[Senate Hearing 111-]
[From the U.S. Government Publishing Office]
DEPARTMENT OF DEFENSE APPROPRIATIONS FOR FISCAL YEAR 2010
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THURSDAY, JUNE 18, 2009
U.S. Senate,
Subcommittee of the Committee on Appropriations,
Washington, DC.
The subcommittee met at 10:30 a.m., in room SD-192, Dirksen
Senate Office Building, Hon. Daniel K. Inouye (chairman)
presiding.
Present: Senators Inouye and Cochran.
NONDEPARTMENTAL WITNESSES
STATEMENT OF ALEC PETKOFF, DEPUTY DIRECTOR, NATIONAL
SECURITY COMMISSION, THE AMERICAN LEGION
OPENING STATEMENT OF SENATOR DANIEL K. INOUYE
Chairman Inouye. I'm pleased to welcome all of you to this
hearing, where we'll receive public testimony pertaining to
various issues related to the fiscal year 2010 Defense
appropriations request.
Because we have so many witnesses who wish to present
testimony, I'd like to remind each witness that, unfortunately,
they'll have to be limited to 3 minutes. Like to have this all
day, but I have a supplemental appropriations pending on the
floor.
So at this point, I'd like to recognize the first witness,
Mr. Alec Petkoff, deputy director of the--national security of
The American Legion.
Mr. Petkoff. Thank you, Mr. Chairman.
Mr. Chairman, I want to thank you for inviting The American
Legion to share its views on defense appropriations for fiscal
year 2010.
Since its founding in 1919, The American Legion remains
steadfast in support of a strong national defense. The United
States is a Nation at war, still battling against extremist
Islamists all over the world. The United States also must be
prepared for any number of threats to our national security,
whether they arise from powerful nation states, rogue nation
states, nonstate violent extremists, natural disasters, or
instability resulting from economic downturns in the world
economy.
Our need for a ready and robust military is clear. Now is
not the time to slow down or reduce the level of spending
required to keep our country safe from this spectrum of
threats. From quality-of-life issues, to force structure, to
military healthcare, to procurement, none of these areas should
be neglected at the expense of the other. With this in mind, we
would like to briefly highlight some vital areas of concern.
The first area of concern is the size of the active duty
force. For decades, The American Legion has advocated for an
active duty force of at least 2.1 million members. Since
September 11, 2001, we have seen the results of having a force
that is too small in relation to our national security needs.
The results have been dramatically bad for our military
servicemembers. These results are multiple deployments without
adequate dwell time, straining military servicemembers, and
likewise their families, to the breaking point; the required
implementation of stop-loss, and the dramatic transformation of
the National Guard from a strategic force to an operational
force, which has increased our risk and reduced our strategic
freedom of action. These results have had negative impacts on
readiness and quality of life.
Three years ago, Congress decided to increase the size of
the force, adding 65,000 soldiers to the Army. This initiative
has been a success. The Army reached its increased recruiting
goal earlier this year, 2 years ahead of schedule. The Grow the
Force Initiative has been successful, but that does not mean it
should end.
This is reinforced by Defense Secretary Robert Gates, who
said, in testimony before the Senate Armed Services Committee
last month, that despite the success of the Grow the Force
Initiative, he remains concerned by the limited dwell time that
our soldiers have between deployments. Therefore, The American
Legion recommends further funding to significantly increase the
size of the force beyond the original Grow the Force
Initiative.
The American Legion also has the following recommendations
for the subcommittee:
In military personnel, The American Legion supports a
military pay raise from the suggested 2.9 percent to 3.9
percent, to help close the civilian-military pay gap, and
additional funds for Reserve Officer Training Corps.
In operation and maintenance, with respect to defense
health programs, The American Legion supports the full funding
of TRICARE for retirees, dependents, and all Reserve forces.
The American Legion also supports wounded warrior care
improvements, to include outreach and treatment for traumatic
brain injury and all mental and combat-stress related
illnesses. And finally, funding for a standalone DOD research
program into blood cancers, through the congressionally
directed medical research program.
In procurement, the Army should obtain necessary equipment
to man the full complement of 48 brigade combat teams, as
opposed to the proposed cutback to 45, and continue to refit
and update the equipment of our Reserve forces, and timely
procurement of advanced Air Force and Navy weapons systems,
aircraft, and ships.
In research, development, testing and evaluation, increases
in missile defense, electronic warfare technology, and weapons
technology are needed. Cuts to missile defense seem unwise.
And finally, military construction--construction
improvements to base medical facilities, commissaries,
exchanges, and other facilities. And we urge that whenever a
base realignment and closure is conducted, that certain base
facilities, such as medical facilities, commissaries,
exchanges, and other facilities, be preserved for use by active
duty, reservists, retired military, veterans, and their
families.
The American Legion, again, thanks the chairman for having
this important hearing, and for inviting us to present our
views. I look forward to continue working with this
subcommittee on these important issues of national defense.
Chairman Inouye. Thank you very much. I would welcome any
written material you may have.
Mr. Petkoff. I would like to submit our written testimony
for the record at this time, Mr. Chairman.
Chairman Inouye. Thank you.
[The statement follows:]
Prepared Statement of Alec Petkoff
Mr. Chairman and members of the Subcommittee, thank you for
inviting The American Legion to share its views on defense
appropriations for fiscal year 2010. Since its founding in 1919, The
American Legion remains steadfast in its support of a strong national
defense which is reflected in the Preamble to The American Legion
Constitution, namely, ``To uphold and defend the Constitution of the
United States of America,'' and ``to inculcate a sense of individual
obligation to the community, state and nation.''
The United States is a Nation at war still battling against
extremist Islamists all over the world. The United States also must be
prepared for any number of threats to our national security whether
they arise from powerful nation-states like Russia or China; rogue
nation-states like Iran, North Korea or Somalia; natural disasters; or
instability resulting from economic downturns in the world economy. Our
need for a robust military is clear. Now is not the time to slow down
or reduce the level of spending required to keep our country safe. With
this in mind, The American Legion offers the following recommendations
with a brief summary of explanation followed by a more complete
rendering of The American Legion's views and recommendations:
APPROPRIATIONS PROPOSALS FOR SELECTED GENERAL DISCRETIONARY PROGRAMS FOR DEPARTMENT OF DEFENSE FOR FISCAL YEAR
2010\1\
[In Billions]
----------------------------------------------------------------------------------------------------------------
Proposed
Funding for defense The American
fiscal year funding for Legion's fiscal
2009 fiscal year year 2010
2010 recommendations
----------------------------------------------------------------------------------------------------------------
Total Defense Spending......................................... $654.7 $663.7 $728.2
Military Personnel............................................. $142.7 $149.6 $150
Operation and Maintenance...................................... $273.5 $276.2 $315.7
Defense Health Programs (Operation and Maintenance)............ $25.7 $26.9 \2\ $63.2
Procurement.................................................... $133.2 $131.2 $136.2
Research, Development, Test and Evaluation..................... $81.7 $78.9 $100
Military Construction.......................................... $28 $22.9 $26.3
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\1\ Includes Overseas Contingency Operations or OCO funding.
\2\ Increase already included in Operation and Maintenance.
Military Personnel.--Military pay raise from 2.9 to 3.4 percent to
help close the civilian/military pay gap. Additional funds for Reserve
Officer Training Corps (ROTC).
Operation and Maintenance.--The Administration's overall modest
increase in operations and maintenance is found mostly in the line
item, ``Administration and Servicewide Activities'' while the line item
``Operation Forces'' actually gets a decrease. While one can only
assume the decrease is predicated on a drawdown of forces in Iraq, The
American Legion recommends that more funds be allocated in case the
plans for withdrawal are found to be premature by either the Iraqi
government or more importantly our commanders on the ground.
Defense Health Programs.--Fully fund TRICARE for retirees,
dependents and all reserve forces; Stand alone fund for blood cancers;
Wounded Warrior Care improvements.
Procurement--Army.--Obtain necessary equipment to man the full
complement of 48 BCTs, Navy--Oppose shifting the Navy Aircraft Carrier
program to a 5-year build cycle. Longer cycles only mean larger costs
and a weakened force. Air Force--Continue to purchase more F-22 Raptors
and to hasten purchase and building of the aerial refueling tankers.
Reserve Forces--Continue to refit and update equipment.
Research, Development, Test and Evaluation.--Increases in missile
defense, electronic warfare technology, and weapons technology needed.
Cuts to missile defense are unwise.
Military Construction.--Construction and improvements to base
medical facilities, commissaries, exchanges and other facilities.
The American Legion upholds the following national security
principles as fundamental to the best interests of the United States:
--The National Security Strategy needs to be reassessed so that
missions and resources are more closely aligned, particularly
during the upcoming Quadrennial Defense Review.
--The credibility of the United States in an unstable world needs to
be maintained by retaining requisite military capabilities to
deal with actual and potential threats.
--Such a strategy requires that the Armed Forces be more fully
structured, equipped and budgeted to achieve this strategy.
--Active and reserve military end strengths should be increased to an
absolute minimum of 2.1 million for the foreseeable future.
--At least 12 full-strength Army Divisions, 11 deployable Navy
aircraft carrier battle groups, three or more Marine Corps
Expeditionary Forces, and 13 or more active Air Force fighter
wing equivalents should be retained, as the minimum needed
baseline force.
--Defense budgets should be funded at least 4 percent of Gross
Domestic Product (GDP) during time of peace, and at 5 percent
or more during time of war to fund both people and weapons
requirements.
--The National Guard and Reserves must be realistically manned,
structured, equipped, trained, fully deployable and maintained
at high readiness levels, and not over-utilized in order to
accomplish their increasing and indispensable missions and
roles in the national defense.
--Peacetime Selective Service registration should be retained so as
to maintain a viable capability to rapidly reconstitute forces
in the event of emergencies or war.
--Force modernization for the Armed Forces needs to be realistically
funded, and not further delayed, or the United States is likely
to unnecessarily risk American lives in the years ahead.
Production of airlift and sealift assets needs to be expedited.
--The American people expect that whenever Armed Forces are
committed, that they will be committed only when America's
vital national interests are threatened and only as a last
resort after all reasonable alternatives have been explored and
tried.
--Peacekeeping, peace enforcement, peace-making and humanitarian
operations detract from military readiness to conduct combat
operations across the full spectrum of potential conflicts.
Such operations should be limited, congressionally approved and
separately appropriated on a case-by-case basis.
--The honorable nature of military service should be upheld, as it
not only represents fulfillment of American patriotic
obligation, but is also a privilege and responsibility of
citizenship that embodies the highest form of service to the
Nation.
--The United States Government must honor its obligations to all
service members, veterans, military retirees and their families
with equitable earned benefits, lasting military retirement
compensation and other appropriate incentives, such as timely
access to quality health care for all beneficiaries.
--Major incentives for military service should include an enhanced GI
Bill for education and training, improved quality-of-life
features, and a reduced operational tempo in order to recruit
and retain a high-quality and fully manned, professionally led
force.
--The United States Government is urged to retain the necessary
deployed forces worldwide to accomplish short-term as well as
long-term commitments and contingencies.
The American Legion would like to thank Subcommittee Members for
their hard work on previous legislation to improve the quality-of-life
for America's Total Force military, retirees, and their families.
This portion of the statement will contain issues on the following
subject areas:
--Quality-of-Life;
--Force Structure;
--Manpower and Weapons Systems;
--POW/MIA.
QUALITY-OF-LIFE
It is with particular purpose that The American Legion address
quality-of-life issues before the issues of ``force structure'' and
``manpower and weapons systems'' as concerns our national defense.
Maintaining a high quality-of-life for our service members has to be
the first priority of any nation that seeks to defend its interests at
home or abroad. Whether it be the infantryman, the pilot, the mechanic,
or the cook, America needs to be able to attract and retain the best
and brightest our Nation has to offer. Without such Americans to answer
the call to service, all other money spent on defense will be in vain.
And so it is with good reason that The American Legion is first
concerned with the enhancement of quality-of-life issues for active-
duty service members, Reservists, the wounded and disabled, military
retirees, and their families. If we are to win the war on terror, and
prepare for the wars of tomorrow--in this decade and beyond--we must
take care of the DOD's (Department of Defense) greatest assets; namely,
its men and women in uniform.
The United States must honor its obligations to all service members
(past, present and future) and their families. The American Legion
urges the Congress and DOD to support and fund quality-of-life features
for Active-Duty, National Guard and Reservists as well as military
retirees, veterans and their dependents, and military survivors. This
is including but not limited to, the following:
--Military pay comparability for the Armed Forces and regular
increases in the Basic Allowances for Quarters; renovation and
construction of military quarters and increased funding for
child day care centers are direly needed. Pay raises must be
competitive with the private sector;
--Adequate medical, mental and dental health services; morale,
welfare and recreational facilities; and non-privatized
exchanges and commissary facilities. The Defense Commissary
Agency (DECA) and its functions should be retained and not
relegated to the military services;
--Preserving an attractive retirement system for the active and
Reserve components and annual cost-of-living adjustments
(COLAs) paid at the same rate and concurrently with other
Federal retiree COLAs; oppose any changes to the military
retirement system, whether prospective or retroactive, that
would violate contracts made with military retirees and
undermine morale and readiness;
--Requiring that the Services perform mandatory physical
examinations, without waivers, for all separating veterans;
--Fully funding the concurrent receipt of military retirement pay,
military separation pays, and Department of Veterans Affairs
(VA) disability compensation as well as Special Compensation
pays for disabled military retirees;
--That the Survivor Benefit Plan and Dependency and Indemnity
Compensation (SBP/DIC) offset be eliminated;
--TRICARE for Life and the TRICARE Senior Pharmacy program for
Medicare-eligible military retirees, their dependents and
military survivors, should be adequately funded; and regular
cost-of-living adjustments to military retirement deployment
pay, capital gains tax exclusions, tax-free and increased death
gratuity payments, and combat zone tax exclusions for service
in South Korea;
--Congressional re-enactment of Impact Aid to fund the local public
school education of military dependents;
--Adequately protecting the American public and the Armed Forces from
the actual or potentially harmful effects of friendly and
hostile chemical, biological and nuclear agents or munitions;
--Urging the Congress to extend and improve additional quality-of-
life benefits, allowances and privileges to the National Guard
and Reserves involved in homeland security and other missions
so as to more closely approximate those of the active force.
Military retirement pay and TRICARE healthcare for members of
the Reserve Components should be authorized before age 60.
Hazardous duty and incentive pays for Reservists should be the
same as active duty; tax credits to private businesses that pay
the difference between military and civilian salaries to
mobilized Reservists and restore travel exemptions for Reserve
and Guard members for expenses associated with attending
drills;
--Military health care should also be provided to members of the
Reserve Components and their dependents, who become injured
while on active duty status regardless of the number of days
served on active duty, to the same degree as active duty
members under the same circumstances;
--Whenever a Base Realignment and Closure (BRAC) is conducted, The
American Legion will urge that certain base facilities such as
base medical facilities, commissaries, exchanges and other
facilities be preserved for use by active duty and Reservist
personnel and military retired veterans and their families;
--Walter Reed Army Medical Center not be closed until after Overseas
Contingency Operations have ended;
--That the numerous, recurring and serious pay problems experienced
by the Active and Reserve Components be immediately resolved;
and
--Traumatic Brain Injury and Combat Stress Disorders be diagnosed and
effectively treated in the military.
Wounded Warrior Care
The respective branches of the military often like to pontificate
on how they all ``take care of their own.'' Nowhere is this statement
put more to the test than when dealing with the combat and severely
wounded. Since the Building 18 episode at Walter Reed Army Medical
Center, a well-deserved spotlight was put on the whole transition
process for outgoing military personnel. The resulting findings were
somewhat surprising in that it was not the quality of medical care that
was in question, but rather it was everything else. Some of those
issues included electronic transference of medical records; scheduling
of appointments; housing; family support issues; the Physical
Evaluation Board (PEB) and Medical Evaluation Board (MEB) process;
applying for VA benefits and receiving them without a gap in pay upon
discharge from the military; endless forms, paperwork and tests.
The American Legion supports many of the reforms, most of which are
still in the form of pilot programs, that address these issues. Warrior
Transition Units (WTUs) need to be fully funded and fully staffed. PEB/
MEB process needs to be overhauled. Great strides have been made since
2007, but the progress made (particularly in the area of the WTUs) not
only needs to be maintained but expanded.
The American Legion supports some of the recommendations of the
President's Commission on Care for America's Returning Wounded Warriors
(the Dole/Shalala Commission). Under the Commission's proposal, service
members found unfit for military duty (a determination made by DOD
based on a joint VA/DOD collaborative examination process) would be
awarded a lifetime annuity payment by DOD based on years of service and
rank. The purpose of this annuity is to compensate for the loss of the
service member's military career.
As these reforms are instituted, the new rating system and
compensation should be made retroactive to correct those past egregious
disability decisions and call for the re-rating and reevaluation of
immediate past military disability retired personnel.
Since Operations Enduring Freedom and Iraqi Freedom began, over
5,000 Americans have given their lives in our operations in Iraq and
Afghanistan and over 34,000 have been wounded in action. Of those
wounded, over 15,700 did not return to duty. Caring for our military
and ensuring good quality-of-life for the service member and the family
is part of the ongoing cost of war and national security.
The fiscal year 2009 budget has $3 billion to improve army
barracks, military hospitals, and other facilities. The American Legion
recommends a minimum of $3.4 billion for fiscal year 2010 in order to
ensure that there are no delays in construction and improvement of
living quarters and medical facilities.
The fiscal year 2009 budget has $25.8 billion, $2.4 billion above
2008, for medical care. This includes $300 million for traumatic brain
injury (TBI) and psychological health. The American Legion applauds
Congress for this increase and recommends that funding for fiscal year
2010 be $28 billion in order to sustain current costs and to improve
treatment for TBI and psychological health professionals, particularly
for the Reserve force that may live in rural areas.
Force Health Protection
The American Legion continues to actively monitor the DOD's
implementation of Force Health Protection policies and urges continual
congressional oversight to ensure that all Force Health Protection laws
and policies, including thorough pre- and post-deployment physical and
mental examinations, are being properly implemented in a consistent
manner by all military branches.
The American Legion also urges DOD to actively track and follow-up,
with proper medical care, adverse reactions to vaccinations as well as
any and all health-related complaints associated with the ingestion of
controversial drugs such as pyridostigmine bromide and Lariamand. In
addition, The American Legion urges DOD to continually improve its
treatment of service personnel who have been diagnosed with post-
traumatic stress disorder and/or traumatic brain injury.
Concurrent Receipt of Military Retired and Severance Pays and
Disability Compensation and Their Dependents
Military retired pay and disability compensation have been
erroneously equated in one form or another for too long. One pay is
earned through service and the other is compensation for debilitating
injuries that were acquired while in service (on the job, so to speak).
To offset one against the other is clearly unfair.
The American Legion expresses its gratitude to the Congress for the
authorization of both Combat-Related Special Compensation (CRSC) and
partial concurrent receipt for over 200,000 disabled military retirees
but urges the Congress to authorize and fund full concurrent receipt
for all disabled military retirees to include those rated at 40 percent
and below and to authorize the CRSC payment of military disability
retiree pay and VA disability compensation for those disabled military
retirees.
Additionally, The American Legion urges Congress to eliminate the
phase-in of provisions in Public Law 108-136 so as to accelerate
restored retired pay in less than 10 years and to authorize the
concurrent receipt of military severance pay for less than 30 percent
disabled service members and VA disability compensation.
TRICARE
The American Legion has a longstanding position that it should
prevail upon any Administration and DOD to reconsider any proposals to
implement any increases in the military retirees' TRICARE enrollment
fees, deductibles, or premiums. The American Legion urges Congress to
fully fund military and VA healthcare programs for beneficiaries as
well as a permanent TRICARE program for Guardsmen and Reservists. The
American Legion recommends that the following guidelines be
incorporated as part of the DOD healthcare package for military
retirees, dependents and military survivors:
--Administrative barriers to an effective TRICARE system to include
raising TRICARE provider reimbursements; program portability
between TRICARE regions; reducing delays in claim payments; and
increasing electronic claims processing need to be removed.
Improve TRICARE enrollment procedures, beneficiary education,
decrease administrative burdens, eliminate non-availability
requirements and eliminate unnecessary reporting requirements;
--TRICARE programs to include the TRICARE for Life and the TRICARE
Senior Pharmacy programs which are used by 1.3 million
Medicare-eligible military retirees and their dependents should
be fully funded annually;
--Restore TRICARE reimbursement policy to pay up to what TRICARE
would have paid had there been no other health insurance as was
the policy before 1993;
--Dual eligible disabled retirees continue to receive health care
from both military treatment facilities and VA medical centers.
TRICARE Prime Remote should be included for military retirees,
dependents and military survivors;
--All military beneficiaries should be authorized to receive dental
and visual care at military treatment facilities;
--Retired Reservists and their dependents should be eligible for
TRICARE coverage when they become eligible to receive
retirement pay; The American Legion urges that all discharging
service members, active and Reservists be required to have
discharge and retirement physical examinations; physicals
should not be optional or abbreviated;
--Adequate military medical personnel, to include graduates of the
Uniformed Services University of Health Sciences and members of
the Commissioned Officer Corps of the Public Health Service,
should be retained on active duty to provide health care for
active duty and retired military personnel and their
dependents;
--The Federal Employee Health Benefits Plan (FEHBP) should be
authorized as an alternative to TRICARE for those military
retirees and dependents who can afford such premiums;
--TRICARE fees should not be increased except as authorized by
Congress, not by DOD;
--Military construction funding should be authorized for the
construction of Walter Reed Military Medical Center and the
Fort Belvoir Army Community Center;
--If Congress increases TRICARE fees, the increases should be at a
rate no larger than the rate of pay increases for Active,
Reserve, National Guard, military and medical retirees, and
military survivors.
Quality-of-Life for National Guard and Reserve Forces
The American Legion urges Congress and DOD to pass legislation and
create policy that addresses all the needs of the Reserve forces to
include:
--Full range of active duty retention bonuses and recruiting
incentives, pay promotions and health care quality-of-life be
applicably activated to the National Guard and Reserve;
--Qualified Reservists should be authorized to receive Military
retirement pay and TRICARE healthcare before age 60;
--Hazardous duty and incentive pays for Reservists set the same as
active-duty;
--Creating tax credits to private businesses paying the difference
between military and civilian salaries to mobilized Reservists;
--Restoring travel exemptions for Reserve and Guard members for
expenses associated with attending drills;
--Military health care provided to members of the Reserve Components
and their dependents, who become injured while on active duty
status regardless of the number of days served on active duty;
--Retired Reservists and their dependents should be eligible for
TRICARE coverage when they become eligible to receive
retirement pay;
--All discharging Reservists should be required to have complete
discharge and/or retirement physical examinations to the same
standard as the active-duty force.
General Quality-of-Life Issues
Armed Forces Retirement Homes
The American Legion urges the Congress to support and fund those
measures, to include annual Congressional appropriations, which will
provide for the long-term solvency and viability of the Armed Forces
Retirement Home--Washington. The American Legion also strongly supports
the rebuilding of the Armed Forces Retirement Home at Gulfport,
Mississippi.
Support for the Selective Service Registration Program
The American Legion supports the retention of the Selective Service
Registration Program as being in the best interests of all Americans,
and its maintenance is a proven cost-effective, essential, and rapid
means of reconstituting the required forces to protect our national
security interests.
Reforming the Military Absentee Voting System
The American Legion urges that appropriate laws and guidelines be
developed at Federal, State and local levels with the intent that all
military absentee voters and their families will have their votes
counted in every election. The American Legion also recommends that the
sending and receiving of blank and completed military absentee ballots
be accomplished electronically as much as possible.
Military Commissaries
The American Legion urges DOD and the Congress to continue full
Federal funding of the military commissary system and to retain this
vital non-pay compensation benefit system. This quality-of-life benefit
is essential to the morale and readiness of the dedicated men and women
who have served, and continue to serve, the national security interests
of the United States. The American Legion opposes any efforts to
institute ``variable pricing'' or to privatize the military commissary
system or to dismantle or downsize the Defense Commissary Agency.
Military Funeral Honors
The American Legion reaffirms that the Congress should mandate and
appropriately fund DOD and the Military Services, to include
reimbursing the National Guard, so as to provide military honors upon
request at veterans' funerals in coordination with Veterans' Service
Organizations such as The American Legion at local levels. The
Department of Defense should implement equitable and expedient
reimbursement procedures for members of the veterans' service
organizations who participate in military funeral honors.
The American Legion also recommends that an action be taken to
change the wordage, as currently written in Section 578 Public Law 106-
65 to: That any and all funeral directors performing services for any
veteran of The United States armed forces shall be required to ask the
veteran's family member or other interested party if military honors
are requested, at no expense to the family, rather than placing the
burden upon the veteran's family at this time of bereavement.
FORCE STRUCTURE
The current active-duty personnel level has been funded to maintain
just under 1.37 million active-duty service members. Military leaders
had been making up manpower shortages by increasing the OPTEMPO,
increasing rotations to combat zones, and by over-utilizing the Reserve
Components. American military personnel are deployed to over 150
countries worldwide. Many of these personnel are from the Reserve
Components. Multiple deployments, particularly to combat zones, are
often the core element of the recruitment and retention challenges that
have confronted the Army. While all the services have met or exceeded
their recruitment goals for 2008, this is due in large part to the
uncertainty in the economy and to the great successes our forces are
having in Iraq. All of the services could find themselves in
recruitment difficulties again if the economy recovers quickly or if
casualties begin to rise again either in Iraq, Afghanistan or some
other area of the world where our national security is threatened. We
applaud Congress for funding the requested end strength increases of
7,000 for the Army, 5,000 for the Marine Corps, and 1,300 for the Army
Guard for fiscal year 2009. However, The American Legion insists that
these nominal increases are not enough to adequately provide for the
needs of a strong national security posture. The active force combined
with the reserve force still only totals under 1.75 million. As stated
previously, The American Legion urges an active and reserve force of
2.1 million.
Modernization of weapons systems is vital to properly equip the
armed forces, but is totally ineffective without adequate personnel to
effectively operate state-of-the-art weaponry. No military personnel
should go into battle with unarmed or under-armored vehicles or without
body armor or with vehicles and helicopters that are approaching or
exceeding their service lives. America stands to lose its service
members on the battlefield and during training exercises due to aging
equipment. The current practice of trading off force structures and
active-duty personnel levels to recoup or bolster modernization or
transformation resources must be discontinued. The Army and the Marine
Corps need to be immediately funded to reset their combat forces so as
to maintain their readiness.
The American Legion recommends restoring former military force
structures and increasing active-duty end strengths so as to improve
military readiness and to more adequately pursue the Overseas
Contingency Operations (OCO). The American Legion seeks to improve
alignment of service levels with missions to ease deployment rates and
improve quality-of-life features. Ensuring readiness also requires
retaining the peacetime Selective Service System to register young men
for possible military service in case of a national emergency. Military
history repeatedly demonstrates that it is far better to err on the
side of preserving robust forces to protect America's interests than to
suffer the consequences of an inadequate force structure or military
non-readiness, especially during time of war.
America needs a more realistic strategy with appropriate force
structure, weaponry, and equipment with increased active-duty and
Reserve components and readiness levels to achieve its national
security objectives.
Other Force Structure Issues and Recommendations
Support for the Non-Federal Roles of the National Guard
The active-duty force must be able to better accomplish its
operational objectives around the globe without relying so heavily on
the National Guard. The Guard must go back to its primary roles in
homeland security and used as a mainly strategic asset and not as an
operational one. The American Legion urges the Congress to retain
National Guard units at reasonable readiness levels so that in addition
to their active duty missions they may continue to provide civil
disturbance and natural and man-made disaster assistance; perform civil
defense and drug interdictions functions as well as other essential
State or Federal roles as required to include border security.
Uniformed Services University of the Health Sciences (USU)
The American Legion urges the Congress to: continue its
demonstrated commitment to USU, as a national asset, for the continued
provision of uniquely educated and trained uniformed physicians,
advanced practice nurses, and scientists dedicated to careers of
service in the Army, Navy, Air Force, and the United States Public
Health Service; support timely construction at the USU campus during
fiscal years 2009-2010; continue funding the University's collaborative
effort for sharing its chemical, radiological and biological, nuclear
and high yield explosive (CBRNE) expertise and training; support
development of the USU Immersive, Wide Area Virtual Environment (WAVE)
Simulation for CBRNE/WMD Medical Readiness Training; support funding
for the Graduate School of Nursing Teaching/Educational Programs; and,
encourage continued close collaboration and progress towards the OSD-
proposed Joint Medical Command and WRNMMC with USU as the core academic
health center.
Aeronautical and Space Exploration
The American Legion deems it imperative that the United States, in
the face of increasing competition, maintain its hard-won status as the
world leader in aeronautics and aircraft production and in space
exploration and research. To realize this goal, we urge the Congress to
provide:
--Adequate funding for the Nation's civilian and military aerospace
research and development programs to maintain U.S.
technological leadership.
--Adequate funding to build, upgrade and enhance the Nation's
civilian and military aerospace research facilities and wind
tunnels.
--A renewed national commitment to education involving academia in
aeronautical and aerospace engineering research and
technologies insuring a state-of-the art educated work force.
--Over-watch and investigate functions and related activities with
respect to the transfer of American aerospace technology
abroad.
Combating Cyberspace Threats
The American Legion urges the Congress to appropriate the necessary
funding and resources to combat the continuing cyberspace and other
threats to the United States in the 21st Century.
National Missile Defense System
The American Legion urges the United States Government to develop
and continue to deploy a national missile defense system which is in
the national interest of the United States and the American people and
an essential ingredient of our homeland security.
Considering the growing threats of rocket and missile attacks by
Iran and North Korea, proposed cuts to missile defense seem unwise.
Even if cuts are being made in systems that are not deemed successful,
those monies should be reallocated to those defense systems that are
working.
MANPOWER AND WEAPONS SYSTEMS
The President's fiscal year 2010 Defense budget request should
require continued funding to sustain current Overseas Contingency
Operations (OCO) while maintaining the war-fighting capabilities of the
Armed Forces. For years, the increased Operations Tempo (OPTEMPO), OCO,
and budgetary shortfalls have had a devastating impact on military
readiness, modernization, and personnel.
The American Legion recommends that the fiscal year 2010 Defense
appropriations bill should include higher military pay raises and
allowances as well as recruitment bonuses and incentives. The Defense
Health Program, to include the TRICARE health care system, needs to be
fully funded without new or increased TRICARE fees. Authorizations for
continued higher spending on modernization must include: the resetting,
repairing and procuring of Army weapons systems and equipment;
continued spending for development of, and fielding, Joint Strike
Fighters for the Air Force and Navy; and, procurement of more F-22A
Raptor fighter jets and aerial refueling tankers for the Air Force.
The American Legion urges Congress to increase defense spending to
levels that represent at least 5 percent of GDP. This represents not
only ongoing needs, but also the shared burden of the American people
during a time of war.
Defense budgets, military manpower and force structures are
currently one-third of their 1986 peacetime levels. Military
capabilities are at significantly lower levels than the Persian Gulf
War in 1991. With only 10 active Army divisions in the inventory, it is
little wonder that thousands of Reservists and Guardsmen have been
called to active-duty to bolster homeland security and in fighting the
wars in Iraq and Afghanistan. The current plan to cap the Brigade
Combat Team numbers to 45, as opposed to the recommended 48, is a
terrible case of robbing Peter to pay Paul. While the size of the force
will still increase, the actual size of combat ready ground forces will
still be inadequate. If our national security needs require more
administrators and trainers, then so be it, but it should not come at a
cost of a reduction in combat ready forces.
The American Legion, along with its previous quality-of-life and
force structure recommendations, further recommends the following as
regards the purchasing of weapons systems and armaments in general:
Rebuilding America's Defense Industrial Base
The American Legion urges the new administration and the Congress
to rebuild America's industrial base by continuing to adequately fund
research, development and acquisition budgets to assure that our
military production can meet national requirements especially when U.S.
military power is committed. Rebuilding America's industrial base
could, and perhaps should, be part of the administration's plan to
reinvigorate the economy.
We encourage the new Administration and the Congress in the
rebuilding of America's defense industrial base by having a proper
balance of policies that:
--Increase and then sustain domestic production at levels that
maintain a robust and internationally competitive defense
industry.
--Keep the arms industry internationally competitive.
--Ensure that the United States is not putting itself at risk by
having our armaments produced offshore.
Buy American
The American Legion urges Congress to require Government
contractors to utilize American-made components and subsystems in
construction of their equipment over those made by foreign
subcontractors for use by the United States military services to ensure
the defense of the country, as well as the continued employment of
Americans and veterans at subcontractor facilities.
Foreign Investments in the American Defense Industry
The American Legion urges the U.S. Government to ensure that
foreign entities are not permitted to own critical industries,
especially those involved in producing defense items. The American
Legion further opposes the transfer and sales of sensitive technologies
which may endanger our national security and economic interests.
Commercial Shipbuilding for Defense
The American Legion urges the Congress to vigorously act to stop
the further erosion of our vital maritime capability by boosting naval
budgets, promoting commercial shipbuilding, expanding the use of U.S.
flagships in world commerce, and resisting foreign actions that would
further damage America's defense industrial base.
Procurement of Sufficient F-22 Aircraft
The American Legion advocates that the procurement of F-22 Raptor
aircraft should be approved and funded by Congress for the stated USAF
requirement of 381 and that such procurement be funded through
additional appropriations even if that should result in an increase in
the overall National Defense Budget.
MILITARY CONSTRUCTION
Military Construction is directly related to the quality-of-life of
the service member and their dependants. As such, Military Construction
must be funded to a level that meets the immediate and future needs of
DOD. The cornerstone to a strong national defense is not based on
weapon systems purchased or the way the force structure is organized,
but rather, the way military service members and their families are
treated and cared for on military installations within the continental
United States and overseas. In today's All-Volunteer Armed Forces,
maintaining the highest quality-of-life standards is the least we
should do in the interest of national security and as the thanks of a
grateful Nation to those who serve.
Military Construction
The $26.3 billion recommendation is based of the current force
structure of 1.75 million. This recommendation also accounts for the
modest upcoming authorized increases in the sizes of the Army and
Marine Corps.
In fiscal year 2009, $25 billion, ($4.4 billion above fiscal year
2008) was appropriated for Military Construction. The large increase is
mostly due to the costs of implementing Base Realignment and Closure
(BRAC) and plans to increase the size of the Army and Marine Corps. It
should be noted that The American Legion recommends a 2.1 million man
force structure as opposed to the current force size. As such, if
authorization and funding for the expansion of the active-duty and
reserve force increased by an additional 50,000 service members for
fiscal year 2010 (in order to get closer to The American Legion's
recommended force structure level), The American Legion would recommend
$31.3 billion for Military Construction funding for the construction
associated with such an expansion of forces.
Quality-of-Life and BRAC
A quality-of-life concern that must be considered is the welfare of
our retired military. Often, when a service member retires from
service, whether medically of by longevity, they choose to live in
close proximity to a military installation. They choose this in order
to have access to the benefits they earned from honorable service.
Those benefits include access to base medical facilities, commissaries,
exchanges and other facilities.
Whenever a Base Realignment and Closure (BRAC) is conducted, The
American Legion will urge that certain base facilities (such as base
medical facilities, commissaries, exchanges and other facilities) be
preserved for use by active-duty and Reservist personnel and military
retired veterans and their families.
One key element of quality of life for service members and their
families is the quality of their housing, whether it is supplied by the
military in the form of on-base housing, or the availability and
quality of off-base housing. Long standing policy of DOD has been to
rely on local community housing. This policy comes into conflict with
reality where there is a localized influx of military families, whether
from BRAC or ``Grow the Army''-like programs.
Currently, roughly 63 percent of all military families reside in
off-base, private sector housing. A further 26 percent reside in
residences built under the Military Housing Privatization authorities.
Of the remaining 11 percent, 8 percent live in Government-owned housing
and 3 percent in (primarily overseas) leased housing. However, the
transience of forces may cause localized market problems in the coming
years, as changes occur resulting from BRAC, Grow the Force
initiatives, global re-posturing and joint basing. Some installations
may suddenly find they have a surplus of housing as a result, while in
other areas housing availability may be in deficit. Ensuring that
service members and their families have access to safe, affordable and
sufficient housing must remain a priority in order to address the
quality of life for these families.
One initiative which has received excellent reviews from the
services has been the Military Housing Privatization Initiative (MHPI)
which encourages high quality construction, sustainment, and renovation
of military housing by leveraging capital and expertise from the
private sector. Under this initiative, 94 projects have been awarded,
allowing the DOD to eliminate nearly all inadequate domestic family
housing. This program should be continued and expanded with additional
resources.
Numerous media reports surfaced last year of troops returning from
OCO to barracks that were unsatisfactory. In one case, a distraught
father of a soldier with the 82nd Airborne at Fort Bragg, NC went so
far as film the living conditions and to publicize it through social
networking sites. Following this renewed interest, the Army in
particular began a sweeping inspection of all its living facilities and
barracks to ascertain the level of need that many of them required in
terms of maintenance and repair. The reforms resulted in the First
Sergeants Barracks Initiative (FSBI) where the barracks are continually
monitored for needed repairs, and ``ownership'' of barracks for
deployed troops is transferred to post control for the duration of the
deployment. This successful innovation should be adequately funded to
accomplish these needed renovations.
In October of 2007, Secretary of the Army Pete Geren initiated a
program entitled the ``Army Family Covenant.'' At the time he stated:
The Health of our all-volunteer force, our Soldier-volunteers, our
Family-volunteers, depends on the health of the Family. The readiness
of our all-volunteer force depends on the health of the Families. I can
assure you that your Army leadership understands the important
contribution each and every one of you makes. We need to make sure we
step up and provide the support families need so the army stays healthy
and ready.
This covenant addressed various ways to improve family readiness
by:
--Standardizing and funding existing family programs and services;
--Increasing accessibility and quality of healthcare;
--Improving Soldier and Family Housing;
--Ensuring excellence in schools, youth services, and child care; and
--Expanding education and employment opportunities for family
members.
While we enlist soldiers, airmen, marines and navy personnel, we
also re-enlist families. Issues of the covenant from which funding
comes under the rubric of the Military Construction appropriations
should be funded fully to ensure that we maintain a high level of
quality of life, and thereby ensure a higher rate of reenlistment for
the Armed Forces.
The commitment to this program by the Army was demonstrated by the
testimony of Keith Easton, Assistant Secretary of the Army for
Installations on March 12. He noted that the Army Family Covenant
Program has shown significant progress in meeting its' goals since it
came into existence. The program itself shows a commitment and
understanding of the importance of family in our force structure and
maintaining readiness and force levels. This program is another which
should be expanded through adequate funding, to ensure the well being
of service members and demonstrate the national commitment towards
helping them individually and collectively prosper and reach their
potential.
Increased spending in the area of military construction not only
serves the strategic needs of the armed forces but also the needs of
the service members. It takes approximately 8 years to build a senior
Non-Commissioned Officer. To lose a member of the armed forces like
that to the civilian world, because they feel they can have a better
quality of life for them and their family outside of the services, is a
cost that can not be recouped.
The American Legion fully supports the Army Family Covenant Program
and engages all of its 14,000+ local American Legion posts to become
involved.
Wounded Warrior Care
All branches of the armed forces ascribe to the ethic that they
``take care of their own.'' Nowhere is this statement put more to the
test than when dealing with the combat and severely wounded. Since the
Building 18 episode at Walter Reed Army Medical Center, a well-deserved
spotlight was put on the whole transition process for outgoing military
personnel. The fiscal year 2009 budget has $3 billion to improve army
barracks, military hospitals, and other facilities. The American Legion
recommends a minimum of $3.4 billion for fiscal year 2010 in order to
ensure that there are no delays in construction and improvement of
living quarters and medical facilities.
Further, The American Legion advocates that Walter Reed Army
Medical Center should not be closed until after the wars in Iraq and
Afghanistan have ended. As such Walter Reed Army Medical Center needs
to be funded at levels high enough to meet and exceed the high
standards of care our service members deserve.
Uniformed Services University of the Health Sciences
The American Legion has supported the Uniformed Services University
of the Health Sciences (USU), since its establishment in 1972 as the
Nation's Federal Academic Health Center. USU is dedicated to providing
uniquely educated and trained uniformed officers for the United States
Army, Navy, Air Force and Public Health Service. USU alumni are
currently serving over 20-year careers and thus providing continuity
and leadership for the Military Health System (MHS) as physicians,
advanced practice nurses and scientists. USU F. Edward Heert School of
Medicine has a year-round, 4-year curriculum that is nearly 700 hours
longer than found at other U.S. medical schools. These extra hours
focus on epidemiology, health promotion, disease prevention, tropical
medicine, leadership and field exercises. Doctoral and Masters degrees
in the biomedical sciences and public health are awarded by
interdisciplinary and department-based graduate programs within the
School of Medicine. Programs include infectious disease, neuroscience,
and preventive medicine research.
USU Graduate School of Nursing offers a Master of Science in
Nursing degree in Nurse Anesthesia, Family Nurse Practitioner,
Perioperative Clinical Nursing, Psychiatric Mental Health Nurse
Practitioner, and a full and part-time program for a Ph.D. degree in
Nursing Science. The university's continuing education program is
unique and extensive, serving and sustaining the professional and
readiness requirements of the Defense Department's worldwide military
healthcare community.
The university's nationally ranked military and civilian faculty
conduct cutting edge research in the biomedical sciences and in areas
specific to the DOD health care mission such as combat casualty care,
infectious diseases and radiation biology. The university specializes
in military and public health medicine, focusing on keeping people
healthy, disease prevention, and diagnosis and treatment. USU faculty
offer significant expertise in tropical medicine and hygiene,
parasitology, epidemiologic methods and preventive medicine.
The Department of Defense and the United States Congress have
recognized that the extensive military-unique and preventive health
care education provided in the multi-service environment of USU ensures
Medical Readiness and Force Health Protection for the MHS. USU is
recognized as the place where students receive thorough preparation to
deal with the medical aspects of Weapons of Mass Destruction, including
chemical, radiological and biological, nuclear and high yield explosive
(CBRNE) terrorism or other catastrophe. USU has developed similar
training for civilian first responders, medical professionals and
emergency planners. USU is also uniquely qualified and experienced in
simulation technology, education and training.
With the establishment by the Office of the Secretary of Defense
(OSD) of a Joint Medical Command in fiscal year 2008, the role of USU
will expand. Plans to establish the Walter Reed National Military
Medical Center (WRNMMC) by 2011 has created close collaboration between
the Armed Services Flag Officers and the President of USU to create a
world-class military academic health center, expanding the role of USU.
As stated previously, The American Legion urges the Subcommittee
to: continue its demonstrated commitment to USU, as a national asset,
for the continued provision of uniquely educated and trained uniformed
physicians, advanced practice nurses, and scientists dedicated to
careers of service in the Army, Navy, Air Force, and the United States
Public Health Service; support timely construction at the USU campus
during fiscal years 2009-2010; continue funding the University's
collaborative effort for sharing its chemical, radiological and
biological, nuclear and high yield explosive (CBRNE) expertise and
training; support development of the USU Immersive, Wide Area Virtual
Environment (WAVE) Simulation for CBRNE/WMD Medical Readiness Training;
support funding for the Graduate School of Nursing Teaching/Educational
Programs; and, encourage continued close collaboration and progress
towards the OSD-proposed Joint Medical Command and WRNMMC with USU as
the core academic health center.
Armed Forces Retirement Homes
The United States Soldiers' and Airmen's Home (USSAH) and the
United States Naval Home (USNH), jointly called the Armed Forces
Retirement Home (AFRH), are continuing care facilities which were
created more than 150 years ago to offer retirement homes for
distinguished veterans who had served as soldiers, sailors, airmen and
Marines in our Nation's conflicts. The AFRH system, which is available
to retiree veterans from all the Armed Services whose active duty was
at least 50 percent enlisted or warrant officer, has been supported by
a trust fund resourced by 50 cents a month withheld from active duty
enlisted and warrant officer paychecks as well as from fines and
forfeitures from disciplinary actions, resident fees and interest
income. The extensive downsizing of the Armed Forces has resulted in a
39 percent decrease in that revenue and, coupled with rising nursing
home care costs, the Homes have been operating at an $8-10 million
annual deficit which would reportedly require both Homes to close their
doors.
The American Legion urges the Subcommittee to support measures
which will provide for the long-term solvency and viability of the
Armed Forces Retirement Home--Washington, DC. The American Legion also
strongly supports the rebuilding of the Armed Forces Retirement Home at
Gulfport, Mississippi which was destroyed by Hurricane Katrina.
American Battle Monuments Commission
The American Battle Monuments Commission (ABMC) was established by
law in 1923, as an independent agency of the Executive Branch of the
United States Government. The Commission's commemorative mission
includes:
--Designing, constructing, operating and maintaining permanent
American cemeteries in foreign countries.
--Establishing and maintaining U.S. military memorials, monuments and
markers where American armed forces have served overseas since
April 6, 1917, and within the United States when directed by
public law.
--Controlling the design and construction of permanent U.S. military
monuments and markers by other U.S. citizens and organizations,
both public and private, and encouraging their maintenance.
The resulting United States Military Cemeteries have been
established throughout the world and are hallowed grounds for America's
war dead. United States Military Cemeteries existing in foreign
countries today are in need of adequate funding for repair,
maintenance, additional manpower and other necessities to preserve the
integrity of all monuments and cemeteries which are realizing increased
numbers of visitors annually.
Adequate funding and human resources to the American Battle
Monuments Commission must be provided in order to properly maintain and
preserve these hallowed, final resting places for America's war dead
located on foreign soil. In fiscal year 2009, $59.5 million, $15
million above fiscal year 2008 was provided for the care and operation
of our military monuments and cemeteries around the world. The American
Legion applauded this increased funding and supports the continued full
funding for the needs of the American Battle Monuments Commission.
Funding for Joint POW/MIA Accounting Command
The American Legion has long been deeply committed to achieving the
fullest possible accounting for U.S. personnel still held captive,
missing and unaccounted for from all of our Nation's wars. The level of
personnel and funding for the Joint POW/MIA Accounting Command (JPAC)
has not been increased at a level commensurate with the expanded
requirement to obtain answers on Americans unaccounted from wars and
conflicts prior to the Vietnam War. It is the responsibility of the
U.S. Government to account as fully as possible for America's missing
veterans, including--if confirmed deceased--the recovery of their
remains when possible. The Congress has a duty and obligation to
appropriate funds necessary for all Government agencies involved in
carrying out strategies, programs and operations to solve this issue
and obtain answers for the POW/MIA families and our Nation's veterans.
This accounting effort should not be considered complete until all
reasonable actions have been taken to achieve the fullest possible
accounting. The American Legion calls on Congress to provide increases
in personnel and full funding for the efforts of JPAC, the Defense POW/
Missing Personnel Office (DPMO), the Life Sciences Equipment
Laboratory, and the Armed Forces DNA Laboratory, including specific
authorization to augment assigned personnel when additional assets and
resources are necessary. The American Legion remains steadfast in our
commitment to the goal of achieving the fullest possible accounting for
all U.S. military and designated civilian personnel missing from our
Nation's wars.
JPAC was forced to reduce field operations in pursuit of missing
U.S. personnel in early 2006 due to a failure of DOD to provide
adequate funding. The mission of JPAC has been expanded by Congress to
include investigation and recovery operations dating back to and
including unaccounted for WWII personnel, while funding levels have not
increased to meet this requirement. The headquarters currently utilized
by JPAC is no longer capable of housing neither the expanded command
nor the expanded laboratory requirements for forensic identifications.
The American Legion calls on the Congress to ensure that JPAC has at
least $62 million per year in operation funds and an additional $64
million per year for fiscal year 2010 through fiscal year 2011 for JPAC
military construction funds as part of the budget for the Department of
Defense in connection with JPAC. The American Legion calls on the
Congress to ensure that such funds be approved and restricted for use
for no purpose other than those included in the mission statement of
the Joint POW/MIA Accounting Command, Hickam AFB, Hawaii.
The American Legion commends Admiral Timothy Keating, Commander,
U.S. Pacific Command, for his commitment to seek U.S. Navy funding in
the amount of $105 million to begin construction of a new JPAC
headquarters, including a state-of-the-art laboratory in fiscal year
2010, to be completed in fiscal year 2011. Furthermore, The American
Legion urges the Congress to fully fund this U.S. Navy military
construction project to ensure that those who serve our Nation--past,
present, and future--are returned and accounted for as fully as
possible.
