[Senate Hearing 112-]
[From the U.S. Government Publishing Office]
DEPARTMENT OF DEFENSE APPROPRIATIONS FOR FISCAL YEAR 2012
----------
WEDNESDAY, JUNE 22, 2011
U.S. Senate,
Committee on Appropriations,
Washington, DC.
The subcommittee met at 10:39 a.m., in room SD-192, Dirksen
Senate Office Building, Hon. Daniel K. Inouye (chairman)
presiding.
Present: Senators Inouye, Cochran, and Shelby.
NONDEPARTMENTAL WITNESSES
OPENING STATEMENT OF CHAIRMAN DANIEL K. INOUYE
Chairman Inouye. First, I'd like to apologize to all of you
for this lateness. Last night we were deluged with
thunderstorms, and I live in Rockville, Maryland. It took me 2
hours to get in. No traffic lights, and American drivers
without traffic lights.
So I'd like to welcome all of you to this hearing to
receive testimony pertaining to the various issues related to
defense appropriations requests. Because we have so many
witnesses, I will have to remind the witnesses that they will
be limited to 4 minutes apiece. I'm sorry about that.
At this point I'd like to recognize my vice chairman,
Senator Cochran.
STATEMENT OF SENATOR THAD COCHRAN
Senator Cochran. Mr. Chairman, thank you. It's a pleasure
to join you in welcoming the witnesses to the hearing. We
appreciate your interest in our work and it will make a
contribution to helping improve our national security and the
work we do here in supporting our military forces and related
interests around the world.
Chairman Inouye. Our first witness is Dr. Matthew King of
the American Thoracic Society. Dr. King.
STATEMENT OF MATTHEW KING, M.D., ON BEHALF OF THE
AMERICAN THORACIC SOCIETY
Dr. King. Mr. Chairman, members of the subcommittee: Thank
you for hearing me today. My name is Matt King. I'm a pulmonary
physician in Nashville, Tennessee, and I've worked at both
Vanderbilt University and the Nashville Veterans Administration
(VA) Hospital with military personnel and veterans.
I'm testifying today on behalf of the American Thoracic
Society, which is a medical professional organization dedicated
to the prevention, treatment, and cure of lung disease. Many of
the members of the American Thoracic Society work in the
military and with the VA, and as such we've become deeply
concerned with the respiratory issues that some of our military
personnel are suffering.
There is a real cause for concern here. As you may have
read in the New York Times over the weekend, there have been
several studies reporting a startling number of respiratory
disorders in our military personnel returning from Iraq and
Afghanistan. In fact, military personnel that have served in
Iraq and Afghanistan are reporting severe respiratory diseases
at a rate seven times higher than people who are serving
elsewhere.
Studies have documented increases in asthma, fixed
obstructive lung disease, allergic rhinitis, and several other
rare pulmonary disorders. I personally have been involved in a
study that's going to be published next month of 50 veterans
returning from Iraq and Afghanistan that have a rare incurable
pulmonary disease caused constrictive bronchiolitis. These
patients often have normal pulmonary function tests, but,
despite their normal tests, are having severe respiratory
symptoms.
We don't know exactly why, but Iraq and Afghanistan
veterans are exposed to a number of inhalational insults,
ranging from dust storms to inhaled smoke from burn pits to
aerosolized metal and chemicals from exploding improvised
explosive devices (IEDs), blast overpressure or shock waves to
the lung, outdoor allergens such as date pollen, and indoor
allergens such as the mold aspergillus. We think many of these
are contributing. We've identified many respiratory illnesses,
but we really don't know the scope of the problem.
So there are several questions: What are the key causative
agents? How many veterans are experiencing this disease? What
is the best way to identify and treat the servicemen and women?
Attention is needed to address these and other important
questions.
The American Thoracic Society recommends the following
steps: All service men and women should have pre- and post-
deployment pulmonary function testing. The Department of
Defense (DOD) and VA should support projects to establish a
more comprehensive normative pulmonary function test database
used to evaluate military men and women. The DOD and VA should
jointly create and fund a program to study the respiratory
exposures that may be contributing to these respiratory
illnesses. Potential goals of this kind of research program
could include identifying the exact agents to which people are
exposed and that may be causing the illnesses, considering
potential population-based and individual interventions that
could prevent or at least reduce exposure to these causative
agents, and supporting research and to improve prevention,
detection, and treatments for deployment-related respiratory
diseases.
Also, the DOD and VA should consider establishing centers
of excellence to enhance research and clinical treatment of
these service men and women that are returning with deployment-
related respiratory illnesses.
Finally, we believe that the DOD and VA should create a
standard administrative approach to determining respiratory
disability for the Operation Iraqi Freedom and Enduring Freedom
service personnel.
Thank you. The American Thoracic Society appreciates the
opportunity to testify here. I'd be happy to answer any
questions.
[The statement follows:]
Prepared Statement of Dr. Matthew King
The American Thoracic Society appreciates the opportunity to
testify before the Senate Department of Defense Appropriations
Subcommittee regarding the fiscal year 2012 budget.
The American Thoracic Society is a medical professional society of
over 15.000 members who are dedicated to the prevention, detection,
treatment and cure of respiratory, sleep and critical care related
illnesses. Our physicians, nurses, respiratory therapists and basic
scientists are engaged in research, education and advocacy to reduce
the worldwide burden of respiratory diseases.
Many members of the American Thoracic Society service as
researchers and clinicians in the U.S. military and at VA medical
centers. As such, we are deeply concerned about the respiratory health
of U.S. military personal.
And there is cause for concern.
A surprising number of returning service men and women from Iraq
and Afghanistan are experiencing moderate to server respiratory
diseases. There are several anecdotes of military personal who were
elite athletes--marathon runners, road cyclists--before deployment are
no longer able to complete the 2 mile physical readiness run. Even more
puzzling, is in many cases, these service men and women have normal
pulmonary function text values. Despite having normal pulmonary
function test values, these service members severely de-saturate during
exercise.
Physicians have described a new disease called Iraq-Afghanistan War
lung injury (IAW-LI), among soldiers deployed to these countries as
part of Operation Iraqi Freedom, Operation Enduring Freedom, and
Operation New Dawn. Not only do soldiers deployed to Iraq and
Afghanistan suffer serious respiratory problems at a rate seven times
that of soldiers deployed elsewhere, but the respiratory issues they
present with show a unique pattern of fixed obstruction in half of
cases, while most of the rest are clinically reversible new-onset
asthma, in addition to the rare interstitial lung disease called
nonspecific interstitial pneumonitis associated with inhalation of
titanium and iron.
Iraq and Afghanistan veterans are faced with a barrage of
respiratory insults, including: (1) dust from the sand, (2) smoke from
the burn pits, (3) aerosolized metals and chemicals from exploded IEDs,
associated with (4) blast overpressure or shock waves to the lung, (5)
outdoor aeroallergens such as date pollen, and (6) indoor aeroallergens
such as mold aspergillus. Researchers have experimentally exposed mouse
models to samples of the dust taken from Iraq and Afghanistan and found
that it produces extreme histological responses, underscoring the
severe exposures that these soldiers undergo.
A case series study was recently presented at the American Thoracic
Society international conference by Robert Miller, MD, of Vanderbilt
University. Dr. Miller discussed a cohort of patients with constrictive
bronchiolitis who were deployed in Iraq.
While clinicians and researchers have defined the condition, there
is much we don't know. There are uncertainties regarding the number of
service men and women who are experiencing deployment related
respiratory illnesses. Complicating both clinical and research efforts
is that fact that deployed troops do not receive pre and post
deployment pulmonary function tests--in this case a simple spirometry
test--that would help doctors know the extent of lung damage.
Further challenges include the spectrum of possible lung diseases
that may be occurring from Southwest Asia exposures, such as asthma,
constrictive bronchiolitis, acute eosinophilic pneumonia and
rhinosinusitis, and the variability in exposures that may confer risk,
including particulate matter from desert dusts, burn pits, vehicle
exhaust and tobacco smoke.
Clinicians face a different set of challenges with this patient
population, including the role of targeted medical surveillance in
determining need for further respiratory diagnostic evaluation, and,
importantly, the role of surgical lung biopsy in clinical diagnosis of
post-deployment lung disease.
Attention is needed to address the respiratory illnesses suffered
by returning service men and women. The ATS recommends the Department
of Defense and the Department of Veterans Affairs take the following
steps:
--The American Thoracic Society recommends all military personal
deployed in combat receive a pre- and post-deployment pulmonary
function test.
--Support projects to establish more comprehensive normative
pulmonary function test values for military men and women.
--The Department of Defense and the Department of Veterans Affairs
jointly create and fund a program to study respiratory
exposures of servicemen and women deployed in Iraq and
Afghanistan. Potential goals of this joint research program
could include:
--Identify likely agents responsible for respiratory illnesses of
returning OEF and OIF personal;
--Consider potential population based and individual interventions
to prevent or reduce exposure to causative agents; and
--Support research into improved prevention, detection and
treatments for deployment-related respiratory disease.
--Establish Centers of Excellence to facilitate improved research and
clinical treatment of service men and women experiencing severe
deployment-related respiratory illnesses.
--The Department of Defense and the Department of Veterans Affair
consider administrative standardized approaches to determining
respiratory disability for deployment related respiratory
illnesses.
The American Thoracic Society appreciates the opportunity to
testify before the House Department of Defense Appropriations
Subcommittee. We would be happy to answer any questions or provide
follow up information.
Chairman Inouye. Dr. King, I thank you very much. Will you
share with this subcommittee the results of your testing, your
findings?
Dr. King. Of my personal study?
Chairman Inouye. Yes.
Dr. King. We have had 80 to 100 people from Fort Campbell
in Kentucky referred to Vanderbilt University, where we've done
extensive testing in patients, in whom we were unable to
identify any other cause of potential respiratory symptoms. We
did open-lung biopsies and found this constrictive
bronchiolitis, which is an untreatable and irreversible
condition, to which we speculate it is a reaction to some
inhalational toxin experienced in Southwest Asia.
Chairman Inouye. Thank you.
Senator Cochran.
Senator Cochran. I think we owe you a debt of gratitude and
thanks for bringing this to our attention. I think you can be
assured we'll look into it and try to make a decision that
responds to the challenge.
Dr. King. Thank you very much.
Chairman Inouye. Senator Shelby.
Senator Shelby. No comments. I just want to hear the
witnesses. Thank you, Mr. Chairman.
Chairman Inouye. Thank you.
Our next witness is Ms. Dee Linde of the Dystonia Medical
Research Foundation. Ms. Linde.
STATEMENT OF DEE LINDE, PATIENT ADVOCATE, DYSTONIA
MEDICAL RESEARCH FOUNDATION
Ms. Linde. Thank you, Mr. Chairman, and aloha nui loa to
you.
Mr. Chairman and members of the Senate Defense
Appropriations Subcommittee: Thank you for the opportunity to
testify today. My name is Dee Linde and I am a dystonia patient
and volunteer with the Dystonia Medical Research Foundation, or
DMRS. As a veteran and former Navy petty officer, I am honored
to testify before this subcommittee.
The DMRS is a patient-centered nonprofit organization
dedicated to serving dystonia patients and their families.
Dystonia is a neurological movement disorder that causes
muscles to contract and spasm involuntarily. Dystonia is a
chronic disorder whose symptoms vary in degrees of frequency,
intensity, disability, and pain. Dystonia can be generalized or
focal. Generalized dystonias affect all major muscle groups,
resulting in twisting repetitive movements and abnormal
postures. Focal dystonias affect a specific part of the body,
such as the legs, arms, eyelids, or vocal cords.
Dystonia can be hereditary or caused by trauma, and it
affects approximately 300,000 persons in the United States. At
this time there is no cure for dystonia and treatment is highly
individualized. Patients frequently rely on invasive therapies.
In 1995, after my Navy career, I started feeling symptoms
for what would later be diagnosed as tardive dystonia, which is
medication-induced dystonia. The symptoms started as
uncontrollable shivering sensations. Over the next 2 years, the
symptoms continued to worsen and I started feeling like I was
being squeezed in a vise. My diaphragm was constricted and I
couldn't breathe. I also had blepharospasm, a form of dystonia
that forcibly shut my eyes, leaving me functionally blind even
though there was nothing wrong with my vision.
My dystonia affected my entire upper body and for years my
spasms wouldn't allow me to sit in a chair or sleep safely in
bed with my husband. I spent those years having to sleep and
even eat on the floor.
After I developed dystonia, I was forced to give up my
private practice as a psychotherapist. Since I am a veteran, I
receive all my medical care through the VA system. In 2000, I
underwent surgery to receive deep brain stimulation (DBS). The
neurosurgeon implanted leads into my brain that emit constant
electrical pulses which interrupt the bad signals and help
control my symptoms. Thanks to DBS, I have gone from being
completely nonfunctional to having the ability to walk and move
like a healthy individual. I'm happy to say that I am now
almost completely symptom free.
The DMRS has received reports that the incidence of
dystonia in the United States has noticeably increased since
our military forces were deployed to Iraq and Afghanistan. A
June 2006 article in Military Medicine titled ``Post-Traumatic
Shoulder Dystonia in an Active Duty Soldier'' stated that:
``Dystonia after minor trauma can be as crippling as a
penetrating wound, with disability that renders the soldier
unable to perform his duties.''
Awareness of this disorder, dystonia, is essential to avoid
mislabeling and possibly mistreating a true neurological
disease. The Department of Defense peer-reviewed medical
research program is the most essential program studying
dystonia in military and veteran populations, and I myself was
the consumer reviewer on this panel. This program is critical
to developing a better understanding of the mechanisms
connecting trauma and dystonia.
The dystonia community would like to thank the subcommittee
for adding dystonia to the list of conditions eligible for
study under the program in the fiscal year 2010 and 2011
defense appropriation bills. We urge the subcommittee to
maintain dystonia as an eligible condition in the defense peer-
reviewed medical research program in fiscal year 2012.
Thank you for allowing me the opportunity to address the
subcommittee today.
Chairman Inouye. Ms. Linde, I thank you very much for your
testimony and we will do our best.
Ms. Linde. Thank you.
Chairman Inouye. Senator Cochran.
Senator Cochran. Mr. Chairman, I have nothing further to
add. We appreciate your presence and your advice and
observations for the benefit of the subcommittee.
Chairman Inouye. Senator Shelby.
Senator Shelby. Nothing to add either, but I appreciate all
of you being here.
Ms. Linde. Thank you.
Chairman Inouye. Thank you very much.
[The statement follows:]
Prepared Statement of Dee Linde
Mr. Chairman and members of the Senate Appropriations Defense
Subcommittee, thank you for the opportunity to testify today. My name
is Dee Linde, and I am a dystonia patient and volunteer with the
Dystonia Medical Research Foundation or ``DMRF.'' I am also a former
Navy service member and I am honored to testify before this
subcommittee. The DMRF is a patient-centered, nonprofit organization
dedicated to serving dystonia patients and their families. The DMRF
works to advance dystonia research, increase dystonia awareness, and
provide support for those living with the disorder.
Dystonia is a neurological movement disorder that causes muscles to
contract and spasm involuntarily. Dystonia is not usually fatal, but it
is a chronic disorder whose symptoms vary in degrees of frequency,
intensity, disability, and pain. Dystonia can be generalized or focal.
Generalized dystonia affects all major muscle groups, resulting in
twisting repetitive movements and abnormal postures. Focal dystonia
affects a specific part of the body such as the legs, arms, hands,
neck, face, mouth, eyelids, or vocal chords. Dystonia can be hereditary
or caused by trauma, and it affects approximately 300,000 persons in
the United States. At this time, there is no cure for dystonia and
treatment is highly individualized. Patients frequently rely on
invasive therapies like botulinum toxin injections or deep brain
stimulation (DBS) to help manage their symptoms.
In 1995, after my Navy career, I started feeling symptoms for what
would later be diagnosed as tardive dystonia, which is medication-
induced dystonia. The symptoms started as an uncontrollable shivering
sensation that often prompted people to ask me if I was cold. Over the
next 2 years, the symptoms continued to worsen and I started feeling
like I was being squeezed: my diaphragm was constricted and I couldn't
breathe. I also had belpharospasm which meant that my eyes would shut
forcibly and uncontrollably, leaving me functionally blind even though
there was nothing wrong with my vision.
The tardive dystonia affected my entire upper body and for years my
spasms didn't allow me to sit in a chair, or sleep safely in the bed
with my husband. As a family joke, my mother made my husband a nose
guard to wear because I kept hitting him during the night. I spent
those years having to sleep and even eat on the floor. Before I
developed dystonia, I had my own private practice as a licensed
psychotherapist which I had to give up as a result of my spasms.
Because I have other service-connected disabilities and am
considered 100 percent unemployable, I receive care at the Veterans
hospital in Portland, Oregon. In 2000, I underwent surgery to receive
deep brain stimulation (DBS). The surgeons implanted leads into my
basil ganglia which is the part of the brain that controls movement.
The leads emit electric pulses that interrupt the bad signals that my
brain is sending to my body and allow me to control my movement. Thanks
to DBS, I have gone from being completely non-functional, to having the
ability to walk and to move like a healthy individual. I am happy to
say that I am now almost completely symptom free. The battery packs for
the DBS are implanted under my clavical, and I used to return to the
hospital every 2 years to surgically replace them. In 2010, I had the
new rechargeable battery implanted. This battery lasts for 9 years, and
now I literally ``recharge my batteries'' for 2.5 hours at the end of
every week.
The DMRF has received reports that the incidence of dystonia in the
United States has noticeably increased since our military forces were
deployed to Iraq and Afghanistan. This recent increase is widely
considered to be the result of a well-documented link between traumatic
injuries and the onset of dystonia. A June 2006 article in Military
Medicine, titled ``Post-Traumatic Shoulder Dystonia in an Active Duty
Soldier'' reported on dystonia experienced by military personnel and
stated that ``Dystonia after minor trauma can be as crippling as a
penetrating wound, with disability that renders the soldier unable to
perform his duties . . . awareness of this disorder [dystonia] is
essential to avoid mislabeling, and possibly mistreating, a true
neurological disease.'' As military personnel remain deployed for
longer periods, we can expect dystonia prevalence in military and
veterans populations to continue to rise.
Although Federal dystonia research is conducted through a number of
medical and scientific agencies, the Department of Defense (DOD) Peer-
Reviewed Medical Research Program remains the most essential program
studying dystonia in military and veteran populations. This program is
critical to developing a better understanding of the mechanisms
connecting trauma and dystonia. The DMRF would like to thank the
Subcommittee for adding dystonia to the list of conditions eligible for
study under the DOD Peer-Reviewed Medical Research Program in the
fiscal year 2010 and 2011 Defense Appropriation bills. The DMRF is
excited to report that dystonia researchers were granted two awards in
fiscal year 2010. We urge the Committee to maintain dystonia as a
condition eligible for study through the Peer-Reviewed Medical Research
Program in fiscal year 2012.
Thank you again for allowing me the opportunity to address the
Subcommittee today. I hope you will continue to include dystonia as a
condition eligible for study under the DOD Peer-Reviewed Medical
Research Program. Below is a poem that I composed during one of my most
difficult moments, and I hope this poem provides greater insight to the
hardships and loneliness faced in enduring this disorder.
DYSHARMONIA
The twitch \1\ doctor says it's dystonia
Which is far from the likes of harmonia
The muscles don't work in dystonia
But how graceful they are in harmonia
I can walk down the street
Without two left feet
I can hold my head high
Not low like a geek
I can keep both my eyes wide open
And swallow my food without chokin'
But that's with harmonia
And I've got dystonia
Which leaves me just feelin'
Alonia
\1\ twitch doctor = Movement Disorder Specialist.
Chairman Inouye. Our next witness is Ms. Barbara Zarnikow,
Interstitial Cystitis Association.
STATEMENT OF BARBARA ZARNIKOW, CO-CHAIR, INTERSTITIAL
CYSTITIS ASSOCIATION
Ms. Zarnikow. Chairman Inouye, Ranking Member Cochran, and
distinguished members of the Defense Subcommittee: Thank you
for the opportunity to testify today, to present testimony
today on interstitial cystitis, commonly known as ``IC.'' I am
Barbara Zarnikow from Buffalo Grove, Illinois. I am an IC
patient and co-chair of the Interstitial Cystitis Association,
a nonprofit organization which provides advocacy, research
funding, and education for patients living with IC.
IC is a chronic debilitating condition characterized by
recurring pain, pressure, and discomfort in the bladder and
pelvic region. It is often associated with frequent and urgent
urination. There is no known cause and it can take years to
diagnose because it is often misdiagnosed. There is not a test
to diagnose IC, so it is diagnosed through the process of
elimination of other diseases with similar symptoms.
IC affects an estimated 3 to 8 million women in the United
States and is often believed to be primarily a women's disease.
However, recent research shows that 1 to 4 million men suffer
from IC as well. IC is a debilitating disease that has an
impact on the quality of life similar to what's been reported
by individuals suffering from end stage renal disease and
rheumatoid arthritis. IC can cause patients to suffer from
severe pain, sleep deprivation, high rates of depression,
anxiety, and overall decline in quality of life. IC affects all
aspects of a patient's life.
A study conducted between 1992 and 2002 found that
approximately 1.4 percent of veterans served by the Veterans
Health Administration were being treated for IC. The study also
showed a 14 percent increase in patients being treated for IC
in VHA during this same period.
IC is currently part of the Department of Defense peer-
reviewed medical research program. This is so important because
studies have shown that the incidence of IC in our population
is much higher than previously thought.
A prime example of how IC can impact members of the
military is former Navy Captain Gary Mowrey, retired, who was
forced to cut his career short as a result of IC. Captain
Mowrey was in the Navy for 25 years and has served as commander
of the VAQ133 Squadron, operations officer on the USS Dwight D.
Eisenhower, chief of the Enlisted Performance Division in the
Bureau of Naval Personnel, and earned a Southwest Asia Service
Medal with two stars for his service in Operation Desert Storm.
In 1994 he began to experience significant pelvic pain and
could not always make it to the bathroom. He was not even able
to sit through normal meetings. After months of unsuccessful
antibiotic treatments for urinary tract infections, Captain
Mowrey was diagnosed with IC, and shortly after retired due to
the pain and limitations imposed by IC.
He then attempted to teach high school math, but had to
retire from this position as well due to the pain, frequent
urination, and fatigue associated with having to urinate 20 to
30 times each night. If you've ever had a bladder infection or
know someone who has, imagine if that infection never went away
and you had to live with these symptoms your entire life. That
is IC.
On behalf of IC patients, including many veterans, we
request IC continue to be eligible for the peer-reviewed
medical research program for fiscal year 2012. Thank you for
your time and consideration.
Chairman Inouye. Ms. Zarnikow, I thank you very much on
behalf of the subcommittee. We appreciate it very much.
[The statement follows:]
Prepared Statement of Barbara Gordon, RD, Executive Director,
Interstitial Cystitis Association
Chairman Inouye, Ranking Member Cochran, and distinguished members
of the Subcommittee, thank you for the opportunity to present
information on Interstitial Cystitis (IC). The Interstitial Cystitis
Association (ICA) provides advocacy, research funding, and education to
ensure early diagnosis and optimal care with dignity for people
affected by IC. Until the biomedical research community discovers a
cure for IC, our primary goal remains the discovery of more efficient
and effective treatments to help patients live with the disease.
IC is a chronic condition characterized by recurring pain,
pressure, and discomfort in the bladder and pelvic region. The
condition is often associated with urinary frequency and urgency,
although this is not a universal symptom. The cause of IC is unknown.
Diagnosis is made only after excluding other urinary and bladder
conditions, possibly causing 1 or more years of delay between the onset
of symptoms and treatment. Men suffering from IC are often misdiagnosed
with bladder infections and chronic prostatitis. Women are frequently
misdiagnosed with endometriosis, inflammatory bowel disease (IBD),
irritable bowel syndrome (IBS), vulvodynia, and fibromyalgia, which
commonly co-occur with IC. When healthcare providers are not properly
educated about IC, patients may suffer for years before receiving an
accurate diagnosis and appropriate treatment.
Although IC is considered a ``women's disease,'' scientific
evidence shows that all demographic groups are affected by IC. Women,
men, and children of all ages, ethnicities, and socioeconomic
backgrounds develop IC, although it is most commonly found in women.
Recent prevalence data reports that 3 to 8 million American women and 1
to 4 million American men suffer from IC. Using the most conservative
estimates, at least 1 out of every 77 Americans suffer from IC, and
further study may indicate prevalence rates as high as 1 out of every
28 people. Based on this information, IC affects more people than
breast cancer, Alzheimer's diseases, and autism combined.
The effects of IC are pervasive and insidious, damaging work life
and productivity, psychological well-being, personal relationships, and
general health. Quality of life studies have found that the impact of
IC can equal the severity of rheumatoid arthritis and end-stage renal
disease. Health-related quality of life in women with IC is worse than
in women with endometriosis, vulvodynia, or overactive bladder alone.
IC patients have significantly more sleep dysfunction, higher rates of
depression, increased catastrophizing, anxiety and sexual dysfunction.
Although IC research is currently conducted through a number of
Federal entities, including the National Institutes of Health (NIH) and
the Centers for Disease Control and Prevention (CDC), the DOD's Peer-
Reviewed Medical Research Program (PRMRP) remains essential. The PRMRP
is an indispensable resource for studying emerging areas in IC
research, such as prevalence in men, the role of environmental
conditions such as diet in development and diagnosis, barriers to
treatment, and IC awareness within the medical military community.
Specifically, IC education and awareness among military medical
professionals takes on heightened importance, as neither the
President's fiscal year 2012 budget request nor the Centers for Disease
Control and Preventions fiscal year 2011 Operating Plan include renewed
funding for the CDC's IC Education and Awareness Program.
On behalf of ICA, and as an IC patient, I would like to thank the
Subcommittee for including IC as a condition eligible for study under
the DOD's PRMRP in the fiscal years 2010 and 2011 DOD Appropriations
bills. The scientific community showed great interest in the program,
responding to the initial grant announcement with an immense outpouring
of proposals. We urge Congress to maintain IC's eligibility in the
PRMRP in the fiscal year 2012 DOD Appropriations bill, as the number of
current military members, family members, and veterans affected by IC
is increasing.
Ms. Zarnikow. Thank you.
Senator Cochran. Thank you for your attendance. We
appreciate your giving us this information and the observations
you have about this problem.
Chairman Inouye. Senator Shelby.
Senator Shelby. I thank the whole panel and I thank this
woman who just gave this presentation. This is very
interesting. It affects a lot of people. I know that.
Thank you, Mr. Chairman.
Ms. Zarnikow. It does affect a lot of people.
Chairman Inouye. Thank you very much.
Ms. Zarnikow. Thank you.
Chairman Inouye. Our next witness is Mr. Dane Christiansen,
International Foundation for Functional Gastrointestinal
Disorders.
STATEMENT OF DANE R. CHRISTIANSEN, DEVELOPMENT
COORDINATOR, INTERNATIONAL FOUNDATION FOR
FUNCTIONAL GASTROINTESTINAL DISORDERS
Mr. Christiansen. Chairman Inouye, Ranking Member Cochran,
Senator Shelby, and the distinguished members of the Defense
Appropriations Subcommittee: Thank you for the opportunity to
present testimony. My name is Dane Christiansen and I am
testifying on behalf of the International Foundation for
Functional Gastrointestinal Disorders, or IFFGD. We request
that the subcommittee include functional gastrointestinal
disorders on the list of conditions deemed eligible for study
through the Department of Defense peer-reviewed medical
research program within fiscal year 2012 defense appropriations
legislation.
Founded in 1991, IFFGD is a nonprofit patient-driven
organization dedicated to helping individuals affected by
functional gastrointestinal and motility disorders. The phrase
``functional gastrointestinal disorder'' or ``functional GI
disorder'' refers to a family of conditions where the nerves,
muscles, and related mechanisms of the digestive tract do not
function properly. The result is multiple, persistent, and
often painful symptoms, ranging from nausea and vomiting to
altered bowel habit.
Over two dozen functional gastrointestinal disorders have
been identified. Severity ranges from bothersome to disabling
and life-altering. The conditions may strike anywhere along the
GI tract. One thing they have in common is that little is
understood about their underlying mechanisms and as a result
little is understood about treatment.
The few treatments available reduce symptoms in some but
not all patients. These conditions are chronic, costly from a
healthcare standpoint, impair productivity, and exact a
tremendous toll in terms of quality of life. The onset of a
functional gastrointestinal disorders can be triggered by
infection of the GI tract and/or severe stress. Deployed
military personnel face an elevated chance of experiencing
these risk factors.
The 2010 Institute of Medicine (IOM) report that looked at
health effects of serving in the gulf war concluded that there
is sufficient evidence for an association between deployment
and symptoms consistent with functional gastrointestinal
disorders. Functional gastrointestinal disorders are one of the
hallmarks of what was previously described as gulf war
syndrome.
The Veterans Administration recognizes a presumption of
service connection for the purposes of soldiers with functional
gastrointestinal disorders applying for disability benefits.
In order to better articulate the suffering associated with
functional gastrointestinal disorders, I would like to be the
voice of Dr. Brennan Spiegel, a physician who regularly sees
military personnel affected by these conditions. I'm quoting
now:
``Those of us in the VA are now witnessing a near-epidemic
emerging and that is chronic GI symptoms, like abdominal pain,
nausea, vomiting, and diarrhea. The stories are heartbreaking
and compelling and they are constant and unrelenting. Imagine
having the stomach flu. Now think about having that every day
and being told that we can't treat it very well.
``Every Monday morning at the West Los Angeles VA Medical
Center, our clinic cares for at least 5 to 10 patients with
service-related GI symptoms. Recently, a soldier entered my VA
exam room square-jawed and battle-tested. Within minutes, he
was crying, averting eye contact, and trying to explain that
his life came to a near halt after kicking in a door one day in
Tikrit. His abdomen was burning while in the moment and he
stifled nausea to get through the event. Then, when it was
over, he broke from his troop and threw up. It's never stopped
and that was 2 years ago.
``There are so many other stories like this. We're making
progress, but we don't have good answers or good treatments.''
Please consider including functional gastrointestinal
disorders on the eligible conditions list for the DOD peer-
reviewed medical research program within fiscal year 2012
defense appropriations legislation. This would allow
researchers to begin working to better understand, diagnose,
and treat these conditions, particularly as they impact
veterans and active duty military personnel.
Thank you for your time and your consideration of this
request.
[The statement follows:]
Prepared Statement of Nancy J. Norton, President and Co-Founder,
International Foundation for Functional Gastrointestinal Disorders
Thank you for the opportunity to present the views of the
International Foundation for Functional Gastrointestinal Disorders
(IFFGD) regarding functional gastrointestinal disorders (FGIDs) among
service personnel and veterans. I am here today to request that that
the Subcommittee include FGIDs as a condition eligible for study in the
Department of Defense (DOD) Peer-Reviewed Medical Research Program in
fiscal year 2012.
Established in 1991, IFFGD is a patient-driven nonprofit
organization dedicated to assisting individuals affected by functional
GI disorders, and providing education and support for patients,
healthcare providers, and the public at large. Our mission is to inform
and support people affected by painful and debilitating digestive
conditions, about which little is understood and few (if any) treatment
options exist. The IFFGD also works to advance critical research on
functional GI and motility disorders, in order to provide patients with
better treatment options, and to eventually find a cure.
FGIDs are disorders in which the movement of the intestines, the
sensitivity of the nerves of the intestines, or the way in which the
brain controls intestinal function is impaired. People who suffer from
FGIDs have no structural abnormality which makes it difficult to
identify their condition using X-rays, blood tests or endoscopies.
Instead, FGIDs are typically identified and defined by the collection
of symptoms experienced by the patient. For this reason, it is not
uncommon for FGID suffers to have unnecessary surgery, medication, and
medical devices before receiving a proper diagnosis. Examples of FGIDs
include irritable bowel syndrome (IBS) and functional dyspepsia. IBS is
characterized by abdominal pain and discomfort associated with a change
in bowel pattern, such as diarrhea and/or constipation. Symptoms of
functional dyspepsia usually include an upset stomach, pain in the
belly, and bloating.
FGIDs can be emotionally and physically debilitating. Due to
persistent pain and bowel unpredictability, individuals who suffer from
this disorder may distance themselves from social events, work, and
even may fear leaving their home. Stigma surrounding bowel habits may
act as barrier to treatment, as patients are not comfortable discussing
their symptoms with doctors. Because FGID symptoms are relatively
common and not life-threatening, many people dismiss their symptoms or
attempt to self-medicate using over-the-counter medications.
In April 2010, the National Academy of Sciences (NAS) published a
report titled ``Gulf War and Health, Volume 8: Update on the Health
Effects of Serving in the Gulf War'' which determined that there is
sufficient evidence to associate deployment to the gulf war and FGIDs,
including IBS and functional dyspepsia. According to the report, there
have been a large number of FGID cases among gulf war veterans, and
their symptoms have continued to be persistent in the years since that
war. The NAS report focused on the incidence of GI disorders among
veterans and did not attempt to determine causality. However, the
report provides compelling evidence linking exposure to enteric
pathogens during deployment and the development of FGIDs. The NAS
recommended that further research be conducted on this association.
The Department of Defense (DOD) Peer-Reviewed Medical Research
Program conducts important research on medical conditions that impact
veterans and active duty military personnel. Given the conclusions of
the NAS report, and the report's recommendations for further research
on the link between FGIDs and exposures experienced by veterans in the
gulf war, FGIDs would make an appropriate addition to the eligible
conditions list for the Defense Medical Research Program. Therefore, we
ask that you include ``functional gastrointestinal disorders'' as a
condition eligible for study in the fiscal year 2012 DOD Peer-Reviewed
Medical Research Program.
Thank you again for the opportunity to address the Subcommittee
today. I hope you agree that the evidence linking FGIDs to service in
the gulf war is compelling, and that you will include ``functional
gastrointestinal disorders'' as a condition eligible for study in the
Department of Defense Peer-Reviewed Medical Research Program in fiscal
year 2012.
IBS INFORMATION
IBS, one of the most common functional GI disorders, strikes all
demographic groups. It affects 30 to 45 million Americans,
conservatively at least 1 out of every 10 people. Between 9 to 23
percent of the worldwide population suffers from IBS, resulting in
significant human suffering and disability. IBS as a chronic disease is
characterized by a group of symptoms that may vary from person to
person, but typically include abdominal pain and discomfort associated
with a change in bowel pattern, such as diarrhea and/or constipation.
As a ``functional disorder'', IBS affects the way the muscles and
nerves work, but the bowel does not appear to be damaged on medical
tests. Without a definitive diagnostic test, many cases of IBS go
undiagnosed or misdiagnosed for years. It is not uncommon for IBS
suffers to have unnecessary surgery, medication, and medical devices
before receiving a proper diagnosis. Even after IBS is identified,
treatment options are sorely lacking and vary widely from patient to
patient. What is known is that IBS requires a multidisciplinary
approach to research and treatment.
Chairman Inouye. I thank you very much, Mr. Christiansen.
Your request will be very seriously considered. Thank you.
Senator Cochran.
Senator Cochran. Mr. Chairman, thank you for bringing the
witnesses to the subcommittee today to let us hear about these
situations. I think we have an obligation to look carefully
into the suggestions of service connection between the events
in their military deployment and the symptoms that are later
discovered. I hope we have enough people who are willing to
devote attention to this so we can figure out a way to find a
cure or medicinal palliatives that make it better or in any
other way possible to help restore them to good health.
Chairman Inouye. Senator Shelby.
Senator Shelby. What are the, say, two most promising areas
of research in this area to date, dealing with all of these
issues?
Mr. Christiansen. I am not a physician like Dr. King. I
would hate to comment. But we do work extensively to support
and encourage research whenever possible. There is a number of
areas where we're learning more and more about gut flora and
the type of bacteria that is normally within the gut and how
something like a GI infection or eating food or drinking water
from a country or an area where health conditions aren't up to
par may throw that balance off, allow things, pathogens, to
leak deeper into the gut than they would normally be, and that
would explain why the conditions are chronic as opposed to it
just goes through your system and then you're okay a couple
weeks later. So looking at the gut flora is becoming more and
more of a promising area.
I would also say--and this is a little bit off of
functional gastrointestinal disorders directly, but it applies
to this whole larger family of functional GI motility
disorders, particularly as it applies to veterans and members
of the military--that tremendous steps are being made in
regenerative medicine, trying to actually regrow parts of the
digestive system that may not be working. The anal sphincter is
a perfect example. There is tremendous efforts underway to
actually in a lab setting repair and regrow anal sphincters,
and if this--for example, if there's a soldier who suffered an
IED attack and significant pelvic floor damage, regenerative
medicine could one day be at a point where he could get a new
anal sphincter and return to a normal quality of life. So those
are two areas I'd acknowledge off the top.
Senator Shelby. Have there been studies to show that this
is a higher rate of problems with military service personnel as
opposed to the general population?
Mr. Christiansen. Yes. The IOM report I previously cited,
there was actually two IOM studies that looked at this. I'd be
happy to share the results of those studies with the
subcommittee. But it is--they had a very high threshold for
acknowledging service connection and they found that the
incidence was higher than it would be in the general population
as a result of military service.
Senator Shelby. Thank you.
Chairman Inouye. I thank you very much. I'd like to thank
the panel.
Our next panel consists of: Ms. Kathleen Moakler, National
Military Family Association; Chief Master Sergeant John R.
``Doc'' McCauslin, Air Force Sergeants Association; Captain
Charles D. Connor, U.S. Navy retired, American Lung
Association; Mr. Rick Jones, National Association for Uniformed
Services.
Our first witness, Ms. Kathleen Moakler. Welcome.
STATEMENT OF KATHLEEN B. MOAKLER, GOVERNMENT RELATIONS
DIRECTOR, NATIONAL MILITARY FAMILY
ASSOCIATION
Ms. Moakler. Thank you, Chairman Inouye, Senator Cochran,
Senator Shelby, for allowing us to speak with you this morning
about military families, our Nation's families. We continue to
share the concerns of military families with policymakers, as
we have for over 40 years.
In the past several years, the National Military Family
Association has done informal surveys with military families on
our web site. In our most recent survey, when 1,200 family
members responded on their top priorities, over 84 percent felt
it was important that Congress and DOD focus on ensuring
support programs meet the needs of families experiencing
multiple deployments. Almost 80 percent felt that helping
wounded service members and their families should be a top
priority, and 78 percent felt that helping surviving families
was an important priority.
We applaud the words of Defense Secretary Gates and
Chairman Mullen before this subcommittee last week when they
stressed the need for continued funding for military family
programs and support of the wounded. Our association agrees
that we will be dealing with the costs of these wars for years
to come and we cannot afford to shortchange our wounded
warriors and our military families, who have sacrificed so much
and will continue to sacrifice.
We also agree with Admiral Mullen that communities must
join with DOD and the services to support service members,
veterans, and military families in their midst. To help with
that effort, our association has developed ``Finding Common
Ground,'' a toolkit for communities supporting military
families that includes easily achievable action items and
useful resources to guide anyone who wants to support military
families, but doesn't know where to start. It can be downloaded
for free at our website, militaryfamily.org.
Child care remains a concern for military families, as
evidenced by a recent Pew Center on the States survey. We are
pleased that, in addition to building new child development
centers, DOD and the services are taking innovative steps to
address these concerns by working to improve capacity in
private child care agencies within States. But the need
remains, especially for the families of the deployed National
Guard and Reserve.
At our Operation Purple Healing Adventures Camp for
families of the wounded, ill, and injured, families continue to
tell us there is a tremendous need for child care services at
or near military treatment facilities. Families need child care
to attend medical appointments, especially mental healthcare
appointments. Our association urges Congress to sustain funding
and resources to meet the child care needs of military
families, to include hourly, drop-in, and increased respite
care across all services, for families of deployed service
members and the wounded, ill, and injured, as well as those
with special needs family members.
Our association also feels that funding to provide more
dedicated resources, such as youth or teen centers, and
enhanced partnerships with national youth-serving
organizations, would be important ways to better meet the needs
of our older youth and teens during deployment.
In 2009 the policy concerning the attendance of the media
at the dignified transfer of remains at Dover Air Force Base
was changed. Family members are now given the option of flying
to Dover. In previous years only about 3 percent of family
members attended this ceremony. Since the policy change, over
90 percent of families are sending members to Dover to attend.
This is provided by the--the money for this is provided by the
services and none of the costs have been funded. We would ask
that funds be appropriated to cover the costs of this
extraordinary expense.
Thank you for your long-term interest in support of--and
support for military families. I look forward to any questions
you may have.
[The statement follows:]
Prepared Statement of Kathleen B. Moakler
The National Military Family Association is the leading nonprofit
organization committed to improving the lives of military families. Our
over 40 years of accomplishments have made us a trusted resource for
families and the Nation's leaders. We have been at the vanguard of
promoting an appropriate quality of life for active duty, National
Guard, Reserve, retired service members, their families and survivors
from the seven uniformed services: Army, Navy, Air Force, Marine Corps,
Coast Guard, Public Health Service and the National Oceanic and
Atmospheric Administration.
Association Volunteers and Representatives in military communities
worldwide provide a direct link between military families and the
Association staff in the Nation's capital. These volunteers are our
``eyes and ears,'' bringing shared local concerns to national
attention.
The Association does not have or receive Federal grants or
contracts.
Chairman Inouye and Distinguished Members of the Subcommittee, the
National Military Family Association would like to thank you for the
opportunity to present testimony for the record concerning the quality
of life of military families--the Nation's families. In the 10th year
of war, we continue to see the impact of repeated deployments and
separations on our service members and their families. We appreciate
your recognition of the service and sacrifice of these families. Your
response through legislation to the increased need for support as
situations have arisen has resulted in programs and policies that have
helped sustain our families through these difficult times.
We recognize, too, the emphasis that the Administration is placing
on supporting military families. The work of Mrs. Obama and Dr. Biden
through the Joining Forces initiative in raising awareness of the
sacrifices military families are making has been well received by the
Nation and appreciated by our families. The American people are
beginning to understand how 1 percent of our population in the United
States is being called upon to bear 100 percent of the burden of
defending our Nation, giving up years of family life together, and how
they need the support of the other 99 percent of Americans to continue
carrying that burden.
The recent Presidential Study Directive-9, which called on Federal
agencies to outline how they are presently or could in the future
support military families, reinforced Administration support as well.
The vision of the study, as contained in the report Strengthening Our
Military Families, Meeting America's Commitment, is, ``to ensure that:
--The U.S. military recruits and retains the highest-caliber
volunteers to contribute to the Nation's defense and security;
--Service members can have strong family lives while maintaining the
highest state of readiness;
--Civilian family members can live fulfilling lives while supporting
their service member(s); and
--The United States better understands and appreciates the
experience, strength, and commitment to service of our military
families.
This vision resonates with all that our Association has tried to
work for during our 42 year history. We believe policies and programs
should provide a firm foundation for families challenged by the
uncertainties of deployment and transformation. Our Association cares
about the health and resilience of military families. Innovative and
evidence based approaches are essential to address the needs of
military children. Families promote a service member's well-being. We
realize support for service members and their families is not solely
provided by the government. Communities also uphold the families.
Our Nation did not expect to be involved in such a protracted
conflict. Our military families continue to require effective tools and
resources to remain strong. We ask Congress, policymakers, non-
government organizations, and communities to remain vigilant and
respond in a proactive manner. Our Nation can express recognition for
their sacrifices by promoting the well-being of military families.
In this statement, the National Military Family Association will
expand on several issues of importance to military families: Family
readiness, family health, and family transitions.
Family Readiness
Policies, programs and services must adapt to the changing needs of
service members and families. Standardization in delivery,
accessibility, and funding are essential. Educated and resourced
families are able to take greater responsibility for their own
readiness. Recognition should be given to the unique challenges facing
families with special needs. Support should provide for families of all
components, in every phase of military life, no matter where they live.
We appreciate provisions in the National Defense Authorization Acts
and Appropriations legislation in the past several years that
recognized many of these important issues. Excellent programs exist
across the Department of Defense (DOD) and the Services to support our
military families. There are redundancies in some areas and times when
a new program was initiated before anyone looked to see if an existing
program could be adapted to answer an evolving need. We realize all
Americans will be asked to tighten their belts in this time of tighter
budgets and some military family programs may need to be downsized or
eliminated. We ask your support for programs that do work when looking
for efficiencies, rewarding best practices and programs that are truly
meeting the needs of families. While we understand that communities and
non-government organizations may fill gaps in areas where government
programs are lacking, we maintain DOD and the Department of Veterans
Affairs (VA) still have a responsibility to provide an appropriate
level of support for our service members, veterans, their families, and
survivors. In this section we will highlight some of these best
practices and identify needs.
Child Care
Child care remains a concern for military families, as evidenced by
a recent Pew Center on the States survey (http://www.preknow.org/
documents/2011_MilitaryFamiliesSurvey.pdf). We are pleased that in
addition to building new Child Development Centers, DOD and the
Services are taking innovative steps to address these concerns.
In December, DOD announced a new pilot initiative in 13 States
aimed at improving the quality of child care within communities, which
should translate into increased child care capacity for military
families living in geographically dispersed areas. Last year, DOD
contracted with SitterCity.com to help military families find
caregivers and military subsidized child care providers. The military
Services and the National Association of Child Care Resource and
Referral Agencies (NACCRRA) continue to partner to provide subsidized
child care to families who cannot access installation based child
development centers.
At our Operation Purple Healing Adventures camp for families of
the wounded, ill and injured, families continue to tell us there is a
tremendous need for child care services at or near military treatment
facilities. Families need child care to attend medical appointments,
especially mental health appointments. Our Association encourages the
expansion of drop-in child care for medical appointments on the DOD or
VA premises or partnerships with other organizations to provide this
valuable service.
We appreciate the requirement in the fiscal year 2010 National
Defense Authorization Act calling for a report on financial assistance
provided for child care costs across the Services and Components to
support the families of service members deployed in support of a
contingency operation and we look forward to the results.
Our Association urges Congress to sustain funding and resources to
meet the child care needs of military families to include hourly, drop-
in, and increased respite care across all Services for families of
deployed service members and the wounded, ill, and injured, as well as
those with special needs family members.
Working with Youth
Older children and teens must not be overlooked. School personnel
need to be educated on issues affecting military students and must be
sensitive to their needs. To achieve this goal, schools need tools.
Parents need tools, too. Military parents constantly seek more
resources to assist their children in coping with military life,
especially the challenges and stress of frequent deployments. Parents
tell us repeatedly they want resources to ``help them help their
children.'' Support for parents in their efforts to help children of
all ages is increasing, but continues to be fragmented. New Federal,
public-private initiatives, increased awareness, and support by DOD and
civilian schools educating military children have been developed.
However, many military parents are either not aware such programs exist
or find the programs do not always meet their needs.
Through our Operation Purple camps, our Association has begun to
identify the cumulative effects multiple deployments are having on the
emotional growth and well-being of military children and the challenges
posed to the relationship between deployed parent, caregiver, and
children in this stressful environment. Understanding a need for
qualitative analysis of this information, we commissioned the RAND
Corporation to conduct a longitudinal study on the experience of 1,500
families. RAND followed these families for 1 year, and interviewed the
non-deployed caregiver/parent and one child per family between 11 and
17 years of age at three time points over the year. Recruitment of
participants was extremely successful because families were eager to
share their experiences. The research addressed three key questions:
--How are school-age military children faring?
--What types of issues do military children face related to
deployment?
--How are non-deployed caregivers handling deployment and what
challenges do they face?
In January 2011, RAND released the report, ``Views from the
Homefront: The Experience of Youth and Spouses from Military Families''
(http://www.rand.org/pubs/technical_reports/TR913.html), detailing the
longitudinal findings. The research showed:
--Older teens reported more difficulties during deployment and
reintegration.
--Girls reported more difficulties during reintegration.
--There were few differences on military characteristics, but reserve
component youth reported more difficulties during deployment.
--Reserve component caregivers reported more challenges with
deployment and reintegration.
--The total number of months away mattered more than the number of
deployments.
--There is a direct correlation between the mental health of the
caregiver and the well-being of the child.
--Quality of family communication mattered to both children and
caregiver well-being.
What are the implications of these findings? Families facing longer
deployments need targeted support--especially for older teens, girls
and the reserve component. Support needs to be in place across the
entire deployment cycle, including reintegration, and some non-deployed
parents may need targeted mental health support. One way to address
these needs would be to create a safe, supportive environment for older
youth and teens. Dedicated installation Youth Centers with activities
for our older youth would go a long way to help with this. Since many
military families, especially those with older children, live off the
installation, enhanced partnerships between DOD and national youth-
serving organizations are also essential. DOD's current work with the
4-H program is an example of this outreach and support of military
children in the community. DOD can encourage other organizations to
share outreach strategies and work together to strengthen a network of
support for military youth in their civilian communities. We must
ensure, however, that, once we have encouraged these community
organizations and services to engage with families, we also encourage
installations and installation services to be collaborative and not set
up roadblocks to interaction and support.
To address the issues highlighted by our research, our Association
hosted a summit in May 2010, where we engaged with experts to develop
research-based action items. Our Blue Ribbon Panel outlined innovative
and pragmatic ideas to improve the well-being of military families,
recognizing it is imperative solutions involve a broad network of
government agencies, community groups, businesses, and concerned
citizens.
We've published the recommendations from the summit in Finding
Common Ground: A Toolkit for Communities Supporting Military Families.
The toolkit is organized in a format similar to our Association's well-
received Military Kids and Teens Toolkits. It contains cards for each
of the intended communities--including Educators, Friends and Family,
Senior leaders, Employers, and Health Care Providers--whose help is so
important to military families. It also contains the summary document
with the recommendations formulated by our Blue Ribbon Panel and summit
participants.
Our goal was to create a user-friendly resource, with easily
achievable action items and pertinent resources to guide everyone who
wants to support military families, but may not know how. The toolkit
lists concrete actions individuals, organizations, and communities can
take to assist and support our military families. We hope that when
someone receives a copy, they will go first to the card that most fits
their relationship to military families and look for ideas and
resources. We would like them to then take the time to explore other
cards and the summit summary. While many of the suggested actions are
simple, we've also presented some of the tougher things that require
the building of partnerships and a longer-term focus. These actions are
not exhaustive. It is our hope this toolkit will start conversations
and stimulate action. Everyone can contribute--it doesn't need to be
complicated or expensive. Just remembering to include military families
in outreach is the beginning.
Our Association feels that funding to provide more dedicated
resources, such as youth or teen centers and enhanced partnerships with
national youth-serving organizations, would be important ways to better
meet the needs of our older youth and teens during deployment.
Military Housing
In our recent study conducted by RAND, researchers found that
living in military housing was related to fewer caregiver-reported
deployment-related challenges. Fewer caregivers who lived in military
housing reported their children had difficulties adjusting to parent
absence (e.g., missing school activities, feeling sad, or not having
peers who understand what their life is like) as compared to caregivers
who rented homes. The study team explored the factors that determine a
military family's housing situation in more detail. Among the list of
potential reasons provided for the question, ``Why did you choose to
rent?'' researchers found that the top three reasons parents/caregivers
cited for renting included: military housing was not available (31
percent), renting was most affordable (28 percent), and preference to
not to invest in the purchase of a home (26 percent).
Privatized housing expands the opportunity for families to live on
the installation and is a welcome change for military families. We are
pleased with the annual report that addresses the best practices for
executing privatized housing contracts. As privatized housing evolves,
the Services are responsible for executing contracts and overseeing the
contractors on their installations. With more joint basing, more than
one Service often occupies an installation. The Services must work
together to create consistent policies not only within their Service,
but across the Services as well. Pet policies, deposit requirements,
and utility policies are some examples of differences across
installations and across Services. How will Commanders address these
variances under joint basing? Military families face many transitions
when they move, and navigating the various policies and requirements of
each contractor is frustrating and confusing. It's time for the
Services to increase their oversight and work on creating seamless
transitions by creating consistent policies across the Services.
In the GAO Report ``Military Housing: Enhancements Needed to
Housing Allowance Process and Information Sharing among Services'' GAO
published in May 2011, GAO highlighted the military Services have
consistently underestimated the amount needed to pay the basic
allowance of housing by $820 million to $1.3 billion each year since
2006. Since the Services have underestimated the amount needed to pay
the allowance, DOD has had to shift funds budgeted from other
programs--which disrupts the funding to these program.
The key factor to underestimation is the timing of developing the
budget process--it takes nearly 1 year to determine the rates. While
this process is needed, it causes the Services to underestimate the
true cost of the housing allowance. Rates are set in December--10
months after the President's budget is submitted to Congress and 2
months after the new fiscal year begins. In addition, changes in
planned force structure (i.e. grow the force initiatives), and the
increased use of mobilized reserve personnel (more personnel eligible
to receive a housing allowance) present other challenges.
The same GAO report highlighted housing deficits ranging from 1
percent to 20 percent of the total demand at growth installations.
While Military construction does not fall under the purview of this
Committee, this Committee can help address the housing deficient by
extending the use of the Temporary Lodging Expense Allowance. This
allowance is designed to partially offset expenses when the service
member occupies temporary quarters while relocating from one
installation to another. Generally payable for up to 10 days--the Army
has extended it up to 60 days at growth installations, such as Fort
Drum and Fort Bliss.
We ask Congress to consider the importance of family well-being by
addressing Basic Allowance for Housing (BAH) inequities.
We also ask for additional money to cover the housing allowance
shortage.
We recommend that DOD provide the Services with the flexibility to
extend the Temporary Lodging Expense Allowance at growth installations
where there is a shortage of available housing.
Commissaries and Exchanges
The Military Personnel Subcommittee of the House Armed Services
Committee (HASC) held two hearings this year to discuss the importance
of sustaining Morale, Welfare, and Recreation (MWR) programs and the
commissary and exchange systems. We maintain that these programs must
not become easy targets for the budget cutters. The military resale
hearing reinforced the importance of the commissary and exchange and
stressed the need for them to remain fiscally sound without reducing
the benefit to military families. Our Association feels strongly that
these quality programs for military families should be preserved,
especially during this era of increased budget austerity.
Our Association is concerned about one issue raised at the recent
HASC resale hearing: the potential negative repercussions of the Tax
Increase Prevention and Reconciliation Act of 2005 (TIPRA) on the
military community. This legislation included a provision, Section 511,
mandating Federal, State, and local governments to withhold 3 percent
from payments for goods and services to contractors after December 31,
2010. While the implementation has been delayed until December 31,
2011, we believe this withholding requirement will have a direct impact
on military families. We believe vendors who provide products sold in
exchanges and commissaries will end up passing on the implementation
costs to patrons and will be less willing to offer deals, allowances,
promotions, and prompt payment discounts, which will thus diminish the
value of the benefit for military families. The implementation costs
for the exchange systems may also result in reduced dividends for MWR
programs, which already operate on tight budgets. Although our
Association realizes this tax issue does not fall under the Senate
Appropriations Committee's jurisdiction, we ask Congress to repeal
Section 511 of TIPRA in order to protect this important benefit for
military families. If full repeal is not possible, we urge Congress to
exempt the Defense Commissary Agency, Exchanges and MWR programs from
the withholding requirement. Military families, who have borne the
burden of this war for nearly 10 years, should not have to incur
additional costs at commissaries and exchanges due to the effects of
this law, which will compromise their quality of life programs when
they need them most.
The commissary benefit is a vital part of the compensation package
for service members and retirees, and is valued by them, their
families, and survivors. Our surveys and those conducted by DOD
indicate that military families consider the commissary one of their
most important benefits. In addition to providing average savings of
more than 30 percent over local supermarkets, commissaries provide a
sense of community. Commissary shoppers gain an opportunity to connect
with other military families and are provided with information on
installation programs and activities through bulletin boards and
publications. Commissary shoppers also receive nutritional information
through commissary promotions and campaigns, as well as the opportunity
for educational scholarships for their children.
Active duty and reserve component families have benefitted greatly
from the addition of case lot sales. Our Association thanks Congress
for allowing the use of proceeds from surcharges collected at these
sales to help defray their costs. Case lot sales continue to be
extremely well received and attended by family members not located near
an installation. According to Army Staff Sgt. Jenny Mae Pridemore,
quoted in the Charleston Daily Mail, ``We don't have easy access to a
commissary in West Virginia and with the economy the way it is everyone
is having a tough time. The soldiers and the airmen really need this
support.'' On average, case lot sales save families between 40 and 50
percent compared to commercial prices. This provides tremendous
financial support for our remote families, and is a tangible way to
thank them for their service to our Nation.
In addition to commissary benefits, the military exchange system
provides valuable cost savings to members of the military community,
while reinvesting their profits in essential MWR programs. Our
Association strongly believes that every effort must be made to ensure
that this important benefit and the MWR revenue is preserved,
especially as facilities are down-sized or closed overseas.
Our Association urges Congress to continue to protect the
commissary and exchange benefits, and preserve the MWR revenue all of
which are vital to maintaining a health military community.
We also ask Congress to repeal Section 511 of TIPRA. If full repeal
is not achievable, we urge Congress to exempt the Defense Commissary
Agency, Exchanges and MWR programs from this withholding requirement.
National Guard and Reserve
Our Association has long recognized the unique challenges our
National Guard and Reserve families face and their need for additional
support. Reserve component families are often geographically dispersed,
live in rural areas, have service members deployed as individual
augmentees, and do not consistently have the same family support
programs as their active duty counterparts. According to the research
conducted for us by the RAND Corporation, spouses of service members in
the National Guard and Reserves reported poorer emotional well-being
and greater household challenges than their full-time active duty
peers. Our Association believes that greater access to resources
supporting National Guard and Reserve caregivers is needed to further
strengthen our reserve component families.
We appreciate the great strides that have been made in recent years
by both Congress and the Services to help support our reserve component
families. Our Association would like to thank Congress for the fiscal
year 2011 NDAA provision authorizing travel and transportation for
members of the Uniformed Services and up to three designees to attend
Yellow Ribbon Reintegration Program events, and for the provision
enhancing the Yellow Ribbon Reintegration Program by authorizing
service and State-based programs to provide access to all service
members and their families. We appreciate your ongoing support of the
Yellow Ribbon Reintegration Program and ask that you continue funding
this quality of life program for reserve component families.
Our Association is gratified that family readiness is now seen as a
critical component to mission readiness. We have long believed that
robust family programs are integral to maintaining family readiness,
for both our active duty and reserve component families. We are pleased
the Department of Defense Reserve Family Readiness Award recognizes the
top unit in each of the Reserve Components that demonstrate superior
family readiness and outstanding mission readiness.
Our Association asks Congress to continue funding the Yellow Ribbon
Reintegration Program and stresses the need for greater access to
resources supporting our Reserve Component caregivers.
Flexible Spending Accounts
Congress has provided the Armed Forces with the authority to
establish Flexible Spending Accounts (FSA), yet the Service Secretaries
have not established these important tax savings accounts for service
members. We are pleased H.R. 791 and S. 387 have been introduced to
press each of the seven Service Secretaries to create a plan to
implement FSAs for uniformed service members. FSAs were highlighted as
a key issue presented to the Army Family Action Plan at their 2011
Department of the Army level conference. FSAs would be especially
helpful for families with out-of-pocket dependent care and healthcare
expenses. It is imperative that FSAs for uniformed service members take
into account the unique aspects of the military lifestyle, such as
Permanent Change of Station (PCS) moves and deployments, which are not
compatible with traditional FSAs. We ask that the flexibility of a
rollover or transfer of funds to the next year be considered.
Our Association supports Flexible Spending Accounts for uniformed
service members that account for the unique aspects of military life
including deployments and Permanent Change of Station moves.
Financial Readiness
Ongoing financial literacy and education is critically important
for today's military families. Military families are not a static
population; new service members join the military daily. For many, this
may be their first job with a consistent paycheck. The youthfulness and
inexperience of junior service members makes them easy targets for
financial predators. Financial readiness is a crucial component of
family readiness. The Department of Defense Financial Readiness
Campaign brings financial literacy to the forefront and it is important
that financial education endeavors include military families.
Our Association looks forward to the establishment of the Office of
Service Member Affairs this July. We encourage Congress to monitor the
implementation of this office to ensure it provides adequate support to
service members and their families. Military families should have a
mechanism to submit a concern and receive a response. The new office
must work in partnership with DOD.
Military families are not immune from the housing crisis. We
applaud Congress for expanding the Homeowners' Assistance Program to
wounded, ill, and injured service members, survivors, and service
members with Permanent Change of Station orders meeting certain
parameters. We have heard countless stories from families across the
Nation who have orders to move and cannot sell their home. Due to the
mobility of military life, military homeowners must be prepared to be a
landlord. We encourage DOD to continue to track the impact of the
housing crisis on military families.
We appreciate the increase to the Family Separation Allowance (FSA)
that was made at the beginning of the war. In more than 10 years,
however, there has not been another increase. We ask that the Family
Separation Allowance be indexed to the Cost of Living Allowance (COLA)
to better reflect rising costs for services.
Our Association asks Congress to increase the Family Separation
Allowance by indexing it to COLA.
Family Health
When considering changes to the healthcare benefit, our Association
urges policymakers to recognize the unique conditions of service and
the extraordinary sacrifices demanded of military members and families.
Repeated deployments, caring for the wounded, and the stress of
uncertainty create a need for greater access to professional behavioral
healthcare for all military family members.
Family readiness calls for access to quality healthcare and mental
health services. Families need to be assured the various elements of
their military health system are coordinated and working as a
synergistic system. The direct care system of Military Treatment
Facilities (MTFs) and the purchased care segment of civilian providers
under the TRICARE contracts must work in tandem to meet military
readiness requirements and ensure they meet access standards for all
military beneficiaries.
Congress must provide timely and accurate funding for healthcare.
DOD healthcare facilities must be funded to be ``world class,''
offering state-of-the-art healthcare services supported by evidence-
based research and design. Funding must also support the renovation of
existing facilities or complete replacement of out-of-date DOD
healthcare facilities. As we close Walter Reed Army Medical Center and
open the new Fort Belvoir Community Hospital and the new Walter Reed
National Military Medical Center, as part of the National Capitol
Region BRAC process, we must be assured these projects are properly and
fully funded. We encourage Congress to provide any additional funding
recommended by DOD and the Defense Health Board's BRAC Subcommittee's
report.
Our Association recommends that DOD be funded to ``world class'',
offering state-of-the-art healthcare services. Funding must also
support renovation of existing facilities or replacement of out-of-date
DOD healthcare facilities.
TRICARE Reimbursement
Our Association is concerned that continuing pressure to lower
Medicare reimbursement rates will create a hollow benefit for TRICARE
beneficiaries. We are appreciative Congress passed the Medicare and
Medicaid Extenders Act of 2010 (Public Law 111-309), which provided a
1-year extension of current Medicare physician payment rates until
December 31, 2011. As the 112th Congress takes up Medicare legislation
this year, we ask you to consider how this legislation will impact
military healthcare, especially our most vulnerable populations, our
families living in rural communities, and those needing access to
mental health services.
While we have been impressed with the strides TMA and the TRICARE
contractors are making in adding providers, especially mental health
providers to the networks, we believe more must be done to persuade
healthcare and mental healthcare providers to participate and remain in
the TRICARE system, even if that means DOD must raise reimbursement
rates. We frequently hear from providers who will not participate in
TRICARE because of what they believe are time-consuming requirements
and low reimbursement rates. National provider shortages in the mental
health field, especially in child and adolescent psychology, are
exacerbated in many cases by low TRICARE reimbursement rates, TRICARE
rules, or military-unique geographic challenges, such as large military
beneficiary populations in rural or traditionally underserved areas.
Many mental health providers are willing to see military beneficiaries
on a voluntary status. We need to do more to attract mental health
providers to join the TRICARE network. Increasing reimbursement rates
is just one way of enticing them.
Since TRICARE payments are linked to Medicare payments, we need
Medicare reimbursement rates to be increased to improve access to
providers.
DOD will need additional funding to offset proposed TRICARE savings
through increasing TRICARE Prime Retiree enrollment fees and changes to
the Pharmacy copays enacted by Congress.
Cost Saving Strategies in the 2012 Budget
We appreciate DOD's continued focus on cost savings strategies in
the 2012 budget. DOD's proposed TRICARE changes include a change in
enrollment fees for TRICARE Prime for under age 65 retirees and a
change in pharmacy co-pays. DOD should also incur savings through
better management of healthcare costs. Our Association has always
supported a mechanism to provide for modest increases to TRICARE Prime
enrollment fee for retirees under age 65. TRICARE Prime, the managed
care option for military beneficiaries, provides guaranteed access, low
out of pocket costs, additional coverage, and more continuity of care
than the basic military health benefit of TRICARE Standard. The annual
enrollment fee of $230 per year for an individual retiree or $460 for a
family has not been increased since the start of TRICARE Prime in 1995.
We agree that DOD's proposed fiscal year 2012 increase of $5 per
month per family and $2.50 per month per individual plan is indeed
modest. We applaud DOD for deciding not to make any changes to the
TRICARE benefit for active duty, active duty family members, medically
retired service members, and survivors of service members and for not
making any changes to the TRICARE Standard and TRICARE for Life (TFL)
benefit.
We have some concerns regarding DOD's selection of a civilian-based
index in determining TRICARE Prime retiree enrollment fee increases
after 2012. Our Association has always supported the use of Cost of
Living Allowance (COLA) as a yearly index tied to TRICARE Prime retiree
enrollment fee increases. We believe if DOD thought the rate of $230
for individual and $460 for family was appropriate in 1995, then yearly
increases tied to COLA would maintain that same principle. Our
objection to the utilization of a civilian index is based on our
concern that civilian healthcare experts cannot agree on an accurate
index on which to base civilian healthcare yearly cost increases. The
Task Force on the Future of Military Health Care ``strongly recommended
that DOD and Congress accept a method for indexing that is annual and
automatic.'' However, the Task Force recommended ``using a civilian-
only rather than total cost (including civilian and MTF costs for Prime
beneficiaries) because the Task Force and DOD have greater confidence
in the accuracy of the civilian care data and its auditability.'' We
ask Congress to adopt the Task Force's DOD accountability
recommendation and require DOD to become more accurate and establish a
common cost accounting system across the MHS. Until it can do so,
however, we believe increases tied to COLA are the most fair to
beneficiaries and predictable for DOD.
We do not support DOD's budget proposal to change the U.S. Family
Health Plan (USFHP) eligibility, asking newly enrolled beneficiaries to
transition from USFHP once they become Medicare/TRICARE for Life
eligible. Our Association believes USFHP is already providing TMA's
medical home model of care, maintaining efficiencies, capturing
savings, and improving patient outcomes. Every dollar spent in
preventative medicine is captured later when the onset of beneficiary
co-morbid and chronic diseases are delayed. It is difficult to quantify
the long-term savings not only in actual cost to the healthcare plan--
and thus to the government--but to the improvement in the quality of
life for the beneficiary. Removing beneficiaries from USFHP at a time
when they and the system will benefit the most from their preventative
and disease management programs would greatly impact the continuity and
quality of care to our beneficiaries and only cost shift the cost of
their care from one government agency to another. Almost all USFHP
enrollees already purchase Medicare Part B in case they decide to leave
the plan or spend long periods of time in warmer parts of the country.
