[Senate Hearing 111-]
[From the U.S. Government Publishing Office]
DEPARTMENT OF DEFENSE APPROPRIATIONS FOR FISCAL YEAR 2011
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WEDNESDAY, JUNE 23, 2010
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
OPENING STATEMENT OF CHAIRMAN DANIEL K. INOUYE
Chairman Inouye. I would like to welcome everyone to this
hearing where we receive public testimony pertaining to various
issues related to the fiscal year 2011 Defense appropriations
request.
Because we have so many witnesses today, I would like to
remind each witness that they will be limited to no more than 4
minutes apiece. But I can assure you that your full statements
will be made part of the record.
And at this point, I would like to recognize the vice
chairman of this subcommittee, Senator Cochran of Mississippi.
STATEMENT OF SENATOR THAD COCHRAN
Senator Cochran. Mr. Chairman, thank you very much.
I am very pleased to join you and welcome our witnesses who
are here today to talk about their views in connection with the
Defense Department's fiscal year 2011 budget.
We appreciate your assistance and the time you have taken
to prepare your remarks and to present them to us today. Thank
you very much.
Chairman Inouye. The subcommittee has divided the witnesses
into four panels. And the first panel consists of Mr. H. James
Gooden; Rear Admiral Casey Coane of the Navy, retired; Ms.
Janet Hieshetter; and Mr. John R. Davis.
Mr. Gooden, are you prepared?
STATEMENT OF H. JAMES GOODEN, CHAIRMAN, BOARD OF
DIRECTORS, AMERICAN LUNG ASSOCIATION
Mr. Gooden. Yes, I am.
Chairman Inouye. Please proceed.
Mr. Gooden. Mr. Chairman, Mr. Vice Chairman, and members of
the subcommittee, my name is Jim Gooden, and I am the chairman
of the board of directors of the American Lung Association. I
am honored to testify today.
The American Lung Association was founded in 1904 to fight
tuberculosis, and today, our mission is to save lives by
improving lung health and preventing lung disease. We
accomplish this through research, advocacy, and education.
The American Lung Association wishes to call your attention
to three issues for the Department of Defense's fiscal year
2011 budget. Number one, the terrible burden on the military
caused by tobacco use and the need for the Department to
aggressively combat it by implementing recommendations from the
Institute of Medicine. Two, the importance of restoring the
original intent and full funding for the Peer-Reviewed Lung
Cancer Research Program. And number three, addressing the
health threat posed by burn pits in Iraq and Afghanistan.
First, I would like to speak to the need for the Department
of Defense to better combat tobacco use. Tobacco use remains a
significant problem for the military. The Department of Defense
has started moving in the right direction with making
submarines smoke free, as well as other positive actions. But
much more is needed to curb tobacco use in the military. Here
are a few statistics to point out to what the Department of
Defense is up against.
While smoking rates among Active Duty personnel have
essentially remained steady since 2002, rates among deployed
personnel are significantly higher, and alarmingly, more than 1
in 7, or 15 percent, of Active Duty personnel began smoking
after joining the service. This alarming use of tobacco in the
military has severe consequences and impacts troop readiness.
It impairs physical capacity, vision, and hearing, and
increases the chance of physical injury and hospitalization.
Furthermore, the healthcare expenses associated with these
behaviors have cost the Department of Defense billions of
dollars. The Pentagon spends over $1.6 billion on tobacco-
related medical care, increased hospitalization, and lost days
of work. Lost productivity costs are primarily caused by
smoking breaks and greater absenteeism.
Last summer, the prestigious Institute of Medicine, or IOM,
issued a report entitled ``Combating Tobacco Use in Military
and Veteran Populations.'' The IOM recommendations include
common-sense approaches to eliminating the use of tobacco in
the U.S. military. Some of the IOM's recommendations include
tobacco-free policies should be phased in, starting with
military academies and officer candidate training programs,
followed by new enlisted accessions and then all Active Duty
personnel.
Also, end the sale of tobacco products on all military
installations. Ensure that all DOD personnel have barrier-free
access to tobacco cessation services and that healthcare and
health promotion staff are trained to help tobacco users quit.
The American Lung Association recommends that the
Department of Defense implement all recommendations called for
in the 2009 IOM report, and we ask for this subcommittee's
leadership in ensuring that that happens. Second, the American
Lung Association strongly supports the Lung Cancer Research
Program (LCRP) in the Congressionally Directed Medical Research
Program and its original intent to research the scope of lung
cancer in our military.
We urge this subcommittee to restore the funding level to
the fiscal year 2009 level of $20 million, and we request that
the 2011 governing language for the LCRP be returned to its
original intent as directed by the 2009 program, which directed
the funds to be awarded competitively and to identify, treat,
and manage early curable lung cancer.
We urge that the national registry be established to track
all personnel who were exposed to burn pits while in Iraq. The
American Lung Association also recommends that the DOD begin
immediately to find alternatives to this method of waste
disposal.
Mr. Chairman, in summary, our Nation's military is the best
in the world, and we should do whatever necessary to ensure
that the lung health needs of our armed services are fully met.
Thank you for this opportunity.
Thank you very much, Mr. Chairman.
Chairman Inouye. Just a matter of curiosity, when I was a
young soldier, we were given K-rations for lunches, and in each
pack, there was a little pack of cigarettes. And then you were
able to buy cigarettes, if you wished to, for 5 cents a pack.
When were these practices ceased?
Mr. Gooden. To that, I will have to defer to my other
specialists that are here with me from the American Lung
Association, and if they cannot answer at this time, we will
gladly be able to put that on the record.
Chairman Inouye. Thank you very much.
Mr. Gooden. Thank you, sir.
[The statement follows:]
Prepared Statement of James Gooden
Mr. Chairman and members of the Committee, my name is James Gooden
and I am the Chairman of the Board of Directors of the American Lung
Association. I am honored to testify today.
The American Lung Association was founded in 1904 to fight
tuberculosis and today, our mission is to save lives by improving lung
health and preventing lung disease. We accomplish this through
research, advocacy and education.
The American Lung Association wishes to call your attention to
three issues for the Department of Defense's (DOD) fiscal year 2011
budget: the terrible burden on the military caused by tobacco use and
the need for the Department to aggressively combat it; the importance
of restoring funding for the Peer-Review Lung Cancer Research Program
to $20 million; and the health threat posed by burn pits in Iraq and
Afghanistan.
First, the American Lung Association is concerned about the use of
tobacco products by troops within the military. The effects of both the
health and performance of our troops are significantly hindered by the
prevalence of smoking and smokeless tobacco products. As a result, we
urge the Department of Defense to immediately implement the
recommendations in the Institute of Medicine's 2009 Report, Combating
Tobacco Use in Military and Veteran Populations.
Next, the American Lung Association recommends and supports
restoring funding to $20 million for the Peer-Reviewed Lung Cancer
Research Program (LCRP) within the Department of Defense
Congressionally Directed Medical Research Program (CDMRP). We were
disappointed that this critical public health research program was cut
in fiscal year 2010 by $5 million and ask that the funding return to
$20 million. Finally, the American Lung Association is deeply troubled
by reports of the use of burn pits and the negative effects on lung
health on soldiers in both Iraq and Afghanistan. Thus, we urge the DOD
to immediately find alternatives to this method of waste disposal.
Combating Tobacco Use
Tobacco use remains the leading cause of preventable death in the
United States and not surprisingly, is a significant problem within the
military as well. The DOD has started moving in the right direction
with its recent smoking ban on submarines and other positive actions,
but much more is needed to curb tobacco use in the military.
The 2008 Department of Defense Survey of Health Behaviors among
Active Duty Personnel found that smoking rates among active duty
personnel have essentially remained steady since 2002. However, smoking
rates among deployed personnel are significantly higher and,
alarmingly, more than one in seven (15 percent) of active duty
personnel begin smoking after joining the service.
Currently, the smoking rate for active duty military is 30.5
percent, with smoking rates highest among personnel ages 18 to 25--
especially among soldiers and Marines. The Department of Veterans
Affairs estimates that more than 50 percent of all active duty
personnel stationed in Iraq smoke.\1\
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\1\ Hamlett-Berry, KW, as cited in Beckham, JC et al. Preliminary
findings from a clinical demonstration project for veterans returning
from Iraq or Afghanistan. Military Medicine. May 2008; 173(5):448-51.
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This alarming use of tobacco in the military has severe
consequences. First, tobacco use compromises military readiness.
Studies have found that smoking is one of the best predictors of
training failure and smokers also report significantly more stress from
military duty than non-smokers. Smoking is also shown to impair a
person's physical capacity, vision, or hearing and increase their
chances of physical injury and hospitalization.\2\ In addition; if a
soldier experiences nicotine withdrawal while on active duty;
depression, anxiety, and difficulty concentrating on cogitative tasks
can develop.\3\ All of these consequences have a negative impact on the
performance of our men and women in our armed forces.
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\2\ Institute of Medicine. Combating Tobacco Use in Military and
Veteran Populations. 2009; 3-4.
\3\ Institute of Medicine. Combating Tobacco Use in Military and
Veteran Populations. 2009; 4.
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Furthermore, the healthcare expenses associated with these
behaviors have cost the DOD billions of dollars. The Pentagon spends
over $1.6 billion on tobacco-related medical care, increased
hospitalization and lost days of work. Lost productivity costs are
primarily caused by smoking breaks (estimated at 30 minutes over 220
work days a year) and greater absenteeism. There are also great costs
associated with the failure of new recruits to complete basic training.
It is clear that more must be done to reduce smoking rates and tobacco
use among active duty personnel.
Last summer, the prestigious Institute of Medicine (IOM) issued a
report entitled, Combating Tobacco Use in Military and Veterans
Populations. The panel found ``tobacco control does not have a high
priority in DOD or VA.'' This report, which was requested by both
departments, issued a series of recommendations, which the American
Lung Association fully supports and asks this Committee to ensure are
implemented.
The IOM recommendations include commonsense approaches to
eliminating the use of tobacco use in the U.S. military. Some of the
IOM's recommendations include:
--Phase in tobacco-free policies by starting with military academies,
officer-candidate training programs, and university-based
reserve officer training corps programs. Then the IOM
recommends new enlisted accessions be required to be tobacco-
free, followed by all active-duty personnel;
--Eliminate tobacco use on military installations using a phased-in
approach;
--End the sales of tobacco products on all military installations.
Personnel often have access to cheap tobacco products on base,
which can serve to start and perpetuate addictions;
--Ensure that all DOD healthcare and health promotion staff are
trained in the standard cessation treatment protocols; and
--Ensure that all DOD personnel have barrier-free access to tobacco
cessation services.
According to the IOM, the authority for the implementation of all
the recommendations should rest with the highest levels of the
Department, including the surgeon general of each armed service and the
individual installation commander. The American Lung Association asks
for the Committee's leadership to ensure this occurs.
The United States military cannot fight two wars without ready and
healthy troops to successfully complete each mission. With tobacco use
causing a decrease of troop readiness, performance and health, the DOD
can no longer afford to stand idly by.
Therefore, the American Lung Association recommends that the
Department of Defense implement all recommendations called for in the
2009 IOM report. The IOM has laid out a very careful, scientifically-
based road map for the DOD to follow and the American Lung Association
strongly urges that its recommendations be implemented without delay.
Peer Reviewed Lung Cancer Research Program
The American Lung Association strongly supports the Lung Cancer
Research Program (LCRP) in the Congressionally Directed Medical
Research Program (CDMRP) and its original intent to research the scope
of lung cancer in our military. It is for that reason that we were
deeply disappointed by changes made by Congress in fiscal year 2010 to
the both the LCRP's governing language and funding.
First, LCRP's funding was cut by 25 percent--$5 million--which may
diminish the effectiveness of this crucial research. We urge this
Committee to restore the funding level to the fiscal year 2009 level of
$20 million.
In addition to the reduced funding, the American Lung Association
is troubled by the change in governance language of the LCRP authorized
by the Congress last fiscal year. The language change not only has
consequences for the LCRP in the future but also hampered the
implementation of the 2009 LCRP. We request that the 2011 governing
language for the LCRP be returned to its original intent, as directed
by the 2009 program: ``These funds shall be for competitive research .
. . Priority shall be given to the development of the integrated
components to identify, treat and manage early curable lung cancer''.
Troubling Lung Health Concern in Iraq and Afghanistan
The American Lung Association is extremely troubled by reports of
soldiers who were exposed to burn pits in Iraq and Afghanistan, and are
now returning home with lung illnesses including asthma, chronic
bronchitis and sleep apnea. Civilians are also at risk.
Emissions from burning waste contain fine particulate matter,
sulfur oxides, carbon monoxide, volatile organic compounds, and various
irritant gases such as nitrogen oxides that can scar the lungs.
Emissions also contain chemicals that are known or suspected to be
carcinogens.
For vulnerable populations, such as people with cardiovascular
diseases, diabetes, asthma and chronic respiratory disease, exposure to
these burn pits is particularly harmful. Even short exposures can kill.
However, the health impact of particle pollution is not limited to
individuals with pre-existing conditions. Healthy, young adults who
work outside--such as our young men and women in uniform--are also at
higher risk.
EPA has just concluded that particulate matter causes heart
attacks, asthma attacks, and early death. The particles are extremely
small and are unable to be filtered out of our respiratory system.
Instead, these small particles end up deep in the lungs where they
remain for months, causing structural damage and chemical changes. In
some cases, the particles can move through the lungs and penetrate the
bloodstream. Larger particles will end up in the upper respiratory
system, causing coughs.
Given what we know about the health effects of burning refuse, the
American Lung Association recommends that the DOD begin immediately to
find alternatives to this method of waste disposal. It is important
that the short- and long-term consequences of exposure to these burn
pits be monitored by DOD in conjunction with the VA. Finally, we urge
that a national registry be established to track all personnel who were
exposed to burn pits while in Iraq and Afghanistan.
Conclusion
Mr. Chairman, in summary, our nation's military is the best in the
world and we should do whatever necessary to ensure that the lung
health needs of our armed services are fully met. We can ill afford to
fight a third war against tobacco and unsafe air conditions with their
severe consequences. Thank you for this opportunity.
Chairman Inouye. Our next witness is Rear Admiral Casey
Coane. Admiral.
STATEMENT OF REAR ADMIRAL CASEY COANE, UNITED STATES
NAVY (RETIRED), EXECUTIVE DIRECTOR,
ASSOCIATION OF THE UNITED STATES NAVY
Admiral Coane. Mr. Chairman, Senator Cochran, the
Association of the United States Navy is once again very
pleased to have this opportunity to testify before you.
Our Veterans Service Organization focuses a majority of its
legislative activity on personnel issues and the equipment
necessary for the Navy to carry out its missions. It is only
through the attention of Congress and committees such as yours
that we can be sure that the needs of our young men and women
are being met. We are grateful to take this particular
opportunity to speak to you about equipment.
With the pressing personnel needs of the services, it may
seem a bit cold for me to be here speaking about ships and
aircraft. Nonetheless, the equipment of which I am speaking is
vital to the conduct of this war and directly supports the
thousands of Navy men and women serving on the ground in
Afghanistan, Iraq, or other places in the theater, such as the
Horn of Africa. Today, 14,000 Navy people are ashore in
Operation Iraqi Freedom (OIF), Operation Enduring Freedom
(OEF), including Active Duty and reservists.
We are pleased with the increased emphasis that the House
has recently shown toward the Navy's ship building plan in
order to meet the Nation's maritime strategy. We urge the
Senate to do the same.
I invite the subcommittee's attention to the recently
released National Guard and Reserve equipment report for fiscal
year 2011, signed out by the Assistant Secretary of Defense for
Reserve Affairs. In the Navy section of this report, the point
is made that the Navy has successfully and fully integrated its
Reserve component.
The significance here is that all the Navy's overused and
aging organic airlift aircraft are in the Reserve component.
The Navy Reserves electronic attack squadron right here at
Andrews Air Force Base is a critical and frequently deployed
component of the Navy's arsenal and is badly in need of new F-
18G Growler aircraft to replace its aged A-6Bs.
The Secretary's report lists aircraft as the top Navy
equipping challenge. The aircraft programs listed are the C-40
replacement for the C-9s, the P-8, the Growlers I mentioned,
and the KC-130J airlifters. Our association could not agree
more.
The issue, as Secretary McCarthy indicates on page 14 of
the report, is not just newer aircraft, it is that the current
aircraft have aged and turned the maintenance expense curve to
the extent that prudent business practices, on behalf of the
taxpayer, dictate replacement now.
The Navy needs six more C-40s to finish the program, and it
needs some of them this year. The P-8 is an on-time, on-budget
program to replace aging and grounded P-3s, the backbone of the
Navy's overland reconnaissance effort in theater. Anything that
this subcommittee could do to accelerate that program, perhaps
by utilization of the NGREA account, would be most beneficial.
The Navy and Air Force have testified to the unfunded need
for electronic attack aircraft in fiscal year 2012 and beyond.
Without the transition of the Navy Reserve squadron to the
Growler, the Navy will--and I quote from the report--``lose
critical operational and strategic Reserve airborne electronic
attack capability and capacity.'' We urge the subcommittee to
ensure this does not happen.
The Navy's 30-year aircraft program, the Naval Aviation
Plan 2030, has the requirement for the replacement of the C-
130T airlifters with the new KC-130Js. Currently, this
essential tactical, intra-theater airlift is operating five
aircraft short of its requirement.
Each year that the new aircraft is delayed will force the
Navy to spend more money to upgrade worn-out aircraft to meet
new European aviation aircraft standards without which they
cannot fly across Europe. We urge the subcommittee to bring the
KC-130J forward in the future year defense plan (FYDP) or by
adding to the NGREA account.
Again, the Association of the United States Navy thanks the
subcommittee for their tireless efforts on behalf of our
services and for providing this opportunity to be heard.
Thank you.
Chairman Inouye. Thank you very much, Admiral.
Do you have any questions?
Thank you very much, sir.
[The statement follows:]
Prepared Statement of Rear Admiral Casey Coane
The Association of the United States Navy (AUSN) recently changed
its name as of May 19, 2009. The association, formerly known as the
Naval Reserve Association, traces its roots back to 1919 and is devoted
solely to service to the Nation, Navy, the Navy Reserve and Navy
Reserve officers and enlisted. It is the premier national education and
professional organization for Active Duty Navy, Navy Reserve personnel,
Veterans of the Navy, families of the Navy, and the Association Voice
of the Navy and Navy Reserve.
Full membership is offered to all members of the U.S. Navy and
Naval Reserve. Association members come from all ranks and components.
The Association has active duty, reserve, and veterans from all 50
states, U.S. Territories, Europe, and Asia. Forty-five percent of AUSN
membership is active reservists, active duty, while the remaining 55
percent are made up of retirees, veterans, and involved DOD civilians.
The National Headquarters is located at 1619 King Street Alexandria,
VA. 703-548-5800.
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 VSO-MSO association works diligently to
educate Congress, our members, and the public on Navy equipment, force
structure, policy issues, personnel and family issues and Navy
veterans.
I thank this Committee for the on-going stewardship on the
important issues of national defense and, especially, the
reconstitution and support of the Navy during wartime. At a time of
war, non-partisan leadership sets the example.
Your unwavering support for our deployed Service Members in Iraq
and Afghanistan (of which over 14,000 Sailors are deployed at Sea in
the AOR and over 10,000 are on the ground--Active and Reserve) and for
the world-wide fight against terrorism is of crucial importance.
Today's Sailors watch Congressional actions closely. AUSN would like to
highlight some areas of emphasis.
As a nation, we need to supply our service members with the
critical equipment and support needed for individual training, unit
training and combat as well as humanitarian and peacekeeping
operations. Additionally, we must never forget the Navy families,
reserve members and the employers of these unselfish volunteers--Active
and Reserve.
In recent years, the Maritime Strategy has been highlighted,
debated and disputed. We feel this is a time where the Total Navy force
needs to be stabilized, strengthened, and be reconstituted--because of
the consistent, constant, and increasing National Security crisis in a
dangerous world--
--Piracy is on the rise in many areas of the world, and especially in
the 5th Fleet AOR;
--The flow of commerce still remains a top priority for our economy;
--Naval engagement and support on the ground, in the air, and on the
seas for OIF and OEF has not decreased;
--Ever increasing Middle East instability;
--Ballistic missile threats (N Korea-Iran) and the Navy requirement
to be the front line of defense for missile defense threat;
--U.S. Navy response to natural disasters; tsunami, Haiti, Chile, and
possible man made disasters (oil spill support);
--Humanitarian assistance in the Philippines, Indonesia, and American
Samoa; and
--Ever increasing and changing Arctic issues.
In addition to equipment to accomplish assigned missions, the AUSN
believes that the Administration and Congress must make it a high
priority to maintain, if not increase, but at least stabilize the end
strengths of already overworked, and perhaps overstretched, military
forces. This includes the Active Navy and the Navy Reserve. Reductions
in manpower are generally for appropriations reasons within the
Service, not because people are not needed and their benefits are not a
requirement.
Our current maritime history and strategy--requires that our nation
must achieve the 313+ Navy Ships, not decrease them, and there should
be a balance between personnel end-strengths and equipment.
Carriers, submarines, and Naval Aviation are more relevant than
ever--as proven by initial and constant actions in Iraq and Afghanistan
and ongoing operations in OIF-OEF and throughout Southwest Asia.
Additionally--Navy weapon systems and personnel play a critical role in
Natural disasters around the world! Therefore, it is not a time--to cut
back.
We must fund the Navy for proper shipbuilding and aviation programs
which the House this year authorized funds to accomplish.
As you know, neither the Navy nor the Navy Reserve has ever been a
garrisoned force--but, a deployed force. Nothing has changed in recent
contingency operations or wars, except that the Navy's forces needs
equipment as much as anyone.
We recognize that there are many issues that need to be addressed
by this Committee and this Congress. The Association of the United
States Navy supports the Navy's fiscal year 2011 budget submission and
the Unfunded Programs List provided by the Chief of Naval Operations
that addressed an increased shipbuilding and increase aircraft
procurement to relieve the documented shortages and maintenance
requirements.
Overwhelmingly, we have heard Service Chiefs, Reserve Chiefs and
Senior Enlisted Advisors discuss the need and requirement for more and
unit equipment for training in order to be ready as well as combat
equipment in the field. Navy needs to have equipment and unit cohesion
to keep personnel trained. This means--Navy equipment and Navy Reserve
equipment with units.
Equipment Ownership
Issue.--Sharing of equipment has been done in the past. However,
nothing could be more of a personnel readiness issue and is ill
advised. This issue needs to be addressed if the current National
Security Strategy is to succeed.
Position.--The overwhelming majority of Navy and Navy Reserve
members join to have hands-on experience on equipment. The training and
personnel readiness of members depends on constant hands-on equipment
exposure. History shows, this can only be accomplished through
appropriate equipment, since the training cycles are rarely if ever--
synchronized with the training or exercise times or deployment times.
Additionally, historical records show that units with unite hardware
maintain equipment at higher than average material and often have
better training readiness. This is especially true with Navy Reserve
units. Current and future war fighting requirements will need these
highly qualified units when the Combatant Commanders require fully
ready units.
Navy has proven its readiness. The personnel readiness, retention,
and training of all members will depend on them having equipment that
they can utilize, maintain, train on, and deploy with when called upon.
AUSN recommends the Committee strengthen the Navy equipment
appropriation as the House has done in the fiscal year 2011 NDAA in
order to maintain optimally qualified and trained Navy and Navy Reserve
forces.
Pay, Promotion, and Pride
Pay needs to be competitive. If pay is too low, or expenses too
high, a service member knows that time may be better invested
elsewhere. The current pay raise discussions of 1.9 percent is woefully
inadequate when the Nation considers what service members, Navy
members, are doing in defense of this nation. The risks and sacrifices
of every service member, to defend this great nation, make it illogical
to formulate a direct comparison of civil pay to military pay. It just
does not make common sense.
Promotions need to be fairly regular, and attainable.
Pride is a combination of professionalism, parity and awards: doing
the job well with requisite equipment, and being recognized for one's
sacrifices and efforts.
Care must be taken that the current tremendous reservoir of
operational capability be maintained and not lost due to resource
shortages. Officers, Chief Petty Officers, and Petty Officers need to
exercise leadership and professional competence to maintain their
capabilities. In the current environment of Navy Individual Augmentee
in support of ground forces, there is a risk that Navy mid-grade
leadership will not be able to flourish due to the extended ground war
of OIF and OEF. Having the right equipment is critical to our Maritime
Strategy.
In summary, we believe the Committee needs to address the following
issues for Navy and Navy Reserve in the best interest of our National
Security:
--Fund the 9 Navy Ships provided for in the House fiscal year 2011
NDAA.
--Fund one C-40A for the Navy, per the past years documented request;
Navy must replace the C-9s and replace the C-20Gs in Hawaii and
Maryland.
--Fund the FA-18 E/F and FA-18 E/F Growlers per the House fiscal year
2011 NDAA and include unit assets for Navy Reserve units
currently in EA-6B aircraft.
--Just as other services are having difficulties with intra theater
C-130 assets, the Navy needs to replace their C-130 aircraft
with C-130J for the Navy and Navy Reserve.
--Increase funding for Naval Reserve equipment in NGREA: Increase
Navy Reserve NGREA by $100 million; and Naval Expeditionary
Combat Equipment.
For the foreseeable future, we must be realistic about what the
unintended consequences are from a high rate of usage. History shows
that an Active force and Reserve force are needed for any country to
adequately meet its defense requirements, and to enable success in
offensive operations. Our Active Duty Navy and the current operational
Reserve members are pleased to be making a significant contribution to
the nation's defense as operational forces; however, the reality is
that the added stress on Active Navy and the Reserve could pose long
term consequences for our country in recruiting, retention, family and
employer support. In a time of budget cut discussions, this is not the
time to cut end-strengths on an already stressed force. We have already
been down this road previously. This issue deserves your attention in
pay, maintaining end-strengths, proper equipment, Family Support
Programs, Transition Assistance Programs and for the Employer Support
for the Guard and Reserve programs.
Thank you for your ongoing support of the Nation, the Armed
Services, the United States Navy, the United States Navy Reserve, their
families, and Navy veterans, and the fine men and women who defend our
country.
Chairman Inouye. Our next witness is Ms. Kathy Rentfrow.
Ms. Rentfrow.
STATEMENT OF KATHY RENTFROW, VOLUNTEER, DYSTONIA
MEDICAL RESEARCH FOUNDATION
Ms. Rentfrow. Mr. Chairman and members of the Senate
Appropriations Defense Subcommittee, thank you for allowing me
the opportunity to testify today.
My name is Kathy Rentfrow, and I am a volunteer with the
Dystonia Medical Research Foundation, or DMRF. The DMRF is a
patient-centered, nonprofit organization dedicated to serving
dystonia patients and their families.
The DMRF works to advance dystonia research, increase
dystonia awareness, and provide support for those living with
the disorder. More importantly, I am a proud military spouse
and the mother of a child suffering from dystonia.
Dystonia is a neurological movement disorder that causes
muscles to contract and spasm involuntarily. Dystonia is not
usually fatal, but it is a chronic disorder whose symptoms vary
in degrees of frequency, intensity, disability, and pain.
Dystonia can be generalized, affecting all major muscle
groups, resulting in twisting, repetitive movements, and
abnormal postures, or focal, affecting a specific part of the
body, such as the legs, arms, hands, neck, face, mouth,
eyelids, or vocal cords.
At this time, no known cure exists, and treatment is highly
individualized. Patients frequently rely on invasive therapies
like botulinum toxin injections or deep brain stimulation, DBS,
to help manage their symptoms.
At age 6, while our family was stationed in Washington, my
daughter Melissa was diagnosed with generalized dystonia at
Madigan Army Medical Center. What began as muscle spasms in her
left shoulder, progressed throughout her entire arm, her right
hand, legs, and vocal cords.
Now, at age 15, Melissa is luckier than many dystonia
patients, and this is in large part to the superior care she
receives as a military dependent. Due to my husband's position
as a permanent military professor at the United States Naval
Academy, our daughter is able to receive care at Walter Reed
Army Medical Center.
Melissa responds well to treatment with medications, but
still needs to take upwards of 20 pills per day. Unlike many
dystonia sufferers, Melissa's extensive costs are covered by
TRICARE. Although she does not have use of her left arm, she is
able to walk and talk without more invasive treatments like
botulinum toxin injections, or DBS. This not only affects
Melissa's quality of life, but also that of our entire family.
Dystonia is not a discriminatory condition. It affects
people of all backgrounds, and this increasingly includes
military personnel. Conservative estimates suggest that
dystonia affects no less than 300,000 Americans. However, the
incidence of dystonia has seen a noticeable increase since our
military forces were deployed to Iraq and Afghanistan. This
recent increase is widely considered to be the result of a
well-documented link between head injuries, other traumatic
injuries, and the onset of dystonia.
Until a cure for dystonia can be discovered, it remains
vital we learn more about the exact causes of the condition and
develop more effective and efficient treatments. Although
Federal dystonia research is conducted through a number of
medical and scientific agencies, the DOD's Peer-Reviewed
Medical Research Program remains the most essential program in
studying dystonia in military and veteran populations.
The DMRF has been receiving increasing reports of dystonia
from service personnel and family members, as well as increased
anecdotal evidence from medical professionals linking dystonia
to traumatic brain injury, or TBI. As the subcommittee is
aware, TBI has emerged as a trademark injury of the current war
efforts in Iraq and Afghanistan, often sustained as the result
of improvised explosive devices.
More and more, TBI and other traumatic injuries are serving
as the catalyst for the onset of dystonia. As military
personnel remain deployed for longer periods, we can expect
dystonia prevalence in military and veterans populations to
increase.
Thank you for allowing me the opportunity to address the
subcommittee today. As the mother of a child suffering from
dystonia and as a military spouse concerned with the well-being
of our troops, I hope you will continue to include dystonia as
a condition eligible for the DOD Peer-Reviewed Medical Research
Program.
Chairman Inouye. May I assure you that the subcommittee
will most seriously consider your request. That, I can assure
you.
Ms. Rentfrow. Thank you.
Chairman Inouye. Do you have any----
Senator Cochran. I wish we had more time to go into
questions and discussions, but I think you can be assured that
we take everybody's testimony seriously. And we want you all to
know that we appreciate your being here and keeping us up to
date on the needs that we face through our medical programs in
the military.
Thank you.
[The statement follows:]
Prepared Statement of Kathy Rentfrow
Mr. Chairman and members of the Senate Appropriations Defense
Subcommittee, thank you for allowing me the opportunity to testify
before you today. My name is Kathy Rentfrow, and I am a volunteer with
the Dystonia Medical Research Foundation or ``DMRF''. The DMRF is a
patient-centered nonprofit organization dedicated to serving dystonia
patients and their families. The DMRF works to advance dystonia
research, increase dystonia awareness, and provide support for those
living with the disorder. Most importantly, I am a proud military
spouse and the mother of a child suffering from dystonia.
