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




 
       DEPARTMENT OF DEFENSE APPROPRIATIONS FOR FISCAL YEAR 2024

                              ----------                              

                                       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 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 Collins, 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 Fiscal Year 2024 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 
82,290 Americans will be diagnosed with bladder cancer in 2023. 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 provide 
predictable investment 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 can grow and that more 
research applications are funded moving forward, particularly for 
younger investigators who may be interested in pursuing bladder cancer 
research but are unsure of the field's financial stability and the 
feasibility of their grant applications given extremely limited 
resources.
    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 FY 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. Unfortunately, bladder cancer is a 
lagging indicator for carcinogens given it tends to impact older 
individuals. However, we can be sure that there is likely a connection 
to burn pits based on other inhaled carcinogens being known risk 
factors.
    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. He was 
treated with intravesical BCG, the standard treatment for this type of 
bladder cancer. BCG is also a relatively ineffective vaccine for 
tuberculosis and is more than one hundred years old. 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.
    The fact that the general standard of care for bladder cancer is a 
very old, ineffective TB vaccine should both shock and also reinforce 
the necessity of more research funding for this disease. This case 
highlights the critical need for 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 in 
the armed forces will directly benefit from advancements against 
bladder cancer given its higher incidence rate among veterans than the 
general public. By establishing an $8 million Bladder Cancer Research 
Program in FY 2024, 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 Government Accountability Office
    Chairman Tester, Ranking Member Collins, and members of the Defense 
Appropriations subcommittee, thank you for the opportunity to submit 
this written testimony.
    The Government Accountability Office plays a critical role in 
Congressional oversight of the Executive Branch. Unfortunately, that 
role may be stymied when it comes to the Intelligence Community 
(``IC''). Despite the fact that, by statute, GAO already has the 
purview to conduct oversight of all Federal agencies \1\ and has since 
its creation in 1921,\2\ the IC has, with a few exceptions, insisted 
that it is not subject to such audits since its inception. This 
effectively deprives Congress of one of the most effective tools in its 
arsenal, especially at a time when the activities of the IC present 
some of the most pressing needs for robust oversight in the Executive 
Branch. I respectfully recommend that Congress take steps to 
conclusively validate GAO's jurisdiction in such matters.
---------------------------------------------------------------------------
    \1\ See 31 U.S.C. Sec. Sec. 712, 717, 3523(a) (GAO has authority to 
investigate each ``department, agency, or instrumentality of the United 
States Government.'').
    \2\ Budget and Accounting Act, Pub. L. 67-13, 42 Stat. 26, June 10, 
1921 (``All departments and establishments shall furnish to the 
Comptroller General such information regarding the powers, duties, 
activities, organization, financial transactions, and methods of 
business of their respective offices as he may from time to time 
require of them.'').
---------------------------------------------------------------------------
    In response to the IC's recalcitrance, some Members of Congress 
have periodically attempted to resolve the matter over the past few 
decades. For instance, then-Congressman Leon Panetta introduced a bill 
in 1987 called the CIA Accountability Act to officially clarify GAO's 
authority vis-a-vis the Central Intelligence Agency (``CIA'') and the 
IC as a whole.\3\ Unfortunately, it was not enacted. In 1988, GAO 
attempted to conduct an investigation ``[i]n order to evaluate whether 
'information about illegal activities by high level officials of other 
nations may not be adequately considered in U.S. foreign policy 
decisions,''' leading the National Security Council to request an 
opinion from the Department of Justice Office of Legal Counsel which 
has been cited ever since:
---------------------------------------------------------------------------
    \3\ H.R. 3603, available at https://fas.org/irp/eprint/panetta-
1987.pdf.
---------------------------------------------------------------------------
      We therefore conclude based on the nature of the GAO request that 
        the subject of the GAO investigation is the Executive's 
        discharge of its constitutional foreign policy 
        responsibilities, not its statutory responsibilities. The 
        subject is thus not ``a program or activity the Government 
        carries out under existing law,'' and it is beyond GAO's 
        authority under 31 U.S.C. Sec. 717(b). . . .
      In addition to the infirmity in GAO's statutory authority to 
        pursue this investigation, we believe that GAO is specifically 
        precluded by statute from access to intelligence information. 
        In establishing by law the oversight relationship between the 
        intelligence committees and the executive branch, Congress 
        indicated that such oversight would be the exclusive means for 
        Congress to gain access to confidential intelligence 