There must be another mechanism in which beneficiaries would be allowed
to continue in this patient-centered program. USFHP also meets the
Patient Protection and Accountability Care Act's definition of an
Accountable Care Organization. They certainly have the model of care
desired by civilian healthcare experts and should be used by DOD as a
method to test best-practices that can be implemented within the direct
care system.
Our Association understands the need for TRICARE to align itself
with Medicare reimbursement payments. DOD's proposal to implement
reimbursement payment for Sole Community Hospitals is another example
of its search for efficiencies. According to TMA, 20 hospitals that
serve military beneficiaries could be affected by this change. We
appreciate the 4-year phased-in approach. However, our Association
recommends Congress encourage TMA to reach out to these hospitals and
provide waivers if warranted and provide oversight to ensure
beneficiaries aren't unfairly impacted by this proposal.
Our Association approves of DOD's modest increase to TRICARE Prime
enrollment fees for working age retirees.
We recommend that future increases to TRICARE Prime enrollment fees
for working age retirees be indexed to retired pay cost of living
adjustments and support legislative language in the House NDAA fiscal
year 2012.
We recommend that Medicare-eligible beneficiaries using the USFHP
be allowed to remain in the program and Congress should continue to
fund this TRICARE option for beneficiaries.
We recommend Congress encourage TMA to reach out to Sole Community
hospitals serving large numbers of military beneficiaries and provide
waivers if warranted. Congress may need to provide additional funding
to help offset this proposed reimbursement change by TMA.
Other Cost Saving Proposals
We ask Congress to establish better oversight for DOD's
accountability in becoming more cost-efficient. We recommend:
--Requiring the Comptroller General to audit MTFs on a random basis
until all have been examined for their ability to provide
quality healthcare in a cost-effective manner.
--Creating a committee, similar in nature to the Medicare Payment
Advisory Commission, to provide oversight of the DOD Military
Health System (MHS) and make annual recommendations to
Congress. The Task Force on the Future of Military Health Care
often stated it was unable to address certain issues not within
their charter or within the timeframe in which they were
commissioned to examine the issues. This Commission would have
the time to examine every issue in an unbiased manner.
--Establishing a Unified ``Joint'' Medical Command structure. This
was recommended by the Defense Health Board in 2006 and 2009
and included in the U.S. House Armed Service Committee's fiscal
year 2011 NDAA proposal and passed by the House of
Representatives.
We are supportive of TMA's movement toward a medical home model of
patient and family centered care within the direct and purchase care
systems. An integrated healthcare model, where beneficiaries will be
seen by the same healthcare team focused on well-being and prevention,
is a well-known cost saver for healthcare expenditures. Our concern is
with the individual Services' interpretation of the medical home model
and its ability to truly function as designed. Our MTFs are still
undergoing frequent provider deployments; therefore, the model must be
staffed well enough to absorb unexpected deployments to theater, normal
staff rotation, and still maintain continuity of providers within the
medical home.
Our Association believes right-sizing to optimize MTF capabilities
through innovating staffing methods; adopting coordination of care
models, such as medical home; timely replacement of medical facilities
utilizing ``world class'' and ``unified construction standards;'' and
increased funding allocations, would allow more beneficiaries to be
cared for in the MTFs. This would be a win-win situation because it
increases MTF capabilities, which DOD asserts is the most cost
effective. It also allows more families, who state they want to receive
care within the MTF, the opportunity to do so. The Task Force made
recommendations to make the DOD MHS more cost-efficient, which we
support. They conclude the MHS must be appropriately sized, resourced,
and stabilized and make changes in its business and healthcare
practices. We encourage Congress to include the recommendations of the
Task Force on the Future of Military Health Care in this year's fiscal
year 2012 NDAA. These include:
--Restructuring TMA to place greater emphasis on its acquisition
role.
--Examining and implementing strategies to ensure compliance with the
principles of value-driven healthcare.
--Incorporating health information technology systems and
implementing transparency of quality measures and pricing
information throughout the MHS. (This is also a civilian
healthcare requirement in the recently passed Patient
Protection and Affordable Care Act.)
--Reassessing requirements for purchased care contracts to determine
whether more cost effective strategies can be implemented.
--Removing systemic obstacles to the use of more efficient and cost-
effective contracting strategies.
Wounded Service Members Have Wounded Families
Our Association asserts that behind every wounded service member
and veteran is a wounded family. It is our belief the government,
especially the DOD and VA, must take a more inclusive view of military
and veterans' families. Those who have the responsibility to care for
the wounded, ill, and injured service member must also consider the
needs of the spouse, children, parents of single service members and
their siblings, and the caregivers. DOD and VA need to think
proactively as a team and one system, rather than separately; and
addressing problems and implementing initiatives upstream while the
service member is still on active duty status.
Reintegration programs become a key ingredient in the family's
success. For the past 3 years, we have piloted our Operation Purple
Healing Adventures camp to help wounded, ill, and injured service
members and their families learn to play again as a family. We hear
from the families who participate in this camp, as well as others
dealing with the recovery of their wounded service members, that, even
with Congressional intervention and implementation of the Services'
programs, many issues still create difficulties for them well into the
recovery period. Families find themselves having to redefine their
roles following the injury of the service member. They must learn how
to parent and become a spouse/lover with an injury. Each member needs
to understand the unique aspects the injury brings to the family unit.
Parenting from a wheelchair brings a whole new challenge, especially
when dealing with teenagers. Parents need opportunities to get together
with other parents who are in similar situations and share their
experiences and successful coping methods. Our Association believes all
must focus on treating the whole family, with DOD and VA programs
offering skill based training for coping, intervention, resiliency, and
overcoming adversities. Injury interrupts the normal cycle of
deployment and the reintegration process. DOD, the VA, and non-
governmental organizations must provide opportunities for the entire
family and for the couple to reconnect and bond, especially during the
rehabilitation and recovery phases.
DOD and the VA must do more to work together both during the
treatment phase and the wounded service member's transition to ease the
family's burden. They must break down regulatory barriers to care and
expand support through the Vet Centers the VA medical centers, and the
community-based outpatient clinics (CBOCs). We recommend DOD partner
with the VA to allow military families access to mental health services
throughout the VA's entire network of care using the TRICARE benefit.
Before expanding support services to families, however, VA facilities
must establish a holistic, family centered approach to care when
providing mental health counseling and programs to the wounded, ill,
and injured service member or veteran.
We remain concerned about the transition of wounded, injured, and
ill service members and their families from active duty status to that
of the medically retired. While we are grateful, DOD has proposed to
exempt medically retired service members, survivors, and their families
from the TRICARE Prime enrollment fee increases, we believe wounded
service members need even more assistance in their transition. We
continue to recommend that a legislative change be made to create a 3-
year transition period in which medically retired service members and
their families would be treated as active duty family members in terms
of TRICARE fees, benefits, and MTF access. This transition period would
mirror that currently offered to surviving spouses and would allow the
medically retired time to adjust to their new status without having to
adjust to a different level of TRICARE support.
Case Management.--Our Association still finds families trying to
navigate a variety of complex healthcare systems alone, trying to find
the right combination of care. Our most seriously wounded, ill, and
injured service members, veterans, and their families are often
assigned multiple case managers. Families often wonder which one is the
``right'' case manager. We believe DOD and the VA must look at whether
the multiple, layered case managers have streamlined the process or
have only aggravated it. We know the goal is for a seamless transition
of care between DOD and the VA. However, we continue to hear from
families, whose service member is still on active duty and meets the
Federal Recovery Coordinator (FRC) requirement, who have not been told
FRCs exist or that the family qualifies for one. We are awaiting the
Government Accountability Office's (GAO) FRC report to determine how
that program is working in caring for our most seriously wounded, ill,
and injured service members and veterans and what can be done to
improve the case management process.
Caregivers of the Wounded
Caregivers need to be recognized for the important role they play
in the care of their loved one. Without them, the quality of life of
the wounded service members and veterans, such as physical, psycho-
social, and mental health, would be significantly compromised. They are
viewed as an invaluable resource to DOD and VA healthcare providers
because they tend to the needs of the service members and the veterans
on a regular basis. And, their daily involvement saves DOD, VA, and
State agency healthcare dollars in the long run. Their long-term
psychological care needs must be addressed. Caregivers of the severely
wounded, ill, and injured service members who are now veterans have a
long road ahead of them. In order to perform their job well, they will
require access to mental health services.
The VA has made a strong effort in supporting veterans' caregivers.
DOD should follow suit and expand its definition, which still does not
align with Public Law 111-163. We appreciate the inclusion in fiscal
year 2010 NDAA of compensation for service members with assistance in
everyday living and the refinement in fiscal year 2011 NDAA. The VA
recently released their VA Caregiver Implementation Plan. Our
Association had the opportunity to testify at a recent House Veterans'
Affairs Committee hearing Implementation of Caregiver Assistance: Are
we getting it right? about our concerns related to the VA's caregiver
implementation plan. We believe the VA is waiting too long to provide
valuable resources to caregivers of our wounded and injured service
members and veterans who had served in Operation Iraqi Freedom/
Operation Enduring Freedom/Operation New Dawn (OIF/OEF/OND). The intent
of the law was to allow caregivers to receive value-added benefits in a
timely manner in order to improve the caregiver's overall quality of
life and train them to provide quality of care to their service member
and veteran. The VA's interpretation also has the potential to impact
the DOD's Special Compensation for Service Members law passed as part
of fiscal year 2010 NDAA and modified in fiscal year 2011. The one area
of immediate concern is the potential gap in financial compensation
when the service member transitions to veteran status. The VA's
application process and caregiver validation process appear to be very
time intensive. The DOD compensation benefit expires at 90-days
following separation from active duty. Other concerns include:
--Narrower eligibility requirements than what the law intended;
--Lack of illness being covered, such as cancer from a chemical
exposure;
--Delay in the caregiver's receipt of healthcare benefits if
currently uninsured, respite care, and training; and
--Exclusion of non-medical care from the VA's caregiver stipend.
The VA's decision to delay access to valuable training may force
each Service to begin its own training program. Thus, each Service's
training program will vary in its scope and practice and may not meet
VA's training objectives. This disconnect could force the caregiver to
undergo two different training programs in order to provide and care
and receive benefits.
Our Association also believes the current laws do not go far
enough. Compensation of caregivers should be a priority for DOD and the
Secretary of Homeland Security. Non-medical care should be factored
into DOD's compensation to service members. The goal is to create a
seamless transition of caregiver benefit between DOD and the VA. We ask
Congress to assist in meeting that responsibility. Congress will need
to be ready to fully fund both DOD and VA caregiver benefit programs.
The VA currently has eight caregiver assistance pilot programs to
expand and improve healthcare education and provide needed training and
resources for caregivers who assist disabled and aging veterans in
their homes. DOD should evaluate these pilot programs to determine
whether to adopt them for caregivers of service members still on active
duty. Caregivers' responsibilities start while the service member is
still on active duty. Congress will need to fund these pilot programs.
Relocation Allowance and Housing for Medically-Retired Single
Service Members.--Active Duty service members and their spouses qualify
through the DOD for military orders to move their household goods when
they leave the military service. Medically retired service members are
given a final PCS move. Medically retired married service members are
allowed to move their family; however, medically retired single service
members only qualify for moving their own personal goods.
Our Association suggests that legislation be passed to allow
medically retired single service members the opportunity to have their
caregiver's household goods moved as a part of the medical retired
single service member's PCS move. This should be allowed for the
qualified caregiver of the wounded service member and the caregiver's
family (if warranted), such as a sibling who is married with children,
or mom and dad. This would allow for the entire caregiver's family to
move, not just the caregiver. The reason for the move is to allow the
medically retired single service member the opportunity to relocate
with their caregiver to an area offering the best medical care, rather
than the current option that only allows for the medically retired
single service member to move their belongings to where the caregiver
currently resides. The current option may not be ideal because the area
in which the caregiver lives may not be able to provide all the
healthcare services required for treating and caring for the medically
retired service member. Instead of trying to create the services in the
area, a better solution may be to allow the medically retired service
member, their caregiver, and the caregiver's family to relocate to an
area where services already exist.
The decision on where to relocate for optimum care should be made
with the FRC (case manager), the service member's medical physician,
the service member, and the caregiver. All aspects of care for the
medically retired service member and their caregiver shall be
considered. These include a holistic examination of the medically
retired service member, the caregiver, and the caregiver's family for,
but not limited to, their needs and opportunities for healthcare,
employment, transportation, and education. The priority for the
relocation should be where the best quality of services is readily
available for the medically retired service member and his/her
caregiver.
The consideration for a temporary partial shipment of caregiver's
household goods may also be allowed, if deemed necessary by the case
management team.
We ask Congress to allow medically retired service members and
their families to maintain the active duty family TRICARE benefit for a
transition period of 3 years following the date of medical retirement,
comparable to the benefit for surviving spouses.
Service members medically discharged from service and their family
members should be allowed to continue for 1 year as active duty for
TRICARE and then start the Continued Health Care Benefit Program
(CHCBP) if needed.
Congress will need to fully fund training, compensation and other
support programs for caregivers of the wounded, ill and injured because
of the important role they play in the successful rehabilitation and
care of the service member and veteran.
We request legislation funding medically retired single service
members to have their caregiver's household goods moved as a part of
their final PCS move.
Congress will need to fully fund DOD's Caregiver Compensation
benefit for military service members and the VA's caregiver benefit for
caregivers.
Senior Oversight Committee
Our Association is appreciative of the provision in the fiscal year
2009 NDAA continuing the DOD and VA Senior Oversight Committee (SOC)
until December 2010. The DOD established the Office of Wounded Warrior
Care and Transition Policy to take over the SOC responsibilities. The
Office has seen frequent leadership and staff changes and a narrowing
of its mission. We urge Congress to put a mechanism in place to
continue to monitor this Office for its responsibilities in maintaining
DOD and VA's partnership and making sure joint initiatives create a
seamless transition of services and benefits for our wounded, ill, and
injured service members, veterans, their families, and caregivers.
Defense Centers of Excellence
A recent GAO report found the Defense Centers of Excellence (DCoE)
for Psychological Health and Traumatic Brain Injury has been challenged
by a mission that lacked clarity and by time-consuming hiring
practices. DCoE has experienced a lack of adequate funding hampering
their ability to hire adequate staff and begin to provide care for the
patient population as they were created to address. These include the
Vision Center of Excellence, Hearing Center of Excellence, and the
Traumatic Extremity Injury and Amputation Center of Excellence. We
recommend Congress immediately fund these Centers and require DOD to
provide resources to effectively establish these Centers and meet DOD's
definition of ``world class'' facilities.
The Defense Centers of Excellence is providing a transition benefit
for mental health services for active duty service members, called
inTransition. Our Association recommends this program be expanded to
provide the same benefit to active duty spouses and their children.
Families often complain about the lack of seamless transition of care
when they PCS. This program will not only provide a warm hand-off
between mental health providers when moving between and within Regions,
but more importantly, enable mental health services to begin during the
move, when families are between duty stations and most venerable.
We must educate those who care for our service members and veterans
about the effects of Traumatic Brain Injury (TBI), Post-Traumatic
Stress (PTS), Post-Traumatic Stress Disorder (PTSD), and suicide in
order to help accurately diagnose and treat the service member/
veteran's condition. These families are on the ``sharp end of the
spear'' and are more likely to pick up on changes attributed to either
condition and relay this information to their healthcare providers.
Families need tools to help them deal with the daily issues that arise
when living with and caring for a service member or veteran with TBI
and/or PTS/PTSD. Programs are being developed by each Service. However,
they are narrow in focus targeting line leaders and healthcare
providers, but not broad enough to capture our military family members
and the communities they live in. As Services roll out suicide
prevention programs, we need to fund programs that include our
families, communities, and support personnel. The Deployment Health
Clinical Center (DHCC), an umbrella organization to DCoE, offers a 3
week PTSD course for service members and a separate 1-week course for
their family members. These programs are making a difference in the
quality of the service members and their families lives. Currently, the
family member PTSD program is funded by a nonprofit organization. These
programs need to continue; therefore, they need to be fully funded by
Congress.
Our Association encourages all Congressional Committees with
jurisdiction over military personnel and veterans matters to talk on
these important issues. Congress, DOD, and VA can no longer continue to
create policies in a vacuum and focus on each agency separately because
our wounded, ill, and injured service members and their families need
seamless, coordinated support from each.
We recommend Congress immediately fund the Vision Center of
Excellence, Hearing Center of Excellence, and the Traumatic Extremity
Injury and Amputation Center of Excellence and require DOD to provide
resources to effectively establish these Centers and meet DOD's
definition of ``world class'' facilities.
We recommend Congress fully fund DHCC's PTSD programs for service
members and their family members s they may continue uninterrupted.
We recommend the ``inTransition'' program be expanded to provide
the same benefit to active duty family members. This program would need
to be funded to be expanded to include them.
Family Transitions
Policies and programs must provide training and support for
families during the many transitions military families experience.
Quality education for spouses and children, financial literacy, and
spouse career progression need attention. When families experience a
life-changing event, they require a responsive system to support them.
Our Nation must continue to ensure our surviving family members receive
the support they deserve.
Survivors
The Services continue to improve their outreach to surviving
families. In particular, the Army's SOS (Survivor Outreach Services)
program makes an effort to remind these families they are not
forgotten. We most appreciate the special consideration, sensitivity,
and outreach to the families whose service members have committed
suicide. We would like to acknowledge the work of the Tragedy
Assistance Program for Survivors (TAPS) in this area as well. They have
developed unique outreach to these families and held support
conferences to help surviving family members navigate what is a very
difficult time with many unanswered questions. DOD and the VA must work
together to ensure surviving spouses and their children can receive the
mental health services they need, through all of VA's venues. We
believe Congress must grant authority to allow coverage of bereavement
or grief counseling under the TRICARE behavioral health benefit. The
goal is the right care at the right time for optimum treatment effect.
In 2009, the policy concerning the attendance of the media at the
dignified transfer of remains at Dover AFB was changed. Primary next-
of-kin (PNOK) of the service member who dies in theater is asked to
make a decision shortly after they are notified of the loss as to
whether or not the media may film the dignified transfer of remains of
their loved one during this ceremony. Family members are also given the
option of flying to Dover themselves to witness this ceremony. In
previous years, only about 3 percent of family members attended this
ceremony. Since the policy change, over 90 percent of families send
some family members to Dover to attend. The travel of up to 3 family
members and the casualty assistance officer on a commercial carrier are
provided for. In the NDAA fiscal year 2010, eligible family member
travel to memorial services for a service member who dies in theater
was authorized. This is in addition to travel to the funeral of the
service member. None of the costs associated with this travel has been
funded for the Services. We would ask that funds be appropriated to
cover the costs of this extraordinary expense.
Our Association recommends that grief counseling be more readily
available to survivors as a TRICARE benefit.
We ask that funding be appropriated for the travel costs for
surviving family members to attend the dignified transfer of remains in
Dover and for eligible surviving family members to attend memorial
services for service members who die in theater.
Our Association still believes the benefit change that will provide
the most significant long-term advantage to the financial security of
all surviving families would be to end the Dependency and Indemnity
Compensation (DIC) offset to the Survivor Benefit Plan (SBP). Ending
this offset would correct an inequity that has existed for many years.
Each payment serves a different purpose. The DIC is a special indemnity
(compensation or insurance) payment paid by the VA to the survivor when
the service member's service causes his or her death. The SBP annuity,
paid by DOD, reflects the longevity of the service of the military
member. It is ordinarily calculated at 55 percent of retired pay.
Military retirees who elect SBP pay a portion of their retired pay to
ensure that their family has a guaranteed income should the retiree
die. If that retiree dies due to a service-connected disability, their
survivor becomes eligible for DIC.
Surviving active duty spouses can make several choices, dependent
upon their circumstances and the ages of their children. Because SBP is
offset by the DIC payment, the spouse may choose to waive this benefit
and select the ``child only'' option. In this scenario, the spouse
would receive the DIC payment and the children would receive the full
SBP amount until each child turns 18 (23 if in college), as well as the
individual child DIC until each child turns 18 (23 if in college). Once
the children have left the house, this choice currently leaves the
spouse with an annual income of $13,848, a significant drop in income
from what the family had been earning while the service member was
alive and on active duty. The percentage of loss is even greater for
survivors whose service members served longer. Those who give their
lives for their country deserve more fair compensation for their
surviving spouses.
We believe several other adjustments could be made to the Survivor
Benefit Plan. Allowing payment of the SBP benefits into a Special Needs
Trust in cases of disabled beneficiaries will preserve their
eligibility for income based support programs. The government should be
able to switch SBP payments to children if a surviving spouse is
convicted of complicity in the member's death.
We believe there needs to be DIC equity with other Federal survivor
benefits. Currently, DIC is set at $1,154 monthly (43 percent of the
Disabled Retirees Compensation). Survivors of Federal workers have
their annuity set at 55 percent of their Disabled Retirees
Compensation. Military survivors should receive 55 percent of VA
Disability Compensation. We are awaiting the overdue report. We support
raising DIC payments to 55 percent of VA Disability Compensation. When
changes are made, we ask Congress to ensure that DIC eligibles under
the old system receive an equivalent increase.
Imagine that you have just experienced the death of your spouse, a
retired service member. In your grief, you navigate all the gates you
must, fill out paperwork, notify all the offices required. Then, the
overdrawn notices start showing up in your mailbox. Bills that you
thought had been paid at the beginning of the month suddenly appear
with ``overdue'' on them. Retirees are paid proactively, that is, they
receive retired pay for the upcoming month i.e. on May 31, a retiree
receives retired pay for the month of June. Presently, the government
has the authority to take back the full month's pay from the retiree's
checking account when that retiree dies. Payment for the number of days
the retiree was alive in the month is subsequently returned to the
surviving spouse. The VA, on the other hand, allows the surviving
spouse to keep the last month of disability pay. We support H.R. 493,
which would allow the surviving spouse or family to keep the last month
of retired pay to avoid financial penalties caused by the decrease of
funds in a checking account.
We ask the DIC offset to SBP be eliminated to recognize the length
of commitment and service of the career service member and spouse. We
support H.R. 178 and S. 260, which both provide for that elimination.
We also request that SBP benefits be allowed to be paid to a
Special Needs Trust in cases of disabled family members.
We ask that DIC be increased to 55 percent of VA Disability
Compensation.
We support H.R. 493, ``The Military Retiree Survivor Comfort Act'',
to provide for forgiveness of overpayments of retired pay paid to
deceased retired members of the Armed Forces following their death.
Education of Military Children
Military families place a high value on the quality of their
children's education. It is a leading factor in determining many
important family decisions, such as volunteering for duty assignments,
choosing to accompany the service member or staying behind, selecting
where a family lives within their new community, deciding whether to
spend their financial resources on private school, or considering
homeschooling options. It can even impact a families' decision to
remain in the Service.
Military families want quality education for their children just as
their civilian counterparts do. It is important to remember that
military families define ``quality of education'' differently. For
military families, it is not enough for children to be doing well in
their current schools they must also be prepared for the next location.
Most military children will move at least twice during their high
school years and most will attend six to nine different schools between
kindergarten and 12th grade. Although the Interstate Compact on
Educational Opportunity for Military Children is helping to alleviate
many of the transition issues our families face when moving, it does
not address the quality of education in our schools. Though many of our
civilian schools are already doing an excellent job of educating and
supporting our military children, we believe military children deserve
a quality education wherever they may live. That is why our Association
has spent over 40 years working to improve education for our military
children and empowering parents to become their children's best
advocate.
With more than 90 percent of military-connected students now
attending civilian schools, our Association is pleased that the
Department of Defense has completed a 90-day preliminary assessment of
how to provide a world-class education for all of the 1.2 million
school-aged children, not just those under the Department of Defense
Education Activity's (DODEA) purview. Our Association was invited by
Dr. Clifford L. Stanley, Under Secretary of Defense for Personnel and
Readiness, to participate in the Education Review Debriefing and to
offer our insights on the way ahead. We look forward to the final
report and to working with DOD to support its implementation. We thank
the Department of Defense for the educational support programs already
available to military children, such as the tutoring program for
deployed service member families, and DODEA's virtual high schools. Our
Association believes these programs are making a difference and would
be beneficial to all military families.
We were also pleased the President's landmark directive,
``Strengthening Our Military Families,'' listed as one of its top
priorities the need to ensure excellence in military children's
education and their development. We greatly appreciate the Department
of Education committing to making military families one of its
priorities for its discretionary grant programs and for including our
Association as a military stakeholder in finding ways to strengthen
military families within the Reauthorization of the Elementary and
Secondary Education Act.
Our Association thanks Congress for providing additional funding to
civilian school districts educating military children through DODEA's
Educational Partnership Grant Program. We are aware that DODEA's
expanded authority to shares its expertise, experience and resources to
assist military children during transitions, to sharpen the expertise
of teachers and administrators in meeting the needs of military
children, and to provide assistance to local education agencies on
deployment support for military children is set to expire in 2013. We
ask Congress to extend the authority for the Educational Partnership
Grant Program past 2013.
We strongly urge Congress to ensure it is providing appropriate and
timely funding of Impact Aid through the Department of Education. We
also ask that you allow school districts experiencing high levels of
growth, due to military base realignment, to apply for Impact Aid funds
using current student enrollment numbers rather than the previous year.
In addition, we call on Congress to increase DOD Supplemental Impact
Aid funding for schools educating large numbers of military connected
students. Our Association has long believed that both Impact Aid
programs are critical to ensuring that school districts can provide
quality education for our military children.
We strongly urge Congress to ensure it is providing appropriate
funding of Impact Aid through the Department of Education at authorized
levels and to allow school districts experiencing high growth due to
base realignments to apply for Impact Aid funds using current student
enrollment numbers.
We ask Congress to increase the DOD supplement to Impact Aid to $60
million.
We also ask Congress to extend the authority for the DODEA
Educational Partnership Grant Program.
Spouse Education and Employment
We are pleased the NDAA fiscal year 2011 calls for a report on
military spouse education programs. Our recent surveys and feedback we
have received from military families indicates they appreciate in-state
tuition and the Post 9/11 G.I. Bill transferability. Our Association
would like to thank Congress for the enhancements made to the Post 9/11
G.I. Bill last session. We are especially pleased that spouses of
active duty service members are now eligible for the book stipend and
the authority to grant transferability has been extended to families of
the Commissioned Corps of NOAA and the U.S. Public Health Service.
DOD's most-cited program success for military spouses is the
Military Spouse Career Advance Account (MyCAA)--in its original form.
In October 2010, MyCAA was significant revised and seasoned spouses who
are no longer eligible feel their education pursuits are not supported
by the Department of Defense. Many military spouses delay their
education to support the service member's career. Since 2004, our
Association has been fortunate to sponsor our Joanne Holbrook Patton
Military Spouse Scholarship Program, with the generosity of donors who
wish to help military families. Of particular interest, 33.5 percent of
applicants from our 2011 scholarship applicant pool stated their
education was interrupted because of the military lifestyle (frequent
moves, TDYs, moving expenses, etc.) and 12.2 percent of those directly
attributed the interruption to deployment of the service member.
Military spouses remain committed to their education and need
assistance from Congress to fulfill their educational pursuits. We ask
Congress to push DOD to fully reinstate the MyCAA program to include
all military spouses, regardless of their service member's rank and to
ensure the funding is available for this reinstatement. We also ask
Congress to work with the appropriate Service Secretaries to extend the
MyCAA program to spouses of the Coast Guard, the Commissioned Corps of
NOAA, and the U.S. Public Health Service.
The fiscal year 2011 NDAA report on military spouse education
programs only addresses one aspect--education. In order to determine if
the education programs are working, we recommend a report on spouse
employment programs. The NDAA fiscal year 2010 created a pilot program
to secure internships for military spouses with Federal agencies.
Funding for the program continues through fiscal year 2011. A report on
military spouse employment programs should include an assessment of the
military spouse Federal internship program. Military spouses want more
Federal employment opportunities. Should the pilot become a permanent
program? We urge Congress to monitor the pilot to ensure spouses are
able to access the program and eligible spouses are able to find
Federal employment after successful completion of the internship. Our
Association recommends Congress requests a report on military spouse
employment programs.
To further spouse employment opportunities, we recommend an
expansion to the Work Opportunity Tax Credit for employers who hire
spouses of active duty and reserve component service members as
proposed through the Military Spouse Employment Act, H.R. 687. This
employer tax credit is one way to encourage corporate America to hire
military spouses.
We also recommend providing a tax credit to military spouses to
offset the expense of obtaining a career license or credential when the
service member is relocated to a new duty station. Military spouses are
financially disadvantaged by government ordered moves when they are
required to obtain a career license in a new State to practice in their
profession. Many military spouses must maintain a career license in
multiple States, costing hundreds of dollars. For example, a pharmacist
can only reciprocate to another State from their original license,
which requires a military spouse pharmacist to maintain a license in
more than one State. When our Association asked military spouses to
share their employment challenges with us, a military spouse of 26
years stated, ``The very most frustrating part about the process, is
that obtaining a license does not guarantee that I will find
employment. I have been licensed in [Kentucky] for a full year and in
that time have gotten one 6-hour shift of work. That one shift does not
even begin to recover the expense of obtaining my license here.'' We
recommend that Congress pass the Military Spouse Job Continuity Act or
similar legislation to reduce the financial barrier licensed military
spouses must overcome with each move in order to find employment.
Our Association urges Congress to recognize the value of military
spouses by fully funding the MyCAA program for all military spouses,
expand the Work Opportunity Tax Credit to include military spouses, and
provide a tax credit to offset state license and credential fees.
Support for Special Needs Families
The NDAA fiscal year 2010 established the Office of Community
Support for Military Families with Special Needs to enhance and improve
DOD support around the world for military families with special needs,
whether medical or educational. Our Association remains concerned that
the Office has not received the proper resources to address the
medical, educational, relocation, and family support resources our
special needs families often require. This Office must address these
various needs in a holistic manner in order to effectively implement
change. The original intent of the legislation was to have the office
reside in the Office of the Under Secretary of Defense for Personnel
and Readiness in order to bring together all entities having
responsibility for the medical, educational, relocation, and family
support needs of special needs military family member. At present,
however, the office comes under the jurisdiction of the Deputy
Assistant Secretary of Defense for Military Community and Family
Policy.
Case management for military beneficiaries with special needs is
not consistent across the Services or the TRICARE Regions because the
coordination care for the military family is being done by a non-
synergistic healthcare system. Beneficiaries try to obtain an
appointment and then find themselves getting partial healthcare within
the MTF, while other healthcare is referred out into the purchased care
network. Thus, military families end up managing their own care.
Incongruence in the case management process becomes more apparent when
military family members transfer from one TRICARE Region to another and
when transferring within the same TRICARE Region. This incongruence is
further exacerbated when a special needs family member is involved and
they require not only medical intervention, but non-medical care as
well. Families need a seamless transition and a warm hand-off between
and within TRICARE Regions and a universal case management process
across the MHS. Each TRICARE Managed Care Support Contractor (MCSC) has
created different case management processes. TRICARE leaders must work
closely with their family support counterparts through the Office of
Community Support for Military Families with Special Needs to develop a
coordinated case management system that takes into account other
military and community resources.
We applaud the attention Congress and DOD have given to our special
needs family members in the past 2 years and their desire to create
robust healthcare, educational, and family support services for special
needs family members. But, these robust services do not follow them
when they retire. We encourage the Services to allow these military
families the opportunity to have their final duty station be in an area
of their choice, preferably in the same State in which they plan to
live after the service member retires, to enable them to begin the
process of becoming eligible for State and local services while still
on active duty. We also suggest the Extended Care Health Option (ECHO)
be extended for 1 year after retirement for those family members
already enrolled in ECHO prior to retirement. More importantly, our
Association recommends if the ECHO program is extended, it must be for
all who are eligible for the program because we should not create a
different benefit simply based on medical diagnosis.
The Office of Community Support is beginning a study on Medicaid
availability for special needs military family members. Our Association
is anxiously awaiting this report's findings. We will be especially
interested in the types of value-added services individual State
Medicaid waivers offer their enrollees and whether State budget
difficulties are making it more difficult for military families to
qualify for and participate in waiver programs. This information will
provide yet another avenue to identify additional services ECHO may
include in order to help address our families' frequent moves and their
inability to often qualify for these additional value-added benefits in
a timely manner.
There has been discussion over the past several years by Congress
and military families regarding the ECHO program. The ECHO program was
originally designed to allow military families with special needs to
receive additional services to offset their lack of eligibility for
State or federally provided services impacted by frequent moves. We
suggest that before making any more adjustments to the ECHO program,
Congress should request a GAO report to determine if the ECHO program
is working as it was originally designed and if it has been effective
in addressing the needs of this population. We also hear from our ECHO
eligible families that they could benefit from additional programs and
healthcare services to address their special needs. We request a DOD
pilot study to identify what additional service(s), if any, our special
needs families need to improve their quality of life, such as cooling
vests, diapers, and some nutritional supplements. We recommend families
have access to $3,000 of additional funds to purchase self-selected
items, programs, and/or services not already covered by ECHO. DOD would
be required to authorize each purchase to verify the requested item,
program, or service is appropriate. The pilot study will identify gaps
in coverage and provide DOD and Congress with a list of possible extra
ECHO benefits for special needs families. We need to make the right
fixes so we can be assured we apply the correct solutions. Our
Association believes the Medicaid waiver report, the GAO report, along
with the pilot study will provide DOD and Congress with the valuable
information needed to determine if the ECHO program needs to be
modified in order to provide the right level of extra coverage for our
special needs families. We also recommend a report examining the impact
of the war on special needs military families.
We ask Congress to request a GAO report to determine if the ECHO
program is working as it was originally designed and if it has been
effective in addressing the needs of this population.
We request Congress fund a DOD pilot study to identify what
additional service(s), if any, our special needs families need to
improve their quality of life.
We recommend that the Extended Care Health Option (ECHO) program be
extended for 1 year after retirement for those already enrolled in ECHO
prior to retirement.
We also recommend a report examining the impact of the war on our
special needs families.
Families on the Move
A Permanent Change of Station (PCS) move to an overseas location
can be especially stressful for our families. Military families are
faced with the prospect of being thousands of miles from extended
family and living in a foreign culture. At many overseas locations,
there are insufficient numbers of government quarters resulting in the
requirement to live on the local economy away from the installation.
Family members in these situations can feel extremely isolated; for
some the only connection to anything familiar is the local military
installation. Unfortunately, current law permits the shipment of only
one vehicle to an overseas location, including Alaska and Hawaii. Since
most families today have two vehicles, they sell one of the vehicles.
Upon arriving at the new duty station, the service member requires
transportation to and from the place of duty leaving the military
spouse and family members at home without transportation. This lack of
transportation limits the ability of spouses to secure employment and
the ability of children to participate in extracurricular activities.
While the purchase of a second vehicle alleviates these issues, it also
results in significant expense while the family is already absorbing
other costs associated with a move. Simply permitting the shipment of a
second vehicle at government expense could alleviate this expense and
acknowledge the needs of today's military family.
Travel allowances and reimbursement rates have not kept pace with
the out-of-pocket costs associated with today's moves. In a recent PCS
survey conducted by our Association, more than 50 percent of survey
respondents identified uncovered expenses related to the move as their
top moving challenge. Military families are authorized 10 days for a
housing hunting trip, but the cost for trip is the responsibility of
the service member. Families with two vehicles may ship one vehicle and
travel together in the second vehicle. The vehicle will be shipped at
the service member's expense and then the service member will be
reimbursed funds not used to drive the second vehicle to help offset
the cost of shipping it. Or, families may drive both vehicles and
receive reimbursement provided by the Monetary Allowance in Lieu of
Transportation (MALT) rate. MALT is not intended to reimburse for all
costs of operating a car but is payment in lieu of transportation on a
commercial carrier. Yet, a TDY mileage rate considers the fixed and
variable costs to operate a vehicle. Travel allowances and
reimbursement rates should be brought in line with the actually out-of-
pocket costs borne by military families.
Our Association supports the Service Members Permanent Change of
Station Relief Act, S. 472 and believes it will reduce some of the
additional moving expenses incurred by many military families.
Our Association requests that Congress authorize the shipment of a
second vehicle to an overseas location (at least Alaska and Hawaii) on
accompanied tours, and that Congress address the out-of-pocket expenses
military families bear for government ordered moves.
Military Families--Our Nation's Families
Military families have been supporting their warriors in time of
war for 10 years. DOD and the military Services, with the help and
guidance of Congress have developed programs and policies to respond to
their changing and developing needs over this time. Families have come
to rely on this support. They appreciate the spotlight of recognition
that has been shone on their experience by the First Lady and Dr.
Biden. They are heartened by the new sense of cooperation between
government agencies in coordinating support. They know that it is up to
them to make use of the tools and programs provided to become more
resilient with each deployment. Congress provides the authorization and
funding for these tools and programs. Even in a time of austere
budgets, our Nation needs to sustain this support in order to maintain
readiness. Our military families deserve no less.
Chairman Inouye. I thank you very much, Ms. Moakler.
Senator Cochran.
Senator Cochran. I'm curious, what's the estimated cost of
the reimbursement if the Congress desired to or decided to
respond to that request?
Ms. Moakler. I don't know, because it depends on how long,
how far the family is coming from. But right now the units
themselves are taking that money out of hide, out of their
family support funds.
Senator Cochran. Thank you.
Chairman Inouye. Senator Shelby.
Senator Shelby. Mr. Chairman, just an observation. I know
Ms. Moakler is her as an advocate and she's got a great record
of family support. I believe this subcommittee has a good
record of support for our military through the appropriation,
and their families, which we think are very important to the
wellbeing and the readiness of our soldiers.
Ms. Moakler. We agree.
Senator Shelby. Thank you.
Chairman Inouye. Thank you very much.
Our next witness, Chief Master Sergeant John McCauslin, Air
Force Sergeants Association.
STATEMENT OF CHIEF MASTER SERGEANT JOHN R. ``DOC''
McCAUSLIN, CHIEF EXECUTIVE OFFICER, AIR
FORCE SERGEANTS ASSOCIATION
Sergeant McCauslin. Good morning, Chairman Inouye, Ranking
Member Cochran, Senator Shelby, and other members of this
subcommittee. On behalf of the 110,000 members of the Air Force
Sergeants Association, thanks for this opportunity to offer our
views of our members on the fiscal year 2012 priorities. This
morning I will briefly cover some specific areas we urge your
subcommittee to provide funding for.
Let me begin with healthcare. In coordination with the
Military Coalition and governmental agencies, we want to ensure
that our military members and their families continue to
receive a cost-effective sustainable healthcare benefit, and we
greatly appreciate the past efforts of you and this
subcommittee to make that happen.
Last week the Senate Armed Services Committee marked the
National Defense Authorization Act and we were greatly
disappointed that the bill permits TRICARE fee increases.
Before seeking increases in military healthcare, we would urge
that you consider all funding options relative to adequate and
sustainable healthcare for our military and their families and
get full detailed justification for the raise of such from DOD.
The care of those who have borne the horrors and hazards of
battle needs your constant attention. More than 42,000 service
members have been wounded in action since the conflicts began.
Thousands more suffer from the unseen wounds of war. We support
full funding for the care of wounded warriors, including moneys
for research and treatment of traumatic brain injuries, post-
traumatic stress disorder, and all those other war-related
issues.
On a related matter, this Nation owes those heroes an
everlasting gratitude and compensation that extends well beyond
their time in the military. It calls attention to the
importance of proper documentation of care received on the
battlefield and their recovery afterward. DOD and VA have made
great strides in recent years developing a joint electronic
health record. But it's imperative that this work continue
until that job is done. This is one that actually saves the
taxpayers money.
We also urge continued funding of military base pay, so
that annual military pay raises exceed the ECI index by at
least one-half of 1 percent, and we support targeted pay raises
for midgrade enlisted personnel who have recently assumed
increased responsibility. The bottom line here is regular
military pay raises must be maintained by DOD so that we can
continue to recruit and retain the very best and brightest.
Another hot button issue is the homelessness and
unemployment of our veterans. The VA has estimated that 25
percent of all homeless individuals in the United States are
veterans. According to the Bureau of Labor Statistics, the
estimated jobless rate among male veterans ages 18 to 24 was
more than 30 percent just last month, compared to 18 percent
among civilians of the same age and gender group. This is an
absolute shame. DOD and VA recently agreed to tackle this issue
jointly, so we encourage you to provide enough resources to
make that happen.
Caring for survivors of military members is always a matter
of concern. Those with military survivor plan annuities should
be able to also receive VA's dependency and indemnity
compensation payments without offset. The special survivors
indemnity allowance created by Congress in 2008 to minimize
those losses is appreciated, but it only restores a fraction of
the nearly $1,200 surviving spouses lose each month. We as a
Nation must be able to do better than that.
We would like to thank Senator Bill Nelson for introducing
S. 260 and the 38 Senators, 8 of which are on your
subcommittee, sir, who have co-sponsored this important
legislation. You may recall that in the 111th Congress there
were 62 co-sponsors in the Senate to fix this. It's high time
we act.
Another precious asset is, the National Guard and Air Force
Reserve currently have to wait until they reach age 60 before
they draw their retirement pay. They are currently over 50
percent of our mission completion, yet subject to this holding
situation. A provision in last year's NDAA allows the reserve
components to shave off some time of their minimum retired age
in exchange for equal periods of active duty service in combat
zones. We are nowhere near resolving this issue and appreciate
your continued attention.
Mr. Chairman, that's all I have today. On behalf of our
association, I thank you and the members of your subcommittee
for their dedication to those of us who serve.
[The statement follows:]
Prepared Statement of John R. ``Doc'' McCauslin
Chairman Inouye, Ranking Member Cochran, and distinguished members
of the Defense subcommittee, on behalf of the 111,000 members of the
Air Force Sergeants Association, thank you for this opportunity to
offer the views of our members on the military personnel programs that
affect those serving (and who have served) our Nation. This hearing
will address issues critical to those serving and who have served our
Nation.
AFSA represents active duty, guard, reserve, retired, and veteran
enlisted Air Force members and their families, and this year marks our
50th Anniversary in doing so. Your continuing efforts toward improving
the quality of their lives make a real difference, and our members are
grateful. In this statement, I will list several specific goals that we
hope this committee will consider funding in fiscal year 2012 on behalf
of current and past enlisted members and their families. The content of
this statement reflects the views of our members as they have
communicated them to us. As always, we are prepared to present more
details and to discuss these issues with your staffs.
BASIC MILITARY PAY
Tremendous progress has been made in recent years to close the gap
between civilian sector and military compensation. AFSA appreciates
these steady efforts and we hope they will continue. We believe linking
pay raises to the employment cost index (ECI) is essential to
recruiting and retaining the very best and brightest volunteers.
The President's fiscal year 2012 budget proposal calls for a 1.6
percent pay increase for active duty service members--the minimum
amount by law. AFSA believes that the formula for determining annual
pay increases to be ECI + 0.5 percent until the gap is completed
eliminated. If we want to continue having an all volunteer force, we
must continue on the path to close the aforementioned pay gap!
QUALITY OF LIFE
Our Nation's military should not be considered a financial burden
but considered a national treasure as they preserve our national
security for all that live here. If we expect to retain this precious
resource, we must provide them and their families, with decent and safe
work centers, family housing and dormitories, healthcare, child care
and physical fitness centers, and recreational programs and facilities.
These areas are a prime recruitment and retention incentive for our
Airmen and their families. This directly impacts their desire to
continue serving through multiple deployments and extended separations
from family and friends.
This Nation devotes considerable resources to train and equip
America's sons and daughters--a long term investment--and that same
level of commitment should be reflected in the facilities and equipment
they use and in where they live, work, and play.
We urge extreme caution in deferring these costs, especially at
installations impacted by base realignment and closure (BRAC) decisions
and mission-related shifts.
We applaud congressional support for military housing privatization
initiatives. This has provided housing at a much faster pace than would
have been possible through military construction alone.
AFSA urges Congress to fully fund appropriate accounts to ensure
our installations eliminate substandard housing and work centers as
quickly as possible. Those devoted to serving this Nation deserve
better.
Tremendous strides have been made to improve access to quality
child care and fitness centers on military installations, and we are
grateful to the Department of Defense and Congress for these collective
efforts. However, there is still much more work to be done. I have
personally visited over 125 Air Force installations in the States and
overseas these past 3 years and I can assure you that the demand for
adequate child care is a top priority among our Airmen and their
families. The availability of on base Child Development Centers (CDC)
plays a critical role in each military family's decision whether or not
to remain in the service. So I urge Congress to dedicate the funding
necessary to build more CDCs and eliminate the space deficit that
exists today.
HEALTHCARE
Like many Military and Veterans Service Organizations (MSO/VSO's),
AFSA wants to ensure that past, present and future service members and
families receive the inexpensive, high quality healthcare benefit that
they so richly deserve. And we are concerned with repeated attempts by
DOD to shift healthcare costs onto the back of retirees--particularly
how they are perceived by active duty service members, many of whom
have fought in Iraq and Afghanistan over the past 10 years.
As Abraham Lincoln correctly observed, ``The willingness with which
our young people are likely to serve in any war, no matter how
justified, shall be directly proportional to how they perceive the
Veterans of earlier wars were treated and appreciated by their
nation.''
To date, Congress has rejected the Pentagons proposed raids on
earned medical benefits, and we greatly appreciate your work which
allowed that to happen.
This year the Pentagon is once again asking for higher fees and
their current plan would raise enrollment fees for ``working age''
retirees and their families who use TRICARE Prime would increase by 13
percent in fiscal year 2012. The National Health Expenditure index,
produced by the Centers for Medicare and Medicaid Services, would be
used beginning in fiscal year 2013, to determine annual enrollment fee
increases thereafter.
Co-pays for prescription drugs obtained at retail pharmacies would
also rise under DOD's plan--from $3 to $5 for generics, $9 to $12 for
brand name, and $22 to $25 for non-formulary medications at retail
pharmacies. Non-formulary medications obtained through TRICARES Home
Delivery would also increase to $25 from $22.
At first glance, the increases DOD is proposing appear modest but
we view them as the ``foot in the door'' which will provide the impetus
for a long line of future TRICARE program changes. Regrettably, the
House recently chose to include, or rather exclude, language in its
version of the fiscal year 2012 National Defense Authorization Act
(H.R. 1540) which would allow DOD's plan to move forward. It does
however, limit increases in fiscal year 2013 and beyond to the rate of
the annual COLA.
AFSA does not discount the country's current fiscal dilemma, or the
need to get the Federal budget under control. Nor is it is an issue of
sacrificing a little more so everyone shares a greater portion of the
load. The question is should they pay more before lesser priority
programs are cut first? No one has sacrificed more then the men and
women who have worn or are wearing the Nation's uniform. We simply
believe it is unwise to raise TRICARE fees at a time when we have
thousands of men and women in harms way overseas. What kind of message
are we sending to them? Many of the individuals that would be affected
by the proposed increases were promised free lifetime healthcare by
DOD's recruiters to entice them to enlist, and career counselors to
induce them to reenlist. Right, wrong, or indifferent, a decision to
increase fees at this time would likely be viewed as another breech of
promises made by the government. This in turn could adversely affect
the services quality recruiting and retention efforts.
I urge this Subcommittee to ensure continued, full funding for
Defense Health Program. Before seeking increases in enrollment fees,
deductibles or co-payments, DOD should pursue any and all options to
contain the growth of healthcare spending in ways that do not
disadvantage beneficiaries and provide incentives to promote healthy
lifestyles.
Again, we appreciate your consistent support in recent years to
protect beneficiaries from disproportional healthcare fee increases.
Support Judicious VA-DOD Sharing Arrangements
We encourage this Subcommittee to fund programs that eliminate
waste and increase efficiency between DOD and VA.
AFSA supports the judicious use of VA-DOD sharing arrangements
involving network inclusion in the DOD healthcare program, especially
when it includes consolidating physical examinations at the time of
separation. It makes no sense to order a full physical exam on your
retirement from the military and then within 30 days the VA has ordered
their own complete physical exam with most of the same exotic and
expensive exams.
The decision to begin this process represents a good, common-sense
approach that should eliminate problems of inconsistency, save time,
and take care of veterans in a timely manner. These initiatives will
save funding dollars. AFSA recommends that Congress closely monitor the
collaboration process to ensure these sharing projects actually improve
access and quality of care for eligible beneficiaries. DOD beneficiary
participation in VA facilities must never endanger the scope or
availability of care for traditional VA patients, nor should any VA-DOD
sharing arrangement jeopardize access and/or treatment of DOD health
services beneficiaries. One example of a successful joint sharing
arrangement is the clinic with ambulatory care services being in
Colorado Springs, Colorado. This will aid the large number of veterans
remaining in the area and support the increases in Colorado Springs as
a result of BRAC initiatives. The VA and DOD each have a lengthy and
comprehensive history of agreeing to work on such projects, but follow-
through is lacking. ``We urge these committees to encourage joint VA-
DOD efforts, but ask you to exercise close oversight to ensure such
arrangements are implemented properly.''
CARING FOR SURVIVORS
Support of Survivors.--AFSA commends this committee for previous
legislation, which allowed retention of Dependency and Indemnity
Compensation (DIC), burial entitlements, and VA home loan eligibility
for surviving spouses who remarry after age 57. However, we strongly
recommend the age 57 DIC remarriage provision be reduced to age 55 to
make it consistent with all other Federal survivor benefit programs.
We also endorse the view that surviving spouses with military
Survivor Benefit Plan (SBP) annuities should be able to concurrently
receive earned SBP benefits and DIC payments related to their sponsor's
service-connected death.
We strongly recommend the Subcommittee fund Senator Bill Nelson's
(D-FL) bill, S. 260 which would eliminate this unfair offset.
Survivors of retirees who draw the final full month's retired pay
for the month in which retirees die should not have to pay this
compensation back. This is however, what current law requires.
At a time when the surviving spouse and family members are trying
to put their lives back together, DOD comes and takes the money back.
Not some of it; all of it. The entire month. Weeks later, the
proportionate amount of retired pay may be returned to the spouse but
the damage has already been done.
AFSA believes it is wrong to subject survivors to this kind of
``financial nit-picking'' at a tragic time lives. If there's ever a
time for the Government to give a military beneficiary a tiny break,
surely this is it. And we encourage this subcommittee to provide
sufficient funding to remove this requirement from the books.
Other Survivor issues included in our Top Priorities are:
--Permit the member to designate multiple SBP beneficiaries with a
presumption that such designations and related allocations of
SBP benefits must be proportionate to the allocation of retired
pay.
--Provide for eligibility for housing loans guaranteed by the
Department of Veterans Affairs for the surviving spouses of
certain totally disabled veterans.
DEBT COMMISSION PROPOSALS
Oppose the following Debt commission recommendations:
--Freeze Federal salaries, bonuses and other comp for 3 years
including military non-combat pay;
--Reduce spending on base support and facility maintenance;
--Integrate military kids into local schools in the United States;
--Use highest 5 years for civil svc and military retiree pay;
--Reform military retiree system to vest after 10 years and defer
collection to age 60; and
--Full 20+ years of military retired pay starts age 57.
Work Toward a Consistent Funding Formula and Program Permanence.--
This association believes that the parameters of who will be served,
what care will be provided, the facilities needed, and the full funding
to accomplish those missions should be stabilized as mandatory
obligations. If that were so, and Congress did not have to go through
redefinition drills as economic philosophies change, the strength of
the economy fluctuates, and the numbers of veterans increases or
decreases--these committees and this Nation would not have to re-debate
obligations and funding each year. We believe that these important
programs should be beyond debate and should fall under mandatory rather
than discretionary spending.
The following are a few of the Debt Commission issues recognized in
our Top Priorities:
--Make adjustments to the Household Goods (HHG) weight allowances
that take into consideration the number of family members;
--If advantageous to the Government, reimburse transportation
expenses for PCSing members to take their POVs to a location
other than a commercial storage facility;
--Resist DOD/DECA efforts to reduce the benefit that negatively alter
current pricing policies, or provide the benefit to non-
military beneficiaries;
--Resist the Base Exchange merger process to prevent degradation of
the benefit; and
--Monitor/scrutinize housing privatization efforts to preclude
adverse impact on all military members.
AIR NATIONAL GUARD AND RESERVE RETIREMENT
Reduce the earliest Guard and Reserve retirement compensation age
from 60 to 55.--Legislation was introduced in previous years to provide
a more equitable retirement for the men and women serving in the Guard
and Reserves. This proposed legislation would have reduced the age for
receipt of retirement pay for Guard and Reserve retirees from 60 to 55.
Active duty members draw retirement pay the day after they retire. Yet,
Guard and Reserve retirees currently have to wait until they reach age
60 before they can draw retirement pay.
Provide Concurrent Retirement and Disability Pay (CRDP) For Service
Incurred Disabilities.--National Guard and Reserve with 20 or more good
years are currently able to receive CRDP, however, they must wait until
they are 60 years of age and begin to receive their retirement check.
This policy must be changed, and along with the reduction in retirement
age eligibility, is a benefit our Guard and Reserve deserve. They have
incurred a service connected disability and we must provide concurrent
retirement and disability pay to them.
Many Guard/Reserve retirees have spent more time in a combat zone
than their active duty counterparts. The DOD has not supported
legislation to provide Guard/Reserve men and women more equitable
retirement pay in the past. Additional requirements and reliance has
been placed on the Guard/Reserve in recent years. It is time to
recognize our men and women in uniform serving in the Guard and Reserve
and provide them a more equitable retirement system.
Provide employer and self-employed tax credits and enhance job
security.--AFSA supports legislation to allow the work opportunity
credit to small businesses, which hire members of the Reserve
Components. We encourage this Subcommittee to provide the funding
necessary to make this happen.
Award Full Veterans Benefit Status to Guard and Reserve Members.--
It is long overdue that we recognize those servicemembers in the Guard
and Reserve who have sustained a commitment to readiness as veterans
after 20 years of honorable service to our country. Certain Guard and
Reserve members that complete 20 years of qualifying service for a
reserve (non-regular) retirement have never been called to active duty
service during their careers. At age 60, they are entitled to start
receiving their reserve military retired pay, Government healthcare,
and other benefits of service including some veterans' benefits. But,
current statutes deny them full standing as a ``veteran'' of the armed
forces and as a result they are not entitled to all veteran benefits.
Our goal, along with our TMC partners, is to support pending
legislation that will include in the definition(s) of ``veteran''
retirees of the Guard/Reserve components who have completed 20 years or
more of qualifying service, but are not considered to be veterans under
the current statutory definitions.
EDUCATION PROGRAMS
There's no escaping the fact that college costs are rising. As the
gap between the cost of an education and value of the Montgomery GI
Bill (MGIB) widened, the significance of the benefit became less
apparent. For that reason, the Post-9/11 GI Bill is a giant step
forward. However, we must make sure that the new Post-9/11 GI Bill
stays current at all times, so that this benefit will not lose its
effectiveness when it comes to recruiting this Nation's finest young
men and women into service. As a member of The Military Coalition and
the Partnership for Veterans' Education, we strongly recommend you make
the remaining technical corrections to the Post-9/11 GI Bill. Examples
that standout are active duty not receiving the $1,000 annual book
stipend, Title 32 credit for Guard and Reserve service, and BAH for
those veterans or retirees taking on-line college courses full-time.
Providing in-State tuition rates at federally supported State
universities and colleges.--Regardless of residency requirements, is an
important goal for AFSA due to the rise in servicemembers and their
families returning to institutions to further their education and other
numerous PCS moves involved with the CONUS.
Ensure full funding for the mission of the Impact Aid Program.--
Impact Aid Program is to disburse payments to local educational
agencies that are financially burdened by Federal activities and to
provide technical assistance and support services.
Preserve Tuition Assistance.--The discretionary Air Force Tuition
Assistance (TA) Program is an important quality of life program that
provides tuition and fees for courses taken by active duty personnel.
The program is one of the most frequent reasons given for enlisting and
re-enlisting in the Air Force.
Implement the Interstate Compact!.--The Interstate Compact on
Educational Opportunity for Military Children works to correct the
inequalities that military children face as they transfer from one
school (system) to another due to deployments or permanent change of
station moves by their servicemember parent.
By implementing this Compact, States can work together to achieve
cohesive education goals and assure military students are well prepared
for success after high school graduation. We encourage your strong
support for those who serve this Nation and ask that you take necessary
measures to pass this Act in your State and implement this important
program. The States that thus far are absent from supporting the
``sense of the Senate'' are Nebraska, Massachusetts, Vermont, West
Virginia, Minnesota, New Hampshire, and Wyoming.
Repeal or Greatly Modify the Uniformed Services Former Spouses
Protection Act (USFSPA--Public Law 97-252).--AFSA urges this
Subcommittee to support some fairness provisions for the USFSPA. While
this law was passed with good intentions in the mid 1980s, the
demographics of military service and their families have changed. As a
result, military members are now the only U.S. citizens who are put at
a significant disadvantage in divorce proceedings.
Because of the USFSPA, the following situations now exist:
--A military member is subject to giving part of his/her military
retirement pay (for the rest of his/her life) to anyone who was
married to him/her during the military career regardless of the
duration of the marriage.
--The divorce retirement pay separation is based on the military
member's retirement pay--not what the member's pay was at the
time of divorce (often many years later).
--A military retiree can be paying this ``award'' to multiple former
spouses.
--It takes a military member 20 years to earn a retirement; it takes
a former spouse only having been married to the member (for any
duration, no matter how brief) to get a portion of the member's
retirement pay.
--Under this law, in practice judges award part of the member's
retirement pay regardless of fault or circumstances.
--There is no statute of limitations on this law; i.e., unless the
original divorce decree explicitly waived separation of future
retirement earnings, a former spouse who the military member
has not seen for many years can have the original divorce
decree amended and ``highjack'' part of the military member's
retirement pay.
--The former spouse's ``award'' does not terminate upon remarriage of
the former spouse.
--The ``award'' to a former spouse under this law is above and beyond
child support and alimony.
--The law is considered unfair, illogical, and inconsistent. The
member's military retired pay which the Government refers to as
``deferred compensation'' is, under this law, treated as
property rather than compensation. Additionally, the law is
applied inconsistently from State to State.
--In most cases, the military retiree has no claim to part of the
former spouse's retirement pay.
--Of all U.S. citizens, it is unconscionable that military members
who put their lives on the line are uniquely subjected to such
an unfair and discriminatory law.
--While there may be unique cases (which can be dealt with by the
court on a case-by-case basis) where a long-term, very
supported former spouse is the victim, in the vast majority of
the cases we are talking about divorces that arise which are
the fault of either or both parties--at least half of the time
not the military member. In fact, with the current levels of
military deployments, more and more military members are
receiving ``Dear John'' and ``Dear Jane'' letters while they
serve.
--This is not a male-vs.-female issue. More and more female military
members are falling victim to this law. These are just a few of
the inequities of this law. We believe this law needs to be
repealed or, at the least, greatly modified to be fairer to
military members. We urge the Subcommittee to support any
funding requirement that may be necessary to take action on
this unfair law--for the benefit of those men and women who are
currently defending the interests of this nation and its
freedom.
CONCLUSION
Chairman Inouye, Ranking Member Cochran, in conclusion, I want to
thank you again for this opportunity to express the views of our
members on these important issues as you consider the fiscal year 2012
budget. We realize that those charged as caretakers of the taxpayers'
money must budget wisely and make decisions based on many factors. As
tax dollars dwindle, the degree of difficulty deciding what can be
addressed, and what cannot, grows significantly.
AFSA contends that it is of paramount importance for a nation to
provide quality healthcare and top-notch benefits in exchange for the
devotion, sacrifice, and service of military members. So, too, must
those making the decisions take into consideration the decisions of the
past, the trust of those who are impacted, and the negative
consequences upon those who have based their trust in our Government?
We sincerely believe that the work done by your committees is among the
most important on the Hill. On behalf of all AFSA members, we
appreciate your efforts and, as always, are ready to support you in
matters of mutual concern.
The Air Force Sergeants Association looks forward to working with
you in this 112th Congress.
Chairman Inouye. I can assure you that the matter of the
unemployed and homeless will be a very high priority. Thank you
very much.
Sergeant McCauslin. Thank you, Senator.
Chairman Inouye. Senator Cochran.
Senator Cochran. Thank you for bringing these facts and
figures to our attention. It occurs to me that we need to give
this our best consideration. I think you can be assured that
that will happen.
Sergeant McCauslin. Thank you, sir.
Chairman Inouye. Senator Shelby.
Senator Shelby. Mr. Chairman, just an observation.
Sergeant, Mr. McCauslin----
Sergeant McCauslin. Yes, sir.
Senator Shelby [continuing]. You speak well for the
Sergeants Association. There are a lot of you, but you had a
distinguished military record yourself. I was just reading
that. You're to be commended. You're a good spokesman for them.
Thank you. We respect that.
Sergeant McCauslin. Thank you, sir.
Chairman Inouye. Thank you very much, Sergeant.
Our next witness is Captain Connor, American Lung
Association. Captain.
STATEMENT OF CAPTAIN CHARLES D. CONNOR, UNITED STATES
NAVY (RETIRED), PRESIDENT AND CHIEF
EXECUTIVE OFFICER, AMERICAN LUNG
ASSOCIATION
Captain Connor. Thank you very much, Senator. It's a
pleasure to be here. Mr. Chairman, with your permission, I
would like to pass on the greetings of two of your admirers in
Honolulu I met with last week, Dr. Michael Chun and Aaron Mahi.
I'm passing on their greetings to you this morning.
I'm, as you said, a retired Navy captain. I'm President and
CEO of the American Lung Association. The American Lung
Association has been around for more than 100 years and our
mission is to save lives by improving lung health and fighting
lung disease. We do this through three big things: research,
advocacy, and educational programs.
I'd like to take a few seconds of the subcommittee's time
to talk about three big things today: the terrible burden on
the military caused by tobacco use and the need for DOD to
start combatting it; to ask your consideration for restoring
funding for the peer-reviewed lung cancer research program to
$20 million; and third, to discuss briefly what you've heard
about this morning already, which is the threat posed by our
soldiers in Iraq and Afghanistan to toxic pollutants in the
air.
Firstly, let me address tobacco use if I may. Tobacco use,
as you well know, is the leading cause of preventable death in
the United States today. Not surprisingly, it is also a very
significant problem in our military as well. DOD has made some
small progress, but much, much more needs to be done. Currently
the smoking rate for civilians in America is about 20 percent.
It's about 30 percent in the military, 30.5 exactly, and we
think the combat arms people in deployed status, it's probably
much higher than that. The highest smoking rates in the
military are for those people between 18 and 25, especially
soldiers and marines.
More than one in seven active duty personnel begin smoking
after they join the military. So it's a very, very severe
problem.
The use of tobacco is a severe compromiser of readiness and
performance. Studies have shown that smoking is the best
predictor of training failure and it's also been shown to
increase soldiers' chances of physical injury and
hospitalization. Now, you may have been surprised, as I was, to
see the Secretary of Defense in the last year for the first
time in my recollection complain about the cost of military
healthcare. The biggest driver of healthcare is tobacco use. So
the Pentagon spends over $1.6 billion of appropriated funds in
treating tobacco-related medical care, increased
hospitalization, and lost days of work.
Just 2 years ago, the Institute of Medicine issued a big
thick report I could have brought today entitled ``Tobacco Use
in the Military and Veterans Population.'' The panel found that
tobacco control does not have a very high priority in the
military--that's what we think as well--and that it will take a
long time to get the military off tobacco. They suggested as
long as 20 years.
So the American Lung Association believes now is the time
to attack this problem if it's going to take that long, and DOD
is overdue in announcing how it intends to implement those
recommendations.
Two other things briefly in the minute I have left. We
strongly support the lung cancer research program in the
congressionally directed medical research program. We urge you
to restore it to its original intent and the $20 million. The
original intent was for competitive research grants and
priority given to deployment of integrated components to
identify, treat, and manage early curable lung cancer.
Last, I will not repeat what you've heard already today,
but we are extremely concerned about the respiratory disease of
soldiers and marines coming back from theater. We recommend DOD
immediately begin to find alternatives to burning trash for
waste disposal and to make burn pits more efficient. We also
urge DOD to take steps to minimize troop exposure to pollutants
and to further monitor pollution efforts. We think military
people should be measured for respiratory illness before they
go to theater and then coming back, so that we can compare
apples to apples, so to speak, without comparing military
respiratory disease with the civilian population. So I think
there's some attention that needs to be paid to that.
Thank you very much.
[The statement follows:]
Prepared Statement of Charles D. Connor
Mr. Chairman and members of the Committee, the American Lung
Association is honored to present this testimony to the Senate
Appropriations Subcommittee on Defense. The American Lung Association
was founded in 1904 to fight tuberculosis and today, our mission is to
save lives by improving lung health and preventing lung disease. We
accomplish this through research, advocacy and education.
The American Lung Association wishes to call your attention to
three issues for the Department of Defense's (DOD) fiscal year 2012
budget: the terrible burden on the military caused by tobacco use and
the need for the Department to aggressively combat it; the importance
of restoring funding for the Peer-Reviewed Lung Cancer Research Program
to $20 million; and the health threat posed by soldiers' exposure to
toxic pollutants in Iraq and Afghanistan.
First, the American Lung Association is concerned about the use of
tobacco products by the troops. The effects of both the health and
performance of our troops are significantly hindered by the prevalence
of smoking and use of smokeless tobacco products. As a result, we urge
the Department of Defense to immediately implement the recommendations
in the Institute of Medicine's 2009 Report, Combating Tobacco Use in
Military and Veteran Populations.
Next, the American Lung Association recommends and supports
restoring funding to $20 million for the Peer-Reviewed Lung Cancer
Research Program (LCRP) within the Department of Defense
Congressionally Directed Medical Research Program (CDMRP). Finally, the
American Lung Association is deeply concerned about the respiratory
health of our soldiers in Iraq and Afghanistan. We urge the DOD to
immediately find alternatives to using burn pits, to track the
incidence of respiratory disease related to service, and to take other
steps that will improve the lung health of soldiers.
Combating Tobacco Use
Tobacco use remains the leading cause of preventable death in the
United States and not surprisingly, is a significant problem within the
military as well. The DOD has made some small progress, including its
recent smokefree policy on submarines, but significantly more will need
to be done to reduce the billion dollar price tag that comes with
military personnel using tobacco products.
The 2008 Department of Defense Survey of Health Behaviors among
Active Duty Personnel found that smoking rates among active duty
personnel have essentially remained steady since 2002. However, smoking
rates among deployed personnel are significantly higher and,
alarmingly, more than one in seven (15 percent) of active duty
personnel begin smoking after joining the service.
