it is on the web site so if anybody wants to to read it they can there will be hard copies coming out later that's armed services dot housetop for those people that are interested the reserve component is transforming from a strategic to an operational reserve we need to give our men and women the guard reserve the tools they need to take up this mission most important thing they bring to the table is themselves their health in the medical and dental readiness of the force oral health is often overlooked but as we are learning extremely important aspect of overall prita point readiness the odio said that ninety five percent of military personnel active in reserve should fall into the class one or class two dental fitness categories many of their healthy enough to deploy right now none of the services are meeting these goals for the reserve component but the army and marine corps have struggled the most it's a public health issue for the country but it's also a readiness issue for our military only forty three point two percent of the army national guard and fifty point six percent of the army reserv ts currently ready to deploy only seventy seven point seven percent of the marine corps reserve is ready to since none of the services are meeting the only goal i hope we're going to figure out why today today we'll hear about some of the challenges the services face and how they facing and i hope we'll hear some good ideas about how these issues can be addressed in the future i know that the army national guard thirty ninth infantry brigade in my home district in arkansas struggled with many of these challenges when they recently deployed to iraq for their second tour and these challenges occurred during their first tour several years ago also i'm proud of their hard work in the creative ways in which they accomplished the pre mobilization readiness mission under adverse conditions but they encountered additional challenges at the  work to do improving that and readiness rates and a reserve component will require a combination of command emphasis accountability on the part invisible services service members incentives and possibly program problematic changes that's why we're here to talk about consent that he be allowed to participate and that i would like to hear mr akin's opening same for any comments he want to make thank you mr chairman and thank you witnesses for joining us here today the hearing clearly demonstrates the value of our subcommittee in the good we can do for men and unit and ben and women in uniform first glance dental readiness may not seem to be a subject congress would focus on and in fact i don't remember any previous hearings on the topic fundraiser reflection all would conclude the dental readiness is a very timely and critical topic armies throughout history have suffered more casualties from sickness than from convent inflicted wounds in today's military forces are no exception indeed medical and dental readiness are key components of ensuring units are ready to deploy and effectively proport for for their missions in combat or witnesses are well grounded in the challenges of ensuring members of the army navy marine corps and air force reserve components are definitely ready to deploy and in the effectiveness of the part of the defense and individual service approaches to this issue i would not want to be in their shoes i cannot imagine a more difficult job  find ways to entice relatively juvenile reserve component service members most on limited income to undergo periodic bedell examination and treatment with sometimes minimal reimbursement so they can deploy to iraq for twelve or fifteen months frankly i'm surprised anyone goes to the dentist with a command tour in iraq as a reward of compliance in reviewing your testimony i understand that each component faces somewhat different obstacles and has cho n to manage the problem in ways i look forward to hearing about your programs and the recommendations that you would have and how we in congress can help to make your job easier thank you very much and general of united states air force it's my understanding that none of you have testified formally before congress before is that correct it's kind of well i want you to relax you may feel a little pinch and it may here isn't strange sounds and smells and funny is going by we anticipate there will be vote sometime in the next ten fifteen twenty minutes which will interrupt us but we'll go as far as we can with opening statements so carol martin we begin with you thank you mr chairman and distinguished members of the subcommittee i thank you for your strong interest in improving the dental readiness of reserve and national guard service members as the chief of the dental care branch of the tri care management activity i am responsible for the management of the various departments as it stands dental programs that provide care to beneficiaries  service members who are world wide deployable don't class two individuals with the current dental examination who have who have or old conditions diseases that require non urgent care or reevaluation these oral conditions which are likely to result in a dental emergency within twelve months the service members are all sold worldwide deployable dental class three individuals who require urgent or emergent dental treatment that have not accomplished will likely result in a dell emergency within twelve months class three individuals are not worldwide deployable and dental costs for individuals who have not obtained periodic dental examinations or patients with an unknown dental classification class for individuals are not worldwide deployable over the past twelve months individual medical readiness reports for the reserve component have not shown any significant change none of the services meets the d o d goal of ninety five percent on readiness as of january two thousand and eight the army national guard was at forty three point two percent army reserve fifty point six percent marine corps reserves seventy seven point seven percent air force reserve eighty four point nine percent air force national guard eighty eight point eight percent and the navy reserve was ninety point zero zero percent the majority of the cost of the dental conditions in our service members are a result of dental decay which is a chronic infectious disease to properly treat and prevent dental decay individuals at high risk for this disease must modify their diet and eating behaviors and practice good day the or the oral hygiene that these measures are not taken then so the case may be her often resulting in a more extensive treatment needs such as a larger filling a root canal and or a crown and just a little pinch several studies have validated the importance of deities oral health and redness cost cation system a published study by the tri service center for health studies showed the del emergency rate for class three personnel is eight point eight times higher than personnel in class one and three point nine times