    [Senate Hearing 114-658, Part 6]
    [From the U.S. Government Publishing Office]

                                                     S. Hrg. 114-658, Pt. 6

    DEPARTMENT OF DEFENSE AUTHORIZATION FOR APPROPRIATIONS FOR FISCAL YEAR
                   2017 AND THE FUTURE YEARS DEFENSE PROGRAM

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

                                    HEARING

                                   before the

                          COMMITTEE ON ARMED SERVICES
                              UNITED STATES SENATE

                        ONE HUNDRED FOURTEENTH CONGRESS

                                 SECOND SESSION

                                       ON

                                    S. 2943

         TO AUTHORIZE APPROPRIATIONS FOR FISCAL YEAR 2017 FOR MILITARY
    ACTIVITIES OF THE DEPARTMENT OF DEFENSE, FOR MILITARY CONSTRUCTION, AND
       FOR DEFENSE ACTIVITIES OF THE DEPARTMENT OF ENERGY, TO PRESCRIBE
       MILITARY PERSONNEL STRENGTHS FOR SUCH FISCAL YEAR, AND FOR OTHER
                                    PURPOSES

                                   ----------

                                     PART 6

                                   PERSONNEL

                                   ----------

                                 MARCH 8, 2016

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

             Printed for the use of the Committee on Armed Services

    DEPARTMENT OF DEFENSE AUTHORIZATION FOR APPROPRIATIONS FOR FISCAL YEAR
          2017 AND THE FUTURE YEARS DEFENSE PROGRAM--Part 6  PERSONNEL

                                                     S. Hrg. 114-658, Pt. 6

    DEPARTMENT OF DEFENSE AUTHORIZATION FOR APPROPRIATIONS FOR FISCAL YEAR
                   2017 AND THE FUTURE YEARS DEFENSE PROGRAM

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

                                    HEARING

                                   before the

                          COMMITTEE ON ARMED SERVICES
                              UNITED STATES SENATE

                        ONE HUNDRED FOURTEENTH CONGRESS

                                 SECOND SESSION

                                       ON

                                    S. 2943

         TO AUTHORIZE APPROPRIATIONS FOR FISCAL YEAR 2017 FOR MILITARY
    ACTIVITIES OF THE DEPARTMENT OF DEFENSE, FOR MILITARY CONSTRUCTION, AND
       FOR DEFENSE ACTIVITIES OF THE DEPARTMENT OF ENERGY, TO PRESCRIBE
       MILITARY PERSONNEL STRENGTHS FOR SUCH FISCAL YEAR, AND FOR OTHER
                                    PURPOSES

                                   __________

                                     PART 6

                                   PERSONNEL

                                   __________

                                 MARCH 8, 2016

                                   __________

             Printed for the use of the Committee on Armed Services

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

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

                                ________

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                          COMMITTEE ON ARMED SERVICES

      JOHN McCAIN, Arizona, Chairman          JACK REED, Rhode Island
    JAMES M. INHOFE, Oklahoma                 BILL NELSON, Florida
    JEFF SESSIONS, Alabama                    CLAIRE McCASKILL, Missouri
    ROGER F. WICKER, Mississippi              JOE MANCHIN III, West Virginia
    KELLY AYOTTE, New Hampshire               JEANNE SHAHEEN, New Hampshire
    DEB FISCHER, Nebraska                     KIRSTEN E. GILLIBRAND, New York
    TOM COTTON, Arkansas                      RICHARD BLUMENTHAL, Connecticut
    MIKE ROUNDS, South Dakota                 JOE DONNELLY, Indiana
    JONI ERNST, Iowa                          MAZIE K. HIRONO, Hawaii
    THOM TILLIS, North Carolina               TIM KAINE, Virginia
    DAN SULLIVAN, Alaska                      ANGUS S. KING, JR., Maine
    MIKE LEE, Utah                            MARTIN HEINRICH, New Mexico
    LINDSEY GRAHAM, South Carolina
    TED CRUZ, Texas

                         Christian D. Brose, Staff Director
                        Elizabeth L. King, Minority Staff Director

                                  ____________

                           Subcommittee on Personnel

                     LINDSEY GRAHAM, South Carolina, Chairman

    ROGER F. WICKER, Mississippi        KIRSTEN E. GILLIBRAND, New York
    TOM COTTON, Arkansas                CLAIRE McCASKILL, Missouri
    THOM TILLIS, North Carolina         RICHARD BLUMENTHAL, Connecticut
    DAN SULLIVAN, Alaska                ANGUS S. KING, JR., Maine

                                      (ii)

                               C O N T E N T S

                                  __________

                                 March 3, 2016

                                                                       Page

    Military Personnel Posture.......................................     1

    McConville, Lieutenant General James C., USA, Deputy Chief of         3
      Staff for Personnel, United States Army.
    Moran, Vice Admiral William F., USN, Deputy Chief of Naval            8
      Operations for Manpower, Personnel, Training, and Education,
      United States Navy.
    Brilakis, Lieutenant General Mark A., USMC, Deputy Commandant for    15
      Manpower and Reserve Affairs, United States Marine Corps.
     Grosso, Lieutenant General Gina M., USAF, Deputy Chief of Staff     23
      for Manpower, Personnel, and Services, United States Air Force.
    Roth-Douquet, Kathy, Chief Executive Officer, Blue Star Families.    49
    Raezer, Joyce W., Executive Director, National Military Family       57
      Association.
    Bousum, Scott, Legislative Director, The Enlisted Association of     80
      the National Guard of the United States.
    Davis, Joseph E., Public Affairs Director, Veterans of Foreign      112
      Wars.

    Questions for the Record.........................................   130

                                     (iii)

    DEPARTMENT OF DEFENSE AUTHORIZATION FOR APPROPRIATIONS FOR FISCAL YEAR
                   2017 AND THE FUTURE YEARS DEFENSE PROGRAM

                                  ----------

                             TUESDAY, MARCH 8, 2016

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

                           MILITARY PERSONNEL POSTURE

        The subcommittee met, pursuant to notice, at 2:40 p.m. in
    Room SH-216, Hart Senate Office Building, Senator Lindsey O.
    Graham (chairman of the subcommittee) presiding.
        Subcommittee members present: Senators Graham, Wicker,
    Tillis, Sullivan, Gillibrand, Blumenthal, and King.

             OPENING STATEMENT OF SENATOR LINDSEY O. GRAHAM

        Senator Graham. The committee meets this afternoon to
    review the military personnel defense authorization request for
    fiscal year 2017 and future years defense programs.
        We are fortunate to have two panels of distinguished
    witnesses joining us today. On the first panel, we have
    Lieutenant General McConville, Vice Admiral Moran, Lieutenant
    General Brilakis, and Lieutenant General Grasso. On the second
    panel, we have Ms. Kathy Douquet, Chief Executive Officer of
    Blue Star Families; Ms. Joyce Raezer, Executive Director of the
    National Military Family Association; Mr. Scott Bousum,
    Legislative Director of The Enlisted Association of the Nation
    Guard of the United States; Mr. Joseph Davis, Public Affairs
    Director of the Veterans of Foreign Wars.
        As we consider this year's military personnel defense
    authorization request, we must continue to ask ourselves what
    impact these authorizations and requested changes in policy
    will have on our servicemembers and their families. We must
    also balance that with the reality of sequestration and the
    need to preserve the readiness of our Armed Forces.
        This subcommittee is primarily concerned with modernizing
    the military health care system this year. As I have stated
    publicly many times, our goal is to reform the health care
    system to deliver higher-quality care, to improve access to
    high-quality providers, and to ensure a strong focus on combat
    casualty care. I hope that both panels of witnesses today will
    address military health care reform.
        In the last year's NDAA [National Defense Authorization
    Act], this committee, along with our House colleagues, acted
    upon recommendations of the Independent Military Compensation
    and Retirement Modernization Commission. The reforms made will
    vastly expand the military retirement benefits to reach more of
    those who served. We owe it to those members to reward them for
    their service to this Nation.
        To this point, I find it particularly concerning that the
    Department of Defense has proposed legislation that would
    dramatically decrease the number of servicemembers who are
    eligible for the thrift savings plan contributions from the
    Government. It was an intentional choice by this committee to
    set eligibility to 2 years and 1 day of service. The Department
    came over last year and asked us to modify that by pushing the
    eligibility date further into a servicemember's career. We
    unanimously rejected that call last year, and we will continue
    to reject requests from the Department of Defense that would
    delay Government contributions until 5 years of service. We
    believe that the new retirement system should benefit more
    servicemembers. Let me be clear. It is our commitment to the
    many servicemembers who go out on deployment before reaching
    their fifth year of service that they too have earned some
    retirement.
        I am also concerned that the Department's proposal that
    would continue to suppress military pay raises misses the mark.
    For the last 3 years, this administration has failed to allow
    servicemembers' pay to keep up with the private sector wage
    growth. This is the fourth year in a row where the Department
    is shortchanging servicemembers. The personnel budget came over
    to us as neutral. This means that savings the Department took
    from giving a lower pay raise and delaying Government
    retirement contributions went to other benefits within the
    personnel budget. This money did not go to readiness. Instead,
    this money went to pay the costly fringe benefits as part of
    the focus of the future.
        To all the witnesses, I hope today you will tell us what we
    can do to make your job more efficient, better serve those
    under your care, and find a way to make health care not only of
    a higher quality but sustainable in terms of cost.
        With that, I will turn it over to the ranking member,
    Senator Gillibrand.

               STATEMENT OF SENATOR KIRSTEN E. GILLIBRAND

        Senator Gillibrand. Thank you, Mr. Chairman. I join with
    you today in welcoming our witnesses to review the Department's
    fiscal year 2017 budget request.
        As we begin our review of DOD's [Department of Defense's]
    budget and programs, I applaud the Department's progress in
    opening all service positions, including combat positions, to
    women. I believe this change will strengthen our military over
    time because it will provide access to the full spectrum of
    talent available for military service by allowing anyone, man
    or woman, who can meet the standard for service to compete for
    those positions.
        It is important that we now turn our full attention to
    successful implementation of this change, and I look forward to
    hearing from our witnesses about their plans to achieve success
    in this area.
        I am also committed to making our military justice system
    the best in the world, and I would be interested to hear
    specifically from the Navy regarding the changes that have been
    made to create a specialized career track for litigators.
    Specifically, how has this specialized training improved
    litigation on sexual assault cases?
        I continue to be concerned about how we support families
    with children and other dependents with special needs such as
    children with autism and other developmental difficulties. I am
    concerned about the availability of support services for these
    families, how they are assigned, what happens to the family
    when the member deploys, and whether these programs are fully
    funded in the budget. I would like to hear more about each
    service handles this very vulnerable population and in what
    ways this subcommittee might be helpful.
        Finally, I understand the Department will again propose
    measures to slow growth of personnel costs, including health
    care, within the Department. I remain concerned, as I was the
    last 2 years, about the cumulative impact these proposals have
    on the most vulnerable servicemembers, our junior enlisted and
    their families. I would like to hear the witnesses' views as to
    whether the services can continue to recruit and retain
    America's very best for military service with the benefits
    package they would provide under this budget, especially in
    light of an ever-improving civilian economy. Recruiting
    talented individuals for service and retaining them and their
    families is the ultimate test of the fairness and adequacy of
    our military compensation system. I believe that policies that
    support military families will ensure we are able to attract
    and retain the best individuals for our Armed Forces.
        Again, I thank our witnesses, and I look forward to your
    testimony.
        Thank you, Senator Graham.
        Senator Graham. Thank you very much.
        General McConville?

       STATEMENT OF LIEUTENANT GENERAL JAMES C. McCONVILLE, USA,
        DEPUTY CHIEF OF STAFF FOR PERSONNEL, UNITED STATES ARMY

        General McConville. Thank you, sir. Chairman Graham,
    Ranking Member Gillibrand, distinguished members of this
    committee, I thank you for the opportunity to appear before you
    on behalf of the United States Army. I have submitted a
    statement for the record and would like to highlight a few
    points from it, if I could, now.
        The Army's people and our soldiers, civilians, families,
    retirees, and veterans are our greatest asset. We are the most
    formidable ground combat force on earth, and we must stay that
    way.
        Readiness is our number one priority, and manning the Army
    is the key component of readiness. As the Army draws down from
    2010 wartime high of 1.13 million soldiers to 980,000 soldiers
    by 2018, we will have the smallest Active Army end strength
    since before World War II.
        Commensurate with the military drawdown, we are also
    drawing down our civilian workforce. With an Active force this
    size, we must sustain the highest quality force possible. The
    drawdown we are executing is performance-based, and we have
    done everything we can to deal with our soldiers with the
    utmost compassion and care and remain committed to our
    soldiers, give them the benefits they have earned and the
    respect they deserve as soldiers for life.
        As the G1 of the Army and the father of three soldiers, I
    take this responsibility very seriously. It breaks my heart
    that we have to involuntarily separate soldiers who have served
    so honorably during this time of conflict.
        While we are doing the drawdown, we also need to shape the
    future force. We still need to recruit resilient and fit
    soldiers of character. We must also continue to retain the most
    talented soldiers and noncommissioned officers who have the
    experience and skills that we need to meet our future needs.
        To build this high quality Army that is trained and ready,
    we must leverage all the available talent to ensure every
    individual can get on the field and play their position both
    home and away.
        To accomplish this, we are moving from an industrial age
    personnel management system to a modern talent management
    system that will fundamentally change the way we manage all
    three components called IPPS-A [Integrated Personnel and Pay
    System-Army].
        Diversity is important to our Army. Through our outreach
    and marketing efforts, we have focused on increasing diversity
    of the force in under-represented branches and occupations. We
    are committed to giving all soldiers who can meet the standards
    of military occupation specialty the opportunity to serve in
    that specialty. Opening all the military occupations provides
    increased opportunities for our women and increases the talent
    pool for the Army.
        We are focused on personal resiliency, sexual harassment
    and assault response and prevention, and suicide prevention,
    and we remain fully committed in all these areas.
        Additionally, we are helping our soldiers who are
    transitioning out of the military find quality employment. We
    consider all soldiers soldiers for life, and we believe they
    deserve our sincere gratitude for their enduring recognition of
    their service. Today's soldiers will not only influence the
    next generation of young people to join the Army but will
    connect communities across the Nation with this Army.
        So at the end of the day, the Army is people. The men and
    women who serve our Nation today, along with their families,
    and all those who have served in the past are our most
    important asset. As a Nation, we must ensure they have the
    required resources they need so they are ready when we ask them
    to fight and win our Nation's wars.
        I thank you all for your continued support of our all-
    volunteer Army. I look forward to your questions.
        [The prepared statement of General McConville follows:]

          Prepared Statement by Lieutenant General James C. McConville
        Chairman Graham, Senator Gillibrand, Distinguished Members of this
    Committee, I thank you for the opportunity to appear before you on
    behalf of the United States Army.
        The Army is people and our soldiers, civilians, retirees, veterans,
    and families are our greatest asset. We are the most formidable ground
    combat force on earth, and our missions today include fighting
    terrorists around the world; training Afghan and Iraqi Army Forces;
    peacekeeping in the Sinai Peninsula and Kosovo; missile defense in the
    Persian Gulf; security assistance in Africa and South America;
    deterrence in Europe, the Republic of Korea, and Kuwait; rapid
    deployment global contingency Forces; and response Forces for the
    Homeland. The Army currently has approximately 190,000 soldiers in
    support of U.S. Geographic Combatant Command missions and deployed to
    140 countries.
        Readiness is our number one priority and manning the Army is one of
    the key components of readiness. As the Army draws down from the fiscal
    year 2010 wartime high of 1,133,000 to 980,000 by fiscal year 2018, we
    will have the smallest Active Component Army end strength since before
    WWII. Our Total Army end strength currently stands at approximately
    1.03 million with the Active Component (AC) currently at approximately
    483,000, the Army Reserve (USAR) at approximately 200,000, and the Army
    National Guard (ARNG) at approximately 348,000. We forecast our Total
    Army end strength to be approximately 990,000 by the end of fiscal year
    2017 with 460,000 AC, 195,000 USAR and 335,000 ARNG. With an Active
    force this size, we must sustain the highest quality force possible.
        Achieving an AC 450,000 end strength by fiscal year 2018 requires a
    40,000 reduction, of which approximately 14,000 will be involuntary.
    The Army has already involuntarily separated of approximately 4,400
    soldiers (1,100 enlisted and 3,300 officer) from Active Duty since the
    start of the drawdown. This drawdown is performance based, and we have
    strived to conduct separations with the utmost compassion and care, and
    remain committed to giving soldiers the benefits they've earned and the
    dignity and respect they deserve. The separating soldier's chain of
    command is actively involved in the transition process and Transition
    Assistance Programs are available to ensure a smooth takeoff.
        A primary difference between this drawdown and the drawdown after
    the first Gulf War is our use of involuntary separation boards. Our
    involuntary reduction programs focus on quantity by grade and skill and
    on quality by assessing a soldier's potential for future service. We
    only use involuntary separations when necessary because we recognize
    there are qualified and committed soldiers who will be asked to
    separate from Active Duty. We are encouraging qualified soldiers who
    must transition from Active Duty to continue to use their skills in the
    USAR or the ARNG.
        Simultaneous to the drawdown and to shape the future force, we
    still need to recruit resilient and fit soldiers of character who can
    become competent, committed, agile and adaptable leaders in the
    Profession of Arms. This effort starts with comprehensive, focused
    national and local marketing strategies. Marketing efforts this year
    alone have resulted in increases in the number of prospects who are
    willing to consider Army service. Despite a challenging recruiting
    environment, where fewer than one in three U.S. youths are qualified to
    serve and only one in eight have a propensity to enlist, the Army
    achieved its fiscal year 2015 AC recruiting mission of 59,000 with more
    than 95 percent of enlistees holding high school diplomas. The ARNG
    successfully recruited to meet end strength and the USAR was in
    striking distance of its fiscal year 2015 recruiting mission. We are
    aggressively working to achieve fiscal year 2016 Active and Reserve
    component recruiting goals, and we are focused on bringing in high
    quality recruits to reduce first-term attrition.
        The Army must continue to retain the most talented soldiers and
    non-commissioned officers with the experience and skills necessary to
    meet our future needs. Even with current challenges, persistent
    conflict, continued drawdowns and budgetary uncertainty, the AC, USAR
    and ARNG each achieved their fiscal year 2015 retention missions and
    are on track to successfully meet their respective fiscal year 2016
    retention missions.
        Commensurate with the military drawdown, we have drawn down our
    Civilian Workforce from a wartime high in fiscal year 2011 of 284,000
    (238,000 Army appropriations) to 247,000 (206,000 Army appropriations)
    in fiscal year 2015, with a projected workforce of 240,000 (196,000
    Army appropriations) by fiscal year 2017. As the Army evolves, and the
    Civilian Workforce is reduced, we are continuing to make improvements
    in how we recruit, manage, develop and evaluate our Civilians. Ongoing
    initiatives are designed to institutionalize career programs,
    leadership training, individual development and senior leader talent
    management, which ensures civilian leaders are developed on par with
    their military counterparts.
        The Army Civilian Training and Education Development System Intern
    Program provides for a strategic succession plan to replenish the
    Civilian workforce while maintaining the requisite skills required for
    functional proficiency. Program re-engineering efforts have resulted in
    improved hiring execution, with program goals to hire 1,000 interns
    annually. Fifty percent of the intern hires are within science,
    technology, engineering and mathematic fields, and about half of our
    intern hires are veterans.
        Diversity is important to the Army. Through our outreach and
    marketing efforts, we are focused on increasing diversity of the force
    in underrepresented branches and occupations. We've seen improvements
    in representing the diversity of America's talent in our officer corps.
    The United States Military Academy (USMA) increased the number of
    female cadets from 16 percent in the class of 2016 to 22 percent in the
    class of 2019. The Reserve Officer Training Corps (ROTC) experienced
    similar growth in female enrollments from 21 percent in 2016 to more
    than 27 percent women in class of 2019. Further, the officer corps has
    had an increase in African American Accessions--15 percent in USMA
    class of 2019 are African American versus 8 percent of the class of
    2016, and 13 percent will commission through ROTC in 2019, versus an
    average of 11 percent from 2012-2016. Through marketing and targeted
    recruiting and retention efforts, we remain committed to sustaining a
    high-quality All-Volunteer Force of the future that represents the
    diversity of America.
        The Army is committed to giving all soldiers who can meet the
    standards of a Military Occupational Specialty (MOS) the opportunity to
    serve in that MOS. From May 2012 to October 2015, we opened more than
    95,000 positions to women. Pending approval of our implementation plan,
    we will open approximately 125,000 additional positions to women in
    Infantry, Armor and Field Artillery as well as approximately 13,000
    positions in Special Forces. Opening all military occupations provides
    increased opportunities for women and more talent for the Army.
        To build a Total Army of Active, Reserve and National Guard Forces,
    as well as Civilians, who are trained and ready to take on the
    challenges of the future, we must leverage and manage all available
    talent and ensure every individual is able to get on the field and play
    his or her position. Our goal, is complete visibility of all of our
    knowledge, skills, abilities and behaviors to ensure the right person
    is in the right job at the right time. To accomplish this, we must move
    from a personnel management system to a talent management system. We
    are actively pursuing the Integrated Personnel and Pay System--Army
    (IPPS-A). IPPS-A is a Human Resources Information System (HRIS) that
    for the first time, will allow the Army to manage the AC, USAR, and
    ARNG on one HRIS, providing visibility of the knowledge, skills,
    abilities and behaviors of the Total Force. Next, it will allow us to
    manage talents and match them to Army requirements. Finally, it will
    provide us an audit capability to ensure personnel and pay are
    compliant with the law.
        The Army's prioritization on readiness and taking care of soldiers
    has resulted in reducing our non-deployable soldier population from a
    high of 17 percent Active Component Brigade Combat Team non-deployables
    in April 2011 to approximately 10 percent of the Total Army in December
    2015. To ensure soldiers get the benefits they have earned, the Army
    continues to reduce the time it takes for a soldier to process through
    the Integrated Disability Evaluation System (IDES). Active component
    averages approximately 220 days and Reserve component approximately 269
    days. Similarly, we've reduced the IDES inventory from about 17,000
    soldiers in December 2014 to just under 13,000 soldiers in December
    2015. We've also reduced the Temporary Disabled Retired List from
    approximately 17,000 in December 2014 to 8,816 soldiers in December
    2015.
        Personal resiliency is fundamental to readiness. At our 25
    Resilience/Performance Training Centers, we've certified 35,000 Master
    Resiliency Trainers who are resident in company level formations to
    help train on 14 resiliency skills. Every trainee receives two hours of
    resiliency training in Basic Combat Training. This year, we've also
    piloted a teen resiliency program for seventh to twelfth-graders that
    develops self-awareness, self-regulation, and helps to build character
    and social connections. We continue to field the Commander's Risk
    Reduction Dashboard to help unit commanders better see the level of
    resiliency in their formations. We continue to use the Global
    Assessment Tool (GAT), a self-awareness tool for soldiers to measure
    their personal resilience by assessing their own physical,
    psychological, social and spiritual readiness. In fiscal year 2015
    alone, more than 781,000 soldiers completed the GAT.
        Sexual Harassment/Assault Response and Prevention (SHARP) remains a
    top priority for our Army. Sexual violence goes against everything we
    stand for as soldiers. The ``Not In My Squad'' Campaign, led by the
    Sergeant Major of the Army, stresses the importance of trust at squad
    level and the basic leadership traits of competence, character and
    commitment. Through this effort and continued leader emphasis, we will
    improve command climates to ensure every soldier is treated with
    dignity and respect.
        While reports of sexual harassment and assaults have increased in
    the past year, prevalence has decreased. Prevalence is the percentage
    of Active Duty servicemembers who have indicated they experienced
    unwanted sexual contact within the past 12 months. In fiscal year 2014
    the Army received 2,606 reports (2,072 were reported by soldiers). This
    marks a 12 percent increase from fiscal year 2013 and is 60 percent
    higher than fiscal year 2012 (1,572). Prevalence is down from 8,800 in
    fiscal year 2012 to 7,300 in fiscal year 2014. An increase in reporting
    reflects increased trust in the chain of command. Our Sexual Assault
    Response Coordinators, Victim Advocates, Program Managers and Special
    Victim Counsels continue to provide support to victims through more
    than 12 resource centers. This concerted effort and emphasis on the
    victim--now fully instituted on our installations--has allowed us to
    programmatically shift to prevention from reaction in the coming year.
    The SHARP Academy is a best practice in this prevention effort, having
    trained 230 personnel in fiscal year 2014 and 395 in fiscal year 2015.
        Suicide remains a serious concern for our Army. With the number of
    deaths by suicide in the AC at the lowest in the last six years, and
    suicide rates in the USAR and ARNG, within historical norms, the Army
    remains committed to combating suicide with a multi-disciplinary,
    holistic approach to suicide prevention. Key to this approach is
    getting the soldiers' family, squad leader and buddies sensitized to
    the indicators, difficult life transitions and high risk behaviors that
    could lead to a suicide, and then having the required behavioral health
    care at the point of need.
        Key to suicide prevention is decreasing the stigma associated with
    seeking behavioral health care. Behavioral health encounters for the
    Total Army grew from approximately 700,000 in fiscal year 2003 to
    approximately 1.6 million in fiscal year 2014, indicating greater trust
    in the system. Active Duty soldiers using behavior health services
    increased from 5.7 percent in fiscal year 2003 to 15.6 percent in
    fiscal year 2014. Reserve component soldiers using behavioral health
    care increased from 2.5 percent in fiscal year 2003 to 7.2 percent in
    fiscal year 2014. Family members using behavior health services
    likewise increased from approximately 300,000 in fiscal year 2003 to
    1,300,000 in fiscal year 2014. In addition to reducing the stigma
    associated with seeking help, the Army has provided more timely care.
    In 2014 more than 90 percent of soldiers were seen by a privileged
    mental health provider within thirty days--this is an increase from 25
    percent in fiscal year 2011. Embedding services with brigade combat
    teams is a proven best practice--one that we've recently leveraged for
    the Army Substance Abuse Program, by aligning services under MEDCOM.
        In addition to taking care of soldiers and their families while
    they are in the Army, we are committed to helping them transition into
    the civilian world. We know that only 10 percent of enlisted soldiers
    and 30 percent of officers stay in the service for 20 years, the point
    where they are eligible for retirement. It is clear that we must focus
    on preparing our soldiers for life after their service. Every year
    about 120,000 soldiers transition from the Army and we must ensure they
    have a smooth transition to civilian life with quality employment.
        VOW Act compliance across the Army was 88 percent--the Active
    Component at 90 percent, ARNG at 85 percent and USAR at 75 percent.
    Compliance numbers increased sharply over last year with an 18 percent
    increase across the Total Army. The compliance rate in the Active
    Component was up 7 percent; ARNG produced the largest increase of 39
    percent; and USAR recorded a 24 percent improvement.
        We consider all soldiers to be ``Soldiers for Life'' who deserve
    our enduring gratitude and recognition of their service. Today's
    soldiers will not only influence the next generation of young people to
    join the Army but will connect communities across the Nation with its
    Army.
        In addition to building strong relationships with Government, non-
    Government and private sector entities, we have synchronized our
    efforts to provide post military service career opportunities by
    enabling collaborative efforts with the Departments of Veterans Affairs
    and Labor to bring Transition Summits to installations worldwide.
    Soldier for Life continues to leverage our interagency partners, the
    private sector and non-profit philanthropic organizations connecting
    soldiers and their Families with opportunities across the country
    assisting their reintegration into civilian society.
        At the end of the day, the Army is people. The men and women who
    serve our Nation, along with their families, are our most important
    asset. As a Nation, we must ensure they have the required resources so
    they are ready when called upon to fight and win our Nation's wars. I
    thank all of you for your continued support of our All-Volunteer Army.

        Senator Graham. Admiral?

     STATEMENT OF VICE ADMIRAL WILLIAM F. MORAN, USN, DEPUTY CHIEF
      OF NAVAL OPERATIONS FOR MANPOWER, PERSONNEL, TRAINING, AND
                     EDUCATION, UNITED STATES NAVY

        Admiral Moran. Thank you, Mr. Chairman, Ranking Member
    Gillibrand, Senator King. It is great to be here this
    afternoon, and I am honored to represent the over 600,000 men
    and women of our U.S. Navy, Active, Reserve, and Navy
    civilians.
        Over the years, your stalwart support on behalf of them and
    their families has had a profound effect on the health of our
    force today. It is a diverse, strong force, blessed with
    unparalleled talent and selfless commitment to serve.
        But there are reasons to pay very close attention to
    potential challenges and risks ahead for all of us. An
    unpredictable economy, a declining veteran population, a legacy
    personnel system, and growing competition for high-tech schools
    threaten our future. So we need to consider every dimension of
    our operating environment in order to reduce the risk to
    replenishing our workforce with very high-quality people.
        Fortunately, our current healthy manning in the fleet has
    given us an opportunity to boldly look to transform our
    personnel system and set the table for the next 30 years in the
    Navy. Its policies, analytic tools, and supporting
    infrastructure will hold us back unless we upgrade this system.
    Our workforce is anxious for this change. They expect greater
    transparency and responsiveness, and they expect a system that
    speaks to them.
        So we are on a path to modernize and have begun setting the
    conditions to match their expectations. Sailors who are driven
    by tenacity, consumed with passion for excellence and the will
    to win, who understand and appreciate that there is no better
    place to be and no more rewarding life to live than to serve--
    that is who builds a great Navy. That is the Navy we have and
    the Navy we intend to keep. As military professionals, we have
    a covenant with our sailors and the American people to do
    nothing less.
        I really appreciate the opportunity to be here, Mr.
    Chairman. I look forward to your questions.
        [The prepared statement of Admiral Moran follows:]