        information in the possession of the executive branch.
      This intelligence oversight system has been codified at 50 U.S.C. 
        Sec. 413. That section sets forth requirements for the Director 
        of Central Intelligence, the heads of all other Federal 
        agencies involved in intelligence activities, and the President 
        to inform the Congress through the intelligence committees (and 
        in some circumstances the Speaker and minority leader of the 
        House of Representatives and the majority and minority leaders 
        of the Senate) of intelligence activities.\4\
---------------------------------------------------------------------------
    \4\ Investigative Authority of the General Accounting Office, 12 
Op. Off. Legal Counsel 171 (1988).
---------------------------------------------------------------------------
    Over two decades later, this fight was still underway. When an 
amendment to the FY2010 Intelligence Authorization Act (``IAA'') sought 
to reaffirm GAO authority, it prompted a veto threat in the form of a 
letter from Director of the Office of Management and Budget Peter 
Orszag,\5\ which Acting Comptroller General Gene Dodaro thoroughly 
refuted, demonstrating that ``[n]either the language of section 413 nor 
its legislative history provides support for this position'' and that 
the IC's resistance ``has greatly impeded GAO's work for the 
intelligence committees and also jeopardizes some of GAO's work for 
other committees of jurisdiction, including Armed Services, 
Appropriations, Judiciary, and Foreign Relations, among others.'' \6\
---------------------------------------------------------------------------
    \5\ Letter from Orszag to Feinstein of 3/15/10, available at 
https://fas.org/irp/news/2010/03/omb031610.pdf.
    \6\ Letter from Dodaro to Feinstein of 3/18/10, available at http:/
/www.pogoarchives.org/m/co/dodaro-letter-to-intel-committees-
20100318.pdf. Mr. Dodaro concluded that reaffirming GAO's authority in 
this area ``would prove beneficial both to the conduct of oversight by 
the intelligence committees and to the efficiency and effectiveness of 
IC operations.''
---------------------------------------------------------------------------
    Despite Mr. Dodaro's testimony, the enacted law took a middle-of-
the-road approach, stating that clarification was necessary but 
deferring to the Executive for that clarification, instructing the 
Director of National Intelligence (``DNI'') to ``issue a written 
directive governing the access of the Comptroller General to 
information in the possession of an element of the intelligence 
community.'' \7\ The DNI, for his part, issued Intelligence Community 
Directive 114 the following year, which reluctantly admitted that GAO 
had some authority to investigate the IC, but adopted a severely 
restrictive interpretation of the scope of that authority:
---------------------------------------------------------------------------
    \7\ 50 U.S.C. Sec. 3308.
---------------------------------------------------------------------------
      Information that falls within the purview of the congressional 
        intelligence oversight committees generally shall not be made 
        available to GAO to support a GAO audit or review of core 
        national intelligence capabilities and activities, which 
        include intelligence collection operations, intelligence 
        analyses and analytical techniques, counterintelligence 
        operations, and intelligence funding. IC elements may on a 
        case-by-case basis provide information in response to any GAO 
        requests not related to GAO audits or reviews of core national 
        intelligence capabilities and activities.\8\
---------------------------------------------------------------------------
    \8\ ICD 114(D)(4)(b), available at https://www.dni.gov/files/
documents/ICD/ICD_114.pdf.
---------------------------------------------------------------------------
    In other words, GAO can investigate anything involving the IC that 
the Intelligence Committees cannot, which amounts to basically nothing. 
Moreover, this is not an academic dispute: in response to a question 
about this matter from Congressman Yoder in 2018, Mr. Dodaro explained 
that this remained an ongoing controversy, although the situation is 
minimally better than it was before 2010:
      Mr. YODER. Do you need additional support from Congress--
      Mr. DODARO. Yes.
      Mr. YODER [continuing]. Or direction to the intel agencies to 
        make sure they are aware that this is an authority you have?
      Mr. DODARO. Yes, that would be helpful.\9\
---------------------------------------------------------------------------
    \9\ Legislative Branch Appropriations for 2019: Part 2, Fiscal Year 
2019 Legislative Branch Appropriations Requests, Hearings before the 
Subcomm. on the Legislative Branch of the House Comm. on 
Appropriations, 115th Cong., 2d Sess. 310 (Apr. 25, 2018) (testimony of 
Comp. Gen. Gene Dodaro) (testifying that GAO has been able to 
investigate peripheral matters in the IC such as ``a facilities area'' 
and contract management in the last few years).
---------------------------------------------------------------------------
    When Mr. Dodaro testified before the House Legislative Branch 
Appropriations subcommittee in 2019 regarding GAO's FY2020 budget, 
Chairman Ryan again asked him about this matter, and Mr. Dodaro again 
remarked that GAO needs ``the cooperation of the Intelligence 
Community'' because GAO ``ha[s] more difficulties when the request 
comes from non-intelligence committees,'' concluding, ``I think we 
could do more, particularly in the management area, and in the 
investments that are made, in that area, whether there's good return on 
