[Senate Hearing 112-]
[From the U.S. Government Publishing Office]
DEPARTMENT OF DEFENSE APPROPRIATIONS FOR FISCAL YEAR 2013
----------
WEDNESDAY, JUNE 6, 2012
U.S. Senate,
Committee on Appropriations,
Washington, DC.
The subcommittee met at 10:03 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 our witnesses this
morning to the Department of Defense subcommittee to receive
public testimony pertaining to various issues related to the
fiscal year 2013 Department of Defense (DOD) appropriations
request. Due to the number of witnesses who wish to present
testimony this morning, I'd like to remind each witness that
they will be limited to no more than 4 minutes. However, your
full statements will be made part of the official record, and I
look forward to hearing from each of you today on the many
important and serious subjects that you will address.
But before I do, I'd like to recognize the Vice Chairman of
the Committee, Senator Cochran, for any comments he may wish to
make.
STATEMENT OF SENATOR THAD COCHRAN
Senator Cochran. Mr. Chairman, I'm pleased to join you in
welcoming our witnesses to the hearing today reviewing the
fiscal year 2013 DOD request for appropriations. We appreciate
the witnesses' interest in the subject and we look forward to
hearing your testimony and hearing from each one of you.
Thank you.
Chairman Inouye. Our first witness represents the Air Force
Sergeants Association (AFSA), former Command Master Sergeant
John R. ``Doc'' McCauslin.
STATEMENT OF CHIEF MASTER SERGEANT JOHN R. ``DOC''
McCAUSLIN, U.S. AIR FORCE (RETIRED), CHIEF
EXECUTIVE OFFICER, AIR FORCE SERGEANTS
ASSOCIATION
Sergeant McCauslin. Chairman Inouye, Ranking Member
Cochran, and distinguished members of the Department of Defense
subcommittee: On behalf of the 110,000 members of the Air Force
Sergeants Association, thank you for this opportunity to
present the views of our members on the military personnel
programs that affect those serving and who have served our
Nation. Your continuing efforts toward improving the quality of
lives have certainly made a real difference.
In the interest of time, I will briefly touch on four
specific funding goals for this subcommittee. Those goals are:
military pay; healthcare; Survivor Benefit Plan (SBP)
Dependency and Indemnity Compensation (DIC); and Guard and
Reserve GI Bill. Three others of great importance to us--
tuition assistance, final pay, and sequestration-were covered
in my written testimony to you.
Thanks to the great work of your subcommittee, the Congress
has made significant strides to restore military pay
comparability over these past 12 years, including a statutory
change that explicitly ties military pay raises to the
Employment Cost Index growth. Past history has regularly and
consistently demonstrated that significant problems occur when
those pay and benefits are reduced or eliminated.
The very top of all discussion about earned benefits is
TRICARE. Healthcare and the immediate receipt of retirement pay
are the only incentives that DOD can offer to entice someone to
volunteer 20 or more years of their youth to our Nation just to
be eligible. Despite acknowledging this long-term commitment,
DOD again re-introduced plans, rejected by the Congress in the
past, to force military dependents and retirees to either pay
more for their healthcare coverage or to opt out of TRICARE
entirely.
AFSA considers it a supreme breach of faith to force those
who serve to sacrifice even more. It denigrates the years of
up-front service and the unlimited liability required of career
military and their families. And if breaking faith with those
currently serving is wrong, so is imposing a major bait-and-
switch change on those who already completed a 20- or 30-year
career induced by promises of current benefits.
Recent public statements speak to the conundrum we
presently think of. President Obama has said, ``As a Nation,
we're facing tough choices as we put our fiscal house in order.
But I want to be absolutely clear: We cannot and we must not
balance the budget on the backs of our veterans.'' All of our
military retirees are those veterans.
An appropriate quote by Senator Jim Webb recently was,
``You can't renegotiate the front end once the back end is
done. This is an obligation that has been made to people whose
military careers are now done.'' Senator Webb understands that
very few join the military intent on making it a career.
I am pleased to note that the 2013 National Defense
Authorization Act approved by the Senate Armed Services
Committee 2 weeks ago rejects many of those planned increases
and the bill now awaits action on your Senate floor. I urge you
to support their efforts with the necessary appropriation.
AFSA endorses the view that surviving spouses with military
survivor benefit plan annuities should be able to concurrently
receive earned SBP benefits and DIC payments related to their
sponsor's service-connected death. We would like to thank
Senator Bill Nelson for introducing S. 260 and the 50 Senators
who have co-sponsored this important repeal legislation.
Arguably, the best piece of legislation ever passed by the
Congress, and thanks to the efforts of many of you here, the
Post-9/11 GI Bill, is providing unprecedented educational
opportunities for thousands of men and women who served in
uniform since 9/11. Regrettably, benefits for joining the
Selective Reserve were not included in that bill. AFSA strongly
recommends the Congress work to restore basic Reserve
Montgomery GI Bill benefits to the historic benchmark of 47 to
50 percent of active-duty benefits. In conclusion, on behalf of
all AFSA members, we appreciate your efforts and, as always,
we're ready to support you in matters of mutual concern.
PREPARED STATEMENT
AFSA contends that it is of paramount importance for a
Nation to provide quality healthcare and top-notch benefits in
exchange for the devotion, sacrifice, and service of our
military members. To quote Bob Woodward from his book ``The War
Within'', ``Those who serve and their families are the
surrogates of all Americans. They bear the risk and strain of a
year or more in a foreign land. So many have spent their youth
and spilled their blood in a fight far from home. What do we
owe them? Everything. And what do we give them? Much less than
they deserve.''
[The statement follows:]
Prepared Statement of Chief Master Sergeant John R. ``Doc'' McCauslin
Chairman Inouye, Ranking Member Cochran, and distinguished members
of the Department of Defense subcommittee: On behalf of the 110,000
members of the Air Force Sergeants Association (AFSA), thank you for
this opportunity to present the views of our members on the military
personnel programs that affect those serving (and who have served) our
Nation. This hearing will address issues critical to those serving and
who have served our Nation.
Your continuing efforts toward improving the quality of their lives
have made a real difference, and our members are grateful. In this
statement, I have identified specific funding goals we hope this
subcommittee will consider for fiscal year 2013 on behalf of current
and past enlisted members and their families. AFSA represents Active
Duty, Guard, Reserve, retired, and veteran enlisted Air Force members
and their families. The content of this statement reflects the views of
our members as they have communicated them to us. As always, we are
prepared to present more details and to discuss these issues with your
staffs.
proposed fiscal year 2013 funding
The administration requested $525.4 billion for Department of
Defense (DOD) base budget for fiscal year 2013, a $5.2 billion or 1-
percent reduction from this year's spending level. We understand a plan
recently approved by the House Appropriations Committee provides an
increase of $1.1 billion more than the fiscal year 2012 level and $3.1
billion more than the President's request. AFSA encourages you to
follow their lead to ensure the Department has sufficient funds to meet
the needs of our Nation's defense.
military pay raises
Thanks to the great work of this subcommittee. The Congress has
made great strides to restore military pay comparability over the past
12 years, including a statutory change that explicitly ties military
pay raises to Employment Cost Index (ECI) growth. The current formula
provides military servicemembers with a 1.7-percent pay raise in fiscal
year 2013, and we urge you to set aside the necessary funding to make
certain this is so. That said, we are very concerned that the
administration plans break the tie to civilian pay growth in future
years by limiting military raises to 0.5 percent, 1 percent, and 1.5
percent for 2015, 2016, and 2017, respectively. Past history has
clearly shown that significant retention problems will occur when pay
and benefits are reduced or eliminated. Recent calls to cut back on
military raises, create a new comparability standard or substitute more
bonuses for pay raises in the interests of deficit reduction are
exceptionally short-sighted in view of the extensive negative
experience with military pay raise caps. AFSA urges the subcommittee to
fully fund these important pay increases not just this year, but in
future years, based on the ECI as specified in current law.
sequestration
Our members are deeply concerned with the prospect of sequestration
and how it could undermine proper defense funding in the coming years.
As a result of the Budget Control Act of 2011, DOD now faces the
specter of another $500 billion in defense cuts beyond $490 billion in
reductions previously agreed to. That is, of course, unless the
Congress intervenes. Military leaders from the top down have made it
quite clear that an additional $500 billion of cuts would do
catastrophic damage to our military, hollow out the force, and degrade
its ability to protect the country. America's military strength exists
to secure the blessings of ordered liberty for the American people. We
sincerely hope Members of Congress can find an alternative to punitive
reductions mandated by sequestration which would force across-the-board
cuts to defense programs including pay and benefits which would
threaten the future viability of the all-volunteer force. Less than 1
percent of the population is shouldering 100 percent of the burden of
maintaining our national security, and we hope you will act soon so
they won't be left wondering when, or if, the rug will be pulled out
from underneath them.
retirement benefits
The administration's proposed fiscal year 2013 budget called for
the creation of a base realignment and closure-like panel that will
review current military compensation and recommend changes (most likely
reductions) for the Congress to consider. The commission is to be
formulated on the premise that the groups agreed upon plan must save
DOD money. Instead of approaching the subject with discussion on what
is the Nation's obligation to those who serve, the administration plans
to use a formula that lays out a predetermined result. We believe those
who serve and have served in uniform deserve better. Senior military
leaders often speak of the importance of ``Keeping the faith'' with
military members, particularly where earned benefits are concerned--
benefits like retired pay and healthcare. Right now, airmen are asking,
``Where is the faith?'' And they are looking to you, the Members of
Congress, to provide that answer. ``Passing the buck'' to
servicemembers instead fulfilling promised benefits will only serve to
undermine long-term retention and readiness. Much of the success of the
all-volunteer force can be directly attributed to the benefits we
provide military members in return for their service and sacrifice. Not
just them, but their families, too. Do we want to risk this? I urge you
to resist any plan that reduces pay and benefits and fully fund the
existing systems that have directly contributed to the extraordinary
success of the all-volunteer force for nearly four decades.
tricare
No military personnel issues is more sacrosanct than pay and
benefits, which is why healthcare is such a sensitive subject. It and
the immediate receipt of retirement pay are the only incentives DOD can
offer to entice someone to first volunteer 20 or more years of their
youth to the Nation just to be eligible. Yet, despite acknowledging
this long-term commitment, DOD again reintroduced plans--rejected by
the Congress in the past--to force military dependents and retirees to
either pay more for their healthcare coverage or to opt out of TRICARE
entirely. Specifically, the department proposes to raise beneficiary
costs by:
--raising annual fees by as much as $2,000 or more for retired
families younger than age 65;
--establishing new annual enrollment fees of up to $950 for retired
couples older than age 65;
--imposing ``means testing'' of military retiree health benefits
based on their retired income--something no other Federal
program does;
--dramatically increasing pharmacy co-pays to approach or surpass the
median of current civilian plans; and
--tying future annual increases to an unspecified health cost index
estimated to average more than 6 percent each year.
In announcing these so-called ``modest'' proposals, DOD leaders
stressed their intent to ``keep faith with currently serving troops''
by avoiding any retirement changes that would affect the current force.
But their concept of ``keeping faith on retirement'' apparently doesn't
extend to retirement healthcare benefits, as the proposed changes would
affect any currently serving member who retires the day after they were
implemented. Further, the proposed pharmacy changes would affect
hundreds of thousands of currently serving Guard/Reserve members and
families, as well as the family members of currently serving personnel
who don't have access to military pharmacies.
Modest increases? How could raising out-of pocket healthcare costs
$2,000 annually or increasing pharmacy copays up to 375 percent be
considered modest? And I remind the members of this panel that our more
senior retirees, those in TRICARE for Life, are already required to
participate in Medicare Part B in order to retain their earned
healthcare coverage.
AFSA regards all efforts to force those who serve and sacrifice the
most, to sacrifice even more, as a supreme breach of faith. It
denigrates the years of upfront service and sacrifice required of
career military and their families, plus these anti-people proposals
will be perceived very negatively by future generations, who may
consider civilian employment far more rewarding and safer than military
service. And if breaking faith with the currently serving is wrong, so
is imposing a major ``bait and switch'' change on those who already
completed 20-30 year careers, induced by promises of current benefits.
At a recent hearing to examine the administration's proposed fee
hike, Senator Jim Webb (D-VA) accurately observed, ``You can't
renegotiate the front end once the back end is done. This is an
obligation that has been made to people whose military careers are now
done.'' Senator Webb understands few join the military intent on making
it a career which involves multiple moves and hazardous deployments,
their children constantly uprooted from schools and spouses from career
opportunities, virtually zero in home ownership equity, and upon
military retirement, potential age discrimination entering the civilian
marketplace. In fact, only 8.5 percent of those who serve in the
military ever reach retirement, a percentage derived by dividing DOD's
1.9 million retirees by the Department of Veterans Affairs' (VA) 22.2
million veterans--a percentage that is even less if medical retirees
are excluded.
Like Senator Webb, our greatest concern is that the continued
erosion of pay and benefits could lead to the end of a professionally
led, all-volunteer military that for 39 years and more than a decade of
nonstop war has served the American public extremely well. We hope you
believe likewise, and will fully fund the military healthcare system.
Other healthcare issues included in our priorities are listed
below. Funding for each of these issues is encouraged, and we would be
happy to provide additional information if requested:
--exempt those military retirees who entered service prior to
December 7, 1956, from the obligation of Medicare Part B
payments;
--oppose the various recommendations for retirees aged 38-64 to seek
healthcare coverage from somewhere else besides TRICARE;
--include Applied Behavior Analysis (ABA) therapy as part of regular
TRICARE coverage; and
--establish a full optometry benefit for military retirees.
tuition assistance
The discretionary Air Force Tuition Assistance program is an
important quality of life program that provides tuition and fees for
courses taken by Active-Duty personnel. The program is one of the most
frequent reasons given for enlisting and re-enlisting in the Air Force,
and we urge full funding for this program.
family readiness and support
A fully funded, robust family readiness program is crucial to
military readiness, and especially appropriate given the continuing
demands of deployments and the uncertainty of the legacy of the effects
11 years of war have had on servicemembers and their families. AFSA
urges the subcommittee to continue much-needed supplemental funding
authority to schools impacted by large populations of military students
(Impact Aid), fully fund effective family readiness programs, and
support the child care needs of our highly deployable force.
military resale system
AFSA strongly believes military commissary, exchange and Morale
Welfare and Recreation programs contribute significantly to a strong
national defense by sustaining morale and quality of life for military
beneficiaries both within the United States and around the globe. In
surveys looking at the benefits of service, military servicemembers
often cite access to the commissary and exchange as one of their top
five benefits. With this in mind, we urge this subcommittee to resist
initiatives to civilianize or consolidate DOD resale systems in any way
that would reduce their value to patrons. AFSA instead urges a thorough
review of the findings of an extensive and costly ($17 million)
multiyear study that found consolidation is not a cost-effective
approach to running these important systems.
retiree/survivor issues
Concurrent Receipt.--AFSA continues its advocacy for legislation
that provides concurrent receipt of military retired pay and veterans'
disability compensation for all disabled retirees without offset. Under
current statues, retirees with 50 percent or greater disabilities will
receive their full-retired pay and VA disability in fiscal year 2014.
The Congress should now focus on eliminating this unjust offset for
veterans with lesser disabilities and in particular, individuals who
were medically retired with less than 20 years of service due to a
service-connected illness or injury. They are not treated equally.
Age-57 Dependency and Indemnity Compensation (DIC) Remarriage.--
AFSA commends Members of Congress for previous legislation, which
allowed retention of DIC, burial entitlements, and VA home loan
eligibility for surviving spouses who remarry after age 57. However, we
strongly recommend the age-57 DIC remarriage provision be reduced to
age 55 to make it consistent with all other Federal survivor benefit
programs.
Repeal Survivor Benefit Plan (SBP)/DIC Offset.--We endorse the view
that surviving spouses with military SBP annuities should be able to
concurrently receive earned SBP benefits and DIC payments related to
their sponsor's service-connected death. We would like to thank Senator
Bill Nelson (D-FL) for introducing S. 260 and the 50 Senators who have
co-sponsored this important legislation to repeal the SBP-DIC offset.
Despite budgetary difficulties, we sincerely hope the Congress will
find the funding to eliminate this unfair offset.
Retention of Final Paycheck.--Current regulations require survivors
of deceased military retirees to return any retirement payment received
in the month the retiree passes away or any subsequent month
thereafter. Once a retirees passes, the Defense Finance and Accounting
Service stops payment on the retirement account, recalculates the final
payment to cover only the days in the month the retiree was alive, and
then forwards a check for those days to the surviving spouse.
Understandably, this practice can have an adverse impact on the
surviving spouse. When the retirement pay is deposited, they use those
funds to make payment on items such as mortgages, medical expenses, or
other living expenses. Automatically withdrawing those funds can
inadvertently cause essential payments to bounce and places great
financial strain on a beneficiary already faced with the prospect of
additional costs associated with their loved one's death. AFSA strongly
encourages this subcommittee to appropriate the funds necessary to
bring an end to this abhorrent practice.
guard and reserve issues
Reduce the Earliest Guard and Reserve Retirement Compensation Age
From 60 to 55.--Legislation was introduced during the last Congress to
provide a more equitable retirement for the men and women serving in
the Guard and Reserves. The proposed legislation would have reduced the
age for receipt of retirement pay for Guard and Reserve retirees from
60 to 55. Active-Duty members draw retirement pay the day after they
retire. Yet, Guard and Reserve retirees currently have to wait until
they reach age 60 before they can draw retirement pay. Although
legislation addressing this issue does not exist in the 112th Congress,
we urge the members of this subcommittee to support it when and if it
is reintroduced.
Reduction of Retirement Age Due to Title 10 Service.--A provision
in the fiscal year 2008 National Defense Authorization Act reduces the
Reserve component retirement age requirement by 3 months for each
cumulative 90 days ordered to Active Duty. However, this provision only
credits active service since January 28, 2008, so it disenfranchises
and devalues the service of hundreds of thousands of Guard and Reserve
members who served combat tours (multiple tours, in thousands of cases)
between 2001 and 2008. These contributions to national security are
further demeaned by language that specifies eligible service must fall
within a given fiscal year (e.g., a reservist receives no credit for a
90-day tour that began in August and ended in November because the
period of service spanned 2 fiscal years).
AFSA supports full funding of initiatives that eliminate the fiscal
year limitation and authorizes early retirement credit for all Guard
and Reserve members who have served on Active-Duty tours of at least 90
days retroactive to September 11, 2001.
Provide Concurrent Retirement and Disability Pay (CRDP) for Service
Incurred Disabilities.--National Guard and Reserve with 20 or more good
years are currently able to receive CRDP; however, they must wait until
they are 60 years of age and begin to receive their retirement check.
This policy must be changed, and along with the reduction in retirement
age eligibility, is a benefit our Guard and Reserve deserve. They have
incurred a service-connected disability, and we must provide concurrent
retirement and disability pay to them.
Many Guard/Reserve retirees have spent more time in a combat zone
than their Active Duty counterparts. DOD has not supported legislation
to provide Guard/Reserve men and women more equitable retirement pay in
the past. Additional requirements and reliance has been placed on the
Guard and Reserve in recent years. It is time to recognize our men and
women in uniform serving in the Reserve components and provide them a
more equitable retirement system.
Award Full Veterans Benefit Status to Guard and Reserve Members.--
It is long overdue that we recognize those servicemembers in the Guard
and Reserve who have sustained a commitment to readiness as veterans
after 20 years of honorable service to our country. Certain Guard and
Reserve members that complete 20 years of qualifying service for a
reserve (nonregular) retirement have never been called to active-duty
service during their careers. At age 60, they are entitled to start
receiving their Reserve military retired pay, Government healthcare,
and other benefits of service including some veterans' benefits. But,
current statutes deny them full standing as a ``veteran'' of the Armed
Forces. S. 491, the ``Honor America's Guard-Reserve Retirees Act of
2011'' introduced by Senator Mark Pryor (D-AR) and a House-approved
bill, H.R. 1025 by Representative Tim Walz (D-MN) would change current
statues to include in the definition(s) of ``veteran'' retirees of the
Guard and Reserve components who have completed 20 years or more of
qualifying service. There is little or no cost associated with this
change, it's simply the right thing to do, and I encourage the members
of this subcommittee to support Senator Pryor's bill.
Guard/Reserve GI Bill.--Arguably the best piece of legislation ever
passed by the Congress, and thanks to the efforts of many of you here,
the Post-9/11 GI Bill is providing unprecedented educational
opportunities for the thousands of men and women who served in uniform
since 9/11 and for many of their family members. Regrettably, many
volunteers who join the Selected Reserve were left behind in this
legislation because Selected Reserve Montgomery GI Bill (MGIB) Benefits
were not upgraded or integrated in the Post-9/11 GI Bill as AFSA
previously recommended.
AFSA supports funding of legislation that restores basic Reserve
MGIB benefits for initially joining the Selected Reserve to the
historic benchmark of 47-50 percent of active-duty benefits; integrates
Reserve and Active Duty MGIB laws in title 38, and enacts academic
protections for mobilized Guard and Reserve students, including refund
guarantees and exemption of Federal student loan payments during
activation.
uniformed services former spouses protection act
AFSA urges this subcommittee to support some fairness provisions
for the Uniformed Services Former Spouses Protection Act (USFSPA)
(Public Law 97-252). While this law was passed with good intentions in
the mid-1980s, the demographics of military service and their families
have changed. As a result, military members are now the only U.S.
citizens who are put at a significant disadvantage in divorce
proceedings. Because of the USFSPA, the following situations now exist:
--A military member is subject to giving part of his/her military
retirement pay (for the rest of his/her life) to anyone who was
married to him/her during the military career regardless of the
duration of the marriage.
--The divorce retirement pay separation is based on the military
member's retirement pay--not what the member's pay was at the
time of divorce (often many years later).
--A military retiree can be paying this ``award'' to multiple former
spouses.
--It takes a military member 20 years to earn a retirement; it takes
a former spouse only having been married to the member (for any
duration, no matter how brief) to get a portion of the member's
retirement pay.
--Under this law, in practice judges award part of the member's
retirement pay regardless of fault or circumstances.
--There is no statute of limitations on this law; i.e., unless the
original divorce decree explicitly waived separation of future
retirement earnings, a former spouse who the military member
has not seen for many years can have the original divorce
decree amended and ``highjack'' part of the military member's
retirement pay.
--The former spouse's ``award'' does not terminate upon remarriage of
the former spouse.
--The ``award'' to a former spouse under this law is above and beyond
child support and alimony.
--The law is unfair, illogical, and inconsistent. The member's
military retired pay which the Government refers to as
``deferred compensation'' is, under this law, treated as
property rather than compensation. Additionally, the law is
applied inconsistently from State to State.
--In most cases, the military retiree has no claim to part of the
former spouse's retirement pay.
--Of all U.S. citizens, it is unconscionable that military members
who put their lives on the line are uniquely subjected to such
an unfair and discriminatory law.
--While there may be unique cases (which can be dealt with by the
court on a case-by-case basis) where a long-term, very
supported former spouse is the victim, in the vast majority of
the cases we are talking about divorces that arise which are
the fault of either or both parties--at least one-half of the
time not the military member. In fact, with the current levels
of military deployments, more and more military members are
receiving ``Dear John'' and ``Dear Jane'' letters while they
serve.
--This is not a male-versus-female issue. More and more female
military members are falling victim to this law. These are just
a few of the inequities of this law. We believe this law needs
to be repealed or, at the least, greatly modified to be fairer
to military members. We urge the subcommittee to support any
funding requirement that may be necessary to take action on
this unfair law--for the benefit of those men and women who are
currently defending the interests of this Nation and its
freedom.
conclusion
Chairman Inouye, Ranking Member Cochran, in conclusion, I want to
thank you again for this opportunity to express the views of our
members on these important issues as you consider fiscal year 2013
appropriations. We realize that those charged as caretakers of the
taxpayers' money must budget wisely and make decisions based on many
factors. As tax dollars dwindle, the degree of difficulty deciding what
can be addressed, and what cannot, grows significantly.
AFSA contends that it is of paramount importance for a nation to
provide quality healthcare and top-notch benefits in exchange for the
devotion, sacrifice, and service of military members. So, too, must
those making the decisions take into consideration the decisions of the
past, the trust of those who are impacted, and the negative
consequences upon those who have based their trust in our Government.
We sincerely believe that the work done by your committees is among the
most important on the Hill. On behalf of all AFSA members, we
appreciate your efforts and, as always, are ready to support you in
matters of mutual concern.
Chairman Inouye. I thank you very much, Sergeant. May I
just assure you that we'll never forget anyone who is willing
to stand in harm's way on our behalf.
Sergeant McCauslin. Thank you, Sir.
Chairman Inouye. Our next witness, Ms. Elizabeth Vink,
represents the International Foundation for Functional
Gastrointestinal Disorders.
STATEMENT OF ELISABETH VINK, PROGRAM ASSISTANT,
INTERNATIONAL FOUNDATION FOR FUNCTIONAL
GASTROINTESTINAL DISORDERS
Ms. Vink. Chairman Inouye, Vice Chairman Cochran: Thank you
for the opportunity to present testimony regarding functional
gastrointestinal disorders (FGIDs) among service personnel and
veterans. My name is Elisabeth Vink, and I am testifying on
behalf of the International Foundation for Functional
Gastrointestinal Disorders (IFFGD). IFFGD is a nonprofit
organization dedicated to supporting individuals affected by
functional gastrointestinal and motility disorders through
education and research. I am also a proud member of a military
family, with my father having served 23 years in the U.S. Air
Force, and I appreciate the opportunity to present testimony in
support of veterans like my dad.
FGIDs are disorders in which the movement of the
intestines, the sensitivity of the nerves of the intestines, or
the way in which the brain controls intestinal function is
impaired. The result is multiple, persistent, and often painful
symptoms ranging from nausea and vomiting to altered bowel
habit.
More than two dozen different FGIDs have been identified,
ranging in severity from bothersome to disabling. One thing
these conditions have in common is that little is understood
about their underlying mechanisms, making them difficult to
treat effectively. The onset of a functional gastrointestinal
(GI) disorder can be triggered by severe stress and infections
of the digestive system.
Deployed military personnel face an elevated chance of
experiencing these risk factors and developing FGIDs as a
result of their service. For this reason, continued research
through the Department of Defense (DOD) Gulf War Illness
Research Program (GWIRP) is critical in fiscal year 2013.
In 2010, the Institute of Medicine (IOM) published a report
titled ``Gulf War and Health, Volume 8; Update on the Health
Effects of Serving in the Gulf War'', which determined that
there is sufficient evidence to associate deployment to the
gulf war and FGIDs. According to the report, there have been a
large number of FGID cases among gulf war veterans and their
symptoms have continued in the years since the war. Based on
the report from IOM, the Department of Veterans Affairs (VA)
adopted a final rule in August 2011 stating that there is a
presumptive service connection between FGIDs and service in the
Southwest Asia theater of operations during the Persian Gulf
war.
Our military personnel are taught to put duty first, and we
have noticed that by the time they reach out to us their
condition is incredibly painful or highly disruptive to their
life. Not only are these disorders hard to treat, but, in the
words of one retired sergeant, these sometimes very
embarrassing GI disorders are just as hard to talk about.
In order to better articulate the suffering associated with
FGIDs, I would like to share with you the voices of veterans
affected by these disorders. This is from Steven in North
Carolina, who served in the Persian Gulf theater of operations.
``While there and since my return, I have been plagued with a
multitude of GI problems, including irritable bowel syndrome
(IBS). I suffered nearly constant diarrhea for over 10 years
before the IBS was ever diagnosed. None of my GI problems
existed prior to my deployment and they simply do not seem to
go away afterwards.''
Another veteran, Jason, mentioned the prevalence of these
conditions. ``While speaking with several of my former
soldiers, I came to realize that they are experiencing the same
signs and symptoms. I am the first one of a group of friends
and veterans that is doing research to find out that we are not
alone.''
PREPARED STATEMENT
The DOD Gulf War Illness Research Program conducts
important research on the complex set of chronic symptoms that
impact gulf war veterans. Given the conclusions of the IOM
report and the report's recommendations for further research on
the length between FGIDs and exposures experienced by veterans
in the gulf war, we ask that you continue to support the Gulf
War Illness Research Program and encourage research into FGIDs
through this program, so that important research on FGIDs among
veterans can be conducted.
Thank you for your time and your consideration of this
request.
[The statement follows:]
Prepared Statement of Elisabeth Vink, Program Assistant, International
Foundation for Functional Gastrointestinal Disorders
Thank you for the opportunity to present the views of the
International Foundation for Functional Gastrointestinal Disorders
(IFFGD) regarding functional gastrointestinal disorders (FGIDs) among
service personnel and veterans. FGIDs are recognized by the Department
of Veterans Affairs (VA) as disabling and connected to military service
as a part of gulf war illness, and we request that the subcommittee
continue support the Department of Defense (DOD) Gulf War Illness
Research Program (GWIRP) through the Congressionally Directed Medical
Research Program. I am a proud member of a military family, with my
father having served 23 years in the U.S. Air Force, and I appreciate
the opportunity to present testimony in support of veterans like my
dad.
Established in 1991, IFFGD is a patient-driven nonprofit
organization dedicated to assisting individuals affected by FGIDs, and
providing education and support for patients, healthcare providers, and
the public at large. Our mission is to inform and support people
affected by painful and debilitating digestive conditions, about which
little is understood and few (if any) treatment options exist. The
IFFGD also works to advance critical research on functional
gastrointestinal (GI) and motility disorders, in order to provide
patients with better treatment options, and to eventually find a cure.
FGIDs are disorders in which the movement of the intestines, the
sensitivity of the nerves of the intestines, or the way in which the
brain controls intestinal function is impaired. People who suffer from
FGIDs have no structural abnormality, which makes it difficult to
identify their condition using xrays, blood tests, or endoscopies.
Instead, FGIDs are typically identified and defined by the collection
of symptoms experienced by the patient. For this reason, it is not
uncommon for FGID suffers to have unnecessary surgery, medication, and
medical devices before receiving a proper diagnosis.
More than two dozen different FGIDs have been identified. Severity
ranges from bothersome to disabling and life-altering. The conditions
may strike anywhere along the gastrointestinal tract, from nausea and
vomiting to altered bowel habit. Examples of FGIDs include irritable
bowel syndrome (IBS) and functional dyspepsia. IBS is characterized by
abdominal pain and discomfort associated with a change in bowel
pattern, such as diarrhea and/or constipation. Symptoms of functional
dyspepsia usually include an upset stomach, pain in the belly, and
bloating.
FGIDs can be emotionally and physically debilitating. Due to
persistent pain and bowel unpredictability, individuals who suffer from
these disorders may distance themselves from social events, work, and
even may fear leaving their home. Stigma surrounding bowel habits may
act as barrier to treatment, as patients are not comfortable discussing
their symptoms with doctors.
The onset of a functional GI disorder can be triggered by severe
stress and infections of the digestive system. Deployed military
personnel face an elevated chance of experiencing these risk factors
and developing FGIDs as a result of their service. In April 2010, the
Institute of Medicine (IOM) published a report titled ``Gulf War and
Health, Volume 8: Update on the Health Effects of Serving in the Gulf
War'', which determined that there is sufficient evidence to associate
deployment to the gulf war and FGIDs. According to the report, there
have been a large number of FGID cases among gulf war veterans, and
their symptoms have continued to be persistent in the years since the
war. The IOM report focused on the incidence of GI disorders among
veterans and did not attempt to determine causality. However, the
report provides compelling evidence linking exposure to enteric
pathogens during deployment and the development of FGIDs. The IOM
recommended that further research be conducted on this association.
Based on the report from IOM, Department of Veterans Affairs
adopted a final rule on August 15, 2011, stating that there is a
presumptive service connection between FGIDs and service in the
Southwest Asia theater of operations during the Persian Gulf war. This
includes conditions like IBS and functional dyspepsia.
At IFFGD we hear from numerous veterans about their difficulties
with FGIDs, including conditions such as IBS and cyclic vomiting
syndrome. Our military personnel are taught to put duty first, and at
IFFGD we have noticed that by the time they reach out to us, their
situation is usually pretty bad. Not only are these disorders hard to
treat, but in the words of one retired Sergeant, these ``sometimes very
embarrassing GI disorders'' are just as hard to talk about. In order to
better articulate the suffering associated with FGIDs, I would like to
share with you the voices of veterans affected by these disorders. This
is from Stephen in North Carolina:
``I am a Desert Shield/Desert Storm veteran that served in the
Persian Gulf theater of operations from August 1990 to March 1991, as
the G2 Sergeant Major for the 24th Infantry Division. While there, and
since my return, I have been plagued with a multitude of GI problems
including IBS, a functional GI problem. I suffered nearly constant
diarrhea for over 10 years before the IBS was ever diagnosed. None of
my GI problems existed prior to my deployment and they simply do not
seem to go away afterwards.''
This is from Jason, who contacted us earlier this year:
``I am a disabled Iraq veteran that was deployed during 2003-2005
timeframe with a National Guard unit attached to Active Duty. Since
returning from Iraq, I have had issues with my gastrointestinal tract.
I have made a few attempts to try to pinpoint the cause of this change
in my bodily function to no avail . . . While speaking with several of
my former soldiers I came to realize that they are experiencing the
same signs and symptoms. I am the first one of a group of friends/vets
that is doing research to find out that we are not alone.''
The DOD Gulf War Illness Research Program conducts important
research on the complex set of chronic symptoms that impact Gulf War
Veterans. Given the conclusions of the IOM report and the report's
recommendations for further research on the link between FGIDs and
exposures experienced by veterans in the Gulf War, we ask that you
continue to support the Gulf War Illness Research Program and encourage
research into FGIDs through this program so that important research on
FGIDs among veterans can be conducted.
Thank you again for the opportunity to address the subcommittee.
Chairman Inouye. Thank you very much. If this matter is
service-connected, I can assure you we're morally bound to do
something about it.
Thank you.
Ms. Vink. Thank you, Chairman.
Chairman Inouye. Our next witness is Mr. Anthony Castaldo,
representing the United States Hereditary Angiodema
Association.
STATEMENT OF ANTHONY CASTALDO, PRESIDENT, U.S.
HEREDITARY ANGIOEDEMA ASSOCIATION
Mr. Castaldo. Chairman Inouye and Vice Chairman Cochran:
I'm delighted to present testimony today on hereditary
angioedema (HAE). I am Anthony Castaldo, president of the
United States HAE Association, a Honolulu-based nonprofit
patient services, research, and advocacy organization that
represents more than 4,500 HAE patients.
Now, HAE is a rare, debilitating, and potentially life-
threatening genetic condition that occurs in about 1 in 50,000
people. HAE patients experience frequent attacks of intense
swelling of various body parts, including the hands, face,
feet, throat, and abdomen. Abdominal attacks involve
excruciating abdominal pain, nausea, and vomiting. Attacks
involving the throat are particularly dangerous because the
swelling can progress to the point where the airway closes and
causes death by suffocation.
The historical mortality rate for HAE sufferers is well
over 30 percent and, tragically, even today HAE patients
continue to die from swelling attacks that close the airway.
Unfortunately, according to a recent study HAE patients suffer
for almost a decade before obtaining an accurate diagnosis, and
are therefore often subject to unnecessary exploratory surgery
and ineffective medical procedures.
Now, the swelling experienced by many HAE patients is
actually caused by a genetic defect that results in deficient
levels of a key blood protein. However, there are still
patients in the HAE Association community who do not yet know
what causes their swelling. Despite a family history of
debilitating and life-threatening swelling attacks, these
patients have normal levels of the protein that I mentioned
earlier. This important subset of HAE sufferers represent a
significant unmet medical need and research is required to
identify the genetic and biochemical markers for this form of
HAE.
Mr. Chairman and Vice Chairman Cochran, I'd like to share
some examples of how HAE has a significant impact on the
ability to serve in our country's armed services. Today, right
on the island, Hawaiian island of Oahu, there was a remarkable
young man, Christian Davis, whose dreams of following his
father's footsteps and becoming an Air Force pilot have been
dashed because his HAE symptoms prevent him from military
service.
Christian, who bravely endures frequent HAE attacks
involving his abdomen and throat, loved to visit Hickham Air
Force Base and proudly watch his father, Lieutenant Colonel
Milton Davis, take off and land Hawaii Air National Guard C-17
cargo planes. With visions of one day serving America by
grasping the controls and piloting a C-17, Christian eagerly
began the process of applying for military service. It did not
take long, however, for this young man's aspirations to be
dowsed by the reality that HEA would cause him to be rejected
for military service.
My father, who experienced severe swelling attacks, yet
served with distinction in the Korean war, chose to endure his
excruciating swelling without seeking treatment, so he could
continue to serve his country. Of course, in those days HAE had
not yet been identified as a discrete disease. Indeed, my dad
was so proud to serve as a U.S. military police officer that
while in Korea he stopped reporting to the field hospital
during swelling attacks, in an attempt to avoid a medical
discharge.
PREPARED STATEMENT
Mr. Chairman and Mr. Vice Chairman, on behalf of HEA
patients in the United States, including those like Christian
Davis who would like to serve his country, and veterans like my
dad, who remained on active duty despite suffering from
debilitating HAE swelling attacks, I would like to request that
the subcommittee continue--that HAE continue to be eligible for
the Peer-Reviewed Medical Research Program for fiscal year
2013. There is a critical need for research in understanding
all causes of HAE, including currently available treatments,
and ultimately finding a cure.
Thank you for inviting me to appear today.
[The statement follows:]
Prepared Statement of Anthony Castaldo
Chairman Inouye, Vice Chairman Cochran, and distinguished members
of the Defense subcommittee: Thank you for the opportunity to present
testimony on Hereditary Angioedema (HAE). I am Anthony Castaldo,
president of the United States Hereditary Angeioedema Association
(USHAEA) and an HAE patient. USHAEA is a nonprofit patient advocacy
organization founded to provide patient support, educate patients and
their families, advance HAE research, and find a cure. Our efforts
include providing research funding to scientific investigators to
increase the HAE knowledge base and maintaining a patient registry to
support groundbreaking research efforts. Today, we would like to
request the continued inclusion of HAE in the fiscal year 2013 Peer-
Reviewed Medical Research Program (PRMRP) within the Department of
Defense (DOD) appropriations bill.
My family has a long history of military service, my grandfather
served in the Great War and my father and uncle in Korea; I grew up
understanding the sacrifices and dedication of our servicemen and
women. I, however, was and am unable to serve my country in the same
way because of my condition. There are also a number of other men and
women who were prevented from serving in the military due to an HAE
diagnosis.
HAE is a rare and potentially life-threatening inherited disease
with symptoms of severe, recurring, debilitating attacks of edema
(swelling). HAE patients have a defect in the gene that controls a
blood protein called C1-inhibitor, so it is also more specifically
referred to as C1-inhibitor deficiency. This genetic defect results in
production of either inadequate or nonfunctioning C1-inhibitor protein.
Because the defective C1-inhibitor does not adequately perform its
regulatory function, a biochemical imbalance can occur and produce an
unwanted peptide--called bradykinin--that induces the capillaries to
release fluids into surrounding tissues, thereby causing swelling.
People with HAE experience attacks of severe swelling that affect
various body parts including the hands, feet, face, airway (throat),
and intestinal wall. Swelling of the throat is the most life-
threatening aspect of HAE, because the airway can close and cause death
by suffocation. Studies reveal that more than 50 percent of patients
will experience at least one throat attack in their lifetime.
HAE swelling is disfiguring, extremely painful, and debilitating.
Attacks of abdominal swelling involve severe and excruciating pain,
vomiting, and diarrhea. Because abdominal attacks mimic a surgical
emergency, approximately one-third of patients with undiagnosed HAE
undergo unnecessary surgery. Untreated, an average HAE attack lasts
between 24 and 72 hours, but some attacks may last longer and be
accompanied by prolonged fatigue.
The majority of HAE patients experience their first attack during
childhood or adolescence. Most attacks occur spontaneously with no
apparent reason, but anxiety, stress, minor trauma, medical, surgical,
and dental procedures, and illnesses such as colds and flu have been
cited as common triggers. ACE inhibitors (a blood pressure control
medication) and estrogen-derived medications (birth control pills and
hormone replacement drugs) have also been shown to exacerbate HAE
attacks.