higher than the rate class two personnel a recent report on nine hundred air force personnel deployed for one hundred twenty days found that only one point seven percent received any needed dental care during the deployment almost sixty five percent of these personnel were dental class one when deployed if we deploy personnel in good oral health their chances for a deadly murda c during the deployment are significantly reduced there are several programs available to improve the dull help of the reserve component members i would like t highlight those programs for you today for reserve component members without employer sponsored dental insurance the o t offers to try care dental program a comprehensive delegations program for active duty family members reserve component members and their families over the past two years about eight to ten percent of eligible reserve members have enrolled in this program the air guard has the highest in roman with twenty one point eight percent the lowest in roman rate as in the marine corps reserve at only two point eight percent the government pays sixty percent of the monthly premium and the reserve a space forty percent currently a reservist pays a low monthly premium of eleven dollars and fifty eight cents a t t p provides an annual maximum payment for dental services of twelve hundred dollars with cost for the more expensive procedures such as root canals crowns and extractions most preventive services like cleanings and exams are covered at one hundred percent and do not count toward the annual maximum payment for fiscal year two thousand and seven seventy one point six percent of the reservist enroll in the tri care dental program utilized one covered procedure that cheapie network of dentist is quite large with over eighty four thousand four hundred thirty four participating dell offices this includes sixty three thousand five hundred fifty five general dentist locations and twenty thousand seven hundred sixty nine special locations in addition the reserve health readiness program provides dental care for reservist this program has a network of contracted dentists that provides dental exams and class three treatment needs to assist reserv achieving and maintaining dental readiness for in the past twelve months approximately one hundred eighty thousand reservists received their annual dental exam and seven thousand five hundred class three patients received the required dental care in this program ninety two percent of the reserv received their exams in treatment were army reservists on ninety day activation orders are eligible for dental care at the same level as active duty service members the majority of this dental care is provided to military dental treatment facilities when needed to be for us are also made a dentist in the private sector a transitional assistance management program commonly referred to as tampa includes a dental benefit for recently deactivated or separated military members this program provides space available care and military dental treatment facilities for one hundred eighty days from the date of leaving active duty status unfortunately few facilities have space available to treat these members but reservists who are deactivated and who will remain in the reserves are eligible to enroll in the tr program finally all service members were separated from active duty receive a certificate of release or discharge from active duty a section of this form documents were there any dental conditions requiring treatment the d of you could not provide prior to separation of treatment is required the member may apply for v a treatment within one hundred eighty days of release from active duty on average about eighteen percent of eligible deactivate a reservist have utilized this benefit over the past three years mr chairman distinguished subcommittee members thank you for your interest in improving readiness of our national guard members and reservists as you can the department offer several options to improve the dental readiness of the service members we look forward to your continued support as we work together to improve the oral health of reserve component members i'll be happy to answer any questions that you may have thank you colonel martin yes mr chairman and members of the committee i want to thank you for allowing me to speak to you about army reserve component dental readiness of my written testimony i have outlined a and extensive historical perspective of dental readiness for the army active and army reserve components to summarize by the first gulf war active component units were able to ploy with minimal and dentistry requirements due to their high levels of baseline dental readiness while at the same time army reserve component units arrived at extremely high rates of on readiness as happened again at the beginning of the g war on terrorism since two thousand and four the army active and reserve component dental subject matter experts have cooperated to improve dental readiness report rates of the mobilization platforms by stander rising exam protocols and documentation the validation process at the mobilization platform and storage of dental digital digitized dental information for further use these improvements have reduced no go rates to the platforms from eighty seven percent no go in two thousand and four to the present rates that you see in table one and f y zero six and zero seven during the first half of f y o eight more dramatic improvements occurred especially by the army national guard brigade combat teams and i attribute these improvements in dental readiness due to a combination of first army command emphasis directed to the b c d commander's initiation of the reserve component dental readiness systems early in the alert phase and diligent work done by the state dental surgeon in table two you can see of my written testimony and see a comparison of the b c d units and smaller size units and you can see that the smaller size units report with less favourite's of dental readiness and i attribute this to less command emphasis and a larger percent of cross leveling from non alert in units that are not eligible for d s c three care as an example over six percent of the thirty ninth the c t was crossed leveled as a replacement soldiers after reporting the camp shelby after the main body had reported and over twenty six percent of those were d f c three and i use example to point out a major issue army reserve component soldiers may be mobilized with short notice at any time and if not afforded d f c three care regardless of alert status prior to mobilization then they lose training time at the mobilization platform remedying those d f c three conditions for the first procedures and i'll refer you there for the details of those operations in their presence format in my written testimony i've described the challenges to achieving better army reserve component dental readiness and suffice it to say the challenges are complex and will require a multiple set or dashboard