[Senate Hearing 118-]
[From the U.S. Government Publishing Office]


 
       DEPARTMENT OF DEFENSE APPROPRIATIONS FOR FISCAL YEAR 2023

                              ----------                              

                                       U.S. Senate,
           Subcommittee of the Committee on Appropriations,
                                                    Washington, DC.

                       NONDEPARTMENTAL WITNESSES

    [Clerk's note.--The subcommittee was unable to hold 
hearings on nondepartmental witnesses. The statements and 
letters of those submitting written testimony are as follows:]
      Prepared Statement of the American Psychological Association
    The American Psychological Association (APA) is the largest 
scientific and professional organization representing psychology in the 
U.S., numbering over 135,000 researchers, educators, clinicians, 
consultants and students. For decades, psychologists have played vital 
roles within the Department of Defense (DoD), as providers of clinical 
services to military personnel and their families, and as scientific 
researchers investigating mission-targeted issues, such as counter-
terrorism, Post-Traumatic Stress Disorder (PTSD), and Traumatic Brain 
Injury (TBI).
    The performance of psychologists in training and performance in the 
field remains an essential part of the readiness. Psychologists play 
key roles in the development and deployment of programs such as the 
Army Resilience Directorate Training Support program that emphasizes 
the value of mental readiness. Teaching servicemembers and civilians 
the value of cognitive capability, emotional capability, and 
interpersonal/social capabilities show the real value of psychological 
science.
    Today, psychologists continue to bring unique and critical 
expertise that is essential to meeting the needs of the military and 
its personnel.
    APA urges Congress to provide the following funding levels for 
programs within the Department of Defense (DoD) in FY23.
               defense science & technology (s&t) program
    In addition to providing essential clinical services to our 
military service members and their families, psychological scientists 
within DoD conduct cutting-edge, mission-specific research critical to 
our National defense. Psychological scientists address a broad range of 
important issues and problems vital to our National defense, including 
expertise in conflict prevention and resolution; promoting non-
discriminatory and evidence-based recruitment and retention; modeling 
behavior of individuals and groups; as well as understanding and 
optimizing cognitive functioning, perceptual awareness, complex 
decision-making, stress resilience, and human- systems interactions.
    Within DoD, the majority of behavioral, cognitive and social 
science is funded through the Army Research Institute for the 
Behavioral and Social Sciences (ARI) and Army Research Laboratory 
(ARL); the Office of Naval Research (ONR); and the Air Force Research 
Laboratory (AFRL), with additional, smaller human systems research 
programs funded through the Office of the Secretary of Defense (OSD) 
and the Defense Advanced Research Projects Agency (DARPA).
    The military service laboratories provide a stable, mission-
oriented focus for behavioral and social science, conducting and 
sponsoring basic (6.1), applied/exploratory development (6.2) and 
advanced development (6.3) research. All of the services fund human-
related research in the broad categories of personnel, training and 
leader development; warfighter protection, sustainment and physical 
performance; and system interfaces and cognitive processing.
    DoD funding for psychological research has supported a number of 
major medical advancements, including the use of Virtual Reality (VR) 
as a clinical, evidence-based tool to address the assessment, 
prevention, and treatment of PTSD. Bravemind, for example, is a virtual 
Iraq/Afghanistan exposure therapy tool that is currently used in 
approximately 100 sites around the U.S., including VA hospitals, 
military bases and university centers. While traditional prolonged 
exposure therapy for PTSD involves the gradual reliving of a traumatic 
event in the patient's imagination under a clinician's care, Bravemind 
allows clinicians to gradually immerse patients into virtual combat 
scenarios that reflect their specific traumatic experiences in a 
controlled, stepwise fashion. Clinicians are then able monitor the 
intensity of the patients' stress responses through brain imaging and 
psychophysiological assessment techniques. Literature has shown that 
patients with PTSD who were unresponsive to traditional prolonged 
exposure therapy using their imaginations often responded successfully 
to VR therapy using Bravemind.
    Continued support for this research is essential to improving 
mental and behavioral health outcomes for our Nation's veterans and 
servicemembers.
    APA joins the Coalition for National Security Research (CNSR) in 
urging Congress to increase FY23 Defense S&T funding consistent with 
recommendations of the National Defense Strategy Commission.
                      minerva research initiative
    Launched in 2008, the Minerva Research Initiative is the 
Department's signature social science basic research program that funds 
university-led teams which conduct social science research in areas of 
strategic importance to U.S. national security policy. Minerva provides 
critical access to expertise to help the military better understand how 
social, cultural, behavioral, and political forces impact security and 
stability in regions significant to America's interests abroad. Across 
the behavioral and social sciences, approximately 10 percent of all 
Minerva grants have been awarded to support psychological science. 
Recent Minerva-supported psychological research includes, Bio-Markers 
and Counter-Messages: Measuring Individual Differences in the Influence 
of Extremist Propaganda and Counter-Messages (2017) and Autonomy 
Refugee Psychology and Its Potential for Refugee Radicalization (2016). 
Research like this provides the DoD with unique insights that help 
shape national security policies and better position the U.S. in a 
complex global environment.
    The Minerva Research Initiative, funded primarily from the Basic 
Research Initiative PE, received renewed support after the fiscal 
Year2022 budget request called for dramatic cuts. The fiscal Year2023 
budget request supports roughly the level appropriated in fiscal 
Year2022 ($17 million). Minerva serves as DOD's flagship social science 
program that funds university-led teams to conduct social science 
research on areas of strategic importance to U.S. national security 
policy including efforts related to great power competition and near-
peer competition that can deter conflict or enhance understanding of 
adversaries' environments to promote DoD success in potential 
conflicts.
    APA joins CNSR in urging Congress to restore Defense-Wide funding 
for Minerva and increase its overall budget to $17 million in FY23.
                      artificial intelligence (ai)
    Psychological research from all disciplines of psychology has 
supported advancements in AI since its inception, including cognitive, 
personality, social, neuropsychology, developmental, clinical, and 
experimental psychology. Each discipline of the field provides a unique 
perspective and contribution to the ongoing development of AI. APA 
urges continued investments in AI research, including effective methods 
for human-AI collaboration. Human/AI cooperation is one area which 
illustrates the unique contributions of psychological science. As 
experts in human behavior, psychologists work to examine how subtle 
behaviors that are vital to cognitive processes and action, such as eye 
contact, apply in the context of human-AI interaction, such as 
autonomous vehicles and social robotics.
    APA strongly urges continued support for the National Security 
Commission on Artificial Intelligence, which is charged by Congress to 
examine AI through the lens of national competitiveness, the means to 
sustain technological advantage, trends in international cooperation 
and competitiveness, ways to foster greater investment in basic and 
advanced research, workforce and training, potential risks of military 
use, ethical concerns, establishment of data standards, and the future 
evolution of AI.
    APA urges Congress to prioritize funding aligned with the 
recommendations outlined by the Commission's 2019 Interim Report, which 
identifies five fundamental lines of effort that are necessary to 
preserve U.S. advantages, including:
      (1) invest in AI research and development;
      (2) apply AI to national security missions;
      (3) train and recuit AI talent;
      (4) protect and build upon U.S. technology advantages; and
      (5) marshal global AI cooperation.
              defense health programs and medical research
    In order to maintain a strong military, it is imperative that 
Congress continues to prioritize the health, including mental and 
behavioral health, of our Nation's servicemembers. While suicide and 
suicidal ideation continues to be a major concern for all veterans, 
servicemembers, and their families, those living in rural communities 
with limited access to care remain particularly at risk.
    Increased funding for telehealth services within the DoD system is 
critical to ensuring this population receives the evidence-based mental 
and behavioral health care they need.
    APA urges Congress to provide robust funding for the Defense Health 
Agency (DHA), including increased funding for telehealth services 
within the DoD system.
    APA also encourages Congress to expand the Defense Suicide 
Prevention Office's (DSPO) efforts to address military suicide 
prevention. Using the REACH-VET model, REACH-MIL would analyze existing 
data from health records of members of the military serving on active 
duty to identify members who are at a statistically elevated risk for 
suicide in order to provide preemptive care and support for 
servicemembers before they have or express suicidal thoughts to 
clinicians.
    Within the DSPO, we urge Congress to provide funding for REACH-MIL, 
a pilot program on suicide prevention in the military health care 
system based on the predictive analytics suicide prevention program 
REACH-VET within the Department of Veterans Affairs (VA).
       congressionally directed medical research programs (cdmrp)
    CNSR supports robust funding for investments in critical medical 
research at DoD. This includes the CDMRP, which supports research to 
understand, prevent, diagnose, and treat diseases and medical issues 
that are prevalent and specifically impact service members, veterans, 
and their families. These programs address diseases such as epilepsy, 
spinal cord injuries, Alzheimer's, Gulf War Illness, Traumatic Brain 
Injury, Posttraumatic Stress Disorder, and psychological health, among 
many other critical issues.
    CDMRP funds high-risk, high-impact research that is complementary 
but not duplicative of efforts at other agencies such as the National 
Institutes of Health (NIH). In fact, the National Academies has 
assessed that CDMRPs appropriately coordinate research priorities with 
other funding agencies and have an effective review and selection 
process for awarding funds not dissimilar to the process used by 
NIH.\1\
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    \1\ https://www.nap.edu/catalog/23652/evaluation-of-the-
congressionally-directed-medical-research-programs-review-process.
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    With NIH only being able to fund approximately 19 percent of 
proposals it receives,\2\ CDMRPs play an important role in ensuring 
that military-relevant innovative biomedical research is conducted. 
However, in fiscal Year2020, these programs proved highly competitive 
as CDMRP programs had an average success rate of just 13 percent--more 
than 6,600 proposals unfunded.\3\ An increase in funding is 
particularly vital this year to mitigate the impact of the recent spike 
of inflation on the purchasing power of individual CDMRP programs, 
particularly those programs that have been flat funded for several 
years.
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    \2\ https://nexus.od.nih.gov/all/2022/03/07/fy-2021-by-the-numbers-
extramural-grant-investments-in-research/.
    \3\ https://cdmrp.army.mil/pubs/annreports/2021annrep/
2021annreport.pdf.
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    APA joins the Defense Health Research Consortium (DHRC) in urging 
Congress to increase funding for the Congressionally Directed Medical 
Research Programs by five percent plus inflation FY23.