the investments in all cases.'' \10\ And in his testimony before that 
subcommittee in 2020, Mr. Dodaro testified, ``It's the same status as 
it was last year. Congress could work with the Intelligence Committees 
to provide better direction to the intelligence agencies to cooperate 
with us.'' \11\
---------------------------------------------------------------------------
    \10\ Available at https://www.youtube.com/watch?v=G3WU2uZMlyk.
    \11\ Available at https://www.youtube.com/watch?v=uaRnD62qun4. Mr. 
Dodaro's testimony last year reiterated the same point, see https://
www.youtube.com/watch?v=-PQWaMSJG7Y.
---------------------------------------------------------------------------
    In fact, however, even the involvement of the Intelligence 
Committees is not sufficient to overcome the IC's reliance on ICD 114 
to obstruct meaningful GAO access. In a meeting in 2019 with staffers 
from the House Legislative Branch and Defense Appropriations 
subcommittees, a member of the latter subcommittee's staff dismissed 
the need for reform, arguing that IC components do not refuse GAO 
requests for information if GAO was acting pursuant to an Intelligence 
Committee request. That presumption is unfortunately false. One need 
only consider the example of AR 13-5, the internal CIA regulation which 
implements ICD 114. This regulation directly addresses the question of 
how the Agency should respond to a GAO request for information when GAO 
is acting under the direction of an Intelligence Committee:
      As a general rule, if GAO makes a request on behalf of or to 
        obtain information responsive to a tasking by an intelligence 
        oversight committee, the [Point of Contact (``POC'')] will 
        ensure that the CIA response to GAO does not contain 
        information prohibited in paragraph b.(2)(c)(3) above.\12\ The 
        response to GAO shall indicate that information responsive to 
        the tasking, but not authorized for release to GAO under the 
        provisions of ICD 114, shall be made directly available to the 
        requesting intelligence oversight committee. The POC shall 
        prepare an additional response for the intelligence oversight 
        committee that contains information responsive to the committee 
        request, but not authorized for GAO access.\13\
---------------------------------------------------------------------------
    \12\ That paragraph reads:
      Information that falls within the purview of the congressional 
intelligence oversight committees generally shall not be made available 
to GAO to support an audit or review of intelligence collection 
operations; covert action; intelligence capabilities related to 
national intelligence activities; counterintelligence operations; 
intelligence analysis and analytical techniques; intelligence sources 
and methods; or intelligence budgets or funding; (including records or 
expenditures made under the authority of 22 U.S.C. 2396(a)(8) or 10 
U.S.C. 127, 7231 and 50 U.S.C. 403j(b)).
    \13\ Available at https://s3.amazonaws.com/demandprogress/
documents/2023-03-17---AR_13-5.pdf.
---------------------------------------------------------------------------
    In other words, if GAO asks CIA for any information which would 
fall under the jurisdiction of an Intelligence Committee, CIA will 
simply refuse to cooperate, but if an Intelligence Committee tasks GAO 
to make the request, CIA will still refuse to provide the information 
to GAO, but instead will send the information directly to the relevant 
Intelligence Committee. In neither situation does GAO receive the 
requested information.
    GAO possesses significantly more resources and institutional 
expertise in certain kinds of Executive Branch investigations than even 
the most robust committee staff, and there is frankly no reason for 
this arbitrary restriction on its authority. Congress gave the 
Executive Branch a chance to establish reasonable limitations which 
balanced the Executive's legitimate interests with one of the most 
important functions of Congress-effective oversight. Instead of 
crafting a reasonable policy, the DNI memorialized the IC's original 
hardline position.
    I recommend this subcommittee include language to remove any doubt 
concerning GAO's audit power over the IC by advancing a measure that 
reStates Section 335 of the FY2010 IAA, as engrossed by the House of 
Representatives in February 2010.\14\
---------------------------------------------------------------------------
    \14\ Available at https://www.gpo.gov/fdsys/pkg/BILLS-111hr2701eh/
pdf/BILLS-111hr2701eh.pdf.
---------------------------------------------------------------------------
    Not only would taking such a measure resolve a longstanding 
problem, but it would be revenue neutral, since it would not require 
GAO to take on any more responsibilities than it already has; it would 
only open the universe of matters it may investigate. When one 
considers the fact that the number of GAO employees with Top Secret/
Sensitive Compartmented Information (``TS/SCI'') clearances is higher 
than the combined number of staffers employed by both Intelligence 
Committees, it is clear that these artificial restrictions on GAO's 
authority are causing Congress to expend more financial and manpower 
resources to accomplish less oversight over a significant portion of 
the Executive Branch. In a time of crisis, when agencies across the 
Government are spending vast amounts of time, money, and resources to 
combat a once-in-a-century threat, it is more important that ever that 
GAO be able to investigate allegations of governmental waste, fraud, 
abuse, and violations of law wherever they may be found. It is time for 
Congress to assert its prerogatives to protect its oversight 
capabilities over all agencies.