Currently, the smoking rate for active duty military is 30.5
percent, with smoking rates highest among personnel ages 18 to 25--
especially among soldiers and Marines. The Department of Veterans
Affairs estimates that more than 50 percent of all active duty
personnel stationed in Iraq smoke.\1\ The use of tobacco compromises
military readiness and the performance of our men and women in the
armed forces. Studies have found that smoking is one of the best
predictors of training failure, and it has also been shown to increase
soldiers' chances of physical injury and hospitalization.\2\ Tobacco
use not only costs the DOD in troop readiness and health--it also costs
the DOD money. The Pentagon spends over $1.6 billion on tobacco-related
medical care, increased hospitalization and lost days of work.\3\
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\1\ Hamlett-Berry, KW, as cited in Beckham, JC et al. Preliminary
findings from a clinical demonstration project for veterans returning
from Iraq or Afghanistan. Military Medicine. May 2008; 173(5):448-51.
\2\ Institute of Medicine. Combating Tobacco Use in Military and
Veteran Populations. 2009; 3-4.
\3\ Institute of Medicine. Combating Tobacco Use in Military and
Veteran Populations. 2009; 56.
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In 2009, the prestigious Institute of Medicine (IOM) issued a
report entitled, Combating Tobacco Use in Military and Veteran
Populations. The panel found ``tobacco control does not have a high
priority in DOD or VA.'' This report, which was requested by both
departments, issued a series of recommendations, which the American
Lung Association fully supports and asks this Committee to ensure are
implemented.
The IOM recommendations include commonsense approaches to
eliminating the use of tobacco in the U.S. military. Some of the IOM's
recommendations include:
--Phase in tobacco-free policies by starting with military academies,
officer-candidate training programs, and university-based
reserve officer training corps programs. Then the IOM
recommends new enlisted accessions be required to be tobacco-
free, followed by all active-duty personnel;
--Eliminate tobacco use on military installations using a phased-in
approach;
--End the sales of tobacco products on all military installations.
Personnel often have access to cheap tobacco products on base,
which can serve to start and perpetuate addictions;
--Ensure that all DOD healthcare and health promotion staff are
trained in the standard cessation treatment protocols;
--Ensure that all DOD personnel and their families have barrier-free
access to tobacco cessation services.
A recent investigation conducted by American Public Media \4\
highlights that the discount price for tobacco products on base is
significantly more--in some cases 20 percent--than the 5 percent
permitted under law. The easiest way to end this problem is to end
tobacco sales on all military installations.
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\4\ Herships, Sally. ``Military underprices tobacco more than law
allows.'' American Public Media. http://marketplace.publicradio.org/
display/web/2011/06/01/pm-military-underprices-tobacco-more-than-law-
allows/. Accessed June 3, 2011.
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The American Lung Association recommends that the Department of
Defense implement all recommendations called for in the 2009 IOM
report. The IOM has laid out a very careful, scientifically based road
map for the DOD to follow and the American Lung Association strongly
urges the Committee to ensure that the report's recommendations be
implemented without further delay.
Peer Reviewed Lung Cancer Research Program
The American Lung Association strongly supports the Lung Cancer
Research Program (LCRP) in the Congressionally Directed Medical
Research Program (CDMRP) and its original intent to research the scope
of lung cancer in our military.
In fiscal year 2011, LCRP received $12.8 million. We urge this
Committee to restore the funding level to the fiscal year 2009 level of
$20 million. In addition to the reduced funding, the American Lung
Association is troubled by the change in governance language of the
LCRP authorized by the Congress in fiscal year 2010. We request that
the 2012 governing language for the LCRP be returned to its original
intent, as directed by the 2009 program: ``These funds shall be for
competitive research . . . . Priority shall be given to the development
of the integrated components to identify, treat and manage early
curable lung cancer''.
Troubling Lung Health Concerns in Iraq and Afghanistan
The American Lung Association is extremely troubled by reports of
soldiers and civilians who are returning home from Iraq and Afghanistan
with lung illnesses including asthma, chronic bronchitis and sleep
apnea. Several new studies discussed below show that the airborne
particle pollution our troops breathe in these areas may cause or
contribute to these problems.
A recent DOD study found that air in several Middle East locations
contained high concentrations of desert sand, as well as particles that
likely came from human-generated sources--especially trash burned in
open pits and diesel exhaust. Breathing particulate matter causes heart
attacks, asthma attacks, and even early death. People most at risk from
particulate matter include those with underlying diseases such as
asthma, but the health impact of particle pollution is not limited to
individuals with pre-existing chronic conditions. Healthy, young adults
who work outside--such as our young men and women in uniform--are also
at higher risk. Data from a 2009 study of soldiers deployed in Iraq and
Afghanistan found that 14 percent of them suffered new-onset
respiratory symptoms, a much higher rate than their non-deployed
colleagues. In a review of the DOD studies, the National Academy of
Sciences National Research Council (NRC) concluded that troops deployed
in the Middle East are ``exposed to high concentrations'' of
particulate matter associated with harm ``affecting troop readiness
during service'' and even ``occurring years after exposure.'' \5\
---------------------------------------------------------------------------
\5\ National Academy of Sciences, National Research Council. Review
of the Department of Defense Enhanced Particulate Matter Surveillance
Program Report. 2010. http://www.nap.edu/catalog/12911.html. Accessed
June 7, 2011.
---------------------------------------------------------------------------
Several studies, released in May at the American Thoracic Society
2011 International Conference, show mounting evidence for the
importance of solving these problems. One large study showed that
asthma rates in soldiers deployed to Iraq are higher than in soldiers
deployed elsewhere. The study also showed that soldiers who served in
Iraq had more serious asthma--i.e., lower lung function--than non Iraq
personnel. In fact, records show that 14 percent of medic visits in
Iraq are for respiratory issues, which is a higher percentage than from
the previous Iraq war.\6\
---------------------------------------------------------------------------
\6\ Szema, Anthony M. Overview of Exposures And New Onset Asthma In
Soldiers Serving In Iraq And Afghanistan. As presented at American
Thoracic Society 2011 International Conference, May 18, 2011.
---------------------------------------------------------------------------
There are several probable causes for this alarming prevalence of
respiratory disease in our current war arenas. The most obvious cause
is exposure to dust. There are multiple kinds of dust from multiple
sources in the Middle East. Measurements show that the amount of
harmful particles in the air is over 600 percent higher than the levels
considered acceptable for public health in the United States. More
significant sources of toxic air pollution are burn pits, which are lit
with jet fuel and sometimes burn continuously for years. This method of
disposing of trash can be incredibly harmful to soldiers who work in
the pits' vicinity. Major explosions, IEDs, and fungus can also cause
harmful respiratory effects.\7\
---------------------------------------------------------------------------
\7\ Szema, Anthony M. Overview Of Exposures And New Onset Asthma In
Soldiers Serving In Iraq And Afghanistan. As presented at American
Thoracic Society 2011 International Conference, May 18, 2011.
---------------------------------------------------------------------------
While we know these problems exist, it is also clear that the DOD
needs to do a better job at identifying and tracking them. Respiratory
disease is difficult to detect, especially in personnel who are
younger, healthier and more athletic than the general population.
Military personnel need to be tested for respiratory and lung function
pre-deployment so that doctors can make useful comparison with post-
deployment results, instead of comparing soldiers to the population
average. Another possible solution is to use non-traditional measures
to detect problems--such as ability to complete a 2-mile run, as
suggested by one researcher.\8\
---------------------------------------------------------------------------
\8\ Miller, Robert. Constrictive Bronchiolitis Among Soldiers
Exposed To Burn Pits, Desert Dust And Fires In Southwest Asia. As
presented at American Thoracic Society 2011 International Conference,
May 18, 2011.
---------------------------------------------------------------------------
To protect the troops from the hazards discussed and resulting lung
disease, the American Lung Association recommends that DOD begin
immediately to find alternatives to burning trash for waste disposal
and/or make burn pits more efficient. We also strongly urge DOD to take
steps to minimize troop exposure to pollutants and to further monitor
pollution levels. Military doctors also must develop better ways to
measure and track lung disease in military personnel, including taking
baseline measures prior to deployment and creating a national registry
to track all veterans who were exposed to these pollutants while in
Iraq and Afghanistan. These problems are pervasive throughout the
military, and DOD officials need to take leadership roles in creating
positive change.
Conclusion
Mr. Chairman, in summary, our Nation's military is the best in the
world and we should do whatever necessary to ensure that the lung
health needs of our armed services are fully met. Our troops must be
protected from tobacco and unsafe air pollution and the severe health
consequences. Thank you for this opportunity.
Chairman Inouye. I thank you very much, Captain. I'm one of
the one out of seven. I began smoking after I got in, but I
quit. But all of us received in our K rations a pack of four
cigarettes free. That's how we learned.
Senator Cochran.
Senator Cochran. We appreciate very much your being here
today and bringing this reminder to our attention. It's
something that we need to work hard on and I hope we can be
successful. It seems to me that this is probably the most
preventable kind of medical problem that we can work on and the
chairman has certainly indicated a willingness to cooperate, so
I think you can look forward to cooperation from this
subcommittee.
Captain Connor. Thank you.
Mr. Vice Chairman, if I may, I'd like to leave behind a
very recent article from the American Journal of Public Health,
which fully reveals the extent to which the tobacco industry
has got its hands in the Senate and the House. We actually have
enshrined into law, if you can believe it, obstacles to DOD
attacking the smoking problem. So with your permission, I'd
like to leave that behind.
Chairman Inouye. Without objection, it will be made part of
the record.
[The information follows:]
[From the American Journal of Public Health, March 2011]
Forcing the Navy to Sell Cigarettes on Ships: How the Tobacco Industry
and Politicians Torpedoed Navy Tobacco Control
(Naphtali Offen, Sarah R Arvey, Elizabeth A Smith, Ruth E Malone)
In 1986, the U.S. Navy announced the goal of becoming smoke-free by
2000. However, efforts to restrict tobacco sales and use aboard the USS
Roosevelt prompted tobacco industry lobbyists to persuade their allies
in Congress to legislate that all naval ships must sell tobacco.
Congress also removed control of ships' stores from the Navy. By 1993,
the Navy abandoned its smoke-free goal entirely and promised smokers a
place to smoke on all ships. Congressional complicity in promoting the
agenda of the tobacco industry thwarted the Navy's efforts to achieve a
healthy military workforce. Because of military lobbying constraints,
civilian pressure on Congress may be necessary to establish effective
tobacco control policies in the armed forces. (Am J Public Health.
2011;101:404-411. doi: 10.2105/AJPH.2010.196329)
At more than 30 percent,\1\ \2\ the prevalence of smoking in the
military is 50 percent higher than is the civilian rate, with a 40
percent prevalence among those aged 18 to 25 years \3\ and nearly 50
percent among those who have been in a war
zone.\2\ \4\ From 1998 to 2005, tobacco use in the military increased
7.7 percent, from 29.9 percent to 32.2 percent, reversing the decline
of prior decades.\4\ A tobacco-friendly military culture persists,
including the availability of cheap tobacco products,\5\ liberal
smoking breaks,\6\ and easily accessible smoking areas.\6\ \7\ Smoking
damages health and readiness \8\ \9\ \10\ \11\ and increases medical
and training
costs.\12\ \13\ \14\ \15\ In addition to short-term effects, such as
impairment to vision and hearing, long-term consequences include lung
and other cancers, cardiovascular disease, chronic obstructive
pulmonary disease, and problematic wound healing.\4\ The U.S.
Department of Defense spends more than $1.6 billion annually on
tobacco-related health care and absenteeism.\4\
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\1\ Bray RM, Hourani LL. Substance use trends among active duty
military personnel: findings from the United States Department of
Defense Health Related Behavior Surveys, 1980-2005. Addiction.
2007;102(7):1092-1101.
\2\ Volkow ND. Director's perspective: substance abuse among
troops, veterans, and their families. NIDA Notes. 2009; 22(5):1092-
1101.
\3\ Bray RM, Hourani LL, Olmsted DLR, et al. 2005 Department of
Defense survey of health related behaviors among active duty military
personnel: a component of the Defense Lifestyle Assessment Program
(DLAP). December 2006. Prepared by RTI International. Report No. DAMD
17-00-2-0057. Available at: http://www.ha.osd.mil/special_reports/
2005_Health_Behaviors_Survey_1-07.pdf. Accessed May 10, 2010.
\4\ Institute of Medicine. Combating Tobacco Use in Military and
Veteran Populations. Washington, DC: National Academic Press; 2009.
\5\ Smith EA, Blackman VS, Malone RE. Death at a discount: how the
tobacco industry thwarted tobacco control policies in U.S. military
commissaries. Tob Control 2007;16(1):38-46.
\6\ Haddock CK, Hoffman KM, Peterson A, et al. Factors which
influence tobacco use among junior enlisted in the United States Army
and Air Force: a formative research study. Am J Health Promot.
2009;23(4):241-246.
\7\ Jahnke SA, Haddock CK, Poston WS, Hoffman KM, Hughey J, Lando
HA. A qualitative analysis of the tobacco control climate in the U.S.
military. Nicotine Tob Res. 2010;12(2):88-95.
\8\ Dept of the Navy, Office of the Secretary. SECNAV instruction
5100.13E, Navy and Marine Corps tobacco policy. Available at: http://
www. mccsmiramar.com/pdfs/5100_13E.pdf. Accessed March 3, 2010.
\9\ Conway T, Cronan T. Smoking, exercise, and physical fitness.
Prev Med. 1992;21(6):723-734.
\10\ Zadoo V, Fengler S, Catterson M. The effects of alcohol and
tobacco use on troop readiness. Mil Med. 1993;158(7): 480-484.
\11\ Conway TL. Tobacco use and the United States military: a
longstanding problem. Tob Control. 1998;7(3):219-221.
\12\ Helyer AJ, Brehm WT, Perino L. Economic consequences of
tobacco use for the Department of Defense, 1995. Mil Med.
1998;163(4):217-221.
\13\ Klesges RC, Haddock CK, Chang CF, Talcott GW, Lando HA. The
association of smoking and the cost of military training. Tob Control.
2001;10(1):43-47.
\14\ Dall TM, Zhang Y, Chen YJ, et al. Cost associated with being
overweight and with obesity, high alcohol consumption, and tobacco use
within the military health system's TRICARE prime-enrolled population.
Am J Health Promot. 2007; 22(2):120-139.
\15\ Woodruff SI, Conway TL, Shillington AM, Clapp JD, Lemus H,
Reed MB. Cigarette smoking and subsequent hospitalization in a cohort
of young U.S. Navy female recruits. Nicotine Tob Res. 2010; 12(4):365-
373.
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In addition to compromised military readiness and Department of
Defense expenses, a tobacco-friendly military culture takes a societal
toll--economic and human--long after military personnel return to
civilian life. The Department of Veterans Affairs spent $5 billion in
2008 treating veterans with chronic obstructive pulmonary disease, a
diagnosis most often associated with smoking.\4\ Lifelong smokers have
a 50 percent chance of dying prematurely.\4\ Most costs must be borne
by the veteran: in 1998, Congress denied disability pensions to
tobacco-sickened veterans who began to smoke during their service,
initially labeling smoking in the military as ``willful misconduct.''
\16\
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\16\ Offen N, Smith EA, Malone RE. ``Willful misconduct'': how the
U.S. government prevented tobacco-disabled veterans from obtaining
disability pensions. Am J Public Health. 2010;100(7):1166-1173.
---------------------------------------------------------------------------
Department of Defense Directive 1010.10, issued in 1986,
established a baseline ``policy on smoking in the DOD [Department of
Defense] occupied buildings and facilities.'' \17\ The policy
emphasized a healthy military that discouraged smoking and designated
authority to the services and to individual commanders to set specific
policies.\18\ However, subsequent attempts to set such policies
achieved limited results,\19\ \20\ in part because of the tobacco
industry's influence on Congress.\5\ \18\
---------------------------------------------------------------------------
\17\ Taft WH. Department of Defense Directive 1010.10 Health
Promotion. March 11, 1986. Philip Morris collection. Bates no.
2047563159/3166. Available at: http://legacy.library.ucsf.edu/tid/
des52e00. Accessed October 23, 2006.
\18\ Arvey S, Malone RE. Advance and retreat: tobacco control
policy in the U.S. military. Mil Med. 2008;173(10):985-991.
\19\ Smith EA, Malone RE. Tobacco targeting of military personnel:
``The plums are here to be plucked.'' Mil Med. 2009;174(8):797-806.
\20\ Smith EA, Malone RE. ``Everywhere the soldier will be'':
wartime tobacco promotion in the U.S. military. Am J Public Health.
2009;99(9):1595-1602.
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The industry successfully lobbied Congress to prevent the military
from raising the prices of tobacco products sold in military stores,\5\
and to ensure that in-store tobacco promotions would not be
prohibited.\18\ Congress also prevented the army from implementing a
stronger tobacco control policy than that set by Directive 1010.10,
although the directive was intended to be a policy floor upon which the
services could expand.\18\ To achieve its goals, Congress privately
pressured military tobacco control advocates,\18\ publicly scolded
them,\5\ interfered with funding for military programs,\5\ and passed
laws preventing the establishment of recommended tobacco control
policies.\5\ \16\
We examined an attempt by a former captain of the USS Theodore
Roosevelt to ban smoking on the aircraft carrier and showed how tobacco
industry lobbyists, working through their allies in the U.S. Congress,
were successful in stymieing his efforts and forcing the Navy to sell
cigarettes on all ships.
METHODS
As part of a larger project examining tobacco industry influence on
the U.S. military, we searched internal tobacco industry documents
released following the Master Settlement Agreement.\21\ Data were
collected from the University of California, San Francisco Legacy
Tobacco Documents Library (available at: http://legacy.
library.ucsf.edu) and Tobacco Documents Online (available at: http://
tobaccodocuments.org). Initial search terms included ``Navy/smokefree''
and ``Navy/cigarettes''; we used a snowball approach to locate
additional material.\22\ We also searched the LexisNexis database for
media coverage,\23\ the Library of Congress Thomas database of
legislative history,\24\ and the U.S. Code collection at Cornell
University Law School,\25\ and conducted Internet searches for
supplemental documents. We attempted to interview all principals in
this case study and spoke with the former captain of the USS Roosevelt,
Admiral Stanley Bryant (November 9, 2009) and former Navy Master Chief
Petty Officer James Herdt (January 14, 2010), both of whom advocated
for the USS Roosevelt policy change. We also interviewed former
Secretary of the Navy John Dalton (October 22, 2009), who opposed the
policy. Otherwise unattributed quotations from these individuals are
taken from the interviews. Our inability to secure other interviews is
a limitation of this study. We analyzed approximately 340 industry
documents and 80 documents from other sources using an interpretive
approach, chronologically organizing our findings as a descriptive case
study.\26\ \27\
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\21\ National Association of Attorneys General. Master Settlement
Agreement. Available at: http://www.naag.org/upload/
1109185724_1032468605_cigmsa.pdf. Accessed July 7, 2009.
\22\ Malone RE, Balbach ED. Tobacco industry documents: treasure
trove or quagmire? Tob Control. 2000;9(3):334-338.
\23\ LexisNexis Academic Web site. Available at: http://
www.lexisnexis.com/us/lnacademic. Accessed September 20, 2008.
\24\ Library of Congress Thomas Web page. Available at: http://
thomas.loc.gov/home/multicongress/multicongress.html. Accessed
September 20, 2008.
\25\ Cornell University Law School US Code collection. Available
at: http://www.law.cornell.edu/uscode. Accessed September 13, 2008.
\26\ Hill MR. Archival Strategies and Techniques. Newbury Park, CA:
Sage Publications; 1993.
\27\ Yin RK. Case Study Research Design and Methods. Thousand Oaks,
CA: Sage Publications; 1994.
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RESULTS
Following Directive 1010.10, some Navy leaders began to propose
policies to reduce smoking among their personnel. As early as 1986,
Chief of Naval Operations James Watkins (1982-1986) proposed a tobacco-
free Navy,\28\ a goal reiterated in 1990 by the Navy surgeon general,
Vice-Admiral James Zimble (1987-1990).\29\ In February 1992, the Navy
issued Instruction 6100.2, emphasizing tobacco-use prevention,
cessation, and the protection of nonsmokers from secondhand smoke.\30\
As a result, a number of ships restricted tobacco sales by limiting the
number of brands carried, raising prices, or not selling tax-free
cigarettes.\31\ Some ships restricted smoking to limited venues,\31\
tobacco-related promotional activities were curtailed at one Navy
exchange,\32\ and naval hospitals ashore went smoke-free.\33\ In early
1993, Navy Surgeon General Donald Hagen (1991-1995) asked the Office of
the Secretary of Defense to end tobacco product price subsidies in
commissaries and exchanges in all service branches, arguing that low
cigarette prices contributed to high rates of smoking in the
military.\34\ By late 1993, the Office of the Secretary of Defense had
not responded.\35\ \36\ (Cigarette prices in commissaries remained low,
and only in 1996 were they marginally increased, at the instigation of
an Assistant Secretary of Defense.) \5\
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\28\ Taylor M, Stump D. Sailors are under the ``smoking gun.''
September 6, 1995. Philip Morris collection. Bates no. 2048895176/5180.
Available at: http://legacy.library.ucsf.edu/tid/yre35c00. Accessed
January 16, 2008.
\29\ Zimble JA. I am writing to strongly object to Camel cigarette
advertising that includes naval vessels and aircraft in the background.
June 11, 1990. RJ Reynolds collection. Bates no. 507471512. Available
at: http://legacy.library.ucsf.edu/action/document/view?tid=eso24d00.
Accessed January 24, 2007.
\30\ Dept of the Navy, Office of the Chief of Naval Operations.
OPNAV Instruction 6100.2, Health Promotion Program. Available at:
http://www-nehc.med.navy.mil/bumed/tcat/tobacco/opnav%206100.2.pdf.
Accessed March 3, 2010.
\31\ Glennie L. Navy ship smoking restrictions. May 18, 1992.
Philip Morris collection. Bates no. 2023176786. Available at: http://
legacy.library.ucsf.edu/tid/trs95e00. Accessed April 15, 2008.
\32\ O'Rourke R. Dept of the Navy, Sale and use of tobacco
products. June 19, 1992. Philip Morris collection. Bates no.
2076220349/0350. Available at: http://legacy.library.ucsf.edu/tid/
bqc62c00. Accessed April 28, 2009.
\33\ Navy News & Undersea Technology. First steps to a smoke-free
Navy are under way. May 14, 1990. Philip Morris collection. Bates no.
2023175502. Available at: http://legacy.library.ucsf.edu/tid/oqx83e00.
Accessed April 8, 2008.
\34\ Hagen DF. Tobacco use reduction. March 24, 1993. Philip Morris
collection. Bates no. 2023172986. Available at: http://
legacy.library.ucsf.edu/tid/iuc85e00. Accessed December 6, 2006.
\35\ Juliana J. Key issues: DOD smoking policies. May 6, 1993.
Available at: http://tobaccodocuments.org/nysa_ti_s1/TI03081755.html.
Accessed April 8, 2008.
\36\ Linehan K. Washington outlook for 1994. December 29, 1993.
Philip Morris collection. Bates no. 2025774681/4698. Available at:
http://legacy.library.ucsf.edu/tid/vho14e00. Accessed January 5, 2008.
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USS Roosevelt Bans Smoking
Shortly after assuming command of the aircraft carrier Theodore
Roosevelt, Captain Stanley W. Bryant announced that the ship would
become entirely smoke-free by July 1993, including an end to cigarette
sales in the ship's store. Motivated by a recently released report that
secondhand smoke caused cancer in nonsmokers, Bryant felt obliged to
act. He said, ``I'm the commanding officer of these kids and I can't
have them inhaling secondhand smoke. I wouldn't put them in the line of
fire. I'm not going to put them in the line of smoke.'' Navy Surgeon
General Hagen and Chief of Naval Operations Admiral Frank B. Kelso
(1990-1994) supported Bryant's efforts.\37\ \38\
---------------------------------------------------------------------------
\37\ Law Offices of Shook. Hardy & Bacon. Report on recent ETS and
IAQ developments. August 6, 1993. Lorillard collection. Bates no.
87806034/6062. Available at: http://legacy.library.ucsf.edu/tid/
tzb40e00. Accessed April 15, 2008.
\38\ Tobacco Institute. Executive summary. August 6, 1993. Tobacco
Institute collection. Bates no. TICT0004527/4528. Available at: http://
legacy.library.ucsf.edu/tid/lgc42f00. Accessed April 28, 2009.
---------------------------------------------------------------------------
The Roosevelt left port in March 1993 for 6 months at sea, having
informed the crew in advance of the impending policy change. Cigarettes
were removed from the ship's store, but chew tobacco was available
because, according to Bryant, ``although it's bad for the person, it
doesn't adversely affect the other crew members.'' Crewmen were allowed
to bring cigarettes aboard and would be able to smoke them in the few
lavatories set aside for that purpose until the ban went into effect
July 4. Thereafter, they would be able to smoke only in ports of call.
Those lavatories were among the only spaces on board where the air was
vented directly to the outside and not recirculated; however,
maintaining smoking in the lavatories was untenable because
measurements of the air quality in the lavatories showed high levels of
toxicity and the smoke strayed to nearby berths.
According to Bryant, crew reaction was mixed: many nonsmokers
expressed support, and some smokers complained. Command Master Chief
James Herdt, who served as the highest-ranking enlisted person under
Bryant, said the new policy was opposed by an ``incredibly small group
of people.'' When a crew member asked Bryant how he could take away his
right to smoke, Bryant told him the military regulates the length of
hair and fingernails, how one dresses, and other such matters that many
things, such as conjugal privileges and alcohol consumption, are
prohibited on ship; and that smoking cigarettes, like drinking alcohol
and smoking marijuana, affected the health and welfare of the rest of
the crew. Bryant reported that few infractions occurred and that he
received many letters from his crew's family members thanking him for
protecting their loved ones from smoke and making it easier for smokers
to quit.
Tobacco Industry Reaction
Philip Morris and the Tobacco Institute, the industry's lobbying
arm, observed that Navy Instruction 6100.2 represented a policy shift
from accommodating both smokers and nonsmokers to privileging
nonsmokers. One Philip Morris military sales executive said, ``We are
very concerned that the Navy appears to be getting to the point where
they are mandating non-smoking.'' \31\ His colleague, Rita O'Rourke,
noted that Instruction 6100.2 established that ``where conflicts arise
between the rights of smokers and rights of the nonsmokers, those of
the nonsmokers shall prevail.'' \39\ She called attention to permission
given to commanders to punish violations, and argued that the provision
forced smokers to quit.\39\ With the emergence of stricter policies
than Department of Defense Directive 1010.10, O'Rourke wondered whether
to suggest that the Department of Defense revisit the issue, although
that would risk a decision that ``all Services . . . become smoke-
free.'' \40\
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\39\ O'Rourke R. Department of the Navy violations of Department of
Defense Directive 1010.10. March 6, 1993. Philip Morris collection.
Bates no. 2023172961/2965. Available at: http://
legacy.library.ucsf.edu/tid/ouc85e00. Accessed November 17, 2006.
\40\ O'Rourke R. DOD-sale and use of tobacco products. March 16,
1993. Philip Morris collection. Bates no. 2023172957/2959. Available
at: http://legacy.library.ucsf.edu/tid/muc85e00. Accessed October 17,
2006.
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Bryant's tobacco control measures on the Roosevelt elicited
particular industry concern. In a list of suggested talking points,
Tobacco Institute counsel Jim Juliana told colleagues that the policy
constituted ``discrimination,'' a denial of freedom of choice, and a
breach of contract. He argued,
People are recruited and granted certain privileges and rights
which now seem to be denied in the middle of their service to their
country.\35\
(Bryant noted that when recruits ledge an oath to the Constitution,
``it doesn't say a damn thing about smoking.'') Juliana argued that the
Roosevelt was home as well as workplace and suggested that tobacco
products would be smuggled aboard and ``used illegally and unwarranted
and unnecessary punitive actions'' would result.\35\
Congressional Hearing
Only a month after the Roosevelt went smoke-free, the Morale,
Welfare, and Recreation (MWR) Panel of the House Armed Services
Committee (HASC) took up the issue of tobacco control in the Navy, and
the USS Roosevelt in particular.\41\ The panel had oversight of MWR
activities offered to sailors, such as entertainment and sports
programs. MWR was funded by profits from the ships' stores. Tobacco-
friendly politicians challenged Rear Admiral Commander John Kavanaugh
of Navy Exchange Command on the Navy's tobacco control policies, using
many of the arguments suggested in a memo prepared by Juliana. For
example, Representative Herbert Bateman (R-VA) characterized not being
able to smoke aboard ship as a ``trauma'' for crew.\41\ He likened Navy
smoking restrictions to the failed national policy of Prohibition
(although alcohol use is prohibited on Navy ships).\42\ Representative
John Tanner (D-TN), thought it was ``entirely appropriate to perhaps
restrict smoking for the convenience of those who object violently.''
\41\ ``But,'' he added, ``somebody is banning a legal commodity.'' \41\
He wondered if lottery tickets or hair spray might be next.\41\
Representative Solomon Ortiz (D-TX), chair of the panel, assured
Kavanaugh that forcing sailors to remain smoke-free for months-long
deployments would ``cause problems.'' \41\
---------------------------------------------------------------------------
\41\ Exchange operations and activities: hearing before the Morale,
Welfare, and Recreation Panel of the Committee on Armed Services, House
of Representatives, 103rd Congress (1993).
\42\ Moore RS, Ames GM, Cunradi CB. Physical and social
availability of alcohol for young enlisted naval personnel in and
around home port. Subst Abuse Treat Prev Policy. 2007;2:17.
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The panel was most concerned about eliminating cigarette sales in
the ship's store. Will Cofer, MWR Panel staff member and long-time
tobacco industry ally,\43\ contended that the Roosevelt policy
prohibiting sales had ``created a black market within the Navy of
selling cigarettes from one ship to another ship.'' He said, ``[S]ome
GIs are selling cigarettes at inflated prices to guys on the ship that
can't buy cigarettes.'' \41\ (Bryant and Herdt acknowledged there was
some profiteering on the Roosevelt when cigarettes were removed from
the ship's store, but said that it was minimal.)
---------------------------------------------------------------------------
\43\ Gaillard RC. Project Breakthrough. March 24, 1994. RJ Reynolds
collection. Bates no. 509721550/1552. Available at: http://
legacy.library.ucsf.edu/tid/ofz63d00. Accessed February 17, 2010.
---------------------------------------------------------------------------
The real question about sales, however, involved the profits from
the ship's stores. These profits supported MWR activities, and
eliminating tobacco sales would reduce funding for them. Representative
Bateman found it ``incredible'' that implementing a smoke-free base
policy wouldn't ``impact revenues generated from the sale of tobacco
products on that base.'' Kavanaugh acknowledged that ``profits and
sales will be reduced,'' assuring the panel that there had been ``no
move to take cigarettes out of Navy exchanges,'' and that only 2 out of
the Navy's ``500 some ships'' had banned sales.\41\ Representative
Martin Lancaster (D-NC) questioned Kavanaugh about allowing local-level
leaders to implement site-specific policy, expressing concern about how
MWR funds would be equitably distributed among units that profited from
tobacco sales and those that did not.\41\
Under congressional pressure, Kavanaugh said that he would report
the panel's concerns to the Office of the Secretary of the Navy and the
Chief Naval Officer.\41\ After Kavanaugh delivered the message that the
MWR Panel was very disturbed by Captain Bryant's decision, the Navy
sent the panel an official response, stating, ``The Navy's smoking
policy, for both afloat and ashore commands, is under review by Navy
leadership.'' \41\
During the first 3 Congresses of the 1990s, the percentage of
members of the MWR Panel who accepted contributions from the tobacco
industry was higher than the congressional average. Although MWR Panel
members received about 15 percent more industry money than other
members during the first 2 Congresses of the 1990s, they accepted 93
percent more than all House members during the 103rd Congress (1993-
1994), when this issue was considered (Table 1). In total, the tobacco
industry contributed at least $4.4 million to members of the House
during these 3 Congresses.\44\
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\44\ Center for Responsive Politics. Tobacco: Money to Congress.
Available at: http://www.opensecrets.org/industries/
summary.php?cycle=1990&ind=A02. Accessed May 12, 2010.
TABLE 1.--CAMPAIGN CONTRIBUTIONS FROM THE TOBACCO INDUSTRY TO MEMBERS OF THE MORALE, WELFARE AND RECREATIONAL
(MWR) PANEL OF THE HOUSE OF REPRESENTATIVES' COMMITTEE ON ARMED SERVICES
[Amounts in dollars]
----------------------------------------------------------------------------------------------------------------
Contributions
---------------------------------------------------
1990 \1\ 1992 \2\ 1994 \3\ Career
----------------------------------------------------------------------------------------------------------------
MWR Panel recipient:
Neil Abercrombia (D-HI)................................. ........... 500 1,500 9,500
Herbert H. Bateman (R-VA)............................... 8,100 8,450 5,260 41,548
Earl Hutto (D-FL)....................................... ........... ........... ........... ...........
John R. Kasich (R-OH)................................... 500 500 1,500 9,500
H. Martin Lancaster (D-NC).............................. 18,200 22,198 44,720 85,118
Donald H. Machtley (R-RI)............................... 1,750 ........... ........... 1,750
Solomon P. Ortiz (D-TX)................................. 1,000 500 6,000 33,000
Owen B. Pickett (D-VA................................... 2,850 2,000 6,500 25,750
Bob Stump (R-AZ)........................................ 2,000 3,500 2,500 15,250
John S. Tanner (D-TN)................................... 5,700 4,700 5,500 157,700
Robert A. Underwood (D-GU).............................. ........... ........... ........... ...........
---------------------------------------------------
Total contributions received.......................... 40,100 42,348 73,480 379,116
===================================================
Average donation received by all MWR Panel members.......... 3,645 3,850 6,680 ...........
Average donation received by all House members.............. 3,118 3,393 3,458 ...........
----------------------------------------------------------------------------------------------------------------
\1\ MWR Panel members received on average 16.9 percent more than all House members.
\2\ MWR Panel members received on average 13.5 percent more than all House members.
\3\ MWR Panel members received on average 93.2 percent more than all House members.
Congress Retaliates
Tobacco industry observers interpreted the outcome of the HASC MWR
Panel hearing as favorable to the industry. Internal industry
communique's described various members of the panel as supportive of
the industry's position and noted that ``the military commanders who
appeared before the panel stated that they would not support
eliminating sales of tobacco products and would make their opposition
known to officials.'' \45\
---------------------------------------------------------------------------
\45\ [Philip Morris.] House panel voices opposition to DOD efforts
to establish ``smoke-free'' military. August 9, 1993. Philip Morris
collection. Bates no. 2047992778/2785. Available at: http://
legacy.library.ucsf.edu/tid/rgi57d00. Accessed January 25, 2008.
---------------------------------------------------------------------------
However, industry reports were overly optimistic. Just 3 days after
the hearing, the Tobacco Institute learned that Admiral Kelso had
endorsed Bryant's decision to ban smoking and cigarette sales aboard
the USS Roosevelt. The Institute reported to tobacco companies that
Several Members of Congress believe they were betrayed by this
decision and intend to take legislative action including the removal of
all Naval ship stores from the commissary system, thus eliminating the
subsidy and forcing price increases on all other products.\38\
Command Master Chief Herdt of the USS Roosevelt received a
shipboard call from the highestranking enlisted person in the Navy,
Master Chief Petty Officer John Hagan, urging a reversal of the ban.
Hagan had been summoned to the office of a HASC MWR congressman, who
chastised him severely about the nosmoking policy. Hagan reportedly
said he had never been treated so abusively in his role as Master Chief
Petty Officer. Nonetheless, Herdt and Bryant decided to continue the
no-smoking policy.
A month after the hearing, in September 1993, Representative Owen
Pickett (D-VA) and Representative Ortiz sponsored an amendment to the
Defense Authorization Act for Fiscal Year 1994, stripping Federal
subsidies from Navy ships' stores and requiring that they all sell
tobacco products.\46\ The amendment did not contain obviously pro-
tobacco language, but merely revised the applicable section to replace
the word ``may'' with ``shall,'' thus reading: ``(c) Items Sold.--
Merchandise sold by ship stores afloat shall include items in the
following categories . . .'' and listed ``tobacco products'' as one
among many items that must be made available.\47\ The law does not
mention specific tobacco products.
---------------------------------------------------------------------------
\46\ Tobacco Institute. Executive summary. September 17, 1993.
Lorillard collection. Bates no. 87686227/6228. Available at: http://
legacy.library.ucsf.edu/tid/txt21e00. Accessed April 15, 2008.
\47\ Cornell University Law School U.S. Code collection. Title 10,
Subtitle C, Part IV, Chapter 651, Sec. 7604 ships' stores: sale of
goods and services. Available at: http://www.law.cornell.edu/uscode/
html/uscode10/usc_sec_10_00007604--000-.html. Accessed August 14, 2009.
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The amendment also transferred ``the authority over all ships [sic]
stores from ship captains to the Navy Exchange Command (NEXCOM).'' \48\
This transfer meant that oversight would now reside in ``the Morale
Welfare, and Recreation (MWR) Panel of the House Armed Services
Committee.'' \49\
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\48\ Scott GR. Sale of tobacco products on ships stores. April 7,
1994. Philip Morris collection. Bates no. 2073010489. Available at:
http://legacy.library.ucsf.edu/tid/xps57c00. Accessed January 16, 2008.
\49\ [Philip Morris.] Washington Report: Defense Authorization Bill
conferees adopt provision requiring ship stores to sell tobacco
products. November 29, 1993. Philip Morris collection. Bates no.
2046215439/5445. Available at: http://legacy.library.ucsf.edu/tid/
vuh92e00. Accessed January 16, 2008.
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The tobacco industry reported that the legislation was prompted by
the Navy's tobacco control efforts. Philip Morris observed that
``Congressional intervention reversed the imposition of a `smokefree'
policy aboard Navy ships.'' \36\ The Tobacco Institute noted that the
Chief of Naval Operations angered Congressman Pickett and others by
``reneging on his promise to reverse the order by the Commanding
Officer of the USS Roosevelt banning smoking and tobacco sales aboard
ship.'' \46\
Navy Response
Before the Defense Authorization Act had been approved and signed
by the President, the Navy implemented a new service-wide policy that
prevented local-level personnel from banning smoking entirely.\50\ On
October 21, 1993, Secretary of the Navy John Dalton issued the
``Smoking policy for Department of Navy controlled spaces,'' effective
January 1, 1994, which described exactly where designated smoking
spaces would be established on ships or submarines.\50\
---------------------------------------------------------------------------
\50\ Dept of the Navy. Smoking policy for Department of the Navy
(DoN) controlled spaces. October 22, 1993. Philip Morris collection.
Bates no. 2023172656/2658. Available at: http://
legacy.library.ucsf.edu/tid/jtt14e00. Accessed December 1, 2006.
---------------------------------------------------------------------------
Dalton sent Ortiz a copy of the policy.\51\ He wrote,
``Appreciating your interest in the issue of smoking aboard Navy ships,
I am pleased to advise you that . . . I have approved a policy that
will be applicable to all Navy ships.'' \51\ He continued, ``Tobacco
products will be sold in ship's stores and will be priced similarly to
those sold in Navy Exchanges ashore.'' The new policy addressed only
smoking regulations and not sales, suggesting that Dalton may have
raised the sales issue in his cover letter and implemented the policy
in an effort to forestall the adoption of the Pickett-Ortiz amendment.
Ortiz immediately shared the victory with his tobacco industry allies,
faxing the documents to Philip Morris just ``minutes after'' receiving
Dalton's letter and policy memo.\52\
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\51\ Dalton JH. Letter from John Dalton to Solomon Ortiz. October
21, 1993. Philip Morris collection. Bates no. 2023172654. Available at:
http://legacy.library.ucsf.edu/tid/suc85e00. Accessed December 7, 2006.
\52\ Scott G. Navy smoking policy. October 22, 1993. Philip Morris
collection. Bates no. 2023172653. Available at: http://
legacy.library.ucsf.edu/tid/ruc85e00. Accessed January 25, 2008.
---------------------------------------------------------------------------
A naval press release characterized the policy as protecting people
from ``involuntary exposure to environmental tobacco smoke'' \53\
rather than reinstating smoking areas on ships that had eliminated
them. The media thus reported Dalton's policy as a crackdown on
smoking, as opposed to a capitulation to members of the HASC MWR
Panel.\54\ When interviewed, Dalton was unable to recall additional
details of the incident.
---------------------------------------------------------------------------
\53\ Navy announces new smoking policy [press release]. Washington,
DC: U.S. Navy; October 21, 1993. Available at: http://www.navy.mil/
navydata/news/mednews/med93/med93041.txt. Accessed November 9, 2009.
\54\ Morris P. Navy cracks down on smoking with uniform new
regulations. November 17, 1993. Philip Morris collection. Bates no.
2048159074/9146. Available at: http://legacy.library.ucsf.edu/tid/
xrs65e00. Accessed April 24, 2008.
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Despite Dalton's policy, the Pickett-Ortiz amendment passed. The
Navy tried to argue for amending it, contending that it would
``increase the cost of merchandise to sailors, reduce funding for their
ship's morale, welfare, and recreation (MWR) programs and result in a
less efficient program.'' \55\ In response, Pickett inserted language
into the act delaying the date of implementation for 1 year, which
successfully thwarted the Navy's attempt to repeal the law.\56\
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\55\ Roark D. Impact on afloat sailors by converting ships stores
from appropriated to non-appropriated funding. April 6, 1994. Philip
Morris collection. Bates no. 2073010490. Available at: http://
legacy.library.ucsf.edu/tid/wps57c00. Accessed April 10, 2008.
\56\ U.S. Congress. Sec. 382. Ships' stores. May 4, 1994. Philip
Morris collection. Bates no. 2073010557. Available at: http://
legacy.library.ucsf.edu/tid/fps57c00. Accessed April 15, 2008.
---------------------------------------------------------------------------
In September 1995, the Navy newspaper Soundings reported that the
Navy had ``thrown in the towel'' and abandoned plans to become smoke-
free by 2000.\28\ The Navy was reported to have ``conceded'' that the
goal was ``unrealistic.'' \28\ Instead, it established a goal to reduce
smoking rates to 35 percent, the equivalent civilian rate at the
time.\28\ As of 2005, the smoking prevalence in the Navy was 32
percent,\4\ still more than 50 percent above the corresponding civilian
rate of 21 percent.
Tobacco Industry Confidence
Internal industry communique's with wording such as ``the provision
we put through last year'' \57\ reveal the extent to which the industry
was confident of the power it wielded. At the end of 1993, one Philip
Morris executive wrote, ``We are continuing to stimulate congressional
opposition to efforts to restrict the sale of tobacco products in the
military.'' \36\ Another Philip Morris employee wrote in 1994, ``We
will be working with the MWR Panel to attempt to ensure that the
Pickett-Ortiz provision is not repealed.'' \48\ Industry lobbyists
enjoyed access to key committee members.\40\
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\57\ Scott GR. DOD--cigarettes. May 5, 1994. Philip Morris
collection. Bates no. 2073010555. Available at: http://
legacy.library.ucsf.edu/tid/hps57c00. Accessed April 10, 2008.
---------------------------------------------------------------------------
Kelso visited the Roosevelt when it was deployed in the
Mediterranean in August 1993 and told Bryant he was doing the right
thing in banning smoking. However, when the Roosevelt returned to port
in September 1993, Kelso told Bryant he was taking ``immense heat''
from every corner, including Congress and the Secretary of the Navy,
for Bryant's actions and that all ships, including the Roosevelt, would
have to accommodate smokers by providing a dedicated smoking area. In
retrospect, Bryant was grateful that Kelso had put off overriding the
Roosevelt's smokefree policy until after its deployment. Bryant said,
``I'm taking care of my crew. Who's going to take me to task for that?
And in fact, the military did not.'' He added, ``You've got to do what
you think is right. For the most part, the media and Congress respect
that, but then you've got big money and the tobacco industry that work
against it.''
DISCUSSION
In this case, the tobacco industry's influence over Congress
clearly has harmed sailors in 2 ways. Foremost, sailors have been left
exposed to secondhand smoke while deployed, compromising their safety
and health. Congressional action mandating cigarette sales also ensured
that this exposure would continue; the Navy could not in the future
adopt strong tobacco control policies without congressional approval,
since doing so would likely be difficult--and obviously hypocritical--
to enforce a smokefree ship while still selling cigarettes. For
instance, smoking on submarines continued to be allowed until it was
prohibited at the end of 2010.\58\ \59\ Second, an opportunity to
denormalize smoking was lost, and a tobacco-friendly atmosphere was
maintained.
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\58\ U.S. Navy. Smoking to be extinguished on submarines. Available
at: http://www.navy.mil/search/display.asp?story_id=52488. Accessed May
12, 2010.
\59\ Shanker T. To protect health of nonsmokers, Navy bans tobacco
use on its submarine fleet. The New York Times. June 21, 2010:A16.
Available at: http://www.nytimes.com/2010/06/21/us/21smoking.html.
Accessed June 24, 2010.
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The tobacco industry appears to have had significant influence on
Navy tobacco control efforts. Between 1988 and 1994, nearly 70 percent
of Members of Congress received tobacco industry money,\44\ which has
been found to be associated with legislative support for tobacco
industry positions.\60\ \61\ \62\ House MWR Panel members, many of whom
represented tobacco States, accepted on average more and larger
campaign contributions than other Housemembers. Certainly the industry
and its consultants believed their actions resulted in reversing the
smoke-free policies aboard the USS Roosevelt.
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\60\ Luke DA, Krauss M. Where there's smoke there's money: tobacco
industry campaign contributions and U.S. Congressional voting. Am J
Prev Med. 2004; 27(5):363-72.
\61\ Glantz SA, Begay ME. Tobacco industry campaign contributions
are affecting tobacco control policymaking in California. Journal of
the American Medical Association. 1994;272(15):1176-82.
\62\ Monardi F, Glantz SA. Are tobacco industry campaign
contributions influencing State legislative behavior? Am J Public
Health. 1998;88(6):918-23.
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The U.S. military is one of the most powerful institutions in the
world. Its mission, the protection of the country, requires personnel
at peak readiness and performance; hence, military training stresses
physical and mental fitness. The ultimate responsibility for
maintaining this force lies with Congress, which retains essential
civilian oversight of the military. Such oversight, however, leaves
military policy vulnerable to other interests.
A consistent pattern of congressional interference with military
tobacco control efforts suggests several lessons for advocates. First,
the industry-scripted response to military tobacco control policy that
positions tobacco use as a ``right'' to be defended by Congress must be
countered. Military readiness requires restrictions on activities or
characteristics that interfere with fitness. All branches of the
military, for example, set healthy weight parameters for recruits \63\;
restricting tobacco use is no more a violation of rights than is
requiringmaintenance of appropriate weight.
---------------------------------------------------------------------------
\63\ 10 Steps to joining the military: height and weight charts.
Available at: http://www.military.com/Recruiting/Content/
0,13898,rec_step07_hw,00.html. Accessed May 3, 2010.
---------------------------------------------------------------------------
Second, congressional intervention has largely taken place out of
public view; the MWR Panel's actions ultimately took the form of small,
seemingly technical changes to a comprehensive and necessary piece of
legislation. It is likely that most Members of Congress were unaware of
these amendments and their long-term impact on the health of Navy
personnel. Such action is in keeping with other pro-tobacco legislative
efforts, such as the passage of an amendment to the 1986 defense
authorization bill requiring military commissaries to sell tobacco and
forbidding them to raise prices.\5\ Directing public attention to such
legislation, and making its proponents justify it in public, will
likely be a necessary part of changing military tobacco control policy.
Finally, civilian public health organizations must play a stronger
role in these efforts. The public may believe that the military is
resistant to tobacco control; however, multiple studies have
demonstrated that advocates at all levels of tobacco control in the
military find themselves or their services to be the target of
political attacks.\5\ \18\ Because all active-duty military personnel
are constrained by the structural controls on their lobbying activity,
their ability to respond to these attacks is limited. A coalition of
public health, tobacco control, and veterans' service groups and
health-focused congressional allies needs to organize to achieve
effective military tobacco control policies. Such a coalition could
shine a light on congressional actions that thwart military tobacco
control efforts and facilitate those that help the military achieve the
goal recently called for by the Institute of Medicine: a tobacco-free
military.\4\
This coalition could reframe military tobacco control issues.
Veterans might be particularly effective at debunking the idea that
military personnel deserve the freedom to smoke by talking about years
of postservice addiction that began in a tobaccofriendly military.\16\
Similar reframing should be used in advocating for clean indoor air for
all military personnel. Tobacco-sickened veterans could help drive home
the point that military policy lags behind civilian policy in the
percentages of people fully protected by proven, effective tobacco
control policies recommended for use globally,\64\ including smoke-free
spaces and high tobacco taxes. Members of the services assume
unavoidable risks as part of the military mission, but exposure to
cigarette smoke should not be one of them.
---------------------------------------------------------------------------
\64\ World Health Organization. WHO Framework Convention on Tobacco
Control. Available at: http://www.who.int/tobacco/framework/en.
Accessed February 26, 2010.
Senator Cochran. Thank you.
Chairman Inouye. Senator Shelby.
Senator Shelby. Have there been studies comparing, say, the
returning veterans' respiratory and lung problems, say, with
the ones that came out of the Gulf in 1991?
Captain Connor. Senator Shelby, I would like to research
that and get right back to you with a full answer to that.
Senator Shelby. Would you do that for the record?
Captain Connor. We certainly will get right back to you on
that.
[The information follows:]
I wanted to thank you and the Senate Appropriations
Subcommittee on Defense for allowing me the opportunity to
testify on June 22 about lung health and the military. I also
wanted to follow up with some information regarding questions
you asked me about lung health problems in veterans and steps
the Department of Defense (DOD) has taken regarding tobacco.
First, you asked me if there were any data comparing the
lung health of veterans of the 1991 gulf war to veterans of the
current conflict. Researchers and doctors are beginning to
address this question. The evidence thus far shows that
veterans of the first gulf war had a variety of respiratory
problems, which we are likely to find in veterans of the
current war. However, there are also differences in the toxins
personnel were exposed to, and in length of time they were
exposed. As you know, the first gulf war was much shorter than
the current one. We are still learning how these differences
affect the lung health of today's troops.
There is certainly enough evidence to warrant concern for
our current troops and action from DOD. One study conducted by
Vanderbilt University suggests that certain exposures during
the current conflict have caused serious cases of constrictive
bronchiolitis, a condition associated with damage or
destruction of over 50 percent of small airways.\1\ In a review
of DOD studies, the National Academy of Sciences' National
Research Council (NRC) concluded that troops deployed in the
Middle East are ``exposed to high concentrations'' of
particulate matter associated with harm ``affecting troop
readiness during service'' and even ``occurring years after
exposure.'' \2\ Much more surveillance and research is needed,
which is why I urged in my testimony that DOD be required to
develop better ways to measure and track lung disease in
military personnel, including taking baseline measures prior to
deployment and creating a national registry to track all
veterans who were exposed to pollutants while in Iraq and
Afghanistan.
---------------------------------------------------------------------------
\1\ Robert F. Miller, MD. Vanderbilt University Medical Center.
Testimony before the United States Senate Committee on Veterans'
Affairs. ``Airway injury in U.S. soldiers following service in Iraq and
Afghanistan'' October 8, 2009.
\2\ National Academy of Sciences, National Research Council. Review
of the Department of Defense Enhanced Particulate Matter Surveillance
Program Report. 2010. http://www.nap.edu/catalog/12911.html. Accessed
June 7, 2011.
---------------------------------------------------------------------------
I also wanted to follow-up with you regarding your question
about what the DOD has done so far to help tobacco users in the
military quit. As I shared in my testimony, the Institute of
Medicine (IOM) found that the Pentagon spends $1.6 billion
annually on tobacco-related medical care, increased
hospitalization and lost days of work. While there have been
some efforts--notably the ``Quit Tobacco, Make Everyone Proud''
website \3\--they have not been enough, especially in light of
the severity of the problem. Access to tobacco cessation
programs and medication varies among bases and military
branches. And despite urgings from the Institute of Medicine
report on the subject,\4\ and a requirement in the Duncan
Hunter National Defense Authorization for Fiscal Year 2009,\5\
TRICARE still does not cover treatments to help tobacco users
quit.
---------------------------------------------------------------------------
\3\ www.ucanquit2.org.
\4\ Institute of Medicine. Combating Tobacco Use in Military and
Veteran Populations. 2009. http://www.nap.edu/
catalog.php?record_id=12632.
\5\ http://www.dod.gov/dodgc/olc/docs/2009NDAA_PL110-417.pdf.
---------------------------------------------------------------------------
The American Lung Association recommends that the
Department of Defense implement all recommendations called for
in the 2009 IOM report Combating Tobacco Use in Military and
Veterans Populations that I discussed in my testimony. The IOM
has laid out a very careful, scientifically based road map for
the DOD to follow and the American Lung Association strongly
urges the Committee to ensure that the report's recommendations
be implemented without further delay.
Senator Shelby. Second, what is the Department of Defense
doing to discourage smoking? As the chairman noted, they used
to promote smoking, I guess, or help, aid, and abet it. What
are they doing to discourage it, because a lot of the young
people, not just soldiers but in our college campuses, a lot of
them smoke. A lot of them quit. A lot of them quit too late.
Captain Connor. Right. It's a two-part question, what are
they doing to prevent it and stop it; and then what are they
doing to help people get off cigarettes.
Senator Shelby. Right.
Captain Connor. There are some smoking cessation efforts
which we believe could be better resourced. We don't feel
they're doing nearly enough to prevent it. The study that I
referred to has very excellent concrete recommendations, like
let's suggest all officers not smoke. When kids come into boot
camp, they can't smoke. So we could start by grandfathering
that starting today, saying, okay, when you get through boot
camp, guess what, you can't go back smoking.
So there's a number of things that could be done to attack
this problem over time. Nobody's suggesting that the knife come
down tomorrow and say no smoking. But I think steps could be
taken to arrest this problem and stop it from growing.
Senator Shelby. I think all of us know that the more you
smoke the less you're going to run, probably the fewer miles
you're going to march, the fewer minutes you can do exercise,
too. That's just common sense.
Captain Connor. That's right. The other thing, you've got
the military exchanges are making money from the cigarettes.
That's a big issue, too. Then there's a reluctance of combat
commanders that we hear about from the health people in DOD, a
reluctance to deprive troops of something that they say affects
their morale and things like that.
Senator Shelby. Thank you.
Chairman Inouye. Thank you very much, Captain.
The next witness is Mr. Rick Jones, National Association
for Uniformed Services.
STATEMENT OF RICK JONES, LEGISLATIVE DIRECTOR, NATIONAL
ASSOCIATION FOR UNIFORMED SERVICES
Mr. Jones. Chairman Inouye, Vice Chairman Cochran, Senator
Shelby: Thank you very much.
The National Association for Uniformed Services is
concerned about the investment we're making in our defense. As
hard as you work, too often we still depend on aging fleets of
aircraft, ships, and vehicles across the services. We must
continue to drive toward modernization and that means
investment.
The message our members ask me to bring is simple and
direct: Anyone who goes into harm's way under the flag of the
United States needs to be deployed with the best our Nation can
provide. Our troops in the field depend on America's support.
Critical funding provides them the margins they need for
success.
TRICARE, the provision of quality, timely healthcare, is
considered one of the most important non-cash earned benefits
afforded those who serve a career in the military. Our service
members and their families make great sacrifices for all of us.
The TRICARE benefit reflects the commitment of a Nation to
those who serve, and it deserves your wholehearted support.
Our fiscal situation, of course, requires shared sacrifice.
But our military and our military retirees should bear no more
than their share. For those who give their career to a
uniformed service, our organization asks you to provide full
funding for the securing of their earned benefit.
It's our understanding that certain leaders in Congress
have agreed with the Department of Defense regarding a 13
percent increase in TRICARE fees paid by military retirees.
NAUS does not agree and, after hearing for more than a year the
Secretary of Defense and the Chairman of the Joint Chiefs say
that rising costs of retiree healthcare was crippling our
Nation's national security, we read that the House
Appropriations Committee intends to use $330 million of
unexecuted money in the TRICARE health program for funding
additional congressionally directed medical research programs,
many of which are outside traditional battlefield medicine and/
or duplicate subjects covered by the National Institutes of
Health. It's not appropriate. Our folks might be outraged when
they hear this, that their healthcare they'll have to pay more
for, but the money's going for additional research in areas
unrelated to the military.
My association urges you to provide adequate funding for
military construction and family housing accounts. The funds
for base allowance and housing should ensure that those serving
our country are able to afford to live in quality housing.
Walter Reed. Another matter of great interest to our
members is the plan to realign the National Capital area's
military health programs. While we herald this development,
we're hearing that things may not be quite in order or ready by
the September BRAC deadline. The deadline may have to be
extended and we hope that you'll take a look at that to make
sure that our wounded warriors don't fall through the cracks in
this transfer from the old Walter Reed to the new Bethesda
facility.
DOD prosthetic research. My organization and association
encourages the subcommittee to ensure that funding for DOD
prosthetic research is adequate to support the full range of
programs needed to meet current and future challenges facing
wounded warriors.
Post-traumatic stress and traumatic brain injury are indeed
signature injuries and they deserve your support.
We would also ask that the Armed Forces Retirement Home
receive your attention. We encourage both the home in
Washington, DC, and the home in Gulfport, Mississippi, give
your attention to both of those for adequate funding. The
Gulfport home has been open now for about 9 months, the new
one, and we're encouraged to read what's going on down there
with regard to care. But we're also concerned about some of the
investigations regarding employees.
The Uniformed Services Health System deserves your support
and we thank you very much for the opportunity to testify.
[The statement follows:]
Prepared Statement of Rick Jones
Chairman Inouye, Vice Chairman Cochran, and members of the
Subcommittee: It is a pleasure to appear before you today to present
the views of The National Association for Uniformed Services on the
fiscal year 2012 Defense Appropriations bill.
My name is Rick Jones, Legislative Director of the National
Association for Uniformed Services (NAUS). And for the record, NAUS has
not received any Federal grant or contract during the current fiscal
year or during the previous 2 fiscal years in relation to any of the
subjects discussed today.
As you know, the National Association for Uniformed Services,
founded in 1968, represents all ranks, branches and components of
uniformed services personnel, their spouses and survivors. The
Association includes personnel of the active, retired, Reserve and
National Guard, disabled veterans, veterans community and their
families. We love our country and our flag, believe in a strong
national defense, support our troops and honor their service.
Mr. Chairman, the first and most important responsibility of our
government is the protection of our citizens. As we all know, we are at
war. That is why the defense appropriations bill is so very important.
It is critical that we provide the resources to those who fight for our
protection and our way of life. We need to give our courageous men and
women everything they need to prevail. And we must recognize as well
that we must provide priority funding to keep the promises made to the
generations of warriors whose sacrifice has paid for today's freedom.
We simply must have a strong investment in the size and capability
of our air, land and naval forces. And we must invest in fielding new
weapons systems today to meet the challenges of tomorrow.
We cannot depend on aging fleets of aircraft, ships and vehicles
across the services. We must continue to drive toward modernization and
make available the resources we will need to meet and defeat the next
threats to our security.
Our Nation is protected by the finest military the world has ever
seen. The message our members want you to hear is simple and direct:
Any one who goes into harm's way under the flag of the United States
needs to be deployed with the best our Nation can provide. We need to
give our brave men and women everything they need to succeed. And we
must never cut off or unnecessarily delay critical funding for our
troops in the field.
The National Association for Uniformed Services is very proud of
the job this generation of Americans is doing to defend America. Every
day they risk their lives, half a world away from loved ones. Their
daily sacrifice is done in today's voluntary force. What they do is
vital to our security. And the debt we owe them is enormous.
Our Association also carries concerns about a number of related
matters. Among these is the provision of a proper healthcare for the
military community and recognition of the funding requirements for
TRICARE for retired military. Also, we will ask for adequate funding to
improve the pay for members of our armed forces and to address a number
of other challenges including TRICARE Reserve Select and the Survivor
Benefit Plan.
We also have a number of related priority concerns such as the
diagnosis and care of troops returning with post traumatic stress
disorder (PTSD) and traumatic brain injury (TBI), the need for enhanced
priority in the area of prosthetics research, and providing improved
seamless transition for returning troops between the Department of
Defense (DOD) and the Department of Veterans Affairs (VA). In addition,
we would like to ensure that adequate funds are provided to defeat
injuries from the enemy's use of improvised explosive devices (IEDs).
TRICARE and Military Quality of Life: Health Care
Quality healthcare is a strong incentive to make military service a
career. The provision of quality, timely care is considered one of the
most important benefits afforded the career military. The TRICARE
benefit, earned through a career of service in the uniformed services,
reflects the commitment of a Nation, and it deserves your wholehearted
support.
It should also be recognized that discussions have once again begun
on increasing the retiree-paid costs of TRICARE earned by military
retirees and their families. We remember the outrageous statement of
Dr. Gail Wilensky, a co-chair of the Task Force on the Future of
Military, calling congressional passage of TRICARE for Life ``a big
mistake.''
And more recently, we heard Admiral Mike Mullen, the current
Chairman of Joint Chiefs of Staff, call for increases in TRICARE fees.
Mullen said, ``It's a given as far as I'm concerned.''
Our Association does not believe those who have given so much to
their country in service and sacrifice should again be placed at the
head of the line for budget reductions. We have testified before the
authorizing committee to ``hold the line'' on fee increases. However,
with comments like these from those in military leadership positions,
there is little wonder that retirees and active duty personnel are
concerned.
Seldom has NAUS seen such a lowing in confidence about the
direction of those who manage the program. Faith in our leadership
continues, but it is a weakening faith. And unless something changes,
it is bound to affect recruiting and retention, even in a down economy.
Fraud and Criminal Activity Costs Medicare and TRICARE Billions of
Dollars
Reports continue from the Government Accountability Office (GAO),
the investigative arm of the United States Congress, and related
government agencies that show us that multi-billions of Medicare money
is being ripped off every year. While those in government responsible
for the management of Medicare and TRICARE tell us that their
investigations into these matters are working, the clear sign suggests
otherwise. Our Medicare and TRICARE programs are desperately in need of
improved management to stop the loss of billions of dollars.
Here are a couple of examples. GAO reports that one company billed
Medicare for $170 million for HIV drugs. In truth, the company
dispensed less than $1 million. In addition, the company billed $142
million for nonexistent delivery of supplies and parts and medical
equipment.
In another example, fake Medicare providers billed Medicare for
prosthetic arms on people who already have two arms. The fraud amounted
to $1.4 billion of bills for people who do not need prosthetics.
We need action to corral fraud and bring it to an end. What we've
seen, however, is delay and second-hand attention with insufficient
resources dedicated to TRICARE fraud conviction and recovery of money
paid wrongly to medical care thieves.
Last year, we cited the lack of information on TRICARE fraud
activities. We suggested that one need only view the TRICARE Program
Integrity Office web site to see a reflection of this inactivity. At
that time the most recent Fraud Report was dated 2008 there were only
two items listed under ``News'' for 2010 and no items for 2009.
This year, it's good, though hardly adequate, to see the TRICARE
Program Integrity Office update its information on its activities. The
report for 2010 indicates that a TRICARE Anti-Fraud Conference took
place last April. While these is no related ``News'' on this conference
as there was in 2007, the report notes, ``the education, information
sharing and networking that takes place during and after each
conference creates a surge in fraud case identification and referrals
from attendees.'' Yet there is nothing in the ``News'' that supports
such a surge of beneficial activity took place. It seems more gloss
than fact.
Our members tire of hearing they should pay more for the healthcare
earned in honorable service to country when they hear stories about or
see little evidence of our government doing anything but sitting on its
hands, often taking little to no action for years on this type of
criminal activity, with the exception of an annual conference.
NAUS urges the Subcommittee to challenge DOD and TRICARE
authorities to put some guts behind efforts to drive fraud down and out
of the system. If left unchecked, fraud will increasingly strip away
resources from government programs like TRICARE. And unless Congress
directs the Administration to take action, we all know who will be left
holding the bag and paying higher fees to cover fraud losses--the law-
abiding retiree and family.
We urge the Subcommittee to take the actions necessary for honoring
our obligation to those men and women who have worn the Nation's
military uniform. Use your spending power to move TRICARE to root out
the corruption, fraud and waste. And help confirm America's solemn,
moral obligation to support our troops, our military retirees, and
their families. They have kept their promise to our Nation, now it's
time for us to keep our promise to them.
Military Quality of Life: Pay
For fiscal year 2012, the Administration recommends a 1.6 percent
across-the-board pay increase for members of the Armed Forces. The
proposal is designed, according to the Pentagon, to keep military pay
in line with civilian wage growth.
The National Association for Uniformed Services commends Congress
and the Administration for its attention to troops pay. A good job has
been done over the recently past years to narrow the gap between
civilian-sector and military pay. The differential, which was as great
as 14 percent in the late 1990s, has been reduced to just below 3
percent with the January 2011 pay increase.
The National Association for Uniformed Services applauds you, Mr.
Chairman, for the strides you have made, and we encourage you to
continue your efforts to ensure DOD manpower policy maintains a
compensation package that is attractive and competitive to our fighting
men and women.
We also encourage your review of providing bonus incentives to
entice individuals with certain needed skills into special jobs that
help supply our manpower for critical assets. These packages can also
attract ``old hands'' to come back into the game with their skills.
The National Association for Uniformed Services asks you to do all
you can to fully compensate these brave men and women for being in
harm's way, we should clearly recognize the risks they face and make
every effort to appropriately compensate them for the job they do.
Military Quality of Life: Family Housing Accounts
The National Association for Uniformed Services urges the
Subcommittee to provide adequate funding for military construction and
family housing accounts used by DOD to provide our service members and
their families quality housing. The funds for base allowance and
housing should ensure that those serving our country are able to afford
to live in quality housing whether on or off the base. The current
program to upgrade military housing by privatizing Defense housing
stock is working well. We encourage continued oversight in this area to
ensure joint military-developer activity continues to improve housing
options. Clearly, we need to be particularly alert to this challenge as
we implement BRAC and related rebasing changes.
The National Association for Uniformed Services also asks special
provision be granted the National Guard and Reserve for planning and
design in the upgrade of facilities. Since the terrorist attacks of
September 11, 2001, our Guardsmen and reservists have witnessed an
upward spiral in the rate of deployment and mobilization. The mission
has clearly changed, and we must recognize that Reserve Component
Forces account for an increasing role in our national defense and
homeland security responsibilities. The challenge to help them keep
pace is an obligation we owe for their vital service.
Increase Force Readiness Funds
The readiness of our forces is in decline. The long war fought by
an overstretched force tells us one thing: there are simply too many
missions and too few troops. Extended and repeated deployments are
taking a human toll. Back-to-back deployments means, in practical
terms, that our troops face unrealistic demands. To sustain the service
we must recognize that an increase in troop strength is needed and it
must be resourced.
In addition, we ask you to give priority to funding for the
operations and maintenance accounts where money is secured to reset,
recapitalize and renew the force. The National Guard, for example, has
virtually depleted its equipment inventory, causing rising concern
about its capacity to respond to disasters at home or to train for its
missions abroad.
The deficiencies in the equipment available for the National Guard
to respond to such disasters include sufficient levels of trucks,
tractors, communication, and miscellaneous equipment. If we have
another overwhelming storm, tornado, hurricane or, God forbid, a large-
scale terrorist attack, our National Guard is not going to have the
basic level of resources to do the job right.