Dystonia is a neurological movement disorder that causes muscles to
contract and spasm involuntarily. Dystonia is not usually fatal, but it
is a chronic disorder whose symptoms vary in degrees of frequency,
intensity, disability, and pain. Dystonia can be generalized, affecting
all major muscle groups, and resulting in twisting repetitive movements
and abnormal postures or focal, affecting a specific part of the body
such as the legs, arms, hands, neck, face, mouth, eyelids, or vocal
chords. At this time, no known cure exists and treatment is highly
individualized. Patients frequently rely on invasive therapies like
botulinum toxin injections or deep brain stimulation (DBS) to help
manage their symptoms.
At age 6, while our family was stationed in Washington State, my
daughter Melissa was diagnosed with generalized dystonia at Madigan
Army Medical Center. What began as muscle spasms in her left shoulder
and progressed throughout the entire arm, her right hand, legs, and
vocal chords. Now at age 15, Melissa is luckier than many dystonia
patients, and this is in large part to the superior care she receives
as a military dependent. Due to my husband's position as a permanent
military professor at the U.S. Naval academy, our daughter is able to
receive care at Walter Reed Army Medical Center. Melissa responds well
to treatment with medications, but still needs to take upwards of 20
pills per day. Unlike many dystonia sufferers, Tricare covers the
extensive costs of her medications. Although she does not have use of
her left arm, she is able to walk and talk without more invasive
treatments like botulinum toxin injections or DBS. Dystonia affects not
only Melissa's quality of life, but also that of our entire family.
Dystonia is not a discriminatory condition, as it affects people of
all backgrounds and this increasingly includes military personnel.
Conservative estimates suggest that dystonia affects no less than
300,000 Americans. However, the incidence of dystonia has seen a
noticeable increase since our military forces were deployed to Iraq and
Afghanistan. This recent increase is widely considered to be the result
of a well documented link between head injuries, other traumatic
injuries, and the onset of dystonia. Until a cure for dystonia is
discovered, it remains vital we learn more about the exact causes of
the condition and develop more effective and efficient treatments for
patients.
Although Federal dystonia research is conducted through a number of
medical and scientific agencies, the DOD's Peer-Reviewed Medical
Research Program remains the most essential program studying dystonia
in military and veteran populations. The DMRF has been receiving
increasing reports of dystonia from service personnel and family
members, as well as increased antidotal evidence from medical
professionals linking dystonia to traumatic brain injury or ``TBI''. As
the committee is aware, TBI has emerged as a trademark injury of the
current war efforts in Iraq and Afghanistan, often sustained as the
result of improvised explosive devices. More and more, TBI and other
traumatic injuries are serving as the catalyst for the onset of
dystonia. As military personnel remain deployed for longer periods, we
can expect dystonia prevalence in military and veterans populations to
increase, particularly in combat personnel.
Dystonia severity and symptoms can vary dramatically from person to
person, often drastically effecting quality of life. A June 2006
article in Military Medicine, titled Post-Traumatic Shoulder Dystonia
in an Active Duty Soldier reported that, ``Dystonia after minor trauma
can be as crippling as a penetrating wound, with disability that
renders the soldier unable to perform his duties.'' The article goes on
to say that although battlefield treatment may not be practical,
``awareness of this disorder [dystonia] is essential to avoid
mislabeling, and possibly mistreating, a true neurological disease.''
The DMRF would like to thank the Subcommittee for adding dystonia
to the list of conditions eligible for study under the DOD Peer-
Reviewed Medical Research Program in the fiscal year 2010 DOD
Appropriations bill. Unlike other Federally funded medical research
programs, conditions eligible for study through the Peer-Reviewed
Medical Research Program must affect members of the armed services and
their families. As traumatic injuries and dystonia among service
personnel increases, it is critical that we develop a better understand
of the mechanisms connecting TBI and dystonia. We urge Congress to
maintain dystonia as a condition deemed eligible for study through the
Peer-Reviewed Medical Research Program, as the number of current
military members and veterans with dystonia swells.
Thank you again for allowing me the opportunity to address the
Subcommittee today. As the mother of a child suffering from dystonia,
and as a military spouse concerned with the well-being of our troops
and veterans, I hope you will continue to include dystonia as condition
eligible for study under the DOD Peer-Reviewed Medical Research
Program.
Chairman Inouye. And now, may I recognize Mr. John Davis.
Mr. Davis.
STATEMENT OF JOHN R. DAVIS, DIRECTOR, LEGISLATIVE
PROGRAMS, FLEET RESERVE ASSOCIATION
Mr. Davis. Thank you, Mr. Chairman.
My name is John Davis, and I want to thank you for the
opportunity to express the views of the Fleet Reserve
Association. The association appreciates the administration's
second consecutive request for full funding of the TRICARE
program without a fee increase.
We believe we need to look at other cost-saving options
first before looking at a TRICARE fee increase. Further, FRA
believes that raising TRICARE fees during wartime would send
the wrong message 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.
FRA welcomes the administration's focus on creating an
electronic health record for service members that can follow
them to the Department of Veterans Affairs (VA) and for the
rest of their lives. Oversight notwithstanding, adequate
funding for an effective delivery system between DOD and VA to
guarantee a seamless transition and quality services for
wounded personnel is very important to our membership.
The association appreciates President Obama's support for
authorizing chapter 61 retirees to receive full military
retired pay and full veterans' disability compensation. FRA
continues to seek authorization of funding of full concurrent
receipt for all disabled retirees. An FRA survey indicates that
more than 70 percent of military retirees cite concurrent
receipt among their top priorities.
The association strongly supports the fiscal year 2011
budget request of $408 million to cover the first phase of the
5-year cost of concurrent receipt for chapter 61 beneficiaries
that are 90 percent or more disabled and supports provisions in
the so-called ``tax extenders bill''--that is H.R. 4213--that
expands the concurrent receipt of military retired pay and the
VA disability compensation.
Family support is also important and should include full
funding for compensation, training and certification, and
respite care for family members functioning as full-time
caregivers for wounded warriors. The recently enacted
Caregivers and Veterans Omnibus Health Services Act--that is S.
1963--and parallel provision in the Senate version of the
Defense authorization bill improves compensation, training, and
assistance for caregivers of severely disabled Active Duty
service members. And if authorized, FRA supports funding for
these enhancements.
FRA strongly supports the funding of a 1.9 percent pay
increase, which is 0.5 percent above the administration's
request for fiscal year 2011. Pay increases in recent years
have helped close the pay gap and contributed to improved
morale, readiness, and retention. Pay and benefits must reflect
the fact that military service is very different from the work
in the private sector.
If authorized, FRA supports funding retroactive eligibility
for early retirement benefits to include reservists who have
supported contingency operations since 9/11/2001. The 2008
Defense authorization act reduces the Reserve retirement age,
which is age 60, by 3 months for each cumulative 90 days
ordered to Active Duty. This applies only to servicemen after
the effective date of legislation, which is January 28, 2008,
and leaves out more than 600,000 reservists mobilized since 9/
11.
Again, thank you for allowing FRA to submit its views to
the subcommittee.
Chairman Inouye. Mr. Davis, I can assure you that the
subcommittee is well aware that the men and women who serve in
uniform are all volunteers. And as far as we are concerned,
anyone who is willing to stand in harm's way on our behalf
deserves the very best. We give it the highest priority.
Thank you very much.
Senator Cochran. Thank you very much, Mr. Chairman.
We appreciate your testimony and the reminders of the real-
life challenges that many of our servicemen and women face, and
I hope this subcommittee can respond in a way that shows our
concern and support for their efforts and their unselfish
service.
[The statement follows:]
Prepared Statement of John R. Davis
the fra
The Fleet Reserve Association (FRA) is the oldest and largest
enlisted organization serving active duty, Reserves, retired and
veterans of the Navy, Marine Corps, and Coast Guard. It is
Congressionally Chartered, recognized by the Department of Veterans
Affairs (VA) as an accrediting Veteran Service Organization (VSO) for
claim representation and entrusted to serve all veterans who seek its
help. In 2007, FRA was selected for full membership on the National
Veterans' Day Committee.
FRA was established in 1924 and its name is derived from the Navy's
program for personnel transferring to the Fleet Reserve or Fleet Marine
Corps Reserve after 20 or more years of active duty, but less than 30
years for retirement purposes. During the required period of service in
the Fleet Reserve, assigned personnel earn retainer pay and are subject
to recall by the Secretary of the Navy.
FRA's mission is to act as the premier ``watch dog'' organization
in maintaining and improving the quality of life for Sea Service
personnel and their families. FRA is a leading advocate on Capitol Hill
for enlisted active duty, Reserve, retired and veterans of the Sea
Services. The Association also sponsors a National Americanism Essay
Program and other recognition and relief programs. In addition, the
newly established FRA Education Foundation oversees the Association's
scholarship program that presents awards totaling nearly $100,000 to
deserving students each year.
The Association is also a founding member of The Military Coalition
(TMC), a 34-member consortium of military and veteran's organizations.
FRA hosts most TMC meetings and members of its staff serve in a number
of TMC leadership roles.
FRA celebrated 85 years of service in November 2009. For over eight
decades, dedication to its members has resulted in legislation
enhancing quality of life programs for Sea Services personnel, other
members of the uniformed services plus their families and survivors,
while protecting their rights and privileges. CHAMPUS, now TRICARE, was
an initiative of FRA, as was the Uniformed Services Survivor Benefit
Plan (USSBP). More recently, FRA led the way in reforming the REDUX
Retirement Plan, obtaining targeted pay increases for mid-level
enlisted personnel, and sea pay for junior enlisted sailors. FRA also
played a leading role in advocating recently enacted predatory lending
protections and absentee voting reform for service members and their
dependents.
FRA's motto is: ``Loyalty, Protection, and Service.''
overview
Mr. Chairman, the Fleet Reserve Association salutes you, members of
the Subcommittee, and your staff for the strong and unwavering support
of funding essential programs for active duty, Reserve Component, and
retired members of the uniformed services, their families, and
survivors. The Subcommittee's work in funding important programs has
greatly enhanced care and support for our wounded warriors, improved
military pay, eliminated out-of-pocket housing expenses, improved
healthcare, and enhanced other personnel, retirement and survivor
programs. This funding is critical in maintaining readiness and is
invaluable to our Armed Forces engaged in a long and protracted two
front war, sustaining other operational commitments and fulfilling
commitments to those who've served in the past. But more still needs to
be done. A constant high priority for FRA is full funding of the
Defense Health Program (DHP) to ensure quality care for active duty,
retirees, Reservists, and their families.
FRA's other 2010 priorities include annual active duty pay
increases that are at least a half percent above the Employment Cost
Index (ECI), to help close the pay gap between active duty and private
sector pay, full concurrent receipt of military retired pay and VA
disability compensation, retirement credit for reservists that have
been mobilized since September 1, 2001, enhanced family readiness via
improved communications and awareness initiatives related to benefits
and quality of life programs, and introduction and enactment of
legislation to eliminate inequities in the Uniformed Service Former
Spouses Protection Act (USFSPA).
The Administration's fiscal year 2011 proposed budget for a second
consecutive year fully funds the DHP budget without shifting additional
cost burdens to military retirees. FRA appreciates this and strongly
supports efforts to fully implement electronic health records that will
follow service members as they transition from DOD to the VA. FRA also
supports additional improvements in concurrent receipt to expand the
number of disabled military retirees receiving both their full military
retired pay and VA disability compensation. The fiscal year 2011 budget
also calls for a 1.4-percent active duty pay increase that equals the
Employment Cost Index (ECI). The budget further increases care for
wounded warriors by 5.8 percent, enhances family support by 3 percent,
adds $87 million to child development centers, and boosts family
counseling/relocation assistance by $37 million over the current fiscal
year 2010 budget.
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 and other challenges 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.''
health care
Healthcare is especially significant to all FRA Shipmates
regardless of their status and protecting and/or enhancing this benefit
is the Association's top legislative priority. A recently released FRA
survey indicates that nearly 90 percent of all active duty, Reserve,
retired, and veteran respondents cited healthcare access as a
critically important quality-of-life benefit associated with their
military service. From 2006-2008 retirees under age 65 were targeted by
DOD to pay significantly higher healthcare fees. Many of these retirees
served before the recent pay and benefit enhancements were enacted and
receive significantly less retired pay than those serving and retiring
in the same pay grade with the same years of service today. Promises
were made to them about healthcare for life in return for a career in
the military with low pay and challenging duty assignments and many
believe they are entitled to free healthcare for life.
Efforts to enact a national healthcare reform coupled with
inaccurate and widespread information on the associated impact on
retiree healthcare benefits has created unease and a sense of
uncertainty for our members. FRA opposes any effort to integrate
TRICARE and VA healthcare into any national healthcare program. The
Association is concerned about proposed Medicare spending cuts
associated with reform legislation and scheduled cuts for physician
reimbursement rates for Medicare and TRICARE beneficiaries that could
negatively impact availability of care, and quality of services. It's
also important to note that healthcare 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.
FRA strongly supports fully funding the TRICARE program and ``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, 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 healthcare spending in the coming years.
concurrent receipt
The Association appreciates President Obama's support for
authorizing Chapter 61 retirees to receive their full military retired
pay and veteran's disability compensation and continues to seek timely
and comprehensive implementation of legislation that authorizes the
full concurrent receipt for all disabled retirees. As with last year's
budget, the proposed fiscal year 2011 budget does not provide funding
or identify spending offsets for these improvements and does not comply
with House budgeting rules. The above referenced FRA survey indicates
that more than 70 percent of military retirees cite concurrent receipt
among their top priorities. The Association strongly supports the
fiscal year 2011 budget request of $408 million to cover the first
phase of the 5-year cost for concurrent receipt for Chapter 61
beneficiaries that are 90 percent or more disabled and supports the
provisions in the so-called ``tax-extenders'' bill (H.R. 4213) that
expands the concurrent receipt of military retired pay and VA
disability compensation. The measure would authorize service members
who are medically retired with less than 20 years of service (Chapter
61 retirees) and have a disability rating of 90 to 100 percent to
receive both payments, without offset, starting on January 1, 2011. The
following year concurrent receipt would be expanded to those with 70-
to 80-percent disability ratings.
wounded warriors
FRA appreciates the substantial Wounded Warriors provisions in the
fiscal year 2008 National Defense Authorization Act (NDAA). Despite
jurisdictional challenges, considerable progress has been made in this
area. However, the enactment of authorizing legislation is only the
first step in helping wounded warriors. Sustained funding is also
critical for successful implementation. Jurisdictional challenges
notwithstanding adequate funding for an effective delivery system
between DOD and VA to guarantee seamless transition and quality
services for wounded personnel, particularly those suffering from Post
Traumatic Stress Disorder (PTSD) and Traumatic Brain Injuries (TBI) is
very important to our membership. Family support is also critical for
success, and should include full funding for compensation, training,
and certification, and respite care for family members functioning as
full-time caregivers for wounded warriors. FRA supported the recently
enacted ``Caregivers and Veterans Omnibus Health Services Act'' (S.
1963), and parallel legislation included in the Senate's version of the
fiscal year 2011 Defense Authorization bill (S. 3454) to improve
compensation, training and assistance for caregivers of several
disabled active-duty service members.
adequate personnel end strength
Funding for adequate service end strengths is essential to success
in Iraq and Afghanistan and to sustaining other operations vital to our
national security. FRA notes the Marine Corps' success in attaining its
current end strength level and strongly supports the proposed Navy end
strength increase in 2011. A recent Navy Times story entitled ``Sailor
shortage,'' cites too much work to do in the Navy and not enough people
to do it--and lists the associated effects which include little time
for rest, fewer people to maintain and repair shipboard equipment, crew
members with valuable skills being pulled for other jobs and not
replaced and lower material ship readiness.
The strain of repeated deployments continues and is also related to
the adequacy of end strengths--and FRA is tracking disturbing
indicators of the effects which include increased prescription drug and
alcohol use, increasing mental healthcare appointments, alarming
suicide rates plus more military divorces. Stress on service members
and their families was addressed during a recent Senate Personnel
Subcommittee hearing along with serious and continuing concerns about
associated effects which can include morale, readiness and retention
challenges. FRA urges this distinguished Subcommittee to ensure funding
for adequate end strengths and people programs consistent with the
Association's DOD funding goal of at least 5 percent of the GDP.
active duty pay improvements
Our Nation is at war and there is no more critical morale issue for
active duty warriors than adequate pay. This is reflected in the more
than 96 percent of active duty respondents to FRA's recent survey
indicating that pay is ``very important.'' The Employment Cost Index
for fiscal year 2011 is 1.4 percent and based on statistics from 15
months before the effective date of the proposed active duty pay
increase. The Association appreciates the strong support from this
distinguished Subcommittee in funding pay increases that have reduced
the 13.5 percent pay gap (1999) to the current level of 2.4 percent. In
addition, FRA notes that even with a fiscal year 2011 pay increase that
is 0.5 percent above the ECI, the result will be the smallest pay hike
since 1958. FRA urges the Subcommittee to continue the fund pay
increases at least 0.5 percent above the ECI until the remaining 2.4
percent pay gap is eliminated.
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
mobilized to augment active duty components. As a result, the Reserve
component is no longer a strategic Reserve, but is an operational
Reserve that is an integral part of the total force. And because of
these increasing demands, including missions abroad over longer periods
of time, it is 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 (H.R. 208/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 after the effective date
(January 28, 2008) leaving out more than 600,000 Reservists mobilized
since 9/11 for duty in Afghanistan and Iraq.
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 these funding
recommendations to this distinguished Subcommittee. The Association
reiterates its profound gratitude for the extraordinary progress this
Subcommittee has made in funding a wide range of military personnel and
retiree benefits and quality-of-life programs for all uniformed
services personnel and their families and survivors. Thank you again
for the opportunity to present the FRA's views on these critically
important topics.
Chairman Inouye. I would like to thank the first panel, and
may I now call upon the second panel made up of Mr. Terry C.
Wicks, Ms. Karen Mason, Ms. Katie Savant, and Dr. Dan Putka.
Welcome, and may I first call upon Mr. Terry Wicks.
STATEMENT OF TERRY C. WICKS, CERTIFIED REGISTERED NURSE
ANESTHETIST, MHS, AMERICAN ASSOCIATION OF
NURSE ANESTHETISTS
Mr. Wicks. Chairman Inouye, Vice Chairman Cochran, good
morning. My name is Terry Wicks.
Chairman Inouye. Will you put on the mike, please?
Mr. Wicks. My name is Terry Wicks. I am past president of
the 40,000 member American Association of Nurse Anesthetists,
and while on Active Duty in the military, I also served as
president of the Hawaii Association of Nurse Anesthetists.
The quality of healthcare America provides our servicemen
and servicewomen 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, and I will also
provide you our recommendations to further improve military
healthcare for these challenging times.
I also ask unanimous consent that our written statement be
entered in the record.
Chairman Inouye. Without objection.
Mr. Wicks. America's CRNAs provide some 32 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 is 50 times safer
than it was in the early 1980s.
For the United States armed forces, CRNAs are particularly
critical. In 2009, over 500 Active Duty and more than 750
reservist CRNAs provided anesthesia care indispensable to our
armed forces' current mission.
Not long ago, one CRNA, Major General Gale Pollock, served
as acting Surgeon General of the United States Army. Today,
CRNAs serve in major military hospitals, at educational
institutions, aboard ships, and in isolated bases abroad and at
home. And as members of forward surgical teams, they serve as
close to the tip of the spear as they can be.
In most of these environments, CRNAs provide anesthesia
services alone--without anesthesiologists--enabling surgeons
and other clinicians to safely deliver lifesaving care. But in
recent years, the number of CRNAs in the armed forces has
fallen below the number needed. The private market for CRNA
services is very, very 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 multi-year
agreements.
The profession of nurse anesthesia has likewise responded.
The Counsel on Certification of Nurse Anesthetists reported
that in 2009, our schools produced 2,228 graduates, double the
number since 2000. And 2,386 nurse anesthetists were certified.
That growth is expected to continue.
The Counsel on Accreditation of Nurse Anesthesia
Educational Programs projects that CRNA schools will produce
over 2,400 graduates in 2010. These combined actions have
helped strengthen the services' readiness and the quality of
healthcare available to our servicemen and servicewomen.
So our first recommendation to you is to extend and
strengthen the successful ISP program for CRNAs. The
authorizing committee has extended the ISP program. We would
encourage this subcommittee to continue funding ISP levels
sufficient for the services to recruit and retain the CRNAs
needed for the mission.
Our second recommendation is for the subcommittee to
encourage all services to adopt a joint scope of practice.
Standard practices across the services enhance patient safety
and the quality of healthcare for our servicemen and women. The
Navy, in particular, has made a great deal of progress toward
adopting a joint scope of independent practitioners. We
encourage its adoption in all 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 of our military men and women
get the care that they need and deserve.
Thank you, and I would be happy to take any questions.
Chairman Inouye. Thank you very much.
I can assure that this subcommittee is well aware of the
shortage of nurse anesthetists. We are also aware that if it
weren't for nurse anesthetists, we won't have any anesthesia in
rural America because 85 percent of that is administered by
nurse anesthetists.
Mr. Wicks. Yes, sir.
Chairman Inouye. So we are going to do our very best.
Mr. Wicks. Thank you.
Chairman Inouye. Do you have any questions?
I thank you very much, sir.
[The statement follows:]
Prepared Statement of Terry C. Wicks
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 harms 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 2010, there are 108 accredited nurse anesthesia schools to
support the profession, and the number of qualified registered nurses
applying to these schools continues to climb. The growth in the number
of schools, number of applicants, and production capacity has yielded
significant growth in the number of student nurse anesthetists
graduating and being certified into the profession. The Council on
Certification of Nurse Anesthetists reports that in 2009 our schools
produced 2,228 graduates, a 66 percent increase since 2003, and 2,386
nurse anesthetists became certified. This growth is expected to
continue. The Council on Accreditation of Nurse Anesthesia Educational
Programs (COA) projects that the 108 CRNA schools will produce 2,430
graduates in 2010.
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 2011, 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, texas
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, Texas 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,
Massachusetts. 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 Joseph O'Sullivan, CRNA, Ph.D., 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.
Thank you. If you have further questions, please contact the AANA
Federal Government Affairs Office at 202-484-8400.
Chairman Inouye. And our next witness is Ms. Karen Mason.
STATEMENT OF KAREN MASON, REGISTERED NURSE, OVARIAN
CANCER NATIONAL ALLIANCE
Ms. Mason. Good morning, Mr. Chairman and Mr. Vice
Chairman. I am honored to appear before you in support of the
Ovarian Cancer National Alliance's request of $30 million for
the Department of Defense Ovarian Cancer Research Program.
My name is Karen Mason, and I am an intensive care nurse
from Pitman, New Jersey. I also serve as an integration panel
member for the Ovarian Cancer Research Program, which I will
refer to as the OCRP for the remainder of my testimony.
As a 9 year survivor of late-stage ovarian cancer, I feel a
strong sense of responsibility to my community and sit before
you today as the voice of all women with this disease--past,
present, and future.
During my 9 years of survivorship, I have befriended many
women who also had late-stage ovarian cancer. One by one, I
have watched most of these women die. Today, in the Delaware
Valley, I know of no other woman diagnosed at a late stage who
has survived as long as I have.
I still speak to women newly diagnosed to offer them hope,
but now I must hold a piece of my heart in reserve. It is my
hope that today I can beseech you to share this responsibility
to fund research conducted by the OCRP to find new treatments
and early detection for women with or at risk of ovarian
cancer.
This year, approximately 20,000 women will be diagnosed
with ovarian cancer, and 15,000 women will die of this disease.
Ovarian cancer has no test like the mammogram for breast cancer
or the Pap test for cervical cancer. Because there is no
reliable early detection test, women must rely on their and
their doctor's knowledge of ovarian cancer symptoms.
However, most women and even their physicians do not know
the symptoms of ovarian cancer, which are often confused with
less-threatening conditions. Even with symptom awareness, by
the time a woman has symptoms, she will already have late-stage
cancer. Two out of three women with ovarian cancer are
diagnosed when their cancer is late stage as mine was.
Current treatments are brutal and consist of long debulking
surgeries, followed by months of chemotherapies. Even when the
initial treatment response seems positive, around 70 to 95
percent of women diagnosed at stages III or IV will have a
recurrence.
The OCRP has one bold aim--to eliminate ovarian cancer.
Since 1997, the OCRP has funded out-of-the-box, innovative
research focused on detection, diagnosis, prevention, and
control of ovarian cancer. Many of the funded proposals can be
characterized as high risk and high reward. Although we take
risk in the research we fund, we believe that investing in
innovative research will result in a great breakthrough in the
fight against ovarian cancer.
I have volunteered my time for the past 3 years to serve as
an integration panel member for the OCRP. I work alongside
physicians, scientists, and other patient advocates, and
together, we select proposals that we think merit funding. This
spring, we received approximately 350 pre-applications. Sadly,
we will only be able to fund approximately 30 full proposals.
We worry that the cure could be heading into the trash can.
The ovarian cancer community was extremely disappointed
when we found out that the OCRP funding was reduced from $20
million in 2009 to $18.75 million in 2010. This cut is shocking
when you consider our mortality rate has not decreased, and new
treatments and an early detection test are still so desperately
needed.
By increasing the OCRP's funding to $30 million for 2011 so
that more research can be carried out, you not only help women
currently battling this deadly beast, but future generations of
women at risk.
Thank you for this opportunity, and I am happy to answer
any questions.
Chairman Inouye. I thank you very much for your testimony.
This subcommittee, about 25 years ago, took a step that was
considered rather courageous. We began the cancer research
programs for breast cancer. And although women who wear the
uniform are required to take physicals, and if they do have
breast cancer, that should be somehow detected before they take
the oath. We felt that since Defense Department had the money,
we would begin our research programs.
It may interest you to know that at this moment, DOD funds
more research money than the National Institutes of Health. So
I can assure you that your request is given our highest
priority.
Ms. Mason. Thank you.
Senator Cochran. I was reminded, Mr. Chairman, that you and
Senator Stevens led the way for this subcommittee in
recommending these funding levels, and I am sure that we will
continue to be guided by your good judgment and your serious
request for continued funding.
Chairman Inouye. Thank you very much, Ms. Mason.
[The statement follows:]
Prepared Statement of Karen Mason
Good morning, Mr. Chairman, Ranking Member and Members of the
Subcommittee. I am honored to appear before you in support of the
Ovarian Cancer National Alliance's request of a minimum of $30 million
for the Department of Defense Ovarian Cancer Research Program in fiscal
year 2011. My name is Karen Mason and I am an intensive care nurse from
Pitman, New Jersey. I also serve as an Integration Panel member for the
Ovarian Cancer Research Program, which I will refer to as the OCRP for
the remainder of my testimony.
As a 9 year survivor of late stage ovarian cancer, I feel a strong
sense of responsibility to my community and sit before you today as the
voice of all women with this disease, past, present and future. It is
my hope that today I can beseech you to share this responsibility to
fund research conducted by the OCRP that works to find new treatments
and an early detection test for ovarian cancer.
This year, approximately 20,000 women will be diagnosed with
ovarian cancer and 15,000 women will die of this disease.\1\ Ovarian
cancer has no test like the mammogram for breast cancer or pap test for
cervical cancer. Because there is no reliable early detection test,
women must rely on their--and their doctors'--knowledge of ovarian
cancer symptoms.
---------------------------------------------------------------------------
\1\ ``Ovarian Cancer.'' National Cancer Institute. May 4, 2010
.
---------------------------------------------------------------------------
However, most women, and even their doctors, do not know the
symptoms of ovarian cancer, which are bloating, pelvic or abdominal
pain, urinary urgency or frequency, and difficulty eating or feeling
full quickly. These symptoms are often confused with less threatening
conditions.
Unfortunately, even with symptom awareness, by the time a woman has
symptoms, she will already have late stage cancer. Two out of three
women with ovarian cancer are diagnosed when their cancer is late
stage, as mine was.\2\ Current treatments are brutal and consist of
long ``debulking'' surgeries followed by months of chemotherapies. Even
when the initial treatment response seems positive, around 70-95
percent of women diagnosed at stages 3 or 4 will have a recurrence.\3\
---------------------------------------------------------------------------
\2\ M.J. Horner, L.A. G. Ries, M. Krapcho, N. Neyman, R. Aminou, N.
Howlader, S.F. Altekruse, E.J. Feuer, L. Huang, A. Mariotto, B.A.
Miller, D.R. Lewis, M.P. Eisner, D.G. Stinchcomb, E.K. Edwards, eds.
SEER Cancer Statistics Review 1975-2006. National Cancer Institute,
2009. http://seer.cancer.gov/csr/1975_2006.
\3\ Armstrong, M.D., Deborah. ``Treatment of Recurrent Disease
Q&A.'' John Hopkins Pathology. May 9, 2010 .
---------------------------------------------------------------------------
During my 9 years of survivorship, I have befriended many women who
also had late-stage ovarian cancer. One by one, I have watched most of
these women die. Today in the Delaware Valley, I know of no other woman
diagnosed at a late stage who has survived as long as I have. I still
speak to woman newly diagnosed to offer them hope, but now I must hold
a piece of my heart in reserve.
The OCRP has one bold aim: to eliminate ovarian cancer. Since 1997,
the OCRP has funded out of the box, innovative research focused on
detection, diagnosis, prevention and control of ovarian cancer. Many of
the funded proposals can be characterized as high risk and high reward.
Although we take risks in the research we fund, we believe that
investing in innovative research will result in great breakthroughs in
the fight against ovarian cancer.
An example of a scientific breakthrough that came out of the OCRP
was the creation of the OVA1 test for risk stratification. This test
was recently brought to the market and has received much media
attention, most notably in the March 9 edition of the Wall Street
Journal.\4\ In 2003, Dr. Zhen Zhang, an investigator at John Hopkins
School of Medicine received an Idea Development Award from the OCRP in
the amount of $563,022. Dr. Zhang's research eventually led to the
creation of OVA1, which is a blood test that can help physicians
determine if a woman's pelvic mass is at risk for being malignant.
While OVA1 is not an early detection test, it is a step in the right
direction.
---------------------------------------------------------------------------
\4\ Johannes, Laura. ``Test to Help Determine If Ovarian Masses Are
Cancer.'' The Wall Street Journal March 9, 2010. .
---------------------------------------------------------------------------
The OCRP is also special in that it involves patient advocates at
all levels. I have volunteered my time for the past 3 years to serve as
an Integration Panel Member for the OCRP. I work alongside physicians,
scientists and other patient advocates and together, we select
proposals that we believe merit funding. Patient advocates hold equal
weight with scientists and physicians when funding proposals and
deciding the program's vision for the future.