              Prepared Statement by Vice Admiral William F. Moran
                                i. introduction
        Chairman Graham, Ranking Member Gillibrand, and distinguished
    members of the Committee, I am honored to appear before you to review
    Navy manpower, personnel, training, education and family support
    programs and priorities for fiscal year 2017.
                      ii. a ready and capable global navy
        From providing kinetic strike options to commanders leading the
    fight against ISIL (Islamic State of Iraq and the Levant), to
    monitoring developments in the South China Sea, worldwide naval
    presence matters now more than ever. With 40 percent of our ships
    underway, and forward deployed Forces all around the globe, your Navy
    is truly America's away team. Our ability to perform our mission
    depends first and foremost on our Navy Team--sailors, both Active and
    Reserve, Navy Civilians, and their families.
        Strengthening the Navy Team is a key element of Navy's A Design for
    Maintaining Maritime Superiority. Some of the biggest impacts that we
    can make on our warfighting capability do not involve a lot of money,
    but instead are changes to how we do business. Recent results from the
    Optimized Fleet Response Plan (O-FRP) have reinforced the value of
    properly manning our ships, submarines and aviation squadrons, both in
    terms of numbers and with the right skill sets. As our platforms
    continue to become more technologically advanced, and the missions
    become more complex, the demand will grow for recruits with a high
    aptitude who can learn faster on the job, innovate naturally, and
    master new, complex skills over a career. At the same time, competition
    for skilled labor will intensify, which requires an agile personnel
    organization that can recognize challenges and opportunities and
    quickly respond with effective solutions. My organization is in need of
    an upgrade, akin to modernizing any weapons system. Our sailors operate
    at the speed of warfare at sea and in the air, and expect that same
    opportunity for involvement, for frank dialogue and for choices when it
    comes to their career decisions. Our sailor 2025 program, funded in
    this budget, is a dynamic set of initiatives, process improvements and
    management tools that address many of the challenges we face in
    building a more competitive personnel management system. The three
    pillars of this program are Personnel System Modernization, to better
    identify and reward talent while expanding career choice and
    flexibility; Ready, Relevant Learning, to deliver tailored learning
    solutions along a sailor's career continuum; and Enriched Culture, to
    enhance empowerment and trust at all levels by improving sailor and
    family resilience and health.
        To move forward on ``Strengthening our Navy Team for the Future'',
    the Navy Manpower, Personnel, Training & Education (MPT&E) enterprise
    has focused on three complimentary lines-of-effort--Force Readiness and
    Manning, Force Management, and Force Resiliency. My guiding principles
    are to maintain trust, balance our limited force to meet future
    challenges, and provide stability for the lives of sailors, Navy
    civilians, and families. There are limits to even our most thoughtful
    investments in platforms and technologies--but unbounded potential when
    we design for and make smart investments in our people.
        We must maintain a ready and capable naval force comprised of
    ships, submarines, squadrons and units, appropriately manned and
    trained to carry out their warfighting missions. To accomplish this, we
    will continue to develop and implement policies that facilitate
    delivery of highly trained and fully qualified personnel to fill
    billets at sea. Since December of 2012, we have filled nearly 11,000
    gapped at-sea billets. We must balance filling deploying units'
    critical billets with qualified personnel while maintaining healthy
    ship-to-shore cycles for our sailors. To help in this effort, Navy has
    expanded the O-FRP from its inception in 2014 to provide more capacity
    and predictability in maintenance and training, while providing
    stability for our deploying Forces and their families.
        Healthy warfighting communities, with an understanding of
    tomorrow's force structure and battle plans, are the underpinning of a
    ready force. Manning our units with the right number and type of
    properly trained and experienced sailors is a critical element of
    readiness. In the proposed fiscal year 2017 budget request, Navy end
    strength is properly aligned with force structure in support of mission
    requirements. While we project a reduction in end strength as a result
    of a decrease in military personnel requirements--primarily driven by
    one less Air Wing and the efficiencies associated with the start of a
    more modern and efficient training effort--those reductions will be
    achieved through natural attrition. Navy continues to attract the best-
    qualified candidates to serve, who often present creative solutions to
    our most vexing operational and even foreign policy challenges--and we
    want to keep it that way. Our success in retaining and developing
    talent and our high quality work force depends on our ability to
    provide excellent quality of service for our sailors, civilian
    employees and families.
        We ask an incredible amount of our sailors and their families. In
    return, we are inherently responsible for providing them with the level
    of support, positive working environments, and care commensurate with
    their personal sacrifices. Navy has implemented a continuum of harm
    prevention strategy to provide coordinated and complementary efforts to
    improve sailor resilience and readiness--including sexual assault
    prevention and suicide prevention. This strategy recognizes the common
    factors in destructive behaviors, such as alcohol abuse. It recognizes
    the value of fostering a positive command climate, the need for peer-
    to-peer intervention training, and the importance of addressing all
    wrong behaviors, even those that seem relatively minor. Navy's 21st
    Century sailor Office integrates, under one umbrella, the programs that
    sustain and instill resilience and fitness in sailors. The 21st Century
    Sailor Office provides a focusing lens and overarching policy support
    to these critical programs and is embarked on a comprehensive campaign
    to engage the fleet and expand resiliency programs. We are continuing
    our efforts to promote a healthy, efficient, and professional work
    environment, continuing outstanding support of families, and fulfilling
    our promise to aid servicemembers that transition to civilian life.
                       iii. force readiness and manning:
        We continue our efforts to maintain required manning and readiness
    levels by attracting highly qualified men and women to serve in the
    most effective and technologically advanced naval force in history. We
    will develop, train and educate a ready force to deliver the right
    person with the right skills in the right job at the right time--a
    metric we call ``fit.'' We are also taking deliberate steps to forecast
    future operating environments and ensure we are prepared to meet
    emerging challenges. These plans support our goals to retain our most
    talented sailors and maintain readiness to meet fleet requirements. To
    remain operationally effective, we will deliver technical training and
    advanced education throughout a career.
        Fleet Manning: We continue to make considerable progress in
    improving fleet-manning and warfighting readiness. In fiscal year 2015,
    we reduced the number of gaps at sea to approximately 1,800, a
    reduction of 3,900 gaps. We filled 98.7 percent of all enlisted sea
    duty billets; Sailors in the proper seniority and possessing the
    appropriate skill level filled 91 percent of those same billets. In
    support of the Optimized Fleet Response Plan, we will man deploying
    units earlier in the training cycle to ensure a more cohesive team upon
    deployment. We are meeting these objectives by modernizing our enlisted
    distribution systems with a Billet-Based Distribution (BBD) capability
    that will modernize our legacy distribution programs, and which will
    provide a more detailed enlisted demand signal to more efficiently, and
    accurately, meet enlisted manning requirements.
        Retention: We continue to monitor retention behavior closely across
    the Navy. End of fiscal year 2015 enlisted retention was 98 percent of
    goal for sailors with up to six years of service, 99 percent of goal
    for sailors with 6-10 years of service, and 105 percent of goal for
    sailors with 10-14 years of service. While we anticipate meeting
    aggregate enlisted retention goals in fiscal year 2016, we continue to
    experience retention challenges and inventory shortfalls within some
    communities, such as Information Warfare, Nuclear Field, Special
    Warfare, and Advanced Electronics. Targeting junior enlisted personnel
    possessing these unique skills with increased incentives will remain
    critical for achieving required retention and sustaining a healthy
    force into the future. After experiencing strong retention in fiscal
    year 2014 and fiscal year 2015, current economic indicators suggest a
    greater pull from the civilian workforce for our top talent over the
    next couple of years. Getting ahead of this impending change requires
    focused targeting of bonus programs, particularly Selective
    Reenlistment Bonuses among high-demand critical skill sets and less
    technical skill sets that an improving economy may adversely affect. We
    must focus on retaining sailors in the right mix of ratings and pay
    grades to position Navy to meet future mission requirements.
        Continuum of Service initiatives permit us to retain valuable
    skills and experience of sailors transitioning from Active Duty to the
    Reserve Component, while also providing opportunities for Reserve
    Component personnel with certain skills to reduce shortfalls in the
    Active component. We offer some qualified Reserve Component sailors the
    opportunity to convert to permanent Active Duty careers and compete for
    advancement while on Active Duty, and we continue to grant High-Year
    Tenure waiver requests for sailors who fill critical gaps at sea.
        Officer continuation remains at historically high levels due, in
    large part, to targeted incentive pays and bonuses, improved mentoring,
    recent efforts to add flexible career options, and increased emphasis
    on life-work integration initiatives. However, specific Active Duty
    control-grade officer inventory shortfalls remain in select
    Unrestricted Line, Restricted Line and Staff Corps communities,
    including Aviation and nuclear-trained Surface Warfare Officers. We are
    actively attacking these shortfalls through targeted incentives and
    other retention tools.
        Recruiting (Enlisted): The sailors we have in the Navy today are
    the best we have ever seen. Our success is largely due to inclusive
    diversity recruiting practices and Science, Technology, Engineering,
    and Mathematics (STEM) outreach. Strategic partnerships with STEM-
    related affinity groups, and engagements with high school and college
    students, have heightened awareness of Navy service as a highly
    desirable career option, inspired the next generation of technically
    capable sailors, developed centers of influence that contribute to
    recruiting efforts, and further diversified the Navy. We remain
    vigilant as the unemployment rate drops below six percent, mindful of
    our limited marketing and advertising resources, and with an eye toward
    our ability to continue meeting all goals in an improving economy.
        Recruiting (Officer): In fiscal year 2015, we achieved our Active
    component general officer recruiting goal. We continue to face
    challenges in achieving Reserve component general and medical officer
    recruiting goals, in part, due to strong Active Duty retention that
    significantly reduced the prior service pool--the source of most
    Reserve component accessions. In addition to the medical community, we
    face Reserve component challenges in aviation, Naval Special Warfare,
    Intelligence, and the Judge Advocate General Corps.
        We continue to see significant interest in opportunities to serve
    through the United States Naval Academy (USNA) and Navy Reserve Officer
    Training Corps (NROTC), with the number of highly qualified applicants
    vastly exceeding the number of available appointments. All our officer
    accession sources continue to attract the finest applicants and
    graduate technically competent leaders for commissioned naval service.
        Training: A pillar of our sailor 2025 initiative, which we call
    ``Ready Relevant Learning'', transforms our legacy training
    architecture into an agile continuum of learning that supports an
    increasingly complex Fleet and our future sailors. While our current
    training is working, we see changes that will stress its continued
    effectiveness. First, the combination of emerging threats, complex
    missions and new technologies demand a growing number of recruits with
    high aptitude who can learn faster on the job and master new skills
    over a career. Second, in order to attract a diverse and educated work
    force, we must provide training opportunities delivered at the point of
    need, when and where a sailor is ready to learn. Finally, we must be
    more efficient with a sailor's time by delivering training when they
    have the context and experience to apply the learned skills. Ready
    Relevant Learning delivers the right training at the right time--
    continual training in a mobile, modular environment to help ensure that
    knowledge is refreshed, renewed, and relevant to changing platforms or
    technologies. This provides Navy with the best-qualified and skilled
    personnel through resourcing efficiency and at a reduced time-to-train.
        Education: Education offers an asymmetric advantage in developing
    leaders and instilling in them attributes necessary to innovate, adapt,
    and succeed today and in the future. As a strategic investment that
    enhances force effectiveness and supports fleet global operational
    excellence and dominance, education provides sailors with relevant
    knowledge, skills, and abilities; ties educational opportunities to
    leader development; and supports a career continuum framework of
    technical experts, joint warfighters and strategic leaders. Our
    education strategy explicitly links resource allocation to education
    investments in the highest priorities supporting operational primacy,
    and encompasses both on-duty and voluntary off-duty education
    opportunities. The development of critical thinking skills and problem-
    solving in complex environments are key components in achieving our
    education goals.
        Professional Military Education: U.S. Naval Postgraduate School
    (NPS) and U.S. Naval War College (NWC) are designed to develop a
    resilient, knowledgeable and adaptable force. Both institutions develop
    members to meet future intellectual demands, and the diverse mix of
    Navy, other service, civilian and international students help build
    long-term relationships. NPS offers resident and non-resident degree
    and non-degree programs that develop a range of critical skills
    essential to winning in combat, engaging in peace and building the Navy
    of the future. NWC provides resident and non-resident Navy-specific
    Professional Military Education (PME) with embedded Joint Professional
    Military Education (JPME) that produces strategically-minded,
    critically thinking leaders who are skilled in maritime and joint
    planning and operations, and who are prepared to meet the demands of
    the uncertain and dynamic contemporary international security
    environment. Both institutions develop members of the force for the
    intellectual demands they will encounter, and assist in building key
    relationships through a diverse mix of students. The Navy Leadership
    and Ethics Center (NLEC), established at NWC in 2014, maintains
    responsibility for Leadership and Ethics development across the Navy.
    By charting the course for Navy leader development, NLEC sets the
    standard within the naval profession of arms. We demand our leaders to
    have self-reliance and independence, humility and integrity, discipline
    and resourcefulness, and trust and confidence. Leaders at all levels of
    our Navy must set the example by providing the purpose, direction, and
    motivation essential for successful mission accomplishment.
        Voluntary Education/Tuition Assistance: Navy voluntary education
    provides excellent opportunities for academic, technical, intellectual,
    personal, and professional development of sailors and contributes to
    their overall readiness as well as to the quality of life for sailors
    and their families. The Tuition Assistance (TA) Program remains a top
    priority in support of Navy's overarching Education Strategy, funding
    100 percent of demand in fiscal year 2015 for sailors pursuing
    education while serving on Active Duty. Participants are encouraged to
    pursue education with a clear path to a degree or credential, and are
    expected to complete in-rate qualifications, exhibit Navy core values,
    maintain physical fitness, while achieving their education goals.
        The Post-9/11 GI Bill is a U.S. Department of Veterans Affairs (VA)
    education benefit for qualifying veterans, Active Duty, and Selected
    Reservists. Members may transfer this benefit to eligible family
    members in exchange for a service obligation. The ability to transfer
    unused portions of the Post-9/11 GI Bill to dependents is a highly
    recognized benefit and contributes to the morale of our force.
        Credentialing and Licensure: The Navy Credentialing Program and
    Navy Credentialing Opportunities On-Line (COOL) website integrate
    closely with other Navy, Department of Defense, and Department of Labor
    (DoL) programs, including Defense Activity for Non-Traditional
    Education (DANTES) credentialing program, United Services Military
    Apprenticeship Program (USMAP), and Department of Veterans Affairs (VA)
    GI Bill, to help sailors meet license and credentialing requirements.
        The Navy and Marine Corps Credentialing Opportunities On-Line
    programs recently merged to form the Department of the Navy (DON) COOL
    website, which averages 4.2 million hits per month and benefits both
    sailors and marines. DON COOL offers the opportunity to earn civilian
    certifications and licenses corresponding to their Navy ratings,
    designators, collateral duties, and out-of-rating assignments. Earning
    credentials assists sailors in successfully transitioning into the
    civilian workforce. Every Navy occupation has at least one professional
    credential available and we currently pay for over 14,000 credentials
    per year awarded to about 7,000 sailors.
                              iv. force management
        We will shape the force to ensure we excel in the operational
    environment of today and tomorrow and remain within fiscal bounds. We
    want to retain our best and brightest--the Personnel System
    Modernization pillar of the sailor 2025 initiative will enable us to
    expand career choice and flexibility and better recognize sustained
    superior performance. While independent of the Department of Defense's
    Force of the Future initiatives, both create policies and career
    opportunities to attract and retain a highly talented workforce. The
    Enriched Culture pillar of sailor 2025 also seeks to create an
    inclusive culture to attract a force that reflects the society we
    serve, and builds toward a more family-friendly life-work balance, with
    the enablers to allow sailors to stay Navy. Effective force management
    includes continued growth of efforts to leverage diversity and support
    our women in service for a mission ready fleet.
        End Strength: The President's fiscal year 2017 budget request
    supports Active end strength of 322,900 and selected Reserve end
    strength of 58,000. We have maximized efficiencies within the military
    billet base and seek to stabilize Active component end strength at
    approximately 323,100 Active, and 58,900 Selected Reserve by 2021, as
    the appropriate end strength for Navy's projected force structure. We
    are carefully monitoring force management efforts to ensure that we
    meet end strength requirements within fiscal constraints, as we
    continue to fine tune the health of the force.
        In the current environment, the demand for Navy operating Forces
    and Navy Active component manpower, capability and capacity are not
    abating. In many cases, there have been significant increases in demand
    for Naval Forces. We strive to continue to meet fleet demand, while
    delivering proper force balance/mix, and improving Sea/Shore balance.
    Ready Reserve sailors are Navy's primary source of mobilization
    manpower and surge operational support. Maintaining the appropriate
    levels and types of sailors in the Reserve Force allows for the needed
    operational capacities and strategic depth to meet Total Force
    requirements. Our flexibility, responsiveness, and ability to serve
    across a wide spectrum of operations enhance the Navy Total Force.
        Compensation: We demand much of our sailors, and in return, they
    receive appropriate compensation. Over the past 13 years, pay raises,
    elimination of out-of-pocket housing expenses, TRICARE for Life and
    enactment of the post-9/11 GI Bill, have yielded the most generous
    total military compensation package in history and compares favorably
    with the private sector. This has allowed the Navy to continue to
    succeed in recruiting and retaining the high quality, All-Volunteer
    Force, despite over a decade at war.
        However, in the current fiscally constrained environment, reducing
    personnel costs is essential to achieve a proper balance of
    compensating the force, with costs for training and equipping them. We
    expect to meet recruiting and retention requirements, despite slowed
    growth in regular military compensation, as we continue judiciously
    applying targeted special and incentive pays.
        Women in Service: America's All-Volunteer Force requires that the
    U.S. military have access to every talented American who can add
    strength to the force. To be effective in our mission against today's
    and tomorrow's threats, we have to be postured to benefit from the best
    people our nation has to offer. For that reason, the Navy did not
    request any exemptions to the Department of Defense policy on opening
    combat positions to women; all Navy occupations, including previously
    closed Sea, Air, Land (SEAL) and Special Warfare Combatant-Craft
    Crewmen (SWCC), are open to women.
        We believe that everyone should be offered the chance to serve in
    any occupation in the Navy--regardless of gender--as long as they are
    able to meet the standard. With women representing 18 percent of our
    Navy force, they will become an even more critical part of our
    warfighting team, serving side-by-side in the most challenging combat
    roles. The Navy has successfully integrated women into aviation,
    surface ships, submarines, and riverine Forces, as well as other small,
    high-risk operations teams like Explosive Ordinance Disposal and Navy
    Divers. We know how to integrate--it starts on day one of training with
    leadership reinforcement of team building behaviors. Our goal is to
    ensure that the best-qualified and most capable sailors carry out our
    mission. The Navy is the best we have ever seen. We aim to make it even
    better.
        Leveraging Diversity: As the world becomes increasingly globalized
    and our nation more diverse, our ability to attract, recruit, develop,
    employ, and retain talent and experience from the entire population is
    essential to mission success. The 2010 U.S. Census projects that by
    2020, racial/ethnic groups, other than white non-Hispanics, will
    comprise over 40 percent of the recruiting market, with increasing
    minority representation over time. Navy's ability to access and retain
    the talents of every component group in our society has a direct impact
    on mission success at home and abroad. We want men and women who are
    right for the right job, regardless of race, gender, sexual
    orientation, creed, or hometown. It is important that we not think,
    act, and look the same. The strength of our service is our diversity--
    it is our asymmetric advantage.
                              v. force resiliency
        Under the Enriched Culture pillar of sailor 2025, we continue to
    focus efforts on improving sailor toughness while promoting a culture
    of respect and total fitness to prevent destructive behaviors. Our 21st
    Century sailor initiatives make clear the value we place on the well-
    being, safety, and health of sailors. We will create and maintain a
    positive command climate where sailors have access to the services they
    need from the Navy. Most importantly, we will continue to care for our
    sailors and their families--the foundation on which our Navy is built.
        This year, we launched our ``Chart the Course'' training campaign
    to emphasize and reinforce positive behaviors, personal responsibility
    and peer support. This training uses scenario-based videos and
    facilitator led discussions to provide engaging, interactive discussion
    among peer groups. Among many topics included in the training are
    sexual assault and harassment, alcohol awareness, and retaliation
    against sailors who report or are victims of destructive behaviors. Our
    best sailors want to be held accountable, and this training reinforces
    that.
        Suicide Prevention and Operational Stress Control: Combating
    suicide is an all hands evolution, all the time. Suicide Prevention
    efforts empower sailors to be psychologically healthy, adaptive, and
    mission ready by providing information, training, tools, and policies
    to reduce suicide risk. A comprehensive four-prong approach envelopes
    training, intervention, response, and reporting, to ensure a support
    network and skills needed to thrive, not just survive. Navy Operational
    Stress Control is the foundation of our suicide prevention initiatives,
    supporting the fleet with resources to navigate the stressors and
    challenges commonly associated with Navy life, to help sailors build
    resilience and maintain personal readiness. We are currently managing
    six Operational Stress Control mobile training teams, which deliver
    resiliency lessons to ships, squadrons, and submarines before overseas
    deployment. We also hired resiliency counselors to deploy with our
    largest concentration of sailors onboard `big deck' ships. These
    counselors are civilian, credentialed, clinical professionals who go to
    sea alongside extant teams of chaplains, behavioral psychologists and
    other medical professionals who proactively assist sailors each day. In
    addition, we have another program of credentialed, clinical, civilian
    counselors that make up the Psychological Health Outreach Program
    (PHOP) that ensures our Navy Reserve sailors have full access to
    appropriate psychological health care services, to increase resilience,
    and to facilitate recovery, which is essential to maintaining a ready
    military force. We want to create a Navy culture that rewards
    preventative actions, recognizes seeking help as a sign of strength,
    and reintegrates those treated for stress-related issues back into the
    command.
        Sexual Assault Prevention and Response (SAPR): We are committed to
    reducing, with the goal of eliminating, sexual assault from within our
    ranks. In fiscal year 2015, we continued efforts at creating a
    culturally aware and educated sailor in an environment intolerant of
    sexual assault, supported by a well-defined prevention, reporting,
    investigation, military justice, and victim advocacy program. This
    year, the Chief of Naval Operations announced five new initiatives to
    advance our efforts of eradicating sexual assault in the Navy. They
    include:

        1.  A Shipmate is not a ``bystander.'' If you see something wrong,
    do something right.
        2.  Establish Counselors within the Fleet and Family Support
    Centers as a resource for victim support.
        3.  Improve our personnel management practices and procedures,
    following a sexual assault experience.
        4.  Continue our efforts to educate sailors and reduce alcohol
    abuse in the Navy, particularly binge drinking.
        5.  Better utilize technology to remove cultural barriers and
    stigma associated with reporting a sexual assault or seeking advice and
    counsel.

        In addition to these initiatives, Navy is part of a team effort
    that includes the other Services to attack retaliation by better
    understanding the prevalence of the types of retaliatory behavior,
    including reprisal, ostracism, and maltreatment.
        Command Climate: Every sailor deserves to work in an environment
    free of discrimination, sexual harassment, fraternization, and hazing.
    Sustaining a good commend climate is vital to achieving and maintaining
    mission readiness and is an essential element of commander
    accountability. Yet providing a positive command climate in the Navy is
    not only the commander's responsibility, but also the responsibility of
    every sailor within that command. Sailors are trained and encouraged to
    intervene where good order and discipline is breaking down, giving them
    ownership of the type of environment in which they want to work.
        Alcohol and Substance Abuse Prevention: Navy Alcohol and Drug Abuse
    Prevention (NADAP) programs support enhanced Fleet, Family, and
    Personal Readiness through aggressive alcohol abuse and drug abuse
    prevention. Substance abuse puts lives and missions at risk, undercuts
    unit readiness and morale, and is inconsistent with Navy's ethos and
    core values of Honor, Courage and Commitment.
        The ``Keep What You've Earned'' campaign seeks to encourage
    responsible drinking among sailors by celebrating the achievements in
    their Navy careers. Through recognition of their hard work and
    dedication, sailors see their accomplishments and how much they have to
    lose if they make poor choices.
        Navy's policy on drug abuse is ``zero tolerance.'' Detection,
    deterrence, and prevention are key elements in combating drug abuse. We
    recently expanded our urinalysis program to detect prescription drugs
    and synthetic drugs. As a result, detections of wrongful prescription
    drug use have climbed, while positive synthetic drug results have
    declined. In response, Navy launched the ``Prescription for Discharge''
    campaign to educate sailors on the proper use of prescription drugs.
    Our goal is to provide sailors with the support network, health care,
    and skills needed to overcome adversity and make responsible decisions.
        Fleet and Family Support: Fleet and Family Support programs are a
    critical component in enhancing mission readiness and Navy's 21st
    Century Sailor initiative. Family support programs assist commanding
    officers, sailors and their families to manage the unique demands of
    the military lifestyle, balancing military commitment with family life.
    Navy Fleet and Family Support Centers ensure military families are
    informed, healthy, and resilient through robust programs to include
    relocation assistance, non-medical and family counseling, personal and
    family life education, personal financial management services,
    information and referral services, deployment assistance, domestic
    violence prevention and response services, exceptional family member
    liaison, emergency family assistance and transition assistance. Navy
    child and youth programs provide the highest quality childcare, ranked
    number one in the nation for quality standards and oversight. Navy
    morale, welfare, and recreation programs provide core fitness and
    recreation for sailors and their families to enhance quality of life
    and encourage life-long positive and healthy leisure pursuits. As part
    of the Navy Talent Management Initiative, we are extending our hours of
    operation at fitness centers and child development centers to retain
    our most talented sailors and maintain readiness to meet fleet
    requirements.
        Transition Goals, Plans Success (Transition GPS): Transition GPS
    replaced the 20-year-old Transition Assistance Program (TAP). The
    development and implementation of this initiative to extend the
    continuum of care to retirement, and well beyond, was a collective
    effort involving all military services. Created by the Office of the
    Secretary of Defense, with full participation by the Department of
    Veteran's Affairs, Department of Labor, and the Small Business
    Administration, Transition GPS increases sailors' abilities to overcome
    challenges they may face in pursuit of their chosen civilian career
    path. Participation is mandatory for all Active and most Reserve
    component members separating after having served 180 days or more of
    continuous Active Duty. Commands are required to document participation
    and completion of core elements via the Defense Manpower Data Center
    on-line tool.
                                 vi. conclusion
        Our mission remains to attract, recruit, develop, assign, and
    retain a highly-skilled workforce for the Navy. The President's fiscal
    year 2017 budget request supports the critical programs that will
    continue to support Navy MPT&E programs, and support programs that
    bolster sailors and their families and increase their resilience. I
    look forward to working with you as we continue to shape the Navy to
    meet current and emerging requirements. On behalf of the men and women
    of the United States Navy, and their families, thank you for your
    sustained commitment and unwavering support.

    STATEMENT OF LIEUTENANT GENERAL MARK A. BRILAKIS, USMC, DEPUTY
      COMMANDANT FOR MANPOWER AND RESERVE AFFAIRS, UNITED STATES
                              MARINE CORPS

        General Brilakis. Chairman King--excuse me--Chairman
    Graham, Ranking Member Gillibrand, Senator King--sir, I just
    did not want to leave you out.
        [Laughter.]
        General Brilakis. It is my privilege to appear before you
    today to discuss your marines. Marines are the foundation of
    the Marine Corps. They are the Corps' most sacred resource and
    always will be. Marines are recruited, educated, trained, and
    retained in order to answer the Nation's call to fight and to
    win. Everything we do in the Marine Corps must contribute to
    their readiness and combat effectiveness.
        The Marine Corps is in the final year of our drawdown. We
    have accomplished this drawdown primarily using voluntary
    separation authorities, and we appreciate the support of
    Congress and especially this subcommittee for those
    flexibilities that you have given us.
        Overall, recruiting and retention are strong. We are
    bringing in and keeping young men and women of character whose
    past service and future potential makes the Corps stronger.
        These marines are supported by our civilian workforce,
    approximately 95 percent of whom do not work in Washington.
    They work on our bases, stations, depots, and installations.
    They serve alongside our marines throughout the world in every
    occupation and at every level. Our civilians have truly showed
    themselves to be semper fidelis as they keep our marines and
    their families forefront in their actions and efforts. For that
    they have my personal admiration.
        It is imperative that we continue to keep faith with our
    military and civilian workforce, else we risk losing enormously
    talented and dedicated professionals. By ensuring that we take
    care of all marines and their families and our civilian
    personnel, we fulfill our responsibility to keep faith with the
    honor, courage, and commitment they have given to this Nation.
        Thank you very much for the opportunity to present this
    testimony. I look forward to answering your questions.
        [The prepared statement of General Brilakis follows:]

           Prepared Statement by Lieutenant General Mark A. Brilakis
                                  introduction
        Chairman Graham, Ranking Member Gillibrand, and distinguished
    Members of the Subcommittee, it is my privilege to appear before you
    today to provide an overview on Marine Corps personnel.
        Since our founding in 1775, Marines have answered our Nation's
    call, faithfully serving the American people and maintaining a world
    class standard of military excellence. Your Marine Corps is, and will
    continue to be, our Nation's expeditionary force in readiness. We will
    be ready to rapidly respond to crises around the Globe to ensure the
    continued security of the American people and to protect the interests
    that underpin our Nation. Marines will be always faithful to the trust
    which the American people have vested in them.
                                   our people
        Marines are the foundation of the Marine Corps. They are the Corps'
    most sacred resource, and always will be. Your marines are recruited,
    educated, trained, and retained to win our Nation's battles. They are
    smart, resilient, fit, disciplined, and able to overcome adversity.
    Recruiting high quality youth and retaining those whose past service
    and future potential makes the Corps stronger is our highest priority.
    Everything we do in the Marine Corps must contribute to their combat
    readiness and combat effectiveness.
                                  end strength
        Your Marine Corps is in its final year of drawing down Active
    component end strength from a high of 202,000 in 2010 to a steady-state
    strength of 182,000. We have accomplished this drawdown using primarily
    the voluntary separation authorities you have granted us. We appreciate
    the support of Congress, especially this Subcommittee, for those
    flexibilities. They have been instrumental in enabling us to ``keep
    faith'' with our marines. We have used only a few targeted involuntary
    measures and only for individuals who were eligible for early
    retirement. We do not foresee needing any additional force shaping
    authorities.
        Even though our end strength goals plan for a steady-state 182,000
    force, most of the force shaping authorities you have given us will
    remain relevant and utilized. These measures will continue to help us
    right-size MOSs (Military Occupational Specialities), reduce promotion
    pin-on times, and eliminate grade stagnation.
                             marine corps reserves
        The Marine Corps Reserve is nearing completion of its drawdown. The
    plan is to reduce Reserve end strength to 38,500 marines by fiscal year
    2017; we foresee no challenges in meeting this fiscal year 2017 goal.
    In fact, the Marine Corps Reserve has grown stronger despite the end
    strength reduction.
        Our Reserve unit personnel readiness stands at its highest level in
    a generation. Higher enlisted retention rates have been integral to our
    success. Retention has increased by 3-percentage points over the past
    five years--that equates to approximately 250 more marines per year.
    Better retention has helped fix many of our staffing shortages across
    Marine Forces Reserve. For example, our Staff NCO (non-comissioned
    officers) manning has increased from 66 percent in September 2013 to 82
    percent as of January 2016.
        While these are welcome and positive trends, we always look for
    ways to improve personnel readiness. We have implemented a
    comprehensive manpower management plan to provide full service support
    to our Reserve officers and Staff NCOs for their career management.
    Beginning in fiscal year 2017, we will expand this plan to provide
    full-service manpower management support for the entire Selected
    Reserve. This is a talent management initiative that will help our
    NCOs, Staff NCOs and officers transition between commands and provide
    our Active and Reserve units with the ``right marine, at the right
    place, at the right time.''
        Our Reserve officer staffing is healthy as well. In fact, it
    reached a record high of 88 percent in February 2016. This increased
    staffing has been driven by two major sources: officers transitioning
    from the Active Component and the Reserve Officer Commissioning
    Program. Bonuses and incentives have been effective in attracting more
    marines from the Active Component. For instance, our Aviator Retention
    Pay incentive has had a direct and positive impact on our squadron
    staffing rates, which have increased by 14 percent since 2013.
    Additionally, the Reserve Officer Commissioning Program has produced a
    total of 1,107 lieutenants for the Marine Corps since its creation in
    2006. As a result, our ground company grade officer strength has
    increased from 21 percent in 2013, to 90 percent today.
                                   recruiting
        All recruiting efforts for the Marine Corps (officer, enlisted,
    regular, Reserve, and prior-service) fall under the purview of the
    Marine Corps Recruiting Command. Operationally, this provides us with
    tremendous flexibility and unity of command, facilitating all efforts
    to meet accession requirements. The Marine Corps applies, evaluates,
    and refines proven, time-tested officer and enlisted recruiting
    policies and procedures that enforce and maintain high mental, moral,
    and physical standards of our applicants, such as SAT (Scholastic
    Aptitude Test), ACT (American College Testing), and ASVAB (Armed
    Services Vocational Aptitude Battery) testing; pre-enlistment physical
    screening and fitness tests; and background checks and pre-enlistment
    screening.
        Last fiscal year, we successfully achieved all enlisted and officer
    recruiting goals for both the Active and Reserve Components, and
    completed the year with a fiscal year 2016 start pool of nearly 55
    percent.
        For fiscal year 2016, our enlisted mission is 30,500 regulars
    (active component) and 5,105 reservists. We expect to achieve our
    annual recruiting `shipping' mission (i.e. new accessions sent to
    recruit training) and quality goals. The Department of Defense requires
    90 percent of enlistees to have a high school diploma or equivalent;
    last year, the Marine Corps achieved 99.9 percent and expects to be at
    or near this level for fiscal year 2016.
        Our officer accession mission for fiscal year 2016 is 1,500 Active
    Duty and 90 Reserve officers. We are well on our way toward these goals
    and foresee no issues meeting them.
        Incentives, such as our enlistment bonuses, allow us to ship new
    recruits at critical times to balance recruit loads at the depots and
    meet school seat requirements. It is important to note that only eight
    percent of new Marine Corps recruits receive an enlistment bonus. We
    appreciate Congress' support for these priority programs that assist
    our keeping high quality marines.
        To meet future challenges in the current recruiting environment, it
    is imperative that we maintain our high standards both for our
    recruiters and those who volunteer to serve in our Corps. Recruiting
    quality youth ultimately translates into higher performance, reduced
    attrition, increased retention, and improved readiness for the
    operating Forces. Our actions, commitment, and investments today in
    recruiting ensure a high state of readiness in our Corps tomorrow.
                                   retention
        As the Marine Corps draws down to a steady-state 182,000 force,
    competition for retention will continue. We will retain the very best
    marines capable of fulfilling our leadership and operational needs.
    This is accomplished through a competitive career designation process
    for officers and a thorough evaluation process for enlisted marines,
    both of which are designed to measure, analyze, and compare our
    marines' performance and accomplishments.
        Marine Corps retention models, systems, policies, and processes
    emphasize consistency of leadership, personnel stability, and sustained
    readiness across the force. Officer career designation incorporates a
    board system that enables leadership to examine officer records and
    accomplishments. After designation, the promotion process continues the
    evaluation of marine officers. It is a primary tool by which retention
    of only the best and most qualified is achieved.
        Tiered rating system for enlisted marines takes into account a
    number of quantifiable performance factors and includes both immediate
    and higher leadership input. It helps to set achievable goals for
    marines as they compete for retention. After initial reenlistment, the
    evaluation and continued retention of high quality enlisted marines is
    supported by a detailed and continual performance evaluation system
    which is fully integrated with the promotion process. Those marines
    with the best proven records are promoted and retained.
        Incentive pays remain critical to our retention effort, allowing
    the Marine Corps to fill hard to recruit positions, such as cyber
    security technicians and counter intelligence specialists. Similarly,
    Selective Reenlistment Bonuses (SRBs) allow us to shape our career
    force. SRBs target critical MOSs and supports lateral movement of
    marines to these MOSs.
                            marine corps integration
        As our Commandant recently testified, executing a successful gender
    integration plan will be a key to sustaining readiness, as well as
    ensuring we give all marines the greatest opportunity to succeed as
    valued members of the Corps. The issue of gender integration is not
    about ``women in combat,'' since women in our Corps have clearly
    demonstrated their outstanding service in combat, most recently in Iraq
    and Afghanistan. Our current efforts are about placing the best and
    most fully qualified marines where they can succeed and make the
    strongest contribution to the missions the Marine Corps executes as the
    Nation's expeditionary force-in-readiness.
        During the last two years, the Marine Corps undertook a
    comprehensive research effort to better understand the impacts of
    gender integration on combat effectiveness and health of the force. Our
    research analyzed the performance of individual marines in our formal
    MOS-producing ground combat arms courses. As a result, we developed,
    refined, and implemented improved occupation-specific physical
    standards and the associated screening tools for obtaining these MOSs.
        But the individual is only one aspect. The Marine Corps fights in
    teams--as units--in an arena where strength and speed win and second
    place is truly an unforgiving prize. Therefore, we studied both gender
    integrated and non-integrated units, operating as squads, teams, and
    crews; and we did this under live-fire conditions that most closely
    replicate actual ground combat conditions. This is the first time this
    level of research has been conducted. Our study was peer-reviewed by
    three well-respected, independent organizations to ensure diversity and
    depth of feedback regarding the research methodology. The female
    volunteers for this study were quality marines in every respect;
    physically, they were well above the average female marine in the
    fleet. The most significant findings were the large disparity in
    performance during movement under load--both marching and firing
    weapons.
        Currently, the Marine Corps is stepping out smartly to facilitate
    the integration of all qualified marines into previously closed ground
    combat MOSs and units. Integration will be executed in a well-planned
    and responsible manner. The framework of our research was--and
    continues to be--viewed through three interrelated lenses: first and
    foremost, the combat effectiveness of our marine units; second, the
    health and welfare of our individual marines; and finally, with an eye
    toward the best talent management of our total force--both today and
    into the future. I continue to have concerns in all three areas, but am
    confident that our assessment and subsequent adjustments during
    implementation will help us find the best way forward. Our readiness
    and combat effectiveness will remain the guiding focus as we implement
    our plan.
                                civilian marines
        Our civilian marines support the mission and daily functions of the
    Marine Corps and are an integral part of our Total Force. They
    exemplify our core values; they embrace esprit de corps, teamwork, and
    pride in belonging to our Nation's Corps of Marines. Serving alongside
    our marines throughout the world, in every occupation and at every
    level, our civilian appropriated funded workforce remains by far the
    leanest of all services, with a ratio of one civilian to every ten
    Active Duty marines.
        Approximately 95 percent of our civilians do not work in the
    Washington, DC, region. The vast majority reside at our bases,
    stations, depots, and installations. Sixty-eight percent are veterans
    who have chosen to continue to serve our Nation; of those, thirteen
    percent are disabled veterans. Our civilian non-appropriated funded
    workforce steadfastly continues to provide vital support to our
    marines, Reserve marines, their families, and our wounded, ill and
    injured.
        Already lean, we are in the midst of reducing our 17,500 civilian
    marine appropriated fund workforce to 15,800 by fiscal year 2017, and
    are working to implement the Management Headquarters Activities
    provision in the fiscal year 2016 NDAA. We are actively seeking ways to
    achieve these goals through attrition and various voluntary workforce-
    shaping flexibilities; our intent is not to implement any service-wide
    reduction in force (RIF).
        The last few years have not been easy on our civilian marines, with
    limited pay raises and furloughs or threat of furloughs several times.
    Throughout all of this uncertainty, our civilians have truly showed
    themselves as Semper Fidelis as they kept our marines and their
    families in the forefront. For that, they have my personal admiration.
    During these challenging times, it is imperative that we continue to
    keep faith with our workforce, else we risk losing enormously talented
    and dedicated professionals. Our civilian labor represents less than
    five percent of the Marine Corps' total O&M budget, demonstrating that
    our ``best value'' for the defense dollar applies to our civilians as
    well as our marines.
                         force of the future initiative
        The Marine Corps is in the midst of the Department of Defense Force
    of the Future Initiative. The initiative touches on nearly all aspects
    of military and civilian personnel systems. In many cases, the changes
    driven by this initiative codifies what has been existing service
    practices. In all cases, we continue to advocate for service
    flexibility which enables the Marine Corps to enhance our human
    resource processes without impacting our ability to execute title 10
    responsibilities.
                   taking care of marines and their families
        Taking care of marines and their families is a key element of
    overall readiness and combat effectiveness. The adage ``we recruit
    marines, we retain families'' remains as true today as ever. Our
    comprehensive package of services seeks the holistic fitness and
    readiness of our marines and families--body, mind, spirit, and social.
                              casualty assistance
        The most solemn care we can provide to our marine families is to
    care for our fallen marines and assist families at every step. We
    strive to do just that. Despite the drawdown from combat operations,
    casualties are still occurring daily. Even while not in a combat
    theater, the mass casualty incidents in Nepal, the Chattanooga
    shooting, and training incidents in Florida and Hawaii prove over and
    over again that being our Nation's expeditionary force in readiness has
    its share of risks.
        Our casualty assistance program is committed to ensuring the
    families of our fallen are always treated with the utmost compassion,
    dignity, and honor. Our uniformed Casualty Assistance Calls Officers
    (CACO) make in-person notifications to the Next-Of-Kin (NOK), often
    with a Chaplain, for all deceased marines; telephone notifications are
    made for the wounded, ill, and injured. When warranted, family members
    may travel to bedside via Invitational Travel Orders. Following
    notification, CACOs assist the NOK with burial arrangements,
    applications for benefits and entitlements, contact with benevolent and
    philanthropic organizations, obtaining reports of investigation, and
    other pertinent issues.
        The Marine Corps Long Term Assistance Program (LTAP) is a permanent
    resource of the NOK, ensuring they receive sustained, quality
    assistance from the Marine Corps. This includes NOK being contacted
    from a representative from LTAP approximately 60 days and at one year
    mark following the death to identify and resolve any persistent issues
    and to assist and attend to the needs of Marine Corps Survivors
    indefinitely. LTAP representatives also routinely attend quarterly DOD/
    VA Survivor Forums and TAPS National Survivor and Good Grief Camps.
                              wounded warrior care
        The Marine Corps' Wounded Warrior Regiment (WWR) continues to
    function as a central pillar of our pledge to ``keep faith'' with those
    who have served. The WWR will be an enduring need because marines
    supporting operations in or near combat zones will continue to need
    care management; instances of PTS (post-traumatic stress disorder) and
    TBI (traumatic brain injury) continue to increase due to delayed onset
    and as marines often delay seeking help; and severe non-combat
    illnesses, such as cancer, do not end with combat.
        Our WWR remains committed to providing comprehensive recovery care.
    For the Marine Corps, recovery care is not a process. Care coordinated
    through the WWR is soundly based upon an authentic relationship between
    care providers and the marine and his or her family members. This bond
    allows all parties to be vested in a common purpose: to provide our
    Nation's wounded, ill and injured (WII) marines the care and support
    needed for successful recovery and to ensure they and their families
    transition to meaningful, productive new roles.
        Since our WWR was established in 2007, thousands of WII marines and
    family members have benefitted from its care coordination capabilities.
    These capabilities include Recovery Care Coordinators to help WII
    marines develop and execute Comprehensive Recovery Plans, District
    Injured Support Coordinators, the Marine Corps' representatives for WII
    marines in their civilian communities, who can be at a WII marines
    doorstep in a matter of hours, a liaison to the Department of Veterans
    Affairs to enhance coordination between the organizations, and the
    Sergeant Merlin German Wounded Warrior Call Center to conduct outreach
    to WII marines and receive calls for assistance. Our call center
    conducts an average of 10,500 outreach calls per month and receives an
    average of 1,100 incoming calls for assistance per month. The call
    center can also connect a marine directly to a medical professional who
    may direct or advocate for behavioral health/medical care.
        In sum, WII marines and their family members receive customized,
    caring support, based upon their assessed needs, from the point of
    injury or illness, through rehabilitation, and finally as they return
    to duty or reintegrate to their hometowns. The Marine Corps does not
    utilize a ``fire and forget'' mentality. marines and their families,
    the Congress, and the public at large can be reassured that the Marine
    Corps, through the WWR, will continue recovery care in times of war and
    in peacetime.
                               behavioral health
        The Marine Corps Behavioral Health Program acts as an integrated
    community based service model focused on the prevention and
    intervention of suicide, substance abuse, combat operational stress,
    and family advocacy. When addressing behavioral health care, we
    typically see marines, family members, and others, with multiple
    stressors or conditions. Even as the Marine Corps moves into a post
    OIF/OEF (Operation Iraqi Freedom/Operation Enduring Freedom)
    environment, continued support ensures the readiness of our marines and
    their families, especially for those with delayed onset of symptoms.
        Because behavioral health issues are complex and contain many
    common stressors and factors, the Marine Corps has incorporated a
    holistic view of prevention. For example, the Marine Corps introduced
    ``Protect What You've Earned'' which reinforces the Marine Corps
    culture of leadership through personal action and accountability.
    Through it, we seek to reduce high-risk decision-making thereby
    reducing sexual assault, domestic violence, suicide, alcohol and other
    substance misuse-related incidents.
        To support our marines, attached sailors, and families, the Marine
    Corps offer world-class prevention and counseling services at each
    installation. All behavioral health programs provide free confidential
    services offered by licensed, credentialed professionals. Professionals
    conduct comprehensive assessments and individually-tailor counseling
    sessions to address substance abuse, relationship difficulties,
    domestic violence, child neglect and other stress related concerns
    before more serious conditions develop. These services are available to
    individuals, couples, families and children.
                               suicide prevention
        One of the highest priorities of our behavioral health program is
    suicide prevention. Preventing suicide has proven to be a very
    challenging task given the complex nature of the problem. We are
    constantly evolving and assessing our programs to coincide with best
    practices.
        A main focus of our suicide prevention efforts is the Marine
    Intercept Program (MIP). It is a combined effort between HQMC
    (headquarters Marine Corps), installation Community Counseling
    Programs, and commanders. MIP provides care coordination, regular
    telephone check-ins and suicide assessment for marines with a reported
    suicidal ideation or suicide attempt. MIP is a ``super safety net'' for
    marines identified at increased risk for suicide. Services include
    continuous assessment and safety planning as well as a series of caring
    contacts for a minimum of 90 days.
        In 2015, 1,247 reports of suicide ideations or attempts were
    reported and assigned to MIP. Of the total marines offered MIP, 77
    percent accepted services. Based on a preliminary review of early MIP
    data in 2014, Marines receiving MIP services accessed care 2.5 times
    sooner, miss fewer appointments and engaged specialty care more often.
        The Marine Corps DSTRESS line provides anonymous, 24/7/365 phone,
    chat and Skype support with a duty to warn if danger is imminent. Since
    its inception in 2010, DSTRESS has helped save 36 lives; it also helps
    to increase the total fitness of our Marine Corps families by providing
    live support for effectively coping with the wide spectrum of
    challenges of life in the Corps. Marines contact DSTRESS for varying
    reasons including relationship issues, stress management, post-
    traumatic stress, depression-suicidal ideation, and sexual assault.
        In order to leverage the power of social media, the Marine Corps
    recently launched a marketing awareness campaign addressing suicide
    prevention. The main message is to highlight the trend of individuals
    expressing suicidal thoughts on social media and detail what steps to
    take if someone is in emotional distress. The social media posts
    highlight the DSTRESS Line, and instruct individuals to use Facebook's
    Suicide Prevention Tool to report concerns. To date, almost 300,000
    individuals viewed and shared these posts, resulting in an 800 percent
    increase in traffic to the DSTRESS website in a 2 day period beginning
    on 12 January 2016. More such social media posts are being planned.
        One of the newer initiatives we are introducing is Conquering
    Stress with Strength. It is workshop that focuses on family members
    under stress. This is the first available, family-focused training to
    develop family skills for appropriately responding to high-stress
    situations.
                      sexual assault prevention & response
        We will not be satisfied until sexual assault is eliminated in the
    Marine Corps. We are encouraged by fiscal year 14 survey data
    indicating a 30 percent decrease in the prevalence of unwanted sexual
    contact since fiscal year 12. In that same time period, there was a 94
    percent increase in the number of victims coming forward to report.
    While the next prevalence survey will not be fielded until the end of
    fiscal year 2016, preliminary fiscal year 15 data show that we have
    sustained our levels of reporting. In addition, from fiscal year 14 to
    fiscal year 15, we saw an increase in the number of victims filing
    unrestricted reports, which demonstrates increased confidence in our
    response system and in commander support. Another positive trend is
    that more victims of sexual assault are reporting the crime within
    three days of the incident, placing the Marine Corps in a better
    position to hold offenders appropriately accountable by facilitating
    more timely investigations.
        Male victims are an extremely underreported population. The Marine
    Corps is developing a more in-depth knowledge of the factors that
    influence the reporting decision among male marines who experience
    sexual assault. We are integrating specific information on male victims
    in our prevention education and training. Significantly, we have posted
    five products addressing male victimization on official Marine Corps
    social media pages, reaching a combined total of more than one million
    people. SAPR (Sexual Assault Prevention Response) is also hosting a
    subject matter expert panel on male victims of sexual assault in April
    2016 to inform our prevention practices and program development. From
    fiscal year 14 to fiscal year 15, the number of male victims filing
    reports increased slightly, a positive indication for this population
    that has been reluctant to report.
        The Marine Corps takes allegations and acts of retaliation very
    seriously. Retaliatory behavior--whether on duty, on liberty, or
    online--is unconscionable and should never be tolerated. We are taking
    a number of actions to address this problem. For example, our Sexual
    Assault Response Coordinators and SAPR Victim Advocates are trained to
    ask victims about experiences of retaliation during their monthly
    safety check-ins. In addition, our case management group chairs are
    required to assess all reports of retaliation in their monthly
    meetings, ensuring that they are properly referred for resolution. We
    have also posted social media products that specifically address
    retaliation which have reached more than 341,000 people. In addition,
    steps are underway to integrate retaliation into SAPR training products
    for all marines. The message is clear: If a marine reports misconduct
    or a crime like sexual assault, they deserve--as a fellow marine--to be
    treated with dignity and respect.
                              transition readiness
        As the Marine Corps has reduced its end strength over the last few
    years, more of our marines and their families have made the transition
    to civilian life. It is imperative that we ensure they have the right
    preparation to reach personal goals and effectively translate their
    military experiences to a successful civilian life.
        Our Marine For Life Cycle is a holistic process, not an event.
    Beginning at the point of recruiting, the Marine Corps strives to
    provide a continuum of tangible learning or experienced-based
    opportunities to ensure that every marine is transition-ready
    throughout their career.
        At their first permanent duty station, marines complete the
    personal readiness seminar. It provides an overview of personal and
    professional development services, such as family member employment,
    voluntary education, personal financial management, and servicemembers'
    rights.
        Approximately a year prior to separation, marines complete our
    transition readiness seminar. It is a week-long program that includes
    mandatory standardized core curriculum followed by the choice of one of
    three additional two-day tracks that are in line with their individual
    future goals and objectives--higher education, career and technical
    training, or entrepreneurship.
        No later than 90 days prior separation, marines will meet with
    their commanding officer for Capstone review. At this time, the
    commanding officer will validate whether the marine has met their
    career readiness standards. If a marine does not meet their career
    readiness standards or have a viable transition plan, we provide a warm
    handover to Department of Labor or Veteran Affairs partner agencies for
    additional post-transition assistance.
        After separation, our nationwide network of Marine For Life
    representatives reach back to provide support to marines. In order to
    build a robust virtual community, we are currently expanding our
    network to include an online presence on LinkedIn, Facebook, and
    Twitter. Our goal is to have an online community and network of marines
    and friends of marines to help transitioning marines identify
    opportunities in the civilian marketplace.
        One way to ensure that marines will be successful in transitioning
    is to ensure that their military skills and work experience can be
    transferred into a civilian job. The 2014 National Defense
    Authorization Act charged the Services to make credentialing
    information available to all members upon their initial training and at
    every stage of training in their MOSs. The Marine Corps Credentialing
    Opportunities On-Line (COOL) is part of that initiative. It links
    marines with certifications and licenses related to their Military
    Occupational Specialties across the continuum of the Marine For Life
    Cycle.
        COOL is an open public website that is available and accessible to
    those currently serving, veterans, spouses, potential employers across
    all industries, enterprises, credentialing agencies, and associations.
    A credential translates Marine Corps technical skills into marketable
    language recognized by employers and may make the post service job
    search easier. Marines are able to choose from 943 certifications
    depending on their MOS or by the name of a specific credential or
    agency. Marines can also find general information on a myriad of
    resources to support their personal and professional development plans.
        As of July 2015, the Marine Corps is paying for examination fees
    and annual maintenance for enlisted marines to earn civilian/industry
    credentials, which are closely aligned with the marine's MOS.
                         marine corps exchange services
        The Marine Corps delivers a myriad quality of life programs via an
    integrated Marine Corps Community Services (MCCS) construct that
    combines Morale, Welfare and Recreation; Marine Corps Exchange (MCX);
    Warfighter and Family Services; and Child Development Programs. This
    integrated model is unique within DOD and provides many operating
    efficiencies, including consolidated non-appropriated fund back-office
    support, e.g. human resources, finance and accounting, procurement,
    construction and information technology.
        Our MCX is an integral business component of MCCS delivering
    products and services in garrison and expeditionary environments.
    Marines and families can count on real savings when they shop at the
    MCX; the most recent market basket survey showed an average savings of
    over 24 percent, while maintaining a consistent gross margin. The
    military resale system is one of the largest employers of military
    family members, about 30 percent of the Marine Corps Exchange workforce
    is a veteran or a military family member. The MCX revenue contributions
    to MCCS remain an essential and mission critical asset to the Marine
    Corps.
        Transformation and innovation is the fabric of MCCS as we continue
    to investigate new program and service delivery models by leveraging
    technology, partnerships, and sponsorships. The Marine Corps is also an
    active participant in the newly established Defense Resale Business
    Optimization Board chartered to seek efficiencies, while preserving the
    valued quality of life benefits provided by both commissaries and
    exchanges.
                                   conclusion
        The marines of our Corps represent the American people who have
    stepped forward and sworn to defend and protect our Nation. Through
    recruiting, training, education, and retention of men and women of
    character who take up our challenge to become one of ``the Few and the
    Proud,'' we will enhance the quality of our Corps and our overall
    combat effectiveness. By ensuring that we take care of all marines and
    their families, we fulfill our responsibility to keep faith with the
    honor, courage, and commitment they have so freely given.
        Our individual marines are our most precious asset. They are proud
    of what they do. They are proud of the ``Eagle, Globe, and Anchor'' and
    what it represents to our Nation. With your support, a vibrant Marine
    Corps will continue to meet our Nation's call.
        Thank you for the opportunity to present this testimony.