HAE's genetic defect can be passed on in families. A child has a
50-percent chance of inheriting the disease from a parent with HAE.
However, the absence of family history does not rule out the HAE
diagnosis; scientists report that as many as 25 percent of HAE cases
today result from patients who had a spontaneous mutation of the C1-
inhibitor gene at conception. These patients can also pass the
defective gene to their offspring. Worldwide, it is estimated that this
condition affects between 1 in 10,000 and 1 in 30,000 people.
peer-reviewed medical research program
On behalf of the HAE community, including our military families, I
would like to thank the subcommittee for recognizing HAE as a condition
eligible for study through Peer-Reviewed Medical Research Program
(PRMRP) in the committee reports accompanying the fiscal year 2012 DOD
appropriations bill. The scientific community showed great interest in
the program, responding to the grant announcements with an immense
outpouring of proposals. We urge the Congress to maintain HAE's
eligibility in the PRMRP in committee reports accompanying the fiscal
year 2013 DOD appropriations bill, to help find a cure so the men and
women born with HAE can serve their country in the Armed Forces and
help their families with the very challenging condition.
Thank you for the opportunity to present the views of the HAE
community.
Chairman Inouye. I thank you very much, Mr. Castaldo. I
assure you that we'll look into this matter.
Mr. Castaldo. Thank you, Sir.
Chairman Inouye. Thank you.
Our next witness is Lieutenant Colonel Carl Hicks,
representing the Pulmonary Hypertension Association.
STATEMENT OF LIEUTENANT COLONEL CARL HICKS, U.S. ARMY
(RETIRED), PULMONARY HYPERTENSION
ASSOCIATION
Colonel Hicks. Mr. Chairman, first I'd like to acknowledge
you as a personal hero. Your actions long ago set an example
for bravery and sacrifice, inspiring so many young Americans
who would later follow as infantrymen and earn the combat
infantryman's badge. Sir, I was one of them, and I'm especially
humbled to be in your presence, as any American would be. Thank
you.
And thank you for having me here today to speak on behalf
of hundreds of thousands of Americans impacted by pulmonary
hypertension (PH). On behalf of the PH community, I am here to
request that you once again include pulmonary hypertension as a
condition eligible for study through the Department of Defense
(DOD) Peer-Reviewed Medical Research Program.
I volunteer for a grassroots, patient-centric organization
called the Pulmonary Hypertension Association (PHA). With more
than 20,000 members and supporters, including more than 250
support groups across the country, PHA now is recognized
worldwide. We are dedicated to improving treatment options and
finding cures for PH and supporting affected individuals
through coordinated research, education, and advocacy
activities.
PH is a debilitating and usually fatal condition where
blood pressure in the lungs rises to dangerously high levels.
In PH patients, the walls of the arteries that take the blood
from the side of the heart to the lungs thicken, scar, and
constrict, and as a result the right side of the heart has to
pump harder to move blood into the lungs, causing it to enlarge
and ultimately fail.
Symptoms of PH include shortness of breath, fatigue, chest
pain, dizziness, and fainting. The stricken feel, even at rest,
as though they are suffocating, because they are. The only way
to ultimately survive being stricken with PH is to undergo a
lung or a heart-lung transplant.
August 16, 1981, was one of the happiest days of my life. I
was a young airborne Ranger infantry captain who had worked his
way up from private. I felt pretty tough. Holding my first-born
Meaghan in my arms moments after she was born, I looked down
into her beautiful little face and vowed these arms would
protect her from everything, and there was no doubt that I
could.
Fast-forward 13 happy years and our little happy family had
grown to three healthy, beautiful Army brats. I had been
promoted rapidly, and we were on our way back from Germany to
assume the command of the 10th Mountain Division. Life could
not have been better.
Days away from leaving, Meaghan, who was a fit, healthy
young gymnast of 13, fainted and complained of shortness of
breath. Initially misdiagnosed, we were soon at Walter Reed,
where I was confident they could solve the problem. After 3
days of testing, an Army doctor asked me to join him around the
corner, where he said: ``Colonel Hicks, I regret to inform you,
but your daughter, Meaghan, has a terminal illness. She has
less than a year to live and there is nothing we can do for
her.''
I was not such a tough warrior any more. Little did they
know that Meaghan was a tough warrior, though, and with the
combined help and prayers of many she lived another 12 years
before declining precipitously. Finally, the only hope for
Meaghan was a dangerous heart and lung transplant, which she
fearlessly endured. But there were serious complications.
Undaunted, she fought on, never quitting or giving up.
As she once again began to decline, helpless to find ways
to comfort her, I offered her an old Ranger tee shirt to wear
as she lay in bed. She was so proud that she rallied briefly.
Yet, 48 hours later we lost her. I had failed my most important
mission, that promise to protect her from everything. She was
the bravest person I have ever known.
PREPARED STATEMENT
Distinguished members, while new treatment options have
been developed for PH in recent years, they are limited and
there remains no cure. For the members of our military and
their families who are struggling with PH, the hope for a
better quality of life depends on advancements made through
biomedical research. It is important to note that research in
this area has a potential to yield additional benefits toward
the study of America's number one killer, heart disease, as
well as other lung illnesses.
Pulmonary hypertension was included as a condition eligible
for study through DOD Peer-Reviewed Medical Research Program in
2009. I respectfully request once again that we renew that
commitment toward a better tomorrow made through this important
research by including pulmonary hypertension as a condition
eligible for fiscal year 2013.
Thank you.
[The statement follows:]
Prepared Statement of Lieutenant Colonel Carl Hicks
Chairman Inouye, Ranking Member Cochran, and distinguished members
of the subcommittee: Thank you for having me here today to speak on
behalf of the hundreds of thousands of Americans impacted by pulmonary
hypertension (PH). As a military veteran and as a veteran of the
ongoing battle against PH, it is my honor to appear before you as a
representative of the Pulmonary Hypertension Association (PHA). On
behalf of the PH community, I am here to request that you once again
include PH as a condition eligible for study through the Department of
Defense (DOD) Peer-Reviewed Medical Research Program (PRMRP) as you
work to complete fiscal year 2013 Defense appropriations.
PHA has served the PH community for more than 20 years. In 1990,
three PH patients found each other with the help of the National
Organization for Rare Disorders and shortly thereafter founded PHA. At
that time, the condition was largely unknown amongst the general public
and within the medical community; there were fewer than 200 diagnosed
cases of the disease. Since then, PHA has grown into a nationwide
network of more than 20,000 members and supporters, including more than
250 support groups across the country. PHA is dedicated to improving
treatment options and finding cures for PH, and supporting affected
individuals through coordinated research, education, and advocacy
activities. We now have an international presence and reputation around
the world for which I am deeply proud.
PH is a debilitating and often fatal condition where the blood
pressure in the lungs rises to dangerously high levels. In PH patients,
the walls of the arteries that take blood from the right side of the
heart to the lungs thicken and constrict. As a result, the right side
of the heart has to pump harder to move blood into the lungs, causing
it to enlarge and ultimately fail. Symptoms of PH include shortness of
breath, fatigue, chest pain, dizziness, and fainting. The only way to
ultimately survive being stricken with PH is a lung or heart-lung
transplant.
On August 16, 1981, I was a young Airborne Ranger Infantry captain
who'd worked his way up from private and felt pretty tough. As I held
my firstborn child, Meaghan, in my arms moments after she was born, I
looked down into her beautiful little face and knew these arms could
protect her from anything, and I lovingly told her so in front of her
beaming mother. Fast forward 13 happy years and our little family had
grown to three happy, healthy, beautiful Army brats. I had been
promoted multiple times below the zone, and we were on our way back
from Europe so I could assume a new command in the 10th Mountain
Division. Life couldn't have been better, or so I thought.
Days away from leaving, Meaghan, a super fit healthy gymnast of 13,
fainted and complained of shortness of breath. Initially misdiagnosed
as are almost all, we eventually ended up at Walter Reed. Two days
later a young Army doctor asked me to join him around the corner where
he said, ``Colonel Hicks, I regret to inform you that your daughter,
Meaghan, has a terminal illness, and there is nothing we can do for
her. She has less than a year to live at best.'' I was no longer the
tough battle-hardened Ranger that moments before I was.
Little did they know that Meaghan was tough, and combined with the
help of a civilian physician, she lived another 12 years before
declining precipitously. Finally the only hope was a dangerous heart-
lung transplant which she fearlessly endured. But there were
complications. Undaunted, she fought on, never quitting or giving up.
As she again began to decline and she asked for my Ranger t-shirt to
wear. Forty-eight hours later, with all of us around her, she lost her
last fight. I had failed my mission and didn't keep that promise to
protect from everything, but Meaghan, she never gave up. Rangers both
retired and Active Duty came from around the world for her celebration
of life, and we did a Ranger ``roll-call'' for her and stood to salute
when she didn't respond. She was the bravest person I ever knew, and
she never, ever quit.
Gentlemen, while new treatment options have been developed for PH
in recent years, these treatment options are limited and there remains
no cure. For the members of our military and their families who are
struggling with PH, the hope for a better quality of life depends on
advancements made through biomedical research. It is important to note
that research in this area has the potential to yield additional
benefits towards the study of America's number one killer, heart
disease. PH was included as a condition eligible for study through the
DOD's Peer-Reviewed Medical Research Program as recently as 2009. I ask
that this subcommittee renew the commitment towards a better tomorrow
made through this important research by including pulmonary
hypertension as a condition eligible for study through the Peer-
Reviewed Medical Research Program in fiscal year 2013.
PHA Fiscal Year 2013 DOD Appropriations Recommendations
Peer-Reviewed Medical Research Program (PRMRP):
--Please, once again, include pulmonary hypertension (PH) on the list
of conditions deemed eligible for study through the DOD PRMRP
as you continue your important work on the fiscal year 2013
Defense appropriations bill.
--In addition, please provide $50 million for PRMRP, which is housed
within the DOD Congressionally Directed Medical Research
Program, so that this program may continue to advance important
research activities focused on a number of conditions.
Thank you for your time and your consideration of this request.
Chairman Inouye. I thank you very much and thank you for
your kind words. We will make certain that this matter is
continued.
Colonel Hicks. Thank you, Sir.
Chairman Inouye. Thank you.
The next group of witnesses: Mr. Neal Thompson of the
Interstitial Cystitis Association; Mr. Danny Smith of the
Scleroderma Foundation; Ms. Dee Linde, the Dystonia Medical
Research Foundation; and Ms. Joy Simha, National Breast Cancer
Coalition.
I call upon Mr. Thompson.
STATEMENT OF F. NEAL THOMPSON, TREASURER, BOARD OF
DIRECTORS, INTERSTITIAL CYSTITIS
ASSOCIATION
Mr. Thompson. Thank you. Chairman Inouye, Vice Chairman
Cochran, distinguished members of the subcommittee: Thank you
for the opportunity to present testimony before you today. My
name is Neal Thompson. I'm speaking on behalf of the
Interstitial Cystitis Association (ICA). The ICA advocates for
interstitial cystitis (IC) research, raises awareness, and
serves as a center hub for healthcare providers, researchers,
and millions of patients with IC.
I'm also a lieutenant colonel in the Virginia Defense
Force, which is a voluntary military organization set up to
provide support for the Department of Military Affairs, which
is the Virginia National Guard and Army Guard.
I was a high-level insurance executive, but my life came to
a screeching halt when I got this IC base. I couldn't travel. I
couldn't sleep. Fortunately, I was able to get a diagnosis from
the Medical College of Virginia, from a doctor there who was
also working at the Department of Veterans Affairs (VA)
hospital. So that changed my life and I was able to get some
treatment.
IC is a chronic condition characterized by recurring pain,
pressure, and discomfort of the bladder and pelvic region. It's
often associated with urinary frequency and urgency. The cause
of IC is still unknown and the diagnosis is made only after
excluding other urinary and bladder conditions.
Misdiagnosis is very common, and when healthcare providers
are not properly educated about IC patients may suffer for
years before receiving an accurate diagnosis, often as long as
5 years. IC is often considered a woman's disease, but, while
it is more common in women, scientific evidence shows that all
demographic groups are affected by IC. It is estimated that 12
million Americans have IC symptoms.
The effects of IC are damaging to work life, psychological
well-being, personal relationships, and general health. The
impact on IC quality of life is equally as severe as rheumatoid
arthritis and end stage renal disease. IC can cause patients to
suffer from sleep dysfunction, high rates of depression,
anxiety, sexual dysfunction, and in some cases, suicide.
The burden of IC on our military, the Nation's military
members and veterans, is significant. The Urological Disease of
America Project conducted between 1999 and 2002 found that
approximately 1.4 of all veterans who utilized the Veterans
Health Administration (VHA) have been treated for IC. This
study also showed a 14-percent increase in IC patients within
the VHA over the same period.
The ICA has also heard from many service men and women
about their struggles with IC, including a woman who is just
currently in field training, who experienced severe pain every
time she fired her weapon. Several individuals, such as former
Navy Captain Gary Monray, were forced to retire from their
military career due to pain and limitations imposed by IC.
IC research through the Department of Defense Peer-Reviewed
Medical Research Program remains essential for expanding our
knowledge of this painful condition. This program is an
indispensable resource for studying emerging areas of IC
research, such as prevalence in men, the role of environmental
conditions, and development and diagnosis and various
treatments.
PREPARED STATEMENT
Senator, I've read your Medal of Honor designation in 1945
and I read the actions taken in Northern Italy. It's chilling
just to read that, but at the time I'm sure you knew what was
happening and you knew the cause and you knew what the
treatment. What is so insidious about IC is you don't see it
externally and we still need more research to find the cure.
On behalf of IC patients, including many veterans, we
request IC continue to be eligible for the Peer-Reviewed
Medical Research Program for fiscal year 2013.
Thank you for your time and consideration.
[The statement follows:]
Prepared Statement of F. Neal Thompson
Chairman Inouye, Vice Chairman Cochran, and distinguished members
of the subcommittee: Thank you for the opportunity to present
information on interstitial cystitis (IC). I am Neal Thompson,
treasurer of the board of directors of the Interstitial Cystitis
Association (ICA). 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.
I am a member of the Virginia Defense Forces, a volunteer military
reserve set up to provide back up for the Virginia National Guard. This
group, when called to active duty, is trained to secure any Federal and
State property left in place in the event of the mobilization of the
Virginia National Guard. I was a high-level financial executive, but my
life came to a complete stop because of IC. I struggled for many years
to get a diagnosis while trying to keep an active travel schedule and
meet the demands of a high-level position. The challenges of being
diagnosed and finding an effective treatment eventually forced me to
leave work due to disability.
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 1 or more years of delay between the 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. It
is estimated that as many as 12 million Americans have IC symptoms,
more people than Alzheimer's, breast cancer, and autism combined.
The effects of IC are pervasive and insidious, damaging work life,
psychological well-being, personal relationships, and general health.
The impact of IC on quality of life is equally as severe as rheumatoid
arthritis and end-stage renal disease. Health-related quality of life
in individuals with IC is worse than in individuals with endometriosis,
vulvodynia, and overactive bladder. IC patients have significantly more
sleep dysfunction, higher rates of depression, anxiety, and sexual
dysfunction.
The burden of IC among our Nation's servicemembers and veterans is
significant. The Urologic Diseases in America Project, conducted
between 1999 and 2002, found that approximately 1.4 percent of all
veterans utilizing the Veterans Health Administration (VHA) had been
treated for IC. This study also showed a 14-percent increase in IC
patients within VHA over the same period.
Navy Captain Gary Mowrey (Retired) was forced to cut his naval
career short as a result of IC. Captain Mowrey was in the Navy for 25
years and has served as commander of the VAQ133 Squadron, operations
officer on the USS Dwight D. Eisenhower, chief of the Enlisted
Performance Division in the Bureau of Naval Personnel, and earned a
Southwest Asia service medal with two stars for his service in
Operation Desert Storm. In 1994, he began to experience significant
pain, could not always make it to the restroom, and was not even able
to sit through normal meetings. After months of unsuccessful antibiotic
treatments for urinary tract infections, Captain Mowrey was diagnosed
with IC, and retired due to the pain and limitations imposed by IC. He
then attempted to teach high school math, but had to retire from this
position as well due to the pain and frequent urination associated with
his IC.
Although IC research is currently conducted through a number of
Federal entities, including the National Institutes of Health 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 2013 budget request did not include renewed funding for the CDC's
IC Education and Awareness Program.
On behalf of the IC community, including our veterans, I would like
to thank the subcommittee for recognizing IC as a condition eligible
for study through the DOD's PRMRP in the committee reports accompanying
the fiscal years 2010, 2011, and 2012 DOD appropriations bills. The
scientific community showed great interest in IC research through this
program. We urge the Congress to maintain IC's eligibility in the PRMRP
in committee report accompanying the fiscal year 2013 DOD
appropriations bill, as the number of current military members, family
members, and veterans affected by IC is increasing.
Chairman Inouye. Sir, I can assure you that we'll do our
best to maintain the eligibility of IC patients. Thank you very
much.
Now may I call upon Mr. Danny L. Smith.
STATEMENT OF DANNY L. SMITH, U.S. ARMY (RETIRED),
SCLERODERMA FOUNDATION
Mr. Smith. Chairman Inouye, Ranking Member Cochran, and
distinguished members of the Defense subcommittee: Thank you
for the opportunity to talk to you today about scleroderma. I'm
Danny Smith from Saginaw, Michigan. I have been a scleroderma
patient since 1999. Before my battle with scleroderma started,
I was in the U.S. Army--Hawaii 1965 and Vietnam 1966.
The word ``scleroderma'' literally means ``hard skin'',
which is one of the most manifestations of the disease. The
cause of scleroderma is unknown, although it involves an
overproduction of collagen. This can cause the hardening of the
internal organs. Serious complications of the disease include
pain, skin ulcers, pulmonary hypertension, disorders of the
digestive system, and others.
For me, it began with my hands. They turned blue, stiffened
up. I could not move my fingers. I went to my doctor. She sent
me to a rheumatologist. They sent me to a rheumatologist. He
diagnosed me with scleroderma eventually. I had just gotten a
new job working for the United Auto Workers (UAW), and I didn't
get to sit in that chair because they put me on disability
right away and I never got there.
But as time went on, the skin on my arms and my hands got
tighter. I could not even close my hands. A few months later, I
began an experimental treatment called cytoxin infusion for
scleroderma, taken once a month for 2 years. My scleroderma
began impacting my right lung. Breathing became difficult. I
was losing weight and coloration of my skin was changing.
The rheumatologist referred me to a lung specialist at the
University of Michigan. The lung specialist said that my right
lung was not fluctuating. It was beginning to harden and turn
to stone, which is a term used in scleroderma. After many
tests, counseling on risk, I decided to go ahead with the lung
transplant. On September 20, 2004, at 11 p.m., I got a phone
call that a lung was available. I was on the operating table
the next morning at 7:30 a.m.
PREPARED STATEMENT
As I said before, the exact cause of scleroderma is not
known. However, it is suspected that an unknown inciting event
can trigger autoimmune reactions. Additionally, toxic agents
soldiers may be exposed to on a battlefield have often proved
to cause lung injury and fibrosis. The successful completion of
studies being done by DOD will bring us much closer to being
able to treat scleroderma, lung disease, and other diseases
involving lung injury and fibrosis to human patients. This is
very important because there are currently no effective FDA-
approved treatments for these diseases.
On behalf of scleroderma patients, we request scleroderma
continue to be eligible for the Peer-Reviewed Medical Research
Program for fiscal year 2013.
Thank you very much.
[The statement follows:]
Prepared Statement of Danny L. Smith
Chairman Inouye, Ranking Member Cochran, and distinguished members
of the subcommittee: As a military veteran, it is my honor to appear
before you as a representative of the Scleroderma Foundation and on
behalf of those living with scleroderma. My name is Danny L. Smith. I
live in Saginaw, Michigan and I was in the U.S. Army from September
1964 until September 1967. I was discharged at Fort Lewis, Washington
and was stationed in Hawaii in 1965 and Vietnam in 1966 at Cu Chi. I
was diagnosed with scleroderma in 1999. I also have had lupus since the
mid-1970s. I am here to request that you continue to include
scleroderma as a condition eligible for study through the Department of
Defense's (DOD) Peer-Reviewed Medical Research Program (PRMRP) as you
work to complete fiscal year 2013 Defense appropriations.
The Scleroderma Foundation is a national organization for people
with scleroderma and their families and friends. The Foundation's
mission is threefold:
--support to help patients and their families cope with scleroderma
through mutual support programs, peer counseling, physician
referrals, and educational information;
--education to promote public awareness and education through patient
and health professional seminars, literature, and publicity
campaigns; and
--research to stimulate and support research to improve treatment and
ultimately find the cause of and cure for scleroderma and
related diseases.
Systemic sclerosis (scleroderma) is a chronic autoimmune disorder
marked by early skin lesions and the progressive tissue fibrosis. More
than skin deep, this thickening and hardening of connective tissue
affects the blood capillaries, the gastrointestinal tract, the lungs,
and the heart. In scleroderma patients, fibrosis frequently leads to
organ dysfunction, serious illness, and death. Researchers have yet to
determine the underlying cause of this disfiguring, debilitating
condition or find an effective antifibrotic remedy. Scleroderma impacts
approximately 300,000 Americans; 80 percent of whom are women diagnosed
during their child-bearing years. Scleroderma also has a highly
disproportionate impact on Native American, African-American, and
Hispanic populations. These groups tend to exhibit more rapidly
progressing and severe cases of the disease. Scleroderma lung disease
is categorized as an interstitial lung disease (ILD). ILD refers to a
broad category of lung diseases, of which scleroderma is one among
nearly 150 conditions, marked by fibrosis or scarring of the lungs. The
net result of the fibrosis is ineffective respiration or difficulty
breathing. Lung fibrosis occurs in nearly all patients with systemic
sclerosis and for reasons that are not clear, severe lung scarring is
seen more frequently in men and in African-American scleroderma
patients. I was one of these men. Lung disease is the number one cause
of death in scleroderma patients.
It began with trouble with my hands at work. They were turning blue
and I could not flex them. I went to my family doctor and she referred
me to a rheumatologist who subsequently diagnosed me with Raynaud's
(the blue color) and scleroderma. As time went on the skin was getting
tighter on my arms and so tight on my hands that I could not even close
them. The doctor started me on an exercise program for my arms and
hands. A few months later I began an experimental treatment, Cytoxin
Infusion, for the scleroderma, taken once a month. I was on it for 2
years. After 2 years, my scleroderma began impacting my right lung.
Breathing became difficult, I was losing weight, and the coloration of
my skin was changing. The rheumatologist then referred me to a lung
specialist at the University of Michigan. The lung specialist said that
my right lung was not fluctuating and was beginning to harden or turn
to stone--a term used with scleroderma.
When I inquired about a transplant I was tested and counseled by
multiple doctors because the operation would be experimental. There
were considerable risks. I was finally put on the transplant list. On
September 20, 2004, I got a phone call at 11 p.m. that a lung was
available. They said I needed to get to Ann Arbor as quickly as
possible. When I got there they checked to make sure I was healthy
enough for the operation and ran tests for infection. I was on the
operating table the next morning, September 21, at 7:30 a.m. I was in
the hospital for a week. Having become so weak being on oxygen for 2
years, I also required extensive physical therapy. Since the operation
I have been doing well. The lung is still functioning as well today as
the day I received it.
Since my operation I have joined a Scleroderma Foundation support
group and found out there is so much we don't know about scleroderma.
We all differ in our degrees of the illness. I have learned that none
of us are the same or have the same outcomes. For example, I knew a
young lady, 17 years old, who had scleroderma. Her one wish was to go
to Disney World. A trip was arranged for her and her family. She was
not doing well but wanted to go anyway. She made it to Florida and to
the hotel but then needed to go to the hospital. She passed away the
next day without getting to see Disney World. The doctors here in
Saginaw used some of the treatments on her that were used on me. The
treatments worked for me but not for her.
As I stated before, I am a veteran of the United States Army and a
Vietnam Vet. Scleroderma research is of utmost importance to the
military. The exact cause of scleroderma is not known; however, it is
suspected that an unknown inciting event triggers injury, probably to
cells lining the blood vessels. There are also changes in the body's
immune system that cause the immune cells to react to body components
including the connective tissue. A major consequence of these so-called
``autoimmune reactions'' is stimulation of fibroblasts (cells that make
collagen and other connective tissue components). The net result is
excessive accumulation of collagen and other connective tissue
components in parts of the body such as skin, lungs, and walls of the
arteries. A veteran's immune system disability may be related to his
in-service chemical exposure. Systemic sclerosis and systemic lupus
have been reported in patients exposed to TCE.
Additionally, toxic agents soldiers may be exposed to on the
battlefield have also proved to cause lung injury/fibrosis. The
successful completion of studies will bring us much closer to being
able to treat scleroderma lung disease and other diseases involving
lung injury/fibrosis in human patients. This is of the utmost urgency
because there are currently no effective, U.S. Food and Drug
Administration-approved treatments for these diseases.
On behalf of the scleroderma community, including our veterans, I
would like to thank the subcommittee for recognizing scleroderma as a
condition eligible for study through the DOD's PRMRP in the committee
reports accompanying the fiscal years 2010, 2011, and 2012 DOD
appropriations bills. The scientific community showed great interest in
the program, responding to the grant announcements with an immense
outpouring of proposals. We urge the Congress to maintain scleroderma's
eligibility in the PRMRP.
Chairman Inouye. We'll do our best to make certain that
it's eligible for research.
Thank you very much, Sir.
Our next witness is Ms. Dee Linde, representing the
Dystonia Medical Research Foundation.
STATEMENT OF DEE LINDE, PATIENT ADVOCATE, DYSTONIA
ADVOCACY NETWORK
Ms. Linde. Mr. Chairman, Mr. Vice Chairman: Thank you for
the opportunity to testify here today. My name is Dee Linde and
I'm a dystonia patient and volunteer with the Dystonia Advocacy
Network (DAN). As a veteran and former Navy petty officer, I am
honored to testify before this subcommittee.
The DAN is comprised of five dystonia patient groups and
works to advance dystonia research, increase dystonia
awareness, and provide support for dystonia patients. Dystonia
is a rare neurological movement disorder that causes muscles to
contract and spasm involuntarily. Dystonia is a chronic
disorder whose symptoms vary in degrees of frequency,
intensity, disability, and pain. Dystonia can be generalized or
focal. Generalized dystonia affects all major muscle groups,
resulting in twisting, repetitive movements, and abnormal
postures. Focal dystonia affects a specific part of the body,
such as the legs, arms, eyelids, or vocal cords.
Dystonia can be hereditary or caused by trauma, and it
affects approximately 300,000 persons in the United States. At
this time there is no cure for dystonia and treatment is highly
individualized. Patients frequently rely on invasive therapies.
In 1995, after my Navy career, I started feeling symptoms
from what would later be diagnosed as tardive dystonia, which
is medication-induced dystonia. The symptoms started as an
uncontrollable shivering sensation. Over the next 2 years, the
symptoms continued to worsen and I started feeling like I was
being squeezed in a vise. My diaphragm was constricted and I
couldn't breathe. I also had blepharospasm, a form of dystonia
that forcibly shut my eyes, leaving me functionally blind even
though there was nothing wrong with my vision.
My dystonia affected my entire upper body and for years my
spasms didn't allow me to sit in a chair or sleep safely in bed
with my husband. I spent those years having to sleep and even
eat on the floor. I was also forced to give up my private
practice as a psychotherapist.
In 2000, I underwent surgery to receive deep brain
stimulation (DBS). The neurosurgeon implanted leads into my
brain that emit constant electrical pulses which interrupt the
bad signals and help control my symptoms. Thanks to DBS, I have
gone from being completely nonfunctional to having the ability
to walk and to move like a healthy individual and I am now
almost completely symptom-free. But DBS is not a cure.
The Dystonia Medical Research Foundation (DMRF) has
received reports that the incidence of dystonia in the United
States has noticeably increased since our military forces were
deployed to Iraq and Afghanistan. An article in Military
Medicine titled ``Post-Traumatic Shoulder Dystonia in an Active
Duty Soldier'' stated that, ``Dystonia after minor trauma can
be as crippling as a penetrating wound, with disability that
renders the soldier unable to perform his duties.''
Awareness of this disorder is essential to avoid
mislabeling and possibly mistreating a true neurological
disease.
In addition, a study published this month in ``Science
Translational Medicine'' found that blast exposures can cause
structural problems in the brain. We believe these structural
problems will lead to increased dystonia.
The Department of Defense Peer-Reviewed Medical Research
Program is critical to developing a better understanding of the
mechanisms connecting trauma and dystonia.
PREPARED STATEMENT
The dystonia community would like to thank the subcommittee
for adding dystonia to the list of conditions eligible for
study under this program since fiscal year 2010. We're excited
to report that dystonia researchers have competed successfully
within the peer-reviewed system every year thus far. We urge
the subcommittee to maintain dystonia as an eligible condition
in the Defense Peer-Reviewed Medical Research Program in fiscal
year 2013.
Thank you again for your time and interest.
[The statement follows:]
Prepared Statement of Dee Linde
Mr. Chairman and members of the Senate Department of Defense
Appropriations subcommittee, thank you for the opportunity to testify
today. My name is Dee Linde, and I am a dystonia patient and volunteer
with the Dystonia Advocacy Network (DAN). I am also a former Navy
servicemember, and I am honored to testify before this subcommittee.
The DAN is comprised of five dystonia patient groups working
collaboratively to meet the needs of those affected:
--the Benign Essential Blepharospasm Research Foundation (BEBRF);
--the Dystonia Medical Research Foundation (DMRF);
--the National Spasmodic Dysphonia Association (NSDA);
--the National Spasmodic Torticollis Association (NSTA); and
--ST/Dystonia, Inc.
The DAN works to advance dystonia research, increase dystonia
awareness, and provide support for those living with the disorder. On
behalf of the dystonia community, I am here to request that you include
dystonia as a condition eligible for study through the Peer-Reviewed
Medical Research Program as you work to complete fiscal year 2013
Department of Defense appropriations.
Dystonia is a rare neurological movement disorder that causes
muscles to contract and spasm involuntarily. It is a chronic disorder
whose symptoms vary in degrees of frequency, intensity, disability, and
pain. Dystonia can be generalized or focal. Generalized dystonia
affects all major muscle groups, resulting in twisting repetitive
movements and abnormal postures. Focal dystonia affects a specific part
of the body such as the legs, arms, hands, eyelids, or vocal chords.
Dystonia can be hereditary or caused by trauma such as a car crash or a
blast exposure as experienced by military personnel. At this time,
there is no cure for dystonia 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.
In 1995, after my Navy career, I started feeling symptoms for what
would later be diagnosed as tardive dystonia, which is medication-
induced dystonia. The symptoms started as an uncontrollable shivering
sensation that often prompted people to ask me if I was cold. Over the
next 2 years, the symptoms continued to worsen, and I started feeling
like I was being squeezed: my diaphragm was constricted and I couldn't
breathe. I also had belpharospasm which meant that my eyes would shut
forcibly and uncontrollably, leaving me functionally blind even though
there was nothing wrong with my vision.
The tardive dystonia affected my entire upper body and for years my
spasms didn't allow me to sit in a chair, or sleep safely in the bed
with my husband. As a family joke, my mother made my husband a nose
guard to wear because I kept hitting him during the night. We made
light of the situation when we could, but I was facing much hardship
and loneliness. I spent those years having to sleep and even eat on the
floor. Before I developed dystonia, I had my own private practice as a
licensed psychotherapist which I had to give up as a result of my
spasms.
Because I have other service-connected disabilities and am
considered 100-percent unemployable, I receive care at the Veterans
hospital in Portland, Oregon. In 2000, I underwent surgery to receive
DBS. The surgeons implanted leads into my basil ganglia, the part of
the brain that controls movement. The DBS therapy delivers constant
electrical stimulation that interrupts the bad signals and helps
control the involuntary movements. Thanks to DBS, I have gone from
being completely nonfunctional, to having the ability to walk and to
move like a healthy individual. I am happy to say that I am now almost
completely symptom free. Many dystonia patients who undergo DBS do not
experience the positive results on the scale that I have, and some
undergo brain surgery only to find that the DBS has no effect.
Moreover, DBS is a treatment--not a cure.
The DAN has received reports that the incidence of dystonia in the
United States has noticeably increased 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 traumatic
injuries and the onset of dystonia. A June 2006 article in ``Military
Medicine'' entitled ``Post-Traumatic Shoulder Dystonia in an Active
Duty Soldier'' reported on dystonia experienced by military personnel
and concluded the following:
``Dystonia after minor trauma can be as crippling as a penetrating
wound, with disability that renders the soldier unable to perform his
duties . . . awareness of this disorder [dystonia] is essential to
avoid mislabeling, and possibly mistreating, a true neurological
disease.''
More recently, a study published in the May 16, 2012 issue of
``Science Translational Medicine'' led by Dr. Lee E. Goldstein of
Boston University's School of Medicine found that blast exposures can
cause structural problems in the brain that we believe will lead to
increased dystonia. As military personnel remain deployed for longer
periods, we can expect dystonia prevalence in military and veterans
populations to continue to rise.
Although Federal dystonia research is conducted through a number of
medical and scientific agencies, the Department of Defense (DOD) Peer-
Reviewed Medical Research Program remains the most essential program
studying dystonia in military and veteran populations. This program is
critical to developing a better understanding of the mechanisms
connecting trauma and dystonia. For the past 2 years, I have been a
consumer reviewer on this panel. The DAN 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, fiscal year 2011, and fiscal year 2012 Defense
Appropriation bills. The DAN is excited to report that dystonia
researchers have competed successfully within the peer-reviewed system
every year which underscores the important nature of their work. We
urge the subcommittee to maintain dystonia as a condition eligible for
study through the Peer-Reviewed Medical Research Program in fiscal year
2013.
Thank you again for allowing me the opportunity to address the
subcommittee today. I hope you will continue to include dystonia as a
condition eligible for study under the DOD Peer-Reviewed Medical
Research Program.
DAN Fiscal Year 2013 Defense Appropriations Recommendations
Peer-Reviewed Medical Research Program (PRMRP):
--Include ``dystonia'' as a condition eligible for study through the
PRMRP.
--Provide $50 million for PRMRP, which is housed within the
Congressionally Directed Medical Research Program.
Chairman Inouye. If this matter is service-connected, I can
assure you that we'll do our best to make certain your
organization continues its research.
Ms. Linde. Thank you.
Chairman Inouye. Thank you.
Our next witness is Ms. Joy Simha, representing the
National Breast Cancer Coalition.
STATEMENT OF JOY SIMHA, MEMBER, BOARD OF DIRECTORS,
NATIONAL BREAST CANCER COALITION
Ms. Simha. Thank you very much. I am Joy Simha, an 18-year
breast cancer survivor, co-founder of the Young Survival
Coalition and a member of the board of directors of the
National Breast Cancer Coalition, which is an organization made
up of hundreds of grassroots organizations from across the
country.
Chairman Inouye, Ranking Member Cochran, members of the
subcommittee: We thank you for your longstanding support for
the Department of Defense Peer-Reviewed Breast Cancer Research
Program (BCRP). You know the importance of this program to
women and their families both within and outside the military
across the country, to the scientific and healthcare
communities, and to the Department of Defense, because much of
the progress that has been made in the fight against breast
cancer is due to your investment in this important program.
The vision of the Department of Defense Peer-Reviewed BCRP
is to eradicate breast cancer by funding innovative, high-
impact research through the unique partnership of the Congress,
the Army, scientists, and consumers.
The Department of the Army must be applauded for overseeing
this unique program. It's established itself as a model medical
research program, respected throughout the cancer and broader
medical communities 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.
It is lauded worldwide and others try to emulate the program.
Its specific focus on breast cancer allows it 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 have the potential to benefit not just breast cancer,
but all cancers, as well as other diseases. Biomedical research
is literally being transformed by the Department of Defense
BCRP, 90 percent of the funds appropriated go to research.
Advocates bring a necessary perspective to the table,
ensuring that the science funded by the program is not only
meritorious, but also relevant to the women whose lives are
affected by this disease.
You may remember Karen Moss, a retired Air Force Lieutenant
Colonel who served almost 21 years on active duty and she
chaired the integration panel. Karen passed away in September
2008. She was committed to making a difference and ensuring
that the voices of consumer advocates were heard by the
scientific community, challenging scientists to always think
differently.
Her legacy reminds us that breast cancer is not just a
struggle for scientists; it's a disease of the people. She
chaired the integration panel the year that she died. 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 to keep the program focused on its
vision.
PREPARED STATEMENT
This is research that will help us win a very real and
devastating war against a very vicious enemy. You and your
subcommittee have shown great determination and leadership in
funding the DOD Peer-Reviewed BCRP at a level that has brought
us closer to ending this disease. I am hopeful that you will
continue that determination and leadership.
Thank you again for the opportunity to submit testimony and
represent all the people across this country who care about
ending this disease. Thank you.
[The statement follows:]
Prepared Statement of Joy Simha
Thank you, Mr. Chairman and members of the Appropriations
Subcommittee on the Department of 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, an 18-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 (DOD) Breast Cancer Research Program
(BCRP). My testimony represents the hundreds of member organizations
and thousands of individual members of the NBCC. NBCC is a grassroots
organization dedicated to ending breast cancer through action and
advocacy. Since its founding in 1991, NBCC has been guided by three
primary goals:
--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.
In September 2010, in order to change the conversation about breast
cancer and restore the sense of urgency in the fight to end the
disease, NBCC launched Breast Cancer Deadline 2020--a deadline to end
breast cancer by January 1, 2020.
Chairman Inouye and Ranking Member Cochran, we appreciate your
longstanding support for the Department of Defense (DOD) Peer-Reviewed
Breast Cancer Research Program. As you know, this program was born from
a powerful grassroots effort led by NBCC, and has become a unique
partnership among consumers, scientists, Members of Congress and the
military. You and your subcommittee have shown great determination and
leadership in funding DOD Peer-Reviewed BCRP at a level that has
brought us closer to ending this disease. I am hopeful that you and
your subcommittee 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 DOD. Much of the progress that has been made in the
fight against breast cancer is due to the Appropriations Committee's
investment in breast cancer research through the DOD BCRP. To support
this progress moving forward, we ask that you support a $150 million
appropriation for fiscal year 2013. In order to continue the success of
the program, you must ensure that it maintains its integrity and
separate identity, in addition to this 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 DOD Peer-Reviewed BCRP 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. Its
specific focus on breast cancer allows it 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 have 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.
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 the
science funded by the program fills important gaps not already being
addressed by other funding agencies. Since 1992, more than 700 breast
cancer survivors have served on the BCRP review panels.
Four years ago, Karin Noss, a retired Air Force Lieutenant Colonel
who served almost 21 years on active duty as a missile launch officer
and intelligence analyst, chaired the Integration Panel. Karin was 36
years old when she discovered a lump that was misdiagnosed by
mammography and clinical exam; just more than 1 year later, however,
she was diagnosed with Stage II breast cancer. Her diagnosis inspired
her to become knowledgeable about her disease, and as a trained
consumer advocate she began participating as a consumer reviewer on
BCRP scientific peer-review panels in 1997. Karin was committed to
making a difference and ensuring that the voice of consumer advocates
was heard by the scientific community, challenging scientists to think
differently.
Karin worked tirelessly in support of the BCRP through the pain and
fatigue of metastatic breast cancer. She died of the disease in
September 2008. Just a few weeks before her passing, Karin served what
would be her final role for the BCRP when she chaired the fiscal year
2008 Vision Setting Meeting, an important milestone at which the
program determines which award mechanisms to offer in order to move
research forward. She said that:
``Consumer involvement in all facets of the BCRP has proven crucial
to ensuring not only that the best and most innovative science gets
funded, but that the science will really make a difference to those of
us living with the disease.''
Karin demonstrated an amazing strength, determination, and
commitment to eradicating breast cancer. She was an optimist,
determined to make things better for women with breast cancer whose
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 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, three-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 2010 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, Ph.D., 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. For example, in fiscal year 2009, Dr. Seongbong Jo of the
University of Mississippi was granted a concept award to develop a
multifunctional nanoparticle that can selectively recognize breast
cancer and specifically inhibit the growth of cancer cells, while
minimally affecting normal cells. This has the potential to
significantly improve the delivery of breast cancer chemotherapy,
increase its efficiency, and contribute to the reduction of breast
cancer mortality rates.