Walter Reed Army Medical Center
Another matter of great interest to our members is the plan to
realign and consolidate military health facilities in the National
Capital Region. The proposed plan includes the realignment of all
highly specialized and sophisticated medical services currently located
at Walter Reed Army Medical Center in Washington, DC, to the National
Naval Medical Center in Bethesda, Maryland, and the closing of the
existing Walter Reed by September 15, 2011.
Our members are concerned about recent reports that the newly
expanded medical center in Bethesda, Maryland, and the new community
hospital at Fort Belvoir in Fairfax County, Virginia, are unready for
the move. According to these reports, a number of operating rooms and
patient services are not in conditions to allow transferring patients
and staff from Walter Reed.
The National Association for Uniformed Services believes that
Congress must continue to provide adequate resources for WRAMC to
maintain its base operations' support and medical services required for
uninterrupted care of our catastrophically wounded soldiers and Marines
as they move through needed treatment in this premier medical center.
We request that funds be in place to ensure that Walter Reed
remains open, fully operational and fully functional, until the planned
facilities at both Bethesda and Fort Belvoir are in place, fully
functional and ready to give appropriate care and treatment to the men
and women wounded in armed service. A 9-month delay would make a world
of difference for our retirees and for the wounded warriors and their
families.
Our wounded warriors deserve our Nation's best, most compassionate
healthcare and quality treatment system. They earned it the hard way.
And with application of the proper resources, we know the Nation will
continue to hold the well being of soldiers and their families as our
number one priority.
Department of Defense, Seamless Transition Between the DOD and VA
The development of electronic medical records remains a major goal.
It is our view that providing a seamless transition for recently
discharged military is especially important for servicemembers leaving
the military for medical reasons related to combat, particularly for
the most severely injured patients.
The National Association for Uniformed Services is pleased to
receive the support of President Obama and the forward movement of
Secretaries Gates and Shinseki toward this long-supported goal of
providing a comprehensive e-health record.
The National Association for Uniformed Services calls on the
Appropriations Committee to continue the push for DOD and VA to follow
through on establishing a bi-directional, interoperable electronic
medical record. Since 1982, these two departments have been working on
sharing critical medical records, yet to date neither has effectively
come together in coordination with the other.
Taking care of soldiers, sailors, airmen and marines is a national
obligation, and doing it right sends a strong signal to those currently
in military service as well as to those thinking about joining the
military.
DOD must be directed to adopt electronic architecture including
software, data standards and data repositories that are compatible with
systems in use at the Department of Veterans Affairs. It makes absolute
sense and it would lower costs for both organizations.
If our seriously wounded troops are to receive the care they
deserve, the departments must do what is necessary to establish a
system that allows seamless transition of medical records. It is
essential if our Nation is to ensure that all troops receive timely,
quality healthcare and other benefits earned in military service.
To improve the DOD/VA exchange, the transfer should include a
detailed history of care provided and an assessment of what each
patient may require in the future, including mental health services. No
veteran leaving military service should fall through the bureaucratic
cracks.
Defense Department Force Protection
The National Association for Uniformed Services urges the
Subcommittee to provide adequate funding to rapidly deploy and acquire
the full range of force protection capabilities for deployed forces.
This would include resources for up-armored high mobility multipurpose
wheeled vehicles and add-on ballistic protection to provide force
protection for soldiers in Iraq and Afghanistan, ensure increased
activity for joint research and treatment effort to treat combat blast
injuries resulting from improvised explosive devices (IEDs), rocket
propelled grenades, and other attacks; and facilitate the early
deployment of new technology, equipment, and tactics to counter the
threat of IEDs.
We ask special consideration be given to counter IEDs, defined as
makeshift or ``homemade'' bombs, often used by enemy forces to destroy
military convoys and currently the leading cause of casualties to
troops deployed in Iraq. These devices are the weapon of choice and,
unfortunately, a very effective weapon used by our enemy. The Joint
Improvised Explosive Device Defeat Organization (JIEDDO) is established
to coordinate efforts that would help eliminate the threat posed by
these IEDs. We urge efforts to advance investment in technology to
counteract radio-controlled devices used to detonate these killers.
Maintaining support is required to stay ahead of our enemy and to
decrease casualties caused by IEDs.
Defense Health Program--TRICARE Reserve Select
Mr. Chairman, another area that requires attention is reservist
participation in TRICARE. As we are all aware, National Guard and
Reserve personnel have seen an upward spiral of mobilization and
deployment since the terrorist attacks of September 11, 2001. The
mission has changed and with it our reliance on these forces has risen.
Congress has recognized these changes and begun to update and upgrade
protections and benefits for those called away from family, home and
employment to active duty. We urge your commitment to these troops to
ensure that the long overdue changes made in the provision of their
heathcare and related benefits is adequately resourced. We are one
force, all bearing a critical share of the load.
Department of Defense, Prosthetic Research
Clearly, care for our troops with limb loss is a matter of national
concern. The global war on terrorism in Iraq and Afghanistan has
produced wounded soldiers with multiple amputations and limb loss who
in previous conflicts would have died from their injuries. Improved
body armor and better advances in battlefield medicine reduce the
number of fatalities, however injured soldiers are coming back
oftentimes with severe, devastating physical losses.
In order to help meet the challenge, Defense Department research
must be adequately funded to continue its critical focus on treatment
of troops surviving this war with grievous injuries. The research
program also requires funding for continued development of advanced
prosthesis that will focus on the use of prosthetics with
microprocessors that will perform more like the natural limb.
The National Association for Uniformed Services encourages the
Subcommittee to ensure that funding for Defense Department's prosthetic
research is adequate to support the full range of programs needed to
meet current and future health challenges facing wounded veterans. To
meet the situation, the Subcommittee needs to focus a substantial,
dedicated funding stream on Defense Department research to address the
care needs of a growing number of casualties who require specialized
treatment and rehabilitation that result from their armed service.
We would also like to see better coordination between the
Department of Defense Advanced Research Projects Agency and the
Department of Veterans Affairs in the development of prosthetics that
are readily adaptable to aid amputees.
Post Traumatic Stress Disorder (PTSD) and Traumatic Brain Injury (TBI)
The National Association for Uniformed Services supports a higher
priority on Defense Department care of troops demonstrating symptoms of
mental health disorders and traumatic brain injury.
It is said that traumatic brain injury (TBI) is the signature
injury of the Iraq war. Blast injuries often cause permanent damage to
brain tissue. Veterans with severe TBI will require extensive
rehabilitation and medical and clinical support, including neurological
and psychiatric services with physical and psycho-social therapies.
We call on the Subcommittee to fund a full spectrum of TBI care and
to recognize that care is also needed for patients suffering from mild
to moderate brain injuries, as well. The approach to this problem
requires resources for hiring caseworkers, doctors, nurses, clinicians
and general caregivers if we are to meet the needs of these men and
women and their families.
The mental condition known as Post Traumatic Stress Disorder (PTSD)
has been well known for over a hundred years under an assortment of
different names. For example more than 60 years ago, Army psychiatrists
reported, ``That each moment of combat imposes a strain so great that .
. . psychiatric casualties are as inevitable as gunshot and shrapnel
wounds in warfare.''
PTSD is a serious psychiatric disorder. While the government has
demonstrated over the past several years a higher level of attention to
those military personnel who exhibit PTSD symptoms, more should be done
to assist service members found to be at risk.
Pre-deployment and post-deployment medicine is very important. Our
legacy of the gulf war demonstrates the concept that we need to
understand the health of our service members as a continuum, from pre-
to post-deployment.
The National Association for Uniformed Services applauds the extent
of help provided by the Defense Department, however, we encourage that
more resources be made available to assist. Early recognition of the
symptoms and proactive programs are essential to help many of those who
must deal with the debilitating effects of mental injuries, as
inevitable in combat as gunshot and shrapnel wounds.
We encourage the Members of the Subcommittee to provide these
funds, to closely monitor their expenditure and to see they are not
redirected to other areas of defense spending.
Armed Forces Retirement Home
The National Association for Uniformed Services is pleased to note
the Subcommittee's continued interest in providing funds for the Armed
Forces Retirement Home (AFRH). We urge the Subcommittee to meet the
challenge in providing adequate funding for the facilities in
Washington, DC, and Gulfport, Mississippi.
And we thank the Subcommittee for the provision of funding that has
led to the successful reopening of the Armed Forces Retirement Home in
Gulfport, destroyed in 2005 as a result of Hurricane Katrina. The
Gulfport facility has the capacity to provide independent living,
assisted living and long-term care to more than 500 residents.
Regarding Gulfport, members of our association are seriously
concerned about a recent investigation into healthcare and related
operations at the Mississippi Retirement Home. According to published
reports five employees have resigned as a result of the investigation
initiated by the AFRH acting chief operating officer. We ask that you
ensure that residents' care and health is not put at risk by the
reported troubles at Gulfport.
The National Association for Uniformed Services applauds the
Subcommittee's clear recognition of the Washington AFRH as a historic
national treasure. And we look forward to working with the Subcommittee
to continue providing a residence for and quality-of-life enhancements
to these deserving veterans. We ask that continued care and attention
be given to the mixed-use development to the property's southern end,
as approved.
The AFRH homes are historic national treasures, and we thank
Congress for its oversight of this gentle program and its work to
provide for a world-class care for military retirees.
Improved Medicine with Less Cost at Military Treatment Facilities
The National Association for Uniformed Services is also seriously
concerned over the consistent push to have Military Health System
beneficiaries age of 65 and over moved into the civilian sector from
military care. That is a very serious problem for the Graduate Medical
Education (GME) programs in the MHS; the patients over 65 are required
for sound GME programs, which, in turn, ensure that the military can
retain the appropriate number of physicians who are board certified in
their specialties.
TRICARE/HA policies are pushing these patients out of military
facilities and into the private sector where the cost per patient is at
least twice as expensive as that provided within Military Treatment
Facilities (MTFs). We understand that there are many retirees and their
families who must use the private sector due to the distance from the
closest MTF; however, where possible, it is best for the patients
themselves, GME, medical readiness, and the minimizing the cost of
TRICARE premiums if as many non-active duty beneficiaries are taken
care of within the MTFs. As more and more MHS beneficiaries are pushed
into the private sector, the cost of the MHS rises. The MHS can provide
better medicine, more appreciated service and do it at improved medical
readiness and less cost to the taxpayers.
Uniformed Services University of the Health Sciences
As you know, the Uniformed Services University of the Health
Sciences (USUHS) is the Nation's Federal school of medicine and
graduate school of nursing. The medical students are all active-duty
uniformed officers in the Army, Navy, Air Force and U.S. Public Health
Service who are being educated to deal with wartime casualties,
national disasters, emerging diseases and other public health
emergencies.
The National Association for Uniformed Services supports the USUHS
and requests adequate funding be provided to ensure continued
accredited training, especially in the area of chemical, biological,
radiological and nuclear response. In this regard, it is our
understanding that USUHS requires funding for training and educational
focus on biological threats and incidents for military, civilian,
uniformed first responders and healthcare providers across the nation.
Our members would also like to recognize the high quality of the
medical education and training provided at the Uniformed Services
University of the Health Sciences. The care given Congresswomen
Gabrielle Giffords offers a clear example.
USUHS trained three of the key physicians who performed life-saving
procedures in the hours following the tragedy in Tucson. Retired Navy
Captain Peter Rhee relied on more than 20 years of military medical
experience to provide experienced trauma care to the Congresswoman.
Interim Chief of Neurology Army Colonel Geoffrey Ling assisted and Dr.
Jim Ecklund, another highly regarded neurosurgeon, was also part of the
brain injury team. All are graduates of the military university, and by
the way, Dr. Ecklund was a classmate of Dr. Rhee's at USUHS.
Joint POW/MIA Accounting Command (JPAC)
We also want the fullest accounting of our missing servicemen and
ask for your support in DOD dedicated efforts to find and identify
remains. It is a duty owed to the families of those still missing as
well as to those who served and who currently serve.
NAUS supports the fullest possible accounting of our missing
servicemen. It is a duty we owe the families, to ensure that those who
wear our country's uniform are never abandoned. We request that
appropriate funds be provided to support the JPAC mission for fiscal
year 2012.
Appreciation for the Opportunity to Testify
As a staunch advocate for our uniformed service men and women, The
National Association for Uniformed Services recognizes that these brave
men and women did not fail us in their service to country, and we, in
turn, must not fail them in providing the benefits and services they
earned through honorable military service.
Mr. Chairman, The National Association for Uniformed Services
appreciates the Subcommittee's hard work. We ask that you continue to
work in good faith to put the dollars where they are most needed: in
strengthening our national defense, ensuring troop protection,
compensating those who serve, providing for DOD medical services
including TRICARE, and building adequate housing for military troops
and their families, and in the related defense matters discussed today.
These are some of our Nation's highest priority needs, and we are
confident you will give them the level of attention they deserve.
The National Association for Uniformed Services is confident you
will take special care of our Nation's greatest assets: the men and
women who serve and have served in uniform. We are proud of the service
they give to America every day. They are vital to our defense and
national security. The price we pay as a Nation for their service and
their earned benefits is a continuing cost of war, and it will never
cost more nor is it ever likely to equal the value of their service.
Again, the National Association for Uniformed Services deeply
appreciates the opportunity to present the Association's views on the
issues before the Defense Appropriations Subcommittee.
Chairman Inouye. Mr. Jones, your concerns will be seriously
considered, I guarantee you, sir.
Senator Cochran. Mr. Chairman, I can't help but compliment
the witness for mentioning the retirement home in Gulfport. I'm
happy to report the last time I drove by the facility it looked
like it was on the road to full recovery. Residents who had
lived there before Hurricane Katrina are returning and happy to
be back home. So thank you for the support that you've given to
that initiative.
Mr. Jones. Great to hear that report. Thank you, Senator.
Chairman Inouye. Senator Shelby.
Senator Shelby. Mr. Chairman, I just want to thank the
whole panel, and add Mr. Jones's testimony to that. Thank you
very much.
Chairman Inouye. Thank you very much.
May I thank the panel on behalf of the subcommittee.
Our next panel: Ms. Fran Visco, National Breast Cancer
Coalition; Ms. Mary Hesdorffer, Mesothelioma Applied Research
Foundation; Major General David Bockel, Reserve Officers
Association; Captain Mike Smith, National Military and Veterans
Alliance.
STATEMENT OF FRAN VISCO, PRESIDENT, NATIONAL BREAST
CANCER FOUNDATION
Ms. Visco. Thank you very much. Thank you, Chairman Inouye,
Ranking Member Cochran, and Senator Shelby, for inviting me to
testify today. I'm Fran Visco, a 23-year breast cancer survivor
and President of the National Breast Cancer Coalition, which is
a coalition of hundreds of organizations from across the
country.
I also want to thank you so very much for launching and
supporting the DOD peer-reviewed breast cancer research
program. It's meant so much to women and men across the
country, both within the military and without. You know that
you created something innovative, something very special, that
has saved lives, and it's given hope to very many.
But there are still too many women and men who die of
breast cancer. Like you may remember Lieutenant Colonel Karen
Moss of the U.S. Air Force, who spoke to the subcommittee many
times about the importance of this program. Lieutenant Colonel
Yvonne Andejeski of the U.S. Army, who died of breast cancer in
her 30s while she was a director of the peer-reviewed program.
And just yesterday, at a meeting of the DOD program we took a
moment to remember Lieutenant Commander Yowanna Maria Collins
Wilson of the U.S. Navy, who died of breast cancer in her 30s
while on active duty.
The partnership that has developed over the years between
the military, the public, and the scientists who are involved
in this program is extremely important and helpful to all of
us. I cannot say enough about the dedication and passion the
military has brought to this program. The breast cancer
research program is the only government program focused solely,
funding program focused solely, on ending breast cancer. It is
a program that leverages years of this Nation's investment in
biomedical research and in breast cancer and applies the
results of that investment to women and men everywhere. It is
known and respected worldwide and it expands this Nation's
preeminence in scientific research.
Ninety percent of the funds appropriated go to research.
The administrative costs of this program are minimal and that
is because of the military and how well they operate this
program. It is a transparent program. It's accountable to the
taxpayers, and it is complementary and not duplicative of other
programs.
Because of the way it is structured and because of the fact
that it is in the Army, it is able to rapidly respond to
scientific discoveries and quickly fill gaps in scientific and
patient needs. I recall General Martinez Lopez, who led these
efforts a number of years ago, telling us how important this
program was to the military, not just because of the morale
that it brought, but also because of the relationships that had
been created between DOD and a part of the scientific community
that is important to their work, but not typically engaged with
the military, and also because of the models that the program
created that have been replicated elsewhere within the military
and actually even in other countries.
This program has been a resounding success, and I'm here to
express our appreciation for your leadership in getting this
program started and in making certain that it continues.
Thank you very much.
[The statement follows:]
Prepared Statement of Fran Visco
Thank you, Mr. Chairman and members of the Appropriations
Subcommittee on Defense, for the opportunity to submit testimony today
about a program that has made a significant difference in the lives of
women and their families.
I am Fran Visco, a 22-year breast cancer survivor, a wife and
mother, a lawyer, and President of the National Breast Cancer Coalition
(NBCC). My testimony represents the hundreds of member organizations
and thousands of individual members of the Coalition. NBCC is a
grassroots organization dedicated to ending breast cancer through
action and advocacy. Since its founding in 1991, NBCC has been guided
by three primary goals: to increase Federal funding for breast cancer
research and collaborate with the scientific community to implement new
models of research; improve access to high quality healthcare and
breast cancer clinical trials for all women; and expand the influence
of breast cancer advocates wherever breast cancer decisions are made.
Last September, in order to change the conversation about breast cancer
and restore the sense of urgency in the fight to end the disease, NBCC
launched Breast Cancer Deadline 2020--a deadline to end breast cancer
by January 1, 2020.
Chairman Inouye and Ranking Member Cochran, we appreciate your
longstanding support for the Department of Defense peer reviewed Breast
Cancer Research Program. As you know, this program was born from a
powerful grassroots effort led by NBCC, and has become a unique
partnership among consumers, scientists, Members of Congress and the
military. You and your Committee have shown great determination and
leadership in funding the Department of Defense (DOD) peer reviewed
Breast Cancer Research Program (BCRP) at a level that has brought us
closer to ending this disease. I am hopeful that you and your Committee
will continue that determination and leadership.
I know you recognize the importance of this program to women and
their families across the country, to the scientific and healthcare
communities and to the Department of Defense. Much of the progress in
the fight against breast cancer has been made possible by the
Appropriations Committee's investment in breast cancer research through
the DOD BCRP. To support this unprecedented progress moving forward, we
ask that you support a separate $150 million appropriation, level
funding, for fiscal year 2012. In order to continue the success of the
Program, you must ensure that it maintain its integrity and separate
identity, in addition to level funding. This is important not just for
breast cancer, but for all biomedical research that has benefited from
this incredible government program.
Vision and Mission
The vision of the Department of Defense peer reviewed Breast Cancer
Research Program is to ``eradicate breast cancer by funding innovative,
high-impact research through a partnership of scientists and
consumers.'' The meaningful and unprecedented partnership of scientists
and consumers has been the foundation of this model program from the
very beginning. It is important to understand this collaboration:
consumers and scientists working side by side, asking the difficult
questions, bringing the vision of the program to life, challenging
researchers and the public to do what is needed and then overseeing the
process every step of the way to make certain it works. This unique
collaboration is successful: every year researchers submit proposals
that reach the highest level asked of them by the program and every
year we make progress for women and men everywhere.
And it owes its success to the dedication of the U.S. Army and
their belief and support of this mission. And of course, to you. It is
these integrated efforts that make this program unique.
The Department of the Army must be applauded for overseeing the DOD
BCRP which has established itself as a model medical research program,
respected throughout the cancer and broader medical community for its
innovative, transparent and accountable approach. This program is
incredibly streamlined. The flexibility of the program has allowed the
Army to administer it with unparalleled efficiency and effectiveness.
Because there is little bureaucracy, the program is able to respond
quickly to what is currently happening in the research community. Its
specific focus on breast cancer allows it to rapidly support innovative
proposals that reflect the most recent discoveries in the field. It is
responsive, not just to the scientific community, but also to the
public. The pioneering research performed through the program and the
unique vision it maintains has the potential to benefit not just breast
cancer, but all cancers as well as other diseases. Biomedical research
is literally being transformed by the DOD BCRP's success.
Consumer Participation
Advocates bring a necessary perspective to the table, ensuring that
the science funded by this program is not only meritorious, but that it
is also meaningful and will make a difference in people's lives. The
consumer advocates bring accountability and transparency to the
process. They are trained in science and advocacy and work with
scientists willing to challenge the status quo to ensure that the
science funded by the program fills important gaps not already being
addressed by other funding agencies. Since 1992, more than 600 breast
cancer survivors have served on the BCRP review panels.
Two years ago, Carolina Hinestrosa, a breast cancer survivor and
trained consumer advocate, chaired the Integration Panel and led the
charge in challenging BCRP investigators to think outside the box for
revelations about how to eradicate breast cancer. Despite the fact that
her own disease was progressing, she remained steadfast in working
alongside scientists and consumers to move breast cancer research in
new directions. Unwilling to give up, she fought tirelessly until the
end of her life for a future free of breast cancer.
Carolina died in June 2009 from soft tissue sarcoma, a late side
effect of the radiation that was used to treat her breast cancer. She
once eloquently described the unique structure of the DOD BCRP:
``The Breast Cancer Research Program channels powerful synergy from
the collaboration of the best and brightest in the scientific world
with the primary stakeholder, the consumer, toward bold research
efforts aimed at ending breast cancer.''
No one was bolder than Carolina, who was fierce and determined in
her work on the DOD BCRP and in all aspects of life she led as a
dedicated breast cancer advocate, mother to a beautiful daughter, and
dear friend to so many. Carolina's legacy reminds us that breast cancer
is not just a struggle for scientists; it is a disease of the people.
The consumers who sit alongside the scientists at the vision setting,
peer review and programmatic review stages of the BCRP are there to
ensure that no one forgets the women who have died from this disease,
and the daughters they leave behind, and to keep the program focused on
its vision.
For many consumers, participation in the program is ``life
changing'' because of their ability to be involved in the process of
finding answers to this disease. In the words of one advocate:
``Participating in the peer review and programmatic review has been
an incredible experience. Working side by side with the scientists,
challenging the status quo and sharing excitement about new research
ideas . . . it is a breast cancer survivor's opportunity to make a
meaningful difference. I will be forever grateful to the advocates who
imagined this novel paradigm for research and continue to develop new
approaches to eradicate breast cancer in my granddaughters'
lifetime.''------Marlene McCarthy, two-time breast cancer ``thriver'',
Rhode Island Breast Cancer Coalition
Scientists who participate in the Program agree that working with
the advocates has changed the way they do science. Let me quote Greg
Hannon, the fiscal year 2010 DOD BCRP Integration Panel Chair:
``The most important aspect of being a part of the BCRP, for me,
has been the interaction with consumer advocates. They have currently
affected the way that I think about breast cancer, but they have also
impacted the way that I do science more generally. They are a constant
reminder that our goal should be to impact people's lives.''------Greg
Hannon, PhD, Cold Spring Harbor Laboratory
Unique Structure
The DOD BCRP uses a two-tiered review process for proposal
evaluation, with both steps including scientists as well as consumers.
The first tier is scientific peer review in which proposals are weighed
against established criteria for determining scientific merit. The
second tier is programmatic review conducted by the Integration Panel
(composed of scientists and consumers) that compares submissions across
areas and recommends proposals for funding based on scientific merit,
portfolio balance and relevance to program goals.
Scientific reviewers and other professionals participating in both
the peer review and the programmatic review process are selected for
their subject matter expertise. Consumer participants are recommended
by an organization and chosen on the basis of their experience,
training and recommendations.
The BCRP has the strictest conflict of interest policy of any
research funding program or institute. This policy has served it well
through the years. Its method for choosing peer and programmatic review
panels has produced a model that has been replicated by funding
entities around the world.
It is important to note that the Integration Panel that designs
this Program has a strategic plan for how best to spend the funds
appropriated. This plan is based on the state of the science--both what
scientists and consumers know now and the gaps in our knowledge--as
well as the needs of the public. While this plan is mission driven, and
helps ensure that the science keeps to that mission of eradicating
breast cancer in mind, it does not restrict scientific freedom,
creativity or innovation. The Integration Panel carefully allocates
these resources, but it does not predetermine the specific research
areas to be addressed.
Distinctive Funding Opportunities
The DOD BCRP research portfolio includes many different types of
projects, including support for innovative individuals and ideas,
impact on translating research from the bench to the bedside, and
training of breast cancer researchers.
Innovation
The Innovative Developmental and Exploratory Awards (IDEA) grants
of the DOD program have been critical in the effort to respond to new
discoveries and to encourage and support innovative, risk-taking
research. Concept Awards support funding even earlier in the process of
discovery. These grants have been instrumental in the development of
promising breast cancer research by allowing scientists to explore
beyond the realm of traditional research and unleash incredible new
ideas. IDEA and Concept grants are uniquely designed to dramatically
advance our knowledge in areas that offer the greatest potential. They
are precisely the type of grants that rarely receive funding through
more traditional programs such as the National Institutes of Health and
private research programs. They therefore complement, and do not
duplicate, other Federal funding programs. This is true of other DOD
award mechanisms as well.
Innovator awards invest in world renowned, outstanding individuals
rather than projects, by providing funding and freedom to pursue highly
creative, potentially groundbreaking research that could ultimately
accelerate the eradication of breast cancer. For example, in fiscal
year 2008, Dr. Mauro Ferrari of the University of Texas Health Science
Center at Houston was granted an Innovator Award to develop novel
vectors for the optimal delivery of individualized breast cancer
treatments. This is promising based on the astounding variability in
breast cancer tumors and the challenges presented in determining which
treatments will be most effective and how to deliver those treatments
to each individual patient. In fiscal year 2006, Dr. Gertraud
Maskarinec of the University of Hawaii received a synergistic IDEA
grant to study effectiveness of the Dual Energy X-Ray Absorptiometry
(DXA) as a method to evaluate breast cancer risks in women and young
girls.
The Era of Hope Scholar Award supports the formation of the next
generation of leaders in breast cancer research, by identifying the
best and brightest scientists early in their careers and giving them
the necessary resources to pursue a highly innovative vision of ending
breast cancer. Dr. Shiladitya Sengupta from Brigham and Women's
Hospital, Harvard Medical School, received a fiscal year 2006 Era of
Hope Scholar Award to explore new strategies in the treatment of breast
cancer that target both the tumor and the supporting network
surrounding it. In fiscal year 2007, Dr. Gene Bidwell of the University
of Mississippi Medical Center received an Era of Hope Postdoctoral
Award to study thermally targeted delivery of inhibitor peptides, which
is an underdeveloped strategy for cancer therapy.
One of the most promising outcomes of research funded by the DOD
BCRP was the development of the first monoclonal antibody targeted
therapy that prolongs the lives of women with a particularly aggressive
type of advanced breast cancer. Researchers found that over-expression
of HER-2/neu in breast cancer cells results in very aggressive biologic
behavior. The same researchers demonstrated that an antibody directed
against HER-2/neu could slow the growth of the cancer cells that over-
expressed the gene. This research, which led to the development of the
targeted therapy, was made possible in part by a DOD BCRP-funded
infrastructure grant. Other researchers funded by the DOD BCRP are
identifying similar targets that are involved in the initiation and
progression of cancer.
These are just a few examples of innovative funding opportunities
at the DOD BCRP that are filling gaps in breast cancer research.
Translational Research
The DOD BCRP also focuses on moving research from the bench to the
bedside. DOD BCRP awards are designed to fill niches that are not
addressed by other Federal agencies. The BCRP considers translational
research to be the process by which the application of well-founded
laboratory or other pre-clinical insight result in a clinical trial. To
enhance this critical area of research, several research opportunities
have been offered. Clinical Translational Research Awards have been
awarded for investigator-initiated projects that involve a clinical
trial within the lifetime of the award. The BCRP has expanded its
emphasis on translational research by also offering five different
types of awards that support work at the critical juncture between
laboratory research and bedside applications.
The Multi Team Award mechanism brings together the world's most
highly qualified individuals and institutions to address a major
overarching question in breast cancer research that could make a
significant contribution toward the eradication of breast cancer. Many
of these Teams are working on questions that will translate into direct
clinical applications. These Teams include the expertise of basic,
epidemiology and clinical researchers, as well as consumer advocates.
Training
The DOD BCRP is also cognizant of the need to invest in tomorrow's
breast cancer researchers. Dr. J. Chuck Harrell, Ph.D. at the
University of Colorado, Denver and the University of North Carolina at
Chapel Hill, for example, received a Predoctoral Traineeship Award to
investigate hormonal regulation of lymph node metastasis, the majority
of which retain estrogen receptors (ER) and/or progesterone receptors.
Through his research, Dr. Harrell determined that lymph node
microenvironment alters ER expression and function in the lymph nodes,
effecting tumor growth. These findings led Dr. Harrell to conduct
further research in the field of breast metastasis during his
postdoctoral work. Jim Hongjun of the Battelle Memorial Institute
received a postdoctoral award for the early detection of breast cancer
using post-translationally modified biomarkers.
Dr. John Niederhuber, former Director of the National Cancer
Institute (NCI), said the following about the Program when he was
Director of the University of Wisconsin Comprehensive Cancer Center in
April, 1999:
``Research projects at our institution funded by the Department of
Defense are searching for new knowledge in many different fields
including: identification of risk factors, investigating new therapies
and their mechanism of action, developing new imaging techniques and
the development of new models to study [breast cancer] . . . Continued
availability of this money is critical for continued progress in the
nation's battle against this deadly disease.''
Scientists and consumers agree that it is vital that these grants
continue to support breast cancer research. To sustain the Program's
momentum, $150 million for peer reviewed research is needed in fiscal
year 2012.
Outcomes and Reviews of the DOD BCRP
The outcomes of the BCRP-funded research can be gauged, in part, by
the number of publications, abstracts/presentations, and patents/
licensures reported by awardees. To date, there have been more than
12,241 publications in scientific journals, more than 12,000 abstracts
and nearly 550 patents/licensure applications. The American public can
truly be proud of its investment in the DOD BCRP. Scientific
achievements that are the direct result of the DOD BCRP grants are
undoubtedly moving us closer to eradicating breast cancer.
The success of the DOD peer reviewed Breast Cancer Research Program
has been illustrated by several unique assessments of the Program. The
Institute of Medicine (IOM), which originally recommended the structure
for the Program, independently re-examined the Program in a report
published in 1997. They published another report on the Program in
2004. Their findings overwhelmingly encouraged the continuation of the
Program and offered guidance for program implementation improvements.
The 1997 IOM review of the DOD peer reviewed Breast Cancer Research
Program commended the Program, stating, ``the Program fills a unique
niche among public and private funding sources for cancer research. It
is not duplicative of other programs and is a promising vehicle for
forging new ideas and scientific breakthroughs in the Nation's fight
against breast cancer.'' The 2004 report spoke to the importance of the
program and the need for its continuation.
The DOD peer reviewed Breast Cancer Research Program not only
provides a funding mechanism for high-risk, high-return research, but
also reports the results of this research to the American people every
2 to 3 years at a public meeting called the Era of Hope. The 1997
meeting was the first time a federally funded program reported back to
the public in detail not only on the funds used, but also on the
research undertaken, the knowledge gained from that research and future
directions to be pursued.
Sixteen hundred consumers and researchers met for the fifth Era of
Hope meeting in June, 2008. As MSNBC.com's Bob Bazell wrote, this
meeting ``brought together many of the most committed breast cancer
activists with some of the Nation's top cancer scientists. The
conference's directive is to push researchers to think `out of the box'
for potential treatments, methods of detection and prevention . . .''
He went on to say ``the program . . . has racked up some impressive
accomplishments in high-risk research projects . . ..''
One of the topics reported on at the meeting was the development of
more effective breast imaging methods. An example of the important work
that is coming out of the DOD BCRP includes a new screening method,
molecular breast imaging, which helps detect breast cancer in women
with dense breasts--which can be difficult using a mammogram alone. I
invite you to log on to NBCC's website http://
influence.breastcancerdeadline2020.org/ to learn more about the
exciting research reported at the 2008 Era of Hope. The next Era of
Hope meeting will occur this August.
The DOD peer reviewed Breast Cancer Research Program has attracted
scientists across a broad spectrum of disciplines, launched new
mechanisms for research and facilitated new thinking in breast cancer
research and research in general. A report on all research that has
been funded through the DOD BCRP is available to the public.
Individuals can go to the Department of Defense website and look at the
abstracts for each proposal at http://cdmrp.army.mil/bcrp/.
Commitment of the National Breast Cancer Coalition
The National Breast Cancer Coalition is strongly committed to the
DOD BCRP in every aspect, as we truly believe it is one of our best
chances for reaching Breast Cancer Deadline 2020's goal of ending the
disease by the end of the decade. The Coalition and its members are
dedicated to working with you to ensure the continuation of funding for
this Program at a level that allows this research to forge ahead. From
1992, with the launch of our ``300 Million More Campaign'' that formed
the basis of this Program, until now, NBCC advocates have appreciated
your support.
Over the years, our members have shown their continuing support for
this Program through petition campaigns, collecting more than 2.6
million signatures, and through their advocacy on an almost daily basis
around the country asking for support of the DOD BCRP.
Consumer advocates have worked hard over the years to keep this
program free of political influence. Often, specific institutions or
disgruntled scientists try to change the program though legislation,
pushing for funding for their specific research or institution, or try
to change the program in other ways, because they did not receive
funding through the process, one that is fair, transparent and
successful. The DOD BCRP has been successful for so many years because
of the experience and expertise of consumer involvement, and because of
the unique peer review and programmatic structure of the program. We
urge this Committee to protect the integrity of the important model
this program has become.
There are nearly 3 million women living with breast cancer in this
country today. This year, more than 40,000 will die of the disease and
more than 260,000 will be diagnosed. We still do not know how to
prevent breast cancer, how to diagnose it in a way to make a real
difference or how to cure it. It is an incredibly complex disease. We
simply cannot afford to walk away from this program.
Since the very beginning of this Program in 1992, Congress has
stood with us in support of this important approach in the fight
against breast cancer. In the years since, Chairman Inouye and Ranking
Member Cochran, you and this entire Committee have been leaders in the
effort to continue this innovative investment in breast cancer
research.
NBCC asks you, the Defense Appropriations Subcommittee, to
recognize the importance of what has been initiated by the
Appropriations Committee. You have set in motion an innovative and
highly efficient approach to fighting the breast cancer epidemic. We
ask you now to continue your leadership and fund the Program at $150
million and maintain its integrity. This is research that will help us
win this very real and devastating war against a cruel enemy.
Thank you again for the opportunity to submit testimony and for
giving hope to all women and their families, and especially to the
nearly 3 million women in the United States living with breast cancer
and all those who share in the mission to end breast cancer.
Chairman Inouye. I thank you very much, Ms. Visco. My wife
of 57 years died of cancer, so I'm constantly reminded.
Ms. Visco. Yes.
Chairman Inouye. Senator Cochran.
Senator Cochran. Thank you very much for your presence. We
appreciate the information that you've provided to the
subcommittee.
Ms. Visco. You're welcome.
Chairman Inouye. Senator Shelby.
Senator Shelby. Mr. Chairman, I appreciate the testimony
and her commitment to finding a cure. We all are supporting
this on the subcommittee.
Mr. Chairman, I would be interested--and the subcommittee
may have done some work in this, because we all support this
because this is the right thing to do, connected to our service
people, we all benefit. What connection and how does this
correlate with, what we're doing in DOD, to what they're doing
in NIH? Because I serve on that subcommittee, as all of you do,
and that would be interesting, to make sure that we're spending
all we can and getting the bang that we can with the taxpayers'
money and make sure that there's not a lot of overlap there.
I don't know this, but as an appropriator with all of us--
and you're the chair--we're going to have to look at this,
because we're all committed to helping you.
Ms. Visco. Yes. Actually, Senator, the program is
structured in a way to make certain that there is no overlap. I
know that members of the military have been and are perfectly
willing and capable of briefing you on exactly how that works.
Senator Shelby. Thank you.
Ms. Visco. Thank you.
Chairman Inouye. Thank you very much.
Ms. Hesdorffer.
STATEMENT OF MARY HESDORFFER, MS, CRNP, MEDICAL
LIAISON, MESOTHELIOMA APPLIED RESEARCH
FOUNDATION
Ms. Hesdorffer. Thank you, Chairman Inouye and Ranking
Member Cochran and members of the subcommittee. Thank you for
the opportunity to discuss mesothelioma and its connection to
the military service. Your support is critical to our mission
and I look forward to continuing our relationship with the
committee.
My name is Mary Hesdorffer. I'm a nurse practitioner with
over a decade's experience in mesothelioma treatment and
research, and I serve as the medical liaison to the
Mesothelioma Applied Research Foundation, as well as being on
staff at Johns Hopkins Medical Institution.
The Mesothelioma Applied Research Foundation is a national
nonprofit dedicated to eradicating mesothelioma as a life-
ending disease by funding research, providing education and
support for patients, and leading advocacy for the national
commitment to end this tragedy.
Mesothelioma, as many of you know, is an aggressive cancer.
It's directly caused by asbestos. It's one of the most painful
and fatal of cancers. It invades the chest, destroys vital
organs, and crushes the lungs. Long-term survivors of
mesothelioma are described as 3-year survivors, so you know the
seriousness of what we are facing.
It disproportionately affects our service men and women and
their families. As you may know, until its fatal toxicity
became fully recognized it was considered a magic mineral. It
was used extensively in the Navy right up until the 1970s. It
was used in engines, nuclear reactors, conditioners, packing,
brakes, clutches, winches. In fact, it was used all over Navy
ships, even in living spaces, where pipes were overhead, and in
kitchens, where asbestos was used in the ovens. It was used in
wiring of appliances. Aside from the Navy ships, it was used on
military planes extensively, on military vehicles, insulating
materials on quonset huts, and in living quarters.
As a result, millions of Navy--millions of defense
personnel, servicemen and shipyard workers, have been exposed
to asbestos. A study at a Groton, Connecticut, shipyard found
that over 100,000 workers have been exposed to asbestos over
the years at just this one shipyard.
Following the time of exposure, the disease can manifest
itself any time from 10 to 50 years. So we still have many,
many, many patients who were diagnosed or who were exposed to
asbestos in the 70s who will still be developing this disease
in future years.
As the daughter of a merchant marine and the mother of a
veteran of the war in Iraq, it's an issue that's very close to
my heart. These are the people who have defended our country
and built its fleet. They're heroes like former Chief Naval
Officer Admiral Elmo Zumwalt, who led the Navy during Vietnam.
He was diagnosed in the year 2000 and just 3 months after his
diagnosis he was dead from this disease.
Lewis Deets was another one of our Navy veterans. He was
serving on a ship where a fire broke out. He was exposed to
asbestos during the burning and then he was also exposed as he
replaced the burned asbestos blocks. In 1999 he was diagnosed
with mesothelioma and died 4 months later at the age of 55.
Bob Tregget, another retired sailor, was diagnosed in 2008.
He was exposed as a sailor.
I can go on and talk to you about all of these military
personnel, but I think we all understand the connection between
asbestos and this disease.
Since 1992 the Department of Defense has been charged with
promoting research on diseases related to military service.
Since then it has funded over $5.4 billion for a range of
diseases, some only tangentially related to military service,
but overlooked mesothelioma research for 16 years, even though
asbestos was used all over military installations and vehicles,
especially Navy ships. This is an injustice to the estimated
one-third of mesothelioma patients who were exposed to asbestos
on U.S. Navy ships and shipyards.
Currently there are about 3,500 patients a year diagnosed
with mesothelioma and 3,000 patients a year die from the
disease. If we look at one-third of the patients having been
Navy vets, we're looking at about 1,000 patients a year of
former people who were exposed on the Navy ships.
In fiscal year 2009 the DOD took responsibility more
seriously and made awards totaling $2.7 million for two
mesothelioma projects. In January of this year, we had two
people awarded technology development awards. We have many
people applying for the awards, but we're giving less than 2.6
percent of these awards out.
We feel that all of these research areas warrant attention,
but since mesothelioma is a rapidly fatal, excruciating and
painful cancer, we ask the subcommittee to appropriate to DOD
for fiscal year 2012 $5 million for a dedicated mesothelioma
research program. I'm asking for your help. We can't do this
alone.
Thank you.
[The statement follows:]
Prepared Statement of Mary Hesdorffer
Chairman Inouye, Ranking Member Cochran, and Members of the
Committee, thank you for the opportunity to discuss the Mesothelioma
connection to military service. Your support is critical to our
mission, and I look forward to continuing our relationship with this
committee.
My name is Mary Hesdorffer, I am a nurse practitioner with over a
decade's experience in mesothelioma treatment and research, and serve
as the Medical Liaison to the Mesothelioma Applied Research Foundation.
The Mesothelioma Applied Research Foundation is the national nonprofit
dedicated to eradicating mesothelioma as a life-ending disease by
funding research, providing education and support for patients, and
leading advocacy efforts for a national commitment to end the
mesothelioma tragedy.
Mesothelioma is an aggressive cancer caused by asbestos. It is
among the most painful and fatal of cancers, as it invades the chest,
destroys vital organs, and crushes the lungs. Mesothelioma
disproportionally affects our service men and women and their families.
As you may know, until its fatal toxicity became fully recognized,
asbestos was regarded as the magic mineral. It has excellent
fireproofing, insulating, filling and bonding properties. By the late
1930's and through at least the late 70's the Navy was using it
extensively. It was used in engines, nuclear reactors, decking
materials, pipe covering, hull insulation, valves, pumps, gaskets,
boilers, distillers, evaporators, conditioners, rope packing, and
brakes and clutches on winches. In fact it was used all over Navy
ships, even in living spaces where pipes were overhead and in kitchens
where asbestos was used in ovens and in the wiring of appliances. Aside
from Navy ships, asbestos was also used on military planes extensively,
on military vehicles, and as insulating material on Quonset huts and
living quarters.
As a result, millions of military defense personnel, servicemen and
shipyard workers, were heavily exposed. A study at the Groton,
Connecticut shipyard found that over 100,000 workers had been exposed
to asbestos over the years at just one shipyard. The disease takes 10
to 50 years to develop, so many of these veterans and workers are now
being diagnosed. As the daughter of a merchant marine and the mother of
a veteran of the war in Iraq, this is an issue close to my heart.
These are the people who defended our country and built its fleet.
They are heroes like former Chief Naval Officer Admiral Elmo Zumwalt,
Jr., who led the Navy during Vietnam and was renowned for his concern
for enlisted men. Despite his rank, prestige, power, and leadership in
protecting the health of Navy servicemen and veterans, Admiral Zumwalt
died at Duke University in 2000, just 3 months after being diagnosed
with mesothelioma.
Lewis Deets was another of these heroes. Four days after turning
the legal age of 18, Lewis joined the Navy. He was not drafted. He
volunteered, willingly putting his life on the line to serve his
country in Vietnam. He served in the war for over 4 years, from 1962 to
1967, as a ship boilerman. For his valiance in combat operations
against the guerilla forces in Vietnam he received a Letter of
Commendation and The Navy Unit Commendation Ribbon for Exceptional
Service. In December 1965, while Lewis was serving aboard the USS Kitty
Hawk in the Gulf of Tonkin, a fierce fire broke out. The boilers,
filled with asbestos, were burning. Two sailors were killed and 29 were
injured. Lewis was one of the 29 injured; he suffered smoke inhalation
while fighting the fire. After the fire, he helped rebuild the boilers,
replacing the burned asbestos blocks. In 1999 he was diagnosed with
mesothelioma, and died 4 months later at age 55.
Bob Tregget was a 57 year old retired sailor who was diagnosed with
mesothelioma in 2008. Bob was exposed to asbestos as a sailor in the
U.S. Navy from 1965 to 1972, proud to serve his country aboard a
nuclear submarine whose mission was to deter a nuclear attack upon the
United States. To treat his disease, Bob had the state of the art
treatment. He had 3 months of systemic chemotherapy with a new, and
quite toxic, drug combination. Then he had a grueling surgery, to open
up his chest, remove his sixth rib, amputate his right lung, remove the
diaphragm and parts of the linings around his lungs and his heart.
After 2 weeks of postoperative hospitalization to recover and still
with substantial postoperative pain, he had radiation, which left him
with second degree burns on his back, in his mouth, and in his airways.
Less than 1 year later, in 2009, he lost his battle with Mesothelioma.
Admiral Zumwalt's, Boilerman Deets' and Sailor Tregget's stories
are not atypical. Many more meso patients were exposed in the Navy, or
working in a shipyard. Almost 3,000 Americans die each year of meso,
and one study found that one-third of patients were exposed on U.S.
Navy ships or shipyards. That's 1,000 U.S. veterans and shipyard
workers per year, lost through service to country, just as if they had
been on a battlefield.
I am currently working with Mike Clements, who was diagnosed with
Mesothelioma in 2005 at the age of 59. Mike served in active duty for 6
years, at which time he worked in 3 different shipyards and spent time
on a submarine. While he cannot pinpoint this exposure to asbestos, he
is certain there is a correlation between his service and diagnosis.
Further, he lost his father to Mesothelioma, who was also a Navy
veteran.
Asbestos exposure among naval personnel was widespread from the
1930s through the 1980s, and exposure to asbestos still occurred after
the 1980s during ship repair, overhaul, and decommissioning. We have
not yet seen the end of exposures to asbestos. Asbestos exposures have
been reported among the troops in Iraq and Afghanistan. On July 14,
2004, members of the 877th Engineer Battalion of Alabama's Army
National Guard were exposed to asbestos in their camp in Mosul, Iraq.
Soldiers in wars that extend into third world countries, where asbestos
use is increasing without stringent regulations, may also be at risk
for exposure during tours of duty. Even low-dose, incidental exposures
cause mesothelioma. For all those who will develop mesothelioma as a
result of these past or ongoing exposures, the only hope is that we
will develop effective treatment.
Since 1992, the Department of Defense (DOD) has been charged with
promoting research on diseases related to military service. Since then
it has funded over $5.4 billion for a range of diseases--some only
tangentially related to military service, but overlooked mesothelioma
research for 16 years even though asbestos was used all over military
installations and vehicles, especially Navy ships. This is an injustice
to the estimated one-third of mesothelioma patients were exposed to
asbestos on U.S. Navy ships and shipyards.
There are brilliant researchers are dedicated to mesothelioma. The
Food and Drug Administration (FDA) has now approved one drug which has
some effectiveness, proving that the tumor is not invincible.
Biomarkers are being identified. Two of the most exciting areas in
cancer research--gene therapy and biomarker discovery for early
detection and treatment--look particularly promising in mesothelioma.
The Meso Foundation has funded $7.1 million to support research in
these and other areas. Now we need the Federal Government's partnership
to develop the promising findings into effective treatments.
Your subcommittee has recognized the need and taken the lead. For
the past 3 years a budget has been passed (fiscal years 2008, 2009 and
2010), you have directed DOD to spur research for this service-related
cancer by including it as an area of emphasis in the Peer Reviewed
Medical Research Program.
As a result, in early 2008 the DOD awarded its first mesothelioma
research grant ever, a $1.4 million award to Courtney Broaddus, M.D.
for exciting work to understand the role of macrophage induced
inflammation in mesothelioma.
The mesothelioma community greatly appreciated this important first
step. Thirty-eight mesothelioma researchers applied for support in
2008. The single award represents only a 2.6 percent success rate for
mesothelioma applications. This does not comply with the Senate's
directive that DOD begin to seriously address this critical disease.
Thirty-seven other researchers put in the time, effort and expense to
gather preliminary data and apply, and then were rejected. Such a low
success rate of 2.6 percent will discourage top researchers from
interest in mesothelioma; they will direct their effort and expertise
into other, better funded cancers. Mesothelioma research will not
advance, effective treatments will not be found, and veterans and
current members exposed to asbestos through their military service will
be left without hope.
In fiscal year 2009, the DOD took its responsibility more
seriously, and made awards totaling $2,750,549 for two important
mesothelioma projects: Harvey Pass, M.D. and Margaret E. Huflejt, Ph.D.
to investigate new markers for early detection of mesothelioma and
identify new therapeutic targets. Lee Krug, M.D. received an award to
lead a multi-site clinical trial of a promising new therapy based on
the WT-1 vaccine, which will directly impact patients and offers them
new hope. For the 2009 grants, two mesothelioma projects were awarded,
out of 56 applications submitted. This is slightly better, but still an
awards-to-applications ratio of only 4 percent.
In January of this year, Michel Sadelain, M.D., Ph.D., and Prasad
Adusumilli, M.D. were awarded a $2.6 million Technology/Therapeutic
Development Award to translate mesothelin-targeted immunotherapy for
fiscal year 2010. This is a reduction of $150,000 from fiscal year 2009
funding levels for mesothelioma.
Such low success rates will not encourage top young researchers to
move into mesothelioma, or experienced researchers to stay in meso.
Rather than mere eligibility, mesothelioma needs to be one of the
diseases that is assigned a specific appropriation.
Since the Committee's intent to spur mesothelioma research is not
being executed through the PRMRP, we believe the Committee must respond
by directing DOD to establish a dedicated mesothelioma program. For
2009, Congress added dedicated funding for all of the following as new
programs, in addition to the DOD's existing programs for Breast Cancer,
Prostate Cancer, Ovarian Cancer, Neurofibromatosis, Tuberous Sclerosis
Complex, and the Peer Reviewed Medical Research Program:
--Autism Research Program--$8 million;
--Gulf War Illness Research Program--$8 million;
--Amyotrophic Lateral Sclerosis Research Program--$5 million;
--Bone Marrow Failure Research Program--$5 million;
--Multiple Sclerosis Research Program--$5 million;
--Peer Reviewed Lung Cancer Research Program--$20 million; and
--Peer Reviewed Cancer Research Program--$16 million.
The Peer Reviewed Cancer Research Program funds are restricted as
follows: $4 million for research of melanoma and other skin cancers as
related to deployments of service members to areas of high exposure; $2
million for research of pediatric brain tumors within the field of
childhood cancer research; $8 million for genetic cancer research and
its relation to exposure to the various environments that are unique to
a military lifestyle; and $2 million for non-invasive cancer ablation
research into non-invasive cancer treatment including selective
targeting with nano-particles.
In 2010, Congress added dedicated funding for the following as new
programs:
--Chiropractic Clinical Trial--$8.2 millionl; and
--Defense Medical Research and Development $275 million.
All of these research areas warrant attention, but mesothelioma is
a rapidly fatal, excruciatingly painful cancer directly related to
military service. We ask the Committee to appropriate to DOD for fiscal
year 2012 $5 million for a dedicated Mesothelioma Research Program or
as a specific restriction within the Peer Reviewed Cancer Research
Program. This will boost the long-neglected field of mesothelioma
research, enabling mesothelioma researchers to build a better
understanding of the disease and develop effective treatments. This
will translate directly to saving lives and reducing suffering of
veterans battling mesothelioma.
We look to the Senate Defense Appropriations Subcommittee to
provide continued leadership and hope to the servicemen and women and
veterans who develop this cancer after serving our Nation. Thank you
for the opportunity to provide testimony before the Subcommittee and we
hope that we can work together to develop life-saving treatments for
mesothelioma. We thank you for considering our fiscal year 2012 request
for $5 million for Mesothelioma research.
Chairman Inouye. Thank you very much, Ms. Hesdorffer.
Senator Cochran.
Senator Cochran. Thank you very much. I think your
testimony has added to our understanding of how devastating
some of these physical problems and life and death issues are,
particularly for those of us who served in the Navy. As you
were reciting that list of names, I couldn't help but remember
my service in the Navy aboard a ship out of Boston,
Massachusetts--a wonderful opportunity for me, growing up in
the Deep South, to get to know about things around the world
that I would have never been exposed to. But to find out I was
also exposed to some of these life-threatening situations
brings to me the realization of how lucky so many of us are who
have led healthy lives in spite of the fact that we've been
exposed to these dangerous situations.
But I think we have a definite obligation to do everything
we can to try to save lives now and improve the quality of life
of those who have been more unfortunate than I was.
Ms. Hesdorffer. Thank you.
Chairman Inouye. Senator Shelby.
Senator Shelby. Thank you, Mr. Chairman.
I appreciate your testimony here. We know this is a
horrible situation. I've known people--I had a former
congressional colleague of mine from Alabama who worked one
summer, who's dead now, as an asbestos worker, because it was a
great insulator, as you point out. They didn't know then or, if
they knew, the workers didn't know what danger they were
playing with.
I guess my question--we know that a lot of this lies
dormant for years and years and years. I guess we've all been
exposed, but some to more degree than others, to a lot of this
and didn't even know it. We used to--oh, gosh, all over America
we used to have asbestos siding on homes, asbestos everywhere,
because it was, as you pointed out, the so-called perfect
mineral for insulation. It had great qualities, but a big
danger.
What is the real danger today of our troops as they are in
harm's way, posted everywhere in the world? Is it third world
countries using asbestos because it's there and it's available
and maybe they don't appreciate the danger to it?
Ms. Hesdorffer. Well, I think part of the problem is life
is cheap, it's expendable. Canada is still mining asbestos and
still exporting it. So we have India, we have so many patients
are dying of mesothelioma, probably before they're diagnosed
because it's mistaken often for tuberculosis.
Our troops have been exposed in Afghanistan, Iraq, in many
of the third world countries. An epidemic now is occurring in
Japan, because Japan probably has used asbestos now for a
number of years, where they're just beginning to see diagnosed
cases.
Senator Shelby. Are they still using--a lot of countries in
the world, like you mentioned Japan, are they still using
asbestos because of the properties of a great insulator?
Ms. Hesdorffer. Yes.
Senator Shelby. Irrespective of the danger?
Senator Shelby. Slumdog Millionaire, if you look at that
movie and you saw those huts that those children were running
over, those were asbestos huts. Those roofs were all made of
asbestos. We're using it as a fire retardant in many countries.
Senator Shelby. My last question: Briefly, tell us what
drug, pharmaceutical breakthroughs, other things, methods of
treatment, either help alleviate some of the problems, or is
that just too far away?
Ms. Hesdorffer. Well, I'd like to just briefly--we had
Olympta was approved in 2004. Prior to that, there was no
approved agent. Patients who get Olympta now--without
treatment, the life expectancy is 9.2 months. With Olympta, the
life expectancy is 12.3 months. Surgery where----
Senator Shelby. It's a killer, period.
Ms. Hesdorffer. It's a uniformly fatal disease. That's how
every research article starts out.
Senator Shelby. Thank you.
Thank you, Mr. Chairman.
Chairman Inouye. Thank you.
Ms. Hesdorffer. Thank you.
Chairman Inouye. Major General Bockel.
STATEMENT OF MAJOR GENERAL DAVID BOCKEL, UNITED STATES
ARMY (RETIRED), EXECUTIVE DIRECTOR, RESERVE
OFFICERS ASSOCIATION
General Bockel. Mr. Chairman, Mr. Vice Chairman, Senator
Shelby: The Reserve Officers Association thanks you for the
invitation to appear and give testimony. I'm Major General
David Bockel, Executive Director of the Reserve Officers
Association. I'm also authorized to speak in behalf of the
Reserve Enlisted Association.
As both the Congress and the Pentagon are looking at
reducing defense expenses, ROA finds itself again confronted
with protecting one of America's greatest assets, the reserve
components. The National Guard and the other Reserve components
are proud members of the total force who fully understand their
duty and are proudly serving operationally. Not only have they
contributed to the war effort, but they have made a difference
in maintaining an all-volunteer military force and providing
the active force more time at home.
Yet, as discussions occur in both Congress and the Pentagon
on how to reduce the budget and the deficit, the peril of lower
defense spending is that the Reserve components will become the
billpayer. As seen in the past, the risk exists where defense
planners may be tempted to put the National Guard and title 10
reserve on the shelf by providing them hand-me-down outmoded
equipment and underfunded training.
With over 800,000 Guard and Reserve members having been
mobilized, this Nation has a generation of warfighters who have
the knowledge and experience that hasn't existed in the Reserve
component since the end of the Vietnam war. Almost every
officer and enlisted leader is a combat-tested veteran. To
waste this capability is a poor return on the investment of
money already spent. Only by establishing parity in training,
equipment, pay, and compensation will permit us to keep them
available for use as an enduring operational force.
ROA and REA's written testimony includes a list of unfunded
requirements that we hope this subcommittee will fund, but we
also urge the subcommittee to specifically identify funding for
both the National Guard and other Reserve components
exclusively to train and equip the Reserve components by
providing funds for the National Guard and Reserve equipment
appropriation. Dedicating funds to Guard and Reserve equipment
provides Reserve chiefs and National Guard directors with the
flexibility of prioritizing their funding.
But some in the active component would cut National Guard
and Reserve pay for the active duty, undermining the concept of
the total force. Some would have you believe that the National
Guard and Reserve are more expensive to maintain than the
active duty forces. However, when citizen warriors are recalled
for an extended period the cost is about the same as for an
active duty member. It's the lower overhead in the years when
the National Guard and Reserve member is not on active duty
that provides the economy. The citizen warrior cost over a life
cycle is far less than the cost of an active component
warfighter.
Additional cost savings are found when civilian knowledge
and proficiencies can be called upon at no cost to the military
for training. DOD officials have admitted that many Reserve
component members are working in state-of-the-art industries as
civilian employees, an asset that the Pentagon can't match.
Another concern ROA and REA share is legal support for
veterans and Guard and Reserve members returning from
deployment to face ever-increasing challenges of reemployment.
On June 1, 2009, ROA established the Servicemembers Law Center.
This is a service to provide active, Guard, and Reserve, as
well as separated veterans. The center is averaging over 5,000
inquiries a year, with the majority of them about employment
and reemployment rights.
This is a no-fee service and it does not provide legal
representation. But such a service does cost money. Currently,
through ROA's financial support it allows this center to be a
one-man shop. Our vision is to grow this, to increase the staff
and services provided to our veteran and Reserve component
community, which will take additional funding.
ROA would love to meet with your staff to discuss how this
subcommittee can provide monetary support, and it appears that
the language may be included in the Senate NDAA that would
provide an authorizing source for such funding.
Another concern that I personally have been working for is
on the treatment for the victims of traumatic brain injury.
Anecdotal evidence of hyperbaric oxygen therapy as well as
other alternative treatments have shown significant success and
needs to be better funded.
Thank you again for your consideration of our testimony.
I'm available to answer any questions.
[The statement follows:]
Prepared Statement of Major General David Bockel
The Reserve Officers Association of the United States (ROA) is a
professional association of commissioned and warrant officers of our
Nation's seven uniformed services, and their spouses. ROA was founded
in 1922 during the drawdown years following the end of World War I. It
was formed as a permanent institution dedicated to National Defense,
with a goal to teach America about the dangers of unpreparedness. When
chartered by Congress in 1950, the act established the objective of ROA
to: ``. . . support and promote the development and execution of a
military policy for the United States that will provide adequate
National Security.''
The Association's 65,000 members include Reserve and Guard
Soldiers, Sailors, Marines, Airmen, and Coast Guardsmen who frequently
serve on Active Duty to meet critical needs of the uniformed services
and their families. ROA's membership also includes officers from the
U.S. Public Health Service and the National Oceanic and Atmospheric
Administration who often are first responders during national disasters
and help prepare for homeland security.
The Reserve Enlisted Association is an advocate for the enlisted
men and women of the United States Military Reserve Components in
support of National Security and Homeland Defense, with emphasis on the
readiness, training, and quality of life issues affecting their welfare
and that of their families and survivors. REA is the only Joint Reserve
association representing enlisted reservists--all ranks from all five
branches of the military.
PRIORITIES
CY 2011 Legislative Priorities are:
--Recapitalize the Total force to include fully funding equipment and
training for the National Guard and Reserves.
--Ensure that the Reserve and National Guard continue in a key
national defense role, both at home and abroad.
--Provide adequate resources and authorities to support the current
recruiting and retention requirements of the Reserves and
National Guard.
--Support citizen warriors, families and survivors.
Issues to help fund, equip, and train
Advocate for adequate funding to maintain National Defense during
times of war and peace.
Regenerate the Reserve Components (RC) with field compatible
equipment.
Improve and implement adequate tracking processes on Guard and
Reserve appropriations and borrowed Reserve Component equipment needing
to be returned or replaced.
Fully fund Military Pay Appropriation to guarantee a minimum of 48
drills and 2 weeks training.
Sustain authorization and appropriation to National Guard and
Reserve Equipment Account (NGREA) to permit flexibility for Reserve
Chiefs in support of mission and readiness needs.
Optimize funding for additional training, preparation and
operational support.
Keep Active and Reserve personnel and Operation and Maintenance
funding separate.
Issues to assist recruiting and retention
Support continued incentives for affiliation, reenlistment,
retention and continuation in the Reserve Component.
Pay and Compensation
Simplify the Reserve duty order system without compromising drill
compensation.
Offer Professional pay for Reserve Component medical professionals,
consistent with the Active Component's pay.
Eliminate the one-thirtieth rule for Aviation Career Incentive Pay,
Career Enlisted Flyers Incentive Pay, Diving Special Duty Pay, and
Hazardous Duty Incentive Pay.
Education
Continue funding the GI Bill for the 21st Century.
Health Care
Provide Medical and Dental Readiness through subsidized preventive
healthcare.
Extend military coverage for restorative dental care for up to 90
days following deployment.
Spouse Support
Repeal the Survivor Benefits Plan--Dependency Indemnity Clause
(DIC) offset.
national guard and reserve equipment accounts
It is important to maintain separate equipment and personnel
accounts to allow Reserve Component Chiefs the ability to direct
dollars to vital needs.
Key Issues facing the Armed Forces concerning equipment:
--Developing the best equipment for troops fighting in overseas
contingency operations.
--Procuring new equipment for all U.S. Forces.
--Modernize by upgrading the equipment already in the inventory.
--Replacing the equipment deployed from the homeland to the war.
--Making sure new and renewed equipment gets into the right hands,
including the Reserve Component.
Reserve Component Equipping Sources:
--Procurement.
--Cascading of equipment from Active Component.
--Cross-leveling.
--Recapitalization and overhaul of legacy (old) equipment.
--Congressional add-ons.
--National Guard and Reserve Appropriations (NGREA).
--Supplemental appropriation, such as OCO funding.
national guard and reserve equipment appropriation
Once a strategic force, the Reserve Components are now also being
employed as an operational asset; stressing an ever greater need for
procurement flexibility as provided by the National Guard and Reserve
Equipment Appropriations (NGREA). Much-needed items not funded by the
respective service budget are frequently purchased through NGREA. In
some cases, it is used to procure unit equipment to match a state of
modernizations that aligns with the battlefield.
The Reserve and Guard are faced with the ongoing challenges of how
to replace worn out equipment, equipment lost due to combat operations,
legacy equipment that is becoming irrelevant or obsolete, and, in
general, replacing what is lost in combat, or aged through the abnormal
wear and tear of deployment. The Reserve Components benefit greatly
from a National Military Resource Strategy that includes a National
Guard and Reserve Equipment Appropriation.
Congress has provided funding for the NGREA for over 30 years. At
times, this funding has made the difference in a unit's abilities to
carry out vital missions.
ROA thanks Congress for approving $850 million for NGREA for fiscal
year 2011, but more dollars continue to be needed. ROA urges Congress
to appropriate into NGREA an amount that is proportional to the
missions being performed, which will enable the Reserve Component to
meet its readiness requirements.
End Strength
The ROA would like to place a moratorium on any potential
reductions to the Guard and Reserve manning levels. Manpower numbers
need to include not only deployable assets, but individuals in the
accession pipeline. ROA urges this subcommittee to fund the support of:
--Army National Guard of the United States, 358,200.
--Army Reserve, 206,000.
--Navy Reserve, 66,200.
--Marine Corps Reserve, 39,600.
--Air National Guard of the United States, 106,700.
--Air Force Reserve, 71,400.
--Coast Guard Reserve, 10,000.
In a time of war and force rebalancing, it is wrong to make cuts to
the end strength of the Reserve Components. We need to pause to permit
force planning and strategy to catch-up with budget reductions.
NONFUNDED ARMY RESERVE COMPONENT EQUIPMENT
While General Martin E. Dempsey, U.S. Army Chief of Staff, has said
that the Army is not going forward with any unfunded requirements in
his letter to Congress, this is not the case for the Army Reserve or
the Army National Guard.
Army Reserve (USAR) Unfunded Requirements
While the Army Reserve has 80 percent of its equipment on-hand,
only 65 percent of it modernized. Further, the USAR remains short in
several areas of critical equipment. Around 35 percent of its required
equipment lines are at less than 65 percent on hand. A percentage of
the USAR equipment is deployed.
An enduring operational force cannot be fully effective if it is
underfunded and has to borrow personnel and equipment from one unit to
shore up another to meet mission requirements. Currently in the basic
budget, the USAR is funded at strategic levels rather than for its
operational contributions.
Top USAR Equipping Challenges of an Operational Reserve:
--Equip USAR formations to optimal operational levels for full
spectrum operations.
--Maintain USAR equipment at the Army standard of 90 percent fully
mission capable.
--Increase equipment modernization in an era of decreasing resources.
--Increase facility and manpower capabilities to sustain modernized
and emerging equipment.
--Modernize the Army Reserve Tactical Wheeled Vehicle (TWV) fleet.
--Increase Resourcing for logistics automation technology required
refresh.
--Increase Funding for state-of-the-art maintenance facilities.
--Gain full transparency for equipment procurement through unit level
receipt.
[Dollars in millions]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Ground Vehicles:
Heavy Expanded Mobility Tactical Truck (HEMTT-LET), $161
1086 req'd...........................................
Rough Terrain Container Handler, 215 req'd............ 192
Truck, Forklift, ATLAS, 71 req'd...................... 11.8
Tractor Line Haul M915, 169 req'd..................... 29
HEMTT Common Bridge Transporter, M1977, 69 req'd...... 15.4
Command Post of the Future (CPOF), 49 req'd............... 16
Soldier Weapons........................................... 15.7
Machine Gun, 7.62 mm, M240B, req'd 1,000..............
Carbine, 5.56 mm, M4, req'd 3,233 $1,329 20,058 23,291
Machine Gun, Grenade, 40 mm, MK19 MOD III,............
Helicopter, Utility, UH-60L, 8 req'd...................... 38.4
Power Plants and Generators:
100KW Distribution System, 1,062 req'd................ 15.5
Power Plant, 5kW, TM, AN/MJQ-35, 250 req'd............ 11.6
Generator Set, 10kW, MEP-803A TQG, 445 req'd.......... 6.4
Generator Set, 10kW, PU-798 TQG, 242.................. 6.2
------------------------------------------------------------------------
Simulators.--The use of simulations and simulators minimizes
turbulence for USAR Soldiers and their families caused by training
demands during the first 2 years of the ARFORGEN process by enabling
individuals and units to train at their home station and during
exercises in a safe environment without the increased wear and tear on
equipment.