Last fall during our vision setting day, I suggested that if the
OCRP was truly seeking innovative out of the box researchers, perhaps
the reviewers should be blinded as to who the researchers were and what
institutions they represent. Imagine my delight when the panel agreed.
Because researchers and institutions were blinded to us, a relatively
unknown researcher from a lesser institution could conceivably be
invited to submit a full proposal based solely on his or her idea.
However, one of my community's biggest fears is that the relatively
low incidence of ovarian cancer (lifetime risk of developing invasive
ovarian cancer is 1 in 71) versus other types of cancers (lifetime risk
of developing breast cancer is 1 in 8) has resulted in a much smaller
investment in ovarian cancer research, thus dissuading young scientists
from studying ovarian cancer and instead choosing to head into other
organ sites for their careers in order to secure research funding.\5\
\6\
---------------------------------------------------------------------------
\5\ ``What Are the Key Statistics About Ovarian Cancer?'' American
Cancer Society. May 2, 2010 .
\6\ ``Probability of Breast Cancer in American Women.'' American
Cancer Society. May 3, 2010 .
---------------------------------------------------------------------------
Additionally, Michael Seiden, M.D, Ph.D, President and CEO of Fox
Chase Cancer Center and a fellow Integration Panel Member aptly stated
that:
``Reducing the burden of ovarian cancer requires recruiting and,
more importantly, mentoring a group of scientists and clinicians who
are committed to building sustained and productive careers in ovarian
cancer research. Few academic medical or research centers have the
large ovarian cancer research teams and the number of junior faculty
focused on developing careers that are supported through peer-reviewed,
competitively funded ovarian cancer research. Often junior faculty have
few if any peers at their research center with common interests; thus,
this group often lacks specific mentoring and networking opportunities
that would maximize the pace of their career development.''
The OCRP addressed this concern last year. We voted to award
funding for the creation of an Ovarian Cancer Academy. The Academy puts
the African proverb ``it takes a village to raise a child'' into action
by training the next generation of ovarian cancer researchers. This
award will develop a unique, interactive virtual academy that will
provide intensive mentoring, national networking, and a peer group for
junior faculty. Under the guidance of mentors and a chosen Academy
Dean, it is hoped that successful, highly productive ovarian cancer
researchers will emerge.
But in order to continue supporting innovative research, the OCRP
needs increased funding. This spring, we received approximately 350
pre-applications. In the end, we will only be able to fund
approximately 30 full proposals. The ovarian cancer community worries
that the cure could be heading to the trash can. Only with increased
funding can the OCRP grow and continue to contribute to the fight
against ovarian cancer.
ovarian cancer community concerned by funding cuts to the ocrp
The ovarian cancer community was extremely disappointed when we
found out that OCRP funding was reduced from $20 million in 2009 to
$18.75 in 2010. It is shocking when you consider our mortality rate has
not decreased and new treatments and an early detection test are still
so desperately needed.
[GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]
The OCRP remains a modest program compared to the other cancer
programs in the Congressionally-Directed Medical Research Programs, and
yet has made vast strides in the fight against ovarian cancer with
relatively few resources. With an increase in funding, the program can
support more research into screening, early diagnosis and treatment of
ovarian cancer.
congressional support for fiscal year 2011 appropriation request
This year, the ovarian cancer community has been proactive in
securing support for our fiscal year 2011 appropriation request. A
letter addressed to you in support of the $30 million appropriation for
the OCRP was signed by Senator Robert Menendez and Senator Olympia
Snowe, who were joined by Senators Daniel Akaka, Barbara Boxer, Sherrod
Brown, Roland Burris, Ben Cardin, Bob Casey, Susan Collins, Chris Dodd,
Richard Durbin, Kirsten Gillibrand, John Kerry, Kay Hagan, Ted Kaufman,
Herb Kohl, Frank Lautenberg, Joe Lieberman, Blanche Lincoln, Jack Reed,
Bernard Sanders, Charles Schumer, Debbie Stabenow, Sheldon Whitehouse,
and Ron Wyden.
A companion letter in the House supporting the $30 million request
was sent to Chairman Dicks and Ranking Member Young from Congresswoman
Rosa DeLauro and Congressman Dan Burton, who were joined by 84
Representatives from both sides of the aisle: Representatives Andrews,
Baldwin, Berkley, Berman, Blumenauer, Boswell, Boucher, Corrine Brown,
Capuano, Carney, Carson, Castor, Cleaver, Cohen, Conyers, Crowley,
Cummings, Susan Davis, DeGette, Delahunt, Doggett, Donna Edwards,
Ellison, Farr, Frank, Gerlach, Gene Green, Grijalva, Gutierrez, John
Hall, Halvorson, Hastings, Hirono, Hodes, Holt, Eddie Bernice Johnson,
Kildee, Kilroy, Kind, Peter King, Kucinich, Lance, Levin, LoBiondo,
Loebsack, Lynch, Maloney, Edward Markey, Marshall, McDermott, McGovern,
Meeks, Michaud, George Miller, Brad Miller, Dennis Moore, Gwen Moore,
Christopher Murphy, Patrick Murphy, Nadler, Norton, Oberstar, Pascrell,
Peterson, Rahall, Richardson, Rush, Schakowsky, Bobby Scott, David
Scott, Sestak, Shea-Porter, Snyder, Mike Thompson, Tierney, Tonko,
Tsongas, Van Hollen, Velazquez, Walz, Wasserman Schultz, Waxman, Wu and
Yarmuth.
appropriation request for fiscal year 2011
On behalf of the entire ovarian cancer community--patients, family
members, clinicians and researchers--we greatly appreciate 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 a minimum of $30 million in fiscal year 2011 funding for the
Department of Defense Ovarian Cancer Research Program.
Chairman Inouye. Our next witness, Ms. Katie Savant, Deputy
Director of Government Relations, National Military Family
Association.
STATEMENT OF KATIE SAVANT, GOVERNMENT RELATIONS DEPUTY
DIRECTOR, NATIONAL MILITARY FAMILY
ASSOCIATION
Ms. Savant. Chairman Inouye, Senator Cochran, the National
Military Family Association would like to thank you for the
opportunity to present testimony on the quality of life of
military families.
Many families have faced the challenge of deployment for 8
plus years. It is imperative that programs and services that
provide a firm foundation for our families are fully funded.
Programs must continue to adapt to the changing needs of
service members and their families as they cope with multiple
deployments, react to separations, balance reintegration,
adjust to a wounded or ill service member, or grieve the loss
of a fallen service member. Programs should provide for
families in all stages of deployment and reach out to them in
all geographical locations.
Our association would like to thank the subcommittee for
showing strong support for military families by funding
essential programs that support today's dynamic and diverse
military family, but more needs to be done. In this statement,
our association will address areas that require additional
funding or new funding.
In May 2008, our association commissioned the RAND
Corporation to conduct a longitudinal study on the deployment
experiences of 1,500 families. The baseline findings were
presented to Congress earlier this year. As a result of this
research, our association believes we need dedicated resources,
such as additional youth or teen centers, to support the needs
of our older youth and teens during deployment.
National Guard and Reserve component families appreciate
the implementation of the Yellow Ribbon Program. Our
association asked Congress to fully fund the Yellow Ribbon
Program so it is consistent across the Nation and accessible to
all families.
The National Defense Authorization Act (NDAA) for Fiscal
Year 2010 established the Office of Community Support for
military families with special needs. The new office will go a
long way in identifying and addressing special needs services.
In order for this office to be successful, it will require
funding.
Military families place a high priority on the education of
our military children. With States facing major budget cuts,
Impact Aid will be a critical component to help school
districts. We urge Congress to fully fund Impact Aid to its
authorized levels.
Military families are monitoring national healthcare reform
and its potential impact in our population. We thank Congress
for legislation that recognizes TRICARE meets minimal essential
coverage under healthcare reform. However, we request your
continued vigilance to ensure quality healthcare for military
families.
We suggest additional funding and flexibility in hiring
practices when our military doctors deploy. We also recommend
additional funding to DOD for possible civilian provider
shortages due to reduced Medicare reimbursement rates and
potential decreased provider availability due to healthcare
reform.
Our association applauds the recent passage of the
Caregivers and Veterans Health Services Act. We would like to
highlight two additional areas that will support our wounded
service members. In last year's NDAA, it provided compensation
for service members with assistance in everyday living.
Unfortunately, this DOD mandate was not funded.
For a seamless transition from Active Duty to veteran
status, the service member's compensation amount should match
the aid and attendance level the wounded service member would
be eligible for by the Veterans Administration (VA).
Additionally, current law permits the Secretary of the VA to
provide a caregiver stipend. Caregivers have been shown to play
an important role in maintaining the well-being of service
members, and this provision should be funded.
Our association has long advocated for enhanced benefits
for survivors. Over 90 percent of families attended the
ceremony at Dover to witness the dignified transfer of remains.
Currently, the services are funding the travel out of pocket.
We ask that funding be appropriated for travel costs for
surviving family members to attend.
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 when the war
ends. We ask for you to help the Nation sustain and support our
military families.
Thank you.
Chairman Inouye. I thank you very much, Ms. Savant.
We are well aware that in World War II and Korea and
Vietnam, the words ``military family'' were not used too often
because when I was a little soldier, in my regiment, 4 percent
had dependents, 96 percent were single.
Ms. Savant. Wow.
Chairman Inouye. Today, in a typical regiment, 70 percent
have dependents. So we know that this is an important part of
army life and military life. So I can assure you that if we are
to maintain this strong military posture, we will have to look
into military families.
Ms. Savant. Thank you.
Senator Cochran. Mr. Chairman, thank you for your
leadership in providing sensitive and meaningful assistance to
families. And I know with programs like the Yellow Ribbon
Program and others, families are doing a great job with self
help and contributions that are very, very important to the
morale of our troops, men and women.
Ms. Savant. Thank you.
Chairman Inouye. Thank you very much.
[The statement follows:]
Prepared Statement of Katie Savant
The National Military Family Association is the leading nonprofit
organization committed to improving the lives of military families. Our
40 years of accomplishments have made us a trusted resource for
families and the Nation's leaders. We have been at the vanguard of
promoting an appropriate quality of life for active duty, National
Guard, Reserve, retired service members, their families and survivors
from the seven uniformed services: Army, Navy, Air Force, Marine Corps,
Coast Guard, Public Health Service and the National Oceanic and
Atmospheric Administration.
Association Representatives in military communities worldwide
provide a direct link between military families and the Association
staff in the Nation's capital. These volunteer Representatives are our
``eyes and ears,'' bringing shared local concerns to national
attention.
The Association does not have or receive Federal grants or
contracts.
Our website is: www.MilitaryFamily.org.
Chairman Inouye, Ranking Member Cochran, and Distinguished Members
of the Subcommittee, the National Military Family Association would
like to thank you for the opportunity to present testimony on the
quality of life of military families--the Nation's families. As the war
has continued, the quality of life of our service members and their
families has been severely impacted. Your recognition of the sacrifices
of these families and your response through legislation to the
increased need for support have resulted in programs and policies that
have helped sustain our families through these difficult times.
In this statement, our Association will expand on several issues of
importance to military families: Family Readiness, Family Health, and
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
and Appropriations legislation in the past several years that
recognized many of these important issues. Excellent programs exist
across the Department of Defense (DOD) and the Services to support our
military families. There are redundancies in some areas, times when a
new program was initiated before looking to see if an existing program
could be adapted to answer an evolving need. Service members and their
families are continuously in the deployment cycle, anticipating the
next separation, in the throes of deployment, or trying to reintegrate
when the service member returns. Dwell times seem shorter and shorter
as training, schools, and relocation impede on time that is spent in
the family setting.
``My husband will have 3 months at home with us between deployment
and being sent to school in January for 2 months and we will be PCSing
soon afterwards. . . . This does not leave much time for reintegration
and reconnection.''
We feel that now is the time to look at best practices and at those
programs that are truly meeting the needs of families. In this section
we will talk about existing programs, highlight best practices and
identify needs.
Child Care
At every military family conference we attended last year, child
care was in the top five issues affecting families--drop-in care being
the most requested need. Some installations are responding to these
needs in innovative ways. For instance, in a recent visit to Kodiak,
Alaska, we noted the gym facility provided watch care for its patrons.
Mom worked out on the treadmill or elliptical while her child played in
a safe carpeted and fenced-in area right across from her. Another area
of the gym, previously an aerobics room, had been transformed into a
large play area for ``Mom and me'' groups to play in the frequently
inclement weather. These solutions aren't expensive, but do require
thinking outside the box.
Innovative strategies are needed to address the non-availability of
after-hours child care (before 6 a.m. and after 6 p.m.) and respite
care. We applaud the partnership between the Services and the National
Association of Child Care Resource and Referral Agencies (NACCRRA) that
provides subsidized child care 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 the Services have rolled
out more respite care for special needs families, but are concerned
when we hear that some installations are already experiencing
shortfalls of funding for respite care early in the year.
At our Operation Purple Healing Adventures camp for families of
the wounded, ill, and injured, families told us there is a tremendous
need for access to adequate child care on or near military treatment
facilities. Families need the availability of child care in order to
attend medical appointments, especially mental health appointments. Our
Association encourages the creation of drop-in child care for medical
appointments on the DOD or VA premises or partnerships with other
organizations to provide this valuable service.
We appreciate the requirement in the National Defense Authorization
Act fiscal year 2010 (NDAA fiscal year 2010) calling for a report on
financial assistance provided for child care costs across the Services
and Components to support the families of those service members
deployed in support of a contingency operation and we look forward to
the results.
Our Association urges Congress to ensure resources are available to
meet the child care needs of military families to include hourly, drop-
in and increased respite care across all Services for families of
deployed service members and the wounded, ill, and injured, as well as
those family members with special needs.
Working with Youth
Older children and teens must not be overlooked. School personnel
need to be educated on issues affecting military students and must be
sensitive to their needs. To achieve this goal, schools need tools.
Parents need tools, too. Military parents constantly seek more
resources to assist their children in coping with military life,
especially the challenges and stress of frequent deployments. Parents
tell us repeatedly they want resources to ``help them help their
children.'' Support for parents in their efforts to help children of
all ages is increasing, but continues to be fragmented. New Federal,
public-private initiatives, increased awareness, and support by DOD and
civilian schools educating military children have been developed.
However, many military parents are either not aware such programs exist
or find the programs do not always meet their needs.
Our Association is working to meet this pressing need through our
Operation Purple (OPC) summer camps. Unique in its ability to reach
out and gather military children of different age groups, Services, and
components, our Operation Purple program provides a safe and fun
environment in which military children feel immediately supported and
understood. For the second year, with the support of private donors, we
achieved our goal of sending 10,000 military children to camp in 2009.
We also provided the camp experience to families of the wounded. This
year, we expect to maintain those numbers by offering 92 weeks of camp
in 40 states, Guam and Germany. In 2009, we introduced a new program
under our Operation Purple umbrella, offering family reintegration
retreats in the National Parks. They have been well received by our
families and more apply than can attend. We are offering 10 retreats
this year.
Through our Operation Purple camps, our Association has begun to
identify the cumulative effects multiple deployments are having on the
emotional growth and well being of military children and the challenges
posed to the relationship between deployed parent, caregiver, and
children in this stressful environment. Understanding a need for
qualitative analysis of this information, we commissioned the RAND
Corporation to conduct a pilot study in 2007 aimed at the current
functioning and wellness of military children attending Operation
Purple camps and assessing the potential benefits of the OPC program in
this environment of multiple and extended deployments.
In May 2008, we embarked on phase two of the project--a
longitudinal study on the experience of 1,507 families, which is a much
larger and more diverse sample than included in our pilot study. RAND
followed these families for 1 year, and interviewed the non-deployed
caregiver/parent and one child per family between 11 and 17 years of
age at three time points over a year. Recruitment of participants was
extremely successful because families were eager to share their
experiences. The research addressed two key questions:
How are school-age military children faring?
What types of issues do military children face related to
deployment?
In December, the baseline findings of the research were published
in the journal Pediatrics. Findings showed:
--As the months of parental deployment increased so did the child's
challenges.
--The total number of months away mattered more than the number of
deployments.
--Older children experienced more difficulties during deployment.
--There is a direct correlation between the mental health of the
caregiver and the well-being of the child.
--Girls experienced more difficulty during reintegration, the period
of months readjusting after the service member's homecoming.
--About one-third of the children reported symptoms of anxiety, which
is somewhat higher than the percentage reported in other
national studies of children.
--In these initial findings, there were no differences in results
between Services or Components.
What are the implications? Families facing longer deployments need
targeted support--especially for older teens and girls. Supports need
to be in place across the entire deployment cycle, including
reintegration, and some non-deployed parents may need targeted mental
health support. One way to address these needs would be to create a
safe, supportive environment for older youth and teens. Dedicated Youth
Centers with activities for our older youth would go a long way to help
with this.
Our Association feels that more dedicated resources, such as youth
or teen centers, would be beneficial to address the needs of our older
youth and teens during deployment.
Families Overseas
Families stationed overseas face increased challenges when their
service member is deployed into theater. One such challenge we have
heard from families stationed in European Command (EUCOM) concerns care
for a family member, usually the spouse, who may be injured or confined
to bed for an extended illness during deployment. Instead of pulling
the service member back from theater, why not provide transportation
for an extended family member or friend to come from the States to care
for the injured or ill family member? This has been a recommendation
from the EUCOM Quality of Life conference for several years.
National Guard and Reserve
The National Military Family Association has long recognized the
unique challenges our Reserve Component families face and their need
for additional support. National Guard and Reserve families are often
geographically dispersed, live in rural areas, and do not have the same
family support programs as their active duty counterparts. The final
report from the Commission on the National Guard and Reserve confirmed
what we have always asserted: ``Reserve Component families 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.''
This is especially true when it comes to accessing the same level
of counseling and behavioral health support as active duty families.
However, our Association applauds the innovative counseling and
behavioral health support to National Guard and Reserve families, in
the form of Military OneSource counseling, the TRICARE Assistance
Program (TRIAP), and Military Family Life Consultants (MFLC). Combined,
these valuable resources are helping to address a critical need for our
Reserve Component families.
In the past several years, great strides have been made by both
Congress and the Services to help strengthen our National Guard and
Reserve families. Our Association wishes to thank Congress for
authorizing these important provisions. We urge you to fully fund these
vital quality of life programs critical to our Reserve Component
families, who have sacrificed greatly in support of our Nation.
In addition, our Association would like to thank Congress for the
provisions allowing for the implementation of the Yellow Ribbon
Program, and for including reporting requirements on the program's
progress in the NDAA fiscal year 2010. We continue to urge Congress to
make the funding for this program permanent. In addition, we ask that
you conduct oversight hearings to ensure that Yellow Ribbon services
are consistent across the nation. We also ask that the definition of
family member be expanded to allow non-ID card holders to attend these
important programs, in order to support their service member and gain
valuable information.
Our Association asks Congress to fully fund the Yellow Ribbon
Program, and provide oversight hearings to ensure that Yellow Ribbon
services are consistent across the nation, and are accessible to all
Reserve Component families. We also ask for funding for those persons
designated by the service member to attend Yellow Ribbon Program
events.
family health
Family readiness calls for access to quality healthcare 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 healthcare system
may not have all the resources it needs to meet both the military
medical readiness mission and provide access to healthcare 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.
Congress must provide timely and accurate funding for healthcare.
DOD healthcare facilities must be funded to be ``world class,''
offering state-of-the-art healthcare services supported by evidence-
based research and design. Funding must also support the renovation of
existing facilities or complete replacement of out-of-date DOD
healthcare facilities. As we get closer to the closure of Walter Reed
Army Medical Center and the opening of the new Fort Belvoir Community
Hospital and the new Walter Reed National Military Medical Center, as
part of the National Capitol Region BRAC process, we must be assured
these projects are properly and fully funded. We encourage Congress to
provide any additional funding recommended by the Defense Health
Board's BRAC Subcommittee's report.
Military Health System
Improving Access to Care
In the question and answer period during the U.S. Senate Committee
on Armed Services' Subcommittee on Personnel on June 3, 2009, Senator
Lindsey Graham (R-SC) asked panel members to ``give a grade to
TRICARE.'' Panel members rated TRICARE a ``B'' or a ``C minus.'' Our
Association's Director of Government Relations stated it was a two part
question and assigned the ``quality of care, B. Access to care, C
minus.'' The panelist and Subcommittee Members 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 healthcare
challenge has been getting timely care from their local military
hospital or clinic.
Our Association continues to examine military families' experiences
with accessing the Military Health System (MHS). Families' main issues
are: access to their Primary Care Managers (PCM); getting someone to
answer the phone at central appointments; having appointments available
when they finally got through to central appointments; after hours
care; getting a referral for specialty care; being able to see the same
provider or PCM; and having appointments available 60, 90, and 120 days
out in our MTFs. Families familiar with how the MHS referral system
works seem better able to navigate the system. Those families who are
unfamiliar report delays in receiving treatment or sometimes decide to
give up on the referral process and never obtain a specialty
appointment. Continuity of care is important to maintain quality of
care. The MTFs are stressed from 9 years of provider deployments,
directly affecting the quality of care and contributing to increased
costs. Our Association thanks Congress for requiring, in the NDAA
fiscal year 2009, a report on access to care and we look forward to the
findings. This report must distinguish between access issues in the
MTFs, as opposed to access in the civilian TRICARE networks.
Our most seriously wounded, ill, and injured 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, coordinators from Service branch, Traumatic
Brain Injury (TBI) care coordinators, Department of Veteran Affairs
(VA) liaisons, et cetera. The goal is for a seamless transition of care
between and within the two governmental agencies, DOD and the VA.
However, with so many coordinators to choose from, families often
wonder which one is the ``right'' case manager. We often hear from
families, some whose service member has long been medically retired
with a 100 percent disability rating or others with less than 1 year
from date-of-injury, who have not yet been assigned a FRC. We need to
look at whether the multiple, layered case managers have streamlined
the process, or have only aggravated it. Our Association still finds
families trying to navigate alone a variety of complex healthcare
systems, trying to find the right combination of care. Individual
Service wounded, ill, and injured program directors and case managers
are often reluctant to inform families that FRCs exist or that the
family qualifies for one. Many qualify for and use Medicare, VA, DOD's
TRICARE direct and purchased care, private health insurance, and state
agencies. Why can't the process be streamlined?
Support for Special Needs Families
Case management for military beneficiaries with special needs is
not consistent because the coordination of the military family's care
is being done by a non-synergistic MHS. Beneficiaries try to obtain an
appointment and then find themselves getting partial healthcare within
the MTF, while other healthcare is referred out into the purchased care
network. Thus, military families end up managing their own care.
Incongruence in the case management process becomes more apparent when
military family members transfer from one TRICARE region to another and
is further exacerbated when a special needs family member is involved.
Families need a seamless transition and a warm handoff between TRICARE
regions and a universal case management process across the MHS. The
current case management system is under review by DOD and TRICARE
Management Activity (TMA). Each TRICARE Managed Care Contractor has
created different case management processes.
We applaud Congress and DOD's desire to create robust healthcare,
educational, and family support services for special needs children.
But, these robust services do not follow them when they retire. We
encourage the Services to allow these military families the opportunity
to have their final duty station be in an area of their choice. We
suggest the Extended Care Health Option (ECHO) be extended for 1 year
after retirement for those already enrolled in ECHO prior to
retirement. If the ECHO program is extended, it must be for all who are
eligible for the program. We should not create a different benefit
simply based on diagnosis.
There has been discussion over the past years by Congress and
military families regarding the ECHO program. The NDAA fiscal year 2009
included a provision to increase the cap on certain benefits under the
ECHO program and the NDAA fiscal year 2010 established the Office of
Community Support for Military Families with Special Needs. The ECHO
program was originally designed to allow military families with special
needs to receive additional services to offset their lack of
eligibility for state or Federally provided services impacted by
frequent moves. We suggest that before making any more adjustments to
the ECHO program, Congress should direct DOD to certify if the ECHO
program is working as it was originally designed and if it has been
effective in addressing the needs of this population. We need to make
the right fixes so we can be assured we apply the correct solutions.
This new office will go a long way in identifying and addressing
special needs. However, we must remember that our special needs
families often require medical, educational, and family support
resources. This new office must address all these various needs in
order to effectively implement change.
We ask for funding for the Office of Community Support for Military
Families with Special Needs so this important new office can begin
helping our special needs families.
National Guard and Reserve Member Family Health Care
National Guard and Reserve families need increased education about
their healthcare benefits. We also believe that paying a stipend (NDAA
fiscal year 2008) 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.
Grey Area Reservist
Our Association would like to thank Congress for the new TRICARE
benefit for Grey Area Reservists. We want to make sure this benefit is
quickly implemented and they have access to a robust network.
TRICARE Reimbursement
Our Association is concerned that continuing pressure to lower
Medicare reimbursement rates will create a hollow benefit for TRICARE
beneficiaries. As the 111th Congress takes up Medicare legislation, we
request consideration of how this legislation will impact military
families' healthcare, 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.
If that is the case, DOD may need additional funding for the
flexibility to increase provider reimbursement rates if shortages
develop.
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 NDAA fiscal year 2008. However, we still need
to examine its effect on the cost of medications for both beneficiaries
and DOD. Also, we will need to see how this potentially impacts
Medicare, civilian private insurance, and the National Health Care
Reform drug pricing negotiations.
We believe it is imperative that all medications available through
TRICARE Retail Pharmacy (TRRx) should also be made available through
TRICARE Mail Order Pharmacy (TMOP). Medications treating chronic
conditions, such as asthma, diabetes, and hypertension should be made
available at the lowest level of co-payment regardless of brand or
generic status. We agree with the recommendations of The Task Force on
the Future of Military Health Care that over-the-counter (OTC) drugs be
a covered pharmacy benefit without a co-payment for TMOP Tier 1
medications.
The new T3 TRICARE contract will provide TRICARE Managed Care
Contractors and Express-Scripts, Inc. the ability to link pharmacy data
with disease management. This will allow for better case management,
increased compliance, and decreased cost, especially for our
chronically ill beneficiaries. However, this valuable tool is currently
unavailable because the T3 contract is partially under protest and has
not yet been awarded.
National Health Care
We thank Congress for legislation that recognizes that TRICARE
meets minimal essential coverage under National Health Care reform.
However, we request your continued vigilance to ensure quality
healthcare for military families. The perfect storm is brewing. TMA
will institute the new T3 contact at the same time healthcare reform
changes are implemented. Currently, at least one out of three TRICARE
Managed Care Contractors could change. This means that the contracts of
those TRICARE providers would need to be renegotiated. Healthcare
reform and Medicare reimbursement rate changes are adding to the
demands and uncertainty of our providers. Our Association is concerned
that providers will be unwilling to remain in the TRICARE network and
it will become very difficult to recruit new providers. The unintended
consequence may be a decrease in access of care due the lack of
available healthcare providers. DOD will need additional funding to
increase reimbursement rates if provider shortages develop.
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 healthcare 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 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 healthcare practices.
We suggest additional funding and flexibility in hiring practices
to address MTF provider deployments.
We recommend additional funding to DOD for potential civilian
provider shortages within the community due to reduced Medicare
reimbursement rates and potential decreased provider availability due
to healthcare reform.
Our Association recommends a 1 year transitional active duty ECHO
benefit for all eligible family members of service members who retire.
We believe that Reserve Component families should be given the
choice of a stipend to continue their employer provided care during
deployment.
Behavioral Health Care
Our Nation must help returning service members and their families
cope with the aftermath of war. DOD, VA, and State agencies must
partner in order to address behavioral health issues early in the
process and provide transitional mental health programs. Partnering
will also capture the National Guard and Reserve member population, who
often straddle these agencies' healthcare 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, 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 remain high, even after military operations
scale down. Our study found the mental health of the caregiver directly
affects the overall well-being of the children. Therefore, we need to
treat the family as a unit rather than as individuals because the
caregiver's health determines the quality of life for the children.
Access to Behavioral Health Care
Our Association is concerned about the overall shortage of
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. The Army Family Action Plan (AFAP) identified mental
health issues as their number three issue for 2010. 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 healthcare 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.
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 by the MHS. Currently, Military Family Life Consultants and
Military OneSource counseling are providing this type of service for
military families on the family support side. The recently introduced
web-based TRICARE Assistance Program (TRIAP) offers another vehicle for
non-medical counseling, especially for those who live far from
counselors. We need to make the Services, along with military family
members, more aware of resources along the continuum. We need the
flexibility of support in both the MHS and family support arenas. We
must educate civilian network providers about our military culture.
Communities along with nongovernment organizations (NGO) are beginning
to fulfill this role, but more needs to be done.
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 healthcare 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. Our study, along with other research, on the
impact of deployment on caregivers and children found it was the
cumulative time deployed that caused increased stress. These reports
demonstrate the amount of stress being placed on our troops and their
families.
Our Association is especially concerned with the scarcity of
services available to the families as they leave the military following
the end of their activation or enlistment. Due to the service member's
separation, the families find themselves ineligible for TRICARE,
Military OneSource, 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 and funding alternative treatment methods, such as telemental
health;
--modifying licensing requirements in order to remove geographic
practice barriers that prevent psychological health providers
from participating in telemental health services outside of a
VA facility;
--educating civilian network psychological health providers about our
military culture as the VA incorporates Project Hero; and
--encouraging DOD and VA to work together to provide a seamless
``warm hand-off'' for families, as well as service members
transitioning from active duty to veteran status and funding
additional transitional support programs if necessary.
National Guard and Reserve Members
The National Military Family Association is especially concerned
about fewer mental healthcare 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. We hear the National Guard Bureau's Psychological
Health Services (PHS) is not working as designed to address their
mental health issues. This program needs to be re-evaluated to
determine its effectiveness.
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. Our study on the
impact of the war on caregivers and children found deployments are
creating layers of stressors, which families are experiencing at
different stages. Teens especially carry a burden of care they are
reluctant to share with the non-deployed parent in order to not ``rock
the boat.'' They are often encumbered by the feeling of trying to keep
the family going, along with anger over changes in their schedules,
increased responsibility, and fear for their deployed parent. Children
of the National Guard and Reserve members face unique challenges since
there are no military installations for them to utilize. They find
themselves ``suddenly military'' without resources to support them.
School systems are generally unaware of this change in focus within
these family units and are ill prepared to lookout for potential
problems caused by these deployments or when an injury occurs. Also
vulnerable, are children who have disabilities that are further
complicated by deployment and subsequent injury of the 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. We appreciate the inclusion of a study on the mental health
needs of our children in the NDAA fiscal year 2010 and hope the
research we commissioned will provide useful information as the study
is designed.