     STATEMENT OF LIEUTENANT GENERAL GINA M. GROSSO, USAF, DEPUTY
     CHIEF OF STAFF FOR MANPOWER, PERSONNEL, AND SERVICES, UNITED
                            STATES AIR FORCE

        General Grosso. Chairman Graham, Ranking Member Gillibrand,
    Senator King, it is my honor as well to appear before you today
    representing our total force airmen and their families.
        As airmen, our purpose is to ensure the Air Force can
    always provide America with global reach, global vigilance, and
    global power. However, 25 years of continuous combat
    operations, coupled with budget instability, and lower-than-
    planned top lines have made the Air Force one of the smallest,
    oldest, and least ready Forces in its history.
        Despite all of this, our Air Force is powered by airmen
    with more talent and education than ever before. Today the
    660,000 Active Duty, Guard, Reserve, and civilian airmen are a
    highly trained, experienced, and battle-tested force, standing
    as vanguards of freedom around the world.
        As you are aware, our Secretary and Chief's top priority is
    taking care of airmen and their families. Airmen and their
    families are without question our most important resource, and
    our budget reflects this truth.
        You are also aware that we have been downsizing in our Air
    Force for years, but this budget stops that decline and begins
    to upsize our total force to address a number of key areas,
    including critical career fields like nuclear, intelligence,
    cyber, maintenance, remotely piloted aircraft, and support
    officers.
        We want to thank this committee for supporting our Active
    Duty plus-up, which is going to go roughly from 311,000 to
    317,000 airmen by the end of this fiscal year. Given our
    current operations tempo, we certainly cannot sink below this
    number, and we believe that the mission demands will indicate
    that we need even more growth in fiscal year 2017.
        The Air Force is committed to improving readiness by
    growing the force, and as such, the fiscal year 2017 budget
    funds increased accessions and expanded retention programs,
    invests in the student training pipeline and adds technical
    training resources, incentivizes retention of critical skills
    in undermanned specialties, maximizes total force airmen to
    meet mission demands, and most importantly, takes care of
    airmen and their families.
        As we continue to rely on the all-volunteer force, we will
    make every effort to leverage the diverse talent from across
    our Nation. We want the men and women of this Nation to see the
    Air Force as an employer of choice where there are no
    artificial barriers to their success.
        This is best illustrated in opening all of the remaining
    closed career fields to women, reinforcing our values that if
    you meet the requirements, you will have the opportunity to
    serve in any position.
        In closing, thank you for your time today and your
    tremendous support and concern for our Nation's airmen. I look
    forward to your questions.
        [The prepared statement of General Grosso follows:]

                             Prepared Statement by
                       LIEUTENANT GENERAL GINA M. GROSSO
                                  introduction
        Despite the last two decades of sustained conflict, the men and
    women of your Air Force are as dedicated as ever before. We have
    witnessed changes in the geopolitical environment that demand increased
    efforts from the Department of Defense in general and specifically the
    Air Force. Our airmen are fully engaged in every region of the world,
    in every mission area, and across the full spectrum of military
    operations.
        Today the Air Force is as busy as it has ever been while also being
    its smallest. We have been downsizing for years but now we must upsize
    modestly in fiscal year 2016 our Total Force to address a number of key
    areas, including critical career fields such as intelligence,
    surveillance and reconnaissance, cyber, maintenance and battlefield
    airmen (e.g., Special Tactics Officer, Combat Controller, Combat Rescue
    Officer, Pararescue, Special Operations Weather and Tactical Air
    Control Party). Recognizing the strength we have yielded from our Total
    Force team, we continue our efforts to integrate our Guard and Reserve
    partners further.
        Our airmen provide a strategic advantage over America's competitors
    and as an Air Force, we remain committed to supporting our airmen and
    their families to ensure they remain resilient and motivated. Our
    personnel programs are geared to attract the airmen of the future and
    retain our talented airmen, and their families.
                            diversity and inclusion
        Diversity and inclusion are national security imperatives and
    critical force multipliers for a military tackling complex challenges
    of geopolitical significance. Air Force senior leaders realize the
    importance of a diverse and inclusive force and we must ensure our
    airmen are representative of the diverse populace from which we draw
    our considerable strength. By ensuring the most talented, culturally
    competent, and operationally relevant force possible, we will be more
    agile, and able to meet nascent requirements quickly and decisively.
    The Air Force is conducting very deliberate planning for its diversity
    and inclusion efforts in 2016.
        A transformational change must start with the Air Force's senior
    leaders. As such, we will establish standard unconscious bias training
    to help initiate a deeper understanding of potential barriers to
    success and as a bridge to operationalizing diversity and inclusion. In
    addition, to help engrain the importance and value of leveraging a
    diverse and inclusive force, the service is codifying and funding our
    Chief Diversity Officer positions at the major commands and direct
    reporting units. Further, we are establishing baseline education and
    training for our diversity and inclusion leaders across the Air Force
    to provide them with a sufficient foundation to chart a clear path for
    our diversity and inclusion initiatives.
        Along with these efforts, we must also make certain we have access
    to the best and brightest our Nation has to offer. Subsequently, we are
    writing a National and Total Force recruiting strategy and
    implementation plan that leverages key strategic partnerships to create
    more effective access to diverse talent pipelines.
        The diversity and inclusion mission is an ongoing, enduring
    requirement, incorporating self-awareness, organizational change and
    constant learning. Human beings are biased by nature, but using
    education, training and deliberate planning can provide an organization
    such as the Air Force with the tools necessary to combat bias and to
    create an equitable and inclusive working environment and culture. The
    Air Force's key diversity governance documents are being rewritten to
    reflect current Air Force strategy as well as to incorporate the Air
    Force imperative of inclusiveness.
                                  end strength
        The demand for airpower in today's military conflicts continues to
    increase. The fiscal year 2016 President's Budget (PB) resized Active
    Duty end-strength from approximately 313,000 to 317,000, and we have a
    deliberate plan to grow from our current inventory of 311,000 to
    317,000 personnel by the end of fiscal year 2016. This growth addresses
    key capability gaps in the nuclear, maintenance, cyber, intelligence,
    surveillance and reconnaissance, remotely piloted aircraft and support
    career fields, ensuring the Air Force increases its ability to meet
    mission demands. Our fiscal year 2017 PB is strategy-driven and
    consistent with the previous year's proposal. The fiscal year 2017
    budget cycle carried forward fiscal year 2016 end strength levels fully
    funding 317,000 across the Future Years Defense Program (FYDP),
    continuing our concerted effort to ``right size'' the force. Moreover,
    it offers the best balance for America's current and future air, space,
    and cyberspace requirements at Bipartisan Budget Act (BBA)-level
    funding ($43.4 billion) for military ($28.4 billion) and civilian
    personnel costs ($14.5 billion to include working capital fund and
    Research, Development, Test and Evaluation). The fiscal year 2017
    budget submission also leveraged PB16 Total Force increases in both the
    Guard and the Reserve thus maintaining warfighting capacity while
    minimizing increases to Active Duty end strength. Subsequently, our
    request outlined a total military force of 491,700 comprised of 317,000
    Active Duty, 105,700 Guard and 69,000 Reserve airmen.
        Our civilian airmen are an integral part of the Air Force team and
    serve in almost every position imaginable, to include critical areas
    such as depot maintenance, science and technology, engineering, fire
    fighters and Air Reserve Technicians. Since 9-11 there have been many
    fluctuations in the civilian workforce size. Over the past 3-years, the
    Air Force civilian workforce increased approximately 14,000 positions
    in key areas including intelligence, surveillance and reconnaissance,
    cyber and nuclear.
        However, we made significant progress with civilian reductions as
    well. Since fiscal year 2012, the Air Force has taken approximately
    24,000 civilian reductions in response to Congressional actions. During
    this time period, we reduced 10,000 positions. Further, we will
    continue to drive civilian reductions moving forward, fully complying
    with the fiscal year 2016 NDAA 25 percent directed HQ reductions.
                           military force management
        The Air Force has shifted force management from a reduction focus
    to a growth posture. To meet this increased end strength, we are
    focusing our force management efforts on bolstering accessions and
    increasing retention of our skilled workforce.
        We are using multiple lines of effort to grow the force. We have
    increased accessions of enlisted airmen entering Basic Military
    Training and the numbers of officers being commissioned. In addition,
    we are retaining experience through robust and expanded special and
    incentive pays; bringing on prior service accessions; using Reserve
    Active Duty tour opportunities; and implementing High-Year-of-Tenure
    extensions.
    Recruiting
        Accessions are the building blocks of the Air Force. Subsequently,
    it is imperative that we maintain a strong focus on recruiting with a
    solid and proficient recruiter force, capable of responding to the
    ever-changing recruiting environment. Air Force brand recognition is an
    enduring requirement to ensure we have the opportunity to increase
    propensity to serve in the Air Force among the eligible youth
    population. Findings suggest that maintaining an all-volunteer force
    requires recruiting efforts to focus on reaching both youth with a
    long-term interest to serve as well as those that were not previously
    propensed. To affect both market segments, we must use advertising to
    change propensity, particularly among tougher segments of the
    population to recruit.
        The recruiting budget includes funding for day-to-day operations,
    personnel costs and advertising activities necessary to the successful
    accomplishment of the recruiting mission. Budget actions, such as
    sequestration in fiscal year 2013, slowed or completely shut down key
    advertising and marketing events, which included the Air Force
    Thunderbird Aerial Demonstration Team, and delayed our national
    television campaign for fiscal year 2014, leading to missed ``key
    spots'' and diminished purchasing power.
        Initial Enlistment Bonuses are critical to our recruiting efforts
    and are funded at $16.1 million in the fiscal year 2017 PB; this
    program greatly assists in producing sufficient recruits to meet
    requirements for high-demand, chronically low manned career fields such
    as battlefield airmen and linguists. We successfully use this program
    to recruit youth into career fields that historically are hard to
    recruit and/or qualify for by awarding a monetary bonus as an
    incentive. The ability to recruit the right requirements at the right
    time for these unique demands without the Initial Enlistment Program
    would be threatened.
    Retention
        We are increasing our accessions and training pipeline to support
    the increased growth, but these new enlistees won't be seasoned for
    some time, thus retaining the experience we have is critical to our
    success in reaching target end strength. To address retention concerns,
    we are using robust and expanded special and incentive pays to retain
    experience; bringing on prior service accessions; using Reserve Active
    Duty tour opportunities; and implementing High Year of Tenure
    extensions. The Air Force weighed under manning, experience levels,
    retention trends and training costs across all Air Force specialty
    codes in determining which career fields to target. Officer retention
    challenges exist for pilots, including remote piloted aircraft pilots,
    combat systems officers, special operators, intelligence, contracting,
    and select health professionals. For the enlisted force, specialties
    facing retention challenges include cyber defense, battlefield airmen,
    intelligence, explosive ordnance disposal, aircraft maintenance, and
    select nuclear enterprise specialties. The quick growth the Air Force
    is planning over the next two fiscal years requires a greatly expanded
    Selective Reenlistment Bonus program, increasing from 40 specialties in
    fiscal year 2015 to 117 in fiscal year 2016. This three-fold increase
    focused on retaining key experience while continuing our deliberate
    plan to grow our force, and we expect a similar size program in fiscal
    year 2017. Additionally similar to fiscal year 2016, the fiscal year
    2017 Selective Reenlistment Bonus program further incentivises airmen
    by providing more money up front to reenlist and thus retains more
    experience during this time of growth. Our budgeted amount to execute
    this program is $226 million.
        Further, we are using High Year of Tenure extensions to retain key
    experience while growing the Air Force by 6,000 in fiscal year 2016.
    The High Year of Tenure program expanded from 38 Air Force Specialties
    in fiscal year 2015 to 122 in fiscal year 2016 and fiscal year 2017.
    This expansion, except where the specialties were fully manned, mirrors
    the Selective Reenlistment Bonus program. Additionally, High Year of
    Tenure expansion included specialties where the training pipeline was
    insufficient for the accession requirement; where specialties were
    undermanned in certain grades; and in areas needed to support the
    expansion of the aircraft maintenance enterprise.
    Bonus and Pay Incentives
        With national security threats increasing around the globe and
    emerging requirements continuing to evolve, it is critical that we
    invest in our current force to retain the experience to maintain and
    expand the Air Force's current capabilities. Special and Incentive pays
    are one of our most flexible and responsive force management tools.
    Accordingly, our fiscal year 2017 budget includes approximately $927.4
    million in Special and Incentive pays, which includes $226 million in
    Selective Reenlistment Bonuses, $12.3 million in Critical Skills
    Retention Bonus and $87.5 million in Aviator Retention Pay. The Air
    Force will use these retention bonuses, along with the full suite of
    Special and Incentive pays, to surgically shape the force in low-
    retaining skills with a focus on maintaining the correct number of
    airmen by specialty and year group. The Air Force is offering Officer
    Critical Skills Retention Bonus programs for Special Tactics, Combat
    Rescue, Contracting, Intelligence officers and remote piloted aircraft
    pilots. Additionally, our Enlisted Critical Skills Retention Bonus
    programs are for the Tactical Air Control Party, Combat Controller,
    Pararescue and Explosive Ordnance Disposal career fields.
        We appreciate the assistance in providing increased bonus and
    aviation pay for our remote piloted aircraft pilot force. With our get-
    well plan for our remotely piloted aircraft team underway, we are
    pleased to be able to compensate these aviators under the same
    authority as all rated career fields. The ability to use monthly
    Aviation Incentive Pay (flight pay) and Aviation Retention Pay, as
    authorized in the fiscal year 2016 National Defense Authorization Act,
    for remotely piloted aircraft pilots will surely bolster retention in
    this field. The Air Force is currently working with the Office of the
    Secretary of Defense to craft a policy allowing a full transition to
    these new authorities.
        We ask for that same assistance with our manned rated force. The
    Air Force is experiencing the lowest pilot retention since 2002. In
    2002, major airline hiring drove the retention rates to 47 percent,
    causing much concern for our service. Since then, we have maintained
    rated retention levels at or above 65 percent with our Aviator
    Retention Pay program. However, in fiscal year 2015 only 55 percent of
    the eligible pilots entered into a bonus agreement. With pilot
    retention decreasing, constrained pilot training pipelines are
    insufficient to train the required number of pilots to replace those
    not retained by the bonus. Of particular concern for the Air Force is
    the status of our fighter pilot inventory, currently undermanned at
    about 520 fighter pilots with the trend continuing downward. We
    continue to monitor closely and will request additional authorities and
    increases as are necessary.
    Compensation Reform
        The Air Force supports the Department's current posture on
    compensation, which is to continue to slow the growth of military
    compensation (other than retirement) pay and benefit costs in order to
    permit a balance in defense spending. Compensation reform is a fiscal
    necessity as compensation represents nearly half of the Department's
    budget. Although adequate compensation is a vital component of an
    airman's quality-of-life, it must remain in balance with readiness,
    capacity, and strategic capabilities necessary for the Air Force's
    future.
        The Air Force must ensure that we maintain readiness and
    modernization. We are working closely with the Department to implement
    the direction in the 2016 NDAA on the blended retirement provisions
    while exploring other possibilities for strategic compensation reform.
    While we support the incremental out of pocket expense in housing
    allowances, we are concerned that any additional reductions in housing
    allowances will have negative effects in sustaining our current force
    and their families.
                         civilian workforce management
        During fiscal year 2015, the Air Force was successful in
    aggressively using pre-Reduction In Force tools to help posture the
    civilian workforce for minimal disruption from workforce management
    initiatives. We continue to manage the delicate balance of right sizing
    in accordance with Congressional and Department guidance and filling
    our allocated civilian vacancies. A round of Voluntary Early Retirement
    Actions and Voluntary Separation Incentive Pay was offered in Fall 2015
    with an effective date of December 31, 2015. Of the 1,400 civilian
    overages identified, at the conclusion of the process, only 89
    individuals were involuntarily separated. At the beginning of fiscal
    year 2016, a needs assessment identified 1,100 civilians as overages
    needing to be placed on funded authorizations. At the end of January
    31, 2016, approximately 300 civilians still require placement and we
    expect that number to continue to decrease as we work the Reduction in
    Force process, which culminates on April 4, 2016. Another needs
    assessment for an additional round of Reduction in Force with an
    effective date of September 30, 2016 will be administered in March. We
    remain optimistic that pre-Reduction In Force efforts will ensure we
    minimize any involuntary separations. Additionally, we do not
    anticipate or expect any furlough adverse impact on our invaluable
    civilian workforce. This stability bodes well with our continued
    efforts to pursue executing our allocated civilian dollars and work
    years and to provide stability among all our civilian airmen looking
    into fiscal year 2017.
    New Beginnings
        The Air Force will transition approximately 131K employees to the
    New Beginnings Defense Performance Management and Appraisal Program in
    April 2017. We welcome this comprehensive and transparent multi-level
    performance management system that links performance expectations with
    organizational goals, provides for regular on-going feedback and allows
    meaningful distinctions in performance. It will move the majority of
    Air Force civilians from a 2-level pass/fail rating pattern to a 3-
    level rating pattern with the ability to rate performance elements as
    ``Outstanding'' and thus provide civilians meaningful distinctions in
    their performance. This shift in focus on communication and
    distinctions in performance allows the Air Force to realize fully a
    culture that embraces and supports a high-performing workforce.
    Additionally, it emphasizes the importance of employee engagement and
    places increased emphasis on leadership behaviors and supervisory
    responsibilities in an effective performance management system. The Air
    Force will be actively engaged over the next year in providing training
    to all impacted civilians as well as their military supervisors.
        New Beginnings also includes initiatives focused on streamlining
    the hiring process, training for supervisors and managers, implementing
    effective means of recruiting, compensating, and incentivizing the
    civilian workforce with a focus on strategic workforce planning to
    shape an effective workforce for today and into the future.
                                 one air force
    Total Force Integration and Continuum of Service
        The Air Force is implementing a number of Continuum of Service
    programs and initiatives consistent with the National Commission on the
    Structure of the Air Force recommendations and aligned under the Air
    Force's Strategic Master Plan and Human Capital Annex governance
    structure. We continue to develop the structure and policies that allow
    for deliberate and purposeful transitions between the Regular Air
    Force, the Air Force Reserve and the Air National Guard.
        Continuum of Service allows the enterprise to retain and preserve
    highly skilled personnel for a longer period by reducing transition
    barriers, incentivizing affiliation with Reserve components as well as
    lengthening the officer career trajectory for selected airmen. Along
    those lines, we have instituted and implemented policy changes and
    programs such as the Career Intermission Program and the Voluntary
    Limited Period of Active Duty Program. Additionally, a number of
    Continuum of Service initiatives are underway within the Human Resource
    Management enterprise to include aviation retention pay options for
    part-time Reserve aircrew members and addressing Air Reserve Component
    retirement concerns in converting Active retirement for those that meet
    time and grade requirements.
        The Air Force will continue to increase the integration and
    holistic management of the total force components; however, a true
    Continuum of Service will require legislative change to enable the
    seamless transition between Air Force components.
    One Air Force A1
        The Air Force's ultimate goal is to provide total force personnel
    policy to lower echelon headquarters and serve any airman, at any
    location, regardless of component or status. The Air Force's initial
    effort under the National Commission on the Structure of the Air
    Force's recommendation regarding integrated force management was to
    focus on establishing a single, integrated manpower, personnel and
    services organization.
        The Air Force began co-locating Air Force Reserve and Air National
    Guard staff members within the Deputy Chief of Staff for Manpower,
    Personnel and Services organization on 1 October 2014 by phasing in
    three Active Guard Reserve officers as division chiefs. Transfer of
    personnel is ongoing using a phased approach with full operational
    capability in fiscal year 2017. Since initial operational capability in
    fiscal year 2015, two Memorandums of Agreements between the Deputy
    Chief of Staff for Manpower, Personnel and Services, the Chief of the
    Air Force Reserve and the Director of the Air National Guard have been
    written to outline and codify the implementation strategy. Twenty-eight
    specific positions have been attached or assigned across the Deputy
    Chief of Staff for Manpower, Personnel and Services organization to
    address personnel management processes to include, but not limited to,
    recruiting, assignments, force development, and force management.
    Air Force Integrated Personnel and Pay System (AFIPPS)
        An integrated Personnel and Pay capability is fundamentally
    required for the Air Force to operationally integrate into One Air
    Force. In May 2015, the Air Force communicated the decision to reassess
    our path toward integrated personnel and pay by looking at two
    alternatives--a new acquisition or optimization of our current
    capability. From that notification through December 2015, the Air Force
    employed a cross-functional team to refine a problem statement, garner
    Service lessons learned along with industry benchmarks, and
    comparatively analyzed differences between the two alternatives. Our
    conclusion is that upgrading our modern existing platform in agile
    delivery cycles is the best use of resources and delivers capability to
    our airmen sooner.
        The Air Force initiated an upgrade to our current human resource
    system of record, fielding enhancements and performing data cleansing
    activities to ready our system for the integration of payroll beginning
    in fiscal year 2018. These efforts simultaneously modernize and
    transform our systems, deliver additional airmen-enabling self-service
    capabilities, and refine the foundation for the complete end-to-end pay
    integration.
        The Air Force remains committed to migrating our human resource
    portfolio to a solution that minimizes future cost and ensures the
    human resource community is postured to deliver capability to the Total
    Force. By focusing actions to deliver state-of-the art commercial
    capabilities and leveraging self-service with upgraded web and mobile
    support to improve human resource access and action, we will reduce our
    operational costs while drastically improving how we support and pay
    our world-class airmen.
                            women in service review
        On December 3, 2015, the Secretary of Defense notified Congress of
    his intent to open all remaining positions and occupations across the
    Department of Defense. On January 4, 2016, the Air Force began
    executing the final Implementation Plan for Full Integration of Women
    in the Air Force and opened 6 previously closed career fields that
    include 4,000 positions across the Total Force. Women now have the
    opportunity to serve in the Air Force as a Special Tactics Officer,
    Combat Controller (Enlisted), Combat Rescue Officer, Pararescue
    (Enlisted), Special Operations Weather (Enlisted) and Tactical Air
    Control Party (TACP) (Enlisted).
        Air Force actions will be guided and informed by our studies, as
    well as the research and analysis conducted by our Sister Services and
    USSOCOM under the Women in Service Review. The implementation plan also
    provides for periodic review and continuous assessments to allow
    incorporation of lessons learned as we go forward. Successful gender
    integration will take time and requires a focus on standards, policy,
    education and engaged leadership across the Total Force.
        These direct ground combat career fields present a challenge to
    find qualified volunteers who have the physical and mental fortitude
    and can persevere through lengthy training pipeline that could span two
    years. Opening these positions to women allow the Air Force to reach
    into the female population to find qualified skill sets.
                               support to familes
    Child and Youth Programs
        Air Force Child and Youth Programs are critical to our airmen, and
    Air Force's goal is to ensure quality, affordable child development
    spaces are available to our airmen and their families. To accomplish
    this, we use a combination of child development centers, family
    childcare homes, and school age programs to support children from birth
    to 12 years of age. These vital programs provided full time childcare
    for more than 64,000 children in 2015. Our community-based programs are
    also crucial in supporting families not located near an Active Duty
    installation. We provided 8,800 children of Total Force families with
    160,000 hours of childcare necessary for Air Force Reserve and Air
    National Guard members to attend unit drill activities.
        Additionally, our Expanded Child Care programs, operated primarily
    through our Family Child Care programs, continue to grow and adapt to
    meet the varied and unique childcare needs of our airmen. Expanded
    Child Care programs offer a more developmentally appropriate home-based
    childcare arrangement in a manner that is much more flexible and
    economical for accommodating the fluctuating numbers of users. In 2015,
    we provided more than 53,000 hours of childcare for more than 2,600
    children of first responders, missile operators, wounded warriors,
    deployed personnel, and parents required to work extended hours or
    dealing with emergency medical care issues. We added two new programs,
    24/7 Child Care to support members working 24 hour shifts and Missile
    Care 2 Program to assist spouses with non-traditional childcare
    requirements during times the Active Duty member is working off the
    installation in the missile field. Our Expanded Child Care program also
    includes skilled care to exceptional family members allowing parents a
    break from the stressors of continuously caring for a child with
    special needs. Geographically separated airmen across the Total Force
    now have access to exceptional family member respite childcare. The
    program has consistently grown with an increase in usage more than 35
    percent from last year serving more than 1,360 children with 101,000
    hours of care.
        In 2016, our priority is to meet the needs of our members and their
    families. We are currently developing implementation plans to extend
    child development center and school age care hours to overlap the
    normal working shifts of Service members by at least two hours. At the
    same time, we are developing a strategic plan to expand capacity in
    critical areas where wait times for enrollment exceed 90 days, which
    goes hand-in-hand with the Military Compensation and Retirement
    Modernization Commission recommendation to improve access to childcare
    on military installations. The continued rollout of the
    MilitaryChildCare.Com initiative, a website for military families
    seeking childcare, will assist in identifying and validating the areas
    with the greatest need. MilitaryChildCare.com expedites childcare
    placement through a standardized Department of Defense request process
    and waitlist management tool and is currently operational at 30 Air
    Force locations with the remaining 44 locations to be operational by
    the end of this calendar year.
    Wounded Warriors
        The Air Force Warrior and Survivor Care office is the Air Force's
    lead in orchestrating a comprehensive, continuum of care that
    synergizes Department of Defense and Veteran Affairs programs to meet
    the medical and non-medical care of wounded, ill, and injured airmen.
    Over the past year, and through the efforts of our Air Force Wounded
    Warrior program, we expanded enrollment in our warrior program by
    improving marketing to our Air National Guard and Air Force Reserve
    units. We continue to work with units to identify airmen who return
    from deployment and are beginning to cope with the effects of post-
    traumatic stress. When symptoms manifest, affected airmen may not
    recognize the need for help immediately and it is our goal to ensure
    they are aware of the assistance avenues that are available.
        We are committed to a lifetime relationship with all airmen and
    their families. To strengthen this commitment, we are in the initial
    stages of developing an Airman for Life program. In addition to
    leveraging existing programs that support an airman's lifecycle, such
    as the Transition Assistance Program and Air Force Families Forever,
    the Airman for Life program will seek to build relationships with non-
    profits, state and local governments, and employment centers to bridge
    potential gaps in support.
        While we are committed to providing world-class treatment for our
    airmen's wound, illness or injury, we are also dedicated to treating
    the whole person and, as an extension of our airmen, their families and
    caregivers as well. We have developed Caregiver Peer Support Forums, as
    a collaborative effort with the Office of the Secretary of Defense and
    the other Service Wounded Warrior programs. These meetings, being
    conducted at all Air Force installations, provide caregivers an
    opportunity to share their experiences and challenges with others that
    best understand what they are going through.
    Transition Assistance
        Approximately 42,000 Total Force Airmen per year leave the Air
    Force. The Veterans Opportunity to Work to Hire Heroes Act of 2011, and
    Veterans Employment Initiative, direct many Transition Assistance
    Program requirements which provide a variety of opportunities for
    transitioning Veterans to engage with civilian employers using their
    training and employment experiences. The Air Force Airman & Family
    Readiness Centers engage with National and Federal partners to ensure
    transitioning servicemembers and their spouses are career ready for
    transitioning back to the private sector.
        One of our newest efforts to help our airmen successfully
    transition to the civilian workforce is the Air Force Credentialing
    Opportunities On-Line Program. The program currently offers 182
    certifications in fields such as Project Management, Information
    Systems Security and Human Resources and provides two distinct
    benefits: first, it continues to professionalize the enlisted force by
    providing up-to-date industry-recognized credentials in an airman's Air
    Force job; second, it provides a way for airmen to prepare for civilian
    life by ensuring that they are ready for work in the civilian sector.
                                   conclusion
        Recent global developments remind us that America's Air Force must
    have the capability to engage anytime, anywhere, and across the full
    spectrum of conflict. To do this we must be able to attract, recruit
    and retain the best our Nation has to offer. Our airmen, a combined
    team of Total Force officers, enlisted, and civilians, are educated,
    innovative, and motivated. When properly trained, effectively equipped,
    and instilled with the trust of their leadership, they will ensure our
    Air Force remains the most powerful in the world. However, our airmen
    do not serve alone. Our Air Force families are a critical component of
    our success and enable this dedicated force to focus on mission
    accomplishment. Maintaining an all-volunteer Air Force is a significant
    undertaking and requires a continuous and significant investment of
    time and national resources. We realized long ago if we do not focus
    and invest towards producing, supporting and retaining the highest
    quality airmen continuously, we as an institution fail. As the Deputy
    Chief of Staff for Manpower, Personnel and Services, I am committed to
    making the Air Force a success.

        Senator Graham. Well, thank you all for your service.
        I will start with the Army. What percentage of the Army's
    budget is personnel?
        General McConville. Senator, it is about 60 percent with
    military and civilian personnel.
        Senator Graham. Admiral?
        Admiral Moran. Senator, it is roughly the same when you
    include all the personnel, the whole team.
        Senator Graham. The Marines?
        General Brilakis. Sir, it is 69 percent. That is civilian
    and military.
        Senator Graham. Air Force?
        General Grosso. Approximately 50 percent.
        Senator Graham. So if we are going to do other things, you
    know, half your budget plus is going to personnel costs.
        There is a debate going on about whether women should be
    subject to the draft now that we have opened up military
    occupations to women. Could you please very briefly share your
    view as to whether or not you think that is a good idea?
        General McConville. Well, I think, as you know, we have
    opened up all combat positions to women, and I think they
    should have the opportunity to serve in whatever position they
    want. The fact that they can serve in combat, they ought to be
    eligible for the draft.
        Senator Graham. We will just let everybody know that
    because you are drafted does not mean you go into combat. You
    got to meet the standards.
        General McConville. Yes, sir, absolutely.
        Admiral Moran. I would agree, Senator, to be consistent in
    a message to everyone in America that wants to serve, Selective
    Service in my personal opinion is appropriate.
        Senator Graham. General?
        General Brilakis. Mr. Chairman, thank you for the question.
        You know, it has been interesting--this discussion that has
    been going on. So the question really is the Selective Service
    Act I think in terms of threats to the Nation, threats to the
    republic and what it does and what it represents, and whether
    or not this is an issue about women and whether we add women
    now that we made this decision to include them in combat roles,
    or whether it is a larger discussion about the Selective
    Service Act and what it means to the Nation.
        I am a planner by nature, and if I have a plan, is that
    plan holistic enough to survive first contact to provide the
    Nation the talent it needs in time of crisis without an
    extended debate. The Selective Service Act should help to allow
    us to act quickly.
        Senator Gillibrand. So yes or no?
        Senator Graham. Yes. Yes or no.
        General Brilakis. I believe in that discussion, all
    Americans have the responsibility to serve the Nation.
        Senator Gillibrand. Good.
        General Grosso. Yes. Women should be included in the
    Selective Service Act.
        Senator Graham. There you go.
        If you are going to change TRICARE, one, does it need to be
    changed, and what would be the biggest recommendation you could
    give us?
        General McConville. Senator, I think everything should be
    on the table as you talked about with the costs going up.
    Having commanded the 101st Airborne Division in combat, I
    understand what it takes to have a highly trained unit that has
    got to be manned, it has got to be equipped, and it has got to
    be trained. We have to spend money on that, and there is not
    enough money to go around. So we need to look at every place,
    and TRICARE is one of those to see where we can more
    efficiently effective so we can continue to man our force,
    equipped and training our force.
        Senator Graham. Does anybody know off the top of their head
    what percentage of DOD's budget in the next decade will go to
    TRICARE or health care?
        General McConville. Not off the top of my head.
        Senator Graham. Admiral?
        Admiral Moran. Sir, I would say that we need to simplify,
    and that is part of the proposal that we are seeing, to
    simplify the plan and reduce the administrative----
        Senator Graham. How about expand the number of people
    servicemembers can go to and their families? Expand the
    network.
        Admiral Moran. Expand the network. We are trying to drive
    more business back into the MTFs [Military Treatment
    Facilities] so that we can keep our readiness of our
    professionals. I think that is the direction we need to
    continue, and that will help reduce costs because we are not
    paying outside the network.
        Senator Graham. Got you.
        General Brilakis. Sir, I agree with Admiral Moran that
    leveraging the existing infrastructure that we have to the
    maximum extent to drive down costs is going to be fundamental
    to the overall TRICARE solution set. But we want to make sure
    that we continue to provide our families and our marines,
    soldiers, sailors, and airmen high-quality health care around
    the globe and in the many different areas in the country where
    they serve.
        General Grosso. I too agree that we need to get as many
    beneficiaries into the traditional military treatment
    facilities as we can and to use the traditional pharmacy that
    the military provides to better leverage that capacity.
        Senator Graham. When it comes to combating sexual assault
    and putting an emphasis on preventing this, how would you rate
    the efforts in each service?
        General McConville. Well, Senator, I would like to answer
    this as a parent. I am a parent of three children. I expect and
    my wife demands that we provide a safe and secure environment
    for our children. I would say we put a tremendous amount of
    resources into getting at this is something we----
        Senator Graham. Do you think people are getting the
    message?
        General McConville. I do. I really do. I think people are
    getting it, but I think we need to continue to work. One of the
    things we have put in place and we got feedback from our
    surveys is a ``not in my squad'' program. Every year we have
    120,000 soldiers come in the Army. Those 120,000 soldiers come
    with the values they brought out and they live in things called
    squads. I think it is extremely important, not just from the
    top down, but from the bottom up to get after this and change
    culture because it is something we just cannot have in our
    military.
        Senator Graham. Briefly, does anybody--does everyone kind
    of agree with that assessment?
        Admiral Moran. Yes, sir.
        Senator Graham. Is it going in the right direction in the
    Navy?
        Admiral Moran. I think our response is better than our
    prevention, and we are getting better at prevention and we are
    really focused on it this year. The CNO [Chief of Naval
    Operations] has added some new initiatives that I would be
    happy to talk about. But, yes, sir, I believe we are.
        General Brilakis. Sir, we cannot ever be satisfied with
    where we are at with respect to sexual assault and response to
    it, but I do believe that we have included all marines into the
    final solution and we are understanding the problem much better
    than we did before.
        General Grosso. I would agree with that. I think we really
    turned our focus now to what is primary prevention and what can
    we learn from the people who do that best. We have funded
    positions at every installation that are primary prevention
    experts, and we are developing a strategy that deals with
    interpersonal violence because when you look at the risk
    factors, the protected factors and the risk factors for
    suicide, sexual assault, family violence, and actually
    workplace violence, they overlap. So we are trying to leverage
    all of these separate programs to better address these
    negative, destructive behaviors.
        Senator Graham. Senator Gillibrand?
        Senator Gillibrand. Thank you. I am going to continue where
    Senator Graham left off.
        So I want to talk a little bit about implementation for
    sexual assault, specifically the Navy. You have done some
    interesting work in terms of creating a complex litigation
    track for counselors to specialize in litigating serious
    offenses, including cases of sexual assault. Could you talk a
    little bit about that? Because I think it is probably one of
    the best strategies I have heard in terms of getting
    performance in actually prosecuting these cases, getting more
    cases to conviction, more cases to have an appropriate penalty,
    not just non-judicial punishment, but something that fits the
    crime of rape. Could you talk a little bit about that?
        Admiral Moran. Senator, I can talk a little bit about it. I
    am a little bit out of my league in terms of being not a
    lawyer.
        However, you are correct in that our AJAG [Assistant Judge
    Advocate Generally] put together a course to help make our
    prosecutors better, to your point, to make they understood how
    to apply the law and really keep the pressure on the system to
    hold people accountable. It is called the military justice
    litigation career track, and we have also assigned
    qualifications to that, so official quals, so that we can
    identify which JAG [Judge Advocate General] members at any
    point in their career who have that qual can be appropriately
    distributed around the fleet, fleet concentration areas, so
    that they can be assigned to those cases. It will kind of
    solidify around those expert prosecutors so that we are
    consistent in how we deal with each case.
        Senator Gillibrand. Do you apply this just for general
    court martials if you also apply it for special court martials?
    Do you know?
        Admiral Moran. I do not know. I can get that answer for
    you.
        [The information follows:]

        Senator Gillibrand, you requested additional information about the
    Navy's creation of a career track for military justice litigation and
    whether these judge advocates practiced in special and general courts-
    martial.
        In 2007, the U.S. Navy Judge Advocate General's Corps implemented
    the Military Justice Litigation Career Track (MJLCT), in recognition
    that litigation skills are perishable and that the growing complexity
    of military justice litigation requires officers to remain in the
    courtroom for successive assignments to maintain proficiency and
    develop expertise. Our MJLCT judge advocates are leading litigation
    throughout the enterprise, most notably as Senior Trial Counsel and
    Senior Defense Counsel at all Naval Legal Service Commands, as
    officers-in-charge at defense office detachments, as directors of Trial
    and Defense Counsel Assistance Programs (TCAP/DCAP), and as Victim's
    Legal Counsel. These judge advocates also serve as trial judges on the
    Navy-Marine Corps Trial Judiciary and as appellate judges on the Navy-
    Marine Corps Court of Criminal Appeals. There are 63 MJLCT billets and
    77 MJLCT judge advocates. At any given time, there are some MJLCT judge
    advocates assigned outside a career track billet on a disassociated
    tour to ensure they remain knowledgeable on Navy matters and enable
    their overall proficiency.
        The mission of the MJLCT is to identify and cultivate judge
    advocates with the requisite education, training, experience, and
    aptitude to maintain the highest quality of representation in complex
    criminal litigation. The MJLCT has three levels of proficiency, which
    career track judge advocates earn based upon their skill development
    and experience in military justice litigation. Before applying for each
    level of proficiency, candidates are expected to meet the applicable
    experience level guidelines for each stage as set forth in the Navy's
    MJLCT policy and must obtain recommendations from senior members of the
    community that are MJLCT judge advocates.
        MJLCT judge advocates litigate cases in both special and general
    courts-martial.