CONCLUSION
The United States continues to fight in OCO and defend our vital
national interests. While America may be safer and has not suffered
another tragic event on our soil since the tragic day of 9/11/01, the
world is still not a safe place. The American Legion thanks the
Subcommittee for inviting The American Legion to this hearing and looks
forward to working with Congress and the administration on the many
issues in National Defense facing our country.
Chairman Inouye. And now the deputy director of the
National Military Family Association, Ms. Kelly Hruska.
STATEMENT OF KELLY B. HRUSKA, GOVERNMENT RELATIONS,
DEPUTY DIRECTOR, NATIONAL MILITARY FAMILY
ASSOCIATION
Ms. Hruska. Thank you, Mr. Chairman, for the opportunity to
highlight the National Military Family Association's belief
that 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, not merely
added on as a part of supplemental funding. Programs must
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 your help
over the past years in addressing many of these important
issues.
The increased access to resources and programs by the Joint
Family Support Assistance Program, now offered in all States
and territories, allows families to receive added help when
they need it, during all cycles of deployment. The Military
Family Readiness Council held its first informal meeting in
December. We feel this will be an effective tool in identifying
programs that work, and in helping to eliminate overlapping or
redundant programs, as the council reviews existing resources
for military families. In an effort to make their efforts more
credible, our association would like to see more funding set
aside to be used for pilot programs that may come out of the
council's recommendations, or allows DOD to replicate best
practices, as necessary. This seed funding would streamline the
bureaucracy and get the pilot programs out to families faster.
Huge strides have been made in the building of brick-and-
mortar child development centers on military installations.
Within the next year or two, thousands of spaces will become
available for our military families. But, the need for more
spaces will still exist. Innovative strategies are needed to
address the non-availability of after-hours childcare and
respite care. We applaud the partnership between the services
and the National Association of Childcare Resources and
Referral Agencies that provides subsidized childcare to
families who cannot access installation-base child development
centers. Including National Guard and Reserve families.
Families often find it difficult to obtain affordable, quality
care, especially during hard-to-fill hours and on weekends.
Both the Navy and the Air Force have piloted 24/7 programs.
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 the Army
Family Covenant, has rolled out more resources for respite care
of families of deployed services. Respite care is needed across
the board for 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 appreciate the recent increase to the special survivor
indemnity allowance, for surviving spouses, but the elimination
of the dependency and indemnity compensation offset to the
survivor benefit plan annuity should still remain a high
priority.
Our association recognizes and appreciates the many
resources and programs that support our military families
during this time of war. The need will not go away the day the
war ends. We believe it is imperative these programs be
included in the regular budget process.
In our written statement we have identified other ways to
assist military families, and will be glad to expand on those
suggestions, should you have any questions.
Military families--one size does not fit all, but they are
united in their sacrifices in support of their servicemembers
and our Nation. We ask you to help the Nation sustain and
support them.
Thank you, sir.
Chairman Inouye. I thank you very much, Ms. Hruska.
And to all the witnesses, if you have supporting documents
and memos, please feel free to submit them, because I can
assure you we'll read them.
[The statement follows:]
Prepared Statement of Kelly B. Hruska
Chairman Inouye and Distinguished Members of this 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. You recognize the sacrifices made by
today's service members and their families by focusing on the many
elements of their quality of life package: access to quality health
care, robust military pay and benefits, support for families dealing
with deployment, and special care for the families of the wounded, ill
and injured and those who have made the greatest sacrifice.
In this statement, our Association will expand on several issues of
importance to military families: Family Readiness; Family Health;
Family Transitions.
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 service
members 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
of the past several years that recognized many of these important
issues. The increased access to resources and programs provided by the
Joint Family Support Assistance Program (JFSAP), now offered in all
States and territories, allows families to receive added help when they
need it during all cycles of deployment. The Military Family Readiness
Council held its first informal meeting in December. We feel this will
be an effective tool in identifying programs that work and in helping
to eliminate overlapping or redundant programs as the Council reviews
existing resources for military families. Our Association is proud to
represent military families as a member of the Council.
Our Association believes that it is imperative full funding for
family readiness programs be included in the regular budget process and
not merely added on as part of supplemental funding.
Child Care
The Services--and families--continue to tell us more child care is
needed to fill the ever growing demand, including hourly, drop-in,
respite, and after-hour child care. We've heard stories like this:
Child care facilities on base are beyond compare--for spouses and
military members who work nine to five. In our increasingly service-
oriented economy, the job I have has me working until at least seven
most days, and usually as late as midnight 1 to 2 days a week. When my
husband deploys or has a stint on second shift, I run out of options
quickly. I have been unable to get another, more conventional job in
the 2 years I have been in this area . . . there are minimum
requirements as to what shifts I need to work to maintain full-time
employment at my current workplace, and I cannot have those waived for
an entire deployment.
Innovative strategies are needed to address the non-availability of
after-hour 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 (NACCRRA) that
provides subsidized childcare to families who cannot access
installation based child development centers. 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 that 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.
At our Operation Purple Healing Adventures camp for families of
the wounded, ill and injured, we were told 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.
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 for families of deployed service members
and the wounded, ill and injured.
Working with Youth
Older children and teens must not be overlooked. School personnel
need to be educated on issues affecting military students and 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, Operation Purple provides a safe and fun environment in
which military children feel immediately supported and understood. Last
year, with the support of private donors, we achieved our goal of
sending 10,000 military children to camp. We also were successful in
expanding the camp experience to families of the wounded and bereaved.
This year, we expect to maintain those numbers by offering 95 weeks of
camp in 37 States and territories, as well as conducting several pilot
family reintegration retreats in the National Parks.
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 contracted with the RAND
Corporation in 2007 to conduct a pilot study aimed at the current
functioning and wellness of military children attending Operation
Purple camps and assessing the potential benefits of the OPC program in
this environment of multiple and extended deployments. The results of
the pilot study were published last spring and confirmed much of what
we have heard from individual families. They also highlighted gaps in
our current knowledge, including how family relationships are affected
by deployment and reintegration. The study looked at differences in
child and caregiver experiences based on Service component, such as how
life is different during deployment for families from the Active
Component compared to those in the Guard or Reserve.
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
is following these families for 1 year, and interviewing the non-
deployed caregiver/parent and one child per family between 11 and 17
years of age at three time points over that year. Recruitment of
participants has been extremely successful because families are eager
to share their experiences. RAND is currently gathering information
from these families for the 6-month follow-up survey. Preliminary
findings from the first round of surveys provide additional support for
the pilot study results and identify new areas to investigate. This
includes examining the relationship between the total months of
deployment that a family experiences and its association with non-
deployed caregiver's mental health and child's well-being at school and
at home. In addition, RAND is assessing the impact of reintegration on
the families and how this varies by a service member's rank and Service
component.
This study will provide valuable data to inform the future creation
and implementation of services for children and families. More
specifically, we hope this study will provide more detailed and clearer
understanding of the impact of multiple and extended deployments on
military children and their families. We expect to present the final
study results in Spring 2010.
National Guard and Reserve
Our Association would like to thank Congress for authorizing many
provisions that affect our Reserve Component families, who have
sacrificed greatly in support of our Nation. We continue to ask
Congress to fully fund these programs so vital to the quality of life
of our National Guard and Reserve families.
The National Military Family Association has long realized the
unique challenges our Reserve Component families face and their need
for additional support. This need was highlighted in the final report
from the Commission on the National Guard and Reserves, which confirmed
what we had always asserted: ``Reserve Component family members face
special challenges because they are often at a considerable distance
from military facilities and lack the on-base infrastructure and
assistance available to active duty families.'' While citing a robust
volunteer network as crucial, the report also stated that family
readiness suffers when there are too few paid staff professionals
supporting the volunteers.
Our Association would also like to thank Congress for the
provisions which allowed for the implementation of the Yellow Ribbon
Reintegration program which is so crucial to the well-being of our
Reserve Component families. We urge Congress to make the funding for
this program permanent. We also believe that family members should be
paid a travel allowance to attend these important reintegration
programs. Furthermore, DOD and service providers need to move away from
the one-size fits all approach to reintegration which does not work for
all the Reserve Components due to the specific nature of each mission
and the varying length of deployments.
Our Association asks Congress to fully fund the Yellow Ribbon
Reintegration program and other provisions affecting our Reserve
Component families and to move away from the one-size fits all approach
to reintegration.
Military Housing
Privatized housing is a welcome change for military families and we
are pleased the fiscal year 2009 NDAA called for an annual report that
addresses the best practices for executing privatized housing
contracts. With our depressed economy, increased oversight is critical
to ensure timely completion of these important projects. Project delays
negatively impact the quality of life of our families.
Commanders must be held accountable for the quality of housing and
customer service in privatized communities. Housing areas remain the
responsibility of the installation Commander even when managed by a
private company. Services members who are wounded and must move to a
handicap accessible home or break their lease provisions due to short-
notice PCS orders should not be penalized. Service members should not
languish on wait lists while civilians occupy housing. While
privatization contracts permit other non-military occupants for vacant
units, Commanders must ensure that privatized housing is first and
foremost meeting the needs of the active duty population of the
installation. In some cases, this will require modification or
renegotiation of contracts.
Our Association feels there needs to be a review of BAH standards.
While families who live on the installation are better off, families
living off the installation are forced to absorb more out-of-pocket
expenses in order to live in a home that will meet their needs. BAH
standards are based on an outdated concept of what would constitute a
reasonable dwelling. For example, in order to receive BAH for a single
family dwelling a service member must be an E9. However, if that same
service member lived in military housing, he or she would likely have a
single family home at the rank of E6 or E7. BAH standards should mirror
the type of dwelling a service member would occupy if government
quarters were available.
Our Association believes that BAH standards should be reviewed and
should better reflect the type of dwelling the service member would
occupy if government quarters were available.
Commissaries and Exchanges
The commissary is a key element of the total compensation package
for service members and retirees and is valued by them, their families,
and survivors. Not only do our surveys indicate that military families
consider the commissary one of their most important benefits, during
this economic downturn, many families are returning to the commissary
to help them reduce their grocery budget. In addition to providing
average savings of more than 30 percent over local supermarkets,
commissaries provide an important tie to the military community.
Commissary shoppers get more than groceries at the commissary. They
gain an opportunity to connect with other military family members and
to get information on installation programs and activities through
bulletin boards and installation publications. Finally, commissary
shoppers receive nutrition information and education through commissary
promotions and educational campaigns contributing to the overall health
of the entire beneficiary population.
Our Association appreciates the provision included in the fiscal
year 2009 NDAA allowing the use of proceeds from surcharges collected
at remote case lot sales for Reserve Component members to help defray
the cost of those case lot sales. This inclusion helps family members,
not located near an installation partake in the valuable commissary
benefit.
Our Association is concerned there will not be enough commissaries
to serve areas experiencing substantial growth, including those
locations with service members 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.
The military exchange system serves as a community hub, in addition
to providing valuable cost savings to members of the military
community. Equally important is the fact that exchange system profits
are reinvested in important Morale, Welfare and Recreation (MWR)
programs, resulting in quality of life improvements for the entire
community. We believe 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. Exchanges must also
continue to be responsive to the needs of deployed service members in
combat zones and have the right mix of goods at the right prices for
the full range of beneficiaries.
Family Care Plans
We have heard from single parent and dual military families about
the expenses incurred when they have to relocate their children to
another location when they are activated for deployment. This issue was
raised within the Army Family Action Plan process. Service members
requiring activation of Family Care Plans are not compensated for the
travel of dependents and shipment of the dependent's household goods.
Some items such as infant equipment, computers and toys are necessary
for the emotional and physical well-being of the children in their new
environment during an already stressful time. Implementation of the
Family Care Plan should not create additional financial hardship and
emotional stress on the service member and family.
We recommend that changes be made to the DOD Joint Travel
Regulations to provide for travel and shipment of household goods to
fulfill the needs of a deploying service member's Family Care Plan.
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 (MTF) 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 an interview with syndicated Military Update columnist Tom
Philpott in December of 2008, MG (Dr.) Elder Granger, deputy director
of TRICARE, gave the Military Health System (MHS) an overall grade of
``C-plus or B-minus''. His 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. In
previous testimony before this subcommittee we have noted the failure
of MTFs to meet TRICARE Prime access standards and to be held
accountable in the same way as the TRICARE contractors are for meeting
those standards in the purchased care arena.
In discussions with families the main issues are: access to their
Primary Care Managers (PCM); getting appointments; 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. Families familiar with how the MHS referral system
works seem better able to navigate the system. Those families who are
unfamiliar experienced delays in receiving treatment or decide to give
up on the referral process and never obtain a specialty appointment.
Case management for military beneficiaries with special needs is
not consistent across the MHS, whether within the MTFs or in the
purchased care arena. Thus, military families end up managing their own
care. The shortage of available health care providers only adds to the
dilemma. 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. Meanwhile,
the coordination of the military family's care is being done by a non-
synergistic health care system. Incongruence in the case management
process becomes more apparent when military family members transfer
from one TRICARE region to another and is further exasperated when a
special needs family member is involved. Each TRICARE Managed Care
Contractor has created different case management processes. There needs
to be a seamless transition and a warm handoff between TRICARE regions
for these families and the establishment of a universal case management
process across the MHS.
Our wounded, ill, and injured service members, veterans, and their
families are assigned case managers. In fact, there are many different
case managers: Federal Recovery Coordinators (FRC), Recovery Care
Coordinators, each branch of Service, TBI care coordinators, VA
liaisons, etc. The goal is for a seamless transition of care between
and within the two governmental agencies: DOD and the VA. However, with
so many to choose from, families often wonder which one is the
``right'' case manager. We often hear from families, some who have long
since been medically retired with a 100 percent disability rating or
others with less than 1 year out 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 these families alone trying to navigate a
variety of complex health care systems trying to find the right
combination of care. Many qualify for and use Medicare, VA, DOD's
TRICARE direct and purchased care, private health insurance, and State
agencies. Does this population really need all of these different
systems of receiving health care? Why can't the process be streamlined?
TRICARE
While Congress temporarily forestalled increases over the past 2
years, we believe DOD officials will continue to support large
increased retiree enrollment fees for TRICARE Prime combined with a
tiered system of enrollment fees, the institution of a TRICARE standard
enrollment fee and increased TRICARE Standard deductibles. Two reports,
the Task Force on the Future of the Military Health Care and The Tenth
Quadrennial Review of Military Compensation Volume II, recently
recommended the same.
We acknowledge the annual Prime enrollment fee has not increased in
more than 10 years and that it may be reasonable to have a mechanism to
increase fees. With this in mind, we have presented an alternative to
DOD's proposal should Congress deem some cost increase necessary. The
most important feature of our proposal is that any fee increase be no
greater than the percentage increase in the retiree cost of living
adjustment (COLA). If DOD thought $230/$460 was a fair fee for all in
1995, then it would appear that raising the fees simply by the
percentage increase in retiree pay is also fair. We also suggest it
would be reasonable to adjust the TRICARE Standard deductibles by tying
increases to the percentage of the retiree annual COLA. We stand ready
to provide more information on this issue if needed.
Support for Special Needs Families
We applaud Congress and DOD's desire to create a robust health care
and educational service 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.
There was discussion last year by Congress and military families
regarding the ECHO program. The fiscal year 2009 NDAA included a
provision to increase the cap on certain benefits under the ECHO
program to $36,000 per year for training, rehabilitation, special
education, assistive technology devices, institutional care and under
certain circumstances, transportation to and from institutions or
facilities, because certain beneficiaries bump up against it. 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 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.
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 may prove to be more
cost-effective for the government than subsidizing 72 percent of the
costs of TRICARE Reserve Select for National Guard or Reserve members
not on active duty.
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 access to mental health services.
National provider shortages in the psychological 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 psychological 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.
We have heard the main reason for the VA not providing health care
and psychological health care services is because they cannot be
reimbursed for care rendered to a family member. However, the VA is a
qualified TRICARE provider. This allows the VA to bill for services
rendered in their facilities to a TRICARE beneficiary. There may be a
way to bill other health insurance companies as well. The VA needs to
look at the possibility for other methods of payments.
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 service members, retirees, their
families, and survivors.
We appreciate the inclusion of Federal pricing for the TRICARE
retail pharmacies in the fiscal year 2008 NDAA. However, we 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 the
overall negotiation of future drug prices by Medicare and civilian
private insurance programs.
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 OTC drugs be a covered pharmacy benefit and
there be a zero co-pay for TMOP Tier 1 medications.
National Health Care Proposal
Our Association is cautious about current rhetoric by the
Administration and Congress regarding the establishment of a National
health care insurance program. As the 111th Congress takes up a
National health care insurance proposal, we request consideration of
how this legislation will also impact TRICARE, military families'
access to health care, and especially recruitment and retention of our
service members at a time of war.
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 Advisory 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.
Our Association does not support the recommendation of the Task
Force on the Future of Military Health Care to carve out one regional
TRICARE contractor to provide both the pharmacy and health care
benefit. We agree a link between pharmacy and disease management is
necessary, but feel this pilot would only further erode DOD's ability
to maximize potential savings through TMOP. We were also disappointed
to find no mention of disease management or a requirement for
coordination between the pharmacy contractor and Managed Care Support
Contractors in the Request for Proposals for the new TRICARE pharmacy
contract. The ability certainly exists for them to share information
bi-directionally and should be established.
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.
Our Association suggests this Subcommittee DOD reassess the
resource sharing program used prior to the implementation of the T-Nex
contracts and take the steps necessary to ensure Military Treatment
Facilities (MTF) meet access standards with high quality health care
providers.
We also suggest this Subcommittee direct the Department to make
case management services more consistent across the direct and
purchased care segments of the MHS.
Our Association recommends a 1-year transitional active duty ECHO
benefit for the family members of service members who retire.
We believe tying increases in TRICARE enrollment fees to the
percentage increase in the Retiree Cost of Living Adjustment (COLA) is
a fair way to increase beneficiary cost shares should Congress deem an
increase necessary.
We oppose DOD's proposal to institute a TRICARE Standard enrollment
fee and believe Congress should reject this proposal because it changes
beneficiaries' entitlement to health care under TRICARE Standard to
just another insurance plan.
Our Association strongly believes an enrollment fee for TFL is not
appropriate.
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 service members and their families
cope with the aftermaths 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 to stress reduction
techniques, to individual or family counseling, to 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 service members and families
experience numerous lengthy and dangerous deployments, we believe the
need for confidential, preventative psychological health services will
continue to rise. It will also remain high for some time even after
military operations scale down.
Access to Behavioral Health Care
Our Association is concerned about the overall shortage of
psychological 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 service members and
their families. While families are pleased more psychological health
providers are available in theater to assist their service members,
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 compassion fatigue, creating burnout and
exacerbating the provider shortage problem.
We have seen an increase in the number of psychological 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 psychological health provider list on the
contractor's websites that the provider is full and no longer taking
patients. The list must be up-to-date in order to handle real time
demands by families. We need to continue to recruit more psychological
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 service members. Family members are a key component to a
service member's psychological well-being. We recommend an extended
outreach program to service members, veterans, and their families of
available psychological health resources, such as DOD, VA, and State
agencies. Families want to be able to access care with a psychological
health provider who understands or is sympathetic to the issues they
face.
Frequent and lengthy deployments create a sharp need in
psychological health services by family members and service members 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 psychological 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. 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.
Availability of Treatment
Do DOD, VA and State agencies have adequate psychological 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 service members.
The team found the top non-combat 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. 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 service member's
separation, the families find themselves ineligible for TRICARE, and
are very rarely eligible for healthcare through the VA. Many will
choose to locate in rural areas lacking available psychological health
providers. We need to address the distance issues families face in
finding psychological health resources and obtaining appropriate care.
Isolated service members, 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; and
--educating civilian network psychological health providers about our
military culture as the VA incorporates Project Hero.
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 as well as service members
who leave the military following the end of their enlistment. They 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 no
mental health providers available. Policy makers 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.
Wounded, Ill, and Injured Families
When designing support for the wounded, ill, and injured in today's
conflict, our Association believes the government, especially DOD, VA,
and State agencies, must take a more inclusive view of military and
veterans' families. Those who have the responsibility to care for the
wounded service member must also consider the needs of the spouse,
children, parents of single service members, siblings, and other
caregivers. Family members are an integral part of the health care team
and recovery process.
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 service members 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 service members and the veterans
on a regular basis. And, 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 services members 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 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 restrict 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. 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, or injured service
member 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
service members); and sponsor a longitudinal study, similar to DOD's
Millennium Cohort Study, in order to get a better understanding of the
long-term effects of war on our military families.
Children
Our Association is concerned about the impact deployment and/or the
injury of the service member is having on our most vulnerable
population, children of our military and veterans. Multiple 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 service members.
Their families find stress can be overwhelming, but are afraid to reach
out for assistance for fear of retribution to the service member's
career. They often choose not to seek care for themselves or their
families.
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 Military Treatment Facility (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 encourage partnerships between government agencies, DOD, VA and
State agencies and recommend they reach out to those private and non-
governmental 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.
Caregivers
In the 7th year of the Global War on Terror, care for the
caregivers must become a priority. 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 service members 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
service member'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 service members and veterans must be educated about
the effects of mTBI and PTSD in order to help accurately diagnose and
treat the service member/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.
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.
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 is piloting two family
retreats in the National Parks to promote family reintegration
following deployment.
We recommend an extended outreach program to service members,
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 service members); and sponsor a
longitudinal study, similar to DOD's Millennium Cohort Study, in order
to get a better understanding of the long-term effects of war on our
military families.
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 Service Members Have Wounded Families
Our Association asserts that behind every wounded service member
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 service member must also consider the
needs of the spouse, children, parents of single service members and
their siblings, and the caregivers. We appreciate the inclusion in the
fiscal year 2008 NDAA Wounded Warrior provision for health care
services to be provided by the DOD and VA for family members. 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 service member is still on active duty status.
Reintegration programs become a key ingredient in the family's
success. In the spring of 2008, our Association held a focus group
composed of wounded service members and their families to learn more
about issues affecting them. Families find themselves having to
redefine their roles following the injury of the service member. 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 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. We piloted a
Operation Purple Healing Adventures camp to help wounded service
members and their families learn to play again as a family and plan one
more in the summer of 2009.
Brooke Army Medical Center (BAMC) has recognized a need to support
these families by expanding in terms of guesthouses co-located 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 BAMC's which has found a way to embrace the family unit
during this difficult time.
Transitioning for the Wounded and Their Families
Transitions can be especially problematic for wounded, ill, and
injured service members, 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
service member has been wounded and ending with the DOD, VA, and State
agencies working together, creating a seamless transition, as the
wounded service member 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
service members 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. Service members
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 certain programs offered to active
duty, such as ECHO for 3 years. Following that period, they would pay
TRICARE premiums at the rate for retirees. Service members 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
Caregivers need to be recognized for the important role they play
in the care of their loved one. The VA has made a strong effort in
supporting veterans' caregivers. The DOD should follow suit and expand
their definition. Caregivers of the severely wounded, ill, and injured
services members have a long road ahead of them. In order to perform
their job well, they must be given the skills to be successful. This
will require the caregiver to be trained through a standardized,
certified program, and appropriately compensated for the care they
provide. The time to implement these programs is while the service
member is still on active duty status.
Our Association proposes that new types of financial compensation
be established for caregivers of injured service members and veterans
that could begin while the hospitalized service member is still on
active duty and continue throughout the transition to care under the
VA. This compensation should recognize the types of medical and non-
medical care services provided by the caregiver, travel to appointments
and coordinating with providers, and the severity of injury. It should
also take into account the changing levels of service provided by the
caregiver as the veteran's condition improves or diminishes or needs
for medical treatment changes. These needs would have to be assessed
quickly with little time delay in order to provide the correct amount
of compensation. The caregiver should be paid directly for their
services, but the compensation should be linked to training and
certification paid for by the VA and transferable to employment in the
civilian sector if the care is no longer needed by the service member.
Our Association looks forward to discussing details of implementing
such a plan with Members of this Subcommittee.
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. Perhaps, caregivers of severely injured
service members or veterans can be given the option of buying health
insurance through the Federal Employees Health Benefit Program or
through enrollment in CHAMPVA. A mechanism should also be established
to assist caregivers who are forced out of the work force to save for
their retirements, for example, through the Federal Thrift Savings
Plan.
There must be a provision for transition 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.
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 themselves. Caregivers' responsibilities
start while the service member is still on active duty.
Relocation Allowance
Active Duty service members and their spouses qualify through the
DOD for military orders to move their household goods (known as a
Permanent Change of Station (PCS)) when they leave the military
service. Medically retired service members are given a final PCS move.
Medically retired married service members are allowed to move their
family; however, medically retired single service members only qualify
for moving their own personal goods.
The National Military Family Association is requesting the ability
for medically retired single service members to be allowed the
opportunity to have their caregiver's household goods moved as a part
of the medical retired single service member's PCS move. This should be
allowed for the qualified caregiver of the wounded service member 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 service member 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 service member 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 service member. Instead of trying to create
the services in the area, a better solution may be to allow the
medically retired service member, 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 service
member's medical physician, the service member, and the caregiver. All
aspects of care for the medically retired service member and their
caregiver shall be considered. These include a holistic examination of
the medically retired service member, 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
service member and his/her 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.
Provide transitioning wounded, ill and injured service members and
their families a bridge of extended active duty TRICARE eligibility for
3 years, comparable to the benefit for surviving spouses.
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 service member.
Service members medically discharged from service and their family
members shall be allowed to continue for 1 year as active duty for
TRICARE and then start the Continued Health Care Benefit Program
(CHCBP) if needed.
Senior Oversight Committee
Our Association is appreciative of the provision in the fiscal year
2009 NDAA continuing the DOD/VA Senior Oversight Committee (SOC) for an
additional year. We understand a permanent structure is in the process
of being established and manned. We urge Congress to put a mechanism in
place to continue to monitor DOD and VA's partnership initiatives for
our wounded, ill, and injured service members and their families, while
this organization is being created.
The National Military Family Association encourages the Armed
Service Committee along with the Veterans' Affairs Committee to talk on
these important issues. We can no longer be content on focusing on each
agency separately because this population moves too frequently between
the two agencies, especially our wounded, ill, and injured service
members and their families.
We would like to thank you again for the opportunity to provide
information on the health care needs for the service members, veterans,
and their families. Military families support the Nation's military
missions. The least their country can do is make sure service members,
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 service members 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.
FAMILY TRANSITIONS
Our Association will promote policies and access to programs
providing training and support for families during the many transitions
they experience.
Survivors
In the past year, the Services have been focusing on outreach to
surviving families. In particular, the Army's SOS (Survivor Outreach
Services) 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 ask that the active duty TRICARE Dental benefit be extended to
surviving children to mirror the active duty TRICARE medical benefit to
which they are now eligible. We also ask that eligibility be expanded
to those Reserve Component family members who had not been enrolled in
the active duty TRICARE Dental benefit prior to the service member's
death.
Our Association recommends that surviving children be allowed to
remain in the TRICARE Dental Program until they age out of TRICARE
eligibility and that eligibility be expanded to those Reserve Component
survivors who had not been enrolled prior to the service member'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 service member'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 service member was
alive and on active duty. The percentage of loss is even greater for
survivors whose service members served longer. Those who give their
lives for their country deserve more fair compensation for their
surviving spouses.
We appreciate the establishment of a special survivor indemnity
allowance as a first step in the process to eliminate the DIC offset to
SBP.
We believe several other adjustments could be made to the Survivor
Benefit Plan. 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 ask the DIC offset to SBP be eliminated to recognize the length
of commitment and service of the career service member and spouse. We
also request that SBP benefits be allowed to be paid to a Special Needs
Trust in cases of disabled family members.
Spouse Employment, Unemployment
Our Association appreciates the expansion of the Military Spouse
Career Advancement Accounts. We look forward to the rollout and full
implementation of the expanded program and hope that the definition of
``portable careers'' is broad enough to support the diverse military
spouse population. 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 service
members, and to provide tax credits to military spouses to offset the
expense in obtaining career licenses and certifications when service
members are relocated to a new duty station within a different State.
Families on the Move
Our Association is concerned about the timely implementation of the
Defense Personal Property Program, formerly titled ``Families First.''
Worldwide rollout is still incomplete and it is unclear if customer
satisfaction surveys are incorporated into the carrier ranking process.
Full Replacement Value has been rolled out, but is handled differently
by each carrier. Families are confused about how and where to file
claims. Congressional oversight is needed to press for implementation
of this program and deliver the best possible service to our families.
Our Association is grateful for the addition of the weight
allowance for spousal professional materials. We ask that Congress
broaden the language to require the Service Secretaries to implement
this much needed benefit.
A PCS move to an overseas location can be especially stressful.
Military families are faced with the prospect of being thousands of
miles from extended family and living in a foreign culture. At many
overseas locations, there are insufficient numbers of government
quarters resulting in the requirement to live on the local economy away
from the installation. Family members in these situations can feel
extremely isolated; for some the only connection to anything familiar
is the local military installation. Unfortunately, current law permits
the shipment of only one vehicle to an overseas location, including
Alaska and Hawaii. Since most families today have two vehicles, they
sell one of the vehicles.
Upon arriving at the new duty station, the service member requires
transportation to and from the place of duty leaving the military
spouse and family members at home without transportation. This lack of
transportation limits the ability of spouses to secure employment and
the ability of children to participate in extra curricular activities.
While the purchase of a second vehicle alleviates these issues, it also
results in significant expense while the family is already absorbing
other costs associated with a move. Simply permitting the shipment of a
second vehicle at government expense could alleviate this expense and
acknowledge the needs of today's military family.
Our Association requests that Congress ease the burden of military
PCS moves on military families by pressing for the full implementation
of the Defense Personal Property Program and by authorizing the
shipment of a second vehicle for families assigned to an overseas
location on accompanied tours.
Education of Military Children
While our Association remains appreciative for the additional
funding you provide to civilian school districts educating large
numbers of military children, DOD Impact Aid still remains under-
funded. We urge Congress to increase funding for schools educating
large numbers of military children to $60 million for fiscal year 2010.
We also encourage you to make the additional funding for school
districts experiencing growth available to all school districts
experiencing significant enrollment increases and not just to those
districts meeting the current 20 percent enrollment threshold. The
arrival of several hundred military students can be financially
devastating to any school district, regardless of how many of those
students the district already serves. This supplement to Impact Aid is
vital to school districts that have shouldered the burden of ensuring
military children receive a quality education despite the stresses of
military life.
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. With over 70,000 military
families returning to the United States, at the same time the Army is
moving over one third of its soldiers within the United States, we urge
Congress to authorize an increase in this level of funding until BRAC
and Global Rebasing moves are completed.
Although it does not fall under the purview of this Subcommittee,
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 service members and their families. Under this provision,
colleges and universities receiving Federal funding under the act will
be required to offer in-State tuition rates for active duty service
members and their families and provide continuity of in-State rates if
the service member receives orders for an assignment 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.
Our Association congratulates the DOD Office of Personnel and
Readiness and the Council of State Governments (CSG) for drafting the
Interstate Compact on Educational Opportunity for Military Children and
for spearheading the adoption of this important legislation. Designed
to alleviate many of the transition issues facing military children,
the Compact has now been adopted in 20 States. In addition, Hawaii has
a Compact bill awaiting their Governor's signature, and 11 other States
are working active legislation this year. With 10 States needed to
enact the Compact, the first meeting of the Interstate Commission on
Educational Opportunity for Military Children met in October 2008. Our
Association is pleased to have been a member of both the Advisory Group
and Drafting Team, and has been working actively to support the
adoption of this Compact, which will greatly enhance the quality of
life of our military children and families.
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 to
allow all school districts experiencing a significant growth in their
military student population due to BRAC, Global Rebasing, or
installation housing changes to be eligible for the additional funding
currently available only to districts with an enrollment of at least 20
percent military children.
Spouse Education
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. In 2007, we
published Education and the Military Spouse: The Long Road to Success,
based on spouse scholarship applicant survey responses, identifying
education issues and barriers specific to military spouses. The entire
report may be found at www.nmfa.org/education.
The survey found military spouses, like their service members and
the military as a whole, value education and set education goals for
themselves. Yet, military spouses often feel their options are limited.
Deployments, the shortage of affordable and quality child care,
frequent moves, the lack of educational benefits and tuition assistance
for tuition are discouraging. For military spouses, the total cost of
obtaining a degree can be significantly higher than the cost for
civilian students. The unique circumstances that accompany the military
lifestyle have significant negative impacts upon a spouse's ability to
remain continuously enrolled in an educational program. Military
spouses often take longer than the expected time to complete their
degrees. More than one-third of those surveyed have been working toward
their goal for 5 years or more. The report offers recommendations for
solutions that Congress could provide:
--Ensuring installation education centers have the funding necessary
to support spouse education programs and initiatives;
--Providing additional child care funding to support child care needs
of military spouse-scholars;
--Helping to defray additional costs incurred by military spouses who
ultimately spend more than civilian counterparts to obtain a
degree.
Our Association wishes to thank Congress for passing the Post 9/11
G.I. Bill for service members and for including transferability of the
benefit to spouses and children. We will continue to monitor the
implementation of this benefit, and hope to see the regulations posted
soon.
Military Families--Our Nation's Families
We thank you for your support of our service members 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 service members 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 population. Working together, we can improve the quality
of life for all these families.
Chairman Inouye. Our next witness represents the Fleet
Reserve Association: Mr. John Davis, director of legislative
programs.
Mr. Davis.
STATEMENT OF JOHN R. DAVIS, DIRECTOR, LEGISLATIVE
PROGRAMS, FLEET RESERVE ASSOCIATION
Mr. Davis. Good morning, Chairman Inouye. My name is John
Davis, and I want to thank you for the opportunity to express
FRA's views today.
The association also wants to thank the Obama
administration for adequately funding healthcare without a
proposed TRICARE fee increase.
FRA believes that raising TRICARE fees during the war on
terror would send the wrong message, and that could impact
recruitment and retention. A recent FRA survey indicates that
more than 90 percent of all active duty, retired, and veteran
respondents cited healthcare as their top quality-of-life
benefit. That is why FRA supports the Military Retirees Health
Care Protection Act, H.R. 816, that would prohibit increasing
TRICARE fees unless approved by Congress.
FRA welcomes the 10-percent increase in funding to provide
case managers and mental health counselors to heal and
rehabilitate our wounded warriors. Adequate funding is
necessary for a seamless transition and quality services for
wounded warriors, especially those with traumatic brain injury
(TBI) and post traumatic stress disorder (PTSD).
FRA is also grateful for the administration calling for
improvements to concurrent receipt. And it's also mentioned in
the budget resolution.
The offset for chapter 61 retirees would be phased out over
5 years. FRA supports legislation authorizing the immediate
payment of concurrent receipt of full military retired pay and
veterans disability compensation for all disabled retirees. And
this improvement is a big step toward achieving that goal. And
if authorized, we urge the subcommittee to provide funding.
FRA strongly supports the funding of the 3.4 percent pay
increase for active duty pay, which is one-half of 1 percent
above the administration's request. Pay increases, in recent
years, have contributed to improved morale, readiness, and
retention. Better pay reduces family stress, especially for
junior enlisted. Military pay and benefits must reflect the
fact that military service is very different from work in the
private sector. FRA strongly supports the fully funded family
readiness program and stands foursquare in support of our
Nation's reservists. Due to the demands of the war on terror,
Reserve units are now increasingly being mobilized to augment
active duty components. As a result of these operational
demands, the Reserve component is no longer a strategic
reserve, but is now an operational reserve. And that is an
integral part of the total force. That is why, if authorized,
FRA supports funding for retroactive eligibility for early
retirement benefit, to include reservists who have supported
contingency operations since September 11, 2001.
The 2008 Defense Authorization Act reduced the Reserve
retirement age by 3 months for every 90 days of active duty,
but this only applies to the service after the effective date
of the legislation, which is January 28, 2008, and leaves out
more than 600,000 reservists mobilized since 9/11.
Thank you again for giving me this opportunity to speak.
Chairman Inouye. Thank you very much, Mr. Davis.
[The statement follows:]
Prepared Statement of John R. Davis
OVERVIEW
Mr. Chairman, ensuring that wounded troops, their families and the
survivors of those killed in action are cared for by a grateful Nation
remains an overriding priority for the Fleet Reserve Association (FRA).
The Association thanks you and the entire Subcommittee for your strong
and continuing support of funding for the Department of Defense (DOD)
portion of the Wounded Warrior Assistance Program. Another top FRA
priority is full funding of the Defense Health Program (DHP) to ensure
quality care for active duty, retirees, Reservists, and their families.
THE FISCAL YEAR 2010 BUDGET
The DOD request totals $663.8 billion for fiscal year 2010, which
is a base budget increase of $20.5 billion representing a 4-percent
increase over fiscal year 2009 (2.1 percent in real growth). It is
noteworthy that for the first time in 4 years, the proposed budget
fully funds military health care programs without calling for a TRICARE
fee increase. FRA appreciates the reluctance of the new administration
to shift health care costs to beneficiaries, and the inclusion of
additional money to make improvements in current receipt to expand the
number of disabled military retirees receiving both their full military
retired pay and VA disability compensation. The budget also calls for a
2.9-percent active duty pay increase that equals the Employment Cost
Index (ECI), $1.1 billion to fund military housing and support programs
for service members and their families, and $3.3 billion to support
injured service members in their recovery, rehabilitation, and
reintegration.
As Operation Iraqi Freedom ends and troops depart from Iraq, some
will be urging reductions in spending, despite the need to bolster
efforts in Afghanistan and other operational commitments around the
world. FRA understands the budgetary concerns generated by the current
economic slowdown but advocates that cutting the DOD budget during the
Global War on Terror would be short sighted and that America needs a
Defense budget that will provide adequate spending levels for both
``benefits and bullets.''
This statement lists the concerns of our members, keeping in mind
that the Association's primary goal is to endorse any positive safety
programs, rewards, quality of life improvements that support members of
the Uniform Services, particularly those serving in hostile areas, and
their families, and survivors.
WOUNDED WARRIORS
A two-front war, a lengthy occupation and repeated deployments for
many service members has put a strain on the DOD/VA medical system that
treats our wounded warriors. The system is impacted not only by volume
but by the complexity of injuries and the military has shown that it is
woefully inadequate in recognizing and treating cases of Traumatic
Brain Injury (TBI) and Post Traumatic Stress Disorder (PTSD).
In recent years substantial progress has been made in the treatment
of the Nation's wounded warriors. The fiscal year 2010 budget provides
$3.3 billion to support injured service members in their recovery and
rehabilitation and FRA appreciates the $300 million increase over
fiscal year 2009 for mental health programs which includes additional
case managers, and mental health counselors. The budget also provides
for an expedited Disability Evaluation System (DES), and construction
of 12 additional wounded warrior transition complexes. The budget also
continues implementation of the Walter Reed National Military Medical
Center, Bethesda, Maryland, DeWitt Army Community Hospital, Fort
Belvoir, Virginia, and BRAC projects within the national capitol
region. More than $400 million is targeted for medical research for
Traumatic Brain Injury (TBI) and other casualty treatment issues. FRA
advocates for resources to support an effective delivery system between
DOD and VA to ensure seamless transition and quality services for
wounded personnel, particularly those suffering from PTSD and TBI.
Adequate funding is essential to providing pre- and post-deployment
screenings for mental and physical injuries, and if authorized
compensation, training, and health care coverage for family members
forced into service as full-time caregivers for the severely wounded
warriors. Further, the War on Terror has seen an increasing percentage
of women serving in the military (15 percent in 2009 as compared to 4.4
percent in 1988) and combined with the asymmetrical nature of the
conflict will undoubtedly cause an increasing number of women
casualties that will place unique demands upon the military health care
system requiring additional associated funding.
HEALTH CARE
Adequately funding health care benefits for all beneficiaries is
part of the cost of defending our Nation and a recent FRA survey
indicates that more than 90 percent of all active duty, retired, and
veteran respondents and most Reserve participants cited health care as
their top quality-of-life benefit. Accordingly, protecting and/or
enhancing health care access for all beneficiaries is FRA's top 2009
legislative priority.
Health care costs both in the military and throughout society have
continued to increase faster than the Consumer Price Index (CPI) making
this a prime target for those wanting to cut the DOD budget. Many
beneficiaries targeted in recent proposals to drastically increase
health care fees are those who served prior to enactment of the recent
and significant pay and benefit enhancements and receive significantly
less in retired pay than those serving and retiring in the same pay
grade with the same years of service today. They clearly recall
promises made to them about the benefit of health care for life in
return for a career, and many believe they are entitled to ``free''
health care for life based on the Government's past commitments.
For these reasons, FRA strongly supports ``The Military Retirees'
Health Care Protection Act'' (H.R. 816) sponsored by Representatives
Chet Edwards (TX) and Walter Jones (NC). The legislation would prohibit
DOD from increasing TRICARE fees, specifying that the authority to
increase TRICARE fees exists only in Congress.
DOD must continue to investigate and implement other TRICARE cost-
saving options as an alternative to shifting costs to retiree
beneficiaries. FRA notes progress in this area in expanding use of the
mail order pharmacy program, Federal pricing for prescription drugs and
a pilot program of preventative care for TRICARE beneficiaries under
age 65, and elimination of co-pays for certain preventative services.
The Association believes these efforts will prove beneficial in slowing
military health care spending in the coming years.
Our Nation is at war and imposing higher health care costs on
retirees would send a powerful negative message not only to retirees,
but to those currently serving about the value of their service. The
prospect of drastically higher health care fees for retirees is also a
morale issue with the senior enlisted communities who view this as an
erosion of their career benefits. Unlike private sector employees,
military retirees have answered the call to serve, and most have done
so under extremely difficult circumstances while separated from their
families to defend the freedoms we enjoy today.
CONCURRENT RECEIPT
FRA appreciates a boost in compensation for benefiting disabled
retirees in the new Administration's budget. The fiscal year 2010
budget includes funding for expansion of concurrent receipt of military
retired pay and VA disability compensation to retirees who were
medically retired from service (Chapter 61 Retirees). Under current law
these benefits (CRDP) are offset by the amount of VA disability
compensation. This offset would be phased-out over 5 years. FRA
supports legislation authorizing the immediate payment of concurrent
receipt of full military retired pay and veterans' disability
compensation for all disabled retirees, and these improvements reflect
a big step toward achieving this goal.
PROTECT PERSONNEL PROGRAMS
Active Duty Pay.--FRA strongly supports the authorization and
funding of a 3.4 percent fiscal year 2010 pay increase which is
consistent with past support of annual active duty pay increases that
are at least 0.5 percent above the Employment Cost Index (ECI). The
Association also supports targeted increases, as appropriate for mid-
career and senior enlisted personnel to help close the remaining 2.9
percent pay gap between active duty and private sector pay.
Adequate and targeted pay increases authorized in recent years,
particularly for middle grade and senior petty and noncommissioned
officers, have contributed to improved morale, readiness, and
retention. Better pay reduces family stress, especially for junior
enlisted and may reduce the need for military personnel use of short-
term pay day loans unaware of the ruinous long-term impact of excessive
interest rates. Military pay and benefits must reflect the fact that
military service is very different from work in the private sector.
End Strength.--Adequate active duty and Reserves end strengths are
essential to success in Operations Enduring Freedom (OEF) and Iraqi
Freedom, and other commitments around the world. The fiscal year 2010
budget supports additional end strength for the Marine Corps (202,000)
and halts Navy end strength reductions. The Association supports
funding to support these proposals and also strongly supports funding
for bonuses for service members with extended deployments.
FAMILY READINESS
FRA supports a fully funded, robust family readiness program which
is 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, and they often are being asked
to do without in other important areas.
The availability of child care is especially important when so much
of the force is deployed and this program, along with other family
readiness programs must be adequately funded in fiscal year 2010 and
beyond.
BRAC and Rebasing.--Adequate resources are required to fund
essential quality of life programs and services at bases impacted by
the Base Realignment and Closure (BRAC) and rebasing initiatives. FRA
is concerned about sustaining commissary access, MWR programs and other
support for service members and their families particularly at
installations most impacted by these actions. These include Guam, where
a significant number of Marines and their families are being relocated
from Okinawa. The shortage of funds is curtailing or closing some of
the activities while the costs of participating in others have recently
increased.
Family Housing.--The Association welcomes the $200 million more for
family housing, child care, and other support services over the fiscal
year 2009 budget. Adequate military housing that's well maintained is
critical to retention and morale.
Child and Youth Programs.--MCPON Rick West testified before the
House Appropriations Subcommittee on Military Construction and Veterans
Affairs in February 2009 that there is a need for more child care
facilities since the Navy currently provides for only 72 percent of
capacity while the goal is 80 percent. Access to child care is
important and FRA urges Congress to authorize adequate funding for this
important program.
RESERVE ISSUES
FRA stands foursquare in support of the Nation's Reservists. Due to
the demands of the War on Terror, Reserve units are now increasingly
being mobilized to augment active duty components. As a result of these
operational demands, Reserve component is no longer a strategic Reserve
but is now an operational Reserve that is an integral part of the total
force. And because of these increasing demands on Reservists to perform
multiple missions abroad over longer periods of time, it's essential to
improve compensation and benefits to retain currently serving personnel
and attract quality recruits.
Retirement.--If authorized, FRA supports funding retroactive
eligibility for the early retirement benefit to include Reservists who
have supported contingency operations since 9/11/2001 (S. 831/S. 644).
The fiscal year 2008 Defense Authorization Act (H.R. 4986) reduces the
Reserve retirement age (age 60) by 3 months for each cumulative 90-days
ordered to active duty. The provision however only applies to service
after the effective date of the legislation, and leaves out more than
600,000 Reservists mobilized since 9/11 for Afghanistan and Iraq and to
respond to natural disasters like Hurricane Katrina. About 142,000 of
them have been deployed multiple times in the past 6 years.
Family Support.--FRA supports resources to allow increased outreach
to connect Reserve families with support programs. This includes
increased funding for family readiness, especially for those
geographically dispersed, not readily accessible to military
installations, and inexperienced with the military. Unlike active duty
families who often live near military facilities and support services,
most Reserve families live in civilian communities where information
and support is not readily available. Congressional hearing witnesses
have indicated that many of the half million mobilized Guard and
Reserve personnel have not received transition assistance services they
and their families need to make a successful transition back to
civilian life.
CONCLUSION
FRA is grateful for the opportunity to present the organization's
views to this distinguished Subcommittee. The Association reiterates
its profound gratitude for the extraordinary progress this
Subcommittee, with outstanding staff support, has made in advancing a
wide range of enhanced benefits and quality-of-life programs for all
uniformed services personnel, retirees, their families and survivors.
Thank you.
Chairman Inouye. I'd like to point out that, at this
moment, several subcommittees are having their meetings or
conferences. As a result, you can see that they're busy
elsewhere. The vice chairman of this subcommittee had to go to
the Energy Committee subcommittee, because he is the senior
member there.
So, if I may, I'd like to call upon him for any remarks he
may have.
STATEMENT OF SENATOR THAD COCHRAN
Senator Cochran. Mr. Chairman, thank you very much.
I'm pleased to be able to come by and join you in thanking
these witnesses for preparing testimony, and giving us the
benefit of your observations and experience and interest as we
review the budget for this next fiscal year for the Department
of Defense and related agencies.
Because of your experiences and your knowledge, we take
what you say very seriously, and we will carefully review your
statements and make sure that the subcommittee considers them
as we proceed through our appropriations process for this next
fiscal year.
Thank you.
Chairman Inouye. Thank you very much.
And next, the Chief Executive Officer of the Air Force
Sergeants Association, Command Master Sergeant John McCauslin,
of the Air Force.
STATEMENT OF COMMAND MASTER SERGEANT JOHN R. McCAUSLIN,
UNITED STATES AIR FORCE (RET.), CHIEF
EXECUTIVE OFFICER, AIR FORCE SERGEANTS
ASSOCIATION
Sergeant McCauslin. Good morning, Chairman Inouye, Senator
Cochran.
On behalf of the 125,000 members of the Air Force Sergeants
Association, I thank you for your continued support of our
airmen and their families. I appreciate this opportunity to
present our perspective of six important areas of priority for
the fiscal year 2010 defense appropriations.
First, Air Force manpower and equipment. AFSA strongly
believes the aging fleet of legacy Air Force systems,
facilities, and equipment needs to be modernized. However, we
also know the truly most valuable weapon that America has are
those serving this Nation, especially the men and women wearing
chevrons.