    [This statement was submitted by Kel McClanahan, Executive 
Director, National Security Counselors.]
                                 ______
                                 
 Prepared Statement of The HALO Trust and Mines Advisory Group 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 
25,300 acres of land, and to destroy more than 400,000 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 $21 million in Fiscal Year 2023. However, the FY24 President's 
Budget proposes only $9.068 million for HD R&D, which would represent a 
57% decrease from the previous year's appropriation. 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 6 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%. The Wirehound in Afghanistan, 
used to identify hard-to-detect IED components, has increased clearance 
by over 200% compared to traditional methods. The FAE Mulcher, a 
vegetation clearing tool being used by MAG in Cambodia, can clear 200% 
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. HD R&D equipment will 
also be essential to demining efforts in Ukraine, where technological 
advancements are already beginning to support the removal of mines and 
various items of unexploded ordnance in urban areas from the current 
conflict.
    We appreciate the support this subcommittee has provided for this 
valuable program, and urge the subcommittee to raise funding to a level 
of $23 million in FY24 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 and Jamie Franklin, Executive Director, Mines Advisory 
Group 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 (FY) 2024 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 the 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 
3,500 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 healthcare 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 FY 2024 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 Carolyn Sommerich, President and 
Steven C. Kemp, CAE, Executive Director, Human Factors and Ergonomics 
Society.]
                                 ______
                                 
                    Prepared Statement of Jump Aero
    Dear Members of the U.S. Senate Committee on Appropriations, 
subcommittee on Defense,
    Emergency response times for 46 million rural Americans are twice 
as long as response times in urban areas. This disparity contributes to 
higher mortality rates in 430,000 time-critical medical emergencies 
each year in rural America. Dual-use electric vertical takeoff and 
landing (eVTOL) technologies such as those being developed at Jump Aero 
have the potential to cut rural response times in half--helping first 
responders save an additional 100,000 lives each year in the United 
States.
    The U.S. Air Force's Agility Prime program has been instrumental in 
catalyzing and accelerating the development of Jump Aero's lifesaving 
eVTOL technology. The Agility Prime program should have the full 
support of all who care about improving emergency response outcomes for 
both the warfighter and rural Americans.
    Beyond Jump Aero's particular mission, it is strategically critical 
that the United States assume a global leadership role in the emerging 
advanced air mobility industry. As an experienced aviation 
entrepreneur, I can say with certainty that funding the Agility Prime 
program is the most direct and impactful avenue to achieving the goal 
of US leadership in advanced air mobility. It will continue to help 
small companies like Jump Aero develop and deliver on our life-saving 
promise. I ask that the committee consider increasing funding for the 
Agility Prime program.
    I would be happy to make time to elaborate on any of the points 
above if given the opportunity. Thank you for your due consideration.