IDEA and concept grants are uniquely designed to dramatically
advance our knowledge in areas that offer the greatest potential. In
fiscal year 2006, Dr. Gertraud Maskarinec of the University of Hawaii
received a synergistic IDEA grant to study effectiveness of the Dual
Energy Xray Absorptiometry (DXA) as a method to evaluate breast cancer
risks in women and young girls. Such a method, which could possibly be
used to prevent breast cancer during adulthood, is currently not
available because the risk of xray-based mammograms is considered too
high in that age group. Such grants are precisely the types 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 as well.
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. Dr. Dennis Slamon of the
University of California, Los Angeles was granted an innovator award in
fiscal year 2010 to develop new insights that will result in the
development of novel treatment initiatives for all of the current
therapeutic subtypes of breast cancer. This research builds upon the
past gains in understanding of the molecular diversity of human breast
cancer which has led treatment away from the ``one-size-fits-all''
therapeutic approaches, and the success of existing treatments of
specific breast cancer subtypes.
The Era of Hope Scholar Award supports 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. Stuart S. Martin of the University of Maryland,
Baltimore received a fiscal year 2010 Era of Hope Scholar Award to
build an international consortium to define a molecular framework that
governs the mechanical properties of a certain type of tumor cell
which, because of its shape, poses a greater metastatic risk than other
cells.
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, Herceptin, 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 results 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 towards 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. Erin McCoy of the University of Alabama,
Birmingham received a fiscal year 2010 Predoctoral Traineeship Award
for work on the potential role a certain protein, CD68, plays in breast
cancer cells attaching themselves to bone which allows metastatic
growth to take place. The bone is the most common site for breast
cancer metastasis. In fiscal year 2011, Dr. Julie O'Neal of the
University of Louisville received a Postdoctoral Fellowship Award to
study breast cancer biology with an emphasis on identifying enzymes
that are required for breast cancer growth.
Dr. John Niederhuber, former 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 2013.
outcomes and reviews of the department of defense breast cancer
research program
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
14,724 publications in scientific journals, more than 19,013 abstracts
and nearly 643 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
moving us closer to eradicating breast cancer.
The success of the DOD Peer-Reviewed BCRP has been illustrated by
several unique assessments of the program. The Institute of Medicine
(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 BCRP 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 BCRP 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 sixth Era of
Hope meeting in August 2011. As MSNBC.com's Bob Bazell wrote, this
meeting ``brings 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 . . .''
During the 2011 Era of Hope, investigators presented work that
challenged paradigms and pushed boundaries with innovative, high-impact
approaches. Some of the research presented looked at new ways to treat
the spread of breast cancer, including a vaccine for HER2+ breast
cancer that has stopped responding to treatment, and an innovative
treatment using nanoparticles of HDL cholesterol tied to chemotherapy
drugs to more directly zero in on cancer cells.
The DOD Peer-Reviewed BCRP 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 Web site 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 reaching Breast Cancer Deadline 2020's goal of ending the
disease by the end of the decade. 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 subcommittee to protect the integrity of the important model
this program has become.
There are nearly 3 million women living with breast cancer in this
country today. This year, approximately 40,000 will die of the disease
and more than 260,000 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 end 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, the 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 subcommittee have been leaders in
the effort to continue this innovative investment in breast cancer
research.
NBCC asks you, the Department of 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
nearly 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. I thank you for your testimony and I can
assure you that we'll do our very best to maintain the funding.
Thank you.
Next panel.
Our next panel consists of: the Honorable Charles Curie,
American Foundation for Suicide Prevention; Captain Charles D.
Connor, United States Navy, Retired, representing the American
Lung Association; Dr. William Strickland, representing the
American Psychological Association; and Mr. Robert Ginyard,
ZERO--the Project to End Prostate Cancer.
May I call upon Mr. Curie.
STATEMENT OF HON. CHARLES CURIE, MEMBER, NATIONAL BOARD
OF DIRECTORS AND PUBLIC POLICY COUNCIL,
AMERICAN FOUNDATION FOR SUICIDE PREVENTION
Mr. Curie. Chairman Inouye, Vice Chairman Cochran: Thank
you for providing the American Foundation for Suicide
Prevention (AFSP) with the opportunity to present testimony on
the needs of programs within the Department of Defense (DOD)
that play a critical role in suicide prevention efforts among
our Nation's military personnel. I respectfully submit my
written comments for the record.
Chairman Inouye. Without objection.
Mr. Curie. My name is Charles Curie. I'm a member of AFSP's
Public Policy Council and I serve on its National Board of
Directors. AFSP is the leading national not-for-profit
grassroots organization exclusively dedicated to understanding
and preventing suicide through research, education, and
advocacy, and to reaching out to people with mental disorders
and those impacted by suicide.
My professional experience spans 30 years in the mental
health and substance use services field. I was nominated by
President George W. Bush and confirmed by the U.S. Senate from
2001 to 2006 to head the Substance Abuse and Mental Health
Services Administration (SAMHSA). As SAMHSA Administrator, I
led the $3.4 billion agency responsible for improving the
accountability, effectiveness, and capacity of the Nation's
substance abuse prevention, addictions treatment, and mental
health services, including the President's New Freedom
Commission on Mental Health, the Strategic Prevention
Framework, Access to Recovery, National Outcome Measures, and
work with postconflict and war-torn countries' mental health
service systems, including Iraq and Afghanistan.
At the outset, I would like to thank the DOD and
specifically the Department of the Army for the tremendous
strides they have taken in recent years to not only understand
suicide, but for the concrete steps they have taken to prevent
suicide among their ranks. The DOD message that it's okay to
seek help and that getting help is the courageous thing to do
certainly saves lives and brings a new level of attention to
the problem of suicide.
Today, more than 1.9 million warriors have deployed for
Operation Iraqi Freedom and Operation Enduring Freedom, two of
our Nation's longest conflicts. The physical and psychological
demands on both the deployed and nondeployed soldiers have been
enormous. These demands are highlighted by the steady increases
in suicides among Army personnel since 2005.
Consider these facts: From 2005 to 2011, more than 927
active-duty Army personnel took their own lives; in 2008,
estimates of the rate of suicide among active-duty soldiers
began to surpass the suicide rate among U.S. civilians; 278
active-duty Army personnel, National Guard members, and Army
reservists died by suicide in 2011; and year-to-date data
indicates that so far 2012 is on track to be a record-high year
for suicides in the Army.
While access to affordable and quality treatment of mental
disorders is critical in preventing suicide, public health
efforts to get in front of suicide prevention are equally, if
not more, important than healthcare efforts, because we know it
is far more difficult to change behavior once someone has
already attempted suicide or has received treatment in an
inpatient treatment facility.
Last year, the Congress appropriated an $8.1 million
increase for the suicide prevention program under the Defense
Health Program. While AFSP appreciates the Congress's
commitment to preventing suicide among our Nation's military
personnel, this funding sits largely unused because of
restrictions on how those dollars must be spent. According to
the Office of the Secretary of Defense, Defense Health Program
dollars must be used for healthcare delivery programs and
services, not for prevention, education and training, or
research and development programs.
PREPARED STATEMENT
Requiring additional funding to be spent on treatment is
not going to help get in front of the problem. The services
should have the authority to spend it on prevention efforts and
not just healthcare delivery. Therefore, AFSP requests that
this subcommittee add clarifying language to the fiscal year
2013 Defense appropriations bill that would allow for these
dollars to be spent on pre-medical related prevention,
education, and outreach programs.
Thank you, Mr. Chairman, Mr. Vice Chairman, for the
opportunity.
[The statement follows:]
Prepared Statement of Charles Curie
Chairman Inouye, Ranking Member Cochran, and members of the
subcommittee: Thank you for providing the American Foundation for
Suicide Prevention (AFSP) with the opportunity to provide testimony on
the needs of programs within the Department of Defense (DOD) that play
a critical role in suicide prevention efforts among our Nation's
military personnel.
At the outset, I would like to thank the DOD, and specifically the
Department of the Army, for the tremendous strides they have taken in
recent years to not only understand suicide, but for the concrete steps
they have taken to prevent suicide among their ranks. Military leaders
are now more willing to openly talk about suicide within the military,
as well as among veterans and the civilian population. The DOD message
that it is okay to seek help, that getting help is the courageous thing
to do, has certainly saved lives and brought a new level of attention
to the problem of suicide. But we cannot wait for one minute, nor
soften our collective resolve, inside and outside of Government, to
help active duty military, veterans, and their families understand the
warning signs of suicide, or where to get help.
AFSP is the leading national not-for-profit, grassroots
organization exclusively dedicated to understanding and preventing
suicide through research, education, and advocacy, and to reaching out
to people with mental disorders and those impacted by suicide. You can
see more at www.afsp.org.
My name is Charles Curie. I am member of AFSP's Public Policy
Council, and I serve on the AFSP National Board of Directors. I am also
the Principal and Founder of The Curie Group, LLC, a management and
consulting firm specializing in working with leaders of the healthcare
field, particularly the mental health services and substance use
treatment and prevention arenas, to facilitate the transformation of
services and to attain increasingly positive outcomes in the lives of
people worldwide. I currently reside in Rockville, Maryland.
My professional experience spans 30 years in the mental health and
substance use services fields. I was nominated by President George W.
Bush and confirmed by the U.S. Senate from 2001 to 2006 to head the
Substance Abuse and Mental Health Services Administration (SAMHSA). As
SAMHSA Administrator, I led the $3.4 billion agency responsible for
improving the accountability, capacity, and effectiveness of the
Nation's substance abuse prevention, addictions treatment, and mental
health services, including The President's New Freedom Commission on
Mental Health, the Strategic Prevention Framework for substance use
prevention, Access to Recovery, National Outcome Measures and work with
post-conflict and war-torn countries metal health and substance use
treatment service systems, including Iraq and Afghanistan.
More than 1.9 million warriors have deployed for Operation Iraqi
Freedom (OIF) and Operation Enduring Freedom (OEF), two of our Nation's
longest conflicts (IOM, 2010). The physical and psychological demands
on both the deployed and nondeployed soldiers have been enormous. These
demands are highlighted by the steady increase in suicides among Army
personnel since 2005.
Consider these facts:
--From 2005 through 2011, more than 927 active duty Army personnel
took their own lives.
--In 2008, estimates of the rate of suicide among active duty
soldiers in the regular Army, Army Reserve, and Army National
Guard began to surpass the suicide rate among U.S.
civilians.\1\
---------------------------------------------------------------------------
\1\ Kuehn BM. Soldier suicide rates continue to rise: military,
scientists work to stem the tide. JAMA 2009; 301: 1111-13.
---------------------------------------------------------------------------
--Two hundred seventy-eight active duty Army personnel, National
Guard members, and Army reservists died by suicide in 2011.
--Year-to-date data indicates that 2012 is on track to be a record-
high year for suicides in the Army.
In light of studies that have shown more than 90 percent of people
who die from suicide have one or more psychiatric disorders at the time
of their death; critical context for these alarming suicide numbers was
provided in the April edition of the Medical Surveillance Monthly
Report (MSMR).
The MSMR showed that in 2011 mental disorders accounted for more
hospital bed days than any other medical category, and substance abuse
and mood disorder admissions accounted for 24 percent of the total DOD
hospital bed days.
This report also stated that outpatient behavioral health treatment
was the third highest workload category, and that the largest
percentage increase in workload between 2007 and 2011 was for mental
disorders (99-percent increase or 943,924 additional medical
encounters).
While access to affordable and quality treatment of mental
disorders is critical in preventing suicide, public health efforts to
``get in front'' of suicide prevention are equally, if not more,
important than healthcare efforts because we know that it is far more
difficult to change behavior once someone has already attempted suicide
or has received treatment in an inpatient treatment facility.
Last year, the Congress appropriated an $8,158,156 program increase
for suicide prevention under the Defense Health Program. While AFSP
appreciates the Congress's commitment to preventing suicide among our
Nation's military personnel, this funding sits largely unused because
of restrictions on how those dollars must be spent.
According to the Office of the Secretary of Defense, Defense Health
Program dollars must be used for healthcare delivery programs and
services and not for education and training or research and development
programs.
Requiring additional funding to be spent on treatment is not going
help the services get in ``front'' of this problem. The services should
have the authority to spend it on ``program evaluation'' and prevention
efforts and not just on healthcare delivery.
Therefore, AFSP requests that this subcommittee add clarifying
language to the fiscal year 2013 Defense appropriations bill that would
allow for these dollars to be spent on pre-medical related prevention,
education, and outreach programs.
Chairman Inouye, Ranking Member Cochran, and members of the
subcommittee: AFSP once again thanks you for the opportunity to provide
testimony on the funding needs of programs within the Department of
Defense that play a critical role in suicide prevention efforts. With
your help, we can assure those tasked with leading the Department of
Defense's response to the unacceptably high rate of suicide among our
military personnel will have the resources necessary to effectively
prevent suicide.
Chairman Inouye. I'm certain you're aware that this
subcommittee is deeply concerned about the rising rate of
suicides. We will make certain that these funds are used for
research and prevention.
Thank you very much.
Mr. Curie. Thank you.
Chairman Inouye. Our next witness is Captain Charles D.
Connor, representing the American Lung Association.
STATEMENT OF CAPTAIN CHARLES D. CONNOR, U.S. NAVY
(RETIRED), PRESIDENT AND CHIEF EXECUTIVE
OFFICER, AMERICAN LUNG ASSOCIATION
Captain Connor. Thank you very much, Mr. Chairman, Mr. Vice
Chairman. It's an honor to be here before you today to discuss
important matters such as the health of our Armed Forces. As a
retired Navy captain myself, it's very important to me as well.
The American Lung Association, as you know, was founded in
1904 to fight tuberculosis. Today, our mission is to save lives
by improving lung health and fighting lung disease. We
accomplish this through three research, advocacy, and
education.
All of us here, of course, recognize the importance of
keeping our military people healthy. Tobacco's adverse impact
on health is well known and extensively documented.
Accordingly, our view is that tobacco is an insidious enemy of
combat readiness.
Additionally, as this subcommittee well knows, healthcare
costs for our troops and their families continue to rise, both
for the Department of Defense (DOD) and the Veterans
Administration (VA). More than a billion dollars of this
healthcare bill is being driven by tobacco use annually. We owe
it to our military people and their families and the taxpayers
to prioritize the lung health of our troops.
The American Lung Association wishes to invite your
attention to three issues today for the DOD fiscal year 2013
budget: Number one, the terrible burden on the military caused
by tobacco use and the need for the Department to aggressively
combat it; the importance of restoring funds for the Peer-
Reviewed Lung Cancer Research Program to $20 million; and
finally, the health threat posed by soldiers' current and past
exposure to toxic pollutants in Iraq and Afghanistan.
The first subject is tobacco, briefly. Tobacco is a
significant public health problem for the Defense Department,
and it's not a problem that DOD simply inherited. More than 1
in 7 active duty personnel begin smoking after joining the
service.
The American Lung Association recognizes the Department of
the Navy's recent efforts to reduce tobacco use in their
branch, such as the Navy's 21st Century Sailor and Marine
Initiative announced just in the past few weeks. This
initiative will help sailors and marines quit tobacco and
promote tobacco-free environments. It also puts in place
environmental changes that will reduce tobacco use throughout
the Navy and Marine Corps.
Likewise, the American Lung Association also recognizes the
Air Force for its March 26 instruction on tobacco use. The
instruction states that, ``The goal is a tobacco-free Air
Force.'' It lays out strong policies on tobacco-free facilities
and workplaces, tobacco use in formal training programs, and
tobacco cessation programs. The document also establishes clear
responsibilities within the Air Force chain of command to
accomplish these goals and enforce their policies.
So these steps are really the first signal from the
military that tobacco use is disfavored. Both of these efforts,
the Departments of the Navy and the Air Force, are
unprecedented investments in the comprehensive health of
sailors, marines, airmen, and their families. So the American
Lung Association hopes these initiatives expand quickly to
cover all military personnel.
Also in 2011, DOD released a proposed rule implementing
coverage of tobacco cessation treatment through TRICARE. When
finalized, this new coverage will give soldiers and their
families the help they need to quit tobacco.
All of these actions follow recommendations in the
Institute of Medicine's report ``Combatting Tobacco Use in
Military and Veterans Populations'', which is now as of this
month 3 years old. The American Lung Association urges the DOD
and VA to fully implement all the recommendations in the report
and, importantly, we urge the Congress to remove any
legislative barriers that exist to implementing these
recommendations.
I'd like to leave for the record two articles from the
American Journal of Public Health that fully document the
extent to which the tobacco industry through their friends in
the Congress over decades past have enshrined into law
impediments that will impede the elimination of tobacco in the
military.
Just to wind up, we strongly support the Lung Cancer
Research Program and Congressionally Directed Medical Research
Program and its original intent to research the scope of lung
cancer in our military. We urge the subcommittee to restore the
funding level to $20 million and make sure the program is
returned to its original intent as directed by the 2009
program, which states, ``These funds shall be used for
competitive research. Priority shall be given to the
development of integrated components to identify, treat, and
manage early curable lung cancer.''
Last, respiratory item, the American Lung Association
continues to be troubled by reports of soldiers and civilians
returning from Iraq and Afghanistan with lung illness. Research
is beginning to show that the air our troops breathe in the war
theater can have high concentrations of particulate matter,
which can cause or worsen lung disease.
PREPARED STATEMENT
Data from a 2009 study of soldiers deployed in Iraq and
Afghanistan found that 14 percent of them suffered new-onset
respiratory symptoms. This is a much higher rate than their
nondeployed colleagues. So we urge that immediate steps be
taken to minimize troop exposure to pollutants and that DOD
investigate pollutants in the air our troops breathe.
Thank you very much for your time today.
[The statement follows:]
Prepared Statement of Captain Charles D. Connor
The American Lung Association is pleased to present this testimony
to the Senate Appropriations subcommittee on the Department of Defense
(DOD). 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.
I have no doubt you recognize the importance of keeping our
soldiers' lungs healthy. A soldier who uses tobacco or has asthma or
other lung disease is a soldier whose readiness for combat is
potentially compromised. Additionally, healthcare costs for these
troops continue to rise, both for DOD and for the Veteran's
Administration (VA). We owe it to our soldiers, their families, and
taxpayers to prioritize troops' lung health.
The American Lung Association wishes to invite your attention to
three issues for the DOD fiscal year 2013 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-Reviewed Lung
Cancer Research Program to $20 million; and
--the health threat posed by soldiers' exposure to toxic pollutants
in Iraq and Afghanistan.
tobacco use in the military
Tobacco use is a significant public health problem for DOD. And it
is not a problem DOD has simply inherited. More than 1 in 7
(approximately 15 percent) of active duty personnel begin smoking after
joining the service.
The American Lung Association recognizes the Department of the
Navy's recent efforts to reduce tobacco use in the military, such as
the Navy's 21st Century Sailor initiative. This initiative will help
sailors and marines quit tobacco, promote tobacco-free environments,
and put in place environmental changes that will reduce tobacco use
throughout the Navy and Marine Corps.
The American Lung Association also recognizes the Department of the
Air Force for its March 26 Air Force Instruction (AFI 40-102) on
Tobacco Use in the Air Force. The Instruction states that ``the goal is
a tobacco-free Air Force,'' and lays out strong policies on tobacco-
free facilities and workplaces, tobacco use in formal training
programs, and tobacco cessation programs. The document also establishes
clear responsibilities within the Air Force chain of command to
accomplish its goal and enforce the policies. Both of these efforts are
unprecedented investments in the comprehensive health of sailors,
marines, and airmen and their families. The American Lung Association
hopes these initiatives expand to other military branches.
In 2011, DOD released a proposed rule implementing coverage of
tobacco cessation treatment through TRICARE. When finalized, this new
coverage will give soldiers and their families the help they need to
quit tobacco.
All of these actions follow recommendations in the Institute of
Medicine's report Combating Tobacco Use in Military and Veterans
Populations. The American Lung Association urges DOD and VA to fully
implement all recommendations included in the report.
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. In fiscal year 2012, LCRP received
$10.2 million. We urge this subcommittee to restore the funding level
to $20 million and that 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''.
In August 2011, the National Cancer Institute released results from
its National Lung Screening Trial (NLST), a randomized clinical trial
that screened at-risk smokers with either low-dose computed tomography
(CT) or standard chest xray. The study found that screening individuals
with low-dose CT scans could reduce lung cancer mortality by 20 percent
compared to chest xray. These are exciting results, but conclusions can
only be drawn for the segment of the population tested by the NLST:
--current or former smokers aged 55 to 74 years;
--a smoking history of at least one pack a day for at least 30 years;
and
--no history of lung cancer. As the report made clear, CT scans
should be recommended for this narrowly defined population of
patients--but evidence does not support recommending them for
everyone.
The American Lung Association recently endorsed screening for this
defined population.
The Lung Cancer Research Program has the potential to further
knowledge on the early detection of lung cancer. The program recently
funded an exciting study at Boston University aimed at discovering
biomarkers to improve the accuracy of lung cancer diagnoses. We
encourage the DOD to continue its research into lung cancer.
respiratory health issues
The American Lung Association is troubled by reports of soldiers
and civilians returning from Iraq and Afghanistan with lung illnesses.
Research is beginning to show that the air troops breathe in the war
theater can have high concentrations of particulate matter, which can
cause or worsen lung disease. Data from a 2009 study of soldiers
deployed in Iraq and Afghanistan found that 14 percent of them suffered
new-onset respiratory symptoms, a much higher rate than their
nondeployed colleagues. The American Lung Association urges that
immediate steps be taken to minimize troop exposure to pollutants and
that the DOD investigate pollutants in the air our troops breathe.
conclusion
In summary, this 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. Troops must be protected from tobacco
and unsafe air pollution and the severe health consequences.
Thank you.
Chairman Inouye. The matter that you have discussed is very
serious and we look upon it as very serious. I can assure you
that we'll continue funding this.
Thank you.
Our next witness is Dr. William Strickland, representing
the American Psychological Association.
STATEMENT OF WILLIAM J. STRICKLAND, Ph.D., AMERICAN
PSYCHOLOGICAL ASSOCIATION
Dr. Strickland. Good morning, Mr. Chairman and Mr. Vice
Chairman. I'm Dr. Bill Strickland from the Human Resources
Research Organization (HumRRO). I'm submitting testimony today
on behalf of the American Psychological Association (APA),
which is a scientific and professional organization of more
than 137,000 psychologists.
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 counterterrorism. My
own military-oriented research and consulting focus on
recruiting, selecting, and training enlisted members of the
Army and the Air Force.
My testimony this morning will focus on reversing
administration-proposed cuts to the DOD science and technology
(S&T) budget. In terms of the overall DOD S&T budget, the
President's request for fiscal year 2013 represents another
step backward for defense research. Defense S&T would fall from
an enacted fiscal year 2012 level of $12.3 billion to $11.9
billion.
APA urges the subcommittee to reverse this cut to the
critical Defense Science Program by providing a total of $12.5
billion in Defense S&T funds in fiscal year 2013. APA also
encourages the subcommittee to provide increased funding to
reverse specific cuts to psychological research throughout the
military research laboratories. This human-centered research is
vital to sustaining warfighter superiority and both the
national academies and the Defense Science Board recommend that
DOD fund priority research in the behavioral sciences in
support of national security.
In the President's proposed fiscal year 2013 budget, the
Army and Air Force basic and applied research accounts all
would be reduced. The Air Force Research Laboratory's Human
Effectiveness Directorate is an example of a vital DOD human-
centered research program slated for dramatic cuts.
Headquartered at Wright-Paterson Air Force Base in Ohio, with
additional research sites in Texas and Arizona, the Human
Effectiveness Directorate's mission is to provide science and
leading-edge technology to define human capabilities,
vulnerabilities and effectiveness, to train warfighters, to
integrate operators and weapons systems, and to protect Air
Force personnel while sustaining aerospace operations.
The directorate is the heart of human-centered science and
technology in the Air Force as it integrates both biological
and cognitive technologies to optimize and protect airmen's
capabilities to fly, fight, and win in air, space, and
cyberspace. Proposed cuts to this directorate would cripple the
Air Force's to optimize the human elements of warfighting
capability.
PREPARED STATEMENT
We urge you to support the men and women on the front lines
by reversing yet another round of cuts to the overall Defense
S&T account, and specifically to the human-oriented research
projects within the military laboratories.
Thank you and I'd be happy to answer any questions.
Chairman Inouye. We will most certainly look into these
cuts. I've been told that you have some report language you'd
like to recommend.
Dr. Strickland. Yes, Sir, we do. It's in my written
statement.
Chairman Inouye. Will you submit that, Sir?
Dr. Strickland. Yes, Sir.
Chairman Inouye. I thank you very much, Doctor.
[The statement follows:]
Prepared Statement of William J. Strickland, Ph.D.
The American Psychological Association (APA) is a scientific and
professional organization of more than 137,000 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 counterterrorism. 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.
fiscal year 2013 department of defense appropriations summary
The President's budget request for basic and applied research at
DOD in fiscal year 2013 is $11.9 billion, a significant cut from the
enacted fiscal year 2012 level of $12.3 billion. APA urges the
subcommittee to reverse this cut to the critical Defense Science
Program by providing a total of $12.5 billion for Defense S&T in fiscal
year 2013.
APA also encourages the subcommittee to provide increased funding
to reverse specific cuts to psychological research through the military
research laboratories. This human-centered research is vital to
sustaining warfighter superiority.
department of defense 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 servicemembers 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 department of
defense
Within DOD, the majority of behavioral, cognitive, and social
science is funded through the Army Research Institute for the
Behavioral and Social Sciences (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, 6.3) while concurrently preparing for the next war (with
technology ``in the works,'' 6.2) and the war after next (by taking
advantage of ideas emerging from basic research, 6.1). 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
A recent 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 2013 department of defense budget for science and
technology
Department of Defense
In terms of the overall DOD S&T budget, the President's request for
fiscal year 2013 again represents a step backward for defense research.
Defense S&T would fall from an enacted fiscal year 2012 level of $12.3
to $11.9 billion. The military service labs and Defense-wide research
offices would see variable decreases, but also in some cases increases,
to their accounts. The Army and Air Force 6.1, 6.2, and 6.3 accounts
all would be reduced in the proposed budget. Navy's basic research
account (6.1) would remain funded at the fiscal year 2012 level, but
its 6.2 and 6.3 applied research portfolios each would see decreases.
DOD's OSD Defense-wide account would get increased funding in fiscal
year 2013 for both its basic 6.1 and advanced development 6.3 research,
whereas its 6.2 applied research account would be cut.
AFRL's Human Effectiveness Directorate is an example of a vital DOD
human-centered research program slated for dramatic cuts in the
President's fiscal year 2013 budget. Headquartered at Wright-Patterson
Air Force Base in Ohio (with additional research sites in Texas and
Arizona), the 711th Human Performance Wing's Human Effectiveness
Directorate's mission is to provide ``science and leading-edge
technology to define human capabilities, vulnerabilities and
effectiveness; train warfighters; integrate operators and weapon
systems; protect Air Force personnel; and sustain aerospace operations.
The directorate is the heart of human-centered science and technology
for the Air Force'', and integrates ``biological and cognitive
technologies to optimize and protect the Airman's capabilities to fly,
fight and win in air, space and cyberspace''. Proposed cuts to this
Directorate would cripple the Air Force's ability to optimize the human
elements of warfighting capability.
Defense Advanced Research Projects Agency
Defense Advanced Research Projects Agency (DARPA) is slated for a
slight agency-wide increase over its fiscal year 2012 level, increasing
from $2.74 to $2.75 billion in fiscal year 2013.
summary
The President's budget request for basic and applied research at
DOD in fiscal year 2013 is $11.9 billion, a significant cut from the
enacted fiscal year 2012 level of $12.3 billion. APA urges the
subcommittee to reverse this cut to the critical Defense Science
Program by providing a total of $12.5 billion for Defense S&T in fiscal
year 2013.
APA also encourages the subcommittee to provide increased funding
to reverse specific cuts to psychological research through the military
research laboratories. This human-centered research is vital to
sustaining warfighter superiority.
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 decisionmaking, 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 continues to meet the challenges of current
engagements, 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 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
2013 which would encourage the DOD to fully fund its behavioral
research programs within the military laboratories and the Minerva
Initiative:
department of defense
Research, Development, Test, and Evaluation
Warfighter Research.--The subcommittee notes the increased demands
on our military personnel, including high operational tempo, leadership
and training challenges, new and ever-changing stresses on
decisionmaking and cognitive readiness, and complex human-technology
interactions. To help address these issues vital to our national
security, the subcommittee 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 for the Behavioral and Social Sciences
and Army Research Laboratory; and
--the Office of Naval Research.
The Committee also notes the critical contributions of behavioral
science to combating counterinsurgencies and understanding extremist
ideologies, and renews its strong support for the DOD Minerva
Initiative.
Chairman Inouye. Our next witness is Mr. Robert Ginyard,
ZERO--the Project to End Prostate Cancer.
STATEMENT OF ROBERT GINYARD, MEMBER, BOARD OF
DIRECTORS, ZERO--THE PROJECT TO END
PROSTATE CANCER
Mr. Ginyard. Good morning, Mr. Chairman. Good morning, Vice
Chairman. Thank you for the opportunity to speak to you about
the prostate cancer research program and the Congressionally
Directed Medical Research Programs at the Department of
Defense.
My name is Robert Ginyard. I am a member of the Board of
Directors of ZERO--The Project to End Prostate Cancer, but I'm
also a prostate cancer survivor.
ZERO is a patient advocacy organization that raises
awareness and educates men and their families about prostate
cancer. Of particular importance to us is the issue of early
detection. It is a fact that early detection of prostate cancer
increases the likelihood that a man will survive prostate
cancer. In fact, if caught early the cancer--surviving cancer
at least 5 years is nearly 100 percent. If the cancer spreads
outside of the prostate into other organs, the chances drop to
29 percent. This is why I'm here today.
The recent actions taken by the United States Preventative
Service Task Force (USPSTF) threaten men's access to care and
makes it more important than ever for us to protect critical
research dollars that will help doctors make better decisions
about the diagnosis and treatment.
Two years ago my life was changed forever when I heard the
words: ``You have prostate cancer.'' Because my father also had
prostate cancer, I began having my prostate checked at age 40.
I am now 49. During my annual checkup, my doctor noticed that
my prostate-specific antigen (PSA) level was high, and it had
been rising in recent years. After the results of this PSA,
however, my doctor suggested that I see a urologist.
A few days after, I received a call that I would never want
to wish on anyone else. The doctor said: You do have prostate
cancer. I recall the doctor mentioning that he hated to give
this news on a Monday morning and, quite frankly, it wouldn't
have mattered what day he had given me this news.
I remember crying in the stairwell outside of my office.
The only thing I thought about was death, how long do I have to
live, will I see my daughters go to their prom, will I see them
go off to college, how will my beautiful wife and children make
out without me if something happens to me?
After getting over my diagnosis, it was time to take
action. I elected to receive a radical prostatectomy in 2010,
but because there were positive margins I had to undergo 4
months of radiation treatment and 4 months of hormone
treatment. Thirteen months afterwards, I'm proud to say, I'm
happy to say, I'm blessed to say, I am cancer-free with a great
quality of life.
But one of the most important things that came out of my
experiences things. During my daily treatments, most of the men
that I was in treatment with would always talk about their
wives. They would talk about them with hope in their voices.
They talked about how they wanted to enjoy life rather than
focus on death. It is my hope that we find a cure for prostate
cancer so that every day will be a father's day, a son's day, a
brother's day, a good friend's day.
I'm here today because prostate cancer affects the family,
not just the man. I am here today because I want the important
research at the Congressionally Directed Medical Research
Program, and particularly the Prostate Cancer Research Program.
Prostate cancer is a disease that is diagnosed in more than
240,000 American men each year and will kill 28,000 men in
2012. It is the second leading cause of cancer deaths among
men. One in six men--1 in 4 African-American men--will get
prostate cancer. Some will only be in their 30s.
The recent recommendation change by the USPSTF has
highlighted the issue of early detection for prostate cancer.
However, the issue is not whether we should be trying to detect
prostate cancer early, but how we can do it most effectively
and identify what cancers should be treated versus the ones
that shouldn't. The only way that doctors will know the answer
to this question is through advances that may be closer than we
think.
In 2010, research partially funded by the Prostate Cancer
Research Program identified 24 types of prostate cancer. Each
of these are aggressive forms of the disease. If we could
identify what type of cancer a man has, we could more
effectively determine if he needs treatment and how aggressive
treatment should be. This would render moot the argument some
make that the disease is overtreated and ultimately save men's
lives.
The Prostate Cancer Research Program is funding some of the
most critical research in cancer today. I ask that the
committee continue to fund this important, important research.
Many men will count on you. Many women will count on you. Their
family members will count on you.
PREPARED STATEMENT
It is one day that I can always look back and say: Hey,
look, I was there with you. I hope we get through this
together. I just ask for your continued support in this
initiative. There are many men who are really hoping that you
make the right decision to allocate the proper resources for
this research.
I thank you for your time and I thank you for your efforts
and all that you've done. Thank you.
[The statement follows:]
Prepared Statement of Robert Ginyard
Mr. Chairman and members of the subcommittee: Thank you for the
opportunity to speak to you about the Prostate Cancer Research Program
(PCRP) and the Congressionally Directed Medical Research Programs
(CDMRP) at the Department of Defense. My name is Robert Ginyard--I am a
member of the Board of Directors of ZERO--The Project to End Prostate
Cancer. Many people can speak effectively about the research this
program has done or is doing, about its history, funding levels, and
accomplishments, but I want to tell you about my experience with
prostate cancer and how you are having an impact on the lives of
patients and will continue to impact the lives of men and their
families through the research funded by the PCRP.
ZERO is a patient advocacy organization that raises awareness and
educates men and their families about prostate cancer. Of particular
importance to us is the issue of early detection. It is a fact that
early detection of prostate cancer increases the likelihood that a man
will survive prostate cancer. In fact, if caught early, a man's chances
of surviving cancer at least 5 years is nearly 100 percent--if the
cancer spreads outside of the prostate into other organs those chances
drop to 29 percent. This is why I am here today--recent actions by the
United States Preventive Services Task Force (USPSTF) threaten men's
access to care and makes it more important than ever for us to protect
critical research dollars that will help doctors make better decisions
about diagnosis and treatment.
Two years ago, my life was changed forever by three words I thought
I would never hear: ``You have cancer.'' Prior to receiving the news
that I had prostate cancer, I was engaged in another sort of battle--
seeking investors to raise capital for my tote bag company. And then
things came to an unexpected halt.
Because my father also had prostate cancer, I began having my
prostate checked at age 40; I am now 49. During my annual check up my
doctor noticed that my prostate specific antigen (PSA) level was high--
it had been rising in recent years. After the results of this PSA,
however, my doctor suggested I see a urologist for a biopsy. After a
few days, I received a call that I thought I would never receive--we
did find cancer in your prostate. I recall the doctor mentioning that
he hated to deliver this type of news on a Monday morning. Quite
frankly, with this type of news, it would not have made a difference
what day I received it. I remember crying in a stairwell outside of my
office. The only thing I thought of was death. How long do I have to
live? Will this mean I won't get to see my beautiful daughters go to
their high school prom, or graduate from college? How will my wife and
daughters make it without me?
After getting over the shock of my diagnosis, it was time to take
action and research the treatment options that were available to me. I
elected to have a radical prostatectomy in August 2010. Because there
were positive margins after my surgery, I underwent 4 months of hormone
therapy and 8 weeks of radiation treatments. Thirteen months after
treatment, I am happy to be cancer-free with a great quality of life.
One of the most interesting things that came out of my prostate
cancer experience was the power of hope. During my daily radiation
treatments, many of the men who I got to know on a very personal basis
always had a look of hope in their eyes. Going through with their
treatments they always talked about their wives. They talked about it
with hope in their voices--hope that their treatment will cure them, or
keep the cancer away long enough to be more engaged in living rather
than focusing on dying. It is with this hope that we must continue to
fund prostate cancer research so that everyday will be father's day,
son's day, grandfather's day, uncle's day, brother's day, or simply a
good friend's day.
I am here today because prostate cancer affects the family, not
just the man. I am here today because I want to stress the importance
of research at the CDMRP and particularly the PCRP.
Prostate cancer is a disease that is diagnosed in more than 240,000
American men each year and will kill more than 28,000 men in 2012. It
is the second-leading cause of cancer related deaths among men. One in
six men--1 in 4 African-American men--will get prostate cancer and some
will only be in their 30s. It's not just an old man's disease.
The recent recommendation change by the USPSTF has highlighted the
issue of early detection for prostate cancer. However, the issue is not
whether we should be trying to detect prostate cancer early, but how
can we do it most effectively and identify the cancers that should be
treated versus the ones that shouldn't.
The only way doctors will ever really know the answer to this
question is through advances that may be closer than we think. In 2010,
research partially funded by the PCRP identified 24 different types of
prostate cancer. Eight of these are aggressive forms of the disease. If
we could identify what type of prostate cancer a man has, we could more
effectively determine if he needs treatment and how aggressive that
treatment should be. This would render moot the argument some make that
the disease is over-treated, and ultimately save men's lives.
Another innovative funding mechanism of the PCRP is the Clinical
Trials Consortium. To address the significant logistical challenges of
multicenter clinical research, the clinical trials consortium was
started to promote rapid Phase I and Phase II trials of promising new
treatments for prostate cancer.
Since 2005, nearly 90 trials with more than 2,600 patients have
taken place, leading to potential treatments that will soon be
available to patients. Two recently approved drugs, XGEVA and ZYTIGA,
benefited from the consortium, accelerating their approval time by more
than 2 years.
The PCRP is funding some of the most critical work in cancer today.
The program uses innovative approaches to funnel research dollars
directly into the best research to accelerate discovery, translate
discoveries into clinical practice, and improve the quality of care and
quality of life of men with prostate cancer.
It is the only federally funded program that focuses exclusively on
prostate cancer, which enables them to identify and support research on
the most critical issues facing prostate cancer patients today. The
program funds innovative, high-impact studies--the type of research
most likely to make a difference.
I understand that the subcommittee is working under extremely tight
budgetary constraints this year and that many tough decisions are
ahead. This program is important to the millions of men who are living
with the disease, those who have survived the disease and those who are
at risk for the disease, including our veterans and active duty
military personnel.
Active duty males are twice as likely to develop prostate cancer as
their civilian counterparts. While serving our country, the United
States Armed Forces are exposed to deleterious contaminants such as
Agent Orange and depleted uranium. These contaminants are proven to
cause prostate cancer in American veterans. Unfortunately, the genomes
of prostate cancer caused by Agent Orange are the more aggressive
strands of the disease, and they also appear earlier in a man's life.
In addition, a recent study showed that Air Force personnel were
diagnosed with prostate cancer at an average age of just 48.
There are many men that will be diagnosed with cancer this year.
These men are placing their hope in this subcommittee that you will
consider them as you make the decision to allocate the proper resources
to help find a cure for this disease that not only affects men, but
their families and other loved ones.
Thank you very much for your time.
Chairman Inouye. I thank you very much, Mr. Ginyard, and I
can assure you we'll do our best to continue funding.
Mr. Ginyard. Thank you, Sir.
Chairman Inouye. I'd like to thank the panel.
Our next panel consists of: Captain Marshall Hanson, U.S.
Navy, Retired, representing Associations for America's Defense;
Major General Andrew ``Drew'' Davis, United States Marine
Corps, Retired, representing the Reserve Officers Association;
Ms. Karen Goraleski, representing the American Society for
Tropical Medicine and Hygiene; and Mr. John Davis, representing
the Fleet Reserve Association.
May I call upon Captain Hanson.
STATEMENT OF CAPTAIN MARSHALL A. HANSON, U.S. NAVY
(RETIRED), ACTING CHAIRMAN, ASSOCIATIONS
FOR AMERICA'S DEFENSE
Captain Hanson. Thank you, Mr. Chairman, Senator Cochran.