Operational demands, including deployments, have greatly
increased to include intelligence activity, reconnaissance, and
surveillance resources, the newest combatant command in Africa,
the new Air Force Cyber Command, increased activity in
Afghanistan and elsewhere overseas. Therefore, AFSA supports
General Schwartz's request for more F-35 aircraft to do our job
of preserving peace through deterrence.
Quality of life. Our Nation's military should not be
considered a financial burden, but considered a national
treasure, as they preserve our national security for all that
live here. If we expect to retain this precious resource, we
simply must provide they and their families with decent and
safe work centers, family housing and dormitories, healthcare,
childcare, physical fitness centers, and recreational programs
and facilities. Tremendous strides have been made to improve
access to quality childcare and fitness centers on our military
installations, and we're grateful to the Department of Defense
and Congress for these collective efforts. However, there's
still much work to be done. I have personally visited over 125
Air Force installations in the States and overseas these past 3
years, and I can assure you that the demand for adequate
childcare and decent, affordable housing is a top priority
among our airmen and their families' decision to stay or get
out.
Veterans Affairs healthcare funding. AFSA believes that the
healthcare portion of Veterans Affairs (VA) funding should be
moved to mandatory annual spending. One of the Nation's highest
obligations is their willingness to fully fund VA healthcare
facilities and other programs for those who have served in the
past or are serving today and will serve in the future.
On a positive note, we're particularly pleased by the
tremendous support of Congress and this subcommittee to
implement and fund wounded warrior programs across America.
The Air Force Sergeants Association applauds the actions of
this subcommittee, other committees and subcommittees, to
directly address the issue of unique health challenges faced by
our women veterans. AFSA urges an increase to the VA budget so
that they can appropriately care for these female veterans, now
and in the future.
Regarding the educational benefits. The post-9/11 GI bill
was a giant step forward, even though there are still some
funding shortfalls being currently worked by Senator Webb's
office, and we urge your subcommittee's support.
And finally, my final point concerns basic military pay and
the tremendous pay gap, for these last 15 years, that you've
helped us close. However, we still have serious problems in the
junior enlisted. For example, enrollment in food stamps rose 25
percent in the military this last year alone. Our junior
enlisted are all volunteers serving our Nation, yet thousands
remain on food stamps.
In conclusion, this was a very brief presentation of our
perspective for you. Our detailed, typed testimony has been
personally delivered to your subcommittee staff for inclusion
today.
Thank you very much.
Chairman Inouye. I thank you very much, Command Master
Sergeant.
[The statement follows:]
Prepared Statement of John R. ``Doc'' McCauslin
Mr. Chairman and distinguished committee members, on behalf of the
125,000 members of the Air Force Sergeants Association, (AFSA), I thank
you for your continued support of Airmen and their families. I
appreciate this opportunity to present our perspective on priorities
for the fiscal year 2010 defense appropriations.
The Air Force Sergeants Association (AFSA) represents Air Force
Active Duty, Air National Guard, Air Force Reserve Command, including
active, retired and veteran enlisted Airmen and their families. We are
grateful for this subcommittee's efforts, and I cannot overstate the
importance your work is to those serving this Nation.
You certainly have a daunting task before you and shoulder the
tremendous responsibility as you wisely appropriate limited resources
based on many factors. The degree of difficulty deciding what is funded
isn't lost on us. It is significant.
AIR FORCE MANPOWER
AFSA strongly believes the aging fleet of legacy Air Force systems,
facilities, and equipment needs to be modernized. However, we also know
the truly most valuable weapon America has are those serving this great
Nation, especially the men and women wearing chevrons of the enlisted
grades.
We are deeply concerned about the recent Air Force drawdown of
manpower in order to facilitate funding of system modernization and
recapitalization but we greatly appreciate Congressional support that
has reinstated some of that lost resource. The impact on Air Force
ability to maintain the highest level of readiness was felt throughout
the smaller force and it placed even more stress on our maintainers and
security forces.
Although well-intended, that drawdown did not appear to have
yielded the results envisioned. Some efficiency was gained as Airmen
exercised innovation and continuous process improvement in order to
accomplish more. The ole adage ``do more with less'' certainly and
quickly became a reality.
Operational demands including deployments have increased over this
same time--increased intelligence activity, reconnaissance and
surveillance (ISR) resources, supporting the newest combatant command
in Africa, the new Air Force Cyber Command based in Louisiana,
increased activity in Afghanistan, and elsewhere overseas. The Air
Force has increased its capabilities to ward off threats from the cyber
domain and accomplishing the expanding workload associated with more
inspections and maintenance to keep aging airframes mission ready.
With the appropriate recommendations from the Armed Service
committees, we need to continue offering enlistment bonuses for those
career fields that are physically demanding and highly skilled hard to
fill jobs since 2001. With Congressional assistance, coupled with the
hard work of our Air Force recruiters, we can continue to meet the
required annual needs of new Combat Controllers, Para-rescue; Tactical
Air Control Party; Explosive Ordinance Disposal; Security Forces;
Linguist and Survival, Evasion, Resistance, and Escape Instructors. The
amount offered at the initial enlistment ranges from $2,000 to $13,000,
depending on the career specialty and terms of enlistment. These are
currently the only fields offering enlistment bonuses for fiscal year
2009. Congress authorized hazardous duty allowance for all DOD
firefighters, still today the services have not funded this program.
The Air Force has over 3,000 firefighters who have been authorized this
allowance by Congress but not funded.
AFSA believes a course correction is needed to avert severe
adverse, long-term consequences that have already begun to affect
morale, retention and combat readiness. We strongly support increasing
and fully funding Air Force end strength to 332,800.
QUALITY OF LIFE
Our Nation's military should not be considered a financial burden
but considered a national treasure as they preserve our national
security for all that live here. If we expect to retain this precious
resource, we must provide they and their families, with decent and safe
work centers, family housing and dormitories, health care, child care
and physical fitness centers, and recreational programs and facilities.
These areas are a prime recruitment and retention incentive for our
Airmen and their families. This directly impacts their desire to
continue serving through multiple deployments and extended separations
from family and friends.
This Nation devotes considerable resources to train and equip
America's sons and daughters--a long term investment--and that same
level of commitment should be reflected in the facilities and equipment
they use and in where they live, work, and play.
We urge extreme caution in deferring these costs, especially at
installations impacted by base realignment and closure (BRAC) decisions
and mission-related shifts.
We applaud congressional support for military housing privatization
initiatives. This has provided housing at a much faster pace than would
have been possible through military construction alone.
AFSA urges Congress to fully fund appropriate accounts to ensure
our installations eliminate substandard housing and work centers as
quickly as possible. Those devoted to serving this Nation deserve
better.
Tremendous strides have been made to improve access to quality
child care and fitness centers on military installations, and we are
grateful to the Department of Defense and Congress for these collective
efforts. However, there is still much more work to be done. I have
personally visited over 125 Air Force installations in the states and
overseas these past three years and I can assure you that the demand
for adequate child care is a top priority among our Airmen and their
families. The importance of this is directly reflected in the military
members' family decision to remain in the service or exit.
VETERANS AFFAIRS HEALTHCARE FUNDING
AFSA believes that the healthcare portion of Veterans Affairs (VA)
funding should be moved to mandatory annual spending. One of this
Nation's highest obligations is the willingness to fully fund VA health
care, facilities, and other programs for those who have served in the
past, are serving today and will serve in the future.
There are many challenges facing veterans and we are encouraged by
the initiatives centered on improving access for all veterans
regardless of their VA designated category. Much more emphasis has to
be focused on continuity of care and addressing the scars of war, some
obvious and others not so, such as traumatic brain injuries and post
traumatic stress disorders. We are particularly pleased by the
tremendous support of Congress and this Committee to implement and fund
Wounded Warrior programs across America. The outpouring of support from
civilian communities and volunteer support has been truly amazing and
very much appreciated.
WOMEN VETERANS HEALTHCARE ISSUES
The Air Force Sergeants Association applauds the actions of this
committee, other committees and sub-committees to directly address the
issue of the unique health challenges faced by women veterans. Between
1990 and 2000, the women veteran population increased by over 33
percent from 1.2 million to 1.6 million, and women now represent
approximately 9 percent of the total veteran population. By next year,
the VA estimates women veterans will comprise well over 10 percent of
the veteran population. Currently women make up more than 20 percent of
the active duty Air Force, Air National Guard 19 percent, and
approximately 26 percent of the Air Force Reserves with thousands
serving, or having already returned from serving, in Iraq, Afghanistan
and other places a long way from our shores. AFSA urges an increase to
the VA budget so they can appropriately care for these veterans now and
in the future.
IMPACT AID
Military leaders often use the phrase, ``we recruit the member, but
we retain the family'' when talking about quality of life and
retention. Impact Aid is a program at the very core of this premise,
because it directly affects the quality of educational programs
provided to the children of military service members. In the Department
of Defense Dependent Schools, there are over 79,000 children of our
active duty force scattered all over the globe.
These children lead unique lives, fraught with challenges
associated with frequent changes in schools, repeatedly being uprooted
and having to readjust to new communities and friends. Many of these
school children are in other countries in either the DODDS system or
host nation schools that are not affected by Impact Aid funding.
Worrying about what resources might or might not be available to school
administrators should not be yet another concern heaped upon them and
their parents.
The Impact Aid program provides Federal funding to public school
districts in the United States with enrollment of students that have a
parent who is a member of the Armed Forces, living on and/or assigned
to a military installation.
The budget proposed by the administration is identical to the
approved funding in 2009 in spite of increased financial obligations by
the servicing local school districts. It has a completely detrimental
effect on the military member and their decision to take that next
assignment or opt to get out for the good of his or her family. The
implicit statement in this action is military children are a lower
priority than others in our Nation. We ask this committee to take the
steps necessary to show our military men and women that the education
of their children is as important at the next child.
AFSA is grateful that Congress funded Impact Aid with 1.265.7
million this past fiscal year. We strongly urge increased funding of
this important family quality of life area that has a direct bearing on
reenlistment rates and military families quality of life. We urge
Congress restore this program to its rightful full funding.
BASIC MILITARY PAY
Tremendous progress has been made over the last 15+ years to close
the gap between civilian sector and military compensation. AFSA
appreciates these steady efforts and we encourage further steps. We
believe linking pay raises to the employment cost index (ECI) is
essential to recruiting and retaining the very best and brightest
volunteers. AFSA urges the formula for determining annual pay increases
to be ECI + 0.5 percent until the gap is completed eliminated. If we
want to continue having an all volunteer force then we must continue on
the path to close the aforementioned pay gap. Enrollment in food stamps
rose 25 percent in the military last year. Our junior enlisted are all
volunteers serving our Nation, yet they remain on monthly use of food
stamps.
TRANSITION ASSISTANCE PROGRAMS
The all-volunteer military force repeatedly answers this Nation's
call to duty and at the end of their tours of duty, whether a few years
or after decades of service, all transition to civilian life.
Section 502 of the National Defense Authorization Act of Fiscal
Year 1991 codified in sections 1141-1143 and 1144-1150 of title 10,
United States Code, authorized comprehensive assistance benefits and
services for separating service members and their spouses.
From that legislation, grew a valuable partnership between the
Department of Labor and the Departments of Defense, Veterans Affairs
and Homeland Security to provide Transition Assistance Program (TAP)
employment workshops, VA Benefits Briefings and the Disabled Transition
Assistance Program (DTAP). These programs and briefings provide service
members valuable job placement assistance, training opportunities, and
education on veteran benefits so they make informed choices about post-
service opportunities.
We urge the committee to continue fully funding transition
assistance programs at a level that serves our deserving volunteer
veterans.
In addition, we ask you to support the initiatives in this Congress
to pass legislation and fund a program that would create hiring
preferences across the Federal Government for military spouses. Under
current law, veterans of America's Armed Forces are entitled to
preferences over others in competitive hiring positions in Federal
Government. We believe the sacrifice of family members warrant this
consideration as well.
VETERANS EDUCATION BENEFITS
There's no escaping the fact that college costs are rising. As the
gap between the cost of an education and value of the MGIB widens, the
significance of the benefit becomes less apparent. For that reason, the
Post 9-11 GI Bill was a giant step forward. However, we must make sure
that the new post 9-11 stays current at all times, so that this benefit
will not lose its effectiveness when it comes to recruiting this
Nation's finest young men and women into service. As a member of The
Military Coalition and the Partnership for Veterans' Education, we
strongly recommend you make the technical corrections to the Post 9-11
Veterans GI Bill that need to be done prior to its implementation this
August 1st.
When young enlisted men and women opt for military service, they
should know that this Nation will provide them with a no-cost, complete
education, as do numerous companies in the private industry. We, as a
Government, give them a one-time chance to enroll in the MGIB during
basic training. The Department of Defense charges them $1,200 to enroll
at a time when they can least afford it. Service-members are even
offered an opportunity to increase their education benefit by paying an
additional $600.
Now that the new Post 9-11 GI bill is coming on board for free,
those who already paid for but who have not yet utilized the Montgomery
GI Bill, will now have to wait until their chapter 33 entitlements are
exhausted before they will be allowed to receive a refund on their
Montgomery GI bill contributions. Under current law, those who have
contributed the additional $600, will not have that money returned to
them at all.
This is unacceptable.
In good faith and trusting their Government-funded education will
be provided in their best interest, service-members now find a program
that does not require further investment in their education. However
the Government will withhold the service-member's Montgomery GI Bill
initial investment and not refund it. Our recommendation is that the
service-members who chose to enroll in the chapter 33 benefit, and who
bought the additional benefit for $600, should be given their
investment back or granted an additional 2 years of chapter 30 benefits
to roll their $600 education investment into the new education bill.
The latest shortfall with the new bill is that all active duty will not
receive the $1,000 book allowance. We urge the appropriate committees
to make the necessary corrections to ensure those on active duty
receive this allowance.
Mr. Chairman, we appreciate your efforts and thank you for this
opportunity to share our perspective. AFSA realizes the many difficult
decisions this committee must make and hope the information presented
today proves helpful. As always, the Air Force Sergeants Association
remains ready to support you in matters of mutual concern.
Chairman Inouye. And our next witness represents the
American Psychological Association, Dr. Gavin O'Shea.
STATEMENT OF GAVIN O'SHEA, Ph.D., ON BEHALF OF THE
AMERICAN PSYCHOLOGICAL ASSOCIATION
Dr. O'Shea. Good morning Mr. Chairman and members of the
subcommittee. I'm Dr. Gavin O'Shea from HumRRO, the Human
Resources Research Organization. I'm submitting testimony on
behalf of the American Psychological Association, or APA, a
scientific and professional organization of more than 148,000
psychologists.
For decades, clinical and research psychologists have used
their unique and critical expertise to meet the needs of our
military and its personnel, playing a vital role within the
Department of Defense. My own military-oriented research and
consulting focuses on organizational commitment, personnel
selection, and leadership assessment.
This morning, I focus on APA's request that Congress
reverse disturbing administration cuts to DOD's science and
technology budget and maintain support for important behavioral
sciences research on counterterrorism and counterintelligence
operations.
In terms of the overall DOD S&T budget, the President's
request for fiscal year 2010 represents a dramatic step
backward for defense research. Defense S&T would fall from the
current fiscal year 2009 level of $13.6 billion to $11.6
billion, with cuts across the board. With very few exceptions,
all basic and applied research accounts within military labs
would face cuts, some as high as 50 percent.
This is not the time to reduce support for research that is
vital to our Nation's continued security in a global atmosphere
of uncertainty and asymmetric threats. APA urges the
subcommittee to reverse this cut to the critical defense
science program by providing $14 billion for defense S&T in
fiscal year 2010.
Finally, APA is also concerned about the potential loss of
invaluable human-centered research programs related to
counterintelligence and counterterrorism due to the
reorganization of the CIFA office into the Defense Intelligence
Agency (DIA). APA urges the subcommittee to provide ongoing
funding in fiscal year 2010 for DIA's behavioral research
programs on cyberdefense, insider threat, credibility
assessment, detection of deception, and other operational
challenges.
As noted in a recent National Research Council report,
``People are the heart of all military efforts. People operate
the available weaponry and technology, and they constitute a
complex military system composed of teams and groups at
multiple levels. Scientific research on human behavior is
crucial to the military, because it provides knowledge about
how people work together, and use weapons and technology to
extend and amplify their forces.''
The defense research programs need your help more than ever
this year, and we look forward to your support.
Thank you.
Chairman Inouye. I thank you very much, Dr. O'Shea.
[The statement follows:]
Prepared Statement of Gavan O'Shea
The American Psychological Association (APA) is a scientific and
professional organization of more than 148,000 psychologists and
affiliates.
For decades, psychologists have played vital roles within the
Department of Defense (DOD), as providers of clinical services to
military personnel and their families, and as scientific researchers
investigating mission-targeted issues ranging from airplane cockpit
design to human intelligence-gathering. More than ever before,
psychologists today bring unique and critical expertise to meeting the
needs of our military and its personnel. APA's testimony will focus on
reversing Administration cuts to the overall DOD Science and Technology
(S&T) budget and maintaining support for important behavioral sciences
research within DOD.
DOD RESEARCH
``People are the heart of all military efforts. People operate the
available weaponry and technology, and they constitute a complex
military system composed of teams and groups at multiple levels.
Scientific research on human behavior is crucial to the military
because it provides knowledge about how people work together and use
weapons and technology to extend and amplify their forces.''----Human
Behavior in Military Contexts, Report of the National Research Council,
2008.
Just as a large number of psychologists provide high-quality
clinical services to our military service members stateside and abroad,
psychological scientists within DOD conduct cutting-edge, mission-
specific research critical to national defense.
In terms of the overall DOD S&T budget, the President's request for
fiscal year 2010 represents a dramatic step backward for defense
research. Defense S&T would fall from the estimated fiscal year 2009
level of $13.6 billion to $11.6 billion with cuts across the board.
With the exception of a less-than-1-percent increase in Air Force basic
(6.1) research and an increase in basic research in the Office of the
Secretary of Defense, all military labs would see cuts to their 6.1,
6.2 and 6.3 accounts, some as high as 50 percent.
The President's budget request for basic and applied research at
DOD in fiscal year 2010 is $11.6 billion, which represents a stunning
decrease of almost $2 billion or 15 percent from the enacted fiscal
year 2009 level of $13.6 billion. APA urges the Subcommittee to reverse
this cut to the critical defense science program by providing a total
of $14 billion for Defense S&T in fiscal year 2010. This is not the
time to cut back on research vital to our Nation's continued security
in a global atmosphere of uncertainty and asymmetric threats.
behavioral research within the military service labs and dod
Within DOD, the majority of behavioral, cognitive and social
science is funded through the Army Research Institute (ARI) and Army
Research Laboratory (ARL); the Office of Naval Research (ONR); and the
Air Force Research Laboratory (AFRL), with additional, smaller human
systems research programs funded through the Office of the Secretary of
Defense, the Defense Advanced Research Projects Agency (DARPA), and
DOD's Defense Intelligence Agency (DIA).
The military service laboratories provide a stable, mission-
oriented focus for science, conducting and sponsoring basic (6.1),
applied/exploratory development (6.2) and advanced development (6.3)
research. These three levels of research are roughly parallel to the
military's need to win a current war (through products in advanced
development) while concurrently preparing for the next war (with
technology ``in the works'') and the war after next (by taking
advantage of ideas emerging from basic research). All of the services
fund human-related research in the broad categories of personnel,
training and leader development; warfighter protection, sustainment and
physical performance; and system interfaces and cognitive processing.
National Academies Report Calls for Doubling Behavioral Research
The 2008 National Academies report on Human Behavior in Military
Contexts recommended doubling the current budgets for basic and applied
behavioral and social science research ``across the U.S. military
research agencies.'' It specifically called for enhanced research in
six areas:
--intercultural competence;
--teams in complex environments;
--technology-based training;
--nonverbal behavior;
--emotion; and
--behavioral neurophysiology.
Behavioral and social science research programs eliminated from the
mission labs due to cuts or flat funding are extremely unlikely to be
picked up by industry, which focuses on short-term, profit-driven
product development. Once the expertise is gone, there is absolutely no
way to ``catch up'' when defense mission needs for critical human-
oriented research develop. As DOD noted in its own Report to the Senate
Appropriations Committee: ``Military knowledge needs are not
sufficiently like the needs of the private sector that retooling
behavioral, cognitive and social science research carried out for other
purposes can be expected to substitute for service-supported research,
development, testing, and evaluation . . . our choice, therefore, is
between paying for it ourselves and not having it.''
Defense Science Board Calls for Priority Research in Social and
Behavioral Sciences: Mapping the Human Terrain
This emphasis on the importance of social and behavioral research
within DOD is echoed by the Defense Science Board (DSB), an independent
group of scientists and defense industry leaders whose charge is to
advise the Secretary of Defense and the Chairman of the Joint Chiefs of
Staff on ``scientific, technical, manufacturing, acquisition process,
and other matters of special interest to the Department of Defense.''
In its 2007 report on 21st Century Strategic Technology Vectors,
the DSB identified a set of four operational capabilities and the
''enabling technologies'' needed to accomplish major future military
missions (analogous to winning the Cold War in previous decades). In
identifying these capabilities, DSB specifically noted that ``the
report defined technology broadly, to include tools enabled by the
social sciences as well as the physical and life sciences.'' Of the
four priority capabilities and corresponding areas of research
identified by the DSB for priority funding from DOD, the first was
defined as ``mapping the human terrain.''
maintaining behavioral research on counterintelligence
In addition to strengthening the DOD S&T account, and behavioral
research within the military labs in particular, APA also is concerned
with maintaining invaluable human-centered research programs formerly
within DOD's Counterintelligence Field Activity (CIFA) now that staff
and programming have been transferred to the Defense Intelligence
Agency. Within this DIA program, psychologists lead intramural and
extramural research programs on counterintelligence issues ranging from
models of ``insider threat'' to cybersecurity and detection of
deception. These psychologists also consult with the three military
services to translate findings from behavioral research directly into
enhanced counterintelligence operations on the ground.
APA urges the Subcommittee to provide ongoing funding in fiscal
year 2010 for counterintelligence behavioral science research programs
at DIA in light of their direct support for military intelligence
operations.
SUMMARY
On behalf of APA, I would like to express my appreciation for this
opportunity to present testimony before the Subcommittee. Clearly,
psychological scientists address a broad range of important issues and
problems vital to our national security, with expertise in modeling
behavior of individuals and groups, understanding and optimizing
cognitive functioning, perceptual awareness, complex decision-making,
stress resilience, recruitment and retention, and human-systems
interactions. We urge you to support the men and women on the front
lines by reversing another round of cuts to the overall defense S&T
account and the human-oriented research projects within the military
laboratories and CIFA.
As our Nation rises to meet the challenges of current engagements
in Iraq and Afghanistan as well as other asymmetric threats and
increased demand for homeland defense and infrastructure protection,
enhanced battlespace awareness and warfighter protection are absolutely
critical. Our ability to both foresee and immediately adapt to changing
security environments will only become more vital over the next several
decades. Accordingly, DOD must support basic Science and Technology
(S&T) research on both the near-term readiness and modernization needs
of the department and on the long-term future needs of the warfighter.
Below is suggested appropriations report language for fiscal year
2010 which would encourage the Department of Defense to fully fund its
behavioral research programs within the military laboratories and
protect counterintelligence research:
Department of Defense
Research, Development, Test, and Evaluation
Behavioral Research in the Military Service Laboratories.--The
Committee notes the increased demands on our military personnel,
including high operational tempo, leadership and training challenges,
new and ever-changing stresses on decision-making and cognitive
readiness, and complex human-technology interactions. To help address
these issues vital to our national security, the Committee has provided
increased funding to reverse cuts to psychological research through the
military research laboratories: the Air Force Office of Scientific
Research and Air Force Research Laboratory; the Army Research Institute
and Army Research Laboratory; and the Office of Naval Research.
Human-Centered Counterintelligence Research.--The Committee urges
the Department of Defense to continue supporting human-centered
research, formerly coordinated through the Counterintelligence Field
Activity, at the Defense Intelligence Agency.
Chairman Inouye. And now may I call upon the chair of the
Extremities War Injuries Project Team of the American Academy
of Orthopaedic Surgeons, Dr. Andrew Pollak.
STATEMENT OF ANDREW N. POLLAK, M.D., CHAIR, EXTREMITY
WAR INJURIES AND DISASTER PREPAREDNESS
PROJECT TEAM, AMERICAN ACADEMY OF
ORTHOPAEDIC SURGEONS
Dr. Pollak. Good morning, Senators. I'm Dr. Andy Pollak,
and I chair the Extremity War Injuries Project Team for the
American Academy of Orthopaedic Surgeons. During the day, I
serve as chief of orthopaedic surgery at the Shock Trauma
Center at the University of Maryland in Baltimore.
On behalf of military and civilian orthopaedic surgeons and
researchers throughout the country, I take this opportunity to
urge the subcommittee to continue to provide significant
resources for peer-reviewed medical research in the area of
extremity war injuries, injuries arising from trauma to the
bones, joints, muscles, and tendons of the arms and legs.
We thank you for providing the DOD with the funding for
this purpose since fiscal year 2006, including $117 million
total in fiscal year 2009, and we urge you to consider
increasing funding for this program, in fiscal year 2010, to
$150 million.
Chairman Inouye, we know of your personal experience
involving extremity trauma during war, and appreciate the fact
that you have both personal and professional perspectives from
which to address this issue.
We're very grateful for the dedicated work of Senators
Harkin and Hutchison, both members of the subcommittee. They
worked together in support of last year's appropriation, and
have both expressed support for growing this program to $150
million for fiscal year 2010.
Mr. Chairman, I've had the privilege of performing surgery
in military facilities in Balad, Iraq, and Landstuhl, Germany.
I can assure this subcommittee of the outstanding quality of
trauma care being delivered by the military health system
there. The problem facing surgeons emanates from limitations in
medical knowledge and techniques in the management of these
horrific injuries. We need your help to advance the state of
the art. We also need your help to improve our ability to treat
consequences of severe injury to the extremities, such as
arthritis, nerve damage, infection, and failure of bones to
heal properly.
I'll keep the statistics short. Extremity injury is the
most common type of injury sustained in battle, affecting over
80 percent of wounded warriors. Extremity wounds are the
greatest source of expense related to hospitalization of
wounded warriors after combat injury. Extremity war wounds are
the greatest source of war-related disability expense for the
military, expected to total $1.8 billion, lifetime, for
payments related to injuries sustained to American warriors in
Iraq and Afghanistan, exclusive of costs associated with their
medical care. And conditions analogous to arthritis were the
most common reason for disability-related retirement from the
Army in 2008.
The peer-reviewed orthopaedic research programs were
designed to help military surgeons find new, limb-sparing
techniques, with the goals of avoiding amputations, and
preserving and restoring the function of injured extremities,
limiting disability and suffering, and, whenever possible,
allowing our warriors to return to duty as soon as it's safely
possible.
The interest and capacity of the U.S. research community is
very strong. This past year, as a result of funding made
available in the fiscal year 2008 supplemental appropriation,
the DOD accepted applications for development of a consortium
of military and civilian trauma centers to begin work on the
critically important clinical studies necessary to understand
the best ways to treat extremity injuries, and to translate
recent scientific advances in bone growth and tissue
regeneration to the real world, where these advances can help
improve the lives of our injured heroes.
Mr. Chairman, Mr. Vice Chairman, you've recognized the
urgent need to finance extremity research over the past 4
years, and we're extremely grateful for that support. Based on
the level of scientific need, our goal is to see the Defense
Department programs achieve an operating level of $150 million
per year.
Thank you and the entire subcommittee for your vision and
leadership in responding to this appeal. We strongly urge your
continued action.
Chairman Inouye. All right, thank you very much, Dr.
Pollak.
[The statement follows:]
Prepared Statement of Andrew N. Pollak
Chairman Inouye, Vice Chairman Cochran, Members of the Senate
Defense Appropriations Subcommittee, thank you for the opportunity to
testify today. I am Andrew N. Pollak, M.D., and I speak today on behalf
of the American Academy of Orthopaedic Surgeons (AAOS), of which I am
an active member, as well as my military and civilian orthopaedic
surgery colleagues who are involved in extremity trauma research and
care.
I am Chair of the Academy's Extremity War Injuries and Disaster
Preparedness Project Team, past-chair of its Board of Specialty
Societies, and a subspecialist in orthopaedic traumatology. I am
Associate Director of Trauma and Head of the Division of Orthopaedic
Traumatology at the R Adams Cowley Shock Trauma Center and the
University of Maryland School of Medicine. My Division at Shock Trauma
is responsible for providing education and training in orthopaedic
traumatology to residents from eight separate training programs
nationally, including the Bethesda Naval, Walter Reed Army and Tripler
Army military orthopaedic residency programs. In addition, Shock Trauma
serves as the home for the Air Force Center for the Sustainment of
Trauma and Readiness Skills (CSTARS) program. I also serve as Second
Vice President of the Orthopaedic Trauma Association.
Senators, on behalf of all the military and civilian members of the
American Academy of Orthopaedic Surgeons, please allow me to take this
opportunity today to thank you both, as well as the Members of this
Subcommittee, for your vision and leadership in providing funding in
fiscal years 2006 through 2009 for the peer reviewed medical research
program on orthopaedic and extremity war injuries. In particular, we
thank you for providing $66 million in your fiscal year 2009 Conference
Bill and for creating the Peer Reviewed Orthopedic Research Program to
cover the full range of research--from basic to clinical trials.
We also thank you most sincerely for your consideration of
providing funding in the fiscal year 2009 Supplemental Appropriations
Bill. Your commitment to building this research enterprise and enabling
the Department of Defense to pursue answers to its critical medical
needs must be recognized. Clearly this effort by the Congress will
provide medical benefit through improved treatments and procedures to
help our Wounded Warriors heal better and quicker.
We are very grateful for the dedicated work of Senators Tom Harkin
and Kay Bailey Hutchison--both Members of this Subcommittee--in
sponsoring a ``Dear Colleague'' letter this year supporting the
ultimate goal of achieving an annual operating level of $150 million
per year for this critical peer reviewed research program.
It really cannot be overstated: the level and consistency of
appropriations you are providing are ``game-changing.'' It provides the
Department with the ability to move rapidly in developing the full
research continuum, especially clinical trials--an essential form of
investigation that has not existed in the extremity injury field
previously because of a lack of significant and sustained resources.
Just last month because of your support the U.S. Army's Medical
Research and Materiel Command accepted applications in response to its
first ever call for the formation of network for clinical research into
these challenges. In addition because of this critical funding, in
April the Command hosted a 2-day scientific conference to further
examine needs, and prioritize areas for its broadened research agenda.
Mr. Chairman, our message is straightforward:
--Extremity trauma and its sequelae represent the single most common
injury class our wounded warriors suffer, the greatest source
of inpatient medical care expense for the DOD, the single
greatest source of injury related disability expense for the
military, and the most common cause for disability retirement
from all branches of the armed services;
--the state of the science must be advanced to provide better
treatment options for our wounded service members who suffer
extremity trauma and other injuries to their bone and muscles
with a goal of limiting the profound long-term disability
associated with these injuries;
--the current peer reviewed research program has great potential to
address a wide range of bone and muscle injuries and conditions
that are sidelining our troops at increasing rates; and
--the Defense Department must be convinced to proactively budget for
research on military-related orthopaedic injuries, including
extremity trauma, but until that occurs, we believe that the
Congress has an obligation to ensure--as you have done--that
the necessary resources are appropriated and directed to the
task.
As the Iraq and Afghanistan conflicts enter their seventh year, the
Nation continues to face a profound need for focused medical research
to help military surgeons find new limb-sparing techniques with the
goal of avoiding amputations and preserving and restoring the function
of injured extremities.
Chairman Inouye, we know of your experience with extremity trauma
during war and appreciate the fact that you have both personal and
professional perspectives from which to address this issue and we honor
your service as well as that of Vice Chairman Cochran.
U.S. military researchers have documented that approximately 82
percent of war injuries suffered fighting the global war on terror
involve the extremities--often severe and multiple injuries to the arms
and legs.
The evidence is also reflected in legislative documents. House
Report 111-105 accompanying the recent fiscal year 2009 Supplemental
Appropriations Bill, H.R. 2346, correctly states that ``. . . extremity
injuries are the most prevalent injury, and amputations following
battlefield injury now occur as twice the rate as in past wars.
Understanding how to treat and facilitate rapid recovery from
orthopedic injuries should be one of the top priorities for the
Military Health System.''
The Report accompanying the fiscal year 2009 House Appropriations
Bill made similar points and added: ``. . . the committee believes that
every aspect of research shall be considered during a time when unique
and dynamic research and treatment is necessary to provide the soldiers
the greatest ability to recover from injuries sustained on the
battlefield.''
House Report 110-279 accompanying the fiscal year 2008 Defense
Appropriations Bill stated that ``Extremity injuries are the number one
battlefield injury . . . dynamic research and treatment is necessary to
provide service members the greatest ability to recover from injuries
sustained on the battlefield.''
A recent U.S. Army analysis of soldiers injured in Iraq and
Afghanistan from 2001 through 2005 shows that extremity injuries
account for the greatest proportion of medical resource utilization and
cause the greatest number of disabled soldiers. In fact, soldiers with
extremity injuries had the longest average inpatient stays, accounted
for 65 percent of total inpatient resource utilization and 64 percent
of projected disability benefits costs in the future. The projected
disability cost for extremity injuries sustained in this conflict to
date--exclusive of ANY short or long-term medical costs--is estimated
to be approximately $1.2 billion.
In addition, muscle and bone injuries are sidelining a growing
number of troops in our current conflicts. Data from the U.S. Army
reported 257,000 acute orthopaedic injuries in 2007--an increase of
10,000 over the previous year. Increasing numbers of troops are listed
as ``non-deployable'' as a result of injuries related to carrying heavy
combat gear in repeated deployments, and, in the case of Afghanistan,
carrying those loads in high altitude settings.
A February 1, 2009 Washington Post article on this challenge stated
that ``Army leaders and experts say the injuries--linked to the stress
of bearing heavy loads during repeated 12- or 15-month combat tours--
have increased the number of soldiers categorized as ``non
deployable.''
The article goes on to quote General Peter W. Chiarelli, the Army
Vice Chief of Staff: ``You can't hump a rucksack at 8,000 to 11,000
feet for 15 months, even at a young age, and not have that have an
impact on your body, and we are seeing an increase in muscular-skeletal
issues.''
THE PEER REVIEWED ORTHOPAEDIC RESEARCH PROGRAM
Chairman Inouye, the AAOS and military and civilian orthopaedic
surgeons and researchers are very grateful for your Subcommittee's
vision in providing support for Peer Reviewed Orthopedic Research. This
is the first program created in the Department of Defense dedicated
exclusively to funding peer-reviewed intramural and extramural
orthopaedic research. Having the program administered on behalf of the
Defense Health Program by the U.S. Army Medical Research and Materiel
Command, Fort Dietrick, ensures that the funding closely follows the
research priorities established by the Armed Forces. With the
assistance of the Army's Institute of Surgical Research, MRMC has
extensive experience administering military-related research grant
programs. Military orthopaedic surgeons have also had significant input
into the creation of this program and fully support its goals.
The design of the program fosters collaboration between civilian
and military orthopaedic surgeons and researchers and various
facilities. Civilian researchers have the expertise and resources to
assist their military colleagues with the growing number of patients
and musculoskeletal injuries and war wound challenges in building the
military research program. As can been seen in extensive numbers of
research applications submitted under each RFP, civilian investigators
are extremely interested in advancing this research and have responded
enthusiastically to engage in this important work which will also
provide wide ranging spin-off benefits to civilian trauma patients.
The program is growing to encompass the full spectrum of research,
from basic and translational studies to clinical trials. It focuses on
targeted, competitively-awarded research where peer reviewers score
proposals on the degree of (1) military relevance, (2) military impact,
and (3) scientific merit. Military and civilian orthopaedic surgeons
are highly involved in defining the research topics and in evaluating
and scoring the proposals. This unique process ensures that projects
selected for funding have the highest chance for improving treatment of
battlefield injuries and deployment related musculoskeletal injuries.
Significant new funding from the Congress will allow for more
robust numbers of grants, a broader scope of work and increased multi-
institutional collaboration. As mentioned earlier, clinical trials and
more in-depth tracking of long term outcomes are in the planning
stages--important components in rapidly advancing the state of the
science.
By funding the Peer Reviewed Orthopedic Research Program--operated
on behalf of all services by the Army's Medical Research and Materiel
Command--your committee is advancing the state of the science in this
field to the benefit of our current servicemen and women--and those who
will step forward in the future to defend our Nation. Your action will
directly result in improved treatments for our Wounded Warriors and
injured troops now and in future conflicts.
It is important to point out that unique to the current conflicts
is a new type of patient, a war fighter with multiple and severely
mangled extremities who is otherwise free of life-threatening injury to
the torso or whose life-threatening injuries have been successfully
addressed because of improvements in protective body armor and the
excellent care quickly delivered through the echelon treatment system.
Such injuries are rarely seen in civilian surgical hospitals, even in
Level 1 trauma centers like my own at Shock Trauma in Baltimore.
Current challenges that often compound the battlefield injuries include
serious infections due to the nature of the injuries and the
environment in which they are sustained, and the need for immediate
transport for more complex surgery.
The Academy's interest in this effort began in the very early days
of Operation Enduring Freedom when our deployed military Academy
members began to report the great clinical needs that were emerging as
they went about their work in surgery to save injured servicemen and
women. Soon studies on the nature of injuries in Iraq and Afghanistan
documented the high proportion of extremity injuries as well as the
severity of injuries.
I have been fortunate to travel to and operate in the U.S. Army
Hospital in Landstuhl, Germany several times and to the Air Force
Theater Hospital in Balad, Iraq to initiate the Academy's Distinguished
Visiting Scholars Program. This program is a joint initiative between
the AAOS and the Orthopaedic Trauma Association. The activity allows
civilian orthopaedic trauma specialists with demonstrated clinical
expertise and national recognition for their teaching abilities to
volunteer two weeks at a time to be away from their practices
performing surgery and teaching at Landstuhl Regional Medical Center. I
also had the privilege of operating in Balad, Iraq as part of a request
by Air Force Surgeon General James Roudebush to evaluate the trauma
care being delivered at the Air Force Theater Hospital and to
investigate the feasibility and value of extending the Distinguished
Visiting Scholars Program into Iraq and Afghanistan. Based on my
experiences in Balad, I can assure this committee of the outstanding
quality of trauma care being delivered there by the military health
system. I believe the quality of medical care being delivered to our
injured warriors in Balad is at or above the care being delivered in
our finest trauma centers within the United States.
On January 21-23 of this year, the fourth annual Extremity War
Injuries Scientific Symposium was held in Washington, DC, sponsored by
our Academy, along with the Society of Military Orthopaedic Surgeons,
The Orthopaedic Research Society and the Orthopaedic Trauma
Association. This combined effort of three major associations and the
United States military began in 2006 in an initiative to examine the
nature of extremity injuries sustained during Operation Enduring
Freedom and Operation Iraqi Freedom and to plan for advancing the state
of the science and treatment of these injuries. Each year the meetings
are attended by over 175 military and civilian leaders in orthopaedic
and extremity medical research and treatment from around the world. We
have been very fortunate to have had many outstanding leaders speak to
the conference audiences in the past about their perspectives on
injuries being sustained by our armed forces. These speakers have
included Joint Chiefs Chairman Adm. Michael Mullen, Senator Tom Harkin,
Representatives John Murtha, Dutch Ruppersberger, and Tom Latham, and
the previous Assistant Secretary of Defense for Health Affairs, Ward
Casscells. This conference series has produced widely referenced
scientific publications describing the clinical challenges posed by
extremity war injuries, and a research agenda to guide the scientific
community and the managers of the Peer Reviewed Orthopedic Research
Program in planning and executing the program.
ORTHOPAEDIC TRAUMA FROM OPERATION IRAQI FREEDOM AND OPERATION ENDURING
FREEDOM
The likelihood of surviving wounds on the battlefield was 69.7
percent in WWII and 76.4 percent in Vietnam. Now, thanks in part to the
use of body armor, ``up-armored'' vehicles, intense training of our
combat personnel and surgical capability within minutes of the
battlefield, survivability has increased dramatically to 90.2 percent
as of February 2007.
The Armed Forces are attempting to return significantly injured
warriors to full function or limit their disabilities to a functional
level in the case of the most severe injuries. The ability to provide
improved recovery of function moves toward the goal of keeping injured
warriors part of the military team. Moreover, when they do leave the
Armed Forces, these rehabilitated warriors have a greater chance of
finding worthwhile occupations outside of the service to contribute
positively to society. The military believes that it has a duty and
obligation to provide the highest level of care and rehabilitation to
those men and women who have suffered the most while serving the
country and our Academy fully supports those efforts.
It comes as no surprise that the vast majority of trauma
experienced in Iraq and Afghanistan is orthopaedic-related, especially
upper and lower extremity and spine. A recent article in the Journal of
Orthopaedic Trauma reports on wounds sustained in Operation Iraqi
Freedom (OIF) and Operation Enduring Freedom (OEF) based on data from
the Joint Theater Trauma Registry, a database of medical treatment
information from theater of combat operations at U.S. Army medical
treatment facilities. From October, 2001 through January, 2005, of
1,566 soldiers who were injured by hostile enemy action, 1,281 (82
percent) had extremity injuries, with each solider sustaining, on
average, 2.28 extremity wounds. These estimates do not include non-
American and civilians receiving medical care through U.S. military
facilities. (Owens, Kragh, Macaitis, Svoboda and Wenke.
Characterization of Extremity Wounds in Operation Iraqi Freedom and
Operation Enduring Freedom. J Orthopaedic Trauma. Vol. 21, No. 4, April
2007. 254-257.)
An earlier article reported on 256 battle casualties treated at the
Landstuhl Regional Medical Center in Germany during the first 2 months
of OIF, finding 68 percent sustained an extremity injury. The reported
mechanism of injury was explosives in 48 percent, gun-shot wounds in 30
percent and blunt trauma in 21 percent. As the war has moved from an
offensive phase to the current counter-insurgency campaign, higher
rates of injuries from explosives have been experienced. (Johnson BA.
Carmack D, Neary M, et al. Operation Iraqi Freedom: the Landstuhl
Regional Medical Center experience. J Foot Ankle Surg. 2005; 44:177-
183.) According to the JTTR, between 2001 and 2005, explosive
mechanisms accounted for 78 percent of the war injuries compared to 18
percent from gun shots.
While medical and technological advancements, as well as the use of
fast-moving Forward Surgical Teams, have dramatically decreased the
lethality of war wounds, wounded soldiers who may have died in previous
conflicts from their injuries are now surviving and have to learn to
recover from devastating injuries. While body armor is very effective
in protecting a soldier's torso, his or her extremities are
particularly vulnerable during attacks.
Characteristics of Military Orthopaedic Trauma
At this point there have been almost 40,000 warriors evacuated to
Landstuhl Regional Medical Center in the Global War on Terror. Of
these, almost 16,000 have been wounded in action. As mentioned earlier,
the vast majority have injuries to their extremities--often severe and
multiple injuries to the arms and legs. Most wounds are caused by
exploding ordinance--frequently, improvised explosive devices (IEDs),
rocket-propelled grenades (RPGs), as well as high-velocity gunshot
wounds. Military surgeons report an average of 3 wounds per casualty.
According to the New England Journal of Medicine, blast injuries
are producing an unprecedented number of ``mangled extremities''--limbs
with severe soft-tissue and bone injuries. (``Casualties of War--
Military Care for the Wounded from Iraq and Afghanistan,'' NEJM,
December 9, 2004). The result of such trauma is open, complex wounds
with severe bone fragmentation. Often there is nerve damage, as well as
damage to tendons, muscles, vessels, and soft-tissue. In these types of
wounds, infection is often a problem. According to the JTTR, 53 percent
of the extremity wounds are classified as penetrating soft-tissue
wounds, while fractures compose 26 percent of extremity wounds. Other
types of extremity wounds composing less than 5 percent each are burns,
sprains, nerve injuries, abrasions, amputations, contusions,
dislocations, and vascular injuries.
The sheer number of extremity injuries represents a staggering
health burden. Between January 2003, and February 2009, over 15,000
U.S. Warriors have been wounded-in-action severely enough to require
evacuation out of theater. In addition, 780 American patients have lost
at least one limb.
Military Versus Civilian Orthopaedic Trauma
While there are similarities between military orthopaedic trauma
and the types of orthopaedic trauma seen in civilian settings, there
are several major differences that must be noted.
With orthopaedic military trauma, there are up to five echelons of
care, unlike in civilian settings when those injured are most likely to
receive initial treatment at the highest level center. Instead, wounded
warriors get passed from one level of care to the next, with physicians
and other health care providers rendering the most appropriate type of
care possible in the context of the limitations of a battlefield
environment in order to ensure the best possible outcome. The surgeon
in each subsequent level of care must try to recreate what was
previously done. In addition, a majority of injured soldiers have to be
``med-evaced'' to receive care and transportation is often delayed due
to weather or combat conditions. It has been our experience that over
65-percent of the trauma is urgent and requires immediate attention.
Injuries from IEDs and other explosive ordnance in Iraq and
Afghanistan differ markedly from those of gunshot wounds sustained in
civilian society. The contamination, infection and soft-tissue injury
caused by exploding ordnance requires more aggressive treatment and new
techniques, especially when the wounded warrior was in close proximity
to the blast radius.
Warriors are usually in excellent health prior to injury. However,
through the evacuation process they may not be able to eat due to
medical considerations resulting in impaired body nitrogen stores and
decreased ability to heal wounds and fight infections. This presents
many complicating factors when determining the most appropriate care.
The setting in which care is initially provided to wounded soldiers
is less than ideal, to say the least, especially in comparison to a
sterile hospital setting. The environment, such as that seen in Iraq
and Afghanistan, is dusty and hot, leading to concerns about secondary
contamination of wounds in the hospital setting. For example, infection
from acinetobacter baumanni, a ubiquitous organism found in the desert
soil of Afghanistan and Iraq, is extremely common. In addition, the
surgical environment is under constant threat of attack by insurgents.
Imagine teams of medical specialists working in close quarters to save
an injured serviceman while mortars or rockets are raining down on the
hospital. Finally, the forward-deployed surgical team is faced with
limited resources that make providing the highest level of care
difficult.
While, as I have stated, there are many unique characteristics of
orthopaedic military trauma, there is no doubt that research done on
orthopaedic military trauma also benefits trauma victims in civilian
settings. Many of the great advancements in orthopaedic trauma care
have been made during times of war, including principles of debridement
of open wounds, utilization of external fixation and use of tourniquets
for control of hemorrhage which has been used extensively during the
current conflict.
Research Needs.--With such strong research interest and capacity,
and the great need for medical breakthroughs in this field, the
scientific community believes that a sustained, multi-year program
funded at $150 million per year is justified. Such significant funding
is required allow the Defense Department to conduct multi-center
clinical trials--research projects that would greatly advance the field
and significantly benefit the battlefield injured warriors. In
addition, basic and translational research also must be sustained, as
in any major research undertaking, to provide the underpinnings for
advancing clinical breakthroughs. Research in the management of
extremity injuries and other disabling orthopaedic conditions will lead
to quicker recovery times, improved function of limbs, better response
rates to infection, and new advances in rehabilitation benefiting both
military and civilian patients. General areas of research need include
bone regeneration, improved healing of massive soft tissue damage,
prevention of wound infection, techniques to improve irrigation and
debridement of blast injuries, prevention of bone reformation
abnormalities, and epidemiology of current battle-related injuries.
Specific areas of research need include:
--Prevention and treatment of post-traumatic arthritis;
--Prevention and treatment of infections following high-energy
extremity war injury;
--Management of segmental bone defects;
--Establishment of tissue viability markers--this would assist
surgeons in better understanding the ideal frequency and
techniques of debridement wound cleaning);
--Timing of treatment--early versus late surgical treatment;
--Prevention and treatment of chronic neck and low back arthritic
conditions resulting from combat associated stress and overuse
injury;
--Treatment of severe muscle, nerve, ligament and other soft-tissue
injury associated with combat trauma; and
--Rehabilitation of high-performance warriors after significant
combat related injury.
Future Needs of Orthopaedic Research
As mentioned earlier, an important development in this scientific
effort has been the convening of the annual Extremity War Injury
Symposia, which began in January of 2006. These widely attended medical
conferences in Washington, D.C. bring together leading military and
civilian clinicians and researchers to focus on the immediate needs of
personnel sustaining extremity injuries. Discussions at the conferences
have confirmed that there is tremendous interest and much untapped
research capacity in the Nation's military and civilian research
community.