    Best regards,
    Carl Dietrich
    Founder & CEO
    [email protected]

    [This statement was submitted by Carl Dietrich, Ph.D., Founder & 
CEO, Jump Aero.]
                                 ______
                                 
          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 2024, we are requesting at least $25 million for the 
Peer-reviewed Neurofibromatosis Research Program (NFRP) within the 
Defense Health Program, the same as the Fiscal Year 2023 enacted level. 
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 NFRP 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.--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 FY2023 funding for the NFRP has 
amounted to $427.85 million, in addition to the original $8 million 
appropriated in FY1992. In addition, between FY1996 and FY2021, 471 
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 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 2024 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 2024 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, 
The Neurofibromatosis Network.]
                                 ______
                                 
         Prepared Statement of the Society for Industrial and 
                       Organizational Psychology
    On behalf of the Society for Industrial and Organizational 
Psychology (SIOP), we are pleased to provide this written testimony to 
the Senate Appropriations subcommittee on Defense for the official 
record. In this testimony, SIOP urges the subcommittee to increase 
social science funding within the Department of Defense, including 
through the Minerva Research Initiative.
                 continued support for social sciences
    SIOP encourages Congress to continue funding for social science 
research at the Department of Defense. Inquiry into social and 
behavioral sciences, including topics covered by industrial and 
organizational (I-O) psychology, is critical to ensuring our National 
security, allowing military and civilian officials to better understand 
our adversaries and the social and political context that influences 
future conflicts. I-O psychology is the study of human behavior in the 
workplace, including pressing national security topics such as hiring 
and selection of individuals suited to high-risk jobs, enabling better 
collaboration between service branches using team science, improving 
morale and productivity, and examining training and onboarding 
procedures. I-O psychology research contributes to the Department's 
readiness mission by improving warfighter performance and providing 
evidence-based best practices on organizational structure and teaming. 
We therefore ask that you continue to support I-O psychology by 
providing no less than $37 million to the Minerva Research Initiative 
part of the Department's Defense Wide Basic Research Initiatives 
program, a $20 million increase.
    Minerva is the Department's premier social science program, 
informing topics like cyber defense, social impacts of autonomy, 
deterrence, and sociopolitical instability, and supporting the societal 
and technological objectives of the 2022 National Defense Strategy by 
providing a basis for integrated social sciences (religion, politics, 
social culture, and history) into DOD's tactical and strategic 
operations. Leveraging the social sciences helps the military 
understand, anticipate, and prevail in the face of challenges defined 
by rapid technological change, adversaries in every operating domain, 
and a combination of conventional threats with state and non-state 
actors and individuals capable of interrupting diplomatic and political 
activities through disinformation and cyber activities.
    The knowledge created through sound social science research--the 
hallmark of the Minerva program--is critical to the Department's 
development of complex military strategies that address threats and 
challenges across the full spectrum of military action. Minerva's 
cutting-edge social science research sets the foundation for a better 
understanding of current and future conflicts and arms decision-makers 
with knowledge about the social, cultural, behavioral, and political 
dynamics that shape our global interactions.
    Thank you for the opportunity to offer SIOP's support for DOD 
research. Please do not hesitate to contact SIOP should you have any 
questions. Additional information is also available at www.siop.org.

    [This statement was submitted by Dr. Mo Wang, President and Tracy 
L. Vanneman, Executive Director, Society for Industrial and 
Organizational 
Psychology.]
                                 ______
                                 