of solutions within his first one hundred days the army surgeon general directed a complete review of the army reserve component dental readiness system and the assistant surgeon general for force projection assembled a multi component work group in march two thousand and eight to conduct a capabilities base assessment and develop a prioritized list of courses of action these courses of action are currently being worked through the army leadership and conclusion i want to thank you mr chairman and the distinguished members of the subcommittee for your interest since aboard and then proving army reserve component dental opportunity come before you to address concerns about the dental readiness of soldiers for the army national guard down the readiness of our citizen soldiers is a critical element in our ability to meet army deployment requirements as you know the army national guard's transition to an operational force has dramatically increased the demands on your citizen soldiers historically our soldiers and leaders relied on a link the mobilization process to address dental readiness issues in february two thousand and seven the department defense implemented a twelve month mobilization policy this policy is good for the guard and takes soldiers away from their families and employers for less time however dental readiness must now be addressed at the home station the army national guard medical team in conjunction with our u s army general command colleagues has successfully managed this transition since the beginning of the fiscal year states have prepared five brigade combat teams for deployment sending their units to the most station over ninety percent generally ready for example the thirty nin from arkansas arrive to camp shelby in january with a ninety two percent of them with nice two percent of their soldiers dental ready this is a tremendous improvement from their last mobilization in october two thousand and three when the average readiness of a guard unit reporting to mope station was thirteen percent this improvement has enabled commanders to focus on collective training and maximize the boots on ground time in theater to ensure mixture and success the same approach is being used this year by pennsylvania's fifty six stryker  and twenty eight the combat aviation brigade new jersey's fiftieth infantry b c t v north carolina's thirty eight heavy b c t and the fifty six thirty six infantry b c t from texas the same programs policies and procedures that have been used to ready t hese p c t s for deployment need to be applied to our force as a whole the challenge before the army national guard is the low level of baseline dental readiness only forty three percent of the force is generally ready to deploy a few army national guardsmen have private dental insurance and only seven percent participate in the tri care reserve dental program truly herculean efforts must be applied by the states once a unit is alerted to achieve full dental readiness to overcome these challenges the army national guard in collaboration with the office of a certain general u s army general command u s army reserve has has developed a plan to improve baseline readiness has been approved by the army guard that leadership this plan provides dental treatment for soldiers outside of alert identify dental issues must be corrected and a sitter's will within enable our soldiers to be treated at home as recommended by the commission on the national guard and reserve there should be incentives and enforcement of dental readiness guard and guardsmen should not take unpaid leave to go to the dentist providing two medical readiness days per soldier is an incentive for soldiers to complete readiness requirements in a way for commanders to ensure compliance the unit status report in the medical protection system or med pros provides leaders with the ability to track a unit's dental readiness increasing in sustaining dental readiness of the guard requires a per staffing the army national guard dental corps is currently less than sixty percent strength and forty percent of those remaining dentists are retirement eligible department offense has requested that congress increase the retirement age of national guard medical corps and jail crossers from sixty four to sixty eight the president's president's budget also requests now before congress seeks an increase in the level of full time manning of our force this is critical we urge the congress to support these proposals this is a very exciting time to be in the guard the army national guard has deployed over three hundred thousand dental ready soldiers in support of the nation since september eleventh two thousand and one good afternoon and thank you for this opportunity to present to you today about maybe's mission that of ensuring dental readiness for all its marines and sailors in both reserve and active dental readiness is a state where a sailor marine is ready to deploy and likely not to experience a dental emergency while away from home when recruiters assessed and initial examiner perform and he or she is classified according to his or her dental disease annual exams are required for both reserve an active component sailors  a system that prioritizes care based on their level of dental disease the sailor or marine is operationally dentally ready ody are if you she falls into either class one no disease or class two disease unlikely to cause a dental emergency within twelve months the goal as stated by the office of the secretary of defense for health affairs is for all services to reach ninety five percent o t r there is currently no navy specific mandate but the past three years incoming navy and marine corps recruits have entered boot camp at an average o t r of twenty nine percent at the navy and marine corps boot camps navy dentistry has maintained a heavy dental presence that focuses on reaching a ninety five percent goal before recruits go back to reserve status or reach their duty stations while we have fallen short of the ninety five percent goal in last few years we have maintained an o t r in the eightieth percentile historically through two thousand to percentage across the navy has been in the mid ninety's or above since two thousand and two however it's fallen to eighty six eighty seven percent as we shift resources to focus on personnel who are getting ready to deploy for the navy reserve the sixteen thousand one hundred ninety three service members are still drilling and have over the first quarter of fiscal year zero eight the overall o t r for the marine corps reserves seventy seven point seven percent with six and a half percent being considered class three our efforts to focus on deploying marine reservists have paid off and the last two battalions to deploy in two thousand and seven went out at greater than ninety five percent of our active duty marine units deployed at ninety ninety seven percent o t r the research challenges the o t r include dental officer and technical technician rest t