These extraordinary scientific meetings were a partnership effort
between organized orthopaedic surgery, military surgeons and
researchers. They were attended by key military and civilian physicians
and researchers committed to the care of extremity injuries. The first
conference addressed current challenges in the management of extremity
trauma associated with recent combat in Iraq and Afghanistan. The major
focus was to identify opportunities to improve care for the sons and
daughters of America who have been injured serving our Nation. The
second focused on the best way to deliver care within the early
echelons of treatment. The third explored the wide spectrum of needs in
definitive reconstruction of injuries. Scientific proceedings from the
symposia have been published by our Academy and made available to the
military and civilian research community. Each conference has continued
to refine the list of prioritized research needs which I will
summarize:
Timing of Treatment
Better data are necessary to establish best practices with regard
to timing of debridement, timing of temporary stabilization and timing
of definitive stabilization. Development of animal models of early
versus late operative treatment of open injuries may be helpful.
Prospective clinical comparisons of treatment groups will be helpful in
gaining further understanding of the relative role of surgical timing
on outcomes.
Techniques of Debridement
More information is necessary about effective means of
demonstrating adequacy of debridement. Current challenges, particularly
for surgeons with limited experience in wound debridement, exist in
understanding how to establish long-term tissue viability or lack
thereof at the time of an index operative debridement. Since patients
in military settings are typically transferred away from the care of
the surgeon performing the initial debridement prior to delivery of
secondary care, opportunities to learn about the efficacy of initial
procedures are lost. Development of animal models of blast injury could
help establish tissue viability markers. Additional study is necessary
to understand ideal frequencies and techniques of debridement.
Transport Issues
Clinical experience suggests that current air evacuation techniques
are associated with development of complications in wound and extremity
management although the specific role of individual variables in the
genesis of these complications is unclear. Possible contributing
factors include altitude, hypothermia and secondary wound
contamination. Clinical and animal models are necessary to help develop
an understanding of transport issues.
Coverage Issues
Controlled studies defining the role of timing of coverage in
outcome following high-energy extremity war injuries are lacking. Also
necessary is more information about markers and indicators to help
assess the readiness of a wound and host for coverage procedures.
Additional animal modeling and clinical marker evaluation are necessary
to develop understanding in this area.
Antibiotic Treatments
Emergence of resistant organisms continues to provide challenges in
the treatment of infection following high-energy extremity war
injuries. Broader prophylaxis likely encourages development of
antibiotic resistance. In the context of a dwindling pipeline of new
antibiotics, particularly those directed toward gram-negative
organisms, development of new technologies to fight infection is
necessary. This patient population offers opportunity to assess
efficacy of vaccination against common pathogens. Partnerships with
infectious disease researchers currently involved in addressing similar
questions warrants further development.
Management of Segmental Bone Defects
A multitude of different techniques for management of segmental
bone defects is available. These include bone transport, massive onlay
grafting with and without use of recombinant proteins, delayed
allograft reconstruction, and acute shortening. While some techniques
are more appropriate than others after analysis of other clinical
variables, controlled trials comparing efficacy between treatment
methods are lacking. Variables that may affect outcome can be grouped
according to patient characteristics including co-morbidities, injury
characteristics including severity of bony and soft-tissue wounds, and
treatment variables including method of internal fixation selected.
Evaluation of new technologies for treatment of segmental bone defects
should include assessment of efficacy with adequate control for
confounding variables and assessment of cost-effectiveness.
Partnerships with other military research programs may be particularly
effective in improving clinical capabilities in this area.
Development of an Animal Model
A large animal survival military blast injury model is necessary to
serve as a platform for multiple research questions including: negative
pressure wound therapy v. bead pouch v. dressing changes; wound
debridement strategy; effect of topical antibiotics; modulation of
inflammatory response; timing of wound closure; and vascular shunt
utilization.
Prevention of Post-Traumatic Arthritis
More research is necessary to better understand how to address
traumatic injuries to articular cartilage with associated articular
loss. Current treatment options include artificial joint replacement
and joint fusion. Regeneration of cartilage and re-growth of joint
surfaces is poorly understood and warrants further investigation.
Similarly, the role of cadaver joint surfaces in replacing injured
joints in soldiers warrants further consideration and investigation.
Initial research has been exciting in this area, particularly in the
area of allograft hand transplantation.
Amputee Issues
Development and validation of ``best practice'' guidelines for
multidisciplinary care of the amputee is essential. Treatment protocols
should be tested clinically. Studies should be designed to allow for
differentiation between the impacts of the process versus the device on
outcome. Failure mode analysis as a tool to evaluate efficacy of
treatment protocols and elucidate shortcomings should be utilized.
Clinically, studies should focus on defining requirements for the
residual limb length necessary to achieve success without proceeding to
higher level amputation. Outcomes based comparisons of amputation
techniques for similar injuries and similar levels should be performed.
Use of local tissue lengthening and free tissue transfer techniques
should be evaluated. In the context of current results and increasing
levels of expectation for function following amputation, development of
more sensitive and military appropriate outcomes monitors is necessary.
Heterotopic Ossification
This condition, known as ``H.O.'' by the many soldiers who
experience it, is abnormal and uncontrolled bone growth that often
occurs following severe bone destruction or fracture. Animal models of
heterotopic ossification should be utilized to develop early markers
for heterotopic ossification that could identify opportunities for
early treatment and prevention. Better information is needed about
burden of disease including prevalence following amputation for
civilian versus military trauma and frequency with which symptoms
develop. Treatment methods such as surgical debridement, while
effective, necessarily interrupt rehabilitation. Prevention could
expedite recovery and potentially improve outcome.
CONCLUSION
With extremity trauma injuries being the most common form of injury
seen in current military conflicts and musculoskeletal injuries
becoming an increasing factor in sidelining our troops, it is crucial
that significant funding be directed specifically to the advancement of
research. The AAOS has worked closely with the top military orthopaedic
surgeons and medical leaders, at world-class facilities such as the
U.S. Army Institute of Surgical Research, Brooke Army Medical Center,
Bethesda Naval Hospital, Landstuhl Regional Medical Center, the Medical
Research and Materiel Command and Walter Reed Army Medical Center to
identify the gaps in research and clinical treatment--and the
challenges are many.
Orthopaedic research currently being carried out at those and other
facilities, and at civilian medical centers, is vital to the health of
our soldiers and to the Armed Forces' objective to return injured
soldiers to full function in hopes that they can continue to be
contributing soldiers and active members of society.
The 17,000 members of our Academy thank you for sustaining the Peer
Reviewed Orthopedic Research Program. While Congress funds an extensive
array of medical research through the Department of Defense, with over
80 percent of military trauma being extremity-related, I can assure you
that this type of medical research will greatly benefit our men and
women serving in the Global War on Terror and in future conflicts.
Mr. Chairman and Mr. Vice Chairman, the American Academy of
Orthopaedic Surgeons, as well as the entire orthopaedic trauma
community, stands ready to work with this Subcommittee to identify and
prioritize research opportunities for the advancement in the care of
extremity and orthopaedic injuries. Military and civilian orthopaedic
surgeons and researchers are committed to pursuing scientific inquiry
that will benefit the unfortunately high number of soldiers afflicted
with such conditions and return them to the highest level of function
possible. This investment to improve treatment for our soldiers will be
well spent. It is imperative that the Federal Government--when
establishing its defense health research priorities in the future--
continues to ensure that research on treating orthopaedic and extremity
war injuries remains a top priority. We appreciate your consideration
of our perspective on this critical issue and urge your continued
action on behalf of our Nation's servicemen and women.
Chairman Inouye. And we'd like to thank the whole panel and
now call upon the new panel.
Thank you very much.
The next panel consists of Ms. Frances Visco, Ms. Jackie S.
Rowles, Mr. Rick Jones, Ms. Cara Tenenbaum, Colonel William
Holahan, and Ms. Elizabeth Cochran.
I've been advised that Mr. Wicks will be substituting for
Ms. Jackie Rowles.
And our next witness is the president of the National
Breast Cancer Coalition, Ms. Frances Visco.
STATEMENT OF FRAN VISCO, J.D., PRESIDENT, NATIONAL
BREAST CANCER COALITION
Ms. Visco. Thank you, Chairman Inouye, Senator Cochran.
I'm here as a 22-year breast cancer survivor, a wife, a
mother, and the president of the National Breast Cancer
Coalition. As you know, NBCC is a coalition of more than 600
organizations from across the country whose mission is to end
breast cancer.
I want to thank you, as I do every year, for your continued
support of this program. And I want to report to you that this
program continues to be incredibly successful. It continues to
create new models of science, new models of research, through a
competitive, peer-reviewed process that releases funding to
scientists around the world.
This program has funded innovative research, it has filled
the gaps in the traditional funding mechanisms. It has also
been copied by the National Institutes of Health, by private
foundations. The models that this program has launched have now
changed science in many different areas within the Department
of Defense, collaborations within the Defense Department, and
without. It has resulted in bringing many new young scientists
into the field of research, and biomedical research. And I'm
very proud to say--very proud of the military--that this
program has incredibly low administrative costs, so that 90
percent--more than 90 percent of the appropriations go directly
to research funding.
There's an incredibly high return on the investment of
these funds. And, most importantly, this program is
transparent, and it is accountable to the taxpayers. It is
possible to see where every dollar of these funds has gone. And
the public gets a report of the results of the research that
has been funded with these dollars.
It has made an incredible difference to women with breast
cancer, to their families, but really to all disease research.
And I want to take my last moments to say how grateful we are
to the members of the military, to--who administer this
program. They are passionately committed to this mission, and
they do an incredible job. And I want to thank you very much
for continuing and allowing this program to proceed.
Thank you.
Chairman Inouye. Thank you very much, Ms. Visco.
[The statement follows:]
Prepared Statement of Fran Visco
Thank you, Mr. Chairman and members of the Appropriations
Subcommittee on Defense, for the opportunity to submit testimony today
about a Program that has made a significant difference in the lives of
women and their families.
I am Fran Visco, a 21-year breast cancer survivor, a wife and
mother, a lawyer, and President of the National Breast Cancer Coalition
(NBCC). My testimony represents the hundreds of member organizations
and thousands of individual members of the Coalition. NBCC is a
grassroots organization dedicated to ending breast cancer through
action and advocacy. The Coalition's main goals are to increase Federal
funding for breast cancer research and collaborate with the scientific
community to implement new models of research; improve access to high
quality health care and breast cancer clinical trials for all women;
and expand the influence of breast cancer advocates wherever breast
cancer decisions are made.
You and your Committee have shown great determination and
leadership in funding the Department of Defense (DOD) peer-reviewed
Breast Cancer Research Program (BCRP) at a level that has brought us
closer to eradicating this disease. Chairman Inouye and Ranking Member
Cochran, we appreciate your longstanding personal support for this
Program. I am hopeful that you and your Committee will continue that
determination and leadership.
I know you recognize the importance of this Program to women and
their families across the country, to the scientific and health care
communities and to the Department of Defense. Much of the progress in
the fight against breast cancer has been made possible by the
Appropriations Committee's investment in breast cancer research through
the DOD BCRP. This Program has launched new models of biomedical
research that have benefited other agencies and both public and private
institutions. It has changed for the better the way research is
performed and has been replicated by programs focused on other
diseases, by other countries and states. To support this unprecedented
progress moving forward, we ask that you support a separate $150
million appropriation for fiscal year 2010. In order to continue the
success of the Program, you must ensure that it maintain its integrity
and separate identity, in addition to the requested level of funding.
This is important not just for breast cancer, but for all biomedical
research that has benefited from this incredible government Program. In
addition, as Institute of Medicine (IOM) reports concluded in 1997 and
2004, there continues to be excellent science that would go unfunded
without this Program. It is only through a separate appropriation that
this Program is able to continue to focus on breast cancer yet impact
all other research. The separate appropriation of $150 million will
ensure that this Program can rapidly respond to changes and new
discoveries in the field and fill the gaps in traditional funding
mechanisms.
Since its inception, this Program has matured into a broad-reaching
influential voice forging new and innovative directions for breast
cancer research and science. Breast cancer is an extraordinarily
complex disease. Despite the enormous successes and advancements in
breast cancer research made through funding from the DOD BCRP, we still
do not know what causes breast cancer, how to prevent it, or how to
cure it. It is critical that innovative research through this unique
Program continues so that we can move forward toward eradicating this
disease.
OVERVIEW OF THE DOD BREAST CANCER RESEARCH PROGRAM
The DOD peer-reviewed Breast Cancer Research Program has
established itself as a model medical research program, respected
throughout the cancer and broader medical community for its innovative,
transparent and accountable approach. The pioneering research performed
through the Program has the potential to benefit not just breast
cancer, but all cancers, as well as other diseases. Biomedical research
is being transformed by the DOD BCRP's success.
This Program is both innovative and incredibly streamlined. It
continues to be overseen by an Integration Panel including
distinguished scientists and advocates, as recommended by the IOM.
Because there is little bureaucracy, the Program is able to respond
quickly to what is currently happening in the research community.
Because of its specific focus on breast cancer, it is able to rapidly
support innovative proposals that reflect the most recent discoveries
in the field. It is responsive, not just to the scientific community,
but also to the public. The flexibility of the Program has allowed the
Army to administer it with unparalleled efficiency and effectiveness.
An integral part of this Program has been the inclusion of consumer
advocates at every level. Breast cancer is not just a problem of
scientists; it is a problem of people. Advocates bring a necessary
perspective to the table, ensuring that the science funded by this
Program is not only meritorious, but it is also meaningful and will
make a difference in people's lives. The consumer advocates bring
accountability and transparency to the process. Many of the scientists
who have participated in the Program have said that working with the
advocates has changed the way they approach research. Let me quote Dr.
Michael Diefenbach of Mount Sinai School of Medicine:
``I have served as a reviewer for the Department of Defense's
Breast and Prostate Cancer Review programs and I am a member of the
behavioral study section for the National Cancer Institute . . . I find
survivors or advocate reviewers as they are sometimes called bring a
sense of realism to the review process that is very important to the
selection and ultimately funding process of important research . . .
Both sides bring important aspects to the review process and the
selected projects are ultimately those that can fulfill scientific
rigor and translatability from the research arena to clinical practice.
I urge that future review panels include advocate reviewers in the
review process.''
Since 1992, nearly 600 breast cancer survivors have served on the
BCRP peer review panels. As a result of this inclusion of consumers,
the Program has created an unprecedented working relationship between
the public, scientists, and the military, and ultimately has led to new
avenues of research in breast cancer. The vital role of the advocates
in the success of the BCRP has led to consumer inclusion in other
biomedical research programs at DOD. This Program now serves as an
international model.
It is important to note that the Integration Panel that designs
this Program has a strategic plan for how best to spend the funds
appropriated. This plan is based on the state of the science--both what
scientists know now and the gaps in our knowledge--as well as the needs
of the public. While this plan is mission driven, and helps ensure that
the science keeps that mission--eradicating breast cancer--in mind, it
does not restrict scientific freedom, creativity or innovation. The
Integration Panel carefully allocates these resources, but it does not
predetermine the specific research areas to be addressed.
UNIQUE FUNDING OPPORTUNITIES
The DOD BCRP research portfolio includes many different types of
projects, including support for innovative ideas, networks to
facilitate clinical trials, and training of breast cancer researchers.
Developments in the past few years have begun to offer breast
cancer researchers fascinating insights into the biology of breast
cancer and have brought into sharp focus the areas of research that
hold promise and will build on the knowledge and investment we have
made. The Innovative Developmental and Exploratory Awards (IDEA) grants
of the DOD Program have been critical in the effort to respond to new
discoveries and to encourage and support innovative, risk-taking
research. Concept Awards support funding even earlier in the process of
discovery. These grants have been instrumental in the development of
promising breast cancer research by allowing scientists to explore
beyond the realm of traditional research and unleash incredible new
ideas. IDEA and Concept grants are uniquely designed to dramatically
advance our knowledge in areas that offer the greatest potential. IDEA
and Concept grants are precisely the type of grants that rarely receive
funding through more traditional programs such as the National
Institutes of Health and private research programs. They therefore
complement, and do not duplicate, other Federal funding programs. This
is true of other DOD award mechanisms also.
Innovator awards invest in world renowned, outstanding individuals
rather than projects, by providing funding and freedom to pursue highly
creative, potentially groundbreaking research that could ultimately
accelerate the eradication of breast cancer. The Era of Hope Scholar
Award supports the formation of the next generation of leaders in
breast cancer research, by identifying the best and brightest
scientists early in their careers and giving them the necessary
resources to pursue a highly innovative vision of ending breast cancer.
These are just a few examples of innovative funding opportunities
at the DOD BCRP that are filling gaps in breast cancer research.
Scientists have lauded the Program and the importance of these award
mechanisms. In 2005, Zelton Dave Sharp wrote about the importance of
the Concept award mechanism:
``Our Concept grant has enabled us to obtain necessary data to
recently apply for a larger grant to support this project. We could
have never gotten to this stage without the Concept award. Our eventual
goal is to use the technology we are developing to identify new
compounds that will be effective in preventing and/or treating breast
cancer . . . Equally important, however, the DOD BCRP does an
outstanding job of supporting graduate student trainees in breast
cancer research, through training grants and pre-doctoral fellowships .
. . The young people supported by these awards are the lifeblood of
science, and since they are starting their training on projects
relevant to breast cancer, there is a high probability they will devote
their entire careers to finding a cure. These young scientists are by
far the most important `products' that the DOD BCRP produces.''----
Zelton Dave Sharp, Associate Professor, Interim Director/Chairman,
Institute of Biotechnology/Dept. Molecular Medicine, University of
Texas Health Science Center (August 2005).
The DOD BCRP also focuses on moving research from the bench to the
bedside. DOD BCRP awards are designed to fill niches that are not
addressed by other Federal agencies. The BCRP considers translational
research to be the application of well-founded laboratory or other pre-
clinical insight into a clinical trial. To enhance this critical area
of research, several research opportunities have been offered. Clinical
Translational Research Awards have been awarded for investigator-
initiated projects that involve a clinical trial within the lifetime of
the award. The BCRP has expanded its emphasis on translational research
by also offering five different types of awards that support work at
the critical juncture between laboratory research and bedside
applications.
The Centers of Excellence award mechanism brings together the
world's most highly qualified individuals and institutions to address a
major overarching question in breast cancer research that could make a
significant contribution towards the eradication of breast cancer. Many
of these Centers are working on questions that will translate into
direct clinical applications. These Centers include the expertise of
basic, epidemiology and clinical researchers, as well as consumer
advocates.
Dr. John Niederhuber, now the Director of the National Cancer
Institute (NCI), said the following about the Program when he was
Director of the University of Wisconsin Comprehensive Cancer Center in
April, 1999:
``Research projects at our institution funded by the Department of
Defense are searching for new knowledge in many different fields
including: identification of risk factors, investigating new therapies
and their mechanism of action, developing new imaging techniques and
the development of new models to study [breast cancer] . . . Continued
availability of this money is critical for continued progress in the
Nation's battle against this deadly disease.''
Scientists and consumers agree that it is vital that these grants
continue to support breast cancer research. To sustain the Program's
momentum, $150 million for peer-reviewed research is needed in fiscal
year 2010.
SCIENTIFIC ACHIEVEMENTS
One of the most promising outcomes of research funded by the DOD
BCRP was the development of the first monoclonal antibody targeted
therapy that prolongs the lives of women with a particularly aggressive
type of advanced breast cancer. This drug could not have been developed
without first researching and understanding the gene known as HER-2/
neu, which is involved in the progression of some breast cancers.
Researchers found that over-expression of HER-2/neu in breast cancer
cells results in very aggressive biologic behavior. The same
researchers demonstrated that an antibody directed against HER-2/neu
could slow the growth of the cancer cells that over-expressed the gene.
This research, which led to the development of the targeted therapy,
was made possible in part by a DOD BCRP-funded infrastructure grant.
Other researchers funded by the DOD BCRP are identifying similar kinds
of genes that are involved in the initiation and progression of cancer.
Another example of innovation in the Program is in the area of
imaging. One DOD BCRP awardee developed a new use for medical
hyperspectral imaging (MHSI) technology. This work demonstrated the
usefulness of MHSI as a rapid, noninvasive, and cost-effective
evaluation of normal and tumor tissue during a real-time operating
procedure. Application of MHSI to surgical procedures has the potential
to significantly reduce local recurrence of breast tumors and may
facilitate early determination of tumor malignancy.
Studies funded by the DOD BCRP are examining the role of estrogen
and estrogen signaling in breast cancer. For example, one study
examined the effects of the two main pathways that produce estrogen.
Estrogen is often processed by one of two pathways; one yields
biologically active substances while the other does not. It has been
suggested that women who process estrogen via the biologically active
pathway may be at higher risk of developing breast cancer. This
research will yield insights into the effects of estrogen processing on
breast cancer risk in women with and without family histories of breast
cancer.
Another example of success from the Program is a study of sentinel
lymph nodes (SLNs). This study confirmed that SLNs are indicators of
metastatic progression of disease. The resulting knowledge from this
study and others has led to a new standard of care for lymph node
biopsies. If the first lymph node is negative for cancer cells, then it
is unnecessary to remove all the lymph nodes. This helps prevent
lymphodema which can be painful and have lasting complications.
FEDERAL MONEY WELL SPENT
The DOD BCRP is as efficient as it is innovative. In fact, 90
percent of funds go directly to research grants. The flexibility of the
Program allows the Army to administer it in such a way as to maximize
its limited resources. The Program is able to quickly respond to
current scientific advances and fulfills an important niche by focusing
on research that is traditionally under-funded. This was confirmed and
reiterated in two separate IOM reports released in 1997 and 2004. The
areas of focus of the DOD BCRP span a broad spectrum and include basic,
clinical, behavioral, environmental sciences, and alternative therapy
studies, to name a few. The BCRP benefits women and their families by
maximizing resources and filling in the gaps in breast cancer research.
The Program is responsive to the scientific community and to the
public. This is evidenced by the inclusion of consumer advocates at
both the peer and programmatic review levels. The consumer perspective
helps the scientists understand how the research will affect the
community and allows for funding decisions based on the concerns and
needs of patients and the medical community.
The outcomes of the BCRP-funded research can be gauged, in part, by
the number of publications, abstracts/presentations, and patents/
licensures reported by awardees. To date, there have been more than
12,241 publications in scientific journals, more than 12,000 abstracts
and nearly 550 patents/licensure applications. The American public can
truly be proud of its investment in the DOD BCRP. Scientific
achievements that are the direct result of the DOD BCRP grants are
undoubtedly moving us closer to eradicating breast cancer.
INDEPENDENT ASSESSMENTS OF PROGRAM SUCCESS
The success of the DOD peer-reviewed Breast Cancer Research Program
has been illustrated by several unique assessments of the Program. The
IOM, which originally recommended the structure for the Program,
independently re-examined the Program in a report published in 1997.
They published another report on the Program in 2004. Their findings
overwhelmingly encouraged the continuation of the Program and offered
guidance for program implementation improvements.
The 1997 IOM review of the DOD peer-reviewed Breast Cancer Research
Program commended the Program, stating, ``the Program fills a unique
niche among public and private funding sources for cancer research. It
is not duplicative of other programs and is a promising vehicle for
forging new ideas and scientific breakthroughs in the Nation's fight
against breast cancer.'' The 2004 report spoke to the importance of the
program and the need for its continuation.
TRANSPARENT AND ACCOUNTABLE TO THE PUBLIC
The DOD peer-reviewed Breast Cancer Research Program not only
provides a funding mechanism for high-risk, high-return research, but
also reports the results of this research to the American people every
2 to 3 years at a public meeting called the Era of Hope. The 1997
meeting was the first time a federally-funded program reported back to
the public in detail not only on the funds used, but also on the
research undertaken, the knowledge gained from that research and future
directions to be pursued.
Sixteen hundred and consumers and researchers met for the fifth Era
of Hope meeting in June, 2008. As MSNBC.com's Bob Bazell wrote, this
meeting ``brought together many of the most committed breast cancer
activists with some of the Nation's top cancer scientists. The
conference's directive is to push researchers to think `out of the box'
for potential treatments, methods of detection and prevention in
ways.'' He went on to say ``the program . . . has racked up some
impressive accomplishments in high-risk research projects . . .''
One of the topics reported on at the meeting was the development of
more effective breast imaging methods. An example of the important work
that is coming out of the DOD BCRP includes a new screening method
called molecular breast imaging, which helps detect breast cancer in
women with dense breasts--which can be difficult using a mammogram
alone. I invite you to log on to NBCC's new website http://
influence.stopbreastcancer.org/ to learn more about the exciting
research reported at the 2008 Era of Hope.
The DOD peer-reviewed Breast Cancer Research Program has attracted
scientists across a broad spectrum of disciplines, launched new
mechanisms for research and facilitated new thinking in breast cancer
research and research in general. A report on all research that has
been funded through the DOD BCRP is available to the public.
Individuals can go to the Department of Defense website and look at the
abstracts for each proposal at http://cdmrp.army.mil/bcrp/.
COMMITMENT OF THE NATIONAL BREAST CANCER COALITION
The National Breast Cancer Coalition is strongly committed to the
DOD BCRP in every aspect, as we truly believe it is one of our best
chances for finding cures for and ways to prevent breast cancer. The
Coalition and its members are dedicated to working with you to ensure
the continuation of funding for this Program at a level that allows
this research to forge ahead. From 1992, with the launch of our ``300
Million More Campaign'' that formed the basis of this Program, until
now, NBCC advocates have appreciated your support.
Over the years, our members have shown their continuing support for
this Program through petition campaigns, collecting more than 2.6
million signatures, and through their advocacy on an almost daily basis
around the country asking for support of the DOD BCRP.
There are 3 million women living with breast cancer in this country
today. This year, more than 40,000 will die of the disease and more
than 240,000 will be diagnosed. We still do not know how to prevent
breast cancer, how to diagnose it truly early or how to cure it. It is
an incredibly complex disease. We simply cannot afford to walk away
from this program.
Since the very beginning of this Program in 1992, Congress has
stood with us in support of this important investment in the fight
against breast cancer. In the years since, Chairman Inouye and Ranking
Member Cochran, you and this entire Committee have been leaders in the
effort to continue this innovative investment in breast cancer
research.
NBCC asks you, the Defense Appropriations Subcommittee, to
recognize the importance of what has been initiated by the
Appropriations Committee. You have set in motion an innovative and
highly efficient approach to fighting the breast cancer epidemic. We
ask you now to continue your leadership and fund the Program at $150
million and maintain its integrity. This is research that will help us
win this very real and devastating war against a cruel enemy.
Thank you again for the opportunity to submit testimony and for
giving hope to all women and their families, and especially to the 3
million women in the United States living with breast cancer.
Chairman Inouye. And now may I call upon Mr. Wicks,
representing the American Association of Nurse Anesthetists.
STATEMENT OF TERRY WICKS, PAST PRESIDENT, ON BEHALF OF
THE AMERICAN ASSOCIATION OF NURSE
ANESTHETISTS (AANA)
Mr. Wicks. Chairman Inouye, Senator Cochran, and members of
the subcommittee, good morning.
My name is Terry Wicks, and I am a past president of the
40,000-member American Association of Nurse Anesthetists. The
quality of healthcare America provides our servicemen and women
and their dependents has long been this subcommittee's high
priority. Today, I report to you the contributions that
certified registered nurse anesthetists, or CRNAs, make toward
our services' mission. I will also provide you our
recommendations to further improve military healthcare for
these challenging times.
I also ask that--unanimous consent that my written
statement be entered into the record.
Chairman Inouye. So ordered.
Mr. Wicks. America's CRNAs provide some 30 million
anesthetics annually, in every healthcare setting requiring
anesthesia care. And we provide that care safely. The Institute
of Medicine reported, in 2000, that anesthesia care is 50 times
safer than it was in the early 1980s.
For the United States Armed Forces, CRNAs are particularly
critical. In 2005, 493 active duty and 790 reservist nurse
anesthetists provided anesthesia care indispensable to our
Armed Forces' current mission. Not long ago one CRNA, Major
General Gail Pollock, served as Acting Surgeon General of the
Army.
Today, CRNAs serve in major military hospitals, in
educational institutions, aboard ships, and in isolated bases
abroad and at home, and as members of forward surgical teams,
and they are as close to the tip of the spear as they can be.
In most of these environments, CRNAs provide anesthesia
services, alone, with anesthesiologists, enabling surgeons and
other clinicians to safely deliver lifesaving care to our
soldiers.
In recent years, however, the number of CRNAs needed in the
Armed Forces has fallen below--the number of CRNAs in the
services has fallen below the number needed. The private market
for nurse anesthetists is extremely strong, and the military
has struggled to compete. The services, this subcommittee, and
the authorizing committees have responded with increased
benefits to CRNAs, incentive specialty pay, and the health
professions loan repayment program, focusing on incentives for
multiyear agreements.
The profession of nurse anesthesia has likewise responded.
Our Council on Certification of Nurse Anesthetists reports
that, in 2008, our schools produced 2,161 graduates, double the
number since the year 2000, and 2,100 nurse anesthetists were
certified. That growth is expected to continue, and the Council
on Accreditation of Nurse Anesthesia Educational Programs
projects that nurse anesthesia programs will produce over 2,400
graduates in 2009.
These combined actions have helped strengthen the services'
readiness and the quality of healthcare available to our
servicemen and women.
So, our first recommendation to you is to extend and
strengthen this successful incentive service pay program for
CRNAs. The authorizing committee has extended the ISP program,
and we encourage this subcommittee to continue funding ISP
levels sufficient for the services to recruit and retain CRNAs
needed for the mission.
Our second recommendation is for the subcommittee to
encourage all the services to adopt the joint scope of
practice. Standard practice across the services enhances
patient safety and the quality of healthcare of our servicemen
and women. The Navy, in particular, has made a great deal of
progress toward adopting the joint scope of practice of
independent practitioners. We encourage its adoption in all the
services.
Like our military CRNAs that serve each and every day, the
American Association of Nurse Anesthetists stands ready to work
with Congress to ensure that all our Nation's military men and
women get the care they need and deserve.
Thank you, and I'll be happy to answer any question that
you may have.
Chairman Inouye. All right. Thank you very much, Mr. Wicks.
[The statement follows:]
Prepared Statement of Jackie S. Rowles, CRNA, MBA, MA, FAAPM,
President, American Association of Nurse Anesthetists (AANA)
Chairman Inouye, Ranking Member Cochran, and Members of the
Subcommittee: The American Association of Nurse Anesthetists (AANA) is
the professional association that represents over 40,000 Certified
Registered Nurse Anesthetists (CRNAs) across the United States,
including more than 500 active duty and over 750 reservists in the
military reported in 2009. The AANA appreciates the opportunity to
provide testimony regarding CRNAs in the military. We would also like
to thank this committee for the help it has given us in assisting the
Department of Defense (DOD) and each of the services to recruit and
retain CRNAs.
CRNAS AND THE ARMED FORCES: A TRADITION OF SERVICE
Let us begin by describing the profession of nurse anesthesia, and
its history and role with the Armed Forces of the United States.
In the administration of anesthesia, CRNAs perform the same
functions as anesthesiologists and work in every setting in which
anesthesia is delivered including hospital surgical suites and
obstetrical delivery rooms, ambulatory surgical centers, health
maintenance organizations, and the offices of dentists, podiatrists,
ophthalmologists, and plastic surgeons. Today, CRNAs administer some 30
million anesthetics given to patients each year in the United States.
Nurse anesthetists are also the sole anesthesia providers in the vast
majority of rural hospitals, assuring access to surgical, obstetrical
and other healthcare services for millions of rural Americans.
Our tradition of service to the military and our Veterans is
buttressed by our personal, professional commitment to patient safety,
made evident through research into our practice. In our professional
association, we state emphatically ``our members' only business is
patient safety.'' Safety is assured through education, high standards
of professional practice, and commitment to continuing education.
Having first practiced as registered nurses, CRNAs are educated to the
master's degree level, and some to the doctoral level, and meet the
most stringent continuing education and recertification standards in
the field. Thanks to this tradition of advanced education and clinical
practice excellence, we are humbled and honored to note that anesthesia
is 50 times safer now than in the early 1980s (National Academy of
Sciences, 2000). Research further demonstrates that the care delivered
by CRNAs, physician anesthesiologists, or by both working together
yields similar patient safety outcomes. In addition to studies
performed by the National Academy of Sciences in 1977, Forrest in 1980,
Bechtoldt in 1981, the Minnesota Department of Health in 1994, and
others, Dr. Michael Pine, MD, MBA, recently concluded once again that
among CRNAs and physician anesthesiologists, ``the type of anesthesia
provider does not affect inpatient surgical mortality'' (Pine, 2003).
Thus, the practice of anesthesia is a recognized specialty in nursing
and medicine. Most recently, a study published in Nursing Research
confirmed obstetrical anesthesia services are extremely safe, and that
there is no difference in safety between hospitals that use only CRNAs
compared with those that use only anesthesiologists (Simonson et al,
2007). Both CRNAs and anesthesiologists administer anesthesia for all
types of surgical procedures from the simplest to the most complex,
either as single providers or together.
NURSE ANESTHETISTS IN THE MILITARY
Since the mid-19th century, our profession of nurse anesthesia has
been proud and honored to provide anesthesia care for our past and
present military personnel and their families. From the Civil War to
the present day, nurse anesthetists have been the principal anesthesia
providers in combat areas of every war in which the United States has
been engaged.
Military nurse anesthetists have been honored and decorated by the
U.S. and foreign governments for outstanding achievements, resulting
from their dedication and commitment to duty and competence in managing
seriously wounded casualties. In World War II, there were 17 nurse
anesthetists to every one anesthesiologist. In Vietnam, the ratio of
CRNAs to physician anesthetists was approximately 3:1. Two nurse
anesthetists were killed in Vietnam and their names have been engraved
on the Vietnam Memorial Wall. During the Panama strike, only CRNAs were
sent with the fighting forces. Nurse anesthetists served with honor
during Desert Shield and Desert Storm.
Military CRNAs also provide critical anesthesia support to
humanitarian missions around the globe in such places as Bosnia and
Somalia. In May 2003, approximately 364 nurse anesthetists had been
deployed to the Middle East for the military mission for ``Operation
Iraqi Freedom'' and ``Operation Enduring Freedom.'' When President
George W. Bush initiated ``Operation Enduring Freedom,'' CRNAs were
immediately deployed. With the new special operations environment new
training was needed to prepare our CRNAs to ensure military medical
mobilization and readiness. Brigadier General Barbara C. Brannon,
Assistant Surgeon General, Air Force Nursing Services, testified before
this Senate Committee on May 8, 2002, to provide an account of CRNAs on
the job overseas. She stated, ``Lt. Col Beisser, a certified registered
nurse anesthetist (CRNA) leading a Mobile Forward Surgical Team (MFST),
recently commended the seamless interoperability he witnessed during
treatment of trauma victims in Special Forces mass casualty incident.''
Data gathered from the U.S. Armed Forces anesthesia communities
reveal that CRNAs have often been the sole anesthesia providers at
certain facilities, both at home and while forward deployed. For
decades CRNAs have staffed ships, isolated U.S. Bases, and forward
surgical teams without physician anesthesia support. The U.S. Army
Joint Special Operations Command Medical Team and all Army Forward
Surgical Teams are staffed solely by CRNAs. Military CRNAs have a long
proud history of providing independent support and quality anesthesia
care to military men and women, their families and to people from many
nations who have found themselves in harm's way.
In the current mission, CRNAs are deployed all over the world, on
land and at sea. This committee must ensure that we retain and recruit
CRNAs for now and in the future to serve in these military deployments
overseas. This committee must ensure that we retain and recruit CRNAs
now and in the future to serve in these military overseas deployments
and humanitarian efforts, and to ensure the maximum readiness of
America's armed services.
NURSE ANESTHESIA PROVIDER SUPPLY AND DEMAND: SOLUTIONS FOR RECRUITMENT
AND RETENTION
In all of the Services, maintaining adequate numbers of active duty
CRNAs is of utmost concern. For several years, the number of CRNAs
serving in active duty fell short of the number authorized by the
Department of Defense (DOD). This is further complicated by strong
demand for CRNAs in both the public and private sectors.
It is essential to understand that while there is strong demand for
CRNA services in the public and private healthcare sectors, the
profession of nurse anesthesia is working effectively to meet this
workforce challenge. The AANA anticipates growing demand for CRNAs. Our
evidence suggests that while vacancies exist, the demand for anesthesia
professionals can be met if appropriate actions are taken. As of
January 2009, there are 108 accredited CRNA schools to support the
profession of nurse anesthesia. The number of qualified registered
nurses applying to CRNA schools continues to climb. The growth in the
number of schools, the number of applicants, and in production
capacity, has yielded significant growth in the number of nurse
anesthetists graduating and being certified into the profession, while
absolutely maintaining and strengthening the quality and competence of
these clinicians. The Council on Certification of Nurse Anesthetists
reports that in 2008, our schools produced 2,161 graduates, double the
number since 2000, and 2,110 nurse anesthetists were certified. The
growth is expected to continue. The Council on Accreditation of Nurse
Anesthesia Educational Programs (COA) projects that CRNA schools will
produce over 2,417 graduates in 2009.
This Committee can greatly assist in the effort to attract and
maintain essential numbers of nurse anesthetists in the military by
their support to increase special pays.
INCENTIVE SPECIAL PAY FOR NURSES
According to a March 1994 study requested by the Health Policy
Directorate of Health Affairs and conducted by DOD, a large pay gap
existed between annual civilian and military pay in 1992. This study
concluded, ``this earnings gap is a major reason why the military has
difficulty retaining CRNAs.'' In order to address this pay gap, in the
fiscal year 1995 Defense Authorization bill Congress authorized the
implementation of an increase in the annual Incentive Special Pay (ISP)
for nurse anesthetists from $6,000 to $15,000 for those CRNAs no longer
under service obligation to pay back their anesthesia education. Those
CRNAs who remained obligated receive the $6,000 ISP.
Both the House and Senate passed the fiscal year 2003 Defense
Authorization Act Conference report, H. Rept. 107-772, which included
an ISP increase to $50,000. The report included an increase in ISP for
nurse anesthetists from $15,000 to $50,000. The AANA is requesting that
this committee fund the ISP at $50,000 for all the branches of the
armed services to retain and recruit CRNAs now and into the future. Per
the testimony provided in 2006 from the three services' Nurse Corps
leaders, the AANA is aware that there is an active effort with the
Surgeons General to closely evaluate and adjust ISP rates and policies
needed to support the recruitment and retention of CRNAs. In 2006,
Major General Gale Pollock, MBA, MHA, MS, CRNA, FACHE, Deputy Surgeon
General, Army Nurse Corps of the U.S. Army stated in testimony before
this Subcommittee, ``I am particularly concerned about the retention of
our certified registered nurse anesthetists (CRNAs). Our inventory of
CRNAs is currently at 73 percent. The restructuring of the incentive
special pay program for CRNAs last year, as well as the 180 (day)-
deployment rotation policy were good first steps in stemming the loss
of these highly trained providers. We are working closely with the
Surgeon General's staff to closely evaluate and adjust rates and
policies where needed.''
There have been positive results from the Nurse Corps and Surgeons
General initiatives to increase incentive special pays for CRNAs. In
testimony before the House Armed Services Committee in 2007, Gen.
Pollock stated, ``We have . . . increased the Incentive Special Pay
(ISP) Certified Registered Nurse Anesthetist, and expanded use of the
Health Professions Loan Repayment Program (HPLRP). The . . . Nurse
Anesthetist bonuses have been very successful in retaining these
providers who are critically important to our mission on the
battlefield.'' She also stated in that same statement, ``In 2004, we
increased the multi-year bonuses we offer to Certified Registered Nurse
Anesthetists with emphasis on incentives for multi-year agreements. A
year's worth of experience indicates that this increased bonus, 180-day
deployments, and a revamped Professional Filler system to improve
deployment equity is helping to retain CRNAs.''
There still continues to be high demand for CRNAs in the healthcare
community leading to higher incomes widening the gap in pay for CRNAs
in the civilian sector compared to the military. However, the ISP and
other incentives the services are providing CRNAs has helped close that
gap the past 3 years, according to the most recent AANA membership
survey data. In civilian practice, all additional skills, experience,
duties and responsibilities, and hours of work are compensated for
monetarily. Additionally, training (tuition and continuing education),
healthcare, retirement, recruitment and retention bonuses, and other
benefits often equal or exceed those offered in the military.
Therefore, it is vitally important that the Incentive Special Pay (ISP)
be supported to ensure retention of CRNAs in the military.
AANA thanks this Committee for its support of the annual ISP for
nurse anesthetists. AANA strongly recommends the continuation in the
annual funding for ISP at $50,000 or more for fiscal year 2010, which
recognizes the special skills and advanced education that CRNAs bring
to the DOD healthcare system, and supports the mission of our U.S.
Armed Forces.
BOARD CERTIFICATION PAY FOR NURSES
Included in the fiscal year 1996 Defense Authorization bill was
language authorizing the implementation of a board certification pay
for certain clinicians who are not physicians, including advanced
practice nurses.
AANA is highly supportive of board certification pay for all
advanced practice nurses. The establishment of this type of pay for
nurses recognizes that there are levels of excellence in the profession
of nursing that should be recognized, just as in the medical
profession. In addition, this pay may assist in closing the earnings
gap, which may help with retention of CRNAs.
While many CRNAs have received board certification pay, some remain
ineligible. Since certification to practice as a CRNA does not require
a specific master's degree, many nurse anesthetists have chosen to
diversify their education by pursuing an advanced degree in other
related fields. But CRNAs with master's degrees in education,
administration, or management are not eligible for board certification
pay since their graduate degree is not in a clinical specialty. Many
CRNAs who have non-clinical master's degrees either chose or were
guided by their respective services to pursue a degree other than in a
clinical specialty. The AANA encourages DOD and the respective services
to reexamine the issue of restricting board certification pay only to
CRNAs who have specific clinical master's degrees.
DOD/VA RESOURCE SHARING: U.S. ARMY-VA JOINT PROGRAM IN NURSE
ANESTHESIA, FORT SAM HOUSTON, SAN ANTONIO, TX
The establishment of the joint U.S. Army-VA program in nurse
anesthesia education at the U.S. Army Graduate Program in Anesthesia
Nursing, Fort Sam Houston, in San Antonio, TX holds the promise of
making significant improvements in the VA CRNA workforce, as well as
improving retention of DOD registered nurses in a cost effective
manner. The current program utilizes existing resources from both the
Department of Veterans Affairs Employee Incentive Scholarship Program
(EISP) and VA hospitals to fund tuition, books, and salary
reimbursement for student registered nurse anesthetists (SRNAs). This
joint program also serves the interests of the Army.
This VA nurse anesthesia program started in June 2004 with three
openings for VA registered nurses to apply to and earn a Master of
Science in Nursing (MSN) in anesthesia granted through the University
of Texas Houston Health Science Center. In the future, the program is
granting degrees through the Northeastern University Bouve College of
Health Sciences nurse anesthesia educational program in Boston, Mass.
At a time of increased deployments in medical military personnel, this
type of VA-DOD partnership is a cost-effective model to fill these gaps
in the military healthcare system. At Fort Sam Houston, the VA faculty
director has covered her Army colleagues' didactic classes when they
are deployed at a moments notice. This benefits both the VA and the DOD
to ensure the nurse anesthesia students are trained and certified in a
timely manner to meet their workforce obligation to the Federal
Government as anesthesia providers. We are pleased to note that the
Department of Veterans' Affairs Acting Deputy Under Secretary for
Health and the U.S. Army Surgeon General approved funding to start this
VA nurse anesthesia school in 2004. In addition, the VA director has
been pleased to work under the direction of the Army program director
LTC Thomas Ceremuga, CRNA, PhD to further the continued success of this
U.S. Army-VA partnership. With modest levels of additional funding in
the VA EISP, this joint U.S. Army-VA nurse anesthesia education
initiative can grow and thrive, and serve as a model for meeting other
VA workforce needs, particularly in nursing.
CONCLUSION
In conclusion, the AANA believes that the recruitment and retention
of CRNAs in the armed services is of critical concern. By Congress
supporting these efforts to recruit and retain CRNAS, the military is
able to meet the mission to provide benefit care and deployment care--a
mission that is unique to the military.
The AANA would also like to thank the Surgeons General and Nurse
Corp leadership for their support in meeting the needs of the
profession within the military workforce. Last, we commend and thank
this committee for their continued support for CRNAs in the military.
Chairman Inouye. Our next witness is the legislative
director of the National Association for Uniformed Services,
Mr. Rick Jones.
STATEMENT OF RICHARD A. ``RICK'' JONES, LEGISLATIVE
DIRECTOR, NATIONAL ASSOCIATION FOR
UNIFORMED SERVICES
Mr. Jones. Chairman Inouye, Ranking Member Cochran, it's a
privilege to be invited before your subcommittee.
My association is very proud of the job our young
generation is doing overseas. They risk their lives every day,
and what we do for them is vital for the debt we owe them and
the vital job they do for security.
Mr. Chairman, quality healthcare is a strong incentive for
a military career. My association asks that you ensure full
funding is provided to maintain the value of the healthcare
benefit that has been earned by these men and women who have
served a career in our military.
Mr. Chairman, the war on terror is fought by an
overstretched force. There are signs of wear; simply too many
missions and too few troops. We must increase troop strength;
it must be resourced. We ask that you give priority to funding
operation and maintenance accounts to reset, recapitalize, and
renew the force.
My association asks, also, that you maintain the Walter
Reed facility. Its operations support and medical services
require an uninterrupted care for those who are
catastrophically wounded. We request that funds be in place to
ensure that Walter Reed remain open, fully operational, fully
functional, until the planned facilities at Bethesda and Fort
Belvoir are in place and ready to give appropriate care to
these young servicemen and women.
Our wounded warriors deserve the Nation's best quality
treatment. They earned it the hard way. With proper resources,
we know our Nation will continue to hold the well-being of
these troops in hand.
Traumatic brain injury is the signature injury of the war
overseas. We request that the subcommittee fund a full spectrum
of traumatic brain injury care. The approach to this problem
requires resources for hiring doctors, nurses, clinicians,
general caregivers. And we must meet the needs of these men and
women and their families. They have given so much for our
Nation.
We encourage the subcommittee to ensure funding for the
Defense Department prosthetic research, to make sure that that
is adequately funded. We support the Uniformed Service
University Healthcare. That Federal school has the--provides
medical instruction to all active duty troops who provide for
wartime casualties, for national disasters, for emerging
diseases. And we support the Armed Forces Retirement Home in
Washington, DC, and in Gulfport, Mississippi.
Mr. Chairman, regarding the supplemental, NAUS received a
message from one of our members who wanted us to assure that we
support a strong, timely action on the emergency supplemental.
The bill will assure that, as our sons and daughters go into
harm's way under the flag of the United States, they will have
the vital wherewithal to carry out their mission. He's
concerned, however, that when he sees not one dime, one penny,
nor a shadow of concern is given to our military survivors, yet
$1 billion will be spent on a program to replace older cars--
cash for clunkers--he says he's concerned about our survivors.
Thank you very much for the opportunity to testify.
Chairman Inouye. Thank you very much, Director Jones.
[The statement follows:]
Prepared Statement of Rick Jones
Chairman Inouye, Ranking Member Cochran, and members of the
Subcommittee, it is a pleasure to appear before you today to present
the views of the National Association for Uniformed Services on the
fiscal year 2010 Defense Appropriations Bill.
My name is Richard ``Rick'' Jones, Legislative Director of the
National Association for Uniformed Services (NAUS). And for the record,
NAUS has not received any Federal grant or contract during the current
fiscal year or during the previous 2 years in relation to any of the
subjects discussed today.
As you know, the National Association for Uniformed Services,
founded in 1968, represents all ranks, branches and components of
uniformed services personnel, their spouses and survivors. The
Association includes all personnel of the active, retired, Reserve and
National Guard, disabled veterans, veterans community and their
families. We love our country, believe in a strong national defense,
support our troops, and honor their service.
Mr. Chairman, the first and most important responsibility of our
government is the protection of our citizens. As we all know, we are at
war. That is why the defense appropriations bill is so very important.
It is critical that we provide the resources to those who fight for our
protection and our way of life. We need to give our courageous men and
women everything they need to prevail. And we must recognize as well
that we must provide priority funding to keep the promises made to the
generations of warriors whose sacrifice has paid for today's freedom.
