are identified to
    enable Reserve officers to qualify via the standard path. The Services
    are expecting the next JDAL, scheduled for release in late summer, will
    contain many Joint Staff headquarters SELRES positions. These positions
    will aid in providing SELRES officers with opportunities to qualify for
    JQO designation through the S-JDA process in the future, but more
    Reserve component JDAL billets are still necessary to provide a viable
    part time path to JQO for Reserve component officers.
        General Kelly. We continue to emphasize the importance of having
    our Reserve officers become joint qualified. The first step in our plan
    is for all field grade Reserve officers to complete Phase I of JPME
    qualification. We ensure our Reserve officers have several
    opportunities to complete JPME I by offering both resident and non-
    resident courses. Resident courses provide the opportunity for the
    individual reservist to participate in the full-length 10 months of
    course work. Resident courses are challenging for the Reserve component
    officers to attend. We currently receive 16 school seats from the four
    Service Command and Staff colleges; however, the limiting factor is the
    ability of the Reserve officer to be able to take 9 to 10 months off
    from civilian employment to attend a full-length school. While use of
    resident courses has been challenging, we have seen success in
    increasing the rate of JPME I qualified Reserve officers through our
    non-resident weekend seminar program. This fully funded program offers
    Reserve officers an opportunity to attend monthly seminars at one of 16
    different locations across the country.
        While not in great number, we also receive school seats and
    encourage attendance at JPME II accredited resident programs at the
    Service War Colleges and combined (JPME I & II) programs at the
    National War College, Industrial College of the Armed Forces, and the
    Joint Advanced Warfighting School. Again, the issue is more of time for
    the Reserve officer. We will need to explore additional opportunities
    for our Reserve officers to receive JPME II as the Marine Corps
    currently does not have a seminar program for JPME II.
        The most challenging issue with Reserve officers obtaining the
    Joint Qualification is finding the billets and the time to serve either
    2 years in a full time or a cumulative 3 years in a Joint Duty
    Assignment--Reserve. Without a change to this requirement for Reserve
    officers, we do not foresee our rate of fully joint qualified officers
    increasing dramatically.

        5. Senator Burris. General McKinley, General Stultz, Admiral
    Debbink, and General Kelly, have you budgeted for joint qualified in
    the Program Objectives Memorandum?
        General McKinley. Yes, we have budgeted for Joint qualified
    courses. There are a number of courses in the Army National Guard
    (ARNG) program which provide joint certification or credit. Seat
    allocations for joint courses are determined at an annual Structure and
    Manning Decision Review. The joint courses for professional education
    (JPME) are the following:

             Resident Intermediate Level Education Course (JPME
            level I)-- 40 seats/year
             Resident Army War College (JPME level II)-- 17 seats/
            year
             Joint Advanced Warfighting School (JPME level II)--one
            seat every other year
             Reserve Component National Security Issues Seminar (2
            Joint Qualification Points)--25 seats/year
             Reserve Component National Security Course (2 Joint
            Qualification Points)--25 seats/year

        The ARNG does not program for, or receive seat allocations for
    Advanced JPME; we receive limited seats from Human Resources Command
    during the current year.
        General Stultz. Yes, the USAR has programmed the school seats
    necessary to support the educational requirements for the joint
    qualified designation.
        Admiral Debbink. Yes; the joint education programs are high on our
    priority list, and we have budgeted for the JPME quotas as part of our
    RPN discretionary funds. Additionally, we have funded and budgeted for
    the Naval War College distance learning materials from OMNR funds.
        General Kelly. Joint qualified can be achieved in two different
    ways: (1) through attendance at a formal PME school and PCS to a 3-year
    joint billet; or (2) attendance at a formal PME school plus 3 years
    cumulative time in joint billets. COMMARFORRES does not have any direct
    resourcing responsibilities with regard to the joint qualification of
    the Reserve component. Conversely, TECOM budgets/programs for all joint
    PME formal schooling to include associated temporary assigned duty and
    M&RA budgets/programs for all associated PCS to joint billets.

        6. Senator Burris. Secretary McCarthy, General McKinley, General
    Wyatt, General Carpenter, General Stultz, Admiral Debbink, General
    Kelly, and General Stenner, in 2001, OSD, Reserve Affairs, in a report
    for the 2001 Quadrennial Defense Review, outlined a new approach to
    military service as a continuum between full-time duty and service for
    only a few days a year. The report suggested ``a new availability and
    service paradigm--referred to here as a continuum of service (COS)--
    that provides individual servicemembers greater flexibility in becoming
    involved in and supporting the Department's mission. In turn, the
    Department would have greater flexibility in accessing the variety of
    skills required to meet its evolving requirements.'' What are your
    thoughts on the COS initiative?
        Secretary McCarthy. The Department of Defense (DOD) is committed to
    an effective COS. Faced with the competing demands of providing an
    affordable national defense and maintaining the all-volunteer character
    of the military, we must find an approach that facilitates the
    maintenance of a balanced Total Force. The Reserve components must
    provide a trained and cost-effective expansion force, ready to augment
    and reinforce the Active component, in time of war and in support of
    other contingencies.
        Statutory policies and directives, as well as cultural, financial,
    and technological factors, often impede the seamless movement of Total
    Force members between components. In combination, these factors can
    constitute barriers that seriously diminish the capacity of the
    Department to acquire and retain the personnel and skills needed today
    and in the future.
        The goal of the COS is to dissolve the lines between Active
    component and Reserve component duty so movement from one to the other
    status offers optimum operational flexibility. The COS also facilitates
    different levels of part-time affiliation that are more consistent with
    how Guard and Reserve members are currently being utilized.
        General McKinley. In many ways, both the COS and the
    Operationalization of the Reserve Component concepts are essentially a
    reflection of the modern reality in the National Guard. These concepts
    help the National Guard Bureau shape our strategic planning,
    particularly in terms of utilization and development of our human
    capital, our soldiers and airmen. In the National Guard, our principal
    effort related to the COS is an initiative focused on Senior Leader
    Development. Key leaders from both the Army and ANG from across the
    Nation have been helping to generate new policy initiatives to ensure
    that our assignment, education, and promotion policies all facilitate
    the repeated changes in duty status--from traditional guardsman to
    mobilized soldier or airman to Active Guard and Reserve (AGR) and
    back--that are required in order to sustain our support of OCOs. These
    initiatives both touch every member of the National Guard, but not in a
    negative way. Every Guard soldier or airman in our all-volunteer
    organizations has either joined the Service or made a decision to
    reenlist or extend at some point following September 11. Our force
    consists of soldiers and airmen who have chosen to be a part of an
    operational force. The policy initiatives aren't intended to ask more
    of them, but rather will ensure that we maximize opportunities for
    their growth and development in support of operational requirements.
    The COS ready set for the National Guard means that members of the
    National Guard have a broader exposure to point qualification training,
    assignments, and immersion in positions of increased exposure and
    familiarization of multiple service duties (both Title 10 and Title
    32). Additionally, the alignment of authorities for call to duty are
    broader with a range of purposes. Today the National Guard has 27 duty
    statuses that require new orders for the specific purpose of duty. Each
    of these purposes must be aligned with either title 10 or 32 and we
    propose that once a member is called to duty in either title 10 or
    title 32 status that a range of purposes could be proposed with one
    single call to duty order thus reducing the complexity of systems of
    record and cascading pay and entitlement changes. While the COS
    initiative could remove barriers, we must continue to balance the
    demands of our soldiers and airmen in relationship to their time away
    from employers and family. Both of these are absolutely critical so
    they must be carefully considered when reviewing readiness training and
    further development of our force. We will carefully consider this
    stewardship and fragile balance of demands.
        General Wyatt and General Stenner. The COS initiative is an
    initiative we support, and we have to get it right. Moving between
    total force components can be difficult. Airmen often encounter
    barriers when transitioning between the AFR, ANG, and the regular Air
    Force. The depth and breadth of the skills of our highly trained, ready
    force means nothing if our airmen are not accessible.
        The COS initiative is our consolidated, Total Force effort to
    increase that accessibility by eliminating barriers to participation
    and exploring creative, innovative paths to service. Through this
    initiative, the AFR seeks to remove the barriers to service which
    encumber the seamless movement between duty statuses required to
    support total force operations. Two examples of barriers that the COS
    initiative is working to address include streamlining the accession
    process from military to civilian government employment and easing a
    member's transition between components without jeopardizing pay or
    medical care.
        With the removal of barriers like these, the COS initiative can
    promote the development of a total force human resource management
    system that retains highly skilled airmen for a lifetime of service.
    This also means making sure people who leave the Active component have
    an option to continue serving in the AFR as part of a COS.
        The AFR is 100 percent behind each Total Force initiative and is an
    active team member at the COS table. We are diligently working to
    continue to identify the existing barriers so we can eliminate those we
    can and minimize the rest.
        General Carpenter. In many ways, both the COS and the
    Operationalization of the Reserve Component concepts are essentially a
    reflection of the modern reality in the National Guard. These concepts
    help us to shape our strategic planning, particularly in terms of
    utilization and development of our human capital, our soldiers and
    airmen. In the National Guard, our principal effort related to the COS
    is an initiative focused on Senior Leader Development. Key leaders from
    both the Army and ANG from across the Nation have been helping to
    generate new policy initiatives to ensure that our assignment,
    education, and promotion policies all facilitate the repeated changes
    in duty status---from traditional guardsman to mobilized soldier or
    airman to Active Guard and Reserve (AGR) and back--that are required in
    order to sustain our support of OCOs. Frankly, these initiatives both
    touch every member of the National Guard, but not in a negative way.
    Every Guard soldier or airman in our all-volunteer organizations has
    either joined the Service or made a decision to reenlist or extend at
    some point following September 11. Our force consists of soldiers and
    airmen who have chosen to be a part of an operational force. The policy
    initiatives aren't intended to ask more of them, but rather will ensure
    that we maximize opportunities for their growth and development.
        General Stultz. Ensuring a COS is a human capital objective seeking
    to inspire soldiers to a lifetime of service. An effective COS would
    allow an individual to serve a career seamlessly transitioning between
    Active (full-time), Reserve (part-time), or civilian status based on
    both the needs of the Army and the needs of the individual. As national
    security demands and personal circumstances change, the soldier's
    status could change without severing his or her military affiliation. A
    COS would provide the Army's personnel management system maximum
    flexibility allowing the Army to leverage talent, military and civilian
    skills, experience and expertise at the right place and time for
    maximum impact. A fully functioning continuum would be cost effective,
    reducing recruiting, retention, transition and training costs.
    Establishing a truly functional COS requires modifying policies,
    processes, and some statutes to define training and professional
    development, career benefits (compensation, entitlements), transition
    requirements, and management procedures. The Army currently is moving
    incrementally toward a COS. The end-state is to maintain a
    comprehensive system of human capital management (COS) utilizing the
    best talent available to ensure national security. Achieving the end-
    state will require the cooperative efforts of the Army, DOD, and
    Congress.
        Admiral Debbink. The Chief of Naval Operations, Admiral Roughead,
    has described COS as a strategic imperative. Navy's vision is a
    personnel management system that allows us to recruit sailors once and
    retain them for life through variable and flexible service options
    providing a career continuum of meaningful and valued work. COS allows
    the ability to change lanes easily from Active to Reserve and back
    again which will pay significant dividends for both our people and the
    Navy. COS will: help improve life-work balance and flexibility for our
    military personnel; improve retention and fit; and decrease recruiting
    costs by allowing recruiters to focus on people joining the Navy for
    the first time, instead of re-recruiting our veterans. The COS value
    proposition is a ready, relevant, and cost-effective workforce that
    provides both operational flexibility and strategic depth at the most
    value to the Navy.
        General Kelly. MARFORRES generally supports efforts to improve the
    COS, but believes these efforts need to be tailored to each Service's
    unique requirement. Currently (as provided by RA) the Marine Corps has
    no official position regarding this question.