The impact of the wounded, ill, and injured on children is often
overlooked and underestimated. Military children experience a
metaphorical death of the parent they once knew and must make many
adjustments as their parent recovers. Many families relocate to be near
the treating MTF or the VA Polytrauma Center in order to make the
rehabilitation process more successful. As the spouse focuses on the
rehabilitation and recovery, older children take on new roles. They may
become the caregivers for other siblings, as well as for the wounded
parent. Many spouses send their children to stay with neighbors or
extended family members, as they tend to their wounded, ill, and
injured spouse. Children get shuffled from place to place until they
can be reunited with their parents. Once reunited, they must adapt to
the parent's new injury and living with the ``new normal.'' We
appreciate the inclusion of a study to assess the impact on children of
the severely wounded in the NDAA fiscal year 2010.
We encourage partnerships between government agencies, DOD, VA and
State agencies and recommend they reach out to those private and NGOs
who are experts on children and adolescents. They could identify and
incorporate best practices in the prevention and treatment of mental
health issues affecting our military children. We must remember to
focus on preventative care upstream, while still in the active duty
phase, in order to have a solid family unit as they head into the
veteran phase of their lives. School systems must become more involved
in establishing and providing supportive services for our nation's
children.
Caregiver Burnout
In the ninth year of war, care for the caregivers must become a
priority. There are several levels of caregivers. Our Association hears
from the senior officer and enlisted spouses who are so often called
upon to be the strength for others. We hear from the healthcare
providers, educators, 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 healthcare 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 healthcare
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
healthcare providers. Programs are being developed by each Service.
However, they are narrow in focus targeting line leaders and healthcare
providers, but not broad enough to capture our military family members
and the communities they live in.
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 TBI; and
encouraging them to seek assistance when having financial,
relationship, legal, and occupational difficulties. We appreciate the
inclusion in the NDAA fiscal year 2010 for education programs targeting
pain management and substance abuse for our families. As Services roll
out suicide prevention programs, we need to include our families,
communities, and support personnel.
Successful return and reunion programs will require attention and
funding over the long term, as well as a strong partnership at all
levels between the various mental health arms of DOD, VA, and State
agencies. DOD and VA need to provide family and individual counseling
to address these unique issues. Opportunities for the entire family and
for the couple to reconnect and bond must also be provided. Our
Association has recognized this need and successfully piloted family
retreats in the National Parks promoting family reintegration following
deployment.
We recommend an extended outreach program to 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).
We recommend the use and funding 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. 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. For the past 2 years, we have piloted our Operation Purple
Healing Adventures camp to help wounded service members and their
families learn to play again as a family. We hear from the families who
participate in this camp, as well as others dealing with the recovery
of their wounded service members that, even with Congressional
intervention and implementation of the Services' programs, many issues
still create difficulties for them well into the recovery period.
Families find themselves having to redefine their roles following the
injury of the 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 DOD and VA programs offering skill based
training for coping, intervention, resiliency, and overcoming
adversities. Injury interrupts the normal cycle of deployment and the
reintegration process. We must provide opportunities for the entire
family and for the couple to reconnect and bond, especially during the
rehabilitation and recovery phases.
Brooke Army Medical Center (BAMC) has recognized a need to support
these families by expanding in terms of guesthouses 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.
The Vet Centers are an available resource for veterans' families
providing adjustment, vocational, and family and marriage counseling.
The VA healthcare facilities and the community-based outpatient clinics
(CBOCs) have a ready supply of mental health providers. 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 healthcare facilities to develop a holistic
approach to care by including families when providing mental health
counseling and programs to the wounded, ill, and 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 and perform a pre and post-deployment mental health screening on
family members (similar to the PDHA and PDHRA currently being done for
service members). This recommendation will require additional funding.
We appreciate the NDAA fiscal year 2010 report on the impact of the war
on families and the DOD's Millennium Cohort Study including families.
Both will help us gain a better understanding of the long-term effects
of war on our military families.
Transitioning for the Wounded and Their Families
Transitions can be especially problematic for wounded, ill, and
injured service members, veterans, and their families. The DOD and the
VA healthcare 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' healthcare
systems and, eventually, from active duty status to veteran status.
Transition of healthcare 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 healthcare 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. 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 healthcare 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 healthcare dollars in the long run. Their long-term
psychological care needs must be addressed. Caregivers of the severely
wounded, ill, and injured service 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 and these services must be
funded.
The VA has made a strong effort in supporting veterans' caregivers.
The DOD should follow suit and expand their definition. We appreciate
the inclusion in NDAA fiscal year 2010 of compensation for service
members with assistance in everyday living. This provision will need
funding.
Compensation of caregivers should be a priority for DOD and the
Secretary of Homeland Security for our Coast Guard. Caregivers must be
recognized for their sacrifices and the important role they play in
maintaining the quality of life of our wounded, ill, and injured
service members and veterans. Current law allows the Secretary of the
VA to provide a caregiver stipend, however it is an unfunded mandate.
Our Association strongly believes this stipend needs to be fully
funded.
Consideration should also be given to creating innovative ways to
meet the healthcare and insurance needs of the caregiver, with an
option to include their family. Current law does not include a
``family'' option.
There must be a provision for transition benefits for the caregiver
if the caregiver's services are no longer needed, chooses to no longer
participate, or is asked by the veteran to no longer provide services.
The caregiver, once qualified, should still be able to maintain
healthcare coverage for 1 year. Compensation would discontinue
following the end of services/care provided by the caregiver. Our
Association looks forward to discussing details of implementing such a
plan with Members of this Subcommittee.
The VA currently has eight caregiver assistance pilot programs to
expand and improve healthcare education and provide needed training and
resources for caregivers who assist disabled and aging veterans in
their homes. Caregivers' responsibilities start while the service
member is still on active duty. DOD should evaluate these pilot
programs to determine whether to adopt them for themselves. If adopted,
DOD will need funding for these programs.
Relocation Allowance and Housing
Active Duty service members and their spouses qualify through the
DOD for military orders to move their household goods 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.
Our Association suggests that legislation be passed to allow
medically retired single service members 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, ill, and injured 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 healthcare 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 healthcare, 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. This relocation provision will
require DOD funding.
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.
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.
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.
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 medically retired single service member's PCS move.
Senior Oversight Committee
Our Association is appreciative of the provision in the NDAA fiscal
year 2010 establishing a DOD Task Force on the Care, Management, and
Transition of Recovery, Wounded, Ill, and Injured Members of the Armed
Forces to access policies and programs. This Task Force will be
independent and in a position to monitor DOD and VA's partnership
initiatives for our wounded, ill, and injured service members and their
families.
The National Military Family Association encourages the all
committees with jurisdiction over military personnel and veterans
matters to talk on these important issues. We can no longer continue to
create policies in a vacuum and be content on focusing on each agency
separately because this population moves too frequently between the two
agencies, especially our wounded, ill, and injured service members and
their families.
family transitions
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 thank Congress for extending the TRICARE Dental benefit to
surviving children. We ask that eligibility be expanded to those active
duty 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 eligibility be expanded to active
duty survivors who had not been enrolled in the TRICARE Dental Program
prior to the service member's death. We also recommend that grief
counseling be more readily available to survivors.
In 2009, the policy concerning the attendance of the media at the
dignified transfer of remains at Dover AFB was changed. Primary next-
of-kin (PNOK) of the service member who dies in theater is asked to
make a decision shortly after they are notified of the loss as to
whether or not the media may film the dignified transfer of remains of
their loved one during this ceremony. Family members are also given the
option of flying to Dover themselves to witness this ceremony. In
previous years, only about 3 percent of family members attended this
ceremony. Since the policy change, over 90 percent of families send
some family members to Dover to attend. The travel of up to 3 family
members and the casualty assistance officer on a commercial carrier are
provided for. In the NDAA fiscal year 2010, eligible family member
travel to memorial services for a service member who dies in theater
was authorized. This is in addition to travel to the funeral of the
service member. None of the costs associated with this travel has been
funded for the Services. We would ask that funds be appropriated to
cover the costs of this extraordinary expense.
We ask that funding be appropriated for the travel costs for
surviving family members to attend the dignified transfer of remains in
Dover and for eligible surviving family members to attend memorial
services for service members who die in theater.
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 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 believe there needs to be DIC equity with other Federal survivor
benefits. Currently, DIC is set at $1,154 monthly (43 percent of the
Disabled Retirees Compensation). Survivors of Federal workers have
their annuity set at 55 percent of their Disabled Retirees
Compensation. Military survivors should receive 55 percent of VA
Disability Compensation. We are pleased that the requirement for a
report to assess the adequacy of DIC payments was included in the NDAA
fiscal year 2009. We are awaiting the overdue report. We support
raising DIC payments to 55 percent of VA Disability Compensation. When
changes are made, ensure that DIC eligibles under the old system
receive an equivalent increase.
We ask the DIC offset to SBP be eliminated to recognize the length
of commitment and service of the career 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.
We ask that DIC be increased to 55 percent of VA Disability
Compensation.
Education of Military Children
The National Military Family Association would like to thank
Congress for including a ``Sense of Congress'' in regards to the
Interstate Compact on Educational Opportunity for Military Children in
last year's National Defense Authorization Act. The Compact has now
been adopted in 30 states and covers over 84 percent of our military
children. The Interstate Commission, the governing body of the Compact,
is working to educate military families, educators, and states on the
appropriate usage of the Compact. The adoption of the Compact is a
tremendous victory for military families who place a high value on
education.
However, military families define the quality of that education
differently than most states or districts that look only at issues
within their boundaries. For military families, it is not enough for
children to be doing well in their current schools, they must also be
prepared for the next location. The same is true for children in
underperforming school systems. Families are concerned that they will
lag behind students in the next location. With many states cutting
educational programs due to the economic downturn, this concern is
growing. A prime example is Hawaii, which opted to furlough teachers on
Fridays, cutting 17 days from the school calendar. With elementary
schools already on a shortened schedule for Wednesday, these students
are only getting approximately 3\1/2\ days of instruction every other
week. In addition, the recent cuts have made it increasing hard for
schools to meet IEP requirements for special needs students.
Furthermore, Hawaii is requiring parents to pay more for busing, and
the cost of school meals have gone up 76 percent. Our Association
believes that Hawaii's cuts are just the ``tip of the iceberg'' as we
are beginning to see other states make tough choices as well. Although
Hawaii's educational system has long been a concern for military
families, many of whom opt for expensive private education, Hawaii is
not the only place where parents have concerns. The National Military
Family Association believes that our military children deserve to have
a good quality education wherever they may live. However, our
Association recognizes that how that quality education is provided may
differ in each location.
We urge Congress to encourage solutions for the current educational
situation across the nation and recognize that service members' lack of
confidence that their children may receive a quality education in an
assignment location can affect the readiness of the force in that
location.
While our Association remains appreciative for the additional
funding Congress provides to civilian school districts educating
military children, Impact Aid continues to be under-funded. We urge
Congress to provide appropriate and timely funding of Impact Aid
through the Department of Education. In addition, we urge Congress to
increase DOD Impact Aid funding for schools educating large numbers of
military children to $60 million for fiscal year 2011. We also ask
Congress to include an additional $5 million in funding for special
needs children. The DOD supplement to Impact Aid is critically
important to ensure school districts provide quality education for our
military children.
As increased numbers of military families move into new communities
due to Global Rebasing and BRAC, their housing needs are being met
further and further away from the installation. Thus, military children
may be attending school in districts whose familiarity with the
military lifestyle may be limited. Educating large numbers of military
children will put an added burden on schools already hard-pressed to
meet the needs of their current populations. We urge Congress to
authorize an increase in this level of funding until BRAC and Global
Rebasing moves are completed.
Once again, we thank Congress for passing the Higher Education
Opportunity Act of 2008, which contained many new provisions affecting
military families. Chief among them was a provision to expand in-state
tuition eligibility for military service members and their families,
and provide continuity of in-state rates if the service member receives
Permanent Change of Station (PCS) orders out of state. However, family
members have to be currently enrolled in order to be eligible for
continuity of in-state tuition. Our Association is concerned that this
would preclude a senior in high school from receiving in-state tuition
rates if his or her family PCS's prior to matriculation. We urge
Congress to amend this provision.
We ask Congress to increase the DOD supplement to Impact Aid to $60
million to help districts better meet the additional demands caused by
large numbers of military children, deployment-related issues, and the
effects of military programs and policies. We also ask Congress to
include an additional $5 million for school districts with Special
Needs children.
Spouse Education & Employment
Our Association wishes to thank Congress for recent enhancement to
spouse education opportunities. In-state tuition, Post 9/11 G.I. bill
transferability to spouses and children, and other initiatives have
provided spouses with more educational opportunities than previous
years.
Since 2004, our Association has been fortunate to sponsor our
Joanne Holbrook Patton Military Spouse Scholarship Program, with the
generosity of donors who wish to help military families. Our 2010
application period closed on January 31, 2010. We saw a 33 percent
increase in applications from previous years with more than 8,000
military spouses applying to our program. Military spouses remain
committed to their education and need assistance from Congress to
fulfill their educational pursuits.
We have heard from many military spouses who are pleased with the
expansion of the Military Spouse Career Advancement Accounts, now
called MyCAA. Unfortunately the abrupt halt of the program on February
16, 2010 created a financial burden and undue stress for military
spouses. We are pleased DOD has reinstated the program for the 136,583
spouses enrolled in the program prior to February 16, 2010. We ask
Congress to push DOD to fully restart this critical program for all
eligible spouses as soon as possible. We also ask Congress to fully
fund the MyCAA program, which is providing essential educational and
career support to military spouses. The MyCAA program is not available
to all military spouses. We ask Congress to work with the appropriate
Service Secretary to expand this funding to the spouses of Coast Guard,
the Commissioned Corps of NOAA and U.S. Public Health Service.
Our Association thanks you for establishing a pilot program to
secure internships for military spouses with Federal agencies. Military
spouses look forward to enhanced career opportunities through the pilot
program. We hope Congress will monitor the implementation of the
program to ensure spouses are able to access the program and eligible
spouses are able to find Federal employment after successful completion
of the internship program.
To further spouse employment opportunities, we recommend an
expansion to the Workforce Opportunity Tax Credit for employers who
hire spouses of active duty and Reserve component 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.
The Services are experiencing a shortage of medical, mental health
and child care providers. Many of our spouses are trained in these
professions or would like to seek training in these professions. We
think the Services have an opportunity to create portable career
opportunities for spouses seeking in-demand professions. In addition to
the MyCAA funding, what can the Services do to encourage spouse
employment and solve provider shortages? We would like to see the
Services reach out to military spouses and offer affordable, flexible
training programs in high demand professions to help alleviate provider
shortages.
Our Association urges Congress to recognize the value of military
spouses by fully funding the MyCAA program, and by creating training
programs and employment opportunities for military spouses in high
demand professions to help fill our provider shortages.
Families on the Move
A PCS move to an overseas location can be especially stressful for
our families. 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 extracurricular 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.
Travel allowances and reimbursement rates have not kept pace with
the out-of-pocket costs associated with today's moves. Military
families are authorized 10 days for a housing hunting trip, but the
cost for trip is the responsibility of the service member. Families
with two vehicles may ship one vehicle and travel together in the
second vehicle. The vehicle will be shipped at the service member's
expense and then the service member will be reimbursed funds not used
to drive the second vehicle to help offset the cost of shipping it. Or,
families may drive both vehicles and receive reimbursement provided by
the Monetary Allowance in Lieu of Transportation (MALT) rate. MALT is
not intended to reimburse for all costs of operating a car but is
payment in lieu of transportation on a commercial carrier. Yet, a TDY
mileage rate considers the fixed and variable costs to operate a
vehicle. Travel allowances and reimbursement rates should be brought in
line with the actually out-of-pocket costs borne by military families.
Our Association requests that Congress authorize the shipment of a
second vehicle to an overseas location (at least Alaska and Hawaii) on
accompanied tours, and that Congress address the out-of-pocket expenses
military families bare for government ordered moves.
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 is Dr. Dan Putka,
American Psychological Association. Am I correct, Putka?
STATEMENT OF DAN PUTKA, Ph.D., ON BEHALF OF THE
AMERICAN PSYCHOLOGICAL ASSOCIATION
Dr. Putka. Good morning, Mr. Chairman and Ranking Member
Cochran.
I am Dr. Dan Putka from HumRRO, the Human Resources
Research Organization. I am submitting testimony on behalf of
the American Psychological Association, or APA, a scientific
and professional organization of more than 152,000
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 focus on the recruitment and retention of committed
high-performing military personnel.
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 through DOD's Minerva Initiative.
In the President's proposed fiscal year 2011 budget,
defense S&T would fall from the estimated fiscal year 2010
level of $14.7 billion to $12.3 billion, a decrease of 16.3
percent. All military labs would see cuts to their 6.2 and 6.3
applied research accounts, with some cuts as high as 49
percent, namely, the Army's 6.3 account.
Defense supported basic research, the 6.1 account, would
fare better under the President's budget, and APA supports the
substantial increase proposed for the Defense-wide basic
research program. But we are very concerned about the deep cuts
to near-term research supported by the 6.2 and 6.3 program
accounts.
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 $15 billion for defense S&T in
fiscal year 2011.
Within the S&T program, APA encourages the subcommittee to
follow the recommendations from the National Academies and the
Defense Science Board to fund priority research in the
behavioral sciences in support of national security.
Psychological scientists supported by the military labs address
a broad range of important issues and problems vital to our
national defense, with expertise in modeling behavior of
individuals and groups, understanding and optimizing cognitive
functioning, perceptual awareness, complex decisionmaking,
stress resilience, recruitment and retention, military family
functioning, and human systems interactions.
Psychological scientists also have critical expertise in
understanding extremist ideologies, radicalization processes,
and counterinsurgencies. And we hope you will join the House in
renewing your strong support for the DOD Minerva Initiative to
address these and other compelling 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.
Thank you for this opportunity.
Chairman Inouye. Doctor, as you may be well aware, it
wasn't too long ago when DOD did not fully recognize the worth
of psychologists. They were not considered good enough to be in
the star rank.
But this subcommittee took the step to give psychologists
the recognition they deserve. And as a result, we have much
psychological research and psychologists on our staffs. So you
can be assured that we won't take a back seat to anything.
Senator Cochran. Mr. Chairman, I think it is interesting to
observe that the Minerva Initiative was established by
Secretary Gates I think with the realization that a better
understanding of extremist ideologies in the world today need
the attention of the Department of Defense.
So we have hopes that through funding programs like that,
making sure there is enough money there to achieve our goals,
we can improve the safety factor of service and of citizenship
in our great country.
Chairman Inouye. I thank you very much, and I thank the
panel.
[The statement follows:]
Prepared Statement of Dan J. Putka
The American Psychological Association (APA) is a scientific and
professional organization of more than 152,000 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 counter-terrorism. 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
(and their families), psychological scientists within DOD conduct
cutting-edge, mission-specific research critical to national defense.
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 (OSD) and the Defense Advanced Research Projects Agency
(DARPA).
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
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 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''--understanding the human side of warfare and national
security.
fiscal year 2011 dod budget for science and technology
DOD
In terms of the overall DOD S&T budget, the President's request for
fiscal year 2011 again represents a dramatic step backward for defense
research. Defense S&T would fall from the estimated fiscal year 2010
level of $14.7 billion to $12.3 billion (a decrease of 16.3 percent).
All military labs would see cuts to their 6.2 and 6.3 research
accounts, with some cuts as high as 49 percent (the Army's 6.3
account). Defense-supported basic research (6.1 level accounts) would
fare better under the President's budget, and APA supports the
substantial increase proposed for the OSD's Defense-wide basic research
program, but we are very concerned about the deep cuts to near-term
research supported by the 6.2 and 6.3 program accounts.
DARPA
DARPA's overall funding would increase only slightly in the
President's fiscal year 2011 budget, from $3 billion to $3.1 billion.
The agency's home for basic research, the Defense Research Sciences
Account, however, would be strengthened significantly. APA supports
DARPA's transformative sciences priorities for this account, which
include research that taps ``converging technological forces and
transformational trends in the areas of computing and the computing-
reliant subareas of social sciences, life sciences, manufacturing and
commerce.''
focus for minerva research
APA was pleased to see the House Armed Services Committee note (in
the fiscal year 2011 National Defense Authorization Act) its support
for ``the use of social science to support key DOD missions such as
irregular warfare, counterinsurgency, and stability and reconstruction
operations'' through research funded by the DOD Minerva initiative
established by Secretary Gates. APA agrees with the House that DOD
``has not provided enough focus for the Minerva initiative to develop a
deep enough expertise in any of its seven topic areas,'' especially in
``understanding the extremist ideologies that help fuel recruitment of
terrorists.'' APA supports the fiscal year 2011 NDAA authorization of
$96.2 million, $5 million above the President's budget request, for DOD
to conduct Minerva initiative research to improve our understanding of
extremist ideologies.
summary
The President's budget request for basic and applied research at
DOD in fiscal year 2011 is $12.3 billion, which represents a dramatic
cut of $2.4 billion or 16 percent from the enacted fiscal year 2010
level of $14.7 billion. APA urges the Subcommittee to reverse this cut
to the critical defense science program by providing a total of $15
billion for Defense S&T in fiscal year 2011.
APA supports the substantial increases to DOD's and DARPA's basic
research portfolios, but joins the Coalition for National Security
Research in urging Congress to provide sufficient overall funding to
reach the Pentagon's goal of investing 3 percent of DOD's total budget
in Defense S&T.
Within the S&T program, APA encourages the Subcommittee to follow
recommendations from the National Academies and the Defense Science
Board to fund priority research in the behavioral sciences in support
of national security. Clearly, psychological scientists address a broad
range of important issues and problems vital to our national defense,
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.
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
2011 which would encourage the Department of Defense to fully fund its
behavioral research programs within the military laboratories and the
Minerva initiative:
department of defense
research, development, test, and evaluation
The Minerva Initiative and 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. The Committee also notes the critical contributions of
behavioral science to combating counter-insurgencies and understanding
extremist ideologies, and renews its strong support for the DOD Minerva
initiative.
Chairman Inouye. And now I would like to proceed to the
third panel, consisting of Dr. John C. Elkas, Mr. Richard
``Rick'' A. Jones, Ms. Elizabeth Cochran, and Dr. Jonathan
Berman.
May I recognize Dr. John C. Elkas.
STATEMENT OF JOHN C. ELKAS, M.D., J.D., ON BEHALF OF
THE SOCIETY OF GYNECOLOGIC ONCOLOGISTS
Dr. Elkas. Mr. Chairman and Vice Chairman, thank you for
inviting me to testify at today's hearing.
My name is Dr. John Elkas, and I am here on behalf of the
Society of Gynecologic Oncologists. The SGO is a national
medical specialty organization of physicians who are trained in
the comprehensive care and management of women with gynecologic
malignancies.
I also practice medicine in the D.C. metropolitan area and
am a commander in the United States Naval Reserve and an
adjunct associate professor of obstetrics and gynecology for
the Uniformed Services University of the Health Sciences.
I spent 14 years in Active Duty service caring for women
within the Department of Defense family with ovarian cancer,
and I can speak personally to the impact that the OCRP is
having on the care of military women with ovarian cancer.
I am honored to be here and pleased that this subcommittee
is focusing its attention on the OCRP. Since its inception now
13 years ago, this DOD program has delivered benefits to
ovarian cancer research that far exceed the annual level of
Federal funding.
As this subcommittee knows, ovarian cancer causes more
deaths than any other gynecologic malignancy and is the fourth
highest cause of cancer death among American women. One of our
biggest challenges lie in the fact that only 20 percent of
ovarian cancer is detected at an early stage, while most of our
patients are diagnosed at an advanced stage, where we heard the
5 year survival is markedly lower.
We, the members of the SGO, along with our patients who are
battling this disease every day, depend on the OCRP research
funding. It is through this type of research funding that a
screening and early detection method for ovarian cancer can be
identified, which will allow us to save as many as 15,000 lives
each year in the United States.
Since its inception in fiscal year 1997, the OCRP has
funded 209 grants, totaling more than $140 million. Much of
this has been accomplished with the resources that we are
talking about today.
In Senator Mikulski's home State of Maryland, where many of
my patients also live, the OCRP has funded research on
important questions such as defining bio-markers that could be
fundamental to development of a blood test for early-stage
disease and developing and evaluating alpha target based
approach for also treating advanced disease.
In Senator Murray's home State of Washington, where five
OCRP-funded grants reside, questions such as the development of
blood tests for new small molecules in the blood that might be
used for detection and the examination of all women--of all of
a woman's DNA to find new genes or groups of genes that may
cause ovarian cancer in families.
In Senator Feinstein's home State of California, 24 grants
have been funded by the OCRP since the program was created in
1997, looking at questions such as inhibiting--strategies for
targeting and inhibiting tumor growth, identification of cancer
stem cells.
So, as you can see, these are just a few examples of the
209 grants that have served as a catalyst for attracting
outstanding researchers to the field of ovarian cancer
research. Investigators funded by the OCRP have succeeded with
several crucial breakthroughs in bringing us closer in both the
prevention and early detection of ovarian cancer. Were it not
for this, many researchers might have abandoned their hopes of
a career in basic and translational research in ovarian cancer.
Therefore, the Society of Gynecologic Oncologists joins
with the Ovarian Cancer National Alliance and the American
Congress of Obstetricians and Gynecologists to urge this
subcommittee to increase Federal funding to a minimum of $30
million in fiscal year 2011 for the OCRP.
Thank you, gentlemen.
Chairman Inouye. I thank you very much, Doctor.
On a personal note, 4 years ago, I lost my wife of 57 years
to cancer of the liver. So this matter is a matter of personal
interest. So I can assure you this subcommittee supports it.
Senator Cochran. Thank you very much.
I notice that the request is that we fund the program at
$30 million. What is the current level of funding, do you
recall?
Dr. Elkas. $18.7 million, sir.
Senator Cochran. Okay. Thank you.
Chairman Inouye. Thank you very much, Doctor.
[The statement follows:]
Prepared Statement of John C. Elkas
Mr. Chairman, Ranking Member and members of the subcommittee, thank
you for inviting me to testify at today's hearing. My name is Dr. John
C. Elkas, and I am Vice Chairman of the Bylaws Committee and a former
member of the Government Relations Committee of the Society of
Gynecologic Oncologists (SGO). I practice medicine in the D.C.-
metropolitan area, where I am an associate clinical professor in the
department of obstetrics and gynecology at the George Washington
University Medical Center and in private practice in Annandale,
Virginia. I am also a Commander in the U.S. Naval Reserve and an
adjunct associate professor of obstetrics and gynecology for the
Uniformed Services University of the Health Sciences in Bethesda,
Maryland.
I am honored to be here and pleased that this subcommittee is
focusing attention on the Department of Defense (DOD) Congressionally
Directed Medical Research Program in Ovarian Cancer (OCRP). Since its
inception now 13 years ago, this DOD program has delivered benefits to
ovarian cancer research that far exceed the annual level of Federal
funding.
This morning, I will try to outline some of the important
contributions this DOD program has made to ovarian cancer research and
the well-being of our patients. In fact, it is quite easy to
demonstrate that this investment by the Federal government has resulted
in substantial benefits and value to medicine, to science and most
importantly improved patient care.
As this subcommittee may know, ovarian cancer usually arises from
the cells on the surface of the ovary and can be extremely difficult to
detect. According to the American Cancer Society, in 2009, more than
21,500 women were diagnosed with ovarian cancer and approximately
15,000 lost their lives to this terrible disease. Ovarian cancer causes
more deaths than all the other cancers of the female reproductive tract
combined, and is the fourth highest cause of cancer deaths among
American women. One of our biggest challenges lies in the fact that
only 19 percent of all ovarian cancers are detected at a localized
stage, when the 5-year relative survival rate approaches 93 percent.
Unfortunately, most ovarian cancer is diagnosed at late or advanced
stage, when the 5-year survival rate is only 31 percent.
Nationally, biomedical research funding has grown over the last
decade through increased funding to the National Institutes of Health,
in no small part to the amazing efforts of members of this
Subcommittee. Yet funding for gynecologic cancer research, especially
for the deadliest cancer that we treat, ovarian cancer, has been
relatively flat. Since fiscal year 2003, the funding levels for
gynecologic cancer research and training programs at the NIH, NCI, and
CDC have not kept pace with inflation, with the funding for ovarian
cancer programs and research training for gynecologic oncologists
actually suffering specific cuts in funding due to the loss of an
ovarian cancer Specialized Project of Research Excellence (SPORE) in
2007 that had been awarded to a partnership of DUKE and the University
of Alabama-Birmingham. Were it not for the DOD OCRP, many researchers
might have abandoned their hopes of a career in basic and translation
research in ovarian cancer and our patients and the women of America
would be waiting even longer for reliable screening tests and more
effective therapeutic approaches.
As a leader in the Society of Gynecologic Oncologists (SGO) and as
a gynecologic oncologist who has provided care to women affiliated with
the United States Navy, I believe that I bring a comprehensive
perspective to our request for increased support. The SGO is a national
medical specialty organization of physicians who are trained in the
comprehensive management of women with malignancies of the reproductive
tract. Our purpose is to improve the care of women with gynecologic
cancer by encouraging research, disseminating knowledge which will
raise the standards of practice in the prevention and treatment of
gynecologic malignancies and cooperating with other organizations
interested in women's healthcare, oncology and related fields. The
Society's membership, totaling more than 1,300, is comprised of
gynecologic oncologists, as well as other related women's cancer
healthcare specialists including medical oncologists, radiation
oncologists, nurses, social workers and pathologists. SGO members
provide multidisciplinary cancer treatment including surgery,
chemotherapy, radiation therapy, and supportive care. More information
on the SGO can be found at www.sgo.org.
We, the members of the SGO, along with our patients who are
battling ovarian cancer every day, depend on the DOD OCRP research
funding. It is through this type of research funding that a screening
and early detection method for ovarian cancer can be identified which
will allow us to save many of the 15,000 lives that are lost to this
disease each year. Therefore, the SGO respectfully recommends that this
Subcommittee provide the DOD OCRP with a minimum of $30 million in
Federal funding for fiscal year 2011.
department of defense ovarian cancer research program: building an army
of ovarian cancer researchers
New Investigators Join the Fight
Since its inception in fiscal year 1997, the DOD OCRP has funded
209 grants totaling more than $140 million in funding. The common goal
of these research grants has been to promote innovative, integrated,
and multidisciplinary research that will lead to prevention, early
detection, and ultimately control of ovarian cancer. Much has been
accomplished in the last decade to move us forward in achieving this
goal.