At the start, I want to express NAUS concern about the amount of
our investment in our national defense. At the height of the War on
Terror, our current defense budget represents only a little more than 4
percent of the gross national product, as opposed to the average of 5.7
percent of GNP in the peacetime years between 1940 and 2000.
We cannot look the other way in a time when we face such serious
threats. Resources are required to ensure our military is fully
staffed, trained, and equipped to achieve victory against our enemies.
Leaders in Congress and the administration need to balance our
priorities and ensure our defense in a dangerous world.
Here, I would like to make special mention of the leadership and
contribution this panel has made in providing the resources and support
our forces need to complete their mission. Defending the United States
homeland and the cause of freedom means that the dangers we face must
be confronted. And it means that the brave men and women who put on the
uniform must have the very best training, best weapons, best care and
wherewithal we can give them.
The members of this important panel have taken every step to give
our fighting men and women the funds they need, despite allocations we
view as insufficient for our total defense needs. You have made
difficult priority decisions that have helped defend America and taken
special care of one of our greatest assets, namely our men and women in
uniform.
And the National Association for Uniformed Services is very proud
of the job this generation of Americans is doing to defend America.
Every day they risk their lives, half a world away from loved ones.
Their daily sacrifice is done in today's voluntary force. What they do
is vital to our security. And the debt we owe them is enormous.
Our Association does, however, have some concerns about a number of
matters. Among the major issues that we will address today is the
provision of a proper health care for the military community and
recognition of the funding requirements for TRICARE for retired
military. Also, we will ask for adequate funding to improve the pay for
members of our armed forces and to address a number of other challenges
including TRICARE Reserve Select and the Survivor Benefit Plan.
We also have a number of related priority concerns such as the
diagnosis and care of troops returning with Post Traumatic Stress
Disorder (PTSD) and Traumatic Brain Injury (TBI), the need for enhanced
priority in the area of prosthetics research, and providing improved
seamless transition for returning troops between the Department of
Defense (DOD) and the Department of Veterans Affairs (VA). In addition,
we would like to ensure that adequate funds are provided to defeat
injuries from the enemy's use of Improvised Explosive Devices (IEDs).
TRICARE AND MILITARY QUALITY OF LIFE: HEALTH CARE
Quality health care is a strong incentive to make military service
a career. The provision of quality, timely care is considered one of
the most important benefits afforded the career military. The TRICARE
benefit, earned through a career of service in the uniformed services,
reflects the commitment of a Nation, and it deserves your wholehearted
support.
It should also be recognized that discussions have once again begun
on increasing the retiree-paid costs of TRICARE earned by military
retirees and their families. We remember the outrageous statement of
Dr. Gail Wilensky, a co-chair of the Task Force on the Future of
Military, calling congressional passage of TRICARE for Life ``a big
mistake.''
And more recently, we heard Admiral Mike Mullen, the current
Chairman of Joint Chiefs of Staff, call for an increase in TRICARE
fees. Mullen said, ``It's a given as far as I'm concerned.''
Fortunately, President Obama has taken fee increases off the table
this year in the administration budget recommendation. However, with
comments like these from those in leadership positions, there is little
wonder that retirees and active duty personnel are upset.
Seldom has NAUS seen such a lowing in confidence about the
direction of those who manage the program. Faith in our leadership
continues, but it is a weakening faith. And unless something changes,
it is bound to affect recruiting and retention.
criminal activity costs medicare and tricare billions of dollars
Recent testimony and studies from the Government Accountability
Office (GAO), the investigative arm of the United States Congress,
shows us that at least $80 billion worth of Medicare money is being
ripped off every year. Frankly, it demonstrates that criminal activity
costs Medicare and TRICARE billions of dollars.
Here are a couple of examples. GAO reports that one company billed
Medicare for $170 million for HIV drugs. In truth, the company
dispensed less than a million dollars. In addition, the company billed
$142 million for nonexistent delivery of supplies and parts and medical
equipment.
In another example, fake Medicare providers billed Medicare for
prosthetic arms on people who already have two arms. The fraud amounted
to $1.4 billion of bills for people who do not need prosthetics.
TRICARE is closely tied to Medicare and its operations are not
immune. According to Rose Sabo, Director of the TRICARE Program
Integrity Office, the Government Accountability Office says that 10
percent of all health care expenditures are fraudulent. With a military
health system annual cost of $47 billion, fraudulent purchase of care
in the military health system would amount to $4.7 billion.
Last year a Philippine corporation was ordered to pay back more
than $100 million following a TRICARE fraud conviction. But despite
TRICARE efforts to uncover this type of criminal activity, money
continues to go out the door with insufficient resources dedicated to
its recovery.
Regarding TRICARE efforts to uncover fraud problems, it should be
noted that documents by the Department of Defense Inspector General
(DODIG) reported the fraud as early as 1998 to TRICARE Management
Activity (TMA). But it wasn't until 2005 that TMA stopped paying the
fraudulent claims reported 7 years earlier by DODIG.
NAUS urges the Subcommittee to challenge DOD and TRICARE
authorities to put some guts behind efforts to drive fraud down and out
of the system. If left unchecked, fraud will increasingly strip away
resources from government programs like TRICARE. And unless Congress
directs the administration to take action, you know who will be left in
the breach, holding the bag--the law abiding retiree and family.
We recently learned of an incident of clear outright healthcare
fraud involving a Medicare/TRICARE provider. The patient was a member
of a veterans-related survivor organization and a TRICARE for Life
beneficiary. She went to visit a doctor for the first time but was not
content with the provider so she did not see him again. But bills
against TRICARE continued to roll in for visits and services that were
never provided. The beneficiary reported this suspicious activity to
the TRICARE Management Activity. TRICARE officials were reticent to
talk to the individual when she called them again to report additional
fraudulent bills. When the individual's survivor organization became
involved, it was told by TRICARE not to worry about the billings
because the bogus charges only added up to about $2,500, which fell
below the level of investigative action. The TMA rational is
troublesome on many levels. It is, of course, quite possible that the
same doctor charged TRICARE for the ``care'' of other patients.
A fair portion of the cost of controlling Medicare and TRICARE
fraud can be directly attributed to the detection of it. In this
instance, a beneficiary attempted to perform her civic duty by
``sounding the alarm'' only to be ignored by the agency that claims to
be committed to preventing, identifying, and assisting in the
prosecution of healthcare fraud, not only to save valuable benefit
dollars but also to ensure that eligible beneficiaries receive
appropriate medical care. Deceitful schemes can adversely impact the
quality of the care received. NAUS believes that criminal activity
should be identified and prosecuted to the fullest extent of the law,
whether it is for $2,500 or $250,000.
America expects its government to move courageously and tackle the
real problems of issues like fraud in the TRICARE system and the
Medicare system. The government should direct and resource its
investigative teams to root out criminal activity, rather than looking
to take money out of the pockets of military retirees. With hard work
and honest public service, we are confident Congress will have more
than enough money to pay for earned benefits like TRICARE.
The National Association for Uniformed Services urges increased
funding for the Defense Criminal Investigative Service (DCIS), the
criminal investigative arm of the DOD Inspector General, and for the
TRICARE Program Integrity Office, responsible for anti-fraud activity
in the military health system.
We urge the Subcommittee to take the actions necessary for honoring
our obligation to those men and women who have worn the Nation's
military uniform. Root out the corruption, fraud and waste. And confirm
America's solemn, moral obligation to support our troops, our military
retirees, and their families. They have kept their promise to our
Nation, now it's time for us to keep our promise to them.
MILITARY QUALITY OF LIFE: PAY
For fiscal year 2010, the administration recommends a 2.9 percent
across-the-board pay increase for members of the Armed Forces. The
proposal is designed, according to the Pentagon, to keep military pay
in line with civilian wage growth.
The National Association for Uniformed Services calls on you to put
our troops and their families first. Our forces are stretched thin, at
war, yet getting the job done. We ask you to express the Nation's
gratitude for their critical service, increase basic pay and drill pay
one-half percent above the administration's request to 3.4 percent.
Congress and the administration have done a good job over the
recent past to narrow the gap between civilian-sector and military pay.
The differential, which was as great as 14 percent in the late 1990s,
has been reduced to just under 4 percent with the January 2009 pay
increase.
However, we can do better than simply maintaining a rough measure
of comparability with the civilian wage scale. To help retention of
experience and entice recruitment, the pay differential is important.
We have made significant strides. But we are still below the private
sector.
In addition, we urge the appropriations panel to never lose sight
of the fact that our DOD manpower policy needs a compensation package
that is reasonable and competitive. Bonuses have a role in this area.
Bonuses for instance can pull people into special jobs that help supply
our manpower for critical assets, and they can also entice ``old
hands'' to come back into the game with their skills.
The National Association for Uniformed Services asks you to do all
you can to fully compensate these brave men and women for being in
harm's way, we should clearly recognize the risks they face and make
every effort to appropriately compensate them for the job they do.
military quality of life: basic allowance for housing
The National Association for Uniformed Services strongly supports
revised housing standards within the Basic Allowance for Housing (BAH).
We are most grateful for the congressional actions reducing out-of-
pocket housing expenses for servicemembers over the last several years.
Despite the many advances made, many enlisted personnel continue to
face steep challenge in providing themselves and their families with
affordable off-base housing and utility expenses. BAH provisions must
ensure that rates keep pace with housing costs in communities where
military members serve and reside. Efforts to better align actual
housing rates can reduce unnecessary stress and help those who serve
better focus on the job at hand, rather than the struggle with meeting
housing costs for their families.
MILITARY QUALITY OF LIFE: FAMILY HOUSING ACCOUNTS
The National Association for Uniformed Services urges the
Subcommittee to provide adequate funding for military construction and
family housing accounts used by DOD to provide our service members and
their families quality housing. The funds for base allowance and
housing should ensure that those serving our country are able to afford
to live in quality housing whether on or off the base. The current
program to upgrade military housing by privatizing Defense housing
stock is working well. We encourage continued oversight in this area to
ensure joint military-developer activity continues to improve housing
options. Clearly, we need to be particularly alert to this challenge as
we implement BRAC and related rebasing changes.
The National Association for Uniformed Services also asks special
provision be granted the National Guard and Reserve for planning and
design in the upgrade of facilities. Since the terrorist attacks of
Sept. 11, 2001, our Guardsmen and reservists have witnessed an upward
spiral in the rate of deployment and mobilization. The mission has
clearly changed, and we must recognize they account for an increasing
role in our national defense and homeland security responsibilities.
The challenge to help them keep pace is an obligation we owe for their
vital service.
INCREASE FORCE READINESS FUNDS
The readiness of our forces is in decline. The long war fought by
an overstretched force tells us one thing: there are simply too many
missions and too few troops. Extended and repeated deployments are
taking a human toll. Back-to-back deployments means, in practical
terms, that our troops face unrealistic demands. To sustain the service
we must recognize that an increase in troop strength is needed and it
must be resourced.
In addition, we ask you to give priority to funding for the
operations and maintenance accounts where money is secured to reset,
recapitalize and renew the force. The National Guard, for example, has
virtually depleted its equipment inventory, causing rising concern
about its capacity to respond to disasters at home or to train for its
missions abroad.
The deficiencies in the equipment available for the National Guard
to respond to such disasters include sufficient levels of trucks,
tractors, communication, and miscellaneous equipment. If we have
another overwhelming storm, hurricane or, God forbid, a large-scale
terrorist attack, our National Guard is not going to have the basic
level of resources to do the job right.
WALTER REED ARMY MEDICAL CENTER
Another matter of great interest to our members is the plan to
realign and consolidate military health facilities in the National
Capital Region. The proposed plan includes the realignment of all
highly specialized and sophisticated medical services currently located
at Walter Reed Army Medical Center in Washington, DC, to the National
Naval Medical Center in Bethesda, MD, and the closing of the existing
Walter Reed by 2011.
While we herald the renewed review of the adequacy of our hospital
facilities and the care and treatment of our wounded warriors that
result from last year's news reports of deteriorating conditions at
Walter Reed Army Medical Center, the National Association for Uniformed
Services believes that Congress must continue to provide adequate
resources for WRAMC to maintain its base operations' support and
medical services that are required for uninterrupted care of our
catastrophically wounded soldiers and marines as they move through this
premier medical center.
We request that funds be in place to ensure that Walter Reed
remains open, fully operational and fully functional, until the planned
facilities at Bethesda or Fort Belvoir are in place and ready to give
appropriate care and treatment to the men and women wounded in armed
service.
Our wounded warriors deserve our Nation's best, most compassionate
healthcare and quality treatment system. They earned it the hard way.
And with application of the proper resources, we know the Nation will
continue to hold the well-being of soldiers and their families as our
number one priority.
department of defense, seamless transition between the dod and va
The development of electronic medical records remains a major goal.
It is our view that providing a seamless transition for recently
discharged military is especially important for servicemembers leaving
the military for medical reasons related to combat, particularly for
the most severely injured patients.
The National Association for Uniformed Services is pleased to
receive the support of President Obama and the forward movement of
Secretaries Gates and Shinseki toward this long-supported goal of
providing a comprehensive e-health record.
The National Association for Uniformed Services calls on the
appropriations committee to continue the push for DOD and VA to follow
through on establishing a bi-directional, interoperable electronic
medical record. Since 1982, these two departments have been working on
sharing critical medical records, yet to date neither has effectively
come together in coordination with the other.
The time for foot dragging is over. Taking care of soldiers,
sailors, airmen, and marines is a national obligation, and doing it
right sends a strong signal to those currently in military service as
well as to those thinking about joining the military.
DOD must be directed to adopt electronic architecture including
software, data standards, and data repositories that are compatible
with the system used at the Department of Veterans Affairs. It makes
absolute sense and it would lower costs for both organizations.
If our seriously wounded troops are to receive the care they
deserve, the departments must do what is necessary to establish a
system that allows seamless transition of medical records. It is
essential if our Nation is to ensure that all troops receive timely,
quality health care and other benefits earned in military service.
To improve the DOD/VA exchange, the hand-off should include a
detailed history of care provided and an assessment of what each
patient may require in the future, including mental health services. No
veteran leaving military service should fall through the bureaucratic
cracks.
DEFENSE DEPARTMENT FORCE PROTECTION
The National Association for Uniformed Services urges the
Subcommittee to provide adequate funding to rapidly deploy and acquire
the full range of force protection capabilities for deployed forces.
This would include resources for up-armored high mobility multipurpose
wheeled vehicles and add-on ballistic protection to provide force
protection for soldiers in Iraq and Afghanistan, ensure increased
activity for joint research and treatment effort to treat combat blast
injuries resulting from improvised explosive devices (IEDs), rocket
propelled grenades, and other attacks; and facilitate the early
deployment of new technology, equipment, and tactics to counter the
threat of IEDs.
We ask special consideration be given to counter IEDs, defined as
makeshift or ``homemade'' bombs, often used by enemy forces to destroy
military convoys and currently the leading cause of casualties to
troops deployed in Iraq. These devices are the weapon of choice and,
unfortunately, a very efficient weapon used by our enemy. The Joint
Improvised Explosive Device Defeat Organization (JIEDDO) is established
to coordinate efforts that would help eliminate the threat posed by
these IEDs. We urge efforts to advance investment in technology to
counteract radio-controlled devices used to detonate these killers.
Maintaining support is required to stay ahead of our enemy and to
decrease casualties caused by IEDs.
DEFENSE HEALTH PROGRAM--TRICARE RESERVE SELECT
Mr. Chairman, another area that requires attention is reservist
participation in TRICARE. As we are all aware, National Guard and
Reserve personnel have seen an upward spiral of mobilization and
deployment since the terrorist attacks of Sept. 11, 2001. The mission
has changed and with it our reliance on these forces has risen.
Congress has recognized these changes and begun to update and upgrade
protections and benefits for those called away from family, home, and
employment to active duty. We urge your commitment to these troops to
ensure that the long overdue changes made in the provision of their
heath care and related benefits is adequately resourced. We are one
force, all bearing a critical share of the load.
DEPARTMENT OF DEFENSE, PROSTHETIC RESEARCH
Clearly, care for our troops with limb loss is a matter of national
concern. The global war on terrorism in Iraq and Afghanistan has
produced wounded soldiers with multiple amputations and limb loss who
in previous conflicts would have died from their injuries. Improved
body armor and better advances in battlefield medicine reduce the
number of fatalities, however injured soldiers are coming back
oftentimes with severe, devastating physical losses.
In order to help meet the challenge, Defense Department research
must be adequately funded to continue its critical focus on treatment
of troops surviving this war with grievous injuries. The research
program also requires funding for continued development of advanced
prosthesis that will focus on the use of prosthetics with
microprocessors that will perform more like the natural limb.
The National Association for Uniformed Services encourages the
Subcommittee to ensure that funding for Defense Department's prosthetic
research is adequate to support the full range of programs needed to
meet current and future health challenges facing wounded veterans. To
meet the situation, the Subcommittee needs to focus a substantial,
dedicated funding stream on Defense Department research to address the
care needs of a growing number of casualties who require specialized
treatment and rehabilitation that result from their armed service.
We would also like to see better coordination between the
Department of Defense Advanced Research Projects Agency and the
Department of Veterans Affairs in the development of prosthetics that
are readily adaptable to aid amputees.
post traumatic stress disorder (ptsd) and traumatic brain injury (tbi)
The National Association for Uniformed Services supports a higher
priority on Defense Department care of troops demonstrating symptoms of
mental health disorders and traumatic brain injury.
It is said that Traumatic Brain Injury (TBI) is the signature
injury of the Iraq war. Blast injuries often cause permanent damage to
brain tissue. Veterans with severe TBI will require extensive
rehabilitation and medical and clinical support, including neurological
and psychiatric services with physical and psycho-social therapies.
We call on the Subcommittee to fund a full spectrum of TBI care and
to recognize that care is also needed for patients suffering from mild
to moderate brain injuries, as well. The approach to this problem
requires resources for hiring caseworkers, doctors, nurses, clinicians,
and general caregivers if we are to meet the needs of these men and
women and their families.
The mental condition known as Post Traumatic Stress Disorder (PTSD)
has been well known for over a hundred years under an assortment of
different names. For example more than 60 years ago, Army psychiatrists
reported, ``That each moment of combat imposes a strain so great that .
. . psychiatric casualties are as inevitable as gunshot and shrapnel
wounds in warfare.''
PTSD is a serious psychiatric disorder. While the government has
demonstrated over the past several years a higher level of attention to
those military personnel who exhibit PTSD symptoms, more should be done
to assist service members found to be at risk.
Pre-deployment and post-deployment medicine is very important. Our
legacy of the Gulf War demonstrates the concept that we need to
understand the health of our service members as a continuum, from pre-
to post-deployment.
The National Association for Uniformed Services applauds the extent
of help provided by the Defense Department, however we encourage that
more resources be made available to assist. Early recognition of the
symptoms and proactive programs are essential to help many of those who
must deal with the debilitating effects of mental injuries, as
inevitable in combat as gunshot and shrapnel wounds.
We encourage the Members of the Subcommittee to provide for these
funds and to closely monitor their expenditure and to see they are not
redirected to other areas of defense spending.
ARMED FORCES RETIREMENT HOME
The National Association for Uniformed Services encourages the
Subcommittee's continued interest in providing funds for the Armed
Forces Retirement Home (AFRH).
We urge the Subcommittee to continue its help in providing adequate
funding to alleviate the strains on the Washington home. Also, we
remain concerned about the future of the Gulfport home, so we urge your
continued close oversight on its re-construction. And we thank the
subcommittee for the construction of a new Armed Forces Retirement Home
at its present location in Gulfport.
The National Association for Uniformed Services also asks the
Subcommittee to closely review administration plans to sell great
portions of the Washington AFRH to developers. The AFRH home is a
historic national treasure, and we thank Congress for its oversight of
this gentle program and its work to provide for a world-class quality-
of-life support system for these deserving veterans.
improved medicine with less cost at military treatment facilities
The National Association for Uniformed Services is also seriously
concerned over the consistent push to have Military Health System
beneficiaries age of 65 and over moved into the civilian sector from
military care. That is a very serious problem for the Graduate Medical
Education (GME) programs in the MHS; the patients over 65 are required
for sound GME programs, which, in turn, ensure that the military can
retain the appropriate number of physicians who are board certified in
their specialties.
TRICARE/HA policies are pushing out those patients not on active
duty into the private sector where the cost per patient is at least
twice as expensive as that provided within Military Treatment
Facilities (MTFs). We understand that there are many retirees and their
families who must use the private sector due to the distance from the
closest MTF; however, where possible, it is best for the patients
themselves, GME, medical readiness, and the minimizing the cost of
TRICARE premiums if as many non-active duty beneficiaries are taken
care of within the MTFs. As more and more MHS beneficiaries are pushed
into the private sector, the cost of the MHS rises. The MHS can provide
better medicine, more appreciated service and do it at improved medical
readiness and less cost to the taxpayers.
UNIFORMED SERVICES UNIVERSITY OF THE HEALTH SCIENCES
As you know, the Uniformed Services University of the Health
Sciences (USUHS) is the Nation's Federal school of medicine and
graduate school of nursing. The medical students are all active-duty
uniformed officers in the Army, Navy, Air Force, and U.S. Public Health
Service who are being educated to deal with wartime casualties,
national disasters, emerging diseases, and other public health
emergencies.
The National Association for Uniformed Services supports the USUHS
and requests adequate funding be provided to ensure continued
accredited training, especially in the area of chemical, biological,
radiological, and nuclear response. In this regard, it is our
understanding that USUHS requires funding for training and educational
focus on biological threats and incidents for military, civilian,
uniformed first responders, and healthcare providers across the Nation.
JOINT POW/MIA ACCOUNTING COMMAND (JPAC)
We also want the fullest accounting of our missing servicemen and
ask for your support in DOD dedicated efforts to find and identify
remains. It is a duty we owe to the families of those still missing as
well as to those who served or who currently serve. And as President
Bush said, ``It is a signal that those who wear our country's military
uniform will never be abandoned.''
In recent years, funding for the Joint POW/MIA Accounting Command
(JPAC) has fallen short, forcing the agency to scale back and even
cancel many of its investigative and recovery operations. NAUS supports
the fullest possible accounting of our missing servicemen. It is a duty
we owe the families, to ensure that those who wear our country's
uniform are never abandoned. We request that appropriate funds be
provided to support the JPAC mission for fiscal year 2010.
APPRECIATION FOR THE OPPORTUNITY TO TESTIFY
As a staunch advocate for our uniformed service men and women, the
National Association for Uniformed Services recognizes that these brave
men and women did not fail us in their service to country, and we, in
turn, must not fail them in providing the benefits and services they
earned through honorable military service.
Mr. Chairman, the National Association for Uniformed Services
appreciates the Subcommittee's hard work. We ask that you continue to
work in good faith to put the dollars where they are most needed: in
strengthening our national defense, ensuring troop protection,
compensating those who serve, providing for DOD medical services
including TRICARE, and building adequate housing for military troops
and their families, and in the related defense matters discussed today.
These are some of our Nation's highest priority needs and we ask that
they be given the level of attention they deserve.
The National Association for Uniformed Services is confident you
will take special care of our Nation's greatest assets: the men and
women who serve and have served in uniform. We are proud of the service
they give to America every day. They are vital to our defense and
national security. The price we pay as a Nation for their earned
benefits is a continuing cost of war, and it will never cost more nor
equal the value of their service.
We thank you for your efforts, your hard work. And we look forward
to working with you to ensure we continue to provide sufficient
resources to protect the earned benefits for those giving military
service to America every day.
Again, the National Association for Uniformed Services deeply
appreciates the opportunity to present the Association's views on the
issues before the Defense Appropriations Subcommittee.
Chairman Inouye. Our next witness represents the Ovarian
Cancer National Alliance, Ms. Cara Tenenbaum.
STATEMENT OF CARA TENENBAUM, SENIOR POLICY DIRECTOR,
OVARIAN CANCER NATIONAL ALLIANCE
Ms. Tenenbaum. Good morning, Mr. Chairman, Vice Chairman. I
want to thank you and all the members of the subcommittee for
the opportunity to testify today. I'm here to talk about the
Department of Defense's Ovarian Cancer Research Program, one of
the congressionally directed medical research programs.
For more than 10 years, the Ovarian Cancer National
Alliance has worked with you to fund groundbreaking research
that will help women diagnosed with, and women at high risk
for, ovarian cancer. The ovarian cancer community is so
grateful for the money you've appropriated in the past and last
year, and we respectfully request further funding for this
year, fiscal year 2010.
Simply put, the ovarian cancer research program's mission
is to eliminate ovarian cancer. It's the only Federal research
program with that mission, conquering the disease. Of course,
that's a complicated effort. It requires understanding the
cause of the disease, its development, how the disease spreads,
and recurrence.
The Ovarian Cancer Research Program has a two-tiered peer-
review system that chooses the best potential research. Much of
this research has been published, patented, granted further
Federal funding by the National Cancer Institute, and/or gone
into commercial development.
Ovarian cancer is rarely diagnosed in early stages, when
survival is best. There is no reliable early-detection test,
but the Ovarian Cancer Research Program has made progress on
this front. There is one early-detection test that's currently
looking at commercialization--it's a urine biomarker test--and
another you may have read about in the newspaper, the cancer-
sniffing dogs.
The Ovarian Cancer Research Program has also developed two
working models--animal models of ovarian cancer--for ovarian
cancer: the mouse model, which is commonly used in research,
but also the chicken model, which is the only other known
animal to get ovarian cancer.
I'm here, not only as an employee of the Ovarian Cancer
National Alliance, but as someone with a personal interest in
ovarian cancer. I'm an Ashkenazi Jew, my family is from Eastern
Europe, and I have a strong family history of cancer. My
mother, a breast cancer survivor, is here with me. And I know
that I'm at high risk for both breast cancer and ovarian
cancer. Because there is no early-detection test, I know that
I, and so many other women, have to remain vigilant about our
health.
I'm here, and I'm honored to be here, on behalf of the
ovarian cancer community. And I ask, on behalf of all of these
daughters, mothers, and sisters, like my own--my sister is also
here--that you continue to support the Ovarian Cancer Research
Program, so that we all have a better chance at detecting
ovarian cancer early. We ask you to continue supporting the
Ovarian Cancer Research Program's mission to eliminate this
deadly disease.
Thank you for your time.
Chairman Inouye. All right. Thank you very much, Ms.
Tenenbaum.
[The statement follows:]
Prepared Statement of Cara Tenenbaum
Mr. Chairman, Ranking Member, and Members of the Committee, thank
you for the opportunity to testify before you today about the
Department of Defense's Ovarian Cancer Research Program, one of the
Congressionally Directed Medical Research Programs.
My name is Cara Tenenbaum, and I'm the Senior Policy Director at
the Ovarian Cancer National Alliance. For more than 10 years, we have
worked with you to fund ground breaking research that will help women
diagnosed with, and women at high risk for, ovarian cancer. The ovarian
cancer community is so grateful for the $20 million you appropriated to
the Ovarian Cancer Research Program for fiscal year 2009. This year we
respectfully request $30 million for this program.
Simply put, the Ovarian Cancer Research Program's mission is to
eliminate ovarian cancer. It is the only Federal research program that
seeks to conquer this disease, rather than explore it. Of course,
conquering ovarian cancer is a complicated effort that requires
understanding the causes of the disease, its development, how it
spreads and recurrence. The Ovarian Cancer Research Program has a two
tiered peer review system that chooses the best potential research.
Much of this research has been published, patented, granted further
Federal funding by the National Cancer Institute and/or gone into
commercial development.
Ovarian cancer is rarely diagnosed in the early stages when
survival is best. There is no reliable early detection test, which is
an urgent priority for the ovarian cancer community. The Ovarian Cancer
Research Program has funded two early detection tests that are in
development: one in progress is the discovery and commercialization of
a urine biomarker test; the second is a breath test, which you may have
read about in the popular press under headlines like ``Cancer Sniffing
Dogs.''
The Ovarian Cancer Research Program has also developed working
animal models of ovarian cancer: the mouse model, which is commonly
used in medical research; and the chicken model, which is the only
other animal known to get ovarian cancer.
What makes this program unique is not just its use of ovarian
cancer survivors as patient reviewers, and its transparency and low
overhead, but the numerous grant mechanisms that provide a flexible
model that funds innovative research.
I am here, not only as an employee of the Ovarian Cancer National
Alliance, but as someone with a personal interest in ovarian cancer. As
an Ashkenazi Jew with a strong family history of cancer--my mother, a
breast cancer survivor is here with me--I know that I am at high risk
for both breast and ovarian cancer. As there is no reliable early
detection test for ovarian cancer, I, like so many others, have to rely
on my own vigilance for early detection of ovarian cancer.
As a single woman who hopes to have children one day, I'm not ready
for prophylactic surgery, although many of the patients I speak with
have urged me to consider it. I am not even interested in genetic
testing at this point, because without any action steps, I'm left with
more worry than solutions. And so, on behalf of the millions of
daughters, mothers, and sisters, like my own who has joined me here, I
ask that you continue to support funding the Ovarian Cancer Research
Program so that we all have a better chance of detecting ovarian cancer
early, fighting it with better treatments and fulfilling the Ovarian
Cancer Research Program's mission to eliminate this deadly disease.
I am honored to be here representing the ovarian cancer community
in respectfully requesting that Congress provide $30 million for the
Ovarian Cancer Research Program (OCRP) in fiscal year 2010 as part of
the Federal Government's investment in the Department of Defense's
Congressionally Directed Medical Research Programs (CDMRP).
THE OVARIAN CANCER RESEARCH PROGRAM
The Ovarian Cancer Research Program was created in 1997 to address
a lack of ovarian cancer research, which remains the deadliest
gynecologic cancer. The program uses a two tier peer review system,
including patient advocates in both levels of review. Reviews are made
not only on scientific rigor, but on the impact the proposed research
will have on the disease and patients.
To date, accomplishments reported by awardees include 371
publications, 431 abstracts/presentations, and 15 patents applied for/
obtained. The Ovarian Cancer Research Program meets each year to
evaluate the science and determine funding priorities for the upcoming
year. This flexibility, along with input from patient advocates and
leading researchers, allows the Ovarian Cancer Research Program to fill
current research gaps. Much of the research funded by the Ovarian
Cancer Research Program continues to get larger grants from this seed
money, including four Ovarian Cancer Specialized Programs of Research
Excellence (SPORES) funded by the National Cancer Institute.
The program provides awards in the following categories:
Collaborative Translational Research Award, Consortium Development
Award, Idea Development Award, Ovarian Cancer Academy Award, Career
Development Award, Translational Research Partnership Award,
Historically Black Colleges and Universities/Minority Institution
Collaborative Research Awards, Pilot Awards, and the New Investigator
Research Award. From 1997 to 2009 more than $140 million has been
awarded through these mechanisms.
In fiscal year 2009 alone:
--A New Investigator Award funded a research project using
immunotherapy, rather than chemotherapy or surgery, to fight
tumors;
--An Idea Development award funded a research project on biomarkers,
including the discovery of a biomarker that is elevated 3 years
prior to clinical diagnosis of ovarian cancer;
--An Idea Development award to explore the use of a new drug as a
single agent and in combination with existing chemotherapy
regimens to shrink tumors;
--An Idea Development Award to fund preclinical studies of DNA
therapies that induce ovarian cancer cell death without any
toxicity to normal cells;
--Phase II research in angiogenisis inhibitors, which stop new blood
vessels from forming in a tumor.
OVARIAN CANCER'S DEADLY STATISTICS
According to the American Cancer Society, in 2009, more than 21,000
American women will be diagnosed with ovarian cancer, and more than
15,000 will lose their lives to this terrible disease. Ovarian cancer
is the fifth leading cause of cancer death in women. Currently, more
than half of the women diagnosed with ovarian cancer will die within 5
years. When detected early, the 5-year survival rate increases to more
than 90 percent, but when detected in the late stages, the 5-year
survival rate drops to less than 29 percent.
In the more than 30 years since the War on Cancer was declared,
ovarian cancer mortality rates have not significantly improved. A valid
and reliable screening test--a critical tool for improving early
diagnosis and survival rates--still does not exist for ovarian cancer.
Behind the sobering statistics are the lost lives of our loved ones,
colleagues, and community members. While we have been waiting for the
development of an effective early detection test, thousands of our
wives, mothers, daughters, and sisters have lost their battle with
ovarian cancer.
More than three-quarters of women diagnosed with ovarian cancer
will have at least one recurrence. These recurrences may indicate that
the tumor cells are no longer responsive to some therapies, leaving
women with fewer treatment options. The Ovarian Cancer Research Program
spends almost 20 percent of its grant money studying recurrence. Almost
a third is spent on understanding ovarian cancer cell biology,
genetics, and molecular biology, areas that we hope will lead to a more
reliable early detection test.
In 2007, a number of prominent cancer organizations released a
consensus statement identifying the early warning symptoms of ovarian
cancer. Without a reliable diagnostic test, we can rely only on this
set of vague symptoms of a deadly disease, and trust that both women
and the medical community will identify these symptoms and act promptly
and quickly. Unfortunately, we know that this does not always happen.
Too many women are diagnosed late due to the lack of a test; too many
women and their families endure life-threatening and debilitating
treatments to kill cancer; too many women are lost to this horrible
disease.
SUMMARY
The Ovarian Cancer National Alliance has made commitments to work
with Congress, the Administration, and other policymakers and
stakeholders to improve the survival rate from ovarian cancer through
education, public policy, research, and communication. Please know that
we appreciate and understand that our Nation faces many challenges and
that Congress has limited resources to allocate; however, we are
concerned that without increased funding to bolster and expand ovarian
cancer research efforts, the Nation will continue to see growing
numbers of women losing their battle with this terrible disease.
On behalf of the entire ovarian cancer community--patients, family
members, clinicians, and researchers--we thank you for your leadership
and support of Federal programs that seek to reduce and prevent
suffering from ovarian cancer. Thank you in advance for your support of
$30 million in fiscal year 2010 funding for the Ovarian Cancer Research
Program.
Chairman Inouye. You know, I just can't resist this
temptation but if you'll forgive me, the Ovarian Cancer
Treatment Program and the Breast Cancer Treatment Program are
earmarks. They were not suggested by the administration or by
experts. The Congress did that. And today we're being condemned
for earmarks. But----
The next witness represents the Reserve Officers
Association, Colonel William Holahan.
STATEMENT OF COLONEL WILLIAM HOLAHAN, UNITED STATES
MARINE CORPS (RET.), DIRECTOR, MEMBER
SERVICES, RESERVE OFFICERS ASSOCIATION OF
THE UNITED STATES
Colonel Holahan. Mr. Chairman, Senator Cochran, we ask the
subcommittee that our submitted written testimony, particularly
with regard to the unfunded equipment and priorities of those
Reserve components noted therein, be accepted for the record.
Chairman Inouye. It will be made part of the record.
Colonel Holahan. Thank you for the opportunity to speak
once again on the issue of funding for our Nation's Reserve
components.
Today the United States cannot conduct extended military
operations without the augmentation and reinforcement of its
active component. That reinforcement must come from one of two
sources: a draft, or the National Guard and Reserve.
The 700,000 men and women of our Nation's Reserve
components have provided that reinforcing and augmenting force
since 2001. They have saved the country from a draft. Every
indication I see and hear is that they can and will continue to
do so, if they are properly trained, equipped, and supported.
The Congress has made great strides in increasing the funding
for these important needs, but realism demands that we
recognize the armed services frequently push the needs of their
Reserve components to a lower priority in times when funding is
tight.
The Reserve Officers Association--and I have been
authorized to speak on this subject for the Reserve Enlisted
Association, as well--urges this subcommittee to specifically
identify appropriations for resetting of both the National
Guard and the Reserve, such that it must be spent to train and
re-equip the Reserve components for both their homeland defense
mission and any overseas contingency operations that they may
be assigned.
Each Reserve component has shared with ROA that there is a
continued problem of tracking equipment specifically
appropriated to the Reserves from manufacturers to a service's
Reserve component. Frustrations continue with the belief that
the active component either pushes out Reserve items during
production, or actually redirects equipment in distribution
channels before it reaches their reserve.
At the end of the day, the Nation wants an All-Volunteer
Force, and it does not want a draft. The only way to achieve
both of these objectives is to ensure that the Reserve and the
National Guard continue to be filled with the same type of
great American patriots who serve, today. To do that, you must
ensure that they are fully trained, properly re-equipped, and
that their families are adequately supported. And you ensure
that your appropriations get where you intend that they go.
Thank you for your consideration.
Chairman Inouye. Thank you very much, Colonel Holahan.
[The statement follows:]
Prepared Statement of William Holahan
PRIORITIES
CY 2009 Legislative Priorities are:
Providing adequate resources and authorities to support the current
recruiting and retention requirements of the Reserves and National
Guard.
Reset the whole force to include fully funding equipment and
training for the National Guard and Reserves.
Support citizen warriors, families and survivors.
Assure that the Reserve and National Guard continue in a key
national defense role, both at home and abroad.
Issues To Help Fund, Equip, and Train
Advocate for adequate funding to maintain National Defense during
overseas contingency operations.
Regenerate the Reserve Components (RC) with field compatible
equipment.
Fence RC dollars for appropriated Reserve equipment.
Fully fund Military Pay Appropriation to guarantee a minimum of 48
drills and 2 weeks training.
Sustain authorization and appropriation to National Guard and
Reserve Equipment Account (NGREA) to permit flexibility for Reserve
Chiefs in support of mission and readiness needs.
Optimize funding for additional training, preparation and
operational support.
Keep Active and Reserve personnel and Operation & Maintenance
funding separate.
Equip Reserve Component members with equivalent personnel
protection as Active Duty.
Issues To Assist Recruiting and Retention
Support continued incentives for affiliation, reenlistment,
retention and continuation in the Reserve Component.
Pay and Compensation
Provide permanent differential pay for Federal employees.
Offer Professional pay for RC medical professionals.
Eliminate the 1/30th rule for Aviation Career Incentive Pay, Career
Enlisted Flyers Incentive Pay, Diving Special Duty Pay, and Hazardous
Duty Incentive Pay.
Education
Continued funding for the GI Bill for the 21st Century.
Health Care
Provide Medical and Dental Readiness through subsidized preventive
health care.
Extend military coverage for restorative dental care for up to 180
days following deployment.
Spouse Support
Repeal the SBP-Dependency Indemnity Clause (DIC) offset.
national guard & reserve equipment & personnel accounts
It is important to maintain separate equipment and personnel
accounts to allow Reserve Component Chiefs the ability to direct
dollars to needs.
Key Issues Facing the Armed Forces Concerning Equipment
Developing the best equipment for troops fighting in overseas
contingency operations.
Procuring new equipment for all U.S. Forces.
Maintaining or upgrading the equipment already in the inventory.
Replacing the equipment deployed from the homeland to the war.
Making sure new and renewed equipment gets into the right hands,
including the Reserve Component.
Reserve Component Equipping Sources
Procurement.
Cascading of equipment from Active Component.
Cross-leveling.
Recapitalization and overhaul of legacy (old) equipment.
Congressional adds.
National Guard and Reserve Appropriations (NGREA).
Supplemental appropriation.
CONTINUED RESETTING OF THE FORCE
Resetting or reconstitution of the force is the process to restore
people, aircraft and equipment to a high state of readiness following a
period of higher-than-normal, or surge, operations.
Some equipment goes through recapitalization: stripping down and
rebuilding equipment completely. Recapitalization is one of the fastest
ways to get equipment back to units for use, and on some equipment,
such as trucks, recapitalization costs only 75 percent of replacement
costs. A second option is to upgrade equipment, such as adding armor. A
third option is to simply extend the equipment's service life through a
maintenance program.
Theater operations in Iraqi and Afghanistan are consuming the
Reserve Component force's equipment. Wear and tear is at a rate many
times higher then planned. Battle damage expends additional resources.
New equipment suited for mountain warfare will be needed with the shift
back into Afghanistan.
In addition to dollars already spent to maintain this well-worn
equipment for ongoing operations, the Armed Forces will likely incur
large expenditures in the future to repair or replace (reset) a
significant amount of equipment when hostilities cease. It is still
unknown how much equipment will be left in Afghanistan.
PERSONNEL TRAINING
When Reserve Component personnel participate in an operation they
are focused on the needs of the particular mission, which may not
include everything required to maintain qualification status in their
military occupation specialty (MOS, AFSC, NEC).
--There are many different aspects of training that are affected:
--Skills that must be refreshed for specialty;
--Training needed for upgrade but delayed by mission;
--Ancillary training missed;
--Professional military education needed to stay competitive;
--Professional continuing education requirements for single-managed
career fields and other certified or licensed specialties
required annually;
--Graduate education in business related areas to address force
transformation and induce officer retention.
--Loss, training a replacement: There are particular challenges that
occur to the force when a loss occurs during a mobilization or
operation and depending on the specialty this can be a
particularly critical requirement that must be met:
--Recruiting may require particular attention to enticing certain
specialties or skills to fill critical billets;
--Minimum levels of training (84 days basic, plus specialty
training);
--Retraining may be required due to force leveling as emphasis is
shifted within the service to meet emerging requirements.
END STRENGTH
The ROA would like to place a moratorium on reductions to the Guard
and Reserve manning levels. Manpower numbers need to include not only
deployable assets, but individuals in the accession pipeline. ROA urges
this subcommittee to fund to support:
--Army National Guard of the United States, 358,200.
--Army Reserve, 206,000.
--Navy Reserve, 66,700.
--Marine Corps Reserve, 39,600.
--Air National Guard of the United States, 106,756.
--Air Force Reserve, 69,900.
--Coast Guard Reserve, 10,000.
In a time of war and the highest OPTEMPO in recent history, it is
wrong to make cuts to the end strength of the Reserve Components. We
need to pause to permit force planning and strategy to catch-up with
budget reductions.
With the Navy's requested increase by 2,500 sailors, corresponding
increases need to be made in the Navy Reserve. The Navy Reserve is
providing most of the individual augmentee support for the Navy in
overseas operations. Five years ago was the last time the Navy
evaluated its USNR requirements; such a study needs to be done again.
READINESS
Readiness is a product of many factors, including the quality of
officers and enlisted, full staffing, extensive training and exercises,
well-maintained weapons and authorized equipment, efficient procedures,
and the capacity to operate at a fast tempo.
The Defense Department does not attempt to keep all Active units at
the C-1 level. The risk is without resetting the force returning Active
and Reserve units will be C-4 or lower because of missing equipment,
and without authorized equipment their training levels will
deteriorate.
NONFUNDED ARMY RESERVE COMPONENT EQUIPMENT
The Army National Guard and Army Reserve have made significant
contributions to ongoing military operations, but equipment shortages
and personnel challenges continue and if left unattended, may hamper
the Reserves' preparedness for future overseas and domestic missions.
To provide deployable units, the Army National Guard and the Army
Reserve have cross-leveled large quantities of personnel and equipment
to deploying units, an approach that has resulted in growing shortages
in nondeployed units.
Army Reserve Unfunded Requirements
The 21st Century Army Reserve mobilizes continuously with 12
percent of its force consistently deployed in support of the current
contingencies. However, the Army Reserve lacks the ability to fully
train Army Reserve Soldiers on the same equipment the Army uses in the
field. To prepare to perform a dangerous mission, soldiers must have
modern equipment and state-of-the-art training facilities. The Army
Reserve has 73 percent of its required equipment on hand. Under
currently programmed funding, the Army Reserve should reach 85 percent
equipment on hand by fiscal year 2016 with the goal of 100 percent on
hand by fiscal year 2019.
C-12 Huran Cargo Transport Airplane (7)--$63 Million
Replace aircraft permanently transferred to Intelligence,
Surveillance and Reconnaissance (ISR) mission. Seven below total
authorized count. Capacity lift 5,185 lbs, distance 1,710 miles.
Communications Security (COMSEC) AKMS/Computer Sets
(3648)--$8.6 Million
Provide secure communications to (4) companies with AN/GYK-49(V)1
&AN/PYQ-10(C) sets.
Cargo Bed, Demountable PLS 8 x20 (5498)--$109.7 Million
Transportation Support: pacing item for Medium Truck Company, 360
each.
Optical Data Entry Reader (115)--$25.5 Million
Imaging/Reader automation to fix trailer transfer and Inland Cargo
units.
Heavy/Medium Trailers (1760)--$115.8 Million
Cargo--MTV with dropsides (M1095); flatbed--LMTV w/dropsides
(M1086)
Army National Guard Unfunded Equipment Requirements
Army National Guard (ARNG) units deployed overseas have the most
up-to-date equipment available. However, a significant amount of
equipment is currently unavailable to the Army National Guard in the
States due to continuing rotational deployments and emerging
modernization requirements. Many States have expressed concern about
the resulting shortfalls of equipment for training as well as for
domestic emergency response operations.
Aviation Upgrade Kits--$100.5 Million
UH-60A to UH-60L Upgrade Kits; LUH-72A S&S Mission Equipment
Package.
Homeland Security Command and Control Package--$168.4
Million
Joint Incident Site Communications and Interim Satcom Incident
Site. (JISC & ISISCS); Wideband Imagery Satellite Terminals, and Full
Motion Video (FMV) downlink to support state and local leaders during
natural and manmade disasters.
M777A2 Lightweight 155mm Howitzer (18)--$54 Million
To ensure readiness of Army National Guard (ARNG) Fire Support,
Field Artillery units.
Transportation--$1.15 Billion
FMTV/LMTV Cargo Trucks; HMMWV; HTV 8x8 Heavy Trucks; Tactical
Trailers.
Force XXI Battlefield Command Brigade and Below (FBCB2)--
$179 Million
To ensure readiness of ARNG Combat Support and Combat Service
Support (CS/CSS) units.
Also needed: To organize a second Stryker Brigade Combat Team
(SBCT)
AIR FORCE RESERVE COMPONENT EQUIPMENT PRIORITIES
ROA continues to support military aircraft Multi-Year Procurement
(MYP) beginning with 15 for more C-17s and 8 more C-130Js for USAir
Force and its Reserve. Further, ROA supports additional funding for
continued Research and Development of the next generation bomber.
Air Force Reserve Unfunded Requirements
The Air Force Reserve (AFR) mission is to be an integrated member
of the Total Air Force to support mission requirements of the joint
warfighter. To achieve interoperability in the future, the Air Force
Reserve top priorities for nonfunded equipment are:
C-40 D multi-role airlift (3)--$370 Million
To replace aging C-9 C's at Scott Air Force Base: mission requests
exceed aircraft availability.
KC-130J Aircraft (2)--$148 Million
These Aircraft are needed to fill the shortfall in Search and
Rescue refueling capabilities.
Cyber Systems Defense--$109 Million
Upgrade Active Duty and AF Reserve network infrastructure to ensure
overall A.F. mission.
Helmet Mounted Cueing System--$38 Million
Upgrade and enhancement to engagement systems.
Defensive Systems
Airlift Defensive Systems (16) Install ADS systems onto (16) AFRC
C-5As at Lackland Air Force Base against IR missile threats.
Infra-Red Counter Measures (42) Procure and install (42) LAIRCM
lite systems on AFRC C-5s. Protects high value national assets against
advanced IR missile threats.
Missile Warning System (MWS) Upgrade/replacement--Improve and
integrate the existing Electronic Attack (EA) for A-10 and F-16 and
Electronic Protection (EP) for A-10, F-16 and HC-130.
Air National Guard Unfunded Equipment Requirements
Shortfalls in equipment will impact the Air National Guard's
ability to support the National Guard's response to disasters and
terrorist incidents in the homeland. Improved equipping strengthens
readiness for both overseas and homeland missions and improves the ANG
capability to train on mission-essential equipment.
Infra-Red Counter Measures--$240.7 Million
Procure and install LAIRCM systems on C-5, C-17, C-130, 130, HC-
130, EC-130, KC-135 a/c.
Air Defensive Systems--$59.31 Million
Install ADS systems onto C-5, C-17, F-15 aircraft.
Missile Warning Systems--$22.48 Million
Upgrade/replacement--Improve and integrate the existing Electronic
Attack (EA) and Electronic Protection (EP) for A-10, C-130.
Rear Aspect Visual Scan Capability/Safire--$57.2 Million
Increase the field of view on C-5, C-17 transports and add a larger
window in the C-130 paratroop doors.