        7. Senator Burris. Secretary McCarthy, General McKinley, General
    Wyatt, General Carpenter, General Stultz, Admiral Debbink, General
    Kelly, and General Stenner, how many Reserve component personnel are
    affected by this policy and what are the projected costs?
        Secretary McCarthy. The COS concept applies to all military
    servicemembers in the Active component (1.4 million) and the Reserve
    components (851,000 Selected reservists and 218,000 Individual Ready
    reservists).
        A comprehensive cost analysis of this policy has not been
    completed. Individual legislative proposals supporting this initiative
    are forthcoming and will include cost estimates when applicable. The
    remaining issue is access to servicemembers and reducing the barriers
    that impede the seamless movement of Total Force members between
    components. The COS capitalizes on the operational experience of the
    Active Guard and Reserve components and enhances a return on our
    training and education investment. Making the best use of our military
    talent pool, particularly in an era of increasingly constrained
    resources, translates to a more capable force at a lower cost.
        General McKinley. The COS is a human capital strategy rather than a
    program or policy, as a result the National Guard Bureau cannot at this
    time provide the number of Reserve component personnel that would be
    affected or a projected cost. However, this strategy would impact the
    majority of Reserve component personnel. For example, there are
    multiple barriers that cause interruptions in pay, benefits, and
    entitlements when Reserve component members transition the continuum of
    Active, Reserve, civilian, and inactive service. Removing these
    barriers would go a long way toward achieving the goal of retaining and
    effectively employing highly qualified military members throughout
    their careers.
        General Wyatt and General Stenner. Since 2007, the Air Reserve
    Personnel Center (ARPC) has processed approximately 583 joint
    applications (480 in the Joint Management Information System and 103 in
    the legacy system). Of the 583, only 13 officers are fully Joint
    Officer qualified (level III) while 34 are level IIs. Our numbers are
    low because all eligible Reserve officers have not yet applied. We are
    diligently communicating joint requirements and application processes.
        We are focusing our efforts on increasing the number of AFR
    positions on the Joint Duty Assignment Listing (JDAL) as well as slots
    in joint education schools. We are reviewing AFR billets (Active Guard
    and Reserve, IMA, and traditional reservists) that the joint matters
    definition and collaborating with combatant commanders' (COCOM) staffs
    to address those eligible for JDAL inclusion. This allows us to make
    the best use of existing resources and appropriately acknowledge the
    individuals working in those positions doing joint work. This effort is
    accompanied by pursuit of the training slots which must/should go with
    the JDAL billets in order to get our officers formal joint
    qualifications. Lastly, we have a deliberate methodology to move our
    younger officers--in particular our developmental education graduates--
    into joint experiences early in preparation for future opportunities as
    senior officers.
        To date, the costs have been negligible. We are working with the
    COCOMs to re-designate already funded full-time and part-time billets
    into the JDAL. The only other costs at this time have been the manpower
    costs associated with administering this program, which equates to
    approximately three full-time equivalents. These costs have been
    absorbed into executing our existing personnel programs.
        General Carpenter and General Stultz. The COS is a human capital
    strategy rather than a program or policy, as a result the National
    Guard Bureau cannot at this time provide the number of Reserve
    component personnel that would be affected or a projected cost.
    However, this strategy would impact the majority of Reserve component
    personnel. For example, there are multiple barriers that cause
    interruptions in pay, benefits, and entitlements when Reserve component
    members transition the continuum of Active, Reserve, civilian, and
    inactive service. Removing these barriers would go a long way toward
    achieving the goal of retaining and effectively employing highly
    qualified military members throughout their careers.
        Admiral Debbink. Because the COS is a key element of a
    comprehensive personnel management strategy that provides service
    options to both Active and Reserve component sailors, every sailor in
    the Navy Total Force is affected by COS initiatives. COS is not a
    Reserve-centric imperative.
        Although initially there are costs associated with realignment of
    personnel and programs to support COS efforts, it is anticipated that
    the benefits of these initiatives when realized will be fiscally
    positive. Specifically, the COS value proposition benefits recruiting
    and training efforts, reducing costs as sailors are afforded flexible
    service options to seamlessly transition between Active component and
    Reserve component. COS will help our Navy more efficiently retain the
    talents of a skilled and ready workforce and provide a career continuum
    of meaningful and valued work. COS will ultimately allow an individual
    to have the option to serve over the course of a lifetime.
        General Kelly. We are unable to provide an accurate answer to this
    question within the allotted timeframe. This question will require
    detailed analysis by the Service Level Headquarters.

        8. Senator Burris. Secretary McCarthy and General McKinley, how
    does DOD plan to implement the COS policy?
        Secretary McCarthy. The Report of the Commission on the Guard and
    Reserve included 14 recommendations on the COS. In responding to these
    recommendations, the Department has made significant progress on the
    establishment of a joint duty career path for Reserve officers and
    enlisted members. The Department is developing a civilian skills data
    base to allow Reserve component members to enter and receive credit for
    civilian training and skills.
        Additionally, a Joint Service COS Working Group was established to
    identify and eliminate barriers to fielding capabilities by providing
    seamless transition between Total Force components (Active component,
    Reserve component, and civilians) to fill the Nation's requirements.
    Coordinated actions between Services result in retention of experienced
    and trained individuals and eliminate barriers that prevent transition
    between differing service commitments and between military and civilian
    service.
        The Working Group is addressing the reform of military personnel
    records information management, to include a review of the types of
    information (such as waivers and law enforcement infractions) that
    should be maintained throughout servicemembers' careers. It is also
    addressing the life cycle management of medical records. The Working
    Group continues to work with the Services on improving the seamless
    transition between the Active and Reserve components. As an example,
    Navy's Perform to Serve Program now has a SELRES option, whereby a
    member being released from Active Duty can affiliate into the Reserve
    component without having to process through recruiting.
        General McKinley. At the National Guard Bureau we will continue to
    work with DOD to implement a COS policy. Current ongoing initiatives
    supporting the COS strategy would significantly improve smooth
    integration of the Reserve component into the Total Force and enhance
    unity of effort thus improving overall military readiness. Several
    legislative or policy changes are under consideration that would better
    enable the Reserve component to serve as an operational force.

        9. Senator Burris. Secretary McCarthy and General McKinley, how
    does policy support the plan to operationalize the Reserve component?
        Secretary McCarthy. The DOD Directive 1200.17, published in October
    2008, established the overarching set of principles and policies to
    promote and support the management of the Reserve components as an
    operational force. It outlines the major stakeholders' responsibilities
    and defines terms of reference necessary to accomplish those
    responsibilities. The current policy based on this directive defines
    the duration and frequency for orders to Active Duty and implements the
    train, mobilize, deploy model that ensures our servicemembers are
    mission ready yet able to balance the needs of their families, civilian
    careers, and periodic military service.
        General McKinley. While the COS strategy is a broad concept under
    development rather than a policy per se, the strategy is critically
    important to continued success in operationalizing the Reserve
    component. Current ongoing initiatives supporting the COS strategy
    would significantly improve smooth integration of the Reserve component
    into the Total Force and enhance unity of effort thus improving overall
    military readiness.
                                     ______

                   Questions Submitted by Senator John McCain
                   force structure for the air national guard
        10. Senator McCain. General Wyatt, on June 26, 2009, the Air Force
    formally announced force structure realignments for fiscal year 2010,
    including the following for the Arizona ANG at Davis-Monthan Air Force
    Base: ``The 214th Reconnaissance Group has an increase of 217 drill
    positions to meet validated MQ-1 shortfalls. Total impact is an
    increase of 217 drill positions.'' From this statement, the Air Force
    clearly identified a need to meet validated MQ-1 (also known as the
    Predator) mission shortfalls. What is the current status of the
    increase of 217 positions for the 214th?
        General Wyatt. The original Air Force fiscal year 2010 Force
    Structure Announcement (FSA) that went public on 26 Jun 09, errantly
    reflected a +217 drill positions for the 214th Reconnaissance Group
    (RG). These were holdover positions that were the result of attempting
    to place manpower back into Arizona when the fiscal year 2010 Combat
    Air Forces (CAF) Redux was going to result in the loss of 30 F-16s from
    the 162 Fighter Wing in Tucson. When that force structure reduction for
    Tucson was later reversed by OSD, the 217 drill positions added to the
    214 RG Unit Manning Document were placed back at Tucson. This
    correction was made and reflected in the 21 Sep 09 version of the FSA.
    The increase of 217 positions at the 214 RG was to increase their
    capability beyond the one Combat Air Patrol (CAP) they currently fly.
    The 214 RG is sufficiently manned to fly their current Unit Type Code
    (UTC) tasking of one steady state MQ-1 CAP. No additional manpower
    resources are currently scheduled to be added to the 214 RG.

        11. Senator McCain. General Wyatt, is the ANG taking part in an Air
    Force study to determine the objective manning authorizations for an
    MQ-1 squadron? If so, can you give me an update on this action?
        General Wyatt. The NGB is in the process of developing a manpower
    study plan to validate the MQ-1 manpower requirement with the goal of
    completing the study by end of fiscal year 2010. Additionally, we have
    developed a ``model'' Unit Manning Document (UMD) for implementation at
    each of our MQ-1 units, incorporating distilled lessons learned from
    over 4 years of MQ-1 operations. Our goal is to standardize each of our
    existing units to this model, as well as ensure that each new unit is
    designed in accordance with the model UMD. This will ensure that units
    are manned efficiently and able to meet sustained operational demands.

        12. Senator McCain. General Wyatt, when will a final determination
    be made on the number of positions to be added to the 214th?
        General Wyatt. While the Air Force would like to increase the
    capacity at the 214th beyond their current 1 CAP UTC, fiscal
    constraints on manpower resources have prohibited an increase in
    capacity at the 214 RG without offsetting ANG manpower from other valid
    mission sets in the State of Arizona.

              facilities and infrastructure for the national guard
        13. Senator McCain. General McKinley, I am aware that over half of
    the 3,300 readiness centers (formerly known as armories), across the
    country needed to train 358,000 ARNG members are rated as inadequate to
    support their assigned mission by the Adjutant Generals in each State.
    The substandard conditions of these facilities, as well as locations
    that do not reflect current demographic trends, impact the ability to
    train and quickly respond to State requirements as well as Federal
    missions. Are you comfortable that the amounts proposed in the current
    Future Years Defense Plan to invest in readiness centers?
        General McKinley. The current Future Years Defense Program contains
    only a fraction of what is necessary in both military construction
    (MILCON) and Operations and Maintenance Restoration and Modernization
    to appropriately locate and adequately refurbish ARNG readiness centers
    to a standard that enables a 21st century Army National Guard
    operational reserve. The ARNG has a 14.2 million square foot shortfall
    in Readiness Centers. If the current level of funding in the Future
    Years Defense Program is sustained over the next decade, the average
    age of readiness centers will increase from 40 years to 50 years and
    will not address the current square footage shortfall. These readiness
    centers do not support training an operational force because they were
    designed and built prior to 1960, with lower training requirements,
    fewer personnel, and less equipment.