    [This statement was submitted by Katherine B. McGuire, Chief 
Advocacy Officer, American Psychological Association Services, Inc.]
                                 ______
                                 
       Prepared Statement of the American Urological Association
    The American Urological Association, the premier organization for 
urologists worldwide with over 15,000 urologists across the United 
States, thanks Chairman Tester, Ranking Member Shelby, and fellow 
members of the committee for the opportunity to provide written 
testimony on the health needs of our military and veterans, including 
bladder cancer. Our testimony will outline the importance of combatting 
bladder cancer to our Nation's military and veteran population. 
Specifically, we respectfully request an $8 million line item within 
the Congressionally Directed Medical Research Program (CDMRP) for 
bladder cancer to stabilize the field and fund groundbreaking science 
that can finally bend the survival rate of bladder cancer in the right 
direction.
    Bladder cancer is the fourth most commonly diagnosed cancer in U.S. 
military and veteran populations, and the sixth most commonly diagnosed 
cancer in Americans. Additionally, it is estimated that approximately 
81,180 Americans, will be diagnosed with bladder cancer in 2022. While 
survival rates for many other cancers have increased, the 5-year 
survival rate for bladder cancer has not improved in more than 30 
years. Congress has previously provided funding for bladder cancer 
research through the DoD's Peer Reviewed Cancer Research Program 
(PRCRP). Despite the support to date for innovative and competitive 
bladder cancer research, there remains an urgent need to make 
investments that will improve the outcomes for this deadly cancer. A 
dedicated funding line will help attract researchers to this field by 
demonstrating a sustained commitment to this work.
    The American Urological Association represents the interests of 
urologists across the United States. We understand that new tools, 
treatments, and techniques are necessary to ensure that a bladder 
cancer diagnosis has good long-term outcomes. Yet time and again, 
research dollars go to other, higher profile cancers. Highlighting 
bladder cancer's importance to our military community by including a 
line item will ensure that the research field remains strong and that 
more research applications are funded moving forward.
    Our membership has seen first-hand what bladder cancer can do to a 
patient. For example, one bladder cancer patient is a 71 year-old 
veteran of the Vietnam war living in Maryland with high risk non-muscle 
invasive bladder cancer. Like many patients, he was unfamiliar with 
bladder cancer when he began to have blood in his urine several years 
ago. When told that bladder cancer was the fourth most common cancer 
among men in the United States, he and his wife were shocked. We 
treated him with intravesical BCG, the standard treatment for this type 
of bladder cancer. BCG is also a relatively ineffective vaccine for 
tuberculosis. Unfortunately, soon after treatment his cancer recurred. 
At that point, his options were either a radical cystectomy, surgery to 
remove his bladder necessitating urinary tract reconstruction, or a 
second-line therapy. With few FDA approved therapies available, the 
patient chose an experimental clinical trial involving intravesical 
gemcitabine and docetaxel therapies. He has responded well thus far on 
this second line therapy.
    This case highlights the critical need of more funding to further 
research and scientific understanding of bladder cancer, a disease 
which is particularly prevalent among veterans. From this one example, 
it is clear that there is a gap in patient awareness about bladder 
cancer and a lack of treatments available for patients who recur after 
BCG. We know that second-line therapies are lacking and identifying 
novel therapies that avoid major surgery is a prominent focus of 
research efforts. It is clear more must be done, and that our men and 
women will directly benefit from advancements against bladder cancer.
    The relevance to U.S. veterans is clear: many veterans were exposed 
to high levels of ``rainbow herbicides,'' including Agent Blue and 
Agent Orange which are both recognized as highly toxic. In the National 
Defense Authorization Act for Fiscal Year 2021, Congress directed the 
addition of bladder cancer to the Department of Veteran's Affairs list 
of presumptive diseases linked to Agent Orange exposure. This addition 
came after the National Academy of Medicine included bladder cancer on 
its list of ``suggestive evidence of association'' with Agent Orange 
exposure. Additionally, researchers are just learning that there may be 
a significant link between exposure to burn puts and bladder cancer, 
which must be further explored. By establishing an $8 million Bladder 
Cancer Research Program in fiscal Year2023, we can ensure that bladder 
cancer research and the well-being of bladder cancer patients, 
particularly service members and veterans, is a national priority.
    We thank you for your time and attention to this urgent health 
priority for our military and veteran population.
                                 ______
                                 
       Prepared Statement of the Bladder Cancer Advocacy Network
    The Bladder Cancer Advocacy Network (BCAN), the only national 
patient advocacy organization devoted to advancing bladder cancer 
research and supporting the more than 700,000 Americans with this 
common cancer, thanks Chairman Tester, Ranking Member Shelby, and 
fellow members of the committee for the opportunity to provide written 
testimony on the health needs of our military and veterans, including 
bladder cancer.
    Our testimony will outline the importance of combatting bladder 
cancer to our Nation's military and veteran population. Specifically, 
we respectfully request an $8 million line item within the 
Congressionally Directed Medical Research Program (CDMRP) for bladder 
cancer to stabilize the field and fund groundbreaking science that can 
finally bend the survival rate of bladder cancer in the right 
direction.
    Bladder cancer is the fourth most commonly diagnosed cancer in the 
U.S. military and veteran populations, and the sixth most commonly 
diagnosed cancer in Americans. Additionally, it is estimated that 
approximately 81,180 Americans, will be diagnosed with bladder cancer 
in 2022. While survival rates for many other cancers have increased, 
the 5-year survival rate for bladder cancer has not improved in more 
than 30 years.
    Congress has previously provided funding for bladder cancer 
research through the DoD's Peer Reviewed Cancer Research Program 
(PRCRP). Despite the support to date for innovative and competitive 
bladder cancer research, there remains an urgent need to make 
investments that will improve the outcomes for this deadly cancer. A 
dedicated funding line will help attract researchers to this field by 
demonstrating a sustained commitment to this work.
    As a national patient advocacy organization, BCAN is eager to see 
new tools, treatments, and techniques developed that are necessary to 
ensure that a bladder cancer diagnosis has good long-term outcomes. Yet 
time and again, research dollars go to other, higher profile cancers. 
Highlighting bladder cancer's importance to our military community by 
including a line item will ensure that the research field remains 
strong and that more research applications are funded moving forward. 
The relevance to U.S. veterans is clear: many veterans were exposed to 
high levels of ``rainbow herbicides,'' including Agent Blue and Agent 
Orange which are both recognized as highly toxic. In the National 
Defense Authorization Act for fiscal year 2021, Congress directed the 
addition of bladder cancer to the Department of Veteran's Affairs list 
of presumptive diseases linked to Agent Orange exposure. This addition 
came after the National Academy of Medicine included bladder cancer on 
its list of ``suggestive evidence of association'' with Agent Orange 
exposure.
    Additionally, researchers are just learning that there may be a 
significant link between exposure to burn pits and bladder cancer, 
which must be further explored. By establishing an $8 million Bladder 
Cancer Research Program in fiscal year 2023 in the CDMRP, we can ensure 
that bladder cancer research and the well-being of bladder cancer 
patients, particularly service members and veterans, is a national 
priority. We thank you for your time and attention to this urgent 
health priority for our military and veteran population and stand ready 
to answer any questions you may have.
                                 ______
                                 
   Prepared Statement of the Coalition for National Security Research
    Dear Chairman Tester and Ranking Member Shelby, and distinguished 
Members of the subcommittee, thank you for the opportunity to submit 
outside witness testimony as you begin crafting the fiscal year 2023 
Defense Appropriations bill. The Coalition for National Security 
Research (CNSR) (https://cnsr4research.org/) is a broad-based alliance 
of more than 100 members from industry, academia, scientific and 
professional associations, and non-profits conducting vital scientific 
research to create new and improve existing technologies and 
capabilities to support the U.S. Department of Defense's (DoD) 
operations.
    Investments in basic and applied scientific research, development, 
test and evaluation of new technologies and equipment are necessary so 
forces will have the systems and equipment for tomorrow's challenges. 
With approximately 70 percent of Research, Development, Test and 
Evaluation (RDT&E) conducted extramurally,\1\ DoD relies on its 
partners such as CNSR members to perform the RDT&E that will provide 
the Department the technologies and capabilities it needs to secure our 
National security. For example, with Russia and other adversaries 
rising on the world stage and seeking potential avenues to attack U.S. 
systems and infrastructure, defense funding for cybersecurity is 
critical to ensure our energy and national security. Further, if the 
United States military is to maintain its technological advantage 
during the great power competition, it is imperative that we make 
robust investments in the Defense Science and Technology (S&T) 
enterprise, including strengthening the future defense workforce.
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    \1\ https://ncses.nsf.gov/pubs/nsf22323.
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      fiscal year 2022 budget request for the defense s&t program
    The Biden-Harris Interim National Security Strategic Guidance 
States that the United States will double down on science and 
technology investments and support cutting-edge technologies and 
capabilities that will advance our military and national security in 
the future.\2\ Unfortunately, the fiscal year 2023 budget fails to meet 
the commitment in the Interim National Security Strategic Guidance and 
request the appropriate resources to implement the NDS.
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    \2\ https://www.whitehouse.gov/briefing-room/statements-releases/
2021/03/03/interim-national-security-strategic-guidance/.
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    While the budget requests the largest RDT&E top line ever, it 
simultaneously calls for cutting Defense S&T funding within the larger 
portfolio by 13 percent or more than $2.4 billion. The budget also 
requests cutting defense basic research, the type of research that 
makes discoveries to enable future technologies and military 
capabilities, by 14 percent or more than $387 million. With China 
investing three times more annually in R&D than the U.S. and likely to 
be the world's top R&D performer in the near future,\3\ now is not the 
time to cut funding for the DoD's primary programs that create new 
technologies and capabilities--as well as to help train the next 
generation defense workforce--to ensure the U.S. military maintains its 
global dominance.
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    \3\ https://ncses.nsf.gov/pubs/nsb20203.
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    The fiscal year 2023 budget proposes more than just cutting the 
Defense S&T program below fiscal year 2022 Congressionally enacted 
levels, it proposes to cut certain research programs below levels 
requested in the fiscal year 2022 budget request. More specifically, 
DoD requested fewer resources compared to its last budget request for 
key basic research programs at the Army, Navy, and Defense Threat 
Reduction Agency (DTRA). This de-emphasis on supporting the kind of 
research that maintains our technological and strategic advantage over 
adversaries developing advanced capabilities puts the military at a 
competitive disadvantage. Condoning this proposed budget will have many 
negative, sustained implications for our National security in the 
short-term and long-term.
    CNSR urges Congress to reject cuts requested in the fiscal Year2023 
budget for the Defense S&T program and increase funding by at least 6 
percent over fiscal Year2022 consistent with the recommendations from 
the National Defense Strategy Commission; \4\ DSB; \5\ National 
Security Commission on Artificial Intelligence (NSCAI); \6\ National 
Academies; \7\ Center for a New American Security (CNAS); \8\ House 
Armed Services Committee's Future of Defense Task Force; \9\ Council on 
Competitiveness; \10\ and American Academy of Arts and Sciences.\11\
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    \4\ https://www.usip.org/sites/default/files/2018-11/providing-for-
the-common-defense.pdf.
    \5\ http://www.dtic.mil/dtic/tr/fulltext/u2/a403874.pdf.
    \6\ https://www.nscai.gov/wp-content/uploads/2021/03/Full-Report-
Digital-1.pdf.
    \7\ https://www.nap.edu/catalog/11463/rising-above-the-gathering-
storm-energizing-and-employing-america-for.
    \8\ https://www.cnas.org/publications/commentary/sharpening-the-u-
s-militarys-edge-critical-steps-for-the-next-administration.
    \9\ https://armedservices.house.gov/--cache/files/2/6/26129500-
d208-47ba-a9f7-25a8f82828b0/6D5C75605DE8DDF0013712923B4388D7.future-of-
defense-task-force-report.pdf.
    \10\ https://www.compete.org/reports/all/202.
    \11\ https://www.amacad.org/sites/default/files/publication/
resources/Perils-of-Complacency_Full-Report_1.pdf.
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               defense basic research pe recommendations
    For decades, the defense basic research programs have provided the 
scientific breakthroughs to give the warfighter the weapons and 
infrastructure needed to succeed. Capabilities that help ensure our 
National security--such as advances in hypersonics testing, various 
quantum technologies, semiconductors critical to defense radar systems, 
solar cell efficiency, laser technologies, stealth capabilities, night 
vision, GPS, sonar, radar, precision munitions, biosensors, and near-
real-time delivery of battlefield information--all derive from defense 
basic research.
    We offer the following recommendations for the key defense basic 
research PEs that serve as the foundation of the defense innovation 
pipeline necessary to maintaining the U.S. military's global 
technological superiority.