Personal Protective Equipment, M4 Rifles--$34.77 Million
Force Protection Mobility Bag Upgrades/Replacements--
$113.72 Million
NAVY RESERVE UNFUNDED PRIORITIES
Active Reserve Integration (ARI) aligns Active and Reserve
component units to achieve unity of command. Navy Reservists are fully
integrated into their Active component supported commands. Little
distinction is drawn between Active component and Reserve component
equipment, but unique missions remain.
C-40 A Combo Cargo/Passenger Airlift (4)--$402 Million
The Navy requires a Navy Unique Fleet Essential Airlift Replacement
Aircraft. The C-40A is able to carry 121 passengers or 40,000 pounds of
cargo, compared with 90 passengers or 30,000 pounds for the C-9.
KC-130J Super Hercules Aircraft Tankers (4)--$160 Million
These Aircraft are needed to fill the shortfall in Navy Unique
Fleet Essential Airlift (NUFEA). Procurement price close to upgrading
existing C-130Ts with the benefit of a long life span.
P-3 Maritime Patrol Aircraft Fixes--$312 Million
Due to the grounding of 39 airframes in December 2007, there is a
shortage of maritime patrol and reconnaissance aircraft, which are
flown in associate Active and Reserve crews. P-3 wing crack kits are
still needed for fiscal year 2010.
F-5 Radar/Electronic Attack Block-2--$148.3 Million
Aircraft used in adversarial training of F-18 pilots. Heightens
adversary competition conditions.
C-40 Hangar, Oceana--$31.4 Million
MARINE CORPS RESERVE UNFUNDED PRIORITIES
The Marine Corps Reserve faces two primary equipping challenges,
supporting and sustaining its forward deployed forces in the Long War
while simultaneous resetting and modernizing the Force to prepare for
future challenges. Only by equally equipping and maintaining both the
Active and Reserve forces will an integrated Total Force be seamless.
KC-130J Super Hercules Aircraft tankers (4)--$160 Million
These Aircraft are needed to fill the shortfall in Marine Corps
Essential Airlift. Procurement price close to upgrading existing C-
130Ts with the benefit of a long life span. Commandant, USMC, has
testified that acquisition must be accelerated.
Light Armored Vehicles--LAV (14)--$21 Million
A shortfall in a USMCR light armor reconnaissance company, the LAV-
25 is an all-terrain, all-weather vehicle with night capabilities. It
provides strategic mobility to reach and engage the threat, tactical
mobility for effective use of fire power.
Training Allowance (T/A) Shortfalls--$187.7 Million
Shortfalls consist of over 300 items needed for individual combat
clothing and equipment, including protective vests, poncho, liner,
gloves, cold weather clothing, environmental test sets, took kits,
tents, camouflage netting, communications systems, engineering
equipment, combat and logistics vehicles and weapon systems.
MCB Vehicle Maintenance Facility--$10.9 Million
Additional vehicle storage and maintenance: routine preventive and
corrective maintenance are still performed throughout the country by
Marines. Ground equipment maintenance efforts have expanded over the
past few years, leveraging contracted services and depot-level
capabilities.
TRANSPARENCY OF PROCUREMENT
Each Reserve Component has shared with ROA that there is a
continued problem of tracking equipment specifically appropriated to
the Reserves from manufacturer to a service's Reserve Component.
Frustrations continue with a belief that the Active Component either
pushes out Reserve items during production or actual misappropriates
equipment in distribution before it reaches the Reserve.
NATIONAL GUARD AND RESERVE EQUIPMENT APPROPRIATION
Much-needed items not funded by the respective service budget are
frequently purchased through this appropriation. In some cases it is
used to bring unit equipment readiness to a needed State for
mobilization. With the war, the Reserve and Guard are faced with
mounting challenges. Funding levels, rising costs, lack of replacement
parts for older equipment, etc. have made it difficult for the Reserve
Components to maintain their aging equipment, not to mention
modernizing and recapitalizing to support a viable legacy force. The
Reserve Components benefit greatly from a National Military Resource
Strategy that includes a National Guard and Reserve Equipment
Appropriation.
CIOR/CIOMR FUNDING REQUEST
The Interallied Confederation of Reserve Officers (CIOR) was
founded in 1948, and its affiliate organization, The Interallied
Confederation of Medical Reserve Officers (CIOMR) was founded in 1947.
The organization is a nonpolitical, independent confederation of
national reserve associations of the signatory countries of the North
Atlantic Treaty (NATO). Presently there are 16 member nation
delegations representing over 800,000 reserve officers. CIOR supports
four programs to improve professional development and international
understanding.
Military Competition.--The CIOR Military Competition is a strenuous
3-day contest on warfighting skills among Reserve Officers teams from
member countries. These contests emphasize combined and joint military
actions relevant to the multinational aspects of current and future
Alliance operations.
Language Academy.--The two official languages of NATO are English
and French. As a non-government body, operating on a limited budget, it
is not in a position to afford the expense of providing simultaneous
translation services. The Academy offers intensive courses in English
and French as specified by NATO Military Agency for Standardization,
which affords international junior officer members the opportunity to
become fluent in English as a second language.
Partnership for Peace (PfP).--Established by CIOR Executive
Committee in 1994 with the focus of assisting NATO PfP nations with the
development of Reserve officer and enlisted organizations according to
democratic principles. CIOR's PfP Committee, fully supports the
development of civil-military relationships and respect for democratic
ideals within PfP nations. CIOR PfP Committee also assists in the
invitation process to participating countries in the Military
Competition.
Young Reserve Officers Workshop.--The workshops are arranged
annually by the NATO International Staff (IS). Selected issues are
assigned to joint seminars through the CIOR Defense and Security Issues
(SECDEF) Commission. Junior grade officers work in a joint seminar
environment to analyze Reserve concerns relevant to NATO.
Dues do not cover the workshops and individual countries help fund
the events. The Department of the Army as Executive Agent hasn't been
funding these programs. Senate leadership support would be beneficial.
CONCLUSION
DoD is in the middle of executing a war and operations in Iraq and
Afghanistan. The impact of these operations is affecting the very
nature of the Guard and Reserve, not just the execution of Roles and
Missions. Without adequate funding, the Guard and Reserve may be viewed
as a source to provide funds to the Active Component. It makes sense to
fully fund the most cost efficient components of the Total Force, its
Reserve Components.
At a time of war, we are expending the smallest percentage of GDP
in history on National Defense. Funding now reflects close to 4 percent
of GDP including supplemental dollars. ROA has a resolution urging that
defense spending should be 5 percent to cover both the war and homeland
security. While these are big dollars, the President and Congress must
understand that this type of investment is what it will take to equip,
train and maintain an all-volunteer force for adequate National
Security.
The Reserve Officers Association, again, would like to thank the
sub-committee for the opportunity to present our testimony. We are
looking forward to working with you, and supporting your efforts in any
way that we can.
Chairman Inouye. Our next witness is the Secretary of the
Associations for America's Defense, Ms. Elizabeth Cochran.
STATEMENT OF ELIZABETH COCHRAN, SECRETARY, ASSOCIATIONS
FOR AMERICA'S DEFENSE
Ms. Cochran. Thank you, Mr. Chairman and Mr. Vice Chairman.
The Associations for America's Defense is very grateful to
testify today, and we'd like to submit written testimony at
this time.
We would like to thank this subcommittee for its
stewardship on defense issues and setting an example by its
nonpartisan leadership. The Associations for America's Defense
is concerned that U.S. defense policy is sacrificing future
security for near-term readiness. It's been suggested that the
United States should focus on wars we're fighting today, not on
future wars that may not occur. The Pentagon's priorities sound
like money will be redirected to more immediate needs.
Erosion in the capability in the force means added risk
will be faced today and tomorrow. According to the Office of
Management and Budget, base defense spending, projected at $534
billion in 2010, will stay relatively flat for the next 5
years. We disagree with placing such budgetary constraints on
defense, because it can lead to readiness and effectiveness
being subtly degraded, which won't be immediately evident. We
support increasing defense spending to 5 percent of the gross
domestic product during times of war to cover procurement, and
prevent unnecessary personnel end-strength cuts.
The Associations for America's Defense is alarmed about the
fiscal year 2010 unfunded programs list, submitted by the
military services, which is 87 percent lower than fiscal year
2009's request. We're concerned the unfunded requests were
driven by budgetary factors more than risk assessment, which
will impact national security.
As always, our military will do everything to accomplish
its missions, but response time is measured by equipment
readiness. Due to the DOD's tactical aircraft acquisition
programs having been blunted by cost and schedule overruns, the
Air Force has offered to retire 250 fighter jets in one year,
which the Secretary of Defense has accepted. Until new systems
are acquired in sufficient quantities to replace legacy fleets,
those legacy systems must be sustained. Airlift contributions
in moving cargo and passengers are indispensable to American
warfighters. As the military continues to become more
expeditionary, more airlifts in C-17 and C-130Js will be
required. Procurement needs to be accelerated and modernized,
and mobility requirements need to be reported upon.
The need for air refueling is utilized worldwide in DOD
operations. But, significant numbers of tankers are old and
plagued with structural problems. The Air Force would like to
retire as many as 131 of the Eisenhower-era KC-135E tankers by
the end of the decade. These aircraft must be replaced.
Finally, we ask this subcommittee to continue to provide
appropriations for the National Guard and Reserve equipment
requirements. The National Guard's goal is to make at least
one-half the army and air assets available to Governors and
adjutants general at any given time. Appropriating funds to
Guard and Reserve equipment provides Reserve chiefs with
flexibility prioritizing funding.
Once again, I thank you for your ongoing support for the
Nation's armed services and the fine men and women who defend
our country. Please contact us with any questions.
Thank you.
Chairman Inouye. Thank you very much, Ms. Cochran.
And I thank the panel.
[The statement follows:]
Prepared Statement of Elizabeth Cochran
INTRODUCTION
Mister Chairman and distinguished members of the Committee, the
Associations for America's Defense (A4AD) is again very grateful for
the invitation to testify before you about our views and suggestions
concerning current and future issues facing the defense appropriations.
The Association for America's Defense is an adhoc group of 12
military and veteran associations that have concerns about national
security issues. Collectively, we represent armed forces members and
their families, who are serving our Nation, or who have done so in the
past.
CURRENT VERSUS FUTURE: ISSUES FACING DEFENSE
The Associations for America's Defense would like to thank this
subcommittee for the on-going stewardship that it has demonstrated on
issues of Defense. At a time of war, its pro-defense and non-partisan
leadership continues to set the example.
Emergent Risks
Members of this group are concerned that U.S. Defense policy is
sacrificing future security for near term readiness. So focused are our
efforts to provide security and stabilization in Afghanistan and a
withdrawal from Iraq, that risk is being accepted as an element in
future force planning. Force planning is being driven by current
overseas contingency operations, and to allow for budget limitations.
Careful study is needed to make the right choice. A4AD is pleased that
Congress and this subcommittee continue oversight in these decisions.
What seems to be overlooked is that the United States is involved
in a Cold War as well as a Hot war. With the United States preoccupied
with the Middle East, North Korea, China, Russia, and Iran are growing
areas of risk.
Korean Peninsula
Provocatively, North Korea successfully tested a nuclear weapon at
full yield, unilaterally withdrew from that 1953 armistice, and
continues to test-fire missiles from both its coasts. The South sent a
high speed missile patrol boat into Western waters in response to a
reported amphibious assault training staged by the North. South Korean
and U.S. troops have been put on the highest alert level in 3 years,
and the South Korean Coast Guard is escorting its fishing boats.
North Korea has 1.2 million troops, with the 655,000 South Korean
soldiers and 30,000 U.S. troops stationed to the South. While not an
immediate danger to the United States, North Korea is still viewed as a
threat by its neighbors, and represents a destabilizing factor in Asia.
Recent events may be mere posturing, but North Korea is still a failed
state, where misinterpretation clouded by hubris could start a war. The
North has prepositioned and could fire up to 250,000 rounds of heavy
artillery in the first 48 hours of war along the border and into Seoul.
China
China remains the elephant in the war room. As the United States
expends resources in the Middle East and continues to restructures the
military to fight terrorism, China patiently waits for America's
ability to project force to weaken.
China's armed forces are the biggest in the world and have
undergone double-digit increases in military spending since the early
1990s. The Pentagon has reported that China's actual spending on
military is up to 250 percent higher than figures reported by the
Chinese government, and their cost of materials and labor is much
lower. This year, China chose to increase its defense budget by almost
15 percent. China's build-up of sea and air military power appears
aimed at the United States, according to Admiral Michael Mullen, the
chairman of the U.S. Joint Chiefs of Staff.
The U.S. military strategy cannot be held hostage by international
debts. While China is the biggest foreign holder of U.S. Treasuries
with $768 billion at the end of the first quarter, we can't be lulled
into a sense of complacency.
Russia
Russian President Dmitry Medvedev has called for ``comprehensive
rearmament.'' Last March, in televised remarks to defense ministry
officials, Medvedev proclaimed the ``most important task is to re-equip
the [Russian] armed forces with the newest weapons systems.'' Russia's
defense budget could jump 30 percent this year, increasing Moscow's
military might and preserving its arms-export industry, reports Peter
Brookes of the Heritage Foundation. The country will aim for 70 percent
of its weaponry to be ``modern'' by 2020, Defense Minister Anatoly
Serdyukov said, according to RIA-Novosti, the state-run news agency.
Following an April meeting with President Medvedev, the Obama
administration is seeking a new start with Russia. Underlying U.S.-
Russian frictions are issues of NATO military expansion to countries
like Georgia and Ukraine, and U.S. plans to base a missile defense
system in Poland and the Czech Republic to defend against attacks from
countries like Iran. Concerns have been voiced about a European
military threat to Russian gas and oil fields.
Iran
While Iran lobs petulant rhetoric towards the United States, the
real international tension is between Israel and Iran. Israel views
Tehran's atomic work as a threat, and would consider military action
against Iran. If Iran was attacked, it has threatened to ``eliminate
Israel.'' Israeli leadership has warned Iran that any attack on Israel
would result in the ``destruction of the Iranian nation.'' Israel is
believed to have between 75 to 200 nuclear warheads with a megaton
capacity.
Force Structure: An Erosion in Capability
Supporting the National Security Strategy requires that the United
States to maintain robust and versatile military forces that can
accomplish a wide variety of missions. The two major theater war (2MTW)
approach was an innovation at the end of the Cold War. It was based on
the proposition that the United States should prepare for the
possibility that two regional conflicts could arise at the same time,
so that if the United States were engaged in a conflict in one theater,
an adversary in a second theater could be prevented from gaining his
objectives in the other. In 1996, the United States adopted the ``win-
hold-win'' concept--a strategy to fight and win one major regional
contingency, with enough force to hold another foe at a stalemate until
the first battle is won, and then to move the forces to the second
theater.
The Bush Administration's ``1-4-2-1 strategy'' from the 2001
Quadrennial Defense Review (QDR) called their new military strategy
``1-4-2-1,'' which meant: ``1'' Defend the United States; ``4'' Deter
aggression in four critical regions: Europe, Northeast Asia, Southwest
Asia, the Middle East; ``2'' Maintain the capability to combat
aggression in two of these regions simultaneously; and ``1'' Maintain a
capability to ``win decisively'' up to and including forcing regime
change and occupation in one of those two conflicts ``at a time and
place of our choosing.''
A top to bottom review in 2005, suggested change to the national
strategy as to mount one conventional campaign while devoting more
resources to defending American territory and antiterrorism efforts.
In a speech announcing the fiscal year 2010 Defense Budget,
Secretary of Defense Robert Gates stated ``Our conventional
modernization goals should be tied to the actual and prospective
capabilities of known future adversaries--not by what might be
technologically feasible for a potential adversary given unlimited time
and resources . . .''
``This budget is less about numbers than it is about how the
military thinks about the nature of warfare and prepares for the
future,'' Secretary of Defense Robert Gates testified before the Senate
Armed Services Committee on May 14, 2009. Gates says that the United
States should focus on the wars that we are fighting today, not on
future wars that may never occur. He also asserts that U.S.
conventional capabilities will remain superior for another 15 years.
Anthony Cordesman, a national security expert for the Center for
Strategic and International Studies, says that Gates' plan should be
viewed as a set of short-term fixes aimed at helping ``a serious cost
containment problem,'' not a new national security policy.
War planners are often accused of planning for the last war.
Secretary Gates speaks to enhancing the capabilities of fighting
today's wars. A concern arises on whether the Pentagon's focus should
be on irregular or conventional warfare, and whether it should be
preparing for a full scale ``peer'' war. From his priorities, it sounds
like Secretary Gates will be redirecting money to more immediate needs.
Each strategy permitted change to resize a force that was
originally oriented to global war to a smaller force focused on smaller
regional contingencies. But the erosion in the capability and the force
means added risks will be faced today and tomorrow than when the 2MTW
standard was established. ``The danger is in the poverty of
expectation, a routine obsession with danger that are familiar rather
than likely,'' wrote Thomas Schelling, in the Forward to: Pearl Harbor:
Decision and Warning (1962).
Funding for the Future
Base defense spending, projected at $534 billion in 2010, will stay
relatively flat for the next 5 years, counting inflation, according to
spending outlines by the Office of Management and Budget. ``It is
simply not reasonable to expect the defense budget to continue
increasing at the same rate it has over the last number of years,''
Secretary Gates told the Senate committee. ``We should be able to
secure our Nation with a base budget of more than half a trillion
dollars.''
Hollow Force
The Associations for America's Defense couldn't disagree more by
placing such budgetary constraints on the defense. A4AD members
question the spending priorities of the current administration.
``Fiscal restraint for defense and fiscal largesse for everything
else,'' commented Rep. John McHugh at a HASC hearing on the Defense
Budget in May.
The result of such budgetary policy could again lead to a hollow
force whose readiness and effectiveness has been subtly degraded and
whose lessened efficiency will not be immediately evident. This process
which echoes of the past, raises no red flags and sounds no alarms, and
the damage can go unnoticed and unremedied until a crisis arises that
highlights just how much readiness has decayed.
Defense as a Factor of GDP
Secretary Gates has warned that that each defense budget decision
is ``zero sum,'' providing money for one program will take money away
from another. A4AD encourages the appropriations subcommittee on
defense to scrutinize the recommended spending amount for defense. Each
member association supports increasing defense spending to 5 percent of
Gross Domestic Product during times of war to cover procurement and
prevent unnecessary personnel end strength cuts.
A Changing Manpower Structure
Secretary Gates proposed spending an extra $11 billion to finish
enlarging the Army and the Marine Corps and to halt reductions in the
Air Force and the Navy. The Navy has asked for an increase in end
strength of nearly 2,500 to 328,800 sailors. The Navy Reserve (USNR) on
the other hand would be reduced to 65,506, a cut of 1,194. The Navy
Reserve continues to be cut, and it is the main contributor to the
Navy's individual augmentees (IA) force on the ground in Iraq and, now,
Afghanistan. Of the requested dollars to support 4,400 by the Navy, the
Navy Reserve supplies 3,000.
A4AD supports a moratorium on further cuts including the Navy
Reserve. We further suggest that a Zero Based Review (ZBR) be performed
to evaluate the manning level of the USNR. The last review was done
over 5 years ago, and much has changed since.
Maintaining a Surge Capability
The armed forces need to provide critical surge capacity for
homeland security, domestic and expeditionary support to national
security and defense, and response to domestic disasters, both natural
and man-made that goes beyond operational forces. A strategic surge
construct includes manpower, airlift and air refueling, sealift
inventory, logistics, and communication to provide a surge-to-demand
operation. This requires funding for training, equipping and
maintenance of a mission-ready strategic reserve composed of active and
reserve units. An additional requirement is excess infrastructure which
would permit the housing of additional forces that are called-up beyond
the normal operational force.
Dependence on Foreign Partnership
Part of the U.S. military strategy is to rely on long-term
alliances to augment U.S. forces. ``To succeed in any efforts the
Department must harness and integrate all aspects of national power and
work closely with a wide range of allies, friends and partners,'' as
stated in a DOD progress report. ``Our strategy emphasizes the
capacities of a broad spectrum of partners . . . We must also seek to
strengthen the resiliency of the international system . . . helping
others to police themselves and their regions.'' It's been recommended
in the budget to increase funding of global partnerships efforts by
$500 million in the fiscal year 2010 base budget proposal, to support
training and equipping foreign militaries to undertake counter
terrorism and stability operations. Performances by allies have yet
proven to be a good return on investment.
The risk of basing a national security policy on foreign interests
and good world citizenship is increasingly uncertain because the United
States does not necessarily control our foreign partners; countries
whose objectives may differ with from own. This is more an exercise of
consensus building rather than security integration. Alliances should
be viewed as a tool and a force multiplier, but not the foundation of
National Security.
UNFUNDED REQUIREMENTS
The fiscal year 2010 Unfunded Program Lists submitted by the
military services to Congress was 87 percent less than was requested
for fiscal year 2009 with requests for only $3.44 billion versus $29.9
billion the year before. A4AD has concerns that the unfunded requests
were driven more by budgetary factors than risk assessment which will
impact national security. The following are lists submitted by A4AD
including additional non-funded recommendations.
Tactical Aircraft
DOD's efforts to recapitalize and modernize its tactical air forces
have been blunted by cost and schedule overruns in its new tactical
aircraft acquisition programs. The Air Force has offered a plan to
retire 250 fighter jets in 1 year alone, which the Secretary of Defense
has accepted.
Until new systems are acquired in sufficient quantities to replace
legacy fleets, legacy systems must be sustained and kept operationally
relevant. The risk of the older aircraft and their crews and support
personnel being eliminated before the new aircraft are on line could
result in a significant security shortfall.
Airlift
Hundreds of thousands of hours have been flown, and millions of
passengers and tons of cargo have been airlifted. Their contributions
in moving cargo and passengers are absolutely indispensable to American
warfighters in the Global War on Terrorism. Both Air Force and Naval
airframes and air crew are being stressed by these lift missions. As
the U.S. military continues to become more expeditionary, it will
require more airlift. Procurement needs to be accelerated and
modernized, and mobility requirements need to be reported upon.
DOD should buy an additional (35) C-17s above the current 205 to
ensure an adequate airlift force for the future and allow for
attrition--C-17s are being worn out at a higher rate than anticipated
in the Global War on Terrorism. Given the C-5's advanced age, it makes
more sense to retire the oldest and most worn out of these planes and
use the upgrade funds to buy more C-17s. DOD should also continue with
a joint multi-year procurement of C-130Js.
The Navy and Marine Corps need C-40-A replacements for the C-9B
aircraft. The Navy requires Navy Unique Fleet Essential Airlift. The C-
40A, a derivative of the 737-700C a Federal Aviation Administration
(FAA) certified, while the aging C-9 fleet is not compliant with either
future global navigation requirements or noise abatement standards that
restrict flights into European airfields.
Tankers
The need for air refueling is reconfirmed on a daily basis in
worldwide DOD operations. A significant number of tankers are old and
plagued with structural problems. The Air Force would like to retire as
many as 131 of the Eisenhower-era KC-135E tankers by the end of the
decade. DOD and Congress must work together to replace of these
aircraft.
NGREA
A4AD asks this committee to continue to provide appropriations for
unfunded National Guard and Reserve Equipment Requirements. The
National Guard's goal is to make at least half of Army and Air assets
(personnel and equipment) available to the Governors and Adjutants
General at any given time. To appropriate funds to Guard and Reserve
equipment provides Reserve Chiefs with a flexibility of prioritizing
funding.
UNFUNDED EQUIPMENT REQUIREMENTS
[The services are not listed in priority order.]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Air Force:
C-17 Globemaster III transport aircraft (15)........ $3.9 billion
C-130J Super Hercules (5)........................... 395 million
Battlefield Airborne Communications Node (2) lease 180.2 million
and operation......................................
Upgrade kits for the EC-130s/Compass Call 78 million
Modifications (4)..................................
HH-60G Pave Hawk (3) Search and Rescue.............. 120 million
AAQ-29 Forward Looking Infra Red System--FLIR (81) 81 million
HH-60G.............................................
Air Force Reserve:
C-5A Airlift Defense system (ADS) (42).............. 17.3 million
C-130H LAIRCM--Large Aircraft I/R Counter Measures 56.6 million
(6)................................................
C-130J LAIRCM (2)................................... 22 million
Missile Warning Systems and Electronic Protection, A- 27.9 million
10, F-16...........................................
C-5 Structural repair............................... 22 million
Note: USAFR has a $1 billion MILCON backlog.
Air National Guard:
C-40C pax aircraft, procurement (1) and avionics 98.6 million
upgrade............................................
C-38 aircraft, replacement program.................. 110 million
Radio, Beyond Line of Sight (BLOS) ADS TACSAT, F-15, 109.7 million
F-16C..............................................
Electronic Attack Pod, A-10, F-16C.................. 44 million
Helmet Mounted Cueing System, A -10, F-16C, HH-60G.. 38 million
Note: Air National Guard faces a MILCON backlog of $2
billion to recapitalize facilities.
Army:
Aviation Support Equipment.......................... 36.2 million
Field Feeding....................................... 30.7 million
Force XXI Battlefield Command Brigade and Below..... 179 million
Information System Security COMSEC.................. 44.8 million
Liquid Logistics Storage and Distribution........... 2 million
Army Reserve:
Palletized Load System (PLS) Trailer................ 27.8 million
Tactical Light Truck (Ambulance HMMWV, Armament 183.8 million
Carrier HMMWV, Troop/Cargo Carrier HMMWV)..........
Command Post (FBCB2/TOCS/UYK-128) computer set, 181.4 million
shelter............................................
Support (Antenna-OE-361(V)/Loudspeakers tactical)... 13.4 million
HEMTT (Tactical Heavy wrecker)...................... 55.9 million
Army National Guard:
CH-47F Chinook helicopters (6) in fiscal year 10.... 66 million
UH-60M Black Hawk medium-lift helicopter (10) in 164 million
fiscal year 10.....................................
Warfighter Information Network-Tactical (WIN-T)..... 1.2 billion
Communication Systems (JNN, SINCGARS, HF)........... 1.5 billion
Stryker combat vehicles, various configurations 1.4 billion
(549)..............................................
Note: $280 million/year is the investment necessary to
effectively recapitalize MILCON.
Navy:
P-3 Repair/Recovery Plan, kit installation.......... 462 million
Aviation Depot Maintenance, to fund 86 deferred 195 million
airframes and 314 engines..........................
Ship Depot Maintenance, for 20 surface ship 200 million
availabilities.....................................
C-130J Super Hercules (1) to replace Blue Angels 64 million
transport..........................................
Navy Reserve:
C-40A Combo cargo/passenger airlift aircraft (4).... 402 million
KC-130J Super Hercules aircraft (4)................. 256 million
Maritime Expeditionary Warfare Equipment............ 35.5 million
Maritime Prepositioning Force Utility Boats (RHIB).. 6.6 million
Information Systems Security Program................ 5.5 million
Marine Corps:
MTVR trailers (buys 352) to cover shortfall......... 28.9 million
Engineer Equipment for Logistics Support:
TRAMs, bucket loader (93)....................... 21 million
Forklift, Light Rough Terrain--LRTF (96)........ 13 million
Forklift, Extended Boom (177)................... 24 million
MV-22 Osprey Aircraft, Improvements, and Upgrades... 17.4 million
Mountain Terrain Support Vehicles (10).............. 10.2 million
Tier I UAS (146) Digital Data Link upgrade kits..... 10.5 million
Note: Military Construction requirements are $70.5
million.
Marine Forces Reserves:
KC-130Js Super Hercules tanker aircraft (2)......... 128 million
Light Armored Vehicles (14)......................... 21 million
Helmet Mounted Displays (SA-HMDs) Systems........... ..............
Theater Provided Equipment Sensors.................. ..............
------------------------------------------------------------------------
Conclusion
A4AD is a working group of military and veteran associations
looking beyond personnel issues to the broader issues of National
Defense.
This testimony is an overview, and expanded data on information
within this document can be provided upon request.
Thank you for your ongoing support of the Nation, the Armed
Services, and the fine young men and women who defend our country.
Please contact us with any questions.
Chairman Inouye. Now we have our final panel, consisting of
Dr. Philip Boudjouk; the president and CEO, Ms. Sandra Raymond,
Dr. George Zitnay, Captain Ike Puzon, of the Navy, Ms. Mary
Hesdorffer, Dr. Jonathan Berman, vice president--Mr. George
Dahlman, and General Michael Dunn.
Thank you very much.
Representing the Coalition of EPSCoR/IDeA States, Dr.
Philip Boudjouk. Is that the correct pronunciation?
Dr. Boudjouk. Mr. Chairman, ``boo-jock'' is the correct
pronunciation.
Chairman Inouye. Boudjouk.
Dr. Boudjouk. Boudjouk, thank you.
STATEMENT OF PHILIP BOUDJOUK, Ph.D., VICE PRESIDENT,
RESEARCH, CREATIVE ACTIVIES AND TECHNOLOGY
TRANSFER, NORTH DAKOTA STATE UNIVERSITY;
CHAIR, COALITION OF EPSCoR/IDeA STATES
Dr. Boudjouk. Chairman Inouye, Ranking Member Cochran,
members of the subcommittee, thank you for the opportunity to
testify today on the importance of maintaining and adequately
funding the Department of Defense DEPSCoR program.
My name is Philip Boudjouk, and I serve as the vice
president of research, creative activities, and technology
transfer at North Dakota State University, and I also serve as
chair of the Coalition of EPSCoR/IDeA States, a nonprofit
organization representing the 21 States and two territories
currently eligible to receive DOD DEPSCoR research awards.
DEPSCoR was originally authorized by section 257 of the
National Defense Authorization Act of 1995 to ensure a
nationwide, multi-State infrastructure to support the 6.1 basic
research needs of the Department of Defense. In recent years,
Congress has generously provided funding for DEPSCoR between
$15 and $17 million, and has affirmatively rejected efforts by
the previous administration to reduce the size of the program.
In the fiscal year 2009 National Defense Authorization Act,
the Senate directed a federally funded Research and Development
Center assessment of the DEPSCoR program to determine its value
to the Department and to the American taxpayer. The Institute
for Defense Analyses concluded that DEPSCoR has strengthened
the nationwide basic research capacity. More importantly, the
assessment determined that the DEPSCoR States' share of
nondefense--non-DEPSCoR DOD science and engineering funding
increased steadily from inception of the program to today.
However, the administration's proposed 2010 DOD budget
recommends no funding for DEPSCoR. The 23 eligible DEPSCoR
jurisdictions must therefore rely on Congress to ensure the
DEPSCoR program is adequately funded, at a level that ensures
our Nation maintains a nationwide infrastructure of DOD
research capabilities.
Allowing the DEPSCoR program to go unfunded in fiscal year
2010 will not only create a critical shortfall in our national
research infrastructure, but it will, likewise, have dire
consequences for DEPSCoR States that otherwise may not receive
an investment of DOD research funding. Therefore, we
respectfully request that the DEPSCoR program at a minimum of
$20 million.
Mr. Chairman, every State has important contributions to
make to our Nation's research competitiveness, and every State
has scientists and engineers that can contribute significantly
to supporting the research needs of DOD.
Thank you for the opportunity to testify before the
subcommittee.
Chairman Inouye. I thank you very much, sir.
[The statement follows:]
Prepared Statement of Philip Boudjouk
Chairman Inouye, Ranking Member Cochran, Members of the
Subcommittee: Thank you for the opportunity to testify today on the
importance of maintaining and adequately funding the Department of
Defense Experimental Program to Stimulate Competitive Research
(DEPSCoR) \1\.
---------------------------------------------------------------------------
\1\ Alabama, Alaska, Arkansas, Delaware, Hawaii, Idaho, Kansas,
Kentucky, Louisiana, Maine, Mississippi, Montana, Nebraska, Nevada, New
Hampshire, New Mexico, North Dakota, Oklahoma, Puerto Rico, Rhode
Island, South Carolina, South Dakota, Vermont, Virgin Islands, West
Virginia, and Wyoming.
States in bold letters are eligible for the DEPSCoR program. All of
the States listed above are also eligible for the EPSCoR program.
---------------------------------------------------------------------------
My name is Philip Boudjouk and I serve as the Vice President of
Research, Creative Activities and Technology Transfer at North Dakota
State University. I also currently serve as Chair of the Coalition of
EPSCoR/IDeA States, a non-profit organization representing the 21
States and 2 territories currently eligible to receive Department of
Defense DEPSCoR research awards.
EPSCoR States have a vast reservoir of talent and capacity. They
represent 20 percent of the U.S. population, 25 percent of the research
and doctoral universities, and 18 percent of the Nation's scientists
and engineers. The EPSCoR program is critical to ensuring that we
maintain a national infrastructure of research and engineering by
providing much needed funding to these leading universities and
scientists.
As you know, DEPSCoR was initially authorized by Section 257 of the
National Defense Authorization Act of 1995 (Public Law 103-337) to
ensure a nationwide, multi-State infrastructure to support the 6.1
basic research needs of the Department of Defense. Today, 21 States and
two territories participate in DEPSCoR, receiving grants from the
Department to perform research that directly responds to specific
priorities identified by the Department and announced under competitive
solicitations to the eligible DEPSCoR States.
At the program's peak funding level, DEPSCoR received nearly $25
million to fund Department of Defense basic research in eligible
States. In recent years, Congress has generously provided funding for
DEPSCoR between $15 million and $17 million, and has affirmatively
rejected efforts by the previous administration to reduce the size of
the DEPSCoR program.
Additionally, in the fiscal year 2009 National Defense
Authorization Act, the Senate directed a federally funded research and
development center assessment of the DEPSCoR program to determine its
value to the Department and to the American taxpayer. The Institute for
Defense Analayses (IDA) was entrusted with the assessment and concluded
in its study that DEPSCoR has strengthened the nationwide basic
research capacity in the following areas:
--DEPSCoR awards have funded first-time investigators in defense-
related basic research;
--DEPSCoR awards have contributed to publications and patents;
--DEPSCoR awards have supported graduate student and postdoctoral
training;
--DEPSCoR awards have supported purchase and maintenance of cutting
edge research equipment; and
--DEPSCoR awards have supported collaborations among researchers in
all States.
Perhaps most importantly, the IDA assessment determined that the
DEPSCoR States' share of non-DEPSCoR Department of Defense science and
engineering funding increased steadily from inception of the program to
today. This finding provides firm evidence that DEPSCoR is a valuable
use of taxpayer dollars because it demonstrates that DEPSCoR provides a
return on investment to the Department of Defense that far exceeds the
funding amount provided for the program each year.
Mr. Chairman, DEPSCoR is also a valuable use of taxpayer dollars
because it represents Federal research money well spent. Past DEPSCoR
research has included:
--designing helicopter rotors;
--modeling sea ice predictions to aid ship and submarine navigation;
--prediction of river currents for Navy operations;
--securing critical software systems;
--developing chem.-biodefense agents;
--enhancing stored energy density for weapons;
--improving wireless communication for warfighter systems;
--determining the effect of exposure of military personnel to extreme
physical and climatic conditions;
--preventing laser damage to aircraft optical guidance systems;
--increasing durability of lightweight composite materials; and
--developing small plastic air-vehicles for the Air Force.
Despite this important work, and despite the positive assessment
provided to the Senate by the Institute for Defense Analyses, the
administration's proposed fiscal year 2010 Department of Defense budget
recommends no funding for DEPSCoR. The 23 DEPSCoR eligible
jurisdictions must therefore rely on Congress once again to ensure the
DEPSCoR program is adequately funded at a level that ensures our Nation
maintains a nationwide infrastructure of Department of Defense research
capabilities.
Mr. Chairman, every State has important contributions to make to
our Nation's research competitiveness and every State has scientists
and engineers that can contribute significantly to supporting the
research needs of the Department of Defense. Accordingly, it is vital
that we build a Department of Defense research infrastructure that
leaves no State behind. Allowing the DEPSCoR program to go unfunded in
fiscal year 2010 will not only create a critical shortfall in our
national research infrastructure, but it will likewise have dire
consequences for DEPSCoR States that otherwise may not receive an
investment of Department of Defense research funding.
As the Committee considers the President's fiscal year 2010 budget
proposal for the Department of Defense, the Coalition of EPSCoR/IDeA
States, representing major research universities and institutions
across 23 participating jurisdictions, respectfully requests that the
DEPSCoR program be funded at a minimum of $20 million. Participating
DEPSCoR institutions continue to advance the basic research priorities
of the Department of Defense and it is the sincere hope of our
Coalition that this Subcommittee will consider robustly funding the
DEPSCoR program in fiscal year 2010.
The Coalition of EPSCoR/IDeA States is grateful for this
opportunity to testify before the Subcommittee. We look forward to
continuing to work with the Senate to ensure the DEPSCoR program fully
supports our Nation's critical research infrastructure requirements.
Thank you Mr. Chairman.
Chairman Inouye. And our next witness is the president and
chief executive officer of the Lupus Foundation of America, Ms.
Sandra Raymond.
Ms. Raymond?
STATEMENT OF SANDRA C. RAYMOND, PRESIDENT AND CHIEF
EXECUTIVE OFFICER, LUPUS FOUNDATION OF
AMERICA, INC.
Ms. Raymond. Thank you, Chairman Inouye, Ranking Member
Cochran, and all of the subcommittee members. We thank you for
the work that you are doing to serve and protect our country
and the health of our servicemen and women. I'm here today to
talk with you about a largely undiagnosed health issue of
concern in the military and in the population at large, and
that is lupus.
In April 2003, a 22-year-old female soldier was about to be
deployed to Iraq. As is the practice, she was given the
standard battery of vaccines, and soon after she received the
shots, she died. This soldier had undiagnosed lupus, and the
live viruses in the vaccine were said, by a panel of medical
experts, to have caused a fatal reaction.
In people with compromised immune systems, live viruses and
other triggers can cause the body to attack its own tissues and
organs, and this can lead to morbidity and death.
Lupus is a chronic, life-threatening disease of the immune
system. It's the prototypical autoimmune disease, and learning
more about it will provide clues to understanding autoimmune
diseases that affect 23 million Americans.
The disease principally affects young women in their
childbearing years, but men and children also develop lupus. It
is two to three times more common among African-Americans,
Hispanics, Asian Americans and Pacific Islanders, and American
Indians. This health disparity remains unexplained.
Three issues make lupus directly relevant to the DOD's
medical research program.
First, vaccinations given routinely to American servicemen
and women may trigger fatal reactions, especially since
military doctors have no way to screen for lupus or underlying
autoimmune diseases.
Second, lupus disproportionately affects minority
populations and young people, those most likely to be in the
military. Minorities comprise over one-third of the active duty
military members; and among enlisted women the percentage in
2004 was almost 40 percent.
Third, environmental stresses are known to cause lupus. We
know that genes linked to lupus are triggered by environmental,
hormonal, and stress factors. These may be exacerbated by
intense training, foreign deployment, exposure to chemical
agents, battle, and more.
But, there is a way to insure that military personnel are
protected, and that is through identification of biological
markers that can detect lupus. We all know that measurement of
blood pressure or cholesterol are biological markers that can
tell us if we're at risk for cardiovascular disease or stroke.
In lupus, scientists have now identified a number of biomarkers
that are prime candidates for validation. And, once validated,
an early detection test can be developed to screen for lupus.
With the leadership of military lupus scientists, and academic
centers across the United States, this research can get off to
a running start.
While it's important that lupus remain in the peer-review
program, we respectfully ask you to consider initiating what we
call the Lupus Biomarker and Test Development Research Project.
As part of the defense program, or the clinical investigation
program of force health protection and readiness, establishing
this program has the potential to save lives. Start-up costs
are estimated to be $6 million.
We thank you for the opportunity to speak today, and we
look forward to working with you to address this public health
issue.
Thank you.
Chairman Inouye. Thank you very much, Ms. Raymond.
[The statement follows:]
Prepared Statement of Sandra C. Raymond
Chairman Inouye, Ranking Member Cochran, and Distinguished
Subcommittee Members, my name is Sandra Claire Raymond and I am the
President and CEO of the Lupus Foundation of America. I want to take
this opportunity to thank you for all you are doing to serve and
protect our country and the health of our servicemen and women.
In April of 2003, a 22-year-old female soldier about to be deployed
to Iraq was given the standard battery of vaccines and soon after these
were administered she died. This soldier had undiagnosed lupus and live
viruses in the vaccines triggered a fatal reaction. Lupus is a chronic
and life-threatening disease that causes the immune system to become
unbalanced, causing inflammation and tissue damage to virtually every
organ system. It is the prototypical autoimmune disease and learning
more about lupus will have broad-ranging implications for the estimated
23 million Americans suffering from autoimmune diseases. Lupus affects
women, men and children, but, women in their child-bearing years are
most at risk. The disease is two to three times more common among
African Americans, Hispanics, Asian Americans and Pacific Islanders and
American Indians. This health disparity remains unexplained. A recent
study indicates that lupus annually costs the Nation an estimated $31.4
billion in direct and indirect expenditures.
Here are the issues that are directly relevant to the DOD's medical
research programs:
--Vaccinations given routinely to American Service men and women may
trigger fatal reactions. Military physicians have no way to
screen personnel for lupus or other autoimmune diseases prior
to administering necessary vaccinations.
--Lupus disproportionately affects minorities and young people--those
most likely to be in the military. Minorities comprise over one
third of the active duty military members. 2004 statistics
indicate that among active duty enlisted women, the minority
percentage is even higher: 38.7 percent are minorities. And,
again the 2004 statistics indicate that African Americans make
up 18.3 percent of the military but less than 13 percent of the
general population. African Americans are among those most at
risk for lupus. Their disease begins earlier in life and is
generally more severe. More than 90 percent of active duty
military personnel are age 40 or younger and lupus strikes
people between the ages of 15 and 44. In 2004, 11,000
individuals with lupus, active duty personnel and dependents,
receive care through the DOD healthcare system and that number
has been increasing in these last 5 years.
--Environmental stresses are known to cause lupus flares. Genes
linked to lupus may be triggered by environmental, hormonal and
stress factors exacerbated by intense training, foreign
deployment, exposure to unaccustomed environment, chemical
agents, battle and trauma.
Chairman Inouye, I want to thank you and the Congress for naming
lupus as one of the diseases that can be researched under the Peer
Reviewed Medical Research Program. The research projects that have been
funded since 2005 have provided valuable insights into this devastating
disease. However, in order to ensure that military personnel and their
families are protected, there is an urgent and unmet need to validate
biomarkers to detect lupus. Scientists have identified a number of
biomarkers that are now ready for validation and this work will lead to
an early detection test to screen for lupus. In fact, there is a
network of academic medical centers across the country interested in
this project and with leadership and coordination from the military
lupus scientists, this project can get off to a running start. We ask
that lupus remain in the congressionally directed Peer Reviewed Medical
Research Program; however, in addition, we believe that lupus biomarker
and test development research should originate in the DOD's Defense
Health Program. With respect, we ask for $6 million to establish this
program. Thank you for providing me with this opportunity to speak
today and I look forward to working with all of you to help improve the
lives of our soldiers living with lupus.
Chairman Inouye. Our next witness is Dr. Zitnay, co-founder
of the Defense and Veterans Brain Injury Center.
STATEMENT OF GEORGE A. ZITNAY, Ph.D., CO-FOUNDER,
DEFENSE AND VETERANS BRAIN INJURY CENTER
Dr. Zitnay. Good morning, Mr. Chairman, Vice Chairman
Cochran. It's a pleasure to be with you today.
As the chairman stated, I'm the co-founder of the Defense
and Veterans Brain Injury Center, and I recently retired, so
I'm here today as a volunteer on behalf of the participants in
the 2008 International Conference on Behavioral Health and
Traumatic Brain Injury, convened at the request of the
Congressional Brain Injury Task Force, chaired by Mr. Bill
Pascrell and Todd Platts.
I come before you today to request $370 million in funding
for brain injury care, research, treatment, and training,
through the Defense and Veterans Brain Injury Center, an
affiliate of the Defense Center of Excellence in Psychological
Health and TBI. As you know, TBI is the signature injury in the
wars in Iraq and Afghanistan, affecting over 360,000 of our
troops. Some 300,000 have also been identified as experiencing
post traumatic stress disorder.
Blast-related injuries, extended deployments, all
contribute to the unprecedented number of warriors suffering
from TBI and psychological conditions such as anxiety,
depression, PTSD, and, unfortunately, suicide.
The long-term effects and consequences of TBI and PTSD will
cost millions unless we start treating now, with available
technology that is now currently available in the private
sector.
In a report to Congress issued earlier this year, the
experts at the international conference noted that the private
sector--mostly academic centers of excellence across the
country, and major clinics--have available the advanced
technology and treatments that should be made available now to
our men and women, and our wounded warriors, especially in the
rural areas. They will benefit from this advanced care through
the use of telemedicine and rehabilitation.
For example, new technology, and new advances in brain
imaging, reveals that even the most severe--the most severe TBI
patient improves, with brain stimulation. It's electrical
stimulation applied to the inner brain. This helps the
individual wake up. And once they wake up we can then provide
rehabilitation until they gain function. We also know that
neutraceuticals can also help repair brain tissue.
Our request includes $50 million for a--DVBIC demonstration
project, to utilize these advanced techniques to improve the
standard of care for severe TBI patients. While many with
severe TBI will never return to active duty, some may, if they
get this advanced technology. But, most importantly, they will
be able to live a life worth living.
DVBIC is a partnership between the DOD and the VA with
the--trauma centers, and it was created by Congress to ensure
the optimum care is given.
Finally, we request $20 million for education and training
of brain injury specialists. There is confusion between mild
TBI and PTSD, but they are distinct conditions. TBI can be
mild, as in concussion, or severe, as in unresponsive states of
consciousness. Training is particularly needed in our rural
areas of the country, as some of our young men and women who
return home never get the chance to seek treatment, because it
is too far away.
Thank you for your leadership; thank you for your support
of the Defense and Veterans Brain Injury; but most of all for
your care for our wounded warriors.
Chairman Inouye. Thank you very much, Dr. Zitnay.
[The statement follows:]
Prepared Statement of George A. Zitnay
Dear Chairman Inouye, Vice Chairman Cochran and Members of the
Senate Appropriations Subcommittee on Defense: Thank you for this
opportunity to submit testimony in support of funding brain injury
programs and initiatives in the Department of Defense. I am George A.
Zitnay, PhD, a neuropsychologist and co-founder of the Defense and
Veterans Brain Injury Center (DVBIC).
I have over 40 years of experience in the fields of brain injury,
psychology and disability, including serving as the Executive Director
of the Kennedy Foundation, Assistant Commissioner of Mental Retardation
in Massachusetts, Commissioner of Mental Health, Mental Retardation and
Corrections for the State of Maine, and a founder and Chair of the
International Brain Injury Association and the National Brain Injury
Research, Treatment and Training Foundation. I have served on the
Advisory Committees to the Centers for Disease Control and Prevention
(CDC) and the National Institutes of Health (NIH), was an Expert
Advisor on Trauma to the Director General of the World Health
Organization (WHO) and served as Chair of the WHO Neurotrauma
Committee.
In 1992, as President of the national Brain Injury Association, I
worked with Congress and the Administration to establish what was then
called the Defense and Veterans Head Injury Program (DVHIP) after the
Gulf War as there was no brain injury program at the time. I have since
worn many hats, and helped build the civilian partners to DVBIC:
Virginia NeuroCare, Laurel Highlands and DVBIC-Johnstown. I recently
retired as an advisor to the Department of Defense (DOD) regarding
policies to improve the care and rehabilitation of wounded warriors
sustaining brain injury.
I am pleased to report that DVBIC continues to be the primary
leader in DOD for all brain injury issues. DVBIC has come to define
optimal care for military personnel and veterans with brain injuries.
Their motto is ``to learn as we treat.''
The DVBIC has been proactive since its inception, and what began as
a small research program, the DVBIC now has 19 sites.\1\ In 2007 your
committee helped move DVBIC funding from under the auspices of the
Uniformed Services University of the Health Sciences (USUHS) over to
the Army's Medical and Materiel Command at Fort Detrick. DVBIC is now
the key operational component for brain injury of Defense Centers of
Excellence for Psychological Health and Traumatic Brain Injury (DCoE)
under DOD Health Affairs.
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\1\ Walter Reed Army Medical Center, Washington, DC; Landstuhl
Regional Medical Center, Germany; National Naval Medical Center,
Bethesda, MD; James A. Haley Veterans Hospital, Tampa, FL; Naval
Medical Center San Diego, San Diego, CA; Camp Pendleton, San Diego, CA;
Minneapolis Veterans Affairs Medical Center, Minneapolis, MN; Veterans
Affairs Palo Alto Health Care System, Palo Alto, CA; Fort Bragg, NC;
Fort Carson, CO; Fort Hood, TX; Camp Lejeune, NC; Fort Campbell,
Kentucky; Boston VA, Massachusetts; Virginia Neurocare, Inc.,
Charlottesville, VA; Hunter McGuire Veterans Affairs Medical Center,
Richmond, VA; Wilford Hall Medical Center, Lackland Air Force Base, TX;
Brooks Army Medical Center, San Antonio, TX; Laurel Highlands,
Johnstown, PA; DVBIC-Johnstown, PA.