retention and recruiting and the loss of seventeen percent of the reserve dental corps billets as the navy reserve dental corps has become smaller providing regular exams has become a challenge we are meeting this challenge by using contract dentists offering more incentives to retain and recruit hosting dental standdown for units to get exams all at one time and having traveling down teams go to remote locations in addition there is a perception by reservists that the cost of the tri care dental program eleven dollars fifty eight cents per month plus twenty percent cost share for fillings is prohibitive we are addressing the issue this issue by increasing our education efforts for reservist on the value of this program to maintain our the our goals with decrease reserve an active dental corps personnel we have increased the use of private sector dentist through the military medical support office program shifting care of the private sector has increased them in cost over the past four years from three point seven million in two thousand to thirty four million in two thousand and seven retaining dental care officers in the reserve an active component has been increasingly difficult in recent years almost seventy percent of junior officers are leaving active duty after the complete the first obligated to or and are not affiliated with the active research one of the major issues as been dental assistant support which is now beginning to move another motivator for getting out of the service has been the rates of promotion pay for dental care officers promotion issues are improving and we hopeful the trend will be maintained in addition recent improvements by the national defense authorization act increased additional special pay for junior down officers by six thousand to ten thousand or twelve thousand based on years of service we expect this increas and have a positive impact on retention today with this increased pay and active duty dentist in washington d c with four years of experience and about ninety five thousand dollars plus benefits improvements to dental corps a session bonuses for reserve and active duty and stipend for reserve scholarship programs have recently improved and we thank you for your support we are optimistic these enhanced months of improved our recruitment efforts and as we at this point in the fiscal year expect to meet our session goals currently we are almost  hundred percent ahead of where we were at this time last year in the reserve corps we have already gained fourteen new dental officers compared with two in fiscal year zero seven chevy snyder members of the committee thank you again for the opportunity to testify before you and share with you how navy dentistry is insuring sailors and marines dental readiness is our number one priority we appreciate your efforts to improve our recruitment retention as well as interest in this very important issue i stand prepared to answer your question before you today to discuss the dental readiness of the air national guard in air force reserve the our career reserve component medical and dental services exist and operate with an air force culture of accountability where medics work directly for the line of the air force are home stations facilities form the foundation from which we are provides combatant commanders a fit and healthy force our emphasis is on fitness prevention surveillance so that we can be ready deploy if need be in less than seventy two hours air guard and reserve dental readiness is at eighty nine and eighty six percent respectively the statistics represent a steady upward trend over the past year and compare favorably to department of sense goal of ninety five percent are steadily improving dental read contributor to many factors first and foremost is command emphasis and support at all levels the ark holds unit commanders and individual service members responsible for the member's readiness to deploy and provides policies to ensure dental readiness we have several methods an arc member can receive their annual dental exam by a military dentist a civilian or tri care dental plan participating dentist or by contract or dentistry reserve health  although medical squadrons track dental readiness rates each arc unit also has a non medical unit health monitor who tracks upcoming and overdue medical and dental needs this creates ownership of medical readiness within the unit itself and ha positive effect on our readiness our compliance policies may be the most effective are tools to steadily improve readiness air reservist or guardsmen in dental class three requiring urgent or emergent dental treatment are placed on a medical profile and cannot have orders cut to deploy while profiled members are given a limited time frame to correct their dental efficiencies failure to have the required treatment can lead from profiling to administrative discharge of the member commanders do have the authority to grant a waiver to allow deployment of a member in dental class three but this is extremely rare all arc units have regular health service inspections and units with sufficient programs identified to line commanders who are held accountable for the medical and dental readiness of their units another tenet of our success has been the full alignment with the active duty air force dental service and using the same web based reporting and tracking tool the dental data system web or d d s w some challenges do remain for the ark to be able to steadily improve our dental readiness the cost of meeting standards can sometimes be prohibitive prohibitive especially for the lower ranking enlisted personnel even with tri care dental plan available many air us areas have limited networks of dental providers furthermore due to time constraints and rigors of basic military training and technical school access to newest sessions for dental treatment is very limited and usually consists of palliative care for just needs currently there is no transitional assistance management program or tampa available for dental care following deployment and although the ark and the active duty air force  same web based tracking reporting tool we are not yet set up to implement the electronic dental records or also which will surely improve accuracy of readiness as reservists and guardsmen transition from inactive to active status and back again to improve dental readiness reserve and guard units can utilize dentists from other units for support higher headquarters monitors readiness statistics conduct site visits and provide distance where needed geographically separated remote or understaffed units can utilize contractor supported dental exams increased emphasis by commanders and unit health monitors and recruiters to inform reserve and guard members of the benefits presently provided in the reserve health rayna's program may also improve re ss we are also considering the introduction of a precession dental screening exam to determine the dental class of an individual which could help alleviate the