Army National Guard (ARNG) Unfunded Equipment Requirements
Even though Congress has provided $37 billion in equipment to the
Army National Guard (ARNG) in the past 6 years, the on-hand percentage
for all equipment is currently at 92 percent, there is a need for
modernization and restoration. The Army National Guard provides more
than 40 percent of the Army's rotary wing assets. With the increased
optemp there is an increase in need for aircraft modernization.
Required land force maintenance results in shortages as the ARN does
not have a quantity of selected end-items authorized for use by units
as immediate replacements when critical equipment is sent to depots for
repair.
Top ARNG Equipping Challenges:
--Improve interoperability with AC forces.
--Equip units for pre-mobilization training and deployment.
--Equip units for their Homeland Missions.
--Modernize ARNG helicopter fleet.
--Modernize ARNG Tactical Wheeled Vehicle (TWV) fleet.
[Dollars in millions]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Ground Transportation:
Light, Med, and Heavy Tactical Trailers, 6,675 req'd.. $200
Armored Security Vehicle (ASV), M1117................. 91
Bradley Fighting Vehicle, Infantry, M2A2, 95 req'd.... 123
HMMWV Shelter Carrier, Heavy, M1097, 707 req'd........ 43.6
Aviation:
Helicopter, Utility, UH-60L, 30 req'd................. 145.7
Light Utility Helicopter, UH-72A, 44 req'd............ 171.6
Helicopter, Cargo CH-47F, 3 req'd..................... 90
Medical Field Systems, 2,249 req'd........................ 11
------------------------------------------------------------------------
The Assistant Secretary of the Army (Acquisitions, Logistics &
Technology) recently directed the Program Executive Office--Aviation to
divest the C-23 Sherpa aircraft not later than December 31, 2014 as the
Army had decided that it shouldn't be in the fixed wing business. Yet
these aircraft are needed in the ARNG because the assets would be
utilized in state missions, if not Federal.
AIR FORCE RESERVE COMPONENTS EQUIPMENT PRIORITIES
Air Force Reserve Unfunded Requirements
The Air Force Reserve (AFR) is focused on rebalancing its force,
recapitalizing its equipment and infrastructure, and supporting its
Reservists. Sustaining operations on five continents, the resulting
wear and tear weighs heavily on aging equipment. When Legacy aircraft
are called upon to support operational missions, the equipment is
stressed at a greater rate. Since the start of combat, the majority of
AFR equipment requirements have been aircraft upgrades.
Top AFR Equipping Challenges:
--Defensive Systems.--LAIRCM, ADS, and MWS: equip aircraft lacking
adequate infrared missile protection for combat operations.
--Data Link and Secure Communications.--Data link network supporting
image/video, threat updates, and SLOS/BLOS communications for
combat missions.
[Dollars in millions]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
F-16 Systems, CDU, Combined AIFF w/Mode 5/S, Sim Trainer $10
Upgrade..................................................
C-130 Systems, New Armor, RWR, TAWS, VECTS, LED posit 92.8
Lights...................................................
LAIR Countermeasures KC-135 (15).......................... 118.4
Infra-Red Counter Measures C-17s.......................... 60
Security Forces Weapons & Tactical Equipment.............. 3.2
Guardian Angel Weapon System (GAWS):
Tactical Communication Headset........................ 5
HC-130 Wireless Intercom.............................. 6
CSAR Common Data Link................................. 6
------------------------------------------------------------------------
Air National Guard Unfunded Equipment Requirements
Given adequate equipment and training, the Air National Guard (ANG)
will continue to fulfill its Total Force obligations. As the Nation's
first military responder, the Air Force has increased reliance on its
Reserve Components, requiring equipment and training comparable to the
active component Air Force. The Air National Guard's support to civil
authorities is based upon the concept of ``dual use,'' equipment
purchased by the Air Force for the Air National Guard's Federal combat
mission, which can be adapted and used domestically when not needed
overseas.
Shortfalls in equipment will impact the Air National Guard's
ability to support the National Guard's response to disasters and
terrorist incidents in the homeland.
ANG Equipping Challenges:
--Modernize aging aircraft and other weapons systems for both dual-
mission and combat deployments.
--Equipment to satisfy requirements for domestic operations in each
Emergency.
--Support Function (ESF).
--Maintain C-5: Failing major fuselage structures and funding for
depot maintenance.
--Define an Air Force validation process for both Federal and state
domestic response needs.
--Program aging ANG F-16 aircraft for the Service Life Extension
Program (SLEP).
An ANG wing contains not only aircraft but fire trucks, forklifts,
portable light carts, emergency medical equipment including ambulances,
air traffic control equipment, explosives ordinance equipment, etc., as
well as well trained experts--valuable in response to civil
emergencies.
[Dollars in millions]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
C-27J Airlift, 4 req'd.................................... $124
C-40C Airlift, 1 req'd.................................... 98
C-38 Replacement Aircraft, 4 req'd........................ 254
C-5 Structural Repair..................................... 310
C-17 Next Generation Threat Detection System.............. 59
MC-130 Integrated BLOS/LOS/Data Link/VDL, 167, req'd...... 66.8
F-16 Advanced Targeting Pod Upgrades...................... 260
------------------------------------------------------------------------
NAVY RESERVE UNFUNDED PRIORITIES
Active Reserve Integration (ARI) aligns Active and Reserve
component units to achieve unity of command. Operationally, the Navy
Reserve is fully engaged across the spectrum of Navy, Marine Corps, and
joint operations, from peace to war. It has been the primary provider
of Individual Augmentees for the overseas contingency operations
filling Army, and Air Force assignments.
Top U.S. Navy Reserve Equipping Challenges:
--Aircraft procurement (C-40A, P-8, KC-130J, C-37B and F/A-18E).
--Expeditionary equipment procurement (MESF, EOD, NCF, NAVELSG,
MCAST, EXPCOMBATCAM, and NEIC).
[Dollars in millions]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
C-40 A Combo cargo/passenger Airlift, 5 req'd............. $425
Aircraft recapitalization is necessary due to the C-
9B's increasing operating and depot costs, decreasing
availability and inability to meet future avionics/
engine mandates required to operate worldwide. The C-
40A has twice the range, payload, days of
availability of the C-9B, and also has the unique
capability of carrying hazardous cargo and passengers
simultaneously with no restrictions. C-40 replaces an
aging fleet of C-9, C-12 and C-20.
Maritime Expeditionary Security Force..................... 20
Navy Expeditionary Combat Command has 17,000 Navy
Reservists and requires $3.1 billion in Reserve
Component Table of Allowance equipment. Force Utility
Boat MPF-UB, 3 req'd $3 million.
KC-130J Super Hercules Aircraft tankers, 2 req'd.......... 168
Aircraft needed to fill the shortfall in Navy Unique
Fleet Essential Airlift. Procurement price close to
upgrading existing C-130Ts with the benefit of a
longer life span. 24 req'd.
Helicopter, Combat SAR, HH-60H (Seahawk), 1 req'd......... 15.5
C-37 B (Gulf Stream) Aircraft (1)......................... 64
The Navy Reserve helps maintain executive transport
airlift to support the Depart. of the Navy.
Civil Engineering Support Equipment--Tactical Vehicles.... 4.4
------------------------------------------------------------------------
MARINE CORPS RESERVE UNFUNDED PRIORITIES
Marine Forces Reserve (MFR) has two primary equipping priorities--
outfitting individuals who are preparing to deploy and sufficiently
equipping units to conduct home station training. Individuals receive
100 percent of the necessary warfighting equipment. MFR units are
equipped to a level identified by the Training Allowance (TA). MFR
units are equipped with the same equipment that is utilized by the
Active Component, but in quantities tailored to fit Reserve training
center needs. It is imperative that MFR units train with the same
equipment they will utilize while deployed.
Top MCR Equipping Challenges:
--Providing units the ``right amount'' of equipment to effectively
train in a pre-activation environment.
--Achieving USMCR goal that the Reserve TA contains the same
equipment as the active component.
--Resetting and modernizing the MRF to prepare for future challenges.
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
KC-130J Super Hercules Aircraft tankers, 21 remaining... $1.5 billion
The ``T'' and ``J'' aircraft are very different
airframes, requiring different logistical,
maintenance, and aircrew requirements. The longer
both airframes are maintained, the longer twice the
cost for logistics, maintenance training, and
aircrew training will be spent.
Light Armored Vehicles--LAV-25, procure 27 remaining,... $68 million
Completing modernization of Light Armored Vehicle
(LAV) family filling a shortfall in a USMCR light
armor reconnaissance company. It provides strategic
mobility to reach and engage the threat, tactical
mobility for effective use of fire power.
Logistics Vehicle System Replacement (LVSR) 108 required $650,000 each
Supports accelerated modernization and rapid
fielding.
Simulators: KC-130J Weapons System Trainer.............. $25 million
Training transformation remains the cutting-edge
arena of simulation and simulators.
Training Allowance (T/A) Shortfalls..................... $145 million
Shortfalls consist of over 300 items needed for
individual combat clothing and equipment, including
protective vests, ponchos, liners, gloves, cold
weather clothing, environmental test sets, tool
kits, tents, camouflage netting, communications
systems, engineering equipment, combat and
logistics vehicles and weapon systems.
------------------------------------------------------------------------
SERVICE MEMBERS LAW CENTER
The Reserve Officers Association developed a Service Members Law
Center, advising Active and Reserve service members who are subject to
legal problems that occur during deployment.
In the last year, the Service Members Law Center has received over
6,000 calls and e-mails with legal questions. Eighty percent of them
deal with the issue of employment and reemployment of veterans. Of
those who have contacted us, the ROA Service Members Law Center has
referred about 5 percent to attorneys.
The American Bar Association supports legislation S. 1106, Justice
for the Troops, to support programs on pro bono legal assistance for
members of the Armed Forces. The Service Members Law Center has already
been educating the law community on just that, and provides over 700
case studies for online use by law offices.
The Law Center refers names of attorneys who work on related legal
issues, encouraging law firms to represent service members. The Center
also educates and trains lawyers, especially active and reserve judge
advocates, on service member protection cases. It is also a resource to
Congress. Last year, the Supreme Court gave judgment on its first
USERRA case. The Service Members Law Center filed an amicus curiae
(friend of the court) brief on this case.
ROA sets aside office spaces and staffs a lawyer to answer
questions of serving members and veterans. Legal services, as suggested
by S. 1106, could be sought by the Service Members Law Center if it
expanded its staff. This would require additional financial support.
Anticipated overall cost for expansion in fiscal year 2012:
$150,000.
Military Voting
The Service Members Law Center also answers questions about
Military Voting. Its director works with the Federal Voting Assistance
Program staff to help communicate information to improve military voter
participation in Federal elections. FVAP announced a $16 million grant
program to expand those online voting support tools at the State and
local level, all of which will be linked to the voter through the FVAP
website portal.
ROA and REA fully support additional funding of DOD's Federal
Voting Assistance Program for $35.107 million.
CIOR/CIOMR FUNDING REQUEST
The Interallied Confederation of Reserve Officers (CIOR) was
founded in 1948, and the Interallied Confederation of Medical Reserve
Officers (CIOMR) was founded in 1947. These organizations are
nonpolitical, independent confederations of national reserve
associations of the signatory countries of the North Atlantic Treaty
Organization (NATO). Presently, there are 16 member nation delegations
representing over 800,000 reserve officers. CIOR supports several
programs to improve professional development and international
understanding. The Reserve Officers Association of the United States
represents the United States as its official member to CIOR.
Military Competition.--The CIOR Military Competition is a strenuous
3 day contest on warfighting skills among Reserve Officers teams from
member countries. The contest emphasizes combined and joint military
actions relevant to the multinational aspects of current and future
Alliance operations.
Language Academy.--The two official languages of NATO are English
and French. As a non-government body operating on a limited budget, it
is not in a position to afford the expense of providing simultaneous
translation services. The Academy offers intensive courses in English
and French as specified by NATO Military Agency for Standardization,
which affords international junior officer members the opportunity to
become fluent in English as a second language.
Young Reserve Officers Workshop.--The workshops are arranged
annually by the NATO International Staff (IS). Selected issues are
assigned to joint seminars through the CIOR Defense and Security Issues
(SECDEF) Commission. Junior grade officers work in a joint seminar
environment to analyze Reserve concerns relevant to NATO.
Dues do not cover the workshops, and individual countries help fund
the events. Presently no service has Executive Agency for CIOR, so
these programs aren't being funded.
Military Competition funding needs at $150,000 per fiscal year.
CONCLUSION
The impact of operations in Iraq and Afghanistan is affecting the
very nature of the Guard and Reserve, not just the execution of Roles
and Missions. It makes sense to fully fund the most cost efficient
components of the Total Force, its Reserve Components.
At a time of war, we are expending the smallest percentage of GDP
in history on National Defense. Funding now reflects close to 4 percent
of GDP including supplemental dollars. ROA has a resolution urging that
defense spending should be 5 percent to cover both the war and homeland
security. While these are big dollars, the President and Congress must
understand that this type of investment is what it will take to equip,
train and maintain an all-volunteer force for adequate National
Security.
The Reserve Officers Association, again, would like to thank the
subcommittee for the opportunity to present our testimony. We are
looking forward to working with you and supporting your efforts in any
way that we can.
Chairman Inouye. Thank you very much, General Bockel.
Senator Cochran.
Senator Cochran. Thank you, General Bockel. We appreciate
your coming here today and giving us your observations and your
service, too, to veterans who have served in our military. When
you mentioned the hyperbaric chamber, I just recalled the use
of that in rehabilitating horses, thoroughbreds for racing. The
fellow who really put the biggest bit of attention and his own
personal funds into that had a horse that finally won the
Kentucky Derby a couple of years ago.
General Bockel. There it is.
Senator Cochran. It didn't make him run any faster, but it
showed the capabilities of treatment for damaged tissues, and
it led to the use by men and women who had been in the service.
Out at our Bethesda Naval Hospital, I think they have planned
for a unit to be installed for trial, and we now will have an
opportunity for a higher rate of recovery from a lot of things
because of that initiative.
General Bockel. In the case of traumatic brain injury,
there is no uniform understanding of the condition and the
treatment. It is also a continuity of care issue. From DOD
healthcare through Veterans Affairs into the private healthcare
arena, there is no continuity, no common understanding. The
treatment does work. It's been proven anecdotally. There's a
doctor at LSU by the name of Paul Harch who's the leader in the
treatment, and I personally know of a retired Army Reserve
brigadier general who's a judge in Fort Walton Beach, Florida,
who spent 2 years in Walter Reed, most of that time suffering
from traumatic brain injury, who received the hyperbaric
therapy at George Washington University Hospital, and he's back
on the bench practicing today.
Senator Shelby. That's remarkable.
Well, thank you very much for being here. Your testimony
will be given very careful consideration.
General Bockel. Thank you.
Chairman Inouye. Senator Shelby.
Senator Shelby. Mr. Chairman, I appreciate the General's
testimony and his advocacy here through the paper. He had a
distinguished military career before he came to that. We share
one thing in common: We both are graduates of the University of
Alabama. When he was there he was a distinguished student, but
he was also a distinguished graduate of their ROTC program,
which served him well in his career.
General Bockel. They never thought I would get this far,
Senator.
Senator Shelby. But you have.
Chairman Inouye. Thank you very much.
Captain Smith.
STATEMENT OF CAPTAIN MIKE SMITH, UNITED STATES NAVY
(RETIRED), NATIONAL MILITARY AND VETERANS
ALLIANCE
Captain Smith. Chairman Inouye, Senator Cochran, and
Senator Shelby: The National Military and Veterans Alliance, or
NMVA, is honored to again testify. The alliance represents
military retiree veterans and survivor associations with over
3.5 million members. The NMVA supports a strong national
security.
The challenges of the deficit and an adequately funded
defense are at the forefront of discussions in Congress and,
while the alliance is well aware that the subcommittee faces
certain budget constraints, the NMVA continues to urge the
President and Congress to increase defense spending to 5
percent of gross domestic product during times of high
utilization of the military to cover procurement, prevent
unnecessary personnel cuts, and afford needed benefits for
serving members and retirees. With the U.S. military taking
action in four different countries, no one can deny that it is
being decidedly used.
It is crucial that military healthcare is funded. NMVA is
concerned that as new programs are initiated they won't receive
the funding that they need. Treating PTS and TBI shouldn't be
on the cheap and alternative treatments should be explored so
that our serving members can return to a normal life.
The alliance is concerned that the President's DOD
healthcare budget continues to undercut the military's
beneficiaries' needs. We ask that you continue to fully fund
military healthcare in fiscal year 2012.
It is also important that we have parity in equipment and
training for the new operational Guard and Reserve. Cuts in the
strength of the Reserve component seem counterintuitive to
prevent any unforeseen strategic event. The willingness of our
young people today to serve in future conflicts will relate to
their perception of how the veterans of this war are being
treated.
The NMVA thanks this subcommittee for funding the phased-in
survivor benefit plan dependency and indemnity compensation
offset. But widows of members who were killed in the line of
service are continuing to be penalized. Even under the present
offset, the vast majority of our enlisted families receive
little benefit from this new program because SBP is almost
completely offset by DIC. The NMVA respectfully requests that
this subcommittee find excess funding to expand this provision.
The alliance also hopes that this subcommittee will fully
fund the $67.7 million authorized by the Senate Armed Services
Committee for the two armed forces retirees homes.
As the overseas contingency operations wind down, the
challenges faced by our active and Reserve serving members will
not go away. The alliance is confident of your ongoing support
of national security and that you will keep the budgeting
burden off the shoulders of the warriors, the retirees, their
families, and survivors.
The NMVA would like to thank the subcommittee for its
efforts and, of course, this morning's opportunity to testify.
Thank you.
[The statement follows:]
Prepared Statement of Captain Mike Smith
MEMBERSHIP
American Logistics Association
American Military Retirees Association
American Military Society
American Retirees Association
American Veterans (AMVETS)
American WWII Orphans Network
Armed Forces Marketing Council
Armed Forces Top Enlisted Association
Army Navy Union
Association of the U.S. Navy
Catholic War Veterans
Gold Star Wives of America
Hispanic War Veterans Association
Japanese American Veterans Association
Korean War Veterans Foundation
Legion of Valor
Military Order of Foreign Wars
Military Order of the Purple Heart
Military Order of the World Wars
National Association for Uniformed Services
National Gulf War Resource Center
Naval Enlisted Reserve Association
Paralyzed Veterans of America
Reserve Enlisted Association
Reserve Officers Associations
Society of Military Widows
TREA Senior Citizen League
The Flag and General Officers' Network
The Retired Enlisted Association
Tragedy Assistance Program for Survivors
Uniformed Services Disabled Retirees
Veterans of Foreign Wars of the U.S.
Veterans of Modern Warfare
Vietnam Veterans of America
Women in Search of Equity
INTRODUCTION
Mister Chairman and distinguished members of the Committee, the
National Military and Veterans Alliance (NMVA) is very grateful to
submit testimony to you about our views and suggestions concerning
defense funding issues. The overall goal of the National Military and
Veterans Alliance is a strong National Defense. In light of this
overall objective, we would request that the committee examine the
following proposals.
The ``Alliance'' is made up of 35 organizations, which provide it
with a scope of expertise in military, veteran, family, and survivor
issues.
While the NMVA highlights the funding of benefits, we do this
because it supports National Defense. A often quoted phrase, ``The
willingness with which our young people are likely to serve in any war,
no matter how justified, shall be directly proportional as to how they
perceive the Veterans of earlier wars were treated and appreciated by
their country,'' has been frequently attributed to General George
Washington. Yet today, many of the programs that have been viewed as
being veteran or retiree are viable programs for the young serving
members of this war and shouldn't be discounted.
The NMVA is very concerned over comments made by the leadership at
the Pentagon that pay and compensation of serving members should be
cut. This is very short sighted, based on a false premise that
recruiting and retention successes will continue. To make such cuts
will just hasten a hollowing of the force.
The young men and women who serve do so under enormous pressures.
Telltale signs of this strain include growing post traumatic stress,
upsetting suicide rates, and increasing divorce rates. The impact goes
beyond just the serving member and affects extended families and
communities with further unintended consequences and sometimes tragic
results.
The National Military and Veterans Alliance, through this
testimony, hopes to address funding issues that apply to the current
and future veterans who have defended this country.
FUNDING NATIONAL DEFENSE
NMVA is pleased to observe that the Congress continues to discuss
how much should be spent on National Defense, but the baseline defense
budget is now 3.5 percent of America's Gross Domestic Product (GDP).
The Alliance urges the President and Congress to maintain defense
spending at 5 percent of GDP during times of war to cover procurement
and prevent unnecessary personnel end strength cuts.
PAY AND COMPENSATION
Our serving members are patriots willing to accept peril and
sacrifice to defend the values of this country. All they ask for is
fair recompense for their actions. At a time of war, compensation
rarely offsets the risks.
The NMVA requests funding so that the annual enlisted military pay
raise exceeds the Employment Cost Index (ECI) by at least half of 1
percent.
If unable to provide a pay raise higher than the President's
request, this committee should target pay raises for the mid-grade
members, who have increased responsibility in relation to the overall
service mission, are also at the highest risk of leaving the service.
NMVA supports applying the same allowance standards to both Active
and Reserve when it comes to Aviation Career Incentive Pay, Career
Enlisted Flyers Incentive Pay, Diving Special Duty Pay, Hazardous Duty
Incentive Pay and other special pays. Guard and Reserve members are
performing more specialized hours, but are currently being paid less.
The Service chiefs have admitted one of the biggest retention
challenges is to recruit and retain medical professionals. NMVA urges
the inclusion of bonus/cash payments (Incentive Specialty Pay) into the
calculations of Retirement Pay for military healthcare providers. NMVA
has received feedback that this would be incentive to many medical
professionals to stay in longer.
G-R Bonuses.--Guard and Reserve component members may be eligible
for one of three bonuses, Prior Enlistment Bonus, Reenlistment Bonus
and Reserve Affiliation Bonuses for Prior Service Personnel. These
bonuses are used to keep men and woman in mission critical military
occupational specialties (MOS) that are experiencing falling numbers or
are difficult to fill. This point cannot be understated. The operation
tempo, financial stress and competition with Active Duty recruiting
necessitate continuing incentives. The NMVA supports expanding and
funding bonuses to the Reserve Components.
Reserve/Guard Funding.--NMVA is concerned about a possible
recommendation from the 11th Quadrennial Review of Military
Compensation to end ``2 days pay for 1 days work,'' and replace it with
a plan to provide one-thirtieth of a month's pay model, which would
include both pay and allowances.
Even with allowances, pay would be less than the current system,
and the accounting would be far more complex. Allowances differ between
individuals and can be affected by commute distances and even zip
codes. Certain allowances that are unlikely to be uniformly paid
include geographic differences, housing variables, tuition assistance,
travel, and adjustments to compensate for missing healthcare.
Additionally there have been DOD suggestions that pay should differ
for those in the Guard and Reserve who are in strategic units and
operational units. This concept would undermine the Force Generation
Plan, which would have the readiness of a Reserve Component unit
increase over a 5 year cycle, favored by both the Army and the Marine
Reserve. In the early years a unit would be in a strategic status, and
for the final 2 years be in an operational mode. Pay should not differ
during different stages of FORCGEN.
The NMVA strongly recommends that the reserve pay system continue
on a ``2 days pay for two drills in a day,'' be funded and be retained,
as is.
EDUCATIONAL ISSUES
Practically all active duty and Selected Reserve enlisted
accessions have a high school diploma or equivalent. A college degree
is the basic prerequisite for service as a commissioned officer, and is
now expected of most enlisted as they advance beyond E-6.
Officers to promote above O-4 are expected to have a post graduate
degree. The ever-growing complexity of weapons systems and support
equipment requires a force with far higher education and aptitude than
in previous years.
Post 9/11 GI Bill
According to a survey conducted by military.com, 36 percent of
individuals on active duty want to transfer the benefit to their spouse
and 48 percent would transfer it to their children. The Post 9/11 GI
Bill provides the much desired transferability option to spouses and
children in exchange for an agreement from the serving member that they
will continue to serve another 4 years in military service.
The National Military and Veterans Alliance supports future funding
to continue the transferability of the Post 9/11 GI Bill, as it is an
important retention and recruiting resource.
MGIB-SR Enhancements
The Montgomery G.I. Bill for Selective Reserves (MGIB-SR) will
continue to be an important recruiting and retention tool for the
Reserve Components. With massive troop rotations, the Reserve forces
can expect to have retention shortfalls, unless the government provides
enhanced education incentives as well.
The problem with the current MGIB-SR is that the Selected Reserve
MGIB has failed to maintain a creditable rate of benefits with those
authorized in Title 38, Chapter 30. MGIB-SR has not even been increased
by cost-of-living increases since 1985. In that year MGIB rates were
established at 47 percent of active duty benefits. The MGIB-SR rate is
28 percent of the Chapter 30 benefits. Overall the allowance has inched
up by only 7 percent since its inception, as the cost of education has
climbed significantly.
The NMVA requests appropriations funding to raise the MGIB-SR and
lock the rate at 50 percent of the active duty benefit. Cost: $25
million/first year, $1.4 billion over 10.
FORCE POLICY AND STRUCTURE
End Strength
The NMVA is concerned about cuts in the end strength boosts of the
Active Duty Component of the Army and Marine Corps as have been
recommended by Defense Authorizers. The goal for active duty dwell time
is 1:3. This has yet to be achieved under current operations tempo, and
end strength cuts will only further impact dwell time. Trying to pay
the defense bills by premature manpower reductions will have
consequences.
Manning Cut Moratorium
The NMVA would also like to put a freeze on reductions to the Guard
and Reserve manning levels. A moratorium on reductions to End Strength
is needed until the impact of rebalancing of the force is understood.
The Alliance is pleased to see a recommended increase in the Navy and
Air Force Reserves. NMVA urges this subcommittee to at least fund to
last year's levels for other Reserve Components.
survivor benefit plan (sbp) and survivor improvements
The Alliance wishes to deeply thank this Subcommittee for your
funding of improvements in the myriad of survivor programs, including
funding the Special Survivor Indemnity Allowance.
However, there is still an issue remaining to deal with:
Providing funds to end the SBP/DIC offset.
SBP is a purchased annuity, available as an elected earned employee
benefit. This program provides a guaranteed income payable to survivors
of retired military upon the member's death. Dependency and Indemnity
Compensation (DIC) is an indemnity program to compensate a family for
the loss of a loved one due to a service connected death. They are
different benefits created to fulfill different purposes and needs. At
this time the SBP annuity the service member has paid for is offset
dollar for dollar for the DIC survivor benefits paid through the
Department of Veteran Affairs.
SBP/DIC Offset affects several groups. The first is the family of a
medically retired member of the uniformed services. If the service
member is leaving the service disabled it is only wise to enroll in the
Survivor Benefit Plan (perhaps being uninsurable in the private
sector). If a later death is service connected then the survivor loses
their SBP annuity to DIC.
A second group affected by this offset is families whose service
member died on active duty. Recently Congress created active duty SBP.
These service members never had the chance to pay into the SBP program.
But clearly Congress intended to give these families a benefit. With
the present offset in place, the vast majority of families receive no
benefit from this new program, because the vast numbers of our losses
are young men or women in the lower paying ranks.
Other affected families are service members who have already served
a substantial time in the military. Their surviving spouse is left in a
worse financial position that a younger widow. The older widows will
normally not be receiving benefits for her children from either Social
Security or the VA and will normally have more substantial financial
obligations (mortgages etc). This spouse is very dependent on the SBP
and DIC payments and should be able to receive both.
The NMVA respectfully requests that this Subcommittee fund the SBP/
DIC offset.
CURRENT AND FUTURE ISSUES FACING UNIFORMED SERVICES
Healthcare
The National Military and Veterans Alliance once again thanks this
Committee for the great strides that have been made over the last few
years to improve the healthcare provided to the active duty members,
their families, survivors and Medicare eligible retirees of all the
Uniformed Services. The improvements have been historic. TRICARE for
Life and the Senior Pharmacy Program have improved the life and health
of Medicare Eligible Military Retirees, their families, and survivors.
Yet many serious problems need to be addressed:
Wounded Warrior Programs
The Alliance supports continued funding for the wounded warriors,
including monies for research and treatment on Traumatic Brain Injuries
(TBI), Post Traumatic Stress Disorder (PTSD), the blinded, and our
amputees. The Nation owes these heroes an everlasting gratitude and
recompense that extends beyond their time in the military. These
casualties only bring a heightened need for a DOD/VA electronic health
record accord to permit a seamless transition from being in the
military to being a civilian.
Full Funding for the Military Health Program
The Alliance applauds the Subcommittee's role in providing adequate
funding for the Defense Health Program (DHP) in the past several budget
cycles. As the cost of healthcare has risen throughout the country, you
have provided adequate increases to the DHP to keep pace with these
increases.
Full funding for the defense health program is a top priority for
the NMVA. With the additional costs that have come with the deployments
to Southwest Asia, Afghanistan and Iraq, we must all stay vigilant
against future budgetary shortfalls that would damage the quality and
availability of military healthcare. NMVA is confident that this
subcommittee will continue to fund the DHP so that there will be no
budget shortfalls.
The National Military and Veterans Alliance urges the Subcommittee
to continue to ensure full funding for the Defense Health Program
including the full costs of all new programs.
TRICARE Pharmacy Programs
NMVA supports the continued expansion of use of the TRICARE Mail
Order pharmacy.
To truly motivate beneficiaries to a shift from retail to mail
order adjustments need to be made to both generic and brand name drugs
co-payments. NMVA recommends that both generic and brand name mail
order prescriptions be reduced to zero dollar co-payments to align with
military clinics.
Ideally, the NMVA would like to see the reduction in mail order co-
payments without an increase in co-payments for Retail Pharmacy.
The National Military and Veterans Alliance urges the Subcommittee
to adequately fund adjustments to co-payments in support of
recommendations from Defense Authorizers.
TRICARE Standard Improvements
TRICARE Standard grows in importance with every year that the
global war on terrorism continues. A growing population of mobilized
and demobilized Reservists depends upon TRICARE Standard. A growing
number of younger retirees are more mobile than those of the past, and
likely to live outside the TRICARE Prime network.
An ongoing challenge for TRICARE Standard involves creating
initiatives to convince healthcare providers to accept TRICARE Standard
patients. Healthcare providers are dissatisfied with TRICARE
reimbursement rates that are tied to Medicare reimbursement levels. The
Alliance is pleased by Congress' plan to prevent near-term reductions
in Medicare reimbursement rates, which will help the TRICARE Program.
Yet this is not enough. TRICARE Standard is hobbled with a
reputation and history of low and slow payments as well as what still
seems like complicated procedures and administrative forms that make it
harder and harder for beneficiaries to find healthcare providers that
will accept TRICARE. Any improvements in the rates paid for Medicare/
TRICARE should be a great help in this area. Additionally, any further
steps to simplify the administrative burdens and complications for
healthcare providers for TRICARE beneficiaries hopefully will increase
the number of available providers.
The Alliance asks the Defense Subcommittee to include language
encouraging continued increases in TRICARE/Medicare reimbursement
rates.
TRICARE Retiree Dental Plan (TRDP)
The focus of the TRICARE Retiree Dental Plan (TRDP) is to maintain
the dental health of Uniformed Services retirees and their family
members. With ever increasing premium costs, NMVA feels that the
Department should assist retirees in maintaining their dental health by
providing a government cost-share for the retiree dental plan. With
many retirees and their families on a fixed income, an effort should be
made to help ease the financial burden on this population and promote a
seamless transition from the active duty dental plan to the retiree
dental plan in cost structure. Additionally, we hope the Congress will
enlarge the retiree dental plan to include retired beneficiaries who
live overseas.
The NMVA would appreciate this Committee's consideration of both
proposals.
NATIONAL GUARD AND RESERVE HEALTHCARE
Mobilized Healthcare--Dental Readiness of Reservists
The number one problem faced by Reservists being recalled has been
dental readiness. A model for healthcare would be the TRICARE Dental
Program, which offers subsidized dental coverage for Selected
Reservists and self-insurance for SELRES families.
In an ideal world, this would be universal dental coverage.
However, reality is that the services are facing challenges. Premium
increases to the individual Reservist have caused some junior members
to forgo coverage. Dental readiness has dropped. The Military services
are trying to determine how best to motivate their Reserve Component
members but feel compromised by mandating a premium program if
Reservists must pay a portion of it.
Services have been authorized to provide dental treatment as well
as examination, but have no funding to support this service. By the
time many Guard and Reserve are mobilized, their schedule is so short
fused that the processing dentists don't have time for extensive
repair.
The National Military Veterans Alliance supports funding for
utilization of Guard and Reserve Dentists to examine and treat
Guardsmen and Reservists who have substandard dental hygiene. The
TRICARE Dental Program should be continued, because the Alliance
believes it has pulled up overall Dental Readiness.
Demobilized Dental Care
Under the revised transitional healthcare benefit plan, Guard and
Reserve, who were ordered to active duty for more than 30 days in
support of a contingency, have 180 days of transition healthcare
following their period of active service, but similar coverage is not
provided for dental restoration.
Dental hygiene is not a priority on the battlefield, and many
Reserve and Guard are being discharged with dental readiness levels
much lower than when they were first recalled. At a minimum, DOD must
restore the dental state to an acceptable level that would be ready for
mobilization, or provide a subsidy for 180 days after demobilization to
permit restoration from a civilian source. Current policy is a 30 day
window with dental care being space available at a priority less than
active duty families.
NMVA asks the committee for funding to support a DOD's
demobilization dental care program. Additional funds should be
appropriated to cover the cost of TRICARE Dental premiums and co-
payments for the 6 months following demobilization if DOD is unable to
do the restoration.
OTHER GUARD AND RESERVE ISSUES
Ensure adequate funding to equip Guard and Reserve at a level that
allows them to carry out their mission. Do not turn these crucial
assets over to the active duty force. In the same vein we ask that the
Congress ensure adequate funding that allows a Guardsman/Reservist to
complete 48 drills and 15 annual training days per member per year. DOD
has been tempted to expend some of these funds on active duty support
rather than personnel readiness.
The NMVA strongly recommends that Reserve Program funding remain at
sufficient levels to adequately train, equip and support the robust
reserve force that has been so critical and successful during our
Nation's recent major conflicts.
While Defense Authorizers provided an early retirement benefit in
fiscal year 2008, only those who have served in support of a
contingency operation since January 28, 2008 are eligible, which is
nearly 6 years and four months after Guard and Reserve members first
were mobilized to support the active duty force in this conflict. Over
725,000 Reservists, who have served during this period, were excluded
from eligibility. The explanation given was lack of mandatory funding
offset. To exclude a portion of our warriors is akin to offering the
original GI Bill to those who served after 1944.
NMVA hopes that this subcommittee can help identify excess funding
that would permit an expanded early retirement benefit for those who
have served.
MILITARY VOTING
NMVA also feels that significant progress has been made in military
voting rights in the past 2 years through passage of the MOVE Act of
2009, and the new programs implemented by the Federal Voting Assistance
Program. These new programs include such innovations as online tools to
assist voters in filling out registration forms and back-up ballots, as
well as the online ballot delivery tools developed by 17 States, with
FVAP support, and fielded for the 2010 election. Recently, FVAP
announced a $16 million grant program to expand those online voting
support tools at the State and local level, all of which will be linked
to the voter through the FVAP website portal.
NMVA fully supports additional funding of DOD's Federal Voting
Assistance Program for $35.107 million, and the budget PE Numbers are
0901220SE and 0605803SE, Project 4.
REINTEGRATION PROGRAMS
As overseas contingency operations wind down, a temptation will be
to reduce funds to yellow ribbon and other reintegration programs, but
young men and women will continue to leave active duty, and members
serving and the Guard and Reserve will likely continue to be called up
to active duty. NMVA supports continued funding to Yellow Ribbon and
TAP programs.
These programs must be further examined to enhance the resilience
training. Resilience survival training prepares one to better adapt to
life's misfortunes and setbacks. While programs are in place to focus
on suicide, there are other challenges to be faced such as unemployment
and military divorce that need to be addressed, including seminars to
better understand the current laws.
ARMED FORCES RETIREMENT HOMES
Dormitories and buildings at the AFRH--Washington, DC campus
continue to need refurbishing. While the AFRJ--Gulfport facility has
reopened, the Navy/Marine Corps residents continue to need funding for
the finishing touches of the site.
NMVA urges this subcommittee to continue funding upgrades at the
Washington, DC facility and improvements at the Gulfport facility.
CONCLUSION
Mr. Chairman and distinguished members of the Subcommittee, the
Alliance again wishes to emphasize that we are grateful for and
delighted with the large steps forward that the Congress has affected
the last few years. We are aware of the continuing concern all of the
subcommittee's members have shown for the health and welfare of our
service personnel and their families. Therefore, we hope that this
subcommittee can further advance these suggestions in this committee or
in other positions that the members hold. We are very grateful for the
opportunity to submit these issues of crucial concern to our collective
memberships. Thank you.
Chairman Inouye. Thank you very much, Captain Smith.
Senator Cochran.
Senator Cochran. Mr. Chairman, thank you.
Let me again reiterate our appreciation for the
participation of those of you who have served in the military
and through your experience have direct knowledge of a lot of
these issues that we are now confronting. The information that
you're providing and the suggestions are deeply appreciated.
Thank you.
Chairman Inouye. Senator Shelby.
Senator Shelby. I thank Captain Smith and the whole panel.
I was looking at your membership. You represent the umbrella of
all these groups, so you do it well.
So thank you, Mr. Chairman.
Chairman Inouye. Thank you.
I'd like to thank the panel. Now the next panel: Captain
Ike Puzon, U.S. Navy retired, Associations for America's
Defense; Dr. Donald Jenkins, National Trauma Institute; Rear
Admiral Casey Coane, U.S. Navy retired, Association for the
U.S. Navy; Ms. Karen Goraleski, American Society of Tropical
Medicine and Hygiene.
May I call on Captain Puzon.
STATEMENT OF CAPTAIN IKE PUZON, UNITED STATES NAVY
(RETIRED), ON BEHALF OF THE ASSOCIATIONS
FOR AMERICA'S DEFENSE
Captain Puzon. Mr. Chairman, Senator Cochran, Senator
Shelby: The Associations for America's Defense is very grateful
to testify today. We would like to thank the subcommittee for
your stewardship on the defense issues and setting an example
through your nonpartisan leadership.
The Associations for America's Defense is concerned that
U.S. defense policy is sacrificing security due to budget
pressures and readiness. Most concerning is the vigorous
pursuit to cut existing programs. Chairman of the Joint Chiefs
of Staff Admiral Mike Mullen in his testimony before the Senate
Armed Services Committee in February recognized that: ``In the
back end of previous conflicts, we were able to contract our
equipment inventory by shedding our oldest capital assets,
reducing the average age of our systems. We cannot do this
today because of the high pace and duration of combat
operations. We must actually recapitalize our systems to
restore our readiness and avoid becoming a hollow force.''
A4AD is in agreement, and in addition we are alarmed that
the fiscal year 2012 unfunded program list submitted by the
military services was not made publicly available and that the
Army do not even have such a list this year. Moreover, the past
2 years we saw significant reductions in the unfunded lists
submitted, leading to a speculation that military services are
no longer permitted to produce their full unfunded needs.
Additionally, the results of such budgetary policy could
again lead to a hollow force whose readiness and effectiveness
has been subtly degraded and lessened efficiency will not be
immediately evident.
We support increasing defense spending to 5 percent of the
gross domestic production during times of war to cover
procurement and prevent unnecessary personnel end strength
cuts. As always, our military will do everything possible to
accomplish its missions, but response time is measured by
equipment readiness and availability.
Defense Secretary Robert Gates has warned against hollowing
out the force from a lack of proper training, lack of proper
maintenance and equipment and manpower. Also, U.S. Joint Forces
Command General Ray Odierno said recently: ``We must avoid the
trap of doing more with less, which is a recipe for creating a
hollow force.'' He further qualified this by asking: ``What are
we going to stop doing?''
Ominously, both the 30-year shipbuilding and aviation plans
are at risk of achieving their goals. The Navy's plan to build
a 313-ship fleet doesn't match reality, in which funding is
highly unlikely to meet this goal. In addition, there are plans
to extend the service life of already 40-year-old ships another
28 years. For the aviation plan, the original assumption
forecasted a 3 percent average annual growth for aviation
programs over the next decade. But now there are predicted a
zero-growth aviation budget for 2017.
As these plans are not bearing the fruit that was
originally projected, it is imperative that until the new
systems are acquired in sufficient quantities to replace legacy
fleets, legacy systems must be sustained and kept operational.
As the military continues to become more expeditionary,
more airlifts are needed, such as C-17s, C-130Js, and C-40s.
They will be required. Yet DOD has decided to shut down
production of C-17. Procurement needs to be accelerated,
modernized, and mobility requirements need to be acknowledged.
We ask this subcommittee to continue to provide appropriations
for unfunded National Guard and Reserve equipment requirements.
Of great concern is the potential to revert the Reserve
component back to a strategic reserve. Our national security
demands both an operational and strategic reserve. We urge the
subcommittee to study the comprehensive review of the future
role of Reserve components, which calls for reserve equipment.
We genuinely appreciate the support of the subcommittee,
particularly at the time when there is growing pressure on the
congressional members promoting further cuts. Thank you again.
I look forward to your questions.
[The statement follows:]
Prepared Statement of Captain Ike Puzon
ASSOCIATIONS FOR AMERICA'S DEFENSE
Founded in January 2002, the Association for America's Defense
(A4AD) is an adhoc group of Military and Veteran Associations that have
concerns about National Security issues that are not normally addressed
by The Military Coalition (TMC) and the National Military Veterans
Alliance (NMVA), but participants are members from each. Members have
developed expertise in the various branches of the Armed Forces and
provide input on force policy and structure. Among the issues that are
addressed are equipment, end strength, force structure, and defense
policy. A4AD, also, cooperatively works with other associations, who
provide input while not including their association name to the
membership roster.
PARTICIPATING ASSOCIATIONS
American Military Society
Army and Navy Union
Association of the U.S. Navy
Enlisted Assoc. of the National Guard of the U.S.
Hispanic War Veterans of America
Marine Corps Reserve Association
Military Order of World Wars
National Assoc. for Uniformed Services
Naval Enlisted Reserve Association
Reserve Enlisted Association
Reserve Officers Association
The Flag and General Officers' Network
The Retired Enlisted Association
INTRODUCTION
Mister Chairman and distinguished members of the committee, the
Associations for America's Defense (A4AD) is again very grateful for
the invitation to testify before you about our views and suggestions
concerning current and future issues facing the defense appropriations.
The Association for America's Defense is an adhoc group of 13
military and veteran associations that have concerns about national
security issues. Collectively, we represent armed forces members and
their families, who are serving our Nation, or who have done so in the
past.
CURRENT VERSUS FUTURE: ISSUES FACING DEFENSE
The Associations for America's Defense would like to thank this
subcommittee for the ongoing stewardship that it has demonstrated on
issues of defense. While in a time of war, this subcommittee's pro-
defense and non-partisan leadership continues to set an example.
Force Structure: Erosion in Capability
The 2010 Quadrennial Defense Review's (QDR) objectives include:
further rebalance the Armed Force's capabilities to prevail in today's
wars while building needed capabilities to deal with future threats;
and reform Department of Defense's (DOD) institutions and processes to
better support warfighters' urgent needs; purchase weapons that are
usable, affordable, and needed; and ensure that taxpayer dollars are
spent wisely and responsibly. The new QDR calls for DOD to continually
evolve and adapt in response to the changing security environment.
Retiring Secretary of Defense Robert Gates said that, ``It is
vitally important to protect the military modernization accounts,'' and
to, ``push ahead with new capabilities, from an air refueling tanker
fleet to ballistic missile submarines.'' Additionally when referring to
paying America's budget by defense Gates also stated that, ``If you cut
the defense budget by 10 percent, which would be catastrophic in terms
of force structure, that's $55 billion out of a $1.4 trillion
deficit,'' further saying, ``We are not the problem.''
The Chairman of the Joint Chiefs of Staff Admiral Mike Mullen well-
known for his saying that the ``national debt is the greatest threat to
national security,'' in his testimony before the Senate Armed Services
Committee in February 2011 also recognized the following regarding
equipment:
In the ``back end'' of previous conflicts, we were able to contract
our equipment inventory by shedding our oldest capital assets, reducing
the average age of our systems. We cannot do this today, because the
high pace and durations of combat operations have consumed the
equipment of all our Services much faster than our peacetime programs
can recapitalize them. We must actually recapitalize our systems to
restore our readiness and avoid becoming a hollow force.
Hollow Force
A4AD strongly disagrees with placing budgetary constraints on
defense especially in light of the fact that many have recommended
cutting defense in order to pay off debt despite it only being 20
percent of the overall budget. Member associations also question the
current administration's spending priorities which place more
importance on the immediate future rather than a short and long term
approach. The result of such a budgetary policy again lead to a hollow
force whose readiness and effectiveness has been subtly degraded and
lessened efficiency will not be evident immediately. This process,
echoing the past, raises no red flags and sounds no alarms, and the
damage can go unnoticed and unremedied until a crisis arises
highlighting readiness decay.
Even Secretary Gates has ominously warned against ``. . . hollowing
out of the force from a lack of proper training, maintenance and
equipment--and manpower.'' But he's not the only one, the commander of
U.S. Joint Forces Command General Raymond Odierno also has said
recently, ``We must avoid the trap of doing more with less, which is a
recipe for creating a hollow force,'' and further qualified this by
asking, ``what are we going to stop doing?''
Emergent Risks
Members of this group are concerned that U.S. defense policy is
sacrificing future security for near term readiness. Our efforts are so
focused to provide security and stabilization and then withdrawal in
Afghanistan and Iraq. While risk is being accepted as an element of
future force planning, current planning is driven by current overseas
contingency operations, and progressively more on budget limitations.
What seems to be overlooked is that the United States is involved
in a Cold War in S.E. Asia as well as a Hot War with two theaters in
S.W. Asia. Security issues in North Africa, the Middle East, North
Korea, China, Iran, and Russia add to the growing areas of risk.
Arab Awakening
The Middle East is in the midst of great turmoil in which multiple
countries have and continue to see uprisings, there's a widening gap
between Christians and Muslims in Egypt, Syria has seen numerous
civilian deaths, Israel is increasingly defensive, Yemen edges closely
to civil war, more attacks are surfacing in Iraq, Libya remains in a
stalemate, in addition to other problems.
It is concerning that while in the thick of continuing protests and
instability numerous western nations are pledging significant funding
for alleged ``Arab countries in transition to democracy''. The United
States' best interest is to ensure that there is reliable leadership in
Arab states, civil relations toward Israel, and reduced violence
against civilians. Also any assistance given must be targeted to
support the U.S. National Security Strategy and have detailed goals
attached.
Korean Peninsula
North Korea has 1.2 million active and 7.7 million reserve forces
while South Korea had 653,000 active and 3.2 million reserve soldiers
in 2010, and there are 28,500 U.S. troops stationed to the South. While
not an immediate danger to the United States, North Korea is viewed as
an increased threat to its neighbors, and is potentially a
destabilizing factor in Asia. North Korea may be posturing, but it is
still a failed state, where misinterpretation clouded by hubris could
start a war.
Recently South Korea has admitted that it has held secret
discussions with North Korea in May, yet North Korea utilized the
opportunity to embarrass the South. Some analysts actually believe that
the two nations may be entering into a new dangerous phase. This is
further emphasized by the cool relations of the past year in which
North Korea committed attacks against South Korea on Yeonpyeong Island
and the sinking of the navy vessel ROKS Cheonan, which resulted in 50
deaths. In fact South Korea intends to increase its defense budget by
nearly 5.8 percent in 2011, which is partially in response to these
attacks.
China
China has worked very hard to create a facade to the world to
conceal its true strengths and weaknesses. According to Chief of Naval
Operations Admiral Gary Roughead, at a SAC-D hearing, ``The Chinese
Navy is the fastest-growing in the world today.''
Of great concern is China's defense budget which `officially' will
increase 12.7 percent, 600 billion Yuan or roughly $91 billion, for
2011. Some of the increase will go toward the strategic nuclear force,
the strategic missile unit, and the Navy. But this is not the whole
budget and in fact it doesn't include the cost for procuring or
building new weapons which could almost double the defense budget.
What's more experts across the board estimate that China's actually
spends far more than is reported, ranging from over $150 billion as DOD
reported in 2010 (up to 250 percent higher than figures reported by the
Chinese government ) to as much as $400 billion as estimated by
GlobalSecurity.org based on ``a more appropriate purchasing power
parity (PPP) basis''.
In addition their cost of materials and labor is much lower.
China's GDP climbed to 9.6 percent while the United States is at 2.6
percent as of the third quarter for 2010. According to the CIA World
Fact Book ``because China's exchange rate is determine by fiat, rather
than by market forces, the official exchange rate measure of GDP is not
an accurate measure of China's output; GDP at the official exchange
rate substantially understates the actual level of China's output vis-
a-vis the rest of the world; in China's situation, GDP at purchasing
power parity provides the best measure for comparing output across
countries.''
China's build-up of sea and air military power appears aimed at the
United States, according to Admiral Michael Mullen. Furthermore China
is reluctant to support international efforts in reproaching North
Korea. China has stated that it will field its advanced new J-20
stealth fighter in 2017-19.
Furthermore there is also the aggressive behavior. Recently the
Philippines deployed two warplanes when a ship searching for oil
complained of being harassed by two Chinese patrol boats in the South
China Sea, Japan deployed F-15 fighter jets when Chinese surveillance
and anti-submarine aircraft flew near the East China Sea disputed
islands, and at all times China pursues overtaking Taiwan. China also
associates with adversarial nations, specifically Iran and Venezuela
who both openly antagonize the United States.
Iran
While Iran lobs petulant rhetoric toward the United States, the
real international tension is between Israel and Iran, and Iran's
handiwork in various Middle Eastern uprisings such as Bahrain which is
already considered to be an Iranian quasi-satellite state.
Israel views Tehran's atomic work as a threat, and would consider
military action against Iran as it has threatened to ``eliminate
Israel.'' Israeli leadership has warned Iran that any attack on Israel
would result in the ``destruction of the Iranian nation.'' Israel is
believed to have between 75 to 200 nuclear warheads with a megaton
capacity.
Two Iranian warships passed through the Suez Canal upon receiving
approval from Egypt, which Israel called a provocation. Iran has also
sent a submarine into the Red Sea.
Russia
While the Obama Administration has been working on a ``reset''
policy toward Russia, including a new START treaty, there are areas of
concern. A distressing issue is their ongoing relationship with Iran.
Additionally Russia sells arms to countries like Syria and Venezuela.
Prime Minister Vladimir Putin stated recently, ``Despite the
difficult environment in which we are today, we still found a way to
not only maintain but also increase the total amount of state defense
order.'' Russia's defense budget rose by 34 percent in 2009, as
reported by the International Institute of Strategic Study, and has
plans for incremental defense spending increases starting 2011 with a
$19.2 billion, $24.3 billion in 2012, and then $38.8 billion in 2013.
Funding for the Future
Since Secretary Gates initiated the practice of reviewing all the
services' unfunded requirements lists prior to testifying before
Congress the unfunded lists have shown a dramatic reduction from $33.3
billion for fiscal year 2008 and $31 billion for fiscal year 2009 to
$3.8 billion for fiscal year 2010 and $2.6 billion for fiscal year
2011.
Secretary Gates instituted a plan to save $100 billion over 5
years. Two-thirds of the savings are supposed to come from decreasing
overhead and one-third from cuts in weapons systems and force
structure. For the 2012 budget, the military services and defense
agencies have been asked to find $7 billion in savings. In addition
President Obama has ordered $400 billion in national security spending
cuts over 10 years as the administration identifies ways to reduce the
Federal deficit. These impending cuts are in addition to weapon systems
cuts from the past couple years amounting to more than $330 billion.
Secretary Gates stated, ``. . . sustaining the current force
structure and making needed investments in modernization will require
annual real growth of 2 (percent) to 3 percent, which is 1 (percent) to
2 percent above current top line budget projections,'' in a briefing at
DOD in Aug. 2010.
Defense as a Factor of GDP
Secretary Gates has warned that that each defense budget decision
is ``zero sum,'' providing money for one program will take money away
from another. A4AD encourages the Appropriations Subcommittee on
Defense to scrutinize the recommended spending amount for defense. Each
member association supports defense spending at 5 percent of Gross
Domestic Product during times of war to cover procurement and prevent
unnecessary end strength cuts.
A Changing Manpower Structure
The 2010 QDR reduces the number of active Army brigade combat teams
to 45 and Air Force tactical fighter wings to 17, while maintaining the
202,100 Marine Corps active manpower level. The Navy's fiscal year 2011
budget keeps the goal of a 313 ship battle fleet, but its 30 year
shipbuilding plan includes 276 ship, thus not reaching the goal. As a
result of these planned cuts, the Heritage Foundation projects there
will be a 5 percent decrease in manpower over the next 5 years.
A4AD supports a moratorium on further cuts including the National
Guard and Title 10 Reserve. We further suggest that a Zero Based Review
(ZBR) be performed to evaluate the current manning requirements.
Additionally, as the active force is cut, these manpower and equipment
assets should be transferred into the Reserve Components.
Maintaining a Surge Capability
The Armed Forces need to provide critical surge capacity for
homeland security, domestic and expeditionary support to national
security and defense, and response to domestic disasters, both natural
and man-made that goes beyond operational forces. A strategic surge
construct includes manpower, airlift and air refueling, sealift
inventory, logistics, and communications to provide a surge-to-demand
operation. This requires funding for training, equipping and
maintenance of a mission-ready strategic reserve composed of active and
reserve units.
Dependence on Foreign Partnership
Part of the U.S. military strategy is to rely on long-term
alliances to augment U.S. forces. As stated in a DOD progress report,
``Our strategy emphasizes the capacities of a broad spectrum of
partners . . .. We must also seek to strengthen the resiliency of the
international system . . . helping others to police themselves and
their regions.'' The fiscal year 2012 budget request included $500
million for fiscal year 2012, which helps build capabilities of key
partners. Yet many allies are cutting their forces.
The risk of basing a national security policy on foreign interests
and good world citizenship is increasingly uncertain because their
national objectives can differ from our own. Alliances should be viewed
as a tool and a force multiplier, but not the foundation of National
Security.
Seapower Dominance
The United States, as a maritime Nation, is on the cusp of losing
it dominance at sea. The U.S. Navy has been incrementally depreciating
through reductions and ever-more aging assets. Now, there are plans to
extend the service life of already 40-year old ships another 28 years
through 2039. While service life extension programs may cost effective
in the short term, continual repairs and downgraded readiness will
prove to be more expensive than replacing an asset in the long term.
The cost will not just be defense based, but will impact the
national and world economy. The United States has maintained its
presence and strength throughout the world, attributing greatly to
reducing aggressive behavior such as dealing with piracy, regional
disorder, drug trade, human trafficking and much more. According to
MacKenzie Eaglen of Heritage Foundation, ``The U.S. Navy's global
presence has added immeasurably to U.S. economic vitality and to the
economies of America's friends and allies, not to mention those of its
enemies.''
A4AD is particularly concerned that the Navy is no longer as of
2011 required to submit a full plan each year to Congress, but rather
ties it to the QDR which is only updated once every 4 years, causing
the Navy to be slow to respond to changing threats. Once the U.S.
seapower capability is lost, it will be extremely difficult to regain a
dominant position in the world seas.
UNFUNDED REQUIREMENTS
The Unfunded Program Lists submitted by the military services to
Congress have been reduced significantly since fiscal year 2009 and
A4AD has concerns that these requests continue to be driven more by
budgetary factors than risk assessment. Of particular concern is the
Army who officially has no unfunded requirements, in spite of the fact
that its equipment has been the most highly utilized in overseas
contingency operations in Iraq and Afghanistan, leading to high wear
and tear. A4AD is distressed that by limiting the unfunded lists,
Congress is unable to make informed decisions on appropriating for
defense.
Aviation Plans
Although the first long-term aviation plan was submitted to
Congress in fiscal year 2011 forecasting a 3 percent average annual
real growth for aviation programs over the next decade, in the fiscal
year 2012 report investment assumptions changed and now predict a zero
real growth aviation budget after 2017. Regrettably the aviation plan
did not consider rotary wing, tilt-rotor, or trainer aircraft.
Tactical Aircraft
The Air Force has accelerated a plan to retire 250 fighter jets
including 112 F-15s and 134 F-16s. Also the Air Force plans to ground
18 F-16s in the USANG due to the fiscal year 2012 presidential budget
request that didn't include funding for three F-16s for six States
each.
The Air Force-Navy-Marine Corps fighter inventory will decline
steadily from 3,264 airframes in fiscal year 2011 to 2,883 in fiscal
year 2018, at which point the air fleet is supposed to have a slow
increase.
Until new systems are acquired in sufficient quantities to replace
legacy fleets, legacy systems must be sustained and kept operationally
relevant. The risk of the older aircraft and their crews and support
personnel being eliminated before the new aircraft are on line could
result in a significant security shortfall.
Airlift
Hundreds of thousands of hours have been flown, and millions of
passengers and tons of cargo have been airlifted. Air Force and Naval
airframes and air crews are being stressed by these lift missions. As
the military continues to be more expeditionary it will require more
airlift. Procurement needs to be accelerated and modernized, and
mobility requirements need to be reported upon.
While DOD has decided to shut down production of C-17s, existing C-
17s are being worn out at a higher rate than anticipated. Congress
should independently examine actual airlift needs, and plan for C-17
modernization, a possible follow-on procurement. Furthermore shutting
down production of C-17s or any equipment causes great difficulty for
reopening such lines and will cause unnecessary delays in the future.
The Navy and Marine Corps need C-40A replacements for the C-9B
aircraft; only nine C-40s have been ordered since 1997 to replace 29 C-
9Bs. The Navy requires Navy Unique Fleet Essential Airlift. The C-40A,
a derivative of the 737-700C a Federal Aviation Administration (FAA)
certified, while the aging C-9 fleet is not compliant with either
future global navigation requirements or noise abatement standards that
restrict flights into European airfields.
NGREA
A4AD asks this committee to continue to provide appropriations for
unfunded National Guard and Reserve Equipment Requirements. The
National Guard's goal is to make at least half of Army and Air assets
(personnel and equipment) available to the Governors and Adjutants
General at any given time. To appropriate funds to Guard and Reserve
equipment provides Reserve Chiefs with a flexibility of prioritizing
funding.
UNFUNDED EQUIPMENT REQUIREMENTS
[The services and lists are not in priority order. Amounts are total
cost, not individual. If item is preceded by a number in parentheses
that is the quantity needed.]
------------------------------------------------------------------------
Amount
------------------------------------------------------------------------
Air Force Active:
F-35 Joint Strike Fighter......................... Unknown
Aircraft Training Simulators...................... Unknown
F-16 SLEP......................................... Unknown
Air Force Reserve (USAFR):
C-130--requirement of LAIRCOM and SLOS/BLOS $73.3 million
capability.......................................
A-10/F-16--requirement of Day/Night Helmet Mounted $9.8 million
Integrated Targeting (HMIT) (PA, SP).............
ACS--requirement of Grissom R-12 Refuelers........ $0.9 million
HC-130--requirement of Integrated EW suite (ALQ- $6 million
213) with VECTS..................................
C-130--requirement of SAFIRE Look Out Capability $19.3 million
and MASS Spray System............................
Air Force Reserve (USAFR) Submitted MILCON
Requirements:
Airfield Control Tower/Base Ops, March, CA........ $16.39 million
RED HORSE Readiness and Training Facility, $9.593 million
Charleston, SC...................................
Unspecified Minor Construction--Reserve, Various $5.434 million
Locations........................................
Planning and Design--Reserve, Various Locations... $2.2 million
Air Force Reserve (USAFR) Significant Major Item
Shortages Submitted:
(21) C-130 Large Aircraft Infrared Countermeasures $63 million
(LAIRCOM)........................................
(55) C-130 SLOS/BLOS Capability................... $20.7 million
(148) A-10/F-16 Mounted Cueing System (HMCS)...... $4.3 million
(4) Grissom R-12 Refuelers........................ $0.9 million
(5) HC-130 Integrated EW suite (ALQ-213) with $3 million
VECTS............................................
Air National Guard (USANG):
F-15 AESA--Continues to be a high priority for Unknown
adds because it is too expensive to spend NGREA
on. Some could be a purchased if NGREA is
significantly increased..........................
A-10 and F-16 HMIT................................ Unknown
KC-135 IRCM....................................... Unknown
C-130 IRCM........................................ Unknown
Guardian Angel (GA) Recovery Vehicles. This is Unknown
also called ``PJ recovery vehicles'', but GA is
the weapon system encompassing PJs, Special
Tactics Squadrons, and Combat Controllers and
they all need recovery vehicles..................
Air National Guard (USANG) Significant Major Item
Shortages Submitted:
(322) A-10/F-16 Helmet Mounted Integrated $38.64 million
Targeting System.................................
(77) Large Aircraft Infrared Countermeasures $431.2 million
(LAIRCOM) (C-140, C-17, C-5).....................
(68,272) Security Force Mobility Bag Upgrades, $86.15 million
Personal Protective Equipment (PPE), and Wea-
pons.............................................
C-130 Loadmaster Lookout Windows and Crashworthy $164 million
Loadmaster Seats.................................
(30) F-15 Active Electronically Scanned Array $261.6 million
(AESA) Radar.....................................
Army Active:
Ground Combat Vehicle............................. Unknown
Mobile, Secure Wireless Network--Brigade Combat Unknown
Team Modernization (BCTM)........................
HMWWV Modernization............................... Unknown
CH-47 Chinook Helicopter.......................... Unknown
AH-64 Apache Longbow Block III upgrade............ Unknown
Army National Guard (USARNG) Significant Major Item
Shortages Submitted:
(30,442) Command Posts--Tactical Operations Center $1.166 million
(TOC) & Standardized Integrated Command Post
System (SICPS)...................................
(5,428) Family of Medium Tactical Wheeled Vehicles $1.519 million
(11) Shadow Tactical Unmanned Aircraft Systems.... $297 million
(3,614) General Engineering Equipment--for $366.7 million
homeland response missions.......................
(290) Chemical/Biological protective Shelter...... $208.8 million
Army National Guard (USARNG) Top Equipment MOD and
Capability Shortfall List:
Army Battle Command System (ABCS)................. Unknown
Air & Missile Defense Systems (Avenger Unknown
Modernization)...................................
ATLAS (All Terrain Lifter-Army System I and II)... Unknown
Aviation Ground Support Equipment................. Unknown
Aviation Systems (CH-47F, UH60 A-A-L Mod, UH-60M, Unknown
AH64 MOD, LUH-72 MEP)............................
Army Reserve (USAR) Significant Major Item Shortages
Submitted:
(34) Command Post System and Integration (SICPS).. $6.8 million
(4,860) Medium Tactical Vehicles.................. $1.701 billion
(63) HMMWV Ambulance.............................. $25.01 million
(4,541) Light Medium Tactical Truck Cargo......... $1.589 billion
(98) Heavy Scraper--for Horizontal Construction $30.58 million
mission..........................................
Marine Corps Reserve (USMCR) Significant Major Item
Shortages Submitted:
(5) Light Armored Vehicle (LAV), 25 mm (LAV-25A2). $16 million
(5) LAV, Maint/Recovery (LAV-R)................... $11 million
(15) LAV, Logistics (LAV-L)....................... $30 million
(3) LAV, Mortar (LAV-M)........................... $7.5 million
(14) LAV, Anti-tank (LAV-AT)...................... $44.8 million
Navy and Marine Corps Active \1\:
F-35 Joint Strike Fighter......................... Unknown
Attack Submarines................................. Unknown
LPD-17............................................ Unknown
Navy Reserve (USNR) Significant Major Item Shortages
Submitted:
(5) C-40A......................................... $408.5 million
Naval Construction Force (NCF) Tactical Vehicles $38 million
and Support Equipment Table of Allowances (TOA)..
Navy Expeditionary Logistics Support Group $75 million
(NAVELSG) TOA Equipment..........................
Explosive Ordnance Disposal (EOD) TOA Equipment... $58.89 million
Maritime Expeditionary Security Force (MESF) TOA $119 million
Equipment........................................
------------------------------------------------------------------------
\1\ The Navy's fleet is the smallest it has been in almost 100 years.
While the service has made plans to expand in the coming years; to 324
ships by 2021; funding doesn't support this growth. Shipbuilding costs
continue on an exponential path and at the same time domestic
shipbuilding yards are beginning to close, putting a larger fleet at
risk; the ship building budget needs to be increased.
Reserve Components (RCs)
According to the National Guard and Reserve Equipment Report
(NGRER) for fiscal year 2012 the aggregate equipment shortage for all
of the RCs is about $54.2 billion as compared to $45 billion from last
year. Common challenges for the RCs are ensuring that equipment is
available for pre-mobilization training, transparency of equipment
procurement and distribution, and maintenance.
CONCLUSION
A4AD is a working group of military and veteran associations
looking beyond personnel issues to the broader issues of National
Defense. This testimony is an overview, and expanded data on
information within this document can be provided upon request.
Thank you for your ongoing support of the Nation, the Armed
Services, and the fine young men and women who defend our country.
Please contact us with any questions.
Chairman Inouye. Thank you very much, Captain Puzon.
Senator Cochran.
Senator Cochran. Mr. Chairman, I want to join you in
welcoming and thanking this panel of witnesses for being here
today. We have a copy of the testimony and background
information that our staff has provided us. It's a shame that
we have such a pressurized situation that we're facing here
with many commitments all during the same day and at the same
time we're supposed to be here. I was just looking at my
schedule to see where I was supposed to be right about now and
it was somewhere else.
But that's something that you shouldn't have to suffer
from, and that's why I wanted to simply say, because we are not
spending 2 or 3 hours, which we probably ought to do, with this
one panel because of the pressure of so many other activities
and issues, we are forced to make decisions that are
troublesome to us.
So, having said that, I'm going to yield to my good friend
from Alabama for specific questions that he may have of this
witness. But thank you very much for taking time to provide us
with your testimony.
Chairman Inouye. Senator Shelby.
Senator Shelby. Thank you, Mr. Chairman.
Thank you for your testimony and also your complete written
testimony. I think one of your strong statements is in the
record. You say members of this group--that's your group--``are
concerned that the U.S. defense policy is sacrificing future
security for near-term readiness.'' That is a concern of all of
us. We've got to balance that, because if we have near-term
readiness where are we going to be in 10 years, 5 years,
because we've been on the cutting edge a long time, and it's
served us well and we cannot give this up.
The other point that you make in your written testimony,
the Chinese navy is the fastest growing navy in the world
today. I think we realize this on this Defense Appropriation
Committee, and we've got to consider today, but we've also got
to consider tomorrow, because if we're not prepared for
tomorrow, as you pointed out, we've not served our country
well, have we?
Captain Puzon. That's correct, sir. Thank you.
Senator Shelby. Thank you, Mr. Chairman.