In Senator Mikulski's home state of Maryland, where many of my
patients also live, the DOD OCRP has funded research on important
questions such as:
--Defining biomarkers of serous carcinoma, using molecular biologic
and immunologic approaches, which are critical as probes for
the etiology/pathogenesis of ovarian cancer. Identifying
biomarkers is fundamental to the development of a blood test
for diagnosis of early stage disease and also ovarian cancer-
specific vaccines;
--Developing and evaluating a targeted alpha-particle based approach
for treating disseminated ovarian cancer. Alpha-particles are
short-range, very potent emissions that kill cells by incurring
damage that cannot be repaired; one to three alpha-particles
tracking through a cell nucleus can be enough to kill a cell.
The tumor killing potential of alpha-particles is not subject
to the kind of resistance that is seen in chemotherapy; and
--Understanding of the molecular genetic pathways involved in ovarian
cancer development leading to the identification of the cancer-
causing genes (``oncogenes'') for ovarian cancer.
In Senator Murray's home state of Washington, the DOD OCRP has
funded five grants in the last 5 years to either the University of
Washington or to the Fred Hutchinson Cancer Center to study research
questions regarding:
--The usefulness of two candidate blood-based microRNA markers for
ovarian cancer detection, and the identification of microRNAs
produced by ovarian cancer at the earliest stages, which may
also be the basis for future blood tests for ovarian cancer
detection;
--The first application of complete human genome sequencing to the
identification of genes for inherited ovarian cancer. The
identification of new ovarian cancer genes will allow
prevention strategies to be extended to hundreds of families
for which causal ovarian cancer genes are currently unknown;
and
--Proposed novel technology, stored serum samples, and ongoing
clinical studies, with the intend of developing a pipeline that
can identify biomarkers that have the greatest utility for
women; biomarkers that identify cancer early and work well for
the women in most need of early detection, that can immediately
be evaluated clinically.
One of the first, and very successful, grant recipients from the
DOD OCRP hails from the Fred Hutchinson Cancer Research Center in
Seattle, WA, Dr. Nicole Urban. Dr. Urban has worked extensively in the
field of ovarian cancer early detection biomarker discovery and
validation. Her current program in translational ovarian cancer
research was built on work funded in fiscal year 1997 by the OCRP,
``Use of Novel Technologies to Identify and Investigate Molecular
Markers for Ovarian Cancer Screening and Prevention.'' Working with
Beth Karlan, M.D. at Cedars-Sinai and Leroy Hood, Ph.D., M.D. at the
University of Washington, she identified novel ovarian cancer
biomarkers including HE4, Mesothelin (MSLN), and SLPI using comparative
hybridization methods. This discovery lead to funding in 1999 from the
National Cancer Institute (NCI) for the Pacific Ovarian Cancer Research
Consortium (POCRC) Specialized Program of Research Excellence (SPORE)
in ovarian cancer.
The DOD and NCI funding allowed her to develop resources for
translational ovarian cancer research including collection, management,
and allocation of tissue and blood samples from women with ovarian
cancer, women with benign ovarian conditions, and women with healthy
ovaries. The DOD grant provided the foundation for what is now a mature
specimen repository that has accelerated the progress of scientists at
many academic institutions and industry.
In Senator Feinstein's home state of California, 24 grants have
been funded by the DOD OCRP since the program was created in 1997 to
study research questions such as:
--Strategies for targeting and inhibiting a protein called focal
adhesion kinase (FAK) that promotes tumor growth-metastasis.
With very few viable treatment options for metastatic ovarian
cancer, this research could lead to drug development targeting
these types of proteins;
--Developing a tumor-targeting drug delivery system using Nexil
nanoparticles that selectively adhere to and are ingested by
ovarian carcinoma cells following injection into the peritoneal
cavity. The hypothesis for this research is that the
selectivity of Nexil can be substantially further improved by
attaching peptides that cause the particle to bind to the
cancer cells and that this will further increase the
effectiveness of intraperitoneal therapy; and
--Using several avenues of investigation, based on our understanding
of the biology of stem cells, to identify and isolate cancer
stem cells from epithelial ovarian cancer. This has significant
implications for our basic scientific understanding of ovarian
cancer and may drastically alter treatment strategies in the
near future. Therapies targeted at the cancer stem cells offer
the potential for long-term cures that have eluded most
patients with ovarian cancer.
In Senator Hutchinson's home state of Texas, 19 grants have been
funded since the inception of the DOD OCRP in 1997, to study research
questions regarding:
--Understanding the pre-treatment genomic profile of ovarian cancer
to then isolate the predictive response of the cancer to anti-
vasculature treatment, possibly leading to the identification
of targets for novel anti-vasculature therapies;
--Ovarian cancer development directly in the specific patient and her
own tumor. While this process has lagged behind in ovarian
cancer and improving patient outcomes, it has shown great
promise in other solid, tumor cancers; and
--Identifying the earliest molecular changes associated with BRCA1-
and BRCA2-related and sporadic ovarian cancers, leading to
biomarker identification for early detection.
As you can see from these few examples, the 209 grants have served
as a catalyst for attracting outstanding scientists to the field of
ovarian cancer research. In the 4 year period of fiscal year 1998-
fiscal year 2001 the OCRP enabled the recruitment of 29 new
investigators into the area of ovarian cancer research.
Federally Funding is Leveraged Through Partnerships and Collaborations
In addition to an increase in the number of investigators, the
dollars appropriated over the last 13 years have been leveraged through
partnerships and collaborations to yield even greater returns, both
here and abroad. Past-President of the SGO, Dr. Andrew Berchuck of Duke
University Medical Center leveraged his OCRP DOD grants to form an
international Ovarian Cancer Association Consortium (OCAC) that is now
comprised of over 20 groups from all across the globe. The consortium
meets biannually and is working together to identify and validate
single nucleotide polymorphisms (SNPs) that affect disease risk through
both candidate gene approaches and genome-wide association studies
(GWAS). OCAC reported last year in Nature Genetics the results of the
first ovarian cancer GWAS, which identified a SNP in the region of the
BNC2 gene on chromosome 9 (Nature Genetics 2009, 41:996-1000.)
Dr. Berchuck and his colleagues in the association envision a
future in which reduction of ovarian cancer incidence and mortality
will be accomplished by implementation of screening and prevention
interventions in women at moderately increased risk. Such a focused
approach may be more feasible than population-based approaches, given
the relative rarity of ovarian cancer.
The DOD OCRP program also serves the purpose of strengthening U.S.
relationships with our allies, such as Australia, the United Kingdom,
and Canada. Dr. Peter Bowtell, from the Peter MacCallum Cancer Centre
in Melbourne, Australia, was awarded a fiscal year 2000 Ovarian Cancer
Research Program (OCRP) Program Project Award to study the molecular
epidemiology of ovarian cancer. With funds from this award, he and his
colleagues formed the Australian Ovarian Cancer Study (AOCS), a
population-based cohort of over 2,000 women with ovarian cancer,
including over 1,800 with invasive or borderline cancer. With a bank of
over 1,100 fresh-frozen tumors, hundreds of formalin-fixed, paraffin-
embedded (FFPE) blocks, and very detailed clinical follow-up, AOCS has
enabled over 60 projects since its inception, including international
collaborative studies in the United States, United Kingdom, and Canada.
AOCS has facilitated approximately 40 publications, most of which have
been released in the past 2 years.
One last important example of the value of the DOD OCRP's
contribution to science is the program's focus on inviting proposals
from the Historically Black Colleges and Universities and Minority-
Serving Institutions. This important effort to reach beyond established
clinical research partnerships expands the core research infrastructure
for these institutions which helps them to attract new investigators,
leveraging complementary initiatives, and supporting collaborative
ventures.
Over the decade that the OCRP has been in existence, the 209
grantees have used their DOD funding to establish an ovarian cancer
research enterprise that is much greater in value than the annually
appropriated Federal funding.
Opportunities are Lost Because of Current Level of Federal Funding
These examples of achievement are obscured to a great degree by
opportunities that have been missed. At this current level of funding,
this is only a very small portion of what the DOD OCRP program could do
as we envision a day where through prevention, early detection, and
better treatments, ovarian cancer is a manageable and frequently
curable disease. Consistently, the OCRP receives over 500 letters of
intent for the annual funding cycle. Of this group, about 50 percent
are invited to submit full proposals. Prior to fiscal year 2009, the
OCRP was only able to fund approximately 16 grants per year, a pay line
of less than 7 percent. With an increase in funding to $20 million in
fiscal year 2009, the OCRP was able to fund 22 awards. However, for
fiscal year 2010 the program was cut by $1.25 million and so the
possibility of the OCRP being able to fund even 20 grantees is in
jeopardy. To provide sufficient and effective funding to enable us to
do our jobs and create an environment where our scientific research can
succeed, we need a minimum investment of $30 million in fiscal year
2011.
department of defense ovarian cancer research program: exemplary
execution with real world results
Integration Panel Leads to Continuous Evaluation and Greater Focus
By using the mechanism of an Integration Panel to provide the two-
tier review process, the OCRP is able to reset the areas of research
focus on an annual basis, thereby actively managing and evaluating the
OCRP current grant portfolio. Gaps in ongoing research can be filled to
complement initiatives sponsored by other agencies, and most
importantly to fund high risk/high reward studies that take advantage
of the newest scientific breakthroughs that can then be attributed to
prevention, early detection and better treatments for ovarian cancer.
An example of this happened in Senator Mikulski's and my home state of
Maryland regarding the development of the OVA1 test, a blood test that
can help physicians determine if a woman's pelvic mass is at risk for
being malignant. The investigator, Zhen Zhang, Ph.D. at Johns Hopkins
School of Medicine, received funding from an Idea Development Award in
fiscal year 2003. Dr. Zhang discovered and validated five serum
biomarkers for the early detection of ovarian cancer. This bench
research was then translated and moved through clinical trials. The OVA
test was approved by the FDA and is now available to clinicians for use
in patient care.
More Than a Decade of Scientific Success
The program's successes have been documented in numerous ways,
including 469 publications in professional medical journals and books;
576 abstracts and presentations given at professional meetings; and 24
patents, applications and licenses granted to awardees of the program.
Investigators funded by the OCRP have succeeded with several crucial
breakthroughs in bringing us closer to an algorithm for use in
prevention and early detection of ovarian cancer.
The Society of Gynecologic Oncologists joins with the Ovarian
Cancer National Alliance and the American Congress of Obstetricians and
Gynecologists to urge this Subcommittee to increase Federal funding at
a minimum to $30 million in fiscal year 2011 for the OCRP. This will
allow for the discoveries and research breakthroughs in the first
decade of this program to be further developed and expanded upon,
hopefully bringing us by the end of the second decade of this program
to our ultimate goal of prevention, early detection and finally
elimination of ovarian cancer. I thank you for your leadership and the
leadership of the Subcommittee on this issue.
Chairman Inouye. Now may I recognize Mr. Richard A. Jones.
STATEMENT OF RICHARD A. JONES, LEGISLATIVE DIRECTOR,
NATIONAL ASSOCIATION FOR UNIFORMED SERVICES
Mr. Jones. Chairman Inouye, Vice Chairman Cochran, thank
you for the opportunity to give our views on key issues under
your consideration.
The National Association for Uniformed Services is pleased
with certain aspects of the President's budget, specifically
those that laser-focus on winning the wars in Iraq and
Afghanistan. Choosing to win these wars, however, should not
mean we must depend on aging fleets of aircraft, ships, and
vehicles across the services. We must continue toward
modernization.
One of the main messages our members want you to hear is
really simple and direct. Anyone who goes into harm's way under
the flag of the United States needs to be deployed with the
best our Nation can provide, and we must never cut off or
unnecessarily delay critical funding for our troops in the
field.
Regarding TRICARE, the provision of quality, timely
healthcare is considered one of the most important earned
benefits afforded to those who serve a career in the military.
The TRICARE benefit reflects the commitment of a nation, and it
deserves your wholehearted support. For those who give their
career in uniformed service now asks you to provide full
funding to secure their earned benefit.
The administration recommends a 1.4 percent across-the-
board pay raise. My association asks you to seek an increase of
0.5 percent above the administration's request, to 1.9 percent.
We should clearly recognize the risks our men and women in
uniform face, and we should make every effort to appropriately
compensate them for the job they do.
My association urges you also to provide adequate funding
for military construction and family housing accounts. These
funds for base allowance and housing should ensure that those
serving in our military are able to afford to live in quality
housing whether on or off the base.
The long war fought by an overstretched force gives us a
clear warning. There are simply too many missions and too few
troops. In addition to increasing troop strength, priority must
be given to funding for accounts to reset, recapitalize, and
renew the force. The National Guard, for example, has virtually
depleted its equipment inventory, causing rising concern about
its capacity to respond to disasters at home or train for the
missions abroad.
Regarding Walter Reed--that is a matter of great interest
to our members as we plan to realign our health facilities in
the Nation's capital--we need to keep Walter Reed open as long
as it is necessary to care for those who are at Walter Reed. We
must not close Walter Reed prematurely.
My association 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.
Traumatic brain injury is the signature injury of the Iraq
war. 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. The approach to
this problem requires resources for hiring caseworkers,
doctors, nurses, clinicians, and general caregivers if we are
to meet the needs of those who are wounded and their families.
Post traumatic stress disorder (PTSD) is a very serious
psychiatric disorder. Pre-deployment and post-deployment
checkups are very important. Early recognition of the symptoms
can serve a great deal toward recovery. We encourage the
members of the subcommittee, Mr. Chairman, to provide these
funds, to closely monitor their expenditure to ensure they are
not directed to areas of other defense spending.
The Armed Forces Retirement Homes are important to those
who have served in the military at Washington, DC, and
Gulfport, Mississippi. We look forward to the reopening of the
Gulfport home in October, and we ask that you continue care for
those programs.
Mr. Chairman, Vice Chairman, thank you very much for the
opportunity to present testimony today.
Chairman Inouye. I thank you very much.
This subcommittee, as some may be aware, has appropriated
nearly $1 trillion in the last 10 years to support our efforts
in Afghanistan and Iraq. And we have done so without hesitation
because we want our men to return home in as good a condition
as they were when they went in there.
But this has been a costly activity, but we will keep on
paying. So I can assure you that your recommendations will be
seriously considered.
Mr. Jones. We thank you for the supplemental speed--
supplemental bill and the speed that you handled that, sir. We
hope that the House follows your suit.
Senator Cochran. Mr. Chairman, I can report that the Armed
Forces Retirement Home in Gulfport, Mississippi, is nearing
completion of the reconstruction that has been going on, and
they are expecting to open that home in October 2010.
Mr. Jones. Excellent. Thank you, sir.
Chairman Inouye. We will go to the opening.
[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 2011 Defense Appropriations Bill.
My name is 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 fiscal 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 personnel of the active, retired, Reserve and
National Guard, disabled veterans, veterans community and their
families. We love our country and our flag, 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.
Presently, we have under consideration the President's fiscal year
2011 defense budget request of $708 billion for its discretionary and
war funding. According to the Defense Department, this represents an
increase of 3.4 percent from the previous year. In fact, however,
that's about 1.8 percent real growth after inflation.
Last year, we heard Defense Secretary Gates order the Defense
Department to come up with $60 billion in cuts over the next 5 years.
In fact, certain Members of Congress are calling for cuts in defense
spending. In certain quarters of Congress, congressional leaders have
recommended a 25 percent cut in the defense budget.
The National Association for Uniformed Services is pleased with
certain aspects of the President's recommendation, specifically those
that laser focus on winning the wars in Iraq and Afghanistan. Choosing
to win these wars, however, should not mean our country must assume
greater risk in conventional national defense challenges or neglect to
consider the very real emerging threats of the future.
We simply must have a strong investment in the size and capability
of our air, land and naval forces. And we must invest in fielding new
weapons systems today to meet the challenges of tomorrow.
We cannot depend on aging fleets of aircraft, ships and vehicles
across the services. We must continue to drive towards modernization
and make available the resources we will need to meet and defeat the
next threats to our security.
Our nation is protected by the finest military the world has ever
seen. The message our members want you to hear is simple and direct:
Any one who goes into harm's way under the flag of the United States
needs to be deployed with the best our nation can provide. We need to
give our brave men and women everything they need to succeed. And we
must never cut off or unnecessarily delay critical funding for our
troops in the field.
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 also carries concerns about a number of related
matters. Among these is the provision of a proper healthcare 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 healthcare 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 increases 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 concerned.
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, even in a down economy.
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, show
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 $1 million. 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 officials at the TRICARE Program Integrity Office,
approximately 10 percent of all healthcare expenditures are fraudulent.
With a military health system annual cost of $51 billion, fraudulent
purchase of care in the military health system would amount to more
than $5 billion.
We need action to corral fraud and bring it to an end. What we've
seen, however, is delay and second-hand attention with insufficient
resources dedicated to TRICARE fraud conviction and recovery of money
paid to medical care thieves. If one goes to the TRICARE Program
Integrity Office web site, one sees a reflection of this inactivity.
The most recent Fraud Report is dated 2008 and under ``News,'' there
are two items for 2010 and no items for 2009. The question we hear
continually is whether anything is going on except talk about raising
fees and copays.
As an example, NAUS is informed that the Department of Defense
Inspector General reported fraud problems in the Philippines as long
ago as 1998. Yet fraudulent payments continued for 7 years, untended,
merely observed, until finally, more than a year ago, action was taken
to curb the problem and order a Philippine corporation to pay back more
than $100 million in fraudulent payments.
Our members tire of hearing they should pay more when they hear
stories about or see little evidence of our government doing anything
but sitting on its hands, often taking little to no action for years on
this type of criminal activity.
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, we all know who will be left
holding the bag--the law-abiding retiree and family.
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 2011, the Administration recommends a 1.4 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 Members of
Congress 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
1.9 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 3 percent with the January 2010 pay
increase.
The National Association for Uniformed Services applauds you, Mr.
Chairman, for the strides you have made, and we encourage you to
continue your efforts to ensure DOD manpower policy maintains a
compensation package that is reasonable and competitive.
We also encourage your review of providing bonus incentives to
entice individuals with certain needed skills into special jobs that
help supply our manpower for critical assets. These packages can also
attract ``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: 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 that Reserve Component Forces
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.
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 healthcare and other benefits earned in military service.
To improve the DOD/VA exchange, the transfer 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 effective 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 100 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 these
funds, 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 is pleased to note
the Subcommittee's continued interest in providing funds for the Armed
Forces Retirement Home (AFRH). We urge the Subcommittee to meet the
challenge in providing adequate funding for the facility in Washington,
DC, and Gulfport, Mississippi.
And we thank the Subcommittee for the provision of funding that has
led to the reconstruction of the Armed Forces Retirement Home in
Gulfport, destroyed in 2005 as a result of Hurricane Katrina. And we
look forward to the opening of the home scheduled for October 2010.
NAUS is informed that when completed (the construction is 96 percent
done, May 2010), the facility will provide independent living, assisted
living and long-term care to more than 500 residents.
The National Association for Uniformed Services also applauds the
recognition of the Washington AFRH as a historic national treasure. And
we look forward to working with the Subcommittee to continue providing
a residence for and quality-of-life enhancements to these deserving
veterans. We ask that continued care and attention be given to the
mixed-use development to the property's southern end, as approved.
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 care for military retirees.
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 these patients out of military
facilities and 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.
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 2011.
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.
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. Next witness, Ms. Elizabeth Cochran. Ms.
Cochran.
STATEMENT OF ELIZABETH COCHRAN, SECRETARY, ASSOCIATIONS
FOR AMERICA'S DEFENSE
Ms. Cochran. Thank you, Mr. Chairman.
Mr. Chairman and Mr. Vice Chairman of the subcommittee, the
Associations for America's Defense is very grateful to testify
today. We would like to thank the subcommittee for its
stewardship on defense issues and setting an example of your
nonpartisan leadership.
The Associations for America's Defense is concerned that
U.S. defense policy is sacrificing future security for near-
term readiness. Most concerning is the vigorous pursuit to cut
existing programs.
Admiral Mike Mullen stated during his testimony before the
House Armed Services Committee in February that as fiscal
pressures increase, our ability to build future weapons systems
will be impacted by decreasing modernization budgets, as well
as mergers and acquisitions.
A4AD is in agreement, and we are alarmed about the fiscal
year 2011 unfunded program list submitted by the services,
which continues on fiscal year 2010's list, which was 87
percent lower than 2009's. We are more concerned that unfunded
requests continue to be driven by budgetary factors more than
risk assessment, which will impact national security.
Additionally, the result of such budgetary policy could
again lead to a hollow force whose readiness and effectiveness
has been subsequently degraded, and lessened efficiency may not
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.
According to the Office of Management and Budget, base
defense spending will stay relatively flat for the next 5
years. We disagree with placing such constraints on defense
because it could lead to readiness and effectiveness being
degraded.
As always, our military will do everything possible to
accomplish its missions, but response time is measured by
equipment readiness. Last year, due to DOD's tactical aircraft
acquisition programs being blunted by cost and schedule
overruns, the Air Force offered to retire 250 fighter jets,
which the Secretary of Defense accepted.
Until new systems are acquired in sufficient quantities to
replace legacy fleets, these legacy systems must be sustained.
As the military continues to become more expeditionary, more
airlift C-17 and C-130Js will be required. Yet DOD has decided
to shut down production of C-17s.
Procurement needs to be accelerated, 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.
We also thank this subcommittee to continue to provide its
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's assets available to Governors and
adjunct generals at any given time. Appropriating funds for the
Guard and Reserve equipment provides Reserve chiefs and Guard
directors with flexibility of prioritizing funding.
Earlier this month, a sustainable defense task force
released the report ``Debt, Deficits, and Defense: A Way
Forward.'' We are distressed that it recommends cutting up to
$443 billion for conventional forces, canceling several
programs including the MV-22 Osprey, the expeditionary fighting
vehicle, Air Force and Marine Corps F-35, reducing the size of
the Navy to 230 ships, 8 air wings, and cutting up to 200,000
military personnel.
Another very worrisome aspect is the recommendation to
revert the Reserve components back to a strategic reserve
strictly. National security demands both an operational and a
strategic reserve. When at war, there is an outstanding threat,
and it is not time for a peace dividend.
A4AD members are very concerned about planned cuts as
proposed by DOD and this task force. We generally appreciate
the support of the subcommittee, particularly at a time when
there is growing pressure from other members to cut further
programs.
Once again, we thank you for your ongoing support of the
Nation, the armed forces, and our fine men and women serving
this Nation. Please contact us with any questions.
Thank you.
Chairman Inouye. I thank you very much, Ms. Cochran.
An association of this nature, we would expect that a four-
star general testify. But you have done a good job.
Thank you.
Senator Cochran. Thank you very much for looking carefully
at all aspects of the budget requests submitted by the
administration. I think your testimony will be very helpful to
the subcommittee as we continue our deliberations.
[The statement follows:]
Prepared Statement of Elizabeth Cochran
associations for america's defense
Founded in January of 2002, the Association for America's Defense
(A4AD) is an adhoc group of Military and Veteran Associations that have
concerns about National Security issues that are not normally addressed
by The Military Coalition (TMC) and the National Military Veterans
Alliance (NMVA), but participants are members from each. Members have
developed expertise in the various branches of the Armed Forces and
provide input on force policy and structure. Among the issues that are
addressed are equipment, end strength, force structure, and defense
policy. A4AD, also, cooperatively works with other associations, who
provide input while not including their association name to the
membership roster.
Participating Associations: Air Force Association; Army and Navy
Union; Association of the U.S. Navy; Enlisted Assoc. of the National
Guard of the U.S.; Marine Corps Reserve Association; Military Order of
World Wars; National Assoc. for Uniformed Services; Naval Enlisted
Reserve Association; Reserve Enlisted Association; Reserve Officers
Association; The Flag and General Officers' Network; and The Retired
Enlisted Association.
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 twelve
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 ongoing stewardship that it has demonstrated on
issues of defense. While in a time of war, this subcommittee's pro-
defense and non-partisan leadership continues to set an example.
Force Structure: Erosion in Capability
The Obama Administration's 2010 Quadrennial Defense Review (QDR)
advances two objectives: further rebalance the Armed Force's
capabilities to prevail in today's wars while building needed
capabilities to deal with future threats; and second, reform the
Department of Defense's (DOD) institutions and processes to better
support warfighters' urgent needs; purchase weapons that are usable,
affordable, and needed; and ensure that taxpayer dollars are spent
wisely and responsibly. The new QDR calls for DOD to continually evolve
and adapt in response to the changing security environment.
During his testimony before the House Armed Services Committee
(HASC) in February, Admiral Mike Mullen stated, ``. . . I am growing
concerned about our defense industrial base, particularly in ship
building and space. As fiscal pressures increase, our ability to build
future weapon systems will be impacted by decreasing modernization
budgets as well as mergers and acquisitions.''
In 2009 Secretary of Defense Robert Gates testified before the
Senate Armed Services Committee (SASC) 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 DOD's focus should be on
irregular or conventional warfare, and whether it should be preparing
for a full scale ``peer'' war.
Hollow Force
A4AD could not disagree more by placing such budgetary constraints
on defense. Member associations question the spending priorities of the
current administration. ``Fiscal restraint for defense and fiscal
largesse for everything else,'' commented then ranking member John
McHugh at a HASC hearing on the defense budget in May 2009.
The result of such a budgetary policy could again lead to a hollow
force whose readiness and effectiveness has been subtly degraded and
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
highlighting how much readiness decayed.
Emergent Risks
Members of this group are concerned that U.S. defense policy is
sacrificing future security for near term readiness. Our efforts are so
focused to provide security and stabilization in Afghanistan and
withdrawing from Iraq, that risk is being accepted as an element of
future force planning. Force planning is being driven by current
overseas contingency operations, and increasingly on 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 two theaters as well as varying
issues in the Middle East, North Korea, China, Russia, and Iran which
are growing areas of risk.
Korean Peninsula
Provocatively, North Korea successfully tested a nuclear weapon at
full yield, unilaterally withdrew from that 1953 armistice. The
Republic of Korea lost a navy ship sunk to a torpedo. South Korean and
U.S. troops have been put on the highest alert level in years.
North Korea has 1.2 million troops, with 655,000 South Korean
soldiers and 28,500 U.S. troops stationed to the South. While not an
immediate danger to the United States, North Korea is viewed as an
increased threat to its neighbors, and is potentially a destabilizing
factor in Asia. North Korea may be posturing, but it 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 a war along the border and into
Seoul.
China
China's armed forces are the largest in the world and have
undergone double-digit increases in military spending since the early
90s. DOD has reported that China's actual spending on its military is
up to 250 percent higher than figures reported by the Chinese
government, and their cost of materials and labor is much lower. In
2009, China's defense budget increased by almost 15 percent and further
increased about 7.5 percent for 2010. DOD's 2009 report to Congress on
China's military strength estimated in 2008 that its spending ranged
from $105 and $150 billion, the second highest in the world after the
United States. It should be noted that these dollars go further within
the Chinese economy as well.
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
Joint Chiefs of Staff. Furthermore China is reluctant to support
international efforts in reproaching North Korea, which recently as
evidenced by the sunk South Korean naval vessel.
The U.S. military strategy cannot be held hostage by international
debts. While China is the biggest foreign holder of U.S. Treasuries
with $895.2 billion at the end of March, we cannot be lulled into a
sense of complacency.
Russia
While the Obama Administration has been working on a ``reset''
policy towards Russia, including a new START treaty, there are areas of
concern. A distressing issue is their relationship with Iran which the
United States and even the United Nations have brought sanctions
against. Additionally Russia sells arms to countries like Syria and
Venezuela that also have ties to Iran.
Prime Minister Vladimir Putin stated recently that, ``Despite the
difficult environment in which we are today, we still found a way to
not only maintain but also increase the total amount of state defense
order.'' Russia's defense budget rose by 34 percent in 2009, as
reported by the International Institute of Strategic Study in an annual
report.
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 as 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.
Funding for the Future
Since Secretary Gates initiated the practice of reviewing all the
services' unfunded requirements lists prior to testifying before
Congress the result has been in fiscal restraint. The unfunded lists
have shown a dramatic reduction from $33.3 billion for fiscal year 2008
and $31 billion for fiscal year 2009 to $3.8 billion for fiscal year
2010 and $2.6 billion for fiscal year 2011. Most notable is that the
Air Force in prior years represented about 50 percent of the total
unfunded requirements list and is now proportionate to the other
services.
In 2009 Secretary Gates told SASC, ``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.'' He went further saying, ``We
should be able to secure our nation with a base budget of more than
half a trillion dollars.'' Following through on these statements the
Secretary has instituted a plan to save $100 billion over 5 years. Two-
thirds of the savings are supposed to come from decreasing overhead and
one-third from cuts in weapons systems and force structure, meaning
less people. For the 2012 budget, the military services and defense
agencies have been asked to find $7 billion in savings.
These impending cuts are in addition to weapon systems cuts from
last year which amounted to about $300 billion. Despite the great need
to manage budgets in light of the financial situation that the United
States faces, we are still conducting two theaters in a war, and should
be prepared to fight if another threat challenges U.S. National
Security.
Defense as a Factor of GDP
Secretary Gates has warned 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
The 2010 QDR recommends incremental reductions in force structure
shrinking the fleet to about 250 to 260 ships, reducing the number of
active Army brigade combat teams to 45 and Air Force tactical fighter
wings to 17, while maintaining the 202,100 Marine Corps active manpower
level. The Heritage Foundation projects there will be a 5 percent
decrease in manpower over the next 5 years.
A4AD supports a moratorium on further cuts including the National
Guard and other military Reserve. We further suggest that a Zero Based
Review (ZBR) be performed to evaluate the current manning requirements.
Additionally, as the active force is cut, these manpower and equipment
assets should remain in the Reserve Components.
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 communications 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. 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.'' The fiscal year 2011 budget request included an
increase from $350 to $500 million for the Global Train and Equip
authority that helps build capabilities of key partners.
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 as their
national objectives can differ from our own. Alliances should be viewed
as a tool and a force multiplier, but not the foundation of National
Security.
unfunded requirements
The fiscal year 2011 Unfunded Program Lists submitted by the
military services to Congress continued in fiscal year 2010's steps,
which was 87 percent less than was requested for fiscal year 2009. A4AD
has concerns that the unfunded requests continue to be 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. For fiscal year 2010 the Air Force
offered a plan to retire 250 fighter jets in one year alone, which
Secretary Gates accepted.
Yet the HASC observed after approving Navy and Marine Corps
procurement, and research and development programs in May, that it's
concerned about the unacceptable deficit of approximately 250 tactical
aircraft by 2017, warning future budget requests must address this.
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 overseas contingencies. Both Air Force and Naval
airframes and air crew are being stressed by these lift missions. As
the 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.