problem of arc members arriving on base not deployable dental class three after completion of basic and technical training lastly we fully support implementing the electronic dental record in the ark as it becomes available for deployment in closing mr chairman we are proud of our compliments and continued improvement of the air force reserve and air national guard dental readiness rates we thank you in the members of your subcommittee for your interest and support and look forward to your help in continuing that improvement thank you thank you will go ahead and put me on the five and a clock here and we'll go through our five minute rule here to the noise you heard there was we have one vote perhaps followed by a series of votes it's not clear yet so we'll have to take a break here probably after my questions but we should have time to get have reflects the fact that we as a nation haven't haven't solved a lot of healthcare issues including dental ones so you're ending up with a representative sample of our population that doesn't have the kind of of dental health we need but i think some people when they heard about this thought that somehow this is a bit of a trivial problem but i mean just the emphasis like the whole purpose of this is to avoid dental emergencies people you're sending to a war zone for seven twelve or fifteen months and i can imagine being in the mountains f of afghanistan or someplace and and in iraq with a big dental abscess trying to figure out how men get that resolved get it treated not to mention you then pulling some away from their unit and causing a disruption and then as a couple you pointed out the second issue is if you have to deal with this during the pre mobilization period which is the pre to point a period we talk about the thirty five hundred ten hour days lost or the five thousand ten hour days lost those are we can do days but there are most of the training days that means are being pulled away from training for a war zone and then the third part of it i guess is just quality of life i can't imagine sending somebody over there cavalierly saying well you've got a big hole in your mouth but we don't have time to do that right now toughened up for twelve months i mean that's not the kind of country are that's and we have learned that that's shortsighted so this is a very very  solve this problem just by enforcing current policy or is that an unrealistic goal current policy allows for an annual exam regardless of alert status done at no cost to themselves and so it does not solve the problem for the large group of alerted mobilized reserve of non mobilized reserve but not alerted and the large number of cross leveling that goes on is causing that loss of training time at the platforms and that's unpredictable and the only way to solve that is to have a care system that is there all the time regardless of the alert status  now that would seem to me recalling my boot camp days when i couldn't go to the bathroom without somebody ordering me to have got a captive audience there why is that only eighty percent these are not going to be pulled away percent and that's on the active side again they have a lot of things that they have to accomplish in the boot camp and they are busy and they don't have a lot of time for dental and we try to fit them in and get as much done as we can when we can day they come in and we get as much as we can as we can i mean most of that later my time is expired what we'll do is will recess for the votes i'm sorry can't predict how long this will be we have several staff members that can help you with any and resume i think that we're ok for we've already kept you about almost in to for time but i think that we're ok for a while now unfortunately our members were hearing it started two thirty and figured that after four thirty they could have other things so we don't have as good a response as we did early on but i apologize for that and soon as he's ready to recognize i certainly appreciate you're all waiting around for quite a while we have that happen and committees all of a sudden call votes and we're not always sure when they're going to do it so it does tend to break things up i guess my question and one that  we've been talking about a little bit is the transition of whose responsibility is what so i'm thinking about somebody that is let's say they're on reserve for some particular moment and is there on reserve i would guess that reserve people their dental care is paid for out of their own pocket is that typically the case that this is something that's going to be called up and then he's going to serve so if you start at the beginning when they're on reserve who pays for the dental care for some of these just on reserve anybody want to answer the question i'll start with if the individuals enrolled in the tri care dental program then certain procedure exam and cleaning will be covered by that dental plan and they will not pay for any of that process so a reserve some of these on reserve could have that insurance yes or ok if they didn't have that then but they would normally then just pay for it on their own pocket then they get called up and let's say if they were not paying attention to their teeth they're young and bulletproof or something like that if you took that scenario  you give the devil exam probably when they came in and then let's say for instance they might have a cavity or two or something like that so that would mean they'd be would that be like level three yes or ok so then you'd send them to a dentist and it might be a say in sure an army dentist or something like that or it might be somebody that you contract with either which way would that be what would probably happen next yes or and you try to fit that in in their training is you're getting ready to be deployed or something is that typically when that would happen i think for the majority of times i would be correct is that when they get ready to be mobilized different assets will come into play as far as to take care of their dental needs i'm just thinking my own son is a captain in the marines and as i recall before he was deployed they always had sort of everybody was working up getting used to working together so that would be the time probably they get the dental care which would then bring him up to a level one or two or something like that right then when they let's say they've been in iraq for a year fourteen months or something like that and they come back now at that point if they had something going on let's say they've got some cabbies because they drank too much coke over in iraq or something like that then whose responsibility would be to provide that dental care with that still be the active force that come out of the o d i need to go back a little bit it really depends upon their status in deer's if if they're still on active duty status then there are all their dental needs to be taken care of via the active duty benefits which you know most of us can be taken care of inside of our military