Chairman Inouye. Thank you.
Dr. Jenkins.
STATEMENT OF DONALD H. JENKINS, M.D., VICE CHAIRMAN,
NATIONAL TRAUMA INSTITUTE
Dr. Jenkins. Mr. Chairman, Vice Chairman Cochran, Senator
Shelby: Thank you for the opportunity to testify today on
behalf of the National Trauma Institute, or NTI, to urge the
subcommittee to invest a greater amount of Department of
Defense medical research funds in the primary conditions which
kill our soldiers.
According to military medical officials, non-compressible
hemorrhage is the leading cause of death among combatants whose
deaths are considered potentially survivable. NTI believes an
accelerated program of research into non-compressible
hemorrhage will result in the first truly novel advances in
treating this difficult problem, will save the lives of
soldiers wounded in combat, and will have a tremendous impact
on civilian casualties and costs as well.
I'm currently the Chief of Trauma for the Mayo Clinic and
serve on the Defense Health Board. Prior to retiring from the
United States Air Force, I was Chairman of General Surgery and
Chief of Trauma at Wilford Hall Air Force Medical Center, the
Air Force flagship medical facility. I'm here today in my
capacity as Vice Chairman of the nonprofit National Trauma
Institute, which was formed in 2006 by leaders of America's
trauma organizations in response to frustration over lack of
trauma research funding.
NTI advocates for trauma research and is a national
coordinating center for trauma research and funding. Military
officials estimate that 19 percent of combat deaths are
potentially survivable. To put that in context of our current
war operations, 1,100 warriors wounded in the current wars
might have survived, but didn't because treatment strategies
were lacking.
Over 84 percent of those deaths were due to hemorrhage and
about 600 potentially survivable deaths resulted from
hemorrhage in regions of the body, such as the neck, chest,
abdomen, groin, and back, that couldn't be treated by
tourniquets or compression. New tourniquets and hemostatic
bandages have had major impact on the decline in trauma combat
deaths due to extremity hemorrhage, but compression is rarely
effective for penetrating wounds to the torso, where major
vessels can be damaged, resulting in massive hemorrhage. At
present such wounds are normally only treatable through surgery
and typically such patients do not survive to reach the
operating table.
Current combat casualty care guidelines for medics do not
include strategies to stop bleeding from non-compressible
hemorrhage, because there are none. There is not even a method
to detect whether a soldier is bleeding internally or how much
blood has been lost. It should be a priority to develop simple,
rapid, and field-expedient techniques which can be used by
medics on the battlefield or first responders in the civilian
setting to detect and treat non-compressible hemorrhage.
Turning to that civilian context, trauma is responsible for
over 60 percent of deaths of Americans under the age of 44.
That's more than all other causes of death combined in that age
group. It's responsible for the deaths of nearly 180,000
Americans and nearly 30 million injuries every year. And it's
the second most expensive public health problem facing the
United States. Hemorrhage is responsible for nearly 40 percent
of deaths following traumatic injury in the civilian setting.
Advances in research can be applied to both military and
civilian casualties. It has been proven repeatedly that medical
research saves lives. In 1950 a diagnosis of leukemia was a
death sentence. Research led to chemotherapy and treatments
such as bone marrow transplant, such that today 90 percent of
those patients survive. Imagine even a 5 percent decrease in
trauma-related death, injury, and economic burden. That would
save the United States $35 billion a year, prevent 1.5 million
injuries, and save nearly 9,000 American lives every year.
NTI recommends the subcommittee fund research into the
major cause of preventable death of our military and set aside
at least $15 million for peer-reviewed research into non-
compressible hemorrhage for the fiscal year 2012 DOD
appropriations bill.
Mr. Chairman, Senator Cochran, Senator Shelby, thank you
for the opportunity to present the views of the National Trauma
Institute.
[The statement follows:]
Prepared Statement of Dr. Donald H. Jenkins
Mr. Chairman, Vice Chairman Cochran and Members of the
Subcommittee: Thank you for the opportunity to testify today to urge
the subcommittee to invest a greater amount of DOD medical research
funds in the primary conditions which kill our soldiers. According to
military medical officials, non-compressible hemorrhage is the leading
cause of death among combatants whose deaths are considered
``potentially survivable.'' The National Trauma Institute (NTI)
believes an accelerated program of research into non-compressible
hemorrhage will result in the first truly novel advances in treating
this difficult problem, will save the lives of soldiers wounded in
combat, and will have tremendous impact on civilian casualties and
costs.
I am currently the Chief of Trauma for the Mayo Clinic and serve on
the Defense Health Board. Prior to retiring from the Air Force in 2008,
I was Director of the Joint Theater Trauma System, Chair of General
Surgery and Chief of Trauma Services at Wilford Hall Medical Center,
the Air Force's flagship medical facility. During my Air Force career,
I also served as principal advisor to the Air Force Surgeon General on
all surgery and trauma-related issues for first-strike deployable
teams.
I am here today in my capacity as vice chairman of the nonprofit
National Trauma Institute which was formed in 2006 by leaders of
America's trauma organizations in response to frustration over lack of
funding of trauma research. With the support and participation of the
national trauma community, NTI advocates and manages funding for trauma
research and is a national coordinating center for trauma research
funding. Since September 2009, NTI has issued two national calls for
proposals and has received a total of 177 pre-proposals from 32 States
and the District of Columbia. After rigorous peer-review, the
organization awarded $3.9 million to 16 proposals--seven single-center
studies and nine multi-center studies involving an additional 32
centers. Studies are ongoing, and NTI expects the first research
outcomes within 6 months. However, $3.9 million is a drop in the
bucket, and these studies will barely begin to build the body of
knowledge necessary for improved treatments and outcomes in the field
of trauma in the United States.
NON COMPRESSIBLE HEMORRHAGE
According to military documents and officials, the major cause of
death from combat wounds is hemorrhage. Nineteen percent of combat
deaths are judged to be potentially survivable \1\. In other words,
1,100 warriors wounded in Iraq or Afghanistan might have survived to
come home to their loved ones, but didn't because treatment strategies
were lacking. Over 900 (84 percent) deaths were due to hemorrhage, and
66 percent of these, about 600 potentially survivable deaths, resulted
from hemorrhage in regions of the body such as the neck, chest,
abdomen, groin, and back that couldn't be treated by a tourniquet or
compression \1\.
---------------------------------------------------------------------------
\1\ Kelly, J.F., Ritenour, A.E., McLaughlin, D.F., Bagg, K.A.,
Apodaca, A.N., Mallak, C.T., Pearse, L., Lawnick, M.M., Champion, H.R.,
Wade, C.E., and Holcomb, J.B. (2008) Injury severity and causes of
death from Operation Iraqi Freedom and Operation Enduring Freedom:
2003-2004 versus 2006. J Trauma 64, S21-26.
Extremity wounds are amenable to compression to stop bleeding, and
new tourniquets and hemostatic bandages have had a major impact on the
decline in combat deaths due to extremity hemorrhage. But compression
is rarely effective for penetrating wounds to the torso and major
vessels can be damaged resulting in massive hemorrhage. At present,
such wounds are normally only treatable through surgical intervention
and typically such patients do not survive to reach the operating room.
Currently, there is no active intervention for noncompressible
hemorrhage available to military medics, who along with civilian
responders have only the tools their predecessors had in the early 20th
century. There is not even a method to detect whether the wounded
warrior is bleeding internally, and if so, how much blood has been
lost. The current Tactical Combat Casualty Care guidelines for medics
and corpsmen do not include strategies to stem bleeding from non-
compressible hemorrhage because no solutions are available \2\. NTI
hopes to decrease the mortality of severely injured patients suffering
from torso hemorrhage. This can only be accomplished through research
into the development of simple, rapid and field-expedient techniques
which can be used by medics on the battlefield or first responders in a
civilian context to detect and treat non-compressible hemorrhage.
Examples of current NTI research in non-compressible hemorrhage
include:
---------------------------------------------------------------------------
\2\ (2009) Tactical Combat Casualty Care Guidelines. http://
www.usaisr.amedd.army.mil/tccc/TCCC%20Guidelines%20091104.pdf. Accessed
June 2, 2011.
---------------------------------------------------------------------------
--The use of ultrasonography to measure the diameter of the vena cava
to determine whether this will give an accurate indication of
low blood volume.
--An observational study to determine the incidence and prevalence of
clotting abnormalities in severely injured patients and to
study the complex biology of proteins to better understand,
predict, diagnose and treat bleeding after trauma.
--Supplementation of hemorrhagic shock patients with vasopressin, a
hormone needed to support high blood pressure. Vasopressin at
high doses has been shown to improve blood pressure, decrease
blood loss and improve survival in animal models with lethal
blood loss. This study will investigate the use of vasopressin
in trauma patients.
Another challenge in hemorrhage is resuscitation--the restoration
of blood volume and pressure. Traditional resuscitation includes large
volumes of intravenous fluids followed by blood and finally plasma.
However, now this large intravenous fluid load is thought to worsen the
trauma patient's coagulopathy (blood clotting problems), increasing
bleeding. There is strong retrospective evidence that for patients
requiring massive transfusion, a higher proportion of plasma and
platelets, when compared to red cells, results in improved survival.
Based on a 2004 research study \3\, the current Joint Theater Trauma
Clinical Practice Guideline for Forward Surgical Teams and Combat
Support Hospitals advocates a plasma, platelet, and red cell
resuscitation regime in lieu of the standard intravenous fluids.
Currently, there is no blood substitute available for in-theater use.
The Army Medical Department/USA Institute of Surgical Research is
working on a freeze dried plasma solution; however this product has not
yet received FDA approval. Remarkably, current treatments used by
military medics for restoration of blood volume are very similar to
those originally used in 1831 when saline was first given as an
intravenous fluid to cholera patients \4\.
---------------------------------------------------------------------------
\3\ Holcomb, J.B., Jenkins, D., Rhee, P., Johannigman, J., Mahoney,
P., Mehta, S., Cox, E.D., Gehrke, M.J., Beilman, G.J., Schreiber, M.,
Flaherty, S.F., Grathwohl, K.W., Spinella, P.C., Perkins, J.G.,
Beekley, A.C., McMullin, N.R., Park, M.S., Gonzalez, E.A., Wade, C.E.,
Dubick, M.A., Schwab, C.W., Moore, F.A., Champion, H.R., Hoyt, D.B.,
and Hess, J.R. (2007) Damage Control Resuscitation: Directly Addressing
the Early Coagulopathy of Trauma. The Journal of Trauma 62, 307-310.
\4\ Blackborne, L.H.C. (2011) 1831. The Army Department Medical
Journal April-June 2011, 6-10.
---------------------------------------------------------------------------
IMPACT OF TRAUMA ON UNITED STATES CIVILIANS
Traumatic injury is the cause of death of nearly every soldier in
combat. On the civilian front, trauma/injury is responsible for over 61
percent of the deaths of Americans between the ages of 1 and 44 each
year \5\. That's more than all forms of cancer, heart disease, HIV,
liver disease, stroke and diabetes combined. An American dies every 3
minutes due to trauma. That's 179,000 deaths in addition to 29.6
million injuries every year \5\.
---------------------------------------------------------------------------
\5\ CDC (2006) Centers for Disease Control/WISQARS. http://
webappa.cdc.gov/sasweb/ncipc/mortrate10_sy.html. Accessed March 16,
2011.
Trauma is the second most expensive public health problem facing
the United States. Data from the Agency for Healthcare Research and
Quality (AHRQ) on the 10 most expensive health conditions puts the
annual medical costs from trauma at $72 billion, second only to heart
conditions at $76 billion, and ahead of cancer and all other diseases
\6\. The National Safety Council estimates the true economic burden to
be more than $690 billion per year, since trauma has an ongoing cost to
society due to disability, and is the leading cause of years of
productive life lost \7\.
---------------------------------------------------------------------------
\6\ AHRQ (2008) Big Money: Cost of 10 Most Expensive Health
Conditions Near $500 Billion. Agency for Healthcare Research and
Quality http://www.ahrq.gov/news/nn/nn012308.htm. Accessed June 2,
2011.
\7\ NSC (2011) Summary from Injury Facts, 2011 Edition. National
Safety Council http://www.nsc.org/news_resources/
injury_and_death_statistics/Documents/Summary%202011.pdf. Accessed
March 16, 2011.
Advances in research can be applied to both military and civilian
casualties. Many of the problems associated with hemorrhage of all
kinds are potentially solvable and are transferable between military
and civilian trauma care. The funding recommended by NTI could have a
dramatic impact on civilian mortality in the U.S. Hemorrhage is
responsible for 30 percent to 40 percent of deaths following a
traumatic injury to civilians \8\.
---------------------------------------------------------------------------
\8\ Holcomb, J.B. (2010) Optimal Use of Blood Products in Severely
Injured Trauma Patients. Hematology, 465-469.
---------------------------------------------------------------------------
WHY TRAUMA RESEARCH IS SO CHALLENGING
Trauma research is challenging for many reasons. Injury can be
severe, and diagnosis of extent and location of injury can be
difficult. Sometimes the patient is unconscious or unable to
communicate, unable to give consent. Patients are often unaccompanied
by next-of-kin to assist in decisionmaking. Enrolling patients in
trauma studies sometimes requires community consent and involvement
because treatments may need to be started en route to the hospital or
military treatment facility. Placebos are not usually an option,
because real treatment must be given to injured patients.
In trauma, there is no time to try different treatments, consider
alternatives or have multiple appointments to discuss care. We must arm
medical personnel with the tools they need to make the right decisions
quickly. Lives can be saved. Focused clinical research will provide
knowledge, tools and answers.
Often a single Level 1 Trauma Center can't recruit enough patients
with specific enrollment criteria to conduct a statistically
significant study that provides enough evidence to reach a conclusion
that would alter clinical practice. Therefore large, multi-center
studies are required, and these necessitate substantial funding. Due to
limited funding, studies have often been narrow in size, sporadic, and/
or conducted on the basis of a physician's personal interest, rather
than a cohesive approach borne from a national trauma research agenda.
The majority of the funding added by Congress in fiscal year 2011
did not go to trauma-related research \9\. The Congressionally Directed
Medical Research Program did fund some research into areas that cause a
high degree of disability in wounded warriors returning home, such as
orthopaedic, eye, ear, craniofacial, and traumatic brain injury. NTI
urges the subcommittee to equally fund the major cause of preventable
death of our soldiers, sailors, airmen and marines.
---------------------------------------------------------------------------
\9\ (2011) H.R.1473.
---------------------------------------------------------------------------
For fiscal year 2011, Congress added over $700 million to the
President's budget request for DOD medical research funding.
Recognizing the need to reduce overall Federal spending, this sum is
significantly less than Congress provided in fiscal year 2009 and
fiscal year 2010 when over $1 billion was added each year.
The National Trauma Institute believes that whatever additional sum
Congress determines can be allocated to DOD medical research for fiscal
year 2012 should be directed more specifically to research of the
traumatic medical conditions which most severely affect our soldiers.
RESEARCH WORKS
It has been proven repeatedly that medical research saves lives.
For instance, in 1950 a diagnosis of leukemia was tantamount to a death
sentence. Research led to chemotherapy treatments in the 1950s and bone
marrow transplantations in the 1970s. A substantial investment in
research has led to safer and more effective treatments, and today
there is a 90 percent survival rate for leukemia \10\. Another example
is breast cancer. Thirty years ago only 74 percent of women who were
diagnosed lived for another 5 years. Due to research into early
detection, chemotherapy and pharmaceuticals, the 10-year survival rate
for breast cancer is now 98 percent \11\.
---------------------------------------------------------------------------
\10\ (2011) Research Successes. Leukemia and Lymphoma Society
http://www.lls.org/#/aboutlls/researchsuccesses/. Accessed June 2,
2011.
\11\ (2011) Our Work. Susan G. Komen For the Cure http://
ww5.komen.org/AboutUs/OurWork.html. Accessed June 2, 2011.
---------------------------------------------------------------------------
Fifty years of dedicated research into proper diagnosis and
treatment of leukemia has led to an 80 percent reduction in the death
rate. Imagine even a 5 percent reduction in trauma deaths, injuries and
economic burden--this would save the United States $35 billion, prevent
1.5 million injuries, and save almost 9,000 lives every year.
Recommendation.--Hence NTI recommends that Congress set aside a
major portion of DOD medical research funding--at least $15 million--in
the Defense Health Program account for a peer-reviewed research program
to spur better technology to treat non-compressible hemorrhage.
Chairman Inouye. I thank you very much, Dr. Jenkins.
Senator Cochran. I may have missed it, but what
specifically would you recommend that we do in terms of
procedure or education requirements that would help address the
problem that you've described in your testimony?
Dr. Jenkins. Yes, sir. Hemorrhage from the extremities has
been treated with a number of devices that have been developed,
invented specifically for use in combat, that have now been
translated over into the civilian setting, so that EMS agencies
carry tourniquets and hemostatic bandages. There is no such
device if your liver or spleen is damaged in a traumatic event.
The soldiers on the battlefield when injured, cared for by
medics, the medic has no tools to treat that non-compressible
hemorrhage except to get him to surgery as soon as possible.
These soldiers have died awaiting the opportunity to get to
surgery.
We need treatments that we can render to those soldiers on
the battlefield, to those citizens in the field, by EMS
agencies, so that we can stop that hemorrhage and stop that
death.
Senator Cochran. Thank you very much.
Chairman Inouye. Thank you.
Senator Shelby.
Senator Shelby. Mr. Chairman, just a quick observation and
question. We've learned a lot and we've also, with helicopters
and medical treatment, which have changed a lot. We've learned
a lot since Vietnam, certainly since Korea, since the Second
World War, and so forth. What is the basic survival rate in
combat, heavy combat, now compared to, say, Vietnam, Korea? Do
you have some statistics on that, because I know from what I
have observed at Walter Reed and Bethesda and talking to a lot
of veterans they probably wouldn't have survived, a lot of
them, even in Vietnam, in the Second World War, Korea, and so
forth.
You're doing a lot better that way, but also they're facing
great challenges. The sooner you get to them and the sooner
they get medical help and sometimes get to the hospital, the
better.
Have you got any comments on that? Am I right, on the right
track here?
Dr. Jenkins. You are on the right track, sir. The Joint
Trauma Registry keeps very specific data on this and keeps a
rolling number that they look at. We look specifically at what
one would call the case fatality rate, if injured the risk of
dying.
Senator Shelby. Can you furnish this to the subcommittee?
You may have, but as I said earlier, I serve on another
committee, subcommittee, dealing with the NIH and everything,
and we're all interested in all of it. Right now we're focused
on the military. But trauma is everywhere and what goes on in
the military translates to others too, does it not?
Dr. Jenkins. Yes, sir. Survival is better because of
advances in combat medicine, because of better body armor.
We're at the point now where we have--we're looking
specifically at casualties who should have survived had we only
better tools and techniques to be able to get them to live
through it.
Senator Shelby. Thank you, Mr. Chairman.
Chairman Inouye. Thank you, Dr. Jenkins.
Rear Admiral Coane.
STATEMENT OF REAR ADMIRAL CASEY COANE, UNITED STATES
NAVY (RETIRED), EXECUTIVE DIRECTOR,
ASSOCIATION FOR THE UNITED STATES NAVY
Admiral Coane. Mr. Chairman, Senator Cochran, Senator
Shelby: The Association for the United States Navy is once
again very pleased to have this opportunity to testify. Our
association focuses its legislative activity on both personnel
issues and the equipment necessary for the Navy and Navy
Reserve to accomplish its missions. It is only through the
attention of Congress and SUBcommittees such as yours that we
can be sure that their needs are met.
We are grateful for this annual opportunity and, in a
departure from many of my colleagues earlier this morning, I'm
going to speak about equipping the Navy. The ships and aircraft
of which I am speaking are vital to this war effort and
directly support the thousands of Navy and other services' men
and women serving on the ground in Iraq, Afghanistan, or other
places ashore in operations worldwide, 53,000 sailors deployed
today, including 5,300 mobilized reservists.
I have a few general statements and then I will address
specific programs. We are pleased with the increased emphasis
that the House and Senate have shown toward Navy shipbuilding
in order to fulfil the Nation's maritime strategy. To meet
those requirements, the Navy needs your support for the current
shipbuilding plans. The Navy is behind on the 313-ship plan due
to funding shortages and the only means to achieve a realistic
plan is through this subcommittee's efforts.
As the current efforts in Iraq and Afghanistan wind down,
the need for our Navy to protect our sea lines of
communication, through which 90 percent of our commerce flows,
will, as always, remain an issue of national security.
Regarding the Navy Reserve, the irreversible transition
from a strategic reserve to an operational reserve with
predictable and periodic mobilization increases the need for
these Reserve components to be properly resourced for
equipment. The recent comprehensive review on Reserve component
report stresses the need to ensure that these components have
both the equipment necessary to do the job and also the
equipment necessary to train for the mission.
The Navy's 30-year aircraft program, the Naval Aviation
Plan 2030, is well laid out and moving forward, but it still
has significant challenges ahead in the areas of tactical
fighters and logistics for out-CONUS operations. Aircraft
programs of great concern are the C-40 replacement for the C-9s
and the KC-130J tactical airlifters to replace the C-130s. Both
of these aircraft are extensively used for intra-theater
operations for Iraq, Afghanistan, and support Navy fleet
movements worldwide, including disaster relief operations.
The issue is not just newer aircraft. The C-40As are Navy-
unique fleet essential airlift, not VIP transport. The issue is
that the current C-9 aircraft and C-20Gs have turned the
maintenance expense curve to the extent that prudent business
practices dictate replacement now. These aircraft in Hawaii,
Fort Worth, and Maryland are scheduled to be decommissioned in
fiscal year 2012 to 2014.
The Navy needs five to six more C-40s to finish the program
and it needs some of them this year. Anything that this
subcommittee could do to fund and accelerate that program,
perhaps by utilization of the National Guard and Reserve
equipment accounts, would be most beneficial to the Navy and
the Navy Reserve.
The 30-year plan has the requirement for the replacement of
the C-130Ts with the KC-130J aircraft. Currently this essential
tactical intra-theater airlift is operating five aircraft short
of requirement. Each year that the new aircraft is delayed will
force the Navy to spend more money to upgrade worn-out aircraft
to meet the new worldwide aviation equipment standards. We urge
the committee to bring the KC-130J forward in the FYDP or by
adding to the NGRE account.
The P-8 aircraft is an on-time, on-budget program to
replace the P-3 aircraft, the backbone of the Navy's
reconnaissance effort in theater, as well as the Navy's current
anti-submarine and anti-shipping combat aircraft, as
demonstrated recently in Libyan operations. Unfortunately, P-8
procurement was planned so far to the right that many, many P-
3s are already grounded with broken wings. Anything that this
subcommittee could do to accelerate that program, perhaps again
by use of the NGRE accounts, would be most beneficial.
Again, the Association of the United States Navy thanks the
subcommittee for their tireless efforts on behalf of the Navy
and for providing this opportunity to be heard today.
[The statement follows:]
Prepared Statement of Rear Admiral Casey Coane
THE ASSOCIATION OF THE UNITED STATES NAVY
The Association of the United States Navy (AUSN) recently changed
its name as of May 19, 2009. The association, formerly known as the
Naval Reserve Association, traces its roots back to 1919 and is devoted
solely to service to the Nation, Navy, the Navy Reserve and Navy
Reserve officers and enlisted. It is the premier national education and
professional organization for Active Duty Navy, Navy Reserve personnel,
Veterans of the Navy, families of the Navy, and the Association Voice
of the Navy and Navy Reserve.
Full membership is offered to all members of the U.S. Navy and
Naval Reserve. Association members come from all ranks and components.
The Association has active duty, reserve, and veterans from all 50
States, U.S. Territories, Europe, and Asia. Forty-five percent of AUSN
membership is active reservists, active duty, while the remaining 55
percent are made up of retirees, veterans, and involved DOD civilians.
The National Headquarters is located at 1619 King Street Alexandria,
Virginia. 703-548-5800.
Mister Chairman and distinguished members of the Committee, the
Association of the United States Navy is very grateful to have the
opportunity to testify.
Our transitioned VSO-MSO association works diligently to educate
Congress, our members, and the public on Navy equipment, force
structure, policy issues, personnel and family issues and Navy
veterans.
I thank this Committee for the ongoing stewardship on the important
issues of national defense and, especially, the reconstitution and
support of the Navy during wartime. At a time of war, non-partisan
leadership sets the example.
Your unwavering support for our deployed Service Members in Iraq
and Afghanistan (of which over 14,000 Sailors are deployed at Sea in
the AOR and over 10,000 are on the ground--Active and Reserve) and for
the world-wide fight against terrorism is of crucial importance.
Today's Sailors watch Congressional actions closely. AUSN would like to
highlight some areas of emphasis.
As a Nation, we need to supply our service members with the
critical equipment and support needed for individual training, unit
training and combat as well as humanitarian and peacekeeping
operations. Additionally, we must never forget the Navy families,
reserve members and the employers of these unselfish volunteers--Active
and Reserve.
In recent years, the Maritime Strategy has been highlighted,
debated and disputed. We feel this is a time where the Total Navy force
needs to be stabilized, strengthened, and be reconstituted--because of
the consistent, constant, and increasing National Security crisis in a
dangerous world--
--Piracy is on the rise in many areas of the world, and especially in
the 5th Fleet AOR;
--The flow of commerce still remains a top priority for our economy;
--Naval engagement and support on the ground, in the air, and on the
seas for OIF and OEF has not decreased;
--Ever increasing Middle East instability;
--Ballistic missile threats (N Korea-Iran) and the Navy requirement
to be the front line of defense for missile defense threat;
--U.S. Navy response to natural disasters; tsunami, Haiti, Chile, and
possible man made disasters (oil spill support);
--Humanitarian assistance in the Philippines, Indonesia, and American
Samoa; and
--Ever increasing and changing Arctic issues.
In addition to equipment to accomplish assigned missions, the AUSN
believes that the administration and Congress must make it a high
priority to maintain, if not increase, but at least stabilize the end
strengths of already overworked, and perhaps overstretched, military
forces. This includes the Active Navy and the Navy Reserve.
--Reductions in manpower are generally resource driven within the
Service, not because people are not needed, and the reductions
of their benefits are resource driven.
Our current maritime history and strategy--requires that our Nation
must achieve the 313+ Navy Ships, not decrease them, and there should
be a balance between personnel end-strengths and equipment.
As proven in recent events (Libya, Piracy, Osama Bin Laden, OCO
operations) Naval Special Operations, U.S. Carriers, submarines, and
Naval Aviation are more relevant than ever--as proven by constant
actions in Iraq and Afghanistan and ongoing operations in OIF-OEF and
throughout Southwest Asia. Additionally--Navy weapon systems and
personnel play a critical role in Natural disasters around the world!
Therefore, it is not a time--to cut back. Our adversaries are only
waiting for the time for us to cut back or to stall. China is
developing a peer Chinese Navy.
We must fund the Navy for proper shipbuilding and aviation programs
which the House this year authorized funds to accomplish.
As you know, neither the Navy nor the Navy Reserve has ever been a
garrisoned force--but, a deployed force. Nothing has changed in recent
contingency operations or wars, except that the Navy's forces needs
equipment as much as anyone. We have worn out current equipment and we
need the manpower and infrastructure to ensure that current and future
equipment stays ready.
We recognize that there are many issues and priorities that need to
be addressed by this Committee and this Congress. The Association of
the United States Navy supports the Navy's fiscal year 2012 budget
submission and the past years Unfunded Programs List provided by the
Chief of Naval Operations that addressed an increased shipbuilding and
increase aircraft procurement to relieve the documented shortages and
maintenance requirements.
Overwhelmingly, we have heard Service Chiefs, Reserve Chiefs and
Senior Enlisted Advisors discuss the need and requirement for more
equipment and unit equipment for training in order to be ready as well
as combat equipment in the field. Navy needs to have equipment and unit
cohesion to keep personnel trained. This means--Navy equipment and Navy
Reserve equipment with units.
Equipment Ownership
Issue: Sharing of equipment has been done in the past. However,
nothing could be more of a personnel readiness issue and is ill
advised. This issue needs to be addressed if the current National
Security Strategy is to succeed.
Position: The overwhelming majority of Navy and Navy Reserve
members join to have hands-on experience on equipment. The training and
personnel readiness of members depends on constant hands-on equipment
exposure. History shows, this can only be accomplished through
appropriate equipment, since the training cycles are rarely if ever--
synchronized with the training or exercise times or deployment times.
Additionally, historical records show that units with unit hardware
maintain equipment at higher than average material and often have
better training readiness. This is especially true with Navy Reserve
units. Current and future warfighting requirements will need these
highly qualified units when the Combatant Commanders require fully
ready units.
Navy has proven its readiness. The personnel readiness, retention,
and training of all members will depend on them having equipment that
they can utilize, maintain, train on, and deploy with when called upon.
AUSN recommends the Committee strengthen the Navy equipment
appropriation as the House has done in the fiscal year 2012 NDAA in
order to maintain optimally qualified and trained Navy and Navy Reserve
forces.
Equipment Needs and Request
AUSN respects the tremendous pressure on the U.S. budget. However,
the Navy and the Navy Reserve where a deployed force prior to September
11, 2001 and the Navy and the Navy Reserve will remain a deployed force
for foreseeable future. Therefore we request that you give strong
consideration to: Funding one C-40A in the fiscal year 2012
appropriations bill for replacement of aged aircraft in Maryland and
Hawaii; fund two C-130J aircraft for Navy and Navy Reserve in the
fiscal year 2012 appropriations bill; and ensure the proper lead
funding is available to maintain TACAIR aircraft for 11 Carrier Air
Wings.
Manpower issues--Pay, and End-strength
Pay needs to be competitive. If pay is too low, or expenses too
high, a service member knows that time may be better invested
elsewhere.
The current discussions about changes in retirement and increases
in healthcare is woefully inappropriate when the Nation considers what
service members, Navy members, are doing in defense of this Nation, and
in support of natural disasters. The risks and sacrifices of every
service member, to defend this great Nation, make it illogical to
formulate a policy change in retirement pay for military when they
sacrifice so much. It just does not make common sense.
End-strength is the core of any service accomplishing the mission.
Navy and Navy Reserve has taken a fair share of budget driven end-
strength cuts in the previous 10 years. It is time to stop the cuts and
ensure that we have the right number of people to conduct operations.
Care must be taken that the current tremendous reservoir of
operational capability be maintained and not lost due to resource
shortages. Officers, Chief Petty Officers, and Petty Officers need to
exercise leadership and professional competence to maintain their
capabilities. In the current environment of Navy Individual Augmentee
in support of ground forces, there is a risk that Navy mid-grade
leadership will not be able to flourish due to the extended ground war
of OIF and OEF. Having the right equipment is critical to our Maritime
Strategy.
In summary, we believe the Committee needs to address the following
issues for Navy and Navy Reserve in the best interest of our National
Security:
--Fund one C-40A for the Navy, per the past years documented request;
--Navy must replace the C-9s and replace the C-20Gs in Hawaii and
Maryland.
--Fund the FA-18 E/F and FA-18 E/F Growlers per the House fiscal year
2011 NDAA and include unit assets for Navy Reserve units
currently in EA-6B aircraft.
--Fund the Navy Ships provided for in the House fiscal year 2012
NDAA.
--Just as other services are having difficulties with intra theater
C-130 assets, the Navy needs to replace their C-130 aircraft
with C-130J for the Navy and Navy Reserve.
--Request you fund 2 C-130J Aircraft for Navy Reserve for combat
support for Navy and Navy Reserve assets in theater
operations for OCO.
--Increase funding for Naval Reserve equipment in NGREA
--Increase Navy Reserve NGREA by $100 million
--Naval Expeditionary Combat Equipment
--Ensure proper lead funding for TACAIR Navy Aircraft.
For the foreseeable future, we must be realistic about what the
unintended consequences are from a high rate of usage. History shows
that an Active force and Reserve force are needed for any country to
adequately meet its defense requirements, and to enable success in
offensive operations. Our Active Duty Navy and the current operational
Reserve members are pleased to be making a significant contribution to
the Nation's defense as operational forces; however, the reality is
that the added stress on Active Navy and the Reserve could pose long
term consequences for our country in recruiting, retention, family and
employer support. In a time of budget cut discussions, this is not the
time to cut end-strengths on an already stressed force. We have already
been down this road previously. This issue deserves your attention in
pay, maintaining end-strengths, proper equipment, Family Support
Programs, Transition Assistance Programs and for the Employer Support
for the Guard and Reserve programs.
Thank you for your ongoing support of the Nation, the Armed
Services, the United States Navy, the United States Navy Reserve, their
families, and Navy veterans, and the fine men and women who defend our
country.
Chairman Inouye. Thank you very much, Rear Admiral Coane.
Senator Cochran.
Senator Cochran. Mr. Chairman, I was wondering about our
other witness at the table here. We're to ask you questions
now?
Let me ask you. If the funding is added as you request, is
this going to be additional funding that we'll have to come up
with over and above the allocation of the subcommittee, or do
you recommend any offsets in funding that would have to be
undertaken?
Admiral Coane. No, sir. I'm concerned--we have--in this
year's budget there's one C-40, but in the 2012, 2013, and 2014
budgets those have been zeroed out. The Navy's program is to
buy 17 of them. There are still five more they've got to have.
As I mentioned, the C-20Gs are falling off the table,
literally.
So this is additional National Guard and Reserve equipment
funding that we're suggesting. The unfunded list, as has been
mentioned before, for the Navy is virtually nonexistent. That's
not because they don't need things. That's because of DOD
policy. So we need to look further into supporting these
aircraft.
The C-20Gs in Hawaii and the ones here at Andrews have
flown thousands of hours beyond what Gulfstream ever intended
those airplanes to fly, because they were built as corporate
jets. The Navy operates them with cargo doors, but they're used
up and they're going to just simply go away. We've got to
replace that asset.
Senator Shelby. Do we run the risk of having accidents and
failures if we don't replace those with other assets?
Admiral Coane. Senator, I'm careful. I had a 34-year career
in the airline world as well as an aviator, so I'm very careful
to talk about--are we running the risk? Well, flying aircraft
is always a risk-reward or risk-benefit business. Any time we
get airborne, as you know, there's risk involved. Does the risk
go up on the aircraft? I would say that our military people
manage the aging of the aircraft. What goes up is the expense
of operating the aircraft. In the case of broken-wing P-3s,
they're simply worn out and you can't do anything about it.
So I wouldn't suggest to you that--I wouldn't ring the
safety bell and say that our military won't continue to be
safe, because they're good at that. But the financial
obligation--when an aircraft turns the maintenance curve, the
dollars go significantly higher very, very quickly. Our C-9s
and our C-20s and the C-130Ts are at that point.
Senator Cochran. Thank you very much for your perspective.
I think that's very helpful to our subcommittee.
Admiral Coane. Yes, sir.
Senator Cochran. Thank you.
Chairman Inouye. Senator Shelby.
Senator Shelby. Mr. Chairman, I'll try to be brief here.
The Admiral here has gotten my attention on some things, and
I'm sure the subcommittee.
The survivability rate--well, the death rate of
hemorrhage--hemorrhage is a big cause of death, right,
battlefield, hemorrhaging?
Admiral Coane. Senator, are you referring to my colleague
here to my right?
Senator Shelby. Yes, hemorrhaging; is that right, on the
battlefield?
Dr. Jenkins. Yes, sir.
Senator Shelby. So what they're trying to do, you're trying
to get into research whether you can deal with wounds to the
torso, the neck, the blood vessels, all of this, because if you
can do that you'll save lives, right?
Dr. Jenkins. Yes, sir, precisely correct.
Senator Shelby. But a lot of that is--you're using, a lot
of it's the same treatment we've used for years. We haven't had
a super-breakthrough there, have we?
Dr. Jenkins. And that's directly related to the lack of
research funding and why NTI exists, sir, yes, sir.
Senator Shelby. Thank you.
Chairman Inouye. Thank you very much.
Ms. Goraleski.
STATEMENT OF KAREN A, GORALESKI, EXECUTIVE DIRECTOR,
AMERICAN SOCIETY OF TROPICAL MEDICINE AND
HYGIENE
Ms. Goraleski. Chairman Inouye, Ranking Member Cochran,
Senator Shelby, and subcommittee staff: My name is Karen
Goraleski and I am the Executive Director of the American
Society of Tropical Medicine and Hygiene. Thank you for the
privilege of testifying before you today. We are the principal
professional membership organization of scientists, physicians,
clinicians, epidemiologists, and program professionals
dedicated to the prevention and control of tropical diseases.
We are here today to request that the subcommittee expand
funding for the DOD's efforts to develop new preventions,
treatments, vaccines, and diagnostics that will prevent--that
will protect our service members and other Americans from
tropical diseases and at the same time will reduce premature
deaths and disability in the developing world.
The central public policy priority of the Society is to
reduce the burden of infectious disease in the developing
world, areas of the world where many of our military serve.
Many of our top health concerns align with the superbly
executed and longstanding DOD research on tropical diseases and
on what are also called the neglected tropical diseases.
Mission success and readiness will be hampered without
sustained efforts to reduce these no longer so-called
``exotic'' health threats.
Infectious disease is the ever-present enemy. The drugs and
preventive measures used in earlier conflicts in tropical
regions no longer are as reliable as they once were. Therefore,
our task list for new and effective tools must not only focus
on today, but on tomorrow.
There are three particular DOD facilities working to
strengthen mission readiness and success: The Army Medical
Research Institute for Infectious Diseases, the Walter Reed
Army Institute for Research, and the U.S. Naval Medical
Research Center.
First, USAMRID. Its mission is to protect our military from
biological threats. Through its biosafety levels 3 and 4 labs
and its world-class highly trained personnel, they are in the
business of generating countermeasures to biological threats to
our country. Like each of these facilities, their work delivers
a return on investment that extends beyond our military to
citizens.
Next is WRAIR. A large part of the DOD investment in
infectious disease research and development is facilitated
through WRAIR. In addition to DOD funding, WRAIR has advanced
infectious disease research and provided cost-effective
solutions, in part by working smart through domestic and
international public-private partnerships. Their portfolio
includes work on a malaria vaccine and efforts to control its
transmission, as well as that of other vector-borne diseases,
drug developments for leishmaniasis, enteric disease research,
and HIV/AIDS research.
Through its collaborative efforts, WRAIR has developed
several exciting vaccine candidates, including one that
recently began the ever-large phase 3 trial for a malaria
vaccine, RTSS. Is this encouraging? Yes. Do we need to find out
more? Yes.
Last, NMRC. The premier research facility includes a focus
on malaria, enteric diseases, causes of traveler's diarrhea,
dengue fever, now seen in southern Florida, and scrub typhus.
In addition to its work accomplished in the United States, the
Navy's three overseas medical research laboratories located in
Peru, Egypt, and Indonesia offer outstanding scientific
collaborations and equally productive relationships with their
governments that in turn help the United States.
In closing, all three facilities offer state-of-the-art
technologies to protect our troops and can save millions of
lives of people around the world. Closer to home, they also
provide good-paying, quality jobs to American scientists, lab
personnel, and ancillary businesses. ASTMH is confident that
increased support for efforts to reduce these global and in
some instances U.S. health threats is the smart thing to do for
America and the right thing to do for the world.
Thank you for this opportunity. The Society stands ready to
serve as an expert resource to you. We are all in this
together.
[The statement follows:]
Prepared Statement of Karen A. Goraleski
EXECUTIVE SUMMARY
The American Society of Tropical Medicine and Hygiene (ASTMH)--the
principal professional membership organization representing, educating,
and supporting scientists, physicians, clinicians, researchers,
epidemiologists, and other health professionals dedicated to the
prevention and control of tropical diseases--appreciates the
opportunity to submit written testimony to Senate Defense
Appropriations Subcommittee.
The central public policy priority of ASTMH is reducing the burden
of infectious disease in the developing world. To that end, we advocate
implementation and funding of Federal programs that address the
research, prevention, and control of infectious diseases that are
leading causes of death and disability in the developing world, and
which pose threats to U.S. citizens. Many of our current priorities
overlap with the excellent and long-standing tropical medicine and
neglected disease research work being done within the Department of
Defense, including malaria and other vector-borne diseases; tropical
diseases such as dengue fever and leishmaniasis; and enteric diseases.
Because U.S. servicemen and women are often deployed to tropical
regions endemic to tropical diseases, reducing the risk that these
diseases present to servicemen and women is often critical to mission
success. Our military has long taken a primary role in the development
of treatments for tropical diseases, such as anti-malarial drugs. As a
result of this investment and the innovation employed by these military
scientists, they have developed many of the most effective and widely
used treatments for these diseases.
For this reason, we respectfully request that the Subcommittee
expand funding for the Department of Defense's longstanding and
successful efforts to develop new drugs, vaccines, and diagnostics
designed to protect service members from malaria and tropical diseases.
Specifically, ASTMH requests that increased funding be allocated to the
Army Medical Research Institute for Infectious Diseases (USAMRIID), the
Walter Reed Army Institute of Research (WRAIR), and the U.S. Naval
Medical Research Center (UNMC), who work closely together to maximize
and ensure the most efficient research portfolios.
UNITED STATES ARMY MEDICAL RESEARCH INSTITUTE FOR INFECTIOUS DISEASES
USAMRIID's mission includes advancing research to develop medical
solutions--vaccines, drugs, diagnostics, and information--to protect
our military service members from biological threats. USAMRIID has
Biosafety Level 3 and Level 4 laboratories and world-class expertise in
the generation of countermeasures for biological threats playing a
critical role in the status of our country's preparedness for
biological terrorism and biological warfare. While their primary
mission is to protect the service members, like each of the research
facilities, their important work benefits civilians as well.
WALTER REED ARMY INSTITUTE OF RESEARCH
A large part of DOD investments in infectious disease research and
development are facilitated through WRAIR, which since fiscal year 2007
has performed more that $250 million in DOD research. Through critical
public private partnerships with companies such as GSK and Sanofi, as
well as nonprofits such as the Gates Foundation and Medicines for
Malaria Venture, WRAIR invests in malaria vaccine and drug development,
drug development for leishmaniasis, enteric disease research, vector
control for malaria and other vector-born infections, and HIV/AIDS
research and treatment. While each of these investments is crucial to
the protection of U.S. troops abroad, WRAIR is also a partner to the
global health community in saving the lives of some of the world's
poorest people suffering from some of the most neglected diseases.
WRAIR has research laboratories around the globe, including a
public health reference laboratory in The Republic of Georgia; dengue
fever clinical trials in the Philippines; malaria clinical studies and
Global Emerging Infectious Surveillance in Kenya; military entomology
network field sites in Thailand, the Philippines, Nepal, Cambodia,
Korea, Kenya, Ethiopia, Egypt, Libya, Ghana, Liberia and Peru; as well
as several other coordination efforts with national health ministries
and defense units. This diversity in research capacity puts WRAIR in
the unique position to be a leader in research and development for
tropical diseases--research that will aid our military men and women as
well as people living in these disease-endemic countries.
UNITED STATES NAVAL MEDICAL RESEARCH CENTER
NMRC is a premier medical and health research organization whose
focus includes tropical medicine and infectious disease. The Infectious
Disease Directorate (IDD) of NMRC focuses on malaria, enteric diseases,
and viral rickettsial diseases. IDD has an annual budget exceeding $10
million and conducts research on infectious diseases that are
considered to be a significant threat to our deployed sailors, marines,
soldiers and airmen. Their current research efforts are focused on
malaria, bacterial causes of traveler's diarrhea, dengue fever, and
scrub typhus with particular emphasis on vaccine discovery and testing.
The research is enhanced by IDD's close working relationship with the
Navy's three overseas medical research laboratories located in Peru,
Egypt, and Indonesia. These laboratories also afford diplomatic
advancement through the close working relationships they have developed
with governments and citizens of those countries.
TROPICAL MEDICINE AND TROPICAL DISEASES
The term ``tropical medicine'' refers to the wide-ranging clinical,
research, and educational efforts of physicians, scientists, and public
health officials with a focus on the diagnosis, mitigation, prevention,
and treatment of vector borne diseases prevalent in the areas of the
world with a tropical climate. Most tropical diseases are located in
either sub-Saharan Africa, parts of Asia (including the Indian
subcontinent), or Central and South America. Many of the world's
developing nations are located in these areas; thus tropical medicine
tends to focus on diseases that impact the world's most impoverished
individuals.
U.S. troops are currently deployed or likely to be deployed in many
of these same tropical areas. U.S. citizens, working, traveling and
vacationing overseas are similarly impacted by these same tropical
diseases, many of which have been ignored and neglected for decades.
Furthermore, some of the agents responsible for these diseases could be
introduced and become established in the United States (as was the case
with West Nile virus), or might even be weaponized.
The United States has a long history of leading the fight against
tropical diseases which cause human suffering and pose a great
financial burden that can negatively impact a country's economic and
political stability. The benefits of U.S. investment in tropical
diseases extend beyond economics and humanitarianism and into diplomacy
as well.
MALARIA--A FORMIDABLE FOE FOR U.S. MILITARY OPERATIONS
Service members deployed by the U.S. military comprise a majority
of the healthy adults traveling each year to malarial regions on behalf
of the U.S. Government. Malaria has long been a threat to U.S. military
deployment success. In fact, more person-days were lost among U.S.
military personnel due to malaria than to bullets during every military
campaign fought in malaria-endemic regions during the 20th century. For
this reason, the U.S. military has long taken a primary role in the
development of anti-malarial drugs, and nearly all of the most
effective and widely used anti-malarials were developed in part by U.S.
military researchers. Drugs that have saved countless lives throughout
the world were originally developed by the U.S. military to protect
troops serving in tropical regions during WWII, the Korean War, and the
Vietnam War.
In recent years the broader international community has increased
its efforts to reduce the impact of malaria in the developing world,
particularly by reducing childhood malaria mortality, and the U.S.
military plays an important role in this broad partnership. However,
military malaria researchers at NMRC and WRAIR are working practically
alone in the area most directly related to U.S. national security:
drugs and vaccines designed to protect or treat healthy adults with no
developed resistance to malaria who travel to regions endemic to the
disease. NMRC and WRAIR are working on the development of a malaria
vaccine and on malaria diagnostics and other drugs to treat malaria--an
especially essential investment as current malaria drugs face their
first signs of drug resistance.
The malaria parasite demonstrates a notorious and consistent
ability to quickly develop resistance to new drugs. The latest
generation of medicines is increasingly facing drug-resistance. Malaria
parasites in Southeast Asia have already shown resistance to
mefloquine; resistant strains of the parasite have also been identified
in West Africa and South America. There are early indications that
parasite populations in Southeast Asia may already be developing
limited resistance to artemisinin, currently the most powerful anti-
malarial available. Further, the most deadly variant of malaria--
Plasmodium falciparum--is believed by the World Health Organization to
have become resistant to ``nearly all anti-malarials in current use.''
Resistance is not yet universal among the global Plasmodium
falciparum population, with parasites in a given geographic area having
developed resistance to some drugs and not others. However, the sheer
speed with which the parasite is developing resistance to mefloquine
and artemisinin--drugs developed in the 1970s--bodes of a crisis of
such significance that military malaria researchers cannot afford to
rest on their laurels.
WRAIR, in concert with multiple organizations including the CDC and
vaccine manufacturers, has developed several exciting vaccine
candidates, including one that recently began the first ever large-
scale Phase 3 trial for a malaria vaccine, (RTS,S). In earlier trials,
the vaccine has been shown to decrease clinical episodes of malaria by
over 50 percent in children in Africa. Despite these advances, the
vaccine might be unsuitable for deploying personnel and travelers,
because of its efficacy level. As a result, there is still a
significant need for continued funding for ongoing research.
Developing new antimalarials as quickly as the parasite becomes
resistant to existing ones is an extraordinary challenge, and one that
requires significant resources, especially as U.S. military operations
in malaria-endemic countries increase. Without new anti-malarials to
replace existing drugs as they become obsolete, military operations
could be halted in their tracks by malaria. The recent malaria outbreak
affecting 80 of 220 Marines in Liberia in 2003 serves as an ominous
reminder of the impact of malaria on military operations. Humanitarian
missions also place Americans at risk of malaria as evidenced by
several Americans contracting malaria while supporting Haitian
earthquake relief efforts.
TROPICAL DISEASE IMPACT ON MILITARY OPERATIONS
Few other U.S. Government agencies devote as much time, funding,
manpower, and direct research to tackling these devastating diseases as
the DOD. The work ultimately goes beyond protecting soldiers and
benefits the people living in the countries where these diseases cause
the most harm. The recent success of the RTS, S malaria vaccine and its
advancement to Phase 3 trials is just one success story from this
program. DOD also does great research for other tropical diseases
including leishmaniasis and dengue fever, two potentially deadly
diseases of great risk to our troops and even greater risk to the
citizens of these disease endemic regions.
Leishmaniasis is a vector borne disease that is caused by the
parasite leishmania. It is transmitted through the bite of the female
phlebotomine sandfly. Leishmaniasis comes in several forms, the most
serious of which is visceral leishmaniasis, which affects internal
organs and can be deadly if left untreated.
According to the WHO, over 350 million people are at risk of
leishmaniasis in 88 countries around the world. It is estimated that 12
million people are currently infected with leishmaniasis and 2 million
new infections occur annually. Coinfection of leishmaniasis and HIV is
becoming increasingly common, and WHO notes that because of a weakened
immune system leishmaniasis can lead to an accelerated onset of AIDS in
HIV-positive patients.
Because of leishmaniasis' prevalence in Iraq, the DOD has spent
significant time and resources on the development of drugs and new
tools for the treatment of leishmaniasis. As more troops return from
Iraq and Afghanistan, it is likely DOD will see an increase in
leishmaniasis cases in our soldiers. WRAIR discovered and developed
Sitamaquine, a drug that once completed, will be an oral treatment for
leishmaniasis. While essential for the safety of our servicemen and
women abroad, these types of innovations will also be extremely
beneficial to the at risk populations world wide that are living in
leishmaniasis endemic countries.
Dengue fever, according to the WHO is the most common of all
mosquito-borne viral infections. About 2.5 billion people live in
places where dengue infection is possible and last year we saw a few
cases pop up in the United States. There are four different viruses
that can cause dengue infections. While infection from one of the four
viruses will leave a person immune to that strain of the virus, it does
not prevent them from contracting the other three, and subsequent
infections can often be more serious.
The DOD has seen about 28 cases of dengue in soldiers per year.
While none of these cases resulted in the death of a soldier,
hospitalization time is lengthy. Currently, there are several research
and development efforts underway within the department of defense both
for treatments and vaccines for dengue.
U.S. GOVERNMENT ACTION IS NEEDED FOR MISSION READINESS
The role of infectious disease in the success or failure of
military operations is often overlooked. Even a cursory review of U.S.
and world military history, however, underscores that the need to keep
military personnel safe from infectious disease is critical to mission
success. The drugs and prophylaxis used to keep our men and women safe
from malaria and tropical diseases during previous conflicts in
tropical regions are no longer reliable. Ensuring the safety of those
men and women in future conflicts and deployments will require research
on new tools. Additional funds and a greater commitment from the
Federal Government are necessary to make progress in malaria and
tropical disease prevention, treatment, and control.
ASTMH feels strongly that increased support for efforts to reduce
this threat is warranted. A more substantial investment will help to
protect American soldiers and potentially save the lives of millions of
individuals around the world. We appreciate the opportunity to share
our views in our testimony, and please be assured that ASTMH stands
ready to serve as a resource on this and any other tropical disease
policy matters.
Thank you for your attention to this matter.
Chairman Inouye. I thank you very much, Ms. Goraleski.
Senator Cochran.
Senator Cochran. Ms. Goraleski, how close do you think we
are to developing a new vaccine or a more effective vaccine
against malaria? It seems to be a big threat.
Ms. Goraleski. We are at a very positive place in terms of
a malaria vaccine. We're just starting that phase 3 clinical
trial. We're very hopeful.
Chairman Inouye. Thank you very much.
Senator Shelby.
Senator Shelby. Besides malaria, what are, say, one or two
of the most challenging tropical diseases? I know there are
many out there.
Ms. Goraleski. The parasitic diseases are very, very
challenging. Sandflies transmit leishmaniasis. We also have
other parasites that are equally debilitating and often hard to
diagnose at first and then can last for decades.
Senator Shelby. Thank you.
Chairman Inouye. I thank the panel very much.
Now may I call upon: Major General Gus Hargett, National
Guard Association of the United States; Mr. Dale Lumme, Navy
League of the United States; Mr. John R. Davis, Fleet Reserve
Association; Ms. Susan Leighton, Ovarian Cancer National
Alliance.
May I call upon Major General Hargett.
STATEMENT OF MAJOR GENERAL GUS HARGETT, UNITED STATES
ARMY (RETIRED), PRESIDENT, NATIONAL GUARD
ASSOCIATION OF THE UNITED STATES
General Hargett. Mr. Chairman, thank you for the
opportunity to testify on behalf of the 470,000 national
guardsmen across the country, our citizen soldiers and airmen.
As our Nation struggles with how to get its financial house
in order, I propose we give a hard look at how we could
leverage the cost efficiencies inherent in the National Guard
to reduce defense costs without reducing capabilities. Every
day soldiers and airmen of the National Guard are serving
across the Nation and around the world in more places than any
component of the armed forces, and they do it for a fraction of
the cost. To best meet its Federal and State missions, the
National Guard must be resourced adequately and
proportionately, increasing National Guard personnel end
strength and ensuring the force has the equipment and resources
needed to provide more capabilities at a lower cost to the
taxpayer.
Our National Guard has been an integral part of the war
fight. Hundreds of thousands of Army national guardsmen have
deployed overseas since September the 11th, many serving
multiple deployments. We have a battle-proven operational force
and it would be a disservice for our National Guard to revert
back to pre-9-11 levels of equipment, readiness, and training.
It has been estimated that the annual requirement for the
Army Guard to maintain its current operational level is $400
million. While DOD has asked more and more of our National
Guard, the funding requests for the Guard have not kept pace.
Thankfully, Congress has helped bridge the gap. Since 1982
Congress has provided valuable funding through the National
Guard and Reserve equipment account, enabling both the Army and
Air Guard to procure more needed equipment and provide
essential modernization upgrades. With this funding, the Army
Guard has been able to significantly close the gap on many of
its unfunded requirements. It has enabled units across the
Nation to go from 40 percent of its required dual use equipment
on hand just a few years ago to nearly 75 percent today. While
the Army Guard has made significant progress in recent years,
the need for equipment, additional equipment, remains.
The Air Guard also continues to use NGREA funding for vital
modernization efforts and domestic operation requirements.
Along with NGREA, Congress has been instrumental in other
modernization efforts for the Air Guard. This subcommittee has
led the way in funding the active electronic scanned array
radar, or AESAR, for the Air Guard F-15s. However, even with
the progress made to date, there remains a shortfall in funding
of $52.8 million to complete this program.
Without adequate funding from NGREA and other sources, the
Air Guard will be unable to modernize fighter and mobility
legacy platforms. The Air Guard must remain an equal and
effective partner in all fielding modernization, to include the
C-130Js, C-27s, F-35s, the KC-45.
While equipment funding is vital, the true strength of the
National Guard is its people. An unrivaled blend of civilian
and military skills ensures that our National Guard members are
effective when conducting missions abroad and at home. The
National Guard State Partnership Program, the Agricultural
Development Teams, and the Southwest Border Missions are
shining examples of the unique skill set of our National Guard
men and women. However, the current budget request creates a
shortfall of $12 million for the State Partnership Program and
$75 million for the counterdrug program.
In conclusion, as America's first military organization,
the National Guard has proven for 375 years that it is right
for America. Drawing on the experience of the last 10 years of
the war fight, we are convinced that the National Guard will
emerge as a more cost effective and more mission-capable force
into the future.
Thank you for the opportunity to testify today on behalf of
our Guard men and women.
[The statement follows:]
Prepared Statement of Major General Gus Hargett
The National Guard Association of the United States is a
nonpartisan organization representing nearly 45,000 current and former
Army and Air National Guard officers. Formed in 1878, NGAUS is focused
on procuring better equipment, standardized training and a more combat-
ready force by petitioning Congress for resources. Well over a century
later, NGAUS has the same mission.
Our goal is to maintain the freedom and security of this Nation by
guaranteeing a strong national defense through the provision of a
vital, dynamic National Guard as a part of the Total Force.
THE NATIONAL GUARD--``RIGHT FOR AMERICA''
``A National Guard in balance is one that adds value to America. It
is structured and resourced with adaptive and innovative citizen
Soldiers and Airmen, ready to provide global security and assistance. A
National Guard in balance works as a critical interagency partner at
the local, State and Federal levels . . . anytime, anywhere.''------
General Craig R. McKinley, Chief, National Guard Bureau
Following the Vietnam war, General Creighton Abrams was determined
to establish a clear linkage between the employment of the Army and the
engagement of public support for military operations. General Abrams
reasoned that by creating a force structure that integrated Reserve and
Active Components so closely as to make them inextricable would ensure
Presidents would never again send the Army to war without the Reserves
and the commitment of the American people.
Today, with locations in more than 3,300 communities across the
Nation, the National Guard provides an indispensable link between the
military and the citizens of our great Nation.
The key to National Guard efficiency is the predominantly part-time
(traditional) force that can mobilize quickly for combat operations, or
respond when needed for disaster response or homeland defense.
Unless activated for combat service, fully trained traditional
National Guard members cost approximately 25 percent of their Active
counterparts. National Guard efficiencies compared to regular military
components include: fewer ``pay days'' per year, lower medical costs,
significantly lower training costs beyond initial qualification
training, virtually no costs for relocating families and household
goods to new duty assignments every 3 or 4 years, fewer entitlements
such as basic allowance for housing, lower base support costs in terms
of services and facilities including commissaries, base housing, base
exchanges, and child care facilities.
On average, 17 United States Governors call out their National
Guard each day to protect life or property, and the Guard responds
immediately, effectively, appropriately, and in-force.
The Air National Guard (ANG) has 106,700 personnel and provides 33
percent of the Total Air Force capabilities for less than 7 percent of
the Total Force Defense Budget including: 100 percent of the Air
Force's air defense interceptor force, 33 percent of the general
purpose fighter force, 45 percent of the tactical airlift and 6 percent
of the special operations capability, 43 percent of the air refueling
KC-135 tankers, 28 percent of the rescue and recovery capability, 23
percent of tactical air support forces, 10 percent of the bomber force
and 8 percent of the strategic airlift forces. Additionally, Air Guard
members provide a wide variety of support missions to include:
security, medical support, civil engineering, air refueling, strike,
airlift, and Intelligence, Surveillance, and Reconnaissance (ISR).
The Army National Guard has 358,200 personnel and provides 32
percent of the Total Army end-strength for only 11 percent of the Total
Army Defense Budget. By the end of fiscal year 2010, the Army National
Guard force structure will include 8 Division Headquarters, seven
Brigade Combat Teams (BCT), and 44 multi-functional Support Brigades.
Additionally, the Army National Guard will have continued the
conversion of 21 BCTs, completing transformation of the second set of
seven BCTs in fiscal year 2010. Since 9/11/2001, more than 340,000 Army
National Guard men and women have been activated in support of ongoing
combat operations. On any given day, more than 50,000 Guard soldiers
are ``on point'' for the Nation.
As the Department of Defense implements policies to reform the way
the Pentagon does business by directing the Service chiefs to find more
than $100 billion in savings over the next 5 years, the National Guard
is ready and able to play an important role in achieving these
necessary goals.
The National Guard provides vast capabilities to our country in its
dual-use, domestic support missions and overseas defense, missions
while continuing to maintain cost-effectiveness. Increasing National
Guard end strength and resourcing and recapitalizing its force will
offer more capability and value at a lower cost to America.
Maintaining a Ready, Relevant, and Accessible National Guard
For the National Guard to best meet it's Federal and State missions
it must be resourced adequately and proportionately. Since fiscal year
1982 Congress has funded the National Guard and Reserve Equipment
Account (NGREA) enabling both the Army and Air National Guard to
procure much needed equipment and provide essential modernization
upgrades. Since its start in fiscal year 1982, the Army National Guard
has received more $9.29 billion and the Air National Guard has received
$6 billion in NGREA funding.
Since fiscal year 2006 Congress has provided the ARNG with 50
percent of its total NGREA funding. With this funding, the ARNG has
been able to significantly close the gap on many of its emerging
requirements and new equipment program procurements. This has enabled
our units across the country to go from 40 percent of required
equipment on-hand a few years ago, to nearly 75 percent today. This
dramatic turnaround is the direct result of congressional support and
action.
For example, using NGREA funds, the ARNG has been able to purchase
an additional 1,500 Family of Medium Tactical Vehicles (FMTVs), with
plans to purchase another 1,100. The ARNG has been able to invest
millions in critical updates to systems such as Tactical Operation
Combat System (TOCS), Standard Integration Command Post System (SICPS),
and War fighter Information Network-Tactical (WIN-T).
While the ARNG has made significant progress, the need for
additional equipment funding remains. The National Guard and Reserve
Equipment Report for Fiscal Year 2012 (Fiscal Year 2012 NGRER),
completed in accordance with Section 10541, Title 10, United States
Code, identifies several challenges for the ARNG. The fiscal year 2012
NGRER identifies a $40 billion total shortfall for the ARNG (Page 1-4).
Additionally, the ARNG estimates it needs ``$3.5 to $4.5 billion in
annual programmed funding (versus a $2.3 billion per year average in
the current Future Years Defense Program) to continue to modernize and
maintain current EOH levels and interoperability'' (Fiscal Year 2012
NGRER, Page 2-9).
The Fiscal Year 2012 NGRER also identifies the following challenges
regarding equipment:
--Achieving full component-level transparency for equipment
procurement and distribution;
--Equipping ARNG units for pre-mobilization training and deployment;
and
--Equipping ARNG units for their homeland missions (pages 1-8, 1-9).
NGAUS has worked with Congress over the years to increase the
transparency of equipment procurement and better equip the force for
training requirements and homeland missions.
The ARNG helicopter fleet remains an area of concern. The Army
National Guard Black Hawk fleet will soon grow to 849 helicopters. Five
hundred of these are older UH-60A models, with an average age exceeding
25 years. Many UH-60As are in need of immediate replacement/conversion.
The ``A'' model is more expensive to operate, cannot operate at higher
altitudes, and has a 1,000 lbs lower payload capability than the newer
``L'' and ``M'' models.
The ARNG currently has a documented requirement for 210 UH-72A
Lakota helicopters to support domestic missions in ``permissive''
environments. With over 150 aircraft now delivered to the Army on-cost
and within schedule, the UH-72A has proven to be a robust and efficient
multirole platform. Leveraging the success of this program for
additional missions could lead to even greater efficiencies in meeting
operational needs.
The Army National Guard Chinook helicopter fleet total requirement
is 161 aircraft. Currently, the shortage is 17 aircraft, and all
aircraft in this fleet are CH-47D models except 3 new CH-47Fs that were
delivered in May. The average age of the CH-47D aircraft are 25 years,
with many that are older. The need for replacement is immediate because
the helicopters are not only being utilized at home to support many
missions, but also in deployments abroad especially in Afghanistan.
This is compounded with the CH-47D's deterioration from age, recent
operational tempo, and losses in theater. The new CH-47F provides
better survivability, upgraded avionics (CAAS cockpit), a new airframe,
and improved operational capability. The new features save lives and
allow missions to be completed that wouldn't have been attempted with
the CH-47D models.
Finally, modernizing the ARNG Tactical Wheeled Vehicle fleet is an
issue. While the ARNG has reached 100 percent of the requirement for
High-Mobility Multipurpose Wheeled Vehicles (HMMWV), 72 percent of the
fleet has already reached its Economic Useful Life of 20 years and over
60 percent of the ARNG's HMMWV inventory are legacy vehicles, and are
between 20 to 25 years old. Additionally, the ARNG remains short of its
requirement for Family of Medium Tactical Vehicles.
The ANG continues to use NGREA funding for vital modernization
efforts and specialized domestic operations requirements. They have
procured essential equipment such as satellite communications kits for
our Tactical Air Control Party (TACP), medical equipment for
pararescue, body armor for security forces, helmet mounted cuing
systems for fighter aircraft, defensive systems for mobility aircraft,
firefighting vehicles, and more. With the need to fully fund ongoing
operations and continued pressure on defense budgets, obtaining
adequate funding for procuring equipment and modernization efforts will
continue to be a challenge. Without adequate funding from NGREA or
other sources, the ANG will be unable to modernize legacy platforms and
equipment and will no longer remain an equal and effective partner in
the Total Force.
In the last year the National Guard Bureau has implemented process
changes in order to better obligate these funds and field the procured
equipment and upgrades to our Soldiers and Airmen at a more rapid rate.
Along with NGREA, Congress has been instrumental in other
modernization efforts for the Air National Guard. It was Congress that
funded the LITENING Targeting pods for the Air National Guard F-16
which killed the insurgent leader Abu Musab al-Zarqawi in Iraq. And it
is Congress that has continued to fund the Active Electronic Scanned
Array (AESA) radar for Air National Guard F-15Cs. Since fiscal year
2006, Congress has provided $313 million for the AESA radar program for
ANG F-15s. The AESA radar is being fielded to our fighter wings which
currently perform the air sovereignty alert mission in the skies over
our Nation. This new radar provides our pilots with the combat
capability necessary to perform the homeland defense mission by
providing the ability to detect asymmetric threats like cruise missiles
or low observable aircraft threatening our Nation's security. However,
there remains a shortfall in funding to complete this program. The
fiscal year 2012 President's budget request again did not provide the
necessary funding to continue this essential program. For fiscal year
2012, the ANG has recognized an unfunded requirement of $52.8 million
for F-15C AESA radars in its Weapons System Modernization Book.
The Fiscal Year 2012 NGRER identifies a $7 billion shortfall for
modernization programs and shortfalls (page 5-11) in the ANG documented
in the Weapons System Modernization Book. NGAUS has identified unfunded
modernization priorities to include (in addition to the already
identified AESA radar):
--$13.85 million for the Helmet Mounted Integrated Targeting (HMIT)
for A-10's (Aircraft Procurement);
--$8.3 million for the HMIT for F-16's (Aircraft Procurement);
--$12.12 million for the Center Display Unit for F-16's (Aircraft
Procurement);
--$32.8 million for the Center Display Unit for F-16's (RDTE);
--$9 million for the Center Display Unit for F-15's (RDTE);
--$20.5 million for LC-130 Eight Bladed Propeller Upgrade (Aircraft
Procurement);
--$10.74 million for Advanced Infrared Countermeasures (IRCM) Self
Protection Suite for C-130's (Aircraft Procurement);
--$70.3 million for Infrared Counter Measures (IRCM) Defensive
Systems for KC-135's (Aircraft Procurement);
--$6 million for Infrared Counter Measures (IRCM) Defensive Systems
for KC-135's (RDTE);
--$2.4 million for Improved Watercraft and Ground Recovery Vehicles
(Other Than Aircraft Procurement); and
--$46 million for two D-RAPCON Systems (Other than Aircraft
Procurement).