While DOD has decided to shut down production of C-17s, existing C-
17s are being worn out at a higher rate than anticipated. Congress
should independently examine actual airlift needs, and plan for C-17
modernization, a possible follow-on procurement. Given the C-5's
advanced age, it makes more sense to retire the oldest and most worn of
these planes and use the upgrade funds to buy more C-5s and modernize
current C-5 aircraft. DOD should also continue with a joint multi-year
procurement of C-130Js.
The Navy and Marine Corps need C-40A replacements for the C-9B
aircraft; only nine C-40s have been ordered since 1997 to replace 29 C-
9Bs. 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.
The Air Force-Navy-Marine Corps fighter inventory will decline
steadily from 3,264 airframes in fiscal year 2011 to 2,883 in fiscal
year 2018, at which point the air fleet is supposed to have a slow
increase.
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. A
contract needs to be offered. A4AD thanks this committee for its
ongoing support to resolve this issue.
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 and lists are not in priority order.]
------------------------------------------------------------------------
Amounts in
millions
------------------------------------------------------------------------
Air Force:
C-130 Aircraft Armor (79).............................. $15.8
C-130 NVIS Windows (64)................................ 1
C-130 Crash Resistant Loadmaster Seat Modifications 19
(76)..................................................
C-17 Armor Refurbishment and Replacement (17).......... 2
Air Force Submitted Requirements:
Weapons System Sustainment: Programmed Depot 337.2
Maintenance (PDMs), High Velocity Maintenance (HVM),
Service Life Extension Program (SLEP)/Scheduled
Structural Inspections (SSI), and engine overhauls
[ANG & AFR included]..................................
Theater Posture: contract maintenance of Base 70
Expeditionary Airfield Resources (BEAR)/War Readiness
Material assets; procure Fuels Operational Readiness
Capability equipment (FORCE) sets, fuel bladders/
liners................................................
DCGS Integrated C3 PED System.......................... 55
Battlefield Airmen Equipment/JTAC Modeling & Simulation 28.7
Vehicle & Support Equipment Procurement................ 57.1
Air Force Reserve (USAFR):
LITENING Targeting pod (19)............................ 24
C-130 Secure Line of Sight/Beynold Line of Sight (SLOS/ 22.1
BLOS) (63)............................................
AFRC ATP Procurement & Spiral Upgrade (54)............. 54
C-130 Aircraft Armor (79).............................. 15.8
C-130 Crash Resistant Loadmaster Seats (76)............ 19
F-16 All WX A-G Precision Self-Targeting Capability 120
(54)..................................................
A-10 On Board Oxygen Generating System (OBOGS) (54).... 11.1
Air National Guard (USANG):
F-15 Digital Video Recorder (DVR) (upgrades to ANG F-15 7
aircraft).............................................
C-37B (Gulf Stream) aircraft (4)....................... 256
USANG requires at Andrews AFB to replace the aging C- 1,000
38A fleet C-17 (5 minimum)............................
Requirement identified by NGAUS, EANGUS, AGAUS, and
ROA:
Security Forces Tactical Vehicles:
HMMWVs (1,700)................................. 170
LTMVs (500).................................... 100
Upgraded Personal Protective Equipment:
IOTVs (4,600).................................. 3.1
ESAPI Plates (9,200)........................... 7.5
Concealable Body Armor (8,800)................. 4.4
Air Refueling Tanker replacements...................... ( \1\ )
Army Submitted Requirements:
Line of Communication Bridge (LOCB).................... 15
Light Weight Counter-Mortar Radar (LCMR)............... 47.1
NAVSTAR GPS: Defense Advanced GPS Receiver (DAGR)...... 51.2
Civil Affairs/Psychological Operations (CA/Psy Ops).... 55
Advanced Field Artillery Tactical Data System (AFATDS) 16.2
Forward Entry Devices.................................
Patriot................................................ 133.6
Test 7 Evaluation Instrumentation...................... 17.7
Army Test Range Infrastructure......................... 22.9
Army Reserve (USAR):
Helicopter, Attack AH-64D (3).......................... 75.5
MTV 5 Ton Cargo Truck, M108s (448)..................... 57.4
LMTV 2.5 Ton Cargo Truck, M1079 (23)................... 3.7
HMMWVs (humvees), ARMT Carrier, M1025 (1,037).......... 78
Night Vision Goggles, AN/PVX-7B (7,740)................ 28
Weapons:
Machine Gun, 7.62MM, M240B (3,445)................. 20.6
Carbine Rifle, 5.56MM, M4 (6,441).................. 3.7
Next Generation of Loudspeaker System (NGLS) Manpak, 86.7
NGLS Vehicle (1,344)..................................
Army National Guard (USARNG):
ATLAS (All Terrain Lifter-Army System and II), Truck 4.3
Lift..................................................
Chemical Decontamination (JSTDS-SS, CBPS).............. 11
Radios, COTS Tactical Radios........................... 10
FMTV (Truck tractor: MTV W/E, Truck Van: Expansible MTV 507
W/E)..................................................
Joint Assault Bridge (Carrier Bridge Launching: Joint 35
Assault XM1074).......................................
Navy Submitted Requirements:
Aviation Spares: T/M/S, Fleet aircraft................. 423
Ship Depot Maintenance: deferred surface ship non- 35
docking availabilities................................
Aviation Depot Maintenance: deferred airframes/engines. 74
Navy Reserve (USNR):
C-40A Combo cargo/passenger airlift aircraft (5)....... 75
EA-18G, Growler (2) Additional 3 Growlers will be 142.8
needed in fiscal year 2012............................
Navy Expeditionary Combat Command...................... 20
MPF Utility Boat (3)................................... 3
Marine Corps Submitted Requirements:
CH-53 Reliability Improvements......................... 34
Warfighter Equipment: KC-130J, UC-35ER, UC-12W......... 168
Readiness: M88A2 Improved Recovery Vehicle, Mine Roller 131
System, Assault Breacher Vehicle, Family of Field
Medical Equipment.....................................
Modernization of Child Development Center.............. 18
Marine Forces Reserves (MFR):
KC-130J Super Hercules Aircraft tankers (4)............ 200
Light Armored Vehicles (LAV)........................... 1.5
Training Allowance (T/A) Shortfalls (To provide most up 145
to date Individual Combat & Protective Equipment: M4
rifles, Rifle Combat Optic (RCO) scopes, Light weight
helmets, Small Arms Protective Insert (SAPI) plates,
Modular Tactical Vests, Flame Resistant)..............
Logistics Vehicle Replacement System Cargo............. ( \1\ )
------------------------------------------------------------------------
\1\ Unkown.
Note: A4AD recommends further investment in the DDG 1000 or a similar
concept. This vessel was designed to allow expansion for future
systems and technology. Any new construction should permit maximized
modernization. Restarting procurement of the DDG 51 (Arleigh Burke)
class Aegis destroyers limit the Navy with a 35 year old hull design,
which requires 350 people to crew. While higher costs are cited,
Congress should find ways to reduce shipbuilding, maintenance and
manpower cost, rather than constrain technology.
Reserve Components (RCs)
The National Guard Bureau has stated that the aggregate equipment
shortage for the RCs is about $45 billion. Common challenges for the
RCs are ensuring that equipment is available for pre-mobilization
training, transparency of equipment procurement and distribution, and
maintenance.
One of USANG's top issues is modernizing legacy aircraft and other
weapon systems for dual missions and combat deployments.
USARNG equipment challenges include, but aren't limited to
modernizing both the helicopter and Tactical Wheeled Vehicle (TWV)
fleets, and interoperability with the active component. Additionally
while the ARNG's total equipment on hand (EOH) is 77 percent, there's
only 62 percent of the authorized equipment in the continental United
States (CONUS) available to governors. The Army expects ARNG's total
EOH will fall to 74 percent during 2010.
The USAFR's primary obstacles are defensive systems funding
shortfalls, and modernization of data link and secure communications.
The USAR has concerns about the modernization of equipment and
maintenance infrastructure to support ARFORGEN, sustainment of
equipment to support deploying units and ARFOGEN, and increases in
procurement funding. Additionally Lieutenant General Jack Stultz, chief
of the Army Reserve, stated in testimony before the HASC Readiness
subcommittee this spring that the USAR is challenged by ``still being
budgeted as a strategic reserve.''
USNR top equipping challenges are aircraft procurement specifically
for C-40A, E/A-18G, P-8, and KC-130J; and equipment for civil
engineering, material handling, and communications for OCO-related
units.
The USMFR is concerned about ensuring deploying members continue to
receive up to date individual combat clothing and protective equipment
in theater as well as maintaining the right amount of equipment on hand
at RC units to train prior to deployment.
Active Components
In DOD's new 30-year aircraft investment blueprint it calls for the
Air Force to pause for at least 10 years in production of new strategic
airlifters and long-range bombers. The plan also slows the process to
purchase F-35s causing it to not meet its force level requirements
until 2035.
The Marine Expeditionary Fighting Vehicle (EFV) will be delayed for
another year.
The Marine Corps (USMC) face a primary challenge of having been a
land force for the last decade. The USMC's naval character has taken a
back seat to fighting a virulent resistance in an extended land
campaign, and some core competencies are waning.
Family
A consistent complaint from military families across the board is
the lack of spaces and/or prolonged waiting lists for child care
centers. While the military has built up child care systems, it is
still an urgent need by many, especially those with special needs.
Retiree
The fiscal year 2008 early retirement benefit for RC members was
passed, but it excluded approximately 600,000 members. This law should
be fixed so that RC members' service counts from post-September 11,
2001 rather than from the bill enactment date in 2008.
Health Care
As the operational tempo for our service members continues to be
high and they persist to endure repeated deployments, it becomes ever
more essential to provide efficient and timely health screenings for
pre- and post-deployments.
Achieving and maintaining individual medical readiness standards
throughout a service member's continuum of service is necessary for the
military services and components to meet mission requirements as an
operational force.
Military Voting
Congress legislatively mandated DOD to develop an Internet voting
system for military voters, but HASC cut $25 million from DOD's Federal
Voting Assistance Program (FVAP).
The House stated it was concerned with the immaturity of the
Internet voting system standards being developed by the Elections
Assistance Commission, supported by FVAP. Denying DOD the funding could
ensure those standards remain immature, and may compel the States to
proceed with their own Internet voting systems without Federal voting
standards or guidelines in place.
As the SASC reported bill supports, the Senate Appropriations
Committee should fully fund these important programs. Without these
vital funds, military voters will be condemned to continued
disenfranchisement, lost voting opportunities, and reliance on State-
run systems unsupported by Federal standards or evaluation.
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. Our next witness is Dr. Jonathan Berman,
secretary-treasurer, American Society of Tropical Medicine and
Hygiene.
STATEMENT OF JONATHAN BERMAN, M.D., Ph.D. COLONEL
(RETIRED), UNITED STATES ARMY MEDICAL
CORPS, ON BEHALF OF THE AMERICAN SOCIETY OF
TROPICAL MEDICINE AND HYGIENE
Dr. Berman. Thank you, Mr. Chairman.
I appreciate this opportunity to testify on behalf of the
American Society of Tropical Medicine. I am Dr. Berman,
Colonel, Medical Corps, retired from the United States Army.
The American Society of Tropical Medicine and Hygiene is
the principal professional membership organization in the
United States, and actually in the world, for tropical medicine
and global health. ASTMH represents physicians, researchers,
epidemiologists, other health professionals dedicated to the
prevention and control of tropical diseases.
Because the military operates in many tropical regions,
reducing the risk that tropical diseases present to servicemen
and women is often critical to mission success and service
personnel morale. Malaria and other insect-transmitted
diseases, such as leishmaniasis and dengue, are particular
examples.
Antimalarial drugs have saved countless lives throughout
the world, including U.S. troops during World War II, Korea,
and Vietnam. The U.S. military has long taken a primary role in
the development of antimalarial drugs and vaccines, and nearly
all of the most used antimalarials today were developed at
least in part by U.S. military researchers.
Over 350 million people are at risk for leishmaniasis in 88
countries, 12 million infected currently, 2 million new
infections each year. Leishmaniasis was a particular problem
for Operation Iraqi Freedom, as a result of which 700 American
service personnel became infected. As it happens, the
Washington Post yesterday had a large article on leishmaniasis
built around statements from military personnel here in the
Washington area.
Because of leishmaniasis's prevalence in Iraq and Southwest
Asia in general, DOD has spent large resources on this disease,
and DOD personnel are the leaders worldwide in development of
new anti-leishmanial drugs.
Dengue is the leading cause of illness and death in the
tropics and subtropics, as many as 100 million people are
infected yearly. Although dengue rarely occurs in the United
States, it is endemic in Puerto Rico, and periodic outbreaks
occur in Samoa and Guam.
The intersection of militarily important diseases and
tropical medicine is the reason that 15 percent of ASTMH
members are also members of the military. For this reason, we
respectfully request that the subcommittee expand funding for
DOD's longstanding and successful efforts to develop new drugs,
vaccines, and diagnostics to protect service personnel from
malaria and tropical diseases.
Specifically, we request that in fiscal year 2011, the
subcommittee ensure $70 million to DOD to support its ID
research efforts through USAMRIID, WRAIR, and NMRC. Presently,
DOD funding for this research is about $47 million. To keep up
with biomedical inflation, fiscal year 2011 funding needs to be
$60 million, and as said, to fill the gaps that have been
created by underfunding, ASTMH urges Congress to fund DOD ID
research at $70 million--70--in fiscal year 2011.
Thank you very much, Mr. Chairman and vice chairman.
Chairman Inouye. I thank you very much, Doctor.
I can assure you that this subcommittee is giving this
matter our highest priority.
Senator Cochran. Mr. Chairman?
Chairman Inouye. Our last panel, and I want to thank the
panel very much.
Senator Cochran. Mr. Chairman, could I put in a word for--
--
Chairman Inouye. Yes.
Senator Cochran [continuing]. The last witness? I notice in
my notes here that the University of Mississippi has this
Center for Natural Products Research and is doing some work in
collaboration with Walter Reed Army Institute finding safe
drugs to use against the parasites that cause malaria, which
was one of the topics that you touched on.
Is progress being made in this program? Are you familiar
with that?
Dr. Berman. Yes, sir, I am. There is work on 8-
aminoquinolines as replacement for our present drugs. It is an
excellent center and really leads in this total effort.
Senator Cochran. Thank you.
Chairman Inouye. Thank you very much.
[The statement follows:]
Prepared Statement of Jonathan Berman
The American Society of Tropical Medicine and Hygiene (ASTMH) is
the principal professional membership organization in the United
States, and in the world, for Tropical Medicine and Global Health.
ASTMH represents physicians, researchers, epidemiologists, and other
health professionals dedicated to the prevention and control of
tropical diseases. We appreciate the opportunity to submit testimony to
the Senate Defense Appropriations Subcommittee and I request that our
full testimony be submitted for the record.
Because the military operates in many tropical regions, reducing
the risk that tropical diseases present to servicemen and women is
often critical to mission success.
Malaria and other insect-transmitted diseases such as leishmaniasis
and dengue are particular examples.
Antimalarial drugs have saved countless lives throughout the world,
including troops serving in tropical regions during WWII, the Korean
War, and the Vietnam War. The U.S. military has long taken a primary
role in the development of anti-malarial drugs, and nearly all of the
most used anti-malarials were developed in part by U.S. military
researchers.
Over 350 million people are at risk of leishmaniasis in 88
countries around the world. 12 million people are currently infected
and 2 million new infections occur annually. Leishmaniasis was a
particular problem for Operation Iraqi Freedom, as a result of which
700 American service personnel became infected [Weina 2004]. Because of
leishmaniasis' prevalence in Iraq and in Southwest Asia in general, the
DOD has spent significant time and resources on this disease and DOD
personnel are the leaders in development of new antileishmanial drugs.
Dengue is a leading cause of illness and death in the tropics and
subtropics. As many as 100 million people are infected yearly. Although
dengue rarely occurs in the continental United States, it is endemic in
Puerto Rico, and in many popular tourist destinations in Latin America
and Southeast Asia; periodic outbreaks occur in Samoa and Guam. The DOD
has seen about 28 cases of dengue in soldiers per year.
The intersection of militarily-important diseases and Tropical
medicine is the reason that 15 percent of ASTMH members are members of
the military.
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 and tropical
diseases. Specifically, we request that in fiscal year 2011, the
Subcommittee ensure $70 million to the Department of Defense (DOD) to
support its infectious disease research efforts through the Army
Medical Research Institute for Infectious Diseases, the Walter Reed
Army Institute of Research, and the U.S. Naval Medical Research Center.
Presently, DOD funding for this important research is at about $47
million. To keep up with biomedical inflation since 2000, fiscal year
2011 funding must be about $60 million. In order to fill the gaps that
have been created by underfunding, ASTMH urges Congress to fund DOD
infectious disease research at $70 million in fiscal year 2011.
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.
Chairman Inouye. And our final panel consists of Dr. George
Zitnay, Major General David Bockel, Ms. Joy Simha, and Dr. John
Boslego.
Welcome to the subcommittee, and may I recognize Dr. George
Zitnay.
STATEMENT OF GEORGE A. ZITNAY, Ph.D., CO-FOUNDER,
DEFENSE AND VETERANS BRAIN INJURY CENTER
Dr. Zitnay. Good morning, Chairman Inouye and Vice Chairman
Cochran. It is good to be here.
My name is George Zitnay. I am the co-founder of the
Defense and Brain Injury Center. And before I retired last
year, I have spent over 40 years in the field of brain injury.
And I have been involved, obviously, in the work of the
Department of Defense since the Vietnam war.
I have worked very hard on behalf of the military and for
wounded warriors and their families, and I come before you this
morning to urge funding for the Defense and Veterans Brain
Injury Center at the $40 million level for 2011 and for the new
National Intrepid Center of Excellence, $45 million.
I am requesting specific line-item status for these
agencies, as each is responsible for brain injury care,
research, treatment, and training. NICoE, or the National
Intrepid Center of Excellence, is having its ribbon-cutting
ceremony tomorrow, and I hope that both of you will be able to
attend that wonderful ceremony at Bethesda tomorrow.
As you well know, the NICoE is a volunteer effort on behalf
of Mr. Fisher and many individuals. And we are hopeful that the
NICoE will be able to treat some 500 service members each year,
and their families, for whom standard treatment for TBI has not
worked. And I am hopeful that the NICoE will push the envelope
to develop cutting-edge research and rehabilitation for
individuals with traumatic brain injury from the mild level of
TBI all the way through to coma.
TBI continues to be the signature injury in the wars in
Iraq and Afghanistan, affecting over 10 percent of all deployed
service personnel. Blast-related injuries and extended
deployments are contributing to an unprecedented number of
warriors suffering from TBI, psychological conditions such as
anxiety, depression, PTSD, and suicide. The long-term effects
of blast injury are yet unknown, and more research is
necessary.
Also, we need to really make sure that standard pre-
deployment baseline measurement and assessments are being done
consistently across the services. In addition, there needs to
be a much greater emphasis on connecting injured warriors when
they return home to community resources and to provide support
and education for family members because they are the first
people to recognize the symptoms, particularly of mild TBI and
PTSD.
Last year when I came before this subcommittee, I talked
about those individuals in the vegetative state and the
minimally conscious. I am very unhappy to report that we still
have not provided the level of care necessary for these young
men and women between the ages of 18 and 25.
You know that the private sector has really moved ahead in
this area. Bob Woodruff is a good example. Look at what ABC was
able to do by providing him with the best care possible. There
is new technology and new opportunities to wake these
individuals up with deep brain stimulation and other types of
progress. However, that has not been done. We have still not
developed a partnership with universities and those major
centers.
And I want you to know that the VA has renamed the nursing
homes that they operate for these individuals from nursing
homes to community living centers. What a nice opportunity,
isn't it?
While we know many with severe TBI will not go back to
work, I can assure you that they deserve the best. And last
year, the late Congressman Jack Murtha brought together in
Johnstown a large group of experts in this area and really
wanted to have this as one of the things that he was quite
interested in. Unfortunately, Mr. Chairman and Vice Chairman
Cochran, this has not been done.
And as I know, since I live in Johnstown, Mr. Murtha wanted
this to be accomplished. He invited all of the people to come
together, and I can assure you that a consortium composed of
Harvard, people from MIT, from Cornell Medical Center, from St.
Joseph's Hospital, from Rockefeller have all come together, and
they know that what can be done to serve these individuals.
But even though he brought them together, this has not been
done, and it has been over a year. So I urge you to consider
funding at the $40 million level for the Defense and Veterans
Brain Injury Center and for those individuals who now will be
served by the new Intrepid Center at Bethesda.
And in closing, what I would like to suggest is that since
this continuing war in Afghanistan and Iraq, what we have
observed is that more and more individuals come home. They seem
normal. But it is not until their family members really
recognize that something is going on that they need then to
have care.
And quite frankly, we need to do a lot more in our
communities all across this country, whether it is in
Mississippi or Hawaii or wherever it is, to connect up our
servicemen and women with the best that is possible in our
communities.
Thank you very much for all that you have done, and I urge
you to support at the $40 million level for DVBIC and for the
new NICoE Center of Excellence.
Chairman Inouye. I can assure that we will do exactly that.
Dr. Zitnay. Thank you very much, Mr. Chairman.
Senator Cochran. Thank you for the insight that you have
given us and also for your unselfish service in trying to
personally make a difference for a lot of servicemen and women
who have been injured.
Dr. Zitnay. Well, I am retired now, and I come before you
as a volunteer because I am still most interested in what
happens to our young men and women in the military.
Thank you very much.
[The statement follows:]
Prepared Statement of George A. Zitnay
Dear Chairman Inouye, Ranking Member 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, Ph.D., 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. Last year I
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 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\ and serves as
the key operational component for brain injury of the Defense Centers
of Excellence for Psychological Health and Traumatic Brain Injury
(DCoE) under DOD Health Affairs.
---------------------------------------------------------------------------
\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.
---------------------------------------------------------------------------
I am here today to ask for your support for $40 million for the
DVBIC and $45 million for the National Intrepid Center of Excellence
(NICoE) in the Defense Appropriations bill for fiscal year 2011. This
level of funding is consistent with the request made by 30 Members of
the Congressional Brain Injury Task Force to the House Appropriations
Committee as well as with the President's budget request. The
Administration requested a total of $920 million: $670 million for
treatment and $250 million for research. Since DVBIC and NICoE provide
both treatment and research, line items are requested for these
individual agencies.
As you know, traumatic brain injury (TBI) remains the ``signature
injury'' of the conflicts in Iraq and Afghanistan, affecting over 10
percent of all deployed service personnel. Blast-related injuries from
improvised explosive devices and extended deployments are contributing
to an unprecedented number of TBIs (ranging from mild, as in
concussion, to severe, as in unresponsive states of consciousness) and
psychological conditions such as anxiety, depression, post traumatic
stress disorder (PTSD) and suicide. TBI-related health issues cost
billions of dollars, not including lost productivity or diminished
quality of life.
For a myriad of reasons, it is in everyone's best interest--our
wounded warriors, their families and loved ones, our national security
and military readiness and the nation's taxpayers--to assure that
service members with TBI are given the appropriate treatment and
rehabilitation as soon as possible. Our country cannot afford to allow
service members to fall through the cracks and suffer from the
deleterious effects, sometimes life long, of TBI.
After sustaining an initial TBI, a service member is at twice the
risk of sustaining another TBI and compounding the injury. This can be
particularly devastating in a combat zone especially if not removed
from action. A 2009 Consensus group of brain injury specialists (50
civilian and military experts), suggested that troops with mild TBI
receive cognitive rehabilitation as soon as possible.
(Neurorehabilitation. 2010 Jan 1; 26 (3): 239-55.
On June 7, 2010, National Public Radio and Propublica published the
results of an independent investigation which showed that despite the
DOD's efforts to detect and treat TBI, a huge number remain
undiagnosed. NPR reports that ``the nation's most senior medical
officers are attempting to downplay the seriousness of so-called mild
TBI. As a result, soldiers haven't been getting treatment.'' (http://
www.propublica.org/feature/brain-injuries-remain-undiagnosed-in-
thousands-of-soldiers). The report states that ``tens of thousands of
troops with TBI have gone uncounted.''
Consistent Screening is Needed
Four years ago, DVBIC began a comparative study on the efficacy of
6 diagnostic screening tools but for various reasons there has been
delay in publishing the results. Since May 2008, a pre-deployment
cognitive test is used based on DVBIC's ANAM, but post deployment has
been inconsistent. It is my understanding that top DOD officials fear
that greater screening may produce false positives and follow up
assessments and treatment will be expensive. This is unacceptable. In
cases of positive screenings or when there is suspicion of TBI, a
neuropsychological battery should be performed. Pending the results of
DVBIC's study, DOD should convene a panel of outside experts to reach a
consensus on the best post deployment screening tool which has
demonstrated efficacy and use it consistently across the board.
Amendments have been offered to the DOD Authorization bill currently
under consideration that would help achieve this. Brigadier General
Loree Sutton, head of the Defense Centers of Excellence for
Psychological Health and TBI has repeatedly stated that her goal is to
have ``consistent standards of excellence across the board.'' This is
an area that desperately needs consistency.
Long Term Effects of Blast Injury Remain Unknown
The lnstitute of Medicine's (IOM) Preliminary Assessment on the
Readjustment Needs of Veterans, Service Members and Their Families
(March 31, 2010) notes that there is a paucity of information on the
lifetime needs of persons with TBI in the military and civilian sectors
and recommends funding for additional research into protocols to manage
the lifetime effects of TBI.
This issue is compounded by the fact that blast injuries from IEDs
are quite different from TBIs sustained in the civilian sector, from
sports and car crashes. There is even less information on the long term
effects of blasts.
The National Defense Authorization Act for Fiscal Year 2008
specifically directed DVBIC to conduct a 15 year study. Assuring
funding of some $40 million specifically for DVBIC would further this
goal.
Comorbid Conditions
As I testified last year, the distinction between TBI and PTSD
remains a problem. Some senior DOD medical officers continue to argue
that symptoms can be treated without regard to the underlying problem.
This is wrong. Treatments for PTSD are often contraindicated for TBI
and vice versa. A service member with PTSD may be prescribed a beta
blocker to address memory of the trauma, but it unknown how these
treatments may affect recovery from TBI. Similarly, a stimulant may be
prescribed for TBI to enhance certain brain activity, but stimulants
may exacerbate certain symptoms of PTSD.
More research must be done to develop evidence-based guidelines for
TBI and PTSD, as well as guidelines to address the complexities of
comorbid conditions.
Education
The need continues for greater education and training for TBI
specialists, particularly neurologists, physiatrists,
neuropsychologists, cognitive rehabilitation specialists and physician
assistants, occupational therapists, and physical therapists. For the
past 3 years, DVBIC has held annual training sessions for some 800
military medics. Continued funding is also needed for multi-media
initiatives, development and dissemination of educational materials for
providers, as well as informational tools for injured service members
and their families and loved ones.
Outreach
Congress should continue funding the DVBIC to improve outreach to
service members in remote and underserved areas and follow up. Funding
is needed to increase the number of case managers as well as expand
DVBIC's TBI Care Coordination program to monitor the continuum of TBI
services and connect service members with local and regional TBI-
related resources, clinical services, as well as family and patient
support services.
The IOM recommended that DOD and the Veterans Administration
improve coordination and communication among the multitude of programs
that have been created to meet the needs of returning service members
and veterans. DVBIC coordination with civilian, private and public,
resources and services could help fill the gaps in information and
referral and service delivery.
Greater effort needs to be made to create a safety net so that
undiagnosed or misdiagnosed service members do not fall through the
cracks. National Guard and Reserves are at particular risk as they
often return to their civilian lives. In cases where TBI has been
indicated, there have been reports of resistance from military
treatment facilities in addressing their needs.
A total of $40 million is requested for DVBIC to continue its work
and expand and improve as necessary.
NICoE
Scheduled to open this month, the National Intrepid Center of
Excellence is expected to ``use an innovative holistic approach to the
referral, assessment, diagnosis and treatment of those with complex
psychological health and TBI disorders'' and serve as ``a global leader
in generating, improving, and harnessing the latest advances in
science, therapy, telehealth, education, research and technology while
also providing compassionate family-centered care for service members
and their loved ones throughout the recovery and community
reintegration process.'' (Testimony of Charles L. Rice, MD, Acting
Assistant Secretary of Defense for Health Affairs before HASC hearing
April 13, 2010).
NICoE is to provide neurological and psychological treatment to
some 500 service members per year, for whom standard treatment is not
successful. NICoE holds much promise, as clinical research can be done
like never before. What's needed is to push the envelope and develop
cutting edge rehabilitation efforts for various levels of TBI and then
track long term outcomes. As a Center of Excellence, NICoE should lead
the way in redefining the standard of care.
It is envisioned that NICoE would develop specific treatment plan
and then seek out community resources in an injured personnel's own
community. However, funding is needed not only to encourage innovation
but to assure that such treatments will be paid for when service
members return to their communities, as new treatments will not likely
yet be covered by Tricare.
In order to provide intensive and innovative rehabilitation,
research and coordination with consortia of public and private partners
will be necessary. $30 million is needed for pilot projects to treat
service members with various levels of TBI, including severe TBI and
disorders of consciousness.
A total of $45 million for NICoE is requested to be included in the
DOD Appropriations bill for fiscal year 2011 for these purposes.
In conclusion, DOD has made some significant strides in addressing
the needs of service members with TBI, but more research and innovative
treatment is needed. Your leadership and continued support for our
wounded warriors is very much appreciated.
Thank you for your consideration of this request to help improve
the lives of our wounded warriors.
Chairman Inouye. Our next witness is Major General David
Bockel, executive director of the Reserve Officers Association
of the United States.
STATEMENT OF MAJOR GENERAL DAVID BOCKEL, UNITED STATES
ARMY (RETIRED), EXECUTIVE DIRECTOR, RESERVE
OFFICERS ASSOCIATION
General Bockel. Mr. Chairman, Mr. Vice Chairman, the
Reserve Officers Association thanks you for the invitation to
appear and give testimony.
I am Major General David Bockel. I am the executive
director of the Reserve Officers Association, and I am also
authorized to speak on behalf of the Reserve Enlisted
Association.
A debate is going on whether the Reserve components are
becoming too expensive and pricing themselves out of the market
as an operational component. It is interesting to note that the
argument about the cost of the Reserve and National Guard
incentives, benefits, and readiness posture dates back to World
War II. At that time, just as now, there were those who said
that the Reserve component training, pay, and benefits would be
unaffordable and would necessitate long-term costs.
As both the Congress and the Pentagon are looking at
reducing defense expenses, ROA finds itself again confronted
with protecting one of America's greatest assets, the Reserve
components. There are some who would take cuts from the Reserve
rather than the Active Duty force. ROA and REA fully understand
that when citizen warriors are used for an extended period,
there is a substantial personnel cost. It is a cost of war.