                   Prepared Statement of TB Alliance
    TB Alliance is pleased to submit this testimony to the Senate 
Committee on Appropriations, subcommittee on Defense for consideration 
in fiscal year (FY) 2024 appropriations. TB Alliance is a not-for-
profit organization dedicated to the discovery, development, and 
delivery of better, faster acting and affordable tuberculosis drugs 
that are available to those who need them. We submit this testimony and 
urge the subcommittee to once again include Tuberculosis (TB) in the 
Congressionally Directed Medical Research Program's Peer Reviewed 
Medical Research Program's (CDMRP PRMRP) list of eligible diseases in 
FY 2024 as it did the previous fiscal year.
    As you know, the men and women in our armed forces are responsible 
for protecting our Nation from threats both domestic and abroad. A 
critical element of DoD's mission is supporting infectious disease 
research, which it conducts at various facilities such as the Walter 
Reed Army Institute of Research and the Naval Medical Research Center. 
Since DoD cannot programmatically fund every disease that could cause 
harm to our Nation's military personnel, Congress fills this gap in 
research through the CDMRP, which presents a critical opportunity for 
Congress to directly influence research funding by providing a list of 
approved diseases eligible for competitive peer reviewed grant 
opportunities via the PRMRP.
    TB, an airborne disease, is the second leading global infectious 
killer globally--just behind COVID-19--with about 1.6 million deaths in 
2021 according to the World Health Organization (WHO). The global TB 
pandemic, including the rapid spread of drug-resistant TB, poses a 
serious global security threat. Although considered a low-incidence 
country, every US state continues to report TB cases each year and the 
airborne disease continues to be a significant public health issue. 
According to the Centers for Disease Control and Prevention (CDC), 
there are up to 13 million individuals in the U.S. with latent TB 
infections; a future reservoir of active TB cases. In 2021, the Centers 
for Disease Control and Prevention reported nearly 8,000 cases of TB in 
the U.S. The cost to treat and care for a patient with TB in the US 
averages $20,000 for drug-susceptible TB, $182,000 for MDR-TB, and 
$568,000 for XDR-TB according to most recent estimates.
    TB also remains of particular concern for the Department of Defense 
(DoD) because of its potential impact on our armed forces. Our global 
military footprint means that American military men and women are 
posted in countries and regions that experience high rates of both 
active TB disease and TB infection. For instance, in Europe, where over 
100,000 U.S. troops and dependents are stationed, there were nearly 
164,000 cases of TB and 73,000 cases of MDR-TB in 2021. In the Western 
Pacific region, nearly 82,000 troops live amidst over 1.8 million cases 
of TB and 70,000 cases of MDR-TB according to the most recent WHO 
estimates. Ukraine alone had an estimated 31,000 cases of TB and 11,000 
cases of MDR-TB. With the war in Ukraine sadly ongoing, millions of 
Ukrainians are seeking refuge in NATO ally countries, some of whom are 
on TB treatment or have undiagnosed TB. Outbreaks of MDR-TB around the 
world could cause drug shortages, severe economic consequences, and 
possibly extensive fatalities as well as global destabilization. 
Funding research and development now can make this scenario less likely 
in the future.
    Additionally, through programs like the Pacific Pathways, thousands 
of US military members rotate through countries around the Pacific Rim 
like the Philippines and Thailand to strengthen our military alliances, 
where a combined 844,000 cases of TB occurred in 2021, including 
thousands of cases of MDR-TB. However, the WHO estimates that global TB 
numbers are actually much higher than currently reported due to 
disruptions in diagnosis stemming from the COVID-19 pandemic and 
resource diversion.
    For these reasons, more research into TB and related treatments, 
vaccines, and diagnostics is imperative if we want to avoid tragic 
scenarios of MDR- and XDR-TB outbreaks in the future. Having adequate 
treatments on hand in case our warfighters fall ill with TB is critical 
to our military's mission readiness and our National security. Today, 
we are at a unique and unprecedented point in TB research due to 
positive advancements in key areas of development. Recently, the FDA 
approved a new drug regimen to treat XDR-TB and complicated MDR-TB--
demonstrating that better diagnostics, a fully effective vaccine, and 
shorter, less toxic treatment regimens are the only way we will 
successfully eliminate TB. The DoD CDMRP funding has been integral in 
these efforts.
    We thank the subcommittee for its previous inclusion of TB in the 
CDMRP PRMRP in FY 2023. However, we urge you to build off the progress 
already made and continue to include TB in the list of eligible 
diseases for FY 2024.
    Respectfully.

    [This statement was submitted by Pietro Turilli, Senior Vice 
President, External Affairs, TB Alliance.]
                                 ______
                                 
     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 FY 24 NDAA budget: line-item funding in the DHP 
budget and an amount of $12 million for the TriService Nursing Research 
Program (TSNRP), a program that continues to have a positive impact 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.
    Until FY 2023, when Congress more than doubled its budget, TSNRP 
funding levels have remained static since 1992; 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 FY 2020. 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 maintain funding for TSNRP ($12M) and create a 
line item for it in the NDAA budget for FY24 and throughout the 
remainder of the 24-27 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 Hon. Linda S. Schwartz, Maj. 
(Ret), U.S. Air Force; 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.]
                                 ______
                                 