In the near future the ANG will be fully submerged into the
recapitalization crisis that the entire Air Force has become victim
too. When the F-22 buy was cut off at 187 aircraft (from the 750
originally planned to be purchased) the ANG lost most hope of being
assigned those aircraft, with the exception of the classic associate
relationship at Langley (Richmond, Virginia ANG) and Hawaii.
Although the USAF is planning to acquire 1763 F-35's, the only ANG
facility identified to receive the F-35 to date has been Burlington,
Vermont. Beyond that, the USAF has been very slow to make any other
final decisions as to which, if any other, ANG locations will receive
these aircraft beyond the first six Active units, leaving ANG leaders
wondering if the Guard will make the cut if the F-35 buy is cut short.
The USAF has announced that it will perform a Service Life
Extension Program (SLEP) to approximately 300 F-16s, most of which will
be Active Component (AC) Block 50 and 40's. The question remains, how
will the USAF ensure the longevity of older ANG F-16s, or will they
eventually ``cascade'' the modernized Block 40/50's F-16's to the ANG
as the AC receives new F-35's? And, what happens if the AC does not
receive F-35's as anticipated? The Air Force has lacked transparency
with the Air National Guard leadership. We believe it is time to end
this and use the ANG as a model of how to field and execute the fighter
mission in the future.
When discussing the crisis as related to the airlift and transport
fleet one should remember how the ANG received the aircraft they now
have. During the 1980's and early 1990's, the Air National Guard
acquired a significant number of C-130 Hercules via congressional ad's,
even though the effort was opposed by the Pentagon. Today, however, the
Pentagon is either looking to transfer some of the newer models to AC
locations, or claiming there is an excess of up to 40 of these
aircraft, which, they indicate are offsetting an equal amount of C-
27Js.
The USAF is modernizing its C-5B/C fleet with both the Avionics
Modernization Program (AMP) and Reliability Enhancement and Re-engining
Program (RERP), to the C-5M configuration. However, even though the Air
Force has programmed the C-5A's (only operated in the Reserve
Component) for AMP, these aircraft are not programmed to receive the
RERP upgrade. Today, the USAF has begun to retire some of these
aircraft. Despite not having the same upgraded range and fuel
efficiency, unmodified C-5A's would not be inter-flyable by Active/
Reserve Component crews. This lack of commitment to the ANG C-5 fleet
has left units that operate these aircraft wondering what lies ahead in
their future, thereby negatively impacting their ability to recruit the
future generation of militia airmen.
After several years of the Army and Air Force coordinating to
determine how many C-27J's would be required to provide direct ``last
tactical mile'' airlift support for the Army, and homeland response
capabilities for the ANG, the Joint Requirements Oversight Council
(JROC) validated that 78 aircraft were necessary to fill this
requirement. However, subsequently, the Secretary of Defense (SECDEF)
seemed to ``arbitrarily'' change that number to 38, assigned the
mission to the ANG, and justified the cut in C-27's to the Mobility
Capabilities Requirements Study 16 (MCRS) that had identified an excess
of 40 older C-130's. Unfortunately, the MCRS had not included the C-27
direct support mission in this study. When the total number of C-27's
were reduced from 78 to 38, this caused the Air Force to also reduce
the number of aircraft based in any one location from the standard 8
Primary Assigned Aircraft (PAA) per unit to 4, which hampers effective
training and operations. Additionally, since the Army has declared that
``fixed wing aviation is not a core competency,'' the Pentagon is also
divesting the ARNG of its aging C-23 fleet before the ANG will be in a
position to provide comparable airlift support stateside, since it will
be focused on fulfilling its combat mission in the Middle East.
Although the USAF has finally selected a new tanker aircraft, to
date, it is unclear where these aircraft will be stationed.
Finally, even though the Army does not consider fixed-wing aviation
to be a core competency, logic tells us that some level of fixed-wing
capability makes economic and functional sense as a niche mission,
which has always been acknowledged and authorized under Joint Doctrine.
And, even though the ANG may fully commit to providing direct support
(primarily during combat operations), there will always be ``pop up''
missions, both stateside and deployed, that would justify a small fleet
of fixed-wing support aircraft for the ARNG. Thus, a program to replace
the aging C-12 and C-26 aircraft with a fleet of new light aircraft to
take on this requirement should be pursued.
The Added Value of Citizen Soldiers and Airmen
The true strength of the National Guard is in its people. It's our
citizen soldiers and airmen who juggle two jobs and a family life are
invaluable to our Nation's defense. An unrivaled blend of civilian and
military skills ensures that our members are effective when conducting
missions abroad and at home.
The National Guard supports programs unmatched to other Active and
Reserve Components. Members of the National Guard actively work on
global engagement programs, domestic support programs and youth
programs to improve our communities.
The State Partnership Program (SPP) was created in 1993 with only a
handful of partner nations. Today, these mutually beneficial
relationships are established with more than 60 foreign nations. They
work together to improve regional security, stability and prosperity.
The fiscal year 2012 President's budget request creates a shortfall of
$12 million for the SPP.
The Agribusiness Development Teams (ADT) is another great example
of the National Guard's fusion of military capability and civilian
skills. The ADTs are working with the Afghan Ministry of Agriculture,
Irrigation and Livestock to educate and train Afghan farmers in modern
agriculture methods and techniques. These efforts will undoubtedly
increase the quality of life and economic stability for the region
while leading to improved opportunities for the Afghanistan agriculture
community.
The domestic support realm ranges depending on the immediate needs
of the regions and the longer term outcomes that they will produce. The
National Guard has successfully supported the Southwest border security
mission during Operation Jump Start from 2006-2008 and has continued to
assist the U.S. Customs and Border Protection, Department of Homeland
Security and the Immigrations and Customs Enforcement. Along with
border security, National Guard members are assisting these entities by
engaging in counter-narcotic missions on the Southwest border.
The National Guard's Counter Drug Programs help local law
enforcement agencies with analysis and ground support resulting in tens
of billions of dollars worth of drugs, property, weapons and cash each
year. The National Guard's Training Centers in Mississippi, Florida,
Iowa, Pennsylvania, and Washington train over 100,000 military
personnel, law enforcement officers, and interagency members each year.
The fiscal year 2012 funding shortfall for the Counterdrug Program is
$75 million.
When a crisis occurs, whether man-made or natural, the National
Guard is ready to respond. National Guard members have responded to an
unprecedented number of devastating tornadoes across the Nation in from
Alabama to Massachusetts, including the town of Joplin, Missouri; they
are currently performing flood relief missions in Arkansas, Louisiana,
Mississippi, Montana, North and South Dakota, Nebraska, Vermont and
Wyoming; and just a few months ago they were fighting wildfires over
West Texas with their C-130Js from the California ANG.
The National Guard has designed structured response packages which
are scalable to provide tiered response to local, State, regional or
national level chemical, biological, radiological, nuclear, or
explosives (CBRNE) incidents. In addition, the National Guard is
working with the Department of Defense to stand up 10 Homeland Response
Forces (HRFs). These HRFs will consist of 566 personnel and provide
life saving capabilities during emergencies, bridging the gap between
the initial National Guard response and Title 10 capabilities.
Our citizen soldiers and airmen are dedicated to improving their
communities and our Nation's future. This is why the National Guard
Youth ChalleNGe Program exists. The NGYCP is an award winning,
community based program which mentors high school dropouts and leads
them to become successful and productive citizens and lead successful
and fulfilling lives. Since 1993, the NGYCP has graduated over 95,500
students and saved over $175 million annually in juvenile correction
costs.
Conclusion
In today's fiscally challenged environment, it is imperative that
our Nation looks to our cost effective and mission proven National
Guard as a solution to maintain our high level of national security at
an affordable cost. As America's first military organization, the
National Guard has proven for 375 years that it is ``Right for
America.'' With the continued support of Congress, the National Guard
will emerge as an even more cost-effective and mission capable force in
the future.
Chairman Inouye. Thank you very much, General Hargett.
Senator Cochran.
Senator Cochran. You may have mentioned this in your
statement and I didn't notice the specifics, but is the
National Guard being called on for deployments at this time in
any conflict going on anywhere outside the United States?
General Hargett. Yes, sir. There are still guardsmen in
Iraq, Afghanistan, and Kuwait, and probably Kosovo and other
places around the world.
Senator Cochran. Do you have any estimation or any
indication--you can't predict when the war's going to be over
and we can come home and declare victory, but what do you hear
from people you trust about the future for the Guard's
deployment? At some point you're going to have to say, hey,
wait a minute, we don't have anybody to send.
General Hargett. I predict that we will be deploying
guardsmen long into the future. I think we're an integral part
of the force and I think to continue to even do the
peacekeeping operations we will continue to deploy some
guardsmen.
Senator Cochran. It seems to me that, with the continued
pressures and strains on family relationships and
unpredictability of deployment schedules, how you can maintain
a job at home, in the traditional sense of the Guard and
Reserve being mobilized for emergencies only, things that
aren't anticipated or couldn't be handled by regular forces--do
you see any breakdown in the system?
General Hargett. You know, as the former Adjutant General
of the Tennessee Guard, I can speak for Tennessee. But I will
tell you that the one thing that's unrecognized in what we have
done for the last 10 years are the families and employers who
have--I will tell you that I think the guardsmen are willing to
do this forever. I think the strain will be families and
employers as we go forward, and I think we've got to have
programs that take care of families, programs that take care of
employers, and look toward the future.
But I think continued use of the Guard and Reserve can
easily be accomplished with the proper programs with employers
and families involved in those programs.
Senator Cochran. Well, I know just from my personal
experience, my son was a National Guard officer in the
Mississippi Army National Guard and he loved it and was ready
to go any minute, anywhere. I think that's an indication of the
way most people felt in our State. I just wonder how long they
can sustain that, though, and manage family, homes, careers,
which is what they do.
But thank you very much. It's a real compliment, I think,
to those who are involved in the Guard and continue to make it
an important force for our national security.
General Hargett. Thank you.
Senator Cochran. Thank you for your service.
Chairman Inouye. Thank you.
Senator Shelby.
Senator Shelby. I just appreciate his appearance here and
his testimony. All of you, I think this has been a good
hearing. I know you've had limited time, but we're going to
absorb a lot of this.
Thank you, Mr. Chairman.
Chairman Inouye. Thank you.
Mr. Lumme.
STATEMENT OF DALE LUMME, NATIONAL EXECUTIVE DIRECTOR,
NAVY LEAGUE OF THE UNITED STATES
Mr. Lumme. Chairman Inouye, Ranking Member Cochran,
distinguished members of the subcommittee: Thank you for the
opportunity to appear before you today to discuss the most
urgent needs of our sea services and maritime industry. As a
retired Navy captain and naval aviator, and on behalf of the
thousands of worldwide members of the Navy League, I would like
to thank this subcommittee for its diligent stewardship and
oversight of the sea services. I think, as witnessed by
Chairman Inouye receiving the highest Navy League award 3 years
ago for his maritime stewardship and then the reigning Navy
League Award winner Senator Cochran, thank you for your service
to the Navy, Marine, Coast Guard, and flag merchant marine.
The Navy League is a nonprofit civilian organization whose
mission it is to educate the American people about the enduring
importance of sea power to a maritime Nation and to support the
men and women of the United States sea services. Since the Navy
League's founding in 1902 with the support of President Teddy
Roosevelt, the organization has vigorously promoted America's
maritime interests through our strong advocacy of our sea
services, the U.S. flag merchant marine, Coast Guard, Marine
Corps, and Navy.
President Roosevelt asserted that a Navy could justify its
existence only by the protection of maritime shipping. He
stated that ``True national greatness has in all ages and in
all countries throughout the world been based upon waterborne
commerce.''
Just this past weekend, in response to the President's
weekend address, North Dakota Senator John Hoeven stated:
``Over 100 years ago, President Roosevelt launched a Navy
mission known as the Great White Fleet on a voyage around the
world. President Roosevelt's leadership put the world on notice
that the United States was a global maritime Nation open for
business.''
The Navy League strongly believes that a vibrant U.S.
maritime industry is a critical part of our national security
and now a vital part of our economic recovery. Navy veteran
President John F. Kennedy in June 1963 aboard the USS Kitty
Hawk stated: ``Recent events have indicated that control of the
sea means security, control of the seas can mean peace, and the
United States must control the seas to protect its own national
security.''
Over the last 20 years, a disturbing trend has emerged. We
continue to ask our sea services to do more and more for our
country, yet the size of our naval fleet continues to shrink.
The Congress has heard recent testimony that our Navy is at its
lowest level since 1916.
It is not the job of the Navy League to advise the U.S.
Congress how to tackle our national debt crisis, but it is the
job to pass appropriations bills and not continuing
resolutions. The Navy and Marine Corps and Coast Guard is still
recovering from the continuing resolution from fiscal year 2011
and we implore upon you for fiscal year 2012 not to pass
another continuing resolution to harm our combat readiness.
It may appear an easy way to cut spending is to cut defense
and big procurement items like ships and aircraft, and that may
be considered some of the easiest targets. The national
security of the United States depends on a Navy with sufficient
number of ships to maintain a forward global presence critical
to the U.S. economy and the protection of our democratic
freedoms that we take for granted.
The number one problem facing the United States Navy today
is the lack of a fully funded, achievable shipbuilding program
that produces the right ships with the right capabilities for
the right cost, in the most cost-efficient, economic
quantities. The Navy League of the United States fully supports
rebuilding the fleet to a goal, as recently stated by the
Secretary of the Navy, of 325 ships to properly execute the
maritime strategy.
The Navy League also supports pursuit of multi-year
procurement strategies for the MH-60 helicopter, continued
acquisition of the F-35 to replace the AV-8, the acquisition of
an affordable combat vehicle to replace the aging and costly
amphibious assault vehicle, and, importantly, supports the
sustainment of a significant deterrent capability of our
ballistic missile submarine forces, including the replacement
of the Ohio class submarines, and strongly believes this should
be funded on a national imperative outside of the Navy's FCN.
The Navy is buying what they can afford, not what our Nation's
security needs.
The CNO recently commented at a current strategy forum:
``It is our persistent forward presence that allows for speed
and flexibility of response for our Nation that has been called
upon repeatedly over the last 2 decades, and most recently in
ongoing ops in Libya and Japan.''
The Secretary of the Navy recently commented that:
``Sometimes the U.S. Navy-Marine Corps team follows the storm
to the shore and sometimes it must bring the storm.'' The
United States is a maritime Nation with global
responsibilities. With a forward-engaged naval tradition as a
foundation of our existence, the Navy-Marine Corps team is
inseparable.
The future success of shipbuilding and many of our Navy
programs is contingent upon our Nation's support of science,
technology, engineering, and math education programs. The Navy
League strongly supports additional funding levels for STEM and
is working to support efforts to expand this program through
our Navy Sea Cadets and Worldwide Councils.
In conclusion, America is a maritime Nation and must
maintain its status of maritime superiority if there is to be
peace and prosperity and economic prosperity throughout the
world.
Thank you for your continued support of America's sea
services.
[The statement follows:]
Prepared Statement of Dale Lumme
Chairman Inouye, Ranking Member Cochran, distinguished members of
the Subcommittee, thank you for the opportunity to appear before you
today to discuss the most urgent needs of our sea services and maritime
industry.
On behalf of the 50,000 members of the Navy League worldwide, I
would like to thank this committee for its diligent work to ensure our
sea services are provided with the very best our country can give them.
The Navy League is a nonprofit civilian organization whose mission
is to educate the American people and their leaders about the enduring
importance of sea power to a maritime nation, and to support the men
and women of the U.S. sea services.
Since the Navy League's founding, in 1902, with the support of
President Theodore Roosevelt, the organization has vigorously promoted
America's maritime interests through our strong advocacy of all the sea
services--to include the U.S.-Flag Merchant Marine, the U.S. Coast
Guard, the U.S. Marine Corps and the U.S. Navy--and the industries that
support them.
The founding direction of the Navy League--adopted 109 years ago--
is still appropriate today. The Navy League mission strongly supports
the long-standing U.S. policy that a viable U.S. maritime industry is a
critical part of our national security and now a vital part of our
economic recovery.
President Roosevelt asserted that a navy could justify its
existence only by the protection of maritime shipping. He described the
sea as a network of trade routes, and stated that true national
greatness has, in all ages and in all countries throughout the world,
been based upon waterborne commerce.
It is the Navy League's firm belief that providing for maritime
security is--and must always be--the first and most important
cornerstone of national security.
However, over the last 20 years, a disturbing trend has emerged. We
continue to ask our sea services to do more and more for our country,
yet the size of our naval fleet continues to shrink and plans to fund
and rebuild naval platforms continue to be plagued by unchecked cost
growth and significant construction delays. The security and prosperity
of our Nation lies in our ability to protect and defend our people, our
shores and our economic interests at home and abroad. Until we change
the tone of the conversation on the industrial base and future
readiness from ``like to have'' to ``urgent priority,'' we may be
putting the security and prosperity of the American people in jeopardy.
With respect to the Navy League's support of the United States Navy
The number one problem facing the Navy today is the lack of a fully
funded, achievable shipbuilding program that produces the right ships,
with the right capabilities, for the right costs, in the most cost
effective economic quantities.
The goal of a 325-ship Navy is a long way from reality, but as we
have seen in recent operations this Nation's fleet is in high demand on
a daily basis.
Our fleet already is stretched to the breaking point and it will
become more difficult to react rapidly to humanitarian and disaster
situations and stand ready to defeat aggression. The United States will
not be able to meet all of our global commitments as the number of
ships continues to decline.
In order to provide our Nation with the maritime security
capability needed to meet our global commitments, our Shipbuilding and
Conversion, Navy (SCN) account should be funded at $25 billion per year
(or more) to achieve a force level of 325 ships.
A 325-ship Navy is not just a number. It means hulls with the
capability to maintain presence, project power and influence events.
They must be capable of prevailing in conflict, whether alone or as
part of a task force.
The fleet must have sufficient aircraft of the right mix, and key
to that requirement is getting the next-generation fighter/attack
aircraft--the carrier variant and the short take-off and vertical-
landing (STOVL) variant of the F-35 Lightning II, also known as the
Joint Strike Fighter (JSF)--operational in numbers. The timely delivery
of the JSF, along with the recently extended multiyear buy of F/A-18E/F
Super Hornet multirole fighters and EA-18G Growler airborne electronic
attack aircraft, will help close the projected strike fighter gap in
the latter part of this decade.
Finally, it is vitally important that the Navy maintain a credible
cyber force and develop leap-ahead, interoperable and resilient
capabilities in cyberspace to successfully counter and defeat a
determined, asymmetric threat.
Chief of Naval Operations Admiral Gary Roughead recently commented
at the Current Strategy Forum in June 2011 that:
The Navy's forward presence and flexible range of capabilities
gives our Nation options to remain globally engaged with partners, and
ensure our access wherever our Nation's interests might dwell.
While our ships are able to surge on short notice, it is our
persistent forward presence that allows for the speed and flexibility
of response the Nation has called upon repeatedly over the last two
decades, and most recently in ongoing operations in Libya and Japan.
Specifically, the CNO stated:
``Off Libya, deployed ships and submarines broke off their patrol
and maritime ballistic missile defense missions to deliver tomahawk
missiles against radar and command and control sites, creating in short
order the conditions under which a no-fly zone could be imposed.
``Off Japan, the deployed Ronald Reagan Strike Group responded
immediately to the natural disaster there, with helicopter flights to
deliver humanitarian aid and medical capabilities, with nuclear
expertise and heavy lift to participate in the relief effort.''
The Navy League of the United States:
--Fully supports rebuilding the fleet to a level of 325 ships to
properly execute the Maritime Strategy and, inclusive in this
ship count, should be not less than: 11 aircraft carriers; 38
amphibious ships, four more if the Global Fleet Station concept
is adopted; 48 attack submarines; and 55 Littoral Combat Ships
(LCSs).
--Supports the sustainment of a minimum of 10 carrier air wings,
including the continued multi-year procurement of the F/A-18E/F
Super Hornet, the pursuit of multi-year procurement strategies
for the MH-60 helicopter and the E-2C/D Hawkeye airborne early
warning (AEW) aircraft, and full development and follow-on
procurement of the F-35 Lightning II.
--Supports the continuing development, procurement and deployment of
the Navy portion of the Ballistic Missile Defense System,
including long-range surveillance and tracking capability to
queue ground-based intercept systems and, ultimately, the
ability to detect, track and engage medium and long-range
ballistic missiles well distant from the United States.
--Supports the sustainment of the significant deterrent capability
that our ballistic-missile submarine, or SSBN, force offers,
including the replacement of the Ohio-class SSBNs at the rate
of one per year, which should be funded as a national
imperative outside of the Navy's SCN plan.
--Strongly supports the acquisition of two new Virginia-class
submarines per year.
--Supports maintaining two U.S.-owned sources for building Navy
submarines, and maintaining a teaming agreement for
constructing Virginia-class submarines wherein one shipyard
serves as the prime contractor and the other serves as its
major subcontractor.
--Supports the Navy's LCS acquisition strategy to select 10 units of
each hull form, based on sea trials and operating experience of
the initial hulls, to attain the unique attributes of each for
the LCS class.
--Supports the P-8A Multi-mission Maritime Aircraft and Broad Area
Maritime Surveillance System, which will contribute
surveillance data to Maritime Operations Centers and Regional
Operations Centers. These centers will fuse information for
dissemination to Navy, Coast Guard and Joint Force Maritime
Component Commanders and our allies for military and
counterdrug operations.
--Supports the continuing integration of unmanned aircraft systems
(UASs) into the fleet, including the expansion of the
deployment of the MQ-8B Fire Scout vertical takeoff unmanned
aerial vehicle, and deploying an unmanned aircraft squadron on
an aircraft carrier at the earliest opportunity.
--Believes that increased emphasis and funding is required to allow
Navy and Coast Guard operations in the polar regions to protect
our access to natural resources as well as preclude these
regions from becoming sanctuaries for potential adversaries.
Communications, logistics, ship and aircraft modifications are
essential for such operations.
--Supports continued funding for Combat Logistics Force assets,
including oiler/ammunition carriers and dry cargo/ammunition
carriers; large, medium-speed roll-on/roll-off ships; and new
classes of special mission vessels, all of which will be
employed in the Maritime Preposition Force (Future) squadrons.
--Urges that naval C\4\ISR systems have increased levels of
information flow, resource assignments and adaptability, and
that procurement processes be modified to ensure the rapid
insertion of new technology.
--Supports Navy emphasis on cyber warfare to ensure the viability of
our C\2\ systems even in the face of increased cyber attacks.
--Supports rapid passage of the United Nations Convention on the Law
of the Sea, or Law of the Sea Treaty, which seeks to establish
a comprehensive set of rules governing the oceans.
With respect to the Navy League's support of the United States Marine
Corps
The United States is a maritime nation with global
responsibilities. With a forward engaged naval tradition as the
foundation of our existence, the Navy-Marine Corps Team is inseparable.
The forward presence allows for the Navy-Marine Corps Team to build
relationships around the globe. But, we must remember, countries, like
mothers-in-law, are happy to see you come, but you are just as happy to
see you go.
The Navy-Marine Corps Team's persistent forward presence and
multimission capability present an unparalleled ability to rapidly
project U.S. power across the global commons--land, sea, air, space and
cyber.
Amphibious forces with robust and organic logistical sustainment
bring significant advantages, including the ability to overcome the
tyranny of distance and to project power where there is no basing or
infrastructure--a strong deterrent capability for our Nation. To
Marines, ``expeditionary'' is a state of mind that drives the way they
organize, train, develop and procure equipment.
By definition, the role of the Navy-Marine Corps Team as America's
crisis response force necessitates a high state of unit readiness and
an ability to sustain ourselves logistically.
The Corps must regain its expertise in amphibious operations and
maintain that capability in force structure. The service also must be
provided the resources to reset the force; restore or acquire anew the
equipment capabilities consumed in the ongoing wars; and field the F-
35B STOVL variant, develop a new, affordable Amphibious Combat Vehicle
and field sufficient amphibious lift, starting with an additional LPD
17.
The new Marine Armor System, the up-armored High Mobility
Multipurpose Wheeled Vehicle (or Humvee), the Marine Personnel Carrier
and the Joint Light Tactical Vehicle will be instrumental in achieving
these goals. To enhance the forcible-entry ability, the Corps must
develop the expeditionary fighting vehicle replacement vehicle, the
Amphibious Combat Vehicle.
Significant support is needed for weapon improvements for the
MAGTF, particularly in the 155 mm Howitzer, the High Mobility Artillery
Rocket System (HIMARS) and Naval Surface Fire Support.
Within Marine Aviation, the F-35B STOVL variant of the Lightning
II, the MV-22 Osprey tiltrotor, the CH-53K heavy-lift helicopter, the
UH-1 and AH-1 helicopters will provide the MAGTF commander with
unsurpassed warfighting capability.
The combatant commanders (COCOMs) multiple missions require more
than the planned number of amphibious ships to meet their demand for
forward presence and crisis response. At a minimum, 38 amphibious ships
are needed to provide an adequate number of Expeditionary Strike Groups
(ESGs) and Marine Expeditionary Units, deploy naval forces in single
ships as Global Fleet Stations and provide adequate time for training
and maintenance.
The COCOMs know that in a natural disaster or humanitarian crisis,
a large-deck amphibious ship is the most utilitarian platform in the
naval fleet. The Amphibious Force brings helicopter lift, mobile
communications, medical and engineering, all the capabilities most
needed in a humanitarian assistance or disaster relief scenario.
The Nation requires a fleet of amphibious ships to support the
forcible entry amphibious force of two brigades. In light of fiscal
constraints, the Department of the Navy stated that it will sustain a
minimum of 33 amphibious ships in the assault echelon. Amphibious
capability demands sea basing and the Maritime Prepositioning Force.
Protecting U.S. interests around the globe and forcible entry are
directly tied to these amphibious capabilities.
The Navy League of the United States supports:
--The full funding of costs associated with resetting the force to
meet current and future requirements.
--The acquisition of an affordable amphibious combat vehicle to
ensure we have the ability to maneuver against adversaries that
are becoming increasingly capable, and to replace the aging and
costly Amphibious Assault Vehicle force.
--The continued acquisition of the F-35B to replace the AV-8 Harrier
and F/A-18 Hornet aircraft, and the acquisition of unmanned air
and ground systems to further enhance the flexibility, mobility
and versatility of Marine Corps forces.
--Adequate Navy shipping and sealift platforms to provide the
expeditionary lift to support present and future COCOM
requirements.
--Continued full-rate production of the MV-22 Osprey. Recent
successful deployments to Afghanistan of the MV-22 reinforce
the immediate need for this capability for both the Marine
Corps and U.S. Special Operations Command.
--The recapitalization of the workhorses of Marine Corps aviation--
the KC-130J aircraft, equipped with an improved aerial
refueling system, and the CH-53K, and the acquisition of UH-1Y
Huey and AH-1Z Super Cobra helicopters.
--The acquisition of modern air, ground and logistics C\2\ systems
such as Combat Operations Centers, the Joint Tactical Radio
System, the Common Air C\2\ System, Joint Tactical Common
Operational Picture Workstation and the Global Combat Support
System to support joint and coalition operations.
--The successful and continuous armor upgrades of vehicles as well as
anti-sniper technology and anti-improvised explosive device
technologies.
--The continued acquisition of MAGTF fires improvements, particularly
in the 155 mm Howitzer and HIMARS, and sufficient naval surface
fire for joint forcible-entry operations.
--The ongoing reconstitution and modernization efforts in the wake of
the extremely demanding rotation cycle of personnel and
equipment in Afghanistan.
--The transition to network-centric expeditionary forces able to
execute the war on terrorism with ready, relevant and capable
forces, supported by ISR assets that strengthen joint and
combined capabilities, ensure presence and provide surge.
With respect to the Navy League's support of the United States Coast
Guard
The U.S. Coast Guard, the 5th Armed Force, is the lead agency for
maritime homeland security. The USCG is in the process of determining
operational requirements for the Offshore Patrol Cutter, and then will
build the ships as soon as feasible to replace outdated and unreliable
Medium Endurance Cutters. The total requirement is for 25 vessels
delivered at two per/year.
Global climate change is opening up polar sea lanes, highlighting
competing territorial claims. Therefore, it is essential that
responsibility for ensuring our national sovereignty and interests in
the Polar Regions is assigned appropriately to the U.S. Coast Guard.
The NLUS Supports the transfer of icebreaker maintenance funds from
the National Science Foundation to the Coast Guard. The need for a
robust presence in the polar regions is supported by the Joint Chiefs
of Staff to accommodate security and sovereignty concerns. The first
step is to put the management of the Nation's icebreaking capability
where it belongs--with the Coast Guard.
With respect to the Navy League's support of the United States Flag
Merchant Marine
A strong commercial U.S. Flag Merchant Marine is more critical than
ever.
95 percent of the equipment and supplies required to deploy U.S.
forces is delivered by U.S. flagged and government owned vessels,
manned by U.S. citizen mariners.
The Navy League of the United States supports the Jones Act and the
Passenger Vessels Services Act which requires U.S. built ships and U.S.
citizen crews--because they protect critical national infrastructure
and provide added sealift capacity, are important to economic and
national security.
The recapitalization of the ready reserve force (RRF) is vitally
important to our maritime industry. The RRF should not be cut back
until sufficient replacement capacity and capability are available.
A strong strategic sealift merchant reserve component is needed in
the U.S. Navy to ensure that critical mariner skills and experience are
retained to support Navy and strategic sealift transportation.
The Navy League of the United States supports combined government
and industry efforts to counter piracy by introducing new technologies,
and if requested by the shipping companies, placing armed guards aboard
ships to prevent boardings.
SHIPBUILDING
The Navy continues to struggle to meet its operational demand for
deployable warships. The Navy deploys as many ships today as it did in
the early 1990s, but with only two-thirds the number of ships in the
fleet. The Navy is hard pressed to match and outpace threats from
ballistic missiles, cruise missiles, aircraft and submarines.
All three of the U.S. Navy's fleets--the fleet in planning, the
fleet in construction and the fleet in being--are stressed with budget
limitations.
Good news lies with the success of aircraft carrier construction
and the midlife refueling overhauls of the existing Nimitz class. The
Virginia-class submarine construction continues with two boats a year
authorized and funded beginning in 2011.
The Ohio SSBN replacement is under design, with efforts to restrain
costs and still meet the expected operational demands. This development
and construction program, if allowed to remain in the Navy's SCN
funding accounts, will create havoc with other vital construction
programs. These costs should be funded independently as a national
strategic investment.
Major shipyards along the gulf coast have suffered from modest
amounts of facility modernization and significant storm damage repair
over the past decade. These shipyards must be able to plan on a
sustainable and predictable workload, which will provide the revenue to
support a trained work force, and facilities needed to construct our
fleet.
Along with constructing and supporting the Navy fleet, these yards,
with the Naval Sea Systems Command, must support and cooperate closely
with the U.S. Coast Guard, Military Sealift Command and MARAD. The
plans, best practices, procedures, and research and development all
must be shared with the industrial base. There also must be development
in the domestic oil and gas industry's emergency response capability,
sufficient to handle large and small oil spill response, such as the
Deepwater Horizon oil spill.
The shipbuilding industry needs increased investment in maritime
research and development that includes dual-use vessels for America's
Marine Highway System, with military-useful capabilities that can be
called upon for DOD strategic sealift capability.
The Navy must continue to strengthen and improve research and
reassess its design, procurement and integration processes to produce
affordable, combat-credible and survivable surface ships and
submarines. Research is vital to the future fleet and its capabilities.
The Navy League of the United States supports:
--An increase of shipbuilding funds to the level of at least $25
billion per year, with the associated research and development
dollars to fund the requirements and design work that precedes
contracting for ship and submarine construction.
--Ensuring that the funds for the SSBN(X), the Ohio-class submarine
replacement, are provided as needed outside of the Navy's SCN
budgets to preclude the disruption and delay of other vital
shipbuilding programs.
--Adequate funding to recover and continue to build and sustain a
vital organic Navy Shipbuilding Technical Authority, including
a robust design and research capability and capacity, which has
dwindled and remains at a reduced and inadequate size.
INDUSTRIAL BASE
The industrial base that services this Nation's Sea Services is, at
best, stagnant and most likely declining. This is cause for great
concern because it inhibits efficient ship construction, ship repair
(battle damage) and ship modernization in a time of increased tension
or crisis. It also inhibits price and technical competition, which
results in paying more for goods and services and acquiring less
advanced equipment and systems for warships and aircraft.
The Navy and Coast Guard are only purchasing what they can afford--
not what they require to meet fleet needs. Our stocks of spare parts
are reduced in number and our critical battle spares (shafts,
propellers, reduction gears) are nearly nonexistent. The same limited
availability of combat system components, such as weapon launchers,
guns and sensors, would preclude our performing meaningful battle
damage repairs and restoration, which with a small fleet is an
important capability.
The only practical source of this equipment today is found in the
new-construction shipyards. The manufacturing lead time is extensive,
therefore we need spares. The defense supply system stocks little if
any of the critical steel, aluminum, piping and electric cable needed
for major repairs.
The labor pool possessing the critical skills necessary to produce
our equipment and systems and construct our warships is aging, with key
personnel leaving and not being replaced in kind. Ship construction and
related industries are not viewed by today's younger generation as a
viable career path.
The key element to achieving on-time and on-price production for
our technically advanced systems and ships is a trained and dedicated
workforce. These shortages result in the all-too-common poor
performance experienced in shipyards and manufacturing plants. The only
solution is additional training and education at all levels. We are
especially stressed with the low number of experienced ship design
personnel and senior managers within the Navy and in industry.
The future success of shipbuilding and many other Navy programs is
contingent on our Nation's support of Science, Technology, Engineering,
and Mathematics (STEM) education programs. According to the Office of
Naval Research, more than 30 percent of current DOD Science and
Technology professionals are expected to retire within the next 9
years.
STEM education equips our next-generation Sailors, Marines,
scientists, architects, and engineers with the tools they need to
develop new technologies and platforms that will defend America in the
future.
The National Science Foundation notes that roughly half of all U.S.
economic growth over the last 50 years was the product of scientific
innovation. It is vital to our economic and national security that we
encourage and support math and science education programs at all
levels. A host of programs have been designed and funded in STEM
disciplines in order to reach kids in middle school and high school and
inspire them to explore the opportunities and rewards that exist with a
technical major.
From its beginnings, the U.S. Navy has been a leader in leveraging
technology and developing science-based solutions to defend U.S.
interests. Today's investments in science and technology research will
help the Navy maintain its edge as the high-tech service of the future.
The Navy League supports additional funding levels for STEM and is
working to support efforts to expand this program.
Global trade is still robust, yet our own foreign commerce is
carried in mostly foreign-built and foreign-crewed ships. A modest
increase, beyond Jones Act construction, in commercial shipbuilding
would give a substantial boost to our shipyards and marine vendors.
Facilities at the larger shipyards in the United States are capable
of constructing merchant ships as well as warships, but cannot match
the costs, schedules and efficiencies of shipyards in Europe and Asia.
On the other hand, U.S. yards construct and equip the best warships,
aircraft carriers and submarines in the world. They are unmatched in
capability, but are struggling to maintain that lead.
No nation can support and sustain a capable and sizeable Navy
without a strong and sustaining industrial base manned with adequate
numbers of skilled personnel. It is essential that this Nation have a
policy at the highest levels of government to support and sustain an
adequate industrial base capable of providing and supporting a strong
Navy and maritime commerce.
The Navy League of the United States urges:
--The U.S. Government to develop and institute an effective
industrial base policy that addresses critical issues such as
the development of improved ships, ship systems and weapons
with the capacity to annually produce multiple ships of a class
and the capability to increase capacity rapidly in time of
national need or emergency.
--An increased and stable level of predictable funding for the ships,
submarines, aircraft and combat systems that are the essential
elements of our fleet. The cost of these programs continues to
rise beyond normal inflation rates, which is linked to low
production rates and unstable funding. Improved staffing,
additional research and stable programs with a reasonable
annual production rate will help contain rising costs. Costs
are related to schedule and, at present, our production times
are excessive and should be reduced. A strong industrial base
will assist in achieving affordable pricing for the Navy's
programs.
--Capital investments in our existing infrastructure to allow us to
stay abreast of the latest technological advances, attract the
best young engineers and skilled workers, and ensure that we
have the capability and capacity to surge repair, produce and
construct the nation's fleet in time of crisis.
--Expanded use of advanced acquisition strategies, including block
buys, multiyear-priced options with innovative funding
approaches, such as time-phased and advanced appropriations
that stabilize accounts and avoid disruptive funding spikes and
voids.
--Support of the provision included in the fiscal year 2012 National
Defense Authorization Act that allows the Secretary of the Navy
the authority of advance purchase of major components during
construction of the next two Ford-class aircraft carriers and
to achieve cost savings by entering into multiyear advance
procurement agreements.
--Adopting incentives to cut costs and schedules and reward firms
that achieve significant savings in both money and time, while
maintaining quality. This will create an environment in which
high-performing companies can achieve returns on capital
comparable to those commercial enterprises of similar risk and
capitalization. Contracts should be structured so that earning
higher fees for higher performance is achievable.
RESETTING OUR FORCES
The national imperative to reset our Maritime Forces requires, not
only the replacement of equipment, but also demands the continued
effort to attract, train and retain intelligent and capable men and
women.
The resetting of our Maritime Forces requires the will of the
American people, the President and Congress to commit the necessary
resources to be prepared for our Nation's next battle. We can no longer
demand more from an already stressed manpower pool to respond to
worldwide disasters while redeploying to war zones and maintaining a
high operational tempo.
Combat operations have been continuous and equipment has been
subjected to intense use in harsh environments. Aside from the
requirement to buy new equipment for the increased end strength, the
entire force needs extensive rehabilitation, repair and replacement as
weapons and equipment are rotated out of combat.
Likewise, prepositioned stocks and training base stocks must be
replenished. The current reset cost estimate exceeds $15.6 billion, of
which only about $10.9 billion has been funded. As the fight continues,
the reset costs for equipment and training will increase apace, and
Congress needs to understand and support this requirement.
As the Marine Corps modernizes its combat forces, funding must be
continued for individual survivability programs, to include personal
protective equipment, lighter-weight gear and modern force-protection
systems. Ground mobility must be improved to provide the Marine Corps
the capability to effectively operate across the mission spectrum yet
remain tailored in size to be deployable and employable.
Navy League Community Service
Every year, the Navy League participates in countless activities
that support service members and their families. Highlights of some of
the accomplishments of the Navy League this past year include:
--$1,395,712 was given by Navy League of the United States to support
the members of the sea services and their families.
--Navy League supported 1,545 Welcome Home Receptions, Holiday
Parties, Child Care, R&R Programs, Ship Dinners and Luncheons
and BBQ's totaling $603,046.
--Navy League adopted or supported 401 Navy, Coast Guard and Merchant
Marine ships and Marine Corps units in 2010.
--Navy League organized or provided substantial support for 16 Navy
and Coast Guard ship commissioning ceremonies.
--1,925 Sea Service Awards were given in 2010 totaling $185,720.
--$41,970 was given in support of 546 transitioning sea service
members and their families.
--$230,227 was provided to 146 Sea Cadets.
--$103,158 was provided to 415 JROTC units.
--$112,981 in scholarships were given to 71 sea service youths.
--Over $20,000 worth of care packages were sent to the USO and troops
overseas.
--Over 1 million paperback books have been sent to Operation
Paperback for overseas military personnel.
Additionally, the Navy League of the United States is the sponsor
of the Naval Sea Cadet Corps (NSCC). The Sea Cadets were founded by the
Navy League in 1958 at the request of then-CNO Admiral Arleigh Burke.
The goal was to establish a youth organization that would ``create a
favorable image of the Navy on the part of American youth.'' The Naval
Sea Cadet Corps was subsequently chartered by Congress in 1962 as a
nonprofit, civilian development and training organization for youth
ages 13 through 17, sponsored by the Navy League and supported by both
the U.S. Navy and U.S. Coast Guard.
The Sea Cadets recently signed a Memorandum of Understanding with
the Coast Guard Auxiliary for training and support, and have also
discussed Sea Cadet participation in the activities of NOAA. Included
under the NSCC umbrella is the Navy League Cadet Corps, a junior
program for children ages 11 through 13. The NSCC program has grown
nationally to 10,487 participants in 387 units in all 50 States, Guam
and Puerto Rico. The program is run by volunteers with the objective of
developing within youth an interest and skill in seamanship and
seagoing subjects; developing an appreciation for our navy's history,
customs, traditions and its significant role in national defense;
developing positive qualities of patriotism, courage, self-reliance,
confidence, and pride in our Nation and other attributes which
contribute to development of strong moral character, good citizenship
traits and a drug-free, gang-free lifestyle; and to present the
advantages and prestige of a military career.
Many cadets enlist in the services, estimated at about 2,000 per
year from an eligibility pool of about 20,000. Admiral Roughead
recently indicated that every ex-Sea Cadet that enlists in the Navy
represents a $14,000 saving in recruiting costs to the Navy. We are
very proud that over 12 percent of the current brigade of Naval Academy
Midshipmen are former Naval Sea Cadets.
CONCLUSION
Forward deployed forces provide a forward presence creating global
engagements that are critical to the U.S. economy, world trade and the
protection of democratic freedoms that so many take for granted. The
guarantors of these vital elements are hulls in the water, boots on the
ground and aircraft overhead.
Since ``presence with the capability to engage'' is the primary
strength of the Sea Services, it is imperative that we fund an
aggressive shipbuilding and modernization program. Sustained maritime
superiority is paramount to supporting the American economy.
America is a maritime nation and must maintain its status of
maritime superiority if there is to be peace and economic prosperity
around the world. Secretary of the Navy Mabus recently commented that:
``Sometimes the U.S. Navy-Marine Corps Team follows the storm to the
shore--sometimes we must bring the storm''.
In 2020, 40 percent of the U.S. Gross Domestic Product will be
dependent on ocean shipping and maritime trade. Maritime superiority is
essential to our economy.
The Navy League is committed to educating and informing, the senior
leadership in the Executive and Legislative branches of the U.S.
Government, as well as the media and the American people, of the
continuing need for U.S. sea power, both naval and commercial, to
protect U.S. interests throughout the world and ensure the Nation's
economic well-being.
The most important ``reform'' that can be made in the field of
national defense is to provide adequate funding for America's Sea
Services, which are the greatest force for peace in the world.
Chairman Inouye. Thank you very much, Mr. Lumme.
Senator Cochran.
Senator Cochran. Mr. Chairman, thank you.
Thank you very much, Mr. Lumme, for your comments and
observations. I know the Navy League is a voluntary
organization of mostly former officers or enlisted active duty
persons who have served in the U.S. Navy; is that right?
Mr. Lumme. Actually, it's not, sir. We only have 28 percent
that are former military, so we have over 70 percent that are
volunteers that had no military service at all.
Senator Cochran. How do you sell people on the fact that
they ought to pay dues to the Navy League? What is the purpose
of the organization?
Mr. Lumme. Our advocacy of the sea service is not only for
the combat readiness and support of maritime--because we do
flag merchant marine and Coast Guard also. We also support the
families. We have individual augmentee programs, we have adopt
a sailor programs, adopt a ship programs. Most of the ship
commissionings that go on around the United States, Coast Guard
and Navy, are done by the Navy League as a sponsor.
So we sell that because of patriotic support by the members
who didn't join the military, but maybe want to help in other
ways.
Senator Cochran. Well, I think that's admirable and I
commend you for the work you do. I enjoyed serving in the Navy.
We were lucky we weren't at war at the time. I might not have
enjoyed it so much if somebody had been shooting at us or
trying to sink our ship.
But the Navy has really done a great job in projecting
power and a presence and influence throughout the world, I
guess for the last--how many years? When did the Navy League
start?
Mr. Lumme. The Navy League started in 1902.
Senator Shelby. 1902. Quite a record of service and
accomplishment.
Thank you.
Chairman Inouye. Thank you.
Senator Shelby.
Senator Shelby. Mr. Chairman, I just want to tell Mr. Davis
I appreciate his testimony and appearing here today.
Chairman Inouye. Our next witness is Mr. John Davis of the
Fleet Reserve Association.
STATEMENT OF JOHN R. DAVIS, DIRECTOR, LEGISLATIVE
PROGRAMS, FLEET RESERVE ASSOCIATION
Mr. Davis. Chairman Inouye, Vice Chairman Cochran, and
Senator Shelby: My name is John Davis and I want to thank you
for the opportunity to express the views of the Fleet Reserve
Association.
Ensuring adequate funding for the military health system is
a top legislative priority for the association and very
important to every segment of our membership. This is reflected
in responses to the association's 2011 online survey, which
revealed that over 90 percent of all active duty, reserve,
retired, and veteran respondents cited healthcare access as a
critically important quality of life benefit associated with
their military service.
FRA opposes drastic TRICARE enrollment fee increases and
opposed the 2006 proposed increase, which was up to $2,000
increase every year for TRICARE Prime and an estimated index
which would cause an increase every year of about 7.5 percent.
The association opposes the current administration's
proposal. Although it provides a modest increase in 2012, it
does mandate further increases past 2012 based on an index that
measures healthcare inflation and assumes a 6.2 percent
increase every year.
The FRA prefers the TRICARE provisions in the House and
Senate defense authorization bills. That, like the
administration's proposals, provides a modest adjustment, $2.50
per month for individuals and $5 per month for families that
are getting TRICARE Prime, and--and I can't overestimate this
enough--in the out-years it provides a cap for any future
increases that is no more greater than the percentage increase
for the cost of living adjustment for retirees. This ensures
that the military retirees' compensation will not be eroded by
their healthcare costs in future years.
We are also thankful that there are no increases for
TRICARE Standard, for their survivors, for TRICARE for Life,
and of course for active duty military.
The House version also eliminates copays for mail order
generic drug prescriptions. That is something that FRA has long
supported.
FRA welcomes the administration's focus on creating an
electronic health record for service members that can follow
them to the Department of Veterans Affairs and for the rest of
their life.
Notwithstanding the oversight limitations, adequate funding
for an effective delivery system between DOD and VA to
guarantee a seamless transition and quality of service for
wounded personnel is very important to our membership.
The association notes that the administration has not
proposed authorizing chapter 61 retirees to receive full
military retired pay and veterans disability compensation, as
it has done the last 2 years. FRA continues to seek
authorization and funding of full concurrent receipt from all
disabled retirees.
Family support is also important and should include funding
for compensation, training, and certification for respite care
for family members functioning as full-time caregivers for
wounded warriors. These provisions were enacted in the fiscal
year 2011 defense authorization and are similar to the
Caregivers and Veterans Omnibus Health Care Service Act, S.
1963, that was enacted for the VA. Both acts improve
compensation, training, and assistance for caregivers of
severely disabled active duty service members.
FRA also supports the funding for a 1.6 percent active duty
pay increase, which at least keeps pace with salaries in the
private sector. If authorized, FRA supports funding retroactive
eligibility for early retirement benefit, to include reservists
who have supported contingency operations since September 11,
2001.
Again, I want to thank you for allowing me to submit my
views, the FRA's views, to this subcommittee.
[The statement follows:]
Prepared Statement of John R. Davis
THE FRA
The Fleet Reserve Association (FRA) is the oldest and largest
enlisted organization serving active duty, Reserves, retired and
veterans of the Navy, Marine Corps, and Coast Guard. It is
Congressionally Chartered, recognized by the Department of Veterans
Affairs (VA) as an accrediting Veteran Service Organization (VSO) for
claim representation and entrusted to serve all veterans who seek its
help. In 2007, FRA was selected for full membership on the National
Veterans' Day Committee.
FRA was established in 1924 and its name is derived from the Navy's
program for personnel transferring to the Fleet Reserve or Fleet Marine
Corps Reserve after 20 or more years of active duty, but less than 30
years for retirement purposes. During the required period of service in
the Fleet Reserve, assigned personnel earn retainer pay and are subject
to recall by the Secretary of the Navy.
FRA's mission is to act as the premier ``watch dog'' organization
in maintaining and improving the quality of life for Sea Service
personnel and their families. FRA is a leading advocate on Capitol Hill
for enlisted active duty, Reserve, retired and veterans of the Sea
Services. The Association also sponsors a National Americanism Essay
Program and other recognition and relief programs. In addition, the
newly established FRA Education Foundation oversees the Association's
scholarship program that presents awards totaling nearly $120,000 to
deserving students each year.
The Association is also a founding member of The Military Coalition
(TMC), a consortium of more than 30 military and veteran's
organizations. FRA hosts most TMC meetings and members of its staff
serve in a number of TMC leadership roles.
FRA celebrated 86 years of service in November 2010. For nearly
nine decades, dedication to its members has resulted in legislation
enhancing quality of life programs for Sea Services personnel, other
members of the uniformed services plus their families and survivors,
while protecting their rights and privileges. CHAMPUS, now TRICARE, was
an initiative of FRA, as was the Uniformed Services Survivor Benefit
Plan (USSBP). More recently, FRA led the way in reforming the REDUX
Retirement Plan, obtaining targeted pay increases for mid-level
enlisted personnel, and sea pay for junior enlisted sailors. FRA also
played a leading role in advocating recently enacted predatory lending
protections and absentee voting reform for service members and their
dependents.
FRA's motto is: ``Loyalty, Protection, and Service.''
OVERVIEW
Mr. Chairman, the Fleet Reserve Association salutes you, members of
the Subcommittee, and your staff for the strong and unwavering support
for essential programs important to active duty, Reserve Component, and
retired members of the uniformed services, their families, and
survivors. The Subcommittee's work in funding these programs has
greatly enhanced care and support for our wounded warriors, improved
military pay, eliminated out-of-pocket housing expenses, improved
healthcare, and enhanced other personnel, retirement and survivor
programs. This funding is critical in maintaining readiness and is
invaluable to our Armed Forces engaged in a long and protracted two
front war, sustaining other operational commitments and fulfilling
commitments to those who've served in the past. But more still needs to
be done.
A continuing high priority for FRA is full funding of the Military
Health System (MHS) to ensure quality care for active duty, retirees,
Reservists, and their families. FRA's other 2011 priorities include
annual active duty pay increases that are at least equal to the
Employment Cost Index (ECI), to help keep pace with private sector pay,
retirement credit for reservists that have been mobilized since
September 1, 2001, enhanced family readiness via improved
communications and awareness initiatives related to benefits and
quality of life programs, retention of full final month's retired pay
for surviving spouse, and introduction and enactment of legislation to
eliminate inequities in the Uniformed Service Former Spouses Protection
Act (USFSPA).
The Association also supports additional concurrent receipt
improvements to expand the number of disabled military retirees
receiving both their full military retired pay and VA disability
compensation as proposed in the administration's budget request from
last year.
The fiscal year 2012 budget calls for a 1.6-percent active duty pay
increase that equals the Employment Cost Index (ECI) and FRA supports
that increase. The Association also supports efforts to reduce the so-
called ``Military Widows tax'' imposed on beneficiaries whose Survivor
Benefit Plan (SBP) annuity is offset by the amount they receive in
Dependency and Indemnity Compensation (DIC), and if authorized, funding
to support this change.
HEALTHCARE
Healthcare is especially significant to all FRA Shipmates
regardless of their status and protecting and/or enhancing this benefit
as noted above is the Association's top legislative priority. Responses
to a recent FRA survey indicate that nearly 90 percent of active duty,
Reserve, retired, and veteran respondents cited healthcare access as a
critically important quality-of-life benefit.
The administration is proposing an increase to the TRICARE Prime
annual enrollment fee from $230 to $260 for individuals and from $460
to $520 per retired family. Starting in 2013 the annual enrollment fee
would be increased to keep pace with a medical inflation index. The
proposal also eliminates pharmacy co-pays for mail-order generic drugs
and increases the current retail formulary pharmacy $9 co-pay by $2 to
$3. There are no proposed increases for TRICARE Standard, survivors,
TRICARE-for-Life beneficiaries, and those who are medically retired.
There are also no out-of-pocket costs for active duty service members.
This proposed fee increase would represent a 13 percent increase in the
TRICARE Prime annual enrollment fee in the first year and would
apparently be indexed to Medicare Part B coverage cost increases in the
out-years. FRA is opposed to using Medicare costs for disabled and 65
and older beneficiaries as a basis for adjusting premiums for military
retirees age 38-64 that undoubtedly have lower healthcare costs than
individuals under Medicare.
If approved, FRA believes future premium adjustments for TRICARE
Prime beneficiaries under age 65 should be based on the Consumer Price
Index (CPI) since military retired pay cost-of-living-adjustments
(COLAs) are based on that measure. Any index in excess of the CPI would
grind down the value of their retired pay and would counter the purpose
of the COLA which to maintain the purchasing power of the beneficiary.
The House Defense Authorization bill (H.R. 1540) authorizes the 2012
fees increase per the administration's budget, but limits further
increases to no more than the annual COLA, and provides the requested
changes to pharmacy co-pays.
The House Defense Appropriations Subcommittee bill provides $32.3
billion for the Military Health System (MHS) in 2012 which is $935
million more than the last fiscal year and $119 million more than
requested by the administration. In conjunction with this, FRA strongly
supports funding to fully implement bidirectional electronic health
records that will follow service members as they transition from DOD to
the VA.
FRA also notes recommendations in recent Government Accountability
Office (GAO) testimony before the House Committee on Oversight and
Government Reform which identified Federal programs, agencies, offices
and initiatives that have duplicative goals or activities. Number two
on a list of 81 areas for consideration is realigning DOD's military
medical command structures and consolidating common functions to
increase efficiency which would result in projected savings of from
``$281 million to $460 million'' annually. In addition, GAO cites
opportunities for DOD and the Department of Veterans' Affairs (VA) to
jointly modernize their respective electronic health record systems,
and also control drug costs by increasing joint contracting.
DOD must continue to investigate and implement other TRICARE cost-
saving options. The Association notes the elimination of 780 contract
positions in conjunction with streamlining TRICARE Management Activity
functions along with increasing inter-service cooperation and co-
locating medical headquarters operations.
FRA also notes progress in expanding use of the mail order pharmacy
program, Federal pricing for prescription drugs, a pilot program of
preventative care for TRICARE beneficiaries under age 65, and
elimination of co-pays for certain preventative services. The
Association believes these efforts will prove beneficial in slowing
military healthcare spending in the coming years.
WOUNDED WARRIOR CARE
Last year Congress authorized a monthly stipend under the DOD
family caregiver program for catastrophically injured or ill wounded
warriors that is equal to the caregiver stipend provided by the
Department of Veterans' Affairs (VA). The new program will help many
caregivers, however, the enactment and implementation of the
legislation is only the first step and effective oversight and
sustained funding are also critical to ensuring future support for
these caregivers. A recent Navy Times survey on wounded warrior care
(November 29, 2010) indicates that 77 percent of caregivers have no
life of their own; 72 percent feel isolated; and 63 percent suffer from
depression.
DES
In response to the Dole/Shalala Commission Report a pilot program
was created (NDAA--fiscal year 2008--Public Law 110-181) known as the
Disability Evaluation System (DES). The pilot provides a single
disability exam conducted to VA standards that will be used by both VA
and DOD and a single disability rating by VA that is binding upon both
Departments. This pilot program has expanded and become the Integrated
Disability Evaluation System (IDES) and is viewed as a common-sense
approach that FRA believes will reduce bureaucratic redtape and help
streamline the process and warrants expansion to the entire disability
rating system. Despite jurisdictional concerns, the Association urges
the Subcommittee to provide oversight and adequate funding as the IDES
is implemented.
CONCURRENT RECEIPT
The Association notes that the administration has not proposed
authorizing Chapter 61 retirees to receive their full military retired
pay and veteran's disability compensation as it has the last two fiscal
years. FRA continues to seek timely and comprehensive implementation of
legislation that authorizes and funds the full concurrent receipt for
all disabled retirees and supports ``The Retired Pay Restoration Act''
(S. 344) sponsored by Majority Leader Senator Harry Reid (Nevada) which
is comprehensive legislation that authorizes concurrent receipt for all
disabled retirees, including those with less than 20 years of service
who have been medically retired (Chapter 61s).
FULL FINAL MONTH'S PAY
Current regulations require survivors of deceased armed forces
retirees to return any retirement payment received in the month the
retiree passes away or any subsequent moth thereafter. Upon the demise
of a retired service member in receipt of military retired pay the
surviving spouse is to notify the Department of Defense of the death.
The Defense Department's finance arm, Defense Finance and Accounting
Service (DFAS) then stops payment on the retirement account,
recalculates the final payment to cover only the days in the month the
retiree was alive, forwards a check for those days to the surviving
spouse (beneficiary) and, if not reported in a timely manner, recoups
any payment(s) made covering periods subsequent to the retiree's death.
The recouping is made without consideration of the survivor's financial
status.
At a most painful time, the surviving spouse is faced with the task
of arranging and paying for the deceased retiree's interment and that
difficulty is only amplified by the loss of retirement income when it
is needed most.
That is why FRA is supporting ``The Military Retiree Survivor
Comfort Act,'' (H.R. 493) sponsored by Rep. Walter Jones (North
Carolina).
The measure is related to a similar pay policy enacted by the
Department of Veterans Affairs (VA). Congress passed a law in 1996 that
allows a surviving spouse to retain the veteran's disability and VA
pension payments issued for the month of the veteran's death. FRA
believes military retired pay should be no different.
To offset some of the costs, if the spouse is entitled to survivor
benefit annuities (SBP) on the retiree's death, there will be no
payment of the annuity for the month the retirement payment is provided
the surviving spouse. If authorized, FRA urges this subcommittee to
provide adequate funding to correct inequities associated with this
policy.
DEFENSE BUDGET
FRA supports a defense budget of at least 5 percent of GDP to fund
both people and weapons programs. The current level of defense spending
(4.7 percent including supplemental spending in fiscal year 2010) is
significantly lower than past wartime periods as a percentage of GDP
and the Association is concerned that the administration's 5-year
spending plan of 1 percent above inflation may not be enough for both
people programs and weapon systems.
ACTIVE DUTY PAY
The military has been appropriately excluded from the pay freeze
for Federal employees announced by President Obama on November 29, 2010
and FRA strongly supports the proposed 1.6 percent pay increase that
equals the 2010 Employment Cost Index (ECI). The United States however,
is in the 10th year of war and there is no more vital morale issue for
our current warriors than adequate pay.
A total of 92 percent of active duty personnel who responded to
FRA's recent quality of life issues survey consider pay as ``very
important,'' which was the highest rating. The Association appreciates
the strong support from this distinguished Subcommittee in reducing the
13.5 percent pay gap to 2.4 percent since 1999 and reiterates the fact
that the ECI lags 15 months behind the effect date of pay adjustments
due to budget preparation and associated Congressional action on annual
authorizing and appropriations legislation. It should also be noted
that the enacted fiscal year 2011 1.4 percent pay increase and the
proposed fiscal year 2012 adjustment are the smallest pay increases in
recent memory and do not further reduce the pay gap .
The Association recommends that this distinguished Subcommittee
provide funding for an active duty pay increase at least equal to the
ECI so as not to increase the pay gap between civilian and military
pay.
END STRENGTHS
Sufficient funding to support adequate end strengths for the
military is vital for success in Afghanistan and to sustaining other
operations vital to our national security. FRA is concerned about calls
for reducing end strength in the out-years to save money on the defense
budget while still engaged for almost 10 years of war in Iraq and
Afghanistan, a third war in Libya, renewed violence in Korea late last
year, and support for the natural disaster in Japan. The strain of
repeated deployments continues and is reflected in troubling stress-
related statistics that include alarming suicide rates, prescription
drug abuse, alcohol use and military divorce rates. These are also
related to the adequacy of end strengths and the need for adequate
dwell time between deployments--issues that have been repeatedly
addressed in Congressional oversight hearings.
RESERVE ISSUES
FRA stands foursquare in support of the Nation's Reservists. Due to
the demands of the War on Terror, Reserve units are increasingly
mobilized to augment active duty components. As a result, the Reserve
component is no longer a strategic Reserve, but is an essential
operational Reserve that is an integral part of the total force that
has been at war for almost a decade. And because of these increasing
demands, including missions abroad over longer periods of time, it is
essential to ensure adequate funding for military compensation and
benefits to retain currently serving personnel and attract quality
recruits.
Retirement.--If authorized, FRA supports funding retroactive
eligibility for the early retirement benefit to include Reservists who
have supported contingency operations since 9/11/2001 (H.R. 181). The
fiscal year 2008 Defense Authorization Act (H.R. 4986) reduces the
Reserve retirement age (age 60) by 3 months for each cumulative 90-days
ordered to active duty after the effective date (January 28, 2008)
leaving out more than 600,000 Reservists mobilized since 9/11 for duty
in Afghanistan and Iraq.
Family Support.--FRA supports resources to allow increased outreach
to connect Reserve families with support programs. This includes
increased funding for family readiness, especially for those
geographically dispersed, not readily accessible to military
installations, and inexperienced with the military. Unlike active duty
families who often live near military facilities and support services,
most Reserve families live in civilian communities where information
and support is not readily available. Congressional hearing witnesses
have indicated that many of the half million mobilized Guard and
Reserve personnel have not received transition assistance services they
and their families need to make a successful transition back to
civilian life.
CONCLUSION
FRA is grateful for the opportunity to present these
recommendations to this distinguished Subcommittee. The Association
reiterates its gratitude for the extraordinary progress this
Subcommittee has made in funding a wide range of military personnel and
retiree benefits and quality-of-life programs for all uniformed
services personnel and their families and survivors.
Chairman Inouye. Thank you very much, Mr. Davis.
Senator Cochran.
Senator Cochran. Mr. Chairman, I think we should express
our appreciation to Mr. Davis for being here and helping us
understand the recommendations of his organization. We know
it's one of the oldest organizations supporting active duty
military personnel and has a record of achievement. We thank
you for your continued interest.
Mr. Davis. Thank you.
Chairman Inouye. Senator Shelby.
Senator Shelby. Mr. Chairman, I already thanked him. I got
ahead of the panel a minute ago. But I will reiterate that.
Mr. Davis. You can thank me again.
Senator Shelby. We appreciate you being here.
Mr. Davis. Thank you.
Senator Shelby. Thank you.
Chairman Inouye. Thank you.
Now may I call upon Ms. Leighton. Ms. Leighton.
STATEMENT OF SUSAN LEIGHTON ON BEHALF OF THE OVARIAN
CANCER NATIONAL ALLIANCE
Ms. Leighton. Good morning, Mr. Chairman, Mr. Vice
Chairman, and Senator Shelby. I'm honored to appear before you
in support of the Ovarian Cancer National Alliance's request of
$20 million for the Department of Defense ovarian cancer
research program, which I will henceforth refer to as the
``OCRP.''
My name is Susan Leighton. I'm from Huntsville, Alabama,
where my husband and I settled after his retirement from the
United States Army as a chief warrant officer 3. I am also a
veteran.
In the summer of 1997, at the age of 48, I was diagnosed
with stage 3C ovarian cancer. Women diagnosed in later stages
like myself have only a 20 percent chance of surviving 5 years.
In an instant, I went from preparing to take my daughter to
college to wondering whether I would see her graduate.
I was treated at the University of Alabama in Birmingham.
My healthcare was paid for by my husband's military health
plan. I was fortunate to enter treatment the year after two
chemotherapeutic agents had been approved for use as first-time
treatment of ovarian cancer. The combination of surgery and
those two agents put me into remission. With the exception of
one recurrence, I have remained with no evidence of disease.
The research that led to the discovery of those two agents
saved my life. I saw my daughter graduate from Auburn
University, begin a career, and walk down the aisle to marry.
Unfortunately, the majority of women diagnosed do not have this
fairy tale ending.
Ovarian cancer is a heterogeneous disease. Many women do
not respond to the type of chemotherapy that helped me. The
survival rate for this disease has remained fairly stable.
Fewer than 50 percent of the approximately 21,000 women
diagnosed each year will be alive in 5 years.
The solution to improving the survival rates is simple:
Research. Being one of the handful of long-term survivors, I
feel a responsibility to speak for other ovarian cancer
patients. I have participated as a consumer reviewer on the
OCRP panels for 2 years, bringing the patient's perspective to
the table. As a reviewer, I help decide which research will
benefit women diagnosed with ovarian cancer and those at risk
of developing it in the future.
I have seen the focus move toward studying cellular
pathways of cancer. We are on the precipice of understanding
how ovarian cancer develops, grows, and spreads, and ultimately
eliminating it.
I recently returned from the annual meeting of the American
Society of Clinical Oncology, where I heard about studies of
PARP inhibitors and anti-angiogenesis agents, which are showing
promising results for ovarian cancer survivors. Many of those
studies were funded by grants from the OCRP.
We are very aware of the current economic climate and
understand the constraints you face when determining where best
to allocate funds. For that reason, we are asking for flat
funding of the OCRP in fiscal year 2012.
My cancer support group in Alabama has a memorial statue in
our garden of life and remembrance. I have watched over the
years as we have added name after name to that statue. The
young man who engraves those names for us each year refuses to
take payment, telling us that the only payment he wants is a
call telling him that we have no new names to add. The only way
this will happen is by eliminating ovarian cancer.
The situation in Alabama is no different than in Hawaii,
Tennessee, Texas, or any other State. By flat funding the OCRP
we will be able to maintain our current level of research and
move closer to that goal.
Thank you for the opportunity to speak on behalf of women
battling ovarian cancer today, and I'm happy to answer any
questions.
[The statement follows:]
Prepared Statement of Susan Leighton
Good morning, Mr. Chairman, Mr. Vice Chair and Members of the
Subcommittee. I am honored to appear before you in support of the
Ovarian Cancer National Alliance's request of $20 million for the
Department of Defense Ovarian Cancer Research Program (DOD OCRP), which
I will henceforth refer to as the OCRP. My name is Susan Leighton. I am
from Huntsville, Alabama, where my husband and I settled after his
retirement from the United States Army as a Chief Warrant Officer,
Three.
The Ovarian Cancer National Alliance (the Alliance) thanks the
Subcommittee for the opportunity to submit comments for the record
regarding the Alliance's fiscal year 2012 funding recommendations. We
believe these recommendations are critical to ensure that advances can
be made to help reduce and prevent suffering from ovarian cancer. For
the last 14 years, the ovarian cancer community has worked to increase
awareness of ovarian cancer and advocated for additional Federal
resources to support research that would lead to more effective
diagnostics and treatments.
As an umbrella organization representing more than 50 State and
local groups, the Alliance unites the efforts of grassroots activists,
women's health advocates and healthcare professionals to bring national
attention to ovarian cancer.
As part of these efforts, Alliance advocates for continued Federal
investment in the Department of Defense Congressionally Directed
Medical Research Programs (CDMRP). The Alliance respectfully requests
that the Senate Appropriations Subcommittee on Defense maintain the
fiscal year 2011 funding level of $20 million for the DOD OCRP in
fiscal year 2012.
In the summer of 1997, at the age of 48, I was diagnosed with stage
IIIC ovarian cancer. Women diagnosed in later stages, like me, have
only a 20 percent chance of surviving 5 years. In an instant, I went
from preparing to take my daughter to college to wondering whether I
would see her graduate.