dental treatment facilities once they deployed if they were reserve and they were deployed wouldn't they be called active duty then yes they would as i'm kind of confused because of or rather the people that you know they're sort of halfway active and halfway citizen and i can't keep all of the conditions straight ok so what if they're if they're deployed they're active duty then then they would be responsibility of whichever branch they were in or maybe you would have times an army guy go to air force dentist or whatever so yes that is so whatever that the logical close dental facility depending on their situation up to the time when they're when they're no longer active or they're going back probably to their reserve unit i would assume so it's up to that day they're still the  still regular military and then when they go back to the reserve unit then would that mean that they go back to either that insurance policy they had or they just pay for their own dental care themselves  sir but there's also a benefit if if they serve for more than ninety days there's also a v a benefit ok they can also we simply let's take our scenario that they've been in iraq for a year or something then they've been over ninety days so then they would qualify and not they would pay for everything else their own pocket to be under the v a care then that is correct if they if their discharge papers say that all their dental care was not completed prior to discharge they can take that pa exam when they come back or without them they could request it depends upon the unit units and i'd have to defer to the services to be able to answer that specific question anybody know if it's policy one way or the other this is colonel by now exam has given during the demobilization process with our current policy say that again the no exam is given during demobilization process with our current policy if somebody comes back and they say that they have an emergency situation they're treated by that dental treatment facility before they are a frat are released processed through the dental administrative process for demobilization so from a practical point of view let's say come back and let's say i've had a tooth that's been bothering down what's going on with it just  may be a regular soldier would they probably then be looked at and given an exam and then a determination say haddock some cavities from greg in my coke too much and with that would you actually pick that up then well we would do is if the soldiers said that they had a condition that was causing them an emergency problem at that time we would fix the emergent condition would that mean i'm just saying you have a cavity maybe it's not an emergency to this just sore or you suspect there may be a problem with that be an emergency per se or not that would not be an emergency it would not yes so they might have some cavities and probably they would not be taken care of then until  actually we're out probably what we have is correct sir ok so is it a but is it fairly clear line if they get metal if they get medical or dental care up to that while they're in active then it's an active duty responsibility as soon as they're out when they usually come back though in reserve is it a pretty short period of time when they actually get back in country and they're released is that pretty quickly just like a week or so or yes   when i came to san antonio and you and three other officers testified with regard to this only what you call it the army dental care system overview support now that you had an opportunity to reflect and you've also given testimony several times upon your reflection is it fair to say that you knew the numbers were not going were not fair and accurate as they were testified to me when i was a san antonio are not incorrect they are just a different way of looking at how the costs for that process were arrived that we have so is it fair to say that you were then following orders in that you were to make this program as as costly as possible that is incorrect sir there were other courses of action that were actually more  presented to me a study that said that a dental exam in radiographs if you were to do it at the mobilization would be three hundred seven dollars which is at the ninety fifth percentile times one hundred for the country now you can play word smith all you like because others have already gone back and looked at this and said yes these are bad numbers now i'm not your commander so i'm going to be straight up with you because if i were your commander i would prefer charges against three field grade officers and one general officer in the army dental corps i would for audit is very serious charge  serious charges called the intent to deceive you see what you guys didn't know down there in san antonio what you do know now is that this this study was something that was created by the surgeon general  then and myself so what you did in your little gamesmanship down there to sort of protect your idea of all do the contracting at the same time will utilize the v a you guys really messed up you really have messed up bad now what hurts what hurts at the at the most is soldiers are getting taken care of now from the army's point of view now you perhaps the army now has this perspective because you made it very clear to me when you said you it was colonel hansen with with general service sitting right next to him looking me in the eye and saying that not our mission said in such a strong forceful and yet almost arrogant tone not our mission ok that's why i've had some conversations here with the chairman of this committee because we then become your bil payer purpose here is really for our me to take care of army now when i look at this statement i've been around long enough to know this statement is very for what you've given a written statement is very poor because what to ensure dental readiness for army reserve army guard soldiers who should be providing that dental care colonel it should be a multifactorial situation first of all for the active component when soldiers are coming in the basic training on we should be able to provide it as much as we can within the four to six day period but again and then  does not determine what goes on in those four to six is still embrace not our mission we believe it is our mission so your testimony now has changed why is it changed personally speaking it is changed because we think it's the right thing to do in order to reset the entire force and to improve the dental readiness of both components and i suppose personally your reflection there at the moment if you recognize that what was done here was wrong i'll come back i'll ask for further question with regard to the reset because it's one year plus ninety days will go around again mr blair i want to ask you  on page on the first page of your written statement you mentioned it in your in your statement you refer to the thirty ninth and you say to ensure mission success the same processes and techniques are being