                                                [$ in Thousands]
----------------------------------------------------------------------------------------------------------------
                                                                               FY22                   CNSR FY23
            Agency--RDT&E              Program Element (PE)     FY22  BR     Enacted     FY23  PBR     Request
----------------------------------------------------------------------------------------------------------------
Army................................  Defense Research           $297,241     $368,751     $279,328     $392,455
                                       Sciences.
Army................................  University Research         $66,981      $91,241      $70,775      $97,500
                                       Initiatives.
Army................................  University and              $94,003     $126,267     $100,909     $134,888
                                       Industry Research
                                       Centers.
Army................................  Cyber Collaborative          $5,067       $5,067       $5,355       $5,371
                                       Research Alliance.
Army................................  Artificial                  $10,183      $15,183      $10,456      $16,094
                                       Intelligence and
                                       Machine Learning
                                       Basic Research.
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Navy................................  University Research        $117,448     $153,505     $116,816     $185,392
                                       Initiatives.
Navy................................  Defense Research           $484,421     $523,324     $499,116     $554,826
                                       Sciences.
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Air Force...........................  Defense Research           $328,303     $353,303     $375,325     $375,325
                                       Sciences.
Air Force...........................  University Research        $162,403     $187,403     $171,192     $198,647
                                       Initiatives.
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Defense-Wide........................  DTRA Basic Research         $11,828      $11,828      $11,584      $12,538
                                       Initiatives.
Defense-Wide........................  Basic Research              $39,828      $76,702      $62,836      $81,438
                                       Initiatives.
Defense-Wide........................  National Defense           $112,195     $144,841     $132,347     $153,907
                                       Education Program.
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                    university research initiatives
    The fiscal Year2023 budget request would cut University Research 
Initiatives (URIs) across the military services and defense-wide. Given 
that universities and colleges perform the majority (55 percent) of 
DoD-funded basic research,\12\ the type of research that creates 
paradigm shifts in DoD's technological capabilities, cutting URIs this 
significantly will not only harm defense innovation efforts, but also 
workforce development since basic research funding often attracts the 
most creative minds in fields of critical interest to DoD.\13\
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    \12\ https://ncses.nsf.gov/pubs/nsf21329.
    \13\ https://dsb.cto.mil/reports/2010s/BasicResearch.pdf.
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    A program within URIs, the Multidisciplinary University Research 
Initiative (MURI), regularly produces revolutionary military 
technologies and has become an essential skunkworks for creating 
innovation.\14\ Unfortunately, the fiscal year 2023 budget request 
would require cuts to MURIs at levels below fiscal year 2005, adjusted 
for inflation. This will only exacerbate the fact that the program is 
already dramatically underfunded. According to DoD, the MURI program 
received 298 proposals in fiscal year 2021 but was only able to make 36 
awards--leaving 262 proposals unfunded, including proposals with 
potentially game-changing research projects due to a lack of 
appropriations. Not funding potentially revolutionary defense 
scientific research will hurt our ability to maintain global military 
technological superiority.
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    \14\ https://www.ida.org/idamedia/Corporate/Files/Publications/
IDA.../STD/D-5361.pdf.
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    The situation is similar for the Defense University Research 
Instrumentation Program (DURIP), which provides infrastructure and 
equipment support to build universities' capacity to conduct defense-
relevant research. The fiscal year 2023 budget request would also cut 
funding for DURIP. According to DoD, the DURIP program received 742 
proposals in fiscal year 2021 but was only able to make 244 awards--
leaving a staggering 498 proposals unfunded due to a lack of 
appropriations. If universities and colleges do not have the 
infrastructure and equipment necessary to do unique defense research, 
the DoD will potentially lose its biggest source of support for 
developing new capabilities.
                      minerva research initiative
    The Minerva Research Initiative is DoD's signature social science 
basic research program that funds university-led teams to address 
problems of strategic importance to U.S. national security. As noted by 
DoD officials, because many national security challenges are driven by 
complex social dynamics, Minerva is an important source of new ideas to 
better understand social, behavioral, cultural, and political 
considerations that are inherent to our security and stability. The 
fiscal year 2023 budget request supports roughly the level appropriated 
in fiscal year 2022 ($17 million).
    This represents critical, renewed support will enable Minerva to 
conduct research that is aligned with and critical to carrying out the 
NDS in support of Department-wide priorities. Recently funded Minerva 
projects, such as ``Russian Disinformation and Propaganda Campaigns'' 
and ``Empirical Analysis for Meeting Great Power Challenges'' have 
given DoD unique insights that help shape future national security 
policies and better position the warfighter to navigate a complex 
global environment. Despite this exciting support, Minerva is another 
underfunded defense basic research program. According to DoD, in fiscal 
year 2021, Minerva received 220 applications but only funded 17--at 
least 10 projects were determined to be worthy of funding but were not 
funded due to a lack of appropriations.
              defense applied research pe recommendations
    Basic scientific research is just the first step in creating new or 
improving existing military technologies. Researchers, scientists, and 
engineers must apply the fundamental knowledge learned from basic 
research to solve complex military problems and develop the systems and 
components for potential solutions. To that end, we propose to 
highlight the success of the Defense-Wide Manufacturing Science & 
Technology PE, which the fiscal year 2023 budget requests provides a 
mere $1 million increase compared to fiscal year 2022 enacted levels. 
This PE provides DoD's contributions to the Manufacturing USA 
Institutes that help move discoveries from the Nation's universities 
and research laboratories to the defense industrial base while 
strengthening the U.S. workforce. For example, DoD-funded institutes 
have demonstrated enhanced heat exchange capabilities for additive 
manufacturing, addressed cybersecurity supply chain issues, reduced 
weight of armor for military ground vehicles, and developed a first-of-
its-kind advanced functional fiber to enable underwater 
communications.\15\ In fiscal year 2020, the Manufacturing USA 
Institutes conducted more than 500 major applied research and 
development projects of high priority to broad industry sectors. In 
addition, the network had more than 70,000 workers and students 
participate in education and workforce development activities. The 
Manufacturing USA Network is an exemplary program supporting 
implementation of the NDS to enhance the domestic manufacturing and the 
defense industrial base. In order to ensure that discoveries made 
through basic research are translated into practical military 
technologies and capabilities, we offer the following recommendations 
for our priority applied research PEs.
---------------------------------------------------------------------------
    \15\ https://www.nist.gov/publications/manufacturing-usa-20192020-
highlights-report.


                            [$ in Thousands]
------------------------------------------------------------------------
                               Program Element
        Agency--RDT&E                (PE)          CNSR FY23  Request
------------------------------------------------------------------------
Army.........................  Lethality                General Support
                                Technology.
Army.........................  Soldier                  General Support
                                Lethality
                                Technology.
Army.........................  Ground                   General Support
                                Technology.
Army.........................  Next Generation          General Support
                                Combat Vehicle
                                Technology.
Army.........................  High                     General Support
                                Performance
                                Computing
                                Modernization.
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Navy.........................  Marine Corps             General Support
                                Land Force
                                Technology.
Navy.........................  Common Picture           General Support
                                Applied
                                Research.
Navy.........................  Warfighter               General Support
                                Sustainment
                                Applied
                                Research.
Navy.........................  Electromagnetic          General Support
                                Systems
                                Applied
                                Research.
Navy.........................  Ocean                    General Support
                                Warfighting
                                Environmental
                                Applied
                                Research.
Navy.........................  Future Naval             General Support
                                Capabilities
                                Applied
                                Research.
Navy.........................  Manufacturing            General Support
                                Technology
                                Program.
Navy.........................  Advanced                 General Support
                                Undersea
                                Prototyping.
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Air Force....................  Materials......          General Support
Air Force....................  Human                    General Support
                                Effectiveness
                                Applied
                                Research.
Air Force....................  Aerospace                General Support
                                Sensors.
Air Force....................  Directed Energy          General Support
                                Technology.
Air Force....................  Dominant                 General Support
                                Information
                                Sciences and
                                Methods.
Air Force....................  High Energy              General Support
                                Laser Research.
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Defense-Wide.................  Cyber Security           General Support
                                Research.
Defense-Wide.................  Defense-Wide             General Support
                                Manufacturing
                                S&T Program.
------------------------------------------------------------------------

   defense advanced research projects agency (darpa) recommendations
    DARPA's ability to create truly revolutionary new capabilities is 
well documented. AI, microelectronics, speech recognition, touchscreen 
displays, unmanned aerial vehicles, and advanced wireless capabilities 
all stem from DARPA-funded research. DARPA has worked with the academic 
community to create the Internet, computer chips critical to AI 
systems, self-driving cars, stealth technologies, metamaterials, and 
neuro-prosthetics. More recently, DARPA's research was partially 
responsible for developing RNA-based vaccines, which have been critical 
in the global response to COVID-19.\16\ It is safe to say that the 
world would be a different place without DARPA-enabled research. CNSR 
strongly supports robust funding for DARPA. Consistent with the fiscal 
year 2023 budget request, we recommend a funding level of $4.1 billion 
for DARPA to continue supporting game-changing scientific research.
---------------------------------------------------------------------------
    \16\ https://www.appropriations.senate.gov/imo/media/doc/
Tompkinspercent20Statementpercent
20Forpercent20Thepercent20Record.pdf.
---------------------------------------------------------------------------
    Again, thank you for the opportunity to submit outside witness 
testimony as you develop the fiscal year 2023 Defense Appropriations 
bill. Please do not hesitate to contact us if we can be of any 
assistance during the fiscal year 2023 appropriations process.
                                 ______
                                 