        Senator Gillibrand. For the other services, I would
    recommend you to look into this because one of the challenges
    we have is that our services have generally looked at lawyers
    as generalists, that we want you to be good at everything so
    that when you are advising a general, you know a little bit
    about everything.
        But we have seen, when I have delved into how are these
    cases actually prosecuted, how many convictions do you get as a
    percentage of convictions in the civilian world, and what are
    the penalties, we do not actually look very good compared to
    the best prosecution offices in the country. A lot of the DA's
    [District Attorney] offices do not do very well at this either,
    but some do. The ones that do it is because they
    professionalize. So the Manhattan DA's office, for example, is
    a perfect place to look for how do you professionalize
    prosecution of tough felonies. Sexual assault are some of the
    hardest cases in the world to prosecute effectively. They are
    tough because you have to weigh evidence in a way that is very
    difficult, and it is just hard to prove. So when they do it
    well, it is because they professionalize and they have career
    track people who are focused on how do you prosecute tough
    felonies. So I think every one of the services should work on
    this as a way to get better results in the cases that do go
    forward.
        But I would like you each to answer one question. I
    understand you all think we are making progress. Why is the
    retaliation rate unchanged? It is still at 62 percent.
    Retaliation as perceived by the victim are three kinds of
    retaliation: 30 percent peer-to-peer, 30 percent
    administrative, 30 percent professional. So do not say it all
    seems to be peer-to-peer because that is not the case. In a
    third and a third, and if you combine that, that is 60, it is
    from the commander. It is either administrative or
    professional.
        So I want you to talk about why is retaliation where it is.
    Have you personally seen any prosecution of retaliation in your
    services at all this year? If not, why do you think that is?
    Give me an answer on how we fix this retaliation problem.
        I liked the fact that one of you said ``not in my squad''
    because the perception of these survivors is sexual harassment
    60 percent of the time is from their direct commander, not
    sexual assault, but sexual harassment. So women are perceiving
    their unit commander to be one who is creating a poor climate
    for them to be successful. So that is a huge problem with,
    again, not pushing back on retaliation peer-to-peer or ones
    coming from a commander through administrative or professional.
    I would like your comments on those.
        General McConville. Senator, I agree with you. As we looked
    at the report that came out, the last report, we saw reporting
    going up, which we thought was a good thing, we saw propensity
    coming down, but the retaliation at 62 percent is what we went
    after.
        Really, that is why we put together a retaliation strategy.
    We have got to get that down to the lowest levels, and we have
    got to get it into the squads. We have got to get it into the
    command. We have got to hold commanders responsible. We have
    had cases of retaliation reported. Commanders have taken
    appropriate action. I can come back to you on the record for
    what those actual actions were taken.
        [The information referred to follows:]

        The Army has collected data for the Department of Defense (DOD)
    Sexual Assault Response Prevention Office (SAPRO) as part of its
    department-wide review of retaliation in the Armed Forces. DOD SAPRO
    has provided guidance on how to collect this information and will give
    the Army further guidance on its distribution. If approved by DOD, the
    Army anticipates releasing this information in May 2016, coinciding
    with the release of Annual Report on Sexual Assault in the Military.
    For the way forward, the Army is exploring ways to improve data
    collection that will allow for easier collection of retaliation data
    using existing databases. Additionally, the DOD Comprehensive Plan will
    formalize data collection with a single point of contact and
    standardize definitions of retaliation across the Services.

        But I can tell you that is our biggest concern right now.
    We thought we had a good path both for reporting and for
    propensity, but to us retaliation is the area we still need to
    get after.
        Admiral Moran. I will just add, Senator, that all of us in
    OSD [Office of the Secretary of Defense] have recognized that
    the data on retaliation is not going in the right direction. We
    have got a working group. We are defining, we are setting the
    baseline definition for retaliation because there is a lot of
    misunderstanding about it to many folks, and then throwing that
    and adding it into our training, which is becoming more and
    more effective, on destructive behaviors. We have put
    retaliation into that construct as well. To Jim's point, we
    have to do it at the local level. We have to train peer-to-
    peer. We have to make sure we are talking to each other and
    understanding the misperceptions that go along with this aspect
    of sexual assault.
        General Brilakis. Thanks for the question, Senator
    Gillibrand.
        Thanks to this subcommittee and the Congress for actually
    bringing this to everybody's attention. There has been a lot of
    realization into what is going on. The commands themselves have
    taken action to publish policies to identify to make their
    servicemembers understand what it is when we talk about
    retaliation or reprisal. We are participating, along with the
    other services, in the OSD working group to develop an overall
    SAPR retaliation set of policies, understanding these
    definitions, et cetera. In the Marine Corps, the IG [Inspector
    General] and NCIS [Naval Criminal Investigation Station
    Headquarters] primarily are the investigative arms in these
    cases and advise commanders on the information and the
    prosecutorial options that are available to commanders, as far
    as this goes. It is a crime. It cannot be tolerated. We are all
    taking steps to make this one of those things that is knowledge
    in action or prevalent within the services.
        General Grosso. Senator Gillibrand, the only thing I would
    add to that is that we are educating all leaders that more than
    one out of every two victims that come forward experience some
    negative outcome that they perceive as negative. I think that
    is very surprising when you start sharing that data. So you
    have to be cognizant that whatever you are doing--we are not
    doing enough so that these victims are getting the care they
    need. So we have started doing that.
        The other thing we have emphasized is the people that the
    victim comes forward who they trust to be much more proactive
    and ask how are you doing, can I help you, how is your
    experience in the workplace going. So those people that are
    primary caregivers and that are SARCs [Sexual Assault/Spouse
    Abuse Resource Center] that do more in the case management--we
    want them to be more engaged with the individual, knowing that
    more than one out of every two has some negative experience, so
    be a little bit more involved in soliciting their input and
    addressing it at real time.
        Senator Gillibrand. Just quickly a yes or no. Do you know
    of any cases of retaliation being prosecuted in your service?
    Just yes or no.
        General McConville. I am not aware.
        Admiral Moran. Yes.
        General Brilakis. I do not at this time.
        General Grosso. No.
        Senator Gillibrand. Because I would like to follow up with
    you on a case.
        Thank you, Mr. Chairman.
        Senator Graham. Senator Tillis?
        Senator Tillis. Thank you, Mr. Chair, and my compliments to
    the staff on cleaning up that spill. I thought they were going
    to have to use a shop-vac. It was a big one.
        Thank you all for being here.
        A quick question on TRICARE. The legislative proposal for
    2017 looks like it aims at keeping most of the beneficiaries in
    the military hospitals and the clinics. Do you agree with that?
    Do you think that that is the right strategy? Can you explain
    to me why?
        General McConville. Senator, I think, at least from a
    military standpoint, we cannot outsource combat care, and so
    that should be the number one priority. Having just returned
    with the 101st Airborne in combat, we have the incredible
    medical providers, and that is going to be the number one thing
    to do. So we got to keep that capability within our medical
    treatment facilities.
        We also have an obligation to take care of our families and
    our retirees. That is where we need to take a look at how to do
    that best. There are some places, medical treatment facilities,
    where we just do not have the work to keep them open. So we
    have got to be innovative and maybe we bring them down to
    clinics, but we still meet the needs. There are some cost
    savings. We can get at those things while we are providing the
    right care. But we got to think through how we do that. So some
    places we can do it. Other places we cannot. But the overriding
    principle for us is are we maintaining the readiness of the
    military, do we have the right medical folks ready to go to
    combat if we need to do that.
        Admiral Moran. Yes, I completely agree with Jim's
    assessment, Senator.
        Senator Tillis. Thank you.
        General Brilakis. I do as well, sir. Our medical treatment
    facilities--we have invested huge amounts of money. We have got
    great talent in there. They have to be kept up to speed. They
    got to learn their job. We do that by ensuring a constant flow
    of patients. But we cannot do that at the expense of our
    families and our servicemembers. So we have got to make sure we
    balance that with the things that are available to those
    members that are outside the proximity of a medical treatment
    facility. I think ultimately it is a very careful balance,
    managing costs, availability, access, and also health care.
        General Grosso. We would agree as well. Where there is
    availability, we would for every beneficiary go to an MTF.
        Senator Tillis. You know, one thing I would like for us to
    do is look at as much collaboration as possible. I sit on the
    Veterans Affairs Committee, and we are talking about--we
    obviously have to invest for a certain amount of capacity. So
    in some of our facilities, we may not be at capacity, but we
    are prepared, in the event that we need to, to find some
    efficient way to make those resources available. At times, you
    have other instances where maybe you do not have the capacity.
    But I think collaboration and collaboration with the private
    sector and the communities you are embedded in--I would like to
    see more of that, just get more leverage out of it.
        I do not know if Senator Gillibrand brought this up, but I
    am kind of curious. There is one thing that we talked about in
    a full committee a week or so ago, and it has to do with
    cutting the reimbursement rate for treatment for autism,
    children with autism. It looks like we are cutting that really
    below the national average. That could be at the expense of
    providing treatment.
        In your experiences, are these kinds of treatments things
    that your military families are concerned with, and do you
    share the view that maybe we should delay cutting the
    reimbursement rate?
        General McConville. Well, Senator, I know we have an
    exceptional family member program, and a lot of our military
    families look to that to take care of their children. I know
    some very close to me that have children in that program. So
    from a standpoint, I would have to look at the absolute case,
    but I think we owe it to these families who are serving in the
    military the care they need for their kids.
        Senator Tillis. It seems to me there is nothing more we
    could do to help our soldiers stay focused on their duties than
    to make sure we are taking care of their families back home.
        Admiral Moran, do you have a comment?
        Admiral Moran. No, sir, not really other than I am sure
    that any family--and I have got sailors working for me who have
    autistic kids, that if they see the benefit to the treatment
    that their children are getting being eroded through rate cuts,
    they are concerned. I would have to look at what the exact
    proposal is and balance that against all the other----
        Senator Tillis. Well, I think the other thing to look at--I
    want to ask another question. It is on a different subject. But
    I think the thing to look at, increasingly a number of private
    sector companies are providing these treatments. Other States
    are mandating the care. It could ultimately become a threat to
    people who would otherwise like to stay in the military where
    the financial burden is such that they will go get a job where
    the coverages are out there. It could ultimately represent a
    loss of good people who would otherwise stick around if they
    had the same alternative under TRICARE.
        A completely different subject, and it has to do with
    commissaries. Can you talk a little bit about what we can do?
    You know, there is some discussion of privatization. We know
    there are a lot of concerns expressed with that. Can you talk
    about things that we can do that could potentially improve
    efficiency and maintain costs? I think that is one of the key
    drivers behind people's support of the current plan is because
    they do not want to see the costs go up.
        We will start in reverse order this time.
        General Grosso. Well, we think there a couple things, and
    actually I think these are policy issues that they are working
    at the OSD level. But one of them is variable pricing so that
    they have some flexibility depending on their location to
    maximize the price competitive with their local area.
        I think the second thing is local branding, so getting a
    DeCA [Defense Commissary Agency] brand that has the potential
    to save a significant amount of money.
        Then I think the third thing would be to leverage the
    efficiencies that the exchange services have got in the back
    shop and learn from the exchange services to lean out the
    business portion of the DeCA process.
        Senator Tillis. Thank you.
        General Brilakis. Senator Tillis, thank you very much.
        I agree with everything that Gina just said. Variable
    pricing, branding, et cetera, all those are limitations on what
    they can do. We need to take a look at it as a business, and if
    we are going to achieve efficiencies in the commissary program,
    we need to look at it and execute it that way. One hundred
    percent APF-funded [appropriated fund]. The real question is
    how do we bring that down. Our exchanges at one point were that
    way, and now they are all NAF-funded [nonappropriated fund],
    although I do have some concerns about trying to have the
    exchange services become combined with the commissary services.
        DeCA needs to be brought into a more business-like footing
    before we go to consideration about combining both exchange
    services and commissary services because each of the services
    do their exchanges a little bit different and the result and
    the dollars that go to support our marines, soldiers, and
    airmen and sailors reside and rest on our ability to run our
    exchange services economically and successfully.
        Senator Tillis. Thank you.
        Thank you, Mr. Chair.
        Senator Graham. Senator King?
        Senator King. I want to move to another subject. All of you
    at the beginning of your testimony spoke in terms of working on
    drawing down, on reducing force and where you are in that
    process. The other hearing that I am supposed to be at right
    now--and I am going to have to leave shortly--is with Director
    Clapper, the Director of National Intelligence, who testified
    before this committee that in his 50 years of Government
    service, he has never seen a more complex, dangerous, and
    growing threat environment than what we are facing today.
        It worries me that we are doing these drawdowns based upon
    decisions about budgets made in 2011 before ISIS [Islamic State
    of Iraq and Syria], before Syria, before North Korea nuclear,
    before the South China Sea, before the Ukraine, and we are
    embarked on a policy direction that may not comport with the
    reality that we face.
        General, could you comment on that?
        General McConville. Yes, I could, Senator.
        As you know, the Army is on a drawdown ramp to 450,000
    soldiers. That 450,000 soldiers--980,000 in the total force.
    That was based on some conditions and assumptions that were
    made around the 2011 to 2012 time frame. Those assumptions and
    conditions are changing. We are sitting today at 482,000
    soldiers, a little over a million in the force right now. I
    think as we move forward, we need to take a look, if the
    conditions have changed, what the type of things we want our
    Army to do and how much risk we should take.
        Senator King. One of the things that worries me is if
    conditions do change--and in fact, they are changing before our
    eyes--and you need to ramp back up, that is not a spigot you
    can turn on. That is an 18-month--to stand up a brigade is, I
    am told, 18 months to 2 years at the shortest. Is that correct?
        General McConville. That is absolutely true.
        Senator King. Other comments on the idea that maybe we have
    got the aircraft carrier, Admiral, going in a certain direction
    and we need to think about changing direction.
        Admiral Moran. Yes, sir. Senator, thanks for the question.
        You know, we have spent the last 2 or 3 years now trying to
    reset our OPTEMPO [operational tempo] to something sustainable,
    both for the equipment that we have and just as importantly for
    the people. The crises you talk about--we always counsel our
    sailors that as much as we are trying to drawdown our OPTEMPO
    so it is more reasonable and sustainable and predictable for
    sailors and their families, the world is getting a vote.
        Senator King. But if the threats are going up----
        Admiral Moran. That is what I mean.
        Senator King.--and the people are going down, the OPTEMPO
    is going to go up. I worry about burning people out. This
    hearing is about personnel, and we are talking about
    compensation and retirement. But the OPTEMPO is a big factor.
    Is it not?
        Admiral Moran. Absolutely.
        Senator King. General, do you agree?
        General Brilakis. Absolutely, Senator King.
        In our reduction from 202,000 down to what was originally
    186,800 marines, which was determined to be the optimal number
    for the size of the force, the balance of the marine air ground
    task force, the capabilities and the sustainment of rotational
    deployments, the OPTEMPO and DEPTEMPO [deployment tempo], we
    have since--because of the price sensitivity that we have, as I
    testified earlier, about 7 cents out of every dime goes to pay
    for our people. So when reductions pressures--sequestration
    puts pressure on the top line, the only way that we can pay
    that is a reduction in the end strength. So we have gone from
    186,800, which is the ideal size, to 184,000, now down to
    182,000 primarily due to budgetary pressures.
        Even in that determination of the 186,800 marines as being
    that balanced force, since that time, in the last 4 years,
    these issues that you brought up, a rising Russia, South China
    Sea concerns, additional forward presence, rotational
    requirements, additional actions in the regional areas, has put
    even further pressure on that. In the readiness component, our
    ability to provide ready Forces today has been--we are under
    pressure. We are already above what we believe to be the
    sustainable number, the one to----
        Senator King. Certainly we cannot avoid--or should we avoid
    budgetary considerations? We all have to live within budgets.
    The whole country does. But the driver should be the demands
    and the threats.
        General Brilakis. Absolutely, sir. I think we need to
    balance the things we ask of our services to do and especially
    in uncertain times like we have today.
        Senator King. General, in your opening testimony, you said
    something like this is the smallest Air Force we have had in--
    --
        General Grosso. Yes, Senator King. In fact, you will see in
    our budget that is why we are growing end strength. So we are
    through the drawdown. We are growing back up to 317,000, and we
    absolutely believe we need more for the very reasons you cited.
        Senator King. I am running out of time. I would like to ask
    a question for the record, if you all could supply us. We made
    some changes last year in the retirement program, and I am
    interested in sort of mid-course discussion of how that is
    working. Should there be some modifications to it? Is it
    working in the way it should? I have heard a complaint that
    lower-level enlisted people cannot make the payments or have
    the financial education necessary to make the payments into the
    401(k) that gets them to their 50 percent at the end. I would
    just like your thoughts on how that looks now from the field.
        [The information referred to follows:]

        General Grosso. The new retirement system is scheduled to take
    effect on January 1, 2018. The Air Force, in concert with the other
    services and the Office of Secretary of Defense, is currently working
    on several lines of effort in order to make sure we are ready to
    execute on schedule and our Servicemembers receive the proper
    education. First, in terms of policy, the Department of Defense is
    drafting the implementation policy. Once published, it will be used to
    ensure the Services all implement in the same manner.
        The education of our airmen is a major focus area and will be an
    ongoing process beginning later this year and continuing up to and
    beyond the effective implementation date in 2018. In addition to pre-
    implementation training, we are developing systematic, reoccurring
    training throughout an airman's career. As examples, there will be a
    series of courses beginning the latter part of CY2016 to address the
    key target audiences for this change: leaders/supervisors,
    servicemembers with less than 12 Years of Service, financial managers
    or personal financial counselors and finally new accessions. An ``Opt-
    in'' course will be targeted at the large group of airmen who will be
    making the choice whether to opt into the new system or remain with the
    current retirement plan. We are also developing a ``train the trainer''
    for financial professionals, counselors and managers who will be
    advising our airman as they make these critical decisions.
        The decision on how much to contribute to the Thrift Saving Plan
    will be different for every airman. As the education mechanism is
    matured and each airman understands his or her choices, they will be
    able to make the decision that is best for his or her situation. This
    contribution decision is not static and will likely change based upon a
    member's life events. To aid in an airmen's decision, a retirement
    calculator will be created which airmen and their families can access
    from work or home to facilitate the choices using their own pay data.
        With regard to potential modifications, we continue to believe that
    flexibility in execution of the Continuation Pay is a critical aspect
    for the Services to be able to shape the force and maintain the right
    retention level for each service. As well, TSP matching to the end of a
    member's service recognizes the contributions and maintains the pool of
    senior leaders (both officers and enlisted) needed to manage our force.
        General McConville. The retirement changes go into effect in 2018,
    and so far everything is on course for a successful implementation. The
    Department of Defense did submit some modifications in the fiscal year
    2017 Defense Omnibus. Of these, the most important is the flexibility
    in the administration of continuation pay. The program so far is
    working the way it should. We are revamping our financial education
    plan in 2017 so that the lower-level enlisted force has all the
    necessary financial education to make an informed decision about their
    retirement selection. All personnel can contribute up to 5 percent of
    their pay into their Thrift Savings Plan (TSP) retirement account and
    get a matching 5 percent added from the Government.
        Admiral Moran. We are preparing to implement the Blended Retirement
    System (BRS) on January 1, 2018. As we prepare, we believe that
    additional flexibility to offer Continuation Pay (CP) earlier, or
    later, than 12 years of service, as is currently specified in statute,
    would be critical to its efficacy as a force management tool.
        I am unaware of sailors expressing concerns over an inability to
    make contributions into the Thrift Savings Plan (TSP). Anecdotally,
    sailors appear appreciative of the flexibility and choice BRS will
    offer, should they elect to opt in. We will provide financial literacy
    training that gives sailors the information necessary to make the best
    decisions for their individual situations, including training on the
    advantages and risks of enrolling in TSP and the benefit of matching
    Government contributions. This is important for the long-term financial
    security of all our sailors, including those who serve only a single
    term as well as those who remain for a career.
        General Brilakis. The modernized retirement system is set to go
    into effect 1 January 2018. It is too early to assess it. As we
    approach the effective date, we will monitor the changes closely for
    impacts to all marines, paying close attention to our young enlisted
    population, and assess whether or not they are able to make sufficient
    contributions to their Thrift Savings Plan.
        The Marine Corps currently employs a financial education strategy
    that provides all marines access to financial education topics timed
    and targeted with corresponding life events like deployments,
    promotions, reenlistments, marriage, and retirement. This strategy
    ensures that Marines are aware of their compensation and benefits and
    are prepared to make timely decisions necessary to ensure their
    personal financial readiness. We are updating our financial education
    and counseling curricula to give all Marines the information they need
    so that they can make an informed decision about the modernized
    retirement system and the Thrift Savings Plan.

        Senator King. The other thing I would like for the record--
    I had a conversation this morning with the Admiral, that 84
    percent of his incoming recruits are from military families. My
    question is, is that true of all of you, and is that
    sustainable given the smaller size of the military? If that is
    where our main recruiting pool is, we are going to have to
    think, it seems to me, about broader recruiting.
        [The information referred to follows:]

        General Grosso. When we review the survey's completed by our new
    airmen in the Air Force, approximately 52 percent state they have an
    immediate family member (parent) who served in the military. At this
    time we feel this number is sustainable with the size of the Air Force
    and also a healthy number as it reflects we are actively recruiting
    members who have no previous affiliation or family ties to the
    military. We continue to expand recruiting efforts beyond traditional
    recruiting pools and look to further advancements in the future
    expanding our recruitment, seeking greater diversity and continuing to
    attract talented youth into the United States Air Force.
        General McConville. The Army does not have the ability or data
    available to view prospects' family's military backgrounds. The Joint
    Advertising Market Research and Studies (JAMRS) surveys provide
    insights into recruiting, advertising and marketing trends. The JAMRS
    Spring 2014 Department of Defense New Recruit Survey of approximately
    8,000 Army recruits surveyed indicated: 26 percent had a father who
    served in the military, (16 percent in the Army only); 6 percent had a
    mother who served in the military, (4 percent in the Army only); 79
    percent had a parent, step parent, grandparent, sibling, cousin &/or
    aunt/uncle who served in the military, (59 percent in the Army only).
        Admiral Moran. A recent Joint Advertising Market & Research Studies
    (JAMRS) report reflects that 82 percent of Navy recruits have a family
    member who served in the military. While we have always focused
    recruiting efforts and resources across the population of the nation in
    search of the highest-quality talent within the eligible market space,
    a decline in the overall veteran population will create a tighter
    recruiting market in the future. We also expect the recruiting
    challenge to grow as the economy continues to improve and competition
    for the best and brightest becomes increasingly keen.
        General Brilakis. According to the Joint Advertising Market
    Research and Studies, 77 percent of new Marine Corps Recruits indicated
    that they have a family member who served; 22 percent indicated they
    had a parent who served. My own personal story is that I have served
    over 34 years in the Marine Corps. My father served two years in the
    Air Force at the end of the Korean War and my brother served five years
    in the Coast Guard. My wife served three years in the Army after she
    graduated college, and my daughter is currently serving as a Navy
    Corpsman in Sigonella, Sicily. While my family has a long history of
    service to the Nation, only I chose to make military service a career
    choice. I'm very proud of our collective service--especially as the son
    and grandson of immigrants.

        Senator King. So I am out of time, but I hope you could
    give me some response to those for the record. Thank you very
    much.
        Thank you, Mr. Chairman.
        Senator Graham. Senator Wicker?
        Senator Wicker. Well, thank you all for your service and
    your testimony.
        You know, Senator King's question about any changes that
    might need to be made early, maybe not mid-course, but early
    corrections that need to be made on this major change enacted
    last year--I think that is worth talking about. So let me start
    down here with Lieutenant General McConville. Has Senator King
    uncovered something that is a concern that needs to be worked
    out?
        General McConville. Well, Senator, I think there is a
    concern when I look at the new retirement program. It has great
    value in the fact that about 85 percent of our soldiers will
    get some type of retirement. What we worry about is our
    noncommissioned officers. The way the retirement works is you
    get 40 percent at 20 years. The way you make that up is by
    going along and saving in the thrift savings program. So for
    most folks, the way the math works out, if you max out your
    savings and put it in there and do what you want to do and get
    your continuation pay, you will probably be ahead at retirement
    age if you do that.
        But a lot of our young soldiers live paycheck to paycheck,
    and if they cannot start saving early, they are going to have a
    tough time staying with the force when they get to 20 to 25. We
    have some great noncommissioned officers who are serving 30 to
    32 years doing hard work, and we want to make sure that they
    have a good retirement when they get to that level.
        Senator Wicker. We will just go on down the line here.
        Admiral Moran. Yes, sir. Senator, there are several
    proposals that DOD has put forward that they would like to see
    modified. The one that is most important to me is the ability
    to force shape at the mid-career. So this continuation pay at
    12 years is locked right now at 12 years. I believe in the
    Navy, in particular with our growing high-tech skill
    requirements and our lower skill requirements, we need
    flexibility in that 12 years. Something from 8 to 14 might be
    more appropriate. But I can get you more detail on what we
    think would be best for the Navy. The other proposals are
    interesting, but I think the most important to me and the Navy
    is the ability to have flexibility in the 12-year continuation
    pay proposal.
        [The information referred to follows:]

        As we prepare to implement the Blended Retirement System (BRS) on
    January 1, 2018, the flexibility to offer Continuation Pay (CP)
    earlier, or later, than 12 years of service, as is currently specified
    in statute, would be critical to its efficacy as a force management
    tool. We would prefer that the statute offer sufficient flexibility for
    each Service to implement payment of CP as early as the 8-year point
    and, perhaps, as late as the 14-year point, as the force management
    needs of the individual Service dictate.
        Having the flexibility to adjust the timing of when CP is paid will
    provide an important tool for managing the required All-Volunteer Force
    profile with the proper mix of personnel in specific enlisted ratings
    and officer designators.

        Senator Wicker. General Brilakis?
        General Brilakis. Senator Wicker, thank you very much.
        I agree with Admiral Moran and General McConville. You
    know, we have not begun the retirement program. It begins the
    beginning of calendar year 2018. So we are still not sure
    exactly what we are going to get. We are not sure on the take
    rate because our young enlisted marines and officers will have
    the option of whether they opt into the TSP [Thrift Savings
    Plan]. They will have that 20-year retirement at a lower rate,
    but if you are going to come close to what the current 50
    percent retirement at 20 years provides, you have to start
    doing the savings. I think that goes to Jim's earlier comment
    with respect to the NCOs.
        On the continuation pay, we believe that we do need the
    flexibility because if we are having retention issues earlier,
    it would be one of those things that we can use to increase our
    retention.
        Senator Wicker. General Grasso, do you take serious issue
    with anything that has been said, or should we move along to
    another topic?
        General Grosso. Continuation pay. We would like to see
    matching up to 30 years of service, not stopping at 26 because
    we have a significant portion of our senior NCOs that serve
    that we need to stay in beyond 26 years.
        Senator Wicker. Let us see. Admiral Moran, on page 18 of
    your testimony, you talk about the drug abuse policy in the
    Navy is zero tolerance, detection, deterrence, and prevention.
    Then you also mentioned prescription drug abuse, wrongful
    prescription drugs. You have increased detections there. We are
    dealing with this issue right now on the floor of the Senate
    with regard to the general population.
        I will start with you and then ask if anybody else has any
    thoughts about that. Do you have any suggestions for us as we
    grapple with this issue society-wide that we might learn from
    what you have learned specifically in the Navy, sir?
        Admiral Moran. Senator, I really appreciate this question.
        The difficulty with this problem is that it is moving all
    the time. Prescription drugs or drugs that develop over time
    are moving at a pace that it is not your traditional illicit
    drugs that we are worried about so much, but it is some of the
    other ones that come along.
        On the prescription side, there are policies that we have
    had that we continue to have to educate our workforce about,
    that when an expiration of a prescription is complete, you are
    not allowed to continue to use that once or even a year later.
    I see these cases all the time. There is a misunderstanding,
    but there is also maybe some character issues with some of the
    folks. But most of it is just a lack of understanding on both
    the command side and the policy for the young sailors. So we
    are trying to educate our force better to make sure we can get
    our arms around this.
        Senator Wicker. You are working, obviously, with your
    medical corps on that.
        Admiral Moran. Absolutely. Yes, sir.
        Senator Wicker. Anyone else want to jump in in the limited
    time we have?
        [No response.]
        Senator Wicker. Thank you very much.
        Thank you, Mr. Chairman.
        Senator Graham. Anything else?
        Senator Wicker. Well, okay. Let me make one observation. I
    notice, Admiral Moran, you talk about diversity. I am certainly
    happy that you are involved in that. Religious diversity within
    the services.
        We have a concern, many of us, about basically tolerance
    for it is okay to be a Christian in the service. We see some
    evidence in some of the publications that come forward that
    there has been an overreaction on the part of supervisors for
    our military personnel simply displaying at their workplace an
    indication that they are Christians and that they feel
    seriously about that and making that statement from a personal
    standpoint.
        I will not ask you to respond, but I would just say I hope
    that we do not bend over backwards so far in the name of
    diversity that we start trampling on the First Amendment rights
    of our servicemembers at whatever level to express their belief
    in a certain religious doctrine and that we do not, in the name
    of diversity, or some opposition to or some concern that we
    might offend, that we do not overreact and start trampling on
    the rights of Christian service people to express themselves,
    just as we allow minority members to express themselves.
        Thank you for indulging me on that, Mr. Chair.
        Senator Graham. Senator Sullivan?
        Senator Sullivan. Thank you, Mr. Chair.
        I would like to follow up on what Senator King was talking
    about earlier, the end strength issues. In particular, General
    McConville, if you do not mind, I want to focus a little bit on
    the Army end strength.
        So the QDR [Quadrennal Defense Review] put an Army end
    strength at 450,000, and as you know, General Milley is taking
    a hard look at that, given the significant national security
    threats that we are seeing globally that certainly were not
    really as nearly apparent as Senator King mentioned when that
    number was initially put out there as a target.
        In the last 2 weeks--just 2 weeks--before this committee,
    we have had the PACOM [United States Pacific Command]
    commander, EUCOM [United States Europe Command] commander,
    CENTCOM [United States Central Command] commander, SOCOM
    [United States Special Operations Command] commander, commander
    of our Forces in Korea, AFRICOM [United States Africa Command]
    commander, all expressing concerns even today, this morning,
    three four-star Army generals at the pinnacle of their career
    on the 450,000 number as representing too high a risk for the
    country's national security. Do you agree with that assessment?
        General McConville. I am very concerned about 450,000. I am
    the Chief of Personnel, and I am supposed to man the force. I
    am manning the force right now at 482,000.
        Senator Sullivan. Are you stretched? Do you feel that you
    are stretched at 482,000?
        General McConville. At 482,000, we are able to meet
    requirements but we are stretched.
        Senator Sullivan. Do you see any of the threats and
    requirements due to those threats lessening in the next 6
    months or year or 2 years or maybe even increasing?
        General McConville. Well, if I knew, I am not sure, but I
    think we need to be ready for the threats to increase. That is
    the buffer we provide. You know, I said to the committee I
    commanded the 101st Airborne Division. I have been in this job
    19 months now. The 101st Airborne Division has deployed twice.
    It went to Liberia and they fought Ebola, and now they just
    took over in Iraq. So that is the OPTEMPO that our soldiers are
    seeing as we bring the force down. Again, we are at 482,000
    right now.
        Senator Sullivan. So what should we be doing? I believe
    there is bipartisan support on this committee to relook at and
    increase that number. Is that something this committee should
    be looking at, increasing the 450,000?
        General McConville. You have had a chance for General
    Milley to give you his assessment. He is doing posture hearings
    right now. I think the way ahead is for him to take a look at
    what we have, what the future looks like, do assessment, see if
    the conditions are going to change, then come back with a
    recommendation through the Secretary of Defense for where we
    should go on that.
        Senator Sullivan. How important do you think it is? It is
    one thing to have the Chief of Staff of the Army, other members
    of the Army talking about this. We know that sometimes services
    want to make sure there is significant Forces. But how
    important do you think it is that literally every combatant
    commander--every single combatant commander--regardless of
    branch of service, has come before this committee saying
    450,000 is going to be a too substantial risk to the Nation's
    security? Do you think that bolsters the case that the 450,000
    number is too low
        General McConville. Well, I think as we know, the combatant
    commanders are the ones who are going to execute the mission.
    They are taking a look at their requirements, and they are
    coming back and providing their best military advice, and that
    best military advice will come in at the Secretary of Defense
    level and they will decide how they want to best allocate the
    resources that we have.
        Senator Sullivan. Let me ask another question that relates.
    I know there was a discussion of some of the issues surrounding
    the Force of the Future, Mr. Carson's focus on this. This is
    just a general question. Do you see sometimes that the
    requirements from the Congress or sometimes the civilian
    leadership sometimes forget about the focus on warfighting?
        I am just mentioning that as someone who served in the
    Reserves and on Active Duty for over 2 decades. It always seems
    like there are new requirements that are coming from somewhere
    for our Forces to undertake in terms of training. In my
    experience, they rarely relate to the core focus of what we do
    in the military. In the Marine Corps infantry, it is close with
    and destroy the enemy.
        Do you sometimes worry--and I am just asking all four of
    you--that we get that balance out of kilter to the detriment of
    our readiness and training, particularly if they are mandates
    coming from Congress? Or do you think that right now the focus
    on training and the military's core mission, which is to defend
    the country, is still the priority that you are hearing from
    this committee or other Members of Congress or other civilian
    leaders?
        General Brilakis. Sir, I think it is a concern for all of
    us on a daily basis. I do not think there is any decision we
    make or any action that we make that is not focused wholly on
    readiness and implications on the force and how it affects us.
    The Force of the Future in specific in our interactions with
    OSD on the working groups and at the executive level--we have
    asked for flexibility.
        Senator Sullivan. Were you even consulted on a lot of those
    initiatives as the uniformed military leaders?
        General Brilakis. Sir, we participated in a set of working
    groups at the colonel and general officer level during the
    course of the Force of the Future development. We had the
    opportunity to make our concerns known. I for one maintained
    concerns in the cost, which is not readily apparent, whether it
    is cost in terms of opportunity cost, whether is in terms of
    cost of dollars, the amount of time that we have had to study
    some of these recommendations, et cetera.
        But I do believe that we will have the opportunity, having
    submitted some implementation plans already on some of the
    things the Secretary has already announced. The starting date
    for some of these is in the future, and we will have the
    opportunity to take a look at these and study them, to learn
    the costs.
        Most importantly I think to all of us was the flexibility
    in the recommendations that the services, based on mission,
    service culture, et cetera, had the ability to take a look at
    what applied to us, what did not apply based upon what we have
    done because, quite frankly, there are things that we do as a
    Marine Corps that the Air Force does not do right now. The
    Force of the Future wanted everybody to take a look at it.
        So there are actions and activities. I do not know the
    future costs. I do know the costs are out there, and I do know
    in this fiscal environment, those costs may supplant some of
    the other things that we are concerned about.
        Senator Sullivan. Any other thoughts on that? Thanks,
    General.
        General Grosso. Sir, I would just add that it is always
    about readiness today versus readiness tomorrow. So if you
    think about it, the airmen and soldiers and sailors and marines
    that we are bringing in today will be fighting more in 20 to 25
    years. So the Force of the Future actually synchronized
    relatively closely with the Human Capital Annex we wrote as
    part of our new master strategic plan in 2015. So I do think it
    is important--and General McConville mentioned this--that we
    modernize some of our personnel practices. The Force of the
    Future has helped us do some of that.
        Senator Sullivan. But not at the expense of the serious
    mission and training that is required by our military.
        General McConville. Yes, sir. What I see is it is a zero
    sum game. So we have got to be ready. We have got to be ready
    to fight now. In fact, we are fighting now. So it is not a
    question, you know, are we going to fight tomorrow. So we are
    going to fight now or we are going to fight tomorrow.
        But within the Force of the Future, there are some things
    that are worth the cost, and I would argue the integrated
    personnel and pay system, which is going to fundamentally
    change the way we can manage the total force--for the first
    time, we will have the total force, all three components, on
    one system. We will be able to actually manage the talent
    management of 1 million soldiers, and we will be able to meet
    the auditability requirements of the Congress all with this
    system. So when I look at that, that is something we absolutely
    want to do as we go forward.
        Admiral Moran. Senator, I agree with Jim--everybody here
    really--in terms of the value of the Force of the Future is it
    set tension in the system of trying to understand, on one hand,
    what should be mandated. On the other hand, where we all kind
    of camped out was give us discretionary authorities where we
    needed to manage our Forces. We are all different. Some are
    getting smaller. Some are getting bigger. We need different
    authorities at different points in time. So mandates do not
    necessarily help us.
        Consider TERA, or the Temporary Early Retirement Authority.
    Some of us have used it in the last 5 years. Others have not
    seen the need. It is nice to have the discretionary authority
    when you are trying to manage these Forces.
        To your original question, though, on the burden of
    training, I think we all enter that discussion and
    consideration that at the end of the day, some of this training
    is absolutely necessary so that Americans have confidence in
    their military. There are issues that we all deal with every
    day that we have to balance fiscally, but if we do not have the
    confidence of the American people--and we have tremendous
    confidence today. We want to keep it. So that training is
    foremost in our mind. Much of it comes from Congress, and there
    is a lot of it that we put on ourselves that we have gone back
    and looked at to try to reduce that burden on the fleet so we
    can get to your very good point about are we training to war-
    fight. We have been challenged by that over the last 10 years.
        Senator Sullivan. Thank you.
        Thank you, Mr. Chairman.
        Senator Graham. Any other questions of the panel? Yes?
        Senator Gillibrand. I am going to submit for the record a
    line of questioning about combat integration that I would like
    you to answer, and they are specific to each of the services.
    Thank you.
        Senator Sullivan. Mr. Chairman, I just had one other.
        Each of you mentioned in your testimony--and I apologize if
    we have already talked about this, but the initiatives that you
    are taking particularly with regard to mental health care for
    uniformed members transitioning out of the military. We are all
    on this panel very concerned, as I know all of you are, on the
    issue of suicide. Do you think that we are getting a handle on
    that issue? Do you think that we are reducing the stigma that
    relates to some of these mental health issues or issues that
    are kind of related like PTSD and other issues that can lead to
    suicide?
        General McConville. Well, Senator, this is something that
    is very important for the Army. We have really gone after this
    problem. So we have done some studies. We had MIT
    [Massachusetts Institute of Technology] do a study because the
    key thing about behavioral health issues is, when I look at it,
    people do not commit suicide. They die of suicide. People do
    not commit heart disease. They die of heart disease. So what we
    have to do is we have to make sure they get the care and they
    get it early on. If there is a stigma attached to it, they are
    not going to do it.
        We just had a study done by MIT from 2003 to today.
    Basically we have gone from 5 percent to 15 percent of our
    soldiers are using behavioral health care. We are also seeing a
    number of soldiers that have come into the Army with behavioral
    health challenges. That has gone down.
        The other thing that was really key for us was putting
    embedded behavioral health down at the brigade level. So it is
    near the point of need. You know, the stigma was before you had
    to go find it. You had to get to it. You had to try to get an
    appointment. By pushing it down to where our soldiers can get
    it early, that is when we get the best results. So it is early
    and it is near. That is what we want to do, and that is were we
    are going to get the best results.
        So we are starting to see some reductions. One suicide is
    still too many, but we are starting to see some trends in the
    right direction on that.
        Admiral Moran. Senator, this is immensely important to all
    of us. I think we are learning from each other as we go down
    this path. I am very keenly interested in what the Marine Corps
    is doing in their Marine Intercept program. They figured out
    that a lot of young men and women who have ideations ultimately
    do commit suicide. It has not always been well understood. We
    are beginning to see the data now that says we have got to pay
    a lot closer attention to those with ideations, in other words,
    stay with them much longer through the process, and you may
    have to stay with them forever to make sure that they feel like
    they are part of the team and not alone and isolated. That
    generally is where we are seeing the suicides occur in young
    males primarily in our service.
        General Brilakis. The issue of stigma, Senator--it is a
    great question. It is about talking to marines early and
    talking to them often. It is about discussing those elements
    and letting them know that any issue that they may have that
    comes up, we are dealing with youngsters whose maturity levels
    are developing, and their coping mechanisms are not necessarily
    fully developed. We put them in a hyper-pressurized
    environment. You never want to drive anybody into the shadows.
    You want to bring them out. Having that discussion, making them
    understand what it is that we can do, all the resources that
    are available, making them available in such a way that they
    are wearing the same uniform that those individuals are, that
    they are not wearing the same uniform, so depending upon who
    they feel they can reach out to is important.
        Admiral Moran mentioned the Marine Intercept program. One
    of those things that we developed with feedback from the
    marines, a program that once we identify an individual, whether
    it is through an ideation, whether it is through just an
    admission that things are rough, we put them into that program.
    We offer them the opportunity to involve the Marine Intercept
    program. They have the ability to opt out. About 80 percent of
    them accept the Marine Intercept program. We have 1,500 marines
    currently on it, and for those that are involved, they have
    accepted it, we have not to date seen one individual die from
    suicide. It is a grassroots effort, but it is a growing effort
    and we continue to work those issues hard because a suicide is
    a very complex problem, as you well know.
        General Grosso. We have just seen our suicide rates go up
    the last couple years, which is causing us great concern. We
    have taken a pause in how we are addressing it, and we have
    actually learned from our sister services on how we can get
    better at this. So we are putting a lot of resources back into
    understanding why is this happening and what can we do about
    it. That is when we decided to, again, put these prevention
    specialists at the installation level. We also need, we
    believe, just like our sister services, to put more resources
    down at the individual level on the installation to help
    people--make it easier for them to get help basically.
        Senator Sullivan. Thank you.
        Thank you, Mr. Chairman.
        Senator Graham. Anything else?
        [No response.]
        Senator Graham. Thank you all for your testimony.
        We have received testimony from these witnesses and others
    on these important topics in advance of today's hearing. I move
    that we include all written statements received by this
    subcommittee for today's hearing on the record. Without
    objection, so ordered.
        Senator Graham. Thank you all very much.
        The next panel, please.
        [Pause.]
        Senator Graham. Thank you to the second panel here. Now we
    will go ahead and get started with Ms. Roth-Douquet.
        Ms. Roth-Douquet. Douquet.
        Senator Graham. Douquet. I am sorry. Thank you.
        Ms. Roth-Douquet. Thank you. It is a difficult name.
        Senator Graham. No, a nice name.