        14. Senator McCain. General McKinley, what is the National Guard
    Bureau doing to address this issue?
        General McKinley. The National Guard Bureau works with all 54
    States and Territories to work around solutions to its operational
    challenges. Facilities are being refurbished with modest migrations
    from ARNG Operations and Maintenance, Facilities Sustainment funds
    focused on those facilities that are most at need. An analytical
    process is used to identify the most pressing MILCON requirement, which
    determines the distribution of funding. We coordinate our requirements
    with the Army and Secretary of Defense and communicate the impacts of
    lack of funding.

        15. Senator McCain. General McKinley, how would you assess the risk
    to the mission from the conditions of readiness centers?
        General McKinley. I would characterize the risk as moderate and
    increasingly dire as the MILCON investment is redirected to other
    priorities. Buildings are brick and mortar, and unlike the soldier that
    adapts to adversity, will fail if not adequately cared for. Recruiting
    is adversely effected because most our facilities were built in 1960
    and earlier, and American demographics shifted the recruiting base away
    from those facilities. These older facilities do not have the
    infrastructure or size to accommodate today's training simulators and
    equipment to train an operational force.

        16. Senator McCain. General McKinley, what can be done to improve
    the usefulness of readiness centers to meet the needs of the Guard and
    each State?
        General McKinley. ARNG Readiness Centers provide unique
    capabilities to the State and community. With approximately 3,000
    Readiness Centers in virtually every community across the Nation, the
    ARNG provides not only a place for soldiers to drill but also a
    facility that often hosts events for soldiers and their families as
    well as other community activities. Many can serve as a shelter to
    large numbers of civilians in the event of natural or man-made
    disasters. Furthermore, since Readiness Centers are traditionally
    located in the heart of the community, they allow a location for
    National Guard soldiers to quickly assemble and draw equipment in order
    to support domestic support operations. Readiness Centers can also
    serve as logistics centers and resource distribution points for
    interagency crisis response.
        The age of current National Guard facilities threatens rapid
    response capability. The average age of a Readiness Center is 41 years
    old. Forty percent of all Readiness Centers are over 50 years old and
    don't meet space standards for administration, classrooms, supply, and
    maintenance.
        The ARNG needs significant investment in Readiness Centers in terms
    of both MILCON and O&M Restoration and Modernization funding. Worn out
    or obsolete Readiness Centers need to be replaced, and in many cases,
    new facilities should be opened near population centers that can
    support the authorized force structure. Other Readiness Centers can be
    refurbished and continue to be used for a few more decades. Building
    new facilities and refurbishing existing facilities, especially with
    energy saving features, will result in a more efficient, more prepared
    force that will support the mission as well as the local communities.
        Many Readiness Centers lack the space and quality currently
    authorized. This limits multi-agency operations and impacts
    organizational capabilities and effectiveness, specifically the ability
    to store equipment on site and allow rapid response to incidents. As a
    result, many do not meet existing requirements for storage space. In
    cases where facilities do not meet code requirements (Americans with
    Disabilities Act, restrooms for females, and sufficient parking), this
    reduces their ability to serve as community-based shelters. Many
    Readiness Centers are not optimally sited for emergency response, due
    to population shifts since the buildings were constructed.
        Many ARNG Training Sites rely on World War II wood barracks for
    billeting and lack authorized administrative/classroom facilities that
    would allow training on homeland defense and OCO tasks. Many of these
    facilities lack proper support for the IT requirements of today's
    technologically-oriented military. Also, many of these facilities have
    not kept pace with an evolving Army and do not have adequate
    administrative spaces for current manning/staffing requirements, or
    classroom space to efficiently train soldiers.
        Many of the older vehicle maintenance facilities do not have the
    capacity to adequately service today's inventory of vehicles, resulting
    in lower vehicle operational readiness rates that degrades collective
    training and vehicle availability in the event of an emergency.
    Maintenance bays are too small to accommodate larger vehicles. Cranes
    and lifting devices do not have the capacity to lift larger motors.
    Storage is inadequate to hold the size and quantity of spare parts
    required to maintain these vehicles. Parking surfaces around the
    maintenance facilities are too small to store all of the assigned
    vehicles. Also, new ARNG equipment has increased demand for space to
    store vehicles and parts.
        The ARNG has recently taken up the challenge to bring the older
    facilities ``up to code'' and make them energy efficient. Also, when
    the ARNG builds a new facility, the goal is to use innovative and
    sustainable building strategies. Recent ``green'' accomplishments
    include energy saving initiatives along with the reduction of hazardous
    waste.
        The Arizona Guard is using the Earth's natural insulation to heat
    and cool their 5,200 square-foot ECO-building. The building is burrowed
    into the ground within walls of recycled tires filled with compacted
    earth. The building also has an atrium that is designed to provide
    abundant natural light. The roof has cisterns that collect rain water-
    runoff. On the grounds the facility has 18-kilowatt photovoltaic wind
    turbines. The State has a central energy control system that controls
    the indoor climate of the ECO building as well as many other public
    buildings across the State.
        The Michigan Guard revamped their re-painting facility to use non-
    toxic paints and paint stripping processes. They switched from a
    solvent-based paint to a water-based paint and shifted from a hazardous
    working environment to one that is virtually pollution free for the
    environment and for the workers. They also shifted from a toxic paint
    stripping process to a water-based solution using high-pressure water
    jets. By filtering and regenerating waste water, they reduced waste to
    about 2 to 3 pounds per vehicle.
        The Colorado Guard has a new Army Aviation Support Facility
    constructed primarily from recycled and locally-made materials. The
    facility is lighted almost entirely by sunlight during day time
    operations. The facility uses roof runoff to irrigate drought-resistant
    plants. The facility also has a unique modular design that accommodates
    a full-time staff of 70 and ``expands'' to handle the drill weekend
    staff of 350 soldiers.
        The Minnesota Guard has a new model for readiness centers with
    Federal, State, and community missions. Ten of Minnesota's 63 readiness
    centers are designed as ``hybrid'' training and community centers.
    These hybrid centers have amenities such as ice rinks, gyms, banquet
    halls, and exhibition space.
        The Hawaii Guard has taken an interagency approach breaking ground
    with a new facility they will share with the USAR and the Hawaii Office
    of Veterans Services. This facility will make use of photovoltaic
    panels to help reduce energy usage and costs.
        The New Mexico Guard is building a 30-module 54-kilowatt
    photovoltaic solar farm. This solar project will not only reduce the
    amount of electricity bought from the service provider but will also
    reduce the amount of greenhouse gases generated by the consumption. The
    New Jersey Guard recently completed a 170-kilowatt photovoltaic car
    port. This car port takes underutilized space to provide shelter for
    parked vehicles and generates electricity for some of Sea Girt training
    site facilities. The renewable energy produced will reduce
    approximately 165 tons of greenhouse gas emissions annually.
        Projects include the construction of a new Readiness Center in
    Owensboro, KY, to replace a building whose foundation is in danger of
    failing due to severe long-term ground water infiltration. The
    construction of the second and final phase of a Regional Training
    Institute in Bangor, ME, is currently using inadequate World War II era
    facilities. A new construction project supplies potable water to the
    Mead, NE, training site because existing water supply infrastructure is
    outdated and undersized for demand. Infrastructure site work to stops
    the erosion caused by the rising level of an adjacent lake at Camp
    Grafton in North Dakota.
        In light of the critical importance of our Readiness Centers, the
    ARNG plans to conduct a nationwide assessment of our facilities so that
    we can prioritize our efforts in terms of current infrastructure
    conditions and mission requirements. The results of this planned study
    should ensure optimal return on the investment made in these
    installations.

           proposed funding for facilities for the air force reserves
        17. Senator McCain. General Stenner, the AFR has almost 3,000
    facilities at 63 locations supporting 71,000 personnel and 348
    aircraft. With all these facilities and operations, the President's
    budget for fiscal year 2011 proposes only one MILCON project for the
    AFR, a $3.4 million maintenance facility at Patrick Air Force Base, FL,
    at a cost of $3.4 million buried in the total amount of $1.5 billion
    requested for Air Force MILCON. Why is there only one MILCON project in
    the President's budget request?
        General Stenner. During fiscal year 2011 budget formulation, the
    three components of the Air Force (Active Duty, AFR, and ANG) took risk
    in current mission MILCON to fund other essential priorities. The Air
    Force decision was to fund the top current mission priority for each
    Major Command plus new mission requirements. The AFR top current
    mission priority is included in the budget request, and there were no
    new mission requirements for this year which resulted in the one MILCON
    project for the AFR.

        18. Senator McCain. General Stenner, is this a fair and accurate
    reflection of your requirements?
        General Stenner. One current mission MILCON project per year beyond
    this budget year will not allow the AFR to recapitalize our
    infrastructure at an acceptable rate. The AFR currently has over a $1.2
    billion backlog. Reserve component facilities directly correlate to
    readiness as well as quality of life.

        19. Senator McCain. General Stenner, are AFR facilities really in
    such great shape that practically no MILCON funding is needed to
    address facility conditions?
        General Stenner. No, this level of funding for one project was a
    risk taken to fund other priorities. One project per year beyond this
    fiscal year will not allow recapitalization of our aging facilities and
    will substantially increase our current $1.2 billion backlog.

        20. Senator McCain. General Stenner, in your opinion, is the Air
    Force taking steps to correct this disparity?
        General Stenner. The Air Force plans to look much more closely at
    the distribution of MILCON funding in the upcoming Program Objective
    Memorandum (POM) to ensure that all three components' requirements are
    equitably addressed.

              base realignment and closure implementation progress
        21. Senator McCain. General Kelly, Base Realignment and Closure
    (BRAC) 2005 created many challenges for our Reserve Forces. How would
    you assess your Service's progress in implementing BRAC requirements?
        General Kelly. Marine Forces Reserve is executing 25 of the 47
    Marine Corps BRAC Projects. MARFORRES is currently planning for
    successful completion of all BRAC closures and moves by BRAC deadline
    of September 15, 2011. All projects have final siting approval with
    majority under construction. Of special note are the closure of
    Mobilization Command in Kansas City and consolidation with other
    headquarters elements of MARFORRES at the Federal City Project in New
    Orleans. The Marine Compound in New Orleans has recently been
    designated as Marine Corps Support Facility, New Orleans and the
    project is currently ahead of schedule with opening planned for June
    2011. Currently, 3 of the 25 projects (Akron, OH; Lehigh Valley, PA;
    and Brunswick, ME) are being tracked for completion in fourth quarter
    of 2011. These three projects are being managed closely by MARFORRES,
    Navy BRAC Program Managers, and HQMC to seek on-time execution, but
    mitigation plans are be developed for any further slippage to
    accommodate closure and movement into alternate facilities if required.
    Funding tails for operations and maintenance post BRAC are being
    refined and updated for inclusion in future budget submissions.