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I am here today to ask for your support for $370 million in the
Defense Appropriations bill for fiscal year 2010 for the DCoE which
includes $50 million specifically for a consortium of private sector
entities to partner with DCoE and DVBIC to move the standard of care
for brain injury forward, as well as $20 million for education and
training of brain injury specialists.
As you know, traumatic brain injury (TBI) is the ``signature
injury'' of the conflicts in Iraq and Afghanistan, affecting some
360,000 service personnel and some 300,000 have experienced post
traumatic stress disorder (PTSD). Blast-related injuries and extended
deployments are contributing to an unprecedented number of warriors
suffering from traumatic brain injury (ranging from mild, as in
concussion, to severe, as in unresponsive states of consciousness) and
psychological conditions such as anxiety, depression, PTSD and suicide.
The Rand Corporation, DOD, and CDC report that the long term
effects and consequences of TBI, PTSD, and other psychological health
issues will cost billions of dollars in care, treatment, and
rehabilitation unless action is taken. The Rand Report estimates that
PTSD-related and major depression-related costs could range from a 1-
year cost of $25,000 in mild cases to $408,000 for severe cases. The
total cost for TBI-related health issues is in the billions of dollars
and does not include the lost productivity or the deleterious effects
to quality of life. In reality, it has been well-established that the
health care needs of our young service members returning from OIF/OEF
are not being met and are overwhelming the current veterans' health
care system that has been primarily designed to care for elderly
veterans.
In 2005, the Conemaugh International Symposium, brought together 60
of the world's finest neuroscientists and physicians from across the
United States and from 12 other nations, including representatives from
the National Institutes of Health (NIH), CDC, DOD, Veterans
Administration (VA), and the National Institute for Disability and
Rehabilitation Research, resulting in a strong recommendation for
United States Congressional action to significantly improve outcomes in
wounded warriors with traumatic brain injury. In addition, the
Symposium report called for the creation of Seven Centers of Excellence
in TBI treatment, research and training to be located across the
Nation.
A second international meeting on Disorders of Consciousness
produced the Mohonk Report, in which scientists, ethicists, physicians,
and family members from across the United States, as well as leading
neuroscientists from Israel, Europe, and South America, collaborated to
prepare an action report to Congress that focused on Improving Outcomes
for Individuals with Disorders of Consciousness. The report called on
Congress to fund a network of highly specialized centers, utilizing the
latest technology available, to significantly improve outcomes for
wounded warriors living in the minimally conscious state.
A third follow-up meeting of experts, the Symposium on Severe and
Minimally Conscious Wounded Warriors, occurred in the spring of 2008,
in Johnstown, Pennsylvania. This meeting rendered a Feasibility Study
on treating wounded warriors with disorders of consciousness which was
subsequently delivered to the DVBIC for consideration.
Based upon the history and results of these international meetings,
the International Conference on Behavioral Health and Traumatic Brain
Injury was convened in October 2008, hosted by Congressmen Bill
Pascrell and Todd Platts, co-chairs of the Congressional Brain Injury
Task Force, and sponsored by the DOD, DVBIC, and numerous other groups
to prepare recommendations for action and funding by the United States
Congress.
The Executive Report from this meeting of over 100 international
experts generated critical recommendations in the areas of Research,
Education, Assessment, Family, and Treatment. The authors of the report
concluded: ``The over-arching goal is to provide our wounded warriors
and their families with what they deserve: the best health care and
support services that our state-of-the-art science and medicine have to
offer. In doing so, we will create a standard of excellence in military
health care, research, and training that will serve as an exemplary
model for the rest of the world.'' The report requested from Congress a
total of $350 million in funding to achieve that goal.
On March 12, 2009 representatives of the International Conference
unveiled a Report to Congress (the Paterson Report) calling for action
now to improve the care of wounded warriors.
The Paterson Report noted:
--new advances in brain imaging are revealing that even those with
the most severe levels of TBI have preserved brain tissue which
can be used through deep brain electrical stimulation to help
the individual wake up and regain function;
--new advanced technologies can help those wounded warriors with loss
of sight regain some vision;
--new cognitive protheses can help those wounded warriors with severe
memory loss regain the ability to plan and remember;
--neutraceuticals can help restore parts of damaged brains; and
--new screening and early automated psychological tools and tests can
help detect those at risk for PTSD and other psychological
disorders.
What we need to do now is to make these advanced technologies and
treatments that are available in the private sector available to our
wounded warriors, and we need to offer services and clinics in our
rural areas through telemedicine and tele-rehabilitation.
TREAT NOW CONSORTIUM
Our funding request includes $50 million specifically for the work
of a consortium of private sector providers (called TREAT NOW:
Treatment and Research Excellence Achieved Today: Neuroscientists for
Our Warriors) who have come together to improve the standard of care of
wounded warriors as soon as possible.
For those warriors who have sustained the most severe TBIs, the
recommendations from the Reports of the Aspen and Mohonk Meetings are
not being followed. Thus, the current standard of care for these
warriors is inconsistent, clinically unreliable, and not maximally
effective. The exact number of these wounded warriors from Operation
Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) who suffer
from severe disorders of consciousness (SDOC) is unknown. The DVBIC
reports that 4 percent of the 15,000 TBI patients examined and/or
treated by their Center suffer from SDOC. This is an underestimation of
the true number of warriors because it does not include those seen or
treated at other military hospitals and programs and the dependents of
wounded warriors and veterans.
Serving under the auspices of the DCoE, the Consortium will
complement, and partner with the DVBIC and the National Intrepid Center
of Excellence (NICoE) in their vision and commitment to improve the
current system of medical care and support for troops sustaining severe
TBIs. The partners include some of the best scientists, researchers and
rehabilitation specialists from around the United States. While
geographically diverse, participating members are heavily invested in
improving tele-health technologies. There is no project like it and DOD
Health Affairs is interested in moving it forward.
TBI VS. PTSD
Much has been accomplished by the DCoE in its efforts to improve
public awareness of TBI and psychological disorders, address the stigma
associated with such conditions, and help connect family, caregivers
and wounded warriors with appropriate information, treatment and
services.
There are concerns however about an overemphasis on psychological
disorders that affects the public perception of TBI. Many in the brain
injury medical and family support community do not want to see TBI
becoming considered a ``psychological disorder.'' This concern comes
from the fact that in no other health care system are psychological
issues and brain injury combined--not in the DVA, NIH, or any
university medical program. Brain injury specialists and family
advocates want to be assured that as much focus and funding is being
put into the science of brain injury rehabilitation and treatment as is
being put into the psychological effects of combat. Of the 25 programs
funded under the Congressionally Directed Medical Research Program with
2007 supplemental funding, only 8 were for brain injury.
We must not lose sight of the actual cause of subsequent
psychological problems. TBI can lead to depression and suicide but TBI
is not itself a psychological disorder. Treatments for TBI and PTSD are
not only different, but can be contraindicated and make the patient
worse. In working with the Wounded Warrior Project, I have heard many
stories of warriors with brain injury not getting the right treatment
because they were sent to a psychologist instead of a neuropsychologist
and given drugs for PTSD that exacerbated the effects of TBI.
There are harmful reports like the USA Today article on April 15,
2009 \2\, in which Cols. Charles Hoge and Carl Castro argue that the
DOD and DVA are overemphasizing mild TBI among troops and that the
focus should be more on the symptoms rather than the cause. Citing the
Hoge-Castro article in The New England Journal of Medicine, USA Today
reports that ``symptoms blamed on TBI after troops return home likely
are due to depression, PTSD or substance abuse . . . and overemphasis
on mild TBI keeps troops with those conditions from being properly
treated . . . most troops who suffered a concussion in battle recovered
within days of the injury.'' This is very damaging to the efforts to
improve public awareness of TBI.
---------------------------------------------------------------------------
\2\ Zoroya, Gregg, ``Officials: Troops Hurt by Brain Injury
Focus,'' USA Today, April 15, 2009.
---------------------------------------------------------------------------
A plethora of leading brain injury specialists dispute Hoge and
Castro's claims and urge caution in making changes to screening
procedures. David Hovda, PhD, Director of the Brain Injury Research
Center at UCLA, strongly recommended continuing screening, saying that
without it, troops may develop long-term neurological problems after
numerous concussions, similar to former professional football players.
Research conducted at the Defense Advanced Research Projects Agency
(DARPA) shows that the most common cause of TBI in combat, blast
injury, causes a range of injury from mild (concussion) to severe.
I urge your Committee to recommend that DOD continue its practice
of screening which is based on the best science available and offers
troops the best chance at recovery.
In addition the Paterson Report recommended that the National
Institutes of Health and the DOD convene a ``Consensus Conference'' to
clearly define mild TBI and PTSD and establish specific standards for
treatment. The Report recommended that definitions and treatment
standards be evidence based and incorporate a thorough review of
available treatment programs and outcome measures. The Report urged the
Consensus Conference to strive to equitably involve all stakeholders.
The confusion has devastating effects when it results in wounded
warriors not seeking treatment. DVBIC officials have reported that
troops are now less likely to seek help for mild brain injury if it is
considered to be a ``psychological disorder.''
President Obama made a speech last week regarding health care
reform and urged that we ``fix what's broken and move forward with what
works.'' The same should be said about improving DOD's health system.
While the increase in suicides has brought public attention to the
stresses of combat, the complex issues of TBI should not get lost or
overlooked. The research and treatment for TBI must remain distinct and
the focus of the DVBIC must be preserved. DVBIC needs to continue to be
recognized as the center of excellence in providing brain injury care
and research.
$20 million for education and training brain injury specialists
We recommend an additional $20 million be appropriated specifically
for training medical students in brain injury diagnosis, treatment and
rehabilitation. We need more brain injury specialists in the medical
field. More neurologists, neuropsychologists and physiatrists and
rehabilitation specialists should be educated by the Uniformed Services
University for the Health Sciences.
In summary, we respectfully request $370 million for fiscal year
2010 to enhance ongoing projects of the DCoE and to develop new
initiatives to improve the care of wounded warriors and support for
their families. We need to assure that our brave men and women who are
injured in the course of duty are given every possible opportunity for
the best medical care, rehabilitation and community reentry assistance
that we as a Nation can provide.
Thank you for your consideration of this request to help improve
the care of our wounded warriors.
Chairman Inouye. Our next witness is the director of
legislation, Association of the United States Navy, Captain Ike
Puzon.
STATEMENT OF CAPTAIN IKE PUZON, UNITED STATES NAVY
(RET.), DIRECTOR OF LEGISLATION,
ASSOCIATION OF THE UNITED STATES NAVY
Captain Puzon. Mr. Chairman, Mr. Vice Chairman, and the
Association of the United States Navy is grateful to have the
opportunity to testify today.
Our newly transitioned association is now focused on
equipment, force structure, policy issues, manpower issues, for
a total force.
Your unwavering support for our deployed servicemembers in
Iraq and Afghanistan and the worldwide fight against terrorism
is of crucial importance. AUSN would like to highlight three
areas of importance.
The C-40--first, the C-40 aircraft originally listed in the
unfunded list, to replace critically overused C-20G aircraft,
and to replace overaged and overused C-9 transport, both are
playing a vital role in Iraq and Afghanistan and worldwide
contingency operations.
Second, the EF-18 Growler aircraft for U.S. Navy and U.S.
Navy Reserves, specifically in the Navy Reserve, to replace
aged aircraft in a Maryland-based squadron that is currently
deployed to Iraq and Afghanistan.
And finally, number three, stabilization of authorized end-
strength for active Navy and Navy Reserve.
In recent years, the Pentagon has recommended the repeal of
separate budget requests for procurement Reserve equipment. A
combined appropriations for each service does not guarantee
needed equipment for National Guard and Reserve components. We
do not agree with the Pentagon's position on this issue, and
ask that the subcommittee continue to provide separate
appropriations against National Guard and Reserve equipment.
For the foreseeable future, we must be realistic about what
the unintended consequences are for a very high rate of usage
for active and Reserve components. Our active duty Navy and the
current Reserve members are pleased to making it--a significant
contribution to the Navy's defense as operational forces.
However, the reality of it all is that the added stress on the
total force could pose long-term consequences for our country
in terms of recruiting, retention, and family support. The Navy
has a total of over 10,000 people--personnel deployed in
Operation Iraqi Freedom (OIF). The Navy Reserve continues to
mobilize 4,500 sailors for the support of the ongoing global
war on terror (GWOT). Your Navy is engaged throughout.
We recognize that there are many issues that need address
by the subcommittee. We are perplexed by the short Navy
unfunded program list. History points to a larger list.
Overwhelmingly, we hear that--discussions and requirements for
more and better equipment for training total force is
necessary.
In summary, we believe the subcommittee needs to address
the following issues for total force, in the best interest of
our national security: fund the C-40A for Navy Reserve and
Navy, per previous supplementals, and we replace the C-9
transport and the C-20G; fund the E/F-18 Growler; increase
funding for the National Guard and Reserve equipment; and
establish end-strength stabilization for the Navy and Navy
Reserve.
Thank you for your--opportunity.
Chairman Inouye. Thank you very much, Captain Puzon.
[The statement follows:]
Prepared Statement of Ike Puzon
Mister Chairman and distinguished members of the Committee, the
Association of the United States Navy is very grateful to have the
opportunity to testify.
Our newly transitioned association looks at equipment, force
structure, policy issues, and manpower issues.
We would like to thank this Committee for the on-going stewardship
on the important issues of national defense and, especially, the
reconstitution and transformation of the Navy. At a time of war, non-
partisan leadership sets the example.
Your unwavering support for our deployed Service Members in Iraq
and Afghanistan and the world-wide fight against terrorism and piracy
is of crucial importance. AUSN would like to highlight some areas of
emphasis.
--C-40A Aircraft to replace critically overused C-20G in Hawaii and
Maryland; and, to replace over aged C-9 transports--both are
playing a vital role in Iraq and Afghanistan. They are not VIP
aircraft--but, can be used for such missions.
--EF/A 18 Growler aircraft for U.S. Navy and U.S. Navy Reserve--
specifically to replace aged aircraft in a Maryland based
squadron that is currently deployed to Iraq and Afghanistan.
--C-130J aircraft--to meet the intra-theater needs of the Geographic
Commanders and Navy component commanders.
These issues are in line with all previous years Navy and Navy
Reserve unfunded list.
As a Nation, we need to supply our service members (active duty and
reserve) with the critical equipment and support needed for individual
training, unit training, and combat.
In recent years, the Pentagon has recommended the repeal of
separate budget requests for procuring Reserve Equipment. A combined
equipment appropriation for each service does not guarantee needed
equipment for the National Guard and Reserve Components. For the Navy
Reserve, this is especially true. We do not agree with the Pentagon's
position on this issue and history has proven the requirements for
NGREA, and we ask this committee to continue to provide separate
appropriations against NG and RE requirements.
In addition to equipment to accomplish assigned missions, AUSN
believes that the Administration and Congress must make it a high
priority to maintain, if not increase, the end strengths of already
overworked, and perhaps even overstretched, military forces. This
includes the Active Duty Navy & Navy Reserve. The Navy Reserve has
always proven to be a highly cost-effective and superbly capable
operational and surge force in times of both peace and war. At a
minimum, the Navy Reserve should be stabilized since they are deployed
with active forces in Iraq and Afghanistan.
For the foreseeable future, we must be realistic about what the
unintended consequences are from a high rate of usage. History shows
that a Reserve force is needed for any country to adequately meet its
defense requirements, and to enable success in offensive operations.
Our Active Duty Navy and the current Reserve members are pleased to be
making a significant contribution to the Nation's defense as
operational forces; however, the reality of it all is that the added
stress on the Reserve could pose long term consequences for our country
in recruiting, retention, family and employer support. This issue
deserves your attention in Family Support Programs, Transition
Assistance Programs and for the Employer Support for the Guard and
Reserve programs.
At the same time, the Navy has a total of over 10,000 personnel
deployed in OIF/OEF theaters; Navy Reserve continues to mobilize over
4,500 Sailors in support for the on-going GWOT. Your Navy is engaged
throughout the world in operations.
Care must be taken that that tremendous reservoir of operational
capability be maintained and not capriciously dissipated. Officers,
Chief Petty Officers, and Petty Officers need to exercise leadership
and professional competence to maintain their capabilities. There is a
risk that they will not be able to do so in the present model of
utilization of Navy Reserve and Active Duty IA utilizations.
AUSN is perplexed by this year's Navy Unfunded Programs list
provided by the Chief of Naval Operations. We fully support CNO's
unfunded list. However, history points at a much larger unfunded list
and the needs are there.
Specific Equipment and Funding needs of the Navy Reserve include:
--C-40 funding to replace dangerously aged C-9s. These are war
fighting logistic weapons systems. 2 Aircraft were programmed
for fiscal year 2009 supplemental, and 4 were programmed for
fiscal year 2009 funding. The Navy did not get these funded. We
have to replace aging C-9s to maintain Navy and Marine Corps
engagement in the GWOT.
First:
--It is the Navy's only world-wide intra-theater organic airlift,
operated by the U.S. Navy.
--Navy currently operates 9 C-40As, in three locations: Fort Worth,
Jacksonville, San Diego.
--These aircraft are needed for Hawaii, Maryland, Texas and
Washington units.
--A pending CNA study--substantiates the requirements for 31-35 C-
40As to replace aging C-9s.
Second:
--CNO, SECNAV, & DOD have supported the requirement for C-40As.
--Commander, Naval Air Force 2007 Top Priority List stated the
requirement for at least 32 aircraft.
Third:
--Current average age of remaining C-9s that the C-40 replaces is: 38
years.
--There will be no commercial operation of the C-9s or derivates by
2011.
--C-9s can not meet the GWOT requirement, due to MC rates, and
availability of only 171 days in 2006.
--Modifications required to make C-9s compliant with stage III Noise
compliance, and worldwide Communications/Navigation/
Surveillance/Air Traffic Management compliance--are cost
prohibitive.
--There are growing concerns about the availability and Mission
Capability rates of the C-20Gs at Hawaii and Maryland units.
Fourth:
--737 Commercial Availability is slipping away, if we do not act now;
loss of production line positions in fiscal year 2008-09--due
to commercial demand would slip to 2013, and increase in DOD,
Service expenditures.
--C-130J procurement funding for 6 C-130s for the Navy Reserve.
--E/F-18 Growler procurement to replace aged and retiring EA-6B
aircraft at Maryland units, and for Active Duty Navy usage.
Currently the NR EA-6B unit provides 90 continuous detachments
in support of OIF/OEF.
--A full range of Navy Expeditionary Command equipment.
People join the Reserve Components to serve their country and
operate equipment. Recruiting and retention issues have moved to center
stage for all services and their reserve components. In all likelihood
the Navy will not meet its target for new Navy Reservists and the Navy
Reserve will be challenged to appreciably slow the departure of
experienced personnel this fiscal year. We've heard that Reserve Chiefs
are in agreement, expressing concern that senior personnel could leave
when equipment is not available for training. Besides reenlistment
bonuses which are needed, we feel that dedicated Navy Reserve equipment
and Navy Reserve units are a major factor in recruiting and retaining
qualified personnel in the Navy Reserve.
Overwhelmingly, we have heard Reserve Chiefs and Senior Enlisted
Advisors discuss the need and requirement for more and better equipment
for Reserve Component training. The Navy Reserve is in dire need of
equipment to keep personnel in the Navy Reserve and to keep them
trained. We must have equipment and unit cohesion to keep personnel
trained. This means--Navy Reserve equipment and Navy Reserve specific
units with equipment.
the reserve component as a worker pool
Issue: The view of the Reserve Component that has been suggested
within the Pentagon is to consider the Reserve as of a labor pool,
where Reservists could be brought onto Active Duty at the needs of a
Service and returned, when the requirement is no longer needed. It has
also been suggested that an Active Duty member should be able to rotate
off active duty for a period, spending that tenure as a Reservist,
returning to active duty when family, or education matters are
corrected.
Position: The Guard and Reserve should not be viewed as a
temporary-hiring agency. Too often the Active Component views the
recall of a Reservist as a means to fill a gap in existing active duty
manning.
EQUIPMENT OWNERSHIP
Issue: An internal study by the Navy has suggested that Naval
Reserve equipment should be transferred to the Navy. At first glance,
the recommendation of transferring Reserve Component hardware back to
the Active component appears not to be a personnel issue. However,
nothing could be more of a personnel readiness issue and is ill
advised. Besides being attempted several times before, this issue needs
to be addressed if the current National Security Strategy is to
succeed.
Position: The overwhelming majority of Reserve members join the RC
to have hands-on experience on equipment. The training and personnel
readiness of Reserve members depends on constant hands-on equipment
exposure. History shows, this can only be accomplished through Reserve
equipment, since the training cycles of Active Components are rarely if
ever--synchronized with the training or exercise times of Reserve
units. Additionally, historical records show that Reserve units with
hardware maintain equipment at or higher than average material and
often better training readiness. Current and future war fighting
requirements will need these highly qualified units when the Combatant
Commanders require fully ready units.
Reserve and Guard units have proven their readiness. The personnel
readiness, retention, and training of Reserve and Guard members will
depend on them having Reserve equipment that they can utilize,
maintain, train on, and deploy with when called upon. Depending on
hardware from the Active Component, has never been successful for many
functional reasons. The AUSN recommends the Committee strengthen the
Reserve and Guard equipment appropriation in order to maintain
optimally qualified and trained Reserve and Guard personnel.
In summary, we believe the Committee needs to address the following
issues for Navy and Navy Reservists in the best interest of our
National Security:
--Fund C-40A for the Navy Reserve, per the fiscal year 2009
Supplemental; we must replace the C-9s and replace the C-20Gs
in Hawaii and Maryland.
--Fund 6 C-130Js for the Navy Reserve, per the CNO unfunded list.
--Moratorium on Active Duty end-strength cuts.
--Establish an End-strength cap of 68,000 as a floor for end strength
to Navy Reserve manpower--providing for surge-ability and
operational force.
--Increase funding for Naval Reserve equipment in NGREA
--E/F-18 Growler aircraft for Navy and Navy Reserve units,
especially the NR unit stationed in Maryland.
--Explosive Ordnance Disposal Equipment
We thank the committee for consideration of these tools to assist
the Navy and Navy Reserve in an age of increased sacrifice and
utilization of these forces.
Thank you for your ongoing support of the Nation, the Armed
Services, The United States Navy, The United States Navy Reserve, and
the fine men and women who defend our country.
Chairman Inouye. Our next witness represents the
Mesothelioma Applied Research Foundation, Ms. Mary Hesdorffer.
STATEMENT OF MARY HESDORFFER, NURSE PRACTITIONER,
MEDICAL LIAISON, MESOTHELIOMA APPLIED
RESEARCH FOUNDATION (MARF)
Ms. Hesdorffer. Good morning, distinguished members of the
U.S. Senate Defense Appropriations Subcommittee. Thank you for
the opportunity to address you on a cruel cancer that kills our
veterans.
My name is Mary Hesdorffer, I'm a nurse practitioner, and
I'm the medical liaison to the Mesothelioma Applied Research
Foundation.
Your subcommittee has recognized the strong connection
between mesothelioma and military service. Because asbestos was
heavily used all over Navy ships, millions of servicemen and
shipyard workers were exposed. One study found that one-third
of today's meso victims were exposed on U.S. Navy ships, or
shipyards, like Pearl Harbor, Puget Sound, and Groton.
A renowned meso researcher from Lake Forest just shared
with me, the other night, that the rate of veterans who have
been exposed to asbestos have a sevenfold increase in
mesothelioma over the normal population. Dangerous exposures
continue today, and have been reported among the troops in Iraq
and Afghanistan, and there's also grave concern for our first
responders to 9/11. My son just returned from Iraq, and he was
a responder at 9/11, so I have a deep concern over these
exposures.
Asbestos is common in buildings, including the utility
tunnels right below us. For all those who develop mesothelioma
as a result, the only hope is that we will develop an effective
treatment, yet mesothelioma has virtually received no Federal
funding. Therefore, treatments have not advanced. We only have
one approved treatment for this disease; it takes a life
expectancy of between 6 to 9 months to, now, 12.2 months.
Your subcommittee has recognized the need and has taken the
lead. For the past 2 years, you have directed DOD to spur
research for meso by including it in the PR and RP. However,
your leadership was thwarted this year. Thirty-eight
mesothelioma research grants were submitted to the--for the
review year for 2008, which demonstrates a huge interest in
mesothelioma. But, while other diseases got six grants each,
DOD is funding only one mesothelioma grant.
It's critically needed, our research funding. The research
with--Dr. Courtney Broaddus is one of the world's top meso
experts, and she told us that, without this grant, she was
going to have to close her lab. This really has salvaged her
career.
Going forward on an award rate of 2.6 percent is still not
enough to encourage top researchers to apply, or new
researchers to establish their careers in mesothelioma. The
research will not advance, effective treatments will not be
found. We believe that the subcommittee must make clear to DOD
its intent to spur mesothelioma research by directing DOD to
establish funding of $67 million to DOD for seven new programs,
including a peer-reviewed cancer research program that does not
currently include mesothelioma.
It's a rapidly fatal, excruciatingly painful cancer,
directly related to military service. We ask the subcommittee
to appropriate DOD $5 million for a peer-reviewed cancer
research program that will boost the long-neglected field of
mesothelioma research, translating directly to saving lives and
reducing suffering in veterans.
Thank you.
Chairman Inouye. I thank you very much, Ms. Hesdorffer.
[The statement follows:]
Prepared Statement of Mary Hesdorffer
Distinguished members of the U.S. Senate Defense Appropriations
Subcommittee: Thank you for this opportunity to address a tragic
disease that kills our veterans. My name is Mary Hesdorffer. I am a
nurse practitioner with over a decade's experience in mesothelioma
treatment and research, and am the Medical Liaison for the Mesothelioma
Applied Research Foundation.
MALIGNANT MESOTHELIOMA
Mesothelioma is an aggressive cancer caused by asbestos. It is
among the most painful and fatal of cancers, as it invades the chest,
destroys vital organs, and crushes the lungs.
THE ``MAGIC MINERAL''--EXPOSURES WERE WIDESPREAD
From the 1930s through the 1970s asbestos was used all over Navy
ships. Millions of servicemen and shipyard workers were exposed. Many
of them are now developing mesothelioma, following the disease's long
latency period.
MESOTHELIOMA TAKES OUR HEROES
These are the people who served our country's defense. Heroes like
Admiral Elmo Zumwalt, Jr., Chief Naval Officer during Vietnam,
Commander Harrison Starn, who served from World War II through Vietnam,
and thousands of servicemen like USS Kitty Hawk Boilerman Lewis Deets,
who volunteered for Vietnam at barely 18, all struck down by
mesothelioma. Last year I testified about mesothelioma patient Bob
Tregget, who was exposed to asbestos aboard a nuclear submarine from
1965 to 1972. Following grueling best-available treatment, Bob was
recurrent and in extreme untreatable pain. But he was hanging on,
hoping the next treatment advance would come soon enough to help him.
It didn't and Bob passed away a few months ago.
Almost 3,000 more Americans like Bob die each year of mesothelioma,
and one study found that one-third were exposed on U.S. Navy ships or
shipyards, lost through service to country just as if they had been on
a battlefield.
Many more are being exposed now. Asbestos exposures have been
reported among the troops in Iraq and Afghanistan. There is grave
concern for the heroic first responders from 9/11, including my son,
who just returned from service in Iraq. Asbestos is common in
buildings. The utility tunnels in this very building have dangerous
levels. Even low-dose, incidental exposures cause mesothelioma.
Minnesota Congressman Bruce Vento worked near an asbestos-insulated
boiler in a summer college job. He died of mesothelioma in 2000. His
wife Sue Vento testified before you in 2007. For all those who will
develop mesothelioma as a result of these past or ongoing exposures,
the only hope is that we will develop effective treatment.
MESOTHELIOMA FUNDING HAS NOT KEPT PACE
Yet mesothelioma research has been overlooked. With the huge
Federal investment in cancer research through the NCI, and $4.8 billion
spent in biomedical research through the DOD Congressionally Directed
Research Program since 1992, we are winning the war on cancer and many
other diseases. But for mesothelioma, the National Cancer Institute has
provided virtually no funding, in the range of only $1.7 to $3 million
annually over the course of the last 6 years, and the DOD has not
invested in any mesothelioma research despite the military-service
connection. As a result, advancements in the treatment of mesothelioma
have lagged far behind other cancers. In fact, for decades, there was
no approved treatment better than doing nothing at all. Our veterans
who develop mesothelioma have an average survival of only 4-14 months.
NEW OPPORTUNITIES
But there is good news. Brilliant researchers are dedicated to
mesothelioma. The FDA has now approved one drug which has some
effectiveness, proving that the tumor is not invincible. Biomarkers are
being identified. Two of the most exciting areas in cancer research--
gene therapy and anti-angiogenesis--look particularly promising in
mesothelioma. The Meso Foundation has funded $6 million to support
research in these and other areas. Now we need the Federal Government's
partnership, to develop the promising findings into effective
treatments.
COMMITTEE'S LEADERSHIP THWARTED
Your committee has recognized the need and taken the lead. For the
past 2 years (fiscal years 2008 and 2009), you have directed DOD to
spur research for this service-related cancer by including it as an
area of emphasis in the Peer Reviewed Medical Research Program.
However, I have to report to you that unfortunately your leadership
in acting to spur mesothelioma research has been thwarted. DOD just
announced the results of the PRMRP program for fiscal year 2008.
Thirty-eight mesothelioma research projects were submitted. This
demonstrates the huge demand for mesothelioma research funding that we
testified about and that you directed DOD to address. But while other
diseases got six grants each, DOD (tentatively) funded only one
researcher (Courtney Broaddus) for a mesothelioma project. This is a
successful application rate of just 2.6 percent.
This is critically-needed funding. Dr. Broaddus is one of the
world's top mesothelioma researchers. Indeed she was president of the
International Mesothelioma Interest Group from 1999 through 2002. She
and her team were surviving on three now concluded grants from the Meso
Foundation. This DOD grant salvaged career in mesothelioma research.
(See attached 5/24/09 email from Dr. Broaddus to Meso Foundation
Executive Director Chris Hahn.) We are extremely grateful that thanks
to your leadership and the DOD's awarding this one grant this renowned
researcher will not have to abandon her investment and expertise in
mesothelioma. But 37 other researchers put in the time, effort and
expense to gather preliminary data and apply, and then were rejected.
What happens to them? Going forward, a success rate of just 2.6 percent
will discourage top researchers from applying in mesothelioma; they
will direct their effort and expertise into other, better funded
cancers. Similarly, new researchers will not establish their careers in
mesothelioma either. Mesothelioma research will not advance, effective
treatments will not be found, and veterans and current members exposed
to asbestos through their military service will be left without hope.
A DEDICATED INVESTMENT
Since the Committee's intent to spur mesothelioma research is not
being executed through the PRMRP, we believe the Committee must respond
by directing DOD to establish a dedicated mesothelioma program. For
2009, Congress added dedicated funding for all of the following as new
programs, in addition to the DOD's existing programs for Breast Cancer,
Prostate Cancer, Ovarian Cancer, Neurofibromatosis, Tuberous Sclerosis
Complex, and the Peer Reviewed Medical Research Program:
--Autism Research Program, $8 million;
--Gulf War Illness Research Program, $8 million;
--Amyotrophic Lateral Sclerosis Research Program, $5 million;
--Bone Marrow Failure Research Program, $5 million;
--Multiple Sclerosis Research Program, $5 million;
--Peer Reviewed Lung Cancer Research Program, $20 million;
--Peer Reviewed Cancer Research Program, $16 million, restricted as
follows: $4 million for research of melanoma and other skin
cancers as related to deployments of service members to areas
of high exposure; $2 million for research of pediatric brain
tumors within the field of childhood cancer research; $8
million for genetic cancer research and its relation to
exposure to the various environments that are unique to a
military lifestyle; and $2 million for non-invasive cancer
ablation research into non-invasive cancer treatment including
selective targeting with nano-particles.
All of these research areas warrant attention, but mesothelioma is
a rapidly fatal, excruciatingly painful cancer directly related to
military service. We ask the Committee to appropriate to DOD for fiscal
year 2010 $5 million for a dedicated Mesothelioma Research Program or
as a specific restriction within the Peer Reviewed Cancer Research
Program. This will boost the long-neglected field of mesothelioma
research, enabling mesothelioma researchers to build a better
understanding of the disease and develop effective treatments. This
will translate directly to saving lives and reducing suffering of
veterans battling mesothelioma.
We look to the Senate Defense Appropriations Subcommittee to
provide continued leadership and hope to the servicemen and women and
veterans who develop this cancer after serving our Nation. Thank you
for the opportunity to provide testimony before the Subcommittee and we
hope that we can work together to develop life-saving treatments for
mesothelioma.
Chairman Inouye. And now may I call upon the secretary
treasurer of the American Society of Tropical Medicine and
Hygiene, Dr. Jonathan Berman.
STATEMENT OF JONATHAN D. BERMAN, MD, Ph.D., COLONEL,
UNITED STATES ARMY (RET.), SECRETARY-
TREASURER, AMERICAN SOCIETY OF TROPICAL
MEDICINE AND HYGIENE
Dr. Berman. Mr. Chairman, ranking member, I welcome the
opportunity to testify before you today on behalf of the
American Society of Tropical Medicine and Hygiene, ASTMH.
I commend this subcommittee for its focus on the vital
issue of military infectious disease research, and the
important role of that research in protecting troops deployed
abroad.
I am Dr. Jonathan Berman, secretary/treasurer of ASTMH, and
a retired U.S. Army colonel.
With nearly 3,500 members, ASTMH is the world's largest
professional membership organization dedicated to the
prevention and control of tropical diseases. We represent,
educate, and support tropical medicine's scientists and
clinicians. I want to talk to you today about the importance of
funding for the DOD's infectious disease research and
particularly malaria research.
Malaria is one of the most serious health threats facing
U.S. troops serving abroad. The U.S. military has, for decades,
been on the forefront of global efforts to develop new
antimalarial drugs and the world's first malaria vaccine. These
research efforts are appropriately aimed at protecting and
treating the warfighter, but they have important civilian
applications, as well. Malaria is one of the greatest
infectious-disease killers, and countless lives worldwide have
been saved by antimalarial medicines developed in part or
primarily by the DOD.
Unfortunately, the parasite that causes malaria, like all
microorganisms, is adaptive and develops resistance to drugs
quickly. Until very recently, the military's first-line malaria
therapeutic and prophylactic agent was mefloquine, a drug
developed by military researchers to create a replacement for
chloroquine, used soon after World War II.
Mefloquine came into use in the 1980s, but parasites in
Southeast Asia have already developed resistance to it, and
resistance is now being identified in West Africa and South
America, as well. Consequently, the military no longer
considers mefloquine to be a first-line treatment, and at this
time the military does not have an ideal malarial prophylactic
agent. Ensuring that we can protect troops from malaria in
future deployments means that we must continue to develop new
drugs and an effective vaccine.
Military malaria research funding represented approximately
$23 million in fiscal year 2008, the most recent fiscal year
for which figures are available. This level is not commensurate
with the health threat malaria poses to military operations,
therefore ASTMH respectively requests that the subcommittee
increase funding for malaria research in fiscal year 2010 to
$30 million, and provide subsequent annual increases, ending up
at $77 million in funding in fiscal year 2015.
Mr. Chairman and ranking member, thank you for providing me
with the opportunity to speak today on behalf of ASTMH
regarding this important but often overlooked defense issue.
Chairman Inouye. Thank you very much, Dr. Berman.
[The statement follows:]
Prepared Statement of Jonathan D. Berman
Overview: The American Society of Tropical Medicine and Hygiene
(ASTMH) appreciates the opportunity to submit written testimony to the
Senate Defense Appropriations Subcommittee. With nearly 3,300 members,
ASTMH is the world's largest professional membership organization
dedicated to the prevention and control of tropical diseases. We
represent, educate, and support tropical medicine scientists,
physicians, clinicians, researchers, epidemiologists, and other health
professionals in this field.
Because the military operates in and deploys to so many tropical
regions, reducing the risk that tropical diseases present to servicemen
and women is often critical to mission success. Malaria is a
particularly important disease in this respect, because it is both one
of the world's most common and deadly infectious diseases, and the U.S.
military has a long history of deploying to regions endemic to malaria
and suffering malaria casualties as a result.
For this reason, we respectfully request that the Subcommittee
expand funding for the Department of Defense's longstanding and
successful efforts to develop new drugs, vaccines, and diagnostics
designed to protect servicemen and women from malaria while deployed
abroad. Specifically, we request that in fiscal year 2010, the
Subcommittee ensure that the Department of Defense spends $30 million
on malaria research and development. Furthermore, we request that the
Subcommittee provide annual increases such that total military spending
on malaria research is $76.5 million in fiscal year 2015. This funding
will support ongoing efforts by military researchers to develop a
vaccine against malaria and to develop new anti-malaria drugs to
replace older drugs that are losing their effectiveness as a result of
parasite resistance. Increased malaria research will help ensure that
our soldiers, sailors, airmen, and marines are protected from this
deadly disease when deployed to tropical regions.
We very much appreciate the Subcommittee's consideration of our
views, and we stand ready to work with Subcommittee members and staff
on these and other important tropical disease matters.
ASTMH
ASTMH plays an integral and unique role in the advancement of the
field of tropical medicine. Its mission is to promote global health by
preventing and controlling tropical diseases through research and
education. As such, the Society is the principal membership
organization representing, educating, and supporting tropical medicine
scientists, physicians, researchers, and other health professionals
dedicated to the prevention and control of tropical diseases. Our
members reside in 46 States and the District of Columbia and work in a
myriad of public, private, and nonprofit environments, including
academia, the U.S. military, public institutions, Federal agencies,
private practice, and industry.
The Society's long and distinguished history goes back to the early
20th century. The current organization was formed in 1951 with the
amalgamation of the National Malaria Society and the American Society
of Tropical Medicine. Over the years, the Society has counted many
distinguished scientists among its members, including Nobel laureates.
ASTMH and its members continue to have a major impact on the tropical
diseases and parasitology research carried out around the world.
The central public policy priority of ASTMH is reducing the burden
of infectious disease in the developing world. To that end, we advocate
implementation and funding of Federal programs that address the
prevention and control of infectious diseases that are leading causes
of death and disability in the developing world, and which pose threat
to U.S. citizens. Priority diseases include malaria, Dengue fever,
Leishmaniasis, Ebola, cholera, and tuberculosis.
MALARIA AND MILITARY OPERATIONS
Servicemen and women deployed from the U.S. military comprise a
majority of the healthy adults traveling each year to malarial regions
on behalf of the U.S. Government. For this reason, the U.S. military
has long taken a primary role in the development of anti-malarial
drugs, and nearly all of the most effective and widely used anti-
malarials were developed in part by U.S. military researchers. Drugs
that have saved countless lives throughout the world were originally
developed by the U.S. military to protect troops serving in tropical
regions during WWII, the Korean War, and the Vietnam War.
Fortunately, in recent years the broader international community
has stepped up its efforts to reduce the impact of malaria in the
developing world, particularly by reducing childhood malaria mortality,
and the U.S. military is playing an important role in this broad
partnership. But military malaria researchers are working practically
alone in the area most directly related to U.S. national security:
drugs and vaccines designed to protect or treat healthy adults with no
developed resistance to malaria who travel to regions endemic to the
disease. These drugs and vaccines would benefit everyone living or
traveling in the tropics, but are particularly essential to the United
States for the protection of forces from disease during deployments.
Unfortunately, the prophylaxis and therapeutics currently given to
U.S. servicemen and women are losing their effectiveness. During World
War II, the Korean War, and Vietnam, the quinine-based anti-malaria
drug chloroquine was the chemoprophylaxis and therapy of choice for the
U.S. military. Over time, however, the malaria parasite developed
widespread resistance to choloroquine, making the drug less effective
at protecting deployed troops from malaria. Fortunately, military
researchers at the Walter Reed Army Institute of Research (WRAIR)
achieved the scientific breakthroughs that led to the development of
mefloquine, which quickly replaced chloroquine as the military's front-
line drug against malaria.
The malaria parasite has consistently demonstrated a notorious
ability to quickly become resistant to new drugs, and the latest
generation of medicines is no exception. Malaria parasites in Southeast
Asia have already developed significant resistance to mefloquine, and
resistant strains of the parasite have also been identified in West
Africa and South America. In addition, there are early indications that
parasite populations in southeast Asia may already be developing
limited resistance to arteminisin, currently the most powerful anti-
malarial available. Indeed, the most deadly variant of malaria--
Plasmodium falciparum--is believed by the World Health Organization to
have become resistant to ``nearly all antimalarials in current use.''
This resistance is not yet universal among the global Plasmodium
falciparum population, with parasites in a given geographic area having
developed resistance to some drugs and not others. But the sheer speed
with which the parasite is developing resistance to mefloquine and
arteminisin--drugs developed in the 1970s and 1980s--reminds us that
military malaria researchers cannot afford to rest on their laurels.
Developing new anti-malarials as quickly as the parasite becomes
resistant to existing ones is an extraordinary challenge, and one that
requires significant resources. Without new anti-malarials to replace
existing drugs as they become obsolete, U.S. military operations in
regions endemic to malaria may be compromised.
Unfortunately, our limited ability to protect forces from malaria
infection is not hypothetical: overseas operations are already being
impacted. A 2007 study by Army researchers found that from 2000 through
2005, at least 423 U.S. service members contracted malaria while
deployed overseas, with the vast majority of these cases the result of
deployments to South Korea (where malaria has recently remerged along
the demilitarized zone with North Korea), Afghanistan and, to a lesser
extent, Iraq. Notably, none of these countries are thought of by
experts as being especially dangerous in terms of malaria, as opposed
to the many countries in Sub-Saharan Africa and Southeast Asia where
malaria is much more prevalent, and where more deadly strains of the
parasite thrive. For example, a 2003 peacekeeping operation in Liberia
resulted in a 44 percent malaria infection rate among Marines who spent
at least one night ashore.
Clearly, U.S. service members are insufficiently protected from
malaria. The reasons for this are many, and include drug resistance as
well as ongoing issues with compliance by soldiers who have difficulty
maintaining a malaria prophylaxis regimen under combat conditions, or
who have contraindications to the use of mefloquine or other drugs.\1\
Regardless of the cause for continuing vulnerability to malaria,
however, the outlook is the same: until a malaria vaccine is finally
developed, ensuring the safety and health of U.S. troops deploying to 1
of the more than 100 countries where malaria is endemic will require
the constant development of new malaria drugs, in a race against the
parasite's ability to develop drug resistances.
---------------------------------------------------------------------------
\1\ The aforementioned 2007 Army study found that of 11,725 active
duty Army personnel deployed to Afghanistan during the study period,
9.6 percent had contraindications to the use of mefloquine, the Army's
first-line malaria treatment.
---------------------------------------------------------------------------
To ensure that as many American soldiers as possible are protected
from tropical and other diseases, Congress provides funding each year
to support Department of Defense programs focused on the development of
vaccines and drugs for priority infectious diseases. To that end, the
Walter Reed Army Institute of Research and the Naval Medical Research
Center coordinate one of the world's premier tropical disease research
programs. These entities contributed to the development of the gold
standard for experimental malaria immunization of humans, and the most
advanced and successful drugs current being deployed around the world.
The need to develop new and improved malaria prophylaxis and
treatment for U.S. service members is not yet a crisis, but it could
quickly become one if the United States were to become involved in a
large deployment to a country or region where malaria is endemic,
especially sub-Saharan Africa. Fortunately, a comparatively tiny amount
of increased support for this program would restore the levels of
research and development investment required to produce the drugs that
will safeguard U.S. troops from malaria. In terms of the overall DOD
budget, that malaria research program's funding is small--approximately
$23.1 million in fiscal year 2008--but very important. Cutting funding
for this program would deal a major blow to the military's work to
reduce the impact of malaria on soldiers and civilians alike, thereby
undercutting both the safety of troops deployed to tropical climates,
and the health of civilians in those regions.
FISCAL YEAR 2010 DOD APPROPRIATIONS
To protect U.S. military personnel, research must continue to
develop new anti-malarial drugs and better diagnostics, and to identify
an effective malaria vaccine appropriate for adults with no developed
resistance to malaria. Much of this important research currently is
underway at the Department of Defense. Additional funds and a greater
commitment from the Federal Government are necessary to make progress
in malaria prevention, treatment, and control.
In fiscal year 2008, the Department of Defense spent only $23.1
million on malaria research, despite the fact that malaria historically
has been a leading cause of troop impairment and continues to be a
leading cause of death worldwide. As the 2006 Institute of Medicine
report Battling Malaria: Strengthening the U.S. Military Malaria
Vaccine Program noted, ``Malaria has affected almost all military
deployments since the American Civil War and remains a severe and
ongoing threat.'' ASTMH agrees that malaria remains a severe and
ongoing threat to U.S. military deployments to countries and regions
endemic to malaria, and we believe that increased support for efforts
to reduce this threat is warranted. A more substantial investment will
help to protect American soldiers and potentially save the lives of
millions of individuals around the world.
Therefore, we request that the Subcommittee take support a fiscal
year 2010 Department of Defense malaria research funding level of $30
million. Furthermore, we request that the Subcommittee provide annual
increases to this account such that total military spending on malaria
research is $76.5 million in fiscal year 2015.
By way of comparison with this request, in March of 2007 the
Department of Defense estimated that it would spend $23.1 million on
malaria research in fiscal year 2008. Unfortunately, neither an
estimated level of fiscal year 2009 spending nor a fiscal year 2010
request is available, because the Department of Defense does not
typically report these numbers. However, recent funding trends suggest
that military spending on research in this vital area is falling
steadily.
The role of infectious disease in the success or failure of
military operations is often overlooked, but even a cursory review of
U.S. and world military history underscores the fact that keeping
military personnel safe from infectious disease is critical to mission
success. The drugs and prophylaxis used to keep our men and women safe
from malaria during previous conflicts in tropical regions are no
longer reliable. Ensuring the safety of those men and women in future
conflicts and deployments will require research on new anti-malaria
tools. Thank you for your attention to this matter. We appreciate the
opportunity to share our views, and please be assured that ASTMH stands
ready to serve as a resource on this and any other tropical disease
policy matters.
Our next witness is the senior vice president for public
policy of The Leukemia & Lymphoma Society, Mr. George Dahlman.
STATEMENT OF GEORGE DAHLMAN, SENIOR VICE PRESIDENT FOR
PUBLIC POLICY, THE LEUKEMIA & LYMPHOMA
SOCIETY
Mr. Dahlman. Thank you very much, Mr. Chairman and Senator
Cochran.
I am George Dahlman, I'm pleased to appear today on behalf
of The Leukemia & Lymphoma Society, and all the thousands of
blood cancer patients we represent.
As you know, there have been impressive strides in blood
cancers--that's leukemia, lymphoma, myeloma, and some others--
but, there is a lot of work to be done, and we believe that the
public/private partnership that's part of the DOD's
congressionally directed medical research program is an
important part of that effort, and should be strengthened.
The Leukemia & Lymphoma Society, along with its partners,
believe that this is especially important for the Department of
Defense to address. First, research in blood-related cancers
has significant relevance to the Armed Forces because the
incidence of these cancers is substantially higher among
individuals with chemical and nuclear exposure. Higher
incidences of leukemia have been substantiated in extreme
nuclear incidents in both military and civilian populations,
and individual exposures to chemical agents, such as Agent
Orange in the Vietnam war, caused an increased risk of
contracting lymphoid malignancies.
And now we're seeing the applicability of blood cancer
research played out once again in Iraq and Afghanistan as U.S.
service personnel face consequences of burn pits and the blood
cancers that have been reported.
DOD research on blood cancers addresses the importance of
preparing civilian and military exposure to the weapons being
developed by several hostile nations, and aid in the research
of all cancers.