The statement that, while mobilized, a reservist or
guardsman costs as much as an active component member isn't in
dispute. On the other hand, the citizen warrior cost over a
lifecycle, being mobilized only when needed and placed into a
trained and ready-to-go posture when not recalled, is far less
than the cost of an active component warrior.
Additional cost savings are found when prior service
training develop civilian proficiencies in badly needed
military skill sets, are retained by having adequate number of
Reserve billets across the spectrum of military missions.
National Guard and Reserve members fully understand their
duty and are proud to be serving operationally. And not only
have they contributed to the war effort, but they have made the
difference in maintaining an all-volunteer military force, and
in the truest sense, the Reserve components have saved the
country from a draft.
Establishing parity in training, equipment, pay, and
compensation is only fair when the young men and women in the
Reserve components are taking their place on the front,
assuming the same risk as the Active Duty force. Over 750,000
men and women have left their homes, schools, and workplaces
and have performed magnificently in the overseas operational
contingencies in Afghanistan and Iraq.
The condition of the Reserves and Guard today is different
than it was 9 years ago. In ways, it is better, as almost every
leader now is a combat-tested veteran. In other ways, however,
the condition is worse. Equipment has been destroyed, worn out,
or left in the theater.
Every defense leader recognizes the need to continue to
reset the force. ROA's written testimony includes lists of
unfunded requirements that we hope this subcommittee will fund,
but we also urge the subcommittee to specifically identify
funding for both the National Guard and the Reserve components
exclusively to train and equip the Reserve components.
We hope, too, that this subcommittee continues to provide
appropriations for the National Guard and Reserve equipment
authorization. Appropriating funds to the Guard and Reserve
equipment provides Reserve chiefs and National Guard directors
with the flexibility of prioritizing funding. ROA and REA also
hope that NGREA dollar levels are assessed based on mission
contribution to make it more proportional.
Another concern ROA and REA share is legal support for
veterans and Guard and Reserve members returning from
deployment to face the ever-increasing challenges of
reemployment. On June 1, 2009, ROA established the Service
Members Law Center.
This is a pro bono service that provides legal advice and
guidance to Reserve, National Guard, Active, and separated
veterans, their families, legal counsel, and as well as
providing information to attorneys, bar associations,
employers, Members of Congress, and other interested parties.
It does not provide legal representation.
In just a year, the law center has received over 2,750
requests for information on legal issues. Nearly 60 percent
dealt with employment and reemployment rights. The service may
be free, but this important service does cost money. Currently,
with ROA's financial support, it allows the center to be
virtually a one-man shop.
Awareness of the service outside of ROA membership is only
by word of mouth. This does not--there is not any outside
promotion. With broader awareness, our vision is to grow and
increase the staff and the services provided to our veterans
from both Reserve and Active component communities, which will
make more money--which will take more money. ROA would
appreciate the opportunity to meet with your staff to discuss
how this subcommittee can provide monetary support.
Thank you again for your consideration of our testimony,
and I am available to answer any questions.
Chairman Inouye. I thank you very much, sir.
We have got a workload. I can assure you we will do it.
Senator Cochran. I was just curious about the law center
that you mentioned in your testimony, whether or not there is
pro bono legal activity. I know when I was practicing law in
Mississippi before I came up here to serve in Congress, we had
a volunteer legal services program for people who couldn't
afford lawyers, the poor, and we didn't have as many built-in
programs that provide legal services back then. But now there
are quite a few.
I wonder, are you getting support from local bar
associations for this center?
General Bockel. On a case-by-case basis. The gentleman who
runs this law center, his name is Captain (Retired) Sam Wright,
Navy Reserve, and he is the source authority on USERRA, Service
Member Civil Relief Act, and military voting. When he is
invited to speak to bar associations, if they don't offer an
honoraria, he asks for it.
Interestingly enough, one of our members of the Reserve
Officers Association who is also an attorney is providing an
amicus brief to the United States Supreme Court on a case that
is going to be heard in the fall. And it is going to be very
interesting because it is in I don't know how many years, it is
the first time that a USERRA case has made it that far.
Senator Cochran. Thank you.
Chairman Inouye. Thank you.
[The statement follows:]
Prepared Statement of Major General David Bockel
The Reserve Officers Association of the United States (ROA) is a
professional association of commissioned and warrant officers of our
nation's seven uniformed services, and their spouses. ROA was founded
in 1922 during the drawdown years following the end of World War I. It
was formed as a permanent institution dedicated to National Defense,
with a goal to teach America about the dangers of unpreparedness. When
chartered by Congress in 1950, the act established the objective of ROA
to: ``. . . support and promote the development and execution of a
military policy for the United States that will provide adequate
National Security.''
The Association's 65,000 members include Reserve and Guard
Soldiers, Sailors, Marines, Airmen, and Coast Guardsmen who frequently
serve on Active Duty to meet critical needs of the uniformed services
and their families. ROA's membership also includes officers from the
U.S. Public Health Service and the National Oceanic and Atmospheric
Administration who often are first responders during national disasters
and help prepare for homeland security.
President: Rear Admiral Paul Kayye, MC, USNR (Ret.)
Staff Contacts:
Executive Director: Major General David R. Bockel, USA (Ret.)
Legislative Director, Health Care: CAPT Marshall Hanson, USNR
(Ret.)
Air Force Director: Mr. David Small
Army and Strategic Defense Education Director: Mr. ``Bob'' Feidler
USNR, USMCR, USCGR, Retirement: CAPT Marshall Hanson, USNR (Ret.)
The Reserve Enlisted Association is an advocate for the enlisted
men and women of the United States Military Reserve Components in
support of National Security and Homeland Defense, with emphasis on the
readiness, training, and quality of life issues affecting their welfare
and that of their families and survivors. REA is the only Joint Reserve
association representing enlisted reservists--all ranks from all five
branches of the military.
Executive Director: CMSgt Lani Burnett, USAF (Ret)
priorities
CY 2010 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 and 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 one-thirtieth 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
healthcare.
--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 and reserve equipment 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.
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, 66,500.
--Marine Corps Reserve, 39,600.
--Air National Guard of the United States, 106,700.
--Air Force Reserve, 71,200.
--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.
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.
In order 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 non-deployed units.
Army Reserve Unfunded Requirements
Since 9/11, the Army Reserve has mobilized 185,660 soldiers and
currently has about 29,000 deployed. Shortages of equipment on-hand,
combined with significant substitute items in the Army Reserve's
inventory, compromise units' ability to train in support of the modular
Army and to meet surge requirements. The Army Reserve has about 73
percent of its required equipment on-hand, but some critical items
remain at less than 50 percent fill. Without a higher level of funding,
the Army Reserve is projected to reach 85 percent of its equipment
requirements by the end of fiscal year 2015.
The Army Reserve has a fiscal year 2015 equipment requirement of
$22.05 billion. Under current base budgeting and additional Overseas
Contingency Operation funding the projected programmed funds are only
$17.76 billion. This is a shortfall of $4.29 billion for the Army
Reserve. The minimum NGREA funding to catch-up would be $944 million.
Unresourced equipment includes:
Transportation:
Family of Medium Tactical Vehicles (FMTV)--$1.03 billion
Heavy Tactical Vehicle (HTV)--$503 million
Heavy Expanded Mobility Tactical Truck (HEMTT-LET)--$300 million
Stryker Nuclear Biological and Chemical Recon Vehicle (NBC-RV)--
$547 million
C-27A Cargo Aircraft--$26 million each
--The latest addition to the United States Army Reserve Aviation
fleet is the C-27J Spartan Joint Cargo Aircraft (JCA). The Army
Reserve will be initially receiving 16.
Tactical Quiet Generators [TQG's] PU-807A 100kW (3,036)--$5.8
million
--The Army Reserve requires 8,717 TQG's to perform its wartime
mission as well as its HLS/HLD responsibilities, but has only
5,681 on-hand. Of particular concern in an unfunded shortfall
of 59 100kW power units (PU's) that exists within Combat
Support Hospitals.
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. Equipment is need to replace broken
equipment and battle loses, train in pre-mob, support the TPE, and to
substitute for equipment in transit. To support the mission the ARNG
has cross-leveled equipment. Current equipment procurement averages $5
billion per year. Current equipment levels as of April 2010 are 77
percent of equipment on-hand.
HMMWVs (humvees) (2,063)--$2.4 billion
--ARNG is critically short on certain HMMWV configurations that are
essential to domestic and Overseas Contingency Operations.
Transportation--$1.15 billion
--FMTV/LMTV Cargo Trucks; HMMWV; HTV 8 8 Heavy Trucks; Tactical
Trailers.
Warfighter Information Network-Tactical (WIN-T)--$1.2 billion
--Tactical telecommunications system consisting of infrastructure and
network components from the maneuver battalion to the theater
rear boundary. The WIN-T network provides Command, Control,
Communications, Computers, Intelligence, Surveillance, and
Reconnaissance (C\4\ISR) capabilities that are mobile, secure,
survivable, seamless, and capable of supporting multimedia
tactical information systems.
Stryker combat vehicles, battalion (1)--$1.4 billion
--Eight-wheeled vehicle that can travel up to 62.5 mph. It comes in
10 variants, including an infantry-carrier vehicle, a medical
evacuation vehicle and a command vehicle.
Multi-Temperature Refrigerated Container System (MTRCS)--$7.5
million
--The Army National Guard has no refrigerated container systems on-
hand, creating a combat readiness issue for selected
quartermaster units and forcing states to lease commercial
systems to transport food and medical supplies during HLS/HLD
missions and during training. The MTRCS is the Army's new
refrigerated container system.
air force reserve components equipment priorities
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 unfunded equipment are:
Infra-Red Counter Measures C-130 (21)--$63 million
--The AN/AAQ-24 (V) NEMESIS is an infrared countermeasure system
designed to protect against man-portable (shoulder-launched)
infrared-guided surface-to-air missiles.
Infra-Red Counter Measures KC-135 (15)--$15 million
--KC-135 aircraft deployed in support for Operation Iraqi and
Enduring Freedom have inadequate protection against the
Infrared Missile threat. For the procurement and installation
of the Guardian AN/AAQ-24 (V) Large Aircraft Podded Infrared
Countermeasures (LAIRCM) system.
Infra-Red Counter Measures C-5B/C-17s (13)--$90 million
--For the procurement and installation of the AN/AAQ-24 V NEMESIS, an
infrared countermeasure system designed to protect against man-
portable (shoulder-launched) surface-to-air missiles.
Helmet Mounted Integrated Targeting [HMIT] (39)--$6 million
--Upgrade and enhancement to engagement systems.
C-5 Structural Repair (6)--$66 million
--Stress corrosion cracking of C-5A skins and box beam fittings
requires fleet-wide replacement to avoid grounding and
restriction of outsize cargo-capable to sustain strategic
mobility assets.
Security Forces Weapons & Tactical Equipment--$5.5 million
--Also: The USAFR #1 need is MILCON dollars. Of the total fiscal year
2011 USAF MILCON budget, The AF Reserve was only funded with
$3.4 million for its top facilities project, but is underfunded
by $1 billion.
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.
C-17 Globemaster III transport aircraft (5)--$1.3 billion
--As highlighted as an ANG airlift requirement.
Infra-Red Counter Measures--$238 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--$49 million
--Continue to install ADS systems onto C-5, C-17, and F-15 aircraft.
Security Force Equipment--$79.4 million
--Crowd control, Tasers, Protective garments, eyewear, goggles,
rifles, weapons accessories, traffic control kits, and night
vision devices.
Helmet Mounted Cueing System (HMCS)--$30 million
--The addition of a day/night helmet mounted cueing system (HCMS)
will significantly increase pilot situational awareness (SA),
aircraft survivability, and lethality in every mission area.
Needed for F-16 and A-10 aircraft.
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 (2)--$170 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.
Maritime Expeditionary Security Force--$20 million
--Navy Expeditionary Combat Command has 17,000 Navy Reservists and
requires $3.1 billion in Reserve Component (Table of Allowance)
TOA equipment.
KC-130J Super Hercules Aircraft tankers (2)--$168 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. Twenty-four replacements required through 2030.
C-37 B (Gulf Stream) Aircraft (1)--$64 million
--The Navy Reserve helps maintain executive transport airlift to
support the Department of the Navy.
Civil Engineering Support Equipment--Tactical Vehicles--$4.4
million
marine corps reserve unfunded priorities
More than 54,000 Marine Corps Reservists have executed over 70,000
mobilizations. Nearly one-third of the authorized 39,600 end strength
have deployed outside the continental United States. The young men and
women have become an experienced combat force, but are limited in their
mission by the availability of equipment.
KC-130J Super Hercules Aircraft tankers (4)--$200 million
or advanced procurement--$48 million
--These Aircraft are needed to fill the shortfall in Marine Corps
Essential Airlift. USMCR needs 28 airframes, and procurement
price close to upgrading existing C-130Ts with the benefit of a
longer life span. Commandant, USMC, has testified that
acquisition must be accelerated.
Light Armored Vehicles--LAV--$1.5 million each
--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--$145 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. USMCR goal is to ensure that the Reserve TA contains
the same equipment utilized by the active component.
Obtain latest generation of Individual Combat and Protective
Equipment including: M4 rifles; Rifle Combat Optic (RCO) scopes; Light
weight helmets; Small Arms Protective Insert (SAPI) plates; Modular
Tactical Vests; and Flame Resistant Organizational Gear.
national guard and reserve equipment appropriation
The Reserve components that were once held as a strategic force are
now also being employed as an operational asset as well as a strategic
reserve; stressing an ever greater need for procurement flexibility as
provided by the National Guard and Reserve Equipment Appropriation
(NGREA). Much-needed items not funded by the respective service budget
are frequently purchased through NGREA. In some cases it is used to
bring unit equipment readiness to a needed state for mobilization.
The Reserve and Guard are faced with ongoing challenges on how to
replace worn out equipment, equipment lost due to combat operations,
legacy equipment that is becoming irrelevant or obsolete, and, in
general, replacing that which is gone or aging through the abnormal
wear and tear of deployment. The Reserve Components benefit greatly
from a National Military Resource Strategy that includes a National
Guard and Reserve Equipment Appropriation.
ROA thanks Congress for approving $750 million for NGREA for fiscal
year 2010, but even more dollars are needed. ROA urges Congress to
continue the authorization and appropriate for a modern equipment
account proportional to the missions being performed, which will enable
the Reserve Component to meet its readiness requirements.
service members law center
The Reserve Officers Association developed a Service Members Law
Center, advising Active and Reserve servicemembers who are subject to
legal problems that occur during deployment.
In almost a year of operation (June 1, 2009 through May 6, 2010),
the Service Members Law Center has advised 2,150 individuals, by
telephone and/or e-mail, and in a few instances in person. Of those
2,150, approximately 1,720 (80 percent) were Active or Reserve
Component (overwhelmingly Reserve Component) members of the Armed
Forces. Of those who have contacted us, the ROA Service Members Law
Center has referred about 5 percent to attorneys.
The ROA Service Members Law Center has also heard from and has
provided information to attorneys, employers, congressional staffers,
state legislators and staffers, reporters, and veterans who are not
currently Active or Reserve Component members of the Armed Forces but
have been in the past.
The legal center helps encourage new members to join the Active,
Guard and Reserve components by providing a non-affiliation service to
educate prior service about the Uniformed Services Employment and
Reemployment Rights Act (USERRA) and Servicemember Civil Relief Act
(SCRA) protections, and other legal issues. It helps retention as a
member of the staff works with Active and Reserve Component members to
counsel those who are preparing to deploy, deployed or recently
deployed members facing legal problems.
The Legal Center refers names of attorneys who work related legal
issues, encouraging law firms to represent service members, and educate
and training lawyers, especially active and reserve judge advocates on
service member protection cases. The center is also a resource to
Congress.
The Supreme Court has granted a discretionary review of its first
Supreme Court case under (USERRA). The Service Members Law Center will
file an amicus curiae (friend of the court) brief in July.
ROA sets aside office spaces and has already hired a lawyer to
answer questions of serving members and veterans. The goal is to hire
two additional staff with a paralegal and an administrative law clerk
and provide suitable office equipment and workspace to help man the
Service Members Law Center to expand counsel individuals and their
legal representatives.
Anticipated overall cost fiscal year 2011: $505,000.
cior/ciomr funding request
The Interallied Confederation of Reserve Officers (CIOR) was
founded in 1948, and the Interallied Confederation of Medical Reserve
Officers (CIOMR) was founded in 1947. These organizations are a
nonpolitical, independent confederation of national reserve
associations of the signatory countries of the North Atlantic Treaty
Organization (NATO). Presently there are 16 member nation delegations
representing over 800,000 reserve officers. CIOR supports several
programs to improve professional development and international
understanding. The Reserve Officers Association of the United States
represents the United States and is its member to CIOR.
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.
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. Presently no Service has Executive Agency for CIOR so that
these programs aren't being funded.
Military Competition funding needs at $150,000 per fiscal year.
conclusion
The impact of operations in Iraq and Afghanistan is affecting the
very nature of the Guard and Reserve, not just the execution of Roles
and Missions. 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
subcommittee for the opportunity to present our testimony. We are
looking forward to working with you, and supporting your efforts in any
way that we can.
Chairman Inouye. Our next witness is a member of the board
of directors of the National Breast Cancer Coalition, Ms. Joy
Simha.
STATEMENT OF JOY SIMHA, MEMBER, BOARD OF DIRECTORS,
NATIONAL BREAST CANCER COALITION AND CO-
FOUNDER, YOUNG SURVIVAL COALITION
Ms. Simha. Thank you.
Thank you, Mr. Chairman and members of the Appropriations
Defense Subcommittee for the opportunity to testify here today
about the Department of Defense Breast Cancer Research Program.
As successful as this competitive peer-reviewed program is, it
warrants level funding.
I am Joy Simha. I am a 16-year breast cancer survivor, a
wife, a mother, and one of the co-founders of the Young
Survival Coalition and, as you said, a board member of the
National Breast Cancer Coalition. In addition, I sit on the
integration panel of the Breast Cancer Research Program with
three other survivors and about a dozen scientists.
Chairman Inouye and Ranking Member Cochran, we truly
appreciate your longstanding support of this innovative,
successful program, which represents a meaningful, true way for
women to fight breast cancer. Women and their families across
the country are depending on this program.
The program has a unique structure, which brings
scientists, trained consumers, policymakers, and the Army
together to collaborate toward ending breast cancer. There is
no bureaucracy, and the Army is so efficient and effective in
implementing the program. They should be applauded for using
less than 10 percent of funds for administrative costs.
The program is truly transparent and accountable to the
taxpayer. The Era of Hope, which is a biennial meeting where
scientists report back on their research results, provides
opportunity for others to hear about and collaborate on
innovative research results. In addition, all information about
who gets funded can be found at the Department of Defense
Breast Cancer Web site.
The partnership with educated consumers, scientists, the
Army, policymakers helps keep the science relevant to women. It
ensures the program's sense of urgency at fulfilling its
mission.
This program pushes science to new levels. The focus is in
changing the status quo by creating new models of research. The
collaborators are not afraid to ask the very difficult, complex
questions and fund unique models of research while maintaining
the peer review model.
As a true testimony to our success, the mission, the
mechanisms, and the structure of the program have been used for
models in other programs in other research and scientific
research programs. This program has been applauded by the
Institute of Medicine and others as an exemplary model of
funding research.
The program works. It not only saves women's lives, but it
changes the status quo about how we do research. The Department
of Defense Breast Cancer Research Program is a true means to an
end. People across this country believe in the program and its
ability to end breast cancer. I come to you as a survivor
representing those people and the many wonderful women we have
lost to breast cancer.
I wish to dedicate my testimony today to two women who were
once chairs of the integration panel who lost their lives
recently to breast cancer--Carolina Hinestrosa, who is just
about a 1-year--we lost her about 1 year ago, and Karin Noss.
We continue our work to honor women as amazing as these two so
that we can move forward and try to end breast cancer and save
lives in the future.
Thank you for your support and the opportunity to testify.
Chairman Inouye. I thank you very much for your testimony.
We will do our best.
Senator Cochran. I want to congratulate you on the quality
of your presentation, too. You would be a professional in many,
many areas, but particularly the convincing way you presented
your remarks I thought was worthy of praise.
I noticed that in 2004, there was a report that reviewed
this program and gave it very high marks and talked about the
scientific breakthroughs that were occurring because of the
things that your organization is doing. Congratulations.
Ms. Simha. Thank you.
[The statement follows:]
Prepared Statement of Joy Simha
introduction
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 Joy Simha, a 16-year breast cancer survivor, communications
consultant, a wife and mother, co-founder of The Young Survival
Coalition, and a member of the board of directors of the National
Breast Cancer Coalition (NBCC). I am also a member of the Integration
Panel of the Department of Defense Breast Cancer Research Program. 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 healthcare and breast cancer clinical trials for all women; and
expand the influence of breast cancer advocates wherever breast cancer
decisions are made.
Chairman Inouye and Ranking Member Cochran, we appreciate your
longstanding support for the Department of Defense Peer Reviewed Breast
Cancer Research Program. As you know, this program was born from a
powerful grassroots effort led by the National Breast Cancer Coalition,
and has become a unique partnership among consumers, scientists,
Members of Congress and the military. 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. 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 healthcare
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. To support this unprecedented progress moving forward, we
ask that you support a separate $150 million appropriation, level
funding, for fiscal year 2011. In order to continue the success of the
Program, you must ensure that it maintain its integrity and separate
identity, in addition to level funding. This is important not just for
breast cancer, but for all biomedical research that has benefited from
this incredible government program.
vision and mission
The vision of the Department of Defense Breast Cancer Research
Program is to ``eradicate breast cancer by funding innovative, high-
impact research through a partnership of scientists and consumers.''
The meaningful and unprecedented partnership of scientists and
consumers has been the foundation of this model program from the very
beginning. It is important to understand this collaboration: consumers
and scientists working side by side, asking the difficult questions,
bringing the vision of the program to life, challenging researchers and
the public to do what is needed and then overseeing the process every
step of the way to make certain it works. This unique collaboration is
successful: every year researchers submit proposals that reach the
highest level asked of them by the program and every year we make
progress for women and men everywhere.
And it owes its success to the dedication of the U.S. Army and
their belief and support of this mission. And of course, to you. It is
these integrated efforts that make this program unique.
The Department of the Army must be applauded for overseeing the DOD
BCRP which has established itself as a model medical research program,
respected throughout the cancer and broader medical community for its
innovative, transparent and accountable approach. This program is
incredibly streamlined. The flexibility of the program has allowed the
Army to administer it with unparalleled efficiency and effectiveness.
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 pioneering research performed through the
program and the unique vision it maintains has the potential to benefit
not just breast cancer, but all cancers as well as other diseases.
Biomedical research is literally being transformed by the DOD BCRP's
success.
consumer participation
Advocates bring a necessary perspective to the table, ensuring that
the science funded by this program is not only meritorious, but that it
is also meaningful and will make a difference in people's lives. The
consumer advocates bring accountability and transparency to the
process. They are trained in science and advocacy and work with
scientists willing to challenge the status quo to ensure that science
funded by the program fill important gaps not already being addressed
by other funding agencies. Since 1992, more than 600 breast cancer
survivors have served on the BCRP review panels.
Last year, Carolina Hinestrosa, a breast cancer survivor and
trained consumer advocate, chaired the Integration Panel and led the
charge in challenging BCRP investigators to think outside the box for
revelations about how to eradicate breast cancer. Despite the fact that
her own disease was progressing, she remained steadfast in working
alongside scientists and consumers to move breast cancer research in
new directions. Unwilling to give up, she fought tirelessly until the
end of her life for a future free of breast cancer.
Carolina died last year from soft tissue sarcoma, a late side
effect of the radiation that was used to treat her breast cancer. She
once eloquently described the unique structure of the DOD BCRP:
``The Breast Cancer Research Program channels powerful synergy from
the collaboration of the best and brightest in the scientific world
with the primary stakeholder, the consumer, toward bold research
efforts aimed at ending breast cancer.''
No one was bolder than Carolina, who was fierce and determined in
her work on the DOD BCRP and in all aspects of life she led as a
dedicated breast cancer advocate, mother to a beautiful daughter, and
dear friend to so many. Carolina's legacy reminds us that breast cancer
is not just a struggle for scientists; it is a disease of the people.
The consumers who sit alongside the scientists at the vision setting,
peer review and programmatic review stages of the BCRP are there to
ensure that no one forgets the women who have died from this disease,
and the daughters they leave behind, and to keep the program focused on
its vision.
For many consumers, participation in the program is ``life
changing'' because of their ability to be involved in the process of
finding answers to this disease. In the words of one advocate:
``Participating in the peer review and programmatic review has been
an incredible experience. Working side by side with the scientists,
challenging the status quo and sharing excitement about new research
ideas . . . it is a breast cancer survivor's opportunity to make a
meaningful difference. I will be forever grateful to the advocates who
imagined this novel paradigm for research and continue to develop new
approaches to eradicate breast cancer in my granddaughters'
lifetime.''------Marlene McCarthy, two-time breast cancer ``thriver'',
Rhode Island Breast Cancer Coalition
Scientists who participate in the Program agree that working with
the advocates has changed the way they do science. Let me quote Greg
Hannon, the fiscal year 3010 DOD BCRP Integration Panel Chair:
``The most important aspect of being a part of the BCRP, for me,
has been the interaction with consumer advocates. They have currently
affected the way that I think about breast cancer, but they have also
impacted the way that I do science more generally. They are a constant
reminder that our goal should be to impact people's lives.''------Greg
Hannon, PhD, Cold Spring Harbor Laboratory
unique structure
The DOD BCRP uses a two-tiered review process for proposal
evaluation, with both steps including scientists as well as consumers.
The first tier is scientific peer review in which proposals are weighed
against established criteria for determining scientific merit. The
second tier is programmatic review conducted by the Integration Panel
(composed of scientists and consumers) that compares submissions across
areas and recommends proposals for funding based on scientific merit,
portfolio balance and relevance to program goals.
Scientific reviewers and other professionals participating in both
the peer review and the programmatic review process are selected for
their subject matter expertise. Consumer participants are recommended
by an organization and chosen on the basis of their experience,
training and recommendations.
The BCRP has the strictest conflict of interest policy of any
research funding program or institute. This policy has served it well
through the years. Its method for choosing peer and programmatic review
panels has produced a model that has been replicated by funding
entities around the world.
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 and consumers 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 to that mission of 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.
distinctive funding opportunities
The DOD BCRP research portfolio includes many different types of
projects, including support for innovative individuals and ideas,
impact on translating research from the bench to the bedside, and
training of breast cancer researchers.
Innovation
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. They
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. For example, in fiscal
year 2008, Dr. Mauro Ferrari of the University of Texas Health Science
Center at Houston was granted an Innovator Award to develop novel
vectors for the optimal delivery of individualized breast cancer
treatments. This is promising based on the astounding variability in
breast cancer tumors and the challenges presented in determining which
treatments will be most effective and how to deliver those treatments
to each individual patient. In fiscal year 2006, Dr. Gertraud
Maskarinec of the University of Hawaii received a synergistic IDEA
Award to study effectiveness of the Dual Energy X-Ray Absorptiometry
(DXA) as a method to evaluate breast cancer risks in women and young
girls.
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. Dr. Shiladitya Sengupta from Brigham and Women's
Hospital, Harvard Medical School, received a fiscal year 2006 Era of
Hope Scholar Award to explore new strategies in the treatment of breast
cancer that target both the tumor and the supporting network
surrounding it. In fiscal year 2007, Dr. Gene Bidwell of the University
of Mississippi Medical Center received an Era of Hope Postdoctoral
Award to study thermally targeted delivery of inhibitor peptides, which
is an underdeveloped strategy for cancer therapy.
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. 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 targets that are involved in the initiation and
progression of cancer.
These are just a few examples of innovative funding opportunities
at the DOD BCRP that are filling gaps in breast cancer research.
Translational Research
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 process by which the application of well-founded
laboratory or other pre-clinical insight result in 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 Multi Team 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 toward the eradication of breast cancer. Many
of these Teams are working on questions that will translate into direct
clinical applications. These Teams include the expertise of basic,
epidemiology and clinical researchers, as well as consumer advocates.
Training
The DOD BCRP is also cognizant of the need to invest in tomorrow's
breast cancer researchers. Dr. J. Chuck Harrell, Ph.D. at the
University of Colorado, Denver and the University of North Carolina at
Chapel Hill, for example, received a Predoctoral Traineeship Award to
investigate hormonal regulation of lymph node metastasis, the majority
of which retain estrogen receptors (ER) and/or progesterone receptors.
Through his research, Dr. Harrell determined that lymph node
microenvironment alters ER expression and function in the lymph nodes,
effecting tumor growth. These findings led Dr. Harrell to conduct
further research in the field of breast metastasis during his
postdoctoral work. Jim Hongjun of the Battelle Memorial Institute
received a postdoctoral award for the early detection of breast cancer
using post-translationally modified biomarkers.
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 2011.
outcomes and reviews of the dod bcrp
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.
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.
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 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 . . .''
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,
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 website http://
influence.stopbreastcancer.org/ to learn more about the exciting
research reported at the 2008 Era of Hope. The next Era of Hope meeting
is being planned for 2011.
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 causes of, 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.
Consumer advocates have worked hard over the years to keep this
program free of political influence. Often, specific institutions or
disgruntled scientists try to change the program though legislation,
pushing for funding for their specific research or institution, or try
to change the program in other ways, because they did not receive
funding through the process, one that is fair, transparent and
successful. The DOD BCRP has been successful for so many years because
of the experience and expertise of consumer involvement, and because of
the unique peer review and programmatic structure of the program. We
urge this Committee to protect the integrity of the important model
this program has become.
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 in a way to make a real difference 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 approach 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 and all
those who share in the mission to end breast cancer.
Chairman Inouye. Our final witness represents the Program
for Appropriate Technology in Health, Dr. John W. Boslego.
STATEMENT OF JOHN W. BOSLEGO, M.D., DIRECTOR, VACCINE
DEVELOPMENT GLOBAL PROGRAM, PROGRAM FOR
APPROPRIATE TECHNOLOGY IN HEALTH
Dr. Boslego. Good morning. My name is John Boslego. I am
the director of the Vaccine Development Global Program at PATH.
I would like to begin by thanking Chairman Inouye and
Ranking Member Cochran. I would also like to thank Senators
Patty Murray and Dick Durbin for their ongoing championship of
global health, and Senator Brownback for his leadership in
ensuring access for lifesaving tools for neglected diseases in
low-income countries.
PATH is an international nonprofit organization that
creates sustainable, culturally relevant solutions, enabling
communities worldwide to break longstanding cycles of poor
health. By collaborating with diverse public and private sector
partners, we help provide appropriate health technologies and
vital strategies that change the way people think and act.