        22. Senator McCain. General Kelly, as the Commander, Marine Forces
    Reserve, and Marine Forces North, can you please tell me about the U.S.
    Marine Corps' long-term commitment to New Orleans and your vision for
    your headquarters and continued presence there?
        General Kelly. New Orleans has long been a Marine Corps town, and
    we intend to continue this strong relationship with the city and the
    region. The greater New Orleans area is an important strategic port for
    the country because of the Mississippi River, so it is imperative we
    have a strong military presence here. We are proud it is a strong
    Marine Corps presence.
        First, we are constructing the Marine Corps Support Facility, a
    411,320-square foot building at the Federal City campus located in
    Algiers. This $175 million building will house the MARFORRES and
    MARFORNORTH staffs, and will be a permanent fixture of the Marine
    Corps' ongoing commitment to the people of New Orleans. We expect to
    have our troops permanently occupying the facility around June 2011.
        Another strong commitment to New Orleans is exemplified by the
    proposed $1.5 million repair and renovation of Quarters A, located near
    the Marine Corps Support Facility on the Mississippi River. This will
    be the permanent home of Commander, Marine Forces Reserve, which is a
    three-star billet. It has been home to the past two Marine Forces
    Reserve Commanders, and I intend to continue this tradition.
        We have a solid connection with the people of New Orleans, as
    evidenced by our robust community relations program. My Marines are
    volunteering their time rebuilding homes in the Ninth Ward,
    constructing playgrounds for children across town, working in the
    wetlands, and collecting Christmas toys for the underprivileged. I
    envision that connection will grow stronger over the years as the
    Marine Corps continues to call New Orleans home.
                                     ______

                 Questions Submitted by Senator Lindsey Graham
                   force structure for the air national guard
        23. Senator Graham. General Wyatt, on May 11, 2010, the Air Force
    issued its fiscal year 2011 Force Structure Announcement under which
    the 169th Fighter Wing at McEntire Joint National Guard Base is
    scheduled to lose one WC-130H from backup aircraft inventory (BAI) due
    to mission requirements. I understand that Florida and Louisiana are
    also scheduled to lose one C-130 each. I am very concerned with this
    move as South Carolina, Louisiana, and Florida are hurricane States. In
    addition, these aircraft continue to provide critical support to the
    Department of Homeland Security, Drug Enforcement Administration,
    Federal Emergency Management Agency, South Carolina Civil Support Team,
    National Guard, and the Air Force. Why take away 100 percent of these
    three hurricane States' airlift capability, by completely removing this
    capability, does this compromise any facet of their mission?
        General Wyatt. The decision to move these BAI aircraft to other
    higher priority mission needs was an Air Force Corporate Process
    decision in the fiscal year 2011 Adjusted Program Objective Memorandum
    (APOM). These three aircraft represent 2 percent of the entire ANG C-
    130 Tactical Airlift fleet and only 1.5 percent of the total ANG
    airlift capability. We believe our remaining capability will be more
    than sufficient to respond to the Governor's request for assistance to
    a State emergency.
        The ANG still will continue to have enormous airlift capacity in
    the south to support natural or man-made disasters:

          8 C-130s each at Savannah, GA; Nashville, TN; and Little
    Rock, AK
          8 C-5s at Memphis, TN
          8 C-17s Jackson, MS
          4 C-27Js at Meridian, MS, with their conversion in fiscal
    year 2012

        24. Senator Graham. General Wyatt, what percentage of all ANG
    airlift missions did these three aircraft fly in the past year?
        General Wyatt. In 2009, 12,935.5 Mission Ready Airlift (MRA) hours
    were flown; the three Fighter Support Aircraft (FSA) flew 275.1 of
    those hours. Given this data, the Fighter Support Aircraft flew 2.13
    percent of the MRA missions. Current 2010 data:

          Total MRA hours flown: 6,296.7
          FSA hours flown: 216.7
          Percent of overall missions for FSA: 3.44

        25. Senator Graham. General Wyatt, what percentage of the flying
    hours flown by these three aircraft in the past year were actual
    operational missions as opposed to training missions?
        General Wyatt. All missions flown by these aircraft utilize ANG
    flight training hours, whether they are supporting a mission or
    proficiency/training flights. Typically, these missions are broken down
    into MRA, local training, unit- or State-directed, border patrol, and
    Hurricane Relief for tracking purposes. In 2010, the three aircraft
    have flown 357.6 hours, of which, 56 hours were dedicated to local
    training and aircrew proficiency, with 301.6 hours dedicated to other
    mission sets.
    2009 Data:
          695.1 hours flown by the three aircraft
          121.9 hours for training/proficiency
          573.2 hours for other mission sets

        26. Senator Graham. General Wyatt, what savings do these three
    planes save the American taxpayer in travel and transportation costs
    for the supported Fighter Wings, the ARNG, and the National Guard
    Bureau?
        General Wyatt. The Fighter Support Aircraft represent a very small
    percentage of overall ANG airlift capacity and MRA hours. We believe
    our remaining airlift capability will be more than sufficient to meet
    the Governor's request for assistance to a State emergency. Any
    realized cost savings lost by the departure of these aircraft, is more
    than outweighed by the need to realign the tactical airlift fleet of
    aircraft and retire costly legacy aircraft.

        27. Senator Graham. General Wyatt, how many C-130s are there in the
    BAI? Assuming there are dozens of aircraft in the C-130 BAI, why remove
    these three planes from performing vital homeland security missions or
    responding to natural disasters and not utilize three planes from the
    BAI?
        General Wyatt. There is currently one C-130 BAI and five WC-130 BAI
    in the ANG inventory for fiscal year 2011. BAI aircraft are not funded
    in the budget and are intended to be spare aircraft for regular C-130
    units. These six aircraft represent just 4 percent of the entire ANG C-
    130 Tactical Airlift Fleet. In the event of a homeland security
    incident or natural disaster, the ANG stands ready to meet any request
    for assistance that exceeds any impacted State's organic
    responsibility. The ANG stands ready to respond to any Governor's
    request for assistance to a State emergency.
        Since 2007, the three aircraft have flown a total of 2,803.1 hours
    under the following mission sets:

          Mission Ready Airlift - 1,014.8 hours
          Unit/State directed - 1,190.1 hours
          Border Patrol - 194.5 hours
          Training/proficiency - 404.7 hours
          Hurricane Relief - 8.0 hours
          NGB Directed - 11.0 hours

                  access under existing laws to reserve units
        28. Senator Graham. Secretary McCarthy, in your written testimony,
    you state your view that the National Guard and Reserve should be ``the
    force of first choice, for requirements for which they are well
    suited.'' We need to know more about the impediments to achieving this
    goal so that rapid--but equitable--access to the Reserve components can
    be achieved. Do you think the current mobilization authorities are
    sufficiently flexible and are changes in legislation needed?
        Secretary McCarthy. I believe that current mobilization authorities
    are fairly flexible but may present an impediment to future use of the
    Reserve component as an operational force in some situations. We are
    actively studying alternative proposals to either request new
    legislation or suggest modifications of existing legislation.

        29. Senator Graham. Secretary McCarthy, how would you approach the
    task of creating activation authority, short of a Presidential call up,
    that balances the need for readiness and response with dwell time and
    recognition that reservists must be able to stand down?
        Secretary McCarthy. I agree that any proposed authority needs to
    provide a balance between the servicemember's need for dwell time,
    their response and readiness posture, and our Nation's operational
    requirements.
        I support the idea of an access authority to support continued
    future use of Reserve component capabilities as an operational force.
    This authority will need to provide assured access that creates
    confidence with the gaining force commander that the Reserve components
    are reliable sourcing solutions for predictable missions.
        We are exploring the possibility of requesting that Congress create
    a limited access authority short of a Presidential call up, or, perhaps
    revising the wording of the existing Presidential call up that
    facilitates the balanced, judicious, and prudent use of the Reserve
    components as an operational force in our Nation's future worldwide
    security strategy.

        30. Senator Graham. Secretary McCarthy, is the best approach to do
    this solely on a voluntary basis, through service agreements or do we
    need a more flexible involuntary call up?
        Secretary McCarthy. We believe the best approach is to rely on
    volunteerism as an effective way to muster certain capabilities on very
    short timelines. Service agreements are one possible way to increase
    the effectiveness of volunteer duty over a broader set of capabilities.
    We want to ensure a commitment to predictable and periodic obligated
    service as a condition of membership in selected Reserve units.
    However, when we cannot execute our Nation's security mission solely
    based on volunteers, we may require some type of mandatory call up.

        31. Senator Graham. Secretary McCarthy, what do you see as the most
    significant obstacle to realizing a truly operational reserve in the
    post-OCO steady state?
        Secretary McCarthy. DOD worldwide deployments have forced all of
    the Services to acknowledge the fact that the Reserve components are an
    operational force that bring essential capabilities to the battlespace.
    Even an evolutionary paradigm shift, such as the change in our Reserve
    component's expectations of utilization, encounters various levels of
    support. There needs to be a fully embraced cultural shift that
    recognizes that the Reserves are a force of first choice. To
    successfully bring about this shift we need assured access to the
    Reserve units, breeding confidence in the gaining force commander.