It's nice to be back in this seat after an absence before this
subcommittee of a couple of years.
The Associations for America's Defense (A4AD) is again
honored to testify. A4AD represents 13 associations that share
a concern for our national security.
While the subcommittee is recognized for its stewardship on
the defense issues, the challenges being faced this year seem
almost insurmountable. The administration's new defense
strategy guidance realigns national security with a tighter
Federal budget. Scheduled personnel cuts that start in 2015
will be used to pay for future investments in intelligence,
surveillance, reconnaissance, cyberspace, and counterterrorism.
The resulting reduction in force is supposed to be offset by
building partner capacity and by employing the concept of
reversibility.
While this may look good on paper, one can question the
substance. Not only is the Nation's security at risk of being
hollowed out from underbudgeting, but with the incomplete
strategy the United States might not be planning for a
potential threat.
The Pentagon will rely on traditional and new allies to
complement the U.S. force structure. Yet, European defense
plans will still rely on the United States. With military
budgets being cut in nearly all North Atlantic Treaty
Organization (NATO) countries, there is little promise that
Europe is ready to pick up the slack.
The defense guidance also states that the concept of
reversibility is a key part of the U.S. decision calculus,
placing emphasis on quickly restarting the industrial base and
relying on the right Active-to-Reserve component balance. This
is akin to building our defense foundation on quicksand.
Reversibility will take time, which may not be available in a
crisis.
The Pentagon has warned the Congress that there is no room
for modification of their budget or their strategy. This was
emphasized by the lack of submission of unfunded priority
lists. A4AD agrees with those Senators who wrote the service
chiefs that, without the military's budgetary needs, the
Congress cannot accurately determine the resources necessary
for our Nation's defense.
Normally, A4AD's testimony would include an unfunded list
for both the active and Reserve components which were submitted
by member associations. But the blackout of information has
affected us as much as it has this subcommittee.
When the Air Force suggested hasty cuts to its
infrastructure, the Congress wisely questioned this
hurriedness. The Senate Armed Services Committee has suggested
a commission to study the makeup of the Air Force. A4AD shares
the concern over the lack of analysis and justification and
suggests that this type of study needs to be done for all of
the services.
The Armed Forces need a critical surge capacity for
domestic and expeditionary support to national security in
response to domestic disasters. A strategic surge construct
needs to include manpower, airlift, and air refueling, sealift
inventory, logistics, and communications to provide a surge-to-
demand operation. This capacity requires funding for training,
equipment, and maintenance of a mission-ready strategic reserve
composed of both active and Reserve units.
PREPARED STATEMENT
This in itself is formidable, only complicated further by
budget control. The specter of sequestration only multiplies
the complexity of the puzzle that needs to be solved. The
disastrous consequences of automatic cuts to defense have been
documented in earlier hearings. A4AD asks this subcommittee to
work toward resolving sequestration prior to a lame duck
session, before the meat cleaver chops into the military and
the defense industry.
Thank you again for the opportunity to testify.
[The statement follows:]
Prepared Statement of Captain Marshall Hanson, USN (Retired)
associations for america's defense
Founded in January 2002, the Associations for America's Defense
(A4AD) is an ad hoc group of military and veteran service organizations
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
American Military Society
Army and Navy Union
Association of the U.S. Navy
Enlisted Association of the National Guard of the United States
Hispanic War Veterans of America
Marine Corps Reserve Association
Military Order of World Wars
National Association for Uniformed Services
Naval Enlisted Reserve Association
Reserve Enlisted Association
Reserve Officers Association
The Flag and General Officers' Network
The Retired Enlisted Association
introduction
Mr. Chairman and distinguished members of the subcommittee, A4AD is
again very grateful for the invitation to testify before you about our
views and suggestions concerning current and future issues facing the
Department of Defense Subcommittee Appropriations.
A4AD is an ad hoc group of 13 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
A4AD would like to thank this subcommittee for the on-going
stewardship that it has demonstrated on issues of defense. While in a
time of war, this subcommittee's pro-defense and nonpartisan leadership
continues to set an example.
Force Structure: The Risk of Erosion in Capability
Last January, the Obama administration announced a new Defense
Strategy Guidance, which has been a driving force in current budget
talks. The new strategy realigns national security with a tighter
Federal budget. Not only is the Nation's security at risk of being
hollowed out from being under budgeted, but with an incomplete strategy
the United States might not be planning for a potential future threat.
Not surprisingly, a lot of the aspects about this plan are not new.
The new strategy for the United States has evolved from fighting and
quickly winning two major wars simultaneously into winning one war
while ``deterring'' or ``dismantling'' the designs of a second
potential adversary.
Part of the ``revolution'' in military thinking justifying a new
strategy is a refocus from Europe to ``rebalance toward the Asia-
Pacific region''. It requires a shift of power to the Pacific, with
military end-strength reductions in Europe. But rather than build up
garrisoned forces in the Far East, this plan calls upon the mobility of
the Navy and Air Force to project power.
With a leaner defense strategy, the Pentagon will rely on
traditional and new allies to complement U.S. force structure. With the
U.S. planning to reduce its financial and military presence in Europe,
the Department of Defense (DOD) will expect Europe to take the lead.
Yet with military budgets being cut in nearly all North Atlantic Treaty
Organization (NATO) countries, there is little promise that Europe is
ready to pick up the slack.
Six years ago, Admiral Mike Mullen, then Chief of Naval Operations,
envisioned a thousand-ship Navy, where the U.S. and other navies
worldwide would partner to improve maritime security and information
sharing. ``For it to work, explicit and implicit references to U.S.
security concerns have to go'', warned one unnamed, former military
officer in an ``Armed Forces Journal'' article.
The risk of basing a national security policy on foreign interests
and good world citizenship is increasingly uncertain because 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.
In many ways, the new strategy is ``back to the future'', with DOD
constructing a strategy on old tactics and untried concepts, in order
to save money. This strategy is building a force structure on a shaky
foundation. Rather than rushing into this unknown, the Congress needs
to examine this plan closer.
budgetary constraints
A4AD strongly disagrees with placing budgetary constraints on
defense, especially in light of the fact that under the Budget Control
Act of 2011 (BCA) defense will take 50 percent of the cuts despite
being less than 20 percent of the overall budget. Member associations
also question the current administration's spending priorities, which
place more importance on the immediate future rather than a longer-term
approach.
DOD faces a trigger of an additional $500 billion in budget
reduction starting on January 1, 2013, that is in addition to the $587
billion already planned by DOD as cuts over the next 10 years, unless
something is done by the Congress.
``Historically we've run about 20 percent reductions after these
conflicts'', warned General James E. ``Hoss'' Cartwright, USMC
(Retired), former Vice Chairman of the Joint Chiefs at the Joint
Warfighting Conference. ``We are about halfway there . . . If you take
another two hundred billion out of this budget, we're going to start to
run into a problem if you don't start thinking about strategy.''
At a time when strategy is being shaped by budget, election
posturing, and an authority squabble between the Congress and the
Secretary of Defense, national security is being held hostage.
authority over force structure and strategy
A conflict has arisen over who maintains force structure. Defense
Secretary Leon Panetta has objected to additional defense funding in
the House National Defense Authorization Act, emphasizing that every $1
added to the defense authorization will come at the expense of other
critical national security programs. House Armed Services Committee
chairman Representative Buck McKeon responded that increases were
offset while complying with the overall BCA budget targets, which
specify $487 billion in cuts.
This exchange reflects an ongoing tension between the Pentagon and
the Congress over defense budgeting. The new Defense Strategy Guidance
warns ``as a result of a thorough process that was guided by the
strategy and that left no part of the budget unexamined, we have
developed a well-rounded, balanced package. There is no room for
modification if we are to preserve the force and capabilities that are
needed to protect the country and fulfill the missions of the
Department of Defense.'' The Pentagon is frustrated with any amount of
control by the Congress over the department's business.
A4AD understands that the Congress takes seriously their
constitutional responsibility to raise and maintain the Armed Forces.
This is interpreted as congressional authority to fund, equip, and
train the military and give committees, such as this, oversight on the
force structure, including nonfunded items.
risk of sequestration
As sequestration automatically cuts the Federal budget, DOD faces a
trigger of an additional $500 billion in budget reduction starting on
January 1, 2013 unless the Congress finds an offset or agrees to
reconciliation.
Secretary of Defense Panetta has warned the Congress that if the
automatic cuts of sequestration are allowed to take effect then the
number of U.S. ground troops would fall to pre-1940 levels; the Navy
would have the smallest number of ships since 1915; and the Air Force
would be the smallest ever.
If the President exempts personnel accounts, Secretary Panetta
warns that sequestration could require a 23-percent cut across the
military's budget for fiscal year 2013.
Some are suggesting that reconciliation can wait until after the
election, but the lame duck session schedule is already full. Among
things needing to be considered by December 31, 2012, are reversing
cuts to doctors' Medicare payments, Bush tax rates, 2-percent Social
Security payroll-tax cut, increasing the debt-ceiling negotiations,
expiration of the payroll tax cut, extending unemployment benefits,
rises in the Alternative Minimum Tax and the estate tax rates, tax cuts
from the 2009 economic-growth/stimulus law, the 100-percent write-off
for business investment, transportation and farm bill reauthorizations,
and 12 appropriations bills.
A4AD takes a position that it is vital that reconciliation is
reached prior to the national election. The House has already passed
its version. A4AD hopes that the Senate develops and passes its own
version of a balanced deficit reduction package, thus permitting the
two chambers to conference.
end strength
The administration already proposes cutting 100,000 troops. End-
strength cuts need to be made cautiously.
The deployment of troops to Iraq and Afghanistan proved that the
pre-9/11 end strengths left the Army and Marine Corps undermanned,
which stressed the force. Sequestration would double the reductions for
these two services.
The goal for active duty dwell time is 1:3, and 1:5 for the Reserve
component. After 10 years of war, this has yet to be achieved under
current operations tempo, and end-strength cuts will only further
impact dwell time.
Trying to pay the defense bills by premature manpower reductions
will have consequences.
reversibility?
President Obama made the point that an important goal of his
Defense strategy guidance was to avoid the mistakes made in previous
downsizings. He suggested that this could be done by designing
reversibility into the drawdown.
``The concept of `reversibility'--including the vectors on which we
place our industrial base, our people, our Active-Reserve component
balance, our posture and our partnership emphasis--is a key part of our
decision calculus,'' states the new DOD strategy.
This concept should be approached cautiously. If manpower is
drawndown and industry production lines are shut down, either will take
years to recover.
Adequate training for an infantry warrior can take a year and more,
and even then they lack the field experience. DOD's solution is to keep
midgrade officers and enlisted that can mature into the next-generation
leadership. Unfortunately, this is where shortages currently exist.
If industry is shutdown, skilled labor is laid off, and without
incentives tooling is destroyed. A restart is neither quick nor
inexpensive. Even with equipment back online, the skilled labor has
left for other work opportunities.
Without question, DOD needs to plan how it can sustain basic
proficiencies needed to battle emerging threats before relying on
reversibility. A4AD questions this strategy.
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 capability requires funding for training, equipping,
and maintenance of a mission-ready strategic reserve composed of Active
and Reserve units.
The budget will drive changes to the Armed Forces structure. The
National Guard and Reserve are in a position to fulfill many of the
missions, while remaining an affordable alternative.
base closure or defense realignment?
The President's budget recommends two more rounds of base closures.
A4AD does not support such a base realignment and closure (BRAC)
recommendation.
--BRAC savings are faux savings as these savings are outside the
accounting cycle; with a lot of additional $1 expenses front-
loaded into the DOD budget for infrastructure improvements to
support transferred personnel.
--Too much base reduction eliminates facilities needed to support
surge capability. Some surplus is necessary.
Instead, A4AD recommends that the Congress consider an independent
Defense Realignment Commission that would examine the aggregate
national security structure. The commission could examine:
--Emerging threats;
--Foreign defense treaties and alliance obligations;
--Overseas and forward deployment requirements;
--Foreign defense aid;
--Defense partnerships with the State Department and other agencies,
as well as nongovernmental organizations;
--Requisite missions and elimination of duplicity between the
services;
--Current and future weapon procurement and development;
--Critical industrial base;
--Surge capability and contingency repository;
--Best utilization and force structure of Active and Reserve
components;
--Regional or centralized training, and dual-purpose equipment
availability; and
--Compensation, recruiting and retention, trends, and solutions.
In a time of war and force rebalancing, 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 take precedence over budget reductions.
compensation commission
Another recommendation in the President's budget is a commission to
review deferred compensation. As structured, A4AD does not support this
proposal either, but if considered:
--This should not be a BRAC-like commission. The Congress should not
give up its authority.
--In one section of the President's budget, it suggests that the
President will appoint all of the members on the commission.
The Congress should share in appointments.
--While alternatives to current military retirement should be
explored, A4AD does not support a two-tiered system where two
generations of warriors have different benefit packages.
--An incentivized retirement option could be offered, rather than
making any new mandatory system.
--Should a task force be appointed, A4AD recommends that individuals
with military experience in both the Active and Reserve
component compensation be among those appointed, as the
administration has suggested that both regular and nonregular
(Reserve) retirement should be the same.
unfunded requirements
Earlier this year, the Joint Chiefs of Staff announced its decision
to discontinue the practice of providing the Congress with formal lists
of programs that were excluded from the President's budget request.
A4AD concurs with those Senators who wrote to the Secretary of
Defense that the military's budgetary needs cannot be determined
without the lists, known formally as the Unfunded Priorities Lists.
These lists, which have effectively been an extension of the Pentagon's
annual spending request for more than a decade, provide insight that
may otherwise be overlooked.
In the past, A4AD has submitted unfunded recommendations for the
service components of the Active and Reserve forces. Without such
lists, it is difficult to make recommendations that provide the
committee with additional information that spans even beyond the list.
national guard and reserve equipment requirements
A4AD asks this subcommittee to continue to provide appropriations
for unfunded National Guard and Reserve Equipment Requirements. The
National Guard's goal is to make at least one-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 would provide Reserve Chiefs with a flexibility of
prioritizing funding.
force structure funding
U.S. Army
Much of the media attention has been on the manpower cuts which
could be between 72,000-80,000 soldiers over the next 6 years, along
with a minimum of eight brigade combat teams. If sequestration occurs
reports are that another 100,000 personnel could be cut. The problem
faced by the Army is balancing between end strength, readiness, and
modernization.
Examples of Army reductions in procurement are its M1A1 Abrams
upgrade and Stryker vehicle program taking 84 percent and 57-percent
cuts, respectively, in planned spending. Army cuts create strategic
vulnerabilities.
To ignore the risk of a protracted ground campaign is a security
gamble. The Army has provided between 50 to 70 percent of the U.S.
deployable forces over the last 10 years.
Yet, 1 in 3 Active Army units do not have sufficient personnel to
perform its missions, requiring personnel to be cross-assigned from one
unit to another to accomplish missions. The Army Reserve and National
Guard face similar challenges. Defense cuts will further impact the
Army's ability to train and be ready. The Army needs $25 billion to
reset its force.
Air power and technology may be a critical part of a strategy, but
America's enemies won't fight the way America expects them to. Boots on
the ground will remain a critical part of this Nation's defense.
U.S. Marine Corps
Proposed budget cuts and mission resets could clip USMC's
triphibious flexibility. The USMC's capability to perform a combined
mission of land, naval, and air attack could become unbalanced with the
administration's plan to reset funding and missions to pre-war
strategies, and build-down the Armed Forces.
A change in strategy announced by Secretary of Defense Leon Panetta
would cut the USMC further than the 20,000 announced by the
administration. Under consideration is the elimination of another
infantry battalion and reducing some light-armored reconnaissance
capability.
A4AD supports the House V-22 proposal to procure under a multiyear
procurement contract that will save a proposed $852 million versus
single-year contracts.
The USMC is facing critical shortages of stockpiled equipment such
as radios, small arms, and generators. It needs about $12 billion to
reset its force.
The past three Marine Commandants have emphasized that the USMC
needs to get back to its naval roots as an amphibious force. The
associations have concerns that the stated need for amphibious warships
is a minimum of 33, and the likely cap is 30 ships.
U.S. Navy
Proposed defense cuts could reduce the number of navy ships to the
point that China will become dominant in the Western Pacific. This
reduction undercuts the new Defense Strategy Guidance.
Rather than growing the fleet to 330 ships, under sequestration
analyst warns that the fleet could drop to as few than 230 ships. The
Navy is tempted to retire ships early to reduce manpower requirements,
but this reduction also will reduce capability.
One in five ships when inspected is found not to be combat ready or
is severely degraded. The combatant commanders ask for 16 attack
submarines on a daily basis, but the USN can only provide 10. USN's
repair backlog is $367 million.
The Navy could lose some of its most important shipbuilding
industry partners if it slows down construction schedules.
A4AD applauds the House for reinstating 3 of the 4 cruisers
scheduled to be retired. These are cruisers with the Aegis Combat
System that is suitable for the at-sea missile defense mission. This
provides a flexible option to a land-based site.
U.S. Air Force
The U.S. Air Force's (USAF) fleet is now the oldest it has ever
been, and sequestration cuts will either reduce the number of units
sharply, or eliminate the USAF modernization. Defense cuts will affect
more than 20 USAF acquisition programs. Sequestration will have a
detrimental effect on all of the Air Force's procurements, including
new refueling tankers, tactical fighter jets, remotely piloted
aircraft, and long-range strike bombers.
The average age of a strategic bomber is 34 years. Cutting funds
for a new USAF bomber would seriously setback the progress of a
replacement.
The Air Force plans to drop 500 aircraft from its inventory in the
near future. This is caused by retirement of airplanes, elimination of
close combat missions, and delays in procuring replacements. The USAF
is cutting F-15 and F-16 fighters by more than 200 aircraft before
replacement F-35s are available.
The majority of these cuts are from the Air National Guard and Air
Force Reserve, affecting air sovereignty and surge capability.
The ``Air Force Magazine'' reports that the USAF's end-strength is
7-percent smaller than it was 7 years ago, yet the personnel costs for
this smaller force have risen 16 percent. USAF would have to cut 47,000
airmen out of its total force just to hold personnel spending at a
constant rate between fiscal year 2011 and fiscal year 2017. The Air
Force showed that a high percentage of the cuts would be taken out of
its Reserve components.
A4AD commends the House Armed Services Committee for delaying the
proposed cuts to the Air Reserve Components until the Secretary of the
Air Force provides supporting data, and details as to the affects of
such cuts on National Security. A4AD hopes that Senate will provide
similar direction to DOD.
According to Pentagon reports, the proposed fiscal year 2013 budget
calls for a 12-percent cut in aircraft programs. Aircraft procurement
for the Air Force, Navy, and Marine Corps, and the Army decreased from
$54.2 billion in fiscal year 2012 to a budget request of $47.6 billion
in fiscal year 2013.
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. Thank you very much, Captain. I can assure
you that we are doing our very best to avoid sequestration,
because if that ever happens then this hearing is for naught,
and in the process we may have to take some painful cuts, make
some painful decisions. But I can assure you we'll do our best.
Thank you very much.
Now may I call upon Major General Andrew Davis.
STATEMENT OF MAJOR GENERAL ANDREW DAVIS, U.S. MARINE
CORPS (RETIRED), EXECUTIVE DIRECTOR,
RESERVE OFFICERS ASSOCIATION OF THE UNITED
STATES
General Davis. Chairman Inouye and Senator Cochran: The
Reserve Officers Association (ROA) thanks you for the
invitation to appear and give testimony. I am retired Marine
Major General Drew Davis, the Executive Director of Reserve
Officers Association. I am speaking on behalf of the Reserve
Enlisted Association (REA).
ROA and REA are concerned about how the Congress and the
Pentagon will meet the requirements set by the Budget Control
Act of 2011 and the resulting cuts to the Defense budget. With
the Pentagon looking to reduce the Defense budget, a risk is
that the services will make disproportionate cuts to the
Reserve component to protect active duty roles, missions, and
end strengths.
Army Vice Chief of Staff General Lloyd Austin told the
Senate that with sequestration the Army would likely lose
another 100,000 troops on top of the 72,000 cuts already
planned. He said that one-half of these cuts would be in the
National Guard and the Army Reserve.
Cutting one reservist only provides 35 percent of the cost
savings when compared to the reduction of an active duty
rifleman, airman, or sailor.
As they have shown after 10 years of war, Reserve and Guard
perform their missions on par with active duty, at less
overhead and infrastructure cost. They require no base housing
and no medical care, and their retirement benefit is deferred
to age 60. To ignore the cost efficiencies of the Reserve
component is a disservice to the American taxpayer and violates
the axioms of strategic planning for our Nation's defense.
Additional further cost savings are found when civilian
knowledge and proficiencies can be called upon at no training
cost to the military.
With the Pentagon and the Congress examining our Nation's
security, it would be incorrect to discount the Reserve
components' abilities and cost efficiencies. The Reserve
strength of these part-time warriors provides a cost-saving
solution and are an area to retain competencies for missions
not directly embodied in the administration's new strategic
guidance.
For reversibility to succeed we will need a viable Reserve
component. The Reserve and National Guard are no longer just a
part-time strategic force, but contribute to our Nation's
operational ability to defend itself, project power, and
perform needed noncombat missions.
Nearly 850,000 Reserve and Guard members have been
activated and deployed since September 11, 2001, with more than
275,000 having done so two times or more. By throwing away this
required expertise and can-do attitude, we undermine the total
force at the same time.
Already, the Air Force and Navy are using their Reserve
components as bill-payers. ROA and REA thank those members of
this committee who delayed the recommended cuts by the Air
Force of Reserve component aircraft and facilities. Experienced
warriors are returning to their Reserve component training
sites and are finding aging facilities and obsolete and battle-
damaged equipment. To remain robust and relevant, they need to
have the same type of equipment or simulators for training that
they used during overseas missions. If the Reserve component is
simply put on the shelf, these volunteer young men and women
will walk away.
ROA and REA's written testimony includes lists of unfunded
requirements that we hope this subcommittee will fund. But we
also urge this subcommittee to specifically identify funding
for both the services' Reserve forces and the National Guard
exclusively to train and equip the Reserve components by
providing funds for the National Guard and Reserve equipment
appropriation. Just because the services did not submit a wish
list does not mean there are no wishes or needs.
PREPARED STATEMENT
In addition, we hope that the chairman reconsiders the
military construction appropriations to the Reserve components,
even though that subcommittee has marked up its bill. Our
written testimony includes dollar recommendations.
ROA and REA thank you again for your consideration of our
testimony and we look forward to working with this committee.
[The statement follows:]
Prepared Statement of Major General Andrew Davis
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 the Congress in 1950, the act established the objective of
ROA to: ``. . . support and promote the development and execution of a
military policy for the United States that will provide adequate
National Security''. The mission of ROA is to advocate strong Reserve
components and national security and to support Reserve officers in
their military and civilian lives.
The Association's 58,000 members include Reserve and Guard
soldiers, sailors, marines, airmen, and coastguardsmen, 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. ROA is represented in
each State with 54 departments plus departments in Latin America, the
District of Columbia, Europe, the Far East, and Puerto Rico. Each
department has several chapters throughout the State. ROA has more than
450 chapters worldwide.
ROA is a member of The Military Coalition, where it co-chairs the
Guard and Reserve Committee. ROA is also a member of the National
Military/Veterans Alliance. Overall, ROA works with 75 military,
veterans, and family support organizations.
The Reserve Enlisted Association (REA) 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.
introduction
On behalf of the 1.1 million members of the Reserve and National
Guard, the ROA and the REA thank the subcommittee for the opportunity
to submit testimony on budgeting issues affecting serving members,
retirees, their families, and survivors.
The associations would like to further thank those Senators who
have been working to postpone planned cuts to Reserve component (RC)
aircraft by the Air Force. A proper analysis needs to be done before
premature action is taken that could encumber our national security.
The title 10 Reserve and National Guard are no longer just a part-
time strategic force but are an integral contributor to our Nation's
operational ability to defend itself, assist other countries in
maintaining global peace, and fight against overseas threats. They are
an integrated part of the total force, yet remain a surge capability as
well.
At a time that the Pentagon and the Congress are examining our
Nation's security, it would be incorrect to discount the RC abilities
and cost efficiencies. Instead, these part-time warriors provide a
cost-savings solution and an area to retain competencies for missions
not directly embodied in the administration's new strategic policy,
``Sustaining U.S. Global Leadership: Priorities for a 21st Century
Defense''.
ROA and REA are concerned that as the Pentagon strives to achieve
the administration's goals for this new strategic policy, it is not
seriously considering the available assets and cost efficiencies of the
RC, and that it views the Reserve and National Guard as a bill payer
instead.
The Congress, starting with the leadership of this subcommittee,
should insist on a methodical analysis of suggested reductions in
missions and bases before budgeting for such changes. Haste creates
mistakes.
provide and execute an adequate national security
The ROA is chartered by the Congress ``to support and promote the
development and execution of a military policy for the United States
that will provide adequate national security''.
Requested action:
--Hold congressional hearings on the new policy of ``Sustaining U.S.
Global Leadership: Priorities for the 21st Century Defense''.
--Seek reconciliation to offset Defense sequestration budget cuts.
--Study the impact of manpower cuts to Army and Marine Corps on
national security.
--Avoid simple parity cuts of components without analyzing the best
Active-Reserve balance.
--Maintain robust and versatile all-volunteer Armed Forces that can
accomplish its mission to defend the homeland and U.S.
interests overseas.
ROA and REA question the current spending priorities that place
more importance on the immediate future, rather than first doing a
short- and long-term threat analysis. The result of such a budget-
centric policy could again lead to a hollow force whose readiness and
effectiveness is degraded.
ROA and REA share concerns about reductions in the Department of
Defense, while proposed budgets for other Federal agencies increase. An
example of this is the $13.4 billion budget increase for the Department
of Veteran Affairs (VA). Of this, $10.6 billion is an increase in
mandatory funding. When ROA asked the VA's Chief Financial Officer,
Todd Grams, what offset is being made to allow this increase, his
response was that no offset was needed as all but $1 billion were for
existing programs.
While some VA increase is obviously needed with the ever increasing
number of service-connected veterans who are disabled, injured, or ill,
every agency should be fiscally responsible to help balance the budget
and reduce the ever-growing deficit.
Serving members, retirees, families, and survivors are in effect
being taxed by defense reductions to be the dollar offsets for other
departments. Not only is this unfair, but by making cuts to national
security, it puts future warriors at a greater risk.
reserve strength thru efficiency
``With roughly 1.4 [million] Active-Duty servicemembers, 1.2
million Reserve-component members and likely future missions
worldwide,'' Dennis McCarthy, then-Assistant Secretary of Defense for
Reserve Affairs told ROA, ``the military will need to continue to rely
on reserve strength.''
The Reserve forces are no longer a part-time strategic force but
are an integral contributor to our Nation's operational ability to
defend our soil, assist other countries in maintaining global peace,
and fight in overseas contingency operations, as demonstrated by the
last 10 years of war. The Reserve and National Guard should not be
arbitrarily cut from the defense strategy.
Rather than be limited by historical thinking, and parochial
protections, creative approaches should be explored. The RC needs to
continue in an operational capacity because of cost efficiency and
added value. The cost of the Reserve and National Guard should not be
confused with their value, as their value to national defense is
incalculable.
The RCs remain a cost-efficient and valued force. It is just a
small percentage of the total services budget:
--Army Reserve: 7 percent of the Army budget; 18 percent of the
force.
--Army National Guard: 14 percent of the Army budget; 32 percent of
the force.
--Marine Forces Reserve: 6 percent of the United States Marine Corps
(USMC) budget; 16.5 percent of the force.
--Navy Reserve: 7 percent of the United States Navy budget; 17
percent of the force.
--Air Force Reserve: 4 percent of the Air Force (AF) budget, 14
percent of the force, and 20 percent of the capability.
--Air National Guard: 6 percent of the AF budget and 21 percent of
the force.
Value, on the other hand, is more intangible to calculate. The RC
fills an ongoing need for a surge capability as an insurance policy
against worse-case scenario's. Reserve and National Guard members give
the armed forces access to civilian skills that would prove too
expensive for the uniformed services to train and maintain. With less
than 1 percent of the U.S. population serving in uniform, the RC also
provides a critical link to American communities.
The Reserve and National Guard should also be viewed as a
repository for missions and equipment that aren't addressed in the
administration's new strategic policy. They can sustain special
capabilities not normally needed in peacetime.
Part of the President's budget includes planned end-strength
reductions for both the Army and Marine Corps, by 80,000 and 20,000,
respectively. It should be remembered that individuals cannot be
brought quickly on to active duty on a temporary basis, as it is an
accumulation of experience and training that is acquired over years
that becomes an asset for the military. The Reserve is also a
repository for these skills.
To maintain a strong, relevant, and responsive Reserve force, the
Nation must commit the resources necessary to do so. Reserve strength
is predicated on assuring the necessary resources--funding for
personnel and training, equipment reconstitution, and horizontal
fielding of new technology to the RC, coupled with defining roles and
missions to achieve a strategic/operational Reserve balance.
national guard and reserve equipment appropriation
Once a strategic force, the RCs are now also being employed as an
operational asset; stressing an ever greater need for procurement
flexibility as provided by the National Guard and Reserve Equipment
Appropriations (NGREA). Much-needed items not funded by the respective
service budget are frequently purchased through NGREA. In some cases,
it is used to procure unit equipment to match a state of modernizations
that aligns with the battlefield.
With the active component (AC) controlling procurement, a risk
exists where Defense planners may be tempted to put the National Guard
and title 10 Reserve on the shelf, by providing them ``hand me down''
outmoded equipment and by underfunding training. NGREA gives the
Reserve chiefs some funding control.
The Reserve and National Guard are faced with the ongoing
challenges of how to replace worn out equipment, equipment lost due to
combat operations, legacy equipment that is becoming irrelevant or
obsolete, and, in general, replacing what is lost in combat, or aged
through the abnormal wear and tear of deployment. The RCs benefit
greatly from a National Military Resource Strategy that includes an
NGREA.
The Congress has provided funding for the NGREA for more than 30
years. At times, this funding has made the difference in a unit's
abilities to carry out vital missions.
ROA thanks the Congress for approving $1 billion for NGREA for
fiscal year 2012, but more dollars continue to be needed. ROA urges the
Congress to appropriate into NGREA an amount that is proportional to
the missions being performed, which will enable the RC to meet its
readiness requirements.
military construction
ROA and REA attempted to submit testimony to an earlier hearing on
military construction by the Subcommittee on Military Construction and
Veterans Affairs, and other related agencies, but the associations were
told to submit this during the public witness hearing.
Unfortunately, the Military Construction and Veterans Affairs, and
other related agencies marked up their portion of the Senate version of
the appropriations bill on May 15. It is hoped that the Chairman will
include some of the following information in his Chairman's markup.
Requested Action.--ROA and REA urge the Congress to continue
appropriating funds for Military Construction budgets for the Reserve
and National Guard.
Military Construction funding has not generally kept pace with
essential RC facility modernization, conversion, and replacement
requirements. In fiscal year 2012, Military Construction for the RC was
appropriated $1.2 billion, which was $223 million less then the fiscal
year 2011 enacted level. The RCs indicated they need a higher level of
Military Construction funding in fiscal year 2013.
The RC's mission has changed from being primarily strategic
reserves and ``weekend warriors'' to being an operational reserve. The
RC now has a required high level of mission readiness which needs to be
supported by functional training and facilities for current and future
needs. They must train troops, maintain facilities and prepare troops
postdeployments to return to civilian life. Additionally, families are
supported throughout the force regeneration cycle phases. All of these
initiatives require maintaining, renovating, and modernizing
facilities.
As morale and combat readiness can be significantly affected by
inadequate facilities, it is prudent to sustain fiscal year 2011's
level of improvement (except the Air Force) in funding and allocation
of projects in fiscal year 2013.
Five-year project backlog:
Army National Guard.--Approximately $1.8 billion.
Air National Guard.--Approximately $660 million.
Army Reserve.--Approximately $1 billion.
Air Force Reserves.--Approximately $170 million.
Navy and Marine Corps.--Approximately $240 million.
In 2011, the U.S. Senate found that National Guard Army Reserve
facilities average more than 40 years in age. Other RCs suffer similar
challenges with aging infrastructure. Military Construction requests
fund the Reserve's most critical facilities and support total force
transformation. The Reserve and National Guard will be realigning its
forces to operational missions to provide increased combat service,
while the active-duty end strengths are being reduced.
base closure and realignment commission
The President's budget recommends two more rounds of base closures.
ROA and REA do not support such a base closure and realignment (BRAC)
recommendation. If any action is taken, the emphasis should be placed
on realignment rather than closure.
The association concerns are:
--BRAC savings are faux savings as these savings are beyond the
congressional budget accounting cycle; with a lot of additional
dollar expenses front loaded into the Defense budget for
infrastructure improvements to support transferred personnel.
--Too much base reduction eliminates facilities needed to support
surge capability, some surplus is good.
--Reserve and National Guard facilities should not be included, as
was the case in BRAC 2005 when RC facilities were closed to
reduce the risk of closure to active duty facilities.
association priorities
Calendar year 2011 legislative priorities are:
--Recapitalize the total force to include fully funding equipment and
training for the National Guard and Reserves.
--Ensure that the Reserve and National Guard continue in a key
national defense role, both at home and abroad.
--Provide adequate resources and authorities to support the current
recruiting and retention requirements of the Reserves and
National Guard.
--Support citizen warriors, families and survivors.
Issues To Help Fund, Equip, and Train
Advocate for adequate funding to maintain national defense during
times of war and peace.
Regenerate the RC with field compatible equipment.
Improve and implement adequate tracking processes on National Guard
and Reserve appropriations and borrowed RC equipment needing to be
returned or replaced.
Fully fund the military pay appropriation to guarantee a minimum of
48 drills and 2 weeks of training.
Sustain authorization and appropriation to 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.
Issues To Assist Recruiting and Retention
Support continued incentives for affiliation, re-enlistment,
retention, and continuation in the RC.
Pay and Compensation
Simplify the Reserve duty order system without compromising drill
compensation.
Offer professional pay for RC medical professionals, consistent
with the AC's pay.
Eliminate the 1/30th rule for Aviation Career Incentive Pay, Career
Enlisted Flyers Incentive Pay, Diving Special Duty Pay, and Hazardous
Duty Incentive Pay.
Education
Continue funding the GI bill for the 21st century.
Healthcare
Provide medical and dental readiness through subsidized preventive
healthcare.
Extend military coverage for restorative dental care for up to 90
days following deployment.
Provide funding for transitional TRICARE Reserve Select healthcare
for those beneficiaries being released from drill status.
Spouse Support
Repeal the Survivor Benefits Plan--Dependency Indemnity Clause
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 vital needs.
Key issues facing the Armed Forces concerning equipment:
--Procuring new equipment for all U.S. forces.
--Modernize by 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 RC.
Reserve component equipping sources:
--Procurement.
--Cascading of equipment from AC.
--Cross-leveling.
--Recapitalization and overhaul of legacy (old) equipment.
--Congressional add-ons.
--NGREA.
--Supplemental appropriation, such as overseas contingency operations
funding.
End Strength
The ROA would like to place a moratorium on any potential
reductions to the National 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 the support
of:
--Army National Guard of the United States, 358,200.
--Army Reserve, 206,000.
--Navy Reserve, 66,200.
--Marine Corps Reserve, 39,600.
--Air National Guard of the United States, 106,700.
--Air Force Reserve, 71,400.
--Coast Guard Reserve, 10,000.
In a time of war and force rebalancing, it is wrong to make cuts to
the end strength of the RCs. We need to pause to permit force planning
and strategy to catch-up with budget reductions.
unfunded reserve component equipment
ROA and REA agree with the Senate leadership that the Congress
should be provided with a unfunded list from both Active and Reserve
components. The below charts shows that the ground forces have the
greatest backlog of unfunded equipment.
Chart 1.--Items of unfunded equipment reported in the National Guard
and Reserve Equipment Report published by the Office of the Assistant
Secretary of Defense for Reserve Affairs. Fiscal year 2013 could be the
last year of publication if the Secretary of Defense insists on not
further unfunded lists.
army reserve components equipment priorities
Army Reserve Unfunded Requirements
While the Army Reserve (USAR) has 91 percent of its equipment on-
hand, only 67 percent of it is modernized, a decline of 2 percent from
last year. More new production and recapitalized equipment is needed to
close the gap with the active and the Army Guard.
An enduring operational force cannot be fully effective if it is
underfunded. Theater-provided equipment has allowed the USAR to provide
support during mobilization. The USAR rebuilt 70 percent of its 5-ton
cargo trucks and 83 percent of its semitrailer tankers to meet its
mission.
Top USAR equipping challenges of an operational Reserve are:
--Modernize and sustain equipment in a resource-constrained
environment.
--Equip USAR as an operational force capable of overseas, homeland
defense, and natural disasters.
--Modernize the tactical wheeled vehicle (TWV) fleet.
--Achieve full transparency for equipment procurement and
distribution.
--Expand the use of simulators to mitigate equipment shortfalls and
gain training efficiencies.
USAR UNFUNDED EQUIPMENT
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Force protection:
Alarm Biological Agent [BIDS] M31E2, 63 required...... $69
Armored Security Vehicle, 27 required................. 21
Combat logistics and mobility:
Loader Skid Steer: Type II, 40 required............... 1.2
Rough Terrain Contain Handler, 39 required............ 28.9
Ground vehicles:
Truck Cargo, 5-ton, 771 required...................... 154
Truck Dump, 10-ton, 213 required...................... 42.6
Truck, Expandable Van, 141 required................... 28.2
Soldier systems:
Medium Weapon Thermal Sights [MWTS]AN/PAS-13(V)2, 28.2
1,600 required.......................................
Thermal Sights AN/PAS-13B9V)1, 1,500, required........ 25.5
Javelin Command Launch Unit, 50 required.............. 11.5
Helicopter, Utility, UH-60L, 8 required............... 38.4
------------------------------------------------------------------------
Simulators
The use of simulations and simulators minimizes turbulence for USAR
soldiers and their families caused by training demands during the first
2 years of the Army Force Generation process by enabling individuals
and units to train at their home station and during exercises in a safe
environment without the increased wear and tear on equipment.
Army National Guard Unfunded Equipment Requirements
The on-hand percentage for all equipment is dropped from 92 percent
to 87 percent, and this does not include requirements for training.
Part of this requirement is dual use, with critical items of equipment
being needed for homeland missions with critical use inventory at 89
percent.
Top Army National Guard equipping challenges are:
--Equip units for pre-mobilization training and deployment.
--Equip units for their homeland missions.
--Achieve full transparency for equipment procurement and
distribution.
--Modernize ARNG TWV fleet.
--Improve interoperability with AC forces.
--Modernize the ARNG helicopter fleet.
ARNG UNFUNDED EQUIPMENT
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Strike:
Radar Sets AN/TPQ -36(V)10 and -37(V)9, 10/9 required. $231
Field support:
Containerized kitchen, 69 required.................... 15.5
Bradley Fighting Vehicle, Infantry, M2A3, 45 required. 198
Bradley Fighting Vehicle, Cavalry, M3A3, 29 required.. 116.5
Generator sets, 659 required.......................... 8.2
Air defense:
Radar set: Sentinel AN/MPQ-64......................... 66.5
Aviation:
Helicopter, Attack AH-64D, 16 required................ 402
Helicopter, Utility, UH-60L, 55 required.............. 267
Light Utility Helicopter, UH-72A, 34 required......... 132.6
Helicopter, Cargo CH-47F, 19 required................. 570
Medical field system:
MES Combat Medic, 463 required........................ 1.6
Medical Communications for Combat Casualty Care [MC4] 4.6
Program..............................................
------------------------------------------------------------------------
marine corps reserve unfunded priorities
Marine Forces Reserve (MFR) has two primary equipping priorities--
outfitting individuals who are preparing to deploy and sufficiently
equipping units to conduct home station training. Individuals receive
100 percent of the necessary war fighting equipment. MFR units are
equipped to a level identified by the Training Allowance (TA). MFR
units are equipped with the same equipment that is utilized by the AC,
but in quantities tailored to fit reserve training center needs. It is
imperative that MFR units train with the same equipment they will
utilize while deployed.