               Prepared Statement of The HALO Trust and 
                   Mines Advisory Group (MAG) America
    As the world's largest humanitarian demining organizations, The 
HALO Trust and Mines Advisory Group (MAG) America protect lives and 
restore livelihoods for those threatened by explosive hazards. We 
remove and destroy landmines, improvised explosive devices (IEDs) and 
other explosive remnants of war and help secure weapons that could fall 
into the hands of terrorist groups. For 20 years, HALO and MAG have 
partnered with the U.S. Department of Defense's (DOD) Humanitarian 
Demining Research and Development (HD R&D) Program in more than 10 
countries and territories. This program, implemented by the U.S. Army, 
specializes in developing and testing innovative technologies to detect 
and clear landmines, unexploded ordnance (UXO), and IEDs. These 
technologies increase the effectiveness, efficiency, and safety of 
demining operations for military and humanitarian use--saving lives and 
taxpayer money.
    The HD R&D team designs technologies to respond to technical 
challenges in the field, drawing from new commercial technology, 
equipment currently in use by the DOD, and advanced sensor technology 
available only through other DOD R&D programs. They then trial 
prototypes in real field conditions through partnerships with the 
Department of State's (DOS) humanitarian demining programs. During 
field evaluations, operators provide feedback on the functionality and 
effectiveness of the equipment. This allows HD R&D to modify and 
improve the equipment and increase the U.S. technical capacity to 
respond to explosive threats.
    HD R&D produces four specific outcomes. First, the field evaluation 
process collects data that helps to improve demining technologies used 
by the U.S. Armed Forces and to support geographic combatant commands 
in achieving humanitarian mine action objectives. Second, successfully 
trialed equipment is used to train and equip explosive disposal units 
of the U.S. military as well as allied militaries. By equipping partner 
militaries to address their own explosive threats, U.S. soldiers are 
more likely to remain out of harm's way. Third, HD R&D equipment saves 
civilian lives from landmines, most frequently children, and amplifies 
the impact of American assistance by increasing the amount of clearance 
performed on DOS projects without increasing costs. Fourth, the HD R&D 
program supports American jobs by utilizing American manufactured 
machines and products when possible in their equipment development 
process.
    The HD R&D Program has a track record of success, having performed 
nearly 250 operational field evaluations in 43 countries since 1995. 
The program is responsible for developing advanced technology for the 
Handheld Standoff Mine Detection System (HSTAMIDS), which combines 
metal detection with ground penetrating radar, the rotary mine comb, 
designed to efficiently excavate low metal content anti-vehicle mines, 
and TRAXX, built to cut through hard-to-see tripwires and lift mines 
from soil. Overall, HD R&D equipment has been used to clear more than 
22,000 acres of land, and to destroy more than 396,300 mines and UXO.
    As you know, HD R&D now receives funding from the following 
account: Research, Development, Test & Evaluation, Army/Advanced 
Component Development & Prototypes/PE: 0603920A/Program Title: 
Humanitarian Demining. Due to strong bipartisan support, the program 
received $19 million in Fiscal Year 2022. However, the FY23 President's 
Budget proposes only $8.933 million for HD R&D, which would represent a 
53 percent decrease from the previous year's appropriation, and the 
lowest funding level in over 10 years. This proposed funding reduction 
would substantially curtail the ability of the HD R&D program to 
develop necessary demining equipment that would otherwise protect 
members of the Armed Forces.
    HD R&D equipment has created huge cost savings for humanitarian 
demining programs managed by the State Department through increased 
efficiencies. Through the deployment of HD R&D-developed HSTAMIDS 
detectors, HALO's program in Zimbabwe estimates a cost savings of 
approximately $16 million over the last 5 years and the program was 
able to clear in 5 years what would have otherwise taken eight. The 
Rebel Crusher, a mobile soil sifter and rock crusher used by MAG in 
Lebanon and Iraq has allowed for mine clearance at a rate five times 
faster than with a traditional demining team. Remote-controlled Robocut 
machines, used to cut through tripwires in Ukraine, has accelerated 
clearance rates by an estimated 400 percent. The Wirehound in 
Afghanistan, used to identify hard-to-detect IED components, has 
increased clearance by over 200 percent compared to traditional 
methods. The FAE Mulcher, a vegetation clearing tool being used by MAG 
in Cambodia, can clear 200 percent more area than a single deminer 
using a handheld strimmer. Investing in resources for HD R&D will allow 
humanitarian and military deminers to eliminate threats far more 
quickly.
    Innovative technology developed by HD R&D also protects deminers. 
Advanced machines including the Mini MineWolf and the Medium MineWolf, 
can operate remotely to physically destroy anti-personnel (AP) and 
anti-tank (AT) landmines with no threat to demining personnel.
    This program has a long list of unfunded projects it is waiting to 
trial, including magnetic technology in Iraq, and HD R&D equipment will 
also be essential to demining efforts in Ukraine, where technological 
advancements could support the removal of removing anti-tank mines, and 
clearing trenches and bunkers of explosives.
    We appreciate the support this subcommittee has provided for this 
valuable program, and urge the subcommittee to raise funding to a level 
of $21 million in FY23 for HD R&D. This additional funding will improve 
the ability of U.S. soldiers and our allies' ability to safely detect 
and clear landmines, UXO, and IEDs. This funding is especially 
important as new conflicts uncover new challenges in Ukraine and the 
Middle East.
    Thank you for your consideration of this request.

    [This statement was submitted by Chris Whatley, Executive Director, 
The HALO Trust (USA) and Jamie Franklin, Executive Director, Mines 
Advisory Group (MAG) America.]
                                 ______
                                 
     Prepared Statement of the Human Factors and Ergonomics Society
    On behalf of the Human Factors and Ergonomics Society (HFES), we 
are pleased to provide this written testimony to the Senate 
subcommittee on Defense and Related Agencies for the official record. 
HFES urges the subcommittee to provide robust funding levels for 
Research, Development, Test, and Evaluation (RDT&E) at the Department 
of Defense (DOD) in the fiscal year 2023 appropriations process. 
Specifically, we urge the subcommittee to direct DOD to identify 
opportunities across the services to transition human performance 
research to defense RDT&E activities and acquisition programs to reduce 
cost, strengthen force protection, reduce potential for re-engineering, 
and enhance training.
    HFES and its members believe strongly that investment in scientific 
research serves as an important driver for innovation and the economy, 
and for maintaining American global competitiveness. Accordingly, we 
thank the subcommittee for its longtime recognition of the value of 
scientific and engineering research, and its contribution to innovation 
in the U.S.
           the value of human factors and ergonomics science
    HFES is a multidisciplinary, professional association with over 
4,500 individual members worldwide, including psychologists, 
scientists, engineers, and designers, all with a common interest in 
designing safe and effective systems and equipment that maximize and 
adapt to human capabilities.
    For over 50 years, the U.S. Federal Government has funded 
scientists and engineers to explore and better understand the 
relationship between humans, technology, and the environment. 
Originally stemming from urgent needs to improve the performance of 
humans using complex systems such as aircraft during World War II, the 
field of human factors and ergonomics (HF/E) works to develop safe, 
effective, and practical human use of technology. HF/E does this by 
developing scientific approaches for understanding this complex 
interface, also known as ``human-systems integration.'' Today, HF/E is 
applied to fields as diverse as transportation, architecture, 
environmental design, consumer products, electronics and computers, 
energy systems, medical devices, manufacturing, office automation, 
organizational design and management, aging, farming, health, sports 
and recreation, oil field operations, mining, forensics, and education.
    With increasing reliance by Federal agencies and the private sector 
on technology-aided decision-making, HF/E is vital to effectively 
achieving our National objectives. While a large portion of HF/E 
research exists at the intersection of science and practice-that is, 
HF/E is often viewed more at the ``applied'' end of the science 
continuum-the field also contributes to advancing ``fundamental'' 
scientific understanding of the interface between human decision-
making, engineering, design, technology, and the world around us. The 
reach of HF/E is profound, touching nearly all aspects of human life 
from the health care sector, to the ways we travel, to the hand-held 
devices we use every day.
       human factors and ergonomics at the department of defense
    HFES strongly believes that Federal investments in DOD-funded 
research will have a direct and positive impact on national security, 
the economy, and the overall safety and well-being of Americans. For 
this, HFES supports robust funding for DOD RDT&E programs, including 
HF/E research programs across the Services to encourage further 
advancements in technology and safety, among other areas.
    With the creation of the Department of Defense Human Factors 
Engineering Technical Group (DOD HFE TAG), DOD has demonstrated the 
value it places on the inclusion of HF/E-related research and has 
acknowledged the benefit of interagency collaboration, as it relates to 
RDT&E in this field. DOD HFE TAG is comprised of technical 
representatives from DOD, the National Aeronautical and Space 
Association (NASA), the Federal Aviation Administration (FAA), the 
Department of Homeland Security (DHS), and the Department of Veterans 
Affairs (VA).
    The scope of this working group is broad, making its benefits 
diverse. The goals of DOD HFE TAG are to:
  --Provide a mechanism for the timely exchange of technical 
        information in the development and application of human factors 
        engineering.
  --Enhance coordination among government agencies involved in HF/E 
        technology research, development, and application.
  --Assist in the preparation and coordination of tri-service 
        documents, and sponsor in-depth interaction, which aids in 
        identifying HF/E technical issues and technology gaps.
    In addition, the American National Standards Institute recently 
approved ANSI/HFES 400-2021, the Human Readiness Level Scale in System 
Development Process. This standard, created by HFES, defines the nine 
levels of the Human Readiness Level (HRL) scale and provides guidance 
for their application in the context of systems engineering and human 
systems integration processes. The HRL scale both complements and 
supplements the existing Technology Readiness Level scale to evaluate, 
track, and communicate the readiness of a technology or system for safe 
and effective human use.
    HFES strongly believes that all DOD programs developing new 
technologies should be required to report to the Department on the HRL 
of their systems on an annual basis. The HRL should be reported for 
each major component of new military systems, and should be used to 
identify deficiencies and areas where additional attention to human-
system integration is warranted to reduce risks to program schedules, 
human safety, and effectiveness. DOD's HRL scale should correspond to 
the requirements set forth in ANSI/HFES 400-2021. By incorporating this 
standard DOD will better understand if needed human-system integration 
activities have been conducted before deploying new national security 
systems and technologies.
    Continuing to prioritize HF/E research at DOD, along with 
incorporating the Department's use of the HRL system would undoubtedly 
produce positive impacts on the safety and well-being of American 
citizens.
                               conclusion
    Given DOD's critical role in supporting fundamental research and 
development across defense and engineering disciplines, HFES supports 
robust funding levels for DOD RDT&E programs, especially those that 
specifically fund human factors RDT&E activities, in fiscal Year2023 as 
well as improvements to the inclusion of human systems integration in 
acquisition programs. These investments fund important research 
studies, enabling an evidence base, methodology, and measurements for 
improving organizational function, performance, and design across 
sectors and disciplines.
    On behalf of the HFES, we would like to thank you for the 
opportunity to provide this testimony. Please do not hesitate to 
contact us should you have any questions about HFES or HF/E research. 
HFES truly appreciates the subcommittee's long history of support for 
scientific research and innovation.