                            recruiting and retention
        32. Senator Graham. General McKinley, General Wyatt, and General
    Carpenter, your written testimony indicates that recruiting and
    retention in the National Guard is good, but that there are shortfalls
    in the medical area. Please discuss how each of the Army and ANG are
    doing in recruiting top quality personnel and retaining soldiers and
    airmen in the critical skills you need.
        General McKinley. The ARNG has initiated a medical recruiting
    initiative that targets medical professionals. The goal of the program
    is to initiate a viral marketing effect of recruitment, in which newly
    accessed medical, dental, and physician assistant students assist in
    peer-to-peer recruitment. In addition, the ARNG continues to
    aggressively improve retention of health care professional through
    programs such as the Health Professional Loan Repayment Plan, and
    Retention Bonus programs, which provide incentives from $5,000-25,000
    depending on the critical health specialty.
        The ARNG has also initiated specific programs aimed to address
    shortages in other critical skills. The Military Intelligence Readiness
    Improvement Program commenced in 2004 as the cornerstone of the
    Director of the ARNG's Military Intelligence ``Get Well Plan.'' The
    success of the Military Intelligence Readiness Improvement Program far
    surpassed expectations and contributed significantly to the increase in
    Military Intelligence Personnel Readiness throughout the ARNG.
        In addition, the Low Density Recruiting Program was created to
    address the challenges within other High-Demand/Low-Density Military
    Occupational Skills (MOS), and to more appropriately define expansion
    outside of the Military Intelligence Career Management Field. The key
    component of the program is the ability to facilitate the assignment of
    duty MOS qualification to soldiers with limited geographical
    constraints.
        The Low Density Recruiting Program also works as a tool to retain
    critical personnel in qualified positions who would otherwise require
    training in a different MOS due to the location of their residence in
    respect to the location of their assigned unit.
        General Wyatt. The ARNG has initiated a medical recruiting
    initiative that targets medical professionals. The goal of the program
    is to initiate a viral marketing effect of recruitment, in which newly
    accessed medical, dental, and physician assistant students assist in
    peer-to-peer recruitment. In addition, the ARNG continues to
    aggressively improve retention of health care professional through
    programs such as the Health Professional Loan Repayment Plan, and
    Retention Bonus programs, which provide incentives from $5,000-25,000
    depending on the critical health specialty.
        The ARNG has also initiated specific programs aimed to address
    shortages in other critical skills. The Military Intelligence Readiness
    Improvement Program commenced in 2004 as the cornerstone of the
    Director of the ARNG's Military Intelligence ``Get Well Plan.'' The
    success of the Military Intelligence Readiness Improvement Program far
    surpassed expectations and contributed significantly to the increase in
    Military Intelligence Personnel Readiness throughout the ARNG.
        In addition, the Low Density Recruiting Program was created to
    address the challenges within other High Demand Low Density Military
    Occupational Skills (MOS), and to more appropriately define expansion
    outside of the Military Intelligence Career Management Field. The key
    component of the program is the ability to facilitate the assignment of
    Duty MOS Qualification to soldiers with limited geographical
    constraints. The Low Density Recruiting Program also works as a tool to
    retain critical personnel in qualified positions who would otherwise
    require training in a different MOS due to the location of their
    residence in respect to the location of their assigned unit.
        In regards to the ANG, the advertising branch of the ANG, the
    Recruiting and Retention Directorate, will be launching a precision
    advertising campaign aimed at generating leads to fill critical Health
    Professionals vacancies nationwide. The advertising mediums being
    utilized for this campaign are online search engine marketing and
    online banner ads. All interested individuals will click through to a
    newly designed Health Professional specific landing page www.goang.com/
    hp, providing a single source opportunity sharing platform with
    tracking on the effectiveness of the ads. The projected launch of this
    program is July 2010.
        General Carpenter. The ARNG has initiated a medical recruiting
    initiative that targets medical professionals. The goal of the program
    is to initiate a viral marketing effect of recruitment, in which newly
    accessed medical, dental, and physician assistant students assist in
    peer-to-peer recruitment. In addition, the ARNG continues to
    aggressively improve retention of health care professional through
    programs such as the Health Professional Loan Repayment Plan, and
    Retention Bonus programs, which provide incentives from $5,000-25,000
    depending on the critical health specialty.
        The ARNG has also initiated specific programs aimed to address
    shortages in other critical skills. The Military Intelligence Readiness
    Improvement Program commenced in 2004 as the cornerstone of the
    Director of the ARNG's Military Intelligence ``Get Well Plan.'' The
    success of the Military Intelligence Readiness Improvement Program far
    surpassed expectations and contributed significantly to the increase in
    Military Intelligence Personnel Readiness throughout the ARNG.
        In addition, the Low Density Recruiting Program was created to
    address the challenges within other High Demand Low Density Military
    Occupational Skills (MOS), and to more appropriately define expansion
    outside of the Military Intelligence Career Management Field. The key
    component of the program is the ability to facilitate the assignment of
    Duty MOS Qualification to soldiers with limited geographical
    constraints.
        The Low Density Recruiting Program also works as a tool to retain
    critical personnel in qualified positions who would otherwise require
    training in a different MOS due to the location of their residence in
    respect to the location of their assigned unit.

        33. Senator Graham. General McKinley, General Wyatt, and General
    Carpenter, what, specifically, is the National Guard doing to improve
    its recruiting and retention of health care professionals?
        General McKinley. The ARNG has initiated a medical recruiting
    initiative that targets medical professionals. This program will place
    newly accessed medical, dental, and physician assistant students on T-
    32 Additional Duty Operation Support (ADOS) orders to serve as ARNG
    Medical and Dental Student Recruiters (ASRs) for 1,094 days or the
    completion of their educational program. These positions will be
    available on a first-come, first-served basis and students in all
    States and Territories will be able to participate.
        The goal of this program is to initiate a viral marketing effect of
    recruitment in which the student recruiters assist in peer-to-peer
    recruitment. All ARNG student recruiters will be missioned, and
    performance of this mission will impact orders renewal. Newly
    identified personnel recruited would be afforded the opportunity to
    participate in the ARNG Student Recruiters Programs. The annual cap of
    newly appointed members of the ARNG student recruiters force would be
    200 accessions, with a total program limit of 600.
        The ARNG also continues to aggressively improve the retention of
    health care professional through its current retention programs. This
    includes the Health Professional Loan Repayment Plan, and Special
    Retention Bonuses, where incentives range from $5,000-25,000 depending
    on the critical health specialty.
        The ANG also offers cash bonus, loan repayment, and residency
    stipend to Health Professionals in order to fill critical wartime
    specialties. The Recruiting Operations branch of the ANG Recruiting and
    Retention Directorate has implemented a comprehensive training program
    to improve the officer recruiting and accession process throughout the
    ANG. This training is provided to recruiters, retainers, personnel
    specialists, medical service corps officers, and all others who have a
    role in the Health Professional recruiting and accession process.
        General Wyatt. The ARNG has initiated a medical recruiting
    initiative that targets medical professionals. This program will place
    newly accessed medical, dental, and physician assistant students on T-
    32 ADOS orders to serve as ASRs for 1,094 days or the completion of
    their educational program. These positions will be available on a first
    come, first served basis and students in all States and Territories
    will be able to participate.
        The goal of this program is to initiate a viral marketing effect of
    recruitment in which the student recruiters assist in peer-to-peer
    recruitment. All ARNG student recruiters will be missioned, and
    performance of this mission will impact orders renewal. Newly
    identified personnel recruited would be afforded the opportunity to
    participate in the ARNG Student Recruiters Programs. The annual cap of
    newly appointed members of the ARNG student recruiters force would be
    200 accessions, with a total program limit of 600.
        The ARNG also continues to aggressively improve the retention of
    health care professional through its current retention programs. This
    includes the Health Professional Loan Repayment Plan, and Special
    Retention Bonuses, where incentives range from $5,000-25,000 depending
    on the critical health specialty.
        The ANG also offers cash bonus, loan repayment, and residency
    stipend to health professionals in order to fill critical wartime
    specialties. The Recruiting Operations branch of the ANG Recruiting and
    Retention Directorate has implemented a comprehensive training program
    to improve the officer recruiting and accession process throughout the
    ANG. This training is provided to Recruiters, Retainers, Personnel
    Specialists, Medical Service Corps Officers, and all others who have a
    role in the Health Professional recruiting and accession process.
        General Carpenter. The ARNG has initiated a medical recruiting
    initiative that targets medical professionals. This program will place
    newly accessed medical, dental, and physician assistant students on T-
    32 ADOS orders to serve as ASRs for 1,094 days or the completion of
    their educational program. These positions will be available on a first
    come, first served basis and students in all States and Territories
    will be able to participate.
        The goal of this program is to initiate a viral marketing effect of
    recruitment in which the student recruiters assist in peer-to-peer
    recruitment. All ARNG student recruiters will be missioned, and
    performance of this mission will impact orders renewal. Newly
    identified personnel recruited would be afforded the opportunity to
    participate in the ARNG Student Recruiters Programs. The annual cap of
    newly appointed members of the ARNG student recruiters force would be
    200 accessions, with a total program limit of 600.
        The ARNG also continues to aggressively improve the retention of
    health care professional through its current retention programs. This
    includes the Health Professional Loan Repayment Plan, and Special
    Retention Bonuses, where incentives range from $5,000-25,000 depending
    on the critical health speciality.

        recommendations of the commission on national guard and reserves
        34. Senator Graham. Secretary McCarthy, you have indicated that
    implementing the recommendations of the Commission on National Guard
    and Reserves (CNGR) that have been approved by Secretary Gates is among
    your highest priorities. We have been visited by some of the
    commissioners and were glad to see that you have called on them to
    assist you in this regard. Could you discuss how you plan to go about
    this task and what you view as the most pressing actions that need to
    be taken?
        Secretary McCarthy. The Commission published their final report and
    there were 53 recommendations in the report that the Secretary of
    Defense accepted for action. Implementing these approved action plans
    is among my highest priorities. In order to ensure proper execution of
    these plans, I have restructured my office and assigned a single point
    of contact to further the CNGR implementation efforts and related
    strategic initiatives. Many of the actions called for by the Secretary
    of Defense have already been completed and others have continued down
    their multiyear implementation cycles. The Department's major
    accomplishments include:

             We published DOD Directive 1200.17, Managing the
            Reserve Components as an Operational Force, providing the basis
            for initial strategic planning. It was essential in setting the
            vision and outlining the nine principles to guide the
            management of the Reserve component as an operational force.
             Reserve units are part of force generation models that
            will allow more predictability to Reserve component members.
             U.S. Pacific Command, U.S. Northern Command, and The
            National Guard Bureau have published various Concept of
            Operations Plans for support to Civil Authorities.
             Early access to TRICARE has been extended up to 180
            days prior to activation.
             DOD established the Yellow Ribbon Program office to
            coordinate post-deployment reintegration efforts with the Guard
            and Reserve.

        We plan to continue to stay in touch with stakeholders who are
    committed to fully integrating the Reserve components into the Total
    Force. Future efforts include:

             Identification and elimination of cultural prejudices
            that stand in the way of continued Total Force integration.
             Ensuring that Reserve component readiness issues are
            programmed and funded in the future.
             Ensuring adequate support is available to the families
            and employers of Reserve component members. Longer advance
            notice for mobilizations will lead to less friction and better
            preparation for Reserve component members, their families, and
            employers.

             medical and dental readiness of the reserve components
        35. Senator Graham. General Carpenter, we know that historically
    maintaining medical and dental readiness for the Reserve and Guard has
    been a significant challenge--especially for the ground forces. DOD
    reported that for fiscal year 2008, only 60 percent of the ARNG met the
    Individual Medical Readiness standard. How would you assess the ARNG
    progress in achieving individual medical readiness goals?
        General Carpenter. To date, 63 percent of the ARNG meets DOD
    Individual Medical Readiness standards. From fiscal year 2008 to the
    end of fiscal year 2009, the Army Fully Medically Ready percentage
    increased from 35 percent to 46 percent. The ARNG Dental Readiness GO
    rate at the mobilization platforms has increased from 74 percent in
    fiscal year 2008, to 84 percent in 2010 year to date. The increase can
    be attributed to early and sustained individual soldier medical
    readiness screening through the use of annual Soldier Readiness
    Processing (SRP) events. These SRPs include Periodic Health
    Assessments, dental screening and identification of all Dental
    Readiness Class (DRC) 3 soldiers, and their overall Medical Readiness
    Classification (MRC) 3 issues. MRC 3 issues are documented and
    aggressively case managed to include correction of identified DRC 3
    issues using the Army Selected Reserve Dental Readiness System.

        36. Senator Graham. General Carpenter, what percent of ARNG members
    are currently nondeployable due to medical or dental conditions?
        General Carpenter. Twenty-three percent of ARNG soldiers are
    medically nondeployable, while 11 percent are nondeployable due to
    dental conditions. Issues affecting medical readiness are documented
    and aggressively case managed, including correction of identified
    dental readiness issues using the Army Selected Reserve Dental
    Readiness System. A pilot program slated to begin in fiscal year 2011
    identifies select deploying Medical Readiness Classification 3 soldiers
    for correction and treatment of a deployment limiting medical
    condition.

     mental health outreach for members of the guard and reserve and their
                                    families
        37. Senator Graham. General Carpenter, we know that as many as 15
    percent of our servicemembers who have deployed are returning with some
    kind of mental health need, and that extends to family members as well.
    In the face of a shortage of mental health providers nationwide, are we
    able to meet the needs of members of the Reserve and their families in
    this important area?
        General Carpenter. Yes, currently the ARNG and their families have
    access to contracted civilian behavioral health providers at no cost
    through Military Family Life Consultants, Military OneSource, Directors
    of Psychological Health and various non-profit organizations. The
    Department of Veterans Affairs and Vet Centers continue to expand their
    services and outreach. TRICARE has behavioral health providers, which
    ARNG soldiers can access through the Transitional Assistance Management
    Program, and their families can access through TRICARE Reserve Select.