    STATEMENT OF KATHY ROTH-DOUQUET, CHIEF EXECUTIVE OFFICER, BLUE
                             STAR FAMILIES

        Ms. Roth-Douquet. Senator Graham, Senator Gillibrand, I
    really appreciate you having us here today.
        I am Kathy Roth-Douquet, and I am CEO of Blue Star
    Families. Blue Star Families strengthens military families and
    our Nation by connecting communities and fostering leadership.
    It is the largest chapter-based military families serving
    nonprofit in the U.S. We serve 1.5 million military family
    members annually. We have 35 chapters at home and overseas. BSF
    [Blue Star Families] bridges the gap between our military
    family community and the general public. We have strong ties to
    all branches of services, including Guard and Reserve,
    transitioning veterans, wounded servicemembers and their
    families.
        We are nationally recognized for our annual Military Family
    Lifestyle Survey. It is the largest of its kind, and it
    provides both quantitative and qualitative data that reveals a
    snapshot of the current military force and their families and
    how they are experiencing service life. We conduct it annually.
    We release it with the House and Senate Military Family
    Caucuses, and it is used broadly by the White House, Congress,
    DOD, State and local officials, other nonprofits and
    foundations to help understand our current military family.
        I appreciate that you are focusing particularly on health
    here. We understand health for the military community to be
    broadly stated. It is both immediate issues of health care and
    those conditions that allow families to be healthy and
    resilient.
        Military families are central to the security of our
    Nation. We are doing something unprecedented. This is the first
    time in the history of civilization that such a small number of
    free people voluntarily patrol the globe and keep it safe for
    everyone. Those people have families and nobody should be made
    to choose between serving their country and making sure that
    their family is thriving. All of us care about our families,
    and we will not do work that hurts our families.
        Working to minimize the uncertainty and heightened
    lifestyle requirements that are associated with military
    service helps our Nation achieve current national priorities,
    including stable defense personnel costs, improved recruitment,
    retention and readiness, and a sustainable force.
        So our research suggests that servicemembers? top concern
    is for their family's well-being, and family well-being is the
    top consideration for whether a servicemember stays or leaves
    the force. While the military has adopted a number of reforms
    to support military families in the past few years, there are
    still many opportunities to do more.
        Since our first Military Family Lifestyle Survey in 2009,
    we have seen what it means for military family members to
    serve, and we looked at that blueprint for what it takes to
    strengthen America by supporting those families. Each year we
    emphasize two or three key areas of focus, and today I will
    focus on those areas that have been key for us in this 2015
    survey.
        Military caregivers. Thirty-two percent of the people
    taking our survey identified themselves as caregivers, whether
    they were serving for an aging parent, a child with special
    needs, or a wounded military servicemember. I think importantly
    many of those military family members who identified themselves
    as caregivers to a wounded servicemember did not necessarily
    have a wounded servicemember who identified themselves as
    wounded or was seeking treatment that way. I think many times
    the servicemember's spouse can identify symptoms of PTSD and
    TBI. That becomes a path to serving them that is not something
    that gets identified through formal identification from a
    servicemember.
        Caretaking is fulfilling but stressful. Seventy-five
    percent of the caregivers in our survey had no warning that
    they were going to become caregivers and therefore no training.
    They find that lack of training to be difficult in terms of
    allowing them to do their work.
        Another challenge is the difficulty in finding alternative
    caregivers to take over when they are unable to. More than half
    found that they had a very difficult or somewhat difficult time
    in finding respite.
        Military-connected caregivers not only provide direct care,
    including health care and health assistance, they do case
    management. They provide psychological support, and they
    provide legal and financial support. So they are very important
    to the well-being of the wounded.
        While care provided by military-connected caregivers
    promotes faster recovery for wounded warriors and saves
    millions of dollars in health care costs, most of those cost-
    savings are absorbed by the caregiver's social, legal, and
    economic costs. They are often unable to work, often have to
    leave their work in order to provide that caregiving.
        They themselves often experience health problems that come
    from being a caregiver, both mental health and physical health.
    Research indicates that the majority of caregivers report that
    their own health worsens due to caregiving, and the problems
    related to sleep, stress, pain, depression, and weight changes
    are further concerns.
        The problems associated with these consequences is that
    military-connected caregivers often have little, if any, time
    to prepare for becoming a caregiver and few widely and
    comprehensive training programs to help them to prepare. These
    are all issues that can be addressed and can be solved and can
    make things stronger for us.
        Military spouse employment is an area that we have
    identified as a key concern for military families. The majority
    of military families cannot field a two-income household as 75
    percent of most American families do. That leads to the
    economic insecurity that military families, including
    servicemembers, identify as their top concern related to
    military life. Although removed from warfighting, jobs for
    military spouses do make our military stronger. Many companies
    have created successful initiatives to hire veterans. We have
    an opportunity to provide this same level of support for hiring
    military spouses.
        Forty percent of respondents in our survey this past year
    identified military spouse unemployment as the top obstacle to
    their family's financial security. Only 45 percent of Active
    Duty military spouses were employed full- or part-time. Fifty-
    eight percent would like to be.
        Military lifestyle factors have the greatest impact on
    spouses' ability and preference to work. They move frequently,
    every 1, 2, and 3 years. They are often in remote locations.
    They have heightened caregiver responsibilities. It is
    important to note that military families with employed spouses
    report greater financial security, greater mental health, and
    most importantly for this committee, a higher satisfaction with
    the military lifestyle.
        Findings indicate that unemployment not only affects
    financial security but it also affects the health of military
    families. Sixty-eight percent of respondents who were not
    employed experienced stress from their financial situations.
    Fourty-five percent of unemployed military spouses reported
    symptoms of depression, and 7 percent had thought seriously
    about committing suicide. So we commend this issue for all of
    us to pay attention.
        To address these needs, we need to prioritize military
    spouse employment and education initiatives. We can increase
    coordinating efforts among public, private, and nonprofit
    sectors to promote high-quality, portable work-from-home
    positions for military spouses, and expand veteran and military
    spouse hiring and training initiatives so that both veterans
    and military spouses are included.
        Finally, the frequent moves and geographic separation from
    extended family members makes the need for child care
    especially acute within military families. Thirty-five percent
    in our last survey said that they did not have child care that
    met their needs. That is an enormous number. It is a major
    challenge for working spouses, those seeking work, and even
    those not in the labor force due to aspects of the military
    lifestyle like unpredictable work hours, frequent absences,
    deployments, and the inability to equitably share in child care
    responsibilities.
        Finally, I would like to just touch on behavioral issues.
    The unique demands of military service result in exceptional
    issues and challenges for servicemembers and their families.
    Top stressors for both Active Duty and their spouses included
    employment and work stress, deployments, financial and
    relocation issues. Fifty-two percent of military spouses say
    that isolation from family and friends are a key stressor.
    Mental health for Active Duty and veterans have been of
    national concern. It is also an issue for our military spouses.
    Services are available to Active Duty members and their
    families, but 17 percent of respondents did not use a program
    or benefit related to mental health care because they had
    concern about confidentiality and treatment.
        In addition, a major study by Eaton, et al. found that
    military spouses have similar rates of mental health problems
    to the soldiers themselves, and often display greater symptoms
    of depression and anxiety following separation from their
    spouses due to deployment. This study found that 12 percent of
    military spouses screen positive for major depression, and 17
    percent screen positive for generalized anxiety.
        As mentioned previously, military spouse unemployment
    raises stress levels for military spouses and their
    servicemember.
        We also found that mental health was a factor with
    caregivers. Fourty-four percent of caregivers responded they
    found caregiving somewhat stressful. Sixteen percent found it
    extremely stressful.
        Blue Star Families believes that military families are
    assets to both our national defense and local communities. They
    are central to the health and capability of the All-Volunteer
    Force and are good neighbors who actively engage in making
    their civilian communities great places to live.
        Service members may be employed by their respective
    services, but they work for all Americans. Thus, the
    responsibility for supporting military families is certainly
    the duty of the Department of Defense. However, a healthy
    Nation also shares in this responsibility. We believe there are
    many programs that would have no impact on the national budget
    that would greatly affect military families and DOD by allowing
    us to more actively partner. Nonprofit, private sector, and
    Government can help address many of these concerns.
        Thank you very much, Mr. Chairman.
        [The prepared statement of Ms. Roth-Douquet follows:]

                  Prepared Statement by Ms. Kathy Roth-Douquet
                               blue star families
        Chairman Graham, Ranking Member Gillibrand and other distinguished
    Members of the Subcommittee, thank you for the opportunity to appear
    before you today.
        I am Kathy Roth-Douquet and I am the CEO of Blue Star Families.
    Blue Star Families (BSF) strengthens military families and our nation
    by connecting communities and fostering leadership to millions of
    people. As the largest chapter--based nonprofit organization in the US,
    serving 1.5 million military family members annually, and with 35
    chapters at home and overseas, BSF bridges the gap between our military
    family community and the general public. With strong ties to all
    branches of service, Active Duty, veterans, and their families, BSF is
    nationally recognized for its annual Military Family Lifestyle Survey.
    The largest of its kind, the survey provides both quantitative and
    qualitative data that reveals a snapshot of the current state of the
    servicemembers and their families. Conducted annually, the Military
    Family Lifestyle Survey is used at all levels of Government to help
    inform and educate those tasked with making policy decisions that
    impact servicemembers and their families--who also serve.
           the importance of healthy & resilient military communities
        Military families are central to the security of our nation.
    Including military families as a level of analysis in defense
    considerations is not just the right thing to do--it's also the smart
    thing. Put another way, prioritizing quality of life for servicemembers
    and their families' benefits recruitment, retention, overall readiness,
    and will be crucial to shaping successful future force planning
    initiatives.
        Working to minimize the uncertainty and heightened lifestyle
    requirements that are associated with military service will also help
    our nation to achieve many current national priorities including:
    stable defense personnel costs; improved recruitment, retention and
    readiness; and a sustainable All-Volunteer Force.
        Research suggests that servicemembers' top concern is for their
    family's well-being and family well-being is top consideration in
    whether a service member stays or leaves the force. While the military
    has adopted a number of reforms to support military families in the
    past few years, there is still much more to be done.
                     key  priorities for military families
        Since 2009, Blue Star families has conducted the annual Military
    Family Lifestyle Survey which provides a comprehensive understanding of
    what it means to serve as a military family and is the blueprint for
    strengthening America by supporting military families. Each year, we
    emphasize two to three key areas of focus, based upon the current needs
    identified in that year's survey.
        Our key priorities for the coming year are based on areas of need
    identified in our 2015 survey. We feel improvement in these areas also
    has the greatest potential to reduce the trend of increasing
    uncertainty with the military lifestyle that was a top trend in our
    2015 survey.
        The areas we will be focusing on are:

          the caregiver population--whether that care is to wounded
    warriors, military kids with special needs, an aging parent of an
    Active Duty service member, or an Active Duty service member struggling
    with depression or another mental health issue
          unemployed or underemployed military spouses--military
    spouse unemployment sits around 25 percent and is a top obstacle to the
    financial security and successful retirement or transition planning for
    military families
          concerning rates of behavioral health issues among
    military spouses, for example a recent study found that 12 percent of
    military spouses screen positive for major depression and 17 percent
    screened positive for generalized anxiety, much greater than the rates
    in the general US population of around 6.7 percent and 3.1 percent
    respectively
                              military caregivers
        Our 2015 survey found that 32 percent of military family members
    identified themselves as a caregiver. A caregiver can be someone caring
    for an aging parent, a child with special needs, and/or a wounded
    military service member. While we recognize that caregiving can be
    fulfilling, it can be stressful, particularly if the caregiver lacks
    formal training, as was the case for 75 percent of caregivers who
    responded to our survey. Another challenge is difficulty finding an
    alternate caregiver to take over when they are unable to take on their
    caregiver duties --27 percent of caregivers found it very difficult and
    another 27 percent found it somewhat difficult.
        Military-connected caregivers perform a number of roles, including
    health and health care assistance, case management, psychological
    support, and legal/financial roles.
        While care provided by military-connected caregivers promotes
    faster recovery for wounded warriors and helps save millions of dollars
    in health care costs, much of the cost-savings are absorbed by the
    caregivers' social, legal, and economic costs, as well as costs
    associated with the health problems that they report from being a
    caregiver.
        Research indicates that the majority of caregivers have reported
    that their own health has worsened due to caregiving, with the problems
    related to sleep, stress, pain, depression, and weight changes.
        A big problem associated with these consequences is that military-
    connected caregivers often have very little, if any, time to prepare to
    become a caregiver AND few widely accessible and comprehensive training
    programs exist to help them prepare.
                           military spouse employment
        Many companies have created initiatives to hire veterans due to
    raised awareness about the employment and mental health challenges
    facing military personnel after their service. While we applaud these
    efforts, many fail to address the military family as a whole, often
    omitting military spouses, a major component of the military family.
        Military spouse employment remains a top concern for Active Duty
    military spouses. Forty percent of respondents to our 2015 annual
    Military Family Lifestyle Survey identified military spouse employment
    as a top obstacle to their family's financial security. Only 45 percent
    of Active Duty military spouses responded that they were employed full
    or part-time and of those who were not employed, 58 percent would like
    to be.
        Military lifestyle factors have greatest impact on military
    spouses' ability and preference to work. Seventy-five percent of Active
    Duty military spouses reported being a military spouse had a negative
    impact on their ability to pursue a career. The top three factors
    impacting military spouse employment included service member's job
    demands, frequent moves, and family obligations.
        It is important to note that military families with employed
    spouses reported greater financial security, better mental health, and
    higher satisfaction with the military lifestyle. Findings indicate that
    unemployment not only affects the financial security of military
    families, but their health as well. Sixty-eight percent of respondents
    who were not employed experienced stress from their current personal
    financial situation. Forty-five percent of unemployed military spouses
    reported symptoms of depression and seven percent had thought seriously
    about committing suicide.
        To address these military spouse employment needs, we need to
    prioritize military spouse employment and education initiatives.
    Increase coordinated efforts among the public, private, and nonprofit
    sectors to promote high-quality, portable or work-from-home positions
    for military spouses and expand veteran hiring and training initiatives
    to include military spouses.
        Another solution would be to explore the possibility reducing
    permanent changes of station for servicemembers and their families.
    Many of the challenges associated with spouse employment would be
    mitigated with less frequent moves.
        Finally, the frequent moves and geographic separation from extended
    family members also makes the need for childcare especially acute
    within military families. Childcare is a major challenge for working
    spouses, those seeking work, and even spouses not in the labor market
    whose spouses, due to aspects of the military lifestyle like
    unpredictable work hours, frequent absences, and deployments, are often
    unable to equitably share in childcare responsibilities. Increasing
    access to affordable, flexible, and high quality childcare will remain
    a top challenge and presents a substantial opportunity to provide
    additional military family support.
                            behavioral health issues
        The unique demands of military service result in exceptional issues
    and challenges for servicemembers and their families. The top stressors
    for both Active Duty and their spouses included employment/work stress;
    deployments, financial and relocation issues. In addition, 52 percent
    of military spouses found isolation from family and friends to be a key
    stressor.
        Mental health of our Active military and veterans has been of
    national concern. It is also an issue for our military spouses with
    seven percent of Active Duty spouses indicating they had seriously
    thought about committing suicide during their time associated with the
    military. Though services are available to Active military and their
    families, 17 percent of respondent did not use a program or benefit
    because they had concerns about confidentiality of treatment.
        In addition, Eaton, et al found that military spouses have similar
    rates of mental health problems to the soldiers themselves and often
    display greater symptoms of depression and anxiety following separation
    from their spouse due to deployment Their study found that 12 percent
    of military spouses screen positive for major depression and 17 percent
    screened positive for generalized anxiety.
    ---------------------------------------------------------------------------
        Eaton, et al. Prevalence of Mental Health Problems, Treatment Need,
    and Barriers to Care among Primary Care-Seeking Spouses of Military
    Service Members Involved in Iraq and Afghanistan Deployments. Military
    Medicine. 2008.
        AEaton, et al. Prevalence of Mental Health Problems, Treatment
    Need, and Barriers to Care among Primary Care-Seeking Spouses of
    Military Service Members Involved in Iraq and Afghanistan Deployments.
    Military Medicine. 2008.
    ---------------------------------------------------------------------------
        As mentioned previously, military spouse unemployment raises stress
    levels for military spouses and their service member. We also found
    that mental health was a factors with caregivers. Forty-four percent of
    caregivers responded that they found caregiving somewhat stressful
    while 16 percent found it extremely stressful.
                                   conclusion
        Blue Star Families believes that military families are assets to
    both our national defense and local communities. They are central to
    the health and capability of the All-Volunteer Force and are good
    neighbors actively engaged in making their civilian communities great
    places to live. Service members may be employed by their respective
    services--but they work for all Americans. Thus the responsibility for
    supporting military families is certainly a duty of the Department of
    Defense; however, a healthy nation also shares in this responsibility.
        Thank you very much, Mr. Chairman.

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Senator Graham. Ms. Raezer?

      STATEMENT OF JOYCE W. RAEZER, EXECUTIVE DIRECTOR, NATIONAL
                      MILITARY FAMILY ASSOCIATION

        Ms. Raezer. Thank you, Mr. Chairman, Ranking Member
    Gillibrand, Senator Blumenthal. I appreciate the opportunity to
    speak today on behalf of the National Military Family
    Association and the military families we serve about the fiscal
    year 2017 Defense Department budget proposals.
        Our statement submitted for the record addresses many of
    the issues covered by the budget proposals and others that we
    wish had been covered. I will confine my remarks right now, in
    the interest of time, to just two of those issues: pay and
    TRICARE reform.
        DOD officials like to highlight that their proposed 2017
    pay raise of 1.6 percent is the largest basic pay raise in 4
    years. But as you have noted, if this raise goes through, 2017
    will mark the fourth year in a row military pay raises have
    lagged behind the Employment Cost Index, the standard currently
    in law.
        In recent testimony before the House Military Construction
    and VA [Veterans Affairs] Appropriations Subcommittee, the
    military services senior enlisted advisors spoke of the damage
    to morale that is being done by budget-driven compensation
    cuts. These lower pay raises head the list of morale concerns
    for the enlisted advisors. We are very happy to hear that you
    also share their concerns.
        Although its primary mission is to ensure medical providers
    have the training and tools they need to keep our troops strong
    when in harm's way, the military health system also has an
    obligation to deliver high-quality care to military families,
    retirees, and their families and survivors. Too often families
    tell us DOD fails to meet this obligation.
        We surveyed more than 6,100 military spouses in December
    and January. Nearly 30 percent of those who use military
    treatment facilities reported they rarely or never get an acute
    care appointment within the 24-hour access standard.
        Any discussion of TRICARE reform must start with how DOD
    can fix the problems it knows exist regarding access, quality,
    and patient satisfaction. Unfortunately, DOD provides few
    details in its budget proposal on actual improvements to the
    value of TRICARE or how it will enhance medical readiness.
    Instead, it focuses first on how much military families should
    pay for their health care. What is presented as a comprehensive
    restructure is really just a repackaging of the current system
    at a higher cost to many families and with no expansion of
    networks or improved benefits. Continuing to recapture care in
    military hospitals already failing to provide timely
    appropriate access for current enrollees will neither improve
    patient satisfaction nor comprehensively address readiness
    needs. I look forward to the opportunity during the question
    and answer to share some of our recommendations about things we
    would like you to consider.
        To echo Ms. Roth-Douquet's comment about behavioral health
    needs, this is one area that the Department has not addressed
    in their budget, that increasing demand for behavioral health
    services. In that same survey of 6,100 military spouses, 40
    percent reported that they had looked for behavioral health
    care for themselves or someone in their family. The demand is
    outstripping the supply.
        So as you evaluate the Department's proposed budget, please
    consider how it will meet the needs of military families and
    add value to their quality of life and to the servicemembers'
    quality of service. Does this budget make a servicemember more
    ready to perform the mission? Does it make a mom feel that her
    sick child's health is a priority? Does it ease uncertainty?
    Does it ensure support will be available for a family during a
    deployment? Does it support a spouse eager for a career? Bottom
    line, does this budget keep our military families strong?
        Thank you for your support of military families.
        [The prepared statement of Ms. Raezer follows:]

                     Prepared Statement by Joyce W. Raezer
        The National Military Family Association (NMFA) is the leading
    nonprofit dedicated to serving the families who stand behind the
    uniform. Since 1969, NMFA has worked to strengthen and protect millions
    of families through its advocacy and programs. We provide spouse
    scholarships, camps for military kids, and retreats for families
    reconnecting after deployment and for the families of the wounded, ill,
    or injured. NMFA serves the families of the currently serving, retired,
    wounded or fallen members of the Army, Navy, Marine Corps, Air Force,
    Coast Guard, and Commissioned Corps of the USPHS [United States Public
    Health Service] and NOAA [National Oceanic and Atmospheric
    Administration].
        Association Volunteers in military communities worldwide provide a
    direct link between military families and the Association staff in the
    Nation's capital. These volunteers are our ``eyes and ears,'' bringing
    shared local concerns to national attention.
        The Association does not have or receive federal grants or
    contracts.
        Our website is: www.MilitaryFamily.org.
    Joyce Wessel Raezer, Executive Director
        Joyce became the Executive Director of the National Military Family
    Association in 2007. In that position, she leads the Association's
    programs and initiatives to meet the needs of the families of the seven
    uniformed services and promote improvements in their quality of life.
    She is frequently called on by Government officials, other
    organizations, and the press to share her expertise on the issues
    facing military families. She began her work with the Association in
    1995 as a Volunteer in the Government Relations Department and
    subsequently served in various staff positions, including Government
    Relations Director.
        Joyce has represented military families on several committees and
    task Forces for offices and agencies of the Department of Defense (DOD)
    and military services. Joyce has served on several committees of The
    Military Coalition, an organization of 32 military-related
    associations. She was co-chair of the Coalition's Personnel,
    Compensation, and Commissaries Committee from 2000 to 2007. In 1999 and
    2000, she served on a Congressionally-mandated Federal Advisory Panel
    on DOD Health Care Quality Initiatives. From June 1999 to June 2001,
    Joyce served on the first national Board of Directors for the Military
    Child Education Coalition. In 2004, she authored a chapter on
    ``Transforming Support to Military Families and Communities'' in a book
    published by the MIT Press, Filling the Ranks: Transforming the U.S.
    Military Personnel System.
        In 2006, Joyce received the Gettysburg College Distinguished Alumni
    Award. She was the 1997 recipient of the Association's Margaret Vinson
    Hallgren Award for her advocacy on behalf of military families. She
    also received the ``Champion for Children'' award from the Military
    Impacted Schools Association in 1998. In 2007, Military Spouse Magazine
    listed her on its Who's Who of Military Spouses. In 2012, she was
    honored as a Daily Point of Light by the Points of Light Foundation.
        A Maryland native, Joyce earned a B.A. [Bachelor of Arts] in
    History from Gettysburg College, and a M.A. [Master of Arts] in History
    from the University of Virginia. The spouse of an Army retiree, she is
    the mother of two adult children. She is a former teacher and served on
    the Fort Knox Community Schools Board of Education from 1993 to 1995.
    She was an active volunteer parent in her children's schools. She plays
    hand bells and sings in her church choir, the Northern Virginia
    Chorale, and the Ron Freeman Chorale.
                               executive summary
        The United States military is the most capable fighting force in
    the world. For more than a decade of war, servicemembers and their
    families never failed to answer the call, steadfastly sacrificing in
    order to protect our Nation. They made these sacrifices trusting that
    our Government would provide them with resources to keep them ready.
    Recent national fiscal challenges have left military families confused
    and concerned about whether the programs, resources, and benefits
    contributing to their strength, resilience, and readiness will remain
    available to support them and be flexible enough to address emerging
    needs. The Department of Defense (DOD) must provide the level of
    programs and resources to meet this standard. Sequestration weakens its
    ability to do so. Service members and their families have kept trust
    with America through 15 years of war with multiple deployments and
    separations. Unfortunately, that trust continues to be tested.
        The Administration's fiscal year 2017 (FY17) budget proposal will
    undermine military family readiness in fundamental ways, by cutting
    families' purchasing power and forcing them to bear more of their
    health care costs. At the same time, looming cuts mandated by
    sequestration threaten the programs and services they rely on for
    support. The National Military Family Association (NMFA) makes the
    recommendations in this statement in the name of supporting the
    readiness of military families and maintaining the effectiveness of the
    All-Volunteer Force. We ask the Nation to keep the trust with military
    families and not balance budget shortfalls from the pockets of those
    who serve.
    We ask Congress:
        As you evaluate the proposals submitted by DOD, consider the
    cumulative impact on military families' purchasing power and financial
    well-being, as well as the effects on the morale and readiness of the
    All-Volunteer Force now and in the future.
        Please:
          Reject budget proposals that threaten military family
    financial well-being as a way to save money for the Government.
          Keep military pay commensurate with service and aligned
    with private sector wages.
          Reject the fiscal year 2017 DOD health care proposal. It
    imposes higher fees without enhancing value to beneficiaries and puts
    more pressure on the direct care system--a system that frequently fails
    to fulfill the needs of its current users.
          Preserve the savings military families receive by
    shopping at the commissary and oppose any reform measures that would
    reduce the value of the benefit.
        We especially ask Congress to end sequestration, which places a
    disproportionate burden on our Nation's military to reduce the deficit.
        We also ask Congress to make improving and sustaining the programs
    and resources necessary to keep military families ready a national
    priority.
        We ask Congress to:
          Provide oversight to ensure DOD and the individual
    Services are supporting families of all components by meeting the
    standards for deployment support, reintegration, financial readiness,
    and family health. Fund appropriately at all levels.
          Expand paternity leave to 14 days and allow two weeks of
    adoption leave to both parents in dual-service families.
          Expand the opportunity for spouses to access transition
    information including face-to-face training and on-line training.
    Expand service member and family access to Military OneSource
    counseling and other assistance to one year post-separation.
          Facilitate easier paths to both licensure and employment
    for military spouses and veterans who are in the mental health field
    when they work with our servicemembers and their families. Include
    military spouses who enter the mental health profession in federal
    loan-forgiveness programs.
          Ensure adequate funding for military child care programs,
    including child care fee assistance programs. Improve access to
    installation-based child care and increase availability of part-time
    and hourly care.
          Ensure appropriate and timely funding of Impact Aid
    through the Department of Education (DoEd) and restore funds to the
    Impact Aid federal properties program.
          Continue to authorize DOD Impact Aid for schools
    educating large numbers of military children and restore full funding
    to Department of Defense Education Activity (DODEA) schools and the
    DODEA Grant Program.
          Bring the Extended Care Health Option (ECHO) benefits on
    par with State Medicaid waiver programs and extend ECHO eligibility for
    one year following separation.
          Ensure Family Advocacy programs are funded and resources
    appropriately to help families heal and aid in the prevention of child
    and domestic abuse.
          Correct inequities in Survivor benefits by eliminating
    the Dependency and Indemnity Compensation (DIC) offset to the Survivor
    Benefit Plan (SBP). Extend the Special Survivor Indemnity Allowance
    (SSIA) and ensure SBP annuities for reservists who die while performing
    inactive duty training are calculated using the same criteria as for
    members who die while on Active Duty.
          Exempt Special Compensation for Assistance with
    Activities of Daily Living (SCAADL) payments from income taxes and
    maintain the program, particularly the outreach to wounded warrior
    families.

        After 15 years of war, we continue to see the impact of repeated
    deployments and separations on our servicemembers and their families.
    We appreciate Congress' recognition of the service and sacrifice of
    these families. Your response through legislation to the ever-changing
    need for support has resulted in programs and policies that have helped
    sustain our families through these difficult times.
                     keeping the trust of military families
        After more than a decade of war, servicemembers and their families
    have heroically answered our nation's call to serve. Their sacrifice--
    of life, limb, and family--is offered selflessly, trusting in the
    steadfastness of our Government to provide for their readiness and the
    needs of their families.
        Many military families feel their sacrifices go unnoticed by a
    civilian society preoccupied with domestic concerns such as the economy
    and unemployment. Military families share those concerns. But they also
    feel the Nation is forgetting the price they alone have paid in 15 long
    years of war.
        Trust in Government is essential to the long term viability of the
    All-Volunteer Force. That trust is reinforced through the
    predictability, efficiency, and fairness of compensation and benefits.
    Since 2006, throughout the wars in Iraq and Afghanistan, the
    Administration has proposed various benefit ``reforms,'' mostly in
    health care, which would have increased the financial burden of those
    who have served. The changes proposed in the fiscal year 2017 (FY17)
    budget, coupled with the arbitrary reductions forced by sequestration,
    undermine the trust military families have in the Government's
    commitment to support the All-Volunteer Force over the long term. This
    is a price the Nation cannot afford to pay.
        Moreover, the Administration's proposals to cut pay increases,
    eliminate commissary savings, and increase health care costs pose
    significant risk to the financial well-being of military families.
    Congress must resist these changes.
    The Administration Budget Proposal: A Disaster for Military Family
            Pocketbooks
        The Administration's budget proposal has only added to the growing
    sense of frustration in the military community. Military families are
    financially savvy. They are doing the math and feel they are
    shouldering the burden for balancing the budget when they've shouldered
    the entire burden of the last 15 years of war.
                                   pay raise
        For the fourth year in a row, the Administration is proposing a pay
    increase (1.6 percent) below the level of private sector wage
    increases. Congress chose the Employment Cost Index (ECI) as the
    standard for Active Duty pay raises in order to recruit and retain the
    quality of servicemembers needed to sustain the All-Volunteer Force.
    What's changed?
        We ask Congress to keep military pay commensurate with service and
    aligned with private sector wage increases.
                         military health system reform
        We appreciate Congress has listened to beneficiary concerns
    regarding the Military Health System (MHS) and are gratified you want
    to make the MHS work better for all beneficiaries via military health
    care reform. We hope the changes Congress enacts will truly make a
    difference in military families' ability to access the right care, at
    the right time, and in the right place. Our families deserve no less.
        Given the widespread and clearly-stated interest in Congress for
    MHS Reform this year, our Association had hoped the Department of
    Defense (DOD) budget proposal would outline plans to improve
    beneficiary access, quality, safety, and the patient experience in
    addition to addressing fiscal sustainability and protecting the medical
    readiness of the force. Instead, DOD has once again rebranded the same
    old system, incorporated numerous fee increases, and deemed it new and
    improved.
        While we appreciate DOD's budget proposal has finally acknowledged
    several areas of deficiency within the MHS, simply cataloging the
    problems does not constitute institutional reform.
        We are also concerned the new fee structure is designed to drive
    more care into Military Treatment Facilities (MTFs), but there are no
    additional resources identified in the budget proposal to increase MTF
    capacity, improve access, enhance quality, ensure provider and service
    member medical readiness, or accurately measure DOD progress in meeting
    these goals. We fear this scenario will exacerbate current access and
    quality problems.
        On behalf of the military families we serve, we urge you to reject
    the fiscal year 2017 DOD health care proposal. It imposes higher fees
    without enhancing value to beneficiaries and we believe it will put
    more pressure on the direct care system_a system that frequently fails
    to fulfill the needs of its current users.
    Why MHS Reform is Essential
        Although its primary mission is military medical readiness, the MHS
    has an obligation to deliver a high quality health care benefit to
    military families, retirees and their families, and survivors. In too
    many instances, the MHS fails to fulfill this obligation.
        In our testimony submitted for the record for this Subcommittee's
    February 23, 2016 hearing on military health care reform, we outlined
    our concerns the MHS would continue to nibble around the edges with the
    idea of reform: raising fees, but failing to deliver meaningful
    improvements to the system. \1\ DOD's fiscal year 2017 budget proposal
    brings those fears to life by focusing on significant fee increases,
    particularly for retirees, while doing nothing substantive to improve
    health care delivery for military families.
    ---------------------------------------------------------------------------
        \1\ National Military Family Association Statement for the record,
    Personnel Subcommittee of the Senate Armed Services Committee, February
    23, 2017: http://www.militaryfamily.org/assets/pdfs/testimony/sasc-
    hearing-2-23-16.pdf
    ---------------------------------------------------------------------------
        The status quo is unacceptable. Raising out-of-pocket costs for
    care that is too often substandard or simply inaccessible is
    unthinkable.
        As you consider our feedback on DOD's health care proposal, please
    keep in mind the hurdles our military families regularly face when
    trying to obtain necessary health care:

            On January 6, 2016, I called for an appointment with my PCM for
            a routine well-woman exam and to discuss throat pain that had
            been plaguing me. No appointments were available for 30 days
            with my provider, so they scheduled me for January 19 with
            another provider.

            On the day of my appointment, I waited 90 minutes past my
            appointment time to see the doctor. It took 45 minutes for the
            nurse to take my history and vitals because she was interrupted
            no less than 12 times (I counted) by phone calls and leaving
            the room to find someone to screen her next patient.

            During my routine exam, the doctor found a lump and recommended
            an early diagnostic mammogram. I called the next day and
            scheduled my appointment for Tuesday, February 9, three weeks
            away. On Feb 9, I had the mammogram, which confirmed the mass
            and identified other areas of concern. I had an ultrasound that
            day and was told by the radiologist that I would need a biopsy.

            My referral for the biopsy was processed three days later on a
            Thursday evening. Since Friday was a training holiday and
            Monday was a federal holiday, I had to wait until Tuesday
            morning to call for my appointment. The PCM had suggested the
            biopsy should be done that week, but an appointment was not
            available until the first week of March and results would take
            another 5-10 days. I objected to this timeframe but, since the
            appointment was technically within 30 days from the date of the
            referral, it was considered acceptable--despite the fact that
            the issue had been identified a month prior and results would
            potentially take another two weeks. I requested a referral to a
            facility off-post to have the procedure done sooner and they
            declined to authorize that but offered me an appointment for
            four days earlier. So, now I wait.