used this year and then you li units give us a list what do you consider the the processes and techniques that the thirty ninth used that you think should be used elsewhere or are being used elsewhere specifically one of those processes and techniques for each of our states is unique in terms of their makeup in terms of geography in terms of their dispersion of guardsmen and so there is really no one set solution that we can apply to the nation we depend on the states to develop courses of action for each of their to get those folks ready we have the national guard bureau basically collect best practices from each of these p c t s as they go through this process and they make sure that we learn as an organization how to do this best so what are those best practices the best practices our early identification of the soldiers upon alert doing making sure that every soldier has had an exam ideally they've had that exam before alert and then using the authority and the funding that we have to provide dental treatment for those soldiers during that alert face long before they go to the mobilization station the goal is that units should not train soldiers that are not medically deployable so that basically don't invest in them in training if they if they end up being medically to not deployable in the end state colonel martin the the tri care benefit essentially what it's about eleven so dollars a month and then the max amount that can be paid is twelve hundred dollars is that correct yes or this mr jermyn so you're invested in hundred thirty one hundred forty dollars to offset the possible expense of twelve amount of benefits you get for that amount of money you know how how do you this seems like there's two issues one issue is why haven't more people taken advantage of that second issue is even if somebody has low it is very low there have been certain surveys though that have shown that reservists report that they have dental insurance either through their employment or through their spouse's employment and so there's a much higher upwards of sixty to seventy percent say they have some type of illness surance  the demographics of the young people a lot of them you know their teeth is not the most important thing right then and so you know the value that they place on and having paying eleven dollars have a dollar surance probably not you know to the level where they say ok yes i signed up for that program so those are some of the factors that work into why you know about percentages is low and eight to ten percent we're doing everything we can to improve it in fact we've incentivized our current contractor with an award for the if they can improve that percentage and they've done quite a bit of marketing to that group to to increase the rates to the second question as to why you certain groups not utilize nationwide those who have dental insurance it's about a little over fifty percent actually will utilize a dental service for the t t p it's much higher at seventy one percent part of that i think is self selection people who are enrolling in the program know they have a dental need and so they pay that money in the sometime in march that is correct sir what's going to be the product that comes out is there going to be a written report that will be available to all of us or what's going to be the end result of that prioritized list of the nation is are working through the army leadership at this time so you anticipate there will be a report that will be shared publicly and with the congress and that is correct because the anticipate that will be sometime during toward the end of may i was told that of should be within ninety days the ninety days and what it started which is in march i messed pretty good because we have i mean there may be some things in there that we can be helpful with during the defense bill mark would be a little clarification in the tampa dental benefit language that's currently out there so that we we could provide appropriate  occurs there are different types of methods that are used now where the method is credible or not is the question so the credibility of the army dental corps with regard to how you handled this initiative is a question now others have had the opportunity to scrutinize your work product they find it highly unusual and an aberration of customary practice now that was either forward to be done somebody used some type of curious math for a purpose and it was deceit i believe now you guys didn't know that congress was involved in this so obviously it was going to the surgeon general at the time this is a surgeon general who then gets dismissed and you guys that this is going to go away because it's not our mission even though you're not out of the woods because i suppose i'm upset anybody that cares about their soldiers making sure they get the proper care should be upset especially if we're going to make it part of the operation model initiatives that you don't want to talk about i'm not foolish i can almost see this we've got the leadership of the army dental corps going i don't like this study we don't want to do it's not our mission the books will show decision making a it's not cost effective you get caught then those who catch you go oh my we better do an assessment i asked your dental chief what is his capabilities i came to san antonio with pure intent to fund capabilities gap and work cooperated fully with the gentlemen behind me because i work with him also on the v a that's not how i was treated now we learn in your testimony that you've done your quote capabilities assessment has that been complete yes or no that's capabilities still working through the army leadership working through the army leadership so it's been completed but not signed off so that means so there's a number already attributed to this but you don't willing to give it to the armed services committee because somebody has signed off general cody was going to come over here and tell me but i asked him not to do that because i want him not to testify me in my position is the v a i'm working cooperatively with the armed services committee that is extremely important that's why i said you guys are not of the woods you're in more trouble than you could ever imagine the credibility of the army dental board it just bothers me so much i have so many dentists in my family i grew up as a kid watching my dad never to go on a float trip and go fish and we can't because somebody showed up he's got his teeth knocked out of the little league game and the kid was even my dad's patient but he takes care of it's like you're going to take care of your active duty soldiers with those guardsmen reservists they're not they're not your patients will take care of  congress are prepared to do that so here's my message when you go back to san antonio you tell you the general down there stop fighting us and be forthright no games tell him that for me yes or no games i don't know where this is going to go we'll let the we'll let the investigations