        38. Senator Graham. General Carpenter, some say that embedding
    counselors within Reserve and Guard units is an effective approach. Do
    you agree? What works and what doesn't?
        General Carpenter. The Army continues to improve the equipment on
    hand (EOH) rates as well as the modernization levels for both the ARNG
    and the USAR. The Army sees this as critical to the transformation of
    the Reserve component from a strategic to an operational reserve. The
    Army Equipping Strategy identifies equipping goals for units as they
    progress through the Army Force Generation (ARFORGEN) cycle. These
    equipping goals apply equally across all three components--Active,
    ARNG, and USAR.
        Beginning in fiscal year 2006, the Army significantly increased its
    investment in ARNG equipment, allocating approximately $28.7 billion
    for new procurement and recapitalization between fiscal year 2006 and
    fiscal year 2010. Of particular significance, the ARNG was fully
    equipped with Single Channel Ground and Airborne Radio System
    (SINCGARS) radios and UH-60 Blackhawk helicopters in fiscal year 2009
    and is on track to complete fielding of M4 rifles by the end of fiscal
    year 2010. However, the Blackhawk fleet is still only partially
    modernized and current funding efforts will not produce a modernized
    fleet until the end of fiscal year 2025. Despite the increased
    investment since fiscal year 2006, the ARNG still has critical
    shortfalls and modernization gaps in the truck fleet, helicopter fleet,
    and digital enablers. In addition to supporting OCO, this equipment is
    critical to supporting the ARNG's Homeland Defense/Defense Support to
    Civil Authorities (HLD/DSCA) missions.
    Modernization
        The Army is committed to equipping soldiers going into harm's way
    with the most capable systems possible. This equipping strategy applies
    to Reserve component units as well as Active component units and is
    designed to modernize the USAR and ARNG on par with the Active
    component.
    Transparency
        The ``CNGR''--also known as the ``Punaro Commission''--provided DOD
    with a set of recommendations designed to improve the operational
    readiness of National Guard and Reserve Forces. Two of the
    recommendations (CNGR #42 and #43) directed DOD to increase the
    transparency of equipment requirements, funding, procurement, and
    delivery. Over the past year, the Army has significantly improved
    transparency within its equipment procurement and distribution
    processes.
        Based on the current Army Equipping Strategy, the Army's commitment
    to equipping soldiers going into harm's way with the most capable
    systems possible and the significant increase in transparency, I am
    confident the ARNG is receiving modern equipment which is compatible
    with the Active component.

              priority for funding of medical and dental readiness
        39. Senator Graham. General Carpenter, despite the importance of
    medical and dental readiness, at the end of the day, my sense is that
    funding for medical and dental readiness does not compete well with
    other priorities, such as training and equipment and that the real
    solution is day-in, day-out leadership within Reserve and Guard units.
    What is the best solution to ensure that funding for readiness includes
    and improves medical and dental readiness?
        General Carpenter. The question can be addressed by increasing
    funding to the appropriate level at a fixed amount not to be reduced
    within the fiscal year by internal taxes or external Department of the
    Army directed bills. The ARNG also needs additional full-time medical
    personnel at the State level to identify and case manage soldiers
    considered non-deployable due to medical and dental issues.

                  access under existing laws to reserve units
        40. Senator Graham. General Stultz, Admiral Debbink, General
    Stenner, and General Kelly, in written testimony, you echo General
    McCarthy's view that the Reserve should be ``the force of first choice,
    for requirements for which they are well suited.'' But you note that we
    need better access to the unique units and capabilities in the Reserve
    in a timelier manner. Please comment on this and be specific. We need
    to know what your concerns are and how to address them.
        General Stultz. Yes, I do believe the Nation could and should reap
    more benefits from increased use of the USAR, specifically in
    operations requiring extensive CS/CSS capabilities.
        Our recent history has shown us that such capabilities are
    oftentimes required in unexpected places with little or no advanced
    warning. Our Army's rapid deployment capability is sufficient to show
    timely responsiveness; but, primarily depending on the Active component
    to demonstrate national will in such instances puts us at risk of
    unnecessarily straining the force, especially if such capabilities are
    required in multiple places. To provide the Nation (and our Army) with
    flexibility and accessible depth enables us to maximize the unique
    capabilities of the USAR to help the combatant commander to build
    partner nation capacity and/or protect and sustain human life anywhere
    on the globe. From my perspective, this can be efficiently accomplished
    through legislation that permits the Secretary of Defense to quickly
    activate reservists for unexpected or last minute requests for
    assistance that, if responded to in a timely manner, can go a long way
    in advancing U.S. interests abroad. This permissive authority would
    also have to be supported by legislation that results in the provision
    of supportive services to the soldier and the soldier's family as soon
    as the soldier is notified of a pending mobilization and deployment.
        Admiral Debbink. My specific concerns are:

        (1)  The need to establish the legal authority to most effectively
    delegate access to the Reserve components.
        (2)  The need to plan for sustainable funding in a post-OCO
    environment that will ensure the Services have adequate resources to
    access the strategic depth and operational capabilities of their
    Reserve components.

        Authorities to access the Reserve component during rapidly emerging
    situations, (humanitarian assistance, disaster response, as well as
    other low-intensity crises) should be considered. Amending title 10 to
    create a new statute that allows the President to delegate authority
    through the Secretary of Defense to the Secretaries of the Services,
    the ability to respond to requirements with the most appropriate and
    accessible Forces from either the Active component or Reserve
    component, would permit better access allowing the Reserve component to
    fill the requirements for which they are best suited.
        We should review our budgeting practices for operations in a post-
    OCO environment. While the current budget combined with associated OCO
    supplementals support the present use of the Navy Reserve, we should
    plan and budget for the level, sustainable funding of both the required
    training and operational employment of certain elements of the Navy
    Reserve.
        General Stenner. From a legal perspective, the current proposed
    legislative change addressing the legal constraints of the use of Air
    Reserve Technicians (ARTs) will help provide better access to the
    unique units and capabilities in the Reserve in a timelier manner;
    specifically, the need for flexibility in ART assignments. We must be
    able to place/assign ARTs outside of the traditional unit construct at
    all levels of command and in the IMA program. We also need more
    flexibility to deploy ARTs.
        The second current legislative proposal relating to ART Mandatory
    Separation Dates (MSD) will also help provide better access to the
    unique units and capabilities in the Reserve in a timelier manner.
    Under existing law, the AFR is mandated to extend an ART officer or
    enlisted member's MSD to age 60 at the election of the ART. This
    severely limits career advancement in the ART world. We have proposed a
    change to the law that would give the commander the discretion to
    extend the MSD.
        General Kelly. The Marine Corps has not hesitated to employ the
    Reserves operationally and we concur with the premise that the Reserves
    should not be the ``force of last resort'' as viewed during the Cold
    War. Predictability is significant to tapping into Reserve
    capabilities. The Marine Corps Reserve can be the first choice for
    recurring or predictable missions within their capabilities as we've
    demonstrated with success over the last 8 years. The Marine Corps has
    embraced that premise by ensuring that Marine Corps Reserve
    capabilities are an integral part of the available operating forces
    through our Force Generation Model. We're really not talking about
    unique capabilities or units, but the unique nature of combat tested
    and highly trained Marine reservists who bring with them a wide range
    of civilian experiences and skills. The Reserve's unique nature makes
    it a great complement to our Total Force when conducting stability
    operations in Iraq and Afghanistan as well as performing worldwide
    theater security cooperation and training commitments.
        The current authorities and policies in place for OCO work well and
    allow the needed predictability we desire. However, authority to access
    the Reserve for other operational missions is another matter. Concern
    has been raised within the Defense establishment whether the current
    authorities can justify involuntary mobilization, the key to
    predictability, for missions outside of OCO. The Marine Corps, as well
    as the other Services, are examining the question of access. Without an
    appropriate authority to maintain non-OCO access to the Reserve
    component, we will be unable to meet the great demand for the Marine
    Corps Reserve to meet our training and mentoring capabilities so vital
    to partner nation engagement. A new authority may be needed which will
    require a change to our current laws regarding mobilization. Of course,
    continued use of an operational reserve beyond OCO supplemental funding
    will require appropriate programming within the Marine Corps and DOD to
    ensure adequate funding for the right balance of Active component/
    Reserve component employment.

        41. Senator Graham. General Stultz, Admiral Debbink, General
    Stenner, and General Kelly, do you think the current mobilization
    authorities are sufficiently flexible or are changes in legislation
    needed?
        General Stultz. No, current mobilization authorities are not
    sufficiently flexible. Legislative changes are needed. The type of
    changes I envision are those which permit the Army to mobilize the USAR
    for: domestic emergencies; generating force operations; and overseas
    contingency missions which provide our soldiers an opportunity to
    perform security cooperation missions and/or training exercises in a
    predictable and cyclical manner. Limiting mobilizations to warfighting
    type situations is a major barrier to our transition from a strategic
    reserve into an operational force (per one of the CNGR
    recommendations).
        Admiral Debbink. I believe that the Services need additional
    authorities delegated to them in order to access their Reserve
    components during and for operations other than war or national
    emergencies. A major paradigm shift has taken place with regard to the
    utilization of our Reserve Forces. Current authorities do not allow us
    to deploy reservists in the regular, rotational work of the Services.
    Providing access to the Reserve component to complete these missions
    will help increase the efficiency and capability of the Total Force,
    and will enhance the Reserve component's ability to be the force of
    first choice for DOD requirements around the globe.
        General Stenner. From a legal perspective, the current mobilization
    authorities are sufficiently flexible and no legislative changes are
    needed at this time. The issue is that historically, the current
    mobilization process as identified in the Global Force Management
    Implementation Guides (GFMIG), has not been adhered to resulting in
    confusion mobilizing Reserve Forces. AFR Command proposes to educate
    the Regular Air Force (Active component) on the proper authorities and
    process for mobilizing reservists and require adherence to using the
    proper authorities and the process requirements.
        General Kelly. If we are to truly operationalize our Reserve
    component to support the combatant commanders within the full range of
    military operations after the current authority to involuntarily
    activate has expired, changes to legislation will be required. Current
    authorities lack the flexibility to employ an operational reserve post-
    OEF as there is not an authority that permits involuntary activation of
    units for more than 2 weeks without an authorization from the commander
    in chief. The Services require the ability to involuntarily activate
    units in accordance with their Force Generation models in order to
    provide predictability for the reservist and cohesive capabilities for
    the Combatant Commanders.