Top MFR equipping challenges are:
--Implementing Results of the Strategic Review from the Force
Structure Review Group; 40 percent of USMCR units may be
impacted by this review.
--Transitioning the KC-130 airframe.
--Providing units the ``right amount'' of equipment to effectively
train in a pre-activation environment.
--Achieving USMCR goal that the Reserve TA contains the same
equipment as the AC.
--Resetting and modernizing the MFR to prepare for future challenges.
USMCR UNFUNDED EQUIPMENT
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Aviation:
KC-130J Super Hercules Aircraft Tankers, 2 required... $184.6
UH-1Y Helicopter, Utility, 6 required................. 184.8
MV-22 B Tiltrotor Osprey, 2 required.................. 167.5
USMCR Simulators:
KC-130J Weapons System Trainer, 2 required............ 50
UH-1 Trainer, 1 required.............................. 16.5
Ground Transport:
Truck cargo, 22.5 ton, LVSR, 8 required............... 3.4
Lighted Armed Vehicle, Command/Control, 5 required.... 3
Light Armored Vehicles--LAV-25, procure 1 remaining... 3.2
------------------------------------------------------------------------
air reserve components equipment priorities
The Air Reserve Component (ARC) is made up of both the Air Force
Reserve (AFR) and the Air National Guard. Over the last 10 years they
have met all tasking, and were not asked to perform at full capacity.
ARC alone can cover:
--75 percent of Combat Air Force tasking.
--75 percent of Mobility Air Force tasking.
--50 percent of Aerial Refueling tasking.
Air Force Reserve Unfunded Requirements
AFR while fully integrated with the active for air, space, and
cyberspace, has higher sustainment needs across its fleet. Sustaining
operations on five continents, the resulting wear and tear weighs
heavily on aging equipment.
AFR has some specialized capabilities not found in regular AF
units. These include support of counternarcotics efforts, weather
reconnaissance including hurricane penetration, aeromedical evacuation,
aerial spray capabilities, and forest fire suppression.
Yet AF proposes cuts from the AFR. Even though the AF announced
that the AFR will be reduced by 900 personnel in fiscal year 2013, more
than 3,000 jobs will be realigned.
There will be a risk of further reductions at some locations. There
are 2,093 Reserve and 734 full-time staff (FTS) reductions shown in AF
announcements at six AFR flying locations. These include:
---563 Lackland, Texas (-385 reserve/-178 FTS in C-5s);
---580 Barksdale, Louisiana (-409/-171 closing AFR A-10 combat unit
recently returned from Afghan);
---53 Homestead, Florida (-40/-13 reducing RC F-16s);
---1,448 Pittsburgh, Pennsylvania (-1,122/-326 closing Wing and
Base);
---53 Fort Worth, Texas (-40/-13 reducing RC F-16s); and
---130 Youngstown, Ohio (-97/-33 reducing C-130s).
The closure of Air Reserve Station Pittsburg challenges the
congressional mandate and authority of base closure with more than 300
Federal employees.
Next in fiscal year 2014 and out, the plan to close the entire C-
130 wing at Maxwell, Alabama; the entire C-130 wing/base at
Minneapolis-St. Paul, Minneapolis; a C-130 flying squadron at Keesler,
Mississippi; and the C-130 wing/base at Niagara, New York.
These cuts will affect the surge and reversibility capabilities of
the AF. In these proposed reductions, the AF does not seem to
understand the importance of population/reserve demographics to cost-
effective Reserve unit locations. ROA and REA hope that this committee
supports actions by the House to delay and proposed reductions for a
year to properly review these recommendations.
Top AFR equipping challenges:
--C-5 Maintenance.
Defensive Systems.--LAIRCM, ADS, and MWS: equip aircraft lacking
adequate infrared missile protection for combat operations.
Data Link and Secure Communications.--Data link network
supporting image/video, threat updates, and SLOS/BLOS
communications for combat missions.
UNFUNDED EQUIPMENT
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Aviation:
Large aircraft infrared countermeasures............... $4
F-16 Systems, CDU, Combined AIFF With Mode 5/S, Sim 2
Trainer Upgrade......................................
C-17A upgrades........................................ 10
C-130 system upgrades................................. 13.7
KC-135 modifications.................................. 3.8
Telecommunication:
National Airspace System.............................. 1.3
Air and Space Operations Center....................... 2
Ground transportation:
Medium tactical vehicles.............................. 2.6
------------------------------------------------------------------------
Air National Guard Unfunded Equipment Requirements
The immediate threat the Air National Guard (ANG) was the
threatened reduction of squadrons and aircraft proposed by the Air
Force as cost saving measures. This included the reduction of 5,100 ANG
billets. ROA and REA hope that this committee support actions by the
House to delay and proposed reductions for a year to properly review
these recommendations.
PROPOSED CUTS TO THE ANG
------------------------------------------------------------------------
---------------------------------
C-130 H intratheater airlift.... 21 aircraft....... Provides 40
percent of the
total fleet.
C-5A heavy intertheater airlift. 13 aircraft....... Provides 25
percent of
outsize cargo
airlift.
C-27J short-to-medium range 15 aircraft....... Provides 100
tactical airlift. percent of the
total fleet.
A-10C ground support fighter.... 63 aircraft....... Performed 66
percent of the
missions.
F-16 C Fighter.................. 20 aircraft....... Since 2003, 3
percent of CentAF
taskings.
C-21 A operational support...... 24 aircraft....... Provides 40
percent of the AF
fleet.
------------------------------------------------------------------------
Given adequate equipment and training, the ANG will continue to
fulfill its total force obligations. On-hand equipment is just under 91
percent of requirements with dual use equipment being 88 percent of ANG
assets, but some major items of equipment are nearing 30 years of use.
Operations tempo has been high and prolonged, requiring equipment to be
modernized and recapitalized concurrently.
ANG equipping challenges:
--Modernize aging aircraft and other weapons systems for both dual-
mission and combat deployments.
--De-conflict dual use equipment when required for both Federal and
domestic missions.
--Acquire equipment to satisfy requirements for domestic operations
in each Emergency Support Function (ESF).
--Define an Air Force validation process for both Federal and State
domestic response needs.
--Program aging ANG F-16 aircraft for the Service Life Extension
Program (SLEP).
An ANG wing contains not only aircraft but fire trucks, forklifts,
portable light carts, emergency medical equipment including ambulances,
air traffic control equipment, explosives ordinance equipment, etc., as
well as well-trained experts--valuable in response to civil
emergencies.
UNFUNDED EQUIPMENT
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Command and Control:
Control and reporting center systems.................. $6.6
Air Defense Tactical Satellite Communications......... 1.2
Aviation:
C-17 large aircraft infrared countermeasures and 36.4
detection............................................
C-38 replacement aircraft............................. 62
C-40C Procurement..................................... 103
C-130 H/J Advanced LAIRCM/Missile Warning System...... 58.2
F-15 Advance Digital Warning/Radio Frequency CSM...... 85.7
F-16 advanced targeting pod upgrades.................. 83.5
Dual Mission: Rapidly deployable RPA capability........... 28.5
------------------------------------------------------------------------
navy reserve unfunded priorities
Active Reserve Integration (ARI) aligns active and Reserve
component units to achieve unity of command. Equipment used is the RC
is often experiencing service life of more than 20 years for many
platforms, adding sustainability and interoperability challenges,
leading to training and deployment challenges for mobilization ready
individuals and units. The United States Navy Reserve (USNR) has been
the primary provider of Individual Augmentees for the overseas
contingency operations filling Army and Air Force assignments.
Expeditionary missions include security forces, construction
battalions, cargo handling, and warehouse and fuel operations. The USNR
contributes 1/3 of the personnel in support of Special Warfare
operations. A new mission will be Maritime Civil Affairs which will be
doubling the number of units in the near future.
Top USNR equipping challenges are:
--Aircraft procurement (C-40A, P-8, KC-130J, and C-37B).
--Expeditionary equipment procurement (MESF, EOD, NCF, NAVELSG,
MCAST, EXPCOMBATCAM, and NEIC).
--Navy special warfare equipment.
USNR UNFUNDED EQUIPMENT
[In millions of dollars]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Aviation:
C-40 A Combo Cargo/Passenger Airlift, 4 required...... $340
KC-130J Super Hercules Aircraft Tankers, 2 required... 162
C-37 B (Gulf Stream) Aircraft, 1 required............. 64
H-53 E Sea Dragon, Mine Warfare....................... 24
F-5F Adversarial Aircraft Modification................ 4.3
USNR Expeditionary:
Maritime Civil Affairs Team, Equipment Allowance, 3 1
required.............................................
Tactical Vehicles..................................... 11.8
Civil Engineering Support Equipment................... 1.2
Materials Handling Equipment.......................... 1.2
------------------------------------------------------------------------
[Dollars in millions]
----------------------------------------------------------------------------------------------------------------
Percentage of
Reserve component Requirements On-hand Shortage required $$
----------------------------------------------------------------------------------------------------------------
ARNG 105,594.3 64,867.8 40,726.5 38.6
----------------------------------------------------------------------------------------------------------------
AR 27,283.6 16,634.9 10,648.7 39.0
----------------------------------------------------------------------------------------------------------------
USMCR 6,243.6 5,812.8 430.8 6.9
----------------------------------------------------------------------------------------------------------------
USNR 9,977.4 8,978.2 999.2 10.0
----------------------------------------------------------------------------------------------------------------
ANG 53,620.8 50,778.4 2,842.4 5.3
----------------------------------------------------------------------------------------------------------------
AFR 26,900.7 24,783.3 2,207.4 8.2
----------------------------------------------------------------------------------------------------------------
USCGR 51.1 26.1 25.1 49.0
----------------------------------------------------------------------------------------------------------------
Total 229,761.6 171,881.5 57,880.1 25.2
----------------------------------------------------------------------------------------------------------------
Chart 2.--``Beginning Fiscal Year 2013 Reserve Component Equipment $$$
Shortages'' published by the Office of the Assistant Secretary of
Defense for Reserve Affairs.
The Marine Corps Reserve (USMCR) reflects a 6.9 percent shortage of
its major items; however, the USMCR is equipped to a home station
training allowance only.
conclusion
The operations in Iraq and Afghanistan have demonstrated the
contributions to be made by the Reserve and National Guard. It the
future they will continue to play role in missions to maintain national
security.
This country cannot afford a strategy that writes them out of the
picture. It makes sense to fully fund the most cost efficient
components of the total force, its Reserve components.
The ROA, 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. General, I can assure you that this
subcommittee is well aware of the important role played by
Reserve and Guard forces in Afghanistan and Iraq, and we will
make certain that a study be carried out on base realignment
and closure (BRAC) recommendations and equipment. Those are
important items for this subcommittee.
Thank you very much, Sir.
General Davis. Thank you.
Chairman Inouye. Our next witness is Ms. Karen Goraleski,
representing the American Society of Tropical Medicine and
Hygiene.
STATEMENT OF KAREN GORALESKI, EXECUTIVE DIRECTOR,
AMERICAN SOCIETY OF TROPICAL MEDICINE AND
HYGIENE
Ms. Goraleski. Thank you, Mr. Chairman. Mr. Chairman and
Ranking Member Cochran: My name is Karen Goraleski. I am the
executive director of the American Society of Tropical Medicine
and Hygiene (ASTMH). Thank you for the privilege of testifying
before you today. I am here on behalf of our members, who are
the world's leading experts in the research and treatment of
tropical diseases, to respectfully request that the
subcommittee expand funding for the Department of Defense's
(DOD) efforts to develop new preventions, treatments, vaccines,
and diagnostics that will protect our service men and women
from infectious diseases in areas of the world where many serve
now or may serve in the future.
ASTMH understands the rich return on this DOD investment.
We are concerned that without the sustained resources needed to
address health risks to our troops, we will also inadvertently
hamper military mission success.
As a Nation, we must Americans' tax dollars wisely, and
this particular DOD investment has legs. First, our military
benefits, but so do Americans that travel for business, for
vacation, for school and faith-based volunteer work. Every gain
also helps reduce premature death and disability of those
living in the developing world.
Infectious disease is the ever-present enemy. Our
investments in new and effective tools must have a focus on
today as well as tomorrow. The drugs and preventive measures
used in earlier conflicts are quickly becoming resistant and we
can always bank on Mother Nature to deliver new diseases.
I want to highlight the smart and cost-effective work being
done at two facilities within the DOD, Walter Reed Army
Institute of Research (WRAIR), and the Naval Medical Research
Center (NMRC).
I will begin with WRAIR, which effectively leverages its
modest infectious disease research budget through domestic and
international partnerships, public and private, and they are
continually seeking out new ones. WRAIR's portfolio includes
malaria vaccine and drug development, malaria vector control,
drug development for leishmaniasis, a tropical disease
transmitted by sand flies that is prevalent in Africa, West
Asia, and the Middle East, enteric disease research, and HIV/
AIDS research and treatment.
WRAIR's success relies heavily on collaborations, as seen
in the development of RTS,S with the malaria vaccine initiative
and GlaxoSmithKline. Last fall, this large-scale phase 3 trial
showed an approximate 50-percent efficacy in decreasing
clinical episodes of malaria in African children. This is news
we rightfully celebrate for children and parents living in
malaria endemic countries. But for our military, right now
RTS,S is not suitable as a vaccine for adults who have never
experienced malaria as a child. This leaves us with more work
to do in order to protect our troops, but it is work that is
doable.
The NMRC works both in the United States and in its
overseas medical research laboratories located in Peru, Egypt,
and Cambodia. These labs offer outstanding scientific
collaborations and create deep and lasting relationships in
country. The labs also offer research and education
opportunities that are filled by local citizens, who then in
turn build in-country capacity.
Recently, Navy researchers announced the start of clinical
trials for a dengue fever vaccine to protect our troops from
this sometimes deadly virus found in tropical regions, and even
recently found in the United States. This vaccine would be a
game-changer in tropical medicine. No cure exists and right now
treatment is only symptom management.
PREPARED STATEMENT
In closing, our military must be ready at any time to
embark on a new mission, to a new location, which can mean
exposure to new and emerging health threats. This and the
vexing problem of drug resistance serve as stark reminders as
to why our investments cannot stop and where additional
investments are needed.
Thank you for this opportunity. ASTMH stands ready to serve
as an expert resource to you. We are in this together.
[The statement follows:]
Prepared Statement of Karen Goraleski, Executive Director of American
Society of Tropical Medicine and Hygiene
The American Society of Tropical Medicine and Hygiene (ASTMH)--the
principal professional membership organization representing, educating,
and supporting scientists, physicians, clinicians, researchers,
epidemiologists, and other health professionals dedicated to the
prevention and control of tropical diseases--appreciates the
opportunity to submit written testimony to the Senate Defense
Appropriations subcommittee.
ASTMH respectfully requests that the subcommittee expand funding
for the Department of Defense's (DOD) longstanding efforts to develop
new and more effective drugs, vaccines, and diagnostics designed to
protect servicemembers from infectious diseases including funding for
the important research efforts at the Walter Reed Army Institute of
Research (WRAIR) and the U.S. Naval Medical Research Center (NMRC).
department of defense research protects the u.s. military and civilians
and contributes to global health
A core component of ASTMH membership supports the work of the DOD,
and we understand first-hand the important role that research and
development play in protecting our service men and women deployed
abroad from the threat of infectious disease, as well as contributing
significantly to civilian medical applications. Specifically, DOD
infectious disease research contributes to the protection of:
--U.S. troops that are currently deployed or likely to be deployed in
many tropical areas;
--The safety of U.S. citizens, working, traveling, participating in
volunteer work, and vacationing overseas who are impacted by
these same tropical diseases;
--Our country from agents responsible for these diseases, which could
be introduced and become established in the United States (as
was the case with West Nile virus), or might even be
weaponized; and
--Citizens around the world who suffer disability and death from many
of these same tropical diseases.
walter reed army institute of research
A large part of DOD investments in infectious disease research and
development are facilitated through WRAIR. Between 2007 and 2010,
WRAIR's Center for Infectious Disease Research performed more than $260
million of research for the DOD and had an additional $140 million in
collaborative research work with external partner organizations. WRAIR
has advanced their work through critical public-private partnerships
and collaborative efforts with entities such as:
--GlaxoSmithKline and Sanofi;
--Nonprofit organizations such as the Bill & Melinda Gates
Foundation, Medicines for Malaria Venture, and PATH; and
--Other U.S. agencies including Centers for Disease Control and
Prevention, United States Agency for International Development,
and National Institutes of Health.
WRAIR invests in:
--malaria vaccine and drug development;
--drug development for leishmaniasis;
--enteric disease research;
--vector control for malaria and other vector-borne infections; and
--HIV/AIDS research and treatment.
One example of WRAIR's successful work and collaboration includes
the development of several significant and promising vaccine
candidates, including RTS,S, developed with PATH Malaria Vaccine
Initiative and GlaxoSmithKline, which recently underwent the first-ever
large-scale Phase 3 trial for a malaria vaccine. In trials last year,
the vaccine candidate decreases clinical episodes of malaria in
children in Africa by approximately 50 percent. While we celebrate this
news and the promise that it brings for children living in malaria-
endemic countries, RTS,S is not suitable as a vaccine for adults who
have never experienced malaria during childhood, such as our military
personnel. As a result, there remains a significant need for continued
research funding in order to achieve more robust results.
WRAIR is headquartered in Silver Spring, Maryland, and has research
laboratories around the globe including:
--a public health reference laboratory in The Republic of Georgia;
--dengue fever clinical trials in the Philippines;
--malaria clinical studies and surveillance in Kenya;
--military entomology network field sites in Thailand, the
Philippines, Nepal, Cambodia, Korea, Kenya, Ethiopia, Egypt,
Libya, Ghana, Liberia, and Peru; and
--several other coordination efforts with national health ministries
and defense units.
This diversity in research capacity puts WRAIR in a unique
leadership position in research and development for tropical diseases--
research that aids our military men and women as well as people living
in disease-endemic countries.
united states naval medical research center
NMRC and its affiliated labs conduct basic and applied research in
infectious disease. The Infectious Disease Directorate (IDD) of NMRC
focuses on malaria, enteric diseases, and viral rickettsial diseases.
IDD has an annual budget exceeding $10 million and conducts research on
infectious diseases that are considered to be a significant threat to
our deployed sailors, soldiers, airmen, and marines.
The primary objective of the Navy Malaria Program is to develop a
vaccine that kills the parasite during the first few days of
development in the liver, before it breaks into the blood. The program
is also investigating vaccines that would target blood-stage infection
to limit the severity of symptoms associated with this stage. Both of
these vaccines could alleviate much of the suffering caused by this
parasite in tropical areas.
The research is enhanced by IDD's close working relationship with
the Navy's three overseas medical research laboratories located in
Peru, Egypt, and Indonesia. These laboratories, like those of WRAIR,
afford diplomatic advancement through the close working relationships
they have developed with governments and citizens of those countries.
ASTMH has heard first-hand accounts of the successful diplomatic impact
that both the WRAIR and NMRC overseas labs have on the communities
where they are guests. Many of the researchers and staff who work in
the labs are local to the area and speak highly of the role of the U.S.
military labs.
tropical medicine and u.s. military operations
The term ``tropical medicine'' refers to the wide-ranging clinical,
research, and educational efforts of physicians, scientists, and public
health officials with a focus on the diagnosis, mitigation, prevention,
and treatment of diseases prevalent in the areas of the world with a
tropical climate. Most tropical diseases are located in sub-Saharan
Africa, parts of Asia (including the Indian subcontinent), Central and
South America, and parts of the Middle East. These are the same areas
military troops are often deployed. Since many of the world's
developing nations and economies are located in these areas, tropical
medicine tends to focus on diseases that impact the world's most
impoverished individuals.
case studies--the importance of department of defense's infectious
disease research efforts
Malaria has resulted in the loss of more person-days among U.S.
military personnel than to bullets during every military campaign
fought in malaria-endemic regions during the 20th century.
Because servicemembers deployed by the U.S. military comprise a
majority of the healthy adults traveling each year to malarial regions
on behalf of the U.S. Government, the U.S. military has understandably
taken a primary role in the development of anti-malarial drugs, and
nearly all of the most effective and widely used anti-malarials were
developed in part by U.S. military researchers. Drugs that now continue
to save civilians throughout the world were originally developed by the
U.S. military to protect troops serving in tropical regions during
World War II, the Korean War, and the Vietnam War.
In recent years the broader international community has increased
its efforts to reduce the impact of malaria in the developing world,
particularly by reducing childhood malaria mortality, and the U.S.
military plays an important role in this broad partnership.
Nonetheless, military malaria researchers at NMRC and WRAIR are working
practically alone in the area most directly related to U.S. national
security: drugs and vaccines designed to protect or treat healthy
adults with no developed resistance to malaria who travel to malaria-
endemic regions. NMRC and WRAIR are working on the development of a
malaria vaccine and on malaria diagnostics and other drugs to treat
malaria--an especially essential investment as current malaria drugs
face their first signs of drug resistance.
The latest generation of malaria medicines is increasingly facing
drug-resistance. The most deadly variant of malaria--Plasmodium
falciparum--is believed by the World Health Organization (WHO) to have
become resistant to ``nearly all anti-malarials in current use''. The
malaria parasite demonstrates a notorious and consistent ability to
quickly develop resistance to new drugs. Malaria parasites in Southeast
Asia have already shown resistance to the most recently developed anti-
malarial drug, artemisin.
Developing new antimalarials as quickly as the parasite becomes
resistant to existing ones is an extraordinary challenge, and one that
requires significant resources before this becomes widespread,
especially as United States military operations in malaria-endemic
countries of Africa and Asia increase. Without new anti-malarials to
replace existing drugs as they become obsolete, military operations
could be halted in their tracks by malaria. The 2003 malaria outbreak
affecting 80 of 220 marines in Liberia is an ominous reminder of the
impact of malaria on military operations. Humanitarian missions also
place Americans at risk of malaria, as evidenced by several Americans
contracting malaria while supporting Haitian earthquake relief efforts.
Leishmaniasis is a vector-borne disease that comes in several
forms, the most serious of which is visceral leishmaniasis, which
affects internal organs and can be deadly if left untreated. According
to the WHO, more than 350 million people are at risk of leishmaniasis
in 88 countries around the world. It is estimated that 12 million
people are currently infected with leishmaniasis, and 2 million new
infections occur annually. Co-infection of leishmaniasis and HIV is
becoming increasingly common, and WHO notes that because of a weakened
immune system, leishmaniasis can lead to an accelerated onset of AIDS
in HIV-positive patients.
Because of leishmaniasis' prevalence in Iraq, DOD has spent
significant time and resources on the development of drugs and new
tools for the treatment of leishmaniasis. As more troops return from
Iraq and Afghanistan, it is likely DOD and the Department of Veterans
Affairs will see an increase in leishmaniasis cases in our soldiers.
WRAIR discovered and developed Sitamaquine, a drug that, once
completed, will be an oral treatment for leishmaniasis. While essential
for the safety of our service men and women abroad, these types of
innovations will also be extremely beneficial to the at-risk
populations worldwide living in leishmaniasis-endemic countries.
Dengue fever (``breakbone fever''), according to the WHO, is the
most common of all mosquito-borne viral infections. About 2.5 billion
people live in places where dengue infection can be transmitted by
mosquitoes, and last year we saw a few cases pop up in the United
States. There are four different viruses that can cause dengue
infections. While infection from 1 of the 4 viruses will leave a person
immune to that strain of the virus, it does not prevent them from
contracting the other three, and subsequent infections can often be
more serious.
The DOD has seen about 28 cases of dengue in soldiers per year.
While none of these cases resulted in the death of a soldier,
hospitalization time is lengthy. Currently, there are several research
and development efforts under way within the DOD both for treatments
and vaccines for dengue.
u.s. government action is needed for mission readiness
The role of infectious disease in the success or failure of
military operations is often overlooked. Even a cursory review of U.S.
and world military history, however, underscores that the need to keep
military personnel safe from infectious disease is critical to mission
success. Ensuring the safety of those men and women in future conflicts
and deployments will require research on new tools. Additional funds
and a greater commitment from the Federal Government are necessary to
make progress in tropical disease prevention, treatment, and control.
Although several promising new infectious disease drugs are in
development at WRAIR and NMRC, the U.S. Government's funding level for
these programs has been anemic for several years. There are indications
that the current budget process may decrease or not keep up with
medical research inflation, let alone an increase in real dollars,
despite burgeoning evidence that many of our military's current drugs
are rapidly approaching obsolescence.
Fortunately, a relatively small amount of increased funding for
this program would restore the levels of research and development
investment required to produce the drugs that will safeguard U.S.
troops. In relation to the overall DOD budget, funding for infectious
disease research programs is very small. Cutting funding for this
program would deal a major blow to the military's efforts to reduce the
impact of these diseases on soldiers and civilians alike, thereby
undercutting both the safety of troops deployed to tropical climates
and the health of civilians in those regions.
ASTMH feels strongly that increased support for efforts to reduce
this threat is warranted. A more substantial investment will help to
protect American soldiers and potentially save the lives of millions of
individuals around the world. We appreciate the opportunity to share
our views in our testimony, and please be assured that ASTMH stands
ready to serve as a resource on this and any other tropical disease
policy matter.
Chairman Inouye. Ms. Goraleski, I thank you very much for
your testimony.
The Vice Chairman has a question to ask.
Ms. Goraleski. Yes, Sir.
Senator Cochran. Ms. Goraleski, I know that you are aware
of some collaboration between Walter Reed Hospital and the
University of Mississippi research capacity through the Natural
Products Research Center there. They're working to collaborate
to get Walter Reed Army Institute to identify safe and
effective drugs to treat tropical-related diseases and
illnesses, which you mentioned in your testimony.
I was curious to know if you are aware of this and how
effective any of these research efforts have been assumed to
be, and whether or not we need to put more money into these
efforts than what we have in this year's budget.
Ms. Goraleski. Yes, Sir, I am aware of those
collaborations. Those collaborations are really essential for
us to move progress forward. The Federal Government cannot do
it alone without multiple partnerships. I don't have the
specifics on that research. I just know of it overall, that
there is some interesting and productive developments. But I
will certainly find out the details for you and make sure you
get that immediately. Thank you.
Senator Cochran. Thank you very much. We appreciate your
assistance to the subcommittee.
Ms. Goraleski. You're welcome.
Chairman Inouye. Thank you very much.
Now may I call upon Mr. John R. Davis, representing the
Fleet Reserve Association.
STATEMENT OF JOHN R. DAVIS, DIRECTOR, LEGISLATIVE
PROGRAMS FLEET RESERVE ASSOCIATION
Mr. Davis. My name is John R. Davis and I want to thank the
subcommittee for the opportunity to express the views of the
Fleet Reserve Association (FRA) today.
FRA supports legislation to exclude the Defense budget from
sequestration and agrees with the Secretary of Defense Panetta,
who said these sequestration cuts would, ``do catastrophic
damage to our military, hollowing out the force and degrading
its ability to protect the country''.
Defense accounts for 17 percent of the Federal budget but
will receive 50 percent of the sequestration cuts. Less than 1
percent of the population is shouldering 100 percent of the
burden of maintaining our military and national security, and
the punitive funding reductions mandated by sequestration would
force across-the-board cuts to all programs that could
potentially threaten the all-volunteer force.
Ensuring adequate funding for the military health system
and maintaining the current retirement system are top
legislative priorities for the association. This is reflected
in responses to the association's 2012 survey, completed in
February by more than a thousand current and former
servicemembers, who cited retirement and military health
programs as the most important benefits. Over the past several
years, healthcare has consistently been a top concern for all
segments of the military community, that being the Active Duty,
Reserve component, veterans, and retirees.
This year's survey, however, revealed that active duty and
reservists viewed the military retirement above healthcare and
pay.
FRA believes that the administration's fiscal year 2013
budget request devalues military service by proposing drastic
TRICARE enrollment fee increases for all retirees and excessive
pharmacy co-pay increases. All reservists and 97 percent of
active duty participants in the survey found retirement
benefits as the most important benefit.
FRA appreciates Secretary of Defense Panetta's statement
that those currently serving would not be impacted by the
changes proposed by the administration's proposed retirement
commission, but wonders why there is no similar commitment to
those who have served in the past.
The Senate Armed Services Committee approved the markup
recently for the Defense authorization bill and that expands
this commission to include not just retirement pay, but also
current active duty compensation. Although we are thankful it
excludes currently serving and retirees, the FRA opposes this
base realignment and closure (BRAC)-like type commission
because it would bypass the expertise of this Committee and
subcommittee on Capitol Hill.
FRA supports Senators Frank R. Lautenberg and Marco Rubio's
bill, the Military Health Care Protection Act, that would seek
to protect TRICARE beneficiaries from excessive and unfair
enrollment fee increases and significant hikes in pharmacy co-
pays. The bill will emphasize that military service, unlike
other civilian occupations and associated healthcare costs, are
earned through 20 years or more of arduous service and
sacrifice.
The association does support the administration's fiscal
years 2013 and 2014 active-duty pay increase that is equal to
the Employment Cost Index.
FRA supports a Defense budget at least 5 percent of the
gross domestic product (GDP), that will adequately fund both
people and weapons programs, and is concerned that the
administration's spending plan is not enough to support both,
particularly given the ongoing operational commitments
associated with the new defense strategy. Further, spending on
national defense as a percentage of GDP will be reduced,
despite significant continued war-related expenses and
extensive operational and national security commitments.
PREPARED STATEMENT
The Defense budget could actually shrink by more than 30
percent over the next decade, and the administration projects
outlays of only 2.7 percent of GDP in 2021. That would be down
from last year's 4.5 percent of GDP. That would be down--the
2021 outlays would be pre-World War II outlays. As recently as
1986, though, the United States has spent 6.2 percent of GDP on
defense, with no real detrimental economic impact.
Again, thank you for allowing me to submit FRA's views to
the subcommittee.
[The statement follows:]
Prepared Statement of John R. Davis
the fleet reserve association
The Fleet Reserve Association (FRA) is the oldest and largest
enlisted organization serving Active Duty, Reserves, retired, and
veterans of the Navy, Marine Corps, and Coast Guard. It is
congressionally chartered, recognized by the Department of Veterans
Affairs (VA) as an accrediting Veteran Service Organization (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 Navy.
FRA's mission is to act as the premier ``watch dog'' organization
on Capitol Hill in maintaining and improving the quality of life for
Sea Service personnel and their families. The Association also sponsors
a National Americanism Essay Program and other recognition and relief
programs. In addition, the FRA Education Foundation oversees the
Association's scholarship program that presented awards totaling more
than $120,000 to deserving students last year.
The Association is also a founding member of The Military Coalition
(TMC), a consortium of more than 30 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 87 years of service in November 2011. For nearly
nine 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
Standard) was an initiative of FRA, as was the Uniformed Services
Survivor Benefit Plan (SBP). More recently, FRA led the way in
reforming the REDUX Retirement Plan, obtaining targeted pay increases
for mid-level enlisted personnel, and sea pay for junior enlisted
sailors. FRA also played a leading role in advocating recently enacted
predatory lending protections and absentee voting reform for
servicemembers and their dependents.
FRA's motto is: ``Loyalty, Protection, and Service.''
certification of nonreceipt of federal funds
Pursuant to the requirements of House Rule XI, the FRA has not
received any Federal grant or contract during the current fiscal year
or either of the 2 previous fiscal years.
introduction
Mr. Chairman, the FRA salutes you, members of the subcommittee, and
your staff for the strong and unwavering support of funding for
programs essential to Active Duty, Reserve component, and retired
members of the uniformed services, their families, and survivors. The
subcommittee's work has greatly enhanced care and support for our
wounded warriors and significantly improved military pay and other
benefits and enhanced other personnel, retirement, and survivor
programs. This support is critical in maintaining readiness and is
invaluable to our uniformed services engaged throughout the world
fighting the global War on Terror, sustaining other operational
requirements and fulfilling commitments to those who've served in the
past.
stop department of defense sequestration
As mandated by the 2011 Budget Control Act, failure of the Super
Committee in 2011 to develop a bipartisan plan to contain the growth of
the national debt will force implementation of ``sequestration'' in
January 2013 unless the Congress intervenes. Failure to act will
trigger across-the-board cuts with one-half coming from the defense
budget. FRA agrees with Secretary of Defense Leon Panetta, who said
these cuts ``would do catastrophic damage to our military, hollowing
out the force and degrading its ability to protect the country.''
Defense counts for 17 percent of the Federal budget but will receive 50
percent of the sequestration cuts.
With the American military out of Iraq and the conflict in
Afghanistan winding down, some are suggesting the possibility of a
``peace dividend.'' Although there have been victories in the War on
Terror, there has been no peace treaty with terrorism and an additional
$500 billion in defense cuts beyond the already-planned reductions over
the next decade beginning in fiscal year 2013 could jeopardize
essential funding of military pay and benefit programs, which would
negatively impact recruiting, retention, and overall military
readiness. For these reasons, FRA strongly supports the ``Down Payment
to Protect National Security Act'' (S. 2065) sponsored by Senator Jon
Kyl and a House bill (H.R. 3662) sponsored by the House Armed Services
Committee (HASC) Chairman, Representative Howard P. ``Buck'' McKeon.
These proposals would amend the Budget Control Act of 2011 by excluding
the Department of Defense budget from the first year of sequestration
(2013).
Less than 1 percent of the population is shouldering 100 percent of
the burden of maintaining our national security, and the punitive
funding reductions mandated by sequestration would force major across-
the-board cuts to all programs and could potentially threaten the all-
volunteer force.
budget devalues military service
FRA's membership is especially concerned about the administration's
proposed fiscal year 2013 budget which includes plans to drastically
increase existing TRICARE Prime enrollment fees, implement new fees for
TRICARE Standard and TRICARE-for-Life beneficiaries, and increase
pharmacy co-pays. If authorized, fees would be tiered based on the
beneficiary's retired pay. These increases are a major concern to the
entire military retiree community and since mid-February that concern
has prompted nearly 20,000 messages to Capitol Hill via FRA's Web site
Action Center. Our members are also concerned that the budget calls for
the fees to be adjusted annually based on healthcare inflation after
fiscal year 2017.
As this statement is being written, the Senate Armed Services
Committee has not marked up its version of the Fiscal Year 2013 Defense
Authorization bill. The HASC version of the legislation (H.R. 4310) did
not authorize the proposed healthcare fee increases for all military
retirees--including TRICARE for Life (TFL) beneficiaries. The panel
did, however, authorize higher pharmacy co-pays. In addition, future
co-pay adjustments will be tied to the Consumer Price Index which is
the basis of annual military retired pay adjustments and consistent
with future TRICARE Prime enrollment fee adjustments that became
effective this year. The legislation also authorizes a 5-year pilot
program that would require TFL beneficiaries to use the mail-order,
home delivery program rather than retail pharmacies for maintenance
drugs, and beneficiaries could opt out of the program after 1 year.
There would be no cost for prescriptions filled at military pharmacies.
The budget request also calls for a commission to study and propose
changes to the military retirement system. This BRAC-like process would
bypass the expertise of Senate and House committees and subcommittees
and only allow the Congress an up-or-down vote on the commission's
recommendations. All reservists responding to a recent (February 2012)
FRA survey, and 97 percent of active duty participants ranked
retirement benefits as a very important benefit. More than 1,000
current and former servicemembers participated in the survey. As the
Congress considers plans to reduce DOD costs by revamping the military
retirement program, that benefit is particularly relevant to Active
Duty and Reserve component personnel. Many current servicemembers have
expressed concern about the future of the retired pay and healthcare
benefits they've been promised after they complete a career of military
service. FRA appreciates Secretary of Defense Panetta assuring those
currently serving that they will come under the current retirement
system, but wonders why there is no similar commitment for those who
served in the past?
The budget also requests an Active Duty and Reserve pay hike based
on the Employment Cost Index of 1.7 percent in 2013, and only at that
level in 2014 with capped pay adjustments below that index thereafter.
FRA supports a defense budget of at least 5 percent of GDP that
will adequately fund both people and weapons programs, and is concerned
that the administration's spending plan is not enough to support both,
particularly given ongoing operational commitments associated with the
new defense strategy.
Future spending on national defense as a percentage of GDP will be
reduced despite significant continuing war related expenses and
extensive operational and national security commitments. Wall Street
Journal editorial writers noted, ``Taken altogether, the (defense)
budget could shrink by more than 30 percent in the next decade. The
administration projects outlays at 2.7 percent of GDP in 2021, down
from 4.5 percent last year (which included the cost of Iraq and
Afghanistan). That would put U.S. outlays at 1940 levels--a bad year.
As recently as 1986, a better year, the U.S. spent 6.2 percent of GDP
on defense with no detrimental economic impact. What's different now?
The growing entitlement state. The administration is making a political
choice and sparing Social Security, Medicare and Medicaid, which are
set to hit nearly 11 percent of GDP (without healthcare reform costs)
by 2020.''
Make no mistake about the importance of these entitlement programs;
however, DOD and VA benefits are also important and essential to
maintaining that all volunteer force and our national security.
tricare fee increases
Healthcare benefits are important to every segment of FRA's
membership. The continued growth in healthcare costs is not just a
military challenge but a challenge for the entire society. FRA believes
that military service is a unique profession and notes minimal
projected savings associated with DOD management efficiencies and other
initiatives in fiscal year 2013 and beyond, while retirees are targeted
for major fee hikes. These proposals also follow the 13-percent
military retiree TRICARE Prime increase imposed this year.
Our members are also very concerned about a proposed new TRICARE-
for-Life (TFL) enrollment fee beginning in fiscal year 2013. This is
viewed as another failure to honor commitments to those who served past
careers in the military. These personnel have not benefited from the
significant pay and benefit enhancements enacted since 2000.
The Association believes that military retirees have earned their
TRICARE benefits with 20 or more years of arduous military service with
low pay. As you know, many retirees believe that they were promised
free healthcare for life.
FRA strongly opposes premium increases for TRICARE beneficiaries'
based on healthcare inflation. The Consumer Price Index (CPI) is the
basis for military retiree annual cost-of-living adjustments (COLAs),
the purpose of which is to maintain purchasing power for the
beneficiary. The Association strongly supports adequate funding of the
Military Health Service (MHS) without the drastic fee increases and
extreme pharmacy co-pays for all retirees proposed by the
administration.
retirement commission
The administration proposed the creation of a BRAC-like commission
to review and ``reform'' the current military retirement system.
Numerous studies and commissions have focused on the military
retirement as an opportunity to reduce overhead costs for the Pentagon.
The latest is the Defense Business Board (DBB) proposal to replace the
current system with a 401(k) plan similar to what corporations offer
their employees. This concept has created significant anxiety in the
career active duty community. An FRA online survey released last
October resulted in strong opposition responses to proposals to
``civilianize'' the current military retirement system. More than 1,700
current and former servicemembers responded and nearly 95 percent
believe retiree benefits offer the most appeal if they were joining
today. More than 80 percent of Active Duty and Reserve component
respondents said they'd shorten their term of service if retirement
benefits were changed to conform with the recommendations.
FRA believes that military service is unlike any other career or
occupation, and requires a unique retirement system. Career senior
noncommissioned officers are the backbone of our military and their
leadership and guidance are invaluable and a result of many years of
training and experience.
wounded warriors
FRA believes post-traumatic stress should not be referred to as a
``disorder''. This terminology adds to the stigma of this condition,
and the Association believes it is critical that the military do all it
can to reduce the stigma associated with post-traumatic stress and
traumatic brain injury.
FRA also believes the Armed Services and Veterans Affairs
Committees should remain vigilant regarding their oversight
responsibilities associated with ensuring a ``seamless transition'' for
wounded warriors transitioning from DOD's MHS to the Department of
Veterans Affairs (VA). FRA strongly supports efforts to create and
adequately fund a Joint Virtual Lifetime Electronic Record (VLER) for
every servicemember and believes this would be a major step toward the
long-standing goal of a truly seamless transition from military to
veteran status for all servicemembers and would permit a DOD, VA, or
private healthcare provider immediate access to a veteran's health
data.