    [This statement was submitted by Christopher R. Reid, President and 
Steven C. Kemp, CAE, Executive Director, Human Factors and Ergonomics 
Society.]
                                 ______
                                 
   Prepared Statement of the Joint Baltic American National Committee
    Dear Chairman Tester, Ranking Member Shelby, and Members of the 
subcommittee:
    The Joint Baltic American National Committee, Inc. (JBANC), 
representing the Baltic-American community, has worked closely with 
Congress since 1961 to enhance United States policy towards Estonia, 
Latvia, and Lithuania.
    As the subcommittee considers appropriations for the fiscal year 
2023, we remain very grateful for the unwavering and enduring support 
that the United States has shown to the Baltic countries.
    This week's NATO Summit in Madrid has only strengthened the 
commitment of the United States and other allies to NATO's eastern 
flank. On June 29, President Biden announced the following additional 
long-term U.S. commitments to bolster European security with respect to 
the Baltic region: enhancement of rotational deployments--which include 
armored, aviation, air defense, and special operations forces--to 
reinforce Baltic security, enhance interoperability, and demonstrate 
the flexibility and combat readiness of U.S. forces. Furthermore, the 
United States commits to maintaining a persistent, boots on the ground 
presence in the region and will intensify training with our Baltic 
allies to maintain combat-credible capabilities.
    This support is extremely timely and is of great strategic 
importance for Estonia, Latvia, and Lithuania, and sends an important 
message of deterrence to Russia. U.S. security assistance remains 
existentially critical for the Baltic countries in being able to defend 
against escalating threats from Russia. The Baltic American community 
is especially grateful for continued strong language on security 
assistance to the Baltic countries' capability development in the draft 
FY23 National Defense Authorization Act.
    This year, S.3950, the bipartisan ``Baltic Defense and Deterrence 
Act'' (BDDA) has been introduced to codify the Baltic Security 
Initiative (BSI) into law, providing $250 million per fiscal year 
(2023-2027) to strengthen the Baltic State's conventional military 
capabilities, especially in reconnaissance, air defense, and maritime 
domain awareness. This assistance comes at a critical time as Russia 
continues to execute its illegal, brutal, and unprovoked invasion of 
Ukraine and engages in increasing war-like rhetoric and actions against 
our Eastern European allies. The bill will discourage further Russian 
threats against NATO territory by demonstrating U.S. resolve for Baltic 
security and providing credible military deterrence against Russian 
military provocations along NATO's eastern borders. We urge the 
subcommittee to support these levels for the Baltic countries.
    The bill also supports enhanced U.S.-Baltic security and economic 
ties. If enacted, it would provide $60 million per fiscal year (2023-
2027) to support the Baltic Security and Economic Enhancement 
Initiative, which aims to mitigate economic coercion by Russia and 
China, encourage new opportunities for foreign direct investment and 
U.S. business ties, and bolster Baltic energy security needs.
    We believe that this legislation is important to demonstrate to the 
terrorist Kremlin regime that the Baltic region remains an important 
U.S. national security interest. It will help emphasize the strong 
connection between the Baltic countries and the United States, 
particularly this year when the countries mark their 100 years of 
diplomatic relations.
    It bears repeating that every Estonian, Latvian and Lithuanian 
knows that freedom cannot be taken for granted. Besides their ongoing 
commitment to invest increasing amounts above 2 percent of GDP for 
defense, the Baltic countries have been outstanding in delivering their 
own stocks of weapons and materials to Ukraine to help that country 
continue to defend itself.
    Thank you for the opportunity to address the subcommittee, and for 
your efforts on this important area in transatlantic security. We look 
forward to working with you on this issue. If you or your staff have 
any questions, please contact us.

    [This statement was submitted by Karl Altau, Managing Director, 
Joint Baltic American National Committee, Inc.]
                                 ______
                                 
           Prepared Statement of Manufacturing Times Digital
    On behalf of Manufacturing times Digital (MxD), the National Center 
for Cybersecurity in Manufacturing, we are pleased to provide this 
written testimony to Senate Appropriations subcommittee on Defense for 
the official record.
    MxD urges the subcommittee to provide at least an additional $6 
million for CMMC \1\ Compliance for Cybersecurity in Manufacturing in 
the fiscal year 2023 defense appropriations bill.\2\ It is essential 
that the Nation prioritizes ensuring that small and medium-sized 
manufacturers (SMMs) and enterprises (SMEs) are equipped with the 
knowledge and tools to help them achieve and maintain Department of 
Defense (DoD) CMMC compliance to protect sensitive national security 
information throughout the defense industrial base and to maintain and 
grow the number of suppliers within the defense industrial base.
---------------------------------------------------------------------------
    \1\ Cybersecurity Maturity Model Certification. https://
www.acq.osd.mil/cmmc/index.html.
    \2\ Program Element 0603680D8Z, Line 54, Defense Wide Manufacturing 
Science and Technology Program.
---------------------------------------------------------------------------
    Manufacturing Times Digital (MxD) is a DoD manufacturing innovation 
institute focused on enhancing the global competitiveness of U.S. 
manufacturing by developing and deploying advanced digital 
manufacturing technologies, educating the present and future workforce, 
and securing the U.S. supply base. MxD was launched in February 2014 as 
the second national manufacturing innovation institute, a network known 
as Manufacturing USA. Through our over 300 partnerships, which includes 
the DoD, industry, academia, non-profit organizations, and other 
government stakeholders, MxD integrates multiple digital technologies 
and systems, helping manufacturers improve their operations and driving 
systemic productivity improvements. Developing strong cybersecurity 
practices among manufacturers only addresses part of the problem. For 
the long term, MxD and its partners are focused on the development of a 
U.S. workforce pipeline that can drive and support cybersecurity 
hygiene in manufacturing.
     mxd and the cybersecurity maturity model certification (cmmc)
    MxD strongly believes that investment to help SMMs and SMEs reach 
compliance with the CMMC framework is absolutely necessary to ensure 
that they are not left behind when compliance is required for every 
funding opportunity and contract receiver by October 2025. CMMC 
framework of standards for cybersecurity practices across the Defense 
Industrial Base (DIB), whose organizations contract with and support 
the DoD. The goal of CMMC is to enhance the protection of national 
security information, including Federal Contract Information (FCI) and 
Controlled Unclassified Information (CUI), across the supply chain 
through a standard assessment model and framework for compliance. The 
CMMC program was developed in response to concerns about cyberattacks 
against potentially vulnerable contractors and organizations that 
support DoD.
    Earlier this year, Deputy Secretary of Defense Kathleen Hicks 
warned that over the last 10 years, the U.S. defense industrial base 
lost more than 40 percent of its suppliers and that further attrition 
is possible if that trend continues.\3\ Investment to ensure that 
cybersecurity compliance does not become a barrier to entering or 
remaining in the defense industrial base must be made now.
---------------------------------------------------------------------------
    \3\ Pentagon worried about mergers, especially among hypersonic 
weapons suppliers. https://www.defensenews.com/pentagon/2022/02/15/
pentagon-worried-about-mergers-especially-among-hypersonic-weapons-
suppliers/.
---------------------------------------------------------------------------
    MxD, as the DoD-designated National Center for Cybersecurity in 
Manufacturing (NCCM), is eager and equipped to help SMMs and SMEs not 
only achieve appropriate CMMC status but also evaluate their current 
cyber posture by identifying opportunities to improve upon their cyber 
hygiene, and providing the appropriate tools to react to additional 
requirements from DoD and the CMMC-AB. MxD respectively asks the 
committee to consider funding a suite of resources for free to SMMs and 
SMEs to help them comprehensively achieve and maintain all levels of 
CMMC compliance. These will include:
  --Webinars, videos, and other on-demand training content, vetted and 
        verified as CMMC-compliant to provide to manufacturers and DIB 
        entities within Illinois and beyond, including through 
        collaborative outreach efforts with organizations like the 
        Manufacturing Extension Partnerships and IMEC.
  --Assessment tools to evaluate current cybersecurity posture and 
        identify security capabilities for hundreds of SMEs that 
        require improvements via a Plan of Action & Milestone document 
        resource and provide data to aggregate and understand the 
        changing picture of cybersecurity compliance within the DIB.
  --Development and distribution of at least five new cybersecurity 
        roles, pathways, profiles, and training curriculum specific to 
        the cybersecurity needs of small businesses, expanding the 
        existing MxD Hiring Guide for Cybersecurity in Manufacturing.
  --Recommended, MxD-approved lists of cybersecurity software and 
        products, such as VPNs, firewalls, server security suites, 
        endpoint protection, and more.
  --Subscriptions to specialized MxD Cyber/NCCM content on the latest 
        developments in cybersecurity, cyber threats, and major issues 
        relevant to DIB manufacturing cybersecurity.
  --Dedicated and vetted cybersecurity experts to facilitate tabletop 
        exercises providing validation and improvement opportunities to 
        SMMs with established security capabilities.
             the value of cmmc compliance for smes and smms
    With rapidly growing numbers of companies avoiding Federal 
competitions because of onerous compliance requirements and a 
corresponding glut cybersecurity information that requires specialized 
knowledge for implementation that many companies do not possess, there 
is no central clearinghouse for products, services, and resources 
available to help SMMs achieve CMMC compliance. Without ample, 
sophisticated, and accessible resources for CMMC compliance, the Nation 
risks losing essential suppliers from the DIB because they do not want 
to take on the burden and confusion of implementing CMMC requirements.
    Given initial confusion during DoD's rollout of CMMC in 2020, the 
simplification of its CMMC requirements in 2021 was a welcome change 
for SMMs and SMEs. However, CMMC is still a burden to many businesses, 
especially SMMs, who do not have resources or robust internal processes 
for ensuring cybersecurity awareness and hygiene. While it's important 
to ensure cybersecurity at every step of the supply chain, CMMC 
requirements could limit future participation of SMMs and SMEs in the 
DIB. That is why the implementation of a program proposed is crucial to 
ensure that SMMs and SMEs continue to have a role in the future within 
the DoD.
                               conclusion
    Given MxD's role in supporting SMMs and SMEs across the country, 
MxD respectfully requests the allocation of an additional $6 million of 
funding for CMMC Compliance for Cybersecurity in Manufacturing within 
the Defense-Wide Manufacturing Science and Technology Program to create 
resources and tools to help them reach mandatory CMMC compliance.
    On behalf of MxD, we would like to thank you for the opportunity to 
provide this testimony. Please do not hesitate to contact us should you 
have any questions. MxD truly appreciates the subcommittee's long 
history of support of the USA Manufacturing Institutes and our work in 
areas such as cyber, supply chains, 5G, and workforce development.