                  Prepared Statement of Young Marines
    The Young Marines thank the Senate Committee on Appropriations, 
subcommittee on Defense for this opportunity to provide testimony in 
support of the Young Marines program. Young Marines is a 501c3 national 
youth program for boys and girls ages 8 to high school. The program 
focuses on leadership development, citizenship through community 
service, and living a healthy drug free lifestyle. This includes 
fitness programs and extensive drug demand reduction education. We are 
the largest single program with a focus on drug demand reduction 
education for youth. Over 6 thousand youth members participated in FY22 
nationwide, over 200 thousand have been members since our start in 
1959. Historical data shows approximately 30% of alumni members enter 
military service with a similar cohort for teaching and first 
responders.
    The last few years have produced volumes of reports regarding the 
challenges to our current generation of youth. Obesity, suicide, 
depression, poor overall fitness, negative social media impacts, 
difficulties with personal interaction, and increased dangers from new 
and extremely deadly drugs are all contributing to one of the most 
dangerous and difficult periods for our Nation's youngest member's 
personal development. This is reflected in numerous current studies 
about their declining mental health and ability to be engaged members 
of our society and future workforce. Young Marines does not profess to 
be the answer for all children, but our unique combination of programs 
has proven extremely effective for its members.
    Last year we spanned over 230 locations across 40 States, the 
District of Columbia, and military bases in Okinawa, Japan. The Young 
Marines mission is supported by over 2 thousand volunteers and a paid 
staff of just ten, making it extremely cost effective. Program interest 
is strong coming out of COVID. New unit starts are over double the 
previous averages of the last 5 years and we are spreading into new 
areas of the country. Young Marines youth membership is also coming 
back after the difficulties of meeting during the pandemic. Pre-
pandemic membership was over 8 thousand. We continue to receive the 
highest rating from multiple independent non-profit reviewing 
organizations. A detailed map and other program information can be 
found on our website www.youngmarines.org.
    Young Marines has experienced tremendous growth in size and 
capability over the last decade due in key part to an annual 
Congressional Grant for $4M started in FY10. The grant has been placed 
in the Defense Appropriations Bill: Title VI, Other Defense Programs, 
Drug Interdiction and Counter-Drug Activities Defense (DICD), Drug 
Demand Reduction (DDR). Young Marines did not receive grant funds for 
the last 2 years due to FY22 and FY23 Omnibus Appropriations process. 
The program is running off residual grant funds and reserves but will 
soon be forced to make hard choices on how to continue. These funds 
provide the structure and support to run the general program 
activities, training and education for youth and adults, and 
institutional risk management programs to ensure a sound and safe youth 
development program. The funds keep programs affordable to larger 
cohorts and support critical drug demand reduction education missions 
which are not a normal activity for youth programs. The drug demand 
reduction mission is a main pillar of the program, and Young Marines 
must complete required hours to advance or take part in unique events 
within the program. Furthermore, Young Marines earn additional credit 
for taking the drug demand reduction education mission to their local 
communities and peers. Last year we provided over 50 thousand hours of 
drug demand reduction educational activities in our communities even 
with COVID constraints, in recent years past we routinely provide over 
100 thousand hours of drug demand education to local communities. Last 
year saw record drug overdose deaths across the country. Young Marines 
works to educate its volunteers, parents, and youth members along with 
local communities of the extraordinary dangers of current drugs. These 
efforts have seen the Young Marines program win the annual Department 
of Defense Fulcrum Shield award for Drug Demand Education excellence 12 
times, numerous awards from the Drug Enforcement Administration, and 
multiple awards from other public organizations.
    The Young Marines program directly supports future personnel needs 
of the Department of Defense, National Security workforce, the 
Intelligence Community, Federal Government, over 7 million critical 
transportation jobs, and professions requiring a drug free workforce. 
The Young Marines program exposes youth to the value of service in and 
out of uniform. Contact at [email protected].
    We appreciate the consideration of the subcommittee members in 
supporting various FY24 requests by members of the Senate. We also 
appreciate the support of the subcommittee in reconciliation with the 
House of Representatives Defense Appropriations efforts in support to 
our program.

    [This statement was submitted by Col William P. Davis, USMC (Ret), 
CEO, Young Marines.]