According to Navy Times editors, ``Even before sequestration takes
effect budget cuts have impacted the Office of Wounded Warrior Care and
Transition Policy with the elimination of 40 percent (44 positions) of
the staff, and all 15 contract employees in the transition policy
section that leaves only two full-time civilian employees.'' \1\ Budget
cuts have also resulted in the cancellation of the Virtual Transition
Assistance Program Web site that was scheduled to replace the current
Turbo TAP Web site. FRA is concerned that these cuts could negatively
impact transitioning wounded warriors.
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\1\ ``Navy Times'' editorial, January 16, 2012, page 4.
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The Association also notes the importance of the Navy's Safe Harbor
Program and the Marine Corps Wounded Warrior Regiment that are
providing invaluable support for these personnel and recommends
adequate funding to support these programs.
suicide rates
Suicide in the military is a serious concern for FRA and the
Association notes that active-duty suicides have been reduced or at
least leveled off, but suicides for non-active-duty Reserve component
personnel are increasing. ``More than 2,000 servicemembers killed
themselves in the past decade, including 295 in 2010 compared with 153
in 2001''.\2\
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\2\ ABC News, ``Rising Suicides Stump Military Leaders'', September
27, 2011, Kristina Wong.
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In 2011, there were 51 Navy active-duty suicides and 7 Navy Reserve
suicides which represents an increase from 39 active-duty suicides and
6 Reserve suicides in 2010. To reduce the suicide rate the Navy has
implemented a multifaceted approach with communication, training, and
command support, designed to reduce individual stress and strengthen
psychological health of sailors. The Navy efforts fall within the scope
of their broader family readiness programs and require adequate
resources to sustain these efforts.
In 2011, there were 33 marine suicides and 171 failed suicide
attempts. During the previous year, 37 marines committed suicide and
there were 172 failed attempts. The marines have deployed peer-to-peer
suicide prevention training and are working with the DOD Suicide
Prevention Office to implement the recommendations of the DOD Joint
Task Force on the Prevention of Suicide. Despite these initiatives,
suicides continue and efforts to address the reasons for suicides must
continue to be a top priority. FRA appreciates the provision in the
Fiscal Year 2012 Defense Authorization Act that requires preseparation
counseling for Reservists returning from successful deployments. In
addition, FRA supports Representative Thomas Rooney's bill (H.R. 208)
that authorizes reimbursement for mental health counseling under
TRICARE and requests full funding to support this program if
authorized.
cost-of-living adjustments
Under current law, military retired pay cost-of-living adjustments
(COLAs) are rounded down to the next lowest $1. For many of these
personnel, particularly enlisted retirees, their retired pay is
sometimes the sole source of income for them and their dependents. Over
time, the effect of rounding down can be substantial for these
personnel and FRA supports a policy change to rounding up retiree COLAs
to the next highest $1.
reserve early retirement
A provision of the Fiscal Year 2008 National Defense Authorization
Act reduces the Reserve retirement age requirement by 3 months for each
cumulative 90-days ordered to active duty. This is effective upon the
enactment of the legislation (January 28, 2008) and not retroactive to
October 7, 2001, and the Association supports ``The National Guardsmen
and Reservists Parity for Patriots Act'' (H.R. 181) sponsored by the
House Personnel Subcommittee Chairman, Representative Joe Wilson, to
authorize reservists mobilized since October 7, 2001, to receive credit
in determining eligibility for receipt of early retired pay. Since
September 11, 2001, the Reserve component has changed from a strategic
Reserve to an operational Reserve that now plays a vital role in
prosecuting the war efforts and other operational commitments. This has
resulted in more frequent and longer deployments impacting individual
reservist's careers. Changing the effective date of the Reserve early
retirement would help partially offset lost salary increases,
promotions, 401(k), and other benefit contributions. The Association
urges support and funding for this important legislation.
retention of final full month's retired pay
If authorized, FRA urges the subcommittee to provide funding to
support the retention of the full final month's retired pay by the
surviving spouse (or other designated survivor) of a military retiree
for the month in which the member was alive for at least 24 hours. FRA
strongly supports ``The Military Retiree Survivor Comfort Act'' (H.R.
493), introduced by Representative Walter Jones, which addresses this
issue.
Current regulations require survivors of deceased Armed Forces
retirees to return any retirement payment received in the month the
retiree passes away or any subsequent month thereafter. Upon the demise
of a retired servicemember in receipt of military retired pay, the
surviving spouse is to notify DOD of the death. DOD's financial arm
(DFAS) then stops payment on the retirement account, recalculates the
final payment to cover only the days in the month the retiree was
alive, forwards a check for those days to the surviving spouse
(beneficiary) and, if not reported in a timely manner, recoups any
payment(s) made covering periods subsequent to the retiree's death. The
recouping is made without consideration of the survivor's financial
status.
The measure is related to a similar VA policy. The Congress passed
a law in 1996 that allows a surviving spouse to retain the veteran's
disability and VA pension payments issued for the month of the
veteran's death. FRA believes military retired pay should be no
different.
concurrent receipt
FRA supports legislation authorizing and funding concurrent receipt
of full military retired pay and veterans' disability compensation for
all disabled retirees. The Association strongly supports Senate
Majority Leader, Senator Harry Reid's ``Retired Pay Restoration Act''
(S. 344) and Representative Sanford Bishop's ``Disabled Veterans Tax
Termination Act'' (H.R. 333). Both proposals would authorize
comprehensive concurrent receipt reform, and Representative Gus
Bilirakis's ``Retired Pay Restoration Act'' (H.R. 303) would authorize
current receipt for retirees receiving concurrent retirement and
disability pay (CRDP) with a disability rating of 50 percent or less.
FRA also strongly supports House Personnel Subcommittee Chairman
Representative Joe Wilson's bill (H.R. 186), that expands concurrent
receipt for servicemembers who were medically retired with less than 20
years of service (chapter 61 retirees) and would be phased-in over 5
years. This proposal mirrors the administration's proposal from the
110th Congress. In 2008, the Congress voted to expand eligibility for
combat-related special compensation (CRSC) coverage to chapter 61
retirees and the proposed legislation would, in effect, extend
eligibility for CRDP to all chapter 61 retirees over 5 years. A less
costly improvement to pursue in an austere budget year would be fixing
the so-called ``glitch'' for CRSC that result in compensation declining
when the VA disability rating increases.
military resale system
FRA strongly supports adequate funding for the Defense Commissary
Agency (DeCA) to ensure access to the commissary benefit for all
beneficiaries. Since 2000, DeCA's budget has remained flat in real
dollars, meaning the agency has done more with less for the past 11
years.
The Association also strongly supports the military exchange
systems (AAFES, NEXCOM, and MCX), and urges against revisiting the
concept of consolidation. FRA instead urges a thorough review of the
findings of an extensive and costly ($17 million) multiyear study which
found that this is not a cost-effective approach to running these
important systems.
conclusion
FRA is grateful for the opportunity to provide these
recommendations to this distinguished subcommittee.
Chairman Inouye. I thank you very much, Mr. Davis, for your
testimony, and we will most certainly look into the Lautenberg-
Rubio bill. Thank you.
I thank this panel.
Now, the next panel consists of: Ms. Mary Hesdorffer,
representing the Mesothelioma Applied Research Foundation; Mr.
Stephen Isaacs, representing Aduro Biotech; Dr. Laurence
Corash, representing Cerus Corporation; and Ms. Sharon Smith,
representing the National Trauma Institute.
May I call upon Ms. Mary Hesdorffer.
STATEMENT OF MARY HESDORFFER, ARNP, MSN, MESOTHELIOMA
APPLIED RESEARCH FOUNDATION
Ms. Hesdorffer. Chairman Inouye, Ranking Member Cochran,
and members of the subcommittee: I really want to thank you
again for allowing me to come before you to present our case on
behalf of mesothelioma patients. I'm a nurse practitioner. I've
been treating patients for more than 12 years with this
disease, and I'd like to share a little bit of information that
I think is important for the Department of Defense.
Mesothelioma is directly related to asbestos exposure. It's
an extremely rare disease. There's about 3,500 cases diagnosed
per year. Of those 3,500 cases, one-third can be directly
related to either Navy duty or working in shipyards. So we lose
a tremendous amount of Navy vets to this disease. And it
remains an active threat now because after exposure to asbestos
the latency period can be anywhere from 10 to 50 years. So this
remains a constant threat and something that we really need to
do something about.
From the time of diagnosis, the average survival is
documented as 6 to 9 months. We have one approved therapy and
that's a drug combination, and that extends the median survival
to 12.3 months.
I'd like to use a Navy vet who I'm very close to to give
you an illustration of what the life of a mesothelioma patient
is like. Tom Shikowski, who asked that I share his name and his
story, was a sonar man. He worked as an underwater fire control
technician on the USS Fletcher. He describes his situation as
having spent 4 years in an asbestos cocoon on the Navy ship. He
directly correlates his development of mesothelioma to his time
served in the Navy.
Tom was faced with a tough decision. He could have
chemotherapy and extend life to 12.3 months, or try something
experimental, and the best experimental we have right now is
what we call an extrapleural pneumonectomy, where we remove the
entire lung, the lining of the lung, the lining of the
mediastinum, which is the center of the chest, and the lining
of the heart. The heart is then encased in a sack to keep it in
place. Patients are subjected to chemotherapy and radiation
therapy.
Yet this is not a cure, and in fact Tom, after having
undergone this procedure, now faces a decision of what type of
chemotherapy he's going to have for his fourth recurrence of
the disease. Tom is out of options. He has one lung. It fills
with fluid, and traveling for treatment becomes very difficult,
especially in terms of having so few clinical trials to offer.
What we're asking today is that the subcommittee recognizes
the need for mesothelioma and to spur research in this field.
We'd like you to take this up as a critical national priority
by providing at least $5 million in funding for mesothelioma
research through the Congressionally Directed Medical Research
Program for the fiscal year 2013 Defense appropriations bill,
rather than the mere eligibility in the Peer-Reviewed Cancer
Research Program. Mesothelioma needs to be designated as a
specific line item. Mesothelioma patients, who have already
risked their lives by serving in their country's armed
services, do not have this time to wait.
PREPARED STATEMENT
I care deeply about my mesothelioma patients, the
caregivers, and those people that have lost loved ones to this
disease, and I really ask you to join me in caring deeply about
this community as well and helping us to find a cure and to
raise research dollars so others like Tom will not have to go
through these devastating choices and will enjoy a better
quality of life and extended survival.
Thank you so much.
[The statement follows:]
Prepared Statement of Mary Hesdorffer, ARNP, MSN
Chairman Inouye, Ranking Member Cochran, and members of the
subcommittee: Thank you for the opportunity to speak with you today to
discuss mesothelioma, its connection to military service, and the
desperate need for research. Your support is critical to our mission,
and I look forward to continuing our relationship with this
subcommittee.
My name is Mary Hesdorffer and I am a nurse practitioner that has
worked with mesothelioma patients for over a decade. I am testifying on
behalf of the Mesothelioma Applied Research Foundation and the
Mesothelioma community composed of patients, physicians, caregivers,
and family members. I would like to take this time to stress the
importance of increased funding for the Congressionally Directed
Medical Research Programs (CDMRP) which plays a critical role in
finding and delivering treatments for mesothelioma.
Mesothelioma is an aggressive cancer known to be caused by exposure
to asbestos. Doctors say it is among the most painful and fatal of
cancers, as it invades the chest, abdomen, and heart, and crushes the
lungs and vital organs. Mesothelioma disproportionately affects our
service men and women, as one-third of mesothelioma cases have been
shown to involve exposures in the Navy or working in our Nation's
shipyards.
There are two types of mesothelioma--pleural and peritoneal.
Patients with pleural mesothelioma, which affects the lining of the
lungs, comprise 85 percent of the mesothelioma population and face a
devastating survival time of only 9 months. Peritoneal affects the
lining of the abdomen. The harsh reality for patients with advanced
primary peritoneal cancer is a median survival time of 12.3 months; 5-
year survivals are rare. Mesothelioma patients not only face a
devastatingly short survival time, but also the harsh reality that
there is only one Food and Drug Administration-approved treatment for
mesothelioma. Often, the only option is surgery. I have dedicated my
life to caring for these people, and I am here today to speak for the
many patients that will never have the opportunity to speak for
themselves and give testimony like this.
I am currently directing the care of a Navy veteran, Tom Shikoski.
Tom joined the Navy directly out of high school, at the age of 18. He
said ``I always felt it was my duty as a citizen to serve my country.''
His primary duty was as a sonarman underwater fire control technician
aboard the USS Fletcher DDE445. He spent most of his time below deck,
in his words ``a virtual asbestos cocoon''. He is certain that he was
exposed to asbestos in his 4 years on the USS Fletcher, although he was
never informed about the dangers of asbestos.
Asbestos exposure among Navy personnel was widespread from the
1930s through the 1980s, and exposure to asbestos still occurred after
the 1980s during ship repair, overhaul, and decommissioning. We have
not yet seen the end of exposures to asbestos. Asbestos exposures have
been reported among the troops in Iraq and Afghanistan. Soldiers in
wars that extend into third-world countries, where asbestos use is
increasing without stringent regulations, may also be at risk for
exposure during tours of duty. Even low-dose, incidental exposures can
cause mesothelioma. For all those who will develop mesothelioma as a
result of these past or ongoing exposures, the only hope is that we
will develop effective treatment.
Tom Shikoski had never even heard the word mesothelioma until his
diagnosis. He never thought that his service to his country would come
back to haunt him so many years later. His diagnosis came by accident.
He had gone in for another procedure, and his doctor discovered fluid
in his left lung. He had to undergo another surgery to drain over one
liter of fluid from his lung, and 1 week later, he had the diagnosis of
pleural mesothelioma. He found, through the help of a physician family
friend, a mesothelioma specialist in Texas and had to travel across the
country from his home in Michigan to see a mesothelioma expert. It was
recommended that he have an extrapleural pneumonectomy, a surgical
treatment to remove a lung, a portion of the diaphragm, the linings of
the lungs, and heart. He then had 25 treatments of radiation, followed
by 30 treatments of chemotherapy even though not more than 12
treatments are recommended due to the high risk of anaphylactic shock.
Tom is willing to do anything to spend more time with his wife,
children, and many grandchildren.
Patients take great risks to participate in clinical trials, but
they feel the possibility of helping to find a better treatment is
worth the risk. As peritoneal mesothelioma patient, Bonnie Anderson,
said recently, ``I knew if I was going to die from mesothelioma, I was
going to put it to good use in a clinical trial.''
There are brilliant researchers dedicated to mesothelioma.
Biomarkers are being identified. Two of the most exciting areas in
cancer research--gene therapy and biomarker discovery for early
detection and treatment--look particularly promising in mesothelioma.
The Mesothelioma Applied Research Foundation has made a significant
investment, funding more than $7.6 million to support research in hopes
of giving researchers the first seed grant they need to get started. We
need the continued partnership with the Federal Government to develop
the promising findings into effective treatments.
I will give you an example of how the support of the CDMRP has
helped the promising research initiatives that are giving hope to
mesothelioma patients:
--A vaccine is being developed that would induce an immune response
against WT1, a tumor suppressor gene highly expressed in
mesothelioma patients. A pilot trial was conducted in patients
with mesothelioma to show that it is safe and immunogenic. The
researcher was then funded by a 2009 CDMRP award. Today, a
multisite clinical trial is being conducted on patients
following definitive surgery.
It is efforts like these that give me faith. I am grateful for the
Federal Government's investment in mesothelioma research, the
discoveries being made due to the funding, and I want to see it
continued and increased.
Mesothelioma is known to be caused by exposure to asbestos. We can
not only document the Naval asbestos exposures over the course of the
20th century, but we have evidence that one-third of American
mesothelioma patients were exposed while serving their country or
working as civilians aboard Navy ships. The United States must take
greater action to right this wrong and fund mesothelioma research.
The mesothelioma community urges the subcommittee to recognize
mesothelioma as a critical national priority by providing at least $5
million in funding for mesothelioma research through the CDMRP in the
fiscal year 2013 Defense appropriations bill. Rather than mere
eligibility in the Peer-Reviewed Cancer Research Program, mesothelioma
needs to be designated a specific line item. Mesothelioma patients who
already risked their lives by serving in our Nation's armed services do
not have the time to wait.
I look to the Defense appropriations subcommittee to provide
continued leadership and hope to the people who develop this deadly
cancer. You have the power to lead this battle against mesothelioma.
Thank you for the opportunity to submit testimony and for funding the
CDMRPs at the highest possible level so that patients receiving this
deadly diagnosis of mesothelioma may someday survive.
Chairman Inouye. As you know, we're constantly reminded of
mesothelioma by television ads of law firms. But your
suggestion, I think, has some merit. We'll look into it.
Ms. Hesdorffer. Thank you so much.
Chairman Inouye. Thank you very much.
Now may I call upon Mr. Stephen Isaacs.
STATEMENT OF STEPHEN T. ISAACS, CHAIRMAN AND CHIEF
EXECUTIVE OFFICER, ADURO BIOTECH
Mr. Isaacs. Thank you and good morning, Chairman Inouye,
Ranking Member Cochran, and members of the Defense
subcommittee. It's truly an honor for me to testify before you
today.
I'm the Chairman and CEO of Aduro Biotech from Berkeley,
California, and we develop modern vaccines to both prevent and
treat serious conditions such as cancer, infectious diseases,
and a variety of bioterror pathogens. While these vaccines are
primarily designed for civilian use, they also have a lot to
offer to the military.
My purpose in testifying today is to briefly tell you about
these new vaccine technologies that can make a big difference
to the military and to make a few suggestions about the Peer-
Reviewed Medical Research Program that we participate in and
how the process can be improved.
No one knows better than your subcommittee that development
of modern vaccines to support combat operations, to mitigate
acts of terrorism, and to provide new therapies for DOD-wide
populations is a top priority for DOD. I think the past
problems of a major U.S. Department of Health and Human
Services (HHS) effort to develop a protective vaccine against
anthrax really illustrates the complexity and difficulty of
developing such vaccines.
But, fortunately, there's now a strategic opportunity to
advance recent breakthroughs in vaccine technology, to develop
both therapeutic and preventative vaccines. So briefly, the
problem with many current vaccines is that they are attenuated
or weakened pathogens and they're used to elicit an effective
immune response, but these pathogens carry a risk of causing an
infection. Another approach is to use so-called ``killed
vaccines'', but these simply don't work as well.
To address this problem, my company, Aduro Biotech, has
really developed a very novel platform technology that combines
the safety of a killed vaccine with the efficacy of a live
vaccine. Since 2002 we've raised and invested more than $83
million to the development of the Aduro vaccine platform
technology, and we've made remarkable progress.
Aduro is currently conducting a phase two clinical trial to
treat metastatic pancreatic cancer, and we will begin new
trials on mesothelioma and glioblastoma within the next few
months. We were recently competitively selected to participate
in the peer-reviewed Prostate Cancer Research Program, and I
thank you for your leadership in providing the Pentagon with
the funds for this award. We strongly believe that we can make
a difference in vaccine programs for the Army and the Navy as
well.
In its medical research budget to the Congress, the Army
notes that developing an effective malaria vaccine is a top
priority, and the Navy notes that diseases that were once
confined to remote areas of the world now have the capability
to cross continents.
In our opinion, neither the Army nor the Navy have
sufficient funds to conduct robust vaccine development programs
that are clearly needed to deal with these threats. The main
purpose of testifying is to say that the military could realize
significant breakthroughs by competitively developing modern
preventative and therapeutic vaccines, and I strongly urge your
subcommittee to make it a top priority to give DOD adequate
resources for robust vaccine development programs for our
troops.
The other topic I'd like to briefly address is the process
used by the Army to administer the DOD Congressionally Directed
Medical Research Program that we believe can be improved. Here
are a few of the issues. First, it's not always clear to us
what DOD would like to fund. Is it innovative research or is it
translational medicine?
Second, some topics that are listed as areas of interest
are not funded at all. So in spite of high scores in these
applications, no funding is received, and this is a huge waste
of everybody's time for both the submitters and for the
reviewers.
Finally, there is no path for resubmission of these
applications, such as there is at the National Institutes of
Health (NIH) and the Small Business Innovation Research (SBIR)
program.
So, specifically, we respectfully submit our
recommendations for improving the process, which are the
following: first, consider limiting the use of congressionally
directed medical research funds to applied research; second,
consider directing a specific percentage of the annual programs
to small businesses; and finally, consider directing the
Assistant Secretary of Defense for Health Affairs to submit a
report on how DOD's peer-review process can be strengthened and
approved.
PREPARED STATEMENT
So thank you very much for the opportunity to express my
views about vaccine development that are really directed at
solving important medical issues for our troops. And thanks to
both of you for your interest in these programs and certainly
for your service to our country.
Finally, I really do appreciate the opportunity to present
today, and I invite you and other staff to come and visit Aduro
the next time you're on the west coast.
Thank you very much.
[The statement follows:]
Prepared Statement of Stephen T. Isaacs
Chairman Inouye and Ranking Member Cochran, and members of the
Defense subcommittee: It is an honor for me to testify before your
subcommittee today.
I know that your subcommittee cares deeply about the health and
welfare of the brave men and women who serve our Nation in the Armed
Forces, and that your subcommittee has taken a leadership role in
providing funds for health and biodefense research. My purpose today is
to tell you about the new vaccine technologies like ours that can make
a big difference to the military; and second, to make some suggestions
about the Peer-Reviewed Medical Research Program in order to make it
better for all who participate in it and to provide better value to the
taxpayer.
I am Chairman and CEO of Aduro Biotech Incorporated in Berkeley,
California. We are developing modern vaccines to both prevent and to
treat serious diseases, and while these vaccines are designed for
civilian use, they also offer tremendous capabilities to our Armed
Forces. We team with other companies and nonprofit organizations to
collaboratively develop the best vaccine technologies for specific
purposes.
No one knows better than your subcommittee that development of
modern vaccines to support combat operations, to mitigate acts of
terrorism, and to provide new therapies for the Department of Defense
(DOD)-wide population of military personnel and their dependents is a
top priority for DOD. The past failure of a major Department of Health
and Human Services (HHS)-supported program to develop a prophylactic
(protective) anthrax vaccine illustrates the difficulty in developing
modern vaccines. There is also now a strategic opportunity to advance
recent breakthroughs in therapeutic vaccines to develop treatments for
serious cancers and infectious diseases that affect our war fighters
and their dependents--particularly for pancreatic cancer for which
survival rates are very low--as well as infectious diseases that affect
the military, such as malaria, and improve our defense against
engineered biological threats.
Many current vaccines use small amounts of ``attenuated'' pathogens
to elicit an effective immune response from the body. However, the use
of attenuated microorganisms is often considered inappropriate due to
potential risks that the live microbe itself may be harmful in some
individuals and is out of the question for biodefense applications. An
alternative is the use of ``killed-vaccines'' in which pathogens are
completely inactivated and then used to produce an immune response
without causing the severe effects of the disease; however, the
efficacy of killed vaccines is often not as great as attenuated
strains.
To address this problem, Aduro Biotech has developed novel live-
attenuated double deleted (LADD) vaccines to target specific diseases,
as well as a unique killed but metabolically active (KBMA) vaccine
platform technology that combines the safety of a killed vaccine with
efficacy similar to a live vaccine. Most recently, Aduro has developed
a third vaccine platform in which the vaccine vector actually commits
``suicide'' within the body after stimulating a strong immune response
(``Suicide Strains''). All three of these platforms stimulate the
body's immune system by using a genetically modified form of the common
bacteria Listeria monocytogenes as the platform. Promising work has
been done by Aduro on selected LADD vaccines that are excellent vaccine
candidates in their own right and which require further development,
some of which may also become more desirable if transitioned to KBMA or
Suicide Strains. All three vaccine platforms are designed for the
treatment of cancer, infectious disease, and protection against
bioterror agents.
More than $83 million of private funds have been invested to date
in development of Aduro's revolutionary LADD, KBMA, and Suicide Strain
technologies. These approaches use advanced technology developed by
Aduro to specifically and selectively block the ability of a vaccine
organism to cause disease, yet preserve its ability to stimulate a
robust immune response against selected pathogens or cancerous tumors.
LADD, KBMA, and Suicide Strain vaccines can also be used as therapeutic
agents used to treat cancers such as pancreatic, lung, and melanoma,
and chronic infections such as human papilloma virus, malaria, and
hepatitis B and C.
Remarkable progress has recently been made in treating pancreatic
cancer. Aduro is currently conducting a Phase II clinical trial with a
LADD vaccine to treat metastatic pancreatic cancer, and will begin new
clinical trials on mesothelioma this summer and glioblastoma early next
year.
We were recently competitively selected to participate in the Peer-
Reviewed Prostate Cancer research program, and I am here to thank you
for your leadership in providing the Pentagon the funds that allow
companies like mine to competitively bring in the best new ideas and
new technologies.
In its medical research budget to the Congress, the Army notes that
developing an effective malaria vaccine is a top priority since ``A
highly effective vaccine would reduce or eliminate the use of anti-
malarial drugs and would minimize the progression and impact of drug
resistance to current/future drugs.'' In our opinion, the Army does not
have sufficient malaria research funds to conduct a robust vaccine
development program that it clearly needs. United States servicemembers
are often deployed to regions endemic for malaria. Currently, a large
contingent of U.S. forces is deployed in malarial regions in Southeast
and Southwest Asia. Soldiers in today's military can be exposed to more
than one malaria-endemic region prior to diagnosis. This presents new
complexities for disease monitoring and prevention policy development.
In its medical research budget to the Congress, the Navy notes that
diseases that may have once been confined to remote areas of the world
now have the capability to swathe entire regions and to cross
continents. United States expeditionary operational forces are
especially susceptible due to their exposure to areas/regions of high
risk and the potential for rapid, high-volume transmission among close
quartered personnel. Enteric diseases are of special concern to the
Navy and Marine Corps because of the high morbidity involved and the
potential to infect a large number of personnel through contaminated
food and water sources, especially in regions overseas where food
handling, water supply, and waste disposal practices are questionable.
Respiratory disease has been and will continue to be a main focus of
military disease research and vaccine development. Viruses, bacteria,
and parasites spread by arthropods (e.g., mosquitos, flies, fleas) are
some of the most imminent threats to military forces abroad due to
geographic risk factors and a general lack of effective vaccines and
treatment. Emerging diseases also include new drug-resistant variants
as well as new mutational strains of viral agents. In our opinion, the
Navy does not have sufficient vaccine research funds to conduct a
robust vaccine development program that it clearly needs to meet these
requirements.
The main purpose of testifying before your subcommittee today is to
tell you that the military could make some significant breakthroughs by
competitively developing modern prophylactic and therapeutic vaccines
to solve some of the more difficult challenges for ensuring the health
of our Nation's Armed Forces. Understanding that we are in a very
difficult budget climate, I strongly urge your subcommittee to make it
a top priority to give DOD adequate resources for robust vaccine
development programs for our troops as your subcommittee crafts annual
appropriations bills.
The other topic I would like to briefly address today is the
process used by the Army to administer the DOD Congressionally Directed
Medical Research Program that we and others in our industry believe can
be improved. Here are observations from our perspective:
--It is not clear to the investigators whether DOD would like to fund
early innovative research or technology development, yet
analysis of after-the-fact awards indicates a bias toward basic
research even though solicitations seem to be inviting applied
research proposals. The real-world funding gap, which should be
the intent of the Senate's program, is in applied research not
basic research.
--In some instances topics are listed in their contracting documents,
review panels are formed for these topics, but in the
subsequent review of industry proposals none of these grant
applications are funded--even some with exceptionally high
scores. This seems to be a tremendous waste of everybody's time
including the time of the reviewers.
--The review process seems to be a complete hit and miss; the quality
of the review is highly variable and the comments are often not
very helpful. Steps should be taken to ensure that the
reviewers have a background in and understand the technology
being reviewed.
--There is no path for resubmission and for addressing the reviewer's
comments. Unlike other similar Federal programs, DOD does not
allow for resubmissions. In contrast, National Institutes of
Health (NIH), Small Business Innovation Research (SBIR), and
Advanced Research Projects Agency-Energy (ARPA-E) do allow for
at least one resubmission. The new reviewers are provided with
the full review of the first submission and the investigator
has one page to outline how the resubmission has been changed.
We have had very good experience with resubmissions, which are
the only form of dialogue between submitter and reviewer.
We believe that the following recommendations for improved
management of the Peer-Reviewed Congressionally Directed Medical
Research Programs would give DOD, the Congress, and the taxpayer better
results:
--Consider limiting use of congressionally added medical research
funds, particularly in the Peer-Reviewed Medical Research
Program, to applied research rather that basic research.
--Consider directing a specific percentage of the annual programs to
small businesses.
--Direct the Assistant Secretary of Defense for Health Affairs (ASD
(HA)) submit a report to the Appropriations Committees of the
House and Senate by January 31, 2013, on how DOD's peer-review
process for the Congressionally Directed Medical Research
Programs can be strengthened and improved. ASD (HA) should
specifically examine the procedures used by the Department of
Energy's ARPA-E that are efficient and consistently win praise
from industry.
In closing, I would like to thank you for giving me the opportunity
to express some priorities of vaccine development companies like mine
on the possibilities for strategic breakthroughs in solving thorny
medical issues for our troops through robust, competitive vaccine
development programs.
I would also like to thank you, Chairman Inouye, for your lifetime
of service to our Nation and to commend the other members of the
subcommittee for your dedication to the welfare of the young men and
women who so ably serve our Nation. I appreciate the opportunity to
express my views to you today, and I invite any of the members or staff
to come visit Aduro the next time you are on the west coast.
Chairman Inouye. I thank you very much. Your study shows
that vaccines can have an impact upon prostate cancer?
Mr. Isaacs. Well, we're working on that right now and we
see a very strong impact in animal models that we've developed.
And we've taken this on into human clinical trials in non-
small-cell lung cancer and in pancreatic cancer. We hope to
expand to mesothelioma as well.
Chairman Inouye. I thank you very much.
May I now call upon Dr. Laurence Corash of the Cerus
Corporation.
STATEMENT OF LAURENCE CORASH, M.D., CHIEF MEDICAL
OFFICER, CERUS CORPORATION
Dr. Corash. Thank you, Chairman Inouye and Ranking Member
Cochran, members of the subcommittee, for the opportunity to
testify about the safety of blood transfusion in the military.
I'm a hematologist and I've spent 20 years researching ways to
prevent transfusion-transmitted infections, first at the
National Institutes of Health (NIH), then at the University of
California as chief of laboratory medicine, and now at Cerus
Corporation, and in my capacity as the industry representative
for the U.S. Department of Health and Human Services (HHS)
Advisory Committee on Blood Safety and Availability.
Blood transfusion is a fundamental component of healthcare.
Patients assume that when blood is required it will be
available and it will be safe. But this is not always the case.
My interest in this problem began in the 1980s at the NIH and
then at the University of California, when we saw our patients
infected with a new disease via blood transfusion that we
ultimately recognized as AIDS and the virus as HIV.
We now know, though, that this is not the only threat to
the blood supply and it will not be the last threat. Our
patients have experienced hepatitis B, hepatitis C, West Nile
virus, and today they're facing dengue and bebizia, new
pathogens that cause fatal and debilitating illnesses. There
will be new pathogens in the future.
Improved donor testing has reduced the risk for some of
these infections, but tests do not exist for all pathogens, and
the blood supply remains vulnerable. Testing will always be
inherently a reactive strategy against new pathogens. Improved
donor testing has not solved the problem.
Soldiers on deployment are especially vulnerable to the
problems of providing an adequate and safe blood supply for the
military. As to adequacy, the military relies on its own
donors, but many of these donors are disqualified due to travel
related to deployment. Because blood products have a limited
shelf life and require temperature control, it's not easy to
transport blood to forward areas of deployment where they're
critically required. As a result, the military must frequently
rely on personnel to donate blood in forward areas of
deployment, where it cannot be adequately tested, and this
creates problems of safety due to exposure to unrecognized
pathogens.
Today a solution exists to this problem. It's pathogen
inactivation, treating donated blood to kill microbes. This is
not a novel concept. We pasteurize milk and other intravenous
medications are treated to sterilize them. However, pathogen
inactivation of blood components has been a scientific
challenge.
My colleagues and I started work on this technology years
ago and in 1999 the subcommittee provided the first year of
funding to advance this technology for the military, and we're
grateful for this. In 2003 the technology from our company was
licensed in Europe, and since that time 1 million blood
components treated with this technology have been transfused.
In our country, the respiratory hurdles to pathogen
inactivation have been challenging. But my focus today is on a
modest step to improve safety for the military blood
transfusion supply. The French military have solved the problem
of adequacy and safety for plasma by creating a pathogen-
inactivated freeze-dried plasma. This product has been used in
Afghanistan since 2010. It can be stored for up to 2 years at
room temperature and it's ready for use within 6 minutes.
The U.S. Army is aware of dried plasma, but without FDA
agreement it cannot be used for U.S. troops. The clinical data
from the French army support the use of this freeze-dried
plasma, and the pathogen-inactivate plasma can be available to
the U.S. military through a collaborative program with the
French, at lower cost and more rapidly than other approaches.
PREPARED STATEMENT
Cerus asks that the subcommittee provide funding to support
the licensure of this product and to encourage the FDA to
define an expeditious pathway for licensure. This action is
consistent with the 2009 recommendation by the Assistant
Secretary for Health for implementation of pathogen
inactivation of civilian blood components.
Chairman Inouye, thank you for the opportunity to testify
and for your decades of service to our military and the Nation.
[The statement follows:]
Prepared Statement of Laurence Corash, M.D.
Chairman Inouye and Ranking Member Cochran, and members of the
Defense subcommittee: Thank you for the opportunity to testify before
your subcommittee today about improving blood safety.
I am the Chief Medical Officer for Cerus Corporation in Concord,
California. In the 1980s, I was the director of a university hematology
service in which a majority of our patients were infected by an unknown
virus and developed a disease, we now call AIDS, but which no one knew
existed at the time. There was no way to know at that time that blood
being donated and transfused contained deadly pathogens that could kill
people. Although many steps are taken today to reduce the risk of
infection from donated blood, it is surprising and disappointing that
for both civilian and military purposes there still remains no good way
to prevent new and unknown emerging pathogens from entering the blood
supply and no way to detect them prior to transfusion. Worse, if a
terrorist organization were to engineer novel pathogens and introduce
them into our Nation's blood supply, there is no mechanism for
determining that they are in blood until you see the effects, when it
is far too late. We had a close call with the anthrax event in which
potential blood donors were unknowingly exposed.
There is a better way, and it's called ``pathogen inactivation''.
This is not a novel concept as all other intravenous medications are
sterilized. Unfortunately, our Nation has been slow to implement it,
which is a Food and Drug Administration (FDA) issue. But we are also
asking our military personnel, who maybe wounded in combat, to take
blood-safety risks that are not necessary. I would like to bring this
issue to your attention today, along with an interim solution for your
consideration.
About 16 million units of whole blood were donated in the United
States in 2006. Whole blood can be transfused directly or more commonly
separated into its components:
--red cells;
--plasma; and
--platelets.
Most of the Nation's blood supply is handled by the American Red
Cross and a small number of community blood-banks. The FDA regulates
all blood bank operations.
Blood centers, which have tested for risks like hepatitis C and
AIDS since the 1980s and 1990s, have added a number of new tests on
donated blood in recent years to deal with emerging pathogens. However,
more pathogens have shown up in the donor population as people travel
more, climate change, and urbanization impact pathogen vectors, and
bacterial pathogens become more resilient to antibiotics. Without FDA
approved tests for many infectious risks, blood centers have steadily
added new prohibitions for people wanting to give blood which reduce
the donor pool significantly. In 2006, for example, 12.4 million people
volunteered to donate blood but nearly 2.6 million were turned away
during questionnaire screening. Donors may be rejected simply on the
region of the world to which they travelled, but many of them could be
qualified blood donors if adequate testing was possible or other safety
measures were taken, such as pathogen inactivation.
The Department of Defense (DOD) is generally discouraged from
relying on the domestic blood supply to support the military. The Armed
Services Blood Program supplies blood for 1.3 million servicemembers
and their families each year. Military personnel who were stationed in
Europe for extended periods in the 1980s and 1990s are not allowed to
donate blood, as a precaution against mad cow disease. Soldiers
returning from Iraq and Afghanistan cannot donate blood for at least a
year. As a consequence, a larger population of the military can no
longer donate blood. Measures such as increasing blood recruitment
efforts from military personnel in training billets, from the DOD
civilian workforce, and from military dependents may not be enough.
During recent operations in Iraq and Afghanistan, platelets were
collected from U.S. military members and transfused with limited real-
time testing. The U.S. Army Medical Command for example stated in a
January 2008 news release that:
``. . . field hospitals must rely on local personnel when treating
someone who has suffered catastrophic injuries and needs a lot of blood
quickly. At these times, an urgent call for blood donors is sent out
and our men and women in uniform, already in a war zone, line up on-on
the run to give blood.''
As you can imagine, collecting blood in theater from deployed U.S.
soldiers or civilians entails a significant risk of infection, because
testing in theater is limited. Your subcommittee is aware of the
incident where the British Government raised concerns about 18 of its
troops and 6 civilians who received emergency blood transfusions from
American personnel in Afghanistan without proper testing for infectious
diseases.
As I indicated before, there is a better way to ensure blood
transfusion safety, and it's called ``pathogen inactivation''. In fact,
the Assistant Secretary for Health in the Department of Health and
Human Services established a Federal pathogen inactivation task force
in 2009 based on recommendations from its Advisory Committee on Blood
Safety and Availability. I urge the Senate Appropriations Committee,
through one of its other subcommittees, to look into the lack of
progress that has been made at the Federal level to expedite pathogen
inactivation technology to protect our national blood supply.
Cerus is a biotechnology company based in California founded in
1992 with the mission to develop technology for the inactivation of
infectious microbes, including viruses, bacteria, and parasites, in
blood components (platelets, plasma, and red cells) used for
transfusion support of patients. We have a process for pathogen
inactivation in blood using chemicals and ultraviolet light that
prevents any organism from replicating. Cerus blood technology
inactivates all infectious agents such as bacteria, viruses, and
parasites in blood, whether you know they are there or not. We have
spent more than $600 million developing the technology, of which less
than 7 percent came from the Federal Government, and we have been on an
agonizingly slow process toward FDA approval for its eventual use in
the United States.
The technology is in use in Europe, Asia, Russia, the Middle East,
and South America. The treated blood components have received national
licensure as biologics in France, Germany, Switzerland, and Austria. To
date more than 1 million therapeutic doses have been transfused in more
than 100 blood centers in 16 countries. In France, more than 30,000
patients have received the platelet and plasma products. One Belgian
blood center has used the technology for 9 years. The Swiss Regulatory
Authority mandated use of the platelet technology in 2010. The French
Armed Forces Blood Transfusion Service has used this technology to
create dried plasma which has been used in Afghanistan to treat
severely wounded personnel at the time of injury since 2010.
Surveillance by the regulatory authorities in these countries has shown
that the technology is safe and effective in routine use; and that it
has prevented transfusion-transmitted infections. The red cell
technology is entering Phase 3 clinical trials in Europe.
Cerus has received DOD funding to support the development of
technology specific to the Army's blood transfusion requirements. The
major portion of this funding has supported the red cell technology
program that is now under discussion with FDA for design of Phase 3
clinical trials. Recently, Cerus became aware of the Army's interest in
dried plasma as a means to improve outcomes for severely wounded
personnel. However, the Army has communicated to Cerus the overwhelming
task of taking this product through FDA regulatory approval.
The U.S. Army is aware of the French Armed Forces experience with
the dried plasma product; and Cerus has discussed the use of data from
the French Armed Forces clinical experience with the French Armed
Forces Blood Service to support FDA licensure for the specific
treatment of U.S. military personnel. Cerus believes that these data,
in combination with the substantial European experience with this
technology are relevant and sufficient to support licensure, but prior
discussions with FDA have not resulted in a commitment to use these
data. Cerus believes that there is a need for the pathogen inactivated
dried plasma product and that this product can be made available to the
U.S. Armed Forces through a collaborative manufacturing program with
the French Armed Forces Blood Service. This approach would make this
product available at lower cost and more rapidly than other approaches
currently under consideration. Cerus requests the subcommittees
recommend this initiative with expedited review by FDA which could
improve the outcomes for military personnel with severe traumatic
injuries.