            I consider myself aggressively informed and an outspoken
            advocate. My PCM has sacrificed his personal time for my care,
            calling me twice from the office after 8pm to discuss my
            results and follow up referrals. Yet, here I am, at the mercy
            of an over-worked and inefficient system. The care I need was
            available this week in a local civilian facility, but won't be
            authorized due to procedures and rules. Two months to identify
            a potentially life threatening condition is too long, but it's
            the best I have been able to do. (Military Spouse)

        This story illustrates the maddening inconsistency within the
    direct care system and the negative impact of TRICARE policy and MTF
    interpretations of that policy. On the one hand, this spouse has a
    dedicated medical provider and received immediate turnaround when her
    mammogram indicated an ultrasound was needed. On the other hand, office
    closures and inefficiencies created frustration and delay. Most
    significantly, TRICARE referral policy and the goal of recapturing care
    trumped the opinion of her medical provider and delayed her biopsy.
    Military families need a reliable patient centered health care system
    that consistently meets their needs.
        In late 2015, our Association fielded a survey of 6,148 military
    spouse scholarship applicants, a population that has consistently
    matched the overall demographics of currently-serving families. Nearly
    30 percent of respondents who use an MTF for primary care indicated
    they rarely or never get an acute appointment within the 24-hour access
    standard. This is consistent with findings from a health care survey
    fielded by the Military Officer Association of America (MOAA) in
    December 2015 in which 29 percent of Active Duty spouses reported they
    rarely or never get an acute care appointment within access standards.
        We ask Congress to consider the access, consistency of care, and
    quality issues our families face across the entire MHS--direct care and
    purchased care segments--when seeking care as you evaluate TRICARE
    reform proposals. We would also invite anyone proposing reform to
    detail how their proposals would correct the areas of concern addressed
    by the Department's own Military Health System Review conducted in
    2014. \2\ How does the fiscal year 2017 budget proposal address the
    challenge areas identified in the MHS Review? How will this proposal
    drive progress in meeting the action items identified by then-Secretary
    of Defense Chuck Hagel in his October 1, 2014 memorandum?
    ---------------------------------------------------------------------------
        \2\ Secretary of Defense Military Health System Review Final
    Report: http://www.health.mil/Military-Health-Topics/Access-Cost-
    Quality-and-Safety/MHS-Review
    ---------------------------------------------------------------------------
        We appreciate Congress has made TRICARE Reform a priority and trust
    reform efforts will focus on ensuring both the benefit and the system
    charged with delivering the benefit work better for military families.
    TRICARE Select/Choice: Nothing More than Rebranded TRICARE Prime/
            Standard
        At a time when there is widespread agreement the MHS must be
    reformed to better meet beneficiary needs, DOD has proposed nothing
    more than a rebranding of TRICARE Prime and Standard. The new TRICARE
    Select and TRICARE Choice options do nothing to improve the MHS for
    beneficiaries.
        In the budget overview, DOD contends TRICARE Select/Choice offers
    greater choice at a modestly higher cost. Building on that, in a
    February 21, 2016 DefenseNews interview \3\, Dr. Jonathan Woodson,
    Assistant Secretary of Defense for Health Affairs, stated:
    ---------------------------------------------------------------------------
        \3\ DefenseNews interview with Vago Muradian, 2/21/16: http://
    www.defensenews.com/videos/defense-news/tv/2016/02/21/80700472/

            ``In revising the plan, we listened to the beneficiaries.
            Beneficiaries want more choice. The preferred provider plan
            actually gives them the choice. They can go see the physicians
            they want when they want and it gives them much more latitude
            in self-managing their care. We also heard from beneficiaries
            that some wanted to be in this HMO-like managed care product.
            So that's what we did. We simplified all the varieties of
            programs we had into two. One, a preferred provider product
            which gives you self-managed abilities and great choice and the
    ---------------------------------------------------------------------------
            other is a managed care choice.''

        Although DOD and Dr. Woodson assert the new proposal provides
    beneficiaries with more choice, we fail to see how this is the case.
    Beneficiaries currently have a self-managed option called TRICARE
    Standard, which contains a PPO option called TRICARE Extra. Renaming
    TRICARE Standard as TRICARE Choice does nothing to increase options for
    beneficiaries.
        DOD's references to TRICARE Choice as a modern Preferred Provider
    Option (PPO) led us to hope expanded network coverage might be part of
    the proposal. However, when asked about expanded networks to ensure all
    beneficiaries have access to the PPO option, DOD stated networks will
    cover 85 percent of the population similar to current network
    coverage--yet again, no additional value to beneficiaries. Therefore,
    TRICARE Choice maintains the current options available under TRICARE
    Extra and TRICARE Standard. The only difference? Patients using a
    network provider under the PPO option of TRICARE Choice will pay a
    fixed co-payment instead of a reduced cost-share. Many patients will
    still have no option other than non-network providers, but will pay
    more for the privilege of using them because of the proposed
    ``participation fee'' for TRICARE Choice and the higher deductibles and
    catastrophic cap.
        Our Association is concerned that even though the proposed plan
    outlines no discernible benefit to military families in terms of access
    to care or quality, it will result in implementation costs to DOD. In
    fact, DOD estimates Managed Care Support Contractor contract changes
    and other start-up costs will be $57 million in fiscal year 2017.
    Acknowledging Problems 0 Fixing Problems
        We appreciate that DOD has reached out to beneficiary organizations
    and listened to our concerns, as evidenced by Dr. Woodson's numerous
    public statements and are gratified the fiscal year 2017 budget
    acknowledges the Department must commit to institutional health care
    reform and implement targeted solutions to solve the variety of issues
    facing beneficiaries. Unfortunately, the budget proposal does little
    more than list some MHS problem areas including:

          Direct Care access problems
          Lack of first call resolution
          Cumbersome referral process resulting in administrative
    burdens and delayed access to care
          Lack of seamless mobility for beneficiaries who move
    around the globe
          Failure to properly address pediatric care issues
        The proposal does not even acknowledge several additional areas
    where the MHS fails to meet beneficiary needs, including:
          Problems with Reserve Component coverage
          Failure to consistently issue referrals to TRICARE
    network providers when access standards cannot be met within the direct
    system
          Demand for behavioral health care that continues to
    outstrip supply in both direct and purchased care
          Variable quality and safety within the direct care system
          Inadequate medical case management services and Extended
    Care Health Option (ECHO) benefits for special needs families
          TRICARE coverage gaps, such as refusal to cover numerous
    lab developed tests, including noninvasive prenatal testing
          Customer service issues
          Inconsistent policy implementation at the MTF level

        We believe MHS Reform demands credible and detailed plans to
    address deficiencies within the system. These plans must be accompanied
    by robust and reliable metrics to monitor progress.
    New Fees and Fee Increases: The Primary Element of DOD Health Care
            ``Reform''
        We appreciate some elements of DOD's proposal adhere to key
    principles of military health care, including:

          Zero out-of-pocket costs for Active Duty Service Members
    (ADSMs)--nothing changes for ADSMs with DOD's proposal
          Minimal out-of-pocket cost option for Active Duty Family
    Members (ADFMs)
          Minimal out-of-pocket cost option for medically retired
    and their families and survivors--they are treated the same as ADFMs

        We also appreciate DOD has removed the ER misuse fee included in
    the fiscal year 2016 proposal. Given acute care appointment shortages
    at some MTFs, together with inconsistently applied referral policies
    for civilian urgent care, many TRICARE Prime families face situations
    where the ER is their only option for care. It would be inappropriate
    to penalize military families for seeking care in the ER given direct
    care access challenges.
    Active Duty Families_Fee Increase Specifics
        Given the extraordinary risks, sacrifices and stressors associated
    with military service, it is critical any MHS Reform efforts maintain a
    minimal out-of-pocket cost option for Active Duty families. No/low out-
    of-pocket costs facilitate access to health care and contribute to
    overall family readiness. They also serve to recognize the value of
    military service.
        We are gratified DOD's proposal offers a minimal out-of-pocket cost
    option for all Active Duty families. Past proposals have imposed out-
    of-pocket costs on families without access to an MTF. We appreciate DOD
    listened to our feedback and will allow remotely located Active Duty
    families to self-manage their care without incurring copays or
    deductibles.
        While we are pleased TRICARE Select maintains a no/low cost option
    for Active Duty families, we do have some concerns regarding fee
    changes for ADFMs.

          TRICARE Select vs. TRICARE Prime_Out-of-Network Care:
    With TRICARE Prime, families who must use out-of-network care do not
    incur out-of-pocket costs if they follow Prime's referral and
    authorization process. With TRICARE Select, there are deductibles and
    cost shares associated with all out-of-network care. TRICARE Prime
    families who rely on out-of-network providers could see significant
    out-of-pocket costs with the new plan. We fear these costs will
    disproportionately affect special needs families.
          TRICARE Choice vs. TRICARE Standard: Utilization data for
    TRICARE Standard, the current TRICARE Choice equivalent, suggest Active
    Duty family members who opt to self-manage use significantly more
    health care than the average Prime enrolled ADFM. \4\ This is
    consistent with anecdotal evidence suggesting that within the ADFM
    population, special needs families and those dealing with chronic
    health conditions are the most likely to opt for TRICARE Standard. They
    are willing to incur out-of-pocket costs to avoid barriers to care
    prevalent in TRICARE Prime policy and the direct care system. How will
    the TRICARE Choice fee structure impact TRICARE Standard ADFMs?
    ---------------------------------------------------------------------------
        \4\ Evaluation of the TRICARE Program fiscal year 2015.http://
    www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/
    Health-Care-Program-Evaluation/Annual-Evaluation-of-the-TRICARE-Program
    ---------------------------------------------------------------------------
            -  Network deductible is eliminated to encourage use of network
    versus non-network providers. For families with moderate utilization,
    this change will likely lower total out-of-pocket costs. However, for
    special needs families with high utilization, eliminating the
    deductible only serves to spread costs out over a longer time period.
    We support eliminating the network deductible, but it is important to
    recognize it will provide minimal benefit for many TRICARE Choice
    families.
            -  Out-of-network deductible is doubled. This will increase
    and/or accelerate out-of-pocket costs for those families who must rely
    on out-of-network care--most likely special needs families and those
    seeking behavioral health care (a known TRICARE network inadequacy
    issue.) Given that use of non-network providers is largely driven by
    inadequate network coverage, we believe it is inappropriate to double
    the out-of-network deductible.
            -  Catastrophic cap is increased by 50 percent. The
    catastrophic cap is designed to protect families from financial
    hardship. Many families already incur out-of-pocket costs in excess of
    the catastrophic cap since the cap does not apply to any amount non-
    participating providers may charge above the TRICARE maximum allowable
    amount. Additionally, we know many families make the switch to TRICARE
    Standard after encountering difficulties with the direct care system or
    the referral/authorization process. We fear raising the catastrophic
    cap 50 percent will trap some military families in an underperforming
    direct care system by presenting a financial barrier to switching to
    TRICARE Standard/Choice. This will disproportionately impact special
    needs families, those with chronic conditions, and families seeking
    ongoing behavioral health care.

    Retirees and Families_Fee Increase Specifics
        Career military service can present significant obstacles to long-
    term financial stability, including compromised spouse employment, the
    inability to grow equity in a primary residence, and the unavoidable
    midlife career change upon military retirement. Military retirement
    benefits, including low cost health care, enable career military
    members to serve 20+ years and achieve long-term financial stability in
    spite of those challenges. Robust retirement benefits also serve to
    recognize the extraordinary sacrifices associated with a military
    career. While we have always been willing to entertain modest fee
    increases for working-age retiree health care, we also believe fees
    must be contained to preserve the value of the retirement benefit.
        Under the fiscal year 2017 DOD proposal, retirees face fee
    increases in almost every area. TRICARE Prime/Select participation fees
    would be increased and the plan again proposes a new participation fee
    for TRICARE Standard/Choice beneficiaries. The annual catastrophic cap
    for retiree families would be increased to $4,000. Furthermore,
    participation fees would no longer accrue to the catastrophic cap,
    increasing potential total out-of-pocket costs. Of course, retiree
    families would also be subject to the doubled out-of-network
    deductible.
        TRICARE Standard/Choice families are hit particularly hard. TRICARE
    Standard Retiree families who hit the catastrophic cap (primarily
    special needs families and those facing chronic conditions, including
    behavioral health challenges) face a 63 percent increase in potential
    out-of-pocket costs due to the new participation fee and higher
    catastrophic cap. These fee increases are particularly objectionable as
    they are not accompanied by any improvement in the Standard/Choice
    option, not even an acknowledgement of areas needing such improvement.
        Another element resurrected in the fiscal year 2017 budget is an
    annual open enrollment period with payment of the participation fee.
    Retirees who fail to enroll during this time will forfeit coverage for
    the year, unless they can show they are eligible for enrollment due to
    a qualifying life event. While we understand DOD's rationale for
    seeking clarity on how many beneficiaries will use their TRICARE
    benefit in a given year, we believe existing historical data and trend
    analysis can provide this information without the cost of implementing
    an enrollment fee process that restricts access to the earned health
    care benefit. We oppose the institution of beneficiary fees for the
    Standard/Choice option while beneficiaries are still waiting for DOD to
    make needed improvements.
        Our Association also continues to oppose instituting a DOD TRICARE
    for Life participation fee. Our Medicare-eligible beneficiaries--
    retirees, some severely wounded medically-retired service-members, and
    surviving spouses--already pay a high price just to maintain their
    TRICARE benefit, at least $104.90 per month in Medicare Part B
    premiums. DOD should not impose additional costs on this population.
    NMFA Perspective on Fiscal Year 2017 Fee Increases
        Our Association rejects the notion military health care reform
    starts with the question: ``How much should military families pay for
    their health care?'' We believe the starting point for reform is a
    demonstrated ability to better meet beneficiary needs, together with a
    plan for continuous improvement and modernization of the health care
    benefit. Discussions about the appropriate level of out-of-pocket costs
    should follow, and those discussions should always be grounded in the
    principles of low/no cost health care for Active Duty families and
    retiree costs that reflect the extraordinary sacrifices associated with
    career military service and preserve the value of the retirement
    package.
        We contend the fiscal year 2017 proposed out-of-pocket cost
    increases are too high given DOD's health care proposal provides no
    corresponding increase in value for military families. What is the
    value equation for military families? We believe value equals access to
    timely and appropriate care + the quality of that care + the overall
    patient experience divided by the cost of that care. The budget
    proposal, by focusing primarily on the cost of care to the beneficiary
    fails to address known MHS problems such as access, quality, and the
    direct care patient experience. It does not even acknowledge TRICARE
    coverage issues such as the failure to cover emerging treatments and
    technologies or lack of coverage for alternative therapies (such as
    chiropractic.) It also does not acknowledge the costs incurred by many
    families, whether monetary or borne from the frustration experienced
    when trying to access quality care in an environment with inconsistent
    rules and procedures.
        Our Association also believes out-of-pocket fee increases must be
    used only to sustain or improve the health care benefit. We will not
    support fee increases that fund other DOD initiatives such as lump sum
    retirement payouts.
        Our Association is willing to consider modest out-of-pocket cost
    increases only if they correspond to enhanced value for beneficiaries
    and are used only to sustain or improve the military health care
    benefit.
    National Health Expenditures Index
        Over and above the cost increases specific to fiscal year 2017, the
    DOD proposal would inflate out-of-pocket costs annually by the National
    Health Expenditures (NHE) Per Capita Index. Although the only mention
    of the NHE Index occurs in the participation fee section of the fiscal
    year 2017 budget, senior Defense officials have clarified the Index
    would apply to all out-of-pocket costs including copays, deductibles,
    and catastrophic caps.
        For 2014-24, per capita health spending is projected to grow at an
    average rate of 4.9 percent. \5\ This far outstrips recent military
    retirement cost of living allowances (COLA) and MHS pending growth,
    which has leveled off in recent years. An index this high would reduce
    the overall value of the military retirement benefit as health care
    costs would outpace COLA. It also shifts the cost burden of the health
    care benefit from DOD to beneficiaries over time.
    ---------------------------------------------------------------------------
        \5\ NHE Fact Sheet: https://www.cms.gov/research-statistics-data-
    and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-
    fact-sheet.html
    ---------------------------------------------------------------------------
        Recognizing the fiscal environment meant some fee increases were
    inevitable, we did not oppose recent TRICARE pharmacy fee hikes. We now
    have a pharmacy benefit with copays that mirror those of many
    commercial plans. Our Association is concerned the DOD proposal sets us
    on a path to an overall health benefit, particularly for retirees, that
    is not sufficiently differentiated from civilian plans in terms of
    costs. That outcome is unacceptable.
        It is unrealistic to think military health care out-of-pocket costs
    will never change. We acknowledge it is preferable to increase some
    beneficiary fees slowly over time versus sporadically implementing
    larger increases, the rationale for which is not transparent to the
    beneficiary. Not only would a fee index be more predictable, but it
    would set clear beneficiary expectations for out-of-pocket costs. An
    ambiguously defined health care benefit, together with careless verbal
    promises, has led to feelings of disappointment and betrayal,
    particularly among military retirees. A clearly defined health care
    benefit is vital for the future of the All-Volunteer Force. Career
    military service must not become a buyer beware proposition.
        That said, we believe the NHE Per Capita Index--far higher than
    recent COLA or MHS spending growth rates--is too steep and will result
    in a health benefit with reduced value that does not adequately protect
    military families from health care related financial risk. Any
    mechanism for indexing fees must be designed to ensure out-of-pocket
    costs remain significantly lower than civilian plans. An index designed
    to shift the health care cost burden from DOD to retirees, such as the
    proposed NHE index, is unacceptable.
    Concerns Regarding Fiscal Year 2017 Health Care Recapture Strategy
        Changes in the TRICARE fee structure are designed to drive more
    patient care into the direct system. While we appreciate the need to
    better leverage the MHS's fixed facility and military medical personnel
    investments, we are concerned increased demand will exacerbate MTF
    appointment access problems.
        In Congressional testimony, Dr. Woodson has stated the fiscal year
    2017 proposal includes zero additional direct care resources to address
    increased demand for MTF services. Instead, DOD plans to handle the
    extra patient load by extracting efficiencies from the existing system
    via extended MTF hours on evenings and weekends and expanded use of
    technology including secure messaging, telehealth, and the Nurse Advice
    Line. We believe this plan is unrealistic and inadequate for addressing
    increased demand and believe all of these ``efficiencies'' will
    actually take resources to implement. We have the following concerns:

            Secure Messaging and the Nurse Advice Line (NAL) are
    already in place and do not appear to have had much impact on
    beneficiary appointment access challenges. In fact, DOD has failed to
    address known billing problems related to NAL authorized urgent care,
    leading to growing distrust of the NAL within the military family
    community. DOD must provide specifics on how they will better leverage
    these technologies to free up additional capacity within the direct
    care system. Simply hoping or planning that increased Secure Messaging
    and NAL use will lead to greater efficiencies is not an acceptable
    solution to the inevitable influx of MTF patients under the fiscal year
    2017 proposal.
            While we are optimistic about the possibilities
    surrounding telehealth, we are skeptical DOD will have a comprehensive
    telehealth platform up and running by the projected TRICARE Choice/
    Select launch date of January 2018. We are even more skeptical that a
    newly introduced telehealth system will immediately be able to absorb
    enough clinical care to address the increased demand resulting from
    DOD's proposed TRICARE Select/Choice fee structure.
            Readiness requirements limit the availability of
    military medical personnel for beneficiary health care delivery. We are
    not convinced DOD has a full understanding of MTF capacity for
    beneficiary care given the readiness requirements demanded of military
    medical staff. Our concern is increased beneficiary demand will lead to
    either greater access problems or compromised military medical
    readiness.

        Not only has DOD proposed an unrealistic and inadequate plan to
    address increased demand posed by the fiscal year 2017 proposal, we are
    not convinced DOD has the ability to measure MTF capacity for
    beneficiary care, demand for MTF services, or MTF performance against
    appointment access standards. In a recent meeting with leadership from
    DHA and the Services' medical commands, it became clear DOD continues
    to use the same flawed measure to evaluate beneficiary access to acute
    appointments that was discredited during the 2014 MHS Review. This
    misleading measure reports the percent of acute appointments scheduled
    within access standards but does not track suppressed demand or those
    beneficiaries who are directed to the NAL, civilian urgent care, or the
    ER. To successfully transition significantly more care into the MTFs,
    it will be vital to quantify additional demand and pinpoint areas where
    beneficiary needs are not being met so adjustments can be made. Without
    proper metrics, it will be impossible to monitor progress against MHS
    Reform goals for improving access, quality, safety, and the patient
    experience.
    Health Care Final Thoughts
        Our Association urges you to reject not only the specifics
    contained in the fiscal year 2017 budget proposal, but also DOD's
    approach to MHS Reform. We strongly believe MHS Reform starts with
    tangible improvements to access, quality, safety, and the patient
    experience. We realize costs will also be a key component of reform and
    trust you will ensure they reflect the value of military service.
        The military is a uniquely demanding profession. The combination of
    risk to personal safety, frequent geographic relocations, and lengthy
    family separations is unmatched in the civilian sector. While no
    financial compensation can fully offset the sacrifices made by
    servicemembers and their families, it is imperative the compensation
    and benefits package--including Active Duty and retiree military health
    care benefits--reflect the costs of service.
        We appreciate that recent MHS Reform proposals, including DOD's
    fiscal year 2017 budget and the Military Compensation and Retirement
    Modernization Commission (MCRMC) proposal, adhere to the principle of
    no/low cost care for Active Duty family members. A robust health care
    benefit alleviates barriers to health care, enhances family readiness,
    and allows families to endure the many sacrifices associated with
    military life. We hope as Congress considers reforms you will maintain
    this aspect of the system--it is working and it is essential.
        As you deliberate on the appropriate fee levels for working-age
    retirees, we encourage you to consider the cumulative effects of a
    military career. Under the best of circumstances, career servicemembers
    and their families endure risk, upheaval and sacrifice on a scale that
    is unimaginable to many civilians. Those currently approaching
    retirement eligibility have served the greater part of their careers
    during wartime--a time characterized by relentlessly high operational
    tempo, multiple combat deployments, and tumultuous unpredictability.
    For nearly 15 years, our servicemembers and their families have done
    everything that was asked of them, often at great expense to their
    family relationships and stability and physical and mental health. It's
    not over yet. Young servicemembers currently contemplating their
    futures do so with the understanding global threats persist and
    extraordinary wartime sacrifices and uncertainty will be part and
    parcel of a military career for the foreseeable future. For those who
    endure for 20+ years, we contend the appropriate out-of-pocket costs
    for retiree health care not just be billed as ``a discount off the
    comparable civilian equivalent.''
                                   commissary
        Military families consistently tell us the commissary is one of
    their most valued benefits. The savings military families realize by
    shopping at the commissary is a vital non-pay benefit essential to many
    families' financial well-being, particularly junior families, and those
    stationed overseas or in remote locations. Our Association is grateful
    Congress recognized the importance of this benefit to military families
    and rejected funding cuts included in the Administration's fiscal year
    2016 budget proposal.
        In December 2015, DOD released a fact sheet outlining plans to
    ``optimize'' commissary operations. We were pleased to see in this fact
    sheet both an acknowledgement of the importance of the commissary
    benefit and a commitment to preserving the value of the benefit for
    military families. However, we have concerns about how the Department's
    plans will be put into practice and how military families will be
    affected by efforts to optimize commissary operations. This is
    especially true in light of the Administration's fiscal year 2017
    budget, which proposes a $200 million reduction in commissary
    appropriations. We would like information about how DOD intends to make
    those cuts and what impact, if any, the cuts will have on store
    operations.
        Specifically, we ask Congress to require DOD to provide answers to
    the following questions:

            How does the Department intend to measure the benefits
    of the commissary system as currently constructed, and what metrics
    will it use to ensure any changes do not lead to a reduction in those
    benefits?
            How will the Department implement price flexibility
    while ensuring families continue to receive the full value of the
    commissary benefit?

        The fiscal year 2016 NDAA authorized DOD to establish pilot
    programs that would evaluate the feasibility of various changes to
    commissary operations, including privatizing part or all of the system.
    We thank Congress for its emphasis on preserving savings for military
    families in this provision. However, we note the military resale system
    is highly interdependent; changes to one element of the system may have
    unintended consequences that will affect other parts. For example, if
    one or more high volume store is privatized will the Defense Commissary
    Agency (DeCA) still benefit from economies of scale that allow vendors
    to sell goods at low cost? What would removing those high volume stores
    from the system mean for smaller stores or those in remote locations?
    We urge Congress to carefully consider the effect any change in
    commissary operations will have on military families--particularly, the
    risk the savings they enjoy by shopping at the commissary will be
    reduced or lost.
                           military retirement system
        We appreciate Congress' efforts in the fiscal year 2016 NDAA to
    create a military retirement system that will allow more servicemembers
    to accumulate retirement savings while preserving the defined benefit
    for those who serve a full career. We also support those proposals in
    the fiscal year 2017 budget that would enhance the retirement plan and
    increase its value for servicemembers.
        We ask Congress to increase the maximum level of matched
    contributions to servicemembers' Thrift Savings Plan (TSP) accounts to
    5 percent--the level recommended by the MCRMC. Because the match is
    based on servicemembers' basic pay, rather than total compensation,
    servicemembers should have the option of a higher match in order to
    maximize their retirement savings. We also ask Congress to extend the
    Government match for the full career of the service member, rather than
    ending it at 26 years of service.
        We oppose the Department's proposal to delay matching contributions
    until the service member has completed four years of service. In order
    for servicemembers to maximize the value of the new plan, they must be
    incentivized to begin saving early in their career. Without the
    incentive of a Government match, some servicemembers may delay their
    retirement savings, leading to a greatly diminished benefit in the long
    term.
        Finally, we note on January 1, 2018 servicemembers with less than
    12 years of service will be given the choice of opting in to the new
    retirement system or staying in the old one--a momentous decision with
    the potential for significant financial ramifications. It is incumbent
    upon the Department to ensure these young servicemembers--and their
    spouses--are given the tools and resources they need to make this
    decision. In the view of our Association, online training is not
    sufficient. Service members and spouses require in-person training and
    guidance to answer their questions and ensure they make the best choice
    for their long-term financial well-being. We ask Congress to direct DOD
    to provide additional details on its plan to educate servicemembers and
    their spouses on the new retirement system.
        We ask Congress to increase the maximum level of matched
    contributions to servicemembers' TSP accounts to 5 percent and reject
    DOD's proposal to delay matching contributions until the service member
    completes four year of service.
        We also ask Congress to direct DOD to provide details on its plan
    to educate servicemembers and their spouses on the new retirement
    system.
     cumulative effects of cuts threaten military families' financial well-
                                     being
        The Administration's fiscal year 2017 budget proposal does not
    consider the cumulative effects of a reduced pay raise combined with
    lower BAH payments, loss of commissary savings, and possible out-of-
    pocket health care costs on the purchasing power of servicemembers and
    their families. This budget proposal would reduce cash in a service
    member's pocket!
        We ask Congress to reject budget proposals that threaten military
    family financial well-being as a way to save.
              sequestration: an ongoing threat to family readiness
        The effects of sequestration have already resulted in cuts to
    benefits and programs military families utilize to maintain their
    readiness. Much of the funding for these programs is embedded in the
    Service Operations and Maintenance Accounts, which have been the
    hardest-hit by sequestration. Understanding what is affected by
    sequestration has been confusing for families.
        The total effect of sequestration on military families in unclear.
    What is clear is that military families do not deserve having to deal
    with such uncertainty--uncertainty of the availability of programs they
    rely on, uncertainty of whether their service member will receive the
    training they need to do their job safely, the uncertainty of not
    knowing what new cost they will be asked to absorb from their own
    pockets.
        While the Bipartisan Budget Act of 2015 has provided some relief
    for fiscal year 2016 and fiscal year 2017, we know with future cuts
    required down the road, military families will continue to see threats
    to the programs and resources they require for readiness.
        We ask Congress to end sequestration and end the threat to the
    resources military families depend on for their readiness.
      building the force of the future: what do today's military families
                                     need?
        It has often been said while the military recruits a service
    member, it must retain a family. Our Association has long argued in
    order to build and maintain the quality force our Nation demands, the
    military must support servicemembers as they balance the competing
    demands of military service and family life. Thus, we were gratified to
    see significant family-focused proposals included in Defense Secretary
    Ashton Carter's recent Force of the Future initiative. However, while
    the Force of the Future initiatives, if implemented, can be an
    important first step in easing the strain faced by many servicemembers
    and their families, we urge Congress to continue to strengthen the
    programs and services available to support all troops and families in
    diminishing uncertainty and meeting the daily challenges of military
    life.
                    maternity, paternity and adoption leave
        We commend Secretary Carter for providing 12 weeks of maternity
    leave for new mothers in every branch of service. While this does
    unfortunately represent a reduction from the 18 weeks previously
    available to women in the Navy and Marine Corps, we agree with the
    Secretary this is a benefit that should be standard across the
    services. Increasing maternity leave from six weeks, as was previously
    the case in the Army and Air Force, will allow new mothers to recover
    physically and bond with their newborns before resuming their demanding
    jobs.
        We also applaud the Secretary for recognizing the need for new
    fathers and adoptive parents to spend time with their children.
        We ask Congress to act on the Secretary's proposal to expand
    paternity leave to 14 days and to allow two weeks of adoption leave to
    both parents in dual-service families.
                                   child care
        According to the 2014 Demographics Profile of the Military
    Community, more than 40 percent of servicemembers have children. Of the
    nearly two million military-connected children, the largest cohort--
    almost 38 percent--is under age five. \6\ Thus, it is not surprising
    access to high-quality, affordable child care ranks among the top
    concerns for military families. Like all working parents,
    servicemembers with young children need access to affordable child care
    in order to do their jobs. However, the military lifestyle comes with
    unique challenges and complications for families. Service members
    rarely live near extended family who might be able to assist with child
    care. Their jobs frequently demand long hours, including duty
    overnight. They are often stationed in communities where child care is
    expensive or unavailable.
    ---------------------------------------------------------------------------
        \6\ 2014 Demographics Profile of the Military Community. Rep.
    Office of the Deputy Assistant Secretary of Defense (Military Community
    and Family Policy), http://download. military onesource.mil/12038/MOS/
    Reports/2014-Demographics-Report.pdf
    ---------------------------------------------------------------------------
        We are gratified in recent years DOD has made child care a priority
    and has taken steps to improve families' access to child care. We were
    also pleased to see child care provisions such as expanded hours for
    installation child development centers (CDCs) included in the Force of
    the Future initiatives. However, while expanded CDC hours will address
    the needs of some military families, we urge Congress and the
    Department to consider additional steps in order to meet the needs of
    military families with young children.

            Improve access to installation-based care: For families
    living on or near a military installation, on-base CDCs are often the
    preferred choice for child care, offering a convenient location and
    high quality care at an affordable price. However, in some locations
    demand for spots at installation CDCs far outstrips supply. In many
    places the waiting list is so long the CDC is effectively not an option
    for military families. The problem is exacerbated by the frequent moves
    associated with military life. Following each PCS move, a military
    family must restart the process of looking for care in their new
    community and frequently find themselves again at the bottom of the
    waiting list. In some locations, the issue is lack of physical
    capacity. However, there are other obstacles hindering military
    families' access to care. DOD could alleviate some of the shortage of
    on-installation child care spots by addressing the following issues:
            -  Staffing: In some locations the reason for the insufficient
    supply of on-base care is not a lack of space; it is a lack of staff.
    The process of hiring CDC personnel is lengthy and arduous. It can be
    difficult for CDC directors to find, hire, and put into place qualified
    staff. This limits the number of children a facility can serve. DOD
    should analyze whether and how the hiring process can be streamlined
    while still ensuring that necessary background checks and training take
    place to ensure children's safety. We also endorse the recommendation
    made by the MCRMC that child care workers be exempt from furloughs and
    hiring freezes. Budget cuts should not prevent CDC directors from
    staffing their facilities appropriately.
            -  Wait list management: Typically, each CDC handles its own
    application process and waiting list, so families often must visit
    multiple facilities and submit applications for each hoping a spot
    becomes available. This process adds to families' frustration. We are
    hopeful the rollout of MilitaryChildCare.com to installations worldwide
    will alleviate this issue. MilitaryChildCare.com is DOD's website that
    allows parents to view all installation-based child care options at
    their location and request a spot for their child. We are told the site
    will provide greater visibility of waiting lists, so parents know how
    long they will have to wait for care and the services can determine
    whether access standards are being met. The site is currently utilized
    at selected installations, but is scheduled to be available worldwide
    later this year.
            -  Priority standards: DOD regulations give equal priority for
    child care spots to military families and DOD civilians. While DOD
    civilians also need access to quality, affordable child care, this
    policy puts military families at a disadvantage due to their frequent
    military-ordered moves. Each PCS move puts a military family at the
    bottom of the waiting list for child care. We urge you to ask DOD to
    assess usage of CDCs by DOD civilians and review child care wait list
    priority policies to ensure parity for mobile military families.
            Reinstate the authority to use Operation and
    Maintenance funds to construct child development centers: Prior to
    2009, DOD was given temporary authority to bypass the normal military
    construction approval process and use Operation and Maintenance (O&M)
    funds to construct CDCs. Under this authority, the services were able
    to respond quickly to the growing demand for child care and completed
    construction and renovation projects that allowed them to serve an
    additional 9,000 children. This authority lapsed in 2009. In its
    January 2015 report, the MCRMC recommended this authority be
    reinstated. We agree with the Commission's recommendation.
            Increase participation in the child care fee assistance
    program: The fee assistance program operated by the services is an
    innovative, effective approach to the problem of insufficient child
    care availability on base. The program helps offset the cost of child
    care in the civilian community, ensuring participating families can
    access high quality care at an affordable cost. Despite recent well-
    publicized issues with the Army's program, participating families
    overall report a high level of satisfaction with the program. However,
    relatively few families are able to take advantage of this benefit.
    Expanding participation in the child care fee assistance program would
    address many families' child care needs. We recommend the following
    steps:
            --  Increase number of eligible providers: DOD has stringent
    requirements for child care providers participating in the fee
    assistance program, to include national certification, regular
    inspections, and background checks. However, many states have less
    stringent requirements for providers. In those locations, families
    often have difficulty locating a provider who meets DOD's eligibility
    requirements. The Office of Military Community and Family Policy and
    the Defense State Liaison Office (DSLO) have worked together to
    encourage states to increase their standards to meet DOD's and have had
    a great deal of success in this regard. We encourage them to continue
    with this effort.
            --  Standardize Service requirements: Because the fee
    assistance programs are operated by the individual Services, there are
    variations in eligibility requirements for providers and families. Some
    Services require families live a certain distance from an installation
    in order to participate in the program; others have no geographic
    restrictions. The Marine Corps requires providers to have a specific
    national certification that is not required by the other Services.
    These differences lead to confusion and frustration among families. We
    ask you to direct DOD to review Services' fee assistance programs with
    the goal of standardizing eligibility requirements.
            --  Raise awareness of the program among military families: We
    consistently encounter families who have no idea the fee assistance
    program exists. From our experience, it would seem most families learn
    about the program through word of mouth from other military families.
    If families are not aware of the fee assistance program and cannot
    obtain care on base they may be forced to seek out less than optimal
    caregivers who provide care at a lower cost. DOD must ensure the
    Services are providing information about the fee assistance program to
    eligible families to ensure military children are receiving quality
    care.
            Increase availability of part-time and hourly care:
    Although the focus of the installation child care program is
    understandably on meeting the needs of military families with two
    working parents, many families also tell us of the importance of hourly
    or drop-in care. Many military families--especially those overseas or
    in remote locations--do not have easy access to reliable caregivers.
    For those families, access to drop-in care at an installation child
    care facility can greatly enhance their quality of life, enabling
    parents to go to medical appointments, run errands, and volunteer in
    their communities. This service can be especially vital when the
    service member is deployed, providing the at-home parent with a much
    needed break. We hear from families in many locations budget cuts have
    led CDCs to reduce or eliminate drop-in care. DOD should evaluate the
    programs at installation CDCs to ensure the mix of care offered--full-
    time, part-time and hourly--meets the needs of the families they serve.
                         military children's education
        Our Association has long argued DOD has a responsibility to support
    the schools charged with educating military-connected children, to help
    ensure military kids receive the best possible education. Military
    families often have no control over when and where they move. They
    worry about the effect multiple moves to locations with varying
    standards and curricula will have on their children's academic
    achievement. We urge Congress to continue funding programs designed to
    support the education of military-connected children.
    Impact Aid
        We appreciate the inclusion of $30 million for DOD Impact Aid in
    the fiscal year 2016 NDAA. We ask Congress to continue this funding to
    offset the costs incurred by districts educating large numbers of
    military children. These funds help local school districts meet the
    education needs of military children in an era of declining state
    budgets. Our Association has long believed both DOD and Department of
    Education Impact Aid funding are critical to ensuring school districts
    can provide quality education for military children.
    Department of Defense Education Activity Grant Program
        The John Warner National Defense Authorization Act for fiscal year
    2007 established a grant program, administered by the Department of
    Defense Education Activity (DODEA), to support public schools educating
    large numbers of military children. This innovative program allows DOD
    to offer tangible support to public schools charged with educating
    military-connected students. Schools and school districts are able to
    identify areas of need among the military children they serve and
    design programs to meet those needs. The grants have been used to bring
    Advanced Placement (AP) courses to high schools that would otherwise
    not be able to provide this level of instruction. Other grants have
    been used to fund special education, foreign language instruction, and
    programs to enhance students' education in reading, science, and math.
        Since 2009 this program has awarded nearly $400 million in grants
    to over 180 military-connected school districts. These three-year
    projects have supported nearly 500,000 military-connected students in
    2,200 schools. However, this valuable program will sunset at the end of
    fiscal year 2016 absent Congressional action. It would be regrettable
    if military children lose access to the valuable educational programs
    that have been made possible through the DODEA grant program. A
    relatively small investment can make a huge impact at the local level.
    We ask Congress to reauthorize the DODEA grant program and allow DOD to
    continue supporting military-connected children in public schools.
                    spouse employment and education support
        Spouse employment and education support is a critical component of
    military family readiness. Much like their civilian counterparts, many
    military families rely on two incomes in order to help make ends meet.
    However, military spouses face barriers hindering their educational
    pursuits and career progression due in large part to challenges
    associated with the military lifestyle.
        We are gratified in recent years Congress, DOD, the White House,
    and States have all taken steps to lessen the burden of an Active Duty
    member's military career on military spouses' educational and career
    ambitions. We fully support these initiatives including DOD's portfolio
    of Spouse Education and Career Opportunities (SECO), which includes
    educational funding for select military spouses, career counseling,
    employment support, and the DOD State Liaison Office's (DSLO) state-
    level initiatives. However, while progress has been made, military
    spouses continue to face significantly lower earnings and higher levels
    of unemployment and underemployment than their civilian counterparts
    greatly impacting their families' financial stability. \7\
    ---------------------------------------------------------------------------
        \7\ Institute for Veterans and Military Families, Military Spouse
    Employment Report, Syracuse University (IVMF) February 2014: http://
    vets.syr.edu/wp-content/uploads/2014/02/
    MilitarySpouseEmploymentReport--2013.pdf
    ---------------------------------------------------------------------------
    Grow our Own
        One of our top legislative priorities is to ensure adequate access
    to behavioral health providers who are attuned to the unique stressors
    of military life for servicemembers and their families who have endured
    years of repeated deployments, long separations, and possible injuries
    or illnesses. We support efforts to educate and employ military spouses
    as mental health professionals.
        As military families struggle to cope with the effects of 15 years
    of war, we are seeing an increasing demand for mental health services
    within our families and community. Since 2004, NMFA's military spouse
    scholarship and professional funds program has had more than 73,000
    applicants. Data from this year's 7,000+ scholarship applicants, as
    well as from Active Duty spouse respondents to MOAA's 2015 health care
    survey, indicate alarming rates of behavioral health usage among
    military families. Both surveys show between 40-50 percent of military
    spouses have sought behavioral health care for someone in their family.
        Unfortunately, access to top-notch care is limited. The shortage of
    mental health professionals nationally is mirrored in the military
    community; it is even greater at military installations in remote
    areas. We believe our Nation has an obligation to prevent, diagnose,
    and treat the mental health needs of servicemembers and their families.
    Doing so in the face of a nationwide shortage of mental health
    professionals will require innovative solutions and strategic public-
    private partnerships including Congress, DOD, the VA, and other
    organizations. We believe military spouses may also be a source of help
    for their community.
        Each year we've offered military spouse scholarships, the number of
    spouses pursuing mental health careers and seeking help furthering
    their education has increased. This number reached almost 10 percent of
    our applicant pool of 7,000+ in 2016--more than 600 spouses. Twenty-one
    percent of these mental health profession applicants are spouses of
    wounded or fallen servicemembers. In a recent February 2016 Facebook
    post a Marine Corps spouse shared an experience all too common for
    military spouse mental health professionals:
            ``I'm looking for fellow military spouses who have completed
            the practicum and internship process for clinical mental health
            counseling or who have earned their LPC or LPCC by following
            California, Arizona, or North Carolina state requirements. We
            are currently stationed at Camp Pendleton, CA and I will start
            my practicum this June. I have excelled in my graduate program
            and now I am facing major challenges finding a facility that
            doesn't require a year sign-on and who has openings for new
            interns starting this summer. One specific problem I'm facing
            is we aren't sure when new orders will come or where they will
            be (making it additionally hard to convince licensed
            supervisors to take a new intern on if I will only be there for
            a couple months). Is there anyone who can share a professional
            contact with me?
        Many of our military spouses pursuing careers in mental health
    fields intend to serve military families. Helping these spouses
    overcome obstacles and pursue their careers has the dual benefit of
    assisting the individual spouse and family while addressing the
    shortage of mental health providers in the military community.
        We offer the following recommendations for Congress to consider:

            Include military spouses and others who enter the
    mental health profession in federal loan-forgiveness programs;
            Facilitate easier paths to both licensure and
    employment for military spouses and veterans in the mental health field
    when they work with our servicemembers and families;
            Provide a tax credit for spouses' re-licensing after a
    military move to offset the out-of-pocket cost of the additional
    license;
            Pass legislation to allow military spouses full
    reciprocity when transferring an Active unrestricted mental or
    behavioral health license from one state to another due to PCS;
            Support partnerships between the Military Health System
    and the VA to ease spouse difficulties in obtaining clinical
    supervision hours, reduce licensing barriers, and spur employment of
    military spouses and veterans in the mental health field.