    [This statement was submitted by Berardino Baratta, CEO, Federico 
Sciammarella, President and CTO, and Jennifer Pilat, Vice President of 
Strategy and Engagement, MxD.]
                                 ______
                                 
    Prepared Statement of the National Congress of American Indians
    On behalf of the National Congress of American Indians (NCAI), 
thank you for this opportunity to provide testimony on fiscal year 2023 
funding for the Department of Defense (DoD). DoD has a long and varied 
history of relations with Tribal Nations and Tribal lands. Native 
Americans' service in the military is disproportionately higher than 
other groups' service. Yet, DoD operations have intersected and 
impacted Tribal lands, creating a dichotomy of honor and service 
alongside the destruction of cultural identity and resources. DoD also 
administers government-wide programs critical to economic development 
for Indian Country.
    In 2018, the U.S. Commission on Civil Rights (USCCR) found that 
Federal programs and services serving Indian Country continue to be 
underfunded and Federal initiatives for Native Americans have regressed 
in some ways.\1\ The USCCR report also States that many Native 
Americans face unique challenges and harsh living conditions resulting 
from the United States having removed their Tribal Nations to locations 
without access to adequate resources and basic infrastructure upon 
which their Tribal governments can foster thriving communities.\2\ In 
its initial 2003 A Quiet Crisis report, the USCCR summarized the 
funding shortfall to which Native Americans were subjected, stating 
that, ``laws and policies are meaningless without resources to enforce 
them. Resources are an important demonstration of the U.S. government's 
commitment to its responsibilities, including the obligation to 
preserve civil and other rights . . . [u]nder-funding violates the 
basic tenets of the trust relationship between the [Federal] Government 
and Native peoples and perpetuates a civil rights crisis in Indian 
Country.'' \3\ Due to infringements on Tribal sovereign tax 
jurisdiction, Tribal governments essentially have no tax base and are 
currently unable to utilize traditional economic development tools-e.g. 
tax abatements-to stimulate private sector investment. Instead, Tribal 
Nations largely rely on economic development to generate the revenue 
that other governments take for granted.
---------------------------------------------------------------------------
    \1\ U.S. Commission on Civil Rights, Broken Promises: Continuing 
Federal Funding Shortfall for Native Americans, 3-4, available at: 
https://www.usccr.gov/files/pubs/2018/12-20-Broken-Promises.pdf, 
accessed on: May 25, 2022.
    \2\ Id. at 1.
    \3\ Id. at 2.
---------------------------------------------------------------------------
    Cross-referencing OMB Native American Crosscut data with 
Appropriations Committee reports reveals that fiscal Year2022 spending 
for Native American programs represents approximately 0.84 percent of 
total regular budget authority, and approximately 0.01 percent of total 
regular appropriations budget authority within this subcommittee's 
jurisdiction. With Federal investment metrics such as these, it is no 
surprise that Indian Country is in a State of catastrophe by national 
standards.


    Despite this chronic underinvestment, Indian Country is an 
important economic contributor to national, State, and local 
economies.\4\ Collectively, Tribal Nations comprise the 13 largest 
employers in the United States, with Tribal businesses employing more 
than 700,000 employees, providing economic opportunity for both Native 
and non-Native workers.\5\ Evidence indicates that where Tribal Nations 
are successful with economic development that poverty rates and other 
health issues are lower, while educational outcomes and real per capita 
income are higher.\6\ Further, revenue generated on Tribal lands 
results in a spillover effect that supports local workforces and 
generates tax revenue for surrounding communities.\7\ Ultimately, 
prosperity for Indian Country increases market penetration across 
sectors and productivity in the American labor market, as well as 
improves outcomes associated with other Federal spending that maximize 
value ratios of Federal input to desired output--in simple terms, good 
governance.
---------------------------------------------------------------------------
    \4\ Patrice H. Kunesh, Getting real about Indian Country--
surprising progress in the heartland, https://indiancountrytoday.com/
opinion/getting-real-about-indian-country-surprising-progress-in-the-
heartland, Accessed: April 6, 2022.
    \5\ Id.
    \6\ Id.
    \7\ Id.
---------------------------------------------------------------------------
    The Indian Financing Act Incentives Program, funded through the 
annual Defense Appropriations law, provides funding for additional 
compensation to Native-owned contractors or suppliers to promote 
economic growth in Indian Country and fairness in government 
contracting. In fiscal Year2022, the Indian Financing Act Incentives 
Program received $25 million. Funding for the program has not received 
an increase in the last 4 years, clearly indicating that the program 
has lost purchasing power due to inflation. Similarly, American Indian 
Procurement Technical Assistance Centers provide the training and 
technical assistance necessary to enhance the successes of the Indian 
Incentives Program; however, the program has similarly been flat-funded 
at $4.5 million for the last four fiscal years. NCAI recommends that 
Congress provide $50 million for the Indian Financing Act Incentives 
Program and $5 million for American Indian Procurement Technical 
Assistance Centers.
    Past and current DOD operational and training activities have had 
and continue to have an adverse effect on Tribal environmental health 
and safety, economic, social and cultural welfare. The Native American 
Lands Environmental Mitigation Program (NALEMP) addresses environmental 
impacts on Indian lands from former DOD activities seeking maximum 
Tribal participation through government-to-government consultation. 
NALEMP addresses the impacts of hazardous materials, munitions debris, 
unsafe buildings or structures, lead-based paint or asbestos, and 
abandoned equipment. Unfortunately, the program has been flat-funded at 
$12 million per year since 1993, losing more than half of its 
purchasing power due to inflation. NCAI recommends that Congress 
provide at least $25 million for the mitigation of ongoing 
environmental impacts on Indian lands resulting from DOD activities.
                               conclusion
    Our people have paid for every penny obligated to Indian Country 
hundreds of times over by providing this nation with our land. In order 
for this nation to uphold its promises to its people, it must first 
uphold its promise to this land's First People. We expect to continue 
to be treated as sovereign nations and with governmental parity. When 
we work together, we can achieve so much. We must now continue down 
that path of Nation-to-Nation growth-only then will all of our people 
be able to fully flourish.

    [This statement was submitted by Larry Wright, Jr., Director of 
Leadership 
Engagement and Interim CEO, National Congress of American Indians.]
                                 ______
                                 