The pathogen inactivation technology will also be of benefit to the
civilian population especially for national disaster contingency
planning when normal channels for blood donation, preparation, and
transport may be disrupted by natural disasters or bioterrorism events.
Chairman Inouye, as a Medal of Honor winner who has personally
witnessed the horrors of combat, I wanted to bring to your attention,
and to the subcommittee, that through cooperation with the French
military the Army can now take steps to expedite the availability of
proven pathogen inactivation technology for the U.S. Armed Forces. That
would mean that our soldiers and marines would have more blood
supplies, faster treatment during the critical first moments after
severe injuries, and improved safety during blood transfusions after
being injured in combat.
I thank all the members of the subcommittee for allowing me this
opportunity to testify today, and thank you for your decades of service
to our military and to our Nation.
Chairman Inouye. You've brought up a matter that's very
personal to me because during the war I got about 30
transfusions. I just must have been lucky.
What was the situation in World War II? Was it this bad?
Dr. Corash. Well, it was worse, of course, because
transportation of blood in liquid format and even of plasma was
extraordinarily difficult, and that meant that treatment could
not be delivered close to the point of injury. We know now that
the first 30 minutes are very critical for survival.
It's improved over the years by various measures, but we
have not yet achieved the most optimal outcome. I think the
French have really achieved this. The data from their
experience in Afghanistan for salvage of these wounded
personnel is quite impressive.
Chairman Inouye. If you have any reading material on the
French method, will you submit that, please?
Dr. Corash. I'm sorry, Sir?
Chairman Inouye. On the French method, if you have any
reading material.
Dr. Corash. Yes, I do. I can send you some publications
that have been provided to me by the French military, and I
work very actively with them.
Chairman Inouye. Thank you very much.
May I now call upon Ms. Sharon Smith.
STATEMENT OF SHARON SMITH, EXECUTIVE DIRECTOR, NATIONAL
TRAUMA INSTITUTE
Ms. Smith. Thank you, Mr. Chairman and Ranking Member
Cochran, for the opportunity to testify today to urge the
subcommittee to invest a greater amount of DOD medical research
funds into the primary conditions which kill our soldiers.
According to military trauma surgeons, noncompressible
hemorrhage is the leading cause of death among combatants whose
deaths are considered potentially survivable. This includes
injuries to the neck, chest, abdomen, groin, and back, where a
tourniquet or compression cannot be easily applied. The
National Trauma Institute (NTI) believes an accelerated program
of research into noncompressible hemorrhage will result in the
first truly novel advances in treating this difficult problem,
will save the lives of soldiers wounded in combat, and will
have tremendous impact on civilian casualties and costs.
I'm executive director of the NTI, which is a nonprofit
organization based in San Antonio, Texas, where so many of the
military's medical research assets are centralized. We were
formed in 2006 by leaders of America's trauma organizations in
response to frustration over lack of funding of trauma
research. Our board of directors includes civilian, active
duty, and retired military trauma surgeons, and we advocate and
manage funds for trauma research and are a national
coordinating center for those funds.
In a June 2011 letter, the Defense Health Board, which
provides advice and recommendations to the DOD, cited an urgent
need to improve the evidence base for trauma care, and further
stated that, ``Due to the lack of opportunities to perform
randomized controlled trials on the battlefield, challenges
arise in maintaining the best practice guidelines for the
combat environment.''
The board then recommended that the Department endorse
high-priority medical research, development, testing, and
evaluation (RDT&E) funding for improving battlefield trauma
care. Further, individual members of the board have expressed
grave concern that when the current combat mission ends no
further military medical research progress will be made. A
review of medical advances available to the combat medic has
identified no significant changes during the period of relative
peace from the end of the Vietnam War to September 11, 2011.
The challenge going forward is to fund medical research and
development during peacetime, without the historical impetus
afforded by active combat operations. A time of peace is an
opportunity to make medical advances to ensure readiness for
the next conflict or terrorist threat.
NTI has been invited to meet with the Defense Health Board
later this month to explore how we together can address these
concerns.
Military trauma surgeons agree that the major cause of
death from combat wounds is hemorrhage. In recent conflicts, 21
percent of combat deaths were potentially survivable. In other
words, more than 1,300 warriors wounded in Iraq and Afghanistan
might have survived, but died because treatment strategies were
lacking. More than 600 of these were due to noncompressible
hemorrhage.
Currently there is no active intervention for
noncompressible hemorrhage available to military medics, not
even a method to detect whether the wounded warrior is bleeding
internally and if so how much blood has been lost.
On the civilian front, trauma injury is responsible for
more than 61 percent of the deaths of Americans between the
ages of 1 to 44 every year, more than all forms of cancer,
heart disease, HIV, liver disease, stroke, and diabetes
combined. An American dies every 3 minutes due to trauma, and
that's 170,000 deaths, in addition to 42 million injuries every
year, making trauma the second most expensive healthcare
problem facing the United States, with annual medical costs of
$72 billion.
PREPARED STATEMENT
So NTI recommends that the Congress set aside a much larger
portion of DOD medical research funding for the medical
conditions which most seriously and severely injure, as well as
kill, our soldiers, and in particular maintain or increase
funding for noncompressible hemorrhage, the leading cause of
potentially survivable deaths of our soldiers.
So I thank you again for the opportunity to present our
views.
[The statement follows:]
Prepared Statement of Sharon Smith
Mr. Chairman, Ranking Member Cochran, and members of the
subcommittee: Thank you for the opportunity to testify today to urge
the subcommittee to invest a greater amount of Department of Defense
(DOD) medical research funds in the primary conditions which kill our
soldiers. According to military medical officials, noncompressible
hemorrhage is the leading cause of death among combatants whose deaths
are considered ``potentially survivable.'' The National Trauma
Institute (NTI) believes an accelerated program of research into
noncompressible hemorrhage will result in the first truly novel
advances in treating this difficult problem, will save the lives of
soldiers wounded in combat, and will have tremendous impact on civilian
casualties and costs.
NTI is a nonprofit organization formed in 2006 by leaders of
America's trauma organizations in response to frustration over lack of
funding of trauma research. Our Board of Directors now includes 19
leading physicians totaling hundreds of years in treating traumatic
injuries. Some of these physicians are active duty Army, Navy, and Air
Force doctors in organizations such as the Army's Institute for
Surgical Research in San Antonio, where NTI is based. Others are
retired from the military after 20 plus years serving our Nation and
are bringing the expertise gained in combat theaters to the civilian
setting.
With the support and participation of the national trauma
community, NTI advocates and manages funding for trauma research and is
a national coordinating center for trauma research funding. In recent
years, NTI issued two national calls for proposals and received a total
of 177 pre-proposals from 32 States and the District of Columbia. After
rigorous peer review, NTI awarded $3.9 million to 16 proposals
involving 55 clinical investigators at 39 participating sites spread
across 35 cities and 22 States nationally. Several of these studies are
nearing completion. However, important as these studies are, they will
barely begin to build the body of knowledge necessary for improved
treatments and outcomes in the field of trauma in the United States.
defense health board
As the subcommittee knows, the Defense Health Board is a Federal
advisory committee which provides independent advice and
recommendations on DOD healthcare issues including research to the
Secretary of Defense. The Board, in a letter to the Honorable Jonathan
Woodson, M.D., Assistant Secretary of Defense (Health Affairs) dated
June 2011, cited ``an urgent need to improve the evidence base for
trauma care . . . due to the lack of opportunities to perform
randomized controlled trials on the battlefield, challenges arise in
maintaining . . . best practice guidelines for the combat
environment.'' The DHB then recommended that the Department of Defense
``endorse . . . high-priority medical Research, Development, Test and
Evaluation (RDT&E) issues for improving battlefield trauma care.''
Further, individual members of the Defense Health Board have
expressed grave concern that when the current combat mission ends, no
further military medical research progress will be made. The challenge
going forward will be to provide the necessary support for medical
research and development during peacetime, without the historical
impetus afforded by active combat operations. A review of medical
advances available to the Combat Medic has identified no significant
changes during the period of relative peace from the end of the Vietnam
War to September 11, 2001.\1\
---------------------------------------------------------------------------
\1\ Blackborne, L.H.C. (2011) 1831. The Army Department Medical
Journal April-June 2011, 6-10.
---------------------------------------------------------------------------
A time of peace is an opportunity to make medical advancements to
ensure readiness for the next conflict or terrorist threat. NTI will be
visiting the Defense Health Board later this month to explore how our
country can address these concerns.
noncompressible hemorrhage
According to military documents and officials, the major cause of
death from combat wounds is hemorrhage. In recent conflicts, 21 percent
of combat deaths have been judged to be potentially survivable.\2\ In
other words, more than 1,300 warriors wounded in Iraq or Afghanistan
might have survived to come home to their loved ones, but didn't
because treatment strategies were lacking. More than 1,100 (85 percent)
of these deaths were due to hemorrhage, and 55 percent of these, more
than 600 potentially survivable deaths, resulted from hemorrhage in
regions of the body such as the neck, chest, abdomen, groin, and back
that couldn't be treated by a tourniquet or compression.\2\
---------------------------------------------------------------------------
\2\ Eastridge, B.J., Hardin, M., Cantrell, J., Oetjen-Gerdes, L.,
Zubko, T., Mallak, C., Wade, C.E., Simmons, J., Mace, J., Mabry, R.,
Bolenbaucher, R., Blackbourne, L.H. (2011) Died of wounds on the
battlefield: causation and implications for improving combat casualty
care. J Trauma. 71 (1 Suppl): S4-8.
---------------------------------------------------------------------------
causes of potentially survivable deaths operation iraqi freedom/
operation enduring freedom
NTI commends the Congress for its attention to traumatic brain
injuries and encourages a continuing focus on this potentially
debilitating condition. Yet as the above chart shows, hemorrhage is a
far more common killer of our soldiers, and hemorrhage has received
relatively little funding.
Extremity wounds are amenable to compression to stop bleeding, and
new tourniquets and hemostatic bandages have had a major impact on the
decline in combat deaths due to extremity hemorrhage. But compression
is rarely effective for penetrating wounds to the torso and major
vessels can be damaged resulting in massive hemorrhage. At present,
such wounds are normally only treatable through surgical intervention
and typically such patients do not survive to reach the operating room.
Currently, there is no active intervention for noncompressible
hemorrhage available to military medics, who along with civilian
responders have only the tools their predecessors had in the early 20th
century. There is not even a method to detect whether the wounded
warrior is bleeding internally, and if so, how much blood has been
lost. The current Tactical Combat Casualty Care guidelines for medics
and corpsmen do not include strategies to stem bleeding from
noncompressible hemorrhage because no solutions are available.\3\ NTI
hopes to decrease the mortality of severely injured patients suffering
from torso hemorrhage. This can only be accomplished through research
into the development of simple, rapid and field-expedient techniques
which can be used by medics on the battlefield or first responders in a
civilian context to detect and treat noncompressible hemorrhage.
Examples of current NTI research in noncompressible hemorrhage include:
---------------------------------------------------------------------------
\3\ (2009) Tactical Combat Casualty Care Guidelines. http://
www.usaisr.amedd.army.mil/tccc/TCCC%20Guidelines%20091104.pdf. Accessed
May 20, 2012.
---------------------------------------------------------------------------
--The use of ultrasonography to measure the diameter of the vena cava
to determine whether this will give an accurate indication of
low blood volume.
--An observational study to determine the incidence and prevalence of
clotting abnormalities in severely injured patients and to
study the complex biology of proteins to better understand,
predict, diagnose, and treat bleeding after trauma.
--Supplementation of hemorrhagic shock patients with vasopressin, a
hormone needed to support high blood pressure. Vasopressin at
high doses has been shown to improve blood pressure, decrease
blood loss and improve survival in animal models with lethal
blood loss. This study investigates the use of vasopressin in
trauma patients.
Another challenge in hemorrhage is resuscitation--the restoration
of blood volume and pressure. Traditional resuscitation includes large
volumes of intravenous fluids followed by blood and finally plasma.
However, now this large intravenous fluid load is thought to worsen the
trauma patient's coagulopathy (blood clotting problems), increasing
bleeding. There is strong retrospective evidence that for patients
requiring massive transfusion, a higher proportion of plasma and
platelets, when compared to red cells, results in improved survival.
Based on a 2004 research study,\4\ the current Joint Theater Trauma
Clinical Practice Guideline for Forward Surgical Teams and Combat
Support Hospitals advocates a plasma, platelet, and red cell
resuscitation regime in lieu of the standard intravenous fluids.
Currently, there is no blood substitute available for in-theater use.
The Army Medical Department/USA Institute of Surgical Research is
working on a freeze-dried plasma solution; however, this product has
not yet received FDA approval. Remarkably, current treatments used by
military medics for restoration of blood volume are very similar to
those originally used in 1831 when saline was first given as an
intravenous fluid to cholera patients.\1\
---------------------------------------------------------------------------
\4\ Holcomb, J.B., Jenkins, D., Rhee, P., Johannigman, J., Mahoney,
P., Mehta, S., Cox, E.D., Gehrke, M.J., Beilman, G.J., Schreiber, M.,
Flaherty, S.F., Grathwohl, K.W., Spinella, P.C., Perkins, J.G.,
Beekley, A.C., McMullin, N.R., Park, M.S., Gonzalez, E.A., Wade, C.E.,
Dubick, M.A., Schwab, C.W., Moore, F.A., Champion, H.R., Hoyt, D.B.,
and Hess, J.R. (2007) Damage Control Resuscitation: Directly Addressing
the Early Coagulopathy of Trauma. The Journal of Trauma 62, 307-310.
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Noncompressible hemorrhage is just one example of advances in
research that can be applied to both military and civilian casualties.
Many of the problems associated with hemorrhage of all kinds are
potentially solvable and are transferable between military and civilian
trauma care. The funding recommended by NTI could have a dramatic
impact on civilian mortality in the United States as hemorrhage is
responsible for 30 to 40 percent of deaths following a traumatic injury
to civilians.\5\
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\5\ Holcomb, J.B. (2010) Optimal Use of Blood Products in Severely
Injured Trauma Patients. Hematology, 465-469.
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impact of trauma on united states civilians
Traumatic injury is the cause of death of nearly every soldier in
combat. On the civilian front, trauma/injury is responsible for more
than 61 percent of the deaths of Americans between the ages of 1 and 44
each year.\6\ That's more than all forms of cancer, heart disease, HIV,
liver disease, stroke, and diabetes combined. An American dies every 3
minutes due to trauma. That's 170,000 deaths in addition to 42 million
injuries every year.\6\
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\6\ CDC (2006) Centers for Disease Control/WISQARS. http://
webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html. Accessed March 16,
2012.
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top causes of death in 2009: 1-44 years
Trauma is the second most expensive public health problem facing
the United States. Data from the Agency for Healthcare Research and
Quality (AHRQ) on the ten most expensive health conditions puts the
annual medical costs from trauma at $72 billion, second only to heart
conditions at $76 billion, and ahead of cancer and all other
diseases.\7\ The National Safety Council estimates the true economic
burden to be more than $690 billion per year, since trauma has an
ongoing cost to society due to disability, and is the leading cause of
years of productive life lost.\8\
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\7\ AHRQ (2008) Big Money: Cost of 10 Most Expensive Health
Conditions Near $500 Billion. Agency for Healthcare Research and
Quality http://www.ahrq.gov/news/nn/nn012308.htm. Accessed May 2, 2012.
\8\ NSC (2011) Summary from Injury Facts, 2011 Edition. National
Safety Council http://www.nsc.org/news_resources/
injury_and_death_statistics/Documents/Summary%202011.pdf. Accessed
March 16, 2011.
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eight most expensive health conditions in the united states
department of defense medical research funding
For fiscal year 2012, the Congress added more than $600 million to
the President's budget request for DOD medical research funding. While
very significant, this sum is considerably less than that appropriated
just 2 years prior, when the Congress added more than $1 billion for
DOD medical research. However, roughly 60 percent of the fiscal year
2012 funding the Congress added was not directed to those conditions
such as hemorrhage which are common battlefield injuries and most
severely impact our troops. NTI greatly appreciates the subcommittee's
attention to traumatic brain injury and psychological health. NTI urges
that the Congress set aside equivalent sums for improvements in
treating other lethal or disabling battlefield injuries.
research works
It has been proven repeatedly that medical research saves lives.
For instance, in 1950 a diagnosis of leukemia was tantamount to a death
sentence. Research led to chemotherapy treatments in the 1950s and bone
marrow transplantations in the 1970s. A substantial investment in
research has led to safer and more effective treatments, and today
there is a 90-percent survival rate for leukemia.\9\ Another example is
breast cancer. Thirty years ago only 74 percent of women who were
diagnosed before the breast cancer spread lived for another 5 years.
Due to research into early detection, chemotherapy and pharmaceuticals,
the 5-year comparable survival rate for breast cancer is now 98
percent.\10\
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\9\ (2011) Research Successes. Leukemia and Lymphoma Society http:/
/www.lls.org/#/aboutlls/researchsuccesses/. Accessed May 20, 2012.
\10\ (2011) Our Work. Susan G. Komen For the Cure http://
ww5.komen.org/AboutUs/OurWork.html. Accessed May 20, 2012.
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Fifty years of dedicated research into proper diagnosis and
treatment of leukemia has led to an 80-percent reduction in the death
rate. Imagine even a 5 percent reduction in trauma deaths and economic
burden--this could save the United States $35 billion, save almost
9,000 lives every year, and significantly reduce the extent of
disability of those who do survive a traumatic event.
Recommendation.--NTI recommends that the Congress set aside a much
larger portion of DOD medical research funding for the medical
conditions which most severely injure as well as kill our soldiers and
in particular maintain or increase funding for noncompressible
hemorrhage--the leading cause of potentially survivable deaths of our
soldiers.
Chairman Inouye. I can assure you that we will discuss this
matter with DOD to see if they cannot increase funding. Thank
you very much.
Now the final panel. We have: Rear Admiral Casey Coane,
representing the Association of the United States Navy; Dr.
Andrew Pollak, representing the American Association of
Orthopedic Surgeons; Mr. Mark Haubner, representing the
Arthritis Foundation; and Dr. Remington Nevin, representing the
mefloquine research.
May I call upon Admiral Coane.
STATEMENT OF REAR ADMIRAL CASEY COANE, U.S. NAVY
(RETIRED), EXECUTIVE DIRECTOR, ASSOCIATION
FOR THE UNITED STATES NAVY
Admiral Coane. Chairman Inouye and Ranking Member Cochran:
It's good to be with you again this year. On behalf of the
Association of the United States Navy (AUSN) and our thousands
of members, we thank you and the committee for the work that
you do in support of our Navy, retirees and veterans, as well
as their families. Your hard work has allowed significant
progress in adequately funding our Nation's military that has
also left a lasting impact on national security.
AUSN recognizes the difficulties ahead in your obligation
to abide by the Budget Control Act of 2011, while adequately
funding and providing for our Nation's defense. Our top
concerns with defense appropriations include the proposed
TRICARE increases, Navy shipbuilding, and adequately funding
the National Guard and Reserve equipment account for the Navy
Reserve component. I'll make a brief comment about each and
refer your staff to our written testimony for details.
Regarding TRICARE, AUSN accepts proposed increases in
pharmacy copays right now as reasonable, but urges the Congress
to reject any new fees and any increase in TRICARE Prime fees
that exceeds the cost-of-living adjustment (COLA)-based
standard established just last year in the Defense
Authorization Act.
If we were here discussing changing the age requirements
for social security, there isn't a person in this room who
wouldn't agree that we must grandfather current recipients who
planned for their retirement under the current rule set. The
Defense Department extends no such consideration to those
already retired. In fact, the lion's share of proposed fee
increases applies only to retirees.
AUSN supports legislation to protect the armed service
retirees from proposed increases to their TRICARE coverage,
such as S. 3203, the Military Health Care Protection Act of
2012, which was introduced bipartisanly by Senators Frank R.
Lautenberg and Marco Rubio.
Senators, our Navy is stretched thin today. In this decade
of war our Navy, while the budget has gone up, has gotten only
smaller. Right now the budget calls for fewer ships.
Deployments are lengthening today. We just had a ship return
from, instead of a 6-month deployment, a 10-month wartime
deployment, and we just sent one on a 10-month deployment last
month. This directly impacts families. As I said, the proposed
budget calls for fewer ships.
As the Army and Marine Corps return from Afghanistan, the
Navy's mission will not decrease. In fact, the President has
directed in his January strategic guidance increased efforts in
the Pacific.
Therefore, AUSN urges the Senate Appropriations Committee
to restore planned cuts to the Virginia-class submarine, to
restore 4 of the 7 cruisers now scheduled for early retirement.
This is both necessary to the Navy's mission and cost-effective
for the taxpayer.
Turning to the Reserve component, Senator Cochran, you and
I discussed at this hearing last year the Navy's C-48 transport
aircraft. It's a program of record calling for 17 aircraft to
replace seriously aging C-9B's. Now, in keeping with the
Pentagon's thoughts about unfunded lists, the Navy Reserve
didn't ask for an airplane this year, and yet the program of
record stands. Fourteen have been bought to this date of the
17. Some have been bought with National Guard and Reserve
equipment moneys, which is the right place for that, in the
Reserve component.
PREPARED STATEMENT
The Navy cannot do without this airlift capacity, and each
year that the less capable and far more expensive to operate C-
9s remain, the taxpayers lose. There are no C-40s, as I said,
in the fiscal year 2013 budget. AUSN urges the addition of at
least one, funded through the National Guard and Reserve
Equipment Account (NGREA), this year.
That concludes my testimony, subject to your questions.
[The statement follows:]
Prepared Statement of Rear Admiral Casey Coane
the association of the united states navy
The Association of the United States Navy (AUSN) continues its
mission as the premier advocate for our Nation's sailors and veterans
alike. Formerly known as the Naval Reserve Association, which traces
its roots back to 1954, AUSN was formally established on May 19, 2009,
to expand its focus on the entire Navy. AUSN works for not only our
members, but the Navy and veteran community overall by promoting the
Department of the Navy's interest, encouraging professional development
of officers and enlisted, and educating the public and political bodies
regarding the Nation's welfare and security.
AUSN prides itself on personal career assistance to its members and
successful legislative activity on Capitol Hill regarding equipment and
personnel issues. The Association actively represents our members by
participating in the most distinguished groups protecting the rights of
military personnel. AUSN is a member of The Military Coalition, a group
of 34 associations with a strong history of advocating for the rights
and benefits of military personnel, active and retired. AUSN is also a
member of the National Military Veterans Alliance and an associate
member of the Veterans Day National Committee of the Department of
Veterans' Affairs (VA).
AUSN's members are Active Duty, Reserve and veterans from all 50
States, U.S. territories, Europe, and Asia. AUSN has 81 chapters across
the country. Of our 18,000 members, approximately 95 percent are
veterans. Our national headquarters is located at 1619 King Street,
Alexandria, Virginia, and we can be reached at 703-548-5800.
summary
Chairmen Inouye, Ranking Member Cochran, and members of the Senate
Appropriations Committee, Subcommittee on Defense: AUSN thanks you and
your Committee for the work that you do in support of our Navy,
retirees, and veterans as well as their families. Your hard work has
allowed significant progress in adequately funding our Nation's
military that has also left a lasting impact on our national security.
Last year alone, in the Department of Defense (DOD) Appropriations
Act of 2012, AUSN was pleased to see that the Congress funded Navy
Military personnel at $26.8 billion; Marine Corps military personnel at
$13.6 billion; Navy Reserve personnel at $1.9 billion; and Marine Corps
Reserve personnel at $644 million. In addition, AUSN was pleased to see
$14.9 billion appropriated for Navy Shipbuilding and Conversion; $32.5
billion for the Defense Health Program; and record amounts of National
Guard and Reserve Equipment Account (NGREA) funding at $1 billion, of
which $75 million was appropriated for the Navy Reserve.
As part of a larger military and veteran community, AUSN recognizes
that there are many challenges ahead, especially with the release of
the President's fiscal year 2013 budget request this past February and
his Strategic Guidance earlier this past January. Of great concern
amongst our membership, as well as the Navy and military community, are
the increases in TRICARE rates and enrollment fees in DOD's budget
request. AUSN believes that such changes must be done in accordance
with what is right for our military and veterans given the promises
that were made when they signed up to serve their country, and
especially with those retirees who have already served and whom these
changes effect even more. The impact this will also have upon future
recruitment and retention within the military should also be taken into
consideration as this subcommittee begins appropriating funds for the
various essential DOD programs our servicemembers rely on.
Similarly, AUSN is concerned with the heavy cuts that appear to be
disproportionately allocated to DOD. DOD requested, in the President's
budget request, $614 billion for fiscal year 2013, which reduces $487
billion from its projected spending over the next decade. In the
President's Strategic Guidance, released on January 3, 2012, it states
that, ``we will of necessity rebalance toward the Asia-Pacific
region''; however, the proposed decommissioning of seven older cruisers
(six of which had been scheduled for modernization), delaying the Ohio-
class submarine (SSBN-X) replacement program by 2 years, build two
fewer littoral combat ships (LCS) over the next 5 years (one from each
variant builder), building only one Virginia-class submarine (SSN) in
2014 and delay it to 2018, and the reduction of the joint high speed
vessel (JHSV) from 18 to 10 found in the President's budget seems
counter intuitive to this new strategy.
The overarching, long-term, concerns with the proposed DOD budget
cuts that the AUSN has is that DOD is already requesting $614 billion
for fiscal year 2013, already trimming down $487 billion from its
projected spending over the next decade. However, after the failure of
the Joint Committee on Deficit Reduction, or ``Super Committee'',
failing to find the savings as mandated by the Budget Control Act of
2011 (BCA), come January 2013, the ``sequestration'' mechanism would be
triggered that would automatically slash an additional $450-$500
billion from the military's budget by fiscal year 2021. As a result of
such drastic cuts, Secretary of Defense Leon Panetta has already
stated, in a letter to Senators McCain and Graham last fall, that
sequestration represents a reduction of nearly 20 percent in DOD
funding over the next 10 years with reductions at this level meaning
the smallest Navy since before World War II, potential termination of
the Joint Strike Fighter (JSF) program, delay of the next-generation
ballistic missile submarine and cuts to our existing sub fleet as well
as the cancellation of the LCS program.
AUSN is working with other Military and Veteran Service
Organizations to address these concerns, but in regards to Defense
appropriations, our focus is on the Military Healthcare System (MHS)
that is crucial to our military personnel and the Navy's Equipment/
Procurement needs that is vital to our national security.
military healthcare system funding
AUSN was pleased to hear that the President's budget request
included $32.5 billion for the Defense Health Program (DHP), which was
the same level enacted for fiscal year 2012. However, for the DOD's
unified medical budget, which includes DHP, the President's budget
request included $48.7 billion, which is a reduction of $4.1 billion
from the fiscal year 2012 enacted level of $52.8 billion. The reduction
primarily comes out of the Health Care Accrual Program which includes
healthcare contributions of the Medicare-Eligible Retiree Health Care
Fund to provide for the future costs of our personnel currently serving
on Active Duty and their family members when they retire. AUSN stresses
the importance of adequately funding the MHS and ensure that changes,
like those proposed in the President's budget request, aren't
burdensome to our military.
tricare
The administration's fiscal year 2013 budget request implements
numerous changes to the existing MHS, which is utilized by more than
9.6 million beneficiaries which include active military member, their
families, military retirees and their families, dependent survivors and
certain eligible Reserve component members and their families. Changes
include increases to TRICARE Prime Enrollment fees. Last year, finally
acknowledging the Congress's long-standing concerns about the
inappropriateness of dramatic increases in beneficiary fees, the
administration proposed a 13-percent increase in TRICARE Prime fees. In
the absence of congressional objection, the increase was implemented as
of October 1, 2011. However, the new proposal for fiscal year 2013
through fiscal year 2017 is a dramatic departure, proposing to triple
or quadruple fees over the next 5 years (for example $520 across the
board retired pay levels for fiscal year 2012 to $600/$720/$820 tiered
across the retired pay levels for fiscal year 2013 to $893/$1,523/
$2,048 by fiscal year 2017). AUSN urges the Congress to reject any
increase in TRICARE Prime fees that exceeds the cost-of-living
adjustment (COLA)-based standard established in the Fiscal Year 2012
Defense Authorization Act.
In addition, the fiscal year 2013 budget request institutes an
annual TRICARE Standard Enrollment fee to be phased in over a 5-year
period and then indexed to increases in National Health Expenditures
(NHE) after fiscal year 2017 (for example $0 in fiscal year 2012 to $70
in fiscal year 2013 for individuals and $0 in fiscal year 2012 to $140
for families). The deductibles for TRICARE Standard would also increase
from $150 in fiscal year 2012 to $160 in fiscal year 2013 for
individuals and from $300 in fiscal year 2012 to $320 in fiscal year
2013 for families. TRICARE for Life (TFL) would also see an
implementation of enrollment fees for all three tiers going from $0 for
all three for fiscal year 2012 to $35 for tier 1, $75 for tier 2 and
$115 for tier 3 for fiscal year 2013. In total, the fiscal year 2013
budget request contains $48.7 billion for the entire DOD unified
medical budget to support the MHS, which is a difference of $4.1
billion less than the $52.8 billion that was enacted for fiscal year
2012.
These proposed increases, which require congressional approval, are
part of the Pentagon's plan to cut $487 billion in spending and seeks
to save $1.8 billion from the TRICARE system in the fiscal year 2013
budget, and $12.9 billion by 2017. These rate increases amount to an
overall change of 30-percent to 78-percent increase in TRICARE premiums
for the first year and explodes for a 5-year span increase of 94
percent to 345 percent, more than three times current levels!
AUSN, our membership and the military and veteran community
continue to oppose the establishment of any new fees where there are
none now (such as the enrollment fees for TFL or TRICARE Standard). Our
veterans should get guaranteed access for an enrollment fee which is
not always the case for those that rely on TFL or TRICARE Standard
where many can't find doctors to see them. Where a flat fee exists now
(which DOD is trying to dramatically increase and then index to health
cost growth), we assert that the same rules should apply to those that
the Congress applied to the Prime enrollment fee in the fiscal year
2012 NDAA . . . they should be tied to COLA and not health cost growth.
These changes in the fiscal year 2013 budget request raise concerns
amongst the military community about the impact this will have on
recruiting and maintaining a high quality all volunteer military force.
These benefits have been instrumental in recruiting qualified service
men and women and keeping them in uniform.
pending legislation and appropriations
AUSN was happy to see that the House Appropriations Committee,
Subcommittee on Defense completed its markup in mid-May and included
$32.9 billion for DHP, which is $333.5 million more than the
President's budget request, and $380.2 million more than the amount
appropriated for fiscal year 2012. The markup also includes $2.3
billion for family support and advocacy programs. Increases above the
request include:
--$246 million for cancer research;
--$245 million for medical facility and equipment upgrades;
--$125 million for traumatic brain injury and psychological health
research; and
--$20 million for suicide prevention outreach programs.
AUSN is supportive of these funding levels within the DHP to our
military. In addition, AUSN supports legislation to protect armed
service retirees from proposed increases to their TRICARE coverage such
as S. 3203, the Military Healthcare Protection Act of 2012, which was
introduced bipartisanly by Senators Frank Lautenberg (D-NJ) and Marco
Rubio (R-FL). This bill recognizes the sacrifices made over a 20- or
30-year military career to retirees and seeks to limit the proposed
changes in TRICARE.
navy equipment/procurement
The President's fiscal year 2013 budget request included $43.9
billion for Navy and Marine Corps equipment funding. This is a decrease
of $2.3 billion below the amount enacted for fiscal year 2012 (5-
percent decrease). This includes, within the fiscal year 2013 budget
request for the Navy, the proposed decommissioning of seven older
cruisers (six of which had been scheduled for modernization), delaying
the Ohio-class submarine (SSBN-X) replacement program by 2 years, build
two fewer littoral combat ships (LCS) over the next 5 years (one from
each variant builder), and build only one Virginia-class submarine
(SSN) in 2014 and delay it to 2018. AUSN is concerned that these
funding level decisions are being driven by budget, rather than
strategy, and that the Navy procurement levels do not reflect the needs
of a strong forward presence, especially in the hostile regions of the
Asia-Pacific Theater.
navy shipbuilding and conversion
As the Congress proceeds with consideration of the fiscal year 2013
Defense appropriations bill, it is important that the appropriated
funding levels for Navy equipment meet the needs of our Navy as
recommended by the President's Strategic Guidance released this past
January. In the Strategic Guidance, the Administration highlights that,
``we will of necessity rebalance toward the Asia-Pacific region . . .
[providing] security in the broader Indian Ocean region.'' Yet the
proposed cuts to Navy platforms in the President's budget request are
alarming in that with this refocus in strategy, and the Navy's goal of
a 300-plus fleet, appear to hamper this strategy and reduce our Navy's
capability, making any attempt to deter hostilities in the Pacific very
difficult.
Last year, in the Consolidated Appropriations Act for fiscal year
2012, the Navy was appropriated $14.9 billion for Navy Shipbuilding and
Conversion. Of that, for the Advanced Procurement (AP) for the Carrier
Replacement Program (AP), $554.7 million, for the Virginia-class
submarine, $3.2 billion, for the Virginia-class submarine (AP), $1.5
billion, for the DDG-1000 Program, $453.7 million, or the DDG-51
Destroyer, $2.0 billion, for the DDG-51 Destroyer (AP), $100.7 million,
for the LCS, $1.8 billion and for the joint high speed vessel (JHSV),
$372.3 million. Along with the ship cuts in the President's fiscal year
2013 budget request, this year's request for shipbuilding and
conversion had dramatic cuts in funding levels from the fiscal year
2012 enacted legislation. The fiscal year 2013 budget request includes
a total of $13.6 billion for Navy shipbuilding and conversion (a
reduction of $1.3 billion). Of that, for the Carrier Replacement
Program, $608.1 million (an increase of $53.4 million), for the
Virginia-class submarine, $3.2 billion, for the Virginia-class
submarine (AP), $875 million (a decrease of $625 million), for the DDG-
1000 program, $669.2 million (an increase in $215.5 million), for the
DDG-51 Destroyer, $3 billion (an increase of $1 billion), for the DDG-
51 Destroyer (AP), $466.3 million (an increase of $365.6 million), for
the LCS, $1.8 billion, and for the JHSV, $189.2 million (a decrease of
$183.1 million).
Although AUSN was pleased to see funding increases between the
fiscal year 2012 enacted level and the fiscal year 2013 budget request
in some areas, AUSN was alarmed by some of the other drastic
reductions, especially in the Future Years Defense Program (FYDP)
funding levels, and its effects upon the capability of our Navy to
forward project our forces and deter hostilities as required in the
President's Strategic Guidance of January 2013.
navy reserve national guard and reserve equipment account funding
AUSN was pleased last year when the fiscal year 2012 enacted levels
for National Guard and Reserve Equipment Account (NGREA) were in
historic amounts of $1 billion, of which the Navy Reserve received $75
million. Given the requirements set forth in the annual National Guard
and Reserve Equipment Report (NGRER), AUSN would like to see the
funding levels for the Navy Reserve increase to match their needs and
priorities. With more than 6,000 mobilized or deployed Navy Reserve
sailors, providing about one-half of the Navy's ground forces in the
Central Command and in other critical roles worldwide, equipping the
compatibility with the Active component (AC) is quite the challenge.
Equipment in the Navy Reserve is experiencing a service life of more
than 20 years for many platforms, adding sustainment and
interoperability challenges in preparing Reserve units to train and
deploy mission-ready in support of the Navy's total force.
The Navy Reserve faces many equipping challenges. The first is
aircraft procurement where Naval Aviation Plan 2031 provides a
requirement to replace the aging and maintenance intensive aircraft
that provide critical Reserve component (RC) capability enhancements.
In particular, C-130s are a critical part of the Navy-unique fleet
essential airlift mission between strategic airlift points and the
carrier onboard delivery and vertical onboard delivery to the fleet. In
addition are the C-40As, whereas they are continuously being procured,
with 14 to date, with help from critical NGREA funding, however the C-
40A is still below requirement levels. In addition, the Navy Reserve is
facing shortfalls in expeditionary equipment funding and increased
procurement in force protection, secure communications and a wide range
of logistical equipment will increase the overall capabilities of units
serving in contingency operations. Last, the RC Navy Special Warfare
sea-air-land (SEAL) teams have been fully integrated with the AC since
2008, making up one-third of the personnel mobilized in support of
overseas contingency operations. The RC relies on the equipment of the
AC and the shortfalls become a challenge when 97 percent of special
warfare personnel are mobilized for current operations.
As our Nation's overseas operations decrease, i.e. Iraq and
Afghanistan, Active Duty for Training Funding (ADT) is resulting in
increased utilization and driving an unfunded liability as high as $200
million. With the challenges to equip a total force and the increased
reliance on the RC in the past decade, AUSN believes that the Navy
Reserve should continue to have its funding requirements met to the
best of the subcommittee's ability.
pending legislation and appropriations
AUSN was happy to see that the HAC-D markup included, for Navy
Shipbuilding and Conversion, an appropriation of $15.2 billion to
remain available for obligation until September 30, 2017 (an increase
of 1.7 billion from the fiscal year 2013 budget request). Highlights of
this appropriation include for:
--Carrier Replacement Program: $578.3 million;
--Virginia-class submarine: $3.2 billion;
--Virginia-class submarine--Advance Procurement (AP): $1.6 billion
(increase of $723 million for the subcommittee's return of the
fiscal year 2014 Virginia-class submarine, from the President's
fiscal year 2013 budget request of $874.9 million);
--DDG-1000 Program: $699.2 million;
--DDG-51 destroyer: $4 billion (increase $1 billion from President's
fiscal year 2013 budget request of $3 billion due to
subcommittee adding one additional DDG-51 Arleigh Burke-class
destroyer);
--DDG-51 Destroyer--Advance Procurement (AP): $466.3 million;
--LCS: $1.8 billion; and
--JHSV: $189.2 million.
In addition, AUSN was pleased to see that the NGREA amount was to
include $2 billion; a $1 billion increase in last year's enacted level.
We look forward to seeing the Senate Appropriations Committee consider
these funding levels in the Senate's fiscal year 2013 DOD
appropriations bill.
conclusion
The Association of the United States Navy understands that there
are difficult decisions ahead in regards to this year's fiscal year
2013 budget and how the Senate Appropriations Committee considers
adequately funding our military, while adhering to the Budget Control
Act. Amongst our Legislative Objectives/Priorities for fiscal year 2013
is the looming concern of the effects of an automatic sequestration
trigger upon DOD. AUSN was pleased that the Office of Management and
Budget ruled in favor of exempting the Department of Veterans' Affairs.
However, with our military community relying on TRICARE and DHP, as
well as the President's strategic guidance shifting focus to a volatile
Asia/Pacific region, cuts to DOD need to be carefully looked at and
decisions need to be made based on strategy, rather than budget. On
March 15, 2012, in a Senate Armed Services Committee hearing on the
fiscal year 2013 budget request, the Secretary of the Navy highlighted
how the goal is to have a Navy of more than 300 ships by no later than
2019. In the same hearing, Admiral Jonathan W. Greenert, the Chief of
Naval Operations, testified that ``In my view, if sequestration kicks
in . . . I'm looking at not 285 ships in a given year. I'm looking at
230. We don't have enough force structure to accrue that kind of
savings without reducing procurement.'' However, this raises the
concern that as budget cuts progress, with looming DOD sequestration,
our fleet size could be drastically reduced, and consequently, so could
our capabilities with forward force projection. AUSN urges this
subcommittee to look at all proposals to ensure that vital DOD programs
and platforms, for our military personnel and our strategic
capabilities, aren't subject to further debilitating cuts and
sequestration. In addition, we encourage members of the subcommittee to
look at our Web site which contains detailed analyses of past and
current DOD appropriations measures as the House and Senate
Appropriations Committee's markup and consider the fiscal year 2013 DOD
appropriations bills. (http://www.ausn.org/Advocacy/AppropriationBills/
Defense/tabid/2758/Default.aspx)
Thank you.
Chairman Inouye. As you can imagine, Admiral, this
subcommittee has that assignment of preventing sequestration,
and we will do our absolute best. I can assure you that.