        We ask Congress to increase access to behavioral health providers
    by supporting employment efforts of military spouses in the mental
    health profession.
      office of special needs and the services' exceptional family member
                      programs: more oversight is required
        The Department of Defense Office of Special Needs (OSN) was created
    in the fiscal year 2010 National Defense Authorization Act (fiscal year
    2010 NDAA) (Public Law 111-84) to enhance and improve DOD support
    around the world for military families with special needs, whether
    medical or educational. Despite the establishment of the OSN, gaps in
    support to special needs military families still exist, due in part to
    differences among the various Services' Exceptional Family Member
    programs (EFMP).
        The EFMP is intended to perform three interrelated functions:

        (1)  Identify and enroll eligible family members;
        (2)  Coordinate the assignment process to ensure special needs
    families are not sent to locations that lack adequate resources; and
        (3)  Provide families with information about and referral to local
    resources.

        While some Services take a centralized approach to EFMP, with
    enrollment, assignments, and case management services all housed in a
    single office, other Services' programs are more stovepiped. When a
    breakdown in communication occurs, families may find themselves
    assigned to locations without appropriate medical or educational
    services for their special needs family member or unaware of resources
    available to them through their communities. We often hear from
    families who experience a long wait before receiving services at their
    new installations because of lack of communication between EFMP
    Coordinators at the old and new installations. Families need the
    reassurance they will have continuity of care and a warm hand-off as
    they move from installation to installation.
        A 2012 GAO [Government Accountability Office] report, Better
    Oversight Needed to Improve Services for Children with Special Needs,
    (GAO-12-680, September 10, 2012) noted there are no Department-wide
    benchmarks to set standards for the services' EFM programs. As a
    result, the Department is unable to assess the effectiveness of the
    branches' EFM programs and ensure improvements are made when needed. In
    addition, although OSN was created to enhance and monitor the military
    branches' support for families with special needs, it has no authority
    to compel the branches to comply with DOD or Service-level program
    requirements and it has no direct means by which to hold them
    accountable if they fail to do so.
        DOD must comply with the GAO recommendations and establish
    benchmarks and performance goals for the EFM program. We further ask
    OSN to develop and implement a process for ensuring the branches'
    compliance with EFM program requirements.
        We ask DOD and the Services to set a common standard of support
    families can expect to receive through the EFMP. Families have the
    right to expect a level of service for their special needs family
    members regardless of the color of the uniform they wear. This is
    especially important as joint basing becomes more common and when
    families from one Service live and work on installations operated by
    another.
    Respite Care
        Families with special needs children have unique child care needs.
    For those families, dropping a child off at a day care center or with a
    sitter may not be an option. Instead, parents of special needs children
    need respite care provided by trained caregivers. Access to quality
    respite care allows families to run errands, spend time with other
    children, and simply recharge. Recognizing the importance of respite
    care, especially for military families far from the support of friends
    or extended family, the Services have provided respite care for
    military families with eligible special needs family members as part of
    the EFMP family support function. However, because the respite care
    programs are operated and funded by each of the individual Services,
    eligibility requirements and the number of respite care hours available
    to families vary. This is a significant source of frustration to
    families assigned to joint bases or installations managed by other
    Services. We are also concerned the current fiscal environment may lead
    the Services to reduce the level of respite care they offer.
    Special Needs Navigators and Case Management Not Implemented
        The fiscal year 2010 NDAA included specific directives for
    providing family support and case management services to better serve
    military families with special needs family members. Despite the intent
    of the legislation, those services have not yet been fully implemented,
    leaving families struggling to locate resources in their communities
    and manage their complex medical and non-medical needs.
        The fiscal year 2010 NDAA directed installation EFM programs to
    include ``Special Needs Navigators'' to help families find programs and
    resources available in their civilian communities. In locations where
    Special Need Navigators are part of the EFMP, families report a high
    level of satisfaction with the service and support they receive.
    However, few installation EFMPs include Special Needs Navigators.
        We urge DOD to meet the minimum level of family support
    coordination outlined in the fiscal year 2010 NDAA by expanding access
    to Special Needs Navigators.
        The fiscal year 2010 NDAA also emphasizes the need for enhanced
    case management support. Case management is specifically mentioned
    three times in the legislation:

            In addressing support for military families, the Office
    shall develop a uniform policy that shall include DOD requirements for
    resources (including staffing) to ensure the availability of
    appropriate numbers of case managers to provide individualized support
    for military families with special needs.
            The program shall provide for timely access to
    individual case managers and counselors on matters relating to special
    needs.
            Each program shall provide for appropriate numbers of
    case managers for the development and oversight of individualized
    services plans for educational and medical support for military
    families with special needs.

        Additionally, the fiscal year 2010 NDAA Conference Report language
    makes clear the importance of case management support for special needs
    military families:

            ``The conferees expect that implementation of this section will
            result in substantial improvements in identification and
            outreach to larger numbers of individuals who need support and
            coordination of available services, expansion of case
            management services, more direct training and counseling for
            parents and families, and timely access to information and
            referral to both Department of Defense and other federal,
            State, and local special needs resources and services. The
            conferees direct the Secretary to examine ways to mitigate the
            challenges for families who may be disadvantaged by relocation
            during their military service, and to ensure that enrollment in
            the Exceptional Family Member Program, or any successor to that
            program, is perceived as a positive and necessary family
            readiness resource.''

        Unfortunately, recently-released EFMP proposed regulations provide
    few details on case management services. There are no specifics
    regarding case manager resource requirements, acceptable case
    management access standards, or requirements for the development and
    updating of individualized service plans (medical and educational) for
    military families with special needs. We regularly hear from special
    needs families who are not getting sufficient support from case
    managers in terms of establishing initial care, or re-establishing
    services following a PCS [permanent change of station], for their
    special needs family member.
        Given the critical role of case managers, DOD must expand access to
    high quality case management services for special needs families.
        Section 582 of the fiscal year 2011 NDAA, Enhancement of Community
    Support for Military Families with Special Needs, included two
    provisions that have not been implemented to date:

        (1)  Periodic reviews of the best practices in the United States in
    the provision of medical and educational services to children with
    special needs, and
        (2)  Establishment of an advisory panel on community support for
    military families with special needs.

        DOD should conduct period reviews on the best practices in
    providing medical and educational services to special needs children.
    DOD should also establish an advisory panel on community support for
    special needs military families.
    Access to Health Care for Military Special Needs Families
        Caring for a special needs family member can be difficult and
    draining for any family. However, the impact for military families is
    magnified by the unique challenges associated with military service.
    Frequent geographic relocations are a fact of life for military
    families. A geographic relocation will, by definition, disrupt the
    continuity of care that is so important in managing complex medical
    conditions. After every move, special needs military families must
    begin a lengthy cycle of referrals, authorizations, and waitlists at
    each new duty station, resulting in repeated gaps in care. A nationwide
    shortage in pediatric specialists means even when families have
    successfully navigated the authorization and referral process at their
    new location, they may face a delay of weeks or even months before
    treatment can restart. Military families fear these repeated treatment
    delays have a cumulative and permanent negative effect on their special
    needs family members.
        It is frustrating for military parents to know these treatment
    delays could be mitigated if the process for accessing specialty care
    were more flexible and streamlined to address the unique aspects of
    military life. Unfortunately, TRICARE's rigid referral and
    authorization process--made even more difficult by varying Military
    Treatment Facility (MTF) procedures--too often hinders the transition
    process for military families rather than facilitating it. In addition,
    providers often tell us working with TRICARE is overly complex. Many
    choose not to participate in the TRICARE network because it is too
    difficult to navigate and administer. The resulting shortage of TRICARE
    network providers further impedes families' access to specialty care.
        We appreciate the Administration's fiscal year 2017 budget proposal
    has acknowledged the need for an improved referral process that
    provides seamless mobility and fewer administrative burdens. Changes to
    the referral process should make specialty care access more flexible
    and streamlined to address the unique aspects of military life without
    forcing Active Duty families to pay more out-of-pocket.
        For special needs military families, frequent relocation presents
    another obstacle: the inability to qualify for services through
    Medicaid waivers. Caring for children with complex medical needs can be
    incredibly expensive. We appreciate the MCRMC recognized this problem
    faced by our families with special needs. Most civilian families in
    this situation ultimately receive some form of public assistance,
    typically through state Medicaid waivers. State Medicaid programs
    provide assistance not covered by TRICARE: respite care, employment
    support, housing, supplies, and more flexible medical coverage. Because
    the demand for these services far outstrips the supply, there is a
    lengthy waiting list to receive assistance in most states. For
        that reason, these services are often out of reach for a military
    family who must relocate every two to three years. A military family
    who places their special needs child on a Medicaid waiver waiting list
    must start again at the bottom of the waiting list when they move to a
    new state. The Defense State Liaison Office (DSLO) has recognized
    military families' inability to access care through Medicaid waivers as
    one of its high priority issues and is working with state legislatures
    to address this problem. However, little progress has been made in
    resolving this disparity.
        TRICARE's Extended Care Health Option (ECHO) program was designed
    in part to address this imbalance, by allowing families to access non-
    medical services not covered under TRICARE. According to TRICARE's
    website, benefits covered under ECHO include ``training,
    rehabilitation, special education, assistive technology devices,
    institutional care in private nonprofit, public and State institutions/
    facilities and, if appropriate, transportation to and from such
    institutions/facilities, home health care and respite care for the
    primary caregiver of the ECHO-registered beneficiary.'' However, in
    practice military families find it difficult to obtain services through
    the program.
        This reality was reflected in TRICARE's May 30, 2013 report, The
    Department of Defense Report to Congress on Participation in the
    Extended Care Health Option (ECHO), detailing military families' usage
    of the ECHO benefit. They reported, in 2012, 99 percent of funds
    expended through the ECHO program were spent on Applied Behavioral
    Analysis (ABA) therapy and ECHO Home Health Care (EHHC). Although these
    services are important and popular with special needs families, it is
    impossible to see this statistic and not wonder why families are not
    accessing the long list of other services ostensibly available to them
    under ECHO.
        The MCRMC also found ECHO benefits, as currently implemented, are
    not robust enough to replace state waiver programs. \8\ DOD has assured
    our Association they are working on ECHO improvements. However, other
    than a policy update to cover incontinence supplies, we have heard no
    specifics. Given the importance of ECHO to special needs families, DOD
    must examine how to bring the ECHO benefit on par with state Medicaid
    waiver benefits.
    ---------------------------------------------------------------------------
        \8\ Final Report of the Military Compensation and Retirement
    Modernization Commission--January, 2015
    ---------------------------------------------------------------------------
        Another service much in demand by families is respite care. For
    families with special needs children, the time away afforded by respite
    care is vital. Access to quality respite care allows families to run
    errands, spend time with other children, and simply recharge. Respite
    care is ostensibly available through the ECHO program, but TRICARE
    policies limit its utility. ECHO sets strict requirements for respite
    care providers, making it difficult for families to identify eligible
    providers.
        Congress has given DOD much more discretion in its coverage of ECHO
    benefits than it has concerning medical benefits provided under the
    Basic Program. Thus, TRICARE has the authority to make changes that
    would enhance the ECHO program's utility to military families. Aligning
    ECHO coverage with that of state Medicaid programs, as the MCRMC
    recommends, would do much to enhance special needs military families'
    readiness and quality of life.
        TRICARE should enhance the ECHO program's utility to military
    families by ensuring it covers the products and services families need.
        The transition out of the military and into civilian life is
    difficult for many families but especially so for special needs
    families, who immediately lose access to ECHO benefits. Families may
    still face long waits before being eligible for care through Medicaid,
    which leads either to gaps in treatment or financial hardship for a
    family trying to pay for needed care. To ease the hardship for families
    in this situation, we recommend ECHO eligibility be extended for one
    year following separation to provide more time for families to obtain
    services in their communities or through employer-sponsored insurance.
        We ask Congress to extend eligibility for the Extended Care Health
    Option (ECHO) for one year following separation to provide more time
    for families to obtain services in their communities or through
    employer-sponsored insurance.
                          military families in crisis
        Even though the war in Afghanistan is coming to an end, military
    families continue to live extraordinarily challenging lives.
    Reintegration continues to pose challenges for some. Others are
    concerned they will be impacted by the military drawdown and are
    anxious about their financial futures. Most military families are
    resilient and will successfully address whatever challenges come their
    way. However, some will need help. It is critical military families
    trust DOD services and programs and feel comfortable turning to them in
    times of need. These programs and services must be staffed and
    resourced adequately so when families reach out for help, they can
    trust it is available. Military families must be assured our Nation
    will support them in times of family or personal crisis.
    Suicide
        In 2014, the Defense Suicide Prevention Office (DSPO) released a
    report outlining an approach for tracking military family member
    suicides. The report, Suicide and Military Families: A Report on the
    Feasibility of Tracking Deaths by Suicide among Military Family
    Members, was requested by the Senate and House Armed Services
    Committees.
        We appreciate Congress including a provision directing DOD to track
    military family suicides as well as Reserve Component suicides in the
    fiscal year 2015 NDAA, but are frustrated by DOD's delays in developing
    a plan to meet this mandate. If we don't have solid information on the
    extent of the issue, targeting solutions becomes more difficult.
    Preventing Child Abuse and Neglect, and Domestic Violence
        Research commissioned by our Association \9\ and others during the
    past decade documents the toll of multiple deployments on children and
    families, the difficulties many families face on the service member's
    return, and the added strain a service member's physical and invisible
    wounds can place on a family. These stressors put military families at
    risk for marital/relationship problems and compromised parenting that
    must be addressed with preventative programs.
    ---------------------------------------------------------------------------
        \9\ Anita Chandra, et al., RAND Center for Military Health Policy
    Research, Views from the Homefront: The Experiences of Youth and
    Spouses from Military Families, 2011
    ---------------------------------------------------------------------------
        Current research validates families will experience the effects of
    war long after deployments end. A recent study highlighted parenting
    challenges fathers face following deployment. The study found that
    while deployment is a time of great stress for families, the need for
    support and a strong community continues during the extended period of
    reintegration after the service member returns. This need is
    particularly pronounced when the returning service member is father to
    a young child, and he faces the core challenge of reconnecting with a
    child who has undergone significant developmental changes while he was
    away. \10\ A 2013 research brief issued by Child Trends, Home Front
    Alert: The Risks Facing Young Children in Military Families, \11\
    concluded many children negatively impacted by a parent's repeated
    combat deployments will continue to have exceptional needs as they grow
    older.
    ---------------------------------------------------------------------------
        \10\ Tova B. Walsh, et al., ``Fathering after Military Deployment:
    Parenting Challenges and Goals of Fathers of Young Children,'' Health &
    Social Work: A Journal of the National Association of Social Workers,
    February, 2014
        \11\ ``Home Front Alert: The Risks Facing Young Children in
    Military Families'', Child Trends, July 22, 2013
    ---------------------------------------------------------------------------
        Those looking for budget cuts may find it tempting to slash family
    support, family advocacy, and reintegration programs. However, bringing
    the troops home does not end our military's mission or the necessity to
    support military families. Recent media coverage indicates the
    incidence of child abuse and neglect among Army families has increased.
    We are concerned the extraordinary stress military families have faced
    could lead to increased domestic violence as well. Preventative
    programs focused on effective parenting and rebuilding adult
    relationships are essential. The Government should ensure military
    families have the tools to remain ready and to support the readiness of
    their servicemembers.
        We are encouraged the Family Advocacy Program, a congressionally
    mandated DOD program designed to prevent and respond to child abuse/
    neglect and domestic abuse in military families, has redoubled its
    focus on prevention programs. Their efforts to repair relationships and
    strengthen family function will be essential. Programs like New Parent
    Support focus on helping young parents build strong parenting skills
    early on.
        We encourage Congress and the Department of Defense to ensure that
    Family Advocacy programs are funded and resourced appropriately to help
    families heal and aid in the prevention of child and domestic abuse.
                       support for transitioning families
        Transitioning due to downsizing affects the whole family. In
    addition to the transition assistance program available to
    servicemembers, resources relevant to family members need to be
    identified. Issues such as how to find community resources to replace
    DOD programs and the military spouse's role in the long-term care of
    the family as a whole aren't addressed in the transition classes.
        In May 2014, our Association conducted a survey of military spouses
    facing transition. Over half the spouses indicated they were extremely
    or very concerned about relocation and finding employment. Over three
    quarters of the spouses were extremely/very concerned about being
    financially prepared and finding employment for their service member.
    Access to the counseling and other services provided by Military
    OneSource, beyond the 180 days currently provided, would make available
    resources and information to ease some of the concerns of our
    transitioning military families.
        Expand the opportunity for spouses to access transition information
    including face-to-face training and on-line training.
        Expand family access to Military OneSource to one year from a
    service member's separation from the military.
            today's surviving spouses need the dic offset eliminated
        Our Association has long believed the benefit change that would
    provide the most significant long-term advantage to the financial
    security of all surviving families would be to end the Dependency and
    Indemnity Compensation (DIC) offset to the Survivor Benefit Plan (SBP).
    Although we know there is a significant price tag associated with this
    change, ending this offset would correct an inequity that has existed
    for many years. Each payment serves a different purpose. The DIC is a
    special indemnity (compensation or insurance) payment paid by the VA to
    the survivor when the service member's service causes his or her death.
    The SBP annuity, paid by the Department of Defense (DOD), reflects the
    military member's length of service. It is ordinarily calculated at 55
    percent of retired pay. Military retirees who elect SBP pay a portion
    of their retired pay to ensure their family has a guaranteed income
    should the retiree die. If that retiree dies due to a service-connected
    disability, their survivor becomes eligible for DIC.
        We ask the DIC offset to SBP be eliminated to recognize the length
    of commitment and service of the career service member and spouse.
    Special Survivor Indemnity Allowance
        In the fiscal year 2008 NDAA, the Military Personnel Subcommittee
    established the Special Survivor Indemnity Allowance (SSIA) as a first
    step in a longer-term effort to phase out the DIC offset to SBP.
        That initial legislation authorized the SSIA for all survivors
    affected by the SBP-DIC offset in the amount of $50 per month for
    fiscal year 2009, with the amount increasing by $10 monthly for each of
    the next five years, reaching $100 per month for fiscal year 2014-2016,
    not to exceed the amount of SBP subject to the offset. The authority to
    pay the SSIA, under this initial provision, was to expire on March 1,
    2016.
        In 2009, SSIA payments were extended through the end of fiscal year
    2017, and the monthly SSIA amounts were increased:

        Fiscal year 2014:  $150
        Fiscal year 2015:  $200
        Fiscal year 2016:  $275
        Fiscal year 2017:  $310, with payment authority expiring as of
    Sept. 30, 2017.

        As of fiscal year 2017, phased SSIA increases will have eliminated
    roughly 25 percent of the SBP-DIC penalty.
        Including an extension of SSIA in the fiscal year 2017 National
    Defense Authorization Act is necessary so SBP-DIC widows will not see
    an interruption or elimination of the then-$310 payment.
        Extend SSIA so the modest progress in eliminating the DIC offset to
    SBP will not be lost.
    SBP for Inactive Duty for Training Deaths
        The Eleventh Quadrennial Review of Military Compensation released
    in June, 2012 recognized the Survivor Benefit Plan (SBP) annuity for
    Reserve component personnel who die while performing inactive duty is
    significantly less than the benefit available to survivors of Active
    Duty members and Reserve members who die on Active Duty. Despite their
    inactive status, these reservists are still performing military duties
    at the time of their death. The review report recommends calculating
    SBP benefits for a reservist who dies while performing inactive duty
    training using the same criteria as for a member who dies while on
    Active Duty.
        Calculate Survivor Benefit Program annuities for a reservist who
    dies while performing inactive duty training using the same criteria as
    for a member who dies while on Active Duty.
                  caregiver and wounded service member support
        Service members and their families must be assured our nation will
    provide unwavering support to the wounded, ill, and injured. This
    support must extend beyond the recovering warrior's medical and
    vocational rehabilitation. It must also include programs and services
    that help military caregivers, typically spouses or parents,
    successfully navigate their new role.
    Special Compensation for Assistance with Activities of Daily Living
            (SCAADL)
        Our Association appreciates that Congress authorized monetary
    compensation to caregivers of catastrophically wounded, ill, and
    injured servicemembers via the fiscal year 2010 NDAA. The Special
    Compensation for Assistance with Activities of Daily Living (SCAADL)
    program helps offset the loss of income by a primary caregiver who
    provides non-medical care, support, and assistance to the service
    member.
        We are concerned, however, DOD and the Services are no longer
    providing an appropriate level of information and outreach on this
    important benefit. The SCAADL calculator has not been updated on DOD's
    website since January, 2015. The SCAADL page of the Army's Warrior
    Transition Command is unavailable. Similarly, the Defense Finance and
    Accounting Service website has a dead link to the SCAADL calculator.
        We understand and are grateful the number of combat wounded has
    decreased dramatically. However, there are still thousands of
    servicemembers forward deployed to hostile environments. Military
    service is inherently risky and servicemembers are regularly injured in
    training or other line of duty incidents. It is important we maintain
    programs established over the past 15 years of war to support families
    of the wounded.
        Consistent with recommendations from the Recovering Warrior Task
    Force, we also request a legislative change to exempt SCAADL from
    income taxes to enhance this benefit for wounded warrior families.
        Maintain the SCAADL program, particularly outreach to wounded
    warrior families, and exempt SCAADL payments from income taxes to
    enhance the value to beneficiaries.
    Medicare Eligible Wounded Warriors & TRICARE Coverage
        Medically retired wounded warriors who receive Social Security
    Disability Insurance (SSDI) benefits become eligible for Medicare Part
    A after 24 months on SSDI. At that point, the wounded warrior must
    enroll in Medicare Part B in order to keep TRICARE coverage. After the
    wounded veteran enrolls in Medicare Part B, their TRICARE coverage
    converts to TRICARE for Life (TFL). This poses a variety of problems
    for the severely wounded population:

          In the worst case scenario, the wounded warrior or his/
    her caregiver does not realize or is not appropriately informed they
    must enroll in Medicare Part B and they lose their TRICARE coverage
    entirely.
          In other instances, the wounded warrior or caregiver
    understands and enrolls in Medicare Part B and retains TFL. Although
    medical coverage is retained, the severely wounded veteran is now
    paying more for medical coverage than most other working-age TRICARE
    retirees.
          Finally, there are some severely wounded veterans who
    receive SSDI for over 24 months and are forced onto Medicare/TFL.
    Eventually, the wounded veteran returns to work, but they are required
    to stay on Medicare Part B for eight years after returning to work.
    This results in over $10,000 in Medicare Part B costs to the severely
    wounded warrior who returns to work.

        This is an extremely complex issue facing the most severely wounded
    servicemembers and their caregivers. These families face emotionally
    challenging lives and overwhelming responsibilities. Making a mistake
    on Medicare Part B should not result in the life altering consequence
    of losing health care coverage. Furthermore, our most severely wounded
    warriors should not be forced to pay more for their health care than
    others.
        This complex problem crosses many jurisdictions including the
    Centers for Medicare and Medicaid Services, DOD, the Social Security
    Administration, the Senate Finance Committee, the House Ways and Means
    Committee, the HASC and the SASC. Given this problem impacts our most
    severely wounded veterans and their families, we urge the House and
    Senate Armed Services Committees to take the lead in finding and
    implementing a solution to this complex issue.
    Supporting an Enduring Wounded Warrior Mission
        The reduction in combat operations and the resulting decline in
    combat wounded poses a risk that attention and resources for wounded
    warrior programs and initiatives will shift to competing priorities.
    Some of this shift is certainly warranted, but it is critical
    improvements made over the last 15 years are not lost as we move
    forward. We support Recovering Warrior Task Force recommendations to
    formalize and marshal support for the way forward in wounded warrior
    care and caregiver support for current and future generations of
    wounded warriors.
                     military families-continuing to serve
        Recent national fiscal challenges have left military families
    confused and concerned about whether the programs, resources, and
    benefits contributing to their strength, resilience, and readiness will
    remain available to support them and be flexible enough to address
    emerging needs. The Department of Defense must provide the level of
    programs and resources to meet these needs. Sequestration weakens its
    ability to do so.
        Service members and their families have kept trust with America,
    through more than 15 years of war, with multiple deployments and
    separations. We ask the Nation to keep the trust with military families
    and not try to balance budget shortfalls from the pockets of those who
    serve.
        Evolving world conflicts keep our military servicemembers on call.
    Our military families continue on call as well, even as they are
    dealing with the long-term effects of more than a decade at war. The
    Government should ensure military families have the tools to remain
    ready and to provide for the readiness of their servicemembers.
    Effective support for military families must involve a broad network of
    Government agencies, community groups, businesses, and concerned
    citizens.

        Senator Graham. Mr. Bousum?

     STATEMENT OF SCOTT BOUSUM, LEGISLATIVE DIRECTOR, THE ENLISTED
         ASSOCIATION OF THE NATIONAL GUARD OF THE UNITED STATES

        Mr. Bousum. Chairman Graham, Ranking Member Gillibrand,
    Senator Blumenthal, thank you for allowing me to testify on
    behalf of the Enlisted Association of the National Guard of the
    United States.
        Our membership represents over 414,000 enlisted men and
    women of the Army and Air National Guard, their families and
    survivors, and tens of thousands of National Guard retirees.
    Their lives are touched in some way by the decisions that are
    made by you and your colleagues on the Armed Services
    Committee.
        I worked closely with you and your staff and your House
    counterparts as you developed and considered the blend of
    retirement proposals in the fiscal year 2016 National Defense
    Authorization Act. We understand that much of the conversation
    this year will be about reforms to the health care system.
        Reforms to the personnel system and defense acquisition
    system are driven by the budget. It is clear the Department of
    Defense needs additional funds to research new technologies,
    procure new weapons platforms, maintain equipment, start new
    construction projects, and train and pay servicemembers and
    civilian staff.
        This year the Personnel Subcommittee is looking to reform
    military health care without sacrificing quality, cost, and
    access. During last month's budget rollout, the Department of
    Defense distributed health care proposals to the Active
    component. While the Department is still considering
    improvements for members of the Reserve component, I am
    prepared to discuss some of the ideas starting to be socialized
    on Capitol Hill, such as transferring the management of the
    Reserve component health care to the Office of Personnel
    Management.
        In conjunction with the Reserve Officers Association and
    the National Guard Association of the United States, we
    circulated a health care satisfaction survey to our members.
    Together, our membership reflects the entirety of the Reserve
    component, officers and enlisted. The results of our survey are
    enclosed with my written testimony. Our survey shows that our
    membership likes TRICARE when it works as designed.
        Continuity of care is our greatest challenge.
        I understand that the Reserve Officers Association
    submitted a written statement today with excerpts from our
    survey, and I am prepared to address those comments as well.
        Thank you again for hosting today's hearing and for
    inviting me to discuss Department of Defense personnel
    programs. I look forward to answering your questions.
        [The prepared statement of Mr. Bousum follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Senator Graham. Mr. Davis?

    STATEMENT OF JOSEPH E. DAVIS, PUBLIC AFFAIRS DIRECTOR, VETERANS
                            OF FOREIGN WARS

        Mr. Davis. Thank you, Chairman Graham, Ranking Member
    Gillibrand, Senator Blumenthal. Thank you for letting the 1.7
    million members of the Veterans of Foreign Wars and auxiliaries
    giving us a voice here.
        The VFW [Veterans of Foreign Wars] can support a lot of
    initiatives currently on the table, such as the Force of the
    Future and better suicide and sexual assault prevention and
    response programs. Some initiatives we want tweaked, such as
    matching military pay raises to the ECI [Employment Cost
    Index], increasing the Government's TSP contribution to 6
    percent, and extending it through retirement. Some initiatives
    the VFW opposes, such as starting the Government's TSP program
    match in year 5 instead of year 3, dismantling TRICARE on the
    promise that better service will follow after enrollment fees
    are created or increased, and anything that impacts morale,
    such as the continuation of sequestration, which is still the
    law of the land.
        Everything the VFW wants costs money, but everything we
    want is for somebody else, another veteran, a servicemember or
    their families and survivors. As I said in my written
    statement, our Government's most important responsibility is to
    provide for the security and integrity of our Nation and very
    close second is taking care of those who protect us.
        I look forward to your questions.
        [The prepared statement of Mr. Davis follows:]

    [GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT]

        Senator Graham. Thank you. That was excellent by all of
    you.
        Ms. Raezer, when it comes to TRICARE reform, my goal is to
    make the program sustainable in terms of the budget but also to
    make it more efficient and not repackage the system and just
    charge you more. That is exactly where we are headed, and we
    are not going to do that. We are going to change the system.
    Give me just a couple of top line recommendations.
        Ms. Raezer. I think, first of all, start with what you are
    talking about, start with what is the benefit we want to
    deliver, what are the problems we need to solve. Start with
    designing that and then talk about what people should pay.
        Consider the whole military health system. We cannot wall
    off the military treatment facility and say they have got to
    take care of readiness. They do not have a dog in this hunt.
    They do. Our Active Duty families are having the most trouble
    with the direct care system. So we have to consider it as a
    system.
        Look at ways to pilot some innovations. I think some of the
    suggestions on the Reserve component side may be useful for
    pilots or----
        Senator Graham. Can I interrupt right there? Mr. Bousum.
    How do you say it?
        Mr. Bousum. Bousum.
        Senator Graham. Bousum. I am sorry.
        So we are actually thinking about taking the Guard and
    Reserve and basically putting it into the Federal employee
    system. Right?
        Mr. Bousum. Correct.
        Senator Graham. To me that is pretty exciting. I mean,
    Guard and reservists generally speaking are not next to
    military treatment facilities, and it basically would give you
    the same access to providers every Member of Congress and our
    staff has. You feel like that would be the way to go?
        Mr. Bousum. We do feel like that would be the way to go.
        Senator Graham. You know you got to pay for it.
        Mr. Bousum. True. On that point, we would like for TRICARE
    Reserve Select to be an option on FEHBP [Federal Employee
    Health Benefits Program].
        Senator Graham. Perfect.
        Ms. Roth-----
        Ms. Roth-Douquet. Like a bouquet of flowers.
        Senator Graham. Douquet. Okay.
        About child care, that is probably a problem for everybody
    in the country I guess. What could we do better?
        Ms. Roth-Douquet. There are a couple things. It is a
    problem for everyone in the country, but it is moving every
    one, two, and three years. So even if you do find it, you break
    it and have to start over again.
        Senator Graham. That is the problem is just people move all
    the time.
        Ms. Roth-Douquet. That is the problem. Exactly.
        I think there is a lot to be said in investing more in
    child care centers on base and extending the hours to hours
    that military-connected women, the female servicemembers need,
    starting them from 4:00 a.m. going to 8:00 p.m. That would help
    a lot. Increasing training for military spouses to be child
    care providers so that we both address employment----
        Senator Graham. That would fit two needs there.
        Ms. Roth-Douquet. You would hit two needs there.
        Recognizing that this is a reason people leave military
    service, both females and males. So there is a rationale for
    making investments in it that pay off.
        Senator Graham. We will definitely push that to make sure
    they are looking at using the talented people to maybe provide
    child care.
        Mr. Davis, I really appreciate you talking about
    sequestration. I just want you to know that if we do not fix
    the top lines, none of this is going to work. When 70 percent
    of the Marine Corps' expense comes in personnel, I do not know
    how you keep them ready to fight. This is insane. The threat
    levels are going through the roof. The number of people in the
    services is well below what the threat level exists, and we are
    taking money out of modernization, which means the next fight
    is--I am not looking for a fair fight. I want an overwhelming
    advantage to all the enemies this country may ever face. So I
    just want to compliment you because you are one of the first
    organizations to actually weigh in on the elephant in the room,
    which is the top line number.
        Mr. Davis. Thank you, Mr. Chairman. I appreciated the last
    panel discussion about sequestration because it was created 5
    years ago, but it is still the law of the land.
        Senator Graham. Look what has happened in the last 5 years.
        Mr. Davis. You know, everybody in Congress hates it, but
    nobody has yet dropped the legislation to end it. We have got
    to figure out how to fix it.
        Senator Graham. Thank you all.
        When it comes to health care, I want to try to do in health
    care what we did in retirement, think outside the box and get
    better value and save some money in the process.
        Senator Gillibrand?
        Senator Gillibrand. Thank you, Mr. Chairman.
        Ms. Roth-Douquet, I would like to work with you on a child
    care center proposal to actually write language for this year's
    NDAA because I think it is fundamentally one of the biggest
    problems about why some of the men and women we have trained
    for 10 years are leaving the military because right when
    childbearing years happen, they do not have the resources for
    affordable day care and they cannot manage their child care
    responsibilities. So we are losing so much of our trained men
    and women because we did not take care of their most important
    need. So I would like to work with you.
        I would like to ask you, Ms. Raezer, about a bill that
    Senator Blunt and I introduced in the fall. It is called the
    Military Family Stability Act, which both of your organizations
    support. It allows families of servicemembers to move ahead or
    remain behind for up to 6 months for schooling and employment
    purposes.
        So what led your organizations to support the bill?
        I also support family leave for servicemembers to care for
    children or sick family members. From your experience and that
    of your members, would a more generous leave policy for spouses
    also be helpful? Would these policies not help with retention
    and improve the view of the military as a family-friendly
    employer?
        Ms. Raezer. Thank you, Senator Gillibrand.
        I just also want to note on the child care issue our
    written statement contains some of our recommendations on
    solutions for the child care issue. So we would love to work
    with you on that as well.
        Senator Gillibrand. Great.
        Ms. Raezer. I think the Stability Act--I think military
    families are seeking certainty but sometimes that certainty
    means they need some flexibility to adjust family life to the
    needs of the military. Too often, they do not have that
    flexibility to create a little more certainty in their lives.
    Whether that makes sense or not, it does to many military
    families.
        What the Stability Act does and was attractive to us was
    that it allowed families to plan not just forcing all of their
    plans around a PCS move. We have a senior in high school. It
    would be great to be able to allow that senior to graduate. We
    have a spouse finishing their degree program in nursing, one
    more semester to go. Would it not be great? Or spouse that
    knows they are going to PCS, has been looking or a job finds
    one, but they need him or to start now, allowing that family to
    move ahead. That kind of flexibility adds to the military
    family's loyalty to the military. It could add to family
    financial stability, and it also helps the family feel a little
    more in control of their circumstances. That is why we support
    it and that is why we appreciate your introducing that bill.
        Senator Gillibrand. Thoughts on leave, paid leave?
        Ms. Roth-Douquet. I think paid leave is very useful. What
    we find with our young families--and they are millennials--
    having some control is extremely important to them. So the
    Family Stability Act allows them to choose for their family
    when the move is a good time to go. I think the paid leave also
    puts a little modicum of choice into their own hands. The
    uncertainty of military lifestyle is the number one concern
    that servicemembers stated in our last survey. These kinds of
    efforts make a huge difference with that.
        People pay out of pocket. My husband and mine's last move--
    we paid $10,000 out of pocket to keep our children in school in
    Germany to finish the semester when he had a PCS June 1st. If I
    was not working, that would have been extremely difficult for
    our family. That happens over and over again. Twenty-five
    percent of military families choose to live geographically
    separated because of issues that make moving together
    difficult. That is too much for our families and for the
    future.
        Senator Gillibrand. Thank you.
        Mr. Bousum, I believe the National Guard can play a unique
    role in recruiting and training cyber warriors. Individuals in
    the private sector can join the National Guard, leveraging
    their expertise for the military. For servicemembers with
    training in cyber warfare, they can move into the National
    Guard upon retirement, allowing the military to continue
    utilizing their skills and knowledge.
        What do you see as the role of the National Guard in cyber
    warfare? How can DOD better support our National Guard members?
        Mr. Bousum. I agree. I think that partnerships, especially
    in more populated corridors where our guardsmen and women can
    go in and work in the private sector and actually be skilled up
    on how to secure private company databases--yes, I think that a
    public-private partnership would be a good first step, and I
    definitely think that there is room for the Guard in this area.
        Senator Gillibrand. Great.
        For the record, Ms. Roth-Douquet and Ms. Raezer, I want to
    ask you specifically about the cutting of the autism
    reimbursements, and you can answer that for the record. But we
    have heard it is really damaging because the reimbursement
    rates for the people who typically give the applied behavioral
    therapy is so low that they cannot get a number of treatments
    that they need. So that I will leave for the record.
        Senator Gillibrand. For Mr. Davis for the record, I am very
    concerned about Agent Orange for our blue water Navy vets
    getting the treatment that they need. The VA has been arbitrary
    and just decided if you are serving on blue water, you are not
    covered. If it was brown water, you are covered, even though
    aircraft was covered with Agent Orange, even though they were
    drinking and bathing in Agent Orange-strewn water and have the
    diseases related to exposure.
        I would like a question for the record on that specifically
    for you to respond to.
        Senator Gillibrand. Thank you so much for your testimony.
        Senator Graham. Senator King?
        Senator King. Thank you, Mr. Chair. Thank you for allowing
    me to rejoin the hearing.
        First to our two representatives of the families, in my
    college years in the Washington area, I worked for Allied Van
    Lines moving principally military families. I will never forget
    one military spouse turned to me and said, you know, five moves
    equals a fire. That was the pressure of the moving and the wear
    and tear on the family and also on the possessions. I just want
    to join with Senator Gillibrand. We have got to build in
    flexibility for the family when the duty station changes but
    the school is still not done. I mean, I think that is something
    that we really need to take care of hopefully this year because
    it is just so difficult.
        Mr. Bousum, we talked in the prior panel about the OPTEMPO,
    and part of that is the Guard and the pressure that has been
    put on the Guard in recent years. Are we overstressing the
    Guard by numbers of deployments, length of deployment, and is
    that something that we should be concerned about both in terms
    of the Guard, and I am also concerned about the employer base,
    which is starting to get testy about this frequent deployment
    and lengths of deployment.
        Mr. Bousum. I do not think we are overstressing the Guard.
    I think that the Guard would like to see more predictability. I
    also think that the overuse of 12304b orders--and part of that
    is in my written testimony--is putting a lot of stress on
    family members and our servicemembers. But I do not think that
    we are overstressing the Guard.
        Senator King. So predictability is more important to you
    than numbers, number of deployments.
        The Guard rests to some extent on the good will and support
    of employers, and I am hearing resistance from employers.
        Mr. Bousum. I think it has a bit to do with predictability,
    not quantity. I think that in the post-9/11 world, the reason
    people join the Guard or the Active component is because they
    want to serve. So our members of the Guard want to serve. They
    just want more predictability so that they can allow their
    employer to plan for it.
        Senator King. Good. That is helpful.
        I will ask the same question for the record that I asked of
    the prior panel, and that is, could you supply your reflections
    and thoughts on the effect of the retirement changes that were
    made last year, and are there some necessary adjustments to
    achieve the goals of that plan but to achieve them in a more
    equitable or more effective way? So if you could just give us
    that for the record.
        Senator King. The largest question before this committee
    is, are we recruiting and retaining the people that we need?
    Are there policies that are getting in the way? It worries me
    that, at a time of increasing threats, we are downsizing, as
    you probably heard me ask the questions. But also, the
    requirements for our military personnel are increasing. We have
    Navy ships now that are manned by--personed by half of the
    number that were there 5 to 10 years ago. So the skill level is
    raised. Are the personnel policies, salaries, benefits,
    retirement sufficient to attract and retain the people that we
    need?
        Ms. Raezer. I think that is a huge question that the
    Department faces, that the Nation faces. Right now, if you look
    at the recruiting numbers, you are seeing the services are
    meeting their numbers. They are struggling in some cases, but
    they are meeting their numbers.
        We are concerned on the retention side, as all of these
    things that we have talked about today, the OPTEMPO, the
    unpredictability, the uncertainty, the pressure on compensation
    and benefits, the inability to find child care or get an
    appointment for a sick child or to help that special needs
    child with additional services, that that day-to-day grind
    sometimes is what is wearing our folks down to the point where
    they say we cannot do this anymore. A spouse finds a good job,
    and the servicemember says, you know, let us get out know. Let
    us not move. Let us not mess up what we have. That is the
    worry.
        Senator King. The retention is so important because if we
    could move the average retention out a year, that would be a
    significant savings across the board because of the training
    costs. We are spending a lot of money to train people for a 5-
    year stint. I understand the average retention period is about
    5-plus years. Is that the right number?
        Ms. Raezer. It depends on the service.
        Mr. Bousum. Yes, it depends on the service. It depends on
    the component. The National Guard tends to serve much longer.
        Senator King. Oh, yes, much longer. I understand, but I am
    talking about Active Duty.
        I mean, retention, it seems to me, has got to be a key
    element because of the training costs.
        Ms. Raezer. But it is also difficult right now because
    several of the services are downsizing. So what is the
    incentive for somebody who is highly skilled, who has skills
    that are in demand outside the military? Even if they want to
    stay in the uncertain time of downsizing, what is the incentive
    to stay? If you can find a better opportunity, take it. Part of
    the retention problem is the uncertainty the military faces.
        Senator King. I want to ask our two advocates for the
    families to answer this question. If you could wave a wand, if
    you were sitting on this side of the dais--not that we get to
    wave wands. It is harder than that. But if you could wave a
    wand, what are the two or three things that you would do to
    improve the lives of military families?
        Ms. Roth-Douquet. I frankly think we have the opportunity
    to do that and not spend a lot of budget money, and that is to
    use the bully pulpit to bring more jobs to military spouses. We
    can double the pay of most military families, the majority, 60
    percent, by employing spouses at the level they want to be
    working and that they are employed and able to work. It is one
    of the top reasons that otherwise promotable people leave the
    service. It is just families taking care of themselves the way
    they want to and the way other American families do.
        Senator King. Is the difficulty for spouses due to the
    mobility problem? They have a hard time getting a job----
        Ms. Roth-Douquet. Most people get jobs through
    relationships, and when you are moving every one, two, or three
    years, you are in a place where it takes a while to get a
    relationship. But now that there is remote work--and military
    spouses are invisible. You cannot tell they are a military
    spouse. But if we called on the American people to hire these
    talented folks particularly in technology and remote work areas
    or in the kinds of work we were talking about with child care
    or give more of a preference for on-base hiring, especially
    overseas where people are otherwise not able to work, yet we
    are flying people overseas to take jobs that military spouses
    could do, we could make a significant dent in something that I
    think is actually destabilizing our force.
        Senator King. A new motto, Mr. Chairman. Support our
    warriors. Hire the spouse.
        Senator Graham. Very good.
        Ms. Roth-Douquet. There you go.
        Ms. Raezer. If I could wave a wand and fix something, I
    would make the military health system more responsive to the
    needs of our families.
        Senator Graham. Senator Blumenthal?
        Senator Blumenthal. Thanks, Mr. Chairman.
        I can attest to the fact that nobody on this side of
        the United States Senate wears a Blue Star. I want to thank
    you for your excellent work.
        People sometimes say to me, oh, only two of you? But the
    fact of the matter is that less than 2 percent of our
    population has really been involved in an Active family way in
    any of the wars over these last 15 years. I think that accounts
    for some of the issues that have been raised here because if
    more people were affected, there would be more interest and
    less invisibility to the issues that you have very rightly
    raised. I certainly commend you, all of you, for focusing on
    the need for greater health care and job opportunities,
    training for spouses, and other members of military families.
        I want to ask you, Mr. Bousum, you made a statement which I
    cannot contest with any hard evidence, but my experience has
    been--and I spend a lot of time with our National Guard and our
    reservists in Connecticut, but they are really weary that their
    families, more than they, are weary. Our National Guard and our
    Reserve are always ready to go. They will answer the call. They
    are there because they want to serve, as you have said
    correctly. But their families pay an enormous price, their
    children. After two, three, or more deployments over a period
    of maybe 5 to 10 years, their families suffer or serve and
    sacrifice as much or more than they do. So I would tend to
    agree that maybe they are not feeling the war weariness and
    maybe the direct effects, but their families seem to be--at
    least substantial numbers.
        Would you agree or disagree? I would be interested in you
    thoughts.
        Mr. Bousum. Yes, I do agree with that, and I certainly
    agree with your statement that our family members make as much
    of a sacrifice as our servicemembers do.
        I think that a lot of what you are saying has to do with
    the continuity of care challenges in the health care realm that
    part of this hearing is trying to address. There is a lot of
    bureaucracy when we have 30-some duty statuses and there is a
    lot of fudging the numbers and pushing the paperwork in a way
    that it jeopardizes the benefits that our servicemembers
    receive. There is a lot of knee-jerk reactions and decisions
    based off of information that they just got the day before. I
    think that if we can address some of the health care challenges
    facing our members of the National Guard, especially rural
    members of the National Guard, that we will start to see that
    turn around.
        Senator Blumenthal. Let me ask all of you. I was
    particularly interested in what you said, Mr. Davis, about the
    link between national security and personnel policy because I
    think the two are clearly related.
        You know, I just came from a hearing of the Airland
    Subcommittee of the Armed Services Committee, and the Air Force
    was testifying. In a remote paragraph of one of the
    testimonies, there was this fact. We have 511 open pilot
    positions right now, a deficit, as they put it, of 511, which
    is expected to increase to 834 by 2022. We tend to focus on all
    the bright, shiny objects, the new hardware, the F-35, the new
    planes and all the technology that is exploding in
    significance, and we should be because ultimately that
    technology and weapons platforms are key. But we need to
    recruit and retain, train, and put to work the best of our
    people in the United States. So I want to thank you all for
    your focus on this fact.
        This subcommittee is in my view as important or more
    important than any of the other subcommittees that we have
    because ultimately our greatest asset as a military is our
    people.
        Thank you very much for being here.
        Senator Graham. Any other questions?
        [No response.]
        Senator Graham. It is often said you recruit individuals
    and you retain families. You think about it. A lot of people
    come in single. By the time they reenlist, they are well on
    their way to having their own families.
        Mr. Davis, was there anything you wanted to add?
        Mr. Davis. Sir, I could ask Scott right here to read
    because I basically said right here you recruit the individuals
    and retain the families. I just wrote it as a note.
        [Laughter.]
        Senator Graham. The NSA told me about what you were going
    to say.
        [Laughter.]
        Senator Graham. The bottom line is not only do you help us
    understand the nature of family service, you have ideas. I like
    you all because you just do not complain. You actually have
    concrete things that maybe we can implement. Without you, we
    would be literally in the dark because only two members here
    have family members. So without you, we would really not
    understand what it is like to serve.
        In that regard, thank you very much, and we will try to
    implement as much of your ideas as we can, given the budget
    constraints we have.
        The hearing is adjourned.
        [Whereupon, at 4:30 p.m., the hearing was adjourned.]