          Prepared Statement of the Neurofibromatosis Network
    Thank you for the opportunity to submit testimony to the 
subcommittee on the importance of continued funding for the Department 
of Defense's Peer-reviewed Neurofibromatosis (NF) Research Program 
(NFRP). NF is a terrible genetic disorder closely linked to many common 
diseases widespread among the American population. The highly 
successful Neurofibromatosis Research Program has shown tangible 
results and direct military application with broad implications for the 
general population.
    On behalf of the Neurofibromatosis (NF) Network, a national 
organization of NF advocacy groups, I speak on behalf of the 120,000 
Americans who suffer from NF as well as the millions of Americans who 
suffer from diseases and conditions linked to NF such as cancer, brain 
tumors, heart disease, memory loss, bone abnormalities, deafness, 
blindness, and psychosocial disabilities, such as autism and learning 
disabilities. Thanks in large part to this subcommittee's strong 
support, scientists have made enormous progress since the discovery of 
the NF1 gene in 1990 resulting in clinical trials now being undertaken 
by the NFRP.
    In fiscal year 2023, we are requesting at least $25 million for the 
Peer-reviewed Neurofibromatosis Research Program (NFRP). The NFRP is 
now conducting clinical trials at nation-wide clinical trials centers 
created by NFRP funding. These clinical trials involve drugs that have 
already succeeded in eliminating tumors in humans and rescuing learning 
deficits in mice. In addition, in March 2020, the Food and Drug 
Administration approved the first ever drug, co-developed by NIH and 
AstraZeneca, with seed money from the NFRP, for the treatment of 
plexiform tumors in neurofibromatosis type 1 (NF1). Administrators of 
the Army program have stated that the number of high-quality scientific 
applications justify a much larger program. For these reasons, it is 
imperative that we continue to invest in research if we are to advance 
toward treatments and a cure for the numerous diseases associated with 
NF.
                    what is neurofibromatosis (nf)?
    NF is an unpredictable genetic disorder of the nervous system that 
affects almost every organ system in the body. There are three types of 
NF: NF1, which is more common, NF2, which initially involves tumors 
causing deafness and balance problems, and Schwannomatosis, the 
hallmark of which is severe pain. NF causes tumors to grow along nerves 
including in the skin, just below the skin, and in the brain and spinal 
cord. NF is the most common neurological disorder caused by a single 
gene and affects more people than Cystic Fibrosis, hereditary Muscular 
Dystrophy, Huntington's disease and Tay Sachs combined. It strikes 
worldwide, without regard to gender, race or ethnicity. Approximately 
50 percent of new NF cases result from a spontaneous mutation in an 
individual's genes and 50 percent are inherited.
    NF can cause a myriad of devastating clinical problems including 
nerve and brain tumors; disfiguring skin growths; inability to heal 
after bone fracture, which may ultimately require amputation; 
psychosocial disabilities, including autism and learning disabilities; 
unmanageable chronic pain; deafness; blindness; cardiovascular defects; 
vascular disease; and paralysis. NF gene mutations are also important 
'drivers' of cancers in the lungs, liver, brain and breast.
                    nf's connection to the military
    Neurofibromatosis (NF) has become a clinical 'model' for advancing 
medical research. The genetic information learned from NF holds the key 
to understanding a number of health issues that benefit the war 
fighter, as well as the general population, including cancer, bone 
fracture and repair, vascular disease, nerve regeneration, behavior and 
psychosocial issues, and pain.
    The Neurofibromatosis Research Program (NFRP) is providing critical 
research that directly benefits the War Fighter including:
    Bone Repair.--At least a quarter of children with NF1 have abnormal 
bone growth in any part of the skeleton. In the legs, the long bones 
are weak, prone to fracture and unable to heal properly; this can 
require amputation at a young age. Adults with NF1 can have low bone 
mineral density, placing them at risk of skeletal weakness and injury. 
The NFRP is a strong supporter of NF1 bone defects research and as a 
result this field has made significant progress in the past few years. 
Bone fractures sustained by the war fighter and how to repair them is 
of interest to the military. Research studies will identify new 
information about understanding bone biology and repair and will pave 
the way to new strategies to enhancing bone health and facilitating 
repair.
    Pain.--Severe and unmanageable pain is seen in all forms of NF, 
particularly in schwannomatosis, and significantly impacts quality of 
life. NF research has shown similarities between NF pain and phantom 
limb pain. NFRP funding has been critical in supporting this. Chronic 
pain, and how to treat it effectively, is one of the most poorly 
understood areas of medicine but has very high relevance to those in 
the military recovering from service-related injuries. NF Research in 
this area could help identify new ways to target pain effectively with 
the right drugs or therapies.
    Vascular Disease.--NF1 elevates the risk of vascular disease 
including aneurysm, stroke and vessel occlusive disease. NF1 
predisposes patients to early cardiovascular disease, which is also the 
leading cause of death among United States Veterans. NF research has 
demonstrated that when treating affected NF mouse models with an 
antioxidant medication it reduced vessel disease. Discoveries related 
to cardiovascular disease in NF1 are likely to be more broadly 
informative, including for veterans and active duty military personnel.
    Psychosocial and Cognitive Disabilities.--In the last couple of 
years, NFRP research has revealed common threads between NF1 learning 
disabilities, autism and other related disabilities. Research being 
done within the NF Clinical Trials Consortium, NFRP created clinical 
centers, has led to important findings and expanded research in this 
area. This research contributes to our broadening understanding of how 
brain signaling can impact on behavior and psychosocial difficulties. 
Members of the military returning from service can suffer from 
psychological trauma and it is not easy to understand how this can be 
effectively treated. As we learn more from the NF population about 
psychosocial function, we will be able to shed light on this area for 
the benefit of the military.
    Nerve Tumors and Repair.--Nerves are the most common location for 
tumor development amongpatients with NF1, NF2, and schwannomatosis. 
Tumor growth alone, or treatments for the same, commonly cause nerve 
injury and associated deficits. Identifying mechanisms to improve 
nerverepair would benefit patients with NF, as well as advance the 
science needed to better treat nerve injury common in warfighters.
                    dod' contribution to nf research
    While other Federal agencies support medical research, the 
Department of Defense (DoD) fills a special role by providing peer-
reviewed funding for innovative and rewarding medical research through 
the Congressionally Directed Medical Research Program (CDMRP). CDMRP 
research grants are awarded to researchers in every State in the 
country through a competitive two-tier review process. These well-
executed and efficient programs, including the NFRP, demonstrate the 
government's responsible stewardship of taxpayer dollars.
    Recognizing NF's importance to both the military and to the general 
population, Congress has given the NF Research Program strong 
bipartisan support. From FY1996 through FY2022 funding for the NFRP has 
amounted to $402.85 million, in addition to the original $8 million 
appropriated in FY1992. In addition, between FY1996 and FY2020, 451 
awards have been granted to researchers across the country.
    The CDMRP funds innovative, groundbreaking research which would not 
otherwise have been pursued, and has produced major advances in NF 
research, including conducting clinical trials in a nation-wide 
clinical trials infrastructure created by NFRP funding, development of 
advanced animal models, and preclinical therapeutic experimentation. 
Because of the enormous advances that have been made as a result of the 
NFRP, research in NF has truly become one of the great success stories 
in the current revolution in molecular genetics. In addition, the 
program has brought new researchers into the field of NF. However, 
despite this progress, Army officials administering the program have 
indicated that they could easily fund more applications if funding were 
available because of the high quality of the research applications 
received.
    In order to ensure maximum efficiency, the Army collaborates 
closely with other Federal agencies that are involved in NF research, 
such as the National Institutes of Health (NIH). Senior program staff 
from the National Institute of Neurological Disorders and Stroke 
(NINDS), for example, sit on the Army's NF Research Program Integration 
Panel which sets the long-term vision and funding strategies for the 
program. This assures the highest scientific standard for research 
funding, efficiency and coordination while avoiding duplication or 
overlapping of research efforts.
    Thanks in large part to this subcommittee's support, scientists 
have made enormous progress since the discovery of the NF1 gene. Major 
advances in just the past few years have ushered in an exciting era of 
clinical and translational research in NF with broad implications for 
the general population. These recent advances have included:
  --In March 2020 the Food and Drug Administration approved the first 
        ever drug, co-developed by NIH and AstraZeneca, with seed money 
        from the NFRP, for the treatment of plexiform tumors in 
        neurofibromatosis type 1 (NF1).
  --Phase II and Phase III clinical trials involving new drug therapies 
        for both cancer, hearing tumors, vision tumors, bone graft and 
        cognitive disorders.
  --Establishment of the Neurofibromatosis Clinical Trial Consortium 
        which includes an operation center and 25 clinical sites. 
        Allows for partnerships with well-established NF Centers, 
        pooling expertise and resources, quicker turn arounds of 
        scientific reviews and regulatory approvals, leveraged work 
        with pharmaceutical companies all towards the common goal of 
        new treatments and a cure for Neurofibromatosis.
  --Successful elimination of tumors in NF1 and NF2 mice with the same 
        drug.
  --Development of advanced mouse models showing human symptoms.
  --Rescue of learning deficits in mice with an already existing well 
        known drug.
  --Determination of the biochemical, molecular function of the NF 
        genes and gene products.
  --Connection of NF to numerous diseases because of NF's impact on 
        many body functions.
                        fiscal year 2023 request
    The highly successful NF Research Program has shown tangible 
results and direct military application with broad implications for the 
general population. The program has now advanced to the translational 
and clinical research stages, which are the most promising, yet the 
most expensive direction that NF research has taken. Therefore, 
continued funding is needed to continue to build on the successes of 
this program, and to fund this promising research thereby continuing 
the enormous return on the taxpayers' investment.
    We respectfully request that you include at least $25 million in 
the Fiscal Year 2023 Department of Defense Appropriations bill for the 
Peer-reviewed Neurofibromatosis Research Program. With this 
subcommittee's continued support, we will prevail. Thank you for your 
support.

    [This statement was submitted by Kim Bischoff, Executive Director, 
Neurofibromatosis Network.]
                                 ______
                                 