Admiral Coane. Thank you, Sir. It's absolutely essential
that we do.
Chairman Inouye. Now may I call upon Dr. Andrew Pollak.
STATEMENT OF ANDREW N. POLLAK, M.D., TREASURER,
AMERICAN ASSOCIATION OF ORTHOPAEDIC
SURGEONS
Dr. Pollak. Thank you, Mr. Chairman and Ranking Member. I'm
Dr. Andy Pollak, treasurer of the American Association of
Orthopaedic Surgeons (AOS) and immediate past president of the
Orthopaedic Trauma Association. I'm also chief of orthopaedic
traumatology at the University of Maryland's R. Adams Cowley
Shock Trauma Center in Baltimore.
On behalf of the AOS and my orthopaedic colleagues across
the country, thank you for inviting us to testify before you
today on the Peer-Reviewed Orthopaedic Research Program
(PRORP).
The events of September 11, 2001, catalyzed the global war
on terror, a war that's resulted in thousands of wounded
warriors, most of whom wind up with an extremity injury, an
injured arm or leg. Between Operations Enduring Freedom, Iraqi
Freedom, and New Dawn, more than 47,000 service men and women
have been injured, and of those more than 80 percent have
suffered a limb injury.
The issue of treating the sheer volume of injuries has been
compounded with the newness of the injuries. Improvised
explosive devices (IEDs) have overwhelmed our military medical
providers with new injuries and scant data on how to best treat
them, initially forcing our military surgeons to amputate limbs
at an alarming rate.
The PRORP and the Orthopaedic Extremity Trauma Research
Program (OETRP) were both created as a result of the Congress's
action, specifically this subcommittee's leadership in
recognizing the need for more research to save limbs and limit
disability in our wounded warriors. PRORP is funded through
DOD's health program and was established to quickly develop
focused basic and clinical research through direct grants to
research institutions across the country. The goal is to help
military surgeons address the leading burden of injury and loss
of fitness for military duty by finding new limb-sparing
techniques to save extremities, avoid amputations, and preserve
and restore the function of injured limbs.
PRORP aims to provide all warriors affected by extremity
war injuries the opportunity for optimal recovery and
restoration of function. One of the greatest successes of OET
and PRORP has been the establishment of the Major Extremity
Trauma Research Consortium (METRC). METRC works to produce the
evidence needed to establish treatment guidelines for the
optimal care of the wounded warrior and ultimately improve the
clinical, functional, and quality of life outcomes of both
servicemembers and civilians who sustain high-energy trauma to
the extremities. This research is presently being coordinated
at 54 military and civilian sites throughout the country,
making it a true military-civilian partnership to help our
wounded warriors while learning more about relevant comparable
civilian injuries as well.
One important recently published advance attributable
directly to OET and PRORP has been the research on heterotopic
ossification (HO). HO comes in two main forms, one that appears
in children and is congenital and another that strikes wounded
military personnel and surgery patients and is triggered by
severe injuries and wounds such as amputation.
With HO, the bone grows in abnormal locations and can press
against nerves and blood vessels, resulting in severe pain,
limited motion, problems fitting prosthetic limbs, and skin
breakdown. Nearly 65 percent of wounded warriors with extremity
injuries suffer HO, a problem we understood little about prior
to this program.
Through a grant from OETRP, researchers at Children's
Hospital of Philadelphia have shown that a drug that interrupts
a specific signaling pathway can prevent HO. The potential
benefit to our wounded warriors is astronomical and that
represents an advance that would not have been possible absent
this program.
PREPARED STATEMENT
We're under no illusion that this kind of research is
cheap. We further understand that we're in an era of
unprecedented budget austerity. But the cost of not doing this
research is exponentially higher. An amputation costs three
times more than limb salvage in future medical care and
significantly more than that after accounting for increased
disability payments and the need to replace trained
servicemembers with new recruits.
Furthermore, while we need to get our fiscal house in
order, it can't be done on the backs of our men and women in
uniform. If we put them in harm's way, we have a solemn duty to
give them the best possible medical care, backed by the best
possible science. The Peer-Reviewed Orthopaedic Research
Program helps accomplish just that.
Thank you.
[The statement follows:]
Prepared Statement of Andrew N. Pollak, M.D.
introduction
Good morning, Chairman Inouye, Ranking Member Cochran, and other
distinguished members of the subcommittee. I am Dr. Andrew N. Pollak,
treasurer of the American Association of Orthopaedic Surgeons (AAOS),
and immediate past president of the Orthopaedic Trauma Association. I
am also the chief of orthopaedic traumatology at the University of
Maryland Shock Trauma Center in Baltimore. On behalf of the AAOS and my
orthopaedic surgeon colleagues across the country, thank you for
inviting our organization to testify before you today on the Peer-
Reviewed Orthopaedic Research Program (PRORP) as part of the fiscal
year 2013 budget.
overview
The events of September 11, 2001, served as a catalyst for the
global war on terror. This war has resulted in thousands of wounded
warriors, most of whom wind up with an extremity injury. Between
Operations Enduring Freedom, Iraqi Freedom, and New Dawn, more than
47,000 service men and women have been injured.\1\ Of the injured, more
than 80 percent have suffered a limb injury.\2\
---------------------------------------------------------------------------
\1\ Wounded Warrior Project. http://www.woundedwarriorproject.org/
mission/who-we-serve.aspx.
\2\ United States Army Institute of Surgical Research. http://
www.usaisr.amedd.army.mil/
extremity_trauma_research_regenerative_medicine.html.
---------------------------------------------------------------------------
The issue of treating the sheer volume of injuries has been
compounded with the newness of the injuries. Our men and women in
uniform are facing a new type of weapon that causes a new type of
injury: improvised explosive devices. Overwhelmed with new injuries and
scant data on how best to treat them, our military surgeons were
amputating extremities at an alarming rate.
PRORP and the Orthopaedic Extremity Trauma Research Program (OETRP)
were both created as a result of the Congress's action, specifically
this subcommittee's leadership in recognizing the need for more
research to save limbs and limit disability in our wounded warriors.
PRORP is funded through the Department of Defense Health Program, and
was established to quickly develop focused basic and clinical research
through direct grants to research institutions. The goal is to help
military surgeons address the leading burden of injury and loss of
fitness for military duty by finding new limb-sparing techniques to
save extremities, avoid amputations, and preserve and restore the
function of injured extremities. PRORP aims to provide all warriors
affected by extremity war injuries the opportunity for optimal recovery
and restoration of function.
benefits of research
One of the greatest successes of OETRP and PRORP has been the
establishment of the Major Extremity Trauma Research Consortium
(METRC). METRC works to produce the evidence needed to establish
treatment guidelines for the optimal care of the wounded warrior and
ultimately improve the clinical, functional, and quality-of-life
outcomes of both servicemembers and civilians who sustain high-energy
trauma to the extremities. This research is being coordinated at 54
military and civilian sites throughout the country making it a true
military civilian partnership to help our wounded warriors while
learning more about relevant comparable civilian injuries.
One important recently published advance attributable directly to
OETRP and PRORP has been the research on heterotopic ossification (HO).
HO comes in two main forms--one that appears in children and is
congenital, another that strikes wounded military personnel and surgery
patients and is triggered by severe injuries and wounds such as
amputation. With HO, the bone grows in abnormal locations and can press
against nerves and blood vessels, resulting in severe pain, limited
motion, problems fitting prosthetic limbs, and skin breakdown. It is so
prevalent after high-energy trauma that nearly 65 percent of wounded
warriors with extremity injuries suffer HO.\3\ Through a grant from the
OETRP program, researchers at The Children's Hospital of Philadelphia
have shown that a drug that interrupts a signaling-nuclear protein
pathway can prevent HO. The potential benefit to our wounded warriors
is astronomical.
---------------------------------------------------------------------------
\3\ Science Daily. http://www.sciencedaily.com/releases/2011/04/
110403141331.htm.
---------------------------------------------------------------------------
cost
We are under no illusion that this kind of research is cheap, we
further understand that we are in an era of unprecedented budget
austerity. But the cost of not doing the research is exponentially
higher. An amputation costs three times more than limb salvage in
future medical care and significantly more than that after accounting
for increased disability payments and the increased need to replace
trained servicemembers with new recruits. Indeed, 65 percent of all
combat related medical care resources go to treating extremity
injuries, and almost 70 percent of wounded warriors who suffer an
unfitting condition are unfit to return to duty because of an extremity
injury.\4\
---------------------------------------------------------------------------
\4\ Masini BD, Waterman SM, Wenke JC et al. Resource utilization
and disability outcome assessment of combat casualties from Operation
Iraqi Freedom and Operation Enduring Freedom. J Orthop Trauma. 2009. 23
(4): 261-266.
---------------------------------------------------------------------------
Furthermore, while we need to get our fiscal house in order, it
cannot be done on the backs of the men and women in uniform. If we put
them in harm's way, we have a solemn duty to give them the best
possible medical care backed by the best possible science. The Peer-
Reviewed Orthopaedic Research Program helps accomplish just that.
closing
On behalf of the AAOS, I would like to thank the Chairman, the
Ranking Member, and the entire subcommittee for your interest in and
attention to this important issue facing America's military, and the
surgeons who treat them. We look forward to continuing to work with you
on this matter.
Chairman Inouye. Dr. Pollak, did I hear you say that there
were 47,000 injured in Iraq and Afghanistan, and of that number
80 percent had limb injuries?
Dr. Pollak. Yes, Sir. Yes, the most common injury
sustained. Many of them sustain multiple injuries to multiple
parts of their body. But the limbs are disproportionately
exposed, as the chest and abdomen are protected with body armor
and the head's protected with a helmet.
Chairman Inouye. Do we have enough orthopaedic surgeons?
Dr. Pollak. That's a separate question, Sir. I don't
believe we do at this point. Our orthopaedic surgeons at Walter
Reed and at our military facilities throughout the country
right now are terribly taxed with the number of wounded
warriors returning.
Chairman Inouye. I thank you very much, Sir.
Dr. Pollak. Thank you, Sir.
Chairman Inouye. May I now call on Mr. Mark Haubner and Ms.
Erin O'Rourke.
STATEMENT OF MARK HAUBNER, ARTHRITIS FOUNDATION
Mr. Haubner. Chairman Inouye, Ranking Member Cochran, and
distinguished members of the subcommittee: It's an honor to
have the opportunity to speak with you, especially today, June
6, regarding the importance of funding arthritis research to
benefit the health of our men and women in uniform, our
military veterans, and our Nation.
We would first like to thank the Arthritis Foundation's
2012 Advocacy Leadership Award recipient, Senator Murkowski,
for being a champion for the cause of arthritis research in the
past.
My name is Mark Haubner, from Aquebogue, New York, and with
me in the audience today is Erin O'Rourke from Lake Ronkonkoma,
New York. We are here today as Arthritis Foundation advocacy
ambassadors and as concerned citizens representing 50 million
Americans with arthritis, the number one cause of disability in
the United States. We hope that our comments today give voice
to this very important request in support of peer-reviewed
competitively awarded arthritis research funded by the DOD.
I would like to tell you how arthritis has affected our
lives and the relevance to our military personnel. I broke my
leg while skiing at the age of 14, underwent many operations as
a result, and suffered my first total joint replacement at 44,
which forced me into retirement. I'm having my fifth total
joint replacement next month, 1 of 1 million joint replacements
being done in the United States every year now.
Research now shows that the rampant presence of
osteoarthritis in all of my joints is a result of a post-
traumatic trigger event suffered 30 years before. My colleague
Erin O'Rourke, who began suffering from severe pain in her
hands and fingers at the age of 34, was diagnosed with
rheumatoid arthritis (RA), a debilitating autoimmune disease
that causes unrelenting and destructive inflammation in the
joints. The medications she is taking treat, but do not cure,
arthritis. Due to RA, Erin has twice the risk of developing
heart disease and diabetes, which will likely lead to a
shortened life by almost a decade.
Studies show that our Nation's servicemembers are 32
percent more likely to develop osteoarthritis than the general
population, and the damage is presenting itself within a few
years of active duty. This is already becoming a great burden
on the long-term healthcare provided by the Department of
Veterans Affairs and can only increase with time.
One-third of our combat personnel what are medevaced out of
the field are suffering from a musculoskeletal injury, and
these injuries represent one of the leading causes of
disability and medical discharge for active servicemembers
under the age of 40. Research is needed for arthritis because
the military is facing skyrocketing numbers of Active Duty and
retired personnel fighting the high costs of pain and
disability associated with arthritis, part of a total of $128
billion per year in this country.
Another area of research concerns the inflammation that
occurs with RA. Further investigation of these inflammatory
characteristics will help us to understand and improve the
healing times and skin graft outcomes in wound care.
Thank you all for recognizing the need over the last 3
years to include post-traumatic osteoarthritis and last year
arthritis, which includes both osteo and RA, in the DOD budget
for Congressionally Directed Medical Research Program (CDMRP).
We deeply appreciate the peer-reviewed research funding awards
of almost $5 million from DOD appropriations over the last 2
years.
In conclusion, we ask for your consideration and support of
the following: to continue to include the topics of post-
traumatic osteoarthritis and rheumatoid arthritis in the fiscal
year 2013 DOD appropriations bill for the peer-reviewed medical
research program, CDMRP, under the account of Defense Health
Programs, research and development. Maintaining arthritis
research in the fiscal year 2013 DOD appropriations bill will
aid Armed Forces personnel in active service, military
veterans, and millions of Americans.
I thank you very much for your time and consideration.
PREPARED STATEMENT
Chairman Inouye. Did I hear you say that 30 percent of the
troops were evacuated because of skeletal injury?
Mr. Haubner. Sorry, Sir. It's 32 percent of the military
population that's indicating osteoarthritis and one-third of
the military population medevaced out, is suffering from a
musculoskeletal injury, that's correct.
Chairman Inouye. Can that be traced to the load they have
to carry?
Mr. Haubner. Much is indicated by both Navy and Army
studies that have been done in the past 5 or 10 years. They're
carrying 100-pound packs, 120-pound packs, through the field,
broken field running. It's making an immediate impact on their
health.
Chairman Inouye. World War II was easy. My pack was about
20 pounds.
Mr. Haubner. And the rifle was probably 18 more.
[The statement follows:]
Prepared Statement of the Arthritis Foundation
Nearly 6.5 million Americans have wounds that take months
or even years to heal. Many of these wounds are a consequence
of diabetes, which damages blood vessels and interferes with
normal skin repair. But new research from Georgetown University
Medical Center in Washington, DC, points to another cause:
autoimmune diseases such as rheumatoid arthritis (RA) and
lupus.
The research was presented earlier this month at the
American College of Rheumatology's annual conference, in
Chicago, by rheumatologist and lead author Victoria Shanmugam,
M.D. It has been accepted for publication in the International
Wound Journal.
Dr. Shanmugam had noticed an unusual number of nonhealing
wounds--mostly leg ulcers--in people with autoimmune disorders.
``What I saw clinically was that people who had autoimmune
disease did not respond as well to the usual wound care
treatments. I wanted to try to understand the reason for this
by comparing healing times and [skin] graft outcomes,'' she
says.
Treatment for nonhealing wounds depends on the wound, but
might include special dressings, hyperbaric oxygen, growth
factors, bioengineered skin substitutes and skin grafts. If
treatment doesn't work, the patient faces amputation.
Dr. Shanmugam and her colleagues reviewed the charts of 340
patients who sought care at Georgetown's Center for Wound
Healing and Hyperbaric Medicine during a 3-month period in
2009. Only those with open wounds that hadn't healed after at
least 3 months of normal therapy were included.
Forty-nine percent of these patients had diabetes (both
type 1, which is itself an autoimmune condition, or type 2).
This isn't unusual--diabetes accounts for about one-half of all
chronic wounds. Others had vascular or arterial diseases that
typically cause poor wound healing. What surprised Dr.
Shanmugam was that 23 percent had autoimmune disorders--a far
greater rate than had been expected or previously reported. The
most prevalent autoimmune diseases were RA (28 percent), lupus
(14 percent), and livedoid vasculopathy, a vascular disease
that causes ulcers on the lower legs (also 14 percent).
Dr. Shanmugam then looked at how the people with underlying
autoimmune disease responded to therapy. ``These patients had
larger wounds at the first visit, had higher pain scores and
took significantly longer to heal--14-and-a-half months
compared to just over 10 months for other patients'', she
explains. ``Clearly, there is something in the autoimmune
milieu that is inhibiting wound healing,'' says Dr. Shanmugam.
The next step is a 3-year study funded by the National
Institutes of Health. Under way since May, the study will
monitor autoimmune-related wounds over time. ``We are hoping to
get some understanding of what happens on the cellular and
molecular level in people who don't heal well,'' Dr. Shanmugam
says.
One theory is that diabetes and autoimmune disorders cause
wounds to become stalled in the inflammatory stage of repair,
when the body normally develops new blood vessels. Why this
occurs and what happens at the level of the wound itself are
questions she hopes to answer.
She also will explore whether treating underlying
autoimmune diseases such as RA improves wound healing. ``There
is concern about using potent immune suppressants in people
with open wounds,'' she says, noting that immunosuppressive
drugs are known to interfere with wound healing after surgery.
``But in a cohort of rheumatoid arthritis patients, we found
that aggressive treatment before skin graft surgery resulted in
better outcomes.''
Eric Matteson, M.D., chairman of rheumatology at Mayo
Clinic in Rochester, Minneapolis, agrees with the approach.
``People with rheumatoid arthritis develop wounds for many
reasons. One is that they may have low-grade vasculitis--
inflammation affecting the small blood vessels in the skin.
When the wound is related to the underlying systemic
inflammation of rheumatoid arthritis, not having that
inflammation under control makes it much more difficult to
achieve good wound healing.''
He says that successful wound care requires cooperation and
vigilance. ``Perhaps the biggest message here is that treating
people with autoimmune-related wounds really calls for a team
approach among the rheumatologist, wound-care specialist and
surgeon'', says Dr. Matteson. ``What you often see,
unfortunately, is a primary care doctor who can't properly
manage the wound because of the complexity of the underlying
disorder.''
Dr. Shanmugam believes her findings will affect patient
care in the future. ``Understanding how people respond to wound
care on a molecular level can help guide therapy and may reduce
the risk of infections, which can lead to surgery and even
amputation,'' she says.
As important, she hopes her research will alert other
physicians to this under-recognized problem. ``When a patient
has a leg ulcer that hasn't healed after 3 or 4 months of
normal treatment, I hope doctors will check for autoimmune
disease,'' says Dr. Shanmugam.
Chairman Inouye. I thank you very much.
Mr. Haubner. Thank you, Sir.
Chairman Inouye. And now may I call upon Dr. Remington
Nevin.
STATEMENT OF REMINGTON NEVIN, M.D., MEFLOQUINE RESEARCH
Dr. Nevin. Good morning, Mr. Chairman and members of the
subcommittee. My name is Dr. Remington Nevin. I am a board-
certified preventive medicine physician, epidemiologist, and
medical researcher. I'm a graduate of the Uniformed Services
University School of Medicine, the Johns Hopkins Bloomberg
School of Public Health, and the residency program in
preventive medicine at the Walter Reed Army Institute of
Research, where I was awarded the Distinguished George M.
Sternberg Medal. I have published extensively in medical and
scientific journals and my research has informed and broadly
influenced military public health policy over the past 7 years.
I'm here today to testify on an important issue which I
fear may become the Agent Orange of our generation, a toxic
legacy that affects our troops and our veterans. This is a
critical issue that is in desperate need of research funding.
I'm referring to the harmful effects of the antimalarial drug
mefloquine, also known as Lariam, which was first developed
more than 40 years ago by the Walter Reed Army Institute of
Research.
Mefloquine causes a severe intoxication syndrome
characterized by vivid nightmares, profound anxiety,
aggression, delusional paranoia, dissociative psychosis, and
severe memory loss. Experience has shown that this syndrome,
even if rare, can have tragic consequences both on the
battlefield and on the home front.
My recent research has helped us understand this syndrome
as a toxic encephalopathy that affects the limbic portion of
the brain. With this insight, we now understand the drug's
strong links to suicide and to acts of seemingly senseless and
impulsive violence. Yet new research suggests that even mild
mefloquine intoxication may also lead to neurotoxic brain
injury associated with a range of chronic and debilitating
psychiatric and neurologic symptoms.
It is unknown how many of the hundreds of thousands of
troops previously exposed to mefloquine may be suffering from
the devastating effects of this neurotoxicity. However, I can
tell you that I am contacted nearly every day by military
patients and veterans from the United States and from around
the world seeking diagnosis and care for their symptoms. Their
compelling and often heart-wrenching stories can be found
regularly in media reports worldwide. Invariably, these
patients are frustrated by lack of resources and information
specific to their condition.
A recent publication by the Centers for Disease Control
suggests that the side effects of mefloquine may even confound
the diagnosis and management of post-traumatic stress disorder
and traumatic brain injury.
Given our research commitments to post-traumatic stress and
traumatic brain injury, the first two signature injuries of
modern war, this observation calls for a similarly robust
research agenda into mefloquine neurotoxic brain injury to
ensure that patients with either of these conditions are
receiving accurate diagnosis and the very best medical care.
Some concrete actions for facilitating this research include
expanding the scope and mission of the defense centers of
excellence and the National Intrepid Center of Excellence, to
include the evaluation and care of patients suffering from the
effects of mefloquine, and funding a dedicated mefloquine
research center at a civilian medical school or school of
public health to attract the very best minds to this problem
and to coordinate broad investigations into the
pathophysiology, epidemiology, clinical diagnosis, and
treatment of mefloquine intoxication and neurotoxic brain
injury.
A commitment to this research roughly commensurate with our
initial investment in mefloquine's development will allow us to
mitigate the effects of the toxic legacy it has left behind. If
this issue is left unaddressed, mefloquine could become our
next Agent Orange, but it does not have to. With action,
mefloquine neurotoxic brain injury could join post-traumatic
stress and traumatic brain injury as the third recognized
signature injury of modern war and as a result receive the same
level of commitment shown for these first two conditions.
PREPARED STATEMENT
I would again like to thank you, Mr. Chairman and members
of the subcommittee, for the opportunity to appear before you
and bring this issue to your attention. I should emphasize in
closing that the opinions I express today are my own and do not
necessarily reflect those of the United States Army.
This concludes my prepared statement and I am happy to
answer any questions that you may have.
[The statement follows:]
Prepared Statement of Remington Nevin, M.D., MPH
Good morning, Mr. Chairman and members of the subcommittee. My name
is Dr. Remington Nevin. I am a board-certified preventive medicine
physician, epidemiologist, and medical researcher. I am a graduate of
the Uniformed Services University School of Medicine; the Johns Hopkins
Bloomberg School of Public Health; and the residency program in
preventive medicine at the Walter Reed Army Institute of Research,
where I was awarded the distinguished George M. Sternberg Medal. I have
published extensively in medical and scientific journals, and my
research has informed and broadly influenced military public health
policy for the past 7 years.
I am here today to testify on an important issue which I fear may
become the ``Agent Orange'' of our generation: a toxic legacy that
affects our troops, and our veterans. This is a critical issue that is
in desperate need of research funding.
I am referring to the harmful effects of the antimalarial drug
mefloquine, also known as Lariam, which was first developed more than
40 years ago by the Walter Reed Army Institute of Research.
Mefloquine causes a severe intoxication syndrome, characterized by
vivid nightmares, profound anxiety, aggression, delusional paranoia,
dissociative psychosis, and severe memory loss. Experience has shown
that this syndrome, even if rare, can have tragic consequences, both on
the battlefield, and on the home front.
My recent research has helped us understand this syndrome as a
toxic encephalopathy that affects the limbic portion of the brain. With
this insight, we now understand the drug's strong links to suicide, and
to acts of seemingly senseless and impulsive violence. Yet new research
suggests that even mild mefloquine intoxication may also lead to
neurotoxic brain injury associated with a range of chronic and
debilitating psychiatric and neurologic symptoms.
It is unknown how many of the hundreds of thousands of troops
previously exposed to mefloquine may be suffering from the devastating
effects of this neurotoxicity. I am contacted nearly every day by
military patients and veterans, from the United States, and from around
the world, seeking diagnosis and care for their symptoms. Their
compelling and often heart-wrenching stories can be found regularly in
media reports worldwide. Invariably, these patients are frustrated by a
lack of resources and information specific to their condition.
A recent publication by the Centers for Disease Control suggests
that the side effects of mefloquine may even confound the diagnosis and
management of post-traumatic stress disorder (PTSD) and traumatic brain
injury (TBI).
Given our commitment to post-traumatic stress and traumatic brain
injury, the first two signature injuries of modern war, this
observation calls for a similarly robust research agenda into
mefloquine neurotoxic brain injury, to ensure that patients with these
conditions are receiving accurate diagnosis and the very best medical
care.
Some concrete actions for facilitating this research include:
--Expanding the scope and mission of the Defense Centers of
Excellence and the National Intrepid Center of Excellence to
include the evaluation and care of patients suffering side
effects from mefloquine; and
--Funding a dedicated mefloquine research center at a civilian
medical school or school of public health, to attract the very
best minds to this problem, and to coordinate broad
investigations into the pathophysiology, epidemiology, clinical
diagnosis, and treatment of mefloquine intoxication and
neurotoxic brain injury.
A commitment to this research, roughly commensurate with our
initial investment in mefloquine's development, will allow us to
mitigate the effects of the toxic legacy it has left behind. If this
issue is left unaddressed, mefloquine could become our next ``Agent
Orange'', but it does not have to. With appropriate action, mefloquine
neurotoxic brain injury could join PTSD and TBI as the third recognized
signature injury of modern war, and as a result, receive the same level
of commitment and care shown for these first two conditions.
In conclusion, I would again like to thank you, Mr. Chairman and
members of the subcommittee, for the opportunity to appear before you
and bring this issue to your attention. This concludes my prepared
statement and I am happy to answer any questions that you may have.
Chairman Inouye. I thank you very much, Doctor. I have a
question here submitted by Senator Dianne Feinstein and it
says: Do you believe the mefloquine research you're working on
could develop treatments to reverse intoxication and brain
injury?
Dr. Nevin. Mr. Chairman, despite the permanent nature of
the neurotoxicity produced by mefloquine, I believe that there
may be effective treatments available right now, provided that
the diagnosis of mefloquine neurotoxicity is made. I have
personally treated a number of patients whose conditions have
proven fairly responsive to rehabilitation, including
vestibular, physical, and neuro-optometric therapy. Speech
therapy and cognitive rehabilitation therapy may also hold
promise.
However, obtaining access to such therapy requires that
mefloquine neurotoxic brain injury be correctly diagnosed, such
that patients receive appropriate specialist referrals. This
cannot happen if these symptoms are poorly understood by
healthcare providers or if they are mistaken for such things as
malingering, personality disorder, conversion disorder, or
factitious disorder, as they have been in the past.
For this reason, simply raising awareness of this diagnosis
may prove very helpful in facilitating early treatment.
Now, regarding other therapies, such as potential drug
treatments, evaluating these would require registered clinical
trials, which typically have a time horizon of some years
before they yield results to inform clinical practice. I am
confident that such trials hold promise in identifying drug
therapies that alleviate symptoms and improve patient outcomes,
while not risking a further exacerbation of the condition.
Chairman Inouye. Where does mefloquine come from?
Dr. Nevin. Mr. Chairman, mefloquine is the end product of a
multiyear drug development and discovery effort conducted by
the Walter Reed Army Institute of Research beginning in the
early 1960s. Of more than 300 compounds screened for their
effectiveness and toxicity, mefloquine was one of a handful of
compounds that passed this testing and later went on to
commercial development by the F. Hoffman LaRoche Company.
PREPARED STATEMENT
Chairman Inouye. I thank you very much, and I'd like to
thank all of the witnesses who've testified this morning.
Two organizations have submitted testimony. Without
objection, the testimony of Cummins, Incorporated and Research
Advisory Committee on Gulf War Veterans' Illnesses will be made
part of the record along with any other statements that the
subcommittee may receive.
On behalf of the subcommittee, I thank all the witnesses
for their testimony, and the subcommittee will take these
issues in consideration and I can assure you will look at it
very seriously.
[The statement follows:]
Prepared Statement of Dr. Wayne A. Eckerle, Vice President, Research
and Technology, Cummins Inc.
Cummins Inc., headquartered in Columbus, Indiana, is a corporation
of complementary business units that design, manufacture, distribute
and service engines and related technologies, including fuel systems,
controls, air handling, filtration, emission solutions, and electrical
power generation systems. The funding requests outlined below are
critically important to Cummins' research and development efforts, and
would also represent a sound Federal investment toward a cleaner
environment and improved energy efficiency for our Nation. We request
that the subcommittee fund the programs as identified below.
department of the army
Army Procurement
Other Procurement, Budget Activity 03, Other Support Equipment,
Line No. 171, Generators, Line Item: 0426MA9800, Generators and
Associated Equipment.--Support the administration's request of $60.3
million in fiscal year 2013. $67.8 million was appropriated in fiscal
year 2012. Specifically support the $16.7 million for M53500, Medium
Generator Sets (5-60 kW) and $33.983 million for R62700 Power Units/
Power Plants. Advanced Medium Mobile Power System (AMMPS) generators
and AMMPS Power Units and Power Plants (trailer-mounted AMMPS generator
sets) are the latest generation of Prime Power Generators for the
Department of Defense (DOD) and will replace the obsolete Tactical
Quiet Generators (TQGs) developed in the 1980s. AMMPS generator sets
are 21 percent more fuel-efficient, 15 percent lighter, 35 percent
quieter, and 40 percent more reliable than the TQG. Generators are the
Army's biggest consumer of diesel fuel in current war theatres. When
AMMPS generator sets are fully implemented, the Army and Marines will
realize annual fuel savings of approximately 52 million gallons of JP-8
fuel and more than $745 million in savings based on fuel costs and
current use pattern. This will mean fewer fuel convoys to bases in
active war zones resulting in saved lives of military and civilian
drivers. AMMPS generators will result in annual carbon emissions
reductions of 500,000 metric tons CO2 or 7.7 million metric
tons over the expected life of the generators.
Weapons and Tracked Combat Vehicles, Budget Activity 01, Tracked
Combat Vehicles, Line No. 07, Modification of Tracked Combat Vehicles,
Line Item 2073GZ0410, Paladin Integrated Management Mod In Service,
Paladin Integrated Management.--Support administration's request of
$206.1 million in fiscal year 2013. $46.8 million was appropriated in
fiscal year 2012 to begin low-rate initial production. The M109A6
Paladin is the primary indirect fire weapons platform in the U.S.
Army's Heavy Brigade Combat Team (HBCT) and is expected to be in the
Army inventory through 2050. The PIM program will incorporate Bradley-
based drive-train and suspension components which reduce logistics
footprint and decrease operations and sustainment costs. PIM is vital
to ensuring the long-term viability and sustainability of the M109
family of vehicles (Paladin and FAASV). The program will significantly
reduce the logistics burden placed on our soldiers, and proactively
mitigate obsolescence. The system will feature improved mobility (by
virtue of Bradley-based automotive systems) allowing the fleet to keep
pace with the maneuver force. The system will improve overall soldier
survivability through modifications to the hull to meet increased
threats.
Research and Development Test and Evaluation Programs
Budget Activity 05, System Development and Demonstration, Line No.
121, Program Element No. 0604854A: Artillery Systems, Paladin
Integrated Management .--Support the administration's request of $167.8
million in fiscal year 2013. $120.1 million was appropriated in fiscal
year 2012. The M109A6 Paladin is the primary indirect fire weapons
platform in the U.S. Army's HBCT and is expected to be in the Army
inventory through 2050. This request is to further develop Paladin
Integrated Management (PIM) vehicles and conclude testing. The PIM
effort is a program to ensure the long-term viability and
sustainability of the M109A6 Paladin and its companion ammunition
resupply vehicle, the M992 FAASV. PIM is vital to ensuring the long-
term viability and sustainability of the M109 family of vehicles
(Paladin and FAASV). The program will significantly reduce the
logistics burden placed on our soldiers and proactively mitigate
obsolescence. The system will feature improved mobility (by virtue of
Bradley-based automotive systems) allowing the fleet to keep pace with
the maneuver force.
Budget Activity 07, Operational Systems Development, Line No. 165,
Program Element No. 0203735A: Combat Vehicle Improvement Programs.--
Support the administration's request of $253.9 million in fiscal year
2013. $36.2 million was appropriated in fiscal year 2012 to initiate
the program. Specifically support $74.1 million for the Armored Multi-
Purpose Vehicle (AMP-V) program. AMP-V is an Army program that replaces
the M113 platforms, which cannot be optimized for future U.S. Army
combat operations. The Army has identified a significant capability gap
within the HBCT formation. The Bradley Family of Vehicles are the most
capable and cost effective platform for replacement of the M113. Along
with established production, the recapitalized Bradley vehicles bring
combat- proven mobility, survivability, and adaptability to a variety
of missions. The Army currently has approximately 1,900 Bradley hulls
that could be inducted into the production process. This low cost, low
risk, Military-off-the-Shelf (MOTS) to replace the M113 addresses the
significant capability shortfalls within the HBCT formation. In
addition, it is an efficient use of existing Government-owned assets
and existing Public-Private Partnership arrangements to bridge the
modernization gap. Recapitalizing existing Bradley chassis provides the
most survivable, mobile and protected solution for our soldiers at a
significant lower cost.
department of the air force
Other Procurement
Budget Activity 04, Other Base Maintenance and Support Equip, Item
No. 62, Mobility Equip.--Support the administration's request of $23.8
million ($14.4 million Base and $9.4 million OCO) in fiscal year 2013.
$20.3 million was appropriated in fiscal year 2012. Specifically
support $6.7 million ($4.6 million base and $2 million OCO) in fiscal
year 2013 for the Basic Expeditionary Airfield Resource (BEAR). The
BEAR product is an 800kW prime power mobile generator used by Combat
Air Forces to power mobile airfields in-theatre and around the world.
The finished product will replace the existing MEP unit that is 25
years old and will offer greater fuel economy, increased fuel options
(JP-8), improved noise reduction, and the latest innovative control
technology and functionality. With the ever-increasing global reach of
the U.S. military, the need for reliable mobile power is paramount.
This program is currently funded for the design, development and
preproduction of eight individual BEAR units. These units will undergo
a battery of validation tests. Design and development of the BEAR
product is on schedule. There is interest from other branches of the
military for the BEAR product as well given the increased need for
mobile electric power.
department of the navy
Other Procurement, Marine Corps
Budget Activity 06, Engineer and Other Equipment, Line No. 47, Line
Item 6366, Power Equipment Assorted.--Support the administration's
request of $76.5 million ($56.3 million Base and $20.2 million OCO) in
fiscal year 2013. $27.2 million was appropriated in fiscal year 2012.
Specifically support $26.5 million ($19.5 million Base and $7 million
OCO) in fiscal year 2013 for AMMPS. AMMPS generators are the latest
generation of Prime Power Generators for the DOD and will replace the
obsolete Tactical Quiet Generators (TQGs) developed in the 1980s. AMMPS
generator sets are 21 percent more fuel-efficient, 15 percent lighter,
35-percent quieter and 40 percent more reliable than the TQG.
Generators are the Army's biggest consumer of diesel fuel in current
war theatres. When AMMPS generator sets are fully implemented, the Army
and Marines will realize annual fuel savings of approximately 52
million gallons of JP-8 fuel and more than $745 million in savings
based on fuel costs and current use pattern. This will mean fewer fuel
convoys to bases in active war zones resulting in saved lives of
military and civilian drivers. AMMPS generators will result in annual
carbon emissions reductions of 500,000 metric tons CO2 or
7.7 million metric tons over the expected life of the generators.
______
Prepared Statement of James Binns, Chairman of Research Advisory
Committee on Gulf War Veterans' Illnesses
Dear Chairman Inouye and Ranking Member Cochran: The Gulf War
Illness Research Program (GWIRP) of the Department of Defense (DOD)
Congressionally Directed Medical Research Program (CDMRP) has made
remarkable progress during the past 2 years. As Chairman of the
Research Advisory Committee on Gulf War Veterans Illnesses, created by
Public Law 105-368, I deeply appreciate your support, which has made
this progress possible.
I also appreciate the hearing you held this week to consider
appropriations to CDMRP programs for fiscal year 2013 and am pleased to
submit this letter for the record, to review these recent developments.
In its landmark 2010 report, the Institute of Medicine (IOM)
recognized that the chronic multisymptom illness that affects 250,000
gulf war veterans is a serious disease (not attributable to psychiatric
illness) that also affects other U.S. military forces. It called for a
``renewed research effort with substantial commitment to well-organized
efforts to better identify and treat multisymptom illness in Gulf War
veterans.''
The scientific community responded with a dramatic increase in the
quality and quantity of proposals submitted to the GWIRP at CDMRP. Most
importantly, last summer CDMRP-funded researchers from the University
of California, San Diego, completed the first successful pilot study of
a medication to treat one of the major symptoms of gulf war illness. It
is not a cure, and the study needs be replicated in a full-clinical
trial, but the result is extremely encouraging. As the IOM committee
chair, Dr. Stephen Hauser, chairman of Neurology at the University of
California, San Francisco, and former president of the American
Neurology Association, emphasized in his preface to the IOM report,
``we believe that, through a concerted national effort and rigorous
scientific input, answers can likely be found.''
The GWIRP is the only national program addressing this problem. It
is a peer-reviewed program open to any doctor or scientist on a
competitive basis. By contrast, Department of Veterans Affairs (VA)
research programs are only open to VA doctors, few of whom have
expertise in chronic multisymptom illness. To effectively address a new
and difficult problem like this, it is necessary to enlist the entire
medical scientific community. Because VA has not been able to find
enough qualified researchers, it has reduced funding for gulf war
illness research in its fiscal year 2013 budget from $15 million to
$4.9 million. In contrast, the DOD CDMRP program is attracting a
surplus of excellent investigators. It is critical to shift resources
accordingly to the DOD program, so that the overall Federal research
effort is not reduced just at the time it is producing results and the
Institute of Medicine is pointing the way. The VA budget data is at
http://www.va.gov/budget/docs/summary/Fy2013_Volume_II-
Medical_Programs_Information_Technology.pdf on page 3A-5.
As stated by Dr. Hauser, in his attached letters to you, this
subject is ``vital to the health and effectiveness of current and
future military forces, in addition to Gulf War veterans.'' Recognizing
this importance, last summer the House of Representatives in a
bipartisan roll-call vote increased funding for the program to $10
million in the 2012 DOD appropriations bill, and this figure was
adopted by the Senate-House conference committee.
The Research Advisory Committee has recommended funding this
program at the $40 million level. It is recognized that in fiscal year
2013 such an increase may not be possible. However, this effective
program demonstrably merits increased investment, even in a time of
fiscal austerity. Dr. Hauser has recommended $25 million. An
appropriation of $20 million would hold Federal gulf war illness
research level from last year, taking into account the $10 million VA
reduction.
These funds would be productively spent to capitalize on the
progress that has already been made. Specifically, there are quality
projects in the pipeline that substantially exceed $25 million. These
include highly ranked treatment pilot studies not able to be funded in
previous years due to financial constraints (approximately $20
million), a followup clinical trial of the treatment shown effective in
the completed pilot study (approximately $8 million), and three joint
``consortium'' treatment research programs developed with earlier
planning grants by teams of researchers at different institutions
(approximately $24 million, of which only $4 million has been funded).
At long last, the scientific community has recognized the severity
and scope of this problem and is engaged in its solution. The Congress
has created this superb program, which is succeeding where others have
failed. Please enable these scientists to continue their work.
CONCLUSION OF HEARINGS
Chairman Inouye. This subcommittee will take these issues
into consideration, I can assure you, as we develop the fiscal
year 2013 defense appropriations bill.
This subcommittee will reconvene on Wednesday, June 13, at
which time we'll meet to receive testimony from the Secretary
of Defense and the Chairman of the Joint Chiefs of Staff on the
fiscal year 2013 budget request for DOD.
We stand in recess.
[Whereupon, at 12:02 p.m., Wednesday, June 6, the hearings
were concluded, and the subcommittee was recessed, to reconvene
subject to the call of the Chair.]