        [Questions for the record with answers supplied follow:]

                 Questions Submitted by Senator Lindsey Graham
        1. Senator Graham. Do you consider cryopreservation of eggs and
    sperm to be a medically necessary benefit or a quality of life benefit?
        General McConville. Cryopreservation of eggs and sperm was
    announced by the Secretary of Defense on January 29, 2016 as a Force of
    the Future initiative, focused on improving the Quality of Life for
    Servicemembers and their families while improving the overall mission
    effectiveness and the strength and health of our teams. According to
    Army medical experts, this is a quality of life benefit.
        Admiral Moran. Because I am not a medical professional, I defer to
    the Surgeon General of the Navy on the medical aspects of
    cryopreservation. But I can certainly see that many servicemembers and
    their families may consider it a quality of life benefit, in addition
    to any medical necessity there may be for the practice.
        General Brilakis. When cryopreservation of eggs and sperm is viewed
    in relation to postponing child birth due to operational or career
    demands, it may be considered a quality of life benefit. The question
    is more complex when viewed in relation to the remote possibility of
    losing fertility due to combat injuries. There are a host of legal,
    moral, ethical, and social impacts that must be analyzed and resolved
    prior to determining if this procedure, regardless of the reason,
    should become a service member benefit.
        General Grosso. Air Force cannot provide an official response to
    this question as it warrants a Department of Defense (DOD) response
    since this is a Secretary of Defense initiative.
        Recommended Response for DOD: This investment will provide greater
    flexibility for our troops who want to start a family, but find it
    difficult because of where they find themselves in their careers. The
    military understands the demands upon our servicemembers and wants to
    help them balance commitments to force and commitments to family.
                                   __________
              Questions Submitted by Senator Kirsten E. Gillibrand
                       combat integration implementation
        2. Senator Gillibrand. Now that the decision is made to open all
    military positions, including those in combat, to service by any
    individual, man or woman, who can meet the occupational standard, what
    is the way ahead for each of your services in implementing that
    decision, and how will you work toward ensuring success in this effort?
        General McConville. Upon receiving Secretary of Defense's approval
    of the Army's implementation plan, we will execute a detailed,
    incremental, and methodical approach by publishing an execution order.
    The Army will focus on gender-neutral standards, and a leader's first
    approach, meaning that female infantry and armor leaders (officers or
    noncommissioned officers) would be assigned prior to the assignment of
    female enlisted soldiers being assigned. The Army will continue to
    assess the execution of its implementation plan through continued
    studies to ensure successful gender integration.
        Admiral Moran. We will apply lessons learned from previous
    integration into ships and submarines and will follow approved
    implementation plans, while upholding validated, operationally-
    relevant, gender-neutral, occupational standards. We will select only
    the best, fully-qualified candidates for entry into each profession,
    including those involving combat roles.
        General Brilakis. The Marine Corps began executing the Integration
    Implementation Plan upon approval by the Secretary of Defense. The plan
    has five phases: Setting the Conditions; Recruiting; Entry-Level
    Training; Assignment; and Sustainment. The first two phases have
    already begun and the subsequent phases will begin when female recruits
    demonstrate an interest in formerly closed ground combat arms
    specialties and successfully pass the gender-neutral physical screening
    and entry-level training requirements, along with their male peers. The
    Integration Implementation Plan uses physical screening tests, well-
    defined occupational specialty standards, as well as teaming and
    training cohort assignments, for integration implementation success.
        Education and assessment elements are critical components of the
    Integration Implementation Plan. The Education Plan will commence in
    May 2016 and run through all phases. It will use subject matter experts
    and a train-the-trainer approach to educate every Active Duty marine by
    October 2016 and Selective Marine Corps Reserve Marine by the end of
    January 2017. It will ensure marines understand relevant details of the
    Integration Implementation Plan, address misconceptions, and prepare
    marines and units for further female integration. The Assessment Plan
    will be the mechanism by which integration is evaluated and will inform
    in-stride policy adjustments as necessary. Data related to integration
    issues will be collected and analyzed to help identify opportunities to
    further improve the process and mitigate problems. Ultimately,
    assessment will result in refined policies that improve outcomes.
        General Grosso. The way ahead, per our Air Force Implementation
    Plan for Full Integration, includes opening and managing all military
    positions using the Air Force's existing life cycle processes
    (recruiting, accessions, training, and assignment processes). The Air
    Force Integration plan also pays special attention to seven integration
    emphasis areas highlighted by the Secretary of Defense's (Transparent
    Standards; Population Sizes; Physical Demands and Physiological
    Differences; Conduct and Culture; Talent Management; Operating Abroad;
    Assessment and Adjustment). Successful gender integration will take
    time and requires a focus on standards, policy, education and engaged
    leadership across the Total Force.
        Our integration plan provides several deliberate steps to assist
    with integration to ensure we have created the best opportunities and
    environment for success. We have female cadre assigned in the training
    pipeline and being appointed in operational units to assist with
    integration. While we are not mandating any cohort size or holding up
    any training until a critical mass in reached, our plan values the
    benefits of mixing new airmen with more seasoned airmen where possible
    to help during integration and training. Our plan further includes
    education and communication tools and provides for periodic review,
    data tracking, and continuous assessments to allow incorporation of
    lessons learned and best practices as we move forward. Finally, our
    plan leverages existing Air Force education and training on culture and
    climate to ensure our Air Force standards for dignity and respect are
    practiced at all levels.

        3. Senator Gillibrand. How are you working with your squad and unit
    level leaders to ensure successful integration?
        General McConville. Once the Army receives Secretary of Defense's
    approval of its implementation plan, we will publish an execution order
    that will address an education, training, and communication strategy
    that will be focused on squad and unit-level leaders.
        Admiral Moran. Active, consistent, and committed leadership and
    professionalism will set and maintain a fair and equitable environment
    for successful integration. Additionally, we will ensure success by
    expanding female staff representation at Naval Special Warfare training
    sites, providing instructor training, conducting leadership exchanges
    with integrated Special Operations Forces partners, and direct
    engagement with the force.
        General Brilakis. Our education plan uses a train-the-trainer
    approach that organizes the entire Marine Corps into four tiers based
    on leadership level. Squad leaders and all more junior marines are part
    of the fourth tier and they will receive instruction from their platoon
    commanders and platoon sergeants (tier 3) who, in turn, receive
    education from their company commanders and first sergeants (tier 2).
    Tier 1 individuals will be the designated command representatives from
    every O-6/O-5-level command in the Marine Corps who receive their
    education from the Integration Education Plan subject matter experts
    directly.
        Through the Integration Education Plan, marines will learn the
    accurate details of the Integration Implementation Plan, dispel
    misconceptions, and prepare marines, both female and male, for the
    responsibilities associated with integrated units and specialties.
        General Grosso. Leaders at all levels are vested in successful
    integration. We are receiving continuous assessment and feedback from
    leaders at the squadron and unit level to ensure successful
    integration. We have kept in close contact with the Air Force
    Recruiting Service, Air Force Personnel Center and Career Field
    Managers on potential accessions. When we have females enter the
    training pipeline and then assigned to operational units, leadership,
    working closely with their female support cadre, will provide monthly
    assessment reports to Air Staff which provide the status on integration
    best practices, lessons learned, issues and mitigation efforts. Our
    initial assessment of facilities, equipment, supplies and medical
    support proved adequate for integration, but we will continue to
    monitor and readdress as required. In addition, we have planned for the
    Air Force Inspector General (IG) to review and conduct continued
    assessment that standards are in compliance with public law and track
    and address any IG complaints related to integration.

        4. Senator Gillibrand. General McConville and General Brilakis, are
    you developing predictive tests at the recruit stage to provide better
    outcomes for those servicemembers who seek to join the ground combat
    Forces and if so, can you describe the process being used to develop
    those tests?
        General McConville. The Army this year completed a Physical Demands
    Study and developed a four-event Occupational Physical Assessment Test
    (OPAT), which will allow the Army to screen applicants for their
    propensity to succeed in their assigned specialty prior to entry into
    training. All Army applicants, Officer and Enlisted, will be subject to
    screening with the OPAT. The OPAT is expected to be in place next month
    and to be used for screening later this fiscal year.
        General Brilakis. Applicants seeking a Ground Combat Arms (GCA)
    military occupational specialty (MOS) must meet the following gender-
    neutral Initial Strength Test (IST) standards prior to shipment to
    recruit training: 3 pull-ups; 1.5 mile run in 13:30; 44 crunches in 2
    minutes; and 45 Ammo can lifts. The IST is the first step in the
    physical screening process for an enlisted applicant to be eligible for
    a service in GCA MOSs. Meeting the IST standards provide reasonable
    assurance an applicant has the physical strength and stamina to
    successfully complete recruit training and meet the GCA MOS
    Classification Standards (MCS), a requirement to attend MOS specific
    training following graduation from recruit training.
        GCA MOS Classification Standards (MCS) are more rigorous and must
    be met by each recruit who possesses a GCA contract prior to MOS
    classification toward the end of recruit training. The MCS are: 6 pull-
    ups; 3 mile run in 24:51; Movement to Contact within 3:26; 60 Ammo can
    lifts within 2 minutes; and Complete Maneuver Under Fire within 3:12.
    Our research indicates that recruits, who can meet these MCSs, have a
    reasonable assurance of performing the GCA MOS-Specific Physical
    Standards, are less likely to sustain physical injury in training, and
    are more likely to successfully complete the MOS qualification course.

        5. Senator Gillibrand. What steps are you taking to prevent
    injuries?
        General McConville. Readiness remains the Army's number one
    priority, and preventing injuries of our soldiers is paramount to that
    goal. Over the past few years, the Army conducted multiple scientific
    studies and research to help us establish a deliberate, methodical, and
    standards based approach for putting the right soldiers in the right
    jobs.
        US Army Medical Command (MEDCOM) and the US Army Research Institute
    of Environmental Medicine (USARIEM) conducted a comprehensive Physical
    Demands Study to analyze the physiological requirements of combat
    occupations. The study led to the development of a physical screening
    test called the Occupational Physical Assessment Test (OPAT), which
    beginning June 1, 2016, will help the Army select applicants for
    occupations which they are physically capable of performing to
    standard.
        Furthermore, the Army believes the OPAT will help improve
    performance, reduce attrition, decrease lost training time, improve
    retention, reduce injury, improve overall satisfaction, and improve
    total health.
        Admiral Moran. A Naval Special Warfare (NSW) Human Performance
    Program was developed to address long-term physical human performance
    development and sustainment of NSW Active Duty personnel by providing
    the highest levels of musculoskeletal care and human performance
    enhancement. The program is designed to optimize personnel readiness
    while sustaining and extending each participant's operational career
    through state-of-the-art sports medicine, rehabilitation, physical and
    mental performance enhancement, and nutritional programs.
        NSW continues to conduct studies with Ohio State University,
    University of Pittsburgh, Naval Postgraduate School, and Center for
    Naval Analyses to reduce musculoskeletal injury and improve physical
    readiness. NSW will continue to track injury rates for all candidates,
    and injury rates among female candidates will be compared with those of
    their male counterparts, to identify whether the need for program
    changes is indicated.
        Additionally, NSW Injury Prevention and NSW Rehabilitation Program
    guides are provided to prospective candidates for injury prevention and
    training pipeline preparation. The guides have been reviewed by medical
    personnel of the NSW community to ensure all policies, processes and
    practices are gender-neutral.
        General Brilakis. The Marine Corps has developed a series of
    physical screens to try to minimize the likelihood of injuries for both
    male and female marines. First, prospective marines competing for
    ground combat specialties must complete the ground combat arms initial
    strength test and MOS Classification Standards. These tests will ensure
    that those individuals with a likelihood of succeeding in these
    specialties are assigned appropriately.
        Subsequently, to maintain a physically-intense MOS, marines will
    need to pass the MOS Continuation Standards during their service in the
    operating Forces. The physical performance of non-ground combat arms
    MOS marines will be evaluated against the load-bearing ground combat
    arms (GCA) unit assignment criteria; those non-GCA MOS marines who are
    likely to succeed are assigned to load-bearing units. This will help
    prevent injuries among the non-GCA MOS marine population serving in
    load-bearing units (infantry, reconnaissance, special operations).
        Finally, the Marine Corps is undergoing a comprehensive review of
    fitness throughout the Corps, led by our Training & Education Command.
    This includes potential modifications to the physical fitness test and
    combat fitness test that would incentivize greater fitness and make
    marines more resistant to injuries.
        General Grosso. The Air Force continues to pursue injury prevention
    methods for all airmen. We refined our injury prevention efforts and
    plan to introduce human performance optimization resources into the
    Battlefield Airmen Training. Injury prevention begins with education;
    on proper utilization of body mechanics, use of medically approved
    health supplements (such as iron for women), and preventive physical
    care/exercise/nutrition to strengthen the resilience of the
    musculoskeletal system. The Air Force will surveil to identify physical
    and mental injuries sustained by our Battlefield Airmen, to include
    over use, load bearing and technique driven injuries such as shallow
    water blackout or mental adaptive coaching. Prevention strategies are
    optimized to training and operational mission requirements. Some
    training and operational Battlefield Airmen units have programs that
    embed rapid rehabilitative capabilities along with preventive assets.
    These multidisciplinary teams include: physical therapists, strength
    and conditioning coaches, operational psychologists, athletic trainers,
    and sports medicine physicians. These multi-disciplinary teams have
    proven to increase physical and mental resilience, speed recovery from
    injury, and increase unit/mission readiness for the Battlefield Airmen.

        6. Senator Gillibrand. Have you started to recruit women for combat
    arms positions, and if so, when do you expect the first assignments to
    be made?
        General McConville. The Army has initiated gender neutral training
    for all occupations and plans to train female leaders first for the
    newly opened specialties, followed by recruiting and training the first
    junior enlisted women. The Army has already received applications for
    several dozen female officers, US Military Academy, ROTC and Officer
    Candidate School cadets/candidates to branch in the Infantry and Armor.
    These officers will begin training in the summer of 2016 and expected
    to reach their new units in early 2017. Beginning in April 2016, the
    Army plans to begin enlisting females for Infantry and Armor
    specialties and schedule them for One Station Unit Training (OSUT)
    classes that would allow them to arrive in their first assignments
    after the arrival of female leaders in the same specialties to the same
    units.
        Admiral Moran. We have officially opened Special Warfare Officer
    (113X) and Special Operations Officer (114X) designators, and Special
    Warfare Operator (SEAL) and Special Warfare Combatant-craft Crewman
    (SWCC) enlisted ratings to all qualified applicants. Recruiters and the
    Naval Special Warfare officer and enlisted community managers are
    actively engaging with potential candidates interested in the program.
    Assignments occur upon graduation from SEAL and SWCC pipeline courses.
        General Brilakis. Yes, the Marine Corps commenced recruiting and
    contracted over 70 women into select combat arms positions on 1 October
    2014 following repeal of the 1994 Direct Ground Combat Definition and
    Assignment Rule by the Secretary of Defense. Some have completed
    training and are in the Operating Forces. On 15 March 2016, upon
    approval of the Marine Corps Force Integration Plan by the Secretary of
    Defense, the Marine Corps opened all remaining combat arms positions to
    women. Recently two female officers did request and were granted the
    change of MOS to Artillery while stationed at The Basic School, and are
    currently training at Fort Sill. The USMC has also received two lateral
    move requests from female enlisted marines who participated in the
    GCEITF. However, to date, no female enlisted recruit has either
    volunteered or qualified to be contracted by Marine Corps Recruiting
    Command into one of the newly opened load-bearing MOSs.
        General Grosso. Yes, the Air Force started to recruit women for
    combat arms positions on Jan 4, 2016. As with recruitment of men, there
    are unique challenges in finding women with the motivation, mental and
    physical prowess required for these special operations related career
    fields. While we have had some initial interest, female candidates have
    yet to enter any of the training pipelines.
        Once we have a qualified candidate, Technical training for these
    career fields can run from 6 months to over two years. Due to this
    lengthy timeline, any woman qualifying for a combat position in 2016
    will not be expected to finish training until 2017 or later.

        7. Senator Gillibrand. How are you working with SOCOM to recruit
    and train women to compete for special operations positions?
        General McConville. Army Recruiting Command's Special Operations
    Recruiting Battalion (SORB) works closely with the United States Army
    Special Operations Command (USASOC) to determine recruiting goals and
    requirements for specific units and military occupational specialties.
    USASOC continues to remain fully integrated with gender integration
    efforts at HQDA and SOCOM. Since the inception of the Women in Service
    Review in January 2013, USASOC actions have been synchronized and
    consistent with both HQDA and SOCOM. As the title 10 force providing
    headquarters, USASOC is responsible for training, manning, and
    equipping Army Special Operations Forces (SOF) operators for employment
    across the Geographic Combatant Commands. Current USASOC recruiting and
    training standards are gender neutral, operationally relevant, and
    designed to build and maintain the most qualified Army SOF operator;
    they mirror the Office of the Secretary of Defense-approved standards
    outlined in the Army and SOCOM implementation plans for gender
    integration. All infrastructure and administrative requirements have
    been met to receive female ARSOF candidates beginning on April 1, 2016.
        Admiral Moran. Naval Special Warfare (NSW) is synchronizing
    integration efforts with U.S. Special Operations Command (USSOCOM) by
    conducting working groups and through scheduled weekly interactions
    among working group counterparts. NSW continues to coordinate
    integration efforts with accession and training pipeline partners at
    Navy Recruiting Command, Recruit Training Command and Naval Service
    Training Command.
        General Brilakis. The Marine Corps does not routinely work with
    SOCOM to recruit and train men and women for service in Special
    Operations; however, Marine Corps Forces Special Operations Command
    (MARSOC) has its own Recruiting & Advertising Branch. This branch
    educates the marines through multiple awareness platforms to include
    but not limited to Headquarters Marine Corps MARSOC Screening Team
    visit program, Manpower Management Command visit program, command
    sponsored local area visits, area canvassing, direct e-mail program,
    MARSOC recruiting website (www.marsoc.com), and informational handouts
    (posters, brochures and command pamphlets). Additionally, marines are
    provided a 10-week workout program in preparation for Assessment and
    Selection (A&S). MARSOC is working closely with Headquarters, Marine
    Corps to ensure that recruiting efforts are screening and assigning
    candidates with the requisite abilities and attributes that have the
    greatest potential for completing the training pipeline.
        MARSOC is now actively screening female marines who volunteer for
    A&S. The next scheduled A&S begins August 2016, and has qualified
    candidates. Upon successful selection at A&S, marines will be slated
    for a school seat in an upcoming Individual Training Course (ITC). The
    next ITC begins in January 2017. MARSOC has ensured a two female cadre
    will be in place at ITC and is prepared for the arrival of female
    candidates who complete A&S. ITC is the MOS producing school for the
    Critical Skills Operator and Special Operations Officer. MARSOC
    primarily recruits Corporals, Sergeants, 1st Lieutenants and Captains
    who meet prerequisite standards listed within the Military Occupational
    Specialty Manual and the Marine Corps Force Integration Implementation
    Plan.
        General Grosso. The Air Force is working with SOCOM to recruit and
    train women to compete for special operations positions. For officer
    positions, SOF operators visit the AF Academy and select Air Force ROTC
    detachments to engage, inform and recruit male and female cadets into
    the SOF/BA career fields. We also have permanent party SOF
    representatives at the Air Force Academy who provide leadership, assist
    with recruiting, and provide guidance on training during the initial
    screening phase (to prepare cadets to pass the entry requirements
    broken into three phases for entry to SOF/BA career fields). For our
    enlisted positions, working with our Air Force recruiters, current and
    past SOF operators assist in informing and recruiting when they engage
    with members via phone or email about the career field, or when they
    visit base and community events and functions. In addition, the Air
    Force has contractors, who were previous SOF/BA operators, who are
    mentors and assist in developing and training candidates to help
    prepare them for success in meeting entry and training requirements.

        8. Senator Gillibrand. General Brilakis, will the Marine Corps
    integrate all levels of training and if not, why not?
        General Brilakis. Marine Corps recruit training is combined. Only
    during the initial phase is training accomplished separately. Recruit
    training is designed to transform civilians into marines. The initial
    separation of our recruits removes potential distraction and allows
    recruits to focus on their individual transformation to a marine. This
    sets our female marines up for success because it allows them to
    improve their physical fitness, to be led by female drill instructors,
    and to have female officers as role models. Recruit training gets more
    and more combined as recruits proceed through the recruit training
    syllabus and, once recruits graduate as marines, all Marine Corps
    training is fully combined. We believe the current training process,
    honed over decades of experience, enables recruits to succeed. It has
    proven, during war and peace, the best way to build marines.

        9. Senator Gillibrand. General Brilakis, I noticed that the Marine
    Corps integration plan includes assigning women in cohorts. What size
    would those cohorts be and what will you do if only one woman passes an
    MOS school?
        General Brilakis. The Integration Implementation Plan has two goals
    associated with the assignment of females to previously closed units.
    First is the ``teaming'' concept. The Marine Corps will seek to assign
    females in teams of at least two (ideally of the same military
    occupational specialty). Second is the ``cohesive cohort'' concept.
    Under the cohesive cohort concept, the Marine Corps will seek to assign
    female ground combat arms MOS marines to ground combat arms units along
    with male and female members of their training cohort from their entry-
    level MOS school. Male and female ground combat arms MOS marines who
    have trained together at MOS school have already observed each other's
    performance and can vouch for their respective abilities.
        If only one woman passes a given MOS school then, in accordance
    with our assignment goals, she would be assigned to the unit with at
    least one other junior female of another MOS along with male members of
    her training cohesive cohort at the MOS school.

        10. Senator Gillibrand. General Brilakis, I'm pleased to see that
    the Marine Corps established gender neutral standards for combat MOSs.
    How did you devise these standards? For example, the ground combat arms
    initial strength test requires 25 ammo can lifts; why 25?
        General Brilakis. For clarification, the gender-neutral Initial
    Strength Test (IST) for applicants seeking a Program Enlisted For Code
    associated with a ground combat arms MOS consists of 3 Pull-ups; 1.5
    mile run in 13:30 minutes; 44 Crunches in 2:00 minutes; and 45 (vice
    25) Ammo Can Lifts in 2:00 minutes. Collectively, research efforts from
    2012-2015 identified and validated MOS-specific gender-neutral tasks
    and correlated these tasks to the Service Physical Fitness Test and
    Combat Fitness Test events, enabling development of physical standards
    for IST for MOS Screening and MOS Classification Standards (MCS) for
    MOS Classification. The IST and MCS for ground combat arms MOSs are
    based on the 95th percentile of collected performance data, providing a
    confidence level that 95 percent of those marines who screen through
    the IST would be able to meet the MOS Classification Standards by the
    end of recruit training. Meeting the MSCs in turn provides reasonable
    assurance that marines can perform MOS Specific Physical Standards
    (MSPS) necessary to achieve occupation qualification at the MOS
    Schools. As of 30 September 2015, gender-neutral occupational standards
    have been in use at all Marine Corps MOS-producing schools. As with all
    training, the Marine Corps will continue to review and update
    occupational standards to ensure mission effectiveness across the range
    of military operations.

        11. Senator Gillibrand. General Brilakis, how many marines met
    these standards in the research phase?
        General Brilakis. All of them. Every individual--male and female--
    met the minimum occupational standard for their participation in the
    research. No unqualified individuals were used in the research. For
    example, female 0311 subjects had to graduate from the Infantry
    Training Battalion 0311 course. Additionally, all combat arms female
    marines had to meet a minimum male 17-26 year old Physical Fitness Test
    (PFT) and Combat Fitness Test (CFT) passing score, the same as male
    participants.

        12. Senator Gillibrand. General Brilakis, can you tell me what
    percentage of the men and of the women met the standards in the
    research phase?
        General Brilakis. All of them. Every individual--male and female--
    met the minimum occupational standard for their participation in the
    research. No unqualified individuals were used in the research. For
    example, female 0311 subjects had to graduate from the Infantry
    Training Battalion 0311 course. Additionally, all combat arms female
    marines had to meet a minimum male 17-26 year old Physical Fitness Test
    (PFT) and Combat Fitness Test (CFT) passing score, the same as male
    participants.

        13. Senator Gillibrand. General Brilakis, in your testimony you
    stated, in regards to combat integration: ``The framework of our
    research was--and continues to be--viewed through three interrelated
    lenses: first and foremost, the combat effectiveness of our marine
    units; second, the health and welfare of our individual marines; and
    finally, with an eye toward the best talent management of our total
    force--both today and into the future. I continue to have concerns in
    all three areas, but am confident that our assessment and subsequent
    adjustments during implementation will help us find the best way
    forward.'' Can you expound on your concerns, and how would you address
    each of them?
        General Brilakis. Our study showed that female marines are capable
    of performing physically demanding tasks. However, across all ground
    combat occupational specialties, the gender integrated teams, squads,
    or crews demonstrated somewhat lower performance in the time to
    complete physically-intense tasks, especially under load. This occurred
    despite the fact that our female volunteers were considered to be an
    above-average to well-above-average representation of the PFC-Sergeant
    female population, and had successfully met the physical and academic
    requirements to graduate from their ground combat arms MOS-producing
    school. I believe that clear and occupationally-relevant physical
    performance standards at different points in the accessions and entry-
    level training continuum will help mitigate this risk.
        The associated risk is directly linked to the physiological
    differences between males and females, and the risk lies in the
    cumulative impact of this physiological disadvantage over the course of
    regular, recurring and increasingly more challenging dismounted
    movements under load in the operating Forces. The disparity in injury
    rates between males and females at the Infantry Training Battalion and
    during the conduct of our assessment provides an early indicator to
    that effect. We will try to combat injury risk through physical
    training preparation and equipment enhancements.
        In regard to talent management, we have worked to increase the
    number of female accessions, both officer and enlisted, to
    unprecedented levels in the past few years. The Marine Corps does risk
    losing talented female marines prematurely due to injury and the
    extreme physical demands of the combat arms occupations. An
    inextricable linkage exists between physical capacity and job
    performance, especially in the early stages of a young marine's career.
    The possibility of a female marine being less competitive in these
    occupations may adversely impact our ability to retain females into
    more senior ranks. This would be a tremendous loss for our Corps.
                                  retaliation
        14. Senator Gillibrand. Admiral Moran, you said that there is one
    case of retaliation that was prosecuted in the Navy. Can you please
    provide information about this case including the ranks of the offender
    and victim, whether there was a supervisory relationship between
    offender and victim, the court-martial forum, whether the member was
    tried by panel or judge-alone, the punishment adjudged, the punishment
    approved, and whether there was a plea agreement in the case?
        Admiral Moran. Senator, to clarify, while the offender was held
    accountable there was no prosecution under the Uniform Code of Military
    Justice in this case. The offender was a senior chief petty officer (E-
    8), and the victim a petty officer third class (E-4). The senior chief
    was not the victim's direct supervisor, but was in her chain of
    command.
        In February 2011, the victim initiated a protected communication
    under title 10, United States Code, section 1034, specifically, by
    filing, with the Command Managed Equal Opportunity Advisor, an informal
    sexual harassment complaint against another member of the command. A
    review by the Inspector General of the Navy found that the senior chief
    was aware of the protected communication and had committed reprisal
    against the victim by failing to forward her Officer Candidate School
    (OCS) application for consideration by the chain of command.
        Following the Inspector General's findings, the completed
    investigation was forwarded to commander, U.S. Naval Forces Central
    Command, for administrative or disciplinary action against the
    offender. The commander determined that court-martial was
    disproportionate to the offense, and flag-level formal administrative
    counseling was the appropriate action against the offender. The
    commander informed the Assistant Secretary of the Navy (Manpower and
    Reserve Affairs) of his determination and that the flag-level
    counseling had been completed.
        The investigation was also forwarded to me for corrective action on
    behalf of the victim; unfortunately, I was unable to take corrective
    action. The victim had informed the Inspector General that she no
    longer wished to be considered for commission as a naval officer. I
    informed the Assistant Secretary of the Navy (Manpower and Reserve
    Affairs) of this result. However, I ordered that an appropriately
    redacted copy of the Inspector General's investigation be inserted in
    the senior chief's Official Military Personnel File and, following
    appropriate due process procedures, I subsequently disapproved the
    senior chief's advancement to master chief petty officer (E-9), which
    will also be documented in his record.
                                   __________
                   Questions Submitted by Senator Bill Nelson
          survivor benefit plan offset by death indemnity compensation
        15. Senator Nelson. General McConville, Admiral Moran, General
    Brilakis, General Grosso, currently eligible survivors of Active Duty
    personnel and veterans who have died due to causes connected with their
    military service have Survivor Benefit Plan (SBP) annuities they
    receive reduced dollar-for-dollar by the amount of Death Indemnity
    Compensation (DIC) they receive (the SBP/DIC offset). Given that the
    SBP is a voluntary insurance program that military retirees pay
    premiums into, do you think it is acceptable that eligible survivors
    are denied full payout of this purchased annuity plan based on the
    receipt of a separate entitlement?
        General McConville. As part of the Congressional review of the
    Compensation Reform we are aware of the legislative proposal aimed at
    adjusting the compensation under SBP and DIC. The intent of this
    proposal is to improve Survivor Benefits by granting servicemembers the
    option of purchasing additional SBP coverage, not offset by DIC. This
    would provide servicemembers both an increased choice as well as
    financially increased benefits.
        Admiral Moran. There has been a shift in recent years, most
    noticeably since the 9/11 terrorist attacks, away from original
    Congressional intent to provide a total benefit composed solely of SBP,
    solely of DIC, or of a combination of the two which would equal the
    full SBP benefit. While the emerging view suggests that the DIC offset
    reduces the survivor benefit, that view is inconsistent with original
    Congressional intent.
        I believe we can never do enough for our service men and women, our
    veterans, and their families. If it were affordable, and could be
    funded within the overall President's budget without sacrificing other
    critical readiness priorities, changing the law to provide concurrent
    receipt of full SBP and DIC, without an offset, would be well-received
    by military surviving family members. But, I fully appreciate the
    persistent challenge of finding and establishing the right balance
    between applying increasingly austere resources to readiness costs and
    personnel costs.
        General Brilakis. The Department of Defense has consistently
    opposed proposals to eliminate the offset between Survivor Benefit Plan
    (SBP) annuities and Dependency and Indemnity Compensation (DIC) at
    Government expense primarily because both programs have the same goal--
    to provide a continuing annuity to the survivors of military members or
    former members--and both benefits are subsidized by the Federal
    Government. DOD also notes that allowing concurrent receipt of SBP and
    DIC would create a group of survivors receiving two Government-
    subsidized survivor annuities, whereas survivors of most military
    retirees and survivors of veterans who did not serve to retirement
    would receive only one. Finally, eliminating the SBP offset for all
    survivors entitled to DIC would cost the Military Retirement Fund more
    than $7 billion over 10 years. The Marine Corps defers to DOD on any
    change in position on this issue.
        Admiral Grosso. No, it is not. The Air Force fully supports the
    submission of OLC DESIGNATOR S.979 to repeal the requirement for
    reduction of survivor annuities under the SBP by DIC.
                      special survivor indemnity allowance
        16. Senator Nelson. General McConville, Admiral Moran, General
    Brilakis, General Grosso, currently the Special Survivor Indemnity
    Allowance (SSIA) is payed to eligible survivors whose SBP annuities are
    offset in part or in whole by the DIC they receive--in effect
    offsetting the offset, at least partially. The SSIA provision expires
    at the end of fiscal year 2017. In the absence of a repeal of the SBP/
    DIC offset, do you think it is appropriate to extend SSIA, and if so,
    for how long?
        General McConville. According to the DOD Office of the Actuary, the
    SSIA provision was temporary and was therefore not included as part of
    the DOD budget. The DOD never budgeted as a permanent benefit for this
    provision and currently there are no plans to extend the SSIA past the
    end of fiscal year 2017. While this benefit would assist survivors by
    mitigating the SBP-DIC offset issue, it ultimately would run counter to
    the Department's efforts to control the costs of entitlement programs,
    achieve efficiencies and reduce the deficit.
        Admiral Moran. I support the Department of Defense position not to
    extend SSIA beyond fiscal year 2017.
        General Brilakis. Currently there are no plans to extend the
    Special Survivor Indemnity Allowance past the end of fiscal year 2017.
    The program is not budgeted and will sunset on 30 September 2017. SSIA
    was enacted by Congress and is administered by DOD, so the Marine Corps
    defers to those entities on the appropriateness of extending the
    program.
        General Grosso. In the absence of a repeal to the SBP/DIC offset,
    extending SSIA would certainly benefit the survivors of military
    retirees who participate in SBP. As you can imagine, survivors now
    count on this additional money as income. Removing it totally could
    potentially cause hardship for many. The cost of a total repeal would
    cost the Military Retirement Fund more than $7 billion over 10 years.
    The SSIA extension would provide some relief to survivors as the
    discussion to end the SBP/DIC offset continues. The initial legislation
    for SSIA allowed payments for 8 years with incremental increases, and
    should continue for the foreseeable future.