        42. Senator Graham. General Stultz, Admiral Debbink, General
    Stenner, and General Kelly, how would you approach the task of creating
    activation authority, short of a Presidential call up, that balances
    the need for readiness and response with dwell time and recognition
    that reservists must be able to stand down?
        General Stultz. I would identify various categories for which such
    activations should be appropriate. A few things that come to my mind
    are: domestic emergencies, augmenting the Army's stateside training
    support base, and perhaps helping the combatant commands, in
    coordination with U.S. embassies, strengthen the capacity of partner
    nation's security forces.
        Additionally, I would consult key stakeholders from throughout our
    Employer-Army Reserve Partnership program to determine the type of
    conditions that would be favorable to them, as it relates to acceptable
    frequencies and durations of short-term deployments. I would also
    attempt to find out from them if there were any feasible incentives
    that could help mitigate whatever disruptions would result from call-
    ups that were not of the Presidential call up variety.
        Lastly, I would consult with the families of our Force, and the
    type of information I would seek would be very similar to what I would
    want from the employers: conditions and possible incentives.
        Once complete, I would analyze what's fiscally feasible, and
    legally practical, and then work through the Army's OCCL to develop a
    recommendation that had been reconciled with the Army's human capital
    strategy as it relates to recruiting and retention activities.
        Admiral Debbink. I would approach this task by amending Title 10 to
    create a new statute that allows the Secretary of Defense to delegate
    authority to the Secretary of the Services to recall to Active Duty
    members of the Ready Reserve for a pre-designated set of specific
    missions and a period of not more than 365 days in any 5-year period.
    Notification requirements would be in accordance with current policies
    addressed in DOD Instruction 1235.12 ``Accessing the Reserve
    Components.''
        General Stenner. Although not a legal question, one thought would
    be to ensure the AFR has input into the assets to be activated prior to
    activation to adequately assess the balance between the readiness and
    response and dwell time.
        General Kelly. We need to ensure Reserve component force generation
    models continue to be used as dwell period calculators. When utilized,
    these models provide predictability for Service headquarters,
    servicemembers, families, and employers. We also need to ensure that
    when we recall reservists involuntarily, it is consistent with the
    Guidance for the Employment of the Force priorities and OSD utilization
    rules. Furthermore, we must provide meaningful opportunities for the
    reservist. We view Security Force Assistance and Theater Security
    Cooperation Phase Zero operations as meaningful and existing within the
    ``full spectrum of conflict.'' These operations are wholly suitable for
    mobilizing Reserve capabilities to support, but should not require a
    Presidential recall.

        43. Senator Graham. General Stultz, Admiral Debbink, General
    Stenner, and General Kelly, is the best approach to do this solely on a
    voluntary basis, through service agreements or do we need a more
    flexible involuntary call up?
        General Stultz. I believe an activation authority that's in tune
    with readiness, response, and stand-down requirements is best achieved
    through a more flexible involuntary call up process. The myriad of
    unpredictable challenges to our national interests, should prompt us to
    realize that the timely and enduring use of our force, both Active and
    Reserve components, should not be confined to instances warranting a
    presidential call-up. In light of the far-reaching implications behind
    future activation of Reserve Forces, and an understanding that the USAR
    primarily mobilizes units, not individuals, I feel additional volunteer
    service agreements would be neither mission nor cost effective.
    Instead, I think Congress should empower the SECDEF with the capability
    to initiate actions to assemble, and prepare for activation, a relevant
    and capable force mix to preserve or promote our national interests at
    home or overseas. The value of such autonomy would be easily validated
    whenever the United States had to quickly send the proper military
    capabilities to either prevent or mitigate the effects of a natural
    disaster in a foreign country.
        Admiral Debbink. I believe the best approach is to provide the
    necessary authority for the Services to have routine access to the
    operational elements of the Reserve components. For many capabilities,
    the Reserve component complements the capabilities of the Active
    component, and is the best source for some capabilities. Our reservists
    are all volunteers. When they choose to affiliate with an operational
    unit, they expect to perform Active Duty service in support of the
    country, and they want to be involved in DOD operations globally.
        General Stenner. My belief is that a voluntary basis is the best
    approach. A more flexible involuntary call-up may negatively affect
    recruitment and retention.
        General Kelly. A more flexible involuntary call up should be
    enacted. To fully recognize the potential of the Reserve component as a
    non-OCO operational force, involuntary mobilization authority is
    required to support CCDR requirements across ``the full spectrum of
    conflict.'' Involuntary mobilization authority is required to preserve
    the integrity of Reserve component force generation models because when
    volunteers are cross-leveled between several units, the mission
    readiness of remain-behind units suffer. When a deploying unit's
    personnel and equipment do not originate from within, the mission
    readiness of units that provide volunteers and equipment suffer. This,
    in turn, jeopardizes the reliability of force generation models and
    eliminates the predictability they provide to service headquarters,
    servicemembers, families, and employers.

        44. Senator Graham. General Stultz, Admiral Debbink, General
    Stenner, and General Kelly, we are consistently told the Reserve
    components are more cost effective than the Active Forces. What funding
    challenges do you foresee in realizing an operational reserve?
        General Stultz. To fully operationalize, the USAR will increase
    readiness by reducing the number of post-mobilization training days
    needed to deploy and therefore, increase the amount of time units spend
    boots-on-the-ground for a given mission. To accomplish this goal, the
    USAR foresees the following resourcing challenges in base funding:
    increases in Operational Tempo (OPTEMPO); military pay associated with
    increased pre-mobilization training days as a part of the ARFORGEN
    process; enhancements to the Combat Support Training Centers and
    Medical Regional Training Sites; and increases in flexible full-time
    equivalent support.
        Admiral Debbink. While current budgets and associated OCO
    supplementals support present use of the Navy Reserve, the future
    construct we envision will demand continued sufficient resourcing of
    Fleet support. Current DOD appropriations are pressurized, and
    operational support funding is viewed as ``discretionary.'' Maintaining
    level, sustainable, and adequate funding for the operational elements
    of the Navy Reserve will be a key component of the successful
    implementation of this initiative.
        General Stenner. The operational reserve concept of operations
    necessitates a significant investment in readiness assurance training.
    It's extremely important for Reserve personnel to have ready access to
    state-of-the-art equipment with which to train, and that adequate
    funding be made available to ensure optimum levels of readiness for all
    assigned personnel. One of the largest funding challenges the AFR faces
    is to ensure training requirements are funded adequately to ensure
    members are qualified and ready for deployments. We must ensure mission
    qualified reservists are available and ready for deployment.
        As currently appropriated, the Reserve Personnel, Air Force, (RPA)
    appropriation is for ``training'' reservists. It is not intended to be
    used to perform missions tasked by the Active Duty component. Reserve
    support to the Active Duty component is to be funded through the
    Military Personnel Appropriation (MPA). We are concerned that as the
    AFR becomes more ``operational'', that our increased support activity,
    and funding requirements, will increase costs in MPA, adding further
    stress to an already challenged appropriation. Ultimately, either more
    MPA funding will be needed, or language must be added to clearly and
    specifically allow supporting the Active Duty component using the RPA.
        Finally, the activities associated with an operational reserve
    require additional funding for manpower and facility space for the
    Reserve headquarters, including the issuance of MPA days along with
    travel and per diem supporting the Active Duty taskings.
        General Kelly. Unquestionably the Reserve Forces are more cost
    effective to maintain. This is due primarily to the reduced manpower
    cost. The Reserve Forces are trained, manned, and equipped to the same
    standards as the Active component. For the vast majority of Reserve
    marines, this is accomplished through 48 drills and a 2-week annual
    training period, equating to a paycheck for 62 days a year. Reserve
    Operations and Maintenance costs are somewhat reduced, based on
    supporting the reduced time reservists are actually in a duty status.
    However, the majority of Reserve operations and maintenance costs are
    non-discretionary (i.e. utilities, facilities sustainment and
    maintenance, maintenance of equipment, etc.). Because we train to the
    same standards as our Active component counterparts, Reserve Forces can
    be integrated into the Total Force very quickly and with minimal
    ``specialized'' training. Once activated to fulfill Active component
    missions, the Reserve Forces costs are practically the same as the
    Active component. These are incremental cost in that they are above and
    beyond what is programmed in the Active Duty appropriations to support
    the authorized end strength.
        However, history has proven there are no significant savings in the
    Reserve appropriations, due to activations, unless they are activated
    for an entire year. This is primarily because once notified of the
    intent to activate, Reserve marines accelerate their drills and annual
    training periods to prepare for upcoming activations.

        45. Senator Graham. General Stultz, Admiral Debbink, General
    Stenner, and General Kelly, are there any hidden costs that could
    reduce your Reserve Force's cost effectiveness?
        General Stultz. As a strategic reserve, no. However, there will be
    some costs associated with an operational reserve. Costs include
    medical care before and after mobilization; potential increases in
    Veterans Affairs benefits; post deployment support to soldiers and
    their families; and increases in the overall equipment level of certain
    units. Yet, even with these additional costs for an operational
    reserve, the USAR continues to remain a cost effective force.
        Admiral Debbink. There are no hidden costs.
        General Stenner. Increased readiness ultimately equals increased
    costs. Expediting the process of fully training, qualifying, and
    certifying each individual as quickly as possible, as the AFR is
    determined to do, also increases expenses. The most prominent funding
    issue is the amount of additional support and ``hands on'' time
    required to make sure each reservist is current and fully qualified.
    Many AFR specialty areas are technologically complex and require
    demonstrated proficiency in order for the individual to be considered
    deployment-ready. The legacy missions in the AFR are being supplanted
    by even more challenging requirements in the Air Force's new array of
    emerging organizations, and the need for substantial training drives
    increased costs. Unlike previous eras, Active Duty personnel with the
    requisite skills are not generally available, so the training
    requirements are consequently much greater.
        Additionally, operating costs for Reserve wings located on Active
    Duty and joint installations are increasing as the additive support
    required for reservist qualification and currency training leads to
    increased charges for common support from the Active Duty hosts. The
    host installations have placed limits and restrictions on standard
    services that ultimately increase Reserve expenses and reduce that cost
    effectiveness.
        General Kelly. Major end items are purchased as Total Force
    requirements from the Procurement Appropriation. Due to lead time for
    delivery of these items and changing priorities, it is difficult to
    determine what portion of the Procurement account (outside NGREA),
    which directly supports the Reserves on an annual basis.