Mr. Chairman, and members of the subcommittee, with all due
respect to our colleagues fighting a broad range of
malignancies that are represented in this program, and
certainly not to diminish their significance, a cancer research
program designed for application of military and national
security needs would invariably begin with a strong blood-
cancer research foundation. And recognizing that fact and the
opportunity this research represents, a bipartisan group of 48
Members of Congress recently requested that the program be
instated for $25 million, and be expanded to all blood cancers.
Furthermore, we respectfully request that funding be
dedicated to a collaborative, public/private effort between the
United States Military Cancer Institute, The Leukemia &
Lymphoma Society, and a blue-ribbon panel of scientific
academicians.
Chairman Inouye, as the cosponsor of Senate Bill 51, which
authorizes the U.S. Military Cancer Institute, surely you
recognize that the USMCI has over 9 million electronic medical
records detailing the health histories of servicemen and women
and their families. The military also has serum and tissue
specimens from these individuals stored, as a routine step in
their healthcare. These records and samples together provide a
unique base that can power blood cancer research relevant to
the military environment and lifestyle in a way that is not
possible for any other population. A joint effort, tapping the
expertise of both the USMCI and The Leukemia & Lymphoma Society
represents a unique opportunity to identify valuable research
opportunities and state-of-the-art technology that can address
significant questions on the origins and diagnosis of blood
cancers.
And I would just add, Senator Inouye, it seems odd that
there is this disconnect between the USMCI, on the one hand,
that studies cancer, and the cancer programs that are done
through the CDMRP, as part--at Fort Dietrich--these two groups
do not communicate with one another.
The Leukemia & Lymphoma Society strongly endorses and
enthusiastically supports an effort to pursue this project, and
respectfully urges the subcommittee to include this funding in
the fiscal year 2010 defense appropriations bill.
Thank you.
Chairman Inouye. Thank you very much, Mr. Dahlman.
[The statement follows:]
Prepared Statement of George Dahlman
INTRODUCTION
Mr. Chairman and members of the committee, my name is George
Dahlman, Senior Vice President, Public Policy for The Leukemia &
Lymphoma Society. I am pleased to appear today and testify on behalf of
the Society and the more than 900,000 Americans currently living with
blood cancers and the 135,000 who will be diagnosed with one this
year--recently some of whom have been right here in the Senate
Furthermore, every 10 minutes, someone dies from one of these cancers--
leukemia, lymphoma, Hodgkin's disease and myeloma.
During its 60-year history, the Society has been dedicated to
finding a cure for the blood cancers, and improving the quality of life
of patients and their families. The Society has the distinction of
being both the nation's second largest private cancer organization and
the largest private organization dedicated to biomedical research,
education, patient services and advocacy as they pertain to blood
cancers.
Our central contribution to the search for cures for the blood
cancers is providing a significant amount of the funding for basic,
translational and clinical research. In 2009, we will provide
approximately $70 million in research grants. In addition to our
research funding role, we help educate health care and school
professionals as needed and provide a wide range of services to
individuals with a blood cancer, their caregivers, families, and
friends through our 64 chapters across the country. Finally, we
advocate responsible public policies that will advance our mission of
finding cures for the blood cancers and improving the quality of life
of patients and their families.
We are pleased to report that impressive progress is being made in
the effective treatment of many blood cancers, with 5-year survival
rates doubling and even tripling over the last two decades. More than
90 percent of children with Hodgkin's disease now survive, and survival
for children with acute lymphocytic leukemia and non-Hodgkin's lymphoma
has risen as high as 86 percent.
Just 7 years ago, in fact, a new therapy was approved for chronic
myelogenous leukemia, a form of leukemia for which there were
previously limited treatment options, all with serious side-effects--5-
year survival rates were just over 50 percent. Let me say that more
clearly, if 8 years ago your doctor told you that you had CML, you
would have been informed that there were limited treatment options and
that you should get your affairs in order. Today, those same patients
have access to this new therapy, called Gleevec, which is a so-called
targeted therapy that corrects the molecular defect that causes the
disease, and does so with few side effects. Now, 5-year survival rates
are as high as 96 percent for patients newly diagnosed with chronic
phase CML.
The Society funded the early research that led to Gleevec's
approval, as it has contributed to research on a number of new
therapies. We are pleased that we played a role in the development of
this life-saving therapy, but we realize that our mission is far from
realized. Many forms of leukemia, lymphoma and myeloma still present
daunting treatment challenges. There is much work still to be done, and
we believe that the research partnership between the public and private
sectors--as represented in the Department of Defense's Congressionally
Directed Medical Research Program--is an integral part of that
important effort and should be further strengthened.
THE GRANT PROGRAMS OF THE LEUKEMIA & LYMPHOMA SOCIETY
The grant programs of the Society have traditionally been in three
broad categories: Career Development Program grants, Translational
Research Program grants, and Specialized Centers of Research Program
grants. In our Career Development Program, we fund Scholars, Special
Fellows, and Fellows who are pursuing careers in basic or clinical
research. In our Translational Research Program, we focus on supporting
investigators whose objective is to translate basic research
discoveries into new therapies.
The work of Dr. Brian Druker, an oncologist at Oregon Health
Sciences University and the chief investigator responsible for
Gleevec's development, was supported by a Translational Research
Program grant from the Society.
Our Specialized Centers of Research grant program is intended to
bring investigators together to form new research teams focused on the
discovery of innovative approaches to treating and/or preventing
leukemia, lymphoma, and myeloma. The awards go to those groups that can
demonstrate that their close interaction will create research synergy
and accelerate our search for new and better treatments.
Dr. Druker is certainly a star among those supported by the
Society, but our support in the biomedical field is broad and deep.
Through the Society's research grant programs, we are currently
supporting more than 380 investigators at 134 institutions in 34 States
and 12 other countries.
Not content with these extensive efforts, the Society has launched
a new Therapy Acceleration Program intended to proactively invest in
promising blood cancer therapies that are in early stages of
development by industry, but which may not have sufficient financial
support or market potential to justify private sector investment. In
addition, the Society will use this program to further facilitate the
advancement of therapies in development by academic researchers who may
not have the spectrum of resources or expertise to fulfill the
potential of their discoveries. Directed early phase clinical trial
support in this funding program will further advance new and better
treatments for blood cancer treatments.
IMPACT OF HEMATOLOGICAL CANCERS
Despite enhancements in treating blood cancers, there are still
significant research challenges and opportunities. Hematological, or
blood cancers pose a serious health risk to all Americans. These
cancers are actually a large number of diseases of varied causes and
molecular make-up, and with different treatments, that strike men and
women of all ages. In 2009, more than 130,000 Americans will be
diagnosed with a form of blood-related cancer and almost 65,000 will
die from these cancers. For some, treatment may lead to long-term
remission and cure; for others these are chronic diseases that will
require treatments across a lifetime; and for others treatment options
are still extremely limited. For many, recurring disease will be a
continual threat to a productive and secure life.
A few focused points to put this in perspective:
--Taken together, the hematological cancers are fifth among cancers
in incidence and fourth in mortality.
--Over 900,000 Americans are living with a hematological malignancy
in 2009.
--Almost 65,000 people will die from hematological cancers in 2009,
compared to 160,000 from lung cancer, 41,000 from breast
cancer, 27,000 from prostate cancer, and 52,000 from colorectal
cancer.
--Blood-related cancers still represent serious treatment challenges.
The improved survival for those diagnosed with all types of
hematological cancers has been uneven. The 5-year survival
rates are:
--Hodgkin's disease, 87 percent;
--Non-Hodgkin's lymphoma, 64 percent;
--Leukemias (total), 50 percent;
--Multiple Myeloma, 33 percent;
--Acute Myelogenous Leukemia, 21 percent.
--Individuals who have been treated for leukemia, lymphoma, and
myeloma may suffer serious adverse consequences of treatment,
including second malignancies, organ dysfunction (cardiac,
pulmonary, and endocrine), neuropsychological and psychosocial
aspects, and poor quality of life.
--For the period from 1975 to 2005, the incidence rate for non-
Hodgkin's lymphoma increased by 79 percent (increasing 2.6
percent/year).
--Non-Hodgkin's lymphoma and multiple myeloma rank second and fifth,
respectively, in terms of increased cancer mortality since
1973.
--Lymphoma is the third most common childhood cancer and the fifth
most common cancer among Hispanics of all races. Recent
statistics indicate both increasing incidence and earlier age
of onset for multiple myeloma.
--Multiple myeloma is one of the top 10 leading causes of cancer
death among African Americans.
--Hispanic children of all races under the age of 20 have the highest
rates of childhood leukemias.
--Despite the significant decline in the leukemia and lymphoma death
rates for children in the United States, leukemia is still the
leading cause of death in the United States among children less
than 20 years of age, in females between the ages of 20 and 39
and males between the ages of 60-79.
--Lymphoma is the fourth leading cause of death among males between
the ages of 20 and 39 and the fifth leading cause of death for
females older than 80. Overall, cancer is now the leading cause
of death for U.S. citizens younger than 85 years of age,
overtaking heart disease as the primary killer.
POSSIBLE ENVIRONMENTAL CAUSES OF HEMATOLOGICAL CANCERS
The causes of hematological cancers are varied, and our
understanding of the etiology of leukemia, lymphoma, and myeloma is
limited. Extreme radiation exposures are clearly associated with an
increased incidence of leukemias. Benzene exposures are associated with
increased incidence of a particular form of leukemia. Chemicals in
pesticides and herbicides, as well as viruses such as HIV and EBV,
apparently play a role in some hematological cancers, but for most
cases, no environmental cause is identified. Researchers have recently
published a study reporting that the viral footprint for simian virus
40 (SV40) was found in the tumors of 43 percent of NHL patients. These
research findings may open avenues for investigation of the detection,
prevention, and treatment of NHL. There is a pressing need for more
investigation of the role of infectious agents or environmental toxins
in the initiation or progression of these diseases.
IMPORTANCE TO THE DEPARTMENT OF DEFENSE
The Leukemia & Lymphoma Society, along with its partners in the
American Society of Hematology, Aplastic Anemia & MDS International
Foundation, International Myeloma Foundation, Lymphoma Research
Foundation, and Multiple Myeloma Research Foundation, believe
biomedical research focused on the hematological cancers is
particularly important to the Department of Defense for a number of
reasons.
First, research on blood-related cancers has significant relevance
to the armed forces, as the incidence of these cancers is substantially
higher among individuals with chemical and nuclear exposure. Blood
cancers are linked to members of the military who were exposed to
ionizing radiation, such as those who occupied Japan after World War II
and those who participated in atmospheric nuclear tests between 1945-
1962. Service members who contract multiple myeloma, non-Hodgkin's
lymphoma, and leukemias other than chronic lymphocytic leukemia are
presumed to have contracted these diseases as a result of their
military service; hence, they are eligible to receive benefits from the
Department of Veterans Affairs (VA).
Secondly, in-country Vietnam veterans who contract Hodgkin's
disease, chronic lymphocytic leukemia, multiple myeloma, or non-
Hodgkin's lymphoma are presumed to have contracted these diseases as a
result of their military service and the veterans are eligible to
receive benefits from the VA.
Thirdly, the Institute of Medicine (IOM) has found that Gulf War
veterans are at risk for contracting a number of blood cancers. For
instance, the IOM has found sufficient evidence of a causal
relationship between exposure to benzene and acute leukemias.
Additionally, the IOM has found there is sufficient evidence of an
association between benzene and adult leukemias, and solvents and acute
leukemias. Finally, the IOM has also found there is also limited or
suggestive evidence of an association between exposure to
organophosphorous insecticides to non-Hodgkin's lymphoma and adult
leukemias; carbamates and Benzene to non-Hodgkin's lymphoma; and
solvents to multiple myeloma, adult leukemias, and myelodysplastic
syndromes--a precursor to leukemia.
Furthermore, research in the blood cancers has traditionally
pioneered treatments in other malignancies. Cancer treatments that have
been developed to treat a blood-related cancer are now used or being
tested as treatments for other forms of cancer. Combination
chemotherapy and bone marrow transplants are two striking examples of
treatments first developed for treating blood cancer patients. More
recently, specific targeted therapies have proven useful for treating
patients with solid tumors as well as blood cancers.
From a medical research perspective, it is a particularly promising
time to build a DOD research effort focused on blood-related cancers.
That relevance and opportunity were recognized for a 6-year period when
Congress appropriated $4.5 million annually--for a total of $28
million--to begin initial research into chronic myelogenous leukemia
(CML) through the Congressionally Directed Medical Research Program
(CDMRP). As members of the Subcommittee know, a noteworthy and
admirable distinction of the CDMRP is its cooperative and collaborative
process that incorporates the experience and expertise of a broad range
of patients, researchers and physicians in the field. Since the Chronic
Myelogenous Leukemia Research Program (CMLRP) was announced, members of
the Society, individual patient advocates and leading researchers have
enthusiastically welcomed the opportunity to become a part of this
program and contribute to the promise of a successful, collaborative
quest for a cure.
In spite of the utility and application to individuals who serve in
the military, the CML program was not included in January's 2007
Continuing Resolution funding other fiscal year 2007 CDMRP programs.
This omission, and the program's continued absence seriously
jeopardizes established and promising research projects that have clear
and compelling application to our armed forces as well as pioneering
research for all cancers.
Recognizing that fact and the opportunity this research represents,
a bipartisan group of 45 Members of Congress have requested that the
program be reconstituted at a $25 million level and be expanded to
include all the blood cancers--the leukemias, lymphomas and myeloma.
This would provide the research community with the flexibility to build
on the pioneering tradition that has characterized this field.
With all due respect to our colleagues fighting a broad range of
malignancies that are represented in this program--and certainly not to
diminish their significance--a cancer research program designed for
application to military and national security needs would invariably
include a strong blood cancer research foundation. DOD research on
blood cancers addresses the importance of preparing for civilian and
military exposure to the weapons being developed by several hostile
nations and to aid in the march to more effective treatment for all who
suffer from these diseases. This request clearly has merit for
inclusion in the fiscal year 2010 legislation.
Furthermore, we respectfully request that funding be dedicated to a
collaborative public-private effort between the U.S. Military Cancer
Institute, The Leukemia & Lyphoma Society and a blue ribbon panel of
scientific academicians.
The USMCI has over 9 million electronic medical records detailing
the health histories of service men and women and their families. The
military also has serum and tissue specimens from these individuals
stored as a routine step in their health care. These records and
samples, together, provide a unique base that can power blood cancer
research relevant to the military environment and lifestyle in a way
that is not possible for any other population.
A joint effort, tapping the expertise of both USMCI and LLS,
represents a unique opportunity to identify valuable research
opportunities and state-of-the-art technology that can address
significant questions on the origins and diagnosis of blood cancers.
For example:
--meta-analysis of the existing data may be used to gain insight into
the exposure risks inherent in the military environment that
may predispose the war fighter or their dependents to develop
blood cancer.
--Gene profiling might be used to gauge the existing genetic risk for
blood cancer in a given individual and may guide the delivery
of healthcare and/or deployment decisions.
--Proteomic analysis of historically preserved serial blood samples
from a military member diagnosed with blood cancer may reveal
exposures related to development of the disease and drive
decisions about safety precautions and protective gear.
The Leukemia & Lymphoma Society strongly endorses and
enthusiastically supports this effort and respectfully urges the
Committee to include this funding in the fiscal year 2010 Defense
Appropriations bill.
We believe that building on the foundation Congress initiated over
a 6-year period should not be abandoned and would both significantly
strengthen the military's cancer program and accelerate the development
of all cancer treatments. As history has demonstrated, expanding its
focus into areas that demonstrate great promise; namely the blood-
related cancers of leukemia, lymphoma and myeloma, would substantially
aid the overall cancer research effort and yield great dividends.
Chairman Inouye. And now may I call upon the president of
the Air Force Association, Lieutenant General Michael M. Dunn.
STATEMENT OF LIEUTENANT GENERAL MICHAEL M. DUNN (RET.),
PRESIDENT/CHIEF EXECUTIVE OFFICER, AIR
FORCE ASSOCIATION
General Dunn. Thank you, Mr. Chairman.
Last but not least. Mr. Chairman, Mr. Vice Chairman, I'm
honored to be with you today to talk about the fiscal year 2010
defense budget.
I represent 120,000 members of the Air Force Association,
and I need to point out to this subcommittee that we are
independent of the Air Force, that the Air Force has not made
any inputs, nor seen my statement or my remarks.
At this time I request my written statement be included in
the record.
Chairman Inouye. Without objection.
General Dunn. Mr. Chairman, I have to tell this
subcommittee I'm worried, at this point in history, about the
future. The average age of Air Force aircraft is the oldest in
its very short history--25 years old, one-quarter of a century.
Some types of aircraft are over 50 years old, and, when they
are eventually replaced, some are going to be over 90 years
old.
To begin to replace the fleet, the Air Force has to buy
about 165 aircraft per year, of all types. The 2010 budget
request purchases only 81 aircraft, and 29 of them are unmanned
aerial vehicles, and 13 are for the Air Force Academy.
This puts the Air Force on a replacement rate of about 100
years. Obviously, this is not a sustainable path. Costs to keep
the fleet are rising--fleet ready--are rising, many aircraft
have been grounded over the past few years, planes are breaking
in unpredictable ways, and readiness rates are falling. Our men
and women who serve deserve the very best we, as a Nation, can
provide to them. We have to turn this around.
DOD has stated they need to rebalance the force to focus on
irregular warfare (IW). The sad fact is, they have to do both--
modernize and recapitalize, as well as focusing on IW.
I hope DOD is right about the future, that they won't face
a strong opponent. But, the one thing certain about the future
is we have been wrong over the type of opponent we will face.
We did not anticipate the Japanese attacking the Hawaiian
Islands in World War--to begin World War II for the United
States; we did not anticipate the Korean War, Vietnam, the fall
of the Soviet Union, Iraq's attack on Kuwait, 9/11, nor
Operation Iraqi Freedom. To maintain that all wars in the
future will be irregular wars is--well--not supported by the
lessons of the past.
The decisions made by DOD and this Congress are ones we
will live with for a long time. They are 30-year decisions.
When the Nation terminates or delays seven aircraft production
lines, the impact on our aerospace industry is devastating. And
this is an industry that adds almost $40 billion per year in
positive trade balance. Engineers, design teams, and innovation
will be lost, or hard or expensive to replace; tens of
thousands of jobs will be lost. And these are high paying
manufacturing jobs that benefit, not just local communities,
but the Nation as a whole.
Mr. Chairman, I think you can see why I'm worried. This is
not just about one system or another, this is about air power,
our asymmetric advantage and the reason our past conflicts have
so spectacular, with some of the lowest friendly casualty rates
in the history of warfare. We have to nurture this capability
for the future.
And thank you for your time, sir.
Chairman Inouye. Well, thank you very much, General Dunn.
[The statement follows:]
Prepared Statement of Michael M. Dunn
Ladies and gentleman of the Committee, I am honored to come before
you today, representing the Air Force Association, to discuss your
United States Air Force. I would like to begin my remarks by saluting
our Airmen who strive every day to ensure that America's Air Force is
second to none. These men and women are true heroes and we salute their
dedication and determination, while also recognizing the sacrifices
they make for our Nation.
To borrow a phrase from General Schwartz, the United States Air
Force is truly ``all in.'' Whether deterring potential adversaries,
striking strategic targets, gathering critical intelligence, delivering
humanitarian relief supplies, evacuating wounded, airlifting cargo
around the globe, enabling command and control, rescuing personnel
behind enemy lines, or providing close air support, the Air Force is an
invaluable national asset. Just looking at operations in Iraq and
Afghanistan, the Air Force has flown nearly 60,000 sorties this year
alone. In the real world, this translates into Airmen doing their very
best 24/7 to fight and win on the front lines along with their joint
team partners.
While we are certainly proud of the Air Force's current record,
this success cannot be taken for granted. The Air Force has spent the
past two decades engaged in continuous combat operations and is
utilizing an aircraft fleet that averages nearly a quarter of a century
in age--with some planes in the inventory dating back to the Eisenhower
Administration.
The most obvious problem associated with this aging fleet is that
old airplanes break more often and eventually are no longer airworthy.
In the time since Desert Storm the average age of the Air Force fleet
has increased by nearly a decade and the availability rate has dropped
in a corresponding fashion. This means that since 1991 the percentage
of time an aircraft is not broken and can fly a mission has fallen from
77 percent to 65 percent. Aside from these costly maintenance
challenges, a number of dramatic airworthiness issues have also
afflicted the Air Force fleet. In 2000 the service grounded one third
of its KC-135 air refueling aircraft because of a faulty flight control
component. In 2004 the Air Force discovered that many of its C-130s had
major cracks in their wings. In 2007 an F-15 broke in two while on a
training flight due to structural fatigue, grounding the entire fleet
for months. In 2008 the entire T-38 fleet was grounded for an extended
period because of an aging control surface fixture. Most recently, half
of the A-10 fleet was grounded due to wing cracks and the C-130 fleet
was also grounded due to a faulty bolt found in the wings of many of
the aircraft. More problems are certain to arise as the age of the
fleet continues to increase.
It is also important to consider that most next generation aircraft
yield tremendous operational efficiencies that dramatically offset
their higher per-unit acquisition cost and yield long-term savings.
This performance increase was clearly demonstrated on the first night
of Desert Storm when 20 new F-117 stealth fighters took the
unprecedented step of attacking 28 separate targets. On the same night
it took a combined force of 41 legacy non-stealth aircraft to strike
one target--4 F/A-18s to defend against enemy aircraft, 3 drones to
serve as decoys, 5 EA-6B aircraft to jam enemy radar, along with 4 F-4s
and 17 F/A-18s to suppress enemy surface-to-air missiles so that 4 A-6s
and 4 Tornadoes could strike one target. The full spectrum cost imposed
by these legacy aircraft was tremendous--aircraft development and
acquisition funding, operations and maintenance expenses, personnel
bills, base access issues, etc. Viewed from this perspective, the
encompassing price of new aircraft like the F-22 and F-35 is not so
high.
The global threat environment is rapidly evolving and proliferation
of modern weaponry is negating the survivability of the Air Force's
legacy fleet. Over 30 nations operate fighter aircraft that equal or
exceed the capabilities of the F-15 and F-16, whose designs
respectively date back to the 1960s and 1970s. Nations such as Russia
and China are also developing 5th generation fighters that will have F-
22-like capabilities and will be bought in F-35-like quantities . . .
and sold to other countries. Additionally, dozens of nations operate
surface-to-air missiles that can easily shoot down aircraft such as the
B-1, B-52, F-15, F-16, F-18, Predator, Global Hawk, and more. It is
important to remember that in the final days of Vietnam the Air Force
lost 15 B-52s in 12 days during Operation Linebacker II. Air defenses
have advanced markedly since then but 47 percent of the long range
strike fleet is comprised of these same B-52s. Had the U.S. Air Force
been called upon to engage in the recent Georgian conflict, the B-2 and
F-22 were the only aircraft in the U.S. inventory that would have
survived in the threat environment. U.S. national security demands a
broader array of effective capabilities than just 20 B-2s and 186 F-
22s.
The fiscal year 2010 budget proposal currently under consideration
by Congress fails to make necessary recapitalization investments and
actually exacerbates the challenges facing several key mission sets.
For example, the fiscal year 2010 budget proposal ends production of
the F-22 at 187 aircraft even though the stated military requirement is
for 243 airframes. A fleet comprised of 187 airframes yields a force of
about 100 combat-ready aircraft, no attrition/reserve inventory, and
too few aircraft to engage/deter in more than one operation at a time.
All known analysis undertaken to this point has concluded such a
limited fleet size entails high risk. Air dominance is the precondition
for all successful U.S. military combat operations--this isn't just
about the U.S. Air Force--it is essential for the entire joint team.
This year's budget also discontinues C-17 acquisition at 205
aircraft even though demand for airlift is so high that the Air Force
is currently flying its C-17 airframes over 1,000 hours past what was
originally programmed per year. Additional developments have seen the
ground component grow by 92,000 Soldiers and Marines, increased
reliance on airlift, to include leased Russian aircraft, to get
equipment to Afghanistan and Iraq, and a decision to relocate many
units back to CONUS. Each one of these developments suggests that the
need for military airlift will increase. Closing the C-17 production
line at 205 aircraft risks creating a high-demand low-density mission
set.
Even though existing Combat Search and Rescue (CSAR) helicopters
are rapidly nearing the end of their service lives, the budget cancels
their replacement program. CSAR is a moral imperative. Our current
enemies do not take prisoners of war. They welcome the opportunity to
torture and kill their captives, making CSAR even more critical than
before. In fact, the Air Force CSAR capabilities are in such high
demand in Iraq and Afghanistan that the Weapons School has been closed
so that a maximum number of assets can be surged forward.
The Next Generation Bomber program was also cancelled even though
the current long range strike fleet averages over 40 years in age.
While elements of the force are still capable in certain threat
environments, the proliferation of advanced anti-access weaponry is
curtailing when and where many of the legacy assets can successfully
operate. Twenty B-2s are the only long range strike assets in the Air
Force inventory that can penetrate high threat environments and
survive. These aircraft are approaching 20 years in age, have not been
in production since 1997, and have no viable replacements to backfill
losses. During the Cold War, bombers were primarily viewed as nuclear
deterrence assets. However, actual combat operations have demonstrated
that long range conventional strike is an incredibly important tool.
Modern long range bombers can penetrate air defense systems, respond
rapidly to strike fleeting targets, and operate over long distances
without excessive logistical support. The tactical strike fleet, while
capable, simply does not have the range and payload capabilities to
fulfill many of these missions.
The Airborne Laser (ABL) program was also curtailed even though
nuclear weapons proliferation, combined with advances in delivery
system technology, is yielding an increasingly dangerous world.
Sufficient investment in robust missile defense capabilities is
essential for the security of United States and its allies.
Cumulatively, these decisions will also have a tremendous impact on
the defense industrial base. This sector is an invaluable strategic
partner for the United States. Whether addressing problems through
innovation, delivering high-quality products that enable our forces to
attain victory, or developing solutions for future challenges, the
industrial base is a critical national security asset. The United
States is rapidly approaching the point where it will be limited to one
major heavy aircraft production line (Boeing in Seattle, WA) and one
advanced fighter production facility (Lockheed Martin in Fort Worth,
TX). The proposed fiscal year 2010 budget cuts rapidly accelerate the
decline of this sector. The barriers to entry are extraordinarily high
within the military aerospace industrial base and once the Nation loses
certain core competencies, they will be exceedingly difficult and
costly to regenerate. For example, low observable (stealth) design
teams are incredibly skilled in a highly nuanced field that does not
lend itself to dual-use applications within the civilian aerospace
sector. If projects are not forthcoming to maintain this skill set,
then the country will face major challenges trying to regenerate such
capabilities in the future. Additionally, the military aerospace sector
will have an increasingly difficult time recruiting and retaining
talent amidst these challenging times. Failing to build a viable and
competent workforce for the next generation will have a dramatic impact
on the national security options available to the Nation for the
foreseeable future.
Clearly the United States Air Force is at a strategic crossroads.
The Nation cannot realistically expect Airmen to successfully engage
and survive in future campaigns if it does not equip them with modern
and effective equipment. One of the key lessons from history is the
importance of preparing for the full spectrum of operations. This
country has failed to anticipate numerous critical events--Pearl
Harbor, Berlin Blockade, Cuban Missile Crisis, Soviet Invasion of
Afghanistan, fall of the Shah in Iran, end of the Cold War, Iraq's
invasion of Kuwait, 9/11, etc. Events in the modern world develop
rapidly and the country has to respond quickly with the forces on hand.
The days of WWII-like rapid wartime industrialization are gone. Aside
from rudimentary supplies, effective weapons systems can no longer be
developed in a matter of months and events are often decided by the
time new items are fielded. This demands that the Nation prepare for a
wide variety of contingencies. Otherwise, the lives of the men and
women in uniform will be placed at undue risk as they struggle to
achieve their respective objectives with inadequate tools. While
airpower can operate with relative impunity in current operations, such
access must not be taken for granted in the future. Current legacy
systems will last a few more years, but eventually they will be
retired. Most of the cuts involved in this budget kill the platforms
that were intended to replace these legacy systems. The Chief of Staff
of the Air Force has stated he needs to buy 165 aircraft per year in
order to keep the average age of the fleet the same as it is now--a
quarter of a century old. This budget only buys 81 aircraft--13 of
which are for the Air Force Academy and 29 of which are UAVs. That puts
the Air Force on a replacement rate of over 100 years. It is important
that Congress and the American people fully appreciate the full
ramifications of these decisions. We risk imposing drastic limitations
on the strategic options available to the country for decades into the
future.
ADDITIONAL SUBMITTED STATEMENT
Chairman Inouye. The subcommittee has received testimony
from the National Military and Veterans Alliance and their
testimony will be made part of the record.
[The statement follows:]
Prepared Statement of the National Military and Veterans Alliance
The Alliance was founded in 1996 as an umbrella organization to be
utilized by the various military and veteran associations as a means to
work together towards their common goals. The Alliance member
organizations are: American Logistics Association; American Military
Retirees Association; American Military Society; American Retirees
Association; American World War II Orphans Network; AMVETS (American
Veterans); Armed Forces Marketing Council; Army and Navy Union;
Catholic War Veterans; Gold Star Wives of America, Inc.; Japanese
American Veterans Association; Korean War Veterans Foundation; Legion
of Valor; Military Order of the Purple Heart; Military Order of the
World Wars; Military Order of Foreign Wars; National Assoc. for
Uniformed Services; National Gulf War Resource Center; Naval Enlisted
Reserve Association; Naval Reserve Association; Paralyzed Veterans of
America; Reserve Enlisted Association; Reserve Officers Association;
Society of Military Widows; The Retired Enlisted Association; TREA
Senior Citizens League; Tragedy Assist. Program for Survivors;
Uniformed Services Disabled Retirees; Veterans of Foreign Wars; Vietnam
Veterans of America; Women in Search of Equity.
These organizations have over three and a half million members who
are serving our Nation or who have done so in the past, and their
families.
INTRODUCTION
Mister Chairman and distinguished members of the Committee, the
National Military and Veterans Alliance (NMVA) is very grateful for the
invitation to testify before you about our views and suggestions
concerning defense funding issues. The overall goal of the National
Military and Veterans Alliance is a strong National Defense. In light
of this overall objective, we would request that the committee examine
the following proposals.
While the NMVA highlights the funding of benefits, we do this
because it supports National Defense. A phrase often quoted ``The
willingness with which our young people are likely to serve in any war,
no matter how justified, shall be directly proportional as to how they
perceive the Veterans of earlier wars were treated and appreciated by
their country,'' has been frequently attributed to General George
Washington. Yet today, many of the programs that have been viewed as
being veteran or retiree are viable programs for the young serving
members of this war. This phrase can now read ``The willingness with
which our young people, today, are willing to serve in this war is how
they perceive the veterans of this war are being treated.''
This has been brought to the forefront by how quickly an issue such
as the treatment of wounded warriors suffering from Traumatic Brain
Injury or Post Traumatic stress Disorder has been brought to the
national attention.
In a long war, recruiting and retention becomes paramount. The
National Military and Veterans Alliance, through this testimony, hopes
to address funding issues that apply to the veterans of various
generations.
FUNDING NATIONAL DEFENSE
NMVA is pleased to observe that the Congress continues to discuss
how much should be spent on National Defense. The Alliance urges the
President and Congress to increase defense spending to 5 percent of
Gross Domestic Product during times of war to cover procurement and
prevent unnecessary personnel end strength cuts.
PAY AND COMPENSATION
Our serving members are patriots willing to accept peril and
sacrifice to defend the values of this country. All they ask for is
fair recompense for their actions. At a time of war, compensation
rarely offsets the risks.
The NMVA requests funding so that the annual enlisted military pay
raise exceeds the Employment Cost Index (ECI) by at least half of a
percent.
Further, we hope that this committee continues to support targeted
pay raises for those mid-grade members who have increased
responsibility in relation to the overall service mission. Pay raises
need to be sufficient to close the civilian-military pay gap.
NMVA would apply the same allowance standards to both Active and
Reserve when it comes to Aviation Career Incentive Pay, Career Enlisted
Flyers Incentive Pay, Diving Special Duty Pay, Hazardous Duty Incentive
Pay and other special pays.
The Service chiefs have admitted one of the biggest retention
challenges is to recruit and retain medical professionals. NMVA urges
the inclusion of bonus/cash payments (Incentive Specialty pay IPS) into
the calculations of Retirement Pay for military health care providers.
NMVA has received feedback that this would be incentive to many medical
professionals to stay in longer.
G-R Bonuses.--Guard and Reserve component members may be eligible
for one of three bonuses, Prior Enlistment Bonus, Reenlistment Bonus
and Reserve Affiliation Bonuses for Prior Service Personnel. These
bonuses are used to keep men and woman in mission critical military
occupational specialties (MOS) that are experiencing falling numbers or
are difficult to fill. During their testimony before this committee the
Reserve Chiefs addressed the positive impact that bonuses have upon
retention. This point cannot be understated. The operation tempo,
financial stress and civilian competition for jobs make bonuses a
necessary tool for the DOD to fill essential positions. The NMVA
supports expanding and funding bonuses to the Federal Reserve
Components.
Reserve/Guard Funding.--NMVA is concerned about ongoing DOD
initiatives to end ``two days pay for one days work,'' and replace it
with a plan to provide 1/30 of a Month's pay model, which would include
both pay and allowances. Even with allowances, pay would be less than
the current system. When concerns were addressed about this proposal, a
retention bonus was the suggested solution to keep pay at the current
levels. Allowances differ between individuals and can be affected by
commute distances and even zip codes. Certain allowances that are
unlikely to be paid uniformly include geographic differences, housing
variables, tuition assistance, travel, and adjustments to compensate
for missing health care. The NMVA strongly recommends that the reserve
pay system ``two days pay for one days work,'' be funded and retained,
as is.
EDUCATIONAL ISSUES
MGIB-SR Enhancements
Practically all active duty and Selected Reserve enlisted
accessions have a high school diploma or equivalent. A college degree
is the basic prerequisite for service as a commissioned officer, and is
now expected of most enlisted as they advance beyond E-6. Officers to
promote above O-4 are expected to have a post graduate degree. The
ever-growing complexity of weapons systems and support equipment
requires a force with far higher education and aptitude than in
previous years.
Both political parties are looking at ways of enhancing the GI
bill. There are suggested features in legislation be suggested by both
sides. At a minimum, the GI bill needs to be viewed as more than a
recruiting and retention incentive. Education is a means to help
reintegrate our returning veterans into society. A recent survey by
military.com, of returning military veterans, found that 81 percent
didn't feel fully prepared to enter the work force, and 76 percent of
these veterans said they were unable translate their military skills
into civilian proficiencies.
Transferability of educational benefits to spouses and children are
another key aspect that should be included in a GI Bill enhancement. In
addition, for those with existing degrees and outstanding debts, the GI
Bill stipend, should be allowed to pay-off outstanding student loans.
No enhancement can be accomplished without funding. This should be
viewed as an investment rather than an expense. The original GI bill
provided years of economic stimulus, returning seven dollars for every
dollar invested in veterans.
The National Military and Veterans Alliance asks this subcommittee
to support funding for suggested GI Bill funding.
The Montgomery G.I. Bill for Selective Reserves (MGIB-SR) will
continue to be an important recruiting and retention tool. With massive
troop rotations the Reserve forces can expect to have retention
shortfalls, unless the government provides enhances these incentives as
well.
The problem with the current MGIB-SR is that the Selected Reserve
MGIB has failed to maintain a creditable rate of benefits with those
authorized in Title 38, Chapter 30. MGIB-SR has not even been increased
by cost-of-living increases since 1985. In that year MGIB rates were
established at 47 percent of active duty benefits. The MGIB-SR rate is
28 percent of the Chapter 30 benefits. Overall the allowance has inched
up by only 7 percent since its inception, as the cost of education has
climbed significantly.
The NMVA requests appropriations funding to raise the MGIB-SR and
lock the rate at 50 percent of the active duty benefit. Cost:
$25,000,000/first year, $1,400,000,000 over 10.
FORCE POLICY AND STRUCTURE
War Funding
The Alliance thanks the committee for the war funding amended to
the Supplemental Appropriations Act 2008, H.R. 2642. While the debate
on Iraqi policy is important, the Alliance would like to stress that
resulting legislation should be independent and not included as
language in any Defense Appropriation bill. Supporting the troops
includes providing funding for their missions.
NMVA supports the actions by this subcommittee to put dollars for
the War back into the Emergency Supplemental.
End Strength
The NMVA concurs with funding increases in support of the end
strength boosts of the Active Duty Component of the Army and Marine
Corps that have been recommended by Defense Authorizers. New recruits
need to be found and trained now to start the process so that American
taxpayer can get a return on this investment. Such growth is not
instantaneously productive. Yet, the Alliance is concerned with
continued end strength cuts to the other services: the Air Force and
the Navy. Trying to pay the bills by premature manpower reductions may
have consequences.
Manning Cut Moratorium
The NMVA would also like to put a freeze on reductions to the Guard
and Reserve manning levels. A moratorium on reductions to End Strength
is needed until the impact of an operational reserve structure is
understood. Many force planners call for continuation of a strategic
reserve as well. NMVA urges this subcommittee to at least fund to last
year's levels.
SURVIVOR BENEFIT PLAN (SBP) AND SURVIVOR IMPROVEMENTS
The Alliance wishes to deeply thank this Subcommittee for your
funding of improvements in the myriad of survivor programs.
However, there is still an issue remaining to deal with: Providing
funds to end the SBP/DIC offset.
SBP/DIC Offset affects several groups. The first is the family of a
retired member of the uniformed services. At this time the SBP annuity
the servicemember has paid for is offset dollar for dollar for the DIC
survivor benefits paid through the VA. This puts a disabled retiree in
a very unfortunate position. If the servicemember is leaving the
service disabled it is only wise to enroll in the Survivor Benefit Plan
(perhaps being uninsurable in the private sector). If death is service
connected then the survivor loses dollar for dollar the compensation
received under DIC.
SBP is a purchased annuity, available as an elected earned employee
benefit. The program provides a guaranteed income payable to survivors
of retired military upon the member's death. Dependency and Indemnity
Compensation (DIC) is an indemnity program to compensate a family for
the loss of a loved one due to a service connected death. They are
different programs created to fulfill different purposes and needs.
A second group affected by this dollar for dollar offset is made up
of families whose service member died on active duty. Recently Congress
created active duty SBP. These service members never had the chance to
pay into the SBP program. But clearly Congress intended to give these
families a benefit. With the present offset in place the vast majority
of families receive no benefit from this new program, because the vast
numbers of our losses are young men or women in the lower paying ranks.
SBP is completely offset by DIC payments.
Other affected families are service members who have already served
a substantial time in the military. Their surviving spouse is left in a
worse financial position that a younger widow. The older widows will
normally not be receiving benefits for her children from either Social
Security or the VA and will normally have more substantial financial
obligations (mortgages, etc). This spouse is very dependent on the SBP
and DIC payments and should be able to receive both.
The NMVA respectfully requests this Subcommittee fund the SBP/DIC
offset.
current and future issues facing uniformed services health care
The National Military and Veterans Alliance must once again thank
this Committee for the great strides that have been made over the last
few years to improve the health care provided to the active duty
members, their families, survivors and Medicare eligible retirees of
all the Uniformed Services. The improvements have been historic.
TRICARE for Life and the Senior Pharmacy Program have enormously
improved the life and health of Medicare Eligible Military Retirees
their families and survivors. It has been a very successful few years.
Yet there are still many serious problems to be addressed:
Wounded Warrior Programs
As the committee is aware, Congress has held a number of hearings
about the controversy at Walter Reed Army Medical Center. The NMVA will
not revisit the specifics. With the Independent Review Group and the
Dole/Shalala Commission recommending the closure of Walter Reed, an
emphasis needs to be placed on the urgency of upgrades at Bethesda, and
the new military treatment hospital at Fort Belvoir. NMVA hopes that
this committee will financially support the studies that measure the
adequacy of this plan.
The Alliance supports continued funding for the wounded warriors,
including monies for research and treatment on Traumatic Brain Injuries
(TBI), Post Traumatic Stress Disorder, the blinded, and our amputees.
The Nation owes these heroes an everlasting gratitude and recompense
that extends beyond their time in the military. These casualties only
bring a heightened need for a DOD/VA electronic health record accord to
permit a seamless transition from being in the military to being a
civilian.
Full Funding for the Defense Health Program
The Alliance applauds the Subcommittee's role in providing adequate
funding for the Defense Health Program (DHP) in the past several budget
cycles. As the cost of health care has risen throughout the country,
you have provided adequate increases to the DHP to keep pace with these
increases.
Full funding for the defense health program is a top priority for
the NMVA. With the additional costs that have come with the deployments
to Southwest Asia, Afghanistan and Iraq, we must all stay vigilant
against future budgetary shortfalls that would damage the quality and
availability of health care.
With the authorizers having postponed the Department of Defenses
suggested fee increases, the Alliance is concerned that the budget
saving have already been adjusted out of the President's proposed
budget. NMVA is confident that this subcommittee will continue to fund
the DHP so that there will be no budget shortfalls.
The National Military and Veterans Alliance urges the Subcommittee
to continue to ensure full funding for the Defense Health Program
including the full costs of all new programs.
TRICARE Pharmacy Programs
NMVA supports the continued expansion of use of the TRICARE Mail
Order pharmacy.
To truly motivate beneficiaries to a shift from retail to mail
order adjustments need to be made to both generic and brand name drugs
co-payments. NMVA recommends that both generic and brand name mail
order prescriptions be reduced to zero $$ co-payments to align with
military clinics.
Ideally, the NMVA would like to see the reduction in mail order co-
payments without an increase in co-payments for Retail Pharmacy.
The National Military and Veterans Alliance urges the Subcommittee
to adequately fund adjustments to co-payments in support of
recommendations from Defense Authorizers.
TRICARE Standard Improvements
TRICARE Standard grows in importance with every year that the
Global War on Terrorism continues. A growing population of mobilized
and demobilized Reservists depends upon TRICARE Standard. A growing
number of younger retirees are more mobile than those of the past, and
likely to live outside the TRICARE Prime network.
An ongoing challenge for TRICARE Standard involves creating
initiatives to convince health care providers to accept TRICARE
Standard patients. Health care providers are dissatisfied with TRICARE
reimbursement rates that are tied to Medicare reimbursement levels. The
Alliance is pleased by Congress' plan to prevent near-term reductions
in Medicare reimbursement rates, which will help the TRICARE Program.
Yet this is not enough. TRICARE Standard is hobbled with a
reputation and history of low and slow payments as well as what still
seems like complicated procedures and administrative forms that make it
harder and harder for beneficiaries to find health care providers that
will accept TRICARE. Any improvements in the rates paid for Medicare/
TRICARE should be a great help in this area. Additionally, any further
steps to simplify the administrative burdens and complications for
health care providers for TRICARE beneficiaries hopefully will increase
the number of available providers.
The Alliance asks the Defense Subcommittee to include language
encouraging continued increases in TRICARE/Medicare reimbursement
rates.
TRICARE Retiree Dental Plan (TRDP)
The focus of the TRICARE Retiree Dental Plan (TRDP) is to maintain
the dental health of Uniformed Services retirees and their family
members. Several years ago we saw the need to modify the TRDP
legislation to allow the Department of Defense to include some dental
procedures that had previously not been covered by the program to
achieve equity with the active duty plan.
With ever increasing premium costs, NMVA feels that the Department
should assist retirees in maintaining their dental health by providing
a government cost-share for the retiree dental plan. With many retirees
and their families on a fixed income, an effort should be made to help
ease the financial burden on this population and promote a seamless
transition from the active duty dental plan to the retiree dental plan
in cost structure. Additionally, we hope the Congress will enlarge the
retiree dental plan to include retired beneficiaries who live overseas.
The NMVA would appreciate this Committee's consideration of both
proposals.
NATIONAL GUARD AND RESERVE HEALTH CARE
Funding Improved TRICARE Reserve Select
It is being suggested that the TRICARE Reserve Select healthcare
plan be changed to allow the majority of Selected Reserve participate
at a 28 percent co-payment level with the balance of the premium being
paid by the Department of Defense.
NMVA asks the committee to continue to support funding of the
TRICARE Reserve Select program.
Mobilized Health Care--Dental Readiness of Reservists
The number one problem faced by Reservists being recalled has been
dental readiness. A model for healthcare would be the TRICARE Dental
Program, which offers subsidized dental coverage for Selected
Reservists and self-insurance for SELRES families.
In an ideal world this would be universal dental coverage. Reality
is that the services are facing challenges. Premium increases to the
individual Reservist have caused some junior members to forgo coverage.
Dental readiness has dropped. The Military services are trying to
determine how best to motivate their Reserve Component members but feel
compromised by mandating a premium program if Reservists must pay a
portion of it.
Services have been authorized to provide dental treatment as well
as examination, but without funding to support this service. By the
time many Guard and Reserve are mobilized, their schedule is so short
fused that the processing dentists don't have time for extensive
repair.
The National Military Veterans Alliance supports funding for
utilization of Guard and Reserve Dentists to examine and treat
Guardsmen and Reservists who have substandard dental hygiene. The
TRICARE Dental Program should be continued, because the Alliance
believes it has pulled up overall Dental Readiness.
Demobilized Dental Care
Under the revised transitional healthcare benefit plan, Guard and
Reserve who were ordered to active duty for more than 30 days in
support of a contingency and have 180 days of transition health care
following their period of active service.
Similar coverage is not provided for dental restoration. Dental
hygiene is not a priority on the battlefield, and many Reserve and
Guard are being discharged with dental readiness levels much lower than
when they were first recalled. At a minimum, DOD must restore the
dental state to an acceptable level that would be ready for
mobilization, or provide some subsidize for 180 days to permit
restoration from a civilian source.
Current policy is a 30-day window with dental care being space
available at a priority less than active duty families.
NMVA asks the committee for funding to support a DOD's
demobilization dental care program. Additional funds should be
appropriated to cover the cost of TRICARE Dental premiums and co-
payment for the 6 months following demobilization if DOD is unable to
do the restoration.
OTHER GUARD AND RESERVE ISSUES
Ensure adequate funding to equip Guard and Reserve at a level that
allows them to carry out their mission. Do not turn these crucial
assets over to the active duty force. In the same vein we ask that the
Congress ensure adequate funding that allows a Guardsman/Reservist to
complete 48 drills, and 15 annual training days per member, per year.
DOD has been tempted to expend some of these funds on active duty
support rather than personnel readiness.
The NMVA strongly recommends that Reserve Program funding remain at
sufficient levels to adequately train, equip and support the robust
reserve force that has been so critical and successful during our
Nation's recent major conflicts.
While Defense Authorizers provided an early retirement benefit in
fiscal year 2008, only those who have served in support of a
contingency operation since 28 January 2008 are eligible, nearly 6
years and 4 months after Guard and Reserve members first were mobilized
to support the active duty force in this conflict. Over 600,000
Reservists have served during this period and were excluded from
eligibility. The explanation given was lack of mandatory funding
offset. To exclude a portion of our warriors is akin to offering the
original GI Bill to those who served after 1944.
NMVA hopes that this subcommittee can help identify excess funding
that would permit an expanded early retirement benefit for those who
have served.
ARMED FORCES RETIREMENT HOMES
Following Hurricane Katrina, Navy/Marine Corps residents from AFRJ-
Gulfport were evacuated from the hurricane-devastated campus and were
moved to the AFRH-Washington, D.C. campus. Dormitories were reopened
that are in need of refurbishing.
NMVA urges this subcommittee to continue funding upgrades at the
Washington, D.C. facility, and to continue funding to rebuild the
Gulfport facility.
CONCLUSION
Mr. Chairman and distinguished members of the Subcommittee the
Alliance again wishes to emphasize that we are grateful for and
delighted with the large steps forward that the Congress has affected
the last few years. We are aware of the continuing concern all of the
subcommittee's members have shown for the health and welfare of our
service personnel and their families. Therefore, we hope that this
subcommittee can further advance these suggestions in this committee or
in other positions that the members hold. We are very grateful for the
opportunity to submit these issues of crucial concern to our collective
memberships. Thank you.
CONCLUSION OF HEARINGS
Chairman Inouye. I'd like to thank all of you for your
testimony this morning. The subcommittee will take all issues
seriously, I can assure you. And if you do have documents to
support your testimony, please submit them.
With that, the meeting will stand in recess, subject to the
call of the Chair.
Thank you.
[Whereupon, at 11:40 a.m., Thursday, June 18, the hearings
were concluded, and the subcommittee was recessed, to reconvene
subject to the call of the Chair.]