We wish to take this opportunity to recognize the specific
and unique areas of expertise that the Department of Defense
brings to bear in advancing innovation that ensures that people
in low-resource settings have access to lifesaving
interventions and technologies.
The global health research effort of DOD responds to
diseases many Americans may never see up close, but which
military personnel stationed in the developing world experience
alongside local communities. PATH requests that in fiscal year
2011 the subcommittee provide robust support for DOD research
and development programs aimed at addressing health challenges,
particularly for military malaria vaccine research, as well as
research at the Defense Advanced Research Project Agency, or
DARPA.
For malaria vaccine, more than one-third of the world's
population is at risk of malaria, with approximately 250
million cases occurring every year. And most of the nearly 1
million deaths from malaria are among children in Africa under
the age of 5.
According to a 2006 IOM report, malaria has affected almost
all military deployments since the American civil war and
remains a severe ongoing threat. The same report noted that a
vaccine would be the best method of averting the threat of
malaria, given the likely increasing number of deployments to
high-risk areas.
Military researchers within the Military Infectious Disease
Research Program are at the forefront of efforts to develop a
malaria vaccine. One example of DOD's impact in malaria
research is the most promising vaccine candidate in existence
today, RTS,S. Research at the Walter Reed Army Institute of
Research contributed to the development of the vaccine
candidate, and early testing of RTS,S--created by
GlaxoSmithKline--was done in collaboration with the U.S.
military.
Today, thanks to an innovative partnership between GSK Bio
and PATH Malaria Vaccine Initiative--a PATH program that works
to accelerate development of malaria vaccines and ensure their
availability and accessibility in the developing world--RTS,S
is now in a large-scale phase 3 trial, typically the last stage
of testing prior to licensure. The U.S. Army is assisting in
this trial by supporting one of the field sites in Kenya.
Unfortunately, current funding levels are nowhere near what
is needed to develop urgently needed countermeasures against
malaria. PATH recommends $31.1 million in malaria R&D funding
for DOD in fiscal year 2011.
Another program making great contributions to health
research and development is DARPA. DARPA has identified as a
priority the development of health technologies that can help
both the U.S. military and be of use in DOD-sponsored
humanitarian and relief operations in regions emerging from
conflict.
One of the technologies pioneered by DARPA has led to
electrochemical generators of chlorine. PATH has partnered with
Cascade Design, Inc., on a new generation of smart
electrochlorinators that inactivates bacteria, viruses, and
some protozoa to create safe drinking water. The generators can
be powered by solar-charged batteries, making them accessible
to communities that do not have electricity infrastructure.
In conclusion, in light of the critical role that DOD plays
in global health research and development, we respectfully
request the subcommittee provide the resources to maintain this
important core capacity, including $31.1 million in malaria R&D
funding.
We thank you.
Chairman Inouye. I thank you very much, Doctor, and you may
be assured we will seriously consider your request.
Senator Cochran. Thank you very much.
I think malaria is one of those diseases that worldwide is
probably the most aggressive and probably causes more deaths
and illnesses than any other one malady. Is that right? Is that
an accurate assessment?
Dr. Boslego. Certainly, it is among the top killers,
particularly in Africa.
Senator Cochran. Well, thank you very much for reminding us
of this and your assistance to the subcommittee.
[The statement follows:]
Prepared Statement of John W. Boslego
PATH appreciates the opportunity to submit written testimony
regarding fiscal year 2011 funding for global health research and
development to the Senate Defense Appropriations Subcommittee. PATH is
an international nonprofit organization that creates sustainable,
culturally relevant solutions, enabling communities worldwide to break
longstanding cycles of poor health. By collaborating with diverse
public- and private-sector partners, we help provide appropriate health
technologies and vital strategies that change the way people think and
act.
We wish to take this opportunity to recognize the specific and
unique areas of expertise that the Department of Defense (DOD) brings
to bear in advancing innovation that ensures that people in low-
resource settings have access to life-saving interventions and
technologies. Through DOD, the U.S. Government is able to apply this
core capacity to improving health throughout the world.
The global health research efforts of DOD respond to diseases many
Americans may never see up close, but which military personnel
stationed in the developing world experience alongside local
communities. Medicines, vaccines, and diagnostics for health threats
that disproportionately affect the developing world are critical for
their protection. Health is also an important factor in global
stability and security. The heavy burden of disease in the developing
world hinders economic and social development, which in turn
perpetuates conditions that breed political instability. DOD health
research therefore benefits not only the U.S. military but also has the
potential to reduce this health burden, and by doing so, reduce the
likelihood of physical conflict.
PATH requests that in fiscal year 2011, the Subcommittee provide
robust support for DOD research and development programs aimed at
addressing these health challenges, particularly two important
programs. First, we request that the Subcommittee provide increased
support for military malaria vaccine development efforts. Second, we
request that the Subcommittee support research at the Defense Advanced
Research and Projects Agency (DARPA) aimed at delivering healthcare to
military personnel and civilians in remote, resource-poor, and unstable
locations. PATH also requests that no funding cuts be made to DOD
research and development.
Malaria and Vaccines
Malaria is a parasitic infection transmitted by mosquitoes. More
than one-third of the world's population is at risk of malaria, with
approximately 250 million cases occurring every year. Most of the
nearly 1 million annual deaths from malaria are among children in
Africa under the age of five. A malaria vaccine is desperately needed
to help prevent these deaths. While consistent use of effective
insecticides, insecticide-treated nets, and malaria medicines saves
lives, eradicating or even significantly reducing the impact of malaria
will require additional interventions, including vaccines. Immunization
is one of the most effective health interventions available. Just as it
was necessary to use vaccines to control polio and measles in the
United States, vaccines are needed as part of an effective control
strategy for malaria. Furthermore, vaccines are typically the most
efficient means of protecting military personnel from disease threats.
When troops are deployed, and particularly under combat conditions,
compliance with drug regimens or other disease-protection protocols can
be difficult, if not impossible. Vaccination, in contrast, can be
performed prior to deployment, and allows deployed personnel to remain
focused on mission success, rather than chemoprophylaxis, bed nets, or
insecticide application.
Malaria and the U.S. Military
A 2006 Institute of Medicine (IOM) report \1\ found that ``malaria
has affected almost all military deployments since the American Civil
War and remains a severe and ongoing threat.'' For this reason, the
military has historically taken an active and leading role in the
development of health technologies to protect military personnel from
malaria, or to treat them if they become infected with the disease.
This work includes a robust, cutting-edge program aimed at developing a
highly-efficacious malaria vaccine, suitable for use by military
personnel. The aforementioned IOM study noted ``the fact that a vaccine
would be the best method of averting the threat of malaria given the
likely increasing number of deployments to high-risk areas.'' An
effective vaccine would provide unparalleled protection to servicemen
and women serving in malaria-endemic countries and regions, and would
significantly reduce the impact of noncompliance, drug resistance, and
other significant obstacles that currently limit the military's ability
to provide protection from malaria. Military researchers within the
Military Infectious Disease Research Program, including the U.S. Army
Medical Research Institute of Infectious Diseases, U.S. Naval Medical
Research Center, and the Walter Reed Army Institute of Research
(WRAIR), are at the forefront of efforts to develop a malaria vaccine.
---------------------------------------------------------------------------
\1\ Battling Malaria--Strengthening the U.S. Military Malaria
Vaccine Program. National Academy of Sciences Press, Washington, D.C.
2006.
---------------------------------------------------------------------------
Research at WRAIR, for example, contributed to the development of
the most promising vaccine candidate in existence today, RTS,S. Early
testing of RTS,S--created by GlaxoSmithKline Biologicals (GSK Bio)--was
done in collaboration with the U.S. military. Today, thanks to an
innovative partnership between GSK Bio and the PATH Malaria Vaccine
Initiative (MVI)--a PATH program that works to accelerate the
development of malaria vaccines and ensure their availability and
accessibility in the developing world--RTS,S is now in a large-scale
Phase 3 trial, typically the last stage of testing prior to licensure.
Although the efficacy of RTS,S is unlikely to prove adequate for
military purposes--despite its potential benefit to young children in
Africa--it has shown that developing a vaccine against malaria is
possible and paved the way for other development efforts that could
ultimately allow the military to vaccinate men and women against
malaria before deploying them to endemic regions. Since its
establishment in 1999, MVI has partnered with the military in a number
of malaria vaccine development projects, including the preclinical
development of an adenovirus-vectored malaria vaccine candidate
developed by GenVec, Inc. that used a modified common cold virus to
deliver multiple malaria antigens.
Unfortunately, DOD spending on malaria research has been declining
for several years from levels that were already comparatively small
given the historic impact of malaria on overseas deployments. PATH
requests that the Subcommittee reverse this trend, and provide the
resources needed to develop the necessary tools--including vaccines--to
protect soldiers, sailors, airmen, and marines from this deadly and
debilitating disease threat. This would make possible a continuation of
the kind of collaboration--characterized by joint funding--that
currently exists between MVI and the U.S. Military Malaria Vaccine
Program. In particular, PATH recommends $31.1 million in malaria R&D
funding for DOD in fiscal year 2011.
DARPA and DTRA
The Defense Advanced Research Projects Agency (DARPA) is DOD's
primary research and development component and performs work on the
cutting edge of multiple scientific disciplines, providing a wide range
of critical new technologies and products for use by the military.
DARPA has made and could make additional contributions in one area it
has identified as a priority: developing health technologies that can
both help the U.S. military, and be of use in DOD-sponsored
humanitarian relief operations in regions emerging from conflict.
Military personnel operating in developing countries face many of the
same challenges to healthcare delivery as do the residents of those
countries: electricity and transportation interruptions that can
threaten the integrity of temperature-sensitive medicines and vaccines;
lack of access to trained medical personnel and facilities; and an
absence of infrastructures and technologies that allow for the rapid
manufacture and delivery of medicines and vaccines for the treatment of
unexpected infectious disease threats. Increased support for this
research would help the United States to more effectively assist
developing countries that need vaccines and other basic health
technologies, while ensuring that health products are delivered as
efficiently as possible.
DARPA's investments in austere healthcare delivery systems--through
their focus on disaster medicine in projects such as ``Real World,''
``Rapid Altitude Climatization,'' and ``SAVE II Ventilators''--
represent a commitment to interventions that could have positive and
profound health implications for populations in low-resource settings.
For example, DARPA pioneered technology that has led to electrochemical
generators of chlorine that may be able to fulfill a community's needs
for effective disinfectants for water or surfaces by using just salt
water and a simple battery source, such as a car or motorcycle battery.
The Smart Electrochlorinator provides a chlorine solution used to
treat water from a variety of sources, bringing safe water into small-
community households. The devices effectively inactivate bacteria,
viruses, and some protozoa to create safe drinking water. Since the
generators can be powered by solar-charged batteries, they are
accessible to communities that do not have an electricity
infrastructure. The only resources required are 75 g of table salt and
0.1 kWh per person per year, both potentially renewable. These costs
are significantly less than required for the current large-scale
community systems, resulting in break-even points that are within reach
of very poor, small communities. PATH has partnered with Cascade
Designs, Inc. on a new generation of smart electrochlorinator that has
the potential to expand the project initiated by DARPA to broader
community reach for both military and civilian benefit.
The Defense Threat Reduction Agency (DTRA) is also doing
groundbreaking work as it investigates innovations in vaccine and
chemical reagent thermo-stabilization and point of care diagnostic
tests for infectious diseases that has positive implications for global
health and U.S. military support in low-resource settings. Such
technologies will enable rapid pathogen identification in the field and
threat zone to more rapidly enlist targeted interventions. PATH
requests that the Subcommittee maintain funding for the DARPA and DTRA
research aimed at developing solutions to these and other health
challenges.
Conclusion
In light of the critical role that at DOD plays in global health
research and development, and the fact that investments in this area
have been falling, we respectfully request that the Subcommittee
provide the resources to maintain this important core capacity. We
thank you for your consideration, and hope that you will consider PATH
as a resource and partner on this issue.
ADDITIONAL SUBMITTED STATEMENTS
Chairman Inouye. On behalf of the subcommittee, I would
like to thank all of you, the witnesses, for the testimony
today.
The subcommittee has received some additional statements
which will be inserted into the record at this point.
[The statements follow:]
Prepared Statement of the American Museum of Natural History
Overview
Recognizing its potential to aid the Department of Defense in its
goal to support research to prepare for and respond to the full range
of threats, the American Museum of Natural History seeks in $3.5
million in fiscal year 2011 to contribute its unique resources to the
advancement of research in areas of science closely aligned with DOD's
research priorities and to extend the research effort with an
associated STEM (science, technology, engineering, mathematics)
education component, to help build a workforce adequate to meet the
nation's security needs.
About the American Museum of Natural History
The American Museum of Natural History (AMNH) is one of the
nation's preeminent institutions for scientific research and public
education. Since its founding in 1869, the Museum has pursued its
mission to ``discover, interpret, and disseminate--through scientific
research and education--knowledge about human cultures, the natural
world, and the universe.'' The AMNH research staff numbers over 200,
with tenure track faculty carrying out cutting-edge research in fields
ranging from molecular biology and genome science to earth and space
science, anthropology, and astrophysics. Museum scientists publish
nearly 450 scientific articles each year and enjoy a success rate in
competitive (peer reviewed) scientific grants that is approximately
double the national average. The work of its scientists forms the basis
for all the Museum's activities that seek to explain complex issues and
help people to understand the events and processes that created and
continue to shape the Earth, life and civilization on this planet, and
the universe beyond.
Advancing Research Aligned With National Security Goals
The Department of Defense (DOD) ensures the nation's security and
its capacity to understand and respond to threats in this new era of
complex defense challenges. DOD is committed to the research, tools,
and technology that will achieve these goals, and to ensuring that the
nation's 21st century science, technology, engineering, and mathematics
(STEM) workforce is prepared to meet U.S. preparedness and security
needs.
The American Museum of Natural History (AMNH), in turn, is a
preeminent research and public education institution, home to leading
research programs in biocomputation, comparative genomics, and the
life, physical, environmental, and social sciences--programs that are
positioned to advance the Nation's capacity to prepare for and respond
to security threats. AMNH is also a recognized leader in STEM
education--in both out-of-school settings and with formal education
partners--with local, regional, and national reach, and, with the
recently launched Richard Gilder Graduate School, became the first
American museum authorized to grant the Ph.D. degree.
In fiscal year 2005, AMNH and DOD launched a multi-faceted research
partnership via DARPA that leverages the Museum's unique expertise and
capacity. Since that time, AMNH has been carrying out research that
directly relates to DARPA goals by increasing our capacity to predict
where disease outbreaks might occur and to effectively monitor disease-
causing agents and their global spread. This research project has been
centered on the development of a computational system to rapidly
compare genetic sequences of pathogens, and, utilizing the
computational system, generating a global map showing the spread of
disease-causing viruses over time and place.
Throughout this partnership, DARPA program managers have supported
AMNH's work, have made the research known to other DOD-supported
scientists, and have invited AMNH scientists to participate in DARPA
conferences. With DARPA support to date, the project has: advanced
understanding of emerging infectious disease through the analysis of
the origins and genomic evolution of SARS coronavirus; studied re-
assortment and drug resistance among influenza strains; and developed
methods for mapping the spread of pathogens over time and geography. We
are now able to track global evolution of pathogenic viruses such as
avian influenza, and can identify, for any geographic region, the major
and minor sources of pathogenic viruses. The research has investigated
progressively more complex systems, moving from viruses to the study of
bacteria, including ecological data into the realm of biogeographical
and host-pathogen research.
In fiscal year 2011, the Museum seeks DARPA support to advance its
research in this and other high-priority areas for the Agency, and to
enhance the research program with an associated STEM education
component, providing diverse urban students with science content,
research experiences, and mentoring in the project's STEM areas. In so
doing, AMNH hopes to help meet the need for a well-educated population
of college-level graduates in STEM fields. With this support, which
AMNH will leverage with funds from non-Federal and Federal sources,
AMNH will be able to continue to draw on its unique research, training,
and education capabilities to advance goals critical to DOD and our
national preparedness and security.
______
Prepared Statement of Florida State University
Summary: Florida State University is requesting $5,500,000 from the
Research, Development, Test and Evaluation, Navy, Force Protection
Applied Research (PE# 0602123N, Line 5) for the Integration of Electo-
kinetic Weapons into the Next Generation Navy Ships Program; $4,000,000
from the Defense, Research, Development, Test and Evaluation, Defense-
wide, Government/Industry Co-Sponsorship of University Research (PE#
0601111D8Z, Line 3) for the Integrated Cryo-cooled High Power Density
Systems; $3,800,000 from the Research, Development, Test and
Evaluation, Navy, Defense Research Sciences (PE# 0601153N, Line 3), for
the Jet Engine Noise: Understanding and Reduction program, and
$4,500,000 from the Research, Development, Test and Evaluation, Army
University and Industry Research Centers Program (PE# 0601104A, Line 4)
for the Nanotubes Optimized for Lightweight Exceptional Strength
(NOLES)/Composite Material Program.
Mr. Chairman, I would like to thank you and the Members of the
Subcommittee for this opportunity to present testimony before this
Committee. I would like to take a moment to briefly acquaint you with
Florida State University.
Located in Tallahassee, Florida's capitol, FSU is a comprehensive
Research university with a rapidly growing research base. The
University serves as a center for advanced graduate and professional
studies, exemplary research, and top-quality undergraduate programs.
Faculty members at FSU maintain a strong commitment to quality in
teaching, to performance of research and creative activities, and have
a strong commitment to public service. Among the current or former
faculty are numerous recipients of national and international honors
including Nobel laureates, Pulitzer Prize winners, and several members
of the National Academy of Sciences. Our scientists and engineers do
excellent research, have strong interdisciplinary interests, and often
work closely with industrial partners in the commercialization of the
results of their research. Florida State University had over $200
million this past year in sponsored research awards.
Florida State University attracts students from every state in the
nation and more than 100 foreign countries. The University is committed
to high admission standards that ensure quality in its student body,
which currently includes National Merit and National Achievement
Scholars, Rhodes and Goldwater Scholars, as well as students with
superior creative talent. Since 2005, FSU students have won more than
30 nationally competitive scholarships and fellowships including 3
Rhodes Scholarships, 2 Truman Scholarships, Goldwater, and 18 Fulbright
Fellowships.
At Florida State University, we are very proud of our successes as
well as our emerging reputation as one of the nation's top public
research universities. Our new President, Dr. Eric Barron, will lead
FSU to new heights during his tenure.
Mr. Chairman, let me summarize our primary interest today. The
first project involves improving our nation's fighting capabilities and
is called the Integration of Electro-kinetic Weapons into the Next
Generation Navy Ships Project.
The U.S. Navy is developing the next-generation integrated power
system (NGIPS) for future war ships that have an all-electric platform
of propulsion and weapon loads and electric power systems with rapid
reconfigurable distribution systems for integrated fight-through power
(IFTPS). On-demand delivery of the large amounts of energy needed to
operate these types of nonlinear dynamic loads raises issues that must
be addressed including the appropriate topology for the ship electric
distribution system for rapid reconfiguration to battle readiness and
the energy supply technology for the various nonlinear dynamic load
systems. The goal of this initiative is to investigate the energy
delivery technologies for nonlinear dynamic loads, such as electro-
kinetic weapons systems, and investigate the integration and interface
issues of these loads on the ship NGIPS through system simulations and
prototype tests using power hardware-in-the loop strategies. To meet
these research goals, the FSU facilities will be expanded with a 5 MW
MVDC power converter and upgrade of the large scale real-time
simulator. The results of this effort will provide the Navy's ship-
builders with vital information to design and de-risk deployable ship
NGIPS and load power supplies.
With significant support from the Office of Naval Research (ONR),
FSU has established the Center for Advanced Power Systems (CAPS), which
has integrated a real time digital power system simulation and modeling
capability and hardware test-bed, capable of testing IPS power system
components at ratings up to 5MW, offering unique hardware-in-the-loop
simulation capabilities unavailable anywhere in the world. FSU is
partnering with Florida Atlantic University, Florida International
University, and General Atomics to combine the best talents for
modeling and simulation of ship power systems, hardware-in-the-loop
testing, power supplies for present and future electro-kinetic systems,
and interfacing of the weapon to a ship power system. General Atomics
will provide the power requirements for the weapons interface to the
shipboard power distribution system. The National High Magnetic Field
Laboratory (NHMFL) will utilize its research expertise and
infrastructure for the proposed development. NAVSEA will be an advisor
to the project for weapon system integration. We are requesting
$5,500,000 for this important program.
Our second project is also important to our nation's defense and
involves our Integrated Cryo-cooled High Power Density Systems program.
The objective of this program is to approach the goal of achieving high
power densities through systems integration, management of heat
generation and removal in the electrical system and minimize energy
consumption and capital expenditures of large scale advanced power
systems through cryo-cooled superconducting systems. The research
activities are as follows:
Systems Analysis.--Extensive system modeling and simulation of the
integrated electrical and thermal systems to understand dynamic
performance under normal and adverse conditions is necessary to achieve
an optimal system configuration. Develop prototypes of key technologies
and test in hardware-in-the-loop simulations at levels of several
megawatts (MW) to validate and demonstrate the advanced technologies.
Materials--Advanced Conductors, Semi-conductors and Insulation.--
Characterization of conductor materials (both normal and
superconducting), semi-conductors (for use in power electronic
components) and insulating materials (both thermal and electrical) at
cryogenic temperatures to obtain the data needed to model system
performance and design components for medium voltage dc (MVDC).
Cryo-thermal Systems.--Optimize thermal system options, including
conductive heat transfer and gas phase and fluid phase heat transfer
systems. Modeling to understand effects from heat leaks from the
ambient to the low temperature environment and internal heat generation
are critical to successful performance. Adaptability to economical
fabrication technologies is a major issue for investigation.
System Components.--Consider new concepts for design of system
components and interfaces to achieve optimum system integration. A 30
meter, 10KV DC cable based on 2G HTS wire will be designed, fabricated
and tested to prove the concept of a MVDC superconducting shipboard
power distribution system and provide validated design parameters to
the Navy. NAVSEA will be a scientific adviser to the project.
We are seeking $4,000,000 for this important program in fiscal year
2011.
Third, I would like to tell you about our Jet Engine Noise:
Understanding and Reduction Program. Engine noise from most modern
tactical aircraft is dominated by the jet noise due to the exhaust of
very high-speed (supersonic in most cases) gases from the jet engines;
this portion of the noise is often referred to as jet noise. Noise
levels in the vicinities of these aircraft are extremely high--often as
high as 150 dB. This poses considerable risk to the health and safety
of the personnel on carrier decks or near aircraft runways. These very
high noise levels are also a problem due to their impact on the
communities near military bases. If not properly addressed, the jet
noise issue will continue to worsen since the noise footprint of future
aircraft will likely be much higher due to higher exhaust velocities
from their engines. Recently, the Naval Research Advisory Committee
(NARC) released a report identifying aircraft exhaust noise as a major
problem that requires immediate attention.
Under this proposal, FSU proposes a comprehensive program with the
short- and long-term goals of (a) developing jet noise suppression
technologies that can be retrofitted in the current aircraft fleet; (b)
undertaking a sustained research effort to better understanding the jet
noise sources and fundamentals which will lead to the development of
reduction capacities; and (c) to improve noise suppression technologies
that will become an integral part of the propulsion systems in future
aircraft.
This will be achieved by leveraging our significant and unique
resources and expertise in the study of jet noise and control.
Leveraging resources provided by this program by the State of Florida,
FSU will make appropriate improvements to our test and diagnostic
facilities to provide the needed fundamental understanding for
controlling jet noise. We will use our considerable expertise in Active
Flow and Noise Control to rapidly develop and test many of the
promising noise control concepts; maturing, then transitioning to the
field, the most practical and promising ones. Our team has significant
expertise in both the study and control of jet noise and collectively
represents some of the best scientists and engineers presently working
in this area. Given the interdisciplinary nature of this problem, we
are ideally suited to making a notable impact in solving the jet noise
suppression problem. We are asking for $3,800,000 to initiate this
vital program.
Our final project involves Nanotubes Optimized for Lightweight
Exceptional Strength (NOLES) Composite Materials. The U.S. Army's
objective of developing effective personnel protection and a lighter,
stronger fleet of fighting vehicles may be achieved through the
diminutive nanotubes that (1) are the strongest fiber known, (2) have a
thermal conductivity two times higher than pure diamond, and (3) have
unique electrical conductivity properties and an ultra-high current
carrying capacity. For producing lightweight multifunctional
composites, resins impregnated with nanotubes hold the promise of
creating structures, which will be the strongest ever known, and hence
offer maximum personnel and vehicle protection. Benefits are apparent
not only to defense, but also throughout the commercial world.
Partnered with the Army Research Laboratory, FSU's team of multi-
disciplinary faculty and students has developed unique design,
characterization and rapid prototyping capabilities in the field of
nano-composite research, leading to vital defense applications. The
NOLES research team is developing high performance thermal management
materials utilizing nanotubes. The NOLES team is using nanotube
composites for shielding against electromagnetic interference. Also,
FSU's composites are being tested for missile wings, UAVs and missile
guidance systems by various defense contractors.
Three core programs are envisioned for fiscal year 2011: (1)
innovative lightweight personnel protection based on integrating
cutting-edge technology and commercially available, proven materials
for enhanced safety and security of war fighters; (2) developing
nanotubes as a material platform and supporting manufacturing processes
for a new generation of devices and structures, giving special
attention to the design and demonstration for Army and defense
applications; and (3) utilizing nanotube buckypaper and optically
transparent nanotube thin films initially for liquid crystal display
backlighting and eventually for flexible displays. We are seeking
$4,500,000 to continue this program in fiscal year 2011.
Mr. Chairman, we believe this research is vitally important to our
country and would greatly appreciate your support.
______
Prepared Statement of the Interstitial Cystitis Association
Chairman Inouye, Ranking Member Cochran, and distinguished members
of the Subcommittee, thank you for the opportunity to discuss
Interstitial Cystitis (IC) and to share my story to the Subcommittee.
My name is Lauren Snyder, and I am a 29-year-old special needs teacher
from Haddon Township, New Jersey. I am also a volunteer with the
Interstitial Cystitis Association (ICA), the nation's foremost
nonprofit organization dedicated to improving the quality of life for
people living with IC. The ICA provides advocacy, research funding, and
education to ensure early diagnosis and optimal care with dignity for
people affected by IC. Until the biomedical research community
discovers a cure for IC, our primary goal remains the discovery of more
efficient and effective treatments to help patients live with the
disease.
IC is a chronic condition characterized by recurring pain,
pressure, and discomfort in the bladder and pelvic region. The
condition is often associated with urinary frequency and urgency,
although this is not a universal symptom. The cause of IC is unknown.
Diagnosis is made only after excluding other urinary and bladder
conditions, possibly causing one or more years delay between onset of
symptoms and treatment. Men suffering from IC are often misdiagnosed
with bladder infections and chronic prostatitis. Women are frequently
misdiagnosed with endometriosis, inflammatory bowel disease (IBD),
irritable bowel syndrome (IBS), vulvodynia, and fibromyalgia, which
commonly co-occur with IC. When healthcare providers are not properly
educated about IC, patients may suffer for years before receiving an
accurate diagnosis and appropriate treatment.
Although IC is considered a ``women's disease'', scientific
evidence shows that all demographic groups are affected by IC. Women,
men, and children of all ages, ethnicities, and socioeconomic
backgrounds develop IC, although it is most commonly found in women.
Recent prevalence data reports that 3 to 8 million American women and 1
to 4 million American men suffer from IC. Using the most conservative
estimates, at least one out of every 77 Americans suffer from IC, and
further study may indicate prevalence rates as high as 1 out of every
28 people. Based on this information, IC affects more people than
breast cancer, Alzheimer's diseases, and autism combined.
The effects of IC are pervasive and insidious, damaging work life
and productivity, psychological well-being, personal relationships, and
general health. Quality of life (QoL) studies have found that the
impact of IC can equal the severity of rheumatoid arthritis and end-
stage renal disease. Health-related QoL in women with IC is worse than
in women with endometriosis, vulvodynia, or overactive bladder alone.
IC patients have significantly more sleep dysfunction, higher rates of
depression, increased catastrophizing, anxiety and sexual dysfunction.
After sustaining permanent damage to my gastrointestinal tract as
the result of salmonella poisoning and developing pelvic floor
dysfunction, I underwent a number of surgical procedures that revealed
the extent of damage to my bladder. After other conditions were ruled
out, I finally received the diagnosis of IC and was able to begin
meaning and appropriate treatment. In addition to medications, I
receive Botox injections into my pelvic floor, as well as bladder
instillations. In my case, these treatments, as well as the multiple
surgeries I have undergone, require general anesthesia,
hospitalization, and extended recovery time, causing me to miss work
and other activities. As a person living with a disability, my work
with special needs children is particularly rewarding. Unfortunately,
my job requires bending, lifting, and repositioning my students, which
is painful and challenging with my IC symptoms. In addition to
teaching, I am also a swimming coach, but I have had to reduce my hours
as extended exposure to the chlorine in the pool aggravates my bladder.
Although IC research is currently conducted through a number of
Federal entities, including the National Institutes of Health (NIH) and
the Centers for Disease Control and Prevention (CDC), the DOD's Peer-
Reviewed Medical Research Program (PRMRP) remains essential. The PRMRP
is an indispensable resource for studying emerging areas in IC
research, such as prevalence in men, the role of environmental
conditions such as diet in development and diagnosis, barriers to
treatment, and IC awareness within the medical military community.
Specifically, IC education and awareness among military medical
professionals takes on heightened importance, as the President's fiscal
year 2011 budget request does not include renewed funding for the CDC's
IC Education and Awareness Program.
On behalf of the ICA, and as an IC patient, I would like to thank
the Subcommittee for including IC as a condition eligible for study
under the DOD's PRMRP in the fiscal year 2010 DOD Appropriations bill.
The scientific community showed great interest in the program,
responding to the initial grant announcement with an immense outpouring
of proposals. We urge Congress to maintain IC's eligibility in the
PRMRP in the fiscal year 2011 DOD Appropriations bill, as the number of
current military members, family members, and veterans affected by IC
increases alongside the general population.
CONCLUSION OF HEARINGS
Chairman Inouye. This subcommittee will take these issues
under serious consideration as we develop our fiscal year 2011
Defense appropriations bill, and this concludes our scheduled
hearings for the fiscal year 2011 defense budget.
And accordingly, the subcommittee will stand in recess,
subject to the call of the Chair.
[Whereupon, at 11:56 a.m., Wednesday, June 23, the hearings
were concluded, and the subcommittee was recessed, to reconvene
subject to the call of the Chair.]