       Prepared Statement of the Society of Gynecologic Oncology
    The Society of Gynecologic Oncology (SGO) appreciates the 
opportunity to provide outside witness testimony to the Senate 
Committee on Appropriations subcommittee on Defense for the fiscal year 
2023 defense appropriations bill. As you begin work on fiscal year 2023 
appropriations, we respectfully request that you provide $50 million 
for the Department of Defense (DoD) Ovarian Cancer Research Program and 
establish a separate line-item program for endometrial cancer research 
under the Congressionally Directed Medical Research Program (CDMRP) 
with $10 million in initial appropriations.
    The SGO is the premier medical specialty society for health care 
professionals trained in the comprehensive management of gynecologic 
cancers. The SGO's 2,000 members, who include physicians, nurses, and 
other advanced practice providers, represent the entire oncology team 
dedicated to the treatment and care of patients with gynecologic 
cancers. The SGO's strategic goals include advancing the prevention, 
early diagnosis, and treatment of gynecologic cancers by establishing 
and promoting standards of excellence. Key priorities for the SGO are 
to advocate for more equitable care for all patients and to support 
research aimed at improving outcomes for diverse patient populations.
  appropriate $50 million for the dod ovarian cancer research program
    Ovarian cancer is the fifth leading cause of cancer-related death 
in women and the deadliest of gynecologic cancers. More than 85 percent 
of women are diagnosed in later stages because there is currently no 
early detection test for ovarian cancer. Consequently, nearly 25 
percent of women diagnosed with ovarian cancer will die within a year, 
and less than 50 percent will survive 5 years. In the military, 
gynecologic cancers represent 12 percent of all cancer identified in 
women, and ovarian cancer is one of the most common diagnoses.\1\
---------------------------------------------------------------------------
    \1\ Leah L. Zullig, PhD, MPH, Karen M. Goldstein, MD, MSPH, Kellie 
J. Sims, PhD, MS, Christina D. Williams, PhD, Michael Chang, MD, Dawn 
Provenzale, MD, MHS, and Michael J. Kelley, MD5, J Womens Health 
(Larchmt). 2019 Feb 1; 28(2): 268-275.
---------------------------------------------------------------------------
    The DoD Ovarian Cancer Research Program (OCRP) continues to support 
high impact, innovative research that promotes readiness for military 
members and their families, as well as the overall health of all 
Americans. The OCRP not only supports research to address health 
disparities and improve access to quality care and treatment for those 
diagnosed with ovarian cancer, but it also aims to develop and improve 
screening and diagnostic methods. The program has funded key studies 
that have led to new discoveries and advancements in the treatment and 
understanding of ovarian cancer, including the Food and Drug 
Administration (FDA) approval of Rucaparib, an oral therapy for the 
treatment of advanced ovarian cancer, and OVA1, a blood test combined 
with imaging to identify patients at risk for malignant ovarian cancer. 
To date, the OCRP has resulted in over 1,583 peer-reviewed publications 
and 103 patent applications.
    For these reasons, the SGO is thankful that Congress provided $45 
million for the DoD OCRP in fiscal year 2022, and we request that you 
provide $50 million in fiscal year 2023 to preserve current and support 
future investments in ovarian cancer research. This funding will help 
to advance studies suspended by the COVID-19 pandemic and allow for the 
pursuit of new research to improve the early diagnosis, treatment, and 
survival rates from ovarian cancer.
  support endometrial cancer research by creating a dedicated funding 
                                  line
    Endometrial cancer is the most common gynecological cancer and the 
fourth most common cancer in women. Endometrial cancer has increased in 
the U.S from 40,000 to over 60,000 new cases in the past 10 years. The 
Centers for Disease Control and Prevention reports that endometrial 
cancer deaths have increased 21 percent since 1999.\2\ Its incidence 
and mortality rates are continuing to rise, and the American Cancer 
Society estimates that in 2022 there will be approximately 65,950 new 
cases of endometrial cancer in this country and approximately 12,550 
U.S. women will die from this disease.
---------------------------------------------------------------------------
    \2\ Henley SJ, Miller JW, Dowling NF, Benard VB, Richardson, LC. 
Uterine cancer incidence and mortality--United States, 1999-2016. MMWR 
Morb Mortal Wkly Rep 2018; 67(48): 1333-1338.
---------------------------------------------------------------------------
    Greater prevalence of key risk factors, such as obesity and shifts 
in reproductive trends among women, including delayed childbirth and 
having fewer children, are believed to be contributing to the increased 
incidence of endometrial cancer. While other cancers have shown 
improvements in the number of deaths over time, the National Cancer 
Institute's Surveillance, Epidemiology and End Results Program shows a 
worsening survival rate from endometrial cancer for 1996-2016.\3\
---------------------------------------------------------------------------
    \3\ National Cancer Institute. Surveillance, Epidemiology, and End 
Results Program. Cancer Stat Facts: Uterine Cancer. Available at: 
https://seer.cancer.gov/statfacts/html/corp.html. Last queried February 
13, 2020.
---------------------------------------------------------------------------
    Further, endometrial cancer has a disparate impact on women of 
color as the incidence rate for Black women surpassed that of White 
women in 2007 and continues to increase each year.\4\ The incidence of 
the more aggressive Type II cancers is dramatically higher for Black 
women than for White women. Mortality rates and 5-year survival rates 
are also much worse for Black women. The age-adjusted mortality among 
Black women is approximately 84 percent higher.\5\
---------------------------------------------------------------------------
    \4\ Clarke MA, Devesa SS, Harvey SV, Wentzensen N. Hysterectomy-
corrected uterine corpus cancer incidence trends and differences in 
relative survival reveal racial disparities and rising rates of 
nonendometrioid cancers. J Clin Oncol 2019; 37(22): 1895-1908.
    \5\ Ries LAG, Eisner MP, Kosary CL, eds, et al. SEER cancer 
statistics review, 1973-1998. Bethesda, MD: National Cancer Institute; 
2001. [Google Scholar]
---------------------------------------------------------------------------
    The Veterans Health Administration (VHA) is a high-volume provider 
of cancer care and women are the fastest growing patient population 
utilizing VHA services, growing from 159,810 in 2001 to over 550,000 
today.\6\ In the U.S. military, there are over 213,000 women who 
currently serve as active-duty personnel, accounting for 16 percent of 
the total force, and Black women now constitute nearly one third of all 
women in the U.S. armed forces.\7\ In 2010, the Journal of Women's 
Health reported that among women treated in the VHA, gynecologic 
cancers were 12 percent of all cancer identified in women in the VA 
system. Among gynecological cancers, endometrial cancer was the most 
diagnosed, followed by ovarian, cervical, and other gynecological 
malignancies.\8\ Based on this data, the military population should 
experience a similar increase in endometrial cancer rates as in the 
general population.
---------------------------------------------------------------------------
    \6\ https://www.womenshealth.va.gov/WOMENSHEALTH/
WomensHealthServices/healthcare_
about.asp.
    \7\ Eileen Patten and Kim Parker, Women in the U.S. Military: 
Growing Share, Distinctive Profile, Pew Research Center, 2011, http://
www.pewsocialtrends.org/2011/12/22/women-in-the-u-s-military-
growingshare-distinctive-profile/; Office of the Assistant Secretary of 
Defense for Personnel and Readiness, Department of Defense, Population 
Representation in the Military Services Annual Report, 2013.
    \8\ Leah L. Zullig, PhD, MPH, Karen M. Goldstein, MD, MSPH, Kellie 
J. Sims, PhD, MS, Christina D. Williams, PhD, Michael Chang, MD, Dawn 
Provenzale, MD, MHS, and Michael J. Kelley, MD5, J Womens Health 
(Larchmt). 2019 Feb 1; 28(2): 268-275.
---------------------------------------------------------------------------
    The SGO believes the pace of discovery in endometrial cancer 
research is inadequate given the poor progress in reversing endometrial 
cancer incidence and mortality and the well-documented disparities in 
endometrial cancer. A new DoD endometrial cancer research program will 
advance endometrial cancer research by enhancing and sustaining the 
pool of endometrial cancer scientists, reduce the risk of endometrial 
cancer, and improve patient outcomes and survival rates for all women, 
particularly women of color, impacted by the disease.
                               conclusion
    Thank you again for the opportunity to submit testimony to the 
Committee as you begin your work on the fiscal year 2023 appropriations 
bills. We look forward to working with you to protect the health needs 
of our military and veteran population.
                                 ______
                                 
     Prepared Statement of the TriService Nursing Research Program
    We are writing to ask you to consider an issue critical to military 
health care in the FY23 NDAA budget: line-item funding in the DHP 
budget and an increase to $12 million for the TriService Nursing 
Research Program (TSNRP), a program that continues to have a positive 
effect on servicemembers and the health care professionals that care 
for them and their families.
    TSNRP has a 30-year history of providing value-added research 
conducted by PhD prepared active duty, reserve component and retired 
military nurses on relevant healthcare issues that are important to 
servicemembers and their families, as well as combat-related care not 
replicated elsewhere in the DHA or civilian medicine. TSNRP is the 
Nation's first and only Federal research program that supports military 
nurses to conduct research on the reserve and active-duty populations 
and translate that knowledge into evidence-based practices. Neither the 
NIH/National Institute of Nursing Research nor the VA fund research on 
this population.
    Since its inception in 1992, TSNRP funding levels have remained 
static; in the past two decades, funding remained at $6M annually. 
TSNRP has been funded either through congressionally directed funding 
or by DOD, through use of USUHS O&M dollars that are fungible and 
movable to meet other needs. Though authorized in 10USC 2116, TSNRP has 
an uncertain future should budget cuts force the elimination of this 
valued research program as was the case in FY20. Without this program, 
there is no dedicated funding stream for military nurse researchers to 
continue the vital research that has saved lives and significantly 
improved the care of our Nation's warfighters. It is time to place 
TSNRP in its own line item in the budget to ensure its sustainability 
and to raise the funding level so more studies by nurse researchers can 
be funded. We need your support to increase funding for TSNRP ($12M) 
and create a line item for it in the NDAA budget for FY23 and into the 
24-26 FYDP.
    Military nurses have been conducting research to improve force 
readiness and patient care since the 1950s. With the financial support 
of the TSNRP in the 1990s, military nursing research has expanded with 
notable results. TSNRP also supports the dissertation research and 
translation projects of military doctoral students in nursing schools 
around the country to improve health and quality of life outcomes for 
servicemembers and their families. TSNRP requires that funded 
researchers provide mentorship to new researchers, ensuring knowledge 
and skills are passed from year to year and along generations of 
military researchers.
Select TSNRP Discoveries
  --Home-based and field therapy with self-managed electrical 
        stimulation devices relieving both knee and back pain, helping 
        service members return to duty more quickly and maintain Force 
        Readiness.
  --Specific ventilator settings result in better methods of weaning 
        patients from life support.
  --CoQ10 supplements decrease brain cell injury, potentially 
        mitigating TBI.
  --Powdered clotting agents stop hemorrhage in wounded soldiers, 
        saving lives after severe blood loss from injury on the 
        battlefield.
  --Pocket devices allowing women on the battlefield to care for 
        personal and hygiene needs without embarrassment.
  --Certain transport litters decrease the chance of skin ulcers in 
        wounded service members while in field situations and in 
        transport to fixed military facilities.
  --Blood markers exist for genetic Vitamin D deficiency, and Vitamin D 
        supplements in this population improves bone health, reducing 
        stress fracture injuries that often occur during physically 
        demanding military training.
  --Mental and ethical preparation and resilience training helps 
        service members function better mentally and emotionally in 
        combat, and upon returning home.
  --Complementary treatment modalities such as acupressure can be done 
        in field settings.
  --Soldiers who receive their care in Soldier Centered Medical Homes 
        recover and resume basic training more quickly than those who 
        receive care in a typical medical clinic.
  --Better nurse staffing in military hospitals is associated with 
        fewer medication errors. Burnout in military nurses is linked 
        to low quality of patient care, job dissatisfaction and intent 
        to leave the job and/or the military. Ongoing TSNRP-funded 
        research during the pandemic will provide an update on the 
        military nurse workforce.
Select TSNRP Outcomes
  --TSNRP research assisted families to cope with deployment; addressed 
        gaps in care for active-duty women; ameliorated long-term 
        effects of PTSD on family caregivers; improved the quality of 
        life for burn survivors; and improved patient safety.
  --The TSNRP Women's Health Research Interest Group (WHRIG) recently 
        hosted the inaugural virtual Women in Combat Seminar, which 
        provided education to thousands of participants globally and 
        included topics such as operational performance, mission 
        readiness, and health and well-being.
  --TSNRP has been the leader in evidence-based practice and 
        implementation science in the military healthcare system. The 
        program funds not only research, but also supports education 
        and guidance to implement the research. It aims to ensure that 
        nurses are using the most up-to-date practices to provide 
        beneficiaries the best care possible on the battlefield, in 
        transport, and in military facilities.
    In summary, TSNRP funded research has been responsible for enhanced 
injury resuscitation protocols, improved air-evacuation processes, 
increased readiness of warfighters through bench science research, 
behavioral and nutritional research, and widespread implementation of 
evidence-based practices. One need only peruse the funded studies to 
find sophisticated methodologies in a far-reaching array of research 
from TSNRP funded scientists. For more about TSNRP, visit the website 
at www.triservicenurse.org.

    [This statement was submitted by MG (Ret) Margaret C. Wilmoth, U.S. 
Army Reserve; BG (Ret) William Bester, U.S. Army; COL (Ret) Patricia A. 
Patrician, U.S. Army; LTC (Ret) Deborah Kenny, U.S. Army; Maj. (Ret) 
Linda Schwartz, U.S. Air Force.]