continue i can tell you how disappointed i was when we went back down a second time and events folk too had memory i've been a prosecutor and i've been a defense lawyer so i understand what sane memory is i don't recall i don't have recollection that may not be how it happened that's not what i understood that what was said i think it's simple i think it's an important issue i think it came up twice from the thirty ninth we've talked about that you all think is important issue are we making too big a deal about it the bottom line is it gets done they get mobilized  get fixed adequately have you all done a cost analysis about would be investment to get us where we would ideally like to be at the time of you know alert or mobilization is that going to be so cost prohibitive we're better off by sticking with our kind of scrambling around whether it's we look for processes for the units to to meet this goal are we playing a bit of devil's advocate anybody have any comment there i'll speak to that what we need to get out of the idea of what i called just in time dentistry that is not the right thing for soldiers so when you take a soldier to a mobilization platform and they are still in d s c three conditions not only are they losing training hours but they're getting a lot of dentistry done short amount of time and that's not the right way to treat soldiers what we need is a continuous flowing system that allow reserve components soldiers access to no cost dental care on a year round basis because we never know when an on alerted soldier is going to be cross leveled as a replacement to a unit and then becomes a an obstacle to the training of that unit for instance on the thirty ninth replacements that came after the main body had successfully validated many of those soldiers had less than thirty days of training or rather thirty day training period before they went off with their main unit if those soldiers are not fixed or do not have the ability to be fixed at no cost prior to that time then we're being unfair to that soldier to miss those training hours issue of recruiting and retention of dentists and we're going to solve that sir we have a program has produced a journal but i can share with you that the army national guard takes the crisis very seriously  billets filled in and forty percent of those people are returning eligible when they're faced with the media with a deployment they may drop their papers the numbers decrease every day so you know if you please consider on we have a new program for medical and dental students  where we put them on active duty at their medical or dental school as a recruiter this is a guard program and basically they recruit their fellow students we pay them a second lieutenants they receive a housing allowance we do not receive any tuitions assistance but this enables them to have a good standard of living while they're in dental school or medical school and then they can also take advantage of additional guard programs when they're in their residency or other training programs to pay back their tuition  so we think this is an innovative program that is in the last stages of approval and we think that's going to be a very good fix five to six years from now when we have those graduates coming into the guard who any you have any comments about th medical records and even comments sir i'll comment as far as electronic dental records you saw my written testimony that dan class  use it one of the number one missing one number one reason for soldiers presenting as a no go at a mobilization site is due to missing records or parts of missing records and so we will be able to solve many of those issues of re examining a person because we don't have records showing their d f c right and and the ability to record just just to piggyback on your statement that you said the best way to handle dental care is on a consistent basis you don't just do this emergency in the litter run for ten years and find you've got a mouthful of trouble when you come back dizzy is the implication of that then that you would have people who are on reserve covered or you saying they'd be covered under under some type of dental care th well currently a soldier is permitted to have an annual exam regardless of their alert status upon alert they are allowed to get  fitness class three treatment done at that time what i'm stating is that we need to expand this to on alerted soldiers so that we do not have  problem with cross level soldiers or replacements causing lost training time at mobilization sites and to get us out of there just in time then a stream of which is not how any of us would want to be treated in our own so you're saying that somebody who's not been activated but is in reserve currently my understanding is they could be covered one of two ways either they've got this insurance or goes up to twelve hundred dollars or they just paying for it out of their pocket or maybe their employer gives them something or whatever it is at a school when you're saying you'd like to see those people get it making sure that they all are solid dental care so that they don't carry the dental problem in activate them i think that's what you're saying right is correct sir and no cost to the soldier at no cost so who's going to pay for it then would you say who would pay for that program that it is that something that's in your plan that he does would be part of the initiatives working through the army leadership ok and so can you say who would pay for that question and when you said when you go back and say ok that is our mission the numbers are recalculated it shows that this but the dental exam study once they recalculated number showed that it was cost effective i e brigade size assets that are returning based on the success of the study we have plans that are available to do reset so the painting up based upon this study say is that we know the number of personnel that it would take the facilities exciter in order to do the   i'm unsure of the question you turn and ask somebody who may know at present it is one hundred eighty days are you kidding me when did this occur this occurred recently we made a policy decision to go to push it to nine another ninety days i cannot answer that question i can not answer it because you know and won't tell me or that you do not know what the answer is i do not know what the answer is chairman this is really pretty concerning because the army first of all it's concerning when they do an annual plus ninety days because they're then saying that the ninety days is acceptable level of neglect now the acceptable never justification given your personal opinion that's what you like to give me your personal opinion on why one hundred eighty days is a good policy or not my personal opinion sir is i was surprised by the one hundred eighty days i do not i cannot answer where it came from because i do not know ok if your hand fries would you would you advocate to change it to change that policy i would advocate the change you bet