I was treated at the University of Alabama. I was fortunate to
enter treatment the year after two chemotherapeutic agents had been
approved for use as first line treatment of ovarian cancer. The
combination of surgery and those two agents put me into remission. With
the exception of one recurrence, I have remained with no evidence of
disease. The research that led to the discovery of those two agents
saved my life. I saw my daughter graduate from Auburn University, begin
a great career and walk down the aisle to marry. Unfortunately, the
majority of women diagnosed do not have this fairy tale ending.
Ovarian cancer is a heterogeneous disease. Many women do not
respond to the type of chemotherapy that helped me. The survival rate
for this disease has remained relatively stable; fewer than 50 percent
of the approximately 21,000 women diagnosed each year will be alive in
5 years. The solution to improving these survival rates is simple:
research.
Being one of a handful of long-term survivors, I feel a
responsibility to speak for other ovarian cancer patients. I have
participated as a consumer reviewer on the OCRP panels for 2 years,
bringing the patient's perspective to the table. As a reviewer, I help
decide which research will benefit women diagnosed with ovarian cancer
and those at risk of developing it in the future. I have seen the focus
move toward studying cellular pathways of cancer. We are on the
precipice of understanding how ovarian cancer develops, grows and
spreads--and ultimately eliminating it. I recently returned from the
annual meeting of the American Society of Clinical Oncology, where I
heard about studies of PARP inhibitors and anti-angiogenesis agents,
which are showing promising results for ovarian cancer survivors. Many
of those studies were funded by grants from the OCRP.
The DOD OCRP, which belongs to U.S. Army Medical Research and
Materiel Command (USAMRMC), complements but does not duplicate the
important ovarian cancer research carried out by the National Cancer
Institute (NCI). There are three critical differences between these
research programs.
First, the OCRP funds innovative, high risk, high reward research
which many large, non-DOD Federal research agencies do not have the
flexibility to engage in.
Second, the OCRP is designed to prevent funding research that
overlaps with other ovarian cancer research that has been funded by the
NCI or other agencies. Before funding an award, OCRP grant managers are
required to thoroughly check all sources of information to determine if
a proposal is redundant of a previous OCRP grant or a grant awarded by
another Federal agency such as the NCI.
Third, the OCRP pushes investigators to make rapid progress in
their research by requiring them to reapply every funding cycle.
Because proposal reviews conducted by the OCRP are double-blinded by
investigator and research institution, an investigator's progress is
evaluated on its own merit and must have sufficient new findings, data
or ideas to warrant new funding. The OCRP's unique method of funding
ovarian cancer research has yielded tremendous breakthroughs in the
fight against ovarian cancer, including:
--a new treatment using nanoparticles to deliver diphtheria toxin-
encoding DNA to ovarian cancer cells, leaving healthy cells
unaffected;
--the discovery of a compound that potentially inhibits a form of
ovarian cancer that makes up 40 percent of ovarian cancer
tumors;
--the finding that ovarian cancer cells are sensitive to glucose
deprivation and resveratrol treatment; and
--identification of the earliest molecular changes associated with
BRCA1- and BRCA2-related ovarian cancers, leading to biomarker
identification for early detection.
Cancer research performed by the DOD has been responsible for
fundamentally changing the way cancer research is conducted. Many
innovative practices and methods created by the CDRMPs have been
adopted by the NCI, such as the use of cancer patients as consumer
reviewers in the proposal review process. Furthermore, the CDRMP has
created funding mechanisms to incentivize research that would fill
voids in our understanding of cancer, which NCI has closely duplicated.
One such example is the Idea Award Other awards originated by CDRMPs
that have been duplicated by NCI are the Era of Hope Scholar and
Concept Award mechanisms.
A Modest Research Program that Creates Jobs
The OCRP remains a modest program compared to the other cancer
programs in the CDMRP:
However, even with limited funding, the OCRP has been able to make
vast strides in the fight against ovarian cancer. With flat funding for
fiscal year 2012, the program can maintain current levels of research
regarding screening, early diagnosis and treatment of ovarian cancer.
In a time that necessitates fiscal constraint, the OCRP has been
designed to fund ovarian cancer research with extremely low overhead:
only 4 to 8 percent of the Federal funding is used for administrative
costs.
Additionally, biomedical research like that conducted through the
DOD OCRP, is a major provider of jobs in the United States economy. A
2008 Families USA study found that for every NIH dollar invested in
States, $2 of economic output were created. Additionally, the report
estimated that approximately 350,000 jobs were supported by medical
research in 2007.
Ovarian Cancer's Deadly Statistics
In the 40 years since the War on Cancer was declared, ovarian
cancer mortality rates have not significantly improved. We are very
concerned that without continued funding in fiscal year 2012 for the
DOD OCRP to continue ovarian cancer research efforts, the Nation will
see growing numbers of women losing their battle with ovarian cancer.
The American Cancer Society estimates that in 2011, more than
21,000 American women will be diagnosed with ovarian cancer, and
approximately 15,000 will lose their lives to this terrible disease.
Ovarian cancer is the fifth leading cause of cancer death in women.
Currently, more than one-half of the women diagnosed with ovarian
cancer will die within 5 years. When detected early, the 5-year
survival rate increases to more than 90 percent, but when detected in
the late stages, the 5-year survival rate drops to less than 29
percent.
A valid and reliable screening test--a critical tool for improving
early diagnosis and survival rates--still does not exist for ovarian
cancer. Behind the sobering statistics are the lost lives of our loved
ones, colleagues and community members. While we have been waiting for
the development of an effective early detection test, thousands of our
mothers, daughters, sisters and friends have lost their lives to
ovarian cancer.
In 2007, a number of prominent cancer organizations released a
consensus statement identifying the early warning symptoms of ovarian
cancer. Without a reliable diagnostic test, we can rely only on this
set of vague symptoms of a deadly disease, and trust that both women
and the medical community will identify these symptoms promptly.
Unfortunately, we know that this does not always happen. Too many women
are diagnosed at late stage due to the lack of a test; too many women
and their families endure life-threatening and debilitating treatments
to kill cancer; too many women are lost to this horrible disease.
Our organization exists to ensure that women are diagnosed early,
receive appropriate treatments, are active participants in their care
and not just survive, but thrive. All women should have access to
treatment by a gynecologic oncology specialist. All women should have
access to a valid and reliable detection test. We must deliver new and
better treatments to patients and the physicians and nurses who treat
them. Until we have a test, we must continue to increase awareness and
educate women and health professionals about the signs and symptoms
associated with this disease.
Even with Limited Funding, OCRP Expands
Large ovarian cancer research teams do not exist in many academic
medical or research centers. In order to provide much-needed mentoring,
networking and a peer group for young ovarian cancer researchers, the
OCRP created an Ovarian Cancer Academy award in fiscal year 2009. The
OCRP Ovarian Cancer Academy is intended to develop a unique,
interactive virtual academy that will provide intensive mentoring,
national networking and a peer group for junior faculty. The
overarching goal of this award is to develop young scientists into the
next generation of successful and highly productive ovarian cancer
researchers within a collaborative and interactive research training
environment.
Additionally, in fiscal year 2010 the OCRP allowed ovarian cancer
researchers to compete for the Consortium Award. The Consortium
Development Award is an infrastructure development mechanism that
provides support to create a Coordinating Center and establish the
necessary collaborations at potential research sites for the
development of a multi-institutional ovarian cancer research team.
Participants in these consortiums will be scientists and/or clinicians
who have made significant contributions to the field of ovarian cancer
or who have a specific expertise related to the early changes
associated with ovarian cancer progression.
Senate Support for Fiscal Year 2012 Appropriation Request
This year, the ovarian cancer community has been proactive in
securing support for our fiscal year 2012 appropriation request. A
letter addressed to you in support of the $20 million appropriation for
the OCRP was signed by Senators Robert Menendez and Olympia Snowe, who
were joined by Richard Blumenthal, Susan Collins, Dick Durbin, Kirsten
Gillibrand, Kay Hagan, John F. Kerry, Herb Kohl, Jeffrey Merkley,
Debbie Stabenow and Ron Wyden.
A letter from Senator Robert Casey addressed to you in support of
all medical research conducted by the Department of Defense through the
Congressionally Directed Medical Research Program (CDMRP) was signed by
Senators Barbara Boxer, Al Franken, Kirsten Gillibrand, Tim Johnson,
John Kerry, Patrick Lautenberg, Jack Reed, Olympia Snowe, Jon Tester
and Ron Wyden.
Summary
The Alliance maintains a long-standing commitment to work with
Congress, the Administration, and other policymakers and stakeholders
to improve the survival rate from ovarian cancer through education,
public policy, research and communication. Please know that we
appreciate and understand that our Nation faces many challenges and
that Congress has limited resources to allocate; however, we are
concerned that without the funding to maintain ovarian cancer research
efforts, the Nation will continue to see many women lose their lives to
this terrible disease.
We are very aware of the current economic climate, and understand
the constraints you face when determining where best to allocate funds.
For that reason, we are asking for flat funding of the OCRP in fiscal
year 2012 at $20 million.
My cancer support group in Alabama has a memorial statue in our
Garden of Life and Remembrance. I have watched over the years as we
added name after name to the statue. The young man who engraves those
names each year refuses to take payment, telling us that the only
payment he wants is a call telling him that we have no new names to
add. The only way this will happen is by eliminating ovarian cancer.
The situation in Alabama is no different than that in Hawaii,
Tennessee, Texas or any other State. By flat-funding the Ovarian Cancer
Research Program, we will be able to maintain our current level of
research and move closer to that goal.
Thank you for this opportunity to speak on behalf of women battling
ovarian cancer today. I am happy to answer any questions.
Chairman Inouye. I thank you very much, Ms. Leighton.
Ms. Leighton. Thank you.
Chairman Inouye. Senator Cochran.
Senator Cochran. Mr. Chairman, I am reminded of the
leadership that you and former Chairman Senator Ted Stevens
have given to research in many different areas of troubling
concern, not only to traditional threats to the life and good
health of men and women in active duty situations, but to
families and how they can be affected by misfortune and
illness.
So I think of Ted Stevens and you working together over the
years to make sure that funds are found where there is a need
that exists. I think this is an indication of one of those
instances and we should respond in a favorable way.
Ms. Leighton. Thank you.
Chairman Inouye. Thank you.
Senator Shelby.
Senator Shelby. Mr. Chairman, I appreciate my constituent
testifying here today. I also appreciate her sharing her story,
because she is a survivor where a lot of women with ovarian
cancer have not. As she said in her testimony, her written
testimony, she was fortunate to enter a treatment the year
after two breakthrough agents had come through, through
research, for the treatment.
She also mentions in her--answers one of my questions that
I posed to the subcommittee earlier, whether or not we were
duplicating any of these things. She points out in her
testimony--I think it's very important--that a lot of this
research complements, but does not duplicate, the important
ovarian research, cancer research, carried out by the National
Cancer Institute, and the differences there. I think that's
very, very important.
I'm proud to have her testify here. I like her story and
what she's doing is trying to save other people's lives.
Thank you.
Ms. Leighton. Thank you.
Chairman Inouye. I thank the panel very much. Thank you
very much.
Our last panel: Dr. John Elkas, Society of Gynecologic
Oncologists; and Mr. Jonathan Schwartz, representing ZERO--The
Project to End Prostate Cancer.
May I call upon Dr. Elkas.
STATEMENT OF JOHN C. ELKAS, M.D., COMMANDER, U.S. NAVAL
RESERVE, ON BEHALF OF THE SOCIETY OF
GYNECOLOGIC ONCOLOGISTS
Dr. Elkas. Chairman Inouye, Senator Cochran, Senator
Shelby: Thank you for inviting me to testify in today's
hearing. My name is Dr. John Elkas and I am here today on
behalf of the Society of Gynecologic Oncologists and the
millions of Americans touched each year by ovarian cancer,
including our military families.
I practice medicine in the D.C. metropolitan area, where I
am an associate clinical professor in the department of
obstetrics and gynecology at the George Washington University
Medical Center, and I am also a commander in the United States
Naval Reserve and an adjunct associate professor of obstetrics
and gynecology at the Uniformed Services University of the
Health Sciences.
I am honored to be here and pleased that this subcommittee
is focusing attention on the Department of Defense
congressionally directed medical research program in ovarian
cancer. Since its inception 14 years ago, the OCRP has targeted
the highest needs in ovarian cancer research, funding high-
risk, high-reward research on a range of issues from early
cancer detection to personalized treatment and quality of life.
One in 69 women will develop ovarian cancer and less than
one-half will survive for 5 years. One woman dies of ovarian
cancer every hour in our country. It is expected that more than
22,000 women will be diagnosed with the disease this year and
14,000 women will die from the disease in 2011.
During the last 5 years, over 2600 members of our military
or their families have been hospitalized for ovarian cancer or
suspected ovarian cancer. These individuals have spent over
14,000 bed-days in military treatment facilities.
The Department of Defense ovarian cancer research program,
which belongs to the U.S. Army Medical Research and Material
Command, supports the forward momentum of critical research to
understand, prevent, and treat this disease that affects the
warfighter, military beneficiaries, and the general public.
The DOD OCRP is able to facilitate collaboration between
civilian and military research programs and because of this it
is able to share successes, such as raising the standard of
care of both military and civilian populations, lowering the
incidence, mortality, and burden of ovarian cancer, while in
turn reducing the economic drain on society.
The OCRP's unique method of funding ovarian cancer research
has yielded tremendous breakthroughs in the fight of ovarian
cancer, such as a new treatment using nanoparticles to attack
ovarian cancer cells while leaving healthy cells unaffected,
the finding that ovarian cancer cells are sensitive to glucose
deprivation, leading to more targeted treatments, and
identifying the earliest molecular changes associated with
BRCA1- and BRCA2-related ovarian cancers, leading to biomarker
identification, again for early detection.
Today ovarian cancer researchers are still struggling to
develop the first ovarian cancer screening test. With
traditional research models largely unsuccessful, the innovator
grants awarded by the DOD OCRP are integral in moving this
field of research forward.
The Society of Gynecologic Oncology joins with the Ovarian
Cancer National Alliance and the American Congress of
Obstetricians and Gynecologists to urge this subcommittee to
maintain Federal funding for the OCRP at $20 million for fiscal
year 2012. Military beneficiaries will benefit in the same way
the American general public stands to gain from research on
this deadly disease. For every dollar that is saved from
reducing the cost of cancer care for our military, another
dollar can be used to support the warfighter. The DOD ovarian
cancer research program is making a difference in the lives of
our military beneficiaries and the general public.
Thank you again for your attention to this request and for
allowing me to testify before you today.
[The statement follows:]
Prepared Statement of John C. Elkas
Mr. Chairman, Ranking Member and members of the subcommittee, thank
you for inviting me to testify at today's hearing. My name is Dr. John
C. Elkas and I am here today on behalf of the Society of Gynecologic
Oncology. I practice medicine in the D.C. metropolitan area, where I am
an associate clinical professor in the department of obstetrics and
gynecology at the George Washington University Medical Center and in
private practice in Annandale, Virginia. I am also a Commander in the
U.S. Naval Reserve and an adjunct associate professor of obstetrics and
gynecology for the Uniformed Services University of the Health Sciences
in Bethesda, Maryland.
I am honored to be here and pleased that this subcommittee is
focusing attention on the Department of Defense (DOD) Congressionally
Directed Medical Research Program in Ovarian Cancer (OCRP). Since its
inception now 14 years ago, the OCRP has targeted the highest needs in
ovarian cancer research, funding high-risk, high-reward research on a
range of issues from early cancer detection to personalized treatment
and quality of life.
This morning, I will try to outline some of the important
contributions this DOD program has made to ovarian cancer research, the
well-being of our patients, and its relevance to our military and to
their families. In fact, it is quite easy to demonstrate that this
investment by the Federal Government has resulted in substantial
benefits and value to medicine, to science and most importantly
improved patient care.
As this subcommittee may know, ovarian cancer usually arises from
the cells on the surface of the ovary and can be extremely difficult to
detect. According to the American Cancer Society, in 2010, more than
22,000 women were diagnosed with ovarian cancer and approximately
14,000 lost their lives to this terrible disease. Ovarian cancer causes
more deaths than all the other cancers of the female reproductive tract
combined, and is the fourth highest cause of cancer deaths among
American women. One of our biggest challenges lies in the fact that
only 19 percent of all ovarian cancers are detected at a localized
stage, when the 5-year relative survival rate approaches 93 percent.
Unfortunately, most ovarian cancer is diagnosed at late or advanced
stage, when the 5-year survival rate is only 31 percent.
Nationally, biomedical research funding has grown over the last
decade through increased funding to the National Institutes of Health,
in no small part to the amazing efforts of members of this
Subcommittee. Yet funding for gynecologic cancer research, especially
for the deadliest cancer that we treat, ovarian cancer, has been
relatively flat. Since fiscal year 2003, the funding levels for
gynecologic cancer research and training programs at the NIH, NCI, and
CDC have not kept pace with inflation, with the funding for ovarian
cancer programs and research training for gynecologic oncologists
actually suffering specific cuts in funding due to the loss of an
ovarian cancer Specialized Project of Research Excellence (SPORE) in
2007 that had been awarded to a partnership of DUKE and the University
of Alabama-Birmingham. Were it not for the DOD OCRP, many researchers
might have abandoned their hopes of a career in basic and translation
research in ovarian cancer and our patients and the women of America
would be waiting even longer for reliable screening tests and more
effective therapeutic approaches.
As a leader in the Society of Gynecologic Oncology (SGO) and as a
gynecologic oncologist who has provided care to women affiliated with
the United States Navy, I believe that I bring a comprehensive
perspective to our request for increased support. The SGO is a national
medical specialty organization of physicians who are trained in the
comprehensive management of women with malignancies of the reproductive
tract. Our purpose is to improve the care of women with gynecologic
cancer by encouraging research, disseminating knowledge which will
raise the standards of practice in the prevention and treatment of
gynecologic malignancies and cooperating with other organizations
interested in women's healthcare, oncology and related fields. More
information on the SGO can be found at www.sgo.org.
We, the members of the SGO, along with our patients who are
battling ovarian cancer every day, depend on the DOD OCRP research
funding. It is through this type of research funding that a screening
and early detection method for ovarian cancer can be identified which
will allow us to save many of the 14,000 lives that are lost to this
disease each year.
During the last 5 years, over 2,600 members of our military or
their families have been hospitalized for ovarian cancer or suspected
ovarian cancer. These individuals have spent over 14,000 bed days of
care in military treatment facilities.
The Department of Defense Ovarian Cancer Research Program (DOD
OCRP) which belongs to U.S. Army Medical Research and Materiel Command
(USAMRMC) supports the forward momentum of critical research to
understand, prevent, and treat this disease that affects the
warfighter, military beneficiaries, and the general public. DOD OCRP is
able to facilitate collaboration between civilian and military research
programs. Because the military is involved in research performed at
civilian health facilities nationwide, the DOD OCRP is able to share
successes and assist in raising the standard of care for both military
and civilian populations, lowering the incidence, mortality and burden
of this cancer, while in turn reducing the economic drain on society.
Therefore, on behalf of the SGO, I respectfully request that the
Senate Appropriations Subcommittee on Defense maintain the fiscal year
2011 funding level of $20 million for the OCRD for fiscal year 2012.
Department of Defense Ovarian Cancer Research Program: Building an Army
of Ovarian Cancer Researchers
New Investigators Join the Fight
Since its inception in fiscal year 1997, the DOD OCRP has funded
236 grants totaling more than $160 million in funding. The common goal
of these research grants has been to promote innovative, integrated,
and multidisciplinary research that will lead to prevention, early
detection, and ultimately control of ovarian cancer. Much has been
accomplished in the last decade to move us forward in achieving this
goal.
In Senator Mikulski's home State of Maryland, where many of my
patients also live, the DOD OCRP has funded research on important
questions such as:
--Defining biomarkers of serous carcinoma, using molecular biologic
and immunologic approaches, which are critical as probes for
the etiology/pathogenesis of ovarian cancer. Identifying
biomarkers is fundamental to the development of a blood test
for diagnosis of early stage disease and also ovarian cancer-
specific vaccines;
--Developing and evaluating a targeted alpha-particle based approach
for treating disseminated ovarian cancer. Alpha-particles are
short-range, very potent emissions that kill cells by incurring
damage that cannot be repaired; one to three alpha-particles
tracking through a cell nucleus can be enough to kill a cell.
The tumor killing potential of alpha-particles is not subject
to the kind of resistance that is seen in chemotherapy; and
--Understanding of the molecular genetic pathways involved in ovarian
cancer development leading to the identification of the cancer-
causing genes (``oncogenes'') for ovarian cancer.
In Senator Murray's home State of Washington, the DOD OCRP has
funded five grants in the last 5 years to either the University of
Washington or to the Fred Hutchinson Cancer Center to study research
questions regarding:
--The usefulness of two candidate blood-based microRNA markers for
ovarian cancer detection, and the identification of microRNAs
produced by ovarian cancer at the earliest stages, which may
also be the basis for future blood tests for ovarian cancer
detection;
--The first application of complete human genome sequencing to the
identification of genes for inherited ovarian cancer. The
identification of new ovarian cancer genes will allow
prevention strategies to be extended to hundreds of families
for which causal ovarian cancer genes are currently unknown;
and
--Proposed novel technology, stored serum samples, and ongoing
clinical studies, with the intend of developing a pipeline that
can identify biomarkers that have the greatest utility for
women; biomarkers that identify cancer early and work well for
the women in most need of early detection, that can immediately
be evaluated clinically.
One of the first, and very successful, grant recipients from the
DOD OCRP hails from the Fred Hutchinson Cancer Research Center in
Seattle, Washington, Dr. Nicole Urban. Dr. Urban has worked extensively
in the field of ovarian cancer early detection biomarker discovery and
validation. Her current program in translational ovarian cancer
research was built on work funded in fiscal year 1997 by the OCRP,
``Use of Novel Technologies to Identify and Investigate Molecular
Markers for Ovarian Cancer Screening and Prevention.'' Working with
Beth Karlan, M.D. at Cedars-Sinai and Leroy Hood, Ph.D., M.D. at the
University of Washington, she identified novel ovarian cancer
biomarkers including HE4, Mesothelin (MSLN), and SLPI using comparative
hybridization methods. These discoveries lead to funding in 1999 from
the National Cancer Institute (NCI) for the Pacific Ovarian Cancer
Research Consortium (POCRC) Specialized Program of Research Excellence
(SPORE) in ovarian cancer.
The DOD and NCI funding allowed her to develop resources for
translational ovarian cancer research including collection, management,
and allocation of tissue and blood samples from women with ovarian
cancer, women with benign ovarian conditions, and women with healthy
ovaries. The DOD grant provided the foundation for what is now a mature
specimen repository that has accelerated the progress of scientists at
many academic institutions and industry.
In Senator Feinstein's home State of California, 25 grants have
been funded by the DOD OCRP since the program was created in 1997 to
study research questions such as:
--Strategies for targeting and inhibiting a protein called focal
adhesion kinase (FAK) that promotes tumor growth-metastasis.
With very few viable treatment options for metastatic ovarian
cancer, this research could lead to drug development targeting
these types of proteins;
--Developing a tumor-targeting drug delivery system using Nexil
nanoparticles that selectively adhere to and are ingested by
ovarian carcinoma cells following injection into the peritoneal
cavity. The hypothesis for this research is that the
selectivity of Nexil can be substantially further improved by
attaching peptides that cause the particle to bind to the
cancer cells and that this will further increase the
effectiveness of intraperitoneal therapy; and
--Using several avenues of investigation, based on our understanding
of the biology of stem cells, to identify and isolate cancer
stem cells from epithelial ovarian cancer. This has significant
implications for our basic scientific understanding of ovarian
cancer and may drastically alter treatment strategies in the
near future. Therapies targeted at the cancer stem cells offer
the potential for long-term cures that have eluded most
patients with ovarian cancer.
In Senator Hutchinson's home State of Texas, 20 grants have been
funded since the inception of the DOD OCRP in 1997, to study research
questions regarding:
--Understanding the pre-treatment genomic profile of ovarian cancer
to then isolate the predictive response of the cancer to anti-
vasculature treatment, possibly leading to the identification
of targets for novel anti-vasculature therapies;
--Ovarian cancer development directly in the specific patient and her
own tumor. While this process has lagged behind in ovarian
cancer and improving patient outcomes, it has shown great
promise in other solid, tumor cancers; and
--Identifying the earliest molecular changes associated with BRCA1-
and BRCA2-related and sporadic ovarian cancers, leading to
biomarker identification for early detection.
As you can see from these few examples, the 236 grants have served
as a catalyst for attracting outstanding scientists to the field of
ovarian cancer research. In the 4 year period of fiscal year 1998-
fiscal year 2001 the OCRP enabled the recruitment of 29 new
investigators into the area of ovarian cancer research.
Federally Funding is Leveraged Through Partnerships and
Collaborations
In addition to an increase in the number of investigators, the
dollars appropriated over the last 13 years have been leveraged through
partnerships and collaborations to yield even greater returns, both
here and abroad. Past-President of the SGO, Dr. Andrew Berchuck of Duke
University Medical Center leveraged his OCRP DOD grants to form an
international Ovarian Cancer Association Consortium (OCAC) that is now
comprised of over 20 groups from all across the globe. The consortium
meets biannually and is working together to identify and validate
single nucleotide polymorphisms (SNPs) that affect disease risk through
both candidate gene approaches and genome-wide association studies
(GWAS). OCAC reported last year in Nature Genetics the results of the
first ovarian cancer GWAS, which identified a SNP in the region of the
BNC2 gene on chromosome 9 (Nature Genetics 2009, 41:996-1000.)
Dr. Berchuck and his colleagues in the association envision a
future in which reduction of ovarian cancer incidence and mortality
will be accomplished by implementation of screening and prevention
interventions in women at moderately increased risk. Such a focused
approach may be more feasible than population-based approaches, given
the relative rarity of ovarian cancer.
The DOD OCRP program also serves the purpose of strengthening U.S.
relationships with our allies, such as Australia, the United Kingdom,
and Canada. Dr. Peter Bowtell, from the Peter MacCallum Cancer Centre
in Melbourne, Australia, was awarded a fiscal year 2000 Ovarian Cancer
Research Program (OCRP) Program Project Award to study the molecular
epidemiology of ovarian cancer. With funds from this award, he and his
colleagues formed the Australian Ovarian Cancer Study (AOCS), a
population-based cohort of over 2,000 women with ovarian cancer,
including over 1,800 with invasive or borderline cancer. With a bank of
over 1,100 fresh-frozen tumors, hundreds of formalin-fixed, paraffin-
embedded (FFPE) blocks, and very detailed clinical follow-up, AOCS has
enabled over 60 projects since its inception, including international
collaborative studies in the United States, United Kingdom, and Canada.
AOCS has facilitated approximately 40 publications, most of which have
been released in the past 2 years.
One last important example of the value of the DOD OCRP's
contribution to science is the program's focus on inviting proposals
from the Historically Black Colleges and Universities and Minority-
Serving Institutions. This important effort to reach beyond established
clinical research partnerships expands the core research infrastructure
for these institutions which helps them to attract new investigators,
leveraging complementary initiatives, and supporting collaborative
ventures.
Over the decade that the OCRP has been in existence, the 236
grantees have used their DOD funding to establish an ovarian cancer
research enterprise that is much greater in value than the annually
appropriated Federal funding.
Opportunities are Lost Because of Current Level of Federal
Funding
These examples of achievement are obscured to a great degree by
opportunities that have been missed. At this current level of funding,
this is only a very small portion of what the DOD OCRP program could do
as we envision a day where through prevention, early detection, and
better treatments, ovarian cancer is a manageable and frequently
curable disease. Consistently, the OCRP receives over 500 letters of
intent for the annual funding cycle. Of this group, about 50 percent
are invited to submit full proposals. Prior to fiscal year 2009, the
OCRP was only able to fund approximately 16 grants per year, a pay line
of less than 7 percent. With an increase in funding to $20 million in
fiscal year 2009, $18.75 million in fiscal year 2010 and $20 million in
fiscal year 2011, the program had been able to consistently fund more
grants with the DOD being able to account for every dollar and how it
is used.
Department of Defense Ovarian Cancer Research Program: Exemplary
Execution with Real World Results
Integration Panel Leads to Continuous Evaluation and
Greater Focus
By using the mechanism of an Integration Panel to provide the two-
tier review process, the OCRP is able to reset the areas of research
focus on an annual basis, thereby actively managing and evaluating the
OCRP current grant portfolio. Gaps in ongoing research can be filled to
complement initiatives sponsored by other agencies, and most
importantly to fund high risk/high reward studies that take advantage
of the newest scientific breakthroughs that can then be attributed to
prevention, early detection and better treatments for ovarian cancer.
An example of this happened in Senator Mikulski's and my home State of
Maryland regarding the development of the OVA1 test, a blood test that
can help physicians determine if a woman's pelvic mass is at risk for
being malignant. The investigator, Zhen Zhang, Ph.D. at Johns Hopkins
School of Medicine, received funding from an Idea Development Award in
fiscal year 2003. Dr. Zhang discovered and validated five serum
biomarkers for the early detection of ovarian cancer. This bench
research was then translated and moved through clinical trials. The OVA
test was approved by the FDA and is now available to clinicians for use
in patient care.
More Than a Decade of Scientific Success
The program's successes have been documented in numerous ways,
including 469 publications in professional medical journals and books;
576 abstracts and presentations given at professional meetings; and 24
patents, applications and licenses granted to awardees of the program.
Investigators funded by the OCRP have succeeded with several crucial
breakthroughs in bringing us closer to an algorithm for use in
prevention and early detection of ovarian cancer.
The Society of Gynecologic Oncology joins with the Ovarian Cancer
National Alliance and the American Congress of Obstetricians and
Gynecologists to urge this Subcommittee to maintain Federal funding for
the OCRP at $20 million for fiscal year 2012. Military beneficiaries
will benefit in the same way the general American public stands to gain
from research in these deadly diseases. For every dollar that is saved
from reducing the cost of cancer care for our military, another dollar
can be used to support the warfighter. The DOD Ovarian Cancer Research
Program is making a difference in the lives of military beneficiaries
and the general public. I thank you for your leadership and the
leadership of the Subcommittee on this issue.
Chairman Inouye. I thank you very much, Dr. Elkas.
Senator Cochran.
Senator Cochran. Mr. Chairman, we appreciate very much Dr.
Elkas being here and bringing us up to date on the ovarian
cancer research program. This subcommittee has supported this.
Interesting how many women members of our Committee on
Appropriations are mentioned in the testimony. It just reminds
us that throughout not only the military, but our civilian
population, more and more of our leaders are women, and it's
certainly appropriate that this insidious illness is being
targeted by your organization. We wish you well.
Dr. Elkas. Thank you, sir.
Chairman Inouye. Senator Shelby.
Senator Shelby. Mr. Chairman, I just want to pick up on
some of his testimony.
One of our biggest challenges, you say, lies in the fact
that only 19 percent of all ovarian cancers are detected at a
localized and early stage, when the 5-year relative survival
rate then would approach 93 percent. You point out most ovarian
cancer is diagnosed at a later, advanced stage when the 5-year
survival rate drops down to 31 percent.
Tell me what research is being done and what promise is
there to help do the early detection when the survival rate
could be so high?
Dr. Elkas. Thank you for your question, Senator. I'm
excited because I think what makes the DOD OCRP program so
unique and so wonderful is its ability to fund programs that
would be otherwise very difficult to get funded through the NIH
funding mechanism. Very recently, the FDA approved a screening
test, a serum, a blood test that was developed through these
dollars, that now better allows us to screen and detect ovarian
cancer. It's not a perfect test, but it's certainly a step
forward.
In the coming weeks, in my practice at Fairfax I'll operate
on 20 women in the coming weeks and find one ovarian cancer.
That's 19 unnecessary surgeries. From my 14 years on active
duty service, bringing women back from overseas for surgeries,
many of which unnecessary, but certainly had to be done because
of our lack of a screening modality--we hope that advances like
we've already made will continue to be made, and it's certainly
your help that allows us to do that.
Senator Shelby. What is your approach to the early
treatment? If you could diagnose something or indications real
early, would it, one, save a lot of lives? Obviously. It would
save a lot of money, too, would it not?
Dr. Elkas. Oh, absolutely, absolutely, Senator. Our
survival for early stage ovarian cancer, stage 1 and stage 2,
approaches 88, 85 percent.
Senator Shelby. Something else that got my attention in
here because, as I said earlier, I'm the ranking Republican on
another subcommittee dealing with NIH and so forth, and I'm new
as far as ranking. But you're pointing out that funding for
this cancer research in this area has remained flat, if not
declined, through that; and that there was one ovarian cancer
specialized project of research excellence that had been
awarded to Duke and the University of Alabama-Birmingham and it
was cancelled. What happened there? Was it not promising or
what happened, because I'd be very interested in that.
Dr. Elkas. The specific details of that I will certainly
forward you.
Senator Shelby. Will you send it to me?
Dr. Elkas. Absolutely.
Senator Shelby. And I'll share it with the subcommittee.
Dr. Elkas. Please.
Senator Shelby. Thank you so much.
Dr. Elkas. Thank you. Thank you for your time.
Chairman Inouye. Thank you very much.
Now may I call on Mr. Schwartz.
STATEMENT OF JONATHAN D. SCHWARTZ, CHAIRMAN, BOARD OF
DIRECTORS, ZERO--THE PROJECT TO END
PROSTATE CANCER
Mr. Schwartz. Thank you. Mr. Chairman and distinguished
members of the subcommittee: Thank you for the opportunity to
share my thoughts. I know this has been a long session and I
admire your dedication. Hopefully the last is not least here.
My name is Jonathan Schwartz and I am the Chairman of the
Board of Directors of ZERO--The Project to End Prostate Cancer.
I'm here to stress the importance of research and the
congressionally directed medical research program, and
particularly the prostate cancer research program.
ZERO is a patient advocacy organization that raises
awareness and educates men and their families about prostate
cancer. Of particular importance to us is the issue of early
detection. Not only do we operate a mobile screening program,
we also work with policymakers in Congress and throughout
Government and other organizations to ensure that men have
access to information and services to make decisions that are
in the best interest of their health.
My dad was William Schwartz. He was diagnosed with prostate
cancer at the age of 55. We thought he'd be okay because the
cancer was detected early. Unfortunately, his cancer was very
aggressive and had already spread to his lymph nodes. The
doctors gave him just 2 years to live because back then there
were very few treatment options for prostate cancer.
Thankfully, new treatments became available that extended
his life. He fought the disease for 8 years, and during that
gift of time he saw all his children get married, became a
grandfather, and between chemo sessions was able to travel and
enjoy the company of family and friends. He also volunteered as
the first CEO of the National Prostate Cancer Coalition, which
is now ZERO. He worked tirelessly to increase Federal research
funding because he knew that research would help him and
countless other men.
As a family, we enjoyed much of my dad's last years. But he
also experienced great suffering. We saw firsthand the impact
of this cruel disease.
My dad died at age 63, younger than when most people
retire. We all miss him dearly and wonder what it would be like
to have him in our lives today. I still find it hard to accept
that he will never get to meet my two daughters and they'll
never get to know their ``Papa Bill.''
Our family's experience has led me, my brother and sister,
and of course our mom to care deeply about dad's cause. We
don't want other families to go through this. We want the
number of men suffering from prostate cancer to be as small as
possible. Eventually we want that number to be zero.
I'm here today because of my dad. I'm here today because
prostate cancer affects the family, not just the man. And as I
mentioned, I'm here today because I want to stress the
importance of research at the prostate cancer research program.
Prostate cancer is a disease that's diagnosed in over
200,000 American men each year and will kill nearly 34,000 men
in 2011. It's the second leading cause of cancer-related deaths
among men. One in six men, one in four African American men,
will get prostate cancer, and some of them will be in their
30s. It is not just an old man's disease.
There is much controversy about prostate cancer and
particularly the controversy over testing, when men should
start getting tested, how often they should be tested, what
type of treatment a man should undergo when diagnosed. I
recently met with my Georgia Senators on this topic. Senator
Chambliss, a prostate cancer survivor whose live was saved by
early detection, said it well when he said: ``You have to know
you have it to have a choice about treatment.''
Despite what some people call overdiagnosis, the number of
men dying from prostate cancer is rising. So, Mr. Chairman, the
problem isn't the number of men we are or should be testing.
The problem is knowing whether they have aggressive or indolent
disease and whether or not they should be treated. The only way
doctors will ever really know the answer to these questions is
through advances that may be closer than we think.
Last year, research partially funded by the prostate cancer
research program identified 24 different types of prostate
cancer. Eight of these are aggressive forms of the disease. If
we could identify what type of prostate cancer a man has, we
could more effectively determine if he needs treatment and how
aggressive that treatment should be. This would render moot the
argument some make about the disease being overtreated and
ultimately save men's lives.
Another innovative funding mechanism of the prostate cancer
research program is the Clinical Trials Consortium. To address
the significant logistical challenges of multi-center clinical
research, the Clinical Trials Consortium was started to promote
rapid phase 1 and phase 2 trials of promising new treatments
for prostate cancer. Since 2005, nearly 90 trials with more
than 2,600 patients have taken place, leading to potential
treatments that will soon be available to patients. Two
recently approved drugs, Xgeva and Zytiga, benefited from the
consortium, accelerating their approval time by over 2 years.
Today, without adequate funding, the program could not
support this award mechanism.
The prostate cancer research program is funding some of the
most critical work in cancer today. The program uses innovative
approaches to funnel research dollars directly into the best
research to accelerate discovery, translate discoveries into
clinical practice, and improve the quality of care and quality
of life of men with prostate cancer. It is the only federally
funded program that focuses exclusively on prostate cancer,
which enables them to identify and support research on the most
critical issues facing prostate cancer patients today. The
program funds innovative, high-impact studies, the type of
research most likely to make a difference.
I understand that the subcommittee is working under
extremely tight budgetary constraints this year and the many
tough decisions are ahead. This program is important to the
millions of men who are living with the disease, those who have
survived the disease, and those who are at risk for the
disease, including our veterans and active duty military
personnel.
Active duty males are twice as likely to develop prostate
cancer as their civilian counterparts. While serving their
country, the United States armed forces are exposed to
deleterious contaminants such as Agent Orange and depleted
uranium. These contaminants are proven to cause prostate cancer
in American veterans. Unfortunately, the genomes of prostate
cancer caused by Agent Orange are the most aggressive strands
of the disease and they also appear earlier in a man's life. In
addition, a recent study showed that Air Force personnel were
diagnosed with prostate cancer at an average age of just 48.
In closing, I ask that you support our fight against all
cancers and in particular prostate cancer. Prostate cancer can
and should be a 100 percent detectable and treatable cancer,
and hopefully some day a preventable one. Please support the
research conducted through the congressionally directed medical
research program and the prostate cancer research program by
maintaining their funding levels.
Thank you very much for your time. I'll be happy to answer
any questions.
[The statement follows:]
Prepared Statement of Jonathan D. Schwartz
Mr. Chairman and distinguished members of the subcommittee, thank
you for the opportunity to share my thoughts. My name is Jonathan
Schwartz, and I am Chairman of the Board of Directors of ZERO--The
Project to End Prostate Cancer (ZERO). I am the son of William
Schwartz, who fought prostate cancer for 8 years and volunteered as the
first CEO of the National Prostate Cancer Coalition, which is now ZERO.
My dad was diagnosed at the age of 55. We thought that he would be
okay since the cancer was detected early. The strain of prostate cancer
that he was diagnosed with was very aggressive and had spread to his
lymph nodes. Thankfully there were new treatments that extended his
life. During that 8 year gift, he was there to see his children get
married, become a grandfather, travel, and enjoy family and friends. He
worked tirelessly because he knew that research would help him and
countless other men.
My dad enjoyed much of his last years, but we also experienced
great suffering. We saw firsthand the impact of this cruel disease. We
all miss him dearly, and we are so saddened by all he has missed,
including five more grandchildren. We often wonder what it would be
like to have him in our lives today. Our family's experience has led me
and my brother and sister to care deeply about dad's cause. We don't
want other men and their families to go through this. We want the
number of men suffering from prostate cancer to be as small as
possible. Eventually, we want that number to be ZERO.
I am here today because of my dad. I am here today because prostate
cancer affects the family, not just the man. I am here today because I
want to stress the importance of research and particularly the Prostate
Cancer Research Program and the other programs of the Congressionally
Directed Medical Research Program.
Prostate cancer is a disease that is diagnosed in over 200,000 men
each year and will kill nearly 34,000 men in 2011. It is the second
leading cause of cancer related deaths among men and will inflict 1 in
6 men in their lifetime.
There are too many questions that continue to surround prostate
cancer and too many uncertainties for us to just ignore this disease.
It has been well publicized that cancer is killing less people every
year, but the same cannot be said for prostate cancer. Prostate cancer
deaths have continued to increase.
The answers to these questions are found in research. The
Congressionally Directed Medical Research Program and the Prostate
Cancer Research Program are funding some of the most critical work in
cancer today. The program uses innovative approaches to funnel research
dollars directly into the best research to accelerate discovery,
translate discoveries into clinical practice, and improve the quality
of care and life of men with prostate cancer.
An example of the innovative nature of the PCRP is the Clinical
Trials Consortium. To address the significant logistical challenges of
multicenter clinical research, the PCRP began support of a clinical
trials consortium for rapid Phase I and Phase II clinical trials of
promising new treatments for prostate cancer.
Since their first PCRP award in 2005, each site has fulfilled key
responsibilities in clinical trials design and recruitment. Nearly 70
trials with more than 1,800 patients have taken place, leading to
potential treatments that will soon be at patients' bedsides. Two
recently approved drugs (XGEVA and ZYTIGA) benefited from PCRP funding
and the consortium accelerating their approval time by over 2 years.
The PCRP has played a unique role by identifying two key research
gaps inhibiting forward movement of clinical trials, multicenter
intellectual property and regulatory issues. The program developed and
funded mechanisms to reduce those barriers resulting in unprecedented
accomplishments for recruiting participants over an 18-month period.
Today, without adequate funding, the PCRP cannot support this award
mechanism.
I understand that the committee is working under extremely tight
budgetary constraints this year and that many tough decisions are
ahead. This program is important to the millions of men who are living
with the disease, those who have survived the disease and those who are
at risk for the disease including our veterans and active duty military
personnel.
Active duty males are twice as likely to develop prostate cancer as
their civilian counterparts. While serving our country, the United
States' Armed Forces are exposed to deleterious contaminants such as
Agent Orange and Depleted Uranium. These contaminants, particularly
Agent Orange, are proven to cause prostate cancer in American Veterans.
Unfortunately, the genomes of prostate cancer caused by Agent Orange
are the more aggressive strands of the disease and appear earlier in a
man's life. Studies have shown that military personnel at risk for the
disease are also more likely to be diagnosed earlier in life.
In closing, I ask that you support our fight against all cancers
and in my case in particular, prostate cancer. Support the research
conducted through the Congressionally Directed Medical Research Program
and the Prostate Cancer Research Program by maintaining their funding
levels.
Chairman Inouye. Thank you, Mr. Schwartz.
Senator Cochran.
Senator Cochran. Mr. Chairman, I think it's important to
note that the testimony here reminds us that, while we are
learning more about cancer, we are wondering why cancer is
killing more people every year in the general population,
including more prostate cancer. Prostate cancer seems to be on
the rise. Some other life-threatening cancers seem to be on the
decline.
Another thing I think in the witness's testimony that's
appropriate for this subcommittee to consider when we decide
how much funding is available, if any, for this program is that
Agent Orange has been identified as a causal connector with
prostate cancer for those who have been exposed to that
substance. This is something I think is peculiarly of interest
to the military and appropriate for this subcommittee's
attention. So I'm hopeful that we can find a way to support, as
this witness suggests, an increase in funding for prostate
cancer research.
We appreciate your bringing these facts to the attention of
the subcommittee.
Chairman Inouye. Senator Shelby.
Senator Shelby. Mr. Chairman, I'll be brief, but I would be
remiss if I didn't--I'm a 17-year-old--``17-year-old''--I'm a
17-year survivor of prostate cancer. I've been through that, as
you went through it with your father and your family. A lot of
people don't survive. It's my understanding that--I've been
told that prostate cancer is the number two killer of men in
this country. Research in new surgery procedures, everything,
early diagnosis, has helped save a lot of lives.
I agree with Senator Cochran. We don't need to cut back on
this because if we do break through the research, we're going
to not only save lives, but on a policy level we will save
money down the road. You can do both if we do it right.
Thank you, Mr. Chairman, for calling this hearing. This has
been a very good hearing for me. As I've pointed out, I am the
ranking Republican over on the other subcommittee dealing with
NIH and all the other, and I'm curious as to how this works and
I've found out a lot today.
Thank you, Mr. Chairman.
Chairman Inouye. I thank you very much.
Three organizations have submitted testimony. Without
objection, the testimony of Cummins, Incorporated, Washington
State Neurofibromatosis Families, and the American Foundation
for Suicide Prevention will be made part of the record along
with any other statements that the subcommittee may receive.
On behalf of the subcommittee, I thank all the witnesses
for their testimony, and the subcommittee will take these
issues in consideration and I can assure you will look at it
very seriously.
[The statements follow:]
Prepared Statement of Dr. Wayne A. Eckerle, Vice President, Research
and Technology, Cummins Inc.
Cummins Inc., headquartered in Columbus, Indiana, is a corporation
of complementary business units that design, manufacture, distribute
and service engines and related technologies, including fuel systems,
controls, air handling, filtration, emission solutions and electrical
power generation systems. The funding requests outlined below are
critically important to Cummins' research and development efforts, and
would also represent a sound Federal investment toward a cleaner
environment and improved energy efficiency for our Nation. We request
that the Committee fund the programs as identified below.
DEPARTMENT OF THE ARMY
Other Procurement
Budget Activity 03, Other Support Equipment, Line No. 177,
Generators and Associated Equipment (MA9800), Medium generator Sets (5-
60 kW) (M53500), Advanced Medium Mobile Power System (AMMPS).--Increase
the Administration's request of $11.6 million by $28.4 million to bring
the program total to $40 million in fiscal year 2012. $40 million was
appropriated in fiscal year 2011 and fiscal year 2010. This program is
critical to providing our troops with the latest technology in power
generation. AMMPS generators are the latest generation of Prime Power
Generators for the DOD and will replace the obsolete Tactical Quiet
Generators (TQG's) developed in the 1980s. The AMMPS gensets are 21
percent more fuel-efficient, 15 percent lighter, 35 percent quieter,
and 40 percent more reliable than the TQG. Generators are the Army's
biggest consumer of diesel fuel in current war theatres. When AMMPS
gensets are fully implemented, the Army and Marines will realize annual
fuel savings of approximately 52 million gallons of JP-8 fuel and over
$745 million in savings based on fuel costs and current use pattern.
This will mean fewer fuel convoys to bases in active war zones
resulting in saved lives of military and civilian drivers. AMMPS
generators are fully EPA compliant and will result in annual carbon
emissions reductions of 509,698 metric tons CO2 or 7.7
million metric tons over the expected life of the generators.
Research and Development Test and Evaluation Programs
Volume V-B, Budget Activity 05, System Development & Demonstration,
Line No. 120, Program Element No. 0604854A: Artillery Systems, Paladin
Integrated Management (PIM).--Support the Administration's request of
$120.1 million in fiscal year 2012. The M109A6 Paladin is the primary
indirect fire weapons platform in the U.S. Army's Heavy Brigade Combat
Team (HBCT) and is expected to be in the Army inventory through 2050.
This request is to further develop Paladin Integrated Management (PIM)
vehicles and conclude testing. The PIM effort is a program to ensure
the long-term viability and sustainability of the M109A6 Paladin and
its companion ammunition resupply vehicle, the M992 Field Artillery
Ammunition Support Vehicle (FAASV). PIM is vital to ensuring the long-
term viability and sustainability of the M109 family of vehicles
(Paladin and FAASV). The program will significantly reduce the
logistics burden placed on our soldiers, and proactively mitigate
obsolescence. The system will feature improved mobility (by virtue of
Bradley-based automotive systems), allowing the fleet to keep pace with
the maneuver force.
Volume VII, Budget Activity 07, Operational Systems Development,
Line No. 163, Program Element No. 0203735A: Combat Vehicle Improvement
Program, Armored Multi-Purpose Vehicle (AMPV).--Support
Administration's request of $53.3 million in fiscal year 2012. The
Armored Multi-Purpose Vehicle (AMPV) is a new Army initiated program to
replace the M113 platforms, which cannot be optimized for future U.S.
Army combat operations. The Army has identified a significant
capability gap within the Heavy Brigade Combat Team (HBCT) formation.
The Bradley Family of Vehicles are the most capable and cost effective
platform for replacement of the M113. Along with established
production, the recapitalized Bradley vehicles bring combat-proven
mobility, survivability, and adaptability to a variety of missions. The
Army currently has approximately 1,900 Bradley hulls that could be
inducted into the production process. This low cost, low risk,
Military-off-the-Shelf (MOTS) to replace the M113 addresses the
significant capability shortfalls within the HBCT formation and is an
efficient use of existing Government owned assets and existing Public-
Private Partnership arrangements to bridge the modernization gap.
Recapitalizing existing Bradley chassis provides the most survivable,
mobile and protected solution for our soldiers at a significant lower
cost.
Procurement of Weapons and Tracked Combat Vehicles (W&TCV)
Activity No. 01 Tracked Combat Vehicles, Line No. 07, Howitzer, Med
Sp Ft 155MM M109A6 (MOD) (GA0400), Paladin Integrated Management
(PIM).--Support Administration's request of $46.88 million in fiscal
year 2012. This is to begin low rate initial production vehicles for
Paladin Integrated Management (PIM) procurement. The M109A6 Paladin is
the primary indirect fire weapons platform in the U.S. Army's Heavy
Brigade Combat Team (HBCT) and is expected to be in the Army inventory
through 2050. The PIM program will incorporate Bradley-based drive-
train and suspension components which reduce logistics footprint and
decrease operations and sustainment costs. PIM is vital to ensuring the
long-term viability and sustainability of the M109 family of vehicles
(Paladin and FAASV). The program will significantly reduce the
logistics burden placed on our soldiers, and proactively mitigate
obsolescence. The system will feature improved mobility (by virtue of
Bradley-based automotive systems), allowing the fleet to keep pace with
the maneuver force. The system will improve overall soldier
survivability through modifications to the hull to meet increased
threats.
DEPARTMENT OF THE AIR FORCE
Other Procurement
Budget Activity 04, Other Base Maintenance and Support Equip, Item
No. 61, Mobility Equip, Basic Expeditionary Airfield Resources.--
Maintain the Administration's request of $27 million in fiscal year
2012. Appropriations in fiscal year 2010 and fiscal year 2011 totaled
$29.7 million. Basic Expeditionary Airfield Resource (BEAR) is funded
by the U.S. Air Force and is administered by the PM-MEP office. The
BEAR product is an 800kW prime power mobile generator used by Combat
Air Forces to power mobile airfields in-theatre and around the world.
The finished product will replace the existing MEP unit that is 25
years old and will offer greater fuel economy, increased fuel options
(JP8), improved noise reduction, and the latest innovative control
technology and functionality. With the ever increasing global reach of
the U.S. military, the need for reliable mobile power is paramount.
This program is currently funded for the design, development and
preproduction of 8 individual BEAR units. These units will undergo a
battery of validation tests. Design and development of the BEAR product
is on schedule. There is interest from other branches of the military
for the BEAR product as well given the increased need for mobile
electric power.
______
Prepared Statement of Karen Gunsul, Vice President, Washington State
Neurofibromatosis Families
Thank you for the opportunity to submit testimony to the
Subcommittee on the importance of continued funding for research on
Neurofibromatosis (NF), a terrible genetic disorder closely linked too
many common diseases widespread among the American population.
On behalf of Washington State Neurofibromatosis Families (WSNF) a
participant in a national coalition of NF advocacy groups, I speak on
behalf of the 100,000 Americans who suffer from NF as well as
approximately 175 million Americans who suffer from diseases and
conditions linked to NF such as cancer, brain tumors, heart disease,
memory loss and learning disabilities. I also speak from the heart as
the mother of a son who deals with NF every day. To find treatments
and, ultimately, a cure, for this disorder would benefit him and
countless others.
In fiscal year 2012, I am requesting $16 million to continue the
Army's highly successful Neurofibromatosis Research Program (NFRP), the
same amount that was included for the NFRP in fiscal year 2011. The
Peer-Reviewed Neurofibromatosis Research Program, one of the Department
of Defense's Congressionally Directed Medical Research Programs
(CDMRP), is now conducting clinical trials at nationwide 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. Administrators of the Army program
have stated that the number of high-quality scientific applications
justify a much larger program.
What is Neurofibromatosis (NF)?
NF is a genetic disorder involving the uncontrolled growth of
tumors along the nervous system which can result in terrible
disfigurement, deformity, deafness, blindness, brain tumors, cancer,
and even death. NF can also cause other abnormalities such as unsightly
benign tumors across the entire body and bone deformities. In addition,
approximately one-half of children with NF suffer from learning
disabilities. While not all NF patients suffer from the most severe
symptoms, all NF patients and their families live with the uncertainty
of not knowing whether they will be seriously affected because NF is a
highly variable and progressive disease.
NF is not rare. It is the most common neurological disorder caused
by a single gene and three times more common than Muscular Dystrophy
and Cystic Fibrosis combined, but is not widely known because it has
been poorly diagnosed for many years. Approximately 100,000 Americans
have NF, and it appears in approximately 1 in every 2,500 births. 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. There
are three types of NF: NF1, which is more common, NF2, which primarily
involves tumors causing deafness and balance problems, and
schwannomatosis, the hallmark of which is severe pain. In addition,
advances in NF research stand to benefit over 175 million Americans in
this generation alone because NF is directly linked to many of the most
common diseases affecting the general population.
NF's Connection to the Military
Neurofibromatosis Research addresses areas of great clinical need
directly affecting the health of the warfighter. NF is a complicated
condition closely connected to many common diseases and disorders that
can lead to unmanageable pain, learning disabilities, cancer,
orthopedic abnormalities, deafness, blindness, memory loss, and
amputation. NF also involves inflammation similar to that involved in
wound healing.
Pain Management.--Severe and unmanageable pain is seen in all forms
of NF, particularly in one form of NF called schwannomatosis. Over the
past 3 years, schwannomatosis research has made significant advances
and new research suggests that the molecular or root cause of
schwannomatosis pain may be the same as phantom limb pain. Research is
currently moving forward to identify drugs that might be able to treat
this pain, and these exciting findings could have broad applications
for the military.
Wound Healing, Inflammation and Blood Vessel Growth.--Wound healing
requires new blood vessel growth and tissue inflammation. Mast cells
are critical mediators of inflammation in wound healing, and they must
be quelled and regulated in order to facilitate this healing. Mast
cells are also important players in NF1 tumor growth. In the past few
years, researchers have gained deep knowledge on how mast cells promote
tumor growth, and this research has led to ongoing clinical trials to
block this signaling. The result is that tumors grow slower. As
researchers learn more about blocking mast cell signals in NF, this
research could be translated to the management of mast cells in wounds
and wound healing.
Orthopedic Abnormalities and Amputation.--One-third of children
with NF1 are at risk of developing orthopedic abnormalities that as a
result break easily. In the leg particularly, repeated injuries lead to
amputation below the knee, often in very young children. Recent
research has identified the molecular basis of this, and drug trials in
humans will begin in the next year. This research will lead to a deeper
understanding of how to heal challenging bone breaks and directly
benefit warfighters with major bone breakages or recurring bone breaks
that heal poorly.
Three-Dimensional Clinical Imaging Technologies.--Because NF tumors
are often large and abnormally shaped, they lend themselves well to the
emerging technology of volumetric MRI. This is used to monitor tumor
volume and growth as well as to monitor the effectiveness of a drug
treatment to induce tumor shrinkage or cessation of tumor growth. It is
anticipated that MRI volumetric imaging could have broad applications
in military use.
Link to Other Illnesses
Researchers have determined that NF is closely linked to cancer,
heart disease, learning disabilities, memory loss, brain tumors, and
other disorders including deafness, blindness and orthopedic disorders,
primarily because NF regulates important pathways common to these
disorders such as the RAS, cAMP and PAK pathways. Research on NF
therefore stands to benefit millions of Americans.
Cancer.--NF is closely linked to many of the most common forms of
human cancer, affecting approximately 65 million Americans. In fact, NF
shares these pathways with 70 percent of human cancers. Research has
demonstrated that NF's tumor suppressor protein, neurofibromin,
inhibits RAS, one of the major malignancy causing growth proteins
involved in 30 percent of all cancer. Accordingly, advances in NF
research may well lead to treatments and cures not only for NF
patients, but for all those who suffer from cancer and tumor-related
disorders. Similar studies have also linked epidermal growth factor
receptor (EGF-R) to malignant peripheral nerve sheath tumors (MPNSTs),
a form of cancer which disproportionately strikes NF patients.
Heart disease.--Researchers have demonstrated that mice completely
lacking in NF1 have congenital heart disease that involves the
endocardial cushions which form in the valves of the heart. This is
because the same ras involved in cancer also causes heart valves to
close. Neurofibromin, the protein produced by a normal NF1 gene,
suppresses ras, thus opening up the heart valve. Promising new research
has also connected NF1 to cells lining the blood vessels of the heart,
with implications for other vascular disorders including hypertension,
which affects approximately 50 million Americans. Researchers believe
that further understanding of how an NF1 deficiency leads to heart
disease may help to unravel molecular pathways involved in genetic and
environmental causes of heart disease.
Learning disabilities.--Learning disabilities are the most common
neurological complication in children with NF1. Research aimed at
rescuing learning deficits in children with NF could open the door to
treatments affecting 35 million Americans and 5 percent of the world's
population who also suffer from learning disabilities. In NF1 the
neurocognitive disabilities range includes behavior, memory and
planning. Recent research has shown there are clear molecular links
between autism spectrum disorder and NF1; as well as with many other
cognitive disabilities. Tremendous research advances have recently led
to the first clinical trials of drugs in children with NF1 learning
disabilities. These trials are showing promise. In addition because of
the connection with other types of cognitive disorders such as autism,
researchers and clinicians are actively collaborating on research and
clinical studies, pooling knowledge and resources. It is anticipated
that what we learn from these studies could have an enormous impact on
the significant American population living with learning difficulties
and could potentially save Federal, State, and local governments, as
well as school districts, billions of dollars annually in special
education costs resulting from a treatment for learning disabilities.
Memory loss.--Researchers have also determined that NF is closely
linked to memory loss and are now investigating conducting clinical
trials with drugs that may not only cure NF's cognitive disorders but
also result in treating memory loss as well with enormous implications
for patients who suffer from Alzheimer's disease and other dementias.
Indeed, one leading Army funded researcher is pursuing parallel
research into both NF and Alzheimer's simultaneously.
Deafness.--NF2 accounts for approximately 5 percent of genetic
forms of deafness. It is also related to other types of tumors,
including schwannomas and meningiomas, as well as being a major cause
of balance problems.
The Army's 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, high-risk/high-reward medical research
through the 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 Army's NF Research Program strong
bipartisan support. From fiscal year 1996 through fiscal year 2011
funding for the NFRP has amounted to $230.05 million, in addition to
the original $8 million appropriation in fiscal year 1992. In addition,
between fiscal year 1996 and fiscal year 2009, 245 awards have been
granted to researchers across the country.
The Army program 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 nationwide
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
Army's NF Research Program, 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, sits 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 measure 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:
--Phase II and Phase III clinical trials involving new drug therapies
for both cancer and cognitive disorders;
--Creation of a National Clinical and Pre-Clinical Trials
Infrastructure and NF Centers;
--Successfully eliminating tumors in NF1 and NF2 mice with the same
drug;
--Developing advanced mouse models showing human symptoms;
--Rescuing learning deficits and eliminating tumors in mice with the
same drug;
--Determining the biochemical, molecular function of the NF genes and
gene products;
--Connecting NF to more and more diseases because of NF's impact on
many body functions.
Fiscal Year 2012 Request
The Army's 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. The program has
succeeded in its mission to bring new researchers and new approaches to
research into the field. Therefore, continued funding is needed to take
advantage of promising avenues of investigation, 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.
I respectfully request an appropriation of $16 million in the
fiscal year 2012 Department of Defense Appropriations bill for the
Army's Neurofibromatosis Research Program.
In addition to providing a clear military benefit, the DOD's
Neurofibromatosis Research Program also provides hope for the 100,000
Americans who suffer from NF, as well as over 175 million Americans who
suffer from NF's related diseases and disorders. Leading researchers
now believe that we are on the threshold of a treatment and a cure for
this terrible disease. With this Subcommittee's continued support, we
will prevail. Thank you for your support.
______
Prepared Statement of the American Foundation for Suicide Prevention
Chairman Inouye, Ranking Member Cochran and members of the
Subcommittee. My name is John Madigan, Senior Director of Public Policy
with The American Foundation for Suicide Prevention (AFSP). AFSP thanks
you for the opportunity to provide testimony on the funding needs of
programs within the Department of Defense that play a critical role in
suicide prevention efforts.
AFSP is the leading national not-for-profit organization
exclusively dedicated to understanding and preventing suicide through
research, education and advocacy, and to reaching out to people with
mental disorders and those impacted by suicide. You can find more
information at www.asfp.org and www.spanusa.org.
More than 1.9 million warriors have deployed for Operation Iraqi
Freedom (OIF) and Operation Enduring Freedom (OEF), two of our Nation's
longest conflicts (IOM, 2010). The physical and psychological demands
on both the deployed and non-deployed warriors are enormous. From 2005
to 2009, more than 1,100 members of the Armed Forces took their own
lives, an average of 1 suicide every 36 hours. In that same period, the
suicide rates among Marines and Soldiers sharply increased; the rate in
the Army more than doubled. Numerous commissions, task forces, and
research reports have documented the ``hidden wounds of war''--the
psychological and emotional injuries that have so affected our military
members and their families. The years since 2002 have placed
unprecedented demands on our Armed Forces and military families.
Military operational requirements have risen significantly, and manning
levels across the Services remain too low to meet the ever-increasing
demand. This current imbalance places strain not only on those
deploying, but equally on those who remain in garrison. The cumulative
effects of all these factors are contributing significantly to the
increase in the incidence of suicide and without effective action will
persist well beyond the duration of the current operations and
deployments. Heightened concern regarding this increase in suicides has
led to development of scores of initiatives across the DOD to reduce
risk (Final Report of DOD Task Force on the Prevention of Suicide by
Members of the Armed Forces, August, 2010).
In testimony before this Subcommittee on May 18, Secretary of the
Army John McHugh and General Martin Dempsey, Chief of Staff of the
United States Army, called for the sustainment of $1.7 billion to fund
vital Soldier and Family programs. These programs provide a full range
of essential services and include the Army Campaign for Health
Promotion, Risk Reduction, and Suicide Prevention. Additionally, The
fiscal year 2012 budget request includes adding 24 behavioral health
officers and enlisted technicians to the National Guard Brigade Combat
Teams and expands the Reserve component substance abuse program. It
also included additional funding for 54 Suicide Prevention Program
managers for the National Guard, 38 Suicide Prevention Program Managers
for Army Reserve, and Applied Suicide Intervention Skills Training
(ASIST) and kits for the Reserve component. AFSP commends the
Department of the Army for their efforts to reduce suicides within
their ranks, and urges this Subcommittee to provide the $1.7 billion
requested to sustain their important efforts.
While there is sufficient funding for suicide prevention research
within DOD right now, these efforts need to be sustained to ensure
sufficient resources are devoted to research in the long term. We
believe that funding needs to be sustained for confidential treatment
programs like the Army Confidential Alcohol Treatment and Education
Pilot (CATEP) and TRICARE Assistance Program (TRIAP) which are helping
to change the culture and decrease stigma toward behavioral health
treatment. AFSP also urges this Subcommittee to fully fund the OSD
Office for Suicide Prevention that was created this month.
In addition to Secretary McHugh and General Dempsey's request, AFSP
urges this Subcommittee to fund the following programs or initiatives
at the highest levels possible to address the unacceptably high rates
of suicide among our military personnel.
Comprehensive Behavioral Health System of Care (CBHSOC)
General Eric Shoomaker outlined this program in his testimony
before this Subcommittee on April 6. CBHSOC is based on outcome studies
that demonstrate the profound value of using the system of multiple
touch points in assessing and coordinating health and behavioral health
for a soldier and Family. The CBHSOC creates an integrated,
coordinated, and synchronized behavioral health service delivery system
that will support the total force through all ARFORGEN (Army Force
Generation) phases by providing full spectrum behavioral healthcare.
The CBHSOC is a system of systems built around the need to support
an Army engaged in repeated deployments and its intent is to optimize
care and maximize limited behavioral health resources to ensure the
highest quality of care to Soldiers and Families through a multi-year
campaign with a long-term goal of preventing suicide.
Yellow Ribbon Reintegration Campaign (YRRP)
The Yellow Ribbon Reintegration Program provides information,
services, referrals, and proactive outreach to Soldiers, spouses,
employers, and youth through the different stages of mobilization: pre-
alert, alert, pre-deployment, deployment, post-deployment and
reintegration.
Public Law 111-84, Section 595 gave the YRRP Office the
responsibility for establishing a program to provide Reserve and
National Guard Service members, and their families, training in suicide
prevention, community healing, and response to suicide. The YRRP Office
has engaged several national associations to provide ongoing assistance
in coordinating with community based behavioral health providers and
conducted a needs and gap analysis of all the Reserve Components
existing suicide prevention programs. Continuation of these efforts
will be vital in lowering the rate of suicides among our National Guard
and Reserve personnel.
Air Force Suicide Prevention Efforts
In testimony before this Subcommittee on April 6, Lt. General (Dr.)
Charles Green discussed numerous efforts on behalf of the United States
Air Force that AFSP believes will reduce the rate of suicide in the Air
Force. This includes the additional support the Air Force provides its
most at-risk airmen with frontline supervisor's suicide prevention
training given to all supervisors in career fields with elevated
suicide rates, expanded counseling services beyond those available
through chaplains and mental health clinics, Military Family Life
Consultants and Military OneSource which provides counseling to active
duty members off-base for up to 12 sessions.
Chairman Inouye, Ranking Member Cochran and Members of the
Committee, AFSP once again thanks you for the opportunity to provide
testimony on the funding needs of programs within the Department of
Defense that play a critical role in suicide prevention efforts. With
your help, we can assure those tasked with leading the Department of
Defense's response to the unacceptably high rate of suicide among our
military personnel will have the resources necessary to effectively
prevent suicide.
CONCLUSION OF HEARINGS
Chairman Inouye. The subcommittee will stand in recess, but
we will reconvene on Tuesday, June 28, at which time we'll meet
in closed session to receive testimony on the fiscal year 2012
budget for intelligence activities. The subcommittee is
recessed.
[Whereupon, at 1:06 p.m., Wednesday, June 22, the hearings
were concluded, and the subcommittee was recessed, to reconvene
subject to the call of the Chair.]