        46. Senator Graham. General Stultz, Admiral Debbink, General
    Stenner, and General Kelly, what do you see as the most significant
    obstacle to realizing a truly operational reserve in the post-OCO
    steady state?
        General Stultz. I see funding as the most significant obstacle to
    realizing a truly operational reserve. I mean, we've been effectively
    functioning in this capacity for over 8 years and what has enabled us
    to do all that is required as an operational force: the manning,
    equipping, and training has been provided through a string of budgetary
    supplementals. As an active participant in the Army's budget
    preparation efforts, it is not difficult to see that the Army's base
    budget has minimal capacity to absorb and sustain the costs associated
    with fielding a truly operational reserve. Conventional wisdom suggests
    there is a direct relationship between OCO funding and increased
    utilization of the Reserve component. It only follows that, if OCO
    funding is decreased, the operational tempo that we equate to an
    operational reserve will also decrease. So, I see funding (followed
    closely by current mobilization authorities) as the most significant
    obstacle to realizing a truly operational reserve.
        Admiral Debbink. The most significant obstacle will be ensuring
    appropriate policies and legislation are in effect to allow the
    Services to keep faith with the members, families, and employers of the
    Reserve Forces. Our success in any endeavor, from OCO support to the
    implementation of an operational reserve in the post-OCO environment,
    depends on the strength of the support our reservists and their
    families receive from the military and their civilian employers. By
    providing predictable rotations of active service and ensuring the
    assignment of meaningful work for those periods, the Services will be
    better positioned to maintain readiness and retention levels.
        General Stenner. The higher costs in a fiscally constrained
    environment, ability to recapitalize worn out equipment, and need to
    mirror Active Duty requirements via acquisition programs are the
    largest obstacles to a truly operational reserve.
        The higher costs associated with operational reserve use, as
    opposed to use as a strategic reserve, is due to the generally higher
    rank and experience level of our units. The higher experience and ranks
    of our units translates into higher pay costs when used in an
    operational reserve mode.
        The higher rates of use of equipment in an operational reserve will
    lead to a more rapid retirement of older aircraft and equipment. Once
    again, in a fiscally constrained environment recapitalization may pose
    challenges.
        Active Duty aircraft are updating their equipment with new weapons,
    defensive systems, and communications gear. As new equipment is
    outfitted on Active Duty aircraft, the AFR will need to match these
    improvements to maintain combat readiness and interoperability. This
    too will pose challenges for the operational reserve Air Force.
        General Kelly. Funding an operational reserve from baseline service
    budgets as OCO supplemental funding diminishes. Operational reserve
    funding will likely compete with other service programs and
    requirements, primarily Military Personnel Marine Corps funding as it
    relates to the Marine Corps' Active component end strength.

                               medical readiness
        47. Senator Graham. General Stultz, in a DOD report on the
    individual medical readiness of Reserve Forces, it stated that only 57
    percent of USAR personnel met deployment-ready standards, with
    mobilization-disqualifying dental conditions being the prime reason for
    the low percentage. Despite the importance of medical and dental
    readiness, at the end of the day, my sense is that funding for medical
    and dental readiness does not compete well with other priorities, such
    as training and equipment and that the real solution is day-in, day-out
    leadership within Reserve and Guard units. What is the best solution to
    ensure that funding for readiness includes and improves medical and
    dental readiness?
        General Stultz. Command emphasis and adequate funding have improved
    medical and dental readiness within the USAR.
        Dental readiness has historically been one the lagging indicators
    for overall medical readiness. The Army Selected Reserve Dental
    Readiness System (ASDRS) is an example of prioritizing the utilization
    of medical readiness funding. Implementing the ASDRS program increased
    dental readiness from 52 percent on Oct. 1, 2008 to 63 percent on Oct.
    1, 2009 to 70 percent on May 1, 2010.
        As far as demonstrating an overall return on investment, medical
    readiness improved from 24 percent on Oct. 1, 2008 to 45 percent on
    Oct. 1, 2009 to 58 percent on May 1, 2010. As a result of this
    demonstrated improvement, funding for USAR medical readiness has
    competed well in the POM and is expected to be funded to achieve the
    DOD standard for medical readiness in fiscal year 2012.
                                     ______

                 Questions Submitted by Senator Saxby Chambliss
                                  retired pay
        48. Senator Chambliss. Secretary McCarthy, as you know, I have been
    a strong supporter of allowing qualifying duty performance since
    September 11, 2001, to be counted towards early receipt of retired pay.
    I noticed in your statement that you said ``we must recruit and retain
    prior-service personnel.'' If we were to pass a provision allowing
    qualifying duty since September 11, 2001, to be counted towards early
    receipt of retired pay, what effect do you believe that may have on
    recruiting and retention of prior-service personnel in the Reserve and
    what effect might such a provision have on force shaping of the Guard
    and Reserve in general?
        Secretary McCarthy. Currently, we have not fully reviewed the
    impact of early receipt of retired pay on recruiting and retention on
    prior-service reservists. The 11th Quadrennial Review of Military
    Compensation will review the retirement system and its force shaping
    impact as part of its comprehensive analysis of National Guard and
    Reserve compensation. I am well aware that the Reserve retirement
    system is a significant issue for the members of the National Guard and
    Reserve and we are carefully examining this system.

                               reserve readiness
        49. Senator Chambliss. General Carpenter, in terms of training, how
    are you doing with respect to having up-to-date equipment that you can
    train on?
        General Carpenter. New equipment is coming to the ARNG today at an
    unprecedented rate; the fielding of new equipment requires initial user
    level training. When fielding new equipment, such as a digital command
    and control system to a unit, the Product Manager is required to
    conduct training for the unit; usually the training is done through the
    New Equipment Training (NET) process and is the initial step in
    fielding equipment. NET provides basic level training for operators,
    maintainers, and unit leadership, and provides the foundation for
    further refined collective training at the unit level.
        Part of the ARNG's issue with respect to equipping is the
    timeliness that we receive new equipment. The ARFORGEN cycle is
    designed for units to progressively build readiness in order to be
    operationally available to meet the needs of the Nation on a rotational
    basis. In order to achieve the required readiness levels, unit training
    is designed to become progressively more complex and intense. Equipment
    must be programmed and scheduled to be fielded by units early in their
    respective ARFORGEN cycles in order to facilitate, rather than
    interrupt, the training plans. If a unit receives equipment late in the
    ARFORGEN cycle, critical training events are interrupted and may be
    canceled in order to complete the fielding process. That training must
    then be made up later, most likely at a mobilization station, resulting
    in additional post-mobilization training time and less time that the
    unit will spend deployed in theater.

        50. Senator Chambliss. General Carpenter, I know there are efforts
    to ensure that the Reserve component have access to equipment
    compatible with the Active component, but are you confident that our
    soldiers in the National Guard and Reserve are getting these items?
        General Carpenter. The Army continues to improve the EOH rates as
    well as the modernization levels for both the ARNG and the USAR. The
    Army sees this as critical to the transformation of the Reserve
    component from a strategic to an operational reserve. The Army
    Equipping Strategy identifies equipping goals for units as they
    progress through the ARFORGEN cycle. These equipping goals apply
    equally across all three components--Active, ARNG, and USAR.
        Beginning in fiscal year 2006, the Army significantly increased its
    investment in ARNG equipment, allocating approximately $28.7 billion
    for new procurement and recapitalization between fiscal year 2006 and
    fiscal year 2010. Of particular significance, the ARNG was fully
    equipped with SINCGARS radios and UH-60 Blackhawk helicopters in fiscal
    year 2009 and is on track to complete fielding of M4 rifles by the end
    of fiscal year 2010. However, the Blackhawk fleet is still only
    partially modernized and current funding efforts will not produce a
    modernized fleet until the end of fiscal year 2025. Despite the
    increased investment since fiscal year 2006, the ARNG still has
    critical shortfalls and modernization gaps in the truck fleet,
    helicopter fleet, and digital enablers. In addition to supporting OCO,
    this equipment is critical to supporting the ARNG's Homeland Defense/
    Defense Support to Civil Authorities (HLD/DSCA) missions.
    Modernization
        The Army is committed to equipping soldiers going into harm's way
    with the most capable systems possible. This equipping strategy applies
    to Reserve component units as well as Active component units and is
    designed to modernize the USAR and ARNG on par with the Active
    component.
    Transparency
        The CNGR--also known as the ``Punaro Commission''--provided DOD
    with a set of recommendations designed to improve the operational
    readiness of National Guard and Reserve Forces. Two of the
    recommendations (CNGR #42 and #43) directed DOD to increase the
    transparency of equipment requirements, funding, procurement, and
    delivery. Over the past year, the Army has significantly improved
    transparency within its equipment procurement and distribution
    processes.
        Based on the current Army Equipping Strategy, the Army's commitment
    to equipping soldiers going into harm's way with the most capable
    systems possible and the significant increase in transparency, I am
    confident the ARNG is receiving modern equipment which is compatible
    with the Active component.

        51. Senator Chambliss. General Carpenter, are they able to become
    familiarized with these items at home before they step foot into Iraq
    or Afghanistan and see them for the first time?
        General Carpenter. ARNG soldiers get the appropriate time to become
    familiarized with the new equipment, but we don't always get enough
    time to be proficient enough to realize the full capability of the new
    system.
        Proper training with new equipment has three phases. First, the
    actual operators of the equipment must be trained in basic operation
    and maintenance. Second, the squad or section must be trained in
    integrating the new equipment into the performance of training tasks.
    Finally, as the unit conducts higher-level collective training, the
    various pieces of new equipment are integrated into the unit's
    operations.
        The ARFORGEN design includes time for progressive training to
    ensure that units properly utilize new equipment while deployed. When
    fielding of new equipment occurs late in the ARFORGEN cycle, or even
    after mobilization, this progressive building of proficiency on the new
    equipment is delayed and sometimes lost. Individual operators may have
    a basic understanding of how to operate their equipment, but the unit
    is not sufficiently training in employing the equipment's full
    capability.
                                     ______

                Questions Submitted by Senator George S. LeMieux
                                reserve training
        52. Senator LeMieux. Secretary McCarthy, what is the status of the
    tire removal training project in fiscal year 2010 and what are the
    plans for this continued training activity in fiscal year 2011?
        Secretary McCarthy. In October 2009, Dr. Kenneth Banks, Marine
    Resource Program Manager for Broward County, was notified that the
    Services did not select the Osbourne Reef Tire project as a training
    venue for fiscal year 2010. The Services select the projects based on
    specific training requirements and priorities. None of the Services
    have selected the reef project as a training project in 2011.
        For 3 years, fiscal year 2007 to fiscal year 2009, military dive
    and boat crews have volunteered to conduct a training mission off the
    coast of Fort Lauderdale, FL, to assist Broward County with the 1977
    failed Osbourne Reef Tire project. During the 3 years that training was
    conducted, over 40,000 tires of the 2,000,000 dispersed throughout 36
    miles of ocean floor were removed. The Innovative Readiness Training
    (IRT) has been a very successful program to provide voluntary real
    world pre-deployment training venues for military units while
    benefiting underserved communities throughout the United States.

        53. Senator LeMieux. Secretary McCarthy, can you provide me with a
    status report on the IRT program in the fiscal year 2010 and highlight
    projects in the State of Florida and explain how the fiscal year 2011
    budget request and the National Defense Authorization Act dovetail with
    your plans in Florida for fiscal year 2011?
        Secretary McCarthy. There are no IRT projects being conducted in
    Florida during fiscal year 2010. Broward County was the only entity in
    the State of Florida that submitted a request for military support
    under the IRT program in fiscal year 2010. Broward County was notified
    in October 2009 that none of the Services had selected the Osbourne
    Reef Tire Project as a training venue for fiscal year 2010. IRT is a
    voluntary program which the Services can use for alternative training;
    as such, none of the Services have selected the Osbourne Reef Tire
    project as a training venue for 2011. No other communities or non-
    profits in the State of Florida requested support in accordance with
    the IRT program for fiscal year 2011.
        Section 2012, title 10 U.S.C., DOD Directive 1100.20 and Service
    instructions authorize units or individuals to provide support to non-
    DOD organizations. The Services have the opportunity to review many
    training venues submitted by communities and determine those that will
    meet the mission essential task list training requirements of the
    military personnel. This voluntary training alternative for meeting
    military mobilization readiness requirements has assisted communities
    throughout the United States with infrastructure development and
    medical care.

        [Whereupon, at 11:33 a.m., the subcommittee adjourned.]